Utility of tru-cut biopsy in diagnosis of palpable pediatric soft tissue neoplasms

Context: Soft tissue neoplasms are infrequent in children with sarcomas accounting for approximately 7% of all pediatric malignancies. Morphologic diagnosis is challenging due to overlapping features. Subtyping and categorization of these lesions are difficult on fine-needle aspiration cytology (FNAC) alone owing to tumor heterogeneity and limited material in some cases. Tru-cut biopsies obtain adequate tumor tissue for ancillary studies besides conventional histology. Aim: The study aims to explore the role of tru-cut biopsy to arrive at a definitive diagnosis. The study also highlights the correlation between FNAC and histopathology on tru-cut biopsy besides explaining the significance of a panel of immunohistochemistry (IHC) markers for histological categorization and subtyping. Materials and Methods: A total of 61 children from infancy to 18 years were included in the study. Closed biopsy procedures like FNAC and tru-cut biopsy were performed, and the tru-cut biopsy specimen was subjected to a panel of immunohistochemical markers. Results: Fisher's exact test for sensitivity and specificity towards detection of malignancy was 83% and 86%, respectively for FNAC. For tru-cut biopsy, sensitivity was 94% and specificity was 91%. The two-sided P value (<0.0001) was extremely significant. Cohen's Kappa coefficient value for tru-cut biopsy was 0.772 suggesting a substantial strength of agreement. Tru-cut with IHC had a Kappa value of 0.866 suggesting greater agreement with histopathology. Conclusion: Tru-cut biopsy is a simple, safe, and reliable adjunct to the FNAC. Instead, immunohistochemistry enhances the diagnostic accuracy.

Post-transfusion hepatitis C virus infection among ?-thalassaemic individuals with associated clinical parameters

Background & objectives: Multiple transfusions in ?-thalassaemia patients undergoing regular transfusion regimen are at a risk of developing transfusion transmitted infections, including hepatitis C virus (HCV). The present study was conducted to investigate the association of HCV viraemia and genotype with clinical parameters in HCV seroreactive ?-thalassaemic individuals. Methods: A total of 172 HCV seroreactive ?-thalassaemic individuals aged between 2-35 yr with at least 25 units of blood transfusion were catagorized into four groups (2-12 yr, group 1; 13-19 yr, group 2; 20-29 yr, group 3; 30-35 yr, group 4). Aged matched control samples (n=87; ?-thalassaemics without HCV infection) were also included. HCV RNA was detected by nested reverse transcriptase polymerase chain reaction (RT-PCR) based on 5� UTR of HCV genome, viral load was determined by real-time RT-PCR. Nested RT-PCR amplified partial core region was used for DNA sequencing. Liver function parameters [serum total bilirubin, alanine aminotransferase (ALT) and aspartate aminotransferase (AST)] were also determined. Results: Of the 172 HCV seroreactive individuals, 59.30 per cent (n=102) were HCV RNA positive. HCV viral load ranged from 173 to 32.04�[5] IU/ml; 87.65 per cent were infected with HCV genotype 3. Liver enzymes, such as ALT, AST and serum total bilirubin were significantly elevated in all age groups compared to control groups. Serum ferritin levels were found to be high in all individuals, but 16.27 per cent of HCV-infected individuals with >10,000 IU/ml viral load also showed high ferritin levels (>1500 ?g/l) where the majority of them were infected with HCV genotype 3. Interpretation & conclusions: HCV genotype 3 was the major circulating genotype among ?-thalassaemia patients in this region. Our findings indicated an association between HCV replication and hepatic iron load and also highlighted the need for sensitive quantitative RT-PCR-based detection of HCV RNA in the high risk population

Malaria situation in India with special reference to tribal areas.

Background & objectives: In India, malaria is a major public health problem in states having predominantly tribal population. The objective of this analysis was to find out the incidence of malaria in various states/districts having varied proportions of tribal population using National Vector Borne Disease Control Programme (NVBDCP) data. Methods: States and districts were classified into three categories based on proportions of Scheduled Tribes (ST) population as <10, 10-29.9 and 30 per cent + ST population. Five year average (2008-2012) of all important malaria indicators collected by NVBDCP was taken to normalize the effect of annual fluctuations in malaria incidence. Results: State level analysis revealed that ten states/UTs with 30 per cent or more tribal population comprising only three per cent of total population, contributed 14 per cent of total malaria, 21 per cent Plasmodium falciparum and 29 per cent of deaths due to malaria. Similarly, district level analysis showed that districts with 30 per cent or more tribal population comprising about eight per cent country’s population contributed to 46 per cent of total malaria cases, 70 per cent P. falciparum and 47 per cent malarial deaths in the country. Interpretation & conclusions: our analysis showed that the neglect of the ethnic communities in tribal areas would be detrimental to the overall reduction of morbidity and mortality due to malaria. The fight against the increasing burden of malaria in tribal belt requires adoption of multiple approaches and socio-economic development of the tribal communities.

A novel nested reverse-transcriptase polymerase chain reaction method for rapid hepatitis C virus detection and genotyping.

Purpose: Rapid and specific detection of viral nucleic acid is increasingly important in the diagnosis of infectious diseases. The objective was to develop a rapid, efficient process of nucleic acid based detection of hepatitis C virus (HCV) infection for its diagnosis and treatment follow‑up. Materials and Methods: A two‑step nested reverse‑transcriptase polymerase chain reaction (RT‑PCR) has been standardised on a sample set of 125 individuals from different liver clinics in Kolkata. The method utilises a novel fast nested RT‑PCR for HCV detection and genotyping from HCV infected patient plasma with high processivity. Results: The overall time required from ribonucleic acid (RNA) isolation to nested PCR amplified product detection is reduced to 42% when compared with conventional nested RT‑PCR amplification. The method is sensitive as conventional PCR and detected all HCV RNA positive samples. Sequencing, phylogenetic analysis of the PCR amplified product by this method showed concordant genotypes with conventional PCR. Conclusion: Though being a two‑step process, this method is fast, cost‑efficient, reliable and feasible for regular HCV RNA screening and apt even in resource limited settings. This method could be translated to regular nucleic acid screening for other infectious diseases as regular PCR regimen.

Acute fulminating viral myocarditis: clinically mimicking ARDS.

Viral myocarditis usually presented with influenza like manifestations, cardiac symptoms and signs related to myocarditis. We are presenting a case which was clinically mimicking acute respiratory distress syndrome but careful history taking with chest x-ray examination saves life of the patient.

Gestational choriocarcinoma presenting as hemothorax.

Choriocarcinoma include a spectrum of chorionic neoplasms that may be gestational or non-gestational. By virtue of their high vascularity and affinity of trophoblast for blood vessels, metastases often occur early, and the most common site of such metastases is the lung. Metastatic pleural effusions from choriocarcinoma are infrequent. Pleural seeding usually results from extension of a sub-pleural peripheral nodule. We describe a case of gestational choriocarcinoma whose clinical presentation was medical like hemothorax as in our case rather than gynecologic.

Systemic lupus erythematosus presenting with recurrent pleural effusion without any systemic manifestation.

Pleural effusion can be the sole presenting manifestation in about 5 percent of cases with SLE. We are reporting a case of SLE which presented with recurrent pelural effusion without other systemic manifestation.

Heavy metals in water of the rivers Hooghly and Haldi at Haldia and their impact on fish.

The paper deals with the measurement of five heavy metals viz., Cd, Cu, Mn, Pb and Zn in water of the rivers Hooghly and Haldi at Haldia during June 1999 to October 2002. The industrial effluent out fall (OF) at Patikhali, Haldia was also taken as sampling site along with above out fall (AOF) and below out fall (BOF) sites. Most of the metals exhibited their least concentration at the sampling site above the Haldia industrial area of river Hooghly. The average concentrations of the studied metals were Cd 2-14, Cu 5-19, Mn 8-88, Pb 17-41 and Zn 22-37 microg l(-1). Comparison of the data with the Criterion Continuous Concentration (CCC) of USA revealed that Cd, Cu and Pb were the pollutants present at alarming level to disturb the aquatic life process in the zone. The effect was found to reflect on the tissue level aberrations in the residential fishes. The other two metals viz., Mn and Zn were probably less harmful to the aquatic ecosystem. In India, necessity is felt to develop the CCC values, which will be more appropriate for protection of aquatic environment than comparing with drinking water standards.

Ultra-structural observations on the lymphoid organs of the freshwater catfish, Clarias batrachus (Linnaeus).

Light microscopic and ultra-structural studies of the lymphoid tissues such as blood immunocytes, spleen and pronephros of the freshwater catfish, Clarias batrachus, were carried out. The peripheral blood showed nucleated erythrocytes, total leucocytic count (TLC) more than that observed in mammalian blood and leucocytes with morphological appearance similar to the mammalian white blood cells (WBCs). The spleen and pronephros showed presence of numerous lymphocytes, monocytes and nucleated red blood cells (RBCs) along with hemosiderin-containing macrophages. The morphology of lymphoid organs of the catfish has been discussed in light of the evolution of the immune system in this class of vertebrates.

Unusual presentation of schwannoma.

Schwannomas are slow growing benign tumours arising from the nerve sheath. Two cases of schwannoma arising from the vagus nerve are presented here. One case was found in a 6-year-old boy and another one in a 30-year-old man. In the first case the tumour was detected on the left side of the neck just below the angle of the mandible, and in the second case it was found on the lower part of the right side of the neck. Histopathology confirmed the diagnosis as first one to be of Antoni-A type and the second one to be of Antoni-B type. Both the tumours were excised and on follow-up the patients were doing well.

Antipyretic activity of Nelumbo nucifera rhizome extract.

Antipyretic activity of methanolic extract of rhizome of N. nucifera was studied on normal body temperature and yeast induced pyrexia in rats. Yeast suspension (10 ml/kg, s.c.) increased rectal temperature after 19 hr of administration. The extract, in doses of 200, 300 or 400 mg/kg (po) produced significant dose dependent lowering of normal body temperature and yeast provoked elevation of body temperature in rats. The effect produced was comparable with the standard antipyretic drug, paracetamol (150 mg/kg, i.p.).

Raised serum IgE levels in chronic inflammatory lung diseases.

OBJECTIVE: To study the serum IgE response in nonallergic subjects with chronic inflammatory lung diseases. SETTING: Christian Medical College Hospital, Vellore. SUBJECTS: Twenty six patients with bronchiectasis, five with pulmonary mycosis referred from all over India and 30 healthy subjects. MAIN OUTCOME MEASURES: Serum IgE value (determined by radioimmuno assay) above the upper limit of normal control range (136 to 948 iu/ml) was considered as raised level. RESULTS: Of the 26 patients with bronchiectasis 13 had pyogenic infections, six had pulmonary tuberculosis; in six patients sputum culture was sterile while another patient had herpes zoster. Five cases of mycosis included one each of actinomycosis, aspergillosis, blastomycosis, cryptococcosis and nocardiasis. The serum IgE levels were raised in 20 (65%) of the 31 patients. CONCLUSION: Associated bacterial, fungal and parasitic infections were probably responsible for inducing an hyper-IgE response in these non-allergic subjects.

Modulation of Fc and C3b receptor activity of mouse peritoneal macrophages elicited by preformed immune complexes.

A study was undertaken to reveal the role of Fc and C3b receptor of mouse peritoneal macrophages (MPM) in the uptake of radiolabelled immune complexes. Large latticed preformed complexes consisting of human serum albumin (HSA)-anti HSA at equivalence (IC-Eq) and with antibody excess (IC-Ab) were observed to be avidly taken up by resident macrophages unlike small size complexes with antigen excess (IC-Ag). Macrophages elicited by thioglycollate (Tg) showed higher IC-binding capacity while IC-elicited MPM showed reduction in the same when compared to the resident cells. However, complement coated complexes were significantly taken up by these IC-elicited macrophages. Uptake studies were further extended to determine the expression of Fc and C3b receptor activity in MPM when elicited with preformed IC. Tg-elicited MPM were observed to bind greater number of IgG-coated erythrocytes (E-IgG) than resident MPM whereas IC-elicited MPM bound E-IgG poorly. When Fc receptors were blocked by in vitro IC treatment, poor binding of complement coated E-IgG [E(IgG)C] was recorded in resident MPM. The present complement medicated rosetting data tends to show enhanced expression of C3b receptors on IC-elicited macrophages.

Chest malignancies & serum immunoglobulin E.

Serum IgE levels were measured by the radioimmunoassay technique in the sera of 53 patients with neoplastic chest diseases. Forty seven patients had malignant chest tumours and another 6 had benign tumours or mediastinal cysts. They included 33 smokers and 20 non-smokers. For comparison, 30 normal non-smoking controls matched for age and sex were included. The serum IgE levels in patients with chest malignancies showed an increase as compared to controls. The IgE levels increased significantly in adenocarcinoma (P < 0.01) and squamous cell carcinoma (P < 0.001), while they were not raised in poorly differentiated carcinoma. There was no significant difference between the serum IgE levels of 32 smokers and 15 non-smokers with malignant chest tumours.

Serum immunoglobulin E response in sputum positive patients with pulmonary tuberculosis.

A marked elevation of serum IgE level (6939 +/- 5651 IU/ml) was observed in 20 untreated and drug sensitive patients with sputum AFB positive pulmonary tuberculosis. Of them 18 were freshly diagnosed and were totally untreated. Their mean serum IgE level was 6715 +/- 5545 IU/ml. The remaining two patients presented with a relapse of the disease but were sensitive to all anti-tuberculosis drugs. Their serum IgE levels before retreatment were 2828 and 15079 IU/ml respectively. In the 13 chronic drug resistant patients who never had sputum conversion, the serum IgE level (1116 +/- 1897 IU/ml) was significantly lower (P < 0.01). It is suggested that the high serum IgE response in freshly diagnosed untreated and drug sensitive patients with illness of short duration may be related to strong early tuberculin hypersensitivity reaction and protective immunity, whereas low serum IgE response in chronic drug resistant cases with high bacterial load for prolonged duration may be related to the generation of suppressor CD8 lymphocytes eventually leading to suppression of B cells committed to the synthesis of protective serum IgE.

T cell subpopulations in amoebic liver abscess.

BACKGROUND. Cellular immunity may play a major role in the pathogenesis of amoebic liver abscess but there is little data on the effect of treatment on T cell subpopulations in such patients. METHODS. We performed a prospective, controlled study of the T lymphocyte subpopulations in 17 patients with amoebic liver abscess before, and at 4 and 8 weeks after treatment with metronidazole (30 mg/kg/day). T4 and T8 cells were studied using monoclonal antibodies by the alkaline phosphatase anti-alkaline phosphatase staining technique. RESULTS. The mean T4 cell percentages in the acute stage of illness and at 4 and 8 weeks after treatment were 27, 26 and 27 respectively and the mean T8 cell percentages were 19, 24 and 29. The T4:T8 ratio at the acute stage was 1.7, and 1.1 and 1.2 at 4 and 8 weeks of therapy. The T4:T8 ratio at the acute stage did not differ significantly (p > 0.05) from that in the control group. However, at 4 and 8 weeks after therapy there was a significant increase (p < 0.05) in the T8 cells with no significant change in the T4 cells. CONCLUSION. We suggest that sensitization of the T8 cells occurs in patients with amoebic liver abscess in the later phase of the disease. This may be responsible for the elimination of the parasite from the human host.

Colonic immunity in patients and amoebic liver abscess.

Secretory immunoglobulin A (S-IgA), coproantibody titre (antiamoebic) and IgA, IgG, IgM immunocytes in rectal mucosa were studied in 13 patients with amoebic liver abscess (ALA) prior to and 4-6 weeks after completion of antiamoebic therapy. Ten asymptomatic Entamoeba histolytica cyst passers and 17 healthy age and sex matched volunteers served as controls. Fecal S-IgA levels and counts of IgA bearing immunocytes in mucosa were significantly higher in patients with ALA and cyst passers as compared to healthy controls and showed a significant fall after treatment. Fecal antiamoebic antibodies were high in cyst passers and in cases of ALA after treatment. Raised levels of S-IgA and IgA class immunocyte counts probably indicate a local mucosal immune response directed at containing the infection.

Undernutrition and lepromatous leprosy. Serum vitamin A and E levels in leprosy spectrum.

Serum vitamins A and E were estimated by spectrophotocolorimetric methods in 67 leprosy patients comprising 9 BT, 10 BB, 15 BL, 27 LL, including 12 Histoid cases. These findings were evaluated in comparison to 55 normal subjects serving as controls. A significant reductions in the mean serum levels of Vitamins 'A' and 'E' were observed in the leprosy groups as compared to normal controls. These findings are of considerable importance and need to be taken note of in the light of delineating these alterations to the cause or effect of the disease. As far as we know, this is the first report describing serum levels of Vitamins 'A' and 'E' in the leprosy spectrum.