Annals of Pathology and Laboratory Medicine

Synovial Sarcoma: a Clinicopathological Study with Emphasis on Rare Sites

Imtiaz Ahmed — 2018-11-24

Background: Synovial sarcoma is an infrequently diagnosed soft tissue sarcoma of the younger population with a male preponderance. Although the disease tends to home itself in the extremities particularly around the joints in the vast majority of cases, it can also occur in other surprising locations which warrant careful and meticulous histopathological examination accompanied by a judicious use of the immunohistochemical panel.

Methods: Search of the pathology database was done to identify cases of synovial sarcomas in rare sites.

Result: seven cases of synovial sarcoma were identified, three of which were at extremely uncommon sites rendering the diagnosis challenging and intriguing.

Conclusion: Differential diagnosis of synovial sarcoma should always be kept in mind in a young patient with a mass lesion of short duration, not only at the extremities but also involving other rarer locations like the lungs, heart and kidney.

Aspiration Cytology along with Histomorphological correlation of salivary gland lesions

Rajini T — 2018-11-24

Background: Fine needle aspiration cytology (FNAC) of salivary glands is one of the most commonly done first line investigations in the head and neck region. A wide variety of benign and malignant tumors originate in the salivary glands and insufficient tumor cells make their diagnosis difficult in some patients.

The aim of this study was to evaluate the efficacy of fine-needle aspiration cytology in the diagnosis of salivary gland lesions by correlating cytological findings with histopathology.

Methods: All the FNAC slides of salivary gland lesions received at our tertiary hospital for a period of 6years from January 2013 to July 2017were reviewed retrospectively. Histopathological correlation was done for cases wherever available

Result: FNAC categorized 50% of the salivary gland lesions as neoplastic and 50% as non-neoplastic lesions. Amongst the neoplastic lesions, 64.28% were benign and 35.72%were malignant cases. Histopathological examination revealed that 66.64% of the cases were benign and 33.36% were malignant. Fine needle aspiration cytology had a sensitivity, specificity and diagnostic accuracy of 75%, 100% and 94.05%, respectively. The positive predictive value and negative predictive value were 100% and 92.75%, respectively.

Conclusion: : Fine needle aspiration of the salivary gland is a safe and reliable technique in the primary diagnosis of salivary gland lesions. This study has shown that fine needle aspiration cytology has a high sensitivity, specificity and diagnostic accuracy in diagnosing salivary gland lesions. Being an rninimally invasive procedure, FNA of salivary glands continues to be an important diagnostic tool in the preoperative diagnosis of salivary gland lesions despite few pitfalls in diagnosing due to cytomorphological overlapping.

Intraoperative Frozen Section Assessment of Sentinel Lymph Node Biopsy in Breast Carcinoma to Determine the Axillary Lymph Node Status

Ramawatar R Soni — 2018-11-24

BACKGROUND: Breast cancer is commonest malignancy of females all over the world. Modified radical mastectomy is still considered as a standard for treating breast cancers. Axillary lymphadenectomy is achieved at the cost of significant morbidity, with a high acute complication rate and a high chronic lymphedema rate. Sentinel lymph node biopsy is associated with better arm function, better quality of life, a shorter hospital stay, and faster recommencement of daily activities than standard axillary lymph node dissection. There are inconsistencies and controversies regarding the pathological work-up of sentinel lymph nodes and no generally applied guidelines exist.

METHODS: In total, 60 breast carcinoma cases were studied over a period of 2 years. The axillary lymph node status was determined intra-operatively in carcinoma breast by frozen section assessment of sentinel lymph node.

RESULTS: Intraoperative frozen section had sensitivity of 90.3%, specificity of 100%, positive predictive value of 100%, negative predictive value of 90.6% and diagnostic accuracy of 95%. The sentinel lymph node biopsy had a false negative rate of 13.3%. 16.1% cases showed only sentinel lymph node positivity with non-sentinel lymph nodes free from metastasis. The positivity of sentinel lymph node for metastasis was dependent upon certain characteristics of patients such as tumour size, tumour location and grade of tumour and was independent of patient’s age.

CONCLUSION: Intraoperative frozen section evaluation of sentinel lymph node (SLN) to predict the status of non-SLN can be recommended only in selected patients in early stage of disease.

C-Reactive Protein : An Important Diagnostic Tool in Neonatal Sepsis

Nirav S Panchal — 2018-11-24

Background: Global burden of pediatric mortality during the very first month of life is around four million per year. In developing country like India, neonatal mortality is as high as one fourth (25%) of the global burden means around one million per year. Among the various common causes, infection or sepsis alone contributes for almost 30-40% of total neonatal deaths. The study is aimed to determine the effectiveness of C-reactive protein (CRP) as a diagnostic tool in neonatal sepsis.

Materials and Methods: This is a cohort prospective study. Study included total 123 patients considering inclusion and exclusion criteria. Blood samples were taken from all the patients for blood culture and CRP measurements. Results of blood culture and CRP were recorded and statistical analysis was performed by GraphPad Instat Demo.

Results: Out of 123 patients included in the study blood culture was positive in 71 (57.72%) patients and CRP was raised in 72 (58.54%) patients. Sensitivity, specificity, positive predictive value and negative predictive value for CRP were found to be 98.59%, 96.15%, 97.23% and 98.04% respectively.

Conclusion: C-reactive protein has high sensitivity and specificity with good positive predictive value and negative predictive value for establishing diagnosis of neonatal sepsis and results with CRP are comparable to those with blood culture.

The Cytological Spectrum of Major Salivary Gland Lesions: An Observational Study

R Bhuvanamha Devi — 2018-11-24

Background: Fine needle aspiration cytology (FNAC) is an accurate, cost effective & safe technique for diagnosing salivary gland lesions. We conducted this study to observe the cytological spectrum of different salivary gland lesions in tertiary care hospitals.

Methods: This is a prospective study carried from June 2010 to April 2014 at SBMCH Chromepet and SRM MCH & RC, Potheri. Fine needle aspiration was performed on patients presenting with complaints of salivary gland lesions. Data was statistically analyzed.

Result: FNAC is performed on total of 135 salivary gland lesions. 11 were non diagnostic aspirate (8.2%), 58 were non neoplastic lesions (42.9%) and 66 were neoplastic lesions (48.9%). The most common benign tumor of salivary gland is pleomorphic adenoma and mucoepidemoid carcinoma was the most common malignant tumor. The most common major salivary gland involved is parotid gland.

Conclusion: In the present study, neoplastic lesions were more common than non-neoplastic lesions. We conclude that inspite of few diagnostic pitfalls FNAC still plays a vital role in differentiating neoplastic from non- neoplastic salivary gland lesions to provide guideline for appropriate patient management.

KEYWORDS: Cytology, FNAC, Salivary Gland, Neoplastic Lesion, Non-Neoplastic Lesion.

Histopathological Spectrum of Gall Bladder Lesions in A Tertiary Care Hospital in The Malwa Belt

Shaffy Thukral — 2018-11-28

Introduction: Gallbladder stones are commonest disorder among gall bladder lesions and are usually asymptomatic. Its frequency in cholecystectomy specimens is not clear. The aim of this study was to report the morphological variants and frequency of different lesions in cholecystectomy specimens. Objective: To study the various histopathological spectrum of gall bladder lesions.

Materials And Methods: In present study we have studied total 141 cases of gall bladder lesion during the period of 6 months from April 2017 to October 2017 in the Dept. of Pathology at Adesh Institute of Medical Sciences and Research, Bathinda.

Results: Benign lesions of gall bladder outnumbered the malignant ones with non-neoplastic lesions accounting for 93.6% (132 cases) with chronic calculous cholecystitis contributing the majority of the non-neoplastic lesions (49.64%) followed by cholesterolosis (22.69%), acalculous cholecystitis (4.96%), followed by gangrenous and xanthogranulomatous cholecystitis. Females were predominantly affected in the present study with total 107 cases out of 141 cases-75.8% cases. Most of the non-neoplastic lesions of the gall bladder lesions are common in 3rd, 4th and 5th decades of life. Neoplastic lesions of the gall bladder were common in 5th, 6th and 7th decades of life. Out of 141 cases 5 cases are of adenocarcinoma of gall bladder-3.5% of all cases. The mean age of patient with adenocarcinoma of gall bladder is 60.8 years.

Conclusion: Gall bladder lesions were common indication for surgical intervention and pathological evaluation. Most of them were inflammatory lesions with cholelithiasis, however thorough examination is important as these lesions may progress to fatal malignancies.

A Clinicopathological Analysis of 120 Cases of Prostate Biopsies and Their Correlation with Prostate Specific Antigen levels

Anu Sumi Issac — 2018-11-28

Interpretation of prostate lesions in TURP and needle biopsies have always been a challenge due to their varied presentation. PSA, produced by epithelial cells of all types of prostatic tissue, is the key factor for screening and detection of prostate cancer. The present study aimed to analyze the histopathological changes of prostate and correlate them with PSA levels.

Methods:

One hundred and twenty cases of prostate lesions were obtained in two years. H&E stained sections were examined and a histopathological diagnosis was given.

Result:

Out of the 120 cases, 92 (76.7%) were Benign Prostatic Hyperplasia (BPH), 9 (7.5%) were Prostatic Intraepithelial Neoplasia (PIN) and 19 (15.8%) were Prostate Carcinoma (PCa). All three lesions presented predominantly with obstructive lower urinary tract symptoms. In the BPH group, mean age was 66 years and mean PSA of 7.21ng/mL. In the PIN group, majority were low grade PIN (77.8%), mean age of 66.56 years and mean PSA 38.23ng/mL. The highest PSA obtained in this study was 199ng/mL in a case of low grade PIN. In the Prostate carcinoma group, mean age was 66 years, mean PSA 63.8 ng/mL, majority were conventional adenocarcinomas (94.7 %). Most of the carcinomas had a Gleason sum < 6 and were well differentiated tumours (52.6%).

Conclusion:

All three groups had a common mean age of presentation and serum PSA levels were not always conclusive of the concerned pathology. Therefore, prostate lesions should be thoroughly evaluated by histopathology keeping in mind their neoplastic potential.

Fibrinogen and D Dimer in Healthy Nigerian Women on Hormonal Contraceptives

Sani Bako Abubakar — 2018-11-28

Introduction: Hormonal contraceptives have been associated with increased tendency of thromboembolic disorders. However, a balance between fibrin generation and fibrinolytic activity has been shown to minimize the risk. The aim of the study was to assess the serum fibrinogen and D-Dimer level in hormonal contraceptives users.

Methods: A total of 160 consenting participants made of 80 subjects on different forms of hormonal contraceptives and 80 controls on non hormonal IUCD were recruited into this study. A structured questionnaire was administered to obtain information required; blood samples were collected from each of the participant into appropriate containers using standard methods. Fibrinogen assay was done using the STAGO STart®4 coagulation analyzer while D-dimer was measured using ZYMUTEST DDIMER ELISA kit (HYPHEN BioMed). The results were analyzed using SPSS version 17.0 software. Statistical significance was based on p value < 0.05.

Results. The mean fibrinogen levels of the study group and controls were 387.10±62.52 and 276.85±52.70 respectively, (reference range 180-400ng/ml). The mean D dimer concentrations of the study group was markedly elevated 813.36±212.35 while that of the controls was 257.04±108.33 (reference range <400). Both analytes showed a statistically significant difference between the study group and control (P<0.05). None of the client on COCP has elevated D dimer level.

Conclusion: The significant increase in the procoagulant protein- fibrinogen and corresponding increase in fibrinolytic activity as demonstrated by elevated Ddimer level reflect a balance between fibrin formation and degradation hence minimizing the VTE risk. This balance is less prominent with use of COCP and can be attributed to the oestrogen component.

Prostate Specific Antigen (PSA) Levels and its Correlation to Prostatic Lesions

Apurva Mangesh Londhe — 2018-11-29

Background:

To correlate PSA levels with prostatic lesions and grade of Prostatic adenocarcinoma

Methods:

The study includes male patients with lower urinary tract complaints, advised to get their PSA levels and Transrectal ultrasound (TRUS) guided prostatic biopsy done. Study design was observational and retrospective. Universal sampling method has been used for selection, during study period May 2015 to September 2016. Ethical clearance has been obtained from Medical Ethical Committee of Saifee Hospital. We received 116 TRUS biopsies in the described time frame. The relevant data for these were collected from the hospital and departmental records.

Results:

Out of 116 cases, 57 cases were malignant and 59 cases were benign. Fifty-three (93%) of the malign1ant cases and 54 (91.5%) of the benign cases had PSA levels above 4 ng/ml. Thus, association of PSA level and type of lesion was found to be statistically insignificant (p >0.05). The mean PSA level was 19.67ng/ml in Grade 1 Prostatic adenocarcinoma, 10.84ng/ml in Grade 2 Prostatic adenocarcinoma, 21.07ng/ml in Grade 3 Prostatic adenocarcinoma, 39.06ng/ml in Grade 4 Prostatic adenocarcinoma and 399.26ng/ml in Grade 5 Prostatic adenocarcinoma. Thus, the mean PSA level increased as the grade increased but it was statistically not significant (p>0.05).

Conclusion:

Serum PSA level as tumor marker has limitations. Thus, histopathological examination is more specific for correct diagnosis in clinically suspicious cases.

Study of Liver Biopsy in Chronic Liver Diseases

Pavan Kulkarni — 2018-11-29

Background

Chronic liver disease (CLD) represents liver disorders of varying causes and severity in which hepatic inflammation and necrosis continue for at least 6 months. The treatment of cause leads to regression of fibrosis and parenchymal recovery. Liver biopsy is often used to establish the diagnosis, assess the severity of disease in CLD and its role is evolving with advances in medical technology.

To study the histopathological pattern of injury in patients with CLD and thereby establish a possible etiologic diagnosis in correlation with clinical, biochemical and serologic findings.

Methods

Thirty five cases of CLD with histopathological features of necroinflammation/fibrosis were studied for a period of five years. Along with demographics and laboratory parameters, sections were studied for the pattern and degree of injury. Grading and staging were done using standard systems.

Results

Nonalcoholic fatty liver disease (31.42%) and alcoholic liver disease (25.71%) were the most common causes followed by viral hepatitis (11.42%) and drug induced liver injury (8.58%). One case each of autoimmune hepatitis and primary biliary cirrhosis were seen. A definitive diagnosis was not possible in six patients, and only a probable etiology was considered.

Conclusion

The natural history of CLD is changing and is important to establish an etiological diagnosis. Despite the advances in diagnostic techniques, liver biopsy remains a valuable tool to establish the etiology and traditional descriptive reports still hold importance for the treatment and prognosis. However, it remains challenging and should be interpreted in the setting of clinical, biochemical, serological and radiological findings.

Evaluation of Mean Platelet Volume in Diabetes Mellitus and Its Role in Microvascular Complications

Sruthi Prasad — 2018-11-29

BACKGROUND

Diabetes mellitus (DM) is a metabolic disorder characterised by hyperglycaemia. The hyperglycaemia results in altered platelet function as reflected in the platelet indices (mean platelet volume-MPV, platelet distribution width and plateletcrit). Altered platelet function has also been implicated in the occurrence of diabetic vascular complications. Evaluation of platelet indices may serve to provide an insight into the pathogenesis of DM as well as possibly evaluate the risk of progression of the disease. The aim of the current study was to evaluate the MPV in patients with DM and compare it with a non-diabetic control group. We also attempted to determine the association between MPV and microvascular complications within the diabetic cohort.

METHODS

The study was carried out on patients with diabetes mellitus, attending the medicine out-patient department. Relevant history was taken and fasting blood glucose and hematological parameters (platelet indices and complete blood counts) were assessed as a part of the routine investigations requested by the physician itself. A total of 320 diabetics were screened for the study. After applying exclusion criteria, 52 diabetics were included in the study. We also included 62 non-diabetic, age and sex matched controls in the study. Statistical analysis was performed.

RESULTS AND CONCLUSION:

MPV levels were significantly higher in diabetic patients when compared to non-diabetic controls. Also, within the diabetic group, MPV values were significantly higher in diabetics with microvascular complications (24 patients) as opposed to the ones without.

MPV is a simple, convenient and cost-effective routine hematological investigation which plays a significant role in the pathogenesis of diabetes mellitus and may serve as a useful prognostic marker to herald the onset of microvascular complications in the diabetic population.

A Study to Determine the Diagnostic Accuracy of Endometrial aspiration Cytology with Histopathological Correlation at Rural Tertiary Health Care Hospital

Siva Kaliyamoorthy — 2018-11-29

Background: Endometrial cytopathology is a powerful tool for the detection of a wide variety of benign lesions,atypias, inflammatory changes and infectious organisms. It is also helpful for the cyto-hormonal evaluation of patients and the detection of endometrial malignancies. Aim:To assess the adequacy of the aspirated endometrial sample and identify the morphological parameters with regard to making a definite diagnosis. The aim of this study is to analyse the accuracy of endometrial aspiration cytology diagnosis in comparison with histopathological correlation.

Methods: Endometrial aspiration using a Karman’s cannula was done in 58 patients who presented with abnormal uterine bleeding to the department of Obstetrics and Gynecology during the period of July 2013 to Jan 2015. The cytology smears were stained with Papanicolaou stain and May- Grunwald- Gimesastain. Following aspiration Dilatation and Curettage was done for all cases. The formalin fixed tissue samples of curettage were stained with Hematoxylin and eosin staining for obtaining the histopathological diagnosis. The statistical analysis was performed using EPI info version 3.5.3. Chi square test was used to correlate the parameters.

Result: : In the present study endometrial aspiration cytology and histopathological correlation were performed on 58 cases. The patterns identified on EAC were 27 cases of benign endometrium (46.6%), 24 cases of simple hyperplasia(41.4%) , 4 cases of endometritis(6.8%),1 atypical hyperplasia (1.7%) and 2 cases of malignancies (3.4%). Secretory phase endometrium was the most common benign lesion amounting to 36.2% .

Conclusion: Endometrial aspiration cytology was found to be a safe outpatient procedure in the diagnosis of cyclic changes and endometrial lesions.The accuracy of identifying benign, inflammatory and malignant lesions was 98.28% to 100% making EAC an effective procedure.

Clinico-Pathological Analysis of Thymic Epithelial Tumours

Divya S — 2018-11-29

Background:

Thymic epithelial tumours are anterior mediastinal neoplasms and they exhibit a spectrum of histomorphological features.

Methods:

In this study we analysed the clinico-pathological spectrum of thymic epithelial tumors at our institution. It is a retrospective and descriptive study done at our Department of Pathology, Amala Institute of Medical Sciences, Thrissur, Kerala over a period of ten years from August 2008 to August 2018. Histological sections of each case were meticulously analysed. Immunohistochemistry was done if needed.

Result:

In this study 17 cases of thymic epithelial tumors were analysed. A male preponderance of 58.8% was observed. Age ranged from 24 to 73 years with a mean age range of 54.4 years. Most common histological subtype of thymoma was Type B and Type AB. 4 cases were associated with myasthenia gravis. Masaoka Stage I was commonly observed.

Conclusion:

Thymic epithelial tumors are a unique group of anterior mediastinal neoplasms which also pose a diagnostic challenge. This study highlights the significance of clinico-pathological correlation and staging of thymic neoplasms.

Clinicopathological Significance Of Human Epidermal Growth Factor Receptor- 2 (HER-2/Neu) Over-Expression In Gastric And Oesophageal Carcinomas Of Upper Gastrointestinal Biopsies

Lynda Dennis Rodrigues — 2018-11-30

INTRODUCTION: HER-2/neu plays a key role in the pathogenesis of gastric and oesophageal carcinomas and it’s over expression has been documented in 6.8–34% of gastric carcinomas and 10-12.1% of oesophageal adenocarcinoma. Detecting the HER-2/neu status is a prerequisite for monoclonal antibody therapy. In this study, immunohistochemistry was used to detect HER-2/neu over- expression in gastric and oesophageal carcinomas.

OBJECTIVE: To associate HER-2/neu over-expression with age, sex, type and grade of gastric and esophageal carcinomas in upper gastrointestinal (UGI) endoscopic biopsies.

METHODS: HER-2/neu expression was investigated by immunohistochemistry on esophageal and gastric carcinomas of UGI endoscopic biopsies received at our institution. Association between the expression of HER-2/neu and clinico-pathological parameters was statistically analysed.

RESULTS: The association was not statistically significant between age, sex and grade of the tumour with HER-2/neu overexpression. HER-2/neu overexpression was seen in 14.2% of gastric adenocarcinomas, 20% of esophageal adenocarcinomas and 4% of esophageal squamous cell carcinomas. Predominantly, intestinal type (9.5%) of gastric carcinoma showed HER-2neu over-expression followed by diffuse type (2.3%) and mixed type (2.3%).

CONCLUSION: In view of increasing trend of UGI tract malignancies and associated poor survival of advanced carcinomas, assessing HER-2/neu over-expression in gastric and esophageal carcinomas is helpful to decide the utility of adjuvant targeted chemotherapy.

Histopathological Spectrum of Ophthalmic Lesions

Rajharsh D Hanmante — 2018-11-30

Background: Ophthalmic pathology is unique in many respects as it encompasses wide range of tissues - epithelia, connective tissue and specialized tissue. Pathologies ranging from trauma, degenerative, inflammatory and neoplastic conditions can affect any of the various components of orbito-ocular system. This study is designed to review the histopathologic patterns of orbito-ocular specimens sent to the histopathologist.

Methods: It is a retrospective review of slides and paraffin-embedded blocks of all ophthalmic specimens received over a period 05 year at the histopathology department. Clinical data including age, sex, site of the lesion and clinical summary were extracted from the histopathology requisition forms.

Result: Total 116 cases were studied over a period of 05 year from January 2012 to December 2016. M:F ratio was 1.1:1. Majority of cases (40%) presented during 4 th to 5 th decade of life. Lid was the commonest site of lesion affecting to 61 (52.6%) cases followed by conjunctiva in 27 (23.3%), lacrimal gland in 15 (12.9%) and eye ball in 09 (7.7%) cases. Benign lesions were most common constituting the 43% cases followed by inflammatory lesions (31%) and Malignant (26%).

Among the Benign lesions, Naevi was the predominant lesion accounting for 15.5% cases followed by cystic lesions (13%). Among the malignant lesions, Squamous cell carcinoma was the predominant lesions seen in 15 cases, followed by Basal cell carcinoma 04 cases. Sebaceous gland carcinoma (04), Retinoblastoma (03), Hidradenocarcinoma (01), Mucinous carcinoma of eye lid (01), Malignant Melanoma (01) and Verrucous carcinoma (01) were the other malignant lesions.

Conclusion: Eye is the vital organ for vision. In our study, Naevi was the most common benign and Squamous cell carcinoma was the most common malignant lesion. Literature data showed that, different geographic areas had predilection for different ophthalmic lesions. Thus, it is emphasized that more studies are needed to know the geographical pattern of ophthalmic lesions.

Mast Cell Profile in Benign and Malignant Prostatic Lesions

Bismay Das — 2018-11-30

Introduction: Mast cells have an important role in innate and adaptive immunity. There role in tumour pathology is under investigation due to studies linking them to angiogenesis, tissue remodeling and stromal immunomodulation. Reports suggest that they can exert both pro or anti tumour effects. The role of mast cells may be influenced by its location in the lesion. In the present study, the number and distribution of mast cells in both benign and malignant prostatic lesions were recorded.

Methodology: Fifty seven patients of benign prostatic hyperplasia (BPH) and 43 patients of adenocarcinoma (Ca) were the subjects of the study. Inflammatory conditions of prostate like prostatitis and other malignancies of prostate like sarcoma, transitional cell carcinoma etc were excluded from the study. This was a descriptive study with purposive sampling.

Histological diagnosis was made by examining sections stained with Haematoxylin and Eosin. Additional sections from the same block were stained for mast cells using Giemsa stains as per standard protocol. Mast cell count was done in minimum 6 random high power microscopy field in four different regions viz., intraglandular, periglandular, stromal and perivascular regions for BPH and intratumoral, peritumoral, stromal and perivascular regions for Ca. Results were analysed statistically.

Results:

In BPH cases showed a significantly higher number of mast cells in stromal as well as periglandular areas followed by perivascular area. Only few mast cells were observed in intraglandular area. Similar was the observations in adenocarcinoma cases where the maximum number of mast cells were concentrated in the stromal and perilesional area. The number of mast cells in stroma of BPHwas higher as compared to that of adenocarcinoma. In rest of the areas, the numbers were comparable.

Conclusion: This study showed no remarkable difference in the number and distribution of mast cells in benign and malignant prostatic lesions. There is paucity of such studies in the literature and the possible utility of mast cell count to differentiate malignant from benign and atypical conditions needs further evaluation.

Fine Needle Aspiration Cytology Study of Soft Tissue Tumours

Anand Kanasagara — 2018-11-30

Background: The diagnosis of soft tissue tumours has always been difficult and controversial. The use of fine needle aspiration cytology ( FNAC ) instead of incisional biopsy for the diagnosis of soft tissue tumours was first reported in 1919 and since then has become a very popular cytodiagnostic procedure. Our aim is to study type of soft tissue tumors, age, sex and site distribution, incidence of benign and malignant lesions, to know role of FNAC and its efficacy in diagnosis of soft tissue tumors & compare our results with previous published studies.

Methods: Total 140 cases of soft tissue tumors were studied prospectively from september 2013 to november 2015, out of them 31 cases were followed up for cytology-histopathology comparison.

Results: Most common site of soft tissue tumors was upper extremities, 91.5% of all the lesions were benign & most common tumor was lipoma.

Conclusion: FNAC is a very useful tool for diagnosis of soft tissue tumors, in our study we found that FNAC was 100% accurate in diagnosing malignant tumors, 96% accurate in diagnosing benign soft tissue tumors & 90.3% efficient in identifying whether a tumor is benign or malignant.

Evaluation Of Expression Patterns Of Cytokeratin And Mucin Peptide Core Antigen For Diagnostic Role In Upper Gastrointestinal Tract Pre Neoplastic And Neoplastic Lesions

Mallika Dixit — 2018-11-30

Introduction:

Gastrointestinal tract (GIT) lesions include a wide variety of lesions, which may be diagnostically challenging on histopathology and may be difficult to differentiate without the aid of immunohistochemical stains.

Objective: The present study was undertaken to histopathologically analyze the upper GIT lesions and determine the expression pattern of cytokeratin (CK) and mucin peptide core antigen (MUC) in these lesions and their usefulness in diagnosis.

Material and Methods: A 135 cases with clinical diagnosis of upper GIT lesions including Barrett’s metaplasia (BM), carcinoma esophagus, gastric intestinal metaplasia (GIM) and gastric carcinoma were included. Standard diagnostic criteria were used in evaluating tissue sections and arriving at a diagnosis. Relevant clinical data including age, gender, complications and symptoms of disease were noted. Immunohistochemical evaluation of the lesions were done. The antibody panel included CK7, CK18, CK19, CK20, MUC1&MUC2.

Results: Immunohistochemical pattern CK7-/CK20+ was seen in 85% gastric adenocarcinoma and 82% gastric intestinal metaplasia. CK7+/CK20- was characteristic of esophageal adenocarcinoma. CK7+/CK20+ pattern was characteristic of Barrett’s metaplasia. MUC1 and MUC2 expression was seen in both goblet and non goblet cells in Barrett’s metaplasia, MUC1 in both gastric intestinal metaplasia and MUC2 in only goblet cells. MUC2 is a good marker of mucinous carcinomas of esophagus and stomach.

Conclusions: Pre-neoplastic and neoplastic lesions of the gastrointestinal tract are varied yet histologically challenging, often prove to be a diagnostic dilemma. Understanding unique immunohistochemical profiles of each, combined with histopathological and endoscopic correlation greatly assists in the diagnosis and management of these lesions.

A Cystic Granulosa Cell Tumor of Ovary: An Incidental Finding in a 50 years Old Lady

Padam Kumari Agarwal — 2018-11-29

Granulosa cell tumours (GCTs) are rare ovarian sex cord stromal tumours. GCTs usually are oestrogen producing neoplasms and hence consequently, symptoms related to hyperestrogenism are common at the time of diagnosis. Here we document a case of cystic GCT that was incidentally discovered on histopathological examination. An abdominal hysterectomy was done for abnormal uterine bleeding in a 50 years old lady, clinically was thought to be due to uterine fibroid. A unilateral oophorectomy was also done due to a small cyst in the left ovary, which on histopathological examination revealed cystic granulosa cell tumour in the ovary. Equipped with this knowledge, a better clinical correlation with the presenting symptoms could be made in future by clinicians and pathologists. The final diagnosis may change the prognosis and also the future treatment plan.

Icthyosis Uteri with in Situ Carcinoma

Almas Iqbal Pathan — 2018-11-29

Icthyosis uteri is a rare condition in which entire surface of the endometrium is replaced by stratified squamous epithelium. Two cases of Icthyosis uteri are reported for their rarity. The first case was of a 70 year old female with a history of lower abdominal pain and white PV (per vaginal) discharge since 3 months. The second case was of a 70 year old female with history of PV (per vaginal) spotting and breathlessness since 1 year. Gross examination of uterine cavity showed rough and irregular endometrial surface in the first case while in second case endometrium was atrophic. Microscopy of endometrium in both cases revealed total replacement of endometrial glands by stratified squamous epithelium with changes of in situ carcinoma or severe dysplasia. Cervix also showed severe dysplasia or CIN (cervical intra epithelial neoplasia) III in both the cases.

A Unique Case of Sclerosing Mediastinal B Cell Lymphoma

Vijay Kaul — 2018-11-29

Primary mediastinal B cell lymphoma is a rare subtype of diffuse large B cell Lymphoma (DLBCL) arising from putative thymic B cell origin. It accounts for 2-4 % of NHL. The present case was a 55 years old male presented with sudden onset of cough. Chest x ray and CT thorax showed presence of mildly enhancing solid mass in anterior mediastinum. Fine needle aspiration cytology (FNAC) from the mediastinal mass showed presence of poorly differentiated malignant neoplasm. Trucut biopsy from the same showed presence of tumour with foci of hyalinization. On immunohistochemistry tumour cells expressed CD20, CD 30 and CD 23. Hence the diagnosis of NHL of mediastinal sclerosing B cell type was made.

The present case was one of the rare cases of Non Hodgkin Lymphoma (NHL) with an unusual presentation. Primary mediastinal B cell Lymphoma (PMBCL) with sclerosis is a distinct subtype of NHL with unique clinicopathological aspects and aggressive behavior. Prompt recognition and aggressive treatment may lead to relatively longer survival of patients.