Indian Journal of Pathology: Research and Practice

Introduction: Tuberculosis (TB) is a major health problem in developing countries. The most common presentation of extrapulmonary TB is peripheral lymphadenopathy. Fine needle aspiration cytology (FNAC) is a most useful procedure in the evaluation of peripheral lymphadenopathy as a possible noninvasive alternative to excisional biopsy. Aims and Objectives: To compare the result of conventional ZN method with fluorescent method of detection of acid-fast bacilli in lymph node aspirate and to study the efficacy and advantages of using fluorescent stain for detection of acid-fast bacilli in lymph node cytology. Material and Methods: FNAC was performed in 227 cases of lymphadenopathypresented to the department of Pathology, SMIMER, Surat. Routine cytology, conventional ZN method and fluorescent method were performed on aspirated smears. The advantages of the fluorescent method over the conventional ZN method was analyzed. Results: Out of 227 aspirates, 16 were excluded from the study due to diagnosis of malignancy and 211 cases were evaluated. Among the 211 aspirates, 56.87% (120/211) were positive for AFB on the conventional ZN method, while the smear positivity increased to 65.40% (138/211) on the fluorescent method. Conclusions: Fluorescent microscopy is speedy and easy method of screening, and it reduces observer fatigue. The fluorescent method has more advantages than conventional ZN method. The fluorescent method has higher bacillary positivity rates as compare to conventional ZN method. Hence, the fluorescent method can be used with routine cytology for the identification of AFB. 

Keywords: Cytology; Fluorescent Method; Tuberculosis; Ziehl– Neelsen Stain. 

Introduction: Accreditation agencies mandate continualbmonitor of pre-analytical, analytical and post-analytical processes. The laboratory process at Histopathology is complex and involves multiple steps. Since interpretation of slide requires good microscopic section, floaters on glass slides can be a source of error. Our study is designed to compound frequency, identify location and processes for origin of floaters and to formulate measures to reduce their incidence. Material And Methods: Twelve various commonly encountered tissue bits/ biopsies were processed together on a same day. Imprint smears taken from the sediment of water bath fluid utilized. The section were stained and examined for number, size, location and tissue type of the floater tissue wherever found. Results: All of the 12 slides revealed floaters with average of one in each section. Most (7/13) were located at edge of slide; most common tissue type of floater was displaced native type (5/13). An ovarian tumor floater found adjacent to endometrium could have led to misinterpretation. Comment: Detection of extraneous tissue contamination in slides rather than blocks implies water bath as the commoner source. A suspect tissue fragment at edge of slide is more likely to be a floater. The study highlights importance of cleaning the water bath to reduce the contamination of slides with floaters.

Keywords: Tissue Floaters; Diagnostic Errors; Contamination.  

Histomorphological study of pediatric brain tumours in children upto fourteen years was done in tertiary care centre for a period of three years. Supratentorial region was most common site. Astrocytoma was the most common tumour reported. Context: To understand the varied histomorphological spectrum of pediatric brain tumour in our setup. Aim: This is a retrospective study to analyse the histopathological profile of brain tumours in the age group upto fourteen years and statistically correlate the frequency of these tumours in the study with that of the literature and to report rare variants. Settings and Design: Observational study of histomorphology of pediatric brain tumours in a tertiary care centre for period of three years. Methods and Material: A total of 100 cases of brain tumours occuring in the age group upto fourteen years during the period from September 2015 to August 2018 were taken for study. Clinical, radiological and histopathological details collected. The tumours were classified according to World Health Organisation classification. The age, sex and site predilection of these tumours were studied along with histological typing. Statistical analysis used:- Results: In age group zero to four years we had 24 cases. In 5-10 years of age we had 45 cases. In 11-14 years we had 31 cases. 52.9% cases were supratentorial in location 47.10% cases were infratentorial. Conclusions: Paediatric Brain tumours were of higher incidence in the age group of five to ten years. Supratentorial tumours are more common than infratentorial. Astrocytoma was the leading brain tumour in paediatric age group except five to ten years where medulloblastoma was the leading one. Choroid plexus papilloma was found highest upto four years of age. Astrocytoma and ependymoma were common in male and Meningioma in female.Medulloblastoma, choroid plexus papilloma and craniopharyngioma have nearly equal distribution with mild male preponderance.

Keywords: Pediatric Brain Tumours; Histopathological Study. 

Background: Testis is affected by various non neoplastic and neoplastic lesions. Non neoplastic lesions include congenital anomalies, inflammatory, infective, vascular lesions, cysts, and atrophy. The incidence of testicular neoplasm is rising in western countries. Incidence in India is relatively rare due to the lack of adequate published data. Objectives: This study was undertaken to analyse the demographic and clinical profile and morphological patterns of testicular lesions. Materials and methods: This is a retrospective study done in a tertiary care hospital in Mangalore, Karnataka. The case records of 78 patients who underwent orchidectomy during 2 years period between July 2016 and June 2018 were retrieved and analysed. Demographic profile, clinical presentation, side of the lesion and histopathology of the lseion were studied. Results: We conducted a retrospective study of 78 patients who underwent orchidectomy, out of which 68 (87%) were non neoplastic and 10 (13%) were neoplastic lesions. Non neoplastic testicular pathology was common in 2nd and 4th decade. Among neoplastic lesions, commonest age group was 31-40 years and 71-80 years (30% each). Testicular pain was the commonest mode of presentation in non neoplastic lesions, while testicular swelling was the most common presentation in patients of neoplastic lesions. Among non neoplastic lesions, testicular torsion and infarction is the commonest (22%) followed by undescended testis (17%). Out of 10 cases of neoplastic lesions, 5 (50%) were seminoma. Conclusion: Non neoplastic lesions of testis are far more common than neoplastic ones. Testicular pain is the commonest symptom in non neoplastic lesions whereas patients with neoplastic lesions present with complains of painless enlargement of testis. Non neoplastic lesions occur in young adults whereas neoplastic lesions occur in young adults as well as elderly and commonly unilateral. Testicular torsion and undescended testis are commonly encountered non neoplastic testicular lesions while Seminoma is the commonest neoplastic lesion.

Keywords: Undescended Testis; Testicular Torsion; Seminoma; Orchidectomy; Histopathology.  

Background: The present study is an attempt to evaluate the causes and clinical manifestations of febrile thrombocytopenia in pediatric age group. Method: A careful history was recorded with general physical examination and detailed systemic examination. This was followed by routine investigations which included complete blood count, total leucocyte count, renal function test, liver function test, PT and INR, urine routine, ECG, USG, X-ray chest were done wherever indicated. Conclusion: Early onset sepsis was found to be the most common etiology of febrile thrombocytopenia among pediatric age group. After fever, the most common clinical manifestation was chills and rigor; and icterus. Most common bleeding manifestation was petechiae commonly seen in cases with severe thrombocytopenia. The clinical presentation of such cases is mostly sufficient to diagnose the condition and start its management. Study Designed: Prospective Observational Study.

Keywords: Clinical; Manifestations; Thrombocytopenia; Children & Fever. 

Context: A major risk of blood transfusion is transmission of infectious diseases, few of which have clinical importance. Many of these infectious agents may cause death or prolonged illness. Therefore it is necessary to understand the organisms which could be transmitted through transfusion of blood and its components, and means by which this could be prevented. Aims: Screening of blood for transfusion transmitted infections like HIV 1 & 2, Hepatitis B & C, Syphilis and Malaria to ensure safe blood transfusion. Methods and Material: The present retrospective study was carried out at the regional blood bank of a tertiary care hospital attached to a government medical college. Data over a period of 5 years (January 2013 to December 2017) was collected from the records of the blood bank. Statistical analysis used: After data collection, data entry was done in MS Excel. Data was analyzed with the help of frequency and percentage table. The association among various study parameters was assessed with the help of Chi-square test. p value < 0.05 was considered as statistically significant. Results: The overall prevalence of HIV, HBV, HCV and Syphilis were 0.095%, 0.563%, 0.007% and 0.001% respectively among total 66,000 blood units collected. All donors were seronegative for Malaria. Conclusions: There is a need for careful selection of voluntary blood donors and screening procedures can improve the blood safety. NAT (Nucleic Acid Amplification Test) should be included for all important viral infections with a view to bring down the window period of these infections and cases with low viremia.

Keywords: Blood Donors; Seroprevalence; Transfusion Transmitted Infections.  

Background: Dengue fever is the most common arbovirus infection in the world. Clinical manifestation range from fever to dengue shock syndrome (DSS). Clinical diagnosis can be difficult, as its presenting signs and symptoms can easily be confused with other febrile illnesses. Though specific diagnostic tests like NS1 antigen and dengue specific IgM antibody by immunochromatography are currently available for rapid diagnosis and early management in secondary and tertiary care centers, resource limited settings have problems with the early detection, due to non availability of such expensive diagnostic tests. Also, specific tests for monitoring the disease activity, has not come in to regular practice till date, in many parts of the world. Hence, in addition to early and accurate diagnosis, early markers of progression to severe disease are urgently needed. Aim of the study: To emphasize the importance of peripheral smear examination in the early assessment and monitoring of disease activity in patients with dengue fever. Methods: A prospective study of one year (January 2017 – December 2017), during which 132 patients with dengue fever (78 cases positive for NS1 antigen and 54 cases positive for anti Dengue IgM antibody), tested and confirmed by tests for NS1 antigen and Anti Dengue IgM antibody were selected for the study and their peripheral smears were simultaneously examined and the findings were noted and compared. The patients were followed up with serial platelet counts and band forms during their hospital stay. Results: The peripheral smear findings noted for all the 132 dengue positive patients were leucopenia (91%), neutropenia (89%), bandemia (80%), reactive lymphocytosis (95%) and thrombocytopenia (84%). There were 6 cases of dengue hemorrhagic syndrome and all such patients had very low platelet counts (<50000) and bandemia >15%. In all the cases, clinical improvement was consistently associated with rising platelet count along with clearance of band forms. Conclusion: These peripheral smear findings are consistently present in majority of the patients with dengue fever. Such findings can be considered for diagnosis and monitoring the disease activity of dengue fever, especially in resource limited settings for early diagnosis and effective management.

Keywords: Dengue; Bandemia; Thrombocytopenia; Reactive Lymphocytes; Leucopenia.  

Background: Micronucleus test is an excellent biomarker for predicting the cancer risk and can be successfully used to screen the population groups who are at risk for cervical cancer. It can be used to detect cervical cancer is preclinical asymptomatic phase. Aim: The aim of our study is to compare the micronucleus score in the spectrum of cervical lesions and to evaluate the role of micronucleus in assessing the risk of cervical cancer. Materials and methods: It is a retrospective study done in the Department of Pathology, Narayana Medical College and Hospital, Nellore, Andhra Pradesh, India for a period of 6 months from April 2018 to September 2018. Total number
of 67 conventional Pap smear cases were studied. MN score was expressed as the number of micro nucleated cells present per 1000 epithelial cells. Results: In all the categories, single micronucleus is more common when compared to multiple micronuclei (P=<0.001). Multiple micronuclei were more common in HSIL and invasive carcinoma when compared to other categories. There is gradual increase in micronucleus score from normal category to invasive carcinoma. The difference in mean micronucleus score in HSIL and invasive carcinoma when compared to other categories is statistically significant (p=<0.0001). Conclusion: Micronucleus scoring is an easy, simple, reliable and reproducible objective test which can be done on routine conventional Pap smear. Individuals who have risk factors for cervical cancer must be screened for this simple micronucleus count along with their cervical smear examination. 

Keywords: Biomarker; Cervical Cancer; Micronucleus; Pap Smear.  

Background: Lymphadenopathy is a common clinical complaint and has many causes/etiologies Both benign and malignant conditions can present with lymphadenopathy. FNAC in metastatic lymph nodes has acquired very wide acceptance in medical and surgical field since it offers several outraging advantages to patients and physicians alike. Aims: This is a baseline study to evaluate the cytomorphological patterns of metastatic lymphadenopathy, the age and sex distribution of the patients and to study the pattern of lymph node involvement. Methods: This retrospective study included all the outdoor and indoor patients with metastatic lymphadenopathy diagnosed in our institution by FNAC. Results: 117 cases of metastatic lymph nodes were diagnosed by FNAC. Cervical lymph nodes are the most commonly involved group of lymph nodes and Squamous cell carcinoma is the most common cause of metastatic lymphadenopathy. Conclusion: FNAC plays a very important role in the diagnosis of metastatic lymphadenopathy. Being a simple and minimally invasive test, FNAC in the hands of a skilful experienced cytopathologist avoids the need for more invasive excision biopsy.

Keywords: FNAC; Metastatic Lymphadenopathy; Squamous Cell Carcinoma; Malignancy; Lymph Nodes. 

Introduction: Breast cancer is the leading cause of death in females, whose meticulous evaluation is required for an early diagnosis. Aims and objectives: In our study we evaluated the role of triple assessment in diagnosing breast cancer and its sensitivity and specificity with regards to histopathology (HPE). Materials and methods: A total of 235 cases were included in our study who presented to OPD with lump in the breast and evaluated by triple assessment which includes clinical examination, mammography, FNAC and correlated with histopathology findings.Results:Out of 235 cases presented with breast lump, most seen in mean age group of 43 yrs. Each modality in triple assessment is correlated with HPE findings to elicit positive predictive value (PPV), negative predictive value (NPV), sensitivity (Sn), specificity (Sp). 1.- Clinical examination on comparison with HPE shows PPV, NPV, Sn, Sp as 91.4%, 99%, 98.5, 86.5 respectively. 2.-Mammography on comparison with HPE shows PPV, NPV, Sn, Sp as 100, 99, 100, 94.6 respectively. 3.- FNAC on comparison with HPE shows PPV, NPV, Sn, Sp as 92.3, 99.5, 98.5, 97.3 respectively. Conclusion: Triple assessment is a gold standard technique for assessing breast lesions. Optimal use of triple assessment helps not only in timely accurate diagnosis but also to relieve the psychological burden of the patients.

Keywords: Breast Disease; Triple Assessment; FNAC.  

Context: Thyroid fine needle aspiration cytology (FNAC) is used extensively to identify the nodules that require surgery and helps to decrease the overall incidence of thyroidectomy in patients with benign disease. Aim: The aim of this study was to study the various cell patterns, the cellular details and background elements observed in FNA smears of thyroid lesions and to correlate with the histological diagnosis. Settings and Design: This retrospective study was conducted in the Department of Pathology, Sree Balaji Medical College & Hospital, Chennai. Methods and Material: 148 FNAC slides of thyroid lesions were studied for the predominant cell pattern, cell morphology and background. The cell patterns observed were Normofollicular/Macrofollicular, Microfollicular, Papillary, Syncytial, Dispersed and Cystic. The cytological diagnoses were compared with the histopathological diagnosis wherever possible. Histopathology was available for 86 cases. Statistical analysis used: The results were tabulated and analysed with IBM SPSS version 20. Results: The correlation between predominant cell pattern, cell type and background with the histopathology, using Kendall tau-b Correlation and Kappa Measure of Agreement (κ), was high. Conclusions: We conclude that analysis of the predominant cell pattern in combination with the cellular morphology and background, serves as a valuable tool for the interpretation of fine needle aspirates of thyroid lesions.

Keywords: Thyroid; Cell Pattern; Follicular; Papillary; Syncytial; Cystic.

Introduction:Blood group antigens can be immunogenic in individuals in whom the corresponding antigen is absent on the red blood cells. This mismatch can occur during transfusion
or pregnancy. Aim of the Study: To estimate the prevalence of unexpected red cell antibodies in multigravida women requiring transfusion support. Materials and Methods: This cross-sectional study was carried out in the department of Transfusion Medicine, over a period of one year from Nov. 2015 to Oct. 2016. The study was conducted on 414 blood samples of multigravida antenatal women requiring transfusion support. Data was entered into Microsoft excel and statistical analysis was performed using SPSS software (version 20). Results: During the study period, 414 multigravida women were screened for the presence of red cell alloantibodies. Majority in this study were in the age group of 26 to 30 years. Among the study population, 91.3% were Rh D positive and 8.7% were Rh D negative. Most of the study population belonged to the B positive blood group (29.47%). Most of the mothers were in gravida 2. The overall prevalence of unexpected red cell antibodies in multigravida women was 1.69% [Antibodies identified were Anti D (57.14%), Anti s, Anti Fyb, Anti D & C]. Conclusions:etection and identification of red cell antibodies in patients before transfusion is important to avoid the formation of antigen antibody complexes in vivo which would lessen the survival of the transfused cells.

 Keywords: Unexpected Red Cell Antibodies; Antibody Screening; Blood Transfusion. 

Introduction: In women, breast lesions are one of the most commonly encountered lesions. Lesions may be benign or malignant, pathological confirmation of the nature of any mass in the breast is needed by all physicians for proper management of lesions. Fine Needle Aspiration Cytology (FNAC) and breast ultrasound is important in the characterization of breast lump to differentiate benign from malignant disease so all palpable breast masses require proper workup, early diagnosis and management. Aim: 1  To correlate and to evaluate the role of cytology and radiology in diagnosing breast lesions. 2. To decrease unnecessary surgery in benign conditions. Materials and methods: 100 patients with breast lumps were examined clinically, evaluated with Radiology and FNAC by using PAP, H&E, and Geimsa stains. Hence, correlation vof Radiologic and cytologic findings is important for diagnosing and management of breast carcinoma and to reduce unnecessary surgery in benign conditions. Result: Total 100 cases were evaluated by FNAC and radiologically, among which 88 cases have same results and among them 50 cases were confirmed histologically. Conclusion: Considering patient’s comfort, lack of requirement of anesthesia, simple to perform, cost effective, rapid analysis and reporting makes FNAC an ideal initial diagnostic modality in breast lumps.

 Keywords: Breast Lesions; FNAC; Radiology. 

Background: p63 is a member of p53 family of transcription factors which have important function in tumorogenesis and oncogenesis. It is involved in cellular differentiation and exposed in nuclei of myoepithelial cells of normal breast. Aim: To study immunoexpresion of p63 in the benign, insitu, and invasive ductal carcinoma of breast. Material and Methods: The present study was conducted on 110 cases of formalin fixed paraffin embedded histological sections of surgically resected breast tissue specimens suspected to have neoplastic lesions and mastectomy specimens already diagnosed as carcinoma on cytology for a period of one year. Result: p63 is strongly expressed in all benign breast lesion in form of continuous peripheral rim around ductal epithelial cells, except atypical ductal hyperplasia in which moderate expression of p63 was noted in form of scattered as less continuous rim of myoepithelial cells similarly moderate to weak expression with focal gaps was described in ductal carcinoma of in situ and no expression was noted in infiltrative ductal carcinoma. Conclusion: p63 is a hallmark of very poorly differential cells or cells component with higher histological grade in breast carcinoma. Hence p63 can be used as an indicator of aggressiveness of breast carcinoma as a marker of choice in differentiating benign and malignant breast lesions. 

Background: HER-2/neu is a gene localized on chromosome 17q21 which encodes a growth factor receptor like molecule with tyrosine kinase activity and is known to encode a transmembrane glycoprotein. Aim: To study the expression of HER2/neu in benign and malignant lesions of cervix. Material and Methods: The present study was conducted on 100 cases of resected cervical tissue specimen suspected to have neoplastic lesions and hysterectomy specimen already diagnosed as carcinoma on cytology for a period of 12 months (September 2018 to August 2019). Results: Majority of benign cases were negative for HER-2/neu except few cases and positivity was higher in malignant than premalignant. Positivity was also higher in adenocarcinoma as compared to squamous cell carcinoma. Conclusion: HER-2/neu serves as a biological marker to identify high risk subgroups and can be useful as target for new treatment modalities.

Context:Multiple myeloma is a malignant neoplasm of plasma cells involving the bone marrow. Before entering into aggressive phase, there is a frequent occurrence of extramedullary manifestations. The sites of predilection for extramedullary plasmacytoma are nasopharynx, larynx and upper respiratory tract. Aims: The aim of this present study is to highlight the importance to have high index of suspicion to consider a diagnosis of plasmacytoma based on histomorphological features even in the absence of classical clinical findings. Settings and Design: This study was done as a retrospective study in Coimbatore Medical College Hospital, Coimbatore over a period of 6 months from November 2017 to April 2018 in cases diagnosed as plasma cell lesions. Methods and Materials: 14 Cases of incidentally diagnosed plasma cell myeloma in a period of 6 months were taken. Out of these, 6 cases presented as soft tissue lesions,
3 cases as viscera - organ involvement and 5 cases as lytic lesios of bone. Immunohistochemical confirmation was done with CD 138, kappa and lambda. Results: Fine Needle Aspiration was done for all soft tissue lesions and was reported as plasmacytoma. Subsequently biopsies also proved the same. CD 138 was positive in all cases, kappa in 3 cases and lambda in 11 cases. Two cases were non secretory myeloma with negative serum M protein and urine Bence Jones protein. Conclusions: Soft tissue lesions in patients over the age of 50years should always include a diagnosis of plasmcytoma when sheets of plasma cells are seen. CD 138 showed 100% sensitivity,
with lambda expression in plasma cell myeloma with multiple bony and subcutaneous lesions. Kappa was positive in cases with visceral involvement. 

Background: Anemia is an important health problem worldwide and particularly in children. It affects their growth and social performance and may lead to morbidity and mortality. The main objective of the study was to determine the morphological types of anemia and to assess their etiological factors by necessary investigations. Material and Methods: Duration of study period was two years from July 2013 to June 2015. The first 100 cases in this period were taken for study. Children within age group from 6 months to 13 years attending NRIGH pediatric and oncology department who were clinically diagnosed as anemic were selected for study. A detailed history was recorded and necessary investigations were done. Results: The maximum number ofpatients were in the age group of 1 year to 5 years (50%). There was a male preponderance (56%) as compared to females (44%). Moderate degree of anemia was found in maximum number of cases and in preschool children, while severe and mild degrees of anemia were seen in school going children. Microcytic hypochromic anemia (61%) was the most common morphological type of anemia and macrocytic anemia (4%) was least common. Iron deficiency anemia (56%) was the common etiological type among nutritional anemias and in hemolytic anemias, β thalassemia major (63.6%) was common. Conclusion: Study of patterns of anemia is essential to direct the investigation since it reflects the underlying etiopathological factors. This aids in better management and treatment of the anemia which goes a long way in improving quality of life.

Context: Endometrial carcinoma is one of the most common malignancies occurring in postmenopausal females. Endometrial carcinomas are of two types, type I and type II. Type I is the most common encountered type of endometrial carcinoma. Aim: The aim of this study was to study the spectrum of histomorphology of endometrial carcinomas with special reference to immunohistochemical findings including ER PR and p 53. Methods and Material: This was a prospective study conducted over a period of eighteen months. Thirty cases of endometrial carcinomas were included in the study. The diagnosis of endometrial carcinoma was confirmed after microscopic examination. Immunohistochemical expression of ER, PR and P53 was studied. Statistical analysis: Correlation between the histopathological results and immunohistochemistry results were calculated by using chi square tests and test of sample proportion. Results: The association of histologic type I of endometrial carcinoma with estrogen receptor and progesterone receptor was significant with the p value less than 0.01 and 0.05 respectively. The association of histologic type II of endometrial carcinoma with p53 was significant with the p value less than 0.05. Conclusion: In the present study, significant association was noted between estrogen and progesterone receptor in type I endometrial carcinoma and between type II endometrial carcinoma and p53. The expression of ER and PR were found to be related to disease recurrence, reports suggest that ER, PR and p53 status, as determined by IHC, can be used as an independent predictor for disease recurrence. 

Introduction: The present study was done to compare the diagnostic accuracy of Fine Needle Aspiration Cytology (FNAC) in differentiating the benign and malignant lesions of palpable breast lumps with histopathological correlation and alsoto study the accuracy of FNAC procedure. Materials and Method: A retrospective study was done for a period of one year from January 2017 to January 2018. Fine needle aspiration was carried out in Department of pathology by pathologist, slides were stained with May-grunwald Giemsa morphology was studied, lumpectomy, wide excision and modified radical mastectomies were received depending on diagnosis on cytology. FNAC and biopsy results were correlated. Results: The most common age group for benign lesions were between 11 to 40 years and for the malignant lesion was 41 to 70 years. Fibroadenoma was most common among benign neoplasms and infiltrating ductal carcinoma (IDC) constituted highest number of cases among malignant neoplasms. Total benign cases were 22 and malignant were 11, premalignant (2 fibrocystic disease with atypia and 1 atypical ductal hyperplasia), and granulomatous mastitis were 2 out of total 38 cases. Conclusion: FNAC of the breast lump is an OPD based diagnostic method for determining the nature of the breast lump. It is safe, minimally painful, without anesthesia. Requiring only syringe, needle, glass slides and fixatives. Repeat FNAC can be performed if necessary. Best screening method required for categorization of different lesions of breast which aids in prevention of cancer and proper management of lesions. 

Background: Diabetes mellitus is one of the most common diseases with hyperglycemia as the main etiological factor. Elevated blood sugars in the body are a predisposing factor for thrombosis. Vascular complications are a cause of the morbidity in diabetics. Mean Platelet Volume and Platelet Distribution Width are the platelet indices which are elevated in a thrombogenic state. Thus we have evaluated the role of these two parameters in type II diabetics. ims: • To calculate the Mean platelet volume and Platelet distribution width in both controls and cases • Correlate these indices with HbA1c, duration of diabetes and the presence of vascular complications in diabetics. Settings and Design study: Prospective. Methods and Material: A one year prospective study was done. 150 subjects were included divided into cases and controls. Cases were again divided into those with vascular complications (23) and those without vascular complications (52). Platelet indices were studied with special emphasis on Mean platelet volume and Platelet distribution width among both cases and controls. These were compared with glycosylated hemoglobin, duration of diabetes and presence of vascular complications. Statistical analysis used: SPSS. Results: Mean platelet volume and Platelet distribution width were elevated in diabetics when compared to non-diabetics and the increase was more relavant in those with complications. Statistical significance was seen with Mean platelet volume but not with Platelet distribution width. Conclusion: Our study thus highlights the differences in platelet indices among diabetics and non diabetics with emphasis on those with vascular complications. 

Background: Fine needle aspiration cytology (FNAC) is applied as the primary tool for the diagnosis in breast masses because of its ease and rapidity. However, it is a largely subjective tool.
The morphological overlap among the sequential lesions from the precancerous group to frank carcinoma further cause “gray zone” in cytology, estimated to constitute 8.9%. Morphometry is the measurement of cell parameters microscopically by image analysis. The present study has been undertaken to evaluate role of nuclear morphometry in benign and malignant breast neoplasms. Aim: To classify breast lumps according to guidelines given by UK National Health Service Breast Screening Program (NHSBSP) and to compare the nuclear morphometry among those categories. Setting and design: A retrospective-prospective study. Material and Methods: Cases with palpable breast lumps were evaluated by FNAC and were cytologically classified according to UKNHSBSP guidelines. Nuclear Morphometric parameters: nuclear area, perimeter, long and short axis and diameter were studied and compared within the various categories. Statistical Analysis used: Student’s t test was used as the test of significance. Result: Mean age was 37.7 years. 47.3% cases belonged to Category C2 (benign), 6.8% cases to Category
C3 (atypia probably benign), 17.6% cases Category C4 (suspicious of malignancy) and 27% belonged to Category C5 (malignant). The nuclear morphometric parameters including nuclear area, perimeter, short axis, long axis and diameter were found to be statistically significant (p<0.05) in differentiating between benign and malignant categories. Conclusion: Nuclear morphometry serves as a valuable method in distinguishing benign and malignant breast aspirates and also correlates well with the cytological categories. 

Introduction: Mast cells in the tumour microenvironment have both pro-tumorigenic and anti-tumorigenic roles and play a major role in determining the progression of the tumour including metastatic potential. The present analysis was undertaken to assess their role in the metastatic potential to regional lymph nodes in gastric carcinoma. Methods: Tissue from fifty three cases of gastricgastric carcinoma including fourteen endoscopic biopsies and fourteen gastrectomy specimens were 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 not statistically significantly different in regional lymph nodes without microscopic metastatic deposits (n= 71; Mean±SD: 1.5±0.67) compared to lymph nodes showing metastatic deposits (n=74; Mean MCD±SD: 1.2±0.42). Conclusions: Our results indicate that the role of mast cells in gastric carcinoma especially metastatic potential to regional lymph nodes is equivocal, in sharp contrast to our previous study in breast carcinoma which indicated a protective role. This could also be explained by the participation of mast cells in the benign inflammatory stages even before the onset of gastric carcinoma, a phenomenon that is not seen in breast carcinoma

Background: Cutaneous adnexal tumor is a collective term for tumors arising from various adnexal units of the skin. These tumors share many common features even though they differentiate along one line. Adnexal tumors are relatively uncommon and they pose a diagnostic difficulty due to morphological overlap. They are classified according to appendageal differentiation. These tumors have to be differentiated from other primary cutaneous neoplasm and cutaneous metastasis. Adnexal tumors are significant because some can give a clue to the association of internal visceral malignancy. Methods: All adnexal tumours showing sweat gland differentiation diagnosed over the period of 5 years was studied. The Haematoxylin and Eosin stained slides were analysed for patterns to differentiate each entity from other cutaneous tumours. Result: Thirty adnexal tumours were diagnosed over a period of 5 years. Clinical presentations varied from discrete swellings and nodules to ulcerated masses. Most of the lesions were distributed in the head, neck and extremities. Histologically 26 cases were benign and 4 cases were malignant. Majority of the tumours were encountered in females (18 out of 30). Commonest tumour encountered was eccrine poroma followed by eccrine spiradenoma and Syringocystadenoma papilleferum. Malignant tumours encountered were Porocarcinoma and hidradenocarcinoma. Conclusion: Cutaneous adnexal tumors are complex due to their diverse origin and varied histological appearance. Sweat gland tumors are the commonest tumors encountered. Many of these entities have morphological overlap. Although majorities of adnexal tumors are benign, malignant counterparts are also rarely encountered, causing further diagnostic difficulties. Hence thorough histopathological examination is required for final diagnosis. 

Background: Neonatal sepsis is one of the important causes of morbidity and mortality in the neonatal period. Objectives: To analyse the hematological findings according to Rodwells hematological scoring system and correlation with blood culture. Materials and methods: A Total of 120 neonates were included in the study. Blood samples from 120 neonates were subjected to blood culture and Hematological scoring system (HSS). They were divided in to 3 groups i.e group 1 (proven sepsis - 32), group 2 (probable sepsis - 56) and group 3 (Normal infant - 32). Results: Out of 120 infants, 32 had positive blood culture. Majority (66.6%) were preterm. Male to female ratio was 1.7:1. Out of 32 sepsis cases, 27 (84.3%) had predominant score was 5 >. Maximum number of cases 31 (55.31%)) showed score with 3-4 in probable sepsis group. Association of hematological parameters and scores was found to be statistically significant (p<0.05). Majority of parameters found to have high sensitivity while platelet count and Total Neutrophils count (TNC) had high specificity. Combination of hematological tests found to have high sensitivity and specificity when compared to single hematological test. Conclusion: Hematological scoring system is easy, cheap and cost effective screening tool for early diagnosis of neonatal sepsis. 

Keywords: Hematological Scoring System; Hematological Parameters; Culture; Neonatal Sepsis.

 

 Background: Intraoperative squash cytology is a simple and reliable technique for rapid intraoperative diagnosis of neurosurgical specimens. Intraoperative squash cytology is a fairly accurate diagnostic modality which can be used in place of frozen sections. Aim: To assess the diagnostic accuracy of the squash preparation and to compare it with the histopathology sections. Materials and Methods: This study was conducted over a period of eight 8 years (May 2010 to June 2018) which included 131 patients with CNS lesions. The cytological preparations were stained by the rapid H & E method. The squash interpretation was compared with the paraffin section diagnosis. Results: Of the 131 patients, Squash cytology diagnosis was offered in all the cases. With hematoxylin and eosin-stained histopathology sections as the gold standard, the diagnostic accuracy of squash cytology was 95.4% (125/131). Among these cases, gliomas formed the largest group comprising of 50 cases (38.1%). The accuracy of squash cytology in this group was 94% (47/50). Conclusions: CNS squash preparations can be used for rapid and reliable intraoperative diagnosis for CNS lesions. 

Keywords: Central Nervous System Lesions; Intraoperative  Diagnosis; Squash Preparation.

 L-lactate is the end product of anaerobic glycolysis. It is derived predominantly from white skeletal muscle, brain, skin, renal medulla and erythrocytes. Lactate dehydrogenase catalysis the reduction of pyruvate to lactate. There are two major clinical settings in which lactic acidosis occur: (1) Conditions associated with hypoxia e.g. shock, congestive heart failure, myocardial infarction, blood loss and pulmonary edema. (2) Metabolic or drug/toxin related disorders like diabetes mellitus, hepatic disease and neoplasia. Objective of study is to find out the variation of lactate level in diabetic patient taking hypoglycemic drugs and also the correlation between fasting blood glucose and lactate in diabetic patients. It is an observational study in which 50 control subjects (fasting blood sugar 110 mg/dl) considered as case, all diabetics irrespective of treatment (OHA/Insulin). Age group 35-70 yrs. Lactate level ≤1.9 taken as normal. Lactate level among control group found to be 1.12±0.18 (mean±SD) with fasting blood sugar level found to be 92.99±5.64 (mean ± SD). In control group lactate level among control group found to be 2.03±0.23 (mean±SD) with fasting blood sugar level found to be 115.28±2.83 (mean±SD). The two-tailed pvalue is less than 0.0001. By conventional criteria, this difference is considered to be extremely statistically significant. In this, the lactate level found to be 2.03±0.23 among case group. This study also shows that after using metformin some individuals have fasting blood sugar more than 110 mg/dl 115.28±2.83.There is slight increase in lactate level among case group 2.03±0.23 These observations suggest that accumulation of metformin may not be as significant with respect to high arterial levels of lactate. 

Keywords: Diabetes Mellitus; Blood Sugar Level; Metformin; Lactate Level; Lactic Acidosis.

 Introduction/Background: The aim of the present study is to determine the expression of p16INK4a and its prognostic utility in the head and neck squamous cell carcinomas (HNSCC). Squamous cell carcinoma of the head and neck is a major public health problem in developing countries. A subset of head and neck cancer is associated with the human papillomavirus (HPV) [1]. Viral infection is closely correlated with expression of p16INK4a in these tumours. p16INK4a is the strongest independent prognostic marker in HNSCC and is associated with favourable prognosis [1]. Materials and Methods: The present study is retrospective study done during the period from June 2016 to July 2017. A total of 52 cases were taken and histological grading was done according to WHO criteria. p16INK4a expression was determined by immunohistochemical staining on the paraffin embedded tissue sections. Results: Out of 52 cases, 41/52 cases (78.8%) were positive for p16INK4a and remaining 11/52 cases (21.2%) were negative for p16INK4a. Expression of p16INK4a was graded accordingly. Conclusion: p16INK4a is an independent prognostic marker for HNSCC. p16 protein overexpression is very sensitive for the presence of transcriptionally active HPV and is widely available and also easy to interpret the test result. Expression of p16INK4a has major impact on treatment response and survival in patients with HNSCC. 

Keywords: Head and Neck Squamous Cell Carcinomas (HNSCC) 

 Introduction: Breast lump is the commonest presentation of breast diseases. Diagnosis of breast diseases can be made out based on history, physical examination and investigations, like cytology, histology and radiology. Several studies have shown that triple tests consisting of clinical, cytopathological and radiological examinations are more accurate, when all the three are positive; the accuracy approaches almost 100% for malignancy. Materials and methods: A 3 years retrospective study was performed in the Department of Pathology in a tertiary care centre. The cytological slides and corresponding histological slides were retrieved from the archives, and the cytological smears of palpable breasts were assessed. Statistical analysis: concordance study between conventional, MMSI and comparison with Histopathology.

Results: A total 226 patients with palpable breast lump were included in the study. A total of 18 cases were diagnosed by histopathology and there was 100% correlation between conventional and post MMSI diagnosis. A total of 144 cases were diagnosed in this category by histopathology 134 (94.4%), cases showed correlation, whereas 2 (1.4%) were under diagnosed as non proliferative breast diseases and 6 (4.2%) were over diagnosed as carcinoma by conventional cytology. Proliferative breast diseases with atypia. Out of 6 cases diagnosed on histopathology, MMSI showed 100% correlation, whereas conventional cytology 2 cases were under diagnosed as category 2 and 2 cases were correctly categorized as category 3, and 2 cases were over diagnosed as category 4. Carcinoma in situ/ Carcinoma. Out of 58 cases diagnosed by histopathology, 52 (89.7%) showed correlation with MMSI and conventional smears. 6 (10.3%)cases were under diagnosed and categorized as category 3 by MMSI. 4 cases (6.9%) were under diagnosed and categorized as category 2 and 2 cases (3.4%) were under diagnosed and categorized to category 1 by conventional cytology. Conclusion: The present study concludes that Masood’s modified scoring index has better diagnostic accuracy than conventional cytology method in diagnosing proliferative breast diseases without atypia and proliferative breast diseases with atypia, which is very useful in management of patents. 

Keywords: Breast Carcinoma; Fine Needle Aspiration Cytology; Tumor Grading; Proliferative Breast Diseases; Atypia.

 Background: Soft tissue tumors are mesenchymal proliferation, that occur in extraskeletal, non-epithelial tissue of the body, excluding the viscera, covering of brain and lymphoreticular system. Benign tumors are more common than malignant soft tissue tumors. Histopathological examination of soft tissue tumor is gold standard method for initial diagnosis and management of patient accordingly. Aims & Objectives: 1) To study the occurrence of soft tissue tumors in relation to age, sex and anatomical site distribution. 2) To study histopathological spectrum of soft tissue tumors. 3) To study frequency of occurrence of benign and malignant soft tissue tumors. Material and Methods: This retrospective study include total 97 soft tissues biopsy specimens which were received from January 2015 to July 2018. After processing and microscopic examination of tissue sections histopathological diagnosis given and tumors were classified according to WHO classification and result were correlated with clinical details of patient. Result: Peak age of incidence of soft tissue tumors was between 2nd to 5th decades. Male: Female ratio was 1:1. Benign tumors (97.93%) were more common than malignant tumors (2.06%). Most common soft tissue tumor was adipocytic tumors. Conclusion: Proper gross examination of the specimen and adequate sampling of the tumors and histopathological diagnosis of tumor by light microscopic evaluation of H&E stained sections remain the gold standard technique for initial diagnosis and further management of soft tissue tumors and is sufficient for the majority of cases. 

Keywards: Soft Tissue Tumor; Histopathology; Benign; Malignant 

CMF is said to be the most uncommon benign tumors in the oral cavity. Very few cases in the oral cavity have been reported so far. Its uniqueness & rare occurrence in the Head & Neck area has made us report the dental image of the same.

Keywords: Chondromyxoid Fibroma; Benign Tumor; Giant Cell Tumor. 

Introduction: The skin is the largest organ of the body. Skin tumors are abnormal growths of tissues that can be malignant or benign. Tumors of cutaneous appendages are uncommon, classified into tumors of sweat gland, hairfollicle and sebaceous gland. Aim: To study the spectrum of skin and adnexal tumors with respect to age, sex, and histopathological pattern. Materials and Methods: Present study is a retrospective study from Jan 2016 to June 2017 at department of pathology Shimoga institute of medical sciences, shimoga. All the specimens of skin /cutaneous adnexal tumors were analyzed and lesions were categorized according to WHO classification system. Results: out of 50 skin tumors, 38 were benign and 12 were malignant with benign to malignant ration of 3.16:1. Incidence of benign epidermal/keratinocytic tumors were highest 29 cases (58%), followed by adnexal tumors 13 cases (26%) and melanocytic tumors 8cases (16%). Maximum number of benign tumors was seen in 3rd and 4th decade of life and malignant tumors in 6th and 7th decade of life. Conclusion: Benign tumors were common in middle age where as malignant tumors showed an ascending trend in age. Most of the tumors were male predominant .Melanocytic tumors were female predominant. Keratinocytic tumors were the commonest lesion which included warts, seborrheic keratosis and fibroepithelial polyps (8% each). Among the malignant tumors squamous cell carcinoma (SCC) was commonest (66.6%) followed by basal cell carcinoma (22.2%).

Keywords: Skin/ Adnexal Tumors; Age; Sex Distribution. 

Background: Soft tissue tumors are defined as non epithelial, extra skeletal tissue of the body exclusive of the reticulo-endothelial system, glia, and supporting tissue of various parenchymal organs. Soft tissue tumours constitute a large and heterogenous group of neoplasms. WHO has classified soft tissue tumors in different categories like Adipocytic tumors, Fibroblastic/Myofibroblastic, Fibro-histiocytic, Smooth muscle, Pericytic, Skeletal muscle, Vascular, Chondro-osseous & tumors of uncertain differentiation. These are further subdivided into benign, intermediate & malignant. This study aims to analyze the histopathological findings of soft tissue tumors and their distribution according to age, sex and site of occurrence in patients. Aims and Objectives: To study the macroscopic and microscopic pathology of benign and malignant soft tissue tumour and there clinico-pathological correlation at rural set up. Materials and Methods: The study was conducted in Indian Institute of Medical Sciences Medical College, Warudi Dist. Jalna, from 1st of January 2017 to November 2017. A Cross sectional study of 151 cases of soft tissue tumors were carried out in details. A pretested proforma was used to classify each tumor and details like age, sex, clinical features, gross and microscopic findings were noted. Results: The most common soft tissue tumor in the study were benign tumors (139 cases), followed by malignant (8 cases) and four cases were reported as intermediate. Lipomas were the most common benign tumors accounting for 99 out of 139 cases. Benign peripheral nerve sheath tumors were the next most common tumor accounting for 22 cases. Benign vascular tumors (10) and benign Fibroblastic-Myofibroblastic tumors (5) accounted for 15 cases. Of 10 cases of benign vascular tumor, all cases were of hemangioma. Of 22 benign peripheral nerve sheath tumors, 12 cases were reported as neurofibroma and 10 schwannomas. Of 7 cases of Fibrohistiocytic tumor, 3 cases were benign, 2 cases of intermediate (Dermatofibrosarcoma protuberance) and 2 cases of malignant fibrous histiocytoma (MFH). Of 8 cases of Fibroblastic/Myofibroblastic tumor, 5 cases were of Benign and 3 cases of malignant variant (Two Fibro sarcoma and one low grade fibromyxoid sarcoma). 8 out of 151 cases were malignant tumors, 2 cases were malignant fibrous histiocytoma (MFH) and 2 were fibrosarcoma whereas malignant peripheral nerve sheath tumor (MPNST), Liposarcoma, low grade fibromyxoid sarcoma and Embryonal Rhabdomyosarcoma accounted for one case each. Conclusion: Benign soft tissue tumors outnumbered malignant tumors by a ratio of 17:1. Lipomas were the most common benign tumors and Malignant fibroblastic/Myofibroblastic tumors were the most common malignant tumors in the present study. Most patients with soft tissue neoplasm presented with painless mass. Sarcomas, for the most part develop as deeply located mass. Hematoxylin and eosin stained sections represented the mainstay of diagnosis.

Keywords: Tumors; Hematoxylin; Fibrosarcoma; Parenchymal Organs. 

Background: Micronuclei (MN) scoring has been used as a biomarker of chromosomal damage, genome instability and cancer risk. Micronuclei scoring can be exploited in the screening of high risk population of a specific cancer. Aims: 1. to score the micronuclei in the fibroadenomas and infiltrating ductal carcinoma (IDC). 2. To compare the micronuclei scores in fibroadenomas and various grades of infiltrating ductal carcinomas. Methodology: A retrospective study was done in the Department of Pathology including thirty cases of fibroadenoma and thirty cases of infiltrating ductal carcinoma. Micronuclei scoring was done on Papanicolaou and Hematoxylin and Eosin stained smears of these cases. Carcinoma were graded by Robinson cytological grading. Statistical analysis was done to assess the difference in MN scoring between the Fibroadenoma group and IDC. Results: Mean micronuclei score range was 1.9±1.7 in Fibroadenoma and 25.1±11.7 in Infiltrating duct carcinoma. It was 20.2±10.3, 23.1±9.5 and 29.9±12.4 in IDC cytological grades 1,2 and 3 respectively. Statistical analysis showed significant increase in MN score in ductal carcinoma when compared with fibroadenoma.

Keywords: Micro Nuclei; Fibroadenoma; Infilreating Ductal Carcinoma.

Introduction: Computed Tomography (CT) guided percutaneous fine-needle aspiration cytology (FNAC) of suspicious lung lesions is a widely accepted diagnostic method with relatively low cost, negligible mortality and limited morbidity. CT guided FNAC is helpful in distinguishing between benign and malignant lesions and confirming the diagnosis which would help the clinicians in deciding the therapeutic management. Aims and Objectives: The purpose of this study is to evaluate the pathological spectrum of lung lesions through CT guided FNAC. Material and Methods: This is a retrospective study which was carried out in the department of Pathology, Yenepoya Medical College, Mangalore. Fifty patients having lung space occupying lesion (SOL) on chest X-ray and CT scan were selected for the procedureand were included in the study. Results: Out of 50 cases, 37 were males and 13 females. Age range was from 25 to 80 years with mean age of 58.8 yrs. Majority were Non Small Cell Lung Carcinoma (NSCLC) (13 cases, 26%), of which 3 were suggestive of primary adenocarcinoma and one was a case of squamous cell carcinoma(SCC), followed by 8 cases of adenocarcinoma (16%) (Figure 1) , 2 cases of squamous cell carcinoma (4%), 2 cases of small cell carcinoma (4%), 4 cases of poorly differentiated carcinoma(8%) and one case each of metastatic carcinoma, neuroendocrine origin and fungus (Aspergillosis). Conclusion: There is increasing role of cytology in diagnosing both neoplastic and nonneoplastic lesions of lung. Performing FNAC is much easier and helps in prompt diagnosis and management of patients.

Keywords: Lung; Aspiration; Adenocarcinoma; Aspergillosis. 

Objective: To determine the prevalence of low sperm count (oligozoospermia) & azoospermia (absence of sperms) in seminal plasma infertile male & to assess the pattern & distribution of abnormal sperm parameters in infertile men. Methods: The descriptive cross-sectional study was carried out at the Department of Pathology R.D.Gardi Medical College, Ujjain from August 2016 to August 2017. A total of 100 consecutively consenting male partners of women fulfilling the inclusion criteria between 20 and 45 years of age were approached. Semen analysis was performed according to methods and standards defined by the World Health Organisation (WHO). Samples were categorised into normozoospermia, oligozoospermia and azoospermia on the basis of sperm count. Results: Out of the 120 males approached, 20 (20) had to be left out either because of their unwillingness or inability to pass semen. The study sample comprised of 100 response rate (83.33%) normozoospermia was observed in 47 (47%) males, azoospermia in 9 (9%), and oligozoospermia in 44(44%) The oligozoospermic samples had low ejaculated volume, but significantly higher percentage of non-motile sperms 62% ( normal 33%) and abnormal morphology 43% (Normal 31%) in comparison to normozoospermic samples. Conclusion: Semen analysis is the basic diagnostic test that should be performed on all couples or singles that are suffering from infertility and or are concerned about having infertility. The purpose of the test is to detect possible abnormalities and/or “weaknesses “within the sperm. Sperm concentration, motility and morphology are related to each other, factors that cause deterioration of one of them usually also have negative impact on the other two as well.

Keywords: Infertility; Semen; Sperm; Motility; Normozoospermia Oligozoospermia; Azoospermia; Asthenozoospermia; Teratozoospermia. 

Background: Breast cancer is 2nd most common malignancy in Indian women. FNAC is first line of investigation for breast lump. Aims: 1)To diagnose and classify breast lesions on cytology according to probabilistic approach. 2) To evaluate accuracy of probabilistic approach by correlating with Histopathological diagnosis wherever possible. Study Design: Prospective study of FNACs classified into positive, suspicious, proliferative with atypia, proliferative without atypia and unremarkable categories. Results: Total 237 cases were studied. The probability of finding carcinoma on histopathology from positive, suspicious and proliferative with atypia categories were 100%, 80% and 43.75% respectively. All the lesions from proliferative without atypia and unremarkable categories were benign on histology. There were no false positive cases. The specificity and sensitivity were 100% and 90.54%. Conclusion: The probabilistic approach with defined diagnostic criteria is an accurate, uniform and reduces inter-observer variability. It minimizes false positives without compromising sensitivity for detecting carcinoma. This scheme of reporting breast FNA provide the rational basis for guidelines for management of breast lesions.

Keywords: Probabilistic Approach; Breast FNAC; Positive for Carcinoma. 

Introduction: The prevalence of hormone receptor positive breast cancer in Asian countries is found to be lower than the western world where more than 50% of the tumors express hormone receptors. Studies have found consecutive decrease of ER, PR expression as a measure of differentiation of the tumour with low grade having the highest and high grade having the lowest ER/PR expression. Detection of vascular invasion in the primary tumor is a marker of metastatic potential and has prognostic significance, particularly in the lymph node negative group and helps to predict both recurrence and long-term survival. Aims and Objectives: To study the expression of ER, PR and HER2/neu status by immunohistochemistry and correlation of clinicopathological parameters with hormone receptor status and HER2/neu expression. Results: In the present study the age range of the patients was between 35-80 years. Out of 53 cases, majority (72%) of them were invasive ductal carcinoma. Other tumors included medullary carcinoma, lobular carcinoma, metastatic carcinoma and poorly differentiated carcinoma. Nineteen out of 53 tumors (36% of the cases) showed triple negativity and only one tumor showed triple positivity. Of the total cases 32% of the tumors were ER+/PR+, 17 % ER+/PR- and 4% showed ER-/PR+. Conclusion: This study highlights the importance of various prognostic factors and hormone receptor status evaluation that will aid in therapeutic intervention.

Keywords: Breast Cancer; ER; PR; HER2/neu; Lymphovascular. 

Background: The pathological bone lesions are wide array from inflammatory to neoplastic conditions. The X-ray helps in exact location of lesion, but most often times it is very difficult to diagnose and differentiate. This problem can be overcome with the help of histopathological study. Objective: To study histopathological spectrum of bone lesions and correlate them with age, gender, site and type of lesion. Materials and Methods: The present Descriptive, Cross sectional study was carried out at Dr. PSIMS and RF from December 2014 to November 2016. A total of 82 bone biopsies were received. Histopathological examination of the bone specimens was performed after detailed clinical and radiological examination. After fixation, decalcification, processing and H&E staining, histopathological diagnosis was made. This study was approved by the institutional ethical committee. Result: Total 82 cases of bone biopsies were analyzed. Out of 82 bone lesions 65(79.3%) were Non-neoplastic, 16(19.5%) cases were Neoplastic and 1 (1.2%) case was inadequate for diagnostic evaluation. Benign bone lesions were more preponderant than malignant with 13(15.5%) and 3(3.7%) cases respectively. Chronic osteomyelitis was the most common non- neoplastic lesion. Osteochondroma and Osteosarcoma were most common benign and malignant lesions respectively. Tibia was most common bone involved in benign lesions and femur for malignant lesions. Maximum number of bone lesions present in the age group between 40-60 years, with male preponderance. Conclusion: An integrated use of clinical, radiological, and histopathological findings were recommended to increase accuracy of diagnosis and for better management of the patient

Keywords: Bone Lesions; Osteochondroma; Chronic Osteomyelitis; Histopathology; Osteosarcoma; Chondrosarcoma. 

Background: Gastrointestinal polyps are proliferative or neoplastic mucosal lesions, projecting into gastrointestinal lumina. Certain polyps like adenomatous polyps have more clinical importance because they have the risk of malignancy. Aim: The aim of our study is to determine the age and sex distribution, location, histological type and also to assess the benign or malignant potential of gastrointestinal polyps. Materials and Methods: This study was done in the Department of Pathology, Narayana Medical College and Hospital, Nellore, Andhra Pradesh, India, over a period of two years from October 2015 to September 2017. Total 160 Cases of Gatrointestinal polyps were studied. Results: Gatrointestinal polyps were more common in males (60%) than females (40%) and were common in the age group between 51-60 years (40%). Commonest clinical symptom was malena (28.12%). Rectum was the commonest site (28.75%), followed by sigmoid colon (18.75%). The most prevalent type of gastrointestinal polyp was adenomatous polyp (50%). The commonest subtype of adenomatous polyp was tubular variant (82.5%). Conclusion: High grades of dysplasia was commonly observed in villous and tubulovillous types of adenomatous polyps. As adenomatous polyps have more risk of malignant transformation, early diagnosis and removal is a highly effective method in preventing colorectal cancer.

Keywords: Adenomatous Polyp; Dysplasia; Gastro Intestinal Polyps; Rectum; Tubular Variant. 

Background: Endometrial cells are rarely seen in pap smears. Their presence in postmenopausal women > 45 years may suggest endometrial pathology. Aims: To evaluate the pap smears of cases with significant endometrial histopathology for the presence of endometrial cells; its association with age and menopausal status and its sensitivity in detection of endometrial pathology. Settings & Design: Cross sectional retrospective case control study. Meterials and Methods: Endometrial biopsies grouped as cases (significant endometrial pathology hyperplasia, carcinoma, polyps, carcinoma) and control (basal, proliferative, secretory) were collected for a period of two years. Their pap smears were evaluated for the presence of endometrial cells. Statistical Analysis: Descriptive statistics was used. Results: Among the 58 cases and 58 controls, endometrial cells were present in 31% (18/58) of cases and 17% (10/58) of controls. Age >45 years, menopausal status and postmenopausal bleeding had no association. 25% of simple hyperplasia, 50% of complex hyperplasia, 37.5% of endometrial polyp and 50% of endometrial carcinoma cases had endometrial cells. The sensitivity of detection of significant endometrial pathology by endometrial cells was 31%; specificity 82%; positive predictive value 64% and negative predictive value 54%. The average number of clusters were >2 in the cases and <2 in the control. The clusters had papillae/club like/swirl morphology or atypical in cases. Conclusion: We conclude from our study that we should document the presence of endometrial cells in patients with any symptom of irregular bleeding irrespective of age and menopausal status especially when there are more than two clusters with distinct morphologies like papillae/ club/swirls.

Keywords: Endometrial Cells; Pap Smears; Significant Endometrial Pathology. 

Background: Thyroid lesions are common, presenting mostly as enlargement of thyroid gland. Fine needle aspiration cytology (FNAC) of the thyroid is an easy procedure providing rapid and accurate diagnosis. Terminology for reporting has varied amongst pathologists. Bethesda system provides guidelines for cytological reporting category and management. Aim: To classify the thyroid lesions according to Bethesda system for reporting thyroid cytology, compare with conventional system and correlate cytological diagnosis Material and Methods: A prospective study was conducted over a period of 2 years on 202 consecutive patients. FNAC of thyroid gland was done and smears prepared.Smears were reviewed and cytological reporting was done according to both conventional and Bethesda systems. Result: Most of the patients were females (177, 87.6%) with a mean age of 37.4 years. 4.0% were non diagnostic, 91.1% were benign, 1.5% were atypia/follicular lesion of undetermined significance, 1.0% were suspicious for follicular neoplasm/ follicular neoplasm and 2.4% were malignant. Radiological findings were available in 100cases and showed diagnostic deviation in 2 cases with cytological findings. Histopathological correlation was present in 16 cases and revealed minor deviation in one case. Conclusion: The Bethesda System for Thyroid Cytology is a useful method in reporting different thyroid lesions. In our study a definite interpretation for lesions in category I and III was provided by following specific criteria. Standardising the reporting methodology increases the reproducibility of diagnosis.

Keywords: Cytology; Correlation; Conventional; Bethesda System; Radiological; Biochemical; FNAC. 

Background: Hematological abnormalities are quite frequent in cirrhotic patients and commonly include various types of anemias, thrombocytopenia and increased PT/INR. Some of these parameters are used as prognostic markers in scoring systems like Child-Pugh and Model for End Stage Liver Disease (MELD). Aim: We aimed to assess the various hematological parameters in cirrhotic patients and correlate them with disease severity based on Child-Pugh and MELD scoring systems. Materials and Methods: 87 patients diagnosed with cirrhosis irrespective of etiology were studied over a period of 2 years. Complete blood count, peripheral smear and coagulation parameters were noted along with relevant clinical history. Variations in these were compared with Child-Pugh and MELD scoring systems. Results: Macrocytic anemia and spur cell anemia were seen in 33 and 7 patients respectively. Thrombocytopenia was noted in 33 patients. 67 patients had prolonged PT. According to Child-Pugh classification, 65.5% of patients came under Grade C, 27.6% under Grade B and 6% under Grade A respectively. According to MELD score, 24% of patients had a score < 15 and 76% had a score of 15. Hematological parameters like MCH, MCHC and Total count showed a significant positive correlation with both Child-Pugh and MELD scoring systems with p < 0.05. Hemoglobin, RBC count and RDW showed a negative correlation with both Child-Pugh and MELD scoring systems with p value < 0.05. Coagulation parameters PT and PT/INR showed a significant positive correlation with both Child-Pugh and MELD scoring with p value < 0.001. Conclusions: Although a number of hematological abnormalities are seen in cirrhotic patients, only few of them show significant correlation with disease severity. Hence it is suggested that these parameters be used for prognostication in cirrhotics.

Keywords: Child-Pugh; Cirrhosis; Hematological; MELD. 

Background: The diagnosis of early Mycosis Fungoides (MF) is quite challenging because of its overlapping clinicopathologic findings with various reactive dermatoses. A comprehensive assessment of clinical history is absolutely essential as pathologic criteria alone are insufficient. Aim: We aimed to diagnose early MF seeking an algorithm proposed by the International Society for Cutaneous Lymphoma (ISCL), define various significant diagnostic criteria and describe the associated clinical and histological mimics. Materials and Methods : Formalin fixed, paraffin embedded and H&E stained sections of forty skin biopsies from thirty nine clinically suspected early MF patients (n = 39) were studied initially. Various clinical and histopathological parameters were recorded followed by immunohistochemistry (IHC) with selected markers to arrive at a proper diagnosis. Results: Early MF was diagnosed in 9 patients (23.1%), parapsoriasis in 5 patients (12.8%), psoriasiform dermatitis in 7 patients (17.9%) and spongiotic dermatitis in 5 patients (12.8%). Remaining 13 patients (33.3%) were grouped under miscellaneous category comprising of other reactive dermatoses. Atypical lymphocytes were seen in 8 patients with early MF (n = 9) and 2 patients with parapsoriasis (n = 5). No statistical significance was observed between the two groups (P > 0.05, Fisher’s exact test). Conclusions: Some patients with early MF fail to show the typical histological features of the disease. In such instances, multiple biopsies from different lesions are highly useful and the algorithm developed by ISCL is a valid tool in diagnosis. Epidermotropism is considered as histological hallmark. IHC is not needed in all cases, particularly when the clinical and histopathological features are quite obvious.

Keywords: Algorithm; Early MF; Epidermotropism; ISCL; Reactive Dermatoses. 

Background: The incidence of clinically evident thyroid nodules is 4-5% in the general population. Fine needle aspiration cytology of thyroid can be used as diagnostic test along with ultrasonography for evaluation of thyroid lesions. Aims and Objective: To study cytological profile of thyroid lesions and correlate the results with Ultrasonography findings and clinical features. Material and Methods: This prospective study was carried out in department of pathology on 250 patients with thyroid swelling who came from surgical departments from the period of October 2016 to October 2017 at Narayana medical college and hospital, Nellore. Results of FNAC were correlated with those of USG reports and clinical features of the patient. Results: Out of 250 cases, 227 [90.8%] cases were benign, 8 [3.2%] cases were malignant on FNAC. About 220 cases (88%) were females and (12%) were males (male to female ratio 1:733). On USG 68% cases were diagnosed as benign and 2.8% cases were malignant. Out of which on cytology 90.8% were benign & 3.2% cases were malignant. On FNAC Multinodulargoitre (47.2%), colloidgoitre(6%), Thyroiditis((34%), diagnosed. Follicular neoplasm (4%), suspicious of malignancy 5 cases (2%) diagnosed under indeterminate category on FNAC. On USG nodular goitre (52.4%), colloid goitre(5.6%), Thyroiditis 73 cases(29.2%), Follicular adenoma 16 cases (6.4%) and malignancy 7 cases (2.8%). Thyroglossal cyst (2.8%), Graves disease (0.68%) diagnosed on FNAC and USG as well. Conclusion: Ultra sound and Fine needle aspiration cytology are advocated as first line examination for the assessment of thyroid lesions along with clinical examination and helps to come to the proper diagnosis

Keywords: Fine Needle Aspiration Cytology; Ultrasonography; Thyroid Lesions; Benign; Malignant. 

Background: Fibroepithelial polyps are common small protuberant benign lesions primarily developing in areas where the skin forms creases such as neck, axillae, and groin. They may also arise on the face, usually on the eyelids. It occurs predominantly with advancing age, typically painless, and do not grow or change over time. An important triggering factor seems to be frequent irritation of the skin, especially in persons who are obese. Diagnostic problem is faced when it is located at unusual site and huge size. Materials and Methods: Retrieval of all cases of fibroepithelial polyp were made from August 2014 to May 2017. A retrospective analysis of all cases of fibroepithelial polyps reported in histopathology section of department of Pathology, AIIMS, Patna weredone with patient’s details, site of lesion, gross and microscopic findings. Conclusion: Fibroepithelial polyp is a common entity but their occurrence at unusual site pose a diagnostic challenge to both the clinicians and pathologists.

Keywords: Fibroepithelial; Polyp; Neoplasm; Intertriginous; Histopathology; Pedunculated. 

Introduction: Skin diseases are one of the most common health problems in India. Histopathological examination of skin biopsy is the gold standard for most dermatological diagnosis. Our medical college being the only govt tertiary institute in north Maharashtra this work has been undertaken, to study the spectrum of various skin disorders that affect the north Maharashtra population. Methods: The study was undertaken in the department of Pathology, S.B.H. Govt Medical College and Hospital, Dhule the only tertiary care centre in North Maharashtra region. It included all the skin biopsies received by the department of pathology for histopathological examination during January 2013- December 2015. Histopathological classification of skin diseases based on the site, pattern and cytology of the histological changes seen in the biopsy was used. According to which we divided skin diseases in VIII groups. Results: Out of 175 patients highest no of patients (n=39) were observed in 21 to 30 yrs with majority being females (50.28% n=88). Maximum no of cases belonged to group V disorders (n=75; 42.86%) i.e. perivascular, diffuse and granulomatous infiltrates of reticular dermis followed by, Group VI disorders (n=30; 17.14%) i.e. tumors and cysts of dermis and subcutis. In the group V leprosy was the most prevalent skin disease (n=57). Pemphigus vulgaris (2.86%) was the most common vesiculobullous lesion. Conclusions: Leprosy is the most common (42.86%) skin problem seen in the present population. This emphasizes the need for the rigorous measures to be implemented for prevention, diagnosis and treatment of leprosy in the present region.

Keywords: Leprosy; Skin Biopsy; Skin Tumor; Vesiculobullous. 

Introduction: Tuberculosis is a chronic infectious disease caused by mycobacterium tubercular bacilli. It primarily affects lung and it can involve any organ system in the body. There are various methods for detection of acid fast bacilli in the sputum examination for the diagnosis of tuberculosis. Material and Method: Our study was done clinically suspected tubercular patients in the tertiary care hospital. On all received samples ZN stain was applied by two method (conventional and bleach). Result: 682 cases out of 3962 total cases are positive both in conventional method and bleach method and the 188 cases are positive only in bleach method. Conclusion: The majority of positive cases in bleach method showed easily visible and detectable. AFB morphology was observed to be better preserved to in the bleach method. The bleach method is safe, inexpensive and easy to perform and requires no additional equipment.

Keyword: Tuberculosis (TB); Mycobacterium Tubercular Bacilli (MTB) Acid Fast Bacilli (AFB); Ziehl- Neelsen (ZN Stain) and Bleach (Sodium Hypochlorite). 

Background: Cancer of uterine cervix is a leading cause of mortality and morbidity among women worldwide Papanicolaou cytological (Pap) test is, in many respects, the ideal screening test. Cervical cancer has a defined premalignant phase of many years, which allows repeated tests to significantly reduce the impact of individual false negative test results. Cervical cytology is inexpensive and readily accepted among Indian women.This is a retrospective study aimed to evaluate all previously conducted cervical smears examined at a teaching tertiary hospital during a two and half year period to find out the prevalence of abnormal pap smears. Materials & Methods: Detailed clinical data and Pap smear cytology reports were obtained from June 2014 to December 2016 and data noted in a structured Performa. All the smears were reported as per the revised 2014 Bethesda system. Prevalence of epithelial abnormalities was calculated in percentages. Results: Out of 1671 cases, 1635(97.8%) were negative for intraepithelial lesion/malignancy, 36 cases (2.15%) were positive for intraepithelial lesion. Conclusion: Pap smear provides supportive evidence as a tool for screening for cervical cancer. There is a need to increase the awareness among women to know the utility of this test to prevent precancerous changes in cervix can be detected before they progress to frank malignancy.

Keywords: Cervical Cancer; Screening; Bethesda System; Pap Smear; Papanicolaou. 

Introduction: 70% of clinical decision making is predicted upon, or confirmed by, or documented by medical laboratory test results. Accurate laboratory services are required for diagnosis, to identify causative factors, staging, treatment initiation, monitoring drug efficacy and toxic effects in cancer patients. Purpose: 1. to provide accurate, early, reliable and universally acceptable results to patients in a Cost-effective way. 2. To improve operational efficiency and safety of laboratory personnel 3. Encourage other laboratories to apply for National Accreditation Board for Testing and Calibration Laboratories (NABL). Methods: A quality manager was appointed to supervise the implementation of accreditation. Quality manual was prepared and from it Standard Operating Procedures (SOPs), registers and formats were made according to International Organization for Standardization (ISO) 15189 guidelines. Results: Quality of our laboratory services and reports are improved thereby gaining the confidence of clinicians and patients in our institute. Our technicians are more efficient in their work. Conclusions: Although accreditation is a time consuming and laborious process, it is a doable process. It provides early warning signs and identifies lacunae in our system. We encourage all the teaching hospitals and laboratories to apply for accreditation.

Keywords: Accreditation; Hematology Laboratory; ISO 15189; NABL. 

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