Minakshi Bhardwaj

Persistence of histoplasma in adrenals 7 years after antifungal therapy.

Adrenal histoplasmosis is an uncommon cause for adrenal insufficiency. The duration of treatment for adrenal histoplasmosis is not clear. Existing treatment regimens advocate antifungals given for periods ranging from 6 months to 2 years. We report here a rare case who showed persistence of histoplasma in adrenal biopsy 7 years after being initially treated with itraconazole for 9 months. This calls for a prolonged therapy with regular review of adrenal morphology and histology in these patients.

Prolonged adrenal insufficiency after unilateral adrenalectomy for Cushing's Syndrome

The contralateral healthy adrenal in patients undergoing unilateral adrenalectomy for Cushings is known to be suppressed temporarily and forms the basis of peri and postoperative steroids. We present four cases of Cushings who had prolonged adrenal insufficiency with continued requirement for steroids for periods ranging 1–4 years after unilateral adrenalectomy for Cushing’s. We further review literature regarding the recovery of the hypothalamo pituitary adrenal axis postsurgery in patients with Cushings syndrome.

Primary Malignant Melanoma of Pleura: A Case Report and Literature Review.

Malignant melanoma is one of the most aggressive and treatment resistant skin cancers. India enjoys a low incidence of melanoma, and age specific incidence rates for cutaneous malignant melanoma (CMM) are being less than 0.5 per 1,000,000. This could be due to under‐reporting of melanoma on account of a low index of suspicion by clinicians and pathologists alike. Most common site for origin of primary melanoma is skin, accounting for about 91.2% of all reported primary malignant melanoma cases. Other primary sites are relatively uncommon. Primary pleural melanoma is a very rare tumor and to the best of our knowledge, only seven cases have been reported so far worldwide. We hereby discuss a new case, only second from India. Our patient also had coexistent congenital hairy nevus, an unusual association also noted in two previously reported cases. Excluding primary cutaneous melanoma with pleural metastasis was a diagnostic challenge in this case but multiple cutaneous biopsies together with clinical and findings helped us arrive at this unusual diagnosis. Unfortunately, the patient succumbed to his illness. Diagn. Cytopathol. 2016;44:648–652.

Kimura’s disease presenting with inguinal lymphadenopathy in an 11-year old girl: A case report

Kimura’s disease (KD), mostly seen in young Asian boys, typically manifests with subcutaneous lesions and cervical lymphadenopathy. It has a good prognosis and has no risk of malignancy. Inguinal lymphadenopathy is rarely reported as a presenting feature of KD. Here we report such a case of KD in an 11-year old girl. The diagnosis of KD was confirmed in this case by characteristic histopathological findings of the excised lymph node.

Hormonal profile of melasma in Indian females

Background: Several factors have been implicated in the etiology of melasma which include ultraviolet radiation, genetics, pregnancy, skin type, and drugs. However, there is a paucity of literature regarding the role of endocrine factors. Aim: To study the clinical and hormonal correlation in female patients with melasma. Methods: A total of 30 untreated female patients with melasma were included in the study. The control group included an equal number of age-matched females. Assays of free testosterone, total testosterone, dehydroepiandrosterone sulfate, 17-hydroxyprogesterone, luteinizing hormone (LH), follicle stimulating hormone, prolactin, 17β-estradiol (E2), progesterone, free triiodothyronine, free tetraiodothyronine, thyroid stimulating hormone were done on the 5th or 6th day of the menstrual cycle in the midfollicular phase. Results: The difference between means of free testosterone, total testosterone, LH, estradiol, progesterone, and free thyroxine of melasma cases and controls was found to be statistically significant. No correlation was found between the severity of melasma and the mean hormone levels. Conclusion: It can be inferred that these hormonal alterations may represent a subclinical evidence of a suppressed hypothalamic-gonadal axis and preclude the role of hormones in the pathogenesis of melasma.

A rare tumor of salivary gland: Diagnostic Dilemma on fine needle aspiration cytology

Salivary gland cytopathology is a diagnostically challenging area with overlapping cytomorphological features between benign, malignant, and metastatic tumors. We report the case of 45-year-old male who presented with two swellings in right retroauricular and infraauricular region along with a palpable single right cervical lymph node. On ultrasonography of the neck, a possibility of malignant lesion was given. Contrast enhanced computed tomography of the head showed a large well-defined space occupying lesion in right temporooccipital region eroding the skull bone with both extra and intracranial extension. Fine needle aspiration was performed from both swellings and cervical lymph node. Based on cytological features and clinicoradiological examination, a possibility of metastasis from epithelial malignancy (adenocarcinoma) was suggested. The retroauricular region swelling was excised, and a diagnosis of salivary duct carcinoma was given on histopathology. In this article, we discuss the diverse presentation, cytomorphological features, and differential diagnosis of this rare salivary gland tumor.

Chronic hypersensitivity pneumonia due to pigeon breeders’ disease

BackgroundPigeon breeders’ disease usually affects adults. Children are more likely to be affected when they share living space with a backyard poultry or pigeon breeding.Case characteristicsA 12-year-old girl with persistent cough for 3 years and dyspnea for 2 years.ObervationShe was dignosed to be having allergy to pigeon droppings, based on reports of lung biopsy and allergy testing.MessagePigeon breaders’ disease should be considered in a child who presents with features of chronic hypersensiticity pneumonitis.

Cutaneous meningioma: A cytomorphological diagnosis

Cutaneous meningiomas are rare tumors. These are ectopic meningothelial cells located in the dermis and subcutis, and are usually seen on the scalp. Here, we report the case of a 40-year-old woman who presented with a slowly growing asymptomatic mass over the scalp in the right parieto-occipital region. The lesion was firm, adherent to underlying structures, and covered by normal appearing skin. The cytomorphological features along with histological and immunohistochemical studies showing positivity for epithelial membrane antigen, Vimentin, and S100 helped in making a definitive diagnosis of cutaneous meningioma. No evidence of intracranial meningioma was noted in contrast-enhanced computed tomography of the brain.

Primitive neuroectodermal tumor presenting with superior vena cava syndrome

Peripheral primitive neuroectodermal tumor (PNET) of the chest wall is considered akin to Ewings sarcoma in terms of histology, immunohistology and cytogenetics. These tumors usually occur in children and young adults. These tumors usually present with cough, fever, chest pain and hemoptysis. Initial presentation as superior vena cava syndrome (SVCS) is rarely seen. Complete blockage of venous drainage in SVCS may lead to fatal outcome. These tumors are highly aggressive with a high incidence of local recurrence and distant metastases. Combination therapy comprising of chemotherapy, radiotherapy and surgery can be lifesaving in these patients. We present a case of primary mediastinal PNET in a 12-year-old girl. To the best of our knowledge, this is the first case of PNET presenting with SVCS in children.

A Rare Case of Type I RenalTubular Acidosis with Membranous Nephropathy Presenting as Hypokalemic Paralysis

Type 1 renal tubular acidosis (RTA), or distal RTA (dRTA), is a disorder of renal tubular acidification, which is generally asymptomatic but may rarely present as hypokalemic paralysis. Here, we report the case of a young male who presented with sudden onset weakness of all 4 limbs and a 2-month history of swelling of the legs. An investigation revealed hypokalemia, metabolic acidosis, and nephrotic syndrome. Additional analyses revealed normal anion gap metabolic acidosis with a positive urine anion gap and dRTA. Renal biopsy showed evidence of membranous nephropathy (MN). The patients weakness improved with potassium supplements. Normalization of the serum potassium level and disappearance of proteinuria were established with an ACE inhibitor and potassium supplementation. This case is an unusual combination of dRTA with MN coupled with the rare presenting symptoms of hypokalemic paralysis and medullary nephrocalcinosis.