Annals of Pathology and Laboratory Medicine <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 2016): 74.20</p> Pacific Group of e-Journals (PaGe) en-US Annals of Pathology and Laboratory Medicine 2394-6466 <p>Authors who publish with this journal agree to the following terms:</p> <ol> <li class="show">Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a&nbsp;<a href="">Creative Commons Attribution License</a>&nbsp;that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.</li> <li class="show">Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.</li> <li class="show">Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See&nbsp;The Effect of Open Access at</li> </ol> <p>&nbsp;</p> Clinicopathological Significance of HER2/neu Expression in Gastric Carcinoma <p><strong>Background:</strong> Gastric cancer remains the most common cause of cancer related death worldwide. HER2/neu protein overexpression in gastric carcinoma was found to be an independent indicator of poor prognosis.</p> <p>The present study was designed to evaluate the frequency of HER2/neu expression in gastric carcinoma, and also the relationship between HER2/neu expression with clinicopathological parameters.</p> <p><strong>Methods:</strong> Analysis of HER2/neu expression was done by immunohistochemistry in 41 specimens of Gastric carcinoma over a period of one year and was correlated with clinicopathological parameters. Samples with IHC score 2+ and 3+ were taken as HER2 positive.</p> <p><strong>Result:</strong> The study revealed 15 (36.6%) cases of gastric carcinoma being positive for HER2/neu. Of the 41 cases, 5 were classified as score 3+ (12.2%), 10 were classified as score 2+ (24.4%), 11 were classified as score 1+ (26.8%) and 15 were classified as score 0 (36.6%). Peak incidence was found in the age group of 41-50 years. Significant correlation of HER2/neu expression was found with intestinal type (<em>p</em>-value=0.003) and also with moderately differentiated type (p-value=0.018) of gastric adenocarcinoma. However, no significant correlation was found with the other clinicalpathological parameters like age, sex, site, lymph node status and staging.</p> <p><strong>Conclusion: </strong>HER-2/neu over-expression was significantly associated with intestinal type and moderately differentiated gastric carcinoma. HER2/neu status can be considered as an important prognostic factor in gastric carcinoma.</p> Ashim Manta Pranita Medhi ##submission.copyrightStatement## 2019-09-27 2019-09-27 6 9 444 450 10.21276/apalm.2405 Determination of Quality outcome indicators in National Quality Assurance Standards (NQAS) accredited Hematology and Clinical Pathological laboratory <p><strong>Background:</strong></p> <p>Laboratory plays a vital role in disease control and prevention by providing timely data or information for patient management and disease surveillance. Quality in laboratory has huge impact on diagnosis and patient management as about 80% of all diagnosis is made on the basis of laboratory tests.</p> <p>&nbsp;<strong>Methods:</strong></p> <p>The study was conducted in Central Diagnostic Laboratories of GMERS Medical College, Junagadh which is NQAS (National Quality Assurance Standards). The hospital uses internet and data is retrieved by the systems department. The study was conducted from January 2015 to December 2018. A total of 2,13,476 samples were received in the hematology and clinical pathology section. Different quality outcome indicators of hematology and clinical pathology laboratory were studied.</p> <p><strong>Result:</strong></p> <p>All Quality parameters were consistently improved from 2015 to 2018 due to new instrumentation, IQC, EQC, timely instrument maintenance, laboratory information system (LIS), telephonic communications and monthly-yearly quality improvement meetings. Some important indicators like&nbsp;&nbsp; TAT, critical alert were not reach up to the target value but due continuous improvement plane we soon reach target level.</p> <p><strong>Conclusion: </strong></p> <p>The concept of quality indicators has revolutionized the field of laboratory medicine. These indicators are of most importance in the comparison of individual laboratory performance with the aim of improving laboratory services and quality.</p> Killol Nathubhai Desai Chiragkumar B Menapara ##submission.copyrightStatement## 2019-10-01 2019-10-01 6 9 A451 454 10.21276/apalm.2409 Histomorphological Study of The Spectrum of Prostatic Lesions in Surgical Biopsy Specimens <p><strong>Background:</strong> Prostatism is one of the commonest health concerns in geriatric population with significant morbidity and mortality. The incidence of it increases with age. Histopathological evaluation plays a major role in the diagnosis and management of Prostate lesions. <strong>Aims and Objectives: </strong>To study the spectrum of prostate specimens encountered by the pathologists and to categorize them based on their histomorphological features and to correlate it with the clinical and other laboratory parameters. <strong>Material and methods:</strong> Hematoxylin and Eosin sections of 100 prostatic biopsies received in the department of Pathology of a tertiary care centre over a period of 18 months were studied. Relevant clinical and laboratory data were collected.</p> <p><strong>Results:</strong> Out of 100 prostatic biopsies studied, 91 were TURP and 9 were core biopsies. Prostatic lesions was common in the age group of 61-70 years. 75% of cases were benign with or without prostatitis, 15% malignant and 10% cases were pre malignant. 25% cases were found to have associated prostatitis with the benign and malignant lesions. The most common microscopic feature in benign cases was fibromuscular hyperplasia.</p> <p><strong>Conclusion:</strong> The present study shows that benign lesions are more common than the malignant ones. Among benign lesions, BPH was the most common entity. The most common age group affected was 7<sup>th</sup> decade.</p> Srikanth K N Gandhi Mourouguessine Vimal Erli Amel Ivan ##submission.copyrightStatement## 2019-10-01 2019-10-01 6 9 A455 458 10.21276/apalm.2482 Histopathological spectrum of upper gastrointestinal lesions in a tertiary care centre <p>Background: Gastrointestinal disorders are commonly encountered in clinical practice. Histopathologic examination of the endoscopic biopsies will help in definitive diagnosis and early therapeutic intervention. This study is done to know the various lesions presenting in our hospital.</p> <p>Materials and methods: This is a prospective study done in the Department of Pathology, Kanachur Institute of Medical Sciences between January 2018 to January 2019. 100 cases from esophagus up to the second part of duodenum were studied. The biopsies were sent to the histopathology lab in 10% buffered formalin. They were processed, sectioned and stained with H&amp;E</p> <p>Results: of the 100 cases, 26 cases were from the esophagus, 66 from the stomach and 8 from duodenum. Of the 26 esophageal biopsies, 6 cases showed dysplastic changes, 4 had hyperplastic epithelium, 3 showed chronic inflammatory changes, 2 showed features of reflux esophagitis and 11 were diagnosed as Squamous cell carcinoma. Of the 66 gastric biopsies, majority were benign, commonest being chronic non specific gastritis. 8 cases were malignant and showed features of Adenocarcinoma. Among the 8 duodenal biopsies all showed features of chronic duodenitis.</p> <p>Conclusion: Biopsies helps in establishing a definite diagnosis of upper gastrointestinal lesions at an early stage thereby reducing the progression to invasive carcinoma</p> Mridula Kamath Suchithra A Shetty Shreesha Khandige ##submission.copyrightStatement## 2019-10-01 2019-10-01 6 9 A459 462 10.21276/apalm.2552 Clinicopathological spectrum of Intracranial Posterior Fossa Tumours and their Prognostic significance <p><strong>Background:</strong> Intracranial Posterior fossa tumors are critical brain lesions with significant neurological morbidity and mortality due to limited space and involvement of vital brain stem nuclei and fourth ventricle. Early diagnosis of posterior fossa tumors is vital to prevent potential risks of Brain stem compression, herniation, hydrocephalus and death.</p> <p><strong>Aim of the study:</strong> 1. To study the morphological spectrum of intracranial posterior fossa SOLs. 2.To determine the frequency of posterior fossa SOLs reported in the tertiary care center of Nalgonda district. 3. To correlate clinical presentation with histopathological diagnosis and assess prognosis, and compare it with national and international literature.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</p> <p><strong>Materials and Methods:</strong> The present study was a retrospective description study conducted at the Department of pathology, Kamineni Institute of Medical Sciences, Narketpalli over a period of 3 years starting from June 2015 to June 2018. During this period, histopathological analysis of all the intracranial posterior cranial fossa tumors was done, correlated with clinical and radiological findings and prognosis assessed.</p> <p><strong>Result:</strong> In our study Posterior fossa tumors are predominantly seen in adults with peak incidence in fourth decade. In children majority of the tumors were reported below 5 years of age. Most common presenting symptom was head ache and vomiting. Most common tumor was Medulloblastoma in children and Schwannoma in adults. Most common location was Cerebello-pontine angle followed by cerebellum. Recurrence rates were higher for CP angle tumors due to difficult sub-total resection. Prognosis is good for patients with total resection of tumors.</p> <p><strong>Conclusion: </strong>Posterior fossa tumours are critical brain lesions with significant neurological morbidity and mortality. With rapid advancement in radiology and advent of modern therapeutic modalities early diagnosis and treatment is possible in many cases. Histopathology remains the gold standard in diagnosing Intracranial Posterior fossa tumours and necessary for the formulation of further management after neurosurgery.</p> Srinivas DD Gubbala Sridevi Mattaparti Bhavani . ##submission.copyrightStatement## 2019-10-01 2019-10-01 6 9 A463 474 10.21276/apalm.2614 Changing Role of Liver Biopsy Indications in A Tertiary Care Centre <p>Background: The histomorphological study of liver biopsy is the best means to ascertain the nature and signifi­cance of pathological processes occurring in the liver. The current non-invasive tools are unqualified to replace liver biopsy in clinical practice.</p> <p>Methods: This is a one year prospective study from January 2017 to 2018. A total of twenty five cases suspected to have chronic parenchymal liver disease, inflammatory lesions or neoplastic lesions were included in the study. Detailed history and investigations done including biochemical parameters, radiological and other investigative procedures done were recorded and percutaneous liver biopsy was done using trucut needle.</p> <p>Results: Out of the total 25 liver biopsy done, 60% cases were male, 40% were females. Majority of the patients belonged to the sixth decade (32%). Youngest patient was a 12 year boy with history of intermittent jaundice since birth, and the oldest patient was a 78 year old male. The most prevalent pathological diagnosis was cirrhosis with steatohepatitis with 7 cases (28%), followed by Non Alcoholic Fatty Liver Disease (NAFLD) and autoimmune hepatitis, 12% each.</p> <p>Conclusion: Liver biopsy is the gold standard for diagnosis of chronic liver diseases and plays a valuable role in diagnosis, prognostic and management of liver diseases.</p> Kalaranjini K V Jinu Abraham Glaxon Sheela Vasudevan ##submission.copyrightStatement## 2019-10-01 2019-10-01 6 9 A475 480 10.21276/apalm.2633 Correlation of hs-CRP Levels with Anti-CCP And Rheumatoid Factor Among Clinically Suspected Rheumatoid Arthritis Cases <p><strong>Objective:</strong>&nbsp;Despite the wide availability of markers to diagnose the established disease of RA, there is lack of evidence for the suitability of any of these established biomarkers for diagnosing the disease at an early stage of its pathogenesis. Hs-CRP has the potential to be useful as a predictor of early inflammation in clinically suspected RA cases.</p> <p><strong>Methods</strong>: 80 patients (40: anti-CCP positive; 40: anti-CCP negative) irrespective of their age and gender were enrolled. RF status and hs-CRP levels were determined in these patients. Correlation of hs-CRP levels with anti-CCP was done.</p> <p><strong>Results:</strong>&nbsp;Mean anti-CCP levels among RF positive and negative cases were 410 U/ml and 62.4 U/ml respectively. Among both the groups of anti-CCP positive and negative patients, majority had hs-CRP levels between 50-60 mg/l. Hs-CRP levels were more than 6 mg/l in majority of the suspected arthritis cases irrespective of the anti-CCP or RF status. Mean hs-CRP levels were 50.8 and 43.6 mg/l among anti-CCP positive and negative cases respectively by unpaired t-test. There was no correlation between serum anti-CCP and hs-CRP levels among both anti-CCP negative and positive cases.</p> <p><strong>Conclusions:</strong>&nbsp; Hs-CRP when used alone or in combination with other established markers, can aid in the early diagnosis, prediction of course of disease and assessment of response to treatment in RA cases.</p> Bineeta Kashyap Nisha Goyal Krishna Singha Mohd Tajuddin N P Singh Rajnish Avasthi ##submission.copyrightStatement## 2019-10-01 2019-10-01 6 9 A481 486 10.21276/apalm.2651 Metaplastic carcinoma of the breast <p>Metaplastic carcinoma of the breast is a rare tumor which accounts for less than 1% of all the primary breast malignancies. It commonly occurs in women more than 50 years of age and are usually triple negative tumors with basal like subtype. Metaplastic carcinomas of breast have a very aggressive behaviour resulting in worse prognosis and a dismal disease free survival. However most metaplastic carcinomas express EGFR, therefore early and correct diagnosis benefits the patient to receive anti-EGFR drugs like cetuximab and geftinib. We are reporting two cases of metaplastic carcinomas, one with spindle cell differentiation and the other with squamous differentiation.</p> Keerthini Ganesan Sandhya Sundaram Leena Dennis Joseph ##submission.copyrightStatement## 2019-10-01 2019-10-01 6 9 C94 96 10.21276/apalm.2429 Mixed Connective Tissue Disease Highlighting Diagnostic Exigency and Treatment Woes <p>Mixed connective tissue disease (MCTD) is a rare connective tissue disease characterized by manifestations that overlap symptoms typical of several other inflammatory diseases of connective tissue. A presence of anti-ribonucleoprotein antibodies (antiU1RNP) in high titer is a typical immunological finding.</p> <p>A 20 year old female complained of chilling and cyanosis of fingers on cold exposure since 5 years, with pain and numbness, hardening of skin of both hands, episodes of Raynaud’s phenomenon,gangrenous changes, self amputation of distal digit of middle finger. Systemic manifestations were also associated. &nbsp;A 15 year old female complained of thickening and tightening of skin of face and hands since 5 months, associated with joint pains, shortness of breath, dysphagia and photosensitivity of skin. Both cases were positive for Anti U1-RNP and Anti-SSA/Ro52 antibodies. Serology, radiology and histopathology were performed..</p> <p>MCTD may be difficult to define as definite classification criteria are not fulfilled. Young and pediatric patients with skin manifestations must be investigated to initiate early treatment and monitor renal parameters. Patient compliance and trust in treating physician is a key to early diagnosis and treatment. Treating physician must recognize symptoms and refer patients to higher centres.</p> Sabahat Zamani Nagma Nabila Afsar Idrees Akhtar Afroze Atiya Begum ##submission.copyrightStatement## 2019-10-01 2019-10-01 6 9 C97 100 10.21276/apalm.2468 A Review of Tripe Negtive Marker of IHC in Medullary Carcinoma Breast <p>Medullary carcinoma of the breast is an uncommon variant of invasive ductal carcinoma, which constitutes nearly 5% of all breast cancers in men and women. These tumours are often associated with favourable prognosis despite showing aggressive behaviour. In this study a patient presented with history of breast lump aged 48 years in left breast since one year .In mammography it was described as &nbsp;&nbsp;BIRADS II and fine needle aspiration cytology showed suspicious for malignancy .Histopathology report showed medullary carcinoma breast lesion. Immunochemistry was also done for ER , PR and Her-2neu&nbsp; and it showed negative for ER ,PR and HER 2 Neu. &nbsp;</p> Swati Sahay Aarushi Bansal Aditya Singh ##submission.copyrightStatement## 2019-10-01 2019-10-01 6 9 C100 103 10.21276/apalm.2620