Tumors of accessory parotid gland are considered in the differential diagnosis of a mid cheek mass. Parotidectomy is the procedure of choice. All pathological types of parotid main gland tumors occur in the accessory parotid gland also. Presenting as a mid cheek or infrazygomatic mass, the tumors of this accessory parotid gland are notorious for recurrences, if adequate margins are not achieved. We describe two such cases of such a tumor. 40-year-old male with a slowly progressive mid cheek mass was operated by a mid cheek incision. Histopathology of the tumor was pleomorphic adenoma. Facial nerve paresis recovered complelety in 6 months. A 52-year-old female with progressive mid cheek mass who underwent parotidectomy and neck dissection by a modified Blair's incision was diagnosed with extranodal marginal zone lymphoma with focal transformation to a diffuse large B-cell lymphoma. Chemotherapy with CHOP regime was initiated. There was no recurrence at 6 months of follow-up. Lymphoma of accessory parotid gland is a very rare tumor. Standard parotidectomy incision is advocated to prevent damage to facial nerve branches.
Lymphoma of the salivary gland accounts for 5% of cases of extranodal lymphoma and 10% of malignant salivary gland tumors. Most primary salivary gland lymphomas are B marginal zone lymphomas arising on a background of sialadenitis associated with an autoimmune disorder such as Sjorgen's syndrome. This report describes a case of primary B-cell lymphoma arising in the parotid gland in a middle-aged female, which was not associated with an autoimmune disorder. Immunohistochemistry studies confirmed the clonal B-cell nature of the tumor. This case highlights the fact that B-cell lymphoma in the salivary gland can go unrecognized due to its non-specific symptoms and requires immunohistochemistry studies for confirmation. We present this case for its rarity.
A 60-year-old female presented to the Emergency room with complaints of diffuse lower abdominal pain for one day duration with three episodes of haematochezia over eight hours duration. On examination, she had pallor and tachycardia. On clinical examination of abdomen, there was tenderness, mild guarding, rebound tenderness and an ill defined mass in the right iliac fossa. On rectal examination, blood staining of digit was present. The laboratory tests showed haemoglobin of 8 gm% and leukocytosis 16000 cells/mm 3 . Chest and abdomen X-rays were normal. Ultrasound abdomen reported an ill defined mass in RIF with minimal free fluid and probe tenderness. CECT of abdomen demonstrated a peripheral enhancing, encapsulated abscess in RIF, in close contact with base of caecum and adjacent peritoneal inflammation, suggesting a sealed caecal perforation [Table/ Fig-1].abdomen was closed in layers.Pathological findings: Pathological examination revealed a 6 cm x 5 cm x 3 cm submucosal mass extending into the antimesenteric Gastrointestinal Stromal Tumours (GISTs) are tumours of the gut found mostly in stomach and small intestine. The complications are Gastrointestinal (GI) bleeding, obstruction, pain and rarely perforation. We are reporting an abnormal presentation of GIST masquerading as an acute abdomen with Right Iliac Fossa (RIF) mass in 60-year-old lady. Contrast Enhanced Computed Tomography (CECT) of abdomen revealed a peripherally enhancing encapsulated abscess in RIF in close contact with base of caecum and adjacent peritonitis suggesting caecal perforation. On laparotomy, a gangrenous perforated ileal GIST was identified along the antimesenteric border of ileum. Pathological examination confirmed the tumour to be a GIST of spindle cell type, further reiterated by immunohistochemistry. Our case report emphasizes, GIST as a rare and unusual differential diagnosis of RIF mass, and to have high degree of clinical suspicion when a similar situation is encountered in an emergency scenario, keeping in mind the poor outcome due to delay in appropriate management of the disease.
IntroductionOptimization of postoperative care is often contingent upon the risk stratification tools such as surgical scores that are used to prognosticate potential complications.AimThis study evaluates the utility of surgical Apgar score (SAS) as a tool to predict morbidity and 30-day mortality among patients post general surgical procedures.Material and methodsThe study cohort comprised of 400 patients aged between 15 to 75 years, and prospectively undergoing emergency or elective general surgery. SAS of patients were extracted from the anesthesiologist’s records on estimated blood loss, lowest heart rate and lowest mean arterial pressure. Post-operative outcomes such as major complications and mortality within 30 days of surgery were monitored.Results and DiscussionOut of the 297 elective procedures, 22 (7.41%) cases had major complications. While among those undergoing emergency surgeries (103), 38 (36.86%) patients developed major complications. The odds of developing major complications in patients with the high-risk SAS scores (31; 51.67%) was 5.42 (CI: 3.03–9.70) times greater than in patients with low-risk SAS scores (29; 48.33%). The odds of expiring after a general surgery was 11.92 times higher in high-risk patients (9; 75%) when contrasted with low-risk patients (3; 25%). The sensitivity and specificity of SAS in predicting major complications is 51.67% and 83.53%, respectively. The sensitivity and specificity of SAS in predicting mortality are 75% and 79.9%, respectively.ConclusionsSAS serves as a simple and dependable tool to predict morbidity and 30-day mortality in patients undergoing surgical procedures under anesthesia other than local, requiring intensive perioperative monitoring.
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