Indian Journal of Pathology: Research and Practice

Filariasis, a tropical parasite infection, caused by thread - like nematode, which is a common problem in the Indian sub-continent. Occurance of filariasis with Acute Myeloid leukemia (AML) is unusual finding. Very few cases have been documented in literature so far. Here we report bancroftian filariasis in a male patient in association with Acute Myeloid Leukemia.

Keywords: Acute myeloid leukemia; Microfilarae.

Background: Salivary glands are subjected to a wide and heterogenous range of tumor like conditions as well as tumors, and fine needle aspiration (FNA) forms an inexpensive, easy, reliable diagnostic modality. Aims/Objectives: 1. To study series of salivary gland lesions on FNAC at our institute. 2. To assess age, gender and site wise distribution of salivary gland lesions. Materials and method: A 4 year study was conducted from January 2015 to December 2018. All the salivary gland lesion FNAC performed in the department of Pathology, SIMS, Shimoga during the study period were included in the study, with exclusion of cases where the aspirate was acellular or hemorrhagic. Corresponding biopsy specimens if available during the study period were reviewed. Results: 143 cases of salivary gland lesions were included in the study. Non-neoplastic lesions were 77 (53.84%) and neoplastic lesions were 66 (46.15%). Non-neoplastic lesions were further divided into 3 categories inflammatory (52 cases, 67.53%), sialadenosis (13cases, 16.88%) and cystic (12 cases, 15.58%). Benign neoplasms accounted for 58 cases (87.87%) and malignant neoplasms were 08 cases (12.12%). Commonest non-neoplastic lesion belonged to inflammatory category, i.e. chronic sialadenitis (29 cases, 55.76%). Commonest benign and malignant neoplasm was Pleomorphic adenoma (52 cases, 89.65%) and Mucoepidermoid carcinoma (04 cases, 50%) respectively. Conclusion: In the present study we have shown the variety of lesions associated with salivary glands, both non-neoplastic and neoplastic. With increasing incidence of these salivary gland lesions, fine needle aspiration cytology has emerged as an easy and economical diagnostic modality.

Keywords: Parotid; FNAC; Pleomorphic adenoma; Histopathology.

Introduction: Red blood cell (RBC) histograms are graphical representations of cell frequencies versus cell sizes. Comparison of size of the patient’s cell with the normal population is possible with the help of histogram. RBC histogram along with Red cell indices, Hematocrit and red cell distribution width provides a significant information in various red cell disorders. Aims and Objectives: The objectives were to know the advantage and utility of RBC histogram in various anemias and study RBC histogram patterns along with peripheral smear examination. Material and Methods: 724 cases of outpatient department with Hemoglobin less than 12 gm% on complete blood count from SMIMER, Surat were included in study. RBC histogram generated in automated hematology analyzer were compared to the peripheral smear findings of the same patient. Results: Out of 724 cases, almost equal cases had normal curve and left shift of curve (34.81% and 33.70% respectively). 26.66% cases showed broad based histogram. Histogram of 3.18% cases were shifted to right and 1.65% had bimodal peak. Conclusions: Good interpretation of histogram provides significant information in diagnosis and follow-up of many hematological conditions. Red cell histogram can be used as important screening test in diagnosis of anemia before further hematological analysis.

Keywords: RBC histogram; Peripheral smear; Anemia.

Introduction: Hyperpigmentary skin disorders may be defined as increased pigmentation of the skin and/or mucous membranes to the extent that the patient concerned seeks medical advice. They have varied etiological factors and overlapping clinical features, thus necessitating the use of histopathology to aid the diagnosis. Aims/Objectives: To study the series of hyperpigmented skin lesions at our institute and to assess age, gender, site wise distribution of hyperpigmented skin lesions. Materials and Method: Study was conducted in the Department of Pathology, SDM College of Medical Sciences and Hospital, Dharwad, over a period of 5 years. Cases with hyperpigmented skin lesions seeking consultation in Dermatology and Surgery department were subjected to punch/ excisional biopsy after patient’s consent. Tissue bits were subjected for processing and stained with H&E stain. Special stains were used whenever required. Results: 102 cases of hyperpigmented skin lesions were studied, out of which, 35 cases were non-neoplastic hyperpigmented lesions and 67 cases were neoplastic hyerpigmented lesions. In non-neoplastic lesions, 31 cases (88.57%) were inflammatory lesions with classical lichen planus being common (25.71%); others were 3 cases of metabolic lesions (8.57%) with 1 case each of macular amyloidosis, lichen amyloidosis, acanthosis nigricans and 1 case of infective lesion – Pityriasis versicolor (2.85%). In neoplastic lesions 89.55% cases were benign with Intradermal nevus (41.79%) being common and 10.44% were malignant with Malignant melanoma (7.46%) being common. Conclusion: Hyperpimentary skin lesions are not uncommon and have overlapping clinical features. Histopathology plays a crucial role in diagnosing the lesions as well as differentiating melanocytic lesions from non-melanocytic lesions as both present with skin hyperpigmentation.

Keywords: Skin; Hyperpigmentation; Special stains; Lichen planus; Malignant melanoma; Histopathology.

Background: Breast cancer is one of the leading cancer affecting women in India. An early diagnosis has a great significance especially since it carries a high morbidity and mortality rate. It is common among women in both developed and developing countries. Objectives: The present study was carried out to determine the histopathological and immunohistochemical pattern of invasive ductal carcinoma breast in a tertiary care institute. Methodology: 1418 cases of breast cancer diagnosed as invasive ductal carcinoma (IDC) were studied in the department of pathology of a teaching hospital. Estrogen receptor (ER), Progesterone receptor(PR) and Her-2/Neu expression were assessed using immunohistochemical staining and correlated with other prognostic factors including age, tumour size, grade and histomorphological type. Study Area: The study was carried out in the department of histopathology of a tertiary care institute in northern India. Study Design: Formalin fixed paraffin embedded paraffin blocks were analysed. The study duration was 9 years (January 2011 – December 2018). Statistical Analysis: The results were analyzed using SPSS statistical package version 26.

Keywords: Carcinoma; Breast; Mastectomy; IHC; ER; PR; Her-2/Neu; Prognosis.

Introduction: Lipomatous tumors are one of the most common neoplasms in humans and are one of the very complex areas of soft tissue tumors. These tumors vary greatly in incidence, clinical presentation, gross, microscopic appearance and also in biological behavior. Aim: The goal of this study was to find out the ten year incidence, histological spectrum and demographic features of lipomatous tumors in a tertiary care centre in Kerala. Materials and Methods: This is a retrospective study conducted in Department of Pathology, Sree Narayana Institute of Medical Sciences, Eranakulam. We collected the information regarding all resected cases of lipomatous tumors in last 10 years (April 2009 to March 2019) from departmental records and also from MRD. Tissues were received in 10% formalin, processed and stained with hematoxylin and eosin staining. Results: It is seen that out of 418 lipomatous tumors reported in our department in last ten years, commonest one being mature lipoma followed by angiolipoma. Most of the tumors were benign with one well differentiated liposarcoma and four cases of high grade liposarcoma. Tumors seen more in males (67%). The common sites affected are head and neck, trunk, extremities, shoulder etc. Malignant tumors were seen mainly in elderly population and occur in deeper soft tissues. Conclusions: Detailed histopathological examination combined with novel diagnostic techniques like molecular studies can be more helpful in reaching correct diagnosis and further studies are recommended in this area.

Keywords: Soft tissue, Lipoma; Sarcoma

Introduction: The present Study was planned to determine the role of histopathological examination of all surgically resected appendix to rule out various incidental (neuroedocrine tumor, parasitic infection )and common findings like acute appendicitis, which were difficult to diagnose by any other modality of diagnosis. Material and Methods: Present study was done retrospectively in Pacific Institute of Medical Sciences, Udaipur from January 2018 to December 2018. 144 patients were diagnosed acute appendicitis or recurrent acute appendicitis, who underwent appendectomy, either laparoscopic or open, were included. These patients were reviewed with Gross, patients’ age, sex, and histopathological reports. Results: A total of 144 specimens were analyzed 80 (55.56%) were males and 64 (44.44%) were females. M:F ratio 1.25:1. Histopathological examination showed healing appendicitis was the most common finding (44.46%) followed by acute appendicitis (35.42%), Recurrent appendicitis 6 (4.17%), Acute appendicitis with periappendicitis 5 (3.47%), Acute suppurative appendicitis 12 (8.33%), Enterobius vermicularis (Parasitic) 1 (0.69%), Tubercular pathology 1 (0.69%), Gangrenous appendicitis 2 (1.39%), Appendicular endometrosis 1(0.69%). Conclusion: There is a higher incidence of appendicitis between 31 to 40 years. The necessity for histopathological evaluation is increase due to wide range of diagnosis and its mimics to various pelvic pathology clinically.

Keywords: Appendicitis; Histopathological examination; Incidental findings; Pelvic pathology.

Introduction: Effusion of serous cavities is commonly encountered in clinical practice. If we know the primary site, it is possible to avoid the unnecessary exploratory surgery. Diagnostic paracentesis should be a part of the routine evaluation of the patient with effusion. In many cases, a definitive diagnosis cannot be reached based on morphology alone; thus, the diagnostic yield and its accuracy in effusion cytology can be enhanced though the utilization of ancillary techniques. Many previous studies have shown the role of immunocytochemical (ICC) in diagnosis in malignant cells. Material and Method: 55 cases of serous effusions were included in this study. Routine examination of specimen was done after proper patient identifications. For Immunocytochemistry Polymeric technique was performed on cell smear preparation, prepared earlier. Results: in the present study cytological evaluation along with immunocytochemical analysis of 55 cases, presenting with serous effusion was done. The patients were of the age range from 19 to 77 years. We studied 55 effusion fluids in which 23 (41.81%) effusions were found to be of inflammatory etiology because of predominance of inflammatory cells and reactive mesothelial cells in them, followed by 21 (38.18%) fluids showing malignant metastatic deposits. All prepared smears were then subjected for immunocytochemical staining utilizing antibody for CEA, and cytokeratin. Positive immunostaining for CEA was obtained in 11 out of 21 cytological malignant effusions. All the epithelial origin tumors including squamous cell carcinoma and mesothelioma are positive for cytokeratin. Adenocarcinoma are negative for cytokeratin Unequivocal cytoplasmic staining observed in >20–30% tumor cells was considered positive. Positive immunostaining for cytokeratin was obtained in three cases out of 21 cytologically malignant effusions. Cytokeratin was consistently absent in all the cytologically benign effusions. Discussion: ICC is an established important adjunct diagnostic tool for differentiate among various tumors. This study was designed to study the immunocytochemical reactivity patterns of various antibodies with cells of malignant and benign effusions and to evaluate their potential role in routine diagnostic cytology. Conclusions: CEA was found to be 64.28% sensitive in cytologically positive cases of adenocarcinoma similarly Cytokeratin has 75% sensitivity as a tumor marker in cytologically positive cases of squamous cell carcinoma.

Keywords: Immunocytochemistry; Effusion; CEA; Cytokeratin; Malignancy; Adenocarcinoma; Squamous cell carcinoma.

Introduction: Synovium is the primary site of inflammation and is affected in variety of joint diseases. Examination of synovial tissue can assist in diagnosis of some joint diseases, and in several atypical and rare synovial disorders. This study aims to describe the histomorphological changes in synovium and to evaluate the clinical presentation and radiological findings in various joint diseases.Aim of the study:To describe the clinical presentations, radiological findings and histomorphological changes in various synovial lesions. Materials and Methods: This was a prospective, descriptive type of study done over a period of two years. All synovial biopsy specimens sent from department of Orthopaedics in the study period were subjected to routine histopathological processing. The clinical and radiological details were collected. The radiological and histopathology findings were compared and the morphological features in various synovial/joint diseases were studied. Results: A total of 120 synovial tissue specimens were studied. The age group in this study ranged from 3 years to 77 years. The male to female ratio was 1.4:1. The most common joint involved was knee joint (74 cases, 61.7%). Common clinical features were of pain and swelling of the affected joint. Majority of cases had no significant radiological abnormality (72.5%). Others showed nonspecific findings (10.8%), degenerative changes (10%), and loose bodies (6.7%). The most common morphological change was synovial hyperplasia. (92 cases, 76.7%). The most common inflammatory infiltrate was lymphocytes (45 cases, 37.5%). The most common lesion found in synovial biopsy was non-specific synovitis (33 cases). Conclusion: Synovial pathology is common in 41–50 years males and presents often with pain and swelling. The most commonly involved sites are large joints like knee and hip and majority of cases do not show significant radiological abnormality. The most common synovial lesion in our study was non-specific synovitis. Inflammatory lesions have various etiologies. Degenerative changes show varied morphology. Tumor and tumor-like conditions can also be encountered.

Keywords: Synovial biopsy; Joint disease morphology; Synovitis; Rheumatoid arthritis.