Annals of Pathology and Laboratory Medicine

Role of Immunohistochemistry in The Subtyping of Non Small Cell Lung Carcinoma on True Cut Lung Biopsies

Alekhya M — 2018-06-18

BACKGROUND: Worldwide, lung carcinoma is the most common cancer in terms of number of cases and deaths. Lung carcinomas are broadly divided into small cell carcinoma and non-small cell lung carcinoma(NSCLC). In recent years availability of targeted therapies necessitated subtyping the NSCLC to improve the survival and quality of life. NSCLC can be subtyped by routine Haematoxylin and Eosin (H&E) stained section slides alone, poorly differentiated tumors are difficult to segregate morphologically, especially in true-cut biopsies, necessitating ancillary techniques like immunohistochemistry (IHC). Hence this study was taken up to examine accuracy of diagnosis of Non-Small Cell Lung Carcinoma (NSCLC) on biopsy samples initially made based on morphology and then with IHC using relevant markers like CK5, CK6, CK7, Napsin-A, TTF-1, P63, Synaptophysin and Chromogranin-A.

METHODS: A prospective study of two years and six months duration during which

111 cases of NSCLC on true-cut biopsies were first reported on Haematoxylin and

Eosin sections and later subjected for IHC.

RESULTS: Out of 111 cases, after IHC, 80 were diagnosed as adenocarcinoma and

31 as squamous cell carcinoma NSCLC were common in the 6^thdecade. In

adenocarcinoma positivity for CK7, TTF1 and Napsin-A was 95%, 75%and 78.75%

respectively. In squamous cell carcinoma positivity for CK5, CK6 and P63 was 84%,

81% and 90% respectively.

CONCLUSION: CK5, CK6 and P63 can be used for confirming squamous cell

carcinoma and CK7, TTF-1 and Napsin-A for adenocarcinoma. We recommend a

IHC panel consisting of P63, TTF1 and Napsin-A in NSCLC-unclassifiable and

poorly differentiated carcinoma on H&E.

Clinicopathological Study of Gallbladder Lesions

Geeta Kumari — 2018-06-18

Background: Gallbladder is one of the most frequently surgically resected organs which stores and concentrates the bile and is involved by both non neoplastic as well as neoplastic diseases. Chronic calculous cholecystitis is the most common benign lesion of gallbladder and pain abdomen is the commonest clinical presentation. Both non neoplastic and neoplastic lesions have similar clinical presentation and overlapping radiological findings.

Methods: Total 550 cholecystectomy specimens were received in pathology department. Grossly, formalin fixed specimens were examined carefully and section were given from neck, fundus and body of gallbladder. Whenever it was necessary, additional sections were given. After processing, the H&E stained sections were studied thoroughly. All the clinical details were taken from case papers.

Result: The commonly seen non neoplastic lesions were chronic calculous cholecystitis (405 cases), chronic cholecystitis (85 cases), Acute on chronic cholecystitis with or without stones (18 and 3 cases), acute necrotizing cholecystitis (2 cases), eosinophilic cholecystitis (3 cases), follicular cholecystitis (3cases), lymphoplasmacytic cholecystitis (1case), xathogranulomatous cholecystitis (9 cases), cholesterosis (4 cases), mucocele of gall bladder (2 cases), adenomyomatosis (3 cases) and gallbladder cholesterol polyp with cholecystitis (2 cases). Among neoplastic lesions 1 case was adenoma with severe dysplasia and 9 cases were adenocarcinoma.

Conclusion: Chronic calculous cholecystitis was the most common lesion and out of 9 cases of carcinoma, 7 cases were diagnosed incidentally. Therefore, histopathological evaluation plays a critical role in identifying incidental gallbladder carcinoma for proper management of patients.

Cytokeratin Expression Profile Study in Malignant Ovarian Tumors

Jeyanthi Gnanamuthu — 2018-06-19

Background: Expression of cytokeratin is seen in varied ovarian tumors including primary surface epithelial tumors, Granulosa cell tumors, Sertoli – Leydig cell tumors, non dysgerminomatous germ cell tumors and metastatic carcinomas. The aim of the study is to demonstrate various patterns of cytokeratin expression in epithelial and non-epithelial malignant ovarian tumors.

Methods: Materials for the present study of 39 cases of malignant ovarian tumors obtained from the patients admitted during the period of two years. For histopathological examination, 10% formalin fixed embedded representative tissue sections were studied with Haematoxylin and Eosin. Detailed microscopic examination was carried out. Application of IHC for cytokeratin expression study was carried by streptavidin – biotin complex method. The details of clinical history and relevant investigations were obtained.

Results: The total number of malignant ovarian tumors studied during two year period was 39 cases. Among that, serous tumors was the most common [25 cases (64.6%)], followed by Sex cord stromal tumors [6 cases (15.3%)], metastatic tumors [4 cases (10.2%)] and Germ cell tumors [4 cases (10.2%). Cytokeratin was positive in >50% of serous epithelial cells, followed by krukenberg tumor and showed focal positivity in non-epithelial tumors.

Conclusion: Evaluation for pancytokeratin (AE 1 / AE 3) in the context of ovarian tumors is useful only in specific instances including identification of epithelial differentiation in an apparently undifferentiated neoplasms and distinction of dysgerminoma from non dysgerminomatous germ cell tumors. Non dysgerminomatous germ cell tumors characteristically express cytokeratin diffusely and strongly, whereas in dysgerminoma it shows only focal and weak expression.

Histopathological Evaluation of Surgically Treated Renal Lesions

Disha Singla — 2018-06-19

Background: Nephrectomy is a common procedure in surgical practice. It is indicated in patients presenting with symptomatic chronic infections, obstruction, calculus disease, and severe traumatic injury to renal cell carcinomas.

Methods: The present study was conducted in the Department of Pathology and included all nephrectomy specimens received in the department over a period of five years (January 2011 - December 2015). Patient particulars were recorded, which included age, sex, chief complain and clinical findings; investigations such as CT scan, USG, and other relevant investigations were also noted. Meticulous histopathological examination was done and diagnosis was given.

Result: Total 124 patients underwent nephrectomy for various renal lesions in the last 5 years. There were 93 (75%) male and 31 (25%) female patients. In 12 patients, tumor was diagnosed on routine abdominal ultrasonographic screening for some other complains. Flank pain was the most common presenting symptom observed in 76 (61.29%) patients, followed by hematuria in 22 (17.54%) patients. On histopathological examination, 94 (75.80%) were non-neoplastic renal lesions and 30 (15.20%) were tumors. In non-neoplastic lesions of total nephrectomy specimens chronic pyelonephritis 70 (56.46%) was the most common type of lesions followed by pyonephrosis 9 (7.26%). There was also presence 4 (3.23%) of cases of Tuberculosis kidney. Overall, RCC was the most common 20 (16.13%) renal tumor.

Conclusion: The present study provides a fair insight into the histological patterns of lesions in nephrectomy specimens in our institution and its correlation with studies conducted across the world.

A Comparative Study between Conventional and Bethesda System for Reporting Thyroid Cytopathology

Shabana Azad — 2018-06-19

Background: Disorders of thyroid gland are very common. Thyroid cancers comprise 1% of all malignancies, and are the most common cancer of endocrine system. It is more common in females as compared to males.

Method: 51 Patients with enlarged thyroid gland were studied. All the thyroid FNAC cases were reported and compared by using both the conventional and the Bethesda System for Reporting Thyroid Cytopathology (TBSTRC). The conventional system includes description of the microscopic findings of the case along with a final impression at the end. In equivocal cases, the differentials were given. However, for statistical analysis, the reporting system was modified into five category system. The categories were-1) Inadequate 2) Benign 3) Equivocal 4) Follicular 5) Malignant

Results:The age at presentation of the patient varied widely from 10 years to 100 years. The mean age of presentation is 40 years. There was female preponderance amongst the patients (94.1% females). In the vast majority of the cases TBSRTC is equivalent to the conventional system in the pattern of reporting.

Conclusion: TBSRTC may be viewed as a better screening test for thyroid lesions. Follicular patterned lesions pose the greatest difficulty in evaluating thyroid FNAC smears with their being significant overlap in the cytological features of different lesions.

An Evaluation study of Platelet Volume Indices (PVI) in Type-2 Diabetes Mellitus and its Micro and Macro Vascular Complications

Killol Nathubhai Desai — 2018-06-19

Background:

The study was performed to analyse PVI such as mean platelet volume (MPV), platelet distribution width (PDW) and platelet-large cell ratio (P-LCR) that are useful for identifying large and haemostatically active platelets, which are risk factors for developing diabetes and its complication.

Methods:

Case–control study was conducted on 1026 Type 2 diabetics and 616 nondiabetics. Detailed clinical history regarding duration, hypertension and complications was taken. PVI was obtained using three part automated cell counter. Fasting blood glucose, hemoglobin A1C, lipid profile, creatinine were also obtained. Diabetics were further categorized into patients with complications and without complications.

Result:

MPV, PDW, P-LCR and platelet count were significantly increased in diabetic patients with complications as compared to diabetics without complications and nondiabetic group (P < 0.0001, < 0.0001, 0.0044, 0.023 respectively). We found statistically significant correlation between MPV and diabetic retinopathy (P < 0.0001), nephropathy (P = 0.04), neuropathy (P < 0.0001), coronary artery disease (P < 0.0001), diabetic foot (P = 0.005). PDW was statistically significantly increased in diabetic retinopathy (P < 0.0001), neuropathy (P < 0.0001), coronary artery disease (P < 0.0001), diabetic foot (P = 0.005). P-LCR was statistically significantly increased in diabetic retinopathy (P < 0.0001), neuropathy (P = 0.003), coronary artery disease (P < 0.0001), diabetic foot (P = 0.034).

Conclusion:

MPV, PDW and P-LCR are predictive biomarkers of diabetic vascular complications. They are more significant in microvascular complications than macrovascular complications.

Comparison of Fixative Properties of Honey with Ethanol in Oral Cytological Smears

Mahmood Nawaz Khan — 2018-06-19

Background: Fixation is an important step in cytopathological diagnosis. Ethanol is traditionally a popular and widely used fixative for cytopathological diagnosis. But ethanol is expensive and subjected to pilferage thus decreasing its ability. Ethanol denatures proteins and glycogen by precipitation. Hence in a search of better, ecofriendly and cost effective fixative, honey can be as efficient as ethanol in cytological fixation. Properties of honey such as high osmolarity, low pH and the presence of components such as ascorbic acid, hydrogen peroxide and phenol inhibine, all contribute to its anti-oxidative and antibacterial effects.

Methods:- A cross sectional comparative study was carried out after ethical approval on healthy patients fulfilling the inclusion criteria referred to the Department of Pathology in BLDEU’S Shri B.M. Patil Medical College, Hospital and Research centre, Vijayapur. After informed consent two buccal smears were obtained from each individual, one was fixed in Ethanol and other was fixed in Honey (20%) for a minimum of 15 min. After staining, smears were scored for cytomorphological characters.

Results:- Out of the 200 cases studied, honey fixed smears showed cytomorphological features similar to ethanol among which nuclear staining, clarity and uniformity of staining showed significant p value (p <0.05) where as cytoplasmic staining, cell morphology showed no statistical difference. (p>0.05)

Conclusion: The present study offers an innovative proposal of using natural eco-friendly sweeteners, as fixative in cytopathology. The results are promising and invoke extensive large multicentric collaborative work to reach a global consensus on this fixative.

A Study on Histopathological Spectrum of Lesions in Urinary Bladder Specimens

Susmitha S — 2018-06-19

INTRODUCTION:

Urinary bladder lesions constitute an important source of clinical signs and symptoms. Both non-neoplastic and neoplastic lesions are quite common. Neoplastic lesions are responsible for significant morbidity and mortality throughout the world. Urinary bladder cancer is 2^nd most common cancer after prostate cancer in genitourinary system. Histopathological analysis of cystoscopic bladder biopsy and Transurethral resection of the bladder tumor (TURBT) material are the mainstay for cancer diagnosis.

OBJECTIVE:

To describe the histopathological spectrum of urinary bladder lesions in TURBT and cystoscopic biopsies.

METHODOLOGY: All urinary bladder specimens were included in the study. The specimens were grossly examined and entire tissue was processed in all cases as per standard protocol. Multiple sections of 3-5 micron thickness were obtained and stained with H&E, followed by histopathological examination to classify them into non – neoplastic & neoplastic lesions on light microscopy.

RESULTS:

Total 48 cases were studied, out of which 20 were cystoscopic bladder biopsies and 28 were TURBT specimens. Non-neoplastic lesions was predominantly comprised of chronic non-specific cystitis. Among the neoplastic lesions, urothelial carcinoma is the predominant type and was most commonly seen in age group of 51-80 years constituting 92.85%. These neoplastic lesions were more common among males (71.43%) with M:F ratio of 2.5:1. Invasive urothelial carcinoma was the predominant type followed by various noninvasive urothelial lesions.

CONCLUSION:

Urinary bladder lesions are heterogenous and awareness regarding the various histological features of these lesions, their neoplastic potential, risk of recurrence and possible pitfalls can help pathologists for accurate diagnosis.

Histopathological and Immunohistochemical Study of Endometrial Lesions Obtained from D&C and Hysterectomy Specimens at a Tertiary Care Hospital

Aarti B Bhattacharya — 2018-06-20

Background: Endometrial lesions are represented by a set of diversified disorders which has challenged clinicians for a long time. Due to its chances of progressing to malignant states, the condition needs prompt and focussed study, keeping clinical context in view.

Methods: This 12-month (June 2016-May 2017) cross-sectional study involved 100 specimens from dilatation and curettage (D & C) and hysterectomy specimens from female patients aged ≥ 18 years who presented with complain of pelvic pain, abnormal uterine bleeding, dysmenorrhoea, pelvic mass and infertility. For all the specimens received, histopathological and immunohistochemical assessment was done.

Results: Out of 100 cases of abnormal uterine bleeding 44 females showed physiological changes, 25 females showed benign lesions and 20 females had malignant lesions of endometrium. Out of 20 cases of endometrial carcinoma 50 % were well differentiated and 25% were moderately differentiated and 25% were poorly differentiated. Expression of Ki-67 was >35% in poorly differentiated carcinoma. Well differentiated carcinoma showed 80-85% positivity of ER, moderately differentiated showed 30-35% positivity and poorly differentiated carcinoma showed 6-12%. The association between benign and malignant endometrial lesion was found to be statistically significant with age-group, history of contraceptive use and chronic illnesses (p<0.05).

Conclusion: Endometrial biopsy is one of the prompt tools in diagnosis and assessment of the benign and malignant diseases of endometrium. Immunohistochemical markers like ER (hormonal receptor) and Ki-67 ( proliferative marker) play a major role in diagnosis, prognostication and therapeutic management of malignant cases.

A Comparative Study of Thyroid Cytology Reporting by Bethesda System and Routine Cytology in a Teaching Institute of Sub Himalayan Region

Nirmalesh Mahata — 2018-06-20

Introduction: Fine needle aspiration cytology (FNAC) is an important preoperative diagnostic tool for thyroid lesions which are endemic in the Sub-Himalayan belt. But sometimes, the FNAC procedures are unable to guide clinicians for definite management. Bethesda System for Reporting Thyroid Cytology (BSRTC) has been formulated to be more sensitive and specific than routine cytological examination in diagnosis of thyroid swellings and act a better tool than the latter due to its objectivity. It may, thus, improve the clinical management of thyroid diseases and even may prevent unnecessary thyroidectomy.

Aims and Objective: The study is aimed to compare the interpretation of thyroid FNAC smears by conventional reporting and by BSRTC in patients of thyroid swellings in the Sub-Himalayan regions.

Material and Methods: This observational study was done at the Department of Pathology from July 2015 to June 2016. Total 145 cases of thyroid swellings were included for study and reported by both BSRTC and conventional (routine) reporting system. Each of the reporting system was correlated with the available histopathological findings and statistical assessments were performed.

Results: Among the total 145 cases, colloid nodules followed by thyroiditis were most common benign conditions in both the reporting systems and among the malignancies; papillary carcinoma was the most predominant. Statistical assessment showed that sensitivity, specificity as well as positive and negative predictive values was higher in BSRTC compared to the conventional reporting system.

Conclusion: BSRTC is more accurate than conventional reporting system for thyroid cytology and its management strategy can help to prevent unnecessary thyroidectomy.

Increasing Incidence of Malignancy Among Male Breast Lesions in The Urban Population of India

Sujata Mallick — 2018-06-20

Background: Among the male breast lesion gynaecomastia is the most common lesion present. Breast malignancy accounts for less than 1% of all male malignancy. Aim of this study was to see the increasing incidence of breast carcinoma among males in India

Methods: A retrospective study was undertaken in KPC Medical College, catering to an urban population, over a period of three and a half years. 32 male breast lesions which presented in the surgery department were analysed.

Result: 75% of the cases were gynaecomastia which is the most common male breast lesion,other benign breast lesions like epidermal cyst, breast abscess and fibroadenoma comprised 9.3% of the total lesions present. Breast carcinoma, In situ lesion and sarcoma of the breast accounted for 15.5% of the cases.

Conclusion: Worldwide studies have shown male breast carcinoma to be less than 1%. Our study showed a prevalence of 15.5% breast malignancy, showing a phenomenal increase in breast carcinoma among male patient.

Knowledge and Attitude of Cervical Cancer Screening and its Prophylactic Vaccination Against Human Papillomavirus Among the Undergraduate Medical Students in a Tertiary Care Hospital

Ramya Gandhi — 2018-06-20

Background: Cervical cancer is the second most common malignancy in females and Human papilloma virus[HPV] is the main etiological factor of cervical cancer and it is an important public health issues .The aim of this study is to assess the level of awareness and attitude towards cervical cancer screening and its prophylactic HPV vaccination amongst the undergraduate medical students.

Methods: It is a cross sectional study and it was conducted by the Department of Pathology and Pharmacology at Sri Manakula Vinayagar Medical College and hospital ,Puducherry in south India by involving the M.B.B.S undergraduate students from July 2017 to August 2017. Totally 400 students were consented from second year to final year for this study ,a validated and pre-tested questionnaires were filled by them .

Result: It was observed that majority of the participants were in the age group of 20- 21 and male participants (50.3%) were higher than female participants ( 49.7%). Majority of the participants were from 5^th semester(41.5%), 7^th semester(26.5%), 9^th semester (25.8%) compared to the 6^th and 8^th semester. 96.8% of the participants showed positive attitude about their knowledge on cervical cancer and 91.5% regarding pap smear and 55% for HPV vaccination. Very few students 7% had already taken vaccine with no significant differences between the various semesters of medical students.

Conclusion: In conclusion the Knowledge and attitude of the participants were positive and high .But only few students had vaccination .Thus ,more knowledge about cervical cancer, pap smear screening and HPV vaccination campaign services can be provided among the medical students.

Immunohistochemical Study of p53 Expression in Colorectal Adenocarcinomas and its Clinicopathological Correlation

Varshaa Chithrra — 2018-06-22

Background: Colorectal carcinoma is the fourth most frequent cancer in men and the third in women worldwide. The identification of molecular markers that have a prognostic significance in colorectal carcinoma may have an impact on its treatment. This study aims to identify and evaluate the immunohistochemical expression of p53 in colorectal adenocarcinomas and to correlate its expression with various clinicopathological parameters.

Methods: The present study was an observational study done in 30 surgical resection specimens received in the Department of Pathology, SRM Medical College and Research Centre, Kattankulathur, Tamil Nadu from June 2015-June 2017. Clinical history and clinicopathological parameters were obtained ,histomorphological and immunohistochemical evaluation was done and the results were correlated with clinicopathological variables. The IHC panel we used was mouse monoclonal p53 antibody (PathnSitu).

Result: In our study, p53 overexpression was noted in 70% cases of colorectal adenocarcinomas. p53 overexpression was noted more in conventional adenocarcinomas (85.7%), more in left sided colonic carcinomas (71.4%), in advanced pT stage (57.1% in pT3) and also in cases with lymph node metastasis (57.1%). No statistically significant correlation of p53 with other clinicopathological variables such as age, gender, nature of specimen, tumor site, size, histological type, grade, tumor perforation, bowel wall invasion and perineural invasion were noted.

Conclusion: Our study supports that p53 overexpression is an indicator of poor prognosis and may prove as an useful marker in identifying high risk patients who may benefit from adjuvant therapy in the early stage of disease.

Spectrum of Clinico-Pathological Profile of Poems Syndrome

Anandraj Vaithy — 2018-06-22

Background: Plasma cell Dyscrasias being an unique hematological neoplasm characterized by monoclonal B cell proliferation of Plasma cell, it is usually associated with paraneoplastic syndromes having many differentials. Among the types, POEMS syndrome is an unusual condition characterized by spectrum of clinical manifestations involving hematopoietic and systemic manifestation with many co-morbidities. Laboratory diagnosis remains as the mainstay of diagnosis often making the clinician to examine retrospectively. Among various laboratory tests, Hematological parameters allied with biochemical values and radio-imaging are contributory. In the present study we analyzed the spectrum of Clinical manifestations of POEMS syndrome and emphasized the fact that clinico-pathological correlation helps in early diagnosis of POEMS syndrome, thereby prompt treatment can be initiated.

Methodology: Specific criteria was fixed to label POEMS syndrome based on the knowledge gained by previous Research works. A clear clinical details was collected from the patients in a prescribed proforma. Among the studied cases the criteria to label POEMS syndrome included the following clinical manifestations and its subsequent laboratory interpretations Polyneuropathy, M-protein, Organomegaly (hepatomegaly, splenomegaly or lymphadenopathy), Endocrinopathy (hypothyroidism, diabetes mellitus, hypoadrenocorticismorhypogonadism), skin changes (hyperpigmentation, hypertrichosis, or thickening), and Effusion or Peripheral edema. Three of these above six criteria were kept as minimal requirement for the diagnosis. While the first two were kept as major criteria, the rest are assumed to be minor criteria.

Results:The study period was for a period of seven years and included a series of 9cases.Male preponderance was noted with high incidence in middle age. At many instances it was evident that laboratory diagnosis especially hematological parameters reinforced retrospective evaluation by Clinician to clinch the diagnosis. While M- band electrophoresis and high ESR was uniformly seen in all cases, the associated co-morbidities are variable with skin lesions and bone marrow plasmacytosis. Biochemical & radiological reports were contributory in picking up the condition.

Conclusion: POEMS syndrome is a paraneoplastic condition affecting the middle age individuals with male preponderance unlike other classical myeloma. The present study showed that incidence of POEMS syndrome is fairly higher and judicious correlation of laboratory interpretations especially hematological parameters will definitely aid in better health care management of the patients.

Histopathological Evaluation of Tumours And Cysts of The Epidermis and Dermal Adnexae in a Tertiary Care Hospital

Ramya Gandhi — 2018-06-22

Background: Skin tumours are a challenging group of conditions ,it is difficult to classify and these are diagnosed chiefly by histopathology. The aim of our study was to analyze the incidence and classify the histopathological pattern of tumours and cysts of the epidermis and dermal appendages.

Methods: The current study was a retrospective observational study of epidermal and adnexal tumours and cysts over a period of five and half years from January2007 to December 2012 reported in the department of Pathology ,SMVMCH,Pondicherry over a 5 year period from were analysed and correlated statistically.

Result: Out of 160 skin lesions 62 were found to be epidermal and dermal adnexal tumours, among these benign adnexal tumours(14%) were the commonest followed by benign epidermal tumours(12.5%) ,malignant epidermal tumours(10.5%) and malignant adnexal tumours(2%).The ratio of benign(42) to malignant(22) tumour was 1.9:1.the ratio of benign(20) to malignant(17) epidermal tumour was 1.17:1 .The ratio of benign adnexal(22) to malignant counterpart (3) was 7.3:1 and the ratio of skin tumours (62) to cystic lesion(98) was 1:1.5. The commonest epidermal tumour was seborrheic keratosis. Epidermal cysts were the commonest type of cyst in the epidermis. Common skin appendage tumours were nodular hidradenoma followed by pilomatrixoma. The common malignant tumour was basal cell carcinoma.

Conclusion: Cutaneous tumours represent the complexity of the epidermal and dermal adnexae since they have a similar morphology to their cell of origin .Hence the histopathological examination is mandatory for diagnosis and categorization of these tumours.

Expression of Estrogen and Progesterone Receptor Status in Breast Carcinoma Using Quick Score

Divya S Deth — 2018-06-22

Background : Breast carcinoma is the most common malignant tumour and the leading cause of carcinoma death in women. The hormone receptor status is important nowadays due to its prognostic and therapeutic significance. The objective of this study was to correlate estrogen (ER) and progesterone receptor (PR) status with clinicopathological parameters like age, lymphnode status, size of the tumour and tumour grade of breast carcinoma.

Methods : This study was conducted in the Department of Pathology, Government Medical College, Thrissur from January 2012- June 2013. 100 mastectomy specimens were received and analysed for both histological grading and immunohistochemically by quick score for ER and PR markers.

Results : Majority of the cases were between 50-60 years of age with invasive ductal carcinoma grade 2. ER, PR positivity in this study was 67% and 62% respectively with both receptors positive for 61% of cases. In this study 55% showed no axillary lymphnode involvement and 45% showed lymphnode involvement with majority cases had size between 2 and 5 cm.

Cyto-Histo-Biochemical And Ultrasonographic Correlation of Thyroid Lesions –A Multidisciplinary Approach: An Experience at Rural Tertiary Care Hospital in Southern coast of India

Vaishali Dhananjay Kotasthane — 2018-06-22

Introduction: Thyroid lesions are one of the most common palpable lesions subjected for FNAC.Fine Needle Aspiration Cytology (FNAC) of the thyroid gland is now a well-established first-line diagnostic test for the evaluation of diffuses thyroid lesions as well as of thyroid nodules with the main purpose of confirming benign lesions and thereby, reducing unnecessary surgery.Apart from cytology, other investigations like ultrasonography (USG),thyroid function tests(TFTs) play a supportive for better understanding of thyroid nodules under evaluation.Also, there is some "gray zone" of thyroid cytology where the diagnostic efficacy of FNA declines sharply.Radioimaging (ultrasonography) can be helpful in grey areas of indeterminate lesions and non-diagnostic aspirates. Though USG features alone cannot predict malignancy or benignity, but techniques that combine USG features and FNA cytology are most effective and most accurate for predicting malignancy.

Aims and Objectives:We aimed to evaluate cytological features of palpable thyroid lesions and to correlate with histopathological , radiological and thyroid function tests wherever available, at a rural tertiary health care institute in southern coastal region of India.

Materials /methods:This study was analysis of 156 cases of palpable diffuse and nodular thyroid lesions subjected to FNAC over a period of one and half year at a rural tertiary health care Institute.

Results:Thyroid lesions constituted 19.3% of total lesions subjected to FNAC in study period.Age group ranged from 13 - 77 years, maximum cases belonged to 5^th decade with female preponderance . Clinically, nodular swelling accounted for 86% cases.Benign lesions detected were 75.6%. Malignant lesion accounted for 7.7% cases.Cyto-histo correlation overall was noted in 72.2% cases with benign lesions showed 76.92% were as malignant lesion showed 100% correlation. Sensitivity, specificity , positive predictive value, negative predictive value and diagnostic accuracy was 40%, 100%,100%, 78.6% and 81.3% respectively. Similarly, Overall Radio- cytological concordance was 81.03%. In hormonal correlation, majority (59%) were euthyroid. In these lesions, 60.9% were goitres whereas in cases with hypothyroidism, majority (56%) had thyroiditis.

Conclusion: FNAC is simple, cost-effective, more specific than sensitive procedure for evaluating thyroid masses, further evaluation of thyroid nodule for thyroid function status and radiological support especially in grey zone area of indeterminate lesion has a definitive role to play.

Lymphoid Blast Crisis in a Case of Paediatric Chronic Myeloid Leukaemia

K V Vinu Balraam — 2018-06-17

Chronic myeloid leukemia (CML) is a myeloproliferative neoplasm in which the granulocytes are the major proliferative component and is characterised by the chromosomal translocation t(9;22)(q34.1;q11.2) leading to the formation of Philadelphia chromosome (Ph) containing the BCR-ABL1 fusion gene. This entity is quite rare in paediatric age group and even unusual is a child presenting for the first time in an accelerated or blast crisis. Here we unfold an noteworthy case of a 9 year old school going child presenting with complains of vague abdominal distension who on further evaluation was found to be living through leukaemia.

Idiopathic Giant Cell Myocarditis

Anita Neelkanth Kavatkar — 2018-06-17

Two cases of idiopathic giant cell myocarditis are reported for their rarity .The first case was of a 47 years old male brought to hospital with a history of uneasiness and sudden death. The second case was of a 55 years old male. Gross examination of heart showed whitish fibrotic areas. Microscopy of the heart in both cases revealed large confluent areas of myocyte necrosis along with plenty of giant cells and lymphocytes and occasional eosinophils. Ziehl Neelsen (ZN ) and periodic acid Schiff (PAS) stains were negative. There were no asteroid bodies or Schumann bodies in the giant cells.

Adenocarcinoma of Ampulla of Vater Presented as Recurrent Jaundice

Sunil Vitthalrao Jagtap — 2018-06-17

Background Ampullary carcinoma are relatively uncommon neoplasm which approximately seen in 0.2% of gastrointestinal carcinomas. Clinically these patient generally present at an earlier stage of the disease. As their strategic location may cause early biliary obstruction.

Case history A 70 year old male patient was presented with history of pain in abdomen, anorexia and repeated history of jaundice. On ultrasonography and CT scan abdomen-pelvis showed proliferative growth at periampullary area suggestive of ampullary malignancy. Associated cholelithiasis was noted. Patient underwent surgical treatment of pancreaticoduodenectomy with cholecystectomy. On histopathology revealed moderately differentiated intestinal type of adenocarcinoma of ampulla of Vater, Grade II.

Conclusion We are presenting this uncommon neoplasm for its rarity, recently distinguished subtype on histopathology, clinical behavior and radiological findings.