Chronic Invasive Fungal Granuloma-A Diagnostic Dilemma in an Immunocompetent Host.

INTRODUCTION: Invasive fungal sinusitis, though considered to be rare entity, is nowadays frequently encountered, not only in immunocompromised patients but also in immunocompetent patients. The changing prevalence towards immunocompetent hosts is due to the indiscriminate usage of broad spectrum antibiotics, steroids, and immunosuppressive drugs. Diagnosing invasive fungal sinusitis should not pose any difficulty to both the clinician [a whitish colour secretion in elderly Diabetics, and CT Scan PNS showing concretion in the sinus along with destruction of the surrounding bone] and to the pathologist; however, when the invasive fungal sinus infection presents in a form of a granuloma then its diagnosis imposes a challenge to medical professionals. CASE REPORT: We are presenting a case study,which consists of 3 cases of chronic invasive fungal sinus infection.Two patients were treated for tuberculoma and had completed a course of Anti Koch's Treatment and one patient was given a trial of broad spectrum antibiotics and steroids.Eventually all cases were diagnosed as a chronic invasive form of fungal granuloma (CIFG). CONCLUSION: CIFG of the paranasal sinuses is seen in immunocompetent hosts, especially those that are in the 2nd and 3rd decades of their lives. Gradually progressive proptosis is the primary presenting symptom. MRI scanning is a better imaging modality compared to CT scanning. Routine H&E staining may prove inadequate and special stains such as the GMS stain should be employed in the slightest doubt of a fungal aetiology. A team approach towards patients is paramount for early diagnosis and timely medical and surgical intervention.

Late-onset schizophrenia with isolated cavum vergae: Case report and literature review.

Cavum septum pellucidum (CSP) and cavum vergae (CV) have separately and together been associated with an increased risk of neurodevelopmental disorders and psychosis; however, there is little literature on the psychopathological significance of isolated CV, and no previous report of isolated CV in late-onset psychosis. We describe an 80-year-old woman who presented with a 1-month history of psychotic symptoms qualifying for a diagnosis of schizophreniform disorder. Physical (including neurological) examination, bedside cognitive testing, and laboratory investigations were all within normal limits. A magnetic resonance imaging scan of the brain revealed an insignificant CSP with prominent CV. The patient showed almost complete recovery from psychosis after 4-6 weeks of treatment with quetiapine (200 mg/day). She maintained improvement with this medication at an 18-month follow-up; medication taper was associated with re-emergence of hallucinations. We briefly discuss CSP and CV in the context of vulnerability to psychosis. We examine whether isolated CV is a benign and incidental finding versus a biological risk factor for neuropsychiatric illness. We suggest specific studies to resolve the uncertainty.

Microcystic adenoma of pancreas: a case report.

Microcystic adenomas of the pancreas are rare benign neoplasms that occur most frequently in elderly females. Characteristically, the tumors have a spongy gross appearance and are composed of innumerable cysts lined by flat, and cuboidal cells which are rich in glycogen. They commonly present with abdominal discomfort or pain. In this case report, we present a cystic neoplasm of pancreas in a 65-year-old lady who clinically presented with discomfort in the abdomen and hyperglycaemia. Proximal pancreatectomy was done. Histopathological examination of surgical specimen confirmed the diagnosis of "Microcystic Adenoma ofPancreas". Despite of the rarity, microcystic adenoma should kept in the mind as the differential diagnosis of cystic lesions of pancreas.

Acute basophilic leukaemia: a case report.

Acute basophilic leukaemia is an uncommon form of acute leukaemia, rarely occurring as de novo disease. Due to rarity of the disease, consistent diagnostic criteria for the identification of this entity still remain the topic of discussion. Immunophenotypic profile, electron microscopy and cytogenetic analysis in addition to morphological features, are said to be highly desirable for correct identification of this entity. In set-up like ours, where such facilities are either not available or not in reach of the patients due to financial constraints, morphological features and simple technique like demonstration of metachromasia in blasts with toluidine blue stain remain the most useful diagnostic tool for identification of this rare condition. We present a case of acute basophilic leukaemia with (11q23)-MLL gene rearrangement, in an 18-year-old male with review of literature and discussion of diagnostic criteria.

Cervical thymic cyst: a case report.

Cervical thymic cysts are rare benign lesions. It should be considered in the differential diagnosis of cervical cysts in paediatric age group. This paper presents a case of a 6 years male child who presented with gradually increasing painless mass on right side of neck. Surgical excision was done. Histopathological study revealed features diagnostic of thymic cyst. It was clinically diagnosed as branchial cleft cyst. Though rare, thymic cysts should be included in the differential diagnosis of neck masses, especially in children.

Benign fibrous histiocytoma of bone: a case report.

Benign fibrous histiocytoma (BFH) occurs commonly in soft tissues with very few cases of BFH of bone on record. We report a case of BFH of tibia in fifty year old male who presented with supracondylar fracture femur due to trivial fall and a brief review of literature.

AIDS related kaposi's sarcoma.

A case report of a 22-year-old HIV-infected heterosexual man with Kaposi's sarcoma is described. The need for high index of suspicion and new mode of therapy are discussed.

Churg Strauss syndrome-clinicopathological aspects--report of a case.

An elderly person presented with exertional dyspnoea, cough, rhinorrhea and multiple swelling in submandibular region. This case was found to have marked eosinophilia with upper, as well lower respiratory tract involvements. Erroneous treatment patient received in past for pulmonary tuberculosis without any beneficial result. Open lung biopsy was undertaken, revealed evidence of vascultitis and perivascular inflammatory changes. The case findings and histopathological discussions are reviewed briefly.

Autosomal recessive polycystic kidney disease (ARPKD)--a report of two cases.

Autosomal Recessive Polycystic Kidney (ARPKD) is a very rare entity (1 in 15,000 live births) and mostly not compatible with life. Early diagnosis and genetic councelling may help prevent such births. Two interested cases are presented.

Carotid body paraganglioma with coexistent pheochromocytoma in childhood.

A male child aged six years presented with a swelling in neck and hypertension. He was diagnosed to have and operated for Carotid body paraganglioma with Coexistent pheochromocytoma. Hypertension persisted even after excision of both the tumours which could be controlled with anti-hypertensive agents. The case is discussed with review of literature.