A lesion on lip – Hemangioma with Chronic Granuloma.

Infections as well as tumours and tumour-like conditions are common in the oral cavity. While hemangiomas are benign vascular tumours which may be encountered in any part of the body, granulomatous infections are unusual in the mouth. We discuss below the rare occurrence of a hemangioma on the lip which was associated with a chronic granuloma.

Diagnostic Approach to Thyroid Nodules.

Derangement of thyroid function is a common clinical problem, with variable clinical presentations ranging from subtle, incidentally discovered disorders to overt disease, with frank disturbances of hormone levels and visible thyroid enlargement. In addition, there are the autoimmune thyroid disorders, and the neoplastic enlargements which result in palpable nodules. A large amount of new information has become available in recent times. They provide a comprehensive approach to diagnosis of thyroid nodules, ranging from initial evaluation, clinical and ultrasound criteria for fine-needle aspiration biopsy, interpretation of fine-needle aspiration biopsy results, and their management. Recommendations regarding the initial management of thyroid cancer include those relating to optimal surgical management, radioiodine remnant ablation, and suppression therapy using levothyroxine. Recommendations related to long-term management of differentiated thyroid cancer include those related to surveillance for recurrent disease using ultrasound and serum thyroglobulin as well as those related to management of recurrent and metastatic disease. We went through the published literature available electronically and assessed the various studies and their results. The results were reviewed carefully and interpreted in order to analyse the approach to diagnosis of thyroid swellings, especially in the Indian context. Although a detailed review is outside the scope of this paper, we will attempt to discuss some of these guidelines, especially in light of the scenario in our region.

Malignant Melanoma of Anal Canal – A Diagnostic Dilemma

A 50-year-old male presented with major complaints of bleeding per -rectum and generalized weakness for past one and a half month. Digital rectal examination (DRE) and colonoscopy revealed a thrombosed internal haemorrhoid, which was surgically excised. Histopathological examination (HPE) was pointing towards anal malignant melanoma, which was further confirmed by positive immunohistochemistry (IHC) for HMB-45. As the patient had no secondaries or lymph node enlargement, he was referred for loco-regional radiotherapy. Primary ano-rectal melanoma is a rare but locally aggressive neoplasm capable of early metastasis. Owing to its non-specific clinical presentation it may be mistaken for benign conditions like haemorrhoids and may prove fatal.  Surgical treatment may range from wide local excision (WLE) to abdomino-perineal resection (APR) with controversial role of chemo-radiation in advanced cases. Prognosis is usually bleak with a 5-year survival rate of less than 20%. Owing to the rarity of ano-rectal melanoma and importance of its early detection and management, this case is being reported here.

Myopericytoma of lip: A rare lesion in an unusual location.

Myopericytoma is a rare benign tumor with perivascular myoid differentiation. It shares histomorpholoic features with the so-called hemangiopericytoma, myofi broma and glomus tumor. We hereby report the case of a 14-year-old boy who presented with a slowly growing, painless, fi rm mass on upper lip, diagnosed as myopericytoma on the basis of histopathology and immunohistochemistry. To the best of our knowledge, this is only the second such reported case.