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   Table of Contents - Current issue
Coverpage
July-September 2017
Volume 60 | Issue 3
Page Nos. 311-452

Online since Friday, September 22, 2017

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EDITORIAL  

From Editor's desk p. 311
Vatsala Misra
DOI:10.4103/IJPM.IJPM_584_17  PMID:28937362
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GUEST EDITORIAL Top

Cardiac myxomas with glandular elements p. 312
Pradeep Vaideeswar
DOI:10.4103/IJPM.IJPM_448_17  PMID:28937363
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ORIGINAL ARTICLES Top

Nucleic acid amplification testing in Indian blood banks: A review with perspectives Highly accessed article p. 313
Kanjaksha Ghosh, Kanchan Mishra
DOI:10.4103/IJPM.IJPM_361_16  PMID:28937364
Background: Nucleic acid amplification testing (NAT) is restricted to a few blood banks in India since 2008. This review was directed toward understanding NAT yield in different parts of the country and prevalence in the NAT of different types of virus. Materials and Methods: English literature was searched from 1990 to 2016 in PubMed, Scopus, Ind med, and Google database using properly constructed key words. Literature was collected and finally the data were synthesized. Results: NAT results from 11 publications and one personal communication showed that till date 389387 blood units have been NAT tested from various parts of the country. NAT yield varied from 1:476 to 1:4403 in various studies. Till date, 58/2550 (2%) blood banks of India are doing NAT testing but all of them have not published their results. Majority of the centers have used ID-NAT (Individual NAT) protocol and 21 blood banks are using minipool format of the test. One center has used in-house NAT testing system. In >70% of the time, the NAT positivity with due to hepatitis B (Hep B). For individual infection, NAT yield from the pooled data showed HIV in 1:66,000, Hep C virus 1:5484 and Hep B in 1:1761 seronegative donors. Discussion and Conclusion: In view of the very high NAT yield (1:1361), NAT in some from needs to be universally applied in Indian blood banks. However, the high Hep B occult infection suggests stricter donor selection and immunization of adults for Hep B may be way forward toward ensuring the viral safety of blood components in India.
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Immunohistochemical characterization of glandular elements in glandular cardiac myxoma: Study of six cases p. 319
Devajit Nath, Sudheer Arava, Ruma Ray, Amol Kumar Bhoje, Rachit Saxena, Shiv Kumar Chaudhary
DOI:10.4103/IJPM.IJPM_225_16  PMID:28937365
Back ground: Glandular cardiac myxoma has varying clinical presentation with uncertain histogenesis and debatable immunohistochemical profile. Glandular epithelial differentiations are rare phenomenon known to be present as an intrinsic component of the tumor. The origin of the glands has been attributed to epithelial differentiation of a totipotent cardiomyogenic precursor cells or the entrapped foregut rests in the tumor. Materials and Methods: Retrospective study includes six cases of glandular cardiac myxoma collected over a perior of 4 years. Sections were examined to define the histogenesis, histological and immunohistochemical profile of the glandular elements. Results: Incidence of glandular cardiac myxoma was 6.6% with a male to female ratio of 1:2.Mean age was 49.9 years. Left atrium was the commonest site. Five were sporadic and one was familial. Chest pain and dyspnea were the commonest clinical symptoms. Histologically all myxoma showed well formed glandular structures with typical myxomatous area. No atypia, mitosis or necrosis was identified in the glandular elements. Markers in six cases of glandular cardiac myxoma were immunopositive for CK7, CK 19, EMA, CEA, focally for E-cadherin while immunonegative for CK20, Chromogranin, Synaptophysin, calretenin, vimentin, B-catenin, TTF-1 and GCDFP-15 favoring enteric differentiation. Conclusion: Glandular cardiac myxoma is a rare entity which shows characteristics similar to those of classical cardiac myxoma with benign glandular elements showing enteric differentiation. Complete surgical excision is the treatment of choice with good prognosis. It is important to recognize this entity to avoid an erroneous diagnosis of metastatic adenocarcinoma.
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Correlation between human epidermal growth factor receptor 2 oncoprotein expression and some prognostic factors in papillary thyroid carcinoma p. 324
Shervin Rabiee, Mohamadreza Jalali Nadoushan, Neda Mehdizade Rayeni, Iman Ansari
DOI:10.4103/IJPM.IJPM_332_15  PMID:28937366
Background: Thyroid cancer is one of the increasing cancer diagnoses in the United States. Papillary thyroid carcinoma (PTC) is the most common thyroid cancer. There are a few researches done determining the role of human epidermal growth factor receptor 2 HER2 (erbB-2) in PTC prognosis. They also have been controversial. This study is designed to determine the correlation of HER2 expression with tumor size, lymph node involvement, and capsular invasion as prognostic factors. Materials and Methods: This research was a cross-sectional descriptive-analytic study. Information about age, sex, tumor size, and lymph node involvement of 85 patients undergone thyroidectomy and diagnosed PTC in Mostafa Khomeini Hospital during 2010–2012, have been derived from their medical records. Four-micron sections made from paraffin embedded blocks and HER2 expression was assessed by immunohistochemistry. Other sections were stained with H and E Method and capsular invasion was evaluated by microscope. Results: In this study, 88.2% of patients were female and 11.8% of patients were male. About 37.6% of samples were HER2 positive. There was no significant correlation between HER2 and lymph node involvement (P = 0.649), (P > 0.05). A significant correlation found between HER2 and capsular invasion (P = 0.000), (P < 0.05). This study found a significant correlation between HER2 and tumor size (P = 0.000), (P < 0.05). Conclusion: HER2 oncoprotein expression is correlated with increased tumor size and capsular invasion. Hence, HER2 can be used to assess PTC prognosis.
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Associations between epidermal growth factor receptor and topoisomerase II-alpha gene copy number variations, human papillomavirus positivity, and cytologic analysis in cervical cell lesions p. 328
Işın Kaya, Oya Nermin Sivrikoz, Özdal Etlik, Abdülkadir Gök
DOI:10.4103/IJPM.IJPM_275_16  PMID:28937367
Background: Cervical cancer is the second most common gynecologic cancer worldwide. Human papillomavirus (HPV) infection is a leading etiological factor in cervical carcinoma.The aim of this study was to compare HPV positivity, EGFR and TOP2A gene copy number variations and cervical cytologic findings. Materials and Methods: The study group comprised 100 female volunteers between 21-64 years old. Cytologic analysis was performed using the liquid-based cytology technique. HPV DNA testing was performed in all cases. Copy number variations that belong to EGFR and TOP2A genes evaluated by using FISH analysis. Results: Cytologic analysis of the cervical samples revealed abnormal findings in 13 of the 100 study subjects. ASCUS , LSIL, HSIL were determined in 8, 2 and 3 cases respectively as the result of cytologic analysis on all cases. Forty-one (41%) of the 100 women were HPV-positive. Chi-square analysis confirmed that HPV-positive women showed significantly more abnormal cytology (P = 0.035). EGFR deletion, TOP2A deletion and both EGFR and TOP2A deletion were determined in 1, 8 and 1 cases respectively. We found no statistical difference in abnormal cytologic findings between subjects with these gene deletions and subjects with normal gene copy numbers (P > 0.05 for both). No cases of amplification were determined for either gene. Conclusion: As a result, HPV positivity and the determination of changes that may occur in the gene copy number in patients with abnormal cytology can be an important tool on account of prognosis. Research with more patients may be suggested.
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Human immunodeficiency virus-associated cystic lymphoid hyperplasia: An immunohistochemical description p. 336
Shabnum Meer, Shailen Dulabh
DOI:10.4103/IJPM.IJPM_664_16  PMID:28937368
Background: Cystic lymphoid hyperplasia (CLH) describes benign salivary lymphoepithelial cysts with a strong link to human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS). The pathogenesis is related to ductal dilatation of entrapped salivary elements due to intranodal HIV-associated atypical lymphoid hyperplasia. Very little is known about the immunophenotypic profile of this entity. Aim: This study aims to describe the immunopathological features of a series of CLH cases in HIV-positive patients to clarify the etiopathogenesis. Materials and Methods: Paraffin-embedded tissue from 25 cases of parotid CLH in HIV seropositive patients was immunohistochemically analyzed with CD3, CD20, CD4, CD8, and p24 using standard procedures. Statistical Analysis: The data are mostly descriptive and were analyzed using EpiInfo (3.5.1) (CDC, Atlanta, USA); significant differences were analyzed using the Student's t-test and the Chi-square test with a statistical significance level of P < 0.05 being used. Results: Immunostaining showed a CD8:CD4 of ~1:1 except in selected cases with decreased CD4 and increased CD8 expression in the interfollicular (IF) areas. p24 staining revealed 100% specificity in HIV-associated CLH. Conclusion: The immunohistochemical description of CD20, CD3, CD4, and CD8 provides an understanding of CLH pathogenesis. CLH of parotid lymph nodes in confirmed HIV-positive patients with 100% specificity with HIV p24 antibody validates the strong association of CLH with HIV and AIDS. The CD4:CD8 ratio was ~1:1; however, increased CD8 expression within IF areas may indicate possible HIV-related CLH as compared to other cystic parotid lesions.
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Study of association of Epstein-Barr virus in lymphomas by Epstein-Barr virus-encoded RNA in situ hybridization: An Indian perspective from a tertiary care cancer institute p. 341
Roshani Gala, Jatin S Gandhi, Gurudutt Gupta, Shrruti K Grover, Anila Sharma, Sunil Pasricha, Anurag Mehta
DOI:10.4103/IJPM.IJPM_49_17  PMID:28937369
Background: The Epstein-Barr virus (EBV), also called human herpesvirus 4, is a virus of the herpes family. The EBV-associated lymphomas include Burkitt lymphoma, classic Hodgkin lymphoma (HL), lymphomas arising in immunocompromised individuals, peripheral T-cell lymphomas, angioimmunoblastic T-cell lymphoma, extranodal nasal-type natural killer/T-cell lymphoma, and other rare histotypes. Objective: The present study evaluated the role of EBV as an etiologic agent in various lymphomas and determined an Indian perspective in a tertiary care cancer center compared to that of Western literature. Materials and Methods: Clinicopathological spectrum was studied in 184 cases of lymphomas using a standard immunohistochemistry panel and in situ hybridization for Epstein-Barr virus-encoded RNA (EBER) expression. Results and Conclusions: The prevalence of EBV was described in various HL and non-HL's and was found similar to that of Western literature. EBER expression was also observed in the nonneoplastic bystander cells in the studied cases which need further evaluation on larger scale studies.
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Clinicopathologic features of four rare types of chordomas, confirmed by brachyury immunostaining p. 350
Bharat Rekhi, Devmalya Banerjee, Mukta Ramadwar, Jyoti Bajpai, Nirmala A Jambhekar
DOI:10.4103/IJPM.IJPM_409_16  PMID:28937370
Background: A wide clinicopathologic spectrum of a chordoma exists. Brachyury constitutes as its most useful diagnostic immunohistochemical (IHC) marker. Methods: During a 7-year-period, 4 unusual histopathologic types of chordomas were identified. Immunohistochemistry was performed by polymer technique. Results: Clinicopathologic features of the 4 cases are as follows: Cases 1 and 2: Two tumors occurred in the sacrococcygeal and lumbosacral regions of a 42-year-old male and a 34-year-old female, respectively. Histopathologic examination showed areas of classical chordoma; juxtaposed to a high-grade, spindle cell sarcoma. By IHC, cytokeratin (CK), epithelial membrane antigen (EMA), S-100 protein, and brachyury were found to be distinctly positive in the differentiated chordomatous areas. Both these cases were diagnosed as dedifferentiated chordomas. The first patient, postresection and adjuvant radiation therapy (RT), died after 14 months of therapy. Case 3: A 58-year-old male presented with pain in his sacral region and urinary incontinence. Imaging disclosed a sacral mass. Histopathologic examination showed physaliphorous cells intimately admixed with, markedly pleomorphic cells, scattered mitotic figures, and focal tumor necrosis. By IHC, the tumor cells were positive for CK, AE1/AE3, S-100 protein, brachyury, and INI1/SMARCB1. The diagnosis of a poorly differentiated chordoma was offered. Despite surgical resection and adjuvant RT, the patient died within 18 months. Case 4: A 58-year-old male presented with a soft tissue lesion in his left leg. Histopathologic examination showed physaliphorous cells, embedded in a myxohyaline stroma. By IHC, the tumor cells were positive for EMA, S-100 protein, brachyury, and INI1. Diagnosis of an extra-axial, soft tissue chordoma was offered. Conclusions: These four unusual chordomas, confirmed by brachyury immunoexpression, constitute as one of the first such documentation from our country, revealing a wide clinicopathologic spectrum of chordomas. Dedifferentiated and poorly differentiated chordomas are associated with an aggressive clinical course. Further diagnostic implications are discussed herewith.
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NPM1 and FLT3 mutations in acute myeloid leukemia with normal karyotype: Indian perspective p. 355
Sudha Sazawal, Neha Singh, Sonal Jain, Sunita Chhikara, Rekha Chaubey, Jina Bhattacharyya, Kandarpa Kr Saikia, Manoranjan Mahapatra, Renu Saxena
DOI:10.4103/IJPM.IJPM_501_15  PMID:28937371
Background: FLT3-ITD and NPM1 mutations are considered to be the major determinants of the patient response to therapy and outcome. The primary aim of this study was to establish the correlation between these molecular mutations and the clinico-hematologic parameters as well as the prognostic outcome of the Indian acute myeloid leukemia (AML) patients. Materials and Methods: This prospective study involved newly diagnosed nonpromyelocytic AML patients who had undergone complete diagnostic workup, including immunophenotyping, conventional cytogenetics and molecular analysis for NPM1 and FLT3-ITD mutation by reverse transcriptase polymerase chain reaction at presentation. Results: Overall, the prevalence of NPM1 and FLT3-ITD mutations was found to be 14.4% and 10.8%, respectively. Among patients with normal karyotype, leukocytosis was significantly associated with NPM1+ group than the NPM1− group (P = 0.0019) and more severe degree of anemia was observed in the FLT3-ITD+ patients than the other groups (P = 0.025). No significant correlation was found in terms of age at presentation (P = 0.56), sex ratio (P = 0.467), median platelet count (P = 0.27), and blast percentage between NPM1+ and FLT3-ITD+ groups. Complete remission (CR) rates were better in the NPM1+/FLT3-ITD− group than the other three groups. Unlike most other studies, improved CR rates as well as disease-free survival were observed in the NPM−/FLT3-ITD− group than the FLT3-ITD+ groups although not reaching statistically significant levels. Conclusion: Some differences in the clinical behavior of the Indian AML patients in comparison to that of the West in the presence of NPM1 and FLT3-ITD suggests that comprehensive studies are required to confirm the definitive role of these mutations among AML patients, especially with normal karyotype.
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Age-related reference intervals for immunoglobulin levels and lymphocyte subsets in Indian children p. 360
Gaurav Narula, Shanaz Khodaiji, Arun Bableshwar, Manjeet Singh Bindra
DOI:10.4103/IJPM.IJPM_542_16  PMID:28937372
Background: In children, innate and adaptive immunity varies with age, disease status, and ethnicity, reflected by lymphocyte subsets and serum immunoglobulin (Ig) levels. The paucity of such data from the Indian subcontinent necessitated this study. Aims: This study aims to determine reference ranges of Ig and lymphocyte subsets in Indian children from birth to 5 years. Settings and Design: Neonates, infants, and children from a tertiary care hospital were selected and categorized into 5 groups from cord blood/newborn to 5 years. Materials and Methods: Samples were taken from cord blood and healthy children up to 5 years of age. Complete blood counts, serum Ig levels (by turbidimetry), and lymphocyte subsets (by flow cytometry) were studied, and reference ranges calculated. Results: Four hundred and three samples were analyzed; 53 from cord blood and 350 from children 1 month to 5 years. High IgG levels were noted at birth, which decreased in the first 6 months followed by a rise thereafter. IgM remained low in infancy and peaked at 13–36 months. IgA levels were very low at birth but increased with age. CD4 counts were high in cord blood till 3 years of age and then declined. CD8 and CD19 counts remained steady till 5 years of age. CD56 increased after the age of 2 years. Conclusions: While our data correlated well with published literature, notable differences were higher IgM levels seen in 1–3 years' age group and higher natural killer cells through all age groups in our study. Our results provide the largest database of its kind from our country.
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Radiological tests versus pathological diagnostics: Complimentary or antagonistic relationship? The experience of a tertiary hospital p. 365
Maria A Arafah, Hala M Kfoury
DOI:10.4103/IJPM.IJPM_35_17  PMID:28937373
Introduction: Early detection of breast cancer plays a pivotal role in the outcome of the disease. Diagnostic modalities encompass radiological and pathological findings. The aim of this study is to evaluate the correlation between the results of these two modalities in a tertiary hospital. Materials and Methods: From a total of 180 patients, 203 ultrasound-guided breast core needle biopsies (US-CNBs) were included in this study over a period of a year (May 2015 - May 2016). All clinical parameters, the site of the biopsy, the size of the needle, the radiological findings, the pathological diagnoses as well as all available follow-up data were reviewed. The concordance between the radiological and pathological results was studied and a statistical analysis conforms to the Pearson Chi-square test was applied. Results: The majority of our patients were above 40 years of age. A strong and statistically significant association was noted between radiological findings and histopathological results (Pearson's Chi-square test = 186.28, P ≤ 0.0001) with only four discordant cases (1.97%). This discrepancy was not statistically associated with age, site of biopsy, needle size, or number of cores obtained (P = 0.621, P = 0.584, P = 0.786, and P = 0.478, respectively). Conclusions: US-CNB is an accurate method in the diagnosis of breast lesions. Radiological and pathological correlation is of utmost importance in relation to patient's care and to reduce false rates. Follow-up of concordant benign lesions is essential. In addition, the importance of a multidisciplinary breast conference during which input from all teams caring for the patient is strongly emphasized.
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BRIEF COMMUNICATIONS Top

Malignant phyllodes tumor with heterologous differentiation: Clinicopathological spectrum of nine cases in a tertiary care institute in Eastern India p. 371
Mamita Nayak, Susama Patra, Pritinanda Mishra, Nibedita Sahoo, Prakash Kumar Sasmal, Tushar Subhadarshan Mishra
DOI:10.4103/IJPM.IJPM_426_16  PMID:28937374
Phyllodes tumors are uncommon fibroepithelial neoplasms of breast. Heterologous sarcomatous differentiation of malignant phyllodes tumor (MPT) is a rare phenomenon as shown in the literature. Herein we report a series of nine cases from a tertiary care centre in Eastern India. Patients demographic data and clinical details were obtained from the medical records. Histopathology and immunohistochemical studies were analysed and diagnosed accordingly. Out of 38 cases of PT, 13 were found to be MPT, of which 9 cases showed heterologous differentiation in the form of angiosarcoma, fibrosarcoma, undifferentiated sarcoma, extensive squamous differentiation and with lipomatous metaplasia. Proper diagnosis and subtyping of the sarcomatous component is essential for deciding the correct treatment modality and prognostication of the disease. However there is no clear cut treatment protocol is available because of paucity of data.
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Superficial CD34-positive fibroblastic tumor: A new entity; case report and review of literature p. 377
Neelam Sood, Binit Kumar Khandelia
DOI:10.4103/IJPM.IJPM_589_16  PMID:28937375
Earlier, categorized under low grade malignant fibrous histiocytoma and low grade sarcomas, 'superficial CD34 positive fibroblastic tumor', a newly proposed entity, is a low grade mesenchymal tumor of intermediate malignant potential. Morphological features include monomorphic neoplastic spindle cells arranged in a fascicular to storiform pattern along with sheets of pleomorphic epithelioid cells, and multinucleated giant cells with glassy cytoplasm. Diffuse vimentin and characteristic diffuse CD34 positivity is seen in all cases with few showing focal cytokeratin expression. Rest of the melanocytic and mesenchymal markers are negative. Herein, we present a case of superficial CD34-positive fibroblastic tumor in arm swelling of a 16-year-old female. Differential diagnosis of the same on the basis of morphology as well as immunohistochemistry has also been discussed. This is the first case reported from India to the best of our knowledge.
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Meningioma with the unique coexistence of secretory and lipomatous components: A case report with immunohistochemical study p. 381
Purwa R Patil, Bhushan M Warpe, Vijay H Juvekar, Vidya Manohar
DOI:10.4103/IJPM.IJPM_123_16  PMID:28937376
Meningioma is the most common extra-axial neoplasm which accounts for 30% of all intracranial tumors with a female predilection. These tumors exhibit a broad spectrum of differentiation potency corresponding to different histological subtypes. Meningothelial cells can rarely show separate secretory or lipomatous (metaplastic) transformation. The coexistence of these two different histological subtypes in a single meningeal tumor is extremely rare with only two reported cases. We report an uncommon case of meningioma in a 40-year-old female showing histological admixture of both secretory and lipomatous (metaplastic) meningioma, which to our knowledge is only the third reported case in the world. It highlights the multipotency of phenotypic transformation of primary meningothelial cells. This rare tumor behaves in a fashion similar to benign meningioma of WHO Grade I type.
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Levels of interleukins 2, 6, 8, and 10 in patients with irritable bowel syndrome p. 385
Shaileshkumar R Patel, Anshul Singh, Vatsala Misra, Sri Prakash Misra, Manisha Dwivedi, Pawan Trivedi
DOI:10.4103/IJPM.IJPM_544_16  PMID:28937377
Irritable bowel syndrome (IBS) was previously considered as a psychosomatic disorder. But recent studies indicate that inflammation plays a significant role. The present study was undertaken to evaluate role of pro-inflammatory (IL 2, IL 6 and IL 8) and anti-inflammatory (IL 10) cytokines in clinically diagnosed patients of IBS. 51 patients and 29 controls were included in this study. On the basis of history of gastrointestinal infection, patients were divided into Post Infectious (PIIBS) and Non Post Infectious (NPIIBS) groups. All subsequently underwent colonoscopy and a rectosigmoid biopsy as well as measurement of levels of IL 2, 6, 8 and 10. The levels of IL 2 and IL 8 were significantly raised in IBS patients compared to controls with the mean level of IL 2,6 and 8 higher in PIIBS group than NPIIBS group but statistically significant for IL 8 only. The mean level IL-10 was reduced in patients compared to controls but statistically insignificant. Present study shows that Interleukin levels are altered in patients suffering from IBS and may have a key role in its pathogenesis.
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CASE REPORTS Top

Papillary thyroid carcinoma with nodular fasciitis-like stroma: A rare variant with distinctive morphology p. 390
Kavita Mardi
DOI:10.4103/IJPM.IJPM_832_15  PMID:28937378
Papillary thyroid carcinoma (PTC) is a common malignancy with multiple variants, some of which are rarely encountered in routine surgical pathology practice. PTC with exuberant nodular fasciitis-like stroma or PTC with fibromatosis-like stroma is one such variant. This tumor is characterized by an abundant stromal component with an intervening epithelial component with the typical morphologic features of PTC. We describe gross and histopathological features of this rare variant of papillary carcinoma in a 38-year-old female and review the literature. We also discuss the importance of a thorough search for epithelial components within any fibroproliferative lesion of the thyroid and address the diagnostic difficulties created by the tumor's extensive stromal component. Given the rarity of this condition, the experience gained from the present case is a useful addition to the current knowledge on disease prognostication and management.
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Nasal angiomyolipoma: Report of two cases of an extremely rare entity p. 393
Mohammed Abdul Aleem, Ather Fatima, P Kumudachalam, Ramya Priyadarshini
DOI:10.4103/IJPM.IJPM_414_16  PMID:28937379
Nasal angiomyolipoma (AML) are extremely rare tumors and so far <15 cases have been reported in the literature, and this is the first instance that Nasal AML is reported from India. We report two cases of AML arising in the nasal cavity described in 60-year-old male and 50-year-old female patient. Grossly, they were well circumscribed, lobulated masses, and microscopically, they were composed of an intimate mixture of mature fat, smooth muscle cells, and thick-walled varying sized blood vessels. Immunoexpression pattern and histopathology were characteristic. Both the patients had complete resolution of symptoms after endoscopic excision of the tumor.
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Bilateral ovarian metastases as the presenting manifestation of lung carcinoid in a 50-year-old woman: Case study and review of literature p. 396
Subhashis Mitra, Amiya Jhunjhunwala, Hema Chakraborty
DOI:10.4103/IJPM.IJPM_232_16  PMID:28937380
Neuroendocrine tumors (NETs) are neoplasms arising from dispersed neuroendocrine cells, localized to the gastrointestinal tract (GIT), lungs, adrenal medulla, and other sites. The term “carcinoid tumor” is usually limited to NETs of the lung and GIT. Ovarian carcinoids are uncommon, accounting for 0.1% of ovarian malignancies and 5% of all NETs. Primary ovarian tumors arise in pure form or as a component of teratomas, while ovarian NET metastases are predominantly from gastrointestinal primaries. To the best of our knowledge, there are only two previous reports of bronchopulmonary carcinoids (PCs) metastasizing to the ovaries. We describe a case of PC in a 50-year-old woman, with bilateral ovarian tumors as the presenting manifestation of the disease, and discuss the clinical and pathobiologic significance of this presentation.
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Intrapulmonary ectopic liver associated with scimitar syndrome p. 399
Sajna V. M. Kutty, M Lilly, Shalini Kuruvila, Sajan Koshy
DOI:10.4103/IJPM.IJPM_416_16  PMID:28937381
We report a case of intrapulmonary ectopic liver associated with Scimitar syndrome. A two month old male child who presented with features of congestive cardiac failure underwent extensive cardiac and radiological investigations and was diagnosed with Scimitar syndrome. He was also found to have a mass in the lower lobe of the right lung, the possibilities being either a pulmonary sequestration or a diaphragmatic hernia. As his dyspnea progressively worsened, a right lower lobectomy was performed at the age of two years. Intraoperatively, no connecting pedicle or hernia sac was seen. The resected lung specimen showed a light brown mass enclosed by the lung parenchyma and microscopy showed cords of normal hepatocytes with portal tracts. The hepatocytes were positive for Hep Par1, and bile ducts were CK 7 positive. To the best of our knowledge, this is the first reported case of an intrapulmonary ectopic liver associated with Scimitar syndrome.
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Malignant fibrous histiocytoma arising from renal capsule: An extremely rare entity p. 402
Shilpa Bairwa, Ashok Sangwaiya, Mariyam Ansari, Arpita Jindal, Sapna Singla, Ajay Yadav
DOI:10.4103/IJPM.IJPM_810_15  PMID:28937382
Malignant fibrous histiocytoma (MFH) usually presents in the extremities or retroperitoneum. MFH arising from renal parenchyma or renal capsule is extremely rare, only few cases have been reported in literature and portend a poor prognosis. Renal MFH is differentiated from renal cell carcinoma, renal sarcoma, and sarcomatoid renal tumor only by histological and immunohistochemical studies. Since the therapeutic options for MFH are different, its early diagnosis is imperative. Herein, we report a case of a primary renal MFH in a 35-year-old male.
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Multicentric papillary and chromophobe renal cell carcinomas in a patient with autosomal dominant polycystic kidney disease: Report of a rare case p. 405
Nibedita Sahoo, Susama Patra, Swagatika Senapati, Tushar S Mishra
DOI:10.4103/IJPM.IJPM_357_16  PMID:28937383
The causal relationship of autosomal dominant polycystic kidney disease (ADPKD) with the development of renal cell carcinoma (RCC) is still not known. We describe a case of bilateral PKD complicated with a large enhancing mass and multiple small nodules in the left kidney. The histopathological study of the nephrectomy specimen revealed the synchronous occurrence of eosinophilic variant of chromophobe RCC (EVCRCC) and multicentric papillary RCC (PRCC) in a background of ADPKD. To the best of our knowledge, this case is the first to describe the collision tumor of EVCRCC and multicentric PRCC in ADPKD.
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Nonspecific granulomatous prostatitis in association with eosinophilic epithelial metaplasia and prostatic adenocarcinoma p. 409
Dorian I Dikov, Maria Stoyanova Koleva, Zhivko K Peshev, Veselin T Belovezhdov
DOI:10.4103/IJPM.IJPM_130_16  PMID:28937384
We present the first case of nonspecific granulomatous prostatitis (NSGP) associated with both eosinophilic epithelial metaplasia (EM) in benign glands and prostatic adenocarcinoma (PCa). The patient was a 68-year old man with a history of obstructive prostatic syndrome. After a transurethral resection of the prostate, the histologic analysis revealed NSGP and PCa. EM was seen in benign peri-granulomatous secretory epithelial cells as PAS Diastase positive granular eosinophilic transformation of the apical cell cytoplasm. This unusual cell appearance closely simulated the Paneth cell-like changes found in PCa. Negative chromogranin expression and weakly positive P504S immune staining in the foci of EM, surrounded by P63 positive basal cells confirmed the benign EM - phenotype. The combination of NSGP with both EM and PCa has not been reported in medical literature so far. Some observations concerning their differential diagnosis are suggested.
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Primary classical Hodgkin lymphoma of rectum: Report of an extremely rare case and review of the literature p. 412
Jayasudha Arundhathi Vasudevan, Rekha A Nair, K Rakul Nambiar
DOI:10.4103/IJPM.IJPM_767_16  PMID:28937385
Hodgkin lymphoma (HL) commonly presents as nodal disease, but in a subset of cases, the disease primarily develops in extranodal sites. Primary classical HL of the gastrointestinal (GI) tract is an extremely rare occurrence. Primary nature of the disease is confirmed after a complete lymphoma work up including chest radiograph, computed tomography scan, peripheral blood, and bone marrow studies. Only a few cases of primary GI lymphomas with limited immunohistochemical or molecular confirmation have been reported in literature. We report the case of a 64-year-old immunocompetent woman with primary rectal HL. She presented with constipation, and on sigmoidoscopy examination, she was detected to have an ulceroproliferative circumferential growth in the rectum. Considering the possibility of rectal carcinoma, a low anterior resection was done. Histology was suggestive of mixed cellularity classical HL. She was started on combination chemotherapy, and she responded well to treatment. However, she developed pulmonary complication after the fourth cycle of chemotherapy and succumbed to the illness. Primary rectal HL is extremely rare, and to the best of our knowledge, only 16 cases have been reported previously. We believe that reporting this case will add to the scarce data about this unusual presentation in immunocompetent patients.
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Bilateral seminomas coexisting with adenomatoid tumor: An unusual occurrence p. 415
Suchi Mittal, Rathindra Sarangi, Sunila Jain
DOI:10.4103/IJPM.IJPM_871_15  PMID:28937386
Coexistence of bilateral seminomas and adenomatoid tumor is rare. We encountered an interesting case of bilateral testicular seminomas along with a paratesticular nodule which was diagnosed as an adenomatoid tumor on histology. Although seminomas and adenomatoid tumor are frequent neoplasms, bilaterality and their coexistence have been rarely described and can pose diagnostic difficulties. Herein, we describe a case of a 53-year-old man who presented with bilateral testicular swellings which were diagnosed as bilateral seminomas with an adenomatoid tumor in the left paratesticular region on histopathology. The pathological findings of these coexistent tumors and the utility of immunohistochemistry in establishing a correct diagnosis in such scenarios are discussed.
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Malignant chondroid syringoma of thigh with late metastasis to lung: A very rare case report p. 418
Mayur Kothiya, Neha Mittal, Rajiv Kumar, Shubhada Kane
DOI:10.4103/IJPM.IJPM_322_16  PMID:28937387
Mixed/biphasic tumors include epithelial-myoepithelial tumors, pleomorphic adenoma, matrix-producing tumors, cutaneous mixed tumors such as chondroid syringoma (CS), malignant mixed tumors (carcinosarcomas), pulmonary blastomas (in lung), and many others. Morphology may show overlap between various mixed tumors. At any particular site, whether these tumors are primary or metastasis from other sites is difficult to determine, more so if primary is unknown or not disclosed. CS is a rare benign mixed/biphasic skin adnexal tumor, considered as cutaneous counterpart of pleomorphic adenoma. Its malignant variant, malignant CS is reported only occasionally. We describe a case of a 51 year old female who presented with multiple masses in both lungs. This case is a very rare example of late metastasis to lungs from a primary malignant CS of thigh.
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Undiagnosed senile systemic amyloidosis with mesenteric angiopathy leading to fatal outcomes: Two case series with a review of literature p. 421
Avneesh Gupta, Maryna Tarbunova, Anil Aggrawal, Anges E Aysola
DOI:10.4103/IJPM.IJPM_278_16  PMID:28937388
Amyloid mesenteric angiopathy is difficult to diagnose as gastrointestinal (GI) signs are nonspecific and radiological studies rarely identify amyloid deposits with certainty. The objective of this study was to highlight the pathological findings of amyloid mesenteric angiopathy in cases of senile systemic amyloidosis. Literature review, author's research data, and practice experience were used. Systemic amyloidosis should be considered in the differential diagnoses when evaluating nonspecific and unexplained GI in patient population aged >55 years to decrease the morbidity and fatal outcomes.
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Incontinentia pigmenti, an x-linked dominant disorder, in a 2-year-old boy with Klinefelter syndrome p. 424
Abhilasha Williams, Laxmisha Chandrashekar, Vivi M Srivastava, Meera Thomas, Saban Horo, Renu George
DOI:10.4103/IJPM.IJPM_91_16  PMID:28937389
Incontinentia pigmenti (IP) is a rare X-linked dominant disorder, in which skin lesions distributed along Blaschko's lines appear shortly after birth. Early lesions which are erythematous/bullous evolve over time into warty lesions, hyperpigmented swirls/macules, and atrophic hypopigmented streaks. Clinical features are heterogeneous. Abnormalities of the teeth, nails, hair, eyes, central nervous system, and breast may also be present. While intelligence is generally normal, varied degrees of intellectual disability/developmental delay have been reported. Lifespan is normal. IP is associated with mutations of the inhibitor of kappa light polypeptide gene enhancer in B cell, kinase gamma (IKBKG) gene on chromosome Xq28. This gene is involved in the activation of nuclear factor kappa B which protects cells against apoptosis; therefore, cells with IKBKG mutations are extremely susceptible to apoptosis. X-linked dominant disorders are lethal to male fetuses. Males who survive with IP either have mosaicism or an additional X chromosome (Klinefelter syndrome). We present a 22-month-old boy with IP and Klinefelter syndrome.
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Nonpigmented strain of Chromobacterium violaceum causing neonatal septicemia: A rare case report p. 427
Shreekant Tiwari, Swetalona Pattanaik, Siba Shankar Beriha
DOI:10.4103/IJPM.IJPM_479_16  PMID:28937390
Human infection caused by Chromobacterium violaceum is rare but has got high fatality in septicemia. Nonpigmented strains of C. violaceum have been found similar in pathogenicity to pigmented strains. Pigment production is not an exclusive character of the genus Chromobacterium because around 9%–11% strains of C. violaceum are nonpigmented. Herewith, we report a nonpigmented strain of C. violaceum from a case of neonatal septicemia that was successfully treated with gentamicin plus imipenem.
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Metastasis within a metastasis to the thyroid: A rare phenomenon p. 430
Yin Ping Wong, Khairunisa Ahmad Affandi, Geok Chin Tan, Rohaizak Muhammad
DOI:10.4103/IJPM.IJPM_287_16  PMID:28937391
Metastatic disease involving the thyroid gland is uncommon. Solitary thyroid metastases from various primary sites particularly kidney, lung, and breast had been previously described. To the best of our knowledge, metastases from two topographically separate primary malignancies to the thyroid have never been documented hitherto. This is the first reported case of cancer-to-cancer metastasis involving an invasive breast carcinoma metastasized within a metastatic renal cell carcinoma in the nonneoplastic thyroid in a 58-year-old woman. Distinguishing a secondary thyroid metastases from a primary thyroid malignancy is utmost crucial as treatment differs. The possibility of tumor metastases from two separated primaries should always be considered in a tumor exhibiting malignant cell populations with two distinctive histomorphological appearances. The role of immunohistochemistry stains in equivocal cases cannot be overemphasized.
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IMAGES Top

Fine-needle aspiration cytology of leishmanial lymphadenitis in a HIV reactive patient p. 433
Biswajit Biswas, Subrata Pal
DOI:10.4103/IJPM.IJPM_626_16  PMID:28937392
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Primary intraosseous Rosai-Dorfman disease: Long-term follow-up with recurrence after surgical excision p. 435
Amarathunga A. H. Priyani, Samaratunga A. A. Shirani, Gamage Amila, Gunatilake W Asiri
DOI:10.4103/IJPM.IJPM_509_16  PMID:28937393
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Leukemic phase of hepatosplenic T-cell lymphoma: A great masquerader of acute leukemia p. 437
Saniya Sharma, Sreejesh Sreedharanunni, Man Updesh Singh Sachdeva, Gaurav Prakash, Neelam Varma
DOI:10.4103/IJPM.IJPM_39_17  PMID:28937394
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TRIBUTE Top

Prof. M. Balaraman Nair p. 439
KP Aravindan
DOI:10.4103/0377-4929.215403  PMID:28937395
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LETTERS TO EDITOR Top

Metastasis as initial presentation of squamous cell carcinoma of gallbladder: A rare clinical entity p. 440
Pradip Kendre, Pritam Kataria, Apurva Patel, Lal Chand Mittal, Tushar Mule
DOI:10.4103/IJPM.IJPM_113_17  PMID:28937396
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Pacemaker lead infective endocarditis in immunocompetent host due to Aspergillus: An uncommon occurrence p. 441
Aminder Singh, Abhishek Goyal, Bhupinder Singh, Neena Sood
DOI:10.4103/IJPM.IJPM_257_16  PMID:28937397
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Immunoglobulin G4-related orbital disease: An important differential diagnosis for orbital swellings with lymphoplasmacytic infiltration p. 443
Samrat Bordoloi, Jayaram Iyengar
DOI:10.4103/IJPM.IJPM_476_16  PMID:28937398
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Subcutaneous cysticercosis and cytological findings p. 445
Beuy Joob, Viroj Wiwanitkit
DOI:10.4103/IJPM.IJPM_389_17  PMID:28937399
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Megakaryocytic blast crisis in chronic myeloid leukemia: A primary presentation p. 445
Komal Mahendra Ashar, Viren Vaghasiya, Smita Chetan Patel
DOI:10.4103/IJPM.IJPM_841_16  PMID:28937400
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The expression of interleukin-17 in cutaneous lesions of lupus erythematosus in pediatric-onset systemic lupus erythematosus p. 447
Govind Suresh Mittal, Sathish Kumar, Meera Thomas, Visali Jeyaseelan, Renu George
DOI:10.4103/IJPM.IJPM_655_16  PMID:28937401
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Effect of processing time on analysis of rare event in minimal residual disease study p. 449
Sandeep Rai, Uma Bhardwaj, Saroj Singh, Aroonima Misra
DOI:10.4103/IJPM.IJPM_353_16  PMID:28937402
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Helicobacter pylori prevalence and relation with obesity p. 451
Saime Hacer Ozdemir, Çagrı Aksu, Ebru Ozden, Irem Narman, Seda Varlik, Burak Aksu, Ozgur Kasimay, Aysegul Karahasan Yagci
DOI:10.4103/IJPM.IJPM_374_16  PMID:28937403
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