Assessment and Applicability of Various Elements of Quality Assurance in Histopathology Laboratory: A Study from A Tertiary Care Hospital in Eastern Region of India

Background Quality control in histopathology is rela?vely newer concept and less understood because of its subjec?vity. Aim:The present study was conducted to assess and determine applicability of the different elements of quality assurance in the histopathology laboratory of a ter?ary care hospital in eastern region of India. Material and methods: An observa?onal, retrospec?ve and analy?c study for one year and three months was conducted. 2000 samples were selected by simple random sampling including the biopsy specimens and cell blocks received in the histopathology laboratory. Results:Of the 2000 samples, 1880 (94%) were accepted and 120 rejected (6%) due to mainly pre analy?cal factors. Of the rejected samples, 35 samples (29.2%) were without proper fixa?ve, 48 samples (40%) had incomplete requisi?on forms, 37 samples (30.8%) had incomplete/ absent clinical history. Lack of adherence to standard ?ssue fixa?on protocols were observed in 55 cases (2.75%). Inadequate preven?ve maintenance and delay in renewal of maintenance contracts were the most common cause of failure of maintenance of equipment. Improper staining was found in 35 cases (1.75%). Grossing of specimens were inadequate in 104 cases (5.2%). Concurrence in diagnosis was found in majority cases (1892 cases, 94.6%). Random case review was done with adequate precision (97.5%) and accuracy (96.6 %). Maintenance of turnaround ?me was found in most cases (1800 cases, 90%). Conclusion: Standard opera?ng procedures, training of staffs, equipment maintenance, alertness to maintain turnaround ?me and awareness, proper report documenta?on and storage are the key factors to successfully uphold quality assurance.

Extraovarian granulosa cell tumor.

Extraovarian granulosa cell tumor (GCT) is a very uncommon tumor, assumed to arise from the ectopic gonadal tissue along the embryonal route of the genital ridge. One such rare case of extraovarian GCT was encountered in a 58-year-old female who presented with a large intraabdominal lump. Computerized tomography revealed one large retroperitoneal mass measuring 15 cm x 16 cm and another mesenteric mass of 8 cm x 5 cm size. The patient had a history of hysterectomy with bilateral salpingooophorectomy 20 years ago for uterine leiomyoma. Ultrasonography-guided aspiration smears revealed cytological features suggestive of GCT. Histopathological examination of the excised masses showed features of adult-type GCT. Because metastatic epithelial tumors, particularly from the ovaries, may show identical morphology, immunostains for inhibin and epithelial membrane antigen (EMA) were performed. The tumor showed positivity for inhibin while EMA was negative thus confirming the diagnosis of GCT. As this patient had no previous history of GCT and was oophorectomized 20 years ago, the tumor was considered as extraovarian. A diagnosis of extraovarian GCT should be carried out after excluding any previous history of GCT of the ovary. Immunostains help to differentiate GCTs from other neoplasms.

Retiform hemangioendothelioma with lymph node metastasis: a rare entity.

Retiform hemangioendothelioma (RH) is a rare, recently described, unique kind of low grade angiosarcoma. The tumor is characterized by distinctive arborizing blood vessels that mimic the appearance of rete testis. The tumor chiefly originates from the skin and subcutaneous tissue and has a tendency to recur locally. Only one case with lymph node metastasis has been reported previously. Another such rare case of RH is being reported in an adult female who presented with a subcutaneous nodule, underwent multiple recurrences and uniquely metastasized to regional lymph node.

Thyroid dysfunction modulates glucoregulatory mechanism in rat.

The role of the thyroid gland in glucose homeostasis remains incompletely understood. To get a better insight hypo-and hyperthyroid conditions were experimentally induced in rat and found severe defects in glucose homeostasis. While blood glucose level returned to normal level after 2.5 hr of oral glucose challenge in control rats the blood glucose level remained high even after 24 hr of glucose load in both hypo- and hyperthyroid rats. These experimentally manipulated rats displayed higher levels of liver glycogen (10.45-22.8-fold) and serum glutamic pyruvic transaminase (1.48-9.8-fold). Liver histology of hyperthyroid treated rats revealed hepatotoxicity. From the results it can be concluded that thyroid gland plays an important role in glucose homeostasis.

Lungs: victim of synchronous double malignancies.

A 20 year young man was referred to our institution with superior vena cava (SVC) syndrome, multiple lung opacities and a mass lesion in the right upper zone (RUZ). CT-guided FNAC from the mass lesion was consistent with the diagnosis of non-small cell lung carcinoma (NSCLC). A lump in his left testis was detected during clinical examination. Both FNAC and excisional biopsy of the testicular mass confirmed the diagnosis of immature teratoma with choriocarcinoma, a form of non-seminomatous germ cell tumour (NSGCT). With chemotherapy all metastatic lesions of lung and SVC syndrome disappeared, and the tumour-marker levels decreased. However, the opacity in RUZ progessed to involve right recurrent laryngeal nerve at thoracic inlet, metastasized to the brain, and the patient expired after 4th cycle of chemotherapy. This case of synchronous double primary malignancies (SDPM) is being reported for its rarity.

Immature mediastinal teratoma--a rare pathology.

A 9 year old female presented with 8 months history of right sided chest pain and respiratory distress. Chest X-ray revealed a large anterior mediastinal mass. Histopathology of the mass revealed features of an immature teratoma. The case is being presented because of its rare occurrence in the mediastinum.

Clear cell carcinoid tumour of lung--a case report.

An unusual case of pulmonary clear cell carcinoid tumour in a fifteen year old boy is being described. The differential diagnoses considered in this case are described. This is one of the uncommon varieties of carcinoid of lung reported in the world literature.