Indian Journal of Pathology: Research and Practice

Background: Increased expression of the epidermal growth factor receptor (EGFR) gene has been shown in a large number of tumors, generally indicating a more aggressive biological behavior of cancers than those with low or normal expression. The role of EGFR in the tumorigenesis of the uterine cervix has been poorly understood and controversial.

Aim: In order to explore the relationship between EGFR status and cervical carcinoma this study has been conducted to evaluate the expression of epidermal growth factor receptor (EGFR) protein in benign conditions of cervix, cervical intraepitheal lesions (CIN) and squamous cell carcinoma (SCC) of cervix.

Material & Methods-: Immunohistochemical expression of EGFR in 106 cases of various lesions of uterine cervix was studied including chronic non specific cervicitis, CIN and SCC then correlation between histopathological diagnosis and EGFR immunostaining was also observed.

Results: Most of the cases of chronic cervicitis (87.5%) were negative for EGFR expression. 9/ 21 cases (42.9%) of low grade CIN showed positivity for EGFR while 27/36 (77.78%) of high grade CIN expressed EGFR. 26/33 cases (78.79%) of invasive Squamous cell carcinoma showed strong immunoexpression of EGFR. A gradual increase in the intensity and rate of expression from chronic cervicitis, low grade CIN and high grade CIN to invasive squamous cell carcinoma was observed.

Conclusion: A statistically significant correlation was found between increases of EGFR positivity from CIN to SCC. EGFR expression level in the premalignant.

Keywords: EGFR; CIN; SCC; Uterine Cervix. 

Context: Anaemia is defined as reduction below normal limits of the total circulating red cell mass. It is measured by the reduction in packed red cell volume or reduction in haemoglobin concentration of blood. Blood transfusion will be helpful in the correction of anemia.

Aims: This study is aimed at evaluating the effect of packed red cells transfusion in anemic patients by comparing pre and post transfusion hematological work up.

Methods and Material: The present study was done in the department of pathology comprised of 130 anaemic patients who received packed red cell transfusion in Sri Manakula Vinayagar Medical College and Hospital. Data was collected from September 2012 to May 2014. Haematological parameters were collected by automated haematology analyser. Peripheral smear and reticulocyte smear were made.
Statistical Analysis used: Mean, standard deviation was done using Epi Info software. P value was calculated using paired test. Microsoft word and Excel have been used to generate graphs, tables etc.

Results: Out of 130 patients, 45 (34.6%) were iron deficiency anaemia followed by 43 (33.1%) anaemia of chronic disease, 18 (13.8%) anaemia of chronic kidney disease, 10 (7.7%) anaemia of liver disease, 10 (7.7%) dimorphic anaemia and 4 (3.1%) anaemia in hypersplenism. After one unit of packed red cell transfusion the mean increase in Hb in IDA was 1.106gm/dl, in anaemia of ACD was 0.922gm/dl, in anaemia of CKD was 1.015gm/ dl, in anaemia of liver disease was 0.614gm/dl, in anaemia of combined deficiency was 0.925gm/dl and in hypersplenism was 0.367 gm/dl.

Conclusions: Desirable improvement was seen in most of the patients with respect to all haematological parameters and clinical outcome.

Keywords: Packed Red Cells; Anaemia; Indications for Transfusion. 

Introduction: Lesions involving oral cavity are very common in India, especially in the areas where tobacco, pan and related products are extensively used. Tongue, lip, floor of mouth, hard palate, gingiva and buccal mucosa are usually involved. Malignant lesions in the oral cavity are one of the most common malignant lesions in the Indian subcontinent. Early diagnosis is very important and can be lifesaving because, in late stages, they may be progressed to severe dysplasia, carcinoma in situ and/or carcinoma. Oral cancer is more common in men in developing countries.

Aims and objectives: (i)To study the different types of oral cavity lesions. (ii)To study the prevalence of oral cavity malignancies. (iii)To find the correlation between personal habits and oral cavity lesions.

Material and Methods: This study included patients presenting with definitive oral cavity masses, leucoplakia or ulcers. All cases of oral cavity lesions were included in the study. FNAC or Scrape cytology was done whenever possible and biopsy were obtained in the form of incisional, excisional or punch biopsy for histopathological examination. The H & E staining was used for microscopic evaluation of cytological smears and histopathological sections.

Result: A total of 170 cases were analyzed during the study period. Malignant lesions were the most common oral cavity lesions accounting to about 41%.The most common site was buccal mucosa (35.88%) followed by tongue (24.12%). Males were more commonly affected than females with the ratio of 1.25:1.Tobacco chewing was the most common personal habit related to non-neoplastic and malignant lesions of oral cavity.

Keywords: Buccal Mucosa; Leucoplakia; Oral Cavity Lesions. 

Background: Fine needle aspiration cytology (FNAC) is a very important component of pre-operative investigation in combination with clinical, radiological and other laboratory data. In spite of its advances and advantages, conventional FNAC fails to achieve a 100% accuracy. To improve the accuracy of FNAC, a supravital stained Toluidine blue wet mount (TBWM) preparation of the aspirate and Methylene blue/Eosin (M/E) stained smears are studied

Aim: To assess the diagnostic rapidity of the Toluidine blue wet mount preparation and Methylene blue/Eosin stain in FNAC and to compare the morphological features and results obtained from rapid stains with conventional PAP and H&E techniques in FNAC.

Materials and Methods: The study was conducted on Fine needle aspirates from 96 patients presenting with breast lump in the Department of Pathology. TBWM, M/E stain, H&E stain and Pap stain was done for all 96 cases. Time taken for each stain is assessed and the morphology of rapid stains were compared with the conventional stain. Quality index was calculated for all the stains.

Statistical Analysis: Validation was done using tests like Sensitivity, Specificity, Positive predictive value and ROC curve. The p value £ 0.05 was considered significant.

Results: Toluidine blue wet mount takes only 2 minutes for staining followed by Methylene blue/eosin which takes 5 minutes. M/E stain gave the same result as compared to the conventional stains [PAP and H&E]. In TBWM there was difficulty in diagnosing few cases due to three dimensional clusters. The sensitivity and specificity of TBWM were 68% and 94% whereas for M/E stain 99% and 100%. The quality index of PAP stain, H&E stain, M/E stain and TBWM were 0.86, 0.82, 0.72, 0.66 respectively.

Conclusion: TBWM and M/E stain can be routinely undertaken as a supplementary procedure for conventional stains to improve the cellularity and to reduce the time taken for re-sampling.

Keywords: Toludine Blue Wet Mount; Methylene/Eosin; Rapid Cytodiagnosis; Quality Index. 

Background: Most common malignancy in women in western world is breast cancer. Ki-67 is a prognostic and proliferative marker distinguishing luminal type A from type B breast cancer.

Aims: The aim of the present study was to detect Ki-67 expression in breast carcinoma cases by IHC and to study Ki-67 expression with some histopathological features such as histological type of tumor, grade of tumor & involvement of lymph node (LN).

Study Design: Retroprospective

Material and Methods: The retroprospective study of 36 cases was conducted in the Department of Pathology at tertiary care hospital (U.P. West) during a period of 5 years.

Statistical Analysis used: It was done by a descriptive statistics and chi square test to look for any correlation between Ki-67 expression with histological type of tumor, grade of tumor and lymph node involvement. It was considered significant when p value was <0.05.

Result: Invasive carcinoma of no special type were the most common histological malignancy followed by invasive lobular carcinoma, carcinoma of neuroendocrine differentiation and metaplastic carcinoma. Majority of breast carcinoma cases showed T2 stage, Nottingham Modified Bloom Richardson System grade II and lymph node positivity. 63.89% cases of breast cancer were under group 1 of Ki-67 positivity, 25% were under group 2 Ki-67 positivity and 11.11% cases showed group 3 Ki-67 positivity.

Conclusion: Invasive carcinoma of no special type was the commonest histological type. No statistically significant association of Ki-67 positivity was found with grade, histological type, TNM stage & lymph node positivity.

Keywords: Breast; Ki-67; Cancer; Positivity; Grade. 

Background and Aims: Fine Needle Aspiration (FNA) which is used for making a cytological diagnosis has become an indispensable component of the work-up of many abnormalities. Intra-abdominal masses always remain an enigma in surgical practice. A documentary evidence of nature of pathology before institution of therapy is mandatory. The objectives of this study were to adopt Ultrasonography (USG) guided fine needle aspiration in the diagnosis of abdomino-pelvic masses, to assess its efficacy and to study the cytological features of these masses.

Materials and Methods: Twohundred patients with clinically or sonologically diagnosed abdomino-pelvic masses were taken up for the study. FNAC was performed under real time USG guidance. Two to four smears were prepared for each case. Air-dried smears were stained with wright’s stain and wet fixed smears were stained with H&E and Pap.

Results: The intra-abdominal and pelvic masses were divided according to the organ involved. The commonest organ to be involved was liver with 120 (59.79%) cases followed by gastrointestinal masses with 21 (11.34%) cases and miscellaneous soft tissue and retroperitoneal masses with 21 (11.34%) cases. Ovary was involved in 12 (6.18%) cases. Intra-abdominal lymph nodes were involved in 16 (7.21%) of cases. Pancreas 5 (2.57%), kidney 2 (1.03%) cases, spleen 2(1.03%) cases and gall bladder 1(0.55%).

Conclusion: USG guided FNAC is a relatively simple, economical, quick and safe,nonin­vasive procedure, highly accurate and a safe diagnostic procedure which can pre-empt a lengthy and expensive workup in various abdomino-pelvic masses.

Keywords: Abdomino-Pelvic Masses; FNAC; Ultrasonography.

Background: The exact cause of leiomyoma which affects at least 5 million women throughout the world is not known. Currently there are only few markers for leiomyoma which includes serum protein, prolactin, CA 125, soluble serum HLA-G, vascular endothelial growth factor and lactate dehydrogenase etc. However a reliable marker is still not found. This study is undertaken to analyse the association of oxidative stress and sialic acid in leiomyoma patients compared with control group.

Methods: This non interventional cross sectional study comprised of 50 study subjects with 25 leiomyoma patients (case group) and 25 healthy individuals (control group). Total antioxidant was estimated by phosphomolybdenum method. Serum sialic acid was measured by using diphenylamine method.

Results: The result showed a significant increase in the sialic acid level in leiomyoma patients (80.51±9.61) in comparison with normal healthy individuals (57.73±7.77) with p=0.05. Also an insignificant correlation of Total antioxidant level [TAC] between case and control group (p= 0.591).

Conclusion: In conclusion, serum sialic acid concentration is significantly increased in leiomyoma patients as compared to healthy control. This suggests a probable clinical use of sialic acid evaluation in future as a marker of leiomyoma. An insignificant correlation between total antioxidant and leiomyoma can be due to less involvement of oxidative stress in the pathogenesis of leiomyoma.

Keywords: Leiomyoma; Sialic Acid; Total Antioxidants; Tumour Marker. 

Background: Bone marrow aspiration (BMA) and Bone marrow biopsy (BMB) are very useful procedures for the diagnosis of haematological and non haematological malignancies, typing of anemia, pyrexia of unknown origin and infective diseases.

Objectives: To evaluate and compare the BMA and BMB findings in various haematological disorders.

Subjects: A total of 180 cases diagnosed with various haematological disorders in which bone marrow examination was done by using both the methods i.e. bone marrow aspiration and bone marrow biopsy were taken.

Results: Out of 180 cases, 158 cases were diagnosed on BMA and 168 cases on BMB. Rests of the 22 cases were dry tap on BMA and 12 cases were inadequate on BMB. Age ranged from 1.6 years to 80 years with the mean age of 36.30 years. Diagnostic accuracy of BMA was 100% in megaloblastic anaemia, acute leukaemia, metastatic marrow and ITP. BMB provided diagnosis in additional 6 cases of granulomatous lesion, 3 cases of MPD and 2 cases of LPD. Positive correlation between BMA and BMB was found to be 74.44%. The highest correlation was seen in reactive/leukemoid reaction (100%) and metastatic marrow (100%), correlation was least with aplastic anaemia (30.77%). No positive correlation was found in ITP and granulomatous lesion on BMA and BMB. Dry tap/ haemodilution on BMA were inconclusive in 22 cases (12.22%) maximum being for aplastic anaemia (8/13) cases. In all these cases BMB was diagnostic.

Conclusion: The utility and efficacy of BMB as compared to BMA have been discussed and debated. The answer, though complicated remains essentially the same. Both procedures complement each other.

Study Design: It was a cross sectional study conducted after approval from institutional ethical committee in the Department of Pathology, Sri Aurobindo Medical College and PG Institute, Indore.

Keywords: Bone Marrow Aspiration & Bone Marrow Biopsy. 

Background: The red blood cell surface has a system of antigens on them which constitute the Blood group system. Blood Group is an inherited trait in Mendelian fashion; there are 33 well defined blood group systems. But only ABO and RhD blood group status of the recipient and blood donor are taken into account in Transfusion Medicine.

Aims: The aim of study was to determine the ABO and Rh blood group distribution patterns in blood donors at Rural region of central Maharashtra.
Design: A retrospective study was carried out at blood bank of Rural based Medical college & Hospital at Warudi, Jalna (Central Maharashtra), India, for a period of 5 years from January 2013 to December 2017.

Materials and Methods: The study included 2,531 blood donors. Slide agglutination method with antisera ABO and Rh (Tulip diagnostics Ltd.and Span Diagnostics) was used to do ABO and Rh typing, and if any doubt persisted it was confirmed by tube agglutination method.

Results: The age group of predominant donors ranged between 18-25years (68.03%). Number of male donors surpassed that of female donors, with a ratio of 229:1. Blood group B (32.16%) was the most commonly encountered followed by ‘O’ (29.04%) and ‘A’ (26.31%) and AB (12.48%) which was the least common. The prevalence of Rhesus (Rh) positive was 94.47% and negative was 5.53% respectively.

Conclusion: It is really very important to know the distribution of blood groups in various populations which would help the blood banks and transfusion service policies and would contribute significantly to the National Health System. We carried out this study to determine the frequency of blood groups in our region for the same purpose.

Keywords: ABO; Blood Groups; Blood Donors; Rural (Central Maharashtra) India; Rhesus. 

Background: Malaria, caused by Plasmodium species carries significant mortality and morbidity. WHO estimates the disease burden in India to be up to 75% of all cases from South East Asia. Immune play in malarial infestation resulting in reduction of platelet count is common knowledge now. We undertook this study to evaluate the significance of alterations in platelet count and indices in malaria in comparison to a healthy control group.

Methods: A case control study conducted in a tertiary care hospital based in Dakshina Kannada district. 62 newly diagnosed cases of malaria confirmed by Peripheral smear method over a period of one year, and 50 healthy subjects were included. Cases of malaria with ongoing treatment and the cases which did not undergo malarial diagnostic tests in our institute were excluded. Following informed consent, platelet count and indices obtained from the five part automated haematology analyser (Mindray BC5380) were compiled and tested for significance in SPSS using unpaired t-test.

Results: 31 of the 62 cases showed pure P. vivax infestation, five cases showed pure P. falciparum infestation. 26 cases were mixed malarial infestation, having both P. vivax, and P. falciparum. Platelet count showed a mean value of 82,645/mm3, and 2, 53,380/mm3 in the case and control groups respectively. Statistical analysis showed p-values less than 0.001 in platelet count and indices between cases and controls.

Conclusion: This study demonstrated that platelet count is reduced in malaria with statistically significant alterations of the platelet indices as compared to the control group, raising the possible utility as contributory diagnostic markers of malaria. Replication of these results by studies with a great number of sample size would help validate these findings.

Keywords: Malaria; Blood Platelet; Plateletcrit. 

Background: Abnormal uterine bleeding (AUB) is the most commonand challenging problems presenting to gynaecologists now-a-days. Any bleeding pattern deviated from normal menstrual cycle results in AUB.

Aims and objectives: The present study was conducted to study the histopathological patterns of endometrium in patients presenting with AUB and to elucidate the causes of AUB in different age-groups.

Materials and Methods: 200 cases were analysed in Index Medical College Research centre and Hospital, Indore. The study was conducted after satisfying the specific inclusion and exclusion criteria. The specimens were routinely processed and H & E stained slides were studied. A statistical analysis between the age of presentation and specific endometrial finding was done using Chi-square test.

Result: The most common age group presenting with AUB was perimenopausal (40-50 years) with 107(53.7%) cases followed by reproductive (<40 years) age group with 83 (41.5%) cases. The most common histopathological pattern in perimenopausal patients was simple hyperplasia in 34 (31.78%) cases followed by proliferative phase in 29 (27.10%) cases. Overall proliferative phase was in 64 (32%) cases, simple hyperplasia in 53 (26.50%) cases, secretory phase in 46 (23%) cases, atrophic endometrium in 14(7%) cases, asynchronous endometrium in 9 (4.50%) cases, complex hyperplasia in 6 (3%) cases, endometrial polyp in 4 (2%) cases, endometrial carcinoma in 4 (2%) cases.

Conclusion: The study of histopathological pattern of endometrium in AUB cases is helpful to diagnose and properly manage the cases. There is an age specific association of endometrial findings.

Keywords: Abnormal Uterine Bleeding; H&E Stain & Histopathological Findings. 

Introduction: Anaemia in children is a major health problem worldwide and specially in developing countries like India. Anaemia is associated with visual and auditory dysfunction, cognitive and behavioral abnormalities and delay in psychomotor development. Anaemia is not a diagnosis, but may be a sign of an underlying pathology.

Objectives: To study the morphological pattern of anaemia and its distribution among different age groups and gender in pediatric population.

Material and Methods: A hospital based prospective cross sectional study was under taken at a tertiary health care centre. 500 anaemic cases were included for the study as per WHO criteria and age group ranging from 0-15 years. Evaluation by complete blood count and peripheral smear was done.

Results: Out of 500 anaemic children, the proportion of anaemia in males and females was 64% and 36% respectively. Males outnumbered females in the study. 0-5 year’s age group children were maximally affected. Moderate degree of anaemia was seen in maximum cases. Microcytic hypochromic anaemia was the commonest type of morphological pattern followed by normocytic hypochromic and normocytic normochromic pattern.

Conclusion: Study of morphological pattern of anaemia is essential to direct the further management of underlying etiology.

Keywords: Anaemia; Microcytic; Hypochromic; Children. 

Introduction: Nephrectomy is a common procedure in urological practice. Simple nephrectomy is indicated in patients with an irreversible damaged kidney resulting from symptomatic chronic infections, obstruction, calculus, severe traumatic injury and renal dysplasia. The present study was aimed at studying of wide spectrum of renal diseases, to study the frequency of non neoplastic conditions and correlation with respect to age and sex of the patients.

Methodology: The study was prospective and included 40 nephrectomy specimens over a period of 2 years. The gross morphology and the microscopic features were studied.

Results: In the present study, a total of 40 cases of nephrectomy specimens were studied. Of the 40 cases, 25 were non-neoplastic lesions (62.5%).

Conclusion: It is mandatory for every nephrectomy specimen to be subjected, to a detailed Histopathological examination, for a clinico-pathological correlation to ensure proper management. The clinical outcomes of various histologic subtypes are different, validating for accurate subtyping of renal lesions in clinical practice. Chronic Pyelonephritis was the commonest non-neoplastic lesion in females, which is a consistent finding in the present study. No significant difference was noted in the frequency of males and females in case of other non-neoplastic lesions of kidney.

Keywords: Nephrectomy; Chronic Pyelonephritis; Renal Cell Carcinoma.

Introduction: Lymphadenopathy is a commonly encountered clinical problem. Fine needle aspiration cytology offers immediate preliminary diagnosis. In routine practice <1% of patients with peripheral lymphadenopathy will be having malignant process. This necessitates the study on non-neoplastic lesions of lymph node.

Objectives: 1. To study the spectrum of non-neoplastic lymph node lesions diagnosed by FNAC
2.To study cytomorphological features of various non-neoplastic lymph node lesions by FNAC
3. To correlate with histopathology wherever possible

Methods: This was a two year study from January 2016 to December 2017 conducted in SNMC and HSK hospital and 286 patients with non-neoplastic lymph nodes were included in the study. Lymph node aspiration was done, smears were prepared, fixed, stained with H&E and Pap. Air dried smears were stained with Giemsa and ZN.

Results: The age ranging from 1 month to 85 years. Majority were reactive lymphadeniti (173/286) followed by tuberculous lymphadenitis (49/286), granulomatous lymphadenitis (22/286), acute suppurative lymphadenitis (34/286), Idiopathic necrotizing lymphadenitis (5/286), kimura’s disease (1/286),Rosai-Dorfman disease (1/286), filariasis (1/286). Histopathology was available in 26 cases of which 24 cases on biopsy confirmed the cytological diagnosis. Rest two cases were false negative. In remaining cases lymphadenopathy subsided with appropriate therapy.

Conclusion: FNAC is technically easy, rapid, cost-effective and reliable for diagnosing non-neoplastic lymph node lesions. Repeated aspirations will avoid sampling errors.

Keywords: FNAC; Non-Neoplastic Lymphnode; Lymphadenitis. 

Background: Dry eye is a clinical condition resulting from decreased tear production or increased loss of tears due to evaporation. Conjunctival impression cytology (CIC) helps in evaluating the abnormal tear film status apart from the routine tear function tests.

Aim: We aimed to know the influence of small incision cataract surgery on tear film and assess the changes in tear film by CIC.

Materials and Methods: 101 patients diagnosed with cataract were studied over a period of 2 years. Schirmer’s test, tear film break up time, fluorescein staining and lissamine green staining were done pre and post operatively. Conjunctival impression cytology smears stained with periodic acid Schiff (PAS) stain were analyzed pre and post operatively.

Results: Pre-operatively CIC showed 15 patients (14.8 %) with no cells, 72 patients (71.2 %) with squamous cells and 14 patients (13.8 %) with squamous and goblet cells. Post-operatively 36 patients (35.6 %) showed no cells, 52 patients (51.4 %) showed squamous cells and 13 patients (12.8 %) showed squamous and goblet cells. Pre-operatively Schirmer’s test showed 90 patients (89.1 %) to be normal and 11 patients (10.9 %) abnormal. Post-operatively 85 patients (84.1 %) were normal and 16 patients (15.9 %) were abnormal. Tear film break up time, flourescein staining and lissamine green staining showed no changes pre and post operatively. CIC and Schirmer’s test showed a significant positive correlation with p values of 0.001 and 0.034 respectively. Tear film break up time, fluorescein staining and lissamine green staining showed a negative correlation.

Conclusions: Manual small incision cataract surgery is associated with a significant worsening of tear film stability and CIC is a vital tool with diagnostic accuracy in evaluating tear film status.

Keywords: Cataract; CIC; Dry Eye; Goblet; Squamous; Tear Film. 

Background: Demand of blood and its components is always more than its supply. It is now high time to develop new operational policies for reducing wastage of blood units.

Aims: The aims of this study were to find the rate of discard and compare the results with other studies and determine the preventive measures for wastage of blood.

Setting and Design: This is a retrospective analytical study conducted over a period of five years from 1st January 2013 to 31st December 2017 in the blood bank of a tertiary care hospital.
Material and Methods: The study included the discard rate of whole blood, packed red cells, platelets, Fresh frozen plasma, cryopoor plasma and cryoprecipitate units due to various reasons.

Statistical Analysis: The collected data were analyzed using descriptive statistical methods and by SPSS version 12.0.

Results: The overall rate of discarded blood and blood components was 5.62%. The rate of discard for CP was the highest at 38.55% followed by PC at 9.18%. The rate of discard for whole blood was 6.18%. The rates of discard for FFP, PRC and CPP were 4.74%, 3.81% and 0.84% respectively. The total discard rate due to reactivity for markers of transfusion-transmissible infection was 3.47 % and 1.02% of the blood components were discarded due to expiry.

Conclusion: To deal with the necessity of blood and blood components more strict measures should be taken and pursued for their right utilization and reduction of wastage.

Keywords: Blood Units; Blood Transfusion Services; Inevitable Wastage; Seroreactive. 

Background: Benign skin tumors constitute a small part of the surgical specimens. However, histopathologically, there is a wide variety of benign skin tumors.

Aim and Objectives: To study the histopathology of benign skin tumors and to correlate pathological findings with clinical parameters.

Material and Methods: We have studied 64 specimens of benign tumors of skin received in the department of pathology of our tertiary care institute, from January 2012 to August 2015 byhistopathological examination. The tumors were classified according to WHO classification of skin tumors 2006. The clinical data of the patients and pathological findings were analysed followed by clinicopathological correlation.

Results: Soft tissue tumors of skin were most common (37.5%) followed by keratinocytic tumors (32.81%). Overall, seborrhoeic keratosis and pyogenic granuloma were most frequent (17.19% each) followed by verruca (15.63%). Tumors with hair follicular differentiation and those with eccrine/ apocrine differentiation constituted the majority of appendageal tumors (46.66% each). Hidradenoma and pilomatricoma were the most common appendageal tumors (26.66% each) Verruca, hidradenoma, pilomatricoma, pyogenic granuloma and dermatofibroma were more commonly found before fourth decade, whereas seborrhoeic keratosis was more commonly found after fourth decade. The frequency of benign tumors was equal in males and females. Head and neck region was the most common site (50%) for all the tumors, except verruca which was most frequent on extremities.

Conclusion: Histopathological examination is essential for the diagnosis of benign skin tumors,due to their varied morphological spectrum.

Keywords: Benign Skin Tumors; Adnexal; Seborrheic Keratosis; Pilomatricoma; Hidradenoma. 

Objective: A comparative study of liquid based cytology and conventional pap smear in cervical screening.

Material and Methods: 100samples of cervicovaginal smears prepared by standard conventional and LBC technique were interpreted as per Bethesda system of reporting cervico-vaginal smears. Smear were studied, compared and statistically analyzed. A pvalue < 0.05 is considered statistically significant.

Results: After conversion to LBC the percentage of unsatisfactory smear is decreased. The epithelial abnormalities found in CPS and LBC are in frequency of normal (7%), Chronic cervicitis and infection (44%), mild dysplasia and LSIL (20%), HSIL (23%), AGUS (1%), Ca Cervix (4%), Adenocarcinoma (8%). Inflammatory organisms were almost equally identified in both techniques.

Conclusion: Although a shorter screening time, cleaner background and decreased unsatisfactory smear are the major advantages of LBC, CPS is not inferior to LBC. The data suggests that there is increased detection rate of cervical pre cancerous lesions with LBC. The specificity of the two tests seems similar because of the fact that follow up of negative cases is unavailable.

Keywords: Conventional Pap smear; Liquid Based Cytology. 

Most common sites for neoplastic and non neoplasticlesions is Liver. Ultrasound is the first and most important diagnostic tool for liver diseases. As sonography alone has its limitations, cytomorphologic analysis by FNA is required to increase the diagnostic accuracy. Accurate diagnosis of hepatic masses are very important as treatment ranges from supportive care for advanced metastatic lesions to primary carcinoma [1]. Ultrasound guided FNA of liver is safe,cheap,and relativelynon-invasive procedure with minimum complications. Cytological examination is sensitive and highly specific technique and can be routinely used for evaluation of liver diseases.

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

Introduction:Lymphadenopathy is a term meaning disease of the lymph nodes . It is, however, almost synonymously used with swollen or enlarged lymph nodes due to infection, auto-immune disease or malignancy. FNAC and imprint is a valuable adjunct inprior to the histological diagnosis of lymphadenopathy.

Aim of the Study is to evaluate the diagnostic accuracy and efficacy of fine needle aspiration cytology and imprint cytology study in correlation with histopathological study.

Materials and Methods: was carried out in the department of Pathology, sreebalaji medical college and hospital, chrompet, chennai. 120 Fine needle aspiration cytology (FNAC) and corresponding imprint cytology prior to histopathology were studied in 53 cases.

Results: A total of 120 FNAC for lymphnode enlargement were done which revealed higher incidence of non neoplastic lesions 85% (102 cases) in comparison to neoplastic lesions 15% (18 cases),62 cases were males and 58 cases were females Out of 120 cases that underwent FNAC, excision biopsy was received in 53 cases, in which imprint was made from all 53 biopsy prior to HPE diagnosis which included 66.03% (35 cases) of benign lesions and 15% (18 cases) of malignant lesions.

Conclusion: FNAC cytology for suspicious palpable lymph nodes can be one of the first procedures performed during the patients work up as it could differentiate the infectious process from the neoplastic one, for mainly avoiding unnecessary surgery. Imprint is an reliable, rapid, and inexpensive tool in diagnosis of various lymph node diseases while awaiting histopathology report.

Keywords: FNAC; LN; HP. 

Background: Histological examination of the prostate must also include the description of some important aspects which are present associated with Benign Prostatic Hyperplasia (BPH) and which may condition the progression of the disease.

Aim: To find out incidence of Prostatic Intraepithelial Lesions (PIN) and incidental carcinoma in clinically diagnosed BPH, and to correlate histological findings with patients age and pre-operative serum PSA (prostate specific antigen) level.

Method and Material: 107 TURP (Trans Urethral Resection of Prostate) specimens were processed and studied. Histomorphological diagnosis is made. Correlation of final histological diagnosis with age and serum PSA level, applying one way ANOVA test, was determined.

Results: Out of 107 cases, the incidence of Low Grade PIN was 2 (1.9%), High Grade PIN was 1 (0.9%) and overall PIN was 3 (2.8%). The incidence of T1a was 4 (3.7%), of T1b was 2 (1.9%) and overall prostatic carcinoma was 6 (5.6%). Of these, there were 2 (33.3%) patients in the Gleason Grade 1 and 4 (66.7%) in the Gleason Grade 2. Statistically significant correlation of these premalignant and malignant lesions is demonstrated in comparison to age, whereas serums PSA level do not show any significant correlation.

Conclusion: Both, adenocarcinoma and PIN can be diagnosed on histopathological examination of TURP specimen. Probability of finding these premalignant lesions as well as incidental carcinoma in association with BPH increases with age.PSA levels are not significant indicator of presence of these lesions.

Keywords: Benign Prostatic Hyperplasia; Prostatic Intraepithelial Neoplasia; Prostatic Adenocarcinoma; Incidental Prostatic Carcinoma. 

Background: The diagnosis of iron deficiency anemia (IDA) requires costly and sophisticated work up. Red cell distribution width (RDW), a marker of anisocytosis of RBC is altered in iron deficiency anemia.

Aim: To assess the utility of RDW for the diagnosis of IDA in microcytic hypochromic anemias.

Materials and Methods: Ninety three samples with microcytic anemia were analysed and classified into IDA and Non IDA groups based on serum ferritin. Hematological parameters including RDW were obtained from fully automated hematology analyser ADVIA 2120. Biochemical parameters were derived from COBAS E411 & Ranbox Imola. Receivers operating curve (ROC) was done to assess the sensitivity and specificity of RDW in diagnosis of IDA.

Results: In this study 45 samples were classified as IDA using serum ferritin as gold standard. ROC gave a cut of value of RDW at 19.8 with best sensitivity and specificity in diagnosing iron deficiency anemia. The sensitivity of RDW was 86.67% and specificity of 45.83%.

Conclusion: RDW has limited specificity and moderate sensitivity for diagnosing IDA in microcytic anemias.

Keywords: Red Cell Distribution Width; Iron Deficiency Anemia; Microcytosis. 

Introduction: Malaria is a very stubborn disease which has been taking steady toll of human life even now. It has been mentioned in the literature that many unexpected/ unexplained deaths occurred in malaria endemic regions and on autopsy of these deaths, cause turn out to be malaria.

Material and Methods: This was descriptive observational study conducted for the period of two years. All the diagnosed or suspected cases of cerebral malaria were included in study. Whenever cerebral malaria diagnosed or suspected, brain was removed with usual autopsy technique and fixed with routine techniques.

Results: Out of 3588 autopsies, 60 (1.67%) were the cases of cerebral malaria. On gross examination of brain; the characteristic slate-grey colour was observed in 58.33% (35) cases and presence of malarial pigment seen in other organs.

Conclusion: In malaria endemic areas, unexplained and/or unexpected deaths, should be critically investigated with the autopsy examination.

Keywords: Malaria; Autopsy Findings; Cerebral Malaria. 

Context: Urinary bladder diagnosis can be challenging and conventional markers used were cytokeratins. The new additions are GATA 3, uroplakin and S100P. This study helps to analyze immunohistochemical expression of panel of markers across the spectrum of urinary bladder tumors.

Aims: 1. to evaluate immunohistochemical expression in various subtypes of urothelial neoplasms of the urinary bladder and to correlate this expression with the grade of the tumor. 2. To distinguish between reactive urothelium and carcinoma in situ/ dysplasia using immunoprofile work up.

Settings and Design: Study was performed in the department of Pathology in RGCIRC, Delhi with 70 cases of urinary bladder lesions during period of one year.
Methods and Material: longitudinal study
Statistical Analysis: The tissue sections were scored using CK, UROPLAKIN II, GATA 3, S100P, CD44, p16 and KI 67

Results: 1. CK7+ and CK20+in 92% and 77% cases. p16+ in 83% and CD 44+ in 84%. Newer markers: Uroplakin II-75%; S100P-82% and GATA3-96%positivity. CD44+ in reactive urothelium 5/5 and CK20+ in CIS (12/12) cases. p16+ in 4/5 cases of reactive atypia and CIS 12/12 cases.

Conclusions: The markers are sensitive for urothelial origin & have to be used as panel wherever required.

Keywords: Uroplakin II; Gata 3; Bladder Carcinoma

Introduction: The prostatic cancer is the second most common cause of cancer death in men.

Aim: To elaborate the study of mucin histochemistry in prostatic lesions and establish theutility of Mucin Stains in distinguishing benign lesions from in situ and malignant lesions.

Materials and methods: In the retrospective and prospective study. Cases were admitted and biopsied who underwent prostatic biopsies and surgeries due to various prostatic pathologies. Biopsy specimen paraffin blocks of the tissue were obtained and fresh sections were made with a thickness of six microns on a rotary microtome. All the sections were stained with Hematoxylin and Eosin.

Results: A five year combined retrospective and prospective study from 1 st January 2012 to 31 st October 2016, revealed a total of 347 prostate biopsies. The total number of biopsy specimens received during the above five year period were 13338, and the prostate biopsies accounted for an overall proportion of 2.6 %. 89% of cases in study are malignant and 21% are benign.

Conclusion: Mucin histochemistry evaluation is a simple, reliable and economical technique to confirm the presence of malignancy in suspicious lesions.

Keywords: Mucin Histochemistry; Prostate Lesions; Alcian Blue-PAS Stain. 

Introduction: Periampullary tumours are defined as those that arise within 2 cm of the major papilla in the duodenum. These tumors exhibit different morphology, immunohistochemistry patterns and different clinical behaviors based on the exact site of origin.

Aim of the study:To study the spectrum of histopathological variants of periampullary carcinoma.

Materials and Methods: This was a retrospective study conducted in Upgraded department of Pathology, Osmania Medical College and General Hospital, Hyderabad over a three year period. A total of 66 cases of periampullary carcinomas resected by Whipples procedure were studied. Histopathologic examination, staging and classification of tumorswas done based on site of origin as pancreatic, ampullary, distal common bile duct, and duodenal carcinomas. Immunohistochemistry for CK7, CK20, NSE, Chromogranin A, and Ki67 was done.

Results: The maximum number of patients were in the range of 41 - 50 years with male: female ratio of 1.6:1. Of the 41 pancreatic periampullary carcinomas, majority were adenocarcinomas (35 cases).Out of 13 ampullary carcinomas 08 were Intestinal type and 04 were Pancreaticobiliary type adenocarcinomas and 01 was neuroendocrine type. Of the 62 periampullary adenocarcinomas, 72.5%, 24.1% and 3.4% were well, moderate and poorly differentiated carcinomas respectively. Pathological TNM staging was done in 62 resected specimens. Majority of the pancreatic adenocarcinomas (24 cases) were StageIII.

Conclusion: A combination of tumor size, tumor site, histopathological type and grade, lymphnode involvement and status of resected margins all influence the overall survival of patients undergoing pancreaticoduodenectomy for periampullary carcinomas. Hence, it is important to classify these tumors according to these parameters.

Keywords: Periampullary Carcinoma; Anatomical Site; TNM Staging; Histopathologic Variants 

Introduction: Lymphadenopathy is a common clinical problem. Fine needle aspiration cytology is minimally invasive procedure and helpful in the diagnosis of various swellings especially superficial palpable swellings like lymph nodes.

Aim of the study:To study the spectrum of cytological and histopathological findings of lymph nodes.

Materials and Methods: This was a prospective study where 220 patients underwent FNAC procedure of lymph nodes and out of which 80 patients subsequently underwent biopsy procedure. The patient demographics, clinical presentation, site and consistency of lymph nodes, the cytology and histopathology findings were studied.

Results: There were total 220 patients with 120 males and 100 females and the patient age ranged from 1 to 80 years. Non-neoplastic lesions were more common (95%) than neoplastic lesions (5%). Cervical nodes were the most commonly affected nodes. Granulomatous inflammation of tuberculous etiology was the most common diagnosis (50% cases) on FNAC and also on biopsy. Metastatic malignancy was more common than primary lymphomas.

Conclusion: Lymphadenopathy due to non-neoplastic causes is more common than neoplastic causes. Attention to clinical details is important for evaluation of all cases of lymphadenopathy. Tuberculosis is one of the most common causes giving rise to lymphadenopathy. Metastatic involvement of lymph nodes is more common than primary lymphomas.

Keywords: Lymph Nodes; Cervical; FNAC; Lymph Node Biopsy. 

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