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   Table of Contents - Current issue
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April-June 2016
Volume 59 | Issue 2
Page Nos. 141-268

Online since Monday, May 09, 2016

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EDITORIAL  

From Editor's desk p. 141
Vatsala Misra
DOI:10.4103/0377-4929.182046  PMID:27166028
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ORIGINAL ARTICLES Top

Expression and clinicopathological significance of antiapoptotis protein survivin in gallbladder cancer Highly accessed article p. 143
Vishal Gupta, Madhu Mati Goel, Abhijit Chandra, Parul Gupta, Saket Kumar, Jaya Nigam
DOI:10.4103/0377-4929.182035  PMID:27166029
Background: Clinical significance of survivin (antiapoptosis protein) in gallbladder cancer is not yet established. Aims: This study was performed to assess the expression pattern of survivin in benign and malignant gallbladder lesions using immunohistochemistry (IHC), and to assess its clinicopathological significance. Settings and Design: Prospective study from July 2012 to July 2014 was performed as a part of intramural research project. Materials and Methods: Tissue samples from resected gallbladder for cholelithiasis (n = 27) and carcinoma gallbladder (n= 24) were evaluated for survivin expression by IHC using a scoring system. Their expression was correlated with different clinicopathological parameters. Statistical Analysis: Fisher's exact test, Student's t-test, and Chi-square test were used as appropriate for data analysis. Kaplan–Meier methods were used to calculate overall and disease-free survival rates among different groups. Two-sided P< 0.05 was considered as significant. Results: Benign group (19 females, age [mean ± standard deviation [SD] 45 ± 14 years) and malignant group (20 females, age [mean ± SD] 48.9 ± 13.4 years) were comparable with respect to menopausal status, presence, size and types of stones. However, survivin expression was significantly higher (66.7%, 95% confidence interval [CI] 24–75) in gallbladder cancer than in cholelithiasis group (33%, CI 46–83), P= 0.025). Its expression did not correlate with gender, age, menopausal status, presence of gallstones or their size, number and type, tumor differentiation, and tumor stage. Conclusions: Significantly higher expression of survivin protein in gallbladder cancer as compared to cholelithiasis group suggests its role in gallbladder carcinogenesis though it may not have prognostic value.
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Angiomatoid fibrous histiocytoma: Clinicopathological spectrum of five cases, including EWSR1-CREB1 positive result in a single case p. 148
Bharat Rekhi, Shraddha Adamane, Kiran Ghodke, Saral Desai, Nirmala A Jambhekar
DOI:10.4103/0377-4929.182023  PMID:27166030
Background: Angiomatoid fibrous histiocytoma (AFH) is an unusual soft tissue tumor (STT), characterized by recurrences, but rarely metastasis. Later, certain molecular signatures have been identified underlying this tumor, which at times, is either underdiagnosed as a benign vascular tumor, or over diagnosed as a high-grade pleomorphic sarcoma, including a malignant fibrous histiocytoma. Materials and Methods: Over a 14-year-period, five diagnosed cases of AFH were analyzed. Results: Five tumors occurred in three males and two females, over a wide age-range (median = 21, mean = 30 years); mostly in the extremities (4) (80%). Microscopically, most tumors were circumscribed, comprising large, blood-filed spaces with surrounding histiocytic cells and a “cuff” of lymphoplasmacytic cells. Three tumors revealed solid growth pattern with polygonal to spindle cells, including myxoid matrix in one of these tumors. On molecular analysis, this tumor exhibited EWS-CREB transcript. Immunohistochemically, various tumors were positive for CD68 (n = 2/2), epithelial membrane antigen (n = 3/4), CD99/MIC2 (n = 2/3), and desmin (n = 1/4). All tumors were surgically excised. On follow-up (n = 2), a single patient, who underwent wide-excision was free-of-disease (24 months), while another patient had a recurrence 4 months post tumor excision. Conclusions: This forms as the first documented series on clinicopathological features of AFH, a rare STT, from our country. Significant clinicopathological features include younger age, extremities as commonest site and histopathological appearance of blood-filled spaces with surrounding “cuff” of histiocytic cells and lymphocytes. Tumors with unusual histopathological tumor patterns require molecular confirmation. Surgical resection remains the treatment mainstay.
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p53 and p16 in oral epithelial dysplasia and oral squamous cell carcinoma: A study of 208 cases Highly accessed article p. 153
Juan C Cuevas Gonzalez, Luis A Gaitan Cepeda, Socorro A Borges Yanez, Alejandro Donohue Cornejo, Ana D Mori Estevez, Elba Rosa Leyva Huerta
DOI:10.4103/0377-4929.182037  PMID:27166031
Background: The use of p16 and p53 as biomarkers of malignant transformation of oral epithelial dysplasia (OED) and biological behavior of oral squamous cell carcinoma (OSCC) is controversial. Aim: To determine the immunoexpression of p16 and p53 in OED and OSCC and to establish their possible relation to histopathological grading of OED/OSCC. Materials and Methods: Ninety-six OEDs (40 mild, 36 moderate, and 20 severe dysplasia); and 112 OSCCs (64 well-differentiated, 38 moderately differentiated, and 10 poorly differentiated) coming from archives of four centers of oral pathology were included. Histological slides from all cases were processed with immunohistochemical technique using anti-p53 and anti-p16 antibodies. The intensity of the immunoreactivity were classified using the ImageLab®MCM systemas follows: <60 mild, >60–<90 moderate, and >90 strong. Forstatistical purposesa χ2 test (P < 0.05) was performed. Results: Severe dysplasia show highest relative frequency of p16-positive (35.5%), whereas p53 is associated with mild dysplasia (P = 0.04). Moderately differentiated OSCC had larger relative frequency of p16-positive and p53-positive cases (47.3% both circumstances) (P > 0.05). Statistical association of p16-positive and p53-positive cells to basal stratum of OED (P = 0.0008; P = 0.0000, respectively) and p16-positive cells and p53-positive cells to perivascular zone of OSCC (P = 0.001; P = 0.0000, respectively) was found. Conclusions: p16 and p53 could be not specific enough to identify patients suffering OED with high risk to malignancy; however, the evaluation of the presence of p16 and p53 in the tumoral invasive front of OSCC could contribute to establish the tumor progression.
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Clinicomycological profile of pityriasis versicolor in Assam p. 159
Ajanta Sharma, Debajit Rabha, Saveta Choraria, Debeeka Hazarika, Giasuddin Ahmed, Naba Kumar Hazarika
DOI:10.4103/0377-4929.182027  PMID:27166032
Background: Geographical variation in the distribution of Malassezia species associated with pityriasis versicolor (PV) has led to the necessity of studying epidemiological, mycological, and clinical characteristics of PV. Aims: To study the epidemiological, mycological, and clinical characteristics of PV in a tertiary care hospital. Settings and Design: The study was carried out with a cross-sectional design. Materials and Methods: Two hundred and sixty-two consecutive PV patients were subjected to detailed history, clinical examination, and investigations. Skin scrapings were processed by direct microscopy and culture. Isolates were identified by phenotypic characteristics and polymerase chain reaction-restriction fragment length polymorphism. Association of Malassezia species with clinical and epidemiological characteristics was studied. Statistical analysis of the data was done using statistical software. Results: Maximum number of PV cases (33.9%) belonged to the age group of 21–30 years with a male preponderance. 61.4% of the patients had a sedentary lifestyle, 70.2% showed the gradual onset of the disease, 51.1% presented with pruritus and in 66.4% of the patients symptoms were continuous. Most commonly involved body site was neck (27.8%), 77.09% of the lesions were bilaterally asymmetrical, 87.4% were macular, and 89.3% were hypopigmented. Malassezia furfur (77.3%) was the predominant species. Sedentary lifestyle (61.4%) and increased sweating (48%) were the most commonly associated predisposing factors. Conclusion: PV is more common in males. Distribution of Malassezia species varies significantly from those reported in other parts of India. M. furfur was the most common species responsible for PV in our region. Hence, further studies are required to evaluate the exact cause of this variation.
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Pathologic lesions in children with acquired immunodeficiency syndrome an autopsy study of 11 cases from Mumbai, India p. 166
Dhanesheshwar N Lanjewar, Varsha Omprakash Bhatia, Sonali Dhaneshwar Lanjewar
DOI:10.4103/0377-4929.182028  PMID:27166033
Background: Human immunodeficiency virus (HIV) infection in India has now been prevalent over three decades, and an increasing number of children are being affected with HIV. The spectrum of pathologic lesions in children with acquired immunodeficiency syndrome (AIDS) in India has not been well described. Materials and Methods: A review of systematically conducted autopsies of 11 (10 boys and 1 girl) children with AIDS is presented. Results: The mode of HIV transmission in 6 children was vertical; in one it was blood transfusion and in 4 children route was presumably vertical as these were children of orphanage. The clinical manifestations were failure to thrive; 9 children, persistent gastroenteritis; 8, recurrent fever; 5, bacterial infections; 5, hepatosplenomegaly; 5, candidiasis; 1, scabies; 1, skin rash; 2, tuberculous (TB) meningitis; 1 and paraplegia; in 1 child. The spectrum of pathologic lesions observed were precocious involution in thymus in 3 and dysinvolution in 2 cases. Infectious diseases comprised of TB; 4 cases, cytomegalovirus infection (CMV) 4; bacterial pneumonia and meningitis; 7, and esophageal candidiasis in 2 cases. Dual or multiple infections were observed in 9 (82%) cases; these comprised of two lesions in 2, three lesions in 2, four lesions in 4, and five lesions in 1 case. TB, bacterial pneumonia, meningitis, and CMV infection are the most frequent causes of death in children with AIDS. Vascular lesions showing features of arteriopathy were observed in 5 cases and brain in one case showed non-Hodgkin's lymphoma. Conclusions: This study provides a better insight into the spectrum of pathologic lesions in children with AIDS in India. TB and CMV infection has been found to be the most prevalent infection in our children.
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Clinicopathological characteristics of patients of certain molecular subtypes and elevated postoperative cancer antigen 15.3 levels and its correlation with menopausal status p. 172
Soumi Saha, Suvro Ganguly, Diptendra Kumar Sarkar, Avijit Hazra
DOI:10.4103/0377-4929.182029  PMID:27166034
Context: It is well established that breast cancer subtypes differ in their outcome and treatment response. Aim: To observe tumor characteristics of different molecular subgroup and patients with postoperative (PO) raised cancer antigen 15.3 (CA 15.3) group and variation of tumor nature between pre- and post-menopausal breast cancer patients. Materials and Methods: Blood samples and tumor blocks were collected from 95 nonmetastatic female breast cancer patients. Immunohistochemical stains for estrogen receptors (ER), progesterone receptor (PR), and HER2/Neu were used to classify molecular subtypes. CA 15.3 level was detected by ELISA. Significance levels were ascertained by Pearson Chi-square test. Results: Prevalence of luminal A tumor with grade 3 was high. Triple negative and ER positive (ER+) types showed tumors with high grade and high lymph node (LN) metastasis. More nodal involvement was noticed in patients with PO raised CA 15.3. In addition, premenopausal patients with triple-negative and ER+ subtypes exhibited more aggressive tumors which were characterized by high grade and large numbers of LN metastasis. Conclusion: Clinicopathological characteristics of certain molecular subtypes and influence of menopausal status on it can predict disease recurrence or overall survival of breast cancer patients.
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Comparison of four different methods for detection of biofilm formation by uropathogens p. 177
Pragyan Swagatika Panda, Uma Chaudhary, Surya K Dube
DOI:10.4103/0377-4929.182013  PMID:27166035
Context: Urinary tract infection (UTI) is one of the most common infectious diseases encountered in clinical practice. Emerging resistance of the uropathogens to the antimicrobial agents due to biofilm formation is a matter of concern while treating symptomatic UTI. However, studies comparing different methods for detection of biofilm by uropathogens are scarce. Aims: To compare four different methods for detection of biofilm formation by uropathogens. Settings and Design: Prospective observational study conducted in a tertiary care hospital. Materials and Methods: Totally 300 isolates from urinary samples were analyzed for biofilm formation by four methods, that is, tissue culture plate (TCP) method, tube method (TM), Congo Red Agar (CRA) method and modified CRA (MCRA) method. Statistical Analysis: Chi-square test was applied when two or more set of variables were compared. P < 0.05 considered as statistically significant. Considering TCP to be a gold standard method for our study we calculated other statistical parameters. Results: The rate of biofilm detection was 45.6%, 39.3% and 11% each by TCP, TM, CRA and MCRA methods, respectively. The difference between TCP and only CRA/MCRA was significant, but not that between TCP and TM. There was no difference in the rate of biofilm detection between CRA and MCRA in other isolates, but MCRA is superior to CRA for detection of the staphylococcal biofilm formation. Conclusions: TCP method is the ideal method for detection of bacterial biofilm formation by uropathogens. MCRA method is superior only to CRA for detection of staphylococcal biofilm formation.
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Virulence factor profiles, phylogenetic background, and antimicrobial resistance pattern of lactose fermenting and nonlactose fermenting Escherichia coli from extraintestinal sources p. 180
Arindam Chakraborty, Prabha Adhikari, Shalini Shenoy, Vishwas Saralaya
DOI:10.4103/0377-4929.182032  PMID:27166036
Context: In recent years, nonlactose fermenting (NLF) Escherichia coli have been increasingly isolated in the microbiology laboratory, but their clinical significance has not yet been clearly elucidated. Aims: To characterize the lactose fermenting (LF) and NLF isolates on the basis of their virulence factors, phylogenetic background, and drug resistance property. Settings and Design: This descriptive study was carried out in a multi-specialty tertiary care hospital. Subjects and Methods: Three hundred nonrepeat E. coli isolates from inpatients were studied. Isolates were differentiated as LF and NLF on the basis of colony characteristics on MacConkey's agar. Possession of virulence and drug resistance genes was determined by multiplex polymerase chain reaction (PCR). Phylogenetic analysis was performed by triplex PCR methods. Antibiotic sensitivity testing was performed by disk diffusion method. Results: Of 300 isolates 39 (13%) were NLF isolates. Maximum number of NLF isolates belonged to phylogroups B2 and D when compared with LF isolates. The incidence of iutA, hlyA, and neuC genes were significantly higher in NLF isolates. The presence of drug resistance genes such as AmpC gene, SHV, and CTXM were higher in LF isolates. Conclusions: LF isolates demonstrated a higher antimicrobial resistance and NLF isolates possessed higher virulence properties. The microbiology laboratory should report lactose fermentation profile as it may help the physician to initiate appropriate treatment.
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Utility of MPT64 antigen test for differentiating mycobacteria: Can correlation with liquid culture smear morphology add further value? p. 185
Vidya Nerurkar, Sushma Kattungal, Simi Bhatia
DOI:10.4103/0377-4929.182009  PMID:27166037
Context: Clinical presentation of Mycobacterium tuberculosis complex (MTBC) and non-tuberculous mycobacteria (NTM) infections may or may not be the same, but the treatment is always different. Hence accurate differentiation between MTBC and NTM is of utmost importance. Aims: To assess in parallel, the utility of MPT64 antigen immunochromatography assay (MPT64 ICT) and bacillary morphology on liquid culture smear, for rapid differentiation between MTBC and NTM in clinical isolates. Settings and Designs: Private sector reference laboratory, prospective. Subjects and Methods: Thousand and ninety-three mycobacterial isolates, recovered using Mycobacteria Growth Indicator Tube 960 liquid culture system (BD, USA), were subjected to MPT64 ICT (Standard Diagnostics Inc., Korea), para amino nitrobenzoicacid (PNB), niacin, and nitrate reduction tests. Smears prepared from culture vials were subjected to Ziehl-Neelsen staining and observed microscopically for typical patterns (chords, single cells, etc.,). PNB, nitrate and niacin tests served as the reference method for MTBC identification. Results: Thousand and fourteen and 79 isolates were identified as MTBC and NTM, respectively. MPT64 ICT correctly identified 955/1014 MTBC and all NTM isolates, yielding sensitivity and specificity of 94.2% and 100%, respectively. 936/1014 (92.3%) MTBC isolates revealed characteristic serpentine chording on culture smear including 56/59 MPT64 ICT negative isolates. Sensitivity and specificity of liquid culture smear were 98.1% and 82.3%, respectively. Conclusion: Correlation of MPT64 ICT results with liquid culture smear was useful, especially in MPT64 ICT negative isolates, where the latter could help to determine need and/or type of additional confirmatory testing. Liquid culture smear, however, lacked specificity and cannot be used as a stand alone test.
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Detection of vancomycin resistance in enterococcus species isolated from clinical samples and feces of colonized patients by phenotypic and genotypic methods p. 188
Priyanka Paul Biswas, S Dey, L Adhikari, Aninda Sen
DOI:10.4103/0377-4929.182015  PMID:27166038
Background: The aim of this study was to find out the clinical correlation between the presence of vancomycin-resistant genes (van A and van B) and their expression as detected by phenotypic tests in colonized patients and in clinical isolates. Materials and Methods: Enterococci were isolated from various clinical samples and also from fecal specimens of colonized patients at the time of admission, after 48 h and after 5 days of admission. Identification to species level was done using standard methods. Vancomycin susceptibility in Enterococci was detected by disc diffusion test. Minimum inhibitory concentration was determined by agar dilution method. Multiplex polymerase chain reaction (PCR) was used to detect the presence of van genes. Results: Out of all the clinical and fecal samples processed, 12.0% isolates were either vancomycin resistant or vancomycin intermediate. Further, these isolates carried van A or van B genes as confirmed by PCR methods. Expression of van A gene was found to be more in Enterococcus faecalis (28.3%) as compared to Enterococcus faecium (25.0%) in both clinical and fecal isolates. 16.6% strains of E. faecium and 15.0% strains each of E. faecalis and Enterococcus gallinarum were found to carry van B genes. The overall prevalence of vancomycin resistant Enterococci (VRE) in colonized patients was about 9.6%. Prior administration of antibiotics had significant effect (P = 0.001) on VRE carriage. Urinary tract infection was the most common infection caused by vancomycin susceptible Enterococci (VSE), 105/214 (49.0%) and VRE, 13/36 (36.1%). There was no significant difference (P = 0.112) in the distribution of VRE and VSE in different infection types. Both clinical and fecal VRE showed maximum resistance to penicillin, ampicillin, and piperacillin. Resistance to linezolid was 2.8% in clinically isolated VRE. Conclusion: VRE in our study were found to be resistant to a number of commonly used antibiotics. The frequency of isolation of vancomycin resistant E. faecalis (VRE.fs), which is highly virulent, and the number of strains harboring van A gene in our hospital setup is high and needs to be addressed.
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BRIEF COMMUNICATIONS Top

Genital Mycoplasma and Chlamydia trachomatis infections in patients with genital tract infections attending a tertiary care hospital of North India p. 194
Karnika Saigal, Benu Dhawan, Jyoti Rawre, Neena Khanna, Rama Chaudhry
DOI:10.4103/0377-4929.182019  PMID:27166039
Limited data are available on the prevalence of genital mycoplasmas and Chlamydia trachomatis (CT) among Indian patients with genital tract infections. The objectives of the study were to determine the prevalence of Ureaplasma urealyticum (UU), Mycoplasma hominis (MH), Mycoplasma genitalium (MG), and CT in patients with genital tract infections. The antimicrobial susceptibilities of UU and MH were also assessed. Endocervical swabs/urethral swabs and first void urine samples of patients (n = 164) were collected. UU and MH were detected by culture and multiplex polymerase chain reaction (PCR). MG and CT were identified by PCR. Ureaplasma isolates were further biotyped and serotyped. Antimicrobial susceptibility was done by microbroth dilution method. UU, MH, MG, and CT were detected in 15.2%, 5.4%, 1.2%, and 6% patients, respectively. Ureaplasma parvum serovar 3/14 was the most prevalent. All isolates of UU and MH were uniformly susceptible to doxycycline and josamycin. Routine screening for these pathogens and antimicrobial susceptibility testing is warranted to prevent sequel of infections and formulate treatment guidelines.
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A sporadic outbreak of Burkholderia cepacia complex bacteremia in pediatric intensive care unit of a tertiary care hospital in coastal Karnataka, South India p. 197
Beena Antony, Elizabeth Varkey Cherian, Rekha Boloor, K Varadraj Shenoy
DOI:10.4103/0377-4929.182010  PMID:27166040
Burkholderia cepacia complex (BCC) is a significant opportunistic pathogen in hospitalized and immunocompromised patients, particularly in cystic fibrosis. It is widely distributed in natural habitats such as soil and water and frequently encountered in nosocomial outbreaks due to contaminated disinfectants and medical devices. However reports on outbreaks due to this organism are lacking from the Indian subcontinent. We report here a sporadic outbreak due to BCC which occurred in the pediatric Intensive Care Unit of our institute, the probable source being contaminated distilled water. The isolate from three babies and environmental sources including distilled water were identical and confirmed as BCC. Strict infection control measures were instituted to prevent the spread of infection. This report highlights the potential role of B.cepacia in causing sporadic outbreaks especially in ICUs, associated with water.
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CASE REPORTS Top

Primary mature cystic teratoma with carcinoid mimicking an adrenal tumor: Report of a rare association and review of literature p. 200
Swetha Lakshmi Narla, Sheba Jacob, Ann Kurian, Ashok Parameswaran
DOI:10.4103/0377-4929.182012  PMID:27166041
Teratomas are neoplasms comprising of tissues derived from more than one germ layer. Most common sites are gonads, sacrococcygeal, mediastinal, retroperitoneal, and pineal region. Here, we report a case of 2 -year-old previously healthy female toddlerwho presented with fever and right upper quadrant abdominal pain. Magnetic resonance imaging (MRI) of the abdomen revealed a right suprarenal nonenhancing cystic mass. Focal calcification was seen in the inferomedial aspect of the cyst. Complete surgical resection of the right adrenal gland was done. The patient had an uneventful postoperative course and was free of recurrence at 8 months follow-up. Primary retroperitoneal teratomas of the adrenal gland are very uncommon (4% of all primary teratomas) and can mimic a primary adrenal tumor, hence should be included in the differential diagnosis of adrenal masses.
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Pseudopapillary prostatic adenocarcinoma: A diagnostic pitfall for pathologists p. 203
Anuj Verma, Santosh Menon, Ganesh Bakshi, Sangeeta Desai
DOI:10.4103/0377-4929.182020  PMID:27166042
Prostatic adenocarcinoma and urothelial carcinoma are common tumours seen in elderly patients. They both act as a close differential diagnosis for each other clinically as well as histologically. Various morphological patterns have been described in prostatic adenocarcinomas. However, pseudopapillary pattern was not described until recently a paper which described seven such cases. These tumours mimic urothelial carcinoma as the papillary pattern is usually seen in urothelial carcinoma and may act as a pitfall for the diagnosing pathologists. As both the tumours are treated with different therapeutic protocol it is necessary to differentiate the two and hence the pathologist should be aware of this morphological variant of prostatic carcinoma. Critical histological review and immunohistochemical examination is helpful to make the diagnosis. Here we discuss one such case of pseudopapillary prostatic adenocarcinoma mimicking urothelial carcinoma with a brief review of histological and immunohistochemical examination useful to distinguish the two tumours.
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Angiomyomatous hamartoma of lymph nodes: Clinicopathological study of 6 cases with review of literature p. 206
Sudheer Arava, Gaurav Pratap Singh Gahlot, Rakesh Deepak, Mehar Chand Sharma, Devajit Nath, Singh Ashok
DOI:10.4103/0377-4929.182039  PMID:27166043
Angiomyomatous hamartoma (AMH) is a rare disease with predisposition for inguinal and femoral lymph nodes. Histologically, it is characterized by replacement of lymph nodal parenchyma with irregularly distributed thick walled blood vessels, haphazardly arranged smooth muscle cells, variable amount of fat and fibrous tissue in a sclerotic lymphatic stroma. Few cases have also been reported in popliteal and sub - mandibular location. The exact pathogenesis is still not known. Although this entity is very rare, its recognition is important in discriminating it from other benign and malignant vascular lesions of lymph nodes.
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A rare case of multicentric secretory carcinoma of breast in an adult female with review of literature p. 209
Maithili Mandar Kulkarni, Siddhi Gaurish Sinai Khandeparkar, Avinash R Joshi, Ashish N Dhande
DOI:10.4103/0377-4929.182021  PMID:27166044
Secretory breast carcinomas (SBCs) are considered one of the rarest types of BCs accounting for <0.15% of all breast cancers. The lesions are typically solitary, but rare multicentric cases have been reported. SBC have characteristic histopathological, immunohistochemical, and electron microscopic findings. Children and adolescents with SBC have a favorable prognosis, but disease seems slightly more aggressive in adults. The characteristic ETV6-NTRK3 molecular alteration, leading to a stable chimeric tyrosine kinase fusion product, may be the target of promising new treatment for this unique BC. We present a rare case of multicentric secretory carcinoma of breast with aggressive clinical behavior in a 75-year-old female.
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Persistent Müllerian duct syndrome of mixed anatomical variant (combined male and female type) with mixed germ cell tumor of left intra-abdominal testis p. 212
Manisha Mohapatra, Yerraguntla Sarma Subramanya
DOI:10.4103/0377-4929.182036  PMID:27166045
Persistent Müllerian duct syndrome (PMDS) is a rare form of internal male pseudohermaphroditism characterized by retention of Müllerian duct derivatives in a phenotypically and karyotypically male patient. Deficiency of anti-Müllerian hormone (AMH) secretion or resistance to AMH action due to defective AMH-II receptor is presumed to cause such syndrome in the majority of cases. About 158 PMDS cases have been reported so far, out of which 31 cases are associated with testicular neoplasms. Herein, we describe an interesting case of young male initially diagnosed and treated for inguinal hernia, but finally diagnosed as “PMDS of mixed anatomical variant (combined male and female type) with mixed germ cell tumor of left intra-abdominal testis” comprising components of seminoma and yolk sac tumor and treated successfully.
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Lichen sclerosus of soft palate: A rare case report p. 216
Suyog Tupsakhare, Kishor Patil, Ashok Patil, Shrikant Sonune
DOI:10.4103/0377-4929.182044  PMID:27166046
Lichen sclerosus (LS) is a rare disease affecting the skin and the mucous membrane, and it is chronic inflammatory in nature. It occurs in both males and females, but mainly affects females in the fifth or sixth decade of life. It mainly involves the genital and perianal areas but can affect any part of the body and the involvement of the oral mucosa is exceptionally rare, but sometimes it affects only the oral mucosa. It requires differentiating from other lesions of the oral cavity which looks similar to this lesion. In considering the rarity of the reported cases, the present article reports one more case of LS affecting the soft palate in an edentulous 66 year-old male patient.
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Cavernous hemangiomatous polyp of uterus: A report of case and review of literature p. 220
Mohammad Shahid, Nauman Nisar, Jinous Saremian
DOI:10.4103/0377-4929.182024  PMID:27166047
Cavernous hemangiomatous polyp of uterus is a rare vascular malformation of the uterus. Common sites of malformation in uterine wall include serosa, myometrium, and endometrium and most common presentation is diffuse involvement of uterus. Patients usually present with obstetric and gynecological complications ranging from menorrhagia, intermenstrual bleeding, infertility, and pregnancy-associated complications which includes maternal and fetal demise due to excessive bleeding. Uterine hemangiomas occur at all age groups without preponderance in any decades and are classified into congenital and acquired. Congenital hemangiomas may be associated with hereditary diseases whereas acquired hemangiomas are thought to be associated with both physical changes and hormone alterations.
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Sclerosing angiomatoid nodular transformation of spleen masquerading as carcinoma breast metastasis: Importance of splenic biopsy in obviating splenectomy p. 223
Deep Dutta, Meha Sharma, Vrushali Mahajan, Prem Chopra
DOI:10.4103/0377-4929.182034  PMID:27166048
Metastasis to spleen is rare and usually occurs in the setting of extensive multivisceral metastatic disease. A 60-year-old lady with appropriately managed early breast cancer (breast conservative surgery for Grade-2 infiltrative ductal carcinoma [0.7 cm × 0.5 cm diameter]) in 2006, was detected to have splenic incidentaloma (1.4 cm × 0.8 cm) in November 2012, which was fluoro-deoxy-glucose (FDG) avid on positron emission tomography. Fine needle spiration cytology (FNAC) was normal. More than doubling of lesion size by March 2015 (3.83 cm × 3.03 cm diameter) with persistent FDG positivity lead to Tru-Cut biopsy of spleen, which revealed multiple nodular areas of congestion and hemorrhage, composed of sinusoids (CD31+, CD8+, and CD34), capillaries (CD31+, CD8, and CD34+), and small veins (CD31+, CD8, and CD34), fibrosis, around these nodular areas along with numerous histiocytes (CD68+) consistent with diagnosis of sclerosing angiomatoid nodular transformation (SANT) of spleen. SANT is a benign, reactive vascular transformation of spleen, notorious to mimic metastasis, the cause of its 18FDG avidity due to its rich content of macrophages and myofibroblasts, usually diagnosed postsplenectomy. This report highlights the importance of splenic biopsy over FNAC is diagnosing splenic incidentalomas, which can help prevent splenectomy, and hence the associated morbidity. This is the first report of SANT in carcinoma breast mimicking metastasis.
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Primary cutaneous histoplasmosis mimicking basal cell carcinoma of the eyelid: A case report and review of literature p. 227
Santhi Radhakrishnan, Namrata G Adulkar, Usha Kim
DOI:10.4103/0377-4929.182017  PMID:27166049
We present the case of a 46 years old gentleman with longstanding ulcerative lesion of the right upper eyelid. Biopsy of the lesion revealed intracellular periodic acid–Schiff positive round to oval organisms with a surrounding clear halo suggestive of histoplasmosis. Histoplasma capsulatum specific polymerase chain reaction was positive. The patient was treated with oral antifungals and showed a prompt response to treatment. We report this rare case of primary cutaneous histoplasmosis of the eyelid in an otherwise healthy adult patient.
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Primary retroperitoneal mucinous cystadenocarcinoma in a male patient p. 229
Anuj Khurana, Urmi Mukherjee, Saranya Singaravel
DOI:10.4103/0377-4929.182022  PMID:27166050
Primary retroperitoneal mucinous neoplasms are extremely rare tumors. Less than sixty cases have been reported in international literature until date, with striking female predominance. We report a case of primary mucinous cystadenocarcinoma of the retroperitoneum in a 51-year-old male presenting with nonspecific abdominal complaints. This case is being highlighted for its rare occurrence in a male patient.
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Necrotizing sialometaplasia: Manifestation of a localized unclassified vasculitis p. 232
Swagatika Senapati, Subash Chandra Samal, Rajeev Kumar, Susama Patra
DOI:10.4103/0377-4929.182018  PMID:27166051
Necrotizing sialometaplasia is a rare benign and self-limiting disease, which commonly affects the minor salivary glands. Typically, it involves the seromucinous glands located at palate, buccal mucosa, tongue, tonsil, nasal cavity, trachea, larynx, maxillary sinus, and retromolar trigone. We report two such cases of necrotizing sialometaplasia to create awareness among the pathologists and surgeons because of its close morphological and clinical resemblance to squamous cell carcinoma. We have also documented that, the ischemic necrosis of salivary gland is the result of a vasculitic process.
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Synovial osteolipoma p. 235
Radha Sistla, Josyula Venkata Satya, Tameem Afroz
DOI:10.4103/0377-4929.174827  PMID:27166052
Intraarticular synovial osteolipoma is an extremely rare tumor. Only two cases have been reported earlier to the best of our knowledge. It is a rare histological variant of lipoma, which contains mature lamellar bone. The largest tumor reported so far in the joint is 3 cm × 4 cm. Knee is a most common site. We report a large osteolipoma measuring 12 cm × 10 cm in the knee.
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Scrotal chondroma in a young male: A rare case report p. 238
Sanjeev Kishore, Brijesh Thakur, Sheenam Azad, Sandip Kudesia
DOI:10.4103/0377-4929.182043  PMID:27166053
Soft tissue chondroma is a rare benign, slow growing tumor usually located in hand and foot. Scrotal chondroma is exceedingly rare; chondromas in the pelvic region have also been reported. However, chondroma occurring in the scrotal wall is extremely rare, and only a few cases have been reported worldwide. They should be differentiated from well-differentiated chondrosarcoma. To the best of our knowledge, this is the first case of scrotal chondroma to be reported from India.
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Pleuropulmonary nocardiosis due to Nocardia otitidiscaviarum in a debilitated host p. 240
R Deepa, S Thasneem Banu, G Jayalakshmi, J Durdana Parveen
DOI:10.4103/0377-4929.182011  PMID:27166054
Nocardia otitidiscaviarum is a rare cause of pulmonary nocardiosis. We present a case of pulmonary nocardiosis with pleural involvement in an adolescent with rheumatic heart disease and congestive cardiac failure presenting with right lower lobe consolidation and pleural effusion. Direct gram-stain of pleural fluid showed pus cells with Gram-positive filamentous branching bacilli. Empiric treatment with parenteral ceftriaxone and supportive therapy for cardiac failure was initiated. Pleural fluid culture yielded growth of N. otitidiscaviarum at 72 h. Antibiotic susceptibility testing showed resistance to cephalosporins. The patient expired due to congestive cardiac failure on the 5th day.
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IMAGES Top

Primary cutaneous actinomycosis of scrotal skin: A rare entity often misdiagnosed p. 243
Varna Indushekar, IL Jeswani, Shikha Goyal, Mukesh Punjabi, Chetan B Patil
DOI:10.4103/0377-4929.174852  PMID:27166055
Lichen sclerosus (LS) is a rare disease affecting the skin and the mucous membrane, and it is chronic inflammatory in nature. It occurs in both males and females, but mainly affects females in the fifth or sixth decade of life. It mainly involves the genital and perianal areas but can affect any part of the body and the involvement of the oral mucosa is exceptionally rare, but sometimes it affects only the oral mucosa. It requires differentiating from other lesions of the oral cavity which looks similar to this lesion. In considering the rarity of the reported cases, the present article reports one more case of LS affecting the soft palate in an edentulous 66 year-old male patient.
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Cavernous hemangioma of anterior urethra: An unusual cause of vaginal bleeding p. 245
Arvind Ahuja, Achin K Sen, Minakshi Bhardwaj
DOI:10.4103/0377-4929.174879  PMID:27166056
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EXPRESSIONS Top

Through the looking glass: A day in the life of a histopathologist p. 247
Chandralekha Tampi
DOI:10.4103/0377-4929.182025  PMID:27166057
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QUIZ PAGE Top

Quiz page p. 248

PMID:27166058
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LETTERS TO EDITOR Top

Choroid plexus carcinoma with hyaline globules: An unusual histological feature p. 249
Asha Sharad Shenoy, Heena Maulek Desai
DOI:10.4103/0377-4929.182042  PMID:27166059
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Dendritic fibromyxolipoma of left inguinal region p. 250
Sinem Ciloglu, Alpay Duran, Ekrem Keskin, Ahmet Yigit
DOI:10.4103/0377-4929.182045  PMID:27166060
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Prenatal diagnosis of unilateral agenesis of diaphragm and associated anomalies p. 251
Cezar Morosanu, Andreea Cioca, Florin Stamatian, Doinita Crisan
DOI:10.4103/0377-4929.182014  PMID:27166061
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Xanthogranulomatous osteomyelitis mimicking neoplasm: A rare entity p. 253
Manas R Baisakh, Manas Ranjan Kar, Apurva Agrawal, Nachiketa Mohapatra
DOI:10.4103/0377-4929.182016  PMID:27166062
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Myoepithelioma of soft tissue in the knee: A case report of an unusual location p. 254
Ahrim Moon, Susie Chin, Hee Kyung Kim, Jeong Ja Kwak
DOI:10.4103/0377-4929.182041  PMID:27166063
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Mixed odontogenic tumor p. 256
Treville Pereira, Subraj Shetty
DOI:10.4103/0377-4929.182038  PMID:27166064
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Angiomyofibroblastoma of the right labia major p. 257
Ibrahim Gelincik, Ayhan Yildirim, Ilyas Sayar, Cevat Aktas
DOI:10.4103/0377-4929.182033  PMID:27166065
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Biphenotypic extramedullary blast crisis with MLL gene rearrangement in a case of chronic myeloid leukemia following Dasatinib therapy: An unusual case p. 259
Richa Juneja, Gaurav Dhamija, Tina Dadu, Anil Handoo
DOI:10.4103/0377-4929.182031  PMID:27166066
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Molecular analysis of fluoroquinolone resistance in Salmonella enterica serovar Typhi from a breast abscess case p. 261
Sathishkumar Elumalai, Srivani Seetharaman
DOI:10.4103/0377-4929.182030  PMID:27166067
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Discriminant indices for thalassemia screening: Need for a higher sensitivity p. 262
Ranjeet Singh Mashon, Naveen Kakkar
DOI:10.4103/0377-4929.182040  PMID:27166068
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Loss of CD20 expression in relapsed diffuse large b-cell lymphoma: Clinical significance of an uncommon pathological finding p. 263
Subhashis Mitra, Sanghamitra Mukherjee, Maitreyee Bhattacharyya, Hema Chakraborty
DOI:10.4103/0377-4929.182026  PMID:27166069
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QUIZ ANSWER PAGE Top

Quiz answer page p. 266

PMID:27166070
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FORTHCOMING MEETINGS AND CONFERENCES Top

Forthcoming Meetings and Conferences p. 267

PMID:27166071
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