Indian Journal of Pathology: Research and Practice

Introduction: Alkaptonuric ochronosis is a rare autosomal recessive metabolic disorder resulting from deficiency of homogentisic acid oxidase enzyme leading to deposition of homogentisic acid in various tissues of the body (ochronosis). The most common clinical features are arthritic changes in weight-bearing joints, lumbosacral degenerative disc disease, dark brown discoloration of urine on air exposure, ocular and cutaneous pigmentation, coronary and valvular calcification and renal calculi formation. Histopathological examination from cutaneous/bony lesion is confirmatory. Case History: 52 year old female sustained a stress fracture of the right femoral neck, necessitating surgical repair, which showed black pigmentation of the femoral head and glenoid labrum. On examination pigmentation of the sclera and ear lobe was also noted. Further work up and histopathological examination with histochemistry confirmed it as a case of Ochronotic arthritis. Conclusion: The case is being presented for its rarity.

Keywords: Ochronosis; Homogetisic Acid Oxidase

 Background: High level of CA 125 with associated ovarian mass is highly suspicious of ovarian carcinoma but the possibility of other benign conditions with associated pelvic mass and elevated CA 125 also to be considered. Case Report: We present a case of 51 year old female, who presented with menorrhagia and a pelvic mass with a raised CA 125 of 983.1 U/ml. With a clinical diagnosis of ovarian carcinoma, she underwent staging laparotomy and post operative specimen was subjected for histopathological examination. The biopsy showed benign cystic teratoma with endometriosis in the opposite ovary. Conclusion: The present case emphasizes that not all pelvic masses with raised CA 125 should prompt the diagnosis of ovarian carcinoma, there are various other benign conditions which should be included in the differential diagnosis of a perimenopausal woman. Good clinical history and screening for other benign conditions should be given importance in such patients.

Keywords: Elevated CA 125; Benign Cystic Teratoma; Endometriosis

Introduction: Filariasis is a major health problem in tropical countries including India. Fine needle aspiration cytology plays an important role in prompt recognition of disease. Extranodalfilariasis is a rare entity, and the breast is also one of the sites for filariasis. Patients commonly present with an underlying lump that may occasionally mimic malignancy. The disease mainly involves the lymphatic system of the body. The most frequently involved lymphatics are those of the lower limbs, retroperitoneal tissues, glands, spermatic cord, and epididymis. Lymphatic filariasis is mostly caused by Wuchereriabancrofti and Brugiamalayi. However, filarial breast nodule is a very rare finding even in an endemic region. Here, we present 4 cases of filarial breast lump diagnosed by fine needle aspiration cytology. Case Series: The present cases included incidentally detected four cases of microfilaria in breast aspirates along with the associated underlying breast pathology. Conclusion: Filarial breast nodule is rare, and it often mimics a neoplastic breast lesion. FNAC is a very effective diagnostic tool in the diagnosis of filarial breast lesion and it helps avoid unnecessary surgical procedure. It should be considered as a differential diagnosis for short-lasting nodular breast lump, especially in countries like India, where filariasis is an endemic disease.

Keywords: Microfilaria; Cytology; Breast Lump.

Platelet Satellitism (PS) is a unique, uncommon phenomenon seen in peripheral blood smears prepared from Ethylene Diamine Tetra acetic Acid (EDTA) mixed blood. PS may lead to a misdiagnosis of thrombocytopenia unless peripheral smears are examined carefully. Here, we describe two case of PS incidentally detected during routine check-up.

Keywords: Pseudothrombocytopenia; Satelletism; Platelet; EDTA.

Introduction: Transfusion transmitted infections (TTI) are major risk factors for blood transfusion. To increase the blood safety IDNAT has been introduced along with compulsory donor screening tests in all NACO assisted blood banks by Government of Karnataka and KSAPS from Dec. 2011. To evaluate the safety benefits of introducing IDNAT and to estimate the seroprevalence of infectious markers TTI and their yearly trends among blood donors, a retrospective studywas conducted at Blood bank of Hassan Institute of Medical sciences, Hassan, Karnataka. Materials and Methods: Blood bank records were reviewed retrospectively from January 2013 to December 2016. Results of mandatory serological tests and NAT Yield cases were compared. Descriptive statistics were used to estimate the prevalence of TTI and to show their yearly trends for four consecutive years. Result: Total numbers of blood units collected during study period were 18,694. Voluntary donors were 69% and Replacement donors were 31%. Out of 176 infective cases detected 23 were serologically non reactive but NAT reactive giving a high NAT yield of 1 in 812 cases.Overall prevalence of TTI was 0.94% and seroprevalence of HIV (0.08% ), HBV ( 0.80%), HCV (0.06% ), Syphilis (0.01% ). An increasing trend of HBV infection and decreasing trend of HIV, HCV were observed among blood donors in these four consecutive years. Conclusion: The present study population showedcomparatively low prevalence of Transfusion transmitted infection and it clearly indicated the benefits of IDNAT screening for the improvement of blood safety.

Keywords: IDNAT; Blood Safety; Blood Transfusion.

 Introduction: Cardiac autopsy is the main diagnostic tool to study various histomorphological changes in normal and diseased heart. An autopsy study gives a good measure of the prevalence, grading and distribution pattern of atherosclerotic lesion especially in developing country where resources are limited. Methodology: This retrospective study was conducted in Department of Pathology, Hassan Institute of medical sciences, Hassan . The study period was between January 2013 to August 2016. Heart specimens were obtained from medico legal autopsy performed in the Department of Forensic Medicine,Hassan Institute of Medical science. Heart specimens received as a part of examination of multiple viscera or only heart was taken out from dead body for pathological examination. Results: Out of 149 autopsied heart130( 87%) of cases showed significant coronary artery atherosclerosis in one or more vessels and Triple artery disease was commonest involvement seen in 114 (76%) cases. Conclusion: This study highlights the cardiovascular risk factor screening from early ages of third decades. Most of our observation correlated with the similar studies.

Keywords: Coronary Atherosclerosis; Histopaothology; Heart Autopsy.

Context: Blood transfusion is a life saving measure in various medical and surgical emergencies. Transfusion medicine, apart from being important for the medical treatment of each patient, also has great public health importance. Aims: The aim of our study was to know the prevalence of transfusion transmissible infections among blood donors in our college hospital blood bank. Settings & Design: Retrospective study conducted for 2 years. Methods & Material: This was a retrospective study conducted at the blood transfusion centre of a tertiary care hospital.Voluntary donors were evaluated for the prevalence of HIV, HBS Ag, HCV, Syphilis and Malaria. All the samples were screened by third generation ELISA Kits for HIV, HBsAg and HCV, by Rapid Plasma Reagin method for Syphilis, and by Immunochromatographic test for detection of Plasmodium falciparum and Plasmodium vivax antigen. Results: Total number of voluntary blood donors in the two year period were 3355. The seroprevalence of HIV, HBsAg, HCV were 0.42%, 1.88% and 0.29% respectively. No blood donors were tested positive for syphilis and malaria. Conclusions: Blood is still one of the main sources of transmission of infections. HIV, HBsAg , HCV are still prevalent among voluntary donors.

Keywords: Seroprevalence; Hepatitis B.; Hepatitis C.; Human Immunodeficiency Virus; Donors.

Background: Platelet indices viz. Mean platelet volume (MPV), Platelet distribution width (PDW) and Platelet large cell ratio (P-LCR) are measured in the automated cell counter. These indices are well utilized for certain conditions like idiopathic thrombocytopenic purpura, aplastic anemia and other hemotological disorders to assess the prognosis. Platelet count is decreased in various conditions including infectious and non-infectious disease processes. Infectious conditions like dengue fever, malaria, rickettsia, leptospirosis cause fever and variable degree of thrombocytopenia. Hence a detailed study of platelet indices is undertaken in patients having fever with thrombocytopenia. Materials & Methods: Present study was a prospective study. A total of 150 patients were included over a period of 1 year from Jan 2011 to Dec 2011. Detailed histories, physical and clinical examination of the patients were done to assess the etiology of febrile thrombocytopenia. Serological investigations for dengue fever, leptospirosis and rickettsia were done for confirmation. Results: Majority of the cases were of viral fever (72.6%), which includes dengue fever (10.6%), followed by malaria (15.3%), septicemia (4.6%), enteric fever (4%), leptospirosis (2%), rickettsia & brucellosis (0.6%). The platelet indices PDW (74.6%), MPV (86.6%), P-LCR (80.6%) showed less significant changes. Conclusion: Platelet indices are not changed significantlyin febrile thrombocytopenic patients. Whenever patient with thrombocytopenia presents with changes in platelet indices, non infectious conditions should also be considered in differential diagnosis to manage the patients effectively for better clinical outcomes.

Keywords: Febrile Thrombocytopenia; Platelet Indices.

Context: Transfusion dependent anemia importantly includes thalassemia patients. Thalassemia major is most common monogenic disorder in the world. Thalassemia is a major problem not only for the patients and their families but also for each country’s public health systems with regard to treatment expenses including regular injections, iron chelating agents, frequent hospitalizations and other medical consistencies and they are vulnerable to, social and psychological problems. Aims: Determination of prevalence and severity of depression in transfusion dependent thalassemia major patients attending a tertiary care hospital. Settings and Design: Cross-sectional study. Methods and Material: The study was done at a tertiary care teaching hospital. Thalassemia major patients who received blood transfusions for 2 to 4 weeks interval in the hospital were included in this study. Hamilton Anxiety rating (HAM-A) scale and Hamilton Depression rating scale (HAMD) were used to diagnose the severity for each case. Statistical Analysis Used: WHO Epi Info 7 software was used. Categorical data was expressed in terms of rates, ratios and percentage. Results: Males (83.33%) outnumbered females (13.34%) with male to female ratio of 4:1. Nearly half of the study population was aged between 10 to 12 years. Out of 30 patients, 25 were males and 5 were females. Age range was 10 -18 years with mean age of 12.45 ± 2.41 years. The prevalence of depression was 44.34% with majority showing mild depression. The prevalence of anxiety was 36.67% with majority showing mild severity followed by mild to moderate severity. Conclusions: This study help to understand emotional disorders and the severity of anxiety and depression in  thalassemia patients who are chronically ill and undergo prolonged treatment. Early assessment and treatment by psychiatrist will surely help to have good psychological condition.

Keywords: Transfusion Dependent; Thalassemia; Depression; Anxiety.

Introduction: Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance with onset or first recognition during pregnancy. Women with GDM alone or with type 2 DM are at increased risk of cardiovascular disease (CVD) in future. Literature has shown that platelets play a significant role in the pathogenesis of GDM.There are very few studies relating GDM and platelet parameters emphasized on platelet count (PLT), Mean platelet volume (MPV) and Platelet distribution width (PDW) but not about plateletcrit (PCT) and P-LCR (platelet large cell ratio). The objective of this present study is to compare the platelet parameters including platelet count (PLT), MPV, PDW, PCT and P-LCR in gestational diabetic subjects with healthy pregnant women and to evaluate the effect of GDM on platelet parameters. Materials and Methods: Prospective cross sectional study was conducted for 6 months duration. Ninety GDM patients diagnosed by Oral glucose challenge test (OCT) and Oral glucose tolerance test (OGT) along with ninety normal pregnant females as control were taken up for study. Investigation panel including platelet parameters were done. Results: Statistically significant increase was noted in MPV (p<0.002) and platelet distribution width (p<0.004)and significant decrease was noted in platelet count (p<0.01) in gestational diabetics compared with control group. PCT is decreased in test group but it is only weekly significant (p<0.09), there is no significant difference in P-LCR (p<0.25) among the groups. Conclusion: Determination of these platelet parameters are simple, inexpensive, routinely available and can be used as a predictive markers to identify GDM patients who are at increased risk of CVD in later life.

Keywords: Gestational Diabetes Mellitus; Platelet Parameters; Predictive Value; Screening Methods.

Background and Objectives: The evaluation and management of various hepatic lesions is a common clinical problem and their appropriate management depends on accurate diagnosis. Aim of the study is to study the cytomorphological features of various neoplastic lesions of liver and role of ultrasonography guided fine needle aspiration cytology (FNAC) in the diagnosis of liver malignancies. Materials and Methods: Fifty patients with evidence of liver disease underwent USG guided percutaneous FNAC . Cytomorphologicaldiagnosis were correlated with clinical, biochemical and radiological findings. Results: The age of the patients ranged from 6yrs to 75yrs with 40% males and 60% females. Of the 50 patients the cytological diagnosis of malignancies were rendered in 40 patients and smears of the 10 patients were benign, inflammatory and hemorrhagic. The primary liver lesions were more common than the metastatic lesions. The commonest primary liver malignancy was hepatocellular carcinoma followed by cholangiocarcinoma and hepatoblastoma. The metastatic lesion predominantly was adenocarcinoma. Conclusion: USG guided FNAC of the liver is a safe, simple, cost effective and accurate method for cytological diagnosis of hepatic malignancies.

Keywords: Hepatocellular Carcinoma; Cholangiocarcinoma; Metastatic Adenocarcinoma.

Background: Transfusion transmitted diseases continues to be a major threat for safe transfusion practices. Lack of study from this part of the country propelled us to conduct this study. Materials and Methods: This was a retrospective hospital record based study conducted in a blood bank of a rural tertiary care medical college hospital at Karwar, Karnataka, India. Five year data of blood donors with transfusion transmitted infections (TTIs) were evaluated and analyzed. Results: Among the 2655 donors screened, males (88.5%) were predominant. Among donors screened, hepatitis B (0.67%) was the most common TTI screened. No cases of Hepatitis C was seen during the study period. Conclusion: Prevalence of TTI amongst blood donors in the present study is comparatively low compared to various studies. Larger studies are necessary to predict overall prevalence in this part of the country. Being a smaller blood bank does give better screening strategies and improved donor recruitment, thereby improving blood safety.

Keywords: Blood Donors; TTI; Rural; Hepatitis B.

Background and Objectives: Fine needle aspiration cytology (FNAC) is an accurate, cost effective and safe technique for diagnosing neoplastic lesions of the bone. Objective of the study is to know the utility of fine needle aspiration cytology in the diagnosis of bone tumors and assess the diagnostic accuracy of this technique. Materials and Methods: FNA of bone was performed in 30cases. Smears prepared were fixed in 95% ethyl alcohol and stained by Hematoxylin and Eosin. 9 smears were considered unsatisifactory as they contained acellular hemorrhagic aspirates. The remaining 21 smears were classified as malignant lesion(12) and benign lesions (9). 15 out of the 21 cases were subjected to histopathological examination. Results:The malignant tumors were giant cell tumor (6), osteogenic sarcoma (1), chondrosarcoma (2) and adamantinoma(1), fibrosarcoma (1) and metastasis (1). The benign tumors were osteochondroma (6), osteoblastoma (2) and enchondroma (1). Histological correlation was obtained in 14 cases of the 15 cases operated and the diagnostic accuracy was 93.3% in this study. A case of chondroblasticosteogenic sarcoma that was reported as chondrosarcoma was the only diagnostic error in the study. Conclusion: Fine needle aspiration of bone is a simple reliable and accurate diagnostic technique that can facilitate patient management and preoperative decision making patient decision making and avoid unnecessary invasive procedures for patients with primary or metastatic bone lesions.

Keywords: Fine Needle Aspiration; Bone Tumors; Osteosarcoma; Adamantinoma.

Introduction: Recent advance in the field of tumour suppressor genes and oncogenes have provided the tool for the study the genetic changes occurring at different stages of carcinogenesis including transition from premalignant to malignant. Methodology: Histopathologically diagnosed benign lesions, premalignant lesions & SCC were included in the study which consist of 33 cases of oral squamous cell carcinaoma (of which14 were well differentiated, 14 moderately differentiated and 02 poorly differentiated) and 03 were verrucous carcinoma. 11 premalignant lesions and 08 were benign lesions of the oral cavity. These cases were subjected to routine H&E staining and p53 immunohistochemical staining. Results: In this study, 4 out of 7(57.14%) cases of hyperplasia showed basal p53 positivity whereas the only cases of squamous papilloma was p53 negative. It was observed that 69% of malignant and 63% of premalignant lesions showed suprabasal p53 positivity whereas only one case of benign lesions showed the above pattern of staining. Conclusion: In conclusion, expression of p53 above the basal layer is an early event in oral carcinogenesis and an indicator of a developing carcinoma preceding morphological alterations.

Keywords: p53 Staining; Benign; Premalignant; Malignant Oral Lesions.

Context: Cervical carcinoma is the fourth common malignancy in women worldwide and second most common in developing countries including India. Cytological screening leads to a reduction in the rate of invasive cancer of uterine cervix. The present study highlights the importance of cytospin method of liquid based cytology which improves the efficacy of Papanicolaou smears. Objectives: To compare efficacy of cytospin Papanicolaou smears with conventional Papanicolaou Smears in cervical cancer screening based on Bethesda system of classification, 2014. Materials and Methods: A prospective study of cervical cytology of 134 samples was carried out on women from age group of 18-65 years. Using Ayre’s spatula one slide was prepared and immediately fixed in fixative. The residual material was rinsed in fixative then spun in cytospin to obtain direct smear. Both conventional and cytospin smears were stained by Papanicolaou stain. Results: Of the 134 cervical cytospin smears studied, 87.9% (118 cases) were non-neoplastic, 9.6% (13 cases) were neoplastic lesions and 2.2% (3 cases) were unsatisfactory. The most common neoplastic lesion was LSIL and HSIL accounting for 3% (4 cases) each followed by ASCUS, squamous cell carcinoma and adenocarcinoma. Cytospin showed significant difference in the morphological features compared to conventional. Conclusion: Cytospin method of liquid based cytology is recommended as it improves the sample quality, morphology and also cost effective. It is an alternative screening method in low resource settings, like developing countries including India where women are at high risk for developing cervical cancer.

Keywords: Cervical Carcinoma; Conventional Pap Smear; Cytospin Pap Smear; Liquid Based Cytology.

Introduction: Among the most widely studied tumour suppressor gene are RB & p53 which express PRB retinoblastoma protein & p53 protein respectively. These proteins control cell cycle and are involved in the inhibition of cell proliferation. Mutation of these proteins produce uncontrolled cell proliferation. Methodology: The detailed history including the duration, site, onset, progression, personal habits and duration of those habits like smoking, beetle quid chewing were noted. The clinical diagnosis was recorded. Results: In our study, the most common location was tongue 48% followed by the BUCCAL mucosa of 34% and the least common was the floor of the mouth 6%. It was observed that 59% of the cases in the age group 50-60 year showed suprabasal p53 positivity. Conclusion: No significant association observed between P53 and age,smoking and tobacco use.

Keywords: Oral Lesions; P53; Tobacco.

Objective: Despite progress in prophylaxis and treatment modalities, tuberculous (TB) lymphadenitis still remains a major health problem in developing countries. In India, extrapulmonary TB accounting 20% of all TB cases and its prevalence in the country varies between 8.3% and 13.1%. The aim of this study was to describe various cytological pictures of tuberculous lymphadenitis with their relative frequency and to assess correlation between Fine needle aspiration cytology (FNAC) and Ziehl-Neelsen (Z-N) staining in diagnosing tuberculous lymphadenitis. Materials and Methods: A total of 132 cases with cytological proven tuberculous lymphadenitis were taken up for the study. Details such as age, sex, group of lymph nodes involved, type of aspirate, cytomorphological patterns and Acid fast bacilli (AFB) positivity on ZN staining were analysed. Results: The sites of distribution of lymphadenopathy were as follows: Cervical lymph nodes – 109, Axillary – 21, Inguinal lymph nodes – 02. Cytological patterns in all 132 cases were as follows: Pattern A – 22, Pattern B – 73, Pattern C – 37 cases. On grading of AFB positivity, Grade 1+ observed in 22.7%, Grade 2+ observed in 31.6% 2, and Grade 3+ observed in 45.5% cases. Conclusion: FNAC is a simple, cost effective and minimally invasive technique to diagnose tuberculous lymphadenitis. Since granuloma formation is not often seen in purulent aspirate, ZN staining must be done to rule out tuberculous lymphadenitis.

Keywords: Cytomorphological Patterns; Tuberculous Lymphadenitis; Ziehl Neelsen Stain

 Background: The various histological methods of identification of Helicobacter pylori have different sensitivity and specificity with varying strengths and weaknesses in terms of cost and convenience. Aim: The aim of this study is to compare the efficacy of Giemsa stain with Immunohistochemistry in diagnosing Helicobacter pylori in paraffin embedded tissue sections. Materials and Methods: This is a retrospective study done in a tertiary care centre for a period of 3 years. Multiple bits were taken from the lesion and the adjacent areas in random sample of 50 gastrectomy specimens and processed routinely for paraffin embedding. Sections were stained for Giemsa and immunohistochemistry apart from the routine Haematoxylin and eosin stain. Statistical Analysis: The data were entered and the statistical comparison between the two tests were done using SPSS software version 21. Results: Out of 50 cases of adenocarcinoma stomach, 39(78%) were males and 11(22%) were females. Out of 50 cases H.pylori was detected in 21 cases using Giemsa stain with 42% of positivity (Table.1). Out of 50 cases, Immunohistochemistry detected H.pylori in 25 cases (4 cases more than Giemsa) with a positivity rate of 50%. Conclusion: Sensitivity of Immunohistochemistry is more when compared with Giemsa special staining. Immunohistochemistry can be used to detect coccoid forms of Helicobacter pylori especially in screening for the presence of Helicobacter pylori in high risk patients and also in patients who had been treated with proton pump inhibitors and to confirm eradication following antibiotics against Helicobacter pylori.

Keywords: Helicobacter Pylori; Giemsa; Immunohistochemistry; Gastric Adenocarcinoma; Gastric Biopsy

Background: The safety of blood and blood products is improved by stringent donor selection. Donor deferral, either temporarily or permanently is an important documentation towards safe blood transfusion. Thus it should be evaluated on regular basis. Aims: To analyze the donor deferral rate, to document the causes and their frequency distribution with respect to gender. Settings and Design: This was a prospective study conducted on potential donors registering in Blood bank, Navodaya Medical College, Hospital and Research Centre, Raichur, Karnataka. Detailed history taking, physical examination and screening tests on the blood units collected were performed. Methods and Material: This study was conducted over 2 years (Jan 2014 to Dec 2015). Donor request form was given and those who did not fulfill the donor selection criteria were deferred and analyzed. Results: A total of 6834 donors were registered for blood donation, of which 909 cases (13.3%) were deferred. Deferral rate was 89.2% among males and 10.8% among females. Majority were temporarily deferred- 704 cases (77.4%); most frequently due to low hemoglobin value (17.7%) followed by fever (14.3%). Permanent deferral category included 205 cases (22.6%); mainly due to Hepatitis B virus (HBV) seropositivity (44.9%) followed by hypertension (20.9%). Female donors were deferred more frequently (47%) than males (8.2%); commonest reason being low hemoglobin and fever in both. Conclusion: Donor deferral is beneficial for donors and recipients as it minimizes potential health problems within the community. Hence regular evaluation guides transfusion committee in modifying planning strategies to preserve donor pool.

Keywords: Blood Donor; Donor Deferral; Permanent; Temporary.

Context: Ovarian lesions can present in the form of pain in abdomen, mass lesion or infertility. Any age group can be affected. Mass lesions of ovary are important, as they can be neoplastic or non-neoplastic. Appropriate treatment and prognosis is dependent upon the proper classification and diagnosis of ovarian mass lesions, which can be achieved by histopathological examination of excised ovarian tissue. Aims: Present study aims at classifying ovarian lesions histopathologically and finding the frequency of various ovarian tumors. Methods and Material : Present study is a retrospective study carried out at tertiary hospital attached to medical college in rural area of Maharashtra. All oophorectomy specimens received in central clinical laboratory from January 2012 to June 2016 were included in the study. Clinical details were obtained from requisition forms submitted by gynaecology department along with the ovarian specimen sent for histopathological examination. For detail information regarding the case, case sheets were obtained from medical record section of the hospital. Histopathological slides were retrieved from filing and studied blindly by two histopathologists independently. Results thus obtained were compared with original reports and finalized. Results: A total of 152 cases were included in the study. Histopathological examination was performed on 188 ovaries, of which 59 ovaries didn’t show any pathology. Of the remaining 129 ovaries, non-neoplastic lesions were more common (n=85; 65.89%) than neoplastic lesions(n=44; 34.10%). Follicular cysts were commonest amongst non-neoplatic lesions. In neoplastic category benign tumors were more frequent than malignant tumors. Serous cystadenomas were commonest among benign tumors whereas serous cystadenocarcinomas were commonest among malignant tumors. Conclusions: Histopathological examination of excised ovarian tissue forms the mainstay of diagnosis in most of the cases.

Keywords: Ovarian Lesions; Follicular Cyst; Serous Cystadenoma; Serous Cystadenocarcinoma; Teratoma

Introduction: Hysterectomy is the most common major gynaecological surgery done in the world. Common reasons include abnormal uterine bleeding (AUB) and leiomyoma. Aim and Objectives: This study was done to assess the indications and associated pathological findings among hysterectomy cases in our centre. Materials and Methods: This was a prospective study conducted over a period of three years from Jan 2014 to Dec 2016. All cases of hysterectomy conducted for gynaecological reasons were included in the study. Results: A total of 319 cases were included in the study. Most of the patients who underwent surgery were in the 4th and 5th decade. Common clinical indications included AUB and fibroid. In 45.76% of the hysterectomy specimens, no significant pathology was identified. Most significant histopathological findings were leiomyoma followed by adenomyosis. Conclusion: Hysterectomy still continues to be the surgery of choice for benign conditions, even though in developed countries, it continues to reduce with advent of newer methods. Larger studies are necessary to identify the reasons for hysterectomy, and to avoid hysterectomy for benign conditions, particularly in our part of the world.

 Context: Accurate preoperative diagnosis of thyroid lesions is imperative and helps surgeons to decide the management of the patients. The differential diagnosis of these nodules includes from non neoplastic to malignant lesions. Aims: This study was conducted to assess the utility of cell blocks in hemorrhagic and cystic thyroid aspirations. Settings and Design: This was a prospective study conducted over a period of one year in the department of Pathology. Methods and Material: All Thyroid FNAs that yielded either blood tinged colloid or cystic fluid or hemorrhagic material were included in the Study. CBs were prepared from the residual material after preparation of smears. The cytomorphology of FNA smears were compared with histopathology of cell blocks in all cases. Results: Sensitivity, specificity, PPV, NPV of FNAC was 100%, 94.2%, 83.3%, 100% respectively. Percentage of false positive cases was 5.7% with diagnostic accuracy of 95%. In the present study Cell blocks were contributory to FNAC diagnosis in three cases (6%). Conclusions: Cell block preparation as an adjuvant to FNAC can reduce diagnostic pitfall and improve accuracy of FNA diagnosis. It gives an added opportunity to study architecture of the tissue. Cyto-histologic correlation in all cases may help to improve efficiency of Pathologists.

Keywords: FNAC; Cell Block; Thyroid Nodule; Cyto Histologic Correlation.

Introduction: Women worldwide suffer from gynaecological and obstetric disorders that require hysterectomy as a treatment option. Hysterectomy forms the major bulk among the specimens received in our histopathology laboratory, hence this study was undertaken to know the incidence and also understand the variety of lesions in the hysterectomy specimen. Materials and Methods: The present study was done in the Department of Pathology, KBNIMS, Kalaburagi, from July 2014 to June 2016. All types of hysterectomy specimens (with or without adnexa) received during this period, were studied. Results: Total number of hysterectomy specimens received was 269. Out of 269 cases, non-neoplastic lesions were 141(52%), benign tumors were 114 (43%) and malignant tumors were 14 (5%). One case of tuberculosis of the endometrium was diagnosed. Malignant lesions were 3(1.2%), 2 cases of endometrial adenocarcinoma and 1 case of endometrial stromal sarcoma. Incidence of leiomyoma in present study was 31.8% (86/269) with mean age of 42.42 years and incidence of adenomyosis was 32%. Among 6 malignant tumors of cervix, 4(82%) cases were squamous cell carcinoma, 1 (9%) case of adenocarcinoma, 1 (4.5%) case of adenosquamous carcinoma. One of primary adenocarcinoma of fallopian tube was diagnosed,which was not diagnosed clinically. One case of mucinous cystadenocarcinoma with metastasis to the serosa of the uterus and to the colon, was diagnosed. Conclusion: Study of hysterectomy specimens is fascinating, as a variety of lesions are encountered. This specimen needs to be thoroughly studied, in order to know the different types of lesions in the female genital tract.

Keywords: Hysterectomy; Leiomyoma; Squamous Cell Carcinoma; Tuberculous; Endometritis.

 Context: Thalassemia is a group of inherited hemoglobin disorders characterized by reduced synthesis of one or more of the globin chains leading to imbalanced globin synthesis which is the major factor in determining the severity of the disease in the thalassemia syndromes. The objectives of this study was to analyze the anemia and biochemical profile in thalassemia major patients as very few studies have been done in this region of country. Aims: Determination of anemia and biochemical profile of thalassemia patients. Settings and Design: Cross-sectional study. Methods and Material: The study was done at a tertiary care hospital from January 2014 to December 2014. 35 thalassemia major patients who received blood transfusions in the hospital were included in this study. Complete blood count, Peripheral Smear Examination, Serum Ferritin and Fasting plasma glucose was done. Statistical analysis used: The data was analysed using SPSS version 20. Categorical data was expressed in terms of rates, ratios and percentage. Results: Male to female ratio of 4:1. About 51.43 % of patients were aged between 10 to 12 years. Mean hemoglobin was 6.8 gm±1.08 gm% and peripheral smear examination showed microcytic hypochromic anemia in most of the patients (74.29%)The raised serum ferritin levels were noted in 94.29% of the patients. The activity of all the liver enzymes AST, ALT and ALP were raised. Conclusions: The patients with transfusion dependent thalassemia major are at risk of developing severe anemia and biochemical abnormalities. Hence screening is essential as per guidelines.

Keywords: Thalassemia; Anemia; Biochemical Profile; Ferritin

 There is persistent shortage of active blood donors to meet the increased demand of blood in blood banks. The safety of blood with regard to the risk of transfusion transmissible infection is also an issue of utmost concern in India. Recruitment of voluntary non remunerated blood donors poses major challenge to transfusion services. Hence, there is a serious need to improve the recruitment and retention of healthy voluntary donor population to ensure a safe blood transfusion practice. Students are the appropriate, potential population to recruit regular blood donors and the role of college students in voluntary blood donation is crucial to meet the demand of safe blood. Knowing the attitude and perception of youngsters will help to identify factors and to develop strategies that influence the recruitment and retention of voluntary non-remunerated blood donors. Objective of this study is to assess the knowledge, attitude and practice regarding blood donation among college students. This is a cross-sectional descriptive study carried out at blood bank, Srinivas institute of medical sciences and research centre, Surathkal over a period of one year. A total of 250 college students were recruited. Pretested questionnaires were used to assess their knowledge, attitude, and practice towards blood donation. The age of respondents ranged from 18 - 30 years. Majority of the donor had good knowledge about the age criteria for donor selection, minimum body weight and minimum interval between two donations. Less than half of the participants had some knowledge about the volume of blood collected, provision for blood component separation, storage and shelf life of blood components. There were 115 respondents who had never donated blood before and the chief reason for not donating blood was fear of needle. Around 90% of donors showed positive attitude by expressing their willingness to donate blood if they were asked to donate blood in future. Assessment of knowledge, attitude and perception amongst student population regarding blood donation will help in designing effective health education strategy to improve voluntary blood donation.

Keywords: Blood Donors; Blood Bank; Voluntary; Knowledge; Attitude.

Background: Ultrasonography (USG) guided Fine Needle Aspiration Cytology (FNAC) is an established, safe, reliable and accurate procedure for cytological diagnosis of various retroperitoneal lesions. Aims & Objectives: To study the sensitivity, specificity and diagnostic accuracy of USG guided FNAC in retroperitoneal lesions. Materials & Methods: USG guided Fine Needle Aspirations (FNA) were performed in 54 patients with various retroperitoneal lesions during May 2009 to December 2011. Their cytological diagnosis was compared to Histopathological (HP) diagnosis. True and false (positive and negative) data was analyzed to measure sensitivity, specificity and diagnostic accuracy of USG guided FNAC. Results: Adequate material was aspirated in all 54 cases (Sample adequacy rate 100%). Maximum cases were from Kidney (21) followed by Lymphnode (13), Soft tissue (9), Adrenal (5), Pancreas (4) and Germ cell tumors (2). FNAC was diagnostic in all 54 cases. Among which, 36 cases (66.7%) were malignant and 18 cases (33.3%) were benign. HP correlation was available in 35 (64.8%) cases. HP diagnosis was different from FNAC diagnosis in only 2 (5.7%) cases. Diagnostic Accuracy, Sensitivity and Specificity of USG guided FNAC in retroperitoneal lesions were 94.3%, 92.6% and 100% respectively. Conclusion: Having high sensitivity, specificity and diagnostic accuracy, USG guided FNAC is an OPD based safe, reliable and accurate diagnostic procedure for various retroperitoneal lesions. It doesn’t only provide a preoperative diagnosis to aid in surgical management of resectable tumors, but also helps in avoiding a purely diagnostic laparotomy in cases of advanced cancer or benign lesions.

Keywords: USG Guided; FNAC; Retroperitoneal; Sensitivity; Specificity; Accuracy

 Introduction:  One of the most important prognostic factors in breast cancer is metastasis to regional lymph nodes resulting in a reduced overall survival rate. Mast cells in tissue release both pro-tumourigenic and antitumourigenic substances and can determine progress of the tumour including invasion and metastasis. The present study endeavored to assess mast cell density (MCD) in regional axillary lymph nodes in cases of carcinoma breast with clinicopathological correlation to infer their biological role and pathological significance. Methods: Tissue from forty seven cases of invasive carcinoma of breast (mastectomy with regional axillary lymph node clearance) was analyzed and routine histological findings were recorded. Mast cells were clearly demonstrated in tissue using Toluidine Blue stain at pH 2.3. Mast cells were counted using an eyepiece grid and expressed as no. of cells / per sq. mm, i.e., mast cell density (MCD). The distribution of mast cells within all the sampled lymph nodes (with and without metastasis) was recorded. Results:  Mast cell density was statistically significantly (p<0.0001) increased in regional axillary lymph nodes without microscopic metastatic deposits (n= 255; Mean MCD +/- SD:  6.0 +/- 3.4) compared to lymph nodes showing metastatic deposits (n=140; Mean MCD +/- SD: 0.57 +/- 0.59). Conclusions: Our results indicate a clear anti-tumourigenic role of mast cells within the regional lymph node tissue in carcinoma breast, possibly limiting the mechanisms for invasion of lymphoid tissue and limiting the metastasis. Mast cell density could thereby be a significant prognostic indicator in the management of patients with breast carcinoma.

Keywords: Breast Carcinoma; Lymph Node; Mast Cell; Metastasis; Toluidine Blue.

 Fine needle aspiration cytology (FNAC) is an important diagnostic tool used preoperatively for diagnosis of palpable and non palpable mass lesions. Various techniques have been described for doing the procedure. Aims & Objetive: We conducted a study with the objective of evaluating role of cytospin technique in inadequate and hemmorhagic samples in cytology. To perform immunocytochemistry on the cytospin slides if required during the diagnosis. Results: 19 thyroid cases, 6 salivary gland cases, 30 lymph node cases, 12 soft tissue cases, 9 breast cases and 4 miscellaneous cases were done. Cellularity was inadequate in 1.3% cases in conventional FNAC whereas inadequacy was seen in 8.8% cases of cytospin slides. The cellular details were clear and satisfactory in 100% of the cases in both conventional and cytospin slides. The cytospin slides prepared from the residual hub material was diagnosed as colloid goiter whereas only abundant colloid was seen on conventional smears where opinion was not possible. Granulomas were missed with cytospin technique due to significant decrease in the background caseous necrosis and scattered cellularity. Immunocytochemistry on cytospin slides was convenient due to monolayered cells aiding in appropriate diagnosis. Conclusion: Cytospin can be used as an adjunct to routine smears where limited material or hemorrhagic material is present. Special ancillary tests like immunomarkers and special stains can be done on these slides which aids in rapid and definitive diagnosis.

Keywords: Conventional FNAC; Cytospin Technique; Immunochemistry.

 Introduction: Nasal polyps are polypoidal masses arising from the nasal cavity and paranasal sinuses. They can be non-neoplastic, can have an infective etiology, or they can be benign or malignant. Aim of the Study: To study the histopathological spectrum of nasal polyps. Materials and Methods: This was a prospective study done over a period of 16 months. The study group consisted of 93 individuals from 10 years to 69 years in whom excised nasal polyps were studied histopathologically. These cases were classified into non neoplastic, benign and malignant lesions. Observations and Results: The male to female ratio was 1.73:1. The non-neoplastic lesions were more common (67.74%) than the malignant lesions (5.38%). Allergic morphology was more common. Rhinosporidiosis was a frequent infective etiology. Among benign lesions, hemangioma and among malignant lesions, squamous cell carcinoma were more common. Conclusion: Nasal polyps most commonly show allergic and inflammatory morphology. Rhinosporidiosis presents as nasal polyps in endemic coastal areas. Overall the study has found 5.38% malignant cases, so thorough sampling and study is recommended for all nasal polyps.

Keywords: Nasal polyps; Rhinosporidiosis; Hemangioma; Lesions.

Synovium is a specialized mesenchymal tissue in which varied pathological lesions can occur, but most common are non neoplastic lesions. Aim of the Study: To determine histopathological spectrum of non-neoplastic lesions of synovium and to correlate the clinical and histopathological diagnosis in our tertiary care hospital. Materials & Methods: Prospective study of 65 synovial biopsy samples. Patient’s complete clinical data, radiological findings, biochemical and serological parameters were obtained. Synovial fluid analysis was done in available cases. Histopathological examination of synovial biopsy tissue was done with routine and special histochemical stains wherever necessary. Statistical analysis for sensitivity, specificity and diagnostic accuracy was done. Results: We observed arthritis was common in 5th decade with Male-Female ratio of 1.7: 1. Most were monoarticular disease with the knee joint commonly affected. The common clinical manifestation was joint pain and swelling. The most common lesion was chronic nonspecific synovitis followed by osteoarthritis, tuberculous arthritis, rheumatoid arthritis and septic arthritis. One case of pigmented villonodular synovitis [PVNS], gouty arthritis and ochronotic arthritis were observed in our study. In our study, the diagnostic accuracy of synovial biopsy in comparison with clinical impression was 85% with 73% sensitivity, 97% specificity, 96% positive predictive value and 78% negative predictive value, 27%false negative rate and 3% false positive rate. Conclusion: In our study, we observed that synovial biopsy is cost effective and offers immense help to clinicians in providing appropriate treatment for patients, especially in long standing and subtle inflammatory lesions.

Keywords: Synovial Biopsy; Synovitis; Histopathology; Correlation; Diagnostic Accuracy.