Mucormycosis in COVID‑19 Patients: A Tertiary Care Experience

Introduction: Zygomycetes consisting of Mucorales order is a group of fungal infections. These species cause life threatening opportunistic fungal infections mucormycosis. This infection is highly prevalent in immunocompromised. During the 2nd wave of Covid 19 pandemic corticosteroid treatment was used which has been linked to development of Mucormycosis. In our tertiary care teaching hospital we saw that patients suffering from Covid‑19 infections developed mucormycosis. We present these cases in our study. To study the clinical,demographical,and Laboratory parameters in Covid‑19 patients with Mucormycosis. Material and Methods: Retrospective Study. All biopsy proven cases of Mucormycosis (which developed after Covid‑19 infection) were included. Relevant Clinical Demographics and Laboratory data was retrieved from the available case sheets. The data was tabulated in Excel sheet and further reviewed. Results: A total of 22 patients were diagnosed as suffering from mucormycosis majority were unvaccinated. 11 patients out of 22 (50%) started manifesting mucormycosis within one week of COVID infection. All the patients who had only single comorbidity (22.72%) suffered from mild disease and patient who had more than one comorbidity suffered from moderate (27.27%) to severe (50%) COVID infection. Conclusion: It is suggested that patients with Covid‑19 infection are at risk for development of opportunistic fungal infections like Mucormycosis. Hence the physicians who are involved in treating such patients must be mindful of the fact that mucormycosis can develop in them. Histopathology helps in establishing a concrete diagnosis of Mucormycosis

Clinicopathological analysis of extracranial head and neck schwannoma: A case series

Background: Extracranial head and neck schwannomas are rare tumors which are often clinically misdiagnosed. Preoperative diagnosis of these tumors is challenging but imperative for surgeons so as to avoid nerve damage during excision. Materials and Methods: Sixteen patients diagnosed with extracranial head and neck schwannomas over a period of 2 years were retrospectively analyzed. Clinical details including preoperative fine-needle aspiration cytology (FNAC) and/or computed tomography (CT)/magnetic resonance imaging (MRI) findings were retrieved. FNAC smears and formalin-fixed paraffin-embedded sections were evaluated. Results: Among these 16 tumors, 6 (37.5%) were located in the lateral aspect of neck, 4 (25%) in scalp, 2 (12.5%) in orbit, and one each (6.25%) in palate, tongue, submandibular gland and parotid gland. The mean patient age was 31.3 years. FNAC was performed in 14 cases, of which 8 cases (58.3%) showed features of benign nerve sheath tumor (BNST), two cases (14.2%) were inconclusive with possibility of mesenchymal lesion, two cases (14.2%) were inadequate, one case (8.3%) showed features suggestive of schwannoma, and a diagnosis of nerve sheath tumor inconclusive for malignancy was rendered in a single case. The sensitivity of FNAC in diagnosis of BNST was 71.4%. CT or MRI was performed in five cases, of which an accurate diagnosis was rendered only in one case of orbital schwannoma. Conclusion: Imaging has a limited role in the preoperative diagnosis of head and neck schwannomas owing to nonspecific radiological features. Cellular aspirate smears are helpful in accurate diagnosis even at unusual locations

Hodgkin's lymphoma arising in a case of mycosis fungoides: An unusual association

Mycosis fungoides is a cutaneous T-cell lymphoma with a high risk for developing secondary malignancies, especially B-cell lymphoproliferative disorders. About 40 cases of Hodgkin's lymphoma associated with mycosis fungoides have been reported in literature till date. We report a case of a 35-year-old gentleman who presented with intensely itchy reddish lesions all over the body. Multiple skin biopsies taken from the lesions on scalp and back confirmed the clinical diagnosis of mycosis fungoides. While on treatment, he presented with multiple bilateral cervical, axillary and inguinal lymphadenopathy 9 years after the primary diagnosis of mycosis fungoides. Excision biopsy of a cervical lymph node revealed partial effacement of architecture by a tumor comprising polymorphous background. Histopathology and immunohistochemistry revealed a diagnosis of Hodgkin's lymphoma - nodular sclerosis subtype. The patient was started on chemotherapy for stage IV Hodgkin's lymphoma. Our case emphasizes the importance of keeping secondary Hodgkin's lymphoma in mind while dealing with a patient of mycosis fungoides. Our case immunohistochemically supports the distinct etiopathogenesis of Epstein–Barr virus-negative Hodgkin's lymphoma vis-à-vis cutaneous mycosis fungoides.

Clinico-pathological profile of 22 cases of cystic renal dysplasia.

Renal dysplasia is one of the major renal developmental anomaly characterized by abnormal structural organization and development of metanephric elements. It is usually detected antenatally or in early childhood. The kidney may be multicystic, aplastic, hypoplastic or duplex. We studied 22 cases of cystic renal dysplasia diagnosed over a period often years to identify the spectrum of morphological changes in dysplastic kidney, with special emphasis on mesenchymal changes. Clinical, radiological and gross morphologicalfeatures were noted. Microscopic features were studied in detail, including the epithelial and mesenchymal changes. Twenty-one of the 22 cases studied were children. One case was a 21-year-old adult, which is a rare age at presentation. Male to female ratio was 1.1:1. One of our patients had contra-lateral ureteric stenosis, a rare anomaly reported with renal dysplasia. Ten patients, all autopsy cases, had multi-system congenital anomalies. As cystic renal dysplasia is not a hereditary disease, it must be differentiated from polycystic kidney disease. Other differential diagnoses are cystic nephroma and cystic partially differentiated nephroblastoma. Histopathological examination is the final diagnostic tool since radiological features alone may not be sufficient to exclude other cystic renal lesions. Cartilage may not be seen in all cases of renal dysplasia. Once diagnosed, other associated anomalies should also be looked for.

Multicystic nephroma--report of two cases.

Multicystic Nephroma (MCN) is an uncommon renal pathology, characterized by the presence of usually unilateral circumscribed focal lesion consisting of multiple thin walled cysts. The etiology and pathogenesis of multicystic nephroma is not clear, and it is considered as a neoplastic lesion by many authors. To the best of our knowledge it has not yet been reported from India. We report first two pediatric cases of MCN from India. Computerized Tomography (CT) scan in both the cases revealed a unilateral cystic lesion in the lower pole of kidney. Keeping in mind the age, clinical presentation and radiological appearance, a possibility of Wilm 's tumour with cystic change could not be ruled out preoperatively and both children underwent nephrectomy. Since MCN has a benign behaviour it must be differentiated from focal cystic neoplastic lesions, including Cystic Partially Differentiated Nephroblastoma (CPDN), which has a low but distinct capability for local recurrence, and from Wilm's tumour with cystic change. Segmental form of unilateral renal dysplasia also needs to be considered in the clinical and radiological differential diagnoses.

Congenital cystic adenomatoid malformation of lung--report of three cases.

Congenital cystic adenomatoid malformation (CCAM) of the lung is a rare anomaly of fetal development of terminal respiratory structures. We report three cases of congenital cystic adenomatoid malformation (CCAM) of lung Stocker's type I. All the cases presented with progressive neonatal respiratory distress. One case developed hyaline membrane because of ventilator therapy. No other congenital malformation was found in any of our cases. Two of our cases were suspected on antenatal ultrasonography. Routine prenatal ultrasonography has increased the frequency of prenatal diagnosis of congenital cystic lung malformation including CCAM. The pathogenesis, management and prognosis of CCAM are discussed along with a review of literature.