Annals of Pathology and Laboratory Medicine <p><strong>Annals of Pathology and Laboratory Medicine (APALM)</strong> is an international, Double-blind peer-reviewed, indexed, open access, online and print journal&nbsp;for pathologists, microbiologist, biochemist and clinical laboratory scientists, and is published by <strong><a href="" target="_blank" rel="noopener"><strong>Pacific group of e-Journals</strong>' (<strong>PaGe</strong>)</a>, </strong>an&nbsp;<em>ISO 9001:2008</em> Certified&nbsp;academic publishing house.</p> <p>Set up in 2014, APALM is a specialized journal, which publishes original, peer-reviewed articles&nbsp;in the field of Pathology and Laboratory Medicine which, <em>inter alia</em>, includes Histopathology, Cytopathology, Hematology, Clinical Pathology, Forensic Pathology, Blood Banking, Clinical Bio-Chemistry, Medical Microbiology (Bacteriology, Virology, Mycology, Parasitology), etc.</p> <p><strong>DOI: 10.21276/APALM (<a title="Verify APALM DOI " href="" target="_blank" rel="noopener"></a>)<br></strong></p> <p>Index Copernicus (IC) Value (ICV 2016): 74.20</p> en-US <p>Authors who publish with this journal agree to the following terms:</p> <ol> <li class="show">Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a&nbsp;<a href="">Creative Commons Attribution License</a>&nbsp;that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.</li> <li class="show">Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.</li> <li class="show">Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See&nbsp;The Effect of Open Access at</li> </ol> <p>&nbsp;</p> (Dr. Prashant Goyal) (Amit Saggar) Thu, 02 Apr 2020 12:37:42 +0000 OJS 60 Extensive Myelonecrosis: A Clinicopathological Study from A Tertiary Care Center <p><strong>Background: </strong>The pathophysiology of bone marrow necrosis (BMN) remains unclear; however, the occlusion of microcirculation, accompanied by hypoxemia, causes damage to the cells and plays an important role in development of BMN.</p> <p><strong>Methods: </strong>This is a descriptive study; a retrospective review of all trephine biopsies done over period of 22 months January 2017 to October 2018 in Department of pathology showing BMN were included. Only cases identified which showed extensive myelonecrosis &gt; 20% of the diameter of trephine biopsy specimen was included in the study and BMN had to be diagnosed during life were included. Thirty cases met these criteria over this period.</p> <p><strong>Result:</strong> In the study period, BMN was diagnosed in 30 samples among 3000 trephine biopsies showed extensive necrosis accounting for 1.0%. Almost all patients on peripheral blood examination shows anemia (100%), around 50% patients present with pancytopenia, followed by anemia with thrombocytopenia. From bone marrow aspiration and trephine biopsy examination shows 30 cases MN,among them 16 patients were acute leukemia either newly diagnosed or post chemotherapy follow-up cases, 10 out of 12 patients had severe bone pain before intuition of chemotherapy, acute leukemia followed by necrotizing granulomatous inflammation metastatic carcinoma were other causes for MN and one case was sickle cell hemolytic anemia.</p> <p><strong>Conclusion: </strong>BMN is associated with many diseases, and yet presents with no clear patho physiology. In addition, clinical and laboratory characteristics are non-specific and, in many cases, symptoms are related to the causal condition that is most commonly a hematological disease.</p> Neela Nirmala Jyothi, Pramod Kumar Pamu, T Roshini Paul, Shantveer G Uppin, Megha S Uppin, Sadashivudu Gundeti, K Radhika ##submission.copyrightStatement## Thu, 02 Apr 2020 12:45:13 +0000 Relationship of Mean Platelet Volume and HbA1c in Predicting the Level of Diabetes Control in Type 2 Diabetes Mellitus <p><strong>Background: </strong>MPV is an indicator of platelet size and MPV is increased in DM as compared to non-diabetics, more so in presence of complications. There are few studies evaluating the association between MPV and HbA1c and its role in predicting glycaemic control with conflicting results. The present study was planned to determine the relationship between MPV and HbA1c in predicting the level of diabetes control in type 2 DM.</p> <p><strong>Methodology: </strong>Cross sectional observational study including 100 consecutive cases of type 2 DM aged between 30 to 60 years. Mean platelet volume (MPV), platelet distribution width (PDW) and platelet count were obtained from fully automated haematology analyser Sysmex KX-21.&nbsp; Glycosylated haemoglobin (HbA1c) was analysed by automated haemoglobin analyser.</p> <p><strong>Results: </strong>The mean age among 100 type 2 DM cases was 49.58 ± 14.49 years. The mean value of MPV and HbA1c was 10.25±0.90fl and 5.66± 1.17% respectively. There was no significant correlation found between MPV and HbA1c (r=0.110, p=0.275). Similarly, there were no significant association between MPV and three levels of glycaemic control.</p> <p><strong>Conclusion:</strong> MPV is not a reliable marker for determining glycaemic control in type 2 DM.</p> Amrutha Varshini, Amita K ##submission.copyrightStatement## Thu, 02 Apr 2020 12:50:51 +0000 Relationship Between ABO blood Group and Carcinoma of Cervix in South Gujarat Women <p><strong>Introduction: </strong>Cervical cancer is one of the leading causes of death from cancer and second most common cancer, next only to breast cancer among women worldwide and is the most common female cancer in developing countries as well. In India, cervical cancer is the most common women related cancer, followed by breast cancer. &nbsp;Several studies have suggested an association between blood type A and cervical dysplasia/cancer. The aim of this study was to document the relationship between cervical cancer and ABO blood group in South Gujarat population.</p> <p><strong>Materials and Method:</strong> The present study was an observational descriptive study and was conducted retrospectively among 147 cases of cervical cancer patient admitted in tertiary care hospital, Surat and diagnosed by histopathologically over period of two and half years. Patients personal details were retrieved from Department of pathology and ABO blood group were retrieved from Department of Immunohaematology and blood transfusion. All details were entered in Microsoft excel and analyzed by descriptive statistics.</p> <p><strong>Results:</strong> Among 147 cases, maximum cases were found in age group f 30-44 years and showed preponderance of blood group A(31.97%) followed by group B (29.93%), O (27.21%), AB (10.88%).</p> <p><strong>Conclusion: </strong>The frequency of types A, B, AB and O in cervical cancer was different to the general healthy population in South Gujarat region.</p> Hemali J Tailor, Anisha Dipakbhai Rajani, Rasik N Hathila, Prashant R Patel ##submission.copyrightStatement## Thu, 02 Apr 2020 12:57:09 +0000 Predictive Value Of Platelet Indices For Differentiating Hyper Destructive Thrombocytopenia From Hypo Productive Thrombocytopenia In Patients Attending Teritiary Care Hospital <p><strong>BACKGROUND</strong>: Thrombocytopenia is one of the most critical and complicated clinical conditions to manage. Hence the need for a platelet count has increased over the years in the form of manual smear count and bone marrow examination for discriminating hyper destructive and hypo productive thrombocytopenia. The introduction of platelet indices like mean platelet volume (MPV), platelet distribution width (PDW), Platelet large cell ratio (PLCR) in automated haematology analyzers has provided a window into the cause of thrombocytopenia in the recent years. Hence this study was undertaken to analyze the utility of these platelet indices in hypo productive and hyper destructive thrombocytopenia.</p> <p><strong>&nbsp;</strong></p> <p><strong>METHODS:</strong> A prospective cross-sectional study was conducted on 84 thrombocytopenic patients out of which 49 were hyper destructive and 35 were hypo productive group. The blood samples were analyzed for CBC diff using SYSMEX XN 1000.</p> <p>Statistical analysis was performed to assess the mean SD, Receiver Operating Curve (ROC) to determine the specificity, sensitivity, positive predictive value (PPV) and negative predictive values (NPV) for platelet parameters. Correlation test to determine association between the continuous variables was done.</p> <p><strong>&nbsp;</strong></p> <p><strong>RESULT: </strong>All platelet indices were significantly higher in hyper destructive than in hypo productive group. The MPV and PLCR showed better sensitivity and specificity, positive and negative predictive values when compared to PDW in both the groups. There was statistically significant correlation and difference of platelet parameters like MPV, PDW and PLCR between the hyper destructive and hypo productive thrombocytopenia.</p> <p><strong>CONCLUSION: </strong>The platelet indices MPV and PLCR have better ability to discriminate hyper destructive from hypo productive thrombocytopenia. Evaluating these parameters offers an earlier diagnosis in hyper destructive thrombocytopenia patients avoiding, bone marrow aspiration and even prevent undesirable platelet transfusion.</p> Deepthi Chandrika Chintalapudi, Balasaheb R Yelikar, Mallanna S Mulimani, Anil Reddy Konduru, Savitri M Nerune ##submission.copyrightStatement## Thu, 02 Apr 2020 13:06:08 +0000 Comparison Of Amount Of Elastin Fibres With Histopathological Parameters And Elastography In Breast Carcinoma <p><strong>Background:</strong> Breast carcinoma is the most fre­quently diagnosed cancer and the chief cause of cancer deaths among women worldwide. Cancer registry data shows that incidence of carcinoma breast ranges from 19.3 to 89.7 per 100,000 population (India) and a total of 27.5% cases of cancers in Karnataka. The normal breast tissue is comprised of two major compartments, the epithelium and the stroma. Normally elastic tissue can be seen in periductal and perivascular region of breast. Elastosis, characterized by deposition of elastic fibers in the stroma of infiltrating ductal carcinoma was first described by Cheatle and Cutler, but extensively studied by Shivas &amp; Douglas and others. Several methods for visual grading of elastosis have been proposed but all are semi quantitative and subjective and are dependent on the experience of the observed.</p> <p><strong>Methods:</strong> Blocks of all 87 cases were retrieved from the histopathological section, department of Pathology of our institute. Data regarding the demographic details, clinical presentation of the cases are obtained from the medical record section of our medical record section of our college. The slides were stained with Verhoeff’s van Gieson stain and were screened by two pathologists.</p> <p><strong>Result:</strong> Out of 87 cases studied only 1 case showed elastin fibers score 0, 18 cases showed score 1, 46 cases showed score 2 and 22 cases showed score 3. There was statistical significant correlation between Tumor stage and amount of paratumoral elastin fibers. There was no statistical correlation between Tumor grade, Tumor size, Nodes, Nottingham prognostic index and Modified tsukba scoring and paratumoral elastosis. Out of 87 cases the ER IHC was done in only 23 cases out of which 10 cases showed positivity on Allred scoring and 13 cases were negative. For Progesterone receptors out of 23 cases 9 cases were positive on Allred scoring and 14 were negative and hence the correlation could not be done. The HER2neu was done in 23 cases out of 87 cases where the positivity was seen in 07 cases and it was equivocal in 03 cases and negative in 13 cases.</p> <p><strong>Conclusion: </strong>Our results strongly indicate the presence of Peritumoral elastosis and the lower tumor grade. The paratumoral elastosis and lower tumor stage. Whether and how elastosis is mechanically involved in tumor development and progress requires further study<strong>. </strong></p> Preeti Ashok Utnal, Hemalatha A, Anil Kumar Sakalecha, Parameshwar Keerthi BH ##submission.copyrightStatement## Fri, 03 Apr 2020 15:45:06 +0000 An Evaluation of Donor Deferrals in A Blood Bank of a Tertiary Care Hospital <p><strong>Background:</strong></p> <p>Blood transfusion is a crucial life-saving procedure that has become an integral component of modern medicine. It is therefore, imperative that the supply chain of blood to blood banks be optimized so as to meet the minimum demand of patients. This goal can be readily achieved by forming a safe reduction policy in the deferral rate of potential donors. The aim of this study was to explore the various causes for donor deferrals and to assess their frequency over the past 3½ years in a blood bank of a tertiary care hospital in Bangalore city.</p> <p><strong>Methods:</strong></p> <p>The data for the current retrospective study was collected over a period of 3 years 6 months from October 2015 to March 2019. Donors were asked to fill in a questionnaire followed by physical examination and blood screening tests.</p> <p><strong>Results:</strong></p> <p>Out of 2942 potential blood donors, only 2781 were accepted while the remaining 161 were deferred, the deferral rate being 5.5%. The age group of the deferred donors ranged from 18 to 49 years old, the highest being between 21-30 years old. There was a total of 119 temporary deferrals and 42 permanent deferrals. The most common cause for temporary and permanent deferral was found to be hypertension and sero-positivity for HBV antigen, respectively.</p> <p>&nbsp;</p> <p><strong>Conclusion:</strong></p> <p><strong>&nbsp;</strong></p> <p>In descending order of frequency, the most common causes for permanent deferrals were transfusion transmitted infection, hepatitis-B, Hepatitis-C and HIV and that for temporary deferrals were hypertension, alcohol consumption and anaemia.&nbsp; By identification of the causes for temporary deferrals, appropriate measures can be put in place to motivate these potential donors to return for blood donation at a later date after the underlying cause has been rectified.</p> Shweta Pai, Shiv Kumar Chabba ##submission.copyrightStatement## Fri, 03 Apr 2020 15:51:35 +0000 HER2/neu Expression in Gastrointestinal Carcinoma Among South Indians <p><strong>Background:</strong></p> <p>&nbsp;HER2/neu oncogene overexpression and amplification in breast cancer is well known. Studies have proved its role in gastric cancer and its correlation with the prognosis. Very few studies are there in literature regarding HER2/neu expression in entire gastrointestinal carcinoma. Our study was aimed at HER2/neu expression in gastrointestinal tumors in South Indian Population.</p> <p><strong>M ethods: </strong></p> <p>We included all patients with gastrointestinal carcinoma who either underwent biopsy or surgical excision over the past five years. Slides were reviewed for confirmation of the diagnosis and immunohistochemistry was done using SP3 monoclonal anti-HER2 antibodies. Three independent observers did the scoring for HER2 positivity.</p> <p><strong>Results:</strong></p> <p>Among 35 cases of gastric cancer, only 2 (5.7%) females showed positivity for HER2 scoring and one (2.9%) female showed an equivocal result. All positive and equivocal cases in gastric cancer were intestinal type. Both the cases with HER2 positivity were poorly differentiated tumors. The one with equivocal was a moderately differentiated carcinoma. In colorectal cancer out of 19 cases, only one (5.3%) showed positivity for HER2 whereas in one there was an equivocal response. All the seven cases of small intestinal carcinoma showed negative results for HER2 expression.</p> <p><strong>Conclusion:</strong></p> <p>Overall, HER2/neu expression in gastrointestinal cancer was 4.9%. Female gender, intestinal- type and poorly differentiated cancer showed positivity in gastric cancer. Female gender, left side and low-grade tumor showed positivity in colorectal cancer. Further studies are required with a large sample size to correlate HER2 expression with clinicopathological parameters and its role in prognosis in gastrointestinal carcinomas in the Indian population.</p> Gayathri Priyadharshini, Kiran Chokka Mahesh, Anita Ramdas, Renu G’Boy Varghese ##submission.copyrightStatement## Fri, 03 Apr 2020 16:01:43 +0000 Analysis of Tumor Buds & Worst Pattern of Invasion as Emerging Factor in Determining Lymph Node Metastasis in Oral Squamous Cell Carcinoma <p><strong>Introduction </strong></p> <p>Lymph node metastasis is associated with poor prognosis in oral squamous cell carcinoma. So, it’s important to identify most influencing histological parameter in association with lymph node metastasis.</p> <p><strong>Aim Of Study: </strong>The aim of this study is to analyze various histological parameter including tumor buds and worst pattern of invasion to check its association with lymph node metastasis positive cases.</p> <p><strong>Materials &amp; Methods</strong></p> <p>The study done on 100 oral squamous cell carcinoma patients. The various histopathological parameters like Nuclear Pleomorphism, Number of mitosis, Lymphoplasmacytic inflammation along with tumor buds and WPOI analyzed to check association with node metastasis. The data was tabulated and Fischer’s exact &amp; chi square test applied to calculate p value.</p> <p><strong>Result</strong></p> <p>Invasive tumor buds more than 5 and worst pattern of invasion (WPOI) were strongly associated with positive lymph node metastasis cases. The p value for both has been lowest among all other parameter.</p> <p><strong>Conclusion</strong></p> <p>The tumor buds and Pattern of invasion are most important emerging influencing factor having strong association with nodal metastasis and thus high risk patient can be identified in biopsy specimen.</p> Parth Rajendragiri Goswami, Alpeshpuri P Goswami ##submission.copyrightStatement## Fri, 03 Apr 2020 16:06:58 +0000 Removal of Air-Drying Artifact of Papanicolaou Stained Smears with Normal Saline and Fresh Frozen Plasma <p><strong>Background </strong></p> <p>Papanicolaou stained (Pap) smears in fine needle aspiration cytology play an important role for studying chromatin details of the cells and also ensures its optimal resemblance with the cell nuclei on histological sections. The conventional Pap Stained smears are ethanol fixed before drying. But delay in fixation due to any reason results in drying artifacts in the stained smears making it an inept smear for further examination.</p> <p><strong>Aims &amp; objectives:</strong> To study the role of rehydration fluid for removal of air drying artifact.</p> <p><strong>Material and methods:</strong> Fifty fine needle aspiration smears from different organs with drying artifact in Pap Stained smears were included in the study. The smears were destained, rehydrated with rehydrating fluid for two hours and were restained with Pap stain after fixation with 95 % alcohol.</p> <p><strong>Results :</strong> Smears treated with this solution showed reversal of the air drying artifact with better nuclear details and background material staining.</p> <p><strong>Conclusion:</strong> Rehydration of destained Pap smears with rehydrating fluid followed by restaining results in optimal staining of the nuclear and background details preventing the material loss and making the smears appropriate for staining.</p> Lata ., Manju Kumari, Sachin Kolte, Rashmi Arora ##submission.copyrightStatement## Fri, 03 Apr 2020 16:14:25 +0000 Correlation Between Endometrial Thickness By Ultrasonography and Histopathology in Abnormal Uterine Bleeding <p><strong>Background :</strong></p> <p>Abnormal uterine bleeding (AUB) is the most common presenting complaint of patients in Gynaecology Outpatient department. Early diagnosis of endometrial hyperplasia through ultrasongraphic measurement of endometrial thickness and definite diagnosis by histopathologic examination will help the clinicians to give appropriate treatment to the patients. The objective of this study was to correlate the histopathology findings in abnormal uterine bleeding with endometrial thickness by ultrasonography.</p> <p><strong>Methods :</strong></p> <p>&nbsp;This was a prospective study done from Nov 2016 to June 2018.A total of 382 cases of AUB presenting above 40 years of age were included. Endometrial thickness was measured by ultrasonography. Histopathological findings were studied and compared with the endometrial thickness. Statistical analysis were done using chi square test.</p> <p><strong>Results :</strong></p> <p>&nbsp;A total of 382 cases were analysed. Maximum number of cases were from peri menopausal age group (68.32%). Majority of the cases were due to non organic causes(85.34%). 46.86% of patients had endometrial thickness of 5-10mm followed by</p> <p>endometrial thickness of 11-15mm in 39.01%. Disordered proliferative endometrium was the most common pattern (38.34%) in our study followed by secretory endometrium (35.58%) and menstrual endometrium (18.71%). These findings were found to be statistically significant.</p> <p><strong>Conclusion : </strong></p> <p>A thorough histopathological work up and clinical correlation is mandatory in cases of abnormal uterine bleeding above 40 years to find out organic lesions. Careful screening can detect precursor lesions like endometrial hyperplasia and early cases of endometrial carcinoma which has excellent prognosis and it will help in further management.</p> Sujana G, Vivek Gerorge, Aswathy Chandramohan, Sheela Vasudevan, Divya Anthony ##submission.copyrightStatement## Fri, 03 Apr 2020 16:57:04 +0000 Aneurysmal Fibrous Histiocytoma: <p>Aneurysmal fibrous histiocytoma (AFH) is a rare variant of benign fibrous histiocytoma. This tumor accounts for less than 2% of all fibrous histiocytomas, 1.7% of all cutaneous fibrous histiocytoma and it is typically known to occur in the extremities of middle-aged patients.</p> <p>A 23 year old male presented with slow growing, pigmented, nodular lesion on the left leg for the past 2 years. The swelling was initially non-tender, but there was a sudden increase in size associated with pain for the past 2 months. With a clinical suspicion of malignant melanoma an excision biopsy was performed and further evaluated by histopathology. The skin covered pigment lesion measuring 1.5x0.8x0.5cm showed fibrohistiocytic cellular proliferations containing blood filled spaces lacking endothelium on microscopy. Ancillary testing with bleaching, perls prussion blue reaction demonstrated the pigment as hemosiderin. Subsequently the lesion was negative for CD34 and positive for Factor XIIIA. Based on the histomorphology, ancillary testing and IHC, the diagnosis of Aneurysmal fibrous histiocytoma was made.</p> <p>Aneurysmal fibrous histiocytoma can be a challenging diagnostic entity due to its close clinical resemblance to melanoma and hemngioma. Although the pathogenesis is unclear, it is believed to be caused by extravasation of erythrocytes from capillaries leading to formation of the cystic blood spaces.&nbsp; </p> Sheethal Shanibi T M, Vineetha K V, A M Sahabudheen, Vidyadhar Rao ##submission.copyrightStatement## Fri, 03 Apr 2020 17:04:50 +0000 Adenoid Cystic Carcinoma of Nasal Cavity <p>Adenoid cystic carcinoma (ACC) was first described by billroth in 1856. It is common in minor salivary glands around the mouth, uncommon in parotids and in Nose and paranasal sinuses. Sinonasal ACC accounts for 10-25% of all head and neck ACC.</p> <p>We are reporting a case of nasal cavity adenoid cystic carcinoma in a 70 year old male patient who was presented with bilateral nasal block, nasal bleeding and loss of vision. On examination polypoidal growth was present in bilateral nasal cavity. Biopsy was taken and sent for histopathological examination. Histopathological findings were suggestive of adenoid cystic carcinoma of nasal cavity.</p> <p><strong>ACC</strong> is a slow-growing but highly malignant neoplasm with a remarkable capacity for recurrence. They show no sex predilection and may involve patients of any age, although they usually present in middle-aged or older patients. It has a high risk of recurrence and distant metastasis. Features of diagnostic and therapeutic evaluation are described here with.</p> Arpita J. Nishal, Mubin Patel, Neha S. Shahu ##submission.copyrightStatement## Fri, 03 Apr 2020 17:12:25 +0000