HISTOMORPHOLOGICAL STUDY OF CHOLECYSTECTOMIES IN A TERITIARY CARE CENTER

Introduction: Cholecystectomy is the most common surgical procedure performed for cholelithiasis (gall stones). Cholelithiasis is one of the most common gastro intestinal disorder worldwide. Usually asymptomatic, but commonly encountered symptoms may be right upper quadrant pain, dyspepsia and belching. The incidence of cholelithiasis is 2-4 times more in women than in men. The aim of the present study is to identify various morphological patterns and frequency of gall bladder lesions in cholecystectomy specimens. The Materials And Methods: present study was a cross sectional descriptive study of all cholecystectomy specimens received in the department of pathology, NRI Institute of Medical Sciences, Sangivalasa, Visakhapatnam, Andhra Pradesh; conducted over a period of 12 months from September 2021 to August 2022. The relevant and detailed clinical history were taken and processing was done in these specimens for histopathological examination. A total of 80 cholecystectomy specimens were received in the Results: department. Out of which, 79 were in?ammatory gall bladder lesions and only one case was reported as malignancy. The most common age group affected were in 4th to 5th decade with female preponderance comprising of 47cases (58.75%) while the gall bladder carcinoma was reported in 72 years of age. Among the in?ammatory lesions, most common one was chronic cholecystitis comprising of 64 cases, 80.5% (63.6% associated with gall stones) were chronic cholecystitis, followed by 10 cases (12.5%) of acute cholecystitis (100% associated with gall stones), 2cases (2.5%) of polyps & Adenomyomatosis each. Only one case (1.25%) of each Cholesterolosis & gall bladder adenocarcinoma was reported. Chronic cholecystitis is the Conclusion: most common gall bladder disease for which cholecystectomies are being done. The present had reported various morphological patterns encountered in the cholecystectomy specimens received in the department

A correlation biomarker between BMI and lipid peroxidation in type 2 diabetes mellitus with and without other complications

Objectives: Body mass index (BMI) is a traditional measurement practice that divides a person’s weight by their height to find out whether they have a healthy range of weight. The objective of this study is to understand the relation between BMI and prevalence of diabetes mellitus, hypertension, and dyslipidemia. Material and Methods: BMI distribution among these patients was compared with and without hypertension and dyslipidemia. The improper of secretion of insulin leads to changes in metabolism of lipids, proteins, and carbohydrates also characterized hyperglycemia generally considered as diabetes mellitus (DM). Results: The excessive formation of free radicals induces oxidative stress, and the antioxidant defense system becomes weaken and hence arises diabetic disorder and overproduction of malondialdehyde (MDA). In cells, the polyunsaturated fatty acid peroxidation is considered as the final product and marker of oxidative stress. Conclusion: In this study, significantly increased BMI is observed in diabetic victims in comparison with control group. A significant positive correlation was noticed between glycated hemoglobin, cholesterol, and MDA. In conclusion, for the prevention and management of vascular complication in type 2 diabetes mellitus, maintaining normal levels of MDA and body weight are very important. Further large-scale studies are required to confirm it

Clinicopathological study of premalignant and malignant lesions of cervix along with apoptotic index and Ki-67 expression

Background: Cervical cancer is known to have a good response to radiotherapy. The response and prognosis are dependent on the level of apoptosis. Pap smear and histopathology are cost-effective methods in diagnosing premalignant and malignant lesions of cervix but not accurate in classifying and estimating the progression of the disease, especially in premalignant lesions. Therefore this study was undertaken to know the role of Ki-67 expression and apoptotic index in classifying accurately the premalignant lesions for better management.Methods: The study included 540 cases diagnosed histologically as cervical intraepithelial neoplasia or carcinoma. The apoptotic index is calculated for all the 540 cases using light microscopy on Haematoxylin and Eosin stained sections. Ki-67 immunohistochemical staining was done for 100 cervical biopsies. Ki-67 expression was graded and the Ki-67 labelling index was calculated. Statistical evaluation was done using the unpaired t-test.Results: The Apoptotic index increased with increasing grade of dysplasia. There is a significant difference in the mean apoptotic index between premalignant and malignant lesions of the cervix. The ki-67 index increased with increasing grade of dysplasia. There is a significant difference in the mean Ki-67 index between premalignant and malignant lesions of the cervix.Conclusions: Apoptotic index and proliferative indices have been found useful in distinguishing between premalignant and malignant lesions of the cervix and gives an idea about the proliferative activity of the tumour for better management of the patient and to determine prognosis.

Vascular malformations: a hospital based study

Background: Vascular anomalies comprise a widely heterogeneous group of lesions. Diagnosis and management of these lesions present challenges to the surgeons, radiologists and histopathologists. Accurate classification of these lesions results in appropriate therapy. Aim of the study is to study the role of histopathology and histochemical stain in the diagnosis of vascular malformationMethods: The present study is a hospital based observational study on vascular malformations over a period of three years from 2016 to 2018 done in department of Pathology and Plastic Surgery at tertiary care centre, Visakhapatnam.Results: Out of 107 specimens of vascular anomalies received, 72 cases were vascular neoplasms, 35 were vascular malformations. Majority of the vascular malformations were seen in the cervicofacial region (43%) followed by extremities (37.1%). Most common malformation in the present study was arterio venous malformations (60%) followed by venous malformations (22.8%). Verhoeff’s VanGieson stain demonstrated discontinuity of internal elastic lamina in cases of arteriovenous malformation and helped in differentiating the lesions from capillary malformation and vascular tumors.Conclusions: Histopathology, special histochemical stains along with imaging features can be used to reduce diagnostic difficulties and in helping proper management of vascular malformations.

Clinico-pathological and radiological correlation of CNS tumors along with role of Ki 67 proliferative index in grading Astrocytoma and Meningiomas

Background: CNS neoplasms are a heterogenous group contributing to <2% of all the malignant neoplasms. Imaging and histopathology play a great role in diagnosing these lesions. Aim of the study is to correlate radiological findings with that of histopathology and evaluate the role of Ki 67 proliferative index in various grades of Astrocytomas and MeningiomasMethods: This is an observational study for a period 2 years from July 2015 to June 2017 in Department of Pathology Andhra Medical College. The total number of specimens of CNS tumors received during this period were126. The specimens were routinely processed and stained with H&E. The tumors were classified based on WHO 2016 classification. In total 71 cases-45 cases of meningiomas and 26 cases of astrocytomas, the expression of Ki 67 labelling index was recorded in various grades of these tumors and results tabulated.Results: Among 126 cases, tumors predominantly encountered were of meningeal origin accounting to 45 cases (35.71%) followed by tumors of neuroepithelial origin 35 cases (27.78%). Tumors were seen in all age groups, but common was among 41-50 years of age group with metastatic tumors being seen in >60 year group. Tumors were more common in males with male: female ratio being 1.25:1. Ki 67 proliferative index increased as the grade of tumor increased in both astrocytomas and meningiomas.Conclusions: Grading of meningiomas and astrocytomas are very much essential with reference to prognosis and therapy. Histopathology plays a great role in grading these lesions but Ki 67 proliferative index adds as an adjunct and helps in confirmation and predicting the recurrence of these lesions.

Integrated teaching in medical education: undergraduate student’s perception

Background: Integrated teaching is an effective teaching method for the undergraduate medical students to achieve good knowledge and skills. The aim of this study was to evaluate the effectiveness of vertical integrated teaching.Method: Vertical integrated teaching was conducted on the topic “Nephrotic syndrome” for 2nd MBBS (5th semester) students. Departments which participated in the session were from Physiology, Biochemistry, Pathology and General Medicine. Faculty from each department was allotted 20 minutes for their topic. After completion of all the topics students were given feedback forms. The opinions were tabulated and analysed.Results: Most of the students opined that integrated teaching is useful in gaining knowledge (Understanding, concept clarity and better performance in exams) (79.7%) as well as skill-based learning (Workshops, laboratory, clinical exercises and case discussion) (84.4%).Conclusion: The study showed that undergraduate students agreed that integrated teaching is useful for them in gaining knowledge as well as skill.

Clinical, histopathological and immunofluorescent study of vesicobullous lesions of skin

Background: Vesiculobullous diseases have been the focus of intensive investigation in recent years. However, these disorders are still associated with substantial morbidity, considerable mortality and impaired quality of life. Accurate diagnosis of vesiculobullous lesions of skin entails evaluation of clinical, histopathologic and immunofluorescence findings.Methods: Hospital based prospective study for a period of 24 months from August 2014 to July 2016 in the Department of Pathology at Andhra Medical College, Visakhapatnam, India. Total of 50 patients aged 3-70 years with vesiculobullous lesions of both sexes attending the Department of Dermatology were selected and analysed clinically, histopathological examination and direct immunofluorescence (DIF).Results: In the present study, majority of patients presented between 51-60 yrs of age (32%) with male to female ratio of 1.08:1 and mean age of 46.02 years. Pemphigus vulgaris constituted the most common vesiculobullous disorder (32%) followed by bullous pemphigoid and pemphigus foliaceous, 18% each. Bullae were located intra epidermally in 68% and sub epidermally in 32% of the patients. DIF was positive in 80% of the cases. Overall clinicopathological correlation was established in 74%. Overall histopathological and direct immunofluorescence correlation was established in 78%. Out of 50 cases, 35 cases (70%) correlated clinically and histo-pathologically with direct immunofluorescence.Conclusions: In the present study, on histopathological examination alone pemphigus foliaceus and pemphigus vulgaris could be differentiated. Direct immunofluorescence was useful in differentiating epidermolysis bullosa acquisita from bullous pemphigoid which have similar histopathological picture. This study proves that direct immunofluorescence is confirmatory as well as diagnostic for vesiculobullous disorders.

Cynodon dactylon extract ameliorates cognitive functions and cerebellar oxidative stress in whole body irradiated mice

Objective: To explore the effect of hydroalcoholic extract of Cynodon dactylon on the whole body radiation-induced oxidative status of the cerebellum and cognitive impairments in mice. Methods: Swiss albino mice were randomly divided into the control group, radiation control group, low dose and high dose Cynodon dactylon extract treated groups and pre-treated with Cynodon dactylon extract before irradiation. Cynodon dactylon extract was administered for 7 d daily in low dose (0.25 g/kg) and high dose (1 g/kg). On day 7, mice were irradiated with a sublethal dose of 5 Gy gamma rays. Motor coordination was assessed by elevated rotarod test and spatial memory was studied by water maze test. Subsequently, biochemical markers (glutathione, lipid peroxidation and nitric oxide levels) in the cerebellum were evaluated. Results: The gamma irradiated group showed significant impairment in motor coordination and spatial memory compared to normal mice. Mice treated by Cynodon dactylon extract prior to gamma radiation showed good improvement in both paradigms compared to the radiation control group. Moreover, glutathione level was increased, while lipid peroxidation and nitric oxide levels were significantly reduced in mice receiving low dose and high dose of Cynodon dactylon extract compared to the radiation control group. Conclusions: The present study suggests the neuroprotective role of Cynodon dactylon against radiation-induced cognitive impairment and oxidative stress on the cerebellum of mice.

Cynodon dactylon extract ameliorates cognitive functions and cerebellar oxidative stress in whole body irradiated mice

Objective: To explore the effect of hydroalcoholic extract of Cynodon dactylon on the whole body radiation-induced oxidative status of the cerebellum and cognitive impairments in mice. Methods: Swiss albino mice were randomly divided into the control group, radiation control group, low dose and high dose Cynodon dactylon extract treated groups and pre-treated with Cynodon dactylon extract before irradiation. Cynodon dactylon extract was administered for 7 d daily in low dose (0.25 g/kg) and high dose (1 g/kg). On day 7, mice were irradiated with a sublethal dose of 5 Gy gamma rays. Motor coordination was assessed by elevated rotarod test and spatial memory was studied by water maze test. Subsequently, biochemical markers (glutathione, lipid peroxidation and nitric oxide levels) in the cerebellum were evaluated. Results: The gamma irradiated group showed significant impairment in motor coordination and spatial memory compared to normal mice. Mice treated by Cynodon dactylon extract prior to gamma radiation showed good improvement in both paradigms compared to the radiation control group. Moreover, glutathione level was increased, while lipid peroxidation and nitric oxide levels were significantly reduced in mice receiving low dose and high dose of Cynodon dactylon extract compared to the radiation control group. Conclusions: The present study suggests the neuroprotective role of Cynodon dactylon against radiation-induced cognitive impairment and oxidative stress on the cerebellum of mice.

Recurrent multifocal cutaneous Kaposiform hemangioendothelioma: A rare vascular tumor of infancy and childhood.

Kaposiform hemangioendothelioma (KHE) is a locally aggressive vascular tumor of childhood although cases occurring in adulthood are also described. The features overlap with juvenile capillary hemangioma and Kaposi sarcoma. We report a rare case of recurrent, multifocal (nose and chin) cutaneous KHE initially occurring in a 3‑year‑old female child, uncomplicated by Kasabach–Merritt syndrome. Recurrences occurred over the next 6 years and resulted in complete distortion of the nose, requiring plastic repair.

Leydig cell tumor of ovary with primary hyperparathyroidism: A rare association.

Leydig cell tumors of ovary are extremely rare sex cord stromal tumors that account for <0.2% of ovarian cancers. Most of these tumors can cause hyperandrogenism. A 54 year old multiparous postmenopausal woman, known diabetic and hypertensive, presented with progressive virilization, bone pains and depressed mood for 2 years. Diagnostic evaluation revealed markedly elevated testosterone with normal dehydroepiandrosterone sulphate. Computerized tomography of abdomen showed right ovarian mass with multiple cysts in both kidneys. Biochemical investigations revealed hyperglycemia, hypercalcemia, hypophosphatemia and elevated parathormone (PTH) levels. Sestamibi scan for parathyroids was suggestive of right inferior parathyroid adenoma. Histopathology of the resected right ovarian tumor was consistent with leydig cell tumor of ovary. Postoperatively serum testosterone and blood glucose levels were normalized, but PTH levels remained high. PTH levels were normalized after resection of parathyroid adenoma

Malignant melanoma of breast: a case report.

Malignant melanoma rarely affects the breast. Malignant melanoma of breast is divided into two categories: primary and metastatic lesions. Primary melanoma involves the skin and less commonly the glandular parenchyma of the breast. Differentiating them is very important in deciding on treatment strategies. This case report aims to increase awareness of unusual neoplasms of the breast which requires a different surgical and adjuvant therapeutic approach.

Role of urine sediment cytology in the diagnosis of renal disorders in comparison with biochemical and histopathological findings.

Background: The functional reserve of the kidney being large, serum biochemical parameters do not show abnormality until late. The need to recognize minimal damage in the kidneys is hence valuable. Urine sediment examination is cost effective, time saving and is called “liquid renal biopsy”. The present study was aimed to evaluate the role of urine sediment examination in predicting the severity of renal damage and compare the results with serum biochemical parameters, 24 hour urine protein values and renal biopsy findings. Methods: A total of 149 patients presenting with symptoms pertaining to renal disease were included in the study. Clinical information and serum biochemical parameters were obtained. Urine examination was done and renal biopsy performed in all the cases. 2 scoring systems were adopted to grade the urine sediment findings and renal biopsy grading devised by A. Z. Gyory et al. was used to grade the renal injury. 24 hour urine protein was estimated by Esbach’s method. Urine sediment scores, serum biochemical parameters, 24 hour urine protein values were compared with the grades of renal injury on renal biopsies and statistical significance calculated. Results: 32.8% of patients with renal disease were in the age group of 31-40 years. Nephrotic syndrome was the most common clinical presentation (33.5%) followed by nephritic syndrome (21.4%). The most common histopathological diagnosis was post infectious glomerulonephritis (n = 26) followed by acute interstitial nephritis (n = 17). 14 cases of lupus nephritis were diagnosed all of which were confirmed by “full house” pattern of immunofluorescence. Both the urine sediment scores had high specificity and positive predictive values in predicting the severity of renal injury. 24 hour urine protein had high positive predictive value in predicting the severity of renal injury. Serum biochemical parameters were insignificant in predicting the severity of renal injury. Conclusion: Urine sediment examination can be used as an effective diagnostic test for predicting the severity of renal injury. The decision of further investigations and follow-up can be certainly decided by taking urine microscopy findings and 24 hour urine protein values into consideration.

Prospective study of histopathological patterns of ovarian tumours in a tertiary care centre.

Background: Ovarian tumours account for 3% of all cancers amongst women, being the second most common cancer of the female genital tract. The ovarian tumours are highly heterogenous with a wide range of histological patterns. Aim of current study was to study the histological patterns and the age incidence of the ovarian tumours in our institute. Methods: The present study is a prospective study conducted in the department of pathology, Andhra Medical College, from August 2011 to July 2013. Results: We received a total of 267 specimens of ovarian tumours during this period, out of which, 263 were primary and 4 were secondary tumours. Benign tumours were 209 (78.3%), borderline were 10 (3.7%) and malignant were 48 (18%) in numbers. Overall surface epithelial tumours constituted the majority of tumours accounting for 214 (80.2%) cases, followed by germ cell tumours 38 (14.2%) and sexcord stromal tumours 11 (4.1%). The single most common tumour diagnosed was serous cystadenoma. The most common malignant tumour was serous cystadenocarcinoma. The age groups affected ranged from 11-70 years. The peak age incidences for different histological types were as follows: surface epithelial tumours: 21-50 years, germ cell tumours: 21-30 years, sexcord stromal tumours: 51-60years. Benign tumours were more common in 21-40 years of age, borderline in 31-50 years and malignant tumours in 41-50 years age group. Conclusion: The results from our study were comparable with those reported in literature; however malignant serous and mucinous tumours showed a lower peak age incidence in our study. Krukenberg tumours also occurred in younger age group in our study.

Giant congenital melanocytic nevus scalp: report of a rare case.

Giant congenital melanocytic nevus (garment nevus) is a kind of congenital malformation of neural crest cells with size greater than 20 cm. Malignant melanoma may develop in 2-31% of these lesions. The objective of this paper is to present a unique case of giant nevus which is rare.

A study of prevalence of obesity and an assessment of nutritional status in elderly South Indian Population.

Obesity and abnormal nourishment are the biggest concerns of developed and developing societies. We analysed the nutritional status using Mini Nutrition Assessment (MNA) and correlated the findings with BMI, Waist – to – Hip (W/H) ratio in elderly population of Dakshina Kannada District of Karnataka. Total of 221 elderly subjects above the age of 50 years (105 were males and 116 were females) were recruited, who did not have any morbid diseases. Their Anthropometric parameters namely BMI and W/H were recorded and tabulated. They were grouped into Underweight, Normal, Over weight and Obese and the respective numbers were segregated and shown in table. MNA scores of each group were found out and the correlation was done. Results were analysed by using ANOVA and Tukey – Kramer test using SPSS version 16. The results suggested that there is a correlation between the BMI, W/H ratio with the MNA scores. Underweight elderly had low scores while overweight and obese subjects had higher scores. Women showed a higher tendency to become over weight and obese compared to men. This study reiterates that there is a correlation between anthropometric parameters and the nutritional status. A wider study with more number of subjects could yield more insight into the findings and be useful guide for suggesting any lifestyle modification.

Congenital extraskeletal Ewing's sarcoma of chest wall - A rare case report.

Congenital extraskeletal Ewing's sarcoma or peripheral primitive neuroectodermal tumor is an extremely uncommon and invariably fatal tumor. We report a case of extraskeletal congenital Ewing's sarcoma in a female fetus delivered at 34 weeks of gestation who died immediately after birth. In English literature, majority of cases of Ewing's sarcoma in neonates reported were skeletal. To the best of our knowledge, very few cases of extra-skeletal Ewing's sarcoma in neonates are reported in the literature.

Reversal of impact of BMI on autonomic modulation in geriatric population.

Background: The main cause for most of the old age complication is due to derangement of cardiovascular and autonomic nervous activity. This study was proposed to record and asses the HRV in elderly population involved with respect to Body mass index to predict and prevent further deterioration and thereby help the elder to lead more normal, healthy and active life. Materials& methods: 80 normal volunteers were selected, with ages between 55 to 85 years. They were evaluated clinically for Heart rate variability (HRV) and body mass index. Based on BMI, subjects were divided in to two groups. Group I with 40 subjects whose BMI was ≤25 and group II with 40 subjects whose BMI was 25 to 30. To assess the autonomic changes, in this study different parameters of HRV were recorded in both the groups and compared during normal (N), deep breathing (DB) and cold pressor test (CPT) conditions. Results showed that the SDANN, Time domain HRV was more in subjects with high BMI when compared to subjects with normal BMI during normal condition, in CPT condition parasympathetic activity was more in subjects with high BMI compared to subjects with normal BMI. Conclusion; This study showed in old age higher the BMI more the HRV and the degree of parasympathetic activity was more in higher BMI.

Molecular analysis of genetic stability in long-term micropropagated shoots of banana using RAPD and ISSR markers

A large number of micropropagated plantlets of banana, Musa acuminata var. Nanjanagudu Rasabale (NR), that were developed from axillary shoot bud explants over 10 years ago were screened for genetic variation, if any, using RAPD (Random Amplified Polymorphic DNA) and ISSR (Inter-Simple Sequence Repeats) markers. Of the 4000 in vitro plantlets, 11 were used for screening that involved shoot cultures with distinct variation in morphological characteristics (morphotypes). Similarly, the mother maintained in the field was also subjected for genetic analysis. Out of the 50 RAPD and 25 ISSR primers screened, 30 RAPD and 5 ISSR primers produced totally 424 clear, distinct and reproducible band classes resulting in a total of 5088 bands where the banding patterns for each primer was highly uniform and comparable to the field-grown mother clone from which the cultures had been established. These results indicate that the micropropagation protocol developed by us for rapid in vitro multiplication is appropriate and applicable for clonal propagation of banana var. NR over a long period. This is the first report on the use of genetic markers to establish genetic fidelity of long-term micropropagated banana using RAPD and ISSR.