Cervical amoebiasis mimicking cervical carcinoma: A rare presentation of a common infection

SummaryCervical amoebiasis is an extremely rare diagnosis with only a small number of published case reports. This disease may present as cervical growth mimicking cervical carcinoma. Owing to the similarity of the clinical presentation of bleeding per vagina and per speculum examination showing growth or ulcers, definitive diagnosis is made on microscopic examination only. We present a rare case of cervical amoebiasis in a 28-year-old, multiparous female who presented with a history of vaginal bleeding. The patient was treated with metronidazole and diloxanide furate, after which she recovered. Awareness of this rare entity is important for clinical suspicion and for the pathologist to identify trophozoites and make a diagnosis, preventing unwarranted investigations. Accurate diagnosis also facilitates quick management of a patient; as this disease is an infective pathology that can easily be treated by antibiotics

Xanthogranulomatous inflammation of female adnexa: diverse clinical presentations - a series of 7 cases

Xanthogranulomatous inflammation, a form of destructive chronic inflammation is a rare occurrence in female genital tract, especially ovary and fallopian tube. Its clinical and radiological presentation mimics ovarian malignancy which poses a diagnostic dilemma at times. Histopathology plays a pivotal role in diagnosis of this entity. We described seven cases in total, out of which two cases showed xanthogranulomatous oophoritis and five had both xanthogranulomatous oophoritis and salpingitis, all diagnosed on histopathology. Majority of the patients had abdominal pain, fever and adnexal mass on examination. Most women were treated based on the working diagnosis of malignancy or severe pelvic inflammatory disease. Histopathology remains the gold standard for diagnosis in all these cases, and with the aid of clinical and radiological details helps in ruling out other differential diagnosis

Primary squamous cell carcinoma of the fallopian tube masquerading inflammatory mass

Primary squamous cell carcinoma (SCC) of fallopian tube is exceedingly rare. Till date less than 10 cases have been reported to the best of our knowledge [2-10]. Serous adenocarcinoma is the most common primary malignancy arising from the fallopian tube. Primary SCC of fallopian tube is diagnosed after excluding invasion from the rest of the genital tract and metastasis. We are reporting this rare carcinoma in a 62- year -old female who was taken for laparotomy with pre-operative diagnosis of tubo-ovarian abscess

Cavernous hemangioma of the parotid gland

Cavernous hemangioma (CH), or cavernoma, is a type of benign tumor occurring mostly in the brain, liver, skin, and retina.1,2 Although less commonly, CH can also occur in the spine, orbit, gastrointestinal tract, skeletal muscle, and long bones.1 CH comprises a cluster of abnormally dilated blood vessels that form a mass or lesion.2,3CH is more commonly found in women than men and typically occur between the ages of 40 and 60. Their precise incidence needs to be well-established; however, they account for 2-4% of all parotid gland tumors.2 Still, they are considered one of the less parotid gland common types of tumors.2,3 Most parotid gland tumors are benign, with only about 20% malignant.1,2CH is typically diagnosed by imaging tests such as MRI or CT scans. The location, size, symptoms, and general health of the patient are among the variables that affect how cavernous hemangiomas are treated. Treatment options in symptomatic cases with functional impairment and high risk of bleeding, include medical (steroid or interferon), embolization, surgery, or radiosurgery.2,4Parotid gland tumors can be either benign or malignant. CH of the parotid gland is a relatively rare but well-documented entity in the medical literature. There is currently not enough knowledge on the prevalence of CH in the parotid gland; there were roughly 50 cases reported worldwide, most of which were individual case reports. Overall, the literature suggests that cavernous hemangioma of the parotid gland is a rare benign entity more common in females and typically presents as a painless mass in the parotid gland area. Surgical removal is the primary treatment, and this entity has a good prognosis and a low recurrence risk.1-4 CH of the parotid gland can present with various symptoms, including a painless mass or swelling in the area of the gland, facial nerve weakness or paralysis, and even hearing loss in some cases. The diagnosis of a CH is usually based on imaging studies such as MRI or CT scans, which can show a well-defined, sharply demarcated mass with areas of low and high intensity.2-4A hemangioma's histopathological appearance can help determine the appropriate management and treatment options. Capillary hemangiomas may be treated with topical or oral medications, while surgical removal may be necessary for cavernous hemangiomas, depending on their size and location.2,3Treatment options for parotid gland cavernous hemangiomas depend on the lesion’s size and location, the patient's symptoms and overall health status. In some cases, surgical removal of the tumor may be necessary, which can be challenging due to the proximity of the facial nerve and the risk of its injury. In other cases, observation or radiation therapy may be recommended.3-5Cavernous hemangioma is a type of vascular malformation, but other types of vascular malformations can present with similar symptoms or imaging findings. The differential diagnosis of vascular malformation with cavernous hemangioma includes (i) Venous malformation: a type of vascular malformation that affects veins, and it can look similar to cavernous hemangioma on imaging studies. However, venous malformations typically have a more uniform appearance, while cavernous hemangiomas have a characteristic “popcorn” appearance due to multiple blood-filled spaces; (ii) Capillary malformation: a type of vascular malformation that affects small blood vessels called capillaries. Capillary malformations can present as flat, red, or pink marks on the skin and can sometimes be mistaken for cavernous hemangioma; (iii) arteriovenous malformation: a type of vascular malformation that involves abnormal connections between arteries and veins. Arteriovenous malformations can cause symptoms such as headaches, seizures, and neurological deficits and can be mistaken for cavernous hemangioma on imaging studies; (iv) Lymphatic malformation: a type of vascular malformation that affects the lymphatic vessels and can cause swelling or abnormal growths. Lymphatic malformations can sometimes be mistaken for cavernous hemangioma in imaging studies.4,5Figure 1 refers to a 42-year-old female patient with a painless, slowly growing mass in the right parotid region. The mass had been present for the past 6 months and has gradually increased. The patient reported no other significant symptoms, such as facial weakness or pain. The physical examination revealed a soft, non-tender mass in the right parotid region that measured approximately 6 cm. The overlying skin was normal, and there were no palpable lymph nodes in the neck. The ultrasound examination showed a well-circumscribed, hypoechoic lesion within the superficial lobe of the parotid gland, measuring 5.2 cm. The lesion had a cystic appearance with internal septations, consistent with a vascular lesion. The patient underwent an MRI, which confirmed the presence of a well-defined, lobulated mass in the superficial lobe of the right parotid gland, measuring 5.5 cm. The lesion was hyperintense on T2-weighted images and demonstrated heterogeneous enhancement with gadolinium. The imaging findings were consistent with a diagnosis of vascular malformation of the parotid gland. The patient was referred to a head and neck surgeon for further evaluation and treatment. Due to the lesion’s size and location, surgical resection was recommended. The patient underwent a superficial parotidectomy, and the postoperative course was uneventful. Histopathological examination of the resected specimen confirmed the diagnosis of CH (Figure 1A-1D). The patient was followed up for several months after the surgery, and there was no evidence of recurrence or complications.Figure 1A - gross image showing normal salivary gland tissue along with a well-encapsulated tumor with areas of hemorrhage and comprising of numerous cystic spaces (vascular channels) scale bar = 2,5 cm; B - microscopic examination at low magnification showing normal salivary gland parenchyma along with a capsulated tumor comprised of many dilated vascular channels (H&E 100X); C - higher magnification image showing thick and thin walls vascular spaces in between fibro-muscular stroma (H&E, 400X); D - immunohistochemical reaction for smooth muscle actin (SMA) demonstrating smooth muscle bundles and vessel walls (SMA, 400X).

AN OVERVIEW OF FOURIER TRANSFORM ON IMAGE PROCESSING

The recognition of an images are important in the digital image processing. In this paper we introduce the definition of Fourier Transform and it's properties through which the solution of the problem will be easier than expected and also describe that what is the roll of Fourier transform in image recognition

Sezary syndrome in a young retropositive male: A rare case report

Sezary syndrome, a rare disease, is the leukemic counterpart of mycosis fungoides accounting for less than 5% of cutaneous lymphomas.Very few case reports have been published of Sezary syndrome/mycosis fungoides presenting in young male and with coexisting HIV.We present a case of a 23-year-old retropositive male presenting with Sezary syndrome which is very rare. The present case highlightsthe fact that Sezary syndrome can rarely present in young and retropositive patients. It should be kept in differential diagnosis if apatient presents with erythroderma, generalized lymphadenopathy and characteristic peripheral smear findings. A multimodal approachinvolving flow cytometry, skin biopsy and fine needle aspiration cytology (FNAC) is required for arriving at a definite diagnosis

Exact and Heuristic Methods for the Weapon Target Assignment Problem

The Weapon Target Assignment (WTA) problem is a fundamental problem arising in defense-related applications of operations research. This problem consists of optimally assigning n weapons to m targets so that the total expected survival value of the targets after all the engagements is minimum. The WTA problem can be formulated as a nonlinear integer programming problem and is known to be NP-complete. There do not exist any exact methods for the WTA problem which can solve even small size problems (for example, with 20 weapons and 20 targets). Though several heuristic methods have been proposed to solve the WTA problem, due to the absence of exact methods, no estimates are available on the quality of solutions produced by such heuristics. In this paper, we suggest linear programming, integer programming, and network flow based lower bounding methods using which we obtain several branch and bound algorithms for the WTA problem. We also propose a network flow based construction heuristic and a very large-scale neighborhood (VLSN) search algorithm. We present computational results of our algorithms which indicate that we can solve moderately large size instances (up to 80 weapons and 80 targets) of the WTA problem optimally and obtain almost optimal solutions of fairly large instances (up to 200 weapons and 200 targets) within a few second

Giant virilising adrenal cortical carcinoma

Androgen secreting adrenocortical carcinoma (ACC) is a very rare disease with a poor prognosis. Approximately 80% of tumors are functional, most commonly secreting glucocorticoids. We herewith report a case of a huge functional ACC of the right adrenal gland in a 33-year-old female who presented with complaints of hirsutism, amenorrhea and an abdominal lump. On abdominal examination a large lump was palpable in the right hypochondrium reaching up to the umbilicus. Contrast-enhance computed tomography (CECT) revealed a mass in the right suprarenal region. The tumor measured 29 cm × 20 cm × 12 cm and weighed 7.8 kg, the largest reported case of ACC in the world to the best of our knowledge

Amyloidoza plamkowata jako powikłanie makrogruczolaka prolaktynowego przysadki — nowy związek kliniczny

  Amyloid deposition in the pituitary gland is a rare localised form of amyloidosis, and most commonly reported with prolactinoma. Macular amyloidosis is a rare form of localised cutaneous amyloidosis of obscure aetiology. In contrast to most localised amyloidosis, the precursor protein(s) of both macular amyloidosis and prolactinoma are unknown. A 35-year-old man with chronic headache (six years), blurring of vision (three years), and hyperpigmented macular lesion involving arms, legs, and back (two years) was diagnosed to have hyperprolactinaemia (8927 ng/mL) and secondary adrenal insufficiency. MRI revealed pituitary macroadenoma compressing the optic chiasma, encasing the right carotid artery and extending into the sphenoid sinus. A biopsy of skin from the right upper arm revealed thickened stratum corneum, acanthosis, and deposition of pale eosinophilic material in papillary dermis that gave a rose pink colour under methyl-violet and appeared congophilic with Congo red stain, which under polarised light showed green birefringence, diagnostic of macular amyloidosis. Headache, bitemporal haemianopia, and skin lesion improved following cabergoline therapy. Temporal profile of the disease characterised by symptoms of macroprolactinoma preceding onset of macular amyloidosis with resolution of symptoms of macroprolactinoma, accompanied by reductions in prolactin, and concomitant improvement in macular amyloidosis with cabergoline therapy may suggest some link between macroprolactinoma and macular amyloidosis. This report intends to highlight this novel association of macular amyloidosis and macroprolactinoma. (Endokrynol Pol 2015; 66 (6): 555–558)    Złogi amyloidu w przysadce to rzadka forma lokalizacji amyloidozy. Najczęściej występuje razem z gruczolakiem prolaktynowym przysadki. Amyloidoza plamkowata to rzadka forma skupionej amyloidozy skórnej o niewyjaśnionej etiologii. Przeciwnie do większości amyloidoz występujących w jednym miejscu, białko prekursora zarówno amyloidozy plamkowatej, jak i gruczolaka prolaktynowego pozostają nieznane. U 35-letniego mężczyzny cierpiącego na przewlekły ból głowy (od 6 lat), nieostre widzenie (od 3 lat) oraz plamkowe zmiany pigmentacyjne na rękach, nogach i plecach (od 2 lat) zdiagnozowano hiperprolaktynemię (8927 ng/ml) i wtórną niedoczynność kory nadnerczy. Badanie rezonansem magnetycznym ujawniło makrogruczolaka przysadki mózgowej, uciskającego skrzyżowanie wzrokowe, prawą tętnicę szyjną i ekspansją/rozrostem do zatoki klinowej. Biopsja skóry z górnej części prawego ramienia wykazała pogrubienie warstwy rogowej naskórka, akantozę, złogi bladego materiału kwasochłonnego w warstwie brodawkowatej skóry właściwej, które barwiły na różowo przy zetknięciu z fioletem metylowym i wydawały się podatne na barwienie czerwienią kongo, które w świetle spolaryzowanym ujawniało zieloną dwójłomność, wskazując na występowanie amyloidozy plamkowatej. Ból głowy, niedowidzenie połowicze dwuskroniowe, a także zmiany skórne uległy poprawie po zastosowaniu leczenia kabergoliną. Czas wystąpienia choroby, charakteryzującej się objawami makrogruczolaka prolaktynowego przysadki, poprzedzającymi rozpoczęcie amyloidozy plamkowatej wraz ze złagodzeniem objawów makroprolaktynomy oraz redukcją stężenia prolaktyny, a także jednoczesnej poprawie amyloidozy plamkowatej przy terapii kabergoliną może sugerować, że istnieje związek między makrogruczolakiem prolaktynowym i amyloidozą plamkowatą. Niniejszy raport ma na celu naświetlenie nowego związku między amyloidazą plamkowatą i makrogruczolakiem prolaktynowym przysadki. (Endokrynol Pol 2015; 66 (6): 555–558)

Leiomyoma of maxillary sinus

Leiomyoma is a benign smooth muscle tumor that most commonly occurs in the uterus; however, it can also manifest in various extragenital locations, including the maxillary sinus.1,2 While leiomyomas of the maxillary sinus are occasional, they present unique diagnostic and management challenges. The maxillary sinus, one of the paranasal sinuses in the facial bones, is typically associated with sinusitis or odontogenic infections.1 Therefore, clinicians primarily consider inflammatory or neoplastic etiologies when encountering a mass within the maxillary sinus. Among the possible neoplastic causes, leiomyoma is a less frequently encountered entity, but it should be considered in the differential diagnosis.1,2 Understanding the clinical presentation, radiological features, and appropriate management strategies for leiomyoma of the maxillary sinus is crucial for accurate diagnosis and effective treatment. This case report aims to contribute to the existing medical knowledge by presenting a unique case of leiomyoma arising in the maxillary sinus, discussing the diagnostic approach treatment options, and highlighting any noteworthy findings.2,3 Leiomyoma of the maxillary sinus can present with various symptoms, including nasal obstruction, facial pain or pressure, recurrent sinusitis, epistaxis (nosebleeds), or a palpable mass in the maxillary region.1,3 However, these symptoms are non-specific and can be mistaken for other sinus entities. Therefore, it is essential to consider leiomyoma as a differential diagnosis in patients with such clinical presentations. Diagnosing leiomyoma of the maxillary sinus can be challenging due to its rarity and overlapping symptoms with other sinus entities. Imaging studies, such as compute tomography (CT) or magnetic resonance imaging (MRI), play a crucial role in identifying the presence, location, and extent of the tumor.3,4 However, a definitive diagnosis requires a histopathological examination of the excised tissue. When encountering a maxillary sinus mass, the differential diagnosis includes various benign and malignant conditions. Potential differentials include inverted papilloma, angiofibroma, Schneiderian papilloma, mucocele, and even malignancies like sinonasal carcinoma or sarcoma. Proper evaluation, including clinical, radiological, and histopathological assessment, is necessary to differentiate leiomyoma from other lesions.4,5 Khanna et al.1 reported the case of a leiomyoma originating in the maxillary sinus in a 55-year-old female. The patient presented with facial pain and nasal obstruction. The CT revealed a well-defined mass in the maxillary sinus. Surgical excision was performed, and the histopathological examination confirmed the diagnosis of leiomyoma. Rana et al.2 presented a case of a 37-year-old male with a leiomyoma in the maxillary sinus. The patient complained of nasal obstruction and recurrent sinusitis. The CT imaging showed a polypoidal mass in the maxillary sinus, and endoscopic sinus surgery was performed to remove the tumor. Histopathological examination confirmed the diagnosis of leiomyoma. In a retrospective study by Li et al.3 seven cases of leiomyoma arising from the maxillary sinus were analyzed. The study highlighted these patients' clinical features, radiological findings, and treatment outcomes. The authors emphasized the importance of considering leiomyoma as a potential diagnosis when evaluating maxillary sinus masses. Khan et al.4 reported a case of leiomyoma originating from the maxillary sinus in a 50-year-old male. The patient presented with nasal obstruction, facial pain, and recurrent epistaxis. Imaging studies revealed a soft tissue mass in the maxillary sinus, and endoscopic sinus surgery was performed for complete excision. Histopathological examination confirmed the diagnosis of leiomyoma. Another case report by Nandedkar et al.5 described a rare presentation of leiomyoma in the maxillary sinus in a 24-year-old male. The patient presented with nasal obstruction and was found to have a mass in the maxillary sinus on imaging. Endoscopic sinus surgery was performed, and the tumor was completely excised. Histopathological examination confirmed the diagnosis of leiomyoma. These case reports and studies collectively highlight the variable clinical presentations, radiological features, and successful management strategies for the leiomyoma of the maxillary sinus. Due to the rarity of this condition, a high index of suspicion is required for accurate diagnosis, and surgical excision is the mainstay of treatment. Further research and case studies are needed to expand our knowledge and improve patient outcomes in this rare entity.3,5 The mainstay of treatment for leiomyoma of the maxillary sinus is surgical excision. The approach can vary depending on the size and location of the tumor. Endoscopic sinus surgery (ESS) is often employed as a minimally invasive technique for complete resection.2,3 In certain cases, an open surgical approach may be required for more extensive tumors. Surgery aims to achieve complete excision while preserving the surrounding structures and achieving symptomatic relief. Leiomyoma of the maxillary sinus has a favorable prognosis due to its benign nature. Complete surgical excision usually leads to the resolution of symptoms and low recurrence rates. Long-term follow-up is important to monitor for any recurrence or complications.1,2 It is important to note that the literature on leiomyoma of the maxillary sinus is limited to case reports and small studies due to its rarity. Further research and larger studies are needed to gather more data on this condition's clinical characteristics, optimal treatment approaches, and long-term outcomes. Postoperative care typically involves nasal irrigation, pain management, and antibiotics. Regular follow-up visits are essential to monitor the patient's recovery, assess for any signs of recurrence, and manage any postoperative complications.2,4 The prognosis of leiomyoma of the maxillary sinus is generally favorable. Since leiomyomas are benign tumors, they do not have the potential to metastasize or invade adjacent structures. With complete surgical excision, most patients experience symptom resolution and have low recurrence rates.4,5 In conclusion, leiomyoma of the maxillary sinus is a rare entity that requires consideration in the differential diagnosis of maxillary sinus masses. Despite the diagnostic challenges, accurate evaluation through clinical assessment, imaging studies, and histopathological examination is crucial for appropriate management. Surgical excision remains the primary treatment modality, with a favorable prognosis and low recurrence rates. Figure 1 refers to a 45-year-old female patient who presented to the otolaryngology clinic complaining of progressive nasal obstruction and intermittent dull facial pain on the right side. She reported that her symptoms had been gradually worsening over the past six months. There were no associated symptoms such as epistaxis, nasal discharge, or changes in smell. The patient had no significant medical history and did not report any history of previous sinus infections or allergies. She had no history of smoking or exposure to environmental toxins. On physical examination, tenderness was on palpation over the right maxillary sinus area. The nasal passages appeared patent, with no visible polyps or signs of inflammation. The rest of the head and neck examination, including the oral cavity, was unremarkable. A flexible nasal endoscopy revealed a bulging mass in the right middle meatus obstructing the ostium of the maxillary sinus. The rest of the nasal cavity and other sinus ostia appeared normal. A computed tomography (CT) scan of the paranasal sinuses was obtained, which demonstrated a well-defined, non-enhancing soft tissue mass filling the right maxillary sinus. There were no signs of erosion into surrounding structures or evidence of distant metastasis. Figure 1A – Gross photomicrograph shows a greyish white to tan-white well circumscribed but nonencapsulated tumor. The cut surface shows firm, whorled surface areas with hemorrhage (scale bar= 5 cm); B – shows a tumor composed of interlacing fascicles of smooth muscle bundles (H&E, 40X); C – Immunohistochemical reaction for smooth muscle actin (SMA) demonstrating smooth muscle bundles and vessel walls (100X); D – Immunohistochemical reaction for Desmin shows diffuse cytoplasmic positivity (100X).: Based on the clinical presentation and imaging findings, a provisional diagnosis of leiomyoma of the maxillary sinus was made. The patient was counseled about the benign nature of the tumor and the recommended treatment options. The patient underwent endoscopic sinus surgery (ESS) for complete excision of the leiomyoma. During the procedure, the tumor was identified and carefully dissected from the surrounding sinus mucosa. Hemostasis was achieved, and the surgical site was thoroughly irrigated. Histopathological examination of the excised specimen confirmed the diagnosis of leiomyoma, showing spindle-shaped cells with cigar-shaped nuclei arranged in fascicles. No malignant features or atypical mitotic figures were observed. The patient had an uneventful postoperative recovery with the resolution of her symptoms. She was followed up regularly to monitor for any signs of recurrence or complications. During the follow-up visits, the patient remained asymptomatic, with no signs of tumor recurrence or associated complications