Prognostic factors in infiltrating lobular carcinoma.

Various prognostic factors viz. clinical details, histologic features including subtypes, elastosis, desmoplasia, in situ carcinoma, perineural and vascular invasion, Nottingham Prognostic Index (NPI), and menopausal status were evaluated in Infiltrating Lobular carcinoma (ILC) in the context of patient survival. 138 patients had presented with ILC over a period of 20 years. Histological subtypes of ILC and vascular invasion played a role in the biologic behaviour of the tumour. Interestingly premenopausal status protected against the risk for relapse, while being postmenopausal, increased the risk. NPI was demonstrated as an independent significant prognostic factor and was a good predictor for relapse. This study underlines the role of the pathologist in determination of the prognostic groups in Infiltrating lobular carcinoma.

Histologic spectrum of struma ovarii.

Six cases of struma ovarii, including two with associated carcinoid, with unusual microscopic features are described. The patients' age ranged from 22 to 50 years. The patients were clinically euthyroid. The largest tumour was 10 cms. in great dimension. All tumours were unilateral. Microscopically various changes observed in a non-neoplastic thyroid gland were observed in the struma including Hashimotos thyroiditis and goitrous change. Adenomatous foci with microfollicles were observed in one case. A trabecular carcinoid admixed with mucinous glands lined bygoblet cells which were argyrophilic was seen in two of the neoplasms. This finding is rare and has been reported only once before. In conclusion it is important for a pathologist to be aware of the changes that may be associated with struma ovarii, so as not to confuse it with other neoplasms. A careful search for typical thyroid follicles, or other components of a dermoid help to arrive at a diagnosis.

Hepatic mesothelioma.

We report a 70-year-old woman with mesothelioma in the liver. The tumor was excised, and the patient is well two years later. Light microscopy of the tumor showed papillary and tubular pattern, in addition to areas of densely packed cells arranged in fascicles. These features and the results of histochemistry and immunohistochemistry indicate a probable histogenesis from submesothelial connective tissue.

Tuberculous lymphadenitis in children--role of fine needle aspiation cytology.

OBJECTIVES: Tuberculosis in children remains misdiagnosed, underdiagnosed or paradoxically overtreated as a result of diagnostic difficulties and non-specific manifestations such as lymphadenopathy. The aims of the study were, i) To assess the efficiency of fine needle aspiration cytology (FNAC) in comparison to histology to determine the prevalence of tuberculosis in lymph nodes, ii) To compare the cytological and histopathological features of lymphadenopathy in children to adults, iii) To analyse the clinical significance of the results in the context of diagnosis. MATERIAL AND METHODS: The biopsies of lymph nodes obtained during the seven year period from January 1989 to December 1995 and the lymph nodes on which fine needle aspiration cytology was done during the period, January 1990 to December 1995 were included for the study. Hemotoxylin and Eosin stain was used for basic evaluation of the histopathologic features. A grading system of 0 to 5+ was used to assess the smears to categorise them into diagnostic groups. RESULTS: Among 1396 lymph node biopsies submitted for evaluation of non-neoplastic conditions 54.12% (741) showed tuberculosis, in which children constituted 9.04%. A higher incidence of 68.61% was observed on FNAC. Both on cytology and histology, a necrotizing type of inflammation was observed more in children, which indicated hypersensitivity. CONCLUSION: FNAC was found to be a useful adjunct diagnostic technique especially in children, but the need to develop a sensitive and easily available method to diagnose in asymptomatic and high risk children still persists. Selection of patients with lymphadenopathy for more than three weeks is important, as otherwise nonspecific changes and acute inflammatory changes are likely to interfere with the diagnosis.

Value of endometrial aspiration cytology in assessing endometrial status in symptomatic peri and postmenopausal women.

Endometrial aspiration cytology and curettage were done on fifty one patients, randomly selected from three hundred and nineteen peri and post menopausal patients, who presented with menstrual cycle related complaints. The material obtained on aspiration was made into smears and cell block. The diagnoses of the aspirate and the curettage were made independently and later correlated The sensitivity of the procedure was 81.63% and the specificity was 83.33% A significant correlation was observed between cytologic and histopathologic diagnosis. In hyperplastic states, while on cytology, the diagnosis was made, the degree of hyperplasia was possible only in cell block and in paraffin sections. Thus the low cost feasibility and the sensitivity makes endometrial aspiration a useful diagnostic procedure for screening the endometrial status. However, a negative result does not rule out a malignant process, especially in persistently symptomatic patients and further investigations are mandatory.

A histomorphological study of regional lymphnodes in carcinomas of breast, stomach and colon.

INTRODUCTION: Immune response plays an important role in the interaction between malignant neoplasms and their host, which is reflected as histologic changes in the lymph nodes draining tumours. MATERIAL: 641 regional lymph nodes from 64 primary carcinomas of breast, stomach and colon were examined to assess such a response. METHODS: The lymphnodes were classified into one of the following histological patterns--lymphocyte predominance (LP), germinal centre predominance (GCP), lymphocyte depletion (LD) and unstimulated (U). RESULTS: LP (T Cell response) was the frequently observed pattern in the lymph nodes of breast and stomach. A similar pattern was observed among the survivors irrespective of the involvement of lymph node with tumour. There was a significant association between the histologic pattern of lymph node and stage & grade of the disease in breast carcinoma. CONCLUSION: The correlation of lymph node histology with grade and extent of the disease & survival indicate that the immune system is important in regulating the growth of malignant neoplasms. Such information may help as prognostic indicator and as therapeutic guide for immunotherapy.

Conjunctival impression cytology for detection of early vitamin A deficiency in children.

Children presenting with recurrent infections have a high risk of developing vitamin A deficiency. Conjunctival impression cytology (CIC) was used in the present study in such children to detect subclinical deficiency and to monitor the outcome after therapy. Seventy children with history of recurrent infections, and 10 healthy children in the age group of six months to five years were included in the study. CIC was performed using millipore filter paper and stained with PAS stain. A three tier grading system was used consisting of normal, borderline abnormal and abnormal for interpretation. Vitamin A supplementation was given in children in the latter two categories. Repeat cytology showed reversal to normal in these children. Hence in children with high risk of developing vitamin A deficiency, it is suggested to do CIC for detection and monitoring it.

Mucin histochemistry of the colon in relation to the menstrual cycle and its significance in colonic carcinogenesis.

OBJECTIVES: Epidemiological studies indicate an association between reproductive hormonal factors and colon cancers. The present study was undertaken to evaluate the influence of hormonal variations of the menstrual cycle on the mucin histochemistry of normal colonic mucosa and to analyse its significance in relation to colon cancers. METHODS: Fifty three specimens of colon from both 33 reproductive age group females and 20 postmenopausal females were analysed for mucin histochemistry. RESULTS: An increase in the total mucin content was observed in the late progesterone phase with an increase in the sialomucin fraction. CONCLUSIONS: A postulated mechanism for an estrogenic effect include an increased production of bile acids which may act as either promoter or carcinogen in colonic cancers. The cyclical variations of colonic epithelial mucins indicate a sustained estrogen effect is not possible. Hence it is suggested--the regular menstrual cycles play a protective role and some colon cancers may be hormone induced/dependent.

Evaluation of luteal phase in normal and infertile women.

Evaluation of luteal phase function is an important part of fertility evaluation in the female. Among fifty clinically identified patients with primary infertility certain well-established laboratory methods were used to identify the luteal phase defect. These methods included serum progesterone assays, endometrial biopsy, vaginal cytology, basal body temperatures and cervical mucus scoring, with appropriate controls. Based on both endometrial biopsy which was two or more days out of phase and the serum progesterone level of less than 2.5 ng/ml, luteal phase defect was found in five patients among the 50 patients (10 percent). It was found that an endometrial biopsy which was well dated showed a definite correlation with the progesterone assays and could be considered as the most easily performed and reliable indicator, useful in detecting a luteal phase defect.

Mast cells and macrophages in endometrial lesions.

One hundred and forty cases of endometrial lesions including 128 endometrial polyps, 7 cases of atypical hyperplasia and 5 cases of endometrial carcinoma were studied for mast cells and macrophages. Thirty six uteri with normal cyclic variations served as a control group. A cyclical variation in the mean mast cell value was observed in the control group with an increase in the secretory phase. Endometrial polyps showed a decrease in average mast cell count compared to the proliferative phase controls. Mast cells were significantly decreased in atypical hyperplasia and were absent in endometrial carcinoma. The observations indicate a hormonal basis for the significant variation in mast cell. Their presence probably suggests benign nature of the lesion. PAS positive macrophages were seen only in 4 endometrial polyps, too small for assessment of their significance.

Peanut agglutinin binding by gastric mucosal epithelial cells in Helicobacter pylori associated gastritis.

Gastric biopsies (42) from patients with peptic ulcer disease were classified into Helicobacter pylori positive (32) and negative (10) groups, based on the results of tissue urease test and microscopic demonstration of spiral bacteria. A statistically significant difference in peanut agglutinin (PNA) binding between the two groups was observed, attributable to exposure of sialic acid residues on gastric epithelium in the H. pylori positive group. That the negative binding was due to sialic acid, was further confirmed by application of sialidase digestion technique. These results support the existing biochemical evidence for exposure of sialic acid residues on H. pylori colonized epithelium.

Atmospheric temperature & anovulation in south Indian women with primary infertility.

An attempt at correlating atmospheric temperature, humidity and histologically diagnosed anovulatory endometrium has been made. A total of 140 women who had anovulatory endometrium among 1036 patients who had a clinical diagnosis of primary infertility, over a 5 yr period were studied. The principle of Edwards' test was used to analyse the seasonal trends and the seasonal index for the occurrence of anovulatory endometrium, atmospheric temperature and humidity was calculated using the average percentage method. The results suggest that anovulatory cycles in women with infertility tended to occur more during those months in the year when temperature increased (r = 0.63). However, humidity was not related to anovulation.

Determination of the probable date of delivery using vaginal cytology as an index.

70 normal pregnant females were used for the study, 47 of whom had vaginal cytological follow-up from week 32 till the first stage of labour. 23 additional patients had vaginal smears made in the first stage of labour. The combined intermediate cell value was used as an index of impending labour with values at week 38 being 90.35 +/- 0.0863, week 39 being 89.41 +/- 0.1934, week 40 being 81.25 +/- 0.0558 and at labour being 78.75 +/- 0.0995. The primigravidae showed a stepwise, gradual decrease in mean intermediate cell value from week 38 onwards, while the multigravidae showed a drop only at week 40. From this study, it has been shown, that it is possible to predict labour. It was also evident that there is a difference in reactivity of a primigravida versus multigravida to decreases in circulating progesterone as gauged by intermediate cell counts.

Endometrial biopsy in women with primary infertility.

Of 2616 endometrial biopsies received over a 55 month period, 1022 (39.1%) were from patients with primary infertility. All endometria from these patients were reviewed and while most diagnosis agreed with the primary diagnosis made by the reporting pathologist, an interobserver difference of 6.8 per cent was found. This difference occurred only on biopsies with anovulatory endometrium. Of the 1022 patients, 238 had definite hormonal derangements as assessed by morphological means on endometrial biopsy. Anovulation as assessed by glandular stromal dissociation and as a cause of infertility was noted in 12.6 per cent patients. The incidence of anovulation increased over the age period of 20-25 yr, with a peak at 25 yr. A close parallel was found of the period of anovulation and the period of nubility. An inflammatory cause for the infertility appeared to be negligible in our series.