Vijendra S Shenoy

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.

Cervical thymic cyst: a rare differential diagnosis in lateral neck swelling.

Introduction. Thymic cysts are among the rarest cysts found in the neck. Nests of thymic tissue may be found anywhere along the descent of the thymic primordia from the angle of the mandible to the mediastinum. Mediastinal extension is seen in 50% of cervical thymic cysts. Case Report. We report an uncommon case of a 15-year-old male, who noted a painless, growing mass on left side of his neck of one-year duration. Computerised tomographic scan showed a multiloculated fluid density lesion with enhancing septae in the left parapharyngeal space, extending from the level of mandible up to C7 vertebral level. Here, we discuss the surgical aspect, histopathology, and management of this rare lateral neck swelling. Discussion. Clinically, in most cases, cervical thymic lesions present as a unilateral asymptomatic neck mass, commonly on the left side of the neck, and 75% of patients present before 20 years of age. Conclusion. Thymic cyst should be included as differential diagnosis of cystic neck masses. Greater awareness among the pathologists may decrease misdiagnosis.

Melioidosis and tuberculosis: dual pathogens in a neck abscess.

INTRODUCTION Melioidosis is an infectious disease caused by a saprophytic bacterium, Burkholderia pseudomallei. It is endemic to Southeast Asia and Northern Australia. It may manifest as a pulmonary lesion, osteomyelitis, abscesses in soft tissue and various organs, or as septicaemia. CASE REPORT We report a case of a 40-year-old, diabetic man who presented with a neck lump resulting from super-infection of a tuberculosis cavity with B pseudomallei. The patient was successfully managed by drainage along with meticulous excision of the capsule and prolonged antibiotic and anti-tubercular treatment. DISCUSSION Melioidosis may be confused diagnostically with tuberculosis, as both diseases are endemic in the same regions. Our patient was unfortunate to suffer from both endemic diseases simultaneously, perhaps representing the first such case in the world literature. CONCLUSION Increased awareness of melioidosis is important as, although the organism is easy to culture, it may be dismissed as a contaminant.

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.

Maxillary Antrolith: A Rare Cause of the Recurrent Sinusitis

Introduction. An antrolith is a calcified mass within the maxillary sinus. The origin of the nidus of calcification may be extrinsic (foreign body in sinus) or intrinsic (stagnant mucus and fungal ball). Most antroliths are small and asymptomatic. Larger ones may present as sinusitis with symptoms like pain and discharge. Case Report. We report a case of a 47-year-old lady who presented with heaviness on the left side of the face and loosening of the left 2nd molar tooth since two months. CT scan of the osteomeatal complex and paranasal sinuses showed an opacification of bilateral maxillary sinus and an amorphous area of bone density in the left maxillary sinus. Because of the size of the mass, benign neoplasms were considered in the differential diagnosis. During an endoscopic sinus surgery, it was found to be an antrolith, which was successfully managed by antrostomy and Caldwell-Luc Surgery. Discussion. Antrolith is a rare condition. Rhinoliths are known to invade into the maxillary antrum, but a localised lesion in the antrum is very unusual. A case of an isolated antrolith is presented for its rarity and for differential diagnosis of localised antral disease. Conclusion. Antrolith should be considered as differential diagnosis of unilateral radio-opaque paranasal sinus lesions.

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.