Indian Journal of Pathology: Research and Practice

Context: Lichen planus is a common inflammatory disorder,that commonly affects skin,nail,mucous membrane and hair. The morphology, distribution and colour of lichen planus is usually variable clinically. 

Aim: The aim of the study is to analyse varied clinical presentations and its histopathological correlation.

Material and Methods: A retrospective study conducted in the department of pathology SMVMCH from May 2015 to 2017 june in a histopathologicaly diagnosed cases of Lichen planus which was, received in our department.

Results: Lichen planus occurred in all age groups but commonly seen in middle age to elderly. Equal male and female distribution, majority (28.2%), of patients presented as hypopigmented papule, 79% had hypergranulosis in histology, commonly seen in the lower extremities and clinico- histolpathological correlation diagnostic accuracy was 41.1%. 

Conclusion: This study emphasize, the need for clinical examination, detailed history, and as lichen planus presents with various clinical manifestations. Histopathology serves as diagnostic tool and rules out other lesions which mimic lichen planus. 

Keywords: Lichen Planus; Pruritis; Dermatosis.

Osteochondroma (Exostosis) is the most common benign tumor of the bone. It may occur as solitary or multiple lesions and most commonly affected age group is 11-20 years. Its common complications include cosmetic or osseous deformity, fracture, neurovascular compromise, bursa formation and malignant transformation. Latter is the most serious and feared complication occurring mostly in third to fifth decade. The risk of malignant progression is estimated to range from 1 to 25% in patients with multiple osteochondromas. In this study, we present a case of high grade chondrosarcoma which was diagnosed cytologically in a 27 year old male with multiple osteochondromas. Cytological smears were cellular showing atypical cells with marked
pleomorphism in a background with chondromyxoid material. Subsequent histopathology of the lesion confirmed the diagnosis. Through this case report we wish to highlight that FNAC is very effective in confirming preoperative diagnosis of chondrosarcomatous transformation in osteochondroma.

Keywords: Multiple Osteochondromas(MO); Chondrosarcoma; FNAC.

 

Introduction: Breast acer is a common cancer in Indian population. The assessment of estrogen receptor (ER) status of breast carcinoma is a routine practice to predict the likely outcome of endocrine therapy. The assessment of progesterone receptor (PR) status along with ER gives a stronger predictive power. The present study was undertaken to look at the prevalence of hormone receptor positive breast carcinomas and to correlate the ER/PR status by Quick score with various tumor characteristics in our local population.

Aim of the study: To assess the value of the Quick Score in terms of correlation with the other proven clinicopathological prognostic parameters of breast carcinoma and to document the prevalence of hormone receptor-positive breast carcinomas in patients attending Government General Hospital, Kakinada, Andhra Padesh.

Materials and Methods: Total 122 cases were studied over a two year period and included 109 MRM and 13 simple mastectomy specimens. Routine hematoxylin and
eosin stain and immunohistochemistry for estrogen and progesterone were done on these 122 tissue specimens. Patient age, size, histologic type and grade of the tumor, lymph node status, the ER/PR status with Quick score and the Nottingham prognostic index were studied.

Results: Most of the patients with carcinoma breast were in the 40-60 year age group. Most of the tumors were of size 2-5 cm, histologically were invasive ductal type and also most were of intermediate grade. ER and PR both were negative in 65.5% cases and both were positive in 23.7% cases. 

Conclusion: Breast cancers in India show low hormone receptor expression and tend to occur in younger age group. The grade of tumor and NPI showed significant inverse correlation with Quick score of hormone receptor expression. In the present study, the overall grade of the tumor correlated well not only with the proportion of cells stained but also the intensity of staining, the two components of the Quick score that justify the assessment of staining in giving score.

Keywords: Quick Score; ER and PR Immunohistochemistry; Carcinoma Breast in India.

 

Background: Hyperplastic and Adenomatous polyps are most common in large intestine. Morphological study of polyps helps us to know the incidence and malignant transformation of polyps.

Aims and Objectives: To study the incidence and morphology of colonic Polyps.

Materials and Methods: Prospective study, 52 colonic polyps were reported which include both colonoscopic biopsies (polypectomy) and resection specimens.

Observation and Results: The commonest site of involvement was sigmoid colon and the commonest lesion was adenomatous polyps.

Conclusion: Adenomatous polyps are more common in colon and further study are required to know the malignant transformation.

Keywords: FAP-Familial Adenomatous Polyposis; PJ Polyp-Peutz-Jeghers Polyp.

Background: Although glycated hemoglobin (HbA1c) has recently been incorporated as a diagnostic test in comparison by FBS by the ADA, its validity needs to be established in a community setting.

Objective: To assess the efficacy of HbA1c as a screening and diagnostic test in clinically suspected cases diabetes mellitus and comparison of statistical parameters of HbA1c and FBS.

Materials And Method: Cross sectional study was conducted in Indore, MP at IMCHRC, from July 2015- July 2017 on 430 clinically suspected cases of DM. Intervention included an FBS and HbA1c in all the subjects.

Results: Using ADA criteria of diabetes that is FBS >126mg/dl we got sensitivity of 36.59%, specificity of 96.05%, PPV of 96.08%, NPV of 32.02% and accuracy of 50.69%. HbA1c level at 6.5% had sensitivity 91.94%, specificity 45.42%, PPV 40.57%, NPV 93.29% and accuracy 50.69%. HbA1c level of 5.7% had an sensitivity of 96.77%, specificity 32.03%, PPV 36.58%, NPV 96.08% and accuracy 49.30%. HbA1c level of 6.0 had sensitivity 95.97%, specificity 38.56%, PPV of 38.76%, NPV of 95.93% and accuracy 55.11% for diagnosis of DM.

Conclusion: HbA1c cut point of 6.0% had an optimal sensitivity and specificity of 95.97% and 38.76% respectively, with maximum accuracy of 55.1% and can be used as a screening test anda cutoff point of 6.5% has optimal specificity of 45.45 and NPV of 93.29% and can be used for diagnosis of diabetes. Moreover both HbA1c and FBS should be used together for screening to balance their individual weak parameters.

Keywords: HbA1c; FBS; Accuracy.

Background/Introduction: An ectopic pregnancy occurs when an embryo implants somewhere other than uterus such as in one of the fallopian tubes. Ectopic pregnancy can occur in any extrauterine location in the abdomen but fallopian tube is one of the most frequent site for ectopic implantation. The risk factors associated with ectopic pregnancies varies and includes pelvic inflammatory diseases, previous pelvic or abdominal surgeries and Intrauterine contraceptive device (IUCD). Chlamydia trichomatis is associated with 30-50% cases of ectopic pregnancy.

Aim: The aim of the study is to know the various histopathological changes in ectopic pregnancies in the fallopian tube and the predisposing factors for ectopic pregnancies

Materials And Methods: It is a comparative cross sectional study where 115 fallopian tubes having clinical diagnosis of ectopic gestation and 20 cases of fallopian tubes received after sterilization procedure which is taken for comparison.

Results: Out of 115 specimens of fallopian tubes pelvic inflammatory diseases including acute salpingitis 35% [40 cases], chronic salpingitis 54% [62 cases], salpingitis isthmica nodosa (SIN) [10.4%] 12 cases. 0.6% [1 case] of granulomatous diseases was identified as cause of ectopic pregnancy.

Conclusion: Early diagnosis [A Greatest Challenge], identification of risk factors and timely intervention will help in reducing morbidity and mortality associated with ectopic pregnancy.

Keywords: Ectopic Pregnancy; Fallopian Tubes; Pelvic Inflammatory Disease (Pid).

 

Introduction: Fine Needle Aspiration Cytology is well established diagnostic procedure for the head and neck region. It is simple and rapid procedure. Most common head and neck lesions in paediatric age group are of inflammatory, neoplastic and developmental conditions.

Objectives: To study the role of fine needle aspiration cytology of head and neck lesions in paediatric age group.

Materials and methods: This was a hospital based study where two hundred cases of head and neck lesions of the paediatric age group [0-18 years] were studied for cytomorphology through fine needle aspiration cytology.

Results: There was a male predominance in the case distribution [67%]. Lesions in the lymph nodes were 82%, thyroid - 13%, epidermal/dermoid cyst - 3%, salivary gland - 1%, and benign spindle cell lesion - 1% among the head and neck lesions.

Conclusion: FNAC is an important investigational tool in children for identifying and planning the medical management of inflammatory and infectious conditions. In general, FNA cytology permits a rapid and high diagnostic accuracy, thus making it a desirable method for diagnosing lesions in children. 

Keywords: Head And Neck, Paediatric Age Group, FNAC.

Background: Head and neck squamous cell carcinoma (HNSCC) is an aggressive epithelial malignancy that is the sixth most common neoplasm in the world today. Overexpression of Epidermal Growth Factor Receptor (EGFR) is one of the most common molecular alterations in HNSCC. Promising preclinical studies have prompted the development of clinical trials testing EGFR inhibitors as singleagent therapy or in combination with conventional cytotoxic therapy.

Objectives: This study was aimed to evaluate the immunohistochemical expression of EGFR in malignancies of the upper aerodigestive tract.

Methods: A retrospective and a prospective study was conducted by light microscopy and immunohistochemical examination of 80 resected specimens of malignancies of the upper aerodigestive tract at the Department of Pathology, M.S. Ramaiah hospital, Bangalore over a period of three and a half years between January 2010- June 2013.

Results: All the cases were Squamous cell carcinomas (SCC) of which 72/80 cases were conventional SCC and the remaining were verrucuous carcinoma. Majority were Grade I tumours (43/80). 72 of the 80 cases showed EGFR positivity on IHC with >50% of the tumour cells showing EGFR positivity in 60% of the cases and 53% of cases showing strong intensity staining of EGFR. In majority of stage IVA tumours, >51% of the tumour cells showed EGFR positivity (84%) in comparison with stage I, II and III tumours.

Conclusion: The expression of EGFR protein in HNSCC can be used as a marker for targeted therapy.

Keywords: Epidermal Growth Factor Receptor; Head And Neck Squamous Cell Carcinoma; Immunohistochemistry.

Background and Objectives: Placenta plays a central role in fetal development and well-being. The intimate connection between the fetus and placenta has been recognized throughout history. This study was conducted to evaluate the spectrum of placental pathology associated with low birth weight deliveries (LBW) and to assess various associated etiological factors.

Materials and methods: A total of 106 placentae from LBW deliveries were analyzed in this study for gross and microscopic abnormalities. Clinical data of these cases were also collected and correlated.

Results: The prevalence of placental pathology was found to be 85.2% in LBW deliveries, the most common pathologies being infarction, intervillous hemorrhage, calcification and retroplacental hematoma. The most common clinical conditions associated with LBW were preterm delivery (67%), preeclampsia (30.2%), IUGR (29.2%), and abruptio placenta (9.4%).

Interpretation & Conclusion: Our study shows that LBW deliveries are associated with significant placental pathology. Thus we conclude that examination of placenta in these cases are indispensable and has to be carried out as a routine  protocol.

Keywords: Histopathology; Low Birth Weight; Placenta.

Background and objectives: Ophthalmic pathology being a sub-branch of surgical pathology, deals with the characterization and diagnosis of ocular diseases. In India, not many studies on histopathological study of ocular lesions have been published. Keeping this in view, histopathological study of ocular lesions is undertaken. 

Aims: To study the histopathological spectrum of ocular lesions received in Department of Pathology, K.R. Hospital, Mysore.

Materials and methods: All excised ocular specimens received in Department of Pathology, Mysore Medical College and Research Institute, Mysore during the study period from December 2012 to May 2014 were included in the present study. A total of 100 biopsies and whole specimen of tumours were obtained from various wards of Department of Ophthalmology. Sample for Histopathological diagnosis were obtained either through incisional or excisional biopsy.

Results: A total of 100 ocular lesions from 100 patients were analysed. 51 were women and 49 were men and the age of the patients ranged from 1 year to 73 years. Eyelid (41%) was the most commonly involved site. Clinical diagnosis was consistent with histopathological diagnosis in 69% of cases. Among eyelid lesions, incidence of dermoid cyst was the highest, while in conjunctival lesions, Bowen’s disease was highest followed by other lesions. A clinico-pathological diagnosis of malignant ophthalmic tumors was made in 11% of cases, while 83% cases were benign lesions and 6% were premalignant in nature. 

Conclusion: Out of 100 cases of ocular lesions, eyelid (41%) was the most common site affected and conjunctiva was the second commonest site. Ocular lesions showed no particular sex predilection. Clinico-histopathological correlation was seen in 69% of cases. Precise diagnosis and characterization of all excised ocular lesions by histopathological examination is very important to the clinicians for the further appropriate management of patients.

Keywords: Ocular Lesions; Eyelid; Conjunctiva; Dermoid Cyst.

 

Introduction: Many diseases such as malaria, dengue, pyrexia of unknown origin, pregnancy-induced hypertension are associated with low platelet counts. Automated method is the most reliable method. It is simple, fast, and most widely used. But automated cell counters are not available at underresourced laboratories, especially in rural settings. Hence, platelet estimation by peripheral blood smear is more easy and cost-effective.

Aim: To compare platelet count estimation performed by the peripheral blood smear method and the automated cell counter method. 

Objective: Peripheral Blood smear examination acts as a good quality control tool in assessing the results produced by the automated cell counter.

Materials and Methods: Present study was carried out in the Department of Pathology at a tertiary care centre in rural Haryana. Study included 95 random blood samples collected into ethylenediaminetetraacetic acid. These were examined by both peripheral blood smear and automated cell counter for platelet estimation.

Results: In the present study there was no significant (p = 0.866) difference of values between manual peripheral blood smear (PBS) method (platelets average per 100x, multiplied by 15.0x109/L) of platelet estimation (1.90±0.97 lacs/mm3) when compared with that of automated cell counter platelet value (1.88 lacs/ mm3±0.98). Significant positive correlation between the result of both methods (r=0.996, p=0.0001) was observed when samples were analysed by Pearson correlation test.

Conclusion: Although the necessity of automated cell counters for rapid generation of results of vast number of blood samples is undeniable, yet the results of peripheral blood smear platelet estimation are comparable with them. Hence manual smear examination serves as a quality control tool in assessing the results of the automated cell counters.

Keywords: Automated Method; Manual Method; Peripheral Blood Smear; Platelet Count.

 

Background: In this modern era where many sensitive techniques have emerged for achieving a specific diagnosis, cytological study of pleural fluid cytology still remains an easy and a basic step in diagnosing a variety of pulmonary and nonpulmonary lesions. Both non-malignant and malignant causes of effusion can be identified by the relatively non-invasive technique of pleural fluid cytology. 

Materials and methods: It was a retrospective study including cases over a period of one year. Pleural fluids were analyzed for physical properties like the volume of fluid received, colour and odour. The cells were counted on Neubauers chamber and stained smears were examined to study the type of cells present.

Results: Pleural cytology of 150 cases was studied. The ages of the patients ranged from 8 years to 69 years. Twenty four cases (16%) showed transudative effusion and 126 cases (84%) showed exudative effusion. The most common cause of transudative effusion was congestive cardiac failure (50%), followed by liver cirrhosis. Tuberculosis was the most common (62.2%) cause of exudative effusion. Four cases of malignancy were noted which caused exudative effusion.

Conclusion: Pleural fluid cytology is a simple, easy and effective method for diagnosing various conditions. Numerous pulmonary and systemic conditions can be suspected and diagnosed with this relatively non- invasive method. The cytological examination of body effusion is a complete diagnostic modality which aims at pointing out the etiology of effusions.

Keywords: Pleural Fluid; Transudate; Exudate; Neoplastic Cells.

Introduction: Fine-needle aspiration is well established and the best test in the primary diagnosis of disorders of Thyroid with a high accuracy. A uniform reporting system for thyroid FNA will facilitate effective communication among all health professionals. 

Aims and Objectives: The aim of the study is to provide consistent diagnostic terminology by using new reporting system – Bethesda system. Cytopathology to histopathology correlation help us to calculate the malignancy risk rates of the different BSRTC categories at each individual institution.

Material and Methods: The evaluation begins with demographic factors, physical examination, appropriate investigations, cytological, histopathological correlation and calculating malignancy risk for each category. 1,057 patients of all ages and sexes with clinical diagnosis of goitre in teritiary health care centre were studied.

Results: Out of 1,057 patients, 931 were female and 126 were male patients. Fnac was done in all 1,057 cases and classified the lesions on FNAC using standard system of Bethesda. Out of 1,057 cases, 35 cases were diagnosed as Non Diagnostic/Unsatisfactory, 906 cases as Benign, 57 case as Atypia of undetermined significance/atypical follicular lesion of undetermined significance, 29 as follicular neoplasm/suspicious of follicular neoplasm/ Hurthle cell neoplasm/suspicious of Hurthle cell neoplasm, 11 as suspicious of malignancy and 19 as Malignancy. Out of 1,057 patients, 130 were undergone different modalities of surgical treatment. On histpathology examination out of 130 cases, 43 were Multinodular goitre, 06 were colloid goitre/Colloid cyst, 09 were Hashimotos thyroiditis, 21 were Adenomatoid Goitre, 21 were FollicularAdenoma, 1 was hurthle cell adenoma, 3 were Follicular Carcinoma, 2 were Hurthle cell neoplasm, 17 were Papillary Carcinoma, 3 were Follicular variant of Papillary carcinoma and 4 were Micropapillary carcinoma.

Conclusion: Standard reporting system will help to reduce different diagnostic schema used by different institutions.

Keywords: Bethesda System; Cytology; Goitre; Histopathology; Malignancy Risk.