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. 

Obective: Fine needle aspiration cytology ( FNAC )is less invasive diagnostic modality in almost all lesion with good range of sensitivity, however few false negative and false positive report have been reported, here we emphasis on those misdiagnosed cases with possible explanation. Material & Methods: This study includes a total 43 cases who underwent prior FNAC followed by biopsy examination at our institute. Cytological diagnosis was compared with histological diagnosis. Results: Out of 43 cases studied 26 were benign and 17 were malignant on histology, 3 case of benign and 5 cases of malignant shows discrepancy with histology. We explain possible cause of misdiagnosis.

Keywords: Fine Needle Aspiration; Histological Diagnosis; Salivary Gland; Sensitivity; Specificity. 

Introduction: Tuberculosis (TB) in children is a neglected aspect of the TB epidemic despite it constituting 20% or more of all TB cases in many countries with high TB incidence. Childhood TB is a direct consequence of adult TB but remains overshadowed by adult TB because it is usually smear-negative. Infants and young children are more likely to develop life-threatening forms of TB than older children and adults due to their immature immune systems. Therefore, prompt diagnoses are extremely important although difficult since clinical and radiological signs of TB can be non-specific and variable in children. In developing countries like India, tuberculous lymphadenitis is one of the most common causes of lymphadenopathy. However, anti-tubercular treatment cannot be given only on clinical suspicion. Cytomorphology with acid fast staining proves to be a valuable tool in diagnosing these cases. Aims: To study the utility of fine needle aspiration cytology (FNAC) and various cytomorphological presentations inreference to Ziehl-Neelsen staining in tuberculous lymphadenitis in paediatric age group. Methodology: Total 120patients attending OPD at Dr. Shankarrrao Chavan Government medical college, Nanded were studied for the period of two years. Result: Out of 120 aspirations from tuberculous lymph nodes, we found that only Necrosis without epithelioid cell granulomas was the most common cytological picture seen in 66 cases followed by necrotising granuloma in 25 cases. ZN-stained smears were positive in 76 cases while culture was positive in only 54 cases. The highest smear and culture positivity was noted in cases with only necrosis.overall AFB positivity was 66.3%. Conclusion: Fine needle aspiration cytology is a safe, cheap procedure requiring minimal instrumentation and is highlysensitive to diagnose tuberculous lymphadenitis. The sensitivity can be further increased by complementing cytomorphology with ZiehlNeelsen (ZN) staining for acid-fast Bacilli (AFB) and microbiological culture.

Keywords: Fine Needle Aspiration Cytology(FNAC); Tuberculous Lymphadenitis; Ziehl-Neelsen (ZN) Staining. 

Introduction: Leprosy caused by Mycobacterium Leprae is an important public health problem. It is a chronic granulomatous disease involving skin and peripheral nerves. Histopathological examination of skin provides confirmatory diagnosis in suspected cases and gives indication of progression and regression of disease under treatment. The aim of this study is to identify the clinical pattern of leprosy and its clinicohistopathological correlation. Methods: Clinico Pathological study of 35 leprosy patients was undertaken in the Department of Pathology. Biopsies were taken from most active skin lesions by Department of Dermatology and fixed in 10% formalin. The tissue section stained with Hematoxylin and Eosin and Fite Faraco staining for identifying the bacilli. Histopathological findings were graded according to Ridley and Jopling scale. ClinicoHistopathological correlation was done. Results: Maximum numbers of patients were in their 3rd Decade (28.57%).Males were contributing to majority of the patients (72.5%). One case that we received of LL type was a male. In the clinical spectrum of 35 cases, IL was not contributing to any clinical diagnosis, TT was in 1 (2.85%) case, BT in 19 (54.28%) cases, BB in 5 (14.28%) cases, BL in 5(14.28%) cases, and LL in 5 (14.28%) cases. Common type of skin lesion observed was Macule (54.28%). Commonest site of lesion was Trunk and Upper Limbs (22.85%). Most of the cases were presented as Hypopigmented Lesions (65.71%). Most of the patients showed Anesthetic Lesion (48.57%). In the histopathological spectrum IL cases were contributing to 48.57% of cases, TT cases were 2.85%, BT cases were 25.71%, BB cases were 2.85%, BL cases were 17.14%, LL cases were 2.85%. Overall concordance between Clinical and Histopathological diagnoses was 20%. Conclusions: Clinical examination or histopathological examination alone may not stand as ideal diagnostic tools in diagnosing and classifying leprosy. There are factors like interobserver variation, overlap between different types of leprosy. Clinico histopathological disparity may be reduced by following the criteria strictly both clinically and histopathologically there by providing the patient early and adequate treatment to prevent morbid disabilities. 

Keywords: Leprosy; Histopathology; Ridley-Jopling. 

Background: Dengue fever is a major public health issue forming a burden of monsoon related illness. There is a need to study the clinical features and laboratory investigations to predict the severity of dengue fever for timely intervention and management to decrease the morbidity and mortality. Methods: An observational prospective study was conducted in children of less than 12 years of age in hospitalised cases, to study the severity of clinical features and variations in laboratory finding in proved cases of dengue fever. All cases of thrombocytopenia were included in this study and proved cases of dengue fever which were positive for NS1 antigen (done by ELISA using Dengue NS1 Ag microlisa kit) or IgM antibodies to dengue (done by using DEN MAC ELISA kit) or both NS1Ag and IgM antibodies were compared with laboratory finding of other causes of thrombocytopenia. Results: This study encountered 130 patients with thrombocytopenia during the period of 18 months. Of these 114 cases had infective cause, 12 cases had haematological cause and 4 cases of nutritional deficiency as etiology. Of the 114 cases of infective cause, 47 cases were proved dengue fever. Out of the 47 cases of dengue fever, 22 cases were positive for NS-1 antigen, 14 cases were positive for IgM antibody and 11 cases were positive for both antigen and antibody. Bleeding manifestations were found in 42.55% of cases. In severe thrombocytopenia cases more than three fourth cases had bleeding manifestations. Mortality for dengue was seen in 4.25% of cases. All the patients who expired belonged to Dengue Shock Syndrome. Conclusion: A significant association was seen between bleeding manifestations and severity of thrombocytopenia. A statistically significant correlation of p value < 0.001 was seen with relation to platelet count of dengue and non dengue viral infections.

Keywords: Dengue Fever; NS-1 Antigen; Thrombocytopenia. 

Objectives: FNAC has been used in the pre-operative diagnosis of salivary gland lesions for many years. Existing literature has shown wide range of sensitivity, specificity and diagnostic accuracy of cytological diagnosis. This study was aimed at evaluating salivary gland FNAC for sensitivity, specificity and diagnostic accuracy at a tertiary care center. Materials and Methods: This study included 203 patients from January 2012 to June 2015 who underwent FNAC of salivary gland lesions. The cytological diagnosis was correlated with histopathology wherever possible. The appropriate statistical results were analysed. Results: Total 203 cases were studied. parotid gland-135,submandibular gland- 62,intraoral glands-5 and upper lip-1. FNAC categorised 58.6% of the salivary gland lesions as nonneoplastic and 41. 4% as neoplastic. Among nonneoplastic lesions 83. 9% were sialadenitis. Among neoplastic lesions 80. 95% were benign and 19. 05% were malignant. Cytohistopathologic correlation was available for 32 cases. Overall 25 cases showed 80. 6% correlation. There were 3 false positive cases. Specificity, sensitivity, positive and negative predictive values for malignant lesions were 100%, 50%, 100% and 89.65% respectively. Further statistical analysis showed a good cytohistologic agreement with kappa value of 0. 619. Conclusion: Adequate sampling,high quality smear preparation and established diagnostic criteria can help to diagnose majority of common benign and malignant salivary gland swellings with high level of accuracy. The findings of FNAC should be read in conjunction with clinical findings and in doubtful cases the true nature of the lesion should be confirmed by histopathological examination.

Keywords: Fine Needle Aspiration Cytology; Salivary Glands; Sensitivity; Specificity. 

Objective: Head and neck manifestations of seropositive HIV and AIDS are one of the commonest complications of the disease. FNAC is an excellant first line method for investing the nature of palpable lesions in head and neck region. Hence there is need to know the distribution and cytological features of the various types of lesions in the head and neck region in HIV positive patients and occurrence of different lesions according to age, sex and mode of presentation. Methods: The study included FNAC study of head and neck swellings in HIV seropositive patients referred to the department of pathology, KIMS, HUBLI, over a period of 18 months from 1st November 2012 to 30thApril 2014. Results: Total number of cases in the study were 107. Overall incidence of HIV patients reffered to Cytology was 4% with 70% of them presenting with head and neck swellings. Maximum age was 65 years and minimum was 1 year, majority being in the 3rd and 4^th decade and with male to female ratio as 1:1.07. Ninety percent cases were Inflammatory. Lymph node was the commonest site involved (89.7%) followed by parotid (4.7%) and soft tissue (4.7%). In lymph nodes, tuberculous lymphadenitis was the most common diagnosis (48.9%) followed by reactive lymphadenitis (42.7%), acute suppurative lesion (5.2%), neoplasm (2.1%) and cryptococcal lymphadenitis(1.1%). In parotid, acute sialadenitis (40%) was the most common diagnosis. In cytological diagnosis of malignant cases 3 cases of non hodgkins lymphoma and each of metastasis, poorly differentiated carcinoma, medullary carcinoma thyroid were diagnosed. Cytological pattern of tuberculous lymphadenitis was studied in detail and most common pattern was caseation necrosis with granulomas (48.9%). Conclusion: Fine Needle Aspiration Cytology study is a less expensive, less time consuming and a more patient compliant alternative to histological diagnosis of these swellings. Beside this, it helps in early commencement of appropriate treatement of HIV positive patients by providing rapid diagnosis and also helps in the follow up, especially with Tuberculosis lymphadenitis.

Keywords: HIV; Lymph Node; Tuberculous Lymphadenitis; Cryptococcal Lymphadenitis. 

Introduction: Inflammatory bowel diseases (IBD) are represented mainly by Ulcerative colitis (UC) and Crohn’s disease (CD) but they also include non-infectious inflammations of bowel. The diagnosis depends on clinical, radiographic, endoscopic and histologic features. Ulcerative colitis divided into three phases active phase, remission phase and resolving phase. Crohn’s disease is a chronic inflammatory disease of the digestive tract. Symptoms include abdominal pain and diarrhoea, sometimes bloody, and weight loss. Objective: To know the histopathological distribution of inflammatory bowel diseases in teaching hospital. To determine the extent and severity (different phases) of ulcerative colitis. Material and Methods:The present study was conducted in the Central laboratory, Department of Pathology, Kempegowda institute of Medical Sciences, Bangalore ,during the period July 2010 to June 2013 . One hundred and twenty colonoscopic biopsies from patients attending KIMS Hospital who mainly presented with lower gastrointestinal symptoms were studied. Clinical details, colonoscopic findings were obtained. All the colonoscopic biopsy specimens were immediately fixed in 10% formalin for 24 hours, routinely processed, embedded, serial sections were prepared and stained with Hematoxylin & Eosin and studied under the light microscope. Results: 30 cases (20%) had inflammatory bowel disease. 28 cases of ulcerative colitis and 2 cases of crohn’s diseases were detected. 19 cases of ulcerative colitis were in active phase, 3 in resolving phase, 5 in remission phase and 1 case presented with dysplasia. Conclusion: Mucosal biopsy may be used to monitor the course after therapy and to estimate activity in cases of apparent remission or possible relapse. Colonoscopy with multiple biopsies is now the routine investigation at diagnosis and follow up of patients with ulcerative colitis and Crohn’s disease.

Keywords: Inflammatory Bowel Diseases (IBD); Ulcerative Colitis (UC); Crohn’s Disease (CD); Colonoscopic Biopsies. 

Background: Breast masses cause more anxiety for the patients. This study was undertaken to know the spectrum of benign breast lesions with their age of occurrence. Benign breast lesions are more common than the malignant ones. Timely and accurate diagnosis with treatment will alleviate anxiety to the patient. Methods: This study was carried out in a tertiary hospital of north Karnataka region for a period of five years with one and a half years of prospective study. All histopatholgically proved benign breast lesions and inflammatory lesions were included in this study. Results: Of the 600 cases of breast lesion in five years study, slightly less than three fourths of the cases were benign lesions. Of these fibroadenomas formed nearly three fourths of the cases and the remaining were fibrocystic disease, inflammatory and miscellaneous lesions. Conclusions: This study emphasizes that benign breast lesions are heterogeneous group of lesions including inflammatory lesions, neoplasms, non proliferative lesions, proliferative lesion without atypia and prolifertive lesions with atypia. Some of these lesions are a risk of cancer, such patients need a follow up with sonomammography.

Keywords: Benign Breast Diseases; Fibroadenomas; Fibrocystic Disease; Inflammatory Lesions. 

Context: Organophosphorus (OP) compounds are the most common suicidal poisons in the developing countries. A recent study from south India reported mortality rate of 4% in OP poisoning cases.These compounds exert their toxicity by allowing acetylcholine to overact at its receptors in the central and peripheral nervous system. Aims: The aim was to study the variations in the hematological parameters in patients of OP compound poisoning and clinically correlate these findings with the severity of poisoning and assess the effect of treatment on them. Methods and Material: Patients with definite history of OP compound poisoning and decreased serum levels of pseudocholinesterase (PCE) enzyme were included in the study. The serum pseudocholinesterase levels were estimated at admission. Another EDTA blood sample was subjected to complete blood picture analysis. The same methodology was repeated after treatment. OP poisoning patients were classified into latent, mild, moderate and severe based on serum pseudocholinesterase levels. Concurrently the changes in hematological parameters were correlated with the severity of poisoning before and after treatment. Statistical Analysis Used: Statistical analysis of the percentages, mean, range and chisquare test for associations and Wilcoxon signed-rank test to assess the association were done, with p-value of <0.05 taken as statistical significance at 95% confidence interval Results: The present study showed significant decrease (p<0.001) in serum cholinesterase levels in moderate to severe poisoning. Out of 164 cases, 80 of them showed neutrophilia at admission and reached to values of normal reference range in 81.2% of the cases post-treatment while neutophilia persisted in 18.8% despite treatment which is statistically significant. Conclusions: This study concludes that in resource poor settings where estimation of plasma ChE levels cannot be determined then hematological parameters like total and differential leucocyte counts can predict response to treatment and recovery from OP poisoning.

Keywords: Organophosphorus Compounds; Poisoning; Serum Pseudocholinesterase; Neutrophilia. 

Aim: Breast cancer is the most common cancer in women affecting one in eight in their lifetime [1]. HER-2 gene is amplified in approximately 20-40% of breast cancers [2], which correlates with aggressive disease and amenable to treatment with Trastuzumab. The aim of this study is to detect amplification of HER-2 gene by chromogenic insitu hybridization (CISH) and HER-2 protein by immunohistochemistry in Manual Tissue microarray sections of breast cancer. Materials and Methods: 30 confirmed breast cancer cases were included in the study in which adequate tissue material were available. The breast tissue fixed in 10% buffered formalin were routinely processed and HE stained slide obtained for confirmation of tumour tissue in the paraffin block. A total of 2 Tissue microarray blocks were made each having 15 cores each from different patients using the method described by Singh et al . Sections were taken from each microarray block for HE staining, CISH and IHC study. Results: 20% showed HER-2 protein positivity. 23% were found to be positive for HER-2 gene. Cohens kappa calculated to find the degree of agreement between the HER-2 protein expression detected by IHC and HER-2 gene expression detected by CISH in Tissue microarray sections is 0.510, which indicates moderate agreement. Conclusion: We conclude HER-2 expression in carcinoma breast could be studied by IHC and CISH with ease on Tissue microarray sections, a cost effective method which can be used for both research and diagnostic purposes in resource limited laboratories.

Keywords: Breast Cancer; HER-2/neu; Chromogenic Insitu Hybridization; Immunohistochemistry; Manual Tissue Microarray.

Introduction: With growing awareness in the general population, patients with breast lumps are commonly approaching the clinicians. Fine needle aspiration cytology (FNAC) is accepted as the most sensitive, safe and cost effective procedure for diagnosing lesions of breast. Proliferative diseases of breast (PBD) encompass a number of histologic lesions having a variable risk factor for the development of carcinoma. One approach to resolve the diagnostic difficulties posed by PBD on FNAC has been to apply an objective scoring system proposed by Masood et al [1]. Materials and Methods: A two year prospective study of 350 cases was conducted. Fine needle aspiration procedure, fixation & staining were performed by standard procedures. Cytological scoring by Modified Masood et al scoring system and correlation between cytological scoring category & histological diagnosis was done. Results: Adequacy of FNAC was 94.3% (330/350). Out of 330 cases, 280 were neoplastic and 50 were non-neoplastic. Cytological scoring was done on all 280 cases but histology was available in total 217 cases. Cytohistological correlation of neoplastic lesions was observed in 94.5% cases using cytological scoring system. Conclusion: FNAC is accepted as the most sensitive, specific, accurate, safe and cost effective procedure for diagnosing lesions of breast preoperatively and avoiding unnecessary surgical interventions like diagnostic excision or incisional biposy. The scoring system was useful in aspirates with cytodiagnosis of proliferative breast disease with atypia, as it helped in separating out a proportion of non-atypical cases. It should be implemented in routine cytological reporting.

Keywords: Biopsy; Fine-Needle; Risk Factors; Fibrocystic Breast Disease; Cytodiagnosis. 

Background: Fine Needle Aspiration Cytology (FNAC) is important for pre-operative and pre-treatment diagnosis of benign and malignant thyroid lesions, thus decreasing the incidence of unwanted surgeries. Objectives: The present study aims to classify various cytomorphological lesions of the thyroid according to The Bethesda System for Reporting of Thyroid Cytopathology(TBSRTC) and correlate these with histopathology so as to establish the utility of FNAC in the diagnosis of thyroid lesions. Material & Methods: A retrospective study was conducted in a tertiary care centre to evaluate the diagnostic accuracy of FNAC in lesions of thyroid during a 3 year period. The cytological findings were classified according to the recent TBSRTC and subsequent histopathological correlation was done in all the cases. Results: Out of total 200 cases studied, benign category (II) was the most common (79.0%) followed up by malignant (VI -11.0%) and follicular neoplasm (IV-9.0%) categories. Cyto-histopathologic correlation of all cases was done. The present study showed 92.85% sensitivity, 100% specificity, 100% positive predictive value, 98.8% negative predictive value and 99% diagnostic accuracy in detecting malignant tumors. Conclusions: FNAC is a safe, simple, highly accurate, economical and universally accepted modality for evaluation of thyroid lesions especially in developing countriessuch as India. Use of TBSRTC in reporting thyroid cytopathology has a greater accuracy. There is almost perfect cyto-histopathological concordance and the results are consistent with those available in the literature.

Keywords: Diagnostic Accuracy; FNAC; Histopathology Correlation; Sensitivity; Specificity; Thyroid.

Introduction: The preoperative distinction between benign and malignant ovarian cysts could assist in defining two categaries of patients. Those with a high probability of a malignant neoplasm would obviously undergo appropriate preparation and prompt surgical exploration for definitive diagnostic, therapeutic and staging purposes. Materials and Methods: For the material of our study we had selected 45 patients from gynecology ward during January 2014 –December 2014. The inclusion criteria were presence of cystic lesions in the ovary on ultrasound examination. Fine Needle Aspiration was carried out under ultrasound guidance in the radiology department. The cytological examination was later correlated with the histology of the same cyst removed during laparotomy. Results: Forty five patients ranging in age between 20 and 58 years were included in this study. All had unilocular or multilocular cyst, Septate or non-septate, thin or thick walled ovarian cyst, on ultrasound examination. Nondiagnostic/acellular aspirate was obtained in 06/45 cases, maximum being in cases of follicular cysts (4/6). Highest cases of benign cysts (60%) were noted during this study which includes follicular cysts, leuteal cysts, mucus cysts and endometrioid cyst. In malignant cysts (15.56%) serous cystadenocarcinoma, mucinous cystadenocarcinoma and malignant teratoma were included. Conclusion: Aspiration cytology definitely prove to be one of the most valuable tools in the diagnosis of cystic lesions of the ovary.

Keywords: FNAC; Fine Needle Aspiration Cytology; Cystic Lesions; Ovary; Diagnosis.

Introduction: Blood transfusion saves millions of life around the world. However knowledge regarding the same in the young and healthy population is not adequate. Aims and Objectives: To study the knowledge, attitude and practices regarding blood donation among medical students Materials and methods: A cross sectional study conducted in MIMS, Mandya. Student’s knowledge, attitude, and practice of blood donation were assessed by using pre-tested semi-structured questionnaire. Statistical analysis was done by entering the data in Microsoft excel sheets and by calculating the means and percentages. Results: Mean age of the participants is 19.47 years. Main source of information regarding blood donation was media 59.9%. None of the participants gave 100% correct answers. Only 68% knew minimum weight, 51.1% knew minimum duration between consecutive donations,75.8% knew volume of blood drawn. Majority were aware that people with bleeding disorders (92.8%), hepatitis (94.5%) and sexually transmitted infections [STI’s] (92.3%) should not donate blood. About 17.6% said person under influence of alcohol and 18.7% said person consuming tobacco can donate blood. About 88.5% were aware of transfusion transmitted infections. About 75.2% said voluntary donors are best donors. About 31.3% participants believed that a person might get infections by donating blood. About 98.3% said donating blood is a noble cause, 31.3% participants believed it may be harmful, 87.9% were willing to donate blood however only 21.97% had donated earlier. Conclusion: Knowledge about the prior requisites to donate blood is fairly good. Fear of contracting infections and suffering discomforts post donation was observed. Conducting information and education activities should be encouraged to motivate them.

Keywords: Knowledge; Attitude; Practice; Voluntary Donors. 

With increase in the population of elderly male, the prostatic pathology has gained a separate domain of its own. Prostatic lesions on routine sometimes cause a diagnostic dilemma especially when malignant tissue is limited and is mixed with benign prostatic glands. Aim: This study is aimed to evaluate a complete spectrum of various prostatic lesions with emphasis on the benign mimickers like, Basal Cell Hyperplasia (BCH), inflammatory atypia,atrophy and adenomatous hperplasia. Material and Methods: The present study was a hospital based 10 year retrospective study carried out in the department of Pathology, KIMS Hubli . The materials for the study included histopathology slides and blocks from 315 cases which constituted 0.72% of all the specimen samples received during the study period. Results: The peak age at which the patients underwent prostetectomy was from the 6th to 8th decade.Benign Prostatic Hyperplasia( BPH) was the major histopathological diagnosis comprising of 90.1% cases , followed by adenocarcinoma in 6.7%, atrophy 1.9%, Prostatic Intraepithelial Neoplasia (PIN) 1.0% and 0.3% of metastatic deposits of transitional cell carcinoma. The associated lesions with BPH were, inflammation in 17.1%, basal cell hyperplasia in 11.7% and atypical adenomatous hyperplasia in 0.4% case. There were 1.9% cases of atrophic prostate. Conclusion: The study of prominent histopathological changes of senescence and the features of co-morbid prostate pathology are of great importance. A systematic approach is necessary to evaluate the lesions of prostate and to detect the mimickers of malignancy.

Keywords: Benign Prostatic Hyperplasia; Basal Cell Hyperplasia; Prostatic Intraepithelial Neoplasia. 

Background: Transfusion-transmissible infections such as hepatitis B virus (HBV), human immunodeficiency virus (HIV), hepatitis C virus (HCV) and syphilis are among the greatest threats to blood safety for transfusion recipients thus posing a serious public health problem. This study was done with the aim to study the Seroprevalence of transfusion transmitted infections amongst voluntary and replacement blood donors at Blood Bank and an yearly comparison was made to find out the incidence of HIV, HBV, HCV, Syphilis and Malaria. Methods: In this study, we aimed to access the prevalence and trend of HIV, HBV, HCV and Syphilis over the last 3 years (January 2015 to December 2017) among the blood donors who came to donate Blood at Blood Bank, RBM hospital and associated hospitals as well as in various blood donation camps organized by the same blood bank. Results: From the total of 34628 blood donors, 801 (2.31%) had serological evidence of infection with at least one pathogen, either of HIV, HBV, HCV or Syphilis. These included 23 (0.066%) with HIV, 705 (2.03%) with HBV, 35 (0.10%) with HCV, 47 (0.13%) with Malaria and 27 (0.078%) with Syphilis. Conclusion: From the quantum of blood donors harbouring these infections found in the study, it becomes mandatory to properly select blood donors and perform comprehensive testing of donor’s blood using standard methods to ensure the safety of blood recipients

Keywords: Seroprevalence; Voluntary; Replacement Blood Donors; HIV; HBV; HCV; Malaria; Syphilis; Transfusion Transmissible Infection (TTI). 

Background: Acute appendicitis is the most common surgical emergency associated with an acute phase reaction. The diagnosis of the same is based on detailed clinical history and examination, laboratory and imaging interventions. The aim of the study is to study the role of C- reactive protein, white blood cell counts and polymorph percentage with histopathological examination for accurate diagnosis of appendicitis. Materials and Methods: It’s a retrospective study conducted in, patients presenting with features suggestive of appendicitis and were taken from1st January 2017 to 31st July 2017. The various clinical manifestations were considered and total of 100 cases were included in the study. The correlation of clinical presentation, with laboratory markers like CRP, total WBC counts and Neutrophil percentage with histopathological presentation was done. Results: The CRP levels significantly differed from gangrenous appendicitis (Group C) and catarrhalis and phlegmonous appendicitis (Group B). As compared to Total leucocyte counts and polymorphs percentage the CRP assay had sensitivity of 100% and specificity of 90% in comparison to WBC counts and Polymorph percentages which had a sensitivity of 55% and 75%. The total diagnostic accuracy of CRP assay was 97.7% Conclusion: The diagnostic accuracy of C reactive protein is not significantly higher than WBC and Neutrophil percentages. Though the values of CRP are directly proportional to the severity of inflammation. The combination of CRP, WBC and the polymorph counts together have a greater diagnostic accuracy in cases of appendicitis.

Keywords: Acute Appendicitis; CRP; WBC; Neutrophil Percentage; Histopathology. 

Context: Hysterectomy is one of the most common gynecological surgeries performed. Neoplastic lesions form an important indication for hysterectomy. Histopathological analysis of these specimens adds valuable information and at times reveals multiple neoplasms affecting the female genital tract. Aims: To determine the prevalence of multiple primary neoplasms in the hysterectomy specimens Methods and Material: All the hysterectomy specimens with or without adnexectomy in a 2 year period were studied for their histomorphological features and multiple neoplasms thus noted were recorded. Results: A total of 510 hysterectomies were analyzed. Twenty one cases had multiple neoplastic and/or pre neoplastic lesions in the female genital tract. Conclusions: Though multiple neoplasms occurring in the female genital tract are rare, longer follow up in cancer survivors will throw more light on the prevalence and prognosis of such lesions.

Keywords: Neoplasms; Multiple Primary; Hysterectomy; Uterus. 

Background: Thyroid lesions are most commonly encountered in all age groups. Accurate pre-operative assessment of thyroid diseases leads to improved patient outcome. Objective: To describe the cytomorphological features of thyroid nodules using FNAC along with assessment of thyroid hormonal status of the patient. Material & Method: The study was conducted in Department of Pathology,S.Nijalingappa Medical College, Bagalkot; during June 2016 to May 2017. Included 136/ 151 patients, irrespective of age and sex, with thyroid lesions. Cytological assessment was done using FNAC along with serological evaluation of thyroid hormones. Results: A total of 151 patients underwent cytomorphological assessment using FNAC. 136 had serological studies. Maximum number of patients were females and lesions were most common in 3rd and 4th decade. Lesions were graded as Neoplastic and Non neoplastic. Non neoplastic lesions were more common, with colloid goitre being thecommonest diagnosis, followed by Hashimoto’s thyroiditis. Among neoplastic lesions, Follicular neoplasm was the commonest, followed by 4 cases of papillary carcinoma. Same thyroid diseases showed different thyroid status in different patients. Conclusion: FNAC and thyroid hormone evaluation are highly effective procedures for diagnosis of patients with thyroid lesions. Hence, all types of thyroid lesions must beanalysed by history, examination, FNAC and thyroid hormone profiling.

Keywords: FNAC; Cytomorphology; Thyroid; Colloid Goitre.

Not Provided.