Epidemiology and the diagnostic challenge of extra-pulmonary tuberculosis in a teaching hospital in Ethiopia

Background Ethiopia reported a high rate of extra-pulmonary tuberculosis (EPTB) and the cases are increasing since the last three decades. However, diagnostic evidence to initiate TB treatment among EPTB cases is not well known. Therefore, we described the epidemiology and assessed how EPTB is diagnosed in a teaching hospital in Ethiopia. Methods We conducted a retrospective review among all adult EPTB cases diagnosed in Yekatit 12 Hospital Medical College from 2015 to 2019. Using a standardized data abstraction sheet, we collected data from patients’ medical records on sociodemographic, sites, and laboratory diagnosis of EPTB cases. Results Of the 965 total TB cases, 49.8%(481) had a recorded diagnosis of EPTB during the study period. The mean age of EPTB patients was 32.9 years (SD±13.9) and 50.7% were males. Tubercular lymphadenitis (40.3%), abdominal (23.4%), and pleural TB(13.5%) were the most common sites of EPTB involvement, followed in descending order by the genitourinary, skeletal, central nervous system, abscess, breast, and laryngeal TB. We found a histopathology finding consistent with EPTB in 59.1% of cases, Acid-fast bacilli positive in 1.5%, and the rest diagnosed on radiological grounds. In the majority of cases, more than one diagnostic method was used to diagnose EPTB cases. Conclusions Nearly half of TB patients had a recorded diagnosis of EPTB that comprise heterogeneous anatomical sites. All EPTB patients were started anti-TB therapy without definitive microbiology results. This indicates the diagnostic challenge of EPTB faced in our setting and proves to be significant for TB control in Ethiopia.

PREVALENCE OF NASOPHARYNGEAL CARCINOMA PATIENTS IN DEPARTEMENT OF ORL-HNS HASAN SADIKIN GENERAL HOSPITAL 2010 -2017

Introduction: Nasopharingeal Carcinoma starting from Rosenmuller fossa and intracranial or local spread as a mass in the head area. Nasopharyngeal carcinoma is also associated with hearing problems, serous otitis media, tinnitus, nasal congestion, anosmia, nose bleeding, difficulty swallowing, and dysphonia. Nasopharyngeal carcinoma is a disease that spreads globally and divides races around the world. The purpose of this study is to determine the prevalence of nasopharyngeal disease in Otorhinolaringology-Head and Neck Department, Dr. Hasan Sadikin General Hospital Bandung in 2010-2017. Methods: Medical record method description of Nasopharyngeal Carcinoma at Departement of Otorhinolaringology- Head and Neck Surgery, Dr. Hasan Sadikin General Hospital Bandung in 2010-2017 that used sampling method. Results: There were 1378 patients nasopharyngeal carcinoma, 976 people that included, 657 were men and 319 were women. Obtain most elementary school education (54.9 %) the majority of male patients (67.3 %) with various job background, whereas female patients were housewives (28.1%), and those aged 41-50 years (34%). Most histopathology are undifferentiated carcinoma (58.3 %). Conclusion: Nasopharyngeal Carcinoma patients at the Otorhinolaringology-Head and Neck Surgery Departement. Dr. Hasan Sadikin General Hospital Bandung are 1378 cases. There was higher instance in middle age, and older men and elementary school educated with major histopathology finding was undifferentiated carcinoma

Role of FNAC in evaluation of Parotid Gland Swelling

Objectives: To find out the histological types of parotid neoplasm and to correlate thefindings of FNAC and final histological report in parotid gland neoplasm. Methods: A total 30 cases were studied from the inpatient departments of General Surgeryand Otolaryngology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka sinceJuly, 2011 to April, 2013. Fine Needle Aspiration Cytology (FNAC) was done in all cases andcompared with histopathology finding of postoperative specimen. Result: Regarding sex distribution benign neoplasm in female 13 (56.52%) and in male10(43.47%). As to the malignant parotid neoplasm in female 4(57.14%) and in male3(42.85%). All parotid neoplasm male: female ratio 1:1.3. Two cases involved in deep lobeof parotid & presented with inward and forward bulging of tonsil and pillars. Three cases ofwarthin'stumour only presented with swelling in the tail of parotid gland. In this series outof 30 cases of parotid neoplasm 23 (76.66%) cases were benign and rest 07 (23.33%)were malignant. Pleomorphic adenoma was the most common benign neoplasm 20(66.66%). Mucoepidermoid Carcinoma was most common malignancy 3 (10%) followed byadenoid cystic carcinoma 2 (6.66%). Out of 7, 3 were stage 3(42.85%) and 3 were stage4(42.85%). In histological grading 3 were low grade (42.85%) and 4 were high grade(57.14%). All the patient werepartotidectomy. Few were treated by radical parotidectomyplus radiotherapy. Conclusion: Though it is a small series to comment on the whole spectrum of the parotidgland neoplasm in Bangladesh, yet an idea about the frequency of disease can be establishedbut actual incidence in Bangladesh as a whole can not be ascertained from thisstudy. Journal of Surgical Sciences (2016) Vol. 20 (1) : 7-12

Intraosseous lipoma of the mandible: A rare case report

The lipoma is 5% of benign tumors and 25 to 50% of soft tissue tumors. It most occurs in the upper trunk area, neck and the extremities. But it is rare in the oral and maxillofacial area. It is a benign lesion composed of fat mature adipose tissue that Separated with fibrous septa and surrounded with a thin fibrous capsule. Jaw Intraosseous lipoma is very rare, and its prevalence has been mentioned in articles 1.0%. The case of this manuscript was a 33-year-old woman who referred to an orthodontic specialist with a complaint about the tooth crowding and requesting orthodontic treatment. Based on clinical, radiography and histopathology finding, a diagnosis of intraosseous lipoma of the mandible was made.

Predictor factor of inguinal lymph lode metastasis in men with penile cancer at Sanglah General Hospital, Denpasar, Bali

Background: To know predictor factors of inguinal node metastasis in penile cancer. Methods: A retrospective study about penile cancer in Sanglah Hospital, Bali, from 2011 to 2015. Patients had undergone partial or total penectomy, and inguinal node dissection or excisional biopsy for histopathology finding. Results: A 65 penile cancer patients were diagnosed for 5 years. Mean age was 53,24 ± 13,42 years. Fifteen were excluded and 25 of 50 patients (50%) had inguinal node metastasis. There were significant correlation between pathologic stage (p=0,021), histologic grade (p=0,020) and vascular invasion (p=0,008) with the presence of inguinal node metastasis. Primary tumor of pT1 showed 14% inguinal node metastasis compared to pT2 (42%), pT3 (67%), and pT4 (100%). Histologic grade I, had 22% inguinal node metastasis compared to grade II (50%), and grade III (100%). Only 39% patients without vascular invasion had inguinal node metastasis compared to 83% with vascular invasion. Conclusion: Pathologic stage of primary tumor, histologic grade and vascular invasion were predictor factors of inguinal node metastasis in penile cancer.

Evaluation of validation of Anderson score for diagnosis of acute appendicitis by histopathology

Background: Appendicectomy is a very common operation performed. Removing normal appendix leads to multiphasic problems. Furthermore, appendix has proved to be a useful structure in reconstructive surgeries. We are going to evaluate validation of Anderson score for diagnosis of acute appendicitis and confirm the result by histopathology.Methods: This prospective observational study was performed in Surgery Department in SGT Medical College, Gurugram, Haryana. Total patients were 100. A detailed history was taken, clinical examination and investigations were done. All patients were subjected to Anderson score. Patients were operated. Appendix was sent for Histopathology examination. Analysis of the data was done by SPSS software version 23. Sensitivity, specificity, positive predictive value and negative predictive values were found out. Chi square test was duly applied.Results: In 70 patients, Anderson score was >8, was in favour of acute appendicitis. It means these patients should require surgery. In 30 patients score was <8. Most common histopathology finding was acute appendicitis then diffuse suppurative appendicitis followed by gangrenous appendicitis still followed by diffuse suppurative appendicitis with peri appendicitis.Conclusions: we have found out that if Anderson score is ≥8, appendicectomy should be done. But if Anderson score is <8, as per Anderson scoring system, appendicectomy should not be done, but we should not go by this. We should review the patient, further investigations should be carried out, senior surgeon’s opinion should be taken, and then final decision should be taken.

Temporoparietal Gliosarcoma : A Case Report with Literature Review

Gliosarcoma (GSM) is a primary tumor of the central nervous systemcomposed of both malignant glial and sarcomatous elements. GSM isclassified as grade IV according to World Health Organization (WHO)and regarded as aggressive tumor and often requires both surgeryand radiotherapy. The incidence of GSM is between 1.8%-2.8% ofall malignant gliomas and thus represents an exceptionally rareneoplasm. Consequently, our knowledge about this entity is limited tosmall retrospective case series and case reports. Here, we describe acase of a 46-year-old male with progressive right extremity weakness,accompanied with aphasia. Imaging studies showed a tumor mass inthe left temporoparietal region. Surgery was performed and gross totalremoval was achieved. Histopathology finding established a diagnosisof GSM. The extremity weakness was improved postoperatively withina week.

Genital superficial basall cell carcinoma - a case report / Bazocelularni karcinom kože u genitalnoj regiji - prikaz slučaja

Basal cell carcinoma (BCC) is the most common type of skin cancer in the Caucasian population. However, BCC of the genitalia is extremely rare. To the best of our knowledge, only 30 patients with BCC of the genitalia have been reported in the literature so far. BCC usually occurs in individuals over the age of 50, on sun-exposed areas of the body, and it is more prevalent in females. Superficial BCCs account for approximately 10% of BCC, and are commonly found on the trunk or limbs. This is a report on a 55-year-old male patient with penile BCC, and a literature review on this condition. The patient presented with asymptomatic skin lesions in the genital area which progressed during the last 15 years. Before admission, the patient received: antimycotics, antiviral, antibacterial and corticosteroid therapy, but without any improvement. Examination of the proximal penile skin revealed a sharply marked, smooth and shiny erythematous plaque of about 3.3 x 2 cm, with whitish squamae in the central zone. The histopathology finding revealed a superficial BCC and total excision was recommended. Treatment of the superficial BCC depends on its size and location. It includes surgical removal with possible reconstruction, radiotherapy, application of immunomodulators, local chemotherapy and local retinoid therapy. Although this is an extremely rare type of BCC, it is important to keep in mind that it may affect body areas seldom exposed to direct sunlight.