Study of malignant tumours of the uterine corpus: histopathology and immunohistochemistry

Background: The uterine corpus represents the second most common site for malignancy in the female genital tract. This study was performed to ascertain the profile of malignant tumours of the uterine corpus reported at our centre.Methods: A retrospective analysis of cases retrieved from the archives of the department of pathology from January 2014 to December 2016. Clinical information of the patients was collected from the hospital records.  Classification and grading of the tumours were done according to the current WHO classification.Results: Nineteen cases were studied. There were ten cases of endometrial adenocarcinoma, five cases of leiomyosarcoma, three cases of endometrial stromal sarcoma and one case of carcinosarcoma(malignant mixed mullerian tumour). The age range of endometrial adenocarcinoma was 55 to 85 years and presented with post menopausal bleeding, whereas endometrial stromal sarcomas occurred in women above 45 years of age. Leiomyosarcomas had age range from 26 to 65 years. All leiomyosarcomas were clinically diagnosed as fibroid. Majority of endometrial adenocarcinomas were well differentiated endometroid type. Out of the three endometrial stromal sarcomas two were high grade, one with metastasis. All leiomyosarcomas showed mitotic rate above 10/10hpf.Conclusions: Endometrial carcinomas form the majority of malignant tumours of uterine corpus and occur in older age group followed by leiomyosarcomas. Endometrial stromal sarcomas are less common and occur in middle aged and older patients. Leiomyosarcomas and stromal sarcomas are usually misdiagnosed as fibroids clinically unless metastases are present.

Approach for reporting serous effusion fluid in pleural, peritoneal and pericardial cavity and immunohistochemistry

Background: The aim of this study is to make a detailed cytological study of effusion fluids and compare with cell block study of the representative cases and IHC studies were done.Methods: Prospective study of 216 cases effusion fluids from in and around hospitals, Mangalore. This study conducted over a period of 18 months from October-2014 to April-2016. This study scrutinized and approved by Institutional Ethics Committee. The samples were processed by conventional cytology using Papanicolaou-stain and Cell Block (CB) method using 10% Alcohol-formalin fixative and stained with H and E. The cellularity, architectural patterns, morphological details were studied both smears. Ancillary immunohistochemical staining with calretinin and EMA are done.Results: A total of 216 cases of effusion fluids with cell block study were included, age range of 13 years to 93 years. Pleural fluid comprised of 55.09%, peritoneal fluid of 43.51% and pericardial fluid of 1.38%. 71% were clinically diagnosed as non-neoplastic and 29% were neoplastic condition. In CS study, 84.5% cases were benign/reactive effusion and 8.5% were positive for malignancy. In CB study, 84.5% were benign/reactive effusion and 10.2% were positive for malignancy. In comparison authors found an increase in diagnostic efficacy by 18%. IHC EMA for adenocarcinoma cells has sensitivity of 100% and calretinin for reactive mesothelial cells has specificity of 100%.Conclusions: Authors concluded that cell block technique when used as an adjuvant to routine smear examination in effusion fluids has increased the diagnostic yield and better preservation of architectural pattern. IHC is helpful in differentiating between reactive mesothelial and adenocarcinoma cells.

Which technique is better for reduction of anterior shoulder dislocation? external rotation or Milch method. a review of literature

Anterior shoulder dislocation is the most common joint dislocation in human body. Many methods are traditionally described for reduction of shoulder dislocation. Most of these techniques are painful to patients and may be associated with further injury. An ideal method should be easy, effective, and less painful, not associated with iatrogenic complications and should be easy to teach and learn. Among different methods of reduction, external rotation and Milch methods are more popular. Both methods are found to be atraumatic, relatively painless and can be performed without anesthesia. In this article, we aimed to review the literatures regarding these two methods of reduction and comparing their success rate and outcome. We reviewed the literature to find articles related to reduction of anterior shoulder dislocations applying one of two techniques described above. We searched PubMed and Google Scholar. In total, 46 articles were found, of them 17 articles -which mainly focused on anterior shoulder dislocation reduction by means of two above methods-were included in this review. The results showed that both techniques were effective, safe, relatively painless, and were well tolerated with no complications, but the external rotation method was superior

morphological study of atypical uterine bleeding

To find out the Histopathological pattern of Endomyometrium in atypical uterine bleeding [AUB], also to study organic causes of AUB. A prospective, descriptive study. This study was conducted at the Departments of Pathology and Gynaecology and Obstetrics, Bolan Medical College Complex Hospital Quetta from January 2011 to January 2013. Specimens were received as endometrial curettage and hysterectomy specimens from patients hospitalized in the dept. of Gynaecology and Obstetrics of BMC Complex Hospital Quetta. This study included 300 women's presenting with AUB, irrespective of age and parity. A detailed clinical history followed by physical examination was also carried out in each patients to exclude systemic causes like psychological upsets and early pregnancy states and also exclude general physical abnormalities. After grossing and H and E staining all the sections were studied by group of pathologists. A Total 300 cases were studied, including 100 endometrial curetting's and 200 uteri in patients of atypical uterine bleeding at Bolan Medical Complex Hospital Quetta. The ages of these patients ranged from 20-69 years. Maximum numbers of cases were in age groups 40-49 years. Chronic endometritis [7 out of 100] 7% and the cystic hyperplasia [9 out of 100] 9% were the most important causes of atypical uterine bleeding in endometrial curetting's. No case of endometrial carcinoma was diagnosed in this series. The histological study of hysterectomy specimen revealed multiple leiomyoma's [135 out of 200] 67.5% and adenomyosis [38 out of 200] 19% as the commonest causes of atypical uterine bleeding. [2 out of 200] 1% case of leiomyosarcoma and [1 out of 200] 0.5% case of choriocarcinoma were diagnosed suggesting a lower frequency of uterine malignancy in our study. In conclusion leiomyoma's and adenomyosis are most important causes of AUB after 3[rd] decade of life. Fortunately the frequency of uterine malignancy [excluding cervix] including endometrial carcinoma is much low in our setup as compared to western studies

Usefulness of ultrasound in the diagnosis of infantile hypertrophic pyloric stenosis [IHPS]

The aim of our study was to know the diagnostic accuracy of ultrasonography in infantile hypertrophic pyloric stenosis [IHPS]. Material and This Prospective study of patients with clinical features suggestive of IHPS was carried out from January 2002 to December 2003 [2 years duration], at paediatrics surgery unit of Lady Reading Hospital Peshawar. Patients with clinical suspicion of IHPS were admitted through casualty, OPD and also shifted from other units. After clinical diagnosis of pyloric stenosis, ultrasound scanning was performed in all cases by a single experienced sonographer. All patients underwent surgery and pyloromyotomy was performed in all patients. Patients were followed up for at least 3 months. Twenty patients with clinical suspicion of IHPS were studied. The age ranged from 19 days to 120 days with average of 49 days. Male to female ratio was 19:1. The most common presenting symptom was nonbilious vomiting [100%]. Ultrasound revealed IHPS in all twenty cases. Surgery confirmed the findings of ultrasound scanning, showing 100% sensitivity of ultrasound in diagnosing IHPS. Pyloromyotomy was performed in all cases. There was no complication observed in this study. Ultrasound scanning is a useful tool of investigation and should be done in all suspected cases of IHPS to reduce the diagnostic errors leading to mismanagement