AN UNUSUAL PRESENTATION OF LIPOMA ON THE CHEST

Intramuscular lipoma of the chest wall is a rare finding. We present the case of a 51years male who presented to the hospital with mass on the left side of the chest which was gradually progressive in size. After re- evaluation swelling was round in shape, single with well-defined margin and rubbery consistency. Preoperative imaging HRCT thorax was done which suggested a well-defined round, hypodense, non-enhancing space occupying lesion (10.2x 8.6 x2.3cm) with volume of approximately 100ml noted in the muscle of the chest wall (pectoralis major to pectoralis minor) in the left side of the chest most likely lipoma. Histopathology revealed normal adipocytes with small eccentric nucleus.

Histoplasmosis: epidemiología, diagnóstico y terapéutica / Histoplasmosis: epidemiology, diagnosis and therapy

La histoplasmosis es una enfermedad granulomatosa, producida por hongos dimorfos del género Histoplasma. Se observa en casi todos los países del mundo. En América Latina, en Venezuela, Colombia, Brasil, Argentina, Ecuador, Perú, Paraguay y Uruguay, entre otros. Datos epidemiológicos recienteshanmostrado un aumento de histoplasmosis en Venezuela y otros países.Los clínicos no están conscientes de su importancia en nuestro medio. Objetivo: Dar a conocer la situación actual de esta enfermedad en el Area Metropolitana de Caracas y en otras áreas endémicas, con la intención de crear la inquietud de investigar su incidencia y otras características relevantes en el resto del país. Métodos: Se analizaron las características de todos los pacientes con diagnóstico de certeza de histoplasmosis registrados y realizados por la Sección de Micología Médica ­Dr. Dante Borelli‖ del Instituto de Medicina Tropical de la UCV, referidos de los diferentes hospitales del Distrito Capital y otros estados del país, con énfasis en los datos epidemiológicos, manifestaciones clínicas, diagnóstico, tratamiento y evolución entre 1994 y 2012. Resultados: se encontraron 553 pacientes. La mayoría estaban entre los 20 y 49 años, relacionado con un alto número de pacientes con VIH/SIDA. Hubo más casos en hombres que en mujeres en todos los grupos etarios, menos en los pacientes mayores de 60 años, posiblemente debido a la disminución de los estrógenos, que son protectores en la mujer. Casi todos los pacientes con VIH/SIDA mostraron la forma diseminada, solo uno presentó una forma pulmonar. De los pacientes VIH negativos, 54,62% presentaron infección diseminada y 44,47%, formas pulmonares. 93 de los de enfermedad diseminada tenían estados de inmunocompromiso. El examen directo fue el método más fácil y eficaz para diagnosticar la histoplasmosis. La anfotericina B (AMB) fue el tratamiento para la histoplasmosis en pacientes con o sin SIDA, que requirieron hospitalización, seguido por itraconazol (ITC). Esta droga se utilizó en pacientes que no se encontraban severamente enfermos o con afectación del sistema nervioso central. Conclusiones: histoplasmosis se encuentra en aumento en nuestro país. Se observa con más frecuencia en pacientes con SIDA, inmunosuprimidos y pacientes que han recibido un inóculo abundante. El examen directo con coloraciones especiales es el método de mayor rendimiento para el diagnóstico. Este debe ser realizado por personal con experiencia.Es conveniente utilizar diferentes técnicas para aumentar la probabilidad de obtener un diagnóstico correcto. AMB e ITC son los tratamientos de elección. Los médicos deben estar alertas de los signos y síntomas, correlacionándolos con los antecedentes epidemiológicos, para evitar el retraso del diagnóstico y mejorar la evolución de los pacientes.

Histoplasmosis is a granulomatous disease, caused by dimorphic fungi from the genus Histoplasma. It is described worldwide.In Latin America, Venezuela, Colombia, Brasil, Argentina, Ecuador, Perú, Paraguay and Uruguay among others are affected. Recent epidemiological data have shown an increase of histoplasmosis in Venezuela and other countries. Clinicians are nor aware of the importance of this mycosis. Objective: analyze the current situation of this disease in the Caracas Metropolitan Area and other endemic areas, with intention to create awareness of its incidence and other relevant characteristics in our country. Methods: characteristics of the patients with diagnosis of histoplasmosis, performed and registered at the Sección de Micología Médica ­Dr. Dante Borelli‖, Instituto de Medicina Tropical, UCV, referred from different hospitals at Distrito Capital and other states of the country, with emphasis on epidemiological data, clinical manifestations, diagnosis, treatment and outcome, between 1994 and 2012 are analized. Results: 553 patients were found. Most of them were between 20 and 49 years old, possibly due to a high number of HIV/AIDS patients. There were more male than female patients in all age groups, except in 60 years and older, possibly due to the lack of estrogenic hormones, which protect women from infection. All HIV/AIDS patients but one, presented with a disseminated form of the disease, and one, a pulmonary form. Of the HIV negative patients, 54,62% showed disseminated infection and 44,47%, pulmonary presentation. 93 of the disseminated infection patients had immunocompromising conditions. Direct examination was the easiest and most efficacious diagnostic method. Amphotericin B (AMB) was the drug of choice for the treatment of hospitalized patients, followed by Itraconazole (ITC). This was the preferred treatment for mild to moderate disease or non CNS infection. Conclusions: Histoplasmosis is rising in our country. It is more frequent in HIV/AIDS patients and immune suppression. It is also seen in patients who have inhaled a large inoculum. Direct examination with special stains is the diagnostic method with better results. It must be performed by experienced personnel in fungal diagnosis. The use of different techniques is recommended to improve early and correct diagnosis. AMB and ITC are drugs of choice for the treatment of histoplasmosis. Clinicians should be aware of suggestive symptoms and signs, correlating them with epidemiological data, to avoid diagnostic delay and improve the outcome of the patients.

Role of image guided fine needle aspiration cytology in the diagnosis of intra-abdominal and intra-thoracic lesions

Background: Intrathoracic and intra-abdominal tumors at inaccessible sites pose difficulty in diagnosis. Ultrasonography and computed tomography guided fine needle aspiration cytology has an important role in the diagnosis and distinguishing them as benign and malignant lesions. Image guided FNA has proved to be safe, quick, reliable and cost-effective method for obtaining tissue for cytopathological examination. The objective was to describe the pattern of intra-abdominal and intra thoracic masses on FNAC.Methods: This cross-sectional study was done in the postgraduate Department of pathology Government, Medical college Jammu i.e. 1st September 2017 to 30th September,2018 for a period of one year under image guided FNAC. Air dried and wet fixed smears were stained with may Grunwald Giemsa (MGG) and Papinacolau (PAP) stains respectively. Acid fast bacilli stain was done on additional smears in case of suspected tubercular lesions.Results: A total of 60 patients were subjected to ultrasonography and CT guided intra-abdominal and intra thoracic FNACs in a period of one year. FNAC was performed from various anatomical sites of which intra-abdominal lesions were 40 (liver:21 cases, gallbladder:8 cases, ovary: 3 cases, lymph nodes 3 cases, pancreas: 2 cases, omentum 2 cases, GIT 1 case).  Intrathoracic lesions were twenty (20); out of which lung cases were eighteen (18) and two (2) were mediastinal aspirations.Conclusions: Percutaneous fine needle aspiration cytology under image guidance well described the pattern of deep-seated lesions.

Clinical profile and factors affecting outcome of children with Hepatic Abscess: 19 year study

Objectives@#To describe the clinical profile of children with hepatic abscess, determine their laboratory & imaging findings, medical and surgical treatments and study factors affecting its outcome.@*Methodology@#A retrospective cohort study done in December 2016 on children 0 to Demographic, clinical and diagnostic data were correlated with the outcome and presence of complications.@*Results@#Thirty cases were identified in 19 years but only 25 charts were available for review. Mean age in years was 5.27 +/- 4.80 SD with male predominance. Fever (96%) and abdominal pain (60%) were common symptoms.Only 9 patients had hepatic abscess culture with Staphylococcus aureus (56%) as the most frequent growth. Anemia (76%) and leukocytosis (96%), and solitary (76%), large abscess >5 cms (60%) involving the right lobe (72%), were the common diagnostic findings. Most were treated with antibiotics alone (60%).All patients improved with no mortality noted, while pleural effusion was seen in 8 out of 12 patients with complications. Only male gender was significantly associated with complications both on chi-square (p0.004) and logistic regression (p 0.008). @*Conclusion@#Hepatic abscess is a liver infection usually seen among young and male population, manifesting as fever with anemia and leucocytosis. Most were complicated by pleural effusion with no deaths reported. Male gender had significant association with complications.

Effectiveness of image guided fine needle aspiration cytology in cases of deep seated lesions.

Background: Newer development in radiology has completely revolutionized the approach to percutaneous aspiration of space occupying deep seated lesions making it rapid, inexpensive, versatile and an adjunctive tool for evaluating internal organs. Aims & Objective: The present study was conducted to evaluate the effectiveness of image guided fine needle aspiration cytology in cases of deep seated lesions. Material and Methods: Total 169 aspirations performed from 161 cases in period of two years, 131 (77.51%) were under USG guidance and 38 (22.49%) were under CT guidance. Results: Overall adequacy rate was 76.92% for guided aspirations. Adequacy rate in case of aspirations done by pathologist was much higher than clinicians with P value (with Yates correction) of < 0.05. The most common organ for aspiration was liver (30.18 %), followed by ovary (23.67 %). Guided aspirations were also done from various organs like lung, retroperitoneal lymph nodes, pancreas, stomach, gall bladder, kidney, mediastinum, pleura, suprarenal gland and abdominal wall with high adequacy rate and without complications though with smaller sample size. Cytological diagnosis was possible in 73% cases. Conclusion: Guided aspiration is a simple, safe and cost effective screening test for deep seated lesions with a significant role in the detection of clinically unsuspected malignancy making it an investigation of choice for early confirmation or exclusion of pathology.

Pure Isolated Sphenoid Sinusitis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Isolated sphenoid sinusitis is often misdiagnosed because of its rarity and varied clinical presentation. Presenting symptom is often both subtle andsuggestive of other intracranial lesions. The purpose of this study is to present typical clinical manifestations and treatment of pure bacterial isolated sphenoid sinusitis. Materials and Method: Nine cases of isolated sphenoid sinusitis of bacterial origin were reviewed retrospectively. RESULTS: Two cases were acute and seven cases were chronic. The most common symptom was deep seated headache. Most of them were transferred via other department. Radiologic diagnosis using CT and MRI was enough to distinguish. Four cases were improved by medical treatment. Five cases were treated by endoscopic sphenoidotomy. CONCLUSION: Isolated sphenoid sinusitis should be considered as a possible cause in case of deep seated, intractable headache. And in this case, CT or thorough endoscopic examination should be recommended. Endonasal endoscopic sphenoidotomy is good and simple treatment for cases intractable to medical treatment.

Deep-seated Fungal Infections in Biopsy Specimens

A total of 197 cases of fungal infections in biopsy specimens obtained from the pathology file of the Department of Pathology, Seoul National University Hospital, for a period of 28 years from 1960 to 1987 were studied by histopathologic investigations with analysis of clinical records. The following results are obtained; 1) While most fungal infections increased in number, annual relative frequency of them were between 0.1% and 0.2%. 2) Among 197 cases of fungal infections, deep-seated mycosis was 175 cases (88.8%). Aspergillosis was the most common mycosis, accounting for 29.4 percent. 3) The age and sex distribution of fungal infection was even throughout the ages, but it was more common in age group over fifty, and the male was more frequently affected than the female. 4) Aspergillosis was encountered in 58 cases (29.4%) and the preferred localization was the lung. The candidiasis was seen in 48 cases (24.4%) and the preferred localization of cryptococcosis was lymph node and skin.