Value of Imprint Cytology for the Rapid Diagnosis of Mucormycosis in the COVID-19 Pandemic Setting - A Pilot Study.

Background: The second wave of the coronavirus disease 2019 (COVID-19) pandemic recorded a surge in rhino-orbital-cerebral mucormycosis (ROCM) infection in COVID-19-positive patients with diabetes and on concomitant steroid therapy. The rapidly progressive and devastating nature of the disease necessitated prompt diagnosis and early intervention to improve patient outcomes. Histopathology and fungal culture remain essential tools; however, these investigations have long and variable turn-around times (TATs) and may delay the initiation of treatment. Frozen section is not widely available and should be avoided in COVID-19-positive cases due to the risk of aerosol production and droplet exposure. In cases with high clinicoradiologic suspicion for mucormycosis, imprint cytologic evaluation provides a rapid diagnosis. Familiarity with fungal cytomorphology, awareness of morphologic pitfalls, and implementation of a standardized reporting format aid in diagnostic accuracy. Method: Eighteen COVID-19-positive patients, who were admitted to our hospital with clinical suspicion of mucormycosis during June and July 2021, were included in the study. We used nasal or oral imprint cytology for the initial, rapid detection of Mucor. Cytology findings were correlated with histopathology and fungal culture results. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Results: The sensitivity, specificity, PPV, and NPV were 100%, 100%, 100% and 100%, respectively. Conclusion: This study showed that imprint cytology can be a rapid, cost-effective, first-line diagnostic modality in Mucor diagnosis.

Successful Management of Rhino-Orbital-Cerebral Mucormycosis in a Child with Acute-on-Chronic Kidney Disease and Malnutrition: Case report and literature review.

Mucormycosis is a very rare fungal infection in children. It is caused by opportunistic fungi and mainly affects immunocompromised patients. Early diagnosis is very important for a good outcome. Successful management requires the reversal of the underlying predisposing risk factors, surgical debridement and prompt administration of active antifungal agents, with liposomal amphotericin B being the first-line therapy. This case, to the best of the authors' knowledge, is the first rhino-orbital-cerebral mucormycosis to be reported on among Omani children. We highlight the importance of early diagnosis and prompt surgical and medical interventions in achieving a satisfactory outcome and review the published literature in regard to the management.

COVID-19-Associated Mucormycosis: An Opportunistic Fungal Infection. A Case Series and Review.

BACKGROUND: A surge in COVID-19-associated mucormycosis cases has been observed during the second wave of COVID-19 in summer of 2021. Most cases were reported from India. The Delta variant (B.1.617.2) was the most common variant circulating at that time. Mucormycosis is an opportunistic angioinvasive fungal infection with high morbidity and mortality. METHODS: We present 10 cases of COVID-19-associated rhino-orbital and rhino-orbital-cerebral mucormycosis managed in a secondary hospital in Oman. RESULTS: The median time for developing mucormycosis was two weeks after COVID-19 diagnosis. All patients were newly diagnosed or already known to have poorly controlled diabetes mellitus. Five patients received corticosteroid therapy for COVID-19. Three patients had severe COVID-19 and died of severe acute respiratory distress syndrome and septic shock. Another three patients died of advanced mucormycosis and cerebral involvement. Despite aggressive medical and surgical intervention, the mortality rate was 60% (6/10). CONCLUSION: Mucormycosis is an aggressive opportunistic infection with high morbidity and mortality that requires prompt recognition and urgent intervention. Uncontrolled blood sugar, the use of corticosteroids, and immune dysfunction due to COVID-19 are all important risk factors for development of mucormycosis. Worse outcomes are associated with poor glycemic control despite aggressive medical and surgical interventions.

Annular Elastolytic Giant Cell Granuloma.

Annular elastolytic giant cell granuloma (AEGCG) is a rare, often self-limiting chronic inflammatory disorder mostly occurring in the sun-exposed areas such as the dorsum of hands, extensor surfaces of arms, face, anterior neck, and upper chest. The pathognomonic histological findings include the presence of numerous granulomas associated with loss of elastic fibers that appear to be ingested by multi-nucleated giant cells. Here, we present a case of a 56-year-old woman with multiple, anatomically variable erythematous lesions- annular and papular, mainly in the upper body. The clinical presentation and histopathologic findings support our diagnosis.

Giant Prostatic Hyperplasia: Fourth largest prostate reported in medical literature.

A giant prostatic hyperplasia (GPH) weighing more than 700 g is a rare entity. It is believed that only eight such cases have been previously reported in the medical literature. This case report concerns a patient with a GPH weighing 740 g which was successfully removed by suprapubic prostatectomy. To our knowledge, this is the fourth largest benign prostatic enlargement ever reported in the literature.

Adrenocortical carcinomas: a 12-year clinicopathologic study of 15 cases.

Adrenal cortical carcinomas are rare neoplasms and the definitive diagnostic criteria are distant metastasis and / or local invasion. Due to advances in imaging techniques, adrenal cortical neoplasms are discovered earlier and are smaller, increasing the need for more accurate diagnosis and pathologic indicators of prognosis. A twelve year retrospective clinicopathologic analysis of 15 histopathologically proven cases of adrenocortical carcinomas was done. Clinical details including radiologic findings, endocrine manifestations and gross finding were analysed. Hematoxylin and eosin stained slides were reviewed. Emphasis was on application of Weiss criteria. All fifteen tumors fulfilled Weiss criteria of malignancy, ie. all 15 possessed 3 or more of these criteria of malignancy. Functional tumors showed a greater representation of mixed cell type. It was concluded that Weiss criteria is easy to apply and that a combined evaluation of clinical features, size, weight and microscopic appearance seems necessary for the diagnosis of adrenocortical carcinomas.