Indian Journal of Pathology and Oncology

535-539

Authors: Akanksha Bhatia, Ramya BS, Dayananda S. Biligi, Panchakshari Prasanna BK

Platelet- rich plasma (PRP) has wide clinical applications which have been proved by various studies. There are various methods available now-a-days to prepare PRP but no standard protocol determining the time and centrifugation speed is available. This variation in the reported methods may produce samples with different platelet concentrations which may induce different clinical responses. Hence, the aim of the present study was to compare the different methods of centrifugation for preparation of platelet- rich plasma by estimating the platelet concentration in them. Methods: Whole blood was drawn from 50 healthy volunteers into two citrate tubes which were subjected to different centrifugation speed and time. The first tube underwent double spin at 100g (soft spin) and 400g (hard spin) respectively, for 10 minutes; whereas the second tube underwent single spin at 100g for 10 minutes. The platelet counts before and after centrifugations were then compared. Results: Single spin method yielded a platelet concentration factor of 2.19 as compared with the double spin method where, actually the platelet counts reduced (platelet concentration factor= 0.83). Conclusion: From the above findings we conclude that single centrifugation method is better than double centrifugation method in preparation of platelet rich plasma as evidenced by the high platelet concentration factor (2.19).

544-547

Authors: Archana Gupta, Swati Gupta, Sunil Gupta, Vivek Gupta

Pattern of a disease is studied with the idea of getting information about the clinical presentation, the morphology and the causative factors. The testicular tumors constitute 4th most common cause of death from neoplasia in younger males. Though the etiology of testicular cancers is not well understood, various factors like cryptorchidism, trauma infections and genetics play role in the disease. The testicular tumors are histologically diverse. Aim: Our study was undertaken to study the clinical presentation and morphological patterns of the testicular tumors. A total number of 50 cases of testicular tumors were studied. The majority of the cases i.e. 48 (96%) were of germ cell origin. Only 2 cases (4%) of testicular lymphoma were reported. Materials and Methods: The study was carried out in two parts – retrospective (2005-2007) and prospective (2008-2010). During this period a total number of 50 cases of testicular tumors were diagnosed on small biopsies and orchidectomy specimens. Results: The study work comprised of 50 cases of testicular tumors among which 44 (88%) cases were malignant and 6 (12%) were benign (Table 1). The majority of the testicular tumors i.e. 48 cases (96%) were of germ cell origin. Only 2 cases (4%) of testicular lymphoma were reported (Table 2). No case of sex cord stromal tumor, mixed germ cell sex cord tumor and metastatic tumor was reported. Conclusion: Tumors of the testes present a great variety of histological types with many structural variations. The present study fairly provides an insight into the clinical presentations, prevalence and patterns of testicular tumors.

552-557

Authors: Geethu G. Nair, Fatima Shamsuddin, Thidil Narayanan, Prejisha Balan

India, the second most populous country in the world accounts for about 25% of cervical cancer deaths. Only limited studies are available on the prevalence of cervical epithelial abnormalities in various populations in India, especially in North Kerala. We have undertaken the present study, with the intention to estimate the prevalence of abnormal cervical cytology smears in this region so that appropriate screening strategies can be planned. Methods & Materials: A one year retrospective descriptive study was conducted in Department of Pathology of a private medical college to evaluate all the pap smears reported during September 2012 to August, 2013. Smears were assessed according to the revised 2001 Bethesda system. A total of 2028 cases were analyzed. Prevalence of epithelial abnormalities was calculated in percentages. Results: Out of total 2028 patients, 49 (2.41%) cases revealed epithelial abnormalities. The most frequent epithelial cell abnormality was Low grade Squamous Intra epithelial Lesion (32 cases, 1.58%). Nearly half of the patients with abnormal pap smears presented with a normal looking cervix. Epithelial abnormality was more prevalent in post-menopausal age group. Conclusion: Our hospital based study shows a relatively low prevalence of cervical epithelial abnormality which is similar to that seen in the developed world. Every woman above the age of 30 must be subjected to Pap smear even with a normal looking cervix and this must be continued in post-menopausal period, as most of patients with epithelial abnormalities in our study falls in this group.

564-569

Authors: Mallegowdanadoddi Siddegowda Siddegowda, Jasneet Kaur Sandhu, Sundaram Shivakumar

Thyroid nodules are an unpredictable group of lesions, incidence of which increases with age. Due to an increased incidence of malignancy in children as compared to adults, an aggressive approach to diagnose and manage these lesions is warranted. Aims & Objectives: The objective of present study was to evaluate the frequency of the various thyroid lesions by FNAC in children and young adults and correlate these findings with the histopathological features and thyroid hormone status. Results: The 5-year study included 280 cases, of which most were in the age group of 16-24 years (81.7%) with a female preponderance (93.9%). The benign lesions were more common with nodular colloid goitre being the most common lesion. Among the neoplastic lesions, follicular neoplasms were most common. Hormonal status was available for 250 cases, with most being euthyroid. Cyto-histopathological correlation was available in 15 cases, with 11 displaying positive correlation. The sensitivity of FNAC was 62.5%, specificity was 85.7%, diagnostic accuracy was 73.3% and positive predictive value was 83.3%. Conclusion: Currently, many investigations including diagnostic imaging studies, serological tests as well as histopathological techniques are available to evaluate thyroid lesions. However, FNAC is a reliable diagnostic procedure in children and young adults for evaluating and managing thyroid lesions.

576-581

Authors: Manoj Kumar Gupta, Brijesh Gupta, Kamlesh Kumar

As there is continuous and increased need for early detection of cancer in breast lesion is never-ending. It is so, as the success of treatment depends upon early diagnosis. So role of core needle biopsy (CNB) in screening and diagnosing the breast lesion was evaluated. Aims and Objectives: To find concordance between the diagnostic power of, hormonal receptors, viz. estrogen receptors (ER), progesterone receptors (PR) sensitivity along with expression of HER-2/neu in CNB and excisional biopsy (EB) of breast lesion. Materials and Methods: We have studied the diagnostic accuracy of CNB in 60 breast lesion keeping the EB as gold standard. Immunohistochemical study (IHC) was simultaneously performed with three parameters as ER, PR and HER-2/neu. The results IHC studies of CNB were compared with the same study on EB specimens. Results: Out of which 39 cases were malignant and amazingly CNB has detected the malignancy in 38 cases. Also the IHC of ER, PR and HER-2/neu were well in concordance with the same study in EB specimen. Conclusion: Though CNB is excellent modality for screening, as study reflects, it can surely be used for confirmation also. As IHC results on CNB are also in well concordance with EB, the oncologist can lay out his treatment from very initial step of screening.

587-592

Authors: Neelima Tirumalasetti, Nagaraja Reddy Challa

Thrombocytopenia is a common hematological condition associated with variable etiological factors. Dysplastic changes of megakaryocytes in thrombocytopenia are commonly seen in myelodysplastic syndrome (MDS). However, several studies have described it’s occurrence in non-myelodysplastic hematological conditions. The present study was undertaken to note the various morphological alterations in megakaryocytes (including both dysplastic and non dysplastic changes) in non MDS related thrombocytopenia. Materials and Methods: A prospective study of 78 cases with thrombocytopenia were included in the present study. Cases of MDS were excluded from the study. Informed consent was taken from all the patients with thrombocytopenia and Bone marrow aspiration was done in all cases. Bone marrow aspiration smears were air dried and stained with Leishman stain. Bone marrow aspiration smears were examined for number and various morphological alterations. Special investigations were done in required cases for confirmation of diagnosis. Results: Dysplastic megakaryocytes were observed in 78.6% cases of immune thrombocytopenic purpura and 41.2% cases of megaloblastic anemia. Most common dysplastic feature observed was micromegakaryocyte (32.0%) followed by multiple separate nuclei (21.7%) and hypogranular form was the least observed dysplastic feature (8.9%). Conclusions: Dysplasia in megakaryocytes is a common finding in various non-myelodysplastic syndrome related thrombocytopenia. The mere presence of dysplastic megakaryocyte should not prompt an interpretation of myelodysplastic syndrome and should always be correlated with patient’s clinical and other hematological parameters.

599-605

Authors: Prashant Basavaraj Mahalingashetti, Radha Madhavi T, Balachandra Bhat, Swaminathan Boobalan

Urothelial carcinoma has observed great strides of advances in the field of diagnostics and therapeutics. On the other hand, the last decade witnessed an upheaval in pathological grading which seems to settle down in the recent times. Aims and Objectives: Our study intends to evaluate pathology practices in reporting papillary urothelial carcinomas and highlight the features which can define prognosis and guide molecular studies. Materials and Methods: A consecutive of 32 cases of papillary urothelial carcinoma reported over duration of 2 years were collected. Histopathological slides were reviewed applying WHO/ISUP 2004 diagnostic criteria and compared with primary diagnosis. Results: High grade papillary urothelial carcinoma formed the largest group with 14 cases. Concordance between original diagnosis and review diagnosis was seen in 19 cases only. Invasion into underlying tissue was missed in 6 cases. Associated features like carcinoma in situ, lymphovascular invasion, perineural invasion and stalk invasion were missed in primary reports. Conclusion: As grade and stage dictate prognosis and management plans, it is essential to release veritable reports. The findings emphasize the need to generate a consensus report with multiple opinions.

611-616

Authors: R. Vimal Chander, P. Jayaganesh, Tejaswini Punuru Reddy, Chitra Srinivasan

Granulomatous lesions comprise a large family of disorders sharing a common histological denominator of formation of granulomas, either immune or non-immune category with tuberculosis being the most common cause in our country. Aims and Objectives: To study the spectrum of granulomatous lesions in a tertiary care hospital, to categorise tuberculous versus non-tuberculous causes and to study the incidence of acid-fast bacilli (AFB) positivity in granulomatous lesions. Material and Methods: This is a retrospective descriptive study of all granulomatous lesions reported over a period of two years from November 2013 to November 2015. All cytology and histopathology cases reported as granulomatous inflammation during this period were taken for this study and, while granulomatous lesions of the skin (Hansens disease) were excluded. Histological findings and acid-fast bacilli staining were then analyzed. Result: In this study, majority of the patients were of 51-60 year age group (30%) followed by 41-50 years (21.42%). The majority of the patients were male (64.28%) followed by females (35.72%). Out of a total of 70 patients, 42.86% (30 cases) showed features of tuberculosis, out of which 7 were positive for Acid-fast bacilli by Ziehl Neelsen stain, and 22 were negative. Out of the 30 cases, 22 showed extensive caseation necrosis. One case of tuberculous lymphadenitis was associated with metastatic ductal carcinomatous deposits in axillary lymph node. 41.42 % showed chronic granulomatous inflammation, 4.29% showed foreign body granulomatous reaction (2 cases of fungal infection and 1 case of gossypiboma). 2.86% showed xanthogranuloma, 1.42% showed Lipogranuloma (chalazion). Conclusion: Tuberculosis is considered first in differential diagnosis of granulomatous diseases, especially in the countries with a high incidence of tuberculosis, but detailed analysis of clinical and ancillary studies are essential to rule out other granulomatous lesions. Exact diagnosis is important for treatment purpose as a lot of granulomatous lesions are treated as tuberculosis on an empirical basis.

622-626

Authors: Nagarjuna Chary R, Ather Fatima, Kazi Wajid Husain, Kumuda Chalam P, Ibraheem Javed Mohammed

Spleen, a friable and highly vascular organ lying in the left hypochondrium protected by rib cage, was considered by Galen as an organ full of mystery. Observing the patients who were congenitally asplenic, yet leading normal lives, Aristotle came to a conclusion that spleen was not essential for life. Splenectomy, as a surgical procedure is frequently indicated in those cases where the diagnosis is already established and the purpose of surgery being largely therapeutic or palliative in nature. Splenectomy for diagnostic purposes is quite uncommon. Aims and Objectives: The objective of present study was to study the diagnostic histomorphological features of splenectomies at a single surgical centre in detail. Material and Methods: The present study was undertaken at Department of pathology, Osmania General Hospital, Hyderabad from June 2001 to May 2003. We reviewed 41 specimens that were received over a span of 2 years. All the splenectomy specimens had been formalin fixed, processed, paraffin embedded after meticulous gross examination and sectioned. The Hematoxylin and Eosin stained slides were reviewed by study pathologists. Results: 41 cases of splenectomy were analyzed. There were 18 males and 23 females. Commonest splenic pathology was chronic venous congestion, followed by epidermoid cyst, Hydatid cyst and granulomatous inflammation. Splenic abscess was the least common splenic pathology. No cases of malignancy or metabolic diseases were encountered. Histopathological findings of spleen in various conditions were consistent with the changes consequential to the disease. Conclusion: Chronic venous congestion of spleen proved to be the commonest indication for splenectomy in our study. Fine needle aspiration cytology and core biopsy play an important role in diagnosis of pathological lesions of many organs, while splenectomy specimen forms the first and only opportunity for diagnosis of splenic pathology.

632-635

Authors: Sandhya V, Kumaresan M

The outer root sheath of the anagen and telogen hair is structurally similar to the epidermal layer of the skin. Hence Direct Immunofluorescence(DIF) demonstrating Antibodies to Desmoglein 1 and 3 in Pemphigus group of autoimmune bullous diseases would show a similar pattern in skin & hair. Aim: To compare DIF of skin and telogen hair in pemphigus group of patients in clinically active cases and those in remission. Method: 30 consecutive diagnosed cases of Pemphigus vulgaris (PV) (both active cases and remission) were selected for the prospective study. Other blistering diseases –Dermatitis herpitiformis, Chronic Bullous Dermatosis of childhood and vasulitis were excluded. Skin biopsy and telogen hair obtained by combing were subjected to Direct Immunoflurescence. (Fluorescein Isothyocyanate) FITC –conjugated rabbit antihuman IgG was used. The samples were viewed under fluorescence microscope using a blue filter (490 nm). Green fluorescence was observed. The pattern of staining & intensity of staining were compared. Results: 30 cases of Pemphigus included 22 cases of Pemphigus vulgaris(PV), 5 cases of Pemphigus Foliaceous(PF) and 3 of pemphigus erythematosus(PE). Pemphigus Vulgaris and Pemphigus Foliaceous patients with active disease showed strong ICS(Intercellular substance) deposits in both skin and hair. 37.5% and 50% of Pemphigus Vugaris and Pemphigus Foliaceous in remission showed weak deposits in hair only. All cases of Pemphigus Eryhtematosus showed only ICS pattern with no (BMZ) Basement membrane zone deposits. Conclusion: Direct Immunoflurescence of skin and hair are comparable in pattern and intensity. Telogen hair is a useful tool in remission period as it is easily accessible and picks up potential cases likely to develop relapse and therefore requiring close follow up.

644-648

Authors: Shanmuga Priya S, Rajendiran S, Leena Dennis Joseph, Sai Shalini CN

Aim: To present a comprehensive analysis of autopsy findings in 168 fetuses in a tertiary care teaching hospital and to assess the clinical utility in reaching a final diagnosis. This is essential for counseling regarding the risk of recurrence in cases of congenital anomalies. We also performed autopsy in fetuses that were terminated based on the ultrasonogram that confirmed the malformation and were correlated to evaluate the potential benefit of radiological investigation. Materials and methods: Retrospective review of perinatal autopsy records in a tertiary care centre in South India during three year period (2005-2008) was made. Our study comprises of 168 fetuses, 42 terminated after detecting an anomaly in ultrasonogram and 126 were spontaneous fetal losses. In all cases, fetal autopsy was carried out and internal organs were studied. All fetuses with malformations confirmed by ultrasound findings were compared with autopsy findings. Results: Fetal autopsy was able to provide a definite final diagnosis in 100% of cases. Fetal autopsy correlated very well with the ultrasound findings in all cases. Conclusion: This study helps to analyse the importance of fetal autopsy in identifying the cause of fetal loss that will help in the genetic counseling of the couple.

653-657

Authors: Rahul Mannan, Mridu Manjari, Harleen Kaur, Tejinder Singh Bhasin, Sonam Sharma

Esophageal carcinoma (EC) is an upcoming major health challenge with 4,07,000 deaths related to it reported globally in the year 2008 alone. Its risk factors apart from tobacco and alcohol vary according to various geographical areas which include ethnicity, dietary and other socio-economic factors. This can have a bearing on its various prognostic factors in which Immunohistochemistry (IHC) has emerged as a major tool for predicting the same. p53 has proved to be a particular important molecule in development of many tumors including esophageal carcinoma as it has a role in both tumor immunity and cell cycle. The present study was conducted in Punjabi population where tobacco usage is low because of the societal and religious taboos and where life style and developmental indicators are high in comparison to rest of India. The aim was to analyze epidemiologically the cases suffering from esophageal carcinoma, to study p53 expression in histologically proven cases of esophageal carcinoma and also to correlate p53 positive expression with the type and grade of the tumor along with other clinico-pathological parameters. Material and Methods: The study was conducted on 50 cases of EC diagnosed in the Department of Pathology, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, Punjab, India. The 50 cases (either endoscopic biopsies or esophagectomy specimen) were independently verified for sub classification and histopathological grading. In all the cases patient’s complains, age, gender and other important clinical parameters were recorded. All the cases were taken up for IHC study for p53 expression. The results obtained were tabulated and statistically analyzed. A p value less than 0.05 was considered statistically significant. Result: In the present study, maximum cases (60%) were observed in the age group of 41-60 years where female patients outnumbered male patients in a ratio of (1.3:1). Lower segment (56%) was the most common segment involved. Histopathologically, most of the cases were of the squamous cell type (constituting 94% of the total cases) followed by adenocarcinoma with most of these cases graded as G2 (moderately differentiated). In 20 cases of esophagectomy specimen included in the present study; both lymph node metastasis and adventitial layer involvement (full thickness) was identified in 13 cases each. p53 expression was observed in 50% cases (percentage of positive cells varying from 5-89% with mild, moderate and strong staining intensity) with positivity seen in 48.9% cases of squamous cell carcinoma (ESCC) and 66.7% in adenocarcinoma (EAC). Of the cases included in the study; no significance between grading, lymph node status and p53 expression was elicited. However, correlation of p53 and adventitial involvement was noted and this finding was statistical significant. Conclusion: The present study is the first such study done on North Indian Punjabi population. The finding of significant association of p53 expression with adventitial involvement (full thickness involvement) is an important prognostic factor to comment upon the invasiveness of the disease in an individualized manner.

662-664

Authors: Supriya Sandeepa, Jayaprakash HT, Ashwini MC

1. To evaluate endometrial histopathological patterns in elderly women(adults > 40 years of age) with abnormal uterine bleeding. 2. To observe the frequency of various patterns. Methods: This is a retrospective study with evaluation of the histopathology slides of endometrial samples of 162 patients of > 40 years of age with clinical diagnosis of abnormal uterine bleeding, between 2006 to 2012 were studied. Results: A total of 162 patients were evaluated during the study period. 85 (52.46%) cases were functional lesions, 74 (45.6%) cases showed organic pathology and 3(1.85%) were reported unsatisfactory sample for evaluation. Maximum number of cases were observed in age group of 41-50 years with proliferative phase (60 cases, 49.18%) being the most common functional lesion and endometrial hyperplasia (37 cases, 30.32%) the most common organic lesion 5 cases (3.14%) of endometrial carcinoma were observed. Other endometrial patterns were secretory phase 20(12.57%), proliferative phase 62(38.99%), disordered proliferative endometrium 1(0.62%), lytic phase 1 (0.62%), irregular shedding 1 (0.62%), chronic endometritis 3 (1.88%), pregnancy related 1 (0.62%), atrophic endometrium 6 (3.77%). Conclusion: Endometrial hyperplasia which is a precursor of endometrial carcinoma is most common organic lesion in elderly women. Histopathological examination should be done generously in women presenting with AUB especially after the age of 40 years to rule out malignant pathology as accurate analysis of endometrial samplings is the key to effective therapy and optimal outcome.

673-678

Authors: Trupti Vyasrao Katti, Anand Ananthrao Shankar, Tejeshwini Patil

OTFS are a heterogenous group of tumors with varying stromal activity and produce hormones such as estrogen, androgen or progesterone. These tumors are of due importance as they have widespread clinical, biochemical or pathological effects on various tissues and organs and are commonly observed in female genital tract manifesting as hyperplasias or carcinomas. It is thus important to study OTFS and analyse the associated changes in the endometrium. Objectives: The aims of present study are: 1. Age distribution and clinical features of OTFS. 2. Histopathological spectra of OTFS. 3. Study of functional status of these tumors and associated endo-myometrial changes. Methods: Present study of 2 years (2014-2015) analysed 48 cases of OTFS and their corresponding endo-myometrial changes in hysterectomised patients, at department of pathology, Navodaya Medical College, Raichur, Karnataka. Specimens were examined, processed and stained using Hematoxylin and Eosin. Results: Majority of cases were in reproductive age group (83.3%) compared to postmenopausal (16.7%) category. Most were asymptomatic and few (12%) were symptomatic with menorrhagia and postmenopausal bleeding. Histopathological categories included: surface epithelial tumors (44), dermoid cysts (2), metastatic EOPPC (1) and combined tumor (1). OTFS with active stroma (64.5%) was commonly observed among total cases and the associated endo-myometrial changes, most frequently observed was endometrial polyp (29%) followed by cystoglandular hyperplasia (25.8%), adenomatous polyp (19.4%), adenomatous hyperplasia (16.1%), adenomyosis (8.7%) and leiomyoma (6.5%). Conclusion: As OTFS with active stroma can have ill effects on endo-myometrium, an appropriate screening of the cases clinically and histopathologically would reduce morbidity and mortality, thus helping in better patient outcome.

684-689

Authors: Vanisri HR, Vadiraja N

Hematologic changes have been accepted as a powerful predictor of morbidity and mortality in HIV-infected patients. It has been demonstrated that severe anemia is linked with faster rate of HIV disease progression. HIV infection affects hematological indices like MCV (Mean corpuscular volume), MCH (Mean corpuscular haemoglobin) and MCHC (Mean corpuscular hemoglobin concentration) of patients regardless of age, sex and ART. The rationale of this study was to recognize the association between RBC parameters and immune status in male HIV infected patients. Methods: The objective of this study was to consider red blood cell parameters and immune status and to contemplate the relationship between RBC indices and immune status. Results: Among the 48 HIV infected male patients, the CD4 count was significant and positively correlated with the Hemoglobin (HB) and hematocrit (PCV) values. RDW and MCHC were negatively associated but insignificant with CD4 cell count. RBC, MCV and MCH were positively associated but insignificant. CD4 cell count had a wide range with 1376 cells /cmm because of the impact of one patient whose CD4 count was 1435cells/cmm. However, the median was 290 cells /cmm indicating 50% of patients showed deteriorating CD4 cell counts. Conclusion: HIV infection affects the RBC parameters. Anemia is a significant predictor of HIV progression to AIDS. Hemoglobin concentration could be used as a consistent biomarker of the prognosis in HIV-infected patients, and that a therapeutic approach is vital for patients with anemia. There is significant association with reduced CD4 cell count and altered hemoglobin and hematocrit. Evaluation of these parameters certainly improves the condition and endurance of HIV infected patients.

696-700

Authors: Vijayshree Shivappa Neeravari, Doddappa Malleshappa Bannigidad, Lakshmi Rao

Several studies have found increased association of Diabetes Mellitus(DM) and Hypertension(HTN) in patients with non-Hodgkin lymphoma (NHL). We determined association of Diabetes Mellitus and Hypertension in 410 Non-Hodgkin lymphoma (NHL) patients diagnosed and treated in our institution. Results: 8.5% of NHL cases were associated with diabetes Mellitus. Among NHL patients with diabetes Nodal NHL were commoner than the Extranodal NHL. The most common subtype was Diffuse Large B Cell Lymphoma (DLBCL) followed by Follicular lymphoma (FL) with a frequency of 57.14% and 17.14% respectively. Hypertension was associated with 9.5% of NHL cases. Among the hypertensive patients, Extranodal NHL were more common with DLBCL being the most commonest subtype, followed by follicular lymphoma with a frequency of 56.4% and 20.5% respectively. Conclusion: Diabetes Mellitus and Hypertension are associated with development of NHL either directly or due to drugs used in the treatment. Further studies are required to identify the specific drugs involved in the development of NHL especially in the Asian populations where prevalence of diabetes and Hypertension has increased in the recent years.

704-709

Authors: Ranjana Hawaldar, Sadhna Sodani

Vit B12 deficiency causes macrocytic anemia and the early features of vitamin B12 deficiency in a peripheral blood smear is the presence of macrocytic RBCs and hyper segmented neutrophils and a raised MCV >99 fl. Subclinical deficiency is more prevalent in the population and timely diagnosis of vit B12 deficiency in such patients is of paramount importance so that timely treatment is initiated before overt clinical symptoms become evident and irreversible. The present study was undertaken to evaluate whether the Beckman coulter VCS parameters MoV –DW (monocyte anisocytosis) and NeV-DW (neutrophil anisocytosis) can predict Vitamin B12 deficiency in subclinical cases. Materials and Methods: A total of 200 patients both male and female were included in the study. They were divided in to <20, 21-40, 41-60, 61-80 and more than 80 years age group. WHO criteria for anemia (Hb <12g/dl in women and Hb<13g/dl in men) was followed. The efficacy of hematological parameters and research data (Mean volume of neutrophils and monocytes) and their distribution width were used to detected presence of vit B12 deficiency. Results: A total of 200 patient’s data was used for this purpose. Out of 200 patients 87 (43.5%) were females and 113 (56%) were males. Male to female ratio was 1.29:1. Normal MoV-DW (8.71)NeV - DW (6.89)LyV - DW (5.86) was taken as cut off. It was observed that 50 (25%) patients had normal or near normal Hb concentration but had severe Vit B12 deficiency below 200 pg/ml. Out of these, 43 patients (86%) had MoV-DW > cut off and 40 patients had NeV-DW > cut off, 28(56%) patients had LyV-DW > cut off. Conclusion: No single ideal marker exists for vitB12 deficiency especially in subclinical conditions. However we can say that monocyte & neutrophil anisocytosis (MoV-DW and NeV-DW) are associated with vit B12 deficiency and can be used to predict vit B12 deficiency in subclinical cases. Making use of research VCS parameters from Beckman Coulter LH750 along with complete blood count at a reasonable cost, subclinical vitB12 deficiency can be determined.

714-720

Authors: Ranjan Agrawal, Poospam Sharma, Parbodh Kumar

Cutaneous appendageal tumours can arise from either the eccrine, apocrine, hair follicles or the sebaceous glands. Majority of the tumours are benign. Final diagnosis requires a good clinical as well as histpathological correlation. The aim of the present study was to assess the clinicopathological characteristic of these tumours. Materials & Methods: The present study was a retro-prospective study carried out in the department of Pathology, Rohilkhand Medical College & Hospital, Bareilly (Uttar Pradesh), a tertiary care hospital. The cases were noted, classified and studied according to their age, sex and site. A total of 29 cases were included in the present study over a period of three years. These cases were confirmed to have cutaneous adnexal neoplasm on histopathology. All the specimens were formalin fixed, processed and stained with routine Haematoxylin & Eosin method and special stains were applied wherever necessary. The tumours were classified as apocrine, eccrine, follicular and sebaceous type based on the histopathological report. Results: It was observed that the incidence of skin adnexal tumours was very low in relation to the total number of surgical specimens received in the department of Pathology (0.093%). The mean age of presentation of adnexal tumours in this study was 37.66 years with patients ranging from 10 to 80 years. Females 18 (62.1%) outnumbered the males 11 (37.9%) in the present study. Among 29 cases, 23 cases were benign and 6 cases were malignant. 6 (20.7%) of these tumours were derived from eccrine & apocrine glands, 6 (20.7%) cases showed sebaceous differentiation and 17 (58.6%) cases were tumours of follicular differentiation. The commonest lesion observed was Pilomatricoma in 10 cases (34.4%). Conclusion: Appendageal skin tumours have distinct histological characteristics which differentiates them from other cutaneous tumours. The clinical diagnosis may be difficult because they have overlapping presentations and thus can be differentiated using histopathological examination only.

727-731

Authors: Sunita B. Patil, Chatura KR

Schwannomas exhibit histologic features that may overlap with those of benign and malignant peripheral nerve sheath tumours. This can be the challenging in making accurate histopathological diagnosis there by influence clinical management. Objective: Our study focuses on schwannomas to identify subtypes based on histopathologic attributes and associated clinical features and its variants. Methods: 37 cases of schwannoma were ascertained using records (2003 to 2006) and also prospectively (2006-2008) at JJM Medical college hospital, Davangere. Case and specimen details, slides and blocks were collected from department archives. The specimens were fixed in 10% formalin for 24-48 hours and sampled for detailed histopathological examination. Slides were stained with hematoxylin and eosin. Microscopic findings were noted in a detailed manner in a proforma. Special staining with Perl’s Prussian blue, toluidine blue and immunohistochemistry were performed wherever needed. Results: Classical schwannomas comprised most cases, 31 (83.8%). Histological variants encountered were cellular schwannoma, plexiform schwannoma, ancient schwannoma, schwannoma with pseudoglandular elements, cystic schwannoma and psammomatous schwannoma. Most common locations of classical schwannomas were head & neck region followed by extremities, seen over a wide age range. In only one case of classical schwannoma, histopathological diagnosis correlated with clinical diagnosis. Conclusion: Schwannomas show an interesting histologic variety despite being composed of a limited array of cellular constituents. Key issue for the pathologist includes distinguishing schwannomas from neurofibromas, and MPNSTs from cellular schwannoma or neurofibromas.

736-738

Authors: Dhanalakshmi Subramaniam, Sudha Venkatesh, Sofia Chandrababulu

Central mucoepidermoid carcinoma is very rare constituting 2–4% of all mucoepidermoid carcinomas. Its location in the maxilla is even rarer. The occurrence of this common tumor at the rare site poses a diagnostic challenge to the clinicians and pathologists. Here we report one such rare interesting case of mucoepidermoid carcinoma in a 30 year old female developing in the maxilla with involvement of adjacent vital structures.

742-743

Authors: Banushree CS, Ramachandra V Bhat

Calcific myonecrosis is a rare painful, expansile, calcified mass that develops as a result of compartment syndrome in a muscle of lower extremity. Patient usually present several years after trauma as a mass typically in anterior compartment of leg which can be mistaken for soft tissue tumor. Imaging studies can aid in the diagnosis of this less known entity. However, diagnosis is confirmed by histopathologinal findings of linear calcification and central necrosis inside a cavity in a muscle. We report a rare case of calcific myonecrosis involving posterior compartment of leg in a forty three year old female who had presented with pain in right mid-calf region for two weeks. Color Doppler showed small cystic lesion with calcification suggestive of probable neurofibroma for which complete excicion of the lesion was done and diagnosis of calcific myonecrosis was made on histopathological examination.