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   Table of Contents - Current issue
October-December 2017
Volume 1 | Issue 2
Page Nos. 23-48

Online since Friday, January 19, 2018

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Fertility issue and sperm banking among testicular cancer survivors p. 23
Tapan Kumar Sahoo
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Comparison between crush/squash cytology and frozen section preparation in intraoperative diagnosis of central nervous system lesions p. 25
Swagatika Samal, Rajnish Kalra, Jyoti Sharma, Ishwar Singh, Devasis Panda, Megha Ralli
Aim: The aim of this study is to analyze the correlation/diagnostic accuracy of cytology and frozen section (FS) preparations in the intraoperative diagnoses of central nervous system (CNS) lesions. Materials and Methods: A total of 63 cases of CNS lesions were included in the study from July 2012 to January 2015 at a tertiary care referral hospital. Intraoperative specimens were used for crush/squash smears and FS and correlated with the final histopathological diagnosis. Results: Majority of the patients (73.02%) were presenting in the age range of 21–50 years. There was a slight female preponderance with male-to-female ratio of 1:1.1. Two out of 63 cases were excluded from the cytology correlation analysis due to inadequate materials and 3 out of 63 cases were excluded from the FS correlation analysis due to freezing artifacts. The diagnostic accuracy of cytological preparation was 80.33% for complete correlation with histopathology and was increased to 93.44% for adding the partial correlations. The corresponding figures for FS were 81.67% and 93.33%, respectively, and the difference was insignificant (P = 0.971). The sensitivity, specificity, positive predictive value, and negative predictive value in detecting neoplastic condition on cytology were 94.4%, 85.7%, 98.07%, and 66.67%, respectively, and that of FS were 96.15%, 75%, 96.15%, and 75%, respectively. The corresponding P = 0.872, 0.652, 0.986, and 0.561, respectively. Conclusion: Crush and FS preparation are considered as effective diagnostic procedures for rapid intraoperative diagnosis in CNS lesions without any significant difference in results and when applied simultaneously can produce a higher diagnostic accuracy complementing each other's results.
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Calcaneal osteosarcoma: An unusual cause of chronic pediatric heel pain p. 31
Pradosh Kumar Sarangi, Elluru Santosh Kumar, Jayashree Mohanty
Calcaneal osteosarcoma is a rare entity, which presents with chronic heel pain and swelling and often clinically misdiagnosed as a traumatic or inflammatory process. The diagnostic confusion is because of the rarity of this entity and unawareness of such rare areas of affection of osteosarcoma. This usually leads to delayed diagnosis and treatment and may severely affect the prognosis. We present a rare case of osteosarcoma involving calcaneus in a 10-year-old female who presented with long-standing left heel pain and swelling where the diagnosis of a sinister underlying bone lesion was delayed.
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Effect of denosumab in giant cell tumor of bone p. 34
Ramesh Chandra Maharaj, Sibasish Panigrahi, Biplabi Sarangadhar Das
Giant cell tumor (GCT) of bone is a benign tumor with locally aggressive nature. The presence of mononuclear stromal cells and multinucleated giant cells is the microscopic characteristic feature of the GCT. It is an osteoclastic tumor with destruction of tumor is mediated by the receptor activator of nuclear factor kappa-B ligand (RANKL). Denosumab, a RANKL inhibitor, may reduce or eliminate tumor giant cells, the relative content of proliferative, densely cellular tumor stromal cells, replacing with nonproliferative, differentiated woven new bone. We report a case of GCT of the right distal femur in a 20-year-old female, treated with 6 cycles of denosumab as neoadjuvant therapy, which shows consolidation of the lesion and became amenable for extended curettage with phenol cauterization and cementing without going for any radical surgery shown to have very good functional outcome.
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Primary patellar giant cell tumor: A report of two cases p. 37
Jitendra Mishra, Bikram Keshari Kar, Nirmal Chandra Mohapatra, Anshuman Sahoo
Giant cell tumor (GCT) commonly arises from epiphysis of the long bones, and the most common sites for primary are distal femur, proximal tibia, proximal humerus, and distal radius. Patella is a very rare site for the development of primary GCT. We report two cases with primary GCT of the patella. Both the patients presented with a long history of intermittent right anterior knee pain and knee swelling and were treated by radical excision. In one case, temporary immobilization done by knee arthrodesis with cross K-wires followed by mobilization using hinged knee brace.
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Vaginal primary amelanotic melanoma with survival beyond expectation: A rare case report p. 40
Rohini Vinayak Kulkarni, Bhagyalaxmi Nayak, Sushil K Giri, Sagarika Samantray
Vaginal malignancies are uncommon, constituting 1%–2% of all the female genital tract malignancies. Even rare are melanomas of the vagina with an annual incidence of 0.026/100,000 women worldwide, and amelanotic variant constitutes only 2% of all the vaginal melanomas. Here, we report a case of primary vaginal amelanotic melanoma in a 70-year-old woman, initially treated with wide local excision followed by adjuvant chemotherapy. After six and half years of follow-up, the patient developed a recurrence in the left inguinal nodal region with a suspicious pulmonary nodule and is now under treatment. Amelanotic melanoma has varied clinical presentation and microscopic appearance with the absence of characteristic pigmentation, leading to a diagnostic delay and thus carries a poor prognosis. Therefore, it is prudent to have a high index of suspicion for these rare tumors. Hence, we report this case of primary vaginal melanoma, amelanotic variant with a surprisingly long survival of nearly 7 years for information and pertinent discussion.
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Acute lymphoblastic leukemia with normal platelet count p. 43
Reema Bhushan, Kiran Agarwal, Jyoti Garg
B-acute lymphoblastic leukemia (ALL) often presents as pancytopenia/bicytopenia with thrombocytopenia being very common. A 15-year-old child with high-grade fever showed bicytopenia on peripheral smear with 10% blasts. Bone marrow examination showed 65% lymphoblasts which were negative for myeloperoxidase. The blasts suppressed the erythroid population but not the megakaryocytic population. On flow cytometry, a diagnosis of common – ALL antigen-positive B – precursor ALL was given. To conclude, ALL cannot be excluded in patients who present with a normal platelet count. A bone marrow aspirate is crucial in patients with bi/pancytopenia.
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Primary synovial chondromatosis of knee with both intra-articular and extra-articular involvement: A case report with delayed diagnosis p. 46
Pradosh Kumar Sarangi, T Seetam Kumar
Primary synovial chondromatosis (PSC) is an uncommon benign disease process of unknown etiology in which the synovium undergoes metaplasia, leading to cartilaginous nodules that progressively undergo detachment, mineralization, and even ossification forming loose bodies. It is usually a monoarticular disease with involvement of large joints with knee being the most common. Involvement of smaller joints such as distal radioulnar, tibiofibular, metacarpophalangeal, and metatarsophalangeal joint has also been reported. This disease process is usually intra-articular. Involvement of extra-articular tissues such as bursae and tendon sheaths is rare, and combination of intra- and extra-articular diseases described here is an extremely rare condition. Herewith, we report a male patient with PSC of left knee with involvement of suprapatellar bursa who presented with recurrent knee swelling and pain with diagnostic delay of 2 years. We have also highlighted the role of imaging in the early diagnosis of this disease and briefly reviewed relevant literature.
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