Diagnostic usefulness of triple biopsies (Skin, Muscle and Nerve) in clinically suspected cases of vasculitis in a tertiary care hospital in Gujarat

Introduction: The term vasculitis refers to a heterogeneous group of diseases, all characterized by inflammation and destruction of blood vessel walls leading to ischemic, thrombotic, and hemorrhagic damage to tissues of central and peripheral nervous system. The main indication for triple biopsy (skin, muscle and nerve) is to rule out peripheral vasculitis neuropathy. However, the drawback is that any systemic inflammatory process may show changes in a skin biopsy and hence these changes need to be interpreted with caution. The aim of this study is to establish the diagnostic yield and the usefulness of the triple biopsies in clinically suspected cases of vasculitis. Material and Methods: The present study was conducted in the Department of General Pathology, SBKS MI & RC, Vadodara over a period of one year (1/1/2022 to 31/12/2022). All the clinically suspected cases of vasculitis received at OPD were included in the study. Any case with either muscle, nerve or skin biopsy reported as inadequate were excluded from the study. Results: On evaluation the usefulness of triple biopsies for vasculitis, we found a very low diagnostic yield with only 3.3% of peripheral nerve biopsy and 0.8% of muscle and nerve biopsy showed definite vasculitis. In case of suspected peripheral/systemic vasculitic neuropathy, nerve biopsy was sufficient in the majority of case and has the diagnostic armamentarium for the evaluation of vasculitis. Conclusion: In conclusion, nerve biopsies provide the best yield for the diagnosis of vasculitis, as opposed to muscle and skin biopsies. The role of triple biopsies as a routine protocol for the evaluation of vasculitis is questionable.

Expression and sensitivity of immunohistochemical markers SMA, Desmin, CD10 for uterine leiomyomas - A tertiary care centre experience

Introduction: Leiomyoma is the most common benign tumor of the uterus which usually presents with menorrhagia, pain in abdomen or both. In extremely rare cases where uterine leiomyoma can be difficult to distinguish from other uterine smooth muscle tumors, immunohistochemistry is used. This study was aimed to study the expression and sensitivity of immunohistochemical markers SMA, Desmin, CD 10 for uterine leiomyomas and to find average number of mitosis in uterine leiomyomas using Ki 67. Materials and methods: The present study was carried out in the Department of Pathology, Dhiraj General Hospital and Smt. Bhikhiben Kanjibhai Shah Medical Institute and Research Centre, Sumandeep Vidyapeeth, Piparia. A total 50 cases of uterine leiomyomas after its histological diagnosis were evaluated with immunohistochemical markers SMA, Desmin, CD 10 and Ki 67. Results: SMA expression was seen in all 50 cases of uterine leiomyomas with strong expression in 44 cases (88%). Strong SMA expression was seen more in usual leiomyomas as compared to leiomyomas with secondary changes. Desmin expression was also seen in all the 50 cases of uterine leiomyomas with moderate expression in 26 cases (52%). Weak CD 10 expression was seen in 15 cases of uterine leiomyomas (30%). Ki 67 was expressed very focally in only 3 cases of leiomyomas with mean value of only 0.3% tumor cells. Conclusions: Leimyomas was most frequently seen in the women in 4th decade. The most common clinical presentation was menorrhagia. SMA and Desmin expression was seen in all the cases with strong and moderate immunoreactivity respectively. SMA expression was found to be more specific than Desmin in uterine leiomyoma. Weak CD 10 and focal Ki 67 were expressed only in few cases and were found to be insignificant.

Role of FNAC in head and neck region lymphadenopathy - A tertiary care centre experience

Background: FNAC (Fine Needle Aspiration Cytology) is a well accepted technique and plays an important role in early diagnosis of head and neck lesions. It is a safe and inexpensive outdoor procedure. Materials and methods: This study was carried out over a period of 9 months (January 2021 to September 2021). A total of 60 patients with head and neck lymphadenopathy were subjected to FNAC at a tertiary care centre in Vadodara, Gujarat. All reports were recorded and data was entered and analyzed using Microsoft excel. Results: In the present study, the various causes of head and neck lymphadenopathy were classified according to cytomorphological patterns. Among the diagnostic outcome, overall prevalence of granulomatous lymphadenitis was 35% (21 cases), reactive hyperplasia was 26.67% (16 cases), secondary metastases were 18.33% (11 cases), lymphoma was 10% (6 cases) and acute non-specific lymphadenitis was 10% (6 cases). Conclusion: FNAC is simple, quick, inexpensive and safe diagnostic procedure which also is an useful adjunct to histopathology.

A rare case report of Castleman's disease and review of literature

Castleman’s disease (CD) is a rare lymphoproliferative disorder, described for the first time by Castleman, et al. in 1954 in a single case then in 1956 in a group of 13 patients with localized benign lymphadenopathy. The incidence of CD is unknown and can occur at any age, however it is mainly reported in adults in the literature with a slight feminine predominance (60%). The majority of the previously reported cases of CD in the neck were of the hyaline vascular type and the most common sign was an asymptomatic neck mass. In the present case the patient is having unicentric CD and histologically it is Mixed Type. We are reporting this case because of its rarity.

Cytomegalovirus infection in neonates following exchange transfusion.

OBJECTIVES: This study was undertaken to ascertain the acquisition of cytomegalovirus infection following exchange transfusion and factors affecting such transmission in newborn infants at a tertiary care hospital in India. METHODS: Neonates undergoing double volume exchange transfusion (for any indication) with whole blood in the Neonatal Intensive Care Unit were enrolled over a 8 month period. Serum samples from the infant were collected for CMV serology before exchange transfusion, and at 6 and 12 weeks following the exchange. CMV serology was also conducted on samples obtained from the respective maternal and donor blood. RESULTS: Of 47 neonates who received exchange transfusion during the study period; only 26 (55.3%) neonates were finally followed up till 12 weeks of age. Only 3 (11.5%) children demonstrated CMV seroconversion during follow-up; all were low birth weight and small for gestational age. None of them demonstrated any clinical, hematological, biochemical, or radiological signs suggestive of perinatal CMV infection either at birth or during the course of follow-up. CONCLUSION: Exchange transfusion in neonates can result in perinatal transmission of CMV infection in low birth weight neonates. Such transmission does not result in any immediate manifestations. Data are not sufficient to warrant routine CMV screening of donor blood for exchange transfusion in our setting.

Seroprevalence of cytomegalovirus among voluntary blood donors in Delhi, India.

Cytomegalovirus (CMV) is known to be a significant cause of morbidity and mortality following blood transfusion in children and immunocompromised adults. In India, it is not mandatory to screen donated blood for CMV in blood banks. Very few studies have been conducted in India to estimate the seroprevalence of this infection in voluntary blood donors. This study was conducted to estimate the seroprevalence of CMV among voluntary blood donors in Delhi, India. In this study, none of 200 donors tested positive for CMV IgM antibody, but 95% were positive for CMV IgG antibody. There was no statistically significant difference in seropositivity of CMV based on distribution of age. Of the 200 donors, 3% tested positive for HBsAg, 1% for HIV, 2% for hepatitis C virus, and 4.5% for syphilis. Since about 95% of blood donors in India are seropositive for CMV, it would seem superfluous to screen blood donors for CMV, as very few seronegative blood units would be available for transfusion. Other preventive strategies, such as leukoreduction, etc., could be more appropriate and cost-effective for the prevention of transmission of CMV through infected blood to immunosuppressed individuals.