Clinical Audit of Papillary Thyroid Cancer Reporting Format in Sultan Qaboos University Hospital in Oman.

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Malignant Gastrointestinal Neuroectodermal Tumor of Small Intestine Showing DOG1 Expression: A Case Report and Review of Literature.

Malignant gastrointestinal neuroectodermal tumor (GNET), also referred to as clear cell sarcoma-like tumor of the GI tract is a rare mesenchymal tumor of the gastrointestinal tract. It has to be distinguished from various mimickers including gastrointestinal stromal tumor (GIST) due to its aggressive course and different natural history and therapeutic approach. Here we report a case of GNET arising in the small intestine with aberrant DOG1 expression posing a diagnostic challenge. In this context, the combination of clinical, histomorphological, immunohistochemical, and molecular features helped to establish a proper diagnosis.

Langerhans Cell Hyperplasia Mimicking Langerhans Cell Histiocytosis: A Rare Complication of COVID-19 Vaccination.

Langerhans cell histiocytosis (LCH) is a rare disorder characterized by the abnormal proliferation of Langerhans cells, a type of immune cell that is normally present in the skin and various other tissues. LCH can affect people of any age but is most commonly diagnosed in children. We report a case of a patient with LCH who developed ipsilateral axillary lymphadenopathology post-COVID-19 vaccination. Lymph node biopsy showed diffuse Langerhans cell hyperplasia which mimicked LCH. Clinically and radiologically, it looked to be a reactive lymph node. The patient was kept on follow up only and after 1 year of follow up the size of lymph nodes regressed confirming to be reactive in nature rather than neoplastic. To the best of our knowledge, this is the second case of Langerhans cell hyperplasia post-COVID-19 vaccination being reported in the literature.

Alveolar Soft Part Sarcoma of the Tongue: A Rare Tumor at an Unusual Location.

Alveolar soft part sarcoma (ASPS) is a rare type of soft tissue sarcoma that typically affects adolescents and young adults, though it can occur at any age. We report a case of ASPS of the tongue, which is extremely rare at this location. The patient presented with a polypoidal lesion on the tongue, a biopsy of which showed granular and alveolar morphology. A definitive diagnosis was not rendered due to limited tissue. The case was discussed with the treating surgeon, and excision was recommended with clear margins. Excision of the lesion showed typical ASPS. A TFE-3 immunohistochemical stain was done, which showed strong immunoreactivity, thereby confirming the diagnosis of ASPS. This tumour is rare, and its presence in the tongue makes it extremely infrequent.

Comparison Between Two Types Of Matrix Systems For Contact Tightness In Class-Ii Composite Restorations.

BACKGROUND: The reconstruction of proximal defects with tight contacts has always been a challenge for dental clinicians, especially with composite material. Recent literature shows that the most frequently used matrix systems for the restoration of proximal cavities are circumferential or sectional matrix band systems. The objective of this study was to compare the contact tightness that is achieved with these two matrix band systems when using composite material. METHODS: A total of 30 patients, i.e., 60 cavities were selected in this quasi-experimental study. Patients with two cavities in the posterior teeth were selected. Both the cavities were restored with the circumferential system, i.e., Tofflemire and sectional matrix band system, i.e., Palodent plus on the same appointment. Hence both systems were used in every patient and then contact tightness assess was ed based on an evaluation criterion, i.e., Fédération Dentaire Internationale clinical criteria for evaluation of contact in direct and indirect restorations. To make a comparison between the two systems Chi square test was used and p<0.05. RESULTS: The mean age of the patients in the study was 31 years (SD, 7.59 years) with a range from 18 to 45 years. Most of the contact tightness in the Palodent matrix system was score 1 (n=33, 55%) and score 2 (n=17, 28.3%) while in Tofflemire was score 4 (n=28, 46.7%) and score 5 (n=19, 31.7%). Statistical analysis showed significance (p=.037) between Palodent matrix system contact tightness and Tofflemire. Conclusion: The sectional matrix band system was statistically superior to the circumferential matrix band system in achieving a tighter contact for class II composite restorations.

Durable Response to Pazopanib in a Patient with Fumarate Hydratase-Mutant Tubulocystic Renal Cell Carcinoma.

Tubulocystic carcinoma of the kidney (TC-RCC) is a rare renal tumor and has been recently included as a distinct entity in WHO classification of renal neoplasms. We report the case of a patient with metastatic tubulocystic RCC whose disease progressed through standard of care treatment for nonclear RCC. However, genetic analysis revealed a germline pathogenic variant of fumarate hydratase (FH) gene, and the patient had a sustained and durable response to pazopanib.

Effect of drill quality on biological damage in bone drilling.

Bone drilling is a universal procedure in orthopaedics for fracture fixation, installing implants, or reconstructive surgery. Surgical drills are subjected to wear caused by their repeated use, thermal fatigue, irrigation with saline solution, and sterilization process. Wear of the cutting edges of a drill bit (worn drill) is detrimental for bone tissues and can seriously affect its performance. The aim of this study is to move closer to minimally invasive surgical procedures in bones by investigating the effect of wear of surgical drill bits on their performance. The surface quality of the drill was found to influence the bone temperature, the axial force, the torque and the extent of biological damage around the drilling region. Worn drill produced heat above the threshold level related to thermal necrosis at a depth equal to the wall thickness of an adult human bone. Statistical analysis showed that a sharp drill bit, in combination with a medium drilling speed and drilling at shallow depth, was favourable for safe drilling in bone. This study also suggests the further research on establishing a relationship between surface integrity of a surgical drill bit and irreversible damage that it can induce in delicate tissues of bone using different drill sizes as well as drilling parameters and conditions.

Audit of 100 consecutive basal cell carcinoma specimens at a secondary care centre in the UK.

OBJECTIVE: To audit basal cell carcinoma resections against standard guidelines. METHODS: The retrospective study was done at the Department of Pathology, Sherwood Forest Hospital, Nottinghamshire, United Kingdom, from July 2020 to December 2020 and comprised basal cell carcinoma cases regardless of age and gender. All parameters laid down by the Royal College of Pathologists were matched with the data. Also, incompletely resected specimens were separated, and reasons for incomplete resection were taken into account, and compared with the British Association of Dermatologists 2018 guidelines. RESULTS: Of the 100 consecutive cases, 67(67%) were nodular and nodulocystic, 8(8%) were superficial multifocal, 7(7%) each were infiltrative and mixed nodular and infiltrative, 6(6%) were mixed nodular and superficial, and 5(5%) were mixed superficial and infiltrative. All 100(100%) pathology reports contained the mandatory information set by the Royal College of Pathologists. There were 7(7%) incompletely excised cases. The rate of incomplete excision was also within the acceptable range defined by the British Association of Dermatologists 2018 guidelines. CONCLUSIONS: All basal cell carcinoma resections were in line with the standard guidelines.

Pityriasis Rosea and Pityriasis Rosea-like Eruption Following COVID-19 Vaccinations: Case Series from Oman.

To mitigate the impact of the COVID-19 pandemic, several vaccines have been developed and administered to the public since 2021. A spectrum of cutaneous reactions has been reported among some of the vaccinated individuals. In this case series, we describe three cases of pityriasis rosea and pityriasis rosea-like eruption that manifested after COVID-19 vaccinations, which might suggest the vaccines as a possible trigger.

Fusarium solani Necrotizing Fasciitis Complicating Treatment for Acute Lymphoblastic Leukemia: A Case Report.

Fungal infections due to Fusarium species are serious albeit rare and mostly occur in severely immunocompromised patients. The prognosis of such infections, especially of disseminated manifestations, is poor as a result of multi-antifungal resistance, particularly to azoles. We report a case of a rapidly progressive necrotizing fasciitis of the foot secondary to Fusarium solani in a young female patient with acute lymphoblastic leukemia on consolidation therapy. Surgical debridement was undertaken and liposomal amphotericin was given as definitive therapy for a total of six weeks followed by secondary prophylaxis that resulted in remarked clinical and radiological improvement. High clinical suspicion, prompt surgical intervention, rapid diagnosis, and timely initiation of appropriate antifungal therapy are crucial for a favorable outcome in this relatively uncommon life-threatening infection.

Clinicopathological Features and Outcomes of Gastrointestinal Stromal Tumours in Oman: A multi-centre study.

OBJECTIVES: This study aimed to report the clinicopathological features, management and long-term outcomes of patients with gastrointestinal stromal tumours (GISTs) in Oman. METHODS: This retrospective study was conducted on patients treated for GIST between January 2003 and December 2017 at three tertiary referral centres in Muscat, Oman. All patients with confirmed histopathological diagnoses of GIST and followed-up at the centres during this period were included. Relevant information was retrieved from hospital records until April 2019. RESULTS: A total of 44 patients were included in the study. The median age was 55.5 years and 56.8% were female. The most common primary site of disease was the stomach (63.6%) followed by the jejunum/ileum (18.2%). Two patients (4.5%) had c-Kit-negative, discovered on GIST-1-positive disease. A total of 24 patients (54.5%) presented with localised disease and eight (33.3%) were classified as being at high risk of relapse. Patients with metastatic disease received imatinib in a palliative setting, whereas those with completely resected disease in the intermediate and high-risk groups were treated with adjuvant imatinib. Of the six patients (13.6%) with progressive metastatic disease, of which four had mutations on exon 11 and one on exon 9, while one had wild-type disease. Overall, rates of progression-free survival and overall survival (OS) at 100 months were 77.4% and 80.4%, respectively. Rates of OS for patients with localised and metastatic disease were 89.9% and 80.2%, respectively. CONCLUSION: The presenting features and outcomes of patients with GISTs in Oman were comparable to those reported in the regional and international literature.

Radiographic And Clinical Assessment Of Two Canals In The Maxillary Second Premolar.

BACKGROUND: The second premolar is one of the teeth which are crucial both aesthetically as well as functionally and one of the most commonly endodontically treated tooth. Aim of the study was to assess the number of canals in maxillary second premolar by clinical and radiographic evaluation in Pakistani sub population. It was a cross sectional study conducted in Endodontic Department of Rehmat Memorial Dental Teaching Hospital, Abbottabad, from January 2019 to January 2020. METHODS: One hundred and five patients were selected for the study, based on nonprobability sampling technique. All patients were examined clinically by exploration of pulp chamber followed by intra oral peri-apical radiograph to verify the clinical exploration of canals. RESULTS: One hundred and five patients (46 males (43.8%) and 59 females (56.2%)} were selected for the study. Out of total 105 patients 47 (44.8%) had one canal and 58 (55.2%) had two canals. Out of 46 males 25 (54.3%) had two canals and out of 59 females 33 (56.9%) had two canals. Statistical analysis showed no significant difference (p=0.1871) of canals arrangements between genders. CONCLUSION: Clinicians should be careful whenever doing root canal treatment of maxillary second premolars because of the extreme variability of the anatomy of those teeth, there is always risk of missing the second canal. Frequency of two canals was high, which is not age or gender dependant.

Lafora Disease: Report of a Rare Entity.

Lafora disease is a rare, genetic, glycogen metabolism disorder inherited as autosomal recessive characterized by the presence of inclusion bodies, known as Lafora bodies, within the cytoplasm of the cells in the heart, liver, muscle, and skin. Lafora disease presents as a neurodegenerative disorder that causes impairment in the development of cerebral cortical neurons. We present here a case of Lafora disease that presented with progressive myoclonus epilepsy (PME) and investigated at our center. She was diagnosed to have Lafora disease with typical histological findings on skin biopsy and was found to be positive for the pathogenic mutation on genetic testing.

Treatment Of Breast Cancer; Review And Updates.

Cancer of the breast is the leading female cancer accounting for one fourth of the malignancies. The tumour remains the most researched, read and practiced upon around the Globe. The treatment has substantially improved breast cancer related outcomes, both for early as well as late stages with substantial improvements in disease free and overall survival. Therapeutic decisions not only rest on clinical & tumour characteristics, but also with the evolution of molecular biology and tissue microarray intrinsic sub-types have been found. Attempts are being made to translate therapy from genomic architecture of individual breast cancer. This facilitates customization of treatment avoiding un-necessary toxicity, costs and inconvenience. Optimizing treatment based on individual breast biology seems logical and allows unifying treatment. The paper reviews literature, incorporate updates and also describes immunohistochemistry based molecular classification: which are found simple to adapt, record, present and subsequently manage, summarizing clinical practices in management of these patients.

Primary Gastric Yolk Sac Tumour.

Primary gastric yolk tumours are extremely rare. We report a 52-year-old male who presented to the Sultan Qaboos University Hospital, Muscat, Oman, in 2017 after having undergone a gastrectomy abroad due to a suspected poorly-differentiated adenocarcinoma. The patient subsequently returned to Oman to receive chemotherapy. However, while undergoing chemotherapy, an abdominal computed tomography scan revealed a lobulated mesenteric mass. Microscopic examination of the resected lesion confirmed a diagnosis of a yolk sac tumour. The mass was diffusely positive for α-fetoprotein (AFP) and a gastric carcinoma stain was negative. Gastrectomy slides from the patient's previous surgery were examined retrospectively. The morphology was typical for a yolk sac tumour and was negative for epithelial markers. An AFP stain showed diffuse immunoreactivity. Thus, the patient was deemed to have had a primary gastric yolk sac tumour which had later metastasised to the mesocolon. Germ cell tumour protocols were initiated and the patient responded well to treatment.

Follicular dendritic cell sarcoma presenting as colonic intussusception.

Follicular dendritic cell sarcoma (FDCS) is a rare intermediate grade sarcoma involving a variety of nodal and extra nodal sites. It has two histological subtypes, conventional and inflammatory pseudotumour like variant. We report this interesting case of FDCS presenting colonic intussusception at Shifa International Hospital, Islamabad, Pakistan. Conventional FDCS presenting as a colocolic intussusception is an unusual presentation, and to our knowledge, has never been reported previously. It has wide morphological spectrum on light microscopy and has characteristic immune-reactivity for dendritic cell markers (CD21, CD23, and CD35). Surgical excision is required in all cases while role of adjuvant chemotherapy and radiotherapy is not clearly demonstrated in literature.

Incidental Squamous Cell Carcinoma Of The Renal Pelvis In A Non Functioning Kidney That Was Missed On Two Non-Contrast Ct-Scans.

Although the second most common malignancy after urothelial carcinoma, squamous cell carcinoma (SCC) of the renal pelvis is a rare entity. It has strong association with nephrolithiasis thus emphasizing prompt treatment of renal calculi. Because of rarity and nonspecific clinical and radiological findings, it mostly presents at pT3 or higher stage. We report SCC of renal pelvis that was missed two times on non-contrast CT scans and was diagnosed incidentally in a nephrectomy specimen. Its prognosis is similar to that of urothelial carcinoma of comparable stage. Owing to its rarity, no standard treatment guidelines are available; however radical nephrectomy with lymph node dissection is the initial treatment which can be curative in an early stage disease. Adjuvant chemotherapy and radiotherapy are usually ineffective.

Sex cord stromal tumours of the ovary, experience at Shifa International Hospital Islamabad.

This descriptive study was carried out at Pathology Department, Shifa International Hospital from 2007 to 2016; all sex cord stromal tumours diagnosed during this time period were included. Epithelial, germ cell and metastatic tumours were excluded from the study. A total of 1254 Ovarian tumours were brought to Shifa of which47 (4%) were labeled as sex cord stromal tumours. Of these 36( 76 %)were granulosa cell tumour (adult33, juvenile3), 7 were labeled as sertoli leydig cell tumours (15%), 3 as thecoma/ fibroma group (7%)and only one case was labeled as microcystic stromal tumour of the ovary (2%). Overall age range for sex cord stromal tumours was 42 (12-71). Immunohistochemistry was done in 41 out of 47 cases. Sex cord stromal tumours of the ovary are rare tumours comprising 4% of the total. Adult Granulosa cell tumour is the commonest tumour seen in our study.