Study of Knowledge, Attitude and Practice about sickle cell anemia in patients with positive Sickle Cell Status in Bardoli taluka.

Background: Sickle cell anaemia is widely distributed in African and American negroes. It also seen in Arabian peninsula, Indian Subcontinent and parts of Europe. A high prevalence has been demonstrated in various tribal communities of Gujarat. Aims & Objective: To assess Knowledge, Attitude and Practice about sickle cell anaemia in patients with positive Sickle Cell Status. Materials and Methods: Cross Sectional Observational Study from June 2010 to May 2011. 276 patients with purposive sampling in Bardoli Taluka having sickle cell positivity in age group of 18 to 30 years were taken. Results: Only 16% of the study participants knew correct symptoms of Sickle cell anaemia. 30 % patients were availing the treatment of some kind. It was observed that females were more active as compared to males in taking medication for Sickle Cell Anaemia and the difference between them was found to be significant. It was found that 96 % of the study participants had received Color coded cards after testing showing the high accomplishment of mass screening programs in identifying Sickle Cell Status by simple means. But approximately 90% didn’t know the cause of disease and only 52 (18 %) were counselled about this disease. More than 95% of the participants were unaware regarding their haemoglobin status. Conclusion: All the strategies for the prevention of this outrageous disease will be effective only if they are utilized to its maximal extent by creating more awareness to the affected and also the other population.

Fine needle aspiration cytology: accurate and reliable tool for primary diagnosis of salivary gland lesions.

Background: Management of salivary gland lesions is greatly influenced by preoperative or intraoperative diagnosis of malignancy. Fine needle aspiration cytology (FNAC) is used as a primary diagnostic tool since long. Objective: The objective of study was to evaluate usefulness and diagnostic accuracy of FNAC in primary diagnosis of salivary gland lesions. Methods: Study includes 75 cases suspected of salivary gland lesions evaluated by FNAC from January 2010 to August 2012. Whenever possible follow up histopathology also studied. Results: Out of total of 75 cases of salivary gland lesions 30 cases (40%) were nonneoplastic, 30 cases (40%) were benign and 15 cases (20 %) were malignant. FNAC showed satisfactory sensitivity and specificity with about 91% diagnostic accuracy for benign lesions and for malignant lesions. Conclusions: Study concludes that FNAC has proven to be simple, easy, minimally invasive method with satisfactory accuracy for initial diagnosis of Salivary gland lesions especially benign and malignant neoplasms. It almost accurately type benign tumors like pleomorphic adenoma and showed fair accuracy and reliability. FNAC is vital for management primarily to exclude need of surgery as nonneoplastic lesions are managed conservatively and planning preoperative chemoradiation like in cases of Mucoepidermoid carcinoma arising in odd locations like palate.

Adjunctive role of immunohistochemistry to traditional histomorphology in diagnosis and accurate typing of soft tissue sarcoma.

Background: Soft tissue sarcomas, compared with carcinomas and other neoplasms, are relatively rare and constitute less than 1% of all cancers. Immunohistochemistry (IHC) especially a panel approach is an important adjunct to histopathological morphology and plays an important role in Soft tissue sarcoma diagnosis and accurate typing. Aims & Objective: Current study is to evaluate the utility of histopathology and immunohistochemistry in soft tissue sarcoma diagnosis and accurate typing. Material and Methods: Total of 50 cases of soft tissue sarcoma studied from January 2010 to October 2012. All cases were reported using routine (H&E) Hematoxylin- eosin stain and other ancillary techniques including panel approach of immunohistochemistry. Results: Histomorphology confirmed diagnosis in 22 % cases. In 78 % cases it was contributory to IHC. IHC provide confirmative diagnosis (Single diagnosis) in 45 cases (90%), definitive diagnosis (with two possibilities) in 4 cases (8%) and noncontributory in 1case (2%). Conclusion: Despite the rapid development of molecular genetic techniques, IHC still remains the most important diagnostic tool in the diagnosis of soft tissue tumours aside from recognition of morphologic features and clinical correlation. One of its major utilities is to correctly identify a tumour as mesenchymal or nonmesenchymal origin and then accurate typing done according to specific cell lineage. IHC is specifically useful in tumours of uncertain cell lineage and primitive round cell tumours. Indeed IHC has brought Brown revolution in sarcoma diagnosis and accurate typing. But important not to forget histopathology which provide the basic platform for the panel approach of IHC.

Diagnostic importance of serous fluid examination for detection of various pathological conditions - A study of 355 cases.

Background: Cytological examination of exfoliated cells is very challenging and of paramount importance for diagnosis, staging and prognosis as the finding of cancer cells in such a specimen denotes that the patient has advanced and incurable cancer. Aims & Objective: To study serous effusion for various pathological conditions. Material and Methods: The study was performed on serous effusions. Serous effusions from pleural, pericardial and peritoneal fluid were included and all other fluids were excluded. Their clinical history and other relevant parameters were noted. Collection was performed with 18-gauge needle under local anaesthesia and sterile conditions. When delay, samples were stored at 2-6 ͦC. Conventional smear and or Cytospin method were performed. Ether alcohol (wet fixed) and air dried smears were used. H & E stain, papanicolaou stain and MGG stain were done. Results: Out of total 355 cases, 186 were of pleural fluid, 164 of peritoneal fluid and 5 were of pericardial fluid. 288 cases were benign, 24 cases were malignant effusion, 17 cases were suspicious of malignancy and 26 cases were degenerated. Transudate, haemorrhagic and straw coloured fluid were more common. Conclusion: Benign effusions are common in younger whereas malignant effusions are common in older people. A combined approach to morphology by may-grunwald giemsa, papanicolaou with haematoxylin and eosin stain was better than individual method. Recurrent hemorrhagic effusions are more common in malignant effusions. Conventional smear method can yield good result. Scattered cells are indicative of benign effusions and clusters, 3 D balls, papillary patterns indicate malignant effusions.

Selection of mode of biopsy in histopathological diagnosis of Soft tissue sarcoma depending on diagnostic accuracy and feasibility: Debatable issue in modern era.

Background: Biopsy method of choice is a controversy issue for diagnosis of soft tissue sarcoma which are traditionally been managed by wide excision surgery and radiotherapy. Chemotherapy is reserved for advanced cases. Aims & Objective: The objective of study was to evaluate diagnostic accuracy of various modes of biopsy focusing on image guided core needle biopsy (CNB). Material and Methods: Current study includes 50 cases of soft tissue sarcoma from January 2010 to October 2012. The Mode of biopsies included image guided CNB, open and excision biopsy. Effective accuracy of each was determined by accuracy of biopsy to provide adequate tissue for histopathological and other special examinations like immunohistochemistry to reach final diagnosis. Results: Out of total 50 cases CNB was done in 13 cases, open biopsy in 2 cases and in 35 cases excision biopsy was done. CNB was adequate in 92.31 % cases and 7.69 % cases it was inadequate. Open and excision biopsy were 100 % adequate. Conclusion: Image guided CNB is very helpful in early diagnosis and shows high accuracy especially for high-grade sarcoma. It is less invasive compared to others and differentiate benign from malignant. It is handful when preoperative diagnosis is essential for planning pre-operative chemotherapy especially in patients with primarily inoperable, advanced tumour with compromised performance status or recurrent tumour. But it should be properly directed and representative of whole tumour and require full radiological correlation by experienced hands. Tumours with myxoid pattern, lipomatous tumours and low grade sarcomas encounters lower diagnostic accuracy on CNB.

Improved diagnosis of tuberculosis in lymph node cytology by bleach method for detection of acid fast bacilli in comparison to conventional ziehl neelsen staining method.

Background: Extra pulmonary tuberculosis (TB) is prevalent in developing countries and its diagnosis is often delayed, thus increasing the morbidity and mortality. Bleach method is cost effective, sensitive and safe method for demonstration of Acid fast bacilli (AFB) and is very valuable in diagnosing a case of tuberculous lymphadenitis. This simple procedure would benefit the patients to receive an early and specific treatment. Aims & Objective: The aim of our study was early diagnosis of tuberculosis in lymph node Fine needle aspiration cytology (FNAC) by bleach method for detection of AFB in comparison to conventional Ziehl–Neelsen (ZN) method. Material and Methods: Total 115 cases clinically suspected as tuberculous lymphadenitis in one year duration were included in study. All the aspirates by FNAC were processed for routine cytology, ZN staining and bleach method. The significance of the bleach method over the ZN method was analyzed using the χ2 (chi-square) test. Results: Among the 115 aspirates, 59.13% (68/115) were indicative of TB on cytology, 27.83% (32/115) were positive for AFB on conventional ZN method and the smear positivity increased to 61.74% (71/115) on bleach method. Conclusion: The implementation of the bleach method clearly improves microscopic detection of AFB over ZN method. The bleach method can be easily performed and reduce chances of laboratory acquired infections.

Immunohistochemistry: A diagnostic tool for accurate characterization of undifferentiated malignant tumours.

Background: The impact of diagnostic immunohistochemistry for the surgical pathology is legendary especially when it provides true identity of undifferentiated tumours. This not only is important for prognostication & therapy but also provide further insights into the pathobiology of these tumours. Aims & Objective: This study was undertaken to determine the role and significance of immunohistochemistry for accurate diagnosis and subtyping of undifferentiated malignant tumours as it is essential in guiding therapy and prognosis. Material and Methods: Immunohistochemical staining (IHC) performed was based on Peroxidase Antiperoxidase (PAP) method on paraffin sections, using appropriate mono/polyclonal antibodies. Total 74 cases including six consultation cases were studied from August 2008 to November 2011, which were reported as undifferentiated or poorly differentiated malignant tumor using routine hematoxylin- eosin stains. Results: The histopathology and IHC reports of 74 tumours were reviewed and assigned to appropriate categories. It was possible to arrive at a diagnosis in 73 cases (98.65%) with the help of IHC. Carcinoma was the commonest diagnosis (27 cases, 36.50%) followed by lymphoma (18 cases, 24.32%), sarcoma (14 cases, 18.92%), malignant melanoma (3 cases, 4.05%) and neuroblastoma (3 cases, 4.05%). Conclusion: Immunohistochemistry is helpful in the majority of difficulties arising during histological diagnosis of undifferentiated malignant tumours and serves as a diagnostic, prognostic, and predictive tool.

Study of metastasis in lymph node by fine needle aspiration cytology: our institutional experience.

Background: Fine needle aspiration cytology (FNAC) is a reliable as well as an inexpensive diagnostic method. It is suitable for the developing countries for the diagnosis of lymphadenopathy at any approachable site. Fine needle aspiration cytology not only confirms the presence of metastatic disease but also, in most cases, gives the clue regarding the origin of the primary tumor, prognosis as well in the management of patient for staging purposes. The aim of the study was to detect and diagnose metastasis in lymph nodes. Methods: A study was done of all metastatic lymph node lesions reported in Department of Pathology, Govt. Medical College, Surat from May 2011 to April 2012. Results: A total of 2355 cases of fine needle aspiration cytology were carried out of which 580 cases were of lymph node. Cytology results were positive for metastasis in 157 specimens (27.06%). The most common site was cervical lymph nodes. Maximum numbers of cases of metastatic tumors were in 41-50 yrs age group. There were 115 males and 42 females with a male predominance (Male:Female= 2.8:1). The most common malignancy was squamous cells carcinoma, seen in 118 cases (75.15%), followed by metastatic mammary carcinoma (13 cases, 8.29%). In 26 cases out of 580 cases, histopathological confirmation was done and diagnostic accuracy of FNAC was 100%. Conclusions: Fine needle aspiration cytology of lymphadenopathy is a useful tool in diagnosing metastatic lesions with good certainty.