Autoimmune thyroiditis Correlation between thyroid hormone status and AMA titre

Background: Thyroiditis is the second most common thyroid lesion next to endemic goitre diagnosed on FNA in iodine (I2) deficient areas. This study was carried out to study correlation between thyroid hormone status with anti-thyroid antibodies in cases of autoimmune thyroiditis diagnosed on FNAC. Aim: To correlate thyroid hormone status with anti-thyroid antibodies in cytologically diagnosed cases of autoimmune thyroiditis. Materials and methods: This was a retrospective study carried out in a tertiary care teaching hospital. 150 cases diagnosed as autoimmune thyroiditis in a two year period from January 2010 to December 2011 formed the study group. The clinical history, TFT, and AMA tires were noted from the medical record available with the patient and also from Endocrinology department records. Results: Incidence of autoimmune thyroiditis was found to be 13.4%. Majority of the patients were females (96.7%), 53.3% of cases were seen in the age group 21-40 years age group. Of the patients with autoimmune thyroiditis, 110(73.3%) patients were euthyroid while 32 (21.3%) patients were hypothyroid at the time of FNAC. Only 8(5.3%) patients showed evidence of hyperthyroidism. 8% patients showed subclinical hypothyroidism. In 97 patients anti-microsomal antibody titre (AMA) was available, 83 were positive i.e.85.6% positivity. Of the cytologically diagnosed cases of autoimmune thyroiditis, 14.4% cases showed AMA negativity. Thus FNAC remains the gold standard for the diagnosis. Conclusion: Autoimmune thyroiditis was seen more commonly in females, majority cases were seen in age group of 21-40 years. Euthyroid autoimmune thyroiditis was common in our study. Antimicrosomal antibody titre (AMA) was available in 97 cases, out of which 83 were positive i.e.85.6% positivity. Of the cytologically diagnosed cases of autoimmune thyroiditis, 14.4% cases showed AMA Arun Chopwad, Shweta P. Bijwe. Autoimmune thyroiditis – Correlation between thyroid hormone status and AMA titre. IAIM, 2018; 5(3): 34-43. Page 35 negativity. Thus FNAC remains the gold standard for the diagnosis in subjects with a clinical diagnosis of Hashimoto’s thyroiditis and negative antibody results.

Cytodiagnosis of oral lesions in chronic tobacco users

Background: In the country like India where oral cancer with its associated tobacco chewing habit exists in epidemic proportions, constitutes a major public health hazard. The high percentage of oral cancer if not preventable is curable only if detected in its early stage which require large scale screening of the population at risk carried out repeatedly from time to time. Exfoliative cytology plays important role in this. Aim: To study age and sex wise incidence of oral lesion, to study the clinical presentations, to study the role of tobacco chewing, gutkha, pan with areca nut and smoking in benign, premalignant and malignant lesions of oral cavity, to study the cytomorphological changes in oral cavity of different clinico- pathological lesions of chronic tobacco users, to corelate oral cytology with histopathology where ever possible. Materials and methods: A prospective study was carried out in total 135 chronic tobacco users. Patients above 15 years age who presented with oral lesion and with history of tobacco use in any form for more than 1 year were included in the study. Samples were obtained by scrape method using wooden spatula. All the smears were stained by Papanicolaou stain. Results: In the present study of 135 chronic tobacco users 73.33% were male and 26.67% were females. Male to female ratio was 2.75:1. Maximum 34.07% chronic tobacco users were in the age group of 31-40 year.30 cases of oral submucous fibrosis, 5 cases of leukoplakia and 59 cases of clinically suspected malignancy seen. Most common presenting symptom were ulceration in oral cavity in 51.11%. Commonest site of lesion was buccal mucosa in 56.30% cases. Cytological examination of smear showed dysplasia in 58.52% cases, smears positive / suspicious for malignancy in 37.04% cases and inflammatory smears in 3.70% cases. Clinically suspected malignant lesions were seen maximum (40 cases) in age group of 41-60 years which were using tobacco+lime, kharra, gutkha and tobacco smoking as habits. Incidence of malignancy was seen increasing with increased Shweta P. Bijwe, Arun P. Bakshi. Cytodiagnosis of oral lesions in chronic tobacco users. IAIM, 2018; 5(1): 17-27. Page 18 duration and frequency of tobacco use. Maximum 24 cases of malignancy (40.68%) were seen with use of tobacco for more than 25 years, affecting males commonly. Squamous cell carcinoma was the only histological type seen in all the cases. Percentage accuracy of cytologic diagnosis in oral cancer when compared with histopathological diagnosis was 84.75%. Conclusion: Cytology is a reliable method for diagnosis of oral cancer but histological examination remains the gold standard.

Schwannoma of forearm Difficult clinical diagnosis

Benign tumors involving peripheral nerves of the upper extremity are uncommon. The swelling may be misdiagnosed as other soft tissue neoplasm like lipoma, ganglion or lymph node. Schwannomas also known as neurilemmoma usually originate from Schwann cells located in the peripheral nerve sheaths. They account for about 5% of all the benign soft-tissue neoplasms in the adults and 19% of the tumors occur in upper extremities. Schwannomas generally presented as an asymptomatic mass causing discomfort. With the increasing size of the tumor pain, numbness, and fatigue may occur. We report a case of schwannoma on forearm which was clinically misdiagnosed as foreign body granuloma and was excised. Diagnosis was made on histopathology. Diagnosing the peripheral nerve schwannomas can be challenging clinically. Hence, a detailed clinical, radiological and histopathological evaluation is essential. Peripheral nerve schwannoma is rare and observation of a single patient can add to our understanding this rare disease.

Unusual site of presentation of W Bancrofti with various forms of filaria seen on cytology smears – Report of 2 cases

Abstract Filariasis is a major public health problem in tropical countries like India, China, Indonesia, Africa and the Far East. Aspiration cytology often helps in demonstration of microfilaria and its various forms, from uncommon diverse areas and in unusual clinical presentations like subcutaneous swelling caused by W.bancrofti in our cases. In our cases various forms of W.bancrofti were seen on cytology. Microfilria being most common form seen on cytology, adult worm, coiled forms (embryos) and ova seen less often. FNAC can be helpful in diagnosis of symptomatic as well as asymptomatic cases of lymphatic filariasis. During cytological evaluation of tissue fluids and aspirate from lesions of any part of the body, possibility of filariasis must be kept in mind as a possible differential diagnosis, particularly in endemic areas. This will help to give appropriate therapy to asymptomatic patients.

Correlation of serum C-reactive protein in painful vaso-occlusive crisis in sickle cell disease and its response to analgesic therapy

Background: Sickle cell disease is characterized by chronic hemolysis, frequent infections and recurrent occlusions of microcirculations, which causes painful crisis and results in chronic organ damage and failure. Occlusion of microcirculation and infection are important factors that stimulates production of cytokines and acute phase proteins like C- reactive protein. Aim: To estimate serum C-reactive protein levels in cases of painful vaso-occlusive crisis of sickle cell disease, to study correlation of level of serum C-reactive protein with duration of painful vasoocclusive crisis of sickle cell disease, to study relation between level of serum C-reactive protein and treatment response of analgesic versus analgesic opioid in cases of painful vaso-occlusive crisis of sickle cell disease. Materials and methods: This hospital based observational case control study was carried out at IGGMC, Nagpur, Maharashtra, India. Total 31 cases of sickle cell vaso-occlusive crisis, of age 12 years and above, admitted in hospital and 31 controls included in study. Study protocol was followed in each case. Results: Musculoskeletal, joint pain (83.87%) was most common form of presentation. Exhaustion and severe physical activity (25.80%) was most common precipitating factor. Mean hemoglobin, bilirubin showed statistically significant difference in cases compared to control. Mean CRP on day 1 (40.87±17.22 mg/L) was significantly high compared to control (3.67±0.77 mg/L) with statistical significance p<0.0001.