Traumatic Ulcerative Granuloma with Stromal Eosinophilia: Sinister Appearing Innocuous Lesion

Trauma within the oral cavity is one of the common incidence of occurrence which can be an inducer as well as propagator for wide range of oral lesion of diverse course. A unique combination of formation of granulomatous lesion with reactive eosinophilic stromal infiltration in response of trauma is “traumatic ulcerative granuloma with stromal eosinophilia (TUGSE)”. It is a reactive, infrequent, self-limiting condition of oral mucosa. The commonly involved site and the clinical presentation might click to suspect it as a lesion of oral cancer. Clinical history and examination guide through the diagnosis whereas histopathology forms the basis of the diagnosis.

Duodenal Gastrointestinal Stromal Tumour Imitating as Pancreatic Head Tumour: A Typical Case of Whodunit

Duodenal gastrointestinal stromal tumours (D-GISTs) are rare disease. It may arise commonly from second or third part of the duodenum and can be erroneously diagnosed as a pancreatic head tumour due to proximity and morphology on imaging studies. We present a case of a sixty-year-old woman who presented with abdominal pain and was diagnosed as a case of pancreatic neuroendocrine tumour on radiologic imaging and granulomatous lesion on aspiration cytology. On laparotomy, a ~5x3 cm mass was noted in the pancreatic head and pancreatoduodenectomy was performed. Histopathology reported an exophytic GIST arising from the second part of the duodenum.Hence, D-GIST can invade into the pancreas and mimic pancreatic head tumour; therefore, these tumours should be kept in the differential diagnosis of an atypical pancreatic head mass.

A Conservative Management Approach for Unusual Presentation of Oral Actinomycosis

Actinomycosis is gram-positive saprophytic infection that is characterized by chronic suppurative and granulomatous lesion. It could be found in the oral cavity, lungs, colon, and genital area. In the oral cavity, it is commonly associated with infected root canals presented as persistent infections. This case reports demonstrate an atypical presentation of actinomycosis in the lower left mandibular canine/premolar area showing painless soft tissue lesion associated with bone sequestration. Nonsurgical curettage of the lesion followed by nonsurgical root canal treatment and retreatment to the offended teeth was determined as the treatment modality for this case.

Polyarthritis and erythema nodosum: an unusual presentation of tuberculosis

Reactive arthritis and erythema nodosum occur in presence of active tubercular infection and both are immunological phenomenon. Author described a case report of a 17year old female with 10months history of symmetrical polyarthritis and presence of healed lesions of erythema nodosum. She was also found to have caseating granulomatous lesion in right supraclavicular lymph node which led us to diagnosis of tuberculous lymphadenitis presenting as reactive polyarthritis (poncet’s disease) and erythema nodosum. Her joint pain and swelling dramatically resolved after 2weeks of ATT. Thus, tuberculosis may manifest as reactive polyarthritis (poncet’s disease) and erythema nodosum and they should be kept in mind even in the absence of other clinical clues of TB, to provide patients with a good clinical outcome.

An atypical case of rhinosporidiosis: a case report

<p class="abstract">Rhinosporidiosis is an infective chronic granulomatous lesion caused by an organism rhinosporidium seeberi, which is seen endemic in some parts of Asia. This organism is difficult to culture and the diagnosis is based on histopathological examination. This disease is more commonly seen in men, in second to third decade..<strong> </strong>This case report is regarding a case of a 55 years old lady with history of recurrent rhinosporidiosis in nose. The lesion was found to arise from the inferior meatus and was pale smooth glistening in appearance, insensitive and does not bleed on touch. Site of origin of the polyp and the appearance was atypical of that of rhinosporidiosis. Patient was subjected for endoscopic excision and cauterisation of the base of the lesion and sent for histopathological examination .Biopsy confirmed the diagnosis of rhinosporidiosis.</p>

A histopathological study of granulomatous lesions

Background: Granulomas are the commonest lesions that the pathologists come across in routine practice. Granulomatous inflammation is a special type of chronic inflammation that is a manifestation of many infective, toxic, allergic, autoimmune and neoplastic diseases and also conditions of unknown etiology. The aim of this study is to analyze different granulomatous lesions and to find the frequency and etiology of all granulomatous lesions.Materials and Methods: The study included a total of 218 granulomatous lesions, received over a period of one year from July 2013 to June 2014 in the department of pathology, TUTH. Special stains like Ziehl-Neelsen, PAS and Wade- Fite- Faraco were done whenever required.Results: Granulomatous lesion accounted for 3% of all biopsies. The median age of the patients was 29 years and the majority of the patients were in the age group of 20-29 years with no sex predilection. Majority of granulomas were seen in lymph nodes (32.1%), followed by skin and subcutis (29.4%), and bones and joints (11%). Tuberculosis was the most common cause of granuloma with 143 (65.6%) cases, followed by leprosy, foreign body and fungal infection. The most common type of granuloma was epithelioid (87.2%), followed by epithelioid with suppuration, histiocytic, foreign body and mixed inflammatory.Conclusion: The granulomatous lesion is common in third decade of life with no sex predominance. The commonest site is lymph node with tuberculosis being the most common cause followed by leprosy. The epithelioid type was the most common type of granuloma.