Pathological Spectrum of Urinary Bladder Tumours.

Objective: Recently few reports have reported high incidence of urinary bladder cancer in the Punjab region in India while others have shown high inorganic arsenic levels in the ground waters of the same region. Furthermore, the malignancy of the urinary bladder contributes significantly to the morbidity, mortality and thus adding to the burden on the healthcare and society. Materials and Methods: A retrospective analysis over a period of 4 years was undertaken to review all urinary bladder tumour biopsies, transurethral resection of bladder tumours (TURBT) and cystectomy specimens to study the histomorphological spectrum of the urinary bladder cancers according to the “WHO Classification of Tumours of the Urinary Tract”. The records of Pathology department were probed for urinary bladder specimens. Further demographic characteristics, clinical diagnosis, cystoscopic findings were retrieved from the patient’s files from the record section. The tissue section slides were then reviewed and results recorded. Results: In our cohort, 144 patients were from State of Punjab with about 50% belonging to the city where our hospital is located. Cystoscopic revealed papillary appearance in 112 out of 135 patients. Moreover, 111 cases (82.22 %) were unifocal. Urothelial neoplasms were the most common bladder tumours and Invasive Urothelial Carcinomas constituted the bulk of these. Conclusions: Our cohort comprised of relatively younger population with dominance of high grade urothelial carcinoma showing features of invasion on microscopy. Further, we observed that WHO/ISUP classification to be comprehensive and universally acceptable. The role of arsenic as a causative agent in urothelial neoplasms needs to be studied further.

Role of fiberoptic bronchoscopy and utility of bronchial washings and brushings in the diagnosis of lung diseases.

Transbronchial lung biopsy via fiberoptic bronchoscope is an extremely useful technique by which bronchial as well as lung biopsies along with brushings and washings can be easily and safely taken.1 Fiberoptic bronchoscopy (FOB) was performed and biopsies were done in 250 patients. In addition, bronchial brushings and washings were also taken in 140 and 115 cases, respectively. Adequate material was obtained in 242 cases. The cases were broadly classified into neoplastic and nonneoplastic categories. Malignancies and specific granulomatous diseases, tuberculosis and sarcoidosis were the main diseases diagnosed. Brushings showed a sensitivity of 88.2% and a specificity of 98.9% for the diagnosis of neoplasms. On the other hand, washings had only a 34.9% sensitivity and a 98.6% specificity in diagnosing neoplastic disorders. We concluded that FOB is a safe and effective tool in the diagnostic work-up of suspected malignancies and neoplastic lung diseases.

Comparison of smear cytology with histopathology of the CT guided stereotactic brain biopsy.

The study was undertaken to determine the accuracy of cytological diagnosis of CNS lesions by comparing it with the final histopathological diagnosis of CT guided stereotactic brain biopsy. Squash preparations were prepared from 25 cases of CNS lesions operated in two years. These included 18 astrocytomas, 1 metastatic deposits, 1 epidermoid cyst, 1 Toxoplasmosis, 1 granulomatous inflammation and 3 cases showing normal brain parenchyma. The cytological diagnosis was available to the neurosurgeon within 10 minutes. The cytohistological correlation with paraffin block sections worked out to be 92%. Thus, this proved to be a fairly reliable and rapid method for immediate intra-operative diagnosis.

Chronic hepatitis C in northern India--the pathological and clinical spectrum.

BACKGROUND: The aim of the study was to analyse the morphology, clinical presentation and predisposing factors for chronic hepatitis C infection. METHODS: Clinical presentation of 220 patients who presented with hepatitis C virus infection over five years period (January 1996 to December 2000) were recorded. Liver biopsy specimens from 80 adult patients with chronic hepatitis C virus were evaluated using a semiquantitative scoring system. The possible predisposing risk factors for infection in these patients were recorded. RESULTS: Grading of chronic hepatitis C was minimal/mild in 51 (64%) cases. Seven (8.7%) had high-grade necroinflammatory activity. Fibrosis was absent in 22(27.5%), mild in 29(36.25%), moderate in 11 (13.75%) and 18(22.5%) had evidence of cirrhosis. No significant correlation was found between the level of transaminases and degree of fibrosis or grade of inflammation. More number of patients with history of alcohol consumption had moderate/severe grade of necroinflammatory activity and cirrhosis as compared to those not taking alcohol at all. Potential predisposing factors were use of unsterile syringes, previous surgery and tattooing in multivariate analysis. CONCLUSION: Nearly two-thirds of patients of chronic hepatitis C where liver biopsy was possible have minimal/mild disease at time of diagnosis; 22% have cirrhosis. Though disease severity can only be assessed by liver histology, liver biopsy may not be possible in a sizeable proportion of patients as they present with advanced liver disease. Most of the patients do not have specific symptoms. Reusable needles/syringes is the commonest potential risk factor.

Adult celiac disease in northern India.

OBJECTIVE: To study the presentation of adult celiac disease in a northern Indian hospital. METHODS: Case records of all patients diagnosed as having adult celiac disease in the Gastroenterology unit of this hospital during January 1996 till December 2001 were reviewed. Celiac disease was diagnosed according to the revised ESPGAN criteria. Adult celiac disease was diagnosed if disease manifestations started after 15 years of age. All patients had a minimum of one-year follow up. RESULTS: The mean duration of illness in the 96 patients (mean [SD] age 32.9 [11.4] years; 50 men) diagnosed over the 6-year study period was 7.3 (2.4) years. Diarrhea was present is 67.7% of cases; 18.7% presented with refractory iron-deficiency anemia, and 9.4% with abdominal symptoms like flatulence and distension. Three patients presented with dysphagia and anemia and were diagnosed as having Plummer-Vinson syndrome. Ulcerative colitis, non-alcoholic steatohepatitis, and aphthous ulcers were associated conditions. All patients had significant improvement in symptoms and hematological and biochemical parameters after dietary gluten restriction. CONCLUSION: Adult celiac disease is not rare and usually presents as diarrhea, abdominal distension and flatulence, and refractory anemia.