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   2009| July-September  | Volume 52 | Issue 3  
    Online since August 12, 2009

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Bone marrow biopsy in non-Hodgkin lymphoma: A morphological study
Suneet Kumar, Aarathi R Rau, Ramadas Naik, Hema Kini, Alka M Mathai, Muktha R Pai, Urmila N Khadilkar
July-September 2009, 52(3):332-338
DOI:10.4103/0377-4929.54987  PMID:19679954
Context: Bone marrow (BM) biopsy is an integral part of staging work-up for non-Hodgkin lymphoma (NHL). Aims: To study the characteristics of BM involvement in NHL with respect to incidence, histologic pattern and morphology of infiltration and its discordance with the histology of primary anatomic site. Settings and Design: Forty-nine cases of NHL in which BM biopsy was performed for staging were included in this study, the primary site being classified according to the WHO classification for NHL. Materials and Methods: A prospective study of 49 cases was conducted. Bilateral BM biopsy was obtained from the posterior superior iliac spine. The biopsies were fixed in 10% buffered formalin solution and decalcified using 10% formal - formic acid for 4 - 6 h followed by routine processing. The serial sections were stained by hematoxylin and eosin and reticulin stains. Results: BM biopsy showed involvement by lymphoma in 27 cases (55.10%). Unilateral positivity was found in four cases (14.81% cases). The overall incidence of marrow involvement by NHL was 55.1%. The incidence of involvement was higher in T-cell lymphomas when compared with B-cell lymphomas and predominant pattern of involvement was mixed. Diffuse large B-cell lymphomas had the lowest incidence in all the B-cell lymphomas. A discordant histology between BM and primary anatomic site was found in 29.63% (8/27) of the cases, where it was seen more in follicular lymphomas and diffuse large B-cell lymphomas. Conclusions: Critical examination of BM biopsies can increase the diagnostic accuracy, thereby contributing to the prognosis and appropriate treatment modalities.
  14,289 954 5
Approach to diagnosis of auto-immune hepatitis
Megha Joshi, Urmila Khettry
July-September 2009, 52(3):297-303
DOI:10.4103/0377-4929.54979  PMID:19679947
Auto-immune hepatitis (AIH) is one of the chronic liver diseases, seen predominantly in women, resulting from dysregulated immune mechanisms not yet clearly defined. Based on a combination of clinical and laboratory parameters with both positive and negative weights, the International AIH Group devised a scoring system in 1993. The system was modified in 1999 and has proven useful for both diagnostic and research purposes. This review deliberates on the clinical, immunological and histological features of this entity.
  10,526 2,042 2
Improved microscopical detection of acid-fast bacilli by the modified bleach method in lymphnode aspirates
Vamseedhar Annam, Mahesh H Karigoudar, Balasaheb Ramalingappa Yelikar
July-September 2009, 52(3):349-352
DOI:10.4103/0377-4929.54991  PMID:19679958
Objectives: To improve the smear microscopy for detection of acid-fast bacilli (AFB) in fine needle aspiration cytology (FNAC) of lymph node using the bleach method and also to compare this with cytological diagnosis and the conventional Ziehl-Neelsen (ZN) method. Study Design: In 99 consecutive patients with clinical suspicion of tuberculosis (TB) presenting with lymphadenopathy, FNACs were performed. Smears from the aspirates were processed for routine cytology and the conventional ZN method. The remaining material in the needle hub and/or the syringe was used for the bleach method. The significance of the bleach method over the conventional ZN method and cytology was analyzed using the χ2 test. Results: Of 99 aspirates, 93 were studied and the remaining six were excluded from the study due to diagnosis of malignancy in 4.04% (4/6) and inadequate aspiration in 2.02% (2/6). Among the 93 aspirates, 33.33% (31/93) were positive for AFB on conventional ZN method, 41.94% (39/93) were indicative of TB on cytology and the smear positivity increased to 63.44% (59/93) on bleach method. Conclusion: The bleach method is simple, inexpensive and potent disinfectant, also limiting the risk of laboratory-acquired infections. The implementation of the bleach method clearly improves microscopic detection and can be a useful contribution to routine cytology.
  9,610 651 8
Hemoglobin color scale a diagnostic dilemma
Hema Anand, Rashid Mir, Renu Saxena
July-September 2009, 52(3):360-362
DOI:10.4103/0377-4929.54994  PMID:19679961
Hemoglobin color scale (HCS) is a commercially available test to screen anaemia in the absence of laboratory based hemoglobinometry. The present study was aimed at to compare the efficacy of HCS with Sahli's method (SM) for haemoglobin estimation and to estimate its sensitivity and specificity with respect to auto analyzer as the gold standard. The study was conducted from November 2006 to April 2007 at the department of hematology, All India Institute of Medical Sciences, New Delhi as a project of World Health Organization. The haemoglobin level was measured by all the three methods in 401 patients attending Haematology out patient department. Consent was taken from all the patients. Sensitivity of Sahli's method was 98.2% and specificity was 66.2%, whereas the sensitivity of HCS was 30% and specificity was 100%. Sahli's method was found to be in good agreement with autoanalyzer (gold standard). It was thus concluded that HCS is not as efficacious, as sahil's method for hemoglobin estimations in field.
  9,503 690 7
Melasma: A clinicopathological study of 43 cases
Vermani Sarvjot, Shruti Sharma, Sharmila Mishra, Avninder Singh
July-September 2009, 52(3):357-359
DOI:10.4103/0377-4929.54993  PMID:19679960
Melasma is a symmetrical hypermelanosis of the exposed skin characterized by brown macules on the sun-exposed areas of the skin. The present study was carried out on 43 patients to analyze the correlation between histopathological features with clinical and Wood's light examination. The study showed a clinical and histopathological discordance of 16.2%. Solar elastosis (55.8%) was the single most common histological finding apart from increased melanin concentration, epidermal flattening and dermal lymphomononuclear inflammation.
  8,943 609 23
Congenital sideroblastic anemia: A report of two cases
Sanjeev Kumar Gupta, Seema Rao, Rakhee Kar, Seema Tyagi, Hara Prasad Pati
July-September 2009, 52(3):424-426
DOI:10.4103/0377-4929.55015  PMID:19679982
Sideroblastic anemia, comprising of acquired and congenital forms, is a heterogeneous group of disorders characterized by the presence of ring sideroblasts in the bone marrow. Congenital sideroblastic anemia is a rare condition which is mostly X-linked, caused by mutations of delta-aminolevulinic acid synthase 2. We describe two cases of congenital sideroblastic anemia, one of them indicating an autosomal recessive inheritance, with their clinico-hematological profile. It is important to recognize this entity early in life as a significant percentage of cases respond to pyridoxine thus avoiding any long-term complications.
  7,636 365 -
Salpingitis isthmica nodosa
Nitin Chawla, Sandip Kudesia, Sheenam Azad, Mini Singhal, SML Rai
July-September 2009, 52(3):434-435
DOI:10.4103/0377-4929.55019  PMID:19679986
  7,475 300 4
Ventilator-associated pneumonia caused by carbapenem-resistant Enterobacteriaceae carrying multiple metallo-beta-lactamase genes
Mayank Dwivedi, Anshuman Mishra, Afzal Azim, RK Singh, AK Baronia, KN Prasad, TN Dhole, UN Dwivedi
July-September 2009, 52(3):339-342
DOI:10.4103/0377-4929.54988  PMID:19679955
Context: Ventilator-associated pneumonia (VAP) is a leading nosocomial infection in the intensive care unit (ICU). Members of Enterobacteriaceae are the most common causative agents and carbapenems are the most commonly used antibiotics. Metallo-beta-lactamase (MBL) production leading to treatment failure may go unnoticed by routine disc diffusion susceptibility testing. Moreover, there is not much information on association of MBL-producing Enterobacteriaceae with ICU-acquired VAP. Therefore, a study was undertaken to find out the association of MBL-producing Enterobacteriaceae with VAP. Settings: This study was conducted in a large tertiary care hospital of North India with an eight-bed critical care unit. Materials and Methods: The respiratory samples (bronchoalveolar lavage, protected brush catheter specimens and endotracheal or transtracheal aspirates) obtained from VAP patients (during January 2005-December 2006) were processed, isolated bacteria identified and their antibiotic susceptibilities tested as per standard protocols. The isolates of Enterobacteriaceae resistant to carbapenem were subjected to phenotypic and genotypic tests for the detection of MBLs. Results: Twelve of 64 isolates of Enterobacteriaceae were detected as MBL producers, bla IMP being the most prevalent gene. Additionally, in three strains, simultaneous coexistence of multiple MBL genes was detected. Conclusion: The coexistence of multiple MBL genes in Enterobacteriaceae is an alarming situation. As MBL genes are associated with integrons that can be embedded in transposons, which in turn can be accommodated on plasmids thereby resulting in a highly mobile genetic apparatus, the further spread of these genes in different pathogens is likely to occur.
  6,985 779 6
Histopathological study of pruritic papular eruptions in HIV-infected patients in relationship with CD4, CD8 counts
Vamseedhar Annam, BR Yelikar, Arun C Inamadar, Aparna Palit
July-September 2009, 52(3):321-324
DOI:10.4103/0377-4929.54984  PMID:19679951
Background: Pruritic papular eruptions (PPE) are common cutaneous manifestations in HIV-infected patients. Their frequencies, patterns and associated factors vary from region to region. There is no clear consensus on the etiology of PPE, the exact spectrum of the condition, the pathologic findings, or treatment. The present study is aimed at documenting the histopathological patterns of PPE, and their relation with CD4, CD8 counts in HIV-infected patients. Materials and Methods: The present study lasted for 12 months (September 2005 to August 2006). After informed consent, data on skin disorders, HIV status, CD4 and CD8 counts were obtained by physical examination and laboratory methods. Results: Of the 36 HIV-infected patients with clinical diagnosis of PPE, the most common histopathological patterns were prurigo simplex and eosinophilic folliculitis. The mean CD4 count of PPE was 186.49 cells/mm 3 with mean CD8 count of 619.60 cells/ mm 3 , and the CD4:CD8 ratio was 0.32. Patients with prurigo simplex had significantly lower mean CD4 counts (50.36 30.67 cells/cmm 3 , P < 0.001) while in eosinophilic folliculitis, the mean CD8 counts were higher (1239.77 402.30 cells/cmm 3 ). Conclusion: We conclude that histopathology helps in specifying the pattern of PPE and also indicates underlying immunosuppression and can be a marker of advanced HIV infection. Thus, correlation between the histopathology and immunology findings helps to know the disease process.
  7,198 369 2
Osteopetrosis: A rare cause of anemia - Review of literature
S Saluja, S Bhandari, S Aggarwal, S Kapoor
July-September 2009, 52(3):363-367
DOI:10.4103/0377-4929.54995  PMID:19679962
Normocytic anaemia is caused either by hypoproliferation of haemopoietic tissue or increased destruction of red cell. Osteopetrosis is a rare cause of anaemia. The leading clinical features are pallor, growth failure, hepatosplenomegaly.On hematological examination, anemia, thrombocytopenia, leucocytosis and myelophthisic anemia are commonly observed in this disease. We are highlighting osteopetrosis as a rare cause of anemia presenting to us for evaluation of anemia
  6,966 435 3
Serological profile of HSV-2 in patients attending STI clinic: Evaluation of diagnostic utility of HSV-2 IgM detection
Shilpee Choudhry, VG Ramachandran, Shukla Das, SN Bhattacharya, Narendra Singh Mogha
July-September 2009, 52(3):353-356
DOI:10.4103/0377-4929.54992  PMID:19679959
Objective: The present study was done to evaluate the serological profile of herpes simplex virus-2 (HSV-2) among patients attending sexually transmitted infections (STI) clinic and to determine the utility of detecting HSV-2 IgM antibodies in such patients. A correlation of HSV-2 infection with other STI including HIV has also been attempted. Materials and Methods: Hundred consecutive patients who attended STI clinic, with one or more of the complaints as enunciated by WHO in syndromic approach for the diagnosis of STI, were included as subjects. All subjects were screened for common STI by standard laboratory procedures/ commercially available kits. HSV-1 and HSV-2 IgM antibody was detected by commercially available enzyme immuno assay kit in all patient's sera. Sera were also tested for other STI, namely HIV, Hepatitis B virus, Hepatitis C virus and Treponema pallidum. Antigen detection for Chlamydia trachomatis was done in genital swabs of all patients by Bio-Rad Chlamydia Microplate EIA 31189 (United States) kit. Results: Thirty patients were found to have genital herpes. In 17/30 (56.6%) patients, HSV-2 serology was found to correlate with the clinical diagnosis. The coexistence of other infection in HSV-2 seropositive patients was detected in 8/30 patients. None of the patients having concomitant infections were clinically diagnosed accurately. Sensitivity, specificity, positive predictive value and negative predictive value of IgM antibodies for the diagnosis of genital herpes was 73.91%, 90.91%, 70.83% and 92.91% respectively. Conclusion: HSV-2 IgM detection could only be used as a supportive test for the diagnosis of genital herpes . It needs to be emphasized that the sensitivity and positive predictive value scores are pointers for further improvement in the commercial assay systems and a large sample size may determine the broader utility of such systems.
  6,125 364 5
Urinary tract infection due to Enterobacter sakazakii
Gopalkrishna K Bhat, RS Anandhi, VC Dhanya, Shalini M Shenoy
July-September 2009, 52(3):430-431
DOI:10.4103/0377-4929.55017  PMID:19679984
Enterobacter sakazakii is a rare but important cause of necrotizing enterocolitis, bloodstream infection and central nervous system infections in humans, with mortality rates of 40-80%. It has not been reported to cause urinary tract infection. We report a case of urinary tract infection due to E. sakazakii in a 63-year-old lady with chronic renal failure.
  5,996 341 10
Pure choriocarcinoma of ovary diagnosed by fine needle aspiration cytology
MR Naniwadekar, SR Desai, NS Kshirsagar, NN Angarkar, VD Dombale, SV Jagtap
July-September 2009, 52(3):417-420
DOI:10.4103/0377-4929.55013  PMID:19679980
Pure ovarian choriocarcinoma is extremely rare and can develop as a germ cell tumor or as a metastasis from uterine or tubal gestational choriocarcinoma or rarely from an ovarian pregnancy. The cytomorphologic findings have been reported previously in different sites. However, this is the first case of pure ovarian choriocarcinoma diagnosed on cytology to the best of our knowledge. The distinction between a gestational and nongestational choriocarcinoma is difficult. A 19-year-old female patient presented with an irregular per-vaginal bleeding and a mass in lower abdomen. Fine needle aspiration cytology smears of the mass were hypocellular and showed large, multinucleated giant cells and malignant mononucleated cells. Background was hemorrhagic. Serum β hCG level was 3,80,000 mIU/ml. A diagnosis of choriocarcinoma was offered which was later confirmed by histopathology. The diagnosis of choriocarcinoma on fine needle aspiration cytology is based on the presence of large, multinucleated giant cells and malignant mononucleated cells. A high index of suspicion should be maintained and estimation of serum β hCG plays a key role in supporting the diagnosis.
  5,965 248 6
Renal and perinephric abscess due to Staphylococcus aureus
VP Baradkar, M Mathur, S Kumar
July-September 2009, 52(3):440-441
DOI:10.4103/0377-4929.55022  PMID:19679989
  5,816 296 5
Making and using inexpensive manually constructed tissue micro-array: Experience of a tertiary care hospital in India
Deepak Kumar Singh, Puja Sakhuja, Ranjana Gondal
July-September 2009, 52(3):304-309
DOI:10.4103/0377-4929.54980  PMID:19679948
Background: Tissue micro-array enables the analysis of a large number of tissues simultaneously. Widespread use of this technology is hampered by the high cost of commercial array instruments. We describe our experience of constructing tissue micro-array in a simple method using easily available and inexpensive instruments. Materials and Methods: We used an 11-19 gauge (G) bone marrow trephine biopsy needle/ small sized slotted screwdriver to punch holes in the wax blocks. Cores were taken from donor tissue blocks using a bone marrow trephine biopsy needle and arrayed into host paraffin wax blocks. A detailed database was constructed for each array constructed. Results: The array blocks were used over a period of one year as internal control for immunohistochemistry (IHC), quality control and research. It took about 10 minutes to construct a nine-dot array and about one hour for a 56-dot array. During IHC, the average loss of control dots was less than one per cent. We did not see any loss of antigenicity in the control sections even after four weeks storage. Discussion: Tissue array construction by the technique described here is inexpensive and reliable alternative to automated instruments. Because it is easy to modify the arrays by varying the core size, it is easy to adapt this to individual labs and requirements. We recommend using blocks with cores in 3 3 to 5 4 grids as controls in IHC and for standardizing antibodies and array blocks with a larger number of cores for research.
  4,967 1,111 7
Direct drug susceptibility testing of Mycobacterium tuberculosis to primary anti-tubercular drugs by nitrate reductase assay
Baijayanti Mishra, S Muralidharan, H Srinivasa
July-September 2009, 52(3):343-344
DOI:10.4103/0377-4929.54989  PMID:19679956
Objectives: Traditional drug susceptibility testing for Mycobacterium tuberculosis takes weeks and/or expensive. In this study, we evaluated nitrate reductase assay for drug susceptibility testing which is faster than the visual detection of colonies. Materials and Methods: 32 clinical specimens (direct microscopy positive for AFB with 1+, 2+ or 3+ grading) were decontaminated and the sediment was inoculated onto the L-J medium with INH or Rifampicin incorporated with Potassium nitrate and the same medium without antibiotics at 1;10 dilution as control. After 2 weeks, the control was first tested for color change with addition of nitrate reductase reagents. If found positive, the media with antibiotics were tested and compared. Futher incubation was done if the control was found to be negative. The results obtained was compared with standard direct proportion method for drug susceptibility testing. Results: Resistance of isolates as shown by both methods for INH and Rifampicin was 37.5% and 31.3% respectively. The results showed that NRA and proportion method do not differ significantly ( P < 0.05 for both drugs). Thus an excellent agreement between the results of NRA and proportion method was found for two primary anti-tubercular drugs, 87.5% for INH and 97% for Rifampicin. Conclusion: Nitrate reductase assay is a rapid and inexpensive method for susceptibility testing of M. tuberculosis for primary anti-tubercular drugs and could be an alternative to existing methods, particularly in resource poor settings.
  5,070 535 4
Primary hyperparathyroidism: A clinicopathological experience
Pragati A Sathe, Chitra V Madiwale, Bhuvaneshwari M Kandalkar, Tushar R Bandgar, Nalini S Shah, Padma S Menon
July-September 2009, 52(3):313-320
DOI:10.4103/0377-4929.54983  PMID:19679950
Background: Parathyroid neoplasms form a small percentage of head and neck neoplasms. Primary hyperparathyroidism is caused by parathyroid adenomas, hyperplasia or, rarely, a carcinoma. Materials and Methods: This is a retrospective study of 48 parathyroidectomies received in the Department of Pathology of a major teaching hospital over a period of 10 years. Clinical, biochemical and radiological details were retrieved from medical records. Information regarding routine gross and microscopic examination findings (including frozen section and paraffin sections) was retrieved from departmental records. Results: We had 43 adenomas, three hyperplasias and two carcinomas. The most common age group was 21-30 years. The female:male ratio was 2.5:1. Most patients presented with skeletal manifestations. The pre-operative diagnosis was assisted by ultrasonography in 11 cases, computerized tomography of the neck in 10 cases and sestamibi scans in three cases. Intra-operative parathormone monitoring was performed in one case of adenoma. Frozen section was requested in 28 of 48 cases. There was a discrepancy between frozen section diagnosis and paraffin section diagnosis in two cases. Conclusion: Histopathologic diagnosis is an important guide to decide the type of surgical management. Although pathologic features of parathyroid carcinoma are diagnostically reliable, those of the more commonly encountered lesions of adenoma and hyperplasia may be overlapping and, therefore, indistinctive, more so if only a single gland is available for examination. Because parathyroid lesions are only occasionally encountered by the surgical pathologist, awareness of the spectrum of histologic features along with knowledge of recent trends in diagnosis and surgical management are important.
  4,554 431 9
Endodermal sinus tumor of the vagina in children: A report of two cases
Mimi Gangopadhyay, Kalpana Raha, Swapan K Sinha, Anuradha De, Pranati Bera, Shyamapada Pati
July-September 2009, 52(3):403-404
DOI:10.4103/0377-4929.55008  PMID:19679975
Malignant tumors of the vagina in infants and children are rare, with primary germ cell tumor (endodermal sinus tumor [EST]) being rarer, which carries a dismal prognosis. This tumor is often clinically mistaken as botryoid rhabdomyosarcoma and, on histopathological examination, is often misdiagnosed as clear cell adenocarcinoma. Two cases of EST of the vagina in infants aged 9 and 17 months are reported. Both the patients presented with bleeding per vagina and clinically and by ultrasonography were diagnosed as sarcoma botryoides. Both were diagnosed as primary yolk sac tumors. The serum alfa fetoprotein (AFP) level was 4325 and 9328 ng/ml, respectively. One patient aged 9 months expired 2 months after receiving chemotherapy. The other, aged 17 months, was given chemotherapy followed by surgery with reduction of the AFP levels.
  4,613 213 5
Osseous metaplasia and mature bone formation with extramedullary hematopoiesis in follicular adenoma of thyroid gland
Mohan Harsh, Parul Dimri, Nitin M Nagarkar
July-September 2009, 52(3):377-378
DOI:10.4103/0377-4929.54999  PMID:19679966
Follicular adenomas of the thyroid may be subjected to degenerative changes like hemorrhagic and cystic changes, fibrosis, and calcification. Mature bone formation is a rare phenomenon, but extramedullary hematopoiesis (EMH) has also been rarely reported in thyroid gland. The combination of mature bone formation and EMH is rarer and has been reported, in a single case report, in a multinodular goitre. We describe a case of follicular adenoma with histologically proven osseous metaplasia and mature bone formation with EMH in a middle- aged woman, which, to our knowledge, is the first case in English language literature.
  4,495 208 9
Significance of cytomorphological and microbiological examination of bile collected by endoscopic cannulation of the papilla of vater
Vatsala Misra, Sri P Misra, Premala A Singh, Manisha Dwivedi, Kachnar Verma, Upma Narayan
July-September 2009, 52(3):328-331
DOI:10.4103/0377-4929.54986  PMID:19679953
Background: Bile analysis yields important information such as "biliary microlithiasis" and biliary tract colonization by microorganisms like Salmonella typhi or paratyphi, Escherichia coli , etc., which may progresses to cholelithiasis and have been found to have a role in the development of gallbladder cancer in India. Aim: To perform microscopic, cytomorphological and microbiological examination of bile collected during endoscopic retrograde cholangiopancreatography in patients with benign and malignant lesions of the gallbladder. Materials and Methods: Bile was collected from 48 patients by a catheter inserted through the cystic duct during endoscopic retrograde cholangiopancreatography. Direct microscopy and grading of crystals was performed. Smears prepared from centrifuged deposits were stained with Giemsa, Papanicolaou stain and Gram's stain for cytological and microbiological examination. Special staining for Helicobacter pylori was performed using Loeffler's Methylene blue and Warthin Starry stain. The rest of the sample was used for culture and complete microbiological examination. Results: Thirty-six patients had inflammatory lesions while 12 had malignant lesions. Crystals were observed in 93% of the cases, 13 (28.8%) had only cholesterol crystals, three (6.6%) had bilirubinate and 29 (64.4%) had both cholesterol and bilirubinate crystals. Smears from the centrifuged deposit mainly showed coccoid or cocobacillary bacteria on Gram's staining (81.3%). Five of 12 (41.6%) malignant cases showed epithelial atypia while none of the benign or inflammatory lesions showed such a change in hematoxylin and eosin and Pap-stained smears. Microbiologic analysis showed Staphylococcus aureus (14%), S. saprophyticus (5.5%), Peptococcus (5.5%), Peptostreptococcus (5.5%), Proteus mirabilis (5.5%), E. coli (17%), Enteorbacter cloacae (5.5%) and H. pylori (2.8%). Conclusion: Complete microscopic and microbiological examination of bile directly obtained from the common bile duct during endoscopic retrograde cholangiopancreatography yielded good results as fresh samples could be analyzed. It may help in diagnosis of many gallbladder lesions in early stages, thereby reducing the morbidity and mortality.
  4,291 324 4
Oncocytic sialolipoma of the submandibular gland with sebaceous differentiation: A new pathological entity
Teresa Pusiol, Ilaria Franceschetti, Michele Scialpi, Irene Piscioli
July-September 2009, 52(3):379-382
DOI:10.4103/0377-4929.55000  PMID:19679967
Case Report: We report the case of an oncocytic sialolipoma of the submandibular gland with sebaceous differentiation in a 73-year-old man. The initial symptom was a right submandibular painless mass. Ultrasonography showed a hypoechoic oval mass posterior to the submandibular gland. The tumorectomy was performed with preservation of the salivary gland. The tumor was composed of mature adipose tissue surrounded by a thin fibrous capsule, multiple nodules of oncocytes, normal ductal-acinar units with focal ductal sebaceous differentiation. Discussion: We reviewed literature of the reported cases of mixed tumors of the salivary glands composed of mature adipose tissue with oncocytosis, salivary ducts, and acini with sebaceous differentiation. Conclusions: Sialolipoma and lipoadenoma with or without oncocytosis and/or sebaceous differentiation should be considered organ-specific tumors with a distinct histological appearance and specific terminology.
  4,294 242 18
Hypergranular precursor B-cell acute lymphoblastic leukemia in a 16-year-old boy
Prashant R Tembhare, PG Subramanian, Kunal Sehgal, Badrinath Yajamanam, Ashok Kumar, Sumeet Gujral
July-September 2009, 52(3):421-423
DOI:10.4103/0377-4929.55014  PMID:19679981
Presence of cytoplasmic granules in the blasts is a well known feature of myeloid leukemia. ALL presenting with the numerous cytoplasmic granules in blasts is a rarity and may be misdiagnosed as acute myeloid leukemia. We describe a rare case of hypergranular precursor B-cell acute lymphoblastic leukemia (ALL) in an adolescent male expressing CD10, CD19, CytoCD22, CD34, as well as CD13 and CD117. The blasts were cytochemically negative for myeloperoxidase (MPO), and acid phosphatase (ACP) but were positive for non-specific esterase (NSE). In centers where immunophenotypic panel is usually decided on the basis of morphology with limited antibodies may result in an erroneous typing of such rare diseases. Hence it is important to be aware of this rare entity and to confirm the lineage of acute leukemia by using a comprehensive panel of antibodies for immunophenotypic analysis.
  4,273 234 4
Choroid plexus carcinoma: Report of two cases
Avninder Singh, Sarvjot Vermani, Sharma Shruti
July-September 2009, 52(3):405-407
DOI:10.4103/0377-4929.55009  PMID:19679976
Choroid plexus carcinomas (CPCs) are rare malignant counterparts of choroid plexus papilloma which occur in infants and children with a predilection for the posterior fossa and have a poor prognosis. We report two cases of CPC diagnosed in a 5-year-old boy and a 12-year-old boy and discuss the clinicopathologic features.
  4,241 212 3
Idiopathic splenic arteriolar hyalinosis
Jyotsna Madan, Ashish K Mandal
July-September 2009, 52(3):448-450
DOI:10.4103/0377-4929.55029  PMID:19679996
  4,268 126 -
Primary spinal extradural hydatid cyst causing paraplegia
Sushila Jaiswal, Awadhesh Kumar Jaiswal, Manoj Jain, Sanjay Behari, Rakesh Pandey
July-September 2009, 52(3):432-433
DOI:10.4103/0377-4929.55018  PMID:19679985
Spinal hydatid disease is an uncommon cause of spinal cord compression and it constitutes 1% of all cases of hydatid disease. The authors present a case of a 21-year-old female presenting with rapid onset paraplegia caused by pathologically confirmed by extradural spinal hydatid cyst. Patient had marked improvement following surgical intervention. The case is discussed and the relevant literature is briefly reviewed.
  4,132 208 4
Metanephric stromal tumor: A novel pediatric renal neoplasm
V Rajalakshmi, Philip Chandran, Selvambigai , Jai Ganesh
July-September 2009, 52(3):389-391
DOI:10.4103/0377-4929.55003  PMID:19679970
Metanephric stromal tumor of kidney is a novel pediatric benign stromal specific renal neoplasm. A few cases have been reported in adults also. This tumor is usually centered in the renal medulla with a characteristic microscopic appearance which differentiates this lesion from congenital mesoblastic nephroma and clear cell sarcoma of the kidney. In most cases complete excision alone is curative. The differentiation of metanephric stromal tumor from clear cell sarcoma of the kidney will spare the child from the ill effects of adjuvant chemotherapy. In this communication we describe the gross and microscopic features of metanephric stromal tumor in a one-month-old child with good prognosis.
  3,998 220 4
Extrarenal calyces: A rare anomaly of the renal collecting system
G Nataraju, BN Nandeesh, MN Gayathri
July-September 2009, 52(3):368-369
DOI:10.4103/0377-4929.54996  PMID:19679963
The abnormalities of the renal collecting system represent a complex and often confusing subset of urological anomalies. They manifest in many ways and often make preoperative diagnosis difficult. Extrarenal calyces (wherein the calyces and renal pelvis lie outside the renal parenchyma) is one of the rare anomaly of the collecting system. This anomaly may be associated with other anomalies of the urogenital system. We describe in this case report an unusual case of extrarenal calyces with five long calyces draining a hydronephrotic kidney with associated ureteral atresia. Radiological investigations failed to clearly define these abnormalities. The present case helps in understanding the characteristics of a rare, complex anomaly of the urinary system.
  4,014 197 2
Primary leiomyosarcoma of the penis
Shirley Sundersingh, Urmila Majhi, Kathiresan Narayanaswamy, Satheesan Balasubramanian
July-September 2009, 52(3):447-448
DOI:10.4103/0377-4929.55028  PMID:19679995
  4,034 177 7
Fulminant amebic colitis: A study of six cases
R Nisheena, Anuradha Ananthamurthy, YK Inchara
July-September 2009, 52(3):370-373
DOI:10.4103/0377-4929.54997  PMID:19679964
Background: Amebic colitis although common, rarely presents as fulminant colitis which has a high morbidity and mortality unless treated promptly and appropriately. Aim: To study the clinical, morphological features and outcome of fulminant amebic colitis (FAC). Materials and m0 ethods: A retrospective study of six patients who underwent surgical resections from 2002-06 and were diagnosed with FAC, was carried out. The morphological features assessed included the average number of trophozoites per high-power field and the depth of invasion of trophozoites into the muscularis propria. Results: The study included five adults and one child who underwent surgery for fulminant colitis. Interestingly, a definite preoperative diagnosis of amebic colitis was made only in one patient and suspected in another. Intraoperatively, multiple perforations of the intestine with peritonitis were the most common findings. Gross examination typically revealed multiple ulcers with exudate and intervening normal mucosa. Microscopically, ulceration and myonecrosis with trophozoites within the exudate were seen in all cases. Trophozoites invading the muscularis propria were seen in five cases. Of the cases that showed myoinvasion by trophozoites, two patients expired within two weeks of surgery. One of the patients who expired also showed co-infection with Actinomyces. Conclusion: FAC is an uncommon outcome in amebic colitis with a high mortality requiring prompt surgical intervention.
  3,835 279 4
Frontal recurrence of medulloblastoma five years after excision and craniospinal irradiation
YB Roka, P Bista, GR Sharma, D Adhikari, P Kumar
July-September 2009, 52(3):383-385
DOI:10.4103/0377-4929.55001  PMID:19679968
Medulloblastomas were originally classified under gliomas of the cerebellum until Bailey and Cushing in 1925 named these tumors as medulloblastoma. At present these tumors are classified under primitive neuroectodermal tumor. Surgical excision followed by craniospinal irradiation is the treatment of choice. A 13-year-old-girl operated for posterior fossa medulloblastoma 5 years ago presented with history of headache and vomiting on and off for 4 days in late August 2008. The MRI showed left frontal tumor which on excision was reported as medulloblastoma. Even after optimal treatment reports of recurrence abound in literature. The most common location is in the posterior fossa, followed by spinal, supratentorial, and uncommonly, systemic metastases. We conclude that medulloblastomas are highly aggressive tumor with high local recurrences if the initial excision is incomplete and that recurrence in the supratentorial area although uncommon is still a possibility. This mandates regular follow up of these children till adulthood to catch early recurrences and metastatic disease.
  3,865 205 3
Iatrogenic aspergillus infection of the central nervous system in a pregnant woman
Menaka D. S. Lokuhetty, Harshima D Wijesinghe, Buddhika Weerasundera, A Dayapala
July-September 2009, 52(3):427-429
DOI:10.4103/0377-4929.55016  PMID:19679983
A healthy postnatal woman succumbed to fulminant iatrogenic Aspergillus infection of the central nervous system, following accidental inoculation into the subarachnoid space at spinal anesthesia, during an outbreak of Aspergillus meningitis in Sri Lanka. Autopsy revealed extensive Aspergillus meningitis and culture confirmed Aspergillus fumigatus. The thalamic parenchyma in the brain was invaded by fungal hyphae producing necrotizing angitis with thrombosis, thalamic infarcts and fungal abscesses. The directional growth of fungal hyphae from the extra-luminal side of blood vessels towards the lumen favored extension from the brain parenchyma over hematogenous spread. The spinal parenchyma was resistant to fungal invasion in spite of the heavy growth within the spinal meninges and initial inoculation at spinal level. Modulation of the immune response in pregnancy with depression of selective aspects of cell-mediated immunity probably contributed to rapid spread within the subarachnoid space, to involve the brain parenchyma leading to clinical deterioration and death.
  3,787 209 3
Renal mucinous tubular and spindle cell carcinoma
Niraj Kumari, Poonam Chhabra, Udita Dewan, Manoj Jain
July-September 2009, 52(3):400-402
DOI:10.4103/0377-4929.55007  PMID:19679974
Mucinous tubular and spindle cell carcinoma is a rare variant of renal cell carcinoma, which has recently been described. It has a low malignant potential and is usually confined to the kidney. These are thought to be of the loop of Henle or distal nephron origin. We report a 65-year-old male who presented with flank pain, hematuria and a well-defined renal mass that was diagnosed as mucinous tubular and spindle cell tumor.
  3,725 230 2
Diagnostic efficacy of C4d immunostaining in the detection of the humoral component of renal allograft rejection and therapeutic implications
Sree Latha Guduru, Sarah Kuruvilla, Georgi Abraham, Milly Mathew, S Saravanan
July-September 2009, 52(3):345-348
DOI:10.4103/0377-4929.54990  PMID:19679957
Context: In the current scenario of renal transplantation, the role of immunological methods in the detection of C4d has emerged as a useful adjunct in the recognition of acute humoral rejection (AHR). Few reports of this nature are available from the Indian context although there are several from the Western literature. Aims: To study the humoral component of renal allograft rejection in patients presenting clinically with graft dysfunction by histopathological detection of polymorphs in the peritubular capillaries and the expression of C4d using immunological techniques, as well as the response of patients to appropriate antirejection therapy. Settings and Design: This study from a tertiary care center reemphasizes the importance of recognition of AHR as a cause of renal allograft dysfunction. Materials and Methods: Percutaneous renal biopsies were obtained from 40 postrenal transplant patients and evaluated for C4d using immunofluorescence and immunohistochemical methods. Statistical a0 nalysis used: SPSS software. Results: Positive expression of C4d was seen in a total of 19/40 cases (44.4%) indicating immunological evidence of AHR. Diffusely positive cases were treated with IV immunoglobulin therapy, plasmapheresis and Rituximab following which graft function was restored. Patients with minimal to focal positive expression of C4d responded well to pulse steroids and change in immunosuppressive therapy. Conclusions: C4d staining is a useful adjunct to routine histopathological methods in evaluating the humoral component of acute renal allograft dysfunction and helps in planning appropriate antirejection therapy with the goal of achieving long-term graft survival.
  3,437 276 3
Seroprevalence of Brucella agglutinins: A pilot study
S Nagarathna, S Sharmada, HB Veena Kumari, N Arvind, P Sundar, S Sangeetha
July-September 2009, 52(3):457-458
DOI:10.4103/0377-4929.55036  PMID:19680003
  3,159 480 1
Congenital neuroblastoma with liver metastasis presenting with Hashimoto Pritzker disease
E Sajini Jacob, Renu G Varghese, Pampa C Toi, R Bhaskaran, Ramji Rai
July-September 2009, 52(3):374-376
DOI:10.4103/0377-4929.54998  PMID:19679965
A two-month-old female child presented with discrete skin-colored papules on the forehead and scalp. She was earlier diagnosed to have neuroblastoma of the adrenal gland which had metastasized to the liver. Histological sections of the skin lesion showed a nodule composed of sheets of cells with abundant eosinophilic cytoplasm and an occasional grooving of the nucleus. These cells were CD 68 positive. Eosinophilic abscesses were seen in between the neoplastic cells.
  3,438 178 2
Angioleiomyoma of the nasal cavity
Rajiv C Michael, Sanjeev Shah
July-September 2009, 52(3):386-388
DOI:10.4103/0377-4929.55002  PMID:19679969
Angioleiomyoma is a rare benign tumor in the nasal cavity. There are very few reports in literature. A 34 year old male presented with left sided nasal obstruction and epistaxis. Clinical evaluation revealed a lesion replacing the anterior two-third of the Left inferior turbinate. An endoscopic excision under hypotensive anesthesia was performed. Histopathology confirmed a diagnosis of Angioleiomyoma. The cause and site of origin of angioleiomyomas when they arise from the inferior turbinate remains unclear. We review the literature available on nasal angioleiomyoma. When limited to the nasal cavity endoscopic excision is the treatment of choice.
  3,339 182 3
Extradigital glomus tumor as a cause of chronic perianal pain
KR Rathi, J Jena, BM Dash, D Mitra, PK Patnaik, AR Basu
July-September 2009, 52(3):414-416
DOI:10.4103/0377-4929.55012  PMID:19679979
Glomus tumor is a rare perivascular benign tumor arising from the Sucquet-Hoyer canal of the normal glomus body, most commonly in the digital areas. We report a serving soldier with such a tumor in an atypical site, the perianal region, presenting with episodic shooting pain. Total surgical excision was performed. Histopathology revealed a well-circumscribed tumor composed of clusters of monotonous polygonal cells surrounding capillary-sized blood vessels. Tumor cells also showed immunopositivity for smooth muscle antigen and vimentin. Following excision, the patient was completely relieved of pain and there was no recurrence on follow-up for 6 months.
  3,331 165 4
Significance of deep section in small gastric biopsies
Fatemeh Mahjoub, Morteza Khademalhosseini, Maryam Monajemzadeh, Mehri Najafi Sani
July-September 2009, 52(3):310-312
DOI:10.4103/0377-4929.54982  PMID:19679949
Aim of Study: Chronic gastritis is defined as the presence of chronic mucosal inflammatory changes leading eventually to mucosal atrophy and epithelial metaplasia. This condition constitutes a background for dysplasia and thereby carcinoma. Detection of exact histopathology of inflammatory process is necessary in biopsy specimen. We designed the current study to determine the value of taking more sections in small gastric biopsies for better histopathologic evaluation. Materials and Methods: Gastric biopsy specimen of children who suffered from gastrointestinal (GI) symptoms was sent in 10% formalin to our laboratory. After routine processing, three slides with several sections on them were taken from the specimen: t0 he first was named the superficial section, the second was stained by Giemsa and the third was named deep section (further sections after this slide will diminish in size). The slides were not taken exactly consecutively but several sections were discarded between them. The purpose of this study is to compare the superficial and deep sections for detection of inflammatory processes. Results: In 1062 specimens the results of superficial section and deep section were the same (87.1%) and in 158 specimens the results were different. In 88 (7.2%) specimens deep section was diagnostic. The difference was seen usually as normal tissue in superficial sections but presence of lymphoid follicle in deep sections. The difference between superficial and deep sections was statistically significant. Although obtaining more sections will put an economic burden on the laboratory, we propose that in small gastric biopsies, it is helpful in better evaluation of histopathological changes.
  3,154 341 -
β-lactamase producing Acinetobacter species in hospitalized patients
Ritu Kansal, Anita Pandey, Ashish K Asthana
July-September 2009, 52(3):456-457
DOI:10.4103/0377-4929.55035  PMID:19680002
  3,086 351 2
A cytological and histomorphological case study of an uncommon breast carcinoma: Invasive papillary type
Charusheela R Gore, NK Panicker, PP Karve
July-September 2009, 52(3):411-413
DOI:10.4103/0377-4929.55011  PMID:19679978
Pure papillary carcinoma of the breast is a rare tumour affecting elderly postmenopausal women. We report one case in a relatively younger woman presenting with a clinically benign breast lump.The tumour showed extensive apocrine metaplasia. The ease with which abundant material with highly cellular papillary clumps is obtained on fine needle aspirate should be an important consideration favouring papillary carcinoma. The quality and quantity of stroma in papillae rather than the presence or absence of stromal support should also be a guiding criteria for excluding benign papillary lesions.
  3,136 223 1
Congenital epulis of the newborn
Uday A Gokhale, Charan J Malhotra
July-September 2009, 52(3):436-437
DOI:10.4103/0377-4929.55020  PMID:19679987
  3,082 240 6
Leydig cell tumor: An unusual presentation
Usha Agrawal, Monika Sharma, Dinesh Bhatnagar, Sunita Saxena
July-September 2009, 52(3):395-396
DOI:10.4103/0377-4929.55005  PMID:19679972
Leydig cell tumor is a benign tumor of the testis and malignant transformation, if present, is rare. The case presented here showed certain features of malignancy but no infiltration beyond the capsule or metastasis. The case could not be labeled as benign or malignant and patient is on follow-up. Differential diagnosis and clinical implications of a case in the borderline zone are discussed.
  3,085 190 2
Serous microcystic adenoma of the pancreas
Prakash R Malur, Vijayalaxmi V Suranagi, Hema B Bannur, Shashikant Kulgod
July-September 2009, 52(3):408-410
DOI:10.4103/0377-4929.55010  PMID:19679977
Serous microcystic adenoma (SMA) is a rare benign neoplasm. It accounts for 1-2% of all exocrine pancreatic tumors. It is thought to arise from the ductal epithelial cells. It is usually located in the body and the tail of the pancreas. It is important to identify SMAs and distinguish them from mucinous cystic neoplasm, which can be premalignant or malignant, and pseudocyst, which is a non neoplastic condition. We present one such rare case of SMA occurring in the head of the pancreas, an infrequent location requiring a Whippel's resection.
  3,044 183 3
Sclerosing hemangioma with lymph nodal metastases
Pradeep Vaideeswar
July-September 2009, 52(3):392-394
DOI:10.4103/0377-4929.55004  PMID:19679971
A case of sclerosing hemangioma of the lung is reported in a young male, who presented with recurrent cough and streaky hemoptysis for three years. The tumor was situated in the right upper lobe and was large (over 9 cm), multicentric and associated with metastases to the regional lymph nodes. To the best of our knowledge, only 14 cases with such metastases have been reported.
  2,930 150 7
Long segment ileal duplication with extensive gastric heterotopia
Sunitha Jacob, Anand Mani, VP Singh, William Bhatti
July-September 2009, 52(3):397-399
DOI:10.4103/0377-4929.55006  PMID:19679973
Duplications of the alimentary tract are rare congenital anomalies which can be found at all levels of the alimentary tract. Majority of the duplications present as spherical cysts and usually range from a few millimeters to less than ten centimeters in size. Duplications produce complications such as intestinal obstruction or hemorrhage. A two-month-old infant presented with recurrent episodes of bleeding per rectum. Laparotomy revealed a giant ileal duplicated bowel segment which exhibited extensive gastric heterotopia with focal ulceration.
  2,909 170 3
In-house daily consensus conference: An important quality control/quality assurance activity - Experience at a major referral center
Amna Khurshid, Zubair Ahmad, Asim Qureshi
July-September 2009, 52(3):325-327
DOI:10.4103/0377-4929.54985  PMID:19679952
Background: For every practicing histopathologist, improvement of diagnostic accuracy is an important objective. Personal consults are an important component of quality control (QC)/quality assurance (QA) in our Section of Histopathology. In addition, the College of American Pathologists recommends a daily in-house consensus conference, which is a prospective system by which all difficult and problematic cases are reviewed and discussed and signed out by consensus. Design: In-house consensus conference is held daily using a multi-headed microscope. This collegial session is run by the seniormost consultant in the section and is attended by all histopathology consultants and residents. The consultants and residents present cases of their choice for discussion. The cases may be selected due to diagnostic difficulty, unusual nature of a case, management purposes such as performance of additional biopsies, special studies, etc., or request on the part of clinician or patient. Cases may be shown once or, in case of lack of consensus or difficulty in diagnosis, more than once after additional work-up suggested by the conference. Results: In a 4-month period, 774 (4.1%) cases of a total of over 14,000 well-mixed surgical cases were brought to the in-house daily consultation conference. Four hundred ninety-three cases (63.7%) were conclusively decided the first time while 198 cases (25.5%) were decided by consensus after being shown twice. In 83 cases (10.7%), a definite diagnosis could not be given. The cases on which a definite diagnosis was not possible represents 0.59% of all cases received in the department during the study period. The most common cases were shown from the gastrointestinal tract (115 cases or 14.8%), lymph nodes (110 cases or 14.2%) and soft tissue (82 cases or 10.6%). In most cases in which a definite diagnosis could not be given, the main reason was scanty material or crushed nature of the tissue. Conclusion: The in-house daily consensus conference is an extremely useful QC/QA exercise, which is very important in reaching an accurate diagnosis in difficult and challenging cases and minimizing diagnostic errors.
  2,798 189 -
Calcified amorphous tumor of the heart
Anita Flynn, Geetashree Mukherjee
July-September 2009, 52(3):444-446
DOI:10.4103/0377-4929.55026  PMID:19679992
  2,739 181 5
Invasive cryptococcus infections in immunocompetent individuals may suggest defects in CD40/CD40L signaling pathway
Sujoy Khan
July-September 2009, 52(3):458-459
DOI:10.4103/0377-4929.55037  PMID:19680004
  2,704 183 -
Hb H disease: An under diagnosed entity in Indian setup
Anita Tahlan, Ujjawal Khurana, Anshu Palta, Sandeep Chauhan
July-September 2009, 52(3):451-452
DOI:10.4103/0377-4929.55031  PMID:19679998
  2,644 214 -
Paraphenylenediamine poisoning: Laboratory medicine perspective
Mahendra B Gandhe, Partha S Pal, Priti V Puppalwar, Kalyan Goswami
July-September 2009, 52(3):444-444
DOI:10.4103/0377-4929.55025  PMID:19679993
  2,646 183 2
Increased emperipolesis in megakaryocytes in a case of idiopathic thrombocytopenic purpura
Sharada Rai, Mamta Sharma, Manas Muhary, Ramdas Naik, Ruchi Sinha
July-September 2009, 52(3):452-453
DOI:10.4103/0377-4929.55032  PMID:19679999
  2,498 212 2
Metastatic hepatocellular carcinoma presenting as a gingival mass
Sharada Rai, Ramadas Naik, Muktha R Pai, Astha Gupta
July-September 2009, 52(3):446-447
DOI:10.4103/0377-4929.55027  PMID:19679994
  2,481 223 3
Gingival tuberculosis
Manjit Singh Bal, Vipin Bharti, Aminder Singh
July-September 2009, 52(3):442-443
DOI:10.4103/0377-4929.55023  PMID:19679990
  2,332 275 -
Subcutaneous phaeohypomycosis
S Balamurugan, Rajsekar , Ramesh Rao
July-September 2009, 52(3):454-455
DOI:10.4103/0377-4929.55034  PMID:19680001
  2,400 204 -
Gynecomastia with unusual histology
Radha R Pai, Ruchi Sinha, S Kumar
July-September 2009, 52(3):459-460
DOI:10.4103/0377-4929.55039  PMID:19680005
  2,209 204 -
Pulmonary actinomycosis masquerading as tuberculosis
Asha Rupani, Gayathri Amonkar, Jaya Deshpande
July-September 2009, 52(3):438-439
DOI:10.4103/0377-4929.55021  PMID:19679988
  2,193 196 -
Russian pathology and scientific misconduct
Sergei V Jargin
July-September 2009, 52(3):443-443
DOI:10.4103/0377-4929.55024  PMID:19679991
  2,234 139 1
Osteopontin and its clinical significance
Ramachandran Meenakshisundaram, S Chandra, P Thirumalaikolundusubramanian
July-September 2009, 52(3):459-459
DOI:10.4103/0377-4929.55038  PMID:19680006
  2,090 187 2
Structuring data in anatomic pathology reports
Joy J Mammen, Mark J Tuthill
July-September 2009, 52(3):450-451
DOI:10.4103/0377-4929.55030  PMID:19679997
  2,035 155 -
An unusual soft tissue plasmacytoma with massive intracellular deposition of needle-shaped crystals
Amanjit Bal, Yashwant Kumar, BD Radotra, Sandeep Mohindru
July-September 2009, 52(3):453-454
DOI:10.4103/0377-4929.55033  PMID:19680000
  1,868 127 -
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