Importance Of Tissue Diagnosis Research Articles

1068 Cranial Fasciitis of the Temporal Bone

Abstract We present the case of a child with a rare benign tumour of the temporal bone. A nine-month-old girl was referred to her local paediatric hospital with a painless right-sided, post-auricular swelling increasing in size in the preceding two months. On examination there was a 2x2cm mass overlying the temporal bone posterior to the right ear. The mass was firm, immobile, non-tender and well circumscribed. Ultrasound demonstrated a 1.9cm subcuticular mass with evidence of intracranial extension through the suture. Vascular flow and hyperechoic foci were demonstrated within the lesion. The local paediatric team requested magnetic resonance imaging (MRI) and computed tomography (CT) of temporal bone prior to referral to tertiary care centre. Imaging displayed a 2cm expansile lesion of the temporal bone with cortical loss and effacement of underlying dural venous sinus. The patient proceeded to incisional biopsy for tissue diagnosis which was suggestive of cranial fasciitis. Following discussion at the regional multidisciplinary meeting, she underwent surgical excision of the tumour in a joint Neurosurgery/Otology case. The tumour was fully resected macroscopically, with the normal surrounding bone and mastoid air cells preserved. Final histopathology showed a highly cellular lesion composed of spindle cells arranged in fascicles, with areas of myxoid background and confirmed the tumour to be cranial fasciitis. The child has made a good recovery and will be kept under close clinical follow-up. This case demonstrates a rare benign tumour of the temporal bone that may present to an otolaryngologist and the importance of tissue diagnosis, imaging and multidisciplinary management.

Steroid-responsive intracranial germinoma presenting as Holmes’ tremor: Importance of a tissue diagnosis

Holmes’ tremor (rubral or midbrain outflow tremor) refers to a hyperkinetic movement disorder characterized by mild resting and more severe postural and action tremor often with associated brainstem symptoms, dystonia and cerebellar deficits. This syndrome should prompt lesional evaluation with neuroimaging focused on the dorsal midbrain, cerebellar outflow tracts, and thalamus. Herein we report a 26-year-old previously healthy male who presented with 4years of progressive horizontal diplopia, right Parinaud syndrome, and appendicular ataxia. Neuroimaging revealed a right dorsal midbrain enhancing lesion which completely resolved with intravenous methylprednisolone prompting a diagnosis of neuroinflammatory syndrome. Subsequent clinical and radiographic evaluations, however, revealed steadily progressive left dorsal midbrain syndrome with an expansile enhancing lesion which culminated 4years from symptom onset with a right upper extremity low-frequency rest, postural and action tremor, ataxic dysarthria, and mild right dystonia with dysdiadochokinesia. Uncomplicated brainstem biopsy confirmed intracranial germinoma and the patient underwent definitive radiation therapy with dramatic radiographic response and partial clinical improvement. This case, which to our knowledge is only the second report of intracranial germinoma presenting as Holmes’ tremor, highlights the critical importance of definitive tissue diagnosis in the evaluation of lesional brainstem pathology presenting as Holmes’ tremor. Steroid responsiveness can be seen in non-inflammatory pathology including intracranial germinoma. Prompt evaluation and appropriate treatment are important as Holmes’ tremor responds poorly to symptomatic therapies and response to radiation therapy is favorable for germinomas.

Coexistent Tuberculosis of Spine and Chronic Myeloid Leukemia: Resolving the Diagnostic Dilemma and Management

ABSTRACT Tuberculosis (TB) and association with hematological malignancy is well described in literature. Lymphoid malignancies like non-Hodgkin lymphoma and chronic lymphocytic lymphoma (CLL) are documented but chronic myeloid leukemia (CML) is uncommon. The association of TB and malignancy can be sequential, concurrent or masquerading. We encountered a case posing diagnostic challenge between CML and tuberculosis. The objective to report such a clinical situation is to be aware of such rare possibilities, to analyze the diagnostic methods and subsequent management strategies. Though tuberculosis is usually the first differential diagnosis in endemic areas, it can be overstressed upon and other concurrent pathologies may be missed. Such possibilities should be kept in consideration in cases with poor response or clinical deterioration on antitubercular treatment (ATT). The importance of tissue diagnosis by CT-guided core biopsy as current standard of care is reiterated even in prevalent regions. Multidisciplinary approach is must for optimum outcome. How to cite this article Yadav S, Jayaswal A, Vijayraghavan G, Goswami A. Coexistent Tuberculosis of Spine and Chronic Myeloid Leukemia: Resolving the Diagnostic Dilemma and Management. J Postgrad Med Edu Res 2015;49(2):85-87.

A C7 Chordoma Masquerading as Spinal Tuberculosis

Tuberculosis of cervical spine is a fairly common pathology encountered by the spine surgeon in India. It is not uncommon to find that empirical treatment with anti-tubercular drugs is started based on clinical, hematological and radiological features. We present one such patient who presented to us with dysphagia and was on anti-tubercular treatment for 18 months. It was later diagnosed as a C7 chordoma after an intralesional excision. This emphasizes the fact that a tissue diagnosis is imperative for starting any antimicrobial therapy. The purpose of this report is to highlight the fact that a chordoma should be considered as an important differential diagnosis in the axial skeleton lesions anywhere from the craniovertebral junction to the sacrum; as an early diagnosis has significant impact on the tumor recurrence and long-term survival. This report re-emphasizes the importance of tissue diagnosis by needle aspiration or biopsy before starting the definitive treatment.

A Case of Diffuse Large B-Cell Lymphoma in Association With Paraesophageal Leiomyoma: Highlighting False-Positivity of PET Scan and Importance of Tissue Diagnosis

PET scan and PET/CT scans are being widely used for staging of diffuse large B-cell lymphoma (DLBCL) and Hodgkin lymphoma. They are sensitive and specific imaging techniques available for lymphoma. However, practicing hematologists must be aware of false-positive tests, which can upgrade the stage of the lymphoma significantly and may alter the treatment paradigm for an individual patient. This report describes a case of DLBCL that was upgraded with PET/CT scan to stage IVA from stage IA. Pursuit of tissue biopsy with minimally invasive surgery eventually confirmed it to be stage IA DLBCL and paraesophageal leiomyoma. This case highlights the potential pitfalls of modern imaging techniques and the need for histologic diagnosis.

Oat Cell Carcinoma of Lung Mimicking Choriocarcinoma

ABSTRACT This is the case report of a postcesarean woman who presented with multiple lung secondaries, bilateral ovarian cysts and very high serum β-hCG which turned out not to be choriocarcinoma. This shows the importance of tissue diagnosis even in patients who show all other features of choriocarcinoma.

Solid pseudopapillary tumor of the pancreas mimicking pancreatic pseudocyst

Solid pseudopapillary tumor of the pancreas is a low-grade malignancy, which is very rare and predominantly occurs in young women. We report a case of this tumor in a 30 year-old woman who was initially misdiagnosed with pancreatic pseudocyst based on CT scan findings. EUS with FNA revealed the diagnosis of solid pseudopapillary tumor and guided the surgical approach. This case emphasizes the importance of tissue diagnosis in patients with cystic lesions of the pancreas on CT scan and no obvious history of pancreatitis.