HISTOPATHOLOGICAL EVALUATION OF LOWER GASTROINTESTINAL TRACT ENDOSCOPIC BIOPSIES

Introduction: Lesions of the lower gastrointestinal (GI) tract account for a substantial source of morbidity and mortality worldwide. GIT endoscopy along with biopsy is an established procedure for investigating a wide range of gastrointestinal conditions. It is not only used to diagnose malignant and inflammatory lesions but is also used for monitoring the course, extent of the disease, response of the therapy and early detection of complications. Hence, endoscopy along with biopsy examination facilitates the diagnosis and early management. Methodology: Patients with lower GI tract lesions were included in the study. Endoscopic biopsies were processed for tissue processing. Haematoxlyne and Eosin stained sections were studied. Observations: Of the 202 colonoscopic biopsies studied, sex ratio was 1.3:1. Study population comprises of cases ranging from 6 months up to 84 years. Diarrhoea of chronic duration was the predominant clinical presentation among 27% of cases. Ulcerated lesion was the commonest endoscopic finding seen among 33% cases. On endoscopic examination, 17% cases had proliferative growth, 14% cases had polypoidal growth and 06% cases showed stricture. Rectum was the commonest site of involvement seen among 38% cases. Non-neoplastic lesions were 119 (59%), benign were 16 (08%) and malignant were 67 (33%). Chronic nonspecific colitis was the predominant non-neoplastic lesion seen among 34% cases. Adenocarcinoma was the commonest malignant lesion contributing for 85% of malignant lesions of lower GIT. Conclusion: Colonoscopy with biopsy examination is the gold standard tool for the diagnosis of lower GI lesions. It is simple, safe, and relatively less invasive with high accuracy. Keywords: Endoscopy, Colonoscopy, Lower GIT, Colorectal cancer, Biopsy.

A rare case of acrochordon of external auditory canal

<p class="abstract">Independently arising acrochordon of the external auditory canal is a rare entity with only one reported case in literature. We present here the second such case. A 54-yr old lady presented to our outpatient department with complains of aural fullness and reduced hearing in right ear for 2 weeks. Clinical examination showed a pedunculated polypoidal growth in the external auditory canal. Excisional biopsy and histopathology revealed an acrochordon. Following the procedure, patient was free of symptoms and all structures of the right ear were normal. In the head and neck region, acrochordons have only but once been reported in the external auditory canal and hence should be considered as a differential diagnosis in the masses of this region. Resection must be done for confirmation of diagnosis, differentiation from neoplasia and alleviation of symptoms when associated. </p>

Ileo Ileo COLIC INTUSSUSCEPTION IN 1 YRS OLD CHILD: A RARE CASE REPORT

Intussusception is a common cause of intestinal obstruction and colicky abdominal pain in the children, particularly infants, the commonest being the ileocolic variety with colocolic variety being a very rare entity. We present a case of colocolic intussusception in a 1-year-old girl. A 1-year-old girl presented with history of colicky abdominal pain since 6 hours and non-passage of stools and flatus since 8 hours.The parents also gave history of 4 episodes of vomiting, vomitus contained food particles. Vomitus was not blood stained, foul smelling or bilious. Intraoperative findings included a polypoidal growth in the descending colon as the leading point with the formation of a colo-colic intussusception. The child was taken up for emergency laparotomy. Intraoperatively ilio-ileal intussception was noted at 2 levels with multiple enlarged mesenteric lymph nodes. The intussceptions were reduced manually. On further exploration of the distal end of bowel, appendix was found to be elongated and inflamed. Appendectomy was done, and the sample sent for histopathological examination.

Cutaneous Rhinosporiodosis in Lower Limb Mimicking Squamous Cell Carcinoma : A Case Report

Background: Rhinosporidiosis is a chronic granulomatous disease caused by Rhinosporidiumseeberi. Though cutaneous lesions in Rhinosporidiosis are rare, they may simulate many common dermatological conditions including malignancy thus posing a diagnostic dilemma. Surgical excision is treatment of choice but dapsone can also be used as an adjunct to surgery. Case Presentation: Here, we are reporting a case where a 45 year old male presented with painless progressive polypoidal growth in the right lower limb for five months with central ulceration. Inguinal lymph nodes were also enlarged. Clinically the lesion appeared to be squamous cell carcinoma. FNAC from inguinal lymph node showed reactive changes and the patient underwent wide local excision of the mass. Histopathological report showed that it was a case of Rhinosporiodosis and the patient was referred to department of dermatology for better management. J Shaheed Suhrawardy Med Coll, December 2019, Vol.11(2); 164-166

A rare case report of large bilateral vulval elephantiasis

Elephantiasis, the result of chronic lymphedema, is characterized by gross enlargement of the limbs or genitalia. It occurs because of obstructive diseases of the lymphatic system. Genital elephantiasis is a common result of filariasis. Other causes are lymphogranuloma venereum. granuloma inguinale, carcinomas, lymph node dissection, irradiation and tuberculosis. Filarial elephantiasis of the female genitalia is extremely uncommon, about 1-2% of the total cases of filarial elephantiasis. Mrs. X, 25 years old female, P1L1, resident of a village in Bihar presented to gynaecology OPD of ABVIMS and Dr. RML Hospital on 06th January 2020 with complaint of huge progressively increasing vulval swelling since 3 years. Patient had come from Bihar for treatment. She had been showing in her native place for 2 years but now the lump had made her walking difficult. She did not give history of any drug given for treatment for filariasis. She gave history of being treated for pulmonary Koch 10 years back. On examination, there was a non- ulcerative, polypoidal growth of around 20×14×11 cm arising from bilateral labia majora and minora obstructing the vulval cleft. There was no associated lymphadenopathy or limb oedema. All the investigations were within normal limits. Microfilaria antigen testing done at night was negative. Patient was given diethylcarbamazine and excision of the lump was done on 14th February 2020. Histopathological report showed dilated lymphatics with non-caseating granulomas, consistent with filariasis. In endemic countries like India, filariasis is the commonest cause of elephantiasis; however genital filariasis in woman is very rare. Other cause could be tuberculosis which is still rarer. Early diagnosis and treatment of filariasis can eradicate this neglected tropical disease which causes disfigurement and severe morbidity as its sequelae.

Soft Tissue Tumor Leg - A Rare Presentation of Cutaneous Rhinosporidiosis

Rhinosporidiosis presents commonly as polypoidal growth in nose, but presentation in other sites including skin, genitourinary tract is documented. Cutaneous presentation is rare, which may present as pedunculated swelling or cutaneous ulceration, but presenting as soft tissue tumor is extremely rare. The multifaceted presentation of the disease causes diagnostic dilemma to an unsuspecting physician. Clinical and radiological findings may mislead, but usually typical history helps, and typical histology clinches the diagnosis. We are presenting a case of disseminated cutaneous rhinosporidiosis presented as soft tissue mass lesion in the leg causing diagnostic difficulty due to the rare presentation.

Recently Described Polyphenotypic Tumor: Uterine Tumor Resembling Ovarian Sex Cord Tumor (Utrosct), A Case Report

Uterine tumors resembling ovarian sex cord-like tumors (UTROST) are rarely encountered mesenchymal type of uterine tumors with unknown etiology. They usually exhibit nodular and polypoidal growth pattern and are commonly observed in the 4th to 6th decade. UTROSCTs behave benignly however limited data is available to date. Recently these tumors show a novel recurrent gene fusion involving the NCOA2/3 gene. Hysterectomy with bilateral salpingo-oophorectomy or tumor resection is a treatment option. We report a case of a 35 years old female who presented with dysfunctional uterine bleeding. The diagnosis was initially rendered on endometrial curetting’s and further confirmed on the hysterectomy specimen after application of immunohistochemistry.

Recently Described Polyphenotypic Tumor: Uterine Tumor Resembling Ovarian Sex Cord Tumor (Utrosct), A Case Report

Uterine tumors resembling ovarian sex cord-like tumors (UTROST) are rarely encountered mesenchymal type of uterine tumors with unknown etiology. They usually exhibit nodular and polypoidal growth pattern and are commonly observed in the 4th to 6th decade. UTROSCTs behave benignly however limited data is available to date. Recently these tumors show a novel recurrent gene fusion involving the NCOA2/3 gene. Hysterectomy with bilateral salpingo-oophorectomy or tumor resection is a treatment option. We report a case of a 35 years old female who presented with dysfunctional uterine bleeding. The diagnosis was initially rendered on endometrial curetting’s and further confirmed on the hysterectomy specimen after application of immunohistochemistry.

Inflammatory Myofibroblastic Tumor of Bladder

Inflammatory myofibroblastic tumor (IMT) is a rare benign lesion found in many locations throughout the body and genitourinary tract. In bladder, being very uncommon, it arises from submucosal stroma as a polypoidal growth, and is easily mistaken for a malignant neoplasm—both clinically and radiologically. Essential criteria for the diagnosis of IMT are spindle myoepithelial cell proliferation and lymphoplasmacytic infiltrate. Here, we report a case of a 29-year-old male who presented with painless gross hematuria for 3 days. The patient underwent transurethral resection of the tumor and the final pathological diagnosis was IMT of the bladder.