Indian Journal of Pathology and Oncology

362-365

Authors: Sanjay M, Amita K, Sumukha Makam

Objective: The main objective of this study was to assess the lipid profile in prehypertensives and compare it with that of normal subjects and to study the co relation of blood pressure with lipid profile. Methods: We conducted a cross sectional study on 50 prehypertensives and 50 normotensive subjects. Blood pressures were recorded and serum lipid profiles were measured and compared using student t test. Correlation between blood pressure and serum lipid profile was done. Results: The study results showed significant increase in total cholesterol, LDL, VLDL, Triglyserides in prehypertensives compared to normaltensives. While decrease in HDL value was seen in prehypertensives compared to normaltensives. And there was a significant correlation between blood pressure and lipid profile. Conclusion: Lipid profile is altered in prehypertensives compared to normal. So analysis of lipid profile in pre hypertensive individuals will serve as a useful tool for monitoring adverse cardiovascular outcomes.

372-375

Authors: Tushar Kambale, Banyameen Iqbal, Amardeep Patil, Harsh Kumar

Background: Fine needle aspiration cytology (FNAC) is the established first line investigation of mass lesions in the body. Kun was the first to describe the diagnostic use of FNAC in 1847. About 2-6.5% of all head and neck region neoplasm in adults are from salivary glands which are usually accessible for FNAC. It helps to distinguish salivary glands lesion as inflammatory, benign and malignant hence allowing proper planning for management. Material and Methods: It was a retrospective study carried for the period of Feb 2014 to Feb 2016. 68 cases of salivary gland swelling were included in which cytological and histological studies were done. 22 cases were excluded from the study on view of inadequate material or lack of either FNAC or histology correlation. All the patients were clinically evaluated and FNAC was done using 10 ml disposable syringe and 23/24-gauge needle without using local anesthesia. We classified our FNAC results as true-negative, true-positive, false-negative and false-positive. We also compared the histopathology of the surgical specimens and cytology of the FNAC specimens and evaluated the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV). Results: Parotid gland was commonest affected site. Out of 46 neoplastic lesions 39 (84.7%) were benign and 07 (15.3%) were malignant. An overall of 86.9% (40/46) concordance between FNAC and final histological diagnosis was established. A sensitivity of 97.4% and specificity was 71.4%, were observed with 93.4 % of accuracy. The positive and negative predictive values were 95% and 83.3%, respectively. Conclusion: FNAC is a safe and accurate diagnostic tool. Surgeon can plan treatment according the preoperative FNAC diagnosis and avoid unnecessary surgeries.

379-384

Authors: Upasna Chachra, Hari Shankar Pandey, Naveen Chandra, Bhawana Pant, H.S. Rawat

Background: To study the cytological patterns of lymphadenopathy in our setting to determine the demographic parameters and the clinical presentation of the various causes of lymphadenopathy in adults and children and the diagnostic utility of FNAC in the evaluation of lymphadenopathy. This would help the doctors attending patients in this region to have a basic idea about prevalence of different clinical profiles of palpable lymphadenopathy for easier case detection and better therapeutic outcome. Material & Methods: FNAC was performed using a 22 or 23 gauge needle attached to 20 ml disposable plastic syringe mounted on a syringe holder for single hand grip was used, Slides will be fixed in 95% ethyl alcohol for cytological evaluation using Papanicolaou staining (PAP) and Hematoxylin and Eosin (H&E) stain. Smears are kept air-dried for May–Grünwald–Giemsa staining and Ziehl Neelsen stain. Results: Out of 665 cases, 372 cases (55.9%) were males while 293 cases (44.1%) were females. Male to female ratio is 1.3: 1. Out of total, 76.1% cases were benign and 23.9% cases were malignan

392-396

Authors: G.V.R.N. Krishna Kanth, V. Satyanarayana

Background: Follicular variant of papillary carcinoma is the second common variant of papillary carcinoma. The diagnosis of follicular variant pre-operatively has been really very challenging and the incidence of false diagnosis is also very high. So, an attempt has been made to study the cytological as well as ultrasound findings of histologically proven cases of follicular variant of papillary carcinoma of thyroid. Materials and Methods: Sonographic findings and cytology findings of 20 histologically proven cases of Follicular variant of papillary carcinoma of thyroid are retrospectively reviewed. Results: Only 50% of cases were diagnosed as malignant on ultrasound and only 25% cases were diagnosed malignant on cytology. Conclusion: The sensitivity of diagnosis is more radiologically, so all the thyroid FNAC should be done under ultrasound guidance and also nuclear features of Papillary carcinoma should be more carefully looked into in all suspicious cases. With these initiatives, the accuracy of cytological diagnosis of FVPTC can be substantially increased.

404-408

Authors: Pradeep Tandon, Winnie Gautam

Introduction: High incidence of liver diseases is seen in our country. Diseases of liver that present as a mass lesion can be a diagnostic dilemma. Nowadays guided fine needle aspiration cytology (FNAC) is utilized with greater frequency to identify and diagnose such lesions. The present study was carried out to investigate the profile of liver diseases presenting as a mass lesion in a primary care setting, using guided FNAC as a diagnostic tool. Amongst these patients, efficacy of FNAC in segregating a cohort that needs palliative care only – at the level of primary care medical facility - is also analysed. This would help in minimizing the economic burden of the patient and the expenditure entailed by the society; thereby allowing proper use of scarce medical facilities in resource poor countries. Methods: CT or ultrasound guided FNAC was carried out in 83 patients in a primary medical care facility. Based on cytological diagnosis, their demographic profile was analysed. Results: Primary or secondary malignancy was diagnosed in 46 patients. Metastatic carcinoma comprised the predominant group amongst neoplastic lesions of the liver. In 28 patients, diagnosis of pyogenic or amoebic abscess or hydatid cyst was made. It was possible to identify with the help of guided FNAC, a group of patients suitable for palliative care only. Conclusions: Guided FNAC is a cost effective investigative modality at the level of primary care medical facility for diagnosis of mass lesions in liver

414-420

Authors: Prashant V. Kumavat, Nitin M Gadgil, Hemant Dhusia, Sushant Agarval, Sangita S Margam, Chetan S Chau

Background: This study was undertaken to correlate the clinical, radiological and histo-morphological features of jaw lesions. The histological problem and limitation was also assessed. Not many studies have been reported from India showing attempt to correlate these findings. Material and methods: This is 5 years retrospective analysis of the 49 surgically resected or curetted lesions of jaw. Lesions were grouped as cystic, inflammatory, giant cell lesions, non neoplastic and neoplastic based on histological features. Results: The commonest age group affected was second and third decade (32/ 49 cases). Commonest lesions noted were cystic 23 (46.94%), followed by inflammatory lesions 13 (26.53%). Dentigerous cyst was commonest in cystic lesion with 14 cases (60.87%). Cystic lesions were presented with unilocular radiolucencies. The inflammatory lesions showed characteristic moth eaten appearance. We noted 2 cases (4.08%) each of giant cell lesion and of fibrous dysplasia respectively. Neoplastic lesions were seen in 09 (18.37%) cases and the commonest one were ameloblastoma 3 (33.33%) and osteoma 3 (33.33%). Conclusion: Lesions of jaw are common in second and third decade with most common is lesion being cystic followed by inflammatory. Clinical-radiological correlation is important for diagnosis of giant cell lesions and cystic lesions.

432-436

Authors: Nitin Maheshvar Gadgil, Sangita Ramulu Margam, Chetan Sudhakar Chaudhari, Prashant Vijay Kumavat

Background: Meningiomas are slow-growing and benign tumor of the meninges, which line the skull and enclose the brain. Methods: We have studied 324 cases of meningeal lesions (clinically diagnosed and histologically proved) in Department of Pathology of a tertiary care hospital. We evaluated its frequency, age and sex distribution and documented as per the WHO histological grade of meningioma. Results: The commonest age group affected was 41-60 years. Female predominance was seen. Headache being most common symptom with commonest site was intracranial (88.2%). The meningeal lesions consisted of meningioma (96.6%) and nonmeningioma lesions (3.4%). The commonest histopathological type of mengioma was transitional (24.2%) followed by meningotheliomatous (22.8%). The 85.6% of the meningioma was WHO Grade I tumor. For WHO Grade II meningiomas, mitotic figures and high cellularity was helpful to diagnose the tumors. The non-meningioma lesions included hemangiopericytoma, solitary fibrous tumor, malignant melanoma and metastasis by carcinoma breast, lung and thyroid. Conclusion: From our study, we can conclude that benign meningiomas WHO grade I are most common. Intracranial location is the most common for meningioma. Middle-aged group of 41–60 years was predominently affected and it is uncommon in children.

440-445

Authors: Sumathi

Background: Among various diseases, cancer has become a big threat to human beings globally. The incidence of cancer is increasing nowadays because of modernized world and changing life pattern. Objective: This study aim to measure the incidence and pattern of cancer in rural area of Melmaruvathur, Tamilnadu. Materials and Methods: A retrospective study was carried out in the pathology department of Melmaruvathur Adhiparasakthi institute of medical sciences. Data was collected from cancer register maintained in the pathology department from 2009-2015 .A total of 393 cases were collected and statistically analyzed. Results: The common type of cancer noted in this area was squamous cell carcinoma (43%) affecting cervix, penis, skin, esophagus followed by adenocarcinoma affecting thyroid, breast, stomach, prostate and colon. The age and sex of predominantly affected were females (64%) between the age group of 40-60 years (55%) with an exception that males were commonly affected with stomach cancer (57%) and younger age group of less than 40 years were affected predominantly by thyroid cancer (100%). Conclusion: The incidence of cancer is more common among females and between the age group of 40-60 years in this rural area. The most common cancer affecting females are cancer of cervix, breast and thyroid and males are affected frequently by cancer of penis, prostate and stomach. This study concludes that, the population resides in this rural area is more commonly affected by Genital squamous cell carcinoma followed by papillary carcinoma of thyroid and breast carcinoma

450-455

Authors: Alok Mohan, Ravindra Kumar Jain, Rajender Kumar Thakral

Background: Fine needle aspiration cytology (FNAC) is a well accepted as a diagnostic procedure in adult head and neck lesions. Its use in pediatric population is comparatively new. Only a few studies are available in archives of medical literature in pediatric population. Aims: The study the cytomorphological spectrum of head and neck lesions in pediatric age group. Histopathological correlation was done wherever possible. Material and methods: This was a hospital based, prospective type of study. Patients of age group between 0-12 years of age were included. Cases in two years between the time duration from January 2014 to December 2015 were evaluated for head and neck lesions on Cytopathology. Cytomorphological results were compared with other studies. Histopathological correlation was done wherever possible. Results: FNAC was performed on 1938 patients out of which 215 cases of 0-12 years of age group were included in this study. Cervical lymph nodes were most commonly affected (83.73%). Reactive lymphadenitis followed by granulomatous lymphadenitis was the most common pathology. Second most common site was skin and eyelid. Lesions of salivary glands, soft tissue and thyroid were also encountered. Histopathological correlation was possible in only 8.33% cases and concordant results were seen in 88.89% cases. Conclusions: FNAC plays a crucial role in the diagnosis of pediatric head and neck lesions. Preliminary diagnosis can be made and the spectrum of disease can be easily assessed. Histopathology was needed for confirmation of diagnosis in suspicious cases.

463-469

Authors: Bharati Bhushan Chittawadgi, Sagar Chandrakant Mhetre, Bhusan Basavaraj Chittawadgi

Background: Acute appendicitis is the most common surgical emergency that affect about 7% of the population. Obstruction of the lumen by faecoliths is the usual cause of acute appendicitis. The histopathologic stages of appendicitis are important to regarding prognosis. Study of diagnostic accuracy and pathological correlation aiming to reduce not only late complications but also the rate of negative appendicectomies had been studied worldwide. Application of quantitative microscopic techniques for assessing the diagnosis of inflammatory condition of appendix is quite useful since it imparts objectivity and reliability to the diagnosis. This is the first study we carried out for analysis of severity of acute appendicitis by morphometric measurement of diameter of blood vessels in relation to degree of eosinophil and basophil (mast cells) infiltration. Materials and Methods: A retrospective review of archives of the department of pathology, for the period of three years from 2010 to 2012, we identified 100, clinically and histopathologically diagnosed cases of acute appendicitis. Slides and blocks were selected for the study. Blood vessel morphometric analysis was performed on H and E stained sections. Diameter of one largest measuring blood vessel in each layer (Mucosa, Muscularis propria, Submucosa and serosa) of the appendix, is measured by using ProGres Capture Pro software. Mean and SD of the diameters of the blood vessels in each layer of appendix in 100 specimens were calculated. Number of eosinophils infiltration/10 hpf on H & E stained sections and number of mast cells infiltration/10 hpf on Toluidine blue stained sections in each layer of appendix in 100 specimens were counted by using light microscopy. Results: All 100 patients, who underwent operative procedure, came with chief complaint of pain in the periumbilical region migrating to the right iliac fossa. The mean age of presentation was 25.10 years. This study found that as there is increase in the number of eosinophils (counted as number of eosinophils/10 hpf) in each layer of appendix, there is decrease in the diameter of blood vessel in corresponding layer of the same appendicectomy specimen and as there is increase in the number of mast cells (counted as number of mast cells/10 hpf) in each layer of appendix, there is also increase in the diameter of the blood vessel in corresponding layer of the same appendicectomy specimen in acute appendicitis. Conclusion: The study establishes the statistical correlation between morphometry and degree of cellular inflammatory infiltrate (eosinophils and mast cells counted by using light microscopy) which helps to assess severity of inflammation of the appendix.

479-484

Authors: Sandeep Ojha, Amit Haritwal, Farah J. Meenai, Sonam Gupta

Background and Objectives: Pancytopenia is one of the most common indications for bone marrow (BM) examination. There are spectrums of condition involving the bone marrow (BM) that can present with pancytopenia and include malignant as well as benign diseases. The objective of this study is to evaluate the BM findings in cases of pancytopenia. Materials and Methods: This was a retrospective study of 156 cases of pancytopenia presenting over a period of 3 years. Data were retrieved from laboratory and clinical records and were analysed. Results: Out of 156 cases, the most common cause for pancytopenia in this study was megaloblastic anemia (25.6%), followed by acute leukemia (16%), hypoplastic marrow (14%), metastatic solid tumors (8.9%), myelodysplastic syndrome (MDS) (7.1%), lymphomas (5.7%), plasma cell dyscrasia(3.8%). Along with these there were many benign yet rare causes which may present with pancytopenia like Hemophagocytic syndrome (1.2%), Histoplasmosis (0.6%), Leishmaniasis (0.6%) and Gaucher’s disease (0.6%). Bone marrow examination (combining both aspirate and biopsy) alone was sufficient in diagnosing 55% of cases, while remaining cases require additional details like clinical findings (for cases of MDS, viral infection, hypersplenism, autoimmune, septicemia) and special investigations like hemoglobin electrophoresis for hemoglobinopathy. In only 3.8% cases, BME was inconclusive. Conclusion: BME is an important investigation in diagnostic work up of cases of pancytopenia. In majority of cases, it can provide an accurate diagnosis or at least can guide the approach towards diagnosis and management. Thus, it should be performed in all cases of persistent pancytopenia and should be evaluated in light of clinical details and supportive investigations.

491-495

Authors: Banushree CS, Ramachandra V. Bhat, Udayashankar C

Background: Hansen’s disease is a curable chronic infectious disease. The clinical presentation and histopathological interpretation of skin biopsy may show variations as various types of the disease exist. The clinical diagnosis should be confirmed by histopathological features and bacteriological study before starting treatment for particular type of the disease. Materials and Methods: A retrospective hospital based study was conducted among patients with clinically diagnosed Hansen’s disease classified according to Ridley-Jopling scale. Skin biopsy taken from active lesion was stained with routine Haematoxylin & Eosin (H & E) stain and modified Fite-Faraco’s stain for acid-fast bacillus Results: Out of 107 histologically confirmed cases, male to female ratio was 1.6:1. The age of the patients ranged from 4- 80years. Clinically, BT was the most common type of leprosy with 43% cases followed by TT 20.64% cases, LL 14.95%, BL 13%, IL 8.41% and least common type of leprosy seen clinically was BB with 0% cases. The commonest type on histopathology was BT with 39.25% followed by TT 19.62%. The correlation was highest in lepromatous leprosy(100%).The Clinical and histopathological correlation was seen in 85 cases (79.44%) Conclusion: There can be overlap between different types of leprosy, both clinically and morphologically. So correlation of clinical and histopathological features along with bacteriological index appears to be more useful for accurate typing of leprosy. The concordance was high in LL. BB is rarely diagnosed both clinically and histopathologically.

503-507

Authors: Harveen Kaur Gulati

Background: One minute preceptor (OMP) strategy is a 5 step or “micro-skills” teaching tool for use by faculty in busy ambulatory settings, however analysis of its utility in Pathology especially with respect to resident training has not been done before. Hence, our endeavour was to introduce OMP as a teaching tool for routine slide diagnosis and also to evaluate it. Method: Post graduate residents as well as faculty in pathology were given validated questionnaires to assess perception evaluation and overall effectiveness of the teaching method, following an orientation programme on OMP. The outcomes were evaluated using Likert scale along with open ended questions and analysed using SPSS Software. Result: 30 sessions of OMP were conducted by five faculty members and the eight learners in rotation. Comparison of the change in behaviour of the learner after intervention revealed a statistically significant difference in six out of the nine attributes evaluated. OMP was found to be more effective in improving exam skills, communicating the findings, thinking of logical differentials and in motivating the learner to do self study. OMP was also perceived to be less threatening, more helpful in learning and was strongly recommended to be incorporated as a teaching strategy for teaching routine histopathology slides. Among the faculty, most agreed that OMP was an effective teaching tool which helped identify specific lacunae in learner’s understanding and were willing to adopt OMP as a teaching methodology. However, they also felt that it was more time consuming. Conclusion: The present study is the first of its kind which highlights the advantages and disadvantages of OMP as a teaching learning tool in the field of pathology especially for teaching routine histopathology slides. Although the sample size of this study was small, the positive response to OMP by both the learners and faculty cannot be overlooked.

520-521

Authors: Rupinderjeet Kaur, Puneet Kaur, Jasbir Singh, Monika Bansal

Background: Neuroendocrine carcinoma of the breast is a rare entity. Most patients are in the sixth to seventh decade of life. The criteria for diagnosis were established by the WHO in 2003, and modified in 2013. Based on the limited number of studies done; this entity is thought to have a worse prognosis compared to the usual type of intraductal carcinoma. Case Report: A 45 year old woman presented in the surgical outpatient department with complaint of lump breast. Fine needle aspiration was performed and the case was reported as suspicious of malignancy. Biopsy was advised for further evaluation. Histopathology showed a cellular tumor exhibiting a sheeting pattern with interspersed rosettes. The individual cells were relatively monomorphic, with a salt and pepper chromatin. Intraductal component was also identified. Based on the characteristic morphology and presence of chromogranin positivity in more than 50% of the tumor cells, the lump was diagnosed as primary neuroendocrine carcinoma, well differentiated. Conclusion: This case has been written up because of the rarity of this entity, its characteristic histopathological features, and the importance of differentiating it from intraductal carcinoma, due to a more aggressive course than invasive ductal carcinoma, with a higher propensity for local and distant recurrence and poorer overall survival attributed to this entity by some researchers.

526-527

Authors: Bharat R. Sonwane, Santosh Govind Rathod, Prajakta P. Patil, Parveen Shaikh, Rajan S. Bindu

Malignant fibrous histocytoma is undifferentiated soft tissue sarcoma of mesenchymal origin. It has predilection for male in later age of life, and upper and lower extremities are commonly affected.[1] We are reporting case of 35-year-old female, presented with left eyelid swelling, and histopathologically diagnosed as malignant fibrous histocytoma.