A bleeding heart: case report and review of pericardial angiosarcoma

Abstract Primary cardiac tumors are rare. The cardiac sarcomas are the most common malignant cardiac tumors. These tumors have a dismal prognosis with an overall median survival of 25 months. Clinical features include dyspnea, arrhythmias, pericardial effusions, heart failure, and sudden cardiac death. The diagnosis is often challenging. Therefore, the cardiac imaging workup plays a central role in addition to a high clinical suspicion in the setting of atypical presentations that do not respond to standard therapies. The echocardiography, computed tomography, and cardiac MRI are crucial in clinching the diagnosis. Multimodal treatment with surgery, chemotherapy, and radiotherapy has been shown to improve outcomes, as opposed to using either of these modalities alone. We describe the case of a 30-year-old gentleman with COVID-19 infection who developed recurrent hemorrhagic pericardial effusions refractory to standard treatment and was eventually diagnosed as a case of pericardial angiosarcoma after his biopsy revealed the diagnosis and staging was performed using PET-CT-FDG scan. Our case re-emphasizes the importance of considering a malignant etiology early in the course of the disease presentation, especially in recurrent hemorrhagic effusions despite an inflammatory cytologic diagnosis of fluid. It also highlights the place for cardiac CT and MRI to ascertain the location and spread and to plan the further course of treatment. If diagnosed early, the estimated survival time can be prolonged by instituting a multimodal approach.

Knowledge, attitudes and practices of resident doctors and interns on safe blood transfusion practices: a survey-based study

ABSTRACT Introduction: The knowledge of clinicians regarding blood transfusion services may impact patient care and transfusion outcome. The wide variation in transfusion practices among clinicians leads to inappropriate blood product usage and jeopardizes patient safety. Hence, this survey study aimed to assess knowledge, attitude and practice among the residents and interns of safe blood transfusion. Methods: The online survey was based on self-administered questionnaires of three sections: 1. Demography; 2. Knowledge, and; 3. Attitude and Practice. One point was assigned for the correct response of each question in every section. The knowledge score was further categorized into three categories, depending on the points obtained. The participants were also divided into four groups, depending on their experience. The Kruskal-Wallis test was applied to determine the difference of knowledge and practice scores in three designated groups of residents and interns. A p-value of less than 0.05 was considered to be significant. Result: A total of 247 residents and interns participated in this study. Thirteen participants had an incomplete response. Out of 234 participants, Senior Residents (SR), Junior Residents (JR), and interns were 70, 96 and 68 participants, respectively. The knowledge scores of interns were significantly low, as compared to SRs and JRs. Practice scores of interns were also significantly low, compared to the JRs. However, most of the residents and interns (85%) were aware of the pre-transfusion testing. Conclusion: Therefore, the mandatory incorporation of the transfusion medicine subject in the undergraduate curriculum can help the young budding doctors to better implement the patient blood management.

Prevalence and Factors Associated With Depression among School Going Adolescents in Bengaluru: A Cross-Sectional Study

Introduction: The period of adolescence involves a lot of emotional changes as it is a period of transition to adulthood demanding independence.Adolescents with depression are more likely to have anxiety, disruptive behavior disorder and substance abuse when compared to those who are not depressed. Objective: To estimate the prevalence of depression among school going adolescents and to assess the factors associated with depression among them. Method: A cross-sectional study was conducted among school going adolescents aged 13-16 years in the urban field practice area of a Medical College. Depression was assessed using Beck's depression inventory (BDI). Total 896 adolescents were included in this study. Single stage cluster sampling method was done in which schools were considered as clusters and students constituted the sampling units. Schools were selected by simple random sampling technique using lottery method. Results: In this study about 45.2% of the adolescents had depressive disorder, out of which mild depression was reported among 22.2% students, 12.4% moderately depressed and 10.6% severe depression. Factors like mother's education, lack of communication by father and mother with their children, lack of needs satisfied by the fathers of the adolescents (61.9%), father's role in adolescents' life (62%) and domestic violence in family (69.7%) were some of the important reasons for developing depression among adolescents. Adolescent whose parents were having conflict (69.2%) were found be depressed when compared to those adolescents whose parents had no conflicts this difference was statistically significant (p<0.05). Conclusion: The prevalence of depression was found to be 45.2%. Finding of the study emphasizes the need for creating awareness about the early identification of behavioral changes leading to depression among adolescents by the parents and teachers. It is also important to emphasize to the parents on how their relationship and behavior towards the family affects the mental wellbeing of the adolescents.

A STUDY ON PATTERN AND CLINICAL PROFILES OF CONGENITAL HEART DISEASES IN TERTIARY CARE CENTRE, KAKINADA.

BACKGROUND: Congenital heart disease is an abnormality of anatomical structure of the heart that is of paramount importance. The incidence is approximately 8 per 1000 live births. CHD not only contributes to signi?cant mortality and morbidity but also causes tremendous psychological stress and economical burden to whole family. OBJECTIVE: To study the pattern and clinical pro?le of congenital heart diseases in a tertiary care hospital and to aid for early stdetection and quick referral of children with congenital heart disease In this study, done between January 1 2020 to RESULTS: june 31st 2021, 54 children with con?rmed congenital heart disease were observed. ACHD was the most common type of CHD and of them, VSD was the most common type, followed by ASD. Based on sex distribution, 31 were male (55.5%) and 23 were female (44.5%), with a male: female ratio of 1.25:1. Most children belonged in the age group 6m – 1year (46.2%) followed by (42.5%) in 30days – 6months age. The common clinical presentation observed in this study was breathlessness. The common complication observed in the current study was heart failure followed by malnourishment and recurrent LRTI.

Surgical-exposure-of-teeth-in-cleidocranical-dysplasia-under-procedural-sedation-case-report

Cleidocranial Dysplasia (CCD) is a rare autosomal dominant condition which is mainly characterised by skeletal abnormalties like hypoplastic or aplastic clavicles, increase in transverse diameter of the cranium, delayed closure of fontanelles with presence of open sutures and skeletal changes in maxilla and mandible. 2,4 These patients usually presents with delayed exfoliation of deciduous teeth, delayed or failed eruption of the permanent dentition with multiple supernumerary teeth, protruding mandible and mid- face retrusion.2 We present a case report of a 16 year old girl undergoing multiple surgical exposure of impacted permanent teeth under conscious sedation so as to move them in normal occlusion with orthodontic traction.

A case of superior vena cava syndrome

Superior Vena Cava Syndrome is the clinical manifestation of the Superior Vena Cava obstruction, with severe reduction in venous return from the head, neck and upper extremities. More than 80% cases of SVCS is nearly attributable to advanced malignancy, most commonly lung cancer. SVC syndrome is characterized by congestion and swelling of the face and upper thorax, with distended superficial chest veins. The most severe complications of SVC syndrome include Glottic edema and venous thrombosis in the central nervous system. We represent a case SVC syndrome due to Small Cell Cancer of the lung.

Neutrophil to lymphocyte ratio and C- protein level as markers to predict deterioration in stable COVID-19 patients

The new Corona virus disease (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-COV-2). It is a highly communicable infectious disease [1]. Clinical manifestations of COVID-19 vary from asymptomatic to ARDS leading to death, it is important to differentiate between severe and non-severe cases. Early warning signs can be identified by several laboratory tests which are often expensive, time taking. Neutrophil-lymphocyte ratio (NLR), C- reactive protein (CRP) are two simple tests that can be used as markers for clinical outcome in COVID-19 patients. The aim and objectives of the study were to correlate patients clinical severity and CRP, NLR levels and to assess direct correlation between CRP levels and NLR. 101 patients who fulfilled the inclusion criteria were taken into the study. Patients are divided into mild, moderate severity based on WHO criteria and CBP, CRP were sent on the 6th/ 7th day of illness. Among the 101 patients, 93 were in mild group, 8 were in moderate group. The study group included subjects who aged between 18 years to 80 years of age. Plasma CRP levels were higher in moderate cases than in mild cases, and this difference was significant (p < 0.001). The mean NLR of moderate severity were significantly higher than those of mild cases (p-0.00003). Results showed that NLR was positively correlated with CRP levels.NLR and CRP are potential, reliable and easy-to-use predictors for deteriorating covid-19 infection. The integration of NLR and CRP may lead to improved predictions and help to triage patients at the time of hospital admission.

Modified Trendelenburg Procedure for Varicose Vein

Varicose veins of lower limbs is very common in clinical practice with its associated complications like venous ulcer, edema and pigmentation. Sapheno-femoral in competence and perforator incompetence are the principal cause of varicose veins. Trendlenburg operation of sapheno-femoral ligation and perforator ligation is standard procedure for its treatment. But for a beginner surgeon the procedure has some potential risks like injury to saphenous vein, injury to femoral vein and tributaries during dissection and ligation producing complications like bleeding, haematoma and long operative time. We have modified this Trendlenburg operation by a simple technique of canulating the saphenous vein from mid thigh end to easily identify the T-junction and tributaries. This Modified Trendlenburg Operation reduces the intra-operative complications and decreases the operation time.

Gastrointestinal complications in patients with Chronic Kidney Disease

Background: The most common, non –renal, chronic disorder in patients with ESRD is gastro intestinal disorders, accompanying ESRD including those receiving renal replacement therapy. Among upper gastrointestinal lesions caused by chronic kidney disease- gastritis, esophagitis, gastric ulcer are the most prevalent lesions. Here an attempt is being made to study the upper gastro intestinal changes in chronic kidney disease and evaluate their relationship with the stage of CKD or GFR. Materials and methods: A cross sectional study on 50 patients of, who were diagnosed to have chronic kidney disease and being presented to OPD and admission in Malla Reddy Institute of Medical Sciences, Suraram over a period of one year. All patients with chronic kidney disease who underwent upper gastrointestinal endoscopy were included in the study. Results: 50 patients were included in the study with mean age and males 28 and 22 females. Among 50 patients 42 patients manifested with upper gastrointestinal lesion among them erosive gastritis 13(26%) was most common upper gastrointestinal lesion followed by gastro esophageal reflux disease with or without duodenitis 8 (16%), duodenal ulcer, gastric ulcer 4(8%) each, pangastritis 3(6%), GERD with gastritis, erosive duodenitis, erosive esophagitis, pale gastric mucosa 2(4%) each, angiodysplasia and hiatus hernia 1(2%) each. Conclusion: Majority of the patients with chronic kidney disease have upper gastrointestinal involvement on endoscopic evaluation. Erosive gastritis is the most common lesion Esophageal and duodenal involvement is less common than the gastric lesions. Upper gastrointestinal findings are frequently observed in chronic kidney disease patients on dialysis. Early diagnosis and managementof these upper gastrointestinal lesions in CKD can reduce mortality and morbidity and prevent fatal complication like massive upper gastrointestinal bleed.

COVID-19 Associated Mucormycosis with Newly Diagnosed Diabetes Mellitus in Young Males - A Tertiary Care Experience

Abstract Introduction Patients with a history of or active COVID-19 infection are predisposed to the development of opportunist bacterial and fungal infections. A rising incidence of a rare occurring fungal infection earlier, called mucormycosis, has been reported in abundance across the globe since March 2021, especially in India just as the second wave of COVID-19 began, caused by the trifecta of hyperglycemia (new-onset or exacerbation of pre-existing diabetes), oxygen therapy (invasive or noninvasive ventilation), and prolonged intake of steroids. Objective The present study aimed at assessing the prevalence of post-COVID mucormycosis in males of younger age group and spread of rhino-orbital-cerebral mucormycosis (ROCM). Methods A case-control study was performed over a period of 3 months among 60 male patients with confirmed diagnosis of mucormycosis. Individuals < 40 years old were included in the case group (n = 30), while those > 40 years old were included as controls (n = 30). Disease spread was assessed in three types of ROCM, that is, rhinomaxillary, rhino-orbital, and rhino-orbito-cerebral mucormycosis. Results In the control group, the mean age was 48.47 years old, the mean HbA1c was 10.62 ± 1.88%, with most of them suffering from rhino-orbital mucormycosis. In the case group, the mean age was 31.57 years old, with a mean HbA1c of 10.11 ± 2.46%, and most patients had rhinomaxillary mucormycosis. The duration of steroid intake and mode of oxygen therapy were found to be significant in the severity of ROCM. Conclusion Rising cases of post-COVID mucormycosis have brought to light the fatal consequences of prolonged use of steroids and oxygen therapy towards the development and spread of ROCM among young and middle-aged males.

A case of subclavian steal syndrome

Subclavian steal syndrome is a relatively rare condition that results from occlusion of the subclavian artery proximal to the origin of the vertebral artery. This causes a reversal in the direction of the blood flow in the vertebral artery, leading to symptoms of vertebrobasilar insufficiency. In this article, we report a case of subclavian steal syndrome in a 55 year old male, who presented with giddiness, and variation in blood pressures in both upper limbs, was investigated with doppler and MR angiography. This article emphasises physical examination with discrepancy in pulse and blood pressure should bring attention to diagnosis of this syndrome.

Effectiveness of Neonatal Resuscitation program training among MBBS interns in a Tertiary care hospital of South India

Background: Use of simulation-based learning methodologies enhance performance in both simulated resuscitations and real-life clinical situations. Retention of skill is very important for the MBBS doctors who hardly get any exposure to such learning before entering post-graduate courses. The major cause of early neonatal death is neonatal asphyxia, which can be prevented by neonatal resuscitation. Effective resuscitation at birth can prevent neonatal deaths to a greater extent. Training in cardio-pulmonary resuscitation is critical in determining successful outcomes in perinatal asphyxia. Hence the present study was done to check the retention of knowledge after Neonatal Resuscitation Program (NRP ) training. Methods: A prospective interventional study was carried out among the MBBS interns who started their internship program from March 2020 - February 2021 in ACSR Government Medical College, Nellore. All the Interns were given training in NRP as a part of internship orientation programme during the first week of internship. Out of 150 interns, 143 participated in the study. The interns were oriented to the study and a pretest questionnaire was administered to them to assess their knowledge and skill regarding NRP which was followed by NRP training by the faculty of pediatrics and neonatology. The same questionnaire was administered immediately at the end of the training, 1 and 6 months post NRP training for assessing their knowledge and skill. Results: As compared to pre intervention score, the mean scores of the immediate post intervention score and at 1 month after intervention the mean score was increased with respect to knowledge and skills. After 6 months the mean scores pertaining to knowledge and skill decreased which were statistically significant. Conclusions: A significant decrease in the level of knowledge and skills regarding neonatal resuscitation was observed. Therefore, maintaining resuscitation skill requires continuous practice, supplemented by simulation training as needed.

Diagnosis and Management of Acquired Aplastic Anemia: Consensus Statement of Indian Academy of Pediatrics

Justification: In India, there is a lack of uniformity of treatment strategies for aplastic anemia (AA), and many children are managed only with supportive care due to non-availability of hematopoietic stem cell transplantation (HSCT). Process: Eminent national faculty members were invited to participate in the process of forming a consensus statement in Hyderabad in July, 2016. Draft guidelines were circulated to all members, and comments received in a online meeting in October, 2020 were incorporated into the final draft. These were approved by all experts. Objective: To facilitate appropriate management of children with acquired aplastic anemia. Recommendations: Key recommendations are: i) A bone marrow biopsy is must to make a diagnosis of AA; ii) Rule out inherited bone marrow failure syndromes (IBMFS), connective tissue disorders, viral infections, paroxysmal nocturnal hemoglobinuria (PNH), drug or heavy metal induced marrow suppression in all cases of AA; iii) Conservative approach to transfusions should be followed, with a target to keep hemoglobin >6 g/dL in children with no co-morbidities; iv) HLA-matched sibling donor HSCT is the preferred choice of treatment for newly diagnosed very severe/ severe AA; v) In absence of HLA-matched family donor, a matched unrelated donor (MUD) transplant or immunosuppressive therapy (IST) should be considered as alternate choice based on physician expertise; vi) Fludarabine, cyclophosphamide and anti-thymocyte globulin (ATG) based conditioning with cyclosporine and methotrexate as graft versus host disease (GvHD) prophylaxis is the preferred regimen; vii) Horse ATG and cyclosporine are the recommended drugs for IST. One should wait for 3-6 months for the response assessment and consideration of next line therapy.

Evolution of modern age drug discovery of lipopeptides and computer-aided drug discovery in India

The endeavor has been attempted to present a review on the evolution of modern age drug discovery in India. The contribution of next generation therapeutics options microbial metabolites and the computational drug discovery aspects to the global market from India have been represented. Microbial metabolites such as lipopeptides and peptide therapeutics are gaining worldwide importance due to their multiple applications as broad-spectrum antimicrobial, antiviral, anticancer properties etc. Due to the surge of microbial resistance, tumor resistance, and ongoing pandemic due to constantly mutating corona virus, there is a need to develop next-generation therapeutics options from natural origin, less toxic to the environment, and have higher specificity towards target. Small molecule therapeutics are certainly less specific towards cancer targets hence the cytotoxicity is a major issue in cancer treatment while drug resistance due to the mutations are coming as challenges every day for drug discovery researchers. Microbial lipopeptide reserves a sweet spot in between the small molecule inhibitors and peptide therapeutics because of their amphiphilic compounds consist of a fatty acid side chain and a cyclic peptide moiety of hydrophilic nature. The computational drug discovery approach accelerates the drug discovery process due to the advancement in supercomputer facilities provided by various funding agencies such as the Department of Biotechnology (DBT) and the Department of Science and Technology (DST) in India. The current review article is focusing light on the research contribution of Indian Scientists and Govt. of India in the field of lipopeptide-based research and applications of Computer-aided drug discovery.

Phytonanotechnology: Recent applications and the role of Biocorona

Phytonanotechnology is lately gaining increased interest owing to its potential to modernize agriculture for better yield and nutritional quality. Consequently, Nano-Agri products like nano-biosensors, nano-carriers, and growth augmenters are being developed and applied. However, the limited knowledge of molecular interactions taking place at nano-bio interface remains a major concern. The nanotechnological interventions for healthier crops could rather turn out tobe risky and inefficient in the absence ofclear understanding of molecular mechanisms of nano-bio interactions. Upon entry into tissues or cells, nanoparticles (NPs) adsorb biomolecules forming a biocorona which determines NP uptake, translocation, and reactivity. The composition of biocorona is dependent on the physicochemical characteristics of the NPs, their surroundings, and the interaction time. Recent nascent studies in plants showed the potential of biocorona to influence major cellular pathways or plant responses like energy synthesis, pathogenesis, stress tolerance, and leaf senescence. This mini-review aims at summarizing the recent application of phytonanotechnology, the current status of biocorona studies with an overview of research bottlenecks and future prospects.

A Clinical Study and Management of Non Traumatic Acute Abdomen

Background: The acute abdomen is a condi?on that demands urgent a?en?on and treatment, ranging from trivial to life threatening condi?ons. The aim of this study was to know in detail the epidemiology and outcome in nontrauma?c acute abdomen. Methods: An ins?tu?on based, cross-sec?onal study was conducted from December 2019 to April 2020, at Department of General Surgery Govt. Medical College Kota Rajasthan. The study included 100 cases of non-trauma?c abdomen. Results: Non- trauma?c acute abdominal pain was more common in 2ndto 6thdecade of life. The males to female ra?o is 2.85:1. Hollow viscus perfora?on (30%) forms the commonest cause of acute abdomen followed by acute appendici?s, Sub acute intes?nal obstruc?on, renal/ureteric colic, cholelithiasis, pancrea??s, non-specific pain abdomen, OBG related pathology, liver abscess, Meckel’s diver?culi?s and splenic abscess in 24%, 23%, 8%, 4%, 3%, 3%, 2%, 1%, 1% and 1% respec?vely. Sixteen pa?ents managed conserva?vely. Most common surgical procedures done were exploratory laparotomy with needful for hollow viscus perfora?on and open/laparoscopic appendicectomy for acute appendici?s. Conclusions: Proper history taking, clinical examina?on with suppor?ve imaging findings are most important to narrow the differen?al diagnosis and for immediate interven?on to limit morbidity and mortality.

Tooth Loss and Oral Health-Related Quality of Life among Adult Dental Patients: A Cross-Sectional Study

Background: Oral diseases seriously impair the quality of life (QoL) in a large number of individuals and they may affect various aspects of life. Aim: To determine the relationship between tooth loss and oral health?related quality of life (OHRQoL) among adult dental patients. Study Setting and Design: A cross?sectional study was carried out among 296 adult dental patients aged 35–44 years attending Department of Oral Medicine and Radiology of Panineeya Institute of Dental Sciences and Hospital, Hyderabad, India. Materials and Methods: Oral Health Impact Profile?14 (OHIP?14) was used to assess OHRQoL. Dentition status and periodontal status according to WHO criteria 2013 and position, number of teeth lost by Batista et al. (2014) tooth loss classification were assessed. Statistical Analysis: Mann–Whitney U test and analysis of variance were used to find prevalence and severity of OHIP?14 with tooth loss and logistic regression analysis to evaluate the association between OHIP?14 prevalence and severity based on variables. Results: Except for the subjects with history of previous dental visit, variables such as gender and reason for dental visit showed significant difference (P ? 0.05) with tooth loss. Males subjects, who visited dentist with a history of pain, presence of periodontal disease and tooth loss up to 12 teeth (score 3) emerged as significant predictors for OHIP?14 prevalence (OR = 6.7, OR = 1.13, OR = 3.31). Conclusion: The study strongly evidenced that number and position of tooth loss had negative impacts on OHRQoL

CONCORDANCE: A real?world evidence study to evaluate the concordance of detecting epidermal growth factor receptor (EGFR) mutation by circulating tumor DNA* versus tissue biopsy in patients with metastatic non?small cell lung cancer

Background: Molecular tissue testing in non?small cell lung cancer (NSCLC) is done for the assessment of epidermal growth factor receptor (EGFR) mutation. EGFR mutation status is the basis for deciding the targeted treatment option for patients with metastatic NSCLC. The nonavailability of tissue samples and contraindications for biopsy pose a significant challenge. Hence circulating tumor DNA (ctDNA) by liquid biopsy can be a viable alternative for NSCLC patients. Methods: This study was conducted at 15 sites across India. EGFR mutation testing from plasma was done as part of the study at the central laboratory by the next?generation sequencing (NGS) method and EGFR mutation test results from tissue samples (done as part of routine practice) were recorded for all the patients. Results: Out of the total patients enrolled (N = 245) the majority (64.5% n = 158) were men. The median age of patients was 58.0 (range: 26�) years. The concordance between plasma and tissue testing was found to be 82.9% (95% confidence interval [CI]: 77.55 87.45). The sensitivity and specificity of NGS were 68.4% (95% CI: 56.92 78.37) and 90.1% [95% CI: 84.36 94.21) respectively. Plasma testing detected 1.2% (n = 3) and tissue sample testing detected 2.4% (n = 6) positive status of exon 20 T790M EGFR mutation. Out of the total number of patients enrolled 25 were tissue positive and plasma negative while 16 were plasma positive and tissue negative. Conclusions: This real?world study in Indian patients suggests that plasma testing for EGFR mutation analysis is a viable diagnostic option in newly diagnosed advanced/metastatic NSCLC patients. The noninvasive plasma procedure in patients without available/evaluable tumor sample may enable more patients to receive appropriate targeted therapies by providing clinicians with valuable insights into the patient抯 tumor mutation status. ClinicalTrials.gov Identifier: NCT03562819

The analytical procedure for determination of Assay in finished product of Clofarabine Injection, 1mg/mL is an In-House procedure.

A new and stability-indicating High performance liquid chromatographymethod was developed and validated for simultaneous determination of clofarabine impurities in Injectionformulation.The Chromatographic system consisted of a Shimadzu Class VP Binary pump LC-10ATvp, SIL-10ADvp Auto sampler, CTO-10Avp Column Temperature Oven, SPD-10Avp UV-Visible Detector.The method was validated as per the ICH guidelines Apart from these Chromatographic parameters likeresolution, capacity factor, separation factor, column efficiency and peakasymmetry should also be the ideal for estimation.

Papillary cystadenocarcinoma of the parotid gland: a rare sub-variant of salivary gland adenocarcinoma

Papillary cystadenocarcinoma of the salivary gland is a very rare malignant neoplasm accounting for only 2% of all salivary gland lesions. In 1991 it was first included as a separate entity in the World Health Organization (WHO) classification of salivary gland tumors and in 2017 WHO Classification, the tumor was clubbed as a sub-variant of adenocarcinoma, not otherwise specified. It most commonly occurs in the major salivary glands. Herein we report a case of salivary papillary cystadenocarcinoma in a 54-year-old female, who presented with rapid enlargement of the right parotid swelling. Based on radiology and fine-needle aspiration cytology, a working diagnosis of the malignant tumor involving the superficial lobe of the right parotid gland was made. In view of the malignant nature of the swelling, superficial parotidectomy was done. The histopathology and immunohistochemistry of the mass confirmed the diagnosis of papillary cystadenocarcinoma of the right parotid. With the revised 2017 WHO classification of salivary gland tumors, it is important to report all rare subtypes in order to understand their biology and behavior.