Sphenochoanal polyp

Sphenochoanal polyp are rare tumours arising from sphenoid sinus. The main presenting complain is gradually progressing nasal obstruction. Sphenochoanal polyp mimics antrochoanal polyp clinically. To differentiate it from antrochoanal polyp, diagnostic nasal endoscopy, computer tomography and magnetic resonance imaging of the paranasal sinuses are the investigation of choice. Functional endoscopic sinus surgery is the line of treatment.: A 33years old female presented with right nasal obstruction since 2 years. On Diagnostic nasal endoscopy polypoidal mass was seen partially obliterating the right nasal cavity not arising from middle meatus. CT scan showed polypoidal mass obliterating the nasal cavity, choana and Sphenoid sinus. It was completely excised by functional endoscopic surgery.We present this rare case to highlight the use of diagnostic nasal endoscopy and Computed Tomography in the diagnosis and treatment of Sphenochoanal polyps

A child’s mysterious ear

<p>Foreign body in ear is an emergency encountered by an otolaryngologist and if not removed it can lead to serious complications. Most commonly foreign body in ear is lodged in external auditory canal while it’s rare to find it in middle ear. We report a case of foreign body in the middle ear in a 3-year-old child who presented to us with chronic discharging ear who was then suspected to be unsafe ear and so was taken up for exploration under microscope. A pink polypoidal mass arising from middle ear mucosa was found and following its removal- to our surprise; a blackish rubbery debris filling the middle ear cavity and attic area along with embedded foreign body was extracted. We conclude that pediatric patients with chronic ear discharge not responding to antibiotics should raise a suspicion of FB in the middle ear and explored timely.</p>

CASE REPORT: PLACENTAL POLYP PRESENTING AS A CASE OF SECONDARY POSTPARTUM HAEMORRHAGE

Placental polyp is one of the rare diseases that can affect women after delivery or abortion for indenite period which forms a polypoidal mass in the uterus.1 The incidence of placental polyp is less than 0.25% of all pregnancies.2 The case report is of a 41 year old woman, G8 P6L6 A1 who presented on postpartum day 19 and 30 with secondary postpartum haemorrhage. She underwent check curettage on postpartum day 19 and was discharged. And had to undergo emergency hysterectomy on postpartum day 32 as she presented in shock due to secondary postpartum haemorrhage and the histopathologic ndings were compatible with a placental polyp. Placental polyp can be missed on ultrasound and blind procedure like curettage and histopathology gives a conrmatory diagnosis. In our study, the diagnosis was conrmed by histopathology.

Uterine carcinosarcoma: a rare cause for postmenopausal bleeding

Uterine carcinosarcoma is a rare aggressive tumor also known as Malignant Mixed MullerianTumor. Prognosis is poor with 30-40% having extrauterine involvement at the first presentation and over 10% with distant metastasis. The primary treatment is surgery, along with radio-chemotherapy. We report a case of uterine carcinosarcoma in a 65 y para four lady who presented with blood mixed discharge per vagina for one month and polypoidal mass protruding through the cervical os. Endometrial biopsy showed carcinosarcoma. She was managed with surgery. She received adjuvant chemotherapy paclitaxel and carboplatin. There was no recurrence at six months follow-ups.

Carcinosarcoma Stomach with Biphasic Nodal Metastasis: A Rare Entity

Gastric carcinosarcoma is an extremely rare, aggressive, biphasic tumour composed of a mixture of carcinomatous and sarcomatous elements. Clinical symptoms and imaging studies of carcinosarcoma are not different from that of carcinoma. Biopsy of the lesions may not include both components. Thus, a diagnosis of carcinosarcoma is often rendered in surgical specimens. Immunohistochemistry will help to identify the various components. The relative proportion of the carcinomatous and sarcomatous elements is variable. One of the components may dominate the histologic picture. The common carcinomatous component described is adenocarcinoma with rare cases, showing neuroendocrine and squamous elements. The sarcomatous elements include spindle cell sarcoma which was Not Otherwise Specified (NOS), leiomyosarcoma, fibrosarcoma, osteosarcoma, chondrosarcoma, liposarcoma, undifferentiated sarcoma, myxoid sarcomas, and rhabdomyosarcoma. Herein, the authors are reporting the case of a 62-year-old female patient who presented with abdominal pain and vomiting of three-month duration. Endoscopic examination revealed a large polypoidal mass lesion in the body of stomach. Subtotal gastrectomy was done which showed large polypoidal mass lesion measuring 12×9.5×6 cm. Histopathological examination revealed a biphasic neoplasm with close intermingling of malignant epithelial and mesenchymal elements. Carcinoma component showed glandular, squamous and neuroendocrine areas. The sarcomatous component was spindle cell sarcoma, NOS. On immunohistochemical examination, epithelial component showed cytokeratin positivity. The neuroendocrine component was positive for synaptophysin, chromogranin A and CD56. The p40 positivity noted in the squamous component. The mesenchymal component showed positivity for vimentin. The nodal metastasis showed admixture of carcinoma (glandular and squamous components) and sarcoma.

Embryonal Rhabdomyosarcoma in Middle Ear: A Rare Case Report

Rhabdomyosarcoma (RMS) in middle ear and mastoid are uncommon. Presentation of RMS in these sites include purulent or blood stained discharge, polypoidal mass and granulation tissue. Clinical diagnosis may be delayed due to similar presentation as Chronic Suppurative Otitis Media (CSOM). Authors herein report a case of six-year-old male patient, who presented with a blood stained discharge from right ear for 15 days. On otoscopic examination, a polypoidal mass in external auditory canal was identified. A history of ruptured right tympanic membrane with occasional discharge for two years had been given. Clinical diagnosis of CSOM with aural polyp had been made. Radiographically, it was a soft tissue lesion with poorly defined margins. There were no bony erosions with minimal collection in right middle ear cavity. On routine histopathological examination diagnosis of round cell tumour had been made. On Immunohistochemistry (IHC), tumour was immunoreactive for desmin and vimentin, while negative for Cytokeratin (CK), Leukocyte Common Antigen (LCA), chromogranin and synaptophysin. Tumour was diagnosed as RMS (Embryonal type). This case report shows importance of early diagnosis of RMS in middle ear, which is often delayed and misdiagnosed as CSOM. Delayed diagnosis may lead to, facial nerve involvement, local meningeal involvement and distant metastasis. Histopathological examination and IHC e.g., desmin positivity are the mainstay of diagnosis.

Endoscopic resection of a giant symptomatic Brunner’s gland hamartoma of duodenal bulb

Brunner's gland hamartoma is a very rare benign tumor arising from the Brunner’s gland of duodenum and is usually asymptomatic, but may present with the symptom of duodenal obstruction or upper gastrointestinal bleeding due to ulceration from the tumor, requiring endoscopic or surgical resection. In our study, we report the case of a 57 year-old male who presented with pain over epigastrium, recurrent vomiting, black stool and dizziness with a lowering of hemoglobin up to 7.5 gm/dl. The blood transfusion was done to raise the hemoglobin. The upper gastrointestinal endoscopy revealed a giant submucosal polypoidal mass with a thick short stalk in duodenal bulb causing almost complete obstruction of the lumen of duodenum and there was a superficial ulceration on the under-surface of the mass. The endoscopic ultrasound revealed a submucosal lesion arising from the echo layer three. The computed tomography of abdomen showed that the polypoidal mass was confined to the duodenal lumen with no significant lumphadenopathy and normal biliary and pancreas. The endoscopic polypectomy was attempted, but the lesion was too large to grab the polyp as a whole with the conventional snare. Hence, the repeated partial snare polypectomies were done, followed by submucosal dissection to ensure the complete removal of the mass. There were no complications after the procedure. The histopathology examination of the duodenal mass confirmed the diagnosis of Brunner’s gland hamartoma and showed the presence of Helicobacter pylori as well. The endoscopic treatment of giant Brunner’s gland hamartoma avoided the need of unnecessary more invasive surgical procedure.

Actinomycosis of maxillary antrum presenting as nasal polypi: a rare case

<p class="abstract">Actinomycosis is a rare anaerobic bacterial infection that presents in the form of cervicofacial, pulmonary, thoracic and abdominopelvic infections. It is usually caused by <em>Actinomyces israelii </em>which are a part of normal flora of aerodigestive tracts. They are opportunistic pathogens and cause infections which have odontogenic origin in oral cavity. Cervicofacial actinomycosis accounts for more than half of the cases and commonly affects the mandible. We are reporting a case of actinomycosis of left maxillary antrum presenting as a nasal polypi in a young man. He had presented with nasal discharge and yellowish crusts from left nasal cavity. Diagnostic nasal endoscopy revealed yellowish polypoidal mass arising from the left middle meatus. CT PNS showed soft tissue density mass measuring 3.7×4.3×4.1 cms in left maxillary antrum extending through and obliterating osteomeatal complex extending into left ethmoidal sinus. Patient underwent Functional endoscopic sinus surgery. The yellowish polypoidal mass in left nasal cavity was attached to the floor of the maxillary antrum by a thin stalk and had filled up the antrum. Histopathology of the specimen revealed inflammatory polyp with actinomycosis. Patient had an uneventful recovery and was put on long term antibiotics and regular follow up.</p>

Case of Large Brunners Gland Adenoma

A 23-year-old man was admitted to the surgical ward with a two-month history of epigastric pain, abdominal discomfort, nausea and frequent bouts of vomiting. The Complete Blood Count (CBC) and biochemical investigations were within normal limits. On Endoscopy a large polypoidal mass arising from the second part of duodenum was seen. JMS 2017;20(2):107