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) Mon, 24 Jun 2019 18:51:37 +0000 OJS 60 Use of Patient Samples for Quality Control in Hemogram <p><strong>Background:</strong> Quality control (QC) is an integral part of hematology practice. Various commercial controls are available and routinely used. A complementary method is to use patient sample in various ways especially in a resource limited setup.</p> <p><strong>Methods: </strong>This study was performed in a tertiary care hospital in southern India with 12 laboratories, four using hematology cell counters and eight other smaller side-labs performing Hemoglobin (Hb) estimation by Sahli's or Drabkin's method.</p> <p>The QC tests performed using patient samples were: a. Daily - Average of numbers (AON) of RBC indices of 250-270 samples. These were compared with Levey-Jennings (LJ) charts of commercial controls b. Weekly - Replicate Test (RT) using a single sample for various levels of Hb, WBC and platelet counts; Duplicate Test (DT) using 10 samples; Correlation Check (CC) of 10 samples and Weekly AON c. Monthly - Deviation Index (DI) using one sample for inter-method/ instrument comparability among participating labs.&nbsp;</p> <p><strong>Result: </strong>In daily AON, the graphs of RBC indices did not show significant difference with LJ charts of commercial controls. The co-efficient of variation in RT for various levels of Hb, WBC and platelet counts were in the acceptable range. The precision was higher for Hb and least for low platelet counts. In DT, an occasional random error was detected. In CC, monocytosis flag did not correlate with peripheral smear findings 66.6% times. The DI using z-score showed satisfactory performance among various labs.</p> <p><strong>Conclusion: </strong>Use of patients' blood sample was helpful for internal QC and inter-method/ instrument comparability.</p> Jhansi Priya Harikrishna Gaddam, Rakhee Kar ##submission.copyrightStatement## Mon, 24 Jun 2019 19:00:03 +0000 A Significant Study on EGFR Mutations in Lung Carcinomas <p><u>BACKGROUND</u></p> <p>Lung cancer is one of the leading causes of cancer related deaths among both men and women. Non-small cell lung carcinomas comprises the majority (about 75%) of lung cancers, has proven difficult to treat due to poorly understood pathological mechanism. Recent advances in cell signalling pathways that control cell survival have identified genetic and regulatory aberrations that suppress cell death, promote cell division and induce tumorogenesis. One such discovery is that of epidermal growth factor receptor. Overexpression of EGFR has been reported and implicated in pathogenesis of many human malignancies including Non- small cell carcinoma of lung.</p> <p><u>AIMS AND OBJECTIVES</u></p> <p>To study EGFR expression by immunohistochemistry in diagnosed cases of Non- small cell carcinomas of lung at our institute.</p> <p>To determine the value of EGFR test by IHC in predicting response to targeted therapy and clinical outcome.</p> <p><u>MATERIALS AND METHODS</u></p> <p>A retrospective and prospective study of bronchial biopsies diagnosed as Non-small cell carcinoma for a duration of &nbsp;&nbsp;two years&nbsp; with their expression to EGFR&nbsp; immunohistochemistry marker at our institute and these patients response to the targeted therapy.</p> <p><u>RESULTS</u></p> <p>Out of twenty nine (29) cases of lung malignancies majority were Non -small cell carcinomas- &nbsp;twenty seven cases (27), of which adenocarcinomas were seventeen (17) cases&nbsp; topped the list, followed by squamous cell carcinomas (5) cases, malignant epithelial lesions (3) cases and poorly differentiated carcinomas(2) cases. Small cell carcinomas were two (2) cases. Fifteen cases of non- small cell carcinomas cases showed EGFR mutations and twelve patients were started on the targeted therapy of Gefitinib and Erlonitib. All twelve of them showed good response to chemotherapy.</p> <p><u>CONCLUSIONS</u></p> <p>Most of the Non-small cell carcinomas of lung have EGFR mutations especially all adenocarcinomas in non-smokers. The clinical outcome of patients could be predicted. There is significant response to targeted chemotherapy.</p> Yugandhar Pothina, Gudeli Vahini, M Lalitha Sree, Thota Asha ##submission.copyrightStatement## Mon, 24 Jun 2019 19:08:05 +0000 Utility of Cytological Grading in Proliferative Epithelial Lesions of Breast <p><strong>Background: </strong>Breast carcinoma is the second most common malignancy in women. Fine needle aspiration cytology of breast is rapid, reliable and safe diagnostic tool to distinguish between neoplastic and non neoplastic lesions. Cytological grading of the smears can provide valuable prognostic information.</p> <p>AIMS AND OBJECTIVES: To study the utility of Masood cytological grading system and to compare it against a new proposed cytological grading system in proliferative epithelial lesions of breast.</p> <p><strong>Methods: </strong>The Papanicolaou (PAP) stained Fine Needle Aspiration Cytology (FNAC) smears of proliferative breast lesions were cytologically graded by the Masood cytological grading system and by the newly proposed grading system by two observers independently. Results were correlated with the histopathological diagnosis.</p> <p><strong>Result: </strong>In the study period of 2 years, 54 proliferative epithelial lesions were studied of which 47 were proliferative breast disease without atypia and seven proliferative breast diseases with atypia. 42/54 cases in newly proposed system showed concordance with existing Masood grading system. p-value is 0.000 (&lt; 0.005) which is significant. Sensitivity, specificity, positive predictive value and negative predictive value for newly proposed grading system were 88.67%, 100%, 100% and 85.71% respectively.</p> <p><strong>Conclusion: </strong>A simple slide based scoring system of epithelial lesions of breast is a useful tool in the prognostication and prediction of behavior of proliferative epithelial lesions.</p> Sai Chandana Gali, Udaya Kumar M, Nirmala M J, Prashanth R, Ramaswamy A S ##submission.copyrightStatement## Fri, 28 Jun 2019 06:19:49 +0000 Spectrum of Diseases with Nucleated RBCs <p><strong>Background:</strong></p> <p>Nucleated RBCs (nRBCs) are the precursors of RBCs which are normally found in peripheral smear only in neonatal period. Their presence detected by either peripheral smear examination or automated analyzer beyond neonatal period indicates diverse pathological processes. This study was conducted to evaluate nRBC in the peripheral blood and to determine their significance in spectrum of diseases.</p> <p><strong>Methods:</strong></p> <p>&nbsp;A retrospective study was conducted over a period of 3 months from February 2018 to April 2018 in a tertiary care centre. Data were collected, subsequently tabulated and analyzed.</p> <p><strong>Result:</strong></p> <p>A total of 200 cases having nRBCs were found among which 42 were neonatal (more than expected for age) and 158 were adult cases. Out of 200 cases, 30 cases with increased nRBCs were due to non hematological cause.&nbsp; It was found that nRBCs were detected in 35 critically ill patients (admitted in MICU/PICU) and in 12 patients who succumbed to death. The most common age group excluding neonates in which nRBCs were detected was &gt;50years.</p> <p><strong>Conclusion: </strong></p> <p>Detection of nRBCs in peripheral blood maybe physiological or pathological and there are a wide variety of causes for its release.&nbsp; It’s worthwhile to remember that it’s not only hematological disorders that would result in release of nRBCs into peripheral blood but also other critical conditions can lead to it.</p> Sneha Rao A R, Purnima S Rao, Sandhya I, Shalini P ##submission.copyrightStatement## Fri, 28 Jun 2019 06:29:57 +0000 Clinico-Pathological Study of Tubal Ectopic Gestation and Evaluation of Associated Risk Factors in A Tertiary Care Centre <p><strong>Background</strong>: Ectopic gestation is an obstetric emergency with high morbidity and mortality. Most common site for ectopic pregnancy is fallopian tube. Predisposing risk factors include pelvic inflammatory disease (PID) that is acute and chronic salpingitis, previous abortion, Salphingitis Isthmica Nodosa (SIN); and treatment for infertility. This study was done to identify the common risk factors.</p> <p><strong>Method</strong>: This was a retrospective study carried out for the period of 6 years (January 2013 - December 2018) in M.G.M. Medical college, Aurangabad. 110 cases of tubal ectopic gestations were studied.</p> <p><strong>Results: </strong>Out of 110 ectopic gestations, commonest age of presentation was 25-35years (90.9%), and were multiparous (85.3%). Right sided tube was mostly affected (70.2%), with the risk factors of PID (32%) and previous abortion (30%). Most of the patients presented with pain in abdomen (40.90%) and amenorrhea (31.81%). Predominant histopathological findings were chronic salphingitis with follicular salphingitis (40.90%), acute salphingitis (27.27%) and SIN (22.7%).</p> <p><strong>Conclusion: </strong>Pelvic inflammatory disease, Salphingitis Isthmica Nodosa, acute and chronic salphingitis are predisposing factors for tubal ectopic gestation. Early diagnosis, identification of risk factors and timely intervention will reduce the incidence of ectopic pregnancy and also will help in reducing morbidity and mortality associated with it.</p> Archana S Bembde, Suparna M Bindu, Chandrashekar P Bhale ##submission.copyrightStatement## Fri, 28 Jun 2019 06:45:51 +0000 Diagnostic Significance of Ganglion Cells and Eosinophils in Appendicitis <p><strong>Background:</strong> Appendicectomy is most commonly performed intra-abdominal surgery. The exact etiopathogenesis of appendicitis is not exactly understood. Though eosinophils and ganglion cells are been observed routinely in appendix by many pathologists, little is being highlighted in literature in this regard. Present study was done to access the significance of mean cell count and topography of ganglion cells and eosinophils in association with histological type of appendicitis.</p> <p><strong>Methods:</strong> It’s a retrospective study which included 93 appendicectomy specimens, out of which 65 were included. Remaining 28 cases with gangrenous change, perforation and neoplastic lesions were excluded. Mean cell count of eosinophils and ganglion cells was calculated. Topographical distribution and mean cell count of eosinophils and ganglion cells were correlated with histopathological type of appendicitis. The significance of association was calculated by chi-square test.</p> <p><strong>Result:</strong> The mean eosinophil count was significantly higher in acute appendicitis compared to recurrent appendicitis with a p-value of &lt;0.001. The ganglion cells were found to be more in acute appendicitis than recurrent appendicitis and was statistically significant (p=0.007). Topographic distribution of ganglion cells was predominantly noted within the circular layer only and between longitudinal and circular muscle layer along with circular layer of the muscularis propria in both acute and recurrent appendicitis.</p> <p><strong>Conclusion: </strong>Mean count of eosinophils and ganglion cells were significantly increased in acute appendicitis. Hence, it may be considered as additional diagnostic criteria for acute appendicitis. Atypical localization of ganglion cells in circular layer was noted in both acute and recurrent appendicitis.</p> S Susmitha, Basavaraj P Bommanahalli ##submission.copyrightStatement## Fri, 28 Jun 2019 06:50:47 +0000 Metastatic Melanoma of Unknown Primary Presenting with Multiple Cutaneous Nodules <p>Melanoma usually present as well-known primary lesions. Rarely, they present with the lymph node, subcutaneous or visceral involvement without evidence of any primary lesion. In such cases they are called Melanoma of unknown primary site (MUP). Melanoma are fast growing cancers. Many environmental and genetics factors predispose to their development.</p> <p>We report a case of multiple subcutaneous swellings all over the body in a 42 year male, without any primary skin lesions. Histopathology and immunohistochemistry of these lesions confirmed them to be melanoma. Even after extensive search no primary tumour could be found in the patient.</p> Nivedita Samanta, Swati Sharma, Prahlad H Yathiraj, Ranjini Kudva, Manna Valiathan ##submission.copyrightStatement## Mon, 24 Jun 2019 19:19:12 +0000 T-Cell/ Histiocyte-Rich Large B-Cell Lymphoma of Posterior Mediastinum <p>T-cell/histiocyte-rich large B-cell lymphoma (THRLBCL) is a rare aggressive type of diffuse large B-cell lymphoma (DLBCL) characterized by presence of less than 10% of large atypical B lymphocytes i.e. malignant lymphocytes in the background of T lymphocytes. Pathophysiology is thought to involve cytotokine mediated evasion of T cell immune response by malignant B cells. Mostly, affects lymph node, but can occur in extra nodal sites like bone marrow, liver and spleen. THRLBCL arising in mediastinum is extremely rare. Till date, there are only two case reports ascribing the occurrence of THRLBCL in mediastinum. Herein, we report another case of 49 years old female causing diagnostic dilemma initially but later on could be diagnosed accurately as THRLBCL of posterior mediastinum based on radiological and histopathological examination findings, immunhistochemistry (IHC) result and treated successfully.</p> Manisha Mohapatra, Yerraguntala Subramanya Sarma ##submission.copyrightStatement## Mon, 24 Jun 2019 19:24:26 +0000 Acquired Coagulopathies Secondary to Plasma Cell Dyscrasias <p>We report hemostatic dysfunction in two postmenopausal women presenting with mucosal bleeds secondary to plasma cell dyscrasias. &nbsp;The two postmenopausal women presented with complaints of mucosal bleeds like gum bleed and epistaxis. Peripheral smear examination showed rouleaux formation. After detailed haematological and coagulation work up, one patient was diagnosed as Waldenstro¨m macroglobulinemia (WM) with acquired vWD and impaired platelet function. The second patient was diagnosed as Multiple myeloma (MM) with acquired coagulopathy. Evaluation of elderly patients with bleeding manifestations should also include work up ruling out an acquired coagulation abnormality secondary to plasma cell dyscracia.</p> Hitha Diljith, Ambika Lokababu Pagadalu, Sreerekha Jinkala, Rakhee Kar, Sajini Elizabeth Jacob, Debdatta Basu ##submission.copyrightStatement## Mon, 24 Jun 2019 19:31:45 +0000 Colorectal Carcinoma in A 12 Year Old Child <p><strong>Colorectal carcinoma is a rarely seen&nbsp;&nbsp; malignancy among children. The prognosis of colorectal carcinoma is poorer among children as compared to adults due t o lack of awareness among treating pediatricians and surgeons regarding this entity. A 12 year old female child presented with complaints of recurrent abdominal pain, fullness of abdomen, poor appetite since last 2 years. Abdominal ultrasound was suggestive of a mass arising from the right hypochondrium. Colonoscopy and biopsy confirmed the diagnosis of adenocarcinoma. The possibility of colorectal carcinoma&nbsp; as a differential diagnosis should always be considered in a child who presents with signs and symptoms of intestinal obstruction, intractable abdominal pain, altered bowel habits,&nbsp; long standing abdominal distension and gastrointestinal bleeding. Colorectal carcinoma should not be excluded as a possibility only based on patient’s age.</strong></p> Gunjan Bhatia, Namita Goyal, Sunita Bhargava ##submission.copyrightStatement## Mon, 24 Jun 2019 19:36:40 +0000