Nishi Sharma

Epithelial Myoepithelial Carcinoma of Head and Neck Region

The objective of the study is to document the clinical, histopathological and immunological findings of epithelial myoepithelial carcinoma (EMEC) which is an uncommon neoplasm. The tumour represents less than 0.5–1% of all salivary gland neoplasms. As per literature, it involves the parotid gland most frequently and rarely, the minor salivary glands. We are reporting a series of four cases of EMEC over a period of one and half years, three from minor salivary glands at different sites and one from the deep lobe of parotid. Interestingly, the pre operative FNAC of all the cases revealed benign pathology. Recurrence occurred in three of them after tumour excision. One patient was subjected to post operative radiotherapy and one patient to chemotherapy. Histopathology and immunohistochemistry is very important in this tumour. There is no definitive guideline of treatment in post operative recurrence cases.

Rhinocerebral zygomycosis with pulmonary aspergillosis in a non-HIV-infected patient: an unusual case report from India

Zygomycosis and aspergillosis are two serious opportunistic fungal infections that are commonly seen in immunocompromised patients. Since both these fungi invade vessels of the arterial system, an early and rapid diagnosis by direct examination of KOH mounts of the relevant clinical sample can confirm the diagnosis. Here, we present an unusual case of a diabetic patient who presented with nasal blockade and bleeding for 2 months, along with occasional haemoptysis for 15 days. On investigation, the patient was diagnosed with a case of rhinocerebral zygomycosis and was treated with amphotericin B (1 mg kg(-1) day(-1)), which was subsequently replaced with liposomal amphotericin B (2 mg kg(-1) day(-1)). However, the patient did not completely respond to therapy as haemoptysis continued. Further investigations revealed the presence of Aspergillus flavus in respiratory specimens. Thus, a final diagnosis of rhinocerebral zygomycosis with pulmonary aspergillosis in a non-HIV-infected patient was made, but due to infection of two vital sites by these fungi, the patient could not be saved.

An atypical presentation of cavernous sinus thrombosis

In a typical presentation of cavernous sinus thrombosis there are palsies of IIIrd, IVth and VIth cranial nerves along with disturbance of ophthalmic division (V1) of trigeminal nerve. In this manuscript we report a case of unilateral cavernous sinus thrombosis for its atypical presentation. Atypical features in this case were presence of ipsilateral lower motor neuron type facial nerve palsy and involvement of maxillary (V2) and mandibular (V3) branches of trigeminal nerve along with other nerve palsies. The VIIth nerve palsy in cavernous sinus thrombosis has not been reported in the literature.

Subcutaneous granuloma of the cheek an unusual case report and review of literature.

With the increase in prevalence of extra pulmonary tuberculosis, it has become imperative for clinicians to review their knowledge of unusual presentations of mycobacterial infections. Tuberculous involvement of the subcutaneous tissue and skeletal muscle is rare. Apart from tuberculous lymphadenitis, diagnosis of extrapulmonary tuberculosis may be difficult. We present here a case of tuberculous granuloma of the cheek — an unusual presentation in ENT practice

Role of computed tomography, magnetic resonance imaging, and endoscopy in pretherapeutic evaluation of laryngeal tumors

Purpose: We aimed to evaluate the efficacy of staging of laryngeal tumors by clinical and radiological parameters and role of computed tomography (CT) and magnetic resonance imaging (MRI) in the detection of cartilage invasion. We have done a randomized, cross-sectional study. Materials and Methods: The study comprised 33 patients (29 males and 4 females) and included patients who were clinically diagnosed patients of laryngeal masses, were first evaluated under indirect laryngoscopy and then sent for CT and MRI. Postimaging biopsy was undertaken via direct laryngoscopy. Patients who had contraindications to magnetic resonance (MR) evaluation (pacemakers, claustrophobia, metallic implants) and intravenous administration to contrast material (renal impairment) and patients who were unable to restrain movement and pregnant women were excluded from the study. Results: The sensitivity and specificity in cartilage invasion were as follows: thyroid cartilage (91.7% vs. 71.4%); cricoid cartilage (85.7% vs. 75%); and arytenoid cartilage (91.7% vs. 71.4%). The accuracy rate of MRI in detection of cartilage invasion was thyroid cartilage 84.2%; arytenoid cartilage 84%; cricoid cartilage 78.9%. Diagnostic accuracy of CT staging versus histopathological staging showed sensitivity 60.0%, specificity 85.7%, positive predictive value (PPV) 60.0%, negative predictive value (NPV) 85.7%, accuracy 78.9% (P = 0.084). Diagnostic accuracy of MR staging versus histopathological staging showed sensitivity 80.0%, specificity 92.9%, PPV 80.0%, NPV 92.9%, accuracy 89.5% (P = 0.006). Conclusion: MRI is significantly more sensitive but less specific than CT in detecting neoplastic cartilage invasion. MRI offers higher staging accuracy as compared to CT (89.5% vs. 78.0%) with better soft-tissue resolution and multiplanar imaging.

Acute suppurative thyroiditis following fine-needle aspiration

Fine needle aspiration (FNA) biopsy is commonly used in the diagnosis of thyroid diseases. Serious complications are rare and this procedure is generally safe. Acute suppurative thyroiditis (AST) after FNA has been seldom reported. We report a case of a 57-year-old women without any comorbidities, who developed AST after FNA. The patient was successfully treated by sonographically-guided percutaneous drainage and intravenous antibiotics as per Gram stain and culture sensitivity report. Percutaneous ultrasonography-guided aspiration can be performed as an alternative to surgical drainage in patients developing AST.