Pranay Gaikwad

Subcutaneous bronchogenic cyst.

A34-year-old man presented with a swelling in the suprasternal notch since birth that progressed in size with age. Apart from being a source of embarrassment, the swelling was not associated with any symptom. Clinical examination revealed a 5 5 cm nontender fluctuant subcutaneous swelling in the suprasternal notch. The swelling was brilliantly transilluminant (Fig 1). Preoperative laboratory investigations were normal. Ultrasound evaluation revealed thick-walled cystic swelling of 5.9 2 cm with internal echogenic material seen in the lower neck in midline. With the clinical diagnosis of congenital cyst, the patient underwent the excision of the swelling. Preoperative findings revealed a cystic mass of 4.5 3.5 l.5 cm with congested outer surface containing white gelatinous material. Histopathological examination revealed a cyst wall composed of fibrocollagenous tissue containing few smooth-muscle bundles, lined by ciliated pseudostratified columnar epithelial cells, admixed with goblet cells. Bronchogenic cysts are rare congenital anomalies that are usually located in the mediastinum or lung parenchyma. They are very rare in the neck and are thought to result from abnormal development of the tracheobronchial system. An abnormal budding of the tracheobronchial system between the 22nd and 33rd days of gestation and persistence of such a bud may give rise to bronchogenic cyst. In addition, abnormal migration of a bud may occur during the course of development and rest in different intrathoracic or extrathoracic locations. Maier has classified bronchogenic cysts according to site into paratracheal, carinal, hilar, paraesophageal, and atypical (diaphragm, abdomen, skin, subcutaneous tissue, and supraclavicular region). Most of the cervical bronchogenic cysts are in the midline, usually the upper cervical region. Bronchogenic cysts of the lateral

Persistent chyle leak following radical neck dissection: a solution that can be the solution.

A case report of a chyle leak following radical neck dissection for residual lymph nodal disease performed after chemoradiation for nasopharyngeal carcinoma. This is the first case report of the use of cyanoacrylate for a persistent chyle leak following radical neck dissection.

Slowdown during Parotidectomy A Rare Presentation of the Trigeminocardiac Reflex

T he head and neck region receives sensory innervation through the divisions of the trigeminal nerve. Stimulation of the trigeminal receptors in the nasal cavity during diving can cause reflex bradycardia and hypotension with peripheral vasoconstriction (ie, the diving reflex). This oxygen-conserving effect for the vital organs— heart and brain—thus delays the onset of serious hypoxic damage. The diving reflex is now considered one of the various presentations of a much broader reflex mechanism: the trigeminocardiac reflex (TCR). This reflex is described as the sudden occurrence of dysrhythmia, hypotension, apnea, or gastric hypermotility upon stimulation of any of the sensory branches of the trigeminal nerve. Bradycardia due to the TCR can occur during several maxillofacial, skull base, and ophthalmic procedures. Here we report a case of reversible bradycardia that occurred during a total conservative parotidectomy. This study was approved by the Institutional Review Board (Ethics Committee), Christian Medical College, Vellore, India.

Angiosarcoma of the scalp

A70-year-old man presented with 6 weeks’ duration of hyperpigmented, blue-black nodular lesions on the left parieto-temporal region of scalp. The lesion started as an erythematous macule behind the angle of left eye and rapidly spread with nodule formation and bled to touch in due course of time. This rapid spread occurred while the patient was still in the ward, with treatment planned for a period of 4 to 5 days. On examination, there were hyperpigmented nodular, soft, compressible lesions with ulcerated surfaces that bled to touch over the left frontal, parieto-temporal area with ecchymotic lesions at the periphery making the margins indistinct. Examination of the neck revealed a 1 1 cm firm mobile node in the ipsilateral level II and V. Biopsy of the scalp nodule showed a tumor composed of irregular vascular channels lined by plump endothelial cells with vesicular nuclei and prominent nucleoli surrounded by lymphocytes and plasma cells. The neoplastic cells were positive for CD34, vimentin, and CD34. Angiosarcomas are rare malignant tumors composed of vascular endothelial cells that can originate from either blood vessels or lymphatic channels. They account for 1% to 3% of all soft tissue sarcomas and are rare in the head and neck region and comprise less than 0.1% of all cancers in that region. Although they are rare, 50% of angiosarcomas occur in the head and neck region. It is also referred to as malignant angioendothelioma, malignant hemangioendothelioma, lymphangioendothelioma, hemangiosarcoma, hemangioblastoma, lymphangiosarcoma, malignant angioma, and malignant endothelioma. They are seen in males 3 to 4 times more frequently than in females, with a median age of 61 to 67 years. Although trauma, previous irradiation, longstanding lymphedema, exposure to thorium dioxide, vinyl chloride, insecticides, anabolic steroids, and synthetic estrogens have all been thought of as etiologic factors, its cause is unknown. The scalp and facial skin are the most common areas followed by nasopharynx, larynx, nose, middle ear, paranasal sinuses, thyroid, orbit, and oral cavity. They usually present as progressive multiple separate foci of vascular reddish colored macules, blue-black nodules with ulcerated surface and

Metachronous bilateral mucoepidermoid carcinoma of the parotid gland.

We report a very rare case of bilateral muco-epidermoid carcinoma of the parotid gland that underwent bilateral parotidectomy with neck dissections and radiotherapy. This case has done well for three years and suggests that metachronous bilateral mucoepidermoid carcinoma of the parotid gland, if treated as per the merits of each side, has a reasonable survival.

Malignant Peripheral Nerve Sheath Tumour of the Small Bowel Presenting with Intussusception and Perforation: a Double Jeopardy?

Malignant peripheral nerve sheath tumours (MPNST) are rare soft tissue sarcomas which largely occur in the extremities and the head and neck region. The tumours are aggressive with a high rate of recurrence. Radical surgical resection remains the treatment of choice with adjuvant radiation therapy and chemotherapy still failing to demonstrate a clear benefit. The gastrointestinal tract is an exceedingly rare site for these tumours. We report an unusual case of a young male with an MPNST of the small bowel who presented with an ileocolic intussusception and sigmoid perforation.

Melanosis peritonei in pregnancy: a case report and review of literature

Peritoneal melanosis is a rare condition characterized by pigment deposition in the peritoneum. Benign peritoneal melanosis may occur in association with other congenital cystic conditions such as ovarian dermoid, peritoneal, enteric duplication cysts, or even gastric triplication. We report the case of melanosis peritonei found during pregnancy diagnosed at the time of cesarean section for fetal distress.