Annals of Pathology and Laboratory Medicine

Normoalbuminuric Diabetic Kidney Disease- Need for Renal Biopsy? An Autopsy Study on Western Indian Population

Sonal Paul — 2020-10-25

Introduction: Persistent albuminuria and glomerular filtration rate are considered as the gold standard for the diagnosis of Diabetic Nephropathy (DN).

Methods: In this autopsy study, we evaluated data from a cohort of 67 patients with Type 2 Diabetes Mellitus. We determined the histological prevalence of DN irrespective of the clinical manifestations of renal disease. Patients were stratified by proteinuria and estimated glomerular filtration rate(eGFR). The glomerular, interstitial and vascular lesions were scored as per the established histopathologic classification for DN.

Results: 55 of the 67 patients had clinical as well as histological lesions consistent with DN. 12 patients had histological lesions of DN at autopsy but no clinical evidence of proteinuria, including microalbuminuria in their lifetime.4 of these patients had maintained eGFR. There was no difference in the glomerular lesions in patients with normoalbuminuria regardless of the eGFR. However,50% of the patients with low eGFR showed presence of interstitial fibrosis and tubular atrophy while no interstitial lesions were noted in patients with normoalbuminuria and maintained eGFR. Significant amount of arteriosclerosis was noted in the normoalbuminuric low eGFR patients. Haematuria was significantly associated with proteinuric low GFR patients.

Conclusion: Histological evidence of DN may be seen even in the absence of clinical manifestations, suggesting that, in diabetic kidneys some amount of glomerular and tubulointerstitial damage has already occurred before the onset of proteinuria. Hence, there is a need for routine kidney biopsies in diabetic patients with normoalbuminuria. This will help in the timely diagnosis and appropriate management in the early stages of DN.

Utility of Hematological Scoring System in Diagnosis of Neonatal Sepsis

Aparna S — 2020-10-29

Background: Neonatal septicemia is defined as a clinical syndrome characterized by systemic signs and symptoms caused by a bacterial infection and gives positive blood culture in the first month of life. It is associated with high morbidity and mortality, but early diagnosis and treatment significantly improve the outcomes. The present study brings out a quick and cost- effective Hematological Scoring System that enables early diagnosis of neonatal sepsis

Method: This study was conducted in the Department of Pathology of Sree Gokulam Medical College and Research Foundation, Venjaramoodu, Thiruvananthapuram over 1 year. Eighty neonates with clinical suspicion of sepsis were studied with respect to their peripheral smear findings, blood culture and C-reactive protein levels.

Result: Among the eighty cases, twelve neonates were culture positive. Male gender and late- onset of sepsis were the significant risk parameters. Escherichia coli and Staphylococcus aureus were the most common isolated organisms. Of the different parameters studied I:T ratio and Absolute neutrophil count showed the highest specificity and immature neutrophil count had the highest sensitivity. Forty-one percent of neonates had a high Hematological Scoring System score. The specificity of Hematological Scoring System with a score > 5 was 92%

Conclusion: Hematological Scoring System is a cost-effective, rapid and easy to perform screening test that can be used to rule out sepsis thus avoiding unnecessary administration of antibiotics to unaffected babies. It should be adopted as a routine screening procedure by minimally qualified rural doctors with minimal resources to ensure appropriate action immediately for children with high index of suspicion of sepsis.

Effects of Site of Blood Collection and Duration of Storage on Coagulation Factor V and Factor IX Levels in Fresh Frozen Plasma

Loganathan R — 2020-10-29

Background: As per Indian drugs and cosmetic act & rules 1945 (DCA), 1% or 4 units/month of all components should meet quality control parameter. Aims and objectives: 1.) To assess the level of clotting factors FV and FIX in FFP. 2.) To identify the association between clotting factors FV and FIX in FFP with its mode of collection and storage.

Methods: This is a Cross sectional study design done for a period of 20 months. The comparison of the levels of clotting factors such as V and IX between the blood group were carried out by using independent students’ one-way analysis of variance. All statistical analysis was carried out at 5% level of significance and p-value <0.05 were considered as significant. All statistical analysis was done using software IBM PASW statistics (SPSS) version 19.0.

Result: The present study was done at a south Indian tertiary care center from January 2016 to August 2017. Around 28,919 FFPs were assessed during this study period. On comparing factor levels between blood bank and camp site, there were no significant difference.

Conclusion: In our study, FV and FIX were maintained as per DGHS criteria.

Immunohistochemical expression of p16INK4A in the lesions of uterine cervix

Niharika Rawat — 2020-10-29

Background: Cervical cancer is the major cause of cancer deaths among women. Globally, around 5,70,000 new cases of cervical cancer and 3,11,000 deaths occurred in the year 2018. In India, Cervical cancer is a leading cause of cancer related mortality among women and the number of deaths is 60,000 per year among 97,000 diagnosed patients, especially those from lower socioeconomic group. Human Papilloma Virus (HPV) plays a crucial role in causing cervical dysplasia. This is done by upregulating p16INK4A, a cyclin dependent kinase inhibitor through interaction with cellular regulatory proteins. Hence p16INK4A can be used as a biomarker, since it is directly related variable for the presence of HPV. This study was conducted to evaluate the expression of p16INK4A in benign, premalignant and malignant cervical lesions and to assess its utility in diagnosing and grading cervical lesions.

Methods: A total of 80 cervical specimens categorized histopathologically into nonspecific cervicitis, low grade squamous intraepithelial neoplasia (LSIL), high grade squamous intraepithelial neoplasia (HSIL) and squamous cell carcinoma cervix were included in this prospective study of one-year duration. Immunohistochemical study of p16INK4A were interpreted qualitatively and semi-quantitatively by Allred scoring system (0 to 8 points) which measures the proportion of stained cells and intensity of staining of cells. The collected data were statistically analyzed by ANOVA and chi square test.

Result: Qualitative method showed absence of p16INK4A expression in all nonspecific cervicitis. 16.7% (2/12) LSIL, 100% (12/12) HSIL and 100% (28/28) squamous cell carcinoma cases showed p16INK4A positivity. Allred scoring of p16INK4A showed 66% (8/12) HSIL and 85.7% (24/28) squamous cell carcinoma cases with score 3 positivity. Hence high-grade lesions showed higher expression of this marker.

Conclusion: IHC expression of p16INK4A showed increasing degree of expression from benign to premalignant and malignant lesions suggesting its diagnostic and prognostic value in the cervical cancer management

Paediatric Eyelid Lesions- A Report of 20 Cases

Pragati Sathe — 2020-10-29

Background: Eyelid lesions are one of the commonest lesions encountered by ophthalmologists in their clinical practice. They could be classified in various ways such as neoplastic or non-neoplastic; congenital or acquired. The common benign conditions affecting the eyelid include cysts like dermoid, epidermoid and epithelial cysts, inflammatory lesions, melanocytic nevi and papilloma. Ignorance about the benign nature of the lesion may lead to increased debility.

The purpose of this study is to contribute information to the literature on various eyelid lesions and their incidence as found in a tertiary hospital.

Methods: This is a retrospective observational study of surgically excised eyelid lesions in patients below 12 years of age. The study was conducted after obtaining permission from the Institutional Ethics Committee.

Result: Out of 20 lesions, 15 cases belonged to the non-neoplastic category while five cases were neoplastic in nature. Cystic lesions predominated in the non-neoplastic category (11 out of 15 cases). The remaining four cases in the non-neoplastic category included three cases of infective etiology and one case of developmental etiology. There were no malignant neoplasms found in our study. The common presenting feature was that of eyelid swelling. Highest incidence of eyelid lesions was in the upper lid (14 of 20 cases, i.e. 66.66%).

Conclusion:

It is necessary to subject every lesion of the eyelid to histopathological examination. Sometimes, clinically benign lesions turn out to be malignancies which entails a wider surgery later. This study points out to the wide spectrum of lesions that can afflict the eyelid.

A Study of Histopathological Spectrum of Ovarian Neoplastic and Non-Neoplastic Lesions at Teaching Hospital, Ahmedabad

Piyush Ashokbhai Patel — 2020-10-29

Background: Ovarian carcinoma is one of the most common gynecologic cancers that ranks third after cervical and uterine cancer. ovarian lesions are neoplastic and non neoplastic and many neoplastic lesions are asymptomatic and possess great challenge to the gynecological oncologist.

Aims & Objectives: To analyze frequency, age distribution and histopathological spectrum of ovarian lesions at teaching hospital, Ahmedabad.

Materials & Method: This study was undertaken between period of 1^st January 2018 to 29^th February 2020 at Department of Pathology, GMERS Medical college, sola, Ahmedabad. H and E stained slides were examined by light microscopy and histopathological type of lesions were classified according to World Health Organization (WHO) classification -2014.

Results: There were total 182 cases of ovarian lesions. 56(30.76%) cases are neoplastic, among them only 6(10.71%) were malignant. Surface epithelial tumor (n=27 cases, 48.21%) were most common neoplastic lesion while sex cord stromal tumor (n=8 cases,14.29%) were least common. Most common age group affected for neoplastic lesions was 31-40 years.

Conclusion: We found that ovarian lesions affect wide variation of age starting from 11 years young patient to 65 years old patients. Non neoplastic lesions were almost double in prevalence than neoplastic lesions. Histopathological analysis according to WHO classification reveal that surface epithelial tumors and germ cell tumors were forms the majority of neoplastic lesions.

Diffuse Midline Glioma (H3K27M mutant) in Adult: A Diagnostic Challenge

Sonal Paul — 2020-10-29

Introduction: Diffuse midline glioma (DMG), H3K27M mutant is an infiltrative midline high grade glioma with predominantly astrocytic differentiation and K27M mutation in either H3F3A or HIST1H3B/C.

Case Report: A 45-year-old female presented with complaints of headache and memory loss for 3 months. MRI was suggestive of an infiltrative mass lesion in the quadrigeminal plate cistern suggestive of pineal neoplasm. Squash and histomorphology showed a low-grade astrocytic tumour with infiltrative growth pattern. Microvascular proliferation and necrosis were absent. Immunohistochemistry showed loss of ATRX protein, focal positivity for p53 proteinand IDH1R132H negativity. On molecular analysis, H3K27M mutation was noted and the case was labelled as DMG H3K27Mmutant (WHO IV)

Conclusion: DMG (H3K27M) is a newly added entity in the WHO 4^th revised editionof 2016. It presents with a diagnostic challenge as it has varied histomorphology, not requiring atypia, mitosis, endothelial hyperplasia and necrosis for diagnosis as Grade IV.

A Rare Case Presentation of HbE/ β Thalassemia

Anu Singh — 2020-10-29

HbE/β thalassemia (HbE/β thal) genotype accounts for approximately one half of severe β thalassemia cases worldwide. The disorder shows marked clinical variability ranging from mild asymptomatic anemia to life threatening disease. Here, we report a case of a 2-year-old boy from Bihar presenting with severe haemolytic jaundice. Complete haematological profile and Haemoglobin High Performance Liquid Chromatography (Hb HPLC) using Biorad version was done of the patient along with the family was done to arrive at the diagnosis of this rare hemoglobinopathy.

DLBCL of Clavicle: Role of FNA in diagnosis of Rare Lesion

Cyrus Dara Jokhi — 2020-10-29

Primary bone lymphoma is rare, among which commonly involved site at time of presentation are femur, pelvic bones, tibia and most common type is Large B cell lymphoma which usually occurs in adults. Cases of large B cell lymphoma in clavicle as primary bone lymphoma is extremely rare finding. According to our knowledge this case may be first reported case of world. We are here reporting a case of 62-year female presented as sternoclavicular joint swelling, without fever or pain in local area. Patient was diagnosed on X ray by radiologist, as well as by clinician as, osteosarcoma of right clavicle. Patient came to Department of Cytopathology for FNA for confirmation of X ray finding. On FNA diagnosis of Non-Hodgkin lymphoma was given, and advise for biopsy and immunohistochemistry (IHC) was given for confirmation of diagnosis and to subtype NHL. On IHC Ki67 index was 85%, with diffuse positivity noted for MUM1, CD79a, and CD138 along with cytoplasmic positivity for ALK 1 and patchy positivity for PAX 5. Tumor was negative for BCL6, BCL2, CD20, CD5, CD23, CD10, CD19, CD4, CD8, CD7, CD3. Diagnosis of ALK positive DLBCL was given on biopsy after IHC. Patients with PBL treated with combined modality were found to have a superior outcome, with a significantly better survival (5-year cause-specific survival 95%). So correct and timely pathological diagnosis of DLBCL as PBL is significantly important for prognosis.

Lymphoepithelial Cyst, A Diagnostic Dilemma: Case Report

Meenu Gill — 2020-10-29

Lymphoepithelial cysts are benign, slowly growing unilocular or multilocular lesions that appear in the head and neck region. They are also called branchial cysts and occur due to lymphocyte induced cystic ductular dilatation. The confirmatory diagnosis is always made on histopathological examination after resection.

A 29 years old female patient presented to ENT department, Pt B. D. Sharma PGIMS, Rohtak with a soft to firm, non-tender, swelling in the submandibular region since 2 -3 days and was referred to Department of Pathology for FNAC on which a differential diagnosis of infected epidermoid cyst or squamous cell carcinoma was made and excision biopsy for confirmation and categorization was advised. The swelling was then excised and sent for histopathological examination and a final diagnosis of Lymphoepithelial cyst was made. The confirmatory diagnosis is always made postoperatively by histopathological examination. The treatment of a lymphoepithelial cyst is the surgical approach, which includes complete enucleation of the cyst. This is a case report of a lymphoepithelial cyst diagnosed on histopathology specimen for which differential of Infected cyst or Squamous cell carcinoma was given. The authors intend to highlight the importance of early histopathological diagnosis of Benign LEC as it has been reported to undergo malignant transformation

Plexiform Schwannoma Masquerading as Giant Cell Tumor of Tendon Sheath- A Case Report

Sharanjit Singh — 2020-10-31

Plexiform schwannoma is a rare benign variant of Schwann cell tumor characterised by multinodular plexiform growth pattern. Usual location of this tumor includes trunk, head, neck and upper extremities but it may rarely be found in lower extremities. It generally affects young adults with no sex predilection. We report a case of 37 years old male who presented with gradually progressive swelling of right little finger of 28years duration that was diagnosed as giant cell tumor of tendon sheath clinically, radiologically and intraoperatively. Authors wish to discuss the case due to its clinical rarity and diagnostic difficulties due to many common histological mimickers at that site.

Heat Artifact Mimicking Adenocarcinoma of Fallopian Tube

Prajakta Madhav Bapat — 2020-10-29