Exclusive Endoscopic Approach in the Management of Sinonasal Inverted Papilloma.

Background: With the advancement in endoscopic endonasal surgeries, there has been a change in the surgical approach from the traditional open surgeries to the more conservative endoscopic endonasal approach for the management of sinonasal inverted papilloma. In the present study, we have shared our experience of endoscopic excision inverted papilloma involving the paranasal sinuses in a tertiary care hospital. Materials and methods: It is a retrospective case series of 28 patients who underwent endoscopic excision of inverted papilloma of paranasal sinus in a tertiary care hospital from April 2017 to October 2020. The medical records were retrospectively analyzed for the clinical, radiological, pathological, intraoperative and postoperative findings and later compared among the surgical approaches. Results: Of the total of 28 patients with inverted papilloma (3; Krouse 2 and 25; Krouse 3), 11(21.4%) patients were operated through endoscopic modified Denker, 8(39.3%) patients with endoscopic medial maxillectomy and 6(21.4%) patients with endoscopic sinus surgery. Patients who underwent modified endoscopic approach had lesser complications compared to the standard endoscopic procedures. Conclusion: Endoscopic excision of the sinonasal inverted papilloma can be a valid alternative to the open surgical approach, enabling complete clearance of the disease with a minimal complication rate. A large population with a long-term follow-up may be needed for a better understanding of the results. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-022-03332-6.

Clear cell variant of chondrosarcoma of calcaneum: A case report with review of the literature.

Clear cell chondrosarcoma (CCC) is an uncommon variant constituting less than 2% of all chondrosarcomas. CCC arises most commonly in the proximal end of the femur, followed by the humerus, and other small bones. CCC involving the tarsal bone is very rare, and to the best of our knowledge, only one case has been described involving the calcaneum in the English literature to date. In this article, we discuss a case of CCC involving the right calcaneum with complete clinico-immuno-histomorphological features, which is successfully managed by below-knee amputation. We also reviewed the reported cases of chondrosarcomas involving the calcaneum with special reference to clinical features, therapy, morphology, and follow-up data.

Signet ring cell lymphoma of follicular type with BCL2 gene rearrangement: A rare case with a short review of literature.

A case of signet ring cell lymphoma of presacral lymph node is reported. The patient was diagnosed as follicular lymphoma on the basis of clinical and laboratory features, including immunohistochemistry (IHC) and gene rearrangement studies. Light microscopy examination showed neoplastic atypical cells with signet ring cell morphology in core biopsy of lymph node that stained for B-cell markers by IHC. In addition, the neoplastic cells expressed CD20, CD10, BCL-2, and BCL-6, indicating follicular center origin. Fluorescence in situ hybridization study demonstrated BCL2 gene arrangement. Especially in the case of deep-seated intra-abdominal lymph nodes with atypical presentation, the differential diagnosis arises with nonhemopoietic tumors, and this needs to be distinguished by specific immunostaining and gene arrangement studies.

Rhinosporidiosis of the lacrimal sac masquerading as chronic dacryocystitis: a rare presentation.

Rhinosporidiosis is a chronic infection of the mucous membrane caused by the Rhinosporiduim seeberi, which infects through transepithelial penetration. Although described worldwide, this entity is mostly found in the western hemisphere, afflicting young people, predominantly males, associated in many cases with recreational or professional contact with bath in ponds, rivers, or stagnant waters. The clinical features are varied depending on the affected membrane, in some cases mimicking other diseases postponing the correct diagnosis. Although nasal obstruction and epistaxis are the common clinical presentations in sinonasal rhinosporidiosis, patients with epiphora without a nasal mass often challenge the diagnosis. In the present case, we have documented a case of isolated lacrimal sac rhinosporidiosis masquerading as chronic dacryocystitis, which was successfully managed by endoscopic excision, accompanied by a literature review.

Giant epidermal inclusion cyst of the thyroid: a rare occurrence.

Epidermal inclusion cyst (EIC) of the thyroid is extremely rare in the clinical practice. A handful of cases have been documented in the past in the world literature. A giant EIC of the thyroid is hitherto unreported. This lesion may arise from the squamous metaplasia of the thyroid follicular cells. Though non-neoplastic, giant forms can cause compression of the vital structures of the neck. In the present case, we have described a giant epidermal inclusion cyst successfully managed with surgical management.

Intraconal orbital dermoid cyst: a rare location.

Intraconal dermoid cysts are very unusual in routine clinical practice. Clinical symptoms depend upon the site and extension of the lesion. Though rare, proptosis, diplopia, and orbital pain are the presenting symptoms encountered in patients with an intraorbital dermoid cyst. Although radiology can be diagnostic, a complete correlation with the final histopathology is always mandatory for its confirmation. Endoscopic excision of the cyst ensures a complete cure for the disease without any intraoperative/postoperative complications.

Clinicopathological and Immunohistochemical Profile of Mantle Cell Lymphoma: An Institutional Experience.

Introduction Mantle cell lymphoma (MCL) is a biologically aggressive B-cell non-Hodgkin lymphoma (NHL) with distinctive morphologic, immunophenotypic, and molecular characteristics. Differentiation from other chronic lymphoproliferative disorders is essential for prognostication. Aim This paper aims to study the clinicopathological features of MCL with emphasis on immunohistochemical features and disease correlation. Method To do so, clinicopathological characteristics from 21 cases of MCL (14 males, seven females, M:F=2:1) diagnosed in the last five years i.e. 2015 to 2020, were retrospectively reviewed and correlated with immunohistochemistry (IHC) data. Particularly those pertaining to cyclin D1, SRY-box transcription factor 11 (SOX11), cluster of differentiation (CD) 5, CD23, MIB E3 ubiquitin protein ligase 1 (MIB1), tumor protein 53 (TP53), c-myelocytomatosis oncogene product (c-MYC), multiple myeloma oncogene 1 (MUM1), mouse double minute 2 homolog (MDM2), and Epstein-Barr virus latent membrane protein 1 (EBV-LMP1) expression with its aberrations. Observations This study shows that MCL constituted 4.2% (21/500) of all NHLs with a mean age of 57.5 years (median 60 years, range 30 to 80 years). The disease was nodal in 19, and extranodal in the remaining two cases. 14 of 21 (67%) had generalized lymphadenopathy and 71% had bone marrow (BM) involvement. The nodal involvement was diffuse in 9/17 (53%), 8/21 (38%) had a blastoid morphology, and an in-situ MCL pattern was not seen in any of the cases selected for the study. Cyclin D1 immunoexpression correlated well with SOX11; CD5-negative in five cases; and CD23-positive in three cases. TP53 and c-MYC expression were noted in 17/19 (89.4%) and 8/17 (47%), respectively. MUM1 registered positive in six cases. None of the cases showed immunopositivity for MDM2 and EBV-LMP1. Conclusion In essence, this study indicates that morphological and immunophenotypic subclassification of mantle cell lymphoma with a wider panel of IHC markers is essential for understanding disease biology and better prognostication.

Basidiobolomycosis of Right Colon Mimicking as Carcinoma of Colon.

Gastrointestinal basidiobolomycosis (GIB) is a rare fungal infection with limited geographic distribution. However, the incidence of GIB has shown an increasing trend because of globalization and frequent traveling. GIB is commonly seen to mimic gastrointestinal malignancy and other diseases such as intestinal tuberculosis and inflammatory bowel disease. Tissue diagnosis is considered to be the gold standard for differentiating these mycotic lesions from tuberculosis and malignancy with confirmation of species performed by culture or polymerase chain reaction. The diagnosis of GIB should be conjectured in patients with suspicion of malignancy, with an inconclusive biopsy. It seems prudent to proceed with radical excision of mass early because both colonic malignancy and GIB have high mortality if untreated.

Cytomorphological features of Mammary Analog secretory carcinoma of parotid gland: Report of 3 cases and review of literature.

Mammary analog secretory carcinoma (MASC) of salivary gland is a recently described entity. Due to its rarity and cytomorphological overlap with other salivary gland tumors, it is often difficult to recognize on cytology. Here we describe three such cases with their histopathological correlation. All the three tumors arose in the parotid gland. They were misdiagnosed as mucoepidermoid carcinoma, acinic cell carcinoma and salivary duct adenocarcinoma, respectively. Final diagnosis of MASC was established on their follow-up histopathology and immunochemistry evaluation. Cytosmears of these tumors showed high cellularity with papillary architecture lying within fluid background rich in foamy macrophages. Nuclear atypia varied from minimal to marked with frequent mitosis and presence of necrosis. Cytoplasmic vacuolation was a consistent finding. Although the cytomorphological features of MASC are not specific, a diagnosis of MASC should be strongly considered in the presence of papillary architecture, prominent cytoplasmic vacuolations of the tumor cells and a background of cyst fluid. Immunohistochemistry on cell block may be done to confirm the diagnosis.

Elastosis Perforans Serpiginosa: a D-penicillamine induced dermatoses in a patient with Wilson's disease.

Long term use of D-penicillamine for Wilson's disease can be associated with many adverse reactions and systemic side effects. We report the case of a 28-year-old male patient diagnosed with Wilson's disease presenting with a serpiginous raised violaceous skin lesion in the anterior aspect of the neck over the last six months and two small papules with central umbilication during the last month. Histopathological examination of skin lesions demonstrated transepidermal perforating channel, and the Verhoeff's-van Gieson stain showed marked increase number of irregular serrated elastic fibers suggesting the diagnosis of D- penicillamine induced elastosis perforans serpiginosa.

Altered expression of epigenetic modifiers EZH2, H3K27me3, and DNA methyltransferases in meningiomas - prognostic biomarkers for routine practice.

INTRODUCTION: Meningiomas comprises of a wide variety of histological entities with heterogeneous biological behaviour and prognosis. The plethora of genetic data are yet to produce relevant biomarkers for routine use. In contrast, epigenetic alterations are less elucidated. MATERIAL AND METHODS: The expression of the key molecules involved in the two principal epigenetic systems, i.e. DNA methylation (DNA methyltransferases [DNMT-1, -3A and -3B]) and histone modification (Enhancer of Zeste homolog-2 [EZH2] and trimethyl histone-3 [H3K27me3]) were assessed in 149 cases of meningiomas (grade I - 102, grade II - 47) by immunohistochemistry. RESULTS: Immunopositivity for EZH2 (38.3% vs. 6.0%) and negativity for H3K27me3 (10.6% vs. 1.0%) were significantly more common in grade II tumours. Both were associated with significantly higher proliferative activity. The majority of the cases of both grades showed expression of all three DNMTs. However, high expression of DNMT-1 was significantly more common in grade II tumours (87.8% vs. 66.2%). Expression of EZH2 and loss of H3K27me3 were associated with significantly shorter progression-free survival (hazard ratio [HR] = 4.07 and 0.24, respectively). CONCLUSIONS: The key epigenetic regulators play important roles in the pathobiology of meningiomas. EZH2 positivity and H3K27me3 negativity are associated with aggressive tumour-biology and poor prognosis. Both these markers can easily be assessed by immunohistochemistry and can be incorporated in routine practice.

Ancient Schwannoma of the Infratemporal Fossa: A Case Report.

INTRODUCTION: Ancient schwannoma of infratemporal fossa arising from the trigeminal nerve is very rare in clinical practice. CASE REPORT: A 65-year old male presented to the outpatient department with a progressive swelling over the left parotid for 5 years and pain during chewing for 6 months which was diagnosed as benign spindle cell tumour on cytology. The tumor was excised with a combined transparotid and transmandibular cervical approach and the final pathology was confirmed to an Ancient Schwannoma. CONCLUSION: A giant infratemporal fossa Schwannoma extending to the parapharyngeal space masquerading as a parotid swelling is very unusual. Transparotid transmandibular excision of the infratemporal fossa tumor is an effective approach ensuring complete removal of the tumor with minimal postoperative complications and acceptable cosmoses.

Isolated Primary Rhinosporidiosis of the Parotid Duct: A Rare Presentation.

INTRODUCTION: The primary involvement of the parotid duct in rhinosporidiosis is very rare in clinical practice. Here, we present a case of rhinosporidiosis primarily involving the parotid duct, which was successfully excised through transparotid and transoral approaches. CASE REPORT: A 51-year-old male presented with a painless progressive swelling over the left cheek for nine months. It was diagnosed as a parotid cyst or a mucous retention cyst based upon the radiological and cytological features. The cyst was completely excised with transparotid and transoral approaches, and the final diagnosis was confirmed to be rhinosporidiosis. CONCLUSION: Although the nose and the paranasal sinus are the common sites to be involved in rhinosporidiosis, the affection of the parotid duct is very unusual in clinical practice.

An Unusual Case of Extensive Cavernous Hemangioma of the Nasopharynx.

INTRODUCTION: Giant cavernous hemangioma involving the nose extending to the nasopharynx and oropharynx with complete obstruction of the airway is very unusual and is yet to be described in the literature. In the present case, we have described a giant cavernous hemangioma successfully managed with endoscopic excision. CASE REPORT: A 38-year-old male patient presented with recurrent nasal bleeding for 24 months and progressive obstruction of the right nasal cavity for 8 months. Diagnostic nasal endoscopy showed a greyish mass filling the whole of the right nasal cavity and contrast-enhanced CT scan of the nose and paranasal sinus revealed a large heterogeneous contrast enhanced lesion in the nasal cavity. The endoscopic biopsy was suggestive of cavernous hemangioma. Endoscopic excision was done and the patient has been followed up for the past 12 months without any recurrence of the disease. CONCLUSION: Cavernous hemangioma is an uncommon benign entity of the nose and paranasal sinus. Due to the nonspecific clinical and radiological pictures, it is often a challenge for the preoperative diagnosis. A high index of suspicion and complete understanding of the clinicopathological profile of the patient is vital as the major differential diagnosis is the sinonasal malignancy simulating with a similar clinical picture.

Pectoralis Major Myocutaneous Flap for the Reconstruction of the Palatal Defect.

It is always a challenge for the soft tissue reconstruction of the palatal defects in advanced malignancies of the oral cavity because of the higher chance flap failure. PMMC flap can be successfully used in patients with advanced malignancies to repair the palatal defect without any significant postoperative complication. In the present case, we have presented a case of malignant melanoma of gingivobuccal complex, involving the hard palate where the palatal defect was successfully reconstructed by the PMMC flap.

Submental Ectopic Thyroid Cyst: An Atypical Presentation.

It is very unusual of an ectopic thyroid to be presented as a submental swelling, clinically mimicking a submental cyst. Suspicious of the disease with complete clinical, biochemical and radiological correlation is the mainstay of diagnosis as the first FNAC is not confirmatory of the ectopic thyroid especially in cases of dysgenesis of thyroid tissue in an unusual location. Here we have presented a rare case of an ectopic thyroid gland presented with a submental swelling successfully managed with the conservative treatment.

Vallecular Neurofibroma Successfully Managed with Endoscopic Assisted Coblation: A Novel Technique.

Although solitary neurofibroma can affect the various subsites of the head and neck region, oropharyngeal neurofibroma is very rare and total five cases (four in the soft palate and one in the palatine tonsil) have been reported. Here we present a 42-year old female patient presented to the out patient department with respiratory obstruction and voice change for 3 months. Complete excision of the mass was achieved by endoscopic coablation and which was confirmed to be a neurofibroma.

External Auditory Canal Paraganglioma with Chronic Otitis Media of Ear: A Rare Coexistence.

Paraganglioma is a rare benign tumour accounts for 0.6% of the all the malignancies affecting the head neck region. They originate from the paraganglionic cells from neuroendocrine tissues from skull base to the pelvic floor. Very rarely, temporal bone gets involved by the disease and it is the middle ear and mastoid complex which gets affected by the disease. Isolated involvement of the external auditory canal without the involvement of the tympanomastoid region is very unusual and only 5 cases have been reported in the literature till date. Again, coexisting middle ear disease with the canal paraganglioma is very rare and always being a challenge for the diagnosis due to its atypical presentation and its histopathogical features. Here, we present an atypical case of an external auditory canal paraganglioma, masquerading as complicated chronic otitis media.

Submental island flap reconstruction for carcinoma of the oral cavity: Experience in 30 cases.

OBJECTIVE: The submental flap can be utilized for soft tissue reconstruction in oral cavity malignancies because due to its close approximation to the surgical site, fewer donor site morbidity and the cost effectiveness of the procedure. METHODS: A total of 30 patients with squamous cell carcinoma of the oral cavity were included in the study from July 2012 to August 2015 in a tertiary care referral hospital. Patients with clinical staging I/II/III (T1/T2/T3, N0) oral malignancy were included in the study. Patients with nodal metastasis irrespective of the stage of disease and patients with chronic medical illness/revision cases were excluded from the study. Submental island flap was utilized for the reconstruction of the soft tissue defect in each patient. Patients were followed at monthly interval till 6 months in the postoperative period. RESULTS: The buccal mucosa (12 patients), tongue (10 patients) and floor of mouth (8 patients) were the subsites in the oral cavity. Partial and complete skin necrosis was found in 4 and 2 patients respectively. Postoperative chemoradiation was required in 5 patients. None of the patients had loco regional recurrence till 6 months of follow-up. CONCLUSION: The submental island flap is considered to be the reliable option for the soft tissue reconstruction in oral cancer because of dependent vascular pedicle, less donor site morbidity and the lower cost compared to the free flaps, often preferred in patients with a lower socioeconomic condition.

Surgical management of extracranial nerve sheath tumours in a tertiary care center.

OBJECTIVE: Excision of the nerve sheath tumours of head and neck is always a challenge to the surgeon because of their close proximity of the neurovascular structures. METHODS: It is a retrospective study contained 13 consecutive patients of nerve sheath tumours involving the head and neck from March 2013 to February 2017 in the department of Otorhinolaryngology and Head Neck Surgery in a tertiary care referral hospital. The retrospective clinical data, diagnostic procedures, surgical approaches and their complications are analyzed after 12 months of surgery. RESULTS: Total 13 patients, 7 were females and 6 were males. Painless neck swelling was the most common presentation found in 6 and the most common site of origin was the vagus nerve in the parapharyngeal space (6 patients). Transcervical excision of the tumour was performed in 7 patients. Six needed combined surgical approach for the excision of the tumours. Neurovascular injury was detected in 3 patients, and one patient had recurrent disease during the follow-up period. CONCLUSIONS: Excision of the nerve sheath tumours of head and neck is always a challenge to the surgeon because of their close proximity of the neurovascular structure. Although the transcervical approach is commonly practiced for the majority of the tumours, combined approaches can be effectively applied for extensive nerve sheath tumours with the satisfactory clinical outcome.