Plasmoacanthoma of Lip-A Rare Case with Review of Literature.

Plasmoacanthoma is an extremely rare benign verrucous lesion, with few cases reported in the literature, and it often goes misdiagnosed. An attempt was made to discuss the features and compare them to reduce the diagnostic dilemma in cases of plasmoacanthoma, which mimics squamous cell carcinoma, both for the clinician and pathologist. Written informed consent was obtained from the patient for the case report. Institutional ethical clearance was obtained. A review of the literature was conducted after a PubMed search with the keyword "Plasmoacanthoma" on September 20, 2023. Nine articles were obtained, out of which two were not available. One was excluded since it was on plasma cell cheilitis. Five articles, all of which were in the English language, with a diagnosis of plasmoacanthoma were retrieved for the study. A 70-year-old female presented with an ulcer-exophytic lesion involving the lower lip, mimicking a typical squamous cell carcinoma, for which an edge biopsy of the lesion was taken to confirm. Histopathology revealed it to be plasma cell mucositis. The patient was put on the medical line of management with corticosteroids as per guidelines, with no response. A wedge excision was later done as the patient was not responding to medical therapy, and the final histopathology came out to be "plasmoacanthoma". Due to their close resemblance to malignant lesions and histologically mimicking plasma cell mucositis, such lesions often get misdiagnosed, leading to inadequate management. Various sources of literature related to plasmoacanthoma were compared, and the features and histological findings were tabulated so that if any cases were similar to the present case reports, then we could have other differential diagnoses and work accordingly. Plasmoacanthoma may be present in any age group, and the clinical features may be similar to those of squamous cell carcinoma. PCM and plasmoacanthoma are clinically and histologically mimicking conditions that should be confirmed by excisional biopsy on histopathological examination rather than incisional biopsy to avoid pathological adversity, as seen in our case. IHC with kappa and lambda light chains will help identify clonal plasma cells seen in plasmoacanthoma.

Obstructive Sleep Apnoea Syndrome and Association of AHI Scores with Sensorineural Hearing Loss: An Early Predictor.

Obstructive sleep apnoea syndrome (OSAS) is a condition that is characterised by frequent apnoea and hypopnoea attacks occurring during sleep. The blood supply to cochlea and acoustic nerves is from terminal arteries, thereby making them susceptible to hypoxia. To compare the audiological profiles in patients with OSAS according to Apnoea Hypopnoea index (AHI) score. Descriptive study was conducted in 32 patients diagnosed to have OSAS in a tertiary referral centre over two year period. The study group was divided into mild, moderate, severe OSAS based on AHI score. The hearing evaluation was done using pure tone audiogram (PTA) and distortion product otoacoustic emission test (DPOAE). Moderate and severe OSAS participants had elevated thresholds at higher frequencies in PTA (4 kHz, 8 kHz), although this was not statistically significant. We also noticed, absent DPOAE responses at higher frequencies (4 k, 6 k, 8 k), with increase in the severity of OSAS at higher frequency, which was statistically significant (p value < 0.05). This study revealed elevated hearing thresholds at higher frequencies (4 kHz, 8 kHz) in PTA and DPOEA with an increase in the severity of OSAS. All OSAS patients, especially with AHI > 30 should be regularly screened for hearing loss.

Radiation dose to the cochlea and its association with sensorineural hearing loss in head and neck cancer-A prospective study.

AIM: To determine the effect of cochlear dose on sensorineural hearing loss in patients with head and neck cancer treated by radiotherapy and chemoradiotherapy. MATERIALS AND METHOD: A two-year longitudinal study was conducted on 130 subjects with various head and neck malignancies who were receiving radiotherapy or chemoradiation. 56 patients received only radiotherapy while 74 patients received concurrent chemoradiation five days a week at a dose of 66-70 Gy. They were categorized as having a radiation dose to the cochlea of <35 Gy, <45 Gy or >45 Gy. Pre- and post-therapy audiological evaluation was done using a Pure-tone audiogram, distortion product otoacoustic emission, and impedence. Hearing thresholds were measured at frequencies up to 16,000 Hz. RESULTS: Out of 130 patients 56 received RT alone and 74 received CTRT. There was statistically significant (p value <0.005) difference in Pure-tone audiometry assessment in both the RT and CTRT groups between subjects who received more than and <45 Gy of radiation to the cochlea. There was no significant difference in distortion product otoacoustic emission assessment between patients who received >45 Gy and <45 Gy radiation to the cochlea. Comparison between subjects who received radiation dose of <35 Gy and >45 Gy revealed significant results in the degree of hearing loss (p value <0.005). CONCLUSION: We observed that patients who received >45 Gy of radiation had more sensorineural hearing loss compared to patients who received <45 Gy. A cochlear dose of <35 Gy is associated with significantly lower hearing loss compared to higher doses. We would like to conclude by emphasizing the importance of regular audiological assessments prior to and post radiotherapy and chemoradiotherapy, with regular follow-ups encouraged over a longer period to improve the quality of life in patients with head and neck malignancy.

Audiological profiling in postmenopausal women with osteoporosis.

OBJECTIVES: To compare the audiological profiles in postmenopausal women with and without osteoporosis and to study the pattern of hearing loss in osteoporotic patients. MATERIALS AND METHODS: 80 postmenopausal women were evaluated at a tertiary referral center and were divided into normal, osteopenic and osteoporotic based on BMD results. The hearing evaluation was done using PTA, Impedance audiometry and DPOAE and the results were compared between the groups and analyzed. RESULTS: Osteoporotic patients had higher incidence of sensorineural hearing loss than normal and osteopenic patients and the results were statistically significant (P ≤0.001) on PTA and DPOAE testing. The mean pure tone thresholds were significantly higher in osteoporotic patients in comparison with normal and osteopenic patients. The average hearing loss in osteoporotic patients with sensorineural loss was of mild degree. CONCLUSION: The data reveal that osteoporosis is associated with sensorineural hearing loss in postmenopausal women. The underlying mechanism needs further research but cochlear dysfunction could be an important factor.

A giant vagal schwannoma with unusual extension from skull base to the mediastinum.

Cervical vagal schwannoma is an extremely rare neoplasm. Middle aged people are usually affected. These tumors usually present as asymptomatic masses. These tumors are almost always benign. Preoperative diagnosis of these lesions is important due to the morbidity associated with its excision. Preoperative tissue diagnosis is not accurate. The imaging modality can be done to assess the extent and for planning the treatment. Surgical excision with preservation of neural origin is the treatment option. Giant vagal schwannomas are extremely rare. Only one case has been reported in the literature till date. There has no reported case of extensive vagal schwannoma from skull base to the mediastinum. Here, we describe the asymptomatic presentation of an unusual appearing giant cervical vagal schwannoma with an extension from skull base to the mediastinum.