Indian Journal of Pathology: Research and Practice

 From axilla to groin, accessory breast tissue can present anywhere along the milk line. It can harbour all the pathological conditions as that of the normal breast though incidence is very low. Though the accessory breast and duct ectasia are very common entities presenting separately, coexistence is a rarity. In this case report, a 35 year old female presented with a bilateral painless axillary mass. Ultrasonography and FNAC were reported as lipoma. However, the excision biopsy of the same showed duct ectasia in the right axillary swelling. This case report here shows us the possibility of simultaneous coexistence of accessory breast with duct ectasia with a normal breast finding, however rare it might be.

Keywords: Accessory Breast; Axilla; Duct Ectasia.

 Respiratory epithelial adenomatoid hamartomas (REAHs) are rare, benign proliferations of glands of respiratory tract. These are under diagnosed and pose a challenge while diagnosing other aggressive lesions. We are presenting a case of an elderly male with REAH owing to its rarity.

Keywords: Respiratory Epithelial Adenomatoid Hamartoma; Sinonasal Mass; Glandular Proliferation.

 Introduction: Intracranial cysts are often seen in our daily routine practice. Most of the patients present with symptoms of raised intracranial pressure manifested as headache and vomitings. Most of these are benign in origin with defects in maldevelopment. Histopathological examination plays a major role in the diagnosis of these cases. We have presented a spectrum of lesions in our study period with emphasis on their origin, morphological features and differential diagnosis. Materials and methods: A total of 11 cystic lesions were included in our study. Cystic degeneration of tumors and infective cysts were excluded from our study. Processing was done. Histopatholy slides were made and examined. Immunohistochemistry (IHC) was done wherever required. Results: The lesions included epidermoid, dermoid, neuroenteric, colloid, arachnoid and rathke cleft cysts. Cysts of the neurospinal axis i.e Rathke cleft cyst, colloid cyst and neurenteric cyst had almost identical histological features and the site of the lesion played an important role in the diagnosis of these lesions. Conclusion: Incranial cysts should be diagnosed in correlation with clinical features and imaging findings. These benign lesions can thus be managed appropriately sometimes in aconservative manner also. Histopathological diagnosis thus plays a major role in these intracranial cystic lesions.

Keywords: Incranial cysts; Morphological Spectrum; Histopathological diagnosis; Immunohistochemistry (IHC).

 Objective: This study was carried out to evaluate the spectrum of histopathological lesions in laparoscopic sleeve gastrectomies in morbidly obese patients at a tertiary care hospital in rural Haryana. Methodology: It was a retrospective study conducted in the department of pathology, WCMSRH, Jhajjar, Haryana, over a period of two years (Dec 2016 to Nov 2018). A total of 24 morbidly obese patients underwent sleeve gastrectomies during this period. Histopathological evaluation of all the specimens was carried out and their relation with BMI (Body mass index), age and gender were evaluated. Result: The mean age and BMI were 36. 5 years and 45.2 respectively. Females comprised 70.83% of the sample. Out of total 24 sleeve gastrectomy specimens, 21 showed histopathologic changes, which were categorised as Chronic inactive gastritis (50%), Chronic active gastritis (16.6%), Follicular gastritis (8.3%), Lymphoid aggregates (8.3%) and Intestinal metaplasia (4.16%). Follicular gastritis and intestinal metaplasia were seen only in female patients. Chronic active gastritis was seen in patients with high BMI. Three cases (12.5%) did not show any significant pathology. Conclusion: The sleeve gastrectomy specimens mainly presented with a spectrum of gastritis and chronic inactive gastritis was seen in 50% of the specimens.

Keywords: Laparoscopic Sleeve Gastrectomy; Gastritis; Morbid Obesity

 Context: Helicobacter pylori (H. pylori) is the major cause of chronic gastritis, peptic ulcer and gastric cancer. It causes varied histological derangements & hence the detection of H. pylori is important. Aims: The study was done to evaluate the efficacy of various stains- Hematoxylin & Eosin (H & E), modified Giemsa and Immunohistochemistry (IHC) in the detection of H. pylori and to correlate the H. pylori positivity with histological changes. Settings and Design: Methods and Material: 100 samples of gastric biopsy & resected specimen were studied with H & E, modified Giemsa and IHC stain. Detection of the organism & associated morphological changes were assessed. The stains were validated using IHC as gold standard. Statistical analysis used: Comparison between the stains were assessed using chi square test. Results: Out of 100 cases, 67 showed positivity with IHC & 58 and 63 were positive with H & E and modified Giemsa respectively. Sensitivity and specificity of H & E was 86.6% and 100% & modified Geimsa was 94% and 100% respectively. Mononuclear infiltrate were noted in 67 cases with H. pylori infection. Similarly in 61 cases with neutrophil activity, 12 cases with atrophy and 4 cases with intestinal metaplasia showed associated H. pylori infection. Conclusions: Modified Geimsa stain is less time consuming, cost effective and easily available when compared to IHC but IHC can detect mild infection, where H & E and modified Giemsa are negative.

Keywords: Gastritis; H. pylori; H & E; Immunohistochemistry; Modified Giemsa.

 Introduction: Leucorrhoea is a persistant , excessive white vaginal discharge. It is one of the major problem in gynaecological practice. Pap smear for cervico vaginal cytology examination is one of the common method for detection of various cervical disorders. Aim: to study cervical cytology smears in patients presenting with leucorrhoea Objective: 1] To diagnose and categorise various inflammatory premalignant & malignant lesion of the uterine cervix on cervical cytology smears in patients presenting with leucorrhoea. 2] To correct details in the cytological diagnosis based on Bethesda system (2001) Material & Methods: The present study is a two years prospective observational study done in Dept of pathology at tertiary care hospital total 304 cervicovaginal smears were evaluated The Rapid Pap staining was used for evaluation. Result: Total of 304 cervicovaginal smears studied from patients complaining of leucorrhoea. The patients in the age group of 31-40 years was common consist of 117 cases (38.48%). The multiparous womens were in 167 cases (54.95%). On clinical presentation in all cases presenting symptom was leucorrhoea followed by low backache 37.8%, pain in lower abdomen 26%, PV bleeding 15%, itching 5.6% dyspareunia 3.6%, dysmenorrhoea 2.6%, burning and increased frequency of micturation 1.97% cases. On cytology 288 cases (94.74%) were of non-neoplastic type while 16 cases (5.26%) were of neoplastic type. Among non neoplastic 208 cases (72.22%) were inflammatory smears. The neoplastic lesion were ASCUS 0.33%, LSIL-2.30%, HSIL-1.97%, SCC-0.66%. Conclusion: For leucorrhoea, cervical cytology examiniation provides accurate diagnostic modality and also helpful for early detection of neoplastic lesions.

Keywords: Cervical Cancer; PAP; Cytology

 Background: Fibroid is the commonest tumor of the reproductive tract and frequently encountered problem in gynecological practice. Aim and objectives: To observe the frequency of uterine leiomyoma in relation to age, parity, clinical manifestations, morphology, secondary changes, endometrial status and associated pelvic pathology. Material & methods: Over a period of two years, 1866 hysterectomy specimen sent for histopathology was studied. Uteri with fibroids were included for the study. Clinical data including age, parity, menstrual pattern, presenting symptoms, surgical treatment history of these patients with fibroid was collected and analyzed. Results: Leiomyoma was diagnosed in 350 patients out of 1866 hysterectomies (19.12%). Greater frequency (83.42%) was found in late reproductive and perimenopausal years ie 4th and 5th decade with a mean age of 40.9 years. Most of the patients were multiparous (98.09%). Menorrhagia (46.17%) was the commonest symptom followed by dysmenorrhoea (22%). Most of the leiomyomas were intramural type (55.09%). Degenerative changes were observed in 39.41% of leiomyomas and leiomyomas variants in 2.6% of cases. Conclusion: Leiomyoma is the most common benign tumor of uterus occurring during reproductive age group. Histopathology remains the gold standard method in diagnosing the leiomyoma variants. Accurate histopathological examination is mandatory to rule out malignancy for optimal management and patient well being.

Keywords: Leiomyoma Variants, Hysterectomy; Histomorphology; Degenerative Changes.

 Context: Abnormal uterine bleeding (AUB) is an important clinical entity in females. Aims: The objective of the study was to study the histopathological (HPE) features of endometrium and to correlate its incidence with age factor in patients presenting with history of AUB. Settings and Design: Methods and Material: 198 endometrial curetting and 2 endometrial biopsies were included. Samples that are autolysed and inadequate were excluded. Histopathological patterns were studied with Haematoxylin and Eosin (H&E) staining. Statistical analysis used: Association between various histopathological patterns with age were assessed using chi square test. Results: Maximum cases of AUB were in the perimenopausal women. The most common cause of AUB was cyclical endometrium followed by hyperplasia without atypia. Histopathological patterns significantly correlated with age factors in our study. Conclusions: Our study provides specific stratification of patients with AUB based on many new differentials (compared to conventional approach) that would allow for specific treatment options and thereby improve quality of life for the patients.

Keywords: Abnormal Uterine Bleeding; Perimenopausal; Endometrium; Hyperplasia.

 Introduction: Blood transfusions are one of the major life saving procedures carried out to replace the host blood with that of donor to maintain the circulatory volume of blood. As most of the pathogenic microbes gets transmitted through haematogenous route. In order to provide a safe blood service in India, most sensitive and specific laboratory tests are the need of the hour even though the majority of the donations are through voluntary donations. Aims and Objectives: To study the correlation of ELISA and nucleic acid test in transfusion transmittable viral diseases Material and Methods: A two year study was carried out in Blood Bank of a tertiary health care centre in south central part of India for a duration of two years. All healthynon-remunerated voluntary blood donors were included in the study. Donors known positive for Human immunodeficiency virus (HIV), Hepatitis B or Hepatitis C infection were excluded from the study. ELISA test was performed at the same institution and ID-NAT tests were done at Molecular laboratory of state reference lab. Results: A total of 16,286 voluntary blood donations were collected and tested for HIV, HBV, and HCV over a period of two years. Out of all healthy donors screened with standard operating protocol 13 cases were found to be positive for HIV, 136 cases for HBV and 16 cases for HCV in ELISA. NAT test done with the same donor’s sample is found to be positive in 20 cases for HIV, 158 cases for HBV and 18 cases for HCV. Conclusion: The screening method NAT for TTI is proved to be most effective method to detect TTI viruses than ELISA even in window period .

Keywords: Transfusion Transmittable Diseases; ELISA; NAT.

 Context: Mast cells have a multifunctional capacity. Their role in immunity is well known. Mast cells act as local immune modulators with a capacity to co-ordinate between pro and anti-inflammatory response. Leprosy is classified on the basis of immune status of patients. Mast cells in leprosy have been examined in recent past and are being examined as a basis for future studies. Staining of mast cells by Toluidine blue is well documented. Use of Fite Faraco’s stain can have an additional advantage of staining bacilli and mast cells. Aims: 1. To study average number of Mast cells in various types of leprosy. 2. To study distribution of mast cells with reference to Acid Fast Bacilli. Methods and Material: Study included 65 skin biopsies of histopathologically diagnosed cases of leprosy. Sections were stained by Fite Faraco’s stain, viewed under 400X and mast cells were counted per mm square. Their distribution in various types of leprosy was recorded. Results: Among the patients studied the males outnumbered females by a ratio of 1.6 : 1. Significantly higher Mean Mast Cell Density (27.94) was obtained in Polar Tuberculoid leprosy (TT), lowest was found in Polar Lepromatous leprosy (LL). Maximum numbers of mast cells were distributed around granulomas and glands. However, finding both mast cells and bacilli in same structure was not a constant finding. Conclusions: The higher mast cell density in the immunologically strong group of patients is evidence of the role of mast cells in the activated immune response to M. leprae infections.

Keywords: Leprosy; Ridley-Jopling Classification; Mast Cells; Fite Faraco’s Stain; Mean Mast Cell Density; Immunity.

 Context: Megaloblastic anemias are hematological disorders in which nuclear maturation lags behind the cytoplasmic maturation. Thrombocytopenia in megaloblastic anemia is because of ineffective thrombopoiesis in some studies and hypoproduction in some studies. Objective was to study the spectrum of clinicohematological features in megaloblastic anemia & comparative bone marrow aspiration study ofthrombocytopenia secondary to megaloblastic anemia due to hyper-destruction or hypoproduction. Aims: To understand the clinico-hematological spectrum of Megaloblastic anemia and associated megakaryocytic alterations. Methods and Material:100 cases of thrombocytopenia were included in the study. Bone marrow findings in 35 cases ofthrombocytopenia of megaloblastic etiology was compared with 40 cases of marrow proven hypo productive thrombocytopeniaand 25 cases of hyper destructive thrombocytopenia. Results: Most common age group presenting with megaloblastic anemia was 20-30 years,with M:F ratio 1.4:1. Most common complaints were fatigue and generalised weakness. 14.28% of patients had shown normal in number of megakaryocytes, 57.14% of patients had shown increased number 28.57% had shown decrease in number of megakaryocytes. Dysplastic megakaryocytes were seen in 43.75%, 26.25% & 30% of cases of megaloblastic anemia, acute leukaemia and immune thrombocytopenic purpura respectively. Conclusions: Both hypoproduction and ineffective thrombopoiesis are the underlyingmechanisms in megaloblastic thrombocytopenia as evidenced by marrow findings. We conclude that megaloblastic thrombocytopenia is to be included as separate category apart from hypo proliferative and hyper destructive groups. The presence of dysplastic megakaryocyte should not prompt interpretation of myelodysplastic syndromes and should always be correlated with patient’s clinico hematological parameter.

Keywords: Hypo-Production; Hyper-Destruction; Megaloblastic Anemia.

 Background: Anemia has a significant health burden in developing nation. Etiology is determined by looking at the morphology of R.B.C which determines the degree of hemoglobinization. Aims and objectives: To determine the morphological patterns of anemia and its prevalence in various age groups. Materials and methods: This was a descriptive study done on patients who attended clinical pathology department during January 2017–December 2017 in A.C.S. Medical College and Hospital, Chennai. Complete hemograms of 760 patients were analyzed. This study was approved by the institutional ethical committee. Result: Of the total 760 hemograms, 470 were anemic with a prevalence of 61.8%. This study showed a female preponderance with 65.9%. The most common morphologic pattern of anemia in the present study was microcytic hypochromic, followed by macrocytic and dimorphic. The prevalence of microcytic hypochromic anemia was 46.8% (n=220), followed by macrocytic 31.9% (n=150) and dimorphic 21.2% (n=100) respectively. In females most of the anemias (microcytic, macrocytic and dimorphic) presented between the age group of 20-30 years. In males microcytic anemia was prevalent in 31-40 years whereas dimorphic and macrocytic anemias were prevalent above the age of 50 years Conclusion: Morphology of anemia by smear examination remains the baseline tool for diagnosing anemia. Morphological patterns determine the underlying cause. Peripheral Smear examination being less expensive reduces the financial burden to the patient and this tool being mandatory in evaluation of anemias, helps physician in early diagnosis of anemia and prevent the complications of anemia.

Keywords: R.B.C-Red Blood Cells; HB-Hemoglobin.

 Context: Due to increasing demand for blood components, injudicious utilisation of blood products will definitely have serious implications in resource constrained settings. The staff nurses should be fully aware of all the pitfalls and its associated consequences right from receiving the blood bag from the blood bank, till it is transfused to the patient. Aims: This study aims at analysing the impact of the knowledge scores of the staff nurses in Blood transfusion practices on the Key performance indicators of Blood Component administration. Settings and Design: This study was conducted in Blood bank, Saveetha Medical College Hospital, Thandalam, Chennai, Tamil Nadu. The study population comprised of 220 staff nurses in the period of 2015–2017. Methods and Material: This is an observational study with a cross sectional design and quantitative data analysis. The study is based upon a questionnaire approved by the hospital ethical committee and retrospective data collection of the key performance indicators of blood component administration, from the case sheets of the patients who received blood transfusion. Statistical analysis used: Knowledge scores of the staff nurses were computed using the results of the questionnaire. The percentage of key performance indicators of blood component administration were calculated based on a checklist. Results and Conclusion: The knowledge scores of the staff nurses was found to be insufficient which contributed to low fulfilment of key performance indicators. Multiple steps were taken to improve the knowledge of the staff nurse, in blood transfusion, which eventually lead to a favourable increment in the key performance indicators of Blood component administration.

Keywords: Blood Components; Performance Indicators; Blood Transfusion.

 Introduction: Cancer is the major health issue now days with a burden accounting for almost one in every four deaths. Gastrointestinal tract (GIT) is the most commonly involved system in the human body. Adenocarcinomas are more common among intestinal tumors. However benign tumors are more common than the malignant tumors. Gastrointestinal (GI) cancers constitutes 20% of estimated new carcinoma cases and about 15% of estimated death worldwide. Aim: To study the histomorphology of various gastrointestinal lesions. Materials and methods: It was a retrospective study for 4 years. All the biopsies submitted to Department of pathology, SIMS, Shivamogga for histological evaluation during the study period. Altogether 89 GI specimens were fixed in 10% formalin and processed in semi automatic tissue processor. Routine hematoxylin and eosin stain and special stains were done. Results: Total number of cases were 11,000. Among which 89 cases (0.8%) were GIT specimens, both neoplastic and nonneoplastic. Neoplastic lesions constituted 45 cases (50.6%). Non neoplastic lesions constituted 44 cases (49.4%) which includes both inflammatory and non inflammatory lesions. Conclusion: GI lesions constitutes about 0.8% of all the lesions. Most common neoplastic lesion of oesophagus was squamous cell carcinoma where as adenocarcinoma was most common gastric and intestinal neoplastic lesion.

Keywords: Squamous Cell Carcinoma; Gastrointestinal Lesions; Adenocarcinoma.

 Context: Hystrectomy is the frequently performed gynaecological surgery for various uterine and adnexal pathologies. Varied approaches depending on the clinical features and presentation have been practiced worldwide. A detailed histopathological examination of all the specimens is mandatory to establish a comprehensive diagnosis for the patients. Aims: The aim is to study the pattern of histopathological lesions in hysterectomy specimens in our institution and compare it with similar studies. And also to discuss briefly about the interesting incidental findings made in our institution during this study period. Settings and Design: A retrospective descriptive study was carried on 280 hysterectomised cases over a period of one year from January 2017 to December 2017. The data regarding the patient’s age, parity, type of hysterectomy and histopathological diagnosis were reviewed from the records and database was created and descriptive statistical measures were analysed using SPSS 22.0. Results: A total of 280 cases of hysterectomies were studied. The distribution of hysterectomies was over a wide age group ranging from 29 years to 80 years, most common age group being 41-50 years. Hysterectomies done through abdominal approach (85%) were more ubiquitously practiced in our setup. Histopathologically benign neoplasms (65%) outnumbered malignant ones with leiomyoma being the most common benign lesion to be encountered. Conclusions: Chronic cervicitis (chronic papillary endocervicitis and chronic superficial cervicitis) remains as the most frequent inflammatory pathology followed by leiomyoma. Histopathological analysis of all hysterectomy specimens is imperious in order not to miss incidental malignancies and to provide optimal management for the patient.

Keywords: Hysterectomy; Leiomyoma; Malignancy

 Introduction: Colon cancer is one of the most common malignancies accounting to the 4th most frequent cancer in men and 3rd in women. Though the most commonly used system for cancer staging is TNM classification, it has some prognostic limitations in stage III disease. Node related factors that are of prognostic interest include lymph node size, distribution as well as the lymph node ratio (LNR) which is the quota between positive and total assessed lymph nodes. Aim and objectives: The aim of this study was to evaluate and to describe the lymph node ratio as a prognostic parameter for patients with stage III colon cancer by assessing disease free survival period. Methods: The study is retrospective and included all the patients diagnosed with stage III colon cancer during 2010 to 2014. LNR was calculated and quartile groups were created. LNR and associated parameters were analyzed with reference to disease-free survival (DFS) by follow up of these patients. Results: The Karl Pearson’s correlation analyses was used to determine the correlation coefficient, the Kaplan Meier method was used to analyze survival and the Cox proportional hazard regression model was used for multivariate analysis. The results showed that the lymph node ratio was a prognostic factor in stage III colorectal cancer and had a better prognostic value than did N stage of TNM classification. Conclusion: The lymph node ratio, that is the quota between the number of metastatic lymphnodes and total assessed lymph nodes proved to be a significant prognostic factor in stage III colon cancer as is determined by disease free survival time during follow up of the patients.

Keywords: Colon Cancer; Disease Free Survival; Lymph Node Ratio; Prognostic Parameter.

 Context: Androgen receptor (AR) has been found to be associated with the occurrence and progression of breast cancer; however, their clinical significance in triple negative breast carcinoma (TNBC) cases is still a matter of debate. Aims: The present research work was done to study the expression of AR in TNBC biopsies (ER-, PR-, & HER2/neu-) by immuno-histochemistry and to correlate AR expression patterns in TNBC with Ki-67 and other prognostic markers. Settings and Design: The present cross-sectional study was conducted byDepartment of Pathology, Hind Institute of Medical Sciences, Barabanki, Uttar Pradeshfrom 2015-16. Methods and Material: ER, PR and AR negative expression were defined as <10% nuclear staining and also HER2 (2+), FISH was performed. Nuclear staining was done for estimation of Ki-67. Statistical Analysis Used: Categorialvariables were expressed as frequencies and percentages and Chi-square test was used to study the association. P value < 0.05 was considered as significant. Results: The mean age of TNBC cases was 53.8 ± 11.2 years. The most common Blooms Richardson histopathological grade found was Grade II in 35 cases (70%) followed by Grade III in 15 cases (30%). Majority of TNBC in our study group (60%) were AR positive (intermediate or strong). The AR positivity was found to be significantly associated with postmenopausal status and lymph nodes involvement. About 65% of the cases negative for AR intensity were from patients who were in pre-menopausal group. Among 80% cases with involvement of lymph node, the AR intensity was strongly positive. No significant correlation was observed between AR and Ki-67 expression. Conclusions: Although,in our study no statistically significant correlation was observedbetween AR and Ki-67 index among TNBC cases but a strong AR intensity was observed with lymph node involvement. Thus in TNBC patients, evaluation of AR status may provide additional information on prognosis and treatment.

Keywords: Breast Cancer; Estrogen Receptor; Her-2/Neu; Progesterone R

 Background: Documentation of cyto-histological correlation and discrepancies is an important tool for assessing quality of cytological diagnosis. Regular monitoring of discrepancies provides a window of opportunity to improve the performance of cytology laboratory. Aims: To report cyto-histological discrepancies and factors associated with discrepancies. Settings and Design: This retrospective record based study was done at the cyto-histology laboratory in a tertiary care hospital in Gujarat. Materials and Methods: The samples in which both Fine needle aspiration cytology (FNAC) and histology examination was done during 2015-2017 were included in the study. Diagnoses of these examinations were compared and discrepancies noted. Discrepancies were classified based on organ involved, size and nature of the lesion. The results were reported as proportions. Results: The cyto-histological discrepancies were observed in 36 out of 150 samples (24%). Maximum discrepancies were observed in lymphnodes followed by thyroid and breast lesions. There was no significant difference between rate of discrepancies and size of the lesions. Cyto-histological discrepancies were found more in benign/reactive lesions as compared with malignant lesions (91% vs 9% respectively). Out of 36 discrepancies, 32 samples were benign and 2 samples were malignant, on both the cytology and histology examination with different subtype. Conclusion: Out of total 150 samples, agreement between cytology and histology reports was found in 114 samples; and discrepancy was noted in 36 samples. Documentation of cytohistological correlation is a useful tool to report discrepancies and factors associated with it. This can be monitored on regular basis as a measure to improve quality.

Keywords: Discordance; Discrepancies; Error; Quality Assurance; Quality Control; Quality Improvement

 Introduction: Cervical cancer is the most common, preventable cancer and does not develop suddenly from normal epithelium but is presented by a spectrum of intraepithelial neoplasia. Pap smear is an ideal screening and low cost effective test to detect intraepithelial neoplasia especially in developing countries but has limitations and needs confirmation by histopathology. Aims and Objectives: The aim of this study to see correlation between cervical smear and cervical biopsy. Material and methods: This was prospective study carried out from August 2016 to August 2017 in the Department of Pathology, SMIMER, Surat. A complete clinical history and of the subjects was recorded. Pap smears stained by papanicolaou stain and cervical biopsies, with resected specimens were routinely processed and stained with H & E and examined under microscope. Conventional pap smears were reported by using Bethesda system. Results: Total number of pap smears analysed were 100. NILM constituted major group 64. Amongst the subjects with epithelial cell abnormality (ECA), Atypical squamous cells of undetermined significance (ASCUS) were 4, Atypical Squamous Cells cannot Rule Out High-Grade Squamous Intra-epithelial Lesion (ASC H) 4, Low grade squamous intraepithelial lesion (LSIL) 12, High grade squamous intraepithelial lesion (HSIL) 16. Out of 100, 66 cases are correlated. 34 cases are deferred, 8 cases of NILM on cytology were given the diagnosis of 6 cases of CIN I,2 case of CIN II on histopathology. 2 case of LSIL on pap smear turned out CIN II on histopathology. 2 cases with diagnosis of ASCH and 2 cases with diagnosis of HSIL on pap smears, both are turned out to be squamous cell carcinoma on histopathology. Conclusions: Pap smear is simple, inexpensive and can be performed in the outpatient department. Hence, it should be recommended routinely as a method of improving reproductive health, early detection of premalignant and malignant cervical lesions.

Keywords: NILM; Epithelial Cell Abnormality; Pap Smears; Cervical Cancer, Cervical Biopsy