Indian Journal of Pathology: Research and Practice

Fibrous Dysplasia with extensive cartilaginous component is a rare variant of Fibrous Dysplasia. The median age of presentation is 30 years. It presents as a well defined expansile, lytic lesion of long bones. Most commonly involving the proximal femur. Histopathologically, it shows lobules of mature appearing cartilage within proliferating fibro-osseous component. Differentiating of FD with extensive cartilaginous component from other benign and malignant cartilaginous tumours is of utmost importance. We are presenting this case here for its rare presentation in the proximal humerus of an elderly patient.

Keywords: Fibrous Dysplasia; Fibrous Dysplasia with extensive cartilaginous component.

Background: The presence of epithelial layer along with myoepithelial layer is the basis of benignity for any breast lesion. This study sought to determine if the Value of cytokeratin 5/6 in benign and malignant breast lesions is diagnostic. Cytokeratins are intermediate filaments present in all epithelial cells so it’s positivity in myoepithelial cells differentiate benign lesions from malignant lesions. Material and Methods: Hospital based observational study, carried out on biopsy samples received. Tissue were fixed in formal saline, paraffine blocks were prepared and stained with Haematoxylin and Eosin (H&E). Immunohistochemical (IHC) staining for cytokeratin 5/6 was applied on paraffin embedded sections of 40 samples using avidine biotin peroxidase technique with mouse antihuman polyclonal D5/16B4 antibody and visualized with DAB. The pattern and intensity of staining of tumor cells was observed and graded. Findings: 40 cases of breast lesions were taken, out of which 26 were benign and 14 were malignant. All 26(65%) cases of benign lesions comprising of fibroadenoma and fibrocystic disease were strongly positive. Out of 14(35%) cases 13 cases of IDC(NOS) and 1 case of medullary carcinoma breast 07 (53.8%)cases of IDC(NOS) were CK 5/6 positive with variable staining index. Benign lesions were strongly positive as compare to malignant lesions. Conclusion: Benign lesions are strongly positive for CK5/6 but if malignant lesions are positive for CK5/6, it indicates poor outcome due to basal molecular subtype and have an aggressive behavior.

Keywords: Breast lesions; Cytokeratin 5/6; Immunohistochemical staining; Observational study; Fibroadenoma, fibrocystic disease.

Background: Septicaemia is one of the leading causes of mortality and morbidity in the neonates, especially in the developing countries like India. Objective: To evaluate the usefulness of hematological parameters using hematological scoring system and CRP in the early diagnosis of neonatal sepsis and to study relationship between the hematological variables and bacteriological profile. Methods and Materials: Documenting the data in the Performa, 106 cases were undergone for the measurement of haematological parameters according to haematological scoring system and followed by correlation with culture profile. Results: The HSS score performance was analysed and that INC followed by I: M atio showed highest sensitivity. Platelet count had highest negative predicative value. Culture profile showed 30.6% of positive results. Conclusion: The study of hematological parameters using hematological scoring system with blood culture in the early screening and diagnosis of neonatal sepsis aids in timely treatment, decreasing the neonatal morbidity and mortality.

Keywords: Haemotological parameters; Preterm; Blood culture.

Background: Human Blood is considered as “liquid of life” as it is not replaced by any artificially prepared medicine, though there are tremendous advances in medical sciences. On the other hand advances in medicine have increased the requirement of blood and its products. Globally there is huge disparity between demand and supply. India being the 2nd most populous country in the world is not different with global statistics and has a huge blood requirement, but ironically voluntary blood donation is meager. Many studies done outside India have shown that understanding Knowledge, Attitude and Practice (KAP) about blood donation have helped the governments and health care policy makers to fulfill the pitfalls, thereby increasing the number of voluntary blood donations. In a country like India, where myths, misconceptions, taboos and superstitions pose a barrier to deliver healthcare specially hospitals which cater rural population KAP studies will help to understand and device a system which would encourage voluntary blood donors. Objective: To study Knowledge, Attitude and Practice (KAP) about blood donation, in people attending rural district secondary care hospital. Materials and Methods: A cross sectional descriptive study among outpatients and inpatients attending rural district hospital using self developed questionnaire preferably multiple choice questions (MCQ’S) pattern, with paper and pencil technique. SPSS software and MS excel sheet were used to analyze the data. Results: Analysis of data revealed most of the blood donors were middle aged men compared to their counterpart women. High score knowledge about blood donation was noted among graduates and post graduates with comparable results among voluntary blood donor for more than five times. Middle class people had more number of donors compared to higher class and lower class. Attitude to donate a friend or a relative was common compared to anonymous donation (Altruism)104(28.88%). 231(64.16%)of people knew where blood bank in their locality located.68(18.88%)felt happy and satisfied about blood donation. Only 86(23.88%) donors were encouraged by their family. Conclusion: Knowledge, Attitude and Practice (KAP) about blood donation is affected by regional culture, religion and socioeconomic factors. By accessing KAP of the community shortcomings can be met which could change the KAP in a direction to improve voluntary donations. In continuation to this thought of donating blood can be brought in to practice by using social, mass or print media.

Keywords: Attitude; Blood donation; Knowledge; Practice; Voluntary.

Introduction: Ovarian lesions can manifest from childhood to postmenopausal women. It is one of the most common site for neoplastic and non neoplastic lesions. Among cancers of female genital tract ovarian cancer ranks next only to carcinoma cervix and endometrium. Aims and Objectives: Aim of our study is to analyse and study the pattern of ovarian lesions and their clinico pathological features. Materials and Methods: Its a prospective and a retrospective study of 80 cases at a tertiary care hospital puducherry. All the relevant clinical data are collected from the hospital record files. Data was analyzed using an MS Excel worksheet and calculations of incidence made from the same. Results: Among 80 cases studies 50 were non neoplastic and 35 were neoplastic. Most common non neoplastic lesion was follicular cyst. Among 35 neoplastic lesions 28 were benign, 1 borderline and 6 malignant cases. In benign cases the most common lesion was serous cystadenomas followed by mucinous cystadenomas. Among malignant cases maximum were of serous cystadenocarcinoma. Conclusion: Ovarian lesions exhibit a wide range of histological features. The gold standard diagnosis of ovarian lesions is histopathological analysis. Clinicalpathological correlation enhances the diagnostic valve of ovarian lesions.

Keywords: Benign; Malignant; Ovary; Ovarian cyst.

Purpose: There is a need for a reliable and cost-effective technique for processing of body fluids. Understanding of the wide range of reactive changes is essential for distinguishing benign from malignant cellular changes. In this study, a comparison of conventional smear, cytospin smear and cell block technique in analyzing cytology of body fluids is made. Methods: Fresh body fluid samples received was divided into three parts. The first part was processed by routine centrifugation, second part by cytospin and third part of the fluid was used to prepare cell block by alcohol formalin method. Cytological and histological evaluation of the prepared smears will be done. Results: Eighty body cavity fluid samples were evaluated. Cytospin smears showed clear background, high cellularity, better nuclear features and even distribution of cells. Conclusion: The cytospin smears are better when compared to conventional smears and cell block in analyzing body fluids.

Keywords: Cytospin; Conventional smears; Cell block; Body fluid.

Context: Identification of her2 expression by Immunohistochemistry and correlating it with histopathological parameters in colorectal carcinoma may help know the prognosis and helps for the apt use of anti-Her2 targeted therapy. Aims: To correlate Her2 positivity with clinicopathological parameters in colorectal carcinomas. Settings and Design: Retrospective study. Methods and Material: The study was carried out in the Department of Pathology in a Tertiary Care Centre. Total 30 patients studied. Tissue blocks from colonic biopsies and colectomy specimens of histologically proven colorectal carcinomas were retrieved for immunohistochemical analysis. Clinicopathological characteristics were obtained from patients' medical records and pathology reports. Hematoxylin and Eosin stained slides of biopsies and resected specimens of histologically proven colorectal carcinomas were retrieved and reviewed for histopathological parameters. HERACLES scoring was used for HER2 expression. Data was analysed with appropriate statistical tests. Statistical analysis used: Appropriate statistical tests. Results: Mean age of the patient was 48.32± 3.4 years. 8 (26.67%) patients were HER2 positive. No significant difference was observed in HER2 positivity and grade of tumour (p>0.05). Cytoplasmic expression was most commonly observed in low grade tumour 07(43.75%) but statistically not significant; (p>0.05). Similarly Membranous expression was also commonly observed in low grade tumour. Stage of tumour did not show any association with grade, HER2 expression or HERACLES score. (p>0.05). Conclusions: Assessment of Her2/neu scoring irrespective of histopathological and clinicopathological parameters may help select the appropriate targeted therapy.

Keywords: Clinicopathological; Colorectal cancer; Her2; Immunohistochemistry.

Objective: To describe the patterns of histopathological lesions seen in hysterectomy specimens in different age groups. Methods and Materials: The study is done retrospectively from the data collected from the pathology department at a tertiary care hospital. A total of 285 cases were collected over a period of one year and their histopathological slides and clinical records were evaluated. Results: Out of 280 cases majority belonged to the 41–50 age group and the least number of cases had an age of below 30. In the uterus, among lesions of the myometrium, adenomyosis were the maximum followed closely by leiomyomas. In the cervix, cervicitis grossed the highest number of cases followed by squamous cell carcinoma of the cervix. The ovarian pathologies are diverse and were found to be equally distributed. Conclusion: This study outlines the most common lesions seen in various organs of the female reproductive tract in hysterectomy patients. Keywords: Hysterectomy; Endometrial hyperplasia; Adenomyosis; Leiomyoma; Ovarian cystic lesions; Chronic cervicitis.

Context: Platelet indices (platelet count, Mean Platelet Volume (MPV), platelet distribution width (PDW), plateletcrit) are widely used in understanding pathophysiology of vascular diseases. Pregnancy induced hypertension (PIH) is vascular disorder complicating most of the pregnancy. Aims: The aim of the study is to evaluate platelet indices in PIH and compare with maternal and fetal outcomes. Settings and Design: Prospective study. Methods and Material: Study included 40 pregnant women with gestational hypertension(GH), 40 women with Preeclampsia (PE) and 80 normotensive pregnant women (NP). Statistical Analysis Used: The data were processed on MS excel work sheet and analysis will be carried out using MedCalc Statistical Software version 12.7.8 (MedCalc Software bvba, Ostend, Belgium; http://www.medcalc.org; 2014). The intergroup analysis was carried out by ANOVA and post hoc analysis. Results: Mean MPV and PDW were significantly increased whereas platelet count and plateletcrit were significantly decreased in GH and PE groups. Severe thrombocytopenia was observed in mild PE (11%), severe PE in (27%), HELLP syndrome (75%), Eclampsia (50%). IUGR was observed in 5.8% of PE, PPH in 8.8% of PE and 50% of Eclampsia, low birth weight was observed in 25% of PE and 50% of eclampsia, 6% IUD was observed in PE. Conclusions: Platelet indices i.e. platelet count, MPV, PDW and plateletcrit are a simple, low cost, and rapid routine screening tests. We observed a significant relation between platelet indices and severity of PIH. It also showed that these could be used as markers for diagnosis, as well as for the severity of PIH.

Keywords: Platelet indices; MPV; PDW; Plateletcrit; Preeclampsia; Eclampsia.

Background: Renal cell carcinoma (RCC) is the most common form of renal malignancy. The existing prognostic factors (tumor staging and grading) are considered inadequate as many patients with similar tumor characteristics seem to show different clinical outcomes. This has increased the need for evaluating the role of many molecular biomarkers. This study was undertaken to determine the expression profile of Fascin, an actin bundling protein in RCC. Methods: This cross sectional study was carried out among 64 RCC cases received in the Department of Pathology for a period of four years. Fascin immuno histochemistry was done on the representative paraffin blocks and the slides were examined for membrane and cytoplasmic positivity. The data was statistically analysed with “SPSS Version 23” software. Results: There was a significant statistical correlation between the nuclear grade and fascin expression. However there was no correlation between tumor stage and fascin expression. We also observed a statistically significant correlation between fascin immuno staining and RCC with sarcomatoid changes (p<0.05). Conclusion: Targeted therapy for Fascin may be used as a treatment modality for high grade RCC and RCCs showing sarcomatoid changes.

Keywords: Renal cell carcinoma; Fascin; Sarcomatoid changes.

Introduction: The appendix though a vestigial organ in humans, appendectomy is one of the most commonly performed surgical procedures on emergency basis. Pathologic evaluation of these specimens may reveal unexpected findings occasionally. Aim: A retrospectively study was done to determine histological diagnosis of acute appendicitis and its complications, negative appendectomy rate and unusual histopathological findings. Materials and Methods: Histopathologicalrecords of 240 patients (Male: Female: - 152:88) who underwent appendectomy for acute appendicitis between April 2017 to March 2020 at a rural center in Puducherry. The patient’s age, sex, macroscopic and histopathological examination findings were noted. The specimens with unusual histopathological findings were re-evaluated in detail regarding patient’s demography and its clinicopathological implications. Results: Out of 240 casesthepeak age of incidence of appendicitis was between 16 to 30 years in both sexes. Histological data showed acute appendicitis in 228(95%)which includes acute phlegmonous148(65%), lymphoid hyperplasia 46(20%), gangrenous appendicitis 18(8%), perforated 9 (4%) and with unusual histopathological findings in 7 (3%). Negative appendectomy rate was 5%and it was seen in females between age group of 16 to 30 years. Conclusion: Our study shows higher number of appendicitis in young adults and negative appendectomy rate in females of reproductive age group. So we recommend all appendectomy specimens even having normal gross appearance should undergo routine histopathological examination to avoid any clinically important and treatable conditions. Keywords: Acute appendicitis; Histopathology; Appendectomy.

Background: Transfusion of blood products is a double-edged sword and should use judiciously. Improvements in donor screening and transmissible transfusion diseases testing procedures have led to a decrease in the hazards and risks. However, the dangers of non-infectious complications have become more apparent. These non-infectious complications called as adverse transfusion reactions (ATRs) can either be acute in nature or follow a delayed course. Materials and Methods: A retrospective review of all transfusion reactions reported to the Blood Bank at the tertiary care center between January 2018 and January 2019 was done and analyzed as per Departmental Standard operating procedures. Results: ATRs during or after blood transfusion reported during the one year were 22 (0.28%) out of 7824 units of blood /blood components transfused. ATRs reported were allergic Reactions 10 (45.45%), febrile non hemolytic transfusion reactions (FNHTR) 9 (40.9%), anaphylactic reactions 2 (9.09%) and Isolated hypotension 1 (4.54%). Conclusion: The majority of ATRs were Allergic reactions followed by FNHTRs.

Keywords: Adverse transfusion reactions, hemovigilance, whole blood, FNHTR, Allergic Reactions.

Introduction: Leprosy is a chronic, granulomatous infectious disease caused by Mycobacterium leprae with long incubation period and primarily affects skin and peripheral nerves. Objective of the study is to correlate clinical diagnosis of new leprosy cases with that of histopathological diagnosis. Methods: This study was carried on skin biopsies of 34 newly diagnosed leprosy patients, from June 2017 to May 2019. Routine histopathological processing was done and paraffin sections were stained with Haematoxylin and Eosin, followed by Fite Faraco stain. Release from treatment, partially treated cases and those with lepra reactions were not included in this study. Results: From this study it was observed that, the commonest age group affected by leprosy was 21 to 50 years, males are more commonly affected than female (M:F = 2.09:1) and the most common clinically diagnosed spectrum was Borderline Tuberculoid. Complete agreement between clinical diagnosis and histopathological diagnosis was observed in 64.7% cases and disagreement in 34.3% cases. Conclusion: Leprosy classified by clinical parameters considers only their gross appearance while classification based on histopathological parameters is well defined and accurate and consider the immunological manifestations as well. Thus, histopathological examination helps in making definitive diagnosis and skin biopsy remains gold standard even today.

Keywords: Leprosy; Borderline Tuberculoid; Mycobacterium Leprae; Fite Faraco.