Utility of Immunohistochemical Studies in Differentiating Diagnostically Challenging Radiation-Induced Atypia from Recurrent Squamous Cell Carcinoma: A Case Report and Literature Review, with a Proposed Algorithm for Differentiation

Tuberculosis (TB) is remains as major public health concern. According to WHO reports in 2018, it estimated 10.7 million TB cases throughout the worldwide. Also there are 1.6 million died from TB and 558,000 rifampin-resistant TB (RR-TB) in 2017.

Introduction: Primary and isolated hydatid cysts of the spleen are very rare seen even in endemic country. We report here our experience with primary and isolated splenic hydatid cysts.

Methods: We retrospectively analyzed the record of eight cases of primary and isolated spleen hydatid cyst that treated in Arya and Razi Hospital, Iran, Rasht.

Results: Among eight patients, who underwent treatment for primary and isolated splenic hydatid cyst disease, five patients were male and three patients were female. The mean average cyst diameter was 8 cm (4-15cm). Four of patients underwent splenectomy as the surgical procedure and three of patients underwent cystotomy, partial cystectomy, and omentoplasty processes as a spleen preservative surgery. One case underwent medical treatment with albendazole because the size of cyst was 4 cm. Three patients out of eight could not undergo splenectomy because in two of them the cyst was localized in the lower pole of the spleen and in another patient it was localized in upper pole of the spleen.

Conclusion: Primary and isolated splenic hydatid cyst is very rare. A hydatid cyst must be included in the differential diagnosis of other cystic lesions of the spleen. The best toll for diagnosis is the abdominal tomography and U&S. A splenic hydatid cyst should be treated surgically due to the high risk of a rupture, and the ideal procedure in adulthood is standard splenectomy. The outcome of treatment is good without recurrences.

Dermatophytosis infections are caused by dermatophytes. Drug resistance and toxicity associated with long-term treatment with conventional antifungal drugs has necessitated search for new drugs to treat fungal infections. Natural products found in plants have been scientifically proved to avoid these side effects. The aim of this study was to formulate herbal antifungal cream containing extract of Acalypha wilkesiana as an anti-dermatophytic preparation and evaluate its physicochemical properties, stability and efficacy of the product. The formulated creams containing 0.5, 1 and 2% w/w of extract were subjected to stability tests using temperature variation method at -10, 4, 30, 37 and 45oC. Freeze-thaw test, Centrifuge test, pH and exposure to UV light test were also carried out using standard method. Efficacies of the cream formulations were determined using albino rats

The percentage yield of the extract was (10.2%). Percentage ethanol phytochemical composition indicated that for Alkaloid it is 4.58 ± 0.01%, saponins (3.10 ± 0.23%), flavonoids (1.61 ± 0.04%) and tannins (0.81 ± 0.02%).The antifungal results are in the increasing order Microsporum audounii = Epidermophyton floccosum < M.furfur < Trichophyton mentagrophtes. Temperature stability tests carried out indicated that the cream was very stable. Centrifuge testing indicated that there was no separation of the cream. Light testing indicated no change in the colour and odour of the products. There was no change observed in all the test samples during the freeze-thaw testing. Animal studies evaluation of the ethanolic formulations of the cream indicated that their efficacy against the dermatophytes is concentration dependent and the efficacy is in the increasing order M.audounii < E.floccosum < M.furfur < T.mentagrophyte which shows that 2% Acalypha wilkesiana cream was statistically significant (P<0.05) against all the test microorganisms.

There is numerous evidence for the efficacy of curcumin on the treatment of infectious disease particularly tuberculosis infection. According to review of the literature, curcumin could be considered as a therapeutic option against tuberculosis; but given that immune modulatory of curcumin in immune-response and limitation of data about the main mechanism of curcumin during tuberculosis infection; we discuss the probability of curcumin as a novel treatment option for tuberculosis disease using current evidence.

Introduction: Hydatid cyst is a condition commonly affecting liver and lungs caused most commonly by Echinococcus granulosus where as musculoskeletal or subcutaneous hydatidosis is very rare. and Usually are secondary and resulting from the spread of cysts from other organs, either spontaneously rupture or after spreading from operations for hydatidosis in other regions.

Case Presentation: We present an unusual case of a primary hydatid cyst found in the subcutaneous scalp tissue under occipital region in a 36 year man. Clinical presentation of patient was a huge cystic mass. Ultrasound findings revealed a cyst lesion in the posterior aspect of neck under the occipital region. MRI show a cystic lesion. We removed the entire part of cyst lesion surgically. Macroscopic and microscopic histopathological examinations confirmed the diagnosis of subcutaneous hydatid cyst.

Conclusion: In regions where hydatid disease is endemic, a cystic lesion in any part of the body should be considered a hydatid cyst. The best treatment is surgery and total evacuation of the cyst elements without any spillage of cyst contained and postoperative albendasol therapy.

Intrapericardial Diaphragmatic Hernia (IDH) is the rarest type of adult diaphragmatic hernia and colon obstraction. Only a few cases have been reported. Blunt trauma has been implicated in most cases, but few cases were reported from a stab wound to the anterior chest. Patients presented immediately or up to 15 to 20 years following trauma with symptoms which include of: intermittent bowel obstruction, strangulation, cardiac dysfunction, dyspnea, palpitations, and even cardiac tamponade. The most unusual site for a diaphragmatic hernia to occur is through the central tendon of the diaphragm into the pericardium. Physical findings included bowel sounds in the chest, decreased heart and lung sounds, and an absent point of maximal cardiac impulse. We present the case of a 67-year-old man who suffered a bowel obstruction when the transverse colon and omentum became incarcerated in the intrapericardial cavity from diaphragmatic hernia. Defect presumably resulted from blunt chest and abdominal trauma received six month earlier. Laparatomy is the preferred approach to surgical repair of IDH. Since the symptoms referable to adult IDH can be incapacitating or life threatening, herniorrhaphy should be performed promptly upon diagnosis. In this very rare case with delayed presentation of intrapericardial diaphragmatic hernia, we want to review the symptoms, recommendations of evaluation and the best approach of treatment and outcome of treatment.

Recurrent respiratory papillomatosis is a rare and recurring disease characterized by chronic benign papillomas of the epithelial mucosa in the respiratory tract. It is exclusively caused by human papilloma virus. While the majority of human papilloma virus infections are self-limited, some persist, as is the case in recurrent respiratory papillomatosis. Diagnosis is usually achieved by surgical biopsy and the utility of immunohistochemistry studies. Studies showed that cytology specimens in form of fine needle aspiration could provide definite diagnosis of this entity, especially when cytologic sampling is sufficient to produce a cellblock to be utilized for ancillary studies. We report a case of this rare entity diagnosed solely by cytologic sampling. We also discuss the pathophysiology and management modalities.

Benign cystic hypersecretory hyperplasia and cystic hypersecretory duct carcinoma of the breast share similar histologic features including formation of cystically dilated ducts containing a homogeneous eosinophilic secretion that resembles thyroid colloid. However, cystic hypersecretory duct carcinoma of the breast is associated with proliferative malignant epithelium. Cystic hypersecretory lesions of the breast present with a varying morphologic features in the same mass. Strict histomorphologic criteria and confirmatory immunohistochemistry studies are essential for definitive diagnosis and appropriate management. We present a case where secretory proliferation of a breast mass displayed spectrum of changes from benign hyperplasia, to atypical hyperplasia, to frank ductal carcinoma in situ. Due to limited reported cases of these entities, little is known about the biological behavior, prognosis and molecular study of these lesions. By reporting more cases, we may reveal the biologic behavior of these uncommon lesions.

Epithelioid hemangioendothelioma and epithelioid angiosarcoma are both rare malignancies of endothelial origin. Differentiation of these two diagnoses remains difficult due to their heterogeneous presentation and overlapping morphological features. Here we report a case of a 58-year-old female clinically presenting with primary hepatic vascular neoplasm. She was finally diagnosed with Epithelioid Hemangioendothelioma (EHE) based on cytology sampling and core biopsy. The immunohistochemical (IHC) studies and morphological features of this case may be suggestive of a continuum with Epithelioid Angiosarcoma (EAS). Given the mixed findings exhibited, a plausible intermediate diagnostic entity may be proposed, and further studies are warranted to investigate this possible intermediate variant with optimal management and follow up.

Solitary fibrous tumors are rare and difficult to diagnose. The occurrence of this entity in the head and neck region constitutes approximately 6% of the cases and is associated with higher rates of recurrence. We report a case of a 61-year old male diagnosed with this rare tumor by fine needle aspiration.