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   Table of Contents - Current issue
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January-March 2019
Volume 62 | Issue 1
Page Nos. 1-190

Online since Thursday, January 31, 2019

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EDITORIAL  

From Editor's desk p. 1
Ranjan Agrawal
DOI:10.4103/0377-4929.251285  PMID:30706850
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ORIGINAL ARTICLES Top

Assessment of fragile histidine triad expression in ameloblastoma, odontogenic keratocyst and dentigerous cyst Highly accessed article p. 3
Vanishri Chandrashekhar Haragannavar, Anand S Tegginamani, Shashidara Raju, Shailesh Kudva, Celestina Dawn Peter, DK Shruthi
DOI:10.4103/IJPM.IJPM_403_18  PMID:30706851
Background: FHIT (Fragile histidine triad) a member of tumor suppressor family, has been extensively studied in many solid tumors including head and neck squamous cell carcinoma. Among all head and neck cyst and tumors odontogenic lesions account approximately 3%-9%. The molecular pathogenesis of these lesions is less explored. Defects in cell cycle regulators and tumor suppressor genes could result in the development of odontogenic cyst and tumors. Hence, we aimed to determine the significant role of a tumor suppressor gene FHIT in most commonly occurring odontogenic lesions mainly ameloblastoma, odontogenic keratocyst and dentigerous cyst. Subjects and Methods: Immunohistochemical analysis of FHIT was done in ameloblastoma, odontogenic keratocyst, dentigerous cyst and dental follicle. Interpretation of the stained slides were done using standard scoring criteria by two pathologist. The results were subjected for statistical analysis. Results: Expression of FHIT varied among the groups, with highest negative expression in ameloblastoma 44.4% followed by odontogenic keratocyst 14% and 100%positive expression was seen in dentigerous cyst. The expression levels between the groups were statistically insignificant. Conclusion: The varied expression or negative expression of FHIT could be considered as an indicator for aggressive behavior and transformation of preneoplastic/cystic epithelium.
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Tumor budding in laryngeal carcinoma p. 7
Sumeyye Ekmekci, Ulku Kucuk, Seda Kokkoz, Ebru Cakir, Murat Gumussoy
DOI:10.4103/IJPM.IJPM_428_17  PMID:30706852
Background: Tumor budding was defined as a single cancer cell or a cluster of fewer than five cancer cells in the stroma of the invasive tumor margin. It has been suggested as a prognostic factor in various cancers, such as esophageal, lung, colorectal, and endometrial. There are only a few studies about the prognostic signifi cance of tumor budding in laryngeal carcinomas. Materials and Methods: A total of 81 patients with laryngeal carcinoma diagnosed between 2011 and 2016 and treated by partial or total laryngectomy were evaluated. Clinicopathologic parameters were correlated with the presence and grade of tumor budding. Results: The study was consisted of 77 (95.1%) male and 4 (4.9%) female patients. The mean age of the patients was 60.2 years (min: 42 and max: 78). Median follow-up time was 25 months (min: 7 and max: 54) (SD ±11.5). Histopathologic diagnosis was squamous cell carcinoma (SCC) in all patients. Of the 62 cases showing budding, 2 (3.2%) were stage 1, 12 (19.4%) stage 2, 16 (25.8%) stage 3, and 32 (51.6%) were stage 4. Fifteen cases with budding (24.2%) showed lymphovascular invasion (LVI). None of the nonbudding cases had LVI and perineural invasion (PNI). Statistical analysis revealed that LVI and PNI were signifi cantly associated with budding (P = 0.017 and P = 0.012). Among the tumors showing budding, 37% had lymph node metastasis (LNM). In nonbudding cases 15% had LNM. There was a statistically significant correlation between LNM and budding (P = 0.017). None of the parameters correlated with grade of tumor budding statistically. Conclusion: The results of this study suggest that tumor budding might be used as a prognostic factor in laryngeal SCCs.
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Effectuation to Cognize malignancy risk and accuracy of fine needle aspiration cytology in salivary gland using “Milan System for Reporting Salivary Gland Cytopathology”: A 2 years retrospective study in academic institution p. 11
Veer Karuna, Priya Gupta, Monika Rathi, Kriti Grover, Jitendra Singh Nigam, Nidhi Verma
DOI:10.4103/IJPM.IJPM_380_18  PMID:30706853
Background: To accost things in a particular disciple, egress related to Fine Needle Aspiration Cytology (FNAC) and to standardize reporting pattern, a framework “Milan System for Reporting Salivary Gland Cytopathology” (MSRSGC) has been sponsored. Aim: Aim of this study was to evaluate the potency of salivary gland FNAC reported under Milan guidelines, to calculate malignancy risk, and to compare the preoperative cytological diagnoses with the postoperative histopathological diagnoses. Settings and Design: This was a retrospective study over a period of 2 years (May 2016 to April 2018), which was classified according to Milan system and correlation with histopathology. Furthermore, the risk of malignancy was calculated for all the diagnostic categories. Materials and Methods: FNAC were analyzed on 105 patients with palpable salivary gland. Results were distributed into six categories. About 76 cases were surgically treated and resected tissues were submitted for histopathological examination. Statistical Analysis: The various diagnostic values of the procedure were calculated using the standard formula. Results: We reviewed 105 salivary gland FNA samples and recorded interpretations according to the proposed standardized six categories. Among them, category IV (neoplastic) had more cases (57.14%). The rates of malignancy in histology were as follows: (1) nondiagnostic, 0.0%; (2) nonneoplastic, 0.0%; (3) atypia of undermined significance, 50.00%; (4a) benign, 02.44%; (4b) uncertain malignant potential, 33.33%; (5) suspicious for malignancy, 100%; and (6) malignancy, 93.33%. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of Milan system came out to be 85.00%, 98.14%, 94.44%, 94.64%, and 94.59%, respectively. Conclusion: The six-tier diagnostic categories of the Milan system helps in triaging patients with salivary gland swelling and thus facilitate individualized management.
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Immunohistochemical and morphometrical evaluation of well-differentiated thyroid tumor of uncertain malignant potential p. 17
Dareen A Mohamed, Maha M Shamlola
DOI:10.4103/IJPM.IJPM_199_18  PMID:30706854
Context: Well-differentiated tumor of uncertain malignant potential (WDT-UMP) were encapsulated follicular pattern tumors with diffuse equivocal or focal unequivocal papillary thyroid carcinoma (PTC) type nuclear changes without definite invasion. These tumors are suggested to be borderline in its nature. Immunohistochemistry by CD56, P63, and CK19 are common markers used in differentiation between benign and malignant thyroid tumor. Computerized nuclear morphometry is an inexpensive objective and reproducible tool to evaluate histological features of thyroid tumors. Aims: To categorize WDT-UMP using combined nuclear morphometry and immunohistochemistry of CD56, P63, and CK19. Subjects and Methods: We used CD56, P63, and CK19 immunostaining and mean nuclear area and perimeter morphometry on 20 cases of WDT-UMP, 25 cases malignant thyroid tumors, and 25 cases benign thyroid lesions. Statistical Analysis Used: Student's t-test (Unpaired), analysis of variance (ANOVA) test, and Chi-square tests by SPSS V. 20. Results: Significant differences were obtained between WDT-UMP and benign group according to the three markers, but no significant difference between WDT-UMP and malignant group. The mean nuclear area and mean nuclear perimeter were significantly higher in WDT-UMP group in comparison with the benign group while there were no significant differences with the malignant group. Conclusion: WDT-UMP are intermediate lesions differing from benign lesions of the thyroid and sharing some criteria with PTC to a certain extent.
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Epidermal growth factor receptor and anaplastic lymphoma kinase mutation in adenocarcinoma lung: Their incidence and correlation with histologic patterns p. 24
Pankaj Gupta, Swarnalata Gowrishankar, Meenakshi Swain
DOI:10.4103/IJPM.IJPM_516_16  PMID:30706855
Introduction: Epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK) mutational analysis in adenocarcinoma lung are growing in importance as these tests are essential in guiding the use of targeted therapy. However, the prevalence of these mutations in various populations in India has not been studied. Furthermore, the correlation of histologic pattern with the mutation is not clear. Materials and Methods: A total of 64 biopsy-proven lung adenocarcinomas were selected. In 51 of these, EGFR mutational analysis was performed using Qiagen EGFR pyrosequencing kit and in 56 cases of these ALK1 immunohistochemistry (IHC) was done using ALK (D5F3) antibody and the Ventana Benchmark® XT automated IHC slide staining system for the detection of overexpression. The adenocarcinomas were classified into well, moderate, and poorly differentiated, and the histological pattern was recorded according to the WHO 2014 classification. Results: EGFR mutation was positive in 23 cases (45.10%) and positive ALK1 expression by IHC in 12 cases (21.43%). Both mutations were positive in two cases. Both mutations were seen in well-differentiated and moderately differentiated adenocarcinoma, and the expression was highest in tumors with a predominant acinar pattern. Conclusions: The incidence of both EGFR and ALK1 mutations is higher in the population studied and seem to correlate with a well differentiated, acinar pattern on morphology.
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Second evaluation of the mesenteric tissue after ethanol fixation improved the total and metastatic number of lymph nodes in colorectal resections p. 31
Asli Cakir, İlknur Cetinaslan Turkmen, Asli Unlu Akhan, Merve Akkoc, Pinar Korkmaz
DOI:10.4103/IJPM.IJPM_128_18  PMID:30706856
Context: There is a correlation between prognosis of the colorectal carcinomas and the number of retrieved and metastatic lymph nodes (LNs) from mesentery/mesorectal region. At least 12 LNs must be sampled for accurate evaluation of patients. A number of factors related to surgeon, pathologist, patient and disease could affect the total LN number. For maximizing LN yield, pathologist can use ancillary methods, as fat clearance and special solutions. Aims: This study investigates the effect of second evaluation after ethanol fixation on total and metastatic LN number and assesses factors that influence the dissected LN number. Materials and Methods: 177 colorectal resections were refixed with ethanol for a night, after standard LN sampling. Mesentery/mesorectal tissue was reevaluated for missed LNs. Results were statistically analyzed, P values <0.05 were considered significant. Results: Mean LN number increased from 26 to 30 (median: 20 to 25, P < 0.001) after ethanol fixation. Fourteen cases had additional metastatic LNs after reevaluation of the fat tissue and 5 of them upstaged. 22.5% (44/177) of the patients had <12 LNs before ethanol fixation and this decreased to 14.3% (26/177) after ethanol fixation. Resection type and length, tumor localization, size and histologic degree, pT and neoadjuvant therapy (P < 0.001) had an impact on the LN number (P = 0.034 for histologic degree, P = 0.02 for pT, P < 0.001 for others). Conclusions: Carrying out a second evaluation with ethanol fixation increased total and metastatic LN number and could lead upstage of pN. Ethanol fixation is cost-effective, easy accessible and applicable method; it may improve accuracy of LN assessment and staging, which are important for patients' outcome.
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A study of morphological prognostic factors in colorectal cancer and survival analysis p. 36
S Poornakala, NS Prema
DOI:10.4103/IJPM.IJPM_91_18  PMID:30706857
Context: Globally, colorectal cancer (CRC) is one of the leading causes of cancer death. Many Asian countries experience an increasing incidence of CRC due to changes in diet and lifestyle. Many pathological prognostic factors other than the tumor-node-metastasis (TNM) staging reflect the biological behavior of tumor tissue and influence the treatment and survival. Aims: The aim is to evaluate: (1) Various morphological prognostic factors of colorectal cancer, (2) the correlation of the prognostic factors with survival, and (3) the prognostic factors with independent prognostic significance. Settings and Design: Descriptive study conducted in a tertiary care center in Kerala. Materials and Methods: Five hundred and eighty-seven resected specimens of CRC received from January 1, 2007 to October 31, 2012 were studied for various morphological prognostic factors. Overall survival and disease-free survival were obtained by Kaplan Meier survival analysis. Cox regression analysis was performed to identify the predictors of survival. Results: CRC incidence was higher in the age group 40–60 years and males were dominant. Rectum was the common site with bleeding per rectum as a common symptom. Predominant tumors had ulcerative gross configuration, size ≤5 cm and were free of transverse, radial margin involvement. Majority of tumors were well-differentiated adenocarcinoma with invasion beyond muscularis propria, without vascular, perineural invasion, and lymph node involvement and were in Stage II. The overall and disease-free 3-year survival rates were 89.1% and 88%, respectively. Among the eight significant factors in univariate analysis, tumor histology, depth of invasion, and perineural invasion were found to have independent prognostic significance in multivariate analysis. Conclusions: In addition to the TNM staging, other morphological prognostic factors should be given importance, while considering the patients for adjuvant therapy to improve the survival rates in CRC.
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Expression and immune recognition of polypeptides derived from Hepatitis C virus structural proteins p. 43
Alyaa S. Abdel Halim, Mohamed R Mohamed, Fatma F. Abdel Hamid, Amr M Karim
DOI:10.4103/IJPM.IJPM_604_18  PMID:30706858
Background: Hepatitis C virus (HCV) is characterized by a high degree of nucleotide sequence variability between genotypes. This variability extends to functional and immunological determinants. Serological tests using antigenic segments derived from the HCV polyprotein have been used for the diagnosis of HCV infection. However, available diagnostic Kits do not necessarily take type variability into consideration and are not optimized for HCV genotype 4a (HCV4a), the predominant genotype in Egypt. Aim: The aim of this study was to express some HCV4a-derived polypeptides in order to identify those with immunodiagnostic utility. Materials and Methods: Six sequential/overlapping genomic segments encoding 100–266 amino acid peptides from the core (peptide 1), envelope 1 (E1; peptide 2), envelope 2 (E2; peptides 4, 5, and 6), and E1/E2 (peptide 3) regions of the HCV4apolyprotein were selected for in vitro expression as glutathione S-transferase-fusion proteins. The immunoreactivity of the expressed peptides was evaluated against sera from HCV-infected/uninfected individuals using dot blot, western blot, and enzyme-linked immunosorbent assay. Results: The expressed polypeptides were recognized by HCV-infected sera from 20 patients, while showing no immunoreactivity toward uninfected serum. Peptide 1 derived from the core protein was found to be the most immunoreactive. Conclusion: Expressed polypeptides hold good potential for use in the development of improved HCV immunodiagnostics.
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Immunohistochemistry and morphometric analysis of pelviureteric junction complexes in children with hydronephrosis p. 49
Pradyumna Pan, Neeraj Sachdeva
DOI:10.4103/IJPM.IJPM_535_17  PMID:30706859
Aim: The study aimed to analyze the musculature and innervations of pelviureteric junction (PUJ) complex and upper ureter by morphometry and immunohistochemistry in surgically resected specimens of PUJ obstruction and compares the findings with normal controls. Materials and Methods: Specimens of the PUJ were obtained from twenty patients with hydronephrosis due to PUJ obstruction undergoing surgical treatment in this unit from 2013 to 2015. In the control group, seven PUJ complexes were taken from patients who had nephrectomy due to trauma and Wilms tumor. The sections were stained with H and E stain and elastic von Gieson stain. For immunohistochemistry, the tissue sections were immunostained by an indirect immunoperoxidase method for S-100 and neuron-specific enolase. Results: Histopathologically, the predominant arrangement of muscle fibers was layered, i.e., a thick circular layer surrounded by two longitudinal layers on either side in PUJ of obstruction patients. S-100 immunoreactivity in the muscle layer showed dense neural innervation in PUJ complex of obstructed patients. Conclusions: Circular enhanced musculature may cause a sphincter-like activity with holding up of urine. The higher density of neuronal expression in PUJ might be responsible for causing constant contraction and intrinsic obstruction.
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Differential expression of cyclin E, p63, and Ki-67 in gestational trophoblastic disease and its role in diagnosis and management: A prospective case–control study p. 54
Asaranti Kar, Chandraprava Mishra, Priyadarshini Biswal, Tushar Kar, Sasmita Panda, Subhasini Naik
DOI:10.4103/IJPM.IJPM_82_18  PMID:30706860
Background: Gestational trophoblastic disease (GTD) constitutes a spectrum of tumors and tumor-like conditions, characterized by proliferation of pregnancy-associated trophoblastic tissue of progressive malignant potential. It is very difficult to differentiate these complex groups of lesions basing on histomorphology alone. Immunohistochemistry (IHC) with cyclin E, P63, and Ki-67 has a definite role in the identification of different trophoblasts and entities of GTD and also in the determination of biological behavior. Aims: The aim of this study is to find the differential expression of cyclin E, p63, and Ki-67 in normal placenta, hydropic abortus (HA), and various entities of GTD. Design and Settings: A prospective case–control study conducted in a government medical college. Methods: Total 96 cases, divided into Group A (48 histologically confirmed cases of GTD) and Group B (controls comprising 8 HA and 40 normal placentas of different trimesters), were studied. The histological samples were subjected to IHC using cyclin E, Ki-67, and p63. Statistical Analysis: Results were analyzed using SPSS statistical method. Results: Among the three immunomarkers used, Cyclin E and Ki-67 show statistically significant difference (P < 0.05) when compared between GTD and control groups, but it was insignificant for p63 (P = 0.369). Strong staining intensity of cyclin E and Ki-67 is seen in complete moles, choriocarcinoma, and placental site trophoblastic tumor. Conclusion: This study was done to evaluate the role of cell cycle regulatory proteins such as cyclin E and p63 and proliferation marker Ki-67 in the detection of various trophoblasts and differential diagnosis of the lesions associated with them.
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Juvenile idiopathic inflammatory myopathies: A clinicopathological study with emphasis on muscle histology p. 61
Sundaram Challa, Monalisa Hui, Saumya Jakati, Megha Shantveer Uppin, Liza Rajasekhar, Meena Angamuthu Kannan, Lokesh Lingappa, Murthy Murali Krishna Jagarlapudi
DOI:10.4103/IJPM.IJPM_387_17  PMID:30706861
Background: Juvenile idiopathic inflammatory myopathies (JIIM) are rare and heterogeneous. Subtype identification is important for treatment. Materials and Methods: Patients below 18 years diagnosed as idiopathic inflammatory myopathy (IIM) according to the Bohan and Peter criteria between January 2010 and May 2015 were evaluated with muscle biopsy in the four domains: muscle fiber, inflammation, connective tissue, and vascular, with basic panel of histochemical stains as per recommendations of the European Neuromuscular center (ENMC) workshop 2015. Immunohistochemistry with CD 31 was done to assess capillary density. Results: JIIM constituted 15.25% of IIM with juvenile dermatomyositis (JDM) being the most common subgroup (24/27) followed by juvenile overlap myositis (JOM) (3/27) in association with systemic lupus erythematosus (2) and systemic sclerosis (1). Muscle biopsy in JDM was characterized by perifascicular atrophy, necrosis, degeneration, and regeneration in all and the other features included perivascular inflammation (21), lymphoid aggregates (2), mitochondrial abnormalities (9), sarcoplasmic vacuoles (6), capillary dropout (5), capillary dilatation (6), and perimysial fibrosis (14). JOM was characterized by auto-antibodies and perivascular inflammation. Conclusion: JIIMs were rare and JDM was the most common subtype. Muscle biopsy evaluation as per ENMC criteria characterized the subgroups.
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Tetrachromic VOF/Masson's trichrome/H and E stains: Unmasking their usability in differential stromal hard tissue staining p. 67
Ankita Tandon, Akriti Singh, Devi Charan Shetty, Saurabh Juneja
DOI:10.4103/IJPM.IJPM_242_18  PMID:30706862
Background: Identification and differentiation of stromal hard tissue components is a challenging task. Numerous methods of demonstrating these components have been worked upon in the past. Although some of the methods have been successful, there are many drawbacks of employing them. The need of the hour, therefore is to develop and use a simple, rapid and cost-effective method of identifying stromal hard tissues as they may signify an important change in the diagnosis of the pathology. Our aim is therefore to observe the usability of tetrachromic VOF stain over Hematoxylin and Eosin and Masson's Trichrome in routinely encountered head and neck pathologies. Materials and Method: Routine cases such as Central and peripheral ossifying fibromas, osteomas, giant cell granulomas, osteomyelitis and malignancies like osteosarcomas were retrieved from the department archives and 3 sections from each block were prepared to stain with H and E, Masson's trichrome and modified tetrachromic VOF stains respectively using standard staining protocol. Results: Tetrachromic VOF takes an upper hand in stromal hard tissue differentiation irrespective of the pathology. Conclusion: Modified tetrachromic VOF is simple, cost-effective method and can be employed for diagnosis of cases with hard tissue differentiation within the stroma on routine basis.
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HIV-associated lymphoma: A 5-year clinicopathologic study from India p. 73
Rajalakshmi Sampath, Marie Therese Manipadam, Sheila Nair, Auro Viswabandya, Anand Zachariah
DOI:10.4103/IJPM.IJPM_452_17  PMID:30706863
Context: Relative risk of non-Hodgkin lymphoma (NHL) in people living with HIV is 60–200 times that of normal population. This is the largest series from India on lymphomas arising in HIV-infected individuals including workup for Epstein–Barr virus (EBV) and human herpesvirus-8 (HHV-8). Aims: This study aims to ascertain the distribution and detailed clinicopathologic features of lymphoma arising in HIV-infected persons in India. Settings and Design: The study was done during the period of 2007–2011 in the pathology department of a tertiary care center in South India. Subjects and Methods: All cases diagnosed as lymphoma in the department of pathology during the study period were identified, and patients with HIV positive by serology were included in the study. Clinical details were obtained from electronic records, slides were reviewed and tissue blocks retrieved, and immunohistochemistry for HHV-8 and in situ hybridization for EBV-encoded RNA was done. Statistical Analysis Used: Descriptive statistics were done using SPSS software. Kaplan–Meier curves were used to do survival analysis. Results: Of 3346 patients diagnosed with lymphoma, 73 (2%) were diagnosed to be positive for HIV. About 87.6% of the cases were NHL, of which diffuse large B-cell lymphoma was the most common and plasmablastic lymphoma was the second common subtype. Survival was uniformly poor in 36% of the cases where follow-up was available. Conclusions: The striking differences from world literature included higher frequency of plasmablastic lymphomas, lack of primary central nervous system lymphomas, and low association with HHV8.
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Video projected practical examination as an introduction to formative assessment tool for undergraduate examination in pathology p. 79
Sabina Khan, Mohd Jaseem Hassan, Musharraf Husain, Sujata Jetley
DOI:10.4103/IJPM.IJPM_30_18  PMID:30706864
Background: Assessment of the medical students includes theory as well as practical assessment. Traditional practical examination in pathology which includes viva and spots is now increasingly being questioned because of their inherent lack of validity and reliability, time consumption, and human resource requirement. Therefore, a need was felt for another form of practical examination which can be used as formative assessment, and if found feasible, can be employed in summative assessment too. Aim: The aim of the study was to develop and implement a new method of video projected practical examination (VPPE) as a formative assessment tool for MBBS second professional students so as to improve their learning and academic performance in practical pathology and also to obtain students' perception regarding the effectiveness of VPPE. Methodology: The study was carried out with the MBBS second professional students before their end-of-semester examination in the Department of Pathology. In this new method, slide video projection was used as a formative assessment tool during practical examination. Students were randomly divided into two groups. Group I was subjected to VPPE, while simultaneously conventional practical examination was held for Group II. Assessment results of VPPE were compared with conventional practical examination. Faculty and students feedback was also taken at the end of the examination. Results: Mean marks of the students who undertook VPPE was higher than those who gave conventional practical examination. Majority (95.3%) of the students agreed that VPPE is better than conventional practical examination. Most of the faculty members also felt that it is a more valid and reliable assessment tool. Conclusions: Introducing VPPE as a formative assessment tool in practical pathology enhanced their learning and academic performance. Opinion of examiners and students also showed that VPPE has several advantages over conventional practical examination.
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Randomized cross-over study and a qualitative analysis comparing virtual microscopy and light microscopy for learning undergraduate histopathology p. 84
Samal Nauhria, Prakash VAK Ramdass
DOI:10.4103/IJPM.IJPM_241_18  PMID:30706865
Background: Virtual microscopy (VM) use in teaching and learning is increasing worldwide. However, there is a paucity of information comparing it to light microscopy (LM) in learning undergraduate histopathology. We investigated whether VM or LM had a higher impact on student learning and performance in histopathology. In addition, we investigated whether students preferred VM over LM, and whether VM use provided a platform to fulfill the Accreditation Council for Graduate Medical Education core competencies. Materials and Methods: We used a sequential exploratory mixed method study design. A qualitative phase inquiring about student preference for VM or LM was followed by a randomized cross-over study. Student preference was measured by an online survey based on a Likert scale. In the cross-over study, students were randomized to either the VM or the LM arm, and their mean scores in standardized exams were compared after using VM and LM. Results: A total of 152 students completed the qualitative study and a total of 64 students participated in the cross-over study. Eighty-three percent (83%) of the students preferred to use VM over LM. Students who used VM scored significantly (P < 0.001) higher [(87.1% vs. 72.4%) and (85.3% vs. 76.1%)], respectively, in both phases of the cross-over study compared to those who used LM. Conclusions: Using VM to learn histopathology has significantly increased student learning and performance compared to using LM.
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BRIEF COMMUNICATIONS Top

Immunoglobulin G4 related pancreaticobiliary disease: Report of two cases highlighting the diagnostic criteria p. 91
Abha Thakur, Vikash Agarwal, Yogesh Batra, Deep Goel, Pankaj Kumar Pande, Veena Malhotra
DOI:10.4103/IJPM.IJPM_683_17  PMID:30706866
Two cases of immunoglobulin (IgG4)-related biliary and pancreaticobiliary disease are reported to define its diagnostic features. Case 1 presented with obstructive jaundice and showed IgG4-related disease (RD) involving right and left hepatic duct, common bile duct and gallbladder. Case 2 presented as periampullary mass. Both patients underwent surgical intervention. However, certain clinical and radiological features were present in these cases indicative of the possibility of IgG4-RD.
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Glomerulocystic disease, a rare cause of renal cysts in infants: A series of three cases p. 95
Nelofar Islam, Bappa Mandal, Goutam Bera, Suchandra Mukherjee, Uttara Chatterjee
DOI:10.4103/IJPM.IJPM_643_17  PMID:30706867
Glomerulocystic kidney disease (GCKD) is an uncommon type of cystic renal disease affecting children. It has both sporadic and familial occurrence and is characterized by cortical microcysts associated with dilatation of Bowman's spaces. In some instances, GCKD is an early manifestation of autosomal dominant polycystic kidney disease. Here, we present three cases of GCKD, two in infants and one in a perinatal postmortem. The first one is a case of GCKD with unilateral involvement, diagnosed on surgical biopsy. GCKD is a morphological expression of several hereditary and nonhereditary disorders that differ vastly in their management and long-term outcome. Hence, accurate morphological diagnosis of this entity is important for prognostication and genetic counseling.
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Association of androgen and estrogen receptor expression with prostate volume in benign prostatic hyperplasia p. 99
Karli Sreenivasulu, Hanumanthappa Nandeesha, Lalgudi N Dorairajn, Nachiappa G Rajesh
DOI:10.4103/IJPM.IJPM_315_18  PMID:30706868
Background: The expression of androgen (AR) and estrogen receptors (ER-A, ER-B) in Prostate cancer is well documented, but there are limited data about the same in patients with BPH. Hence the present study was designed to analyse the gene and protein expression of androgen and estrogen receptors in patients with BPH. Materials and Methods: Prostatic tissues were obtained from 27 BPH patients aged between 55 to 85 years by transurethral resection of prostate. Based on prostate volume, BPH patients were divided into two groups, Group A (≤30mL) and Group B (>30mL). The mRNA and protein expression of AR, ER-A and B were assessed by Quantitative real time PCR, Western blotting and Immunohistochemistry. Results: AR gene (P < 0.05) and protein expression (P = 0.03) and ER-A gene (P < 0.05) and protein expression (P = 0.02) was significantly higher in BPH patients with larger prostate size compared to smaller prostate size. Immunohistochemistry showed that AR expression was predominate in ductal cells of larger volume prostate tissues while AR expression in stromal tissue was the dominant finding in patients with smaller prostate size. Also serum estradiol was significantly increased in patients with larger prostate size (P = 0.03). Conclusion: Androgen and Estrogen receptor expression increases with increase in prostate volume in BPH cases.
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Direct immunofluorescence findings in cicatricial alopecia: A retrospective study of 155 cases p. 103
Radhika Agarwal, Meeta Singh, Reema Dahiya, Vishal Singh, Dimple Chaudhary, Nita Khurana, Vijay Kumar Garg
DOI:10.4103/IJPM.IJPM_428_18  PMID:30706869
Objectives: To study the direct immunofluorescence (DIF) in cicatricial alopecia (CA) patients. Materials and Methods: Approximately, 155 skin biopsies from CA patients examined over 7 years (2009–2015). Special stains and Hematoxylin and Eosin were performed, and final histopathological diagnosis was made. DIF (against anti-IgG, IgM, C3, IgA, and fibrinogen) on all these cases and patterns were noted. The descriptive statistics were applied along with ANOVA test. Results: Approximately, 155 patients with Male: Female = 1.24:1, age 7–65 years. In total, 57 cases were of Lichen planopilaris (LPP; 36.7%), 22 Lichen planus (LP; 14.2%), 22 Psuedopalade of Brocq (PPB; 14.2%),16 discoid lupus erythematosus (DLE; 10.3%), 8 end-stage scarring alopecia (ESSA; 5.2%), 2 cases each of Fungal folliculitis (FF), and Folliculitis decalvans (FD; 1.3% each), and in 26 cases, no specific diagnosis could be reached were collectively kept in the category of non-specific findings (NSP; 16.7%). On DIF: LPP positive for IgG = 4 cases (7%), IgM = 26 (45%), IgA = 11 (19.3%), C3 = 16 (28.1%), and fibrinogen = 11 (19.3%). LP positive for IgG = 2 (9%), IgM = 18 (81%), IgA = 2 (9.1%), C3 = 10 (45%), and fibrinogen = 1 (4.5%). DLE positive for IgG = 6 (37%), IgM = 8 (50%), IgA = 1 (6.3%), C3 = 9 (56%), and fibrinogen = 1 (4.5%). Limitations: Because this was a retrospective study, clinical follow-up and treatment history of the patient could not be retrieved. Conclusions: IgG positivity helps significantly in differentiating LPP from DLE (P 0.004) and NSP from DLE (P 0.005). IgM positivity helps significantly in differentiating LPP from LP (P 0.04), LP from PPB (P 0.00) and NSP (P 0.00). C3 positivity helps significantly in differentiating PPB from DLE (P 0.02).
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Plasmablastic lymphoma of bone marrow: Report of a rare case and immunohistochemistry based approach to the diagnosis p. 107
Praveen Sharma, Sreejesh Sreedharanunni, Abin Koshy, Gaurav Prakash, Man Updesh Singh Sachdeva, Pankaj Malhotra
DOI:10.4103/IJPM.IJPM_180_18  PMID:30706870
Plasmablastic lymphoma (PBL) is a distinctly rare neoplasm believed to arise from post-germinal center, terminally differentiated, activated B cells before transformation to plasma cells; and predominantly affecting human immunodeficiency virus (HIV) infected or immunodeficient males. Here, we report a rare case of primary PBL of bone marrow in an immunocompetent male, the diagnosis of which is complicated by the overlapping morphology and immunophenotype with several large cell lymphomas and plasma cell neoplasms; and showing dramatic response to anti-CD30 monoclonal antibody based therapy. We discuss the immunohistochemistry based approach and the possible diagnostic pitfalls in such cases. The inclusion of markers of plasmablastic differentiation in the diagnostic panel of large cell lymphomas is essential to avoid misclassification of these rare lymphomas.
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Prevalence of allergic bronchopulmonary aspergillosis among patients with severe bronchial asthma in a tertiary care hospital in Northern India p. 111
D Bhankhur, N Singla, D Aggarwal, J Chander
DOI:10.4103/IJPM.IJPM_205_18  PMID:30706871
Introduction: The link between fungi and asthma has been known for centuries. About one-third to one-half of severe asthmatics has history of atopic sensitization to filamentous fungi, most predominantly to Aspergillus fumigatus. Allergic bronchopulmonary aspergillosis (ABPA) is the one of the most documented fungal presentations among patients with asthma. This study was done on 50 patients with severe asthma who were consecutively enrolled from January 2016 to June 2017 to look for prevalence of ABPA. Materials and Methods: Blood samples were collected from 50 patients with severe asthma, and serum was separated to test for absolute eosinophil count, total IgE, and Aspergillus fumigates–specific IgE. Results: The prevalence of ABPA was found to be 70% (35/50). Of these, ABPA-B (ABPA with bronchiectasis) was less 31.4% (11/35) when compared with 68.5% (24/35) of patients with serological ABPA. Out of these 35 patients, there were 18 females and 17 were males. The mean age of the patients was 41.3 years. Conclusion: ABPA prevalence is high in patients with severe asthma, and there is a need to look for and evaluate this association further.
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CASE REPORTS Top

A rare cause of progressive neuropathy: Arachnoiditis ossificans p. 114
Manju Kumari, Minakshi Bhardwaj, Ajay Choudhary
DOI:10.4103/IJPM.IJPM_403_17  PMID:30706872
Arachnoiditis ossificans (AO) is a rare type of chronic arachnoiditis characterized by the presence of calcification or ossification of the spinal arachnoid which is usually associated with progressive neurological deficits. It is usually followed by prior history of trauma, surgery, infection, or myelography. Magnetic resonance imaging and computed tomography are the characteristics that are helpful in the diagnosis of most cases. Prognosis and treatment depends on the site and clinical presentation of the patients. We present a case of a young female who presented with a long-standing history of neurological symptoms and a intradural lesion mimicking a tumor.
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Intraductal pseudopodia in pleomorphic adenoma of parotid gland p. 117
K Devaraja, Rajeev Kumar, Prem Sagar, Adarsh Barwad
DOI:10.4103/IJPM.IJPM_307_17  PMID:30706873
Pleomorphic adenoma is the most common salivary gland tumor. Pseudopodia are finger-like projections extending beyond the tumor capsule, seen in pleomorphic adenoma. If not resected completely, these pseudopodia may increase the risk of recurrence after excision of pleomorphic adenoma. While performing a total conservative parotidectomy for the pleomorphic adenoma of the parotid gland, we encountered tumor in the Stensen's duct. On pathological examination, the tumor was not involving the wall of the duct but was passing through the lumen, like a pseudopod. During parotidectomy, the surgeon should inspect the lumen of parotid duct for the presence of any tumor. Pseudopodia of pleomorphic adenoma may extend into the lumen and if not addressed adequately may lead to recurrence of the tumor.
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Low-grade myofibroblastic sarcoma of maxillary sinus and buccal mucosa: Two rare cases and review of the literature p. 119
Anirban Ghosh, Arghya Bandopadhyay, Rajarshi Sarkar
DOI:10.4103/IJPM.IJPM_99_18  PMID:30706874
Low-grade myofibroblastic sarcoma (LGMS) represents an atypical tumor composed of myofibroblasts with a predilection for the head and neck, especially in the tongue and oral cavity, with a high tendency to local recurrence and metastasis, even after a long period. LGMS arising from maxillary sinus and buccal mucosa are not very common. To the best of our knowledge, only 55 cases of low-grade myofibroblastic sarcoma have been reported and only four cases of LGMS of maxillary sinus and three cases of LGMS of buccal mucosa have been reported in world literature. We report two cases of LGMS of the maxillary sinus and buccal mucosa, discussing clinical, histological, inmunohistochemical and therapeutic features.
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Papillary carcinoma thyroid serving as recipient tumor to carcinoma breast: A rare example of tumor-to-tumor metastasis p. 122
Anila Kunjulekshmyamma Raveendrannair, Anitha Mathews, Bipin T Varghese, K Jayasree
DOI:10.4103/IJPM.IJPM_672_17  PMID:30706875
A 36-year-old female presented with lump in the left breast of 2 months duration. Fine-needle aspiration cytology (FNAC) and trucut biopsy confirmed the diagnosis of carcinoma. Clinically, it was T3N1Mx disease. Computed tomography (CT) of the chest detected bilateral lung metastasis. CT head and neck detected a nodule in the thyroid which on FNAC was suspicious of papillary carcinoma. The patient was started on chemotherapy for breast disease with a good initial response; however, while on-follow up, there was progression of disease at primary site. The patient was taken up for surgery. Radical mastectomy along with total thyroidectomy was performed. Histopathological examination showed infiltrating duct carcinoma, not otherwise specified type and papillary carcinoma thyroid. There was a 0.4 cm × 0.4 cm metastatic focus, from breast carcinoma within the papillary carcinoma thyroid. The metastasis was confirmed by immunohistochemistry. Metastasis to thyroid is rare. However, tumor-to-tumor metastasis with papillary carcinoma serving as recipient to breast carcinoma is exceedingly rare with very few case reports in the literature. We report this case for its rarity and also for highlighting the fact that pathologists should keep in mind the possibility of metastasis also when coming across unusual morphology in thyroid lesions.
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Lymphoepithelioma-like carcinoma of breast: A case report and review of the literature p. 125
María Tereza Nieto-Coronel, Víctor Manuel Perez-Sanchez, Jessica Elizabeth Salazar-Campos, Raul Diaz-Molina, Claudia Haydee Arce-Salinas
DOI:10.4103/IJPM.IJPM_761_17  PMID:30706876
Lymphoepithelioma is a rare clinical entity, first was described in nasopharynx, and have been reported in another organs. Lymphoepithelioma-like carcinoma (LEC) of the breast is an undifferentiated carcinoma. Approximately 32 cases have been described, and differential diagnoses include primary breast lymphoma and medullary carcinoma. We present a 57-year-old woman, diagnosed with LEC of the breast, treated with mastectomy, followed by adjuvant chemotherapy, radiotherapy, and hormone therapy, with a disease-free interval of 2 years. There is scarce evidence related to the best treatment choice in this histological type.
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Undifferentiated embryonal sarcoma of the liver in elderly: Case report and review of the literature p. 129
Gunter Gerson, José Telmo Valença, Juliana M Cavalcante, River De Alencar Bandeira Coêlho
DOI:10.4103/IJPM.IJPM_508_16  PMID:30706877
Sarcomas are rare lesions of the liver and represent <1% of primary liver tumors. Embryonic sarcoma (undifferentiated) of the liver is a rare and aggressive malignant tumor that usually occurs in children with a peak incidence between 6 and 10 years. In adults, it is extremely rare with only 13 cases described in patients older than 40 years and 68 cases reported in patients older than 15 years. There is a slight predominance of females in adults. With an emphasis on morphological and immunohistochemical features, as well as on clinical data and imaging studies, we present this case report, in addition to extensive literature review on the topic.
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Incidental retroperitoneal oncocytoma (Ectopic oncocytic adrenocortical adenoma): Case report and review of the literature p. 132
Ismail Saygin, Emel Cakir, Mustafa Emre Ercin, Ilker Eyüboğlu
DOI:10.4103/IJPM.IJPM_58_18  PMID:30706878
Ectopic adrenocortical tissue may be present in many anatomical localizations. Hyperplasia, adenoma or carcinoma can occasionally develop from the ectopic adrenal tissue. Therefore, it should be surgically excised when it is detected. Adrenocortical tumors are the most common type of adrenal neoplasms. Ectopic adrenocortical adenomas are rarely seen. A total of 34 cases of ectopic adrenocortical adenoma (14 of which are oncocytomas) have been reported at different localizations in English literature. Most of them are non-functional. Differential diagnosis is required with other benign or malign oncocytic neoplasms. We report a 56-year-old male patient, who presented with a retroperitoneal mass. Our case is the seventh case of ectopic retroperitoneal adrenal adenoma with oncocytic cells.
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Sclerosing polycystic adenosis: A case report with review of the literature p. 136
Sreelekha Appasani, Preethi Thattaruparambil Ramadas, Jayapriya Gangadharan, Anitha Mathews
DOI:10.4103/IJPM.IJPM_518_17  PMID:30706879
Sclerosing polycystic adenosis (SPA) is primarily a disease of major salivary glands. It was recognized as a distinct morphologic entity by Smith et al. in 1996. To best of our knowledge, 67 cases of SPA are reported in English literature. Here, we describe a case of SPA showing classic histomorphological features, involving the parotid gland of a 17-year-old girl. It was diagnosed as mucoepidermoid carcinoma at a peripheral hospital and was referred to our center. Histologically, it was well circumscribed and composed of lobules, separated by hyalinized stroma. Lobules showed adenosis, foci of acinic cell hyperplasia, and intraductal epithelial proliferation. Immunohistochemistry with p63 highlighted myoepithelial layer around every duct, acinus, and also in foci showing epithelial hyperplasia. There was no evidence of malignancy. Awareness of SPA, a benign rare entity, is essential to avoid misdiagnosing it as other common salivary gland tumors which it may mimic.
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Mullerian adenosarcoma (heterologous) of uterine cervix with sarcomatous overgrowth: A case report with review of the literature p. 139
Debahuti Mohapatra, Pranita Mohanty, Rupanita Biswal
DOI:10.4103/IJPM.IJPM_77_18  PMID:30706880
Mullerian adenosarcoma is a rare biphasic malignant neoplasm of cervix characterized by an admixture of benign epithelial elements and a malignant sarcomatous stromal component, which may be either homologous or heterologous. Mullerian adenosarcoma with stromal overgrowth (MASO) in an aggressive variant of adenosarcoma, which is extremely rare with only two such cases reported till date. In this report, we present a case of MASO of cervix with heterologous elements in a 55/F presenting with postmenopausal bleeding. As it commonly simulates clinically and radiologically as benign cervical polyp, the gynecologists and pathologists should be aware of this extremely rare entity presenting with aggressive clinical course.
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A malignant placental site trophoblastic tumor of the uterus with multiple metastases: A case report of a rare tumor showing an aggressive behavior p. 142
Amany Abdulgader Fathaddin, Maria Abdulrahim Arafah
DOI:10.4103/IJPM.IJPM_45_18  PMID:30706881
One of the very rare forms of gestational neoplastic diseases is the malignant placental site trophoblastic tumor. Due to its rarity, the data regarding its diagnosis and management are limited. The prognosis of this tumor is unpredictable with potential malignant behavior and metastasis. We report a case of malignant placental site trophoblastic tumor with multiple metastatic deposits in the ovaries, lungs, kidneys, adrenals, and pancreas. The patient was treated by surgery and an extensive subsequent chemotherapy. The disease progressed, and the patient died 17 months after diagnosis.
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A case of primary signet-ring cell carcinoma of the cervix containing full genome of human papillomavirus 16 p. 146
Satoshi Kawai, Yutaka Torii, Iwao Kukimoto, Takuma Fujii
DOI:10.4103/IJPM.IJPM_507_17  PMID:30706882
We herein present a case of primary signet-ring cell carcinoma of the cervix. Pelvic magnetic resonance imaging revealed a 38-mm cervical tumor, and computed tomography revealed no findings suggestive of distal metastasis or other tumor origins. Gastrointestinal endoscopy showed no abnormal findings. Histopathology revealed signet-ring cell-type mucinous adenocarcinoma. By immunohistochemistry, tumor cells were negative for the mammary neoplasm marker, gross cystic disease fluid protein 15 and gastrointestinal neoplasm markers, MUC2, MUC6, and CDX2, but positive for p16. These findings suggested human papillomavirus (HPV)-related adenocarcinoma of the cervix. HPV genotyping assays with exfoliated cervical cells and formalin-fixed paraffin-embedded tissues demonstrated HPV16 positivity, suggesting that the primary origin of the tumor was the cervix. The full HPV16 genome was amplified by polymerase chain reaction from exfoliated cervical cells, and the full-genome sequence was determined by next-generation sequencing. This is the first report of primary signet-ring cell carcinoma of the cervix containing the full HPV16 genome.
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Neu Laxova syndrome p. 149
Tanima Dwivedi, Manasi Gosavi
DOI:10.4103/IJPM.IJPM_351_17  PMID:30706883
NeuLaxova syndrome (NLS) is a rare congenital abnormality involving multiple systems. Until date, only 60 cases of this syndrome have been reported in the literature. A stillborn fetus from a 23-year-old female with bad obstetrics history and consanguinity marriage, presented at 41 weeks gestation and not appreciating fetal movements for the past 3 days. Ultrasound examination revealed the absence of fetal cardiac activity and features of growth retardation. The fetus was sent for pathological examination. At autopsy, fetus had ichthyosis over the scalp and face, depressed nasal bridge, low set ears, microcephaly, slopping forehead, wide interdigital spaces, edema of hands and feet, hypoplastic penis, right leg showed congenital talipes equinovarus and left leg showed rocker bottom foot. On dissection, all organs were in situ. Both lungs were hypoplastic, brain was atrophied, and heart showed right ventricle hypertrophied. A diagnosis of NLS was made. Genetic counseling and early serial ultrasound examination should be performed at high-risk families because of its autosomal recessive mode of inheritance. Early diagnosis of the disease may offer termination of the pregnancy as an option. The prognosis is poor, and the affected newborns are either stillborn or die immediately after birth.
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Pulmonary nocardiosis: Report of two cases from a tertiary care hospital p. 153
Archana Baburao, Sruthi Prasad, S Prakash, Huliraj Narayanswamy
DOI:10.4103/IJPM.IJPM_793_17  PMID:30706884
Pulmonary nocardiosis is an uncommon bacterial infection that may lead to severe disease in immunocompromised patients. The disease is rare in immunocompetent patients. Reported cases are few, and the literature is limited because disease recognition is difficult. We present a case report of two patients of pulmonary nocardiosis, who had different clinicoradiological presentations and also responded differently to treatment. Given the rising incidence of cancer, organ transplantation, and use of parenteral steroids, Nocardia is likely to attain a higher place among the causes of pulmonary infections.
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A rare case of disseminated penicilliosis - first of its kind from North India p. 156
Surekha Yadav, Richa Gupta, S Anuradha, Ayush Mohan Makkar
DOI:10.4103/IJPM.IJPM_709_17  PMID:30706885
Penicilliosis is a rare opportunistic fungal infection caused by Talaromyces marneffei, especially in the HIV-infected patients. The untreated disease is highly fatal. The infection is endemic in Southeast Asia and Northeast India. The present case is the first case of disseminated penicilliosis from North India and Delhi in a 31-year-old male, recently diagnosed with HIV. This case highlights the importance of considering an unusual organism as the cause of disseminated disease in the nonendemic area.
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IMAGES Top

Three unusual cases of parasites in eye p. 159
Shailendra Mundhada, Madhavi Deshmukh, Milind Changole
DOI:10.4103/IJPM.IJPM_247_18  PMID:30706886
A 17-year-old male patient presented with cellulitis and mass in the eye noticed approximately 3 months back. The mass was about 1 cm in size and situated at the limbus. All preoperative routine investigations were normal. Surgical exploration revealed a sub-conjunctival cystic mass near the lateral rectus muscle about 1 cm in diameter; the mass was excised. Gross pathological examination revealed a thin-walled cystic mass. There was a hard nodule in the center. Microscopy revealed a wall of cysticercosis. Scolex was also seen. Surrounding tissue revealed sparse acute and chronic inflammatory cells. The case was confirmed by CDC, Atlanta, and was also included in their departmental presentation as an interesting case. A 60-year-old lady presented with complaints of itching over the forehead and right eye for 5 days. She was prescribed steroid eyedrops and antihistaminics. The itching aggravated with eyedrops along with watering and foreign body sensation. On revisit, the ophthalmologist noticed a worm in the right upper subconjunctival space. The worm was carefully removed in toto and sent to the laboratory for identification. The worm was thin, cylindrical, 8–10 cm long and white in color. After microscopic and gross examination of the worm, it was identified as Dirofilaria spp. CDC (Atlanta) confirmed the diagnosis of Dirofilaria. The patient was treated with antihistaminics and was relieved of symptoms without recurrence. A 45-year-old male patient had a painless mass in the eye for the last 3 months. He had no systemic illness. He gave a history of swimming pool use during that time. The mass was excised and submitted for histopathology. Numerous globular cysts representing thick-walled sporangia containing numerous spores diagnostic of Rhinosporidiosis were seen.
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Sialadenoma papilliferum of the hard palate: A rare case report p. 163
Saede Atarbashi-Moghadam, Ali Lotfi, Mohammad Moshref, Sepideh Mokhtari
DOI:10.4103/IJPM.IJPM_687_17  PMID:30706887
Sialadenoma papilliferum (SP) is a rare benign salivary gland tumor with unclear cell origin. This report presents a new case of SP of the hard palate occurring in a 50-year-old female. The lesion was completely excised, and the microscopic features were consistent with SP. The knowledge of this rare entity contributes to proper diagnosis and prevents unnecessary radical surgery and treatment.
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Gingival choristoma masquerading as fibroma p. 165
BL Laxmidevi, TR Marimallappa, Jyothi Mahadesh
DOI:10.4103/IJPM.IJPM_204_18  PMID:30706888
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Extramedullary plasmacytoma of tonsil: an unusual site p. 167
Ritesh Sachdev, Manoj Tayal, Shalini Goel, Rashi Sharma, Dheeraj Gautam
DOI:10.4103/IJPM.IJPM_808_17  PMID:30706889
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Acute amoebic appendicitis: An unusual presentation of a usual infection p. 169
Aditi Goyal, Surbhi Goyal, Chhabi Ranu Gupta
DOI:10.4103/IJPM.IJPM_576_17  PMID:30706890
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Accessory ovary: A rare case report p. 171
Radhika Yajaman Gurumurthy, N Siddharth Shankar, CS Mohan Raj, N Sriram
DOI:10.4103/IJPM.IJPM_648_17  PMID:30706891
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LETTERS TO THE EDITOR Top

Primary cutaneous mucinous carcinoma of the chin: Report of a case p. 173
Alessandra Fin, Lorenzo D'Alì, Sebastiano Mura, Emanuele Rampino Cordaro, Fabrizio De Biasio, Laura Mariuzzi, Pier Camillo Parodi
DOI:10.4103/IJPM.IJPM_136_18  PMID:30706892
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SETTLE tumor of thyroid: Oldest case in literature p. 175
Hamsa Nandini, Vivek Shetty, Akhila Lakshmikantha, HV Sunil, Subramanian Kannan
DOI:10.4103/IJPM.IJPM_774_17  PMID:30706893
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Clear cells in gastric biopsy, are they always neoplastic? p. 177
Faheema Hasan, Sashikant Dighade, Manoj Kumar Bind, Vatsala Misra
DOI:10.4103/IJPM.IJPM_298_18  PMID:30706894
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Persistent mullerian duct syndrome with mixed germ cell tumor of undescended testis: A case report p. 178
Amit K Adhya, Manas R Pradhan
DOI:10.4103/IJPM.IJPM_167_18  PMID:30706895
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Intramyometrial cystic endosalpingiosis - a rare entity in gynecological pathology: A case report and brief review of the literature p. 181
Arpita Saha, Kaushik Saha, Jheelam Mukhopadhyay
DOI:10.4103/IJPM.IJPM_85_18  PMID:30706896
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Intraosseous ganglion of the distal tibia: Clinical, radiological, and histopathological highlights p. 183
Ridhi Sood, Rajnish Garg, Harpreet Kaur, Neena Sood
DOI:10.4103/IJPM.IJPM_638_17  PMID:30706897
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Phenotypic heterogeneity of delta–beta thalassemia p. 185
Sunita Sharma, Shivali Sehgal, Reena Das, Sameer Gulati
DOI:10.4103/IJPM.IJPM_314_17  PMID:30706898
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Sickled red blood cells in urine: A preliminary indicator for the detection of sickle cell trait p. 186
Neha Garg, Rashmi Jain Gupta, Sunil Kumar, Naresh Kumar
DOI:10.4103/IJPM.IJPM_83_18  PMID:30706899
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NEW HORIZON Top

Catechism (Quiz 3) p. 189
Bharat Rekhi
DOI:10.4103/IJPM.IJPM_641_18  PMID:30706900
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