Pseudotumour of the Testis-Awareness Prevents Mismanagement.

Inflammatory pseudotumour of the testis is a rare but important clinical entity to be recognised by the surgical trainee. We present a case of a 30-year-old gentleman who presented with a hard painless testicular mass. Ultrasound scrotum revealed a diffuse paratesticular swelling arising from the tunica vaginalis with a normal-appearing testis. Germ cell tumour markers were normal. Exploration through an inguinal approach confirmed it to be arising from the tunica vaginalis. Wide excision of the tumour along with a cuff of adherent tunica albuginea was done. Final histopathology revealed a diffuse fibrous pseudotumour of the tunica vaginalis confirming its benign nature.

Pictorial Review of Post COVID-19 Acute Invasive Fungal Sinusitis: Clinical Radiologists' Perspective.

Acute invasive fungal sinusitis (AIFS) is a rapidly progressive infection predominantly seen in immunocompromised patients. There is an increasing incidence of AIFS post COVID-19 infection. Yet, there is sparse literature regarding spectrum of cross-sectional imaging findings (CT and MRI) in these patients, which is prudent for appropriate timely surgical intervention. This study aims to highlight spectrum of imaging findings in patients with post-COVID-19 AIFS integrating the clinical details from presentation to follow-up. We retrospectively reviewed the demographics, clinical details and radiological imaging of 31 histopathological proven cases of post COVID-19 AIFS. MR and CT images of these patients were retrieved from the PACS and analysed. 90-day follow-up of these patients was obtained. Statistical analysis was performed using descriptive statistics. Cross-sectional imaging showed nasal cavity involvement in all patients, bilateral in (15, 48%) cases; predominant involvement of maxillary (31, 100%) followed by ethmoid sinuses (29, 93.5%) was seen. MR showed patchy/complete loss of normal mucosal enhancement in the turbinates and sinuses as predominant imaging finding. Maxillary sinus walls erosions were seen in 28 cases (90%). Rhino-orbital and rhino-orbito-cerebral mycosis was seen in 24 (77%) and 14 (45%) respectively. Optic nerve-sheath complex was involved in 15 (48%) cases. Cerebral involvement was seen in form of meningeal enhancement, cerebritis, ischemic changes, cavernous sinus and intracranial arterial thrombosis and aneurysms. Comprehensive knowledge of imaging features of AIFS and recognition of extent of their spread allows radiologists to play pivotal role in alerting the clinician for appropriate therapy to avoid protracted and fatal outcome.

Melanorrhea: Noncontiguous spread of palpebral conjunctival melanoma to the nasolacrimal duct.

A 42-year-old Asian Indian male with a history of conjunctival melanoma in the left eye presented with a recurrent tumor in the upper tarsal conjunctiva. The tumor was completely excised under margin control, followed by two-staged eyelid reconstruction. During the second stage of the eyelid reconstruction, a brown-colored discharge was noted at the punctum, which on cytology was confirmatory of melanoma. Left dacryocystectomy with en bloc nasolacrimal duct (NLD) excision was performed. Histopathology demonstrated infiltration of the NLD by the tumor with no presence of melanoma in the lacrimal sac. Lacrimal oncorrhea is a term used to describe tumor spread by free-floating cells in the tear film. All conjunctival tumors carry a risk of tumor spread by oncorrhea.

Delayed presentation of a virilising, pure testosterone-secreting adrenocortical carcinoma with coexistent composite myelolipoma and a venous thrombus extending to the heart.

A 40-year-old normotensive woman presented with abnormal facial hair for 4 years and amenorrhoea for 13 years. Hormonal, biochemical and haematological evaluation showed isolated elevation of serum testosterone and free testosterone. Her follicle-stimulating hormone and luteinising hormone were in the premenopausal range. Until recently she had reconciled to early 'menopause' and visited beauty clinics but never sought medical evaluation. Imaging revealed an enhancing left adrenal mass with fat densities and venous thrombus extending through the inferior vena cava to a 7 cm mass in the right atrium. She underwent left kidney-preserving surgery utilising hypothermic cardiopulmonary bypass with early clamping of the pulmonary artery without circulatory arrest. Histology showed adrenocortical carcinoma with composite incidental myelolipoma and neoplastic thrombus. At 2 months, testosterone has normalised and she is doing well. Isolated testosterone-secreting adrenocortical carcinoma with massive venous thrombus is rare as is coincidental composite macroscopic myelolipoma.

Quantitative Postural Analysis of Children With Congenital Visual Impairment.

OBJECTIVES: The aim of this study was to compare the postural alignment of children with visual impairment with that of children without visual impairment. METHODS: The sample studied was 74 children of both sexes ages 5 to 12 years. Of these, 34 had visual impairment and 40 were control children. Digital photos from the standing position were used to analyze posture. Postural variables, such as tilt of the head, shoulder position, scapula position, lateral deviation of the spine, ankle position in the frontal plane and head posture, angle of thoracic kyphosis, angle of lumbar lordosis, pelvis position, and knee position in the frontal and sagittal planes, were measured with the Postural Assessment Software 0.63, version 36 (SAPO, São Paulo, Brazil), with markers placed in predetermined bony landmarks. RESULTS: The main results of this study showed that children with visual impairment have increased head tilt (P < .001), shoulder deviation in frontal plane (P = .004), lateral deviation of the spine (P < .001), changes in scapula position (P = .012), higher thoracic kyphosis (P = .004), and lower lumbar lordosis (P < .001). CONCLUSIONS: Visual impairment influences postural alignment. Children with visual impairment had increased head tilt, uneven shoulders, greater lateral deviation of the spine, thoracic kyphosis, lower lumbar lordosis, and more severe valgus deformities on knees.

Ovarian apoplexy resulting from ruptured heterotopic pregnancy following intrauterine insemination.

Heterotopic pregnancy is on the rise with the use of assisted conception and commonly involves the fallopian tube. Ovarian heterotopic pregnancy is rare, with fewer than 40 reported cases in PubMed/Medline; cases of ovarian ectopic pregnancy after intrauterine insemination are even rarer, with only seven published reports. We report here a case of ovarian heterotopic pregnancy following intrauterine insemination; this could possibly be the first such report. Our patient presented with circulatory collapse in the first trimester and laparoscopy disclosed an ovarian pregnancy with hemoperitoneum. Following resection of the ovarian pregnancy, the intrauterine gestation continued undisturbed and the patient delivered at term. Heterotopic pregnancy and unusual ectopic locations should be considered a possibility in pregnant women with pelvic pain, particularly following fertility treatment, including ovarian stimulation and intrauterine insemination.

A rare case of fever of unknown origin: subcutaneous panniculitis-like T-cell lymphoma (SPTCL).

A 26-year-old man presented with high-grade fever, chills, productive cough and episodic abdominal pain of 6 months duration. Physical examination revealed that the patient was febrile and had multiple, ill-defined, tender, indurated, erythematous nodules and plaques over the trunk and thighs. Systemic examination and investigations revealed bilateral exudative pleural effusion with an increased adenosine deaminase (ADA) level. Pulmonary tuberculosis was suspected and the patient was started on a standard four-drug antitubercular regimen. Since his fever persisted, biopsy of the plaque over the trunk was performed, which showed lobular panniculitis with atypical lymphoid cells. Immunohistochemistry showed atypical lymphoid cells, which were CD3 and CD8 positive and CD4 negative. Based on the clinical features, skin biopsy and immunohistochemistry, the diagnosis of subcutaneous panniculitis-like T-cell lymphoma was made. The patient was treated with chemotherapy followed by bone marrow transplantation, and 4-year follow-up showed complete remission of lymphoma.

Collagenofibrotic glomerulopathy in association with Hodgkin's lymphoma.

Deposit glomerulopathies are characterized by fibrillary deposits of various sizes, mainly in the mesangial area. Collagenofibrotic glomerulopathy is a rare type of such fibrillary glomerulopathies characterized by deposits of 60-80 nm fibrils in the sub-endothelial and mesangial areas. It is also associated with increased levels of serum pro-collagen type III peptide (PIIINP). Although most of the initial reports have emanated from Japan, many other scientists around the globe have later reported this disease. Possibility of systemic disease affecting metabolism of type III collagen is postulated but so far no such association has been identified. We report a 26-year-old male patient who presented with insidious onset of febrile illness associated with lymphadenopathy and proteinuria. Lymph node biopsy revealed features of Hodgkin's lymphoma while percutaneous renal biopsy showed features of collagenofibrotic glomerulopathy.

Primary osteoliposarcoma of the bone.

Osteoliposarcoma are rare tumors of the bone. To our knowledge, so far only eight cases have been reported. Some of the reports have referred to these tumors as malignant mesenchymoma. We report a case of a male with osteoliposarcoma of the right femur who presented with pain and restricted movements of the right knee joint. Radiologically, a tumor in the lower end of the right femur was seen extending into the soft tissue. The biopsy was reported as osteosarcoma. The patient received three cycles of neo-adjuvant chemotherapy followed by limb-salvage surgery with provisions for a custom-made prosthesis. A histopathological study of the excision specimen revealed areas of pleomorphic liposarcoma with numerous osteoblasts associated with areas of osteoid surrounded by neoplastic cells. The final diagnosis was osteoliposarcoma. Only 21% tumor necrosis (effects of chemotherapy) was observed. Presently, 26 months following diagnosis, the patient is fine with no evidence of local recurrence or distant metastasis.

Cerebral atypical teratoid rhabdoid tumour arising in a child treated for acute lymphoblastic leukaemia.

Atypical teratoid rhabdoid tumours (ATRT) are rare, arising typically in childhood. ATRT arising as a secondary tumour in children treated for acute lymphoblastic leukaemia have not been reported so far. We report a case of ATRT in a 17-year-old boy, 11 years after he was treatment for acute lymphoblastic leukaemia with cranial radiation.

Myxoid adrenal adenoma with focal pseudoglandular pattern.

Adrenal cortical tumors with myxoid change are rare tumors. To our knowledge, only 22 cases have been described so far in literature, which include 13 carcinomas and 9 adenomas. A pseudoglandular pattern has been described in 9 of these tumors. We report a case of a myxoid adenoma of the left adrenal gland in a 67-year-old woman, with a focal pseudoglandular pattern involving about 20% of the studied tumor. Rest of the tumor was composed of anastomosing cords of tumor cells. Abundant myxoid stroma was present, which stained positively with alcian blue and was weakly focally positive with periodic acid Schiff. Immunophenotype was consistent with an adrenal tumor, i.e., positive for vimentin, inhibin, and melan A. Cytokeratin AE1/AE3 and chromogranin were negative. MIB-1 index was < 0.1%.

Synchronous endometrial carcinoma and a macroprolactinoma: exploring a causal relationship.

BACKGROUND: While unopposed estrogen hormone secretion is most commonly implicated in the pathogenesis of endometrial carcinoma, the role of prolactin has only recently been highlighted. The authors present a case of a synchronous endometrial carcinoma in a patient with a prolactin-secreting macroadenoma. METHODS: A 29-year-old woman presented with a 4-year history of primary infertility, irregular periods and intermittent galactorrhea. Hormonal evaluation revealed elevated prolactin and subnormal luteinizing hormone and follicle-stimulating hormone (FSH) serum concentrations. An ultrasound of the pelvis revealed endometrial thickening. The MRI of the brain confirmed a pituitary macroadenoma. The patient underwent a resectoscopic polypectomy and dilation and curettage followed by transnasal transsphenoidal excision of the pituitary macroadenoma. RESULTS: The biopsy of the endometrium revealed a well-differentiated endometrioid carcinoma while that of the pituitary tumor confirmed a prolactinoma. CONCLUSION: An indirect causal mechanism can be postulated to explain this association. Hyperprolactinemia inhibits gonadotropin-releasing hormone leading to subnormal FSH and luteinizing hormone levels. Though the patient is hypoestrogenic, chronic anovulation with unopposed estrogen secretion can increase the risk of endometrial carcinoma. Patients with prolactinomas and irregular menstrual bleeding should undergo endometrial sampling to rule out this possibility.

Duodenal angiomyolipoma: a case report.

The authors present a case of duodenal angiomyolipoma. Angiomyolipoma is a benign neoplasm, the most common site being the kidney. Extrarenal angiomyolipomas are rare. Only one case of duodenal angiomyolipoma has been reported. A 66 year old man presented with GI bleeding for two years. Endoscopy revealed a duodenal polyp which on histopathology revealed features of angiomyolipoma. On immunohistochemistry, smooth muscle component was positive for Smooth Muscle Actin. HMB-45 showed mild focal positivity. Patient had no history of tuberous sclerosis. Surgical excision of angiomyolipoma is usually curative with rare cases of local recurrence.

Primary lymphoma of the breast: a clinicopathological study.

3 cases of primary non Hodgkins lymphoma of the breast are described, seen over a period of 2 years among 199 cases of breast malignancies. All were diffuse large B cell type. Application of immunohistochemistry greatly aids in differentiating lymphoma from anaplastic carcinoma, with which it can easily be confused. Preoperative diagnosis on a trucut biopsy is an ideal diagnostic method since diagnosis on fine needle aspiration cytology or frozen section may not be possible. Primary breast lymphoma is a rare disease with reported incidence of 0.04-0.53% of all breast malignancies in most series. Accurate diagnosis is essential, so that appropriate treatment may be applied. Two cases were treated with CHOP chemotherapy and radiotherapy along with surgical excision. One case was treated with CHOP chemotherapy.

Benign fibrous histiocytoma of the bladder.

Mesenchymal tumors of the bladder are rare with leiomyoma accounting for most of these. We present a rare case of a bladder benign fibrous histiocytoma in a 52-year-old male. He presented with history of straining during micturition since two years. The magnetic resonance imaging revealed a large intravesical mass. The mass was excised. It weighed 600g, with a maximum dimension of 13cm. Histology was that of a benign fibrous histiocytoma. To our knowledge, only two cases of this tumor have been reported in the bladder so far. The clinical and pathological features are discussed.