Clinicopathological study of premalignant and malignant lesions of cervix along with apoptotic index and Ki-67 expression

Background: Cervical cancer is known to have a good response to radiotherapy. The response and prognosis are dependent on the level of apoptosis. Pap smear and histopathology are cost-effective methods in diagnosing premalignant and malignant lesions of cervix but not accurate in classifying and estimating the progression of the disease, especially in premalignant lesions. Therefore this study was undertaken to know the role of Ki-67 expression and apoptotic index in classifying accurately the premalignant lesions for better management.Methods: The study included 540 cases diagnosed histologically as cervical intraepithelial neoplasia or carcinoma. The apoptotic index is calculated for all the 540 cases using light microscopy on Haematoxylin and Eosin stained sections. Ki-67 immunohistochemical staining was done for 100 cervical biopsies. Ki-67 expression was graded and the Ki-67 labelling index was calculated. Statistical evaluation was done using the unpaired t-test.Results: The Apoptotic index increased with increasing grade of dysplasia. There is a significant difference in the mean apoptotic index between premalignant and malignant lesions of the cervix. The ki-67 index increased with increasing grade of dysplasia. There is a significant difference in the mean Ki-67 index between premalignant and malignant lesions of the cervix.Conclusions: Apoptotic index and proliferative indices have been found useful in distinguishing between premalignant and malignant lesions of the cervix and gives an idea about the proliferative activity of the tumour for better management of the patient and to determine prognosis.

Vascular malformations: a hospital based study

Background: Vascular anomalies comprise a widely heterogeneous group of lesions. Diagnosis and management of these lesions present challenges to the surgeons, radiologists and histopathologists. Accurate classification of these lesions results in appropriate therapy. Aim of the study is to study the role of histopathology and histochemical stain in the diagnosis of vascular malformationMethods: The present study is a hospital based observational study on vascular malformations over a period of three years from 2016 to 2018 done in department of Pathology and Plastic Surgery at tertiary care centre, Visakhapatnam.Results: Out of 107 specimens of vascular anomalies received, 72 cases were vascular neoplasms, 35 were vascular malformations. Majority of the vascular malformations were seen in the cervicofacial region (43%) followed by extremities (37.1%). Most common malformation in the present study was arterio venous malformations (60%) followed by venous malformations (22.8%). Verhoeff’s VanGieson stain demonstrated discontinuity of internal elastic lamina in cases of arteriovenous malformation and helped in differentiating the lesions from capillary malformation and vascular tumors.Conclusions: Histopathology, special histochemical stains along with imaging features can be used to reduce diagnostic difficulties and in helping proper management of vascular malformations.

Clinico-pathological and radiological correlation of CNS tumors along with role of Ki 67 proliferative index in grading Astrocytoma and Meningiomas

Background: CNS neoplasms are a heterogenous group contributing to <2% of all the malignant neoplasms. Imaging and histopathology play a great role in diagnosing these lesions. Aim of the study is to correlate radiological findings with that of histopathology and evaluate the role of Ki 67 proliferative index in various grades of Astrocytomas and MeningiomasMethods: This is an observational study for a period 2 years from July 2015 to June 2017 in Department of Pathology Andhra Medical College. The total number of specimens of CNS tumors received during this period were126. The specimens were routinely processed and stained with H&E. The tumors were classified based on WHO 2016 classification. In total 71 cases-45 cases of meningiomas and 26 cases of astrocytomas, the expression of Ki 67 labelling index was recorded in various grades of these tumors and results tabulated.Results: Among 126 cases, tumors predominantly encountered were of meningeal origin accounting to 45 cases (35.71%) followed by tumors of neuroepithelial origin 35 cases (27.78%). Tumors were seen in all age groups, but common was among 41-50 years of age group with metastatic tumors being seen in >60 year group. Tumors were more common in males with male: female ratio being 1.25:1. Ki 67 proliferative index increased as the grade of tumor increased in both astrocytomas and meningiomas.Conclusions: Grading of meningiomas and astrocytomas are very much essential with reference to prognosis and therapy. Histopathology plays a great role in grading these lesions but Ki 67 proliferative index adds as an adjunct and helps in confirmation and predicting the recurrence of these lesions.

Integrated teaching in medical education: undergraduate student’s perception

Background: Integrated teaching is an effective teaching method for the undergraduate medical students to achieve good knowledge and skills. The aim of this study was to evaluate the effectiveness of vertical integrated teaching.Method: Vertical integrated teaching was conducted on the topic “Nephrotic syndrome” for 2nd MBBS (5th semester) students. Departments which participated in the session were from Physiology, Biochemistry, Pathology and General Medicine. Faculty from each department was allotted 20 minutes for their topic. After completion of all the topics students were given feedback forms. The opinions were tabulated and analysed.Results: Most of the students opined that integrated teaching is useful in gaining knowledge (Understanding, concept clarity and better performance in exams) (79.7%) as well as skill-based learning (Workshops, laboratory, clinical exercises and case discussion) (84.4%).Conclusion: The study showed that undergraduate students agreed that integrated teaching is useful for them in gaining knowledge as well as skill.

Recurrent multifocal cutaneous Kaposiform hemangioendothelioma: A rare vascular tumor of infancy and childhood.

Kaposiform hemangioendothelioma (KHE) is a locally aggressive vascular tumor of childhood although cases occurring in adulthood are also described. The features overlap with juvenile capillary hemangioma and Kaposi sarcoma. We report a rare case of recurrent, multifocal (nose and chin) cutaneous KHE initially occurring in a 3‑year‑old female child, uncomplicated by Kasabach–Merritt syndrome. Recurrences occurred over the next 6 years and resulted in complete distortion of the nose, requiring plastic repair.

A study on Prevalence of Congenital Anomalies in Neonates in a Tertiary Care Hospital.

Background: Congenital anomalies are a major cause of stillbirths and neonatal mortality. The pattern and prevalence of congenital anomalies may vary over time or with geographical location. The aim of this study is to determine the proportion and types of congenital anomalies in live newborns and to study maternal and perinatal risk factors. Methods: This prospective study was conducted over a 1 year period (March 2014 to February 2015) in the department of Pediatrics and Obstetrics/Gynaecology at Patliputra Medical College, Dhanbad, Jharkhand during the period of May 2014 to April 2015. All the live born babies born in this hospital during this period were included. The newborns were examined for the presence of congenital anomalies and mothers were interviewed for socio-demographic variables. Results: During the study period, 8546 babies were born, of which 246 had congenital malformations, making the prevalence 2.19%. Most of the women (57.8%) belonged to the age group between 21 and 30 years. Congenital anomalies were seen more commonly (3.3%) in the multiparas in comparison with primiparas (1.8%). The predominant system involved was Musculo-skeletal system (33.2%) followed by gastro-intestinal (GI) system (15%). Talipes (17.1%) was the most common one in musculoskeletal group and likewise cleft lip and cleft palate in GI system. Congenital anomalies were more likely to be associated with low birth weight, prematurity, multiparity, consanguinity and cesarean delivery. Conclusion: Public awareness about preventable risk factors is to be created and early prenatal diagnosis and management of common anomalies is strongly recommended.

A Prospective Study to Assess the Neonatal Mortality and Morbidity Associated with Preterm labor and Delivery in a Tertiary Care Hospital.

Background: Preterm labor and delivery are one of the challenging obstetric complications encountered by obstetricians, as are preterm neonates for the pediatricians. Therefore, this study was planned to identify etiological factors and to assess the neonatal mortality and morbidity associated with preterm labor and delivery. Methods: This prospective study was conducted over a 6 months period (September 2014 to February 2015) in the department of Obstetrics/Gynaecology and Paediatrics at Patliputra Medical College, Dhanbad, Jharkhand. 325 antenatal women admitted with threatened preterm labor, with or without rupture of membranes, were recruited. They were followed up from admission till delivery and discharge. Gestational age at onset of preterm labor, associated risk factors, response to tocolytics if given, gestational age at delivery, and neonatal outcome were recorded and analyzed.Results: Incidence of preterm labor was found to be 28.26% and that of preterm deliveries 25.9%. Preterm rupture of membranes and infection were the commonest causes of preterm labor. Irrespective of the use of a course of betamethasone, neonatal mortality was significantly higher (P<0.0001) in babies delivering before 34 weeks (30.4%) as compared to that in babies delivering after 34 weeks (3.4%). Septicemia, respiratory distress syndrome (RDS) and birth asphyxia were the important causes of neonatal morbidity.Conclusion: Our results revealed a high incidence of preterm labor and preterm births in comparison to developed countries. Infection is one important modifiable risk factor which can be reduced. Prolongation of delivery for 48 hours by giving tocolytics for getting the benefit of betamethasone coverage reduces morbidity due to RDS but does not reduce overall neonatal mortality below 34 weeks.

Meckel-Gruber syndrome: a case report with review of literature.

Meckel Gruber syndrome is an autosomal recessive disorder, characterized by a combination of renal cysts or cystic renal dysplasia, developmental anomalies of the central nervous system, hepatic dysgenesis and polydactyly. It is a rare syndrome with highest incidence in Gujarati Indians and Finnish population. We report a case of Meckel Gruber syndrome in non Gujarati Indian which was diagnosed on fetal autopsy.

A study of correlation of expression of ER, PR and HER2/neu receptor status with clinico-pathological parameters in breast carcinoma at a tertiary care centre.

Background: In English literature it is documented that the expression of ER and PR is low in Asian countries when compared to that of Western countries. HER2/neu over expression is uniform throughout the world. Studies have shown that triple-negative breast carcinomas are aggressive, likely to spread beyond the breast and recur after treatment. Aims and objectives: To correlate the expression of ER, PR and HER 2/neu with clinico-pathological parameters in infiltrating ductal carcinoma and other variants of breast carcinoma. To determine the clinicopathological parameters in triple negative cases. Methods: This is a prospective study for a period of two years in the Department of Pathology, Andhra Medical College, a tertiary care centre. We received 111 mastectomy specimens during this period out of which 52 patients were funded under Arogyasri and were subjected for ER, PR, HER2/neu receptor study. Results: In the present study total cases analyzed were 52. Infiltrating ductal carcinoma was 41/52 (78.84%) and other variants were 11/52 (21.15%). In our institute infiltrating duct cell carcinoma (NOS) type was the commonest type of carcinoma breast with significant group occurring in less than 45 years of age, 95 % of women were multipara with two or more children and triple negative tumors being 54.83%.In infiltrating ductal carcinoma ER, PR positive expression has no association with age and size of tumor. Their expression was higher in grade 1 tumors 83.3%.The ER,PR negative expression was more in size of tumor being greater than 2 cm; (92.5%),positive lymph nodes (51.8%) and stage II and stage III tumors (96.2%). HER2/neu negative expression was seen in 51.61% of cases. Triple negative receptor expression was seen in 54.83% of infiltrating ductal carcinoma. In the English literature medullary carcinoma is negative for HER2/neu expression but in the present study in 2 cases the expression for HER2/neu was positive. Conclusion: In the present study significant group occurred in less than 45 years of age presenting in advanced stage of the disease. Triple negative cases were seen in 54.8% cases of infiltrating duct cell carcinoma indicating bad prognosis.

A simple slide test to assess erythrocyte aggregation in acute ST-elevated myocardial infarction and acute ischemic stroke: Its prognostic significance.

A simple slide test and image analysis were used to reveal the presence of an acute-phase response and to determine its intensity in subjects of acute myocardial infarction and acute ischemic stroke. Erythrocytes tend to aggregate during an inflammatory process. Evaluation of erythrocyte adhesiveness/aggregation is currently available to the clinicians indirectly by erythrocyte sedimentation rate (ESR), but ESR correlates poorly with erythrocyte aggregation, hence a simple slide technique using citrated blood was used to evaluate erythrocyte aggregation microscopically and also by using image analysis. Aims: (1) To study erythrocyte aggregation/adhesiveness by a simple slide test in subjects with acute ST-elevated myocardial infarction (STEMI), acute ischemic stroke and healthy controls. (2) To study the prognostic significance of ESR and erythrocyte aggregation/adhesiveness test (EAAT) in predicting the outcome after 1 week in subjects of acute myocardial infarction and acute ischemic stroke. Patients and Methods: Three groups of subjects were included in the study; 30 patients of acute STEMI, 30 patients of acute ischemic stroke, and 30 subjects with age- and gender-matched healthy controls. Citrated blood was subjected to simple slide test and ESR estimation by Westergren's method. Stained smears were examined under 400Χ and graded into four grades. Images were taken from nine fields; three each from head, body, and tail of the smear. The degree of erythrocyte aggregation was quantified using a variable called erythrocyte percentage (EP), by using the software MATLAB Version 7.5. A simple program was used to count the number of black and white pixels in the image by selecting a threshold level. Results: The mean ESR of the subjects with acute myocardial infarction (29 + 17.34) was significantly higher (P = 0.001) than the mean ESR of the control group (15.5 + 12.37). The mean EP of the subjects with acute myocardial infarction (69.91 + 13.25) was significantly lower (P < 0.001) than the mean EP of the control group (85.16 + 8.41). The mean ESR of the subjects with acute stroke (40.46 + 33.75) was significantly higher (P = 0.0005) than that of the controls (15.5 + 12.37). The mean EP of the stroke patients (70.59 + 11.30) was significantly lower (P < 0.001) than the mean EP of the controls (85.16 + 8.41). In subjects with acute myocardial infarction there was a significant negative correlation (r = −0.623) between ESR and EP. In acute stroke patients there was a significant negative correlation (r = −0.69) between ESR and EP. On performing standard error of proportions, P value was < 0.05. Conclusion: EAAT is a simple bedside test for erythrocyte aggregation, which indirectly reveals the presence and proportion of inflammation. This test has the potential to assess the prognosis of acute myocardial infarction and acute stroke. It can also be used as a screening test for high-risk individuals, so that necessary interventions could be adopted. However, further studies need to be conducted to establish standard protocols.