Evaluate “Rifampicin Resistance” as Surrogate Marker for Rapid Detection of MDR-TB Using Real-Time PCR Directly on FNAC Samples of Tuberculous Lymphadenitis.

Background: India has the dubious distinction of having second largest burden of MDR-TB cases in the world. According to WHO, MDR-TB is defined as resistance to isoniazid and rifampicin, the two most important drugs for treatment of TB. “Rifampicin resistance” is recommended as surrogate marker for MDR-TB by WHO, as at least, 90% of all rifampicin-resistant clinical isolates are also found resistant to isoniazid. Localization of genetic alterations in the 81-bp “Rifampicin Resistance-Determining Region” of rpoB gene in 96% of rifampicin resistant strains make it particularly amenable for early detection of MDR-TB by molecular techniques like Real-Time PCR. Aim: Evaluation of “rifamipicin resistance” as surrogate marker for rapid detection of MDR-TB using Real-Time PCR directly on FNAC samples of tuberculous lymphadenitis (TBLN). Materials and Methods: Eighty cases of TBLN undergoing anti-tubercular treatment (ATT) and 10 lymphadenitis cases of non-tuberculous origin (controls) were included in the study. To evaluate “rifamipicin resistance” as surrogate marker for rapid detection of MDR-TB, Real-Time PCR and conventional Drug Susceptible Testing (DST) were carried out. Results: Eighteen samples were identified as MDR-TB cases by DST. Real-Time PCR picked up mutated ropB gene in 17 cases out of these 18 MDR-TB cases. Conclusion: “Rifampicin resistance” is an efficient surrogate marker for timely detection of MDR-TB using rapid, accurate and sensitive molecular technique like Real-Time PCR.

Detection of mycobacterial DNA directly from FNAC samples of tuberculous lymphadenopathy using real-time PCR: A preliminary study.

Background: Fine needle aspiration cytology (FNAC) is most commonly used in first line investigation for tuberculous lymphadenopathy (TBLAP). Real-time polymerase chain reaction (PCR) an extremely versatile technique is being used for diagnosis and follow up of patients with infectious diseases. It can also be used for detecting Mycobacterium tuberculosis (Mtb) DNA in FNAC samples of TBLAP for rapid diagnosis and treatment. Aim: Detection of Mtb DNA on FNAC samples of tuberculous lymphadenopathy using Real-time PCR. Material and Methods: Twelve clinico-cytologically diagnosed TBLAP cases and five controls were included in the study. FNA samples were used for studying morphology, AFB demonstration, culture and for detecting Mtb DNA using Real-time PCR. Results: Mtb DNA was detected in ten cases (83.33 %) by Real-time PCR. ZN stain was positive in eight cases and culture in six cases. Conclusion: Detection of Mtb DNA in FNAC samples using Real-time PCR is a time saving, logical, economical approach over the culture based method.

Multicentric extraskeletal myxoid chondrosarcoma of uterine adnexa in a young female: An unusual presentation.

Extraskeletal myxoid chondrosarcoma is a rare soft-tissue sarcoma, mostly occurring in the proximal extremities and limb girdle. Majority of the patients are in fifth and sixth decades of life with male preponderance. We report here a case of primary extraskeletal myxoid chondrosarcoma of the uterine adnexa involving the broad ligament and fallopian tube synchronously without any evidence of uterine/ovarian involvement in a young multiparous female of 27 years. After the histopathological diagnosis, re-excision of the tumor bed with wide local margins was recommended. Since the tumor has an aggressive course, with propensity for late recurrence and metastases to lungs, the patient must be considered for long-term follow-up.

Congenital Malformations in Twins: Effect of Chorionicity and Zygosity.

Twins suffer a high risk of congenital malformations but the data from our region is scanty. In this study, 133 twin pairs (266 twin babies) were studied and a 3.4% incidence of malformations was seen without gender preference. There was no association of chorionicity and zygosity with the risk for having congenital malformations

BCG reaction in twin newborns: effect of zygosity and chorionicity.

OBJECTIVE: To study local response to BCG vaccination in twin babies and find out the effect of zygosity andchorionicity on BCG uptake. DESIGN: Analytical observational study. SETTING: Tertiary hospital. METHODS: Twin pairs born in the hospital were evaluated for zygosity and chorionicity. BCG vaccination was given within 48 hours of birth to babies >/=33 weeks of gestation and birth weight >/= 1500 g. Follow-up was done at 6,10 and 14 weeks. Local response to BCG vaccination was recorded in the form of no reaction, abortive reaction, papule, pustule, ulcer, scab or scar. RESULTS: One hundred thirty three twin pairs were delivered (16 monochorionic, 117 dichorionic); of which zygosity was determined in 110 pairs (81 dizygotic, 29 monozygotic). Two hundred four twin babies qualified for BCG vaccination. After 14 weeks, local reaction was seen in 84.3% babies and scar formed in 41.2% cases. Five abortive reactors and 20 'true non-reactors' were also found. Intra-pair agreement for local BCG reaction was highly significant in both monozygotic/dizygotic, as well as monochorionic/dichorionic twins (P<0.01). However, monozygotic and monochorionic intrapair agreements were not significantly larger than the dizygotic and dichorionic intrapair agreements(P >/= 0.05), respectively. CONCLUSION: Local response to BCG vaccination in twin newborn babies follows same pattern as singletons and there is no effect of zygosity or chorionicity on the uptake.

Sertoli-Leydig cell tumor of ovary with heterologous element: a case report.

Sertoli-Leydig cell tumors are uncommon tumors of ovary accounting for about 1% of sex cord stromal tumors. They constitute between 0.1% to 0.5% of all the primary ovarian neoplasms. The majority of reported cases are moderately or poorly differentiated combined Sertoli-Leydig cell tumors. A rare case of Sertoli-Leydig cell tumor with heterologous element in a 14 year girl is described. The heterologous component comprised smooth muscle, an uncommon element, that was seen in 60 to 70% of the tumor area. The epithelial element of the tumor consisted of solid, tubular and foci of retiform pattern. Both these features imply a poor prognosis.

Aspiration cytology, histology and hormone status in solid and cystic papillary tumor of pancreas--report of three cases.

Solid and cystic papillary tumor of pancreas (SCPT) are rare tumors. Of the well described cases 95% have occurred in women of reproductive age, suggesting a role of hormonal factors in the pathogenesis of this tumor. Only few studies evaluating estrogen and progesterone receptor status have found it to be positive. Cytohistocorrelation and immunohistochemistry for estrogen (ER) and progesterone (PR) receptors of three such cases are reported here. All three were diagnosed by fine needle aspiration cytology (FNAC) and showed cytoplasmic positivity for ER and PR receptors. May-Grunwald Giemsa, Papanicolaou and hematoxylin and eosin stained slides were evaluated for cytology and histopathology. Unstained methanol fixed slides were used for immunohistochemistry. The cytoplasmic staining of ER and PR receptors cannot be underestimated, as shown by Carbone A et al which represents ERII receptors. This study confirms the presence of ER and PR receptors in these tumors and highlights the already established cytological features.