Ay Lakshmi

Malignancy in solitary thyroid nodule: A clinicoradiopathological evaluation

Background: Thyroid nodules are common. They can be either benign or malignant. Solitary thyroid nodules (STN) have a high likelihood of being malignant. They should be characterized properly for optimum management. Materials and Methods: In this study, we have analyzed our departmental data over a period of 5 years. All the patients who presented to the outpatient department with a clinically detected STN were included in the study group. Our approach was individualized. Preoperative ultrasonography (USG) and fine-needle aspiration cytology were planned in all these patients. Hemi thyroidectomy and total thyroidectomy with and without neck dissection were performed wherever appropriate. Results: There were 162 cases of clinically detected STN. USG findings were available in 146 cases. Postoperative histopathology was reported as malignant in 58 cases. Malignant STN was more likely in males. Ultrasonographically detected solid STN were more prone for malignancy as compared to multinodular goiter (P = 0.000) Presence of micro calcification and cervical lymphadenopathy were more commonly noted in malignant thyroid swellings. Conclusion: Solitary thyroid nodules do have a high likelihood of harboring a malignancy. Solid echogenicity, micro calcification and cervical lymphadenopathy on USG were seen more frequently in malignant nodules.

Well-differentiated fetal adenocarcinoma of the lung in an adult male: Report of an unusual tumor with a brief review of literature

We report a case of a well-differentiated fetal adenocarcinoma (WDFA) of the lung in a 50-year-old male smoker. The literature regarding this uncommon tumor is limited. This rare variant of adenocarcinoma is more common in females, in the third and fourth decades. Microscopically it is composed of neoplastic glands and tubules that resemble the fetal lung. Well-differentiated fetal adenocarcinoma is a low-grade malignancy and surgery is the preferred mode of therapy. This uncommon case of a well-differentiated fetal adenocarcinoma in an adult male patient is reported, with relevant immunohistochemical findings, along with a discussion of the current literature.

Space occupying lesion (paraganglioma) of the urinary bladder in a young male: A case report and brief review of the literature

Urinary bladder paragangliomas are rare with a reported incidence of <1% of bladder tumors. In the absence of typical clinical features, histopathology helps in rendering definitive diagnosis. We describe a case of nonfunctional urinary bladder paraganglioma in a 28-year-old male who presented with the chief complaint of abdominal pain. The final diagnosis was made by histopathological and immunohistochemical analysis. It is important to distinguish paraganglioma from urothelial carcinoma as the treatment differs. This is an additional case of nonfunctional urinary bladder paraganglioma in a male patient with a brief review of the literature.

Epitrochlear mass in a patient on maintenance hemodialysis—Kimura disease

Kimura disease is a rare benign inflammatory disorder presenting as subcutaneous masses or lymphnodal mass in the cervical region. Kimura disease is reported sparsely in patients on maintenance hemodialysis. We report an unusual location of Kimura disease in a patient on maintenance hemodialysis, who had a prolonged, persistent asymptomatic eosinophilia.

Parathyroid adenomas: A case series and clinicopathological study from a tertiary care center in South India

Background: The incidence of primary hyperparathyroidism (PHP) in India is 2.5/1000 individuals. The major cause for PHP is parathyroid adenoma. To arrive at the correct diagnosis, clinical setting, biochemical and radiological investigations, the status of other glands assessed intraoperatively and finally histopathologic confirmation is essential. Materials and Methods: We carried out a retrospective analysis of the last 5 years of operated cases of parathyroid adenomas. Diagnosis was based on histological confirmation. In all the cases clinical data, details of biochemical, radiological, and other investigations including histopathological findings were recorded. Results: There were four operated patients of parathyroid adenoma at our center in the last 5 years. Out of four operated cases of parathyroid adenomas, three were symptomatic and one case was detected incidentally. The symptoms were varied and included skeletal, renal, neuromuscular, and neuropsychiatric manifestations. Two of the patients had diabetes mellitus at the time of presentation. They showed improvement in glycemic control after surgery. Histopathologically, all the parathyroid adenomas were of clear cell type without any evidence of capsular or vascular invasion to suggest the possibility of malignancy. Conclusion: Majority of our patients were females who showed symptomatic improvement after surgery. Histopathologically, all the cases were parathyroid adenomas and in one case of papillary carcinoma of thyroid, the parathyroid adenoma was incidentally detected.

A rare case of oropharyngeal melanoma: Case report and brief review of literature

Mucosal melanomas are rare compared with the cutaneous melanomas. They present with advanced stage and are known to have a poor outcome in comparison to their cutaneous counterparts. Mucosal melanomas constitute about 1.3% of all melanomas. The most common site of mucosal melanomas is the head and neck region. In oropharynx, 95% of all malignancies are squamous cell carcinomas. The melanomas of the oropharynx are very rare. Hereby, we are reporting a case of pedunculated mucosal melanoma of oropharynx.

Renal hemangiopericytoma with lung metastasis: A rare case report

Hemangiopericytoma (HPC) is an unusual vascular neoplasm. Renal HPC is very rare. Only a few cases of renal HPC with distant metastasis have been described in the literature. In the absence of specific clinical signs and symptoms and imageological findings, histopathology remains the cornerstone of diagnosis. The present case is a 56-year-old female who presented with abdominal lump and pain of 1-month duration. Her contrast-enhanced computed tomography abdomen and chest showed a large well-defined lobulated heterogeneously enhancing soft tissue density lesion arising from the lower pole of the kidney with central calcification. Nodular opacities were noted in both lungs. It was reported as renal cell carcinoma (RCC) with lung metastasis. She underwent left nephrectomy because of the suspicion of RCC. The histopathology along with immunohistochemistry was reported as HPC. This is an additional case of metastatic renal HPC.

A clinical study of bilateral non-obstructive acute pyelonephritis with acute kidney injury in patients of type 2 diabetes mellitus

The aim of our study was to study the clinical profile of type 2 diabetes mellitus patients admitted with the diagnosis of acute kidney injury (AKI) due to bilateral acute non-obstructive pyelonephritis. The bilateral involvement was identified on various imaging modalities (ultrasound, computed tomography, nuclear scintigrapy). All the patients had AKI. Those with severe AKI underwent hemodialysis. The factors associated with the severity of illness were identified. Twenty-five patients of type 2 diabetes mellitus admitted with the diagnosis of AKI due to bilateral acute non-obstructive pyelonephritis were identified. On ultrasound, bilateral involvement was found in 12 patients and in 17 patients on computed tomography and eight patients on nuclear scintigraphy. Fourteen of them needed dialysis support. Bilateral acute pyelonephritis needs to be considered while evaluating the AKI in type 2 diabetes mellitus patients.

Metastatic calcinosis cutis in patients of end-stage renal disease.

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