Dev Raj Sharma

Thyroid scintigraphy in detecting dual ectopic thyroid: A review

Dear Sir, The thyroid gland is the first endocrine gland to develop during embryogenesis on approximately 24th day of gestation. The developing thyroid is anatomically related to the developing heart, and it is pulled caudally to its definitive location in the anterior neck with the descent of heart. The thyroid completes its descent on reaching anterior to the trachea in the lower neck in the seventh gestational week. The development defects or aberrant migration of the thyroid descent will lead to ectopy of the thyroid. The Foxe 1 mutation is also shown to be associated with molecular pathology of ectopic thyroid in mouse models; however, till date, no known gene for human ectopic thyroid has been demonstrated [1]. An ectopic thyroid gland may occur anywhere along the path of initial descent of the thyroid. The most commonly found ectopic thyroid tissue is at the base of the tongue, i.e. lingual thyroid, which accounts for 90% of the reported cases. Other rare sites for ectopic thyroid are the sublingual, cervical, mediastinal, intracardiac and abdomen [2]. Most of the times, ectopic thyroid might be the only functioning thyroid tissue. Ectopic thyroid is a rare anomaly. It is further uncommon for two distinct ectopic thyroid tissues to be present simultaneously. The web search of Pubmed in English literature revealed only 26 cases of dual ectopic thyroid so far. In this letter, we describe a patient of dual ectopic thyroid where the Tc-pertechnetate thyroid scan clinched the diagnosis and led to correct management. The literature available on dual ectopic thyroid tissue is also being discussed. A 7-year-old girl presented with history of progressive midline swelling of the neck for 1 year. There was no history of pain, fever, pressure or obstructive symptoms and change in voice. Patient did not have any feature of hypo-thyroidism or hyper-thyroidism. Local examination revealed a midline neck swelling of 1.5×1 cm in size, soft in consistency, non-translucent in nature, which moved on tongue protrusion and swallowing. The oral examination showed another small irregular swelling of about 1 cm size near the base of the tongue, which was soft to firm on touch and non-tender (Fig. 1). Her thyroid function tests were suggestive of sub-clinical hypo-thyroidism with value of T3—75 ng/dL (normal=75–210), T4—4.30 μg/dL (normal=4–11) and thyroid-stimulating hormone (TSH)— 17.88 μIU/mL (normal=0.55–5.0). Based on clinical and biochemical examination, a diagnosis of ectopic thyroid was made, and the patient was referred for thyroid scan for confirmation. The thyroid Tc-pertechnetate scan demonstrated two distinct focal areas of radiotracer uptake in the sublingual and subhyoid region and no uptake in region of the thyroid bed (arrows; Fig. 2). A final diagnosis of dual ectopic thyroid was made based on thyroid scan findings. Eur J Nucl Med Mol Imaging (2008) 35:843–846 DOI 10.1007/s00259-007-0672-2

Auditory brainstem evoked responses in hyperlipidaemia: effect of various lipid fractions on auditory function.

OBJECTIVE To evaluate the effect of different lipid fractions on auditory brainstem evoked responses in hyperlipidaemia. METHOD We conducted a single institution (medical college), prospective, cross-sectional study of 25 hyperlipidaemic patients and 25 normolipidaemic controls, all with a normal hearing threshold on pure tone audiometry. Brainstem evoked response audiometry results were recorded in both groups. The hyperlipidaemic group were further divided into two subgroups, based on the serum value of each lipid fraction: those with less than and those with greater than the mean serum value. These two subgroups were further compared with the control group. RESULTS The hyperlipidaemic and normolipidaemic groups had statistically significant differences for all audiometry waves apart from the wave I and the III-V interpeak latencies. The subgroups had a statistically significant difference in brainstem evoked responses. We found a statistically significant association between low-density lipoproteins and many waveforms in the hyperlipidaemic group. CONCLUSION We found that low-density lipoproteins were significantly associated with many waveforms in hyperlipidaemic patients. Thus, low-density lipoproteins may be important in auditory dysfunction.

Pleomorphic adenoma of minor salivary gland with therapeutic misadventure: a rare case report

BackgroundThe benign tumors of nasopharynx are least encountered tumors in otolaryngology, as nasopharynx is considered one of notorious anatomical site for the malignant tumors. Pleomorphic adenoma of the minor salivary gland of nasopharynx and parapharyngeal space is rare. We present a pleomorphic adenoma of minor salivary gland which was mismanaged.Case presentationAn adult male presented with left nostril obstruction for five months. The examination found big mass extending from nasopharynx to oropharynx. On CT scan, this tumor was quite big and extending to the parapharyngeal space. The FNAB found it a carcinoma but it did not respond to radiotherapy. The excision biopsy of tumor revealed it as pleomorphic adenoma. We found only five published reports on this tumor arising from nasopharynx.Discussion and conclusionAlthough, in this case report exact origin of the tumor could not be ascertained as it also appeared to be a parapharyngeal tumor but we kept the possibility of a nasopharyngeal tumor on the basis of clinical features. The pleomorphic adenoma of nasopharynx is rare. It can be misdiagnosed as malignant epithelial tumor on histopathology. The differentiation from its malignant variant is also difficult. A possibility of benign tumor should always be kept in nasopharyngeal growth with no evidence of metastasis, and histopathological diagnosis of growth should be available before any definitive treatment.

Giant tonsillolith causing odynophagia in a child: a rare case report

Giant tonsillolith is a rare clinical entity. Commonly, it occurs between 20–77 years of age. We had a twelve years old female patient, who had odynophagia due to a giant tonsillolith. The stone was removed and tonsillectomy was performed. We reviewed the literature on this rare clinical entity and found that this is the fourth case of giant tonsillolith in a child and largest ever tonsillolith to be reported in English literature.

Hearing loss with phosphodiesterase-5 inhibitors: a prospective and objective analysis with tadalafil.

To assess the effect of tadalafil on auditory functions.

Primary schwannoma of maxillary sinus masquerading as malignant tumour

Polyp and mucocele are the commonest sinonasal tumours and schwannoma is rarely found in the paranasal sinuses. We report a case of a 64-year-old man presenting with progressive nasal obstruction and numbness on left cheek for the past 2 months. High-resolution CT found a soft tissue mass in the maxillary antrum with bony destruction. Clinical features, radiological scan and nasal endoscopic examination were suggestive of a malignant tumour. Tumour was excised through Caldwell-Lucs approach and histopathological examination found a mixed schwannoma.

Evoked response audiometry in scrub typhus: prospective, randomised, case-control study.

OBJECTIVE To investigate the hypothesis of cochlear and retrocochlear damage in scrub typhus, using evoked response audiometry. STUDY DESIGN Prospective, randomised, case-control study. METHODS The study included 25 patients with scrub typhus and 25 controls with other febrile illnesses not known to cause hearing loss. Controls were age- and sex-matched. All subjects underwent pure tone audiometry and evoked response audiometry before commencing treatment. RESULTS Six patients presented with hearing loss, although a total of 23 patients had evidence of symmetrical high frequency loss on pure tone audiometry. Evoked response audiometry found significant prolongation of absolute latencies of wave I, III, V, and wave I-III interpeak latency. Two cases with normal hearing had increased interpeak latencies. These findings constitute level 3b evidence. CONCLUSION Findings were suggestive of retrocochlear pathology in two cases with normal hearing. In other patients, high frequency hearing loss may have led to altered evoked response results. Although scrub typhus appears to cause middle ear cochlear and retrocochlear damage, the presence of such damage could not be fully confirmed by evoked response audiometry.

Audiovestibular changes in diabetes mellitus

Audiovestibular functions in 50 cases of diabetes mellitus have been evaluated to find out the type of hearing loss. Diabetes mellitus causes a significant bilateral symmetrical hearing loss at higher frequencies and with the progress of disease and added complications the hearing further deteriorates. On control of diabetes hearing changes are found to be irreversible. However vestibular functions remain uninvolved in cases of diabetes mellitus. A direct correlation was found between hearing loss and increasing blood sugar level.

Fibrolipoma of the eustachian ostium.

Nasopharyngeal fibrolipoma is extremely rare, with only four case reports in the literature. However, lipoma of the eustachian tube is the rarest with a single case report in the literature. A 50-year-old woman presented with obstruction of both nostrils for the past 1 year. CT scan showed a mass in the postnasal space extending from the right side of the nasopharynx to the oropharynx. The nasal endoscopy found a polypoidal mass arising from the posterior–inferior margin of the right eustachian tube ostium and extending to the oropharynx. Histopathological examination of the excised polyp found features suggestive of fibrolipoma. Fibrolipoma is characterised by prominent bundles of mature collagenous or myxocollagenous stroma intermixed with mature adipocytes. CT is useful in the diagnosis of lipoma but MRI is preferable. This is the second case of eustachian tube fibrolipoma to be reported in the literature that emphasises the role of nasal endoscopy and rarity of this tumour.

Primary non-Hodgkin's lymphoma of the infratemporal fossa: a rare case report

BackgroundThe head and neck are two of the most common sites of extranodal non-Hodgkins lymphoma (NHL). However, primary tumors of the infratemporal fossa are infrequent, and NHL in this region is extremely rare.Case presentationWe present a case of a 41-year-old female that presented with swelling in the right preauricular region that had persisted for the past two years. The patient was diagnosed as having a small lymphocytic NHL. She initially underwent chemo-radiation but reported relapse. The tumor was excised and again the patient underwent chemotherapy. The patient remained symptomatic and developed a second primary squamous cell carcinoma in the right retromolar trigone.Discussion and conclusionWe discussed NHL with an emphasis on extranodal manifestations. Extranodal NHL that is limited to a single site can be managed by surgery and regular follow up. To the best of our knowledge, this is only the second case of primary NHL of the infratemporal fossa to be reported in the literature.