Cystic Ganglionosis in a 3-year-old Mimicking Juvenile Idiopathic Arthritis

Ganglion cysts are common periarticular/peritendinous masses, which are thought to form from myxoid degeneration of collagen that becomes encased by connective tissue.1 This differentiates them from synovial cysts, which are lined by synovium.2,3 The presence of numerous ganglion cysts in multiple locations is very rare and has been termed cystic ganglionosis.4

Ectopic decidua of the appendix: a case report

Background Ectopic decidua is the presence of decidual tissue outside the uterus. Ectopic decidua of the appendix is a rare entity that can present with abdominal symptoms mimicking appendicitis. We report a case of a 39-year-old female patient at 27 weeks gestational age with a 2-day history of right lower quadrant abdominal pain. Case presentation The patient was referred to our hospital with suspicion of either acute appendicitis or threatened rupture of the uterus, the latter of which was considered unlikely following close examination. Therefore, she underwent emergency appendectomy via laparotomy. Microscopic examination revealed decidual tissue with myxoid degeneration in the subserosal layer of the tip side of the appendix, without endometriosis, which was compatible with ectopic decidua (deciduosis). Conclusions Because it is extremely difficult to distinguish ectopic decidua of the appendix from acute appendicitis, even with various imaging modalities, we should be aware that ectopic decidua of the appendix is a differential diagnosis for acute appendicitis in pregnant women.

Serendipitous Discovery of a Benign Obturator Nerve Schwannoma

Schwannomas are typically benign tumours of the peripheral nerves. However, they seldom arise from the obturator nerve. Here we report a case of an uncommon swelling (2.5 × 3.5cm) in a 65-year-old male cadaver which was found during the routine dissection for first MBBS students in the department of Anatomy, Kasturba Medical College, Manipal, India in the month ofDecember 2019. It was seen originating from the left obturator nerve in the pelvis at the level of the sacral promontory. Histopathological investigation revealed a schwannoma. The hypocellular tumor was arranged in a sweeping fascicle pattern with patches of myxoid degeneration. Obturator schwannomas, though rarely seen, can exist in the cadaver, as seen in the present case. Hence, it should be considered as a differential diagnosis for clinical cases of pelvic masses and eliminated only after thorough radiological examination. Knowledge about the existence of such schwannomas is, therefore, a must. Keywords: Schwannoma, Obturator nerves, neurilemmoma, nerve sheath neoplasms.

A RARE CASE OF VULVAL FIBROID DURING PREGNANCY PRESENTING LIKE BARTHOLIN’S ABSCESS

Introduction: - Fibroid are commonly found in uterus and cervix but rarely may found other sites (broad ligament, ovary, Vulva, vagina etc). Here we are presenting a rare case of Vulval Fibroid. Case Report: - A 25 years old woman G4P3L3 with 37 weeks pregnancy presented to OPD with complaint of severe pain at perineal region. There was history of fall in bathroom 1 month ago. On examination there was a swelling at right vulvo-vaginal junction of 4x4 cm, (probably bartholin cyst) with firm smooth surface, with no signs of acute inflammation, for that Incision and drainage was done and an organized mass was resected out. On histopathlogical examination, it was found to be a leiomyoma with myxoid degeneration. Discussion :- fibroids rarely presents with pain and inflammation and on the other hand bartholin’s cyst or abscess mostly presents with pain and inflammation, so detailed history and examination with broad suspicion are the keys to differentiate between Bartholin’s cyst and vulval fibroids.

Oral focal mucinosis of the palate: a rare disease entity

Oral focal mucinosis (OFM) is an extremely rare, benign oral soft tissue condition; less than 10 documented cases have been reported in the literature in patients under 18 years old. OFM has an unknown aetiology and predominantly presents in the fourth and fifth decades. The pathogenesis of OFM may be due to fibroblast overproduction of hyaluronic acid. Clinically, it remains almost impossible to diagnose definitively, due to its lack of pathognomonic features, therefore such lesions may have multiple differential diagnoses and histological analysis is essential to confirm OFM. We present an unusual presentation of OFM in a 14-year-old female patient. Following excision, focal myxoid degeneration of the connective tissue was apparent. This case highlights this rare condition for consideration in differential diagnosis of clinically similar lesions.

Mitral valve prolapse in relation to sport

Depending on the definition of the disease and diagnostic criteria mitral valve prolapse (MVP) is one of the commonest structural abnormalities of the heart. The condition is characterized by myxoid degeneration of the mitral valve and appears to be more common in females. Trans-thoracic echocardiography is the primary diagnostic tool for diagnosing MVP and provides information about the structure and function of the valve, but also allows comprehensive evaluation of the subvalvular complex. Additional trans-oesophageal echocardiography and 3D echocardiography provide excellent further assessment of the mitral valve complex. The vast majority of patients have a relatively benign natural history. However, a small proportion may develop severe mitral regurgitation due to degenerative disease or chordal rupture, infective endocarditis, embolic cerebrovascular accident, supraventricular and ventricular arrhythmias, and sudden cardiac death. Athletic training has the potential for expediting the degenerative process and a propensity for arrhythmias or even sudden death.

Isolated myxoid degeneration of aortic valve: diagnostic dilemma

Myxoid degeneration of the aortic valve as a cause of acute aortic valve regurgitation in young age is uncommon. We report a 39-year-old African-American man with a history of epilepsy and hypertension who presented with a 1-month history of worsening shortness of breath. He was diagnosed with acute pulmonary oedema. Transoesophageal echocardiogram showed normal ejection fraction but severe aortic valve insufficiency with small masses on the ventricular side of the right and non-coronary cusps, small vegetations cannot be ruled out but other valves were normal. Subsequent cultures were negative for endocarditis. Myocardial positron emission tomography (PET) scan was strongly suggestive of cardiac sarcoidosis. However, this diagnosis was ruled out as well when he underwent aortic valve replacement with bioprosthetic valve as he did not want to take long-term anticoagulation. Histological examination of the aortic valve showed myxoid degeneration. The patient was doing very well 1 year after the surgery.