Intersection of policy and Immunization Information Systems (IIS).

BACKGROUND: Immunization information systems (IIS) are confidential, population-based computerized databases that record vaccination doses administered to persons residing within a given geopolitical area. We sought to highlight the evolution of IIS policy over the last two decades, as IIS play a pivotal role in achieving equitable and high vaccine uptake. METHODS: Legal epidemiological research methods were used to assess relevant IIS statutes and administrative codes across all 50 states, the District of Columbia, Philadelphia, and New York City. Where relevant, laws were cross-checked or supplemented with state and local health department resources. Comparisons to previous legal studies enabled evaluation of trends in IIS laws over time. RESULTS: The compilation of current laws provides an updated overview of the diverse interstate and intrastate policies within the US that govern the capabilities and implementation of IIS. The findings of this study show the progress that has been made in the past decade in improving policies that enable IIS to be utilized across the life-course. Conversely, gaps in IIS data collection, limited interoperability with local and national health information systems, and inconsistent access to view or utilize IIS records due to existing policies, continue to limit the full potential of IIS. CONCLUSIONS: In the United States (US), IIS are implemented and managed at the state and local level, creating variability in IIS policies and implementation. Findings from this study serve as a comprehensive benchmark of current IIS laws that may aid policy stakeholders who are exploring amendments to jurisdictional IIS laws.

Prevalence of human papillomavirus infection in abnormal pap smears.

Objectives: This study was undertaken to study the prevalence of human papillomavirus (HPV) infection using the polymerase chain reaction (PCR) technique in abnormal cervical pap smears and to correlate the different cytological results with HPV infection. Material and Methods: A total of 1788 cervical pap smears of women more than 30 years of age conducted over a period of 1 year 3 months (June 2015-August 2016) were screened by liquid-based cytology. High-risk (HR)-HPV testing was performed by PCR in abnormal lesions. Inflammatory smears and some atypical squamous cells of undetermined significance (ASCUS)-reactive cases were excluded from HPV testing. Histopathological correlation was done wherever possible. Results: The overall prevalence of the intraepithelial lesions/malignancy was ASCUS. (ASCUS) - 79 (4.42%), atypical squamous cells cannot exclude high-grade squamous intraepithelial lesion (ASC-H) - 10 (0.56%), low-grade squamous intraepithelial lesion (LSIL) - 26 (1.45%), high-grade squamous intraepithelial lesion (HSIL) - 15 (0.84%), squamous cell carcinoma - 5 (0.28%), and adenocarcinoma - 1 case (0.06%). Overall, 136 (7.60%) samples were classified as abnormal. Seventy-seven samples were included for HR-HPV testing - 20 ASCUS, 10 ASC-H, 26 LSIL, 15 HSIL, and 6 malignant cases. A control group of ten samples with normal cervical cytology within the normal limit (Control) (WNLc) was tested for HR-HPV. HR-HPV was detected in 20% of samples of the WNLc group, 45% of the ASCUS group, 70% of the ASC-H group, 73.07% of the LSIL group, 86.67% of the HSIL, and 83.34% of the samples in the malignant group. Overall, HR-HPV was detected in 68.83% of abnormal cervical pap smears. Conclusion: Our study shows that the percentage of HR-HPV-positive case increases with the severity of cytologic morphology. HPV had 4 times higher positivity in squamous intraepithelial lesion as compared to ASCUS.

Clinicopathological, Immunological, and Laboratory Parameters of Childhood Lupus Nephritis: A Study from Northeast India.

Background Lupus nephrtis in children is associated with high morbidity and mortality. The incidence of childhood systemic lupus erythematosus (SLE) ranges from 3.3 to 8.8/100000 children with a higher Asian preponderance. The predominance of SLE in female pediatric patients increases gradually with age to the values observed in adults. Objectives To assess the clinical, immunological, and histopathological spectrum of childhood lupus nephritis in northeast India and explore the relationship between clinical, biochemical, serological, and histopathological findings. Materials and Methods A retrospective descriptive study was performed over 8 years. Histopathology slides were reviewed by two pathologists, whereas other details were collected from patients' records. Statistical Analysis Statistical analysis was based on the chi-square test and a p -value < 0.05 was considered statistically significant. Results Fifty-three cases of lupus nephritis were included in the study. The patients' age ranged from 5 to 18 years with a mean age of 14.5 years and a female: male ratio of 6.5:1. Edema and hypertension were the commonest clinical presentations, whereas proteinuria was the commonest presenting laboratory parameter. Amongst all the immunological markers, dsDNA was the commonest. Histopathologically, predominantly study population belonged to class IV lupus nephritis. The patients with class IV showed a statistically significant correlation with proteinuria and hematuria at the time of diagnosis. Immunological markers, namely, ANA and anti-ds-DNA positivity were significantly associated with advanced renal histopathology. Conclusion cSLE in northeast India presents mostly as Class IV LN presenting mostly with deranged laboratory parameters and preponderance of various immunological markers and clinical presentations.

Clinicopathological Profile of Immunoglobulin A Nephropathy: A Study from Northeast India.

Immunoglobulin A (IgA) nephropathy is the most common primary glomerulopathy, with wide variation in its prevalence as well as clinical symptoms. Among the laboratory parameters, increased serum creatinine (SCr) levels, mean arterial pressure (MAP), and a decreased estimated glomerular filtration rate (eGFR) point toward poorer renal function. The Oxford 2016 scoring system for IgA nephropathy identified various histopathological variables, which serve as indicators of renal outcomes. There is a paucity of studies on the prevalence as well as the various clinical laboratory parameters correlating with the 2016 Oxford scoring system in northeastern India. The present study showed that IgA nephropathy was more common in the second and third decades, more prevalent in females, and mostly presented with edema. Nephrotic proteinuria, higher SCr, MAP, and decreased eGFR levels at presentation suggested poorer renal function in most subjects. The endocapillary hypercellularity, segmental sclerosis, tubular atrophy, and crescent variables of the 2016 Oxford scoring system showed a statistically significant relationship with various laboratory parameters at presentation.

Immunoglobulin A Nephropathy in a SARS-CoV-2-Positive Patient With Coexistent Metabolic Syndrome.

SARS-CoV-2 viral infection though primarily affects the respiratory system, but concurrent renal involvement is been reported in the medical literature. Acute kidney injury (AKI) is a common finding in SARS-CoV-2-positive patients. An isolated case of IgA nephropathy in a SARS-CoV-2 virus-infected patient has been already reported in the medical literature. Incidence of metabolic syndromes is on the rise considering the change in lifestyle and food habits and the global pandemic of obesity. Renal manifestations of metabolic syndrome are myriad with IgA nephropathy being an occasional manifestation in such patients. We reported a case of IgA nephropathy in a patient in her fourth decade of life diagnosed as metabolic syndrome with concomitant SARS-CoV-2 infection that progressed to chronic kidney damage (CKD) subsequently. In this case report, we postulate that cytokine storm along with hypoxemia secondary to SARS-CoV-2 infection may accelerate the declining renal function however further studies are necessary to confirm this hypothesis considering the rarity of such cases.

Papillary cystadenocarcinoma of the parotid gland: a rare sub-variant of salivary gland adenocarcinoma.

Papillary cystadenocarcinoma of the salivary gland is a very rare malignant neoplasm accounting for only 2% of all salivary gland lesions. In 1991 it was first included as a separate entity in the World Health Organization (WHO) classification of salivary gland tumors and in 2017 WHO Classification, the tumor was clubbed as a sub-variant of adenocarcinoma, not otherwise specified. It most commonly occurs in the major salivary glands. Herein we report a case of salivary papillary cystadenocarcinoma in a 54-year-old female, who presented with rapid enlargement of the right parotid swelling. Based on radiology and fine-needle aspiration cytology, a working diagnosis of the malignant tumor involving the superficial lobe of the right parotid gland was made. In view of the malignant nature of the swelling, superficial parotidectomy was done. The histopathology and immunohistochemistry of the mass confirmed the diagnosis of papillary cystadenocarcinoma of the right parotid. With the revised 2017 WHO classification of salivary gland tumors, it is important to report all rare subtypes in order to understand their biology and behavior.

Papillary cystadenocarcinoma of the parotid gland: a rare sub-variant of salivary gland adenocarcinoma

Papillary cystadenocarcinoma of the salivary gland is a very rare malignant neoplasm accounting for only 2% of all salivary gland lesions. In 1991 it was first included as a separate entity in the World Health Organization (WHO) classification of salivary gland tumors and in 2017 WHO Classification, the tumor was clubbed as a sub-variant of adenocarcinoma, not otherwise specified. It most commonly occurs in the major salivary glands. Herein we report a case of salivary papillary cystadenocarcinoma in a 54-year-old female, who presented with rapid enlargement of the right parotid swelling. Based on radiology and fine-needle aspiration cytology, a working diagnosis of the malignant tumor involving the superficial lobe of the right parotid gland was made. In view of the malignant nature of the swelling, superficial parotidectomy was done. The histopathology and immunohistochemistry of the mass confirmed the diagnosis of papillary cystadenocarcinoma of the right parotid. With the revised 2017 WHO classification of salivary gland tumors, it is important to report all rare subtypes in order to understand their biology and behavior.

Intraoperative Diagnosis of Central Nervous System Tumors: Challenges, Errors, Lessons Learned, and the Surgeon's Perspective.

BACKGROUND: Intraoperative crush smear is an adjuvant in diagnosing central nervous system (CNS) lesions on tissue sent for frozen section. Besides rapid decision-making, it also ensures that minimum injury is caused to the normal brain structures surrounding the intracranial neoplasm. A rapid intraoperative diagnosis helps the surgeon in planning the appropriate surgery. OBJECTIVE: Our objective is to review all the discordant cases between intraoperative and histopathological diagnosis and also to study the crush smear slides for morphological clues that could have been helpful in minimizing such errors, especially for an inexperienced neuropathologist/general pathologist. The surgeon's perspective on the impact of these errors on management is also discussed. METHOD: A prospective study of six years from 2013 to 2019 was conducted. Crush smears were made and stained with rapid hematoxylin and eosin (H&E). The rest of the tissue was processed for permanent tissue sections. Slides in which there was discordance between the intraoperative and permanent paraffin sections were reviewed to ascertain the reasons thereof. RESULTS: A total of 81 specimens of CNS tumors were sent for intraoperative consultation. Out of these, discordance was seen in 13 (16%) cases. CONCLUSION: To minimize diagnostic errors, it is important to do regular analyses of the misinterpreted cases. Knowledge of the pre-operative radiological differential diagnosis is mandatory. Discussion with the surgeon regarding the clinical impact of the errors made will give a clearer picture to the pathologists regarding clinically relevant reporting during intraoperative consultation.

Secondary Hemophagocytic Lymphohistiocytosis in Post-COVID-19 Patients: A Report of Two Cases.

Hemophagocytic lymphohistiocytosis (HLH) is a disease that can affect both children and adults. HLH can be categorized as primary or secondary. Secondary HLH (sHLH) may be secondary to various viral infections. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus infection is a pandemic with multi-system involvement. HLH in COVID-19 positive patients is a recognized entity. However, in post-COVID-19 patients who have recovered and are negative by serological tests and reverse transcription-polymerase chain reaction test may present with sHLH due to dysregulation of the immune system. We highlight this unusual finding of post-COVID-19 sHLH in two cases, who were diagnosed by the new revised H-score.

Tumour Behaviour of Low-Grade Papillary Urothelial Carcinoma: A Single-Centre Retrospective Study.

Background and objective Carcinoma of the urinary bladder is the most common urological cancer, and it accounts for 3.9% of all cancer cases in men. Patients with the subset of noninvasive low-grade papillary urothelial carcinoma (LG-UrCa) are at higher risk for tumour recurrence. In this study, we aimed to analyse the histopathological features of LG-UrCa and to correlate those with recurrence potential as well as disease stage and grade progression. Materials and methods We conducted a retrospective study from January 2016 to December 2018. All cases with presenting biopsy initially reported as LG-UrCa were included in the study. All cases with initial biopsy reported as high-grade papillary urothelial carcinoma (HG-UrCa) were excluded from the study. We used the 2016 World Health Organization/International Society of Urological Pathology (WHO/ISUP) guidelines for the classification of papillary urothelial neoplasm. Results A total of 48 initially diagnosed cases of LG-UrCa were identified. Two out of 48 cases were reclassified as high-grade urothelial carcinoma and were excluded from the study. The mean age of patients at presentation was 56.7 years. The mean duration of follow-up was 19.8 months. The mean size of initial tumours was 3.4 cm. Tumour recurrence was encountered in 14 (30.4%) of 46 patients. Out of the four patients who had high-grade progression (8.7%), two also developed TNM stage progression. These two patients eventually underwent radical cystectomy. Patients with larger initial tumour sizes were found to have an increased tumour recurrence rate (p=0.009). Patients with multiple lesions at initial diagnosis had a significantly higher tumour recurrence rate than those with a single tumour (p=0.02). There was no significant difference with regard to intravesical Bacillus Calmette-Guérin (BCG) and tumour recurrence (p=0.065). None of the clinicopathological parameters were significantly associated with the grade and/or stage progression. Conclusion Based on our findings, patients with larger initial tumour size and tumour multiplicity at presentation had an increased tumour recurrence rate.

IgA nephropathy superimposed on diabetic nephropathy: A case report with review of literature in eight Indian studies.

Diabetes mellitus is one of the foremost diseases in the modern era and diabetic nephropathy contributes to a major percentage of end-stage kidney disease. Although diabetic nephropathy is difficult to revert back, detection of nondiabetic renal disease (NDRD) is important to detect as most of them are treatable. We describe a case of a 62-year-old female with long-standing diabetes mellitus presenting with massive proteinuria and clinical features of nephrotic syndrome. The kidney biopsy showed class III diabetic nephropathy along with focal proliferative glomerulonephritis with crescent formations. The immunofluorescence study showed strong mesangial IgA deposition with the predominance of lambda stain. This confirmed the diagnosis of diabetic nephropathy with superimposed IgA nephropathy. We reviewed eight Indian studies herewith to demonstrate NDRD spectrum in the Indian diabetic scenario.

Association of Co-dominant Immunoglobulin G Deposit in Immunoglobulin A Nephropathy With Poor Clinicopathological and Laboratory Parameters.

INTRODUCTION: Immunoglobulin A (IgA) nephropathy is the commonest primary glomerulonephritis with a wide range of clinical presentations and laboratory findings. There is a paucity of studies regarding the significance of co-dominant immunoglobulin G (IgG) deposition in IgA nephropathy. METHODS: The study included retrospective and prospective biopsy-proven cases of IgA nephropathy from 2013-2020 with a minimum of eight glomeruli. Clinical and laboratory parameters were analysed for the IgA and IgG co-dominant cases as compared to those of the non-IgG group. RESULTS: A total of 58 cases of IgA nephropathy were included in the study out of which 25 biopsies (43.1%) were categorized as IgA plus IgG, and the rest 33 biopsies (56.8%) as the non-IgG group. A significant correlation was noted amongst the IgA plus IgG group with respect to the elevated mean arterial pressure (MAP) (p=0.038) and proteinuria (p=0.002) as compared to the non-IgG group. Amongst the MEST-C (mesangial hypercellularity, endocapillary hypercellularity, segmental sclerosis, tubular atrophy/interstitial fibrosis, crescents) variables, endocapillary hypercellularity correlated with elevated MAP (p=0.04), raised serum creatinine (p=0.005), and decreased estimated glomerular filtration rate (eGFR) (p=0.002). CONCLUSION: Co-dominant IgG deposit serves as an adverse marker pointing towards a deranged renal function in IgA nephropathy.

Gliomas - An experience based on molecular markers.

BACKGROUND: Gliomas account for 45% of all intracranial tumors. Newer technologies have allowed deeper genetic and epigenetic analysis leading to the discovery of IDH (Isocitrate dehydrogenase) mutations and their association with ATRX (alpha-thalassemia/mental retardation syndrome X-linked) and p53, for better diagnosis and prognosis. In this study, we analysed their expression and correlated with various clinicopathological parameters. A follow up to prognosticate gliomas based on the molecular findings is also attempted. MATERIALS AND METHOD: During last 5 years both retrospective and prospective cases were included in the study. Immunohistochemistry for IDH1, ATRX, and p53 was done and reported based on intensity and percentage of tumor cells expressing the markers. RESULTS: A total of 53 cases of gliomas were included, excluding primary glioblastomas and ependymomas. The patient's age ranged from 10 to 53 years. The male to female ratio was 1.3:1. IDH1 positivity was seen in 88% of diffuse astrocytoma, 80% of anaplastic astrocytoma, 90% of oligodendroglioma, 60% of anaplastic oligodendroglioma, and 54% of glioblastoma. A significant association was seen between positive IDH1 expression and low-grade gliomas (p = 0.028). A combined analysis of expression of IDH1 and ATRX versus IDH1, ATRX, and p53 with WHO grade showed a statistically significant association. A follow-up of 32 patients was available. Out of 24 IDH1+ (positive) cases, 22 patients had a median survival of 21.5 months (92%). Out of 8 IDH1- (negative) cases, 5 had a median survival of 15.8 months (62%). CONCLUSION: Gliomas expressing IDH1 mutation show improved survival of patients. Combined analysis of IDH1, ATRX, and p53 has diagnostic and prognostic significance. For routine cases of gliomas, a combination of IDH1 and ATRX are sufficient; however, the use of p53 is recommended for further prognostication and for possible targeted therapy in the future.

Mélange of Lymphoepithelial Lesions of Salivary Glands from a Tertiary Care Center of North East India: Diagnostic Conundrums.

Background Lymphocytic infiltrates of the major salivary glands are involved in a spectrum of diseases that range from reactive to benign and malignant neoplasms. Occasionally, these pathologic entities present difficulties in the clinical and pathological diagnosis. Aim and Objective The aim of this study was to highlight the importance of meticulous cytopathological and histopathological examination (HPE) in solving the diagnostic challenges encountered in the analysis of these salivary gland lesions. Materials and Methods A retrospective analysis of salivary gland lesions was undertaken over a period of 5 years from 2013 to 2018 in the Department of Pathology at our institute. Salivary gland pathologies diagnosed either as chronic sialadenitis or reactive/benign/malignant lymphoepithelial lesions on fine-needle aspiration cytology (FNAC) and as lymphoepithelial carcinoma (LEC) were included in this study. Results A total of 86 cases of salivary gland lesions diagnosed as mentioned above were found during this period. Out of the 86 cases, 16 were subjected to HPE. Biopsy was not warranted in most of the cases diagnosed as chronic sialadenitis. HPE was concordant with the FNAC diagnoses in 13 out of the 16 cases (81.3%), with a single case misinterpreted as LEC on FNAC. Conclusion Benign and malignant lymphoepithelial lesions of salivary glands may sometimes be difficult to differentiate not only from one another on FNAC but also from other malignant lesions. FNAC is an effective tool for the diagnosis of nonneoplastic lesions, but in cases of benign lymphoepithelial lesions in the absence of salivary acini, biopsy is advisable.

Giant cell reparative granuloma of the nasal cavity: a rare site of presentation with review of literature.

Giant cell reparative granuloma (GCRG) was first described in the 1950s. It is an uncommon and benign reactive tumor that is believed to occur after trauma or inflammation. It most commonly occurs in the maxilla and mandible and rarely affects the nasal cavity. It is often seen in children and during the second to third decades of life, predominantly seen among females. Histopathologically, GCRG shows many osteoclast-like multinucleated giant cells scattered in a background of mononuclear stromal cells and spindle-shaped fibroblasts also associated with areas of hemorrhage. The distinction between GCRG and giant cell tumors (GCT)is crucial since both have a similar clinical and histological presentation, but both have different management. GCTs have malignant potential, may metastasize, and have a high rate of recurrence. Surgical excision is the mainstay therapy of GCRG to ensure a low rate of recurrence. Here we discuss two cases GCRG, both presenting as nasal mass.

Metanephric Adenoma with cystic changes- An uncommon presentation of a rare tumor in a young adult.

Metanephric adenoma (MA) is a rare benign neoplasm of the kidney that is usually asymptomatic and incidentally diagnosed. MA usually present as a solid mass; however, a cystic presentation has been reported. The main differential diagnosis of MA is the epithelial predominant Wilms tumor (e-WT) and the solid variant of papillary renal cell carcinoma (pRCC). The presence of the BRAF gene mutation has recently been reported in 85% of MA, and less than 10% of cases of MA do not express this specific gene mutation. Herein we report a 22-year-old man who presented with back pain and abdominal discomfort with a renal mass on the computed tomographic scan. The diagnosis of metanephric adenoma was confirmed histopathologically. In our case, the tumor presented as a solid and cystic mass hence mimicking a papillary renal cell carcinoma. The VE1 protein, which correlates with BRAF gene mutation, did not show any significant expression. We want to highlight that MA can present as a cystic lesion that should be taken into account to avoid unnecessary radical nephrectomy. Also, we demonstrated that a subset of MA might not harbor the BRAF gene and, they are classified as the BRAF wild type MA.

Fine-needle aspiration cytology of mediastinal masses: An institutional experience.

INTRODUCTION: Mediastinal masses are uncommon in clinical practice. Fine-needle aspiration cytology (FNAC) is an important and useful investigation and is considered next to imaging in the diagnosis of mediastinal lesions. AIM: To analyze the mediastinal masses diagnosed on FNAC. MATERIALS AND METHODS: We retrospectively retrieved twenty-five cases, which underwent FNAC under ultrasound or computed tomography (CT) guidance for mediastinal masses, over a period of 4 years. Histopathological correlations were done in cases wherever available. RESULTS: Among twenty-five cases, which were diagnosed through FNAC, eighteen were males and seven were females with age ranging from 6 to 85 years. Ultrasonography (USG)-guided FNAC was performed in three patients, while CT-guided FNAC was performed in twenty-two patients. Out of twenty-five cases, seventeen cases were malignant, six were benign, and two cases were inadequate. FNAC was useful in the diagnosis of 83.3% of cases. Biopsy and/or cell block correlations were available in fourteen cases. In the malignant category, mediastinal invasion by either squamous cell carcinoma or adenocarcinoma constituted the highest number with eight (47%) out of seventeen cases. Among the nonneoplastic conditions, nonspecific inflammation was the most common cause with two cases (8%) out of total cases followed by one case each of tuberculosis, schwannoma, thymoma, and cystic lesion. CONCLUSION: USG or CT-guided FNAC is a safe, minimally invasive, and cost-effective procedure, which can provide a precise diagnosis in the mediastinal masses, and may obviate the need for an invasive surgical approach.

A High-Grade Undifferentiated Endometrial Stromal Sarcoma Presenting as Inversion of the Uterus: A Rare Case.

Endometrial stromal sarcoma (ESS) is a rare malignant tumor that constitutes about 0.2% of all uterine malignancies and 10% of uterine sarcomas. ESS is generally misdiagnosed as leiomyoma or endometrial polyp and typically discovered on histopathological examination postoperatively because of its rarity. Endometrial stromal tumors are composed of cells resembling normal endometrial stroma in its proliferative phase. The histologic diagnosis of the high grade is made if there is a high-grade sarcoma with a high mitotic index and nuclear anaplasia. The mean age of presentation of high-grade endometrial sarcoma is about 61 years with the most common presenting complaint is menorrhagia. The median overall survival for high-grade endometrial sarcoma is 53 months with optimal cytoreduction. A 49-year-old woman P2 L2 presented with nonspecific complaint of discharge and spotting per vaginum. In the present case, the provisional diagnosis by clinical findings as well as imaging was in favor of the inversion of submucous fibroid. Preoperative histopathological examination and immunohistochemistry confirmed the diagnosis of high-grade undifferentiated ESS. Haultain's operation followed by total abdominal hysterectomy and bilateral salpingo-oophorectomy was performed. The patient was referred to another center for radiotherapy. From there, she was lost to follow-up. Rarity of endometrial stromal tumor limits the clinician view to diagnose it preoperatively. We were fortunate to have preoperative histopathological diagnosis of ESS. Furthermore, as ESS is rare and undifferentiated stromal sarcoma is even rarer, literature is lacking on its optimal management. Hence, it is important for all clinicians to keep the high degree of suspicion for ESS while working up any case of abnormal uterine bleeding.

Giant cell reparative granuloma of the nasal cavity: a rare site of presentation with review of literature

Giant cell reparative granuloma (GCRG) was first described in the 1950s. It is an uncommon and benign reactive tumor that is believed to occur after trauma or inflammation. It most commonly occurs in the maxilla and mandible and rarely affects the nasal cavity. It is often seen in children and during the second to third decades of life, predominantly seen among females. Histopathologically, GCRG shows many osteoclast-like multinucleated giant cells scattered in a background of mononuclear stromal cells and spindle-shaped fibroblasts also associated with areas of hemorrhage. The distinction between GCRG and giant cell tumors (GCT)is crucial since both have a similar clinical and histological presentation, but both have different management. GCTs have malignant potential, may metastasize, and have a high rate of recurrence. Surgical excision is the mainstay therapy of GCRG to ensure a low rate of recurrence. Here we discuss two cases GCRG, both presenting as nasal mass.