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.

The Effects of Passive Smoking on the Placental Barrier: A Light Microscopic Study.

Passive exposure to tobacco smoke causes ultrastructural changes in placental vasculature. It was endeavoured to observe under the light microscope, the endothelial cells of the capillaries and to look for microscopic changes in the vasculosyncytial membranes in the terminal villi of placentae of passive smokers exposed largely to bidi smoke. To study effect of passive smoking on placental vasculature a total of 150 placentae were selected from healthy full term gravidas with no history of tobacco use. They were divided into two group viz; passive smokers (n=87) and non passive smokerscontrol (n=63). Three micron thick sections were cut, stained and examined under light microscope. The study revealed that endothelial cells of stromal capillaries of the placental villi were oedematous resulting in irregular capillary lumina (p=0.0007) and vasculosyncytial membrane was significantly absent in terminal villi of passive smokers in comparison to control (p=0.0000).

Ovarian Fibrothecoma with Extensive Cystic Degeneration: Two Case Reports.

Two females aged 70 years and 45 years presented in OPD of Dept. of Gynecology with large abdominal lump and ascites. In both cases, clinical and radiological diagnosis of malignant ovarian tumor was made. Ascitic fluid cytology revealed absence of malignant cells. Panhysterectomy was performed. On histopathological examination, both cases were diagnosed as benign fibrothecoma with extensive cystic change. Postoperative follow-up for about six months was uneventful and both patients recovered completely.

Study of Placenta in HELLP Syndrome Patient: A Case Report.

HELLP syndrome is a multi systemic disorder that complicates pregnancy and has a poor prognosis. HELLP syndrome is frequently associated with severe pre-eclampsia or eclampsia but can also be diagnosed in the absence of these disorders .We report a case of 20 year old married pregnant female who was diagnosed as a patient of HELLP syndrome.

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.