Histopathological Examination Report Research Articles

Clinical assessment of ectopic pregnancy in a tertiary care hospital: An observational study

Background: Ectopic pregnancy is defined as pregnancy that occurs outside normal uterine cavity that occurs due to implantation of fertilized ovum in an aberrant site which is conducive to its growth and development. In developing countries like India, late presentations with tubal rupture and hemodynamic instability, late presentations with tubal rupture causes first trimester maternal morbidity and mortality. For early diagnosis, a clinician should be well aware about the various presentations of ectopic pregnancy. Aims and Objectives: (a) To estimate the incidence, risk factors, clinical manifestations and outcome following different management protocol. (b) To estimate the morbidity and mortality with respect to different types of presentation and management. (c) To understand the need for clinical assessment in order to diagnose early and provide urgent intervention and also to lean toward the possibility of conservative approach in order to preserve fertility. Materials and Methods: The current study was a time bound, Observational descriptive study with Longitudinal design. It was conducted in the Department of Obstetrics and Gynecology, R. G. Kar Medical College and Hospital, between March 2021 and August 2022. One hundred and thirty-eight participants, suspected to have ectopic pregnancy were enrolled for the study. Data collection was done by detailed history taking and physical examination. The basic investigations including hemoglobin, ABO and Rhesus typing, urine pregnancy test, and ultrasound (USG) examination were done. All data were collected on a structural data form and analyzed for descriptive statistics. Post-operative histopathological examination (HPE) reports were collected and final diagnosis was made. Results: About 63.8% of the study population belonged to 21–30 years of age. About 63.7% patients presented with >5–8 weeks of amenorrhea. About 18.1% of the study population were sterilized and the duration between the sterilization and the occurrence of ectopic was 4–10 years in 64% patients. The most common risk factor was h/o Previous C-section (31.8%). The most common clinical symptom was abdominal pain present in 131 (94.9%), 44 (31.9%) participants had all the three classical symptoms with 100% specificity. On examination, forniceal fullness/tenderness was the most specific finding. The most common USG finding was Adnexal mass with empty Uterine cavity with Free fluid (49.2%). Most of the patients were managed with Partial Salpingectomy (30.4%). The final diagnosis of ectopic was made in 129 patients, which was confirmed by HPE reports in 124 patients. Five patients underwent medical treatment. Conclusion: Early diagnosis before rupture and referral are the key factor in reducing the maternal morbidity and mortality.

A rare case of pineoblastoma – Case report

Pineoblastoma is a very rare and aggressive malignant tumor of pineal gland. We report a case of 12-year-old male patient presented to S.V.P. tertiary care hospital with complain of progressive loss of vision in both eyes with nausea and headache. On examination bilateral upward gaze palsy was present. The magnetic resonance imaging report revealed possibility of pineal Germinoma. The patient underwent ventriculoperitoneal shunt insertion surgery for obstructive hydrocephalus and suboccipital craniectomy for tumor resection. The Histopathological examination report stated the tumor as Pineoblastoma, Grade IV. Immunohistochemistry studies were positive for synaptophysin and Integrase interactor-1 (INI-1) markers with high ki-67 labelling index and negative for CD-117 and Glial fibrillary acid protein (GFAP) markers. Microscopic and Immuno histochemisty findings are important to differentiate pineoblastoma from other pineal region tumors.

Predicting the Lymphovascular Invasion in Carcinoma Bladder at Transurethral Resection.

Bladder cancer is among the most common malignant neoplasms in the world. Transurethral resection of bladder tumor (TURBT) is consideredthe standard procedure for diagnosis, staging, and risk classification of bladder tumors. Lymphovascular invasion (LVI) is considered a poor prognostic factor. Its assessment of TURBT is very important for risk stratification and decision-making for further treatment. The purpose of our clinical study is to attempt to predict/assess the correlation between LVI and various preoperative (age, gender, history of smoking, hematuria, urine cytology, and hydronephrosis/hydroureteronephrosis), intraoperative (tumor number, size, and appearance - sessile/ pedunculated) and histopathological (tumor histology, grading, and muscle invasion) factors. In this prospective study, 75 patients with bladder tumors underwent TURBT (standard monopolar TURBT with 1.5% glycine as irrigation solution) in the Department of Urology at Sri Venkateswara Institute of Medical Sciences (SVIMS), Tirupati between October 2021 and March 2023. Histopathological examination (HPE) reports were looked for the presence or absence of LVI. Accordingly, patients were divided into two groups, i.e., those with LVI and those without LVI. Various preoperative and intraoperative variables were analyzed for each subject in both groups. Statistically significant variables occurring in those patients with LVI compared to those without LVI were considered predictors of LVI in bladder tumors. Results: Sixteen patients out of 75 (21.33%) had LVI on their histopathology examination. The mean age was 68.19 years in the group with LVI and 64.14 years in the group without LVI. A total of 60 men (80%) and 15 women (20%) were included in our study. Thirteen men (21.7%) and three women (20%) were found to have LVI. We observed a significant association between the appearance of the tumor and LVI. Fifty-four subjects in our study had sessile tumors. Fifteen out of them (27.8%) hadLVI, while only one out of 21 patients (4.8%) with pedunculated tumors had LVI (p-value=0.028). 30% of subjects who had high-grade tumors on HPE also had LVI. On the contrary, only one of 25 patients (4%) with low-grade tumors had LVI (p-value=0.010). Our study also showed a significant association between muscle invasion and LVI. Thirty-four (45.3%) and 41 (54.7%) patients had muscle-invasive and non-muscle-invasive tumors, respectively. While 12 (35.3%) patients with muscle-invasive tumors had LVI, only four (9.8%) patients with non-muscle-invasive tumors showed LVI (p-value=0.007). We observed that LVI of bladder tumors at first TURBT is significantly associated with tumor grade, tumor appearance, and depth of invasion of the tumor. Though statistically not significant, we further observed that LVI was more commonly found in smokers, patients with hematuria, and larger tumor sizes. We conclude that these factors can be used as reliable predictors of LVI of bladder tumors at their first TURBT.

Diagnostic Accuracy of Frozen Section Analysis and Factors Associated with Discordance of Final Histopathology in Mucinous Ovarian Tumor

Aim and Objective This article determines the diagnostic accuracy of frozen section (FS) in case of mucinous ovarian tumor (MOT) and tailoring of intraoperative treatment decision. Material and Methods This was an observational study in which retrospective data was analyzed prospectively from January 2008 to December 2015 at the Regional Cancer Center. This study included 158 patients with MOT who underwent FS analysis during staging laparotomy at our institute. FS's sensitivity, specificity, and diagnostic accuracy were calculated and compared with final paraffin histopathological examination (HPE). Univariate and multivariate analyses were done to decide factors associated with changes in final HPE. Results FS analysis and final HPE report were concordant in 77.8% (123/158) of the cases and discordant in 22.1% (35/158). Out of 35 discordant cases, 29 (18.3%) were upgraded and 06 (5.6%) were downgraded. Out of 33 borderline cases, 16 (48.4%) were upgraded to malignant MOT and 6 (18.1%) were downgraded to benign MOT on final HPE. Out of 40 malignant MOT, 40 (100%) showed malignancy on final HPE. In the case of benign MOT on FS, 13 out of 85 (15.2%) upgraded to borderline or malignant. Sensitivity and specificity of FS were 76.60 and 55.17%, respectively, for benign MOT, 55.17 and 86.96% for borderline MOT, and 86.96 and 100% for malignant MOT. Conclusion In MOT, due to its large size and heterogeneous nature, it displays spectrum of appearance ranging from benign cyst adenoma, and borderline tumor to adenocarcinoma. Our study showed significant discordance between FS and final histopathological diagnosis in borderline MOT.

Prospective randomized study correlating intra-operative urethral mucosal injury with early period after transurethral resection of the prostate stricture urethra: A novel concept

ObjectiveTo investigate the incidence of urethral stricture during the early period after transurethral resection of the prostate (TURP) and correlate its incidence with intra-operative urethral mucosal injury during TURP. Also to compare the other established risk factors affecting the development of urethral stricture among patients undergoing monopolar or bipolar TURP over a period of 6 months follow-up as the prospective randomized study. MethodsOne hundred and fifty men older than 50 years with lower-urinary tract symptoms associated with benign prostatic hyperplasia were randomized to undergo either standard monopolar TURP with glycine as the irrigation fluid or bipolar TURP with normal saline as irrigant. The prostate size, operative time, intra-operative mucosal rupture, catheter time, catheter traction duration, uroflowmetry, and post-operative stricture rate were compared. ResultsA total of 150 patients underwent TURP, including 74 patients undergoing monopolar TURP (one patient was excluded as his post-operative histopathological examination report was of adenocarcinoma prostate) and 75 patients undergoing bipolar-TURP, all of which were performed using a 26 Fr sheath resectoscope. The mean International Prostate Symptom Score and maximum urinary flow rate score at post-operative 3 months and 6 months were comparable between the groups. Out of 149 patients, nine patients (6.0%) developed urethral stricture. The severity of the injury (urethral mucosal injury) correlated with the likelihood of developing a subsequent complication (stricture urethra). Patients with stricture had significantly larger prostate volume than patients without stricture (65.0 mL vs. 50.0 mL; p=0.030). Patients with stricture had longer operative time than patients without stricture (55.0 min vs. 40.0 min; p=0.002). In both procedures, formation of post-operative stricture urethra was independently associated with intra-operative mucosal injury. ConclusionIntra-operative recognition of urethral mucosal injury helps in prediction of stricture urethra formation in early post-operative period.

Delay in final opinion of autopsy requiring Histo-pathological and chemical analysis

Examination of viscera by pathologist or chemical examiner is a must in cases where the cause of death is not confirmed/ could not be ascertained during the autopsy. Viscera is handed over to police to be taken to respective laboratories for histopathological examination or chemical analysis or for both. This leads to delay in giving the final opinion regarding the cause of death.: To study the delay in giving the final opinion of a particular case from the day of postmortem examination. Study included autopsy cases done in the year 2015 and 2018. The data was collected from the PMR, histopathological and toxicological examination reports and from the final opinion. Delay/ time taken at different levels was studied and the average delay at each level was calculated. Average delay for final opinion was found to be 561 and 378 days for the year 2015 and 2018, respectively. In one case this time taken was more than 7 years. About 63% of the cases studied are still awaiting final disposal.

IS HISTOPATHOLOGICAL EXAMINATION OF EXCISION MATERIAL IN PILONIDAL SINUS SURGERIES A WASTE OF COST, TIME AND LABOR?

INTRODUCTION
 Pilonidal sinus (PS) surgery is one of the most common operations performed in general surgery. Although different treatments are used nowadays, the main treatment of the disease is still surgical excision. Malignant degeneration is very low in patients with chronic pilonidal sinus.Cases have been reported in the literature as case reports. In this study, we aimed to reveal the necessity of routine histopathological examination of the excision material in PS surgery.
 
 MATERIAL & METHODS 
 We have considered patients in our hospital database, who had pilonidal sinus surgery with a diagnosis of PS retrospectively. 939 patients , whose histopathological examination reports of PS excision specimen were accessed , were included in the study.
 
 RESULTS
 Of the 939 patients included in the study, 721 of which (76.8%) are male and 218 of which (23.2%) are female. The mean age of the patients is 25.6 ± 7.4 (min- max :59) years. The number of patients over 50 years was 24 (2.6%). The number of patients operated with recurrent pilonidal sinus was 26 (2.8%). No malignancy was observed in any of the histopathological examinations of 939 excision materials.
 
 CONCLUSION
 No malignancy has been detected in any of our PS cases in the histopathological examination. The necessity of routine histopathological examination of PS excision materials should be questioned and discussed. It causes both a waste of time and money. However, it can be considered for the patients over 50, since the literature shows an increase in risk of malignancy after this age.

Pattern of suspicious deaths of married females brought for medico-legal autopsy at teaching institute of India.

Death is unnatural and suspicious when it is caused by external causation like injury or poisoning or other than natural course. In such deaths of married females, the inquest is carried out, and a medico-legal autopsy is conducted to ascertain the cause of death and manner of death. This record-based, retrospective study was carried out at RVRS Medical College, Rajasthan in the year 2021 (1st January, 2021 to 31st December, 2021) to know the pattern of the suspicious death of married females brought for medico-legal autopsy. The inquest report, medico-legal autopsy report, histopathological examination report, and chemical analysis report findings were tabulated and analyzed. The maximum number (31.62%) of female deaths belonged to the age group of 18-22 years of age. A total of 33.82% of females died during a marriage duration of less than 5 years of married life. A total of 22.79% of female deaths were related to dowry and 60.2% of females belonged to rural areas. A total of 59.56% of females were died due to poisoning and 75% of female deaths considered suicidal. Suspicious deaths of married women brought for medico-legal autopsy must be dealt with due to precaution to determine the cause and manner of death. One must be vigilant that the suspicious death of a married female may be associated with dowry in the Indian scenario.

Modified mandibulotomy as an approach to parapharyngeal space tumors: a case report

BackgroundA mandibulotomy approach has been introduced for removal of posteriorly-based tumors of the oral cavity, oropharynx, and certain parapharyngeal tumors with minimum morbidity.Case presentationA middle-aged male presented with a left-sided upper neck mass for last year and difficulty in swallowing for the past six months. A previous history of sclerotherapy and incision and drainage was present and a histopathological examination report from the incision and drainage-derived tissue was suggestive of lymphangioma. On examination, a single soft globular swelling measuring approximately 6 × 4 cm in the left infra-auricular region and a scar of previous incision and drainage measuring approximately 1 × 0.5 cm was present. Oropharynx: tonsillar bulge was present and reaching up to the uvula. Contrast-enhanced MRI revealed an enhancing lesion suggesting a vascular tumour affecting the pre and post-styloid compartment. The patient underwent surgical excision of the lymphangioma by a modified mandibulotomy approach to improve bony stability, avoiding lip split incision and tooth extraction for medically resistant lymphangioma. So, we introduced our modified technique of mandibulotomy in cases of medically resistant parapharyngeal space tumors with a modified lifting step osteotomy with a thin saw blade.ConclusionThe modified mandibulotomy approach provides a safe and effective means of tumor resection and this technique not only ensures complete tumour resection but also maintains the integrity and functionality of the mandible.

Calcaneum tuberculosis – A rare entity: Case report and review of literature

Calcaneum tuberculosis (TB) is a rare entity, though it is the commonly involved tarsal bone. It does not present with the typical features of TB and can be confused with other pathologies affecting the heel. Very few case reports and case series studies are present to date for describing this rare entity. We report a 23-year-old female who presented to the orthopedic outpatient clinic with pain and swelling around the left heel and posterior aspect of the ankle for 3 months. Her radiograph showed a lytic lesion in the posterosuperior aspect of the calcaneum. Therefore, magnetic resonance imaging was done, which showed a lesion around the posterior-superior aspect of the calcaneum with the involvement of retrocalcaneal bursa. An incisional biopsy was performed, followed by en bloc excision of the lesion. The histopathological examination report suggested granuloma formation with caseous necrosis and the cartridge-based nucleic acid amplification test was also positive for mycobacterial TB infection. Proper clinical history, radiological examination, and biopsy are of utmost importance in these rare entities as they help in making the definitive diagnosis. Anti-Koch treatment is an effective treatment for TB, and the patient improved within 2 months of treatment both clinically (pain, swelling, and activity of daily routine) and radiologically (for bone formation and no recurrence). This report aimed to present a lytic lesion of the calcaneum that turned out to be TB and its management. The follow-up was 18 months post-surgery and showed no signs and symptoms of recurrence.

Accuracy in clinical diagnosis of benign peri-ocular mass lesions

To analyze accuracy in clinical diagnosis of peri-ocular benign lesions. A prospective, interventional study of 279 clinically diagnosed and or histo-pathologically confirmed eyelid mass lesions. At presentation, detailed demographic data, symptoms, duration since the mass noted, it’s location, size & physical appearance, progression/regression/recurrence of the lid mass if any and associated systemic ailments were noted. Then, a pre-treatment clinical diagnosis (PTCD) was made. The treatment given, its outcome and histo-pathological examination (HPE) report were noted. Results then analysed in terms of how many cases needed HPE and in how many did PTCD match with HPE reports. Commonest lesions were of infective type (64.5%) followed by cysts and neoplastic which together contributed for 26.9% cases and others like congenital, traumatic, depositive etc., contributed for 8.6%. Totally, 25.8% sent for HPE; 94.4% did match with PTCD. Accuracy in clinical diagnosis is good with a thorough understanding of physical characteristics of lid mass lesions. Studies on a large scale would be extremely beneficial for the practicing ophthalmologists and the training residents and also for public health-care planning.

A Study on Clinicopathological Corelation and Management of Solitary Thyroid Nodule

Background: A solitary nodule is a goiter which, on clinical examination appears to be a single nodule in one lobe of the thyroid with no palpable abnormality elsewhere in the gland. The incidence of solitary nodule in general population in South India is 9%. This study aims to assess the presence of malignancy in patients presenting with solitary thyroid nodule and to evaluate and compare results of various investigative modalities used to diagnose a solitary thyroid nodule and the outcome of management modalities in solitary thyroid nodule. Methods: The present study on clinicopathological correlation and management of solitary thyroid nodule has been conducted on cases admitted and managed in the Department of Surgery at KIMS medical college, Hubli. Prospective analysis of 50 cases of solitary nodule thyroid in the specified period was done. These cases were selected by random sampling method and studied in detail clinically and recorded as per the proforma. Routine investigations and specific investigations including FNAC of the nodule, Thyroid profile, IDL, Plain X-ray neck, USG neck were done in all cases. Special investigations like radio-isotope scanning were not performed as the facilities were not available. All the patients were managed by surgery and diagnosis was confirmed by histo- pathological examination. The patients were grouped according to different variables like age, sex, size of the nodule, site of the nodule, functional thyroid status, FNAC reports and histo-pathological examination reports, then analyzed and compared with the previous similar studies conducted elsewhere. Results: Total of 50 cases of solitary nodule of thyroid studied. The mean age of presentation is 38.5 years. Cases in 3rd to 5th decades constitutes 72% of the cases studied. Out of 50 cases studied 46 were females and 4 were males, and the ratio comes to M:F = 1 : 11.5. Out of 50 cases along with swelling in front of the neck, 3 cases had pain, 3 cases had discomfort .....

Clinicopathological evaluation of parasitic infections in appendectomy specimens

Background: This study aimed to determine the incidence of parasitic infections in adult patients who underwent appendectomy and to evaluate the clinicopathological features of parasitic infections in appendectomy specimens.
 Methods: Patients who underwent appendectomy between January 2018 and December 2019 with a pre-diagnosis of acute appendicitis (AA) and reported parasitic infection in appendectomy specimens were evaluated retrospectively. Demographic data, comorbidities, clinical and radiological findings, laboratory results, surgical methods, length of hospital stay, postoperative complications, and histopathological examination reports were analyzed.
 Results: 939 adult patients underwent appendectomy with a pre-diagnosis of AA. Upon detecting parasitic infection in the histopathological examination, thirty-one (3.3%) patients were included in this study. Twenty (64.5%) patients were women, and the overall mean age was 31.9 years (18-70 years). Twenty-three (74.2%) patients had Enterobius vermicularis, and 8 (25.8%) patients had Tenia saginata. On laboratory examination, the mean percentage of monocytes was only higher in the Taenia saginata group (0.80 vs. 0.66; p=0.039). Both ultrasonography findings and tomography findings were similar in both groups. The morbidity rate of the study was 12.9% (n=4). There was no difference between the two groups regarding the length of hospital stay and morbidity. 
 Conclusions: Parasitic infections may cause symptoms mimicking acute appendicitis. It should be kept in mind that even in patients with a diagnosis of parasitic intestinal infection, symptoms may have been caused by acute appendicitis, not solely due to parasitic infection.

Large Locally Advanced Duodenal Gastrointestinal Stromal Tumor (GIST) Successfully Managed by Combined Use of Neoadjuvant Imatinib and Surgical Resection

Duodenal GISTs are rare mesenchymal neoplasms of the gastrointestinal tract. The usual presentation is gastrointestinal bleeding or abdominal pain. They can be asymptomatic until they reach a considerable size. Tyrosine kinase inhibitors (TKI) are important in high risk GISTs and in locally advanced disease. We report a 65-year-old man with abdominal discomfort, anemia and clinically palpable abdominal mass. A Computed Tomography (CT) scan of the abdomen and pelvis was done which showed a locally advanced duodenal GIST involving second and third part of duodenum. Neoadjuvant imatinib was given to this patient for 6 months. He underwent Whipple’s procedure and right hemicolectomy. The histopathological examination report revealed a high-risk duodenal GIST. Adjuvant Imatinib was continued for 1 month after the operation. He continued to do well with no evidence of disease recurrence based on post-operative CT abdomen and pelvis.

From diagnosis to treatment: Examining disparities in thyroid nodule evaluation and its impact on patient care

Controversy exists regarding the management of thyroid nodules because of conflicting information regarding the excessive occurrence of thyroid nodules, various occurrence of most cancers stated in the ones surgically excised and the frequency of loss of life from thyroid most cancers. The guidelines suggest an algorithm for evaluation of thyroid masses. 1Workup should start with history and physical examination, proceed to laboratory studies, and then to imaging. Even though FNAC is superior to USG, basically USG is used for evaluation of all thyroid masses initially, followed by FNAC. This study was done to know about the disparities between preoperative investigations and postoperative histopathology report of thyroid swelling. Methods: Study was done in 50 patients with thyroid masses which were subjected to FNAC, TFT and USG neck and their results were later correlated with histopathological examination report (HPR) whenever available. Results: Out of 50, 7 patients had disparities between preoperative and postoperative diagnosis, but it was statistically insignificant. Conclusion: FNAC stands at higher level with respect to P value and significance. Despite the fact is that, there are some patients whose preoperative and postoperative diagnoses were different. They either didn't want the first surgery or they want a second one. 2Detecting malignancy preoperatively allows total thyroidectomy in a single operation without the need for frozen section or a second operation for completion of a thyroidectomy if malignancy is found during the initial thyroid lobectomy. Among them, FNAC was more reliable compared to other investigations in diagnosing malignant conditions preoperatively. Both FNAC and USG over diagnosed colloid goitre.

Comparative evaluation of histopathological analysis, KOH wet mount and fungal culture to diagnose fungal infections in post-COVID patients.

There is increasing prevalence of post-COVID fungal infection of rhinoorbitocerebral region especially mucormycosis and aspergillosis in India.[1] Early diagnosis of these fungal infections are of utmost importance, since it may improve outcome and survival.[2],[3],[4],[5],[6],[7],[8] The objective of this study was to evaluate and compare routine laboratory diagnostic methods, that is, histopathological examination, KOH wet mount and fungal culture in the diagnosis of post-COVID fungal infections. A total of 106 specimens of clinically suspected patients of post-COVID fungal infection of rhinoorbitocerebral region received in histopathology department were included in this study. The data of KOH wet mount and culture were acquired from the microbiology department after histopathological examination. Approximately 88.68% of patients were diagnosed having fungal infections by one of the laboratory methods. The sensitivity of histopathological examination was highest (79.78%), followed by KOH wet mount (58.51%) and fungal culture (35.10%). Rhizopus species of zygomycetes group were the most common isolate (24.24%) on SDA culture. Overall 76% concordance was found between histopathological examination and fungal culture report for morphological identification of fungi. For the diagnosis of post-COVID fungal infection of Rhino-orbito-cerebral region, histopathological examination is was found to be more sensitive and rapid method to detect fungal hyphae. It leads to early treatment, prevents morbidity and mortality.

Atypical Presentation of Traumatic Ulceration Granuloma with Stromal Eosinophilia (TUGSE) of the Tongue: A Case Report

Introduction: This article aims to report a rare case of traumatic ulceration granuloma with stromal eosinophilia (TUGSE) in young children. Contrary to the reported cases in the literature, this article describes an atypical case of TUGSE presented as a solitary tumour on the tongue. Case Report: A 4 years old boy with Down syndrome was referred to the Paediatric Dentistry Department for management of swelling of the tongue, which gradually increased in size. Clinical examination demonstrated a well-defined firm, pedunculated swelling over the left dorsum of the tongue measuring 15 mm x 12 mm. A provisional diagnosis of fibroma was made. Excisional biopsy was performed under general anaesthesia (GA). Recurrence of the lesion was observed and a subsequent surgical excision with the extractions of left primary molars were conducted under GA. The histopathological examination (HPE) reports interpreted the lesion as TUGSE. Conclusion: It is difficult to clinically diagnose TUGSA hence histological findings are paramount to establish the diagnosis. Awareness of TUGSE is crucial to emphasise the correct diagnosis and to deliver appropriate and effective treatment.

Kimura Disease: A Diagnostic Perplexity

Introduction: Kimura disease (KD) is a rare condition of unknown etiology and pathogenesis. This is more common in young males of Asian descent. The most common clinical presentation is presence of unilateral subcutaneous mass in the head and neck region, especially in post-auricular area. We present a case of KD in 26- year- old Asian man who presented with subcutaneous mass behind both auricles. Case report: A 26- year- old man presented to ORL-HNS outpatient department of tertiary care centre with chief complaint of mass behind both ear for 5 months. Incisional biopsy was performed under local anesthesia. Histopathological examination report confirmed the case as KD. Patient was managed with intralesional triamcinolone injection. Conclusion: Kimura disease, though rare, should be considered in differential diagnosis of head and neck subcutaneous masses. A high-index of suspicion and tissue biopsy confirmation is essential to diagnose this condition.

Visceral Malignant Melanoma: Wilderness of a Black Hole

Malignant melanoma (MM) is malignancy of melanocytes, with the commonest primary site being skin. Mucosal melanomas make less than 1% and prognosis is poor if not detected early. Identifying the primary lesion can be challenging and a small percentage of patients falls under the category of melanoma of unknown primary (MUP). We herein report a rare case of an 86- year- old male who presented with frank hematuria and multiple pigmented naevi over bilateral lower limbs. A Computed Tomography Urography (CTU) revealed a bladder tumour at lateral wall, which then proceeded with a transurethral resection of bladder tumour (TURBT). He was discharged well pending histopathological examination (HPE) report. He presented again with small bowel obstruction and a CT showed small bowel intussuscepting tumour with several lungs and right adrenal gland lesions requiring a laparotomy, small bowel resection and anastomosis. A black pigmented tumour was found to be a lead point of the intussusception. Patient recovered well from surgery and was discharged well. HPEs of both the surgeries revealed malignant melanoma, unable to identify the primary tumour. This case shows the notorious behaviour of MM to metastasize without symptoms. Coupled with the similar HPE of both sites of bladder and bowel, it makes it difficult to establish the primary site. CT imaging should be the mainstay choice of investigation to identify primary disease and evidence of metastasis. Initial management of MM should be complete surgical resection of suspected primary lesion. In the unfortunate event of patient developing distant metastasis, role of adjuvant therapy in visceral melanoma is evolving with clinical trials focusing on immunotherapy, tyrosine kinase inhibitors and dacarbazine.

Incidence and Malignancy Rates in Thyroid Nodules in North-East Indian Population by Bethesda System: A Single Institutional Experience of 3 Years.

Suvamoy ChakrabortyIntroduction Goiter is one of the most common conditions encountered clinically (up to 60% of population) with thyroid malignancy being one of the most common endocrine malignancies. The American Thyroid Association has advocated the need for validation of the Bethesda system of fine needle aspiration cytology (FNAC) in each center. The risk of malignancy (ROM) for Bethesda categories in the Indian population is limited. Objective As there are variations in the effectiveness of FNAC, this study aims to study the role of FNAC in evaluating thyroid nodules, estimating the risk of malignancy in thyroid nodules in the North-East Indian population, and correlating the FNAC findings with HPE (histopathological examination). Materials and Methods A total of 110 patients with thyroid nodules had visited the Department of Otorhinolaryngology during 2017-2020. Case records were retrieved, out of which only 66 patients had both FNAC and HPE reports. The FNAC of 66 patients were studied. Statistical Analysis Data were analyzed using STATA V14. Fischer's exact test was used to determine the association of Bethesda system in diagnosing thyroid malignancy. The percentage agreement between the FNAC and HPE was calculated using the Kappa statistics. The diagnostic validity of FNAC in the diagnosis of malignant thyroid nodule was reported. Results The sensitivity, specificity, PPV, and NPV of FNAC in diagnosing thyroid malignancy were 52%, 94.3%, 89%, and 69% respectively. The risk of malignancy (ROM) for Bethesda I to VI categories in our study was 20%, 25%, 67%, 40%, 78%, and 100% respectively ( p -value < 0.001, Fischer's exact test). Conclusion A specificity of 94.3% and PPV of 89% of FNAC makes it a good reliable tool in ruling in malignancy in our population. The higher ROM in indeterminate categories necessitates the need to consider thyroidectomy with or without intraoperative frozen section analysis in our population. Similar higher ROM has been reported in a few other Indian studies. These findings may suggest an increased ROM for Bethesda categories III and IV in the Indian population; however, the statement needs further validation from large multicentric studies with research to find the reason for the increased risk.