Gunshot wounds to the head are usually mortal injuries. We present a unique case of intracranial ricocheting of bullet without neurological deficits. Patient was treated conservatively with antibiotics for one week and prophylactic anticonvulsants for six weeks. Patient is doing well at six months follow up. Repeat X-ray skull showed that bullet was lying in the occipital region. It is recommended that deep seated bullets should be left behind as any attempt to remove that bullet may increase the morbidity and mortality. However close follow up of these patients is very important as these patients may come back with brain abscess.JNMA J Nepal Med Assoc. 2008 Jul-Sep;47(171):145-146.
Background: Penile cancer is now a rare condition. The low incidence of the disease makes a valid estimation of its prognosis difficult. In this study, we made an attempt and propose a nomogram to develop a prognostic rule that could predict the Cancer-Specific Mortality (CSM) free rates in patients with primary penile squalors cell carcinoma of the penis (PPSCC).Methods: This study included 1304 patients diagnosed with PPSCC between the years 2004 & 2011 and treated with penile tumor excision. Subjects were staged as per Surveillance, Epidemiology & End Results stage (SEER), American Joint Committee on Cancer (AJCC), TNM classification and tumor grade (TG). CSM free rates were determined. Univariate and multivariate Cox regression model was used to test the prediction of the CSM free rate. The predictive rule accuracy was created using the receiver operating characteristic curve.
Results: The clinico-pathological profile depicts a mean age of 64.66 ± 14.38 yrs. The most common primary site involved was glans penis (n= 483, 37%) and the disease was most commonly diagnosed at AJCC stage I (n= 670, 51.4%) disease. The cumulative 5-year CSM free rates according to Fine & Gray, & Kaplan-Meier methods were 81.8% and 79.8%, respectively. The predictive accuracy as per SEER stage, AJCC stage, TNM stage alone were 68.8%, 70.3%, 72.3%, respectively. When TG was combined, the predictive accuracy increased to 72.8%, 73.1%, and 75.0%, respectively. TNM stage with TG was most accurate in predicting CSM free rate compared to other models.
Conclusions: TNM stage with TG and AJCC stage with TG appear to have comparable accuracy to predict the CSM free rate in patients with PPSCC, the TNM stage with TG is the most accurate (75%) method to predict the CSM free rates. The addition of the TG variable improved the accuracy of these prognostic models.
A solitary fibrous tumour (SFT) is an unusual spindle cell neoplasm. It frequently arises from the serosal surface of pleural cavity but has recently been described in diverse extrapleural sites. Urogenital localization is rare and only 36 cases of SFTs of the kidney have been described on published report. We report a case of a large SFT clinically and radiologically thought to be renal cell carcinoma arising in the kidney of a 30- year-old female. The radical nephrectomy was performed. The tumour was a well- circumscribed, solid mass attached to the renal pelvis without necrosis and haemorrhage. Histopathologically, a spindle cell neoplasia with alternating hypo and hypercellular areas, storiform, fascicular and hemangipericytoma- like growth pattern and less cellular dense collagen deposits were observed. Immunohistochemical studies revealed reactivity for CD34, CD99 and Bcl-2 protein.
Castleman’s diseas is a rare lymphoproliferative disorder of unknown etiology. We report a 28 years old woman with solitary Castleman’s disease in the left pararenal space. This case was diagnosed preoperatively as renal cell carcinoma. The patient underwent a radical nephrectomy with dissection of pararenal mass. Histopathological examination of the surgically resected specimen showed the hyaline vascular type of Castleman’s disease. A preoperative diagnosis of Castleman’s disease is difficult; therefore, a surgical resection and histopathological evaluation can provide an accurate diagnosis of tumor. Taking this case into consideration, we suggest that Castleman’s disease should be included in the differential diagnosis of renal tumors. DOI: http://dx.doi.org/10.3126/jpn.v3i6.9004 Journal of Pathology of Nepal (2013) Vol. 3, 509-511
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