Annals of Pathology and Laboratory Medicine

Spectrum of Pathological Lesions Observed in Post-Transplant Gastrointestinal Mucosal Biopsies

Merin Jaison, Pushpa Mahadevan, Resha Menon — Thu, 11 Jul 2024 02:28:58 +0530

Background: Gastrointestinal mucosal biopsies in post-transplant patients reveal diverse pathologies, including infections and post-transplant inflammatory bowel disease (IBD). Immunosuppressants, crucial for preventing rejection, pose risks such as nausea, diarrhea, peptic ulcers, infections, and cancers. Diagnosing post-transplant colitis is challenging due to similar clinical and histological features. Pathologies include drug-induced colitis, infection-related colitis, graft-versus-host disease (GVHD), de novo IBD, neoplasms, post-transplant lymphoproliferative diseases (PTLD), and non-specific colitis. Each requires specific treatments, highlighting the need for a multidisciplinary approach. This study evaluates these lesions in our tertiary care center.

Methods: A retrospective study analyzed 46 post-renal and liver transplant patients who underwent GI endoscopy/colonoscopy biopsies at VPS Lakeshore, Kochi, between January 2017 and December 2022. Variables such as patient age, gender, presenting complaint, time from transplantation to symptoms, and histopathological diagnosis were analyzed using SPSS software.

Results: From 2017 to 2022, 46 out of 985 transplant recipients underwent GI biopsies (39 kidney, 7 liver). The cohort was predominantly male (93.5%) with a mean age of 54.93 years. Diarrhea was the primary symptom (45.7%), followed by dyspepsia and anemia, occurring on average 23 months post-transplant. Pathological findings included infection-related colitis (26.1%), drug-induced colitis (8.7%), de novo IBD (2.2%), neoplasms (2.2%), post-transplant lymphoproliferative diseases (2.2%), non-specific colitis (32.6%), and no significant pathology (26.1%).

Conclusion: Post-transplant gastrointestinal diseases are complex, impacting the health and quality of life of recipients. Timely diagnosis and personalized management are crucial. A multidisciplinary approach is essential for effective care, and continued research and clinical efforts are vital for improving outcomes.

An Autopsy Study of Histopathological Examination of Coronary Atherosclerosis by Modified American Heart Association Classification in a Tertiary Care Centre

Thu, 11 Jul 2024 02:38:53 +0530

Background: The study was conducted to assess the atherosclerotic lesions in coronary arteries in autopsy cases, grading them with reference to the Modified American Heart Association (AHA) classification. It also aimed to evaluate atheromatous plaques to determine the age and sex-related prevalence of atherosclerosis at B.J. Medical College, Ahmedabad.

Methods: Autopsies were conducted on 100 cases between the ages of 10-75 years, during the period from January 2023 to July 2023, using conventional techniques. A microscopic assessment of two main coronary arteries was performed.

Results: According to the Modified AHA classification of atherosclerosis, the maximum number of cases belonged to the 40-49 years age group (46 cases), followed by the 21-39 years age group (29 cases). Out of the 100 cases, 85 were male and 15 were female. The degree of atherosclerosis in the left coronary artery (LCA) was greater in comparison to the right coronary artery (RCA). Pathological intimal thickening (PIT), intimal thickening (non-atherosclerotic), and calcified nodules were common lesions found in these coronaries. PIT was the most common lesion involving the coronaries and is the precursor lesion for the development of advanced lesions.

Conclusion: Coronary artery disease is reaching pandemic proportions, so the study of subclinical atherosclerosis is crucial to estimate the disease burden in the asymptomatic population. Autopsy-based studies for evaluating the prevalence of atherosclerosis in a population are cost-effective procedures and help in estimating the future disease burden in the population.

Evaluation of Blood Donor Selection and Deferrals in a Tertiary Care Hospital Blood Centre

Thu, 11 Jul 2024 02:45:08 +0530

Background: Blood transfusion is considered an important life-saving treatment in the medical field, saving millions of lives. In blood transfusion practice, blood donor selection is the first and most important step to safeguard the health of both donors and recipients. Donors may be deferred permanently or temporarily due to various reasons during the screening procedure. This study was carried out to understand the reasons for donor deferral and deferral rates at our blood center.

Methods: A retrospective study was conducted at the Blood Center, GMERS Medical College and Hospital, Gotri, Vadodara, Gujarat, for the period of January 2022 to June 2023. Relevant data on total blood donations and donor deferrals were retrieved from the donor registration form and analyzed.

Results: Out of a total of 6054 blood donors, 721 (11.9%) were deferred. Amongst them, 89.74% were temporarily deferred and 10.26% were permanently deferred. The most common cause for temporary deferral was anemia (Hemoglobin < 12.5 gm%), comprising 53.47%, and the most common cause for permanent deferral was RPR positive status, comprising 40.54%.

Conclusion: Donor selection is a crucial step for safe and healthy blood transfusion. Understanding the reasons for donor deferral can greatly aid in blood donor recruitment efforts, especially targeting temporarily deferred young adult donors who can be returned to the donor pool.

Unveiling the Spectrum: Pathological Perspectives on Neuroendocrine Neoplasms

Thu, 11 Jul 2024 03:08:22 +0530

Background

Neuroendocrine neoplasms (NENs) account for only 0.5% of all malignancies. The incidence is approximately 2 per 100,000 with a female preponderance under the age of 50 years. The main primary sites are the gastrointestinal tract (62-67%) and lungs (22-27%). In the last decade, the incidence has been rising, which might be due to more awareness, improved diagnostic tools, or a change in definition. Neuroendocrine neoplasms are sporadic, but association with the MEN1 syndrome and clustering within families is known. The 5-year survival is mainly associated with the stage of disease: 93% in local disease, 74% in regional disease, and 19% in metastatic disease.

Method

Biopsies received in the Department of Pathology, B.J. Medical College, Ahmedabad over the past 2 years were included. Biopsies were fixed and processed by routine paraffin method, stained by H&E, and also immunohistochemistry was performed.

Results

A total of 50 cases were received, with about 56% males and 44% females, with a median age of 50 years. In our study, most of the tumors were found in the gastro-entero-pancreatic system, followed by the breast and broncho-pulmonary group. NENs were graded based on mitotic count. In total, 12 had G1 grade, 15 had G2 grade, 22 had G3 grade, and 1 was placed in the NEC category. Lymph node or distant site metastasis was not found in any of the cases.

Conclusion

According to our study, the age of presentation of NENs is in the 5th to 6th decade, and the majority occur in the GEP group. Grading of NEN should be carried out according to the latest WHO criteria and is crucial for prognosis and management of patients.

A Study of Fine Needle Aspiration Cytology of Metastatic Squamous Cell Carcinoma of Head and Neck Lymph Nodes

Thu, 11 Jul 2024 03:17:48 +0530

Background: Lesions of the head and neck region are routinely encountered by clinicians, and squamous cell carcinoma (SCC) of the head and neck is the sixth most common cancer worldwide. FNAC (fine-needle aspiration cytology) is one of the most important diagnostic modalities used universally in the initial assessment of patients presenting with palpable head and neck region masses. In this study, cases of head and neck squamous cell carcinoma metastasizing to lymph nodes are studied to evaluate the role of FNAC as a sole diagnostic method.

Materials and Methods: This study was conducted on 100 patients who visited the Cytopathology Department, B.J. Medical College, Civil Hospital, Ahmedabad, during the period from January 2023 to February 2024. FNAC diagnoses were correlated with detailed clinical findings and other relevant investigations.

Results: Out of 100 cases, the maximum cases were found in the age group of 51-60 years. Most of the cases were found in the right submandibular region (28%), and a total of 82% of patients had one or more histories of addiction. Cytomorphological analysis revealed that 54% of cases were SCC, 21% of cases were necrotizing SCC, 4% of cases were keratinizing SCC, 4% of cases were non-keratinizing SCC, 3% of cases were SCC with giant cell reaction, and 14% of cases were suspicious of SCC.

Conclusion: FNAC is a first-line investigation used for head and neck lymphadenopathy, including deposits of metastatic squamous cell carcinoma. Sometimes there is a diagnostic dilemma due to overlapping features on cytology, which should be kept in mind. Public awareness programs are necessary to obviate known etiological factors like tobacco.

Concurrent Benign Brenner Tumor and Mucinous Cystadenoma of an Ovary in a Postmenopausal Woman: A Case Report

Samrita Samaddar, Abhijit Gajendra Bhanji, Vivek Sreekumaran Nair — Thu, 11 Jul 2024 01:12:42 +0530

Ovarian cancer is the most fatal gynecologic malignancy. The surface epithelial tumor is the most common type of ovarian cancer. Among these, mucinous tumors account for 10-15% of ovarian tumors. Surgical pathologists find that mucinous ovarian tumors are among the most challenging ovarian neoplasms to interpret. Sometimes, other types of surface epithelial cancers coexist with mucinous tumors. Because of this, it's critical to diagnose mucinous tumors accurately. On the other hand, the association of Brenner tumors with other neoplasms is rare. Ovarian Brenner tumor has always been discussed by pathologists as an enigmatic tumor because of its rarity and disputed histogenesis. Here, we report a rare case of mucinous cystadenoma of the ovary with a Brenner component in a 68-year-old postmenopausal woman.

A A Rare Case Report on Lhermitte-Duclos Disease: An Intraoperative and Radiopathological Diagnosis

Charu Kiran Agrawal, Nitin M Gadgil, Chetan Chaudhari, Aishwarya Yedke — Thu, 11 Jul 2024 01:18:11 +0530

Background: Lhermitte-Duclos Disease (LDD), also known as dysplastic gangliocytoma of the cerebellum, is a very rare tumor of the cerebellum, with only about 300 cases reported worldwide. It is a slow-growing benign tumor causing diffuse enlargement of the cerebellum due to granular layer hypertrophy.

Case Report: We present a case of a 30-year-old female with symptoms of giddiness, focal convulsions, and loss of consciousness, along with positive cerebellar signs. On MRI, an ill-defined intra-axial lesion showed classical alternating light and dark “tiger stripe” patterns with no contrast enhancement. Frozen and histopathological evaluations confirmed the diagnosis, as there was the presence of atypical ganglion cells replacing the internal molecular layer. The patient underwent total tumor resection.

Conclusion: Lhermitte-Duclos disease is a rare lesion that unilaterally enlarges the cerebellum but maintains the foliar architecture. It is identified as a component of Cowden syndrome, an autosomal dominant cancer predisposition disorder. Recognition of the histological characteristics of this uncommon condition and maintaining a heightened suspicion are imperative for an accurate diagnosis. This should prompt comprehensive examinations to rule out manifestations of associated Cowden syndrome. Lhermitte-Duclos Disease is an infrequent occurrence, and understanding its histological attributes and aligning them with radiological findings is crucial, particularly in small biopsy samples, to ensure a precise diagnosis.

Extraskeletal Myxoid Chondrosarcoma of Thigh: A Case of Uncertain Origin

Kavita Tiwari, Kekhrieneniu Mere — Thu, 11 Jul 2024 01:36:08 +0530

Background: Extraskeletal myxoid chondrosarcoma (EMC) is a rare soft-tissue malignancy that accounts for less than 3% of all soft-tissue sarcomas. It arises in patients older than 35 years, with peak incidence during the 5th and 6th decades. It is distinguished from other sarcomas by its unique histology and a characteristic chromosomal translocation, typically t(9;22)(q22;q12.2), fusing EWSR1 to NR4A3.

Case details: A 60-year-old male presented with a slow-growing mass over the right side of his thigh for approximately one year. The patient complained of pain associated with the mass. FNAC showed a moderately cellular smear displaying chondromyxoid stroma. Suspicion of extraskeletal myxoid chondrosarcoma was made, and the mass was excised and sent to our department for histopathological examination. Grossly, the tumor was 16x14x10 cm, soft to firm, gray-tan colored, lobulated, and nodular. On the cut section, it had a gelatinous surface with cystic and solid areas. Microscopically, the tumor showed a multinodular pattern, with cells arranged in short cords and strands separated by myxoid material. Individual cells had round to oval nuclei with deeply eosinophilic cytoplasm. Few cells showed cytoplasmic vacuolization. Immunohistochemistry was done for further analysis using S100, Vimentin, and Synaptophysin.

Conclusion: Extraskeletal myxoid chondrosarcoma is a tumor of uncertain differentiation. It has intermediate-grade malignant potential and can show metastasis or recurrence. Surgical excision is the treatment modality of choice.

Ancient Schwannoma of Radial Nerve: A Rare Case Report

Thu, 11 Jul 2024 01:44:00 +0530

Introduction

Schwannoma is a benign tumor of nerve sheath origin. Ancient schwannomas were first described by Ackerman and Taylor in 1951. In the upper limb, the ulnar and median nerves are the primary nerves of flexor surfaces where schwannomas typically arise. The radial nerve is involved in just 7% of peripheral schwannomas.

Case Report

A 25-year-old male presented to the surgery OPD with a history of forearm swelling for 5 years. On ultrasonography (USG), there was a hypoechoic lesion in the anterior aspect of the forearm. Based on the long duration, clinical examination, and imaging, a diagnosis of benign nerve sheath tumor was made. Excision biopsy was performed, and a globular grey-white tissue piece measuring 2.5x1.5 cm was received in the Department of Pathology. Sections from the globular mass revealed a well-circumscribed tumor with oval to spindle cells randomly arranged within myxoid stroma. There were areas of marked degenerative changes with occasional interspersed hypocellular areas. Immunohistochemistry (IHC) was applied to further confirm the origin of these cells. These cells were positive for vimentin and S-100. The final diagnosis, based on histomorphological features and IHC, was given as ancient schwannoma.

Conclusion

Ancient schwannomas involving the radial nerve are very rare. They can be confused with malignant peripheral nerve sheath tumors on imaging due to degenerative features and nuclear pleomorphism. Histopathological examination along with IHC is crucial in the diagnosis of these rare tumors. We report the fourth case of an ancient schwannoma in the upper extremity involving the radial nerve.

Giant Lactating Adenoma of Breast: A Diagnostic Dilemma

R. K. Singh, Rajshree Bhati, Deepti Sukheeja, Aanchal Bishnoi, Ridam Jain — Thu, 11 Jul 2024 02:22:02 +0530

Lactating adenoma is a benign breast tumour associated with pregnancy. These can be described as tubular adenomas with secretory changes that usually occur during the third trimester and lactation. Lactating adenomas are typically slow-growing, but sometimes the growth can be rapid. We present one such case of a 28-year-old female with a rapidly progressive right breast lump, which she noticed 1.5 years ago.