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Introduction: Diagnosis of inflammatory bowel disease (IBD) and other inflammatory conditions of the colon cannot beestablished when only one or few features are present as they share many pathological features. Hence, this study is undertakento develop reproducible criteria which are valid in the diagnosis of IBD and to differentiate it further from ulcerative colitis (UC)and Crohn’s disease (CD).Purpose: The purpose of the study was (1) to study the histopathological patterns of the colonic biopsy specimen, (2) to developthe reproducible criteria which aid in the diagnosis of UC and CD, and (3) to evaluate the extent of interobserver variabilityover the final diagnosis.Materials and Methods: Endoscopic punch biopsy procedure was done for 35 cases with suspected IBD which were sent tothe Histopathology Department of Bengaluru Medical College. Tissue bits were fixed in 10% formalin and processed by theconventional method and embedded in paraffin blocks. Sections from these blocks were stained with hematoxylin and eosinaccording to standard procedures. After initial histomorphological reporting was done, the 35 slides were reported again by twopathologists. Cases with proven malignancy were excluded from the study.Results: UC was diagnosed in 19 cases (53%) of 35 cases followed by indefinite for IBD in nine cases (25%). CD was seenin five cases (14%) followed by tuberculosis in two cases (5%). One case had evidence of dysplasia along with features ofUC. The agreement between pathologists for the final diagnosis is 68.5%. Based on P value, the significant features whichare most useful in the diagnosis of UC are: For activity – (1) cryptitis, (2) neutrophilic infiltration in lamina propria, and (3) cryptabscess; for chronicity – (1) crypt distortion, (2) crypt branching, (3) Mucin depletion, (4) crypt atrophy, and (5) crypt dilation.Conclusion: UC was found to be more commonly reported among the IBD cases. Considerable disagreement can be seenbetween experienced pathologists reporting the same slides. Therefore, salient histological features based on better reproducibilityalong with adequate clinical and endoscopy findings can aid in distinguishing between UC and CD.
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Atypical, bizarre, symplasmic (symplastic), or pleomorphic leiomyoma contains bizarre tumor cells with variation in size and shape, hyperchromatic nuclei, giant cells and occasional multinucleated giant cells but no coagulative necrosis or increased mitotic activity. Mitotic counts higher than 10/10hpf in such a tumor indicates a high malignant potential smooth muscle tumor (leiomyosarcoma). Bizarre leiomyoma closely mimics leiomyosarcoma. We report a case of 31 years old, nulliparous woman who presented with a history of infertility. On examination she was found to have uterine fibroid of 28 weeks size over a period of 5 years. She was diagnosed to have fibrobid clinically and on ultrasonographic examination. Hence, a myomectomy was performed. Histomorphological features are of atypical (Symplastic) leiomyoma which closely mimics leiomyosarcoma and immunohistochemical markers are certainly of help to exclude malignancy in case of dilemma.
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The occurrence of acquired conjunctival inclusion cysts following various ophthalmic surgeries such as strabismus surgery, scleral buckling, pars plana vitrectomy, ptosis surgery and phacoemulsification has been reported. We report two cases of conjunctival inclusion cysts following manual Small Incision Cataract Surgery (SICS) in two male patients aged 65 and 67 years. The cysts originated from the scleral tunnel used for manual SICS. Both were treated by excision and confirmed histopathologically. No recurrence was noted at three months follow-up. To our knowledge, conjunctival inclusion cysts following SICS have not been reported previously. Careful reflection of conjunctiva during tunnel construction and posterior chamber intraocular lens implantation may prevent their occurrence.