Indian Journal of Pathology: Research and Practice

Background: Aging in humans is characterised by a selective decline in circulating levels of adrenal androgens, whose production in Zona Reticularis (ZR) of adrenal is enhanced by Cytochrome-B5 (CytB5). Objectives: The present work aims to determine the histomorphological effects of aging and CytB5 distribution in the adult human adrenal cortex during the aging process. Methods: This is an analytical study in which human adult adrenal glands were obtained at autopsy from 39 men and 33 women who suffered a sudden death. The right & the left adrenal glands were received separately and Gross findings, microscopic features and Immunohistochemistry with CytB5 were studied in detail. Results: The mean of weight, length & breadth of both Right & Left adrenal glands were found to decrease with increasing age, which is statistically significant, but without significant difference in the thickness of adrenal glands. The thickness of ZR and expression of CytB5 also showed statistically significant reduction with increasing age. The area which was histologically identified as ZR on H & E staining, corresponded well to the area of CytB5 positivity on IHC.

Keywords: Cytochrome B5; Adrenal; Aging.

Introduction: Transurethral resection of prostate and prostatic biopsies are very common specimens in surgical pathology. Prostatic biopsies are done in cases where there is clinical suspicion of malignancy. These specimens have to be thoroughly examined to avoid false negative diagnosis of adenocarcinoma prostate. Non-neoplastic lesions which are to be distinguished from adenocarcinoma prostate are atrophy including partial atrophy, atypical adenomatous hyperplasia (adenosis), crowded benign glands, sclerosingadenosis, radiation atypia in benign glands, basal cell hyperplasia, clear cell cribriform hyperplasia, non-specific granulomatous prostatitis, dense inflammation and malakoplakia. Aims and objective: The aims of this study is to evaluate the spectrum of histomorphological lesions of prostate and evaluating them with them help of Immunohistochemisry (IHC) markers such as P63 and AMACR. Material and methods: A total of 100 TURP and 20 needle biopsies were collected and examined each under light microscopy for benign, premalignant, and malignant lesions. All the biopsies are stained with H&E and doubtful lesions were stained with P63 and AMACR. Results: Total 90 were benign in TURP and 6 in biopsies specimen. Low grade pin was found in TURP biopsies amounting to 10% and 4% HGPIN in vicinity to neoplastic glands. Most common gleasons scoring was 7. IHC was done, AMACR was positive in HGPIN and in adenocarcinoma and p63 was focally disrupted in HGPIN and totally absent in adenocarcinoma. Conclusion: The substantial proportion of patients undergoing TURP and biopsies for clinically symptomatic benign enlarged prostate emphasizes the need for early diagnosis through histopathological examination.

Keywords: BPH; Carcinoma prostate; PIN; P63 and AMACR.

Background: imprint cytology is a rapid and an accurate way for diagnosis of lesion especially in developing countries in the intraoperative setting where the facility of frozen section is not available. It is very accurate in differentiating between benign and malignant lesions and helps the surgeon to decide the future course of the surgery. Aims: to compare the accuracy of intraoperative imprints made with that of the histopathology Kal sections in breast lesions. Materials and methods: study of 50 cases of breast lesions were done at a tertiary care center comprising of the complete spectrum ranging from benign to malignant region and the findings were correlated with histological findings. Statistical methods: sensitivity, positive predictive value, negative predictive value, and specificity was calculated. Results: Our study included 50 benign and malignant lesions of the breast. On imprint cytology 17 cases were positive for malignancy, 28 cases were negative for malignancy and 5 cases were suspicious for malignancy. No false positive case was reported. All 5 cases which were reported as suspicious for malignancy were reported malignant on histopathology done after surgical biopsy. In the present study diagnostic sensitivity and specificity of imprint cytology was 77.28%, 100% respectively. There were 0% cases of false positive and 10% case of false negative. The negative predictive value was 84.84% and the positive predictive value was 100%. Conclusions: intraoperative imprint cytology is a very accurate tool in differentiating between benign and malignant lesions and can be easily applied in resource-poor and developing countries where the facility of the frozen section may not be available.

Keywords: Activated partial thromboplastin time; Platelet count; Prothrombin time; Type II Diabetes mellitus; SMIMER hospital Surat

Background: In diabetic patients incidence of cardiovascular disease due to thrombosis is higher than healthy individual. PT, aPTT and Platelet count are haematological parameters that give an idea about the coagulation status. So, this study aimed to assess the prothrombin time, activated partial thromboplastin time and platelet counts of type II diabetes mellitus patients. Methods: A comparative study was conducted at SMIMER hospital, Surat. A total 50 type II diabetic patients and 50 healthy control were included in this study. 4 ml of blood was collected in citrate bulb to determined PT, aPTT and Platelet count of these 2 Groups. Results: The mean aPTT of diabetic and healthy control 25.14 ± 6.32 and 35 ± 3.23 s, respectively. The proportion of diabetic patients with normal PT, aPTTand platelet counts was 84.0%, 10% and 92.0%, respectively. There was significant shortening of aPTT in Type II diabetic patients. Conclusions: There was a significant shortening of aPTT in diabetic patients as compared with non-diabetic groups. So, shortening of aPTT in untreated Type II diabetic patients might be useful marker in patients with diabetes and monitoring of the aPTT in newly diagnosed diabetic patients is important to prevent hypercoagulation.

Keywords: Activated partial thromboplastin time; Platelet count; Prothrombin time; Type II Diabetes mellitus; SMIMER hospital Surat.

Background: Soft tissue tumors (STTs) are a complex group of neoplasms and composed of nonepithelial supportive connective tissue. They are rare neoplasms, comprising ≤ 2% of cases. Due to variable origin and overlapping histopathological features, they pose a great diagnostic challenge to histopathologists. Aim: To analyze the relative frequency of STTs in Rohilkhand region according to their nature and demographic profile and also to discuss the role of immunohistochemistry (IHC) in diagnosing and classification of STTs. Materials and Methods: The study included a total of 240 cases of STTs diagnosed at pathology department for a period of 2 years, at a tertiary care teaching hospital of Rohilkhand region. On H&E sections, tumors were classified on the basis of their origin according to WHO classification 2013. Sections were also subjected to IHC analysis using different antibodies, where indicated. Result: Out of the total 240 cases, 214 (89.2%) cases were benign, 8 (3.3%) intermediate and 18 (7.5%) malignant. Incidence of both benign and malignant STTs was more common in males. The peak incidence of benign STTs was observed in the age groups of 21-40yrs and that of malignant tumors in 41–60 yrs. Lipoma was the commonest benign STT (46.7%), while tumors of fibroblastic origin were most common (33.3%) among the malignant category. Few common benign tumors were also identified at rare sites. Out of 18 malignant cases, in 2 (11.1%) cases, no definite opinion could be obtained and were classified as spindle cell sarcomas. Conclusion: Diagnosis of STTs require uses of special stains, immunohistochemistry and molecular methods in addition to the routine microscopic examination of H & E stained slides due to the morphologic similarities with each other and also with carcinomas.

Keywords: Carcinomas; Hematoxylin and Eosin; Immuno-histochemistry; Sarcomas; Soft tissue; Tumors.

Context: Mucoepidermoid carcinoma (MEC) is the most common malignancy of salivary glands accounting for 5–10% being more common in the parotid gland, followed by minor salivary glands, especially palate. It is one of the most problematic tumours due to elusive features. FNAC is a valuable tool to preoperatively assess surgical management. However due to its morphological heterogeneity, overlapping architectural patterns and nuclear features a high false negative rate is seen. Aims: To elucidate the cytomorphological features of MEC. To explore the accuracy and pitfalls of FNAC in MEC by comparing it with final histopathological diagnosis. Methods and Material: This retrospective study was conducted on 15 cases of salivary gland lesions which were diagnosed as MEC on FNAC or later from biopsy/excision specimens by histopathology. The case details and slides were retrieved from the archives for a 10 year period (2006–2015). The cytological features were compared with the final histopathological diagnosis. Results: Out of 15 cases, 7 cases were concordant while 8 cases were found to be discordant with the final histopathological diagnosis. Underdiagnosis and overdiagnosis were noted and the overall diagnostic accuracy was 46.6%. Conclusions: This study of salivary gland tumours emphasizes the inherent problems in cytologic diagnosis of MEC as low & intermediate grade lesions are commonly underdiagnosed as benign.

Keywords: Fine Needle Aspiration Cytology (FNAC); salivary gland; Mucoepidermoid Carcinoma (MEC).

Background and Objectives: It is well known that quite a large number of apparently healthy donors are not able to donate blood successfully because of varied reasons. These donors are deferred temporarily or permanently. The aim of the study was to analyse the incidence of Blood Donor deferral and its various causes and use this information as a guide for promoting voluntary Blood donation. Materials and Methods: Present study is a retrospective descriptive study. All the Blood donors reporting at our Blood Bank in last 18 months period were analysed retrospectively. Data of all the donors deferred due to various causes was analysed at our Blood bank. Results: There were 10,569 donors, of which 557 donors were deferred. Deferral rate amounting to 5.27%. Most common age group deferred was 26–35 years (38.42%). Temporary deferral were 96.76% (n=539) and permanent deferral were 3.23%. Leading causes of temporary deferral were hypertension, hypotension, alcohol intake, medicine intake, infection and permanent deferral causes were epilepsy, uncontrolled diabetes mellitus, thyroid disorder. Conclusion: More studies should be done at state and national level so that enough data can be collected and national policies formulated in deferring donors and moreover analysis of donor deferral pattern will help blood banks to formulate more focused donor screening approach.

Keywords: Blood bank; Blood donors; Donor deferral; Permanent deferral.

Carcinoma prostate falls next to carcinoma lung in incidence and mortality rate. With increasing age of men incidence of prostatic carcinoma is seen to be increasing. In recent years significant achievement is made in early diagnosis and the detection of carcinoma prostate. Technologies such as immunohistochemistry, flow cytometry, fluorescent in situ hybridization (FISH) have helped in the study of premalignant and malignant lesions of prostate. Concept of Intra epithelial development of carcinoma progressing to invasive is a well-recognised phenomenon with cervical cancer, oral cancer and so also the carcinoma Prostate. Orteil in 1926 gave the first description of premalignant changes in the prostate. The premalignant lesions of prostate include prostatic intraepithelial neoplasia (PIN) and atypical adenomatous hyperplasia (AAH) and recently, the new lesion added to the list of premalignant lesion is proliferative inflammatory atrophy (PIA). Screening for prostate cancer is controversial. Although the past several decades have seen declines in overall prostate cancer mortality, some evidence exists that this is a function of improved survival for men with advanced prostate cancer rather than men with early-stage disease who presumably would benefit from screening. It is recommended by-American Urological Association that in general, men 50 years and older with a reasonable certainty of a 10-year life expectancy should be screened annually or biennially. Patients with an elevated risk of disease (e.g., African Americans and those with a family history) should be screened beginning at an earlier age (45 years). In this part of our country the socio-economic conditions and the facilities pose limitations for people screening to be undertaken. In clinical practice, AAH, HGPIN and PIA remains undetected as most of these lesions does not reveal any abnormality on clinical (digital rectal examination), biochemical (PSA level analysis and radiological (trans rectal ultrasound) evaluation. Hence, histopathology remains the gold standard for diagnosis of these putative precursor lesions of prostatic carcinoma. Identification of these lesions of prostate will help in early detection of carcinoma and guide the urologist for appropriate management of the patient.

Keywords: BPH; PIN; CARCINOMA; P63; AMACR.

Introduction: Thyroid lesions are common globally and also in India. Most of the lesions are non-neoplastic or benign but still there are chances of malignancy and hence most of the patients undergo initial FNAC test to ascertain the nature of lesion. Based on the FNAC report the necessity for surgery and extent of surgery are planned. Aim of the study: To study thyroid lesions on cytology and histopathology and also to study the correlation on cytology and histopathology. Materials and Methods: This was a prospective hospital based study. FNAC/thyroid cytology was done and studied in 143 patients. Out of 143 cases, histopathology examination was done in 63 cases and the findings were correlated. Results: For cytology, the patient age ranged from 12 years to 71 years and the male to female ratio was 0.3:1. Nodular/colloid goiter was the most common diagnosis reported on cytology. Cyto-histological correlation yielded sensitivity of 82.4% and the specificity of 91%. The positive predictive value and negative predictive value of cytology to detect thyroid malignancy was 88.6% and 85.9% respectively. Conclusion: Thyroid lesions are more common in the young adults and have a female preponderance. Cytology/FNAC study of thyroid has good sensitivity and specificity for determining the nature of lesions. FNAC procedure is rapid, simple, inexpensive tool and gives quicker diagnosis than the histopathology.

Keywords: Thyroid FNAC; Histopathology of thyroid; Thyroid cytology and histopathology correlation.

Background: Papulosquamous diseases characterized by scaling papules or plaques compose the largest heterogenous group of diseases. Psoriasis is the prototype of a group of cutaneous disorders that show Psoriasiform epidermal hyperplasia. Aim: To determine the histopathological & clinical pattern of Psoriasis and other papulosquamous disorders. Materials and Methods: Histopathological study of Papulo-squamous skin disorders was conducted at Department of Pathology. Sixty one cases attending dermatology OPD and fulfilling inclusion and exclusion criteria were selected for study. Results: Psoriasis occurred in all age groups except below 10 years but was commonly seen in young and middle age groups. Pityriasis rosea, Lichen nitidus, Prurigo simplex and inflammatory linear verrucous epidermal nevus were seen in children and young adults. High predominance was observed in males for all conditions. Fourty seven out of 61 cases showed clinic-pathological correlation which accounted for 77.05% of total cases. Twenty cases of Psoriasis were studied. Most common findings were parakeratosis, acanthosis, Munro microabscesses, hypogranulosis, spongiform pustules and dermal inflammation. Conclusion: Overlapping of both clinical pattern and distribution of papulosquamous skin disorders, which often made clinical diagnosis difficult. Proper clinical observation and histomorphological study will give conclusive diagnosis.

Keywords: Lichen planus; Scaly plaques; Eruptions; Pityriasis; Dermatitis.

Background: The papulosquamous disorders are complex to diagnose, because of the difficulty in identification and may resemble a similar disorder of the group. Lichen planus is an inflammatory dermal condition of the muco-cutaneous surfaces which present with a varied clinical manifestations. High prevalence of disease noted on the Indian subcontinent. Aim: To study the clinical & histopathological presentation of papulosquamous disorders with special emphasis on Lichen Planus. Material and Methods: Descriptive histopathological study of papulosquamous disorders of skin was conducted at Department of Pathology with 61 cases of clinically diagnosed papulosquamous eruptions. Results: Lichen planus was the commonest (57.37%) followed by Psoriasis and Prurigo nodularis. High predominance was observed in males for all diseases. Lichen planus occurred in all age groups but was commonly seen in young and middle age groups. Flat topped papules and plaques were the commonest type of clinical patterns seen in Lichen planus. Out of 35 cases of Lichen planus, 29 were clinically diagnosed and confirmed by histopathology. Conclusion: Clinical diagnosis was difficult due to overlapping of both clinical pattern and distribution of papulosquamous skin disorders. Combination of proper clinical observation, histo-pathological & morphological study for conclusive diagnosis.

Keywords: Dermatitis; Eruptions; Psoriasis; Scaly Papules; Pityriasis.

Introduction: Unlike in other systems, CNS has predominantly neoplastic lesions in comparison with the non-neoplastic ones. However, non-neoplastic CNS lesions are a mimicto neoplastic lesions posing histopathological diagnostic challenge. In the present study we made an attempt to exclusively study the SOLs of CNS which were non-neoplastic. Aim of the study: To document the histopathological spectrum of non-neoplastic SOLs of the CNS. Materials and Methods: Atwo-year prospective study in the department of Pathology, Mediciti Institute of Medical Sciences, Ghanpur, Telangana analysed biopsies of the central nervous system. The non-neoplastic lesions were analyzed for incidence and histopathological spectrum. Results: A total of 255 CNS SOLs were received out of which 24 were non-neoplastic incidence being 9.4%. The patients age ranged from 8 to 70 years. There were 15 male and 9 female patients, the male to female ratio being 1.6:1. 45.8% cases were cystic lesions, 25% cases showed gliosis and 29.1% cases were of infectious etiology. Conclusion: Almost 10% of SOLs in the CNS are of non-neoplastic etiology ranging from cystic lesions to gliosis to treatable infectious causes. Histopathological examination of SOLs of CNS is mandatory to distinguish neoplastic versus nonneoplastic lesions. Often the infectious agent can be identified which helps to institute appropriate therapy.

Keywords: CNS; Cysts; Gliosis; Infections.

Background: Cyclo-Oxygenase-2 (COX-2) derived prostaglandins are known to participate in carcinogenesis, tumor cell invasion and metastasis. COX-2 is expressed in all stages of cancer and it’s over expression is associated with poor prognosis. The purpose of the present study was to correlate COX-2 expression with tumor differentiation and lymphovascular invasion in cervical cancer. Materials and Methods: Fifty one surgically resected hysterectomy specimens and cervical biopsy specimens sent for histopathology department in a tertiary care hospital were included in the study. Formalin-xed parafn-embedded tissue sections were stained by Hematoxylin and Eosin. Immunohisto-chemistry for COX-2 was also performed on these blocks. Statistical analysis used: Chi square test and Fisher Exact test were applied to test the significant associations, where p< 0.05 was considered as statistically significant. Results: Of the 51 specimens, 6 (11.8%) were found to be Cervical intra epithelial neoplasia (CIN), 40 (78.4%) were Squamous cell carcinoma (SCC), 4 (7.9%) were Adenocarcinoma and 1 (1.9%) was of poorly differentiated carcinoma variant. Though majority of the specimens were of invasive carcinomas (45), microscopic evidence of Lymphovascular invasion was seen only in 27 (60%) cases. All adenocarcinoma and poorly differentiated carcinoma cases and some (22) SCC cases showed lymphovascular invasion. Intensity of COX-2 expression was lower in in-situ carcinomas compared to invasive carcinomas. It was found that higher intensity of COX-2 expression was significantly associated with higher tumour grade and lymphovascular invasion. (p < 0.05) Conclusion: In the present study, intensity of COX-2 expression was found to be varying with the tumour grade and lymphovascular invasion in carcinoma cervix. This demonstrates the role of COX-2 as a prognostic marker in cervical carcinomas.

Keywords: Cyclo-Oxygenase-2; Carcinoma of cervix; Lymphovascular invasion; Tumour differentiation.

Background: According to the survey data from the Surveillance, Epidemiology, and End Results (SEER) program, the incidence of malignant GI-NETs is increasing, probably due to increased physician awareness and improved diagnostic techniques. The present study was undertaken to study on occurrence and spectrum of neuroendocrine neoplasms in the digestive system. Method: This hospital-based study was conducted at the Kidwai Memorial Institute of Oncology, Bangalore. The present study consists of 118 cases of Digestive System NENs encountered during a 10 year study period. Retrospective cases were retrieved from the registers of Histopathology and Immuno histochemistry divisions and slides were analyzed. For the prospective study, complete clinical data was obtained from the patient and clinical records. Data regarding routine laboratory investigations, abdominal ultrasound, CT Scan, MRI, upper or lower GI endoscopy and peroperative findings, medical treatment and follow up data were analyzed. Result: Oesophagus was the most common site (35%), followed by the stomach (23%), small intestine (22.0%), large intestine (6.%), rectum (7%), pancreas (4.2%), one case each of appendix, gall bladder, common bile duct and metastasis to the liver. In the oesophagus, NEC was the most common diagnosis. G1 NETs were the most common NENs of the stomach, small intestine and pancreas. G2 NETs were most common in the large intestine, gall bladder, CBD, rectum & liver metastasis. Conclusion: The incidence of neoplasms is increasing because of early diagnosis by use of modern diagnostic methods and better physician awareness. Use of WHO 2010 classification helps in the classification of NENs and grading will impact the treatment and prognosis of individual patients.

Keywords: Neuroendocrine neoplasms; Digestive system; Immunohistochemistry; WHO classification.

Background: Soft tissue tumours (STT) represent a heterogeneous and complex group of mesenchymal lesions that may show a broad range of differentiation. Inspite of their pathological diversity, there is a significant overlap in their clinical and radiological features which highlights the importance of an accurate histopathological diagnosis. Objective: The present work aims to study the histomorphological patterns of soft tissue tumors and to correlate it with clinical presentation and epidemiological distribution according to age, sex and site of occurrence. Methods: 190 cases of patients with soft tissue tumors attending the surgery department in Government Medical College Kottayam were included in the study. Clinical features including symptoms and duration of the swelling were documented. Gross as well as microscopic features (after routine H and E stain) were studied in detail. Results: Soft tissue tumours were seen to comprise 2.78% of all biopsies received. The most common mode of presentation was a painless swelling of prolonged duration. Of the 190 cases studied, 162 cases (85.26%) were benign, 18 cases (9.47%) were malignant and 10 cases (5.26%) were those of intermediate category.

Keywords: Soft tissue tumours; histomorphology.

Background: Breast lump is fairly common complaint in females for which patient seeks medical advice and becomes anxious about the diagnosis. Quick diagnosis by Fine needle aspiration cytology (FNAC) relieves patient’s anxiety and assists in their preoperative management and overall treatment. Aims: To study the cytomorphological spectrum of benign breast lesions in correlation with histological appearances to evaluate the utility of FNAC in the diagnosis of palpable breast lesions. Materials and Methods: A 1.5 years prospective analysis of the data was carried out on 200 patients of breast lump in the Department of Pathology, Mandya Institute of Medical Sciences, Mandya from January 2016 to June 2017. Fine needle aspiration cytology (FNAC) was done and smears were stained with Hematoxyllin and Eosin and May-GrunwaldGiemsa stains. Results: Out of 200 cases 160 cases were benign,38 cases were malignant and 2 cases were inadequate. Among 160 cases maximum cases were of fibroadenoma (62 cases) followed by fibrocystic change (44 cases), gynaecomastia (17 cases), benign epithelial hyperplasia (14 cases), acute mastitis (6 cases), chronic mastitis (4 cases), epidermal cyst (3 cases), subareolar abscess, galactocele and granulomatous mastitis each 2 cases and 1 each case of breast cyst, lipoma, benign spindle cell lesion, benign phyllodes tumor. Histopathological correlation was available in 58 cases and maximum cases were obtained for fibroadenoma followed by fibrocystic change. Conclusion: FNAC of the breast lump is an easily performed outpatient diagnostic method for determining the nature of the breast mass. It is safe, painless, needs no anesthesia. The lumps can be aspirated in the outpatient department, with requiring only a few materials such as syringe, needle and glass slides and fixatives. It can be repeated if necessary.

Keywords: FNAC; breast lesions; HPE.

Background: Histopathological examination remains the gold standard for diagnosis of ovarian tumours. Morphological diversity of ovarian tumours poses many challenges in diagnosis. It is important to have knowledge regarding the non-neoplastic lesions since they may mimic neoplasm clinically and radiologically. Methods: All ovarian biopsies received in the department of pathology over a period of 3 years were studied. Clinical data was obtained from the histopathology requisition forms submitted with the tissue specimens to the Department of Pathology. Respective H&E stained slides were retrieved from the departmental archives and slides were reviewed. Analysis of data was done using descriptive statistics. Result: Totally 178ovarian lesions were studied over a period of 3 years. Majority of lesions (106 out of 178) were neoplastic and rest were (76 out of 178)non neoplastic. Commonest non neoplastic lesion encountered was follicular cyst. Commonest neoplastic lesion encountered was serous cystadenoma followed by mucinous cystadenoma. Conclusion: Ovarian lesions are complex and have varied histological appearance. It is difficult to differentiate the neoplastic and non-neoplastic lesions clinically and radiologically, hence thorough histological examination is mandatory in guiding the proper treatment.

Keywords: Ovarian biopsy; Neoplastic and non-neoplastic lesions.

Introduction: Uterine cervical screening by Papanicoloau method using cervical smears is an important diagnostic tool in the field of public health. Procedure wise uterine cervical screening is an easy, cost effective mean to detect the premalignant and malignant lesions of Uterine Cervix at the earliest in the community at large. Among the uterine cervical lesions, the cervical intra-epithelial neoplasia (CIN) and cervical cancer are still remain the major health problems for women during the reproductive period in developing and developed countries. Aim: To study the spectrum and frequencies of cytomorphological changes that encountered in Cervical smears by Papanicoloau method in accordance with Bethesda system of classification 2014. Material & Methods: This is a retrospective study comprising of analysis of 4634 cervical PAP smears examined as a part of hospital based screening programme during the period from January 2015 to December 2018 in the Cytology division of Pathology department, at Shridevi Institute of Medical Sciences and Research hospital, Tumkur, a tertiary care hospital. However the case sheets, pathological slides and reports were reviewed. Results: The overall frequency of epithelial cell abnormalities in the present study is 5.2%. The atypical squamous cell of undetermined significance (ASC-US), Low-grade squamous intraepithelial lesion (LSIL), High-grade squamous intraepithelial lesions (HSIL) and carcinoma cervix were 0.8%, 3.1%, 1.2% and 0.1% respectively. Discussion: Uterine cervical cancer is the fourth leading cause of death among females in the world and it is the second commonest in India. The cytomorphological changes mainly includes atypical squamous cell of undetermined significance (ASC-US), Low-grade squamous intraepithelial lesion (LSIL), High-grade squamous intraepithelial lesions (HSIL) and carcinoma cervix. Conclusion: Pap smear screening is a simple, safe, useful diagnostic tool for early diagnosis and to detect cervical intraepithelial lesions at the earliest. The aim of cervical cancer screening programme is to detect the precursor cervical lesions and not frank cancer cervix. Hence it is desirable to promote easy pap screening test before 40 years of age. As the resources concerning to cytology based activities are less in Indian settings, the WHO recommendation of once in a life time cervical screening between 35 and 40 years of age is more appropriate to identify the high risk women for carcinoma cervix.

Keywords: Bethesda system; Epithelial cell abnormalities; ASCUS; LSIL; HSIL.

Introduction: One out of every third person is suffering from anaemia throughout the world; moreover half of this anaemic population are suffering with iron deficiency. The credibility of serum ferritin and transferrin for the diagnosis of Iron Deficiency Anaemia (IDA) is still suspicious as different studies have shown different results. Material and Methods: This was a cross sectional study conducted in the pathology department of a Tertiary Health Care Setting. Study population consisted anaemic patients of 18 to 60 years of both sexes. Bone marrow was aspirated and smears were stained using the May-Grunwald-Giemsa stain. With an automated hematology analyzer blood counts were measured. Serum transferrin receptor assays were performed using a commercially available kit based on a polyclonal antibody in a EIA format. Results: The present study included 100 patients suffering from anaemia. Out of these 100 patients, 42 anaemic patients were having iron deficiency; while 58 patients were having non iron deficiency etiology. Transferrin saturation level was significantly low in 11.63% in IDA patients compared to 30.2% in anaemic patients without iron deficiency with p-value <0.01. Serum ferritin level was significantly lower in IDA patients (78.6 ± 33.9 ng/mL vs 180.8 ± 46.2 ng/mL, p<0.01) in comparison to patients without iron deficiency etiology of anaemia. Conclusion: Finding of current study showed that high values of Serum transferrin receptor assays and low level of serum ferritin and transferrin saturation levels has been found associated with IDA. These results suggest that transferrin and serum ferritin should be considered as reliable markers for the diagnosis of IDA. Moreover, this method may be used as a lesser-invasive technique for the diagnosis of IDA; instead of using invasive and painful methods like bone marrow aspiration test. However, studies on larger populations are required to establish serum ferritin and transferrin studies as primary determinants for the diagnosis of IDA.

Keywords: IDA; Anaemia; Serum ferritin; Transferrin.

Introduction: Adnexal masses are most common disease in gynaecology of which ovarian tumors represent 2/3rd of these cases. Ovarian lesionscan be present in any age group and also present in a wide spectrum of histomorphogical patterns. Many ovarian tumours are asymptomatic in the early stages and are unfortunately diagnosed in the advanced stage. The diagnosis of ovarian tumor helps to plan the treatment modality like chemotherapy, radiotherapy and surgery depending upon stage of the tumor and age of the patient. Materials and Methods: This is a prospective study of 85 ovarian lesions at tertiary care hospital within one year period. The specimens of ovarian masses sent from gynaecological departmentare processed by routine paraffin techniques. Microscopic examination was done on sections stained with Haematoxylin and Eosin. Result: The total 85 cases of ovarian neoplasms were studied during study period, out of which 45 were non-neoplastic lesions and 40 lesions were neoplastic. Follicular cysts were the commonest non-neoplastic lesion; 27 cases (60%), followed by endometriosis 11 cases (24.44%). Out of the 40 neoplastic ovarian lesions benign cases were 28 (70%), borderline cases were 3 (7.5%) and malignant cases were 9 (22.5%). Mucinous cystadenoma, followed by serous cystadenoma were most common lesions in benign neoplasm and serous cyst adenocarcinoma was the most common malignant lesion. Conclusion: Tumor-like lesions are more common than ovarian tumors mimicking ovarian neoplasm which manifest a variety of gross and histological features. Their histopathological study is still the gold standard method in diagnosing most of the ovarian lesions.

Keywords: benign; Malignant; Ovarian tumors.

Morphological evaluation of tumor-infiltrating lymphocytes (TIL) is gaining importance as evidence strengthens its clinical relevance as immunological biomarker, in breast cancers. The significance of TIL also lies in the fact that its presence determines the immune response and thereby predicts improved disease outcome independent of chemotherapeutic regimen. The present study was conducted to establish the association of Tumour infiltrating lymphocytes (TIL) with other independent clinicopathological prognostic factors of breast cancer and find their statistical significance. A retrospective study was conducted with random 149 modified radical mastectomy specimens. Data was collected with respect to the following inclusion criteria: age, histological type, histological, grade, tumour size of primary breast cancers, lymph node status, lymphovascular invasion ER, PR, Her 2 neu status by immunohistochemistry. Univariate regression analysis was done for all the variables with TIL. Based on p-value and correlation coefficient these four variables: lymphovascular invasion, histological grade, Her 2 and Triple negative breast cancer (TNBC) showed high association with TIL. Multivariate logistic regression analysis emphasized that the four variables: histological grade, lymphovascular invasion, Her 2 and TNBC together are strongly associated with TIL. Hence the evaluation of TIL density in routine histopathological practice may prove to be of paramount relevance

Keywords: Tumour infiltrating lymphocytes (TIL); Breast cancer; Her 2; Triple negative breast cancer.

Background: Autopsy is an important and most useful way to find out the condition of internalorgans in which a thorough examination is performed on a body after death to evaluate disease or injury thatmay be present and to determine the cause and manner of a person’s death. Material & Methods: This retrospective study was carriedout in the Department of Pathology. Tissue pieces from lungs, retrieved at the time of autopsy, were preserved in 10% formalin. These were processed and paraffin sectioning was done followed by Haematoxylinand Eosin staining. The sections were then examined microscopically. Results: Out of 191 specimens of lungs from autopsy subjects, 142 cases (74.3%) were males and 49 cases (25.6%) werefemales with maximum numbers of cases, in age group of 16-30 years were 73 cases (38.2%).In our study, congestion and edema were the commonest findings and seen in 72 cases(37.69%). Granulomatous (Tuberculosis) lesion was seen 7 cases(3.6%) and Pneumonia wasseen in 15 cases (7.8%). There was only one case of malignancy. Conclusion: In medicolegal autopsies, the histopathological examination helps in establishing the final cause of death. Gross and histopathological study of lung in medicolegal autopsies may quite often reveal some natural disease and its relative contribution towards death. Keywords: Autopsy; Pneumonia and tuberculosis.

Background: Mediastinum is a small extra pleural anatomic compartment between the lungs where wide variety of lesions occurs. Division of mediastinum is helpful in developing a differential diagnosis. Aim: To analyse the pathological features of mediastinal lesions in our hospital. Materials and Methods: This is a retrospective hospital based study in tertiary care hospital on all primary mediastinal lesions over a period of six years (January 2012-December 2017). The data were retrieved from the archives of pathology department. Statistical analysis used: Microsoft Excel sheet. Results: Out of 80 mediastinal lesions, 62 were primary mediastinal lesions. Majority (58.1%) were in anterior compartment with male predominance and male to female ratio of 1.21:1. Age ranged from 11 days to 80 years and adult patients predominate. 44 cases (71%) were of neoplastic nature, among which thymus related tumours predominate followed by lymphoma, germ cell tumours and mesenchymal tumours. Non neoplastic lesions include mediastinal cysts, thymic remnants and thymic hyperplasia, reactive lymphadenitis, tuberculous lymphadenitis and extramedullary haematopoiesis. Conclusion: A multidisciplinary workup is needed in arriving at a diagnosis in case of mediastinal lesion for appropriate management of these rare lesions.

Keywords: Mediastinal lesions, thymic neoplasms, thymoma, mediastinal cysts

Background: Histopathological requisition forms are a mode of communication between clinicians and pathologists. Incomplete requisition forms can significantly impact the quality of histopathological reports. Objective: To determine the degree of completeness of the requisition forms with respect to demographic data and clinical data. Materials and methods: Histopathological requisition forms submitted to the department of Pathology, Gadag Institute of Medical Sciences (GIMS), Gadag from January to December 2018 were evaluated for the completeness of the forms. The data was entered in excel sheet and completeness was assessed by measuring the ratio/percentage of complete cases to total cases. Results: Out of 760 requistion forms, 524 (68.94%) were complete with respect to demographic data. Out of the total 760 forms, 252 (33.15%) were complete with respect to clinical data. Three (0.39%) forms were incomplete with respect to the age. Six (0.78%) forms were incomplete with respect to sex. Clinician’s name was not mentioned in 104 (13.68%) forms. Five (0.65%) cases failed to mention outpatient/inpatient (OP/IP) number. Adequate clinical history and examination findings were not mentioned in 231 (30.3%) of forms and 74 (9.73%) of forms failed to mention clinical diagnosis. Conclusion: In the present study the level of completion of the requisition forms was suboptimal.

Keywords: Requisition forms; Histopathology.

Background: To study the spectrum of CNS tumors in different age groups, locations, clinical presentations, their radiological and histo-pathological profile in local population of Kanpur. Methods: This study includes 119 radiologicaly diagnosed and operated cases of CNS tumors, registered between Sept. 2014 to Aug. 2017 in Pathology Department, RMCH and RC and various other hospitals, Kanpur and classified according to WHO 2007 classification along with grading (WHO Gr.I to Gr.IV) of tumors. Results: A wide range of histopathological spectrum of CNS tumors was observed. Overall tumors of neuroepithelial tissue (47.9%) was the most common entity followed by tumors of meninges (25.2%), cranial and spinal cord nerves (19.3%), metastatic tumors (4.2%), tumors of sellar region (1.7%) and lymphomas (1.7%). The most common CNS tumors found in childhood (1st and 2nd decade) were ependymoma (5.04%), low grade astrocytoma (3.36%) and medulloblastoma (1.68%). In adults (3rd to 6th decade) astrocytic tumors (21.0%) comprise the most common group followed by meningiomas (16.8%). While in elderly (>60 years) astrocytomas (10.1%) were most common followed by meningiomas (6.7%). Out of 119 cases, 80 (67.2%) were supratentorial, 24 (20.2%) infratentorial and 15 (12.6%) spinal. Most common presenting symptom in supratentorial tumors were headache (67.22%), seizure (47.89%) and motor weakness (37.81%) while in CPA tumors hearing loss and ataxia were the most common symptoms. Spinal tumors mainly presented with motor weakness and urinary symptom. Conclusions: Frequency of CNS tumors in local population in different age groups was found to be similar to studies conducted in different parts of India.

Keyword: WHO; CNS; CPA.

Introduction: Bicytopenia is an important clinico-hematological disorder. This study was conducted in Coimbatore Medical College Hospital to identify various causes of bicytopenia. It was done by analysing and correlating hematological indices, peripheral smear and bone marrow morphology of bicytopenia patients. Materials and Methods : It is a prospective study done for a period of one year. In this study, 50 cases of bicytopenia were included. Results : The most common cause of bicytopenia was Combined deficiency (42%) followed by Megaloblastic anemia (24%). The other causes include micronormoblastic erythroid hyperplasia, leukemia, myelodysplastic syndrome, immune thrombocytopenia, metastasis and plasmacytoma. Maximum number of cases seen in the age group of 21-40 years. Conclusion: In this study, causes of bicytopenia were evaluated as it is equally important as pancytopenia in the management of patients. The higher incidence of combined deficiency can be attributed to low socioeconomic status, poor hygiene, inadequate nutrition and lifestyle modification. So analysis of hematological indices, peripheral smear and bone marrow morphology becomes an important diagnostic tool for an early intervention of the patients with bicytopenia.

Keywords: Bicytopenia; Combined deficiency; Megaloblastic anemia.

Clinical manifestation of Haemoglobinopathies may vary from asymptomatic state to severe, lifelong, transfusion dependant anemia and reduced life expectancy. About 1.1% of couples around the world are at risk for having children with a hemoglobin disorder of which 2.7 per 1000 conceptions are actually affected. Screening of Antenetal cases for haemoglobinopathies has a very vital role in preventing thalassaemia births. In this study 674 antenatal cases who were registered at their first visit were screened for Haemoglobinopathies. Clinical history, haematological parameters using LH750 (Beckman Coulter) and Peripheral blood smears were recorded. Whole blood EDTA samples were run on BioRad Variant II Hb-HPLC system (considered as gold standard for haemoglobinopathy secreening) for Hb F and Hb A2 quantification and detection of variant haemoglobins. The results were interpreted based on% of the eluted Haemoglobins and CBC data. Out of 674 cases, 307 (45.55%) showed Normal study, 309 (45.85%) were found to have Hb HPLC Normal Pattern with abnormal RBC indices suggestive of iron deficiency, 45 (6.68%) were found to be Heterozygous for Beta Thalassaemia, 5 (0.74%) Heterozygous for Hb sickle, 3 (0.45%) Heterozygous for Hb sickle with Alpha Thalassemia, 2 (0.30%) Heterozygous Delta Beta Thalassemia, 1 (0.15%) Heterozygous for Hb E, 1 (0.15%) Heterozygous for Hb D coinheritance of Beta Thalassemia to be investigated, 1 (0.15%) Heterozygous for Hb-HOFU. In this study, heterozygous beta thalassemia was the commonest haemoglobin disorder, followed by heterozygous Hb- Sickle and other Hb variants (Fig. 1). We recommend Antenatal screening for haemoglobinopathies in all ANC to rule out haemoglobinopathies because carriers haemoglobinopathies are asymptomatic. With effective screening of the spouse of the carrier women and genetic counseling will greatly help in preventing the disease. Cases with associated deficiency anaemias need further follow up after complete course of haematinics

Keywords: ANC; HPLC; Haemoglobinopathies

Introduction: The platelet number alone does not give a complete picture of platelet maturity and function. Therefore, platelet indices have been the subject of intensive study in recent years, but they have not been firmly established in the neonates. Aims and objectives: To determine the platelet indices in the healthy and sick neonates admitted in the department of paediatrics. Methods: It was a prospective study conducted in neonates born in PES institute of medical sciences and research and other neonatal cases referred for management of disease conditions. Platelet count and its indices were derived for total 140 neonates from the automated haematology analyser SYSMEX × s1000i. A detailed clinical history of neonates was obtained. Results: Out of 140 neonates, 84 (60%) male and 56 (40%) were female. There were no significant differences of platelet indices between healthy neonates 33 (23.6%) and sick neonates 107 (76.4%), between healthy full term 22 (66.7%) and sick full term 93 (6.9%), between healthy preterm 11 (33.3%) and sick preterm 14 (13.1%). Conclusion: These data indicate that platelet indices of neonates showed no significance in values between healthy neonates and sick neonates. Further studies will be needed in clinical application of platelet indices in neonates.

Keywords: Platelet indices; Neonates; Mean platelet volume (MPV).