Bishan D. Radotra

Fungal Rhinosinusitis: A Categorization and Definitional Schema Addressing Current Controversies

Fungal (rhino‐) sinusitis encompasses a wide spectrum of immune and pathological responses, including invasive, chronic, granulomatous, and allergic disease. However, consensus on terminology, pathogenesis, and optimal management is lacking. The International Society for Human and Animal Mycology convened a working group to attempt consensus on terminology and disease classification.

Childhood cutaneous tuberculosis: a study over 25 years from northern India

Abstract

MIB-1 immunolabeling: a valuable marker in prediction of benign recurring meningiomas.

Histological analysis has limited value to predict biological behavior of meningiomas. We investigated the utility of cell proliferative indicator in the evaluation of histologically benign meningiomas. We selected 25 benign non‐recurrent meningiomas, 15 benign recurrent meningiomas after complete surgical resection, 30 atypical meningiomas, and 15 anaplastic meningiomas out of 384 cases studied. MIB‐1 Labeling Index was evaluated by two methods: Highest Labeling Index (HLI) and Random Labeling Index (RLI). There was no dependable histological parameter to predict recurrence among benign‐looking meningiomas. HLI had significant difference when compared with RLI in all categories. The mean MIB‐1 HLI values ± SD were 3.47 ± 2.0% for benign meningiomas, 5.08 ± 4.0% for atypical meningiomas and 11.66 ± 7.06% for anaplastic meningiomas. In comparison, the mean MIB‐1 HLI of benign non‐recurrent meningiomas were 2.66 ± 1.7% and with recurrence were 4.21 ± 2.78% (P = 0.0339). Using receiver operating characteristic, it was seen that neoplasm recurred with the MIB‐1 HLI of > 2.6 having the sensitivity of 64.6% and specificity of 68% among benign (grade I) meningiomas. MIB‐1 positive tumor cells were maximally aggregated at the periphery of excised specimen. MIB‐1 HLI, integrated with standard histopathology can provide better information about the disease biological nature in benign meningiomas.

A study of primary central nervous system lymphoma in northern India

BACKGROUND Primary central nervous system lymphoma (PCNSL) is rare and accounts for 1 to 2% of all lymphomas. There are conflicting reports about the rise in incidence of PCNSL cases in the last two decades; this has largely been attributed to an increase in incidence of AIDS and other immunosuppressive states in some studies. This study was undertaken to view the trend of PCNSL at the Postgraduate Institute of Medical Education and Research, Chandigarh, which is a referral hospital in northern India. METHODS The PCNSL cases from our surgical material of 15 years (1985-1999) were reviewed. Slides were examined independently by three histopathologists. Immunophenotyping was done on paraffin-embedded tissue using indirect immunoperoxidase technique. RESULTS Out of a total of 3,325 intracranial tumors diagnosed during this period (1985-1999), there were 40 cases (1.2%) of PCNSL; gliomas accounted for 1,531 cases (46.04%). The age ranged from 24-75 years with the sex ratio (M:F) being 2:1. HIV serology, available in 14 cases, was negative in all. The parietal lobe was the most common site of involvement. Diffuse large cell lymphoma was the most common morphological type. Immunohistochemistry could be done in 31 cases; 28 cases were found to be B-cell type whereas 3 cases were T-cell type. No statistically significant increase was seen on comparing the number of cases at 5-year intervals. CONCLUSION This study revealed that there has been no significant increase in PCNSL cases over the last 15 years.

KID Syndrome : Response to Acitretin

KID syndrome is rare. We report a 17‐year‐old girl who presented with universally ichthyotic red hue on the face, trunk, and extremities along with deafness and keratitis since childhood. She was diagnosed with KID syndrome. Treatment with acitretin cleared the hyperkeratotic ichthyotic lesions with little effect on the cornea or hearing. Acitretin seems to be a promising new treatment in KID syndrome.

Concurrent skin and nerve histology in leprosy and its role in the classification of leprosy.

Concurrent skin and nerve histology was evaluated in 60 leprosy patients (25 BT, 28 BL and 7 LL). The twin aims were to study the comparative histology and the usefulness of nerve histology in the classification of the disease. In BT patients, clinical and histological classification was in agreement in 11 (44%) skin and 17 (68%) nerve biopsies. Concurrent skin and nerve histology was in consonance in 14 (56%) BT patients, while in 6 (24%) patients, only nerve histology was helpful in the classification of the disease, the skin histology being non-specific. Nerve histology was classified as BL in 3 (12%) BT patients, the skin histology was non-specific. In the BL group, the histology of 23 (82.4%) nerve biopsies correlated with the clinical classification, in contrast to skin histology which correlated with clinical assessment in 19 (68%) patients only. In the LL patients, the histology of nerve correlated with the clinical classification in 5 patients (71.4%), compared to histology of the skin in 4 (57%) patients only. The GF was higher in the nerves than in the skin throughout the leprosy spectrum (BT, BL, LL); the difference was, however, marginal in BL leprosy. The average bacteriological index (BI) was higher in nerves (4+) compared to that of skin histology and slit skin smears (3+) in BL leprosy. There was, however, no difference in the BI of the slit skin smears, skin and nerve biopsies in lepromatous leprosy.(ABSTRACT TRUNCATED AT 250 WORDS)

Infected Intraparenchymal Dermoids: An Underestimated Entity

Infection secondary to a dermal sinus most commonly occurs in the form of cutaneous, epidural, or subdural abscesses. Rarely, it can result in an intramedullary abscess as a result of a dermal sinus. This study presents a clinicoradiological profile of 19 cases harboring abscesses within the dermoids and highlights the importance of dermal sinus acting as a pathway for infections to enter the nervous system. Emergent exploration, pus drainage, and minimal abscess wall excision along with prolonged antibiotic administration remained the management of choice in all cases. Methicillin-sensitive Staphylococcus aureus was the commonest offending organism. In all, 7 patients recovered to normal neurological status, 5 showed no improvement, and 7 improved partially. Improvement in motor power was noted, albeit partially, but bladder functions failed to recover even at long-term follow-up. Even when such infective complications of dermal sinuses are rare, these are potentially serious and disabling.

Giant cell tumour of the clivus

Primary giant cell tumours of the craniospinal axes are rare lesions. These are benign, localized and lytic bony lesions with occasional malignant behaviour. Their clinical behaviour is unpredictable and, hence, management remains controversial. Radical excision of bony lesion, with adjuvant therapy helps in achieving the desired outcome. In the present communication, we present malignant giant cell tumour of clivus, managed successfully with surgical decompression and adjuvant therapy. Patient remains symptom-free at 2 years of follow-up.

Zosteriform Pilar Leiomyoma

Pilar leiomyomas are usually multiple and are commonly found on the extensor aspects of the arm, trunk, and face. They are rarely distributed in a linear fashion or seem to follow a dermatome. We report a case of painful, unilateral, zosteriform cutaneous leiomyoma in a 25‐year‐old housewife. Histopathology revealed interlacing smooth muscle bundles arising from arrector pili muscles. Nifedipine (10 mg) twice daily was remarkably effective in diminishing the pain in our patient.

Multiple, Large, Polypoid Infundibular (Epidermoid) Cysts in a Cyclosporin-Treated Renal Transplant Recipient

Epidermoid cysts are keratin-containing cysts lined by epidermis. They present as single or multiple, spherical, slightly compressible, intradermal or subcutaneous masses, few millimeters to few centimeters in size. Rarely, a single cyst may acquire a very large size [1]. We report a case of multiple, large, polypoid epidermoid cysts in a renal transplant recipient receiving immunosuppressive drugs. A 23-year-old male patient presented with large, cystic masses on the buttocks of 3 years’ duration. He was receiving cyclosporin, azathioprine and prednisolone for his kidney transplantation, which had been done about 3 years previously. However, at the time of presentation, his transplanted kidney was in a state of rejection. The cysts started developing about 3 months after transplantation. Since then, new cysts were emerging and old ones were enlarging. Examination revealed multiple, polypoid, soft cystic lesions located over the medial aspect of the buttock and both greater trochanters of the femur in a bilateral symmetrical distribution. Many large cysts were pedunculated (fig. 1). The size of the cysts ranged from 1 to 8 cm. The overlying skin was covered with prominent blood vessels and was inflamed and ulcerated in some places. Many keratonic plugs were seen in the affected areas. The masses were well defined, soft, cystic, nontender lumps. On exploration under local anesthesia, multiple, soft, yellow or blue encapsulated cysts were revealed. The cysts were dissected bluntly from the surrounding tissue. The specimen sent for histopathology revealed cysts filled with horny material, lined by fully keratinized stratified squamous epithelium, suggestive of infundibular cysts. Epidermoid cysts are usually single or few in number except in patients with Gardner’s syndrome who may have numerous cysts [2]. Reports of multiple, giant epidermoid cysts are almost absent in the dermatological literature [1]. Arizpe and Candiani [1] reported a single giant epidermoid cyst which enlarged slowly over a period of 20 years. Our patient had multiple large cysts, which increased in size relatively rapidly in a period of 3 years. The exact etiology of epidermoid cysts is unknown, but many factors, such as trauma, occlusion of pilosebaceous follicles or human papillomavirus (HPV), have been cited as etiological factors [3]. It is unclear, whether HPV is truly an etiological factor or merely a chance association. A case of bowenoid papulosis developing in a penile inclusion cyst has been reported [4], suggesting a possible role of HPV in the causation of both diseases. Schoendorff et al. [5] reported a case of multiple epidermoid cysts receiving cyclosporin A. A study of cutaneous lesions of 67 cyclosporin-treated renal transplant recipients revealed epidermoid cysts in 28% of patients [6]. However, epiFig. 1. Multiple, large, pedunculated epidermoid cysts over the gluteal region. Note keratotic plugs and prominent vessels.