Histomorphological study of salivary gland neoplasms: fifteen year study

Background: The neoplasms of salivary glands are relatively uncommon and represent less than 2% of all human tumors. They are morphologically diverse, with marked heterogeneity among the different subtypes and even within the same tumor. The unpredictability in the long term outcome imposes a significant challenge in the clinical management.Methods: This is a descriptive study done in a tertiary care teaching hospital over a period of 15 years. Patient details were collected from medical case records. All specimens were evaluated for site, laterality, size, nature of the cut surface and intactness of the capsule. Two to 5 representative bits were taken from each specimen and subjected to routine fixation, processing and section cutting followed by Haematoxylin and Eosin staining.Results: A total of 138 salivary gland tumors were diagnosed from patients in the age group of 13 to 90 years with a mean age of 41.8 years. There were 53 (38.4%) males and 85 (61.6%) females with male to female ratio of 1:1.42. There were 115 (83.3%) benign tumors and 23 (16.7%) malignant tumors. Pleomorphic adenoma accounted for 70.3% of all salivary gland tumors followed by mucoepidermoid carcinoma (10.9%), Warthin tumor (8%), basal cell adenoma (2.9%), adenoid cystic carcinoma (2.2%), squamous cell carcinoma (2.2%), myoepithelioma (1.4%), oxyphillic adenoma (0.7%), acinic cell carcinoma (0.7%) and salivary duct carcinoma (0.7%).Conclusions: The salivary gland neoplasms are relatively uncommon head and neck tumors. Parotid gland is the commonest site of occurrence. Pleomorphic adenoma is the commonest benign and mucoepidermoid carcinoma the commonest malignant salivary gland tumor.

Change in Static Postural Stability after a Home‑based Exercise Program in Persons with Idiopathic Parkinson’s Disease - A Randomized Control Study

Introduction and Purpose:The most common form of parkinsonism is idiopathic Parkinson’s disease. The cardinal symptoms of idiopathicParkinson’s disease are tremor, rigidity, bradykinesia, posture and gait abnormalities, speech changes, depression, gastrointestinal issues,urinary problems, autonomic features, eye abnormalities, cognitive impairments, cranial nerve dysfunction, and swallowing dysfunction.Abnormalities of posture significantly affect activities of daily living in such patients. Static posturography is used to measure the balanceof an individual during standing. Asingle-blinded controlled trial comparing 4 weeks of outpatient physical therapy with no specific therapyshowed significant improvement in gait in patients with Parkinson’s disease. However, the gains were lost when the patients stoppedexercises at the end of the program. Hence, the authors felt that teaching a simple, implementable home-based exercise could benefitthese patients in improving their balance. Any change in static balance could be measured easily with a force platform.Methodology: A total of 62 clinically diagnosed patients with idiopathic Parkinson’s disease attending a tertiary care centerwere randomized into two groups, one rehabilitation group (those who were taught a simple home-based rehabilitation exerciseprogram on an outpatient basis) and a non-rehabilitation (control) group who were not taught the exercises. They were clinicallyevaluated and their center of pressure (COP) sway area was measured using a computerized static posturography instrument(force platform), at first visit, after 1 month, after 3 months, and after 5 months. The differences in their COP sway area betweenthe visits were compared between the two groups to see the change in postural stability.Results and Discussion: Atotal of 62 patients who satisfied the inclusion criteria were inducted in the study after informed consent. Themean age of the rehabilitation group (n = 32) was 58.66 years and the mean age of the non-rehabilitation group (n = 30) was 59.17 years.69% of the rehabilitation group were males and 31% were females, and in the non-rehabilitation group, 67% were males while 37%were females. The mean duration of disease in the rehabilitation group was 8.31 years and that in the non-rehabilitation group was8.67 years. Most of the variables did not show any significant difference, and hence, the groups were comparable. The baseline meanCOP sway area of the rehabilitation group was 76.53 mm2 and that of the non-rehabilitation group was 76.73 mm2. There was a 11.68%decrease in the COP sway area of the rehabilitation group at the end of the 1st month while the non-rehabilitation group had only 0.22%decrease. At the end of the study, i.e., at 5th month, there was a 32.05% decrease in the sway area from baseline in the rehabilitationgroup, indicating significant improvement in static balance. There was only 1.13% decrease in the sway area of the non-rehabilitationgroup. Both the P values were <0.001, and thus, our study revealed that a simple home-based rehabilitation exercise program taughton an outpatient basis to patients with idiopathic Parkinson’s disease can improve the balance in such patients.Conclusion: There was a statistically significant improvement in the static postural stability of patients with idiopathic Parkinson’sdisease who did exercise at home when compared to those who did not perform the home-based exercises. However, longterm studies need to be done to confirm whether this gain is long lasting.

A six-year study of leiomyomata with emphasis on lipoleiomyoma

Background: Leiomyoma is the most common benign neoplasm of the uterus. Lipoleiomyoma is a rare variant usually affecting women in the postmenopausal age group. Incidence of lipoleiomyoma varies from 0.59% - 2.1%. This study was undertaken to analyse the different variants, degenerative changes and to determine the incidence, clinical and morphological features of lipoleiomyoma amongst all the leiomyomas studied.Methods: This study was done in the Department of Pathology over a period of 6 years. Authors studied 575 patients with leiomyoma constituting a total of 1122 leiomyomata as some patients presented with multiple leiomyomata. Further clinicopathological correlation was done.Results: In the present study 98.03% of leiomyomata were uterine in location, 1.06% were cervical, 0.62% were in broad ligament and 0.26 % were in ovary. Among the 1122 leiomyomata studied, degenerative changes were noted in 19.6% of which hyaline degeneration was the most common. Leiomyoma variants constituted 5.27% of all leiomyomata. The incidence of lipoleiomyoma was 0.71% with size ranging from 3-10cm.Conclusions: Leiomyoma is a common tumor of the uterus and lipoleiomyoma variant is very uncommon with unknown etiology. They occur in postmenopausal as well as reproductive age group. The site of lipoleiomyoma can be uterine or extrauterine location such as broad ligament. Coexistance of metabolic derangement is an observation that may have a role in development of lipoleiomyoma.

Sertoli cell tumor arising in a cryptorchid testis presenting as a content of inguinal hernial sac.

Sertoli cell tumors (SCTs) are rare tumors accounting for <1% of all testicular tumors. Here, we report a rare case of SCT in a 60‑year‑old man presenting as a painless swelling in the right groin since childhood. Clinically, he presented with right‑sided inguinal hernia with absence of the right testis. He had normal left testis and had no gynecomastia or infertility. The specimen of hernial sac showed testis with a 1.6 cm × 1.5 cm nodular mass having gray tan‑cut surface. Histopathologically, the testis showed atrophy and the nodular portion showed tumor cells arranged in tubular and microcystic pattern, with no solid pattern or necrosis. The diagnosis of SCT was confirmed with immunohistochemical staining for inhibin which showed fine granular cytoplasmic positivity. Cryptorchid testis having SCT and presenting as a content of inguinal hernia is a rare occurrence.

Mastoid Osteoma: A Case Report

Mastoid osteoma is a rare benign neoplasm of mesenchymal origin. Osteomas of the temporal bone are infrequent, and these mastoid osteomas are a definite rare occurrence. These tumours can present with cosmetic deformity and sometimes with pain. In this report we describe a patient with mastoid osteoma who presented with cosmetic deformity and experienced retro auricular pain.

Transurethral resection of prostate: a comparison of standard monopolar versus bipolar saline resection

INTRODUCTION: Transurethral resection syndrome is an uncommon but potentially life threatening complication. Various irrigating solutions have been used, normal saline being the most physiological. The recent availability of bipolar cautery has permitted the use of normal saline irrigation. MATERIAL AND METHODS: In a randomized prospective study, we compared the safety and efficacy of bipolar cautery (using 0.9 percent normal saline irrigation) versus conventional monopolar cautery (using 1.5 percent glycine irrigation). Pre and postoperative hemoglobin (Hb) and hematocrit values were compared. Hemodynamics and arterial oxygen saturation were monitored throughout the study. Safety end points were changes in serum electrolytes, osmolarity and Hb/PCV (packed cell volume). Efficacy parameters were the International Prostate Symptom Score (IPSS) and Qmax (maximum flow rate in mL/sec) values. RESULTS: Mean preoperative prostate size on ultrasound was 60 ± 20cc. Mean resected weight was 17.6 ± 10.8 g (glycine) and 18.66 ± 12.1 g (saline). Mean resection time was 56.76 ± 14.51 min (glycine) and 55.1 ± 13.3 min (saline). The monopolar glycine group showed a greater decline in serum sodium and osmolarity (4.12 meq/L and 5.14 mosmol/L) compared to the bipolar saline group (1.25 meq/L and 0.43 mosmol/L). However, this was not considered statistically significant. The monopolar glycine group showed a statistically significant decline in Hb and PCV (0.97 gm percent, 2.83, p < 0.005) as compared to the bipolar saline group (0.55 gm percent and 1.62, p < 0.05). Patient follow- up (1,3,6 and 12 months postoperatively) demonstrated an improvement in IPSS and Qmax in both the groups. CONCLUSION: We concluded that bipolar transurethral resection of prostate is clinically comparable to monopolar transurethral resection of prostate with an improved safety profile. However, larger number of patients with longer follow up is essential.

Verteporfin photodynamic therapy of retinal capillary hemangioblastoma in von Hippel-Lindau disease.

An 18-year-old boy presented to us with bilateral retinal hemangioblastoma and von Hippel-Lindau disease with history of cerebral capillary hemangioblastoma and embryonic cell carcinoma of left testes. The vision in the right eye was already lost with development of secondary closed angle glaucoma, optic atrophy with subsequent development of bullous keratopathy. The multiple retinal angiomatous lesions in the seeing left eye were treated with various modalities like triple freeze thaw cryopexy, focal lasers and transpupillary thermo therapy in multiple sittings over a period of almost 20 years since detection. One particular angiomatous lesion in the left eye was showing resistance to all the above mentioned modalities and was finally successfully treated with verteporfin and photodynamic therapy to achieve complete regression without any post-treatment complication and with a sustained 20/20 vision till a follow-up of 15 months.

Plasmacytoid variant of myoepithelioma of palate: a case report.

Myoepitheliomas of intraoral minor salivary glands are rare and are usually of plasmacytoid type. Myoepitheliomas are considered difficult to diagnose without the aid of ultrastructural and histochemical studies. Here we present a case report of plasmacytoid type of myoepithelioma of palate that was diagnosed by light microscopic examination alone. Considering the non-specificity of ultrastructural and histochemical findings, it is important to pay attention to typical features of plasmacytoid myoepitheliomas to arrive at a diagnosis.