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Introduction: Salivary gland lesions are one of the most heterogenous lesions with overlapping features between low grade malignancy and benign lesions thus making them one of the most difficult areas for diagnosing. Cytology of salivary gland lesions plays an extremely important part in diagnosing the lesions and categorising them into non neoplastic, benign and malignant neoplasms, thereby allowing the patients and clinicians to make an accurate decision regarding whether the lesion is followed, biopsied, excised or a radical operation might be needed. Aim: To classify salivary gland lesions according to MILAN System for Reporting Salivary Gland Cytopathology (MSRSGC). Materials and Methods: This observational study was conducted from June 2021 to May 2022 where Fine Neddle Aspiration Cytology (FNAC) of salivary gland lumps was done on patients presenting to the Department of Pathology Rohilkhand Medical College and Hospital, Bareilly. The clinical and radiological features were noted. The cases were diagnosed on conventional cytopathology. Additionally categorisation as per MILAN System was done by two pathologists independently. The results were compared with histopathology, where available. Data was collected, entered and compiled in Microsoft excel followed by analysis using the software Statistical Package for Social Sciences (SPSS) version 23.0. The data was represented in frequency and further analysed using Kappa statistics. Also the validity was calculated in terms of sensitivity, specificity, Positive Predictive Value and Negative Predictive Value (NPV). Results: Total of 60 cases were included with M:F ratio as 1.6:1. Most common age group was third decade with 17 (28.3%) cases, closely followed by fourth decade with 11 (18.3%) cases. Most common salivary gland to be affected was parotid gland with 30 (50%) cases. Most common MILAN category was II, non neoplastic with 26 (43.3%) cases, followed by IV A, benign neoplasm with 19 (31.67%) cases. The Cohen kappa coefficient was 0.952 which showed a near perfect agreement between the two pathologists. The sensitivity, specificity, PPV and NPV and accuracy was 75%, 92.8%, 75% and 92.8%, 89% respectively. The Risk of Malignancy (ROM) for category I,II,III,IVA,VI was 0%, 0%, 50%, 9%, 100% respectively. Conclusion: The MILAN System for Reporting Salivary Gland Cytopathology (MSRSGC) offers a structured reporting system. The terminologies are reproducible and convey clear meaning among all the medical professionals including different pathologists and treating physician or surgeon and guide in deciding the accurate treatment based on the ROM for different categories.

Background and Objectives: Infertility is a sensitive subject carrying with it economic, social, and psychological implications. Work up of male infertility is often hampered by a lack of infrastructure and facilities, as well as inadequate training of pathology residents. The purpose of this research survey was to evaluate the current status of semen analysis practices and compare them to the standards laid down by the World Health Organization (WHO). Materials and Methods: A web-based questionnaire was designed consisting of questions related to semen analysis practices and procedures being followed currently by pathologists in India. A total of 194 pathologists responded. Questions regarding the procedures followed for semen collection, sperm count, volume, normal range, lower normal limit of sperm count, morphology, etc., were included in the survey. These data were recorded. The differences and gaps in the practice with respect to the WHO standards were analyzed. Results: The survey revealed that the printed instructions for semen analysis were available with 38.7% of the respondents; 58.8% of the respondents had a separate room for semen collection; 95.9% performed the analysis manually, and; only 4.1% used automated analyzers. Only 53.6 and 52.6% of the respondents were correctly reporting the normal range of semen volume and sperm counts, respectively. Only 19.6% stated as having read the WHO manual and were also practicing its guidelines, while 14.4% had not read the WHO manual even once. Conclusion: The present study showed a large gap between the practice of semen analysis by respondents from various parts of India and standard procedures as laid down by the WHO. Many laboratories do not follow the standard instructions. There is a need to improve the quality of practice related to semen analysis in this country through appropriate teaching and training in medical institutions as well as through Continuing Medical Education (CMEs) or regular update programs.

The large-scale celebration of National Pathology Day on the birth anniversary of Dr. VR Khanolkar would help pathologists to showcase their role in patient care, medical education, and research, change the image of pathology, and bring this specialty to the forefront.

In recent clinical practice the molecular diagnostics have been significantly empowered and upgraded by the use of Artificial Intelligence and its assisted technologies. The use of Machine leaning and Deep Learning Neural network architectures have brought in a new dimension in clinical oncological research and development. These algorithm based software system with enhanced digital image analysis have emerged into a new branch of digital pathology and contributed immensely towards precision medicine and personal diagnostics. In India, gastric cancer is one of the most common cancers in males as well as in females. Various molecular biomarkers are associated with gastric cancer development and progression of which HER2 protein, a transmembrane tyrosine kinase (TK) receptor of epidermal growth factor receptors (EGFRs) family is of prime importance. The EGF receptor expression in gastric cancer is linked with its prognostics and theragnostics. These expressions are assessed by immunohistochemistry (IHC) and molecular techniques such as Fluorescence in-situ hybridization (FISH), as per recommendations for HER2 targeted immunotherapy. These have motivated the software giants like Google Inc. to produce innovative state of art technologies mimicking human traits such as learning and problem solving skill sets. This field is still under development and is slowly evolving and capturing global importance in recent times. A literature search on PubMed was performed to access updated information for this manuscript.

Portal hypertensive vasculopathy (PHV) represents an increase in the pressure in the portal circulation. This increased pressure leads to changes in the mucosa that can be appreciated endoscopically as well as histopathologically. Lesions can be observed in the entire gastrointestinal tract (GIT) including stomach, duodenum, jejunum and colon. The histological changes are appreciated mainly in the mucosal and submucosal blood vessels. A knowledge of these lesions as well as the changes helps in separating them from other close differentials with specific treatment to be instituted. The pathogenesis of the hemodynamic changes is not well-understood. The underlying factor is increased portal pressure. Studies indicate, that besides increased portal pressure other factors in combination led to the observed changes. Portal hypertensive gastropathy (PHG) is seen in the gastric body and fundus, while varices are noted in the cardia and fundus. Changes may be seen in the small intestine and throughout the colon with anorectal varices. Histopathological changes include dilated, congested and ectatic capillaries and edema in the lamina propria besides a large spectrum of other histopathological changes. Mucosal capillaries with thick irregular wall show absence of red blood cells in the lumen. Thickening of the vessel wall serves as a better marker than the vascular diameter when portal hypertension (PHT) is considered. Long standing cases may show fibrosis in lamina propria. At times, these changes may lead to occult gastrointestinal bleeding. Important differentials need to be ruled out in all the cases as the treatment and the outcome of all differs. Endoscopically or histopathologically if the mucosal changes are observed they should not be overlooked and a detailed work-up must be carried out.

Introduction: Ovarian sex cord-stromal tumours, including Granulosa Cell Tumours (GCTs), are a group of neoplasm that occurs rarely, especially in children. Only 0.1% of all ovarian tumours and 4-5% of GCTs occur in children. They commonly present as precocious puberty especially in prepubertal girls. Aim: To analyse the clinico-pathological features along with the laboratory findings of ovarian mass. Materials and Methods: A prospective study in tertiary care teaching institutions was carried out during a three year study period starting from April 2017 to March 2020. The study was carried out in tertiary care teaching institutions i.e., VCSGG Medical Sciences and Research Institute, Srinagar Garhwal, PauriGarhwal, Doon Medical College, Dehradun and Rohilkhand Medical College, Bareilly. A total of 11 cases of Juvenile Granulosa Cell Tumour (JGCT) among girls in the age group of 5-13 years who presented with precocious puberty were included in the present study. The results were analysed especially the clinico-laboratory parameters including histopathology and Immunohistochemistry (IHC) findings. All the patients underwent resection of the ovarian mass and were subjected to histopathological examination. Microscopy and IHC was compatible with the diagnosis of juvenile GCT in all the 11 cases. Results: Majority of the patients with GCTs of the ovary presented in the early stage. Of the 11 cases included, only one patient was aged 13 years; seven were in the age group of 5-8 years and three in the 9-12 years of age group. The laboratory profile in all showed an elevated Estradiol level, low Luteinizing Hormone (LH) and Follicle Stimulating Hormone (FSH) levels. Among the thyroid profile only the Triiodothyronine (T3) levels were raised while Thyroid Stimulating Hormone (TSH) and Thyroxine (T4) levels were within normal limits. All cases were histopathologically proved and confirmed using IHC markers. Surgery is the primary treatment modality for GCTs. Conclusion: Histopathology along with specific IHC is important in the diagnosis of JGCT. A careful search provides good insight of the tumour and its final outcome. Diagnosing JGCT especially in the early stage is important as they carry a favourable prognosis when treated in the initial phase.

Declared as a pandemic by WHO on March 11, 2020, COVID-19 has brought about a dramatic change in the working of different laboratories across the country. Diagnostic laboratories testing different types of samples play a vital role in the treatment management. Irrespective of their size, each laboratory has to follow strict biosafety guidelines. Different sections of the laboratory receive samples that are variably infectious. Each sample needs to undergo a proper and well-designed processing system so that the personnel involved are not infected and also their close contacts. It takes a huge effort so as to limit the risk of exposure of the working staff during the collection, processing, reporting or dispatching of biohazard samples. Guidelines help in preventing the laboratory staff and healthcare workers from contracting the disease which has a known human to human route of transmission and high rate of mortality. A well-knit approach is the need of the hour to combat this fast spreading disease. We anticipate that the guidelines described in this article will be useful for continuing safe work practices by all the laboratories in the country.

The entire world is under a devastating pandemic caused by COVID-19 with a high mortality rate. Knowledge of the viral structure, factors that help in its progression and spread, pathological findings, diagnostic methods and, treatment modalities helps in understanding the viral disease and also in treating the patients in a better way besides preventing the community spread of this deadly infection. The causative agent is a single- stranded RNA virus. The clinical spectrum varies in symptomatic and asymptomatic patients, who later become potential silent carriers, thus unknowingly spreading the virus. The virus constantly undergoes recombination, with reports of cross-species infections. Studies have indicated a strong immunological basis of COVID-19 infection. Not only does it weaken the immune system causing multi-organ involvement but also helps in its progression and spread to others.Multiple organs especially lungs, heart, kidney, gastrointestinal and hepatic system, brain and skin are affected varying in their severity. Similarly, persons with associated co-morbidities are likely to be affected more in terms of the number as well as in the severity. Real- time reverse transcription polymerase chain reaction confirms the presence of COVID-19 infection. Serological diagnosis helps in diagnosing an ongoing outbreak or retrospective infection. Furthermore, it also identifies individuals who have been infected or have recovered from the disease especially the asymptomatic. This helps in the development of an effective vaccine indicating the status of herd immunity in the community. Different treatment modalities are being tried and under trial. This review article thus highlights the global epidemiological status, characteristic of the virus, symptomatology of the patients, role of diagnostic tests available, organs affected including their morphological changes and the latest line of treatment of COVID-19.

Klippel–Trenaunay–Weber syndrome (KTWS) is a rare congenital malformation, characterized by constellation of arteriovenous malformation, cutaneous capillary malformation, and skeletal or soft-tissue hypertrophy. The exact cause of KTWS is unknown. We present a case of a 1 ½-year-old boy with multiple swellings over the right lower extremity since birth which increased in size in proportion to his general growth. He was diagnosed clinically as Klippel–Trenaunay syndrome (KTS) which on Doppler imaging and on histopathology showed the presence of a multichanneled slow-flowing arteriovenous malformation. KTWS should be distinguished from KTS since clinical features, management, and prognosis of these two entities are distinctly different. Although the diagnosis is primarily clinical, confirmation requires laboratory and imaging studies. The present case is being reported as an interesting case which highlights the fact that distinction between KTWS and KTS may sometimes be difficult.

Lymphatic filariasis is endemic and common in India. Filariasis is a widespread public health problem seen commonly in tropical countries. Filarial organism can be detected in cytological smears from various sites of the body in clinically unsuspected cases of filariasis. Incidental detection of filarial organism has been reported in cytological smears from almost any part of the body; however, it is very rare to detect these organisms in achylous hemorrhagic pleural fluid specimen. Demonstration of microfilaria in liquid-based cytological smears is rarely reported. To the best of our knowledge, the present case of achylous bancroftian pleural effusion diagnosed on liquid-based cytology (LBC) is the first one from the Indian subcontinent. We report a case with microfilariae of Wuchereria bancrofti in an 80-year-old male patient who presented with achylous, hemorrhagic unilateral pleural effusion in LBC.

Actinomycosis is an infrequent bacterial infection encountered nowadays, caused by anaerobic Gram-negative bacterium of Actinomyces species. We report an unusual case of a unilateral tonsillar hypertrophy in a 40-year-old male, caused by actinomycosis masquerading as malignant tumor. To the best of our knowledge, only seven cases of actinomycosis causing unilateral tonsillar hypertrophy have previously been published. Since this anaerobic organism is difficult to culture, the diagnosis is made by observing its associated sulfur granules in the biopsy specimens. Still, actinomycosis represents an important entity in today's context as it is the great masquerader of the head-and-neck lesions because of its myriad presentation that may mimic other common diseases, the difficulties involved in its diagnosis, and the long course of treatment mandatory to eradicate the disease.

Clear cell sarcoma (CCS) is an unusual but aggressive soft-tissue tumor with an incidence of

Introduction: Mucoepidermoid carcinoma (MEC), one of the most common salivary gland malignancies, but it is rare in children. MEC occurs mainly in the parotid gland, followed by the minor salivary glands. Palate being the second common site. Aim: The present study was undertaken with the aim of studying the clinico-pathological presentations as well as the histopathological grading of head and neck mucoepidermoid carcinoma. Materials and Methods: During the 2 year retro-prospective study a total of 12 cases diagnosed as Mucoepidermoid carcinoma in the head and neck region in a tertiary care hospital were included in the present study. Clinic-pathological presentations of these patients were recorded. Histological grading was done as per the Armed Forces Institute of Pathology criteria. Results: Out of the 12 cases, 8 were males and 4 females with the age ranging from 18 to 65 years; the average age being 40.08 years. Four patients each presented with ulcer and ill-defined swelling and 2 each, as growth and cyst. Histopathologically 5 patients were low grade, 6 as intermediate grade and 1 as high grade. Conclusion: Prognosis of patients with MEC greatly depends on the tumour stage as well as the histologic grade of the lesion. Typical treatment involves surgical excision for low grade lesions and surgical excision with elective neck dissection in the ipsilateral neck followed by adjuvant radiation therapy for higher grade lesions. Grade II tumours are treated similarly to grade III since, even though the behaviour resembles grade I tumours, they possess a predilection for nodal metastasis as in grade III lesions.

Papillary lesions of the breast pose great diagnostic challenges on fine needle aspiration cytology (FNAC) due to overlapping features between benign and malignant entities. Preoperative cytodiagnosis is difficult. We present a case of a 52-year-old male who presented with a progressively increasing firm swelling in the left breast for 3 years. The nipple was eroded with ulceration and bleeding. Ultrasonography (USG) revealed a mass measuring 2.9 cm × 1.5 cm in the left breast. FNAC smears were hypercellular with ductal cells arranged in papillae and glandular clusters. At places, the cells had irregular nuclear membrane, prominent nucleoli, fine chromatin, scanty-to-moderate cytoplasm, and high nuclear-cytoplasmic ratio with pleomorphism. Histopathology of the excised swelling was consistent with intracystic papillary carcinoma (IPC) supported with immunohistochemistry markers. The case is being presented due to its rarity.

Soft tissue sarcomas of the genitourinary tract are rare. Paratesticular sarcomas are extremely rare with majority of scrotal masses localizing to the testis and being neoplastic in nature. Paratesticular leiomyosarcomas (LMSs) are located in the spermatic cord, epididymis, or scrotum. However, their location in the scrotal skin or subcutaneous tissue is extremely rare. Only 10 cases have been reported from India previously. Ours is the 11th case. A 50-year-old male presented with a recurrent scrotal mass which was painless and gradually increasing in size. Histopathology and immunohistochemistry confirmed it to be paratesticular LMS. A rare case report with the review of literature is presented.

Introduction: Parasitic infestations are very common in developing countries and are responsible for significant morbidity. Many serological and radiological techniques are available for their detection. However due to the some limitations the microscopic examination of the tissue sections and the aspirated smears stained with appropriate stain remains the gold standard for the diagnosis. Aim: The present study was carried out to assess the spectrum of tissue parasitic infestations in a tertiary care centre of Western Uttar Pradesh, Rohilkhand region. Material and Methods: A total of 60 diagnosed cases of parasites with age ranging from 1 year to 70 years in a two year period from January 2016 to jan 2018 were included in the study. Results: A total of 60 diagnosed cases of parasites were included, of which 3 (5%) cases were detected on bone marrow aspiration, 15 (25%) cases were detected on fine needle aspiration cytology and 42 (70%) cases on histo-pathology sections. Conclusions: Parasitic infestation is a serious problem in our society. The present study was undertaken to emphasize the importance of screening all the histopathology and cytopathology slides for the detection of parasites in any asymptomatic case. As their incidental detection can reduce the morbidity associated with them significantly. Extensive literature search did not show any such study being conducted making this study a unique one.

Introduction: Cholecystectomies are most common surgical specimens sent in pathology laboratories. Most common histologically identified lesion of gallbladder is chronic cholecystitis which on most occasions is associated with cholelithiasis. It is most common indication for cholecystectomy and also associated with gallbladder carcinomas. Aim: The aim of the present was to study the morphological spectrum of gallstone disease and correlation of cholelithiasis with benign and malignant lesions. Materials and Methods: A retrospective study was carried out from January 2012 to June 2016. A total of 1693 specimens were assessed for size of gallbladder, serosa, wall thickness, mucosa, presence/absence of stones, their number, and type along with any mass lesions. Microscopic features assessed included inflammation, cholesterolosis, granulomas, metaplasia, calcification, dysplasia, benign and malignant neoplasms. Results: Maximum numbers of cases were between 31 to 40 years with female preponderance. Chronic cholecystitis was the most common lesion seen in 1170 (69.1%) cases. Associated calculi was present in 1625 cases, mixed and cholesterol type accounting for 1050 (64.6%) and 382 (23.51%) respectively based on morphological appearance. Amongst 439 cases showing metaplasia, antral type metaplasia was most common followed by intestinal metaplasia. Most frequent stromal change was cholesterolosis. Dysplasia was seen in 15 (0.88%) cases and malignancy in 16 cases. Conclusion: Incidental detection of gallbladder malignancy on microscopic examination is the most significant information for the surgeon as well as for the patient and this fact emphasises the importance of subjecting each gallbladder specimen for histopathological examination.

Vulval leiomyomas are rare entities which are seen in the reproductive age group. They are most commonly misdiagnosed as Bartholin’s cyst or Bartholin’s abscess when presenting with features of inflammation. Excisional biopsy is the treatment of choice. Besides this, Estrogen Receptor (ER) and Progesterone Receptor (PR) positivity implicates the usefulness of adjuvant hormonal therapy. We present a case of 38-year-old female who presented with a vulval swelling. She was misdiagnosed clinically as Bartholin’s cyst. Marsupialization of the cyst was done and tissue was sent for histopathology. Microscopy confirmed the diagnosis of vulval leiomyoma with myxoid changes. Additionally, immunohistochemical stains were was also applied, which showed positivity for Vimentin, Desmin, ER and PR and negativity for Pan Cytokeratin (CK), S100. ER and PR positivity is a rare finding in case of leiomyoma with myxoid changes.

Lipofibromatous hamartoma (LFH) is a rare, benign fibrofatty tumor composed of a proliferation of mature adipocytes within peripheral nerves, which form a palpable neurogenic mass. It affects the median nerve in 66-80% of cases, causing pain and sensory and motor deficits in the affected nerve distribution. Patients typically present with gradually enlarging nontender lesions in the distribution of the affected nerve. The lesion is also seen to be associated with macrodactyly. The pathophysiology of LFH is unknown. Treatment of LFH is based on symptoms of the condition. Histopathology is characteristic. We present a case of young male diagnosed as lipofibromatous hamartoma of the median nerve involving the right index finger. The case is presented due to its rarity.

Primary apocrine sweat gland adenocarcinomas are a rare entity, with only a few case reports so far. Many of these carcinomas are slow-growing with a high recurrence rate. A distinct cytological diagnosis can be made, and metastatic adenocarcinomas are always considered as a differential diagnosis on cytology. Our case was a 35-year-old male who presented with a discharging axillary sinus and swelling for the past 1 year. A clinical suspicion of tuberculous sinus was raised that however, remained unsupported by laboratory investigations. There was quite a high suspicion of apocrine adenocarcinoma on cytological examination that was confirmed by histopathology and immunohistochemistry. The patient was successfully treated with total excision and a wide margin. We report this case in view of its rarity and its occurrence in a 35-year-old young male, and emphasize that an initial cytological suspicion should be raised for primary apocrine adenocarcinoma in case of an axillary tumor, especially keeping in consideration the poor prognosis of the same and chances of early metastasis.

Filariasis is a major disease of the tropics. Frequently, lymphatics of the lower limbs, retroperitoneal tissues, spermatic cord, epididymis, and mammary glands are involved. Simultaneous filariasis along with another underlying disease is rare. We present a rare case of filariasis of the axillary lymph node in a modified radical mastectomy specimen, which also showed metastatic deposits of ductal carcinoma breast. The case is presented due to its rarity.

Aim: The present study was undertaken to study the spectrum and pattern of various oral cavity lesions in a tertiary care hospital in Rohilkhand region of Uttar Pradesh, India. Background: Oral cavity is one of the most common sites for tumour and tumour like lesions especially in males. It has been observed that benign lesions are more common than malignant ones. Materials and Methods: A retrospective study was carried out in a tertiary care hospital during the period of two years from June 2012 to May 2014. The study included 133 cases of oral cavity lesions. The parameters included in the study were age, gender, site of the lesion and histopathological diagnosis. Special stains and Immunohistochemical markers were applied as and when required. Data collected were analysed. Results: A total of 133 cases were included in the present study. The age ranged from 8 to 80 years. Males were affected more often than females with a Male: Female ratio of 3.3:1. The most common involved site was tongue 39 (29.32%) followed by tonsil in 30 (22.56%), buccal mucosa 27(20.32%), floor of mouth 14 (10.53%), palate 12(9.02%), lower lip 8 (6.02%), upper lip 2(1.50%) and vestibule in 1 (0.75%) cases. Of the 133 cases, 63 cases (47.36%) were malignant, 52 non-neoplastic (39.10%) and 18 cases (13.53%) of benign neoplasias. The various lesions included - Squamous cell carcinoma, Verrucous carcinoma, Carcinoma-in-situ, Leukoplakia, Fibroma, Lipoma, Squamous cell papilloma, Lymphoid hyperplasia, Pseudoepitheliomatous hyperplasia, Haemangioma, Schwannoma, Atypical Pleomor -phic adenoma, Pleomorphic adenoma, Epidermal cyst, Retention cyst, Parasitic infestation, Tubercular pathology, Granulation tissue, Chronic Sialadenitis and Chronic nonspecific inflammatory pathology. A larger epidemiopathological study in this region needs to be carried out for detailed statistical analysis. Conclusion: Benign lesions were the predominant pathology. Squamous cell carcinoma was the commonest malignant lesion. Histopathological typing of the lesion is mandatory to confirm or rule out malignancy and is essential for the rational management thus avoiding mutilating surgery.

Solitary neurofibromas are rare occurrence in salivary gland region as well as mons pubis of females. We present two cases of teenage girls with swelling in parotid region and mons pubis. Fine needle aspiration cytology was inconclusive in both cases. They were both managed surgically and a diagnosis of neurofibroma was ascertained histopathologically and also confirmed with S-100 immunohistochemistry. The patients were followed up for a period of six months, however, no recurrence was noted. Though, one patient had a previous history of recurrence. We report these cases in view of their rarity of site and age as well as no correlation with neurofibromatosis and clitoromegaly.

Primary ovarian leiomyoma is a rare benign tumour of the ovary, which is seen in women who are aged between 20 years to 65 years. Ovarian leiomyomas can be confused with other spindle cell tumours which display gross anatomical and histological similarities. A case of a primary leiomyoma of the ovary in a pre-menopausal female is being presented here, due to its huge size and unusual presentation.

Syringocystadenoma papilliferum is a benign hamartomatous adnexal tumour. Most of the patients present with solitary lesions in the head and neck region at birth or in early childhood. Multiple lesions are rarely seen and those which arise outside the head and neck region are even more uncommon. A case of syringocystadenoma papilliferum with multiple verrucous lesions and which was located in the right flank, an unusual site, has been presented.

Penile cutaneous horn is a clinical term that describes protruding hyperkeratosis, usually conical in shape, located on glans penis. This lesion is predominantly located on sunexposed areas, so its localisation on the glans penis is very rare. Also, this patient presented with multiple horns which is very unusual.

abstract

Abstract

Lipomas are among the most common mesenchymal neoplasms, however, only 15%-20% involve the head and neck and 1%-4% affect the oral cavity. Lipoma of the tongue represents about 0.3% of all benign lesions of the oral cavity. A 12-year-old boy presented with a globular swelling over the middle of dorsum of tongue since last 4 months duration. The swelling was apparently non-progressive. It was excised under local anaesthesia and histopathologically diagnosed as lipoma tongue. The case is being presented due to its rarity.

Objective: Autonomic neuropathy is associated with dysglycemia that is difficult to control. We investigated if transcutaneous vagus nerve stimulation (tVNS) could improve glycemic levels. Methods: We randomized 145 individuals with type 1 diabetes (T1D) ( n = 70) or type 2 diabetes (T2D) ( n = 75) and diabetic autonomic neuropathy (DAN) to self-administered treatment with active cervical tVNS ( n = 68) or sham ( n = 77) for 1 week (4 daily stimulations) and 8 weeks (2 daily stimulations), separated by a wash-out period of at least 2 weeks. Continuous glucose monitoring (CGM) indices were measured for 104 participants starting 5 days prior to intervention periods, during the 1-week period, and at end of the 8-week period. Primary outcomes were between-group differences in changes in coefficient of variation (CV) and in time in range (TIR 3.9-10 mmol/L). Secondary outcomes were other metrics of CGM and HbA1c. Results: For the 1-week period, median [interquartile range] changes of CV from baseline to follow-up were -1.1 [-4.3;2.0] % in active and -1.5 [-4.4;2.5] % in sham, with no significance between groups ( P = 0.54). For TIR, the corresponding changes were 2.4 [-2.1;7.4] % in active and 5.1 [-2.6;8.8] in sham group ( P = 0.84). For the 8-week treatment period, changes in CV and TIR between groups were also nonsignificant. However, in the subgroup analysis, persons with T1D receiving active tVNS for 8 weeks had a significant reduction in CV compared with the T1D group receiving sham stimulation (estimated treatment effect: -11.6 [95% confidence interval -20.2;-2.0] %, P = 0.009). None of the changes in secondary outcomes between treatment groups were significantly different. Conclusions: Overall, no significant changes were observed in CGM metrics between treatment arms, while individuals with T1D and DAN decreased their CV after 8 weeks of tVNS treatment.

Aims: To address the scarcity of continued education for insulin pump users, we developed and evaluated a new program (NP) for individuals transitioning to a different insulin pump., Methods: In a randomized, controlled 3-month study, adults with type 1 diabetes and suboptimal HbA1c received either NP or usual care program (UC). The NP was designed in collaboration with representatives of the target group and incorporated technical training, case-based learning, and peer experience sharing - encompassing two group sessions, and two follow-up telephone calls. The UC included a single training session led by the pump company with hotline assistance (clinic) but no structured follow-up. The primary endpoint was the difference in time in range (TIR) (70-180 mg/dL (3.9-10.0 mmol/L)), measured by continuous glucose monitoring from baseline to 3 months post-course. Psychosocial self-efficacy was measured by the Diabetes Empowerment Scale (DES-SF)., Results: Thirty-nine participants (median age 43, 74% female) were included. Mean TIR increased significantly in the NP group and remained unchanged in the UC group (between-group difference in change was 13.5% [95% CI: 4.0 to 22.9], p = 0.0064). Psychosocial self-efficacy improved and HbA1c decreased only significantly in the NP group., Conclusions: Applying a novel education program at pump transition significantly improved glycemic outcomes and self-efficacy., (© 2024. The Author(s).)