Annals of Pathology and Laboratory Medicine

Predictive Significance of Renal Histopathology as Correlated with Renal Function in Patients of Nephrotic Syndrome

Sufian Zaheer — 2019-12-28

Background: The advent of renal biopsy in early 1950’s has greatly enhanced the understanding of renal disease including nephrotic syndrome in all areas of clinical nephrology, pathology and investigations. The biopsy data, complemented by appropriate clinical, laboratory information and basic studies has contributed significantly to the body of knowledge of renal disease.

Material and methods: This study was undertaken to analyze the usefulness of renal biopsy in patients of nephrotic syndrome. The present study was conducted on 52 patients of nephrotic syndrome, with detailed clinical examinations, relevant biochemical investigations and these patients were subjected to renal biopsy for detailed histopathological examination.

Results: Of the 52 cases, 34 (65.4%) were male and 18 (34.6%) were females with male to female ratio of 1.9:1 and mean age being 29.5+ 12.5 years. Pre-biopsy clinical assessment revealed the major cause of nephrotic syndrome as primary glomerular disease in 42 (80.8%). Secondary cause of nephrotic syndrome was suspected in the remaining 10 (19.2%) of patients. After pathological evaluation, the major cause of nephrotic syndrome observed in the present study was primary glomerular diseases which accounted for 40 (76.9 %) patients. Secondary glomerular diseases were observed in the remaining 12 (23.1%) patients. Post biopsy histopathological diagnosis lead to change in therapy in 67.4% of the patients and the alteration of therapy post biopsy most commonly revolved around the use of corticosteroid. In 8 patients therapy with cytotoxic drugs was started.

Conclusion: The estimate of prognosis was in agreement (pre-biopsy and post-biopsy) in 61.5 % of cases whereas in 20 (38.5%) patients it was different. In 12 (23.1%) cases a better prognosis was estimated and in 8 (15.4%) cases it was worse than estimated previously.

Laboratory Diagnosis of Renal Disorders

Sharanya K — 2019-12-28

BACKGROUND:

Urinalysis is one of the earliest methods used to screen and detect patients with kidney diseases. It also helps to monitor and assess the severity of the disease process in already diagnosed patients. Microscopy plays a vital role in routine urinalysis and gives more information when analyzed together with chemical strip tests. Introduction of automation of the conventional methods of urinalysis has reduced the disadvantages of manual methods in terms of accuracy of results and turnaround time.

METHOD:

Aim of the present study is to evaluate the performance of an automatic urinalysis system – FUS-100 (which in cooperates an automatic urine chemistry analyzer H-800) manufactured by Dirui Industrial Co. Ltd., China in patients with renal diseases and compare the results of microscopy with manual microscopic analysis. In addition, our study aims to find out the possibility of safely reducing the number of manual microscopy analyses by cross-interpretation of the results generated by FUS-100 automated urine particle analyzer with manual methods. The urine sediments of five hundred urine samples were examined by these two methods.

RESULT

Automation of urine analysis decreases the turnaround time and is less labour intensive leading to better accuracy and precision.

CONCLUSION

Preanalytical errors related to centrifugation and sediment preparation are prevented in automation. Our study tends to suggest that automation of urine microscopy therefore is a more standardized procedure and makes urine microscopy a more objective investigation.

Significance of Serum Prostate Specific Antigen Levels in Evaluating Prostatic Lesions with Histopathological Correlation

Shruti Amit Deshpande — 2019-12-28

Background: Prostate cancer is one of the commonest forms of cancer among men. Serum prostate specific antigen (PSA) used in the diagnosis of prostate cancer is also elevated in other benign and non-malignant diseases of prostate.

Objectives: The objectives of the study were to determine the relationship of serum f(PSA) and t(PSA), its correlation with histopathological findings and to assess the PSA cut off variable in various pathological conditions of prostate with clinical relevance.

Materials and methods: This study included 141 patients admitted for transurethral resection of prostate and 141 control cases. fPSA was determined on blood samples by sandwich enzyme linked immunosorbent assay and total PSA by Enzyme Linked Fluroscent Assay method. The samples were processed and stained with haematoxylin and eosin.

Results: The mean t(PSA) values for benign, premalignant and malignant lesions were 10.3 ng/ml, 20.36 ng/ml and 75.92 ng/ml respectively. The mean serum fPSA values for benign, premalignant and malignant lesions were 3.2 ng/ml, 9 ng/ml and 13.2 ng/ml respectively. The cut off value for tPSA was 12.25 ng/ml and that of fPSA was 9.4ng/ml. The p value(<0.0001) was highly significant in determining premalignant and malignant lesions.

Conclusion: Total PSA is raised in premalignant, malignant, inflammatory and benign neoplastic lesions of prostate. In cases where the t(PSA) values are between four - ten ng/ml, f(PSA) is useful marker in cases of malignancies, which were confirmed on histopathology.

Drug Induced Primary Tubulointerstitial Nephritis

Rojekar Amey — 2019-12-28

Background: Primary Tubulointerstitial Nephritis (TIN) is inflammation of predominantly tubular & interstitial compartment without involving glomeruli and vessels, which may be due to varied etiologies. Drugs are the most common culprit for Primary TIN worldwide. Here we studied a series of primary TIN in renal biopsies at a tertiary care center.

Methods: In this retrospective study of ten year duration, we have studied all cases of primary TIN with history of drug intake. We reviewed these cases for symptoms, etiology and histomorphological features.

Results: A total of 54 cases of primary TIN were described. The age range of the patients was 6 to 72 years with mean of 47.8 years. Pedal edema, puffiness of face were the most common symptoms followed by oliguria. Non-Steroidal Anti-Inflammatory (NSAIDs) were found to be the most common group of drugs causing acute TIN resulting in acute kidney injury (AKI). These are followed by antibiotics and ayurvedic/indigenous preparations. Acute TIN was more commonly seen histopathology than chronic TIN.

Conclusion: NSAIDs are most common cause of TIN followed by ayurvedic drugs. Timely diagnosis and withdrawal of offending agent with prompt treatment may help to preserve or improve renal function.

Anemia: A Diagnostic Malady in Management of Dengue Patients

Nabila Afsar — 2019-12-28

Background: With the high prevalence of anemia and increasing incidence of dengue in developing countries like India, diagnosis of anemia in dengue patients needs to be stressed. There is higher hemoglobin and hematocrit as a result of plasma leakage in dengue, hence diagnosis and treatment of anemia may be missed.

Methods: Hospital based retrospective study was done on 138 patients diagnosed with Dengue fever during the year 2017, in a tertiary care teaching hospital in Hyderabad. The CBC data was retrieved and statistical analysis was performed.

Result: 60% of patients >5 yrs of age showed low Hb however hypochromia on smear was noted in 93.3% of cases. In patients aged 5-11yrs and 12-14 yrs, 31.4% and 14.3% respectively had low Hb, but hypochromia was noted in 48.6% and 57.1% .In non pregnant females, 68.4% showed low Hb while 55.3% cases showed Hypochromia. In males,25% of cases showed low Hb whereas 13.9% showed Hypochromia.

An analysis of 36 in patents with >3 reports was done to demonstrate the variation in Hb,MCV and MCH during course of admission. There was wide variability in Hb concentration of same patient on CV above 1% in 91.7% of the cases. MCV and MCH had CV more than 1.1% and 0.5% in 25% and 69.4% of the cases respectively.

Conclusion: MCV is a stable parameter which can be used to assess the morphological status of the RBC even in a background of heamoconcentration. Complication of volume overload needs to be avoided in an anemic patient suffering from dengue .The importance of inclusion of red cell indices especially MCV in CBC reports is stressed.

Histopathological Examination of Uterine Evacuation Products Following First Trimester Abortion Along with Clinico-Pathological Correlation in A Tertiary Care Centre

Dhruvi Shah — 2019-12-28

Background: Spontaneous abortion also known as miscarriage is one of the most common conditions encountered by the gynecologists and obstetricians. The women who had spontaneous miscarriage have traditionally undergone surgical uterine evacuation of retained products of conception. In recent years more and more patients are evaluated with more and more refined diagnostic techniques and therapeutic interventions. In our center too, it is a routine practice to submit tissues obtained by uterine evacuation to the histopathology department, and to confirm intrauterine fetal tissue.

Methods: The present retrospective study was done for a period of one year in the department of Pathology, Gujarat Adani institute of medical sciences, G. K General Hospital, Bhuj. Total 62 samples of uterine evacuation products were evaluated. Along with their clinico-pathological correlation the histopathological spectrum of the lesions were also studied and the necessary statistical analysis was done.

Result: The most common clinical diagnosis was retained product of conception (34%), followed by hydatidiform mole (24%). The most common histological finding was presence of chorionic villi (55%), followed by presence hydatidiform mole (24%). Clinico-pathological correlation was found in (79%).

Conclusion: The present study was to highlight the importance of histopathological evaluation of the uterine evacuation products. Our study strongly recommends the histopathological examination of all uterine evacuation products as it aids in timely management of the patients.

Secondary Hemophagocytic Lymphohistiocytosis

Poonam Nanwani — 2020-01-04

Introduction : Hemophagocytic lymphohistiocytosis (HLH) is a rare hematological disorder which may be fatal due to uncontrolled activation of immune system. It is characterized by hemophagocytosis in bone marrow, liver or lymph nodes along with presence of fever, pancytopenia, splenomegaly. It has been associated with bacterial, viral, fungal and parasitic infection.

The study aims to explore the utility of bone marrow aspiration in patients with pancytopenia and bicytopenia which supports the diagnosis in a scenario where there is clinical suspicion of HLH.

Material and Methods – prospective study carried out in department of pathology from August 2018 to July 2019. We studied 88 cases of pancytopenia and bicytopenia. All relevant clinical history and investigations were collected. Bone marrow aspiration done and smears were studied in all the cases.

Result – Out of 88 cases studied 28 patients were having bicytopenia and 60 were having pancytopenia with male to female ratio 13 :9.Out of these 88 patients we reported 3 patients as having HLH who fulfill the criteria according to Revised Diagnostic Guidelines for hemophagocytic lymphohistiocytosis (HLH).

Conclusion :-An early diagnosis and treatment is the key to decrease the mortality caused by this dreadful disease and if left undiagnosed and undertreated, Hemophagocytic lymphohistiocytosis can be rapidly progressive and potentially fatal.

Undifferentiated (Anaplastic) Carcinoma of The Thyroid with Abundant Mucin Production

Vaishali Gaikwad — 2019-12-24

Most pathologists are unaware that thyroid gland also produces mucin; often associated with typical thyroid carcinoma rather than primary mucinous neoplasm. We report an unusual case of anaplastic carcinoma of thyroid presenting with abundant extracellular mucin. A 65 year old lady presented with painless, neck swelling since 7-8 months. Thyroid function tests were within normal limits. Imaging suggested neoplastic aetiology of thyroid. Cytology revealed abundant extracellular mucin with occasional large atypical cells. Hence, metastasis followed by primary mucinous thyroid carcinoma was considered. After excluding secondary neoplasms, total thyroidectomy with lymphadenectomy was performed. Histopathology revealed an infiltrative tumour with abundant mucin & necrosis amidst fibrotic bands. Tumour cells were arranged in sheets, with features of anaplasia. Focus of papillary thyroid carcinoma also identified. Mucicarmine and Alcian blue special stains were positive. Immunohistochemistry results of positive cytokeratin and negative TTF1, thyroglobulin and calcitonin confirmed our results.

Clear Cell Carcinoma of Cervix

Charanya Manivannan — 2019-12-24

Clear cell carcinoma of cervix is a rare tumor, accounting for about 4% of cases of cervical adenocarcinoma. It commonly occurs in young women whose mothers had been exposed to diethylstilbestrol (DES). We are reporting a case of clear cell carcinoma of cervix in a 58 year old postmenopausal woman with no history of intrauterine exposure of DES.

Primary Intradural Extramedullary Extra-OsseousEwing’s Sarcoma of Cervical Spine (C5-C7)

Srinivas DD Gubbala — 2019-12-24

Ewing's sarcoma is a rare aggressive tumor common in bone or skeletal component. Primary Intradural Extra-medullary Extra-Osseous Ewing sarcoma of cervical spine is extremely rare malignant neoplasm and only few cases have been reported in the literature. There is a paucity of data regarding the clinical features, natural course, pre-operative diagnosis, treatment modalities and post-operative management. Herein, we report a case of a 22-year-old man who presented with inability to walk and numbness in both lower limbs. MRI findings suggested a possibility of nerve sheath tumor but was diagnosed as Intradural Extra-skeletal Ewing sarcoma on histopathological analysis. The literature with regard to primary spinal intradural extra-skeletal Ewing sarcoma was reviewed.

Paratesticular Tumors: A Report of Two Rare Cases

Sinchana K M — 2019-12-24

Paratesticular tumors are rare comprising 7-10% of total intrascrotal tumors of which 70% are benign and 30% are malignant. Leiomyomas and undifferentiated pleomorphic sarcomas are two such rare paratesticular tumors which should be accurately diagnosed for purpose of treatment and prognosis. We report here two cases. In first case, a 65-year-old man presented with paratesticular mass of 12 years duration. Histology showed features of benign spindle cell tumor. On immunohistochemistry the tumor cells were positive for vimentin, desmin, h-caldesmon and SMA. Based on these findings a diagnosis of leiomyoma of scrotum was made. In second case, a 66-year-old male presented with left paratesticular mass of eight months duration. Histology showed features of high-grade sarcoma. On immunohistochemistry tumor cells were focally positive for SMA and negative for h-caldesmon, desmin, calretinin and ALK-1. A final diagnosis of undifferentiated pleomorphic sarcoma of paratesticular region, grade 3/3 was made.

Hydatid Disease of The Bone

Ekta Jain — 2019-12-31

Hydatid disease of the bone is a very rare condition. It represents about 0.5–4% of all human hydatid disease. Spine is the most affected part of the skeleton (50% cases). Extra-spinal bone hydatidosis is much rare. A 20 year old woman presented with severe pain and swelling in left thigh. On examination, there was a boggy swelling in left thigh suggestive of abscess. MRI of left hip joint and thigh revealed features of osteomyelitis with pathological fracture in upper shaft along with multiloculated collections in upper thigh muscle. Biopsy revealed evidence of Hydatid cyst. Hydatid disease of the bone is a rare manifestation of Echinococcosis. It is hence important to consider the possibility of Hydatid disease of the bone as a differential diagnosis of lucent lesions of bone especially in areas where it is prevalent for proper treatment of the patient. Radiological, laboratory, and clinical findings combined with strong element of suspicion are the key for diagnosis.