Annals of Pathology and Laboratory Medicine

Cytomorphology of Chondroid Syringoma: Analysis of 20 Cases and Review of Literature

Meetu Agrawal — 2019-12-01

Background: Chondroid syringomas [CS] are interesting skin adnexal tumours. They have a remarkable pleomorphic-adenoma like morphology in the skin. Though the histopathology of the tumour has been described in detail in literature, cytomorphological studies are restricted to case reports and small case series. For diagnosing a CS on cytology, the index of suspicion must be high, clinical evaluation must be thorough and knowledge of variant existing morphologies is essential.

Aim: This study was done with the aim of studying the common and variant cytological features of chondroid syringomas.

Methods: This was a retrospective study conducted over a four-year period (2014-17) in the Department of Pathology, VMMC and Safdarjung hospital. Fine needle aspirate smears and biopsy slides were studied. Morphological details were independently reviewed in detail by two pathologists (Dr MS and Dr MA).

Result and Conclusion: The conventional biphasic cell morphology of CS was seen in nearly 50% cases. Rest of the cases showed predominance of one or more variant features in few areas and thus CS was only one of the differential diagnosis in these cases. Nevertheless, FNA proved to be fast, inexpensive and a reliable method for diagnosis of chondroid syringoma. The study will be relevant and helpful in the day to day cytological reporting of CS.

Diagnostic utility of immunohistochemical expression of HE4 in Epithelial Ovarian Neoplasm

Begum Afrin Nahar — 2019-11-23

Background: Mortality in case of ovarian malignancy is high due to late diagnosis. Early and accurate diagnosis can improve the case specific management. HE4 (human epididymis protein 4) which is proved to be overexpressed in the ovarian cancer cells, is considered a new biomarker for ovarian cancer diagnosis. Aims and objectives: The study was undertaken to evaluate the immunohistochemical expression of HE4 in various epithelial ovarian neoplasm.

Material and Methods: It was a cross sectional, prospective, single institution based study, conducted in the department of Pathology in collaboration with the department of Gynecology and Obstetrics, from December 2016 to January 2019 in our institution. A total 71 cases were selected for this study.

Results: Serous tumour was the most common epithelial tumour followed by mucinous tumour. Highest percentage of expression of HE4 was seen in high grade serous cancer and malignant endometrioid tumour. Benign serous and mucinous tumour shows negative expression mostly. We found statistically significant correlation between HE4 expression and different types of epithelial ovarian tumours (p=0.000).

Conclusions: HE4 was highly expressed in malignant ovarian tumour especially serous and endometrioid carcinoma and can be used as an important biomarker for malignant ovarian neoplasm. Expression in high grade ovarian serous cancer supports its prognostic value also.

Immunohistological Diagnosis of Primary and Metastatic Renal Cell Carcinoma Using Panel of Immunohistochemical Markers

Murari Lal Dhanetwal — 2019-11-23

Background:

Tumour heterogeneity and lack of markers with high specificity makes diagnosis of renal cell carcinoma (RCC) challenging. The study was undertaken to evaluate panel of IHC markers to enable diagnosis and reproducible classification in primary and metastatic renal tumors.

Methods:

Descriptive Study wherein 100 cases of RCC and 25 trucut biopsies (20 metastatic and 5 primary renal tumors) were evaluated for morphology and immunostained by panel of immunohistochemical (IHC) markers consisting of CA-9, CD10, CK-7, AMACAR and TFE-3 with additional markers as required.

Result:

Morphologically tumors were grouped as clear cell and nonclear cell (eosinophilic and poorly differentiated). Clear cell RCCs (CCRCC), clear cell papillary RCC (CCPRCC) and multilocular cystic RCC (MCRNLMP) displayed strong statistical association of CA-9 immunostaining (p=50.00, x2-0.000). Inverse correlation was found between the intensity of the staining of CA-9 and tumor grade. (p=32.97, x2=0.000). CA-9 and CK-7 co-expression was evident in all cases of CCPRCC and MCRNLMP. Papillary RCC exhibited positive statistical correlation with CK-7 and AMACAR. E-cadherin and CD117 were required additionally to differentiate between oncocytoma and chromophobe RCC. CD10 and Pax 8 were most helpful in diagnosing metastatic RCCs

Conclusion:

IHC panel consisting of CA-9, CD10, CK7, AMACR and TFE3 helps triage RCCs with clear cell/eosinophilic cell / papillary/poorly differentiated pattern. In a setting of metastatic RCC, use of CD10 and Pax 8 together facilitate primary diagnosis of RCC when tissue available is limited.

Study Of Clinico-Histopathological Correlation of Seborrheic Keratosis

Dharti Durlabhjibhai Jakasania — 2019-11-26

Background: Seborrheic keratosis (SK) is one of the mostcommon epidermal tumors of the skin. However, only a few large-scale clinic-histopathological investigations have been conducted on SK or on the possible correlation be-tween histopathological SK subtype and location. The aim of this study was to analyze the clinical and histopathological features of a relatively large number of cases of diagnosed SK.

Methods: Seventy five (75) pathology slides of skin tissue from patients with clinically diagnosed SK and 67 cases of biopsy-proven SK were analyzed. The biopsy-proven cases of SK were assessed for histopathological subclassification. The demographic, clinical, and histopathological data of the patients were collected for analysis of associated factors.

Result: Seborrheic keratosis commonly present in old age most common age group is 60-70 yr. It affects male and female equally (M:F-1.12:1).Most common etiology in our study is sun exposure. In our study upper extremities are most commonly involved.Among histologically proven 67 cases most common histological type in our study is clinical seborrheic keratosis(CSK) (68.65%) followed by stucco keratosis (23.88%). Among common seborrheic keratosis hyperkeratotic type (31.34%) is most common followed by melanoacanthoma (19.40%).Histopathologically proven cases of seborrheic keratosis shows significant presence histopathological features like hyperkeratosis (69.33%), acanthosis (66.66%) and papillomatosis(60%). Hyperpigmentation is also present in significant number of cases (34.66%).

Conclusion: SK appear to be more common in old-age, with equal sex distribution, predominantly affecting the upper extremities, head, and neck. Sun exposure was the most common etiology.

The most frequent SK histopathological sub-type found in this study was the clinical seborrheic keratosis followed by stucco keratosis. In clinical seborrheic keratosis most common variant was hyperkeratotic type followed by melanoacanthoma. Most of the characteristics of SK are in accordance with the literature published.

Histopathological Study of Psoriasis and Its Grading According to Trozak Scoring System

Neelu Vashist — 2019-11-26

Background: Psoriasis is a chronic papulosquamous disorder of undefined etiology, occuring in 0.09 to 11.4% population. Different clinical types occur with varying histopathology. Early and Late onset psoriasis have been defined based on age at presentation.

Methods: Cases diagnosed as Psoriasis, both clinically and histologically, were examined for the individual features of Psoriasis. Histomorphological grading of the lesions was also done using the Trozak scoring system.

Result: The mean age of the patients was 42.26 with a male predominance (M:F=3.5: 1). Early onset cases constituted 71% of the total cases, while late onset cases were 29%. The histopathological features were found to be variably present. Acanthosis was observed in 96% cases. Hyperkeratosis (94%), parakeratosis (66%), club shaped rete ridges (88%) with regular elongation of rete ridges (72%) with, suprapapillary plate thinning (74%), hypogranulosis (72%), elongation and edema of dermal papillae (88%) were other features seen in majority of cases. Perivascular mononuclear infiltrate in upper dermis of papillae (76%), dermal (76%) and epidermal (78%) neutrophils, spongiform pustules of Kogoj (24%), Munro’s microabscess (28%), were the inflammatory changes observed, present to a greater extent in the early onset cases than the late onset cases. The Trozak scoring system gave an average score of 9.44, with no significant difference in the early and late onset cases of Psoriasis.

Conclusion: Entirely typical histological features are found only in a small percentage of biopsy specimens, even if only clinically typical lesions of psoriasis are examined.

Platelet Estimation by Manual and Automated Methods

Lavanya M — 2019-11-29

Background:

Accurate platelet estimation is essential for the management of the patients with thrombocytopenia. Automated analyzer by its quick and reliable platelet estimation has overtaken the manual methods. But sometimes do produce erroneous results which are to be cross checked by manual methods.

Hence this study was undertaken to compare the traditional manual method and alternate method based on Platelet/RBC ratio for estimating platelets in peripheral smear and to find the most accurate method for detecting Thrombocytopenia.

Methods:

100 samples of EDTA anticoagulated blood is analysed by automated analyzer, then thin peripheral smear is prepared. Manual counts are performed by 1: Traditional Method- average platelet count / 10 Oil immersion field (OIF) x 15,000, 2: Alternate method -platelet/1000 red blood cells (RBC) multiplied by RBC count. Manual methods were compared with the automated analyzer using students t test. The Sensitivity, Specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV) and Likelihood ratio (LR) for positive tests were also calculated for the manual and alternate methods in detecting thrombocytopenia.

Result:

The students t test shows no difference in the platelet counts estimated by traditional method and alternate method. Further the results of sensitivity, specificity, PPV, NPV and LR for positive tests show the traditional and Alternate method can give fairly accurate results.

Conclusion:

The manual method of platelet estimation is found to be the most accurate and can used to quality check the automated analyzer or can be used in underprivileged laboratories, for aiding in proper management of the patient.

Prevalence of Transfusion Transmitted Infections from Eastern Part of India

Chumila Thinley Bhutia — 2019-12-01

Background: Blood transfusion saves millions of lives everyday across the world. However, transmission of infections along with blood transfusion though can be minimized but cannot be completely avoided. The chance of transmitting infections is higher in underdeveloped laboratories with limited resources. Transfusion transmitted infections (TTI’s) can cause significant morbidity and mortality as well.

Methods: A retrospective data analysis was carried out in SMIMS, Gangtok, in the far eastern part of India to estimate the incidence of transfusion transmitted infections (TTI’s) in the last five years, from January, 2013 to December, 2017. 5 ml of venous blood was collected from each donor and blood was screened for HBsAg, HIV, HCV, Syphilis and Malaria using card tests. The reactive cases were confirmed with third generation ELISA, TrueLISA^TM^.

Result: A total of 10,011 blood donors were screened from January, 2013 to December, 2017. Male voluntary donors were more compared to female donors. Among the 135 seropositive cases 92 donors (0.91%) were positive for HBsAg, 23 donors (0.22%) were positive for anti HCV, 16 donors (0.15%) were positive for HIV while 4 donors(0.04%) were positive for syphilis. No case of malaria was noted in our study. The overall prevalence of HBsAg, HCV, HIV and syphilis was 0.91%, 0.15%, 0.22%, and 0.04% respectively.

Conclusion: The goal of routine blood transfusion should be to decrease the seroprevalance of TTI’s. Strict blood donor selection and proper screening methods along with nucleic acid detection can help in reducing the seroprevalance of TTI’s.

Study of Serum Homocysteine Level in Young Patients with Myocardial Infarction and Cerebrovascular Stroke

Meena Rajiv Daveshwar — 2019-12-01

Background: Nowadays, vascular disease is the leading cause of death and disability. India too is facing epidemic of cardiovascular and cerebrovascular disease. The established risk factors for heart disease and stroke account for one half to three fourth of cases. The remainders are the result of other factors that promote atherosclerosis. Elevated blood levels of homocysteine have been linked to increased risk of premature coronary artery disease, stroke and thromboembolism, even among people who have normal cholesterol levels. Hence screen for homocysteine is recommended in patients with premature atherosclerotic disease and unexplained venous thrombosis.

Methods: The present study was performed to correlate the levels of serum homocysteine levels in young patients (</=40 yrs) with myocardial infarction and ischemic cerebrovascular stroke. Thirty cases were studied along with assessment of their risk factor.

Result: It was observed that serum homocysteine levels were significantly raised in coronary

artery disease and ischemic stroke patients.

Conclusion: Increase levels of homocysteine is an important factor that assesses risk independently for coronary artery disease and ishchemic stroke.

Detection and Study of Interleukin -21 Levels in Art Recipients

Manoj Kumar Meena — 2019-12-01

Background: Interleukin-21 (IL-21) is a relatively new immune-enhancing, multifunctional and pleiotropic cytokine that plays an essential role in controlling chronic viral infections. It is a protein that in humans is encoded by IL-21 gene, mapped on chromosome 4 and 180 kb from IL-2 gene and the mRNA encoding the product is 616 nucleotides long. IL-21 is expressed in activated human CD4⁺ T cells but not in most other tissues. In addition, IL-21 expression is up-regulated by Th2 and Th17 subsets of T helper cells, as well as T follicular cells. Further IL-21 is expressed in NKT cells regulating the functions of these cells. IL-21 may be a critical factor in the control of persistent viral infections such as HIV. The intrinsic ability of IL-21 to promote the longevity of B cells should benchmark its role in sustained production of neutralizing antibodies by proliferating and differentiating B cells committed to cognate stimulating antigenic determinants. Nonetheless, immune response to identical or related antigenic insults are quite heterogeneous enlisting complex factors including ethnic and HLA elements in determining the final outcome. Present study aims to explore the levels of IL-21 in a select segment of ART recipients of East Delhi covered by NACP, Govt. of India.

Methods: Estimation of levels of IL-21 was done using ELISA test employing commercially available kit (QAYEE-BIO Kit for Interleukin-21). The method of ELISA used for the present study was sandwich ELISA.

Results: The mean levels of IL-21 in the study of 40 ART recipients were 1178.21±927.063. There were no controls included in the study. The range of IL-21 were 150-6100. In one patient IL-21 levels was not detected.

Conclusion: This study attempts a clinical correlation with the levels of a cytokine which could help in a better understanding of the immunobiology of the disease. In the current study, the levels of IL-21 in samples of ART recipients were detected. In all ART patients the levels of Interleukin-21 were detected except one. Majority of patients showed moderate levels of IL-21. But 3 patients showed high levels of IL-21 >2000 pg/ml who were not associated with opportunistic infections after 10 to 12 months of ART treatment. Therefore, further studies with a higher sample size may be required to arrive at a statistically significant correlation.

Phaeohyphomycosis of Lower Limb

Sushanta Chakma — 2019-12-03

Phaeohyphomycosis is a chronic, progressive cutaneous and subcutaneous infection caused by melanised or dermaticeous fungi and characterized by the presence of brown mycelial structures on fine needle aspiration cytology. These fungi are associated with rural population, involved in various agricultural and outdoor activities. The clinical manifestations that includes superficial and deep local infection to disseminated infection. Herein, we describe the clinical and fine-needle aspiration cytology features of a case of phaeohyphomycosis caused by Phialophora verrucosa.

Lipoma of Parotid Gland

Sonia Verma — 2019-12-03

Lipoma is a common benign tumour which is mesenchymal in origin and arises in every location where fat is normally present, 13% of these occur in the head and neck region. Rarely, Lipoma can arise in the oral cavity, pharynx, larynx and parotid gland.¹ Their occurrence in the head and neck is rare in the first place, even more at the level of the parotid region where they may occur adjacent to the parotid capsule, inside the capsule, or within the substance of the gland.²The incidence of lipoma among parotid tumours ranges from 0.6% to 4.4%, with most series reporting an incidence of 1%.³ Over a period of two decades, only two cases of parotid lipoma were reported from India⁴and one from Pakistan.⁵ Concerning the age of onset, lipoma are most common from the fifth to the sixth decades of life. Those in deep lobe have been reported to be highest in fourth decade.⁴ Recently, improved preoperative evaluation techniques, including the use of computed tomography (CT), magnetic resonance imaging (MRI), and fine-needle aspiration (FNA), have enabled a more accurate assessment of these tumors and a rational approach to their management.⁶ Surgical excision of these tumors is always necessary for definitive diagnosis⁷, but it is challenging because of the facial nerve which courses throughout the parotid gland and could be damaged during surgery if not performed traditionally and by experienced hands.

Squamous Versus Adenosquamous Carcinoma in Gall Bladder

Neeti Nagar — 2019-12-03

The commonest malignancy developing in gall bladder is an adenocarcinoma. Furthermore, the long-standing presence of gall stones is an inciting event in the development of malignancy. Squamous cell carcinomas have been known in the gall bladder. The squamous origin has been attributed to either of the two theories. It could be either squamous metaplasia in the lining of gall bladder and further malignant transformation or origin of a tumor as adenocarcinoma and its further differentiation towards squamous morphology. We support and demonstrate the latter morphology by means of this case.