Annals of Pathology and Laboratory Medicine

Synovial Sarcoma: A Comparative Study of Immunohistochemical Markers (Bcl2 and CD99) versus Fluorescence In Situ Hybridization

2024-06-02T01:05:03+0530

Background

Synovial Sarcoma (SS) is a mesenchymal tumor, which displays a variable degree of epithelial differentiation including gland formation, and has a specific chromosomal translocation t(x;18)(p11;q11) that leads to the formation of an SS18-SSX fusion gene. The diagnostic gold standard for Synovial Sarcoma is the demonstration of the characteristic translocation between the SS18 (SYT) gene on chromosome 18 and one of the three SSX genes (SSX1, SSX2, or rarely SSX4) on chromosome X {t(x;18)(p11.2;q11.2)} [1, 2]. The use of these techniques is limited by many practical issues like cost and specialized equipment availability. Thus, in practice, the diagnosis of SS is usually based on histological examination and immunohistochemistry (IHC) [3, 4]. Our objective is to study the expression of Bcl2 and CD99 in Synovial Sarcoma and to compare the results with fluorescence in situ hybridization (FISH) to evaluate the sensitivity of Bcl2 and CD99 in the diagnosis of Synovial Sarcoma.

Material and Methods

Tissue was processed and microtomy was done. Hematoxylin and eosin (H&E) staining was performed. IHC was carried out on all sections using CD99, Bcl2, EMA, CK, and all other markers which aid in differentiating SS from its mimics. All the formalin-fixed paraffin-embedded (FFPE) tissue samples from 50 histologically diagnosed Synovial Sarcoma cases, which showed Bcl2 and CD99 positivity, were submitted for FISH..

Results

Forty cases out of fifty histologically and Bcl2 & CD99 positive Synovial Sarcoma cases were positive for FISH, showing the t(x;18)(p11.2;q11.2) translocation.

Conclusion

Bcl2, CD99, Vimentin, EMA, and PCK are routinely used markers in the diagnosis of Synovial Sarcoma. It is found that Bcl2 and CD99 are highly sensitive markers in the initial diagnosis and management of Synovial Sarcoma in patients who cannot afford cytogenetic studies.

Evaluation of Clinical and Cytological Profile of Breast Lesions at Tertiary Care Hospital, Bhavnagar

2024-06-02T01:05:03+0530

Background

Breast lump is the common presentation of various breast lesions. Fine needle aspiration cytology (FNAC) is becoming popular as screening and diagnostic method for breast lesions due to its high sensitivity, specificity, low expenditure, conveniency and safety. The aim is to evaluate the demographic distribution and cytological diagnosis of breast lesions and correlate cytological diagnosis with histopathological diagnosis.

Methods

The present retrospective study was conducted on patients of breast lesion at Cytology Section, Pathology Department of Sir T General Hospital, Bhavnagar from 1st July 2021 to 30th June 2022. Data of FNAC findings of breast lump lesions from 1st January 2019 to 31st December 2020 was collected from reporting registers and statistical analysis was done.

Result

Data of 284 cases was available. Of which, 208 (73.23%) cases were diagnosed as benign of which Fibroadenoma was the most common, found in 116 (40.8%) cases with majority of the patients in 21- 40 year age group. Malignant lesions were found in 76 (26.76%) cases, of which Ductal carcinoma was the most common with 52 (18.30%) cases. Data of 64 cases were available for histopathological correlation. Sensitivity of FNAC was found to be 97.36% and specificity 100%.

Conclusion

As FNAC is a simple, easy, OPD based, cost effective procedure with high accuracy in diagnosis of breast lumps it should be used as preliminary investigation for early diagnosis of malignant lesions which can significantly reduce the morbidity and mortality associated with malignancy.

Histopathological Spectrum of Ovarian Tumors at Tertiary Care Hospital – A Three Year Retrospective Study of 45 Cases

2024-06-02T01:05:03+0530

Background

The ovaries are paired intra-pelvic adnexal organs of the female reproductive system involved in many important functions of the body. No organ of the body except the ovary gives rise to such a galaxy of neoplasms. Histopathological examination of the biopsy material is the mainstay of diagnosis, which determines the prognosis and behavior of neoplasm.

Material and Methods

This was a retrospective observational study. A total of 45 cases were studied. All the cases of ovarian tumors were studied with respect to age of presentation, clinical symptoms, and morphological classification. Data thus collected were analyzed and compared with other study findings.

Results

A total of 45 ovarian tumor cases were studied. Surface epithelial tumors were the most common ovarian tumor, constituting 53.3%, followed by germ cell tumors at 31.3%, and sex cord-stromal tumors at 15.5%. Among surface epithelial tumors, serous tumors were the most common. Abdominal pain remained the most common clinical presentation.

Conclusion

Ovarian tumors are the second most common neoplasm in the female genital tract following cervical cancer. Though benign tumors are more common than malignant tumors, it is important to detect the tumor at its early stage. Histopathological findings along with immunohistochemistry are helpful in early diagnosis of ovarian tumors.

Cytomorphological Spectrum of Head and Neck Lesions: A Retrospective Study

2024-06-02T01:05:03+0530

Background

Fine needle aspiration cytology (FNAC) is globally employed as the primary diagnostic method for assessing swellings, particularly in the head and neck area. It offers numerous benefits such as cost-effectiveness, minimal invasiveness, suitability for all age groups, outpatient feasibility, and low complication rates. Most importantly, it helps distinguish between benign and malignant growths. Common pathologies encountered include lymphadenopathies, salivary gland and thyroid lesions, and skin appendage issues.

Material and Methods

A retrospective study was conducted on 305 patients with palpable swellings of the head and neck who presented to the Pathology department from July 2023 to December 2023. FNAC was performed using aspiration and non-aspiration techniques, after which cytomorphological diagnoses were given.

Results

Among the 305 cases analyzed, inflammatory lesions accounted for 65.57% (200 cases), benign lesions for 19.67% (60 cases), and malignant lesions for 14.75% (45 cases). Inflammatory lesions were the most prevalent, followed by benign and malignant lesions. Lymph nodes were the most frequently aspirated sites, followed by the thyroid, with salivary gland cases being the least common. Benign conditions were predominantly observed in the second to fifth decades, while malignant conditions were more prevalent from the fifth decade onwards.

Conclusion

FNAC serves as a rapid, cost-effective, and minimally invasive approach for evaluating head and neck swellings. Moreover, FNAC can offer both diagnostic and therapeutic benefits, particularly in cystic lesions. Consequently, it can be recommended as the primary diagnostic modality for head and neck swellings, aiding surgeons in formulating appropriate surgical strategies for affected patients.

Clinicopathological Study of Epithelial Lacrimal Gland Tumors at Tertiary Eye Hospital

2024-06-02T01:05:04+0530

Background

Lacrimal gland tumors are rare, constituting approximately 9% of all orbital lesions. Primary epithelial lacrimal gland tumors are histologically similar to those arising in the salivary glands. Pleomorphic adenoma and adenoid cystic carcinoma are the most common benign and malignant tumors, respectively.

Material and Methods

A retrospective study of 39 cases of lacrimal gland tumors over a period of 7 years was conducted. A detailed history of patients was taken with special attention to age, sex, macroscopic (gross examination), and microscopic features of the tissue. Microscopic examination was done using the standard H & E staining procedure.

Results

A total of 39 cases of lacrimal gland tumors were studied. Among them, there were 19 cases of pleomorphic adenoma, the most common benign tumor of the lacrimal gland, and 17 cases of adenoid cystic carcinoma, the most common malignant tumor.

Conclusion

The incidence of benign lesions was slightly lower than that of malignant tumors in this study. Benign tumors occurred in a younger age group compared to western studies. Among malignant tumors, adenoid cystic carcinomas were the most common.

Study of Cytomorphological Patterns of Neoplastic Breast Lesions along with Robinson’s Cytological Grading of Invasive Ductal Carcinoma

2024-06-02T01:05:04+0530

Background

Fine Needle Aspiration Cytology (FNAC) plays an important role as it is a simple, minimally invasive, cost-effective, outpatient-based, and rapid diagnostic method. Grading of breast carcinoma is ideal as it helps in the selection of patients for appropriate therapy. The study was undertaken to observe the cytomorphological patterns of neoplastic lesions, assess the grade of invasive ductal carcinoma by Robinson’s cytological grading, and to correlate with Modified Bloom Richardson’s histopathological grading wherever possible.

Material and Methods

A descriptive cross-sectional study was conducted over a period of 2 years (July 2015-June 2017). FNAC of neoplastic breast lesions was studied. Invasive ductal carcinomas were graded according to Robinson’s cytological grading system and compared with Modified Nottingham Bloom-Richardson’s histological grading in instances where resected specimens were available.

Results

In the present study, fibroadenoma (31/33; 94.0%) was the most common benign neoplasm and invasive ductal carcinoma (40/41; 97.6%) was the most common malignant neoplasm. According to Robinson’s cytological grading done on IDC breast, the majority of the cases were grade II [24 (60.0%)]. Histopathological correlation was done by Modified Bloom Richardson’s grading on 13 cases of IDC in which 6 (42.8%) cases were in grade II followed by grade III and I. There was a significant concordance of 71.4% (p=0.015) between Robinson’s cytological grading system and Modified Nottingham Bloom Richardson’s histopathological grading system.

Conclusion

Robinson’s cytological grading on invasive ductal carcinoma of the breast has good concordance with Modified Bloom Richardson’s histopathological grading.

Transfusion Effect of Single and Random Donor Platelets in Thrombocytopenic Pediatric Patients with Hematological Malignancy at Tertiary Care Hospital

2024-06-02T01:05:04+0530

Background

This study was performed to assess differences between Single Donor Platelets (SDP) and Random Donor Platelets (RDP) by evaluating the platelet increment in the form of corrected count increment (CCI), platelet transfusion reaction rates, and the development of refractoriness after multiple platelet transfusions.

Material and Methods

In this two-year prospective study performed at a tertiary care hospital, dose response to platelet transfusions was studied in 68 newly diagnosed pediatric patients with hematological malignancies admitted for induction chemotherapy. The study was divided into three groups based on the type of platelet transfusion received: RDP group: Patients who exclusively received Random Donor Platelets. SDP group: Patients who exclusively received Single Donor Platelets. RDP+SDP group: Patients who received both RDP and SDP. Statistical Analyses Used: Chi-Squared test.

Results

CCI at the end of one hour (1-HR) and 24 hours (24-HR) was significantly greater in the SDP group (p-value 0.0003 and 0.0001, respectively), showing better platelet count increment after SDP transfusion. In the SDP group, the increments after the first and last transfusions were in the same range, whereas in the RDP group, the increments decreased from the first to the last transfusion. Thus, the use of SDPs postponed refractoriness. Maximum cases of the RDP group showed platelet refractoriness (50%), of which 76% were refractory due to an immune cause. The majority of acute platelet transfusion reactions were seen in the RDP group (38.98%), with the most common reaction being febrile non-hemolytic transfusion reaction.

Conclusion

The SDP group showed a better response to platelet transfusion than the other groups (RDP group and RDP+SDP group).

Effectiveness of Objective Structured Practical Examination as an Assessment Method for Indian Medical Graduates: A Pilot Project Carried Out in Pathology at a Medical College in Western India

2024-06-02T01:05:04+0530

Background

Practical assessment plays a vital role in medical education. Traditional Practical Examination (TPE) assesses only the knowledge of students without providing constructive feedback. The Objective Structured Practical Examination (OSPE) is a structured, objective, and unbiased tool for assessment. It evaluates all domains of Miller's pyramid with a few limitations. This study assesses the effectiveness of OSPE compared to TPE for second-year MBBS students in Pathology practical exams as an assessment tool in our hospital settings. It also aims to analyze the perceptions of students and faculty regarding OSPE.

Material and Methods

A hospital-based prospective study was conducted during internal practical exams of second-year MBBS students in the Pathology department of a tertiary care hospital, Ahmedabad, Gujarat, India. A total of 115 students and 13 faculty members were enrolled. After a sensitization session, OSPE was conducted alongside traditional exams with the same set of faculty at the same time in the same lab. Feedback was collected from both students and faculty. Marks obtained and perceptions of both methods were compared.

Results

The marks obtained by students using TPE and OSPE had a median of 12.5 with an IQR of 3 and a median of 15 with an IQR of 2, respectively. The p-value was highly significant, suggesting better marks scored by students in OSPE. According to students' perceptions, the majority felt that OSPE is better, well-structured, unbiased, and less stressful compared to TPE. Most faculty members also gave positive feedback for OSPE.

Conclusion

Both students and faculty have a positive approach towards OSPE as it assesses almost all types of practical skills with the ability to provide feedback. It reduced stress and allowed students to achieve higher marks. They recommended OSPE in the formative assessment of medical students.

A Comparative Study on Diagnostic Efficacy of WBC Parameters, Platelet Count, C-Reactive Protein, and Serum Ferritin in Early Onset and Late Onset Neonatal Sepsis

2024-06-02T01:05:04+0530

Background

Early detection of neonatal sepsis is complicated due to vague symptoms and variations based on gestational age. Rapid identification is vital, and low-cost diagnostic tools like WBC parameters, platelet count, serum ferritin, and C-reactive protein (CRP) can speed up time-sensitive diagnosis. This can mitigate antibiotic resistance and overuse, cutting expenses in underdeveloped regions of India.

Material and Methods

Ninety cases of neonates <90 days [clinically suspicious admitted cases of early onset (EOS) and late onset neonatal sepsis (LOS): 30 cases each and 30 controls] were selected post-September 01, 2022, for the cross-sectional comparative study. Blood samples were obtained upon clinical suspicion of sepsis, prior to antibiotic treatment, and the above-mentioned parameters were analyzed.

Results

Preterm births constituted 20% (EOS), 36% (LOS), and 26% (control). Low birth weight occurred in 36% (EOS), 33% (LOS), and 23% (control); females represented 46% (EOS), 53% (LOS), and 53% (control). Culture-positive cases were 14 (EOS) and 19 (LOS). Notable variations emerged in CRP, I/T ratio, and toxic granules. The combined analysis of EOS and LOS indicated CRP's sensitivity at 78%, specificity at 90%, PPV at 94%, and NPV at 68%. I/T ratio exhibited 72% sensitivity, 97% specificity, 98% PPV, and 64% NPV. Toxic granules demonstrated 50% sensitivity, 97% specificity, 97% PPV, and 50% NPV, showcasing their diagnostic potential across various onset patterns.

Conclusion

For early-onset sepsis, the I/T ratio and toxic granules displayed significant utility, while CRP emerged as a standout performer for late-onset cases. On the whole, CRP emerged as the premier standalone marker, adaptable for pairing in early onset and singly for late onset, with commendable efficacy. Remarkable disparities in ferritin values between septic and non-septic groups call for further exploration of ferritin's diagnostic applicability.

Hashimoto’s Encephalopathy in a Pediatric Female: Time to Revisit This Diagnosis

2024-06-02T01:05:03+0530

Hashimoto’s encephalopathy (HE) is an infrequent encephalopathy of presumed autoimmune origin characterized by high titres of antithyroid antibodies. It is common in females, and although it is seen across all age groups, it is relatively uncommon among the paediatric population, with a prevalence of only about 1.2%. Hashimoto’s encephalopathy is a rare complication of Hashimoto’s thyroiditis and presents with a syndrome of persistent fluctuating neurologic and neuropsychologic deficits associated with elevated antithyroid antibodies, specifically thyroid peroxidase (TPO) antibodies. We present one such case of Hashimoto’s encephalopathy, diagnosed in an 11-year-old female, which mimicked brain death, along with a review of the available literature.

Mixed Small Cell Carcinoma and Mucinous Adenocarcinoma of Appendix: A Rare Case Report with Review of Literature

2024-06-02T01:05:03+0530

Gastrointestinal mixed neuroendocrine non-neuroendocrine neoplasms (MiNEN) are a heterogeneous group of tumors showing different morphological and prognostic features. The biological behavior of MiNEN is mostly driven by its high-grade component. Due to limitations in diagnostic methods and poor awareness, the incidence of MiNEN may be underestimated. The pathogenesis of MiNEN remains controversial. Molecular studies point towards a common monoclonal origin of the two components. Mixed tumors of the appendix are quite rare compared with those occurring elsewhere in the gastrointestinal tract. Although the appendix represents a common site of intestinal neuroendocrine tumors, primary extrapulmonary small cell carcinoma of the appendix is a rare entity. We describe a unique case of primary combined adenocarcinoma and small cell carcinoma of the appendix.