Indian Journal of Pathology: Research and Practice

Blood safety is a challenging task in India, with a population of around 1.39 billion and with A high prevalence rate of HIV (0.30%), HBV (2-4.2%) and HCV (0.5- 1.5%) in general population. TTI’s pose a potential threat to safe blood transfusion practices, and it is more challenging task. Nucleic acid testing (NAT) in blood donor screening has been implemented in many developed countries to reduce the risk of transfusion-transmitted viral infections (TTIs). It is a very sensitive and specific test for detection of viral nucleic acids by shortening the window period, thereby offering blood centers a much higher sensitivity for detecting viral infections and reducing TT1. So NAT is highly beneficial in countries like India which has a high incidence and prevalence of transfusion transmitted infections. But NAT is restricted to a few blood banks in India since 2008 (less than 3%). NAT is expected to identify many NAT yield cases which are not detected by other serological tests. In this view as all our donors are undergoing NAT testing, so we want to project our data to show the efficiency of this test at our Sakra world hospital.

Background: COVID-19 was caused by a virus (SARS-COV-2). On January 30, 2020, the WHO designated the COVID-19 outbreak as a Public Health Emergency of International Concern, and on March 11, 2020, the organization designated the illness as a pandemic. Various medications were tried including Convalescent plasma (CP).CP trials, were initiated based on the principle of viral neutralization and passive immunotherapy. Therefore, it was hypothesized that CP obtained from the blood of recovered patients of COVID-19 may contain immunoglobulins that could neutralize SARS-CoV-2 and thereby improve the course of disease in COVID-19 infection patients. This led to established protocols at various blood centres worldwide to collect plasma from earlier COVID-19 infected patients who had made a full recovery. But little emphasis was paid to the challenges in collecting CP from donors, particularly in Punjab, India, even though numerous studies have focused on the effectiveness of CP as a treatment for COVID-19. The pandemic’s scope led to the assumption that there would be many donors. In real practice, it was difficult to find and choose COVID-19 CP donors who were willing to give and were qualified, fulfilled the inclusion criteria, and had appropriate antibody titers. The current study was undertaken to analyze the challenges and difficulties encountered in collection of plasma from COVID-19 recovered patients in a tertiary care hospital in Northwest Punjab.

Aim: To analyse the challenges and difficulties encountered in collection of convalescent plasma.

Materials and Methods: A prospective cross-sectional survey-based study was done in the COVID-19 recovered blood donors who visited for convalescent plasma (CP) donation at our tertiary care teaching hospital of Punjab. The study was conducted for a period of one year from 01 May 2020 to 30 April 2021.

Results: A total 1050 COVID-19 recovered patients were screened. Out of which 690 were rejected and only 360 patients were recruited for the study. The individuals who fulfilled the inclusion criteria were telephonically contacted and explained the details of the procedure and the benefits of the procedure. They were motivated to come for further tests and they were provided transport for the same. Once they were found to be fit, they were further requested to undergo plasma donation. Out of 360, 182 (50.56%) could not be contacted telephonically and 178(49.44% were contacted telephonically. Out of 178,84(23.33% of total recruited) refused to donate plasma on telephone only, 62(17.22%of total recruited) agreed for Plasma Donation. Rest (32,08.89%) was deferred due to various reasons. Out of 62 only 58 came to the blood Centre. But only 26 donated plasmas. Rest of the patients did not donate plasma due to fear of donation.

Out of 360, 182 (50.56%) could not be contacted telephonically and 178(49.44% were contacted telephonically. Out of 178,84(23.33% of total recruited) refused to donate plasma on telephone only, 62(17.22%of total recruited) agreed for Plasma Donation. Rest (32,08.89%) was deferred due to various reasons. Out of 62 only 58 came to the blood Centre. But only 26 donated plasmas. Rest of the patients did not donate plasma due to fear of donation. Out of 26 patients,22 were males and 4 were females, of which 24 donated plasmas for first time.

Conclusion: Blood donation is inherently an altruistic act and in normal times, donors are healthy individuals who volunteer to donate. In a global on-going pandemic, the “Fear Factor of contracting the disease” acted as a major challenge to motivate and convince a COVID recovered patient for plasma donation. But, with the help of targeted publicity and motivation on the benefits of plasma donation which can save two precious lives with a single donation, we could have increased the plasma donation drive. But the challenge was to motivate, convince, and educate the potential donors and society about the likely benefits of COVID convalescent plasma.

Advanced tissue processing has experienced a significant transformation with the use of automation and developing technology, revolutionising histopathology and diagnostic procedures. Automated tissue processors now provide improved precision, repeatability, and throughput, markedly diminishing human error and turnaround time. Innovations including microwave-assisted processing, vacuum infiltration, and real-time process monitoring have enhanced the preservation of tissue shape and molecular integrity. Simultaneously, innovative technologies such as artificial intelligence (AI), digital pathology, and 3D bio printing are transforming tissue examination and interpretation, facilitating more personalised and data-driven diagnostics. These developments facilitate enhanced standardisation and scalability, especially in high-volume clinical and research environments. Furthermore, innovative reagents and eco-friendly techniques are being formulated to reduce hazardous exposure and environmental impact. The convergence of automation and innovation in tissue processing promises enhanced operational efficiency and profound insights into tissue architecture and disease causes, facilitating the advancement of next-generation precision medicine and therapeutic methods.

Lyme disease is the leading vector-borne infection in temperate climates and presents with heterogeneous cutaneous, neurologic, cardiac, and rheumatologic manifestations that complicate diagnosis and follow-up. This narrative review integrates current evidence on Borrelia burgdorferi transmission dynamics, virulence strategies, organ-specific pathophysiology, host immune responses, and pharmacologic management. We summarize how phase-regulated outer surface proteins, complement evasion, antigenic variation and biofilm-like phenotypes enable persistent infection, while dysregulated Th1-skewed immunity, inadequate IL-10 signalling and genetic susceptibility contribute to antibiotic-refractory arthritis and post-treatment Lyme disease symptoms. Key diagnostic issues, including limitations of two-tier serology in early localized disease and the role of modified ELISA algorithms and CSF analysis in neuroborreliosis, are critically appraised. Finally, we outline evidence-based antimicrobial regimens for stagespecific disease and highlight the need for immunomodulatory strategies in refractory cases. A mechanistic understanding of pathogen–host interactions is essential to improving outcomes and long-term functional recovery in this increasingly prevalent multisystem disorder.

Safety and ethics are essential foundations in the functioning of a histopathology laboratory, where precision, secrecy, and accountability directly influence patient outcomes and diagnostic accuracy. This abstract examines the incorporation of safety protocols and ethical behaviours as fundamental elements of laboratory excellence. It underscores the necessity for comprehensive staff orientation and continuous training to guarantee compliance with biohazard safety protocols, appropriate specimen handling, and adherence to changing regulatory requirements. Equally significant is the development of a robust ethical culture that fosters integrity, respect for patient confidentiality, and accountability in all laboratory procedures. Leadership is pivotal in exemplifying ethical conduct and upholding safety standards, whereas frameworks that promote transparent reporting and ongoing enhancement are essential for risk identification and performance improvement. Ultimately, cultivating a culture grounded in safety and ethics safeguards laboratory personnel and the integrity of results while enhancing the quality of care provided to patients. This comprehensive strategy is essential for maintaining confidence, guaranteeing compliance, and promoting ongoing progress in histopathology practice.

Haemoglobin disorders occur worldwide, with particularly high prevalence in regions such as sub-Saharan Africa, the Mediterranean, the Middle East, and South Asia. One of the most common hemoglobinopathies is sickle cell disorder (HbS). In India, the prevalence of sickle cell haemoglobin ranges from 1% to 40%, with significantly higher rates observed among rural tribal communities. This singlecentre, retrospective study analysed healthcare footfall of sickle cell patients from the tribal area of Dahod.

A total of 105,492 patient records from the District Hospital were reviewed between January and June 2025. At District Hospital-Dahod, the prevalence of sickle cell-positive cases is 16.75%. Among these, 6.66% were diagnosed with sickle cell disease, and 93.34% were identified as a sickle cell trait, silent carriers of the disease. Among the records assessed, 42.42% of individuals sought health care from the obstetrics and gynaecology (OBGY) department. Of these, 98% were females of reproductive age. Within this group, 5.05% were diagnosed with sickle cell disease (SCD), while 90.43% carried the sickle cell trait.

The high predominance of sickle cell trait among antenatal females highlights a critical public health concern that may be contributing to the high maternal and infant mortality rates reported in the Dahod district.

These findings further underscore the need for routine screening protocols, genetic counselling, and the requirement for targeted awareness programs, particularly among adolescent females and young males in tribal regions. The development of more effective healthcare interventions warrants policy attention to mitigate the burden of sickle cell disorder and improve maternal and infant mortality rates in this vulnerable population.

Gall bladder is an uncommon site of extrapulmonary tuberculosis, often presenting with nonspecific symptoms that mimic other gallbladder diseases. It is more prevalent in developing countries. Here, we report a case of a 26-year-old female who presented with right upper quadrant pain. Radiological investigations suggested cholelithiasis, and later histopathological examination revealed gall bladder tuberculosis. We discuss the clinical presentation, diagnostic challenges, and emphasize the crucial role of histopathology in confirming the diagnosis of gallbladder tuberculosis.

Also known as congenital epulis, this is a very rare lesion that presents as a polypoidal swelling. It is most often located over the lateral alveolar ridge, especially of the maxilla. More than 90% of the cases are reported in female and most are found at or soon after birth. Occasional patients have multiple lesions. Depending on the size of the lesion it can be asymptomatic or can cause feeding or respiratory problems. We report a case of 1 day old female neonate with intraoral lesion. This tumour demonstrates an excellent prognosis and is not associated with any syndromes/genetic defects or malignant transformation. Pathologists as well as clinicians should be familiar with this rare entity and its differential diagnosis for correct diagnosis and management.

Olfactory neuroblastoma is an uncommon malignant nasal tumor that originates from neuroepithelial cells of the nasal cavity. It is an embryonal neuroendocrine tumor that originates from neural crest progenitor cells. Olfactory neuroblastoma may infiltrate the sinuses, orbit, and cranium through the nasal cavity. This tumor is characterized by a pattern of slow growth and local recurrence. In pediatric age this tumor is even rarer, with an estimated incidence of 0.1 per 100,000 children up to 15 years. Treatment options are surgical excision or surgery combined with radiotherapy and/or chemotherapy. The present study reports the case of a 1.5-year-old female patient having olfactory neuroblastoma, presenting with a mass in the left nasal cavity.

Introduction: Placental Site Trophoblastic Tumor (PSTT) is a rare and distinct subtype of gestational trophoblastic neoplasia (GTN), arising from intermediate trophoblasts. Representing only 0.23% to 3% of GTD cases globally, PSTT is typically confined to the uterine implantation site.1 Ectopic localization of PSTT, particularly within the fallopian tube, is exceedingly rare, with approximately 20 cases reported in the published literature to date.3 This tumor presents a unique diagnostic challenge as its low production of human chorionic gonadotropin (betahCG) often contradicts standard diagnostic algorithms used for ectopic pregnancy, risking inappropriate conservative management.

Case Presentation: A 32-year-old G2P1 patient presented with 6 weeks of amenorrhea, mild vaginal bleeding, and unilateral lower abdominal pain. Initial quantitative serum beta-hCG was 850 IU/L, with a suboptimal rise over 48 hours. Transvaginal ultrasound confirmed the absence of an intrauterine pregnancy (IUP) and identified a complex, highly vascularized mass (3.5 cm) in the right adnexa, necessitating laparoscopic right salpingectomy. Initial histopathology demonstrated an invasive trophoblastic proliferation. Definitive diagnosis of PSTT was established through immunohistochemistry (IHC), characterized by strong, diffuse positivity for Human Placental Lactogen (hPL), focal positivity for betahCG, and a low proliferative index (Ki-67: 15%)

Management: The patient was staged as FIGO Stage I (localized disease). Given the localized nature and favorable prognostic factors (low mitotic rate, short interval since antecedent pregnancy), adjuvant chemotherapy was avoided. The patient was placed on a rigorous follow-up protocol involving long-term surveillance with periodic imaging (MRI) and monitoring of $\beta$-hCG and hPL, acknowledging the limitations of hCG monitoring alone for PSTT.

Conclusion: Ectopic PSTT is an ultra-rare malignancy whose clinical presentation is misleading due to low $\beta$-hCG production, challenging timely preoperative diagnosis.6 Definitive diagnosis hinges entirely on specialized pathological examination and IHC studies. While salpingectomy can be curative for localized, low-risk disease, specialized, long-term surveillance is mandatory to detect potential late recurrence, emphasizing the necessity of reporting such cases to inform international management guidelines.7