We present a rare case of a 30-year-old woman who presented with a swelling on the lateral aspect of her left forearm, present since 6 months, adjacent to a 16-year-old burn scar. X-ray of elbow joint and forearm revealed the subcutaneous nature of the swelling. Giemsa and periodic acid-Schiff-stained smears and potassium hydroxide mount of fine-needle aspirate of the swelling revealed dematiaceous, branching, and septate fungal hyphae. Fungal culture of the aspirated pus showed growth of Exophiala jeanselmei. Histopathological examination revealed brown-coloured hyphae with foreign body giant cell reaction and palisading granulomas in the surrounding tissue. The patient was successfully treated with surgical excision of the swelling. All the cases of phaeohyphomycosis due to Exophiala spp. in India are also reviewed.
Malignant transformation in a mature cystic teratoma (MCT) is rare occurring in 1.8% out of 8000 cases of MCT. The most common histological types are squamous cell carcinoma (SCC) followed by adenocarcinoma and melanoma. Clinically, these tumors are usually asymptomatic but may be discovered accidentally during gynecologic examination due to mass effect. We present cytology and histology correlation of a rare case of SCC arising in a dermoid cyst with metastasis to sigmoid.
<p class="abstract"><strong>Background:</strong> The two most frequent types of microcytic hypochromic anemia in developing countries are beta thalassemia trait (𝛽-TT) and iron deficiency anemia (IDA). Several indices using blood cell count parameters have been suggested to differentiate between two. In this study we evaluated the reliability of three indices.</p><p class="abstract"><strong>Methods:</strong> The present cross-sectional study was carried out in 300 pregnant females in third trimester. Out of these, 90 microcytic hypochromic females were selected. Mentzers index, red cell distribution width index and Matos and Carvalho index (MCI) were calculated from the regular 3-part analyser haematological parameters.  </p><p class="abstract"><strong>Results:</strong> The Mentzer index was the most reliable index, as it had the highest sensitivity (97.62%), specificity (66.67%), and Youden’s index (64%) for detecting Iron deficiency anaemia; the Matos and Carvalho Index showed higher sensitivity (98.81%)but a much lower specificity (33.3%) and Youden’s index (32%) while the red cell distribution width index showed the sensitivity and specificity of 92.86% and 66.67%, respectively with Youden’s index of 59%.</p><p class="abstract"><strong>Conclusions:</strong> The Mentzer index provided the highest reliabilities for differentiating<strong> </strong>IDA from 𝛽-TT. The new indices have high sensitivities and positive predictive value for identifying IDA, making them useful for screening population at risk. </p>
Primary retroperitoneal teratomas are uncommon extragonadal nonseminomatous germ cell tumors that are composed of well differentiated parenchymal tissues which are derived from more than one of the three embryonic germ cell layers. Here we report an unusual and first of its kind, a case of primary mature cystic retroperitoneal teratoma mimicking as adrenal tumor in a 7-month-old female in which the tumor was predominantly composed of neurogenic tissue histologically which is unlike the usual pattern seen in the teratomas.
Loss of abdominal wall substance is a major cause of incisional hernia formation. It makes repair of this iatrogenic human ailment a difficult surgical problem. The abdominal wall substance loss has compelled the world's surgical community dealing with this condition to substantiate the repair with extra material such as skin, fascia, wire mesh, and lately biocompatible synthetic mesh. Even though the synthetic mesh is compatible and well tolerated by body tissues, it is not without complications. Regenerative repair in the region of the abdominal wall with substance loss is probably the best repair if it can be achieved. With reasonable success in animal experiments and the positive regenerative capacity of stem cells to transform the peritoneum into an aponeurotic layer, the new technique using a Marlex peritoneal sandwich for repair of large incisional hernias was attempted but was not reported in the article published in the World Journal of Surgery in 1991. The present study is based on experiments on seven mongrel dogs. A suitable embryonal segment of autogenous peritoneum was excised and transferred to the rectus sheath region. The gross appearance of the grafted membrane 3 months after operation revealed tough, thick tissue formation. The histology confirmed the presence of collagen fiber tissue in layers similar to the aponeurosis in the grafted peritoneal membrane. The use of this regeneration in the Marlex peritoneal sandwich technique of repair of large incisional hernias and the scientific rationale of tissue regeneration by desired metaplasia is discussed.
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