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Histopathological findings of solitary thyroid nodule: An institutional retrospective analysis
Harendra Kumar Gautam, Suredrendra Kumar Kanaujia, Vinod Kumar, Devendra Maurya, Shiromani Singh
July-December 2018, 1(2):37-40
Background: Thyroid swellings are commonly encountered in the surgical practice and accurate preoperative evaluation of thyroid disorder becomes mandatory for the proper management of the patients. Aims and Objectives: The aim of this study was to study the histopathological finding in patients of solitary thyroid nodule at tertiary center of Kanpur region. Materials and Methods: A total of 100 patients with solitary thyroid nodules were thoroughly examined clinically after taking detail history and fine-needle aspiration cytology. All the patients were subjected to surgery after preoperative preparation and anesthesia checkup. Thyroidectomy specimen was evaluated by histopathological examination. Results: Majority of the patients were between the age group of 21 and 40 years. Female:male ratio was about 5.6:1. Swelling in front of the neck was the most common presentation. Most common solitary thyroid swelling was the colloid goiter. The most common surgery performed was hemithyroidectomy. On histopathological examination, a total of 98 out of total 100 patients presented with benign lesions which included 66 patients of colloid goiter, 16 with follicular adenoma, 4 with lymphocytic thyroiditis, and 12 with adenomatous goiter. Two out of total 100 patients had malignant lesions. Among malignant lesions, papillary carcinoma was found in one patient and anaplastic carcinoma in one patient. Conclusion: The most common histopathological findings of solitary thyroid nodule were colloid goiter followed by follicular adenoma, adenomatous goiter and thyroiditis. Thyroid malignancy was very rare histopathological finding.
  4,493 633 -
Diagnostic issue and caveats of immunoreactivity for Ki67 in hyalinizing trabecular neoplasm with review of literature: A study of one case
Veer Karuna, Priya Gupta, Mamta Gupta, Kriti Grover
January - June 2018, 1(1):1-4
Few benign and malignant thyroid lesions share many histological features including papillary and trabecular pattern, hyalinized stroma, calcification, nuclear grooving and nuclear inclusion. Well formalin fixed right lobe hemithyroidectomy specimen was received. After processing, H and E stain was done. Immunohistochemical studies (TTF, Thyroglobuline, MIB-1) and special stain (Congo red) were done to make a definite diagnosis. The present case describes a relatively rare thyroid tumour – Hyalinizing trabecular tumour with its varied morphological features creating diagnostic difficulties and role of IHC in formulating definitive diagnosis.
  4,413 385 -
BRAF status in the variants of papillary thyroid carcinoma
Daphne Fonseca, Sudha S Murthy, Ravindranath Tagore, Vishal Rao, Chandrashekar S Rao, K V. V N. Raju, Hemant Kumar Nemade, Sundaram Challa
July-December 2018, 1(2):41-47
Aim: The aim was to study the BRAF status by immunohistochemistry (IHC) in the variants of papillary carcinoma thyroid and compare it with the clinicopathological parameters. Materials and Methods: All the thyroid carcinomas diagnosed during the period of January 2015–June 2018 were reviewed and classified according to the WHO 2017 criteria. The demographic and clinicopathological features were noted. Microarrays were prepared on 27 cases, including classic and variants of papillary thyroid carcinoma (PTC), poorly differentiated thyroid carcinoma (PDTC), and medullary thyroid carcinoma (MTC). IHC was performed with BRAF V600E by automated staining. The BRAF status was correlated with known prognostic markers. Results: There were 23 PTC, 3 PDTC, and one MTC. The PTC included seven classic, three solid, two each of microcarcinoma, infiltrative and encapsulated follicular variant, tall-cell variant (TCV), oncocytic and one each of diffuse sclerosing, nodular fasciitis-like stroma, and Warthin-like variants. BRAF positivity was seen in 44.44%, including 11 PTC and one PDTC. The positivity was 85.71% in classic and 31.25% in variants. The age (>45 vs. <45 years), gender (male vs. female), number of lesions (unifocal vs. multifocal), type of tumor (PTC vs. other tumors), subtype of PTC (classic PTC vs. variants), invasion (capsular vs. lymphovascular), and aggressive features (extrathyroidal extension vs. lymph nodal involvement) between BRAF positive and negative tumors were not statistically significant (Fisher's exact test at P < 0.05). Conclusion: BRAF status did not show correlation with known prognostic variables in classic as well as variants of PTC.
  4,260 531 -
Oral squamous cell carcinoma with myiasis
Sakshi Gupta, Arjun Agarwal, Cheena Garg, KY Giri, Archana Chaurasia
July-December 2018, 1(2):52-54
Myiasis is a rare condition that occurred with advanced ulcerated lesions of the oral cavity caused by the larvae in human tissue that evolve to a parasite and is commonly found in tropical countries. Poor oral hygiene is a primary cause for the growth of maggots leading to the development of myiasis. These cases are reported with chief complaint of pain and irritation in a localized area and diagnosed clinically based on the presence of the maggots. Treatment option is manual removal of maggots to cure the inflammatory process and prevent secondary infections. Here, we present a case of oral squamous cell carcinoma with myiasis diagnosed in a 50-year-old female patient.
  4,148 468 -
Oral mucosal melanoma: An enigma to the clinician
Krishna Sireesha Sundaragiri, Shikha Saxena, Chandni Shekhawat, Bharat Sankhla
July-December 2018, 1(2):48-51
Oral mucosal melanoma is a rare oral malignancy with well defined clinical presentation of a pigmented brown macular to nodular lesion. The careful histopathological examination along with immunohistochemistry of the biopsy specimen was helpful in identification of this noxious lesion. A clear distinction between management and prognosis of benign gingival lesions and rarer lesions exists. Thus every general dental practitioner should advocate a mandatory histopathological examination of the each and every gingival growth. We present a unique case of oral mucosal melanoma masquerading as a benign gingival growth without any clinical presence of pigmentation in a 58-year-old male patient.
  3,767 523 -
Cone beam computed tomography and detection of periodontal bone defects in patients with advanced periodontal disease indicated for periodontal surgeries
Abhishek Singh Nayyar
January - June 2018, 1(1):12-20
Context and Aim: Radiographs play an important role in periodontal diagnosis; however, one of the major limitations of the conventional radiological procedures is the presence of considerable overlapping of the overlying anatomical structures and lack of a clear three-dimensional information. Surgical exposure, although being able to evaluate the type and depth of the defect during surgery, provides very little time to the surgeon to plan for the type of procedure required for periodontal regeneration based on the information obtained during surgery. Recently, cone beam computed tomography (CBCT) has emerged as a lower cost alternative to the computed tomography (CT) with high-quality images and lower radiation exposure to the patients, though, in vivo studies, in this regard, are still scarce. The aim of the present study was to assess the efficacy of CBCT in the detection of periodontal bone defects in patients with advanced periodontal disease indicated for periodontal surgeries. Materials and Methods: The present cross-sectional study included patients with advanced periodontal disease indicated for periodontal surgeries. Bone defects were measured first with the help of CBCT software and then, during a surgical intervention using the standardized UNC-15 periodontal probe and compared. Statistical Analysis: Statistical analysis was done using SPSS version 18.0 (SPSS Inc., Chicago, IL, USA). Both the measurements were compared with the help of Student's t-test. P < 0.05 was considered statistically significant while P < 0.001 was considered highly statistically significant. Results: The palatal/lingual sites in anterior teeth which showed a mean CBCT value of 4.0444 mm and mean surgical value of 4.1822 mm revealed the mean difference to be statistically significant along with the distal sites which showed a mean CBCT value of 3.3667 mm and mean surgical value of 3.5217 mm (P = 0.001). The values, although in case of posterior teeth, were not found to be statistically significant. Conclusion: From the observations made from the present study, it could be concluded that CBCT provided good accessibility to visualize sites which were otherwise difficult to access during surgery. Furthermore, the bone density/volume could be detected precisely with the CBCT software which was otherwise not possible with the conventional methods.
  3,812 416 -
Dumb bell shaped conchal dermoid: Unique presentation
Garima Arora, Neena Kasliwal
January - June 2018, 1(1):21-23
Dermoid are common skin tumours. They are found commonly in head and neck areas. Dermoid cyst in region of auricle is extremely rare, we report a rare case of dumbbell shaped dermoid cyst located at the concha of auricle in a 2 year old female child. The child had presented with a mass both on external and internal aspect of concha which later turned out to be a dermoid.
  3,490 286 -
A rare case of isolated retro-orbital fungal granuloma
Mahmood Dhahir Al-Mendalawi
July-December 2018, 1(2):55-55
  3,274 416 -
Gorlin cyst in maxilla: A clinical and histological rarity
Abhishek Singh Nayyar
January - June 2018, 1(1):31-35
Gorlin cyst which is, also, recognised by the synonyms calcifying odontogenic cyst (COC), calcifying ghost cell odontogenic cyst, calcifying cystic odontogenic tumor (CCOT) and dentogenic ghost cell tumor, is a rare developmental lesion was first reported by Gorlin et al. in 1962. It was, later, renamed as calcifying cystic odontogenic tumor (CCOT) in the WHO classification devised in 2005 due to its histological complexity, morphological diversity and aggressive proliferation. Gorlin cyst was, later, re-named several times including Gorlin cyst, calcifying odontogenic cyst (COC), calcifying ghost cell odontogenic cyst, calcifying cystic odontogenic tumor (CCOT) and dentogenic ghost cell tumor. The present case report briefs a case of Gorlin cyst in a 21 year old female which was diagnosed during the diagnostic work-up.
  3,310 283 -
Fibroepithelial polyps of the head and neck
Ramiya Ramachandran Kaipuzha, Davis Thomas Pulimoottil, Satvinder Singh Bakshi, Suriyanarayanan Gopalakrishnan
January - June 2018, 1(1):24-27
Fibroepithelial polyps are benign polypoid lesions arising from the mesodermal tissue and are one of the most common cutaneous lesions, but are rare in the oral cavity and upper airway. Two cases are discussed here. A 40 year old male presented with cough of five months duration associated with an intermittent foreign body sensation in the throat. Examination revealed single smooth pinkish pedunculated mass hanging freely from the superior pole of the left tonsil. The patient underwent tonsillectomy and histopathological examination revealed features of fibroepithelial polyp. A 65 year old male chronic smoker presented with swelling in the mouth behind the upper teeth since two months. Examination of the oral cavity revealed a single, non-tender, firm, smooth pedunculated pink swelling just behind the upper incisor on the right side of hard palate; the mass was excised and found to be a fibroepithelial polyp. The diagnosis of fibroepithelial polyps is primarily by histopathological examination of the excised mass. The key to preventing the recurrence of that lesion is its surgical excision in toto along with elimination of the source of irritation that led to the lesion.
  2,990 370 -
Prevalence of pathologic findings in maxillary sinuses in asymptomatic patients using cone beam computed tomography
Abhishek Singh Nayyar
January - June 2018, 1(1):5-11
Context and Aim: Complications related to maxillary sinuses are often related to their anatomic and pathologic variations and their close approximation to the tooth roots. It, thus, becomes important to study these sinuses even in situations when the patients reporting for dental complaints are asymptomatic for the sinuses. In the present scenario, cone beam computed tomography (CBCT) has emerged as the standard imaging modality for bone and soft tissue abnormalities offering multiple views with thin sectioning. The aim of the present study was to detect the prevalence of pathologic findings in maxillary sinuses in patients who were asymptomatic for the sinuses using cone beam computed tomography (CBCT). Materials and Methods: CBCT scans of 150 patients between the ages of 18 and 70 years reporting for routine dental complaints were analyzed for detecting pathologic findings in the maxillary sinuses. Statistical Analysis Used: The data was analyzed using SPSS version 15.0 (SPSS Inc., Chicago, IL, USA). Distribution of the overall prevalence of pathologic findings according to age and sex were calculated using Chi-Square test while P value <0.05 was considered to be statistically significant. Results: Overall prevalence of pathologic findings was found to be 58% with the prevalence of mucosal thickening being 29.3%, polypoidal mucosal thickening, 36.7%, partial opacification with liquid accumulation, 2%, complete opacification, 0.7% and miscellaneous findings as 0.7%. Conclusion: The present study highlighted the clinical implications, dental pathologies might have, in relation to the maxillary sinuses underlying the significance of their accurate assessment in the perspective of dental and maxillofacial and ENT problems with a multi-disciplinary approach of treatment for the successful treatment of chronic sinus pathoses.
  2,943 389 -
A rare case of isolated retro-orbital fungal granuloma
Ramiya Ramachandran Kaipuzha, Davis Thomas Pulimoottil, Satvinder Singh Bakshi, Suriyanarayanan Gopalakrishnan
January - June 2018, 1(1):28-30
Aspergillus versicolor has been rarely associated with endophthalmitis and epicorneal aspergilloma. We report here the first case of retro-orbital fungal granuloma caused by Aspergillus versicolor. A 52 year old male presented with protrusion associated with pain and watering of the left eye for six months duration. Left eye examination showed axial proptosis and fundus examination revealed blurring of the nasal disc margin. Plain CT of orbits showed a retrobulbar intraconal lesion in the left orbit. The patient was taken up for endoscopic orbital and optic nerve decompression with debulking or retro-orbital mass under general anaesthesia. Culture on Sabaraoud's dextrose agar grew Aspergillus species. The postoperative period was uneventful and the patient was started on Oral itraconazole 100mg twice daily and over the course of two months the left eye proptosis reduced significantly. Successful treatment of aspergillosis requires prompt diagnosis and rapid institution of therapy. Endoscopic clearance of the disease combined with oral antigfungals is the appropriate modality of therapy.
  2,587 269 -
Pleomorphic adenoma of hard palate: An usual tumor in an unusual location with brief review of literature

January-June 2019, 2(1):1-4
Pleomorphic adenoma (PA) is the most common benign tumor affecting the major salivary glands, though infrequently it may arise from the minor salivary glands as well. Majority of tumors affecting the minor salivary gland are malignant. We report a rare case of minor salivary gland PA of the hard palate in a 40-year-old female patient who presented with painless swelling in the palatal region for 2 years affecting swallowing and deglutition. A brief review of literature is also presented here.
  1,640 145 -
Histopathological spectrum of scalp tumors: Analysis with review of literature
Monica Kumbhat, Leena Dennis Joseph, B Subalakshmi, V Vidhya
July-December 2019, 2(2):25-28
Purpose/Background: The scalp is the part of the body, which frequently presents with a wide variety of lesions, which may range from congenital, inflammatory, post traumatic, and neoplastic. Swellings and cysts are common occurrences. Both benign and malignant tumors are located in the scalp and correct diagnosis is needed for appropriate management. Materials and Methods: This is a retrospective study, where we reviewed surgically excised swellings in the scalp, over a duration of 6 years. The data were obtained from the records in pathology department, in a tertiary care hospital in South India and clinical inputs were obtained from the hospital records. These were categorized primarily into benign and malignant lesions. The benign lesions were further classified as cystic lesions, vascular lesions, epidermal proliferations, and skin adnexal tumors. The malignant lesions were sub categorized as primary or secondary (metastatic). Results: One hundred cases of histopathologically proven diverse cases of scalp swellings were included. Majority of them were benign, accounting for 77% with rest of them being malignant (23%). Among these 100 cases, 99 cases primarily originated in the scalp and only one case was a secondary tumor. Pilar cysts accounted for about 18 cases, of which 6 cases showed calcification. Vascular tumors and skin adnexal tumors played a major role. The most common malignant tumor was squamous cell carcinoma. Excision with clear margins was the mode of treatment for majority of the cases, with follow-up oncologist referral, when required. Conclusions: Recognition of the correct diagnosis aids in appropriate management of the patient, allaying the fears and concerns of the patient.
  1,543 156 -
Compound odontoma associated with a dentigerous cyst

January-June 2019, 2(1):12-14
Dentigerous cysts (DCs) and odontomas are lesions of odontogenic origin relatively common in the oral cavity with a rare recurrence after treatment. The purpose of this study is to present a case of association of odontoma with DC in the mandible of a young patient and to describe all cases published in English literature to date. A 16-year-old male patient presented with a well-defined unilocular radiolucent lesion associated with impacted mandibular right canine. Mesially, there was another lesion, mixed with small radiopaque structures, similar to dental structures surrounded by a radiolucent halo. The diagnosis of DC associated with compound odontoma was made. This case report associated with the literature review of other reports highlights that the association of DC with odontoma is rare and further studies are needed to investigate the probable etiology of this association.
  1,528 119 -
Biphenotypic sinonasal sarcoma: An infrequent neoplasm with classical clinical presentation and mimetic histology. Report of two cases

January-June 2019, 2(1):5-8
Biphenotypic sinonasal sarcoma (BSNS) is a rare low-grade sarcoma that occurs mainly in the upper sinonasal tract of middle-aged women. It exhibits a dual immunophenotype characterized by the expression of neural and myogenic markers. It is characterized by PAX3 rearrangement with various fusion partners, being MAML3 the most frequent. BSNS is a locally aggressive neoplasm, with frequent local recurrences but no metastasis reported. Here, we present the clinical, histological, immunohistochemical, and molecular findings of two new cases of BSNS that fulfill the canonical demographic, clinical, morphologic, and molecular criteria described for this infrequent entity.
  1,518 120 -
A case of well-differentiated liposarcoma of the larynx histologically indistinguishable from spindle cell lipoma

January-June 2019, 2(1):9-11
Correctly identifying atypical lipomatous tumors/well-differentiated liposarcomas (WDLs) can be exceedingly difficult, as they account for <0.5% of all laryngeal neoplasms. Diagnosis is further complicated by their morphologic similarity with other more benign lipogenic tumors, such as spindle cell lipoma. We describe a 63-year-old Caucasian man who presented with a left aryepiglottic mass clinically suspicious for a simple cyst. On excision, a frozen section diagnosis of benign fibrolipomatous lesion was reported. Permanent sections revealed an adipocytic neoplasm comprising cellular fibrosis and monomorphic spindle cells, histologically suggestive of a spindle cell/pleomorphic lipoma. Immunostains were positive for CD34 and negative for smooth muscle actin, desmin, and S-100 protein, also consistent with spindle cell/pleomorphic lipoma. However, amplification of MDM2 by fluorescence in situ hybridization confirmed the diagnosis of WDL. The case was reviewed by two soft-tissue pathologists, and they both favored the diagnosis of spindle cell lipoma until reviewing the relevant MDM2 result. The morphology and immunophenotype of WDL have previously been reported as closely related to that of spindle cell lipoma, and this case provides a striking example of how unmistakable these two entities can be on histologic examination alone.
  1,395 106 -
“Primitive myxoid mesenchymal tumor of infancy” - A rare childhood soft-tissue tumor of the mandible
Gittwa Vatsaraj Kottangal, Chaya Prasad, Annie Jojo
July-December 2019, 2(2):29-32
Primitive myxoid mesenchymal tumor of infancy (PMMTI) is an extremely rare soft-tissue tumor of childhood. We report a case of an 18-month-old male child diagnosed with PMMTI of the mandible. Till now <30 cases had been reported in the English literature. Histologically, the tumor consists of primitive spindle/polygonal cells dispersed in a myxoid background with delicate blood vessels. Immunohistochemically, tumor cells are positive for vimentin and negative for all other myoid, neural, epithelial, vascular, and neuroendocrine markers. This tumor was previously included under the diagnostic categories of congenital infantile fibrosarcoma or infantile fibromatosis. Increased awareness of this novel entity is a must as its biological and chemosensitive nature is vastly different from its differentials. Recent immunohistochemical stains and cytogenetic studies have helped to differentiate PMMTI from the other tumors of similar morphology.
  1,336 149 -
Malignant extrarenal rhabdoid tumor of parapharyngeal space: A rare presentation

January-June 2019, 2(1):15-17
Malignant extrarenal rhabdoid tumors (ERRTs) are very rare, highly aggressive tumors and are associated with a poor prognosis. They usually occur in young children. Diligent histopathological examination along with the use of judicious immunohistochemistry (IHC) panel is essential to diagnose this rare entity with distinct therapeutic implications. We report a rare case of ERRT with extension up to the skull base involving the right jugular fossa with thrombus in the right internal jugular vein.
  1,382 100 1
Retraction: Prevalence of pathologic findings in maxillary sinuses in asymptomatic patients using cone beam computed tomography

Ahead of print schedule 0, 0(0):0-0
  1,211 63 -
Monophasic (spindle cell) synovial sarcoma of mandible

January-June 2019, 2(1):18-21
Synovial sarcoma (SS) is a malignant soft-tissue tumor of uncertain histogenesis. It is a malignant mesenchymal tumor commonly affecting the extremities. Rarely, it is seen in areas without any relationship to synovial structures. Only 6%–7% of cases have been reported in the head-and-neck region. In head-and-neck region, it usually involves the hypopharynx, parapharyngeal space, and posterior pharyngeal region. A few cases in mandible have been described in literature. Hereby, we report a rare case of monophasic (spindle cell) SS of the mandible in a 17-year-old male with a previous history of tooth extraction along with an unhealed socket.
  1,050 88 -
Epithelial myoepithelial carcinoma arising in a pleomorphic adenoma
Daphne Fonseca, M Shankar, Chandrasekhara S Rao, Hemanth Kumar Nemade
July-December 2019, 2(2):33-35
Epithelial–myoepithelial carcinoma (EMC) is a rare and low-grade malignant tumor of the salivary gland. We present a case of a 37-year-old male with good general condition with swelling in the right preauricular region for the past 3 years measuring 3 cm × 2 cm with intact facial nerve. This patient had a history of preauricular sinus excision surgery 15 years ago. EMC mostly occurs in elderly females. Rarity of our case is in the fact that it has occurred in a middle-aged male with histologic evidence of preexisting pleomorphic adenoma.
  930 86 -
Cervical neuroblastoma in a 2-month-old child

January-June 2019, 2(1):22-23
  928 69 -
Infected nasolabial cyst: A rare entity with unusual presentation
Purnima Paliwal, Shashikant Singh, Jyoti Mishra, Devender Singh Chauhan
July-December 2019, 2(2):36-38
Cystic lesions of the anterior maxilla and ala of the nose are both odontogenic and nonodontogenic. Nasolabial cyst is an uncommon cystic lesion in this location, which clinically presents with progressive cystic swelling and nasal obstruction. Diagnosis is based on clinical/radiological findings and confirmed by histopathological examination of the excised cyst. Herein, we present a case report of nasolabial cyst in a 50-year-old female who presented with swelling over anterior maxilla.
  854 65 -