Huge congenital teratoma containing tooth in a three-day-old neonate.

Congenital teratoma is a rare cause of congenital proptosis. A full term three-day-old male child was presented with massive unilateral swelling in the left orbit, which was noted since birth. Diagnosis of orbital teratoma without intracranial extension was made based on clinical examination and imaging. Lid-sparing exenteration of the left orbit was done. Histopathological examination confirmed the diagnosis of cystic teratoma. Congenital orbital teratoma with a tooth and mature elements of all the three germ cell layers is reported due to its extreme rarity.

Evaluation of the category high-grade squamous intraepithelial lesion in The Bethesda System for reporting cervical cytology.

BACKGROUND: High grade squamous intraepithelial lesion (HSIL) is a category of The Bethesda System (TBS) for reporting cervical cytology that is in vogue since the introduction of the said system in 1988 and it was not modified in 2001 modification of TBS. The term includes moderate dysplasia (CIN II), severe dysplasia (CIN III) and squamous cell carcinoma in situ. Terms like ASC-US used in TBS are being considered to be not very useful in the prediction about the possible behavior of the pathological status of the cervix. After more than 10 years of use the term HSIL also needs fresh evaluation as in this category two entities of potentially different outcome are clubbed. AIMS: The aim was to find out whether it is justified to have a term like HSIL which includes different points of the spectrum of intraepithelial pathology of cervix from moderate hyperplasia through carcinoma in situ, all having different significance. MATERIALS AND METHODS: In this study 619 cases of cervical cytology reported by TBS were evaluated by comparing them with biopsy reports of the same lesion for the assessment of the sensitivity, specificity and positive predictive value of HSIL as a category of diagnosis in TBS. RESULTS: As a category, HSIL had the diagnostic sensitivity of 96.4%, specificity of 87.5%. The positive predictive value was 96.4%. CONCLUSION: HSIL as a diagnostic category shows a very good predictive accuracy, which implies that it provides a very high probability of the accurate diagnosis collectively of all the conditions in the disease spectrum from moderate dysplasia through in situ carcinoma. Hence, HSIL was found to be a very useful diagnostic category in TBS that conveys proper message to the clinician.

Vanishing bone disease (Gorham's disease) - a rare occurrence of unknown etiology.

A 20-year-old male patient presented with painful swelling around left elbow joint. Radiographic examination revealed osteolytic lesion with pathological fracture of lower end of humerus and upper radius. Upper end of ulna was completely absent along with bony erosion. Histopathology of the bony tissue revealed hemangioma-like lesion composed of vascular channels lined by benign endothelium replacing bone. The diagnosis of Gorham's massive osteolysis was made. Gorham's disease is a benign self-limiting condition affecting any age, may involve any part of the skeleton and is characterized by replacement of bone by hemangiomatous tissue resulting in formation of lesions exhibiting massive osteolysis, which may be to the extent of disappearance of the affected bone in radiograph. This nonhereditary case was not associated with nephropathy, which is often a coexistent condition. The case is being reported for its rarity.

Giant primary ovarian fibrosarcoma: Case report and review of pitfalls.

Primary ovarian fibrosarcomas are very uncommon neoplasms; less than one hundred cases have been reported. Diagnosis can be difficult to establish and other similar appearing mesenchymal lesions must be ruled out. A 23 year old nulliparous woman presented with a huge right ovarian tumor (25 × 17 × 12 cm). Ultrasonography guided aspiration was performed and a strong possibility of fibrosarcoma was suggested based on cytomorphological findings. No epithelial element was noted. She underwent surgical excision which confirmed the diagnosis of primary ovarian fibrosarcoma (the largest till date to our knowledge). Immunohistochemical analyses showed vimentin and CD 34 positivity. We speculate that ovarian fibrosarcoma at the preoperative examination might be considered in the differential diagnosis whenever a unilateral, heterogeneous, largely round solid ovarian lesion is detected.

Conjunctival biopsies and ophthalmic lesions: A histopathologic study in eastern India.

BACKGROUND: The conjunctiva is a thin and flexible mucus membrane that provides a protective barrier to the eye. Very few histopathologic studies have been conducted on conjunctival biopsies in eastern India. MATERIALS AND METHODS: 120 conjunctival biopsies from 117 patients (76 males, 41 females) received during 8 years (January 2003-December 2010) were included in this study. RESULTS: HISTOLOGIC DIAGNOSES WERE: degenerative lesions in 38 cases (31.66%), benign epithelial lesions in 23 cases (19.16%), premalignant and malignant epithelial lesions in 27 cases (22.5%), melanocytic lesions in 10 cases (8.33%), lymphoid in 7 cases (5.83%), and miscellaneous in 15 cases (12.5%). CONCLUSION: Squamous papilloma was the commonest benign tumor, whereas the commonest malignant tumor was squamous cell carcinoma. Melanocytic lesions were less prevalent compared to other/western studies.

Primary pediatric gastrointestinal lymphoma.

BACKGROUND: Primary non-Hodgkin's lymphoma (NHL) of the gastrointestinal (GI) tract is the most common extranodal lymphoma in pediatric age group. Yet, the overall incidence is very low. The rarity of the disease as well as variable clinical presentation prevents early detection when the possibility of cure exists. MATERIALS AND METHODS: We studied six cases of primary GI NHL in pediatric age group with reference to their clinical presentation, anatomic distribution and histopathologic characteristics. RESULTS: All were males except one. Intestinal obstruction was the presenting feature in 50%. Half the cases showed ileocaecal involvement, while large bowel was involved in 16%. Histology showed four cases of diffuse large B-cell lymphoma (DLBCL), one case of Burkitt lymphoma, and one Burkitt-like lymphoma. Immunohistochemistry for Tdt, CD20, CD3, CD30, bcl2, bcl6 confirmed the morphological diagnosis. CONCLUSION: Pediatric GI lymphoma commonly involves the ileocaecal region and presents with intestinal obstruction. A higher prevalence of DLBCL is found compared to other series. A high proliferative index is useful in differentiating Burkitt-like lymphoma from DLBCL.

Correlation of macular thickness and posterior hyaloid change following bevacizumab and triamcinolone in diffuse diabetic macular edema in middle-aged patients.

UNLABELLED: To compare changes in posterior vitreous detachment (PVD) following intravitreal injection of bevacizumab and triamcinolone in diffuse diabetic macular edema in middle-aged type 2 diabetes patients and to correlate this change with change in central macular thickness (CMT). DESIGN: cross sectional study. Fifteen consecutive patients treated by intravitreal bevacizumab (group A) and ten patients treated by intravitreal triamcinolone (group B). Institutional study carried out by retrospective analysis of patient registers including serial optical coherence tomography (OCT) images at baseline, and after 1 and 4 months. A central macular thickness (CMT) and vitreomacular relationship was noted on OCT. PVD was graded on a linear scale (0-4). Change in grade of PVD was correlated with change in CMT at each follow-up. At month 4, the decrease in mean CMT from baseline was 51.2 µ (P = 0.000) and 45 µ (P = 0.022) in group A and group B, respectively, with no significant difference between the two groups (P = 0.874). A change in grades of PVD from baseline to month 4 was significant in both group A (P = 0.001) and group B (P = 0.004) with no significant difference between the two groups (P = 0.906). A significant correlation between change in PVD and reduction of CMT was observed in group A (P = 0.011) but not in group B (P = 0.315). Both bevacizumab and triamcinolone caused a significant reduction in macular thickness and a significant change in grade of PVD. Change in PVD played an influential role in the reduction of macular thickness following bevacizumab.

Distinction of phyllodes tumor from fibroadenoma: Cytologists' perspective.

BACKGROUND: Fibroadenomas and phyllodes tumors may have similar cytological appearances. However, a detailed study of cytomorphology of stromal elements may be helpful in differentiation. AIM: To evaluate the cytological features of phyllodes tumor in our study with special reference to features that can help distinguishing it from fibroadenoma. MATERIALS AND METHODS: The archival materials of our hospital were searched from January 2006 to January 2009 for histopathologically-diagnosed cases of phyllodes tumor. The cases in which previous cytopathology smears were available were included in the study. The cytomorphology of 10 such cases were compared with 25 cytologically-diagnosed and histopathologically-confirmed cases of fibroadenoma. RESULTS: The size, cellularity of stromal fragments, and the proportion of spindle cells in the background are important features in such differentiation.

Inadvertent intracorneal injection of local anesthetic during lid surgery.

PURPOSE: To report a case of inadvertent intracorneal injection of anesthetic agents during lid anesthesia and corneal penetration without full-thickness perforation. METHOD: Case report. RESULTS: Corneal edema with acute loss of vision was noted. The patient was treated with topical, antibiotic, cycloplegic, hyperosmotic agent and lubricant. While the edema slowly subsided, a loss in endothelial cell count was noted. CONCLUSIONS: The effects of intracorneal injection of lignocaine, bupivacaine, and its preservatives have not previously been reported in the literature. A lower postinjection endothelial cell count and associated clinical features in our case indicate that endothelial toxicity occurred. This potential complication should be kept in mind with necessary precautions taken during injection of the eyelid, particularly in cases with preexisting lid laxity.

Prospective randomized comparative study of macular thickness following phacoemulsification and manual small incision cataract surgery.

PURPOSE: To compare macular thickness following uncomplicated phacoemulsification with foldable acrylic lens and manual small incision cataract surgery (MSICS) with non-foldable polymethyl methacrylate (PMMA) lens implantation. METHODS: Prospective study was carried out with one eye each of 224 patients with senile cataract randomized into two groups, phacoemulsification and MSICS, by simple 1:1 randomization. Following surgery by either of the two methods, macular thickness was measured by optical coherence tomography (OCT) on the 1st, 7th, 42nd and 180th postoperative day. Main outcome measure was postoperative macular thickness. RESULTS: On the first postoperative day, central subfield mean thickness (CSMT) in MSICS group was 192.8 +/- 17.9 microm and that in phacoemulsification group was 192.1 +/- 27.4 microm, with no significant difference (p = 0.12). On the 7th day, CSMT in MSICS group (198.9 +/- 21.4 microm) was significantly (p = 0.04) more than that in phacoemulsification group (193.1 +/- 19.3 microm). On the 42nd day, CSMT in MSICS group was 207.8 +/- 26.3 microm and that in phacoemulsification group was 198.3 +/- 23 microm, the difference being significant (p = 0.007). Clinically macular oedema was not diagnosed in any of the patients at any visit. The increase in macular thickness was sub-clinical and did not affect final visual outcome in any patient. CONCLUSION: In spite of the greater theoretical risk of increased postoperative inflammation following MSICS, there was no evidence of cystoid macular oedema, either clinically or on OCT. However, chance of sub-clinical increase in CSMT was more following MSICS compared to phacoemulsification.

An observational study of the pattern of HIV infection in a specified rural area of India with special reference to migratory laborers.

OBJECTIVE: Determination of the pattern of HIV/AIDS in patients attending voluntary confidential counseling and testing center (VCCTC) and prevention of parent-to-child transmission (PPTCT) center of a low-prevalence district of Eastern India. To find out high-risk group and interventional strategy for prevention. METHOD: Cross-sectional exploratory secondary data analysis from the VCCTC and PPTCT register. RESULT: Of the 1348 participants, 160 (11.86%) adults were HIV seropositive. Prevalence in males and females was 9.8% and 20.7%, respectively. Among 22 (1.63%) seropositive children, transmission was vertical in 18 (81.8%). Seventy-one (88.75%) positive adult males were migratory goldsmiths working in Mumbai and other big cities. They were clustered in a particular locality (Daspur). CONCLUSION: Goldsmiths migrated from Daspur to big cities are the bridge populations who are responsible for higher prevalence of HIV in their families and locality. Interventional strategies targeted at this high-risk group are suggested.

Diagnostic accuracy in retinoblastoma.

This study was done to ascertain the accuracy of diagnosis and possible risk of misdiagnosis in suspected retinoblastoma cases by different pre-operative diagnostic procedures like fundoscopy, ultrasonography, computerised tomography, and aqueous cytology study. Twenty-four eyes excised with diagnosis of suspected retinoblastoma were included in the study. Final diagnosis was reached by histopathological examination of excised eyes and compared with pre-operative diagnosis by different diagnostic procedures and accuracy of each procedure was calculated. Twenty-two cases were finally diagnosed as retinoblastoma and 2 cases (8.33%) as other than retinoblastoma. Computerised tomography and aqueous humour cytology were two most specific (100%) tests. Computerised tomography was the most sensitive (95.4%) test. Aqueous cytology was poorly sensitive (9.09%). Both ultrasonography and fundoscopy demonstrated sensitivity over 90% but with low specificity (50%). When test results of fundoscopy and ultrasonography were combined, specificity of this combination was 100% and sensitivity was 95.4%, which match exactly the values of computerised tomography. Combination of fundoscopy and ultrasonography has accuracy as high as that of computerised tomography. In patients with clear media this combination can be used as an effective alternative to computerised tomography to reach a diagnosis with comparable accuracy.

The pattern of malignant epithelial tumours of deep seated organs in young adults.

Epithelial malignancy is common in older age group but it is also an Important cause of morbidity and mortality in young adults. The reports of deep seated carcinomas diagnosed in a one-year time period by CT guided FNAC in a medical college of West Bengal were analysed. Of total 447 malignant lesions of lung diagnosed by aspiration cytology 15 cases (3.3%) occurred in 15-39 years age group.

A clinicopathological study of malignant melanoma with special reference to atypical presentation.

Malignant melanoma is a tumor of melanocytic origin. Lymphatic and hematogenous metastases are common in this condition. Retrospective analysis was performed in 16 consecutive cases diagnosed histopathologically as malignant melanoma at the pathology department of a medial college in eastern India. 75% of the patients were male; majority of them was in their sixth decade. All (100%) the lesions were pigmented. The primary site was known in all cases, except two (12.5%). Out of the 14 cases with known primary site 11 (78.57%) were cutaneous melanomas, including one arising in labia minora, two (14.29%) were ocular and one (7.14%) was vaginal in origin. Among cutaneous melanomas, superficial spreading type was the commonest variety and mixed population of epithelioid and spindle cell was the commonest histopathological pattern. The commonest grade of invasion was grade III (Clark's). The clinical presentation of the case of vaginal melanoma and the two cases of secondary melanomas, including the one with obscure primary tumor, were bewildering and hence are discussed separately.

Idiopathic intracranial hypertension in a child after hemodialysis.

Idiopathic intracranial hypertension remains a disease of unknown etiology. Epidemiology, associations, features, and prognosis in children have changed over the years. The main clinical complaint of pediatric idiopathic intracranial hypertension is headache with visual disturbance. We report on a patient with childhood idiopathic intracranial hypertension, who presented without headache after hemodialysis for acute renal failure. Idiopathic intracranial hypertension without headache is believed to have a poor prognosis. However, this child demonstrated a favorable outcome with medical therapy. The child was followed with serial optical coherence tomography of retinal nerve fiber layer thickness around the optic nerve head. In the absence of a reliable procedure to evaluate the therapeutic efficacy in the follow-up of patients with idiopathic intracranial hypertension, the importance of optical coherence tomography, a noninvasive, objective, and reproducible procedure, is highlighted as a useful adjunct in the management of idiopathic intracranial hypertension.

A cross-sectional study on aqueous humour lactate dehydrogenase level in retinoblastoma.

Lactate dehydrogenase enzyme is a non-specific marker found raised in different body fluids in various pathological conditions. This cross-sectional study was done in a medical college of Kolkata, India to find out lactate dehydrogenase level of aqueous humour in retinoblastoma cases. Aqueous humour lactate dehydrogenase level from 21 histology proved retinoblastoma cases and 21 controls was estimated and compared. Range of lactate dehydrogenase levels in retinoblastoma cases were 863-4819 IU/l; mean being 3396.9 IU/l; and in controls range was 48-146 IU/l; mean being 90.6 IU/l; 76.19% of retinoblastoma cases had value over 3000 IU/l. None of the controls had value above 150 IU/l. The difference between lactate dehydrogenase values of cases and controls was significant (p<0.001).

Evaluation of registered visually disabled individuals in a district of west bengal, India.

OBJECTIVE: To identify the sociodemographic characteristics, degree and cause of visual disability among certified visually disabled individuals in a rural district of West Bengal, India and to identify possible lacunae, if any, in the existing certification system. MATERIALS AND METHODS: A cross-sectional study by secondary data analysis of medical records of 155 visually disabled individuals and their 310 eyes. Demographical features, diagnosis, percentage of visual disability and work activity status of each individual were analyzed. RESULTS: One hundred and thirty one (84.52%) individuals had 100% disability. The number of males was significantly higher than that of females. Fifty eight (37.42%) individuals were below 21 years of age. Phthisis bulbi was the most common cause followed by microphthalmos. Further, 81.29% patients had the same lesion bilaterally. CONCLUSION: Patients with higher grades of disability have attended certification boards. A large number of disabled individuals comprised children and young adults. Male gender bias demands concern.

Epithelial ingrowth following surgery of recurrent pterygium.

Epithelial ingrowth is a rare but devastating condition of the eye, known to complicate incisional ocular procedures. We report a case of secondary glaucoma due to epithelial ingrowth following limbal conjunctival autograft in a case of recurrent pterygium. To prevent such devastating conditions from occurring dissection of recurrent pterygium demands special care to avoid anterior chamber penetration.

Posthepatitis aplastic anaemia presenting only with bilateral vision loss.

Aplastic anaemia is pancytopenia with marrow hypocellularity. Hepatitis-associated aplastic anaemia is a varient or aplastic anaemia that follows an acute attack of seronegative hepatitis. Here a case of hepatitis-associated aplastic anaemia presenting with sudden onset of severe simultaneous bilateral vision loss and without any other usual presenting signs is reported. Partial recovery of blood cell count occurred following immunosuppressive therapy. Posterior hyalodotmy helped rapid resolution of premacular subhyaloid haemorrhage. Although bilateral vision loss may rarely be the initial presentation of aplastic anaemia, no such report is known in hepatitis-associated aplastic anaemia. Posthepatitis vision loss needs careful investigation to exclude an underlying haematological disorder.

An observational study on retinoblastoma cases attending a medical college in Calcutta.

Excision of the eyeball was done in 23 cases with diagnosis of retinoblastoma in a medical college of Calcutta. Of them, 21 cases were histologically proved to be retinoblastoma. A clinicopathological study of these 21 cases was done. Retinoblastoma patients were between 5.5 and 71 months of age, 57.1% were females, in 90.4% cases there was unilateral involvement and left eye was affected in 68.4% patients. All the patients had negative family history. Majority of the patients (85.7%) presented with leucocoria. Multiple presenting features were present in 5 patients. Aqueous humour cytology revealed malignant cells in 9.5% patients. Imprint cytology of cut end of optic nerve stump was negative for malignant cells in all the cases. Histopathological study revealed presence of Flexner-Wintersteiner rosettes in 23.8%, pseudorosettes in 28.6%, anterior chamber involvement in 38%, choroid invasion in 42.8%, optic nerve involvement in 28.6%, necrosis in 28.6% and calcification in 9.5% cases. After one year of follow-up, none developed any metastasis except one patient who had developed intracranial metastasis.