Indian Journal of Pathology and Oncology

57-60

Authors: Amita K, Nithin Kumar H, Shobha SN, Vijay Shankar

Aim: To compare platelet count, mean platelet volume and platelet distribution width in preeclampsia and normal pregnant females in diagnosis and assessing the severity preeclampsia. Materials and Methods: Case control study comprising of 50 preeclamptic females between 20 to 24 weeks of gestation as cases and 50 normotensive pregnant females matched for age and gestation as controls. Preeclamptic patients were separated into three groups as mild (25), moderate (13) and severe preeclampsia (12).Platelet count, mean platelet volume and platelet distribution width measured by automated hematology analyzer sysmex KX 21 was recorded in all the groups and analyzed. Results: Platelet count decreased significantly in patients with preeclampsia as compared to normotensive healthy females. (Mean platelet count in lakhs/cumm ± SD - 1.6688 ±.71890 vs 2.5888 ±.66881, p < 0.0001) Among preeclamptic patients there was significant decrease in platelet count with the increasing severity (mild, moderate and severe preeclampsia - 2.2044 + 0.594, 1.176 + 0.267, 1.0917 + 0.385, p < 0.0001). There was significant increase in PDW in preeclampsia when compared to normotensive pregnant females. (PDW in fl - 15.488 ± 2.4685, 11.755 ± 1.4206, p < 0.0001) There were no significant differences in MPV in normal and preeclampsia and between severities of preeclampsia. Conclusion: Platelet count emerges as a reliable indicator for diagnosing preeclampsia and predicting the severity of disease. Though, PDW is also another reliable marker for diagnosis of preeclampsia, its role in assessing the severity of preeclampsia need to be explored. Also increased MPV is not a significant predictor of preeclampsia in pregnancy.

69-72

Authors: Sily Sreedharan, Prema N S

Background: Intestinal obstruction in the neonate or infantile period poses problem in the management. The diagnosis and the management can be resolved by taking rectal biopsy and proving them as Hirchsprung’s or Pseudohirchsprung’s disease by histo-pathological examination. It helps in better patient management by avoiding unnecessary surgeries in cases of Pseudohirchsprung’s disease. Aim: To study the pathology of Pseudohirchsprung’s disease and its staining pattern in immunohistochemistry with Neuron specific enolase (NSE) and S- 100. Material & methods: Study included all cases with clinical diagnosis of Hirchsprung’s disease, received in the department of pathology of a Govt. Medical college. Duration of study was 2 years from 2005-2007. A total of 90 cases were studied. Results: Out of the 90 cases, 61(67.7%) were diagnosed as Hirchsprung’s disease, 23 cases (25.60%) as Pseudohirchsprung’s disease. Of the 23 cases of Pseudohirchsprung’s disease, 7 cases showed hyperganglionosis, 7 cases showed hypoganglionosis and 9 cases showed normal ganglionic segment. Immunohistochemistry with NSE & S-100 in selected cases showed increased staining of sub mucosal nerve trunks. Conclusion: One fourth of clinically diagnosed cases of Hirchsprung’s disease were actually Pseudohirchsprung’s disease. No definite IHC pattern could be clearly defined. Further studies are recommended for setting up standards for diagnosis of Pseudohirchsprung’s disease, which will aid in better management of the cases.

76-80

Authors: Hawaldar Ranjana, Sodani Sadhna

Evaluation of LH 750 VCS parameters and lymph Index in identifying Dengue fever Background: Dengue is an acute viral infection which affects nearly 50-100 million people across many countries of the world. It is now threatening to become a major health problem across the globe. There is no specific treatment for Dengue and diagnosis depends mainly on serological testing and virus isolation from blood of patients. The major problem physicians face is to distinguish self-limiting Dengue fever from Dengue haemorrhagic fever. Aims and objectives: The present study aims to evaluate the utility of VCS (volume, conductivity, scatter) parameters and lymph index in accurately predicting dengue fever. We retrospectively analysed data from 193 febrile patients coming to our diagnostic centre between August 2014 and October 2014 and calculated the lymph index in the patients positive for dengue infection by serological methods. Materials and Methods: In this retrospective case control study, blood samples were collected from 193 febrile patients between August 2014 and October 2014. A simplified lymphocyte CPD(cell population data), the lymph index, was calculated as LV(lymphocyte volume) X LV- SD (standard deviation of lymphocyte volume) ÷ LC(lymphocyte conductivity). Results: We observed a significant increase in the lymph index in dengue patients (≥13.6) as compared to controls (mean lymph index 10.32). The Sensitivity and Specificity in predicting dengue infection was 71.17% AND 78.05% respectively with a cut off of ≥13.6. Conclusion: These results indicate that lymph index is a good hematological parameter for predicting dengue infection.

84-86

Authors: Preeti R Chakrabarti, Amit Varma, Priyanka Kiyawat, Kapil Gupta

Malignant melanoma is an aggressive tumor with potential to metastasize anywhere within the body. Herein, we report a 51 year male patient clinically diagnosed as diabetic foot ulcer that developed enlarged right inguinal lymph node during treatment. FNAC of right inguinal lymph node was performed. Initial cytological diagnosis of metastatic melanoma was made which lead to clinical suspicion of melanoma masquerading as diabetic foot. Cytomorphological features of metastatic melanoma are described with brief review of literature and value of cytological diagnosis is emphasized.

90-92

Authors: Jyotsna Suri, Rita Kumari, Bhavneet Kour

Eccrine spiradenoma is an uncommon benign tumor of sweat glands. The clinical presentation in majority of cases is as solitary painful dermal nodule less than 5 cm in diameter, with equal incidence in both sexes. The nodule develops most usually on head, neck and dorsal aspect of the trunk and is many times recurrent. Malignant transformation is rare. Differential diagnosis includes other sweat gland tumours, sebaceous cysts and various benign subcutaneous connective tissue disorders. Exact diagnosis and radical surgical excision can avoid recurrence. We here report a case of eccrine spiradenoma, clinically diagnosed as cervical lymphadenitis and stress the importance of role of fine needle aspiration cytology in its diagnosis along with documentation of the cytological diagnostic criteria of the same.

96-97

Authors: Prashant Vijay Kumavat, Urmi S Chakravarty, Shailesh S Vartak, Pankti Hemant Haria

Fine needle aspiration cytology (FNAC) is an important diagnostic tool in the diagnosis of soft tissue nodules around joint. Our patient was a 55 year old man a known hypertensive, diabetic with history of multiple skin coloured nodular lesions on both feet involving ankle, malleoli, Achilles tendon and dorsum of the forth toe associated with discharging sinuses since two years. He did not have any other clinical symptoms. The X ray of both feet showed osteolytic lesions. FNAC of the lesions revealed, monosodium urate crystals (MSU) which are birefringent needle shaped crystals under polarising microscopy. Diagnosis on FNAC was given as gouty tophi. Further investigations done revealed high levels of serum uric acid (10.4mg %) and a confirmed diagnosis of gout was given. It is important that pathologist should be conversant with the cytomorphological features of gout and also should be aware that FNAC can play an important role in the diagnosis of these lesions.

101-104

Authors: Majethia Nikhil Kantilal, Mohd. Unzer Khan, Haria Pankti, Felice Faizal

With the continuing rise in the number of immune-compromised patients, the incidence of invasive mycoses has increased. There are various patterns of fungal infections. Because of limitations in ante mortem clinical diagnosis owing to lack of sensitive diagnostic tools, information regarding frequency and pathogenesis of fungal infections is largely dependent on autopsy. We report a case of 50 year old diabetic female with lower limb cellulitis died of subarachnoid haemorrhage which showed mixed cirrhosis and fungal endocarditis. This presence of fungal endocarditis in a non diseased heart with no major risk factor like previous cardiac surgery or illicit drug abuse, but along with cirrhosis and diabetes is rare. Also fungal endocarditis is commonly associated with hemorrhagic stroke but subarachnoid haemorrhage is very rare.

109

Authors: Hira Mir, Limci Gupta

Indian Journal of Pathology and Oncology (IJPO) is an interdisciplinary journal at the interface of pathology and oncology, including the preclinical and translational research, diagnostics and therapy. The journal covers studies related to pathology including morbid anatomy, surgical pathology, clinical pathology, diagnostic cytopathology including gynecologic cytology. Furthermore, IJPO offers an international forum for the rapid communication of reviews, original research, critical and topical reports with excellence and novelty. Published quarterly, IJPO is dedicated to keeping scientists informed of developments in its focused biomedical fields which span the gap between basic research and clinical medicine.

1-6

Authors: Nirmala T, Kumar Pradeep L., Vani B R., Murthy Srinivasa V., Geetha R L

Total of 100 cases were included in the study. 37 were mild GH, 9 cases were severe GH, 29 cases were mild preeclampsia and 25 cases were in severe preeclampsia group. Prolonged PT, aPTT and D-Dimer was seen in 15 cases, 42 cases and 38 cases respectively. In our study we observed increased mean aPTT of 27.33±4.54 and increased D-Dimer of 0.35±0.33 in severe preeclampsia patients. Hence we emphasize that raised aPTT, D-Dimer are alarming signs for aggressive treatment. Conclusion: Raised aPTT and D-dimer are fairly good indicator of severe preeclampsia and needs aggressive treatment.

14-24

Authors: Jyotsna Suri, Priya Gupta, Rita Kumari

Background: Vesiculobullous disorders of the skin have well defined patterns of deposition of immunoglobulins (Ig) and complement, which can be demonstrated by immunofluorescence techniques, and help in making an accurate diagnosis of the same. Methods: A clinicopathological study of 15 cases of vesiculobullous diseases diagnosed as Pemphigus and Pemphigoid was carried out. The study included six male patients and nine female patients. Light microscopy was done to see the level of cleavage of bullae and the diagnosis was further supported by direct immunofluorescence (DIF) findings. The correlation between intensity of fluorescence and the serum Ig & complement levels was studied. Result: The patterns of deposition of immunoreactants were found to be in conformity with observations of the earlier studies and the Serum Ig & complement levels showed positive correlation with intensity of DIF positivity on skin biopsy. Conclusion: Immunofluorescence has now been well established as a helpful technique in diagnosing bullous lesions which has a bearing on the treatment of these diseases which if not treated properly can prove fatal as a result of life threatening complications.

31-36

Authors: Damle Rajshri P., Suryawanshi Kishor H., Dravid Nandkumar V., Newadkar Dhananjay V.

Dermatofibrosarcoma protuberans (DFSP) is a rare, slow growing fibro histiocytic neoplasm with intermediate to low grade malignancy. It is locally invasive tumor but rarely metastasis with high rate of recurrence. It commonly occurs on the trunk, proximal extremities. We report a rare case of a 58 year old male who presented with very huge mass over anterior chest wall. Wide local surgical resection with surrounding surgical margins was performed. Histopathological examination along with immunohistochemistry confirmed the diagnosis of DFSP. We present this case due to its rarity and its unusual gross appearance.

41-43

Authors: Sarmad Raheem Kareem

Endometriosis is common gynecological condition that may arise spontaneously or in surgical scar, particularly of cesarean section, and it may and cause diagnostic confusion with other surgical conditions. Endometriosis can undergo many metaplastic changes, and this is a case report of markedly decidualized endometriosis.

48-52

Authors: Anshu Gupta, Chhavi Gupta, Anju Kapoor

Plasma cell leukemia (PCL) is a rare disorder that can develop spontaneously (primary) or evolve in patients with multiple myeloma (secondary). Histogenetically, plasma cell leukemia is derived from terminally differentiated B cells. It is diagnosed by the presence of absolute plasma cell count >2000/cumm or >20% circulating plasma cells in blood. We report a rare case of primary plasma cell leukemia in patient with unique presentation of a psychiatric illness having hallucinations, mood changes and loss of insight. The patient had past history of pulmonary tuberculosis and developed de novo PCL as there was no previous history of multiple myeloma. Clinical spectrum, cytomorphological features and prognosis of PCL are also discussed in this case report.

1-3

Authors: Asitava Deb Roy

Indian Journal of Pathology and Oncology (IJPO) is an interdisciplinary journal at the interface of pathology and oncology, including the preclinical and translational research, diagnostics and therapy. The journal covers studies related to pathology including morbid anatomy, surgical pathology, clinical pathology, diagnostic cytopathology including gynecologic cytology. Furthermore, IJPO offers an international forum for the rapid communication of reviews, original research, critical and topical reports with excellence and novelty. Published quarterly, IJPO is dedicated to keeping scientists informed of developments in its focused biomedical fields which span the gap between basic research and clinical medicine.

6-9

Authors: Pratiksha Chheda, Shamma Shetye, Nishtha Vira, Nilesh Shah.

Rapid diagnosis of tuberculosis (TB) is one of the cornerstones for global TB control as it allows early epidemiological and therapeutic interventions. The slow growth of the tubercle bacillus is the greatest obstacle to rapid diagnosis of the disease. Newer molecular methods which are based on nucleic acid amplification (NAA) of different targets, aim to identify the M. tuberculosis complex in 6- 8 hours. In this study, we assessed the performance of careTB Assay, a Real Time based Polymerase Chain Reaction (PCR) for identification of IS6110 insertion sequence which is specific for Mycobacterium Tuberculosis Complex (MTC). Sputum specimens were collected from 100 patients with suspicion of pulmonary tuberculosis and tested for the presence of MTC using careTB kit. The results were compared against MTB culture. The sensitivity, specificity, positive predictive value, and negative predictive value of TB PCR were 92.98%, 88.37%, 91.38% and 90.48% respectively. PCR correctly identified MTC in four of the smear negative/ culture positive samples indicating high sensitivity of the assay. Four of the culture positive MOTT specimens were found to be negative by IS6110 PCR which is highly specific for MTC group of organisms. careTB test is simple, easy to perform and delivers the results in lowest possible turnaround time. Its sensitivity, specificity, and positive predictive value are satisfactory.

14-17

Authors: Harpreet Kaur, Aayushi Gulati.

Fibroids are the commonest benign tumors of female genital tract. They are mainly composed of smooth muscle & fibrous connective tissue. Etiopathogenesis of fibroids is linked to hormones (estrogen & progesterone), genetic factors and some growth factors. Estrogen is the main predisposing factor-there is increased density of estrogen in fibroids compared to normal myometrium and increased concentration of aromatase leading to high local estrogen levels. The growth promoting effect of estrogen & progesterone has been shown to be mediated through local production of growth factors.

24-30

Authors: Sodani Sadhna, Hawaldar Ranjana.

A 50 year old patient cam to Sampurna Sodani Diagnostic Clinic, Indore for routine tests including CBC and Lipid profile. CBC was WNL while chol (211 mg/dl), Triglyceride (109 mg/dl) and HDL was unusually high (113 mg/dl). On further investigations and detailed history it was found that he was a farmer, was nonalcoholic, non-diabetic, normotensive, nonsmoker and had not received any medications for reducing his lipids . He had never undergone any blood tests previously. He complained of headache off and on for which a CT scan was performed and which revealed focal area of hypoattenuation in right anterior centrum semiovale, corona radiate and right lentiform nucleus suggestive of recent right MCA territory infarct. High density lipoprotein or HDL is often called the good cholesterol. It has long been accepted that the HDL is more tightly controlled by genetic factors than are the other lipoproteins (ie, LDL, VLDL, intermediate-density lipoprotein [IDL], and chylomicrons). For example, in certain families, especially some families with Japanese ancestry, a genetic deficiency of cholesteryl ester transfer protein (CETP) is associated with strikingly elevated HDL cholesterol levels. However, environmental factors also have a significant impact on HDL levels. Factors that elevate HDL concentrations include chronic alcoholism, treatment with oral estrogen replacement therapy, extensive aerobic exercise, and treatment with niacin, statins, or fibrates. On the other hand, smoking reduces levels of HDL cholesterol, while quitting smoking leads to a rise in the plasma HDL level. Very high levels of HDL cholesterol have been reported to be atherogenic. The mechanism of this paradoxical effect is not entirely clear. Conclusion: While the epidemiology indicates a strong inverse association between HDL-C and CVD risk, at both extremes of HDL-C distribution, genetic conditions that influence HDL metabolism have a far less predictable relationship to atherosclerosis. Ongoing studies of genetic causes of very high HDL-C also promise to provide similarly important insights on the complex relationship between HDL metabolism and atherosclerosis that could lead to new therapies for the treatment of atherosclerotic CVD.

34-36

Authors: Afsheen Wasif, Limci Gupta.

Mural nodules of the ovary are described as solid masses or nodules which are histologically different from the background cystic tumour. These nodules can be associated with both serous and mucinous ovarian tumours but more commonly with mucinous subtypes. These mural nodules could be benign or malignant. The subtypes include sarcoma-like, sarcomatoid, anaplastic and mixed. We describe a case of a borderline mucinous ovarian tumour with intraepithelial carcinoma with a mural nodule of anaplastic carcinoma.

41-43

Authors: Vartak Shailesh, Anitha Padmanabhan, Ranbir Singh, Urmi Chakravarty Vartak.

A case of Sarcoidosis, presented initially as bilateral parotid gland enlargement and diagnosed on FNAC is discussed here. Smears showed noncaseating epithelioid cell granulomas and few atrophic salivary gland acini. AFB staining of the aspirate smears were negative and no caseous necrosis was seen. After excluding other granulomatous lesions, a differential diagnosis of Tuberculosis and sarcoidosis was suggested. The Serum ACE levels were elevated and x ray chest showed hilar lymphadenopathy. The patient also had xerostomia and xerophthalmia of right eye. The diagnosis of Sarcoidosis was confirmed based on these findings. FNAC, therefore, may be considered a useful diagnostic modality in cases of sarcoidosis presenting primarily with parotid involvement.

47-52

Authors: Banushree C Srinivasamurthy, Swagatika Senapati, Nagarajan K, Arpita Saha.

Basal cell adenoma is a rare benign epithelial tumor of the salivary gland that derives its name from the basaloid appearance of the tumor cells, accounting for 1–2% of all salivary gland epithelial tumors. We report a case of elderly female with a gradually progressive swelling in the pre auricular region for 1year. Fine needle aspiration cytology of the lesion was inconclusive but its classical histopathological features made a confirmed diagnosis of basal cell adenoma.