Death due to sickle cell anaemia, an autopsy diagnosis: a study at a tertiary care hospital.

Background: Sickle cell disease (SCD) is the generic term for the group of inherited haemoglobinopathies caused by the occurrence of Haemoglobin S (HbS) in the homozygous or heterozygous form in combination of Hbs with another abnormal haemoglobin such as HbSC or beta-thalassaemias (HbS-thal). Sickle cell syndromes are remarkable for their clinical heterogeneity, including their presentations as sudden and unexpected deaths due to a sickle cell crisis. Less numbers of deaths are reported due to this cause because of ignorance of autopsy surgeon in considering this disease as a cause of death despite of its high prevalence. While doing autopsy in cases of deaths with no apparent cause and physical over activity medical officer must keep in mind the possibility of death due to vaso-occlusive crisis in sickle cell disease. Methods: The study covers a period of one year (January 2013 - December 2013) and it is a study of cases of autopsy carried out in a tertiary care hospital of South Gujarat. Results: A total of 607 cases examined, out of which sickled red blood cells were detected in 17 cases. The respective records were reviewed. Out of 17 cases, 13 cases were male and 4 cases were females. The youngest person was 15 years female and oldest was 70 years male. Conclusion: Sickle cell crisis is one of the causes of sudden unexplained deaths. The present study highlights the role of autopsy in such cases. Community awareness and marriage counseling programs are also helpful in preventing sickle cell disease.

Cytopathological diagnosis of primary synovial sarcoma of lung–A rare case report.

Synovial sarcomas represent about 10% of all soft tissue sarcomas. Primary pleuropulmonary synovial sarcoma (SS) is a rare neoplasm. We report a case where lung mass was detected on imaging and was reported as synovial sarcoma on cytopathological, histopathological, immunohistochemical analysis and confirmed by cytogenetics.

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.

Histopathological spectrum of tumours of upper aero digestive tract in Surat - A study of 156 cases.

Background: Cancers of the upper aero-digestive tract (UADT) constitute 3.5-4% of all malignancies. Majority of cases are squamous cell carcinomas which are related with various epidemiologic factors. Aims & Objective: The objective of this study is to know the histopathological spectrum of tumours of UADT. Material and Methods: This study comprises of 156 cases of histopathological diagnosed tumours of upper aero digestive tract who attended new civil hospital, government medical college, Surat, from August 2010 to august 2012. All prospective and neoplastic cases were included and retrospective and non- neoplastic cases were excluded. Routine paraffin sectioning and staining was done and immunohistochemistry was applied when required. Results: Out of total 156 cases of UADT, 129 malignant, 19 cases benign and 8 were carcinoma in-situ cases. In malignant cases, 124 (96.00%) cases of carcinomas, 1 (0.80%) case of sarcoma, 2 (1.60%) cases of melanoma, and 2 (1.60%) cases were of lymphomas. Most common site of carcinoma was oral cavity (tongue). Most common carcinoma was Squamous cell carcinoma. Most common site of SCC was hypo pharynx (pyriform Fossa), followed by oral cavity (tongue) and larynx (supra glottis). In benign tumours, most common site was nasal cavity (7 cases) and common varieties were Angiofibroma and Capillary Haemangioma. Conclusion: Tumours of UADT are predominant in males affecting older age group. People with tobacco chewing, smoking, alcoholism, poor socioeconomic background, mixed diet and poor oral hygiene are more vulnerable.

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.

Diagnostic accuracy of fine needle aspiration cytology in soft tissue tumors: our institutional experience.

Background: Diagnosis of Soft tissue tumors by FNAC (Fine needle aspiration cytology) is one of the diagnostic modality of choice in pathological evaluation of soft tissue neoplasms especially to differentiate from the non-neoplastic soft tissue lesions. It is challenging and controversial. Very few centers rely on simple FNAC for diagnosis which is largely due to a lack of experience, familiarity, confidence and tricky cytological features. Methods: We have studied 140 cases of soft-tissue tumors by simple FNAC procedure done by cytopathologist from 01/01/2012 to 31/12/2012. After considering thorough history, clinical, radiology and other findings all cases were reported by the experienced faculty in cytopathology section of our institute. Results: Out of total 140 cases of soft tissue tumors 131 (93.58%) were benign and 9 (6.42%) were malignant. In benign category maximum numbers were lipoma 105 cases (80.15%) followed by benign neural tumors 5 cases (3.82%), ganglion 4 cases (3.05%), benign fibrohistiocytic lesions 2 cases (1.53%) and others. Conclusions: Current study demonstrates that FNAC is valuable as a primary tool in diagnosing soft tissue tumors specifically benign lesions like lipomatous tumors, high grade malignant sarcoma and recurrent lesions. Findings are well supported by histopathological correlation.

Changes in WBC and platelet count in patients with malaria: a hospital based comparative study.

Introduction: Malaria is one of the most common infectious diseases of tropics. It presents with varied clinicopathological manifestations. Most of the complication in malaria occurs due to various hematological abnormalities. Present study was aimed to find out abnormalities in WBC and platelet counts in patients with malaria. Methods: A total 135 patients either hospitalized or treated on an outpatient basis were included in the study after positive identification for malarial parasites on Giemsa stained PSMP smears. WBC and platelet count was carried out on 3 part hematology analyzer (Sysmax KX 21). WBC count less than 4000/cumm was considered as leucopenia and platelet count less than 150000/cumm was considered as thrombocytopenia. Results: The present study includes 135 patients with malaria from which 72.59% of subjects were male and 27.41% of subjects were female. P. falciparum was present in 68.89% of cases, P. vivax in 28.15% of cases. Majority of patients had normal leucocyte count (97.03%). Neutrophilia with lymphopenia was observed in both species of malaria in our study. Thrombocytopenia was observed in89.62% of cases in malaria. Thrombocytopenia in P. falciparum was found in 92.48% of cases and in P. vivax it was 81.57% of cases. Conclusion: Present study did not show any significant change in WBC count. Present study showed neutrophilia with relative lymphopenia in both group of malaria. Incidence of thrombocytopenia was observed in both species of malaria without any statistical significance.