Indian Journal of Pathology and Oncology

Page No. 8-11

Authors: Anushree CN, Sujatha R, Sunita Basanagouda Patil, Jaya Prakash HT

Background: Blood group system consists of antigens present on the surface of red blood cells. Up till now around 700 red cell antigens have been identified. The ABO grouping and Rhesus (Rh) typing are major systems and are inherited by means of Mendelian fashion. They are crucial for blood transfusions, parental testing and in certain forensic related medico legal cases. Also association of blood grouping systems can be attributed to gene associated studies in certain diseases among different population. The distribution pattern of ABO blood grouping systems varies among people around the world and also in different regions of same country. Aims: The study is aimed to determine the distribution pattern of the ABO grouping and Rh typing among blood donors in Dr. BR Ambedkar Medical College, Bangalore and to correlate it with the available data from studies inside India and other parts of the world. Materials and Methods: The study included blood donors in blood bank of Dr. BR Ambedkar Medical College Hospital from July 2012 to May 2016.The study was done on 1959 blood donors. ABO grouping and Rh typing was done using slide agglutination method with antisera A, B, O and Rh. Doubtful cases were reconfirmed by tube agglutination method and reverse grouping using freshly prepared pooled A and B cells. The sex incidence of ABO and Rh blood groups were stated in simple percentages. Results: Male donors were more than female donors, ratio being 77.3: 1. The most common blood group was O (38.8%) and least common being AB (5%). The distribution pattern of blood group O in our population was38.8 % (37.5% O Rh positive and 1.3% O Rh negative). The distribution pattern of blood group B in our population was 34.8% (33.9% B Rh positive and 0.9% B Rh negative) followed by blood group A which was 21.4% (21% A Rh positive and 0.4% A Rh negative) and blood group AB was 5%(4.7% AB Rh positive and 0.3% AB Rh negative) Rh positive were 97.1% and Rh negative were 2.9%. Conclusion: Knowledge of distribution pattern of the different blood groups is very crucial for blood banks and blood transfusion services which significantly contribute to the Health System of the Nation. Knowledge of blood group distribution is important for clinical studies, geographical information and for forensic studies in the general population.

Page No. 18-22

Authors: Binay Kumar, Usha Joshi, Priyansh Srivastav, Harsh Khetan

Objective: To enhance the diagnostic accuracy of papillary carcinoma thyroid by evaluating nuclear and architectural features on cytology with address about the details of cytologic pitfalls. Study Design: 14 cases of papillary carcinoma thyroid diagnosed on FNA cytology, which were confirmed on histology, during last five years, were reviewed, retrospectively, using Papanicolaou stained and May Grunwald Geimsa stained slides for following parametersArchitecture: Papillary pattern, swirling pattern, follicular pattern, sheets. Nuclear features: nuclear inclusion, nuclear grooving, and powdery chromatin. Others: metaplastic cells, chewing gum colloid, cystic macrophage, multinucleated giant cells. Result: Out of the various features evaluated the most consistent findings were papillary and swirling pattern; nuclear inclusion and nuclear grooving and metaplastic cells.In our study, on an average intranuclear grooves were present in 30-40% of the follicular epithelial cells except in one case where it was 80-90%. The average of intranuclear pseudoinclusions was 3-5% in all cases except one where it was 32%. Other findings were multinucleated giant cells, cystic macrophages, chewing gum colloid. Conclusion: Diagnosis of papillary carcinoma thyroid can be made accurately if architectural features (papillary or swirling pattern, nuclear features (nuclear inclusions and grooves) and metaplastic cells are present together in a thyroid aspirate. Among architectural features swirling pattern is consistent finding in our study which could be included among diagnostic criteria.

Page No. 27-30

Authors: Manas Madan, Manisha Sharma, Sanjay Piplani, Karamjit Singh Gill

Introduction: Hurthle cells (HC) are an enigma in thyroid lesions, from being a misnomer, their association with a variety of thyroid nodules and their unpredictable clinical behavior. These can be seen in many thyroid lesions ranging from inflammatory conditions, benign neoplasms and malignant lesions. This study was done to assess the spectrum of hurthle cell lesions of thyroid on cytology and try to establish features that can accurately differentiate between non-neoplastic and neoplastic thyroid lesions. Materials and Methods: The thyroid FNA cases done during Jan 2015- Dec 2015 were collected from the archives of pathology department. Those cases were collected for study where the cytological diagnosis of hurthle cell lesions was made. The diagnosis was divided into follicular neoplasm, hurthle cell neoplasms and thyroid lesions with hurthle cell change. Cytohistological correlation was done wherever possible. Observations & Results: 101 cases contained hurthle cells were identified and studied. The cytological diagnosis was 27 follicular neoplasms (FN) (26.7%), 04 hurthle cell neoplasms (HCN) (3.9%), 51 adenomatous goiter (50.5%) and 19 Hashimotos thyroiditis (HT) (18.8%). Of 27 FN, 22 were diagnosed as FA and 5 as FC. Of 4 HCN, 2 were diagnosed as HCA, 1 as HCC and 1 as PTC on histopathology. Conclusion: Hurthle cells can be found in a large number of thyroid lesions both neoplastic and non-neoplastic. Although no particular finding can differentiate between non-neoplastic and neoplastic hurthle cell containing lesions but certain cytological features can help to diagnose the neoplastic nature of these lesions.

Page No. 35-38

Authors: Nitika Kesarwani, Meena Harsh, Neena Chauhan

Background: Oral squamous cell carcinomas (SCC) still a significant health burden in developed and developing countries. Aims and Objectives: To study the premalignant and malignant lesions of oral cavity, to classify malignant lesions according to histomorphology and to study the expression of epidermal growth factor receptor (EGFR) in lesions. Materials and Methods: Fifty cases of SCC diagnosed by histopathology of oral cavity were studied in the Department of Pathology, Himalayan Institute of Medical Sciences, Dehradun over a period of 12 months. Semi-quantative evaluation of EGFR expression was done. All scores were based on examining the whole section in each biopsy under a multi headed microscope by three observers. Results: Out of 50 patients, 28% were in the age group of 51-60 years, there was an obvious male preponderance (92%). Majority of patients were only tobacco smokers (44%). The commonest site of oral cancers was tongue (26%). Out of total 50 cases, 37 (74%) were malignant and 13 (26%) were premalignant lesion. In present study, 48.64% of malignant and 84.61% premalignant lesion patients showed 3+ positivity of EGFR expression. Conclusion: Oral SCC was most common in male elderly patients, tongue was the most common site and moderately differentiated SCC was most common. Expression of EGFR was increased in both premalignant and malignant lesions. EGFR expression was over expressed in premalignant lesions and decreased in normal mucosa so premalignant lesions can be segregated as they are likely to progress to invasive cancer.

Page No. 45-51

Authors: Rashmi Jain, Ankit Jain

Background & Objectives: FNAC is used as a preoperative diagnostic tool to differentiate between benign and malignant salivary glands (SGs) tumors. The aim of this study was to evaluate the sensitivity, specificity and diagnostic accuracy of the FNAC for SGs lesions. Methods: FNAC was carried out in 144 patients with various SGs lesions and classified. Out of 144 cases, only 59 cases were available for histopathological examination. FNAC diagnosis was compared with the final histological diagnosis; and then sensitivity, specificity and diagnostic accuracy of the FNAC for SGs lesions were calculated. Results: Parotid gland was involved in 54.86% cases, whereas submandibular and minor SGs were involved in 40.27% and 4.86% cases respectively. Non-neoplastic lesions were found in 50.7% cases, whereas benign and malignant lesions were found in 36.8% and 12.5% cases respectively. Submandibular gland was commonly (52.05%) involved in non –neoplastic lesions whereas in benign and malignant lesions, parotid gland was involved 64.15% and 77.78% cases respectively. Chronic sialadenitis (58.9%), pleomorphic adenoma (90.56%) and mucoepidermoid carcinoma (55.55%) were most common lesions among non– neoplastic, benign and malignant lesions respectively. Sensitivity, specificity and diagnostic accuracy of FNAC for neoplastic SGs lesions were 87.50%, 97.44 % and 94.54% respectively. Interpretations & Conclusions: The high sensitivity, specificity and diagnostic accuracy of the FNAC indicates that it may serve as a good pre-operative diagnostic technique for SGs lesions. This study highlights the diagnostic value of FNAC in differentiating benign from malignant lesions which are useful in the planning of further management.

Page No. 56-62

Authors: Kavita Leeladhar Khedekar, Sangita Ramulu Margam, Nitin Maheshwar Gadgil, Gourav Sakhare

Background: Hepatic tuberculosis (TB) is an uncommon manifestation of tuberculosis. The term hepatobiliary TB refers to either isolated hepatic or hepatobiliary involvement with other organ involvement Methods: A five year autopsy study conducted of 236 adult cases of tuberculosis. Clinical details of all cases were obtained from hospital records. Sections from the liver were processed routinely and histopathological findings along with Clinical & biochemical findings were analysed in detail. Results: Commonest age group affected was 31 to 40 years of age with a male: female ratio of 1.29:1. Fever was present in (56.6%). Hepatomegaly along with abdominal pain was significantly associated with Hepatic involvement by TB. Pulmonary and extra pulmonary tuberculosis was seen in 177 and 59 cases respectively. Liver involvement was mainly secondary except in one case. The spectrum of histopathological changes of the liver showed epitheliod cell granulomas in (41.5%), fatty changes in (46.6%), inflammation in (16.5%) and fibrosis in (3.8%) cases. On comparing the liver TB and non-liver TB cases, it was found that fatty changes were more common but there was no difference in the degree of fibrosis in the two groups. Comparing liver function tests, available in 213/236 cases, 61% were abnormal. Deranged AST (65%), ALT (62.05%) & ALP (57. 05%) was seen in hepatic TB cases. Conclusion: Liver involvement was mainly in the form of secondary tuberculosis. Fever, hepatomegaly, abdominal pain, fatty change and caseating granulomas along with deranged liver enzymes are significantly associated with hepatic involvement in cases of tuberculosis.

Page No. 71-76

Authors: Shanmuga Priya S, Leena Dennis Joseph, Rajendiran S., CN Sai Shalini

Background: Papillary squamo transitional cell carcinoma (PSCC) is a distinct subcategory of squamous cell carcinoma of uterine cervix with a propensity to late metastasis and late recurrence. It is related to HPV 16 and 18 with high expression of p16. Histologically, it can be misinterpreted as transitional cell carcinoma and other papillary lesions of cervix like papilloma, verrucous carcinoma and cervical intraepithelial neoplasia grade 3 with papillary features. Aims: To study retrospectively the diagnostic utility of p16 in cervical dysplasia and papillary squamous cell carcinoma at our institution. Materials and Methods: We retrospectively reviewed all cervical lesions between 2008 and 2012. Ten cases of papillary squamous cell carcinoma were included in our study and further evaluated immunohistochemically by p16 and assessed. Results: Out of 882 cases of cervical lesions, 107 were malignant squamous cell carcinoma and 62 cases were Cervical intraepithelial neoplasia (CIN). Ten cases out of 107 malignant lesion were diagnosed as papillary squamotransitional cell carcinoma and immunostained with p16 and evaluated. Statistical significant differences between groups were found using semiquantitative scoring system. The patient ranged in age from 31 yrs to 62 yrs. Conclusion: PSCC of the uterine cervix are a clinicopathological distinct group that are potentially malignant. p16 was expressed in 71.1% of dysplasia and 100% of papillary squamous cell carcinoma.

Page No. 80-84

Authors: Shivraj Nagnath Kanthikar, Dhiraj B. Nikumbh, Nadkumar V. Dravid

Background: Central nervous system (CNS) tumor are considered as most notorious in all types of cancers. Incidence of CNS tumors in developing countries is lower as compared to developed countries, but increased rate has been observed in both. The aim of the study was to highlight the incidence and histological spectrum of CNS tumors in our region. To diagnose and classify brain tumours according to WHO 2007 classification. Material and Methods: This retrospective histopathological analysis of brain tumors was carried out in department of Pathology from January 2014 to December 2015. During this period, a total of 38 neurosurgical specimens were received in department. The specimens were processed by routine histotechniques and immunohistochemistry was performed whenever required. The diagnosed brain tumor studied and classified according to WHO classifications. Results: Among 38 cases, tumours of meningeal tissue (40%) were commonest followed by neuroepithelial tissue (34%). Cranial and spinal nerve sheath tumour (18%) and rarely metastatic tumours (5.3%) were encountered. Tumours were seen in all age groups but mean age group affected was 41-50 years accounting for 14 (36.8%) cases. Male to female ratio of 0.81:1.22 was noted with female preponderance. Conclusion: The present study helps to provide information regarding the burden of disease in our area. Despite the use of modern imaging technique that helps in provisional diagnosis of disease, histological examination is gold standard in diagnosis of varied types. Further utility of immunohistochemistry aids in confirmation and prognosis of disease.

Page No. 92-97

Authors: Rahul Mannan, Sanjay Piplani, Sonam Sharma, Mridu Manjari, Shruti Gupta

Background: Fine Needle Aspiration Cytology (FNAC) has many advantages and utilities in cervical region. Most of the studies documented in the literature regarding head and neck masses, either describe spectrum of lesions or etiological causes. The studies in the past have also tried to associate the FNAC procedure with statistic parameters such as sensitivity, specificity and predictive values / diagnostic accuracy. However, in the present study an attempt was made to correlate the etiological (diagnostic) and site-specific need of doing a FNAC procedure with epidemiological parameters such as age specific sub groups and sex parameters. Materials and Methods: 1708 cases of head and neck swellings reporting for FNAC to the Department of Pathology, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, Punjab, India over a period of three years (January 2012 - December 2014) were included in the study. The final diagnosis with other epidemiological, anatomical and clinical history was obtained from the requisition forms and the final reports filed in the archives of the department. Statistics employed included central distribution parameters such as mean, median and averages. Chi-Square (χ2) test and Fischer’s exact test were employed to analyze and investigate for significance of the cytological diagnosis with epidemiological and anatomical parameters. Results: The most common age group varied from 20-50 years with M:F ratio being 0.7:1. Overall reactive lymphadenitis and lymph nodes were the commonest cause and site for patients to undergo FNAC for swellings of head and neck region. Thyroid, skin and soft tissue lesions were the next commonest sites (36.29% and 19.33% respectively). Across the board, inflammatory pathologies were the commonest lesion reported (66.56%). Statistically it was found that there was significant difference between type of lesion according to the anatomical site (p value= 0.001) and the difference was not attributable to the more number of cases of lymph nodes itself. Statistically, for age specific rates there was a strong association between the type of lymph node lesion with the age specific sub groups (p value= 0.0005) and sex (p value= 0.012). Also noted was a strong association between the type of lymph node malignancy and the age group (p value= 0.002) Interesting point was an equal distribution of NHL over the spectrum with almost equal cases seen in children, young adults and early elderly. This again was found to be statistically significant. There was a strong association between the type of thyroid lesions and the age group but no association was seen between the type of thyroid lesion and either the sex or age specific groups of the subjects. Conclusion: The study concludes that there was significant difference between type of lesion according to the anatomical site. In case of lymph nodes there was a definitive association between the age group and sex of the patient with the ultimate diagnosis rendered. Hence age groups and the sex does play a definitive role in predicting the type of lesion; more so in lymphoid tissue of the head and neck region. There was significant statistical association of the type of lymphoid malignancy with the age and sex. The similar findings were not derived in the rest of the organ systems such as thyroid, salivary glands and skin/ soft tissue lesions.

Page No. 103-107

Authors: Sunilkumar KB, Nikethan B, Harini R

Aim: To compare Immunohistochemistry (IHC) results of large core Tissue micro array (TMA) with the conventional whole section for estrogen receptor (ER), progesterone receptor (PR) and HER2 expression in breast carcinoma cases. Methods: We analyzed 51 breast carcinoma cases. Large core TMAs were manually constructed with easily available materials. Immunohistochemical evaluation of ER, PR and HER2 were carried out in parallel by TMA and whole section methods for all cases as per Allred scoring system. Observed IHC scores were compared. Results: We detected a high concordance rate of 98%, 100% and 98% for ER, PR and HER2 respectively between TMA and whole sections. In addition, the use of TMA caused a significant reduction in the use of laboratory resources- reagents, slides and blocks. Conclusion: Our analysis showed various advantages of TMA over whole sections in IHC assessment. Hence, TMA can be implemented as a valuable tool in the routine assessment of breast biomarkers without compromising quality.

Page No. 111-116

Authors: Usha Muniyappa, Vijaya Mysorekar, Pooja Trehan

Introduction: The diagnosis and classification of soft tissue sarcomas has been a source of difficulty for surgical pathologists. This has been largely attributable to a significant degree of overlap in histologic features among different types of soft tissue sarcomas. The immunohistochemical identification of various cell and tissue markers specific for certain avenues of cell differentiation has permitted more accurate diagnosis and classification of these tumors. Objective: The objective of this study was to evaluate soft tissue tumors which were unclassified on histopathology by IHC for typing the cell lineage. Materials and Methods: We evaluated 61 cases of soft tissue tumours reported in a period of three years from April 2013 to March 2016 in which histopathology was inconclusive and IHC proved to be useful to reach to a definite diagnosis. Conclusion: In our study, IHC contributed to the diagnosis in 80.3% cases where it helped to determine the soft tissue lineage. It was noncontributory in 13.1% cases where even after IHC the lineage could not be determined. In 6.6% cases the final diagnosis given after IHC was not correlating with the histopathological diagnosis. Hence we conclude that only histopathological examination is not sufficient at all times because there is a morphologic overlap of soft tissue sarcomas with each other and with some carcinomas and melanomas. Though immunohistochemistry is not a substitute for histopathological examination, it acts as an adjunct to arrive at definite diagnosis and hence proves to be the most important ancillary technique in the diagnosis of soft tissue tumors

Page No. 122-126

Authors: Vedashree MK, Girish M, Maruthi CV

Fine needle aspiration cytology (FNAC) is an important tool for the diagnosis of various palpable lesions of head and neck. It is an inexpensive, reliable and patient acceptable technique for the diagnosis of lesions. Aim: 1.To study the age and sex incidence and the pathological spectrum of palpable lesions of head and neck in tertiary care hospital. Objectives: 1. To collect the details regarding age and sex of the patients & site of palpable swellings in the head and neck region. 2. To perform fine needle aspirations in such cases and do cytological study. 3. To analyse the frequency of these lesions based on the site and cytological diagnosis. Materials & Methods: This prospective study included 72 cases who presented with palpable head and neck swelling to the department of Pathology, district hospital Chamarajanagar from July 2015 to June 2016. The detailed history and examination of swelling were done. FNAC was performed on all cases and the smears were stained with rapid Hematoxylin and Eosin stain and examined. The smears from the lymph node of cases clinically suspicious of tuberculosis were stained with Ziehl Neelsen technique and Auramine O staining. Results: In our study, females were predominant (63.88%) and males constituted 36.11%. Most of the cases were in thyroid (48.6%), followed by lymph node (40.2%) and equal incidence of lesions in the salivary gland and skin (5.5%). Maximum age was 60 years and the minimum age was 5 years. In thyroid, lymphocytic thyroiditis was the predominant lesion (57.14%) followed by colloid goitre (42.85%). In lymph node FNACs, reactive lymphadenitis was most common (34.48%). Out of 10 smears from lymph node clinically suspicious of tuberculosis, two were positive for Ziehl Neelsen stain and Auramine O stain. Three cases showed metastatic deposits. Out of four salivary gland lesions, three had chronic sialadenitis (75%) and one had Pleomorphic adenoma (25%). All the cutaneous lesions were epidermal cyst cytologically. The age incidence of head and neck swelling was similar to the study conducted in north India but in contrast females were more common in our study than males due to the higher number of thyroid swellings. Cytologically, lymphocytic thyroiditis was higher in our study compared to the studies conducted in the north and western parts of India probably due to the higher prevalence of autoimmunity in this region. The incidence of tuberculous lymphadenitis was less compared to these studies which may be due to less number of lymph node swellings in our study. Conclusion: FNAC is a reliable and inexpensive outpatient procedure for the rapid diagnosis of various palpable lesions in the head and neck region. Thus it is the first investigation of choice in the diagnosis of these swellings.

Page No. 132-134

Authors: Archana Gupta, Swati Gupta, Vipan Gupta, Vivek Gupta

Aim: The study was carried out over a period of 6 months to evaluate the incidence of anemia in Type 2 diabetic patients with normal renal functions. Methods: The study group comprised of 100 patients with TYPE 2 diabetes mellitus and normal renal functions. Haemoglobin concentration, fasting blood sugar and HbA1c (glycated haemoglobin) of the subjects was measured. Renal function test (Serum urea, serum creatinine, serum uric acid, serum sodium and serum potassium) of all the patients were done and were within the normal range. The subjects with abnormal renal functions were excluded from the study. The presence of anemia was defined by haemoglobin level of less than 13 g/dl in men and <12 g/dl in women. Results: In the present study, the patients had high incidence of anemia i.e., 79%. The incidence was more in patients with uncontrolled diabetes and HBA1c level more than 7.5%. Conclusion: This study indicated that poor glycemic control and old age are associated with high incidence of anemia in Type 2 diabetics with normal renal functions.

Page No. 139-146

Authors: Chaitra B, PAV Krishnamacharyulu, P Premalatha, V Tejeswini

Introduction: Breast carcinoma is the most common cancer among women in the urban Indian population and second only to cervical cancer in the rural population. Prognosis is related to a variety of clinical, pathologic and molecular features. Immunohistochemical evaluation of estrogen receptor (ER) and progesterone receptor (PR) status of breast carcinoma has become a routine investigation to predict the response to endocrine therapy. Aims and Objectives: To study patient and tumor characteristics in relation to estrogen and progesterone receptor (ER & PR) status of the tumor. Materials and Methods: This is a retrospective and prospective study of 100 cases of breast carcinoma diagnosed during January 2007 to September 2011 in the department of Pathology, NRI Medical College, and Chinakakani. Clinical details were archived from the files. Routine histological examination and Immunohistochemical analysis of all the cases were done. Results: Tumors were separated into four categories: ER+PR+ (33%), ER+PR− (15%), ER−PR+ (7%) and ER−PR− (45%). ER and PR immunoreactivity increased with advancing age. 52% of cases were in the right breast. Invasive lobular carcinoma, and papillary carcinoma were more frequently ER+PR+. High-grade infiltrating ductal carcinomas, pure comedo ductal carcinoma in situ, mucinous carcinoma and medullary carcinoma were predominantly ER−PR−. ER & PR immunoreactivity decreased with increasing tumor grade, lymph nodal metastasis, presence of tumor necrosis, desmoplasia and lymphovascular emboli. Conclusion: Histological grading together with receptor status offers an excellent method of predicting the prognosis and response to hormonal therapy which lightens up a prospect of various treatment modalities.

Page No. 150-152

Authors: Amita K, Shobha SN, Vijay Shankar S, Abhishek MG

Collision tumor is an entity used to describe the occurrence of two separate primary tumors at one anatomic location. Collision tumors occur at different locations in the body including skin. Syringocystadenoma papilliferum (SP) is an adnexal tumor of apo-eccrine differentiation and is juxtaposed to a nevus in one third of the cases and to a basal cell carcinoma in 10% of the cases. We report an unusual collision of SP and verrucous carcinoma occurring at an unusual location.

Page No. 156-157

Authors: Rigvardhan, Prashant Sengupta, Nishant Taur, Vasu Vardhan

Multiple myeloma (MM) is a clonal proliferation of plasma cells that primarily affects the bone marrow and skeletal system. It mainly affects bone marrow although extramedullary tissues especially reticuloendothelial system may be infiltrated. Serous effusions due to MM are rare. (1) Accurate diagnosis of this condition is important as it portends a poor prognosis with median survival time < 4 months. It is particularly rare (<1%) for MM patients to present as myelomatous pleural effusion (MPE), especially pleural effusion as presenting sign. (2,3) Bilateral myelomatous pleural effusions are even more rare. (2) We describe a case of MM who presented initially as bilateral pleural effusion and was managed in our hospital. To the best of our knowledge, this is the fourth case in literature where bilateral myelomatous pleural effusion was the presenting feature of multiple myeloma.