Clinicopathologic Presentation and Management of Malignant Orbito-ocular Tumors at a Tertiary Care Hospital in Nepal

Introduction: This study was conducted to evaluate the clinical presentations and management of various Orbito-ocular malignancies in Nepal. Materials and methods: This is a prospective study of ocular malignant cases conducted at a tertiary care eye hospital in Kathmandu, Nepal. One hundred and seventeen newly diagnosed eyes with ocular malignancy of 106 patients presenting to the clinic in a year from September 2018 to August 2019 were included for analysis. Patients’ demography, clinical features, various types of malignancies seen in eyes and their management were evaluated. Results: The mean age of patients was 30.35 years with a range from 1 month to 84 years and standard deviation of 26.63. 56% of the total were male. Red eyes and visible mass were the most common symptoms in 23% with intraocular contents in 48% being the most common site involved. Different types of ocular malignancies were detected, among which retinoblastoma was the most common in 38% of patients. Diagnosis in most patients was clinical and/or radiological; incision biopsy was required in 1.7% patients only. Surgical excision of the tumor was the most common treatment done in 29% followed by enucleation in 27% of eyes. Bilateral involvement of the eyes was seen in 10% of the patients. Conclusion: Malignant orbito-ocular tumors can be seen in any age group. Retinoblastoma is the commonest malignancy seen. With the help of imaging, diagnosis is near accurate; hence biopsy is not required in most cases before commencing treatment.

Chondroblastoma of the patella with secondary aneurysmal bone cyst, an easily misdiagnosed bone tumor:a case report with literature review

Background Chondroblastoma (CB) is a rare, primary, benign bone tumor that commonly affects men aged 15–20 years. It is usually detected in the epiphysis of the long bones, such as the proximal femur, humerus, and tibia. The patella is an infrequent site. CB with secondary aneurysmal bone cyst (ABC) is extremely rare in the patella, which can be easily confused with other common bone tumors of the patella. Thus, it is necessary to make the right diagnosis to get a good outcome. Case presentation We have presented here the case of a 30-year-old man who was suffering from anterior knee pain for the past 6 months that had aggravated 2 weeks before the presentation. Osteolytic bone destruction in the patella could be detected in both his X-ray and computed tomography (CT) examinations, while the magnetic resonance imaging (MRI) detected a fluid level. Accordingly, secondary ABC was presumed. We diagnosed the condition as giant cell tumor (GCT) with secondary ABC and, accordingly, performed curettage inside the focus region with autogenous bone grafting following the patient’s medical history, physical manifestations, results of physical and ancillary examinations, and the disease characteristics. However, the intraoperative and postoperative outcomes indicated that the patient’s histopathology was consistent with that of typical CB, suggesting a definitive error in diagnosis. Accordingly, the patient was finally diagnosed with patella CB along with secondary ABC. Conclusions Past studies have demonstrated that the 3 commonest bone tumors affecting the patella are GCT, CB, and ABC. CB with secondary ABC can be easily misdiagnosed as GCT with secondary ABC or ABC. Performing incision biopsy or excision biopsy and conducting histological examination may be the most effective method for suspected CB with secondary ABC.

DIAGNOSTIC ALTERNATIVES TO ENDOCOSPIC ULTRASOUND IN SUBEPITHELIAL LESIONS: A SYSTEMATIC REVIEW

Introduction: Subepithelial lesions are a challenge in clinical practice, often requiring a biopsy for a proper diagnosis. Currently, the gold standard is an endocospic ultrasound, which is rarely available. Objectives: Use a systematic review to check the effectiveness of the mucosal incision-assisted biopsy and assess whether it can be an alternative to endocospic ultrasound. Methods: The most relevant studies in the MedLine and SciELO databases were reviewed, and only randomized controlled clinical trials (RCT) and meta-analyses were considered. The search strategy used the following combinations of keywords: subepithelial lesion mucosal incision biopsy. The following terms were used to identify the study designs: clinical trials. Results: Seven articles that demonstrated the usefulness of the study technique and diagnostic efcacy were included in the scope of this review. This technique seems safe for biopsies. However, it is controversial for the resection of lesions. It has limitations, such as being more time-consuming. Conclusion: Mucosal incision-assisted biopsy can be considered useful in clinical practice and is still an effective technique and an alternative to endocospic ultrasound

CD30-positive T-cell lymphoproliferation of the bulbar conjuntival mucosa showing spontaneous remission

Introduction: CD30-positive T-cell lymphoproliferative lesions represent a spectrum of heterogeneous disorders. Clinical case: An incision biopsy was performed in a 25-year-old man with a lump in the bulbar conjunctiva. Immunohistochemistry indicated membrane positivity for CD3 and CD30 in over 75%. PCR identified the monoclonal nature of the T-cells. The hematological study was normal. Following biopsy, the conjunctival tumor diminished until disappear. Conclusions: Mucosal CD30-positive T-cell lymphoproliferation could be ascribed to a reactive process but it is necessary to rule out a primary conjunctival tumor or the first manifestation of an anaplastic large cell lymphoma.

Giant cell lichenoid stomatitis - An oral medicine case book

A 53-year-old female patient presented with a two-week history of intermittently painful oral mucosal lesions when eating spicy, salty or sour foods. The patient reported a long-term history of psoriasis treated by topical corticosteroids only. The remainder of the patient's medical history was unremarkable. On intraoral examination, lesions were noted bilaterally in the posterior buccal commissures, appearing as centrally erosive lesions bound by white striations (Figure 1). Additionally, there were areas of desquamative gingivitis in the anterior maxillary gingiva. The clinical suspicion was that of oral lichen planus or oral lichenoid lesions. An incision biopsy from the left buccal mucosa was performed and submitted for histo-logical assessment.

Modern treatment of vulvar cancer

BackgroundVulvar cancer accounts for 3–5% of malignant diseases of the female genital tract. The Slovenian incidence rate is 5.5/100,000, which means 57 new cases per year. The most common histological type (90%) is squamous cell carcinoma. Based on etiology, it can be classified into the first type which correlates with human papillomavirus (HPV) infection and the second type which is not associated with HPV. The most common and long-lasting symptom of vulvar cancer is pruritus. The preferred diagnostic procedure to confirm the diagnosis is a punch or incision biopsy. Surgery in combination with radiotherapy is the standard treatment for vulvar cancer. Sentinel lymph node biopsy with lymphoscintigraphy is now a standard part of surgical treatment. Chemotherapy is a palliative treatment option.ConclusionsVulvar cancer is a rare disease. Because of the pathogenesis, surgery and radiotherapy are the main treatment modalities. The sentinel node biopsy (SNB) represents a contemporary approach to the vulvar cancer treatment and significantly reduces morbidity. Improvements in treatment of vulvar cancer contributed to the decrease of mortality among Slovenian women.

An unusual case of giant multilobulated lipoma over left truncal region

Lipomas can virtually occur anywhere in the human body. They can be of varying sizes. Small lipomas are more frequently found, whereas giant lipomas are comparatively rare. These slow-growing, nearly always benign, tumors usually present as non painful, round, mobile masses with a characteristic soft, doughy feel. They are one of the most common benign tumours found in the body. Difference through histopathology and immunochemistry has to be done to rule out other conditions such as liposarcoma. In this report we present a case of a female with a large swelling with multilobulations over the anterolateral aspect of the left thigh and gluteal region. Incision biopsy revealed a lipoma for which primary excision was done safeguarding vital structures. The lipoma was unusual in its size, its appearance and site of occurrence. Histopathology and immunochemistry revealed it to be a lipoma.

Tumors of the Lacrimal Sac: Three case reports

Lacrimal Sac tumors are extremely rare and potentially life threating. It may be primary, secondary and metastasis from distant organ. Lacrimal sac tumors may be broadly classified into epithelial (72%), mesenchymal (12%), lymphoproliferative (11%) and melanocytic (04%). About 72% are malignant; tend to be locally invasive with high recurrence rate. To report three cases of rare primary lacrimal sac tumors. We evaluated three rare case reports on primary lacrimal sac tumors in two tertiary eye hospitals in Bangladesh. 46 year old female, 36 year old male, and a 21-year-old young male, patients presented with mass in the lacrimal sac area. Two of them underwent deep incision biopsy and histopathology revealed Low grade extranodal marginal zone lymphoma (ENMZL). One patient was treated with Radiotherapy and another one with 6-Cycles of CHOP chemotherapy(Cyclophosphamide, Hydroxydaunorubicin, Oncovin,Prednisone). One patient underwent excision biopsy and histopathology reported lacrimal sac haemangiopericytoma. In all cases the lesions were resolved completely. Management of lacrimal sac tumors requires a high index of suspicion, as these are fatal tumor and often misdiagnosed as dacryocystitis. Early and appropriate intervention will help to complete resolution of the tumor as well as to reduce the recurrence. CBMJ 2018 July: Vol. 07 No. 02 P: 45-49

Multifocal Cytokeratin Expression in a Dedifferentiated Solitary Fibrous Tumor With Heterologous Rhabdomyosarcomatous Differentiation: A Challenging Diagnosis!

We report the case of a dedifferentiated solitary fibrous tumor with heterologous rhabdomyosarcomatous differentiation in a 74-year-old male presenting with a rapidly growing, large soft tissue tumoral mass in the gluteal muscles of the right hip. Dedifferentiation in solitary fibrous tumor had not been recognized until very recently and is an extremely rare phenomenon in this tumor type. In the present case, the diagnosis of dedifferentiated solitary fibrous tumor was difficult because of the absence of areas of conventional solitary fibrous tumor with a predominantly poorly differentiated, anaplastic tumor component in the incision biopsy composed of heterogeneous areas with small blue round cell (Ewing sarcoma-like), rhabdoid, epithelioid, and pleomorphic morphology. Moreover, the “unforeseen” strong patchy to multifocal positivity for cytokeratin AE1/AE3 and desmin made the diagnosis of a dedifferentiated solitary fibrous tumor even more challenging in this case. The morphology (presence of branching thin-walled, hemangiopericytoma-like blood vessels) and the immunohistochemical profile (including STAT6 and GRIA2 positivity) were very useful to differentiate this very challenging case of a cytokeratin-positive dedifferentiated solitary fibrous tumor with heterologous rhabdomyosarcomatous differentiation from a broad list of differential diagnoses.