Histopathology of placenta in intrauterine growth restriction (IUGR)

Background: Birth of healthy term baby depends on normal placenta. IUGR is a condition associated with placental insufficiency. There is a close relationship between IUGR and placental qualitative changes. The aim of the present study was to evaluate the morphological and histological changes in placentas of IUGR fetuses and in placentas of normal uncomplicated pregnancies and to determine the relationship that exists between morphological change and frequency of IUGR.Methods: In a cross sectional study conducted in the department of Pathology, GMC Jammu, a total of 60 placenta were received, 30 placenta of IUGR fetus (group 1-case) and 30 placenta of uncomplicated pregnancy with normal single fetus (group 2-control). Exclusion criteria: Twin pregnancy, gestational hypertension, diabetes, congenital anomaly, antepartum hemorrhage and systemic disorder.Results: Placental weights in IUGR group were significantly lower than control group. Average placental weight in IUGR group was 425 gms while in the control group (normal placenta) it was 550 gms. Infarction, intervillous thrombosis, chorionic villitis, hemorrhagic endovasculitis, placental intravascular thrombi, perivillous fibrin deposition, fibrinoid necrosis and villous edema were found to be more common in IUGR group (Group 1-case group) than Normal (Group 2- control group).Conclusions: This study highlightened that significant pathological differences were found between the placentas of IUGR fetus and normal fetus. The gross and microscopic measurement of a placenta is a good way to get proper information about IUGR and helps in management of the pregnancy.

Cytomorphological Features of Tuberculous Lymphadenitis on FNAC.

FNAC smears of 343 cases diagnosed as tuberculous lymphadenitis in the Postgraduate Department of Pathology, Government Medical College, Jammu over a period of three years were reviewed. All the available smears stained by May Grunwald Giemsa and Papani Colaou method including Ziehl Neelsen stain for acid fast bacilli in some cases were evaluated. The disease was seen most frequently in the second and third decades of life (58.9%) with slight female preponderance. Cervical region was the most common site of involvement (83.4%). Three cytomorphological patterns were noted: epithelioid granuloma with necrosis was the most frequent pattern (pattern 2) in 49.3 %, followed by necrotic material without granuloma in 30.6% (pattern 3) and epithelioid cells without necrosis in 20.1% cases (pattern 1) . The AFB positivity rates were 52.9 % and 78% in cytological patterns 2 and 3 respectively with no positivity in pattern 1. Overall positivity for AFB was 64%.

Peritoneal Deciduosis: A Case Report.

Peritoneal deciduosis is a rare incidental finding on caesarean section.This is a self- limited metaplastic change of submesothelial mesenchymal cells during pregnancy. We report a case of diffuse peritoneal ectopic decidual reaction discovered during caesarean section as pale whitish nodules simulating tubercles. Histology showed omentum studded with nodular groups of decidual cells with transition to spindle cells resembling myofibroblasts.

Fine Needle Aspiration Cytology of Ameloblastoma.

Ameloblastoma is the most common tumor of odontogenic origin. It is more common in the mandible than in the maxilla. It often presents as a slow growing, painless swelling. There is often delay in its diagnosis because of its slow growing nature. Fine needle aspiration cytology (FNAC) of jaw lesions is a rapid and non-invasive procedure for the initial evaluation of these lesions. It provides helpful information about them and avoids hasty and unnecessary surgical biopsy. Here we present a case of ameloblastoma diagnosed by fine needle aspiration cytology.

Infantile Fibromatosis - Utility of Fine Needle Aspiration Cytology.

Infantile fibromatosis is a benign tumour of infancy and most common cause of congenital muscular torticollis generally before one years of age and should be differentiated from the neck masses in infants. FNAC can obviate the use of invasive diagnostic procedures.

Pattern of Lymphadenopathy on Fine Needle Aspiration Cytology in Jammu

The present randomized study was undertaken to study cytological features of non-neoplastic and neoplastic lesions of enlarged lymph nodes by FNAC in 656 patients presenting with lymphadenopathy in the Postgraduate Department of Pathology of Government Medical College, Jammu over a period of three year. Tuberculous lymphadenitis, reactive hyperplasia, metastatic carcinoma, pyogenic lymphadenitis and lymphomas were seen in 52.3%, 37.2%, 3.8%, 1% and 2% respectively. However, a solitary case of Langerhans histiocytosis in a three year old child was reported over three years. Reactive hyperplasia was seen most often (74.5%) in first two decades of life, 58.9% tuberculous lymphadenitis in the second and third decades and 88% of metastatic carcinoma over 40 years of age. Cases of lymphoma were distributed in all age groups. Males showed preponderance of reactive hyperplasia, lymphoma and metastatic carcinoma, while tuberculous lymphadenitis showed a slight female preponderance. Cervical lymph nodes were involved most often in all types of lymphadenopathy.

Rheumatoid arthritis: new developments in biologic therapy.

With the development of biologic agents our therapeutic approach to rheumatoid arthritis (RA) and inflammatory diseases in general, has dramatically changed within the last few years. Biologic technically means a substance as the product of biologic system and functionally as an agent that targets specific biologic molecule. Recently a number of endogenous antigens have been identified and these are known to activate CD4+ T cells leading to production of cytokines [interleukin (IL)-1, IL-6] and tumour necrosis factor (TNF)-alpha and immunoglobulins like rheumatoid factor and expression of osteoprotegerin ligands that stimulate osteogenesis leading to joint distruction. Rheumatologists and other practitioners are facing a remarkable wave of new therapies for RA like infliximab, adalimumab, atlizumab, etanercept, anakinra, prosorbacolumn, anti-IL-6 agents, IL-10 and inferferon-r. To date combination therapy of methotrexate plus a single biologic has been widely studied with synergistic effect. Etanercept and infliximab are two biologics available in India.

Verrucous Carcinoma (Ackerman’s Tumour) of Mobile Tongue

Ackerman’s tumour or Verucous carcinoma is a unique clinico-pathological variant of squamous cell carcinoma, occuring mainly in oral cavity and larynx, buccal mucosa being most commonly involved.One case of verrucous involving tip of tongue (T1N0M0/Stage 1) in an adult male is being reported who underwent wide field surgical excision. The clinico-pathological featuire of verruccous carcinoma are being discussed.

The Knowledge, Attitude and Practices regarding HBV Infection of Married Women in the Reproductive Age Group living in Cantonment Area, Sunjawan, Jammu

The present study was conducted to know the knowledge, attitude and practices of 300 married women in the reproductive age group living in the cantonment area Sunjawan, Jammu regarding HBV infection. Only 20% of the women were found aware of the mode of transmission of HBV. However, 50% of the women were having the misconceptions regarding mode of transmission of HBV. 4% of women, 30% of children up to 5 years and 15% of children above 5 years were fully immunized with hepatitis B vaccine. 80% of children up to 5 years and 75% of children above 5 years were fully immunized as per universal immunization programme. Hence, the results of the study clearly indicated the low immunization rate with vaccine against HBV than that under universal immunization programme and further potentiated the need for implementation of the recommendations in 9th five year plan of India regarding introduction of immunization against HBV in universal immunization programme at the earliest .

Glaucoma Therapy: Prescribing Pattern and Cost Analysis

In the present study out of total 200 prescriptions of POAG (primary open angle glaucoma) studied 66% were found to be of monotherapy including timolol, brimonidine, pilocarpine, betaxolol, levobunolol, latanoprost and apraclonidine in 30%, 15 %, 6%, 8% , 4%, 1% and 2% of the prescriptions respectively and 34% were found to be of polypharmacy with timolol+pilocarpine, timolol+acetazolamide, timolol+ brimonidine and betaxolol+brimonidine in 13%, 4%, 8% and 9% of the prescriptions respectively. 10% drugs were prescribed by generic name. Written instruction to the patients regarding dose and dosing interval was mentioned in 100% prescriptions, but the proper method of instillation was mentioned only in 15% of the prescriptions. Results of the present study clearly indicated urgent need for prescribers to improve their communication skills, to give proper instructions to the patient regarding instillation of drug, as little bit of caution like instillation from the side of the eye in the supine position followed by rolling of the eyeball can decrease the wastage, decrease cost and improve compliance. However, in the present scenario cost of the traditional medications like betablockers, pilocarpine etc. is found to be much less than newer medications (prostaglandin analogues, brimonidine). Moreover, in presence of wide cost variation among various brands of the same drug our study could help the opthalmologist to use all possible measures of pharmacoeconomics while prescribing an antiglaucoma drug.

Squamous Cell Carcinoma arising in a Cystic Teratoma.

Malignant transformation in a benign cystic teratoma occurs in 1-3% of cases. A rare case of squamous cell carcinoma arising in a benign cystic teratoma of ovary in a 37 year old female is reported. The patient presented with increasing abdominal girth and pain abdomen and was clinically diagnosed having a large ovarian cyst.