Annals of Pathology and Laboratory Medicine

A Study of Serum Iron Profile in Patients with Chronic Kidney Disease

Indira Shastry — 2020-07-02

Background: Even though anemia and iron deficiency can increase the morbidity and mortality in patients with chronic kidney disease (CKD), an iron overload can be dangerous as well.

Aim: Identify the number of CKD patients with iron deficiency, iron overload, acute phase reaction and anemia of chronic disease in a tertiary care hospital.

Material and methods: The study was conducted in Kasturba medical college, Manipal. 154 patients with CKD were selected for the study irrespective of their treatment status with hematinics and/or erythropoietin.

Results: The mean total serum iron levels were 61μg/dl, Total Iron Binding Capacity (TIBC) 216.43 μg/dl, serum ferritin 539.68 μg/dl, and transferrin saturation of 32.18% respectively. When the serum iron profile of individuals was analyzed, majority (54.25%) of the patients were found to have acute phase reaction and most of them were in advanced stage of renal failure. Normal serum iron profile was found in 37.2% patients, iron overload in 2.2%, anemia of chronic disease in 5.3% and iron deficiency in 1% cases. These findings were statistically significant with the P value of 0.001.

Conclusion: Most common type of serum iron profile found in the study population was acute phase reaction (54%) and majority of them were in stage 5 renal failure. Hence, before beginning an iron therapy, all the patients with anemia in chronic kidney disease should be evaluated for body iron status to prevent iron overload.

Enhancing Cell Block Quality- A Comparative Study Of Formalin And Agar-Based Methods

Shruti Mishra — 2020-07-02

Background: There are not many studies conducted in India to compare cell block preparation methods with reagents and materials that are readily available in all laboratories. This study aimed to standardize and compare two simple cell block techniques, which can be done in low resource settings too. In the study, 35 cases of thyroid, lymph node, and breast were collected for both FNA and cell block preparation for six months.

Materials and Methods: There were separate passes given for both methods. A total of seventy cell blocks made using formalin and agar methods of preparation.

Results: We compared both the methods on technical and morphological levels. The formalin method was overall easy to perform and was yielding good morphological results in 98% cases, the only drawback being cell loss during handling and processing. While in the agar method, there was almost no cell loss, but it was more technically difficult and yielded poorer morphological results. A scoring system was made for cellularity: no cells = 0, hypo-cellular = 1+, hypo-cellular with tissue fragments = 2+, cellular = 3+.18 A score of 2+ and 3+ was scored by 31/35 formalin blocks and 28/35 agar blocks.

Conclusions: The sensitivity of both formalin and agar methods are almost comparable. However, the procedure of the formalin method is far more straightforward and user friendly. Moreover, it also provides a better architectural picture than the agar method.

Cytomorphological Analysis of Neoplastic Lesions of Neck Node with Special Reference to Lymphomas

Junu Devi — 2020-07-03

BACKGROUND: Neoplastic lesions of lymph node in cervical region pose a diagnostic delima and very often cytological diagnosis proves invaluable. An early diagnosis of the lesions is essential for proper management. To assess the frequency distribution and cytological analysis of various neoplastic lesions of lymph node with special reference to the lymphoma.

MATERIAL AND METHODS: this is a cross-sectional study which provides analysis of 164 neoplastic lesions of lymph node out of 758 lymph node aspirate. Cytomorphological pattern and cellular detail are reviewed carefully and diagnosis were made. Histopathological and immunohistochemical correlation done wherever needed.

RESULTS: Out of 164 neoplasms 86.59% secondary neoplasms(61.27% SCC, 19.72% Adenocarcinoma,15.49% poorly differentiated carcinoma,0.70% undifferentiated carcinoma, 0.70% mucoepidermoid carcinoma, 0.70% papillary thyroid carcinoma,1.41% leukemic deposit),12.2% lymphoid neoplasms. M:F = 1.2:1. Diagnostic accuracy was calculated as 98.67%, and false positive rate 1.3%

CONCLUSION: fine needle aspiration cytology is invaluable in rapid diagnosis of lymph node neoplasms of cervical region however histological confirmation and immunohistochemical analysis is mandatory in certain tumors specially lymphomas, poorly and undifferentiated carcinoma for accurate diagnosis and proper management.

Clinicopathological correlation of p63 in Urothelial Carcinoma: Immunohistochemical Study

Rupinderjit Kaur — 2020-07-03

Background: Urothelial cancer (UCa) poses a significant medical and public health concern in most parts of the world and is defined as a pan- urothelial disease in which entire urothelium of the renal pelvis to the urethra can undergo malignant transformation. Bladder tumors account for 90–95% of urothelial carcinomas and are the most common urinary tract malignancy. It is three times less common in females.

Methods: The study was conducted on 40 cases of Urothelial Carcinoma received as biopsy specimens in a tertiary care hospital. There were 20 cases each of low grade and high grade and after grading these were subjected to p63 expression.

Result: 78% of the patients were from 50-75 year age group with Male to Female ratio being 4:1. Painless hematuria was most common complaint. The size varied from 0.5 to 7.2 cm.

For P63, 38 (95%) cases showed positive p63 expression. Of which 20 cases were low grade and 18 (90%) were high grade papillary urothelial carcinomas. Of P63 positive cases 36 cases showed moderate to strong staining intensity whereas two cases showed mild staining intensity. The p63 expression decreased with grade and invasion.

Conclusion: P63 immunoexpression decreases with increasing grade of tumor as well as with invasion thus showing that its expression is related with good prognosis.

Primary Thyroid Lymphoma

Sripriya Krishnan — 2020-07-02

Primary thyroid lymphoma (PTL) is a rare condition and accounts for 5% of all thyroid malignancies. They constitute less than 2 % of all lymphomas. Most PTL’s are non-Hodgkin's lymphomas. It is clinically essential to discriminate between primary or secondary lymphoma of the thyroid as the treatment and prognosis varies. It commonly occurs in women in their sixth and seventh decade. Primary thyroid lymphoma is quite curable without the need for extensive surgery if diagnosed early. We present such a case of a 60- year old female patient presenting with complaints of neck swelling with loss of appetite and dysphagia. Histopathological diagnosis confirmed Primary thyroid lymphoma of B cell origin which was confirmed by immunohistochemistry.

Mesenteric Paraganglioma-A Cyst in The Mist

Saniha P B — 2020-07-02

Extraadrenal paraganglioma is rarely found in the mesentery. It accounts only for 5-10% of cases and may present incidentally as abdominal mass. We report a case of 30 year old male presented as mass per abdomen. A differential diagnosis of neurogenic tumor or cystic mesothelioma was considered based on CT-abdomen. Histopathological examination showed features of mesenteric paraganglioma and confirmed on immunohistochemistry. This case report highlighted several important key issues regarding diagnosis of paraganglioma, including malignant or metastatic potential, recurrence rate, pre and postoperative imaging study and lifelong follow-up of the patient.