Clinical Entity Research Articles

Post-dengue fatigue syndrome: A comprehensive review of an emerging clinical entity

Post-dengue fatigue syndrome (PDFS) is an emerging clinical entity characterised by persistent, debilitating fatigue and other symptoms following acute dengue infection. This review synthesises current evidence on the epidemiology, clinical features, pathophysiology and management of PDFS. Studies suggest that 20–25% of hospitalised dengue patients may develop PDFS, though population-based incidence is likely lower. Risk factors include older age, female sex and possibly host genetic factors. The hallmark symptom is profound fatigue, often accompanied by musculoskeletal pain, cognitive difficulties, sleep disturbances and mood changes. While some patients recover within weeks, others experience symptoms persisting for months or years. The pathophysiology of PDFS remains unclear but may involve persistent immune activation, hypothalamic-pituitary-adrenal axis dysfunction and autonomic nervous system disturbances. Diagnosis is based on the clinical history and exclusion of alternative causes. Management typically involves a multidisciplinary approach, including patient education, graded exercise therapy, cognitive behavioural therapy and symptomatic treatment. However, evidence for specific interventions is limited. Prognosis is variable, with some patients experiencing prolonged disability. Significant research gaps remain, including the need for standardised diagnostic criteria, biomarkers and controlled trials of potential therapies. As dengue’s global burden increases, further investigation of PDFS is crucial to improve recognition and develop evidence-based treatments for this impactful sequela of dengue infection.

Familial mediterranean fever in a patient with ankylosing spondylitis: could familial mediterranean fever explain a typical eight-year ankylosing spondylitis?

Patients with familial mediterranean fever (FMF) often present with musculoskeletal involvement typical of spondyloarthropathy (SpA) or ankylosing spondylitis (AS), posing a diagnostic challenge for medical practitioners and leading to the description of the FMF-related SpA/AS clinical spectrum. Currently, the available data focuses on SpA diagnosis in patients with known FMF, while the contrary is rarely reported in the medical literature. We describe an unusual case of concomitant FMF diagnosis in a patient with an eight-year long history of typical, human leukocyte antigen-B27 positive AS on adalimumab treatment, who presented with recurrent febrile attacks and abdominal pain. The laboratory work-up revealed high titres of serum amyloid A while genetic testing was positive for the pathogenic M694V heterozygous variant in the MEFV gene. The patient was promptly treated with colchicine, showing complete remission of clinical symptoms and normalisation of inflammatory markers to date. We also performed a review of the available literature elaborating on the interrelationship of AS and FMF in terms of pathogenesis and clinical characteristics. Our case highlights the need for reporting of similar cases and further explores the association of AS and FMF as distinct clinical entities or as constituents of the same disease continuum model.

IMPACT organizational survey highlighting provision of services for patients with locally advanced and recurrent colorectal cancer across Great Britain and Ireland.

Locally advanced and recurrent colorectal cancer represents a complex clinical entity, which requires multidisciplinary decision-making and management. The aim of this work is to understand the provision of clinical services in this cohort of patients across Great Britain and Ireland (GB&I) as a key essential step to help facilitate future service development and improvement. A cross-sectional, organizational survey was sent to all colorectal cancer multidisciplinary teams (MDTs) across GB&I. It consisted of 12 key questions addressing the provision of specialist services and advanced surgical techniques. Results are reported in line with the CHERRIES guideline. One hundred and seventy-five MDTs across GB&I participated, with 142 English, 13 Welsh, 14 Scottish, 3 Northern Irish and 3 Irish MDTs. The overall response rate was 93.5% (175/187). Ninety (51.4%) hospital sites reported having a specialist dedicated or subsection MDT. Specialist advanced nursing support was available in 46 (26.2%) hospitals, with a dedicated advanced colorectal cancer outpatient clinic available in 31 (17.7%) hospitals. One hundred and thirteen MDTs (64.5%) offered surgery for advanced colonic cancer, 82 (46.8%) for recurrent colonic cancer, 58 (33.1%) for advanced rectal cancer and 39 (22.2%) for recurrent rectal cancer. A variable number of MDTs offered specialist surgical techniques, including distal sacrectomy [33 (18.9%)], high sacrectomy [16 (9.1%)], complex vascular resection ± reconstruction [33 (18.9%)] and extended lymphadenectomy (pelvic sidewall or para-aortic) [44 (25.1%)]. The IMPACT organizational survey highlights the current variation in the delivery and provision of clinical services for patients with advanced and recurrent colorectal cancer across Great Britain and Ireland.

COVID19 infection and vaccination and the risk of pituitary apoplexy: an entangled yarn.

Pituitary apoplexy (PA) has been increasingly reported in association with both infection from and vaccination for COVID19. Our aim was to analyse the available published cases and compare the clinical characteristics in the two groups (infection vs vaccination). We systematically reviewed the published literature for all cases of PA associated with COVID19 infection or vaccination. We also presented two cases managed at our Centre. Collectively, fortythree cases were analysed. Patients with PA after COVID19 vaccination (n = 7), compared with patients with PA after COVID19 infection (n = 36), were significantly younger (p = 0.009) and had a more abrupt onset of PA (p = 0.022), but showed a milder hormonal involvement (p = 0.008) and a lower rate of persistent hypopituitarism during follow-up (p = 0.001). Patients in the vaccination group did not have clinical risk factors for PA, although this difference did not reach statistical significance. PA associated with COVID19 is a rare but clinically significant entity, although pathophysiological details of this association are lacking. Given the significantly different clinical presentation, we could speculate that PA induced by COVID19 vaccination might represent a distinct clinical entity, with different pathophysiological mechanism, compared to PA from COVID19 infection.

Intensified alkylating chemotherapy for patients with oligometastatic breast cancer harboring homologous recombination deficiency: Primary outcomes from the randomized phase III OLIGO study

BackgroundOligometastatic breast cancer (OMBC) is a clinical entity with a prospect of long-term survival, but uncertainty remains on its optimal treatment. We studied whether intensified alkylating chemotherapy (IACT) improves long-term outcome compared to conventional-dose chemotherapy (CDCT) as part of a multimodality approach for patients with OMBC harboring homologous recombination deficiency (HRD). Patients and methodsEligible patients had HER2-negative OMBC, harboring HRD, with ≤ 3 distant metastases, pathologic proof of distant disease and a favorable response to three cycles CDCT. Participants were randomized 1:1 to continue with either CDCT or IACT. IACT consisted of one mobilization course followed by two cycles of mini-CTC (carboplatin, thiotepa and cyclophosphamide) supported by peripheral blood progenitor cell reinfusion. Primary outcome was event-free survival (EFS). Secondary endpoints included overall survival (OS), quality of life and safety. ResultsSeventy-five patients were randomized to either IACT (n = 36) or CDCT (n = 39). Twenty-three (31 %) patients had hormone receptor-positive disease and 52 (69 %) had triple-negative disease. Median EFS in the IACT-group was 28 months (95 % confidence interval [CI] 21-not reached [NR]) versus 25 months (95 %CI 14-NR) in the CDCT-group (hazard ratio [HR] for recurrence or death 0.78, 95 %CI 0.42–1.42). Median OS was 67 months (95 %CI 37-NR) in the IACT-group and 36 (95 %CI 26-NR) in the CDCT-group (HR 0.74, 95 %CI 0.37–1.48). ConclusionsThe entire study population experienced long-term survival, with median OS well over five years. IACT compared to CDCT did not improve outcome in patients with OMBC harboring study-defined HRD. The optimal therapy for patients with OMBC requires further study. Trial RegistrationClinicalTrials.gov: NCT01646034

Mandibular Defects and Reconstruction Post Oncological Resection in Paediatric Patients

Introduction: Tumours of the paediatric mandible are rare clinical entities, which require a multidisciplinary team management. Surgery is frequently utilized as a modality for local control in the management of paediatric mandibular neoplasms. However, mandibular reconstruction in such age group is more challenging than in their adult counterparts, owing to the developing nature of the mandible and the craniofacial skeleton. Materials & Methods: The medical records of patients below the age of 18 years of age presented to the Paediatric Oncology and Head and Neck Surgical Oncology Departments at the National Cancer Institute of Cairo University from January 2014 to January 2024 with mandibular tumour were reviewed. The review includes; radiological site of the lesion, histo-pathological diagnosis, multidisciplinary team management. Patients that underwent segmental mandibular resection were evaluated for the type of the resultant mandibular defects according to Brown’s classification of mandibular defects and the subsequent reconstruction procedures. Results: Forty-two patients were reported with mandibular neoplasm. Primary mandibular tumours were found in 35 cases (83.3%), of which non odontogenic tumours were diagnosed in 29 cases (69.0%). The anatomical subunits of the mandible; ramus, angle and body were involved in 14 (33.3%), 13 (31.0%) and 15 (35.7%) cases, respectively. Twenty-nine patients underwent segmental mandibular resection. According to Brown’s classification; Class I, Class Ic, Class II, Class IIc, Class III, Class IV and Class IVc were the resultant defects in 0 (0%), 2 (6.9%), 10 (35.5%), 10 (35.5%), 3 (10.3%), 0 (0%), and 4 (13.8%) cases, respectively. Conclusion: The different pathologies of the mandibular neoplasms affecting the paediatric age group frequently involve the ramus of the mandible. With the surgery being the modality of choice in most of such pathologies, the resultant defects following segmental resection and the reconstruction approach in such age group vary greatly from the adult age group. Hence, the free fibular bone segments used for restoration of the ramus projection would be of a relatively larger length. Condylar resection, unfortunately, would hinder the restoration of occlusion relationship, essential for normal development of the maxillofacial skeleton.

Abdominal Lymphatic Malformations: A Novel Approach in Management

Aim of the studyAbdominal lymphatic malformations (LM) are a challenging clinical entity. Complete excision can be impossible due to the infiltrative nature of some lesions and high rate of complications. Sclerotherapy may require multiple episodes of general anaesthesia and an inability to be definitive in terms of diagnosis and treatment. Subsequently we have adopted a newer algorithm of treatment involving a joint procedure with interventional radiology to enable an intra-operative treatment plan based on the findings. We present our early results. MethodA retrospective observational study in a single tertiary paediatric centre from January 2019 to December 2023. The details of each patient were recorded along with their treatment pathway and outcome. Results12 children underwent treatment for abdominal LM. Under GA and laparoscopic vision, pigtail catheters were inserted into the lesion to effect maximal drainage and assessment of surgical anatomy. If resection was feasible this was undertaken through a laparotomy and if not, the drains were retained and sclerotherapy was started.Three underwent drainage with sclerotherapy without resection and 9 underwent drainage with resection. Of the 3 who underwent sclerotherapy 2 have had further treatment and remain under review at a mean follow up of 7.6 months. Of the other 9 there were no signs of recurrence of the LM at a mean follow up of 29 (range 6–56) months. ConclusionWe have found a combined procedure involving IR-guided drainage under laparoscopic vision enabling curative surgical resection to be undertaken, where feasible, with currently no significant morbidity. For those in whom this is not possible then direct intralesional sclerotherapy is the next most useful treatment modality for longer term control of symptoms. Level of evidenceII.

Slowly progressive autosomal dominant Alport Syndrome due to COL4A3 splicing variant.

Alport syndrome is a rare genetic kidney disease caused by variants in the COL4A3/A4/A5 genes. It's characterised by progressive kidney failure, though therapies targeting Renin-Angiotensin System can delay its progression. Additionally, extrarenal manifestations may sometimes coexist. Recent advances in genetic analysis and the necessity to better clarify genotype-phenotype correlations in affected patients raises the importance of detecting even cryptic splicing variants, lying in both canonical and non-canonical splice sites variants such as last exonic nucleotide variants. These variants, often, do not cause an amino acid change but alter the snRNP proteins binding. We studied a big Italian family with Alport syndrome showing a clear dominant pattern of transmission with younger family members having only haematuria and older individuals presenting with End-Stage Kidney Failure (ESKF). Kidney biopsy showed the typical disease hallmarks. We deeply mined the data for SNV and CNV through exome sequencing on DNA from both peripheral blood samples and patients' podocytes-lineage cells. We identified an already reported synonymous variant, c.765G>A (p.(Thr255Thr)), in the last exonic nucleotide of exon 13 of the COL4A3 gene. Employing the patient's podocytes we demonstrated that this variant results in exon skipping leading to an in-frame deletion of 28 amino acids without leaky effect. According to the pattern of transmission, to the kidney biopsy and to the exome data analysis we provided further evidence that autosomal dominant Alport syndrome is a well-defined clinical entity. We also confirmed the pathogenicity of the synonymous COL4A3 variant for the first time demonstrating its role in a dominant pattern of transmission.

Parameatal Urethral Cyst: A Case Report and Review of Literature

Parameatal urethral cyst is a rare congenital clinical entity, which was first reported in 1956 by Thompson and Lantin. Since then, about 50 cases have been published. Most of the cases, which have been reported, were from the Japanese population and on an extensive literature search; few cases have been reported from India. Herewith, we report a case of a Parameatal urethral cyst in a 27 year old male presenting with poor cosmetic.

Quadriceps Muscle Layer Thickness and its association with frailty in critically ill patients: A prospective observational study

BackgroundFrailty is a well-recognized clinical entity known to influence the outcomes of critically ill patients. Muscle ultrasound, particularly Quadriceps Muscle Layer Thickness (QMLT), assesses muscle mass, which is a key component determining frailty. However, no studies have assessed the association between frailty and QMLT. This study aimed to determine the association between the QMLT and frailty in critically ill elderly patients. MethodIn this prospective, observational, single-center study conducted in an ICU in India, patients aged >65 years were enrolled. Baseline frailty was assessed using the Clinical Frailty Scale (CFS). Quadriceps muscle thickness was measured via axial cross-section ultrasound at admission. Patients were categorized as non-frail (CFS 1–4) and frail (CFS ≥5), and their characteristics were compared. Multivariate regression analysis was used to identify factors associated with frailty. Results120 patients were included. The median APACHE II and SOFA scores were 19 [IQR 14.25–23] and 4.5 [IQR 3–6], respectively. The median age was 75 years [IQR 70–82]; 62.5 % were male. The most common comorbidities were diabetes mellitus (60 %) and hypertension (59 %). 65 % were mechanically ventilated. 65 % of patients were frail. Frail patients had higher mortality (37.17 % vs. 16.66 %, p = 0.022). QMLT was lesser in frail than non-frail (1.77 cm vs 2.21 cm, p < 0.001). QMLT decreased with an increase in CFS (p < 0.001). Frail and non-frail patients were further divided into four groups based on the median QMLT (1.96 cm). Frail patients with QMLT below the median had a higher 28-day mortality than non-frail and frail patients with QMLT above the median (48.97 % vs. 16.12 % vs. 18.18 % vs. 17.24 %, p = 0.003). Frailty was independently associated with increasing age (OR, 1.14; 95 % CI: 1.055–1.231, p = 0.001), higher APACHE II score (OR, 1.078; 95 % CI: 1.009–1.151, p = 0.025), and lower QMLT (OR, 0.205; 95 % CI: 0.083–0.509, p = 0.001). ConclusionsWe found an independent association between Quadriceps Muscle Layer Thickness (QMLT) and frailty. QMLT decreased progressively with CFS scores. Frail patients with lower QMLT had increased 28-day mortality. These findings highlight the role of incorporating QMLT measurements along with CFS in frailty evaluations to improve decision-making in critically ill elderly patients.

Pathologic Characteristics and Surgical Outcomes of Pediatric Versus Adult Well-Differentiated Thyroid Cancer.

Despite the rising incidence of pediatric differentiated thyroid cancer (DTC), postoperative outcomes for such tumors have not been well-characterized. The objective of this study was to compare pathologic tumor characteristics and treatment outcomes for pediatric and adult patients with DTC. Retrospective case-control study. National database. Pediatric (<18 years old) and adult (≥18 years old) patients who underwent surgery for DTC in the National Cancer Database (2004-2020) were included. Multivariable logistic, negative binomial, and linear regressions were used to compare pathologic tumor characteristics, treatment characteristics, and short-term surgical outcomes. 337,864 patients with DTC met the study eligibility criteria; 3584 (1.1%) were pediatric patients and 334,280 (98.9%) were adults. After adjustment, pediatric patients were found to have higher rates of pathologic T upstaging (adjusted odds ratio [ORadj]: 1.40, 95% confidence interval [CI]: 1.23-1.59), N upstaging (ORadj: 2.53, 95% CI: 2.23-2.88), and extrathyroidal extension (ORadj: 1.58, 95% CI: 1.29-1.94), compared to adult patients. Pediatric patients were also more likely to receive neck dissection (ORadj: 2.80, 95% CI: 2.55-3.07) and radioactive iodine (ORadj: 1.42, 95% CI: 1.30-1.55). Pediatric patients had higher rates of positive surgical margins (ORadj: 1.25, 95% CI: 1.11-1.41) and 30-day readmissions (ORadj: 1.26, 95% CI: 1.00-1.58) than adult patients. These findings demonstrate that pediatric DTC is associated with more aggressive disease presentations, more radical treatment, and worse short-term surgical outcomes compared to DTC in adults. Pediatric DTC should be considered a unique clinical entity that requires personalized evaluation and multidisciplinary treatment by specialized providers.

Distomolars – Exploring the Rare Clinical Entity in a Northern Nigerian Population

Background: Distomolars are supernumerary teeth erupting distal to the maxillary or mandibular third molars. This present study explored the clinical significance of distomolars in a Nigerian population. Objectives: The aim of the present study was to estimate the prevalence, clinical significance, and pathologies associated with distomolars in a population of Northern Nigerian adults using dental pantomograms. Materials and Methods: This retrospective cross-sectional study was conducted in the Department of Oral Diagnostic Sciences, Aminu Kano Teaching Hospital, Kano State, Nigeria, and it included the extraction of images from the central computer attached to the Planmeca Promax machine. The sampling frame included patients who had dental pantomograms during the two-year period under review. The images were viewed on Planmeca Romexis 4.3.0 R software to identify relevant study variables. Results: Of 4,932 pantomograms reviewed, 107 distomolars were identified. The prevalence of distomolars was 2.17%. The mean age of subjects with a distomolars was 36.25 years, with a male-to-female ratio of 1:1.6. Majority of the distomolars were identified in the maxilla (60.75%) and had typical forms (67.3%) and 72.9% of them were seen unerupted. Conclusion: Distomolars occurred more frequently in females in the Nigerian population, commoner in the maxilla, and were predominantly unerupted and smaller in size than the normal adjacent teeth.

An Exploratory Study of Published Case Reports Using a Systematic Typology.

Case reports are a popular publication type, especially for medical learners. They also are an excellent educational vehicle that can spark a long-term interest in scholarship for medical learners. To maximize publication potential, authors need a framework when writing a case report. We did a manifest content analysis on case reports published in 12 peer-reviewed medical journals between 2010 and 2019. We classified the case reports as detection, extension, diffusion, or fascination. The objective of our study was to determine whether case reports can successfully be classified by their primary contribution to the medial literature as detection, extension, diffusion, or fascination case reports. Using a predefined search strategy, we identified 1,005 manuscripts identified as case reports published from 2010 to 2019 in 12 journals from a variety of medical specialties. Only 673 of the 1,005 (67.0%) met our criteria for a case report. Of these, 59.1% most closely fit the category of diffusion case reports. Fascination case reports were the least common (1.2%). The format of published case reports varied widely among journals. Case reports can be categorized according to their main contribution to the medical literature. Nearly 60% of all published case reports in this study were not published for the purpose of introducing a novel clinical entity. Instead, they were used as a vehicle to educate clinicians about previously described phenomena. Authors seeking to publish case reports should understand how the framing of their report is likely to influence their chances of being published.

Impact of PNPLA3 I148M on Clinical Outcomes in Patients With MASLD.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is a heterogenous clinical and histopathological entity, where multiple metabolic co-factors are intertwined with high interindividual variability. The impact and severity of each factor (including obesity and type 2 diabetes) define a systemic dysmetabolism that can lead to either advanced liver disease and its complication (including hepatocellular carcinoma and clinical events related to portal hypertension) or extrahepatic events: incident cardiovascular disease, chronic kidney disease and extrahepatic cancers. The balance between environmental factors and genetic susceptibility has unique implications in MASLD: the intermittent injury of metabolic co-factors, their fluctuation over time and their specific management, are counterbalanced by the presence of gene variants that can significantly impact the disease at multiple levels. The I148M variant in the PNPLA3 gene is the most investigated genetic susceptibility that induces a more severe steatohepatitis, enhanced fibrogenesis and can shape the incidence of long-term clinical events regardless of, or worsened by, other metabolic risk factors. In this review, we will summarise the updated evidence on the natural history of MASLD accounting for classical metabolic risk factors, the role of PNPLA3 in clinical sub-phenotyping (e.g., 'lean MASLD'), impact on disease severity and fibrosis progression, as well as its role for prognostication, alone or in combination with non-invasive tools into polygenic risk scores.

Evaluating Speech-Language Pathologists' Knowledge of Functional Speech Disorders

Purpose: The purpose of this article is to offer an evaluation of speech-language pathologists' (SLPs') experiences with and knowledge of functional speech disorders. Functional speech disorders occur as a part of functional neurological disorders, a complex disorder that is often overlooked and misdiagnosed. Through an assessment of experience with and common myths about functional speech disorders among SLPs, the importance of providing education to SLPs about this patient population is discussed. Method: As a part of the presentation about functional speech disorders during the 2023 American Speech-Language-Hearing Association Health Care Summit, 122 participants were asked to anonymously respond to a series of questions that outlined their demographics, training in functional speech disorders, and experiences with this patient population. Descriptive data are presented. Results and Conclusions: Among attendees, 58% were exposed to functional speech disorders in graduate school while 75% had seen a patient with a functional speech disorder, most of whom had also diagnosed the patients' communication disorder. This study highlights the role of the SLP in identifying and managing functional speech disorders and the increased attention this patient population has received over time, as well as the work yet to be done. Functional speech disorders are a legitimate clinical entity, for which a diagnosis can be made based on positive clinical features (i.e., is not a diagnosis of exclusion). The call to action includes guidance for clinicians, educators, and academic training programs to support this patient population. See the Appendix for a plain language summary.

Postprandial Symptoms in a Mixed-Meal-Test after Bariatric Surgery - Clinical Experience and a Critical Review of Dumping Syndrome Definition and Management.

Introduction Despite recent attempts to reach a consensus on the diagnostic criteria and treatment of Dumping Syndrome (DS) after bariatric surgery, many questions about the clinical applicability and significance of standardized provocation tests remain unanswered. The objective of this study is to retrospectively evaluate a mixed-meal-test (MMT) based on general nutritional recommendations after bariatric surgery and its clinical value in diagnosing DS. Methods The MMT contained 15.5g of protein, 10g of fat, 20.7g of carbohydrates, and 3.1g of dietary fiber, totaling 241 kcal. Symptoms based on the Sigstad Score, along with blood sugar, hematocrit, pulse rate, and blood pressure, were collected as primary readouts. The analysis included 58 MMTs from 56 patients who reported postprandial symptoms indicative of DS and were referred to the clinic by surgeons or general practitioners. Results Although all individuals reported significant symptoms at home, the MMT showed a positive symptom score (Sigstad Score ≥7) in only 16 cases (28%). Neither a heart rate increase &gt;10 BPM nor the 3% hematocrit increase suggested as cut-offs for early DS by the consensus paper were associated with the Sigstad Score or individually reported symptoms. None of the participants had a glucose decrease below 50 mg/dl; one fell below 60 mg/dl and 14 fell below 70 mg/dl. A blood glucose decrease below 70 mg/dl was not associated with symptoms. Conclusion The MMT showed that only a minority of patients reported classical DS symptoms under controlled conditions. Changes in hematocrit, heart rate, and blood sugar decrease below 70mg/dl did not help to predict symptoms in the individuals studied. The data, in the context of existing evidence, suggest that provocation tests have little value in clinical practice and that DS as a clinical entity after bariatric surgery should be reevaluated.

Rare Encounter: A Study of Oral Cavity Kaposi Sarcoma in Two Cases

Abstract Introduction/Objective Kaposi Sarcoma (KS) of the oral cavity, is an unusual vascular endothelial neoplasm and is the most common malignancy affecting the skin and internal organs in patients with AIDS. The tumor is caused by Human herpesvirus 8 (HHV-8). It rarely metastasizes and can be treated and totally cured by treating the AIDS disease. The oral cavity may be the only/ first site of KS, and therefore, is important in the diagnosis. The lesions present as multiple red-purple macules that develop into plaques or nodules. The hallmark microscopic features are spindle cell proliferation and irregular small, vascular slits, which often run parallel to the epithelium, as well as extravasated RBCs, with hemosiderin deposition and hyaline globules in 50% of lesions. HHV-8 nuclear staining is positive in all cases, which is crucial to differentiate it from other conditions with positivity for spindled cell markers: CD34, CD31, ERG, and FVIII R. The tumor can also be positive for lymphatic-specific markers (D2-40, LYVE-1, VEGFR3, and PROX1) Methods/Case Report We reviewed retrospectively archived cases from our TUH oral pathology database with available H&amp;E slides diagnosed for Kaposi sarcoma between 2013 – 2023. We retrieved two confirmed cases, and we reviewed the slides and clinical information. Results (if a Case Study enter NA) Data were colleceted and analysed. Conclusion Incorporating Kaposi sarcoma into the differential diagnosis of pigmented red-purple vascular lesions in the oral cavity is of paramount importance. Detection of Kaposi sarcoma in this region bears significant prognostic implications, often serving as an initial sign of Kaposi sarcoma and indicating HIV infection. Lesions typically localize on the palate and gingiva. Heightened awareness of this clinical entity is crucial for facilitating early detection and treatment with antiretroviral drugs. Furthermore, the differential diagnosis for lesions with similar clinical presentations encompasses a broad spectrum, including benign conditions such as pyogenic granuloma, hemangioma, bacillary angiomatosis, and even granulation issue, as well as malignant tumors like angiosarcoma. It is noteworthy that considering Kaposi sarcoma in this context prompts pathologists to prioritize ordering stains for HHV-8. This diagnostic approach is supported by the exceptional sensitivity and specificity of HHV-8 stains, which exhibit 99% sensitivity and 100% specificity for diagnosing Kaposi sarcoma, while consistently yielding negative results in all other entities within the differential diagnosis.

Adult epiglottic abscess: A rare clinical entity with a peculiar cause

Epiglottic abscess or collection of pus in the supraglottis is a rare but life threatening complication of acute epiglottitis, with a reported prevalence of 4%. It is pertinent to act fast in these cases as impending airway compromise and sepsis are a possibility. We present a peculiar case report of an adult with acute epiglottic abscess having multifactorial causation which was managed successfully by timely surgical intervention with coblation assisted Incision and Drainage.

Maxillary rhabdomyosarcoma in adult male: A rare clinical entity

Maxillary rhabdomyosarcoma in adult male: A rare clinical entity

Exploring Immunohistochemical Profiling in High-Grade Endometrial Stromal Sarcoma - A Case Study

Abstract Introduction/Objective High grade endometrial stromal sarcoma (HGESS) is a rare and aggressive tumor of endometrial stromal origin comprising about 0.2% of all uterine malignancies. It is often misdiagnosed preoperatively as uterine leiomyoma, leiomyosarcoma or endometrial carcinoma due to lack of well defined clinical and radiological features. We present an unusual case of HGESS with fibroid uterus and abnormal vaginal bleeding. Methods/Case Report A 73-year-old female with a past medical history of uterine fibroids presented with abnormal vaginal bleeding for 6 months. Her MRI uterus revealed enlarged uterus measuring 6.8 X 9.9 X 9.3 cm, multiple fibroids, and endometrial thickness of 4 mm. Hysteroscopic dilation and curettage revealed endometrial polyp and submucosal fibroid. Histopathology of submucosal fibroid revealed loosely cohesive tumor cells with high nuclear/cytoplasmic ratio, scant cytoplasm, and large prominent nucleoli, arranged in solid sheets with myxoid stroma. No glandular formation was identified. Tumor cell necrosis, bizarre tumor cells, and markedly increased mitotic activity, including atypical mitotic figures were present. Immunohistochemistry (IHC) revealed tumor cells diffusely positive for smooth muscle actin, CD10, p53, negative for AE1/AE3, CK7, cam5.2, EMA, ER, PR, desmin, and caldesmon. Ki-67 labels close to 50% of the tumor cells. Combined morphologic and IHC features favored the diagnosis of high-grade sarcoma, including leiomyosarcoma and HGESS. However, the possibility of carcinosarcoma (CS) could not be ruled out. Patient underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy. Final histopathological diagnosis revealed HGESS, pT1b. Lack of carcinomatous component and negative IHC staining for CK7, CAM 5.2, AE1/AE3 ruled out CS. IHC showed tumor cells diffusely positive for CD10, actin, desmin and CD 56, focally positive for caldesmon, cyclin D1 and CD 117 and negative for DOG 1, further supporting the diagnosis for HGESS over leiomyosarcoma. Results (if a Case Study enter NA) NA Conclusion Definitive diagnosis of HGESS is achieved through histology and IHC. An appropriate panel of IHC markers is essential to differentiate between endometrial stromal tumors from leiomyosarcoma and CS. Accurate diagnose of this rare clinical entity is critical especially in its initial stages owing to its poor prognosis and aggressive nature.