Diagnostic accuracy of intra-operative assessment of de-epithelisation of the malleus by the surgeon in type 1 tympanoplasty compared to histopathological examination.

OBJECTIVE: This study was undertaken to determine the accuracy of the surgeon's assessment in detecting epithelial remnants over the malleus after de-epithelisation in tympanoplasty. METHODS: Intra-operatively, the umbo was assessed for epithelial remnants with the microscope. The umbo was then resected and sent for histopathological examination to detect epithelial remnants. RESULTS: Out of 42 cases, microscopic examination findings for epithelium were positive in 16 cases and negative in 26 cases. Histopathology findings were positive in 13 cases. The surgeons' assessment was accurate only in two cases. CONCLUSION: Residents, with their limited experience, are more likely to leave residual epithelium. When the chance of residual epithelium over the umbo is significant, the surgeon has two choices: to place the graft medial to the umbo or to resect the umbo. It is our opinion that the malleus exteriorisation should be incorporated into tympanoplasty training, with the aim of preventing epithelial entrapment in the middle ear.

Sarcomatoid Carcinoma of Renal Pelvis Involving Ureter and Renal Parenchyma with Heterologous Osteosarcomatous Differentiation: A Case Report and Review of Literature.

Sarcomatoid carcinoma is a highgrade rare malignant tumor with both epithelial and mesenchymal components. Sarcomatoid carcinoma in the upper urinary tract is very rare. We reported here a case of sarcomatoid carcinoma of renal pelvis with osteosarcomatous differentiation, with involvement of the ureter and renal parenchyma in a 68-year-old female. Histologically, predominant pleomorphic spindle cell sarcoma component with osteoid production and urothelial carcinoma component with in situ areas were identified. Immunohistochemical analysis showed vimentin positivity in sarcomatous component and cytokeratin positivity in carcinomatous component.

Verrucous Onychomycosis Caused by Curvularia in a Patient with Congenital Pterygium.

A 57 year healthy farmer with congenital nail pterygium presented with a verrucous growth on nail bed since 8 months. He was not diabetic and HIV rapid card test negative. Our clinical diagnosis was chromoblastomycosis but culture showed growth of curvularia species on two occasions and histopathology showed hyphal and yeast forms of the pigmented fungus. After excision biopsy patient was started on oral itraconazole. This case is reported due to rarity of verrucous cutaneous lesions caused by curvularia in immunocompetent individuals.

Atypical Manifestations of Leprosy - A Case Series.

Atypical manifestations are not rare in leprosy and they may present diagnostic challenges. We report a series of five cases having atypical presentations. First case presented with an asymptomatic buccal lesion and later developed skin lesions. Second patient had secondary Anti-phosphospholipidsyndrome (APS) due to leprosy. We also report another interesting case of annular vesiculobullous lesions and erythema nodosumleprosum (ENL) following intake of antibiotics for pneumonia. Other two had exacerbation reactions (ER). Two of these patients were had irregular/incompleteanti-leprosy treatment earlier., These profiles will be of interest to clinicians who may encounter cases with such manifestations.

Anaplastic myeloma presenting as mandibular swelling: Diagnosis by cytology.

Multiple myeloma is a disease resulting from clonal proliferation of plasma cells. A disease of the elderly, jaw lesions are seen in 14% of patients affected with myeloma. Rarely the oral and maxillofacial lesions can be the first manifestation of the disease. We report the case of a 75-year-old man who presented with mandibular swelling. Fine-needle aspiration cytology was done from the swelling and smears were suggestive of anaplastic myeloma, which is a rare and aggressive variant of myeloma. The diagnosis of a plasmacytoma was confirmed by biopsy. Further workup of the patient revealed osteolytic lesions in skull, M band in electrophoresis and evidence of renal failure. Peripheral smear and bone marrow findings were also consistent with myeloma.

Microfilaria in lymph node mimicking Kimura disease.

In tropical and subtropical countries, parasitic infections are very rampant causing peripheral blood and or tissue eosinophilia. Here, a case of microfilaria in lymph node that produced intense eosinophil infiltrate is being reported. The dense eosinophil collection in the lymph node raised a possibility of Kimura's disease because no worms were seen in the initial sectioning of the tissue. Extensive sampling and diligent search revealed sections of microfilaria embedded in the eosinophil abscess along with foreign body giant cell reaction to its sheath material, leading to the correct diagnosis of this case.