Lubna Khan

Cluster endophthalmitis following multiple intravitreal bevacizumab injections from a single use vial.

The risk of endophthalmitis is always a concern when an intraocular procedure is performed. Intravitreal injection is a frequently used method for therapeutic management of many diseases, affecting the posterior segment of the eye. Hence, it is important to assess the risk of complications, especially endophthalmitis. Most studies conducted concentrate on risk assessment from single use from single drug vial. The present article reports the occurrence of cluster endophthalmitis following multiple intravitreal bevacizumab injections from a single vial. Intravitreal injection of bevacizumab was administered to eight eyes of eight patients. Administered dose was prepared from single 4-ml vial of bevacizumab and was injected in the eye, after patient preparation and under aseptic conditions. The procedure was repeated for the remaining patients, thereby imparting multiple pricks in the same vial. Four of the eight patients reported to the hospital on the 3rd day after injection with complaints of pain, watering, and diminution of vision. Two patients reported the following day with similar complaints. Two patients who did not report by the 4th day were contacted and recalled for an examination. All the patients were thoroughly examined using slit lamp biomicroscopy and indirect ophthalmoscopy. Six out of eight were clinically diagnosed to have endophthalmitis and were administered intravitreal antibiotics. The present report highlights possibility of microbial contamination of the drug vial or during compounding process. However, from the present incident, we are encouraged to stay vigilant and wary of contamination

Microfilaria in cytological smears at rare sites coexisting with unusual pathology: A series of seven cases.

Filariasis is a major public health problem in India and microfilaria is sometimes seen during routine fine needle aspiration cytology (FNAC) smears, but it is very rare to find microfilaria coexistent with neoplastic lesions. Here we report a series of seven cases in which microfilaria is associated with neoplastic lesions. Out of these seven cases one is benign and six are malignant. Also we first time report the microfilaria coexistent with parotid pleomorphic adenoma, undifferentiated carcinoma thyroid and gall bladder carcinoma.

Cytological diagnosis of pediatric thyroid nodule in perspective of the Bethesda System for Reporting Thyroid Cytopathology

Background: Thyroid nodule is one of the most common endocrinopathies occurring children and adolescents. Though thyroid nodule is rare in the pediatric age group, the rate of malignancy is much higher in this age group compared to adult population. Aim: The objective is to study the application of The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) in pediatric patients and compare the findings with histology. Materials and Methods: A total of 218 cases younger than 18 years were studied in a 4-year period from August 2010 to July 2014. The smears were categorized according to TBSRTC into six categories — Nondiagnostic, benign, atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS), suspicious for follicular neoplasm (SFN), suspicious for malignancy (SM), and malignancy. Results: Out of 218 cases, 33 were males and 185 were females. Histological follow-up was available in 44 cases. The diagnosis according to TBSRTC included 12 (5.5%) nondiagnostic, 151 (69.26%) benign, 23 (10.5%) AUS/FLUS, 18 (8.2%) SFN, 5 (2.3%) SM, and 9 (4.1%) malignancy cases. On histological follow-up, the rate of malignancy in each category was 0%, 0%, 8.3%, 10% 100%, and 100%, respectively. Conclusion: The study demonstrates that TBSRTC in pediatric thyroid nodule is as sensitive and specific as in adults, especially with 100% accuracy in the diagnosis of benign and malignant categories.

Cutaneous metastasis from visceral malignancy: A rare presentation

Cutaneous metastasis is an uncommon manifestation of visceral malignancy and a grave prognostic indicator. In extremely rare cases it may be the presenting sign of underlying malignancy. Here we report two cases of carcinoma gall bladder that presented with skin nodule. Fine needle aspiration cytology of these nodules revealed metastatic deposits of adenocarcinoma and was instrumental in establishing the primaries.

Prevalence of HBV and HCV in blood donors in Kanpur during the period 1997 through 2005

Viral hepatitis transmitted by parenteral route is emerging as a far more dreaded public health challenge than any other illness. We have collected the data of HBV and HCV seropositivity in replacement and voluntary donors in our Blood Bank during the period January 1997 to December 2005. The results were as follows: Total number of cases studied in 1997 to 2005 — 115073 HbsAg positive cases — 1976 (1.7172%) Anti HCV positive cases — 463 (0.4024%) The overall picture is showing a more or less stable prevalence rate of hepatitis cases among blood donors, who were apparently healthy.

Cytomorphological features of lymphoepithelial carcinoma of submandibular gland in an adolescent male

A case of lymphoepithelial carcinoma (LEC) occurring in right submandibular gland of a 13-year-old Indian male is presented, wherein the lesion unveiled itself only after multiple fine needle aspiration (FNA) procedures. This unusual neoplasm has high frequency of occurrence in Eskimos and a predilection for the parotid gland. The aspirates obtained were highly cellular comprising tight clusters of atypical epithelial cells with admixture of lymphocytes. Histopathological examination of the resected submandibular gland and lymph node chain was consistent with the diagnosis of LEC. Immunohistochemistry (IHC) revealed cytokeratin (CK)-positive and S-100-negative tumor cells lying admixed with CD45-positive lymphoid cells. A detailed otorhinolaryngological examination with inclusion of multiple biopsies was found negative for any primary tumor. Although histopathological features of this entity are well established, only a handful of case reports describing cytological features of this entity are present in medical literature. We conclude that the cytomorphological features of LEC are sufficiently distinctive to at least, suggest a possibility of this lesion.

Central serous chorioretinopathy secondary to tuberculosis: cause or coincidence

32-year-old male with diagnosis of central serous chorioretinopathy (CSCR) in both eyes and negative history of administration of any medicine was treated with bilateral focal laser at leakage point, with visual recovery. Recurrence occurred after 2 years in right eye and was treated successfully with acetazolamide. Second recurrence occurred after 1 year. Acetazolamide was restarted, but no improvement was noted. Thorough re-evaluation of the patient revealed a family history of tuberculosis. Ancillary investigations rendered the presumptive diagnosis of tuberculosis, and antituberculosis treatment led to visual recovery with no recurrences. Present case poses two dilemmas: whether CSCR was secondary to tuberculosis or was it an incidental association in tuberculosis endemic population and second whether resolution occurred due to the treatment of tuberculosis or due to mineralo-corticoid antagonism action of rifampicin. Significance of patient’s history, clinical observation and angiographic studies in the diagnosis of idiopathic and recurrent CSCR is reiterated.

Study on Visual Outcome, Visual Recovery Time, Recurrence, Complications in Patients of Central Serous Retinopathy Treated with and without Early Double Frequency Nd-YAG Laser Photocoagulation

Background: Evaluate final visual outcome, visual recovery time, leakage resolution time on Fundus Angiography (FA), recurrence rate and complications in patients of Central Serous Chorioretinopathy (CSCR) treated with early double frequency Nd-YAG laser photocoagulation as compared to observation alone.Methods: Prospective, interventional, non-randomized, clinical, comparative trial. Two groups with 15 eyes of CSCR in each group were compared. First group treated with early double frequency Nd-YAG laser and other kept on observation. Best Corrected Visual acuity (BCVA) was recorded at baseline, 2 weeks, 1 month, 2 months and 3 months. FA was done at baseline, 2 weeks and 3 months. Contrast sensitivity was recorded at baseline and at the end of 3 months. Residual metamorphopsia checked at the end of 3 months using Amsler Grid.Results: BCVA significantly improved in the laser group at the end of 2 weeks (p<0.001). Although at the end of 3 months all 30 eyes had BCVA of 20/30 or better. At baseline all 30 eyes showed leakage on FA. At 2 weeks none of the eye in laser group showed leakage, while all 15 eyes in the observation group showed some amount of leakage. No leakage found in all 30 eyes at 3 months. Contrast sensitivity and residual metamorphopsia was similar in both groups at 3 months. There were no recurrences in the laser group during follow-up of 1 year, while in the observation group 2 eyes had recurrence. None of the eye in the laser group showed any complication related to laser on follow-up.Conclusions: Early double frequency Nd-YAG laser photocoagulation shortens the time for visual recovery and resolution of leakage on FA in patients of CSCR; is not associated with recurrences or complications but has no effect on the final outcome of quality of vision as compared to observation alone.

Squamous Cell Carcinoma of Cornea: Diagnosed on Cytology

Squamous cell carcinoma (SCC) of eye has a predilection for corneo-scleral limbus which is a transition zone with greatest mitotic activity. Almost all dysplastic lesions of cornea and conjunctiva involve corneo-scleral limbus. Isolated cases of SCC of cornea are rare. SCC may masquerade as benign lesions like squamous papilloma and pterygium. These lesions though removed are usually not submitted for histopathological examination leading to complications like recurrence and metastasis. Here, we report a case of 35 year old male who presented with whitish mass on cornea which was diagnosed as SCC on cytology and later on was confirmed on histopathology. This case is reported for its rarity and for emphasizing that rapid, simple and minimally invasive technique like scrape cytology can be effective in pre or intra operative diagnosis of ocular surface squamous neoplasia thus helping in intra operative decisions regarding resection margins and post operative management.

Carcinoma Gall Bladder Presenting as Bilateral Inguinal Lymphnode Metastasis

The inguinal lymph nodes are common site of metastasis from various organs. However, little is known about gallbladder carcinoma presenting as inguinal lymph node metastasis. W e report a case of a primary gallbladder carcinoma with inguinal lymph node metastasis in a 65-year-old male. Clinically , our patient presented with enlarged inguinal lymph nodes without obvious signs and symptoms related to gallbladder carcinoma. Ultrasound abdomen suggested the possibility of a primary gall bladder carcinoma. Exact diagnoses could only be made after fine needle aspiration from gallbladder mass. A high index of suspicion, thorough clinical examination, cytopathological examination are essential to avoid misdiagnosis in such cases. Gallbladder carcinoma, Metastasis, Inguinal lymph node