Quality control in the histopathology laboratory: an overview with stress on the need for a structured national external quality assessment scheme.

The concept of quality control in histopathology is relatively young and less well understood. Like in other disciplines of laboratory medicine, the concept of quality and its control is applicable to pre analytical, analytical and post analytical activities. Assessment of both precision and accuracy performances is possible by appropriate internal and external quality control and assessment schemes. This article is a review of all processes that achieve quality reporting in histopathology. There is a special focus on external quality assessment - a scheme that lacks organization on a national level in our country. Statistical data derived from a small scale external quality assurance program is also analyzed along with recommendations to organize an effective national scheme with the participation of authorized zonal centers.

Telepathology in India.

Telepathology is the most recent addition to the pathologist's diagnostic tools. It is the acquisition of macroscopic and microscopic images for electronic transmission for diagnosis, consultation and/or education. With the addition of the personal computer at the pathologist's desktop, the stage has been set for one of the greatest advantages the Internet has to offer. Telepathology in India is in infancy, and we at PathoIndia (www.Pathoindia.com) have started a series of publication images from interesting cases in the form of weekly quiz. After cases are published, hundreds of pathologists from around the world are invited by e-mail to send in their diagnosis and comments. The responses to this quiz suggest that telepathology is catching on in the pathology community. Another intention of this series is to identify and select qualified international and Indian pathologists who would be willing to help colleagues from India requesting second opinions online.

Tumours and tumour-like conditions of the para-testicular region--a study of morphological features.

Twenty two patients with tumours or tumour-like conditions of the para-testicular region (PTR) were diagnosed over a 5 year period. Of these, 16 (73%) were benign with only one true neoplasm (papillary cystadenoma). The tumour-like conditions were comprised of 6 cases of adenomatous hyperplasia of epididymis, 4 cases of spermatic granuloma, 2 cases each of spermatocele and nodular-fibrous proliferation and one mesothelial cyst. Three patients with spermatic granuloma gave a history of trauma. No case of adenomatoid tumour was encountered. Six malignant neoplasms were diagnosed (27%) all of which were sarcomas. Five were primary to the PTR and one was a metastatic deposit from a primary leiomyoblastoma of the mesentery. Among the 5 primary sarcomas were 2 cases each of rhabdomyosarcoma and leiomyosarcoma, and 1 case of liposarcoma. The patient with leiomyoblastoma presented first with a measenteric mass which was followed a month later by a rapidly growing mass in the scrotum. Immunohistochemical staining (IHC) and Electron microscopy (EM) were done in this case. Intra-cytoplasmic myofilaments as well as desmosomes were observed. The patients ranged from 14 to 65 years of age and most presented with painless mass in the scrotum. Follow-up was not possible due to practical difficulties.

Langerhans cell histocytosis--a clinicopathological spectrum.

Langerhans cell Histiocytosis--a lesion characterised by proliferation of a variant of epidermal dendritic cell is one of the several syndromes in which histiocytes play a principal role in pathogenesis outside the context of inflammatory and metabolic storage disease. Seven cases were diagnosed as Langerhans cell Histiocytosis over a period of six years. The mode of diagnosis was Fine needle aspiration in 2 cases, open biopsy in four, and both biopsy and FNAC in one. The age range was from 2 months to 58 years and four of the seven patients were males. The lesion was unifocal in 3 cases (two in bone and one involving skin and soft tissue), multifocal in 3 and systemic in one. Electron microscopy was done in one case to demonstrate Birbeck granules. Immunohistochemical demonstration of S 100 protein was done in one case. The clinicopathologic spectrum of Langerhans cell Histiocytosis is brought out in this presentation of seven cases.

Persistent müllerian duct syndrome. A report of two cases.

Two cases of persistence of Müllerian duct structures in phenotypic male patients are reported. One of these was aged 16 years and the other 10 months. Both patients had cryptorchidism and inguinal hernia for which they were operated upon. In both patients parts of uterus and fallopian tubes were identified in the hernial sac. Endocrine evaluation was normal. Karyotyping was performed in the second case which revealed a normal male genotype of 46 XY.

Angiolymphoid hyperplasia with eosinophilia (Kimura's disease).

Angiolymphoid hyperplasia with eosinophilia (AHE) is a rare disease entity which usually presents as subcutaneous nodules, sometimes simulating lymphadenopathy or even angiosarcoma. We present here the histopathological aspects of a case which manifested as a subcutaneous forehead nodule, along with the relevant review of literature concerning this rare entity.

Urine culture sensitivity pattern in a private laboratory setup.

During a two year study period, 6163 samples of urine among a total of 10366 miscellaneous samples received for culture, were analysed. Of these 1488 samples (24.15%) showed evidence of infection. In our study, E. Coli was found most frequently (61.40%) followed by Klebsiella (17.1%). The pattern of antibiotic sensitivity was analysed. Ciprofloxacin and Norfloxacin proved to be the most promising among the new generation of antibiotics. Results with Cloxacillin, Colistin and Lincomycin were found to be disappointing. The study serves to analyse the pattern of urinary infection in our setup and also dwells upon the emergence of strains resistant to even the newer antibiotics.

Auto-antibody profile in systemic lupus erythematosus.

Thirty cases of systemic lupus erythematosus (SLE) were selected on the basis of revised ARA criteria (American Rheumatology Association) and their sera examined for the presence of various auto-antibodies. The male to female ratio was 1:5 and joint manifestations were the commonest mode of presentation. The frequency of various manifestations was found to differ between the two sexes. Renal lesions were observed in 9 (nine) cases. ANF was detected in 28 of the 30 cases and the diffuse pattern was the commonest (11 cases) (37.7%). Six cases had very high titres (a titre of more than 1:1280) of antinuclear factor. Antibodies to DNA were detected in 9 cases (30%). These patients tended to have more severe disease, with high titres of ANF and low complement levels. Presence of antibodies to DNA, however, could not be correlated with the severity of renal lesions. Anti Sm antibody was found in 8 cases (26.7%), anti nRNP antibody in 19 cases (63.3%) and antihistone antibodies in 22 cases (73.3%). Patients harbouring any of these three antibodies tended to have a milder clinical disease.

Fine needle aspiration cytology of intrathoracic lesions--a repraisal.

FNAC was performed in 186 cases. Inadequate material was obtained in 41 cases. A definite diagnosis of malignancy could be made in 120 cases. In five cases a diagnosis "suspicious" of malignancy could be made. No serious complication was encountered with the technique. FNAC is of definite help in diagnosing the intra thoracic lesion whether malignant or inflammatory in nature. It also avoids unnecessary thoracotomy for diagnostic purposes.