Clinico-pathological profile of pediatric lymphadenopathy

Objective : To study the clinico-pathological profile of significant pediatric peripheral lymphadenopathy and to arrive at an etiological diagnosis.Methods : Prospective study in a tertiary care hospital setting. One hundred consecutive children reporting to pediatric OPD from 1 January 1995 to 31 December 1998, aged 1 month to 12 years were studied.Results : The commonest aetiology diagnosed was tubercular lymphadenitis in 35% cases, followed by chronic tonsillopharyngitis in 15% cases. Lymphomas, AIDS and infectious mononucleosis constituted 3,2 and 1 cases each. Aetiology could not be ascertained in 44 (44%) children even after detailed haematological, microbiological, radiological and serological investigations. FNAC’s sensitivity and specificity as compared to ’gold standard of excision lymph node biopsy was 94% and 100% respectively.Conclusion : Tubercular lymphadenitis was the commonest treatable entity of significant pediatric peripheral lymphadenopathy. A majority of the cases even after thorough evaluation, remained undiagnosed. FNAC as a diagnostic modality is almost as sensitive and as specific as excision lymph node biopsy when an adequate aspirate is examined by expert eyes.     

Tuberculosis of paranasal sinuses

Nasal tuberculosis is very rare but much rarer is tuberculosis of paranasal sinuses. It involves especially the maxillary sinus and is usually unilateral. We report an unusual case of tuberculosis of frontal and maxillary sinus in a 68 years old male, who presented with a swelling above left medial canthus, with no other eye or nasal complaints. Clinical and radiological findings on our initial evaluation suggested that the patient had left frontal mucocoele with bilateral maxillary haziness. Diagnosis was established on FNAC report and subsequent Ziehl — Neelsen staining of nasal swabs and tuberculin skin test. Later chest x-ray examination was suggestive of pulmonary tuberculosis, which was the primary cause. Patient responded well to antituberculosis drug therapy.     

Phenotypic diversity of intrahepatic and extrahepatic cholangiocarcinoma on aspiration cytology and core needle biopsy: case series and review of the literature

BACKGROUND: Cholangiocarcinoma (CC) represents approximately 10% of primary liver malignancies and can mimic metastatic adenocarcinoma. METHODS: The authors retrospectively reviewed the cytopathology files at the University of Texas Medical Branch to identify patients who were diagnosed with intrahepatic or extrahepatic CC by aspiration cytology between 1995 and 2004. Brush cytology specimens of extrahepatic CC were excluded. All diagnoses were confirmed as CC by clinical, imaging, and histopathologic findings and by chart review. RESULTS: Cytopathology files from 13 patients with CC diagnosed by FNA were retrieved. The male:female ratio was 5:8, and the patients ranged in age from 29 years to 74 years (mean age, 59 years). In 12 of 13 patients, aspirates were obtained by ultrasound guidance; and, in 1 patient, computed tomography guidance was used. Three patients had aspirates only, 10 patients also had core biopsies, and 1 patient had cell block preparations. The phenotypic distribution of CC according to the World Health Organization (WHO) histologic classification was 9 adenocarcinoma (intrahepatic), not otherwise specified (NOS) (69%); 2 gastric foveolar type (extrahepatic) CCs (15%); 1 intestinal type (extrahepatic) CC (8%); and 1 sarcomatous/spindle cell type (intrahepatic) CC (8%). One adenocarcinoma, NOS was well differentiated CC with bland tubular architecture, and one was pleomorphic. Ancillary histochemical and immunochemical stains were performed on 5 of 13 specimens, which included 4 core biopsies and 1 aspirate with Mucicarmine positivity (3 specimens), carcinoembryonic antigen positivity (3 specimens), and a cytokeratin 7 (CK7)-positive/CK20-negative pattern (2 specimens). The 1 sarcomatous/spindle cell type CC was chromogranin-negative and low molecular weight keratin (cell adhesion molecule 5.2)-positive, which excluded metastatic carcinoid. CONCLUSIONS: Classification of intrahepatic and extrahepatic CC in aspiration cytology specimens was achieved in a reliable manner concordant with the WHO histologic classification. Special types of CC with bland nuclear features posed a diagnostic challenge on cytologic evaluation, particularly the well differentiated CC with tubular architecture and the gastric foveolar type CC with mucin-producing tumor cells. The addition of core biopsy and/or ancillary studies, such as histochemical and immunochemical stains, were helpful in reaching the correct diagnosis.     

Leiomyosarcoma of the inferior vena cava: a case report and review of literature

Tumors of the inferior vena cava are rare, and most of these are leiomyosarcomas. They are most frequent in the sixth decade of life, with a female predominance. We present a 45-year-old male patient with a tumor involving the entire extent of the inferior vena cava. Computerized tomography revealed a heterogeneously enhancing mass with marked expansion of the inferior vena cava with extraluminal extension. Computerized tomography--guided biopsy of the extraluminal component showed features of a fasciculated spindle cell tumor positive for vimentin, smooth muscle actin, and calponin and negative for S-100 antigen. We discuss the clinical presentation imaging findings and review the literature.     

Exacerbation of acute pancreatitis by combined cholinergic stimulation and duct obstruction

BACKGROUND: The role of cholinergic pathways in the pathogenesis of bile-pancreatic duct ligation (BPDL)-induced acute pancreatitis in rats remains controversial. We hypothesized that cholinergic stimulation exacerbates acute pancreatic inflammation in the presence of duct obstruction. METHODS: We studied 34 rats divided into 5 groups as follows: (1) sham operation; (2) BPDL; (3) BPDL with duodenal bile-pancreatic juice (BPJ) replacement fresh from a donor rat; (4) BPDL with BPJ replacement as in 3 above, and carbachol (CCh) 5 ug/h subcutaneously; or (5) CCh 5 ug/h subcutaneously only. Rats were killed after 6 hours. RESULTS: The P value was less than .05 by analysis of variance. Pancreatic morphologic changes and zymogen fraction hyperamylasemia seen with duct ligation (2 vs. 1) were ameliorated significantly by duodenal BPJ replacement (3 vs. 2), but not when exogenous CCh was administered (4 vs. 3), whereas CCh alone showed no significant changes compared with sham (5 vs. 1). CONCLUSIONS: Cholinergic stimulation and duct obstruction synergistically amplify acinar hyperstimulation and exacerbate acute pancreatitis.     

Arthroscopic reconstruction of the anterior cruciate ligament using bone-patellar tendon-bone autograft: experience of the first 100 cases

PURPOSE: To review the results of patients who underwent arthroscopic reconstruction of the anterior cruciate ligament (ACL) via a single incision technique using a bone-patellar tendon-bone autograft. METHODS: Patients with ACL-deficient knees who were symptomatic and wanted to maintain an active lifestyle or continue sporting activities were included. ACL reconstruction using the bone-patellar tendon-bone graft was performed on 100 patients. One-year follow-up was completed in 78 patients who were then reviewed. The mean age of patients reviewed was 26.8 years (range, 21-39 years), of whom 35 (44.9%) were aged between 26 and 30 years. There were 73 men and 5 women (ratio, 14.6:1). Injuries on the right side outnumbered those on the left (44 versus 34). Sports injuries accounted for 66.7% (n = 52) of patients, motor vehicle accidents and household injuries accounted for 30.8% (n = 24) and 2.6% (n = 2), respectively. RESULTS: Excellent and good-to-excellent results were achieved in 7 (9%) and 61 (78.2%) of patients. Residual anterior knee pain (n = 18) was the most common complication, followed by difficulty in regaining full range of motion (n = 10) and divergence of femoral screw (n = 9). CONCLUSION: This procedure provides consistent and reproducible results in carefully selected patients and allows them an early return to sporting activities with minimal residual morbidity.     

Squamous cell carcinoma lower lip - an experience with Karapandzic technique

Carcinoma of the lip is a common cancer of head and neck area. It occurs frequently on the lower lip of middle-aged and elderly males who have a history of chronic sun exposure. Surgical excision and radiotherapy are regarded as equally effective treatment options, but preferred method is surgical excision. Karapandzic technique provides myoneurovascular pedicled advancement flap for reconstruction of the defect after surgical excision. It is a simple and safe technique, functionally and esthetically, sacrifices little tissue, heals rapidly and is effective for repair of defects covering 1/3 to 4/5 of the lower lip. We report a 62 years male who presented with a large, fungating, pus-discharging and tender mass of lower lip. Biopsy confirmed squamous cell carcinoma. Tumor was excised and defect was reconstructed using Karapandzic technique. Patient remained asymptomatic during follow-up visits.     

The plateled-derived growth factor level (PDGF) in Hodgkin's disease and non-Hodgkin's lymphoma and its relationship disease activation

The research reported in this paper was designed to study the role of plateled-derived growth factor (PDGF) in Hodgkin's disease (HD) and non-Hodgkin's lymphomas (NHL). The PDGF levels in 9 patients with HD and 12 NHL and in a control group consisting of 20 people, was measured by ELISA method. The PDGF values in the disease group of 19 patients were raised. The values of PDGF in the control group were 28.977+/-9 pg/ml, but were measured at 147.083+/-54 pg/ml in HD group and 131.487+/-56 pg/ml in NHL group (p < 0.01). The observation of a 5-fold increase in PDGF values in the disease group when compared to the control group suggests that PDGF could itself be considered as a possible factor in the pathogenesis of HD and NHL. In order to support this, there is a need to design additional studies monitoring PDGF in larger number of patients at various stages of the disease.