Asit Ranjan Mridha

Myxopapillary ependymoma of lumbosacral region with metastasis to both cerebellopontine angles: report of a rare case

IntroductionMyxopapillary ependymomas are low grade tumours that are known to recur locally even after complete excision, but metastasis to distant sites is extremely uncommon.Case reportWe report an unusual case of lumbo-sacral myxopapillary ependymoma in a 13-year-old boy with metastasis to both cerebellopontine angles. To the best of our knowledge, this is the youngest patient of metastatic myxopapillary ependymoma.

Anaplastic ependymoma with cartilaginous and osseous metaplasia: report of a rare case and review of literature

Gliomas with cartilaginous metaplasia are extremely uncommon and thought to be due to metaplasia of the mesenchymal supportive elements. The tumors are located in the midline, mostly fourth ventricle and rarely in the pons. The present paper describes an unusual case of anaplastic ependymoma with cartilaginous and osseous metaplasia in a young boy which was located in the suprasellar, interpeduncular prepontine and left cerebello-pontine cistern. To the best of our knowledge, this cartilaginous metaplasia in ependymomas has been reported only thrice.

Outcomes and Prognostic Factors for Ewing-Family Tumors of the Extremities

BACKGROUND There are few published studies describing the clinical results of patients uniformly treated for a Ewing-family tumor of an extremity. METHODS We performed a review of patients who had received uniform treatment consisting of neoadjuvant chemotherapy, surgery and/or radiation therapy as local treatment, and then adjuvant chemotherapy from June 2003 to November 2011 at a single institution. RESULTS There were 158 patients included in the study. The median age was fifteen years. Sixty-nine (44%) of the patients had metastatic disease at presentation. Fifty-seven patients underwent surgery, and forty-one received radical radiation therapy following neoadjuvant chemotherapy. After a median of 24.3 months (range, 1.6 to ninety-seven months) of follow-up, the five-year event-free survival, overall survival, and local control rates (and standard error) were 24.1% ± 4.3%, 43.5% ± 6%, and 55% ± 6.8%, respectively, for the entire cohort and 36.4% ± 6.2%, 57.6% ± 7.4%, and 58.2% ± 7.9%, respectively, for patients without metastases. In the multivariate analysis, metastases predicted inferior event-free survival (p = 0.02) and overall survival (p = 0.03) rates in the entire cohort, whereas radical radiation therapy predicted an inferior local control rate in the entire cohort (p = 0.001) and in patients without metastases (p = 0.04). In the group with localized disease, there was no difference between the patients who received radical radiation therapy and those who underwent surgery with regard to tumor diameter (p = 0.8) or post-neoadjuvant chemotherapy response (p = 0.1). A white blood cell count (WBC) of >11 × 109/L predicted inferior event-free survival (p = 0.005) and local control (p = 0.02) rates for patients without metastases. CONCLUSIONS To our knowledge, this is the largest study on extremity Ewing-family tumors treated with uniform chemotherapy and either surgical resection or radical radiation therapy in Asia. All possible efforts should be made to resect a primary tumor after neoadjuvant chemotherapy, as radical radiation therapy alone results in a poor local control rate despite a good post-neoadjuvant chemotherapy response. Patients without metastases but with a high WBC had inferior event-free survival and local control rates and may require more aggressive therapy. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Rotary ultrasonic drilling on bone: A novel technique to put an end to thermal injury to bone:

Bone drilling is common in orthopedic procedures and the heat produced during conventional experimental drilling often exceeds critical temperature of 47 °C and induces thermal osteonecrosis. The osteonecrosis may be the reason for impaired healing, early loosening and implant failure. This study was undertaken to control the temperature rise by interrupted cutting and reduced friction effects at the interface of drill tool and the bone surface. In this work, rotary ultrasonic drilling technique with diamond abrasive particles coated on the hollow drill tool without any internal or external cooling assistance was used. Experiments were performed at room temperature on the mid-diaphysis sections of fresh pig bones, which were harvested immediately after sacrifice of the animal. Both rotary ultrasonic drilling on bone and conventional surgical drilling on bone were performed in a five set of experiments on each process using identical constant process parameters. The maximum temperature of each trial was recorded by K-type thermocouple device. Ethylenediaminetetraacetic acid decalcification was done for microscopic examination of bone. In this comparative procedure, rotary ultrasonic drilling on bone produced much lower temperature, that is, 40.2 °C ± 0.4 °C and 40.3 °C ± 0.2 °C as compared to that of conventional surgical drilling on bone, that is, 74.9 °C ± 0.8 °C and 74.9 °C ± 0.6 °C with respect to thermocouples fixed at first and second position, respectively. The conventional surgical drilling on bone specimens revealed gross tissue burn, microscopic evidence of thermal osteonecrosis and tissue injury in the form of cracks due to the generated force during drilling. But our novel technique showed no such features. Rotary ultrasonic drilling on bone technique is robust and superior to other methods for drilling as it induces no thermal osteonecrosis and does not damage the bone by generating undue forces during drilling.

Mesothelial/monocytic incidental cardiac excrescences (MICE) with tubercular aortitis: report of the first case with brief review of the literature

Mesothelial/monocytic incidental cardiac excrescence (MICE) is a rare and distinctive cardiac lesion composed of mesothelial and monocytic cells with other inflammatory cells and fibrin. Though the first case of MICE was reported about three decades earlier, to date fewer than 50 cases have been recorded in the available literature.1–5 We describe the case of a 40-year-old male who was admitted in the Department of Cardiothoracic and Vascular Surgery with complaints of dyspnoea (NYHA Class III) of 1 years duration. There was no history of pedal oedema, chest pain, palpitations, syncope, neurological or embolic manifestations or signs of infective endocarditis and rheumatic fever. Clinical examination revealed absence of pallor, jaundice, cyanosis, pedal oedema, lymphadenopathy or Marfanoid features. His general condition was fair. His pulse was 88/min and regular with all peripheral pulses palpable. His blood pressure was 140/80 mmHg. There were peripheral signs of aortic regurgitation. Respiratory system examination did not reveal any abnormality. Cardiovascular examination showed apex beat in the left sixth intercostal space. The heart sounds S1 and S2 were audible with an ejection systolic murmur at the aortic area. Electrocardiogram revealed normal sinus rhythm, left axis deviation and left ventricular hypertrophy. Echocardiography revealed severe aortic regurgitation without any stenosis. The other valves were normal. There was no clot, vegetation or pericardial effusion. With a clinical diagnosis of aortic regurgitation, the patient underwent aortic valve replacement. There was mild serous pericardial effusion, adhesions between the aorta and pericardium and multiple small cystic structures containing gel-like material surrounding the ascending aorta. Cardiomegaly with left ventricular hypertrophy was noted. The right atrium, right ventricle, left atrium and left atrial appendage were unremarkable. The ascending aorta was thick and dilated, and appeared inflamed. The native aortic valve was …

Delayed isolated port-site metastasis of gallbladder cancer following laparoscopic cholecystectomy: report of two cases.

Laparoscopic cholecystectomy is the standard of care for gallstone disease [1]. The histopathological examination of all gallbladder specimens, though resected for gallstone disease, is recommended in order to detect the underlying gallbladder cancer [2]. The presence of incidentally detected gallbladder cancer following laparoscopic cholecystectomy, in most of the patients (except T1a tumors) warrants a completion radical surgery along with excision of port sites in order to lower the risk of locoregional and port-site metastasis [3]. Port-site metastasis usually manifests early following laparoscopic cholecystectomy, in the presence of underlying gallbladder cancer, and reflects an aggressive behavior of tumor; these patients are mostly not amenable to surgical treatment as they have associated disseminated peritoneal disease. We present two cases of delayed (more than 5 years) port-site metastasis following laparoscopic cholecystectomy; they were not diagnosed with gallbladder cancer at the time of cholecystectomy as their gallbladder specimens were not subjected to histopathological examination.

Eumycetoma presenting as a cerebellopontine angle mass lesion

Eumycetoma in the cerebellopontine angle region is extremely uncommon with no case being reported as per an extensive review of the literature by the authors. The authors report a case of cerebellopontine angle eumycetoma in a young female managed by subtotal decompression and antifungal treatment. The pre-operative diagnosis of eumycetoma in this location is extremely difficult and the role of histopathology is very important to characterize this uncommon lesion. The prognosis of this bizarre pathology is dismal despite all treatment modalities as compared to the usual tumors of the cerebellopontine angle that generally have a favorable outcome.

A Prospective Randomized Study to Compare Systemic Emboli Using the Computer-Assisted and Conventional Techniques of Total Knee Arthroplasty

BACKGROUND Conventional total knee arthroplasty is performed with use of an intramedullary alignment guide, which produces elevated intramedullary pressure that can create fat emboli. Total knee arthroplasty performed via computer-assisted surgery does not require an intramedullary femoral rod, raising the question of whether computer-assisted surgery generates less embolic material than conventional total knee arthroplasty. The purpose of this study was to compare the emboli produced in the two techniques. METHODS Fifty-seven patients were randomized into two groups: the computer-assisted surgery group (n = 29) and the conventional total knee arthroplasty group (n = 28). An intramedullary femoral alignment jig was used in the conventional total knee arthroplasty group but not in the computer-assisted surgery group. Intraoperative invasive monitoring was performed with use of transesophageal echocardiography and a pulmonary artery catheter. RESULTS The mean embolic score was 6.21 points for the conventional technique group and 5.48 points for the computer-assisted surgery group (p = 0.0161). After tourniquet deflation, fat emboli were observed in the blood of five patients in the conventional surgery group and one patient in the computer-assisted surgery group. CONCLUSIONS The patients in the computer-assisted surgery group had lower embolic loads compared with the patients in the conventional total knee arthroplasty group. In patients with an uncompromised cardiopulmonary system, the embolic load difference between the techniques was not clinically relevant. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Large lipid-rich mammary analogue secretory carcinoma of parotid gland: An unusual case

Mammary analogue secretory carcinoma (MASC) of the salivary gland is a malignant tumor which bears morphologic, immunohistochemical and molecular features similar to those of mammary secretory carcinoma. The tumor is considered as a low-grade malignancy perhaps slightly more aggressive than acinic cell carcinoma. High-grade transformation with recurrences, regional nodal involvement, metastases, and cancer-related death has been reported in a few cases. We report an unusual case of large MASC of the parotid gland in a young patient without regional lymph node involvement. To the best of our knowledge till date such a large MASC of the salivary gland has not been reported in the English literature.

Xanthogranulomatous inflammation of gallbladder and bile duct causing obstructive jaundice masquerades gallbladder cancer: a formidable diagnostic challenge continues.

Xanthogranulomatous cholecystitis (XGC) is defined as a variant of chronic cholecystitis characterized by intense inflammation and accumulation of lipid laden macrophages [1]. Though XGC is a benign disease, it has the potential of inflammatory invasion and may involve adjacent organs such as duodenum, liver, colon, and common bile duct, and so, XGC has always bewildered the surgeons by its ability to masquerade gallbladder cancer very closely resulting into radical resection. Xanthogranulomatous involvement of bile duct, termed as xanthogranulomatous choledochitis [2] (XGCd), is a rarely reported condition; it may manifest with obstructive jaundice and mimic malignancy. We highlight a case of a 32-year-old who presented with obstructive jaundice and underwent radical resection in view of imaging findings suspicious locally advanced gallbladder cancer; however, histopathological examination of surgical specimen revealed XGC and XGCd. We also make an attempt to review the previously reported cases of XGCd who had presented with obstructive jaundice and imitated malignancy. Case Report