Annals of Pathology and Laboratory Medicine

Cytomorphological Spectrum of Orbital and Peri-orbital Lesions – A Retrospective Study from A Tertiary Care Center, Manipur, India

Yengkhom Daniel Singh — 2024-04-15

Background

Fine needle aspiration cytology (FNAC) is a reliable, safe and simple diagnostic technique which is being implemented in diagnosing palpable and/or visible lesions in the body. This study was conducted for evaluating the role of FNAC as a routine screening/diagnostic tool in a spectrum of orbital and periorbital lesions. The aim of this study was to evaluate the role of FNAC in orbital and periorbital lesions.

Methods

A hospital based cross-sectional study was conducted in the Cytology section, Department of Pathology, RIMS for a period of 10 years from April 2013 to May 2022. A total of 95 cases with orbital and periorbital lesions were inducted in the study through purposive sampling. FNAC procedure was done using 10cc/20cc syringe with 23G/22G needle with or without a Cameco handle. Slides were stained using MGG (May-Grunwald Giemsa) and Pap (Papanicolaou) stains followed by their microscopic examination. Demographic parameters such as age and gender as well as clinical parameters such as size, site and duration of the lesion were analyzed.

Result

The mean age of patients was found to be 33 years with a slight male predominance (54 patients; 56.84%). The adequacy of FNAC was 96.82%. Epidermal Inclusion Cyst (30 cases; 31.58%) was the commonest lesion. Five cases (5; 5.26%) were malignant on cytopathology. By applying Kappa statistics, a near perfect agreement (k=0.86) between FNAC and histopathology was observed, being statistically significant, p=0.01 (<0.05).

Conclusion:

In our study, a high concordance/agreement was observed for the neoplastic lesions, thereby establishing FNAC as a useful tool for screening as well as diagnosing orbital and periorbital lesions. It surrogates other invasive procedures, eliminating complications in nonresectable or inapproachable lesions.

Distribution of Acute Phase Proteins in Post-SARS CoV2 Mucormycosis Infection

Deepti Dixit — 2024-04-15

Background

This study was aimed to estimate the serum levels of acute phase reactants/proteins (APR) which includes serum ferritin, C Reactive Protein, D-dimer and Procalcitonin in mucormycosis infection following SARS CoV2 infection and to determine the clinical, biochemical and histopathological findings in the same.

Methods

It was an observational cross-sectional study. All cases of mucormycosis following SARS CoV2 infection were reviewed. Demographic and clinical details with comorbidities and relevant laboratory investigations which included serum glucose, serum ferritin, C Reactive Protein, D-dimer, Procalcitonin were noted at the time of diagnosis of mucormycosis. Diagnosis of mucormycosis was based on frozen section examination and histopathological examination.

Results

Thirty-two cases of mucormycosis following SARS CoV2 infection confirmed on histopathology were studied. Majority of the cases (77%) were with comorbidity especially having diabetic mellitus type 2. C-Reactive protein, Procalcitonin and serum Ferritin were raised in almost all cases with mean of 80.92±62.5mg/l, 17.99±26.87ng/ml. and 464.9±422.03ng/ml respectively. D Dimer was raised in less than 50% cases with a mean of 828.5±245.9 ng/ml.

Conclusion

Acute phase proteins like C reactive Protein, Procalcitonin, Serum ferritin and D Dimer were raised in Post-SARS CoV2 infected individual who presented now with mucormycosis infection. These markers were raised markedly in critically ill patients thus indicated its pathogenetic role in severe morbidity, thus estimation of serum acute phase reactants can help in predicting the course and severity of illness.

Muscular and Vascular Fallopian Tube Morphology in Ectopic Tubal Pregnancy

Seema Baxi — 2024-04-15

Background

Although literature is full of articles on histopathological changes in fallopian tube in ectopic pregnancy and the predisposing conditions associated with ectopic pregnancy, none have mentioned or reported abnormal muscle and vascular architecture of the tube. The study was undertaken to find the percentage of different sites of ectopic pregnancies coming to the institute for treatment and to calculate the proportion of various morphological risk factors which could have led to the ectopic pregnancy and to discern the various histopathological changes in cases of ectopic tubal pregnancies.

Methods

A retrospective study was conducted on all the cases of ectopic pregnancies in the year of 2021 and 2022. For comparison of morphological changes equal number of tubes received for tubal ligation were assessed as they served age matching purpose. Hematoxylin & eosin-stained slides were retrieved and re-examined for the histological patterns.

Results

92% of the ectopic pregnancies were tubal pregnancies. Amongst predisposing factors of tubal pregnancies detected morphologically, chronic salpingitis was seen in 71.5% of cases while Salpingitis Isthmica Nodosa (SIN) was seen in 26.1% of cases.

Conclusion

Abnormal morphological findings like tubal muscle splaying, arterial wall thickening leading to grotesque shapes, clear changes in different layers of tunica of blood vessel with or without concentric muscle splaying were seen in tubal ectopic pregnancies in significant numbers of cases.

Dual Invasive Pulmonary Mycosis in a Post Covid-19 Patient: An Autopsy Diagnosis

Nitin Sagar Taneja — 2024-04-15

Patients suffering from Covid19 associated lower respiratory tract infection are most often in an immunocompromised state and are indeed vulnerable to a host of bacterial and fungal infections. Among the fungi, common invaders include candidiasis, aspergillosis and mucormycosis. Aspergillosis is a relatively common fungal infection which has been widely reported to occur in patients suffering from or recently recovered Covid19 infection. The invasive form of this fungus, is, however, less commonly reported in literature. Invasive pulmonary mucormycosis is a relatively uncommon pulmonary fungal disease. Its early diagnosis is essential but difficult as it lacks an effective treatment protocol. Commonly affecting a primarily immunocompromised host, the diagnosis of both infecting fungi primarily rests upon detection of their hyphae and/or spores in the lung and vascular tissue. This report describes presence of invasive pulmonary mucor and aspergillosis detected at autopsy in a post covid 19 patient, who presented with a naso-orbital swelling and had a rather silent clinical course followed by sudden onset of a single episode of massive hemoptysis resulting in his death.

A Rare Case of Benign Synchronous Neoplasm of Parotid Salivary Gland

Vijayabasker Mithun — 2024-04-15

Introduction

Salivary gland neoplasms represent 2–6% of all head and neck neoplasms. Salivary gland neoplasms arising from the major salivary glands are predominantly benign. Pleomorphic adenoma is the most common benign neoplasm of the salivary gland, followed by warthin’s tumour. The synchronous occurrence of both of these neoplasms is rarely described. We present a case of unilateral salivary gland neoplasm with two distinct histological lesions, which were found incidentally during gross examination and confirmed microscopically.

Case report

A 72-year-old man with complaints of left parotid swelling, which progressively increased in size over the past 6 months. Ultrasound imaging studies and FNAC show features of pleomorphic adenoma, for which the patient underwent surgery, and the specimen was sent for histopathological examination. In the gross examination, a tan-brown area measuring 0.6 cm in greatest dimension was noted in the parotid salivary gland, in addition to the encapsulated grey-brown neoplasm. Histologically, the tan-brown lesion was found to be an intranodal warthin’s tumour along with a pleomorphic adenoma.

Conclusion

Synchronous neoplasm is a rare entity that can easily be missed in clinical, imaging and even in cytological examinations. Proper histopathological examination of the resected specimens helps in identifying the lesions that were left unrecognized even by imaging studies due to their proximity to the existing neoplasm, as in our case. The use of VTIQ in combination with B-mode ultrasound may be beneficial in detecting the nature of the lesion prior to surgery.