Myopericytoma of the oral cavity

BACKGROUND: Myopericytoma is a rare mesenchymal neoplasm of pericytic cells demonstrating myoid differentiation. The lesion typically arises within the subcutaneous tissue of the extremities. We report a case that, to the best of our knowledge, is the first case of myopericytoma involving the soft tissue of the oral cavity. METHODS: A 36-year-old woman had a 5-mm sessile, whitish-pink, firm tongue nodule. The patient underwent excisional biopsy, and histopathologic examination as well as immunohistochemical analysis were performed. RESULTS: The differential diagnosis by histologic analysis included solitary fibrous tumor, myofibroma, glomus tumor, and myopericytoma. The results of immunohistochemical analysis, when combined with the histologic features, led to a diagnosis of myopericytoma. CONCLUSIONS: Applying strict morphologic criteria and appropriately selective immunohistochemical markers will help to distinguish myopericytoma in the oral cavity.     

Solid pseudopapillary neoplasm of the pancreas: a single institution experience of 14 cases

Solid pseudopapillary neoplasm of pancreas (SPN) is a rare entity; therefore proper diagnosis, evaluation and formulation of treatment protocols is difficult. A total of 14 cases were diagnosed and treated at our institute over a 10-year period (1992-2002). A retrospective study of all these cases was performed with respect to age group most frequently affected, sex ratio, common presenting symptoms and signs, investigative protocols, pathological features, treatment offered, outcome and prognosis. All the 14 patients were females, with a median age of 20 years (range 13-45 years). The commonest presenting symptom was abdominal pain. All these patients underwent surgical exploration; 13 patients underwent resection of the tumour. The average length of postoperative hospital stay was 10.3 days. Significant postoperative morbidity was seen in only one case. There was no postoperative mortality. All these patients who underwent resection were disease-free on follow-up ranging from 6 to 96 months (median 36 months).     

How to Optimize Current (Available) Diagnostic Tests

Isolation of mycobacterium tuberculosis is the gold standard in the diagnosis of childhood tuberculosis. However, it has inherent limitations due to paucibacillary nature of the disease in children and technical difficulties encountered in collection of appropriate sample. Thus, diagnosis is dependent on circumstantial evidence at best supported by conventional tests such as tuberculin test and chest radiograph. Several new tests are being developed but they lack ideal sensitivity and specificity. Hence, it is important to optimise use of current diagnostic tests. Clinical suspicion based on protocol developed by IAP is a pre-requisite of ordering tests and it is only then that proper interpretation is possible. Tuberculin skin test is still a useful screening test. It does help in establishing presence of infection though not necessarily disease. Attention must be paid to ideal test solution, proper technique and cautious interpretation. BCG test is not recommended. Miliary shadows and fibrocaseious cavitary lesions in chest radiograph are highly suggestive of tuberculosis in our epidemiology. CT scan is rarely necessary and is not cost and radiation-effective. It is ideal to attempt bacteriological examination in every suspected case of childhood tuberculosis. Most practical method is collection of gastric aspirate for smear and culture. It is possible to carry out this procedure in out-patient clinic. Better yield is likely with increasing expertise especially in extensive disease. Bronchoalveolar lavage is an invasive test and bacterial yield is comparable to that of gastric aspirate. Tissue collected for histopathological examination must be submitted for bacteriolgocal tests. PCR is not easily available. It has high sensitivity but lower specificity and thus, is not routinely recommended. Serology has no place in diagnosis of tuberculosis. Interferron gamma release assays are also now available. Sensitivity and specificity of Quantiferon Gold and T-spot tests have not been studied in children and hence are not recommended in routine practice. Instead of trying newer tests, it may be best to avail an expert advice in difficult cases.     

Effect of H37Ra on PHA-induced migratory inhibition of leucocytes in patient of tuberculosis.

Eighty nine cases of active pulmonary tuberculosis were classified into four stages depending on the clinical extent of disease. Leucocyte migration inhibition test (LMIT) was done using mitogen phytohaemagglutinin (PHA) and H37Ra specific antigen. Normal PHA responses were observed in all clinical stages while specific immune response in relation to inhibition of leucocyte migration decreased from stage I to stage IV. Effect of H37Ra on PHA induced release of lymphokine was studied by mixing the two and comparing the percentage migratory inhibition of the mixture with that of PHA alone. Increased or decreased values with mixture compared to those with PHA alone were regarded as enhancement or inhibitory effect respectively. Median percentage effect of H37Ra on PHA induced migratory inhibition was found to be inhibitory in first three stages and controls while enhancement effect was observed in stage IV. A total of 22 cases in all stages showed enhancement effect while 48 cases showed inhibitory effect. The possible mechanism of enhancement or inhibitory effect are discussed.     

Oxidative damage and schizophrenia: the potential benefit by atypical antipsychotics

There is evidence to suggest the derangement of the oxidant and antioxidant defense system in schizophrenia. The present study examined the effect of atypical antipsychotics on lipid peroxidation, superoxide dismutase (SOD) and ascorbic acid. For this purpose, a prospective, open-label, 8-week study design was utilized. Serum SOD, serum malondialdehyde (MDA) and plasma ascorbic acid were estimated. Schizophrenic patients (n = 48) were compared with age- and sex-matched healthy volunteers (n = 40). There was a significant increase in serum SOD, serum MDA and a decrease in plasma ascorbic acid in schizophrenic patients as compared to control subjects. The trend altered significantly after the treatment with atypical antipsychotics. The results of the Brief Psychiatric Rating Scale for schizophrenia also improved with the treatment. The findings indicate an involvement of free radicals in schizophrenia and its modification by treatment with atypical antipsychotics. This study can also be used as a predictor of drug response by atypical antipsychotics in schizophrenia.