Disseminated histoplasmosis mimicking laryngeal carcinoma from central India--a case report.

A 58 year old male, chronic smoker, with diabetes mellitus (Type II), residing in Madhya Pradesh presented with dysphagia, hoarseness, odynophagia and significant weight loss. Microlaryngoscopy showed reddish ulcerated area involving valleculae, and pharyngo-epiglottic fold. Histopathological examination showed foamy macrophages containing Histoplasma capsulatum. Patient initially responded to Azoles, relapsed three months after stopping the treatment and presented with oral lesions. Biopsy showed H. capsulatum, histologically as well as on culture. The mycelial phase converted to yeast phase on B.H.I.A. at 37 degrees C confirming the isolate as H. capsulatum. The patient responded well to amphotericin B.

Dyshormonogenetic goitre with clear cell change resembling parathyroid adenoma--a case report.

Dyshormonogenesis is a rare cause of goitre. It is manifestation of mutation in genes controlling the proteins involved in synthesis of thyroid hormones. Though there is wide spectrum of biochemical and clinical presentation, pathological features are similar in all defects. Nonencapsulated nodules with minimal regressive changes and lack of lymphocytic infiltration are important diagnostic features. Clear cell change as seen in this case is common and needs to be differentiated from parathyroid adenoma. Hypercellularity with cellular atypia should not lead to misdiagnosis of malignancy.

Immunohistochemistry of thyroid carcinoma--an experience with thyroglobulin and calcitonin.

A retrospective immunohistochemical study of 33 cases of primary thyroid carcinomas and 5 cases of metastases to thyroid was carried out. The immunostaining for thyroglobulin and calcitonin was done by peroxidase-anti-peroxidase (PAP) technique. The optimum staining results were obtained by proper standardisation of the staining procedure and reagents. The sections were systematically evaluated for immunostaining intensity and distribution. The observations revealed that thyroglobulin and calcitonin could be useful as sensitive and specific histogenetic markers for follicular and parafollicular cell derived thyroid carcinomas respectively. However, there was no absolute correlation between thyroglobulin positivity and grade of differentiation. The immunostaining could not differentiate follicular adenoma from follicular carcinoma. More extensive study using other markers may be useful for better patient management.

Plasmodium falciparum malaria--a diagnostic dilemma.

A retrospective analysis of fifty cases where falciparum malaria was detected at autopsy, was done. Histopathological sections from all organs were taken. Cerebral malaria was seen in 44 cases on histology. Plugging of cerebral vasculature by parasitised erythrocytes (pRBC) was seen in all cases while Durck granulomas were seen in 5 cases. Multiple organ involvement was seen in form of sequestration of pRBC in all the cases. Positive peripheral smear was obtained in only 20 cases (antemortem). Twenty-nine patients had jaundice of which 18 had altered sensorium. They were clinically diagnosed as hepatic failure with or without hepatic encephalopathy. Fever as a symptom was seen in 19 patients. Age varied from 14 years to 80 years. Twenty-three patients died within 12 hours of admission, 12 other patients expired within a day. Only two cases survived more than a week. Specific antimalarial therapy was administered to 29 patients of which only 11 cases received quinine.

Renal amyloidosis--a clinicopathologic study.

A total of 19,075 necropsies and 1169 renal biopsies were scrutinised over a period of 20 years (1973-1992) retrospectively with an aim to study the incidence and pattern of renal amyloidosis in Nair Hospital. A total of 75 cases with amyloidosis were detected, 33 from the necropsy series (0.162%) and 42 from biopsies (3.59%). Secondary amyloidosis was seen in 82.66% and primary amyloidosis in 10.66%. Tuberculosis of various organs was the main cause of secondary amyloidosis (79.03%). Nephrotic syndrome was the common mode of presentation (52%). Besides kidney, which were involved in all cases, the liver, spleen and adrenals were other commonly involved organs at necropsy. Renal failure was the leading cause of death (51.51%). Thioflavine-T proved to be more sensitive technique than other conventional staining methods. The potassium permanganate test is a useful test to distinguish secondary amyloid fibrils from other amyloid fibrils. Abdominal fat aspiration may prove to be specific, sensitive and a routine procedure enabling the early diagnosis of amyloidosis leading to increased incidence of amyloidosis during life than at necropsy.

Gastric carcinoma presenting as solitary cutaneous metastasis.

We report a patient with gastric adenocarcinoma presenting with a cauliflower-like large papillomatous cutaneous metastases on the nape of the neck.

Cytohistomorphology of prostatic lesions--by FNAC & scrape methods.

A pilot study of transrectal fine needle aspiration biopsy was conducted in 44 patients, above the age of 50 years, who presented with features of obstructive uropathy during a one year period between August 1990 and April 1991. Histopathological study was carried out in 23 out of 44 patients, who underwent total prostatectomy or transurethral resection following the aspiration biopsy procedure. In 21 patients FNAB by the transrectal route could not be obtained because of technical difficulties; therefore intraoperative scrape cytology was studied prior to histopathology, of the fresh prostatic specimen. A good cytohistopathological correlation was obtained by both methods; an accuracy of 95.6% and 95.2% with FNAC and scrape respectively. A wide range of benign and malignant lesions were studied.

Experience with bone marrow trephine biopsy.

One hundred and ten bone marrow trephine biopsies were studied from January 1987 to July 1989, using Zenker's acetic acid as fixative and routine paraffin embedding. Trephine biopsies were useful in differential diagnosis of cytopenias, especially when bone marrow aspiration was hypocellular or a dry tap, and in staging of lymphomas and multiple myeloma.

Eosinophilic granuloma of stomach.

A case of eosinophilic granuloma presenting as a large benign gastric ulcer is reported. On operation table, the lesion was interpreted as malignant.