Renal biopsy - indication and its implications in management of children admitted at a tertiary care hospital, Mangalore

Background: Percutaneous renal biopsy is an established diagnostic tool for identification of renal pathology required for diagnosis, treatment, and prognostication. The present study was conducted to know the common indications and histopathological findings of renal biopsy, impact of biopsy report on treatment, and complications of procedure.Methods: This was a retrospective observational study conducted in the paediatric ward of a tertiary care level hospital. Indications of renal biopsy as suggested by medical records were noted down. Any treatment changes happened after final histopathological report were recorded. Statistical analysis was made using statistical package for the social sciences (SPSS) version 20.0 (IBM, NY).Results: The mean age of patients at which biopsy was done was 9.83±5.31 years. Most common indications of renal biopsy were nephritic onset nephrotic syndrome (34.8%), steroid-resistant nephrotic syndrome (21.7%), steroid-dependent nephrotic syndrome requiring calcineurin inhibitors (CNI) (17.4%), lupus nephritis (8.7%), nephrotic syndrome with later age of onset (8.7%), acute kidney injury (AKI) stage 3 (4.3%) and for evidence of calcineurin inhibitor toxicity (4.3%). Focal segmental glomerulosclerosis (26.1%), minimal change disease (21.7%) and membranoproliferative glomerulonephrosis (17.4%) were the most common histopathological findings.Conclusions: This study reiterates the fact that renal biopsy is one of the decisive and diagnostic procedures and has good prognostic value in further management of medical renal disease.

A guise of osteosarcoma: Chondroblastoma-like.

Osteosarcoma (OS) is a rare tumor arising from immature bone forming cells or through neoplastic differentiation of other immature mesenchymal cells into osteoblasts. Chondroblastoma-like OS is one of the rare forms of OS to be seen in jaw bones. Aggressive clinical behavior, osteolytic areas in the radiograph and histological presentation of chondroblastoma such as cells with grooved nuclei, typical chicken-wire calcification along with areas of tumor osteoid, implied the diagnosis as chondroblastoma-like OS. Use of reticulin stain further confirmed the diagnosis. A case of chondroblastoma-like OS is reported, emphasizing the importance of early diagnosis of aggressive jaw lesions with the help of routine radiography, histopathology, and special stains.

Immunohistochemical phospho tensin tumor suppressor gene staining patterns in endometrial hyperplasias: A 2-year study.

Background: Endometrial carcinoma is a common neoplasm associated with the female genital tract with considerable morbidity.Eendometrial hyperplasias have been widely regarded as precursor lesions. It is of importance to the pathologist to identify the subset of hyperplasias or the associated factor which could be a possible forerunner of malignancy. Phospho tensin gene (PTEN) has gained importance as one of the factors responsible. Aim: To determine the variability in PTEN expression patterns in different types of endometrial hyperplasias. Settings and Design: The study was undertaken on samples received at the Department of Pathology from 2005 to 2007. Materials and Methods: One hundred samples with 76 showing hyperplasias of different types formed the core "study group" with simple hyperplasia without atypia predominating. The rest belonged to the control groups. PTEN intensity and percentage positivity, variability in patterns of glandular and stromal expression, the number and type of PTEN null glands in different types of hyperplasia were evaluated. Statistical analyses used were Fisher's exact test based on Monte Carlo test and chi-square test. Results: Complex hyperplasia was associated with a reduction in number of strongly PTEN positive glands, with an increase in null glands, seen in clusters. Co-existing atypia was associated with the weakest staining and in fewer glands. Conclusions: PTEN expression in endometrial hyperplasias can be used as an early warning of heightened cancer risk and a potential target for preventive treatment. However, extensive research is needed along this line to conclusively establish its effectiveness.

Polymorphic fibro-osseous lesion of the bone: a case report with review of literature.

A polymorphic fibro-osseous lesion of the bone is a benign fibro-osseous lesion of the bone with a marked predilection for the proximal femur and characterized by a complex mixture of histological elements. We present one such case of a 35-year-old female with spontaneous onset of pain in the left hip for 3 months and trauma sustained a year ago. An examination revealed tenderness with painful movements over the anterior aspect of the left hip joint and trochanter. A clinico-radiological differential diagnosis of simple bone cyst or fibrous dysplasia was entertained. A microscopic examination of the lesion with clinico-radiologic correlation led to the diagnosis of a polymorphic fibro-osseous lesion. This is a genuine clinico-pathologic entity that is usually asymptomatic with a rare history of trauma or hip pain. It has a distinctive histopathological picture with a better prognosis than its mimics.

Periductal stromal sarcoma of breast with lipoblast-like cells: a case report with review of literature.

The specialized mesenchyme of the breast is the seat of neoplasms with distinct morphology, though with considerable overlap due to the ever increasing number of variants. This article seeks to describe the morphologic features of one such rare neoplasm. A 35-year-old female patient presented with a breast lump that was subsequently excised. Morphological assessment and immunohistochemistry were performed and a diagnosis of periductal stromal sarcoma with lipoblast-like cells (pseudolipoblasts), was made. Being an unusual finding in a rare entity of intermediate grade, it has to be considered, before rendering a diagnosis of a malignant, higher-grade neoplasm.

Multiple myeloma with amyloidosis presenting with recurrent gastrointestinal bleeding.

We report a 45-year-old woman who presented with hematemesis. Endoscopy showed nodular lesions and ulcers in the gastric antrum; histology of the lesions showed amyloidosis. The patient had received melphalan and prednisolone for multiple myeloma 5 years earlier.