A rare case report of Castleman's disease and review of literature

Castleman’s disease (CD) is a rare lymphoproliferative disorder, described for the first time by Castleman, et al. in 1954 in a single case then in 1956 in a group of 13 patients with localized benign lymphadenopathy. The incidence of CD is unknown and can occur at any age, however it is mainly reported in adults in the literature with a slight feminine predominance (60%). The majority of the previously reported cases of CD in the neck were of the hyaline vascular type and the most common sign was an asymptomatic neck mass. In the present case the patient is having unicentric CD and histologically it is Mixed Type. We are reporting this case because of its rarity.

Role of Ki 67 Labelling Index as an Adjunct to Histopathological Diagnosis for Grading of CNS Tumours

The Central Nervous System tumours are unique as they arise from specialized tissue. CNS tumours constitute a wide range of neoplasm that differs in their location, age distribution, extent of invasiveness, morphological features and tendency for progression. We wanted to evaluate the traditional morphological data with knowledge on the prognostication marker Ki 67 antibody in evaluating tumour grade and prognosis of CNS neoplasm.METHODSThis is a cross section study carried out between March 2015 and September 2016 in histopathology department of Dhiraj Hospital on 50 cases of CNS tumours. Immunolabelling of all biopsies was done by horse radish peroxidase technique using rabbit monoclonal antibody to Ki 67 (clone SP 6) (Thermo Scientific, USA). Ki 67 immune positive labelling index was obtained for each tumour and correlated with mitotic labelling index obtained by conventional morphological grading as per WHO 2007 classification.RESULTSIn our study of CNS tumours, all age groups were studied. The mean Ki 67 labelling index (LI) values +/-SD for WHO Grade I tumours were- meningiomas (10) 3.85 (+/1.97) %, schwannoma (3) -3.0 (+/-2.97) %, pituitary adenoma (1) 0.6, craniopharyngioma (1) -1.1% and ependymoma (6) 2.62 (+/-0.60) %. WHO Grade II tumours- atypical angiomatous meningioma (1) -2%, atypical mucinous meningioma (2) -6.15 (+/-1.06) %, gemistocytic astrocytoma (1) -12; pleomorphic xanthoastrocytoma (2) -4.3 (+/-0.99) %, astrocytoma grade ii (2) -3.3 (+/-0.71) %, oligodendroglioma grade ii (4) - 3.9 (+/-0.88) %. WHO grade III tumours- anaplastic astrocytomas (5) -6.82 (+/-2.17) %, anaplastic oligoastrocytoma grade iii (1) -10.8 %. who grade iv-glioblastomas (7) -18.44 (+/-3.97) %; medulloblastomas (1) 20%, metastatic tumour (3) -36 (+/- 22.16) %. In our study, the mean Ki 67 LI (± SD) values for grade II, III and IV glioma is as follows: 4.76 (+/-2.83) %, 7.48 (+/-2.53) % and 18.44 (3.97) % respectively.CONCLUSIONSThis study shows that Ki 67 LI serves as an essential clinical prognostic proliferation marker of particular importance in cases with lower grade histology of Grade II & Grade III astrocytomas, Grade II & Grade III oligodendrogliomas. Ki 67 LI is important in determining benign, atypical and malignant meningiomas, non-invasive and invasive pituitary adenomas.

A rare case of mature teratoma of testis in 55 years old male patient

Background: Laparoscopic surgeries being minimally invasive surgeries are associated with a relatively minor surgical trauma. Excessive pain, nausea and vomiting and fatigue will delay the discharge. Bupivacaine and Ropivacaine, the long acting Local Anaesthetics when given intraperitoneally provide effective pain relief when the pain peaks within 4-6 hours of surgery. Aim: To compare the efficacy of intraperitoneally nebulised Ropivacaine 0.75% and Bupivacaine 0.5% for postoperative analgesia in Laparoscopic surgeries. Materials and methods: This study was a double blinded randomised controlled trial in ASA grade I and II patients” was conducted in 60 patients of both sexes, of age group 20-45 years. They were randomly divided into two groups of 30 patients each: Group R (Ropivacaine) – received intraperitoneal nebulization of Ropivacaine 0.75% 4 ml (30 mg) after the placement of umbilical port and Sreedevi Porika, T. Venkata Naga Lakshmi. Intraperitoneal nebulization of ropivacaine 0.75% vs intraperitoneal nebulization of bupivacaine 0.5% for post-operative analgesia in laparoscopic surgeries: Prospective double blinded randomised controlled trial. IAIM, 2018; 5(9): 105-117. Page 106 Group B (Bupivacaine) – received intra peritoneal nebulization of Bupivacaine 0.5% 4 ml (20 mg) after the placement of umbilical port. Results: There was no significant difference in age and weight between the two groups. Intraoperatively statistically significant differences were observed SBP - At 15 and 30 min post nebulization and at extubation. No significant differences were observed with respect to DBP and HR. Postoperatively DBP and HR differences were found to be statistically significant at 4th post-operative hour. There were no statistically significant differences in SBP and MAP between both the groups. Dynamic VAS scores were statistically significant at extubation and in first 6 hours and not significant at 24 hours between both the groups. Static VAS scores were not statistically significant at all times compared between both the groups. Mean Time for first rescue analgesic requirement was 8.23+0.511 hours in group R vs.7.59+0.52 in group B and was statistically significant (p=0.0001). Mean total rescue analgesic required was 95+33.3 mg Diclofenac in group R vs. 112.6+38.4 in group B with 26% of group R requiring 2 nd dose of rescue analgesic and 50% of patients in group B required 2 nd dose and was not statistically significant. Mean time for unassisted ambulation was 12.8+0.61 hours in group R vs.13.16+0.6 hours in group B which was not statistically significant (p=0.52). Conclusion: From the present study, it is concluded that both Bupivacaine and Ropivacaine are safe and similarly efficacious in reducing postoperative pain following intra-peritoneal nebulization in laparoscopic surgeries.

A case report of Ameloblastoma in 36 years old female patient

Ameloblastoma is benign odontogenic tumor of epithelial origin which is often aggressive and it originates from remnants of the dental lamina and dental organ (odontogenic epithelium). It is generally a painless and slow growing tumor causing expansion of the cortical bone and infiltration of the soft tissues. Its incidence peak is in the third and fourth decade of life and it is most common in black individuals. The ratio of ameloblastoma of the mandible to maxilla is 5 to 1, with higher sensitivity in the mandible. Here we are reporting the case of Ameloblastoma in 36 years old female patient and we are able to find and document the typical histopathological features of Ameloblastoma.