A Rare Case of Primitive Neuroectodermal Tumor of Tongue.

Primitive neuroectodermal tumor of the periphery is a rare entity and belongs to Ewing sarcoma family of tumors. It comprises 1% of all sarcomas and majority of these cases occur in the age group of less than 35 years. It is highly aggressive and patient often presents with distant metastasis leading to poor prognosis. Its characteristic features include t(11:22) translocation. A young female patient presented with growth in the tip of the tongue. Biopsy was done and histopathology using H&E and PAS staining revealed primitive neuroectodermal tumor. Immunohistochemistry helped to confirm the diagnosis. There was no evidence of distant metastasis at the time of presentation. The most accepted modality of treatment is wide surgical excision followed by chemoradiotherapy. The growth was excised and patient was treated with radiotherapy. The patient succumbed to liver metastasis following 10 months of treatment. Peripheral PNET usually affects the long bones like femur and in head and neck region, mandible is most frequently involved. This is a rare case of PNET of tongue with very few references from literature and hence makes it an interesting read.

Perioperative only versus extended antimicrobial usage in tympanomastoid surgery: a randomized trial.

OBJECTIVES/HYPOTHESIS: Antimicrobial prophylaxis is still a matter of debate in ear surgeries. Previous studies have focused on prophylaxis in middle ear surgery alone without inclusion of mastoidectomy. We therefore investigated efficacy of two regimes of antimicrobial prophylaxis in tympanoplasty with cortical mastoidectomy done for mild middle ear disease in chronic otitis media. STUDY DESIGN: Prospective, randomized, controlled, double-blind study. METHODS: Patients undergoing tympanoplasty with cortical mastoidectomy were included and randomized into two study groups. The group I patients received parenteral perioperative antimicrobials; only group II patients received additional extended oral antimicrobials for 8 days more postoperatively. Primary outcomes evaluated were postaural wound infection and graft success, assessed weekly until 1 month. Adverse events and length of hospital stay were evaluated as secondary outcome. RESULTS: Seventy-eight patients were randomized into group I (n = 39) and group II (n = 39). The two groups showed no difference in wound infection rate. The graft success rate in both the group was comparable (94.87% in group I and 97.44% in group II, respectively; P = 1.00). The length of hospital stay was significantly longer (P = 0.00001) in group II (3.05 [0.72], mean [SD]) as compared to group I (2.36 [0.49]). During the first postoperative week, a significantly higher incidence of gastrointestinal disturbances were observed in group II (19 [48.72%] as compared to 1 [2.56%] in group I, P = 0.00001). CONCLUSION: The present study shows that there is no need of extended antimicrobial prophylaxis for tympanoplasty with cortical mastoidectomy done for mild middle ear disease. An indiscriminate use of antimicrobials may lead to increase incidence of adverse events and prolonged hospital stay. LEVEL OF EVIDENCE: 1b.