Indian Journal of Pathology: Research and Practice

  Basal cell adenoma (BCA) is a rare benign epithelial tumor of salivary gland. Amongst the head and neck tumors, salivary gland tumors constitute about 2- 6.5% and of these, basal cell adenoma accounts for about 1-3%. We present a rare case of BCA of salivary gland with fine needle aspiration cytology (FNAC) findings and its correlation with histopathological observations along with review of literature 

Keywords: Basal Cell Adenoma (BCA); Fine Needle Aspiration Cytology (FNAC) Histopathology; Submandibular Salivary Gland (SSG).

  Acute myeloid leukaemia accounts for nearly 15% of all leukaemias in children out of which only about 3% mases present with extramedullary deposits in the other sites like the orbit. Bilateral proptosis is fairly common in association with acute and chronic lymphatic leukaemia, on the other hand myelogenous leukaemia rarely give rise to proptosis. Here we present one case of 6 year old presenting as bilateral proptosis with no other manifestations of systemic malignancy at presentation. Radiological investigation, FNAC, bone marrow study and flowcytometry was done for confirmation. The purpose of reporting such a rare entity is to highlight AML as a rare but important differential diagnosis of bilateral proptosis.

Keywords : Acute Myeloid Leukaemia; Orbital Myeloid Sarcoma; Proptosis.

The growing awareness of female breast cancer has led to increased sensitivity toward pAathological breast conditions in pediatric patients. Palpable breast masses arising in adolescent and pubertal girls are uncommon. The most common benign breast lesions are fibroadenoma and benign phylloides tumors. The mammary tumors with myoepithelial component are very rare in pubertal girls. We report a case of adenomyoepithelioma in a 15 year old girl and discuss the problems of diagnosis of breast masses in adolescent girls.

Keywords: Adenomyoepithelioma; Myoepithelial Tumors; Adolescent Girls; Breast Mass.

 

Background: Sebaceous carcinoma of the eyelid is rare. The diagnosis might be difficult because of its ability to masquerade as other periocular lesions. Prognosis is still regarded as being poor compared with most other malignant eyelid tumors with a mortality second only to malignant melanoma. The present reported cases analyses clinical and histopathological findings. Case Reports: Two case reports were presented here. One presented as primary complaint of progressive painless mass in left lower eyelid in a 75 year female and another case in young 30 year old with history of recurrence, operated previously for the same complaint with unavailable previous report. Both cases on histopathology reported as sebaceous gland carcinoma. Conclusion : Early diagnosis and consequent surgical therapy of sebaceous carcinoma of the eyelid leads to a better outcome and higher survival rates than generally assumed. Even local recurrences can be treated successfully. However, sebaceous carcinoma remains a threatening disease, which leads to death in 9% and to mutilating exenteration in 23% published in an English literature.

Keywords: Sebaceous carcinoma; Meibomian gland; Eyelid.

Background: Annually around 100 million cases of dengue fever and half a million cases of Dengue haemorrhagic fever occurs worldwide. Early recognition and prompt initiation of treatment and platelet transfusion in indicated cases are imperative if disease related morbidity and mortality are to be restricted. Aim: To evaluate the role of platelet count in predicting outcome in dengue patients, to observe the number of serologically dengue positive patients requiring platelet transfusion and observe its outcome. Materials and Methods: The present study was conducted in the Department of Pathology, Sree Mookambika Institute of medical Sciences, Kulasekharam, Kanyakumari District, Tamilnadu during a period of three years from 2013 to 2015. In this study fifty dengue positive cases were taken from the Department of General Medicine, Sree Mookambika Institute of Medical Sciences, Kulasekharam. Results: In this study among fifty patients the patients where platelet transfusion was indicated were 43(86%). Thrombocytopenia was observed in 43(86%) 2(4%) patients had platelet transfusion on the day of admission, 26(52%) on the first day after admission, 8(26%) on the second day after admission and 7(14%) on the third day after admission. In this study 27(54%) of the patients were infused 1-2 units of platelets, 5(10%) of patients were given 3-4 units of platelets, 8(16%) of patients were given 5-6 units, 2(4%) were given 7-8 units of platelets and 1(2%) was given 9-10 units. In this study of 50 patients, 43 were transfused platelets. 3(6.98%) took 2 days for platelet count to return to normal levels, 23(53.49%) took 3 days, 9(20.93%) took 4 days, 3(6.98%) took 5 days and 5(11.63%) took 6 days. Conclusion: Platelet transfusion was initiated in patients with moderate to severe thrombocytopenia. The patients had a smooth and rapid recovery with no adverse outcomes related to the transfusion. All patients in our study group made a complete recovery during the hospital stay within the follow up period. Early suspicion, screening, diagnosis and prompt management of Dengue fever will effectively lower any fatality related to this dreaded illness. 

Keywords: Dengue; Thrombocytopenia; Platelet Transfusion; Fever; Haemorrhage.

Background: Lymphadenopathy is an abnormal increase in size and/ or altered consistency of lymph nodes. It is a very common clinical manifestation of regional or systemic disease caused by the invasion or propagation of either inflammatory cells or neoplastic cells into the node and serves as an excellent clue to the underlying disease. Objectives: The study was undertaken to evaluate the diagnostic efficacy of the fine needle aspiration cytology of lymphadenopathy as compared to open biopsy for histopathological examination, to study the frequency of various neoplastic versus non-neoplastic lesions, their distribution in different age groups and to study the different cytomorphological patterns associated with various lymphadenopathies. Methods: A prospective study was conducted in 400 patients with lymphadenopathy referred to the Departmet of pathology, S.V.S Medical college & Hospital , Mahabubnagar. FNA diagnosis was subsequently correlated and compared with the biopsy diagnosis in the available cases. Results: Out of 400 patients of FNAC for lymphadenopathy excisional biopsy was available in only 85 cases. Non neoplastic & neoplastic lesions were been in 308 cases & 64 cases respectively. 28 smears were non diagnostic. Tuberculous lymphadenitis was the most common lesion in 45.75% of the cases. The overall diagnostic accuracy of FNAC in the present study was 89.41.% with accuracy of 87.19 % for tuberculous lymphadenitis and 1000.00% for metastatic carcinoma. Cervical group of lymphnodes were the most commonly affected group of lymph nodes 59.75%. Epithelioid granulomas with necrosis was the predominant microscopic pattern seen in 55.19% cases Overall AFB positivity was seen in 31.14% cases & predominantly seen in necrosis alone pattern(79%), In our study sensitivity, specificity, Positive and negative predictive values of FNAC in lymphadenopathy were 100 %, 96.97%, 90.48% and 100 % respectively. Conclusion: FNAC is a simple,rapid,cost effective diagnostic tool for patients having significant lymphadenopathy. The metastatic carcinomas, and tuberculous lymphadenopathy can be diagnosed by FNAC with a high degree of accuracy. If FNAC is positive surgeon can proceed to treat the patient without excisional biopsy of the enlarged lymph nodes & most of the diseases are medically curable with limited role for surgery in non-neoplastic lesions. Lack of tissue architecture on FNAC can be overcome by subjecting samples to flow cytometry, T-cell, B-cell markers and immunocytochemistry analysis. 

Keywords: Lymphadenopathy; Diagnostic Efficacy; Fine Needle Aspiration Cytology and Histopathological Examination.

  Background: Quality assurance is an integral part of modern laboratory services. Quality control is relatively easy in hematology and biochemistry laboratories however, similar quality standards are difficult to analyze in surgical laboratories. Comparing the diagnostic accuracy of frozen section with gold standard histopathology can be used for this purpose. Methodology: The data for this two and a half year (January 2014- June 2016) retrospective analysis was retrieved from the records of Department of Pathology, Dayananad Medical College and Hospital Ludhiana, Punjab. The routine protocol of intraoperative consultations in the Department included prior intimation (at least 2 hours before expected sampling) with relevant clinical details and indication of frozen section. The sample was received in normal saline and representative sections were submitted for frozen section after thorough gross examination of the tissue. Results: A total of 200 cases were retrieved from the archives of Department of Pathology during this retrospective analysis. Majority (34.5%) of the intraoperative consultations were sought from the Gynaecology unit {Uterus 53 cases (26.5%) and ovary 16 (8%) cases}. Overall concordance rate was 95% (190/200) with sensitivity of 96.4% and specificity of 100%. Conclusion: The intra-operative consultations using frozen section is a very useful in assessing the quality assurance and the rospective analysis of these methods with routine histopathology can yield adequate quality assessment of a laboratory.

Keywords: Quality Assurance; Surgical Laboratories; Frozen Section.

  Introduction: Skin is a complicated protective covering [1]. It is divided into two seemingly separate but functionally interdependent layers, i.e., epidermis and dermis. Adnexae extend from epidermis into the dermis and consist of specialized cells for hair growth, epithelial renewal (stem cells), and temperature regulation [2]. Epidermis has the capacity to develop an array of keratinocyte lesions, the causes of which are not known. Adnexal tumors may be benign or malignant, solitary or multiple [3]. Aim of the Study: 1. To study the histomorphological features of tumors of epidermis and epidermal appendages. 2. To analyze the clinicopathological features of these tumors. Materials and Methods: This was a 5 years’ study on tumours of epidermis and epidermal appendages, studied i.e., from Jan. 2012 to Dec. 2016. Both biopsies and resected specimens were included in the study. Results: 69 cases of tumours of epidermis and epidermal appendages were encountered, of which, 51 cases (73.91%) were epidermal neoplasms, and 18(26.08%) cases were neoplasms of epidermal appendages. Out of 69 cases, 36(52.17%) were benign neoplasms and 33(47.83%) were malignant neoplasms. The incidence of keratinocytic tumours was high in the present study. Among adnexal tumours, most common were benign sweat gland tumours followed by tumours of hair follicle and sebaceous gland. Malignant adnexal tumours and hematolymphoid tumours were very rare. Conclusion: Skin tumours, at times, may be difficult to diagnose clinically. Hence histopathological examination is a must for definitive diagnosis. Increasing public awareness and surveillance will help in diagnosing the cases early for better management and prognosis.

Keywords: Epidermis; Appendages; Histopathology; Skin and Tumours.

Introduction: The cytological study of pleural fluids is a very simple and relatively non invasive technique, but one of the oldest cytological methods to achieve diagnosis. Cytological evaluation of the pleural fluid is performed mainly to know the presence or absence of malignant cells and to differentiate between transudate and exudates. Determining the etiologic cause of pleural fluid accumulation in pleural cavity is critical for proper treatment of these disorders. Aim: The study was conducted to know the analysis of pleural fluid effusion cases in hospital based population, Nanded district, Maharashtra state. To know the proportion of neoplastic and non neoplastic effusions and to know the pleural effusion caused by bacterial, viral and fungal infections (To rule out Transudates or Exudates), in relation to age, sex, clinical complaints and biochemical investigations. Material and Methods: The material for this study is obtained from in-patients attending the Dr SCGMC and Hospital, Nanded, Maharashtra. The study includes 265 cases of pleural fluid analysis, that is the cases of pleural effusion received from all departments namely tb-chest, medicine and surgery during the year 2016. Results: Out of 265 cases, 249 cases (93.96%) were negative for malignancy and remaining 12 cases (4.53%) were positive for malignancy. Suspicious cases were 4(1.51%). Majority were exudates and adenocarcinomas predominated in number among the malignant cases.

Keywords: Pleural Fluid; Benign; Malignant; Exudates; Mesothelial Cells.

  Background: Fine needle aspiration cytology is an important tool in the diagnosis, prognosis and management of breast carcinoma. It has been recommended that cytological grading should be included in the FNA reports to know the tumor aggressiveness and prognostication. Among the many cytological grading systems existing, there is still no agreement on the most reliable system. Aim: The study was undertaken to evaluate three cytological grading systems and correlate with histological grading by Nottingham modification of Scarff Bloom Richardson (SBR) method. Materials and Methods: Cytological grading by Robinson’s grading, Fisher’s modification of Black nuclear grading and Howell grading systems was done on 50 carcinoma breast cases. Histological grading by Nottingham modification of SBR grading was done. Cytohistologic grading correlation was done by testing concordance, association and correlation. Results: The three cytological grading systems correlated well with histological grading. Fisher’s modification of Black nuclear grading system demonstrated the best correlation ( = 0.61; P < 0.001) and concordance (Percent of agreement=70%) with the SBR’s grading system.Conclusions: Fisher’s modification of Black nuclear grading system is simple, reproducible and showed the best concordance with histological grading.

Keywords: Breast Carcinoma; Cytological Grading; Fine Needle Aspiration Cytology; Prognosis.

  Background: Pregnancy induced hypertension (PIH) is one of the most common causes of both maternal and neonatal morbidity and associated with adverse pregnancy outcomes.Profound changes in coagulation and fibrinolytic system occur during normal pregnancy causing hypercoagulable state. Early identification of high risk women and monitoring derangements in their coagulation system are surely pivotal in the prevention of complications. Hence, this study was undertaken to compare the coagulation profile in pre-eclamptic and eclamptic patients with normotensive pregnant patients. Material and Methods: A total of 240 patients were categorized into two equal groups as Group I - Cases (120 patients of pre-eclampsia and eclampsia) and Group II - Control (120 healthy pregnant women). The coagulation parameters such as BT, CT, PT, aPTT, platelet count of the patients required for the study were carried out by using semi-automated CA-54 coagulation analyzer and kits. Results: Mild PE did not reveal any significant changes in coagulation parameters as compared to healthy pregnant women. However, severe PE and eclampsia were characterized by thrombocytopenia and coagulation abnormalities indicating intravascular coagulation. Platelet count and aPTT had predictive value in screening for consumptive coagulopathy in the severe cases of PE and eclampsia. Discussion: Coagulation studies are the simple, cost effective and readily available tools in early diagnosis of maternal derangement of coagulation in pre-eclampsia and eclampsia. The information of present study might enrich the knowledge of clinician for early identification of pre-eclampsia.

Keywords: Pregnancy Induced Hypertension; Coagulation Profile; Eclampsia; Pre- Eclampsia.

Introduction: Lymph node pathology is complex as it can be affected by a variety of non-neoplastic and neoplastic diseases. Histopathological examination especially at low magnification gives considerable information and helps to arrive at a diagnosis. Aims and Objectives: To study diagnostic histopathological patterns of various lymph node lesions and to study in depth rare lymph node lesions. Materials and Methods: This was a retrospective study carried out in the department of Pathology, Topiwala National Medical College and BYL Nair Hospital, Mumbai, over a period of two years. A total of 255 lymph nodes were examined on routine histopathology and immunohistochemistry was done in a few cases of lymphomas. Observations and Results: There were 153 males and 102 females in the study and the age ranged from 1 year to 85 years. The non neoplastic causes were common for lymphadenopathy and in specific causes, tuberculosis was most common Incidence of metastatic malignancy was 9 % and of lymphomas was 11 %. Conclusion: Lymphadenopathy occurs more commonly due to non-neoplastic causes. Metastatic involvement of lymph nodes is mostly due to carcinomas. Histological evaluation of lymph nodes at low magnification helps to evaluate the architectural patterns of lymph nodes. These along with the identification of the cellular composition help in the diagnosis of lymph node diseases.

Keywords: Lymph Node Lesions; Lymphadenopathy; Immunohistochemistry.

  Background: Routine screening test like Pap smear test can detect early changes in the cervical epithelial cells, thereby facilitating the appropriate management of the disease. The present study investigates the distribution of cervical lesions among rural Indian population from a single center. Methods: The cross-sectional study, conducted between 2015 and 2017, evaluated 281 cervical smears obtained from female subjects aged 20-75 yrs, suspected with abnormalities. The smears collected were subjected to Pap smear test, and interpreted according to Bethesda system of classification 2001. The subjects were grouped based on the age as: 20-40 yrs, 1-50 yrs, 51-70 yrs, and 71-80 yrs, and the age-wise distribution of various types of cervical lesions was evaluated. Results: Out of the 281 smears; abnormal, atrophic, and normal smears were noted in 89.67%, 5.69%, and 4.62% respectively. Smears negative and positive for intraepithelial lesions or malignancies were noted in 6.86%, and 12.81% of the cases respectively. AGUS, LSIL, HSIL, and SCC were more frequent in women belonging to >50 years of age. Conclusion: The present study showed higher incidence of intraepithelial lesions in elderly women (>50 yrs) compared to other age groups.

Keywords: ASCUS; HSIL; NILM; Pap Smear; SCC.

Background: Meningiomas are common brain tumors which are mostly benign and recur frequently. These tumors exhibit steroid hormone receptors which are related to the behavior of the tumor. Aim: To conduct a retrospective study to evaluate the presence of progesterone and estrogen receptors in meningiomas and to correlate their expression with expression of proliferative marker Ki67. Materials and Methods: 24 cases of meningiomas were studied immunohistochemically to detect the expression of ER,PR and Ki67. Other parameters like age and sex were also analyzed. Results: 24 Cases were analyzed and all of them were ER negative. 3 cases were strongly positive, 16 cases were moderately positive and 5 cases were weakly positive for PR immunoreactivity. 3 cases showed moderate positivity, 13 cases were weakly positive and 8 were negative for Ki67. 2 cases of atypical meningioma and 1 case of meningothelial meningioma showed moderate positivity with Ki67and weak positivity with PR immunostaining. Most of these tumors were in the age group of 40-50 years and were seen in females. Conclusion: Tumors with increased PR expression had decreased proliferative rate when compared to tumors with increased Ki67 and decreased PR expression indicating that
PR expression is better prognostic marker for these tumors.

Keywords: Meningioma; Progesterone; Estrogen Receptors; Proliferative Marker Ki67.

  Introduction: Liquid based cytology (LBC) has played a pivotal role in exfoliative cytology. However it can be implemented in Fine needle aspiration (FNA) samples. Automated techniques have been widely used, but limited due to cost and availability. Aim: The objective of the study was to assess the diagnostic efficacy of Manual LBC in FNAC samples. Methods: In this prospective study, a total of 60 FNA samples from various anatomical sites were evaluated. Smears were made from conventional preparation (CP) and manual LBC (MLBC) preparation. Both CP and MLBC preparations were compared for cellularity, background, monolayers, cell architecture, cytoplasmic and nuclear details by a semiquantitative scoring system. P<0.005 was considered statistically significant. Results: Diagnostic accuracy was better in MLBC to CP in view of absence of blood and debris, presence of monolayers and preservation of nuclear and cytoplasmic details. However, with regard to cellularity, informative background and cell architecture there was no statistical significance. Conclusion MLBC performed on FNA samples can be safe, cost effective promising diagnostic technique in combination with CP to achieve high diagnostic yield.

Keywords: MLBC; CP; FNA Samples.

Context: The antiglobulin test is an important test in the detection of immunoglobulin or complement bound on the surface of red blood cells (RBC) and serum antibodies. It is possible that anticoagulants used for collection of blood samples may affect the end result of this test. Aim: To study the variation in degree of agglutination between the antiglobulin test performed on plain blood and anticoagulated blood. Settings and Design: Antiglobulin Test was performed on blood samples collected from umbilical cord of 100 new-born babies during delivery in plain vials and vials with anti-coagulant like ethylenediaminetetraacetic acid (EDTA) and citrate. Methods and Materials: 6 ml of blood samples were collected from umbilical cord immediately after delivery and 2 ml each transferred into: EDTA, Citrate and Plain vials. The sample thus collected was used for performing the direct antiglobulin test. 10% red cell suspension was sensitized with Anti D IgG (as supplied by Tulip diagnostics) at different dilutions of 1/10, 1/20, 1/30 and 1/40. The washed saline suspension of RBC’s is treated with Anti- human globulin serum and agglutination is observed under a microscope at 5X bjective. The picture is taken of microscopic field using MIPS (micro image processing system) and saved Statistical Analysis used: Friedman test and Wilcoxon signed-rank test. Results: The degree of agglutination at various dilutions obtained by using plain blood samples was found to be higher than that obtained by using anticoagulated blood. The citrated blood samples gave intermediate agglutination results between blood samples collected in plain and EDTA vials.

Keywords: Antiglobulin Test; Agglutination; EDTA; Citrate.

 
Background: The prevalence of dyslipidemia in diabetes mellitus [DM] is 95%. Diabetic patients with accompanied dyslipidemia are soft targets of cardiovascular deaths. Glycated Hemoglobin [HbA1C] the gold standard for assessing the glycemic status, has been regarded as an independent risk factor for Coronary Heart Disease [CHD] and stroke. Various studies have contradicting results on the impact ofHbA1C levels on lipid profile in diabetics. Aim: To find out association between glycemic control (HbA1C), age, gender and serum lipid profile in type 2 diabetic patients and non-diabetic subjects. Materials and Methods: A cross-sectional study carried out in SRM Hospital and Research Centre, Chennai. Total 450 subjects (150 controlled & 150 poorly controlled diabetics, 150 non-diabetics) with equal number of males and females in each group and investigated for HbA1C and lipid profile. Statistical Analysis: The data were analyzed by SPSS version 21 using Independent samples student ‘t’ test. ‘p’ value <0.05 was considered as statistically significant. Results: There was a significant increase in mean Total Cholesterol [TC], Triglyceride[TG], Low Density Lipoprotein Cholesterol [LDL-C], Fasting Blood Glucose [FBG] levels and HbA1C between non-diabetics, controlled and poorly controlled diabetics. But High Density Lipoprotein-Cholesterol [HDL-C] was not significant between these study groups. TC, TG, LDL-C levels between males and females in each group were not statistically significant. But mean HDL-C was non-significantly lower in female diabetics. Subjects with worse glycemic control (HbA1C >9%) possessed significantly high values of TC, TG, LDL-C, FBG except HDL-C. No significant correlation for age with respect to serum lipid profile. Conclusion: We conclude, HbA1C predicts dyslipidemia . This highlights the usefulness of HbA1C as dual biomarker (glycemic control and lipidemic state) for screening high risk diabetic patients.

Keywords: Glycated Hemoglobin (HbA1C); Dyslipidemia; Diabetes.

  Background: Psoriasiform term implies that a lesion clinically or histologically mimics psoriasis. Psoriasiform dermatoses often poses diagnostic dilemma to both pathologists and dermatologists. It is essential to follow a systematic approach and use appropriate clinicopathological correlation to arrive at a diagnosis. Aims and objectives: To study histomorphological features of psoriasiform disorders. Material and methods: This is a prospective study of 57 patients diagnosed clinically as psoriasis or with psoriasis as one of the differential diagnosis. Relevant clinical history and physical examination were noted. The skin biopsies taken after the consent were processed in histopathology laboratory and stained with hematoxylin and eosin. A detailed microscopic study of the histomorphological features was done. Obervations and Resutls: The psoriasiform lesion comprised 6% of the total skin biopsies received in the department of pathology. The age distribution pattern revealed that the highest percentage was in the age group of 21-50 yrs with a male preponderance with a ratio of 1.1:1. Psoriasis was the most common lesion noted in the study. Other psoriasiform disorders were parapsoriasis, Pityriasis rosea, Bowens disease, mycosis fungoides, seborrheic dermatitis. Conclusion: There is certain amount of overlap of both clinical pattern and of psoriasis and psoriasiform disorders. Recognition of these commonly encountered psoriasiform disorders clinically and confirming it on histopathology is the key to correct diagnosis and better patient care.

Keywords: Psoriasiform; Parapsoriasis; Pityriasis Rosea.

  Papulosquamous group of skin lesions have certain common clinical presentations and lead to confusion in diagnosis. We undertook this study to analyze the histomorphological findings of various papulosquamous lesions of skin in detail, and to correlate the clinical findings with histomorphological features. Biopsy of clinically diagnosed/suspected cases of apulosquamous lesions were performed in the department of dermatology and sent to the department of pathology in 10% formalin. The specimen obtained were subjected for tissue processing after fixation. Tissue sections are prepared from paraffin block and stained with haematoxylin and eosin, followed by microscopic examination. A total of 50 cases were studied. Psoriasis was
the commonest lesions (44%) followed by Lichen Planus (34%), Pityriasis Rosea (10%), Parapsoriasis (6%), Pityriasis Rubra Pilaris (4%) and Lichen Nitidus (2%). Lesions occurred in all age groups but were common in oung and middle aged. Males were commonly affected. There is an overlap in morphology and distribution of these lesions leading to difficulty in diagnosis. Distinct histopathological features and clinical correlation gives a conclusive diagnosis. Specific histomorphological diagnosis is important to distinguish these lesions 
as the treatment and prognosis varies significantly.

Keywords: Papulosquamous; Histopathology.

Introduction: Granulomatous mastitis (GM) is a rare chronic inflammatory lesion of breast of unknown etiology. This entity clinically and radiologically may simulate carcinoma and presents as palpable breast lump with history of associated pregnancy, lactation or history of oral contraceptive intake. Cytological diagnosis is difficult as microscopic features are non specific and overlaps with other etiologies. Aims/Objectives:To study clinical presentation and cytological features of granulomatous mastitis with histopathological correlation. Methods: Prospective study of 24 cases was done over a period of three years and diagnosed as granulomatous mastitis on FNAC. Clinical data were collected and histopathological correlation was done among 18 cases. Results: Study comprised of 24 cases of granulomatous mastitis with age group ranging from 18 to 48 years (mean age - 33 years). Out of 24 cases, 16 cases had history of taking oral contraceptive pills and 14 were lactating. All the patients presented with breast lump, with abscess in four cases and axillary lymphadenopathy in three cases. Diagnosis of granulomatous mastitis was done on cytology based on the presence of epithelioid cells either in granulomas or scattered along with multinucleated giant cells against background comprising predominantly of neutrophils. Histopathological correlation was done among 18 cases with 100% correlation. Conclusion: Granulomatous mastitis is essentially a diagnosis of exclusion, which can be established by fine needle cytology in majority of cases thereby preventing unnecessary surgeries. matous mastitis diagnosed on cytology with 100% histopathological correlation.

Keywords: Granulomatous; Mastitis; Cytology; Histopathology; Granulomas.

  Cutaneous involvement is a prominent feature in connective tissue disease and the skin lesions are extremely important in diagnosing and subclassifying patients with these conditions. Fifty cases of connective tissue diseases of skin were studied over a period of two years to analyze overlapping of histopathological features, ossible transformation of one disease to the other and co-existing conditions. Routine Haematoxyline and Eosin (H&E) sections were studied along with special stains like Periodic Acid Schiff(PAS) and Verhoeff Vangiesson (VVG) wherever necessary. Fifty cases studied included 18 morphea, 9 systemic sclerosis (SS), 9 discoid lupus erythematosus (DLE), 7 acute cutaneous lupus erythematosus (ACLE), 4 subacute lupus erythematosus (SCLE), 2 lichen sclerosus et atrophicus (LSet A) and 1 case of poikiloderma atrophicans vasculare (PAV). Considerable overlapping of features were observed among skin lesions in acute, subacute and chronic lesions of lupus erythematosus and in cutaneous lesions of systemic sclerosis and morphea. In conclusion, as there is a considerable overlapping of histopathologic features in connective tissue diseases of skin, often it is necessary to use other diagnostic tools like serological and immunological study in conjunction with histopathology with the background of clinical history for a conclusive diagnosis.

Keywords: Connective Tissue Diseases of Skin; Histopathologic Features; Overlapping Features; Coexistence.

  Although clinical and radiographic examination for breast lesions have come to play an important role in the assessment of the malignant potential of a lesion involving the breast, histopathology remains the gold standard in this regard, not only for its diagnostic role but also due to its prognostic implications and as guide to further management. The present prospective observational study was conducted at a rural medical college over 2 years from September 2013 to August 2015 in which 274 cases of breast lesions were assessed and correlation was done between clinic-radiological and histological diagnoses. 67.88% of the lesons were benign neoplasms while 8.46% were malignant. Clinico-radiological features were found to have 93.84% sensitivity and 93.58% specificity for identifying benign lesions; the sensitivity for malignancies was 93.58% while the specificity was 93.84%.

Keywords: Histopathology; Breast Malignancy; Benign Breast Disease; Clinico-Pathological Study.

Background: Conventional Practical Examination (CPE) or Viva only tests the overall performance of the students (cognitive domain) but other domains like psychomotor skills, comprehension and interpretation ability etc. remain overlooked. So Objective Structured Practical Examination (OSPE) is developed as a tool to overcome these limitations of CPE. Aims & Objectives: To compare the effectiveness of Objective Structured Practical Examination (OSPE) with Conventional Practical Examination (CPE) as an assessment tool in pathology subject among 2nd year MBBS students. Materials & Methods: OSPE along with CPE were conducted in the subject of pathology among 123, 2nd year MBBS students during the year 2014. Results of both the methods were compared to each other for their effectiveness as an assessment tool in pathology practical examination. Results: Students got better results in OSPE as compared to CPE. Mean marks obtained in OSPE were 8.6 while 2.9 in CPE out of 10. Most frequently obtained marks in CPE were 2 while in OSPE its 9.SD (Standard Deviation) is 1.3 in OSPE as compared to 1.7 in CPE. Conclusion: OSPE is a reliable, objective, valid and effective method as compared to CPE for assessment of medical student’s performance in pathology practical examination. However, OSPE should be used judiciously to complement CPE rather than totally replacing it.

Keywords: Objective Structured Practical Examination (OSPE); Conventional Practical Examination (CPE); Pathology; MBBS.

Hemoglobinopathiesare monogenic disorders of erythrocyte production. We present an observational study of 200 anaemic patients at a tertiary health care center presented over two years (January 2015 to December 2016). Sickle-thalassemia was the most common form of haemoglobinopathy (56.4%), followed by β-thalassemia carrier (16.6%), Sickle cell trait (15.3%) β-thalassemia (10.2%), & Sickle cell disease (1.28%), respectively. Almost equal incidence in male and female were found. The maximum number of cases came to attention in the age group of 6-15 years followed by those in the age group of 16-30 years.

Keywords: Haemoglobinopathy; Sickle Thalassemia; β-Thalassemia; β-Thalassemia Carrier.

  Introduction: Head and neck lesions are frequent entities encountered in clinical practice. Fine needle aspiration cytology is a simple, rapid, and cost-effective method to sample superficial masses found in head and neck. Common pathologies encountered in head and neck region are specific and nonspecific lymphadenopathies, salivary gland neoplasms, sialadenitis, and lesions of skin appendages.FNAC enables a useful primary evaluation in these cases. Objectives: The objectives were to study various cytological features of neoplastic and non-neoplastic lesions of head and neck region and to evaluate the distribution of various lesions among different age groups. Materials and Methods: A cross-sectional study was conducted from May 2014 to December 2014. FNA was performed on 300 patients with head and neck masses. Thyroid lesions were excluded from study. Aspirations were performed using 22-25 G needles with syringe, and smears stained using Leishman and H & E stain. Fine needle aspiration diagnosis was correlated with relevant clinical details and investigations. Results: Out of 300 fine needle aspiration procedures, 60% were from lymph nodes, 10% from salivary gland, 14% from benign neoplasms and 14% were cysts. Diagnosis was inconclusive in 2% of the cases. The most common diagnosis was reactive/non-specific lymphadenitis (38%) followed by benign neoplasms and cysts (14%). Metastatic carcinomatous deposits in lymph node were most common type of cancer followed by lymphoma. Conclusion: FNA of head and neck masses is a very useful diagnostic tool in separating inflammatory and neoplastic lesions, thus avoiding unnecessary surgeries. FNAC can be recommended as a first line investigation in the diagnosis of head and neck swellings.

Keywords: FNAC; Head and Neck; Reactive Lymphadenitis; Salivary Gland.

  Introduction: A palpable breast lump is a common clinical problem that needs thorough evaluation by clinical examination, FNAC, mammography and biopsy if required. Aim of the Study: To study the accuracy of fine needle aspirations in breast diseases and compare it with histopathology. Materials and Methods: This was a prospective study carried out in the department of Pathology, Shadan Institute of Medical Sciences and Research Centre, Hyderabad. Fine needle aspiration cytology (FNAC) and corresponding histopathology were studied in 81 cases over a three year period. Results: The patient age ranged from 12 to 64 years. Non – neoplastic lesion constituted 12%, benign tumors 47% and malignant tumors 40% on FNAC. Failed aspiration was 1%. There were one false positive and four false negative cases on FNAC. This was mainly due to limitations in FNAC, both in interpretation and nature of lesion. The overall diagnostic accuracy of FNAC was 93.8% with accuracy rate of 90% in non–neoplastic, 73.7% in benign and 93.8% in malignant lesions. Overall sensitivity and specificity were 88.5% and 97.7% respectively. No significant complication was observed in any of the cases investigated by fine needle aspiration cytology. Conclusion: FNAC as an OPD procedure is simple and easy to perform, takes less time gives quicker results. FNAC procedure has no significant complications. It can be used for diagnosis in non-neoplastic and benign proliferative conditionswith reasonably good diagnostic accuracy.

Keywords: Breast Lesions; FNAC; Histopathology Correlation.

  Introduction: Blood safety is always remaining a point of concern. In blood bank all the procedures are starting with donor selection. Individuals disqualified from donating blood are known as “deferred” donors Aim: The aim of the study is to evaluate and analyze the blood donor deferral pattern, apply these findings to recruit them in future for donation and to compare with previous published studies. Materials and Methods: Retrospective study of blood donors was done of four years from January 2013 to December 2016 at tertiary care center. Donor deferral data was analyzed from indoor and outdoor donor forms and registers. Results: Total 4902 potential blood donors were screened at our institute and our outdoor voluntary blood donation camps. 4399 (89.74%) were accepted for blood donation and 503 (10.26%) were deferred. Total number of temporary deferral was 408 and permanent deferral was 95. Discussion: In our study the deferral rate was 10.26%. In order to lessen the loss of blood donors and future recruitment of potential temporary blood donors this study was conducted. Low hemoglobin was the commonest cause (53.20%) of temporary deferral. The commonest age group of deferral is 18-25 years age group. Conclusion: A donor directory should be made and a special mention in it should be there of temporary deferral donors for future recruitment of them. Analysis of deferral pattern helps in formulating a policy for deferral that helps to prevent loss of blood unit by future recruitment of temporary deferred donors and to ensure safe transfusion by forming a permanent deferral registry.

Keywords: Blood Safety; Screening; Donor Deferral.

Introduction: Liver is one of the most common sites for both neoplastic and nonneoplastic lesions. In the suspected liver diseases ultrasound is the first and most important diagnostic tool. As sonography alone has its limitations, cytomorphologic analysis by FNA is required to increase the diagnostic accuracy. Aims and Objectives: To evaluate various neoplastic and nonneoplastic lesions encountered in the liver and to correlate ultrasound findings with the USG FNA diagnosis in liver lesions. Materials and Methods: This was a prospective study comprising of 102 cases of liver lesions diagnosed clinically or radiologically.Abdominal ultrasonography was carried out in all cases. FNAC was performed under ultrasound guidance. Smears were stained with H & E and Wrights stain and were examined for detailed cytomorphological analysis. Observation and Results: The mean age of the patient was 53yrs with M: F ratio of 1.5:1. Out of 102 cases, 3 cases (2.94%) each of inflammatory, cirrhosis, regenerative hyperplasia, one case (0.98%) of simple hepatic cyst, and 83cases (81.37%) were malignant, while one case (0.98%) was suspicious of malignancy. Eight (7.84%) cases were inconclusive. Thus diagnosis was possible in 94 cases with diagnostic yield of 92.2%. Malignant liver aspirates formed vast majority 83 cases (81.37%).Of these 83 cases, primary malignant liver lesions formed 42 cases (50.6%). Out of these 42 cases, 40 cases were hepatocellular carcinoma and two cases were NHL. Metastatic tumour constituted 41 cases (49.4%) of which 35 cases were adenocarcinoma deposits, five cases were Squamous cell carcinoma deposits and one case of lymphoma deposit was found. On ultrasound examination out of 40 cases of HCC, 32 cases had solitary SOL, and 8 cases had multiple SOL. Metastatic carcinoma group showed solitary lesions in 10 cases and multiple lesions in 30 cases. All 3cases of NHL presented as multifocal lesions. Ultrasound diagnosis correlated well with 73 cases out of 90 cases. Discrepancies were found in 17 cases of hepatic lesions between ultrasound diagnosis and cytological diagnosis. Conclusion: Malignant tumors were the commonest of the liver lesions with same incidence of primary and metastatic deposits. HCC presented as solitary lesion and deposits presented with multiple SOLs in most of the cases. On radiological examination, neoplastic and nonneoplastic lesions show overlapping features, hence cytomorphological analysis by FNAC increases the diagnostic accuracy.

Keywords: Fine Needle Aspiration Cytology; Ultrasound; SOL; Hepatocellular Carcinoma; Metastatic.

Introduction: Dysfunctional uterine bleeding (DUB) is defined as increased abnormal endometrial bleeding unrelated to any anatomic lesions/ organic pathology of the genital tract [1]. It is a common problem in woman of reproductive age and about 20% of women affected will seek consultation [2]. Objectives: 1.To study morphological features of endometrium in DUB. 2.To correlate with age, parity and bleeding pattern in women clinically diagnosed as DUB. Methodology: Study was conducted for a period of two years (January 2014 to December 2015) in department of Pathology, Shri Nijalingappa Medical College, Bagalkot. Endometrial samples were obtained from endometrial biopsy or from dilatation and curettage (D & C) and studied with routine haematoxylin & eosin slides. Results: A total of 284 samples were received. Maximum incidence of DUB was found in age group 41-50 years (37.32%), followed by 31-40 years (35.56%) in multiparous (71.83%) women presenting with menorrhagia (71.83%). Endometrial hyperplasia was the predominant lesion seen in 46.47%, of which simple hyperplasia without atypia were 32.74%, complex hyperplasia without atypia in 7.40%, simple hyperplasia with atypia in 2.11% and complex hyperplasia with atypia in 4.22%. Proliferative endometrium was seen in 19.71%, secretory endometrium in 10.21%, disordered proliferative phase in 4.93%, irregular ripening in 8.80%, irregular shedding in 1.75%, atrophic endometrium in 2.46%, while 5.62% samples were considered inadequate. Conclusion: No age was exempted from DUB and highest incidence was noted in 3rd and 4th decades with menorrhagia as the commonest bleeding pattern occurring in multiparous women and microscopically endometrial hyperplasia was most commonly found.

Keywords: Dysfunctional Uterine Bleeding; Menorrhagia; Endometrial Hyperplasia.