ORIGINAL RESEARCH ARTICLE | July 30, 2019
Spectrum of Endometrial Histopathology in Abnormal Uterine Bleeding
Dr. Prachi Mehta, Dr. Sanjeev Narang, Dr. Maj. Gen. S. K. Nema
Page no 530-533 |
10.21276/sjpm.2019.4.7.9
In OBG out-patient department abnormal uterine bleeding (AUB) is one of the commonest presenting symptoms. This
condition is caused by a variety of systemic illnesses or it may be related to pregnancy, polyps, fibroids, adenomyosis,
anovulation or neoplasia. Endometrial biopsy could be used as the first diagnostic step & it is effectively qualitative in
AUB. This study was done for evaluation of spectrum of lesions of endometrium by histopathology and to find the cause
of AUB, in different age groups.
CASE REPORT | July 23, 2019
Ileocecal Intussusception Due to Heterogenous Cecal Polyps; One of Which Is Unusual; a Case Report
Dr. Niranjana Kesavamoorthy, Dr. Sathiyabama, Dr. Radhakrishnan
Page no 519-521 |
10.21276/sjpm.2019.4.7.6
Background: Inflammatory fibroid tumor (IFT) is uncommon tumor in large bowl. In this patient it was the unusual
cause for large bowel intussusception. More over the coexistence of mucinous adenocarcinoma arising from
adenomatous polyp is a rarity previously unreported in the world literature. Case presentation: Here, we present the case
of a 65 year old female who complained of lower abdominal pain with rectal bleeding occasionally. Imaging studied
confirmed the diagnosis of intussusception of ileocecal type. After resection of intestines, two sessile polyps in caecum
were detected. Histology of the polyp’s revealed one showing classical features of IFP and the other a malignant growth
arising from tubular adenoma with deep invasion upto serosal coat. Unusually IFP lacks CD 34 stromal cells.
Conclusions: Intussusception of ileocecal type due to sessile polyps in caecum is a rare surgical event. The heterogenous
nature of these polyps being the cause for this unusual case is previously unreported.
ORIGINAL RESEARCH ARTICLE | July 21, 2019
Clinico-Histopathological Study of Non-Neoplastic Lesions of the Breast
Dr. Chavan Sunil Santram, Dr. Shankar Marshal Toppo
Page no 496-501 |
10.21276/sjpm.2019.4.7.1
Benign breast diseases constitute a heterogeneous group of disorders including developmental abnormality, epithelial and
stromal proliferation, inflammatory lesions and neoplasm. Benign breast lesions deserve attention because of their high
prevalence, their impact on women’s life and due to cancerous potential of some histological types. So the study is aimed
to attempt clinico-pathological correlation of non-neoplastic lesion of breast lump with detail history and pathological
findings. The present study is prospective and retrospective study of non-neoplastic breast lesions carried out in
department of pathology with the help of department of surgery at one of the teaching hospital in north Maharashtra. The
retrospective study was done between May 2015 to July 2018 and prospective study between august 2018 to may 2019.
Total one hundred cases of non neoplastic lesions of breast were studied in detail with relation to available clinical data.
Tissue for H&E sections were fixed in 10% formalin and subjected to routine paraffin embedded processing and stained
with Hematoxylin and Eosin. Out of 78 cases of non- neoplastic lesions of female breast, 45 cases 57.96% were of
benign proliferative lesions, 30 cases 38.46% of inflammatory lesions and 3 cases of miscellaneous lesions. Maximum
numbers of cases were found in age group 21-50 years with commonly presented with lump and pain. Inflammatory
lesions and fibrocystic disease are the two common non neoplastic lesions of the breast tented to occur in 2nd to 4th decade
of life. The most common presenting complaints are lump and pain in the breast.
ORIGINAL RESEARCH ARTICLE | July 23, 2019
Molecular Identification of Cancer Stem Cells in Pediatric Solid Tumours and Its Correlation with Clinicopathological Profile
Vasugi Gramani Arumugam, Sandhya Sundaram, Latha, Julius Xavier Scott
Page no 502-506 |
10.21276/sjpm.2019.4.7.2
Pediatric solid tumours constitute a unique division of importance not only for the age group affected but also for the
increased incidence of recurrence and relapse. OBJECTIVE: The aim of this study is to study the clinicopathological
profile of malignant pediatric solid tumours and also to analyze the expression pattern of cancer stem cell marker, CD44
in a series of pediatric solid tumours. Materials and Methods: 75 cases of malignant solid tumours age group less than
17 years, reported at Sri Ramachandra Medical College from jan 2009 to dec 2013 were included in this study. Formalin
fixed paraffin embedded tissue stained with H&E were used for routine morphology. Immunohistochemical staining was
done using monoclonal anti CD-44 antibody by Streptavidin biotin peroxidase complex technique. Scoring was done
using Histochemical Scoring (H-Score) method. Results: Among the 75 cases 52 (68%) were males and 23(32%) were
females. 22(29%) were CNS neoplasms and 53(71%) were Non CNS neoplasms which included lymphoma, Ewing’s
sarcoma, Osteosarcoma, Wilms tumour, Soft tissue tumours, Germ cell tumours, Neuroblastoma, Hepatoblastoma &
others. The CD 44 expression was variable according to the grades of CNS tumours. Among non CNS neoplasms,
lymphomas showed an increased expression for CD44 with all the 11 of 12 cases (91%) being positive [Mean H-score-
213.4]. Ewing’s sarcoma/PNET (9 cases) and Wilm’s tumour (5 cases) were completely negative for CD44. Conclusion:
Pediatric solid tumours form a wide spectrum. Targeting CD 44 CSCs could be a strategy to improve the outcome in
these tumours.
ORIGINAL RESEARCH ARTICLE | July 23, 2019
Variants of Hemoglobin D Punjab - A Retrospective Study
Dr. Kuntal Devesh Patel
Page no 507-511 |
10.21276/sjpm.2019.4.7.3
Hemoglobin D Punjab or HbD Los Angeles is one of the commoner hemoglobinopathies. In β-chain there is substitution
at position 121 i.e.121 GluGln (Glutamic Acid is replaced by glutamine). The clinical spectrum of all the variants are
usually ranges from asymptomatic state to mild hemolytic anemia and mild to moderate splenomegaly. Here, the
retrospective study was carried out in general population of all the age groups in Dhiraj General Hospital, Vadodara,
Gujarat. The duration of study was 8 months. Diagnosis of HbD Punjab was done by hemoglobin HPLC method with
BIO-RAD D-10™ machine. Total 16 Hb D Punjab cases out of 1245 cases were found. Which were further categorized
in Hemoglobin D trait (HbAD); Hemoglobin D disease (HbDD); Hemoglobin D-β–thalassemia (thalassemia trait/AD
trait or DD homozygous) and Double heterozygous S and D (HbSD) entity. While HPLC reporting, it is very essential to
keep these differentials of Hb D Punjab entity in suspected hemoglobinopathies because in today’s scenario there has
been change in geographic distribution of population. A collective data from clinical history, complete blood count,
HPLC finding & sickling solubility tests enable definitive identification of hemoglobin D Punjab variant.
CASE REPORT | July 23, 2019
Wegener’s Granulomatosis in Unusual Sites; A Case Report with an Emphasis on Histologic Findings
Dr. Niranjana Kesavamoorthy, Dr. Sathiyabama, Dr. Radhakrishnan
Page no 512-515 |
10.21276/sjpm.2019.4.7.4
Wegener’s granulomatosis is an unusual pathologic lesion involving genito urinary systems in both sexes. To establish its
diagnosis, we emphasize more on morphologic features than otherwise and importance of various histologic parameters
encountered in this disease is analyzed extensively. Briefly, differential diagnosis is reviewed and reasons for this
approach are elaborated.
CASE REPORT | July 23, 2019
Primary Ovarian Carcinoid Tumor: Case Report
Damiri, Chahdi H, Allaoui M, MR. El ochi, A. Al Bouzidi, Oukabli M
Page no 516-518 |
10.21276/sjpm.2019.4.7.5
Ovarian germ cell tumours are rare. Of the germ tumours the dermoid cyst is the most common; however the association
of carcinoid tumour with the dermoid cyst is exceptional. We report a case of a 38-years-old woman diagnosed with
primary carcinoid tumor of the right ovary arising in mature cystic teratoma. It is the histological examination, with the
immunohistochemical study that allowed the positive diagnosis. Surgical treatment ofen consists of unilateral
anexectomy.
CASE REPORT | July 23, 2019
An Unusual Cause of Small Bowel Obstruction: A Case Report
Amal Damiri, Hafsa Chahdi, Khadija Setti, Abderrahmane AL Bouzidi, Mohamed Allaoui, Abderrahim El Ktaibi, Mohamed Reda El Ochi, Mohamed Oukabli
Page no 522-525 |
10.21276/sjpm.2019.4.7.7
Enteropathy-associated T-cell lymphoma (EATL) has been introduced since 2001 in the World Health Organisation’s
(WHO) international classification of tumours of haematopoietic and lymphoid tissues as a separate entity from T-cell
lymphomas [1, 2]. The main characteristic of EATL besides its extreme rarity (less than 1% of all non-Hodgkin’s
lymphomas [NHL]) [3] and its location in the intestine is that it is associated with an enteropathy and develops from the
intraepithelial T-lymphocytes of the intestine. This NHL can occur as a complication of a previously recognised
enteropathy or may signal its presence, and its diagnosis is thus based mainly on intestinal mucosa lesions seen at some
distance from the lymphoma. The most classic form of EATL is type I (80%), which is a serious complication of celiac
disease (CD). CD is the only enteropathy that is associated with this particular NHL and the molecular bonds have now
been better described [4-6]. The therapeutic management of EATL remains particularly difficult and its prognosis is very
poor.
CASE REPORT | July 23, 2019
The Interest of the Extemporaneous Examination in the Diagnosis of Breast Tuberculosis
Damiri A, Chahdi Ouazzani H, Setti K, Oukabli M
Page no 526-529 |
10.21276/sjpm.2019.4.7.8
Tuberculosis is an infectious disease caused by bacteria belonging to mycobacterium family (KOCH bacillus). It often
affects low socioeconomic populations, immunosuppressed individuals, and elderly people. The lung remains the most
frequent localization in endemic countries followed by visceral involvement especially digestive one. Our patient is 46
years old with no particular history who presented a mammary nodule measuring 4.5 cm located at the level of the
supero-internal quadrant with no inflammatory sign, with stable general conditions. The mammogram shows a poorly
circumscribed and dense lesion without calcifications with disorganization of the mammary architecture and surface
thickening of the skin. A decision of an extemporaneous examination was made by the surgical team with an initial
diagnosis of breast carcinoma. A diagnosis of granulomatous mastitis has been made by our team while waiting
confirmation of the specificity of the inflammatory reaction after paraffin inclusion. Histological examination after
formalin fixation and paraffin inclusion confirms the tuberculous origin of the lesion. Breast tuberculosis is a rare
disease, even in endemic countries. Its incidence is low both as tuberculous localization (0.06 to 0.1%) and breast disease
(0.025 to 4.5%). The disease evolves in an insidious way and is rarely accompanied by general signs.
ORIGINAL RESEARCH ARTICLE | July 30, 2019
Clinicopathologic Analysis of Breast Lumps
Shashi Upreti
Page no 534-536 |
10.21276/sjpm.2019.4.7.10
Background: Breast diseases are showing a rising trend. The present study was conducted with aim of Clinicopathologic
analysis of Breast Lumps. Materials & Methods: The present study was conducted on 130 breast specimens obtained
from surgery department. The method of biopsy used was either open (excision and incision) or tru-cut needle biopsies
depending on size and clinical parameters at presentation. Results: Maximum patients were seen in age group 40-60
years (70) followed by 20-40 years (40) and >60 years (20). Histological diagnosis was fibroadenoma in 49, fibrocystic
disease in 20, benign phyllodes in 11, duct ectasia in 6, chronic mastitis in 15, granular cell tumour in 10, neurofibromas
in 2, lactating adenomas in 4, lipomas in 6 and invasive lobular carcinomas in 22. Maximum masses were seen in upper
inner quadrants (30%) followed by lower outer quadrants (24%), upper outer quadrants (12%), entire breast (11%), lower
inner quadrants (10%), central (8%) and middle quadrants (5%). The difference was significant (P< 0.05).
Conclusion: Most common breast mass was fibroadenoma followed by invasive lobular carcinomas. Most common site
was upper inner quadrant.
ORIGINAL RESEARCH ARTICLE | July 30, 2019
Analysis of Reasons for Discard of Blood and Its Products in a Blood Bank of a Tertiary Care Hospital
Josephine A, Natarajan Suresh, Bheema Rao
Page no 537-540 |
10.21276/sjpm.2019.4.7.11
Background: Blood transfusion services play a vital role in the modern healthcare scenario, and blood and its
components requirements widely outstrip the supplies therefore a stringent guidelines for transfusion, blood donations
and utilization should be laid down and adhered. This study analyses the causes for discard of blood and its components.
Materials and Methods: This was a retrospective study of various causes of discard of blood and blood components
carried out in blood bank unit of a tertiary care hospital from the data collected from the blood donations by the voluntary
donors from January 2014 to May 2017. Results: A total of 3442 blood bags were collected of which 3378 (98.14%)
were from male donors and 64 (1.85%) were female donors. majority of the donors were in the age group of 21-30 years
(55.37%). a total of 5453 blood /blood components were prepared of which 393 units of blood /blood components were
discarded with an overall discard rate of 7.22%. discard rate for WB, PRC, FFP and platelets were 9.22%,4.12%,7.9%
and 28% respectively. Conclusion: To prevent wastage of blood a proper coordination should be present between the
clinicians and blood bank personnel. An updated software and automation, proper training of staff and a properly
implemented blood transfusion policies would go a long way in reducing wastage of this vital body resource
ORIGINAL RESEARCH ARTICLE | July 30, 2019
Histopathology of Gastrointestinal Lesions in a Tertiary Care Centre
Dr. M. Jyothi Swaroopa, Dr. V. Indira
Page no 541-545 |
10.21276/sjpm.2019.4.7.12
Gastrointestinal lesions are the major group of specimens received in the surgical pathology department. This includes
endoscopic biopsies from gastric and duodenal mucosa, appendicectomies, cholecystectomies and colonoscopy biopsies.
This study was a retrospective analysis done between January 2015 and December 2017 which included 838 biopsies,
both mucosal and resected specimens. These biopsies were fixed in 10% buffered formalin, routinely processed and
paraffin embedded sections were taken and stained with Hematoxylin and Eosin. The stains were interpreted and
statistical analysis of the data obtained was done. The most common specimen received was appendix which accounted
for 49%, followed by cholecystectomies accounting to 38%, 5.5% biopsies from rectum and anal canal, 3%gastric
mucosal biopsies, 3% biopsies from colon, 1% mucosal biopsies from small intestine, 0.5% mucosal biopsies from
esophagus. In this study it was observed that appendix was the most common specimen received, followed by gall
bladder. The most common tumor of esophagus was squamous cell carcinoma. The most common tumor of stomach was
adenocarcinoma. Inflammatory lesions were more common in small intestine. Histopathological analysis of
gastrointestinal lesions helps the clinicians for proper follow up and specific treatment. This study gives an overview of
the various histopathological specimens received in the pathology department.
CASE REPORT | July 30, 2019
Desmoplastic Fibroma - Case Report
Pramila R, Priya R
Page no 546-549 |
10.21276/sjpm.2019.4.7.13
Desmoplastic fibroma (DF) is considered as an extremely rare locally aggressive bone tumor with the clinical
presentation of pain and swelling in the affected site most likely the metaphysic of long bones. Most of the times, a
clinical confusion may occur due to the histological and biological similarity with extra abdominal desmoids tumor of
soft tissue. In this case report, we define the clinico-pathological and radiographic features of DF of the mandible in a 15-
year-old male, who presented to the Outpatient Department with swelling and pain over right wrist. Thus, we present a
classic case of DF exhibiting characteristic features along with a review of the literature.
ORIGINAL RESEARCH ARTICLE | July 30, 2019
Study of Metallo-Beta-Lactamase Producing Gram Negative Bacteria in a Tertiary Care Hospital
Dr. Shilpa Rajesh Shah, Dr. Nisha Chaitanya Karanje
Page no 550-554 |
10.21276/sjpm.2019.4.7.14
Resistant bacteria are emerging worldwide as a threat to the favorable outcome of common infection in community &
hospital settings. Beta-lactams remain a cornerstone for antimicrobial chemotherapy of a large number of bacterial
infections. The most common cause of bacterial resistance to β- lactam antibiotics is the production of β- lactamases,
followed by ESBL’s and then the emergence of MBL activity which is one of the most feared resistance mechanism,
because of its ability to hydrolyze virtually all β- lactams, including cabapenems. However MBL’s are unable to
hydrolyze monobactams & are not inactivated by β- lactamase inhibitors like clavulinic acid, sulbactam and Tazobactam.
In any nosocomial settings, carbapenems are used as the last resort for treatment of MDR gram negative bacterial
infections. MBL producing gram negative bacteria often exhibit resistance to additional classes of drugs and behave as
multidrug resistant bacteria. Hence the present study was undertaken for detection of MBL producing gram negative
bacilli and to help treating physicians to select appropriate antibiotic in our hospital. It was a prospective study conducted
from April 2018 to July 2018 after IEC clearance. The Gram Negative isolates were first screened for MBL production
with ceftazidime disc, & were further tested by Combined Disc Test Method (CDT) and Modified Hodge Test (MHT).
Total 300 gram negative isolates were studied. In these, the MBL producers were 43.6%, majority of the isolates were
from pus (19.3%), followed by urine (14.3%). Amongst these, E. coli was the most common organism isolated (16.3%),
followed by Klebsiella pneumoniae(11%) and Pseudomonas aeruginosa (6.6%).By combined disc test a total of 131
MBL producing strains were isolated and 126 strains were detected by MHT. The exposure of bacterial strains to a
multitude of β- lactams has induced mutation of β- lactamase in many bacteria, expanding their activity even against
carbapenems, by the production of MBL resulting into fewer therapeutic alternatives. Hence detection of MBL is very
important in respect to the treatment plan and sparing use of antibiotics to avoid their spread in the hospitals.
ORIGINAL RESEARCH ARTICLE | July 30, 2019
Clinicopathological and Prognostic Value of PD-1/PD-L1 Expression in Patients with Breast Cancer
Ghada E Esheba
Page no 555-563 |
10.21276/sjpm.2019.4.7.15
Programmed cell death 1 (PD-1), and its ligand programmed cell death-ligand 1 (PD-L1), is important for tumor-immune
escape. Expression PD-L1 was observed in various solid tumors, including breast cancer (BC). The aim of this study is to
examine the expression of PD-1 in tumor infiltrating lymphocytes (TILs) and PD-L1 in tumor cells (TC) in BC cases, to
analyze the association between PD-1 and PD-L1 expression and clinicopathological features, as well as to correlate their
expression with overall survival (OS). This is a retrospective study that was conducted on 110 cases of BC.
Immunohistochemistry was performed to evaluate PD-1 and PD-L1 expression in TILs and TC respectively. There was
no significant association between PD-1expression in TILs and clinicopathological variables. The presence of PD-1+ TIL
was positively associated with PDL-1 expression in tumor cells; however, this association was not statistically significant
(p = 0.062). On the other hand, PD-L1 expression in TC was significantly associated with lymph node involvement (P
<0.0001), advanced stage (P = 0.035), high grade (P <0.0001), high TIL (P = 0.009), and negative ER (P = 0.01). BC
cases with PD-L1 expression had a significantly worse OS (HR = 0.201; 95% CI [0.048 - 0.112], p <0.000). PD-L1
expression was an independent prognostic factor in multivariate analysis (HR = 0.195; 95% CI [0.058 - 0.655], p
=0.008). In conclusion, PD-L1 expression is associated with advanced tumor stage, aggressive subtypes of BC, lymphatic
infiltration, and poor OS in BC.
CASE REPORT | July 30, 2019
Primary Breast Lymphoma Masquerading As Lobular Carcinoma Breast on Fluid Cytology- An Interesting Case
Salony Mittal, Madhumati Goel, Saumya Mittal
Page no 564-566 |
10.21276/sjpm.2019.4.7.16
Primary lymphoma of breast is an uncommon tumour that constitutes 0.04% to 0.5% of malignant breast neoplasms [1].
Here, we present an interesting case of a 28 years old lady who presented with ascites alongwith past history of
lumpectomy breast. Her ascitic fluid cytology showed monomorphic malignant tumour cells of poorly preserved
morphology. Being suspicious of tumour type, we reviewed the clinical details and past histopathology records of the
patient.
ORIGINAL RESEARCH ARTICLE | July 30, 2019
How Many Bronchial Alveolar Lavage Specimens Do We Need?
Lei Jiao, Bandar A. Albaradi2, Cindy Hamielec, Cheryl Main
Page no 567-572 |
10.21276/sjpm.2019.4.7.17
Introduction: Bronchoscopy is a valuable diagnostic tool and has a significant clinical impact on the management of
pneumonia, especially ventilator-associated pneumonia in ICU patients who fail to respond to standard, guideline-based
therapy. The investigation of bronchial alveolar lavage (BAL) specimens involves an extensive laboratory work.
Currently, there are very few published studies evaluating the diagnostic benefit of collecting multiple BAL specimens
during bronchoscopy. These redundant specimens result in a significant workload increase for the diagnostic
microbiology laboratory. Objective: To investigate the optimal number of specimens for bacteriology, virology,
mycology, Pneumocystis jirovecii (PJP) and Legionella penumophila specimens in order to optimize the utility of BAL
specimens with the aim of minimizing harm to the patient and optimizing resource utilization for the laboratory. Method:
BAL specimens collected at an academic institution in Southern Ontario were reviewed retrospectively over a 15 month
period for bacteriology, 16 months for virology, one year for mycology, and three years for L. pneumophila and P.
jirovecii. Results: One thousand sixty-three BAL specimens were ordered for bacterial culture, yielding positive results
in 45.5%. Among them, a concordance rate of 97.1% was found between two or more specimens acquired from different
lung lobes. The concordance rate of multiple virology samples was 98.6% among patients in whom 2 specimens were
collected per procedure, and 100% among those with 3 specimens per procedure. To study whether one specimen is
sufficient for the detection of filamentous fungi, we reviewed 43 BAL samples which grew Aspergillus fumigatus
between. A concordance rate of only 60% was found between two specimens obtained from different lung lobes. A
concordance rate of 100% was found among multiple specimens ordered for L. pneumophila and P. jirovecii with
positivity rates of 0.14% and 0.92% respectively. Conclusion: We recommend a single specimen per BAL be sent from
the most purulent lung segment for bacteriology and viral PCR. Single specimens may also be appropriate for L.
pneumophila and P. jirovecii, however further study is needed. Multiple specimens should be submitted for mycology
investigations. By eliminating duplicate specimens laboratory utilization can be optimized and patient morbidity may be
decreased.
ORIGINAL RESEARCH ARTICLE | July 30, 2019
Prevalence of Candiduria and Characterisation of Candida Species in Tertiary Care Center
V. C. Abishek, Kalyani Mohanram, R. Preethy
Page no 573-576 |
10.21276/sjpm.2019.4.7.18
Introduction: Candida is a genus of yeast which is the most common cause of fungal infection. Candida albicans is most
important fungal opportunistic pathogen. The candiduria refers to the presence of yeast in urine either by the microscope
observation of budding pseudohyphae, or by the growth of fungi in culture. Aim: To find the prevalence of candiduria in
tertiary care Centre. Materials and Method: This was a study conducted at Saveetha medical college from January 2018
to December 2018, the total number of urine sample collected were 10194 out of which 2500 showed various microbial
growth, out of which 50 Candida strains were isolated. Speciation was done according to standard protocol. Result: The
prevalence of candiduria caused by Candida non-albicans species (1.24%) is more than that caused by Candida albicans
species (0.76%). The prevalence is more in female (66%) than male (34%). Among the age group the prevalence is more
in the age group between 21-30 years (50%). Candiduria cases are common among the NON-ICU cases with 92%.
Candiduria is prevalent among the non-diabetic patients with 92%. Conclusion: Urinary tract candidiasis is known as the
most frequent nosocomial fungal infection worldwide. Candida albicans is the most common cause of nosocomial fungal
urinary tract infections; however, a rapid change in the distribution of Candida species is undergoing. Simultaneously,
the increase of urinary tract candidiasis has led to the appearance of antifungal resistant Candida species.