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.

Clinical, histopathological and immunofluorescent study of vesicobullous lesions of skin

Background: Vesiculobullous diseases have been the focus of intensive investigation in recent years. However, these disorders are still associated with substantial morbidity, considerable mortality and impaired quality of life. Accurate diagnosis of vesiculobullous lesions of skin entails evaluation of clinical, histopathologic and immunofluorescence findings.Methods: Hospital based prospective study for a period of 24 months from August 2014 to July 2016 in the Department of Pathology at Andhra Medical College, Visakhapatnam, India. Total of 50 patients aged 3-70 years with vesiculobullous lesions of both sexes attending the Department of Dermatology were selected and analysed clinically, histopathological examination and direct immunofluorescence (DIF).Results: In the present study, majority of patients presented between 51-60 yrs of age (32%) with male to female ratio of 1.08:1 and mean age of 46.02 years. Pemphigus vulgaris constituted the most common vesiculobullous disorder (32%) followed by bullous pemphigoid and pemphigus foliaceous, 18% each. Bullae were located intra epidermally in 68% and sub epidermally in 32% of the patients. DIF was positive in 80% of the cases. Overall clinicopathological correlation was established in 74%. Overall histopathological and direct immunofluorescence correlation was established in 78%. Out of 50 cases, 35 cases (70%) correlated clinically and histo-pathologically with direct immunofluorescence.Conclusions: In the present study, on histopathological examination alone pemphigus foliaceus and pemphigus vulgaris could be differentiated. Direct immunofluorescence was useful in differentiating epidermolysis bullosa acquisita from bullous pemphigoid which have similar histopathological picture. This study proves that direct immunofluorescence is confirmatory as well as diagnostic for vesiculobullous disorders.

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.

Leydig cell tumor of ovary with primary hyperparathyroidism: A rare association.

Leydig cell tumors of ovary are extremely rare sex cord stromal tumors that account for <0.2% of ovarian cancers. Most of these tumors can cause hyperandrogenism. A 54 year old multiparous postmenopausal woman, known diabetic and hypertensive, presented with progressive virilization, bone pains and depressed mood for 2 years. Diagnostic evaluation revealed markedly elevated testosterone with normal dehydroepiandrosterone sulphate. Computerized tomography of abdomen showed right ovarian mass with multiple cysts in both kidneys. Biochemical investigations revealed hyperglycemia, hypercalcemia, hypophosphatemia and elevated parathormone (PTH) levels. Sestamibi scan for parathyroids was suggestive of right inferior parathyroid adenoma. Histopathology of the resected right ovarian tumor was consistent with leydig cell tumor of ovary. Postoperatively serum testosterone and blood glucose levels were normalized, but PTH levels remained high. PTH levels were normalized after resection of parathyroid adenoma

Congenital extraskeletal Ewing's sarcoma of chest wall - A rare case report.

Congenital extraskeletal Ewing's sarcoma or peripheral primitive neuroectodermal tumor is an extremely uncommon and invariably fatal tumor. We report a case of extraskeletal congenital Ewing's sarcoma in a female fetus delivered at 34 weeks of gestation who died immediately after birth. In English literature, majority of cases of Ewing's sarcoma in neonates reported were skeletal. To the best of our knowledge, very few cases of extra-skeletal Ewing's sarcoma in neonates are reported in the literature.