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.

366-371

Authors: Asitava Debroy, Deepti Joshi, Tulika Sinha

Sepsis in newborns is one of the commonest clinical problems encountered by the paediatricians. It accounts for major cases of neonatal mortality and morbidity. The initial presentation of neonatal septicaemia may be subtle and therefore, it is important not only to recognize the neonates with septicaemia but also to identify the non-infected neonates. The primary objective of the clinician caring for infants at risk for neonatal infections is to identify all potential cases of bacterial diseases quickly and begin antibiotic therapy promptly. It is important, however, to determine which of these cases represent true infection and thus require a full course of antibiotics and which do not. Blood culture is the gold standard for diagnosis, but requires 48-72 hours for the final report. It is therefore necessary to have a method for early detection of neonatal sepsis for prompt initiation of antibiotic therapy. This study is designed to evaluate the haematological scoring system put forward by Rodwell for early diagnosis of neonatal septicaemia.

376-378

Authors: M.H. Shariff, Sadiqunissa, Qudusia Sultana

Background: The need for the blood is much higher than its supply. A large number of voluntary blood donors are deferred due to various causes, identified through sensitive laboratory screening for the guaranteed safety of the recipients which lead to loss of precious blood required to save life. Even though blood supply is inadequate, donor selection remains an important task. Objective: This study was been undertaken to evaluate the causes of deferrals among voluntary blood donors and to find a strategy for management of the same. Materials and Methods: A preliminary single center-based study assessing the causes for donor deferral was conducted during the study period of January 2013 to December 2014. The deferral reasons were then classified into temporary and permanent causes and the details were enlisted. Observations and Results: Of the 5321 donors, 4424 were voluntary donors and 897 were replacement donors. From this a total of 406(7.63%) donors were deferred: 293(72.1%) belonged to temporary and 113(27.8%) belonged to permanent category. 3 most common causes observed in our study for temporary deferrals were history of antibiotics intake, anemia and alcohol consumption and for permanent deferrals were hypertension, hepatitis C and hepatitis B. Conclusion: In order to decrease the deferrals and increase the blood donors the blood transfusion centres should take a further step to notify and educate the donors who are temporarily deferred about the reason for doing so and positively encourage and council them to come back again after certain time to donate blood and become regular permanent donors.

385-391

Authors: Kanchan Snehal Kothari, Manjusha Milind Karegar, Uddhav Devilal Kumawat, Leena Pravin Naik

Introduction: A wide spectrum of non-neoplastic and neoplastic lesions can affect the breast. Core needle biopsy (CNB) forms an integral part of the Triple test to evaluate breast lumps and is progressively replacing fine needle aspiration cytology(FNAC). The present study was planned to evaluate the accuracy of diagnosis and spectrum of lesions encountered on CNB. Methods: A retrospective analysis of CNB received over a two year period was done. CNBs were categorized using the UK National Health services breast screening programme (NHSBSP) guidelines and correlated with subsequent excision wherever available. Results: 68 CNB were received, 65/68 had a palpable lump. Malignant lesions(B5) were the most common (43%) followed by B1. Infiltrating duct Carcinoma (IDC- NST) was the most common malignancy. Proliferative and Non proliferative benign lesions, granulomatous and non-specific inflammation, Fibroadenoma and Phyllodes tumor were some of the other lesions seen. Overall concordance between CNB and final excision was 71.4%. 8/10 discordant CNB were from Category B1. For detection of malignancy overall sensitivity, specificity, positive predictive value( PPV), negative predictive value (NPV) and accuracy were 90.4%, 100%, 100%, 87.5% and 94.2% respectively. Sensitivity, specificity, PPV, NPV and accuracy in biopsies with more than 3 cores was 100%. Conclusion: A wide spectrum of lesions can be diagnosed on CNB and CNB is accurate, sensitive and specific for preoperative diagnosis. Study of more than three cores per biopsy and a multidisciplinary approach with clinicoradiologic correlation will improve overall sensitivity and NPV.

397-403

Authors: Seema Bijjaragi, Parismrita Borah, Omkar Puvvala

Aim: The aim of this study is to understand the profile of paediatric surgical pathology specimens in our region. There is paucity of studies on the histologic review in India. Materials & Methods: This is a retrospective analysis of 462 cases of paediatric surgical specimens (Age group 0-12 years) in surgical pathology in a tertiary care centre encountered over a period of one and a half years. Results: Out of 462 cases, 353(76.41%) cases belonged to acquired conditions (both Non-neoplastic and Neoplastic), and 109 (23.59%) cases belonged to congenital and developmental conditions. Males constituted 62.55% while females 37.45%. Gastrointestinal tract was most commonly affected (40.26%) followed by head & neck region (26.19%) and renal & urogenital system (15.58% each). Among acquired conditions (Non-neoplastic and Neoplastic), the most common diagnosed condition was Appendicitis (27.19%) followed by Chronic tonsillitis (24.93%), Inguinal hernia (6.79%), Hydrocele (4.25%), Hemangioma (3.68%), Nonspecific lymphadenitis (3.39%), Empyema (2.83%), TB lymphadenitis and Juvenile polyp (2.55% each) etc. Among acquired neoplastic lesions, there were 4 cases of Wilms tumor, 4 cases of Osteochondroma, 1 case of Fibrous dysplasia, 2 cases of NHL, 1 case of Retinoblastoma, 6 cases of Lipoma and 1 case of Infantile rhabdomyosarcoma. Among congenital and developmental conditions, the most common condition was Hirschsprung’s disease (18.35%), Pelvic ureteric junction obstruction (11%), Meckel’s diverticulum & anorectal malformations (9.17% each), Testicular anomalies & enterogenous cyst (6.42% each) etc. Conclusion: The histopathological patterns of surgical pathology specimens in childhood differ from adults. There are very few published reports on histopathological profile of paediatric surgical pathology specimens in India. Hence, we conducted this study to characterize the histopathological types of surgical pathology specimens among the paediatric patients.

409-413

Authors: Jyothi B Lingegowda, Sathiyamurthy K, Prakash H Muddegowda, Prasanna G Konapur, Ramkumar Kurpad Rama

Background: Assigning a score to cytology/FNA of thyroid lesions can provide important information regarding their neoplastic or non-neoplastic nature. The present study was undertaken to score thyroid lesions on aspirates based on various characteristics and correlating with standard cytological classification. Histopathology was done and the two cytological classification systems (Cytological scoring and Standard method) were compared. Methods: 196 cases of thyroid lesions with preoperative cytologic diagnosis were assigned cytological score/classified. Histopathology diagnosis was compared and statistical analysis was performed; correlation between cytologic score and histopathology was established using Spearman correlation coefficient. Regression analysis was done to assess the significance of each cytological score. Results: Multivariate analysis of cytologic features revealed that the amount of colloid, nuclear features and background pattern are the most influential features. There was high degree of correlation between the scoring methods on cytology with histopathology compared to standard cyto classification with histopathology. There was a significant association (p<0.001) between the scores assigned to cytologic and histopathologic specimens. Interpretation and Conclusion: Cytological scoring method can be used to assess the lesions of the thyroid as a significant relationship exists between both the classification systems and histopathology.

421-426

Authors: Mahjabeen Salma, Tazyeen Kouser, Mohammed Abdul Nasar

Background: The study of Nephrectomy specimens makes an interesting subject. Not only many clinical suspicions are confirmed but also many unsuspecting lesions are brought to light by the Histopahological study. Objective: To study the histopathology of 50 nephrectomy specimen Methods: The present study included retrospective analysis of two years (January 2011 – December 2012) and prospective study of two years and three months (January 2013 – March 2014) of Nephrectomy specimens from the records of Department of Pathology, Dr. V. R. K. Women’s Medical College, and Hyderabad. There were 50 nephrectomy specimens of which 39 were non-neoplastic and 11 were neoplastic. Results: Lesions are more in number in males (31) than in females (19). Non-Neoplastic lesions are more common on Left side (58.98%). The neoplastic lesions are more common on Right side (63.64%). 4 cases of clear cell carcinoma were seen with large cells with abundant clear cytoplasm, centrally located vesicular nucleus with 1 (14.28%) showing nucleoli under low power (Fuhrmans nucleolar grade 3), 2(28.57) showing nucleoli under high power: (Fuhrman nucleolar grade 2) and one (14.28%) with bizarre nucleoli – (Grade 4). Conclusion: Among the 50 nephrectomy specimens 39 (78%) revealed non-neoplastic lesions and 11 (22%) revealed neoplastic lesions. The lesions were more in males (31) than in females (19). Chronic pyelonephritis was the commonest lesion noted.

437-439

Authors: Shivraj Nagnath Kanthikar, Varsha Tukaram Kalshetti

Background: Dengue is an acute viral infection with potential fatal complication. In view of the high mortality rate and to reduce the disease burden, early and specific diagnosis of Dengue Hemorrhagic Fever or Dengue Shock Syndrome followed by supportive therapy reduces morbidity and mortality. This study was undertaken to evaluate the efficacy of NS1 antigen its comparison with platelet count. Method: A total of 358 serum samples were collected from clinically suspected cases of dengue fever, serum samples were tested immediately for NS1, IgM and IgG by immunochromatography based test and correlated the results. Results: Of the 358 serum samples tested, 135(37.70%) were positive for either one or more of the dengue parameters. Among 135 positive cases, 45 (33.33%) showed positivity for NS1 antigen. Out of remaining 90 cases, predominantly 57(63.33%) cases showed positivity for IgM antibody followed by 7 (5.1%) cases showed positivity for IgG. The result of dengue specific parameters were compared against platelet count. Statistical analysis were done by using chi-square test and Z-test. Conclusion: Rapid immunochromatography test is an excellent tool in addressing this potentially fatal epidemic prone infection which is an important public health problem of our country.

446-449

Authors: Vanisha Dhaka, Vaibhav P. Mane, Vishrabdha R. Pawar, D.G. Mote, Sushant V. Mohite

Introduction: Breast cancer is by far the most frequent cancer in females and is second overall next only to lung. Aims and Objectives: To study the breast lesions in simple mastectomy and MRM specimens. To classify the breast lesions and study them with age, clinical presentation and various pathological parameters. Methodology: A 3 years retrospective cross-sectional study of all the mastectomy specimens received in the department of pathology from Jan 2012 to Dec 2015. The sections were retrieved and diagnosis were confirmed. The necessary clinical data was collected from the record sections. Results: Out of 73 mastectomy specimens studied 63 cases of Malignant lesions were found in MRM, 07 cases of malignant lesions in simple mastectomy and only 03 benign lesions were found. 52% cases were in the age group of 41-50 yrs and 54.80% lesions involving the left breast. Only 23.70% cases were fixed to the underlying structures and only 41% cases with lymphnode involvement. 70.72% cases were of IDC and 73.74% were Grade II lesions. Conclusion: In our study maximum number of cases were diagnosed and treated at an earlier stage of malignancy that indicates the early awareness of breast lumps.

456-462

Authors: Dhiraj B. Nikumbh, Shivraj N Kanthikar, Kishor H Suryawanshi, Sunil V Jagtap, Nandkumar V Dravid, Sh

Background: Breast lesions are the heterogeneous diseases that encompass several distinct entities with remarkably different characteristics. While the more common forms of breast cancers are well recognized and understood better, there are many important unusual lesions and malignancies that are less known and less appreciated. Aims and Objectives: To highlight the spectrum, histomorphology and prevalence of unusual breast lesions in our tertiary care hospital. Material and Methods: The clinicopathological records of resected breast lesions submitted to histopathology department over the period of seven years from Jan 2009 to December 2015 were reviewed retrospectively. It was observational, retrospective and descriptive analysis of 473 resected breast lesions including excised, lumpectomy and modified radical mastectomy (MRM) specimens. The most common lesions like infiltrating ductal carcinoma (IDC) and infiltrating lobular carcinoma in malignant category and fibroadenoma, fibrocystic disease in benign category were excluded from the study. We encounter unusual breast lesions that were included in our study. Results: Out of total 473 resected specimens of breast, benign lesions accounted for 336 (71.05 %) and malignant 136 (28.75%). The unusual findings were 5.48% in malignant category and 1.12% in benign category and one in intermediate/ borderline category. In unusual malignant category, we found 8 types of rare tumors out of 12 unusual variants. In benign and intermediate lesions, we found 4 cases of unusual pathologies. Conclusion: This study highlights the importance of histopathology in breast lesions not only in diagnosing the lesion but also in predicting the prognosis. There are more than a dozen variants of breast cancer which are less common. Our study highlights the spectrum, histopathology and prevalence of such unusual lesions in our centre.

470-478

Authors: Asha Sharad Shenoy, Kanchan S. Kothari, Imran Shaikh, Ajay Phadke, Naina Goel

Introduction: Ependymomas are glial neoplasms that account for 4-8% of primary CNS neoplasms. Considerable controversy exists with regards to their prognosis and management, owing to their rarity and heterogeneity. Objectives: To study the clinical and pathologic features of ependymomas and evaluate their important prognostic variables. Materials and Methods: A 10 year retrospective study was carried out. The age, sex, location, clinical presentation, radiologic findings, microscopy, type of excision and follow up findings were studied. Results: 168 ependymomas were identified in a total of 6628 biopsies((2.53%). Majority were seen in the second decade (42/168), M:F ratio was 2:1. 15.48% (26 cases) occurred in the supratentorial compartment, 36.92% (62 cases) infratentorially, and 47.61% (80 cases) in the spinal cord. 90% of the intracranial tumors presented with features of raised ICT while patients with spinal tumors had focal motor deficits. There were 146 classic grade II ependymomas(78.5%), most common location being the posterior fossa, 36 myxopapillary ependymomas(17.8%), all seen in the lumbosacral region and 6 anaplastic ependymomas(3.57%). Anaplastic ependymomas were seen supratentorially in children and young adults while the peak of myxopapillary tumours was in third and fourth decades. 105 patients underwent gross or near total excision while in 16 it was partial or subtotal. Follow up was available in 73 patients. 9 patients died in the immediate post – operative period. Follow up for the rest varied from 3 months to 9 years. Anaplastic ependymomas were associated with a poorer prognosis. In supratentorial and lumbosacral tumours there was no difference in survival between gross total and subtotal excision while in adult infratentorial grade II ependymomas and cervical ependymomas, gross total excision had a better three year survival.

485-490

Authors: Vibhuti Garg, Rajender K. Thakral, Veena K Sharma, Anil K. Agarwal, Kamna Gupta, Apurva Vedi

Background: Conventional pap smear (CPS) examination has been the mainstay for early detection of cervical cancer. However, its widespread use has not been possible due to the inherent limitations, like presence of obscuring blood and inflammation, reducing its sensitivity considerably. Aims & Objectives: The study was performed to compare the efficacy of Manual Liquid based Cytology (MLBC) with CPS and to find out whether MLBC can be established for routine use in our laboratory setup. Materials & Methods: Cervical smears were collected by the gynaecologist using Ayre’s spatula and cytobrush for the conventional Pap smear method and are suspended in a liquid medium for manual liquid based cytology technique. In this study, cervical screening was performed in 481 cases, all were married women of reproductive age group who visited Department of Obstetrics and Gynaecology over a period of one year from July 2014 to June 2015. Slides were examined for cytomorphological parameters. The details regarding cell size, cytoplasmic and nuclear details were studied for making the diagnosis. Result: The sensitivity of CPS in detecting cervical lesions is 95% and by MLBC is 50% while the specificity was 86% with CPS technique and 69% by MLBC technique. Conclusion: The cellular features are better in MLBC as compared to CPS and also background is more clear in MLBC as there was no obscuration by RBCs or inflammatory cells while in CPS, the background is dirty due to the presence of RBCs, necrosis and inflammation.

496-502

Authors: Meenakshi Chowdhary, Anurag Mehta, Brijendra Singh, Kiran Kumar, Ajit Singh Rathore, Devi Charan She

Background: Oral squamous cell carcinoma (OSCC) is the most common head and neck cancers and locoregional recurrence in OSCC is related to lowest survival rate. The present study was undertaken to compare the clinicopathological findings and epidermal growth factor receptor (EGFR) expression in recurrent and non-recurrent cases of OSCC. Methodology: A total of 64 cases of OSCC were studied and immunohistochemistry was done, of which, 33 cases recurred at end of follow up. Categorical variables for each case included age, gender, site of primary lesion, neck metastasis, AJCC stage, locoregional recurrence, histological grade and pattern of invasion. Results: In quantitative analysis, 7 cases (21.2%) of recurrent OSCC and one case (3.2%) of non recurrent OSCC with EGFR extent score 4 was observed. In qualitative analysis, 5 cases (3.22%) of recurrent group and one case (0.64%) of non recurrent group with strong intensity was observed. Recurrent cases of OSCC showed higher score of EGFR expression [extent {p-value 0.001} and intensity {p-value 0.03}]. However, on clinicopathological correlation of EGFR expression, no significant correlation was observed. In TNM stage IV, out of 22 cases only 7 cases (4.48%) showed recurrence. Among 26 cases, 17 Cases (10.88%) of recurrent OSCC with H/P grade I showed recurrence. Recurrence was frequently observed in 15 cases (9.6%) with pattern of invasion (POI) type II. Conclusion: The EGFR expression in between recurrent and non-recurrent OSCC can be exploited as prognostic /or predictive parameter despite its role as therapeutic marker.

508-519

Authors: Puneet Kaur, Anureet Kaur, Anil Kumar Suri, Harpreet Sidhu

Introduction: Endometrial biopsies and curettings constitute an important tool for diagnosis of endometrial pathology; whether benign, pre-malignant and malignant, and help the gynecologist to decide appropriate therapeutic strategy. The present study was carried out to document the histopathological appearances seen in endometrial biopsies, and their age–wise distribution in patients with infertility and abnormal (irregular, excessive or continuous) uterine bleeding due to endometrial causes. Materials and Methods: A total of 214 specimens of endometrial curettings and biopsies from patients with abnormal uterine bleeding due to endometrial causes and inability to conceive, received in the Pathology department, Gian Sagar Medical College and Hospital, Banur, Rajpura, over a period of two years from January 2012 upto December 2013, were retrieved and analyzed retrospectively, and their findings were documented. The tissue had been received in 10% formalin, processed routinely, and the slides had been stained with Hematoxylin and Eosin. Results and Conclusion: The most common histopathological diagnosis was proliferative endometrium seen 33% cases. Products of conception were confirmed histologically in 12% cases. Endometrial hyperplasias were seen in 09% cases, and disordered proliferative endometrium in 06%. Secretory endometrium was seen in 07% cases. 02% biopsies showed atrophic endometrium. Luteal phase defects were seen in 07% of the specimens. 01% cases showed tubercular endometritis and adenocarcinoma each. The most common finding in patients of infertility was proliferative endometrium indicating anovulatory cycles. Endometrial biopsy is a valuable tool in assessment of endometrial status in infertility, as well as benign and malignant pathology in abnormal uterine bleeding due to relative ease and accessibility of procedure and rapid availability of results.

522-525

Authors: Giant Plexiform Unicystic Ameloblastoma: A rare variant of Ameloblastoma Yashita Gupta, Mohd. Jafar Memon, Nighat Hussain, Renuka Gahine

Ameloblastoma is the most common clinically significant odontogenic tumor of the gnathic bones, characterized as a benign but persistent and locally aggressive neoplasm. According to the WHO, it presents in four forms: unicystic, multicystic, peripheral (within soft tissue), and desmoplastic, with the conventional solid intra-osseous type being the most common (86%). Microscopically, many subtypes or patterns have been described: follicular, plexiform, acanthomatous, papilliferous–keratotic (including so-called keratoameloblastoma), granular cell, desmoplastic, vascular, and with dentinoid induction (dentinoameloblastoma). This report describes a case of a giant unicystic ameloblastoma involving the left side of the mandible. Radiographically appearing as a unilocular radiolucency and non-dentigerous in nature. Histopathological analysis showed features of plexiform pattern of a unicystic ameloblastoma.

141-144

Authors: Deepak Kumar B, Sakthidasan Chinnathambi P, Srinivasa Murthy V

Abstract Background: The neoplasms of the adnexa cutis arising from the pluripotent stem cell show differentiation towards one of the four adnexal cell lines i.e. follicular, sebaceous, eccrine and apocrine type. Categorizing these neoplasms into specific cell line differentiation and into benign or malignant is important, as malignant adnexal neoplasms are associated with a number of uncommon genetic syndromes and have an aggressive outcome. This study was conducted to primarily categorize these neoplasms based on their histological differentiation. Methods: Fifty-five cases of adnexa cutis that were reported over a four-year period were classified based on their histopathological differentiation and association with clinical parameters. Results: Thirty-three cases (60%) showed pilosebaceous differentiation with pilomatricoma being the commonest benign neoplasm. Twenty two cases (40%) showed eccrine differentiation. The most common malignant adnexal tumor was sebaceous carcinoma. (3 cases – 5.4%). Conclusion: All clinically suspected nodular/papular lesions should be subjected for histopathological examination and classified by differentiation to accurately determine the biologic behavior of the neoplasm.

152-158

Authors: Anirudha Vasantacharya Kushtagi, Vijayashree Shivappa Neeravari, Sidhalingreddy, Pratima S

Background: Vesiculobullous lesions of skin areheterogenous group of dermatological disorders and are not uncommon. These lesions may present with common clinical presentation as blister clinically, but histopathological features differ. Aims & Objective: This study is under taken to study the clinical and histopathological features of vesciculobullous disorders. Materials and Methods: A total 40 cases of clinically diagnosed blistering disorder were included, the punch biopsy of the lesion was taken. The biopsy was studied for histopathologicalfetures like level of blister formation, acantholysis, spongiosis, basement membrane zone distruction, presence or absence of inflammation. Results: In the present study amongst 40 cases, Pemphigus vulgaris was diagnosed in 12 (30%) cases and detected as most common type, followed by Bullous Pemphigoid in 11 (27.5%) cases. Herpes gestationis (Bullous Pemphigoid) was diagnosed in only one case. Commonly the blisters were seen on trunk, extremeties, axilla and groin. The lesions were slightly male preponderance in the present study. Most of the cases found between 41-70 years of age. Conclusion: The distribution of vesiculobullous lesions in relation to gender, age group, presenting site and histopathological features differ in each type. Histopathological examination gives valuable clue in the diagnosis of particular type of blistering disorder.

165-173

Authors: Deepti Gupta, Ram Kumar Gupta, Rajesh Kumar Gupta

Morphological pattern, clinical presentation and distribution according to age, sex and site of 84 cases of non- neoplastic and neoplastic bone lesions were studied over a period of five years (Retrospective period of 4 years and prospective period of one year). Maximum number of patients were in the age group of 11-30 years. Males were more frequently affected than female, the male to female ratio being 1.9:1. Femur was the most common involved site followed by tibia. Pain/tenderness was the most common clinical feature. Chronic non-specific osteomyelitis was the most common bone lesion (19%) of all the bone pathologies. Osteochondroma was the most common benign bone tumour (14.2%). Metastatic bone tumour was the most common malignant bone lesion (7.1%), while osteosarcoma was the most common primary malignant bone tumour (3.6%). The ratio of benign to malignant bone tumours was 1.8:1. The percentage of tumour like lesions was 50%, while benign bone tumours were 32.1% and malignant bone tumours were 17.86%.

182-186

Authors: Sonali Rajesh Saraf, Nilesh Subodh Naphade, Alka Dattatray Kalgutkar

Hemato-lymphoid disorders can range from simple nutritional anemias to leukemias and lymphomas. Precise analysis of causes of death is needed to focus research efforts and improve morbidity and mortality in Hemato-lymphoid disorders.[1] The morphological evidence of the cause of death was studied in 48 autopsies of hematolymphoid disorders. 16 cases of indolent hematolymphoid disorders were detected which remained undiagnosed during their lifetime and hence were untreated. The clinical presentation and the cause of death in these patients was studied and the reason for such cases being not diagnosed in time was analysed. Most of these patients presented to the tertiary care centre at a very late stage during the course of their disease. Before admission at this tertiary care centre, most of these cases were misdiagnosed as acute febrile illness as the presenting symptom was that of fever.

191-193

Authors: Navin Patel, Asha Gunjaliya, Harshid L Patel

Background: Alcoholism is a major public health problem. Consumption of excessive amount of alcohol for longer duration of period lead to development of various health related issues including hypertension, coronary heart disease and digestive system related disease. Objective: The aim of this study is to demonstrate effect of alcohol consumption on complete blood count(CBC). Materials and Methods: The present cross sectional study is conducted at Kesarsal medical college, Ahmedabad. We select thirty(30) young age men between 20-40 year of age group with history of daily 2 to 3 units of alcohol intake/day for the past 1 to 3 years duration. Another thirty(30) men having same age of first(case) group, who were alcohol abstainers, served as controls. Hematological parameters of both groups were measured by using medonic (merck) Automated Hematology Analyzer. Data were presented as means±SD, and analyzed using the online student T-test. Results: Mean corpuscular volume(MCV) value is found to be raised in case group 92±8 fl as compared to control 85±4 fl.The mean platelet concentration is found to be low 213±68( x 103/LL) as compared to control group 213±68( x 103/LL). Conclusion: From our study we conclude that drinking of alcohol even for a short or moderate duration can affect various hematological parameter like platelet count and mean corpuscular volume(MCV).

197-201

Authors: Manjusha Milind Karegar, Kanchan Kothari, Amit S Mirjolkar

Aims: To study the morphologic spectrum of duodenal biopsy specimens in malabsorption, to correlate the histology with clinical, endoscopic and serological investigations and to assess various aetiologies of malabsorption. Material and Methods: Duodenal biopsies of 50 patients presenting with symptoms of malabsorption were analysed over a period of one year. The clinical details of patients, including their routine blood investigations, serology for Serum tissue transglutaminase (IgA t TG) and Upper gastrointestinal (UGI) endoscopic findings were noted. The villous architecture, villous to crypt ratio (V: C ratio), crypt examination and Intraepithelial lymphocytes were counted. Other findings like presence of parasites, dilated lymphatics, granulomas were also noted down. Results and conclusions: The mean age of presentation was 32.5 years, with a mild female preponderance. Endoscopic mucosal abnormalities were found in 42% of cases and microscopic villous atrophy in 46% of cases. Increase in IELs was found in 48% of cases. Celiac disease was the leading cause (28%) of malabsorption whereas Tropical sprue accounted for only 4% of cases. Not a single case of tuberculosis was encountered.

212-215

Authors: Rajat Gupta, Deepika Dewan, Jyotsna Suri, UK Padha

Background: The ABO and Rhesus (Rh) blood group systems are genetically inherited and play very vital role in blood transfusions, parental and genetic testing and addressing medico legal issues. Objective: This study was conducted to determine the distribution of ABO and Rh blood groups among blood donors in provincial Hospital at Gandhi Nagar, Jammu, India. Materials and Methods: An observational descriptive cross sectional study was conducted at Blood bank of Government Hospital Gandhi Nagar over a period of one year from 1st January 2015 to 31st December 2015. ABO and Rh typing was done using slide agglutination method with antisera ABO and Rh. Tube agglutination method was done in doubtful cases and they were further confirmed by reverse grouping using known pooled A and B cells. Results were reported in percentages and proportions. Results & conclusion: Out of 2808 donors, 2360 (84%) were males and 448 (16%) were females. Majority of donors belonged to age group 26-35 years. The commonest ABO blood group present was B (37%) followed by O (26.3%), A (25.6%) and AB (11.1%) while 2606 (92.8%) donors were Rh-positive and 202(7.2%) donors were Rh negative. Replacement donors (83.1%) were much more than voluntary donors (16.9%). Conclusion: Distribution of ABO and Rh blood groups has important role to play in management and functioning of blood banks.

221-225

Authors: Mahjabeen Salma, Tazyeen Kouser, Mohammed Abdul Nasar

Background: The Endometrium is constantly engaged in the dynamics of shedding and re-growth during active reproductive life. It is controlled by the rise and fall of pituitary and ovarian hormones. This control is executed by proper timing of hormonal release in both absolute and relative amounts. Alterations in the fine tuning mechanism may result in a spectrum of disturbances and Endometrial Hyperplasia is most important among them. Objective: To study the histopathology of endometrial hyperplasia. Methods: The present retrospective study on Endometrial Hyperplasia was undertaken over a period of 5 years. Specimens for the study consisted of Endometrial curetting, fractional Curettage and Hysterectomy specimen with history of abnormal uterine bleeding sent for histopathology examination to the pathology department from Gynecology department. The specimen was received in 10% formation. After adequate fixation bits were taken for tissue processing and H&E staining. Wherever necessary, special stain such as reticulin staining, and PAS were done. Results: Incidence of Endometrial Hyperplasia found to be more in the 4th decade of life followed by 3rd decade. Majority of the Patients with endometrial Hyperplasia are of para 1. Simple Hyperplasia was most common in 788 (86.21%). Conclusion: Among the cases of endometrial hyperplasia, simple hyperplasia was the commonest lesion found followed by complex hyperplasia. Most cases were seen in 4th decade.

231-236

Authors: Shah Alam Sheikh, Siyum Ganguly, Surjya Sekhar Das, Angela Phukan, Jahnabi Das

Introduction: Fine needle aspiration cytology (FNAC) is an efficient, cost effective and safe out-patient procedure in diagnosis of thyroid nodules. With the advent of Bethesda system of reporting thyroid FNAC, the procedure has obtained even more standardization, reproducibility, predictive value and all in all, greater clinical significance. Aim: The aim of this study was to assess the effectiveness of FNAC thyroid reported under Bethesda guidelines by comparing the preoperative cytological diagnoses with the postoperative histopathological diagnoses. Methods: In this study, FNAC of 768 patients of clinically palpable thyroid swelling were evaluated and classified according to the Bethesda system. 188 patients of this group underwent surgical management and histopathological diagnosis was obtained in them. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of FNAC reported under Bethesda system were obtained by comparing the cytological and histopathological diagnoses. Results: The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of FNAC came out to be 83.2%, 63.3%, 74.3%, 74.6% and 74.4% respectively. Conclusion: In our study, FNAC reported under Bethesda system came out to be a highly efficient tool in diagnosis of thyroid nodules. However, addition of more advanced methods like immunocytochemistry and molecular techniques can further increase this efficacy especially in the groups diagnosed as Atypia of undetermined significance/Follicular lesion of undetermined significance, Follicular neoplasm/Suspected for follicular neoplasm and Suspected for malignancy.

242-246

Authors: Vaddatti Tejeswini, P Premalatha

Introduction: The leading cause of death in Indian women is cervical malignancy. The rate of mortality can be reduced by early detection by a sensitive method like cervical cytology. Aim: The aim of this study was to explore various non-infectious, benign and malignant cervical lesion and to establish the utility of pap smear examination in screening cervical lesions. Materials and Methods: This study was carried out at a tertiary care hospital during January 2013 to June 2013. Two hundred and ten pap smears were screened for various lesions. The age group ranged from 18 years to 70 years. Results: Out of 210 pap smears examined, predominant age group was in between 20-40 years. The inflammatory lesions accounted for 94.3% and premalignant and malignant lesions for 5.7%. Conclusions: Pap smear examination is an easily available and cost effective method for screening various cervical lesions.

255-259

Authors: Vanisri HR, Vadiraja N

Background & Objectives: The Hematologic changes in Human immuno­deficiency virus (HIV) infection are well established as the most important complication of the disease. These abnormalities are clinically important in many patients. Hemoglobin levels reveal rapidity of disease development rates and independently predict prognosis. Significance of Red cell distribution width lies in establishing the differential diagnosis of anemia. The intention of this study was to explore red blood cell parameters and immune status and to estimate the relationship between RBC indices and immune status. Methods: The purpose of this study was to understand the relationship between RBC parameters and immune status in HIV patients. Subjects for the study were the reports of hundred HIV patients who are not on anti retroviral therapy, registered in the ART centre. RBC parameters and CD4 cell counts were studied. Results: Among the 52 HIV infected female patients, the CD4 count was significant and positively correlated with MCV, MCH, MCHC, Hemoglobin (HB) and hematocrit (PCV) values. However, insignificant but negative association could be seen between RDW and RBC. Sample median CD4 was 495cells/cmm. However, minimum was 20cells/cmm and maximum was 1300cells/cmm. These two extreme points had an influence on the median. Majority, i.e. 35 females had less than the median CD4 count. The range was 1280cells/cmm indicated that the variability was too high. Conclusion: It is well known that HIV infection is frequently associated with hematologic manifestations, thus affecting the RBC parameters. Anemia influences the natural history of HIV by increasing the disease progression rate and mortality. Majority of the females affected are in their reproductive age group. Untreated anemia may lead to multisystem disabling symptoms and fatigue, exhaustion, increased risk of HIV dementia and poor quality of life. On the other hand, endurance time in HIV-infected persons may be improved after recovery from anemia. There is significant association with reduced CD4 cell count and altered RBC parameters. Therefore it is important to evaluate the RBC parameters to improve the health and survival potential of HIV infected persons.

264-267

Authors: Vijayashree Shivappa Neeravari, Anirudha Vasantacharya Kushtagi, Doddappa Mallappa Bannigidad

Cervical cancer in women living with Human Immunodeficiency Virus (HIV) is a major health problem accounting for 26.1-43.8% of all cancers in Indian Women. Women infected with HIV have a higher risk of developing cervical intraepithelial neoplasms. Dysplasia has been reported in 15 to 64.6% of HIV infected women & these rates are 10-12 times higher than those observed among HIV negative women 13%. Materials and Methods: The aim of this study is to estimate the frequency of abnormal Papanicolau (Pap) smears and mainly to detect precancerous & cancerous lesions as well as inflammatory lesions in HIV-infected women. Results: Total 68 samples were collected. Pap smear abnormalities included LSIL(10.2%). HSIL(4.4%), ASCUS(8.8%), ASC-H(2.9%), Carcinoma(1.4%), Specific Infections 33.8% (Bacterial Vaginosis-19.1%, Trichomonas Vaginalis-5.8%, Candidiasis-5.8%, Herpes Simplex-2.9% Cytolytic smear-1.4%), Non-specific Inflammatory smear (36.7%). Conclusion: In view of high percentage of inflammatory Pap smears, infections and cervical intraepithelial lesions among HIV positives women. Among the various intraepithelial lesions LSIL was the commonest, stressing the need for routine pap smear testing annually in women living with HIV.

276-280

Authors: Bharat Wadha, Alok Mohan, Anil K. Agarwal, Anupam Varshney, Rajnish Kumar, Vibhuti Garg, Purva Sharm

Background: The study of cells in effusional fluid was among the early domains in cytology to draw interest of clinicians and pathologists. Identification of effusional cells as benign reactive or malignant is a diagnostic primary purpose of evaluation. Clinical history when taken into account while evaluating effusions can avoid erroneous diagnosis. Materials and Methods: It was a prospective type of study. A total of 540 cases of serous effusions were cytologically evaluated following detailed history taking and clinical examination. Out of 540 cases all cases of malignant effusions were segregated and categorized according to sex, site (peritoneal or pleural), and origin (primary or metastatic). Results: A total of 50 cases were positive for malignancy.. Most common primary tumors associated with malignant effusions in males and females were of lung and ovary respectively. Most common cause of malignant pleural effusion in males was lung cancer and in females was breast cancer respectively. Most common cause of malignant peritoneal effusion in males was carcinoma GIT and in females was carcinoma ovary respectively. Conclusion: Malignancy emerged as the third most common cause of serous effusions following inflammatory and reactive causes. Malignant effusions were more common in females. Malignant effusions were mainly due to metastatic cancers, mostly adenocarcinomas. The most common cause of malignant pleural effusion in males was carcinoma lung and in females is carcinoma breast, while the most common cause of malignant peritoneal effusion in males was carcinoma GIT and in females was carcinoma ovary respectively.

285-292

Authors: Mandakini B. Tengli, Mohammed Mateen Ahmed

Background: Carcinoma uterine cervix is one of the leading causes of cancer death among women worldwide. To detect this widely prevalent cancer at an early stage, the simplest test has been a pap smear. Reporting of pap smears is done by using The Bethesda System 2001. However, various benign processes can also be recognized morphologically, and diagnosis of these entities can make an important contribution to patient care. Methods: Cyto-histopathological correlation of lesions of uterine cervix in 150 cases. Results: Total numbers of cases correlated in this study were 150. Age group of women, ranged from 23 to 75 years. Majority of the patients belonged to the group of 21 to 30 years. Conclusion: 75% of the cases showed cyto-histopathological correlation. One rare case of adenosquamous carcinoma was detected cytologically and was later confirmed by histopathology.

297-304

Authors: Somendra Kumar Dhariwal, Sanjeev Narang, Arjun Singh, Shrikant Nema

Objective: The present study was undertaken keeping in view the fact that pregnancy produces several changes in the haematological profile of women. It has been documented by many workers that these changes are fairly significant and hence it was theorized that they could be used to predict the onset of unfavorable circumstances during the various phases of pregnancy. The objective of the study was to analyze these changes especially in neutrophils and platelets and to determine their usefulness as surrogate markers for impending pathological changes during pregnancy. Materials and Methods: This case-control design study included 400 healthy pregnant women sub-divided into three groups 1st, 2nd and 3rd trimesters, and 400 healthy non pregnant women. Questionnaire interviews were applied Hematological profiles were assessed. Data were computer analyzed using SPSS program version 18. Results: The present study is a cross sectional design. The study population comprised 400 normal pregnant women and 400 healthy non pregnant women (control group). Neutrophils are significantly increased in pregnant women compared to non-pregnant women and Platelet count of the study population was a significant decrease in platelet count in pregnant women compared to non-pregnant women. Conclusions: 1. The mean ages of controls and pregnant women in the first, second and third trimesters. 2. Unemployment and lower family income were more prevalent among pregnant women. 3. Medical history of the study population showed that the frequency of the previous pregnancy in controls was significantly lower than that in cases. 4. White blood cells and neutrophils were progressively increased whereas lymphocyte count, RBC count, hemoglobin, hematocrit, MCHC and platelet were decreased in pregnant women compared to non-pregnant women as pregnancy advanced.

315-319

Authors: Gayatri Gogoi, Lucky M Duara, Mondita Borgohain, Daljeet Kaur, Uttam Konwar, Dipakkr Sarma

Male breast carcinoma is a very rare malignancy. It mostly has invasive ductal histology while invasive lobular histology is exceptionally uncommon constituting no more than 1-2% of male breast cancer cases. Here we present five cases of invasive lobular breast carcinoma arising in male breasts which were diagnosed by histological examination. Immunohistochemistry was performed to evaluate the hormonal receptor status. Early diagnosis of breast carcinoma in males have prognostic implication in patients’ survival and show better response to hormonal therapy when it is reactive for estrogen and progesterone receptors. Therefore it is mandatory for the pathologists to keep this rare condition in their minds while evaluating any case of male breast lump and to perform a vigorous search for any small focus of this tumour in circumstances of male breast lump including gynaecomastia. Majority of information regarding treatment of male breast cancer is retrospective in nature and is derived mainly from small single-institution series; thus, the choice of treatment modalities is generally guided by extrapolation of data from female breast cancer. Due to paucity of data and the extreme rarity, male breast carcinoma should be considered and managed as a distinct entity. The invasive lobular carcinoma perhaps with an added advantage for being reactive of hormonal receptors, which could be treated by adjuvant Tamoxifen. It is hoped that a long term multicentric studies will help us to know the prognostic implication of uncommon invasive lobular histology, as well as trials could be strategically designed to optimize the treatment.

328-335

Authors: Shanmugasamy K, Anandraj Vaithy K, Bhavani K, Dhananjay S Kotasthane

Introduction: Fine Needle Aspiration Cytology (FNAC) has gained increasing importance in the diagnosis of breast lumps especially it is an easy, non-invasive, simple procedure which can be done on OPD basis. The pre–operative diagnosis of breast lesions by FNAC is highly relied upon. However, there can be some cytological pitfalls in the diagnosis, especially when all the characteristic component of a lesion are not obtained in the aspirate, or when there is an overlap in the cytological features. Hence a review was undertaken with the following objectives. 1. To correlate cytologic and histopathologic diagnosis of breast lesions as a part of internal quality control. 2. To know the incidence of false positive and false negative cases. 3. To find out the sensitivity and specificity of FNACof breast lesions. Methods: This study was conducted for a period of 3 years (April 2009 to March 2012) and 200 cases of fine needle aspirates of breast lumps studied. Out of which 126 cases were followed by histopathological correlation at pathology department; the cases are collected from Mahatma Gandhi Medical College & Research Institute, Sri Balaji Vidhyapeeth University; Pondicherry. Results: Out of 200 cases studied by FNAC, histopathological correlation was available for 126 cases. Cytological diagnosis in general was divided into four categories, benign (76.19%), malignant (15.08%), suspicious (5.56%), and unsatisfactory (3.17%). Maximum patients were in age group of 21 to 30 years. There were 119 female patients and 7 male patients. Fibroadenoma (69.79%) was most common benign neoplasm. There were 5 cases (5.21%) reported by FNAC as gynecomastia. After correlation with histopathology, there was 82.26% of correct diagnosis in all benign lesions. There were 16 cases (84.21%) diagnosed cytologically as malignant and 3 cases (15.79%) as invasive duct carcinoma. Histopathologically all were confirmed as invasive duct carcinoma. Out of that one was reported in male breast. The incidence of false positive case was zero, false negative case was (1.59%). The diagnostic accuracy after histopathological correlation in malignant cases was 98.36%, sensitivity was 92.86% and specificity was 100%. Conclusion: To conclude, fine needle aspiration cytology is a fairly safe procedure in trained hands, and it gives reasonably accurate results, thereby helping the clinicians to plan the best line of treatment. Also with invention of imaging guided aspiration, FNAC went one step ahead in diagnosis of non-palpable lesion of breast. Thus a triple modality of clinical, mammographic and cytological correlation is required and for internal quality control FNAC is correlated with histopathology.

347-350

Authors: Sumit Gupta, Swati Singh, Jaydeep Garewal, Shivangi Vijay, Atul Makhija, Yogesh Gupta

Background: Schneiderian papilloma are benign epithelial neoplasm of three subtypes- exophytic, oncocytic and inverted. The objective of the study performed is to illustrate the histopathological patterns and clinical presentation of schneiderian papilloma subtypes. Sinonasal papillomas are benign yet aggressive neoplasm characterized by high recurrence rate and associated with malignancy. Method: A prospective study was performed of schneiderian papillomas diagnosed in a period of three years. Results: Thirty five patients of sinonasal papilloma who underwent sinus surgery were observed. There were 25(71%) male and 10(29%) female subjects diagnosed at an average age of 53 years(range 10-74years). The three subtypes were classified as exophytic(13 cases); inverted(19cases) and oncocytic papilloma(3cases). Conclusion: Inverted papilloma are the most common sinonasal papilloma.

354-357

Authors: Deepti Gupta, Shalija Kotwal, Jyotsna Suri

Background: Extramedullary hematopoiesis is known to occur mainly in the organs of reticuloendothelial system. It is very rare for EMH to occur in thyroid nodule without any haematological abnormality. Case: A 71 year healthy male presented with 3 month history of dysphagia to solids. Clinical examination revealed thyroid nodule measuring 1 cm in diameter in right lobe of thyroid gland. FNAC was performed and microscopic examination showed presence of hematopoietic elements of all the three lineages in the background of benign thyroid follicular epithelial cells. We are reporting this case because of it’s rarity as, no case of EMH with thyroid nodule causing only dysphagia with no haematological abnormality has ever been reported till date. Conclusion: EMH can present as thyroid nodule with only complaint of difficulty in swallowing with normal haematological parameters. Identification of giant cells as megakaryocyte helps in diagnosis of EMH.

7-10

Authors: Ambedkar Raj Kulandai Velu, Banushree C Srinivasamurthy, Jhansi Rani

Objective: To evaluate diagnostic performance of fine needle aspiration cytology[FNAC] in diagnosis of benign breast lesions. Methods: Women who had FNAC diagnosis of benign breast lesion were followed up with histopathological evaluation to assess the diagnostic accuracy of FNAC. Results: Out of sixty benign cases diagnosed on FNAC, fifty eight cases were benign and one case each of mastitis and fibrocystic disease had infiltrating ductal carcinoma on histopathological examination suggesting 96.7℅ diagnostic accuracy of FNAC in diagnosing benign breast lesions. Conclusion: The correlation between cytology and histology showed that FNAC is an accurate test in diagnosing and managing benign breast lesions.

14-18

Authors: Anand Bhadkariya, Abhiraj Ramchandani, Swati Patel, Manju Purohit

Over: expression of Cytokeratin CK has been reported in malignant cells in aspiration cytology. Immunocyto-chemical detection of cytokeratin is an easier technique than molecular detection in malignant cells. Hence we investigated the presence of this protein in the most common malignant cells. Material and methods: We performed immunocytochemical ICC detection of CK in aspirate cytology of malignant cells with or without inflammatory and benign cells and correlated with varied patterns of CK positivity with respect to cytological diagnosis. Results: In the present study 40% cases of malignant cells were found positive for CK of which the most common pattern observed was diffuse cytoplasmic staining. Among the cases with SCC 66.6% were positive for over-expression of CK wherein diffuse pattern was observed. Conclusion: In the present study, significant number of SCC in aspirate cytology cases observed over-expression of CK. However SCC detection in aspiration cytology is a morphology based technique.

23-25

Authors: B K Sharma, U R Singh

Soft tissues range from very common lipoma to some of the rare tumours in medicine. These tumours were derived from soft tissues. The large majority of the soft tissues tumours are benign, with a high cure rate after surgical excision. The objective of present study was to study the histo-pathological patterns of soft tissue tumors and to find out different variation regarding age, sex & distribution in body. The present study was carried in Department of Pathology, from 21st December 2007 to 20th December 2008. A record of total of 2399 patients was taken. Among 111 positive samples for soft tissue tumor, 10 cases turned out to be malignant. The most common type of soft tissue tumor was Lipomatous in 58.6%, followed by fibroblastic/Myofibroblastic. Over all 56.7% of tumor were diagnosed among male, while 43.3% were diagnosed among females. The most common site that is involved is lower limb.

32-37

Authors: Rajat Gupta, Deepika Dewan, Dinesh Kumar, Jyotsna Suri

Background: Fine needle aspiration cytology (FNAC) is a simple, rapid, cost effective and useful method for diagnostic evaluation of salivary gland lesions due to their superficial nature and easy accessibility. Aim: To study the cytomorphological patterns of the salivary gland lesions and to perform histopathological correlation in suspicious cases in Government District Hospital, Gandhi Nagar, Jammu, India. Material and Methods: In the present study 74 cases were included. FNAC was performed using 22 gauge needle and 10 ml plastic syringe with a detachable syringe holder (Franzen Handle). In each case, three alcohol fixed smears were prepared ,first smear was stained with Papanicolaou stain, second with Giemsa stain and third one was kept unstained for any further required stain. Cytohistological correlation was made in 47 cases only. Results: Parotid gland was the most commonly involved salivary gland. Maximum cases were seen among age group of 21 to 30 years. Most common non neoplastic lesion was chronic sialadenitis while pleomorphic adenoma was commonest benign lesion and adenoid cystic carcinoma was more frequent malignant lesion. Sensitivity, specificity and diagnostic accuracy of FNAC was 66.6%, 95.8% and 93% in case of neoplastic lesions and 100% in non neoplastic lesions. Conclusion: The high accuracy, sensitivity, and specificity of FNAC makes it a useful and reliable screening and diagnostic procedure in case of salivary gland lesions especially in District Hospitals with limited infrastructure.

42-47

Authors: Hawaldar Ranjana, Sodani Sadhna

Introduction: Cervical cancer is the second leading cause of cancer related deaths, next only to breast cancer worldwide, but is easily preventable if detected early. However conventional paps smear technique has many limitations. To overcome these limitations liquid based cytology was introduced in the mid 1990 as a better tool for processing cervical samples the present study was undertaken to compare conventional paps smear with liquid based methods and to assess the diagnostic accuracy of LBC in our setting. Materials and Methods: The present study was a prospective study conducted on the first 300 patients visiting our diagnostic centre for pap smear tests from May to October 2015. The samples were collected with Rovers Cervex brush and a conventional slide was prepared and the brush head was detached and suspended in the preservative fluid. Split samples of CPS and LBC were analysed and reported using the Bethesda system 2001 and results were compared Results: While only 5 patients were found to have unsatisfactory smear in LBC (1.67%), 20 patients had unsatisfactory smear in conventional smear (6.67%). Endocervical cells were not seen in conventional pap smears while LBC showed presence of endocervical cells in all patients. Candida bodies were not evident in LBC smears while the CPS showed presence of candida bodies in 5 cases. ASCUS was reported in 10 (3.31%) patients by CPS while it was found to be present in only 6(2%) patients by LBC technique. Conclusion: The introduction of liquid based cytology technique has brought about a revolution in the field of cervical screening programmes because of its advantages like reduced rate of unsatisfactory smears, increased number of satisfactory smears with adequate endocervical cells, optimal preservation and staining of cellular material, small area on the slide for screening hence lesser time for reporting and non interference by blood, mucus and other cell debris, air drying artefacts which hampers the proper detection of cellular abnormalities by the conventional method and may replace the conventional smear slowly but steadily.

55-59

Authors: Sonam S. Nandyal, Shashikala P, Vidhushi Sahgal

Background and Objectives: Neonatal thrombocytopenia (platelet count less than 150×109/L) is one of the commonest hematological abnormality encountered in neonatal intensive care unit (NICU). Though thrombocytopenia is so prevalent it is often overlooked assuming that it will resolve spontaneously. However, if it is not detected and managed properly can result in devastating complications. The present study highlights the pattern, prevalence, severity and possible causes of neonatal thrombocytopenia encountered in our hospital. Method: A prospective observational study was conducted on sick neonates admitted to NICU with different clinical problems and were evaluated for pattern and severity of thrombocytopenia as per the blood samples analysed. Results: Out of 155 consecutive neonates admitted to NICU, 99 developed thrombocytopenia with a high prevalence of 63.8%. 43.4% had early onset and 56.5% had late onset thrombocytopenia. The most common cause of neonatal thrombocytopenia was prematurity (38.3%) followed by neonatal sepsis (22.2%). Mild and moderate thrombocytopenia was found in 17.1% of the neonates each, while severe was more common accounting for 65.6% of cases. Conclusion: Neonatal thrombocytopenia is common in NICU and it could be used as a prognostic marker for multiple diseases. As its clinical course and outcome depend on etiology, an appropriate diagnostic workup is essential for early diagnosis and better management.

70-72

Authors: Keshav.R. Kulkarni, Ashwin .P. Khageshan, Mahesh C. Baragundi

Introduction: A transfusion transmitted infection (TTI) is a virus, parasite, or other potential pathogen that can be transmitted in donated blood through transfusion to a recipient. Transfusion-transmitted malaria occurs at an estimated rate of 0.25 cases per 1 million blood units collected. Transfusion malaria is fairly common in endemic areas. Since there was no data from our geographical area about malaria among blood donors, the present study was conducted to know the seropositivity of malaria among voluntary and replacement blood donors. Materials and Methods: The present study was carried out in Blood bank of S.N Medical College, Bagalkot from July 2012 to June 2013. Two ml of blood sample was collected in labeled pilot tube at the time of collection of blood from donor tubing of blood bag. Serum was separated. The samples were tested for Malaria by rapid antigen detection test. Results: Of the total 8187 screened blood donors, four units (0.04%) of the blood units were positive for malaria parasites. All the positive units were from replacement donors. Conclusions: Our study showed that the seroprevalence of malaria was low and more in replacement donors compared to voluntary donors. These results suggest that voluntary blood donors services are needed. All blood should be tested for TTI with reduction in unnecessary blood transfusion. Thus ensuring safe blood supply to the recipients.

77-81

Authors: Aysha Ali, Prasanna N Kumar, G. Uma Maheshwari

Background: Venous and Arterial thrombosis are common diseases with an annual incidence of 1 in 1000 per year (1). Several risk factors have been identified like increased levels of coagulation factors –factor VIII,IX,XI,II and fibrinogen which are cumulatively explored by APTT(activated partial thromboplastin time). Elevated factor VIII levels are identified as an independent risk Antiphospholipid antibody syndrome, paroxysymal nocturnal hemoglobinuria, sickle cell disease are also associated with strong tendency for thrombosis. Objectives: (A) To examine the risk factors involved in the pathogenesis of thrombosis in Indian population. (B) To investigate the significance of these risk factors in incidence of venous and arterial thrombosis. Materials: Blood samples were collected from patients presenting with clinical picture of arterial or venous thrombosis for routine tests. The following tests were done on the samples: complete blood count, sickling test, Ham’s acidified serum test, Sucrose lysis test, prothrombin time, activated partial thromboplastin time, lupus anticoagulant assay (dRVVT based), Factor VIII:C assay, anti cardiolipin antibody Results: 310 cases were analysed. 124 patients(40.0%) had presented with proximal and dsital venous thrombosis, 68 patients with recurrent abortions (21.9%), 38 CASES(12.7%) ischemic heart disease and 43 cases (14.3%)with cerebrovascular disease, There were 11 cases of vasculitis (3.7%),10 cases of arterial thrombosis and 16 cases of pulmonary thromboembolism (5.3%). Increased factor VIII: c levels was the commonest risk factor identified followed by Antiphospholipid antibody (23.5%) and shortened APTT. No risk factors were identified in 50.6 % of the cases. There was one case each of sickle cell anemia and paroxysymal nocturnal hemoglobinuria who presented with pulmonary embolism and portal vein thrombosis respectively. Conclusion: The commonest risk factor identified was increased factor VIII: C levels, The presence of antiphospholipid antibodies was found to be linked with ischemic heart disease and venous and arterial thrombosis. There was also a very significant association between the presence of antiphospholipid antibodies, lupus anticoagulant and anticardiolipin antibodies with recurrent abortions. There was a correlation between the shortening of APTT and incidence of venous thromboembolism in this study. This study also showed that APTT is not an optimal screening test for detecting lupus anticoagulants.

86-91

Authors: Meenakshisundaram K, Rajeswari K, Rajalakshmi V

Aims and objectives: 1. To demonstrate the patterns in different premalignant lesions of prostate. 2. Correlating AgNOR counts with various grades of PIN. Materials and methods: This study was conducted in 83 cases of different prostatic biopsy specimens from 2013 -2015. All biopsy samples were routinely processed and stained with both haematoxylin and eosin and with AgNOR stain. Results: The mean AgNOR count and score of high grade prostatic intraepithelial neoplasia was significantly high when compared to low grade intraepithelial lesion. High grade prostatic intraepithelial lesions associated with nodular hyperplasia or with carcinoma was the same. Conclusion: AgNOR is a simple, cost effective and easy stain to evaluate the proliferative activity of the cell. It can be used as an additional test which will be of immense value regarding the progression of preneoplastic lesions in prostate.

96-102

Authors: Vijay.P.M, Sudha.V.M, M.M.Doddikoppad

Synovial sarcoma occurs at any age but peak age is between 10-35 years with slight male predominance. More than 60% occur in lower limb especially thigh, knee and ankle joints. Synovial sarcoma falls in to two main groups: Biphasic and Monophasic spindle cell type. The latter is more common depending on sampling. The other histological variants are the branching, hemangio pericytoma like pattern. Poorly differentiated with round cell morphology resembling Ewing’s sarcoma. Immunohistochemically in addition to epithelial component, spindle cell component also show focal positivity for EMA and keratin. This helps in distinguishing monophasic synovial sarcoma from peripheral nerve Sheath tumor or fibrosarcoma. The aim of this retrospective study is to study the various morphologic patterns of clinically suspected synovial sarcomas, their biological behaviour and prognostic value by immunohistochemical study. A total of 25 cases of clinically suspected cases of synovial sarcoma were studied in the age group of 10 -50 yrs. The most commonest age group were in children & young adults between 10-25 yrs. Among 25 cases, 20 cases were in males & 5 in females indicating male dominance. The commonest site involved was knee and ankle joints & in very few cases showed lesions over the shoulder and hip, rare cases over the anterior abdominal wall & in blood vessels. Microscopically Monophasic synovial sarcoma was the common variant seen in 16 biopsies. Presence of short and plump spindle shaped cells arranged in fascicles, compact sheets with tapering nuclei and poorly defined cytoplasm was seen in 15 biopsies, these biopsies also showed cleft like spaces. Whereas four biopsies showed myxoid change. Four cases of monophasic synovial sarcoma showed atypical mitotic figures > 15/10hpf.Four cases of monophasic synovial sarcoma showed focal positivity for epithelial membrane antigen and keratin. One case of poorly differentiated synovial sarcoma was CK7 positive. Poorly differentiated synovial sarcoma showed cytogenetically positivity for SyT-SSx1 fusion gene indicating poorer prognosis. Study of various morphlogical variants is essential to know their prognostic value & biological behaviours. Monophasic synovial sarcomas have more tendency to recur compared to the biphasic variants. Although histopathological study of synovial biopsy is one of the most valuable means for diagnosis of synovial sarcoma, it has its own limitations. In many instances corroborative clinical, radiological, immunohistochemical studies becomes essential in making an accurate histopathological diagnosis.

107-109

Authors: Iffat Jamal

Adenoid cystic carcinoma constitutes around 0.5%-2% of all carcinomas of uterine cervix. It usually presents in elderly age group. Very few cases have been reported in young age group. Adenoid cystic carcinoma is a rare variant of adenocarcinoma cervix. It is a locally aggressive tumour which is capable of distant metastasis in its early stage. This is a case report of Adenoid cystic carcinoma of uterine cervix, Stage III that was successfully operated upon and followed by radiotherapy.

115-119

Authors: Aditi Das, Renuka Gahine

Background: “Incidentaloma” is an adrenal mass, generally 1 cm or more in diameter, discovered serendipitously during radiological imaging performed for indications other than an evaluation for adrenal disease. Case presentation: We present two cases for their rare presentation as incidentalomas. First case was incidentally discovered adrenal myelolipoma in a 47 year female. Another case was incidentally discovered adrenocortical carcinoma in a 53 year female who initially presented with abdominal pain and deep vein thrombosis. On routine abdominal ultrasonography, adrenal mass was discovered in both the cases and subsequent pathological evaluation revealed diagnosis. Conclusion: These cases highlights the importance of thorough investigation to rule out the possibility of lethal malignancy. The evaluation of incidentalomas focuses on identifying functional masses & treating or resecting them appropriately; identifying adrenal carcinomas early with the intent of attempting complete surgical extirpation; and also to reassure the patients whose masses are neither functional nor malignant.

124-128

Authors: Medhi Pranita, Dowerah Swagata, Dutta Utpal, Dutta Aparna

Undifferentiated carcinoma of the gall bladder is an unusual tumor with a reported incidence of 0.38% of all gallbladder and extrahepatic bile duct cancers. We present a 65 year old female presenting with pain abdomen who was diagnosed with carcinoma gall bladder on ultrasound and CT abdomen. Histopathological examination revealed a 6.5x4x2 cm3 growth extending from the body of the gall bladder upto the fundus. H & E stained sections from the growth revealed sheets and trabeculae of neoplastic cells which were round to polygonal with abundant eosinophilic cytoplasm, multinucleation at places and areas showing spindled tumor cells. A diagnosis of undifferentiated carcinoma of gall bladder with spindle and giant cell type was given. Tumor showed strong positivity for cytokeratin and vimentin. These tumors have a very poor prognosis and therefore early diagnosis is vital to the survival of the patient.