Indian Journal of Pathology and Oncology

489-494

Authors: K. Suresh, K. Florence Nightingale, V. Vydehi, K. Shilpa

Renal cell carcinomas are aggressive tumors which are stratified based on Fuhrman grading and TNM staging for prognosis. The total number of cases of renal cell carcinomas used for this study was 40. Clinicomorphological variables were correlated. Clear cell carcinoma accounted for maximum number of lesions. The clinical manifestations included hypertension, flank pain; flank mass but all features were noted only 10 cases. All the cases showed a male preponderance and common age group was 4th to 6th decade. Furhman Grade and TNM stage can be used as single independent prognostic factors. Clear cell and papillary renal cell carcinomas were low grade tumors with PT1-3 and Furhman grade I or II. Sarcomatoid and undifferentiated carcinomas were high grade tumors with PT4 and furhman grade IV. There was no positive correlation between necrosis of the tumor and Furhman grade, most patients had Furhman grade I or II. There was no correlation between histologic subtype and necrosis. Size alone is not an independent predictive prognostic factor. Microvessel involvement and peripelviceal sinus involvement was seen in sarcomatoid variant. None of the cases in this study showed adrenal involvement.

501-506

Authors: Dipakkumar R. Prajapati, BH Parmar.

Introduction: To provide safe blood to the recipients, proper donor selection and deferral is as important as screening of blood bags for various transfusion transmissible infections (TTI). Aims and Objectives: To study and analyse various causes & rate of pre-donation deferral of blood donors and to take proper follow up actions to decrease the temporary deferral rate without compromising blood quality and recipient’s safety, thus retaining prospective blood donors and preventing loss of precious blood. Materials and Method: A retrospective study of various causes of pre-donation deferral of whole blood donors in the blood bank of our institute was done. Records of all deferrals of Financial Year 2012 to 2016 (4 years) were reviewed and analysed. Results: A total of 6633 potential blood donors were registered during the study period which includes 6474 males (97.6%) and 159 females (2.4%) with 5840 Voluntary and 793 Replacement donations. Out of which, a total of 273 donors (4.11%) were deferred due to various reasons. Among these, 235 were Temporary (86.08%) and 38 were Permanent deferrals (13.92%). The main reason for temporary deferral is Low Haemoglobin; while for permanent deferral is Hepatitis B Positivity. Conclusion: The donor deferral rate obtained in our study is 4.11% which is quite good as compared to higher deferral rates of some other studies. Majority of the donors were males, so encouragement and motivation of female donors is equally important to increase the overall donor pool. Temporary deferrals were more as compared to permanent deferrals. So by counselling and educating the temporary deferred donors regarding some common causes of temporary deferrals and deferral period, they can be brought back for future donations. The Leading causes of permanent deferrals were Transfusion Transmissible Infections (HBV, HIV, HCV). So proper counselling is also necessary to prevent them from donating blood for the safety of the recipient. In this ways, a pool of healthy blood donors can be increased without compromising quality of blood and safety of the recipients as well as donors.

511-516

Authors: Chandrashekhar TN, Sateesh Chavan S.

Introduction: A pink oval structure, the ocular caruncle is a modified cutaneous tissue located at the inner canthus of the eye, medial to the plica semilunaris. By virtue of its tissue diversity, ocular caruncle can give rise to a wide variety of lesions including both non neoplastic and neoplasic and although most of them are benign, clinical diagnosis may be difficult. Aim: To study the incidence and describe clinical and histopathological features of ocular caruncular lesions. Materials and Method: This is a retrospective study of ocular caruncular lesions from the archives from 2006 to 2010 were analyzed both clinically and histopathologically. Results: A total of 22 lesions were analyzed. Thirteen (59.09%) of the patients were women and 9 (40.90%) were men and the age range from 25 to 67years. The main diagnoses were: inflammatory lesions (11 cases), epithelial lesions/tumors (8 cases), melanocytic lesions (2 cases), and a lymphoid lesion (one case). Out of 22 cases, preoperative clinical diagnosis was concordant with histopathological evaluation in 16 cases (72.72%). Most common caruncular lesions were chronic inflammatory followed by epithelial lesions/tumors and melanocytic lesions. Although most of the lesions were benign, clinically most of the lesions are disguising in nature. Conclusion: Ocular caruncular lesions are most commonly inflammatory, less common lesions being epithelial and melanocytic lesions. Some benign lesions are clinically overestimated as ‘malignant’ and some malignant lesions are underestimated as ‘benign’, justifying close pathological work-up of all lesions.

523-528

Authors: Suparna Dubey, Abhimanyu.

Introduction: Advances in healthcare require adequate quantities of safe blood, which can be obtained by regular voluntary blood donation. The college-going students constitute a healthy pool of potential donors. This study was conducted to explore the knowledge, attitudes and practices of blood donation in undergraduate medical students, so that the existing lacunae in the system may be identified and remedied. Materials and Method: A cross-sectional study was conducted on 388 undergraduate medical students, using a structured questionnaire which contained both close and open-ended questions on attitudes and practices. Knowledge was assessed by interview by a single observer. Results: Only 18.04% students had donated blood. Gender was found to be insignificant and socio-economic status (p=0.00004) and knowledge about donation (p<0.00001) were found to have a highly significant effect on blood donation. Voluntary donors donating for altruism constituted 82.9%. Commonest reasons for non-donation included deferrals (40.3%), apathy (35.8%) and fear (17.9%). Deferrals were due to anaemia (37.4%) and inadequate weight (2.8%), almost exclusively in females. Misconceptions related to pain (6.3%), increased rate of infections (6.0%), decreased immunity (0.6%) and syncope (0.6%) were prevalent. Non-donors felt that blood donations were risky (p=0.0261) and perceived a higher degree of risk than donors (p=0.0018). Only 0.6% of the donors were regular donors while 74.3% of donors had donated only once. Blood donation camps were the most important source of knowledge and motivation (34.3%) and all voluntary donors had donated therein. The donation experience was considered good by 58.6% students. To promote donation, non-donors advocated provision of incentives (p=0.00016), which included free replacement of blood for family or friends (35.6%) and free blood tests (29.4%). Conclusions: It is essential to create awareness among medical students and organize blood donation camps to increased recruitment and retention of voluntary donors. This will help attain the goal of 100% voluntary, non-remunerated blood donation laid down by the WHO.

533-535

Authors: Deepak Das, Chumila Thinley Bhutia, Rachna Lamichaney, Bhawana Chettri.

Introduction: Stroke is one of the leading causes of death and disability in India. Various risk factors like smoking, diabetes mellitus, hypertension, hyperlipidemia, obesity and stress are associated with atherosclerosis. Platelets are known to play a critical role in conversion of a chronic atherosclerotic plaque into an occluding thrombus. Various studies have postulated that large platelets or raised mean platelet volume (MPV) are more vulnerable for development of occluding thrombus. The present hospital-based case control study was undertaken to evaluate the importance of platelet volume indices specifically increased MPV in patients with stroke and to compare those values with the normal healthy controls. Materials and Method: We studied 157 cases of stroke patients admitted in our hospital over a period of two years. Platelet variables of stroke patients were measured in an automated analyzer immediately after hospital admission and preferably within 2 hours. Group matching was done for the control subjects and the controls were matched for age, sex and other demographic characteristics. Results: There was no significant difference in mean platelet volume between patients with stroke and the control subjects (p value >0.05, Student‘s t test). Conclusion: Raised MPV or large platelets are not a risk factor for stroke.

540-545

Authors: Parineeta B. Magdum, Manisha A. Atram, Nitin Gangane.

Objectives: 1. To evaluate the serum levels of lipid peroxidation product like thiobarbituric acid reacting substance(TBARS) i.e. Malondialdehyde and Reactive oxygen species(ROS) i.e. Nitric oxide in patients of tubercular, reactive and metastatic lymphadenopathy. 2. To evaluate the antioxidants status i.e. level of ascorbic acid, reduce glutathione and superoxide dismutase in patients of tubercular, reactive and metastatic lymphadenopathy. Materials and Method: Forty cases each of tubercular lymphadenitis, reactive lymphadenitis and metastatic lymphadenopathy was diagnosed on FNAC and evaluated for various parameter i.e. Malondialdehyde, Nitric oxide, ascorbic acid, reduced glutathione and superoxide dismutase by colorimetric method. Thirty healthy individuals were taken as controls. Results: Levels of malondialdehyde and nitric oxide were significantly raised in patients of tubercular lymphadenitis (6.89 ± 1.48nmol/ml) and metastatic lymphadenopathy (8.03±1.51nmol/ml) as compare to patients with reactive lymphadenopathy (4.62 ± 1.14nmol/ml) and control group (4.62 ± 1.45nmol/ml). Superoxide dismutase, reduced glutathione and Ascorbic acid reduce in tubercular (2.14 ± 0.63units/ml) as well as metastastic lymphadenopathy (1.88 ± 0.52units/ml) than reactive lymphadenopathy (3.19 ± 0.54units/ml) and control group (3.42 ± 0.53units/ml). Conclusion: ROS are known to play tremendous role in health and disease. A frequent cellular target to ROS is lipid components of the cell membrane resulting in lipid peroxidation. To counter the harmful effects of ROS, antioxidants defense mechanism operates to detoxify or scavenge these ROS. This may be important for better understanding the pathogenesis of the disease and may contribute to its diagnosis and treatment.

551-554

Authors: Hema M, Savithri Ravindra.

Introduction: Gallbladder diseases are the major causes of morbidity and mortality throughout the world. Majority of the diseases are related to gallstones. Gallstone disease is a risk factor for the development of gallbladder carcinoma. Aims and Objectives: The objective is to study the morphological spectrum of neoplastic diseases in gallbladder, and to note the frequency of malignant neoplasms. Materials and Method: The study was conducted on cholecystectomy specimens received in centrallaboratory, Department of Pathology, KIMS, Bengaluru from July 2009 to June 2014. The cholecystectomy specimens received in 10% formalin were examined in detail for gross and microscopic changes. Neoplasms were studied and categorized. Results: There were 700 cholecystectomy specimens received for histopathological study. There were 17 cases of neoplasms of which 6 were adenomas and 11 were carcinomas. Of the 11 carcinomas 3 were detected only on histopathological examination. Conclusion: Histopathological examination of all the cholecystectomy specimens is a must to rule out incidental carcinoma.

560-563

Authors: SAK Adil, Sharath Kumar HK, Srijana Rao SP, Smriti Gupta

Aim: To study the spectrum of diseases affecting the palatine tonsils and to establish the histopathological criteria for diagnosis of chronic tonsillitis. Materials and Method: 40 palatine tonsillectomy specimen received at Department of pathology were reviewed retrospectively and were subjected to histopathological evaluation and analysed for spectrum of tonsillar diseases and histopathological criteria to establish the diagnosis of chronic tonsillitis. Results: A total of 40 cases were evaluated comprising of 26 males and 14 females. The mean age was 44 years with a range of 7 to 81years. 29 specimens were histologically diagnosed as Chronic tonsillitis and 11 specimens were diagnosed to have malignancy. Tonsillar cyst were found in 3 cases, out of which one showed colonies of Actinomycosis species. Histopathological examination showed lymphocytic infiltrate in 83%, increased plasma cells in 72%, presence of neutrophils in 69%, lymphoid hyperplasia in 69% and fibrosis in 76% of the cases. 11 malignant cases were diagnosed and all of them were reported as Squamous cell carcinoma. No cases of lymphoma were diagnosed. Conclusion: Lymphocytic and neutrophilic infiltration in surface epithelium with or without lymphoid hyperplasia could be fairly used as the criteria for diagnosis of chronic tonsillitis. Among the tonsillar malignancies, Squamous cell carcinoma is the commonest and more common among the adult males with mean age of 60years. Though incidence of malignancy is very rare in children, routine pathological analysis of tonsillectomy specimens is performed so as not to miss an unexpected pathology especially malignancy.

570-574

Authors: GA Vasugi, Sandhya Sundaram, Lawrence D’cruze, Aruna Rajendran, Julius Xavier Scott.

Introduction: The aim of this study is to analyse the clinicopathological profile of malignant pediatric solid tumours and also to evaluate the proliferative index using Ki-67 in a spectrum of these tumours. Materials and Method: 75 cases of malignant solid tumours age group less than 17 years, reported at Sri Ramachandra Medical College from Jan 2009 to Dec 2013 are included in this study. Formalin fixed paraffin embedded tissue stained with H&E were used for routine morphology. Immunohistochemical staining was done using monoclonal anti Ki 67 antibody by Streptavidin biotin peroxidase complex technique. Labelling index or growth fraction is calculated as the percentage of positive cells for 1000 cells evaluated. Results: Among the 75 cases 52 (68%) were males and 23(32%) were females. 22(29%) were CNS neoplasms and 53(71%) were Non CNS neoplasms which included lymphoma, Ewing’s sarcoma, Osteosarcoma, Wilms tumour, Soft tissue tumours, Germ cell tumours, Neuroblastoma, Hepatoblastoma & others. The labelling index was variable according to the grade of the tumours. It varied from 2 to 40% in CNS neoplasms according to the grade and about 1 to 90% in various Non CNS neoplasms. Conclusion: Pediatric solid tumours form a wide spectrum. Ki-67 labelling index may be a useful adjunct in predicting the biological behaviour & prognosis of pediatric solid tumours.

580-585

Authors: G. Vahini, K. Shilpa Madhuri, BA Ramakrishna, Sumakaza, K. Rammurthy.

Introduction: Central nervous system tumours represent unique heterogenous population of neoplasms which include both Benign and Malignant neoplasms. In India, CNS tumours constitute about 1.9% of all the tumours. These tumours pose diagnostic difficulty due to varied presentation and overlapping morphological features. Immunohistochemistry helps in overcoming diagnostic difficulties in problematic cases. Aims and Objectives: The aim of the study is to analyse histopathological spectrum of CNS tumours irrespective of age in a single institution. Materials and Method: A one year prospective study was carried out in department of pathology from 2016 to 2017, at the department of pathology, ASRAM. Neurosurgical specimens were formalin-fixed and paraffin-embedded and stained with Haematoxylin and eosin. Immunohistochemical markers were applied in selective cases like S-100, CD-45, etc. Results: In our study, seventy two (72) brain neoplasms were analysed. Neuroepithelial tumours (25) were most common, followed by meningothelial tumours (22), tumours of sellar origin(12), tumours of cranial and paraspinal nerves(5), metastatic tumours(4) and others (4). Conclusions: The present study highlights the histological diversity of CNS tumours in various age groups. CNS tumours peak incidence was noted at 4th to 5th decade. Meningiomas and astrocytomas were common tumours after 40 years of age. GBM was the most common among astrocytomas. Immunohistochemistry was helpful in dilemmatic cases.

591-594

Authors: Jasmeet Kaur, Rahul Mannan, Mridu Manjari, Tejinder Singh Bhasin, Sonam Sharma.

Introduction: Oral squamous cell carcinoma (OSCC) is the sixth most common cancer in the world. It usually develops in males in the 6th and 7th decade and is caused by tobacco and alcohol consumption. Materials and Method: This study was performed on 40 histopathologically proven cases of squamous cell carcinoma of oral region in Department of Pathology SGRDIMSR, Amritsar, Punjab. Tissue were stained for H & E and further immunostained for p53 receptor. p53 expression was correlated with histological grading, age, sex, vascular, perineural, muscle invasion and lymph node metastasis. Results: In our study, maximum incidence was seen in age group of 41-60 years with a male:female ratio of 7:1. A statistically significant correlation between p53 positivity with grade of carcinoma and cases presenting with nodal metastasis was seen. However, no such correlation was seen with age, sex, vascular, neural and muscle invasion. Conclusion: p53 positivity shows a direct correlation with grade and lymph node metastasis of SCC in head and neck. Thus, p53 has an influence on prognosis.

600-603

Authors: Neerja Shah, Nisha Raval, Jayesh Josh3, Ashok Agnihotri.

Introduction: Tumours of uterus and cervix are extremely common lesions encountered in our routine histopathology practice. However, a few entities like endometrial stromal tumours pose diagnostic challenges. With this study, an attempt has been made to broadly categorize the tumours of uterus and cervix and at the same time look into occurrence of rare lesion like endometrial stromal sarcoma. Materials and Method: Total 2400 hysterectomy specimens received at histopathology section of department of pathology, C U Shah medical college, Surendranagar were studied in a 3 year period from August 2013 to July 2016. A brief clinical history of patient was taken into account. All histopathological details like size, shape, presence of masses, etc were noted and extensive sampling of specimen was done. Result: Total 2400 cases were studied, of which 648 (27%) specimens were neoplastic. Of them, 635 (98%) cases were benign & constituted exclusively of leiomyomas. Amongst 13 malignant lesions, 03 (23%) cases were of endometrial stromal sarcoma, 06 cases were of endometrial carcinoma and 04 cases of cervical carcinoma. Conclusion: As expected, leiomyomas turn out to be most common neoplasms of uterus and cervix. Though rare, certain lesions like endometrial stromal sarcoma do come across in histopathology and such lesions being known for poor prognosis and recurrences are important to be correctly and timely diagnosed.

611-617

Authors: Reshma G. Kini, Zeeshanali Fazalbhouy, Astrid Lovita Miranda, Crysle S Saldanha.

Purpose of study: To evaluate the application of The Bethesda System of Reporting of Thyroid Cytopathology (TBSRTC) in a non-referral setting of a teaching hospital. Materials and Method: We included consecutive thyroid FNAs performed in our institute for a period of two years. The FNAs were classified into six general diagnostic categories (DCs) as per TBSRTC. Analysis was done by calculating the sensitivity, specificity, negative and positive predictive values, likelihood ratios and the incidence of malignancy in each of the categories with respect to the histopathologic diagnosis obtained after surgical resection. Results: A total of 1270 FNAs were categorized as per TBSRTC. DC I constituted 15.6 % of cases, DC II-74.3%, DC III-3.8%, DC IV- 2.4%, DC V-1.% and DC VI-3.1% of cases. Histopathological follow up was available for 253 cases(19.9%)The incidence of malignancy was 0%in DC I, 2.6% in DC II, 33.3% in DC III, 46.15% in DC IV, 77.8% in DC V and 100% in DC VI.The positive predictive value for DC IV,V and VI was 79%and negative predictive value for DC II lesions was 97.2% . A repeat FNA without sonological guidance could re-categorize 22 of the 38 DC I patients into DC II. Conclusion: The TBRTC is a valid method of reporting thyroid FNAs in a non-referral setting as evidenced by the increasing incidence of malignancy obtained with higher DCs.

622-628

Authors: SD Birare, SK Mahule, KT Dalve, NR Patil, NV Naigaonkar

Introduction: Among the cancer related deaths in men, prostatic cancer is the second most common to lung cancer. Important cause for prostatic morbidity and mortality includes inflammation, benign nodular enlargement and tumors. Histopathological diagnosis and grading plays a definitive role in the management of prostatic cancer. The current study aims at analyzing clinicopathological features of various neoplastic and non-neoplastic lesions of the prostate. Materials and Method: The present study included 158 prostatic specimens, which comprises of 157 TURP chips, and 1 prostatectomy specimen. The results were grouped into non-neoplastic and neoplastic lesions. The cases of prostatic adenocarcinoma were graded using Gleason microscopic grading. Results: Out of 158 prostatic specimens studied; 145 were benign lesions, 4 were premalignant and 9 were malignant lesions. Among benign lesions nodular hyperplasia without prostatitis was the most common. The cancer detection rate with prostatic volume < 40 ml was higher than with >40 ml. Most malignant prostatic lesions showed marked elevation in serum PSA levels (>20 ng/ml). Among the malignant lesions, commonest lesion was prostatic adenocarcinoma. Discussion: Since low-grade lesions are usually asymptomatic, awareness of serum PSA level estimation, digital rectal examination should be done among elderly males who are prone for malignancy. Male individuals with a positive family history for prostatic carcinoma must undergo relevant screening test.

632-637

Authors: Neha Sharma, Puneet K. Bhatia, KK Kaul, Sonam Sharma, Manisha Sharma.

Introduction: Pancytopenia is not a disease entity but a triad of findings that may result from a number of disease processes and is defined as simultaneous presence of anaemia, leucopenia and thrombocytopenia. Bone marrow aspiration along with trephine biopsy is important to find out the cause of pancytopenia. The present study was essentially a pilot study which was undertaken over a period of 2 years at a tertiary care teaching hospital. The aims and objectives of this study was to find out the epidemiological spectrum and prevalence of pancytopenia according to age and sex along with the correlation of the clinical, haematological and bone marrow findings of such patients. An attempt was also made to determine the etiopathogenesis of pancytopenia for ascertaining the individual pathological pattern (spectrum). Materials and Method: The present study was conducted in the Postgraduate Department of Pathology, Government Medical College and Associated Hospitals, Jammu, India over a period of 2 years. A total of 100 patients were prospectively analyzed and were subjected to bone marrow examination. Results: The prevalence of pancytopenia in our haematological set-up was observed to be 0.76%. Pancytopenia was seen to be more prevalent in males (62%) in comparison to females (38%) with male to female ratio of 1.64:1. In the present study, majority of cases were diagnosed as megaloblastic anemia (60%) followed by subleukemic acute lymphoblastic leukemia (11%), subleukemic acute myeloblastic leukaemia (4%) and Kala azar (3%). Myelopthisic due to metastatic carcinomatous deposits was the least common etiological factor accounting for one case only. Conclusion: Detailed examination of peripheral smear reveals important information regarding etiology e.g. macro-ovalocytes with hypersegmented neutrophils in megaloblastic anemia, occasional blast cell in subleukemic leukemia, absence of any abnormal/immature cell in aplastic anemia, leucoerythroblastic picture in myelofibrosis, pelgeroid neutrophils in MDS and nRBC with abnormal cells in metastatic malignancies. However, the diagnostic accuracy is increased manifolds when detailed clinical history and examination are combined with complete blood counts and peripheral smear evaluation. Although, bone marrow study (bone marrow aspiration/bone marrow trephine biopsy) provides the definite diagnosis in cases of pancytopenia.

643-646

Authors: Pavneet Kaur Selhi, Vikram Narang, Jyotinder Pal Singh, Neena Sood, Harpreet Kaur.

Punjab, once the leader of green revolution in India, is now suffering from adverse consequences of contaminated water from rapid industrialization and excessive use of chemical fertilizers for high yield of crops. As more and more states practice the agricultural practices followed in Punjab the fear amongst the medical faculty is that the cancer scenario in Punjab will be replicated in other states as well. Therefore apart from Government initiatives, institution base cancer registries are also an indispensible tool in analyzing the spectrum of cancer in population. We hereby present the spectrum of non-hematological malignancies analyzed through over institution based cancer registry.

650-652

Authors: Ranjan Agrawal, Shweta Agrawal, Parbodh Kumar.

Vascular tumours of the female genital tract are very rare. Ovarian haemangiomas are extremely rare benign tumour despite their rich vascular supply, with approximately 60 documented cases in the English literature. They are “non-functional’’ neoplasms. The histogenesis is still debatable. Most of the haemangiomas in the ovary are asymptomatic and of the mixed type.

655-657

Authors: A. Sathish Selvakumar, V. Rajalakshmi.

Osteosarcoma (OS), a primary malignant bone tumor usually arises from the metaphyses of long bones and less commonly in the flat bones. Small cell osteosarcoma (SCO) is a rare variant, comprising 1.5% of all OSs. A 37 years old gentleman presented with left maxillary swelling of 6 months duration and was treated by a local physician but the swelling did not subside. A biopsy revealed small and uniform tumor cells with diffuse growth pattern. Osteoid production, necrosis, and brisk mitoses were seen. A diagnosis of small cell osteosarcoma (SCO) was considered. Immunohistochemistry (IHC) was positive for osteopontin and vimentin with high Ki67 index confirming the diagnosis. He was treated with partial maxillectomy, chemotherapy and radiotherapy. He presented again with local recurrence into the orbit and distant metastases to brain and lung. A palliative complete maxillectomy with total orbital exenteration and defect reconstruction was performed. The patient died six months after the surgery. Differential diagnosis includes small round blue cell tumors like Ewing sarcoma/primitive neuroectodermal tumor (PNET), non-Hodgkin lymphomas, small cell carcinoma, neuroblastoma, and mesenchymal chondrosarcoma. Histopathological evaluation along with negative IHC staining of CK, p63, S100, HMB45, CD99, LCA, SMA and PAS stain helps in ruling out the various differential diagnoses. Surgery and chemotherapy improves disease free survival rates by 10% to 20%. SCO in the flat bones of the head and neck region involving the orbit is very rare with poor prognosis. We highlight SCOs rarity, aggressive behaviour and the role of histopathological evaluation in clinching the diagnosis.

664-666

Authors: Hadiya Naureen, Ashwini HN.

OEIS complex is a rare congenital anomaly characterised by omphalocele, exstrophy of bladder, imperforate anus and spinal defects. It is a defect that affects the midline of the lower inferior body. This condition is mostly fatal and almost incompatible with life. A diabetic multiparous woman with history of previous 2 spontaneous abortions presented with 3rd pregnancy, spontaneously delivered a dead fetus of 17weeks gestational age. Here we present an autopsy case report of a 17 weeks fetus with features of OEIS complex which had the above mentioned features along with left club foot, absence of spleen, pancreas & both internal and external genitalia. Microscopic examination of the placenta showed villi with fibrin clot deposition and calcification suggesting that feto-maternal insufficiency of placenta was the cause of death.

670-673

Authors: Linda Lamngaiching Changsan, Utpal Dutta, Projnan Saikia, Swagata Dowerah.

Introduction: The most common form of testicular neoplasm in prepubertal children is Yolk sac tumour, occurs mostly in the pure form. However, in adults, it is invariably found admixed with other germ cell tumour components. Case Report: A 22-years-old male presented to surgery OPD with abdominal pain for 1 month and on examination, was found to have bilateral cryptorchidism with a swelling on the left iliac fossa. The left testis was resected and was sent for histopathological examination. Microscopy revealed picture of yolk sac tumour and the tissue was again thoroughly sampled to find out other components of a mixed GCT. As none was found and a diagnosis of pure yolk sac tumor, postpubertal-type was made based on morphological features. Immunohistochemistry showed focal positivity for alpha-fetoprotein and CD30 negativity. Conclusion: This case of pure yolk sac tumour, postpubertal-type has been reported in view of its rarity and its aggressive nature compared to its prepubertal counterpart. However, diagnosis of these tumours should only be given after proper extensive sectioning to rule out any other germ cell component.

354-357

Authors: Alok Mohan, Rajnish Kumar, Veena K. Sharma, Pradeep Kumar, Kamna Gupta.

Introduction: Objective Structured Practical Examination (OSPE) is a widely accepted tool to evaluate the practical skills of the medical students. Objectively Structured Practical Examination (OSPE) is gaining wide appreciation and acceptance in practical examination in Basic and Para ─clinical medical subjects. OSPE has been proposed in Pathology for undergraduate medical students. Aims and Objectives: The present study was undertaken to determine the student perception and satisfaction regarding OSPE as a method of assessment of laboratory exercise in pathology. Materials and Method: The present study was carried out among M.B.B.S. students at a teaching medical college in Western Uttar Pradesh. A total of 126 students during their second year of MBBS course participated in the study. They went through the OSPE based practical examination and then a close ended questionnaire was distributed to assess student’s perception regarding the OSPE based examination. Results: According to our study, OSPE was seen as a positive and useful practical experience by 66.67% of the students. Feedback from the students suggested that 83.33% students felt that OSPE was an objective tool in evaluating practical skills. Only 11.9% students perceived it as a stressful experience. Conclusion: OSPE proved to be an efficient, acceptable and useful assessment tool for evaluating practical skills of the students. Such a promising feedback opens the ways for newer innovative modifications in the conventional teaching and evaluating medical education systems. The aim is to groom the medical education system into a more objective and student friendly system.

361-364

Authors: Chaithra R. Jadhav, Banushree C Srinivasamurthy, Keerti Priya SB, Vinita Agrawal, Bharathi KV.

Introduction: Breast cancer is a public health problem worldwide. Breast cancer can be prevented through inexpensive behavioral change. At the same time, not all breast lumps are cancerous and benign breast tumors can be a major source of confusion among young women. This study aimed to assess the level of awareness and risk reduction knowledge about breast tumors and whether the participants are aware about breast self examination (BSE). Materials and Method: A community-based cross-sectional descriptive study involving data from 400 female college students aged above 18 years. The data was collected using a structured and validated questionnaire. The data entry was done in Microsoft excel spreadsheet and SPSS version 17 and descriptive (frequency and percentage) statistics was used for analysis. Results: The self -reported data from 400 college women was obtained with median age of 19. The knowledge about the risk factors among college going female population was low. 42.5% participants knew that breast lump is the most common presentation. 65.75% of participants were aware of breast self examination. Only11% of 65.75% practiced self breast examination regularly. Remaining 89% didn’t know how to practice BSE. Conclusion: This study included college population, yet showed a tremendous lack of knowledge about breast cancer, which shows the ineffectiveness of the breast cancer awareness initiatives in this region. This study highlights the need to formulate awareness programmes and health education to provide breast cancer prevention education targeting college women.

368-371

Authors: Ranjan Agrawal, Mithila Bisht, Nitesh Mohan, Parbodh Kumar.

Peripheral nerve sheath tumors include a spectrum of diseases ranging from benign to malignant entities. They include schwannoma, neurofibroma, malignant peripheral nerve sheath tumors, neurothekeoma, perineurioma, granular cell tumour, mucosal neuroma, and palisaded encapsulated neuroma. Schwannoma is a slow growing tumour derived from the neuroectoderm originating from the Schwann cells of the peripheral neural sheath, most commonly involving the VIII cranial nerve. Other sites in the body can also be affected. Neurofibroma is also a slow-growing tumour and can involve multiple sites. It can have a genetic predisposition. Definitive diagnosis requires histopathological confirmation. Immunohistochemical marker S-100 is confirms the diagnosis.

376-379

Authors: C. Nalinimohan, E. Jayashankar, Ashok Kumar D.

Introduction: Computed tomography (CT) guided Fine needle aspiration cytology (FNAC) is a simple, safer, and rapid technique. CT guidance can assist FNAC from any part of thorax without any major complications. FNAC helps distinguish between benign and malignant lesions and also effectively aids in morphological typing of lung cancer, thereby reducing the delay in initiation of specific therapy like chemotherapy or surgery. Materials and Method: One hundred and twenty three cases of lung mass lesions were evaluated with CT guided FNAC. Smears were stained with May-Grunwald Giemsa and Hemotoxylin & Eosin (H & E) stain for rapid cytopathological evaluation of the lesions. Results: Out of 123 cases included in the study, 90 cases (73.17%) were male and 33 (26.83%) were female. The mean age in malignant cases was 60.3 years whereas it was 50 years in benign lesions. Cytological examination showed that 109 cases were malignant and 14 cases were benign lesions. Cytomorphological diagnosis revealed maximum number of cases belonged to adenocarcinoma (60.9%). Rest of the cases were Squamous cell carcinoma (16.2%), Non-specific inflammation (4.8%), Granulomatous inflammation (3.2%), metastatic deposits (3.2%) and spindle cell neoplasm (1%). Only ten cases could be followed up for histopathological evaluation. All the cases confirmed the primary diagnosis of malignancy on histopathological examination. Conclusion: CT guided FNAC is a simple, and reliable for the diagnosis and sub typing of lung cancer, thereby reducing the delay in initiation of specific therapy like chemotherapy or surgery.

385-390

Authors: G. Barathi, Leena D. Joseph, S. Rajendiran, Suresh Varadarajan.

Objectives: Targeted therapy is now available for various carcinomas with growth factor receptor mutations. C-Kit, a tyrosine kinase receptor is overexpressed in many epithelial malignancies. The aim of this study is to determine the role of c-Kit (CD117) expression by Immunohistochemistry (IHC) in colorectal carcinoma (CRC) and to correlate the same with tumor grade, stage, nodal status and metastasis. Methods: This is a retrospective study conducted on paraffin blocks of histopathology proven CRC. Monoclonal antibody detected against c-kit antigen was observed in the cytoplasm and epithelial membrane of the tumour cells and c-Kit expression was given a score based on staining intensity and percentage of cells showing positivity. A statistical analysis using chi square test was performed to find any difference between the various tumor grade, stage, nodal status and metastasis with respect to their c-kit expression by IHC. Results: c-Kit was negative in 55% of the cases and out of 45% positive cases 3+ positivity was noted in 5% of the cases only. 2+ positivity was seen in 9% and 1+ in 31%. Statistical data showed a p-value of 0.96, 0.70, 0.48 and 0.68 for grade, stage, nodal status and metastasis of the tumor with respect to c-kit expression respectively. Conclusion: C-kit expression by IHC has only a limited role and is statistically not significant as a prognostic or theranostic marker in CRC. Molecular analysis of the tyrosine kinase receptor mutation is needed to determine its aberrant expression.

396-399

Authors: Mallikarjun A. Pattanashetti, Ganga S. Pilli.

Introduction: Thalassemia major is most common monogenic disorder in the world. Around 1,00,000 children are born each year with the severe b homozygous state of the disease in India. The objectives of this study was to assess clinical data and novel transfusion parameters of Thalassemia major patients attending tertiary care hospital. This was undertaken as very few studies have been done in this region of the country. Materials and Method: The study was done at a tertiary care teaching hospital from January 2014 to December 2014. 35 thalassemia major patients who received blood transfusions in the hospital were taken as inclusion. Clinical details, blood transfusion details and novel parameters of transfusion annual blood requirement and its derivatives were collected on proforma for all patients and data interpreted. Result: Males (80%) outnumbered females (20%) with male to female ratio of 4:1. Nearly half of the study population was aged between 10 to 12 years (51.43). Majority of the patients had one blood transfusion per month (91.43%) and were on chelation therapy (71.43%). Novel transfusion parameters which includes Annual blood requirement, Mean Annual pure red cell requirement, Mean Annual iron load and Mean Daily iron loading were calculated for each patient. Conclusion: The present study describes the novel transfusion parameters in blood bank for thalassemia major patients attending the tertiary care hospital and emphasizes on maintenance of transfusion record of thalassemia major patients for better management of these patients.

404-407

Authors: Preethamol S, Prasanth PS.

Pancreatic malignancy is the second leading cause of digestive cancer related death after colon cancer. Pancreatic neoplasms can be divided into Ductal adenocarcinoma, neuroendocrine tumors and cystic neoplasms. Our objective was to study the unususal lesions of pancreas with immunohistochemical expression. From this we reached a conclusion that the variants of pancreatic neoplasms are rare and high index of suspicion, careful search for characteristic histological features and supportive immunohistochemical studies are required for correct diagnosis and appropriate treatment.

413-417

Authors: Suresh Durai, Johnsy Merla, Muthuselvi, Shantaraman.

Introduction: The aim of the study was to minimize formalin exposure in histopathology laboratory and analyze the fixation characteristics of a group of formalin containing compound fixatives with reduced concentration of formaldehyde. Materials and Method: A minimal formalin containing fixative was prepared with varying concentrations of formalin, ethanol, glycerin and hypotonic saline. The pH of the fixative was maintained below 7.2 to 7.4. Multiple human tissue materials of varying sites, organs, and lesions were utilized. Tissue slices were immediately fixed in the prepared compound fixative. A comparative analysis of fixation and staining qualities were done. Result: There is no significant difference between 10% NBF and new fixative at 8 and 10 hours fixation and the new fixative is comparable to 10% NBF in preserving cytoarchitectural features at 8 and 10 hours of fixation. A total of 32 out of 35 cases had a maximum score 9 at 8 and 10 hours fixation. The formaldehyde vapor from the compound fixatives were qualitatively measured and found to be 3 times less in the laboratory atmosphere. Conclusion: The present study demonstrates that a minimal formalin containing fixative can be easily prepared in the laboratory and they are suitable for histopathological examination of routine surgical specimens. The effectiveness of this new compound fixative is comparable to conventional formalin fixation with an improved air quality of the working laboratory and considerably reduced formalin vapor density.

422-425

Authors: E. Jaya Shankar, C. Nalini Mohan, T. Sujatha, G. Satyanarayana, AK Deshpande.

Introduction: Solid-pseudo papillary tumor (SPPT) of the pancreas is a very rare tumor and very few case studies has been published from India. Aims and Objectives: To evaluate the clinical presentations SPPT of pancreas and to discuss the treatment, radiological, histopathological and immunohistochemical (IHC) findings with cytogenetic work up and subsequent follow up of the patients. Materials and Method: We retrospectively reviewed the six patients with SPPT managed in our hospital between 2008 to 2016. All the six cases were noted in females and their age ranges from 15 to 25 years. The clinical diagnosis were confirmed with ultrasound and computerized tomography. Distal Pancreatectomy along with splenectomy in two cases and Whipple’s procedure was performed in other four cases. Cytogenetic workup was done in two cases. Results: The tumors were large, well encapsulated with mean diameter of 7 cm’s, had solid and cystic areas and were distributed in head, body and tail of pancreas. IHC findings revealed tumors, positive for neuron specific enolase, cytokeratin, progesterone, vimentin and focal positivity for chromogranin, and synaptophysin. The follow up of the patient revealed pseudo cyst of pancreas in one case. Cytogenetic work up revealed derivatives of 17th, 13th, 9th chromosomes. Conclusion: SPPT is a rare tumor with good prognosis after surgical resection.

430-433

Authors: Harish SG, Vinit Anand.

India is a country where chewing pan, beetle-areca with lime is common among all age group. External and local irritation of buccal mucosa is associated with high risk of cancer. It may begin as a local lesion or by metastasis or by local extension from neighbor structure. Biopsy and histopathology is definitive tool for diagnosing such lesions. The present study is a retrospective study done involving patients of three years in a tertiary referral hospital in Tumakuru. The objective of the study is to know the prevalence, type of cancer affecting the individuals. A total of 168 oral cancer patients were observed during the study, showed increased risk in males. Peak incidence was seen in individuals belonging to 35-55 year age group. Most common site of lesion was buccal mucosa followed by tongue. Most common type of cancer was squamous cell carcinoma followed by basal cell carcinoma and other minor types.

442-445

Authors: J. Kolsamma Nasrin, V. Aruna Padmavathi, Balamurugan M., CP Luck, Revathy S.

Introduction: Microcytic anemia in chronic disease patients, the commonest differential diagnosis are anemia of chronic disease (ACD) and iron deficiency anemia (IDA). Routine serum markers for body iron store are influenced by inflammatory mediators. Hence, STfr levels were used to identify the body iron status in chronic disease patients. Material and Method: We have included 40 IDA in group A and 60 chronic patients in group B. Group B further sub grouped based on serum ferritin values, serum ferritin >200µg/L as group B1 and serum ferritin between 30-200µg/L as group B2. Serum STfr and serum ferritin levels were measured and compared among groups. Results: In our study, mean STfr values of group A, B1 and B2 patients were 8.305, 2.660 and 5.927 respectively (normal range 5.0+1.0µg/L). Mean serum ferritin values of three groups A, B1and B2 3.86, 562.30 and 58.20 respectively (normal range 30-200µg/L). Comparing between three groups showed statistical significance. Conclusion: STfr levels were elevated in IDA and not affected in ACD group. In iron deficient group of chronic disease patients when serum ferritin levels did not confer the iron status of the body, STfr levels were elevated. In our study STfr correlated to iron status of the body. Suggesting STfr levels can be a valuable marker in ACD.

450-453

Authors: Ranjana Hawaldar, Sadhna Sodani, Ekta Patidar.

Introduction: Almost 80% of the ovarian neoplasms are benign and it is also a common site for primary malignancy, although metastasis to ovaries can also occur. Benign ovarian neoplasms are common in 20-45 years age group. Nulliparity, family history of cancer and genetic mutations are some of the risk factors associated with the development of ovarian neoplasms. Sex cord stromal tumours(SCST) are almost always unilateral while metastatic tumours tend to be bilateral. Most of the benign surface epithelial tumours are cystic while solid tumours with papillary projections seen on gross examination make a diagnosis of malignancy likely. However, microscopic features exhibited by these tumours help in making an accurate diagnosis. Objective: The present two year retrospective study was carried out in the histopathology department of our diagnostic centre from January 2015 to December 2016 to analyse the frequency and histopathological spectrum of ovarian tumours in our setting. Materials and Method: This was a two year retrospective study carried out between January 2015 to December 2016.A total of 146 cases of ovarian specimens were received in formalin in the histopatholgy department .The gross findings were noted and the sections were subjected to paraffin embedding and Hand E staining using standard protocols. The tumours were classified as surface epithelial tumours(SET), sex cord stromal tumours (SST) and germ cell tumours(GCT). The data so obtained was analysed for frequency of these tumours in different age groups. Results: Of the 119 ovarian tumors, 109(91.5%) were benign and 10(8.5%) were malignant. Surface epithelial tumors were most common i.e., 83/ 119(69.7%) followed by germ cell tumors which were 29 out of 119(24.4%), while sex cord stromal tumour were 7 / 119(5.4%). Out of all ovarian neoplasms, serous surface epithelial tumors were the most commonly occurring tumour followed by mature cystic teratomas. Conclusion: Benign ovarian tumours are far more common than their malignant counterparts with surface epithelial tumours being the commonest followed by germ cell tumours, majority presenting in 31-40 years age group. A proper histological diagnosis provides help to the gynaecologist in initiating proper and timely treatment.

458-461

Authors: Shalija Kotwal, Vivek Gandotra, Deepti Gupta, Jyotsna Suri.

Introduction: Due to rapid development and fatal prognosis, esophageal cancer is one of the most serious gastrointestinal cancer worldwide. Esophageal cancer incidence and histological type is extremely variable based upon geographic location, ehinicity and gender. Aim: To study the characteristics of esophageal cancer with respect to the clinical features, age, sex, histopathologic subtypes, location of tumor, in this region. Materials and Method: This retrospective study was done for a period of 5 years in the Department of Pathology GMC Jammu. Data regarding clinical features, age, sex, tumor location and histopathological diagnosis was retrieved from the request forms of the Departments of Pathology. Slides and blocks were taken from the archives of the Department of Pathology. All the slides were re-evaluated. Results: A total of 53 cases of esophageal carcinoma were identified in this study. The youngest patient was 28 years old and oldest patient was 82 years old. Male: female ratio was 1.9:1. Most patients 94% present with progressive dysphagia and weight loss while others 6% had history of chronic reflux disease. Among 53 cases, 21 specimens of esophagectomy and esophagogastrectomy were received while 32 samples were from endoscopic biopsy. Squamous cell carcinoma (SCC) was diagnosed in 47 patients while adenocarcinoma (ADC) was reported in 6 cases. Features like tumor site, tumor size, gross appearance of the tumor, histopathologic type, histopathologic grade, pTNM staging were noted. Most commonly involved site was middle esophagus (n=17) followed by proximal esophagus (n= 9) and lower esophagus (n= 6). The ratio of adenocarcinoma to SCC was 3:1 in the lower esophagus, 1:16 in the mid-esophagus and 0:1 in the upper esophagus. Among SCC cases, well differentiated tumors accounts for 41.5% of cases and moderately differentiated were 30.1%. In ADC group majority of the tumors were well differentiated (3.8%) while moderately differentiated were 7.5%. The highest TNM stage grouping recorded in resected specimens was pT3N1M0 Stage ΙΙΙa. Conclusion: Majority of esophageal carcinomas are of squamous cell carcinoma type, found mostly in middle and upper esophagus and there is increasing trend in incidence of adenocarcinoma of lower end of esophagus due to high prevalence of gastro esophageal reflux disease.

465-467

Authors: Geeta W. Mukhiya, Gulshan K. Mukhiya, KK Bansal.

Introduction: The subject of tumours of the nervous system is often looked upon with apprehension by medical practitioners as central nervous system tumours constitute 1-2% of all the neoplasms. Gliomas constitute 38.7% of CNS tumours in which high grade gliomas are 59.5% of patients with systemic malignancies develop brain metastasis during their disease. Glial fibrillary protein is the most frequently used marker in diagnostic neuro-oncology. Positive reaction to GFAP has been demonstrated in astrocytomas, ependymoma and astrocytic cells of mixed gliomas, subependymal giant cell astrocytoma, pleomorphic xanthoastrocytoma, astroblastoma and gliosarcoma. Aim of the study: In the present study the main aim is to differentiate glial tumours from other lesions by morphology and confirmation by using Glial Fibrillary Acidic Protein (GFAP) immunostaining. Results: In the present study glial tumors formed the largest group of cases (44 cases; 41.9%) diagnosed on cytology. They were further divided into low grade and high grade glioma / astrocytoma (33 cases, 31.4%), oligodendroglioma (1 case, 0.95%) and ependymoma (7 cases, 6.6%) based on cytological features. Subsequently, as shown in table IX, the cytohistopathological correlation for glioma / astrocytoma was 91.6%. There were 10 cases which turned out to be oligodendroglioma (4 cases, 11.1%), ependymoma (4 cases, 11.1%) and ganglioglioma (2 cases, 6.0%).

473-475

Authors: Nidhi Mahajan, Isha Gupta, Anshul Sharma, Kanav Gupta.

Anaplastic large cell lymphoma is defined by a proliferation of large pleomorphic blasts and a constant expression of the CD30 molecule on all neoplastic cells, and has been clinically subdivided into a primary form and a secondary form. We are presenting a case of 54 year old male with multiple nodular lesions and a small non healing ulcer on it over left thigh along with inguinal lymphadenopathy since 3 months. Clinically the patient was diagnosed as Squamous Cell Carcinoma. FNAC from the lymphnode was done and cytodiagnosis of poorly differentiated malignancy was given. However due to presence of few atypical cell, FNAC was done from skin nodule and diagnosis was given as poorly differented malignancy suspicious of anaplastic large cell lymphoma. Confirmation was done by skin biopsy and immunochemistry, tumor cells were positive for CD30,CD 3(focal) and Granzyme B.

479-481

Authors: Aarti Gogia, Mohammad Jaseem Hassan, Sabina Khan, Zeeba Shamim Jairajpuri, Sujata Jetley

Bladder cancer is the most common malignancy of urinary tract. Urothelial carcinoma accounts for 90-95% of bladder cancers and rest 5-10% includes other epithelial and mesenchymal tumors. Squamous cell carcinoma is a very uncommon malignancy of urinary bladder and accounts for only 1-3% of all bladder cancers. Squamous cell carcinoma can be classified as bilharzial and non bilharzial associated depending on epidemiology, pathogenesis, and clinicopathological characteristics. Here we present two cases of non bilharzial Squamous cell carcinoma in 73 years and 85 years old male patients who presented with decreased frequency and pain during micturition and painless Hematuria respectively. On computed tomography bladder wall thickening was reported in both the cases. Transurethral resection of bladder tumour was done and histopathological evaluation confirms the diagnosis of well differentiated Squamous cell carcinoma in both the cases with muscle invasion in the second case. Both the patients are on regular follow up and doing fine for last six months and four months respectively

. 293-296

Authors: Venkatraman J., K. Bhavani, Jeevitha.

Introduction: Transfusion of blood and its components is a life-saving procedure as even a unit of blood can save a patient in need. Though it is said to be a safe procedure as the blood is tested and processed before its use, risk of transmission of infections like HIV, syphilis, hepatitis B, hepatitis C and malaria are still seen. The present study was done to find out the sero-prevalence of Transfusion transmitted infections among blood donors in one of the tertiary health center in south India. Materials and Method: A retrospective study was conducted from January 2012 to May 2016 in a blood bank of a tertiary care hospital in Puducherry. A total of 8959 blood units which were collected from both voluntary and replacement donors during the study period were included. Complete donor’s demography and screening status for TTI’s were analysed. Results: Present study included a total cases of 8959 blood donors during study period. Out of these, 258(2.87%) were positive for TTIs. Higher seroprevalence of TTI’s were noted in replacement donors and younger age group between 18 to 30 years. Conclusion: Following strict donor criteria, adopting sensitive and advanced screening techniques for TTI’s and conducting various awareness programs, it is possible to bring down the sero-positivity of transfusion transmitted infections.

166-173

Authors: Tanvi Monga, Amarjit Singh Kuka, Navtej Singh.

Malignancy is a major cause of childhood death in developed world and in developing countries like India, paediatric tumours are on the rise. Appropriate management of paediatric tumours requires epidemiological data in different geographical areas. Present study was conducted to classify and find out the histopathological profile of solid tumours of childhood and infancy in 15 years from January 1999 to December 2013. In our study of 168 paediatric tumours, 108 (64.29%) were benign, and 60 (35.71%) were malignant. Maximum incidence of paediatric tumours was seen in the age group of 11-14 years (41.67%) and least in the age group of <1 year (10.71%), with male to female ratio of 1. Amongst the benign tumours, soft tissue tumours were most common (56.48%), with highest incidence of vascular tumours (57.36%). Amongst the malignant tumours, most common were Lymphomas (36.67%) and amongst lymphomas, Hodgkin’s lymphomas were more common (63.64%) than non- Hodgkin’s lymphoma (36.36%).

179-182

Authors: Ankur N. Sarvaiya, Sanjay C. Chauhan.

Background: Hepatitis C has a worldwide prevalence. Various risk factors are blood transfusion, intravenous drug use, chronic hemodialysis etc. Aim: To study the seroprevalence of hepatitis c virus in blood donors, and seropositivity in different high risk population subjects. Compare our results with previous published studies. Materials and Method: Serum of total 1658 subjects were tested with microwell enzyme immunoassay method for detection of antibodies to hepatitis c virus, out of them 1408 were blood donors and 250 were high risk population subjects. Results: Of 1408 normal healthy blood donors, 3 were found seropositive post blood donation. In Comparison, 15 were seropositive for anti-hepatitis c virus antibody (6%) in 250 high risk population subjects. Conclusion: Hepatitis C is currently an emerging disease with years of chronic infection in patients. There is no vaccine for hepatitis C, therefore prevention of HCV infection depends upon reducing the risk of exposure to the virus in health-care settings and in higher risk populations, for example, people who inject drugs, and through sexual contact.

188-192

Authors: Deepa Hatwal, Arvind Kumar, Neha Batra.

Background: Abdominal tuberculosis has become one of the leading cause of morbidity and mortality. It can involve any part of gastrointestinal tract. It is a major public health problem in developing countries. Abdominal tuberculosis still presents a diagnostic challenge as clinical symptoms are nonspecific and mimic various gastrointestinal disorders. Aim: To analyse role of various clinical, histopathological and microbiological findings in confirming the diagnosis of abdominal tuberculosis. Materials and Method: A retrospective study was carried out in a tertiary teaching hospital in Uttarakhand and all cases diagnosed as abdominal tuberculosis were included in the study. All relevant data were collected from medical records. Histopathological examination along with Ziehl-Neelsen staining was done in all the cases to detect acid fast bacilli. Results: Out of the 68 cases of abdominal tuberculosis, intestinal tuberculosis had highest incidence of 45.59%, out of which ileum was the most frequent site .This was followed by peritoneal tuberculosis (33.82%) and nodal tuberculosis (14.71%). Stricture was seen in 41.18% cases. It was seen that in intestinal tuberculosis caseating granuloma had 29.03% positivity for acid fast bacilli while non-caseating had a positivity of 12.90%. In lymph node tuberculosis acid fast positivity was 40% in caseating and 10% in non-caseating granuloma. Adenosine deaminase (ADA) level was raised in 100% cases of ascitic type peritoneal tuberculosis. Majority of the patients were in the age group of 21 to 40 years. Abdominal pain was the most common symptom observed in all cases (100%) of abdominal tuberculosis. Conclusion: Significant variations are seen in the clinical presentation of abdominal tuberculosis. Symptoms are non-specific and diagnostic criterias are limited. Advanced tests are required to diagnose the disease accurately. However, in a low resource setting tissue biopsy is the ultimate tool for diagnosis of abdominal tuberculosis.

199-202

Authors: Shobha SN, Rajashekar YR.

Introduction: Aspiration of serous cavities is a simple and relatively noninvasive technique to achieve the diagnosis of cause of pleural effusion. Cytological examination of pleural fluid obtained by tapping is a simple, inexpensive, diagnostic modality of the cause of pleural effusion and further helps in treatment and follow up of the patients. Not only the infective causes, it also helps in cancer patients either primary or metastatic effusions both in diagnosis and management. Materials and Method: This study on pleural fluid cytology was done on 100 cases in Adichunchanagiri Institute of Medical Sciences B G Nagar for a period of 2 years. Relevant and available clinical information regarding age, sex, symptoms and accompanying signs were obtained from the patients. Pleural fluid was analysed for gross appearances and cytological analysis for cell count, cell type and malignant cells. Results: 100 samples of pleural fluid were received. Incidence of pleural effusion was more in males compared to females with a male to female ratio of 1.6:1. In the benign effusions, various clinical conditions noted were Pulmonary tuberculosis, Pneumonia, and anemia with hypoproteinemia, CCF, and Pulmonary infarction. Exudative effusions were more (84%) compared to transudative effusions (16%). Out of 100 samples received clinical diagnosis of malignant effusions was made in 10 cases and 3 cases which were diagnosed as tuberculous effusion turned out to be malignant effusion by cytology. Conclusion: Pleural fluid cytology is one of the easy, inexpensive mode of diagnosis for the cause of pleural effusion, which also helps in the treatment and management of patients. It can be done in any rural set up with basic facilities where sophisticated techniques are not available.

207-212

Authors: Hemavathi Reddy, Anirudha V. Kushtagi.

Background: Platelet transfusion is one of the most crucial therapeutic approaches in Medicine. In addition to their important function in hemostasis, platelet’s role in inflammation has become more evident. Also they have severe and fatal adverse reactions also. Aim: The aim of the study was to determine the number of platelet transfusions that was done during the study period, to study the indications for the transfusions and evaluate its efficacy. Materials and Method: A total of 138 thrombocytopenic patients who received platelet transfusions were evaluated during a one-year study period from Jan 2015 to Dec 2015 at KIMS Koppal, General hospital with attached blood bank. Conditions associated with the thrombocytopenia were studied and categorized. Pre and post-transfusion platelet counts were done and 24-hour corrected count increment (CCI) was calculated to check the efficacy of transfusion. Results: Majority of the platelet recipients were transfused prophylactically when their platelet counts were >20000/μL. The most common category of diagnosis among these patients was infectious diseases. Conclusion: Appropriate component therapy should be actively endorsed as it ensures optimum utilization of a scarce resource in a populous country like India. Platelet transfusion must be guided by population of patients under consideration, the clinical conditions of the patients and perhaps even the resources of the transfusing facility and its ability to respond rapidly to patients transfusion needs.

218-220

Authors: Mamatha K., Arakeri SU.

Introduction: Lymphadenopathy is the commonest clinical presentation encountered in outpatient as well as in inpatient departments, irrespective of age.(1) It is one of the common clinical presentation in both benign and malignant diseases.(2) Differential diagnoses include reactive hyperplasia/inflammatory conditions, granulomatous disorders and malignancy. Cervical group of lymph nodes are easily accessible for FNAC. Because of the accessibility cervical group of lymph nodes are more commonly subjected for FNAC.(6) Hence cytological study of these lymphnodes is very important first line of investigation in distinguishing between reactive hyperplasia and malignancy. Methods and Material: Patients presented with palpable cervical lymphadenopathy referred for cytological evaluation were included. Thorough examination of the patients was done and also detailed clinical history was taken. Standard FNAC procedure was performed; multiple smears were prepared and analyzed. Results: Total number of cases was 220. Out of which, 162 cases were benign/ infectious and 58 were malignant. Most of the cases were in the age group of 20-39years (32.7%)Reactive lymphadenitis was the commonest diagnosis on cytology constituting to 41.4% followed by malignant cases (26.3 %), granulomatous lymphadenitis (17.7%), suppurative lymphadenitis (10%) and necrotizing lymphadenitis (3.6%). Out of total 58 malignant cases, 51 (87.9%) cases were metastatic lesions, 4 cases were lymphoma and in 3 cases differential diagnosis of lymphoma/ metastatic poorly differentiated carcinoma was considered. Squamous cell carcinoma (67.2%) was the most common morphological type diagnosed on cytology in metastatic lymph nodes, followed by adenocarcinoma. Conclusion: FNAC is a cost effective, quick and reliable, simple tool in diagnosing patients presenting with cervical lymphadenopathy. FNAC serves as a rapid tool for the diagnosis of common and treatable causes of cervical lymphadenopathy. It is also a good sensitive first line method in patients with suspected malignant cervical lymphadenopathy.

227-231

Authors: Priyadarshini Devendrappa, Harish Sadula Govinda Reddy.

Introduction: Hashimoto's thyroiditis is recognized as the next most common thyroid lesion after goiter, diagnosed on fine needle aspiration cytology. It is also considered as the foremost cause of hypothyroidism. Fine needle aspiration cytology is notably perceptive in diagnosing Hashimoto’s thyroiditis with a striking diagnostic preciseness. Our analysis is to scrutinize the cytomorphological diversity of Hashimoto’s thyroiditis. Materials and Method: This study includes 56 patients presented with a solitary thyroid nodule and few cases with diffuse thyroid enlargement and those cases, with cytomorphological features favoring Hashimoto’s thyroiditis. Few cases were confirmed by histopathology following surgery and reported as Hashimoto's thyroiditis and immunological results were correlated whenever available. Results: The majority of the patients in our study were females in their middle age group. In the present study lymphoid aggregates, lymphocytic infiltration amidst follicular epithelial cells and Hurthle cell change were the main highlights along with other cells like eosinophils, epithelioid cells, Plasma cells and multinucleated giant cells seen in few cases. The antibody profile was available in only 60% of the cases of which 72.72% showed evidence of raised anti-thyroid peroxidase antibody titers. The histopathological correlation was obtained only 12.5% cases. Conclusion: Hashimoto’s thyroiditis is considered a disease of middle age with female predominance, clinical history and immunological profile alone is not sufficient in diagnosing Hashimoto’s thyroiditis. FNAC plays a symbolic portrayal in the diagnosis of thyroid lesions due to its ease and reasonable price. It can precisely diagnose Hashimoto's thyroiditis in utmost patients.

237-241

Authors: Ruchi Sinha, Hema Kini, Radha R. Pai, Kaushalya K. Sahu, Aarthi Rau.

Introduction: Fibroadenoma and phyllodes tumor are fibroepithelial neoplasms of the breast composed of proliferating mammary epithelial and stromal tissues.It is very rare for infiltrating ductal carcinoma to arise within or be associated with a phyllodes tumor or a fibroadenoma. Methods and Material: Over a period of ten years, all the breast carcinoma cases from the departmental archives were reviewed. Results: Nine cases of synchronous fibroepithelial tumors with infiltrating carcinoma of the ipsilateral breast were reported. In four cases, the carcinoma was seen infiltrating the benign tumor- one a phyllodes tumor and the other three fibroadenomas. In rest of the five cases the tumors were independent of each other. Conclusion: The occurrence of a carcinoma in a fibroepithelial neoplasm, however rare, necessiciates a thorough histopathological examination of all breast lumps.

247-253

Authors: Madhu Chaturvedi, Sangita Margam, Shweta Azad.

Background: Abnormal uterine bleeding (AUB) is one of the most common debilitating menstrual problems and has remained one of the most frequent indications for hysterectomy in developing countries. The problem is common worldwide but causes may vary from one region to another. In about 25% of the patients, the abnormal uterine bleeding is the result of a well-defined organic abnormality. Materials and Method: It was a five year study conducted at a tertiary care hospital, Mumbai. Total of 804 Women who underwent surgical resections and biopsies with complaints of AUB were included in the study and histopathological spectrum of structural pathology was determined. Results: Most common age group affected was 36-45 years. Uterine corpus was common site of pathology (80.2%), followed by cervix (17.4%) Isolated pathology was found in 88.9% cases while multiple pathology in 10.1% cases. Benign pathology formed largest group (82.34%), commonest being leiomyoma (71.6%). Malignancy seen in 14.8% cases, most common malignancy being squamous cell carcinoma (72.72%). Menorrhagia was commonest presentation (64.6%), followed by postmenopausal bleeding (20%) & polymenorrhagia (14.6%). In postmenopausal age group, malignancy was (46.3%) more as compared to age <40 years (8.7%). Rare cases presenting as AUB were encountered viz. serous cystadenoma, mature cystic teratoma and serous cystadenocarcinoma of ovary, malignant mixed mullerian tumor of uterus, metastasis to uterine corpus, and small round cell tumor of cervix. Conclusion: Frequency of benign endometrial pathology as underlying organic cause of AUB is quite high. However, histopathological spectrum in patients with AUB is quite variable with respect to age with increased chances of detecting malignancy in elder females. Therefore Histopathological examination of endometrium should be done generously in women presenting with abnormal uterine bleeding especially after the age of 40 years to rule out malignancy.

260-262

Authors: Shwetha J.H., Ashoka A., Shashikala P..

Introduction: Anemia can negatively affect cognitive development, school performance, physical growth and immunity of the children if not treated during infancy. Objectives: To determine the pattern of anemia among 6 months – 12 months infants. Materials and Method: This prospective hospital based study was conducted for a year among the infants aged 6-12months admitted to tertiary care hospital in Davangere. All those who were hospitalized for any other illness but found to have anemia on routine blood investigations were included and complete haemogram was done to determine the type of anemia. Data was entered in excel sheet and analyzed using SPSS- 20 software. Results: In the present study, 211 infants were anemic, mean age was 8.6 ± 2.4months, majority were females (56.9%), more than half of them had presented with respiratory tract infections and acute gastroenteritis (64%). Mean hemoglobin was 8.54±1.09g/dl. Majority of them had moderate anemia (83%) and microcytic hypochromic anemia was the most common presentation (45%). Conclusion: To conclude, the Prevalence of anemia was 66% in the present study with microcytic hypochromic anemia being the major cause (44.8%) suggesting iron deficiency as the major culprit for nutritional anemia seen in infants.

266-272

Authors: M. Sridevi, P. Karkuzhali.

Introduction: Testicular Fine needle aspiration cytology (FNAC) is Simple and minimally traumatic procedure with less number of complications at the same time more sites could be aspirated safely. As well as FNAC could give better morphological details of different stages of spermatogenesis. Materials and Method: This study was done in 36 infertile men for a one year period to evaluate the cytological features of testicular FNAC and correlate with histological diagnosis, and to correlate various cell indices in different categories of cytological diagnosis. Results: In the present study, in Cytology, the common diagnosis was found to be Maturation arrest with a corresponding Johnson’s score of 3 to 7 was found to be the most frequent cause of male infertility. The correlation between the FNAC and biopsy was 91.9%. Sertoli cell index was found to be increased in hypospermatogenesis. Conclusion: The overall accuracy of FNAC in this study was found to be 86% and well correlated with histological diagnosis. Hence testicular FNAC can be used for the diagnosis of male infertility.

278-281

Authors: Suba G., Jayaprakash H.T., Shradha A..

Background: Lymphnode is one of the commonest site for neoplastic and non-neoplastic diseases. This study was undertaken to analyse the patterns of lesions seen in peripheral lymphadenopathy cases. Materials and Method: This retrospective study of 103 cases of lymphnode biopsies was carried out in the department of pathology for a period of 3 years. Relevant patient data were retrieved from the file. Slides were reviewed thoroughly and special stains were applied wherever necessary. Results: Out of 103 cases, 88 (85.4%) were non-neoplastic lesions and 15 (14.6%) were neoplastic lesions. The most commonly biopsied group was cervical nodes. Tuberculosis was the most common condition 44 cases (42.7%) followed by reactive hyperplasia 41 cases (39.8%). Of the 15 cases (14.6%) of malignancy, 10 (9.7%) were metastatic deposits and 5 (4.9%) were lymphomas. Conclusion: Tuberculosis is the leading cause of lymphadenopathy and young females are commonly affected. Histopathology is the gold standard in confirming the diagnosis of lymphnode lesions.

297-300

Authors: Vikram Narang, Amit Dhiman, Bhavna Garg, Neena Sood, Harsimran Kaur.

Acute leukemia is a heterogenous group of disorders, require multidiscplinary approach for diagnosis and prognostication. Immmunophenotyping has emerged as important tool in diagnosis of hematolymphoid malignancies. Since, Punjab is emerging as cancer capital of India, with leukemia cases on the rise. The diagnostic modalities like flow cytometry need to be popularized and more medical fraternity is required to be familiar with this technique. Therefore we hereby present study from the state of Punjab focussing on leukemia patterns diagnosed by flow cytometry.

308-312

Authors: Vandana Patel, Piyush Solanki, Harshid Patel.

Introduction: Cervical cancer is one of the most common cancers in women worldwide. In India, cervical cancer is the most common woman-related cancer, followed by breast cancer. 80% of the new cervical cancer cases occur in developing countries, like India, which reports approximately one fourth of the world's cases of cervical cancer each year. Objective: The primary objective is to find out the prevalence of awareness amongst women living in rural and urban areas, about the utility of PAP smear in early diagnosis of cervical cancer. Materials and Method: This cross sectional study includes 200 women attending the OPD of Gynecology Department of Government Medical College, Bhavnagar Gujarat from April 2015 to May 2016 of age group of 15 to 60 yrs. Among them 100 women were from rural area and 100 were from urban area. Written consent was taken from each participant, after explaining the aims and objectives of the study. Data was collected using a questionnaire including demographic characteristics, knowledge about cervical cancer and knowledge about PAP smear screening and completed by an interview with these participants. Result: This study has shown that women in our region lack knowledge of cervical cancer and its prevention by early detection by Pap smear both in the rural as well as the urban areas. This study clearly conveys the message that the rural women's educational status need to be strengthened at all levels. Conclusion: In conclusion, our results show that there was inadequate knowledge and practice among certain women groups, especially those above 30 years old, married at young age, and those with low education level. Some women also had a positive attitude, although they needed to have reassurances that could reduce the barriers. A well-organized cervical cancer screening programme providing the Pap-smear test through primary health care services is recommended: this should include raising awareness of women regarding risk factors, and overcoming barriers to having the test such as fear and embarrassment.

318-323

Authors: Shanmuga Priya S., Rajalakshmi V., Veena Bheeman.

Introduction: Breast cancer is the most commonly occurring cancer in females and leading cause of cancer related deaths worldwide. The analysis of gene expression data have suggested that breast carcinoma can be divided into molecular subtypes which have distinct clinical features, different prognosis and clinical outcome. Claudins are members of a large family of tight junction proteins that regulate cell adhesion. Currently there are 40 claudins that are variably expressed in several cancers. Only few studies have examined their expression in breast carcinomas. Recently subtype of claudin with low expression has been described that has a prognostic and predictive indication in relation to response following neoadjuvant chemotherapy. Aim: The aim of this study was to classify breast tumors into the molecular patterns based on the expression of estrogen receptor, progesterone receptor and her-2 neu and to evaluate the expression of claudin, ki-67 and p-53 in invasive breast carcinoma. Pathological response following neoadjuvant chemotherapy was assessed in different molecular patterns of invasive breast carcinomas correlating with expression of claudins. Materials and Method: A retrospective analysis of 100 breast carcinomas immunostained with ER, PR and her-2-neu were performed and tumors were subtyped into molecular patterns. Immunostaining with ki-67 and p-53 was done in 43 cases to assess the pathological response to neoadjuvant chemotherapy. Claudin 1, 3, 4, and 7 was tested in 43 cases by RT-PCR method. Results: Of 100 cases of invasive breast carcinomas diagnosed and immunostained during the 5-year period from 2012-2016, basal-cell type accounts to 20 cases, followed by her-2 enriched type (17 cases), luminal -A (47 cases) and luminal-B (16 cases). Claudin was expressed in luminal A (44.2%), luminal B (26%), basal (16.3%) and her-2 enriched (14%) subtype. Incidence of claudin low was seen in 14% of T2-4 lesions, 7% nodal metastasis and 9.3% of high grade tumors. Pathological response was better for basal-like type when compared to other subtypes.Ki-67 expression was high among triple negative tumors when compared to non-triple negative tumors. Pathological response was good in basal-like subtype when p-53 was expressed. Conclusion: The histopathological examination of the tumor helps in assessing the response following neoadjuvant chemotherapy and can be correlated with expression of claudin, ki-67 and p-53.Claudin-low subtype can be seen in triple negative, luminal A& B and her-2 enriched type. More number of cases need to be studied in future to assess the response rate in claudin –low tumors as this has direct impact on current therapeutic strategies and follow-up is mandatory to look for recurrences.

328-332

Authors: Sanjaykumar C. Chauhan, Ankur N. Sarvaiya.

Introduction: Benign and malignant lesions of prostate are some of the commonest problem of elderly men age group. Prostate specific antigen level, histopathological examination, and digital rectal examination are considered three most important evaluation criteria. Objective: To study clinical and histopathologic spectrum of prostatic lesions and compare prostate specific antigen levels in various non-neoplastic, benign and malignant lesions of prostate. Materials and Method: Study was performed prospectively and retrospectively from January 2013 to December 2016 in the department of Pathology in the tertiary care centre in North Gujarat area over the span of 3 years. Histopathologically Gleason system scoring was analyzed. Prostate specific antigen value was noted in each case. Results: Mean age of all 140 cases was 65.5± 10.7years, of all BPH cases it was 66.07 years, and 72 years of adenocarcinoma cases. Frequency of urination was most common presenting symptom (42 cases - 30%) followed by difficulty in voiding (38 cases – 27.14%). The commonest histopathological diagnosis was benign prostatic hyperplasia - 90 cases (64.28%), next is adenocarcinoma -38 cases (27.14%). The commonest Gleason system score in prostatic adenocarcinoma cases was score 7. Benign prostatic hyperplasia and Prostate carcinoma cases had mean prostate specific antigen value of 5.05 ± 3.15 ng per ml and 59.65 ±38.65 ng per ml respectively. Conclusion: Prostate specific antigen value should be measured periodically in elderly men as a screening tool. Each higher value must be followed by histopathological evaluation of prostate biopsy for exact nature of disease confirmation.

336-338

Authors: Sunitha S., Arundhathi S., Anil Malleshi Betigeri.

Mature cystic teratoma (MCT) is commonest germ cell tumor of ovary. In 1-2% of MCTs malignant transformation is known to occur. Most of the malignancies originating from MCTs are squamous cell carcinomas and adenocarcinomas of intestinal type are exceptionally rare. Nine cases have been reported till date and we are presenting this case because of its rarity and unusual presentation. We are presenting a case of 33 year old female with abdominal mass and raised CEA and CA-125. Histopathology and immunohistochemistry confirmed the diagnosis as adenocarcinoma of intestinal type arising in mature cystic teratoma.

344-347

Authors: Purwa Patil, Varsha Bhatia, Vaishali Walke, Divyaja Sondankar.

Orbital rhabdomyosarcoma (RMS) is the most common orbital malignancy of childhood. It is a highly malignant tumour and is one of the few life threatening diseases, if its diagnosis is delayed. Among the entire group of extraconal intraorbital tumours RMS poses a significant challenge for the pathologist and oncologist in terms of its diagnosis and treatment. This case report highlights the general overview of primary orbital RMS, its histopathological and immunohistochemical features and management.

351-353

Authors: Varsha Pandey, V. Sudarshan, Shiv Chandraker, K. S. Chandrakar.

Primary angiosarcoma of the spleen is a very rare malignant neoplasm. It comprises less than 1% of all splenic sarcomas. It may present with non-traumatic spontaneous rupture of the spleen and lethal hemorrhage. It is difficult to diagnose clinically and has a variable morphological spectrum. It is a highly aggressive malignant tumor having poor prognosis. It is usually found in adults above 40 years of age. A 22 year old female presented with abdominal pain and mass of four month duration. Physical examination revealed splenomegaly and diffuse tenderness all over the abdomen. Following computed tomography scan a possible clinical diagnosis of giant cavernous hamangioma of the spleen was made. Histopathology following splenectomy revealed angiosarcoma. We report this rare case along with review of literature.

Page No. 8-11

Authors: Anushree CN, Sujatha R, Sunita Basanagouda Patil, Jaya Prakash HT

Background: Blood group system consists of antigens present on the surface of red blood cells. Up till now around 700 red cell antigens have been identified. The ABO grouping and Rhesus (Rh) typing are major systems and are inherited by means of Mendelian fashion. They are crucial for blood transfusions, parental testing and in certain forensic related medico legal cases. Also association of blood grouping systems can be attributed to gene associated studies in certain diseases among different population. The distribution pattern of ABO blood grouping systems varies among people around the world and also in different regions of same country. Aims: The study is aimed to determine the distribution pattern of the ABO grouping and Rh typing among blood donors in Dr. BR Ambedkar Medical College, Bangalore and to correlate it with the available data from studies inside India and other parts of the world. Materials and Methods: The study included blood donors in blood bank of Dr. BR Ambedkar Medical College Hospital from July 2012 to May 2016.The study was done on 1959 blood donors. ABO grouping and Rh typing was done using slide agglutination method with antisera A, B, O and Rh. Doubtful cases were reconfirmed by tube agglutination method and reverse grouping using freshly prepared pooled A and B cells. The sex incidence of ABO and Rh blood groups were stated in simple percentages. Results: Male donors were more than female donors, ratio being 77.3: 1. The most common blood group was O (38.8%) and least common being AB (5%). The distribution pattern of blood group O in our population was38.8 % (37.5% O Rh positive and 1.3% O Rh negative). The distribution pattern of blood group B in our population was 34.8% (33.9% B Rh positive and 0.9% B Rh negative) followed by blood group A which was 21.4% (21% A Rh positive and 0.4% A Rh negative) and blood group AB was 5%(4.7% AB Rh positive and 0.3% AB Rh negative) Rh positive were 97.1% and Rh negative were 2.9%. Conclusion: Knowledge of distribution pattern of the different blood groups is very crucial for blood banks and blood transfusion services which significantly contribute to the Health System of the Nation. Knowledge of blood group distribution is important for clinical studies, geographical information and for forensic studies in the general population.

Page No. 18-22

Authors: Binay Kumar, Usha Joshi, Priyansh Srivastav, Harsh Khetan

Objective: To enhance the diagnostic accuracy of papillary carcinoma thyroid by evaluating nuclear and architectural features on cytology with address about the details of cytologic pitfalls. Study Design: 14 cases of papillary carcinoma thyroid diagnosed on FNA cytology, which were confirmed on histology, during last five years, were reviewed, retrospectively, using Papanicolaou stained and May Grunwald Geimsa stained slides for following parametersArchitecture: Papillary pattern, swirling pattern, follicular pattern, sheets. Nuclear features: nuclear inclusion, nuclear grooving, and powdery chromatin. Others: metaplastic cells, chewing gum colloid, cystic macrophage, multinucleated giant cells. Result: Out of the various features evaluated the most consistent findings were papillary and swirling pattern; nuclear inclusion and nuclear grooving and metaplastic cells.In our study, on an average intranuclear grooves were present in 30-40% of the follicular epithelial cells except in one case where it was 80-90%. The average of intranuclear pseudoinclusions was 3-5% in all cases except one where it was 32%. Other findings were multinucleated giant cells, cystic macrophages, chewing gum colloid. Conclusion: Diagnosis of papillary carcinoma thyroid can be made accurately if architectural features (papillary or swirling pattern, nuclear features (nuclear inclusions and grooves) and metaplastic cells are present together in a thyroid aspirate. Among architectural features swirling pattern is consistent finding in our study which could be included among diagnostic criteria.

Page No. 27-30

Authors: Manas Madan, Manisha Sharma, Sanjay Piplani, Karamjit Singh Gill

Introduction: Hurthle cells (HC) are an enigma in thyroid lesions, from being a misnomer, their association with a variety of thyroid nodules and their unpredictable clinical behavior. These can be seen in many thyroid lesions ranging from inflammatory conditions, benign neoplasms and malignant lesions. This study was done to assess the spectrum of hurthle cell lesions of thyroid on cytology and try to establish features that can accurately differentiate between non-neoplastic and neoplastic thyroid lesions. Materials and Methods: The thyroid FNA cases done during Jan 2015- Dec 2015 were collected from the archives of pathology department. Those cases were collected for study where the cytological diagnosis of hurthle cell lesions was made. The diagnosis was divided into follicular neoplasm, hurthle cell neoplasms and thyroid lesions with hurthle cell change. Cytohistological correlation was done wherever possible. Observations & Results: 101 cases contained hurthle cells were identified and studied. The cytological diagnosis was 27 follicular neoplasms (FN) (26.7%), 04 hurthle cell neoplasms (HCN) (3.9%), 51 adenomatous goiter (50.5%) and 19 Hashimotos thyroiditis (HT) (18.8%). Of 27 FN, 22 were diagnosed as FA and 5 as FC. Of 4 HCN, 2 were diagnosed as HCA, 1 as HCC and 1 as PTC on histopathology. Conclusion: Hurthle cells can be found in a large number of thyroid lesions both neoplastic and non-neoplastic. Although no particular finding can differentiate between non-neoplastic and neoplastic hurthle cell containing lesions but certain cytological features can help to diagnose the neoplastic nature of these lesions.

Page No. 35-38

Authors: Nitika Kesarwani, Meena Harsh, Neena Chauhan

Background: Oral squamous cell carcinomas (SCC) still a significant health burden in developed and developing countries. Aims and Objectives: To study the premalignant and malignant lesions of oral cavity, to classify malignant lesions according to histomorphology and to study the expression of epidermal growth factor receptor (EGFR) in lesions. Materials and Methods: Fifty cases of SCC diagnosed by histopathology of oral cavity were studied in the Department of Pathology, Himalayan Institute of Medical Sciences, Dehradun over a period of 12 months. Semi-quantative evaluation of EGFR expression was done. All scores were based on examining the whole section in each biopsy under a multi headed microscope by three observers. Results: Out of 50 patients, 28% were in the age group of 51-60 years, there was an obvious male preponderance (92%). Majority of patients were only tobacco smokers (44%). The commonest site of oral cancers was tongue (26%). Out of total 50 cases, 37 (74%) were malignant and 13 (26%) were premalignant lesion. In present study, 48.64% of malignant and 84.61% premalignant lesion patients showed 3+ positivity of EGFR expression. Conclusion: Oral SCC was most common in male elderly patients, tongue was the most common site and moderately differentiated SCC was most common. Expression of EGFR was increased in both premalignant and malignant lesions. EGFR expression was over expressed in premalignant lesions and decreased in normal mucosa so premalignant lesions can be segregated as they are likely to progress to invasive cancer.

Page No. 45-51

Authors: Rashmi Jain, Ankit Jain

Background & Objectives: FNAC is used as a preoperative diagnostic tool to differentiate between benign and malignant salivary glands (SGs) tumors. The aim of this study was to evaluate the sensitivity, specificity and diagnostic accuracy of the FNAC for SGs lesions. Methods: FNAC was carried out in 144 patients with various SGs lesions and classified. Out of 144 cases, only 59 cases were available for histopathological examination. FNAC diagnosis was compared with the final histological diagnosis; and then sensitivity, specificity and diagnostic accuracy of the FNAC for SGs lesions were calculated. Results: Parotid gland was involved in 54.86% cases, whereas submandibular and minor SGs were involved in 40.27% and 4.86% cases respectively. Non-neoplastic lesions were found in 50.7% cases, whereas benign and malignant lesions were found in 36.8% and 12.5% cases respectively. Submandibular gland was commonly (52.05%) involved in non –neoplastic lesions whereas in benign and malignant lesions, parotid gland was involved 64.15% and 77.78% cases respectively. Chronic sialadenitis (58.9%), pleomorphic adenoma (90.56%) and mucoepidermoid carcinoma (55.55%) were most common lesions among non– neoplastic, benign and malignant lesions respectively. Sensitivity, specificity and diagnostic accuracy of FNAC for neoplastic SGs lesions were 87.50%, 97.44 % and 94.54% respectively. Interpretations & Conclusions: The high sensitivity, specificity and diagnostic accuracy of the FNAC indicates that it may serve as a good pre-operative diagnostic technique for SGs lesions. This study highlights the diagnostic value of FNAC in differentiating benign from malignant lesions which are useful in the planning of further management.

Page No. 56-62

Authors: Kavita Leeladhar Khedekar, Sangita Ramulu Margam, Nitin Maheshwar Gadgil, Gourav Sakhare

Background: Hepatic tuberculosis (TB) is an uncommon manifestation of tuberculosis. The term hepatobiliary TB refers to either isolated hepatic or hepatobiliary involvement with other organ involvement Methods: A five year autopsy study conducted of 236 adult cases of tuberculosis. Clinical details of all cases were obtained from hospital records. Sections from the liver were processed routinely and histopathological findings along with Clinical & biochemical findings were analysed in detail. Results: Commonest age group affected was 31 to 40 years of age with a male: female ratio of 1.29:1. Fever was present in (56.6%). Hepatomegaly along with abdominal pain was significantly associated with Hepatic involvement by TB. Pulmonary and extra pulmonary tuberculosis was seen in 177 and 59 cases respectively. Liver involvement was mainly secondary except in one case. The spectrum of histopathological changes of the liver showed epitheliod cell granulomas in (41.5%), fatty changes in (46.6%), inflammation in (16.5%) and fibrosis in (3.8%) cases. On comparing the liver TB and non-liver TB cases, it was found that fatty changes were more common but there was no difference in the degree of fibrosis in the two groups. Comparing liver function tests, available in 213/236 cases, 61% were abnormal. Deranged AST (65%), ALT (62.05%) & ALP (57. 05%) was seen in hepatic TB cases. Conclusion: Liver involvement was mainly in the form of secondary tuberculosis. Fever, hepatomegaly, abdominal pain, fatty change and caseating granulomas along with deranged liver enzymes are significantly associated with hepatic involvement in cases of tuberculosis.

Page No. 71-76

Authors: Shanmuga Priya S, Leena Dennis Joseph, Rajendiran S., CN Sai Shalini

Background: Papillary squamo transitional cell carcinoma (PSCC) is a distinct subcategory of squamous cell carcinoma of uterine cervix with a propensity to late metastasis and late recurrence. It is related to HPV 16 and 18 with high expression of p16. Histologically, it can be misinterpreted as transitional cell carcinoma and other papillary lesions of cervix like papilloma, verrucous carcinoma and cervical intraepithelial neoplasia grade 3 with papillary features. Aims: To study retrospectively the diagnostic utility of p16 in cervical dysplasia and papillary squamous cell carcinoma at our institution. Materials and Methods: We retrospectively reviewed all cervical lesions between 2008 and 2012. Ten cases of papillary squamous cell carcinoma were included in our study and further evaluated immunohistochemically by p16 and assessed. Results: Out of 882 cases of cervical lesions, 107 were malignant squamous cell carcinoma and 62 cases were Cervical intraepithelial neoplasia (CIN). Ten cases out of 107 malignant lesion were diagnosed as papillary squamotransitional cell carcinoma and immunostained with p16 and evaluated. Statistical significant differences between groups were found using semiquantitative scoring system. The patient ranged in age from 31 yrs to 62 yrs. Conclusion: PSCC of the uterine cervix are a clinicopathological distinct group that are potentially malignant. p16 was expressed in 71.1% of dysplasia and 100% of papillary squamous cell carcinoma.

Page No. 80-84

Authors: Shivraj Nagnath Kanthikar, Dhiraj B. Nikumbh, Nadkumar V. Dravid

Background: Central nervous system (CNS) tumor are considered as most notorious in all types of cancers. Incidence of CNS tumors in developing countries is lower as compared to developed countries, but increased rate has been observed in both. The aim of the study was to highlight the incidence and histological spectrum of CNS tumors in our region. To diagnose and classify brain tumours according to WHO 2007 classification. Material and Methods: This retrospective histopathological analysis of brain tumors was carried out in department of Pathology from January 2014 to December 2015. During this period, a total of 38 neurosurgical specimens were received in department. The specimens were processed by routine histotechniques and immunohistochemistry was performed whenever required. The diagnosed brain tumor studied and classified according to WHO classifications. Results: Among 38 cases, tumours of meningeal tissue (40%) were commonest followed by neuroepithelial tissue (34%). Cranial and spinal nerve sheath tumour (18%) and rarely metastatic tumours (5.3%) were encountered. Tumours were seen in all age groups but mean age group affected was 41-50 years accounting for 14 (36.8%) cases. Male to female ratio of 0.81:1.22 was noted with female preponderance. Conclusion: The present study helps to provide information regarding the burden of disease in our area. Despite the use of modern imaging technique that helps in provisional diagnosis of disease, histological examination is gold standard in diagnosis of varied types. Further utility of immunohistochemistry aids in confirmation and prognosis of disease.

Page No. 92-97

Authors: Rahul Mannan, Sanjay Piplani, Sonam Sharma, Mridu Manjari, Shruti Gupta

Background: Fine Needle Aspiration Cytology (FNAC) has many advantages and utilities in cervical region. Most of the studies documented in the literature regarding head and neck masses, either describe spectrum of lesions or etiological causes. The studies in the past have also tried to associate the FNAC procedure with statistic parameters such as sensitivity, specificity and predictive values / diagnostic accuracy. However, in the present study an attempt was made to correlate the etiological (diagnostic) and site-specific need of doing a FNAC procedure with epidemiological parameters such as age specific sub groups and sex parameters. Materials and Methods: 1708 cases of head and neck swellings reporting for FNAC to the Department of Pathology, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, Punjab, India over a period of three years (January 2012 - December 2014) were included in the study. The final diagnosis with other epidemiological, anatomical and clinical history was obtained from the requisition forms and the final reports filed in the archives of the department. Statistics employed included central distribution parameters such as mean, median and averages. Chi-Square (χ2) test and Fischer’s exact test were employed to analyze and investigate for significance of the cytological diagnosis with epidemiological and anatomical parameters. Results: The most common age group varied from 20-50 years with M:F ratio being 0.7:1. Overall reactive lymphadenitis and lymph nodes were the commonest cause and site for patients to undergo FNAC for swellings of head and neck region. Thyroid, skin and soft tissue lesions were the next commonest sites (36.29% and 19.33% respectively). Across the board, inflammatory pathologies were the commonest lesion reported (66.56%). Statistically it was found that there was significant difference between type of lesion according to the anatomical site (p value= 0.001) and the difference was not attributable to the more number of cases of lymph nodes itself. Statistically, for age specific rates there was a strong association between the type of lymph node lesion with the age specific sub groups (p value= 0.0005) and sex (p value= 0.012). Also noted was a strong association between the type of lymph node malignancy and the age group (p value= 0.002) Interesting point was an equal distribution of NHL over the spectrum with almost equal cases seen in children, young adults and early elderly. This again was found to be statistically significant. There was a strong association between the type of thyroid lesions and the age group but no association was seen between the type of thyroid lesion and either the sex or age specific groups of the subjects. Conclusion: The study concludes that there was significant difference between type of lesion according to the anatomical site. In case of lymph nodes there was a definitive association between the age group and sex of the patient with the ultimate diagnosis rendered. Hence age groups and the sex does play a definitive role in predicting the type of lesion; more so in lymphoid tissue of the head and neck region. There was significant statistical association of the type of lymphoid malignancy with the age and sex. The similar findings were not derived in the rest of the organ systems such as thyroid, salivary glands and skin/ soft tissue lesions.

Page No. 103-107

Authors: Sunilkumar KB, Nikethan B, Harini R

Aim: To compare Immunohistochemistry (IHC) results of large core Tissue micro array (TMA) with the conventional whole section for estrogen receptor (ER), progesterone receptor (PR) and HER2 expression in breast carcinoma cases. Methods: We analyzed 51 breast carcinoma cases. Large core TMAs were manually constructed with easily available materials. Immunohistochemical evaluation of ER, PR and HER2 were carried out in parallel by TMA and whole section methods for all cases as per Allred scoring system. Observed IHC scores were compared. Results: We detected a high concordance rate of 98%, 100% and 98% for ER, PR and HER2 respectively between TMA and whole sections. In addition, the use of TMA caused a significant reduction in the use of laboratory resources- reagents, slides and blocks. Conclusion: Our analysis showed various advantages of TMA over whole sections in IHC assessment. Hence, TMA can be implemented as a valuable tool in the routine assessment of breast biomarkers without compromising quality.

Page No. 111-116

Authors: Usha Muniyappa, Vijaya Mysorekar, Pooja Trehan

Introduction: The diagnosis and classification of soft tissue sarcomas has been a source of difficulty for surgical pathologists. This has been largely attributable to a significant degree of overlap in histologic features among different types of soft tissue sarcomas. The immunohistochemical identification of various cell and tissue markers specific for certain avenues of cell differentiation has permitted more accurate diagnosis and classification of these tumors. Objective: The objective of this study was to evaluate soft tissue tumors which were unclassified on histopathology by IHC for typing the cell lineage. Materials and Methods: We evaluated 61 cases of soft tissue tumours reported in a period of three years from April 2013 to March 2016 in which histopathology was inconclusive and IHC proved to be useful to reach to a definite diagnosis. Conclusion: In our study, IHC contributed to the diagnosis in 80.3% cases where it helped to determine the soft tissue lineage. It was noncontributory in 13.1% cases where even after IHC the lineage could not be determined. In 6.6% cases the final diagnosis given after IHC was not correlating with the histopathological diagnosis. Hence we conclude that only histopathological examination is not sufficient at all times because there is a morphologic overlap of soft tissue sarcomas with each other and with some carcinomas and melanomas. Though immunohistochemistry is not a substitute for histopathological examination, it acts as an adjunct to arrive at definite diagnosis and hence proves to be the most important ancillary technique in the diagnosis of soft tissue tumors

Page No. 122-126

Authors: Vedashree MK, Girish M, Maruthi CV

Fine needle aspiration cytology (FNAC) is an important tool for the diagnosis of various palpable lesions of head and neck. It is an inexpensive, reliable and patient acceptable technique for the diagnosis of lesions. Aim: 1.To study the age and sex incidence and the pathological spectrum of palpable lesions of head and neck in tertiary care hospital. Objectives: 1. To collect the details regarding age and sex of the patients & site of palpable swellings in the head and neck region. 2. To perform fine needle aspirations in such cases and do cytological study. 3. To analyse the frequency of these lesions based on the site and cytological diagnosis. Materials & Methods: This prospective study included 72 cases who presented with palpable head and neck swelling to the department of Pathology, district hospital Chamarajanagar from July 2015 to June 2016. The detailed history and examination of swelling were done. FNAC was performed on all cases and the smears were stained with rapid Hematoxylin and Eosin stain and examined. The smears from the lymph node of cases clinically suspicious of tuberculosis were stained with Ziehl Neelsen technique and Auramine O staining. Results: In our study, females were predominant (63.88%) and males constituted 36.11%. Most of the cases were in thyroid (48.6%), followed by lymph node (40.2%) and equal incidence of lesions in the salivary gland and skin (5.5%). Maximum age was 60 years and the minimum age was 5 years. In thyroid, lymphocytic thyroiditis was the predominant lesion (57.14%) followed by colloid goitre (42.85%). In lymph node FNACs, reactive lymphadenitis was most common (34.48%). Out of 10 smears from lymph node clinically suspicious of tuberculosis, two were positive for Ziehl Neelsen stain and Auramine O stain. Three cases showed metastatic deposits. Out of four salivary gland lesions, three had chronic sialadenitis (75%) and one had Pleomorphic adenoma (25%). All the cutaneous lesions were epidermal cyst cytologically. The age incidence of head and neck swelling was similar to the study conducted in north India but in contrast females were more common in our study than males due to the higher number of thyroid swellings. Cytologically, lymphocytic thyroiditis was higher in our study compared to the studies conducted in the north and western parts of India probably due to the higher prevalence of autoimmunity in this region. The incidence of tuberculous lymphadenitis was less compared to these studies which may be due to less number of lymph node swellings in our study. Conclusion: FNAC is a reliable and inexpensive outpatient procedure for the rapid diagnosis of various palpable lesions in the head and neck region. Thus it is the first investigation of choice in the diagnosis of these swellings.

Page No. 132-134

Authors: Archana Gupta, Swati Gupta, Vipan Gupta, Vivek Gupta

Aim: The study was carried out over a period of 6 months to evaluate the incidence of anemia in Type 2 diabetic patients with normal renal functions. Methods: The study group comprised of 100 patients with TYPE 2 diabetes mellitus and normal renal functions. Haemoglobin concentration, fasting blood sugar and HbA1c (glycated haemoglobin) of the subjects was measured. Renal function test (Serum urea, serum creatinine, serum uric acid, serum sodium and serum potassium) of all the patients were done and were within the normal range. The subjects with abnormal renal functions were excluded from the study. The presence of anemia was defined by haemoglobin level of less than 13 g/dl in men and <12 g/dl in women. Results: In the present study, the patients had high incidence of anemia i.e., 79%. The incidence was more in patients with uncontrolled diabetes and HBA1c level more than 7.5%. Conclusion: This study indicated that poor glycemic control and old age are associated with high incidence of anemia in Type 2 diabetics with normal renal functions.

Page No. 139-146

Authors: Chaitra B, PAV Krishnamacharyulu, P Premalatha, V Tejeswini

Introduction: Breast carcinoma is the most common cancer among women in the urban Indian population and second only to cervical cancer in the rural population. Prognosis is related to a variety of clinical, pathologic and molecular features. Immunohistochemical evaluation of estrogen receptor (ER) and progesterone receptor (PR) status of breast carcinoma has become a routine investigation to predict the response to endocrine therapy. Aims and Objectives: To study patient and tumor characteristics in relation to estrogen and progesterone receptor (ER & PR) status of the tumor. Materials and Methods: This is a retrospective and prospective study of 100 cases of breast carcinoma diagnosed during January 2007 to September 2011 in the department of Pathology, NRI Medical College, and Chinakakani. Clinical details were archived from the files. Routine histological examination and Immunohistochemical analysis of all the cases were done. Results: Tumors were separated into four categories: ER+PR+ (33%), ER+PR− (15%), ER−PR+ (7%) and ER−PR− (45%). ER and PR immunoreactivity increased with advancing age. 52% of cases were in the right breast. Invasive lobular carcinoma, and papillary carcinoma were more frequently ER+PR+. High-grade infiltrating ductal carcinomas, pure comedo ductal carcinoma in situ, mucinous carcinoma and medullary carcinoma were predominantly ER−PR−. ER & PR immunoreactivity decreased with increasing tumor grade, lymph nodal metastasis, presence of tumor necrosis, desmoplasia and lymphovascular emboli. Conclusion: Histological grading together with receptor status offers an excellent method of predicting the prognosis and response to hormonal therapy which lightens up a prospect of various treatment modalities.

Page No. 150-152

Authors: Amita K, Shobha SN, Vijay Shankar S, Abhishek MG

Collision tumor is an entity used to describe the occurrence of two separate primary tumors at one anatomic location. Collision tumors occur at different locations in the body including skin. Syringocystadenoma papilliferum (SP) is an adnexal tumor of apo-eccrine differentiation and is juxtaposed to a nevus in one third of the cases and to a basal cell carcinoma in 10% of the cases. We report an unusual collision of SP and verrucous carcinoma occurring at an unusual location.

Page No. 156-157

Authors: Rigvardhan, Prashant Sengupta, Nishant Taur, Vasu Vardhan

Multiple myeloma (MM) is a clonal proliferation of plasma cells that primarily affects the bone marrow and skeletal system. It mainly affects bone marrow although extramedullary tissues especially reticuloendothelial system may be infiltrated. Serous effusions due to MM are rare. (1) Accurate diagnosis of this condition is important as it portends a poor prognosis with median survival time < 4 months. It is particularly rare (<1%) for MM patients to present as myelomatous pleural effusion (MPE), especially pleural effusion as presenting sign. (2,3) Bilateral myelomatous pleural effusions are even more rare. (2) We describe a case of MM who presented initially as bilateral pleural effusion and was managed in our hospital. To the best of our knowledge, this is the fourth case in literature where bilateral myelomatous pleural effusion was the presenting feature of multiple myeloma.