Malignant Pilomatrixoma over Left Shoulder: A Case Report.

Pilomatrixoma is a benign neoplasm derived from hair follicle matrix cells. Malignant pilomatrixoma is a rare entity. It is still unclear whether malignant pilomatrixoma arise de novo or it is a malignant transformation in an otherwise benign pilomatrix tumor. 50% of the pilomatrixomas cases occur on the head and neck region, on the cheek, preauricular area, eyelids, forehead, scalp, and lateral and posterior neck. Lesions can also occur on the upper and lower extremities and trunk. Pilomatrixomas are more common in children and are seen more frequently in girls. We present a case of left-arm malignant pilomatrixoma in a 14-year-old girl.

Rare case of Hirayama’s disease.

Hirayama‟s disease is a rare benign neurological disorder also known as monomelic amyotrophy, Sobue disease, Juvenile Muscular Atrophy of Distal Upper Extremity (JMADUE). It mainly affects young males in their second or third decades and is most commonly seen in Asian countries like Japan, Malaysia and India. In majority of the cases the cause of the disease is unknown. An 18 year male came with weakness in his right hand and forearm since 1 year. Examination revealed weakness and wasting of muscles of forearm and hand without lower limb involvement and normal deep tendon reflexes. MRI showed focal short segment hyperintense signal in the ventral and right lateral aspect of the cervical cord at C5-C6 level with the involved segment measuring 4x3mm in size. Based on clinical and radiological features a diagnosis of focal amyotrophy was made. Patient is given a cervical collar to prevent flexion at the neck and physiotherapy in the form of hand and forearm exercises were started. Regular follow up of the patient once every 2 months is being done. Hirayama‟s disease is a rare, benign, self-limiting neurological disorder. Early diagnosis and management by preventing cervical flexion with the help of a cervical collar has shown to halt the progression of the disease.

Thoracic outlet syndrome due to compression of subclavian artery at first rib.

Thoracic Outlet Syndrome (TOS) refers to a constellation of signs and symptoms that arise from compression of the neurovascular bundle within the confined space of the thoracic outlet. Neurogenic (nTOS) from brachial plexus compression (95%), venous (vTOS) from subclavian vein compression (3%), & arterial (aTOS) from subclavian artery compression (1%). Most common clinical presentation of aTOS patients is distal upper extremity arterial emboli in otherwise healthy patient. Presenting a case report of arterial thoracic outlet syndrome.

Benefits and limitations of FNAC in thyroid diseases: our institutional experience.

Background: To assess sensitivity and specificity of FNAC as a preoperative diagnostic tool for thyroid pathology. Methods: Relevant clinical data (demographic- age, sex, place, occupation) including history was obtained from the patient. A detailed clinical examination was performed. All these patients were subjected to various investigations which include thyroid function test and FNAC. Then the patients were subjected to routine line of management and followed up. The main component of this study FNAC was performed as per prescribed standard technique; these findings were then correlated with histopathological diagnosis. Results: Out of 150 patients, Eighty eight percent of the patients (132 cases) in our study were females and the rest 12% of the patients were males (18 cases). 72.73% of the females had benign swellings and 27.27% had malignant tumours of thyroid gland whereas 61.11% of male patients in our study had benign swellings and 38.89 % had malignant tumours of thyroid gland. The sensitivity and specificity of FNAC were 84.48%and 78.26%respectively. The positive and negative predictive values were 90.74%and 66.67% respectively. Conclusion: FNAC is safe, simple with economical and cost effective procedure. It gives a reliable pre-operative cytological diagnosis based on which surgical procedures can be confidently executed. An attempt is made hereby to compare our results with worldwide documented literature. The primary purpose is to avoid the false negative cytological reports in thyroid carcinoma as negative report gives a clinician a false sense of security that is harmful in the interest of both the patient and surgeon.