Annals of Pathology and Laboratory Medicine

Profile of IHC Marker in Lung Tumours

Aparna Bhardwaj — 2019-02-15

Background:

Lung biopsy is crucial in histopathological subtyping and classification. However, making an accurate diagnosis in small biopsies can be challenging. This study was aimed to distinguish and classify lung tumors employing immunohistochemical markers TTF-1(thyroid transcription factor 1), Cytokeratin 5/6, Cytokeratin 20, AE1/3. Subsequently, prognostic value of different histological types of lung tumours was established employing Ki-67.

Material & Methods

A total of 52 clinically diagnosed cases of lung carcinoma over a period of two years were included in our study. Of these 2 cases were excluded from the study as they showed granulomas on histopathology. All the cases after being diagnosed on H&E were subjected to Immunohistochemistry (IHC).

Statistical Analysis: The statistical analysis was done using SPSS for Windows 15.0 program. Specificity, sensitivity, positive predictive value, negative predictive value of all these IHC markers was statistically evaluated.

Results

Of 29 cases diagnosed as Squamous cell carcinoma (SCC) on H&E, 26 were CK5/6 positive on IHC. Of 4 cases diagnosed as Primary Adenocarcinoma (ADC) on H&E, 3 were TTF-1 positive. Four cases of poorly differentiated carcinoma diagnosed on H&E, 1 case was diagnosed as SCC and 2 cases as Metastatic ADC on IHC. Ki-67 was high in 82.8% cases of SCC and in 50% cases of ADC. The sensitivity and specificity of CK5/6 and TTF-1 was 100%, 57.1% and 100%, 96.7% respectively.

Conclusion:

Employing IHC markers either singly or in a panel is a useful adjunct to morphological features and clinical parameter in the diagnosis and management of lung tumour.

A Clinicopathological Study of Immunobullous Diseases

Annu Elizabeth Prakash — 2019-02-15

BACKGROUND

Vesiculobullous disorders are a group of disorders involving the formation of a fluid filled cavity within or beneath the epidermis, due to the presence of autoantibodies against adhesion molecules in epidermis and dermis. The clinical presentation and the microscopic features of different diseases belonging to this group vary greatly. This study was undertaken to describe the clinical features and the histopathological patterns of immunobullous diseases.

METHOD

30 cases of immunobullous disorders who attended Dermatology Outpatient Department were included in the study. Relevant clinical details of these cases were collected and punch biopsies were taken from the site of lesion which were used for routine histopathology.

RESULTS

Among the 30 cases included in our study, males were found to be more commonly affected than females. The most common immunobullous lesions encountered were Pemphigus Vulgaris(13/30) and Bullous Pemphigoid (10/30). In pemphigus group of diseases, patients presented with small cutaneous and oral vesicles. Pemphigus foliaceous patients showed cutaneous lesions only. Intraepidermal vesicles containing acantholytic cells and inflammatory cells were characteristic histological features of the Pemphigus group. Bullous pemphigoid lesions were large bullae on the limbs and within the oral cavity. Most of the cases of Bullous Pemphigoid showed the formation of subepidermal bullae predominantly containing eosinophils.

CONCLUSION

Both the clinical findings and the histological features are invaluable in arriving at a definite diagnosis in immunobullous diseases.

Infection Control Practices: Awareness and Knowledge of Undergraduates in Tertiary Care Hospital

Manali Hitenbhai Shah — 2019-02-17

Background: Hospital acquired infection an infection occurring in a patient in a hospital or other health care facility in whom the infection was not present or incubating at the time of admission. Every person associated with health care work should have proper training, knowledge and practice for the same. Undergraduates do not have proper knowledge towards the health care management. As they are in the learning phase, need to train enough.

Methods: It was an observational analytical study. 2^nd year MBBS students were included in the study. A semi-structured preformed questionnaire of total 21 questions having multiple choice questions with the use of Google doc application. Data were analyzed by using Microsoft Excel program.

Result: Total 143 2^nd year MBBS students responded. Knowledge regarding needle stick injuries was 40-60 % while about MDR and XDR TB was up to 70-80 %. Around 60 % knew the correct dosage schedule of Hepatitis B vaccine whereas 70 % emphasized the importance of hand hygiene in hospital acquired infections.

Conclusion: The study shows lack of knowledge and awareness amongst medical students about hospital acquired infections. There is to educate them enough by means of various curriculum activities. More such studies should be done in future to assess their KAP score and guide them well.

Efficacy of Xpert MTB/RIF Assay in the Diagnosis of Smear Negative HIV Seropositive Pulmonary Tuberculosis Patients

Reetika Bansal — 2019-02-18

Background: Tuberculosis (TB) is the most common presenting illness and leading cause of death among people living with HIV(PLHIV).Diagnosis of TB among PLHIV is challenging as false negative results are common with direct microscopy (DM) and culture takes long time. WHO (2013) recommended Xpert MTB/RIF assay as an initial test for diagnosis of TB in PLHIV.

Methods: The present study was conducted on 142 HIV seropositive patients who were clinically suspected to have TB. The sputum specimens obtained from these patients were divided into two parts; one was processed by DM and the other was used for Xpert MTB/RIF assay.

Result: Of the 142 HIV seropositive patients, 90(63.3%) were in the age group of 15-40 years and majority 91(64.08%) were males. Out of 142 sputum specimens collected from these patients, only 5(3.52%) were positive by DM and 31(21.83%) by Xpert MTB/RIF assay. Statistically the difference between the two was significant (p value <0.005). Xpert MTB/RIF assay showed rifampicin resistant in 2(6.45%) specimen. Of the 137 smear negative specimens, Xpert MTB/RIF assay gave positive result in 27 (19.70%). Thus, the sensitivity, specificity, PPV, NPV of the Xpert MTB/RIF assay in comparison to DM was 80% (95%CI=37.6- 96.4), 80.29% (95%CI=72.8-86.1), 12.90% (95%CI=4.21-30.76), 99.09%(95%CI=94.3-99.9) respectively.

Conclusion: Xpert MTB/RIF assay was found to be a sensitive, specific and rapid method for diagnosis of TB and rifampicin resistance in smear negative PLHIV. It’s availability as an initial diagnostic test in PLHIV could significantly reduce the delay in initiation of treatment and prevent the transmission of the disease.

The Clinico-Pathological Spectrum of Endometrial Lesions in Patients with Abnormal Uterine Bleeding in Accordance with PALM-COEIN Classification: A Prospective Study of 3 Years in a Tertiary Care Hospital of Western Uttar Pradesh

Roobina Khan — 2019-02-18

Background: Abnormal uterine bleeding (AUB) is one of the most frequently encountered gynecological complaints in women associated with considerable morbidity and mortality. This study may help clinicians in our population to improve their therapeutic strategies by resorting to minimally invasive modalities and avoiding unnecessary hysterectomies.
The aim of this study is to study the clinic-pathological spectrum and histological patterns various endometrial lesions in patients with AUB in accordance with PALM-COEIN classification.

Methods: The present study was carried out on 265 patients over a period of 2 years in the Department of Pathology, Jawaharlal Nehru Medical College, A.M.U, Aligarh. Endometrial tissue was collected by dilatation and curettage (D and C) and endometrial biopsy and was sent to the histopathology laboratory for evaluation.

Result: The most common clinical presentation was menorrhagia (43.4%), followed by metrorrhagia (19.3 %). Age of patients ranged from 15 to 70 years with peak incidence found in the 5^th decade (41-50 years) (35.4%). On histopathological examination, non- structural causes accounted for the majority of the diagnosis (37%) in which normal cyclical endometrium (AUB-E) was the commonest lesion seen in 37.8 % of cases. Endometrial hyperplasia (AUB-M) was the most common histopathological diagnosis 84(31.7%) amongst structural causes in our study. This was followed by endometrial polyp (AUB-P) in 12(4.5%) cases and endometrial carcinoma in 4(1.5%) respectively.

Conclusion: Our study revealed a clustering of cases around perimenopausal age group. Histopathological examination of endometrium is gold standard diagnostic tool in evaluation of AUB and there is an age specific association of endometrial lesions.

A Study of The Reasons for Deferral of Voluntary Blood Donors at A Tertiary Care Hospital

Nisha Attri — 2019-02-18

Background: Voluntary blood donation forms the basis of procurement of safe blood from a healthy donor. Donor selection is necessary in addition to the screenings of blood bags for infectious diseases. Deferrals lead to loss of precious blood/components available for transfusion. For preventing this, we should be having knowledge of causes of deferral and their frequency.

Methods: The study was conducted in the blood bank of Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, India, from January 2017 to July 2018 to determine the incidence of deferrals. The aim of our study is to know the incidence of donors who were deferred from donating blood and to determine the causes of permanent and temporary deferral.

Result: A total of 21,433 donors were screened. Out of which, 1134 donors were deferred. The total donor deferral rate was 5.29%; the percentages of deferral being 1.62% for females and 3.67% for males. The deferral was maximum between 18- 40 years of age. The temporary deferral was more common than permanent deferral; the reasons in males being anemia, low blood pressure and underweight. The reasons documented in females being anemia, menstrual history within one week, followed by underweight. The most common reason in both males and females, for permanent deferral was hypertension.

Conclusion: Donor deferral rate of 5.29% was found in this study. Females coming forward for blood donation were significantly low. The major causes of deferral were anemia and hypertension.

Gliosarcoma with Chondrosarcomatous Differentiation

Rajeshwari B — 2019-02-15

Gliosarcoma (GS) is a variant of IDH wild type of glioblastoma (WHO grade IV). It is characterized by biphasic tissue pattern showing glial and mesenchymal components. The glial component is usually similar to glioblastoma and the sarcomatous component is usually spindle cell type. Rarely the sarcomatous component can show additional lines of mesenchymal differentiation like cartilage, bone, smooth muscle, skeletal muscles etc. These tumours are more firm and discrete because of the high content of reticulin and collagen in the sarcomatous component. Originally these tumours were thought to arise from sarcomatous transformation of proliferating blood vessels or dedifferentiation of an advanced glioma. The recent studies show that both glial and sarcomatous component show identical mutations in p53, PTEN and TERT genes and suggest a monoclonal origin from a common stem cell. There is no significant difference in prognosis between glioblastoma and gliosarcoma. Here we report a case of gliosarcoma with chondrosarcomatous differentiation in a 52 year old gentleman. The case is presented here for its rarity.

Retroperitoneal Teratoma in an Infant

Barani Karikalan — 2019-02-17

Common location of teratomas in children are sacrococcygeal, gonadal, mediastinal and retroperitoneal, but teratomas may also occur at very unusual locations. A one-year-old girl presented with a large swelling at her left abdomen. Clinical examination revealed a solitary, non-tender, soft to firm, irregular cystic mass, occupying her left abdominal region. Computed Tomography (CT) scan finding was consistent with retroperitoneal teratoma. Complete surgical excision of the tumour was done without any difficulties. Histology of the excised tumour was conclusive of mature cystic teratoma.

FNAC diagnosis of MultilocularAmeloblastoma of the Mandible

Pradeep V Mitra — 2019-02-17

Ameloblastoma is most common benign epithelial odontogenic tumor with malignant potential usually located in jawbone. This tumor is reported to constitute 1-3% of tumors and cyst of jaws. It is common between 3^rd to 5^th decades of life with equal sex distribution. It often presents as a slow growing painless swelling causing perforation of buccal bone along with infiltration of surrounding soft tissue. It has a very high recurrence rate of over 50% even after wide excision.

We present a case of Ameloblastoma in a 71 year female to highlight its cytological features.

Extra Nodal Primary Diffuse Large B-Cell Lymphoma of Thyroid

Anand Kalia — 2019-02-17

Primary Thyroid Lymphoma (PTL) involves less than 5% of all thyroid malignancies. It mostly comes into notice later in life of which Diffuse Large B-Cell Lymphoma (DLBCL) is the commonest type. Though the primary site of lymphoma is Lymph Node, DLBCL involving thyroid primarily and later spreading to Lymph Nodes and other sites is also known. This tumor causes rapid progression of the thyroid mass which can compress the trachea and may even present as an acute emergency. Therefore, it is important to recognize this entity as the treatment and progression differs from other thyroid malignancies

We are presenting the case of Extra Nodal Primary DLBCL of Thyroid gland in a 55 years old female who presented with thyroid swelling along with multiple Cervical Lymph Nodes which on Histopathology and subsequent Immunohistochemistry was confirmed as DLBCL of primary thyroid gland with regional and distant metastases.

Intrascrotal Extratesticular Neurofibroma

Smita Pushkar Bhide — 2019-02-18

Solitary neurofibroma of the scrotum is an extremely rare benign tumor, particularly when it is not associated with neurofibromatosis type I. To the best of our knowledge, less than 10 cases have been reported in the English literature.

We report a case of 77 year old male who presented with large right scrotal mass which was surgically excised and after histopathological examination diagnosis of intrascrotal extratesticular neurofibroma with degenerative atypia was made.