Indian Journal of Pathology: Research and Practice

 Introduction: Carcinoma of the fallopian tube is a rare pelvic malignancy accounting for only 0.3 to 1.1% of all gynaecological cancers with less than 1500 cases reported in the  literature [1,2]. Primary fallopian tube carcinoma isprovisionally misdiagnosed as ovarian carcinoma due to its rarity and symptom overlap.

Case Report: We present the case of a 55 years old female whopresented with complaints of an abdominal mass. After imaging and examination,she was clinically diagnosed as a left adnexal mass most probably of ovarian origin. During diagnostic laparotomy, an adnexal mass with hemoperitoneum was noted. Total abdominal hysterectomy with bilateral salpingo-oophorectomywith lymph node dissection was done and sent for histopathological examination. On gross examination, both the ovaries were uninvolved and tumour masseswere seen in both fallopian tubes, larger in the left tube.After extensive sampling and microscopic examination, a histological diagnosis of papillary serous cystadenocarcinoma of the fallopian tube was given. 

Conclusion: In conclusion, a case of primary fallopian tube carcinoma, although rare should be taken as a possibility for any adnexal mass. Early clinical suspicion followed by prompt investigations will lead to early diagnosis and a better survival. 

Keywords: Primary; Fallopian Tube Malignancy; Papillary Cystadenocarcinoma.

  Blood grouping plays an important vital role in blood and its component transfusions. Blood groups are further grouped as major and minor blood groups. The ABO and Rhesus (Rh) blood groups belongs to major blood group system. These groups vary from individual to individual and also in different parts of the country. The aim of this study is to know the distribution and pattern of different blood groups prevalence in and around Tumkur. The blood groups were done in the blood bank unit. 4114 individuals are screened for ABO and Rhesus (Rh) blood groups. Among the ABO system the commonest blood group is group O, followed by group B, and group  A. The least common group is AB. The same individuals are subjected for Rh grouping. The distribution of Rh-positive and Rh-negative group are 94.87% and 5.13% respectively. 

Keywords: ABO Blood Group; Rh Group.

  Introduction: Atypical uterine bleeding (AUB) is the most common and frequent presenting complaint in gynaecology outpatient department in all age groups, especially in perimenopausal women accounting for more than 70%.

Methods: Prospective analytical study conducted from January 2017 to December 2017 in perimenopausal women (45-55 years). Other age groups with AUB, isolated cervical or vaginal pathology, leiomyoma of other types, bleeding diathesis, medications associated with AUB and pregnancy related causes of bleeding were excluded. Endometrial tissue collected by dilatation and curettage (D&C), endometrial biopsy and hysterectomy specimens subjected to histopathological examination were analysed.

Results: Total 150 specimens were analysed in which 83 were endometrial samples and 67 were hysterectomy specimens. Majority were multiparous women 45-50 years presented with heavy menstrual bleeding and showed proliferative endometrium as the predominant pattern ( 30%). Other endometrial patterns were simple hyperplasia without atypia (23.33%), complex hyperplasia without atypia (4%), secretory endometrium (15.33%), disordered proliferative endometrium (3.33%), irregular ripening (7.33%), irregular shedding (2%), atrophic (5.33%), endometritis (1.33%), endometrial polyp (4%) and carcinoma endometrium in 2% cases. Hysterectomy specimens revealed 51 cases of combined endometrial and myometrial pathologies. Myometrial pathologies included submucosal leiomyoma -44.77% and adenomyosis -31.34% as the causes of AUB.

Conclusion: AUB is one of the commonest reasons for women to seek medical help in all age groups, especially in perimenopausal age. Gynaecologists should pay attention towards these abnormal bleeding patterns along with the evaluation of endometrial tissue for histopathological findings which showed wide variety of abnormalities.

Keywords: Atypical Uterine Bleeding (AUB); Endometrium; Perimenopause

  Context: Since it’s first report in 1982, HIV has emerged as a major pandemic. Haematological abnormalities are among the most common clinicopathological manifestations of HIV infection including impaired haematopoiesis, immune mediated cytopenias and coagulopathies.

Aims: To study haematological parameters in PLHIV and to correlate them with CD4 count. To correlate Absolute Lymphocyte Count (ALC) with CD4 count to evaluate the utility of ALC as a surrogate marker for CD4 count.

Settings and Design: Prospective observational study 

Methods and Material: After obtaining informed consent, 225 PLHIV were clinically evaluated and subjected to CBC, PBS, ALC, ESR and CD4 count. Statistical analysis used: Data was expressed as percentage and mean±standard deviation. Statistical tests used were chi-square test, Fisher’s exact test and Mann-Whitney U test and Kolmogorov-smirnov analysis. Also, Pearson’s rank order correlation and ROC curve was used.

Results: The important haematological findings noted were anaemia (n=123,54.6%), leucopenia(n=34,15.2%), lymphocytopenia (n=128,56.9%), thrombocytopenia (n=10,4.4%) and raised ESR (n=162,72%). CD4 count was reduced in 156 cases (69.3%). Haemoglobin, MCV, MCH and ALC (p<0.0001) showed significant positive correlation with CD4 count. ALC ï‚£ 1400cells/µl indicated CD4<200cells/µl.

Conclusions: The most frequent haematological finding is lymphocytopenia followed by anaemia. Haemoglobin, MCV, MCH and ALC showed rise with increase in CD4 count. ALC ï‚£ 1400cells/µl can act as surrogate marker for CD4<200cells/µl in resource poor settings.

Keywords: Absolute Lymphocyte Count; CD4 Count; ESR; Haematological Parameters; PLHIV.

  Introduction: The spectrum of diseases encountered in post-transplant liver biopsies is broad. The pathologist plays an important role in defining these process. 

Aim: The aim of this study was to evaluate liver allograft biopsies performed for graft dysfunction by analysing the pattern of injury and intensity, and the timeline of occurrence of graft dysfunction. The pathological features of explant liver of these patients were also looked into.

Materials and Methods: Retrospective study was carried out on 110 liver allograft biopsies from 65 patients and their histological findings with clinical presentation were correlated. The period of study was from January 2013 to December 2016. 

Results: The most common histological lesion was preservation-reperfusion injury (PRI) in 40 (36.36%) biopsies followed by acute cellular rejection (ACR) in 32(29.09%) biopsies. Biliary obstruction, sepsis and chronic rejection was present in 5 (4.55%) biopsies each. Five biopsies (4.55%) showed idiopathic posttransplant hepatitis. Steatohepatitis and ischemic necrosis were seen in 4 (3.64%) cases each. Three biopsies (2.73%) showed acute cholangitis. Recurrence of HCV was reported in 1 (0.91%) case and HBV reactivation in one (0.91%) case. Nonspecific changes like focal mild lobular and focal portal inflammation and mild steatosis were present in 4 (3.64%) cases.

Conclusion: Reperfusion injury ( PRI ) in time zero biopsies was the most common finding in our study followed by ACR. 70.9% of biopsies with ACR were observed within 6 months post transplant. Analysis of explant liver specimens showed cirrhosis associated with alcoholic steatohepatitis to be the most common etiology of end stage liver disease leading to transplant. 

Keywords: Reperfusion Injury; Acute Cellular Rejection; Chronic Rejection; Explant; Transplant.

  Context: Eosinophilic enterocolitis is a rare inflammatory disease of unknown origin, characterised by diffuse eosinophilic infiltration of gastrointestinal tract, accompanied by varying abdominal symptoms. The condition is increasing in frequency in recent years and is associated with major complications if untreated. Hence, it is very necessary to diagnose the condition. Hence, the present study was done to evaluate for eosinophilic enterocolitis in intestinal biopsies, and to correlate with peripheral eosinophilia.

Aims: 1. To evaluate intestinal biopsies for eosinophilic enterocolitis. 2. To correlate with peripheral esoinophilia. Settings and Design: All the intestinal biopsies received in the department of Pathology of M.S. Ramaiah Medical College, Bangalore, from November 2015 to November 2016 were evaluated. Specific criteria for diagnosis of eosinophilic enterocolitis was used, criteria being eosinophils ranging from 10-50/HPF in the biopsies. Correlation with peripheral eosinophilia was also done.

Methods and Material: All the intestinal biopsies received in the department of Pathology of M.S. Ramaiah Medical College, Bangalore, from November 2015 to November 2016 were evaluated. Specific criteria for diagnosis of eosinophilic enterocolitis was used, criteria being eosinophils ranging from 10-50/HPF in the biopsies. Correlation with peripheral eosinophilia was also done. Statistical Analysis used: Statistical analysis is not required as it is a analytical study.

Results: A total of 52 cases of intestinal biopsies were obtained during the one year study period. Out of the 52 cases, 5 cases (9.6%) were diagnosed as eosinophilic enterocolitis. Out of the 52 cases, 3 cases (60%) were associated with peripheral eosinophilia. Out of the 5 patients with eosinophilic enterocolitis, 4 were men and only 1 was a woman, 

Conclusions: The incidence of eosinophilic enterocolitis is increasing in recent years. Hence
this condition should be considered in the differential diagnosis whenever a patient presents
with chronic diarrhea. Timely treatment can prevent major complications in these patients.

Keywords: Eosinophilic Enterocolitis; Peripheral Eosinophilia.

  Background:Breast lesion is the most common malignant tumor and the leading cause of carcinoma death in women, with more than 10 lakh cases occurring worldwide annually. Benign breast lesion is a neglected entity despite the fact that it constitutes the majority of breast problems. Breast cancer has taken precedence over benign breast disease since it is more fearsome although the number of females with benign breast disease is substantial.

Materials & Methods: This study was hospital based prospective study including all the patients with breast lump who attended hospital. Comparison between cytology and histology was done according to availability of samples. Their attention was given to age, sex, laterality, non-neoplastic and neoplastic lesions. Specimen was fixed in 10% formalin saline for 24 hours, gross features will be examined, after processing tissue was embedded in paraffin wax to make block with the help of moulds. Serial Section, 3-5 micron thick were cut and these slides were kept in hot oven at 66 OC for one hour to fix the section on slides  before staining with routine Hematoxylin and Eosin.

Results: A total of 100 cases were studied over a period of 1 year,of which benign lesion constituted 82.0% of cases where as malignant cases were 18.0%.In our study, 85 were female (85.0%) and 15 were male (15.0%). All the breast lesions in male were benign lesion (gynaecomastia). Out of 100 patients with breast lesions, 56 (56.0%) had left sided
involvement, 40(40.0%) had right sided involvement whereas 4 (4.0%) had bilateral involvement.

Conclusion: In our study, benign breast diseases are more common compared to malignant diseases of breast in the ratio of 4.55: 1.Breast self-examinationand education to females are very important for early diagnosis and treatment of breast diseases. 

Keywords: Benign; Malignant; Benign Brest Disease; Histopathological

  Introduction : Since the time of Hippocrates the Latin phrase “primum non nocere” i.e. “first, do no harm” has been taught to medical students. In laboratory practice, this is applicable to minimizing error rates,as clinical decision making is based largely in accordance with the laboratory results. Modern quality management tools such as Six Sigma can be the solution towards achieving error free laboratory reports. Six sigma refers to world class quality with a defect rate of 3.4 defects or errors per million opportunities.. The present study was undertaken to analyse the performance of biochemical parameters routinely tested in our laboratory in terms of six sigma scale and to develop a strategy for continuous quality improvement process.

Materials and Methods: This was retrospective study to analyse and evaluate the performance of 25 biochemical tests in our laboratory from January to December 2017. All the biochemical analytes were run on Dade Dimension RxL Max. Internal and External controls were procured from Biorad Laboratories, USA. Two levels of IQC Normal (Level 1) and Abnormal (Level 2) were run for each parameter twice a day. The TEa for calculating sigma metrics were taken from CLIA Guidelines.  

Results :-. In Level 1, 4 analytes: Chloride, SGPT (ALT), Calcium and Urea sigma value was below 3, 7 analytes: Lipase, Albumin, Direct Bilirubin, Total Bilirubin, Cholesterol, Creatinine and Glucose sigma value was between 3–6, 14 analytes: Potassium, Sodium, Alkaline Phosphatase, Amylase, SGOT (AST), HDL Cholesterol, LDL Cholesterol, GGT, Iron, Phosphorus, Total Protein, TIBC, Triglycerides, Uric Acid sigma value was above 6. In Level 2, 2 analytes: Chloride, Calcium sigma value was below 3, 7 analytes: Lipase, Albumin, Total Bilirubin, Direct Bilirubin, Cholesterol, Glucose, Total Protein and TIBC, sigma value was between 3 – 6, 16 analytes: Potassium, Sodium, Alkaline Phosphatase, SGPT (ALT (SGPT)), Amylase, SGOT (AST (SGOT)), Total Bilirubin, Direct Bilirubin, HDL Cholesterol, LDL Cholesterol, Creatinine, GGT, Iron, Phosphorus, Triglycerides, Uric Acid sigma value was above 6.

Conclusion: A Rational QC design is needed to be optimize the QC procedures, reduce the cost of running daily QC and to solve analytical problems and decrease the number of errors to a minimal level. Using six sigma in clinical laboratories has been shown to refine patient care by eliminating the need to retrace steps, correcting errors in laboratory reports and re-performing tests which are wasteful processes both in terms of economics as well as patient dissatisfaction and discomfort 

Keywords: Six Sigma; Total Quality Management; QC.

  Background: Liquid Based Cytology (LBC) is defined as a method of preparing cytological specimens for microscopic evaluation in which the patient’s aspirated specimen is suspended in a liquid medium, which is used to produce a thin layer of cells. The objective of our study was to prove the efficacy of Manual Liquid Based Cytology (MLBC) over Conventional Smear Cytology (CS) in Fine Needle Aspiration (FNA) samples including body fluids.

 Methods: In this comparative study 100 FNA samples from various anatomical sites were assessed by both MLBC and CS technique under the criteria of cellularity, background, cellular preservation, nuclear preservation. These criteria are evaluated by Kruskal-Wallis test and p-value <0.001 is considered as statistically significant. 

Result: MLBC technique shows better results as compare to CS in terms of cellularity and cellular preservation (p-value < 0.001) whereas MLBC doesn’t show statistically significant difference in background (p-value = 0.412) and in nuclear preservation (p-value = 0.567).

Conclusion: This study though shows that MLBC is safe and less time-consuming technique, however it doesn’t offer any diagnostic superiority over CS in the evaluation of FNA samples. We recommend CS as a gold standard technique with MLBC used as a supportive procedure in some cases.

Keywords: Manual Liquid-based Cytology; Conventional Cytology; FNA Samples and Body Fluids.

  Context: Anemia is a widespread health issue globally and its prevalence in developing countries like India is high, particularly in women and children as it plays an important role in their morbidity and mortality. Undiagnosed anemia, can lead to impaired physical and mental development of children, which is preventable.

Aim: To assess the prevalence of anemia in school going children within the age group of 9-14 years. 

Methods and Material: We conducted a cross-sectional study on 400 children in the age group of 9-14 years in two schools. Complete blood count and peripheral smear examination was done.

Results: Anemia was observed in 126 students and females were more commonly affected than males. Females were also noted to have lower mean hemoglobin concentration. Normocytic normochromic anemia was the commonest morphological type observed on peripheral smear.

Conclusions: This study shows the high prevalence rate of anemia in school going children of Vijayapur and need for regular screening of these children and periodic intervention.

Keywords: Anemia; School Children; Iron Deficiency Anemia; Adolescent Females.

  Background: Research is an essential component of medical education, along with it plays an important role in advancement and improvement of health care services.   Objective: To evaluate and assess the attitude, practice and knowledge of research in undergraduate medical students in S. Nijalingappa Medical College & HSK Research Centre, Bagalkot.  Materials and Methods: A cross sectional, structured, pre-validated and self administered questionnaire was completed by 124 undergraduate students of IInd year MBBS. Quantitative evaluation of collected data was done.  Results: Out of the following 124 students, 79% agreed that they can conduct a research before completion of MBBS. 98.2% stated that research is useful for future in medical profession. 60.9% agreed for a term that there is a lack of knowledge on research conduction. While 95.2% showed a response for encouraging mentored health research.  Conclusion: The undergraduate students in the study empowered a positive response towards conducting a research. The problems faced like lack of guidance, time and having a heavy curriculum are to be solved to ensure quality research activities among medical undergraduates. 

Keywords: Attitude; Practice; Knowledge; Research; Undergraduates.

  Background: Cervical infections are commonly encountered problems occurring in the women of the reproductive age group. Pap smear, a screening test for carcinoma cervix is a simple, quick test that can also be used for diagnosing cervico-vaginal infections. The present study was undertaken to study the utility of Pap smears in diagnosing cervicovaginal infections and to study the spectrum of infections occurring in this region.

Objectives: To establish that cervical pap smear is the most simple, easy, quick and painless procedure employed for cervicovaginal infections and to estimate the proportional frequency of normal, inadequate, unsatisfactory, inflammatory and neoplastic smears.

Methods: A Cross sectional study was conducted on 250 pateints. Cervicovaginal smears were collected from patients for various gynaecological problems. Study was mainly carried out in the department of Obstetrics and Gynaecology, Index Medical College Hospital and Research Centre, Indore to assess the utility of pap smear in diagnosing cervicovaginal infections during the period of January 2016 to April 2017.

Results: The overall frequency of normal, inadequate, unsatisfactory, inflammatory, infective and neoplastic smears were 31 (12.4%), 7(2.8%), 7 (2.8%), 111(44.4%), 87 (34.8%) and 25 (10%) respectively. In our study the age range was 20->40yrs. Majority (42.4%) of women belonged to >40 yr age group. The major presenting complaint was white discharge per vagina in 175 (70%) cases. Pelvic pain was the second most common complaint in 35 (14%) cases followed by DUB in 20(8%), prolapse in 12 (4.8%), dyspareunia in 5 (2%) and post-coital bleeding in 3 (1.2%). Among the 87 cases (34.8%) of infective smears, the infections that were observed were- Gardnerella 74 cases followed by Trichomonas-8 and Candida 5.

Conclusion: The cervical smear is the most simple and quick test which is beneficial in diagnosing cervical infections. However, other ancillary tests need to be employed for confirmatory diagnosis.

Keywords: Papanicolaou Smear; Cervico-Vaginal Infections; Bacterial Vaginosis
(Gardnerella); Trichomonas Vaginalis; Fungal Infections.

  Background: Pituitary adenoma represent the third most common primary intracranial tumor in neurosurgical practice constituting about 10% of intracranial neoplasm. In accordance to the new WHO classification pituitary adenoma is classified according to the cell of origin which is detected immunohistochemically. Some of the pituitary adenomas may show features associated with recurrence and resistance to conventional therapy. Serological and IHC correlation helps in separating these high risk adenomas.

AIM: 1. to determine clinical relevance of IHC in pituitary adenomas. 2.Identification of high risk pituitary adenomas based on immunohistochemically

Materials and Methods: 30 surgically resected specimens. Sections were stained for H&E and immunostained for GH, PRL, ACTH, TSH, FSH, LH.

Results: Tumor mainly affected the age group between 24 to 66years. Most cases presented as non functioning macroadenomas. Based on serological and immunohistochemical profile of pituitary adenomas we found the following results: Plurihormonal adenomas-18cases (60%), Silent corticotroph adenoma-5cases (16.67%), Lactotroph adenoma in men-3cases (10%), Null cell adenoma-2cases (6.67%), Functional thyrotroph -1cases, non-functional gonadotroph -1case.

Discussion: The tumors were common between age group of 41-45 yrs, incidence in men were higher. In our study most of the cases were nonfunctional and diagnosed as macroadenomas resulting in pressure effects. The need of the hour is to subtype PA of clinical relevance. With the new WHO classification histological typing , based on immune markers is essential and older classifications of adenomas based on tictorial stains are obsolete. Prognostication based on proliferation markers remains a major challenge in pituitary pathology. Hence high risk category has been identified with the aid of immune markers. 

Conclusion: Earlier the diagnosis of adenoma was considered sufficient for many cases.With new classification based on IHC, it is recommended to correlate the estimated hormones levels with immune markers in routine diagnosis. As this helps in identifying the high risk groups which require intensive investigations and closer follow up.

Keywords: Pituitary Adenoma; Immunohistochemistry; High Risk.

  Safety of Blood and Blood components transfusion begins with healthy donors. Deferral of Blood donation is because of both temporary and permanent reasons. Hence personnel  who are willing to donate blood are not able to donate blood successfully either permanently or temporarily.

Aim: To evaluate the various reasons for blood donor deferral among blood donors in a tertiary care teaching hospital, Blood bank unit.

Material & Methods: A retrospective study from January 2014 to December 2017 was done. An analysis of records of the donors were reviewed in order to find out the rate and causes of pre donation deferral both in male and female in Blood Bank unit.

Results: During this four year period, 7849 donors registered to donate whole blood and blood components and 561 were deferred. The deferral rate was 7.14 %. Among 561 deferral blood donors, 472(84.1%) were male and 89 (15.8%) were female. Female registered donors were less as compared to male. The reasons for deferral were grouped as temporary and permanent. The reasons of temporary and permanent deferral constituted 93.9% and 7.1% respectively. The three most common reasons for temporary deferral were anaemia, under age and low body weight. The permanent reasons were hepatitis, diabetes and respiratory diseases. As per available findings in the literature and findings from our study remain same.

Keywords: Blood Donor; Deferral; Permanent Deferral; Temporary Deferral.

  Objective: To study morphological spectrum of Pleomorphic Adenoma and its limitation on fine needle aspiration cytology.

Material and Methods: 40 cases of Pleomorphic Adenoma were evaluated for variations in cytolological features. Morphological variables like pattern of epithelial cells, type and extent of mesenchymal matrix, metaplastic cells, nuclear chromatin were evaluated to avoid diagnostic pitfalls.

Result: Female preponderance was noted (62.5%) amongst the total of 40 cases with Male:Female ratio of 0.6. Mean age of 43.8 years was noted with parotid being the commonest site of presentation (77.5%). Most of the cases showed classical picture in form of abundant chondromyxoid stroma with clusters and enmeshed epithelial cells. However,
few cases revealed deviation from classical cytological features which could create a diagnostic dilemma.

Conclusion: FNAC is a fairly accurate pre-operative procedure for diagnosis of Pleomorphic Adenoma. Pathologists need to be aware of cytological variations to avoid diagnostic pitfalls.

Keywords:Cytology; Histopathology; Spectrum; Chondromyxoid; Epithelial; Mesenchymal.

  Introduction: Renal tumors comprise a diverse spectrum of neoplastic lesions with patterns that are relatively distinct for children and adults. Radical nephrectomy is indicated to treat different malignant neoplastic conditions of the kidney. Nephrectomy remains the standard of care for patients with a suspected renal mass. Accurate pathological evaluation of renal neoplasms is essential for sub typing, proper staging and assisting in further treatment protocols.

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, 15 were neoplastic lesions (37.5%).

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 sub typing of renal neoplasms in clinical practice.

Keywords: Nephrectomy; Renal Cell Carcinoma; Sarcomatoid; Wilms Tumor.

  Introduction: Uterine sarcomas are highly malignant tumors accounting for 3-7% of all uterine malignancies. According to the World Health Organization, uterine sarcomas consist of two main categories: mesenchymal tumours and mixed tumours.

Aims: To study the clinical presentation and analyze the spectrum of gross and microscopic features of uterine sarcomas. 

Methods: The present retrospective study was conducted in the department of pathology of a medical college teaching hospital from 2011 to 2016. Total number of hysterectomies were 1837, of which leiomyomas accounted for 70% and uterine sarcomas accounted for 0.6% (11 cases). Haematoxylin and Eosin stained slides of 11 cases of all uterine sarcomas were retrieved from the histopathology archives.Clinical features were taken from medical records and all H and E stained slides studied. 

Statistical Analysis: Continuous data was summarised using descriptive statistics. Qualitative variables were summarized using frequency and percentage 

Results: We report a series of 11 cases with mean age of presentation being 44.8 years. In majority of cases the clinical presentation was abdominal pain and vaginal bleeding and the commonest clinical diagnosis was fibroid uterus followed by endometrial carcinoma. Out of 11 cases, 6 cases were of endometrial stromal sarcoma, 2 carcinosarcoma and one case each of leiomyosarcoma, adenosarcoma and undifferentiated sarcoma. The stage of the tumors was predominantly stage I (72.7%) followed by stage IV (18.1%) and stage II (9%). Conclusion: Uterine sarcomas are rare malignant tumor. The diagnosis is difficult due to varied pathological differentiation and can be aided by immunohistochemistry. 

Keywords: Endometrial Stromal Sarcoma; Carcinosarcoma; Leiomyosarcoma.

  Introduction: Thyroid lesions are common in surgical practice and are observed in 4- 7% of the population. Fine needle aspiration cytology [FNAC] is a highly accurate, economical, safe, minimally invasive and rapid , pre-operative diagnostic modality in detecting thyroid lesions. The use of FNAC as the first line of investigation in thyroid lesions has reduced the number of unnecessary thyroidectomy procedures.

Objectives: The present study was undertaken to correlate the fine needle aspiration cytology [FNAC] findings with histopathology wherever possible. Methods: In the present study, 95 cases of thyroid FNACwhich were subsequently
followed by excision biopsy has been statistically analyzed and cyto-histopathological correlation has been interpreted.

Results: Out of 95 cases studied, with cyto-histopathological correlation, the majority of lesions were non- neoplastic. The accuracy was found to be 93%, sensitivity 71.45%, and specificity 100%.

Conclusion: FNAC can be used as a baseline investigation in patients with thyroid lesions and has high accuracy in detecting and differentiating malignant lesions from the benign.

Keywords: FNAC; Accuracy; Sensitivity; Specificity; Cyto-histopathological Correlation.

  Introduction: Dengue fever is the most common Arboviral disease in the world. The four serotypes of dengue virus, 1,2,3 and 4 form an antigenic subgroup of flavivirus. The clinical manifestations of dengue fever range from in apparent to lethal. Various  hematological parameters and reactive lymphocytes (Virocytes)/Plasmacyatoid lymphocytes in peripheral smear can help us in the diagnosis of dengue fever.

Aim: The aim of the study is to emphasize on the utility of hematological parameters  and peripheral smear reactive lymphocytes (virocytes)/plasmacyatoid lymphocytes in the diagnosis of dengue fever.

Materials and Methods: A study was carried on a series of patients who attended various health care centres in and around Kurnool for a period of one month. Patients presented with complaints of fever, headache, rash and body pains. Then these patients were tested for dengue, then those positive cases hematological parameters and peripheral smear were analysed.

Results: Out of 100 dengue positive cases, 40 cases showed increased hematocrit, 60  cases had leucopenia, 100 cases had thrombocytopenia and 60 cases had relative lymphocytosis. On peripheral smear examination 100 cases showed reactive lymphocytes/ plasmacyatoid lymphocytes.

Conclusion: Presence of raised hematocrit, leucopenia, relative lymphocytosis, thrombocytopenia and reactive lymphocytes in peripheral smear helps in the diagnosis of dengue fever. 

Keywords: Dengue Fever; Hematological Parameters; Peripheral Smear; Reactive Lymphocyte; Thrombocytopenia.

  Aim and Objectives: To assess the presence or increase of micronucleus in buccal mucosa smears of tobacco users and compare the micronucleus staining by PAP and Feulgen stain.

Methods: The study was conducted on 500 subjects (tobacco users and non-users),  divided according to duration and form of tobacco use. Exfoliated buccal cells were obtained from each subjects, 2 slides were prepared, stained with PAP and Feulgen stain. Minimum 500 cells were examined from each slide and mean total number of MN and mean MN frequency was evaluated. Study Design: Cross sectional study.

Results: There was statistically significant difference (P<0.05) in the micronucleus assay of tobacco users as compared to non-users by PAP and Feulgen stain , where PAP stain was able to identify higher number of micronuclei. In tobacco users, the mean total number of micronucleus with PAP and Feulgen stain was 17.5±11.2 and 11.87±6.71 respectively. In non-users, the mean total number of micronucleus with PAP and Feulgen stain was 5.70±3.08 and 3.27±1.82 respectively. In users, the mean micronucleus frequency with PAP and Feulgen stain was 1.79±0.65 and 1.61±0.49 respectively. In non-users, the mean micronucleus frequency with PAP and Feulgen stain was 1.18±0.43 and 1.03±0.13 respectively. Duration and form of tobacco use also showed statistically significant difference with PAP stain.

Conclusions: All forms of tobacco can cause and increase micronuclei. Thus micronuclei assay can be used as a marker of genotoxicity.

Keywords: Micronucleus; Oral Cytology; PAP Stain; Feulgen Stain.

  Background: Fine needle aspiration cytology (FNAC) is considered an essential step in the thyroid workup. Altered follicular cells are known as oncocytic cells, oxyphilic cells, Hurthle cells or Askanazy cells. Oncocytic cells may be encountered in a number of thyroid conditions.

Aims: To study the cytomorphological features of oncocytic lesions in thyroid aspirates. Settings and Design: Hospital based and prospective study.

Methods and Material: The present study was a prospective study (June 2016 to  November 2017) carried out in the Department of Pathology. Patients recommended for FNAC by the clinicians were incorporated into the study. Aspirated material was stained with Giemsa stain and Papanicolaou stain. Stained smears were subjected to microscopic examination. Statistical Analysis: Chi square test was used.

Results: A total of 240 cases were included in present study. Oncocytic cells were seen in 154 cases. Oncocytic cells were seen in both neoplastic as well as non-neoplastic lesions of thyroid. In oncocytic cell positive cases, majority of cases were of Hashimoto’s thyroiditis. Neoplastic lesions had cells in sheets without intra epithelial lymphocytes with no to scanty colloid.

Conclusions: Hashimoto’s thyroiditis is most common thyroid lesion in this area. Oncocytic cells when present in follicles, large clusters or multilayered sheets & scanty colloid favor the diagnosis of neoplastic lesions. Abundant colloid favors the non neoplastic lesions.

Keywords: Cytology; FNAC; Hurthle Cells; Hashimoto’s Thyroiditis; Oxyphilic Cells.

  Introduction: Thyroid hormones regulate hematopoiesis and as a result hematological  abnormalitites can occur in thyroid dysfunctions. But these are rarely studied and we attempted to evaluate hematological profile in thyroid dysfunction. 

Materials and Methods: A case- control, cross sectional study was performed on 30 normothyroid, hypothyroid and hyperthyroid patients. The thyroid profile values were compared with the hematological profile and analysed using SPSS software.

Results: Erythrocyte sedimentation rate (ESR) and hematocrit showed significant statistical difference (p < 0.05) between control and both hypothyroid and hyperthyroid groups. Hemoglobin showed significant decrease in hypothyroid group when comparedwith controls. There was a significant increase in red cell distribution width (RDW) in hypothyroid patients when compared with controls.

Conclusion: Hypothyroidism can result in increase in MCV and RDW. Hence, hypothyroid patients should be investigated for red cell indices and RDW. Contradictory to this, patients with unexplained refractory anaemia with increase in MCV and RDW should be investigated with thyroid profile to rule out thyroid dysfunction. This will help in early diagnosis, intervention and thus avoiding the complications.

Keywords: Hematological Profile; Thyroid Function Test; Thyroid Dysfunction; RDW.

  Introduction:Ovarian cystic lesions are commonly encountered surgical specimens presenting  as mass lesion. It is difficult to categorize them as non-neoplastic or neoplastic based only on clinical, radiological or surgical findings. Histopathology aids in diagnosing and categorizing lesions for proper treatment.

Materials and Methods: Fifty-one ovarian cystic mass specimens were received in the Department of Pathology at a tertiary care centre in rural Uttar Pradesh during the period of 1 year. Specimens comprised either hysterectomy specimen with unilateral or bilateral adnexa, or oophorectomy and/or cystectomy. Detail clinical history, physical examination and radiological findings along with provisional diagnosis were obtained. Specimens were fixed in 10% neutral buffered formalin. Detail gross examination performed, and sections were stained with Hematoxylin and Eosin.

Results: Fifty-one ovarian non-neoplastic and neoplastic (benign and malignant) cystic lesions were studied during the period under review. The youngest patient was 15 years old and the oldest 72 years old. The age group 31-40 years showed peak incidence of 17 (33.33%) cases. Considering laterality of ovarian cystic neoplastic lesions, 10 (90.90%) were unilateral and 1 (9.09%) was bilateral. Non-neoplastic ovarian cystic lesions were 40 (78.43%) and the neoplastic ovarian cystic lesions were 11 (21.56%).

Conclusion: It is difficult to categorize ovarian cystic lesions non-neoplastic or neoplastic based on clinical, radiological or surgical findings alone. Histopathological examination of these lesions is of prime importance to diagnose and categorize them for proper treatment. In benign functional cysts spontaneous resolution may occur, hence symptomatic treatment and observation helps to minimize surgery.

Keywords: Ovarian Cyst; Serous Cystadenoma; Mucinous Cystadenoma; Endometriosis;
Mature Cystic Teratoma; Struma Ovarii; Papillary Thyroid Carcinoma.

  Introduction: Chronic lymphocytic thyroiditis (CLT) is included in non-neoplastic thyroid lesions. These are autoimmune disorders characterized by inflammation of thyroid with variable clinical features of altered thyroid function. It has prevalence rate of 1-4% and incidence of 30-60/100000 population per year. It is more common in middle aged women. There is rise in the incidence and diagnosis of CLT due to iodine supplementation of diet and improved diagnostic techniques respectively.

Aims and Objectives: To study clinical presentation and cytological parameters of CLT in detail and study these parameters with respect to cytological grades.

Material and Methods: Total 313 cases of CLT diagnosed on cytology were included in the study. FNAC was done using non-aspiration technique. All the cases were analysed for age, sex and clinical presentation. Cytological parameters were studied in detail and based on these parameters, cases were graded as per Bhatia et al’s criteria.

Results & Discussion: Clinically all the cases presented with anterior neck swelling, followed by hypothyroid and hyperthyroid symptoms. Amongst cytomorphological parameters, background lymphocytes were noted in all 3 grades with varying percentages of other parameters.

Conclusion: Clinical presentation of lymphocytic thyroiditis varies depending on the stage of disease, but careful evaluation of all cytological parameters can make correct diagnosis of CLT.

Keywords: Chronic Lymphocytic Thyroiditis; FNAC; Lymphocytes.

  Iespecially one each of autopsy of brain and one of tertiary hospital. In original article we had cytology and histopathology of lymph nodes, H.P. of Periampullary carcinoma, mucin histochemistry of prostatic n the last issue of April we had very good articles of histopathology, FNAC, PAP’s, smear and Hematology carcinoma, immunohistochemistry linking with H.P. of urinary bladder tumors, autopsy of cerebral malaria (this study was seen in writer’s PG at PGI Chandigarh- many cases with neuropathlogist Dr. AK Banerjy) RBCs indices in iron deficiency anemia, premalignant and accidental finding of prostatic carcinoma in BPH, FNAC, imprint and H.P. of lymph nodes, USG guided FNAC of SOL of liver, liquid based cytology and conventional PAPs smear study of cervix etc. etc. Due to shortage of space and time we finish our editorial upto here with appreciation of all other articles. Writer was in Bareilly and Shahjahanpur a part of west UP last month (Jun 18) and saw spectrum of hematological disorders, nutritional and iron deficiency anemia in different ages and sex and a common peripheral smear finding of
eosinophilia (casue of which we are working)- home town of chairman Mr. A Lal.