Clinicopathological and mycological spectrum of allergic fungal sinusitis in South India.

In the present study, we describe characteristic clinicopathological and radiological features as well as fungal culture results in a series of 24 patients with allergic fungal sinusitis (AFS). Nasal obstruction and discharge with nasal polyposis was the commonest (95.8%) clinical presentation. Allergic mucin was uniformly present in all patients. Aspergillus species were the commonest fungal isolates (95.8%). One case of mixed Aspergillus and Curvularia sinusitis as well as one case of Drechslera sinusitis were also identified. Typical computerized tomography scan features of hyperdense areas interspersed with soft tissue densities in the affected sinuses were seen in all patients. Application of appropriate diagnostic criteria is essential to establish the diagnosis of AFS and distinguish it from invasive fungal sinus infections.

Problems of classification of Henoch Schonlein purpura: an Indian perspective.

A 2-year prospective study was carried out in which 71 patients with primary cutaneous vasculitis were classified using the American College of Rheumatology (ACR) classification and the Chapel Hill Consensus Conference (CHCC) recommendations for Henoch Schonlein purpura (HSP). The sensitivity of the ACR criteria was 64.8% and that of the CHCC definition 31%. When the ACR criteria were combined with results of direct immunofluorescence (DIF) the sensitivity was 78.9%. The concordance between the two systems was low as only 12 patients fulfilled criteria for both classifications. Although the ACR criteria were found to be more useful in the classification of HSP our data suggest that they need to be modified to include adults with disease. The age at onset of disease was higher than that in the west. Seventy per cent of patients identified by either classification were > 20 years of age. The prevalence of gut involvement, microhaematuria and proteinuria was < 25% in both groups. The sensitivity of histopathology on the other hand was 80.4% and was not influenced by the duration of the lesion. The DIF test was a useful adjunct to histopathology if it was done within 48 h as the yield of a positive test was significantly higher in this group as compared to the patients who had the test done later.

Long-term outcome in patients with central neurocytoma following stereotactic biopsy and radiation therapy.

Total excision is usually the recommended treatment for central neurocytomas. The role of radiation therapy in their management is controversial, and is usually reserved for partially resected or recurrent tumours. Long-term outcome was studied in patients with central neurocytoma who were treated with radiation therapy. By retrospective chart review, eight patients with intraventricular tumours, who had undergone radiation therapy following stereotactic biopsy, were identified. The diagnosis of neurocytoma was confirmed based on positive immunostaining with synaptophysin. Clinical and radiological follow-up was obtained. Of eight patients, one died 5 years after treatment from shunt dysfunction and 1 had disseminated intracranial disease 15 months after treatment. Six patients were symptom-free at a mean follow-up period of 78 months and had good local control as demonstrated by CT. Since this tumour can be confused with an oligodendroglioma or an ependymoma on routine histopathology (as happened in seven of our cases); immunohistochemical studies with synaptophysin should be routinely performed for intraventricular glial tumours. Our study supports the beneficial effect of radiation therapy in the management of these tumours.

Pulmonary lipoblastoma: a case report.

We report a case of pulmonary lipoblastoma in a 2-year-old child. This pathology has not been previously reported in the English literature.

The calcified intracorporeal vacuole: an aid to the pathological diagnosis of solitary cerebral cysticercus granulomas.

Fifty four cases of single small (<20 mm) enhancing CT lesions (SSECTLs) of the brain that were excised between 1987 and 1995 were reviewed histologically. In 28 cases the entire cysticercus or its parts were found. In the remaining 26 cases, most had a histological picture suggestive of a parasitic granuloma. In six of these 26 cases, small ovoid masses corresponding in morphology to the intracorporeal vacuoles of a cysticercus were seen lying free in the cavitary space of the granuloma. This lends further strength to the contention that SSECTLs of the brain are caused by cysticercus, and that in the event of a surgical excision, absence of obvious parasitic parts should necessitate a closer search, as calcareous residues of the parasite might be the only evidence of the cysticercal aetiology in the granuloma.

Orbital apex leiomyoma with intracranial extension.

BACKGROUND: Leiomyoma is a rare, benign smooth muscle tumor of the orbit. It occasionally shows some histologic resemblance to other common tumors of the orbit like neurofibroma and schwannoma. Its location at the orbital apex is uncommon and only one case with intracranial extension has been reported so far. CASE DESCRIPTION: A nine-year-old boy presented to us with left orbital pain. Four years earlier he had undergone partial excision, elsewhere, of a tumor at the orbital apex, which was reported as a schwannoma. The computed tomography (CT) scan showed regrowth of the tumor with intracranial extension. The tumor was totally resected by an intracranial route. One year postoperatively there was no recurrence of the tumor. CONCLUSIONS: Leiomyoma of the orbit, though a benign tumor, does show regrowth after partial excision. Total excision, including any intracranial component, is advised. The cases reported so far are reviewed and the histopathology and possible etiopathogenesis of this tumor are discussed.

Quantitative analysis of CD1a (T6) positive Langerhans cells in human tonsil epithelium.

Fifty-one human palatine tonsils of both sexes and 4-54 years of age were studied for quantitative analysis of Langerhans cells in the epithelium using CD1a (T6), which is a specific immunological marker for Langerhans cells and indeterminate cells. Cryo-sections were stained using the avidin biotin peroxidase method. Using light microscopy, CD1a-positive dark brown cells with dendritic processes were identified as Langerhans cells, which were located in the epithelium, subepithelial tissue, follicles and interfollicular areas. The Langerhans cells were counted only in the tonsil epithelium per zone of 1.1 mm length of basement membrane. For each biopsy, 25 such zones were studied. The mean number (SEM) of Langerhans cells per zone of tonsil epithelium was found to be 37 (+/- 0.5). In the male, it was 36 (+/- 0.7) but in the female, it was 38 (+/- 0.2). In different age subgroups, the mean number (SEM) varied between 40 (+/- 1.7) and 14 (+/- 1.1). In the age subgroups of 11-15, 16-20, and 21-25 years, the mean number showed significant sex differences. Since the 11-15, 16-20, and 21-25 age subgroups in the female showed an increased number of Langerhans cells, it is concluded that the immunological role of the palatine tonsils is increased during puberty and adolescence. In the female, there was a negative correlation (r = -0.196, p < 0.01) between age subgroups and mean numbers, but in the male there was no correlation (r = 0.008). Overall, in all the 51 biopsies together, there was a negative correlation (r = -0.017, p < 0.01) and significant (p < 0.001) sex and age differences.

Role of S-100 staining in differentiating leprosy from other granulomatous diseases of the skin.

Since Mycobacterium leprae are rarely demonstrable in the tuberculoid spectrum of leprosy, a confirmatory diagnosis of leprosy can be made on the basis of finding active destruction of cutaneous nerves by granulomatous inflammation in a skin biopsy. Immunoperoxidase staining for S-100 protein, which is a marker for Schwann cells, was used to delineate nerves in lesional skin biopsies of 25 patients with tuberculoid and borderline tuberculoid leprosy as well as 15 controls with nonleprous granulomatous inflammation. Four different patterns of nerve damage were observed: infiltrated, fragmented, absent, and intact. All of the nonleprous granulomatous dermatoses showed only intact nerves, either inside or outside the granuloma, and so S-100 staining can be used to rule out leprosy.

Medullomyoblastoma: A case report.

Medullomyoblastoma is a rare tumour seen in childhood. We report a medullomyoblastoma occurring in the cerebellar vermis of a 4 year old boy. The light microscopic features, immunohistochemistry and histogenesis are described.

Krukenberg tumor of ovary with features of mucinous cystadenocarcinoma.

An unusual case of bilateral Krukenberg tumors having a predominant multicystic mucinous component which on gross and microscopic examination resembled a mucinous cystadenocarcinoma is presented. It is important to distinguish between these two tumors as Krukenberg tumours have a significantly worse prognosis.

Primary sphenoid and petrous apex esthesioneuroblastoma: case report.

A 62-year-old woman presented with raised intracranial pressure and features of a right cerebellopontine angle tumour with extension into the right middle cranial fossa. The patient died before a surgical excision could be performed. The autopsy revealed a primary esthesioneuroblastoma of the sphenoid sinus eroding the petrous bone and extending into the middle cranial fossa with metastatic tumour in the liver, and paratracheal and hilar lymph nodes. Although rare, esthesioneuroblastoma must be considered in the differential diagnosis of petrous-sphenoid lesions.

Cutis laxa.

Two sisters with inherited generalized cutis laxa and a young man with possible acquired cutis laxa are presented.

Vaccine-induced necrobiotic granuloma.

We report two cases of necrobiotic palisaded granulomas which developed at the site of intradermal hepatitis B vaccination. To the best of our knowledge, this kind of reaction has not been reported previously.

Transplant associated Kaposis sarcoma.

This case reports the first transplant associated Kaposis sarcoma reported from India.

Smear diagnosis of central nervous system lesions : a critical appraisal.

Smears, imprints and frozen sections have been recognised as useful adjuncts to diagnosis by the traditional paraffin section in neurosurgical biopsies. In this study, 251 intracranial space occupying lesions were studied by smears and paraffin sections to determine the causes of error and the possible means to avoid them. There were 63 computed tomography guided stereotactic microbiopsies and 188 open biopsies. The overall diagnostic accuracy was 88. In 6.8 of cases the tumour type was diagnosedcorrectly, but the grade was altered subsequent to examining the paraffin sections owing probably to sampling errors. Only 5.2 of cases had an entirely incorrect diagnosis.

Pain in multiple leiomyomas alleviated by nifedipine.

We have confirmed the usefulness of nifedipine in the treatment of pain present in lesions of multiple skin leiomyomata. Our patient, a 28-year-old woman, had hundreds of skin lesions, proven histologically to be leiomyomata. Nifedipine (10 mg) three or four times daily was remarkably effective in diminishing pain that was more marked in the winter season.