128 Rapidly Proliferative Pilomatrixoma On the Eyebrow of A 7-Year-Old Boy – A Case Report

Pilomatrixoma or calcifying epithelioma of Malherbe is a benign tumour originating from pluripotent precursors of hair matrix cells. We present a paediatric patient with a rapidly enlarging eyebrow mass with a differential diagnosis of sebaceous cyst, pyogenic granuloma, or malignancy. A 7-year-old boy presented in primary care with a 0.5cm non-inflammatory nodule on his medial brow present for 2-3 months. History of previous trauma was not elicited and there were no features of bleeding or ulceration. It was then lanced, following diagnosis of an infected sebaceous cyst. Within weeks, the nodule underwent rapid proliferation, enlarging to 2cm in diameter. He was urgently referred to secondary care pending further investigation for possible trauma-induced pyogenic granuloma or malignancy. Upon presentation in secondary care, we observed a protruding erythematous and ulcerated mass, indurated in texture and adherent to overlying skin. The patient was submitted to excisional biopsy with a vertical elliptical approach to minimise distortion of the brow. Small, calcified deposits were observed in the tumour substance. Histologically, basaloid basophilic cells were predominant and mixed with ghost cells and foci of giant multinucleate cells, verifying diagnosis of a pilomatrixoma. Pilomatrixoma exhibits tendency towards mimicry of lesions such as epidermoid, sebaceous, dermoid cyst, pyogenic granuloma or even keratoacanthoma with a pre-operative detection rate as low as 11%. With a bimodal age distribution, arising in the first and sixth decades of life, this case highlights a need for a high degree of suspicion in young patients with careful clinical examination in order to aid diagnosis and prompt appropriate treatment.

Giant Papilloma on the Back of the Knee Joint - A Case Report

Papilloma is a benign tumour projecting above the surface of the skin. It grows from the epithelial tissue; develops as finger like fronds. Human contact with human papilloma virus (HPV) is one of the important causes for its occurrence. It feels rubbery and semisolid in consistency. Papilloma is a slow growing and long-lasting common tumor seen in various parts of the body like skin, breast, cervix, conjunctiva, etc. Its location on the exposed parts of the body like, around the face, neck, limbs, etc. causes much discomfort. Hence most of them prefer an early medical and surgical intervention to restore the cosmetic profile of the body to avoid growing physiopsychological discomforts. Clinical resemblance of any such swellings may require a meticulous examination and evaluation to differentiate them from other commonly seen external growths from the body surface; like sebaceous cyst, dermoid cyst, wart, haemangioma, neurofibroma, etc. One such clinical rare case of unusually large papilloma in an elderly lady aged about 65 years was presented with a swelling in her left popliteal region and excised under local anaesthesia, will be presented along with discussions. Human body is prone to show some solitary or multiple swellings on the inner or outer surface of the body. For the clinical diagnosis of a swelling, it is important for a clinician to know its source of origin. Swellings may arise from the skin, subcutaneous tissue, muscle, vessel, nerve, bone, etc. It is also important to consider whether it is a congenital or acquired defect or it is caused due to any trauma, or could be a mere inflammatory response which lasts temporarily.1 An abnormal growth of cells which grow more rapidly than other normal cells in the body are called neoplasms. They may be benign (harmless) or malignant (cancerous). Benign swellings are usually localized, may grow big without spreading or invading into other structures whereas malignant swellings can spread and invade the nearby tissues directly or through the blood or lymph nodes to different organs through metastasis, hence they need a thorough clinical evaluation. Soft tissue swelling especially in the young individuals often may be missed or delayed in the diagnosis of malignancy due to asymptomatic nature of the lesion with unfamiliar age. The nature of the swelling, its duration, location, and tissue of origin also matters in the final diagnosis. Hence it is important to differentiate a benign swelling from a malignant swelling at the earliest. 2

Frontalis associated intramuscular lipoma: a case report

<p>Lipomas are the most common benign mesenchymal tumours that are composed of adipose tissue. They can occur at any age and can arise in any location, but are more frequently found on the chest, arm, shoulder and thigh. We report a rare case of lipoma attached to the frontalis muscle in a 65 year old male patient. Clinical examination had revealed a 1.5×1.5 cm in size, firm, non-tender, mobile subcutaneous nodule on the right side of the forehead that gradually increased in size over 8 years. Differential diagnosis of lipoma, liposarcoma, epidermal cyst and sebaceous cyst of the forehead were considered. Non-Contrast computed tomography revealed it to be a solitary, localized, circumscribed nodule within the frontalis without any bony involvement. The nodule was surgically removed and the diagnosis of intramuscular lipoma was confirmed on histopathological examination. The postoperative healing was uneventful and one year follow-up did not show recurrence. The prognosis of the rare frontalis associated intramuscular lipoma is good and risk of recurrence is low provided there is complete removal.</p>

Pleomorphic Adenoma of the Submandibular Gland in a 10-Year-Old Child: A Case Report

We report the case of a 10-year-old girl with a painless slowly growing mass that had developed over the course of 2 years in the left submandibular area. Physical examination revealed a firm painless submandibular mass with no other associated signs. Ultrasound graphics were in favor of a sebaceous cyst. Fine-needle aspiration and magnetic resonance images (MRI) concluded to a pleomorphic adenoma of the submandibular gland. The patient underwent left submandibulectomy. Histopathological examination confirmed the diagnosis of pleomorphic adenoma arising from the submandibular gland. The postoperative course was uneventful. Pleomorphic adenoma of the submandibular gland represents a diagnostic and therapeutic dilemma in children. Preoperative evaluation, including MRI and fine-needle aspiration, is recommended. Total submandibulectomy is also recommended to minimize recurrences and to avoid malignant transformation.

Cutaneous cystic lesions: its clinicopathological correlation with emphasis on unusual findings.

Background: Cutaneous cysts are the most common lesions encountered in surgical practice withcosmetic and psychological concern to the patient. Aim: To establish the clinicopathologicalcorrelation of these lesions and also the importance of histological evaluation for the prevention ofmisdiagnosing a benign-appearing malignant lesion. Methods: A retrospective descriptive studywith data collected from archives of histopathology from January 2018 to December 2020 ofclinically diagnosed cutaneous cyst along with age, gender, location and histopathological evaluationwere analysed. Results: 88 cases that were clinically diagnosed as cutaneous cysts had a higherfemale proportion 52.3%. The most common clinical diagnosis is epidermal/ sebaceous cyst. 35.2%of cases were clinically diagnosed accurately but 64.8% of cases did not correlate with clinicaldiagnosis. 4 malignant lesions were misdiagnosed as benign cutaneous cyst clinically. Conclusion:Most often clinically diagnosed cutaneous cysts are not sent for histopathological evaluation which isa very important tool to confirm the diagnosis.

Metastatic Adenocarcinoma of the Lung Presenting as a Soft Tissue Mass

Lung cancer is the leading cause of cancer death in the United States, with more than 230,000 new cases, and approximately 150,000 deaths estimated for 2018. Lung cancer most commonly metastasizes to the brain, liver, lungs, bone, and adrenal system; however, there have been several cases of spread to soft tissues, with an incidence rate of approximately 0.75-9%. The objective of this case report is to highlight an unusual presentation of metastatic adenocarcinoma of the lung. In this case report, patient presented with a 3 × 3 cm soft tissue mass on the back. The mass was slowly growing but had become more painful and wished to have it excised. Preoperatively, the mass was suspected to be a sebaceous cyst but intraoperatively had deep attachments and other suspicious findings. Pathology had a positive immunoprofile for metastatic adenocarcinoma favoring a lung primary. Given this presentation of metastases, the prognosis is poor with a survival time decreasing to around 5 months. Overall, this case reinforces the importance of sending all soft tissue masses for final pathology with accurate labeling and the importance of immunohistochemical testing in aiding the identification of the primary.

Recurrent Cutaneous Adenoid Cystic Carcinoma of Forehead

Adenoid Cystic Carcinoma (ACC) is a malignant tumour more commonly seen in salivary glands and rarely arises from the skin as adnexal tumour. Cutaneous ACC is a rare malignant adnexal tumour of eccrine origin. It has an indolent course and rarely metastasizes. Hereby, authors report a case of 48-year-old male with complaints of swelling on right forehead present for the past four years. Clinical diagnosis of infected sebaceous cyst was made and excised with simple excision. The swelling reappeared within 15 days of first surgery. The cytological examination of the swelling revealed abundant cellularity with predominantly cohesive clusters of monomorphic population of cells centered around eosinophilic hyaline globules suggestive of ACC. Retrieval of previous biopsy report revealed diagnosis of ACC reaching the margins of excision, the report of which was neither collected by either operating surgeon nor by the patient. Histopathological examination revealed classical cribriform pattern of arrangement of tumour cells with perineural infiltration by tumour cells. Immunohistochemistry further confirmed the diagnosis. The present case report brings out the importance of clearance of surgical margins in malignant tumours, including skin adnexal tumours. It also highlights the importance of histopathological examination of benign looking skin adnexal tumours.

A Study on Postoperative Care in the General Surgery Department of a Tertiary Care Hospital

In our study we have attempted to assess and evaluate the rationality of drugs given during post-operative period using standard WHO indicators. A total of 602 patients were included with maximum number of patients in 20-40 and 40- 60 years’ age group. The most common diagnoses for admission were Sebaceous cyst (65), Hernia (52), Diabetic ulcer/ abscess (47) and Cholelithiasis (43). The most common procedures performed in our hospital were Excision biopsy (109), Incision & drainage (55), Wound debridement (48) and Laparoscopic cholecystectomy (39). 208 patients received general anaesthesia, 233 received local anaesthesia and 161 of them were given spinal anaesthesia. Maximum number of patients stayed for a period of 2-4 days. The common group of drugs prescribed were antibiotics (976), I.V. fluids (652), analgesics (652), gastrointestinal drugs (590) and antiseptics (328). The most common analgesics given were Paracetamol (385) and Tramadol (173). The most common antibiotics given were Cefotaxim (420), Metronidazole (451). An average of 6.12 drugs was prescribed per patient. Percentage of drugs prescribed by generic name was (21.3%). Percentage of antibiotics prescribed per prescription was 100%. Percentage of encounters with injection was 88.9%. Percentage of drugs from NLEM was 90.09%. To conclude, the duration of stay in the hospital, the post-operative treatment given and the average number of drugs given per encounter in our study is acceptable.The clinicians should be encouraged to prescribe generic drugs from the list of essential medicines. Antibiotic stewardship should be followed for facilitating the rationale use of antibiotics.