Himachal Mishra

Abstract

Introduction: Hibernoma is a rare benign tumor that originates from brown fat. Hibernoma is thought to arise from areas containing residual brown fat like- the interscapular area, axilla, neck, chest, abdominal cavity, and retroperitoneum. The incidence of this rare tumor has very rarely been reported to occur over the forehead. Being a benign tumor, no association of malignant transformation or metastasis has been reported. Case History: A 23-year-old male presented with a complaint of a painless non-progressive swelling over the forehead for the past 6 months. On examination, the swelling was 2x2 cm, soft, mobile, non-tender, and non-pulsatile with no skin changes. FNAC did which shows sheets and clusters of adipocytes with abundant foamy cytoplasm and reported as “Hibernoma”. The patient has been asked to follow up and for the last 1 year, the tumor is still non-progressive with no pressure symptoms and hence has not undergone surgery. Discussion: Hibernoma is a rare benign tumor of brown fat tissue which constitutes only 1.6% of benign lipomatous tumors but their actual prevalence is still unknown. This tumor very rarely may occur in the forehead area although incidence over the forehead has rarely been reported. Since this tumor is slow growing, painless non-progressive; it mostly presents as an asymptomatic tumor. It has to be included in the differential diagnosis of adipocyte-containing tumors to prevent false treatment. Keywords: Hibernoma, Tumor, Brown fat, Forehead

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Abstract

Background: Gastrointestinal Stromal tumor are rare group of mesenchymal neoplasms originating from the wall of the digestive tract. Outcome strongly dependent on tumor size and mitotic activity. Case Details: A 60-year male presented with abdominal pain and distention for 3 months. After initial evaluation, emergency laparotomy was done. Intraoperatively found to have multiple small nodules in peritoneum and mesenteric border of small intestine and rupture of a big nodule was observed causing peritonitis. Gross examination-Multiple nodular tumour mass in small intestine along with multiple haemorrhagic nodule of varying size seen in mesentry. Microscopy: Tumor arising from muscular layer arranged in interlacing fascicles, bundles, whorls and sheets. Tumor cells are elongated having spindle to elongated nucleus with vesicular to dense chromatin and inconspicuous nucleoli. Some of the nodules shows areas of haemorrhage and necrosis. Mitotic figure > 5/50 HPF seen. Histological grade-G2 High grade >5/50 HPF, TNM grade-PT4PNxPMx. Immunohistochemistry-Diffusely Positive for CD117. Focally positive for DOG1, CD34 & SMA. Discussion: Small intestinal GISTs comprise approximately 30% of all GISTs. Tumor size vary from small nodules to complex masses of around 20 cm. Conclusion: GIST is more common in patients with age >40 years. CD117 and DOG1 positivity are used to define these tumors. Novelty: Only few cases has been reported in small bowel GIST with perforation and multiple nodules.   Keywords: GIST, Stromal, Tumor, Intestinal, Diverticulitis, Perforation

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