A Case of Primary Tuberculous Parotitis Mimicking Parotid Neoplasm: A Rare Clinical Entity.

Primary tuberculous parotitis is an extremely rare entity presenting with nonspecific symptoms, variable clinical signs, and imaging features mimicking parotid neoplasm. It is a clinical and diagnostic challenge, and a confirmed histological diagnosis would indicate nonoperative management, thus avoiding unwarranted surgery and associated morbidity. Tuberculosis of the salivary gland is a relatively rare extrapulmonary manifestation of tuberculosis, with the incidence of tuberculous parotitis being 2%-9%. The prevalence of disseminated tuberculosis has increased in recent times because of the use of immunosuppressive therapy for organ transplantation and chemotherapy. However, the incidence of concurrent pulmonary tuberculosis in patients with tuberculous parotitis is a rarer scenario. Fine-needle aspiration cytology (FNAC) can confirm the diagnosis of tuberculous parotitis with a high sensitivity (84%-100%) and specificity (94%-100%). The utility of FNAC is also enhanced as the aspirate can be utilized for cartridge-based nucleic acid amplification test (CBNAAT) testing for mycobacterium and drug sensitivity testing, thereby further increasing its sensitivity and specificity. This translates to a lesser chance of unnecessary surgical intervention and the potential surgical morbidity. Here, we report a case of parotid swelling in a 72-year-old male, with no evidence of any pulmonary or systemic tuberculosis, with clinical and imaging features suggestive of parotid neoplasm but diagnosed as tubercular parotitis on FNAC. He was started on antitubercular therapy, which resulted in the progressive diminution of the size of the lesion. Primary tuberculous parotitis should be considered a possibility while managing the parotid neoplasm.

Follicular Dowling-Degos Disease Camouflaged as Comedones: A Case Report and Literature Review.

Dowling-Degos disease (DDD) is an uncommon autosomal dominant genodermatosis that resides in the spectrum of diseases presenting with reticulate pigmentation. This disease has varied phenotypic expressions, the classical presentation being reticular pigmentation of flexures involving the axilla, submammary folds, inguinal folds, and neck. Follicular DDD is a variant of DDD with a unique presentation of folliculocentric papules, macules, pits, and comedones associated with the characteristic histological findings of follicle-centered, pigmented, branching, antler horn-like rete ridges sparing the interfollicular epidermis. Due to the rarity and paucity of data about this entity, we describe this case of a 28-year-old female who presented with perioral pitted scars and multiple hyperpigmented folliculocentric comedo-like papules over the face, neck, cubital fossa, and upper trunk, unaccompanied by the typical non-follicular, reticulate flexural hyperpigmentation, which clinically posed a diagnostic challenge. The diagnosis was confirmed by histopathology. We intend to increase clinicians' cognizance with respect to the unique clinical and histopathologic presentation of follicular DDD. More genetic studies could bring more understanding of this complex spectrum.

Intra articular synovial lipoma of the right tarsometatarsal joint- a rare case report.

Intra articular synovial lipomas are very rare and only few cases have been reported till now. We are reporting a rare case of intra articular synovial lipoma of the tarsometatarsal joint in the right foot in a 38-year-old male who presented with dull aching pain in the plantar aspect of the foot while walking. The lesion was resected and subjected to histopathological examination, which showed well defined lobules of mature adipocytes separated by thin fibrous septa and covered by synovial lining. Immunohistochemistry with S100 antigen showed membrane positivity. A diagnosis of intra articular synovial lipoma of the tarsometatarsal joint of the right foot was made. Our English literature search failed to yield any information regarding the occurrence of synovial lipoma in small joints and our case may be the first of its kind.

A Cross-sectional Study of Clinical, Histopathological and Direct Immunofluorescence Spectrum of Vesiculobullous Disorders.

BACKGROUND: Accurate diagnosis of vesiculobullous lesions of skin requires evaluation of clinical, histopathologic and immunofluorescence findings. METHODS: A cross-sectional study of 68 patients to evaluate the clinical, histopathological and direct immunofluorescence (DIF) features in the diagnosis of cutaneous vesiculobullous disorders. The patients with vesiculobullous lesions were subjected to clinical examination regarding socio-demographic and clinical data. Two biopsy specimens were taken, one from intact vesicle for histopathological study and another from perilesional normal looking skin or oral mucosa for DIF. RESULTS: Vesiculobullous lesions constituted 22.08% of total number of skin biopsies. The most common clinical diagnosis was pemphigus vulgaris (PV) in 36 cases, followed by bullous pemphigoid (BP) in 8 cases, pemphigus foliaceous (PF) in 6 cases, and dermatitis herpetiformis (DH) in 4 cases. Characteristic histopathological features were present in 26 cases of PV, 9 cases of BP and 4 cases of PF, and 17.7% showed non- specific changes. DIF was positive in 24 cases of PV, 9 cases of BP and 3 cases of PF, and negative in 34.92% of cases. CONCLUSION: Clinical, histopathological and DIF features together or in combination help in the final diagnosis of vesiculobullous disorders. Individually, none of these methods are diagnostic in each and every case.