Indian Journal of Pathology: Research and Practice

Mixed gonadal dysgenesis represents a genetically, phenotypically and clinically heterogenous entity. It is defined by the presence of dysgenetic testis or streak gonads on one side and differentiated testis on the other side. The exact incidence of MGD is unknown. They can present in childhood with abnormal or ambiguous external genitalia or in an adult with history of primary amenorrhea in female and infertility in male. This discussion briefs about a case of mixed gonadal dysgenesis which is presented here for its rarity. A 22 year old female presented with history of primary amenorrhea. A complete clinical, hormonal, radiological and karyotypic analysis followed by exploratory laparatomy with histological examination of the gonadectomy specimens revealed a diagnosis of mixed gonadal dysgenesis. An important differential diagnosis for MGD includes true hermaphroditism. Histopathological examination of the gonads helps in confirming the diagnosis of MGD.

Keywords: Mixed Gonadal Dysgenesis; True Hermaphroditism; Persistent Mullerian Duct Syndrome.

Biotinidase is responsible for cleaving Biotin from Biocytin. Deficiency of biotinidase affects carboxylase enzymes causing dermatological, neurological, immunological or Ophthalmological complications. Biotinidase deficiency is known inborn error of metabolism having a prevalence of 1: 60,000 live births. We are presenting a case of biotinidase deficiency detected and diagnosed at our center.

Keywords: Biotinidase; Biotin; Biocytin; TLC; Organicaciduria. 

Introduction: Lymph node enlargement results due to proliferation of one or more components of the lymph node as a natural immune response to different antigens. Lymphadenopathy, whether localized or generalized, superficial or visceral, is a common finding in patients. Excision biopsy is the procedure of choice because histological diagnosis depends upon the change in the lymph node architectural pattern as well as the morphological details of the individual cells. Objective: The purpose of the present study was to evaluate the etiology of lymphadenopathy in relation to age and sex and the pattern of histological diagnosis in lymph node biopsy specimens in the department of histopathology in our centre. Materials and Methods: The present retrospective study of lymph node biopsies was conducted in the department of histopathology over a period of one year from January to December 2016. A total of 49 lymph node biopsies were taken into consideration. All biopsies were fixed in 10% formalin for 24 hours and later 3-4 micron thick sections were made from the blocks and staines with Hand E stain.Wherever necessary, AFB staining and immunohistochemistry was performed to aid in the diagnosis. Results: A total of 49 lymph node specimens were received from January 2016 to December 2016 . There were 17 (34.7%) males and 32 (65.3%) females. Cervical lymph nodes were the most commonly biopsied group (65.3%), non-neoplastic lesions were more common comprising 47out of 49 ( 95.9%). TB was the most common cause of lymphadenopathy and accounts for 59.18% of all lesions. Conclusion: Biopsy of the enlarged lymph nodes plays a major role in arriving at a correct etiological diagnosis of lymphadenopathy. Non neeoplastic causes like Tuberculosis with a female preponderance and cervical region was the commonest site affected in our study.

Keywords: Lymphadenopathy; Tuberculosis; Reactive Hyperplasia. 

Salivary glands are unique secretory glands due to its histological diversity and heterogeneity. More than 90% pleomorphic adenoma (PA) are found in majorsalivary gland i.e. parotid. This tumor is known to occur at various other anatomical locations apart from the major salivary glands. 8% of PAs involve the minor salivary glands of which 60-65% in the palate and 5.5% at minor salivary glands of cheek. Less frequent sites such as lacrimal gland, external auditory canal, breast and parapharyngeal space, reported sparsely in English literature. PA at breast and external auditory canal (EAC), can be challenging and may lead to a misdiagnosis, as invasive carcinoma. Involvement of parapharyngeal space are also rare and constitute less than 0.5% of head and neck neoplasm. We are presenting here a series of 10 cases of PA at unusual sites with an aim to highlight the role of FNAC, which has sufficiently high accuracy rate and can be a useful guide in making decisions for further management.

Keywords: Pleomorphic Adenoma; Unusual Sites; Aspiration Cytology; Diagnostic Accuracy.

Background: Malignancies of Salivary gland are not uncommon. Among all the neck and head tumors, they account for 2-6.5% of all tumors. For evaluation of tumors of salivary gland, fine needle aspiration cytology (FNAC) is a commonly used method. Objective: To study the efficacy of FNAC in the diagnosis of salivary gland lesions. Methods: Present study was hospital based diagnostic evaluation study conducted among 96 FNACs from December 2013 to May 2015. The study was conducted in the department of Pathology at a tertiary care hospital. Gold standard used was histopathology of lesions. Results: The FNAC findings in this study were: Non-neoplastic 40, Benign 46, Malignant 7, and Suspicious for malignancy 2 and unsatisfactory. Biopsy examination for comparison was available in 37 cases. Sensitivity of FNAC was 100% and the specificity was found to be 96.97%. The positive predictive value was 80% and the negative predictive value was 100%. The overall diagnostic accuracy in the present study was 97.3% for FNAC. Conclusion: FNAC is less costly, rapid, safe technique. The best part is that this technique is minimally invasive technique. It is as good as a diagnostic test.

Keywords: Histopathology; Salivary Gland; Lesions; Technique; Diagnostic Test; FNAC. 

Context: The initial classification of anemia can be improved substantially by including RDW and histograms of the red cell volume as these variable become part of the routine blood counts. Aims: To evaluate the effectiveness of the RDW parameter in the diagnosis of the erythrocyte disorders. Settings and Design: A hospital based cross sectional diagnostic evaluation study, Department of Pathology, Lt. BRKM Government Medical College. Methods and Material: 250 randomly selected cases of anemia were studied. All patients having hemoglobin value of less than 12.5 gm were included in the present study. Initially all patients were screened by automated cell counter. Those with hemoglobin of less than 12.5 gm were included in the present study. A possible pathophysiologic entity was assigned. Now the peripheral smear was screened and a specific etiology (category or cases) was assigned. Statistical Analysis: Chi square test was used wherever appropriate. P value of less than 0.05 was taken as statistically significant. Results: Decreased MCV and mild increase in RDW was seen in thalassemia trait. Serum iron was found to be normal in IDA patients. Low MCV and high RDW was found to be a good predictor of IDA. Single parameter of high MCV was found to be of poor diagnostic value in B12 deficiency anemia. Very high RDW was a consistent feature of sickle cell disease. Fairly deciding heterogeneity was observed with decrease to normal MCV in cases of various types of hemolytic anemia. Conclusion: RDW is a fairly sensitive and specific diagnostic approach and can eliminate unnecessary expensive and invasive investigations.

Keywords: Sickle Cell Disease; Iron Deficiency Anemia; Beta Thalassemia; MCV; RDW; MCH. 

Background: Seventh most common tumor is urinary bladder tumor among which urothelial carcinoma constitutes 90% of primary bladder tumor. Both neoplastic and non neoplastic diseases produce clinical signs and symptoms. Though the non-neoplastic diseases are disabling, the neoplastic lesions are the source of mortality. This study was conducted to analyze frequency and clinical features of various histopathological lesions of bladder tumors. Materials and Methods: this retrospective study was carried out in the department of pathology, Narayana medical college, Nellore. Clinicopathological data of bladder biopsies received from urology department were analyzed. Results: 68 bladder biopsies were studied. Among them 53 cases were neoplastic and 15 cases were non neoplastic lesions. Both neoplastic and non-neoplastic lesions showed male predominance. Neoplastic lesions were noted in the age group of 61-70 years (28.3%) . Non-neoplastic lesions showed predominance in the 31- 40 years age group. Among the neoplastic lesion low grade papillary urothelial carcinoma invading lamina propria constituted maximum number (32.1%) followed by high grade urothelial carcinoma invading muscle layer (24.4%). Few rare tumors like urachal adenoacrcinoma, mucinous adenocarcinoma, sarcomatoid urothelial carcinoma were also encountered in our study. Among the nonneoplastic lesions, granulomatous cystitis were maximum (46.6%) followed by non-specific chronic cystitis, cystitis cystica, cystitis glandularis and eosinophilic cystitis. Conclusion: In the bladder neoplastic lesions are more common than non-neoplastic lesions. Among the neoplastic lesions, papillary urothelial neoplasms are commonest. Grading of urothelial carcinoma along with presence or absence of muscle invasion is an important prognostic factor. Clinical signs and symptoms like haematuria should not be neglected as it may lead to advanced stage of neoplastic lesions at the time of diagnosis.

Keywords: Bladder Lesions; Urothelial Tumors; Non Neoplastic Lesions. 

Background: The salivary gland tumors account for 6% of all the head and neck tumors. Salivary gland lesions consist of non-neoplastic lesions and neoplastic lesions. FNAC is most commonly used method to diagnose the salivary gland tumors. The main objective of our study was to analyze the spectrum of salivary gland lesions and to evaluate the efficacy of cytology in diagnosing salivary gland lesions by correlating with histopathological findings. Methods: The present retrospective study of 50 cases of FNAC and histopathology of salivary gland lesions was carried out in the department of pathology, Narayana Medical College & Hospital, Nellore, Andhra Pradesh, India, during the period of January 2016 to December 2016. Cytological smears were fixed in ethyl alcohol and then stained with Haemotoxylin & Eosin stains. Salivary gland specimens were fixed in 10% formalin and then stained the paraffin sections by Haemotoxylin & Eosin staining technique. Cytohistopathology correlation was done. Result: In our study, age range of salivary gland lesions was from 26 years to 68 years with a mean age of 43.32 years and female to male ratio is 1.5:1. Majority of the salivary gland lesions were noted in 31-40 years age group. Among the 50 cases of salivary gland lesions, 38(76%) cases were benign neoplasms, 7(14%) cases were malignant neoplasms and 5(10%) cases were inflammatory lesion. Among the benign neoplasms, Pleomorphic adenomas were 35 (92.11%) cases and among the malignant neoplasms, mucoepidermoid carcinomas were 4 (57.14%) cases. The overall diagnostic accuracy in salivary gland lesions was 94.67%. Conclusion: The high accuracy, sensitivity and specificity of FNAC confirm that preoperative cytology is a useful, quick, reliable diagnostic technique for rapid and early diagnosis in salivary gland lesions. Few rare tumors can be missed on cytology, but clinical correlation can give clue to the diagnosis of malignant neoplasms.

Keywords: Salivary Gland Lesions; Cytohistopathological Correlation. 

Introduction: Prostatism is a common disease in the geriatric age group. Benign prostatic hyperplasia and Carcinoma of the prostate are increasingly frequent with advancing age. Aim of the present cross-sectional study is to evaluate the complete spectrum of histopathological types of various prostatic lesions. Materials and Methods: A total of 75 prostate biopsies were received from January 2016 to December 2016 in the Department of Pathology, in a tertiary care hospital, Uttar Pradesh. Routine Hematoxylin and Eosin staining was performed. Reporting of malignant cases included Gleason’s grade and score. Relevant clinical data including the age, presenting complaints, and radiological findings were documented for all the cases. Results: A total of 75 prostate biopsies were received, the mean age was 63.04 years. Most common presenting complaint was difficulty in micturition. Study included, 56 (74.66%) cases of Benign prostatic hyperplasia alone and 5 (6.66%) were of Adenocarcinoma. Chronic Prostatitis 6 (8%) was the most common non-neoplastic lesion associated in cases of benign prostatic hyperplasia. Two (2.66%) cases were of benign prostatic hyperplasia along with Basal cell hyperplasia. One (1.33%) case each of granulomatous prostatitis, cystitis glandularis (urothelium), and squamous metaplasia were associated with benign prostatic hyperplasia. One (1.33%) case each of Prostatic intraepithelial neoplasia, Undifferentiated carcinoma, and post operative spindle cell nodule were also noted. Conclusion: Benign prostatic hyperplasia is the most commonly encountered prostatic lesion. In spite of availability of various investigations, a definitive diagnosis of prostatic lesions can be made by histopathological study only.

Keywords: Benign Prostatic Hyperplasia; Chronic Prostatitis; Basal Cell Hyperplasia; Prostatic Intraepithelial Neoplasia; Carcinoma Prostate; Post Operative Spindle Cell Nodule. 

Background: Squash smear technique is reliable diagnostic tool which provides neurosurgeons with rapid intraoperative diagnosis and helps them to modify their surgical approach. This study was done to assess the accuracy and diagnostic utility of squash smear technique by comparing with histopathological diagnsosis. Materials and Methods: Our study included 33 patients who underwent operation in neurosurgical department, Narayana Medical College and hospital, Nellore. Squash smear technique was used to provide intraoperative diagnosis and was correlated with histopathological diagnosis. Results: 33 cases were studied, out of which 2 were inflammatory lesions and 31 were neoplastic. Neoplastic lesions included astrocytomas (42.4%), meningiomas (27.3%), oligodendrogliomas (3.03%), ependymoma (3.03%), chordoma (3.03%), schwannoma (9.09%), choroid plexus papilloma (3.03%), and pituitary adenoma (3.03%). Non neoplastic cases were 2 cases of tuberculoma (6.06%). Accuracy rate of squash smear technique was 87.9% in our study. 100% accuracy was found in astrocytomas which were maximum in our study followed by meningiomas. Conclusion: squash cytology provides reliable and rapid diagnosis for neurosurgeons. Accuracy is good in astrocytomas when compared to inflammatory conditions and rare tumors like ependymoma and chordoma. Clinical features and radiological findings should be considered to increase the accuracy of squash cytology.

Keywords: Squash Cytology; Intraoperative Diagnosis. 

Introduction: Eosinophilic gastroenteritis is a rare inflammatory condition characterized by increase in number of eosinophils. There are various causes enumerated to eosinophilic gastroenteritis includes H pylori infection, drugs, parasites, allergen. Objective: To find the correlation between eosinophilic gastroenteritis and peripheral blood eosinophilia. Materials and Methods: 85 cases are selected.The diagnostic criteria for eosinophilic gastroenteritis is presence of more than 30 eosinophils per high power field. The absolute eosinophil count of all the cases is noted. Results: Among 85 cases, 59 are males and 26 are females. The mean age of male and female patients included in this study is 51.31 years and 52.46 years respectively. The most common site involved is colon. Kappa (weighted) statistics shows 36% agreement. Discussion: Our study shows only 36% patients have raised absolute eosinophil count. Conclusion: Eosinophilic gastroenteritis is common in 5th decade, more common in male patients. Since only 36% of patients have raised absolute eosinophil count. Biopsy remains the gold standard modality of diagnosis.

Keywords: Allergy; Colon; Eosinophilia; Gastroenteritis.

Background: Acute appendicitis is the one of the most common surgical emergencies in world wide. Gold standards method for diagnosis of acute appendicitis is histopathological examination of appendectomy specimen. Appendiceal lumen obstruction caused by faecolith mainly and unusual factors rarely. Spectrums of appendiceal lesions consist of inflammatory lesions to malignant lesions. Methods: The present retrospective study included 159 appendicectomy specimens received in the department of pathology, Narayana Medical College & Hospital. Nellore, Andhra Pradesh, India, during the period of January 2016 to December 2016. Appendicectomy specimens were fixed in 10% formalin and then stained with Haemotoxylin and Eosin staining technique. Results: Among the 159 appendicectomy specimens, Acute appendicitis account for 72 (45.28%) with peak occurrence in the age group 11-20 years (27.67%) and 21-30 years (25.79%) with male predominance (1.74:1). Unusual findings were noted in 21(13.21%) cases on histopathology. Most common unusual findings included chronic obliterative appendicitis (61.90%), followed by acute eosinophilic appendicitis (14.29%) and Carcinoid appendix (9.52%). Other unusual findings include Granulomatous appendicitis, Enterobius vermicularis parasitic infestation and primary adenocarcinoma of appendix. Conclusion: The gross examination of appendix during surgery cannot detect the unusual findings particularly malignancies. Histopathological examination of appendix is essential to avoid the malignancies missed and gives clinician a clear idea regarding treatment strategy.

Keywords: Appendicitis; Carcinoid; Primary Adenocarcinoma; Enterobius Vermicularis. 

Vitamin B12 is a neurotropic, water soluble vitamin and is one of the major cause of development of Diabetic peripheral neuropathy. Metformin is known to cause depletion of vitamin B12 stores resulting in its deficiency. Thus Looking at the increased incidence of type 2 Diabetes mellitus, and the increased prevalence of vitamin B12 deficiency in the Indian population (vegetarian diet being one of the factor) and since the screening of serum vitamin B12 is a bit costly test, according to the result of this study we may arrive to a conclusion regarding supplementation of vitamin B12 for prevention of peripheral neuropathy in diabetes. Long term use of Vitamin B12 supplements in patients will not cause any harm owing to the fact that it being a water soluble vitamin will be excreted in urine if in excess. Biothesiometer is a simple, portable, reliable, non-invasive method to screen the peripheral neuropathy.

Keywords: Vitamin B12; Diabetes mellitus; Metformin Therapy; Biothesiometer.

Background: Bethesda system of thyroid lesion is the six-tired diagnostic classification based on a probabilistic approach in increasing the specificity and sensitivity of FNAC thyroid lesions. Its capacity to facilitate better cytologic -histologic correlation and role of each diagnostic category to conveys specific risks of malignancy. Methods: The present retrospective study of Bethesda system of cytopathology of thyroid lesion was carried in 100 cases in the department of Pathology, Narayana Medical College & Hospital, Nellore, Andhra Pradesh, India, during the period of January 2016 to December 2016. Cytological smears was fixed in ethylalcohol and then stained with Haematoxylin and Eosin staining technique. Results: In our study the lesion wise distribution after The Bethesda System of Reporting Thyroid Cytopathology (TBSRTC) was benign 77.5%, Atypia of undetermined significance 3.5%, with Follicular Neoplasm at 6%, suspicious for malignancy at 2% and malignant at 11%. The sensitivity and specificity after TBSRTC were 88.13% and 100% respectively with a diagnostic accuracy of 98.55%. On estimation of risk for malignancy in each category it showed 1.95% for benign lesions, 33.33% for Follicular Neoplasm category, suspicious for malignancy had 50% risk and 100% risk for malignancy category. Conclusion: The malignancy potential of each category of Bethesda system gives clinician a clear idea regarding its treatment strategy and TBSRTC has a histopathological correlation as good as any system of reporting.

Keywords: Thyroid Cytopathology; Bethesda System.

Background: Endometriosis is an important benign gynecologic pathology defined by presence of a tissue similar to uterine endometrium, which is located endometrial glands and stroma out side of the uterus associated with pelvic pain. The most common site is ovaries followed by posterior broad ligament, fallopian tubes, and colon and round ligaments. Objective: To evaluate the endometriosis cases through pathologic analysis of histological features, age, site, and clinical presentation of endometriosis. Materials & Methods: Retrospective study was undertaken for a period of 2years from May 2015 to May 2017 in department of pathology, Narayana Medical College & Hospital, Nellore, and Andhra Pradesh, India. Results: 20 Cases of endometriosis recorded in the department of pathology in 2 years (May 2015-May 2017). Of all endometriosis cases, majority were found in 30-40 years age group. Most common site was ovary 11 cases (55%), and least common site was abdominal wall (scar) 1 case (5%), sigmoid colon 1 case (5%). Most common presentation was pelvic pain 7 cases (35%) and dysmenorrhea 5 cases (25%), menorrhagia 4 cases (20%) , constipation 1 case (5%) and abdominal lump 1 case (5%). Common associated pelvic pathology was leiomyoma of uterus. Conclusion: Endometriosis has no pathognonomic signs or symptoms and it is difficult to diagnose clinically. Histopathology is gold standard test for confirmation of the diagnosis.

Keywords: Endometriosis; Histogenesis; Histopathology; Ovaries. 

Introduction: Cancer of the uterine cervix is one of the leading causes of cancer death among women worldwide. In India, it ranks as second leading cause next to breast cancer in women. Aims: To study the clinical presentation of cervical carcinoma correlating with histopathological findings in the Charutar area of Gujarat state at Shree Krishna Hospital, Karamsad. Methods and Material: 68 specimens received from 15 April 2015 to 14 April 2016 with clinical suspicion of cervical carcinoma and histopathologically confirmed were considered for study. Clinical details of the patients were noted with the help of semi-structured proforma. Statistical analysis used: The data was Statistically analyzed using STATA 14 software. Results: Out of 68 confirmed cases for malignancy, 43 (63.24%) had large cell non keratinizing squamous cell carcinoma (LCSCC), 34 (50%) were presented with abnormal bleeding per vaginum, 47 (69.12%) were seen between 41-60 years, 66 (97.06%) were multiparous, 48 (70.59%) had poor genital hygiene, 42 (61.76%) were illiterate, 44 (64.70%) were from low economic class, only 03 (4.41%) had history of cervical cancer screening. Conclusion: The most common cervical cancer in this region of India is squamous cell carcinoma. Majority patients had complained of bleeding per vaginum, between 41- 60 year, multiparous, had poor genital hygiene & illiterate. The study concludes that screening of cervical cancer should be emphasised in women especially in rural areas for early detection of cancer and reduce mortality and morbidity in productive age.

Keywords: Cancer; Awareness; Mortality; Hygiene; Screening. 

Background: It is a physiological process in women and is associated with risk to health of both mother and child. To prevent maternal and fetal morbidity and mortality by early assessment of severity of pre eclampsia and eclampsia. Objective: to compare the coagulation parameters between the test group and control group. Materials and Methods: A total number of 30 normal antenatal women without Pregnancy induced hypertension are included in control group and a total number of cases of Pregnancy induced hypertension are taken as test group. Comparision of coagulation parameters like Activated partial thromboplastin time, Prothrombin time and platelet count were studied in these patients. This study was undertaken for a period of one year of January 2016 to January 2017 in department of pathology, central laboratory, narayana medical college & hospital, Nellore. Results: Coagulation parameters such as Activated partial thromboplastin time, Prothrombin time and platelet count were studied in both 30 control and cases. Study showed significant alteration of coagulation profile depending on severity of disease. All results were statistically analysed. Conclusion: Estimation of different parameters like Activated partial thromboplastin time, Prothrombin time and platelet count play s a role in the diagnosis of Pregnancy induced hypertension and evaluation of risk factors, early detection of which will decrease maternal morbidity and mortality.

Keyords: Pregnancy Induced Hypertension; Preeclampsia; Activated Partial Thromboplastin Time; Prothrombin Time; Platelet Count. 

Background: The ABO and Rhesus (Rh) blood group systems are the most important human blood group systems and are responsible for most of the blood transfusion reactions, transplant rejections, parental testing and legal purposes. Settings and Design: A retrospective study was conducted at Blood Bank, GMC, Latur, and Maharashtra. A total of 6224 blood donors were studied, during the period from 1st January 2016 to 31st May 2017. Materials and Methods: ABO and Rhesus grouping of the donors were determined using the standard monoclonal antisera by slide agglutination method and reverse grouping. Statistical Analysis: The frequency of ABO and Rh blood group typing was expressed in simple percentages. Results: Out of 6224 donors, 6117(98.28%) were male and 107(1.72%) were female donors. The commonest ABO blood group was B (32.97%) followed by O (30.14%), A (26.38%) and least common AB (10.51%). Among 6224 donors, 298 (4.79%) were Rh negative while 5926 (95.21%) were Rh positive. Conclusion: Our study throws light on the distribution of blood groups in Latur region, which is important for blood banks and transfusion service policies that could contribute to National Health System.

Keywords: ABO; Rhesus; Blood Group; Donors.

Introduction: The most commonly encountered clinical problem are the lesions of the thyroid. Most of these can be treated medically or surgically. Fine needle aspiration cytology and histopathological examination together are very helpful in establishing the diagnosis. The role of a pathologist is thus very crucial in establishing the nature of thyroid lesions. Materials and methods: We have taken up a prospective study for a period of two years at Narayana Medical College and General Hospital. We have analysed a total of 250 cases during this period. Cytological and histopathological slides were reviewed and the results were analysed. Results: In our study there was a female predominance with non-neoplastic lesions predominating the neoplastic lesions. Nodular goiter was most common among benign lesions and papillary carcinoma was common in the malignant category. Histopathology plays an important role in the diagnosis of lesions which are missed on cytology or inconclusive on cytology. Conclusion: Fine needle aspiration cytology and histopathology go hand in hand in the diagnosis of thyroid lesions giving almost 100% results.

Keywords: Cytology; Histopathology; Thyroid; Lesions. 

Background: The nasal cavity and the paranasal sinuses form a single functional unit. Malignant sinonasal tumours are characterized by low incidence, non specific symptoms, and late presentation. The malignant sinonasal tumours encompass an entire range of both epithelial and non-epithelial tumours. Aims & Objectives: Our study aims to determine incidence, age, sex, site, mode of presentation and histological types of various malignant sinonasal tumours over a 5 year period. Methods: 107 malignant sinonasal tumors biopsied or surgically excised over a period of five years were studied. Results: We encountered 107 cases of malignant tumors with an incidence of 0.24%. Malignant tumors occurred with a mean age of 52.05 years and the male to female ratio was 2.3:1.Among malignant tumors, epithelial tumors (97 cases) constituting 90.65% predominated over non epithelial tumors (10 cases) constituting 9.35% with a ratio of 9.7:1. Out of the 107 cases 58 tumors involved the nasal cavity (54.21%) and 49 involved paranasal sinuses (45.79%). The most common malignant tumor encountered was squamous cell carcinoma-60 cases (56.07%). Conclusion: The clinical and radiological features of masses of nasal cavity and paranasal sinuses are overlapping and often only a provisional diagnosis is possible. Definite diagnosis requires histopathological examination.

Keywords: Sinonasal Tract; Malignancy; Squamous Cell Carcinoma; Epithelial; Nonepithelial. 

Background: Tuberculosis in India continues to be a major health problem with approximately one eight of total cases being extra pulmonary. The gastrointestinal tract is involved in 66-75% of cases of abdominal tuberculosis. The pathologist plays a central role in diagnosis of intestinal tuberculosis (ITB). Many intestinal lesions especially non-neoplastic share the same clinical background, where characteristic pathological features not only suggest specific diagnosis but also the extent and severity of the disease. Aim: To study the profile of tuberculous lesions of small and large intestine including appendix in relation to age and sex distribution, the clinical presentation and regional distribution of the lesions. Method: A prospective study of 30 diagnosed cases of ITB encounterd in surgically excised specimens of small and large bowel including appendix carried over a period of five years.The diagnosis was based on the presence of caseating or non-caseating epithelioid cell granulomas, acid-fast bacilli (AFB) on histology. Results: Intestinal obstruction was the most frequent clinical presentation in ITB cases in this series.The mean age was 34.2 years with M: F ratio of 2:1. Ileum and ileocaecal region weremost frequently involved. The three gross morphological forms of tuberculous enteritis seen were ulcerative in 70%, ulcero-hypertrophic in 20% and hypertrophic in 10 %cases. Characteristic caseating granulomas were seen in 60% cases. Conclusion: Along with clinical, radiological and endoscopic evaluation, the present study showed that histopathological analysis also plays an important role in the diagnostic and therapeutic approach to intestinal tuberculosis.

Keywords: Intestinal Tuberculosis (ITB); Acid- Fast Bacilli (AFB). 

Introduction: Cancer is one of the major health issues worldwide including India. Breast cancer is by far the most frequent cancer in females with rising incidence and usually presents at advanced stage at diagnosis making the outcome poor, however aggressive the treatment may be and leading to disproportionately higher mortality rates. Aims and Objectives: To study the age, incidence, clinical presentation and histomorphological pattern of carcinoma breast in all mastectomy specimens. Methodology: Four year retrospective study of 170 mastectomy specimens received in the department of pathology from Jan 2012 to Dec 2016. All the sections were retrieved and diagnosis were confirmed and the necessary clinical data was obtained from records department. Histological grading were done according to Modified Scraff-Bloom-Richardson Method. Results: The commonest presenting symptom was painless lump (65% of patients) with slight left breast predominant involvement (55%). The most common site of location were in upper outer quadrant (35%) and the least in subareolar region (3%). Among the histological varieties invasive duct carcinoma not otherwise specified was the commonest (83%) and the least was tubular carcinoma (0.5%). Majority of the patients were between 41-50 years (45%). 56% of cases showed evidence of metastasis in lymph nodes. In our study, 52.1% of carcinomas were in Grade I, 41.3% were in Grade II, and 6.6% were Grade III. Conclusion: Carcinoma breast is affecting young to middle age group and the number of cases increasing every year and we cannot prevent this cancer, all we can do is Breast Awareness and screening programmes is the need of the hour.

Keywords: Breast; Mastectomy; Infiltrating Duct Carcinoma; Tumor Size; Grade. 

Context: Cytopathological assessment of bronchoscopy specimens plays a crucial role in the diagnosis of bronchopulmonary lesions. Aim: Our study was aimed to assess the diagnostic efficacy of cytological techniques in bronchopulmonary lesions in correlation with histopathological examination findings. Settings and Design: Correlative study. Methods and Material: 250 patients with symptoms and signs of pulmonary lesions were selected for the study and bronchoscopy was performed. Specimens from bronchial brush followed by bronchioalveolar lavage were collected and routinely stained with Papanicolaou, Hematoxylin & eosin and Giemsa stains and studied. Special stains like Per-iodic acid Schiff and Ziehl-Neelson were performed as per requirement. Endobronchial biopsy specimens were processed as per routine histopathological techniques and stained. Statistical analysis used: Sensitivity, Specificity, Positive Predictive value, Negative Predictive value and Diagnostic Accuracy. Results: The age of the patients ranged from 20 to 87 years. The male to female ratio was 3.2:1. Out of 250 cases, neoplastic lesions were seen in 48 cases and non-neoplastic lesions were observed in 202 cases. Bronchoalveolar lavage cytology showed 36 true positive cases and 202 true negative cases, Bronchial brushing cytology showed 46 true positive cases and 202 true negative cases as confirmed by Bronchial biopsy. Conclusion: Diagnostic efficacy levels of cytological techniques in pulmonary lesions have acquired sensitivity levels high enough to be recommended for use as routine and definitive diagnostic tools in the evaluation of bronchopulmonary lesions.

Keywords: Bronchoscopy; Endobronchial Biopsy; Cytopathological Assessment; Sensitivity; Specificity. 

Identifying and employing appropriate learning styles could play an important role in selecting teaching styles, which can improve education ultimately.The present study aimed to assess the diversity of learning styles amongst medical students of a Basaveshwara Medical College, Chitradurga, Karnataka in 2014. A cross-sectional study which employed VARK learning style’s questionnaire was done on 89 Second year medical sciences students. Data was collected with use of VARK questionnaire. The validity of the questionnaire was assessed on basis of experts’ views and its reliability was calculated by using Cronbach’s alpha coefficients. Data were analysed by using SPSS software and Chi-square test. The preferred learning styles of medical students in the present study were aural and reading/writing. It is suggested that all medical students must be tested to determine their desired learning styles by using VARK questionnaire, also to choose appropriate teaching methods and to improve educational goals.

Keywords: Visual; Aural; Kinesthetic; Reading; Writing; Quad Modal. 

Background: Platelets are the important constituents of blood which are the main players during the process of thrombus formation. Endothelium produces a large number of substances that affect blood flow and can lead to a hypertensive state. Large observational studies indicate that in hypertension, cardiovascular morbidity and mortality are related to the severity of hypertensive state and to the development of cardiac and vascular changes. Platelet count (PLC) and elevated mean platelet volume (MPV) levels are thought to be closely associated with cardiovascular diseases such as acute ischemic stroke, left ventricular hypertrophy, carotid atherosclerosis as well as hypertension. This study was done to evaluate PLC and MPV in hypertensive patients compared to control normotensive subjects. Methods: This was a cross sectional case control study in tertiary care hospital in Mangalore. During this study period 50 control and 50 cases were analyzed. Results: Among the controls majority are males (68%) with mean age of 44 years. Among the cases, majority are males (62%), with mean age of 60 years. In control, mean PLC were 2, 53,380 cells and average MPV was 8.46 fL. Among the case group, the mean PLC was 2, 36, 417 cells and average MPV was 8.40 fL. Since the p values are more than 0.05, there is no difference in PLC and MPV in cases and controls at the 5% level of significance. There was no increase in the platelet indices in hypertensive patients compared to normotensive patients. Conclusion: Though we started our study anticipating an increase in PLC and MPV in hypertensive patients, the results we obtained could not prove such a correlation. A further study and research involving a great number of patients is needed in this field to support the hypothesis.

Keywords: Platelet Count; Mean Platelet Volume; Hypertension; Correlation. 

Background: Pyogenic granuloma is an excessive proliferation of granulation tissue that usually develops after minor trauma or surgery. Ocular involvement usually happens on the external surface and cornea is rarely involved. The objective of our report is to describe the clinicopathological feature of this rare disease and give insight on clinical features that help in the diagnosis. Case Report: A 62 year old male came with the complain of loss of vision and pain, who had fleshy growth of one week duration on the right eye after development of pain and redness in ophthalmology department. Slit lamp examination showed vascularized central corneal mass with surrounding stromal infiltrates. The mass was excised, and histopathological examination confirmed pyogenic granuloma of the cornea. Conclusion: Pyogenic granulomata of the cornea are rare. However, the present case illustrates the importance of considering benign inflammatory causes in the differential diagnosis of a corneal mass lesion so as to avoid unnecessarily aggressive therapeutic intervention.

Keywords: Pyogenic granuloma; Cornea; Lesion. 

Background: There is some “grey zone” in thyroid cytology where the diagnostic efficacy declines sharply rendering it difficult to categorize the lesions resulting in discrepancy. So, a study was conducted to determine the accuracy of FNAC in diagnosis of thyroid lesions and to assess the correlation between preoperative cytological diagnosis and post operative histopathological diagnosis. It was observed that FNAC is reliable, safe and accurate method as a first line of evaluation in thyroid swelling before the surgery. Aim: To highlight probable causes of error in the cases showing discrepancy between cytological and histological diagnoses. Materials and Methods: A retrospective and prospective study was conducted from June 2013 to July 2015 in Pathology department of our hospital. Patient data were collected and details of their thyroid lesion, including clinicopathological features and FNAC findings were recorded. The cytology reports were compared with the histopathological diagnosis. Results: A total of 136 cases of thyroid lesions were aspirated. 131 cases are adequate for reporting. Remaining 5 cases were sample inadequate. Out of 131 cases, 40 cases were available for histopathological correlation. Age group of 3140 yrs is most effected group with thyroid disorders Adenomatous Goiter is the most common thyroid lesion in study. Statistical analysis of our data shows the diagnostic accuracy of FNAC to be 97%. FNA showed sensitivity and a specificity of 100%. Conclusions: FNAC is a rapid, efficient, costeffective, relatively painless procedure with a high diagnostic accuracy. Hence, it is a valuable tool in the diagnosis and management of patients.

Keywords: CytoHistopathological Correlation; Fine Needle Aspiration Cytology; Thyroid Lesions. 

Background: The purpose of this study was to analyze the trends in the incidence rates of major types of leukemia viz. acute myelogenous leukemia (AML), acute lymphocytic leukemia (ALL), chronic myelogenous leukemia (CML), chronic lymphocytic leukemia (CLL) and mixed phenotypic acute leukemia (MPAL), in the population of upper Assam who have visited Assam Medical College, Dibrugarh, during the period June 2012 to June 2016. Due to the lack of any leukemia screening program, the majority of the people are not aware of the disease. Epidemiological study can play a vital role in understanding the occurrence and outcome of the disease. The present study is carried out to see the pattern of leukemia in different ethnic population of upper Assam. Method: 204 cases of leukemias comprising of 120 males and 84 females were analysed focusing on their ethnicity. Result: The highest number of leukemia cases was found in Mongoloids 83 cases (40.69%) followed by Tea tribes 58 cases (28.43%). The highest number of AML (45.74%), ALL (39.13%) and CLL (72.73%) cases were found in Mongoloids while the highest number of CML (34.09%) was found in Tea tribes. Conclusions: Ethnicity is independent of disease type and severity at diagnosis and should be taken into consideration in the management of leukemia patients, especially in terms of social and psychological support. It reflects socioeconomic differences and must be taken into consideration for long time survival of patients with leukemia.

Keywords: Leukemia; Ethnicity and Race. 

Aim: Aim of the study is to review the cytomorphology of granulomatous lymphadenitis on FNAC and confirm with the final histological diagnosis in available cases. Materials and Methods: A retrospective study of 40 cases in a tertiary referral hospital, Mediciti Institute of Medical Sciences, was done for a one year period, i.e., from June 2015 to May 2016. Result: 6 cases out of 40 underwent surgery. 3 cases confirmed the original FNAC diagnosis of granulomatous lymphadenitis. The other 3 cases were diagnosed as metastatic squamous cell carcinoma, anaplastic large cell lymphoma and diffuse large cell lymphoma respectively. Conclusion: A significant number of cases of FNAC diagnosed as granulomatous lymphadenitis have an identifiable underlying causal pathology. FNAC combined with clinical correlation is the first line investigation that helps to single out those that need further investigation or biopsy. use of additional special stain like ZN stain for AFB and culture for AFB in addition to routine H&E. Use of appropriate stains like PAP stain in suspected metastatic carcinoma and Leishman stain in suspected lymphoma can aid in the diagnosis.

Keywords: Granulomatous Lymphadenitis; FNAC; Carcinoma; Lymphoma. 

Aim: The present study demonstrates the recent experiences in histopathological diagnosis of phyllodes tumor of breast. Material & Methods: Histopathological slides and medical records of eleven cases of phyllodes tumor of breast diagnosed at the Department of Pathology, SRMSIMS, Bareilly from January 2013 to December 2016 were reviewed. Cases were evaluated for degree of stromal cellularity and atypia, mitotic count, stromal overgrowth, and the nature of the tumour borders. Results: The median age at diagnosis was 45 years (range 30 years to 58 years). Mean tumor size was 10.2 cm (range 22cm to 6cm). Tumors predominated on the right side (54.5%). Wide tumorectomy was performed in seven patients and four patients underwent mastectomy. FNAC was performed in seven cases out of which 3 cases were diagnosed as phyllodes, 2 cases showed possibility of phyllodes and 2 cases were diagnosed as fibroadenomas. Histopathologically 10 cases were diagnosed as benign phyllodes and one case was diagnosed as borderline or low malignant potential. There were two cases of recurrent benign phyllodes tumor. Conclusions: The confrontation of our results to the data of the medical literature shows that histological confirmation is required for the diagnosis of phyllode tumors. The treatment of choice is surgery. The prognosis depends on the histological characteristics of these tumors.

Keywords: Phyllodes Tumor; Prognosis; Tumorectomy. 

Background: Several changes in platelet parameters have been reported in Iron deficiency anemia. But underlying mechanism between iron metabolism and megakaryopoiesis is not yet clear. Hence the aim of the study is to evaluate relation between iron and platelet parameters in women with IDA. Materials and Methods: Sixty women with mean age of 33 ± 11 (16 – 78) years with IDA were studied. The relationship between serum iron parameters such as iron, ironbinding capacity, iron saturation and ferritin and platelet parameters such as platelet counts, platelet crit, mean platelet volume (MPV), platelet distribution width (PDW) and large platelet (LPLT) were evaluated by using Pearson correlation and stepwise logistic regression tests. Results: Thrombocytosis and thrombocytopenia were noted about (77.46% and 22.54% ) respectively. Platelet counts were inversely correlated with serum iron and transferrin saturation (p<0.05). Other iron parameter revealed no significant relationship with any platelet parameters. There was a linear relationship between platelet counts and platelet crit (p<0.001) but inverse relationships betweenplatelet counts and both mean platelet volume and ironsaturation (p<0.001, for both). Also there were a linear relationship between platelet distribution width and mean platelet volume (p<0.001) and an inverse correlationbetween platelet distribution width, Mean platelet volume, Platelet crit with both mean corpuscular volume and Mean corpuscular hemoglobin concentration p<O.O01). Platelet crit was linearly correlated with platelet count mean platelet volume, and LPLT (p<0.05). There is no significant correlation between platelet crit with any iron parameter. Conclusion: This study concludes important iron parameter affecting the platelet was serum iron and transferrin saturation. Patient with severe anemia had higher platelet count, PCT and MPV. Changes in platelet parameter are due to low levels of tissue iron. Decrease iron saturation also stimulates megakaryopoiesis and iron has inhibitory effect on platelet counts.

Keywords: Iron Deficiency Anemia; Platelets; Women; Thrombocytosis. 

Background: Dysfunctional uterine bleeding (DUB) is characterized by abnormal bleeding that is unrelated to any identifiable cause. The aim of this study is to establish that, DUB is a disorder of angiogenesis by detecting vascular endothelial growth factor (VEGF) expression on immunohistochemistry(IHC) study of DUB endometria. Material and Methods: It was a cross section study, undertaken at Index Medical College, Indore over a period of 18 months from March 2015 to July 2016. The study includes 100 endometrial dilation and curettage (D&C) and hysterectomy specimen of clinically diagnosed DUB patients. These specimens were studied for histopathology and expression of VEGF. Results: VEGF expression in endometria of DUB patients was significantly higher than in endometria of control group. There was also significant higher expression of VEGF in endometrial hyperplasia. Conclusion: Significantly over expression of VEGF in the endometrial glands in cases of DUB suggest that VEGF plays an important role in the pathogenesis of DUB

Keywords: DUB; Angiogenesis; VEGF; Endometrium. 

Introduction: Ascites represents the pathological collection of fluid in the peritoneal cavity. Spontaneous bacterial peritonitis is the infection of the ascitic fluid. For its diagnosis, the number of polymorphonuclear cell count from the ascitic fluid obtained by diagnostic abdominal paracentesis should equal or exceed 250 cells/ cu.mm and from bacteriological cultures only one type of organism must be isolated. Biochemical analysis is also recommended. It is the most rapid and cost effective method for diagnosing cause of ascites. These patients must be treated with antibiotics aggressively as they have poor prognosis and high mortality if not treated early. Materials and Methods: Study was conducted at a tertiary care hospital, Haryana. All patients under went paracentesis within 24 hours of admission and were diagnosed before giving any antibiotics. Ascitic fluid was submitted in the Central Clinical Laboratory for total and differential leucocyte count, culture and biochemical investigations. Results: Present study included 38 patients of spontaneous bacterial peritonitis. Various clinical signs and symptoms were studied and followed by comparison statistics for all the variants. Statistical study was done to find the etiology for cirrhosis. Culture study revealed various organisms responsible for spontaneous bacterial peritonitis. Conclusion: Polymorphonuclear cell count in ascitic fluid without the need of positive culture is helpful in diagnosing spontaneous bacterial peritonitis. Mortality has decreased because of early diagnosis and effective treatment.

Keywords: Spontaneous Bacterial Peritonitis; Polymorphonuclear Cell Count; Serum/Ascites Albumin Gradient; Culture. 

Background: The past few years have witnessed a global increase in the prevalence of thyroid cancer, and it is the fifth most common cancer in women. The study intends to estimate the prevalence of thyroid malignancies, and the ageand genderwise distribution of thyroid cancer in a rural setting in India. Methods: The study was conducted on 158 subjects presented with thyroid swelling between January 2015 and December 2016. Demographic and clinical details were obtained from all the patients. Fine needle aspiration cytology (FNAC) was used for the diagnosis of thyroid lesions. The subjects were classified into various groups based on the age and gender, and the prevalences of various cytological diagnoses were studied. Results: Thyroid swelling was mostly reported in 2140 years age group for women, and in 4160 years age group for men. Out of the 158 smears studied, only 11 (6.96%) were neoplastic. The most commonly reported thyroid lesion was colloid goitre. Neoplastic lesions like papillary thyroid cancer and benign follicular neoplasm were noted in 2.53%, and 4.43% of the subjects respectively. The prevalence of papillary thyroid cancer was comparable in both males and females, whereas benign follicular neoplasm was more common in females. Conclusion: The common thyroid lesion noted was colloid goitre and the most common thyroid malignancy noted was benign follicular neoplasm.

Keywords: Colloid Goitre; Follicular Neoplasm; Papillary Thyroid Cancer; Thyroid Lesions. 

Background: Bone marrow examination is an important diagnostic tool in the evaluation of cases of myelophthisic anemia. Myelophthisis means replacement of bone marrow elements by the tumor tissue, granulomatous inflammations or fibrosis, which further leads to anemia. Methods: our study was retrospective study which reviewed bone marrow examination of 60 cases with myelophthisic anemia in Narayana Medical College and hospital, during a period of 5years (Jan 2011Jan 2016). Result: Our study of 60 cases revealed, 53 cases having neoplastic involvement of bone marrow and 7 cases having nonneoplastic pathology. 53 cases having neoplastic involvement showed 49 cases with haematological and 4 cases with secondary metastatic deposits. In our study 50% cases presented with anemia, 30% with leukoerythroblastic picture, 13.33% cases presented with pancytopenia & 6.66% cases with thrombocytopenia Conclusion: Our study reflected that the common causes of myelophthisic anemia was neoplastic (88.33%) and tuberculosis (42.86%) commonest among the nonneoplastic involvement.

Keywords: Myelophthisic Anemia; Bone Marrow. 

Introduction: Aim of the Study: To study the spectrum of lesions in cervical lymph nodes onFine Needle Aspiration Cytology. Materials and Methods: This was a prospective study done over a period of two and half yearsin the department of pathology at Kakatiya Medical College, Warangal, Telangana. A total of 330 patients with cervical lymphadenopathy were evaluated. The detailed clinical history was recorded before performing FNAC. Other relevant radiological investigations were also noted for correlation. Results: FNACs was done in 350 cases who presented with enlarged cervical lymph nodes. There were 20 inadequate aspirates which were excludedfrom the study. Age group ranged from1 to 70 years. Majority of the patients (33.3%) were in the age group 2130 years and male to female ratio was 2.3:1. Tuberculous lymphadenitis was the most common diagnosis. Conclusion: FNAC of lymph nodes is very useful and simple procedure in the initial diagnosis of cervical lymphadenopathies.

Keywords: Cervical Lymphnode; Fine Needle Aspiration Cytology; Tuberculosis. 

Introduction: India has high prevalence of HCV in blood donors, which is easily transmitted through infected blood. The aim of the present study is to determine the seroprevalence of HCV in 14727 blood donors in Davangere. Materials & Methods: The present study was conducted to detect Hepatitis C in blood donors (voluntary and replacement donors) for two years & screening done by ELISA (3rd generationUBIR, HCV EIA.40 kit). Results: Seroprevalence of HCV was 0.33%, among which 85% were males (13292) and the remaining were females donors (1435).Among 43 positive donors, one donor was illiterate and the remaining 42 were literate. Out of the total positive donors, married donors showed 0.42% and unmarried showed 0.18% seropositivity. Most of the seropositive individuals were in reproductive age group (1840) Highest prevalence was in age 1835 years. A, B and O group donors were almost equal in number with AB group constituting least number of donors. Conclusion: In conclusion, the present study has established the prevalence the HCV antibody in healthy donors was 0.29% in our area (Davangere). This proves that compulsory screening for HCV lowers the incidence of post transfusion hepatitis (PTH).

Keywords: HCV; Hepatitis C Virus; Sero Prevalence; Blood Donors.

Introduction: Red cell distribution width (RDW), a numeric measure of variability in the size of circulating erythrocytes is a routinely reported haematological parameter commonly part of complete blood cell count. RDW was found to be a strong independent predictor of poor outcome in a variety of cardiovascular disease states even after adjustment for potential confounders, including anaemia and renal dysfunction. The present study was undertaken to analyze the variation in RDW, Hb% and MCV in elderly patients with various illnesses. Aim and Objective: 1. To study the pattern of Red cell Distribution width (RDW) in elderly patients in different diseases. 2. To correlate increased RDW values with other RBC parameters like Hb% and MCV. Materials and Methods: Material for the study consisted of RBC parameters like Hb%, MCV of consecutive patients aged more than 65 years, who had increased RDW, irrespective of their sex and illness which were retrieved from laboratory records. These patients (both in patients and out patients) were referred to haematology laboratory whose Ethylene Diamine Tetra Acetic acid (EDTA) blood samples were analyzed by automated hematology analyser (Horiba Abxpentraxl 80.303pxl 5748 analyzer). Relevant clinical data of these patients like age, sex and clinical diagnoses were also obtained from the clinical records. Data analyzed was expressed in numerals and percentage. Results: Out of 196 patients, blood samples of 60(30.16%) patients had increased RDW, out of which 39(65%) were males and 21(35%) were females. IHD formed the major portion of patients with increased RDW comprising of 31(51.66%) patients. 36 patients had Hb<10gm %( 59.9%) and 40 (66.6%) patients had MCV <70fL. Conclusion: Most of the patients with increased RDW were those with IHD. Majority of them were males. The biologic mechanisms underlying the association of RDW with various diseases merit investigation. RDW is an inexpensive test routinely reported to physicians, further research is needed to determine whether RDW is an useful risk assessment tool in different clinical settings apart from the ones which are proved.

Keywords: RDW; Elderly Patients; IHD. 

Materials and Methods: Four months study was conducted at Index Medical college, Department of Pathology. The initial rapid diagnosis of diabetes was confirmed followed by homocysteine level by ELISA method. Results: Out of 45 diabetic patients enrolled in the study, 36 patients (80% of 36 patients) had blood sugars values <200 mg/dl and 9 patients (20% of 36 patients) had random blood sugar values >200 mg/dl. Out of 23 patients (100% of the 45 patients) with normal homocysteine values, 18 patients (78.26%) had random blood sugar values <200 mg/dl and 5 patients (21.74 Objective: Hyperhomocysteinemia is strongly associated with increased risk of type 2 diabetes mellitus. Patients %) had random blood sugar values >200 mg/ dl. Out of the 22 patients with abnormal plasma homocysteine values, 18 patients (81.82% of the 22 patients) had random blood sugar values <200 mg/dl and 4 patients (18. 18%) had random blood sugar value >200 mg/dl. Conclusion: A regular monitoring of homocysteine levels appears to be a useful strategy to reduce the morbidity and mortality in diabetic patients.

Keywords: Homocysteine; Diabetes; Cardiovascular Diseases. 

Background: Gastrointestinal tumors account for a large proportion of all neoplasms. Colorectal cancer ranks second and stomach cancer ranks fourth amongst the most common tumors of the world, according to the World Cancer Report of 2000. Aims: The present study was undertaken with a view 1) To determine the frequency of GIT tumors with respect to age, sex and site of lesion in our institute. 2) To classify the GIT tumor according to WHO classification. Material and Methods: This was a prospective study over three years period. Gross and histopathological examination of the specimens was done, for assessing appearance and extent of lesion. Stains used were routine hematoxylin and eosin stain. Special stains such as Periodic acid Schiff (PAS), Alcian blue, Mucicarmine were done wherever required. The clinicopathological data was analyzed and observations were noted. Results: Of 129 cases of GI tumours, 98% were malignant and 1.6% was benign. GI malignancies had a peak in 5160 years. M: F ratio was 1.1:1. Colorectal cancers occurred most commonly followed by oesophagus, stomach and small intestine in descending order. Conclusion: There is a need to conduct detailed studies before these societies are transformed into westernlike environments. Otherwise we may miss an unique opportunity to understand the factors that could prevent many cancers in the world.

Keywords: GIT; Tumor; Colorectal; Cancer; Oesophagus; Stomach; Histopathology; Small Intestine 

Introduction: Cytomorphologic features of benign breast lesions which encompasses majority of palpable breast lesions have not been studied in great detail. Aim and objective: To study the cytomorphological aspects of benign breast lesions in patients with an apparent breast lump and their histopathological correlation. To find accuracy of fine needle aspiration cytology (FNAC) in the diagnosis of benign breast lesions. Material and Methods: The present study included 200 prospective cases of benign breast lesions presenting with palpable breast lump in the outpatient department. FNAC was carried out on all of them. Cytomorphological features were studied and correlated with clinicohistopathological features. Results: The most common lesion in our study was fibroadenoma followed by fibrocystic disease. The diagnostic accuracy was 89.16%. Conclusion: FNAC is a simple, rapid, cost effective, highly sensitive and specific procedure in diagnosing benign breast lesions.

Keywords: Benign Breast Lesions; Fine Needle Aspiration Cytology (FNAC). 

Introduction: The present study of Urothelial carcinoma is intended to include: Retrospective hospital based observational study of paraffin section of old block and cases attending our hospital. Material Methods: The study is conducted in the Department of Pathology at SRMS IMS, during a period of 21 months, 1st January 201330th September 2014. Total 80 cases of Urothelial Carcinoma were included in the study. Tumour is classified according to WHO classification and all the 80 cases were subjected to Immunohistochemical study for p53 from the representative areas. Samples demonstrating at least 10% nuclear reactivity were considered positive for p53. Results: Out of 4 cases of PUNLMP, 1 case (25%) was positive for p53. Out of 27 cases of Low grade papillary urothelial carcinoma, 4 cases (14.8%) were positive for p53. Out of 48 cases of High grade papillary urothelial carcinoma, 28 cases (58.3%) were positive for p53. 1 case of Mucinous adenocarcinoma with signet ring change was positive for p53. Discussion: The present study results were in consistency with the other studies, i.e a higher rate of p53 protein positive staining was seen in high grade tumor. Conclusions: p53 alterations are significantly associated to clinicopathological features of poor prognosis, the inclusion of p53 mutation status into a predictive panel of tumor markers for bladder cancer is recommended.

Keywords: p53; Urinary Bladder Carcinoma; IHC.

Background: Micronucleus in buccal mucosa exfoliative cells is essential to have reliable and relevant minimally invasive biomarkers to improve the implementation of biomonitoring, diagnostics, and treatment of disease caused by, or associated with genetic damage. Methods: The present retrospective study was carried in 100 persons in which 25 persons were alcohol consumers, 25 persons were tobacco smokers, 25 persons were both alcohol consumers and tobacco smokers and 25 persons were control group, in the department of pathology, Narayana Medical College & Hospital, Nellore, Andhra Pradesh, India, during the period of January 2016 to December 2016. Cytological smears was fixed in ethyl alcohol and then stained with Hematoxylin & Eosin staining technique and assessed for micronuclei count. Result: The micronucleus count in “A” group was a mean count of 4.89 micronuclei, where as the mean micronucleus count in “S” group was 5.36. The “A+ S” group had the mean micronucleus count of 5.98 and the control group had a mean micronucleus count of 3.67. Conclusion: The present study was undertaken to observe the micronucleus count and micronucleus index among smokers (S group), alcoholics (A group) and smokers and alcoholics together (A+S group) and compare with controls (C group) that had no such life style habits. In this study there was a significant difference between smokers and controls which seem to be more prominent in cases of both smoking and alcoholic group when compared to controls and the significance of alcohol only, was not well proven.

Keywords: Buccal Mucosa; Micronucleus. 

Background: Intraoperative cytology preparation was first introduced by Eisenhart and Cushing in early 1930s. With the advent of CT and MRI guided stereotactic biopsies, smear technique has gained importance because of technical simplicity and good preservation of cytological and nuclear details at low expense. Aims: 1. To study various patterns of central nervous system [CNS] lesions in squash cytology and histopathology. 2. To correlate cytological diagnosis with histopathology. 3. To evaluate the diagnostic utility of intraoperative squash cytology. Settings and Study Design: Analytical study at tertiary care hospital. Material and Methods: Hundred cases were analyzed. Squash smears were prepared from biopsy samples sent in isotonic saline. The smears were stained by Hematoxylin and Eosin [H &E] and Papaniculaou [PAP] stain. Histopathological evaluation was done subsequently from biopsy samples sent in formalin. Special stains were performed in selected cases. Cytomorphological features were correlated with histopathology. Statistical Analysis: Frequencies, ChiSquare Test and Crosstabs were used for calculation. Results: Histopathological diagnosis of hundred cases included neoplastic lesions [90%] and nonneoplastic lesions [10%]. Correct diagnosis was achieved by squash cytology in 68 cases [73.11%] by complete correlation. However, diagnostic accuracy improved considerably [84.94%] after applying partial correlation criteria. For the detection of neoplastic lesions, squash cytology had sensitivity of 95.29%, specificity of 75% and efficacy of 93.54%. The p value, determining efficacy of squash cytology for detecting CNS neoplasms was statistically significant [p<0.005]. Conclusions: Squash cytology is a reliable, rapid and inexpensive intraoperative diagnostic tool. It has high sensitivity and is highly efficacious procedure.

Keywords: Neurosurgical; Squash Cytology; Histopathology; IntraOperative; Diagnostic Accuracy.

Background: Getting adequate exfoliated cells in serous fluids is not an easy task and diagnosis is in dilemma which not only hampers patient’s outcome but also confuses pathologists. Materials from patients submitted in the form of fluids for cytological examination can be evaluated in two fashions :1. Smear technique following centrifugation of the specimen 2. Cell block technique. The present study was done to 1. Evaluate the diagnostic efficacy of routine staining method and cell block technique 2. To diagnose the type of malignancy and to know primary site of malignant effusion by special stains and IHC wherever possible. Methods: Fluids from aspirates of body cavities i.e. pleural, pericardial, peritoneal were collected over a period of two years from September 2014 to July 2016. Fluids obtained were first examined by naked eye for physical characteristics and then processed in two halves. One portion was prepared as conventional method and the other was processed by Cell block technique. Smears obtained were studied and compared. Result: One hundred and four samples were subjected to diagnostic evaluation. Along with conventional smear, fluids were subjected to cell block technique. The age of the patients ranged from 5 to 92 years. Male: female ratio was 0.7:1. The samples were categorized into benign, malignant lesions and suspicious for malignant cells. Additional yield for malignancy was obtained by cell block method when compared to conventional smears. Conclusion: Cell block method provides an additional yield of malignant cells, and thereby, increases the sensitivity of the cytodiagnosis when compared to conventional smear method and use of IHC help to identify primary site of malignancy giving more definitive diagnosis.

Keywords: Cell Block; Conventional Smear; IHC. 

The study is a prospective study undertaken on endometrial curettings from clinically diagnosed cases of abnormal uterine bleeding (AUB). The objectives were to analyze the histomorhological patterns of endometrium in clinically diagnosed cases of AUB in different age groups in comparison with the other similar studies. Patients from all the age groups were included in the study and all types of pregnancy complications were excluded from the study. The endometrial biopsy material, fixed in 10% formalin was processed, sections were cut from blocks prepared from paraffin, stained with H&E and studied. A total of 100 endometrial biopsies from clinically diagnosed AUB patients were studied histopathologically. Out of these 46% were simple hyperplasia, 22% were proliferative endometrium, 9% were complex hyperplasia, 8%were secretory phase, disordered proliferative endometrium and endometrial polyp were 4% each, anovulatory endometrium and adenocarcinoma were 2% each, chronic endometritis , inadequate secretory phase and pillendometrium were 1% each. Majority of the patients in the present study were in the age groups of 4150yrs. Most common presenting complaint in the present study was menorrhagia. In conclusion it is observed that AUB is most common in perimenopausal age groups with histomorphological pattern of simple hyperplasia, followed by normal proliferative pattern, secretory pattern and endometrial carcinoma is seen in older age groups and most commonly presenting with post menopausal bleeding. Histopathological findings in the endometrial biopsies of these patients help to detect & differentiate between functional causes and organic lesions there by facilitating appropriate patient management.

Keywords: Abnormal Uterine Bleeding; Simple Hyperplasia; Menorrhagia.

Background: Papulosquamous skin diseases are amongst the most important dermatological lesions because of their high prevalence. Clinical and histopathological distinction of each of them is of paramount importance because of different treatment modalities and prognosis. Aim: To analyse and classify the cases with non infectious erythematous papulosquamous lesions; psoriasiform and lichenoid dermatitis based on histomorphological characteristics. Materials and Methods: In present study 100 cases of noninfectious erythematous papulosquamous skin disorders were histopathologically examined to analyse the characteristic features in psoriasis and lichenoid dermatitis. Study was done for a period of one and a half year from March 2015 to July 2016. Results: Out of 100 cases of papulosquamous lesions, we encountered 80 cases with histomorphological features consistent with Lichen planus (44%) and psoriasis (36%). These features were analysed and correlated with the clinical diagnosis. Conclusion: Psoriasis and Lichen planus comprise the bulk of papulosquamous skin disorders (80/100 cases). The age group of 2140 years was most frequently involved with both the disease showing male preponderance. The present study signifies the advantage of coherent use of clinical examination and histopathological study in making an accurate diagnosis.

Keywords: Papulosquamous; Erythematous; Lichen Planus; Psoriasis; Histopathology. 

Introduction: Thyroid gland is very often subjected to FNAC as thyroid enlargement is a common clinical problem and also due to its easy accessibility for the procedure. Hurthle cells are commonly encountered in thyroid aspirates from varied etiology. Aim of the Study: To find the significance of Hurthle cells in thyroid cytology and to note the cytological features that would differentiate reliably between different lesions containing Hurthle cells. Materials and Methods: This was a two yearstudy conducted in the Department of Pathology, at NRI Institute of Medical Sciences, Visakhapatnam. A total of 858 thyroid aspirates were done of which 240 cases showed Hurthle cells. These 240 cases consisted of the study group in which histopathology examination was done in 107 cases. There were 229 female and 11 male patients in the age groups of 10 to 70 years. Observations and Results: Hurthle cells were seen in 240 (11.6%) cases. Non neoplastic and neoplastic Hurthle cell lesions comprised 222 (92.5%) and 18 (7.5%) cases respectively.There was a female predominance with the male to female ratio being 1:20. There were 201 cases (83.7%) with non neoplastic and 39 (16.2%) with neoplastic etiology. Hashimoto’s thyroiditis, nodular goiter and follicular adenomas commonly showed Hurthle cells. For Hurthle cell lesions, important cytological features were predominantly monomorphic Hurthle cell population, macronucleoli and absence of inflammatory cells. There was good agreement between the cytology and histopathological examination. Conclusion: Hurthle cells are seen in various lesions of thyroid. The presence of>50% of Hurthlecells in an aspirate indicates a Hurthle cell neoplasm.Aspiration cytology in Hurthle cell lesions can differentiate non neoplastic lesions from neoplastic lesions with high accuracy, but differentiation between benign and malignant neoplasms is less reliable.

Keywords: Thyroid FNAC; Hurthle Cells; Hashimoto’s Thyroiditis; Thyroid Histopathology. 

Introduction: Brucellosis is a major zoonosis in the developing countries including India. The reported incidence of human brucellosis in endemic areas varies widely, from <0.01 to >200 per lakh population. Despite being endemic in many developing countries, brucellosis remains underdiagnosed and underreported. Interpretation of the serological tests is often difficult in endemic areas due to presence of antibodies against Brucella in high proportion of the population . Hence estimation of normal baseline titers of Brucella agglutinins in healthy individuals residing in endemic areas and the cutoff values are necessary for the serodiagnosis of brucellosis. AIM: To determine the baseline titre of brucella agglutinins, amongst apparently healthy blood donors in Dhule, Maharashtra, India. Materials and Methods: A total of 480 serum samples were analyzed by RBPT and STAT method for detection of Brucella Agglutinins over period of 6 months from July 2016 to December 2016. These agglutination tests were performed according to manufacturer‘s guidelines by using commercial kits containing stained Brucella abortus Antigen suspension. Result: Of these 480 samples 32 (6.7%) were positive for Brucella agglutinins by RBPT. Of these 32 RBPT positive samples 22(4.6%) showed agglutination by STAT. Amongst 22 STAT positive samples 15 samples were found positive for Brucella agglutinins at 1:40 and 7 samples were positive at 1:80. Conclusion: As RBPT is very sensitive test and its results should be confirmed by STAT. Since the base line titre of 1:80 by STAT was demonstrated in healthy individuals, titres 1:160 and above should be considered significant along with consistent clinical features.

Keywords: Brucellosis; Baseline Titre; RBPT; STAT; Agglutinins. 

Background: Platelet indices are potentially useful markers for the early detection of the thromboembolic diseases. Platelets are known to be implicated in the pathogenesis of cardiovascular disorders including atherosclerosis and myocardial infarction. Platelet hyperactivity and activation have been suggested to play a role in acute coronary syndrome. The degree of activation is indirectly measured by platelet indices viz. mean platelet volume (MPV), platelet distribution width (PDW) and platelet counts (PC). Hence the present study is undertaken to analyse these parameters in acute coronary syndrome (ACS). Objectives: To determine platelet indices and platelet count in cases and compare it with healthy controls. Materials and Methods: This was a comparative study which included 107 cases diagnosed with acute coronary syndrome and 100 age and sex matched healthy controls. The platelet indices and platelet count of both the groups were obtained by automated hematoanalyser. Plalelet counts thus obtained were confirmed by peripheral smear study. These data were entered in Microsoft excel and analysed using the EPI.INFO version 7.0. Results: The MPV & PDW were significantly higher in cases with ACS as compared to controls. Conclusion: Measurement of platelet indices and platelet count is a simple and cost effective tool that can be used as a marker of coagulation.

Keywords: Platelet Indices; Platelet Distribution Width; Mean Platelet Volume; Platelet Count; Acute Coronary Syndrome. 

Introduction: Cancer of the bladder and of prostate are commonmalignancies all over the world. In some cases it is difficult to point to the exact primary due to the anatomical location and morphology of the tumors from these two sites. Various immunohistochemical markers can be used to identify the primary site and p63 is one such marker. Aim of the study: To study the expression of p63 in urothelial carcinoma and prostatic adenocarcinoma so as to differentiate between the two carcinomas. Materials and Methods: In this study, formalin fixed paraffin blocks from 60 cases of urothelial carcinomas of urinary bladder and 20 cases of prostatic adenocarcinomas were examined on light microscopy and tissue sections from all 80 cases were studied for immunohistochemical staining with p63 marker. Observations and Results: The mean age of patients of urothelial carcinoma and of prostate carcinoma was 54.1 and 64.5 years respectively. There were 28 cases (46.6%) of low grade and 32 cases (53.3%) of high grade urothelial carcinomas. The Gleason score for prostatic carcinoma was 56 for 8 patients, 78 for 9 patients and 910 for 3 patients.In 60 urothelial carcinomas 90% of cases showed p63 positivity. All the 20 cases of prostatic adenocarcinomas were negative for p63. Conclusion: p63 is a reliable marker of urothelial differentiation and it can be used in morphologically difficult cases when the differential diagnosis is between poorly differentiated adenocarcinoma of prostate and high grade urothelial carcinoma of urinary bladder.

Keywords: Urothelial Carcinoma of Bladder; Prostatic Carcinoma; p63 Staining.

Dysfunctional uterine bleeding is irregular uterine bleeding that occurs in the absence of recognizable pelvic pathology, general medical disease, or pregnancy. Endometrial biopsy is often the first diagnostic tool in a case of dysfunctional uterine bleeding. A total of 161 cases were analysed during a period of two years, from January 2015 to January 2017 in the Department of Pathology, BGS Global Institute of Medical Sciences. The frequency of the various endometrial patterns with comparison of the patterns in different age groups was observed and documented.

Keywords: Dysfunctional Uterine Bleeding; Endometrium; Dilatation and Curettage. 

Introduction: Neonatal sepsis has always been a significant health problem worldwide, especially in developing countries. Since it is a treatable condition, it has to be diagnosed at the earliest to initiate treatment and to avoid abuse of antibiotics. Objectives: To study the various changes associated with platelets in neonatal sepsis, and to check the diagnostic value of these markers in the early diagnosis of sepsis in neonates. Study and Design: This is a crosssectional analytical study. Methods: This is a study on the evaluation of platelet count and platelet indices viz, Platelet Distribution Width (PDW) and Mean Platelet Volume (MPV) in neonatal sepsis on blood obtained from neonates with a clinical suspicion of sepsis. A total of 100 cases were included for the study. The platelet count and platelet indices were obtained using automated haematology analyser. Leishman stained smears were studied for platelet count and morphology and correlated with blood culture results. Results: PDW showed sensitivity and specificity of 82% and 73 % respectively. MPV showed sensitivity and specificity of 76% and 40 % respectively. Thrombocytopenia showed sensitivity and specificity of 64% and 82 % respectively. Conclusion: Platelet Distribution Width was the most sensitive marker (82%). Thrombocytopenia was the most specific marker (82%). Owing to the diagnostic confusion that usually surrounds Neonatal Sepsis due to the myriad of clinical features it presents, platelet studies could be used as easily accessible and inexpensive tools for the early detection and treatment of this condition.

Keywords: Platelet Indices; Thrombocytopenia; Neonatal Sepsis. 

Introduction: Carcinoma from almost all the organs has a tendency for regional metastasis. Nodal status is a key prognostic indicator in such patients, particularly with N0 stage. Occult metastasis in the form of micrometastasis (MM) and isolated tumor cells (ITCs), often goes undetected by routine hematoxylin and eosin (H&E) examination using 12 sections for analysis. This limitation could be overcome by combining serial sectioning (SS) with immunohistochemistry (IHC) for the detection of MM. Cytokeratin (CK7) is particularly a useful marker to detect these deposits as their presence has resulted in varied interpretations and different applications of the tumornodemetastasis system. The objective of the study was to detect micrometastases in lymph nodes reported negative on H & E staining by combining SS and IHC and to compare it with conventional H&E staining. Methods: The study was conducted on 181 LNs received from 77 patients which were negative on H &E. The lymph nodes (LNs) positive on H & E were not taken up for the study. IHS with CK7 was performed on these lymph nodes for detection of micrometastsis. Results: The application of combination of SS and IHC using CK7 in our study revealed the presence of MM in 14.36% of the LNs diagnosed as negative on routine H&E examination. Conclusion: In the view of crucial role of occult LN metastasis in prognosis and survival of patients, diagnostic tools such as IHC staining, particularly with CK7, combined with SS should be preferred over conventional methods as they result in upstaging, thus sparing the lowrisk patients the morbidity of unnecessary treatment.

Keywords: Micrometastasis; Lymph Nodes; Immunohistochemistry; Cytokeratin7; Serial Sectioning. 

Introduction: Numerous terminologies are used to describe abnormal uterine bleedingmenorrhagia, metrorrhagia, polymenorrhea, oligomenorrhea, intrmenstrual and postcoital bleeding [6]. The spectrum of cervical changes in perimenopausal age ranges from cervicitis to dysplasia to frank malignancy. Methodology: A total of 415 hysterectomy specimens of perimenopausal age group received at Department of Pathology, Hassan Institute of medical sciences, Hassan between the period of January 2015 and December 2016 were included. Results: The predominant histomorphological pattern in endometrium was proliferative phase (48.43%). Endometrial hyperplasia was seen in 72 cases, out of which atypia was seen in 6 cases. In 7 cases endometrial polyps were seen. 6 cases (1.44%) showed endometrial carcinoma. Conclusion: other than malignant lesions, benign neoplastic and nonneoplastic lesions should also be considered in the evaluation of abnormal uterine bleeding cases

Keywords: Hysterectomy; Histopathology; Endometrium. 

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