Indian Journal of Pathology and Oncology

6-11

Authors: Komal D. Sawaimul, M. Banyameen Iqbal, Vijayalaxmi D. Sawaimul, Tushar Kambale, Rajharsh Hanmante.

Introduction: Haemoglobinopathy is a major genetic public health problems in India, responsible for significant morbidity and mortality. Individuals with trait (carriers) are healthy and unaware of their carrier status unless specifically screened. If a couple carry a clinically significant haemoglobinopathy trait there is a 1 in 4 chance with each pregnancy that their child will inherit a major haemoglobinopathy. The most effective approach to reduce the burden of the society is to reduce the incidence by implementation of a carrier screening programme. Material and Methods: The present study was carried out in a tertiary care hospital for a period of 2 years. 500 Antenatal patients attending Obstetric-out patient department for routine check-up were included in the study. Screening of patient was done by Solubility test, Sickling test and Alkali denaturation test. Finally a very standardized method to detect HbA2 and HbF was done by using an automated High Performance Liquid Chromatography. Results: Out of a total of 500 pregnant women 4% were having haemoglobinopathies, whereas 96% had normal haemoglobin. Out of 20 cases, maximum number of cases i.e. 2.2% was of β –Thalassemia trait, followed by Sickle cell trait cases i.e. 1.2%. Other haemoglobinopathies are also found i.e. sickle cell disease 0.2% δβ Thalassemia case 1.2% and double heterozygous 0.2%.Out of a total of 20 positive pregnant women only partners of 8 women were screened and out of them 37.5% were found positive. Conclusion: Detection of carrier status using HPLC during pregnancy along with couple screening provides prospective parents with the option of testing the fetus for hemoglobinopathy.

18-24

Authors: Dipakkumar R. Prajapati, B. H. Parmar.

Introduction: Apart from sexual transmission, blood transfusion is the other common route of transmission for Syphilis. Aims & Objectives: To study prevalence of seroreactivity of Syphilis in blood donors of our geographical area in relations to their different demographic variables and co-infection with other TTI (Transfusion Transmissible Infections). Materials & Methods: Records of all blood donations and TTI testing at the blood bank of our teaching medical institute from April 2012 to March 2016 were reviewed retrospectively. Data of all blood donors who were seroreactive for Syphilis were analysed in relations to their different demographic variables and results were interpreted accordingly. Results: Out of 6633 registered blood donors, 6360 were accepted including 6246 males (98.2%) and 114 females (1.8%) with 5597 Voluntary (88%) and 763 Replacement (12%) donors. Out of 6360, total 48 donors (0.75%) were found seroreactive for Syphilis including 45 males (0.72%) and 3 females (2.63%) with 39 Voluntary (0.70%) and 9 Replacement (1.18%) donors. Prevalence of Syphilis is comparatively high among age group of 46-55 years. Co-infection of Syphilis with HBV was 2.08%, while any co-infection with HIV, HCV and Malaria was not found. Conclusion: Seroprevalence of Syphilis in blood donors in present study is 0.75%. Even though trend of syphilis is declining, screening of blood donors should be continued to avoid the transmission of undiagnosed and untreated syphilis. Considering the limitations of RPR test, more sensitive and specific tests like Recombinant antigen based EIA and Rapid ImmunoChromatographic Strip (ICS) should be used if available and feasible.

29-34

Authors: Chetan M. Dharaiya, Trupti S. Patel, Majal G. Shah, Jahnavi S. Gandhi.

Introduction: Granulocytic sarcoma is a rare extramedullary tumor comprising of immature myeloid cells in an extramedullary site which is commonly found with myeloid leukemia (acute or chronic) or occasionally with chronic myeloproliferaive disorders or myelodysplastic syndrome. GS may also be the initial manifestation of leukemia. Because of the diverse clinical presentation, differentiation of Granulocytic sarcoma (GS) from malignant lymphomas (Non Hodgkin's lymphoma or Hodgkin’s lymphoma), extramedullary hematopoiesis, poorly differentiated carcinoma and infections is very important for cytopathologist. Materials and Methods: A retrospective study of total 16 cases of GS diagnosed by FNAC (14 FNAs and 2 pleural effusion fluid specimen) was done. Cytology smears were examined for cytomorphology in conjunction with clinical details. Depending upon the population of the cells present on the smears, GS was categorized as blastic, immature or mature GS. Results: The age of patients ranged from 8 years to 50 years with male dominance. (10 males and 6 females).The most commonest site of aspiration was subcutaneous or soft tissue (9 cases) followed by lymphnodes (4 cases) and breast (1 case). 2 cases of GS involving pleural fluid were also included. A detailed history, clinical examination and relevant investigations of patients showed that GS was secondary to acute myeloid leukemia (AML) in 6 patients, was secondary to chronic myeloid leukemia (CML) in 3 patients, and was secondary to juvenile myelomonocytic leukemia (JMNL) in one patients. 6 patients were presented with concurrent myeloproliferative disorder [AML in 4 patients and CML-CP in 2 patients]. Depending upon the population of the cells present on the smears, GS was categorized as blastic GS (7 aspirates), immature GS (3 aspirates) and mature GS (6 aspirates). Conclusion: FNAC plays important role in diagnosis of GS .GS should be included in the diagnosis of undifferentiated neoplasm of the soft tissue or lymph nodes, even in patients with no clinical suspicion of leukemia .Detailed patients clinical history along with careful morphologic evaluation for granulocytic cell identification should helps to reach a definitive diagnosis.

42-45

Authors: Leena Dennis Joseph, C. N. Sai Shalini, Subalakshmi B., Divya D., V. Pavithra.

Introduction: Verrucous lesions present as cauliflower like, slowly growing masses, which may be single, multiple or diffuse involving the broad areas of skin or mucosal surfaces. Clinically these lesions are diagnostic challenges. Histopathology remains the gold standard in diagnosing this diverse group of verrucous lesions. The aim of this study was to understand the microscopy of clinically verrucous lesions. Material and Methods: This is a retrospective data of clinically verrucous lesions over the past five years. Clinical details were obtained from the archives and diagnosis was noted from the pathology records. A total of 116 clinically verrucous lesions were included. Results: Majority of the cases were Verruca vulgaris (37 cases), followed by 33 cases of Seborrheic keratosis. There were 12 cases of verrucous carcinoma, seven cases of tuberculosis verrucosa cutis, six cases of verrucous nevus and one case of verrucous hemangioma. The other cases were of varied histology, inspite of clinically verrucous appearance. All the cases were diagnosed purely based on histopathology findings, which show characteristic morphological features, which help the pathologist in the correct diagnosis. Conclusions: Histopathologic confirmation helps in alleviating the anxiety of the patients and helps us to arrive at a correct diagnosis.

51-54

Authors: Smriti Rathore, Prashant Kumar Singh, Anjana Kumar.

Introduction: India is the diabetic capital of the world. Vitamin B12 deficiency has been recognized since many years ago as an important side effect in diabetic patients who take metformin for more than 5-10 years.This research aimed to determine the prevalence of anemia in type 2 diabetes mellitus (T2DM) and its association with vitamin B12 deficiency due to use of Metformin. Materials and Methods: Total 200 type 2 diabetes mellitus (T2DM) males and females were included in the study.Blood collection for Fasting blood glucose and Hba1c levels were measured from all participants in tubes without anticoagulant. Hemoglobin, mean corpuscular volume (MCV) were measured by automated cell counters. Measurement of vitamin B12 level was done only in those patients who presented with Macrocytic anemia. Results: Among 200 patients, 113 patients were on vegetarian. The prevalence of anemia in this study population was 65(32.5%). 11(16.9%) were diagnosed as Normocytic Normochromic anemia, 22 (33.8%) with Microcytic Hypochromic Anemia, 26(40%) with Macrocytic Anemia and 6(9.2%) with Dimorphic anemia. Among these 32 patients, who presented with macrocytic and dimorphic anemia, vitamin B12 levels were measured. For 23 vitamin B 12 level was<200 pg/ml, and for the rest 9 patient’s vitamin B12 level was >200 pg/ml. 149 patients were on Metformin. Conclusion: Our findings suggest that correction of anemia may have a significant role in prevention of other diabetic complications, thus we recommend that treatment criteria for diabetes should include routine hematological tests and annual screening of Vitamin B12 deficiency along with supplementation should be adopted while treating T2DM.

61-66

Authors: Deepthi. A, CSBR Prasad, Raghavendra Prasad B. N..

Objective: To investigate the basic cause of dimorphic anemia in adult patients using hematological parameters, bone marrow iron stores, serum vitamin B12 and folate assays. Materials and Methods: Hematological parameters and bone marrow, serum vitamin B12 and folate assays of 62 patients with dimorphic anemia were studied to evaluate the basic etiology in dimorphic anemia. Results: The mean MCV was 95.01±13.14fl and MCV was normal in 56.45% cases. BM examination showed megaloblastic maturation in 32.36%, megaloblastic with micronormoblastic maturation in 64.52% cases. BM iron stores were deficient in 32.26% cases. 43.55% cases had only folic acid deficiency, 19.35% cases had only B12 deficiency and 27.42% cases had both B12 and folate deficiency. Combined iron and vitamin deficiencies in 25.8% cases. The mean MCV, MCH, MCHC and RDW were significantly high in combined deficiencies. Conclusion: The common basic cause for dimorphic anemia was folate deficiency. MCV is unreliable as a screening parameter for anemia with vitaminB12 or folate deficiencies. Concomitant deficiencies of B12 or folate with iron deficiency are not infrequent; one type of anemia may mask the other. Serum assays will be appropriate to establish the cause in cases with concomitant deficiencies, as it may result in discordant results with various other tests like hematological parameters.

75-80

Authors: Gayathri T., Shashikala V., Sody Rekha.

Introduction: The wide spectrum of bone tumours, their diverse origin and the tendency of these tumors to produce overlapping anatomic patterns, make osseous neoplasms a complicated but highly challenging area from the point of view of morphological diagnosis. Objectives: To know the pattern of tumour and tumour-like lesions of bone including their incidence, age, sex and anatomical distribution, histo-morphological features in a tertiary care hospital of South India. Materials and Methods: Biopsies and specimens received at the department of Pathology, Karnataka Institute of Medical Sciences, Hubli from July 2006 to June 2011 (5 year period) are included in the study. Results: A total of 115 cases were included in the study of which 104 (90.4%) were tumors of bone and 11 (9.6%) were tumor-like lesions. Primary bone tumors were seen in 101 (97.1%) cases and secondary tumors were seen in 3 cases (2.9%). Out of all lesions studied, malignant bone tumours were 31 (26.9%), benign bone tumours 71 (61.73%) and tumour like lesions 13 (11.3%). Osteochondroma (50.7%) was most common benign tumor followed by osteoclastoma (40.8%). Osteosarcoma was commonest malignant tumor (58%) followed by Ewing’s sarcoma (16.2%). There were 3 cases of secondary tumors- one of renal cell carcinoma and the other two were adenocarcinomas of unknown primary. Conclusion: This study showed that benign tumours accounted for most of the primary bone tumours. Osteochondroma and osteosarcoma are the most common benign and primary malignant bone tumors, respectively.

87-91

Authors: Minesh B. Gandhi, Harshid L. Patel, Aakash Shah.

Introduction: A cerebral lesion refers to any type of abnormal tissue found in the brain, particularly in the cerebral cortex. The cerebrum is responsible for allowing voluntary movements within the human body. Cerebral tumors arise from tissue throughout the brain. Neuroglial cells mainly consist of astrocytes, oligodendrocytes and ependymal cells. These cells provide shelter and maintenance for neurons. About half of the primary CNS tumors derive from glial cells. Aims and Objectives: To study the lesions of cerebrum with age and sex incidence and to find the incidence between neoplastic and non-neoplastic lesions and correlation with radiological appearance and histopathological findings of the lesions. Materials and Methods: A present study including of 150 cases of cerebral lesions. All surgical biopsies were taken at department of Neurosurgery and then send for the histopathology examination in department of Pathology of Smt. N.H.L. Municipal Medical College attached with Sheth V.S. General Hospital, Ahmedabad, Gujarat from July 2011 to June 2013. Results: Out of these total 150 biopsies, 100 were diagnosed as neoplastic lesions and 50 were diagnosed as non-neoplastic lesions. Among the neoplastic lesions, majority cases were of Gliomas (82%). Among the non-neoplastic lesions, majority cases were of infectious origin (60%). Out of total 82 cases of gliomas, 64 were of astrocytic Gliomas (78%). The peak age incidence for patients with neoplastic lesions was the 4th and 5th decade while that for benign lesions was 1st and 3rd decade. The male to female ratio was 2.7:1. Summary and Conclusion: Among the 100 neoplastic lesions most common was Gliomas. Among the glioma, most common was the Astrocytoma (78%) which was followed by the oligodendroglioma (11%) and then Ependymoma (6%). Overall male: female ratio was 2.7:1 in the patient with Glial tumors. Out of 50 non neoplastic cerebral lesions, 30 (60%) were of infectious origin.

97-105

Authors: Kirti Khetan, Gunjan Gupta, Swarnalata G..

Introduction: Renal biopsy is frequently used in complete work-up for renal diseases. The kidney reacts in a limited number of patterns to various injuries and the clinical manifestations corresponding to these reactions are also limited. Aim of the study: To study the non-neoplastic renal diseases in paediatric population 0-15 year age, to study the differences in the disease prevalence between paediatric and adult population, and to document the geographic variation in renal diseases. Materials and Methods: The renal biopsies from 0-15 year age group of both genders were studied for light microscopy and immunofluorescence studies. The clinical presentation of the patients such as nephrotic or nephritic or both or as acute renal failure was noted for clinic pathologic correlation. The paediatric renal diseases were compared with adult renal diseases based on literature search. Also the geographic variations were studied and compared based on published data from different countries. Results: Nephrotic syndrome was the most common clinical presentation for paediatric renal diseases .Minimal change disease (37.8 %) and FSGS (22.4 %) cases commonly presented as nephrotic syndrome. PIGN (37.6 % cases) presented frequently as nephritic syndrome in the paediatric age group. Conclusion: Nephrotic syndrome is the most common indication for renal biopsy and minimal change disease is the commonest cause of nephrotic syndrome in children. Incidence of membranous nephropathy and IgA nephropathy is relatively less in India. PIGN is the most common cause of acute renal failure in the paediatric age group. In systemic lupus erythematosus, most common presentation is nephrotic syndrome with class IV lupus nephritis being more frequent.

112-117

Authors: Rakshatha Nayak, Subhan Ali R, Nisha T.G.

Register Introduction: Septicaemia is one of the major causes of mortality and morbidity during the neonatal period especially in developing countries. Early diagnosis of neonatal sepsis is a diagnostic problem due to non-specific clinical features. Blood culture is the gold standard, but it takes several days and is expensive. Hence there is a critical need for laboratory tests that aid in the rapid diagnosis of neonatal sepsis. Aims and Objectives: To measure the role of Haematological Scoring System and C-reactive protein as an early diagnostic tool for neonatal sepsis. Materials and Methods: This was a prospective study performed on 116 neonates, who were clinically suspected cases of septicaemia, admitted at Neonatal Intensive Care Unit, Yenepoya Hospital, Mangalore. Each hematologic parameter like total leukocyte count, polymorphonuclear neutrophil (PMN) count, immature PMN count, platelet count etc. were analysed in all cases using the Haematological Scoring System (HSS) formulated by Rodwell et al. Blood cultures were performed as a gold standard. C-reactive protein (CRP) was also estimated. Results: Out of 116 neonates, 61(52%) were male neonates and 55(48%) were female neonates. 18(15%) cases were with proven sepsis, 58(50%) cases with probable sepsis and 40(35%) cases were on the safer side. The HSS was found to have a sensitivity of 94.4%, specificity of 75.5%, positive predictive value was 41.4% and negative predictive value was 98.6%. Conclusions: HSS is a rapid, simple and easily affordable screening tool for early detection of neonatal septicaemia. It also provides an effective guideline to make decisions regarding judicious use of antibiotics.

123-129

Authors: Shweta Agarwal, Ranjan Agrawal, Prachi Gupta, Prabodh Kumar.

Introduction: Head and neck lesions are very common in day to day practice. These diseases range from common cold to the uncommon, malignant neoplasms. These lesions are responsible for very high morbidity and mortality. Factors known to contribute to the risk of developing head and neck cancer are smokeless tobacco (Pan masala, soda), alcohol, HPV viral infections, etc. Smokeless tobacco is commonly used in Northern part of India, especially in Uttar Pradesh. Aim: To evaluate the diagnosis, frequency and histopathological subtypes of head and neck lesions and their distribution in different age groups and sex in Western Uttar Pradesh. Settings and Design: A retrospective study of 3 years from March 2014 to February 2017 was conducted and the data were collected from the archives of the department. The data were analyzed using SPSS version 15.0. Materials and Methods: All the biopsies from the head and neck region, which were submitted for histopathology in the Post Graduate department of Pathology, Rohilkhand Medical College and Hospital, Bareilly, were reviewed and analyzed for their demographic profile, age, gender, site and diagnosis. The lesions were then categorized accordingly as inflammatory, benign and malignant. Results: All the lesions of head and neck region, diagnosed on histopathology were included in the present study. A total of three hundred twenty one biopsies were studied, including 212 (66%) males and 109 (34%) females (M: F=1.9:1). 197 (61%) of the cases were benign, followed by 69 (22%) malignant and 55 (17%) inflammatory lesions. The maximum numbers of malignant cases were in the age group of 41 to 50 years with Squamous cell carcinoma as the most common histopathological type. The most common site of malignant lesions was the oral cavity. The maximum benign lesions were in the 11-20 years age group. Conclusions: The present study helped us in assessing the frequency as well as the different histopathological types of head and neck lesions in different age groups and gender in this part of the country.

136-144

Authors: Sujani C. Madabhushi, Shrinivas B. Somalwar, S. Chandrasekar, V. Vijay Sreedhar.

Introduction: Meningiomas account for 13%–25% of primary intracranial tumours and ~25% of intraspinal tumors and histological grading has prognostic and therapeutic implications. However, histological criteria are sometimes not fulfilled to predict the biological behaviour of meningiomas, necessitating use of adjunct ancillary techniques like immunohistochemical markers. The aim of the study was to assess the correlation between the p63 protein expression with MIB-1 labelling index in different histological grades. Materials and Methods: This was a retrospective and prospective study of patients with intracranial and intraspinal meningiomas diagnosed during the period 2009-2014. The H& E Stained histological sections of the entire meningioma tumour were graded according to WHO 2007 criteria. Immunohistochemistry was performed using p63 protein and Ki-67. Result: The age of the patients ranged from 4-75 years including seven children. Out of 135 cases, 46 (34.07) cases occurred in males and the remaining 89(65.92%) cases were females. There were 125 grade I, 06 grade II, 04 grade III meningiomas. Amongst Grade I tumours (n =125) 16% (n=20) exhibited nuclear positivity for p63 protein. Among Grade II (n= 06) and Grade III (n= 04), all showed strong immune expression for p63. Statistical significant increase in mean labelling index (MIB1) was noted between Grade I to II and Grade II to III. Conclusion: Increased p63 expression and Ki-67 labelling index is associated more with high grade Meningioma and possible recurrence.

150-153

Authors: Thejaswini MU, Geethamani V, Sushma TA, Suguna BV, Bhargavi Mohan.

Introduction: The term Corneal Dystrophy refers to a rare heterogeneous group of genetically determined, bilateral, symmetric, primary diseases, restricted to cornea and not associated with previous ocular inflammation. The dystrophies are classified based on the layer of cornea involved, into superficial, stromal and posterior dystrophies, each of which is genetically determined. Though the clinical features are often characteristic, definitive diagnosis is possible only after histological examination. The management protocols and visual prognosis vary with the underlying conditions. The incidence of the subtypes varies with the geographic locations. Objective: To study the prevalence of various subtypes of Corneal Dystrophies in corneal button specimens obtained after penetrating keratoplasty in a referral ophthalmic institute and to correlate with the patient’s age and sex. Materials and Methods: Corneal button specimens received in the ocular pathology laboratory over a period of five years were reviewed. Histopathological features of Corneal Dystrophies were studied and subcategorised. Cliniopathological analysis was made. Results: Out of 660 corneal biopsies reviewed, 42 cases were of corneal dystrophy. The patients were between 2 and 71 years of age, with 14 males and 28 females. Macular dystrophy was the most common with 20 cases, followed by Congenital Hereditary Endothelial Dystrophy (CHED) and Fuch’s endothelial dystrophy (FECD), with 7 cases each. Epithelial basement membrane dystrophy, Reis Buckler Dystrophy (RBCD), Granular dystrophy were the other types. Conclusion: Histopathological sub categorisation of various types of Corneal Dystrophies not only helps in understanding the prevalence, but also in predicting the genetic link and prognosis of the disease category.

157-160

Authors: Deepu Mathew Cherian, C. N. Sai Shalini, Leena Dennis Joseph, Bhawna Dev, Vishwanath M. Pai.

Invasive breast carcinoma – No special type (NST), Pleomorphic carcinoma is a rare morphological variant of invasive carcinoma NST. This is a case report of a 30 year old nulliparous woman who presented with a tender palpable mass in her right breast. Microscopic examination of the breast lump was predominantly composed of pleomorphic and bizarre cells. No positive lymph nodes or distant metastasis was present. This case report is to emphasise on the importance of identifying this variant of breast carcinoma because of its prognostic significance.

164-165

Authors: Sujitha J., Leena D Joseph, J. C.Bose, P. Prithviraj, Sathish Srinivasan.

Renal cell carcinoma (RCC) is the most common primary renal malignant neoplasm in adults, accounting for 90% of renal tumours and 2% of all adult malignancies. Distant metastasis has been reported commonly to bone, lung, abdomen, brain etc. Soft tissue and skeletal muscle metastasis is rare. This is the case of a 59 year old female, who presented with a left lower chest wall mass, which was proven to be a metastatic deposit from a clear cell RCC. The rare presentation in skeletal muscle should be suspected, which should also be differentiated from a benign soft tissue tumour.

170-172

Authors: Simi C. M., K. R. Leenadevi, Boben Thomas.

We report a case of isolated myeloid sarcoma (MS) of maxillary sinus in a patient who had no evidence of leukemia at the time of diagnosis of MS. A 39 year old healthy woman presented with right cheek swelling of one year duration. CT scan of paranasal sinuses showed an illdefined, heterogenously enhancing soft tissue density lesion in relation to right maxilla. CT findings suggested the possibility of inflammatory phlegmon with osteomyelitis. Biopsy showed a malignant round cell neoplasm which on immunohistochemistry was confirmed to be myeloid sarcoma. On follow up, one month later her peripheral blood and bone marrow showed features of Acute Myeloid Leukemia which was confirmed to be AML- M2 on Flow cytometry. The diagnosis of myeloid sarcoma has always been difficult especially when it is presenting in an unusual location in a non leukemic patient.