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We report a rare case of Good’s Syndrome (GS) or thymoma with immunodeficiency in a 48-year-old male patient. This condition presents in the fourth or fifth decade of life. GS should be suspected in a person presenting with recurrent bacterial infections with encapsulated organisms and opportunistic viral and fungal infections in the setting of thymoma, hypogammaglobulinemia and reduced or absent B cells. Our patient presented with chronic diarrhoea for the past three years, repeated esophageal candidiasis and a superior anterior mediastinal mass. Duodenal biopsy showed CMV duodenitis. Lab investigations revealed low IgM levels [hypogammaglobulinemia] and the biopsy from the mediastinal mass was consistent with thymoma. This case is being written to highlight that unexplained repeated opportunistic microbial infections should prompt the clinician to suspect immunodeficiency in the background of a negative HIV status and to emphasize that GS is one of the causes of adult-onset immunodeficiency where early recognition and treatment can improve and alter the course of the disease as GS carries a worse prognosis compared to XLA [X-linked agammaglobulinemia] and CVID [common variable immunodeficiency].

Background: Nasopharyngeal carcinoma(NPC) is a rare malignant carcinoma that develops in the epithelial lining of the nasopharyngeal mucosa It is the most common neoplasm of the Nasopharynxand it is associated with many risk factors; one of them is Epstein-Barr virus infection. An Epstein-Barr virus is a tumorigenic herpes virus that infects and persists in B-lymphocytes without causing disease. This virus is associated with significant pathological conditions, such as benign and malignant lymphoproliferation. Objectives: To determine Epstein -Barr encoded RNA 1&2 (EBER1,2) and latent membrane protein (LMP) expressionin formalin-fixed paraffin-embedded tissue samples obtained from Omani patients diagnosed with nasopharyngeal carcinoma.Also, to identify the pattern and the type(s) of cells infected with EBV in nasopharyngeal carcinoma tissue samples obtained from Omani patients. Moreover, to compare the sensitivity of Immuno histochemistry and in-situ Hybridization for the detection of EBV in the nasopharyngeal carcinoma tissue sample. Materials and Method:Thirteen formalin-fixed paraffin-embedded nasopharyngeal carcinoma tissue samples archived from the period 2010 to 2017, were obtained from the Pathology Departments of Sultan Qaboos University Hospital and the Armed Force Hospital. These tissue samples were processed using two different methods Immunohistochemistry (IHC) and In situ hybridization (ISH). Results:Eleven out of thirteen NPC Omani patients were positive for EBV (84.61%) by either LMP-IHC or EBER-ISH. All cells stained positive for EBV in NPC tissue samples was of malignant type rather than normal cell type. EBV is mostly detected in patients in the age group of less than 50 years old. Also out of the 13 NPC patients, seven females (58.34%), and six males (46.15%) were positive for EBV. Conclusion:This study may provide evidence indicating an association between EBV and nasopharyngeal carcinoma. In addition, the detection of EBV in NPC obtained from Omani patients may encourage the physician to consider using anti-herpes virus drugs in the treatment of EBV positive NPC patients as an additional tool for the treatment of this kind of malignancy.

A 38-year-old female presented with a longstanding painless swelling overlying the scapula on the right side and has been gradually increasing in size with occasional episodes of pain radiating to the right arm. The clinical diagnosis was a soft tissue tumor. MRI was reported as suggestive of irregular fibro-fatty tissue with muscular infiltration and inflammation. Fine needle aspiration (FNA) retrieved a paucicellular aspirate with a few clusters of adipocytes. The diagnosis was a lipomatous lesion and excision was advised for histopathological examination. The intraoperative findings showed the tumor located deep into the rhomboids and latissimus dorsi and extending deep into the right scapula. The excised specimen was sent for histopathological examination. Macroscopically, the specimen was an irregular, lobulated soft tissue mass weighing 209 grams and measuring 11×10×5.5 cm. Serial slicing of the specimen showed greyish white and fatty tissue admixed with hemorrhagic tissue. There was no evidence of necrosis, calcification or cystic change. The microscopic picture of the lesion is shown in Fig 1. Open in a separate window Figure 1 Hematoxylin and eosin (H&E) stain, deeply eosinophilic serrated or beaded bands and globoid structures seen in collagenous stroma (×20).

A 31-year-old male patient presented to the surgical outpatient department at the Armed Forces Hospital, Muscat, Oman, in September 2014 with a swelling on the left side of his forehead that had been on-going for 10 months. A clinical examination showed a subcutaneous, mobile and non-tender swelling. He had a past history of a similar swelling at the same site, which had been operated on four years previously at another hospital. No reports were available regarding the nature of this previous swelling. At presentation, the swelling was diagnosed clinically as a recurrent dermoid cyst and was excised and sent for histopathological examination. The pale grey firm nodular mass (1.2 × 1.0 × 0.8 cm) showed a solid cystic mass when sliced. An irregular cyst lined by hyperplastic synoviocytes forming broad villi and papillae with hyalinised cores infiltrated by lymphocytes and plasma cells was observed on microscopic examination [Figure 1]. Foci of chond-roid metaplasia, haemorrhage and pigment-laden macrophages surrounded by skeletal muscle with atrophic changes and giant cell formation were noted. A histopathological diagnosis of cutaneous metaplastic synovial cyst (CMSC) was made. Immunohistochemistry (IHC) showed vimentin-positive [Figure 2A] and cluster of differentiation (CD) 68-positive [Figure 2B] synoviocytes. However, IHC was negative for pan-cytokeratin and CD34. Figure 1: Haematoxylin and eosin stain at ×4 magnification showing the cyst wall with broad papillae and villi lined by synoviocytes (red arrow) with hyalinised cores (black arrow) in a 31-year-old patient with a cutaneous metaplastic synovial cyst. Figure 2A & B: Immunohistochemistry stains at ×20 magnification showing (A) vimentin-positive (arrows) and (B) cluster of differentiation 68-positive (arrows) synoviocytes in a 31-year-old patient with a cutaneous metaplastic synovial cyst.