No abstract

Diabetic macular edema (DME) is a common cause of moderate visual impairment among people with diabetes. Due to the rising number of people with diabetes in India, the absolute numbers of people with DME are significant. There are several treatment options for DME, and the choice of treatment is based on the availability of retinal specialists and infrastructure for the delivery of treatment. A major challenge is the out-of-pocket expenditure incurred by patients as most treatment options are costly. Treatment also varies based on the associated ocular and systemic conditions. The All India Ophthalmology Society (AIOS) and the Vitreo-Retinal Society of India (VRSI) have developed this consensus statement of the AIOS DR task force and VRSI on practice points of DME management in India. The objective is to describe the preferred practice patterns for the management of DME considering the different presentations of DME in different clinical scenarios.

A 58-year-old male presented to the Outpatients Department for a painless swelling of great toe of right foot, of six months duration. Physical examination revealed a well-defined, firm, fixed, swelling of 2x2 cms on the distal phalanx of great toe of right foot. X-ray of the mass showed a dense soft tissue mass, with no bone involvement. The same was excised and sent for a histopathological examination.Gross examination revealed a well-defined mass of 2x2 cms. Cut section showed a firm, whitish tumour with gelatinous and chalky white areas of calcification, which were covered by a piece of skin on one side [Table/ Fig-1].Microscopic examination showed structure of skin with a tumour in the dermis, which was arranged in lobules which were separated by fibrous septa [Table/ Fig-2,3]. There were islands of mature hyaline cartilage, myxoid areas and foci of granular calcification. Some of the chondrocytes showed atypical nuclei 4]. A histopathological diagnosis of an extraskeletal chondroma was made. DisCussionESC-Soft tissue chondroma is a rare benign cartilaginous tumour and nearly 80% of ESCs are found in the fingers and the rest is seen in hands, feet, toes and trunk [1][2][3][4][5]. Few cases are reported at rare sites like dura, larynx, pharynx, oral cavity, skin, fallopian tube and parotid gland [6][7][8][9][10][11][12]. Pathology Section aBstRaCtExtraskeletal Chondroma (ESC) is uncommon which occurs predominantly in hands and feet. It has a variable histology, with two thirds of the ESCs showing mature hyaline cartilage which is arranged in distinct lobules with fibrosis, or ossification, or myxoid areas and few showing immature patterns, with chondroblasts mimicking extraskeletal myxoid chondrosarcomas (ESMCSs). ESCs can recur but they never metastasize, whereas ESMCSs can metastasize, which require aggressive treatment.We are reporting a case of ESC which was located in the distal phalanx of right foot great toe in a 58-year-old male patient. The histopathology in our case showed features of ESC, with some foci showing myxoid stroma and few chondroblasts with atypical pleomorphic nuclei mimicking ESMCS. Hence, the case had to be carefully evaluated to exclude ESMCS and to make the diagnosis of ESC. The treatment was limited to simple excision of the tumour and extensive surgery and post operative radiotherapy were avoided.