Indian Journal of Pathology and Oncology

7-10

Authors: Ambedkar Raj Kulandai Velu, Banushree C Srinivasamurthy, Jhansi Rani

Objective: To evaluate diagnostic performance of fine needle aspiration cytology[FNAC] in diagnosis of benign breast lesions. Methods: Women who had FNAC diagnosis of benign breast lesion were followed up with histopathological evaluation to assess the diagnostic accuracy of FNAC. Results: Out of sixty benign cases diagnosed on FNAC, fifty eight cases were benign and one case each of mastitis and fibrocystic disease had infiltrating ductal carcinoma on histopathological examination suggesting 96.7℅ diagnostic accuracy of FNAC in diagnosing benign breast lesions. Conclusion: The correlation between cytology and histology showed that FNAC is an accurate test in diagnosing and managing benign breast lesions.

14-18

Authors: Anand Bhadkariya, Abhiraj Ramchandani, Swati Patel, Manju Purohit

Over: expression of Cytokeratin CK has been reported in malignant cells in aspiration cytology. Immunocyto-chemical detection of cytokeratin is an easier technique than molecular detection in malignant cells. Hence we investigated the presence of this protein in the most common malignant cells. Material and methods: We performed immunocytochemical ICC detection of CK in aspirate cytology of malignant cells with or without inflammatory and benign cells and correlated with varied patterns of CK positivity with respect to cytological diagnosis. Results: In the present study 40% cases of malignant cells were found positive for CK of which the most common pattern observed was diffuse cytoplasmic staining. Among the cases with SCC 66.6% were positive for over-expression of CK wherein diffuse pattern was observed. Conclusion: In the present study, significant number of SCC in aspirate cytology cases observed over-expression of CK. However SCC detection in aspiration cytology is a morphology based technique.

23-25

Authors: B K Sharma, U R Singh

Soft tissues range from very common lipoma to some of the rare tumours in medicine. These tumours were derived from soft tissues. The large majority of the soft tissues tumours are benign, with a high cure rate after surgical excision. The objective of present study was to study the histo-pathological patterns of soft tissue tumors and to find out different variation regarding age, sex & distribution in body. The present study was carried in Department of Pathology, from 21st December 2007 to 20th December 2008. A record of total of 2399 patients was taken. Among 111 positive samples for soft tissue tumor, 10 cases turned out to be malignant. The most common type of soft tissue tumor was Lipomatous in 58.6%, followed by fibroblastic/Myofibroblastic. Over all 56.7% of tumor were diagnosed among male, while 43.3% were diagnosed among females. The most common site that is involved is lower limb.

32-37

Authors: Rajat Gupta, Deepika Dewan, Dinesh Kumar, Jyotsna Suri

Background: Fine needle aspiration cytology (FNAC) is a simple, rapid, cost effective and useful method for diagnostic evaluation of salivary gland lesions due to their superficial nature and easy accessibility. Aim: To study the cytomorphological patterns of the salivary gland lesions and to perform histopathological correlation in suspicious cases in Government District Hospital, Gandhi Nagar, Jammu, India. Material and Methods: In the present study 74 cases were included. FNAC was performed using 22 gauge needle and 10 ml plastic syringe with a detachable syringe holder (Franzen Handle). In each case, three alcohol fixed smears were prepared ,first smear was stained with Papanicolaou stain, second with Giemsa stain and third one was kept unstained for any further required stain. Cytohistological correlation was made in 47 cases only. Results: Parotid gland was the most commonly involved salivary gland. Maximum cases were seen among age group of 21 to 30 years. Most common non neoplastic lesion was chronic sialadenitis while pleomorphic adenoma was commonest benign lesion and adenoid cystic carcinoma was more frequent malignant lesion. Sensitivity, specificity and diagnostic accuracy of FNAC was 66.6%, 95.8% and 93% in case of neoplastic lesions and 100% in non neoplastic lesions. Conclusion: The high accuracy, sensitivity, and specificity of FNAC makes it a useful and reliable screening and diagnostic procedure in case of salivary gland lesions especially in District Hospitals with limited infrastructure.

42-47

Authors: Hawaldar Ranjana, Sodani Sadhna

Introduction: Cervical cancer is the second leading cause of cancer related deaths, next only to breast cancer worldwide, but is easily preventable if detected early. However conventional paps smear technique has many limitations. To overcome these limitations liquid based cytology was introduced in the mid 1990 as a better tool for processing cervical samples the present study was undertaken to compare conventional paps smear with liquid based methods and to assess the diagnostic accuracy of LBC in our setting. Materials and Methods: The present study was a prospective study conducted on the first 300 patients visiting our diagnostic centre for pap smear tests from May to October 2015. The samples were collected with Rovers Cervex brush and a conventional slide was prepared and the brush head was detached and suspended in the preservative fluid. Split samples of CPS and LBC were analysed and reported using the Bethesda system 2001 and results were compared Results: While only 5 patients were found to have unsatisfactory smear in LBC (1.67%), 20 patients had unsatisfactory smear in conventional smear (6.67%). Endocervical cells were not seen in conventional pap smears while LBC showed presence of endocervical cells in all patients. Candida bodies were not evident in LBC smears while the CPS showed presence of candida bodies in 5 cases. ASCUS was reported in 10 (3.31%) patients by CPS while it was found to be present in only 6(2%) patients by LBC technique. Conclusion: The introduction of liquid based cytology technique has brought about a revolution in the field of cervical screening programmes because of its advantages like reduced rate of unsatisfactory smears, increased number of satisfactory smears with adequate endocervical cells, optimal preservation and staining of cellular material, small area on the slide for screening hence lesser time for reporting and non interference by blood, mucus and other cell debris, air drying artefacts which hampers the proper detection of cellular abnormalities by the conventional method and may replace the conventional smear slowly but steadily.

55-59

Authors: Sonam S. Nandyal, Shashikala P, Vidhushi Sahgal

Background and Objectives: Neonatal thrombocytopenia (platelet count less than 150×109/L) is one of the commonest hematological abnormality encountered in neonatal intensive care unit (NICU). Though thrombocytopenia is so prevalent it is often overlooked assuming that it will resolve spontaneously. However, if it is not detected and managed properly can result in devastating complications. The present study highlights the pattern, prevalence, severity and possible causes of neonatal thrombocytopenia encountered in our hospital. Method: A prospective observational study was conducted on sick neonates admitted to NICU with different clinical problems and were evaluated for pattern and severity of thrombocytopenia as per the blood samples analysed. Results: Out of 155 consecutive neonates admitted to NICU, 99 developed thrombocytopenia with a high prevalence of 63.8%. 43.4% had early onset and 56.5% had late onset thrombocytopenia. The most common cause of neonatal thrombocytopenia was prematurity (38.3%) followed by neonatal sepsis (22.2%). Mild and moderate thrombocytopenia was found in 17.1% of the neonates each, while severe was more common accounting for 65.6% of cases. Conclusion: Neonatal thrombocytopenia is common in NICU and it could be used as a prognostic marker for multiple diseases. As its clinical course and outcome depend on etiology, an appropriate diagnostic workup is essential for early diagnosis and better management.

70-72

Authors: Keshav.R. Kulkarni, Ashwin .P. Khageshan, Mahesh C. Baragundi

Introduction: A transfusion transmitted infection (TTI) is a virus, parasite, or other potential pathogen that can be transmitted in donated blood through transfusion to a recipient. Transfusion-transmitted malaria occurs at an estimated rate of 0.25 cases per 1 million blood units collected. Transfusion malaria is fairly common in endemic areas. Since there was no data from our geographical area about malaria among blood donors, the present study was conducted to know the seropositivity of malaria among voluntary and replacement blood donors. Materials and Methods: The present study was carried out in Blood bank of S.N Medical College, Bagalkot from July 2012 to June 2013. Two ml of blood sample was collected in labeled pilot tube at the time of collection of blood from donor tubing of blood bag. Serum was separated. The samples were tested for Malaria by rapid antigen detection test. Results: Of the total 8187 screened blood donors, four units (0.04%) of the blood units were positive for malaria parasites. All the positive units were from replacement donors. Conclusions: Our study showed that the seroprevalence of malaria was low and more in replacement donors compared to voluntary donors. These results suggest that voluntary blood donors services are needed. All blood should be tested for TTI with reduction in unnecessary blood transfusion. Thus ensuring safe blood supply to the recipients.

77-81

Authors: Aysha Ali, Prasanna N Kumar, G. Uma Maheshwari

Background: Venous and Arterial thrombosis are common diseases with an annual incidence of 1 in 1000 per year (1). Several risk factors have been identified like increased levels of coagulation factors –factor VIII,IX,XI,II and fibrinogen which are cumulatively explored by APTT(activated partial thromboplastin time). Elevated factor VIII levels are identified as an independent risk Antiphospholipid antibody syndrome, paroxysymal nocturnal hemoglobinuria, sickle cell disease are also associated with strong tendency for thrombosis. Objectives: (A) To examine the risk factors involved in the pathogenesis of thrombosis in Indian population. (B) To investigate the significance of these risk factors in incidence of venous and arterial thrombosis. Materials: Blood samples were collected from patients presenting with clinical picture of arterial or venous thrombosis for routine tests. The following tests were done on the samples: complete blood count, sickling test, Ham’s acidified serum test, Sucrose lysis test, prothrombin time, activated partial thromboplastin time, lupus anticoagulant assay (dRVVT based), Factor VIII:C assay, anti cardiolipin antibody Results: 310 cases were analysed. 124 patients(40.0%) had presented with proximal and dsital venous thrombosis, 68 patients with recurrent abortions (21.9%), 38 CASES(12.7%) ischemic heart disease and 43 cases (14.3%)with cerebrovascular disease, There were 11 cases of vasculitis (3.7%),10 cases of arterial thrombosis and 16 cases of pulmonary thromboembolism (5.3%). Increased factor VIII: c levels was the commonest risk factor identified followed by Antiphospholipid antibody (23.5%) and shortened APTT. No risk factors were identified in 50.6 % of the cases. There was one case each of sickle cell anemia and paroxysymal nocturnal hemoglobinuria who presented with pulmonary embolism and portal vein thrombosis respectively. Conclusion: The commonest risk factor identified was increased factor VIII: C levels, The presence of antiphospholipid antibodies was found to be linked with ischemic heart disease and venous and arterial thrombosis. There was also a very significant association between the presence of antiphospholipid antibodies, lupus anticoagulant and anticardiolipin antibodies with recurrent abortions. There was a correlation between the shortening of APTT and incidence of venous thromboembolism in this study. This study also showed that APTT is not an optimal screening test for detecting lupus anticoagulants.

86-91

Authors: Meenakshisundaram K, Rajeswari K, Rajalakshmi V

Aims and objectives: 1. To demonstrate the patterns in different premalignant lesions of prostate. 2. Correlating AgNOR counts with various grades of PIN. Materials and methods: This study was conducted in 83 cases of different prostatic biopsy specimens from 2013 -2015. All biopsy samples were routinely processed and stained with both haematoxylin and eosin and with AgNOR stain. Results: The mean AgNOR count and score of high grade prostatic intraepithelial neoplasia was significantly high when compared to low grade intraepithelial lesion. High grade prostatic intraepithelial lesions associated with nodular hyperplasia or with carcinoma was the same. Conclusion: AgNOR is a simple, cost effective and easy stain to evaluate the proliferative activity of the cell. It can be used as an additional test which will be of immense value regarding the progression of preneoplastic lesions in prostate.

96-102

Authors: Vijay.P.M, Sudha.V.M, M.M.Doddikoppad

Synovial sarcoma occurs at any age but peak age is between 10-35 years with slight male predominance. More than 60% occur in lower limb especially thigh, knee and ankle joints. Synovial sarcoma falls in to two main groups: Biphasic and Monophasic spindle cell type. The latter is more common depending on sampling. The other histological variants are the branching, hemangio pericytoma like pattern. Poorly differentiated with round cell morphology resembling Ewing’s sarcoma. Immunohistochemically in addition to epithelial component, spindle cell component also show focal positivity for EMA and keratin. This helps in distinguishing monophasic synovial sarcoma from peripheral nerve Sheath tumor or fibrosarcoma. The aim of this retrospective study is to study the various morphologic patterns of clinically suspected synovial sarcomas, their biological behaviour and prognostic value by immunohistochemical study. A total of 25 cases of clinically suspected cases of synovial sarcoma were studied in the age group of 10 -50 yrs. The most commonest age group were in children & young adults between 10-25 yrs. Among 25 cases, 20 cases were in males & 5 in females indicating male dominance. The commonest site involved was knee and ankle joints & in very few cases showed lesions over the shoulder and hip, rare cases over the anterior abdominal wall & in blood vessels. Microscopically Monophasic synovial sarcoma was the common variant seen in 16 biopsies. Presence of short and plump spindle shaped cells arranged in fascicles, compact sheets with tapering nuclei and poorly defined cytoplasm was seen in 15 biopsies, these biopsies also showed cleft like spaces. Whereas four biopsies showed myxoid change. Four cases of monophasic synovial sarcoma showed atypical mitotic figures > 15/10hpf.Four cases of monophasic synovial sarcoma showed focal positivity for epithelial membrane antigen and keratin. One case of poorly differentiated synovial sarcoma was CK7 positive. Poorly differentiated synovial sarcoma showed cytogenetically positivity for SyT-SSx1 fusion gene indicating poorer prognosis. Study of various morphlogical variants is essential to know their prognostic value & biological behaviours. Monophasic synovial sarcomas have more tendency to recur compared to the biphasic variants. Although histopathological study of synovial biopsy is one of the most valuable means for diagnosis of synovial sarcoma, it has its own limitations. In many instances corroborative clinical, radiological, immunohistochemical studies becomes essential in making an accurate histopathological diagnosis.

107-109

Authors: Iffat Jamal

Adenoid cystic carcinoma constitutes around 0.5%-2% of all carcinomas of uterine cervix. It usually presents in elderly age group. Very few cases have been reported in young age group. Adenoid cystic carcinoma is a rare variant of adenocarcinoma cervix. It is a locally aggressive tumour which is capable of distant metastasis in its early stage. This is a case report of Adenoid cystic carcinoma of uterine cervix, Stage III that was successfully operated upon and followed by radiotherapy.

115-119

Authors: Aditi Das, Renuka Gahine

Background: “Incidentaloma” is an adrenal mass, generally 1 cm or more in diameter, discovered serendipitously during radiological imaging performed for indications other than an evaluation for adrenal disease. Case presentation: We present two cases for their rare presentation as incidentalomas. First case was incidentally discovered adrenal myelolipoma in a 47 year female. Another case was incidentally discovered adrenocortical carcinoma in a 53 year female who initially presented with abdominal pain and deep vein thrombosis. On routine abdominal ultrasonography, adrenal mass was discovered in both the cases and subsequent pathological evaluation revealed diagnosis. Conclusion: These cases highlights the importance of thorough investigation to rule out the possibility of lethal malignancy. The evaluation of incidentalomas focuses on identifying functional masses & treating or resecting them appropriately; identifying adrenal carcinomas early with the intent of attempting complete surgical extirpation; and also to reassure the patients whose masses are neither functional nor malignant.

124-128

Authors: Medhi Pranita, Dowerah Swagata, Dutta Utpal, Dutta Aparna

Undifferentiated carcinoma of the gall bladder is an unusual tumor with a reported incidence of 0.38% of all gallbladder and extrahepatic bile duct cancers. We present a 65 year old female presenting with pain abdomen who was diagnosed with carcinoma gall bladder on ultrasound and CT abdomen. Histopathological examination revealed a 6.5x4x2 cm3 growth extending from the body of the gall bladder upto the fundus. H & E stained sections from the growth revealed sheets and trabeculae of neoplastic cells which were round to polygonal with abundant eosinophilic cytoplasm, multinucleation at places and areas showing spindled tumor cells. A diagnosis of undifferentiated carcinoma of gall bladder with spindle and giant cell type was given. Tumor showed strong positivity for cytokeratin and vimentin. These tumors have a very poor prognosis and therefore early diagnosis is vital to the survival of the patient.