Pseudobulbar affect (PBA), or emotional incontinence, is a type of emotional disturbance characterized by uncontrollable episodes of crying, laughing, anger or other emotional displays. PBA occurs secondary to a neurologic disorder or brain injury. Patients may find themselves crying uncontrollably at something that is only moderately sad, being unable to stop themselves for several minutes. Episodes may also be mood-incongruent: a patient may laugh uncontrollably when angry or frustrated, for example. Sometimes, the episodes may switch between emotional states, resulting in the patient crying uncontrollably before dissolving into fits of laughter. The pseudobulbar affect, also referred to as emotional lability, should not be confused with labile mood or labile emotions that stem from emotional instability – affective dysregulation – commonly seen in mental illnesses and certain personality disorders. Signs and symptoms
The cardinal feature of the disorder is a pathologically lowered threshold for exhibiting the behavioral response of laughter, crying, anger or all of the above. An affected individual exhibits episodes of laughter, crying, anger or a combination of these without an apparent motivating stimulus or in response to stimuli that would not have elicited such an emotional response before the onset of their underlying neurologic disorder. In some patients, the emotional response is exaggerated in intensity but is provoked by a stimulus with an emotional valence congruent with the character of the emotional display. For example, a sad stimulus provokes a pathologically exaggerated weeping response instead of a sigh, which the patient normally would have exhibited in that particular instance.
The tumour is described as invasive and is clinically characterised by faster growth than the benign chondroid syringoma. They can generally be diagnosed when presenting "an epithelial component, eccrine or apocrine differentiation and myoepithelial component of fluctuating prominence" (IADVL, 2004). Diagnosis is recommended to follow microscopic analysis to ensure correct examination. Treatment
There currently is no established guideline for the standardised treatment of malignant chondroid syringomas, due to their rarity. However, the efficacy of treatment for malignant mixed tumours depends on the time of diagnosis. An immediate and broad surgical excision "with clear margins" (Tural, Selçukbiricik, Günver, Karışmaz, and Serdengecti, 2013) is considered curative and to be the most successful treatment. This treatment aims for the most efficacious disease control. It is largely agreed that chemotherapy and radiotherapy are ineffective yet are sometimes still recommended, yet radiotherapy reacts positively to skeletal metastasis. Combination chemotherapy for MCS is reported as unbeneficial. MCS is reported to have a high and continual risk of recurrence of metastasis, some patients experiencing metastasis nearly twenty years after the primary examination. Thus this necessitates consistent clinical follow-up in order to maintain a benign state of the tumour and achieve disease control. Prognosis
Malignant mixed tumours have a poor prognosis that is deemed unpredictable due to its spread being lymphatic or blood-borne. As there have only been a limited number of cases that have been reported, prognostic points are challenging to confirm, however mainly "include size, histological type, lymph node involvement, and distant metastasis" (Garcia, Atun, and Fernando, 2016).