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BACKGROUND OBJECTIVES: Microvessel density (MVD) is a surrogate measure of tumour angiogenesis, and is well known for over two decades to identify individuals with a high risk of recurrence with greater prevision than traditional markers. This study aims to assess the utility of MVD and its correlation with the Nottingham Prognostic Index (NPI) and other routine histopathological parameters in carcinoma breast. METHODS: This two year retrospective, cross-sectional and analytical study evaluated 143 women with breast cancer presenting to rural tertiary hospital in central India. These women were graded histopathologically, the immunophenotype was determined using ER (estrogen receptor), PR (progesterone receptor), Her2 neu (human epidermal growth factor receptor 2 neu) and Ki-67 proliferation index (Kiel-67) immunohistochemical markers and anti-CD34 antibody to stain the endothelial cell clusters displaying the microvessels. The NPI was generated for each participant based on the tumour size, histologic grade and involvement of lymph node. The parameters were compared with the CD34 scores. Differential and inferential statistics, including the independent t test, analysis of variance, Pearson's correlation coefficient, Spearman's rank correlation coefficient and point biserial correlation coefficient, were used for statistical analysis. RESULTS: This study showed that CD34 values ranged from 6-36 microvessels/hpf, with 24.16±6.77 microvessels/hpf as the mean. The mean microvessel counts showed a significant positive correlation with the Bloom-Richardson histological grade, vascular invasion, LN (lymph node) positivity and NPI. However, there was no significant correlation of CD34 values with the participant's age, tumour size neither any significant association of CD34 values with the individual's immunophenotype. INTERPRETATIONS CONCLUSIONS: A positive linear correlation of the microvessel counts and the NPI scores suggest that with an increase in tumour angiogenesis, there was increased proliferative potential. Based on the significant correlation between the microvessel counts and the vascular invasion of the tumour masses in this study, it can be assumed that there will be vascular invasion if the microvessel count is higher and vice-versa. Although it is established that angiogenesis and neovascularization are required for the expansion of the solid tumour tissue, the heterogeneous nature of this entity makes it difficult for obtaining a linear correlation. Hence, it is suggested that though neovascularization permits advanced tumour spread it, however, does not guarantee it.
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Neoplasias de la Mama , Carcinoma , Humanos , Femenino , Pronóstico , Densidad Microvascular , Estudios Transversales , Estudios Retrospectivos , Neoplasias de la Mama/genética , Neoplasias de la Mama/patología , Neovascularización Patológica/genéticaRESUMEN
Isolated tubal torsion of the hydrosalpinx is a rare occurrence with a varied clinical presentation, presenting a diagnostic challenge. We present a case involving the isolated torsion of the right hydrosalpinx in a 33-year patient with a history of bilateral tubal ligation who presented with an acute abdomen. Based on ultrasound and clinical findings, an initial diagnosis of ovarian torsion was considered. However, escalating pain severity led to diagnostic laparotomy, revealing torsion in the right hydrosalpinx. Subsequent right salpingectomy was done, and as the patient had undergone tubal ligation, preventive left salpingectomy was also performed. Both ovaries were preserved. The patient experienced an uneventful recovery. A literature review uncovered fewer than 50 reported cases of unilateral or bilateral isolated fallopian tube torsion post-tubal ligation. This case underscores the diagnostic challenges associated with isolated tubal torsion and emphasizes the crucial role of early surgical intervention in preventing morbidity and preserving ovaries.
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Primary umbilical neoplasms are exceptionally rare. Neurofibromas histologic findings vary from collagenous to myxoid matrix according to the neoplastic elements differentiation. We present a case of neurofibroma in the supraumbilical region undergoing cystic myxomatous degeneration. A 75-year-old female presented to the department with a complaint of swelling above the umbilicus for the last three years. The swelling was excised and grossly was a single, irregular, reddish-yellow cystic mass measuring 4.5 × 4 x 3 cm. On the cut section, cystic jelly-like areas were identified, and histopathological features were suggestive of neurofibroma undergoing cystic myxomatous degeneration. The diagnosis needed to be combined with pathological examination, and careful consideration during the surgical intervention was important to confirm there was no residue.
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Colorectal cancer with involvement of the urinary bladder is infrequent in the nonmetastatic setting. Procedures for advanced colorectal cancers with bladder involvement may include partial or complete bladder resections. Proper therapeutic management principles dictate radical surgery when negative margins can be obtained. High-resolution CT imaging along with endoscopic evaluation of the urinary bladder is frequently required to assess the extent of urinary bladder dissection. Here, we present a case of adenocarcinoma of the sigmoid colon with urinary bladder involvement and its treatment.
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This comprehensive review delves into the intricacies of donor site morbidity and scar outcomes in skin transfer techniques central to the field of reconstructive surgery. The review synthesizes existing literature to illuminate the multifaceted factors influencing outcomes by surveying a broad spectrum of grafting methods, from traditional autografts to cutting-edge tissue engineering approaches. Key findings underscore the complex interplay of graft characteristics, surgical techniques, and patient-specific variables. The implications for clinical practice advocate for a nuanced, patient-centered approach, incorporating emerging minimally invasive procedures and adjuvant therapies. The review concludes with recommendations for future research, emphasizing the importance of longitudinal studies, comparative analyses, patient-reported outcomes, advanced imaging techniques, and exploration of tissue engineering innovations. This synthesis advances our understanding of donor site morbidity and scar outcomes. It provides a roadmap for refining clinical protocols, ultimately enhancing the delicate balance between therapeutic efficacy and patient well-being in reconstructive surgery.
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Lipomas are common benign soft tissue tumors composed primarily of mature adipose tissue. They are often encountered clinically due to their characteristic slow growth, typically as soft, painless, subcutaneous nodules. While lipomas are generally asymptomatic, surgical intervention is sought by patients when they lead to discomfort, cosmetic concerns, or functional impairment. In this case report, we present the successful surgical excision of 25 lipomas in the bilateral upper limbs and right thigh of a 43-year-old male. Pre-operative assessment, precise surgical technique, and post-operative care are highlighted as essential management components. The case emphasizes the importance of individualized treatment, ensuring symptomatic lipomas' diagnosis and effective management. This report serves as a valuable reference for healthcare professionals caring for patients with lipomatous lesions, contributing to understanding soft tissue tumor management.
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Plexiform neurofibroma (PF) is a rare benign variant belonging to a subtype of neurofibromatosis type 1 that forms bulging or deforming masses arising from the peripheral nerve sheath. These masses involve surrounding connective tissue or dermal layers, leading to multiple cutaneous changes and certain characteristic appearances. It is these appearances that aid in the diagnosis of PF. We have encountered two distinct patients diagnosed with this disorder. While one patient was clinically and pathologically confirmed for PF, the other had no characteristic cutaneous changes. The diagnosis was made with postoperative histopathology and confirmed with an immunohistochemical examination. There are various modalities in the management of PFs, with surgery being a mainstay in the treatment of disfiguring large PFs, especially in resource-restrained settings. In view of high recurrence rates, postoperative clinical follow-up is a must. This paper describes these patients' typical and atypical clinical presentation and subsequent management.
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Background: Reconstruction of facial defects is often challenging and is dependent on numerous factors including size of the defect, availability of donor site, any existing scar, patient's consent, prognosis, etc. There are various reconstruction modalities highlighted in the literature with their inherent merits and demerits. Considering the versatility of nasolabial flap, we present a case series of different facial defects where nasolabial flap has been used successfully for reconstruction. Case Reports: Three patients with different disease process in three different areas of face were reported. All underwent wide local excision and reconstruction with nasolabial flap. The result obtained was esthetically pleasing with minimal donor site morbidity. Conclusion: Nasolabial flap is a versatile flap and can be effectively used for reconstruction of small to moderate facial defects over any other flaps.
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Antibioma is a tough-walled abscess, which usually forms as a sequela of inadequate or lack of pus drainage during infection and inappropriate use of antibiotics by the patient. In this case report, we present a case of the development of antibioma due to infected polypropylene mesh used in umbilical hernia repair 10 years ago in a 59-year-old obese male. He had a history of umbilical and right inguinal hernioplasty 10 years back. Intraoperatively, we found antibioma whose wall was made up of fibrous mesh and the center was filled with pus and nonfibrous mesh remnants. The pus was found to be sterile, and the wall was made up of fibromuscular adipose tissue with chronic inflammatory cells around it. This is a very rare presentation of umbilical site deep mesh infection as it had no signs of acute inflammation, neither pain nor any pus discharge. We conclude that the possible explanation for the formation of antibioma and its very delayed presentation could be due to mesh infolding and seroma/hematoma formation during previous surgery may have led to the formation of abscess and thick fibrous wall without any fistulous tract and other complications of deep mesh infection.
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Diabetes mellitus is a global health concern characterized by chronic hyperglycemia, and its vascular consequences in the lower extremities pose significant challenges for individuals living with the condition. This comprehensive review delves into the multifaceted landscape of diabetes-related vascular complications in the lower limbs, with a primary focus on current strategies for management and the evaluation of clinical outcomes. This review achieves several critical objectives by synthesizing existing knowledge and research findings. It elucidates the intricate pathophysiological mechanisms underpinning these complications, shedding light on the cellular and molecular processes involved. Additionally, it outlines clinical assessment and diagnostic strategies used to identify and stratify risk, ranging from cutting-edge imaging techniques to clinical examinations. The review comprehensively examines current management strategies, encompassing lifestyle modifications, pharmacological interventions, surgical procedures, and wound care practices. Moreover, it assesses and analyzes clinical outcomes, including limb salvage rates, amputation rates, and overall quality of life for individuals undergoing treatment. In addressing the challenges faced in managing these complications, this review aims to contribute to improved patient care. It proposes future research directions to enhance the management and outcomes of diabetes-related vascular consequences in the lower extremities.
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A rare occurrence in HIV-infected individuals is the development of diffuse infiltrative lymphocytic syndrome (DILS), which is marked by a widespread infiltration of CD8+ lymphocytes in body tissues, persistent elevation of CD8+ lymphocyte levels, as well as bilateral parotid swellings and cervical lymphadenopathy. It is distinct due to its suspected autoimmune origin and is found in about 5-10% of people living with HIV. This retrospective analysis involves two patients admitted to our tertiary care rural hospital with complaints of bilateral parotid swellings, a provisional diagnosis of DILS associated with HIV-positive status and lymphoepithelial cysts, their subsequent management, including conservative treatment and surgical excision of one of our patients. Our goal is to contribute to and advance the knowledge of this rare condition.
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Dermoid cysts are ectodermal inclusion cysts with epithelial lining in the subcutaneous tissue along the lines of embryonic fusion. Encephalocele, meningocele, hemangioma, lipoma, cephalohematoma, and sebaceous cyst are the differential diagnoses. The differentiation between them is essential for effective management to proceed. Obtaining a reliable history, completing a careful physical examination, and accurate radiographic documentation represent the first steps. We report a case of a naso-orbital dermoid cyst that was transilluminant, thus masquerading as a meningocele.
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Quiste Dermoide/cirugía , Neoplasias Nasales/cirugía , Neoplasias Orbitales/cirugía , Quiste Dermoide/diagnóstico por imagen , Quiste Dermoide/patología , Diagnóstico Diferencial , Femenino , Humanos , Meningocele/diagnóstico , Neoplasias Nasales/diagnóstico por imagen , Neoplasias Nasales/patología , Neoplasias Orbitales/diagnóstico por imagen , Neoplasias Orbitales/patología , Radiografía , Adulto JovenRESUMEN
INTRODUCTION: Cheilitis granulomatosa is an idiopathic granulomatous disorder which is rare and cosmetically disturbing. It presents with a persistent painless labial swelling which obscure etiology. Diagnosis is mainly based on the histopathological features following biopsy. There is no definitive treatment of this disease, reason being its lack of well-defined etiology. It has been proven largely resistant to most of the treatment options. CASE DESCRIPTION: A 28-year-old man presented with the labial swelling which was confirmed to be cheilitis granulomatosa following histopathologic examination. We have successfully managed this case using intralesional steroids. CONCLUSION: Intralesional steroids can be used successfully in management of cheilitis granulomatosa.
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Síndrome de Melkersson-Rosenthal , Adulto , Biopsia , Edema , Humanos , Masculino , Síndrome de Melkersson-Rosenthal/diagnóstico , Síndrome de Melkersson-Rosenthal/tratamiento farmacológicoRESUMEN
Squamous cell carcinoma (SCC) arising with chronic lymphedema is a rare condition, though literature suggests a variety of malignant tumors associated with filariasis. We present a case of 70-year-old male patient with a history of penile and scrotal SCC of filarial origin. We here discuss the unusual association of carcinoma and filariasis and its surgical treatment.
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BACKGROUND AND PURPOSE: Diabetes mellitus (DM) is a global pandemic. Among the spectrum of diabetic complications, diabetic foot is a leading cause of morbidity and hence awareness and education regarding primary healthcare inclusive of self-care pertaining to diabetic foot care is of paramount importance. AIM: The aim of the study was to educate patients of DM regarding the disease and its associated complications, specifically pertaining to diabetic foot care. METHODOLOGY: The study was carried out in three phases, first was to assess the diabetic patients related to their awareness on disease complications and diabetic foot care, through pretest questionnaire, the second phase was to sensitize patients and educate them on the same, the third phase was to re assess the knowledge gained by the patients through posttest assessment. RESULTS: The study evaluated the absolute and relative learning gain regarding the awareness and knowledge of foot care among diabetic individuals. The absolute learning gain was 40.92% and the relative learning gain was 76.48% and normalized learning gain was 0. 88, the normalized gain was assessed to be high. CONCLUSION: The study concluded that training and sensitizing individuals with diabetes will definitely help reduce morbidity of diabetic foot and hence the medical and paramedical staff need to spread awareness regards the same.
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The causes of jaundice in the first few weeks of life may be categorised into hematologic, enzymatic/metabolic, infectious and obstructive. Obstructive jaundice results from an interruption in the drainage of bile in the biliary system. Surgical causes of jaundice in neonates are biliary atresia, inspissated bile syndrome, intrahepatic hypoplasia, choledochal cyst, Caroli's disease and spontaneous perforation of the bile duct. Pediatricians should be aware of the pernicious consequences of unresolved biliary obstruction and should thus refer neonates or infants with inexplicable jaundice for surgical exploration at an earlier age.
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Ictericia Neonatal/etiología , Ictericia Neonatal/cirugía , Ictericia Obstructiva/etiología , Ictericia Obstructiva/cirugía , Humanos , Recién Nacido , Ictericia Neonatal/diagnóstico , Ictericia Obstructiva/diagnóstico , Complicaciones Posoperatorias , Factores de RiesgoRESUMEN
In resource limited settings victims of urethral strictures often seek healthcare,when the strictures are far advanced. For a surgeon, management is indeed a challenging task, given the severity and extent of disease, lack of expertise, enough skills and equipment in the healthcare facility. This study was conducted at a rural teaching hospital in central India. All patients were assessed for the extent and severity of strictures and to rule out other causes of lower urinary obstruction. Outcome of all patients was assessed with American Urological Association Urinary Symptom Score and Urinary Flow Rate (ml/sec) before procedure, post procedure and at 6-12 months. Between 2007 and 2009, 110 patients, between 18-75 years of age were enrolled in this study which showed that a third of patients treated with urethral dilatation and optical internal urethrotomy required another intervention. It is conclude that urethral dilatation and internal optical dilatation result in short term improvement in urine flow rates and symptoms. Urethroplasty, the current gold standard of therapy for urethral strictures, results in outcomes that are clinically meaningful and more cost effective for a patient. The Americal Urological Association (AUA) symptom score and Urinarry Flow Ratemay be used to objectively assess outcome following surgical management of urethral strictures.