T-cell lymphomas in a tertiary care center of Mangalore

Background: The clinicomorphology and immunohistochemical features of T-cell lymphomas have been documented. Aim: The aim of the study was to evaluate the spectrum of clincopathological features of T-cell lymphoma with immunohistochemistry correlation in a tertiary care center. Materials and Methods: The present study was conducted on 19 biopsy specimens received from the Department of Pathology, Kasturba Medical College, from referral hospitals of Mangalore city. Cases of nodal and extranodal T-cell lymphomas diagnosed between January 2012 and December 2015 were selected with evaluation of clinical data, histomorphological features, and immunophenotyping. Appropriate panel of antibodies was chosen after morphological evaluation of the cases. Results: Of the 19 cases of T-cell lymphomas, 14 were nodal disease and 5 were extranodal disease. Among the nodal lymphomas, five were primary peripheral T-cell lymphoma-not otherwise specified (PTCL-NOS), four were cases of lymphoblastic lymphoma, three were cases of angioimmunoblastic T-cell lymphomas, and two were cases of anaplastic large-cell lymphoma anaplastic lymphoma kinase (ALK) negative. In extranodal disease, two were mycosis fungoides of skin, one case each of subcutaneous panniculitis-like T-cell lymphoma, T-cell lymphoblastic lymphoma of tonsil, and T-cell lymphoma of the stomach. Conclusions: The diagnosis and subclassification of PTCLs is necessary for therapeutic and prognostic purposes

Evaluation of Hepatoprotective Effect of Essential Oil of Etlingera Fenzlii (Kurz) Skronick & M. Sabu (Zingiberaceae)

Background: Etlingera fenzlii (Kurz) Skronick & M. Sabu (Zingiberaceae), is an endemic species of theAndaman Nicobar Islands. Used by the nomadic tribes, shompens as honey bee repellent and also usedagainst malaria fever, gastrointestinal disorders, wherein the root and flower is boiled in water and used towash the uterus after child birth.Aim: The present study was aimed to investigate the essential oil of Etlingera fenzlii (EOEF) in ethanolinduced hepatotoxicity in Wistar albino rats and silymarin was used as positive control.Methods: Standard drug (Silymarin), essential oil, ethanol were administered orally for 28 days. On 28th dayanimals were sacrificed and blood was collected for assessment of AST, ALT, ALP, total protein, albumin,globulin and histopathological changes in the liver of different groups were also studied.Results: Oral administration of ethanol significantly increased biochemical parameters such as AST, ALT,ALP levels and whereas reverse was observed with test compounds (Silymarin and essential oil).Histopathological studies further substantiate the hepatoprotective effect of E.fenzlii essential oil.Conclusion: Our observation indicates that essential oil of E.fenzlii shows hepatoprotective activity comparedto standard drug silymarin. The present study thus provides a scientific rationale for the traditional use ofE.fenzlii in the management of liver disorders.

Discovered on gastrointestinal stromal tumor 1, a keystone in the diagnosis of extraintestinal gastrointestinal stromal tumors

Introduction: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract (GIT) but have a low incidence. Arising from the interstitial cells of Cajal, GISTs occur at different sites in the GIT with stomach being the most common. They can rarely be seen at sites outside the GIT such as omentum, retroperitoneum and are called as extraintestinal GISTs (EGIST). They have a spindle or epithelioid cell morphology and show positivity by immunohistochemistry (IHC) for CD117. Our aim was to study the clinicopathological and immunohistochemical profile of our cases of EGISTs. Materials and Methods: A cross-sectional study of EGISTs received from 2010 to 2015 was done. IHC with CD117 and discovered on GIST1 (DOG1) was performed and tumors were scored based on the percentage of cells that stained positive. Thirteen abdominal non-GIST spindle cell tumors were included in the study as controls. Results: Seven cases of EGIST were included (four-omental, three-retroperitoneal). All cases stained positive for CD117 and DOG1. One case of epithelioid EGIST scored 4 + with DOG1 and 2 + with CD117. Another case with mixed morphology scored 2 + with DOG1 and 4 + with CD117. All controls were negative for both markers. Conclusion: EGISTs are one of the rare differentials for spindle cell lesions outside the GIT. Although both markers stain positive, DOG1 showed higher score with epithelioid GISTs

Study of the reproducibility of the 2004 World Health Organization classification of urothelial neoplasms.

The aim of the study was to evaluate urinary bladder biopsies showing papillary urothelial neoplastic lesions based on the 2004 WHO/ISUP classification of Urothelial Neoplasms of the Urinary Bladder, to assess the reproducibility of the bladder carcinoma grade. Fifty consecutive transurethral tumor resection biopsies were evaluated by four pathologists independently. The final diagnoses of each pathologist were subjected to statistical analysis to assess the degree of interobserver variability and reproducibility of this classification. Significant interobserver variation was found in the reporting of urothelial neoplasms. In 22 instances there was difference in opinion between PUNLMP and low-grade carcinoma, and in 59 instances between low and high grade carcinoma. The 4 observers never unanimously agreed on the diagnosis of PUNLMP.

Eating disorders among medical students of a rural teaching hospital: a cross-sectional study.

Background: Eating disorders are complex psychiatric syndromes in that can lead to significant and potentially life threatening medical and nutrition complications. Literature from India in this regard is restricted and issues such as eating attitudes and body shape dissatisfaction remain unexplored in the Indian setting. It has been argued that eating disorders are culture-bound disorders specific to western societies. Consequently, these conditions remain understudied in most non-western settings. Objectives: 1) To determine the prevalence of eating disorders and body shape perception among medical students. 2) To assess any association between eating disorders and body shape perception. Methods: A cross-sectional study was conducted among 172 medical students using Eating Attitudes Test-26 (EAT-26), and the Body Shape Questionnaire (BSQ). Anthropometric measurements like height, weight was done for body mass index calculation and analysis was done with open Epi and Microsoft excel. Results: An overall prevalence of overweight was calculated to be 17.4% and obesity, 6.4%. The prevalence of eating disorder symptoms and disordered eating attitudes and behaviours in our study was 16.9% and a significant correlation between distorted eating attitudes and age with body shape dissatisfaction was found. Conclusions: The prevalence of overweight and obesity is on rise and a comparable level of eating disorders was observed. It is recommended to assess BMI along with the body shape concerns while screening for eating disorders among medical students.

A clinicopathological and immunohistochemical study of malignant peripheral nerve sheath tumors.

Background: Malignant Peripheral Nerve Sheath Tumor (MPNST) is a rare aggressive sarcoma that develops within a peripheral nerve and forms a diagnostic challenge in view of its varied histomorphology. This short series highlights the clinicopathological spectrum of 11 cases of MPNST and the incidence of neurofibromatosis 1 (NF1) association. Methods: This retrospective and descriptive study on MPNST was done in the department of pathology, Kasturba medical college Mangalore (Manipal University), India over a period of three years from January 2008 to December 2010. Cases which were histopathologically diagnosed as MPNST were reviewed & immunostains was done where ever indicated to rule out the differentials. Results: A total of 11 cases of MPNST were documented with a wide age range of 17-85 years. Male:female ratio was 2.6:1. Extremities (63.64%) were found to be the most common site. Location wise most of the tumors were deep seated (63.64%) and maximum cases were high grade (54.55%). NF1 association was seen in 2 cases. Heterologous elements in the form of chondroid differentiation was seen in one case. Immunostain with S-100 was focally positive in all the cases. Conclusion: MPNST is a highly aggressive sarcoma with poor prognosis characterized by a challenge in its diagnosis as it has several mimics. Its diagnosis necessitates the incorporation of clinicopathological features and IHC with S-100 protein.

Breast feeding and weaning practices of mothers in a rural area – a cross-sectional study.

Background: Breastfeeding has been a universally accepted practice. Due to awareness in urban areas breastfeeding is practiced by almost all mothers whereas mothers in rural areas practice lesser. This might be due to varied factors like female literacy, low awareness etc. Aims & Objective: To find out the pattern of breast feeding practices in the rural mothers of Nagamangala Taluk, Mandya District. Material and Methods: Mothers with children who were 9 months old and above who came to Bellur PHC for measles vaccination and booster doses of DPT and OPV were included in the study and the data was collected using a pre-tested, structured questionnaire. The study was done for five months from January 2010 To May 2010). Results were analyzed using Percentages, Chi Square test. Results: 28% of the mothers initiated breastfeeding within 60 minutes; prelacteal feeds used were cow’s milk, jaggery water and honey. Only 35% mothers fed their infants exclusively for the optimal duration of 6 months and 36% mothers weaned their infants prematurely. The most common weaning food was cow’s milk. Conclusion: Early breast feeding pattern was found to be low and prevalence of exclusive breast feeding and timely weaning was low.

Profile of retinal vasculitis in a tertiary eye care center in Eastern India.

Aims: To provide a fact file on the etiology, clinical presentations and management of retinal vasculitis in Eastern India. Materials and Methods: Retrospective, record based analysis of retinal vasculitis cases in a tertiary care center in Eastern India from January 2007 to December 2009. Results: One hundred and thirteen eyes of 70 patients of retinal vasculitis were included in this study. Sixty (85.7%) patients were male (mean age 33± 11.1 years) and 10 (14.3%) were female (mean age 32.4 ± 13.6 years). Vasculitis was bilateral in 43 (61.4%) and unilateral in 27 (38.6%) patients. Commonest symptoms were dimness of vision (73; 64.6%) and floaters (36; 31.9%). Vascular sheathing (82; 72.6%) and vitritis (51; 45.1%) were commonest signs. Mantoux test was positive in 21 (30%) patients but tuberculosis was confirmed in only four (5.71%) patients. Raised serum angiotensin-converting enzyme level and positive antinuclear antibody level were reported in four (5.71%) patients each. Human leukocyte antigen B5 (HLA B5) marker was present in one (1.4%) patient. However, none of the total 70 patients were found to have a conclusively proven systemic disease attributable as the cause of retinal vasculitis. Oral corticosteroid (60; 85.7%) was the mainstay of treatment. Forty-eight (42.5%) eyes maintained their initial visual acuity and 43 (38%) gained one or more line at mean follow-up of 16.6± 6.3 months. Conclusion: Retinal vasculitis cases had similar clinical presentations and common treatment plan. There was no systemic disease association with vasculitis warranting a careful approach in prescribing investigations.

Giant cystic thymoma with haemorrhage and necrosis: An unusual case.

Extreme degree of cystic, haemorrhagic and necrotic changes in a thymoma is rare. A 22-year-old male presented with cough, grade 2 dyspnoea, and occasional chest pain for the past six months. Radiological investigations revealed a large cystic lesion in the anterior mediastinum. A benign cystic tumour was suspected. Surgical resection of the tumour was done. Grossly, the almost entirely cystic and haemorrhagic dumb-bell shaped encapsulated tumour showed a subcapsular residual nodule. Histopathological examination was suggestive diagnosis of benign thymoma (World Health Organization [WHO] Type A, medullary type) associated with the rare features of cells with dendritic processes containing melanin pigment seen singly scattered throughout the tumour.

Morphological evaluation of cystitis glandularis.

Cystitis cystica and cystitis glandularis (CG) are relatively common appearances in the urinary bladder though CG may occasionally mimic a neoplasm. Microscopically, two types of CG are recognized, the usual type and intestinal type. This study was undertaken to study the morphology of CG and to highlight the differences in morphology between CG and adenocarcinoma. Eleven cases of CG were seen, of which 3 cases showed predominantly CG, usual type and eight cases showed CG of intestinal type. One case of primary adenocarcinoma was included in this study, where the adjacent bladder mucosa showed CG. Evaluation of the histological features of CG, especially intestinal type helps in correct categorization of this lesion and differentiation from adenocarcinoma of the bladder.

Solitary rectal ulcer syndrome in childhood.

Solitary rectal ulcer syndrome is a rare disorder of childhood and usually goes unrecognised or misdiagnosed because it can mimic various other rectal entities. Here a 9-year old boy presented with bleeding per rectum and altered bowel habits. Colonoscopy revealed multiple ulcers which on histopathological examination showed features of SRUS with severe reactive changes of regeneration mimicking malignancy.

Wegener's granulomatosis mimicking paraneoplastic syndrome.

Wegener's granulomatosis is a distinct clinico-pathological entity characterised by a triad of upper and lower respiratory disease and renal involvement, although atypical presentations can be seen. These patients characteristically have small vessel vasculitis and or granulomatous vasculitis and are usually anti-neutrophilic cytoplasmic antibody (ANCA) positive. We present a case of Wegener's granulomatosis that clinically mimicked a lung neoplasm with a paraneoplastic syndrome. Biopsy and histopathological evaluation of a readily accessible subcutaneous nodule showed small vessel vasculitis. Correlation with clinical data and ANCA positivity led to a definite diagnosis.

Giant hanging melanoma of the eyelid skin.

Cutaneous melanoma of the eyelid is a rare entity. We present a 53-year-old male who had a nevus on the left upper eyelid skin since childhood, which transformed into a huge ulcerated hanging mass in the same region. Excision of the mass was done and histopathology confirmed the diagnosis of nodular malignant melanoma. A small preauricular lymph node showed metastatic melanoma on fine needle aspiration cytology.

Antitumour Activity of Methanolic Extract of Plumeria alba L. Leaves against Dalton Lymphoma Ascites in Mice

Purpose: To evaluate Plumeria alba leaves for antitumor activity against Ehrlich ascites carcinoma (EAC) and Dalton lymphoma ascites (DLA) bearing Swiss albino mice. Method: The antitumour activity of the methanolic extract of Plumeria alba leaves (MPA) was evaluated against EAC and DLA using in-vitro cytotoxic and mean survival time; a decrease in the tumour volume and viable cell count in the DLA tumour hosts. The animal was observed for improvement in the haematological parameters (e.g.; heamoglobin content; red and white blood cells count; and differential cell count) following MPA treatment of the tumour bearing mice. Results: MPA was found to be cytotoxic in the in-vitro model. Intraperitoneal administration of MPA increased the survival time; dead cell count haematological parameters and solid tumour mass was also significantly reduced. Conclusion: MPA possesses significant antitumour activity

Pancreatic epidermoid cyst.

Epidermoid cyst of intrapancreatic spleen is described but epidermoid cyst occurring in the pancreas itself is not documented. We report a 36-year-old man who presented with abdominal pain radiating to the back. On ultrasonography, a multilocular cyst was seen in the head of the pancreas. Fine-needle aspiration cytology suggested a diagnosis of epidermoid cyst, which was confirmed on histology of the resected specimen.

Myxoid liposarcoma of the breast--report of a rare case.

Breast sarcomas are very rare. A 40 year old lady presented with a well-defined hard lump, 6 cm in size, in the left breast. Patient underwent simple mastectomy with axillary clearance following a diagnosis of phylloides tumour on fine needle aspiration cytology. Grossly, it was a circumscribed myxoid tumour. Histopathologically, it fulfilled all the criteria for a diagnosis of myxoid liposarcoma. The absence of epithelial component excluded phylloides tumour.