Indian Journal of Pathology: Research and Practice

Introduction: Diabetes mellitus is a quickly rising public health problem due to the seriousness of its complications. It also causes potential harm to the kidneys of diabetic patients and hence preventive and therapeutic measures should be taken against the various types of lithiasis. Materials and methods: The survey included 100 type 2 diabetics over a period of 6 months. First morning urine samples were examined with a light microscope for qualitative and quantitative analysis of crystalluria. Results: The calcium oxalates were higher in both the genders compared to the other crystalline species, with a frequency of 63% at direct examination. Conclusion: The crystalluria observed in type 2 diabetics showed the predominant prevalence of the calcium oxalate type crystals with a frequency of 63.0%, followed by uric acid with a frequency of 29.0%.

Keywords: Crystalluria; Lithiasis; Diabetes mellitus.

Introduction: Cervical lesions are potential causes of morbidity and mortality in women and biopsy being a routine procedure in the early diagnosis. Our study aims to determine the frequency and histomorphological patterns of various non-neoplastic and neoplastic cervical lesions. Materials and Methods: This study consists of a total of 250 cases of cervical biopsies submitted for histopathology over a period of one year. Clinical details of all the patients were obtained. Results: Among 250 cases included, majority 212 (84.2%) were non neoplastic lesions and 38 (15.2%) were neoplastic, out of which 11 (4.4%) were LSIL, 9 (3.6%) HSIL, 17 (6.8%) carcinomas and one was a case of cervical leiomyoma. Maximum females (50%) subjected to biopsy belonged to the age group of 31–50 years. The mean age for neoplastic lesions was 45 years. Chief complaint in most cases 130 (52%) was white discharge.Conclusion: Biopsy is a valuable procedure which aids in early diagnosis and plan the treatment.

Keywords: Cervical biopsies; Histopathology; Carcinomas.

Background: Human parvovirus B19 virus is one of the recently found agent in transfusion transmitted diseases. Multitransfused patients are at increased risk of parvovirus B19 infection because virus easily escapes inactivation methods and donor units are not routinely screened for B19. There are only few studies suggesting this globally and in Asia. Hence, the aim of this study is to find the prevalence of B19 infection among multi-transfused patients. Materials and methods: One hundred and seventy-three multitransfused patients of different age, gender and diseases with history of multiple transfusion were considered. Assessment of parvovirus B19 specific IgM antibodies in the serum were done by Enzyme-linked immunosorbent assay (ELISA) using B19 VPI and VP2 recombinant and purified antigens. Results: 52 (30%) out of 173 multitransfused patients tested positive for anti-B19 IgM antibodies. Age of the multitransfused patient are from 08 months to 80 years and B19 infection arehighest in less than one to ten year age group with highest prevalence among thalassemia patients (23%). 1/1 HIV positive and 20/50 anti-HCV positive multitransfused patients are found in co-infection with Anti-B19 IgM. Conclusions: Anti-B19 IgM seropositivity is detected in high rates among multitransfused patients. Several measures must be implemented to prevent iatrogenic and nosocomial transmissions including blood donor screening, especially blood given to hematological disorders patients. Data from this study also support the B19 vaccine introduction that primarily protect multitransfused patients against that infection.

Keywords: B19; Blood transfusion; Parvovirus; Multitransfused.

Background: Lymphadenitis is one of the most common extrapulmonary manifestations of tuberculosis. Fine Needle Aspiration Cytology (FNAC) of tuberculous lymph node when combined with Ziehl–Neelsen (ZN) staining for acid-fast bacilli (AFB) has a paramount value in the diagnosis of tuberculosis. Objectives: To describe the cytomorphological patterns of tuberculous lymphadenitis and their correlation with AFB positivity and to describe spectrum of morphological features seen on cytological smears of tuberculous lymphadenitis. Materials and methods: A total of 100 cases of tuberculous lymphadenitis in a tertiary hospital were studied from 2016 to 2017. Fine Needle Aspiration was performed on enlarged lymph nodes and slides were looked for various cytomorphological patterns such as pattern A— epithelioid granulomas without necrosis, pattern B— epithelioid granulomas with necrosis and pattern C— caseaous necrosis without granulomas. Ziehl–Neelsen staining was done for AFB. Cytomorphological patterns of tuberculous lymphadenitis were correlated with AFB positivity. Fisher's exact test was applied to analyze the significance of correlation between cytomorphological patterns and AFB positivity. The p value of <0.05 was considered as significant. Results: The most common cytomorphological pattern observed was Pattern B, i.e. epithelioid granuloma with necrosis. AFB positivity was seen in 18% cases and maximum was observed in pattern C smears which was statistically significant (p = 0.0422). Conclusion: Fine needle aspiration cytology of tubercular lymph node when combined with ZN staining for AFB is one of the useful and economical investigations to understand the different cytomorphological patterns and in the diagnosis of tuberculosis.

Keywords: Tuberculous lymphadenitis; Ziehl–Neelsen stain; Acid-fast bacilli; Epithelioid granuloma; FNAC lymph node; Extrapulmonary tuberculosis.

Introduction: Blood Donation is a major concern in the society as the safe human blood saves many lives at various medical and surgical illnesses. The concept of safe blood is currently stressed since deadly complications of transfusion transmitted infections are commonly encountered in paid and replacement donors. According to WHO, source of safe blood is procured from voluntary non remunerated blood donors. Hence healthy, active and receptive huge student population can be potential blood donors. Paramedical students by virtue of their technical exposure and clinicial knowledge in medical field constitute a right group to donate, educate and motivate others for voluntary blood donation. Aims and objectives: 1. To assess the knowledge, attitude and practice of blood donation. 2. To understand the role of educational intervention regarding voluntary blood donation among paramedical students. Materials and methods: A descriptive analytical study is conducted in the department of pathology of a government medical college. Fifty paramedical students were randomly selected for the study. All the students were asked to fill the prepared simple questionnaire regarding VBD. After this a powerpoint presentation is delivered to the students regarding the knowledge, attitude, practice and awareness of VBD. Results obtained after pre- and post-test are tabulated, analyzed using appropriate statistical methods and discussed.

Keywords: Voluntary blood donation; Safe blood; Awareness.

Context: In India tumors of Central Nervous System account for 1.9% of all tumors. Brain tumors are heterogenous group of neoplasms, affecting different age groups. The age distribution of CNS is said to be bimodal, one peak in children, the second peak in 45–70 years of age. Aims: Histopathological study and distribution of brain tumors in southern Rajasthan. Settings and Design: Cross sectional study. Methods and material: A total of 54 cases were retrieved from the records of histopathology section of pathology department at Pacific Medical College and Hospital for a period of 2 years from 2016 to 2017. Data regarding age, sex, histological diagnosis and site of brain tumor was collected and analyzed. Results: In our study peak incidence of brain tumors is found in 41–50 years age group. Male to female ratio was 1:1 except for meningioma where female predominance was noted. Frontal lobe was the most common site of brain tumors noted in our study. Astrocytoma is the most common histological diagnosis analyzed in our study. Conclusions: The present study highlights the histological diversity in CNS tumors. Further we need a multicentric study to have substantial data for use in future.

Keywords: Central nervous system; Meningioma; Astrocytoma; Neoplasms.

Context: Tumors of the uterine corpus represent the second most common site for malignancy among the female genital system. These neoplasms are classified into epithelial, mesenchymal, mixed epithelial and mesenchymal, lymphoid, myeloid and secondary tumors. Aims: 1. To study the spectrum of lesions of the uterine corpus. 2. To study the incidence of benign and malignant tumors of uterine corpus. 3. To study the age preference among various types of benign and malignant tumors of the uterine corpus. Materials and methods: A prospective study was done in the Department of Pathology, NRI Medical College from June 2018 to July 2019. All the specimens received were fixed in 10% formalin and routinely processed. Sections were made from paraffin-embedded blocks and stained with hemotoxylin and eosin. Statistical analysis used: Percentages. Results: In 439 hysterectomy cases, 190 cases had uterine corpus neoplasms, of which 155 (81.57%) were benign neoplasms, and 35 (18.42%) were malignant. In the benign neoplasms, 153 were leiomyomata, and two were adenomyomata with commonest age group at presentation being 4th decade. In the malignant neoplasms, the most common tumor was welldifferentiated endometrioid carcinoma with 5th decade being the commonest age group of presentation. Four cases of malignancy within an endometrial polyp were noted along with some rare malignancies like clear cell carcinoma (2.85%), serous carcinoma (5.71%), leiomyosarcoma (5.71%), high-grade endometrial stromal sarcoma (2.85%), carcinosarcoma (5.71%) and adenosarcoma (2.85%). Conclusions: In our study, benign pathologies were more common than their malignant counterparts in the uterine corpus. In benign neoplasmsleiomyoma was the most common and in malignant neoplasms well-differentiated endometrioid carcinoma predominated.

Keywords: Hysterectomy; Uterine corpus; Leiomyomata; Endometrioid carcinoma.

Introduction: A better understanding of molecular mechanisms of oral squamous cell carcinoma (OSCC) and identification of potential oncogenes may provide new therapeutic decisions such as targeted therapy. Most of the studies suggest that OSCCs expressing Epidermal growth factor receptor (EGFR) display pathological features of more aggressive tumors and its overexpression is associated with poor prognosis.1 Studies have also shown that the overexpression of HER2/neu increased metastatic potential and that cell proliferation, as measured by the Ki67 labelling index at the invasive tumor front is directly related to the histological grade in OSCC.2,3 Objectives: To study the expression of EGFR and HER2/neu in oral mucosal dysplasia and SCC, to evaluate their correlation, to compare their expression in different histological grades of the tumor, to evaluate the relationship between their expression and tumor proliferation index demonstrated by Ki67 labelling with an aim of emphasizing the role of these biomarkers in oral carcinogenesis as well as their role as potential therapeutic target. Materials and methods: This study was conducted on 68 patients having oral dysplasia or SCC. Immunohistochemistry was done for EGFR, HER2/neu and Ki67 and their expression was evaluated under the microscope. Results: EGFR overexpression is associated with higher grades and poorly differentiated tumors. Expression of EGFR is also more in superficial layer in higher grades of dysplasia. There is statistically significant difference in EGFR expression between cases of dysplasia and OSCC. However no such correlation was found with respect to HER2 expression. Conclusions: We conclude that EGFR overexpression is associated with higher grades and higher intrinsic proliferative activity. Hence EGFR can serve as a good prognostic indicator and a target for anticancer therapy. However no similar role of HER2 could be proved.

Keywords: EGFR; HER2/neu; Ki67; Oral dysplastic epithelium; Oral squamous cell carcinoma.

Introduction: Fine needle aspiration cytology (FNAC) is a cost effective, easy procedure in the diagnosis of breast lesions. The sensitivity and specificity of the procedure are high when combined with clinical examination and imaging. Its accuracy in many situations avoids any unnecessary surgical procedures. Aims and Objectives: The present study was undertaken to know the accuracy of FNAC in Evaluation of various breast lesions and its histopathological correlation. Materials and methods: A retrospective study was conducted over duration of 8 months from January 2019 to August 2019. Needle aspiration was done in 100 cases presenting with breast lesions. Histopathology correlation was done in 33 cases. Results: Fibroadenoma was the most common lesions. Malignancy was reported in 16 cases. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy were found to be 90%, 100%, 100%, 95.83% and 96.96% respectively. Conclusion: The FNAC of breast is cheap, safe, and highly accurate method for diagnosis of breast lump preoperatively to avoid undue surgery. Our study concluded that an occasional false negative case makes it mandatory to biopsy and subject it for histopathological examination before mastectomy where the diagnosis of malignancy on cytology is suspicious.

Keywords: FNAC; Breast; Biopsy; Benign; Malignant; Fibroadenoma; Ductal carcinoma.

Background: Breast cancer is the commonest cancer among women in urban India. Triple assessment includes clinical, radiological and cytological assessment of breast lesions. Guided core needle biopsy has replaced fine needle aspiration cytology in most of the western countries. Aim of the study: The aim of the study is to analyze the concordance of histopathological and radiological findings in BIRADS categories 2, 3, 4 and 5 lesions following core biopsy. Materials and Methods: This was a prospective study done over a period of two years from June 2017 to June 2019. A total of 100 patients with breast lumps who underwent mammographic evaluation were selected for ultrasound guided trucut biopsies which were performed by a single radiologist. Only BIRADS categories 2, 3, 4 and 5 lesions were selected for trucut biopsies. The histopathological diagnosis was correlated with the BIRADS scoring. Results: Most of the women with breast lump were in the fifth decade. Out of 100 patients who underwent core needle biopsy, the positive predictive value for BIRADS 5 lesions for malignancy was 100%, the positive predictive value for BIRADS 4 lesions was 49% and the negative predictive value for BIRADS 2 and 3 lesions for malignancy was 87.5%. Conclusion: Core biopsy is a reliable method to diagnose breast lesions and has high accuracy compared to mammographic categorization using BIRADS score. The present study confirms high positive and negative predictive value for malignancy in BIRADS 5 and BIRADS 3 lesions. The positive predictive value for BIRADS 4 lesions is less due to inclusion of wide spectrum of lesions and also as the subcategorization is subjective. Objective and clear subclassification rules are needed for BIRADS 4 category.

Keywords: Breast trucut biopsy; BIRADS scoring; Histopathology and BIRADS scoring comparison.

Introduction: Rheumatoid arthritis (RA) is a systemic chronic autoimmune disease characterized by symmetric polyarthritis. It is also proved that patients with RA are more prone for premature atherosclerosis resulting in cardiovascular accidents (CVA). Alterations in lipid profile is commonly seen in these patients. We conducted this study to compare lipid profile of patients with RA with Rheumatoid factor (RF) and C-reactive protein (CRP). Materials and methods: A prospective case-control study was conducted on 50 patients with rheumatoid arthritis and 50 healthy controls. Blood samples obtained from such patients attending out-patient department were tested for RF, CRP and lipid profile including total cholesterol, high-density lipoproteins (HDL), low-density lipoprotein (LDL) and triglyceride (TGL). Results: In our study, we did not find strong positive or negative correlation between RF, CRP and lipid profile. We noted a weak positive correlation between RF and LDL and total cholesterol (TC). We also observed a weak negative correlation between RF and TGL, HDL and very low -density lipoprotein (VLDL). There was a weak positive correlation between CRP and LDL and a weak negative correlation between CRP and TC, HDL, VLDL and TGL. Conclusion: In our study we could not find any gross variation in lipid profile in patients with RA but there was a weak correlation between RF, CRP and lipid profile. This could be due to small sample size. Future studies with large sample size may help to give a satistically significant correlation.

Keywords: Rheumatoid arthritis; Lipid profile; Cardiovascular accidents; C-reactive protein.

Aim: The study evaluates the AgNOR (Argyrophilic Nucleolar Organizer Region) scores in the aspiration cytology smears of breast lesions to differentiate benign from malignant. Material and methods: A total of 100 cases who presented with palpable breast lump were subjected to FNAC (Fine Needle Aspiration Cytology). AgNOR staining was done on all the smears to differentiate benign from malignant lesions. Of the 100 cases, 72 cases were benign, 4 were borderline cases and 24 were malignant cases on FNAC. AgNOR stain was done on all the smears and the mean AgNOR count was calculated. Satistical Analysis: The collected data was analyzed by student ‘t’ test. The p values less than 0.05 were considered significant. Results: On FNAC, the distribution of AgNORs in benign lesions were small, uniform, compact, 1–4 dots, central and peripherally placed and in malignant lesions they were small, medium and large, coarse, clumped and 1–8 dots. The mean AgNOR count in FNAC smears of benign lesions was 2.67 and of malignant lesions was 5.71, thus the mean AgNOR counts in malignant lesions were higher when compared to benign lesions on FNAC. The mean AgNOR count in HPE (Histopathological Examination) sections of benign lesion was 1.42 and of malignant lesions was 3.77. The observations revealed statistically significant results between benign and malignant lesions. Thus, AgNOR technique is simple, inexpensive and useful for evaluation of proliferative activity in breast lesions and can be used as an adjunct to FNAC to differentiate benign from malignant lesions of breast.

Keywords: AgNOR; Breast lesions; Aspiration cytology.

Introduction: Colon is frequently affected by wide variety of lesions ranging from inflammatory to neoplastic processes. Colorectal cancer is the fourth ranking cancer worldwide, accounting for approximately 9% of all cancers. Adenocarcinomas are the commonest tumors in colorectal region. Aims and Objectives: 1. To study Spectrum of malignant colonic lesions in our institute and compare the  ndings with other studies. 2. To study age, gender, clinical presentation and site wise distribution of lesions. 3. To study prognostic factors in colorectal carcinomas with emphasis on Histopathological staging. Material methods: This is a 1-year and 8 months retrospective and prospective study from Jan 2018 to August 2019 done in pathology department, DVVPF’s medical college and hospital. Samples included are endoscopic biopsies and surgically resected colonic specimens received from department of General surgery. Sample size- 45. Age, gender and presenting complaints were also studied along with histomorphological analysis. Details of microscopic examination were noted for staging of lesions as per Modified Duke’s staging system. Results and discussion: Colorectal carcinoma is common with increasing age in 48.89% of cases, commonly presenting with bleeding per rectum (53.33%). Rectum was common site noted in 31.11% cases. Adenocarcinomas are common histological type of colorectal carcinoma. Conclusion: Grading and staging are important prognostic factors in colorectal carcinomas affecting the extent of surgery, follow-up treatment and to avoid the risk of tumor recurrence.

Keywords: Adenocarcinoma; Colorectal cancer; Grading; Staging.

Introduction: Thrombocytopenia is a common hematological abnormality observed in hospitalized patients. It is defined as platelet count of less than 150 × 103 per µL. There are various mechanisms like: due to deficient production of platelets, destruction of platelets-both immune or non-immune mediated or due to combination of both. Aims and objective: This study was carried out to find various etiologies of thrombocytopenia. Methods: The prospective study was carried out on 100 patients admitted at SMIMER Hospital in the month of April–June, 2019 and on the basis of their data, platelet count, age distribution, gender and etiology of thrombocytopenia have been studied. Result: Thrombocytopenia is more common in younger age group of patients that is between 21 and 30 years (34/100 patients) with the maximum patients having platelet count between 50,000 and 1,00,000 per µL (48/100 patients). It is more common amongst the male patients (65/100 patients). The most common infective etiology is Plasmodium vivax infection (52%) and non-infective etiology is Megaloblastic Anemia (27%). Conclusion: Thrombocytopenia is usually associated with various etiologies but most common amongst them is infective etiology. Hence, for proper management of the patient, the specific cause should be found out.

Keywords: Thrombocytopenia; P.vivax; Megaloblastic anemia.