Exophytic Growth Research Articles

Imaging features of undifferentiated carcinoma of the pancreas.

The purpose of this retrospective study was to evaluate imaging features of undifferentiated carcinoma of the pancreas. The study group included eight patients with surgically resected undifferentiated carcinoma of the pancreas. Multidetector-row computed tomography (MDCT, n=8) and magnetic resonance imaging (MRI, n=6) findings were retrospectively reviewed. On MDCT, all eight cases were hypovascular with upstream main pancreatic duct (MPD) dilatation, and only 1 showed exophytic growth. Five cases (62.5%) showed necrosis/cystic change, and calcification was observed in two cases (25%). Calcification reflected tumour osteoid components. On MRI, haemorrhage and hemosiderin were observed in 4 of 6 (66.7%) cases. In addition, tumour thrombus in the splenic vein (n=1) and intraductal tumour growth in the MPD (n=2) were pathologically identified, although imaging studies only revealed 1 of these latter cases. Undifferentiated carcinoma of the pancreas may present as a tumour with haemorrhagic necrosis. Coexistence of calcification, intraductal tumour growth in the MPD and tumour thrombus may support the imaging diagnosis of this entity.

LARGE SQUAMOUS PAPILLOMA IN UNUSUAL SITE: A CASE REPORT AND REVIEW OF THE LITERATURE

Squamous papilloma is a benign proliferation of the stratified squamous epithelium, resulting in a papillary mass, which appears as sessile or pedunculated growth with cauliflower-like projection. The most common sites are palate, uvula followed by tongue and lip. Most of the time it usually presents as a solitary, exophytic growth with an average size of less than 1 cm.Here, we report the case of a 28-years-old male patient presented with a solitary sessile, white growth with multiple papillary projections on the right buccal mucosa measuring approximately 4 x 3 cm. An incisional biopsy followed by surgical excision of the lesion was performed confirming the diagnosis of squamous papilloma. This paper highlights a case of unusually large-sized papilloma in an uncommon site.

Extensive Squamous Metaplasia in Hidradenoma Papilliferum of Vulva: Illusion of Squamous Cell Carcinoma

Hidradenoma papilliferum is a rare, slow-growing, benign, cystic, papillary tumour occurring in middle-aged females, in the anogenital region commonly. It involves the anogenital mammary-like glands and is usually asymptomatic. Simple excision is curative. We present a case of hidradenoma papilliferum of long-standing duration with extensive squamous metaplasia. A post-menopausal lady presented with an exophytic growth on the left labia majora and part of mons pubis. It was initially misdiagnosed on the basis of vulvar biopsy and managed as squamous cell carcinoma of the vulva. The final histopathology revealed an epithelial tumour involving the vulva with extensive squamous metaplasia. The tumour involved mainly the dermis and the subcutaneous tissue. This is the first case in the literature where the diagnosis of hidradenoma papilliferum was confused with squamous cell carcinoma of the vulva due to its clinical presentation and extensive squamous metaplasia. Diagnosis of hidradenoma papilliferum should be kept in mind if a woman presents with vulval papillary or nodular lesions. An expert clinical and histopathological review should be done to avoid misdiagnosis.

Computed tomographic characteristics of gastric schwannoma.

ObjectiveThis study aimed to characterize the computed tomographic (CT) features of gastric schwannoma (GS).MethodsWe retrospectively reviewed CT images of 19 cases of histologically proven GS between January 2010 and December 2015. Tumor location, size, contour, margin, growth pattern, and degree and pattern of enhancement, perigastric lymph nodes, ulceration, necrosis, and calcification were evaluated.ResultsGS was located in the gastric body (73.7%), gastric antrum (15.8%), and gastric fundus (10.5%), with a mean maximum diameter of 4.5 ± 1.8 cm. All tumors presented as oval, well-defined solid masses, with exophytic (36.8%), endoluminal (15.8%), or mixed (47.4%) growth patterns. Ulcers (57.9%) and perigastric lymph nodes (47.4%) were observed. Moderate enhancement (87.5%) was observed in the portal phase. Eighteen (94.7%) cases showed homogeneous enhancement.ConclusionsGS typically presents as a mass in the stomach with an exophytic or mixed growth pattern, moderate homogeneous enhancement, and is prone to be accompanied by perigastric lymph node inflammatory reactive swelling. Larger GSs are more likely to be associated with ulcers.

Differentiation of aggressive from non-aggressive pancreatic solid pseudopapillary neoplasms using computed tomography.

Microscopic aggressive behaviors may be related with the prognosis of solid pseudopapillary neoplasms (SPNs). In this study, we investigate computed tomography (CT) features and differential diagnosis of aggressive and non-aggressive SPNs in pancreas. 122 patients with pathologically proven SPNs in pancreas were included. Patients' age, tumor site, texture, shape, margins, exophytic growth, capsule, calcification, hemorrhage, pancreatic duct dilatation or pancreatic parenchyma atrophy, peripancreatic infiltration or metastases, vascular encasement, and enhancement pattern were assessed. The diagnostic accuracy was analyzed by using the receiver operating characteristic curve (ROC). There were 30 aggressive SPNs and 92 non-aggressive SPNs. Aggressive SPNs showed significantly higher frequencies of an ill-defined margin, patient age > 40.5years, and tumor size < 42.1mm, but lower frequencies of complete capsule, hemorrhage compared with non-aggressive SPNs (p < 0.05). Lack of complete capsule and age > 40.5years were independent risk factors of aggressive SPNs (odd ratio 7.08 and 3.1, respectively). When we applied the two predictors in the logistic regression model, the area under the curve (AUC) was 0.77 with sensitivity of 86.7% and specificity of 55.4%. Size less than 42.1mm, lack of complete capsule, ill-defined, and absent bleeding are useful CT imaging features for predicating aggressive SPNs. Patient age > 40.5years and lack of complete capsule showed acceptable diagnostic performance for discriminating aggressive from non-aggressive SPNs.

Treatment: the role of contact X-ray brachytherapy (Papillon) in the management of early rectal cancer.

Treatment: the role of contact X-ray brachytherapy (Papillon) in the management of early rectal cancer.

Highly invasive and poorly differentiated corneal squamous cell carcinoma in a dog

BackgroundPrimary corneal tumors are unusual in dogs although there has been a rise in the prevalence of canine corneal squamous cell carcinoma in the past decades due to different factors. Exposure to ultraviolet radiation, presence of chronic keratitis or history of superficial trauma are some of them. We report for the first time a highly infiltrative corneal neoplasia with both exophytic and deep stromal growth, which presented atypical histologic features of a squamous cell carcinoma.Case presentationAn adult male French bulldog was referred with an exophytic, pink to white gelatinous mass occupying approximately 70% of the central cornea on the right eye. Histological findings from the excisional biopsy were consistent with corneal carcinoma and transconjunctival enucleation was performed at the request of the owner. A final diagnosis of primary corneal squamous cell carcinoma was done based on the squamous differentiation observed in the neoplastic cells of the superficial layers. However, cells in deeper layers were less differentiated, showed pseudoacinar formations and did not expressed marker for stratified squamous epithelium (i.e., cytokeratin 5/6). The dramatic thickening of the cornea and the fact of observing neoplastic cells almost at the level of the Descemet’s membrane make this case very unusual as the squamous cell carcinoma in dogs tends to involve the superficial stroma or colonize the corneal surface as an exophytic lesion.ConclusionsBased on the histological findings, a high infiltrative and poorly differentiated corneal squamous cell carcinoma was diagnosed. In terms of clinical relevance, our results suggest that corneal lesions compatible with neoplasia need an early diagnosis in order to prevent the aggressive growth of the tumor and the enucleation of the eye.

Frequency and radiological characteristics of previously overlooked renal cell carcinoma.

BackgroundA majority of renal tumors are incidentally detected and may therefore have been previously radiologically overlooked. PurposeTo investigate the frequency of previously radiologically overlooked renal cell carcinoma (RCC), identify tumor characteristics and imaging factors that contribute to misdiagnoses and to investigate its consequences. Material and MethodsAll RCCs identified in a regional cancer registry over one year were retrieved (n = 87). All preceding radiological examinations were re-analyzed for overlooked RCCs. ResultsRCCs had been previously overlooked in 18 (21%) of the 87 patients (on 26 examinations: computed tomography [CT] = 16, magnetic resonance imaging [MRI] = 5, urography = 3, ultrasound = 2) or 18 (43%) of the 42 patients who had earlier radiological examinations. Overlooked RCCs were smaller than non-overlooked RCCs (median = 23 mm; range = 10–45 mm vs. 65 mm; range = 13–207 mm) (P < 0.0001), more frequently located in upper pole, 50% vs. 26% (P = 0.0836), and more frequently homogenous, 50% vs. 9% (P = 0.0003). There was no difference in exophytic growth (60% vs. 60%) (P = 0.74). Overlooked RCCs displayed poorer visualization on CT/MRI in all image planes (axial, coronal, sagittal) compared to non-overlooked tumors (P = 0.004, P = 0.001, P < 0.0001, respectively). Overlooked tumors had interval size progression of median 12 mm (range = 0–65 mm) to clinical detection (median = 1033 days). ConclusionsRCCs are frequently overlooked at imaging in the clinical routine. Overlooked tumors were smaller and displayed poorer visualization in all image planes compared to non-overlooked tumors. Substantial delay to clinical diagnosis and variable size progression was noted. Careful attention to the kidneys in multiple image planes seems warranted, irrespective of clinical indication.

Tissue curvature and apicobasal mechanical tension imbalance instruct cancer morphogenesis.

Tubular epithelia are a basic building block of organs and a common site of cancer occurrence1-4. During tumorigenesis, transformed cells overproliferate and epithelial architecture is disrupted. However, the biophysical parameters that underlie the adoption of abnormal tumour tissue shapes are unknown. Here we show in the pancreas of mice that the morphology of epithelial tumours is determined by the interplay of cytoskeletal changes in transformed cells and the existing tubular geometry. To analyse the morphological changes in tissue architecture during the initiation of cancer, we developed a three-dimensional whole-organ imaging technique that enables tissue analysis at single-cell resolution. Oncogenic transformation of pancreatic ducts led to two types of neoplastic growth: exophytic lesions that expanded outwards from the duct and endophytic lesions that grew inwards to the ductal lumen. Myosin activity was higher apically than basally in wild-type cells, but upon transformation this gradient was lost in both lesion types. Three-dimensional vertex model simulations and a continuum theory of epithelial mechanics, which incorporate the cytoskeletal changes observed in transformed cells, indicated that the diameter of the source epithelium instructs the morphology of growing tumours. Three-dimensional imaging revealed that-consistent with theory predictions-small pancreatic ducts produced exophytic growth, whereas large ducts deformed endophytically. Similar patterns of lesion growth were observed in tubular epithelia of the liver and lung; this finding identifies tension imbalance andtissue curvature as fundamental determinants of epithelial tumorigenesis.

A clinicopathological study of upper aerodigestive tract cancers.

The upper aerodigestive tract (UAT) includes the nose and paranasal sinuses, oral cavity, pharynx, larynx, and salivary glands. Cancers of the UAT constitute approximately 4% of all malignancies. In this study, the varied nature of the UAT cancers was studied to find out their incidence, etiology, and clinicopathological correlations. This prospective, observational, and clinicopathological study was conducted on 100 patients who were presented at outdoor in the Department of ENT, Government Medical College/Rajindra Hospital, Patiala, Punjab, India, from October 2016 to October 2018. Proven cases of UAT cancers were taken up and reviewed to gather data on multiple clinicopathological variables, such as age, sex, predisposing factors, and site of pathology. Histopathological differentiation was noted after conducting a biopsy. Most patients of UAT cancers were in the age group of 40-70 years. Maximum incidence was among males (82%) compared to females (28%). The most common predisposing factor was alcohol + smoking (28%), followed by alcohol + chewing tobacco (25%). The most common symptom in the oral cavity was ulcer and odynophagia (38%) each. In oropharyngeal cancers, dysphagia (92%) was the most common symptom. In laryngeal cancers, dyspnea (68%) and hoarseness of voice (32%) were the most common. The most common site involved in UAT cancers was the oral cavity (31%), followed by oropharynx (28%), larynx (22%), hypopharynx (7%), and salivary gland (5%). The most common histopathological type was squamous cell carcinoma (SCC) (90%). Most of the ulceroproliferative and exophytic growth was moderately differentiated SCC on histopathology. Studies are essential for education and awareness aimed at reducing exposure to habit-forming substances.

Glypican-3 and Hep Par-1 are Useful Biomarkers in the Cytologic Assessment of Ascites.

Till date, the utility of cytologic assessment of ascites for the identification of hepatocellular carcinoma (HCC) cells is still debated and the usefulness of immunocytochemistry for glypican-3 (GPC3) and Hep Par-1 in this setting has not been reported. Liquid-based cytology of ascitic fluid of 28 cirrhotic patients was performed and the spots obtained were stained with hematoxylin and eosin, papanicolau, and with GPC3 and Hep Par-1 antibodies. GPC3 and Hep Par-1 antibodies stained positively the atypical cells in the ascites of 2 patients with HCC showing an exophytic growth pattern. The specimens of the patients with nonexophytic HCC, other non-HCC cancers, or cirrhosis stained negatively. We hypothesize a relationship with the exophytic growth of the tumor. Thus, GPC3 and Hep Par-1 are useful in the cytologic assessment of peritoneal effusions to distinguish mesothelial cells and neoplastic non-HCC cells from HCC cells, presence of which, however, represent a very rare event. This is the first study in which GPC3 and Hep Par-1 immunostaining has been used in the cytologic assessment of HCC ascites.

Laparoscopic resection of gastrointestinal stromal tumors (GIST) of the small intestine: a case report

Although gastrointestinal stromal tumors (GISTs) are a rare type of cancer, they are the commonest mesenchymal tumors of the gastrointestinal tract (GIT). GISTs can affect any segment of the GIT, but the usual location is the stomach, followed by the small intestine. Surgical resection of the tumor is the gold standard treatment for localized GISTs, and in patients with inoperable and metastatic disease, imatinib mesylate is the standard treatment. Pathological diagnosis is based on morphology and immunohistochemical findings. We report the case of a 55-year-old man with jejunal GIST presenting with endophytic and exophytic growth, located in the proximal jejunum. He had history of melena, anemia and one episode of enterorrhagia, and was treated with surgical resection of the lesion.Keywords: Gastrointestinal stromal tumor; gastrointestinal neoplasms

Endobronchial metastasis from extrathoracic malignancies: A clinicopathological study of 11 cases.

Introduction:Endobronchial metastases are uncommon. It accounts for 2-28%. Most common tumors that metastasis to the endobronchial site are breast, renal, endometrial and colon carcinomas. They have to be identified properly because they present poor prognosis and different treatment modalities when compared to that of primary lung carcinomas.Materials and Methods:We studied a total of 11 retrospective cases of Endobronchial metastasis. Detailed clinic pathological and radiological findings were analyzed along with a detailed Immunohistochemical workup and Endobronchial findings.Results:Mean age of presentation was 55 years with female predominance (Male to female ratio was 1:1.2). Most common tumors encountered were carcinoma breast (3), colorectal carcinomas (2), renal cell carcinoma (2) followed by one each from carcinoma endometrium, cervix and thyroid. Common symptom was cough followed by dyspnea. Exophytic endobronchial growth was common with right main bronchus being the common site.Conclusion:Endobronchial metastasis occurs in various types of malignancies. It should always be differentiated from primary lung carcinomas as they carries poor prognosis and different treatment protocol when compared to that of primary lung tumors.

Palatal pyogenic granuloma: An unusual complication following mucogingival surgery for alveolar socket preservation

We report a case of palatal pyogenic granuloma following mucogingival surgery for alveolar socket preservation. A 24-year-old systemically healthy female underwent a pediculated palatal pedicle graft procedure to achieve soft tissue augmentation over a grafted maxillary anterior extraction site. After 1 month, a 15 mm × 20 mm exophytic growth extending from the palatal donor site to distance of 3–4 mm from the extraction socket was observed. After obtaining the subject's consent, local anesthesia was administered and the growth was excised from the base. On histopathological examination, the findings suggestive of pyogenic granuloma were seen. Palatal pyogenic granuloma occurs rarely and the authors were unable to find the reports of pyogenic granuloma originating in the vicinity of a surgical wound after a pediculated connective tissue mucogingival procedure. Healing plays a vital role in mucogingival procedures, and thus, it is very important to know about the complications affecting this important cascade of events. Failing to consider potential sources of irritation or trauma at the surgical site may lead to considerable morbidity even in sites that may heal without any untoward complications.

Adenoid cystic carcinoma of palate: A rare case report

A 40-year-old female patient reported to the department with the complaint of a single growth and pain in the upper right back tooth region for 1 year. Intraoral examination revealed a single unilateral exophytic growth seen on the right upper pterygomandibular raphe region. Extraoral examination revealed no facial asymmetry and no evidence of lymphadenopathy. Histopathological examination revealed a hyperparakeratotic stratified squamous epithelium of variable thickness with broad and flattened rete ridges. Lesional tissue showed large sheets of cells surrounded by condensed collagen component. The lesional cells were basaloid in appearance with hyperchromatic nucleus predominately arranged in a cribriform pattern along with eosinophilic material. No evidence of perineural invasion was observed in serial sections. On the basis of these findings, the diagnosis of adenoid cystic carcinoma was established.

Сравнительный анализ результатов лапароскопической и ретроперитонеоскопической резекции почки в зависимости от вида временного и окончательного гемостаза

to carry out a comparative analysis of treatment results of patients with renal tumors who were undergone to nephron-sparing surgery, depending on the type of temporary and definite hemostasis. a total of 163 laparoscopic partial nephrectomies were performed by single surgeon from January 2015 to July 2018. The comparative analysis of treatment results of patients with renal tumors based on following parameters: tumor stage, features of the tumor site, the duration of surgery, the amount of blood loss, complications rate and grade as well as functional and oncological outcomes, depending on the type of temporary and definite hemostasis, was conducted. For preoperative planning the generally accepted nephrometric scale R.E.N.A.L. was used as well as 3D-reconstruction of the tumor. Of the 163 patients, 64 were women (39.3%). The mean age of patients was 56.7+/-11.1 (25-80 years). A clinical stage T1a, T1b, T2 and T3a was diagnosed in 77, 20, 2 and 64 cases, respectively. The average tumor size was 34.8+/-1.1 (11-78 mm). The mean operative time was 84.5+/-32.2 min (30-180). Laparoscopic transperitoneal access was used in 90 patients (55.21%), retroperitoneoscopic approach was chosen in 73 cases (44.79%). The tumor had exophytic growth in 110 cases (67.5%) and in 53 cases it was endophytic (32.5%), while in 59 cases it localized in renal sinus (36.2%). The operative time was significantly shorter in the Group of zero ischemia (72.2+/-29.02 [p<0.001]) and bipolar coagulation of the tumor bed (60.8+/-31.7 [p<0.001]). The mean volume of blood loss was 160.8+/-142.7 ml (30-900). A GFR calculated by the MDRD equation (mean level was 75.7 ml/min/1.73 m2) on the next day and 6 months after surgery showed a slight decrease in group of zero ischemia, compared to other groups: next day and 6 months after surgery it was 72.8+/-21.6 (p<0.001) and 72.01+/-16.6 (p=0.025), respectively. A simple enucleation was performed in 41 cases, while enucleoresection was done in 70 cases. A collection system was opened in 22 cases (13.5%+/-9.8). The suturing and clipping were performed in 20 and 2 patients, respectively. In 2 cases a stenting was performed. In 2 cases there was hemoglobin drop requiring blood transfusion (1.2%+/-3). An embolization due to refractory bleeding was required in 3 cases (1.8%+/-3.7). There was no conversion to open surgery or nephrectomy. Of the 163 tumors, a malignancy was diagnosed in 151 (92.6%+/-7.5) cases. There was no positive surgical margin and recurrence of the tumor. Laparoscopic partial nephrectomy can be successfully performed under zero ischemia. The intervention without clamping of renal blood vessels contributes to significant preservation of the renal function.

Dehydrated human amnion/chorion membrane (dHACM) closure in giant perianal condyloma acuminata (Buschke-Löwenstein tumor)

Abstract Current gold standard treatment of Buschke-Lowenstein tumor (BLT) is surgical excision. Surgical excision in the perianal region leaves a large area to be covered and bears the risk of poor wound healing as well as infection. Dehydrated human amnion/chorion membrane (dHACM) has been proven to be beneficial in wound closure and has been used in many cases, such as deep ulcers, ophthalmological surgeries, tendon repairs, etc. We report a case of 14-month old boy presented with mass from perianal region since six months prior to visit in Dr Soetomo General Hospital Surabaya. From physical examination, pedunculated exophytic growth with cauliflower-like appearance was found and because of the mass size, the anal opening and the rectum was difficult to be evaluated. CT scan obtained showed heterogenous solid mass with multiple calcification with size of ±7,62 × 6,58 × 3,12 cm in perineal cutaneous and subcutaneous tissue that encases the anus and anorectal area. Surgery was performed to remove the mass and the wound was closed with dHACM. Patient healed well without signs of infection nor excessive scarring. Hence, dHACM could be an excellent option in closing wound post excision in BLT cases.

Recurrent Peripheral Giant Cell Granuloma: A Case Report

Objective: This article describes a case of a Peripheral Giant Cell Granuloma (PGCG) in a girl. Introduction: PGCG is a relatively infrequent benign reactive lesion of the gingiva or alveolar ridge that develops in response to local irritation. Clinical appearance consists of a firm or soft smooth surface nodule in dissimilar colors of varying size with sessile or pedunculated implantation base. Radiographic features are generally nonspecific, thereby definitive diagnosis depends on microscopic examination to confirm the entity of PGCG. Case Report: A 6-year-old female patient was referred to the outpatient clinic of an Oral &amp; Maxillofacial Surgery Department with the chief complaint of an intraoral swelling. The intraoral examination showed a painless sessile mass with exophytic growth similar to a tumorous lesion located on the mandibular alveolar ridge extending from distal aspect of right mandibular primary canine to mesial aspect of first permanent molar of the same side. Conclusion: Peripheral giant cell granuloma is a relatively uncommon lesion in children and potential for collaboration with the treatment in young patients should be considered for a successful therapeutic approach.

UNUSUAL PRESENTATION OF TB IN AN ENDEMIC COUNTRY

SESSION TITLE: Pulmonary SESSION TYPE: Global Case Reports PRESENTED ON: 10/10/2018 01:00 PM - 02:00 PM INTRODUCTION: Endobronchial tuberculosis is the tuberculous infection of tracheobronchial tree with histological and microbiological evidence1. Diagnosis of endobronchial tuberculosis remains a challenge, in cases with normal chest radiograph. Endobronchial tuberculosis is highly contagious and delayed diagnosis leads to sequelae of broncho-stenosis. We report three cases of endobronchial tuberculosis diagnosed by bronchoscopy from a tertiary care hospital in Chennai, India. CASE PRESENTATION: Case-1: 48 year old male, with no known comorbidities, presented with hoarseness of voice, dry cough and breathlessness for 6 months. Chest radiograph was normal. Computed tomography showed nodularity of inner surface of trachea. Bronchoscopy revealed pseudomembranous form, corresponding to actively caseating variety of endobronchial TB( figure-1). Bronchial wash and brush showed many acid fast bacilli and bronchial biopsy showed granulomatous inflammation. Bronchoscopy repeated after a course of anti tuberculous treatment showed normal mucosa.Case-2: 31 year old female, presented with dry cough and fever since 6 weeks. Chest x-ray showed right perihilar opacity. CT chest showed few irregular, fluffy opacities in the right upper lobe and right hilar adenopathy. Bronchoscopy revealed tumorous variety with exophytic growth from RUL bronchus( figure-2). Bronchial wash and brush showed many acid fast bacilli and bronchial biopsy showed granulomatous inflammation.Case-3: 66 year old lady, a case of right renal cell carcinoma, with history of pulmonary tuberculosis 15 years back, presented with persistant fever and dry cough for 1 month and was evaluated to have right upper lobe fibrosis and nodular opacities in right upper lobe and left lower lobe on CT Chest. Bronchoscopy revealed ulcerative lesions in right tracheobronchial angle and right lower lobe apical segment(figure-3). Bronchial wash showed many acid fast bacilli and bronchial biopsy showed granulomatous inflammation. DISCUSSION: Endobronchial TB usually occurs in young patients2. Diagnosis is often challenging due to its wide range of presentations, clinically resembling bronchial asthma, foreign body, recurrent non resolving pneumonia, bronchogenic carcinoma. Seven types of endobronchial presentations based on bronchoscopic appearance include actively caseating, edematous hyperaemic, fibrostenotic, tumorous, granular, ulcerative, nonspecific bronchitis3. We hereby report actively caseating, tumurous and ulcerative varieties. Delayed diagnosis leads to multiple, irreversable complications like bronchial stenosis and strictures, airway obstruction, para cicatrical bronchiectasis, hemoptysis and atelectasis. CONCLUSIONS: Bronchoscopy remains investigation of choice for early diagnosis and followup, in cases of high clinical suspicion for tuberculosis with dry cough or sputum negative. Timely diagnosis prevents various complications and infection control. Reference #1: Hoheisel G, Chan BK, Chan CH, et al. Endobronchial tuberculosis : Diagnostic features and therapeutic outcome. Respir Med 1994; 88 : 593-97. Reference #2: M. S. Ip, W. K. Lam, S. Y. So, and C. K. Mok, “Endobronchial tuberculosis revisited,”Chest,vol.89,no.5,pp.727–730,1986 Reference #3: Winner-Muram HT, Rubin SA. Thoracic complications of tuberculosis. J Thoracic Imag 1990; 5 : 46-63 DISCLOSURES: No relevant relationships by ANILKUMAR GANDHAM, source=Web Response No relevant relationships by A. Gayathri, source=Admin input

Primary Laryngeal Tuberculosis: A Series of 15 Cases.

Tuberculosis usually involves the lungs, but can also involve various other organs. Extra pulmonary tuberculosis is very rarely confined to the larynx in the absence of an associated pulmonary lesion. In this retrospective study, clinicopathological characteristics of patients with final diagnosis of laryngeal tuberculosis (LTB) were reviewed. The diagnosis of LTB was based on: (1) the existence of chronic granulomatous inflammation with caseous necrosis in the histopathology of laryngeal lesions or (2) the presence of laryngeal lesions with atypical histopathology (chronic granulomatous inflammation) which had a complete response to anti-tuberculosis therapy. Fifteen cases with a diagnosis of LTB were collected. The patients' age ranged between 24 and 75years with a mean of 49years. On laryngoscopy, 66.6% of cases (10/15) had an ulceroproliferative lesion while the remaining 33.3% of cases (5/15) had an exophytic growth. The pathology of laryngeal lesions revealed chronic granulomatous inflammation with caseous necrosis in nine cases and chronic granulomatous inflammation without necrosis in six cases. Nine out of 15 cases (60%) showed presence of acid-fast bacilli on Ziehl-Neelsen stain. Any evidence of pulmonary tuberculosis was ruled out by chest X-ray findings. The response to anti-tuberculosis therapy was desirable in all patients. Since the introduction of anti-tuberculous therapy, the incidence of LTB has declined. However, with the incidence of TB increasing, the overall incidence of laryngeal involvement may be on the rise. This study highlights the importance to consider the rare possibility of LTB in the presence of non-specific clinical and laryngoscopic signs and to confirm this by histological examination.