Morphological Study on Lumbosacral Transitional Vertebra in Adult Indian Sacra and its Clinical Implications.

Lumbosacral transitional vertebra (Sacralization) is the fusion of 5Th lumber vertebra with the first segment of the sacrum it may be complete or incomplete. In complete sacralization body of the 5Th lumber vertebra completely fuses with the sacrum, where as in incomplete sacralisation shows a well defined joint line between the transverse process and the sacrum. Both forms may be either unilateral or bilateral. Such kind of abnormalities are importance while reporting the X ray, CT and MRI films, during surgical procedures at the Lumbosacral region and making a differential diagnosis for the low back ache patients. Accordingly the present study was designed to evaluate the incidence and morphological study of Sacralization (Lumbosacral transitional vertebra) in adult Indian sacra and its clinical significance. This study was carried out on 150 dry human sacra irrespective of age and sex at Mayo Institute of Medical Sciences- Barabanki,-UP, Melaka Manipal Medical College-Manipal University and Department of Anatomy, KMCT Medical College, Manassery-Calicut. It was observed that out of 150 sacra, 57 (38%) sacra showed sacralization. Out of 57 sacralized bones, 38 (25.33%) bones showed bilateral sacralization, whereas 19 (12.67%) bones showed unilateral sacralization. Such Lumbosacral transitional vertebra may increase the ricks of Disc bulge / herniation or pseudarthrosis (nonunions) with the ilium, degenerative sclerosis around the false joint, compression of lumber nerve roots, low back pain, and false administration of epidural or intradural anaesthetics in lumbosacral region. Its sound knowledge is not only enlightening for the orthopaedic surgeons, also vital for the clinical anatomists, forensic experts and morphologists.

Role of pro-angiogenic marker galectin-3 in follicular neoplasms of thyroid.

The role of pro-angiogenic marker galectin-3 (GAL-3) was examined in differential diagnosis of follicular neoplasms of thyroid into histological subsets of follicular adenoma (FA), follicular carcinoma (FC) and follicular variant of papillary thyroid carcinoma (FVPTC). The study included 22 cases from January 2006 to June 2011 comprising of FA (n = 12), FC (n = 3) and FVPTC (n = 7). Immunohistochemical evaluation of GAL-3 was performed on representative histologic sections from the resected thyroid specimens. The proportion of stained cells and intensity of staining in tumor blood vessels were evaluated. GAL-3 expression showed that angiogenesis was prominent in malignancy (FC and FVPTC) and negative in non-neoplastic thyroid parenchyma and benign condition (FA). GAL-3 expression was found to differentiate benign from malignant follicular neoplasms. Focal and diffuse positivity for GAL-3 was found to be associated with FC and FVPTC respectively, thus GAL-3 can be used as a immunohistochemical marker in the differential diagnosis of follicular neoplasms of thyroid based on the type of expression. Limitation of this study was relatively less number of cases studied; however, this data need to be corroborated in larger cohort.

Palmar cutaneous metastasis from carcinoma cervix.

Carcinoma of the uterine cervix is the most common gynecological malignancy in developing countries. However, its cutaneous metastasis is a rare entity. The reported incidence of cutaneous metastasis ranges from 0.1 to 2%. Frequent sites of cutaneous metastasis in decreasing order are: abdominal wall, vulva and anterior chest wall. To the best of our knowledge, only three cases of cutaneous metastasis to the upper extremity have been reported in the world. We report a case of a 74-year-old postmenopausal lady diagnosed to have carcinoma cervix (stage IIIB) who presented with cutaneous metastasis to palm and thigh, 10 months after radical radiotherapy. At presentation, the primary disease had resolved completely. She had a small nodular growth in the left palm and left thigh. Fine needle aspirate cytology and core needle biopsy from both the nodular lesions were positive for squamous cell carcinoma.

Significance of eosinophils in diagnosing Hashimoto's thyroiditis on fine-needle aspiration cytology.

Background: Hashimoto's thyroiditis (HT) is the most common cause of hypothyroidism in those areas of the world where iodine levels are sufficient. Fine-needle aspiration cytology (FNAC) can accurately diagnose this lesion in most of the patients. However, a small percentage of cases may be missed due to inherent limitations of this procedure. Therefore, cytologic clues to increase sensitivity of diagnosis need to be searched for. Aims: To assess whether an eosinophilic infiltration of the thyroid gland has a higher association with HT than colloid goiter. Materials and Methods: The study was a case-control study. Smears obtained by FNAC of 50 case, each of HT (which served as cases) and colloid goiter (which served as controls) were observed. The number of eosinophils and neutrophils per high-power field (HPF) was counted in all the smears. The eosinophil-neutrophil ratio in the smears, diagnosed as HT, was then compared with that of colloid goiter using unpaired t-test. Results: Smears diagnosed as HT was found to have a significantly higher eosinophil-neutrophil ratio than smears diagnosed as colloid goiter (P value 0.0001). Conclusion: Eosinophilic infiltration of the thyroid gland has higher association with Hashimoto thyroiditis.

Immunohistochemical distinction between mesothelial and adenocarcinoma cells in serous effusions: a combination panel-based approach with a brief review of the literature.

BACKGROUND: The prognostic and therapeutic significance of differentiating adenocarcinoma (AC) from reactive mesothelium (RM) in effusions cannot be overemphasized. To avoid diagnostic errors, ancillary techniques like immunohistochemistry are employed. However, results vary and no universal standard has been accepted so far. OBJECTIVE: To study the combined diagnostic efficacy of epithelial membrane antigen (EMA), carcinoembryonic antigen (CEA), E-cadherin (EC), calretinin (CAL), desmin (DES) and vimentin (VIM) in distinguishing RM from AC cells in serous effusions. STUDY DESIGN: Unequivocally diagnosed cases of 39 adenocarcinomatous and 38 RM populations were studied using sections from 49 formalin-fixed, paraffin-embedded cell blocks. MATERIALS AND METHODS: The immunomarkers were applied on cell block sections using the avidin-biotin peroxidase technique. The distribution/intensity of immunostaining in mesothelial and AC cells were graded semiquantitatively. STATISTICAL ANALYSIS USED: Fischer's exact test was used to calculate the efficacy of individual markers and their combinations. RESULTS: EMA was the best single marker for AC, with 100% sensitivity and 97.37% specificity. For the mesothelial cells, CAL exhibited 100% sensitivity and 92.31% specificity. DES was more specific than CAL but had a poor sensitivity of 55.26%. EC, CEA and VIM had unsatisfactory predictive values precluding their use as individual diagnostic markers. Among the combinations, two panels--EMA+ AND (CAL- OR DES-) for ACs and CAL+ AND (EMA- OR CEA-) for RM had 100% specificities and sensitivities. CONCLUSIONS: Most panel studies on fluid cytology are based on the arbitrary use of individual markers with the best statistical values, leading to a less than accurate diagnostic assessment. We believe that statistical parameters calculated in combination provide for a more practical and objective evaluation as well as allowing for meaningful comparative studies.

Pseudoglandular pattern of basaloid cells in pilomatrixoma in the needle aspiration cytology: a case report.

A varied cytomorphology of pilomatrixoma often results in diagnostic dilemma. Here, we report a case of pilomatrixoma that presented with prominent gland like arrangement of basaloid cells on cytologic smears causing diagnostic problem. Clinical diagnosis in the present case was cervical lymphadenitis and the cytologic smears showed a strikingly varied morphology with few loose clusters of basaloid cells exhibiting pseudoglandular pattern. A possibility of metastatic carcinoma was considered. However, following histopathologic diagnosis of pilomatrixoma, when cytologic smears were reviewed, it was realized that the ghost cells were overlooked as anucleate squames. Our case highlights the importance of careful clinical and cytologic interpretation of pilomatrixoma. Awareness of the cytomorphologic characteristics of ghost cells and their identification in cytologic smears is highly criticalfor an accurate diagnosis. A prominent basaloid cell component of pilomatrixoma with a pseudoglandular pattern, which has not been described earlier, may easily lead to a false positive diagnosis.

Chronic myeloid leukemia presenting with avascular necrosis of femur head.

We report the case of a 15 years girl in whom avascular necrosis (AVN) of right femur head was the presenting feature of chronic stable phase of chronic myeloid leukemia (CML). To date, only three case of CML with AVN have been reported. So, in view of rarity of this condition, a similar case of CML presenting as AVN of femur head is being reported.