Kailash Chand

Study of 7 Cases of Giant Cell Tumor of Soft Tissue

BACKGROUNDnPrimary giant cell tumour of soft tissues is a distinct but uncommon group of neoplasms morphologically identical to osseous giant cell tumor.nnnMETHODSn7 patients with painless growing soft tissue mass, having no attachment to underlying bone, were identified in a four years retrospective study from two zonal hospitals of armed forces. Histopathology of these lesions revealed admixture of multinucleated giant cell with mononuclear cells. All patients were treated by surgical resection and followed up for recurrence. Results : There were 5 male and 2 female patients in the age group of 18 to 56 years. All lesions were superficial, circumscribed and involved extremities except one. Histologic transition between benign and malignant lesion was present in only one of the 7 patients that recurred after three months of surgery for which she had to be operated again. 2 of our 7 cases were lost in follow up.nnnCONCLUSIONnPrimary giant cell tumour of soft tissues usually present as a painless mass and needs to be differentiated from other giant cell rich soft tissue tumors. Benign clinical course is expected if the lesion is excised adequately. Its biological behaviour to have low malignant potential is recognized; but this cannot be predicted and metastasis does occur rarely.

PREVALENCE OF DRUG RESISTANT TUBERCULOSIS IN ARMED FORCES-STUDY FROM A TERTIARY REFERRAL CHEST DISEASES HOSPITAL AT PUNE

This study was conducted to find out the prevalence and pattern of primary and acquired resistance to antimycobacterial drugs among patients of pulmonary tuberculosis, in Armed Forces. Out of 2562 clinically diagnosed patients of tuberculosis, in a span of three years, 1146 were bacteriologically positive. The study included only 1120 smear and culture positive cases, and excluded 26 cases in which no growth was obtained on culture. 192 out of 1120 cases (17.14%), showed overall resistance to one or more antituberculous drugs (ATD). Primary drug resistance (PDR) was observed in 161 (14.37%) and acquired drug resistance (ADR) in 31 isolates (2.77%). Of the resistant cases on short course chemotherapy (SCC), single drug resistance was observed in 99 (51.56%), resistance to any two drugs in 63 (32.81%), and three or more drugs in 30 (15.62%) cases. Analysis of resistance to specific drug revealed 26.56% for streptomycin (S), 15.10% for rifampicin (R), 7.29% for isoniazid (H), 2.08% for pyrazinamide (P) and 0.52% for ethambutol (E). Resistance to H and R was present in 4.16% strain and their combination with other drugs resistance was in 16.14% of the drug resistant strains, thus constituting 2.76% of the total sputum positive cases. A group of 26 cases is also discussed, where there was discrepancy in clinical status and bacteriological parameters and treatment for multi-drug resistant tuberculosis (MDR-TB) was instituted.

Spontaneous Expulsion of Subconjunctival Cysticercus Cellulosae.

Human tapeworm, also manifests in visceral and somatic forms. The encysted eggs of T. solium, after ingestion by man, invades wall of the small intestine and disseminate haematogenously to all the organs of the body to produce, cysticercosis [1]. Cysticerci can lodge in any part of ocular and extra ocular tissue, although ocular localization is not frequent. Its simultaneous association with involvement of brain parenchyma is very uncommon [2]. With CT scan, MRI and ultrasonography, the localization of suspected lesion is easier now. However the final diagnosis relies on histopathology and serology [3]. n nIn subconjunctival cysticercosis (SCC), larva develops small translucent cyst and once it dies, inflammatory reaction is evoked which may lead to blindness [4]. SCC is one of the frequent manifestations in eye but spontaneous expulsion is rare. Only six cases have been reported in the literature since 1970 [5]. n nWe report a case of SCC, which was expulsed from the conjunctiva during ophthalmic examination of the patient on the operation table.

Common Medicolegal Problems Faced by Medical Officers of Armed Forces

Dear Editor, n nThis is in reference to the contemporary issue on the subject published in MJAFI 2002;58:234–40. The authors have brought out nicely the solution to the common problems faced by the medical officers while performing medicolegal duties. n nI shall like to bring to the knowledge of authors that the latest order available on the subject on police clearance for the disposal of dead body has been issued by the office of DGMS vide AHQ letter No 11952/Pol DGMS-5(A) dt 13 Sep 90 and not 31303/Pol/DGMS-5(a) dt 06 Jul 87 as mentioned in your article. Secondly, Appx ‘A’ to this latest letter on police clearance does not have the pertinent contents emphasised by the authors i.e. on receiving the information of death of ————- the case has been investigated by the police and found that there is no reasonable suspicion of foul play involved in the death. n nWould the authors like to take up the matter with the higher HQ to obtain clarification on the subject and communicate to the readers?

VIRAL ASSOCIATED HAEMOPHAGOCYTIC SYNDROME - A POST MORTEM DIAGNOSIS

The clinical and autopsy findings in a young serving soldier, who was hospitalised as a case of pyrexia of unknown origin with hepatosplenomegaly, are presented. Unfortunately, the final diagnosis of viral associated haemophagocytic syndrome (VAHS) could only be established after autopsy. n nVAHS is a benign disorder characterized by systemic proliferation of haemophagocytic histiocyte and its precursors [1]. It is commonly associated with acute systemic viral infections like Epstein-Barr, Cytomegalovirus, Herpes simplex, Varicella zoster, Adeno and HIV viruses [2, 3, 4]. Initially, Risdall et al in 1979 [5], in their original report found the association of these cases with viral infections but in their later study of the cases, no such proven association could be established [3]. n nThis case of VAHS is reported because of its rarity and difficulties in establishing the diagnosis by unwary clinicians. Secondly, in addition to wide spread proliferation of haemophagocytic histiocytes in various organs, the lymph nodes showed extensive necrosis with marked lymphoid depletion, which is an uncommon finding [4].

MULTIDRUG – RESISTANT TUBERCULOSIS (MDRTB) IN CHILDREN

The World Health Organization has estimated that 90 million cases of tuberculosis will occur throughout the world in the 1990s and 30 million people will die from the disease [1]. Drug resistance is emerging as a major obstacle to tuberculosis control in the world and is exacerbated by the growing epidemic of Human Immunodeficiency Virus (HIV) [2]. Treatment of drug-resistant tuberculosis is complex, requiring the use of several toxic drugs over 9 to 18 months. Here we present a case of multidrug resistant tuberculosis in a child.

SCLEROSING HAEMANGIOMA OF LUNG PRESENTING AS SPONTANEOUS HAEMOTHORAX

Sclerosing haemangioma was first described by Leibow and Hubbell [I] in 1956. This is a rare differential diagnosis of pulmonary nodule, which is much commoner in young females. Initially it was thought to be of endothelial origin but some recent electron microscopic studies have demonstrated surfactant apoprotein, their origin being suspected from type II pneumocytes. We present here a young lady of 37 years who presented with sudden spontaneous haemothorax and left lower lobe atelectasis due to nodular mass in perihilar area in lower lobe with absorption atelectasis. Diagnosis was made by histopathological studies after removal of the mass on surgery. We have not come across any case report of this lesion presenting as sudden massive spontaneous haemothorax and major lobar atelectasis.

GASTROINTESTINAL STROMAL TUMOURS

The histogenesis of 10 spindle cell tumors of gastrointestinal tract (GIT) of last three years of our institution was studied, on the basis of immunohistochemical (IHC) staining. The tumours were categorized into benign, borderline malignant and malignant, mainly based on the histologic parameters (HP) such as predominant cell type, cellularity, type of growth pattern, mitotic figures etc. The study included 7 males and 3 females in the age group from 21 to 56 years. 4 tumors were located in stomach and 6 in the small intestine. The initial symptoms included pain abdomen, palpable mass and general weakness. There were 7 benign, 1 borderline and 2 malignant leiomyomatous tumors according to the histologic parameters we followed. Vimentin, desmin, S-100, and non-specific enolase (NSE) were the immunological markers used to identify the cellular lineage. Smooth muscle differentiation was demonstrated by nine (6 benign and 3 malignant) tumours. One male patient (Case 1), originally reported as leiomyoma based on HP, was positive for S-100 and NSE. Another case, a female, categorised as leiomyosarcoma, showed dual differentiation toward myogenic and neural elements on IHC staining (Case 2). IHC study played important role in the identification of cellular differentiation of these tumors as the same was not possible on light microscopic findings alone.

MALIGNANT TERATOID TUMOUR (TERATOCARCINOSARCOMA) OF NASAL CAVITY: Case Report

Polypoid masses are commonly encountered clinical entity in the nasal cavity. Among the neoplastic lesions, malignant teratoid tumour variously termed as blastoma. teratoid carcinosarcoma, malignant teratoma, teratocarcinoma and recently called teratocarcinosarcoma (TCS) etc are probably a homogeneous group of neoplasms with more or less similar histological features [1]. These tumours are exceptionally rare and only 26 published cases could be found by 1991 in the world literature [2].

PROPTOSIS-AN UNUSUAL PRESENTATION OF METASTATIC CARCINOMA PANCREAS: Case Report

Metastatic carcinoma to the eye and ocular adnexa from pancreas are extremely rare as a first indication of such a disease. Majority of these cases arise subsequent to the discovery of the primary tumour. Metastatic orbital tumour are further less frequently encountered than intraocular metastases [1]. We present a case of a unilateral proptosis in an apparently healthy middle aged male without any symptom suggestive of pancreatic malignancy. n nCase Report nA 52-year-old-male presented with one month history of gradually increasing proptosis and impaired vision of the left eye. On examination a small smooth surfaced firm mass was palpated over the medial canthus displacing the left eye ball downward and outward. It was slightly tender and vision was 6/18. Fundoscopy revealed papilloedema. Routine biochemical and haematological investigations were within normal limits except marginally high total leucocyte count of 12,800 per cmm with 74% neutrophils in differential count. A clinical diagnosis of inflammatory orbitopathy was made and the patient was treated with a course of antibiotic and steroid to which he partially responded. He reported after two months with further deterioration of his vision and progressively protruding left eye ball. Computerised tomography scan of left orbit revealed a retrobulbar mass almost of the size of an eye ball [Fig 1]. The possibility of secondaries from a malignancy elsewhere was entertained. FNAC of the mass revealed poorly differentiated adenocarcinoma. n n n n nOpen in a separate window n n nFig. 1 n n nCECT scan of orbit showing a homogeneously enhancing extraocular intraorbital mass with an irregular margin and associated proptosis.