Annals of Pathology and Laboratory Medicine 2020-07-07T11:07:11+00:00 Dr. Prashant Goyal Open Journal Systems <p><strong>Annals of Pathology and Laboratory Medicine (APALM)</strong> is an international, Double-blind peer-reviewed, indexed, open access, online and print journal&nbsp;for pathologists, microbiologist, biochemist and clinical laboratory scientists, and is published by <strong><a href="" target="_blank" rel="noopener"><strong>Pacific group of e-Journals</strong>' (<strong>PaGe</strong>)</a>, </strong>an&nbsp;<em>ISO 9001:2008</em> Certified&nbsp;academic publishing house.</p> <p>Set up in 2014, APALM is a specialized journal, which publishes original, peer-reviewed articles&nbsp;in the field of Pathology and Laboratory Medicine which, <em>inter alia</em>, includes Histopathology, Cytopathology, Hematology, Clinical Pathology, Forensic Pathology, Blood Banking, Clinical Bio-Chemistry, Medical Microbiology (Bacteriology, Virology, Mycology, Parasitology), etc.</p> <p><strong>DOI: 10.21276/APALM (<a title="Verify APALM DOI " href="" target="_blank" rel="noopener"></a>)<br></strong></p> <p>Index Copernicus (IC) Value (ICV 2018): 96.77</p> A Study of Serum Iron Profile in Patients with Chronic Kidney Disease 2020-07-02T10:07:59+00:00 Indira Shastry Sushma Belurkar <p><strong>Background</strong>: Even though anemia and iron deficiency can increase the morbidity and mortality in patients with chronic kidney disease (CKD), an iron overload can be dangerous as well.</p> <p><strong>Aim</strong>: Identify the number of CKD patients with iron deficiency, iron overload, acute phase reaction and anemia of chronic disease in a tertiary care hospital.</p> <p><strong>Material and methods</strong>: The study was conducted in Kasturba medical college, Manipal. 154 patients with CKD were selected for the study irrespective of their treatment status with hematinics and/or erythropoietin.</p> <p><strong>Results:</strong> The mean total serum iron levels were 61μg/dl, Total Iron Binding Capacity (TIBC) 216.43 μg/dl, serum ferritin 539.68 μg/dl, and transferrin saturation of 32.18% respectively. When the serum iron profile of individuals was analyzed, majority (54.25%) of the patients were found to have acute phase reaction and most of them were in advanced stage of renal failure. Normal serum iron profile was found in 37.2% patients, iron overload in 2.2%, anemia of chronic disease in 5.3% and iron deficiency in 1% cases. These findings were statistically significant with the P value of 0.001.</p> <p><strong>Conclusion:</strong> Most common type of serum iron profile found in the study population was acute phase reaction (54%) and majority of them were in stage 5 renal failure. Hence, before beginning an iron therapy, all the patients with anemia in chronic kidney disease should be evaluated for body iron status to prevent iron overload.</p> 2020-07-02T10:07:59+00:00 ##submission.copyrightStatement## Enhancing Cell Block Quality- A Comparative Study Of Formalin And Agar-Based Methods 2020-07-02T10:20:56+00:00 Shruti Mishra Kishore Kumar S. Dipanwita Nag <p><strong>Background</strong>: There are not many studies conducted in India to compare cell block preparation methods with reagents and materials that are readily available in all laboratories. This study aimed to standardize and compare two simple cell block techniques, which can be done in low resource settings too. In the study, 35 cases of thyroid, lymph node, and breast were collected for both FNA and cell block preparation for six months.</p> <p><strong>Materials and Methods</strong>: There were separate passes given for both methods. A total of seventy cell blocks made using formalin and agar methods of preparation.</p> <p><strong>Results</strong>: We compared both the methods on technical and morphological levels. The formalin method was overall easy to perform and was yielding good morphological results in 98% cases, the only drawback being cell loss during handling and processing. While in the agar method, there was almost no cell loss, but it was more technically difficult and yielded poorer morphological results. A scoring system was made for cellularity: no cells = 0, hypo-cellular = 1+, hypo-cellular with tissue fragments = 2+, cellular = 3+.18 A score of 2+ and 3+ was scored by 31/35 formalin blocks and 28/35 agar blocks.</p> <p><strong>Conclusions</strong>: The sensitivity of both formalin and agar methods are almost comparable. However, the procedure of the formalin method is far more straightforward and user friendly. Moreover, it also provides a better architectural picture than the agar method.</p> 2020-07-02T00:00:00+00:00 ##submission.copyrightStatement## Cytomorphological Analysis of Neoplastic Lesions of Neck Node with Special Reference to Lymphomas 2020-07-03T10:29:26+00:00 Junu Devi <p><strong>BACKGROUND</strong>: Neoplastic lesions of lymph node in cervical region pose a diagnostic delima and very often cytological diagnosis proves invaluable. An early diagnosis of the lesions is essential for proper management. To assess the frequency distribution and cytological analysis of various neoplastic lesions of lymph node with special reference to the lymphoma.</p> <p><strong>MATERIAL AND METHODS</strong>: this is a cross-sectional study which provides analysis of 164 neoplastic lesions of lymph node out of 758 lymph node aspirate. Cytomorphological pattern and cellular detail are reviewed carefully and diagnosis were made. Histopathological and immunohistochemical correlation done wherever needed.</p> <p><strong>RESULTS</strong>: Out of 164 neoplasms 86.59% secondary neoplasms(61.27% SCC, 19.72% Adenocarcinoma,15.49% poorly differentiated carcinoma,0.70% undifferentiated carcinoma, 0.70% mucoepidermoid carcinoma, 0.70% papillary thyroid carcinoma,1.41% leukemic deposit),12.2% lymphoid neoplasms. M:F = 1.2:1. Diagnostic accuracy was calculated as 98.67%, and false positive rate 1.3%</p> <p><strong>CONCLUSION</strong>: fine needle aspiration cytology is invaluable in rapid diagnosis of lymph node neoplasms of cervical region however histological confirmation and immunohistochemical analysis is mandatory in certain tumors specially lymphomas, poorly and undifferentiated carcinoma for accurate diagnosis and proper management.</p> 2020-07-03T10:29:26+00:00 ##submission.copyrightStatement## Clinicopathological correlation of p63 in Urothelial Carcinoma: Immunohistochemical Study 2020-07-03T10:37:12+00:00 Rupinderjit Kaur Mridu Manjari Sanjay Piplani <p><strong>Background:</strong> Urothelial cancer (UCa) poses a significant medical and public health concern in most parts of the world and is defined as a pan- urothelial disease in which entire urothelium of the renal pelvis to the urethra can undergo malignant transformation. &nbsp;Bladder tumors account for 90–95% of urothelial carcinomas and are the most common urinary tract malignancy. It is three times less common in females.</p> <p><strong>Methods:</strong> The study was conducted on 40 cases of Urothelial Carcinoma received as biopsy specimens in a tertiary care hospital. There were 20 cases each of low grade and high grade and after grading these were subjected to p63 expression.</p> <p><strong>Result:</strong> 78% of the patients were from 50-75 year age group with Male to Female ratio being 4:1. Painless hematuria was most common complaint. The size varied from 0.5 to 7.2 cm.</p> <p>For P63, 38 (95%) cases showed positive p63 expression. Of which 20 cases were low grade and 18 (90%) were high grade papillary urothelial carcinomas. Of P63 positive cases 36 cases showed moderate to strong staining intensity whereas two cases showed mild staining intensity. The p63 expression decreased with grade and invasion.</p> <p><strong>Conclusion: </strong>&nbsp;&nbsp;P63 immunoexpression decreases with increasing grade of tumor as well as with invasion thus showing that its expression is related with good prognosis. </p> 2020-07-03T10:37:12+00:00 ##submission.copyrightStatement## PD-L1 Expression in Colorectal Carcinoma: Immunohistochemical Study 2020-07-06T06:29:21+00:00 Mehak Gupta Mridu Manjari Harjot Kaur <p><strong>Background : </strong>Colorectal carcinoma is the most common type of GIT malignancy which is a multifactorial process with etiology encompassing genetic factors, environmental exposures and inflammatory conditions of the digestive tract.</p> <p><strong>Method: </strong>40 histologically proven cases of colorectal carcinoma were subjected for IHC expression of PD-L1 using Biocare kit. PD-L1 was taken positive as yellow to brown particles in membrane, cytoplasm or both. It was graded depending upon staining intensity and percentage of the cells and scoring was done by multiplying both and ≥ 3 was taken as positive score.</p> <p><strong>Result : </strong>Most of the cases were in 6<sup>th</sup> and 7<sup>th</sup> decade of life (62.5%) with M:F ratio being 1.4:1. Most common site involved was rectum. Histologically 29 cases were conventional adenocarcinoma with rest being mucinous and mucin secreting type and most of them being moderately differentiated (70%). On immunohistochemistry, PD-L1 expression was seen in 20 cases with moderate and strong intensity. But PD-L1 score was positive in 14 cases (35%). TIL was positive in 57.5% of the cases. Statistically there was significant correlation between histological type of tumor with PD-L1 (p value=0.03) and TIL (p value=0.017). Although PD-L1 positivity was insignificant with histological differentiation (p value=0.65) but TIL was significant (p value=0.03).</p> <p><strong>Conclusion : </strong>PD-L1 expression is relevant to the prognosis as well as for further CRC therapies whereas the TIL cell positivity has become an independent predictor of patients survival.</p> 2020-07-06T06:26:32+00:00 ##submission.copyrightStatement## Evaluation of Epithelial Mesenchymal Transition Markers E-Cadherin and Vimentin in Carcinoma Cervix 2020-07-07T10:11:44+00:00 Naveen Kumar R Charanjeet Ahluwalia Sunita Malik Rashmi Arora <p><strong>Background:</strong> Cervical cancer is the second most common in developing areas. Epithelial to mesenchymal transformation, one of the critical elements in invasion, progression and metastasis of tumour. This study highlights the expression of epithelial mesenchymal markers E-cadherin and vimentin in carcinoma cervix and whether there is any association of expression of these markers with grade of cervical cancer.</p> <p>Objectives:</p> <ol> <li>To study the expression of epithelial mesenchymal transition (EMT) markers</li> </ol> <p>E-cadherin and vimentin in cervical cancer.</p> <ol start="2"> <li>To correlate the immunohistochemical expression of these markers with grade of cervical cancer.</li> </ol> <p><strong>Methods:</strong> 30 cases (n=30) of carcinoma cervix &amp; 30 controls (n=30) of non specific cervicitis diagnosed on H&amp;E were included in this study. H&amp;E stained sections was examined for histological type and grade. Immunohistochemistry for E-Cadherin and Vimentin was performed in all these cases.</p> <p><strong>Result:</strong> Immunohistochemical expression of epithelial marker E-cadherin and of mesenchymal marker vimentin was correlated with the grade of cervical carcinoma. The expression of E-cadherin is reduced and expression of vimentin is increased with increasing grades of carcinoma cervix.</p> <p><strong>Conclusion: </strong>The expression of these EMT markers can be used as a prognostic marker in cervical cancer that are in high risk of progression.</p> 2020-07-07T10:11:44+00:00 ##submission.copyrightStatement## Study of mast Cells in Appendectomy Specimen 2020-07-07T10:26:33+00:00 Janaki V Upadhyay Shaila N Shah <p><strong>Background: </strong>Mast cells play an important role in various inflammatory and immune reaction. Mast cells are constantly present in the appendices, and appendix remains one of the common surgical specimens received at pathology laboratory. Mast cells could be one of the important cell population responsible for nerve proliferation and hypertrophy in cases with clinically and histopathologically diagnosed appendicitis.</p> <p>&nbsp;<strong>Material and methods: </strong>The study was done on 100 surgically resected specimens of appendix received for routine histopathological evaluation at the Department of Pathology, Government&nbsp; Medical College, Bhavnagar, between June 2018 and May 2019. All appendices surgically resected as a therapeutic measure for clinically suspected appendicitis included. Cases of&nbsp; normal appendix and acute gangrenous appendicitis were excluded from the study. The appendices were assessed for their histological changes and density of mast cell infiltration. The mast cells were counted in 1% toluidine blue stained sections.</p> <p><strong>Results:</strong>&nbsp; Out of 100 cases of surgically resected appendices, chronic appendicitis was found in 65% of cases and occurred frequently during the second and third decades of life. Highest mast cell count was seen in acute eosinophilic appendicitis and chronic appendicitis. No significant difference was observed in the mean mast cell counts among the different layers of the appendices studied.</p> <p>&nbsp;<strong>Conclusion:</strong> Mast cell counts were found to be highest in acute eosinophilic appendicitis and chronic appendicitis. Intermediate mast cell counts were seen in acute appendicitis and acute suppurative appendicitis. Mast cells appear to play roles in accentuation of inflammatory process and fibrosis.</p> 2020-07-07T10:26:33+00:00 ##submission.copyrightStatement## Histopathological and Clinicopathological Co-Relation of Non-Neoplastic Cystic Lesions in Surgically Removed Ovaries 2020-07-07T10:33:06+00:00 Dipti Manojbhai Patel Seema N Baxi <p><strong>Introduction:</strong> Neoplastic ovarian lesions have been extensively studied, but less attention is paid to non-neoplastic cystic lesions. Though follicular cysts are the most common of the non-neoplastic cysts, the % of occurrence of individual non-neoplastic lesions is not known. Also, often there is dilemma in reporting the exact type of nonneoplastic cyst. This study was planned with the objectives of assessing percentage of non neoplastic cystic ovaries, determining the morphological forms and relation of the various cysts with age of patient, and to detect whether multicystic non neoplastic lesions are more frequent in present day.</p> <p><strong>Materials and methods</strong>: A prospective hospital based cross sectional non-neoplastic ovarian cysts study was done between January to June 2019 in a tertiary hospital. All hysterectomy specimens with the accompanying ovary/ovaries and oophorectomy specimen were included. Microscopic features were assessed. Data was tabulated in MS excel sheet. Percentage of occurrences of age, size, morphological type, laterality and complaints were calculated.</p> <p><strong>Result</strong>:50% of 193 ovaries had non neoplastic cystic lesions. Non neoplastic cysts were associated with fibroid in 54%<strong>, </strong>DUB in 17% and adenomyosis in 16% cases. They were seen commonly during reproductive age group(83%). Post-menopausal age showed 16% cases. 86% of the non neoplastic ovarian cystic lesions were unilateral. 20% non neoplastic cystic lesions were of &lt;1cm, 74% were 1-5 cm in size and 5% were larger than 5 cm. Morphologically 40% were follicular lesions, 32% were simple serous cysts, 14% were haemorrhagic cysts, 8% corpus luteal cysts and 2% each theca lutein and epithelial inclusion cysts.</p> <p><strong>Conclusion</strong>: Non neoplastic cystic ovaries comprised 50% of all ovarian lesions, 83% were seen during reproductive age group. Leiomyoma, dysfunctional uterine bleeding and adenomyosis were the common clinical features and 70% of the cysts were 1-5 cm in size. There was no relation between morphological types of the cystic lesions and functional status. Simple serous cyst, cystic follicle, follicular cyst, cystic corpus luteum, corpus luteal cyst, theca luteal cyst, epithelial inclusion cyst and haemorrhagic cyst were found of which follicular cyst was the commonest (40%) Multicystic non neoplastic lesions or polycystic ovaries were not found during the period of study.</p> 2020-07-07T10:33:06+00:00 ##submission.copyrightStatement## Study of Various Vesiculobullous Lesions Using Tzanck Smear 2020-07-07T10:39:06+00:00 Sanchit Singhal Hemalata M <p><strong>Background:</strong> The vesiculobullous reaction pattern is characterized by the presence of vesicles or bullae within the epidermis or at the dermoepidermal junction. Despite some having characteristic presentations, it’s difficult to make a definite diagnosis clinically. Hence, cytological evaluation is required for reliable and early diagnosis. Objectives of the study are to determine the incidence of various vesiculobullous lesions and evaluate cytology as a tool for early diagnosis of vesiculobullous lesions.</p> <p><strong>Methods:</strong> For Tzanck smears fresh vesicle or bulla was selected and incised with scalpel, reflecting the roof of bulla. Base of the blister scraped gently and material spread on a glass slide. These smears were stained with MGG (air dried), Pap and H&amp;E stains (fixed).Skin punch biopsies from the bullae were subjected to routine fixation, processing, sectioning and staining.</p> <p><strong>Results:</strong> A total of 62 Tzanck smears were done for vesiculobullous lesions of skin of which 29 had histopathological correlation. Herpes constituted the most common vesiculobullous disorder (42%) followed by bullous pemphigoid (27.4%) and pemphigus vulgaris (19.3%). Most patients were in the age group 61- 70 years. The M:F ratio of 1:1.38 showing female preponderance. Tzanck smears showed acantholytic cells in pemphigus group, eosinophils in bullous pemphigoid and multinucleate giant cells in viral blisters. Histopathology showed intraepidermal acantholysis in pemphigus vulgaris, subcorneal blister in pemphigus foliaceus and subepidermal in bullous pemphigoid.</p> <p><strong>Conclusion:</strong> Cytohistopathological correlation showed an overall sensitivity of 79%. Tzanck smear showed 96% sensitivity for viral infections. Tzanck smear is a quick, non-invasive method for the early diagnosis of vesiculobullous disorders.</p> 2020-07-07T10:39:06+00:00 ##submission.copyrightStatement## Utility of Urine Reagent Strips in CSF Analysis as An Aid to Rapid Diagnosis of Meningitis 2020-07-07T10:45:50+00:00 Abhirami Ganesh R Prabhu M H <p><strong>Background:</strong> Bacterial Meningitis is a medical emergency and timely intervention has an implication on the prognosis and outcome. Examination of the CSF for leucocytes, glucose and proteins are the cornerstones in the diagnosis of meningitis in general and to arrive at the cause. Hence, this study is done to evaluate the usefulness of urinary reagent strip for rapid diagnosis of meningitis.</p> <p><strong>&nbsp;</strong></p> <p><strong>Methods:</strong> This is a prospective single blinded study on 100 CSF samples subjected to index test (Urine reagent strip test-Dirui H10) and definitive test comprised of CSF microscopy and biochemical analysis for proteins and sugar. The diagnostic accuracy of each index test at different cut off levels tabulated in the form of sensitivity, specificity, PPV and NPV.</p> <p>&nbsp;</p> <p><strong>Result:</strong> The sensitivity and specificity for leukocytes by the strip method for ≥15 cells/cumm were 92% and 98.66%, and for protein levels &gt;30 mg/dl were 84.33% and 94.11% respectively. The test showed high specificity (100%) but less sensitivity for glucose &lt;50mg/dl. It was observed that the accuracy of the tests increased with increase in the values of cell counts and proteins and decrease in sugar reaching 100% accuracy for higher cut-offs.</p> <p><strong>&nbsp;</strong></p> <p><strong>Conclusion: </strong>Urine reagent strip can be utilized for the rapid analysis of CSF in both rural areas as well as in centres where the facility is available as it reduces turnaround time.</p> 2020-07-07T10:45:50+00:00 ##submission.copyrightStatement## Epstein Barr Virus in Hodgkin’s Disease a Path Less Treaded 2020-07-07T11:02:20+00:00 Kirti Balhara Sarika Singh Shyamlata Jain M K Daga Anubhav Vindal <p><strong>Background: </strong>Epstein-Barr virus (EBV) is a ubiquitous virus belonging to γ-Herpesvirus subfamily, infecting B cells, T cells, Natural killer (NK) cells &amp; causes both benign and malignant diseases. It has been detected in large subset of Hodgkin lymphoma (HL) cases around the world, especially in countries with poor socioeconomic conditions and among younger age. Limited studies are available reflecting the Indian scenario of HL and EBV association. EBV positivity in Indian HL varies from 28-97% Majority of these studies employed Immunohistochemistry (IHC) for LMP1, a few performed In Situ Hybridisation (ISH) for EBER.</p> <p><strong>Objective:</strong> To study the association of EBV in classical HL by immunohistochemical expression of latent membrane protein 1 (LMP1) antigen in North Indian population and to correlate it with different demographic variables &amp; subtypes of HL.</p> <p><strong>Materials and Methods: </strong>Observational study including 26 untreated HL cases diagnosed on lymph node excision biopsy. IHC was performed for EBV LMP1, CD15, CD30, CD45, CD3, CD20.</p> <p><strong>Results: </strong>Patients ranged in age from 5-55years (median 18yrs), with M:F ratio of 3.3:1. Palpable lymphadenopathy was found in all cases followed by pallor (64%), B symptoms (50%), nodal pain (30.8%) &amp; bulky disease (19.2%). Maximum number of patients were in Stage I (65.4%) followed by stage II&amp;III (15.4% each) &amp; stage IV (3.8%). Mixed cellularity HL comprised 77%, lymphocyte depleted 11.5%, nodular sclerosis 7.7% &amp; lymphocyte rich 3.8%. IHC for EBV LMP1 was positive in 73.1% cases. Mixed cellularity HL showed an association in 70% cases.</p> <p><strong>Conclusions: </strong>HL in India is a disease of young males, with mixed cellularity as the commonest subtype, highly associated with EBV and presentation at an early stage.</p> 2020-07-07T11:02:20+00:00 ##submission.copyrightStatement## Primary Thyroid Lymphoma 2020-07-02T10:26:58+00:00 Sripriya Krishnan I V Renuka C H Ramya Harshitha . <p>Primary thyroid lymphoma (PTL) is a rare condition and accounts for 5% of all thyroid malignancies. They constitute less than 2 % of all lymphomas. Most PTL’s are non-Hodgkin's lymphomas. It is clinically essential to discriminate between primary or secondary lymphoma of the thyroid as the treatment and prognosis varies. It commonly occurs in women in their sixth and seventh decade. Primary thyroid lymphoma is quite curable without the need for extensive surgery if diagnosed early. We present such a case of a 60- year old female patient presenting with complaints of neck swelling with loss of appetite and dysphagia. Histopathological diagnosis confirmed Primary thyroid lymphoma of B cell origin which was confirmed by immunohistochemistry.</p> 2020-07-02T10:26:58+00:00 ##submission.copyrightStatement## Mesenteric Paraganglioma-A Cyst in The Mist 2020-07-02T10:34:37+00:00 Saniha P B M N Jadhav S K Kittur <p>Extraadrenal paraganglioma is rarely found in the mesentery. It accounts only for 5-10% of cases and may present incidentally as abdominal mass. We report a case of 30 year old male presented as mass per abdomen. A differential diagnosis of neurogenic tumor or cystic mesothelioma was considered based on CT-abdomen. Histopathological examination showed features of mesenteric paraganglioma and confirmed on immunohistochemistry. This case report highlighted several important key issues regarding diagnosis of paraganglioma, including malignant or metastatic potential, recurrence rate, pre and postoperative imaging study and lifelong follow-up of the patient.</p> 2020-07-02T10:34:37+00:00 ##submission.copyrightStatement## Solitary Fibrous Tumour of Cheek: A Diagnostic Dilemma 2020-07-07T11:07:11+00:00 Subhash Yadav Shubhada Kane <p>Solitary fibrous tumor (SFT), an uncommon spindle cell neoplasm is believed to be of mesenchymal origin and usually presents as pleural based mass. SFT are rare in the head-neck region but are extremely uncommon intra-orally. The patient was a young male who presented with difficulty in mouth opening. Examination revealed a submucosal nodule on the buccal surface which was histologically and immunohistochemically proven to be SFT. Authors wish to discuss the case due to its rarity and diagnostic difficulties due to many common histological mimickers at that site.</p> 2020-07-07T11:07:11+00:00 ##submission.copyrightStatement##