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   2008| January-March  | Volume 51 | Issue 1  
    Online since April 16, 2008

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Immunohistochemistry in surgical pathology practice: A current perspective of a simple, powerful, yet complex, tool
Nirmala Ajit Jambhekar, Anshuman C Chaturvedi, Bhulaxmi Prakash Madur
January-March 2008, 51(1):2-11
DOI:10.4103/0377-4929.40382  PMID:18417841
Immunohistochemistry (IHC) is a powerful tool in the surgical pathologists' armamentarium. The requests for IHC and the list of monoclonal antibodies have increased tremendously in the past decade. Issues concerning technical reproducibility, uniformity of interpretation, inter-laboratory comparability, and quality assurance are assuming greater importance due to the increased availability of IHC and its impact on diagnosis and therapy. An attempt has been made to give a current perspective of this simple and yet, in some aspects, a complex tool.
  28,833 2,488 8
Comparative study of peripheral blood smear, quantitative buffy coat and modified centrifuged blood smear in malaria diagnosis
PL Bhandari, CV Raghuveer, A Rajeev, PD Bhandari
January-March 2008, 51(1):108-112
DOI:10.4103/0377-4929.40419  PMID:18417878
The present study was aimed at modifying the centrifuged blood smear (modified centrifuged blood smear or MCBS), to make it a feasible and standardized procedure. The results obtained were compared with the current diagnostic methods - peripheral blood smear (PBS) and quantitative buffy coat (QBC). Blood samples collected from 100 suspected malaria patients were subjected to all three tests. It was found that PBS had 86.79% sensitivity and was absolutely specific. QBC was 96.22% sensitive and 93.61% specific. The majority of variations occurred in PBS negative cases; cases with parasite count <++ and with Plasmodium falciparum. It was seen that by the addition of centrifugation to the conventional smear technique (MCBS) improved its sensitivity from 86.79% to near 100%. QBC and MCBS were found superior to PBS. Since MCBS combines principles of both QBC and PBS, it is as sensitive as QBC, as specific as PBS, and above all, easily performed and affordable.
  18,331 1,204 19
Microwave histoprocessing versus conventional histoprocessing
Alka Mary Mathai, Ramadas Naik, Muktha R Pai, Sharada Rai, Poornima Baliga
January-March 2008, 51(1):12-16
DOI:10.4103/0377-4929.40383  PMID:18417842
The aim of the study is to compare the histologic quality of the microwave histoprocessing with that of conventional method and to determine its positive impact on turnaround times and reduction of costs of tissue processing. One hundred and eighty-five paired tissue sections from different organs were taken. Each tissue sections were of size of 15 mm × 10 mm × 3 mm and divided into two; one set as experimental group and the other as control group. The tissues in the experimental group were further divided into six groups and processed by vacuum-microwave method according to six protocols from I to VI. Other tissues in the control group were processed by the conventional method and compared. Overall, the quality of microscopic tissue from both the methods was identical. Microwave processing shortened the time of processing without compromising the overall quality of the histologic section and was cost-effective.
  13,631 1,071 3
Angiomatous meningioma: A diagnostic dilemma
Shalinee Rao, Aarthi Rajkumar, Sarah Kuruvilla
January-March 2008, 51(1):53-55
DOI:10.4103/0377-4929.40397  PMID:18417856
Angiomatous meningioma accounts for 2.1% of all meningiomas. It has features of a typical benign meningioma with many small or large vascular channels which may predominate over its meningothelial elements. We present here a series of three cases of angiomatous meningioma, which posed diagnostic difficulty to clinicians, radiologists, and pathologists. All the three cases showed a tumor entirely composed of thin-walled vascular channels and cells with bland morphology in the background. The diagnosis was confirmed by immunohistochemistry. We present series of three cases to highlight the histomorphological features of this uncommon variant of meningioma that could help in distinguishing it from hemangioblastoma and hemangiopericytoma.
  13,667 515 8
Nodular regenerative hyperplasia of liver
D Shelly, MS Tevatia, AK Praharaj, A Mehta, S Harish, V Baskaran
January-March 2008, 51(1):78-80
DOI:10.4103/0377-4929.40408  PMID:18417867
Nodular regenerative hyperplasia of the liver (NRHL) is a very rare cause of portal hypertension and liver failure. The condition is characterized by diffuse micronodular transformation of hepatic parenchyma without fibrous septa between the nodules. We present our experience with a 32-year-old woman who presented with recurrent episodes of upper gastrointestinal bleeding associated with massive splenomegaly who was subsequently found to have NRHL. This article considers the salient aspects of this rare condition, how it affects the patients and the options available in its management. A plea is made for the need for liver biopsy for all patients with portal hypertension especially those being considered for surgery.
  12,310 448 1
Clinicopathological study of non-neoplastic lesions of nasal cavity and paranasal sinuses
U Zafar, N Khan, N Afroz, SA Hasan
January-March 2008, 51(1):26-29
DOI:10.4103/0377-4929.40386  PMID:18417845
An analysis of cases presenting as mass in nasal cavity (NC), paranasal sinuses (PNS), and nasopharynx (NP) was done over a period of 7 years in Jawaharlal Nehru Medical College, Aligarh. A provisional diagnosis was made after clinical assessment and radiological investigations, but final diagnosis was made after histopathological examination. The incidence of masses in NC, PNS, and NP was 34.3 cases per year, non-neoplastic lesions constituted 60% of these cases and their incidence was 20.7 cases per year. All the cases were carefully examined histopathologically and it was found that the region was affected by a variety of non-neoplastic lesions. Among 240 cases, 145 were non-neoplastic and 95 were neoplastic The lesions in the decreasing order of frequency were - nasal polyp, rhinoscleroma, tuberculosis, fungal infection, fibrous dysplasia, ossifying fibroma, cysts, nasal glioma, and cemento-ossifying fibroma. NP was involved by a range of neoplastic lesions; however, no non-neoplastic lesion was seen in this region.
  11,064 1,101 15
Serum transferrin receptor-ferritin index shows concomitant iron deficiency anemia and anemia of chronic disease is common in patients with rheumatoid arthritis in north India
Richa Goyal, Reena Das, Pradeep Bambery, Gurjeewan Garewal
January-March 2008, 51(1):102-104
DOI:10.4103/0377-4929.40417  PMID:18417876
Anemia is a frequent cause of morbidity in patients with rheumatoid arthritis (RA). We studied the prevalence of anemia of chronic disorders (ACD) and ACD with coexistent iron deficiency anemia (IDA) in patients with RA using sTfR/log ferritin ratio (sTfR - F index). Complete blood counts, percent transferrin saturation, serum ferritin, sTfR, sTfR-F index measurements were carried out in 100 anemic RA patients. Twenty-five IDA subjects without any other illness and 25 age- and sex-matched normal controls were studied. Prevalence of anemia in RA patients was 50.5%. Patients with sTfR-F index value <1.5 were classified as pure ACD and patients with sTfR-F index value >1.5 were classified as ACD with coexistent IDA. Using these criteria, 20% patients were found to have pure ACD and 80% patients had coexistent ACD and IDA. In the normal control group, sTfR-F index was found to be 0.16-1.8. We found that sTfR-F index can clearly distinguish IDA control cases and normal subjects with no overlap in the range of sTfR-F index.
  10,424 620 18
Malignant hemangiopericytoma in the gluteal region: A rare entity
RK Sherwani, K Rahman, K Akhtar, FA Siddiqui, BK Varshney, M.K.A Sherwani
January-March 2008, 51(1):39-41
DOI:10.4103/0377-4929.40391  PMID:18417850
We present here a case of malignant hemangiopericytoma in a 40-year-old female who presented with a history of slowly growing mass in left gluteal region for about 1.5 years. She was evaluated and a mass of 10 × 7.5 × 5.5 cm 3 was found on computed tomography. The tumor was resected and was sent for histopathological evaluation. Grossly the tumor was encapsulated and on cut section it was nodular. Microscopy showed spindle cells forming cords and sheets separated by thin delicate stroma consisting largely of thin-walled vessels revealed by reticulin stain. Pleomorphism and mitotic figures were seen. It was diagnosed as a case of malignant hemangiopericytoma of gluteal region. The patient underwent radiotherapy and did apparently well. She is on regular follow-up because long-term follow-up is essential in all cases as recurrence can occur several years after treatment.
  10,737 176 -
Prevalence of extended-spectrum β-lactamases among Escherichia coli and Klebsiella pneumoniae isolates in a tertiary care hospital
Parul Agrawal, AN Ghosh, Satish Kumar, B Basu, K Kapila
January-March 2008, 51(1):139-142
DOI:10.4103/0377-4929.40428  PMID:18417887
Extended-spectrum β-lactamases (ESBLs) continue to be a major problem in clinical setups the world over, conferring resistance to the expanded-spectrum cephalosporins. Knowledge about their prevalence is essential to guide towards appropriate antibiotic treatment. The aim of the present study is to determine the prevalence of ESBL producers among Escherichia coli and Klebsiella pneumoniae isolates at a tertiary care institution. A total of 357 clinical isolates comprising E. coli (n = 181) and K. pneumoniae (n = 176) were recovered from various clinical samples over a period of six months from April to September 2006. Antibiogram profile of these isolates was determined to commonly used antibiotics, along with screening for ESBL production by the screening test as recommended by the Clinical Laboratory Standards Institute (CLSI). Isolates which showed positive results with screening test were shortlisted for confirmatory tests of ESBL production. Two tests were performed: phenotypic confirmatory test with combination disk and the minimum inhibitory concentration (MIC) reduction test. Out of 357 isolates of E. coli and K. pneumoniae screened for ESBL production, 120 were found to be potential ESBL producers. Of these, 80 isolates were confirmed to be ESBL producers. Thus the prevalence of ESBL-producing isolates of E. coli and K. pneumoniae was found to be 22% (80 out of 357). This was significantly lower than the data available from other hospitals.
  9,333 1,013 21
Splenic lymphoma with villous lymphocytes
Ritu Gupta, Shano Naseem, Shawgi Sukumaran, Rajesh Kashyap, Sukhpreet Kaur, Lily Paul
January-March 2008, 51(1):113-115
DOI:10.4103/0377-4929.40420  PMID:18417879
Splenic lymphoma with villous lymphocytes (SLVL) is a rare disorder that comprises less than 1% of lymphoid neoplasms. It is the leukemic counterpart of splenic marginal zone lymphoma (SMZL) and is characterized by splenomegaly, often with no lymphadenopathy, moderate lymphocytosis and villous lymphocytes on peripheral blood smear. Here, we report a case of SLVL in a 56-year-old male with very high leukocyte counts, massive splenomegaly and relatively few leukemic cells with subtle villous projections on the surface. This disorder is often confused with other chronic lymphoproliferative disorders, especially chronic lymphocytic leukemia (CLL) and hairy cell leukemia and should be differentiated from them. We are reporting this case to highlight the diagnostic pitfalls associated with this disorder.
  9,464 435 1
Coexistence of squamous cell carcinoma with dermoid cyst of ovary
PM Santwani, DP Trivedi, JH Vachhani, NJ Trivedi
January-March 2008, 51(1):81-82
DOI:10.4103/0377-4929.40409  PMID:18417868
A 40-year-old female presented with pain and enlargement of abdomen since last 6 months. A mass was felt over right iliac fossa. Ultrasonography showed partly cystic and solid area in mass arising from ovary. A tooth-like structure was also seen. Dermoid cyst was the diagnosis offered. Laparotomy was performed. Ovarian mass with hair, a tooth and putty-like material was present. Solid white area with thickened wall was found. Histopathology confirmed the findings of dermoid cyst and the thickened area showed squamous cell carcinoma with areas showing keratinous material and giant cell reaction which was also seen at the periphery of tumor areas. Left ovary was normal and no deposits of tumor were seen. Postoperative period was uneventful.
  9,236 335 4
Endometrial stromal nodule with smooth muscle differentiation
V Geetha, S Rupashree, SS Bhat
January-March 2008, 51(1):76-77
DOI:10.4103/0377-4929.40407  PMID:18417866
Uterine tumors composed of a prominent component of smooth muscle and endometrial stroma (so-called stromomyoma) are distinctly uncommon. This article describes the morphological features of one such tumor discovered as an incidental finding in a hysterectomy specimen of a 49-year-old lady with a clinical diagnosis of dysfunctional uterine bleeding. Morphological and immunohistochemical (IHC) evaluation were performed and a final diagnosis of endometrial stromal nodule with smooth muscle differentiation was rendered.
  8,306 240 5
Massive chondroid hamartoma of the lung clinically masquerading as bronchogenic carcinoma
S Jacob, D Mohapatra, M Verghese
January-March 2008, 51(1):61-62
DOI:10.4103/0377-4929.40400  PMID:18417859
Chondroid hamartomas of the lung are uncommon lesions which are generally small sized and asymptomatic. Herein we describe a case of a large-sized pulmonary chondroid hamartoma which clinically mimicked bronchogenic carcinoma. A large hilar growth was detected in the left lung on radiological studies. Left upper lobectomy was done. The growth was well defined with a lobulated bluish cut surface. Histopathology disclosed lobules of mature cartilage rimmed by long slit-like epithelial channels admixed with mature adipose tissue.
  7,759 175 5
Ovarian pregnancy
S Das, R Kalyani, V Lakshmi, ML Harendra Kumar
January-March 2008, 51(1):37-38
DOI:10.4103/0377-4929.40390  PMID:18417849
Ovarian pregnancy is a rare form of extrauterine pregnancy contributing <3% of ectopic pregnancies. We report an ovarian pregnancy in a 23-year female.
  7,488 304 5
Malignant lymphoma presenting as nonhealing ulcer
S Shah
January-March 2008, 51(1):87-87
DOI:10.4103/0377-4929.40412  PMID:18417871
  7,644 108 1
Inflammatory pseudotumor of lymph nodes presenting as pyrexia of unknown origin
H Gulwani, P Chopra
January-March 2008, 51(1):67-69
DOI:10.4103/0377-4929.40403  PMID:18417862
Inflammatory pseudotumor (IPT) is an uncommon benign disorder characterized by proliferation of spindle cells, inflammatory cells, and small vessels. The IPT of lymph nodes is a rare cause of lymphadenopathy that usually affects one or two nodal groups. We describe a 27-year-old male presenting with generalized lymphadenopathy, hepatosplenomegaly and fever for 1 year. Histologic examination of lymph node revealed few remnant lymphoid aggregates with marked sclerosis and numerous anastomosing blood vessels in lymph node parenchyma. Interspersed in between the fibrotic bands was a polymorphic infiltrate composed of lymphocytes, plasma cells, eosinophils, and immunoblasts. Also, many histiocytes, multinucleated giant cells some being Langhan's type and at places forming ill-defined granulomas were observed. The presence of granulomas and Langhan's type of giant cells can lead to a misdiagnosis of tuberculosis as was also done in the present case. It is thus not only important to be aware of this rare benign pathologic entity while dealing with a case of lymphadenopathy, but also consider it in the differential diagnosis of granulomatous disease.
  7,443 246 5
Osteochondroma-like parosteal osteosarcoma
Duddi Sreehari Krishna Swaroop, Sarala Jothi Bai, V Shanthi, BA Ramakrishna
January-March 2008, 51(1):58-60
DOI:10.4103/0377-4929.40399  PMID:18417858
Parosteal osteosarcoma is a well-differentiated, predominantly fibro-osseous variant of osteosarcoma, accounting for 5% of all osteosarcomas. We report a case of parosteal osteosarcoma in the metaphyseal area of right femur, of 2 years' duration in a male aged 35 years. It was mistaken for osteochondroma in the initial biopsy, and the possibility of bizarre parosteal osteochondromatous proliferation (BPOP) was also considered. Subsequent excision of the tumor showed it to be a parosteal osteosarcoma. The patient had recurrence of the lesion after 1 year, and he attended a cancer institute. Follow-up showed metastases of the tumor on bone scan.
  7,248 316 3
Incidence and changing pattern of mycetoma in western Rajasthan
Rashmi Bakshi, Devendra Raj Mathur
January-March 2008, 51(1):154-155
DOI:10.4103/0377-4929.40433  PMID:18417892
Histopathologic analysis of 73 cases of mycetoma occurring in western Rajasthan was done from January 2001 to December 2005. Maduromycotic mycetoma remains commonest in this region as compared to actinomycotic mycetoma, which is more common in the southern part of Rajasthan. The incidence of actinomycotic mycetoma has increased during the last five years in this part of Rajasthan due to changes in climatic conditions, like heavy rainfall, increased irrigation by Rajasthan Canal, urbanization of villages, and modification in agriculture. The ratio of prevalence of maduromycotic mycetoma to the prevalence of actinomycotic mycetoma has decreased from 4:1 to 1.91:1 during the last five years in western Rajasthan.
  6,967 338 17
Evaluation of an enzyme-linked immunoassay for the detection of Cryptosporidium antigen in fecal specimens of HIV/AIDS patients
J Jayalakshmi, B Appalaraju, K Mahadevan
January-March 2008, 51(1):137-138
DOI:10.4103/0377-4929.40427  PMID:18417886
Cryptosporidium parvum, a protozoan parasite, causes severe diarrhea in immunodeficient hosts like HIV/AIDS patients, leading to significant morbidity and mortality. Diagnosis of the Cryptosporidium oocyst in the stool of these patients by conventional microscopy is labor intensive and time consuming. Therefore, we planned to evaluate the usefulness of a stool ELISA test in detecting Cryptosporidial antigen. About 89 stool specimens obtained from HIV-seropositive patients with diarrhea were subjected to an ELISA test and modified acid-fast staining (gold standard), on both direct and formol ether-concentrated specimens. The prevalence of Cryptosporidial diarrhea was found to be 12.4% (11/89). Other enteric pathogens detected were Isospora belli (3), Giardial cyst (3), Entamoeba coli cyst (2), and Entamoeba histolytica cyst (1). Dual infection with Cryptosporidium and Isospora belli was seen in two patients. Concentration technique improved identification by microscopy. The sensitivity and specificity for stool ELISA were found to be 90.9% and 98.7% respectively. The results of stool ELISA indicate that this simple, rapid, reliable, and standardized immunoassay test is sensitive and specific for routine diagnosis and may be useful for large-scale epidemiological studies of Cryptosporidiosis.
  6,591 464 23
Fine needle aspiration cytology of anterior mediastinal masses
Fanny Desai, Manoj Shah, Shreedevi Patel, Shilin N Shukla
January-March 2008, 51(1):88-90
DOI:10.4103/0377-4929.40413  PMID:18417872
Objective: The main aim of the study is to evaluate the computed tomography (CT)-guided fine needle aspiration cytology (FNAC) of anterior mediastinal mass as a diagnostic procedure. Materials and Methods: In all 135 cases, the material was obtained by CT-guided FNAC technique followed by staining with Papanicolaou and May-Grunwald-Giemsa stains. The histological material was obtained by needle biopsies, wedge biopsies and resection specimens. Immunohistochemical stains were used to confirm diagnosis in selected cases. Results: Among 135 cases, cytohistology correlation was found in 92 cases. Correct typing was done in 53.33% cases. No correlation was found in 14.81% cases. Material was unsatisfactory in 18.51% cases. The diagnostic accuracy and positive predictive values were 85.71% and 78.26%, respectively. Conclusion: Although there are some limitations, most lesions of the anterior mediastinum can be diagnosed on FNAC.
  6,667 386 11
Leiomyoma of scrotum
RK Sherwani, K Rahman, K Akhtar, S Zaheer, MJ Hassan, A Haider
January-March 2008, 51(1):72-73
DOI:10.4103/0377-4929.40405  PMID:18417864
Leiomyoma is a benign tumor of smooth muscles. Leiomyoma originating from the scrotum is a rare entity. We report here a case of 50-year-old male who presented with a 4-cm lump in the left side of scrotum. Clinically, it was provisionally diagnosed as sebaceous cyst and was excised. The histopathology showed findings consistent with leiomyoma. There was no cytological atypia or mitosis. The final diagnosis of solitary leiomyoma of scrotum was given. The patient was followed up regularly and is doing fine for last 4 months.
  6,292 195 6
Small-cell neuroendocrine tumor of larynx: A rare presentation
M Dhingra, A Agarwal, S Kaushik, SN Singh
January-March 2008, 51(1):63-64
DOI:10.4103/0377-4929.40401  PMID:18417860
Neuroendocrine tumors of the larynx are extremely rare and represent <1% of all primary laryngeal tumors. We report a case of a 55-year-old man who presented to us with laryngeal tumor, histopathological evaluation of which revealed it to be a neuroendocrine tumor. Diagnosis is based mostly on light microscopy and may be supported by special histochemical stains in some instances.
  6,016 286 7
Simultaneous appearance of dual malignancies of hematopoietic system-multiple myeloma and acute myeloid leukemia
Jyoti Shukla, Shashikant CU Patne, NK Singh, Usha
January-March 2008, 51(1):118-120
DOI:10.4103/0377-4929.40422  PMID:18417881
We herein report a case of denovo and simultaneous appearance of multiple myeloma and acute myeloid leukemia in a 58-year-old female patient, without prior exposure to chemotherapy or radiotherapy. This case is reported because of its extreme rarity.
  6,031 248 8
Nocardia brain abscess in a diabetic patient
Prithwiraj Chakrabarti, Sitansu Sekhar Nandi, Subhash Kumar Todi
January-March 2008, 51(1):151-153
DOI:10.4103/0377-4929.40432  PMID:18417891
Brain abscess due to disseminated nocardia infection is an acute medical emergency among immunocompromised patients. We report a case of rapidly progressive nocardia brain abscess in an apparently healthy diabetic individual. The close similarity of the radiological features with those of malignancy and tuberculosis may delay the diagnosis of central nervous system (CNS) nocardiosis. A high index of suspicion and early intervention like stereotactic brain biopsy remain the cornerstone to increase the chance of positive clinical outcome.
  5,906 315 5
Acid-fast bacilli positive isolated tubercular splenic abscess in a HIV-negative patient
M Jain, S Singh, S Thomas, D Jain
January-March 2008, 51(1):74-75
DOI:10.4103/0377-4929.40406  PMID:18417865
Isolated splenic tubercular abscess in a HIV-negative patient is an exceedingly rare clinical condition. It is even more rare to demonstrate acid-fast bacilli positivity on Ziehl-Neelson stains in such cases. We hereby present one such case.
  5,843 204 6
Unusual presentation of dedifferentiated liposarcoma as paratesticular mass
A Ghosh, R Swami, PK Sen, S Dwaka
January-March 2008, 51(1):42-44
DOI:10.4103/0377-4929.40392  PMID:18417851
A 75-year-old male presented with complaint of painless left inguinoscrotal mass slowly increasing in size since 9 years. Clinical impression was malignancy arising in left testis or cord. Initial incisional biopsy was reported as fibromatosis. Later on wide excision of tumor was done and histopathology showed dedifferentiated liposarcoma with areas of fibromatosis.
  5,733 192 1
The prevalence of extended-spectrum β-lactamase in environmental isolates of Enterobacter
Anjana Sharma, Prashant Dour, Thakur Nirbhay Singh
January-March 2008, 51(1):130-136
DOI:10.4103/0377-4929.40426  PMID:18417885
The incidence of extended-spectrum β-lactamase (ESBL)-producing strains and multidrug-resistant strains of Enterobacter spp. isolated from the 1312 km long river Narmada was investigated. Out of the 57 isolates of Enterobacter, 73.68% were found to be ESBL producers including the isolates of E. taylorae and isolates of E. agglomerans, which have been characterized for the first time. All the isolates were found susceptible to the antibiotic imipenem. AmpC gene was found in all the Enterobacter strains tested. AmpC β-lactamase-producing bacterial pathogens may cause major therapeutic failure if not detected and reported in time. It was seen that these enzymes are mainly chromosomally mediated along with several non-AmpC β-lactamase.
  5,413 497 7
Microfilaria in thyroid gland nodule
Monisha Chowdhary, Sabeena Langer, Meenu Aggarwal, Chetna Agarwal
January-March 2008, 51(1):94-96
DOI:10.4103/0377-4929.40415  PMID:18417874
Presence of microfilaria in the thyroid gland is a rare finding. Filariasis is a common public health problem in the Indian sub-continent. Most of the cases of microfilaria in thyroid gland reported in the literature are associated with goiter and thyroid neoplasms. Here, we present a rare case that showed microfilaria on fine needle aspiration cytology of solitary thyroid nodule.
  5,540 312 14
Sclerosing mucoepidermoid carcinoma with eosinophilia of the thyroid
S Das, R Kalyani
January-March 2008, 51(1):34-36
DOI:10.4103/0377-4929.40389  PMID:18417848
Sclerosing mucoepidermoid carcinoma with eosinophilia (SMECE) is a recently described carcinoma of the thyroid gland associated with Hashimoto's thyroiditis and considered to have a relatively indolent clinical course. We present a 65-year-old female, clinically euthyroid, who presented with a thyroid swelling since last 8 months along with right-sided cervical lymphadenopathy. Fine needle aspiration cytology suggested poorly differentiated carcinoma along with the involvement of the lymphnodes while histopathological examination showed features of SMECE with metastatic deposits in the right-sided cervical lymphnodes.
  5,601 236 12
Enumeration of CD 4 and CD 8 T lymphocytes in healthy HIV seronegative adults of northwest India: A preliminary study
Anita Rungta, Saroj Hooja, Nitya Vyas, Suman Rishi, Alaka Rao, Sonika Gupta
January-March 2008, 51(1):127-129
DOI:10.4103/0377-4929.40425  PMID:18417884
CD4 T lymphocyte count is used to measure the progression of HIV infection and to monitor the response to antiretroviral therapy. Information on reference CD4 and CD8 T cell counts in healthy individuals is lacking in northwest India. Samples from 65 HIV-seronegative healthy volunteers (males, 37; females, 28) aged 18 through 59 years were analyzed using FACS (Fluorescent Antibody Cell Sorter) Count TM System. The values of mean and standard deviation of each lymphocyte subpopulation were estimated. The mean ± SD of absolute numbers of CD4 and CD8 lymphocytes/µl was 743.4 ± 307.8 and 541.7 ± 176.4 in males and 790.7 ± 280.4 and 497.03 ± 203.6 in females respectively. The range of CD4 counts was 379 to 1800 in males and 321 to 1265 in females. The mean CD4:CD8 ratio was 1.43 ± 0.56 in males and 1.78 ± 0.76 in females. The results of this study show a wide variability in CD4 counts in the Indian population. A large multicentric study would define normal ranges of CD4, CD8, and CD4:CD8 ratios among the Indian population.
  5,468 344 5
Proliferative indices, cytogenetics, immunophenotye and other prognostic parameters in myelodysplastic syndromes
Neelam Varma, Subhash Varma
January-March 2008, 51(1):97-101
DOI:10.4103/0377-4929.40416  PMID:18417875
Thirty-five adult myelodysplastic syndrome (MDS) patients were included in this study: 11 refractory anemia (RA), 4 RA with ring sideroblasts (RARS), 9 RA with excess of blasts (RAEB), 10 RAEB in transformation (RAEB-T) and 1 chronic myelomonocytic leukemia (CMML). The ranges of survival were 4-51 months, 40-59 months, 7-38 months, 5-24 months and 5 days, respectively. Three patients died and 3 showed disease progression during the course of the study. A composite analysis of proliferative indices, cytogenetics, immunophenotype and other conventional/novel prognostic parameters in the context of Indian MDS patients was performed. The proliferative indices (AgNOR and Ki 67 positivity), immunophenotypic markers, serum LDH and ferritin levels revealed wide variations and great overlap among different FAB subtypes. The scoring systems (Bournemouth, Dusseldorf and Goasguen) did not correlate with the prognosis and survival (p > 0.05). Clonal cytogenetic abnormalities were detected in 24/35 (68.57%) patients, +8, −5 and −7 being observed commonly. Cytogenetic abnormalities were more frequent in RAEB (88.8%), RAEB-T (80.0%) and RA (63.6%) subtypes of MDS. By Using Mufti's prognostic system and International prognostic scoring system (IPSS), a good positive correlation was found between low risk category and RARS with better survival as compared to other risk categories/FAB subtypes (p < 0.01). However, rest of the FAB subtypes were assigned into high, intermediate and low risk categories without any correlation with the survival and/or leukemic transformation. RARS subtype revealed itself as the better prognostic category according to the cytogenetic findings as well as Mufti's grading system. This was possible due to the longer follow up available for these patients (40-59 months).
  5,207 455 8
Brainstem abscess: The nonsurgical management
R Gupta, S Mohindra, R Chhabra
January-March 2008, 51(1):49-50
DOI:10.4103/0377-4929.40395  PMID:18417854
The brainstem is an unusual location for a pyogenic abscess. Stereotactic aspiration or microsurgical drainage may be required in antibiotic refractory cases. Prolonged antibiotic therapy, along with symptomatic treatment may provide successful outcome. We report a case of cerebellar and brainstem abscess, managed successfully with prolonged antibiotic administration.
  5,424 204 -
Evaluation of iron status: Zinc protoporphyrin vis-a-vis bone marrow iron stores
Sheila Das, Kandathil Joseph Philip
January-March 2008, 51(1):105-107
DOI:10.4103/0377-4929.40418  PMID:18417877
Zinc protoporphyrin (ZPP) in the red cells is an indicator of iron status in the bone marrow (BM) and can be easily measured by Protofluor-Z Hematofluorometer from Helena Laboratories. It is well known that bone marrow iron is a gold standard for the diagnosis of iron deficiency anemia (IDA) even in the pre-latent phase. Hence, it was considered pertinent to evaluate the diagnostic utility of ZPP in comparison with bone marrow iron stores. 107 random BM were selected over a period of 2˝ years; in each case, RBC indices where recorded along with ZPP and Perls' Prussian blue reaction for BM iron stores. The specificity and sensitivity were found to be 77.8% and sensitivity 69.8%, respectively. However, the sensitivity increased up to 96.2% when Hb, RBC indices and ZPP were considered for the diagnosis of IDA.
  5,200 366 5
Primary intraosseous meningioma
N Marwah, S Gupta, S Marwah, S Singh, R Kalra, B Arora
January-March 2008, 51(1):51-52
DOI:10.4103/0377-4929.40396  PMID:18417855
Primary intraosseous meningioma of the skull is an uncommon lesion often confused preoperatively with a primary bone tumor of the skull. We report this rare tumor in a 19-year-old male who was radiographically diagnosed as osteoid osteoma.
  5,226 293 10
Hymenolepis diminuta in a child from rural area
Smita Watwe, Charan Kaur Dardi
January-March 2008, 51(1):149-150
DOI:10.4103/0377-4929.40431  PMID:18417890
We report a rare case of Hymenolepis diminuta infection in a 12-year-old girl from a rural area of Devghar.
  5,236 223 16
Hemophagocytic syndrome
Subhashish Das, R Kalyani
January-March 2008, 51(1):125-126
DOI:10.4103/0377-4929.40424  PMID:18417883
  4,652 513 1
Primary tuberculosis of tongue
AB Sharma, DK Laishram, B Sarma
January-March 2008, 51(1):65-66
DOI:10.4103/0377-4929.40402  PMID:18417861
Primary tuberculosis of tongue is very rare with unusual presentation creating a diagnostic dilemma. We report a case of primary tuberculosis of tongue in a 49-year-old female patient. Tuberculosis was not suspected clinically and there was no other focus elsewhere in the body. Fine needle aspiration cytology was attempted but was inconclusive. The diagnosis was made after histopathological examination.
  4,894 259 6
Morphological spectrum of AIDS-related plasmablastic lymphomas
S Gujral, TM Shet, SV Kane
January-March 2008, 51(1):121-124
DOI:10.4103/0377-4929.40423  PMID:18417882
We have had a recent spurt in cases of AIDS-related lymphoma (ARL) at our centre. Most of these cases are aggressive mature B cell lymphomas, mainly plasmablastic lymphoma (PBL) and diffuse large B-cell lymphoma (DLBCL). Most of the PBL are extranodal in location and are mucosa-based. We reviewed the morphological features of 34 cases of PBL. Diagnosis was based on morphology, immunohistochemistry, proliferation index, HIV positive status and its preference to extranodal sites (mostly mucosa based). We classified PBL into three morphological subtypes (immunoblastic - 25, Burkitt's - 7, plasmacytic - 2). Tumor cells expressed as leucocyte common antigen (LCA) in 60%, CD138 in 100%, EMA in 45% and light chain restriction in 86% cases. CD20 was negative in all cases. Pathologists need to be aware of PBL and its various morphological subtypes as the identification of this entity from its close differentials carries major therapeutic implications.
  4,670 389 12
Sebaceous differentiation in odontogenic keratocyst
T Shamim, V Ipe Varghese, PM Shameena, S Sudha
January-March 2008, 51(1):83-84
DOI:10.4103/0377-4929.40410  PMID:18417869
Sebaceous glands are common in the oral mucosa, but are not normally present with in the jaws. A case of an odontogenic keratocyst with sebaceous glands in the epithelium in a 12-year-old child is presented here, with special emphasis on its histogenesis.
  4,571 313 1
Gleason scoring of prostatic carcinoma: Impact of a web-based tutorial on inter- and intra-observer variability
K Mulay, M Swain, S Jaiman, S Gowrishankar
January-March 2008, 51(1):22-25
DOI:10.4103/0377-4929.40385  PMID:18417844
A total of 40 cases of prostatic adenocarcinomas were scored independently by four pathologists using the Gleason scoring system. After attending a web-based tutorial, the scoring was repeated by all. Consensus scores were obtained by simultaneous viewing of each case in a multihead microscope by all four pathologists. The scores were then compared. The pretutorial kappa (κ) values ranged from 0.36 to 0.64 with an average of 0.459. After the tutorial, the κ values ranged from 0.44 to 0.678 with the average κ value increasing to 0.538, thus indicating an improvement in the agreement. The intraobserver agreement ranged from 0.435 to 0.788. We conclude that web-based tutorials with emphasis on images developed by experts serve to achieve an uniformity in reporting.
  4,495 280 7
A study of proliferative activity, angiogenesis and nuclear grading in renal cell carcinoma
NK Bhattacharyya, U Chatterjee, S Sarkar, AK Kundu
January-March 2008, 51(1):17-21
DOI:10.4103/0377-4929.40384  PMID:18417843
To evaluate the role of proliferative marker, proliferating cell nuclear antigen (PCNA) and microvessel density (MVD) as prognostic markers in renal cell carcinoma (RCC) and to see their relationship with the clinical stage and nuclear grades, we studied 30 cases of RCC for nuclear grading (Fuhrman's nuclear grade), MVD (using anti CD-34 antibody), and PCNA labeling index (using anti-PCNA antibody) over a period of 2.5 years. Staging was assessed by peroperative and radiologic findings. The area of highest MVD within the tumor was selected for microvessel count (MVC) per high-power field (0.1885 mm 2 area). PCNA labeling index was determined by counting percentage of positively stained tumor cell nuclei. PCNA labeling index above 60% was taken as high PCNA index and up to 60% was considered low. There was significant positive correlation between PCNA labeling index with both nuclear grade and clinical stage using Spearman's correlation coefficient. No association was noted between MVC with PCNA, nuclear grade, and clinical stages. Evaluation of proliferative status of RCC is a useful adjunct as a prognostic parameter as it is seen to correlate well with both clinical stage and nuclear grade. In our study, MVD was not seen to correlate with either of these.
  4,364 363 11
Cutaneous metastasis from follicular variant of papillary thyroid carcinoma: A case diagnosed on cytology
Jayati Chakraborty, Anjali Bandyopadhyay, Manoj K Choudhuri, Kalyani Mitra, Debasish Guha, Mamata Guha Mallik
January-March 2008, 51(1):91-93
DOI:10.4103/0377-4929.40414  PMID:18417873
A 40-year-old woman presented with a scalp swelling. A careful clinical examination revealed a left-sided deep-seated thyroid nodule. Fine needle aspiration from both sites disclosed a microfollicular architectural pattern on Giemsa stain and pale nuclei with nuclear grooves on Papanicolaou stain, indicating the possibility of follicular variant of papillary thyroid carcinoma with metastasis to the scalp. Histologic tissue evaluation confirmed the diagnosis. Thus, a diligent search for nuclear features should be performed to enable a diagnosis of follicular variant of papillary thyroid carcinoma on cytology. This helps in patient management obviating the need for a second surgical intervention.
  4,467 203 5
Melanocytoma of cerebellum
S Rai, M Sharma, R Naik, R Sinha, R Philipose, R Verghese
January-March 2008, 51(1):47-48
DOI:10.4103/0377-4929.40394  PMID:18417853
Melanocytomas are rare melanocytic tumors of the central nervous system. We report a rare case of melanocytoma in the cerebellum of a 35-year-old male patient. Computed tomography scan showed a cystic lesion with an enhancing solid component arising from the cerebellum. The lesion was resected and a histological diagnosis of melanocytoma of the cerebellum was made.
  4,485 178 3
Testicular retiform Sertoli cell tumor: A problem in histopathologic diagnosis
K Mardi, J Sharma
January-March 2008, 51(1):70-71
DOI:10.4103/0377-4929.40404  PMID:18417863
A 9-year-old boy who presented with a left scrotal swelling was subsequently diagnosed as retiform sertoli cell tumor of testis which consisted entirely of retiform pattern. The case is reported in view of its rarity in this age group as well as its unique histologic appearance.
  4,347 146 2
Ocular thelaziasis in Assam: A report of two cases
Reema Nath, Kanwar Narain, Lahori Saikia, Bharati Sarma Pujari, Bhaskar Thakuria, J Mahanta
January-March 2008, 51(1):146-148
DOI:10.4103/0377-4929.40430  PMID:18417889
Small, white, thread-like, motile worms were recovered from the conjunctival sac of a 13-year-old girl and a 50-year-old woman from Dibrugarh district, Assam, India. They were identified as thelazia species. These two cases have been reported due to their rarity in India and elsewhere.
  4,267 193 2
Morbidity pattern of hydatid disease (cystic echinococcosis) and lack of its knowledge in patients attending Mamata General Hospital, Khammam, Andhra Pradesh
S Suguna Hemachander, C Rajendra Prasad, M Jessica
January-March 2008, 51(1):143-145
DOI:10.4103/0377-4929.40429  PMID:18417888
There is hearsay that prevalence of hydatid disease in Khammam and Nalgonda districts of Andhra Pradesh is high. We report here a preliminary study conducted to determine the magnitude of the problem of hydatid disease and the morbidity associated with it in patients attending MGH, KMM, A.P. (rural hospital). Eleven cases were identified during the period from November 2005 to May 2006 (seven months). Pain in abdomen, mass per abdomen, loss of appetite, pregnancy complicated by cystic echinococcosis (CE), and jaundice were the main clinical symptoms and signs. Ultrasonography, detection and removal of the cysts on the operation table, microscopic examination of the aspirated hydatid fluid were confirmatory. Ziehl-Neelsen stain of the aspirated fluid revealed acid-fast scolices. Interrogation of the patients and their family members (50) revealed that there was a total lack of knowledge of dog-tapeworm-caused infection in humans. They knew 'rabies' as the only disease man gets from dogs, and tapeworms are from pork and beef.
  4,119 230 3
Granular acute lymphoblastic leukemia in an adult patient
Hema Anand, Seema Tyagi
January-March 2008, 51(1):116-117
DOI:10.4103/0377-4929.40421  PMID:18417880
Granular acute lymphoblastic leukemia (G-ALL) may mimic the diagnosis of acute myeloid leukemia due to the presence of cytoplasmic granules found in the lymphoblasts. This rare variant is commonly seen in children but may occur in adults also. We report a case of G-ALL in an adult female patient.
  4,131 203 2
Filarial granuloma in breast
A Patrikar, S Maimoon, S Mahore
January-March 2008, 51(1):85-86
DOI:10.4103/0377-4929.40411  PMID:18417870
A case of filarial granuloma in breast in a 59-year-old female is reported. Adult worm was identified in a breast nodule.
  4,114 200 6
Extraskeletal osteogenic sarcoma: A rare entity
V Maheshwari, AS Farhan, K Alam Adreena
January-March 2008, 51(1):56-57
DOI:10.4103/0377-4929.40398  PMID:18417857
A 25-year-old female presented with a rapidly increasing painful swelling around right lower thigh and knee for the last 5 months with distant metastasis in the form of lung involvement. X-ray of the part showed only soft tissue swelling without any bony involvement. A diagnosis of extraskeletal osteosarcoma was made which was confirmed by immunohistochemistry.
  3,981 193 3
Sporotrichosis in Mysore: A case report to emphasize the role of histopathology
S Suchitha, B Vijaya, R Sunila, K Anuradha, R Savitha
January-March 2008, 51(1):45-46
DOI:10.4103/0377-4929.40393  PMID:18417852
Lymphocutaneous sporotrichosis is unusual in southern India. The diagnosis was made by histopathological examination which is purported to have poor sensitivity. The culture of the specimen confirmed the diagnosis. The pre-eminent role of a careful study of serial sections is emphasized.
  3,892 238 -
Primary cardiac sarcoma
UN Khadilkar, R Harish, G Tantry, S Kumar, A Tiwari
January-March 2008, 51(1):30-31
DOI:10.4103/0377-4929.40387  PMID:18417846
Primary cardiac sarcomas are uncommon entities. The diagnosis of sarcoma is not made preoperatively because of the rarity of the lesion and the nonspecific nature of the signs and symptoms. This is a report of a case of primary sarcoma arising from the left atrium, in a patient who presented with acute dyspnoea; the sarcoma resembled an atrial myxoma on echocardiography.
  3,916 168 -
Primary bilateral tubal adenocarcinoma associated with uterine leiomyomas
B Sarangthem, S Laishram, A Barindra Sharma, R Konjengbam, K Debnath
January-March 2008, 51(1):32-33
DOI:10.4103/0377-4929.40388  PMID:18417847
Primary adenocarcinoma of the fallopian tube is the least common primary malignant tumor of the female genital tract. Bilaterality is also rare. Often the diagnosis is mistaken for ovarian tumor or tubo-ovarian mass. A case of bilateral primary tubal adenocarcinoma of serous type associated with uterine leiomyomas, without evidence of metastasis occurring in a postmenopausal woman is being reported.
  3,528 167 1
From the Editor's desk
S Satyanarayana
January-March 2008, 51(1):1-1
DOI:10.4103/0377-4929.40381  PMID:19562055
  2,232 141 -
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