Indian Journal of Pathology: Research and Practice

 Aims and Objectives: 1. To know different parameters leading to megaloblastic anaemia and its diagnostic approach. 2. To know the incedence with reference to age and sex. Materials and Methods: This was a institute based retrospective study. The study period was for 1 year. In total 25 cases were scrutinised. Results: In total 25 children with megaloblastic anemia in period of one year were studied. The patients from age group from 6 months to 12 years were included in the study. All patients had diagnosed megaloblastic anaemia. Conclusion: Megaloblastic anemia is one of the common causes of undiagnosed anemia in the above mentioned age group, mostly due to faulty weaninf and food habits. It has a treatment easily available, simple and easily affordable. But if not treated, it causes morbidity due to anaemia as well as due to neurological manifestations. 

 Background: Breast carcinoma is one of the leading causes of malignancy in females.Assessment of Estrogen Receptors (ER)/ Progesterone receptors (PR) and HER2/neu expression in breast cancer is mandatory in clinicalpractice. Immunohistochemistry (IHC) for assessing hormonal receptor status is easier, safer, and hasbetter ability to predict response to adjuvant endocrine therapy. HER2/neu overexpression is shown to have important prognostic and predictive value. The best approach to the use of immunohistochemical markers is to couple them with standard Haematoxylin & Eosin (H&E) based histology and to use panel of markers. Objectives: To assess the ER, PR & HER2/neu status and correlate with histological grade and other clinicopathological parameters. Materials and methods: Fifty cases of breast carcinoma were taken forthe study. H&E sections diagnosed as carcinoma were assessed for histological type and grade. One dedicated block from tumour, not fixed for more than 24 hours in 10% formalin was used for ER/PR and HER2/neu receptor evaluation by IHC. Statistical analysis was done with SPSS software, using chisquare test. Results: A Total of 50 carcinoma breast cases were subjected to IHC. Twenty four cases (48.0%) were of histologic grade-II, 17 cases (34%) of grade III and nine cases (18%) were of grade I. ER, PR and HER2/neu status correlated significantly with histological grade. (p= 0.003). Conclusion: ER, PR & HER2/neu status correlates well with histopathological grading. Hence, immunohistochemical analysis should be incorporated in the routine histopathology reports and canbe of great value in deciding the treatment protocols. 

 Fine Needle Aspiration Cytology (FNAC) is a well known, reliable, inexpensive tool for diagnosing many palpable swellings. FNAC done to confirm metastatic deposits in lymph nodes has been studied thoroughly. FNAC not only confirms but also gives clue to the origin of primary tumor. Present study is undertaken to evaluate cytological features of metastatic deposits in any lymph nodes and to know the pattern of occurrence of various malignancies. Materials and Methods: A retrospective study is done in the department of Pathology, in a tertiary care teaching hospital. Previously diagnosed 135 cases of metastatic lymphadenopathy of patients attending various outpatient departments from the year 2013 to 2016, with history of malignancy or suspected metastasis to lymphnodes or cytologically diagnosed cases of malignant lymphadenopathy are selected for the study. Slides are retrieved from cytology section under department of Pathology. Hematoxylin and Eosin (H&E), Papanicolaou (PAP) stain and Leishman stained slides are examined for the cytological features of malignancy and also for the pattern and classification of various malignancies. Results obtained are tabulated and analysed. 

 Introduction: Malaria causes death of about1.1 to 2.7 million people annually of which majority are children under five years.Hematological changes are some of the most common complications in malaria and they play a major role in malarial pathogenesis. These changes involve the major cell types such as RBC, leucocytes and thrombocytes.This study aimed to access the changes in haematological parameters in smear positive malaria cases, to see the changes in biochemical parameters in smear positive malaria cases and to compare these changes in P. vivaxand P. falciparum infection. Material and Methods: This  observational study was conducted in in a tertiary care center during the period of May 2017 to May 2018. Total two hundred smear positive malaria cases were examined forvarious hematological parameters and biochemical parameters. Results: Results of the present study showed that 110 cases were P. Vivax positive while 90 patients were P. Falciperm positive among 200 smear positive cases. Majority of the patients (70%) have sown either mild (40%) or moderate degree (30%) of anemia. Among 9% of malaria patients Hb Concentration was <7 gm%. Most of the patients (68%), showed haematocrit level in the range of 20-35%.In anemic patients, commonly found RBC morphologywere normocytic, normochromic (64.55%) followed by microcytic hypochromic (29.11%) nearly equal in both P. falciparum and P. vivax malaria.Platelet counts were less than 1.5 lakhs/mm3 both types of malaria patients (71%). Further, severe thrombocytopenia (<50,000) was recorded in 19 malaria patients. Conclusion: Findings of the current study suggest that careful observation of haematological findings are warranted in the malaria patient as anaemia and thrombocytopenia of varying degree of severity have been found in malaria patients. Further, results of the present study showed that P. Falciparum and P. Vivax are associated with serious complications like severe anaemia and malarial hepatitis without any significant difference between both species. Hence, both P. Falciparum and P. Vivaxinfections on suspicion of complication should be further evaluated. However, more studies on larger populations are warranted to assess the haematological parameters in malaria. 

 Malignant proliferative diseases affecting the white cell population results in acute or chronic leukemias and lymphomas. There are several categories of acute leukemias based on the cell of origin and are broadly divided into lymphoid leukemias and myeloid leukemias. Acute lymphoid leukemias are very common in children while Acute Myeloid leukemias are more often seen in older children and young adults. To analyse the morphologic subtypes of Acute leukemias in children using cytochemistry. To determine the type of acute leukemia and associated chromosomal abnormality, to assess the chemotherapeutic response of acute leukemias occurring in paediatric age group, to assess the prognostic significance of age, sex and leucocyte count in acute leukemias in children. Out of 45 cases of acute leukemias there were 33 cases of ALL and 12 cases of AML. Acute myeloid leukemias showed a wide range of chromosomal abnormality, interestingly the Acute myeloid leukemias was found to be on rise in the present study. 

 Background: Nephrectomy is a common urological procedure in urological practice. It is indicated in patients presenting with a wide range of clinical conditions ranging from symptomatic chronic infections, obstruction, calculus disease, and severe traumatic injury and neoplastic conditions. In India management of chronic kidney diseases and neoplasms are posing a great challenge as dialysis and kidney transplantations are expensive for the patients. Aims and Objectives: 1) To study the histopathological features of lesions in nephrectomy specimens 2) To evaluate the frequency of different pathological lesions in nephrectomy specimens 3) To correlate the histopathological diagnosis with the clinical features. Materials and Method: This was a prospective study conducted in the conducted in the department of pathology, M.S. Ramaiah Medical College and Hospitals, Bangalore. The study included all nephrectomy specimens received for routine histopathological examination over a period of 2 years (from July 2014 to June 2016). All the nephrectomy specimens were sent to histopathology section in 10% formalin. All specimens were subjected to detailed gross examination and representative tissue bits were taken. For microscopic examination, 4-5 µm thick paraffin sections were cut and stained with haematoxylin and eosin (H &E). Relevant patient particulars including age, sex, affected side, clinical presentation and investigations such as Computed Tomography, Ultrasonography etc were retrieved from the case files. Results: Out of 62 patients, 38 cases were males and 24 cases were females with male: female ratio of 1.58:1. The mean age was 43.93±18.67 years with the youngest patient aged 1 year and the oldest patient aged 75 years. The mean age of the males was 42.92±19.50 years and the mean age of females was 45.54±17.56 years. Neoplastic lesions accounted for 51.63% of the cases and were more common than non-neoplastic lesions of the kidney which accounted for 48.38% of the cases. Renal cell carcinoma was the commonest lesion of the kidney, accounting for 56.25% of the neoplastic lesions and 29.03% of all renal lesions followed by Wilms’ tumor (6.45%, 4/62). Other neoplastic lesion encountered were Transitional cell carcinoma (4.84%, 3/62), Renal oncocytoma (4.84%, 3/62) Angiomyolipoma (4.84%, 3/62) and Squamous cell carcinoma (1.61%, 1/62). Chronic pyelonephritis was the commonest non-neoplastic lesion encountered in the present study which accounted for 43.33% of all non neoplastic lesions and 20.97% of all the lesions of the kidney followed by Hydronephrosis (16.13%, 10/62). Other non neoplastic lesions Tuberculous pyelonephritis (4.84%, 3/62), Xanthogranulomatous pyelonephritis (1.61%, 1/62), Cystic renal dysplasia (1.61%, 1/62), End stage kidney disease (1.61%, 1/62), Renal hydatid cyst (1.61%, 1/62). Conclusion: The present study provides a fair insight into the histopathological patterns of lesions in nephrectomy. Neoplastic lesions were more common than nonneoplastic lesions of the kidney. Renal cell carcinoma was the commonest neoplastic lesion and chronic pyelonephritis was the commonest nonneoplastic lesion in this series. The histopathological diagnosis generally correlates well with the pre operative clinical diagnosis, however some benign lesion may be misdiagnosed clinically as malignant and some malignant lesions may be misdiagnosed clinically as benign. As renal lesions may be misdiagnosed clinically, it is mandatory that every nephrectomy specimen be subjected to a detail histopathological examination to ensure proper post-operative management. 

Objective: Bone marrow examination performed in cases of pancytopenia detected on peripheral blood smears to find out cause of it. Place & duration: The study was carried out at Integral Institute of Medical Sciences & Research, Lucknow from Jan 2017-June 2018. Material & Methods: We report 43 cases of pancytopenia.Bone marrow aspiration was done by 16 gauze salah needle and obtained smears then stained with leishman and MGG stain. Results: Out of 43 cases, 28 were males and 15 were females. 29 smears shows of hypercellular marrow, hypocellular smears in 8 cases & 6 cases were of normocellular marrow. Conclusion: This study conclude that the megaloblastic anemia was the common etiology. Other causes are acute leukemias, nutritional anemia with dual deficiency & multiple myeloma.

 Background: Platelets are essential for maintaining the integrity of the endothelium and for controlling hemorrhages when the injury to the blood vessels occurs. A low platelet count is a common entity encountered by the general pediatrician. Pediatricians then encountered with the problem of discriminating whether the low platelet count is caused by decreased production (hypoproductive thrombocytopenia) or increased destruction (hyper-productive thrombocytopenia). Material and Methods: The study population consisted of thrombocytopenic patients in the period between March 2017 and March 2018. A total of one hundred eighty patients (180) both female and male were enlisted, with age ranging from 1-14 years. Two groups were made to divide these patients, hyperproductive thrombocytopenia group (n=80) and hypo- roductive thrombocytopenic group (n=100). The automated cell counter with quality control and established reference ranges, was used to measure platelet count, mean platelet volume, and platelet distribution width. The sensitivity and specificity of mean platelet volume and platelet distribution width were calculated under various cutoff ranges for both thrombocytopenic conditions. Results: The sensitivity and specificity of platelet indices were calculated under various cut off  ranges. The MPV with a cutoff of >10.6fL detects 90% of the cases of ITP while excluding 86% of the hypo-productivesituations. When the chosen cutoff for MPV is greater than 12.6fL, detection rate was 50% of the ITP cases while excluding 94% of the hypo-productive cases. Conclusion: Results of the present study suggest that platelet indices are significantly higher in ITP patients compared to patients withhypo-productive thrombocytopenia. Comparing the sensitivity and specificity between MVP and PDW for both groups, PDW is moresensitive to detect the ITP patient than MVP but less specific in a cutoff above the normal range. 

 Introduction: Teratoma are most common germ cell tumor of the ovary. There are various histological types of teratoma and clinically they present with various behavior. The aim of this study is to determine the various morphological pattern and its clinical presentation. Materials and Methods: This is Descriptive study for a period of 4 years from January 2012 to December  2015 at our tertiary care hospital. It consist of total 133 cases of ovarian neoplasm which were surgically removed. Results: A total of 133 cases of ovarian neoplasm were included out of which 24 cases were of ovarian teratoma. In this 22 cases were benign cystic /solid teratomas, 11 case was malignant teratoma and 1 case was of strauma ovari. Out of 22 cases mature teratoma, 21 cases were cystic type and 1 case was of solid type. The cases had dull pelvic pain / dragging discomfort as a common clinical complain. Right sided ovary was involved commonly (64%). The tumor size ranges from 6 cm to 18 cms. The age range in this study was from 12 to 75 years. Conclusion: This study shows mature cystic teratoma are common type of ovarian teratoma (88.6%). Although immature (malignant) and other types are rare, histopathological study play important role in final diagnosis and management of patient. 

 Introduction: Malaria is a common parasitic disease which has remarkable morbidity and mortality in all over the world. In malaria electrolyte imbalances and mineral disturbances are common clinical manifestations. Since Na+ (sodium) and K+ (potassium) are very important for the electrolyte homeostasis in human body. In malaria it is necessary to estimate the levels of these electrolytes in all cases for better management of patients. Materials and methods: The present cross sectional study was carried out over a period of 1 year in the tertiary care hospital, India. All the haematological and biochemical analysis were performed including examination of the thick and thin peripheral smears for malarial parasite. All the confirmed patients of malaria above 1year of age were included in study. The data from the study was analyzed statistically. Results: The incidence of P. falciparum was more than P. Vivax in the present study population. Serum sodium and potassium significantly decreased in falciparum malaria as compared to vivax malaria. Furthermore serum sodium and potassium level were significantly low in the age group of 1-15 years. Conclusion: We can conclude from the present study that serum sodium and potassium are good markers for the severity of the malarial infection. We can prevent complications in malaria patients of all ages by estimating serum electrolytes. 

 Introduction: Thyroid is a readily palpable gland in the anterior inferior neck. Thyroid pathologies are common worldwide and are commonly encountered in clinical practice. Diseases of the thyroid are of great importance because most of them are amenable to medical and surgical management. Thyroid enlargement is a common problem especially in young population causing pressure symptoms and cosmetic deformity. Thyroid lesions may be developmental, inflammatory, hyperplastic and neoplastic. Though FNAC has taken a prominent role on the evaluation of thyroid lesions, thyroid carcinoma closely resembles its benign counterpart making histopathology the gold standard in the diagnosis. Aim of the study is to evaluate the different patterns of thyroid lesions. Methods: Two years retrospective study carried out from July 2015 to June 2017 at SVS Medical college and hospital, Mahabubnagar on 115 biopsy specimens received in the department of pathology. Results: Total number of 115 cases were studied histopathologically out of which 85 were non neoplastic lesions and 30 were neoplastic.Among the non neoplastic lesions multinodular goitre was the most predominant and papillary carcinoma of thyroid in the neoplastic cases.

 Introduction: Chromosomes or chromosomal segments that fail to get incorporated into nuclei during cell division configure as micronuclei (MN), nuclear budding (NB) and chromatin bridges (CB). The frequency of these markers are increased in carcinogen-exposed tissues long before any clinical symptoms are evident. Objectives of the Study: To study and compare the scoring of morphological markers of chromosomal instability in a spectrum of non-neoplastic, intraepithelial intraepithelial neoplasm and invasive cancer of the cervix. Methodology: Retrospective study conducted in the department of pathology, MIMS, Mandya from January 2016 to December 2017. All conventional pap smears with epithelial cell abnormalities  and equal number of age matched pap smears without epithelial cell abnormalities received during study period were interpreted according to 2014 Bethesda system and examined for MN, NB and CB. Results: Out of 150 conventional pap smears studied 53 smears showed neoplastic changes and 75 were non-neoplastic. Carcinoma in situ (LSIL and HSIL) seen in 42 smears and invasive carcinoma in 11 smears. The mean MN score and NB score showed increasing trend towards malignancy with significant p value <0.05. The MN score and NB score is significantly high in invasive carcinoma compared to carcinoma in situ. CB was observed in one case each of LSIL, HSIL and IC. Conclusion: This is a simple, reliable, reproducible and cost-effective test and can serve as an effective biomarker in conjunction with the conventional cervical Pap screening for early diagnosis of CIN and cervical cancer.