A Histopathological Study of Congenital Pouch Colon and its Impact on Management

Background: Congenital Pouch colon(CPC) is a rare variant of anorectal malformations (ARM) whose etiopathogenesis and management are not yet standardized. This prospective study seeks to establish the histopathological characteristics and it’s inference on the etiopathogenesis, management and prognosis of CPC. Methods: This was a prospective comparative study including all neonates with CPC and other high ARM. The excised pouch from the neonates with CPC and a strip of sigmoid colon from other high ARM patients were sent for biopsy and the histopathological features compared. Results: Histopathogical abnormalities were seen involving all the layers of the colonic pouch including mucosa, submucosa and muscularis propria. The statistically significant histopathological differences in the colonic pouch as compared to normal sigmoid colon were mucosal necrosis, focal erosions, inflammation and haemorrhage, muscularis mucosa fibrosis, submucosal congestion and haemorrhage, widening, fibrosis and presence of lymphoid follicles and circular and longitudinal muscle disarray and fibrosis. Also seen was a significant inflammatory infiltrate permeating all the layers of the pouch. Conclusion: CPC has histopathological abnormalities in all the layers of the colon. It is thus pathologically abnormal tissue. The widespread inflammatory reaction in all layers of the CPC raises the possibility of some environmental factor having a role in etiopathogenesis of CPC.

Epithelial–mesenchymal transition in serous and mucinous epithelial tumors of the ovary

Context: The concept of epithelial–mesenchymal transition (EMT) in cancer origin, progression, and metastasis is of recent origin and not fully understood. So far, many cell culture studies have been done to investigate the role of EMT in epithelial ovarian cancer, but only a few human studies have been conducted. Aims: The aim of the study is to study the expression of E-cadherin and vimentin in serous and mucinous tumors of the ovary and to compare their expression in benign and malignant serous and mucinous ovarian tumors. Methods: This study was a prospective study done on 60 patients with a histological diagnosis of serous and mucinous ovarian malignancy. The study was conducted in the Department of Pathology and Department of Obstetrics and Gynaecology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi. The expression of epithelial marker E-cadherin and mesenchymal marker vimentin was studied in each of the tumors. Statistical Analysis: Unpaired t-test/Mann–Whitney test, Chi-Square test/Fisher's exact test, and Kolmogorov–Smirnov test were used. Results: Of the total 60 cases included in the study, 30 benign and 30 malignant cases of serous and mucinous tumors were taken. Of the 30 benign cases, 22 cases (73.3%) were that of serous cystadenomas, whereas 8 (26.67%) cases were of mucinous cystadenomas. Among the malignant cases, 21 cases (70%) were serous surface epithelial ovarian carcinoma, whereas 9 (30%) were mucinous surface epithelial ovarian carcinoma. Subsequently, the malignant cases were graded according to their glandular differentiation. Immunohistochemistry was performed in each of the 60 cases. Conclusion: In the malignant cases with increasing grade of the tumor, a reduced expression of E-cadherin and an increased expression of vimentin were seen in the epithelial cells

An unusual giant schwannoma over face diagnosed on FNAC: a case report

Schwannoma is a slow growing benign peripheral nerve sheath tumor arising from schwann cells. It is also known as neurilemmoma. Although it is common in the head and neck region, it rarely exceeds 10 cm in size. Usually Schwannomas are notlarger than 5 to 6 cm in diameter.Large tumors are uncommon and are found in posterior mediastinum or retroperitoneum. We are presenting an unusual giant cell schwannoma over face (cheek) measuring 12×10cmsin size which caused facial deformity to the patient. The tumor was diagnosed on FNAC where cell block was prepared and IHC was done which showed S-100 positivity. This size schwannomaover cheek site has not been reported in the literature as far our knowledge. Therefore this case is unique for its size over face.

Profile of exudative pleural effusion in the region of Bhuj people

Background: Exudative pleural effusions are a common diagnostic problem in clinical practice, as the list of causes is quite exhaustive, although sometimes they can be inferred from the clinical picture. In the West the most common cause is Para pneumonic effusions followed by malignancy, while in India it is tubercular effusion followed by malignant effusion. Despite the availability of various tests, there is a need for defining the best diagnostic and cost-effective approach to quickly diagnose and treat exudative pleural effusions. The objectives are to conduct a clinical and etiological study of exudative pleural effusion, to evaluate biochemical profile, cytological profile and radiological profiles of exudative pleural effusion.Methods: Prospective study of 100 patients with exudative pleural effusions. The demographic data was expressed as mean±standard deviation. Comparison between groups was done by Chi-Square test and Fischer exact test for categorical variables and Kruskar-Wallis and Mann-Whitney tests for continuous variables.Results: There were 67 males and 33 females. The mean age was 41.6±15.74. The majority were tubercular in origin (67%),13%,8%,3%and 6% were malignant effusions, Synpneumonic effusion, pancreatic effusions and empyema respectively. Diagnosis was not established in 3% of effusions. Massive effusions were seen in 53.8% of malignant effusions and 33.3% of empyemas. Most effusions had a total cell count between 1000 to 5000 cells /mm3.Lymphocyte predominant effusions were seen in 84.6% and 89.6% of malignant and tubercular effusions. 61.5% of malignant effusions had a positive cytology. Tubercular effusion had a pleural fluid ADA more than 40 IU/L. 92.3% of malignant effusion had pleural fluid ADA less than 30IU.Conclusions: Pleural effusion is a commonly encountered in medical practice and in our country, the commonest cause is tuberculosis, as is evidenced from the present study. The initial step in evaluating case of pleural effusion is to establish the cause of pleural effusion which is done by a detailed history, clinical examination and investigations like a chest radiology and pleural fluid analysis. Even in the advanced diagnostic approaches, still detailed clinical history and examination of the patient of the patient is important to make a clinical diagnosis. All suspected cases of pleural effusion should undergo Sonography of the thorax along with routine chest x-ray. Fluid cytology should be done to confirm tuberculosis or to rule out malignancy, which guides the physician for further evaluation of the patient if required.

Leveraging the National Rotavirus Surveillance Network for Monitoring Intussusception.

Objective: To assess feasibility of monitoring intussusception by hospitals participating in the National Rotavirus Surveillance Network. Methods: Questionnaire-based survey in 28 hospitals. One hospital with electronic records selected for detailed data analysis. Results: There was 75% response to the questionnaire. Few network hospitals were suitable for monitoring intussusception in addition to ongoing activities, but there was at least one potential sentinel hospital in each region. The hospital selected for detailed data analysis of cases of intussusception reported an incidence rate of 112 per 100,000 child years in infants. Over 90% of intussusceptions were managed without surgery. Conclusions: Selection of sentinel hospitals for intussusception surveillance is feasible and necessary, but will require training, increased awareness and referral.

Leveraging the National Rotavirus Surveillance Network for Monitoring Intussusception.

Objective: To assess feasibility of monitoring intussusception by hospitals participating in the National Rotavirus Surveillance Network. Methods: Questionnaire-based survey in 28 hospitals. One hospital with electronic records selected for detailed data analysis. Results: There was 75% response to the questionnaire. Few network hospitals were suitable for monitoring intussusception in addition to ongoing activities, but there was at least one potential sentinel hospital in each region. The hospital selected for detailed data analysis of cases of intussusception reported an incidence rate of 112 per 100,000 child years in infants. Over 90% of intussusceptions were managed without surgery. Conclusions: Selection of sentinel hospitals for intussusception surveillance is feasible and necessary, but will require training, increased awareness and referral.

Profile and Trends of Rotavirus Gastroenteritis in Under-five Children in India (2012-2014): Preliminary Report of the Indian National Rotavirus Surveillance Network.

Objective: To estimate the burden of rotavirus-associated gastroenteritis in India. Methods: Hospital-based surveillance network was established, with clinical evaluation and laboratory testing for rotavirus among children aged below 5 years hospitalized with acute gastroenteritis. Results: Between September 2012 and December 2014, stool samples from 10207 children were tested and rotavirus was detected in 39.6% of cases. Infections were more commonly seen among younger children (<2 years). Detection rates were higher during cooler months of September – February. Among rotavirus infected-children, 64.0% had severe or very severe disease. G1P[8] was the predominant rotavirus genotype (62.7%) observed during the surveillance period. Conclusions: Surveillance data highlights the high rotavirus disease burden and emphasizes the need for close monitoring to reduce morbidity and mortality associated with rotavirus gastroenteritis in India.

Expanded Indian National Rotavirus Surveillance Network in the Context of Rotavirus Vaccine Introduction.

Objective: To extend a nation-wide rotavirus surveillance network in India, and to generate geographically representative data on rotaviral disease burden and prevalent strains. Design: Hospital-based surveillance. Setting: A comprehensive multicenter, multi-state hospital based surveillance network was established in a phased manner involving 28 hospital sites across 17 states and two union territories in India. Patients: Cases of acute diarrhea among children below 5 years of age admitted in the participating hospitals. Results: During the 28-month study period between September 2012 and December 2014, 11898 children were enrolled and stool samples from 10207 children admitted with acute diarrhea were tested; 39.6% were positive for rotavirus. Highest positivity was seen in Tanda (60.4%) and Bhubaneswar (60.4%) followed by Midnapore (59.5%). Rotavirus infection was seen more among children aged below 2 years with highest (46.7%) positivity in the age group of 12-23 months. Cooler months of September – February accounted for most of the rotavirus-associated gastroenteritis, with highest prevalence seen during December – February (56.4%). 64% of rotavirus-infected children had severe to very severe disease. G1 P[8] was the predominant rotavirus strain (62.7%) during the surveillance period. Conclusions: The surveillance data highlights the high rotaviral disease burden in India. The network will continue to be a platform for monitoring the impact of the vaccine.

DHR-ICMR Guidelines for diagnosis & management of Rickettsial diseases in India.

Rickettsial diseases, caused by a variety of obligate intracellular, gram-negative bacteria from the genera Rickettsia, Orientia, Ehrlichia, Neorickettsia, Neoehrlichia, and Anaplasma, belonging to the Alphaproteobacteria, are considered some of the most covert emerging and re-emerging diseases and are being increasingly recognized. Among the major groups of rickettsioses, commonly reported diseases in India are scrub typhus, murine flea-borne typhus, Indian tick typhus and Q fever. Rickettsial infections are generally incapacitating and difficult to diagnose; untreated cases have case fatality rates as high as 30-45 per cent with multiple organ dysfunction, if not promptly diagnosed and appropriately treated. The vast variability and non-specific presentation of this infection have often made it difficult to diagnose clinically. Prompt antibiotic therapy shortens the course of the disease, lowers the risk of complications and in turn reduces morbidity and mortality due to rickettsial diseases. There is a distinct need for physicians and health care workers at all levels of care in India to be aware of the clinical features, available diagnostic tests and their interpretation, and the therapy of these infections. Therefore, a Task Force was constituted by the Indian Council of Medical Research (ICMR) to formulate guidelines for diagnosis and management of rickettsial diseases. These guidelines include presenting manifestations, case definition, laboratory criteria (specific and supportive investigations) and treatment.

Direct costs of hospitalization for rotavirus gastroenteritis in different health facilities in India.

Background & objectives: Diarrhoeal disease is the fifth leading cause of all mortality globally. To this burden, rotavirus contributes over half a million deaths annually. This pilot study was conducted to determine the economic burden of diarrhoeal episodes on families from different geographical regions accessing medical facilities in India. Methods: Participants were enrolled from four study sites with eight reporting hospitals, categorized as non-profit and low cost, private and government facilities between November 2008 and February 2009. Questionnaires detailing healthcare utilization, medical and non-medical expenditure and lost income were completed by families of children < 5 yr of age hospitalized for gastroenteritis. All available faecal samples were tested for rotavirus. Results: A total of 211 patients were enrolled. The mean total cost of a hospitalized diarrhoeal episode was 3633 (US$ 66.05) for all facilities, with a marked difference in direct costs between governmental and non-governmental facilities. Costs for rotavirus positive hospitalizations were slightly lower, at 2956 (US$ 53.75). The median cost of a diarrhoeal episode based on annual household expenditure was 6.4 per cent for all-cause diarrhoea and 7.6 per cent for rotavirus diarrhoea. Of the 124 samples collected, 66 (53%) were positive for rotavirus. Interpretation & conclusions: Data on direct costs alone from multiple facilities show that diarrhoeal disease constitutes a large economic burden on Indian families. Affordable, effective vaccines would greatly reduce the economic burden of severe gastroenteritis on patients, families and the government.

Multifocal renal angiomyolipoma presenting as massive intraabdominal hemorrhage.

Angiomyolipomata of the kidney are unusual lesions composed of abnormal thick walled blood vessels, smooth muscle and adipose elements. These are asymptomatic and occasionally present with flank pain, a palpable mass or gross hematuria. They may be associated with tuberous sclerosis. The risk of bleeding is increased with size, and lesions greater than 4 cm have more than 50% chance of significant bleeding. An unusual case of multifocal renal angiomyolipoma associated with tuberous sclerosis and presenting as massive intra abdominal hemorrhage is reported.

Ovarian fibroma: an unusual morphological presentation with elevated CA-125.

This paper reports a case of a 42 year old female patient who presented with a large multi septate, predominantly cystic ovarian mass with elevated CA-125 levels. A diagnosis of malignant ovarian tumour was made on grounds of pre operative investigations and radical surgery was planned. Histopathological examination however revealed an ovarian fibroma with cystic change reinforcing the non specificity of CA-125 as a marker of ovarian malignancy and establishing the importance of a proper histopathological examination even in the most obvious of cases.

Follicular thyroid carcinoma with metastasis to skin diagnosed by fine needle aspiration cytology.

In April 2006, a 55-year-old female presented with a thyroid mass and multiple skin nodules on scalp, forehead and neck. Fine needle aspiration cytology of thyroid mass and multiple skin nodules show tumor cells clusters in a repetitive microfollicular pattern on May-Grunwald-Giemsa stain suggestive of follicular thyroid carcinoma with metastasis to skin. Although follicular carcinoma have a propensity for vascular invasion and hematogenous dissemination, skin is not commonly involved. Only a few cases of cutaneous metastasis from follicular thyroid carcinoma are reported in the English language literature.

Nevoid basal cell carcinoma syndrome (Gorlin's syndrome): a case report.

A case of nevoid basal cell carcinoma syndrome is presented and its varied clinical manifestations and multi-system involvement are emphasised. Our case presented with an early onset of symptoms but sought medical help later on for progressively increasing jaw swelling and pain. On further evaluation, multiple pigmented skin papules, palmar pits, multiple jaw cysts, skull bone osteoporosis, bifid ribs and kyphosis were present. Systemic involvement was minimal. There was no significant family history.

Fine needle aspiration of tophi in asymptomatic gout--a case report.

Gout, a chronic hyperuricemic crystal induced arthropathy, may produce soft tissue masses (tophi). Tophi may be found in synovial membranes, periarticular ligaments, tendons, soft tissues as well as internal organs. We present a case in which diagnosis of gout was made by fine needle aspiration of tophus. The patient had a painless nodule over right ankle which was progressively increasing in size. He gave a past history of painful arthropathy, but serum uric acid levels were within normal limits. At this juncture, FNAC of the ankle tophus was performed which revealed aggregated and innumerable dissociated needle-shaped negatively birefringent crystals of monosodium urate (MSU) on polarization microscopy.