Buccal Fat Pad a Forgotten Option of Reconstruction in Oral Cancer.

The buccal fat pad (BFP) originally described as an anatomic structure without any obvious function. For long period it was considered to be surgical nuisance. However during the last four decades buccal fat is successively used tool for maxillofacial surgery for reconstruction of small to medium sized acquired or congenital soft tissue and bony defect in oral cavity. The aim of present article is to review the database available regarding BFP including its anatomy, clinical usage in oral malignancy as tool of reconstruction after ablative procedures it's success and its adoptability with other loco-regional flap for oral reconstruction in different scenario and our experience with it in tertiary cancer centre in India.

Non psammomatous melanocytic schwannoma presenting as a subcutaneous nodule: A rare presentation of a rare lesion.

Melanocytic schwannoma (MS) is an extremely rare soft tissue tumor accounting for less than 1% of all primitive nerve sheath tumors, with a predilection for spinal nerve involvement. To date, only 20 cases of cutaneous/subcutaneous MS have been described in literature. Here, we describe a case of MS presenting as a subcutaneous nodule in a 22-year-old male in right thigh. On examination, the nodule measured 2.5 × 2.0 × 1.5 cm with overlying skin showing a bluish hue and an ulcer. With a preoperative diagnosis of hemangioma, the patient was taken up for wide local excision and was diagnosed as a case of non psammomatous melanocytic schwannoma based on clinical, histological, and immunohistochemical studies. Immunohistochemistry revealed positivity with S-100, HMB-45, and Melan A with pericellular Laminin positivity. Carney's syndrome was ruled out. MS needs to be differentiated from other pigmented lesions like pigmented neurofibroma, Bednar tumor, cellular blue neavus, and especially malignant melanoma, which has an obvious ominous prognosis. Since MS can show unpredictable behavior especially in absence of overt malignant features, a long term follow up with or without radiotherapy is recommended.

Primary mantle cell lymphoma of appendix.

We present a case of immunohistochemically proven primary mantle cell lymphoma of appendix that presented as a mass in right iliac fossa. The usual presentation of gastrointestinal mantle cell lymphoma is in the form of multiple lymphomatous polyposis. Mantle cell lymphoma has a unique immunohistochemistry and genetic abnormality.

Carcinosarcoma of renal pelvis with immunohistochemical correlation.

Carcinosarcoma, a malignant tumor with biphasic morphology is uncommon in the renal pelvis. Immunohistochemistry (IHC) plays an important role in establishing the diagnosis and differentiating it from other biphasic malignant tumors. We present a rare case of immunohistologically confirmed carcinosarcoma of renal pelvis in a 42-year old female, which possibly developed on a background of multicentric squamous cell carcinoma arising as a consequence of chronic irritation caused by calculi.

Ipsilateral keratoconus associated with long-standing primary hydatid cyst of the orbit.

Hydatid cyst is a cyclozoonotic infection of the larvae form of a platyhelminthes Echinococcus granulosus. The majority of hydatid cysts appear in the liver (65%) and lungs (25%). Kidneys and brain are other less common sites for this disease. Only 1% to 2% cases are seen in the maxillofacial region. These commonly appear as cystic lesions located in the mandible, maxillary sinus, orbit, infratemporal fossa, pterygopalatine fossa, parapharyngeal space, tongue, and parotid and submandibular salivary gland. Hydatid cysts of the orbit are rare and account for 1% of all hydatid cysts. The article presents hydatid cyst of the orbit in a 10-year-old child. Clinical features, investigations, surgical approaches, and adjuvant medical management have been emphasized. We believe that the lateral orbital route allows excellent exposure and safe removal of an intraorbital hydatid cyst located posteriorly, superiorly, and laterally without damaging the surrounding important orbital structures. Upper blepharoplasty incision results in good cosmetic outcome.

A unique case of dystrophic calcification in masseter: a diagnostic challenge.

The objective of this study was to present an unusual case of isolated dystrophic calcification in masseter and the diagnostic challenge it posed. A case report on a 14-year-old boy presented with swelling in left parotid region along with the review of literature was reported. Histopathological and biochemical analyses of the excised mass diagnosed this affliction as dystrophic calcification. Dystrophic calcification is deposition of calcium salt in degenerated tissues in the presence of normal calcium and phosphorous metabolism. It usually occurs in injured tissues. This is different from systemic mineral imbalance causing metastatic calcification and needs to be differentiated. On reviewing the literature, this appears to be the second reported case in the world wide literature. The unique presentation, diagnosis, and surgical management of dystrophic calcification have been described.

Congenital cystic adenomatoid malformation in an adolescent: an unusual presentation with pleural effusion and pneumatocele.

Congenital cystic adenomatoid malformation (CCAM) encompasses a continuum of hamartomatous cystic lung lesions characterised by the presence of abnormal bronchiolar structures of varying sizes or distribution. The CCAM is a disorder of infancy with majority of the cases being diagnosed within the first two years of life. We describe CCAM in a 13-year-old girl complaining of recurrent lower respiratory tract infections since infancy who presented with post-infectious pneumatocele with loculated pleural effusion, and suspected abscess formation and had undergone resection.

Low-grade malignant proliferating pilar tumor simulating a squamous-cell carcinoma in an elderly female: a case report and immunohistochemical study.

A 65-year-old lady presented with an ulcerated lesion over the occipital region of nine-year duration, an incisional biopsy of which was reported as squamous-cell carcinoma. A wide local excision was performed and the tissue was sent for histopathological examination which revealed a low-grade malignant pilar tumor. Focal invasion and atypia were noted. Immunohistochemical (IHC) analysis revealed positivity for CD34 and calretinin immunomarkers favoring outer root sheath origin. Ki67 immunostains revealed a relatively low immunoreactivity indicating the low-grade nature of the tumor; however, p53 immunostain showed strong diffuse nuclear staining confirming the malignant nature of the tumor. Proliferating pilartumors (PPT) are rare tumors and less than 100 well-documented cases of malignant PPT have been reported so far in the literature. These tumors have been recently classified into benign, low- and high-grade malignant tumors and statistically significant difference was found in their biological behavior. However, we propose that IHC can be of immense value in assisting the subtyping of the tumor, so that the behavior and role of adjuvant therapy can be validated in future studies.

Targeting dsRNA-specific single-chain Fv antibody fragments to different cellular locations in Nicotiana tabacum L.

Expression of antibodies or antibody fragments in plants is a useful tool for producing active antibody derivatives for diagnostic or pharmaceutical purposes as well as for immunomodulation. We investigated the effect of cellular expression site on the stability and yield of double-stranded RNA (dsRNA)-specific single-chain Fv-fragments (scFv) in transgenic tobacco. Two antibodies (J2 and P6) belonging to the V23(J558) heavy chain variable gene family but differing in the light chain variable domain were used. scFvs were targeted to the cytoplasm - with or without anchoring them in the plasma membrane -, into the endoplasmic reticulum (ER) and to the apoplast. Although high mRNA concentrations were detected in all cases, scFv proteins accumulated only when scFvs were made ER-resident by appropriate signal sequences. When the ER retention signal was removed to allow scFv-secretion to the apoplast, no scFv-proteins were detected. Despite the strong homology of the VH-sequences of J2 and P6 antibodies, only P6 provided a stable scFv scaffold for intracytoplasmic expression. J2-scFv could not be stabilised either by adding a C-terminal stabilisation signal or by anchoring the protein on the cytoplasmic side of the plasma membrane (PM). It was found that dsRNA-specific J2-scFvs are active in vivo and enhance Potato Virus Y induced symptoms in infected tobacco. This is the first report describing the expression and biological effect of RNA-specific antibodies in plants.

FNAC of salivary gland lesions with histopathological correlation.

HYPOTHESIS: Analysis of salivary gland lesions by FNAC and correlation with histopathology. To evaluate utility of FNAC in salivary gland lesions.Back ground: Salivary gland lesions form about 2-6.5% of all head and neck neoplasms in adults. They are easily accessible for FNAC (Fine Needle Aspiration Cytology) and risks of fistula formation or tumour implantation are low compared surgical biopsy. Also, cytology can provide a distinction between asalivary and non salivary lesion, benign and malignant lesions so also specific and non specific inflammation. METHODS: Seventy patients were studied prospectively over two years. FNAC was done using 10 cc syringes and 20-22 no. needle. Histomorphology was assessed on routine H & E (haemotxylin and eosin) stained paraffin sections. SPAS (periodic acid Schiff) and mucicarmine satins were also done. RESULTS: 80% of the lesions were neoplastic (61% benign, 31% malignant) and 20% were neoplastic. Pleomorphic adenoma was the most frequent benign neoplasm while mucoepidermoid carcinoma was the most frequent malignant lesion. Among the non neoplastic lesions, the maximum number of cases were of chronic sialadentis. In the present study, FNAC has a sensitivity of 94.54% and specificity of 80.95% for neoplastic lesions. CONCLUSIONS: FNAC was found to be a useful diagnostic tool in the evaluation of salivary gland lesions because of its simplicity, excellent patient compliance and rapid diagnosis. This cost effective tool is invaluable in planning the surgical management of the patient.

Profile of bone marrow examination in HIV/AIDS patients to detect opportunistic infections, especially tuberculosis.

Morphological evaluation of 140 bone marrow aspirations received in haematopathology laboratory with serologically established HIV infection, along with other relevant special haematological tests, was done during 1st Jan 1999 - 31st Dec 2002 at state government run tertiary care General Hospital in Maharashtra state, India. Out of 140 cases: 118 (84.28%) patients had anaemia, 25 (17.86%) had leukopenia, while 13 (9.28%) were thrombocytopenic. Dyserythropoiesis was present in 18 (12.86%) cases, dysmyelopoiesis 37 (26.43%) and micromegakaryocytes were noted in 44 (31.43%) cases. Haemophagocytosis was evident in 8 (5.71%) cases. Plasmacytosis encountered in 120 (85.71%) cases was a common feature. Based on clinical profile and results of other investigations 56 (40%) patients were clinically diagnosed to be of Mycobacterium tuberculosis (TB). Of these, 18 (12.86%) bone marrow aspirates were positive for AFB, Mycobacterium tuberculosis. In 4 cases cryptococci were demonstrated (Mucicarmine stain). There was one case each of Histoplasma capsulatum and leishmaniasis. One patient showed dense parasitemia with Plasmodium falciparum. One patient had immunoblastic lymphoma and showed bone marrow infiltration. Findings in this study strongly indicate that in HIV/AIDS, AFB stain should be done on each marrow aspirate to rule out tuberculosis in countries like India; where TB and AIDS are marching together.

A study of mast cells in granulomatous lesions of skin, with special emphasis on leprosy.

76 skin biopsies that included material from 7 controls, 65 granulomatous skin lesions and 2 each of granulation tissue and chronic non-specific inflammation, were subjected to histopathological evaluation on haematoxylin and eosin and pertinent special stains. Mast cell study was done on slides stained by toluidine blue method, with special reference to their location, and morphology and cell count were done with the help of occculomicrometre. In normal skin, mast cell density was 11.43/mm2 with a range of 6-22/mm2 and an S.D. of 5.94. Highest value in the whole series was seen in TVC (66/mm2), followed by lupus vulgaris (50/mm2). Mast cell counts were normal in indeterminate and TT leprosy and showed a rise over the immunological spectrum BT to LL, with values in LL being 32.86/mm2 (28-40/mm2).

Amyloid (spheroid) deposits in pituitary adenoma presenting as Cushing disease--a case report.

A rare case of pituitary adenoma with spheroid amyloid deposits encountered in a 40 year old male is presented.