Tariq Mansoor

Persistent port-site sinus in a patient after laparoscopic cholecystectomy: watch out for gallbladder tuberculosis.

BACKGROUND The gallbladder is rarely affected by mycobacterium tuberculosis. The diagnosis of gallbladder tuberculosis is often not suspected prior to surgery or biopsy. METHOD A young female patient underwent laparoscopic cholecystectomy but presented with a persistently discharging sinus from the port site. RESULTS The gallbladder biopsy revealed granulomas typical of chronic granulomatous tuberculosis. The condition of the patient was improved by antitubercular treatment. CONCLUSIONS Presentation of gallbladder tuberculosis as a persistent discharging sinus at the port site in a patient who has undergone a laparoscopic cholecystectomy is extremely rare. The diagnosis was reached by histopathology only. The rarity of the presentation prompted us to report the case.

Diagnoses of breast masses with ultrasonography and elastography: A comparative study

Context : Non-invasive diagnoses of breast masses remain a challenge to the clinician. Elastography, a new modality using elastic property of breast tissue can effectively differentiate between malignant and benign breast masses minimizing the need for aggressive unnecessary biopsy. Aim: The aim is to evaluate elastography to ascertain whether the differentiation and characterization of benign and malignant breast lumps could be done with it, comparing with the conventional sonography. Settings and Design : Single institutional prospective study. Materials and Methods: The study was conducted on 82 patients with palpable breast lumps. All these cases were subjected to a thorough clinical examination, sonography, elastography, and pathological diagnosis. Results of sonography and elastography were compared considering the pathological diagnosis as standard. Statistical Analysis : Statistical analysis was performed with the McNemar test. All data analysis was conducted using SPSS software (SPSS Inc.). Results: It was observed that the USG diagnosis of carcinoma tallied with the pathological diagnosis in only 88.9% of cases (i.e. 48 out of 54 cases) and the elastographic diagnosis of carcinoma tallied with the pathological diagnosis in 96.3% (i.e. 52 out of 54). On the other hand, out of 34 and 30 cases diagnosed as benign lesions on USG and elastography, respectively, only 28 cases were proved to be benign pathologically. Conclusion: Elastography was found to be more sensitive, specific, and accurate than sonography.

Radiologically guided fine needle aspiration cytology of retroperitoneal and spinal lesions

Aim: This study was undertaken to assess the role of image-guided, fine needle aspiration cytology (FNAC) in the diagnosis of retroperitoneal and spinal lesions. Materials and Methods: Over a period of one year, ultrasonography and computerized tomography-guided FNAC was performed in 55 cases who had presented clinically with signs and symptoms related to the retroperitoneum and spine. Histopathological confirmation was available in 27 out of 55 cases. Results: Of the 55 cases, 39 were males and 16 were females. Malignant and benign lesions accounted for 58.2 and 29.1% respectively. Among the cases on whom radiologically guided FNAC was performed, the spine contributed the largest proportion of cases (32.7%), followed by renal lesions (20%). Among the malignant lesions, renal cell carcinoma was the most commonly found malignancy, followed by metastasis to the spine. In the benign and inflammatory category, tuberculosis of the spine and the lymph nodes was the most common lesion accounting for 68.7% of all cases. On correlating clinical, radiological, and cytologic features, the sensitivity, specificity, and overall accuracy of guided FNAC obtained in this study were 97.1, 84.2, and 92.4% respectively. Conclusions: Radiologically guided FNAC is a fairly accurate and safe procedure in diagnosing the most difficult cases in the region of the retroperitoneum and the spine.

Ultrasound guided fine needle aspiration biopsy of gastrointestinal masses

The study was undertaken to evaluate the role of ultrasound guided fine needle aspiration cytology (FNAC) of gastrointestinal masses in providing higher diagnostic yield and assess its reliability in distinguishing between benign and malignant gastrointestinal lesions. 86 patients with gastrointestinal masses after thorough clinical examination underwent ultrasonographic examination. Those found to have a mass were subjected to FNAC. Smears prepared were fixed in 95% ethyl alcohol and stained with Haematoxylin and Eosin and Papanicolaou stains. Forty (46.5%) were males and 46 (53.5%) females with majority of patients in the third decade in both sexes. Malignant lesions constituted the maximum number of 42 (48.8%) cases, followed by 36 (41.8%) cases of benign and inflammatory lesions. Adenocarcinoma was the most common malignancy accounting for 36 (85.7%) cases; out of which 16 (44.4%) cases were adenocarcinoma stomach and 20 (55.6%) cases were adenocarcinoma intestine. Among the inflammatory and benign lesions, 30 (83.3%) cases were tuberculous followed by 4 (11.1%) cases appendicitis, The mean age of malignancy was 39.2 years and the average age of tuberculous patients in our study was 25.5 years. On cytohistological correlation, 30 were found to be true positive for malignancy, 5 true negative and 1 false negative. There were no false positive cases. We obtained a sensitivity of 93.8%, specificity of 100% and diagnostic accuracy of 94.4% in our study. Ultrasound guided FNAC is an effective and useful method which eliminates the need for surgical biopsy and provides sufficient information for the initiation of therapy. Journal of Cytology 2007; 24 (4) : 173-177

Neurofibromatosis type 1: a rare cause of parotid swelling in a child

Von Recklinghausen disease, also known as neurofibromatosis type 1, is an autosomal dominant disorder that presents as neurocutaneous syndrome. These patients have increased chances of developing other tumors such as plexiform neurofibromas. Plexiform neurofibromas are a proliferation of Schwann cells in the nerve sheath. Affliction of the parotid gland in a young child is a rare presentation of these tumors. We present the management of one such case.

Effect of preamputation lumbar sympathectomy on stump pain of lower limbs in patients of thromboangitis obliterans (Buerger's disease)

Background: Thromboangiitis obliterans (Buerger′s disease) is a nonatherosclerotic inflammatory disorder primarily involving small and medium sized vessels, mainly arteries of the extremities. As the disease progresses, it could cause gangrene and amputation of limbs, eventually leading to persistent pain and disability. Settings and Design: A prospective, randomized, single-blinded comparative study. Materials and Methods: Fifty patients of Buerger′s disease planned for amputation below the knee were divided randomly into two equal groups of 25 each. Patients of both groups were advised to stop smoking. Lumbar (chemical) sympathectomy was carried out in patients of study group 1 week before amputation. The severity of postamputation stump pain was assessed using visual analog scale (VAS) and requirement of analgesics on weekly basis for 12 weeks. The incidence of phantom limb pain and overall quality of life was also evaluated using Short Form-36 (SF-36) scale. Results: VASs and requirement of analgesics were significantly less in patients who underwent lumbar sympathectomy as compared to patients of control group. The quality of life as reflected by SF-36 score was also significantly better in the study group. However, there was no significant difference in the incidence of phantom limb pain in the two groups. No major complications were reported following lumbar sympathectomy. Conclusions: Lumbar sympathectomy significantly decreases the severity of postamputation stump pain of lower limbs and thus improves the overall quality of life in patients of Buerger′s disease.