No abstract

A 45-year-old gentleman presented to ENT outpatient clinic, Christian Medical College, Vellore, India with complaints of gradually progressive, painless, left sided neck swelling since past one year. It had increased in size over the past two months. There was no history of dryness of mouth, no intraoral discharge,dysphagia, fever, loss of weight or appetite or any comorbid medical illness. Neck examination revealed a 5 x 6 cm, well-defined, mass below the left angle of mandible with smooth surface and without any scars or sinuses over it. On palpation, the inspectory findings were confirmed. The swelling was non-tender, having well-defined borders with soft to firm consistency and was not fixed to overlying skin. There were no palpable lymph nodes in the neck. There was no intraoral swelling on bimanual examination. Based on these clinical findings a clinical diagnosis of salivary gland neoplasm was made, FNAC of the swelling was done but was inadequate for proper evaluation. Other possibilities of a soft tissue tumour and rare low grade lymphoma were kept in mind. Sialography was not indicated in this case and hence it was not carried out. Ct FindingsLeft salivary gland was enlarged with a large fatty lesion, 55mm x 45mm x 20mm, having a large mural component. Lesion had solid component in it measuring approximately 27 x 17 mm. with a few mottled densities [Table/ Fig-1]. There was no significant Pathology SectionOncocytic Lipoadenoma of Submandibular Gland: A Case Report lymphadenopathy. Surgery was done under general anaesthesia. Patient was positioned on a shoulder roll with head tilted to right side. Painting with betadine lotion was done followed by drapping. The incision was made in the skin crease 5cm below the angle of mandible and deepened through platysma. Both superficial and deep lobes were identified with preservation of mandibular nerve and hypoglossal nerve with ligation of facial artery and facial vein. A 5 × 5 cm large mass arising from the left submandibular gland was excised and submitted for histopathological examination. After securing complete hemostasis, cervical fascia and skin flaps were sutured back in position. Grossly, the tumour was lobulated, encapsulated mass with well-defined brown areas and adjacent greasy-yellow soft areas [Table/ Fig-2]. Histopathology examination revealed circumscribed tumour composed of lobules and sheets of oncocytes [Table /Fig-3,4]. Also, present were sheets and lobules of mature adipocytes, some of which are entrapped by the oncocytic nodules [Table /Fig-3,4]. There was patchy periductal chronic inflammation and fibrosis. There was focal sebaceous metaplasia at the edges of oncocytic nodules [Table/ Fig-5]. There was no evidence of lymphovascular or perineurial invasion or any extra capsular invasion. Immunohistochemistry was not indicated in this case due to obvious morphological findings, which were consistent with those mentioned in the literature. On a telephonic follow up, no recurrence of symptoms so far. Patient is due for a yearly follow-up duri...

Multiple lytic bone lesions in a child can be a manifestation of various diseases like Langerhans cell histiocytosis, metastatic neuroblastoma, leukemia, hyperparathyroidism, multifocal osteomyelitis and histoplasmosis. Disseminated histoplasmosis caused by Histoplasma capsulatum var. duboisii is well known to present with multiple osteolytic lesions in immunocompromised adults and is mostly restricted to the African subcontinent. Histoplasmosis seen in American and Asian countries is caused by Histoplasma capsulatum var. capsulatum, which presents with pulmonary and systemic manifestations and rarely bone involvement. We report a case of histoplasmosis, caused by H. capsulatum var. capsulatum with extensive lytic bone lesions in a 13 year old immunocompetent boy who presented with prolonged fever, weight loss and multiple boggy swellings. He responded to amphotericin and is currently on Itraconazole. This case is unique for extensive osteolytic lesions with H. capsulatum var. capsulatum infection in an immunocompetent child.

Ross syndrome is a rare dysautonomia characterized by a clinical complex of segmental anhidrosis or hypohidrosis, areflexia, and tonic pupils. A very few cases (≃50) have been reported in literature since its original description in 1958. Here, we report the case of a middle-aged homemaker from Odisha, India, who presented with complaints of segmental hypohidrosis for the past 7 years.