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   2009| October-December  | Volume 52 | Issue 4  
    Online since October 1, 2009

 
 
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ORIGINAL ARTICLES
Megakaryocytic alterations in thrombocytopenia: A bone marrow aspiration study
Manas Muhury, Alka M Mathai, Sharada Rai, Ramadas Naik, Muktha R Pai, Ruchi Sinha
October-December 2009, 52(4):490-494
DOI:10.4103/0377-4929.56132  PMID:19805953
Context: Dysplastic changes are well documented in myelodysplastic syndromes (MDS). However, they are also observed in non-MDS hematological conditions. Aims: To evaluate the megakaryocytic alterations in the bone marrow aspirations in cases of non-MDS related thrombocytopenia. Setting and Design: A prospective study of 144 bone marrow aspirates was conducted in the department of pathology, Kasturba Medical College, Mangalore. The aspirates were studied to assess the number and morphology of the megakaryocytes in non-MDS related thrombocytopenia and evaluate their significance when compared to changes in MDS. Materials and Methods: The bone marrow aspiration smears were stained with Leishman stain and examined under light microscope. Statistical Analysis Used: Fisher's exact test. A P value less than 0.05 was considered significant. Sensitivity and specificity was calculated for those features which were significant in the relevant hematological disorders. Results: The sensitivity of immature megakaryocytes, dysplastic forms and micromegakaryocytes in cases of immune thrombocytopenic purpura was 100%, 89% and 42% respectively. The specificity of emperipolesis was 74%. In cases of infection-associated thrombocytopenia, immature megakaryocytes had a sensitivity of 100% and cytoplasmic vacuolization were 86% specific. The sensitivity of the dysplastic forms in megaloblastic anemia was 75%. However, no platelet budding was observed. The presence of micromegakaryocyte had a specificity of 83% in MDS, and was statistically significant when compared to cases of non-MDS conditions (P<0.05). Conclusions: Careful understanding of the morphological changes of megakaryocytes in bone marrow aspirates can improve the diagnostic accuracy for a wide range of hematological disorders thereby enabling proper therapeutic interventions.
  18,218 1,223 3
LETTERS TO EDITOR
Megakaryocytic emperipolesis: A histological finding in myelodysplastic syndrome
MN Sable, K Sehgal, VS Gadage, PG Subramanian, S Gujral
October-December 2009, 52(4):599-600
DOI:10.4103/0377-4929.56153  PMID:19805998
  13,561 323 3
REVIEW ARTICLE
Foregut cystic developmental malformation: New taxonomy and classification - Unifying embryopathological concepts
Sharad Sharma, Nosratollah Nezakatgoo, Prithvi Sreenivasan, Jason Vanatta, Nicolas Jabbour
October-December 2009, 52(4):461-472
DOI:10.4103/0377-4929.56119  PMID:19805948
Foregut cystic developmental malformations are rare developmental anomalies. The problems inherent to these malformations are their presentation across specialties that include embryology, anatomy, pathology, thoracic foregut surgery, pediatric surgery and general abdominal surgery. The direct consequence of this variation has resulted in diverse terminology, classification and a failure to identify the correlation. The article aims to summarize and unify the embryological concepts of foregut cystic malformation, to suggest a generic title to the various groups of these interrelated disorders and a uniform use of nomenclature on the basis of unifying concepts of embryopathogeneis.
  11,255 868 9
ORIGINAL ARTICLES
Breast carcinoma grading, estimation of tumor size, axillary lymph node status, staging, and nottingham prognostic index scoring on mastectomy specimens
Zubair Ahmad, Amna Khurshid, Asim Qureshi, Romana Idress, Nasira Asghar, Naila Kayani
October-December 2009, 52(4):477-481
DOI:10.4103/0377-4929.56123  PMID:19805950
Introduction: Breast carcinoma is the most common malignant tumor and the leading cause of cancer death in women. In western countries, a sharp increase in the detection of breast carcinoma, largely due to widespread use of mammography, has recently led to a fall in breast cancer mortality. This, however, is not true for less developed countries, in which mortality continues to rise. Objective: The aim of this study was to acquire information about the extent and spread of breast carcinoma in our patients by grading the tumors, determining the tumor size, and axillary lymph node status, staging of the tumors and Nottingham Prognostic Index (NPI) scoring on the available material. Materials and Methods: One hundred and twenty consecutive mastectomy specimens with axillary lymph node sampling removed for breast carcinoma and received in the section of histopathology, Aga Khan University, in the year 2005, were included in the study. Standard protocols were used for the processing of the specimens, and reporting was done using a standard format incorporating all relevant tumor parameters. NPI was applied to the cases. Results: Out of the 120 cases, 5 (4.17) were grade 1, 91 (75.83) were grade 2, and 24 (20%) were grade 3. Also, 9 cases (7.5%) were T1 (4 were T1b, and 5 were T1c); 53 (44.16%) were T2; 50 (41.66%) were T3; and 8 (6.66%) were T4. Axillary lymph nodes were available in 107 cases. In 13 cases, no lymph nodes were recovered. Out of 107 cases 27 (25.23%) lymph nodes were negative for metastases pN0; 29 (27.10%) cases were pN1; 26 (24.30) were pN2; and 25 cases (23.36%) were pN3. Extranodal spread was present in 56 (70%) out of the 80 cases in which lymph nodes were positive. The average microscopic size of nodal metastasis was 1.7 cms. Significant statistical association was found between the number of positive nodes and perinodal extension (P = 0.001). Tumor necrosis was present in 76 out of 120 cases (63.33%). Vascular invasion was present in 43 out of 120 cases (35.83%). NPI scores were greater than 5.4 in 60 out of 107 cases (56.1%) indicating poor prognosis. Conclusion: The large majority of the cases were grade 2 tumors. Most cases (all grades) were T2 or T3, and were axillary lymph node positive. Large majority of cases with nodel metastases showed extra nodal spread. The majority of patients had NPI scores greater than 5.4 indicating poor prognosis. Significant statistical association was found between the number of positive nodes and perinodal extension (P = 0.001). The findings show extensive and advanced disease trends in our patients.
  10,434 818 5
CASE REPORTS
Nodular lymphoid hyperplasia in common variable immunodeficiency syndrome mimicking familial adenomatous polyposis on endoscopy
Mahsa Molaei, Alireza Kaboli, Alireza Modares Fathi, Reza Mashayekhi, Shervin Pejhan, Mohammad Reza Zali
October-December 2009, 52(4):530-533
DOI:10.4103/0377-4929.56152  PMID:19805964
Common variable immunodeficiency syndrome (CVID) includes a heterogeneous disorder characterized by reduced levels of IgG, IgA or IgM, and recurrent bacterial infections with normal T-cell immunity in 60% of patients. It affects the gastrointestinal tract as the largest immune organ with a wide spectrum of symptoms and signs. We present a case of nodular lymphoid hyperplasia (NLH) of the small intestine in a 31-year-old man admitted for evaluation of chronic diarrhea. Upper and lower gastrointestinal endoscopy revealed multiple polyps in the stomach, duodenum, ileum, and large intestine mimicking familial adenomatous polyposis (FAP). Although he had no history of recurrent infection, immunological profiles were in favor of CVID. We emphasize the importance of considering CVID in any patient with gastrointestinal manifestations even in the absence of recurrent bacterial infections. Diagnostic delay results in more morbidity and complications in untreated patients.
  9,480 258 5
ORIGINAL ARTICLES
Nosocomial cross-transmission of Pseudomonas aeruginosa between patients in a tertiary intensive care unit
M Dwivedi, A Mishra, RK Singh, A Azim, AK Baronia, KN Prasad
October-December 2009, 52(4):509-513
DOI:10.4103/0377-4929.56143  PMID:19805958
Background: Nosocomial infection caused by Pseudomonas aeruginosa (P. aeruginosa) is very common, despite the application of various preventive measures in intensive care units (ICUs) leading to increased morbidity, mortality, prolonged hospital stay, and increased treatment cost. Aim: The aim of the present study is to identify the source of P. aeruginosa infection in patients admitted to tertiary ICU. Materials and Methods: From 200 patients selected randomly, appropriate clinical specimens from different sites were collected and processed for the isolation and identification of the nosocomial pathogens. Surveillance samples from environmental sites and hands of nursing staff were also cultured. Results: P. aeruginosa was found to be the most common pathogen associated with nosocomial infections accounting for 23.3% of all bacterial isolates from different infection sites in the ICU. Serotyping of the clinical isolates and surveillance sample isolates from nurses' hands showed serotype E as the most common serotype. Other serotypes of P. aeruginosa were isolated from environmental cultures such as sinks, floors, walls, tap water, etc. Conclusion: Study revealed a high prevalence of P. aeruginosa infections in the ICU attributed to cross transmission from patient to patient via hands of the nursing staff. Strict enforcement of infection control protocols is essential to minimize the disease burden.
  8,388 590 7
LETTERS TO EDITOR
Partial hydatidiform mole with a full-term infant
Kajal Kiran Dhingra, Parul Gupta, Vijay Saroha, L Akhila, Nita Khurana
October-December 2009, 52(4):590-591
DOI:10.4103/0377-4929.56137  PMID:19805991
  7,987 398 -
ORIGINAL ARTICLES
Changing trends in antimicrobial resistance of Salmonella enterica serovar typhi and salmonella enterica serovar paratyphi A in Chennai
Padma Krishnan, M Stalin, S Balasubramanian
October-December 2009, 52(4):505-508
DOI:10.4103/0377-4929.56140  PMID:19805957
Background and Objectives: Chloramphenicol was considered the anti-microbial gold standard for typhoid treatment but, following the increasing worldwide frequency of antibiotic resistance, ciprofloxacin has been the mainstay of therapy since 1980. Recent studies have shown a shifting of susceptibility to conventional drugs like chloramphenicol, ampicillin and cotrimoxazole. The primary objective of the study was to evaluate the in vitro activity of chloramphenicol and other first-line drugs in comparison with cephalosporins and quinolones. Materials and Methods: Fifty isolates of Salmonella obtained from blood culture were subjected to serotyping at the Central Research Institute, Kasauli. Phage typing and biotyping was performed at the National Phage Typing Centre, New Delhi. Antibiotic sensitivity testing was carried out for 10 drugs by the Kirby-Bauer disc diffusion method and minimum inhibitory concentration by broth microdilution for nalidixic acid, chloramphenicol, ciprofloxacin, ceftriaxone, cefixime and ofloxacin. Multi-drug-resistant (MDR) strains were checked for plasmid. Results: In the present study, 70 and 30% of the isolates were Salmonella enterica serovar typhi and paratyphi A, respectively. They were highly sensitive to chloramphenicol (86%), ampicillin (84%) and cotrimoxazole (88%). Highest sensitivity was seen for cephalosporins, followed by quinolones. Seventeen/21 (81%) and 100% of the Salmonella enterica serovar typhi strains belonged to E1 phage type and biotype 1, respectively. Antibiogram showed 2% of the strains to be sensitive to all the drugs tested and 12% were MDR and showed the presence of plasmids. Conclusion: The study indicates reemergence of chloramphenicol-susceptible Salmonella enterica serovar typhi and paratyphi A isolates, a significant decline in MDR strains and high resistance to nalidixic acid. E1 phage type and biotype 1 are found to be most prevalent in Chennai, India.
  6,151 865 7
A histopathologic study of salivary gland tumors in Kano, northern Nigeria
Ochicha Ochicha, Sani Malami, Aminu Mohammed, Akinfenwa Atanda
October-December 2009, 52(4):473-476
DOI:10.4103/0377-4929.56121  PMID:19805949
Significant differences in the global distribution of salivary gland tumors have been reported, but no formal study has been carried out here in Kano, the largest city in northern Nigeria. We therefore undertook this eight-year retrospective study of all histologically diagnosed salivary neoplasms at the histopathology laboratory of our referral teaching hospital in Kano. Seventy-eight salivary gland tumors were diagnosed during the eight-year study period accounting for 0.4% of all neoplasms. Benign tumors were more prevalent, comprising 56.4%, while malignancies were 43.6%. Pleomorphic adenoma and mucoepidermoid carcinoma were the commonest histological types constituting 48.7% and 23.1% respectively, while the most frequent sites were parotid, submandibular and minor salivary glands accounting for 49%, 26% and 24% respectively. As in most studies of black populations there were no adenolymphomas. Age distribution was bimodal with a benign peak in the third decade and a malignant peak in the sixth. Our findings were broadly similar to most other African reports but somewhat at variance with Western literature. Improved hospital attendance with more comprehensive reporting would yield more representative data.
  5,638 1,037 14
Coronary atherosclerosis in sudden cardiac death: An autopsy study
M Lakshmi Sudha, Sandhya Sundaram, K Raman Purushothaman, P Sampath Kumar, D Prathiba
October-December 2009, 52(4):486-489
DOI:10.4103/0377-4929.56130  PMID:19805952
Background: The incidence of ischemic heart disease (IHD) has markedly increased in India over the past few years. Considering the variations in racial, dietary and lifestyle patterns in our population, it is essential to study the biology of coronary atherosclerosis in our patients. Vulnerable plaques have a large number of foam cells, extracellular lipid, thin fibrous caps and clusters of inflammatory cells and are more prone to rupture. These plaques are nourished by the microvessels arising from the vasa vasorum of the blood vessels and by lumen-derived microvessels through the fibrous cap. This autopsy study was designed to analyse the coronary arterial tree in cases of sudden cardiac death, classify coronary atherosclerotic plaques and to assess the factors contributing to vulnerability of the plaques including inflammation, calcification and microvascular density. Materials and Methods: Seven cases of sudden cardiac death were included in the study. The hearts were perfusion-fixed and the coronary arteries along with their main branches were dissected and studied. The location of the plaques, type of plaques, presence of inflammation and calcification were assessed. The cap thickness and microvessel density per 1000um 2 were assessed. The statistical significance was estimated. Results and Conclusions: Extensive high-grade coronary atherosclerotic disease was seen in all sudden cardiac death cases. Majority of the plaques were vulnerable. High-grade inflammation was seen in most of the vulnerable and ruptured plaques. All the ruptured plaques were uncalcified indicating that calcification probably stabilizes the plaques and protects against rupture. Increased microvessel density was noted in ruptured plaques compared to vulnerable plaques. However, it was not statistically significant.
  5,133 547 5
Detection and antifungal susceptibility testing of oral Candida dubliniensis from human immunodeficiency virus-infected patients
Sneha K Chunchanur, Shobha D Nadgir, LH Halesh, BS Patil, Yasmeen Kausar, MR Chandrasekhar
October-December 2009, 52(4):501-504
DOI:10.4103/0377-4929.56138  PMID:19805956
Context: Candida dubliniensis, an opportunistic yeast that has been implicated in oropharyngeal candidiasis (OPC) in patients infected with Human Immunodeficiency Virus (HIV) may be under-reported due to its similarity with Candida albicans. Resistance to Fluconazole is often seen in C. dubliniensis isolates from clinical specimens. Aims: To know the prevalence of C. dubliniensis in OPC in patients infected with HIV and their antifungal susceptibility pattern. Settings and Design: One hundred and thirty-two HIV seropositive individuals and 50 healthy controls were included in the study. Materials and Methods: Two oral swabs were collected from the site of the lesion from 132 HIV-infected patients. Oral rinse was obtained from 50 healthy controls. Samples were inoculated on Sabouraud's dextrose agar (SDA) medium and on HiCrome Candida Differential Agar (CHROM agar) medium. Isolates were speciated by standard tests. Dark green-colored, germ tube positive isolates, which failed to grow at 420C and negative for xylose assimilation were identified as C. dubliniensis. Antifungal susceptibility test was performed by Macro broth dilution technique (National Committee for Clinical Laboratory Standards guidelines). Results and Conclusions: From 132 patients, 22 (16.3%) C. dubliniensis were isolated; samples from healthy controls did not reveal their presence. Antifungal susceptibility test showed higher resistance among C. dubliniensis isolates to azoles compared to C. albicans. Five (22.7%) isolates of C. dubliniensis were resistant to Fluconazole followed by four (18.2%) to Ketoconazole. This study emphasizes the importance of identification and antifungal susceptibility testing of C. dubliniensis in HIV-infected patients.
  4,979 667 10
LETTERS TO EDITOR
Chemotherapy induced cytomorphologic changes in breast carcinoma: A potential diagnostic challenge for the histopathologist
Ruchika Gupta, Raman Arora, Alok Sharma, Amit Kumar Dinda
October-December 2009, 52(4):583-585
DOI:10.4103/0377-4929.56128  PMID:19805986
  4,446 281 -
CASE REPORTS
A case of melanoma in xeroderma pigmentosum
T Narayana Rao, A Bhagyalaxmi, Kamal Ahmed, TS Mohana Rao, K Venkatachalam
October-December 2009, 52(4):524-526
DOI:10.4103/0377-4929.56149  PMID:19805962
Xeroderma pigmentosum (XP) was first described in 1874 by Hebra and Kaposi. [1] It is a rare autosomal recessive disorder characterized by photosensitivity, pigmentary changes, premature skin aging, and malignant tumor development due to cellular hypersensitivity to ultraviolet radiation resulting from a defect in DNA repair. The basic defect in XP is in nucleotide excision repair (NER), leading to deficient repair of damaged DNA. A 12-year-old boy presented with a large growth over the right side of the forehead. The lesion was first noticed before two years as a 2 x 2 cm 2 mass. It was slowly growing and attained the present size of 10 x 8 x 7 cm 3 . The surface showed ulceration with areas of hemorrhage and blackish pigmentation. Also, the patient had hyperpigmented macules over the skin since early childhood. The macules appeared initially over the face and later developed over the other areas of the body. The macules were more over the sun exposed areas. He also had photophobia and both eyes showed corneal opacities. Histopathological examination of the excised growth showed features consistent with melanoma. This case is being presented because of its rare association with xeroderma pigmentosum patients in India.
  4,439 281 4
ORIGINAL ARTICLES
HER-2/neu expression in lesions of uterine cervix: Is it reliable and consistent?
Nidhi Gupta, Sunita Singh, Nisha Marwah, Sanjay Kumar, Sonia Chabra, Rajeev Sen
October-December 2009, 52(4):482-485
DOI:10.4103/0377-4929.56127  PMID:19805951
This study was conducted to evaluate the expression of HER-2/neu oncogene in the lesions of the uterine cervix and to determine its correlation with histological type of malignancy, grade and clinical stage of presentation. One hundred cervical specimens were included in this study. These comprised cases with diagnosis of benign epithelial lesions, squamous cell carcinoma, adenocarcinoma, carcinoma cervix with glandular differentiation and cervical intraepithelial neoplasia. HER-2/neu immunostaining was performed by streptovidin-biotin peroxidase method. Higher expression of HER-2/neu was noted in malignant lesions as compared to benign lesions. Intensity of staining also correlated with clinical stage of presentation, lymph node metastasis and presence of parametrial extension. The over-expression of HER-2 oncoprotein is associated with poor prognosis, metastatic potential and aggressive biological behavior.
  4,260 377 -
LETTERS TO EDITOR
A six month-old girl with botulism due to honey ingestion
Parviz Vahdani, Farhad Abbasi, Mohammad Reza Adhami Mojarad, Ali Akbar Velayati, Mohammad Reza Boloorsaz, Fariba Musavipour, Golnaz Vahdani
October-December 2009, 52(4):592-592
DOI:10.4103/0377-4929.56139  PMID:19805993
  4,370 204 1
ORIGINAL ARTICLES
Predictive value of mid-trimester amniotic fluid high-sensitive C-reactive protein, ferritin, and lactate dehydrogenase for fetal growth restriction
Sedigheh Borna, Alireza Abdollahi, Fatemeh Mirzaei
October-December 2009, 52(4):498-500
DOI:10.4103/0377-4929.56136  PMID:19805955
Background: Fetal growth restriction (FGR) is surprisingly common with placental dysfunction occurring in about 3% of pregnancies and despite advances in obstetric care, FGR remains a major problem in developed countries. Aim: The purpose of this study is to find out the predictive value of amniotic fluid high sensitive C-reactive protein (hs-CRP), ferritin, and lactate dehydrogenase (LDH) for FGR. Materials and Methods: This prospective strategy of this study has been conducted on pregnant women who underwent genetic amniocentesis between 15th and 20th weeks of gestation. All patients were followed up on until delivery. Patients with abnormal karyotype and iatrogenic preterm delivery for fetal and maternal indications were excluded. The samples were immediately sent to laboratory for cytogenetic and biochemical examination. Non-parametric tests and receiver-operator characteristic curve analysis were used for statistical purpose. Results: A significant correlation between incremental amniotic fluid alpha fetoprotein (αFPr) and LDH levels and FGR at gestational weeks 15th-20th was found out. We also found an optimum cut-off value >140 IU/L for the amniotic fluid LDH concentration with a sensitivity of 87.5% and a specificity of 82.4% for the prediction of FGR. Conclusion: Once the LDH value is confirmed, it could serve as a prediction factor for FGR at the time of genetic amniocentesis at gestational weeks 15-20.
  4,043 219 4
CASE REPORTS
Persistent müllerian duct syndrome
Neeraj Prakash, Anuj Khurana, Bhawna Narula
October-December 2009, 52(4):546-548
DOI:10.4103/0377-4929.56160  PMID:19805969
Persistent Müllerian duct syndrome (PMDS) is a rare form of male pseudohermaphroditism characterized by the presence of the Mόllerian duct structures in an otherwise phenotypically as well as genotypically normal male. We report a case of 40-year-old cryptorchid male who was clinically diagnosed as seminoma in the undescended abdominal testis. A diagnosis of PMDS was made on histological evaluation subsequent to abdominal orchidectomy.
  3,933 252 7
Cardiac sarcoidosis causing sudden death
Vijayalaxmi V Suranagi, Prakash R Malur, Hema B Bannur
October-December 2009, 52(4):566-567
DOI:10.4103/0377-4929.56170  PMID:19805976
Sarcoidosis is a systemic disease of young adults. Cardiac involvement is rarely diagnosed clinically. In most cases it presents with arrhythmias and conduction disorders. We report a case of sudden death of a young female, wherein sarcoidosis with prominent cardiac involvement was diagnosed at autopsy. The other organs involved were lung and liver. Cardiac sarcoidosis should be considered in young patients with unexplained conduction disorders.
  3,746 180 2
Idiopathic renal replacement lipomatosis: A case report and review of literature
Vinaya B Shah, Asha B Rupani, Madhavi S Deokar, Hemant R Pathak
October-December 2009, 52(4):552-553
DOI:10.4103/0377-4929.56163  PMID:19805971
Idiopathic renal replacement lipomatosis is a rare condition in which the renal parenchyma, especially the renal sinus is replaced with adipose tissue with increase in perirenal fat. We report a case of renal replacement lipomatosis presenting as a renal mass clinically. The computed tomography scan revealed low density and nodular masses of adipose tissue within the renal parenchyma. The differential diagnosis before surgery was angiomyolipoma, lipoma, and xanthogranulomatous pyelonephritis. After the histological examination and extensive literature search, the diagnosis of renal replacement lipomatosis was made. It is a rare entity and may be missed if not considered due to lack of experience, so we hope that more urologists, radiologists, and pathologists become aware of this entity and recognize it.
  3,713 175 8
IMAGES
Pancreatic abscess secondary to gall stones caused by Escherichia coli
VP Baradkar, M Mathur, S Kumar
October-December 2009, 52(4):573-574
DOI:10.4103/0377-4929.56162  PMID:19805979
  3,720 133 -
CASE REPORTS
Transfusion related acute lung injury
Ratti Ram Sharma, Prasun Bhattacharya, Beenu Thakral, Karan Saluja, Neelam Marwaha
October-December 2009, 52(4):561-563
DOI:10.4103/0377-4929.56168  PMID:19805974
Transfusion related acute lung injury (TRALI) is an uncommon but potentially fatal adverse reaction to transfusion of plasma containing blood components. We describe a case of 10-year-old male child with aplastic anemia, platelet count of 7800/΅l, B positive blood group who developed fever (39.2΀C), difficulty in breathing and cyanosis within 2 hrs after transfusion of a random platelet concentrate. Despite the best resuscitative efforts, the child died within next 24 hrs. The present case highlights the fact that TRALI should be kept as a differential diagnosis in all patients developing acute respiratory discomfort within 6 hrs of transfusion. Without a 'gold standard' the diagnosis of TRALI relies on a high index of suspicion and on excluding other types of transfusion reactions. Notification to transfusion services is crucial to ensure that a proper investigation is carried out and at-risk donor and recipients can be identified, and risk reduction measures can be adopted.
  3,451 374 2
Adenoid cystic carcinoma of uterine cervix in a young patient
Ankit Seth, Asha Agarwal
October-December 2009, 52(4):543-545
DOI:10.4103/0377-4929.56158  PMID:19805968
Adenoid cystic carcinoma of uterine cervix is a rare tumor. Its origin is debatable. It has a high incidence in postmenopausal women but rarely can develop in patients under 40. An association with squamous cell carcinoma has been described. We report a case of adenoid cystic carcinoma of the endocervical canal with foci of squamous cell carcinoma in a 34-year-old suffering from menorrhagia associated with blood-stained vaginal discharge. Per vaginum and per speculum examination revealed a growth. Cervical biopsy showed bits of tissue, suggesting adenoid cystic carcinoma. Patient was operated upon and uterus with cervix sent for histopathological examination. We report this case because of its rarity, particularly in young patients, with description of illustrative pathology and discussion on the histological diagnosis.
  3,611 192 1
Calcifying fibrous pseudotumor in association with hyaline vascular type Castleman's disease
Muhammad Azam, Yousuf A Husen, Shahid Pervez
October-December 2009, 52(4):527-529
DOI:10.4103/0377-4929.56151  PMID:19805963
Calcifying fibrous pseudotumor is a recently described rare entity. It is considered as sclerosing end stage of inflammatory myofibroblastic tumor. An association with hyaline vascular type Castleman's disease has also been described. We report a case of a 13-year-old boy who presented with pain in epigastrium. Computed tomography scan of abdomen revealed a circumscribed mass arising from the gastric wall along the greater curvature. Histology revealed a tumor composed of spindle cells present within the dense hyalinized collagenous tissue. Lymphoplasmacytic infiltrate was seen along with lymphoid follicles, dystrophic and ossifying calcification. Tumor cells were focally positive for alpha smooth muscle actin and negative for anaplastic lymphoma kinase protein.
  3,505 174 4
Adenoid cystic carcinoma of the external auditory canal: Report of two cases
Supreeta P Nayak, Vaishali A Walke, Satish B Helwatkar, Sudhakar K Bobhate
October-December 2009, 52(4):540-542
DOI:10.4103/0377-4929.56157  PMID:19805967
Adenoid cystic carcinoma occurring in the external auditory canal is very rare. Two cases are being reported. One was diagnosed on cytology based on which surgery was planned. In the second case, fine needle aspiration procedure had to be abandoned due to severe pain and a biopsy was required for its diagnosis. Morphologically, it resembles its more common salivary gland counterpart. Though severe pain during needling may be a limiting factor, adenoid cystic carcinoma of external auditory canal can be confidently diagnosed on cytology based on which surgical management can be planned.
  3,454 182 5
Inflammatory psuedo-tumor of the spleen
Sunita Singh, Sonia Chhabra, Shilpi Modi, Nisha Marwah, Anju Rawal, B Arora
October-December 2009, 52(4):564-565
DOI:10.4103/0377-4929.56169  PMID:19805975
Inflammatory pseudo-tumor of spleen, a benign reactive lesion of unknown etiology and pathogenesis, is extremely rare with isolated case reports in literature. These are usually misdiagnosed preoperatively, both clinically and radiologically; metastasis or lymphoproliferative disorders with pathological studies allow reliable diagnosis of the disease. We report the unusual occurrence of this lesion in the spleen.
  3,226 154 -
LETTERS TO EDITOR
A case of metastatic melanoma in the breast with unknown primary site, diagnosed by fine needle aspiration cytology
Anne R Wilkinson, Sadhana D Mahore, Kalpana A Bothale
October-December 2009, 52(4):587-588
DOI:10.4103/0377-4929.56133  PMID:19805989
  3,204 168 1
A case of ovarian leiomyoma with cystic degeneration
VB Ramalakshmi Pullela, Sreeya Das, Bhargavarama Chunduru, Seema Dua
October-December 2009, 52(4):592-594
DOI:10.4103/0377-4929.56141  PMID:19805992
  3,154 212 4
CASE REPORTS
Monophasic synovial sarcoma of tongue
Atin P Agarwal, Tanuja M Shet, Rupali Joshi, Sangeeta B Desai, RF Chinoy
October-December 2009, 52(4):568-570
DOI:10.4103/0377-4929.56167  PMID:19805977
Synovial sarcoma is a well defined morphologic entity extensively researched in literature. Synovial sarcoma displays a wide spectrum of clinical presentations and histologic appearances that may give rise to diagnostic dilemmas. One such unusual site in the head and neck area is the tongue. We report a case of monophasic synovial sarcoma of the tongue in a 22-year-old male. Microscopically, this tumor mimicked a poorly differentiated carcinoma which is more common at this site though the patient was young for this type of tumor. On immunohistochemistry, neoplastic cells were positive for cytokeratin, vimentin, calponin, CD99 and bcl2. Molecular studies - viz. reverse transcriptase polymerase chain reaction revealed a SYT-SSX translocation clinching the diagnosis. This paper highlights the immunohistochemistry profile and SYT-SSX translocation which helped arrive at an accurate diagnosis only because the index of suspicion for a monophasic synovial sarcoma is high.
  3,119 242 1
Leiomyosarcoma of the renal pelvis
Sagar A Dhamne, Nitin M Gadgil, Anita Padmanabhan
October-December 2009, 52(4):549-551
DOI:10.4103/0377-4929.56161  PMID:19805970
Leiomyosarcomas are rare malignant tumors of the kidney. They may arise from the renal capsule, renal vein, renal pelvic musculature or renal parenchyma. Renal pelvis is an uncommon site of occurrence, with around 10 cases reported in the literature so far. Here we present a 60-year-old male who presented with increased urinary frequency, lower limb weakness, anorexia and weight loss. Imaging showed a right renal mass. A renal cell carcinoma was suspected clinically. A right nephrectomy was performed, which showed a large circumscribed mass in the hilar region. Histology revealed a tumor mass arising from the renal pelvis. The tumor was composed of spindle cells arranged in fascicles. Immunohistochemistry showed tumor cells to be positive for smooth muscle actin (SMA) and desmin (Des) and negative for cytokeratin (CK), HMB 45, CD117 (C-kit), and CD34. That confirmed the diagnosis of leiomyosarcoma.
  3,135 188 3
LETTERS TO EDITOR
Intra-abdominal mass: A diagnostic dilemma
Asim Qureshi, Rafay Azhar, Qasim Ahmed
October-December 2009, 52(4):582-583
DOI:10.4103/0377-4929.56126  PMID:19805985
  3,080 159 -
CASE REPORTS
Granulosa cell tumor arising in an ovary with mature teratoma
Priti Trivedi, Trupti Patel, Rohit Jain, Biren Parikh, Pariseema Dave
October-December 2009, 52(4):559-560
DOI:10.4103/0377-4929.56166  PMID:19805973
Granulosa cell tumor (GCT) with synchronous mature teratoma is extremely rare and only eight cases are documented in the literature. GCT is low-grade malignancy and need a close follow up for recurrences which may be late. We report a case of GCT and mature teratoma occurring synchronously in the same ovary in a perimenopausal woman.
  2,972 253 1
Metastatic rhabdomyosarcomatous elements, mimicking a primary sarcoma, in the omentum, from a poorly differentiated ovarian Sertoli-Leydig cell tumor in a young girl: An unusual presentation with a literature review
Bharat Rekhi, Arti Karpate, Kedar K Deodhar, RF Chinoy
October-December 2009, 52(4):554-558
DOI:10.4103/0377-4929.56165  PMID:19805972
Sertoli-Leydig cell tumors (SLCTs) of the ovary with mesenchymal heterologous elements are uncommon. Only few such cases have been documented, showing presence of only mesenchymal heterologous elements at the metastatic site. We report an unusual case in a young girl who presented with an omental mass that was consistent with histopathological features of a high-grade sarcoma, with prominent rhabdomyoblastic differentiation of the embryonal type. The sections from her ovarian mass for which she was operated a year back displayed features of a poorly differentiated SLCT with heterologous elements, including focal rhabdomyoblastic differentiation. This is one of the rare cases, to the best of our knowledge, where only rhabomyosarcomatous elements were identified at the metastatic site, mimicking a primary abdominal rhabdomyosarcoma, in a case of an ovarian SLCT. Further, this case reinforces the presence of rhabdomyosarcomatous elements in an ovarian SLCT to be associated with an aggressive disease course.
  3,054 165 2
ORIGINAL ARTICLES
Evaluation of 100% rapid rescreening of cervical smears
Neelam Sood, Vikas Singh
October-December 2009, 52(4):495-497
DOI:10.4103/0377-4929.56134  PMID:19805954
Advantage of rapid rescreening (RR) over conventional 10% random rescreening of all negative smears has been the topic of debate. RR of negative smears by cytopathologists/cytotechnologists have yielded good results. We undertook the rapid review of all the reported cervical smears to study its results as a means of strict quality control exercise on 2,500 smears.
  2,865 295 1
IMAGES
Primary malignant melanoma of the uterine cervix
Anuj Khurana, Yashpal Jalpota
October-December 2009, 52(4):575-576
DOI:10.4103/0377-4929.56164  PMID:19805980
  2,930 219 2
CASE REPORTS
Primary endobronchial synovial sarcoma confirmed by SYT-SSX1 fusion gene transcript by reverse transcriptase polymerase chain reaction
Rajiv Kumar, Santosh Menon, Sangeeta B Desai, CS Pramesh, Hari Menon, Nirmala Ajit Jambhekar
October-December 2009, 52(4):520-523
DOI:10.4103/0377-4929.56147  PMID:19805961
Primary sarcomas of lung are rare compared to metastatic sarcomas. Herein, we report a rare case of primary pulmonary synovial sarcoma with polypoid endobronchial growth in a 35-year-old lady who presented with cough and dyspnea. A malignant pulmonary tumor was suspected and left pneumonectomy was performed. Grossly, a non-encapsulated polypoidal endobronchial tumor measuring 6 cm in greatest diameter, with a solid, tan-white cut surface was identified. Microscopically, tumor was characterized by a proliferation of oval to spindle-shaped cells arranged in sheets and fascicles. Focal hemangiopericytomatous pattern was noted. Immunohistochemically, tumor cells were positive for vimentin, BCL-2, MIC-2 and calponin and focally positive for pancytokeratin and epithelial membrane antigen. A subsequent molecular analysis performed using reverse transcriptase-polymerase chain reaction with RNA extracted from paraffin-embedded tissue, revealed SYT/SSX1 fusion gene which confirmed the diagnosis of synovial sarcoma. The utility of immunohistochemistry and molecular techniques in diagnosis of such a rare case is stressed and the relevant literature is discussed.
  2,965 183 1
Mucinous tubular and spindle cell carcinoma of kidney: A rare case report and review of the literature
Bita Geramizadeh, Mehdi Salehipour, Ali Moradi
October-December 2009, 52(4):514-516
DOI:10.4103/0377-4929.56144  PMID:19805959
Low grade mucinous tubular and spindle cell carcinoma of kidney was newly established as a distinct renal cell carcinoma in the World Health Organization (WHO) classification of 2004. Until now, less than 60 cases have been reported and the largest series represented approximately 15 patients with this type of tumor. Herein, we report a case of mucinous tubular and spindle cell carcinoma in a 63-year-old male presented with right flank pain which was diagnosed after nephrectomy. Pathologists should consider this diagnosis and its spectrum of histopathologic features in mind to ensure an accurate diagnosis.
  2,889 255 3
Coexistent gastric primary choriocarcinoma and adenocarcinoma
Muktha R Pai, Alka M Mathai, Suneet Kumar, Shivananda Prabhu
October-December 2009, 52(4):537-539
DOI:10.4103/0377-4929.56155  PMID:19805966
Choriocarcinomas are commonly gestational and intrauterine or gonadal in origin. Nongestational and extragonadal disease, especially in the stomach is extremely rare with a poorer prognosis and early metastasis. We herein describe a case of primary gastric choriocarcinoma with liver metastasis in a 69-year-old male. The patient presented with abdominal pain and irregular bowel habits of one month duration. Both endoscopic and radiographic imaging revealed an ulcerated and necrotic circumferential tumor in the pyloric antrum of the stomach. The histopathologic findings of the resected tumor were that of an extensively necrotic and hemorrhagic neoplasm with combined choriocarcinomatous and adenocarcinomatous element. A strongly positive immunohistochemical staining for β- subunit of human chorionic gonadotropin (β-HCG) in the choriocarcinomatous component and a proper correlation with elevated serum β-HCG levels confirmed the diagnosis.
  2,941 180 4
IMAGES
Intraventricular hydatid cyst in a child
Sulata M Kamath, Vijaya V Mysorekar, Saraswathi G Rao, Ravi Gopal Varma
October-December 2009, 52(4):571-572
DOI:10.4103/0377-4929.56159  PMID:19805978
Hydatid disease is caused by the infestation of the larvae of tapeworms of the genus Echinococcus. The definitive hosts of Echinococcus are various carnivores, the common being the dog. All mammals (more often sheep and cattle) are intermediate hosts. Humans get infected through the feco-oral route by ingestion of food or milk contaminated by dog feces containing ova of the parasite or by direct contact with dogs. The most common sites of infestation are the liver (75%) and lungs (15%). Various authors state a frequency of hydatidosis of the brain ranging between only 0.2-4% of cases. [1],[2],[3] The prognosis following surgical intervention is good, especially in pediatric age. [2],[3] Hence early diagnosis of this condition is crucial. We report a rare case of a child with a large intraventricular hydatid cyst that had an excellent recovery following surgery.
  2,829 245 1
LETTERS TO EDITOR
Sirenomelia
Mangala S.R. Gouri, Kalpana M. K. Kumari, Saraswathi G Rao, Uma Devi
October-December 2009, 52(4):579-580
DOI:10.4103/0377-4929.56124  PMID:19805983
  2,572 207 3
CASE REPORTS
Periocular metatypical cell carcinoma with scleral infiltration
Archana Malik, Rakesh K Bansal, Suresh Kumar, Amanpreet Kaur
October-December 2009, 52(4):534-536
DOI:10.4103/0377-4929.56154  PMID:19805965
A 60-year-old male, laborer by occupation, presented with an ulcerative lesion of medial canthus in the left eye along with infiltration and adhesion of lids to globe. He had decreased vision and restricted extraocular movements. Exenteration with skin grafting was done. Histopathologically it was diagnosed as periocular metatypical cell carcinoma with scleral infiltration. Any suspicious lesion should be diagnosed and treated early so as to prevent such extensive damage.
  2,632 111 -
LETTERS TO EDITOR
Mandible like structure with fourteen teeth in a benign cystic teratoma
Sateesh S Chavan, VV Yenni
October-December 2009, 52(4):595-596
DOI:10.4103/0377-4929.56145  PMID:19805995
  2,598 145 1
Ciliated hepatic foregut cyst
Sanjay D Deshmukh, Gayatri S Pathak, Avinash R Joshi, Ajay M Naik
October-December 2009, 52(4):598-599
DOI:10.4103/0377-4929.56150  PMID:19805997
  2,298 151 2
CASE REPORTS
Pulmonary carcinosarcoma masquerading as a cryptic disseminated malignancy
Amulyajit Kaur, J.J.J Falleiro, AK Ghosh, NS Mani
October-December 2009, 52(4):517-519
DOI:10.4103/0377-4929.56146  PMID:19805960
Pulmonary carcinosarcoma is an aggressive rare malignant tumor comprising a mixture of carcinoma and sarcoma components containing differentiated mesenchymal elements, such as malignant cartilage, bone, and skeletal muscle. We report a case which presented with unusual clinical features and proved cryptic until death. At autopsy, it was a stage IV lung malignancy and histopathology revealed a carcinosarcoma comprising an adenocarcinoma and an osteosarcoma with metastasis to the heart, lymph nodes, and both adrenals. To our knowledge, this is the first case of this subtype with metastasis to the heart. The present case had an unusual clinical presentation and its elusive nature towards diagnosis despite dissemination is noteworthy and unique in the literature.
  2,305 139 -
LETTERS TO EDITOR
Primary fallopian tube adenocarcinoma with brain and lung metastasis
Krishnamurthy Jayashree, Choudary Anubuti, Sunila , Manjunath Gundappa
October-December 2009, 52(4):596-598
DOI:10.4103/0377-4929.56148  PMID:19805996
  2,305 131 -
Alternative method of digital photography in pathology
Chayanika Pantola, Sanjay Kala
October-December 2009, 52(4):586-587
DOI:10.4103/0377-4929.56131  PMID:19805988
  2,204 202 -
Longstanding lupus vulgaris with basal cell carcinoma
Madhuri S Kate, Reeta Dhar, DB Borkar, Deoyani R Ganbavale
October-December 2009, 52(4):588-590
DOI:10.4103/0377-4929.56135  PMID:19805990
  2,188 145 -
Objective career planning for a resident pathologist
Sunil Jaiman
October-December 2009, 52(4):580-582
DOI:10.4103/0377-4929.56125  PMID:19805984
  2,016 174 1
Sclerosing stromal tumor of the ovary associated with benign endometrioid peritoneal implants
Anchana Gulati, Rajni Kaushik, Jaishree Sharma
October-December 2009, 52(4):594-595
DOI:10.4103/0377-4929.56142  PMID:19805994
  2,043 138 -
Chondroid heterotopia in the Fallopian tube
Kusum D Jashnani, Rutuja R Baviskar
October-December 2009, 52(4):577-577
DOI:10.4103/0377-4929.56120  PMID:19805982
  2,070 101 -
T-cell/histiocyte rich B-cell lymphoma of mass in caecum and part of ascending colon
Paras R Udhreja, Brijeshkumar J Sapariya
October-December 2009, 52(4):585-586
DOI:10.4103/0377-4929.56129  PMID:19805987
  1,984 136 -
Synchronous papillary thyroid carcinoma with mucinous rectal carcinoma
SG Barreto, T Shet, SV Shrikhande, PJ Shukla
October-December 2009, 52(4):577-579
DOI:10.4103/0377-4929.56122  PMID:19805981
  1,974 140 -
BOOK REVIEW
CD-ROM: Salivary gland tumor oral and surgical pathology
Sridhara Satyanarayana
October-December 2009, 52(4):601-601
  1,667 180 -
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