Indian Journal of Pathology and Oncology

186-188

Authors: Rupali Bavikar, Arvind Valand, (Col) Harsh Kumar, Charusheela Gore, M B Iqbal

Background: India has the highest burden of TB in the world, an estimated 2 million cases annually, and accounting for approximately one fifth of the global incidence. It is also estimated by the World Health Organization (WHO) that 300,000 people die from TB each year in India. The diagnosis of tuberculosis may not be established during the inpatient stay due to many reasons (e.g. extra pulmonary TB, TB in immunocompromised host etc). We did an autopsy study to find out the prevalence of tuberculosis at post mortem in medical inpatients at a tertiary care hospital in Mumbai, India. Methods: This is a prospective study and analysis of 112 consecutive medical autopsies of patients over a period of 12 months carried out at Grant Medical College and Sir JJ group of Hospitals, Mumbai, India. During this period, there were a total of 1558 deaths. A total of 112 medical autopsies were performed and included in this study. We did gross pathological and histopathological analysis. The primary outcome measure was specific disease or diseases. Secondary outcomes were missed tuberculosis, and co morbidities with tuberculosis. Results: The median age of the 112 included patients was 32 years, 70 (63%) were men and 42 (37%) were females. 24 (21%) patients had tuberculosis, of whom 15 (62%) were infected with HIV. 13 (55%) of these 24 patients had disseminated tuberculosis. The risk of disseminated tuberculosis was higher among HIV infected patients than among uninfected patients with 11 of the 13 cases of disseminated tuberculosis diagnosed in HIV infected patients (p<0.009). 6 (33%) of 24 patients with tuberculosis were not diagnosed during their life. Conclusion: Tuberculosis remains a major cause of death in India. Tuberculosis often remains undiagnosed and hence there is a need to increase awareness and actively screen for tuberculosis especially in HIV positive patients.

215-218

Authors: Kulwant Singh, Roque G. Wiseman Pinto

Background and Objectives: Fine needle aspiration cytology is a widely used first line investigation for breast lesions in surgical practice. Gynecomastia is the most common lesion of male breast. FNAC is usually asked for male breast lesions in case of unilateral breast enlargement to rule out malignancy. This study was done to obtain sensitivity, specificity, other statistical parameters and cytohistological correlation in FNAC of male breast lesions so as to know its diagnostic utility. Methods: Study was performed at Goa medical college over a period of seven years. Only the cases with availability of histological diagnosis were included in the study. All slides were stained with Hematoxylin and eosin after fixation in alcohol-ether mixture. Results: Sensitivity, specificity, accuracy, positive predictive value and negative predictive value were 100% for FNAC of male breast lesions. Excellent cytohistologic correlation was also observed. Conclusion: These results indicate that FNAC of male breast lesions shows excellent specificity, sensitivity and cytohistologic correlation. Hence, it can be used in initial diagnostic workup of lesions of male breast.

236-239

Authors: Vijay Shankar S, Manyukumar Vaidya, Amita K

Background: The clinical diagnosis of acute appendicitis(AA) in children and adolescents is still problematic. Objectives: To evaluate the role of Mean Platelet Volume(MPV) in acute appendicitis in children and adolescents. Materials and methods: A retrospective study involving 52 test and 51 control individuals. The statistical analysis expressed as mean MPV ± standard deviation, independent ‘t’ test for calculating p values. Results: In the Group ‘T’ mean MPV was 7.48 and in Group ‘C’ was 8.02. The p value was 0.027 which is less than 0.05 indicating it was statistically significantly lower than the Group ‘C’. Conclusion: Current study indicated that MPV decreases significantly in AA group of children and adolescents. Hence we believe taking MPV into consideration will help in the diagnosis of suspected acute appendicitis in children and adolescents.

251-261

Authors: Ravikanti SK, Abdul Hakeem Attar, Sunitha BR, Murugesh SB

Introduction: Viralskin and mucocutaneous disorders are common in HIV infection and may be the earliest manifestation of the disease. The spectrum of these disorders is wide and may vary in different regions due to varying prevalence of various microbial agents. Therefore, we studied the seroprevalence of HIV infection in patients presenting with skin and mucocutaneous disorders and clinical and regional epidemiological profile of seropositive patients. Objectives: To know incidence of viral opportunistic infections in HIV, with special reference to CD4 counts. Materials and Methods: This is a prospective study. Incidence of clinically and laboratory confirmed cases of viral opportunistic infections in HIV patients are recorded. Blood of these patients were processed for CD4 counts, by Partech Flow cytometry to assess the immune status among them. Results: 85 HIV seropositive patients with viral opportunistic infections with age group of 15-45 years, attending the outpatient and inpatient department for the period of one year from June 2013-June 2014 at Chigateri General Hospital, ART center, were included in this study and CD4 counts were done among them. Out of these,70(88.2%) patients had Herpes zoster with CD4 counts <200mm3, 5(5.8%)patients had Herpes simplex labialis with CD4 counts <200mm3(2.3%), patients had molloscumcontagiosum with CD4 counts <100mm3,1(1.1%) patient each of Herpes genitalis, Cytomegalovirus pneumonia, Ebstien virus infection with CD4counts <200mm3(2.3%) patients of combined infections of Herpes zoster and hepatitis B observed with CD4 count <100mm3(2.3%) patients of combined Herpes zoster and molluscumcontagiosum observed with CD4 count <50mm3. Commonly observed risk group were heterosexual, blood transfusion, non agriculture group, local transport worker and housewife. Conclusions: In this study attempt was made to know the incidence of viral opportunistic infections in HIV seropositive patients with low CD4 counts, in which CD4 counts can be considered as clinical score,which serve as an alarm for timing of prophylaxis and a guide for therapeutic intervention.

265-276

Authors: Gayatri Gogoi, M. Borgohain, H Saikia

Background: Breast cancer is a heterogeneous disease with varied morphological appearances, molecular features, behavior, and response to therapy. High levels of human epidermal growth receptor 2(HER2/NEU) expressions are associated with recurrence and death in breast cancer (BC). Though it is associated with poorer survival but its main importance is as predictors of response to agents that target this transmembrane protein (transtuzumab). The aim of the study was to evaluate the expression pattern of HER2/NEU in invasive component of breast carcinoma and correlate with various prognostic parameters such a tumour size, histologic grade, histologic type, regional lymph node status, and proliferative marker Ki67. Study Setting & Design: A total of 112 breast cancer cases were studied for the histomorphological features followed by immunohistochemical study in the Department of Pathology of a tertiary care hospital. Material and methods: The lumpectomy or mastectomy specimens were fixed on 10% neutral buffered formalin immediately after surgery in 10 fold volume. Important clinical information from patients were collected in Performa. Finally routine hematoxylin and eosin sections were examined to confirm presence of invasive cancer, ascertain histological types, Histological Bloom Richardson grade (BRG)1 and axillary lymph node status. IHC of HER2/NEU protein was done using HER2/NEU antibody following standard procedures. The tumour was also immunostained with Anti ER, Anti PR, and Ki67 primary antibody. Statistical Analysis: Data was analyzed by SPSS software. Results and observation: The mean age of breast cancer presentation in this study was 44.6 years with standard deviation 11.24.This IHC evaluation for HER2/NEU was positive with 3+ score in 18.75% of cases. The data of HER2/NEU expression profiles were correlated with 3 BRG histologic grades of the tumours, it showed a positive association with high histologic grade. HER2/NEU profiles were inversely correlated with ER, PR expression (p value < 0.05). The HER2/NEU expression profiles was also correlated with tumour size and a significant relationship was found (p = 0.041).HER2/NEU positive tumours were belonged to mostly IDC.HER2/NEU expression profile was correlated with proliferative index Ki67 expression in this study and found a direct relationship (p < 0.005). Lymph node status and HER2/NEU showed a significant statistical correlation (p = 0.037). Discussion: The over-expression of HER2/NEU is associated with poorer prognosis, high grade features and resistant to usual chemotherapy10. Our study also revealed that the Patients with higher levels of HER2/NEU- overexpression or amplification had statistically significant with lower levels of ER and PR positive tumours. We also found that when Her 2 neu was positive in tumours along with ER and PR, then it was mostly high BRG and High Ki67.The new addition from our study wasHER2/NEU expression profile correlation with Proliferative marker Ki67 which revealed a positive association. Conclusion: The expression pattern of HER2/NEU protein showed a strong correlation with high Ki67 expression which means these tumours are likely to have higher proliferative fractions leading to high probability of recurrence without management by herceptin therapy.

284-289

Authors: Sanjay M, Sarvesh BM

Background: Good number of paediatric population present with mass lesions to the routine outpatient clinic. Triaging these patients into operative candidates and non-operative candidates is important to avoid them from unnecessary surgical exposure thereby preventing complications which may arise. Aim: The current study aims to evaluate the role of FNAC in pediatric and adolescent age group. Subjects and Methods: A retrospective study of FNAC in age group ≤ 18 years of age presenting with mass lesions was studied for 2 years. Distribution of cases in different age groups, sex, and site of lesion was analyzed. Pediatric lesions were categorized into non-neoplastic, benign, and malignant conditions. Diagnostic efficacy was assessed by comparing subsequent histopathological examination wherever possible. Results: FNAC was performed on 1804 cases in 2 years out of which 154 cases 8.5% (154/1804) were ≤ 18 years of age. Out of 154 cases analysed FNAC in the age group of 1 to 10 years constituted 35.7%(55/154) and in the age group of 11 to 18 years constituted 64.3%(99/154) of study population.Male to female ratio was 0.8:1, ultrasound guided aspiration constituted 1.9% of total number of cases.Most common site of FNAC was lymph node(40.2%) and the commonest finding was reactive lymphadenitis(50/62).Among the benign conditions of other sites Hashimotos thyroiditis in thyroid, Fibroadenoma in breast were the predominant findings.There were 3 malignant lesions one case each of Hodgkins lymphoma, Non-Hodgkins lymphoma and chondroblastoma. The cytological diagnosis concurred with the histopathological findings in all cases. Conclusion: FNAC is simple reliable and cost effective diagnostic modality in paediatric and adolescent age group. It becomes even more apt in a rural tertiary health care institute because of limited resources.

303-308

Authors: Zeenath Begum1, Abdul Hakeem Attar, Mandakini B. Tengli, Mohammed Mateen Ahmed

Background (Aims and Objective): Study of various histopathological patterns in TURP specimens diagnosed as Benign Prostatic Hyperplasia, identifying type and grade of inflammation, incidental detection of carcinoma prostate and application of modified Gleason system. Materials and Methods: From January 2014 to August 2015 a total of 50 TURP specimens were evaluated. The tissue blocks and H&E stained slides of the tissues were retrieved and slides reviewed. Various patterns of proliferation, types and grade of inflammation were studied and classified using standard methods. Incidentally identified carcinoma prostate were classified using WHO Classification and graded using modified Gleason system. Results: 48(96%) were BPH with co-existing chronic prostatitis 12(24%) granulomatous prostatitis 1(2%) and acute prostatitis 2(8%). Papillary hyperplasia was predominant finding 17(34%). Less frequent finding was basal cell hyperplasia, 6(12%) atypical adenomatous hyperplasia 4(8%) and cribriform hyperplasia 1 (2%). Proliferative inflammatory atrophy constituted 3 cases(6%).Scattered necrotic glands were present in 20(40%) cases, periglandular lymphoid aggregation was a frequent finding in these necrotic glands. we reported two cases of adenocarcinoma prostate with modified Gleason score of one (5+4=9) and another score of (5+3=8). Conclusion: With increase in the incidence and mortality rates from prostate cancer, every effort should be made to improve diagnosis. It is necessary to review periodically all TURP in order to identify premalignant lesions, proliferative activity, and grade of inflammation. Efforts should be made to apply modified Gleason system to improve management facility. We also conclude that proliferative activity and invasiveness increases from benign to the malignant end in the spectrum of prostatic lesion.

311-315

Authors: J. Sreedevi, M.Mishra, R.Mohanty, R.Narayan, F.Rana

Context: Sebaceous cell carcinoma is a malignant neoplasm, rarely recognized in extra ocular sites. This neoplasm is aggressive in 29% of patients, lymph node and visceral metastasis are common. Its prognosis depends on early diagnosis of lesion. Clinical & Diagnostic features: An 49 year old female had slow growing nonulcerative subcutaneous nodule on the nape of neck of 9 months duration. On FNAC cytological findings favoured a benign skin adenexal tumor with focal nuclear atypia. On histological examination it was diagnosed as a poorly differentiated sebaceous carcinoma. Conclusion: Extra ocular sebaceous carcinoma is a rare neoplasm. It is difficult to diagnose as it has diverse clinical presentations, histologic patterns and complicated nomenclature. We will discuss the incidence, clinical, and histological findings along with the prognosis of this aggressive neoplasm.