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.