Indian Journal of Pathology and Oncology

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.