Placental Morphology And Fetal Outcome In Pre-eclamptic Pregnancies

Introduction: Pre-eclampsia is one of the major obstetric problem affects 5-8% of all pregnancies leading tomaternal and perinatal morbidity and mortality. Fetal outcome is badly affected by pathological changesdeveloping in placenta.Methods: A cross-sectional descriptive study was carried out in the department of Anatomy with Pathology,Yenepoya Medical College, Mangalore, Karnataka. A total of 32 freshly delivered placentae (24 from pre-eclampticpregnancy and 8 from normal pregnancy) were collected from the Obstetrics and Gynaecology department ofYenepoya Medical College Hospital, Mangalore. Morphologic and morphometric parameters of placentae werenoted and their means were calculated.Results: The morphologic parameters of the placenta were showed significant difference in two groups (p=0.018).Fetal birth weight was lower in pre-eclamptic group and 33% of babies of pre-eclamptic mothers developed IUGR.The incidence of pre-eclamptic patients underwent caesarean section was 71% and 16% of pre-eclamptic mothersdeveloped eclampsia and HELLP syndrome.Discussion: Pre-eclampsia is associated with significant changes in placental morphology due to decreaseduteroplacental blood flow. Prematurity, growth restriction and low birth weight are fetal complications expectedto be linked with pre-eclampsia. Placental weight had relevant connection with the fetal birth weight. Hence, theknowledge of this will be extremely useful in the early diagnosis of placental insufficiency and to plan a safepregnancy with healthy fetal outcome

Megakaryocytic alterations in thrombocytopenia: A bone marrow aspiration study.

Context: Dysplastic changes are well documented in myelodysplastic syndromes (MDS). However, they are also observed in non-MDS hematological conditions. Aims: To evaluate the megakaryocytic alterations in the bone marrow aspirations in cases of non-MDS related thrombocytopenia. Setting and Design: A prospective study of 144 bone marrow aspirates was conducted in the department of pathology, Kasturba Medical College, Mangalore. The aspirates were studied to assess the number and morphology of the megakaryocytes in non-MDS related thrombocytopenia and evaluate their significance when compared to changes in MDS. Materials and Methods: The bone marrow aspiration smears were stained with Leishman stain and examined under light microscope. Statistical Analysis Used: Fisher's exact test. A P value less than 0.05 was considered significant. Sensitivity and specificity was calculated for those features which were significant in the relevant hematological disorders. Results: The sensitivity of immature megakaryocytes, dysplastic forms and micromegakaryocytes in cases of immune thrombocytopenic purpura was 100%, 89% and 42% respectively. The specificity of emperipolesis was 74%. In cases of infection-associated thrombocytopenia, immature megakaryocytes had a sensitivity of 100% and cytoplasmic vacuolization were 86% specific. The sensitivity of the dysplastic forms in megaloblastic anemia was 75%. However, no platelet budding was observed. The presence of micromegakaryocyte had a specificity of 83% in MDS, and was statistically significant when compared to cases of non-MDS conditions (P<0.05). Conclusions: Careful understanding of the morphological changes of megakaryocytes in bone marrow aspirates can improve the diagnostic accuracy for a wide range of hematological disorders thereby enabling proper therapeutic interventions.

Bone marrow biopsy in non-Hodgkin lymphoma: A morphological study.

Context: Bone marrow (BM) biopsy is an integral part of staging work-up for non-Hodgkin lymphoma (NHL). Aims: To study the characteristics of BM involvement in NHL with respect to incidence, histologic pattern and morphology of infiltration and its discordance with the histology of primary anatomic site. Settings and Design: Forty-nine cases of NHL in which BM biopsy was performed for staging were included in this study, the primary site being classified according to the WHO classification for NHL. Materials and Methods: A prospective study of 49 cases was conducted. Bilateral BM biopsy was obtained from the posterior superior iliac spine. The biopsies were fixed in 10% buffered formalin solution and decalcified using 10% formal - formic acid for 4 - 6 h followed by routine processing. The serial sections were stained by hematoxylin and eosin and reticulin stains. Results: BM biopsy showed involvement by lymphoma in 27 cases (55.10%). Unilateral positivity was found in four cases (14.81% cases). The overall incidence of marrow involvement by NHL was 55.1%. The incidence of involvement was higher in T-cell lymphomas when compared with B-cell lymphomas and predominant pattern of involvement was mixed. Diffuse large B-cell lymphomas had the lowest incidence in all the B-cell lymphomas. A discordant histology between BM and primary anatomic site was found in 29.63% (8/27) of the cases, where it was seen more in follicular lymphomas and diffuse large B-cell lymphomas. Conclusions: Critical examination of BM biopsies can increase the diagnostic accuracy, thereby contributing to the prognosis and appropriate treatment modalities.

Myoepithelioma of soft tissue.

Myoepitheliomas and mixed tumors involving deep subcutaneous and subfascial soft tissues of limb or limb girdle are rare lesions as against salivary lesions that are well established conditions. Here, we report a 22-year-old female who presented with painful hard swelling in the left gluteal region of 1(1/2) year duration. MRI showed a large ill-defined heterogeneous mass lesion measuring about 7-8 cm. in the left sacral region eroding the left sacroiliac region and left sacroiliac joint. With a clinical diagnosis of chondrosarcoma, the tumor with the surrounding tissue was resected in segments at surgery. Histomorphology revealed nests, sheets and cords of round to spindled cells with extensive squamous metaplasia in a myxoid to fibrous stroma. These cells extensively infiltrated muscle and bone. The tumor cells expressed immunoreactivity for cytokeratin (AE1/AE3) and S-100.

Morphometric evaluation of endometrial blood vessels.

Five hundred endometrial specimens were studied to document the changes in blood vessels in various phases of menstrual cycle, menstrual disturbances and in unexplained infertility. Sixty-three cases were taken as control and 437 cases as study group which included cases of dysfunctional uterine bleeding (DUB), endometrial polyps, fibroids, adenomyosis, infertility and atrophic endometrium. Using light microscopy, the vascular morphology was studied. The blood vessels were concentrated more in basal layer in the proliferative phase and in functional layer in the secretory phase. Cases of complex hyperplasia and pill endometrium had significantly higher vessel concentration. Congestion and dilatation of blood vessels were significantly higher in cases of DUB. The present study showed a positive correlation between endometrial angiogenesis and menstrual disorders. The alteration in blood vessel morphology has significant role in prognosis and in various anti-angiogenic therapies.

Bilateral angiosarcoma breast diagnosed by fine needle aspiration cytology.

Concurrent or synchronous angiosarcoma (AS) of breast is a rarity. Specific recognition of this neoplasm in cytological specimens is difficult and conclusive diagnosis in the absence of ancillary methods is achieved only uncommonly. Herein, we present a case of bilateral AS of breasts in a 32-year-old lady diagnosed by fine needle aspiration (FNA) cytology, thus enabling a definitive surgical approach. This case report emphasizes that when aspiration smears show vasoformative features consisting of microacini, arborizing microtissue fragments and intracytoplasmic lumen against a bloody background, diagnosis can be made conclusively by FNA with immunohistochemical confirmation.

Microwave histoprocessing versus conventional histoprocessing.

The aim of the study is to compare the histologic quality of the microwave histoprocessing with that of conventional method and to determine its positive impact on turnaround times and reduction of costs of tissue processing. One hundred and eighty-five paired tissue sections from different organs were taken. Each tissue sections were of size of 15 mm x 10 mm x 3 mm and divided into two; one set as experimental group and the other as control group. The tissues in the experimental group were further divided into six groups and processed by vacuum-microwave method according to six protocols from I to VI. Other tissues in the control group were processed by the conventional method and compared. Overall, the quality of microscopic tissue from both the methods was identical. Microwave processing shortened the time of processing without compromising the overall quality of the histologic section and was cost-effective.

Fine needle aspiration of metastatic malignant Leydig cell tumor of testis: a case report.

A 53-year-old male presented with a right inguinal mass of one-year duration. The fine needle aspiration of the inguinal mass showed a highly cellular tumor composed of sheets and isolated, large round to polygonal cells with moderate pleomorphism. Many bare nuclei were seen with occasional intranuclear inclusions. A provisional diagnosis of metastasis probably of testicular tumour was made. The orchidectomy showed a brown tumor replacing the entire testis and infiltrating the epididymis. The histological features showed Leydig cell tumor without Reinke crystalloids.

Case reports of basaloid squamous cell carcinoma--an aggressive variant of squamous cell carcinoma.

Basaloid squamous cell carcinoma (BSCC) is a high grade variant of Squamous Cell Carcinoma with a predilection for the aero-digestive tract. The typical microscopic features of carcinoma with a basaloid pattern in intimate association with a squamous component helps in diagnosis of this tumour. There are few reports in the Indian literature and we report three cases, including one in the sinonasal region. This study discusses the differential diagnosis of BSCC, as recognition of this tumour may have therapeutic implications.

Prolymphocytic leukaemia--report of three cases.

Prolymphocytic leukaemia is a rare subtype of chronic lymphocytic leukaemia. Three such cases are reported here along with clinical details. All these cases were seen in males above 5th decade of life. These patients showed moderate to massive splenomegaly, inconspicuous lymphadenopathy in two cases and one with minimal lymphadenopathy. Peripheral smear showed high leucocyte count with more than 55% of prolymphocytes. Bone marrow aspiration showed diffuse involvement; and in one with minimal lymphadenopathy, lymph node aspiration showed prolymphocytes. All the three patients died within a year after diagnosis.

Mast cell profile in uterine cervix.

Mast cell profile was studied in 50 neoplastic and 50 non-neoplastic conditions of the uterine cervix. The mean number of mast cells decreased to 44.8 in chronic cervicitis with ulceration, whereas the highest number of mast cells was observed in cervical polyp with a mean of 250. The mean number of mast cells was also higher in papillary endocervicitis (102.57) and chronic cervicitis (103.8). Mast cells were found in close proximity to the cervical glands and around blood vessels in non-neoplastic lesions. Mast cell count in carcinoma of cervix ranged from 0 to 210 per 10 HPF with a mean of 48.08. When the invasion by tumour was extensive the total count of mast cells was lower when compared to minimal invasion. The distribution of mast cells was found to be around the tumour deposits. Comparison of mast cell densities in neoplastic and non-neoplastic conditions revealed an increase in chronic inflammatory processes, while in cancers there was diminution in number or total absence of mast cells. There is no conclusive correlation between the age of the patients and the density of mast cells. An inverse relationship existed between the mast cell population and degree of anaplasia as well as of mitotic figures.

Ovarian teratomas in Mangalore.

In the present study 122 ovarian teratomas, reported from the department of pathology, Kasturba Medical College, Mangalore, were predominantly (76%) seen in the age group below 40 years and the peak incidence was in the third decade (39%). Menstrual disturbances, pain abdomen, pregnancy and abdominal distension were the presenting symptoms. Histologically 113 (92.6%) were benign cystic teratomas showing mainly ectodermal tissue derivatives. Struma ovarii (4 cases) revealed colloid, both macro- and microscopically. Immature teratomas (2 cases) were solid and showed embroynal tissue elements. Teratomas with malignant transformations (3 cases) were grossly nodular and were squamous cell carcinomas.

Prolymphocytic leukaemia--report of three cases.

Prolymphocytic leukaemia is a rare subtype of chronic lymphocytic leukaemia. Three such cases were reported here along with clinical details. All these cases were seen in males above 5th decade. These patients showed moderate to massive splenomegaly, inconspicuous lymphadenoapthy in two cases and one with minimal lymphadenopathy. Peripheral smear showed high leukocyte count with more than 55% of prolymphocytes. Bone marrow aspiration showed diffuse involvement and in one with minimal lymphadenopathy, lymphnode aspiration showed prolymphocytes. All the three patients died within a year after diagnosis.

Benign teratoma of the lesser omentum--a case report.

Teratomas of the lesser omentum are extremely rare and all cases reported in the literature have been benign teratomas with mature tissue elements. A case of teratoma, which behaved in benign fashion in spite of immature elements in a 16-year-old male, is reported. The patient remained free of disease 7 years after surgical resection of the tumour.

Study of mast cells in non-neoplastic skin lesions.

Sixty non-neoplastic skin lesions were studied for mast cells by toluidine blue stain. The highest numbers of mast cells were seen in the viral infections of the skin (50/mm2) and lowest number of mast cells in congenital diseases (17/mm2). Out of the cutaneous bacterial infections, highest numbers of mast cells were seen in leprosy (44/mm2) while in lupus vulgaris they were much less (37/mm2). In leprosy cases it was observed that as the lesions moved from indeterminate to both polar tuberculoid and lepromatous, the mast cell count increased. It could therefore be summarised that periodic follow-up of indeterminate and borderline lesions for mast cell count might help in predicting stability of lesions. In non-infectious squamous and papular lesions the mean mast cell count was 39/mm2. The highest numbers of mast cells in the non-infectious vesicular and bullous lesions were in bullous pemhigoid (57/mm2) and lowest in dermatitis (38/mm2).