Indian Journal of Pathology: Research and Practice

Cutaneous reactive angioendotheliomatosis (CRA) is a group of benign skin disorders which comprise 3 main entities: reactive angioendotheliomatosis (RAE), intralymphatichistiocytosis and diffuse dermal angiomatosis (DDA). These disorders are characterized by vascular proliferations which are either intraluminal or periluminal. Of these, RAE is well known to arise in association with chronic systemic disorders. We report a case of a 37 year old female, who presented with multiple, painless skin coloured nodules over the extensor aspect of her upper limb and foot. She also had multiple painful, erythematous nodules over the upper as well as lower limb. Light microscopy of the painless nodules, showed features suggestive of RAE. The painful,erythematous papules of the upper limb, showed features consistent with Borderline Lepromatous Leprosy. Immunohistochemistry with CD31 and CD34 showed positivity of the spindle cells lining the capillaries, proving its vascular origin. To our knowledge, this is the first case to be reported of RAE occurring in the setting of leprosy.

Keywords: Reactive Angioendotheliomatosis; Leprosy; Skin.

Background: Cervix is one of the most common target organs for both non neoplastic and neoplastic diseases of the female genital tract. Cervical cancer is the second most common cancer worldwide having poor prognosis. Carcinoma cervix is the commonest malignancy in Indian women. (Human papilloma virus) HPV infection plays major role in cervical lesions; in which high risk types particularly HPV 16 causes dysplasia and Carcinoma of cervix. 

Materials and Methods: This prospective study was undertaken in the Department of Pathology, Vydehi Institute of Medical Sciences and Research Centre for a period of 1.5 year from January 2015 to May 2016.

Results: 100 cases were included in the study. Out of 100 cases majority were inflammatory i.e. 54% followed by 21% of Cervical Intraepithelial Neoplasia (CIN), 17% invasive carcinoma, 6% benign and 2% of non-neoplastic cervical glandular lesions. Immunohistochemistry was done in (Chronic non-specific cervicitis) CNSC associated with squamous metaplasia and koilocytosis, all non-neoplastic cervical glandular lesions, precancerous lesions and invasive carcinomas.

Conclusion: However, there are many lesions that are mistakenly over diagnosed to be  neoplastic. Therefore, it is recommended to further studies to evaluate these non-neoplastic lesions of the uterine cervix on a community basis. Overexpression of the protein p16INK4A encoded by tumor suppressor gene INK4A is a characteristic of dysplastic & neoplastic alterations of cervical epithelium. The proportion of p16INK4A positive samples increases in the following row: CIN I- CIN II- CIN III- Invasive carcinomas. However p16INK4A negative cervical neoplasms & carcinomas do exists.

Keywords: Neoplastic Lesions; Cervix; Carcinomas.

Clinicopathological study of primary epithelial malignant tumours of thyroid gland: in a tertiary care centre, Kolar. Introduction Thyroid malignancy is the most common malignancy in endocrine system accounting for 87% of all endocrine gland tumors [1]. The incidence of thyroid cancers has been in the rising in the past two decades. The increase in incidence may be due to early detection of asymptomatic cases through screening tests [2,3]. These epithelial tumors are characterized by unique clinical, molecular and biological features [2,4]. Hence it is important to know the different histomorphology of these tumors to foresee prognosis and guide the treatment for better outcome.

Materials and methods: The study was conducted in the department of Pathology, Sri Devaraj Urs Medical College, Kolar constituent college Sri Devaraj Urs Academy of higher education and Research. All the primary malignant epithelial thyroid carcinoma cases were retrieved from the archives of Pathology from January 2010 to December 2016 for the duration of 7 years.

Results: Total numbers of primary epithelial malignancies were 62 cases (2.5% of all malignant cases). The most common thyroid malignancy was the papillary carcinoma (54 cases, 87%) Conclusions Primary epithelial tumors of thyroid accounted to 100% of thyroid malignancy. Most patients presented with neck mass. Papillary carcinoma accounted to 87% of epithelial carcinoma, more common in females. Anaplastic and follicular carcinoma was seen in older age, were associated with distant metastasis 

Keywords: Malignant Epithelial Tumors; Papillary Carcinoma; Medullary Carcinoma;
Vascular Invasion.

Context: Last few decades saw rapid decline of cervical cancer worldwide. However, 75% of the new cases are reported to occur in developing countries due lack of awareness among the female population.

Aims: This study was conducted to determine the prevalence of cervical carcinoma in the urban female population and to evaluate the clinical findings, assess the sociodemographic and risk factors associated with unhealthy cervix in the study group. Settings and Design: This was a descriptive study carried out in KPC medical college Kolkata from December 2014 to December 2017 Methods and Material: Pap smear screening was done on 328 patients presenting with unhealthy cervix, out of which biopsy was obtained from 172 patients. Risk factors, clinical findings and knowledge about awareness programs were taken into consideration. The cytological results were correlated with the clinical findings and compared with the biopsy results.

Results: A total of 19.2% patients presented with epithelial cell abnormality in unhealthy cervical smears. Early age at marriage, multiparity , use of contraceptives and age at first sexual intercourse were 76.4%, 32.2%, 28.3% and 69.9%. Awareness about cause, symptoms, pap test was 5.6%, 6.7% and 6.3%. Risk factors and clinical findings like unhealthy cervix with discharge, erosion and congestion showed significant association (p=0.05%) with cancer. Pap smear of unhealthy cervix showed 73.4% sensitivity and 84.3% accuracy with biopsy. 

Conclusions: Thus in developing countries implementation of more rigorous screening programs and spread of awareness about unhealthy cervix should help bring down the rate of cervical cancer.

Keywords: Pap Smear; Risk Factors Cervix; Cervical Smears; Papanicolaou Test; Uterine Cervical Neoplasms.

Introduction: In India, breast carcinoma is the second most common cause of death in women next only to cervical cancer and the incidence is as high as 20 per 1,00,000 women. The benign lesions are most common in the first few decades of life while incidence of malignant lesions peaks after menopause. The world wide incidence of breast cancer is estimated to be 1.38 million cases which is approximately 10.9% of the total malignancies detected every year.

Materials and Methods: The present retrospective study was undertaken to know the histopathological spectrum of the breast lumps received in the histopathology department of Sampurna Sodani Diagnostic Clinic, a stand alone diagnostic centre of Central Madhya Pradesh. A total of 91 breast specimens, including biopsy, lumpectomy and mastectomy specimens were included in the study.

Results: Out of these 91 cases, 80 cases (87.9%) were benign in nature and 11 cases (12.08%) were of malignant nature. Fibroadenoma was the most common benign neoplasm constituting 79.12% of all cases followed by chronic mastitis (4.39%), fibrocystic disease (2.1%) and benign phylloides tumor and lactating adenoma (1.09%) each. Of the malignant neoplasms, ductal carcinoma was the most common (8.79%) of all lesions followed by papillary carcinoma (2.1%) and one case of medullary carcinoma with an incidence of 1.09% of all malignancies.

Conclusion: Palpable and non - palpable lumps in breasts are common in females and require histopathological diagnosis for proper and timely management. Benign diseases of breasts are far more common than malignancies and fibroadenoma is the most common benign neoplasm.

Keywords: Breast Lump; Fibroadenoma; Ductal Carcinoma; Benign; Malignant.

 

Background: The OLGA staging system which was developed in 2005 assesses the stage of gastric atrophy and also predicts the risk of gastric carcinoma development. High risk OLGA stages carry a significant risk for developing gastric carcinoma. A worldwide study of OLGA gastritis staging showed no cases of high risk OLGA stages in a centre from North India. The present study was undertaken to estimate the prevalence of high risk OLGA stages among dyspeptic patients in a South Indian population and also study the correlation with relevant clinico-pathological parameters. 

Materials and Methods: Ninety-six patients attending the Gastroenterology OPD with dyspepsia were studied . Gastric biopsies were collected according to the Sydney-Houston biopsy protocol and were assessed using the OLGA system.

Results: The prevalence rate of high risk OLGA stages (III& IV) in this study was 6.25% and that of low risk OLGA stages (0, I & II) was 93.75%. The prevalence rate of H.pylori in this study was 62%.

Conclusion: The prevalence rate of high risk OLGA stages was 6.25% in subjects with dyspepsia among this South Indian population.

Keywords: Atrophic Gastritis; Gastric Carcinoma; Helicobacter Pylori.

Introduction: A five part differential leucocyte count is provided by a hematology analyser with abnormalities being detected as flags which are then later on reviewed and confirmed by a pathology trainee or pathologist based on the difficulty level of that individual case or knowledge of the particular trainee. Peripheral smear examination is considered the gold standard and is time consuming and subjective. 

Methods: Using a self prepared 1500 leishman stained leucocyte image dataset the machine learning programme tensor flow from google using image intensity, histogram and convolutional neural network was trained and this was put to test on 80 random leucocyte images.

Results: Only 65% concordance was obtained on 5 tier leucocyte differential count. However 95% concordance was achieved by using a two tier leucocyte differential classification of polynuclear and mononuclear cells. 

Conclusion: Larger dataset of images are needed before image analysis using this model can be used routinely to substitute or as addon to routine peripheral smear examination.

Keywords: Image Classifier; Differential Leucocyte Count; TensorFlow; Peripheral  Smear.

Context: Blood transfusion service is a vital part of the National health service and there is no substitute for human blood and its components. Main objective of National blood policy is to provide safe, adequate quantity of blood, blood components and products. However window period blood donation may not be picked up by the routinely employed screening methods and may carry the risk of transfusing transfusion transmitted infections (TTI).

Aims: Aim of the present study is to find the seroprevalence of transfusion transmitted diseases (viz. HIV, HBV, HCV infection, syphilis and malaria) in blood donors.

Methods and Material: Present study is a retrospective study carried out in hospital attached blood bankof Medical college in rural area of Maharashtra. All blood donations received during a period of seven years i.e from January 2010 to December 2016 were included in the study. Results of screening tests performed for HIV, HBV, HCV infection, syphilis and malaria were noted. Data obtained was tabulated and seroprevalence of individual infecton derived.

Results: The seroprevalence of transfusion transmitted infections in blood donors in present study is 1.46% with seroprevalence of 0.20% for HIV, 1.11% for HBV, 0.12% for HCV infection and 0.02% for syphilis.

Conclusions: Seroprevalence of TTIs among blood donors has a decreasing trend. However the risk of transmitting infection through blood transfusion even though negligible still persists.

Keywords: Blood Donors; Seroprevalence; Transfusion Transmitted Infections.

Context: Thyroid hormones are the important hormone helping in body metabolism. Every cell in the body depends on thyroid hormones for regulation of their metabolism. They are also known to play an important role in hematopoiesis. This study was done to know the impact of thyroid disorders like hypothyroidism and hyperthyroidism on various haematological indices which we see in routine complete blood count done using automated cell counter.

Aims: To study the effect of hypothyroidism and hyperthyroidism on various hematological indices.

Settings and Design: Prospective study Methods and Material: A total of 150 including 50 hypothyroid, 50 hyperthyroid and 50 control subjects were evaluated. A comparison was done on different parameters. 

Statistical analysis used: Results were reported as mean SD for variables. ANOVA and POST HOC test were used to calculate the significance of difference between two groups. P value <0.05 was considered as a significant change.

Results: A statistical difference was observed for MCV and MCH but other parameters did not show any statistically significant difference.

Conclusions: All the patients with thyroid disorders should be periodically evaluated for hematological changes.

Keywords: Thyroid Hormones; Hypothyroid; Hyperthyroid.

Context: In situ carcinoma in breast can be studied at two levels:
1. different morphologic patterns
2. by utilizing a prognostic grading system like the Van Nuys system. This study would provide information regarding the patterns, classification, prognostic grading, also predict the risk of recurrence after excision and assist in selecting treatment options.

Aims:
• To estimate the cases displaying different architectural patterns of in situ carcinoma in invasive breast cancers.
• Determination of prognostic index (Van Nuys) of in situ carcinoma based on these patterns.

Methods and Material: A Cross sectional study of 40 Modified Radical Mastectomy specimens collected for a period of 18 months in our Tertiary care hospital. For histopathology study, specimens were fixed in 10% formalin, processed, paraffin embedded, sections (3-5 ì thickness) taken, stained with Haematoxylin and Eosin and studied under light microscope. Statistical analysis used: Continuous variables are expressed as mean ±SD whereas categorical variables are expressed as percentages. Data was analysed using SPSS version 20. P value < 0.0 was considered as statistically significant.

Results: All architectural patterns of DCIS either single or mixed were present in the cases of invasive breast carcinoma, with solid [9 (36%) cases]: most common single architectural pattern and Solid and comedo [7 (47%) cases]: the most common mixed architectural pattern. High grade ductal carcinoma in situ was seen in 18 patients (45% of cases), intermediate grade in 17 patients (43%) and low grade was seen in 5 patients (12%). 

Conclusions: The current study provides evidence of the frequency of significant histologic heterogeneity of in situ carcinoma, with at least 2 different architectural patterns of ductal carcinoma in situ commonly present in individual lesions.

Keywords: Ductal Carcinoma; In Situ Component; Histological Grading.

 

Background: Abnormal uterine bleeding (AUB) is related with patient’s social,familial and personal life because of the considerable morbidity it causes. The aim of the study was to examine the histopathological patterns of endometrium in patients presenting with AUB as well as to find out its incidence in different age groups.

Materials and Methods: This is a retrospective study, conducted in the Department of Pathology, in a tertiary care teaching hospital, Udaipur from Jan. 2016 to Jan. 2018. The study includes cases of AUB with a probable endometrial cause.The study was done in the form of measures and percentages and showen as tables where found necessary.

Results: A total of 215 cases were studied.The age of the patients were from 18-72 years. Incidence of AUB was most common in the perimenopausal age group. Menorrhagia was the most common presenting complaint. Proliferative endometrium was the most common histopathological finding and was seen in 35.34% patients, followedby secretory endometrium in 18.60% patients, and disordered proliferative endometrium in 17.67% patients.Hyperplasia was seen in 16.73% cases. Malignancy was detected in 2.36% of cases and all were endometrial carcinoma.

Conclusions: Themain indication of endometrial biopsies is to rule out malignancy and endometrial hyperplasia in women over 35 years of age group. When no organic pathology was found,different physiological patterns like secretory phase,proliferative phase and other endometrial changes were observed. The most common endometrial pathology observed was proliferative phase endometrium.

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

Introduction: Neonatal septicemia constitutes one of the major public health problems throughout the world. Early diagnosis of neonatal sepsis poses a great challenge. Hematological scoring system [HSS] formulated by Rodwell et al. can be used to establish early diagnosis of sepsis in neonates. 

Objectives: To evaluate the utility of conventional HSS and modified HSS as a diagnostic tool in the setting of neonatal sepsis and to evaluate the role of additional parameters like nucleated RBC count, Neutrophil Lymphocyte Ratio [NLR] and Platelet Lymphocyte Ratio [PLR] in the diagnosis of neonatal sepsis. '

Materials and Methods: The study was conducted in hematology section of the department of pathology at a rural tertiary care referral institute. It was a prospective study done over a period of six months from January 2015 to June 2015. Fifty-one cases were analyzed. All high risk neonates admitted to NICU [Neonatal Intensive Care Unit] were included in the study. Clinically, neonates were grouped into three categories. Conventional hematological scoring system [HSS] and Modified hematological scoring system were applied to all the cases. Additional hematological parameters like nucleated RBC count, NLR and PLR were also evaluated.

Results: Both conventional hematological scoring system and modified hematological scoring system were found to be statistically significant by Chi-square test (P < 0.05) for clinical correlation. NLR ratio was statistically significant (P < 0.05) for clinical correlation. Nucleated RBC count and PLR were found to be statistically not significant (P > 0.05) for clinical correlation. Sensitivity of conventional HSS and modified HSS were similar (100%) with respect to total WBC count, immature polymorphonuclear neutrophils (PMN) count, immature: total PMN ratio, immature: mature PMN ratio and degenerative changes in PMN. Specificity of total WBC count was better in conventional HSS. Specificity of platelet count was better in modified HSS. 

Conclusion: Hemalotogical scoring system is a useful, simple and reliable tool for evaluating neonatal sepsis. But, modified HSS appears to be more meaningful scoring system than conventional HSS.

Keywords: Diagnostic; Parameter; Neutrophils.

 

Objective: Thyroid lesions are the most common endocrine problem encountered in routine clinical practice. This study describes the various spectrums of thyroid lesions in surgically resected specimen and its correlation with age, gender and cytological findings. Materials and methods: A retrospective study of thyroid lesions were conducted in the Department of pathology, Government Thriuvarur medical college, Thiruvarur over a period of 1 year from Jan 2016 to Dec 2016. Totally 145 cases were studied which include 109 non neoplastic, 7 benign and 29 malignant cases. Pre operative FNAC evaluation was performed in patients with nodular thyroid enlargement. Out of 145 cases pre operative cytological correlation was available for 52 cases. 

Results: Totally 145 surgically resected thyroid specimens were received during the study period of one year with a female: male ratio of 10.7: 1. The age group ranges from 14 years to 67 years and peak incidence was noted in 31-40 years group. Most common lesion noted was nodular goiter (54%) followed by thyroid malignancies (20%). Other lesions observed were thyroiditis (14%), follicular adenoma (5%), nodular hyperplasia with thyroiditis ( 6%) and toxic goiter (1%). Among the malignant tumours, the predominant lesion was papillary carcinoma (90%) followed by follicular (7%) and medullary carcinoma (3%). Conclusion: Non neoplastic lesions are more common than neoplastic lesions with a striking female predominance. This study shows increased prevalence of thyroid lesions with a rising incidence of papillary carcinoma thyroid among the middle aged individuals.

Keywords: Thyroid lesions; FNAC; Papillary Carcinoma; Goitre

Introduction: Ovary is the commonest site for developing non-neoplastic and neoplastic lesions. These lesions can occur in any age group from childhood to postmenopausal women. 

Aims and Objectives: This study was conducted to analyse the histopathological features of all ovarian lesions and classify them. Materials and Methods: Present study is a prospective study of 52 cases carried out over a period of one year from July 2016 to July 2017 . All patients admitted in gynaecologyward posted for oophorectomywith or without hysterectomywere included in the study. Salient findings related to individual case alongwith final histopathogical diagnosis were noted. Results: There were total 58 lesions; out of which 37 were non-neoplastic; 13 were benign; and 8 lesions were of malignant variety. The most common age group involved was 40-59 years. The commonest symptom was abdominal pain and the right sided ovary was commonly involved. Follicular cyst was the commonest non-neoplastic lesion; whereas most commonn benign lesion was mucinous cystadenoma . Serous cystadenocarcinoma was the commonest malignant lesion. 

Conclusion: Ovaries can be affected by variety of non-neoplastic and neoplastic lesions. Good clinical history and physical examination together with USG findings helps in probable diagnosis. Specific diagnosis is based mainly on routine gross and histopathological examination of the specimen. The study of macroscopic and microscopic features of different ovarian tumors enables categorization into morphological type which helps the gynecologists for proper management.

Keywords: Histopathology; Neoplastic Lesions; Non-Neoplastic Lesions; Ovarian Lesions.

Introduction:Cholelithiasis is the most common disease affecting gallbladder. Gallstones cause several histological changes in gallbladder mucosa like acute and chronic inflammation, metaplasia, hyperplasia, calcification and dysplasia. Present study evaluates the incidence of various histopathological lesions observed in routine cholecystectomy specimen. Material and methods:This was a hospital based prospective study conducted over a period of 1 year. Detailed gross examination was done in total 325 routine cholecystectomy specimens and microscopic examination was done on slides stained with hematoxylin and eosin stain. 

Results: Maximum number of patients were in the age group of 21-40 years (49.85%). Number of female patients was 253 (77.85%) and that of male patients was 72 (22.15%). On gross examination, gallstones were found in 239 cases (73.54%). Maximum number of cases 216 (66.46%) and 166 (51.07%) showed normal wall thickness and normal mucosa respectively. Most common histopathological diagnosis was chronic non-specific cholecystitis in 270 (83.07%) cases followed by 8 (2.46%) cases each of follicular cholecystitis, cholesterolosis and adenomyomatosis. Epithelial changes like metaplasia seen in 28 (8.61%)cases, hyperplasia in 17 (5.23%)cases, reactive atypia in 6 (1.85%) cases and dysplasia in 3 (0.92%). Conclusion: Chronic cholecystitis was the most common histopathological diagnosis and it was found to be associated with various changes in gallbladder mucosa like gastric and intestinal metaplasia, hyperplasia and dysplasia. Variants of cholecystitis like xanthogranulomatous cholecystitis, follicular cholecystitis and eosinophilic cholecystitis were also reported. The present study highlights the value of submitting all routine cholecystectomies for thorough histopathological examination. 

Keywords: Chronic Cholecystitis; Gallstones; Acute Emphysematous Cholecystitis; Porcelain Gall Bladder; Dysplasia.

Ovarian cysts and tumours are the major problems in women. Vast majority of ovarian cysts are benign in nature. Ovarian cysts are usually asymptomatic, they are found as an incidental finding during routine ultasonogram. Torsion ovary is a infrequent complication which may present as abdominal pain or acute abdomen. Methodology: The present study was two year retrospective study conducted during the period of Jan 2014 until Dec 2015. 29 cases with adnexal torsion who underwent surgery during this period were included in the study. The clinical details and gross findings were recorded from hospital registry. The histopathology slides were retrieved and findings were recorded. Results: Out of 29 cases 15 cases (51%) were seen between 20-30 years and the common presenting complaint was abdominal pain. The most common presentation (66%) was on the right side and minority (1%) of these lesions were found to be bilateral. Functional cyst was the more prevalent type of lesion 14 cases(48.28) followed by benign serous cystadenoma 9 cases (31%). Conclusion: Acknowledging the fact that majority ovarian cysts were seen in young females, early diagnosis and prompt intervention of cases with rupture or torsion should be made in consideration of the preserving the adnexa.

Keywords: Ovarian Cysts; Torsion; Hemorrhage.

Background: Cervical cancer is one of the leading cancers in women. The confirmation of the disorder can be possible by Pap smear. The present study was conducted to assess the cases of cervical cancer in women using cervical Pap smear. 

Materials & Methods: This study was conducted in the Department of Pathology, ESIC Medical College, Gulburga, Karnataka (India) on 1080 cervico-vaginal smears which were checked for the epithelial abnormalities such as atypical squamous cells of uncertain significance (ASCUS), low-grade squamous intraepithelial lesion (LSIL), non neoplastic intraepithelial lesion (NILM), high-grade squamous intraepithelial lesion (HSIL) and squamous cell carcinoma (SCC). Results: Among 1080 Pap smears, 35 were unsatisfactory, 990 were NILM, 32 were LSIL, 10 were HSIL, 5 were SCC and 8 were ASCUS. The difference was significant (0.01). 1 case of ASCUS, 2 cases of LSIL were seen in age group 31-40 years. 2 cases of ASCUS, 3 cases of LSIL and 1 case of HSIL was seen in age group 41-50 years, 2 cases of ASCUS, 22 cases of LSIL, 6 cases of HSIL were seen in age group 51-60 years, 5 cases of LSIL, 3 cases of were seen in age group 61-70 years. 3 cases of ASCUS were seen in age group 71-80 years. The difference was significant (P- 0.01). The various changes were atrophy (30), non-specific inflammation (55), trichomoniasis (10), candidiasis (25), reactive (25), no other changes (840) and bacterial vaginosis (5). The difference was significant (P- 0.01). Conclusion: Cervical cancer is one of the leading cause of death in women. Pap smear is considered to be effective in detection of lesions in women. It is economical and non sophisticated procedure. Careful Pap smear analysis can be proved beneficial in preventing lesions.

Keywords: Cervical Cancer; Smear; Trichomoniasis.