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   2011| October-December  | Volume 54 | Issue 4  
    Online since January 6, 2012

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Immature teratoma of the ovary: A clinicopathological study of 28 cases
Kedar K Deodhar, Pallavi Suryawanshi, Milap Shah, Bharat Rekhi, RF Chinoy
October-December 2011, 54(4):730-735
DOI:10.4103/0377-4929.91508  PMID:22234099
Aim: Immature teratoma (IT) of the ovary represents 1% of all ovarian cancers and 20% of malignant ovarian germ cell tumors. This retrospective study of 28 such cases aims to look at its morphological spectrum and to study the correlation of the grade and stage of the tumor with prognosis. Materials and Methods: A retrospective study of 28 cases of IT of the ovary was done. Neuroepithelium was graded as grade I, II and III according to the standard criteria. The presence of immature mesenchyme was also looked for and similarly graded. Results: The median age for the cases was 19 years and abdominal pain was the commonest symptom. Neuroepithelium was seen in 26 cases (6 were grade I, 13 were grade II, and 7 were grade III); and two showed immature mesenchymal tissue (IM) only. IM was seen in all 28 cases, but no correlation with the grade of the IT of the ovary is found. The follow up is available in 23 cases ranging from 6 months to 78 months (median 33 months). Of these, 13 were stage I, 3 were stage II and 7 were stage III ITs. Out of 23 patients, 17 patients were alive without evidence of disease recurrence during the last follow up. Adverse events in the form of death and local recurrence occurred in 6 patients. One patient died of the disease at 7 months duration from the disease onset (stage III, grade II IT). Conclusion: Morphological spectrum of IT of ovary is varied. Immature mesenchyme was seen in all the cases of IT of ovary and its presence should prompt a careful search for immature neuroepithelium. Stage I IT of ovary has better prognosis. Combination of surgery and chemotherapy can give longer survival even in recurrent disease.
  29,364 775 -
Core biopsies of the breast: Diagnostic pitfalls
Megha Joshi, Sriharshan J Reddy, Manjiri Nanavidekar, John P Russo, Armand V Russo, Ram Pathak
October-December 2011, 54(4):671-682
DOI:10.4103/0377-4929.91490  PMID:22234089
The incidence of breast cancer is increasing worldwide. In this review article, the authors compare and contrast the incidence of breast cancer, and the inherent differences in the United States (US) and India in screening techniques used for diagnosing breast cancer. In spite of these differences, core biopsies of the breast are common for diagnosis of breast cancer in both countries. The authors describe "Best Practices" in the reporting and processing of core biopsies and in the analysis of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor Receptor 2 (Her2/neu). The pitfalls in the diagnosis of fibroepithelial lesions of the breast on core biopsy are discussed, as also the significance of pseudoangiomatous stromal hyperplasia of the breast (PASH) is discussed in core biopsy. In this review, the management and diagnosis of flat epithelial atypia and radiation atypia are elaborated and the use of immunohistochemistry (IHC) in papillary lesions, phyllodes tumor, and complex sclerosing lesions (radial scars) is illustrated. Rarer lesions such as mucinous and histiocytoid carcinoma are also discussed.
  14,014 731 -
Evaluation of non cyanide methods for hemoglobin estimation
Vinaya B Shah, Bipin S Shah, GV Puranik
October-December 2011, 54(4):764-768
DOI:10.4103/0377-4929.91494  PMID:22234106
Background: The hemoglobincyanide method (HiCN) method for measuring hemoglobin is used extensively worldwide; its advantages are the ready availability of a stable and internationally accepted reference standard calibrator. However, its use may create a problem, as the waste disposal of large volumes of reagent containing cyanide constitutes a potential toxic hazard. Aims and Objective: As an alternative to drabkin`s method of Hb estimation, we attempted to estimate hemoglobin by other non-cyanide methods: alkaline hematin detergent (AHD-575) using Triton X-100 as lyser and alkaline- borax method using quarternary ammonium detergents as lyser. Materials and Methods: The hemoglobin (Hb) results on 200 samples of varying Hb concentrations obtained by these two cyanide free methods were compared with a cyanmethemoglobin method on a colorimeter which is light emitting diode (LED) based. Hemoglobin was also estimated in one hundred blood donors and 25 blood samples of infants and compared by these methods. Statistical analysis used was Pearson`s correlation coefficient. Results: The response of the non cyanide method is linear for serially diluted blood samples over the Hb concentration range from 3gm/dl -20 gm/dl. The non cyanide methods has a precision of + 0.25g/dl (coefficient of variation= (2.34%) and is suitable for use with fixed wavelength or with colorimeters at wavelength- 530 nm and 580 nm. Correlation of these two methods was excellent (r=0.98). The evaluation has shown it to be as reliable and reproducible as HiCN for measuring hemoglobin at all concentrations. The reagents used in non cyanide methods are non-biohazardous and did not affect the reliability of data determination and also the cost was less than HiCN method. Conclusions: Thus, non cyanide methods of Hb estimation offer possibility of safe and quality Hb estimation and should prove useful for routine laboratory use. Non cyanide methods is easily incorporated in hemobloginometers by using very minute quantities of reagents and test sample; hence, these methods can be used to provide point of care testing in blood banks for hemoglobin (Hb) estimation in blood donors.
  13,669 464 -
Uterine smooth muscle tumors of uncertain malignant potential and atypical leiomyoma: A morphological study of these grey zones with clinical correlation
Kedar K Deodhar, Pankaj Goyal, Bharat Rekhi, Santosh Menon, Amita Maheshwari, R Kerkar, HB Tongaonkar
October-December 2011, 54(4):706-711
DOI:10.4103/0377-4929.91500  PMID:22234095
Objectives: To study the histological features in uterine STUMP, and atypical leiomyomas (AL), and to correlate with clinical outcome. Materials and Methods: From January 2004 to August 2010, a total of 21 cases were retrieved from records, labeled as STUMP(7), AL (5), AL with low risk of recurrence (2), smooth muscle tumor of low malignant potential (STLMP) (2), and symplastic leiomyoma (5). The slides were reviewed for coagulative tumor cell necrosis (CTCN), hyaline necrosis/ infarction type necrosis, presence and degree of cytological atypia, mitotic activity, epithelioid morphology and myxoid features. The other characteristics (such as size, circumscription, individual tumor cell necrosis), were noted, wherever available. Results: The mean age was 45 years (median 46; range 24-67 yrs). CTCN was seen in 2 cases on examination of additional material; wherein a revised diagnosis of leiomyosarcoma had been given. Infarction type necrosis and individual cell necrosis was seen in 2 and 3 cases, respectively. Mitoses were less than 5/10hpf in all the cases. One of the tumours labeled as STUMP also had concurrent endometrial adenocarcinoma. Follow up: Follow-up was available in 11 cases (52.3%). One patient had died. (cause not known). In 10 patients, the follow-up ranged from 4 to 56 months (mean 20.9 months; median 15 months) nine patients were alive and well. One patient (labeled STLMP) had metastatic liver disease 3 yrs after the primary surgery, at the last follow-up. Conclusions: 1) There is an overlap in using the terminologies as STUMP, AL, AL with low risk of recurrence, AL with low malignant potential. A designation of STUMP does convey a category of borderline malignancy to the gynecological surgeons. Most behave in a benign fashion and follow-up without adjuvant therapy is currently recommended. Critical evaluation of coagulative tumor necrosis is essential. Follow-up remains a challenge in our setting.
  13,495 466 -
Gastrointestinal lymphomas: Pattern of distribution and histological subtypes: 10 years experience in a tertiary centre in South India
Neeraj Arora, Marie Therese Manipadam, Anna Pulimood, BS Ramakrishna, Ashok Chacko, Susy S Kurian, Sheila Nair
October-December 2011, 54(4):712-719
DOI:10.4103/0377-4929.91502  PMID:22234096
Background and Aim: Gastrointestinal tract (GIT) is one of the major sites of extra-nodal lymphomas constituting 10-15% of all non-Hodgkin's lymphoma cases and about 30-40% of extra-nodal lymphomas. Considerable variation exists in the literature with respect to incidence of the various histological subtypes and sites of involvement. This study was undertaken to ascertain the anatomic distribution, histological subtypes and sites of all GIT lymphomas presenting to a tertiary referral hospital in southern India. Materials and Methods: The histological material of 361 patients over a period of 10 years (2001-2010), with histopathological diagnosis of lymphoma involving the GIT (both primary and secondary), was analyzed retrospectively. All lymphomas were reclassified according to the World Health Organization 2008 classification. Results: These 361 cases include 336 primary and 25 cases of lymphomas, where the involvement was secondary. Primary lymphomas consisted of 267 males (79.64%) and 68 females (20.24%) with a male:female ratio of 3.93:1. The mean age was 45 years (range 3-88). Diffuse large B-cell lymphoma (DLBCL) was the commonest subtype (222 cases; 66.71%), followed by low-grade marginal zone lymphoma of the mucosa associated lymphoid tissue (MALT) type (34 cases; 10.12%) and Burkitt's lymphoma (35 cases; 10.48%). The commonest site was stomach (180 cases; 53.57%), followed by small intestine (79 cases; 23.51%) and large intestine (68 cases; 20.23%), respectively. There were some uncommon types of GIT lymphomas documented during the study. Conclusion: In this largest retrospective single centre study from India, we establish that the pattern of distribution of primary GIT lymphomas (PGLs) in India is similar to the western literature in that the stomach is the commonest site of PGL and DLBCL is the commonest histological subtype. Immunoproliferative small intestinal disease cases were seen in this study, which is uncommon in the west.
  6,197 675 -
Laboratory diagnosis of Toxoplasma gondii infection with direct and indirect diagnostic techniques
Salvatore Pignanelli
October-December 2011, 54(4):786-789
DOI:10.4103/0377-4929.91503  PMID:22234111
Background: Toxoplasma gondii infection, common parasitic zoonoses, is an important cause of spontaneous abortion, mental retardation, encephalitis, ocular disease and death worldwide. Today the major diagnostic techniques for the toxoplasmosis are serological assays, but its have many limitations. Aim : The goal in this study is to improve the diagnostic accuracy of T. gondii infection, using direct (Real Time PCR) and indirect (IgM, IgA, IgG and IgG avidity) diagnostic techniques. Materials and Methods: In the period between 2007 and 2008, 96 non consecutive different clinical samples (38 blood, 40 amniotic fluids, 8 cerebrospinal fluids, 10 vitreous humors) and 96 sera have been studied simultaneously through molecular biology and serological techniques. Results: Direct and indirect diagnostic techniques used in this study for laboratory diagnosis of T. gondii infection were always concordant. Conclusions : The high correlation between direct and indirect diagnostic techniques exhibit that serologic techniques are accurate diagnostic assays as screening test in laboratory diagnosis of toxoplasmosis.
  6,124 215 -
The association of Epstein-Barr Virus infection with multiple myeloma
Mohammad Hadi Sadeghian, Hossein Ayatollahi, Mohammad Reza Keramati, Bahram Memar, Saeed Amel Jamedar, Maryam Mohammadnia Avval, Maryam Sheikhi, Gohar Shaghayegh
October-December 2011, 54(4):720-724
DOI:10.4103/0377-4929.91504  PMID:22234097
Background: Multiple myeloma is a conventional term for clonal proliferation of plasma cells. It is suggested that viruses may have a significant role in the pathogenesis of multiple myeloma. Aims: The aim of this study was to evaluate whether there is an association between multiple myeloma and Epstein-Barr Virus (EBV) by the polymerase chain reaction (PCR) method. Materials and Methods: This case-control study was performed on 60 paraffin-embedded bone marrow biopsies (30 multiple myeloma and 30 normal bone marrow specimens) in the molecular pathology section of our hospital. The patients and control groups were matched according to gender and age. Several sections were cut from each paraffin blocks, and then the deoxyribonucleic acid (DNA) was extracted by the non-heating extraction method. In the next step, PCR was carried out for detection of EBV genome and finally its products were analyzed by electrophoresis. Results: DNA of EBV was detected in 10 patients of the case group (5 males and 5 females) and 3 subjects (2 males and 1 female) of the control group. The Pearson chi-square test showed significant difference between case and control group (P=0.03) for detection of the EBV genome. In myeloma patients, the mean white blood cell count was 9.05 + 4.02 and 5.20 + 2.02 Χ 10 9 /L in EBV positive and negative groups, respectively and a significant difference count was seen for the WBC count. Recommendations: Our results show an association between multiple myeloma and EBV infection.
  6,064 241 -
Epidemiologic lessons: Chickenpox outbreak investigation in a rural community around Chandigarh, North India
Mini Pritam Singh, Gagandeep Singh, Amit Kumar, Amarjeet Singh, Radha Kanta Ratho
October-December 2011, 54(4):772-774
DOI:10.4103/0377-4929.91497  PMID:22234108
Purpose: Primary infection with Varicella Zoster virus (VZV) leads to Varicella or chickenpox. The epidemiology of Varicella has changed dramatically since the introduction of the Varicella vaccine in 1995. The routine childhood immunization in a few countries in the western world like Germany and the United States has reduced the incidence of the disease, associated complications, hospital admissions and deaths related to its complications. However, chickenpox outbreaks are common in naive unvaccinated communities in India. Materials and Methods: We report an outbreak of chickenpox that occurred in a village situated on the outskirts of Chandigarh city in North India in the winter of 2007. The outbreak was confirmed by the detection of VZV IgM by enzyme-linked immunosorbent assay (ELISA) on serum samples from the patients. In patients showing active lesions, Giemsa and indirect immunofluorescence was carried out on scrapings from vesicular lesions. Results: A total of 162 cases occurred in the present outbreak. The serum samples were collected from 20 patients, and all of them showed positive serology for VZV IgM antibodies while 19 showed a positive VZV IgG result by ELISA. The scrapings were collected from two patients showing active lesions, and both were positive by the Tzanck smear examination, and VZV antigen could be demonstrated by immunofluorescence. Conclusions: There is an urgent need to identify naive communities and unvaccinated individuals at risk. Also, there is a need for regular training programmes of health workers posted in peripheral centers so that highly contagious communicable diseases can be picked up in time and such outbreaks can be prevented.
  5,923 313 -
Cherubism - A case report with long term follow up
Lakshmi V Chavali, RM Rao Bhimalingam, PV Sudhakar
October-December 2011, 54(4):793-795
DOI:10.4103/0377-4929.91509  PMID:22234113
Cherubism is a rare non-neoplastic disease of the bone characterized by bilateral painless enlargement of the jaws giving a cherubic appearance to the patient. It is an autosomal dominant disorder but may occur sporadically. In this paper, we have tried to explain about the clinical, radiological and histopathologic features of cherubism by presenting a case study. A case study of a 7 year old male patient, who first presented with mandibular bilateral swellings to our department in 1998, has been presented. In-depth clinical, radiological and histopathologic examination was done. An extensive long-term follow-up till 11 years was maintained. When presented for the first time, radiological investigation showed characteristic multilocular lytic lesions of the mandible bilaterally. Histopathological examination of the biopsy specimen showed proliferating fibrous connective tissue interspersed by multinucleated giant cells. It was diagnosed as a case nonfamilial cherubism. Follow-up after 5 years showed involvement of the maxilla as well, which was then corrected by surgical methods. Upon follow up 11 years after the first presentation, it was seen that the lesion was regressing by itself and there was improvement in facial contour. The natural course of Cherubism through its progression, stabilization and involution of the disease after puberty, has been highlighted in this case. More, in-depth studies to understand the nature and the pathogenesis of this condition better are required.
  5,413 163 -
Malignant transformation in a hybrid schwannoma/perineurioma: Addition to the spectrum of a malignant peripheral nerve sheath tumor
Bharat Rekhi, Nirmala A Jambhekar
October-December 2011, 54(4):825-828
DOI:10.4103/0377-4929.91542  PMID:22234123
Benign nerve sheath tumors include schwannomas, neurofibromas and perineuriomas. The malignant counterpart of a nerve sheath tumor is designated as a malignant peripheral nerve sheath tumor (MPNST). Lately, benign nerve sheath tumors comprising more than one component have been described, including hybrid schwannomas/perineuriomas. However, malignant transformation in a hybrid schwannoma/perineurioma has not been documented so far. Herein, we present a rare case of a young adult male who presented with a soft tissue mass in his right thigh that was excised elsewhere and submitted to us for histopathological review. One of the tissue sections displayed histopathological features of a hybrid schwannoma/perineurioma, including alternate arrangement of benign schwann and perineurial cells, reinforced with S100-P and epithelial membrane antigen positivity, respectively, along with low MIB1 and negative p53 immunostaining. The other two tissue sections showed a spindly sarcomatous tumor that was immunohistochemically positive for S100-P, CD34, p53 and exhibited high MIB1 (30-40%). Diagnosis of a MPNST arising in a hybrid schwannoma/perineurioma was made. This unusual case forms yet another addition to the spectrum of a MPNST.
  5,422 114 -
Prevalence of dengue and chickungunya fever and their co-infection
Usha Kalawat, Krishna K Sharma, Satishkumar G Reddy
October-December 2011, 54(4):844-846
DOI:10.4103/0377-4929.91518  PMID:22234131
  4,516 356 -
Cytomegalovirus esophagitis in nonimmunocompromised patient - Presenting as an acute necrotic (black) esophagitis
Kiran Yagain, Lakshmi Rao, Kanthilatha Pai, Ganesh Pai
October-December 2011, 54(4):852-853
DOI:10.4103/0377-4929.91526  PMID:22234138
  4,679 72 -
Cytomorphology and immunohistochemistry of extrarenal rhabdoid tumor: A case report with review of literature
Manjula Jain, Aparna Harbhajanka, S Roy Choudhary
October-December 2011, 54(4):819-821
DOI:10.4103/0377-4929.91534  PMID:22234121
Extrarenal rhabdoid tumor (ERRT) is a rare, aggressive tumor with extremely poor prognosis. We report a case of ERRT with intraspinal extension in a 1.5-year-old child diagnosed by fine needle aspiration cytology (FNAC) and immunohistochemistry. The child presented with a right lumbar region lump of two months duration. Ultrasound guided FNAC was performed and cell block was prepared. Smears were highly cellular and showed a dispersed population of large round cells having abundant pale eosinophillic cytoplasm, centrally to eccentrically placed nucleus with large prominent nucleoli. Immunohistochemistry was carried out on cell block which was positive for epithelial membrane antigen EMA and Vimentin. It was negative for leucocyte common antigen [LCA], wilms tumor 1, WT1, desmin and neuron specific enolaseNSE, thus ruling out other tumors like lymphoma, Wilms tumor, rhabdomyosarcoma, and neuroblastoma. A final diagnosis of ERRT was given. ERRT is an extremely rare tumor of retroperitoneal area; it should be included in the differential diagnosis of malignant round cell tumor in children. Cell block in this case is mandatory for putting up the panel of immunohistochemistry which can clinch the diagnosis of rhabdoid tumor and treatment can be started as early as possible.
  4,560 126 -
Congenital extraskeletal Ewing's sarcoma of chest wall - A rare case report
Bhagyalakshmi Atla, B Satya Vara Prasad, K Satya Sri, Geeta Vandana
October-December 2011, 54(4):803-805
DOI:10.4103/0377-4929.91515  PMID:22234116
Congenital extraskeletal Ewing's sarcoma or peripheral primitive neuroectodermal tumor is an extremely uncommon and invariably fatal tumor. We report a case of extraskeletal congenital Ewing's sarcoma in a female fetus delivered at 34 weeks of gestation who died immediately after birth. In English literature, majority of cases of Ewing's sarcoma in neonates reported were skeletal. To the best of our knowledge, very few cases of extra-skeletal Ewing's sarcoma in neonates are reported in the literature.
  4,579 95 -
Antioxidant status in beta thalassemia major: A single-center study
Faiza Waseem, Karira A Khemomal, Raihan Sajid
October-December 2011, 54(4):761-763
DOI:10.4103/0377-4929.91489  PMID:22234105
Background: Homozygous β thalassemia may lead to a marked reduction or absence of normal β chain production and accumulation of unpaired alpha-globin chains. A crucial component in the oxidant susceptibility of the thalassemic RBC is the release of heme and iron from the excessive, unpaired α-globin chains. This release can initiate self-amplifying redox reactions, which deplete the cellular reduction potential (e.g., GSH), oxidize additional hemoglobin and accelerate RBC destruction. Furthermore, β-thalassemia patients are under continuous blood transfusion, which, although life-saving, leads to an iron overload with a resultant increase in non-transferrin-bound iron that may cause greater tissue toxicity than iron in other forms. Iron-induced oxidative stress is known to be one of the most important factors determining cell injury in thalassemic patients. Therefore, we designed this study to obtain a comprehensive picture of the iron overload, antioxidant status and cell damage in β thalassemia major patients undergoing regular blood transfusion. Materials and Methods: A total of 48 diagnosed patients of β thalassemia major and 30 age- and sex-matched healthy subjects were included in the study. Estimation of hemoglobin, hematocrit, glutathione peroxidase (GPX), superoxide dismutase (SOD),vitamin E, serum ferritin, total and direct bilirubin, AST and ALT was carried out. Results: The levels of vitamin E, antioxidant enzymes GPX and SOD were significantly lowered in β thalassemic patients as compared with the control group (P<0.001). Serum total and direct bilirubin, AST and ALT were significantly elevated in thalassemic subjects as compared with the control group, indicating liver cell damage. Conclusion: Thus, our findings indicate that thalassemics are in a state of enhanced oxidative stress and that the administration of selective antioxidants would represent a promising approach toward counteracting oxidative damage and its deleterious effects on the disease status.
  4,342 218 -
Cytohistological features of rhinoscleroma
Neelam Sood, Sanjeev Sood, Sunaina Arora, Deepika
October-December 2011, 54(4):806-808
DOI:10.4103/0377-4929.91523  PMID:22234117
Rhinoscleroma, also known as Mikulicz disease, is a chronic progressive disease caused by Klebsiella rhinoscleromatis. The disease is uncommon in Delhi. There are no cytological references of this disease. We describe the cytological features which should alert the pathologist to rule out this entity, which needs to be treated early. Immunohistochemistry on histopathological material is a useful adjunct to the diagnosis.
  4,287 200 -
Moraxella catarrhalis as a respiratory pathogen
Naveen Gupta, Shamma Arora, Shailja Kundra
October-December 2011, 54(4):769-771
DOI:10.4103/0377-4929.91496  PMID:22234107
Background: Moraxella catarrhalis is gaining significance as a pathogen over few decades because of increased rate of isolation in respiratory specimens and due to emergence of multidrug resistant strains. Therefore, appropriate antimicrobial agents are required for eradication and prevention of spread of the organism. Material and Methods: -The study was conducted over 1-year period inpatients of lower respiratory tract infections (L.R.T.I.) in P.G.I.M.S. Rohtak (Haryana) . Assessment of clinical significance of M.catarrhalis was ascertained on the basis of preformed criteria. Results: A total of 63 clinically significant M. catarrhalis were isolated from a tertiary care hospital. The isolates showed maximum resistance to cotrimoxazole (82.5%), pencillin (77.7%), and ampicillin (71.4%) while susceptibility was maximum to cefotaxime (87.3%) followed by tetracycline (85.7%) ciprofloxacin (84.1%), erythromycin (80.9%) amikacin (79.3%), gentamycin (77.7%), and cefazolin (76.2%). Multidrug resistance to >3 antimicrobials was seen in 22 (34.9%) of cases. Conclusions: Predominant or pure growth of M.catarrhalis in throat swabs from cases of L.R.T.I. should be reported and treated by microbiologist and clinician respectively. Antibiotic therapy should be decided based on sensitivity report for rapid respose and recovery of patients.
  4,224 219 -
Frequency of Ki-67 (MIB-1) and P53 expressions among patients with prostate cancer
Seyed Hamid Madani, Somayeh Ameli, Sedigheh Khazaei, Malek Kanani, Babak Izadi
October-December 2011, 54(4):688-691
DOI:10.4103/0377-4929.91492  PMID:22234091
Context: Prostate cancer is the most common malignant tumor in men. Tumor grade is one of the most important prognostic factors of prostate cancer. P53 and Ki-67 expressions have also been considered to be prognostic factors. Aims: This study was performed to investigate the frequency of these proteins expression and compare the obtained results with Gleason's grading. Settings and Design: In this cross-sectional study, 49 paraffin blocks of prostate cancers were assessed. Tumor grade was determined according to the Gleason's criteria. Materials and Methods: Ki-67 and P53 expressions were determined by immunohistochemical staining. Statistical Analysis: The obtained results were analyzed and evaluated using Spearman's statistical test (SPSS version 15). Results: Three out of 49 (6.1%) cases were well differentiated, 21 (43%) moderately differentiated and 25 (51%) were poorly differentiated. P53 was negative in all well-differentiated cases. Ki-67 was negative in 14 cases (28%) including all well-differentiated tumors. Among moderately and poorly differentiated tumors Ki-67 was negative in eight (38%) and three (12%) of cases, respectively. A statistically significant relation was observed between the increased Ki-67 labeling index (LI) and increased Gleason's grade. Conversely, no statistically significant relation was found between P53 expression and increased Gleason's grade. Conclusions: According to the findings of this study, it seems that Ki-67 can be used as a prognostic factor for prostate cancer. On the other hand, the probable relation between P-53 and prostate cancer prognosis requires further studies.
  3,953 276 -
Serodiagnosis of celiac disease in children referred for evaluation of anemia: A pediatric hematology unit's experience
Deepak Bansal, Amita Trehan, Mukesh Kumar Gupta, Neelam Varma, RK Marwaha
October-December 2011, 54(4):756-760
DOI:10.4103/0377-4929.91488  PMID:22234104
Background: Children presenting with typical clinical features of celiac disease (CD) are diagnosed relatively easily, however, diagnosis remains challenging and is often delayed when they present with 'difficult to treat anemia' without overt gastrointestinal manifestations. Index study was undertaken to report profile of patients referred to pediatric hematology unit with 'difficult anemia' who subsequently were diagnosed with CD. Materials and Methods: The records of 83 patients (1988-2008) with CD were scrutinized retrospectively who had presented with predominant hematological manifestations. Results: CD was confirmed histologically in 31 (37%), while 52 (63%) were diagnosed by serology alone. The mean age at diagnosis was 8.0 ± 2.8 years. The mean duration of symptom-diagnosis interval was 40.9 ± 30.6 months. Eighty-one (98%) children had anemia (Hb < 11 g/dl) and 55 (66%) had received iron supplements without discernible benefit. Thirty-nine (47%) patients received a blood transfusion. Thirty-six (43%) patients did not have diarrhea. Majority of the patients had either a microcytic-hypochromic (48%) or dimorphic (43%) anemia. Twenty-four (33%) had thrombocytosis, while 5 (7%) had thrombocytopenia. Mean duration of follow-up for patients on roll in the clinic for more than six months was 17.7 ± 20.9 months. Conclusion: Pediatricians and hematologists need to be aware of the extra-intestinal manifestations of CD. Prolonged duration of symptoms and a diagnosis at a relatively older age is striking in children presenting with predominantly hematological manifestations. Investigations for CD are recommended in children presenting with iron deficiency anemia refractory to hematinics or who have coexisting growth retardation. Necessity for biopsy in overtly symptomatic cases is discussed.
  3,739 288 -
Lymphocyte activation test for diagnosis of seronegative Brucellosis in humans
Fahad M Almajid
October-December 2011, 54(4):775-781
DOI:10.4103/0377-4929.91499  PMID:22234109
Background: Seronegative brucellosis is occasionally encountered in clinical practice especially in localized disease where diagnosis is reached mainly through positive blood culture. Cellular immune responses are pivotal for protection against intracellular bacteria such as Brucella. This study was performed to evaluate the expression of activation markers on peripheral blood mononuclear cells in response to in vitro stimulation by whole-cell suspension of Brucella melitensis for the diagnosis of brucellosis. Materials and Methods: Fifteen seronegative patients with positive blood cultures for Brucella and twenty-five unexposed healthy blood donors serving as controls were recruited for the study. Peripheral blood mononuclear (PBMC) cells were obtained by the method of Ficoll Hypaque density gradient and stimulated in vitro with Brucella antigen. Expression of activation markers was assessed by flow cytometry after staining of PBMC with mononuclear cells with relevant monoclonal antibodies. Results: Incubation with mitogen induced expression of all the four markers was demonstrated in all blood samples. In contrast, samples from all patients of Brucellosis showed significant positive responses with the expression of activation markers (CD38, CD69, CD25, and CD71) on both CD4+ and CD8+ cells as compared with the control group (P < 0.001). Conclusion: It is inferred that there was a remarkable upregulation of activation markers on CD4+ and CD8+ in seronegative patients with Brucellosis. It is recommended that the method can be utilized as a novel diagnostic test for detection of brucellosis where serology is negative.
  3,693 131 -
Detection of IgM and IgG antibodies to Chlamydophila pneumoniae in pediatric community-acquired lower respiratory tract infections
Surinder Kumar, Sanjeev R Saigal, Gulshan R Sethi
October-December 2011, 54(4):782-785
DOI:10.4103/0377-4929.91501  PMID:22234110
Context: Chlamydophila pneumoniae (C. pneumoniae) is an emerging infectious agent with a spectrum of clinical manifestations including lower and upper respiratory tract infections. Aims: To investigate the role of C. pneumoniae in community-acquired lower respiratory tract infections (LRTIs) in children using serological tests. Settings and Design: Two hundred children, age 2 months to 12 years, hospitalized for community-acquired LRTIs were investigated for C. pneumoniae etiology. Materials and Methods: We investigated 200 children hospitalized for community-acquired LRTIs, using ELISA for detecting anti-C. pneumoniae IgM and IgG antibodies. The demographic, clinical and radiological findings for C. pneumoniae antibody positive and C. pneumoniae antibody negative cases were compared. Statistical Analysis Used: Data analysis was performed by Chi-square test and Fisher's exact tests using Epi Info (2002). Results: Clinical and radiological findings in both the groups were comparable. Serological evidence of C. pneumoniae infection was observed in 12 (6%) patients; specific IgM antibodies were detected in 11 (91.67%; specific IgG antibodies in 1 (8.33%) patients, while 4-fold rise in C. pneumoniae IgG antibody titers were noted in none of the patients. Conclusions: C. pneumoniae has a role in community-acquired LRTIs, even in children aged < 5 years. Serological detection using ELISA would enable pediatricians in better management of C. pneumoniae infections.
  3,641 144 -
Systemic mastocytosis with an associated non mast cell lineage clonal hematological disease in a child
Sunita Sharma, Aparna Harbhajanka, Akanksha Jain, Anju Seth
October-December 2011, 54(4):854-856
DOI:10.4103/0377-4929.91531  PMID:22234140
  3,701 68 -
Sodium iodide symporter, estrogen receptor, and progesterone receptor expression in carcinoma breast - An immunohistochemical analysis
Ashwani Tandon, Ashutosh Shrivastava, Ashok Kumar, Aruna K Prayaga, Challa Sundaram, Madan M Godbole
October-December 2011, 54(4):745-751
DOI:10.4103/0377-4929.91514  PMID:22234102
Background: Sodium iodide symporter (NIS), a transporter of iodine is essential for thyroid hormone biosynthesis. It also plays a role in the radioiodine treatment of thyroid cancers. NIS mediated radioiodine transport to breast cancers is under active investigation due to its potential therapeutic utility. Cellular localization and quantification using immunohistochemistry may provide clues for its utility in management of carcinoma breast. Materials and Methods: Human NIS (hNIS) expression was therefore assessed by utilizing a rabbit polyclonal antibody raised against a cloned hNIS in different grades of infiltrating duct carcinoma of breast and its metastatic deposits namely in lymph nodes, bone marrow, and endometrium. Further, hNIS expression was compared with prognostic markers namely estrogen receptor (ER) and progesterone receptor (PR). Results: hNIS was positive in 90.6% cases (29/32) and Scarff-Bloom-Richardson grading was done in 25 cases and 23 cases were NIS positive. Among nongraded cases, 2/2 cases of carcinoma in-situ were positive and 4/5 were positive in cases having post therapy residual tumor status. The strong positivity for hNIS was seen irrespective of ER or PR status and of grade of breast carcinoma and correlated well with western blot analysis. In all the three metastatic sites, NIS was positive in the tumor. Conclusion: These findings indicate the utility of immnohistochemistry for NIS as a new potential prognostic marker and may provide guidance for possible radio iodine therapy in breast cancer patients.
  3,556 141 -
Zosteriform cutaneous metastasis: A primary manifestation of carcinoma breast, rare case report
Shirish S Chandanwale, Charu R Gore, Archana C Buch, Sonali S Misal
October-December 2011, 54(4):863-864
DOI:10.4103/0377-4929.91539  PMID:22234145
  3,618 71 -
Sporadic colorectal polyps and mismatch repair proteins
Mahsa Molaei, Mahdi Yadollahzadeh, Shohreh Almasi, Sepideh Shivarani, Seyed Reza Fatemi, Mohammad Reza Zali
October-December 2011, 54(4):725-729
DOI:10.4103/0377-4929.91505  PMID:22234098
Background: Colorectal cancers often arise from benign polyps. Adenomatous polyps and serrated polyps progress step by step to adenocarcinoma and change into malignant cancers. Genetic and epigenetic changes have correlation with specific stages of polyp-adenocarcinoma progression and colorectal cancer histopathological changes. Aims: In this study we used immunohistochemistry (IHC) staining in sporadic colorectal polyps to assay functional status of MLH1, MSH2, MSH6, and PMS2 proteins, to track genetic/epigenetic roles of this issue in our patients. Materials and Methods: In this cross-sectional study we assessed all patients who were admitted with sporadic colorectal polyps and underwent polypectomy in endoscopy department during 2004-2008. Result: IHC results were abnormal in 6.8% cases for MLH1, in 4.5% cases for MSH2, in 3% for MSH6, and in 4.8% for PMS2. In all cases with abnormal PMS2, MLH1 was also reported as abnormal. Same results were reported for abnormal MSH2, which is accompanied with abnormal MSH6 in all cases (P values < 0.001). There is no significant difference between IHC staining results, gender, dysplasia grade, adenomatous type, and invasion. On the other hand, there was significant difference between IHC staining results, polyp location, and mean age of patients. The same significant difference was between adenomatous polyps and serrated adenoma polyps by MLH1 and PMS2 (P values < 0.05). Conclusion: According to our findings, maybe MMR dysfunction is the cause of sporadic colorectal polyps in younger age and its increasing risk of dysplasia progression and malignancy progression is only in serrated adenoma. Sporadic polyps in left colon had a higher risk to progress to malignancies, and abnormal IHC staining for MLH1 and PMS2 in serrated polyps is much more than in other adenomatous polyps.
  3,533 143 -
Anaplastic transformation of metastatic papillary thyroid carcinoma at shoulder mimicking soft tissue sarcoma
Seema Kaushal, Mehar Chand Sharma, Sandeep R Mathur, Shishir Rastogi, Chander Shekhar Bal, Sunil Chumber
October-December 2011, 54(4):796-799
DOI:10.4103/0377-4929.91512  PMID:22234114
A 52-year-old woman presented with fracture upper end of the left humerus after trivial trauma and aspiration cytology from the lytic lesion in the upper humerus seen on X-ray revealed a metastatic papillary carcinoma from the thyroid. Total thyroidectomy confirmed the papillary carcinoma thyroid. Post-operatively, she was given radioactive iodine (I-131) ablation therapy for 8 years and was asymptomatic during this period; however, for the last 1 year, she has been complaining of swelling in the shoulder, which did not respond to palliative radiotherapy and rapidly increased in size. Disarticulation of the shoulder joint was performed, which showed anaplastic carcinoma on histopathological examination. Anaplastic transformation of papillary carcinoma at the metastatic sites is well documented in the literature and is rare. However, the same has not been reported at the shoulder and from India before. Although soft tissue sarcomas are most common at this site, however, the possibility of anaplastic transformation should be kept in the differential diagnosis of rapidly enlarging painful mass in a known case of metastatic thyroid carcinoma to prevent misdiagnosis.
  3,529 121 -
Cystalline inclusions in plasma cells
Anurag Gupta, Monali Gupta, Anil Handoo, Ashok Vaid
October-December 2011, 54(4):836-837
DOI:10.4103/0377-4929.91545  PMID:22234126
  3,444 135 -
G6PD deficiency in females screened at tertiary care hospital
Monica Sharma, Jasmita Dass, Bhavna Dhingra, Renu Saxena
October-December 2011, 54(4):850-851
DOI:10.4103/0377-4929.91524  PMID:22234136
  3,407 168 -
CDX2 positivity in metastatic endometrial carcinoma to the lung: A diagnostic pitfall
Kedar K Deodhar, Sudeep Gupta, George Karimundackal, HB Tongaonkar
October-December 2011, 54(4):858-860
DOI:10.4103/0377-4929.91535  PMID:22234142
  3,434 65 1
Coagulation inhibitors and activated protein C resistance in recurrent pregnancy losses in Indian women
P Lalita Jyotsna, Sunita Sharma, Shubha S Trivedi
October-December 2011, 54(4):752-755
DOI:10.4103/0377-4929.91507  PMID:22234103
Background: Thrombophilias, both acquired and inherited, have been investigated in the etiopathogenesis of unexplained recurrent pregnancy loss. Aim: To study coagulation inhibitors and activated protein C resistance (APCR) in recurrent pregnancy losses (RPL) occurring in second and third trimesters. Materials and Methods: A total of 30 pregnant women (group A) with two or more recurrent unexplained fetal loses were evaluated for APCR, protein C deficiency, protein S deficiency, antithrombin deficiency, and antiphospholipid antibodies (APLA). Thirty age-matched controls were taken (group B) comprising of pregnant women with at least one live issue. Statistical Analysis: Comparisons between two group frequencies and group means were made using Chi square test and Student's t test, respectively. Results: Protein C and protein S levels were reduced in group A compared with group B and the difference was statistically significant (P=0.005 and P=0.032, respectively). The mean value of antithrombin was slightly reduced in group A compared with group B. APCR was observed in 16.6% cases and 3.3% controls. However, the difference was not statistically significant. APLA was observed in 20% cases and none of the controls. Of these, lupus anticoagulant was positive in 16.6% cases and anticardiolipin antibodies in 10% cases. Combined defects were seen in seven patients. Conclusion: There is a significant risk of RPL in pregnant women with thrombophilias. Therefore, screening for thrombophilias may be justified in pregnant women with unexplained recurrent fetal wastage, especially in second and third trimester.
  3,254 205 -
Comparison of stromal CD10 expression in benign, borderline, and malignant phyllodes tumors among Egyptian female patients
Wael S Ibrahim
October-December 2011, 54(4):741-744
DOI:10.4103/0377-4929.91511  PMID:22234101
Background: Phyllodes tumors are group of biphasic fibroepithelial tumors of the breast of varying malignant potential, ranging from benign tumors to fully malignant sarcomas. According to the Egyptian National Cancer Institute, female malignant cases showed appreciable increase in the recent time period for breast cancer with the malignant phyllodes tumors representing 0.41% of cases in the year 2003-2004. Aims: This is an immunohistochemical study to compare CD10 expression in benign, borderline, and malignant phyllodes tumors, in order to highlight its diagnostic and prognostic values. Materials and Methods: This study conducted 34 Egyptian female cases of phyllodes tumors of different grades to be studied histologically and immunohistochemically using antibodies against CD10. Statistical Analysis: The Chi-square test was used to determine differences in CD10 expression between benign, borderline, and malignant tumors. One-way ANOVA test was used to determine whether the difference was significant. Significance was established at P<0.05. Results: In the 24 cases of benign phyllodes tumors, only four cases (16.7%) showed positive CD10 reactivity. Three cases (60%) out of five borderline phyllodes tumors showed positive CD10 reactivity, while four (80%) out of five cases of malignant phyllodes tumors showed positive CD10 staining. Conclusion: From these highly significant results, we believe that there is a strong correlation between CD10 expression and tumor grade, which could be an important observation that may have both diagnostic and prognostic implications as well as promising potential target for development of novel therapies.
  3,197 141 -
Fournier's gangrene with testicular infarction caused by mucormycosis
Santosh Kumar, Arawat Pushkarna, Varun Sharma, Raguram Ganesamoni, Ritambhra Nada
October-December 2011, 54(4):847-848
DOI:10.4103/0377-4929.91520  PMID:22234133
  3,140 64 -
The prognostic impact of O 6- methylguanine DNA methyltransferase and epidermal growth factor receptor expressions on primary gliosarcoma: A clinicopathologic and immunohistochemical study of seven cases at a single institution
Jui-Wei Lin, You-Ting Wu, I-Wei Chang
October-December 2011, 54(4):683-687
DOI:10.4103/0377-4929.91491  PMID:22234090
Context: Gliosarcoma is an uncommon variant of glioblastoma characterized by a biphasic tissue pattern of glial and mesenchymal differentiation. O 6- methylguanine DNA methyltransferase (MGMT) is a DNA repair protein that removes mutagenic and cytotoxic adducts from O 6 -guanine in DNA. Lack of MGMT protein expression immunohistochemically is related to drug responses in patients of malignant glioma treated with alkylating agents. Epidermal growth factor receptor (EGFR) is the most frequently amplified gene in glioblastoma and associated with tumor invasiveness, angiogenesis, poor survival, and resistance to radiation therapy. Aims: To elucidate the relationship between the statuses of the MGMT as well as EGFR proteins and the prognosis. The study was undertaken on samples received at the Department of Pathology from 2003 to 2009. Materials and Methods: Clinicopathologic and immunohistochemical study of seven cases was performed. Results: This series included three men and four women with a mean age of 49.3 years at first surgery. The median progression-free survival (PFS) was 22.2 months and 8.6 months for primary tumors with 0 to 1+ and 2+ to 3+ MGMT staining, respectively; the median overall survival (OS) was 27.5 months and 14.2 months for primary tumors with 0 to 1+ and 2+ to 3+ MGMT staining, respectively. The median PFS was 17.2 months and 11.2 months for primary tumors with 0 to 1+ and 2+ to 3+ EGFR staining, respectively; the median OS was 20.4 months and 17.7 months for primary tumors with 0 to 1+ and 2+ to 3+ EGFR staining, respectively. Conclusions: The series showed that MGMT and EGFR protein expressions were both unfavorable prognostic factors for patients with gliosarcoma.
  2,983 160 -
Gastric myeloid sarcoma - A report of two cases addressing diagnostic issues
Viijaya Gadage, Gargi Zutshi, Santosh Menon, Tanuja Shet, Sudeep Gupta
October-December 2011, 54(4):832-835
DOI:10.4103/0377-4929.91544  PMID:22234125
Presented herein are two cases of gastric myeloid sarcoma to highlight the diagnostic conundrum and pointers toward accurate diagnosis in such instances. The first case was a 35-year-old man with an ulceronodular mass in the body of stomach. Multiple biopsies were reported as inconclusive chiefly due to the fact that the lamina propria infiltrate was innocuous and failed to mark with CD20 or CD3. Subsequently the patient had extensive disseminated disease which was recognized as myeloid sarcoma but patient succumbed to the disease soon. The second case was a 25-year-old boy who presented with symptoms of gastric outlet obstruction since 6 months. An endoscopy revealed diffuse gastric wall thickening which on biopsy was recognized as myeloid sarcoma but patient developed intestinal obstruction and required ileal resection for symptomatic relief, postoperative patient never recovered and succumbed to the disease. Both patients had marrow involvement by acute myeloid leukemia (AML-M2) with a normal leukocyte count in peripheral blood. Thus gastric myeloid sarcomas are prone to a delayed diagnosis chiefly due to rarity. Pathologist should think of myeloid sarcoma in a hematolymphoid appearing tumor in stomach that is CD20, CD3 negative, has avid Ki67 and shows an infiltrate chiefly centered in lamina propria.
  3,010 96 -
Nonrejection pathology of renal allograft biopsies: 10 years experience from a tertiary care center in north India
Kandathil Joseph Philip, Nalini Calton, Basant Pawar
October-December 2011, 54(4):700-705
DOI:10.4103/0377-4929.91498  PMID:22234094
Background: Renal dysfunction in allograft transplant is common and its assessment is done using Revised Banff '97 working classification, which is the accepted formulation for the evaluation of histological appearance of renal allograft biopsies. The nonrejection category under the Banff working classification of renal allograft pathology forms a large group resulting in allograft dysfunction. Aim: To evaluate the spectrum of histopathological changes seen in renal allograft dysfunction. Materials and Methods: A total of 119 renal biopsies were studied over 10 years presenting with renal allograft dysfunction from a tertiary center in North India. Results: Majority of the biopsies were in the nonrejection category (47.1%), which included few cases of acute tubular necrosis (25.2%), cyclosporine nephrotoxicity (16%), infections (10.9%), and thrombotic microangiopathy (3.4%). The second largest category in our study was acute/active cellular rejection group (31.9%), which displayed moderate to severe tubulitis, mononuclear cell infiltrate in the interstitium, and vasculitis. Antibody-mediated rejection cases were seen in 28.6% of the renal biopsies followed by chronic allograft nephropathy cases (12.6%) showing features of tubular atrophy and interstitial fibrosis. Borderline changes with features of mild tubulitis contributed to 7.6% of the biopsies. The smallest group comprised of only 4.2%, which were within normal histological limits. Conclusion: Timely accurate diagnosis of renal allograft dysfunction is essential for prompt, effective management of renal transplant patients. Thus, nonrejection pathology forms a significant cause of renal dysfunction in patients with renal allograft transplantation.
  2,946 152 -
Splenic angiomatoid nodular transformation in child with inflammatory pseudotumor-like areas
Monika Vyas, Mahesh Deshmukh, Tanuja Shet, Nirmala Jambhekar
October-December 2011, 54(4):829-831
DOI:10.4103/0377-4929.91543  PMID:22234124
Reports of sclerosing angiomatoid transformation (SANT) in the pediatric age group are rare. We present a case of SANT in an 11-year-old child with a history of trauma presenting with rapidly growing splenic lesion since 2 months. A partial splenectomy revealed a well-demarcated nodular lesion 5 × 4 × 4 cm with central area of fibrosis. Most part of the lesion showed ill-defined nodules or diffuse areas of plump epithelioid appearing endothelial units that marked with CD31, but the internodular stroma was inflammatory pseudotumor (IPT)-like with a mitotic count of 1-2/10 hpf. The angiomatoid nodules were diffusely positive for CD31, CD163, and CD68; however, they were negative for CD34, CD30, smooth muscle actin, and CD8. Epstein-Barr virus-encoded RNA in situ hybridization (EBER-ISH) was negative. The MIB1 labeling was fairly high in the IPT area but low in the angiomatoid areas. After the diagnosis of SANT, the patient has had an uneventful follow-up for more than 3 years since surgery. The morphologic findings in the case being discussed reaffirm the finding that SANT may have an IPT component and it can be seen even in pediatric age group.
  3,004 65 -
Increased liver mast cells in patients with chronic hepatitis C
Suda Tekin Koruk, Ilyas Ozardali, Dilnur Dincoglu, Muharrem Bitiren
October-December 2011, 54(4):736-740
DOI:10.4103/0377-4929.91510  PMID:22234100
Background and Aim: The aim of the study was to investigate the mast cell (MC) concentration in the liver tissue of patients diagnosed with chronic hepatitis C and to determine whether there was a correlation with clinical and pathological characteristics of patients. Materials and Methods: The study was conducted on liver biopsy samples from 60 patients with chronic hepatitis C. Clinical and laboratory data were obtained from follow-up records. Stained liver biopsies were examined. Immunohistochemical staining was performed by using an anti-c-kit antibody. Patients were divided into four groups (minimal, mild, moderate, and severe) based on the intensity of inflammation and their hepatic activity index scores and into two groups (no-mild, moderate-severe) according to fibrosis grade. Results: Among patients enrolled, 60.0% (n=36) were men with a mean age of 48.3±12.7 (range 18-64) years. The mean number of mast cells per portal area in the liver was 0.87±0.86 (0-4.0). No correlation was found between alanine aminotransferase (ALT) and hepatitis C virus (HCV). Ribonucleic acid ( RNA ) levels and the degree of inflammation of cases with number of mast cells and liver steatosis (P>0.05). As the degree of fibrosis increased in the liver so did the number of mast cells in portal areas (P=0.001). On the other hand, no correlation was found between the degree of fibrosis and the number of MCs in the sinusoids and steatosis (P<0.05). The increase in the number of MCs in the portal areas correlated with an increase in liver steatosis (t: 0.02, P=0.04). Conclusion: In light of these findings, it appears possible that MC accumulation in chronic HCV patients may be used as an indicator of fibrosis and possibly be considered in the follow-up of these patients.
  2,912 103 -
A study on expression pattern of cyclooxygenase-2 in carcinoma of cervix
Ranjana Bandyopadhyay, Uttara Chatterjee, Santosh Kr. Mondal, Dipanwita Nag, Swapan Kr. Sinha
October-December 2011, 54(4):695-699
DOI:10.4103/0377-4929.91495  PMID:22234093
Objective: The purpose of the present study was to determine the differential expression pattern of cyclooxygenase-2 (COX-2) in patients of carcinoma of uterine cervix and its correlation with tumor differentiation and lymphovascular invasion. Materials and Methods: Seventy (70) cases of cervical carcinoma were included (20 in-situ, 42 invasive squamous cell, and 8 cases of adenocarcinoma). Formalin-fixed paraffin-embedded tissue sections were stained by Hematoxylin and Eosin. Immunohistochemistry for COX-2 were performed on these blocks. Results: A higher expression of COX-2 was seen in invasive squamous cell carcinoma than in in-situ carcinoma (P = 0.002). Five out of eight cases of adenocarcinoma showed strong positivity for COX-2 antibody. Among the histopathological correlates, tumor differentiation did not show a positive correlation (P = 0.717), while lymphovascular invasion was associated with positive staining in majority of the cases (P = 0.001). Conclusion: Expression of COX-2 is more in cases of invasive than in in-situ carcinoma. Adenocarcinomas showed a strong expression of COX-2. A positive association of COX-2 expression and the presence of lymphovascular emboli were found in the present study. COX-2 inhibitors need to be studied as a therapeutic adjunct for the treatment of carcinoma cervix.
  2,800 187 -
Blastoschizomyces capitatus pneumonia: A rare case
S Sreeja, GS Banashankari, MV Bhavana, DR Gayathri Devi
October-December 2011, 54(4):846-847
DOI:10.4103/0377-4929.91519  PMID:22234132
  2,861 89 -
Coexisting intramedullary schwannoma with intramedullary cysticercus: Report of an unusual collision
Mukul Vij, Sushila Jaiswal, Awadhesh Kumar Jaiswal, Sanjay Behari
October-December 2011, 54(4):866-867
DOI:10.4103/0377-4929.91541  PMID:22234147
  2,828 78 -
Diffuse nesidioblastosis of the pancreas in a neonate with seizures
Manjula Jain, Smita Singh, Neha Kawatra Madan, S Roy Choudhury
October-December 2011, 54(4):864-866
DOI:10.4103/0377-4929.91540  PMID:22234146
  2,789 99 -
Multiple focal nodular hyperplasia, an incidental finding on autopsy
Jyothi B Shetty, Anjali D Amrapurkar, Asha S Shenoy
October-December 2011, 54(4):822-824
DOI:10.4103/0377-4929.91538  PMID:22234122
Focal nodular hyperplasia (FNH) is a benign condition of the liver often discovered incidentally on radiological investigation. Although FNH is a well-described lesion in the literature considerable diagnostic problems regarding this entity still remains. We report a case of multiple FNH in a 23-year-old male patient detected as an incidental finding in autopsy. On gross examination FNH was not suspected because of the multiple lesions and the lack of central scar which is characteristically described in FNH. The diagnosis was established on histopathology after examination of multiple sections of the lesions.
  2,744 69 -
Diffuse infiltration of Aspergillus hyphae in the thyroid gland with multinodular goiter
Havva Erdem, Ali Kemal Uzunlar, Ümran Yildirim, Mustafa Yildirim, M Faruk Geyik
October-December 2011, 54(4):814-816
DOI:10.4103/0377-4929.91530  PMID:22234119
A 35-year-old woman presented with a thyroid mass, weakness and shortness of breath of 3 years duration. On physical examination, she had a diffusely enlarged thyroid gland with multiple nodules. There were no signs to suggest immune suppression. The patient farmed and raised livestock. Biochemical tests and hemogram were normal. She underwent surgery, and a histological examination of the surgical specimen revealed nodular hyperplasia. Microscopically, silver methenamine (PASM) stain-positive hyphae that divided into branches at 45° and conidia were detected beside the thyroid capsule, with conidia in the cystic nodule. Moreover, ischemic changes of the thyroid tissue were observed closer to the capsule. We report a case of Aspergillosis of the thyroid of a patient who underwent surgery for a multinodular goiter.
  2,622 83 -
Composite epithelial kidney tumor comprising of adeno and neuroendocrine carcinomatous components: An unusual variant of renal cell carcinoma
Mahesh K Deshmukh, Sridhar Epari, Santosh Menon, Sangeeta B Desai, Hemant Tongaukar
October-December 2011, 54(4):809-813
DOI:10.4103/0377-4929.91528  PMID:22234118
Renal cell carcinomas accounts for an approximately 2% of human malignancies with atleast ten different histological subtypes recognized by the World Health Organization (WHO) 2004 classification. Composite carcinomas with dual divergent epithelial differentiation in kidneys are extremely uncommon. We report an unusual case of a 37-year-old female who presented with symptoms related to renal tumor for the last three years. Computed tomography scan revealed a large heterogenously contrast enhancing left kidney mass comprising of two distinct histological components of low grade adenocarcinomatous and carcinoid-like low grade neuroendocrine carcinomas with presence of hilar lymph nodal metastases of both the components. The component of adenocarcinoma was immunoreactive to E-cadherin, cytokeratins 7 and 19 with negativity for cluster of differentiation 10, cytokeratin 20, CD117, and vimentin; while the neuroendocrine component was immunoreactive for vimentin, chromogranin and synaptophysin with negativity for CD10, CD117, and cytokeratins 7, 19 and 20. MIB-1 labeling index in the both the components was 2-3%. The present case is the first of its kind to be reported in the kidney and emphasizes the diversity potential of kidney tumors.
  2,558 77 -
Bugs on film: The presence of bacterial rods (Citrobacter koseri) on a routine blood film in a septic immunocompromised patient with a femoral vein line
Suran L Fernando, Patricia Lehmann
October-December 2011, 54(4):840-841
DOI:10.4103/0377-4929.91547  PMID:22234128
  2,530 79 -
Juvenile hyaline fibromatosis: A rare lesion
Yasmin Altaf Momin, Bhavana Madhukar Bharambe, Grace D'Costa
October-December 2011, 54(4):838-839
DOI:10.4103/0377-4929.91546  PMID:22234127
  2,492 79 -
Myxoinflammatory fibroblastic sarcoma - Report of two uncommon tumors occurring at classical and unusual sites
Arundhati , Bharat Rekhi, Sangeeta B Desai, Nirmala A Jambhekar
October-December 2011, 54(4):843-844
DOI:10.4103/0377-4929.91517  PMID:22234130
  2,471 87 -
Prevalence of pituitary incidentaloma in the Iranian cadavers
K Aghakhani, M Kadivar, S Kazemi-Esfeh, N Zamani, M Moradi, H Sanaei-Zadeh
October-December 2011, 54(4):692-694
DOI:10.4103/0377-4929.91493  PMID:22234092
Aim: Although one-fourth of the pituitary tumors are inactive and silent, increased total volume of the pituitary gland exerts pressure on sella turcica and corrodes the clinoid processes, resulting in several problems. Therefore, determination of the prevalence of the concealed pituitary tumors is of major concern among clinical practitioners. This study was performed to determine the prevalence of these tumors in cadavers referred to the Iranian Legal Medicine Organization (Kahrizak, Tehran). Materials and Methods: This cross-sectional descriptive study was performed between June 2007 and February 2008. A total of 485 cadavers were selected by simple random sampling method. Pituitary glands were removed and then horizontally cut and four slides were prepared from each of them, stained by hematoxylin and eosin, and evaluated by a light microscope. For statistical analysis, SPSS software (version 16), Mann-Whitney U test, Kolmogorov-Smirnov nonparametric test (K-S test), and Chi-square test were used. Results: Of the 485 investigated cadavers, 365 (75.3%) were males with an average age of 42 ± 20.5 years and 120 (24.7%) were females with an average age of 44 ± 22 years. A total of 61 (12.6%) had concealed pituitary masses. No statistically significant difference was found between the mean age, sex, and body mass index (BMI) of the cadavers with and without concealed tumors (P=0.380 P=0.450, and P=0.884, respectively). Conclusions: In the present study, the prevalence of the concealed pituitary adenomas was 12.6%. There was no correlation between age, sex, and BMI and the prevalence of the concealed masses.
  2,323 73 -
Microfibrillar cardiomyopathy: A rare case
Narender Kumar, Ruma Ray
October-December 2011, 54(4):790-792
DOI:10.4103/0377-4929.91506  PMID:22234112
Microfibrillar cardiomyopathy is a very rare cause of restrictive cardiomyopathy (RCM). The index case was a male patient who presented with shortness of breath and pedal edema. Further clinical investigations favored a clinical diagnosis of RCM. An endomyocardial biopsy revealed subendocardial and interstitial hyaline eosinophillic material resembling amyloid that did not stain with Congo red. An electron microscopic examination showed that this material was composed of twisted linear and bundles of tangled microfibrils. The etiology of the microfibrillar deposition is currently unknown. The pathologists should entertain the diagnosis of microfibrillar cardiomyopathy in suspected cases of amyloidosis that are negative for Congo red.
  2,270 69 -
Paratesticular multicystic mesothelioma
Mani Anand, Vandana Gaopande, Sanjay D Deshmukh
October-December 2011, 54(4):842-843
DOI:10.4103/0377-4929.91516  PMID:22234129
  2,146 65 -
Vulvar hibernoma
Anuradha Sheth, Milan Terzic, Nebojsa Arsenovic
October-December 2011, 54(4):817-818
DOI:10.4103/0377-4929.91532  PMID:22234120
A 35 year old woman presented with 18 months history of a painless, soft, well-circumscribed, vulvar subcutaneous lump which measured approximately 7 cm. The lesion was completely excised and microscopically was consistent with a hibernoma. According to the available literature in English, this is the first reported case of hibernoma of the vulva.
  2,084 69 -
Inflammatory myofibroblastic tumor of renal pelvis : A rare entity
Vinaya B Shah, Vyankatesh T Anchinmane, Deepika Savant
October-December 2011, 54(4):856-858
DOI:10.4103/0377-4929.91533  PMID:22234141
  2,019 67 -
Dual Salmonella typhi infection
Ranjeeta Adhikary, S Joshi
October-December 2011, 54(4):849-850
DOI:10.4103/0377-4929.91522  PMID:22234135
  1,984 100 -
The synchronous primary carcinomas of the rectum and prostate
Semin Ayhan, Arzu Ozdamar, Nalan Nese, Hasan Aydede
October-December 2011, 54(4):800-802
DOI:10.4103/0377-4929.91513  PMID:22234115
The diagnosis of synchronous prostatic and rectal carcinomas is uncommon. To make a correct diagnosis, biopsies of both sites are mandatory. Pathological slides should be compared and immunohistochemical staining should be taken into consideration. In this paper, an unexpected case of synchronous rectal and prostatic carcinomas arising in an 84-year-old male with hematemesis and pelvic pain is reported. These two tumoral components have a distinctive histological appearance. Immunohistochemical evaluation confirmed the diagnosis of these synchronous tumors. This case emphasizes that rectal and prostatic carcinomas can arise simultaneously. In this situation, providing clinicopathological correlation and deciding the necessity of intraoperative consultation in proper time are extremely important.
  2,018 58 -
Differential diagnosis of oncocytic pleomorphic adenoma
Shaodong Yang
October-December 2011, 54(4):853-854
DOI:10.4103/0377-4929.91527  PMID:22234139
  1,830 104 1
A rare case of a rectal polyp with gastric heterotopia
Gautami Kokil, Anna Pulimood, John Mathai
October-December 2011, 54(4):848-849
DOI:10.4103/0377-4929.91521  PMID:22234134
  1,826 64 -
Dengue rapid strip test: A Sri Lankan experience
Kamani M Gunasekera, Channa P Senanayake, Lalitha Mendis
October-December 2011, 54(4):861-863
DOI:10.4103/0377-4929.91537  PMID:22234144
  1,737 86 -
Aberrant CDX2 expression and metastatic endometrial adenocarcinoma to the lung
Antonio D'Antonio
October-December 2011, 54(4):860-861
DOI:10.4103/0377-4929.91536  PMID:22234143
  1,641 41 -
Hydrops fetalis due to maternal anti Jk b
MP Chacko, A Mathan, M Kumar, R Jose
October-December 2011, 54(4):851-852
DOI:10.4103/0377-4929.91525  PMID:22234137
  1,606 65 -
Authors' reply
FV Mariano, EC Vidaurre, RE Bologna-Molina, R Carlos-Bregni, O Paes de Almeida
October-December 2011, 54(4):854-854
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