CLINICO – HISTOPATHOLOGICAL SPECTRUM OF CUTANEOUS VASCULITIS: A RETROSPECTIVE STUDY OF 62 CASES

Context: Cutaneous Vasculitis is the inflammation of vessel walls which leads to hemorrhagic or ischemic events. The histopathological classification of cutaneous vasculitis depends on the vessel size and the dominant immune cell mediating the inflammation. Object: We studied the etiological factors and clinico-pathological spectrum of patients with cutaneous vasculitis at a tertiary referral centre of north India. Design: Skin biopsies of all patients with clinically suspected cutaneous vasculitis presenting over 5 years, between 2009-2014 were reviewed. Cutaneous vasculitis was classified on the basis of etiology (primary or secondary), on the basis of size of vessel wall as well as on the dominant inflammatory cell infiltrating the vessels. Results: Over 5 years, 62 / 103 patients evaluated for vasculitic syndromes had histologically proven vasculitis. Clinically, vasculitis was primary (77.4%) or secondary (22.5%) to drugs, infections, underlying connective tissue diseases and malignancy. Neutrophilic (n=30), lymphocytic (n=18), eosinophilic (n=10), and granulomatous (n=4) vasculitis were the major histopathological groups. Small vessel involvement was seen in 97% cases. Conclusion: Skin biopsy remains the gold standard for diagnosing cutaneous vasculitis. Small vessel vasculitis was the most common type of cutaneous vasculitis with the dominant cell type being neutrophilic. Eosinophilic infiltrate was exclusively associated with primary vasculitis.

Osteolytic lesions of hand and feet: a seven-year experience from a tertiary referral centre of North India

There are 106 bones in hands and feet but their lesions are not commonly reported. This was a retrospective study of all osteolytic lesions involving bones of the hands or feet presenting to the only tertiary referral centre of the north Indian state of Uttarakhand during the 7-year period from January 2006 to December 2012. A compilation of the various demographic, clinical, radiological and histopathological findings was made. Of the 52 lesions encountered in the 7-year record, 75% were asymptomatic. 20 (38.4%) were benign tumours, 20 (38.4%) tumour-like lesions, 9 (17.3%) inflammatory and post traumatic lesions and only 3 (5.7%) were malignant lesions. Giant cell tumour was the most common benign tumour, aneurysmal bone cyst the most common tumour-like lesion and non-specific osteomyelitis was the most common inflammatory and post-traumatic pathology. All phalangeal lesions were non-malignant and 62% were either giant cell tumours or giant cell reactions. Giant cell reaction was confined to upper limb bones; metatarsals were afflicted exclusively with giant cell tumours (n=3) while malignant lesions affected the metacarpals in two and carpal bones in one instance. Aneurysmal bone cysts were seen exclusively in the tarsal (n=4) and carpal bones (n=2), a very rare finding. More cases need to be studied to define patterns of lesions of hands and feet. The definitive diagnosis is essential as many patients with osteolytic lesions may not require surgical intervention.

Lesions of Tongue : A Five Year Experience.

Context: Tongue lesions are quite common and affect both genders and all age groups. However, very few studies concentrate on the histopathological spectrum of tongue lesions, usually including them as a part of oral cavity lesions. No such study has been published from the newly formed state of Uttarakhand. Aim: A retrospective review of histopathology of various types of tongue lesions in different age groups of both genders, amongst cases reported in the department of pathology. Methods and Materials: Study included a total of 121 cases of tongue lesions reported in the histopathology section over a duration of five years, from July 2004 to June 2009. Result: In this study, the most common lesions were malignant (58.7%), followed by benign lesions (33%) and pre-malignant lesions (8.3%). The most common site for tongue lesions was base of tongue (52.8%). Common age groups affected were 41- 50 years (27.2%) and 51-60 years (28.0%). The most common clinical presentation was growth and induration. Overall males were affected more than females; with Male:Female ratio of 3.3:1. Conclusions: The commonest tongue lesion in this study was moderately differentiated squamous cell carcinoma among the malignant lesions whereas chronic inflammation was the commonest out of non-malignant lesions. Tongue may show some less common tumours like schwannoma and hemangioma etc.

Cytohistopathological Correlation in Palpable Breast Lesions.

The objective was to study the correlation between cytological and histopathological features and to find out the sensitivity and specificity of Fine Needle Aspiration Cytology (FNAC) in the diagnosis of breast lesions. Two hundred patients were studied; 150 were retrospective and 50 were prospective cases. Only those patients who had FNAC followed by histopathological examination were included. Useful cytological parameters for diagnosis of malignancy were loss of cell cohesion, cell size, nuclear crowding and overlapping, nuclear size, type of chromatin, absence of bipolar naked nuclei and infiltration of stroma. In present study complete sensitivity was 96.2%, absolute sensitivity was 86.7%, predictive value was 100%, false negative were 1.9%. No false positive smear was seen. We concluded that a definitive diagnosis of malignancy by FNAC could be safely used for definitive treatment but the same was not true for non-malignant, suspicious or atypical smears. In these situations surgical biopsy was considered to be essential for definitive diagnosis.

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.