scholarly journals Isolated Splenic Tuberculosis without Any Radiological Focal Lesion

2015 ◽  
Vol 2015 ◽  
pp. 1-2 ◽  
Author(s):  
Sunil Raviraj ◽  
A. Gogia ◽  
A. Kakar ◽  
S. P. Byotra
Keyword(s):  
Histopathological Examination ◽  
Bone Marrow Aspiration ◽  
Clinical Findings ◽  
Mantoux Test ◽  
Focal Lesion ◽  
Gene Probe ◽  
High Grade Fever ◽  
Splenic Tuberculosis ◽  
Unusual Phenomenon ◽  
Splenic Biopsy

Incidence of tuberculosis (TB) of spleen is a rare entity and isolated splenic tuberculosis is an unusual phenomenon, especially in immunocompetent individuals. We came across a case of 63-year-old male who presented with high grade fever, loss of weight, and generalized weakness of one-month duration. When physically examined, he had pallor and moderate nontender splenomegaly without any other significant clinical findings. He had pancytopenia, elevated ESR, and positive Mantoux test. Ultrasonography and CT scan of abdomen showed splenomegaly without any other relevant findings. Markers of connective tissue disorders and bone marrow aspiration and biopsy all were noncontributory for diagnosis. Hence splenic biopsy was done and sent for histopathological examination. Presence of caseation surrounded by epitheloid granulomas and Langerhans cells was suggestive of diagnosis as tuberculosis. And gene probe for the AFB (acid fast bacilli) came to be positive. No primary focus was present in either lungs or other organs. Patient improved clinically with antitubercular treatment.

scholarly journals Coronavirus disease 2019 infection and pituitary apoplexy: A causal relation or just a coincidence? A case report and review of the literature

2021 ◽  
Vol 12 ◽  
pp. 317
Author(s):  
Walaa A. Kamel ◽  
Mustafa Najibullah ◽  
Mamdouh S. Saleh ◽  
Waleed A. Azab
Keyword(s):  
Mr Imaging ◽  
Causal Relation ◽  
Histopathological Examination ◽  
Case Reports ◽  
English Literature ◽  
Clinical Findings ◽  
Oculomotor Nerve Palsy ◽  
Future Research ◽  
Endoscopic Endonasal ◽  
Transsphenoidal Resection

Background: Pituitary tumor apoplexy (PA) is an emergency condition caused by hemorrhage or infarction of the preexisting adenoma. Many factors are currently well-known to predispose to PA. However, during the period of coronavirus disease 2019 (COVID-19) pandemic, case reports of PA associated with COVID-19 infection have been sequentially published. To the best of our knowledge, four cases have been reported so far in the English literature. We herein report the fifth case of this association and review the pertinent literature. Case Description: A 55-year-old male patient with confirmed COVID-19 infection presented by progressive decrease in visual acuity and oculomotor nerve palsy. His medical history is notable for diabetes mellitus, hypertension, and pituitary macroadenoma resection 11 years ago. He was on hormonal replacement therapy for panhypopituitarism that complicated the surgery. Previous magnetic resonance (MR) imaging studies were consistent with enlarging residual pituitary adenoma. During the current hospitalization, computed tomography revealed hyperdensity of the sellar and suprasellar areas. MR imaging revealed PA in a recurrent large adenoma. Endoscopic endonasal transsphenoidal resection was uneventfully undertaken with near total excision of the adenoma and partial improvement of visual loss and oculomotor palsy. Histopathological examination demonstrated classic features of PA. However, his chest condition progressed and he had to be transferred to COVID-19 intensive care unit in the referring hospital where he was intubated and put on mechanical ventilation. One week later, the patient unfortunately passed away due to complications of severe COVID-19 pneumonia. Conclusion: We report the fifth case of PA associated with COVID-19 infection. Based on our patient’s clinical findings, review of the other reported cases, as well as the available literature, we put forth a multitude of pathophysiological mechanisms induced by COVID-19 that can possibly lead to the development of PA. In our opinion, the association between both conditions is not just a mere coincidence. Although the histopathological features of PA associated with COVID-19 are similar to PA induced by other etiologies, future research may disclose unique pathological fingerprints of COVID-19 virus that explains its capability of inducing PA.

scholarly journals The Confusion between Pustular Psoriasis and Acute Generalized Exanthematous Pustulosis as a Cause of Exfoliative Dermatitis: A Case Report

2021 ◽  
Vol 33 (3) ◽  
pp. 224
Author(s):  
Desiana Widityaning Sari ◽  
Cita Rosita Sigit Prakoeswa ◽  
Damayanti Damayanti ◽  
Sylvia Anggraeni ◽  
Menul Ayu Umborowati ◽  
...  
Keyword(s):  
Histopathological Examination ◽  
Clinical Manifestations ◽  
Clinical Findings ◽  
Pustular Psoriasis ◽  
History Taking ◽  
Exfoliative Dermatitis ◽  
Acute Generalized Exanthematous Pustulosis ◽  
Physical Examinations ◽  
Erythematous Skin ◽  
Exanthematous Pustulosis

Background: Pustular psoriasis and Acute Generalized Exanthematous Pustulosis (AGEP) are grouped under pustular diseases, in which their clinical manifestations are similar. Those diseases can lead to exfoliative dermatitis. Purpose:To evaluate a specific histopathological examination in differentiating Pustular Psoriasis and AGEP. Case: A 55-year-old woman presented with sudden redness and diffused scaly skin with multiple pustules and also fever. She had taken Cefadroxil 2 days before the scales and pustules appeared. Leukocytosis and histopathological examination results from biopsy supported the diagnosis of AGEP. The patient was then hospitalized and received steroid therapy. Within the first week of tapering off, the scales disappeared but the pustules increased. After such clinical findings, the histopathological examination results were revisited and reassessed. Thus, we considered changing the diagnosis to Pustular Psoriasis, and the therapy was switched to Methotrexate. The patient had a better outcome, and the pustules slowly disappeared entirely. Discussion: It is often difficult to differentiate between the pustules in pustular psoriasis and AGEP unless by thorough history-taking and physical examinations. AGEP is characterized by a widespread of pustules with an acute febrile onset; while pustular psoriasis is an acute variant of psoriasis where pustules are spread over erythematous skin and accompanied by high fever and leukocytosis. Conclusion: Histopathological examination is the gold standard for the establishment of pustular psoriasis diagnosis. The histopathological characteristics of pustular psoriasis and AGEP are difficult to differentiate. Therefore, we need detailed history-taking and physical examination to establish the diagnosis.

scholarly journals Cardiac tamponade secondary to hemorrhagic pericardial effiision in five dogs

2017 ◽  
Vol 56 (1) ◽  
pp. 9
Author(s):  
C. G. HATZIGIANNAKIS (Χ.Γ. ΧΑΤΖΗΓΙΑΝΝΑΚΗΣ) ◽  
M. E. MYLONAKIS (Μ. Ε. ΜΥΛΩΝΑΚΗΣ) ◽  
M. N. SARIDOMICHELAKIS (Μ.Ν. ΣΑΡΙΔΟΜΙΧΕΛΑΚΗΣ) ◽  
M. PATSIKAS (Μ. ΠΑΤΣΙΚΑΣ) ◽  
D. PSALLA (Δ. ΨΑΛΛΑ) ◽  
...  
Keyword(s):  
Ultrasound Examination ◽  
Histopathological Examination ◽  
Clinical Findings ◽  
Pericardial Fluid ◽  
Exercise Intolerance ◽  
Right Atrial ◽  
Atrial Wall ◽  
History Of ◽  
Cardiac Silhouette ◽  
The Right

A 7-year old female collie (case 1), a 3-year old male Caucasian-cross (case 2) and three male German shepherds with an age of 11 (case 3), 8.5 (case 4) and 10 (case 5) years, respectively, were admitted with a history of decreased appetite, depression, exercise intolerance, dyspnea and progressive abdominal enlargement, for the last 10 to 60 days. Poor body condition (5/5), muffled heart sounds (5/5), weak femoral pulse (5/5), ascites (5/5), inspiratory or inspiratory-expiratory dyspnea (5/5), pulsus paradoxus (2/5) and jugular vein distension (2/5) were the prominent clinical findings, while mature neutrophilic leukocytosis (3/5), lymphopenia (3/5), eosinopenia (3/5), hypoproteinemia (5/5) and increased urea nitrogen (3/5) were the most prevalent clinicopathologic abnormalities. Apart from a space-occupying lesion onto the right atrial wall of one dog (case 4), radiographic and ultrasound examination showed a globe-shaped cardiac silhouette (5/5), pericardial effusion (5/5), ascites (5/5) and pleural effusion (4/5). A large amount of non-clotting hemorrhagic effusion was drained during pericardiocentesis, resulting in rapid clinical recovery. Physical, chemical and cytological evaluation of the pericardial fluid was non-contributory in the differentiation between neoplastic and non-neoplastic causes of these effusions. Case 3 died 25 days post-pericardiocentesis; right atrium hemangiosarcoma and pulmonary metastases were documented on post mortem histopathological examination. Another dog (case 5) died of unknown causes one month after pericardiocentensis. On the contrary, dogs 1, 2 and 4 were still clinically healthy for a followup period of 16, 2 and 8 months, respectively.

Bilateral fungal infection inducing a serpiginous-like picture

2020 ◽  
pp. 112067212090872
Author(s):  
Alvaro Fernández-Vega González ◽  
Carlos Fernández-Vega González ◽  
Beatriz Fernández-Vega Sanz ◽  
María Teresa Peláez ◽  
Jesús Merayo-Lloves
Keyword(s):  
Visual Acuity ◽  
Fungal Infection ◽  
Inflammatory Diseases ◽  
Histopathological Examination ◽  
Clinical Findings ◽  
Blood Analysis ◽  
Retinal Pigmented Epithelium ◽  
Pigmented Epithelium ◽  
Laboratory Investigations ◽  
The Right

Purpose: To report the clinical findings of a patient who presented with an atypical bilateral fungal retinitis that was established by retinochoroidal biopsy. Methods: Case report. Results: A 56-year-old systemically healthy man presented with progressive visual loss in his left eye for 3 weeks. Visual acuity was 20/40 in the left eye, and 20/20 in the right eye and fundus examination showed macular retinal pigmented epithelium changes in his left eye. Over the following four months, his lesions progressed to serpiginous-like widespread retinal pigmented epithelium atrophy and his visual acuity decreased to 20/100, but no signs of ocular inflammation were found. Treatment with oral corticoids, valganciclovir and trimethoprim/sulfamethoxazole showed no efficacy. Blood analysis and cultures, laboratory investigations, and imaging tests were carried out looking for infectious and inflammatory diseases, but all tests were negative. Two months later, the patient presented with the same kind of lesions in the other eye (right eye), so he was subjected to retinochoroidal biopsy. Histopathological examination of specimen revealed the presence of intraretinal and choroidal fungal hyphae. Oral voriconazole was initiated achieving clinical remission, but no visual improvement was obtained. The source of the infection remains unknown since all tests results were negative. However, his profession as brewmaster might be related to the origin of the infection. Conclusion: Diagnosis of intraocular fungal infection can be challenging. Retinochoroidal biopsy may be useful to establish the diagnosis in those atypical cases with nonrevealing workup and inflammation localized to the retina.

scholarly journals Correlation of clinical and ultrasonographic features with histopathology in post-menopausal bleeding

2020 ◽  
Vol 9 (7) ◽  
pp. 2817
Author(s):  
Meenakshi Vempalli ◽  
Lopamudra B. John ◽  
G. Chandana
Keyword(s):  
Predictive Value ◽  
Histopathological Examination ◽  
Endometrial Thickness ◽  
Tertiary Care ◽  
Statistical Correlation ◽  
Clinical Findings ◽  
Postmenopausal Bleeding ◽  
Tertiary Care Centre ◽  
Post Menopausal ◽  
Sensitivity Specificity

Background: Postmenopausal bleeding is generally regarded as an ominous alarm of genital pathologies which requires a thorough evaluation clinically and pathologically to exclude carcinoma as the cause and ensure a benign pathology. This study aims at finding out whether clinical diagnosis and ultrasonographic features can be reliable parameters for the diagnosis of causes and whether the findings correspond with histopathology reports.Methods: This observational study was conducted in a tertiary care centre in Pondicherry between January 2018 to August 2019. 114 women were enrolled for whom detailed history taking and clinical examination was done. All the patients were subjected to transvaginal ultrasonography. Patients with clinically visible lesions on cervix and vulva were subjected to biopsy and the rest underwent fractional curettage and the sample was sent for histopathological examination. Finally, histopathology report was compared with clinical and ultrasonographic findings.Results: With endometrial thickness cut off of 4 mm, the sensitivity, specificity, positive predictive value and negative predictive value in predicting malignancy by ultrasonography were 100%, 12.3%, 4.5% and 100%. Histopathology showed atrophic endometrium (43.8%), endometrial hyperplasia (8%), endometrial polyp (7.9%) and endometrial carcinoma (3%). Clinical and ultrasonographic findings did not show any statistical correlation with histopathology.Conclusions: Authors conclude that clinical findings and ultrasonographic features do not correlate with histopathology in cases of postmenopausal bleeding for which atrophic endometrium was the commonest etiology. However, ultrasound should be done routinely before endometrial sampling as the sensitivity for predicting malignancy was 100% for endometrial thickness cut off of 4 mm.

scholarly journals Tuberculosis of Sphenoid Sinus: Report of Two Cases

2020 ◽  
Vol 10 (01) ◽  
pp. 42-45
Author(s):  
Vadisha Srinivas Bhat ◽  
Samatha K. J. ◽  
Devika T. ◽  
Shrinath D. Kamath P. ◽  
Rajeshwary Aroor ◽  
...  
Keyword(s):  
Endoscopic Sinus Surgery ◽  
Sphenoid Sinus ◽  
Histopathological Examination ◽  
Clinical Findings ◽  
Sinus Surgery ◽  
Definite Diagnosis ◽  
Radiological Appearance ◽  
Antituberculosis Treatment

AbstractIsolated lesions of the sphenoid sinus are uncommon and difficult to diagnose. In the absence of characteristic clinical findings, the diagnosis of such lesions depends mainly on imaging. However, as radiological appearance cannot provide the clinician with a definite diagnosis, histopathological examination of the specimen is mandatory for the diagnosis. Endoscopic sinus surgery has been an excellent approach for diagnosis as well as treatment of isolated sphenoid sinus lesions. The disease can be effectively treated by antituberculosis treatment. We report two cases of tuberculosis involving the sphenoid sinus only.

scholarly journals Incidental discovery of multiple myeloma, presenting as an amyloid tumor with plasmacytic elements of the thoracic wall

2015 ◽  
Vol 53 (3) ◽  
pp. 267-272
Author(s):  
Oana Şerban ◽  
A. Achim ◽  
Laura Irina Poantă
Keyword(s):  
Multiple Myeloma ◽  
Bone Marrow ◽  
Serum Proteins ◽  
Histopathological Examination ◽  
Bone Marrow Aspiration ◽  
Thoracic Wall ◽  
Light Chains ◽  
Bone Lesions ◽  
Al Amyloidosis ◽  
Contrast Enhanced Ct

AbstractMultiple myeloma is characterized by monoclonal proliferation of bone marrow plasma cells causing multiple bone lesions and overproduction of a monoclonal protein (M-protein) that could deposit in tissues (amyloidosis). Dissemination of the multiple myeloma outside the bone is rare.We present a case of a 76 years old woman presenting with dry cough. Chest X-ray showed a giant tumor of the upper right lung. Contrast enhanced CT revealed a tumor that most probably originated from the structures of the thoracic wall. The transthoracic biopsy was inconclusive. The tumor was resected and the histopathological examination showed amyloid tumor of the thoracic wall with plasmacytic elements and lambda light chains deposits. A bone marrow aspiration was performed that found diffuse plasmacytic infiltrate of 20-60% and the serum proteins electrophoresis with immunofixation revealed elevated IgA and lambda light chains. The patient was diagnosed with IgA and lambda light chains multiple myeloma with consequent AL amyloidosis presenting as thoracic mass.

scholarly journals Spindle cell oncocytoma of the pituitary gland

2019 ◽  
Vol 131 (2) ◽  
pp. 517-525 ◽  
Author(s):  
Alexandra M. Giantini Larsen ◽  
David J. Cote ◽  
Hasan A. Zaidi ◽  
Wenya Linda Bi ◽  
Paul J. Schmitt ◽  
...  
Keyword(s):  
Pituitary Gland ◽  
Spindle Cell ◽  
Histopathological Examination ◽  
S100 Protein ◽  
Residual Tumor ◽  
Pituitary Hormones ◽  
Postoperative Management ◽  
Clinical Findings ◽  
Thyroid Transcription Factor 1 ◽  
Spindle Cell Oncocytoma

OBJECTIVEThe authors report the diagnosis, management, and outcomes of 6 cases of spindle cell oncocytoma (SCO) in an effort to guide clinical diagnosis and management of these uncommon lesions.METHODSThis study is a retrospective review of cases involving adult patients who underwent resection of pituitary lesions at the authors’ institutions between January 2000 and October 2017. The authors identified patients with histopathological confirmation of SCO and collected clinical data, including preoperative, perioperative, and postoperative management, complications, and outcomes.RESULTSSix patients with SCO were identified. Clinical findings at initial presentation included visual disturbances, dizziness, and headache. All patients underwent resection. Four resections were initially performed by the transsphenoidal approach, and 2 resections were performed by craniotomy at an outside institution with subsequent transsphenoidal reoperations. Neither necrosis nor increased mitotic activity was seen in the tumor samples. All samples stained positive for S100 protein and thyroid transcription factor 1 and negative for glial fibrillary acidic protein and pituitary hormones. Five of the samples stained positive for epithelial membrane antigen. The average MIB-1 index was 8.3% (range 2–17). Postoperatively, 3 of the 6 patients received further treatment for progression of residual tumor or for recurrence, 2 have stable residual tumor, and 1 has had no recurrence after gross-total resection. Two patients developed postoperative complications of transient sixth cranial nerve palsy and diplopia. There were no other complications.CONCLUSIONSSCO poses both a diagnostic and therapeutic challenge. These tumors are often initially misdiagnosed as nonfunctional pituitary adenomas because of their sellar location and nonspecific symptomatology. Postoperatively, SCO must also be distinguished from other neoplasms of the posterior pituitary gland through histopathological examination. Resection of SCO can be challenging, given its highly vascular and adherent nature. Long-term follow-up is critical, as the tumor is associated with higher recurrence and progression rates compared to other benign neoplasms of the sella.

scholarly journals Tubercular otitis media: an under diagnosed entity

2016 ◽  
Vol 3 (1) ◽  
pp. 82 ◽  
Author(s):  
Abhishek Maheshwari ◽  
Rajlaxmi Panigrahi
Keyword(s):  
Otitis Media ◽  
Histopathological Examination ◽  
Diagnostic Delay ◽  
Chronic Otitis Media ◽  
Final Diagnosis ◽  
Clinical Findings ◽  
Mycobacterium Tuberculosis Infection ◽  
Mycobacterial Culture ◽  
Anti Tubercular Therapy ◽  
A Prospective Study

<p class="abstract"><strong>Background:</strong> Tubercular otitis media (TOM) is a well described rare entity in literature. Its characteristic diagnostic delay leads to severe irreversible complications. Diagnosis is much more difficult when it co-exists with aural cholesteatoma. Its Actual incidence is thought to be much more, than what is reported in literature. This study was carried out to establish TOM as an under diagnosed entity and to study its various presentations<span lang="EN-IN">. </span></p><p class="abstract"><strong>Methods:</strong> A prospective study was performed in 617 cases (both recurrence and new) of chronic otitis media who gave a fully informed consent, for being investigated for a probable diagnosis of TOM, based on history and clinical findings. Histopathological examination of the granulation tissue retrieved during biopsy/mastoid exploration surgery and mycobacterial culture of the aural discharge was performed in all cases. A final diagnosis was made with either of tests being reported as positive for mycobacterium tuberculosis infection. All confirmed cases were treated with a 6 month course of anti-tubercular therapy<span lang="EN-IN">.  </span></p><p class="abstract"><strong>Results:</strong> Diagnosis of TOM was confirmed in 12 cases. M:F ratio was 1:1.4. Cholesteatoma was found to co-exist in 4 cases (33.33%). A positive histopathology report was obtained in 11 cases (91.67%) while the mycobacterial culture yielded growth in 3 cases (25%) only. Canal wall down mastoidectomy was performed in 9 cases. In all cases, a follow-up with a 6 months course of anti-tubercular therapy gave satisfactory healing with no complications<span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> The incidence of TOM, a potentially dangerous entity is on a rise. Role of surgery is crucial in procuring tissue for histopathological and bacteriological examination.  It is a curable disease if diagnosed in time with early institution of anti-tubercular therapy<span lang="EN-IN">.</span></p>

scholarly journals Uncommon Location of Lipoma: Extraluminally Vagina

2020 ◽  
Vol 48 ◽  
Author(s):  
Baris Guner ◽  
Nevzat Saat ◽  
Mustafa Usta
Keyword(s):  
Surgical Approach ◽  
Histopathological Examination ◽  
Subcutaneous Tissue ◽  
Surgical Techniques ◽  
Clinical Findings ◽  
Female Reproductive Tract ◽  
Benign Tumors ◽  
Vaginal Mucosa ◽  
Blunt Dissection ◽  
Vaginal Tissue

Background: Lipomas are defined as a soft mass of well-differentiated adipose cells among mesenchymal tumors. Considering the localization of lipomas, these masses are commonly seen in subcutaneous tissue. The female reproductive tract is a rare site for development of lipomas and clinical findings appear depending on the size and localization. The connection of the mass with the vagina lumen causes different clinical findings. Intraluminal tumors protrude and arise from the vulva, while extraluminal tumors lead to perineal swelling. This case describes clinical, ultrasonographic, histological examination, and surgical management of extraluminal vaginal lipoma.Case: The present study reports a case of extraluminal vaginal lipoma in a 10-year-old Pitbull crossbred presented with anamnesis of a protruded tissue from the vulvar lips and dysuria following 6-month swelling in the perineum. Clinical examination revealed that the swelling was obvious and localized mostly on the lower left side of the perineum and the vaginal mucosa was protruded from the vulvar lips due to a mass. By vaginal palpation, the mass was not associated with the vaginal mucosa. The mass was located in the perivaginal region and transvaginal ultrasonography revealed a hypoechogenic mass. Based on clinical and ultrasonographic findings, surgery was recommended. The mass was adherent to the serosa of the vagina and it did not enclose the vaginal mucosa. Excision of mass was performed with careful blunt dissection avoiding any urethral disruption and periurethral tissues. After the mass was determined to be extraluminal, there was no need for excision of the vaginal tissue with the mass during operation. Using histopathological examination the mass was identified as a lipoma composed of adipocytes. In addition, ovariohysterectomy was not recommended following the diagnosis of vaginal lipoma.Discussion: Lipomas uncommonly can be localized in unpredicted rare areas such as vagina and vulva in older bitches. Although the majority of reported benign tumors in dogs recommend the surgery, medical treatment including the steroid injections is the other option to limit the lipomas. Considering the vaginal tumors, the surgical approach is also planned as laparotomy since leiomyomas are more common than lipomas. This approach partially results from the adherence of tumors to vaginal tissue. In addition, the location of the mass together without the adjacent tissue damage depending on whether it is intraluminal or extraluminal would make complete tissue removal. In previous reports, while symptoms such as perineal hernia of the lipoma were emphasized, the connection of the lipoma with the vaginal lumen was not evaluated as a significant factor determining the surgical approach. The mass was not connected to the vaginal mucosa and it was determined as extraluminal lipoma in the present study. Mass excision was performed by blunt dissection, avoiding urethral disruption and periurethral tissues. Unlike the most common approach in leiomyomas, this report did not require a total vaginectomy to remove the mass from the vagina. The ovariohysterectomy was not needed to be performed in the present study as in intraluminal vaginal tumors. It was believed that adhesions of lipoma with vaginal lumen is a determining factor in the combination of surgical techniques such as episiotomy and/or ovariohysterectomy. Lipomas should be considered among the tumors in the vaginal region of dogs brought with the complaint of swelling in perineum and protrusion of vaginal tissue.

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