Indian Journal of Pathology: Research and Practice

Abstract
Background: Though fine needle aspiration cytology is the most routinely performed and widely accepted diagnostic procedure for an initial diagnosis in any swelling, we often come across difficulties in diagnosis, if the material obtained is hemorrhagic or fluid in nature. In such cases cell blocks can be prepared from the residual tissue fluids or the aspirated material. Cell blocks then be sectioned, stained and studied. Cell block study can be an useful adjunct to smears for establishing a more definitive cytopathologic diagnosis. Hence this study was conducted to evaluate the efficacy of cell block
with FNAC and to compare the findings of cell block and FNAC with histopathology as gold standard. Methodology: The study was conducted in the department of Pathology at Adichunchanagiri Institute of Medical Sciences and Research Centre. All the cystic/solid lesions sent for fine needle aspiration which yielded sufficient amount of material for the cell block were studied after taking a detailed clinical history. Results: Out of total 66 cases of FNAC and cell block, 35 cases were sent for histopathology. Mean age of the patients was 41.36 years and female patients were more in number (73%). Benign lesions (71.4%) were more than malignant ones (29.6%). Cell block section had more number of thyroid lesions (31%). The diagnostic accuracy of FNAC was found to be 94.28% while that of cell block was 97.14% Interpretation and Conclusion: Though FNAC is the first line of investigation for mass lesions, it has its disadvantages due to fluid and hemorrhagic aspirates. Cell
block provides an excellent complement with FNAC in diagnosis as the diagnostic accuracy increases when FNAC and cell block are combined.
Keywords: CB-Cell block; FNAC-Fine Needle Aspiration Cytology; Histopathology

Leprosy and tuberculosis are chronic granulomatous diseases known to be endemic in our country. Simultaneous occurrence of both infections in a single individual is not an uncommon clinical condition but has been reported infrequently in literature. Erythema Nodosum Leprosum (ENL) is an immunologically mediated hypersensitivity reaction presenting in patients with lepromatous and borderline lepromatous leprosy usually before, during and rarely after multidrug therapy (MDT) for leprosy. Here we report a case of ENL and tubercular lymphadenitis diagnosed simultaneously in a 25 year old young male presenting with fever and other systemic features at the time of admission in our hospital. It is important to identify these cases to avoid monotherapy of tuberculosis. Concurrent occurrence of these diseases can modify the course and presentation of each other and pose diagnostic and therapeutic challenges. Due to relative rarity of occurence of this phenomena we are reporting this case.

Keywords: Erythema Nodosum Leprosum; Tubercular Lymphadenitis.

Background: Thrombocytopenia is one of the commonly encountered haematological abnormalities in neonates admitted in NICU. Various factors such as ARDS, neonatal sepsis, meconium aspiration syndrome, neonatal hyperbilirubinemia, prematurity, low birth weight and necrotising enterocolitis are associated with thrombocytopenia. Monitoring thrombocytopenia in respect to onset and severity is an important predictor for neonatal morbidity and mortality. Material & method: Blood samples of total 185 neonates admitted in NICU during the period of four months (November 2018 to February 2019) were evaluated; out of these, total 45 cases were diagnosed with low platelet count (count < 1.5L/ cumm). These 45 cases were evaluated for onset of development of thrombocytopenia and categorised in early onset (< 72 hrs of birth) and late onset (> 72 hrs of birth). These neonates also observed for severity of thrombocytopenia. Observation: Overall incidence of thrombocytopenia in present study is 41.1%. Most common etiological factor associated was neonatal sepsis followed by ARDS, meconium aspiration syndrome, neonatal hyperbilirubinemia, prematurity, low birth weight and necrotising enterocolitis. Most of the cases were presented with late onset and leading cause of thrombocytopenia among this group was neonatal sepsis in association with other factors like ARDS, meconium aspiration. All the cases of neonatal sepsis were found to have severe thrombocytopenia (platelet count < 50,000/cumm). Conclusion: Neonatal thrombocytopenia is very common haematological finding. It can also be considered as an important sensitive marker for neonatal morbidity specifically in case of thrombocytopenia associated with neonatal sepsis as it manifested before the culture results.

Keywords: Neonatal thrombocytopenia; ARDS; Neonatal sepsis.

Introduction: Finding newer modalities of treatment is the need of the hour for Colorectal carcinoma as the incidence of is on the rise. One such is the finding of overexpression of “Her-2/neu” a biological marker, with “Targeted therapy” which can open new avenues of treatment. Objectives: 1) To study the histopathology of neoplastic lesions in colonoscopic biopsies. 2) To determine the proportion of Her-2/neu overexpression in Colorectal Carcinomas. 3) To study association between Her-2/neu over expression with grade and lymph node status – wherever possible. Methods: All the histologically confirmed Colorectal Adenocarcinomas were subjected to Immunohistochemical staining for detection of Her-2/ neu overexpression. A “3+” complete membrane staining considered positive. Results: In the present study, Immunohistochemical staining of confirmed Adenocarcinomas with Her-2/neu for overexpression revealed a total of 16 (23.5%) cases as Positive, which were histologically low grade tumours, with a statistically significant p value of 0.0012. Conclusion: The incidence of colorectal carcinoma is on the rise at the rate of 2% annually. Herceptin , an antibody directed against Her-2/ neu antigen can be a novel therapy for the poor prognostic groups, which constituted around of 23.5% of cases in our study.

Keywords: Colonoscopy; Colorectal carcinoma; Her-2/neu; Immunohistochemistry.

Context: Cervical cancer is the second leading malignancy in the women occurring worldwide. Researches based on nuclear morphometry on cervicovaginal smears are very much sparse; hence we have taken up this study. Aims: To valuate the role of nuclear morphometric parameters (nuclear radius and area) in differentiation of premalignant lesions of cervix. Settings and Design: Retrospective analysis of nuclear morphometric parameters in cervical smears of 40 cases. Methods and Material: Retrospective analysis of nuclear morphometric parameters in 40 cervical smears (20- LSIL and 20- HSIL) done at Government Kilpauk Medical College. Statistical analysis used: Independent sample t test was used for comparing radius and nuclear area in LSIL and HSIL lesions. Results: There was an appreciable difference in the area of nucleus among the premalignant lesions. The mean nuclear area in LSIL was 109 ± 7.446 um2 and HSIL was 132.48 ± 11.388 um2. Radius of the nucleus also showed appreciable difference in LSIL and HSIL cases included in our study. The mean nuclear radius in LSIL lesions was 3.78 ± 0.25 um and in HSIL lesions was 4.37 ± 0.34 um. Conclusions: Nuclear morphometry is henceforth an useful and dependable investigative tool in the differentiation of premalignant cervical lesions.

Keywords: Nuclear morphometry; LSIL,HSIL.

Background: Skin adnexal tumors are large and diverse group of uncommon neoplasms usually misdiagnosed clinically due to their large variety and variants. Histopathology usually helps in establishing the diagnosis. Aims: To study the spectrum and morphological features of skin adnexal tumors (SATs) at our centre. Methods: This is both retrospective and prospective descriptive study over a period of 5 years (June 2005 to June 2010). The study included all the biopsies and excision specimens submitted for histopathological examination. Results: Most of the SATs were benign (25/31) with head and neck being the most common location (67.74%). Male to female ratio was 1:1.8. There was equal occurrence of tumors of sweat gland and hair follicle differentiation (45%). The most common varieties of tumors encountered in the present study included proliferating trichilemmal tumor and hidradenoma. The concordance between clinical and histopathological diagnosis was found to be 6.45% approximately. Conclusions: SATs are relatively uncommon. As they are often clinically misdiagnosed, histopathology is mandatory for the diagnosis. Although they are not numerically important or therapeutically problematic, nevertheless they form the spectrum of interesting lesions.

Keywords: Adnexal tumor; Proliferating trichilemmal tumor; Hidradenoma; Pilomatricoma.

Background: Thalassemia is one of the major hemoglobinopathies among the population all around the world. Beta thalassemia major results in severe anemia which needs regular repeated blood transfusion, which leads to iron over load in the body which damages the liver, kidney and other. HIV, Hepatitis B and Hepatitis C are common among multiple blood transfusion patients. So to know the severity of the patient, we retrospectively & prospectively correlated transfusion transmitted infection, liver function test and serum ferritin with multiple blood transfused thalassemic patients. Methods: Total 200 subjects were studied. We examined all patients who are clinically and Hematological suspicion of thalassemia and patients diagnosed to have halassemia based on High Performance Liquid Chromatography (HPLC) over a period of 2 years 3 months. The patients groups were evaluated according to the clinicohematological presentation and HPLC study. Results: Mean value of serum ferritin in thalassemia major group was found to be significantly increased (4103.21 ± 2786.9 ng/ml). In thalassemia major group, out of 78 cases 4 cases found reactive for HBV and 9 cases found reactive for HCV. Conclusion: There is significantly higher seroprevalence of both hepatitis B and C markers was observed among the multi-transfused thalassaemic children. Blood screening has significantly reduced the risk of transfusion related hepatitis B and C. However, the risk is still there. So, the health care providers who are involved in the management and blood transfusion of thalassaemic patients should be more aware of this problem.

Keywords: Performance Liquid Chromatography (HPLC); Beta Thalassemia; Serum Ferritin; Transfusion Transmitted Infection (TTI).

Introduction: Papillary lesions are a group of lesions characterized by presence of papillae supported by fibrovascular cores lined by epithelial cells with or without myoepithelial cells. This group of lesions span spectrum of hyperplastic to neoplastic processes. Diagnosis of papillary lesions is challenging for pathologists. Distinction between various lesions as benign, atypical and malignant papillary lesions aid in patient management. Materials and methods: This is a five years study from January 2013 - December 2017. All the cases diagnosed as papillary lesions were considered for the study. Total of 21 cases were reviewed. All the patient details were archived from patient’s records. Paraffin blocks were also archived and IHC for p63, CK5/6, ER, PR and Her2/Neu were performed. Histopathology slides were reviewed by pathologists who were blinded about the original diagnosis. Aims: This study was conducted to analyse the clinico-pathological and immunohistochemical characteristics of papillary lesions of the breast. Results: Age ranged from 29-61 years. Only 2 cases presented with bloody nipple discharge. Male – female ratio was 1:8.5. Majority of the specimen were lumpectomy, followed by modified radical mastectomy and biopsies. Diagnosis of papilloma was made in 6 cases, while remaining 13 cases were diagnosed as papillary carcinoma. Adjacent breast showed changes like inflammation, fibrocystic change, atypical ductal hyperplasia, carcinoma in situ and invasive carcinoma. IHC showed positivity for ER in 10 cases, PR in 9 cases and Her2/neu in 1 case. P63 showed continuous positivity in papillomas but negative in carcinomas. Conclusion: Papillary lesions of breast can range from hyperplastic to neoplastic lesions. Accurate diagnosis will aid in patient management. Immunohistochemistry will help in delineating the lesions.

Keywords: Papillary lesions; Papilloma; Papillary carcinoma; IHC.

Context: Meningiomas constitute about 13-26% of primary intracranial tumours. Although most of the meningiomas are benign grade I tumours, they show a recurrence rate of about 30%. Detection of morphologically benign and biologically aggressive meningiomas cannot be made by routine histology alone. Thus in the present study progesterone receptor was used as an adjuvant approach in the identification of these biologically aggressive meningiomas. Aim: The aim of the study was to assess the histological grade and subtype of meningiomas and to correlate their expression with progesterone receptor in non-recurrent and recurrent tumors. Methods and Material: This was a prospective study conducted over a period of one year from July 2013 - June 2014 in the Department of Pathology, Coimbatore Medical College and Hospital, Coimbatore. Thirty cases of meningioma were assessed histologically and immunohistochemically and correlated with various clinicopathological parameters. Statistical analysis used: Correlation between the histopathological results and immunohistochemistry results were calculated by using chi-square tests and test of sample proportion. Results: Thirty cases of meningioma were included in the study all of which were grade I tumours. Mean age of all cases was 45 years. Females outnumbered males with Female: Male ratio of 2.7:1. Progesterone receptor positivity was seen in about 19 out of 30 cases (63.3%). Progesterone receptor immunoreactivity was higher in females (68%). Age, location of tumour and subtypes had no correlation with progesterone receptor status. Recurrence was noted in 23% of cases (7 out of 30 cases). The recurrence rate was found to be higher in males (25%). Progesterone expression was higher in nonrecurrent tumours (78%). Conclusions: The expression of progesterone receptor was associated with lesser recurrence and better prognosis. Progesterone receptor can be used along with other histological parameters for prognostication of meningiomas. Thus, in the grading of meningiomas, histopathological examination alone is not sufficient, ancillary tests with Progesterone receptor should be included for prognostication of meningiomas.

Keywords: Meningioma; Progesterone receptor; prognosis.

Background: Cytological grading is a useful tool in preoperative prognostication of Breast carcinoma and its management. Aim: To cytologically grade breast carcinoma using Robinson’s and Mouriquand’s grading systems, compare each other and determine which correlates well with Modified Scarff-Bloom Richardson (MSBR) histological grading system. Materials and Methods: 60 cases of Breast lumps were studied from January 2007 to January 2012 whose FNAC and biopsy were performed in our institute. Cytological grading was carried out using Robinson and Mouriquand grading systems and were compared with each other and then each of them were correlated with Modified Scarff-Bloom Richardson histological grading system. Concordance and discordance was accordingly noted amongst them. Results: A total of 60 cases were studied, ages ranging from 35-79 years. By Robinson’s system 20%, 56.67% and 23.33% aspirates were graded as grade I, grade II and grade III respectively. Using Mouriquand’s grading 16.67%, 55% and 28.33% aspirates were graded as grade I, grade II and grade III respectively. Agreement between each other was 82.5%. Agreement between Robinson and MSBR histological grading was 89.17% and between Mouriquand and MSBR histological grade was 80%. Diagnostic accuracy of Robinson’s system was 86.67% and specificity was 70% while Mouriquand system showed an accuracy of 76.67% and specificity of 30%. Conclusion: Comprehensive cytological grading of breast carcinomas was possible using Robinson’s and Mouriquand’s cytological grading system and the concordance between them was 65%. Further, of the 2 cytological grading systems Robinson’s was better because of more objective criteria and easy reproducibility.

Keywords: Breast carcinoma; Cytological grading; Fine needle aspiration; Histological grading.

Background: Tumors of the colon and rectum are one of the most common malignancies worldwide. However, its incidence was less in India compared to the developed countries. In the recent years, due to westernization, sedentary lifestyle and increased consumption of animal fats with less dietary fibre intake have increased the incidence in India in the past few decades. Family history and Microsatellite instability also predisposes the patient to Colo-rectal carcinoma. Many prognostic factors have been studied in Colo-rectal cancers and have been proved. However newer factors like macrophage infiltration in the tumor microenvironment have been studied. Many theories have been put forth to study these macrophages and their sub population M1 and M2. M1 macrophages are considered to be tumoricidal whereas M2 macrophages are considered to promote tumor growth by releasing growth factors and promoting angiogenesis. Hence, the study of these macrophage subpopulation M1 and M2 can help in assessing the prognosis in patients with Colo-rectal cancers. Aims & Objectives: 1. To determine the expression of CD68 and CD163 in Colorectal Cancer. 2. To correlate the expression of CD68 and CD163 with the histological grade and stage of the tumor. Materials and Methods: All Colorectal carcinoma specimens received in the Department of Pathology from R.L. Jalappa Hospital and Research Center attached to Sri Devaraj Urs Medical College, Tamaka, and Kolar from December 2016 to September 2018 and also the paraffin blocks taken from all cases of Colorectal cancer retrieved from Archives of Department of Pathology from the year January 2008 to November 2016 were included in the study. Data regarding the clinical details (Age, Sex, Histological grading) were collected. Hand E slides were reviewed for Histopathological types, grade and staging of the tumor. Immunohistochemistry for CD68 and CD163 (Biocare mouse antibody) was performed on all cases of Colorectal Carcinoma using appropriate positive and negative controls by peroxidase and anti peroxidase method. Results: A total of 62 cases were studied of which 39 were males and 23 were females. The most common site of tumor was Rectum followed by ascending colon. Majority of the tumors were less than 5 cms. The most common grade was moderately differentiated adenocarcinoma. Maximum number of cases were in Stage III, 23 cases (37.1%) Perineural invasion was seen in 2 cases and lymphovascular invasion was seen in 3 cases. Maximum number of cases (64.5%) were in lymphnode ratio less than <0.111. Expression of CD 68 was significantly correlating with site of the tumor, Size of the tumor, Grade, and lymphnode ratio. Expression of CD 163 was correlating with T stage, N stage, TNM stage, and Lymphnode ratio. Conclusion: CD 68 expression was associated with better prognostic factors such as smaller size of tumor, lesser grade and lesser lymphnode ratio(LNR) and CD 163 expression was associated with poorer prognostic factors such as higher T stage, Higher N stage, and higher values of lymphnode ratio (LNR). Hence, CD 69 and CD 163 can serve as a reliable prognostic marker in colo-rectal cancers.

Keywords: Colo-rectal cancer; Immunohistochemistry; Prognosis.

Obective: Breast lumps constitute a significant proportion of surgical cases in women of both developed and developing countries. It is needed to distinguish benign lumps from malignant preoperatively for definite treatment There is wide variety of breast pathology. Epidemiological studies reveal wide disparities in the frequency and distribution of breast ailments across the world. Material & Methods: This study includes a total 250 female patient presented with palpable breast lump and undergone for fine needle aspiration cytology in department of pathology jhalawar medical college. Results: Total 250 patients were presented with breast lump out of which 195 (78%) were benign and 55 (22%) were malignant on cytology. This study shows age range of the patients was from 11 to 70 years. Most of the patients were in the range of age 31 to 50 years.

Keywords: Epidemiological studies; Benign Lumps; Malignant.

Introduction: Cervical lymph node enlargement is frequent presentation in all age groups with a wide spectrum of diseases, ranging from infections to malignancy. Therefore, management of cases depends on lymph node pathology, which can be studied by collecting material through fine needle aspiration method that can be used as an outpatient procedure. Objectives: The study was undertaken to assess the cytomorphological features and incidence of cervical lymph node lesions on fine-needle aspiration cytology (FNAC) and to analyze the utility and diagnostic importance of FNAC in lymph node diseases. Materials and Methods: In this retrospective study, total of 173 patients were selected who had presented with cervical lymph node enlargement at Department of Pathology in our Tertiary Care Centre. Results: In this series of FNAC, 173 cases of cervical lymph nodes were analyzed. The age of patients ranged from 2 years to 85 years with slight male preponderance. Tubercular lymphadenitis comprised the majority (49.1%) followed by reactive lymphoid lesions (24.2%), metastatic malignancies (9.2%), granulomatous lymphadenitis (8%), acute suppurative lymphadenitis (6.9%), chronic nonspecific lymphadenitis (1.1%), necrotizing lymphadenitis (0.5%) and lymphoma (0.5%). Conclusion: FNAC is a simple, safe, reliable, inexpensive and the most diagnostic tool in early detection of lymph node lesions.

Keyword: Fine-needle aspiration cytology, Cervical Lymphadenopathy, Tuberculosis

Mast cells arise from the hemopoietic progenitor cells of the bone marrow derived and were first discovered by Paul Ehrlich in 18th century. They are found in varying numbers in different tissues and are abundant near blood vessels, nerves and in subepithelial tissues. They are constantly present in appendix, the organ most commonly subjected for surgical intervention and removal. The present study was undertaken 1) To compare the mast cell counts in the mucosa, sub mucosa and the muscular layers of the appendix. 2) To compare the mast cell counts in the normal appendix and in the acute, recurrent, and chronic appendicitis in various age groups. Materials and Methods: seven hundred and seventy-seven cases of appendix were evaluated for histopathological changes and number of mast cells in each layer. The mast cell count in various histopathological group were compared using ANOVA (DUNNETT) Test. The degree of mast cell density was evaluated using Pearson’s correlation test. Result: A higher mast cell count was seen in acute eosinophilic appendicitis and recurrent appendicitis. Mean mast cell counts were high in recurrent appendicitis with fibrosis, when compared with no fibrosis. Conclusion: Mast cell activation is one of the important factors in causation of appendicitis and thus this activation of mast cells backs the allergic theory of appendicitis.

Keywords: Mast cells; Appendix; Appendicectomy.