Papillary Microcarcinoma of Thyroid- A Clinicopathological Study in a Tertiary Care Hospital in South India

The incidence of papillary carcinoma of thyroid has shown an increase in the last few decades. One contributing factor is the identification of Papillary Microcarcinoma of thyroid. Papillary Microcarcinoma is defined as a papillary carcinoma which is ≤ 10 mm in size in the greatest dimension. Though it is associated with excellent prognosis, controversies still exist regarding the treatment and follow up of these patients.METHODSThis study is a retrospective study done in a tertiary care hospital in South India over a period of one year from July 2016 to June 2017. All surgically removed thyroid specimens submitted to the Pathology Department of the hospital were studied. The demographic details, clinical features, ultrasound and other imaging studies were obtained from the medical records. The FNAC findings, gross features of surgically removed thyroid and histopathological findings of these thyroid specimens were recorded and analysed. The records of the follow up of these patients were obtained from the corresponding clinical department.RESULTSAmong the 486 thyroid samples received, 59 (12.13%) were malignant tumours of the thyroid, out of which Papillary carcinoma was seen in 50 cases (84.7%) including 11 cases of Papillary Microcarcinoma constituting 18.6% of all thyroid malignancies and 2.26% of thyroidectomies during the study period. Mean age of patients with PMC was 43.9 with a female: male ratio of 10:1. 10 cases were incidental PMC, while one was suspected to be papillary carcinoma on ultrasound examination and FNAC. Only one patient showed high risk features of multifocality, extrathyroidal extension and lymph node metastases. Hence she was given RAI. All patients were followed up. No recurrence has been noted in the two year period of follow up.CONCLUSIONSPapillary Microcarcinoma is being increasingly diagnosed, most of them being incidental. Hence thorough histopathological examination is mandatory to identify these lesions. Though PMC has an excellent prognosis, aggressive treatment may be required in patients with high risk features including nonincidental, lymph node metastasis, multifocality, and extra-thyroid extension.

Utility of Anti-Helicobacter pylori IgG Estimation in the Diagnosis of Acid Peptic Diseases: A Comparison of Serum IgG Level with Rapid Urease Test

Introduction: The mode of treatment of APD is changedradically ever since the role of H.pylori is proved for thiscondition. The study was aimed to detect the utility of antiH.pylori IgG estimation in the diagnosis of acid pepticdiseases.Material and methods: Endoscopic examination of stomachfollowed by Rapid Urease Test on the biopsy material andthe anti-Helicobacter pylori IgG quantitative estimation weredone in 85 patients with history suggestive of acid pepticdisease.Results: 46 (100%) patients with gastritis showed positiveRapid Urease Test within 30 minutes and had serum IgG >30IU/ml. 10 patients with peptic ulcer, 12 patients with non ulcerdyspepsia and 2 patients with carcinoma stomach gave positiveRapid Urease Test after 30minutes and serum IgG level was< 30 IU/ml for these patients. Of the 70 Rapid Urease Testpositive in the study, 2 of the 12 non ulcer dyspepsia patientswere negative for antibody. Endoscopy findings in 15 subjectswere normal and negative for Rapid Urease Test and antiHelicobacter pylori IgG antibody.Conclusion: Estimation of Serum anti-Helicobacter pyloriIgG may be useful as a non invasive method in the diagnosisof gastritis.

Medical problems in children with Down syndrome

Background: Down syndrome (DS) is a major cause of mental retardation of prenatal origin and has several associated co-morbidities involving cardiovascular system, respiratory, endocrine system, hematological, gastrointestinal, musculoskeletal, eye and ear defects, immunological changes and neurological system. This study was conducted to identify the common medical problems in children with Down syndrome and the morbidity associated with these conditions. The objective of the present study was to find out the occurrence of different medical problems in children with DS.Methods: 42 children with a phenotype of Down syndrome in the age group of 0-12 years attending the outpatient, inpatient and Down syndrome Clinic of the Institute of Child Health, Kottayam during the study period were included in the study by purposive sampling. Demographic details were entered, and Pediatric Clinical Examination was performed by the investigator himself to identify the medical problems. Old medical reports were reviewed, and data entered into a proforma and statistically analysed.Results: Out of the 42 children with DS, 22 were males. 15 (35.7%) were less than 1 year, 20 (48.3%) children 1-5 years and 7 (16.1%) children 5-12 years of age. Mean age of the study group was 1.78±0.51 years. Mean age of their mothers at the time of conception was 30.6±5.8 years. 26 (57%) children with Down syndrome had a medical problem during the neonatal period which required hospitalization. Almost all systems are affected and craniofacial features, developmental delay and hypotonia were universal. Various forms of congenital heart diseases were observed in 67% and hypothyroidism in 23.8%.Conclusions: Down syndrome is a common genetic disorder with multisystem involvement. Congenital heart diseases, hypothyroidism and recurrent respiratory infections were the common medical problems identified in this study.