Indian Journal of Pathology and Oncology

186-188

Authors: Rupali Bavikar, Arvind Valand, (Col) Harsh Kumar, Charusheela Gore, M B Iqbal

Background: India has the highest burden of TB in the world, an estimated 2 million cases annually, and accounting for approximately one fifth of the global incidence. It is also estimated by the World Health Organization (WHO) that 300,000 people die from TB each year in India. The diagnosis of tuberculosis may not be established during the inpatient stay due to many reasons (e.g. extra pulmonary TB, TB in immunocompromised host etc). We did an autopsy study to find out the prevalence of tuberculosis at post mortem in medical inpatients at a tertiary care hospital in Mumbai, India. Methods: This is a prospective study and analysis of 112 consecutive medical autopsies of patients over a period of 12 months carried out at Grant Medical College and Sir JJ group of Hospitals, Mumbai, India. During this period, there were a total of 1558 deaths. A total of 112 medical autopsies were performed and included in this study. We did gross pathological and histopathological analysis. The primary outcome measure was specific disease or diseases. Secondary outcomes were missed tuberculosis, and co morbidities with tuberculosis. Results: The median age of the 112 included patients was 32 years, 70 (63%) were men and 42 (37%) were females. 24 (21%) patients had tuberculosis, of whom 15 (62%) were infected with HIV. 13 (55%) of these 24 patients had disseminated tuberculosis. The risk of disseminated tuberculosis was higher among HIV infected patients than among uninfected patients with 11 of the 13 cases of disseminated tuberculosis diagnosed in HIV infected patients (p<0.009). 6 (33%) of 24 patients with tuberculosis were not diagnosed during their life. Conclusion: Tuberculosis remains a major cause of death in India. Tuberculosis often remains undiagnosed and hence there is a need to increase awareness and actively screen for tuberculosis especially in HIV positive patients.

215-218

Authors: Kulwant Singh, Roque G. Wiseman Pinto

Background and Objectives: Fine needle aspiration cytology is a widely used first line investigation for breast lesions in surgical practice. Gynecomastia is the most common lesion of male breast. FNAC is usually asked for male breast lesions in case of unilateral breast enlargement to rule out malignancy. This study was done to obtain sensitivity, specificity, other statistical parameters and cytohistological correlation in FNAC of male breast lesions so as to know its diagnostic utility. Methods: Study was performed at Goa medical college over a period of seven years. Only the cases with availability of histological diagnosis were included in the study. All slides were stained with Hematoxylin and eosin after fixation in alcohol-ether mixture. Results: Sensitivity, specificity, accuracy, positive predictive value and negative predictive value were 100% for FNAC of male breast lesions. Excellent cytohistologic correlation was also observed. Conclusion: These results indicate that FNAC of male breast lesions shows excellent specificity, sensitivity and cytohistologic correlation. Hence, it can be used in initial diagnostic workup of lesions of male breast.

236-239

Authors: Vijay Shankar S, Manyukumar Vaidya, Amita K

Background: The clinical diagnosis of acute appendicitis(AA) in children and adolescents is still problematic. Objectives: To evaluate the role of Mean Platelet Volume(MPV) in acute appendicitis in children and adolescents. Materials and methods: A retrospective study involving 52 test and 51 control individuals. The statistical analysis expressed as mean MPV ± standard deviation, independent ‘t’ test for calculating p values. Results: In the Group ‘T’ mean MPV was 7.48 and in Group ‘C’ was 8.02. The p value was 0.027 which is less than 0.05 indicating it was statistically significantly lower than the Group ‘C’. Conclusion: Current study indicated that MPV decreases significantly in AA group of children and adolescents. Hence we believe taking MPV into consideration will help in the diagnosis of suspected acute appendicitis in children and adolescents.

251-261

Authors: Ravikanti SK, Abdul Hakeem Attar, Sunitha BR, Murugesh SB

Introduction: Viralskin and mucocutaneous disorders are common in HIV infection and may be the earliest manifestation of the disease. The spectrum of these disorders is wide and may vary in different regions due to varying prevalence of various microbial agents. Therefore, we studied the seroprevalence of HIV infection in patients presenting with skin and mucocutaneous disorders and clinical and regional epidemiological profile of seropositive patients. Objectives: To know incidence of viral opportunistic infections in HIV, with special reference to CD4 counts. Materials and Methods: This is a prospective study. Incidence of clinically and laboratory confirmed cases of viral opportunistic infections in HIV patients are recorded. Blood of these patients were processed for CD4 counts, by Partech Flow cytometry to assess the immune status among them. Results: 85 HIV seropositive patients with viral opportunistic infections with age group of 15-45 years, attending the outpatient and inpatient department for the period of one year from June 2013-June 2014 at Chigateri General Hospital, ART center, were included in this study and CD4 counts were done among them. Out of these,70(88.2%) patients had Herpes zoster with CD4 counts <200mm3, 5(5.8%)patients had Herpes simplex labialis with CD4 counts <200mm3(2.3%), patients had molloscumcontagiosum with CD4 counts <100mm3,1(1.1%) patient each of Herpes genitalis, Cytomegalovirus pneumonia, Ebstien virus infection with CD4counts <200mm3(2.3%) patients of combined infections of Herpes zoster and hepatitis B observed with CD4 count <100mm3(2.3%) patients of combined Herpes zoster and molluscumcontagiosum observed with CD4 count <50mm3. Commonly observed risk group were heterosexual, blood transfusion, non agriculture group, local transport worker and housewife. Conclusions: In this study attempt was made to know the incidence of viral opportunistic infections in HIV seropositive patients with low CD4 counts, in which CD4 counts can be considered as clinical score,which serve as an alarm for timing of prophylaxis and a guide for therapeutic intervention.

265-276

Authors: Gayatri Gogoi, M. Borgohain, H Saikia

Background: Breast cancer is a heterogeneous disease with varied morphological appearances, molecular features, behavior, and response to therapy. High levels of human epidermal growth receptor 2(HER2/NEU) expressions are associated with recurrence and death in breast cancer (BC). Though it is associated with poorer survival but its main importance is as predictors of response to agents that target this transmembrane protein (transtuzumab). The aim of the study was to evaluate the expression pattern of HER2/NEU in invasive component of breast carcinoma and correlate with various prognostic parameters such a tumour size, histologic grade, histologic type, regional lymph node status, and proliferative marker Ki67. Study Setting & Design: A total of 112 breast cancer cases were studied for the histomorphological features followed by immunohistochemical study in the Department of Pathology of a tertiary care hospital. Material and methods: The lumpectomy or mastectomy specimens were fixed on 10% neutral buffered formalin immediately after surgery in 10 fold volume. Important clinical information from patients were collected in Performa. Finally routine hematoxylin and eosin sections were examined to confirm presence of invasive cancer, ascertain histological types, Histological Bloom Richardson grade (BRG)1 and axillary lymph node status. IHC of HER2/NEU protein was done using HER2/NEU antibody following standard procedures. The tumour was also immunostained with Anti ER, Anti PR, and Ki67 primary antibody. Statistical Analysis: Data was analyzed by SPSS software. Results and observation: The mean age of breast cancer presentation in this study was 44.6 years with standard deviation 11.24.This IHC evaluation for HER2/NEU was positive with 3+ score in 18.75% of cases. The data of HER2/NEU expression profiles were correlated with 3 BRG histologic grades of the tumours, it showed a positive association with high histologic grade. HER2/NEU profiles were inversely correlated with ER, PR expression (p value < 0.05). The HER2/NEU expression profiles was also correlated with tumour size and a significant relationship was found (p = 0.041).HER2/NEU positive tumours were belonged to mostly IDC.HER2/NEU expression profile was correlated with proliferative index Ki67 expression in this study and found a direct relationship (p < 0.005). Lymph node status and HER2/NEU showed a significant statistical correlation (p = 0.037). Discussion: The over-expression of HER2/NEU is associated with poorer prognosis, high grade features and resistant to usual chemotherapy10. Our study also revealed that the Patients with higher levels of HER2/NEU- overexpression or amplification had statistically significant with lower levels of ER and PR positive tumours. We also found that when Her 2 neu was positive in tumours along with ER and PR, then it was mostly high BRG and High Ki67.The new addition from our study wasHER2/NEU expression profile correlation with Proliferative marker Ki67 which revealed a positive association. Conclusion: The expression pattern of HER2/NEU protein showed a strong correlation with high Ki67 expression which means these tumours are likely to have higher proliferative fractions leading to high probability of recurrence without management by herceptin therapy.

284-289

Authors: Sanjay M, Sarvesh BM

Background: Good number of paediatric population present with mass lesions to the routine outpatient clinic. Triaging these patients into operative candidates and non-operative candidates is important to avoid them from unnecessary surgical exposure thereby preventing complications which may arise. Aim: The current study aims to evaluate the role of FNAC in pediatric and adolescent age group. Subjects and Methods: A retrospective study of FNAC in age group ≤ 18 years of age presenting with mass lesions was studied for 2 years. Distribution of cases in different age groups, sex, and site of lesion was analyzed. Pediatric lesions were categorized into non-neoplastic, benign, and malignant conditions. Diagnostic efficacy was assessed by comparing subsequent histopathological examination wherever possible. Results: FNAC was performed on 1804 cases in 2 years out of which 154 cases 8.5% (154/1804) were ≤ 18 years of age. Out of 154 cases analysed FNAC in the age group of 1 to 10 years constituted 35.7%(55/154) and in the age group of 11 to 18 years constituted 64.3%(99/154) of study population.Male to female ratio was 0.8:1, ultrasound guided aspiration constituted 1.9% of total number of cases.Most common site of FNAC was lymph node(40.2%) and the commonest finding was reactive lymphadenitis(50/62).Among the benign conditions of other sites Hashimotos thyroiditis in thyroid, Fibroadenoma in breast were the predominant findings.There were 3 malignant lesions one case each of Hodgkins lymphoma, Non-Hodgkins lymphoma and chondroblastoma. The cytological diagnosis concurred with the histopathological findings in all cases. Conclusion: FNAC is simple reliable and cost effective diagnostic modality in paediatric and adolescent age group. It becomes even more apt in a rural tertiary health care institute because of limited resources.

303-308

Authors: Zeenath Begum1, Abdul Hakeem Attar, Mandakini B. Tengli, Mohammed Mateen Ahmed

Background (Aims and Objective): Study of various histopathological patterns in TURP specimens diagnosed as Benign Prostatic Hyperplasia, identifying type and grade of inflammation, incidental detection of carcinoma prostate and application of modified Gleason system. Materials and Methods: From January 2014 to August 2015 a total of 50 TURP specimens were evaluated. The tissue blocks and H&E stained slides of the tissues were retrieved and slides reviewed. Various patterns of proliferation, types and grade of inflammation were studied and classified using standard methods. Incidentally identified carcinoma prostate were classified using WHO Classification and graded using modified Gleason system. Results: 48(96%) were BPH with co-existing chronic prostatitis 12(24%) granulomatous prostatitis 1(2%) and acute prostatitis 2(8%). Papillary hyperplasia was predominant finding 17(34%). Less frequent finding was basal cell hyperplasia, 6(12%) atypical adenomatous hyperplasia 4(8%) and cribriform hyperplasia 1 (2%). Proliferative inflammatory atrophy constituted 3 cases(6%).Scattered necrotic glands were present in 20(40%) cases, periglandular lymphoid aggregation was a frequent finding in these necrotic glands. we reported two cases of adenocarcinoma prostate with modified Gleason score of one (5+4=9) and another score of (5+3=8). Conclusion: With increase in the incidence and mortality rates from prostate cancer, every effort should be made to improve diagnosis. It is necessary to review periodically all TURP in order to identify premalignant lesions, proliferative activity, and grade of inflammation. Efforts should be made to apply modified Gleason system to improve management facility. We also conclude that proliferative activity and invasiveness increases from benign to the malignant end in the spectrum of prostatic lesion.

311-315

Authors: J. Sreedevi, M.Mishra, R.Mohanty, R.Narayan, F.Rana

Context: Sebaceous cell carcinoma is a malignant neoplasm, rarely recognized in extra ocular sites. This neoplasm is aggressive in 29% of patients, lymph node and visceral metastasis are common. Its prognosis depends on early diagnosis of lesion. Clinical & Diagnostic features: An 49 year old female had slow growing nonulcerative subcutaneous nodule on the nape of neck of 9 months duration. On FNAC cytological findings favoured a benign skin adenexal tumor with focal nuclear atypia. On histological examination it was diagnosed as a poorly differentiated sebaceous carcinoma. Conclusion: Extra ocular sebaceous carcinoma is a rare neoplasm. It is difficult to diagnose as it has diverse clinical presentations, histologic patterns and complicated nomenclature. We will discuss the incidence, clinical, and histological findings along with the prognosis of this aggressive neoplasm.

113-117

Authors: Abhishek MG, Deepika

Background: Anaemia is the major serious preventable public health problem in Indian rural adolescent females. WHO report of 2002 states anaemia as the most common factor in infant mortality, maternal mortality and pre-term births. Simple health intervention programmes such as vitamin A and Iron supplementation with deworming can decrease the occurrence of anaemia. The present study was conducted to estimate the prevalence of anaemia among adolescent females, to assess the severity of anaemia and to correlate the association of factors like diet, anthropometry, socioeconomic status and menstrual flow with anemia. Methodology: The cross sectional study included 100 high school-going adolescent females whose Hemoglobin was estimated by three part automated hematology analyzer KX 21. Detailed history was elicited regarding socioeconomic status and menstrual flow. Anthropometric measurements were noted. Results: The prevalence of anaemia among adolescent females in our study in a rural area was found to be 40%. Amongst them, 55% had mild anaemia, 35% moderate anaemia and 10% severe Anaemia. Conclusion: Prevalence of mild to moderate anaemia is higher than severe anaemia in adolescent females. This may be attributed to the impact of school based intervention programs which exist since 2009, vitamin A supplementation, iron supplementation, deworming and dietary education.

121-125

Authors: Alok Mohan, Rajnish Garg, R.K. Thakral

Introduction: Case reports of pleomorphic adenomas of usual and unusual sites form a wonderful data in clinical and pathological literature. Pleomorphic adenoma is a biphasic tumor & characterized by admixture of polygonal epithelial & spindle shaped myoepithelial cells in a variable stromal background. Term “Mixed” benign tumor begets from such architecture. Aims and Objectives: The aim of the present study was to highlight the various clinicopathological aspects of pleomorphic adenoma and anatomically analogous tumors of various sites in our archives. Materials and methods: We performed an analysis of clinicopathological features of all “mixed tumors” from our archives. Observation and Results: In our study we studied 39 cases of pleomorphic adenomas from various sites. A few cases were unusual in terms of locations, size and presentation. Most common site is parotid salivary gland. Extra-parotid sites are submandibular glands, minor salivary glands, skin, external auditory canal and vagina etc. Wide surgical excision is treatment of choice. Histopathological diagnosis is rarely difficult. Immunohistochemistry (IHC) is mandatory, in case of suspicion. Conclusion: The results from the present study displayed the various presentations, locations and variability on histopathological architecture, thus highlighting the various clinicopathological aspects of pleomorphic adenoma and anatomically analogous tumors. IHC is required in difficult cases.

131-140

Authors: Fatima Shamsuddin, Urmila N Khadilkar, Debarshi Saha, Sily Sreedharan

Background: Mediastinal lymphomas are relatively uncommon lesions that sometimes pose an interesting diagnostic and therapeutic problem for the clinician. A multifaceted approach to both disease definition and diagnosis, as proposed by the Revised European and American Lymphoma (REAL) classification and updated in the WHO classification is now considered the state of the art. Objective: To classify and evaluate the histomorphology of mediastinal lymphomas and correlate the clinical findings with radiological, immunohistologic and other laboratory parameters. Method: A 5 year study was done in Dept. of Pathology, of a private Medical College on mediastinal lesions. Total number of cases studied was 66, with lymphomas making up 8 cases. Histopathology sections taken were stained with routine Hematoxylin and Eosin stains. Immunohistochemistry was done as required. Results: The age range of patients with mediastinal lymphomas were 12 to 80 years with a mean of 41 years. All non-Hodgkin’s lymphomas (NHL) were NHL-B cell type and were in the older age group. Three out of the four cases of Hodgkin lymphoma (HL) were mixed cellularity type and the fourth was nodular sclerosing type. The HLs were seen in a younger age group. Immunohistochemistry was done in all cases to confirm the diagnosis. Conclusion: Mediastinal lymphomas are rare & interesting neoplasms, usually located in all compartments of mediastinum. A histomorphological analysis aided by immunohistochemistry and radiology permits an exact diagnosis in many cases.

150-157

Authors: Sandhya S, Mathew C F, Jisha K T

Background: CDX2 is a caudal homeobox gene essential for intestinal proliferation and differentiation. Expression of its protein product CDX2 in gastric mucosa is strongly associated with intestinal metaplasia and gastric carcinoma. Objectives: 1. To study the incidence of intestinal metaplasia in gastric cancer 2.To study the expression of CDX2 protein in intestinal metaplasia and gastric carcinoma. Materials and Methods: The study was done for a period of 11/2 years on 50 gastrectomies. The gastric cancer was typed according to Lauren’s classification. Adjacent mucosa was assessed and those with intestinal metaplasia were typed into type I, II and III by histochemistry. Immunohistochemistry for CDX2 was done in all cases of intestinal metaplasia and corresponding gastric carcinomas.The staining was graded semiquantitatively and statistical analysis was done. Results: There were 34(68%), 9(18%) and 6(12%) cases of intestinal, diffuse and mixed type of gastric adenocarcinoma respectively. The most frequent change in adjacent mucosa was chronic gastritis with intestinal metaplasia. CDX2 immunostaining was positive in 24 out of the total 27 cases (88.8%) of intestinal metaplasia and 21 out of 27 cases (77.7%) of gastric cancer. All controls (100%) turned out to be negative, making the above observations statistically significant. Conclusions: Chronic gastritis with intestinal metaplasia is the commonest precursor lesion of gastric adenocarcinoma. CDX2 homeodomain protein which is not expressed in normal gastric mucosa is a sensitive marker for intestinal metaplasia and is closely associated with intestinal type of adenocarcinoma.

161-164

Authors: Rajat Gupta, Deepika Dewan, Jyotsna Suri

Background: Tuberculosis is still a global health concern. Most common presentation of extra pulmonary tuberculosis is tubercular lymphadenitis. In our setting, keeping huge burden of tuberculosis in mind, clinicians have to rely on pathological diagnosis of enlarged lymph nodes i.e. cytomorphology with acid fast staining in diagnosing these cases so that diagnosis and management of such cases can be initiated quickly. Fine needle aspiration cytology (FNAC) of lymph nodes has been a simple, rapid and cost effective procedure for diagnosis of various causes of lymphadenopathies. Our study is the first one in its type in J&K reporting the incidence and pattern of Tubercular Lymphadenitis in secondary level health care hospital. Aims: To report the incidence and describe various cytomorphological patterns of tubercular lymphadenitis in secondary care level Government Hospital, Gandhi Nagar, Jammu. Material and Methods: In a study period of two and a half years, two hundred and thirty one consecutive enlarged lymph nodes were aspirated and subjected to cytomorphological evaluation with Papanicolaou(PAP), Giemsa ,and Ziehl- Neelsen (Z-N) stained smears. Results: Incidence of tubercular lymphadenitis was reported as 34.6% (C.I 0.285-0.411). Around 80% of cases were in the second to fourth decades of life with mean age as 27.08 years and male to female ratio of 1:1.6 .Cervical region was the most common site of involvement with multiple unilateral lymphadenopathy as the most common presentation. The most common cytological picture was epithelioid granulomas with caseous necrosis (52.5%). Overall AFB positivity was seen in 65% cases. Conclusions: FNAC has proved as a very useful first line of investigation in patients presenting with lymphadenopathy, especially in secondary care centres.

170-171

Authors: Medhi Pranita, Dowerah Swagata, Sharma Mahak, Dutta Aparna

Renal teratoma is an extremely rare condition and may create diagnostic confusion with teratoid nephroblastomas or retroperitoneal teratomas with secondary involvement of the kidney .We report a 35 day old female child presenting in paediatric surgery OPD with complaints of pain abdomen and abdominal distension.. On palpation, a lump was felt in the lower abdomen measuring around 5x4x3 cms and a diagnosis of multilocular cystic nephroma was given on CECT abdomen. The kidney mass was excised and on gross examination, multiloculated thin walled cysts containing both mucinous and serous fluid with some areas of hemorrhage were noted. Microscopy revealed areas of columnar epithelium, squamous epithelium with keratin deposition, cartilage, bone, fibrocollageneous tissue and muscle tissue. A diagnosis of mature primary renal teratoma was given. This case was presented as primary renal teratomas are extremely rare and must be considered in the differential diagnosis of infantile renal masses.

175-178

Authors: Vijay Shankar S, Nanjundaswamy D, Amita K, Raghuveer CR

Thyroglossal duct cysts(TDC) are the most common congenital anomaly resulting in midline masses in children (70%in children and 1 % in adults). The occurrence of carcinoma is extremely rare in children as compared to adults. Because of the classical clinical findings of TDC’s preoperative diagnosis of malignancies within them are rarely done. Even fine needle aspiration cytology also less valuable in preoperative diagnosis. The final diagnosis is usually an incidental finding in histopathological examination of excised TDC’s. We report a rare case of papillary thyroid carcinoma in a 17 year old girl and reviewed in the pertinent background of evidence based literature

61-68

Authors: Geethu G Nair, Anupama Achyuthan Manjula

Cell-block preparations made from sedimented cells can be useful adjunct to the routine cytological methods used for pleural and peritoneal fluids. There are only few studies evaluating its diagnostic efficacy and additional benefits when used with routine cytology. This study was conducted to compare the diagnostic efficacy parameters of cell-blocks and routine cytological smears of pleural and peritoneal fluids in suspected cases of malignancy. A one year study was done in a Gov. Medical College on pleural and peritoneal fluids in cases of suspected malignancy. Total number of cases studied was 148. Cytology smears were stained with Papanicolaou stain and cell-block preparations of centrifuged deposits were processed cut at 5 micrometers and the sections stained by Hematoxylin and Eosin in every case. Additional stains and immunohistochemistry were done in the cell- block slides as required. Diagnosis of malignancy by any tissue based method within a period of three months of follow up was taken as the gold standard for analysis. Sensitivity of cell-blocks (0.6714%; 95% CI 0.5476-0.7762) was nearly double that of routine cytology (0.3230; 95% CI 0.2154-0.4517). Both methods had very high specificity. Cell- blocks proved to be superior to smears in pattern recognition and are advantageous when there’s need for immunohistochemistry. Use of cell-blocks as an adjunct to routine cytology smears of body fluids can increase the sensitivity to a considerable extent. It is of further use in pin-pointing a diagnosis by pattern recognition or immunohistochemistry.

73-75

Authors: Padmapriya K, Srinivasa Murthy V, Sandhya Lakshmi BN

Background: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasms of the gastrointestinal tract believed to originate from interstitial cells of Cajal. Development of GISTs outside the gastrointestinal system, called as Extra-intestinal gastrointestinal stromal tumor (EGISTs) is rare. Incidence of primary GIST in the greater omentum has been reported to be <1%. Case report: A rare case of EGIST in an 89 year old woman, arising from the greater omentum is presented here. In this patient EGIST was primary and of epithelioid type with prominent myxoid change. Conclusion: Recognition of myxoid epithelioid variant of EGIST is important as it is defined as a separate entity with availability of molecular targeted therapy.

81-83

Authors: Shulbha V S, Dayananda B S

Indian Journal of Pathology and Oncology (IJPO) is an interdisciplinary journal at the interface of pathology and oncology, including the preclinical and translational research, diagnostics and therapy. The journal covers studies related to pathology including morbid anatomy, surgical pathology, clinical pathology, diagnostic cytopathology including gynecologic cytology. Furthermore, IJPO offers an international forum for the rapid communication of reviews, original research, critical and topical reports with excellence and novelty. Published quarterly, IJPO is dedicated to keeping scientists informed of developments in its focused biomedical fields which span the gap between basic research and clinical medicine.

87-89

Authors: Subhash Chandra Jha

It’s a rare case of acute biphenotypic leukemia which initially presented in an elderly lady with generalized lymphadenopathy and mild hepatosplenomegaly. Biopsy of cervical lymph node was done and diagnosed as Non-Hodgkin’s Lymphoma. Bone marrow smears showed 40% lymphoma cells, a few showing single large nucleolus. Peripheral blood smear showed moderate anemia and leucopenia but normal platelet count. On the basis of cervical biopsy and bone marrow findings, patient was given two cycles of Cyclophosphamide Hydroxydaurorubicin Oncoverin Prednisolone (CHOP) but she did not respond. In view of non responsiveness to CHOP, Immunophenotyping of bone marrow aspirate was done and result showed co-expression of both T-lymphoid and myeloid markers in 90% of atypical cells along with marker of immaturity (CD34) in 72% cells. Analysis showed expression of CyCD3 in 90% cells, CD33 in 95% cells and 60% cells were cytochemically positive for Myeloperoxidase (MPO); thus it was a case of Biphenotypic Acute Leukemia (T-ALL+AML) as per WHO criteria for diagnosis of BAL. So it was an initial presentation of BAL with generalized lymphadenopathy and aleukemic peripheral picture.

93-95

Authors: M. Sridevi, Sonti Sulochana, Vimal Chander, Chitra Srinivasan

Syringocystadenoma papilliferum is a benign skin adnexal tumour with verrucous appearance that is commonly located in the scalp, neck and face. It usually presents at birth as a solitary papule or as multiple papules and increases in size after puberty. It occurs either de novo or within some lesions such as nevus sebaceous. We report a case of a 75 year old female with a cystic lesion in the labia majora, which on histopathological examination revealed syringocystadenoma papilliferum. This case is presented for its unusual location in the vulva as only a few cases were reported in this location in the literature.

98-100

Authors: Sily Sreedharan, Geethu G Nair

Eccrine spiradenoma is an uncommon benign adnexal tumour. Though its histopathology is well established, there are only very few case reports describing its cytomorphology. We are reporting one such rare case of recurrent swelling in back. Cytological features were suggestive of benign appendage tumour of eccrine differentiation, possibly eccrine spiradenoma. This case report is being presented for its rare description in the literature.

105-108

Authors: Amita K, Vijay Shankar S, Sarvesh, Abhishek M G

Giant cell fibroblastoma (GCF) is a rare soft tissue tumor of intermediate group occurring most commonly in children. Unusually it has been known to occur in adults and very rarely to involve patients older than 60 years of age. We report a rare case of giant cell fibroblastoma in a 72 year old female patient Pathologist need to be aware of the occurrence of this rare entity in advanced age and its morphology in order not to mistake it for a high grade sarcoma.

7-13

Authors: Suryawanshi Kishor H., Damle Rajshri P., Dravid Nandkumar V., Tayde Yogesh

Background: Head and neck lesions encompass a multitude of congenital, inflammatory or neoplastic lesions including several anatomic sites and originating in different tissues and organs. Fine needle aspiration cytology (FNAC) is a simple, quick, feasible, cost effective and repeatable outpatient procedure with minimal risk of complication. Aim: 1. To evaluate the role of FNAC and its utility in diagnosis of palpable head neck masses. 2. To study the spectrum of head neck lesions in rural population. 3. To study diagnostic accuracy of FNAC by histopathological correlation wherever possible. Material and methods: The study included 288 patients presented with palpable head and neck swelling in a tertiary care hospital from January 2011 to December 2014. Detailed clinical history of patient was noted. Aspirations were done by using 10 ml syringe and 22/23 gauge needles. Smears were stained with PAP, Haematoxylin and eosin and Leishman stain. Cytomorphological diagnosis was given. Cyto-histopathological correlations were done wherever possible. Results: Out of 288 patients of head and neck lesions studied, lymph node (39.58%) was the predominant site aspirated with tubercular lymphadenitis being the commonest lesion. Thyroid lesions constituted 31.25 % followed by salivary gland (18.75%), soft tissue and miscellaneous (7.29%). FNAC was inconclusive in 3.12 % cases. Overall accuracy rate of FNAC was 93.02% with sensitivity of 81.81 % and specificity of 96.87 %. Conclusion: Though excisional biopsy is the gold standard for diagnosis of head and neck neoplastic lesion. FNAC is a rapid, cheap diagnostic tool now-a-days with overall accuracy rate more than 90 %.

25-30

Authors: Nirmala T, Vani B R., Murthy Srinivasa V., Deepak kumar B., Geetha R L, Kumar Pradeep L.

Background: Hypertension is one of the common medical complications of pregnancy and contributes significantly to maternal and perinatal morbidity and mortality. Hypertension is a sign of an underlying pathology which may be pre-existing or appear for the first time during pregnancy. Various haematological changes like numerical and functional platelet abnormalities, alteration in haemoglobin and erythrocyte parameters and increase in the procoagulant state of normal pregnancy are seen. Aims and Objectives: Evaluation of Platelet indices in PIH. To identify the early platelet parameters predictive of preeclampsia and HELLP syndrome. Materials and methods: A 2 year study was carried out in the Dept. of pathology ESIMC, Bangalore on 100 PIH cases. Platelet indices is done in all the cases. P values for all parameters were statistically derived and evaluated. Results: Total of 100 cases were included in the study. 37 were mild GH, 9 cases were severe GH, 29 cases were mild preeclampsia and 25 cases were in severe preeclampsia group. Thrombocytopenia was observed in 23 cases and elevated MPV in 49 cases. Conclusion: Thrombocytopenia is identified as the most common complications of PIH and at times may be life threatening. Therefore estimation of platelet indices can be considered as an early, simple and rapid procedure in the assessment of severity of pre-eclampsia and to prevent progression to HELLP syndrome and DIC.

37-40

Authors: Rita Kumari, Sindhu Sharma, Priya Gupta

Laryngeal squamous cell carcinoma tends to exhibit local spread with a low incidence of distal metastases. The majority of distant metastases are to the lungs and renal involvement is extremely rare. We present a rare case of metastatic renal tumour originating from Laryngeal squamous cell carcinoma. Fifty year old male diagnosed two years back as Laryngeal squamous cell carcinoma, underwent complete chemo radiation and was clinically free of disease for about two years, now presented with gross haematuria. Physical examination revealed left renal mass which was confirmed on CT scan as heterogeneously enhanced mass in upper part of kidney. Nephrectomy was done. On histopathological examination, well-differentiated squamous cell carcinoma of kidney was reported.

44-47

Authors: Prerna Sachdeva, Anitha Padmaanabhan, Priyanka Katke, N.M Gadgil

The primary leiomyosarcoma invading the spine is an extremely rare neoplasm .We report a case of 75 year old male with no significant medical history presenting with weakness in both lower limbs and incontinence of urine and faeces since 15 days. MRI confirmed the presence a lytic lesion causing collapse of D11-D12 vertebrae with involvement of paravertebral soft tissue and 11-12th ribs. Decompressive surgery was performed for the same and tumour was sent for histopathological examination. On histology, tumour was found to be low grade leiomyosarcoma which showed positivity for desmin and smooth muscle actin on Immunohistochemistry.

53-56

Authors: Hawaldar Ranjana, Sodani Sadhna

India is an ethnically diverse country with marked regional variation. This diversity is reflected in the presence of different Hb variants in different ethnic groups. Hb J Meerut is one such rare variant detected by HPLC as abnormal peak (25.4%) in P3 window with a retention time of 1.85 minutes. This clinically asymptomatic variant has been reported to interfere with HBA1C estimation in diabetic patients.HBA1C values are routinely done to assess glycaemic control in diabetic patients. HbA1C values may be falsely low due to presence of abnormal HB variants. As HbA1C is based on haemoglobin, both quantitative and qualitative, variants in haemoglobin can affect HBA1C values.Here we report a case of a 45 year old male diabetic patient who had a spuriously low HBA1C value on HPLC with an abnormal peak in P3 window .Hb electrophoresis done to detect variant haemoglobin showed an abnormal peak (25.4%) in P3 window at a retention time of 1.85 minutes. A provisional diagnosis of HBJ Meerut was made which was confirmed by capillary electrophoresis.