Histoplasmosis normally do not affect immunocompetent individuals. Prolonged exposure may cause chronic disseminated histoplasmosis. Elderly male patient presented with fever, hematuria and pain in right hypochondrium. He had pallor, fever and mild hepatosplenomegaly. Investigations revealed anemia and thrombocytopenia. Giemsa stained bone marrow aspirate showed yeast-like cells, suggestive of Histoplasma capsulatum. PAS stained bone marrow aspirate and biopsy confirmed the diagnosis.

Gliomas have substantial mortality to incidence rate ratio and a dismal clinical course. Newer molecular insights, therefore, are imperative to refine glioma diagnosis, prognosis and therapy. Meningioma 1 (MN1) gene is a transcriptional co-regulator implicated in other malignancies, albeit its significance in glioma pathology remains to be explored. IGFBP5 is regulated transcriptionally by MN1 and IGF1, and is associated with higher glioma grade and shorter survival time, prompting us to ascertain their correlation in these tumors. We quantified MN1, IGFBP5 and IGF1 expression in 40 glioma samples and examined their interrelatedness. MN1 mRNA-protein inter-correlation and gene’s copy number were evaluated in these tumors. Publicly available TCGA datasets were used to examine the association of MN1 expression levels with patient survival and for validating our findings. We observed MN1 overexpression correlated with low grade (LGGs) and not high grade gliomas (HGGs), and is not determined by copy number alteration of the gene. Notably, gliomas with upregulated MN1 have better overall and progression-free survival. IGFBP5 expression inversely associated with MN1 expression levels in gliomas but correlated positively with IGF1 expression in only LGGs. This suggests a potential grade-specific interplay between repressive and activating roles of MN1 and IGF1, respectively in the regulation of IGFBP5. Thus, MN1 overexpression, a promising predictor of overall and progression-free survival in gliomas, may serve as a prognostic biomarker in clinical practice to categorize patients with survival advantage.

No abstract

Myiasis is the infestation of the body by the larval forms (maggots) of dipterous flies. Ophthalmomyiasis or ocular myiasis refers to the inflammations that involve the eye and ocular adnexa. This may be external, internal, or orbital. Less than 5% of human myiasis cases involve eye. Ophthalmomyiasis varies in severity, ranging from simple irritation to complete destruction of the orbit. The condition is often misdiagnosed as an acute conjunctivitis. Globally, so far, most cases have been reported from rural areas. Here, we present 2 case reports. Both patients belonged to an urban area. The larvae were successfully removed, and both cases are being followed. These cases show that this infection is probably more common in urban areas than reported.

No abstract

Donovanosis is an acquired sexually transmitted disease predominantly affecting the external genitalia. The cervix is an uncommon site of involvement, and can clinically mimic carcinoma of the cervix. The imaging (MR) appearance of donovanosis has not been described previously in the literature. We report a case wherein the MR appearance of cervical donovanosis is indistinguishable from carcinoma of the cervix.

Inflammatory myofibroblastic tumor (IMT) is a rare tumor in the central nervous system (CNS), mostly being extracranial. Approximately 100 sporadic cases have been reported in the literature. The rarity of the tumor, its various histopathological characteristics, and its variable aggressive course render it difficult to diagnose and treat. IMT is generally a histological diagnosis which is rarely suspected preoperatively. It mimics other intracranial tumors such as giant cell tumor, hemangiopericytoma, anaplastic meningioma, plasmacytoma, and lymphoma. Rarely, it can present with a clinical picture which mimics a benign infective process, Rosai-Dorfman disease, or an idiopathic hypertrophic pachymeningitis. High index of suspicion is required as total resection of this lesion is mandatory to prevent recurrence. Here, we describe a case of a 10-year-old child which initially presented with clinical features mimicking chronic suppurative otitis media and radiological presentation of a small intracranial abscess. He was initially treated by an ENT surgeon who started him on intravenous antibiotics, but the patient was lost to follow up. He returned after 2 months with a large lesion at the same location. Histological examination revealed multiple spindle cells with plasma cells and lymphocytes scattered among these spindle cells. The spindle cells were immunopositive for smooth muscle actin and negative for epithelial membrane antigen, S100, and CD34.

Recent genome wide sequencing has identified mutations in IDH1/IDH2 predominantly in grade II-III gliomas and secondary glioblastomas which are associated with favorable clinical outcome. These mutations have become molecular markers of significant diagnostic and prognostic relevance in the assessment of human gliomas. In the current study we evaluated IDH1 (R132) and IDH2 (R172) in 32 gliomas of various grades and tumor subtypes. Sequencing analysis revealed R132H mutations in 18.7% tumors, while none of the cases showed IDH2 (R172) mutations. The frequency of IDH1 mutations was higher in females (21.4%) than males (11.1%), and it was significantly higher in younger patients. Histological analyses demonstrated presence of necrosis and micro vascular proliferation in 69% and 75% respectively. Interestingly, IDH1 mutations were predominantly present in non-necrotic tumors as well as in cases showing microvascular proliferation. Of the six IDH1 positive cases, three were glioblastomas (IV), and one each were anaplastic oligoastrocytoma (III), anaplastic oligodendroglioma III (n=1) and diffuse astrocytoma. In conclusion, IDH1 mutations are quite frequent in Indian glioma patients while IDH2 mutations are not observed. Since IDH mutations are associated with good prognosis, their use in routine clinical practice will enable better risk stratification and management of glioma patients.