Indian Journal of Pathology: Research and Practice

Background: Ampullary cancer is of particular classificatory interest as it may arise either from the intestinal epithelium or the epithelium covering the pancreatobiliary ducts knows as Intestinal type (IT) and Pancreatobiliary type (PBT) respectively. These 2 histological subtypes have different clinical characteristics, in terms of disease stage, recurrence rates and survival. Immunohistochemical staining against specific differentiation markers, including cytokeratins 7 (CK7) and 20 (CK20), mucins 1 (MUC1) and 2 (MUC2), as well as caudal type homeodomain (CDX2) protein, has been proven to be a useful adjunct in determining the exact histological sub type, especially in cases of large or mixed type tumors. Material and Methods: During the study period (2018–2021), 15 consecutive patients with IT and 15 consecutive patients with PBT adenocarcinoma, based on H&E staining characteristics, were included in analysis. Data on clinical parameters, including age, gender, pre-operative assessment of disease stage, CA 19-9 serum levels and histopathological parameters including tumor size, pT stage, pN stage, LVI, PNI and differentiation were collected in a prospective manner from patients’ surgical and pathological records. IHC markers (CK7, CK20, CDX20 and MUC1) were analyzed on all histopathological blocks. Results: In our analysis, pT Stage, Tumor Stage, CA 19-9 (IU/mL), Tumor size (cm), PNI, MUC1, combination CK7/MUC1, CK20, CDX2, combination CK20/CDX2 were significantly associated with histological subtype. CDX2 expression was found to have highest diagnostic accuracy (96.7%) for histological subtype followed by, in decreasing frequency, high CA 19-9 (93.3%), MUC1 (90%) and CK20/CDX2 combination (90%) and CK20 (86.7%). CDX2 was the only marker that showed highest sensitivity (100%) and high specificity (93.3%) for predicting IT. MUC1 positivity was associated with PBT with highest sensitivity of 100% and high specificity of 80%. The combination of CK7/MUC1 showed 86.7% sensitivity and 80% specificity with 83.3% diagnostic accuracy to identify PBT tumor, whereas combination of CK20/CDX2 showed 100% sensitivity and 80% specificity with 90% diagnostic accuracy to identify IT tumor. Conclusion: CDX2 and MUC1 have a highest sensitivity (100%) and highest NPV (100%) for IT and PBT differentiation respectively. These immunohistochemical subtypes correlates well with the conventional histomorphological classification. A panel of IHC markers like CK20 and CDX2 together allows better identification of differentiation than the use of single markers alone.

Introduction: Fine needle aspiration cytology (FNAC) of thyroid is a minimally invasive, cost-effective and an easy to perform outpatient procedure. FNAC along with thyroid function test (TFT) and ultrasonography (USG) helps in proper preoperative assessment, changes clinical management and improves patient outcome. Objectives: 1. To study the cytological features of thyroid lesions using FNAC using. The Bethesda System for Reporting Thyroid Cytology. 2. To correlate thyroid cytology with thyroid hormonal status and USG. Materials/Methods: The study was conducted in the Department of Pathology from January 2020 to December 2020 and included 50 patients with thyroid lesions who underwent FNAC, thyroid function tests and USG. Lesions were evaluated cytologically and categorized according to Bethesda System of classification and correlated with Thyroid profile and USG. Results: Out of 50 cases, females were most affected (92%). Most affected age group was middle aged (21-50 yrs). Bethesda Category I to VI cases were 4%, 82%, 2%, 4%, 2% and 6% respectively. Colloid goitre was the most common among non-neoplastic lesions. Majority of the benign and all malignant lesions were euthyroid. Hypothyroidism was mostly seen in Hashimoto thyroiditis. In 92% of the cases, USG and FNAC diagnosis correlated well. Conclusion: FNAC is a simple diagnostic modality for thyroid lesions with high specificity. The study showed that cytological analysis in conjunction with thyroid profile and USG helps to make accurate diagnosis and determine the course of therapy in effective management of patients with thyroid lesions.

Introduction: Thrombocytopenia is defined as platelet count less than 150,000μl. There are various causes of thrombocytopenia’s include increased peripheral destruction of platelets, decreased production of platelet, increased splenic sequestration abnormal platelet production. Platelet indices including platelet count, mean platelet volume (MPV), platelet distribution width (PDW), plateletcrit (PCT) & large platelet cell ratio (P-LCR) are helpful in evaluation of thrombocytopenias. Present study is evaluating this platelet indices by using five part cell counter. Method: It was an observational cross-sectional study conducted in Department of Pathology. All detected thrombocytopenia cases (platelet countless than 1.5 lakh/mm3) from CBC done by Five Part Cell Counter. Results: 150 cases of thrombocytopenia were included in our study. Majority of patients i.e 66.7% were in the age group of 15-49 yrs including males (52.7%) & females (47.3%). Infective conditions were found to be commonest cause of thrombocytopenia with 108 cases (72%), followed by 13(8.7%) anaemia cases, 8 (5.3%) ITP cases. The commonest cause of thrombocytopenia in was dengue with maximum cases of 74 (49.33%) out of 150 cases of thrombocytopenia. The mean MPV differed significantly (mean 9.5685 vs 8.5381) between two categories i.e in factious conditions vs all other conditions (except infectious), as indicated by a p-value of 0.02. The mean platelet distribution width (PDW) was significantly different [Mean ± SD (63.06 ± 23.63vs 44.00 ± 23.79)] between two categories i.e in factious conditions and all other conditions (except in fectious) as indicated by ap-value

<0.0001. The mean for parameter MPC showed significant difference [Mean ±SD (67.56±20.25 vs 53.30±27.57)] between two categories of dengue and other infectious disease with a p-value of 0.033 by using t-test for in dependent variable. The mean P-LCR was significantly higher (0.01 ± 0.01) in infectious condition as compared to non infectious category (0.004±0.008), as indicated by p-value of 0.007. The mean MP Md if fered significantly between two categories of infectious vs non infectious conditions as indicated by a p-value of 0.03. Conclusion: Newer platelet parameters are being studied so as to ease the prognosis and diagnosis of patients. These parameters are easily available in five part hematological analyser. Parameters like MPV, PDW, MPC, P-LCR & MPM show significant statistical value, thus aiding in diagnosing various causes of thrombocytopenia. PDW & MPM can determine the hypoproductive causes of thrombocytopenia, thus can be utilized for deciding the need of platelet transfusion.>