Improved sensitivity of direct microscopy for Mycobacterium tuberculosis in lymph nodes: comparison of fluorescent microscopy and modified bleach method ZN microscopy along with conventional ZN staining method

Background: Extra pulmonary tuberculosis arises as a result of lymphatic spread from a primary focus. Fine needle aspiration cytology has assumed an important role in the evaluation of peripheral lymphadenopathy as a possible minimally invasive alternative to excisional biopsy. In most low-income countries; the only practically available bacteriologic method for diagnosing EPTB is direct smear microscopy for acid fast bacilli from the sample of the lesion. There are various methods of staining and concentration for improving sensitivity of direct microscopy for detection of tubercle bacilli in specimen.Methods: This prospective study was carried out in the Department of Pathology, Subharti Medical College and associated Chattrapati Shivaji Subharti Hospital, Meerut for a period of 2 years from July 2016 - August 2018 in 151 patients with clinical suspicion of TB and significant lymphadenopathy.Results: AFB positivity increased from 40.39% on conventional ZN stain to 48.34% on modified bleach method ZN stain and to 56.29% on Auramine-O fluorescent stain. Taking fluorescent microscopy (Auramine-O) as reference method the sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of conventional ZN stain and modified bleach method ZN stain were calculated as 71.8%, 100%, 100%, 73.33%, 84.10% and 85.33%,100%,100% ,84.61% ,92.05%, respectively.Conclusions: The addition of fluorescent microscopy (Auramine-O) and modified bleach method ZN microscopy along with conventional ZN staining method would be an important adjunct to improve the microscopic detection of Mycobacterium tuberculosis in fine-needle aspirates of lymph nodes.

Non Gestational Cervical Choriocarcinoma With Urinary Bladder Metastases: An Unusual Case Report.

Primary cervical choriocarcinoma in a woman of child-bearing age with local infiltration into the urinary bladder wall in a 32 year old woman admitted to our hospital with haematuria and vaginal bleeding since 3 months. Ultrasound examination revealed echogenic mass in urinary bladder lumen. Cystectomy with hysterectomy was done. Postoperative pathological examination of surgical specimen showed that case was of primary choriocarcinoma of cervix with local infiltration into the urinary bladder wall.

Dedifferentiated chondrosarcoma of humerus - a case report.

Dedifferentiated chondrosarcoma is a rare and most malignant form of chondrosarcoma, accounting for approximately 11 % of all chondrosarcomas. It generally occurs in older patients having slight male predilection. However, patient in the present case was comparatively younger female with tumour mass in Humerus . The prognosis of dedifferentiated chondrosarcoma is poor. Distant metastasis especially in lungs is often seen. This case is reported here because of its rarity, its association with worse prognosis and absence of pulmonary metastasis, however, subcutaneous nodules were seen at local site.

Histopathological changes in gastric mucosa colonized by H. pylori.

Helicobacter pylori (H. pylori), infection has been linked to acute and chronic gastritis, non-ulcer-dyspepsia, peptic ulcer, gastric adenocarcinoma and gastric non-Hodgkin's lymphoma of mucosa-associated lymphoid tissue (MALT). The epithelial changes in H. pylori colonized gastric mucosa are easy to recognize in routine Haematoxylin & Eosin stained sections and are so distinctive that they can serve as a helpful histological indicator for the presence of H. pylori in gastric biopsies. The histopathology of seventy-five gastric biopsies showing colonization by H. pylori was studied. Histologically, the H. pylori colonized gastric epithelium showed characteristic changes that were topographically related to the bacteria. These changes included irregular surface, epithelial pits, individual cell dropout and microerosion, which were specific for H. pylori colonization. These were absent in areas not colonized by H. pylori and in 20 consecutive H. pylori negative gastric biopsies seen during the same study period. As specific treatment for H. pylori infection is available, identification of H. pylori colonization in gastric biopsies should be attempted in all cases of gastritis, peptic ulcers and non-ulcer-dyspepsia.

Pattern of cancers amongst patients attending Himalayan Institute of Medical Sciences, Dehradun.

This hospital-based study seeks to find out the most common cancers amongst the patients attending Himalayan Institute of Medical Sciences (HIMS), Dehradun, situated in Uttaranchal, which has inadequate health care facilities and low socio-economical status. In our study, of the 20,247 cases reported in the pathology department from July 1996 to Dec. 2003, 18.57% cases were malignant. Male to female ratio was 1.7:1.Top five cancers in males were those of lung, larynx, non-Hodgkins lymphoma, oesophagus & stomach. Top five cancers in females were those of breast, cervix, gall bladder, ovary & oesophagus. Tobacco and alcohol related cancers predominated in males. Skin and soft tissue cancers and were also common amongst both genders. Patients mostly reported with cancers in advanced stages, which could be attributed to poor medical facilities and health awareness in this region.

Intrapleural streptokinase in multiloculated malignant pleural effusion.

Intrapleural administration of fibrinolytic agents has been shown to be effective and safe in the treatment of loculated parapneumonic effusions. Its use in multiloculated malignant pleural effusions has been rarely reported. We report a case of malignant multiloculated pleural effusion who failed to respond to standard chest tube drainage but showed dramatic and complete resolution with intrapleural streptokinase.

Post-Kala-Azar-dermal-leishmaniasis: an unusual presentation from Uttarachal (a non-endemic hilly region of India).

A 26-year-old male resident of Uttaranchal had a single large, erythematous, indurated verrucous plaque on chin of 1 year duration. He had suffered from visceral leishmaniasis 4-years back for which he was treated with injection sodium antimony gluconate (SAG) i.m. OD for 20 days. He had never been to regions endemic for kala-czar (KA) or post-kala-azar-dermal leishmaniasis (PKDL). Skin biopsy showed chronic granulomatous inflammation in the dermis. Giemsa stain revealed LD bodies inside the macrophages. The patient was treated successfully with injection SAG 20 mg/kg parenterally for 60 days. To the best of our knowledge, this is probably the first case of PKDL from the hills of Uttaranchal.