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.

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.

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.

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.

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 GluGln (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.

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.

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.

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.

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.

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.

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

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.

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.

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.

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.

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.

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.

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.