Indian Journal of Pathology: Research and Practice

Introduction: Autopsy plays a crucial role in arriving at the cause of death. At the same time it also unravels a
multitude of findings which would not have clinically manifested. This study throws light on many such findings
which would have otherwise gone unnoticed.

Aim: This study aims at determining the spectrum of histopathological findings including inflammatory, non
neoplastic and neoplastic lesions which were found incidentally and were unrelated to the cause of death with
special emphasis on interesting lesions.

Materials and Method: A retrospective study of medicolegal autopsies for three years i.e., from January 2017 to
December 2019, was undertaken in a tertiary care centre to determine the spectrum of histopathological findings
unrelated to the cause of death.

Statistical Analysis: Individual lesions were expressed in numbers and incidence in percentage along with the
cause of death.

Results: The study consisted of a series of 288 autopsy cases out of which 116 cases had some incidental finding
unrelated to the cause of death. Atherosclerosis was the most common incidental finding (67 cases, 57.75%) followed
by fatty liver (41 cases, 35.34%).Neoplastic lesions accounted for 6.9% of all cases.

Conclusion: This study has elucidated common incidental findings on autopsy reflecting their prevalence in
general population along with afew neoplastic lesions that were discovered incidentally like psammomatous
meningioma, leiomyoma of kidney and serous cystadenofibroma of ovary.

Keywords: Medicolegal autopsies; Incidental finding; Atherosclerosis; Fatty liver
 

Cytsic lesions around joints are commonly encountered in clinical practice. Olecranon bursitis is one such
common condition where the bursal cavity, superficial to the olecranon, becomes inflamed with or without
superadded infection depending on the aetiology.Along with X ray and ultrasound, fine needle aspiration cytology
is a commonly asked procedure for this entity which also provides pain relief by reducing pressure on the bursa.
The thorough history taking supplemented by correlation of various findings in all these investigations can help
add rational to decision-making processes aiding targeted treatment and better patient care. We present a case of
olecranon bursitis to highlight the importance of history taking and to make the reporting cytologist aware of the
minor variations that can be seen on the aspirate smears.
Keywords: Olecranon bursitis; FNAC; Cytology
 

Context: Thalassemia is one of the most common hereditary disorders in Asia and most parts of the world and has drawn the attention of scientific research by many.It is accompanied with metabolic dysregulation, iron overload, chronic hypoxia and cell damage. All physiological changes result in ineffective erythropoiesis, hemolysis and
anemia. Most patients are dependent on either blood transfusion or bone marrow transplantation for survival. Regular transfusion has improved the span and quality of their lives but has been known to cause alterations in the hematological and biochemical parameters.

Aims: The present study was conducted to assess the changes in hematological and biochemical parameters in thalassemia patients for timely correction of any deranged parameters, to prevent any severe complications and to improve quality of life.

Methods and Material: The study was done on 35 thalassemia patients who were admitted for treatment and blood transfusions. Thirty-five healthy individual controls were matched by sex and age. Total iron binding capacity (TIBC), Serum Iron, Serum Calcium, Serum creatinine, Serum phosphorus (P), Serum Alkaline phosphatase (ALP) and Serum Ferritin were estimated. Hemoglobin (Hb), Hematocrit (HCT), Mean corpuscular volume (MCV), Mean corpuscular haemoglobin (MCH), Mean corpuscular haemoglobin concentration (MCHC), Platelet count, Red Cell Distribution Width-Standard Deviation and Coefficient of Variation (RDW-SD, RDW-CV) were measured. Statistical Analysis Used: Statistical analysis was performed using statistical package for the social sciences (Version 17). Results were compared using independent t-test and Mann Whitney U test.

Results: Hb, HCT, MCHC, TIBC, Serum Creatinine and Serum Phosphorous were significantly decreased (p<0.005) in thalassemia patients when compared with control group. RDW(SD), RDW(CV), Serum Iron and Serum Ferritin showed a statistically significant increase (p<0.005) in the thalassemia patients. MCV, MCH, Platelet count,
Serum Calcium and Serum ALP showed no significant difference.

Conclusion: Repeated blood transfusions in thalassemia cause derangement of many hematological and biochemical parameters. Regular monitoring of these parameters is important for better management of patients.

Keywords: Thalassemia; Blood transfusion; Hematological; Biochemical Parameters.

Key Messages: Regular blood transfusion in thalassemia patients causes derangement in their hematological and
biochemical parameters. It is important to monitor these parameters in all thalassemia patients undergoing repeated
blood transfusions. Regular assessment will help in providing timely correction of any deranged parameters,
prevent severe complications and improve the quality of life in these patients.
 

Introduction: Ascites is the pathologic accumulation of fluid within the peritoneal cavity. Accumulation of fluid in the peritoneal cavity resulting in ascites has many different mechanisms.The proper evaluation of ascitic fluidhelps in narrowing the diagnostic dilemma faced by the physicians and helps in better management of the patients.

Objectives: The present study aims to assess the value of ascitic fluid cytology in the differential diagnosis ofascites along with various biochemical parameters and its usefulness in the patient management.

Material and Methods: This prospective study was conducted in the Department of Pathology, at SNMC Bagalkot
over a period of 6 months from November 2019 to april 2020. This study included 120 patients who presentedwith ascites.Detailed examination – physical, cytological, biochemical and microbiological (wherever indicated)was done.

Results: Most common cause of ascitis was cirrhosis followed by tuberculosis,Malignant ascitis was noted in 8.3%
cases. Ascitic fluid cytology was useful not only in the diagnosis but also to assess the response to treatment in thesecases. The total protein content of ascitic fluid was significantly lower in cirrhotic cases as compared to tubercular,acute infective cases and malignant cases.

Conclusion: The exudative ascites is seen with tubercular acute infective and malignant ascites, with proteincontent >3.0 gm/dl and lower glucose levels while the transudative ascites as seen commonly with cirrhotic asciteshas protein content <3.0 gm/dl and a higher glucose levels.The careful cytomorphological examination of ascitic fluid is a valuable, simple, rapid, inexpensive and reliable
technique in the differential diagnosis of ascites.

Keywords: Ascitic fluid cytology; Transudate; Exudate; Cirrhosis.
 

Aims: To analyze clinical parameters, histomorphological features of Nasopharyngeal angiofibroma.Materials and Methods: The present study is a retrospective and prospective study conducted for 6 ½ yrs. durationin a total of 7222 head and neck cases operated, out of which 78 cases were diagnosed as juvenile nasopharyngeal
angiofibroma. All patients were evaluated with routine lab investigations and all clinical features noted. Thepatients were investigated with x-ray and CT head and neck.

Results: Incidence of juvenile nasopharyngeal angiofibroma was 1.08% of head and neck tumours. In all the cases were male incidence was high in second decade.The tumour tissue was lined by pseudostratified epithelium in 52 cases (66.66%) followed by squamous (metaplastic) in 14 cases (17.94%). Remaining 12 cases showed ulceration and
granulation tissue.The calibre of vascular channels was studied in detail showed 36 cases (48.71%) with small thin nonmacular followed by 29 cases which showed large thin nonmuscular vessels. Stroma was composed of plump cells, edematous and fibrous components. Out of 78 cases, 45 cases (57.69%) were composed of mixed pattern with
any of the two or all three components. Secondary changes like thrombus, hemorrhage and necrosis were observed in 17 cases.25 sections rich in stromal cells were selected and subjected to immunohistochemistry-C-kit. Out of 25 cases 23(92%) showed high to moderate immunoexpression and 2 cases (8%) showed weak positivity. C-kit expression was seen in all cases of nasopharyngeal angiofibroma with 92% of high expression.

Conclusions: Study showed new hope and promise of application of C-kit expression in nasopharyngeal angiofibromas to evaluate the response to imatinib therapy.

Keywords: Nasopharngeal; Angiofibroma and C-Kit.
 

Background: Skin adnexal tumors are a group of skin tumors which differentiate towards hair follicles, sebaceousglands, eccrine and apocrine sweat glands. These tumors are uncommon in routine practice and usually cause diagnostic problems. The aim of this study was to determine the incidence of skin adnexal tumors, its correlation
with age group and sex and to study detail histopathological characteristics of each tumor by light microscopy.

Material and Method: A prospective and retrospective study was conducted on 50 cases for four years period (2009to 2013) in department of pathology, ASCOMS, Jammu.

Result: Among the all types of skin appendageal tumors diagnosed 94% were benign and 6% were malignanttumors. Maximum benign tumor cases were seen in age group of 26-50 years and maximum malignant caseswere seen in age group 51-75 years. Tumors were observed most frequently on the scalp in both the sexes. As per
histopathological types of the benign skin appendageal tumors, benign follicular tumor was seen in 23 cases (46%),benign eccrine tumor in 20 cases (40%), benign apocrine in 3 cases (6%) and benign sebaceous tumor in one case(2%).As per histopathological types of malignant tumors, 2 cases of eccrine porocarcinoma and a case of sebaceous
carcinoma were seen.

Conclusion: The incidence of appendageal skin tumors is relatively uncommon. Histopatholgical study of
clinically suspected cases of skin appendageal tumor is a need of an hour.

Keywords: Skin appendageal; Benign tumors; Malignant tumors; Histopathological findings.
 

Background and Aim: Hypertensive disorders of pregnancy commonly known as Pregnancy Induced Hypertension (PIH), affects about 10% of all pregnant women around the world. A variety of haematological abnormalities may occur in women with PIH, thrombocytopenia being the most common. There is also a definite exaggeration of the
hypercoagulable state during PIH due to increase in coagulation factors like fibrinogen. A strong relationship exists between the two most important causes of maternal mortality and morbidity worldwide: Preeclampsia and Postpartum haemorrhage. The aim of this study was to find out the changes that occur in the coagulation profile and
platelet indices in PIH as compared to that in normal pregnancy and if they can be used as a reliable indicator of the onset and severity of Disseminated Intravascular Coagulopathy (DIC) and HELLP Syndrome.Method: A total of hundred pregnant women (50 PIH and 50 control) within the age group of 18 to 35 years after 20 weeks period of
gestation were admitted in the antenatal ward of the Department of Obstetrics and Gynaecology of Index Medical College, Indore. Their complete blood picture with platelets count and coagulation profile were done to compare with normal control pregnant women. Result: Bleeding time (BT), Clotting time (CT), one stage Prothrombin time
(PT), activated partial Thromboplastin time (aPTT) and Thrombin time (TT) was significantly higher amongst cases
than in controls. Conclusion:Thus, authors came to the conclusion that platelet indices and coagulation profile canbe used as a reliable early indicator of onset and severity of DIC and HELLP Syndrome.

Keywords: Pregnancy induced hypertension; coagulation profile; Disseminated Intravascular Coagulopathy; HELLP Syndrome.
 

Benign prostatic hyperplasia (BPH) and adenocarcinoma are common diseases that account for considerablemorbidity and mortality in the aging population. Prostatic intraepithelial neoplasia (PIN) refers to the preinvasive end of the continuum of cellular proliferations within the lining of the prostatic ducts, ductules and acini, with cytological changes mimicking cancer.Prostate cancer (PCa) is the most prevalent cancer found in men above the age of fifty years. Adenocarcinoma of the prostate range from well-differentiated gland forming cancers to poorly
differentiated tumors.

Aim: To evaluate the histopathological variants of prostatic lesions in prostatectomy specimens.

Materials and Methods: A prospective study was done to evaluate the various histological lesions in prostate specimens received in our institution. Statistical Analysis Used: The data collected was entered in MS Excel spreadsheet and analysed using SPSS version 20.
Results: Out of 90 prostate specimens studied, commonest pathology encountered was benign lesions constituting 94.5% and malignant lesions were 5.5%. Out of 84 cases of benign lesions, 51 cases (64.28%) were diagnosed as nodular hyperplasia only and NH was associated with 6 cases of basal cell hyperplasia (7.14%), 5 cases of squamous metaplasias (5.95%), 2 cases of transitional metaplasia (2.38%), and 20 cases (23.80%) of prostatitis. Diagnosis of
prostatic carcinoma was made in 5 cases (5.5%).

Conclusion: Histologically, all the malignant lesions encountered were adenocarcinoma of prostate. The commonest pattern seen was acinar followed by arrangement of tumor cells in cords, sheets and cribriform pattern.
Keywords: Benign prostatic hyperplasia (BPH); Prostatic intraepithelial neoplasia (PIN); Prostatic adenocarcinoma.
 

Benign prostatic hyperplasia (BPH) and adenocarcinoma are common diseases that account for considerable morbidity and mortality in the aging population. Prostatic intraepithelial neoplasia (PIN) refers to the preinvasive end of the continuum of cellular proliferations within the lining of the prostatic ducts, ductules and acini, with cytological changes mimicking cancer.Prostate cancer (PCa) is the most prevalent cancer found in men above the age of fifty years. Adenocarcinoma of the prostate range from well-differentiated gland forming cancers to poorly
differentiated tumors.

Aim: To evaluate the histopathological variants of prostatic lesions in prostatectomy specimens.
Materials and Methods: A prospective study was done to evaluate the various histological lesions in prostate specimens received in our institution. Statistical Analysis Used: The data collected was entered in MS Excel spreadsheet and analysed using SPSS version 20.

Results: Out of 90 prostate specimens studied, commonest pathology encountered was benign lesions constituting 94.5% and malignant lesions were 5.5%. Out of 84 cases of benign lesions, 51 cases (64.28%) were diagnosed as nodular hyperplasia only and NH was associated with 6 cases of basal cell hyperplasia (7.14%), 5 cases of squamousmetaplasias (5.95%), 2 cases of transitional metaplasia (2.38%), and 20 cases (23.80%) of prostatitis. Diagnosis of
prostatic carcinoma was made in 5 cases (5.5%).

Conclusion: Histologically, all the malignant lesions encountered were adenocarcinoma of prostate. The commonest pattern seen was acinar followed by arrangement of tumor cells in cords, sheets and cribriform pattern.

Keywords: Benign prostatic hyperplasia (BPH); Prostatic intraepithelial neoplasia (PIN); Prostatic adenocarcinoma
 

Background and Objective: Endometrial carcinoma is the most common gynaecologic malignancy in perimenopausal, and menopausal women. It is often preceded by endometrial hyperplasia. Estrogen appears to be involved in the development of endometrial carcinoma. Other mechanisms of endometrial carcinogenesis include mutations in
p53, PTEN, and proliferation markers like Ki-67. However, the pattern of Ki-67 expression is not well established in hyperplastic and neoplastic endometrium. Thus, objective of our study was to determine the immunohistochemical expression of Ki-67 in hyperplastic endometrium and endometrial carcinoma.

Methods: Immunohistochemical analysis of Ki-67 was done in 60 fixed, paraffin-embedded endometrial biopsy specimens and uterine resections obtained from patients. Specimens included simple hyperplasia, complex hyperplastic lesions, and endometrial adenocarcinoma.

Results: Ki-67 expression showed strong positivity in complex hyperplasia with atypia when compared to simple
hyperplasia, and complex hyperplasia without atypia. Though high grade endometrial carcinomas expressed more Ki-67 positivity, but there was no statistical significance found between expression of Ki-67 and tumour grading. Strong positivity was seen in advanced tumours with positive correlation between expression of Ki-67 and tumour stage.

Conclusion: Theexpression of Ki-67 may be used as diagnostic and prognostic marker in cases of endometrial carcinoma. Further studies with larger samples are needed to validate these findings.

Keywords: Endometrial Carcinoma; Immunohistochemistry; Ki-67.

Key Messages: Ki-67 expression was positive in 74.3% cases of endometrial hyperplasia. Statistical association  was observed between Ki-67 expression and simple hyperplasia, and between Ki-67 expression and complex hyperplasia with atypia. Ki-67 expression was positive in 80% cases of endometrial carcinoma. Statistical association was noted between tumor staging and Ki-67 exp
 

Background: Haematology analyser that determine Platelet indices, such as Mean Platelet Volume (MPV), Platelet Distribution Width (PDW), Platelet-crit (PCT) and Platelet large cell ratio (P-LCR) may provide some valuable information regarding the underlying mechanism and pathogenesis of thrombocytopenia.

Methods: Prospective observational study of 200 thrombocytopenic samples, hemogram analysis done byautomated haematology analyser and Statistical analysis was done.

Results: Among the 200 cases of thrombocytopenia,66 cases were classified intohypo productive and 134 cases into hyper-destructive thrombocytopenia. Most common cause of hypo-productive and hyper-destructive was Megaloblastic anaemia(52%) and Dengue(42%) respectively. Both MPV and PDW were increased in hyperdestructive thrombocytopenia compared to hypo productive thrombocytopenia.
Conclusion: Increased MPV and PDW may provide a reliable positive diagnosis of Immune Thrombocytopenic Purpura in case of thrombocytopenic patients.

Keywords: Thrombocytopenia; Immune thrombocytopenia; Platelet indices; Mean platelet volume; Platelet
distribution width.
 

Granulomas are organized aggregates of macrophages and other immune cells often with characteristic morphological changes. Granulomas evolved as protective responses to destroy or sequester particles but are frequently pathological in the context of foreign bodies, infections, and inflammatory diseases. Cutaneous diseases occur in 60% to 70% of cases of granulomatous lesions. Present study aimed to study the morphology of cutaneous granulomatous lesions. Total 170 patients with clinical suspicion of granulomatous skin lesions were subjected for punch biopsy from skin lesion. Histopathological examination was done to study the morphology of lesion.
We found 148 cases of Leprosy, 11 cases of tuberculous of skin, 03 cases of actinomycosis and 8 cases were non infectious granulomatous lesions. Age group of the study population varies from 9 year to 69 years and had mean age 35.57 year. 106 were male and 64 were female. Upper limb (41%) followed by lower limb (19%) was the most
common site of biopsy. Clinically, hypopigmented patch (34%) followed by plaque (27%) was the most common presentation. Of the leprosy cases, borderline tuberculoid leprosy (BT- 45%) followed by tuberculoid leprosy (TT –14%) was the predominant lesion. Lupus vulgaris (56%) was the predominant tuberculous skin lesion.

Keywords: Actinomycosis; Biopsy; Borderline Tuberculoid; Granuloma; Leprosy; Lupus Vulgaris; Skin;Tuberculosis; Tuberculoid Leprosy.