Annals of Pathology and Laboratory Medicine

Cytomorphological Study of Palpable Soft Tissue Tumors by Fine Needle Aspiration Cytology

Mamta Dwivedi — 2019-05-24

Background: Soft tissue tumors are a highly heterogeneous group of tumors that are classified by the line of differentiation, according to the adult tissue they resemble. Objective of this study was to assess the utility of fine needle aspiration cytology (FNAC) in diagnosing soft tissue tumors and to do the histo-pathological correlation wherever possible.

Methods: Conventional May-Grunwald Giemsa (MGG) staining was done in all the 100 cases and cytodiagnosis was rendered. Histopathology was available in 41 cases. The cytological diagnosis was correlated with histology in these cases. The accuracy rate, sensitivity, specificity, the positive and negative predictive value were calculated. P value was found by applying Fisher’s exact test.

Results: The study was carried out on aspirates of 100 patients. Out of which 65 cases were benign, 30 were malignant while 5 cases were inadequate. Lipoma was the most common cytologically diagnosed benign lesion. Dermatofibrosarcoma protuberans (DFSP) and synovial sarcoma were found to be the most common malignant soft tissue tumors. Cyto-histological correlation could be achieved in 41 cases, with an accuracy of 92.7%.

Conclusion: FNAC is a well-tolerated and cost-effective procedure. It provides predictive diagnosis of benign or malignant soft tissue tumors and also specific tumor type, especially after correlation with clinical and radiological findings.

Comparison of Histopathological Features of ‘Incidental’ and ‘Non-Incidental’ Papillary Thyroid Microcarcinomas

Abhijit Kalita — 2019-05-24

Background: Papillary thyroid microcarcinoma (Pm) is defined as a papillary carcinoma with size ≤ 10mm. On clinical and histological grounds, there are two presentations-‘incidental’ and ‘non-incidental’. Histopathological parameters like intratumoral/peritumoral fibrosis, multifocality, infiltrative borders, subcapsular location, lymphovascular emboli and histological type have been introduced in the reporting of Pm, besides the size which is considered an important prognostic/risk factor.

Methods: The present study is a 5-year retrospective comparative study between the Pm which were incidentally detected, and those which had been previously diagnosed on fine needle aspiration/radiology or clinically suspicious of Pm.

Result: The number of cases in both incidental (111) and non-incidental (110) Pm have been found to be comparable in the present study, which is attributable to meticulous grossing and extensive sampling of all thyroidectomy specimen. Size and multifocality has been significantly different between incidental and non-incidental Pm (p-value <0.05). The parameters like intratumoral/peritumoral fibrosis, infiltrative border and subcapsular location were significantly higher in larger sizes (>5mm) of non-incidental Pm (p-value <0.05). These parameters, however, were not found to be significant when analysed individually or with one another, between the two groups (p-value >0.05). In the incidental Pm of size ≤ 5mm, a good proportion of cases show these parameters, implicating their importance for further follow-up.

Conclusion: Size and focality has been found to differ between incidental and non-incidental Pm. The histological parameters defined for Pm need to be followed up for a longer period to identify the prognostic significance, and their role in the different manifestation of incidental and non-incidental Pm.

Red Cell Distribution Width and Its Relationship with Microalbuminuria Among Patients with Essential Hypertension

Akhshaya Ponsuba T — 2019-05-29

Background: Elevated Red Cell Distribution Width (RDW) is an indicator of renal damage in hypertensive patients. Microalbuminuria (MAU) is an indicator of risk for cardiovascular complications and progressive renal damage in patients with diabetes and also hypertension.

Objectives: 1. Determine RDW and microalbuminuria in hypertensive patients. 2. Determine RDW levels in hypertensive patients with microalbuminuria and without microalbuminuria and to evaluate the relationship between these two parameters.

Methodology: Our prospective study was conducted on 98 patients attending outpatient clinic for blood pressure check up and treatment. For measurement of RDW - 2 ml blood was collected by clean venepuncture and collected in EDTA tube and determined RDW by automatic cell counter (sysmex KX-21) and for microalbuminuria - Early morning urine samples were collected and microalbumin determined by immunoturbidimetry. Statistical analysis were done using SPSS version – 16.0.

Results: A total of 98 patients were included in the present study with age ranging from 30 – 86 year. All the patients were known hypertensive under treatment and 54 of them also had associated diabetes mellitus. The male to female ratio of the sample was 29:69. Out of the total 98 patients, 58 (59.2%) presented with microalbuminuria and 23 (23.5%) patients had RDW value above normal. Out of the 58 patients with microalbuminuria, 17 (29.3%) patients had RDW value above normal but only 6 (15%) patients out of 40 patients without microalbuminuria had RDW value above normal.

Conclusion: Though we could not find out a direct relationship between RDW and MAU, some of the individual patients with MAU had high RDW compared to patients without MAU. As RDW is routinely done as part of complete blood counts in all patients, if its value is high in hypertensive patients, we can workup the patient for microalbuminuria. Early detection and treatment can avoid complications in these patients.

Correlation of Total Sperm Count with Presence of Round Cells and Abnormal Sperm Morphology in Semen Analysis

Thejasvi Krishnamurthy — 2019-05-29

Background: Among the routine semen parameters, presence of round cells and morphological defects in sperms are important qualitative parameters in semen analysis. Detailing the "round cells" and qualitative defects in sperms becomes important as these factors affect fertility. In this study, we aim to categorise and assess the percentage of round cells and morphological defects of sperms in correlation with total sperm count.

Methods: 70 random semen samples were included which were collected from males being evaluated for infertility. They were divided into two groups based on the total sperm count. Papanicolaou stained smears were studied for categorisation of round cells and qualitative defects in sperms .These were then correlated with total sperm count.

Result: We observed that both the groups showed presence of round cells and morphological defects in sperms with a slightly higher percentage in reduced sperm counts. Round cells observed in our study included immature germ cells, leucocytes and epithelial cells. Frequent morphological defects were round head, large head and coiled tail.

Conclusion: Round cells and morphologically defect sperms are frequently observed in semen samples with reduced sperm counts compared to normal sperm counts.

Clinicopathological Correlation in Dysplastic and Malignant Lesions of The Oral Cavity and Oropharynx in Tertiary Care Center in Central India

Priyanka Yadav — 2019-05-29

Background:

Late detection and diagnosis of oral and oropharyngeal carcinomas are responsible for the related increased morbidity and mortality. Understanding the risk factors and patterns of malignancy can help early identification and prompt treatment of patients with oral cancers. In the current study, we aimed to study the pattern of oral dysplastic and neoplastic lesions in tertiary care centre in central India and study its association with various risk factors.

Methods:

The oral biopsy tissues received in the Department of Pathology, GMC, Bhopal for histopathological evaluation during the duration of one and a half years were included in the study. The data was analysed by appropriate statistical tests (software SPSS).

Result:

A total of 334 cases presented for oral neoplastic lesions during the study period with mean age of presentation of malignant lesions and premalignant lesions being 51 years and 46 years respectively. 78.3% cases were reported as malignant lesions with majority being Well Differentiated Squamous Cell carcinomas (57%) among oral cavity lesions and Moderately Differentiated Squamous Cell Carcinoma (41%) among oropharyngeal lesions. 87% of patients reported use of tobacco chewing smoking and alcohol, either alone or in combination.

Conclusion:

High risk individuals included males more than 35 years of age indulging in tobacco chewing, smoking and alcohol with exclusive tobacco chewing associated more with oral malignant lesions whereas the smoking and alcohol along with tobacco chewing associated more with oropharyngeal lesions. Substance abuse awareness programs and screening early lesions in high risk individuals are recommended to curtail oral malignancies.

Diagnostic Utility of Cell Population Data (CPD) In Sepsis Using Automated Hematology Analysers

Shalini P — 2019-05-30

Background: Sepsis still remains an important cause of morbidity and mortality posing a diagnostic challenge to clinicians across the globe. Lack of a single specific and sensitive test paved the way to many researches. Our study evaluated clinical significance of cell population data (CPD) as biomarkers in sepsis. CPD assesses morphological and functional characteristics of leucocytes using automated hematology analyzer.

Methods: The study population consisted of 100 healthy subjects and 100 clinically suspected cases of sepsis with quick sequential organ failure assessment (qSOFA) score >2. The various cell population data (CPD) were collected using automated hematology analyzer, Sysmex XN1000 during a span of 6 months from January to June 2018 in a tertiary care center and the results were statistically analyzed using Z test.

Result: The WBC count and CPD parameters were assessed. Except for neutrophil , monocyte cell size (NE-FSC, MO-Z) and lymphocyte fluorescence intensity(LY-Y) all other CPD parameters show significant difference (p<0.001) in sepsis group compared to healthy controls.

Conclusion: This study suggested utility of CPD parameters which provide details of size and internal structure of leucocytes to be considered as an important biomarker for diagnosis and management of sepsis.

A Study of Storage Related Changes and Effect of Refrigeration on Hematological Parameters and Blood Cell Morphology in EDTA Anticoagulated Blood

Debdatta Basu — 2019-05-30

Introduction: Delayed sample analysis result in changes in measured parameters and morphology of cells, leading to erroneous reports of complete blood counts and peripheral smear reporting. The present study was aimed at evaluating the changes in blood cell counts and morphology on storage, particularly in the local setting and temperature of a tropical country.

Materials & Methods:

190 patients referred to the laboratory for complete blood counts and peripheral smear examinations were included in the study. Blood counts and peripheral smear examination was done at 0, 2, 6, and 24 hours.

The 6 and 24 hour samples were further studied under three different temperatures, refrigerated, ambient room temperature and at 37⁰C.

Statistical difference between values of studied parameter at different time interval was tested using paired t-test. P < 0.05 was considered for statistical significance.

Results: There was no significant difference between 0 hour& 2 hour samples in any of the parameters. However a significant change was noted in the platelet count between 6 hour refrigerated and 6 hour un-refrigerated. All the red cell parameters and platelet counts and cell morphology were significantly altered at 24 hours in refrigerated and unrefrigerated samples.

Conclusions: Storage of EDTA blood causes changes in the counts and morphology of the cells. Within 2 hours no changes are expected, however if there is an anticipated delay beyond 2 hours, it is worthwhile to refrigerate the samples up to 6 hours, especially when platelet counts are desired.

Incidental Detection of Precancerous and Malignant Gall Bladder Lesions in Routine Cholecystectomy Specimens

Pooja Jain — 2019-05-30

Background & Objectives: Gallbladder dysplasia (GBD) and adenoma are premalignant lesions, which may progress to carcinoma through different pathways. Gall bladder (GB) neoplasms are relatively uncommon and are usually asymptomatic during early stages. We analyzed the clinico-pathological features of precancerous and malignant gallbladder lesions in routine cholecystectomy specimens and studied the association of mucosal metaplasia and gall stones with GB adenoma, dysplasia and carcinoma.

Materials & Methods: This is a 3 year retrospective study where histopathology proven cases of GBD, adenomas and carcinomas were retrieved from Pathology database from January 2012 to December 2014. The clinical details and histopathological features of these cases were studied and analyzed.

Results: Out of total 2200 cholecystectomy specimen studied, 7 cases of GBD, 5 cases of adenoma and 10 gallbladder carcinomas (GBC) were identified. Out of total 22 patients, 11 were females. Predominant clinical feature was pain in 86% cases. On ultrasonography (USG), majority showed cholelithiasis. Cholecystectomy was performed in all predominantly due to cholecystitis and lithiasis. On microscopy, 43% cases of dysplasia showed high grade features, 60% cases of adenoma showed tubular type with pyloric metaplasia and 50% of GBC were moderately differentiated. Associated dysplasia in GBC was noted in 50% and associated metaplasia in 60% cases. Follow up ranged from 2-4.5 years. 40% GBC showed lymph node involvement and 20% showed distant metastasis.

Conclusion: All cholecystectomy specimens should definitely be sent for histopathologic evaluation to detect unapparent GB lesions. Early detection of these lesions may lead to good prognosis and prolonged survival.

Foetal and Perinatal Autopsy – A Study Of 100 Cases

Sharanabasav M Choukimath — 2019-05-30

Background:

Perinatal and foetal Autopsy pave way for bringing down these preventable stillbirths by identifying the potential areas where the health system tend to fail and helps to rule out congenital and infectious diseases and hence their recurrence.

Aims:

To describe and analyse the foetal and perinatal death.
To determine how often the perinatal autopsy determines and confirms the cause of death and how often it changes the clinical diagnosis.

Methods and Material:

Autopsy was performed by the pathologist after obtaining informed written consent from parents, examining grossly and microscopically. The cause of death, whenever found was classified according to the ReCoDe system of classification of cause of death.

Results:

Cause of death was found in 101 (96.2%), unknown in 4 cases (3.8%). Foetal causes were found in 55 (52.4%), lethal Congenital Malformation was seen in 31 (29.5%) cases. Maternal causes were seen in 21 (20%), placental causes were seen in 11 (10.5%) cases. Other causes were attributed in 14 (13.3%) cases.

Autopsy added significant findings to the prenatal diagnosis in 10 cases (10%) and changed and added new findings in (9%) 9 cases. While in (81%) 81 cases, it had confirmed the clinical diagnosis.

Conclusions:

Despite technological advancements, foetal autopsy remains gold standard for diagnosing the cause of death of foetus thus helping prenatal counselling.

Utility of Hematology Histograms

Daksha Prabhat — 2019-06-01

Background: Over the past five decades, hematology analyzers have evolved from semi-automated to fully automated ones. A histogram is a graphic representationof a collection of data based on cell size and/or cell number depicting variations in the process.

Objective: To study hematology histograms in relation with major blood cell components and in cases of acute febrile illness.

Methods: It was a cross sectional observational study conducted over 200 consecutively collected samples from adults. Histograms were obtained from 3-part automated hematology analyzer, evaluated in relation to the RBCs, WBCs and platelets with their peripheral blood smear (PBS) picture and with the cases with diagnosis of acute febrile illness.

Results: In the present study, maximum number of samples were from 15-25 years of age group with a male preponderance. Out of 200 histograms, 102 had combined abnormality of the all 3 blood cell types in varied combinations. Neutrophilia, microcytosis and thrombocytopenia were the most common findings in the respective individual blood cell histograms. Maximum sensitivity of WBC histogram was for neutrophilia (81.08%), that of RBC histogram was for microcytosis (81.3%) while that of platelet histogram was for thrombocytopenia (97.5%). In cases of acute febrile illness, dengue was the most common diagnosis with thrombocytopenia being most common histogram finding.

Conclusion: Histograms provided by the automated hematology analyzers are of great diagnostic and morphologic importance. Histograms obtained from automated analyzers should be complementary to hematological parameters and peripheral blood smear examination.

Malignant Triton Tumour: Case report

Sandeep V — 2019-06-04

Malignant triton tumours (MTTs) are a rare subtype of malignant peripheral nerve sheath tumour (MPNST) showing rhabdomyoblastic differentiation, which have no treatment consensus and a poor prognosis.

This case report presents case of a 71yrs/ male with swelling in Right Hand over one month. Patient had same swelling 2yrs back which was diagnosed as Peripheral Nerve Sheath Tumour on histopathology following which he underwent surgery followed by radiotherapy. Swelling reappeared at same site after 3 months.

FNAC of swelling shows large spindle cells having elongated buckled nuclei, pointed end, with varying nucleus size and coarse nuclear chromatin. Few cells are showing Rabdomyoblastic differentiation.