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Indian Journal of Pathology and Oncology

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1 TRANSFUSION MEDICINE - A BRANCH OF PATHOLOGY OR A SPECIALITY ON ITS OWN?, Asitava Deb Roy
Indian Journal of Pathology and Oncology (IJPO) is an interdisciplinary journal at the interface of pathology and oncology, including the preclinical and translational research, diagnostics and therapy. The journal covers studies related to pathology including morbid anatomy, surgical pathology, clinical pathology, diagnostic cytopathology including gynecologic cytology. Furthermore, IJPO offers an international forum for the rapid communication of reviews, original research, critical and topical reports with excellence and novelty. Published quarterly, IJPO is dedicated to keeping scientists informed of developments in its focused biomedical fields which span the gap between basic research and clinical medicine.
2 QUIZ CASE: AN AUTOPSY SCENARIO, Limci Gupta
Indian Journal of Pathology and Oncology (IJPO) is an interdisciplinary journal at the interface of pathology and oncology, including the preclinical and translational research, diagnostics and therapy. The journal covers studies related to pathology including morbid anatomy, surgical pathology, clinical pathology, diagnostic cytopathology including gynecologic cytology. Furthermore, IJPO offers an international forum for the rapid communication of reviews, original research, critical and topical reports with excellence and novelty. Published quarterly, IJPO is dedicated to keeping scientists informed of developments in its focused biomedical fields which span the gap between basic research and clinical medicine.
3 EVALUATION OF CARETB REAL TIME PCR FOR RAPID DETECTION OF MYCOBACTERIUM TUBERCULOSIS IN PULMONARY SPECIMENS, Pratiksha Chheda, Shamma Shetye, Nishtha Vira, Nilesh Shah
Rapid diagnosis of tuberculosis (TB) is one of the cornerstones for global TB control as it allows early epidemiological and therapeutic interventions. The slow growth of the tubercle bacillus is the greatest obstacle to rapid diagnosis of the disease. Newer molecular methods which are based on nucleic acid amplification (NAA) of different targets, aim to identify the M. tuberculosis complex in 6- 8 hours. In this study, we assessed the performance of careTB Assay, a Real Time based Polymerase Chain Reaction (PCR) for identification of IS6110 insertion sequence which is specific for Mycobacterium Tuberculosis Complex (MTC). Sputum specimens were collected from 100 patients with suspicion of pulmonary tuberculosis and tested for the presence of MTC using careTB kit. The results were compared against MTB culture. The sensitivity, specificity, positive predictive value, and negative predictive value of TB PCR were 92.98%, 88.37%, 91.38% and 90.48% respectively. PCR correctly identified MTC in four of the smear negative/ culture positive samples indicating high sensitivity of the assay. Four of the culture positive MOTT specimens were found to be negative by IS6110 PCR which is highly specific for MTC group of organisms. careTB test is simple, easy to perform and delivers the results in lowest possible turnaround time. Its sensitivity, specificity, and positive predictive value are satisfactory.
4 A RARE CASE OF VERRUCOUS EPIDERMAL NEVUS, Mrunal V. Kesari, Siddhi G S khandeparkar, Gayatri S Pathak, Deshmukh Sanjay D
Indian Journal of Pathology and Oncology (IJPO) is an interdisciplinary journal at the interface of pathology and oncology, including the preclinical and translational research, diagnostics and therapy. The journal covers studies related to pathology including morbid anatomy, surgical pathology, clinical pathology, diagnostic cytopathology including gynecologic cytology. Furthermore, IJPO offers an international forum for the rapid communication of reviews, original research, critical and topical reports with excellence and novelty. Published quarterly, IJPO is dedicated to keeping scientists informed of developments in its focused biomedical fields which span the gap between basic research and clinical medicine.
5 PATHOPHYSIOLOGY OF FIBROIDS, Harpreet Kaur, Aayushi Gulati
Fibroids are the commonest benign tumors of female genital tract. They are mainly composed of smooth muscle & fibrous connective tissue. Etiopathogenesis of fibroids is linked to hormones (estrogen & progesterone), genetic factors and some growth factors. Estrogen is the main predisposing factor-there is increased density of estrogen in fibroids compared to normal myometrium and increased concentration of aromatase leading to high local estrogen levels. The growth promoting effect of estrogen & progesterone has been shown to be mediated through local production of growth factors.
6 MAMMOTH VASCULAR ECCRINE SPIRADENOMA - VASCULAR ECCRINE SPIRADENOMA OF UNUSUALLY LARGE SIZE, Amita K, Vijay Shankar S
Context: Giant Vascular eccrine spiradenoma is a distinct unusual variant of eccrine spiradenoma characterized by extensive vascularity and hemorrhage accompanied by a large size, as compared to the usual eccrine spiradenoma. As a result, clinically and histopathologically it can be mistaken for an angiomatous or a malignant lesion. Also the published reports of giant vascular eccrine spiradenoma depicts the fact that these giant vascular eccrine spiradenoma are no more than 5 cm in size Case report: A 65 year old male patient presented with a mamoth sized i.e., 10 x 6 cm mass in the inguinal region. Clinically and on gross examination a diagnosis of angiosarcoma was made. However a diagnosis of vascular eccrine spiradenoma was made. Conclusion: We propose the term mammoth vascular eccrine spiradenoma for this unusual giagantic variant of vascular eccrine spiradenoma. Awareness of the entity and histopathologic examination will prevent whirlwind of appointments with oncology and enable accurate management decisions.
7 VERY HIGH HDL CHOLESTEROL LEVELS - BOON OR BANE, Sodani Sadhna, Hawaldar Ranjana
A 50 year old patient cam to Sampurna Sodani Diagnostic Clinic, Indore for routine tests including CBC and Lipid profile. CBC was WNL while chol (211 mg/dl), Triglyceride (109 mg/dl) and HDL was unusually high (113 mg/dl). On further investigations and detailed history it was found that he was a farmer, was nonalcoholic, non-diabetic, normotensive, nonsmoker and had not received any medications for reducing his lipids . He had never undergone any blood tests previously. He complained of headache off and on for which a CT scan was performed and which revealed focal area of hypoattenuation in right anterior centrum semiovale, corona radiate and right lentiform nucleus suggestive of recent right MCA territory infarct. High density lipoprotein or HDL is often called the good cholesterol. It has long been accepted that the HDL is more tightly controlled by genetic factors than are the other lipoproteins (ie, LDL, VLDL, intermediate-density lipoprotein [IDL], and chylomicrons). For example, in certain families, especially some families with Japanese ancestry, a genetic deficiency of cholesteryl ester transfer protein (CETP) is associated with strikingly elevated HDL cholesterol levels. However, environmental factors also have a significant impact on HDL levels. Factors that elevate HDL concentrations include chronic alcoholism, treatment with oral estrogen replacement therapy, extensive aerobic exercise, and treatment with niacin, statins, or fibrates. On the other hand, smoking reduces levels of HDL cholesterol, while quitting smoking leads to a rise in the plasma HDL level. Very high levels of HDL cholesterol have been reported to be atherogenic. The mechanism of this paradoxical effect is not entirely clear. Conclusion: While the epidemiology indicates a strong inverse association between HDL-C and CVD risk, at both extremes of HDL-C distribution, genetic conditions that influence HDL metabolism have a far less predictable relationship to atherosclerosis. Ongoing studies of genetic causes of very high HDL-C also promise to provide similarly important insights on the complex relationship between HDL metabolism and atherosclerosis that could lead to new therapies for the treatment of atherosclerotic CVD.
8 CYTOLOGICAL POINTERS TO THE DIAGNOSIS OF A RARE PAROTID GLAND TUMOR - EPITHELIAL-MYOEPITHELIAL CARCINOMA, R Rajani, Amita K
Epithelial-Myoepithelial carcinoma (EMC) of the salivary gland is a rare tumor representing 1% of all salivary gland neoplasm. Fine needle aspiration cytology (FNAC) is the best tool for preoperative diagnosis of salivary gland neoplasms. However there are only few documented case reports of preoperatively diagnosed cases of EMC in English literature. We present a third case of cytologically diagnosed EMC and highlight the fact that three dimensional clusters, acellular basement membrane material, prominent central nucleoli and attempted tubule formation are important pointers to the cytological diagnosis of EMC at cytology.
9 MALIGNANT MURAL NODULE WITHIN AN OVARIAN MUCINOUS TUMOUR, Afsheen Wasif, Limci Gupta
Mural nodules of the ovary are described as solid masses or nodules which are histologically different from the background cystic tumour. These nodules can be associated with both serous and mucinous ovarian tumours but more commonly with mucinous subtypes. These mural nodules could be benign or malignant. The subtypes include sarcoma-like, sarcomatoid, anaplastic and mixed. We describe a case of a borderline mucinous ovarian tumour with intraepithelial carcinoma with a mural nodule of anaplastic carcinoma.
10 A RARE HEMOGLOBIN VARIANT: HB TY GARD DETECTED IN AN INDIAN FAMILY, Pratiksha Chheda, Sandeep Warghade, Milind Chanekar, Yogita Salunkhe, Mayur Nigalye, Rajesh Bendre,
We report an Indian family case of Hb Ty Gard. A one year old male child presented with fever and was found to have low hemoglobin. Variant hemoglobin (Hb) was incidentally detected on HPLC electrophoresis as an unknown abnormal peak. Molecular analysis of ?-globin gene showed presence of codon 124 Pro-Gln (CCA-CAA) variation or Hb Ty Gard. The family studies revealed presence of the same mutation in mother. Mutation analysis of ?-globin gene serves as an important tool for confirmation of rare hemoglobinopathies.
11 SARCOIDOSIS OF BILATERAL PAROTID GLAND - DIAGNOSED ON FINE NEEDLE ASPIRATION CYTOLOGY, Vartak Shailesh, Anitha Padmanabhan, Ranbir Singh, Urmi Chakravarty Vartak
A case of Sarcoidosis, presented initially as bilateral parotid gland enlargement and diagnosed on FNAC is discussed here. Smears showed noncaseating epithelioid cell granulomas and few atrophic salivary gland acini. AFB staining of the aspirate smears were negative and no caseous necrosis was seen. After excluding other granulomatous lesions, a differential diagnosis of Tuberculosis and sarcoidosis was suggested. The Serum ACE levels were elevated and x ray chest showed hilar lymphadenopathy. The patient also had xerostomia and xerophthalmia of right eye. The diagnosis of Sarcoidosis was confirmed based on these findings. FNAC, therefore, may be considered a useful diagnostic modality in cases of sarcoidosis presenting primarily with parotid involvement.
12 APOCRINE HIDROCYSTOMA OF THE EXTERNAL AUDITORY CANAL MASQUERADING AS MALIGNANT MELANOMA: A CASE REPORT, Dr Nupur Sharma, Dr A.K. Mandal
Indian Journal of Pathology and Oncology (IJPO) is an interdisciplinary journal at the interface of pathology and oncology, including the preclinical and translational research, diagnostics and therapy. The journal covers studies related to pathology including morbid anatomy, surgical pathology, clinical pathology, diagnostic cytopathology including gynecologic cytology. Furthermore, IJPO offers an international forum for the rapid communication of reviews, original research, critical and topical reports with excellence and novelty. Published quarterly, IJPO is dedicated to keeping scientists informed of developments in its focused biomedical fields which span the gap between basic research and clinical medicine.
13 BASAL CELL ADENOMA OF MAJOR SALIVARY GLAND WITH REVIEW OF LITERATURE, Banushree C Srinivasamurthy, Swagatika Senapati, Nagarajan K, Arpita Saha
Basal cell adenoma is a rare benign epithelial tumor of the salivary gland that derives its name from the basaloid appearance of the tumor cells, accounting for 12% of all salivary gland epithelial tumors. We report a case of elderly female with a gradually progressive swelling in the pre auricular region for 1year. Fine needle aspiration cytology of the lesion was inconclusive but its classical histopathological features made a confirmed diagnosis of basal cell adenoma.
14 KIKUCHI FUJIMOTO DISEASE NECROTISING CERVICAL LYMPHADENITIS, Jyotsna Suri, Kumari Rita
Kikuchi- Fujimoto disease is a rare benign self-limited disease of unclear etiology. It is important to recognize and diagnose this entity as it closely mimics and is often mistakenly clinically diagnosed as lymphoma. Case report: - We report a case of young male of 24 years age with fever and tender cervical lymphadenopathy. FNAC suggested a diagnosis of reactive lymphadenitis and patient put on broad spectrum antibiotics. As the patient showed no response the biopsy of the cervical lymph node was done and microscopy suggested the diagnosis of Kikuchi disease. Conclusion: - Kikuchi Fujimoto disease is a rare self-limited disease, more common in females .Our case is again a rare case of Kikuchis disease reported in a male patient. Clinician and pathologist should be aware of this entity and keeping it as a close differential diagnosis in appropriate cases will minimize the unnecessary treatment and its side effect.
15 STUDY OF COAGULATION PROFILE IN PREGNANCY INDUCED HYPERTENSION (PIH), Nirmala T, Kumar Pradeep L., Vani B R., Murthy Srinivasa V., Geetha R L
Background: Hypertension is one of the common medical complications of pregnancy and contributes significantly to maternal and perinatal morbidity and mortality. Hypertension is a sign of an underlying pathology which may be pre-existing or appear for the first time during pregnancy. Various haematological changes like numerical and functional platelet abnormalities, alteration in haemoglobin and erythrocyte parameters and hypercoagulable state may be seen. Aims and Objectives: Evaluation of coagulation profile in PIH. Materials and Methods: A 2 year study was carried out in the Dept. of pathology ESIMCPGIMSR, Bangalore on 100 PIH cases. Coagulation profile (PT, aPTT, INR and D-dimer) was done in all cases and values were correlated with the severity of PIH. Results: Total of 100 cases were included in the study. 37 were mild GH, 9 cases were severe GH, 29 cases were mild preeclampsia and 25 cases were in severe preeclampsia group. Prolonged PT, aPTT and D-Dimer was seen in 15 cases, 42 cases and 38 cases respectively. In our study we observed increased mean aPTT of 27.334.54 and increased D-Dimer of 0.350.33 in severe preeclampsia patients. Hence we emphasize that raised aPTT, D-Dimer are alarming signs for aggressive treatment. Conclusion: Raised aPTT and D-dimer are fairly good indicator of severe preeclampsia and needs aggressive treatment.
16 SPECTRUM OF FNAC IN PALPABLE HEAD AND NECK LESIONS IN A TERTIARY CARE HOSPITAL IN INDIA- A 3 YEARS STUDY, Suryawanshi Kishor H., Damle Rajshri P., Dravid Nandkumar V., Tayde Yogesh
Background: Head and neck lesions encompass a multitude of congenital, inflammatory or neoplastic lesions including several anatomic sites and originating in different tissues and organs. Fine needle aspiration cytology (FNAC) is a simple, quick, feasible, cost effective and repeatable outpatient procedure with minimal risk of complication. Aim: 1. To evaluate the role of FNAC and its utility in diagnosis of palpable head neck masses. 2. To study the spectrum of head neck lesions in rural population. 3. To study diagnostic accuracy of FNAC by histopathological correlation wherever possible. Material and methods: The study included 288 patients presented with palpable head and neck swelling in a tertiary care hospital from January 2011 to December 2014. Detailed clinical history of patient was noted. Aspirations were done by using 10 ml syringe and 22/23 gauge needles. Smears were stained with PAP, Haematoxylin and eosin and Leishman stain. Cytomorphological diagnosis was given. Cyto-histopathological correlations were done wherever possible. Results: Out of 288 patients of head and neck lesions studied, lymph node (39.58%) was the predominant site aspirated with tubercular lymphadenitis being the commonest lesion. Thyroid lesions constituted 31.25 % followed by salivary gland (18.75%), soft tissue and miscellaneous (7.29%). FNAC was inconclusive in 3.12 % cases. Overall accuracy rate of FNAC was 93.02% with sensitivity of 81.81 % and specificity of 96.87 %. Conclusion: Though excisional biopsy is the gold standard for diagnosis of head and neck neoplastic lesion. FNAC is a rapid, cheap diagnostic tool now-a-days with overall accuracy rate more than 90 %.
17 A STUDY INTO IMMUNOFLUORESCENCE PATTERNS OF PEMPHIGUS AND PEMPHIGOID AND CORRELATION OF INTENSITY OF FLUORESCENCE OF IMMUNOREACTANTS WITH THEIR SERUM LEVELS, Jyotsna Suri, Priya Gupta, Rita Kumari
Background: Vesiculobullous disorders of the skin have well defined patterns of deposition of immunoglobulins (Ig) and complement, which can be demonstrated by immunofluorescence techniques, and help in making an accurate diagnosis of the same. Methods: A clinicopathological study of 15 cases of vesiculobullous diseases diagnosed as Pemphigus and Pemphigoid was carried out. The study included six male patients and nine female patients. Light microscopy was done to see the level of cleavage of bullae and the diagnosis was further supported by direct immunofluorescence (DIF) findings. The correlation between intensity of fluorescence and the serum Ig & complement levels was studied. Result: The patterns of deposition of immunoreactants were found to be in conformity with observations of the earlier studies and the Serum Ig & complement levels showed positive correlation with intensity of DIF positivity on skin biopsy. Conclusion: Immunofluorescence has now been well established as a helpful technique in diagnosing bullous lesions which has a bearing on the treatment of these diseases which if not treated properly can prove fatal as a result of life threatening complications.
18 STUDY OF PLATELET INDICES IN PREGNANCY INDUCED HYPERTENSION (PIH), Nirmala T, Vani B R., Murthy Srinivasa V., Deepak kumar B., Geetha R L, Kumar Pradeep L.
Background: Hypertension is one of the common medical complications of pregnancy and contributes significantly to maternal and perinatal morbidity and mortality. Hypertension is a sign of an underlying pathology which may be pre-existing or appear for the first time during pregnancy. Various haematological changes like numerical and functional platelet abnormalities, alteration in haemoglobin and erythrocyte parameters and increase in the procoagulant state of normal pregnancy are seen. Aims and Objectives: Evaluation of Platelet indices in PIH. To identify the early platelet parameters predictive of preeclampsia and HELLP syndrome. Materials and methods: A 2 year study was carried out in the Dept. of pathology ESIMC, Bangalore on 100 PIH cases. Platelet indices is done in all the cases. P values for all parameters were statistically derived and evaluated. Results: Total of 100 cases were included in the study. 37 were mild GH, 9 cases were severe GH, 29 cases were mild preeclampsia and 25 cases were in severe preeclampsia group. Thrombocytopenia was observed in 23 cases and elevated MPV in 49 cases. Conclusion: Thrombocytopenia is identified as the most common complications of PIH and at times may be life threatening. Therefore estimation of platelet indices can be considered as an early, simple and rapid procedure in the assessment of severity of pre-eclampsia and to prevent progression to HELLP syndrome and DIC.
19 GIANT DERMATOFIBROSARCOMA PROTUBERANS OVER AN ANTERIOR CHEST WALL: A RARE CASE REPORT, Damle Rajshri P., Suryawanshi Kishor H., Dravid Nandkumar V., Newadkar Dhananjay V.
Dermatofibrosarcoma protuberans (DFSP) is a rare, slow growing fibro histiocytic neoplasm with intermediate to low grade malignancy. It is locally invasive tumor but rarely metastasis with high rate of recurrence. It commonly occurs on the trunk, proximal extremities. We report a rare case of a 58 year old male who presented with very huge mass over anterior chest wall. Wide local surgical resection with surrounding surgical margins was performed. Histopathological examination along with immunohistochemistry confirmed the diagnosis of DFSP. We present this case due to its rarity and its unusual gross appearance.
20 LARYNGEAL SQUAMOUS CELL CARCINOMA WITH RENAL METASTASIS: A RARE CASE REPORT, Rita Kumari, Sindhu Sharma, Priya Gupta
Laryngeal squamous cell carcinoma tends to exhibit local spread with a low incidence of distal metastases. The majority of distant metastases are to the lungs and renal involvement is extremely rare. We present a rare case of metastatic renal tumour originating from Laryngeal squamous cell carcinoma. Fifty year old male diagnosed two years back as Laryngeal squamous cell carcinoma, underwent complete chemo radiation and was clinically free of disease for about two years, now presented with gross haematuria. Physical examination revealed left renal mass which was confirmed on CT scan as heterogeneously enhanced mass in upper part of kidney. Nephrectomy was done. On histopathological examination, well-differentiated squamous cell carcinoma of kidney was reported.
21 INCIDENTAL ENDOMETRIOSIS DURING CESAREAN SECTION SHOWS MARKED DECIDUALIZATION: A CASE REPORT OF UNCOMMON PRESENTATION, Sarmad Raheem Kareem
Endometriosis is common gynecological condition that may arise spontaneously or in surgical scar, particularly of cesarean section, and it may and cause diagnostic confusion with other surgical conditions. Endometriosis can undergo many metaplastic changes, and this is a case report of markedly decidualized endometriosis.
22 PRIMARY LEIOMYOSARCOMA OF SPINE A RARE ENTITY, Prerna Sachdeva, Anitha Padmaanabhan, Priyanka Katke, N.M Gadgil
The primary leiomyosarcoma invading the spine is an extremely rare neoplasm .We report a case of 75 year old male with no significant medical history presenting with weakness in both lower limbs and incontinence of urine and faeces since 15 days. MRI confirmed the presence a lytic lesion causing collapse of D11-D12 vertebrae with involvement of paravertebral soft tissue and 11-12th ribs. Decompressive surgery was performed for the same and tumour was sent for histopathological examination. On histology, tumour was found to be low grade leiomyosarcoma which showed positivity for desmin and smooth muscle actin on Immunohistochemistry.
23 AN UNUSUAL PRESENTATION OF PRIMARY PLASMA CELL LEUKEMIA AS A PSYCHIATRIC DISORDER: A DIAGNOSTIC DILEMMA- A CASE REPORT AND REVIEW OF LITERATURE, Anshu Gupta, Chhavi Gupta, Anju Kapoor
Plasma cell leukemia (PCL) is a rare disorder that can develop spontaneously (primary) or evolve in patients with multiple myeloma (secondary). Histogenetically, plasma cell leukemia is derived from terminally differentiated B cells. It is diagnosed by the presence of absolute plasma cell count >2000/cumm or >20% circulating plasma cells in blood. We report a rare case of primary plasma cell leukemia in patient with unique presentation of a psychiatric illness having hallucinations, mood changes and loss of insight. The patient had past history of pulmonary tuberculosis and developed de novo PCL as there was no previous history of multiple myeloma. Clinical spectrum, cytomorphological features and prognosis of PCL are also discussed in this case report.
24 DETECTION OF HAEMOGLOBIN J IN AN ASYMPTOMATIC DIABETIC PATIENT- A CASE REPORT, Hawaldar Ranjana, Sodani Sadhna
India is an ethnically diverse country with marked regional variation. This diversity is reflected in the presence of different Hb variants in different ethnic groups. Hb J Meerut is one such rare variant detected by HPLC as abnormal peak (25.4%) in P3 window with a retention time of 1.85 minutes. This clinically asymptomatic variant has been reported to interfere with HBA1C estimation in diabetic patients.HBA1C values are routinely done to assess glycaemic control in diabetic patients. HbA1C values may be falsely low due to presence of abnormal HB variants. As HbA1C is based on haemoglobin, both quantitative and qualitative, variants in haemoglobin can affect HBA1C values.Here we report a case of a 45 year old male diabetic patient who had a spuriously low HBA1C value on HPLC with an abnormal peak in P3 window .Hb electrophoresis done to detect variant haemoglobin showed an abnormal peak (25.4%) in P3 window at a retention time of 1.85 minutes. A provisional diagnosis of HBJ Meerut was made which was confirmed by capillary electrophoresis.