Panduranga M Kamath

Maltoma of Thyroid: A Rare Thyroid Tumour

Introduction. Primary thyroid lymphomas constitute up to 5% of all thyroid malignancies and can be divided into non-Hodgkins lymphomas (NHLs) of B- and T-cell types, as well as Hodgkins lymphomas. Mucosa-associated lymphoid tissue (MALT) lymphomas are a relatively recently recognized subset of B-cell NHLs, and they are listed as extranodal marginal zone lymphomas according to the revised European-American lymphoma classification. Case Report. We report an uncommon case of a 44-year-old man, who noted a painless, growing mass on right side of his neck of the three-month duration. Thyroid profile was within normal limits. FNAC showed lymphocytic thyroiditis. The patient underwent a right hemithyroidectomy. The histologic examination and the immunohistochemistry showed an extra nodal marginal B-cell type maltoma (malt lymphoma). CHOP chemotherapy with rituximab was given. The clinical course has been favourable in the first year of followup, with no evidence of local or systemic recurrence of the disease. Discussion. Marginal zone lymphoma encompasses a heterogeneous group of B-cell tumours that variously arise within the lymph nodes, spleen, or extranodal tissues. A case of maltoma of thyroid is presented for its rarity and diagnostic dilemmas. Conclusion. Maltomas are slow-growing lymphomas. The optimal treatment and followup of patients with thyroid maltomas remain controversial at present.

Supravital staining: It's role in detecting early malignancies

The efficacy of supravital staining in the detection of malignancies in oro and oropharyngeal lesions and its role in the detection of malignant changes in premalignant lesions were studied. This prospective study comprises 90 cases of clinically suspicious lesions and it was done over a period of 3 years. Most of the patients had multiple risk factors for the development of malignancy. All underwent staining with a modified solution of 1% toluidine blue (TB). In our study the overall sensitivity was 97.29% and the specificity was 62.5%.

Tuberculosis in the Head and Neck in India: Down but not yet Dead

Background: The aim of this study was to evaluate the various manifestations of tuberculosis in the head and neck region, incidence of the different forms and the diagnostic modalities and the treatment modalities employed. We also studied its coexistence with pulmonary tuberculosis and human immunodeficiency virus infection. Methods: Our study was a prospective study done conducted in the otolaryngology and head and neck surgery departments, Kasturba medical college and allied hospitals in Mangalore, India. The study group comprised 70 patients diagnosed with tuberculous manifestations of the head and neck region over the period of 2 years from 2011-2013. Chest radiography and sputum AFB was also done in all the patients to rule out coexisting pulmonary tuberculosis. All patients were screened for HIV. Results: Our study included 70 patients with tuberculosis of the head and neck region. The most common presentation of tuberculosis in the head and neck region was tuberculous lymphadenitis in 77% followed by deep neck space abscess 10% then laryngeal tuberculosis in 8.50%, submandibular gland tuberculosis in 3% and 1.5% diagnosed with pharyngeal tuberculosis. 12.8% of our patients had coexisting HIV infection and 33% patients had associated pulmonary tuberculosis. Conclusions: Tuberculosis of the head and neck region though not very frequent, still remains an important clinical entity which should be kept in mind especially in developing countries. Involvement of the cervical lymph nodes remains one of the commonest manifestations.

Rhinosporidiosis: A Chronic Tropical Disease in Lateral Pharyngeal Wall

Rhinosporidiosis is a chronic granulomatous disease caused by Rhinosporidium seeberi. It predominantly affects the mucous membranes of the nose and the nasopharynx. Clinically the lesion presents as a pink or red pedunculated polyp in one or both nostrils. Diagnosis can be made by aspiration cytology and examination with May-Grunwald-Giemsa, hematoxylin and eosin, Periodic acid-Schiff and mucicarmine staining. Definitive diagnosis is by histopathology of the specimen. We report a case of Rhinosporidiosis at the lateral pharyngeal wall which is a very rare site for Rhinosporidiosis to occur; was treated by diathermy excision of the mass and cauterization of the base and oral Dapsone to prevent recurrence of the disease.

Mobile phones: Its effect on hearing

Background: Widespread concerns have been raised about the possibility that exposure to the radio frequency fields from mobile telephones or their base stations could affect peoples health. Materials and Methods: Effect on hearing in 120 mobile phone users and nonusers between age group of 18-30 years were studied over 3 years. Group 1 using mobile phone more than 1 hour per day for more than a year and group 2 no usage or less than 1 hour per day for less than a year. Results: Those using phones for 2-3 hours daily, loss of 5 dB in 10%, 10 dB in 3.3%, and 15 dB in 1.6% were noted. Also loss of 5 dB in 6.6% and 10 dB in 3.3% were noted in those using 3-4 hours daily. Sensorinueral hearing loss was seen in 26.6% of the subjects in study group and 3.3% in control group. Conclusion: Our study did not show any significant hearing loss in mobile phone users.

Tuberculosis of Waldeyer's Ring with an Atypical Presentation as Chronic Adeno-Tonsilitis.

Primary tuberculosis of the oropharynx and nasopharynx is a rare clinical entity.It usually arises secondary to pulmonary tuberculosis. We report a rare case of a 20-year-female, who presented with fever and throat pain. Examination revealed hypertrophied adenoids and tonsils, which was ultimately proved as tuberculosis.Enlargement of the palatine tonsils could be due to a multitude of causes, and a thorough evaluation is necessary to arrive at the right diagnosis.Increased awareness of nasopharyngeal and oropharyngeal tuberculosis is important in tropical countries, as the disease may be overlooked resulting in inappropriate management.

Adenoid Cystic Carcinoma- A rare Differential Diagnosis for a mass in the External Auditory Canal.

Primary external auditory canal malignancies are very rare; in which, adenoid cystic carcinoma is extremely rare tumour accounting for approximately 5%. Majority of the patients presents with unilateral severe or dull aching constant ear pain of prolonged duration, reduced hearing and mass in the External Ear. These tumours are treated with aggressive surgical excision and adjuvant radiotherapy. Despite this, the overall prognosis is poor due to recurrences and distant metastasis. We report a rare case of adenoid cystic carcinoma in a 36-year-old female, who presented with right ear pain for the last one year. She was treated with wide local excision of the mass followed by adjuvant radiotherapy.

Chrysosporium: an uncommon fungus in chronic rhinosinusitis.

Chronic rhinosinusitis is one of the commonest health problem encountered in rhinology. Of these allergic fungal rhinosinusitis forms a significant group of patients. Patients commonly present with typical symptoms of sinusitis and the diagnosis is often made after imaging and/or intraoperatively. We report a rare case of allergic fungal sinusitis (AFS) caused by Chrysosporium species in a 70-year-old male with no co-morbidities. The fungus was isolated from allergic mucin collected from the sinuses. Therapy with intravenous Voriconazole was given leading to good relief for the patient, and no recurrences have occurred till date. Infections caused by Chrysosporium species are very rare, and is very rarely been reported to cause sinusitis in humans.

Inverted papilloma of atypical origin with unusual extension into the oropharynx.

Inverted papilloma is a benign tumor with malignant potential that commonly arises from the lateral wall of the nose. We present a case of inverted papilloma, in a premalignant stage, of unusual origin and with oropharyngeal extension. The patient presented with complaints of a nasal mass arising from the left nasal cavity and progressively increasing in size since 2 years. On examination a fleshy, firm, sensitive mass was noted, which was attached to the medial wall, and extending posteriorly and inferiorly into the oropharynx. Diagnostic nasal endoscopy and complete excision of the mass was performed with a stable postoperative period. Histopathology of the mass revealed an inverted nasal papilloma of the septum with carcinoma in situ.

Effect of mastoid drilling on the distortion product otoacoustic emissions in the non operated ear.

OBJECTIVE To monitor the effect of mastoid drilling on the non-operated ear distortion product otoacoustic emissions. MATERIALS AND METHODS Distortion product otoacoustic emissions (DPOAEs) were measured at frequencies of f 2=2, 3, 4 and 5 kHz, and a frequency ratio f 1 /f 2=1.22. DPOAEs were measured in 49 cases, pre and post-operatively who underwent mastoid drilling procedures, compared with each other and with 49 controls who underwent myringoplasty and myringotomy procedures. RESULTS Amplitudes of DPOAEs decreased significantly in those who underwent mastoidectomies over all the measured frequencies in the immediate post-operative period but had recovered by the seventh post operative day. CONCLUSION Drill induced noise can cause temporary decrease in the DPOAEs postoperatively and hence temporary hearing loss for a period of one week.