Indian Journal of Pathology and Oncology

. 434-436

Authors: Chetankumar Maganlal Dharaiya, Bhavesh Ramji Faldu, Harshid L. Patel.

Introduction: Malaria is a serious and sometimes fatal disease caused by a parasite that commonly infects a certain type of mosquito which feeds on humans. There are many Techniques available for Detection of malarial parasite from the blood. Objective: The objective of this study is to determine efficacy of different methods for detection of malaria parasite. Materials and Method: Total 5344 blood samples that came to pathology laboratory are investigated for malarial parasite by different technique like Thin smear and Thick smear that is stained by Gimsa stain and Rapid diagnostic test (RDT) for detection of malarial parasite. Result: Among total 5354 samples were collected 305(5.7%) were found to be positive for malaria. Of the positive samples 300(98.36%) were positive by Thick smear, 221(72.45%) were positive by Thin smear and 281(92.13%) were positive by Antigen detection method. Among them 211(69.18%) cases of P.Vivex, 77(25.24%) cases of P.falciparum and 17(5.6%) had a mixed infection. Sensitivity of Thick smear is 98.36%, Thin smear 72.45% and for antigen detection method it was 92.13%. Conclusion: Detection of malarial parasite can be best done by combination of Antigen detection method and by Microscopic Examination of Thick smear.

358-360

Authors: Archana Gupta, Aneeta Singh, Swati Gupta, Sandeep Kaur, Arvind Khajuria.

Introduction: Pregnancy is associated with substantial changes in the tissue factor pathway and in the hemostatic system.(1) It is also characterised by impressive changes in the activating and inhibitory pathways of coagulation and fibrinolysis resulting in an accelerated but well balanced process of thrombin formation and resolution.(2) These changes serve to protect the mother from the hazards of bleeding imposed by placentation and delivery, but they also carry the risk of an exaggerated response localised or generalised to coagulation stimuli.(3) Aim: The aim of our study was to evaluate prothrombin time, International Normalised Ratio and Platelet count among women presenting with vaginal bleeding in first trimester of pregnancy. Materials and Method: A retrospective study of females with vaginal bleeding in the first trimester of pregnancy was carried out in the Post Graduate Department of Pathology, Acharya Shri Chander College of Medical Sciences (ASCOMS) and Hospital Sidhra in collaboration with Department of Obstetrics and Gynaecology for a period of two years i.e. from 1st January 2015- 31st December 2016, after obtaining the due clearance from Institutional Ethics committee. Conclusion: Coagulation abnormalities are rarely the cause of vaginal bleeding in the first trimester of pregnancy among the women with no previous symptoms of bleeding disorders.

365-367

Authors: Kanchan Kamini, Alok Mohan, Kamna Gupta, Purva Sharma, Veena K. Sharma.

Introduction: Breast cancer is the most frequently diagnosed cancer in women and second most common cause of cancer related death in world.(1) There have been outstanding progress in breast cancer management leading to early detection and treatment of disease for the last few decades. IHC based classification of estrogen receptor/progesterone receptor status works as prognostic factor and help in choosing treatment modalities and is easily approachable. Aim: The present study was undertaken to find out apoptotic index and ER/PR status in breast carcinoma patients and to correlate apoptotic index with ER/PR status and histological grade of breast carcinoma. Material and Method: Sixty six patients with breast neoplasm who were underwent Modified Radical Mastectomy/lumpectomy after the diagnosis of carcinoma breast, on undergoing preliminary FNAC/ Trucut biopsy. Histopathology and IHC were applied on the MRM tissue. Apoptotic index was calculated on H&E stained section. Results: Out of 66 cases studied, maximum cases {60cases (88.2%)} were of Invasive breast carcinoma not otherwise specified (NST). Grade II tumor showed the maximum cases(48.9%). ER positivity was 57.5%, PR positivity was 45.4%. Mean apoptotic index and grade of tumor had significant correlation whereas mean apoptotic index and ER/PR status were not correlated to each other. Conclusion: From the present study, we came to a conclusion that apoptotic index is a useful parameter to assess the prognosis of the patient with the carcinoma breast, similar to ER/PR. Considering the cost factor, in a developing country like India where IHC is beyond the reach of every common man, we conclude that apoptotic index can also be of great help in predicting the prognosis of the patient even if ER/PR status is not known

372-375

Authors: Sudha A, Jayashankar E, Shailaja P, Madhusudan R, Ashok Kumar D.

Introduction: The sequence of Leprosy pathogenesis depends on the host-pathogen immunologic responses. The skin lesions may sometimes be missed, or mistaken for other common dermatoses clinically as well as histologically. Aims and Objectives: The study aims to observe the spectrum of Hansen’s disease and different clinical patterns of Hansen's diagnosed in our hospital. Materials and Method: This was a retrospective study carried out in the department of pathology and dermatology at our hospital, from January 2014 to May 2016. In this period, 53 cases of clinically suspected Hansen’s disease were biopsied. Routine hematoxylin and eosin staining along with special stain was done in all cases. Observations and Results: Out of 53 cases, 22 (41.50%) were borderline tuberculoid type, 8 cases (15.09%) were indeterminate type, borderline lepromatous were 5 (9.43%) and tuberculoid type, were 5 (9.43%). There were 7 cases (13.2%) which had doubtful clinical presentation of Hansen’s disease but on biopsy were reported as nonspecific dermatitis in 6 patients and as normal findings in one patient. Hypopigmented macular lesions, hypoesthetic areas, nerve thickening and combination of the above were the most common clinical findings. Good correlation was seen between the clinical and histopathological findings in 33 cases (62.2%). Conclusions: Histopathological examination of skin lesions is advisable for all suspected cases of leprosy. The early lesions of leprosy, especially the indeterminate type can have nonspecific findings in biopsy and nerve involvement has to be diligently searched for.

380-384

Authors: Aravinda Macharla, Deepthi KN.

Introduction: Diagnosis of ovarian tumors depends basically on histopathological examination of samples. Morphological diversity of ovarian tumors poses many challenges. Awareness of occurrence and frequency of these patterns and cell types in various tumor and tumor like lesions is of paramount diagnostic importance. Objectives: To evaluate the histopathology of lesions of ovary with regard to the standard classification of ovarian tumors and to determine the relative incidence of these histomorphological patterns among different age groups of patients. Materials and Method: Present study was retrospective and prospective study carried out at SVS Medical College, Mahabubnagar. A Total of 7 years study was undertaken out of which 5 years of retrospective and 2 years of prospective study was carried out. Sections were stained with H & E and special stains were done wherever necessary. Results: Out of total 330 lesions, benign ovarian tumors constituted 81.2% while malignant ovarian tumors were 16.4%. Most common benign tumor was Serous Cyst adenoma and malignant tumor was Serous Cystadenocarcinoma. Conclusion: The Diversity of neoplasms makes it mandatory to classify the tumors accurately by histomorphological features following universally accepted classification.

391-395

Authors: Lakshmi Priya U, Sheela Thomas, MP Sasi.

Introduction: Columnar cell lesions (CCL) are thought to be low grade precursor lesions of breast cancer. The prevalence of these lesions has not been well documented in the published literature. Data regarding the same in Indian scenario is also scarce. The present study attempts to document the extent and pattern of distribution of CCL and other proliferative breast lesions in the mastectomy specimens received in our department. Objectives: To find the prevalence of CCL in the mastectomy specimens and to find out the prevalence of various known risk factors in the study population. Materials and Method: The patients who underwent mastectomy or breast conservation surgery for carcinoma breast during December 2012 to May 2014 were included in the descriptive study conducted in the Department of Pathology, Government Medical College, Kozhikode. After taking informed consent clinical details were collected from the patient. Mastectomy specimens were evaluated for the presence of proliferative breast lesions. The variables were statistically analyzed using SPSS version 16.0. Results 60 patients were included in the study. Most of the patients belonged to the age group of 51-60 years. 16 cases were premenopausal and rest 44 postmenopausal. Histological grade 2 was most common and majority of our cases presented in TNM stage 2a. 56.7% cases showed proliferative breast lesions. DCIS was the commonest, seen in 40% cases. CCL were seen in 33.3% cases. No statistically significant relation was obtained between proliferative breast lesions and tumor grade, stage, nodal status, fibrocystic change, triple negativity of the tumor and menopausal status of the patient. As tumor grade progressed, triple negative tumors also increased and this was statistically significant (p<0.05). Conclusion: In our study columnar cell and other proliferative breast lesions were seen in 56.7% mastectomies but CCL did not show any significant relation to menopausal status of the patient, tumor grade, tumor stage, nodal status, fibrocystic breast disease and triple negativity of the tumor.

400-403

Authors: Biradar Manisha V, Chaware Suresh.

Introduction: Lymphadenopathy is the commonest cause of multitude of aetiologies ranging from innocuous reactive lesion to lymph proliferative disorders and metastatic malignancy. FNAC (Fine needle aspiration cytology) is simple, quick, inexpensive method for investigating the cause of lymphadenopathy in developing countries like India. This study is carried out to evaluate the role of FNAC in lymphadenopathies and to assess the various aetiologies of it. Materials and Method: A study was carried out during a period of one year from July 2015 to July 2016, at Government Medical College, Latur. FNAC of 222 patients presenting with lymphadenopathy was done, and were analysed. Results: Maximum patients were diagnosed with Reactive Lymphadenopathy(46.85%), followed by Tuberculous Lymphadenopathy(24.32%), Granulomatous Inflammation(9.91%), Metastatic Lymphadenopathy(9.46%), Suppurative Lymphadenopathy(6.76%) and Primary neoplasm(2.7%). Conclusion: FNAC is most reliable, preliminary screening test to differentiate neoplastic from non-neoplastic cause of lymphadenopathy and therefore preventing unnecessary surgery.

408-412

Authors: Shobha SN, Rajashekar YR.

Introduction The common head and neck lesions encountered in routine daily practice are from lymph nodes, salivary glands, soft tissue tumors, and thyroid. The beginning inexpensive diagnostic procedure that the clinician can think is the Fine needle aspiration cytology (Fnac). It is simple, easy and diagnosis can be obtained in few hours. Materials and Method: Our study is a prospective study which included Fnac technique on 50 cases of head and neck lesions. From lymph nodes, soft tissues, salivary gland. However thyroid lesions were excluded from the study. The study was done for 1 year from 2016 January to 2016 December in Adichunchanagiri Institute of Medical Sciences, Pathology department. Results: Reactive/ non-specific lymphadenitis was the common diagnosis obtained in 19 cases. Followed by metastatic deposits in the lymph nodes in 16 cases. Tuberculous (TB) lymphadenitis was in 8 cases. Salivary gland neoplasm’s in 3 case, and 3 cases of non-neoplastic salivary gland lesions out of which sialadinitis in 2 case and sialadinosis in 1 case. 1 case of epidermal cyst. Conclusion: Fnac is a simple diagnostic tool to diagnose most important clinical conditions like metastatic deposits and TB lymphadenitis. Compared to other expensive mode of diagnosis in this modern medicine era, Fnac still plays a very important vital role in finding the occult malignant neoplasms.

418-421

Authors: Deepti Gupta, Anu Gupta, Jyotsna Suri, Kuldeep Singh.

Objective: To study the pathology of splenectomy specimens in a tertiary care center. Materials and Method: This is a non interventional 5 year retrospective study carried out in the PG Department of Pathology, GMC Jammu, from 1 January 2011 to 31 December 2016. Our study included 85 cases, slides & data for which were retrieved from the histopathology section & the slides reviewed by the authors. Results: Out of 85 cases, 55 were males and 30 females, the M:F ratio being 1.83:1. The age of the patients ranged from 2 to 67 years of age, maximum number of patients were in the age group of 20-30 years(n=32), followed by age group of 30-40 years(n=23). Maximum number of cases were reported as traumatic spleen(n=56), followed by congestive splenomegaly(n=9), septic infarct(n=3), normal spleen with foci of congestion(n=4), hemorrhagic infarct(n=3), splenic abscess(n=2), tubercular splenic abscess(n=4) and one case each of hypersplenism, echinococcus granulosus, Chronic myelogenous leukemia (CML) and myeloid metaplsia. Only one case of malignancy i.e. CML was reported in our study. Conclusion: Splenectomy as a surgery, is both therapeutic and diagnostic, however in our study, it was mostly therapeutic. Other treatment options like partial splenectomy or repair of the laceration should be done to avoid post splenectomy complications.

426-429

Authors: Anu Gupta, Deepti Gupta, Jyotsna Suri, KK Kaul.

Malignancies can present with diversified symptoms and enlarged lymphnodes are one such. FNAC is a basic, dependable and economical diagnostic tool in the interpretation of metastatic lymphadenopathy. Materials and Method: This is a 2 years retrospective study carried out in the department of pathology GMC Jammu from 1-1-2015 till 31-12-2016. It includes 71 cases of lymphadenopathy, diagnosed as positive for metastasis on FNAC. Result: From a total of 71 cases positive for metastasis majority were of Squamous cell carcinoma 28(39.43%) followed by Poorly differentiated carcinoma 24(33.8%), Adenocarcinoma 14(19.71%), Malignant melanoma and anaplastic carcinoma / lymphoma, 2 cases each (2.81%) and 1 (1.4%) case of Small cell carcinoma. Cervical lymphnodes were the most frequently involved group. There were 42 males and 29 females with a male predominance (M:F = 1.4:1). Maximum cases were seen in the age group of 61 – 70 years (19). Cases with a known primary were 18 (25.35%) while rest 53 (74.64%) were without any known primary. Conclusion: FNAC is a valuable diagnostic tool in metastatic lymphadenopathy without giving much trauma to the patients.

437-441

Authors: Mansi Sharma, Vidhu Mahajan, Jyotsna Suri, KK Kaul.

Introduction & Objectives: Testis is affected by both neoplastic and non- neoplastic conditions. Although testicular neoplasms are rare, most of the previous studies of testis are on them only. Our study was undertaken to study histopathological spectrum, age-wise distribution, laterality and clinical presentation of all testicular lesions (both neoplastic and non- neoplastic). Materials and Method: This was a three year retrospective study including all the testicular specimens referred to Department of Pathology, GMC Jammu from 1st Jan 2014 to 31st Dec 2016. Results: The study comprised a total of 57 cases. Non- neoplastic testicular lesions were more common than the neoplastic ones (93 vs. 7%). Non- neoplastic lesions were most common in 2nd decade of life with a wide age range of 5 months- 80 years. Among non-neoplastic lesions (n=53), undescended testis (39.62%) was the most common non-neoplastic lesion followed by inflammatory lesions (24.53%), infarcted testis (torsion, 18.86%) and atrophic testis (16.98%). Inflammatory lesions included nonspecific epididymo-orchitis (15.1%), testicular abscess (5.66%) and tubercular epididymo-orchitis (3.77%). Only 4 cases (7%) of testicular neoplasm were diagnosed in the study period amounting to only 1.33 case/ year. All 4 cases were germ cell neoplasms with age range of 14 months- 35 years and mean age 20.54 years. One case each of seminoma, yolk sac tumour, immature teratoma and mixed germ cell tumour (mixed teratoma and seminoma) was diagnosed. All the lesions were unilateral and 58% of non-neoplastic lesions were right sided. Among both neoplastic and non-neoplastic lesions, the most common symptom was testicular (scrotal/inguinoscrotal) swelling (87%). The second most common presenting complaint was empty scrotum (36.84%) and pain (36%). Inflammatory lesions in addition had history of fever(22.80%). No tumour was found in undescended testes unlike western countries. Conclusion: Majority of testicular lesions are non- neoplastic and neoplastic lesions are rare, most being germ cell neoplasms. Non- neoplastic lesions are seen in all age groups but neoplasms are usually seen in younger age. Non- neoplastic lesions mimic neoplastic ones clinically, testicular swelling being the most common complaint. So histopathological examination is necessary to serve an accurate diagnosis of testicular swellings. Our findings are comparable with most studies.

446-449

Authors: G. Priyanka, Leena Dennis Joseph, G. Barathi, Monica Kumbhat.

Introduction: Colorectal carcinoma(CRC) is one among the many leading causes of cancer related mortality worldwide. The survival rate of patients with CRC is better because of advancements made in the treatment modalities, in terms of surgery and chemotherapeutic options. This study is done to know the immunoexpression of Her 2/neu in CRC and its correlation with histologic grades. Her 2/ neu is considered to be a beneficial Immunohistochemical (IHC) marker for colon cancer which can be used for predicting the prognosis and for targeted therapeutic modality. Materials and Method: The present pilot study was done to understand the expression of Her 2 /neu in histologically proven 25 cases of adenocarcinoma colon using monoclonal anti Her 2 /neu antibody (Biogenix). Positivity was recorded as per the consensus panel recommendations on Her 2/neu scoring.(1) The clinical profile of the patients were obtained from the archives in the Pathology department of our institution. Results: This study had a total of 25 hemicolectomy specimens of colorectal carcinoma. Of the total 25 cases, 14 cases (56%) were males and 11 cases (44%) were females. Forty percentage of patients were in the age group of 50-60 years. Histopathologically, most of them were adenocarcinomas. Her 2/neu expression was negative in all the 25 cases of colorectal carcinoma in our study. The control tissue was Her 2 /neu positive breast carcinoma with complete membrane staining in the tumor cells(3+). Conclusions: Her 2/neu is considered as a therapeutic modality in advanced and metastatic CRC cases. This was a pilot study and we need to perform the IHC stain on more cases to understand its expression in our population.

454-457

Authors: Saritha Karre, Amrutha Gorva, Satyanarayana Veeragandhan, Chandrakumar Shanmugam, Vinay Kumar Parepa.

Aims and Objectives: Cervical cancer has always been a growing concern in developing countries like India. Prevent ability at pre malignant/pre invasive stages has yearned the need for studying screening methods in detail. This study recapitulates the importance of PAP smear as affordable, sensitive screening method and need for repetitive and continuous testing in preventing invasive cancer. Material and Methods: The prospective study spanning for a year (July 2015 to June 2016) consisted of 1990 patients who presented with various gynecological symptoms. All patients were screened by cervical smear stained with PAP stain. Evaluation of the smears carried out by cytopathologist as per The 2001 Bethesda reporting system. Results: 1990 patients study showed inflammatory lesion 1164 (58.49%), metaplasia 46 (2.31%), LSIL 10(0.50), HSIL 4(0.20%), SCC 12(0.60%), ASCUS 72 (3.62%), AGUS 2 (0.1%), atrophy 52(2.61%), inadequate for evaluation 238(11.97%) and 390(19.6%) didn't show any significant pathology. Majority of the patients in our study had non neoplastic inflammatory lesions. Neoplastic lesions (premalignant and malignant) were observed in 100 (5.02%) patients and were seen in 41-70 years age group. Conclusion: The cervical neoplasia is common in 41 -70 years, and they can be subjected to repeated Pap screening program to detect the early lesions (dysplasia) and treated appropriately to prevent cervical cancer.

462-464

Authors: Sharadamani GS.

Introduction: To study the pattern of various etiologies of lymphadenopathy in a rural setting, and to examine the distribution of lesions among diverse age and sex groups. Materials and Methods: The study was conducted on 99 subjects diagnosed with lymphadenopathy at Department of pathology, Vinayaka Missions Medical College and Hospital, Karaikal, Puducherry, India. Detailed clinical and laboratory examinations were performed, and lesion were diagnosed by fine needle aspiration cytology (FNAC). The prevalence of various etiologies was evaluated, and further correlated with age and sex of the participants. Results: Out of the 99 selected patients, 45% of subjects were diagnosed with tuberculous lymphadenitis, followed by 27% with reactive lymphadenitis, 16% with non-specific lymphadenitis, 9% with metastatic deposits, and 2% with supportive lymphadenitis. Conclusion: Tuberculous lymphadenitis was noted as the most prevalent etiology for lymphadenopathy with marked increase in female subjects and cervical region as the major site involved.

468-472

Authors: Vaneet Kaur Sandhu, Navtej Singh.

Introduction: Pleomorphic adenoma exhibit wide morphological spectrum varying from predominantly epithelial types to predominantly stromal types which often pose diagnostic challenge to cytopathologists. Aim: The aim of the present study was to evaluate varied cytomorphological features of pleomorphic adenoma with an emphasis on differential diagnosis and to highlight diagnostic pitfalls. Materials and Method: This was a retrospective study from January 2011 to December 2015 in our Department of Pathology. During this period 220 patients with salivary gland space occupying lesions underwent FNAC, out of which 190 aspirates were satisfactory for evaluation, 75 aspirates were reported as pleomorphic adenoma and these 75 cases were reviewed by two cytopathologists independently for cytomorphological findings, diagnosis and differential diagnosis where needed. Results: On revised cytology 67 cases out of the 75 cases reported initially as pleomorphic adenoma were concordant with the earlier diagnosis. The remaining 8 cases on revised reporting were diagnosed as adenoid cystic carcinoma in 5 cases, mucoepidermoid carcinoma in 2 cases and basal cell adenoma in one case. The cytological smears of 67 cases of pleomorphic adenoma were categorized on basis of cellularity as mild (4.477%), moderate (44.776%) and marked (50.746%) as well as for ratio of epithelial to mesenchymal component. Varied morphological variations like squamous metaplasia (17.9%), mucinous metaplasia (2.9%), oncocytic change (5.9%), hyaline globule (2.9%), giant cells(4.47%), cystic degeneration (22.38%) and plasmacytoid cell differentiation (32.83%) were observed in cytological smears of pleomorphic adenoma. Conclusion: We conclude that adequate and representative sample is essential for proper cytological examination, further Romanowasky stain is mandatory for FNA of salivary gland lesions. Cytopathologists should be aware of varied cytomorphological characteristic of pleomorphic adenoma in order to minimize the possibility of diagnostic errors.

476-478

Authors: Shubbhangi Vinayak Agale, Shubhangi Narayan Jibhkate, Akshay Tiwari, Sushma Bharti.

Introduction: Neurothekeoma is a rare benign soft tissue tumor of uncertain histogenesis which affects adolescents and young adults. It is rare to find these tumors occurring in children. Neurothekeoma usually presents with a small, solitary, and slow-growing nodule or papule on the upper body. Case Report: We describe a case of a 9-year-old girl having large (5x4x1) painful swelling over back of 2 months duration. After total resection of the tumor, histological examination and immunostaining confirmed the diagnosis of myxoid neurothekeoma. The clinicopathological features of this rare tumor and its important differential diagnoses are discussed. Conclusion: Neurothekeoma is a rare tumour in children and its’ myxoid variant is even rarer. This benign tumour has to be differentiated from other malignant tumors as it has good prognosis.