Indian Journal of Pathology: Research and Practice

Introduction: Myelolipoma was described initially by Gierke in 1905 and the term was coined by Obenling in 1929. These are rare benign tumours of the adrenal gland with a cited estimated autopsy prevalence of 0.1-0.2%.

Materials and methods: Two cases have been reported. The first case was a 39 year old female patient and second case, a 42 year old female patient. Adrenalectomy was the surgical procedure done. On gross examination, Case 1 adrenal tissues measured 9 x 6 x 4 cm. Cut surface was firm, brownish coloured with yellowish areas in between. Case 2 tissue measured 7x6x4 cm. Cut surface was firm, brownish with yellowish areas.

Result: In both cases Hematoxylin & eosin stain of sections showed mature adipose tissue with scattered hemopoietic cells. Morphology favoured adrenal myelolipoma.

Conclusion: We conclude that adrenal myelolipomas are small and rare tumours. Myelolipomas are usually asymptomatic and must be monitored clinically for symptoms; routine follow-up imaging studies appear unnecessary for such lesions. Histomorphology suffices for diagnosis.

Keywords: Adrenal; Myelolipomas Adipose Tissue; Hemopoietic Cells; Histomorphology.

Keywords: Breast Lumps; Triple Test `Score; Fnac; Mammography. 

Keywords: TBS; Histopathology; Cervix. 

Introduction: Soft tissue tumors are a diverse & comprise a large spectrum of diagnostic entities. 

Aims: To study the incidence, age, and sex and site distribution of benign soft tissue tumors & to study histopathology of benign, soft tissue tumors and to compare these findings with the workers doing similar studies.

Materials and Methods: It was a retrospective study, conducted in Tertiary Hospital, Delhi. Data from records of surgical biopsy specimen and demographic data for 3yrs [2015-2017] of all the patients with benign soft tissue tumors were included in the study. The distribution and prevalence of soft tissue lesion was noted.

Results: 56 cases of benign soft tissue tumors were included in the study. Lipomas formed the major bulk of benign soft tissue tumors (55%), followed by hemangioma. (25%)The peak incidence of benign soft tissue tumors was observed in the age group of 31 to 40 yrs (23.2%) followed by 51to 60yrs (19.6%). The most common site of occurrence for benign tumors was upper extremity, followed by head & neck.

Conclusion: Extremities were the most common site for benign tumors.Lipomas was the largest group histopathologically, followed by hemangiomas.

Keywords: Soft Tissue Tumors; Hemangioma; Lipoma; Extremities.

Background: Accurate determination of indication is necessary to improve colonoscopic services. A detailed analysis and correlation of the colonoscopic indication with the histopathological diagnosis helps to increase the diagnostic yield of the procedure. The objective of this study was to determine the indications and estimate the diagnostic yield of colonoscopy in a tertiary care centre located in South India.

Materials and Methods: Three hundred and sixty patients who underwent colonoscopy were studied retrospectively. The histological diagnosis was correlated with the indication for colonoscopy and the diagnostic yield was calculated.

Results: The most common indications for colonoscopy in this study were bleeding per rectum, functional bowel disorders, chronic non-bloody diarrhoea and constipation. The overall diagnostic yield was 72.8% and 82.2% in those over the age of 50.

Conclusion: The diagnostic yield was high in our study especially in individuals more than 50 years of age. Colonoscopy remains an effective means of diagnosing colonic disorders. 

Keywords: Colonic Polyps; Colonic Cancer; Colonoscopy.

Introduction: Dermatological lesions are common in all nations but the incidence and spectrum varies from place to place. They can be broadly categorised into non-neoplastic lesions and neoplastic lesions. Clinically they usually presents with overlapping features like hyperpigmentation, hypopigmentation, macules, papules, nodules or either patch. Skin biopsy is the most common ancillary technique used for confirmation of the clinical diagnosis. The present study was conducted to describe the histopathological spectrum of lesions in skin biopsies.

Materials and methods: This is a 2 years retrospective study conducted in department of Pathology, BLDEU’s (deemed to be university) Shri B M Patil Medical College Hospital and Research Centre, Vijayapura, Karnataka and includes 258 cases. All the skin biopsies received were reviewed from archives of the department and examined under light microscopy.

Results: Among 258 cases, 120 cases were males and 138 cases were females with male:female ratio being 0.8:1. Further these lesions were classified into non-neoplastic and neoplastic lesions. Of the 258 cases, 235 cases were nonneoplastic lesions and 23 cases of neoplastic origin. Among the non-neoplastic lesions infectious dermatoses (41.28%) formed the predominant part with leprosy (91 cases) constituting 38.7%. This was followed by inflammatory (40%), vesiculobullous (11.06%), granulomatous (2.12%), lesions of melanocytes (3.82%) and miscellaneous lesions (1.70%). Out of 23 neoplastic lesions, benign were 15 and malignant were 8 cases.

Conclusion: Dermatological lesions are the cutaneous manifestations of exposure to both intrinsic and extrinsic environmental agents. Various lesions have been reported ranging from non-specific inflammatory dermatoses to infective dermatoses and neoplastic lesions.

Keywords: Skin Lesions; Non-Neoplastic Lesions; Infectious Dermatoses; Neoplastic Lesions.

 

Context: Fine-needle aspiration (FNA) is well known non invasive tool for diagnosis of thyroid nodules thereby drastically reducing the number of surgeries. However the most  common limitation of FNA is in follicular lesions termed ‘follicular neoplasms’. This is due to the inability in differentiating benign follicular lesions from malignant. The aim of the study was to study the cytomorphology of follicular lesions of thyroid and to study the sensitivity and specificity of FNA in follicular lesions.

Settings and Design: Retrospective study of 5 years duration from January 2011 to June 2016. All cases which have undergone both FNA and biopsy in our institute and diagnosed as follicular/hurthle cell adenoma, follicular/hurthle cell carcinoma and follicular variant of papillary carcinoma on histopathology are included. 

Statistical analysis used: The data collected was tabulated and analysed by proportions and percentages. Statistical Package for the social sciences (SPSS) version 20.0 software was used to analyse the data.

Results: Out of the 39 cases studied, 14 were given a diagnosis of “follicular neoplasms” on FNA. 16 were given as benign lesions (nodular goitre, adenomatoid goitre, colloid nodule). One each reported as hurthle cell neoplasm and suspicious for malignancy. Seven cases reported as suspicious for papillary carcinoma. 10 out of 14 reported as follicular neoplasms on FNAC were benign and 4 were malignant on histopathology. The rate of malignancy was 35.8%. The most common malignancy was follicular carcinoma. 

Conclusions: There was overlap between benign and malignant follicular patterned lesions on cytology. Follicular lesions prove to be a major challenge in the application of FNA in thyroid lesions.

Keywords: Fine-Needle Aspiration; Follicular Cell Carcinoma; Histopathology.

 

Background: Pleural effusion can be caused by various etiological conditions, commonest being tuberculosis. Histopathological examination, microbiological examination in addition with biochemical analysis of pleural fluid can help in determination of tuberculous pleural effusion. Estimation of Adenosine Deaminase (ADA) levels and lymphocyte / neutrophil ratio in the pleural fluid can help in the early diagnosis.

Material and methods: We studied 208 patients with pleural effusion. In our prospective study of 3 years we analyzed ADA levels along with lymphocyte/ neutrophil ratio in pleural fluid and total counts in the peripheral blood in both patients having tuberculous pleural effusion and non-tuberculous pleural effusion.

Results: Tuberculous pleural effusion cases showed the predominance in the lower age group when compared to non-tuberculous effusion cases. Both of them showed the male predominance. ADA levels in tuberculous pleural effusions ranged from 46.5IU/L to 210IU/L and non tuberculous pleural effusions ranged from 10.1IU/L to 48.4IU/L showing high ADA levels in tuberculous pleural effusions. Lymphocyte predominance was noted in tuberculous effusion where as neutrophil predominance was noted in non tuberculous effusion cases. There was no variability in the total count of leukocytes in peripheral smear.

Conclusion: Assessing ADA levels combined with lymphocyte/neutrophil ratio in the pleural fluid can increase the accuracy in diagnosing tuberculous pleural effusion.

Keywords: Tuberculosis; Pleural Effusion; Adenosine Deaminase; Lymphocyte Predominance. 

Introduction: In tropics malaria is one of the cause of acute febrile illness. Hematological parameter changes involving major cell types such as erythrocytes, leucocytes and platelets are observed in malaria. Present study is done to evaluate hematological parameters in malaria.

Material and Methods: Present study was a two-year hospital-based study conducted at a tertiary health centre in rural Telangana. Total 368 cases diagnosed as acute febrile illness were studied. All the anticoagulated blood samples were submitted for complete blood count and peripheral blood smear for malarial parasite. Hemoglobin, Red cell distribution width, leukocyte count, and platelet counts were the parameters considered. Peripheral smear examination for malaria parasite was taken as gold standard for diagnosis of malaria. Diagnostic accuracy along with sensitivity, specificity, predictive values and likelihood ratios were statistically evaluated using 95% confidence intervals.

Results: Study included 368 patients and those with positive peripheral smear for malaria parasite were 140 (38.04%). Thrombocytopenia (platelet count < 150,000/cu mm) was a strong predictor for malaria (Sensitivity 60%, Specificity 88%, Likelihood ratio + 5.04) and in combination with anemia (Hb < 10 g/dl) it was next best parameter (Sensitivity 69%, Specificity 74%, Likelihood ratio + 2.77). 

Conclusion: Thrombocytopenia along with combination of anemia and thrombocytopeniaproves to be of paramount importance in predicting malarial infection. These hematological parameters supported by clinical findings and gold standard microscopy methods help to improve malaria diagnosis and treatment.

Keywords: Plasmodium Falciparum; Plasmodium Vivax; Thrombocytopenia; Anemia.

 

Context: Neutrophils can demonstrate various inclusions upon examination in the stained peripheral blood smears. Hyperbilirubinemia is a common entity in the neonatal age group. Unusually, smears of children with hyperbilirubinemia can demonstrate bilirubin crystals in the white blood cells especially neutrophils.

Aims: To study the frequency of occurrence of these uncommon crystals in blood films of neonates which were examined during the work up for neonatal sepsis.

Settings and Design: This cross sectional study was conducted in a tertiary teaching hospital

Methods and Material: Neonates who were clinically suspected to have sepsis were evaluated for evidence of sepsis with the help of blood culture, blood cell counts and peripheral blood examination. Attention was paid to the presence of bilirubin crystals in the white blood cells and the same recorded. 

Results: Smears examined from 174 neonates clinically suspected to have neonatal sepsis demonstrated the presence of these bilirubin crystals in 4.6% of the cases. Most of these cases were proven to have sepsis by blood culture. 

Conclusions: Bilirubin crystals are a rare finding in smears of neonates having hyperbilirubinemia. They are frequently seen in septicemic neonates.

Keywords: Hyperbilirubinemia; Bilirubin Crystals; Neonates; Sepsis.

 

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