ABSTRACT
Melanoma blood vessel metastases are very uncommon. Wereport this very rare case of metastatic melanoma along thewall of great saphenous vein (GSV), showing intra and extravascular metastasis. By far only a single case of intravascularmetastatic melanoma (IVMM) of GSV and thirty six cases ofextravascular migratory metastatic melanoma (EVMM) ofGSV have been reported. In our case melanoma cells wereseen both inside and outside of the wall of GSV, and in thedermis. A 60 years old male presented with multiple swellingsupper left thigh since one and a half year. Patient wasoperated. All swellings, along with, part of saphenous vein tillthe knee, and small part of skin were excised under GA.Microscopically, hematoxylin and eosin sections given fromvarious sites showed features of malignant melanoma. Tumorcells were seen in the dermis, and the lumen, as well asoutside the wall of saphenous vein, but not in the epidermis.Only very few melanocytic granules were seen in a singlearea of a section. On Immunohistochemistry –, MarkersHMB45, S100 and Vimentin are strong immunoreactive. CKPAN was focal immunoreactive.In our case the melanoma spread along the wall of the GSV.This pericytic angiotropism of melanoma cells, also showingsigns of intravasation, which suggests that melanomacells may migrate along the external surface of vessels, amechanism termed ‘EVMM and also by invading the bloodvessels ‘IVMM’.
ABSTRACT
To identify and categorize various pathological patterns seen in testicular biopsies of azoospermic males along with their Johnson’s score and to evaluate the importance of the histological examination of testicular biopsies for further clinical planning. Methods: The study was conducted in the Department of Pathology of Mahatma Gandhi Medical College and Hospital, Jaipur, India. Slides prepared from testicular biopsies either unilateral or bilateral (received between January 2003 to December 2012), of 135 patients who had azoospermia on routine semen analysis were retrospectively retrieved and reviewed. Various histopathological patterns were evaluated and categorized and were graded according to the Johnson’s scoring. If more than one histological pattern was noted in the same testicular biopsy it was called as ‘Mixed pattern’ whereas if the right and left testes showed different histological pattern it was called as ‘Discordant pattern’. Results: A total of 152 testicular biopsies were collected from 135 patients (118 patients with unilateral and 17 patients with bilateral testicular biopsies). All the patients had azoospermia on routine semen analysis. The age of the patients ranged from 20 to 51 years. The most common histological pattern observed was Normal spermatogenesis (35.56%) followed by Sertoli cell only syndrome (23.70%) and Germ cell maturation arrest (20%). Hypospermatogenesis and Seminiferous tubule hyalinization was seen only in 2.96% and 2.22% of the cases respectively. Conclusion: This study has shed some light on the possible underlying etiologies of primary male infertility and emphasizes the need for bilateral testicular biopsies and on meticulous pathological examination of all seminiferous tubules in order to identify mixed and discordant patterns. The data extrapolated from our study can serve as a template for better management of primary male infertility and will optimize the advanced therapeutic modalities for the infertile couples.
ABSTRACT
Background: The heterozygous state of Beta-Thalassemia i.e. Beta-Thalassemia Trait (BTT) is usually not associated with any clinical symptoms and possesses abnormality in only a single BetaGlobin gene. Materials and methods: The present study was undertaken from October 2015 to October 2017 in the Department of Pathology of Mahatma Gandhi Medical College and Hospital. In our study, a total of 100 subjects were included with mild or no anemia (Hemoglobin >8 gm/dl) who were referred to the central lab for hemoglobin screening. Hb A2 values were determined by Capillary Hemoglobin electrophoresis for all 48 (BTT) and 52 (Normal/non BTT) subjects. The complete hemogram was done by automated hematology analyzer. The values of red cell indices TRBC, MCV and MCH and six discriminative indices were evaluated for detection of β-thalassemia trait. The results were compiled in tabular form and bar diagram. Results: In the present study, the patients in the BTT group had statistically significantly decreased mean corpuscular volume (MCV) and mean corpuscular hemoglobin (MCH) and increased TRBC count as compared to those in non BTT group. Among the six discrimination indices used highest sensitivity was found for Shine and Lal index (87.5%) followed by Mentzer index (79.16%). The highest specificity was found for E and F (88.46%) followed by RDWI (84.61%). Youden’s index was highest for Mentzer index (61.85%) followed by RDWI (55.44%). Conclusion: From this study, we thus conclude that although no screening test can diagnose β− Thalassemia Trait with 100% sensitivity or specificity, among the hematological parameters MCV, TRBC and MCH most efficiently discriminates β−Thalassemia Trait from other microcytic, hypochromic anemia. Mentzer index with CBC may be the simple, low cost, rapid and can be reliably Prachi Gupta, BP Nag, Abha Mathur. Evaluation of Red Cell Indices and Discriminant Functions in the Detection of Beta Thalassemia Trait. IAIM, 2019; 6(3): 50-59. Page 51 used as a screening test for thalassemia as a routine. However none of the formulas are 100% sensitive and specific.