Indian Journal of Pathology and Oncology

360-365

Authors: Shivaji D. Birare, Apurva R. Dale

A wide spectrum of neoplasms are encountered in the ovary because of the totipotential and multipotential capacity of ovarian germ cells and mesenchymal cells. Ovarian neoplasms are the cause of highest mortality in female genital tract neoplasms. Aim: this study was undertaken to assess the age distribution, presentation and the morphological variants of ovarian neoplasms. Materials and Methods: a retrospective and prospective study was undertaken in the department of pathology from January 2013 to December 2017. Results: out of 105 cases analysed, 98.10% were primary ovarian neoplasms while 1.90% were metastatic tumors. Majority, 85.71% were benign while 8.57% were malignant. Commonest tumors were the surface epithelial tumors (72.38%) followed by 18.09% germ cell tumors and 7.61% sex cord stromal tumors. Benign tumors were common in 4th decade while malignant were common in the 5th decade. The most common presenting complaint was pain in abdomen. Conclusion: Evaluating the exact morphological type is essential in today’s era of targeted therapy for cancer. Further studies on larger population groups are essential to evaluate the outcome with respect to histopathological typing, grading and staging of ovarian tumors.

370-374

Authors: Prashant G Mankar, Sunil Deshpande

Present study was carried out to determine the contribution of early renal biopsy in diagnosis and management of acute renal failure (ARF) cases suspected on clinical grounds to be other than acute tubular necrosis (non ATN-ARF). Total 37 cases fulfilled the inclusion criteria. In 20 out of 37 (54.05%) cases the clinical diagnosis was in concordance with biopsy diagnosis. In 13 out of 37 (35.13%) cases the clinical diagnosis was in discordance with biopsy diagnosis which altered the management of the patient. Remaining 4 out of 37 (10.81%) cases were not diagnosed clinically and diagnosis of ARF was totally based on renal biopsy. So overall management alteration in non ATN - ARF patients was 45.94% (17 out of 37 cases). Thus, early renal biopsy contributes to specific treatment and therefore the outcome of patients with non ATN–ARF.

382-384

Authors: Dina Mary .M, Arasi Rajesh, Suresh Durai J

India is the most tuberculosis prevalent country in the world. Many cases of active tuberculosis are diagnosed at autopsy. This study was aimed to determine the autopsy prevalence of tuberculosis over a period of 3 years at a tertiary care centre. Out of 801 cases of autopies done in 3 years, 27 cases (3.37%) had tuberculosis and 92.59% of cases were active tuberculosis. Most of the cases were seen in men of 40-50 years age group. There is an increasing trend in number of cases over the years. Autopsy cases of tuberculosis can be a source of transmission to health care providers in autopsy rooms and in pathology department. Complex clinical histories prevent the clinical diagnosis of tuberculosis, so clinicians should be sensitised and stringent screening for tuberculosis should be done in all patients with respiratory symptoms.

391-397

Authors: Charusheela R. Gore, P. R. Bardapurkar, Sourabh Paranjape, Shreya Patel, Kunjal Karia

Introduction: Pancytopenia is an important clinico-hematological entity encountered in our day-to-day clinical practice from a number of disease processes primarily and secondarily involving bone marrow. This study was carried out to evaluate bone marrow findings in patients with pancytopenia. Materials and Methods: This is a prospective cross sectional study carried out on 140 pancytopenia patients over the period of one and half years. Relevant clinical details were recorded, followed by screening of patients for routine blood investigations included a complete blood count, peripheral blood smear examination, reticulocyte count. Bone marrow aspiration was done in all cases and bone marrow biopsy performed whenever necessary and Perl’s Prussian blue stain for grading of bone marrow iron stores were done in all cases. Data analysed was compared with various studies published in literature. Results: The maximum cases of pancytopenia were in the age group of 31 to 40 years with male preponderance. Dimorphic anemia (49.3%) was found to be the most common etiology of pancytopenia followed by megaloblastic anemia (35%), iron deficiency anemia (5.7%). We encountered two cases of non-Hodgkin’s lymphoma and one case each of multiple myeloma, acute lymphoblastic leukemia, aplastic anemia and anemia of chronic disease. Most common clinical presentation was pallor followed by fatigue and fever. Conclusion: Present study concludes that basic primary hematological investigations along with bone marrow aspiration/trephine bone biopsy in the pancytopenia patients are helpful in understanding the disease process. This plays a key role in planning the further management.

398-404

Authors: Ranjan Agrawal, Ankita Srivastava, Nitesh Mohan, Anjana Arya, Jagdamba Sharan, Arun Singh

Introduction: Gall bladder diseases are a cause of great concern. Cholelithiasis has troubled humanity since long and has been a common disease worldwide. They are among the most common gastrointestinal conditions presenting with acute pain in abdomen. Gall stone disease is usually common among middle aged females who are fertile and fatty. Materials and Methods: The present study was conducted in in the Department of Pathology of a tertiary care teaching Institute of Western Uttar Pradesh. The study period was one year (October 2015–September 2016) with a sample size of 500 cases. Gross examination of gall bladder was done in the department and sections from representative areas were taken for microscopic examination. Special stains were used as and when required. Statistical analysis was carried out to assess the significance of various risk factors and mucosal changes in different age groups and genders. Results: of the total 500 cases, 441(88.2%) were females and 59(11.80%) were males. Maximum cases of gall bladder disease were in the age group of 31-40 years in both the sexes. Amongst all lesions, 394 (78.8%) patients had gallstones and 106 (21.2%) were acalculous. Majority of the gall stones were of mixed type in 310 (78.69%) cases. The commonest pathological mucosal changes observed included chronic cholecystitis with cholelithiasis in 250 (62.5%) cases. 50 cases each in the pre-malignant and malignant category were observed. Conclusion: Gall bladder diseases are most commonly seen in females. Majority of cases were of chronic cholecystitis with cholelithiasis. Gall stones mainly injure the mucosal columnar epithelium leading to changes such as metaplasia, dysplasia or neoplasia. Knowledge of non-neoplastic as well as pre-neoplastic conditions is important especially since they cause significant morbidity or even mortality.

411-414

Authors: Akash C. Chhabra, Navinkumar R. Patel

Introduction: Human pregnancy also known as gestation, is the time between fertilization of ovum to delivery of a baby. It is approcximately a process of 9 months during which new baby develops inside a womb. Physiologically, pregnancy is a hypercoagulative state. Hypercoagulable state in pregnancy is a naturally occuring preventive response to prevent excess loss of blood during delivery. It is essential to know the range of variations of the coagulation factors during normal pregnancy, if any specific component has to be incriminated as a causative agent for the vascular disorder. Preeclampsia is a serious and life threatening complication in pregnant women. It is a pregnancy specific disorder which rates among one of the major causes of maternal and foetal morbidity and mortality. Aims and Objectives: To evaluate severity of eclampsia by estimating coagulation profile tests in pregnancy induced hypertensive patients. To compare these biochemical parameters between the test group and control group. To correlate the outcome of pregnancy with these biochemical parameters. Materials and Methods: This retrospective study includes 120 females of uncomplicated pregnancy of age group 16-35 years as a control group and 120 females of same age group with pregnancy with hypertension (PIH) attending obstetric outdoor patient department (OPD) of the institute in the year of 2015. Blood samples are withdrawn from all participants for biochemical markers of coagulation study that includes total platelet count (PC), prothrombin time (PT) and activated partial thromboplastin time (APTT). Results: Among total 120 PIH participants, 44 (36.67%) cases were having mild gestational hypertension, 11 (9.17%) cases were having severe gestational hypertension, 34 (28.33%) cases were having mild preeclampsia and 31 (25.83%) cases were having severe preeclampsia. The mean value of PT and APTT is found to be high in PIH cases as compared to control group participants. Conclusion: Parameters like total platelet count (PC), prothrombin time (PT) and activated partial thromboplastin time (APTT) can be used routinely as an early indicator for the assessment of PIH cases and also for detection of its severity. It can also be used to monitor the progression of gestational hypertension to prevent serious complications like preeclampsia and eclampsia. More number of preeclampsia cases are seen in underdeveloped and developing countries due to late diagnosis and inadequate antenatal services.

418-420

Authors: Ashish Tayde, Chetna Agrawal, A. T. Deshmukh

Patients with autoimmune connective tissue diseases often have antibodies that are directed against multiple nuclear antigens called as antinuclear antibodies (ANA). Two testing methods i.e. ELISA and indirect immunofluorescence (IF) techniques are used to detect these antibodies. Though ELISA is a cheaper method, IF is a preferred method for detection of ANA. In our study we have compared these two techniques for their diagnostic performance. Both the testing methods were applied on 155 samples. Of these, 135 samples were from test group and 20 samples were controls (negative and positive controls). Of the 135 test samples, IF yield positive results in 25(18.51%) cases and was found negative in 110(81.49 %) cases. Positive results were found by ELISA in 20(14.81%) cases and negative in 115(85.19 %) cases. Samples showing positive results with both methods were 18(13.33%) and samples showing negative results with both methods were 108(80.0%). 07(5.18%) cases that gave negative results by ELISA were found to be positive by IF. 02(1.48%) samples that were found to be positive by ELISA were negative by IF. Sensitivity & specificity of ELISA was compared with IF and was found to be 90.0% and 93.9% respectively. From this study it can be concluded that for testing ANA, IF is better than ELISA.

429-434

Authors: Jehan Nizam Ansari, Archana Chirag Buch, Aditi Pandey, Ruby Rao, Ayesha Siddique

Introduction: Fibroadenoma commonly known, as ‘Breast Mouse’ is freely mobile, benign tumour of the breast. It is composed of epithelial and stromal components. These components may show varied histomorphological changes. The aim of the present study is to explore the histopathological features of the epithelium and stroma within and around breast fibroadenoma. Materials and Methods: This is a retrospective and prospective unicentre study on total 317 cases of fibroadenoma over a period of two years. Formalin fixed specimens were grossed and stained with routine H&E. Further detailed histopathological examination was done. Results: Simple features were noted in 94% whereas 6% showed complex features. On detailed HPE, proliferative epithelial changes like mild ductal hyperplasia was seen in 73.5% of cases followed by moderate ductal hyperplasia seen in 12.6%. Among the fibrocystic epithelial changes apocrine metaplasia, cystic changes and calcification were observed in 35.91%, 18.3% and 5% cases respectively. Only 71 cases had adjacent parenchyma revealing insignificant changes. Increasing age had statistically significant relationship with complex features. This is statistically significant with p value < 0> Conclusion: Histopathological Examination of fibroadenomas should be done thoroughly to see atypical, complex changes or any malignant feature. Further follow up should be recommended in cases with proliferative changes for early detection of malignancy.

441-445

Authors: Ruchee Khandelwal, Rohit Sharma, Deepti Agarwal, Aakriti Baijal

The present study entitled ”Study of p53 gene expression as a prognostic marker in squamous cell carcinoma of oral cavity” was conducted in the department of pathology SRMSIMS Bareilly, 66 cases diagnosed on histopathology as squamous cell carcinoma of oral cavity from Jan 2016 to Jan 2017 were included in the study. Various parameters analysed for each case included age, gender, site, history of tobacco chewing, smoking &, alcohol consumption, histopathological grade of tumor and p53 expression. The patients age ranged from 24 to 85 years with mean age; 52.09 years and median age; 53 years. Maximum no of patients were male 54(81.8%) and 12 (18.2%) were female. Male: female ratio was 9:2. The most common site of presentation was lateral border of tongue (34.8). In the present study 89.4% were tobacco chewers, 72.7% were alcoholics and 57.6% were smokers.34 cases (51.5%) were diagnosed as well differentiated, 26 cases(39.4%) as moderately differentiated and 6 cases (9.1)% as poorly differentiated squamous cell carcinoma. The p53 expression was observed in 41(62.1%) of cases. The expression of p53 increased with the grade of tumor. The positivity being 17(50%) in cases of well differentiated, 19(73%) in moderately differentiated and 5(83%) in poorly differentiated squamous cell carcinoma. In present study p53 expression is found to be significantly related with tobacco chewing (p value= 0.034), smoking (p value= 0.0046) and tumor grade (p value=0.030). However no association was found with alcohol consumption (p value=0.917) the increasing prevalence of p53 expression with increasing grade of tumor suggests that it can be used as a prognostic indicator in oral cavity cancers.

450-453

Authors: Akashdeep Singh, Shikha Aggarwal, Neena Sood, Pavneet Kaur Selhi, Aminder Singh

Introduction: Malignant pleural effusion is an important complication found in patients of advanced cancers and lead on to exudative effusions. Not much data is available regarding malignant pleural effusions with unknown primary sites so we had conducted a retrospective study to highlights the primary sites in cases of malignant pleural effusions. Materials and Methods: The present study was conducted at a tertiary care centre at Ludhiana, Punjab. Retrospective analysis of case records of 104 patients, diagnosed as malignant pleural effusions on cell cytology out of 2948 cases of pleural fluids during a 6 years period (2012 to 2017) was done and the results were analysed to assess the causes and various primary sites of malignant pleural effusion. Results and Conclusion: A total of 104 pleural fluid samples were found to be positive for malignancy out of 2948 cases of pleural fluids during the study period time. Lung carcinoma was found to be the most common cause of malignant pleural effusion. On morphology, adenocarcinoma was the most common type of cytological diagnosis in all pleural effusions. Unknown primary malignancies presented as pleural effusions in many cases with no specific signs & symptoms. Cytological study can reveal the morphological diagnosis & clinch the primary site of origin in more than 50% of cases. Cytological analysis of pleural fluid should be the initial diagnostic approach to diagnose malignant pleural effusions and tapped effusions must always be sent for cytological study.

458-462

Authors: Harshid L. Patel, Vandana N. Patel

Introduction: The microalbuminuria is defined as urinary excretion rate of albumin is between 20 µg/min and 200 µg/min or between 30 mg/24 hrs and 299 mg/24 hrs. Proteinuria as well as microalbuminuria are independent predictors of cardiovascular morbidity and mortality in patients with essential hypertension. Microalbuminuria is an early marker of diabetic nephropathy. Early recognition of microalbuminuria in diabetic nephropathypermits successful therapeutic intervention and significant postponement of terminal renal failure. Aim: The purpose of present study was to evaluate the prevalence of microalbuminuria in patients with diabetes and hypertension and to check relationship between severity of hypertension with extent of renal dysfunction and its associated coronary artery disease and target organ damage. Materials and Methods: This retro prospective study was conducted in central clinical laboratory of pathology department at Sir Takhatsinhji General Hospital attached with Government Medical College, Bhavnagar, Gujarat, India. In present study we included 100 participants of both sexes having diabetes and hypertension. We also included 25 normal healthy, non-diabetics, non-hypertensive people as control group. Results: Duration of diabetes in all patients varies from 6 to 25 years. All patients were positive for microalbuminuria in diabetes ranging from 16-20 years. Most of the patients (80%) were having hypertension for more than 7.5 years were positive for microalbuminuria. Conclusion: ‘Micral test’ is a rapid, simple, reliable and cost effective diagnostic tool for detection of microalbuminuria. Blood pressure, blood glucose, serum creatinine and serum cholesterol levels are significantly higher in microalbuminuria patients. Hence, the elevations in diabetic patients mark the need for ‘Micral test’ for detection of early renal involvement.

463-469

Authors: Saritha Karre, Amrutha Gorva, Chandrakumar Shanmugam, V. D. Praveen Kumar Gorrela, Satyanarayana Vee

Introduction: The bipartite adrenal gland has tumors arising from cortex, medulla or as metastasis from extra-adrenal sites. Distinguishing benign from malignant types is a challenging task for pathologists, this study gives an insight into adrenal lesions with their histopathological and immunohistochemical findings and its role in categorizing these tumors to aid in their diagnosis and proper management. Aim: To study the Histopathological patterns of adrenal lesions with clinical correlation. Materials and Methods: In a five year period10 surgical specimens of adrenal tumors were resected and studied between July 2010 to June 2015 at Kamineni Institute of Medical Sciences, Narketpally and King Koti. Tissues were processed and stained sections were studied for histopathological patterns and IHC markers used were vimentin, synaptophysin, NSE, chromogranin immunohistochemistry was done wherever necessary and the markers used were vimentin, synaptophysin, NSE, chromogranin. Result: Out of ten adrenal lesions we have studied, two cases were adrenal cysts,1 three were cortical adenoma, one case is Adrenocortical carcinoma-positive for synaptophysin, vimentin, two cases were neuroblastoma-positive for NSE, chromogranin and synaptophysin and two cases are pheochromocytoma - positive for chromogranin. Conclusion: Pathological evaluation and immunohistochemical profiling has got important role in categorizing adrenal tumors along with clinical, radio logical and biochemical inputs and their subsequent management.

477-483

Authors: Ramesh B.H, Rajeshwari .K

Introduction: Abnormal uterine bleeding is considered as one of the most common and perplexing problems both to the patient and gynecologist. Histopathological diagnosis of organic cause of menorrhagia plays an important for appropriate and accurate therapy. Aims and Objectives: The present study mainly aimed at correlating histopathological findings with age, parity and bleeding pattern presented by the patient and to study various associated organic lesions in abnormal uterine bleeding. Materials and Methods: A reterospective study of 111 hysterectomies in patients with complaints of abnormal uterine bleeding over a period of one year from June 2016-May 2017. The histopathological findings with clinical data that includes age, parity, presenting symptoms and other details of the patients with abnormal uterine bleeding was collected and analyzed. Results: In this study, majority of cases were in 4th & 5th decade (81.08%) and were multiparous (93.7%). Menorrhagia was the most frequent presenting complaint (58.57%) followed by metrorrhagia in 13.51%. Of the 111 cases, 51.35% of cases showed histological features of dysfunctional uterine bleeding followed by 48.65% cases with organic lesions. Among organic lesions maximum number of cases of adenomyosis followed by leiomyoma was observed. Conclusion: Clinico-histomorphological evaluation of abnormal uterine bleeding in our study showed maximum number of dysfunctional uterine bleeding followed by adenomyosis and leiyomyoma. Age has definite influence on endometrial histology. There is no constant relationship between the pattern of endometrium and the type of bleeding in cases of abnormal uterine bleeding.

487-493

Authors: Chetna Sharma, Babu Jacinth, Vijayakumar Harivanzan

Introduction: The relative reliability of the morphological features for making a diagnosis of PTC when considered independently is debatable. Quantification of morphological features has been attempted to improve the diagnostic efficacy of FNA thyroid, but universal acceptance is lacking. Aim: This study was aimed to analyze the independent diagnostic significance of the four common morphological features-Nuclear grooves (NG), Intra-nuclear cytoplasmic inclusions (INCI), Papillary Fragments and Metaplastic Cytoplasm, in thyroid swellings using a quantitative approach. Materials and Methods: Retrospective study including thyroid FNA cases with corresponding histopathological report was analyzed. Eighty six cases had at least one of the four morphological features mentioned. The cases with NG were categorized into three groups: >/= 20%; 10-19% and <10> Results: The sensitivity, specificity, PPV and NPV of NG for PTC in the category of ? 20% was 53.3%, 98.2%, 94.1% and 79.7% respectively and the same in the category of > 10% were 66.7%, 75%, 58.8% and 80.8% respectively. Specificity and sensitivity of ‘Frequent’ INCI were 100% and 36.67% respectively. Conclusion: Typical morphological features of PTC can be seen in non-malignant conditions as well. Occurrence of NG >20% and INCI >5% are highly specific for the diagnosis of PTC. Cases with NG between 10-19% should be considered as ‘suspicious for malignancy’ and pathologist should cautiously look for other morphological features.

498-504

Authors: Ruchee Khandelwal, Deepti Agarwal, Surbhi Bansal

A retrospective study was performed to evaluate the diagnostic yield of lung cancer on biopsy, bronchial washings and brushings taken at fibreoptic bronchoscopy. Records of 526 patients were analysed and eventually 107 patients with endobronchial lesions, who had had biopsy, washing and brushing were included in this study. 89 cases were found to be malignant. Squamous cell carcinoma was the most common malignancy. Brush was found to be better than wash in tumor typing, though overall tumor typing using cytology was poor. Sensitivities of bronchial wash, bronchial brush and biopsy were found to be 70.8%, 64% and 94.4% respectively. Biopsy gave the only positive result in 38.2%, only brush in 1.1% and only wash in 1.1% malignant cases. Diagnostic accuracy of bronchial biopsy, brush and wash was found to be 95.3%, 70% and 73.8% respectively. Addition of bronchial wash and brush increased the positive yield by only 2.2% which was insignificant. It was concluded that the wash and brush cytology do not significantly add to the overall yield of positive results obtained from biopsies in endobronchial lesions.

509-511

Authors: Ajitha Porkodi KV, Thanka Johnson, Rajendiran Swaminathan, Susruthan Muralitharan, Lawrence D Cruze

Of the many benign mimickers of soft tissue sarcoma, proliferative fasciitis is a rare entity which is a diagnostic challenge for pathologist. Recognition of this pseudo sarcoma is very essential as it aids in the appropriate management of the same. Other members of the pseudo sarcoma family are proliferative myositis, nodular fasciitis, inflammatory pseudotumor and proliferative peribursitis. We present 3 cases of proliferative fasciitis which was reported in our hospital in the last 10 years, between 2007 and 2017.

516-517

Authors: Vadlamudi Swathi, HR. Chandrasekhar

Oncocytic lipoadenoma a rare benign neoplasm of salivary gland was first described by Hirokawa et al in submandibular gland. We report a case of oncocytic lipoadenoma (oncocytic sialolipoma) in a 69 year old male who presented with an asymptomatic mass in right parotid region for the past 3 months. Grossly the lesion was well encapsulated with homogenous mahogany brown with focal grey yellow areas. Microscopically the lesion was completely encapsulated and showed an intimate admixture of oncocytes and mature adipocytes in almost equal proportion, with areas of focal sebaceous differentiation