ObjectiveThe objective was to study megaloblastic anemia as a cause of pyrexia of unknown origin (PUO).Materials and MethodsWe conducted a study on 15 patients of megaloblastic anemia associated with fever, attending our hospital clinics over a period of 6 months.ResultsWhile 11 patients had symptoms suggesting foci of infection and responded well to intravenous antibiotics, 4 patients had neither any evidence of infection nor responded with empirical broad spectrum antibiotic treatment. They were treated with vitamin B12/folate therapy which led to marked improvement in fever within 48 h. Presenting complaints of the patients and severity/duration of fever along with other epidemiological data were also studied in each case.ConclusionThe present study led us to conclude that megaloblastic anemia forms an important and reversible cause of fever and should be ruled out in all patients presenting with PUO. This knowledge would help the physicians in adequate and timely management of these patients.
Squamous cell carcinoma (SCC) of upper gastrointestinal (GI) tract is an aggressive malignancy more common in older age group. Post 1970’s with advent of endoscopy and the discovery of H. pylori bacteria and with it’s role in malignancy of esophagus and stomach, detection rate of squamous cell carcinoma esophagus has increased subsequently. In this case report we present a case of squamous cell carcinoma gastroesophageal (GE) junction in a 15 years old female owing to its rarity in younger age. The patient presented in the surgery OPD with history of weight loss and dysphagia since the last 5 months. She also complained of epigastric pain and heartburn since the last 2 months. There was no past history of carcinoma of GIT in any family members. Upper GI endoscopy showed an exophytic growth at the GE junction. Histopathological examination of subsequent GE biopsy confirmed the diagnosis of micro-invasive squamous cell carcinoma while the stomach showed features of chronic atrophic gastritis. The patient underwent resection of GE junction through thoraco-abdominal approach followed by radiotherapy for any residual tumour. Our patient is doing well after 3 months post op follow up. This case report emphasises the rare occurrence of SCC in a teenage female with no family history and to consider it in the differential diagnosis in younger patients with similar complaints.
Lymphangioma is a relatively uncommon benign tumour occurring due to malformation of the lymphatic vessels. Lymphangioma in adults is a rare occurrence. Intraoral lymphangiomas occur most frequently on the dorsal tongue and rarely on the palate, buccal mucosa, gingiva and lips. Clinically, lymphangiomas of the oral cavity usually have a plaque formed of small thin-walled vesicles and similar in surface to frog eggs. We present a case of lymphangioma of the tongue in a 34-year-old male who presented with complaints of painless swelling in his tongue with difficulty in speaking for the last 25 days. CT scan revealed a lobulated sharp-contoured soft tissue communicating with the superficial planes with minimum vascularity in colour doppler studies. En masse excision of the firm, solid erythematous mass was performed which microscopically showed multiple dilated endothelial lined vessels filled with a proteinaceous fluid and lymphocytes. A diagnosis of lymphangioma of the tongue was given.
Small-round-blue-cell tumor (SRBCT) or a small-round-cell tumor (SRCT) is a group of malignant neoplasms which are seen more often in children (0-20 years-old) than in adults. They generally include Ewing's sarcoma, peripheral neuroectodermal tumor (PNET), rhabdomyosarcoma, synovial sarcoma, non-Hodgkin's lymphoma, retinoblastoma, neuroblastoma, hepatoblastoma, and nephroblastoma or Wilms' tumor as differential diagnoses of small round cell tumors. They have a characteristic appearance consisting of small round cells that stain blue on Hematoxylin and Eosin stained sections. They typically represent undifferentiated cells which are composed of primitive cells with minimal or no differentiation. Accurate diagnosis of these cancers is essential because the treatment options, responses to therapy and prognoses vary widely depending on the diagnosis. A multimodal approach is employed with fine needle aspiration cytology (FNAC) as an important modality of diagnosis for these tumors. We will discuss ocular retinoblastoma and neuroblastoma in our case series which were diagnosed on fine needle aspiration itself and were later confirmed on histopathological examination. This study was also undertaken to determine the utility and safety of intraocular FNAC as a supportive diagnostic tool where clinical features and imaging were found to be inconclusive.
Tuberculosis is a specific granulomatous infectious disease and a major cause of morbidity and mortality in the developing countries. Primary gingival tuberculosis is extremely rare and is often a forgotten entity. It usually manifests as an ulcer. Oral lesions usually appear as a secondary form of infection. We report a case of primary tuberculosis in a 22 year old female who presented to the dental out-patients department with complaints of diffuse gingival enlargement. The patient had no evidence of tuberculosis anywhere else in the body. The possibility of gingival enlargement due to drugs, leukemia, fungus and sarcoidosis was ruled out. Histopathology of the resected mass showed caseating epithelioid granulomas. Anti-tubercular therapy comprising of 4 drug regimen was administered. On follow up after 6 months, there was no recurrence of the disease. This case emphasizes the need for dental surgeons to include tuberculosis in the differential diagnosis of gingival enlargement for early detection of this highly infectious disease.
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