Bone Marrow Aspiration Findings in Hematological Disorders in Children

Background: Primary objective was to study bone marrow aspiration(BMA) findings in hematological disorders in children with secondary objective to find correlation between peripheral blood film (PBF) findings with BMA.Material & Methods:It was observational and cross-sectional study conducted on 65 children in age group of 1-18 yrs admitted to Pediatrics Department of Government Medical College, Patiala over period of 1 yr. Inclusion criteria was based on clinical and laboratory parameters. Children were of anaemia, leucopenia and pancytopenia. Complete hemogram, reticulocyte count, PBF smear and bone marrow aspiration were done. The data was analyzed using IBM Statistical Packages for Social Sciences SPSS software version 22.Results:The mean age of study population was 10.39�29yrs. 93.8% children presented with pallor followed by fever in 84.6% and lethargy in 66.2%. 62 children were severely anaemic, 33 had bicytopenia, 23 children had pancytopenia. Bone marrow was hypercellular in 59 (90.8%) children. 40 (61.5%) children had megaloblastic anaemia on BMA followed by dimorphic anaemia in 8, Idiopathic thrombocytopenic purpura in 6 children. 4 children each had Megaloblastic anaemia with gelatinous transformation and micronormoblastic anaemia. 2 children had acute lymphatic leukemia and one had aplastic anaemia. The predominant PBF was dimorphic in 30 children, out of whom 22 had megaloblastic anaemia and 8 had dimorphic anaemia on BMA. Conclusions:Bone marrow was megaloblastic in majority (61.5%) of children. There was no significant association found between PBF findings and bone marrow diagnosis.

Role of Fine Needle Aspiration Cytology in Male Breast Lesions.

Fine Needle Aspiration (FNA) is a well-established and widely accepted procedure in the evaluation of breast masses. Fine needle aspiration cytology can be performed as an OPD procedure. It is less traumatic to the patient as compared to surgical biopsy, is cost effective, and can provide rapid results on the same day. Therefore, it can be used as an initial diagnostic procedure for male breast lesions. The aim of our study was to determine the efficacy of Fine-Needle Aspiration Cytology (FNAC) in the diagnosis of male breast lesions and categorization of these lesions as per IAC Categories.METHODSThe present study included 50 cases of male breast lesions presented in the department of the pathology. Fine-Needle Aspiration Cytology (FNAC) was done and slides were stained with MGG and PAP. Findings were analysed by two pathologists independently. Cyto-histological correlation was done in cases wherever possible. Sensitivity and specificity were calculated.RESULTSA total of 50 cases of male breast lesions which had undergone FNAC was analysed in this study. Histopathological examination was available in 10 cases. Gynecomastia C2 (88%) was found to be the most common entity followed by acute on chronic suppurative pathology (4%). There was no false positive or false negative finding. FNAC had a sensitivity and specificity and diagnostic accuracy of 100% for male breast lesions.CONCLUSIONSFNAC is the excellent sensitive and specific diagnostic tool for the assessment of breast lesions in males. Hence, we strongly recommend the use of FNAC as the first-line investigation in the clinical evaluation of male breast lumps.

Sebaceous Cell Carcinoma- Two Rare Case Reports

Bonafide sebaceous carcinoma is extremely rare neoplasm. It may be seen as a component of Muir-Torre syndrome. It should be distinguished from basal cell carcinoma with sebaceous differentiation.

Pigmented Basal Cell Carcinoma of Eyelid: A Case Report

Pigmented basal cell carcinoma is a rare cutaneous variant of BCC with very few cases reported. Exposure to sunlight is the most important environmental risk factor.Pigmented basal cell carcinoma is a very rare variant of basal cell carcinoma that exhibits increased pigmentation.As it is rare, thereby we report here the case of Pigmented basal cell carcinoma on eyelid. Key

Renal Pathologies in Medicolegal Autopsies (150 Cases)

The autopsy has for long been regarded as the gold standard as the most important tool for retrospective quality assessment of clinical diagnosis as well as a key education tool. In autopsy the kidneys are examined for disease, injury and other findings suggesting cause of death or related changes. Grossly some of the diseases may be easily noted on autopsy. Since kidney biopsy is usually avoided in critically ill patient ,histologic evaluation of autopsy of kidneys may be the first and the only opportunity to identify these diseases. Objectives: 1) To study the pattern of histological findings in kidney in minimum 150 autopsy cases based on the material received in Pathology department, GMC, Patiala. 2) To study the latent form of the disease, which couldn’t be diagnosed in lifetime, whenever full data is available. 3)To establish the exact cause of death on renal autopsy findings, wherever possible. 4) To find discrepancy with clinical diagnosis if the data are available. Methods: The present study is an observational study that was conducted over a period of two years. Postpartum renal specimens were received from August, 2016 onwards with a total of 150 cases. The specimens were preserved in 10% formalin immediately after autopsy and were received in fully sealed jars. A thorough gross examination of renal specimens including measurements, weights, consistency, cut surface, details of any lesions if preserved were recorded. Subsequently samples were processed for histopathology. The sections were thoroughly examined microscopically on 4x, 10x, and 40x power of the microscope for any pathology and the results were recorded. Results: In 57 cases (38%) microscopic findings were close to normal histology with no nephropathological diagnosis. 68 cases with tubular and interestial pathology included 43 cases of acute tubular necrosis (28.6%), 3 cases with acute pyelonephritis(2%), 2 cases with chronic pyelonephritis(1.3%) and 20 cases were noted to have cloudy swelling in the tubule(13.3%). Conclusion: In the present study majority of renal autopsies revealed histopathological pattern suggestive of tubular pathologies of which most common was acute tubular necrosis as a cause of sudden collapse of patient leading to death.

Comparative Study of Bone Marrow Aspiration and Bone Marrow Trephine Biopsy in Haematological and Non-Haematological Disorders

Background: This study was conducted in the Department of Pathology, GMC Patiala on 100 patients over period of three years with the objective to study the comparison of the bone marrow aspiration and bone marrow trephine biopsy in haematological and non-haematological disorders in elderly age patients.(Age >50years). Methods: 100 cases with different hematological and non-hematological problems were taken up for the present study with age >50 years. Salah”s bone marrow aspiration needle and Jamshidi’s bone marrow biopsy needle were used to collect the samples. For staining Leishmann’s and H&E stains were used. Results: Majority of the cases were in the age of 50-60. Majority of haematological disorders comprised of anaemia (62%), leukemia(17.7%), multiple myeloma (7.5%), primary myelofibrosis(2.5%), myeloproliferative disorders(2.5%), hypocellular marrow (2.5%), increased eoisinophils and precurcors(1.2%), NHL (1.2%) lymphocytosis(1.2%) and plasmacytosis (1.2%). Both of the 2 cases of non-haematological disorders were of metastatic carcinomatous deposists. Conclusion: The bone marrow aspiration and trephine biopsy were comparative in most of the haematological disorders except in primary and secondary myelofibrosis where biopsy provided clue to the diagnosis. Non-haematological disorders showed the same findings.

Bone Marrow Aspiration Findings in HIV Positive Patients and Correlation with CD4 Count

Background: Bone marrow abnormalities are common in HIV infected individuals and patients with AIDS. Most of the bone marrow abnormalities associated with HIV infection appear to be related directly to the infection or its complications and not to therapeutic intervention. Bone marrow study is an important investigation in HIV infected patients with peripheral hematological abnormalities. The primary objective was to study bone marrow aspiration findings in HIV positive patients and their correlation with CD4 count. Methods: The interventional, crossectional and prospective study was conducted in Department of Pathology, Government Medical College and Rajindra Hospital Patiala on 100 HIV positive patients, during a period of 2 years. Hematological investigations including complete hemogram, peripheral blood film and bone marrow aspiration was done. Absolute CD4 counts were done. Correlation of various bone marrow abnormalities was done with CD4 count. Results: Bone marrow revealed normocellular marrow in majority of cases, followed by hypocellular. Overall prevalence of myelodysplasia was 78%. Dyserythropoiesis was most common dysplastic change (62%) followed by dysmegakaryopoies (36%), dysgranulopoiesis (25%). Reactive plasmacytosis was seen in 44% cases in the range from 6-20%. Increased lymphocytes seen in 9% cases. There was seen significant correlation between myelodysplasia and CD4 count. Conclusion: Bone marrow abnormalities are common in HIV infected individuals and patients with AIDS.So HIV infection should be considered in the differential diagnosis of patients with secondary myelodysplasia or unexplained bone marrow changes.

Clinico-Pathological Correlation of Tubo-Ovarian Lesions

Background: The tubo-ovarian lesions manifest a wide spectrum of clinical, morphological, and histological features. Aims and objectives- To classify the lesions of tubes and ovaries and to correlate the various clinical and histopathological findings with age, chief complaints, and microscopic appearances of lesions. To correlate them radiologically and histopathologically. Methods: The present prospective study was based on the clinico-pathological correlation of various tubo-ovarian lesions in 75 cases over a period of 2 years. The histopathological reports were used to classify the tubo-ovarian lesions and correlate /substantiate the clinical and radiological findings. Results: Out of 75 cases, 51 (68%) ovarian, 18 (24%) tubal, and 6 (8%) cases showed simultaneous involvement of both tube and ovary. Amongst 18 tubal lesions,16 were of ectopic gestation (6 were ruptured) and the rest 2 of salpingitis. Amongst the ovarian lesions,41 cases were of ovarian neoplasms which were categorized as benign and malignant. Serous cystadenoma was the most common benign tumor and serous cystadenocarcinoma was the most malignant tumor. Conclusion: Clinical, radiological and histopathological diagnosis were compared and analysed statistically and the correlation was highly significant. An accurate clinical and radiological examination along with the histopathological examination aids in improving the diagnostic accuracy.

Clinical, Cytological and Histopathological Study of Salivary Gland Lesions

Background: A prospective study was conducted in the Department of Pathology, GMC Patiala for two years on 60 patients with swellings of jaw seeking consultation in Rajindra Hospital, Patiala. Methods: Fine Needle Aspiration Cytology (FNAC) was done on all these patients followed by microscopic examination of the prepared slides and relevant clinical information was collected. The data was compiled and analysed statistically. In lesions where surgery followed FNAC, the comparison was done with histopathology and statistical values were calculated. Results: The results of the study were: non-neoplastic cases were 51.7% and neoplastic cases were 48.3%. Maximum cases were of chronic sialadenitis (30%) followed by pleomorphic adenoma (23.3%). Parotid gland was involved in maximum cases (60%). Biopsies or specimens for histopathological examination were received for 30 cases; maximum cases of which were diagnosed as pleomorphic adenoma on histopathology. Among malignant tumors, mucoepidermoid carcinoma was the most common. Conclusion: On correlating the cytological and histopathological nature of salivary gland lesions, sensitivity of FNAC came out to be 75%, specificity 100% and accuracy was calculated as 93.3%.

Histopathological and Endoscopic Correlation of Gastric Lesions in Endoscopic Gastric Biopsies

ackground: There are a number of lesions that could affect the stomach varying from dyspepsia to highly lethal cancers; that can be chronic and incapacitating or merely an occasional discomfort or asymptomatic. Objective: The study was done to establish a correlation between endoscopic findings and histopathological characteristics of the various pathological gastric lesions. Methods: The study was a prospective study and done on 150 affected patients in 2 years. The endoscopic biopsy was taken from number of points of suspicious lesion for histopathologic diagnosis of the type of gastric lesions. The biopsies were fixed in formalin and adequately processed. The sections were stained with routine Haematoxylin and Eosin stain. Giemsa staining for H.pylori was also done. Results: In this study the most common clinical indications for endoscopic biopsy were pain epigastrium (82.0%) and dyspepsia (67.3%) with mean age of 54.25 and male predominance (1.9:1). The various gastric lesions were chronic gastritis (66.0%), adenocarcinoma (8.0%), no specific diagnosis (8.0%), dysplasia (4.7%), hyperplastic polyp (4.7%), acute on chronic gastritis (3.3%), eosinophilic gastritis (2.0%), acute gastritis (1.3%), intestinal metaplasia (1.3%) and chronic atrophic gastritis (0.7%). Conclusion: H. pylori is most commonly associated with acute on chronic gastritis.

Clinicopathological Study of 100 Cases of Hysterectomies In A Tertiary Care Centre

ackground: A retrospective study of 100 cases of hysterectomies was conducted in Dept. of Pathology, GovernmentMedical College, Patiala. Methods:Clinical and histopathological data were collected and correlation made. Maximum number of patients who underwent hysterectomy were in the age-group of 41-50 years. Results: The median age came out to be 47 yrs. Abnormal uterine bleeding was the most common complaint (82%). Main indication of hysterectomy was fibroid(63%) followed by prolapse (14%) and adenomyosis (12%). Histopathological correlations were made with the clinical findings. On histopathology, leiomyoma was the most common diagnosis followed by atrophic endometrium and adenomyosis. Conclusion: Correlation between clinical and histopathological diagnosis was very good. But still, histopathology remains the mainstay of establishing the confirmatory diagnosis and for histological subtyping of malignancies.

Histopathological Findings in Spleen on Autopsy—A Study of 100 Cases

Background: Autopsies are carried out to establish the identity, cause of death, time of death, and antemortem orpostmortem nature of death. These help in establishing the cause of death and ascertain the disease process which led to death. It provides the opportunity to discover new diseases, to evaluate toxic effects of drugs and therapies. The spleen is the site of direct and indirect toxicity, a target for some carcinogens, and also a site for metastatic neoplasia. Many systemic or generalized diseases have splenic involvement. Methods: The present study was conducted on 100 specimens of spleen on routine autopsies received in the department of pathology, Government Medical College, Patiala, Punjab to find out the frequency of various lesions in spleen on autopsy. All the histological sections were stained in H & E stain, mounted ,examined microscopically & findings were recorded and tabulated. Results: 80 of the 100 autopsies were males, while 20 were females. In 81 (81%) cases, the microscopic findings were congestion, hemorrhage in 8 cases(8%) ,7 cases (7%) had autolytic changes,1 case(1%) had necrosis, granulomatous pathology were seen in 2 cases (2%) and 1 case (1%) had leukemic infiltration. Conclusion: Despite recent advances in diagnostic technology, there is large number of cases of preventable diseases for which the autopsy has remained an important complementary tool for identifying.

Histopathological Correlation of Adenomyosis, Leiomyoma and Dual Pathology in Hysterectomy Specimens as the Cause of Abnormal Uterine Bleeding In Women in Different Age Groups

Background: The objective was to study adenomyosis and leiomyoma as the cause of abnormal uterine bleeding in hysterectomy specimens. Methods: This was a study carried out on 100 hysterectomy specimens, of subjects who presented to the department of Obstetrics and Gynaecology at Government Medical College, Patiala with the complaint of abnormal uterine bleeding. Data including age, parity, symptoms and clinical indication for hysterectomy was collected for the study and the histopathological findings were recorded. The specimens were well grossed and stained with hematoxylin and eosin and examined microscopically.Results: Women in the perimenopausal age (41-50 years) accounted for the highest number of cases (35, 44.30%) presenting with symptoms of AUB. In this age group leiomyoma was found to be the commonest cause of AUB (19, 54.28%). The most common symptom was heavy menstrual bleeding. Clinical, radiological and pathological evaluation correlated well with the diagnosis of leiomyoma but was of little help in diagnosing adenomyosis. Conclusion: Hence, adenomyosis still remains a clinical challenge and should be kept in mind by the clinician as well as the pathologist in women presenting with AUB.

A Study of Comprasion of Conventional Cytology with Liquid Based Cytology of Thyroid FNAC – A Study of 100 Cases

Background: Fine Needle Aspiration (FNA) cytology of the thyroid has been increasingly utilized for the investigation of thyroid lesions. FNA of the thyroid gland is considered to be most cost effective and accurate primary diagnostic procedure for thyroid nodules. In the recent years many approaches has been devised to improve the quality of thyroid FNA cytology because the conventional smear (CS) is subject to error in sample collection and slide preparation. The liquid based cytology (LBC) originally developed for the application of gynaecologic cervical smears, has progressively gained for application of both non gynaecologic and fine needle aspiration cytological material. According to the Wilcoxon signed ranked test for thyroid lesions LBC was not useful in goitre and infectious lesions. It gave better results in anaplastic and medullary carcinoma. So conventional smear is more sensitive, specific and accurate than LBC. Methods: in this prospective study, we had 100 cases of thyroid. In each case, two passes were performed. The first pass was for CS and the second pass yielded material for LBC. Both CS and LBC smears were compared for cellularity, background blood and necrotic cell debris, cell architecture, informative background, presence of a monolayer of cells and nuclear and cytoplasmic details and test on an for statistical analysis. Results: Diagnostic accuracy was better in CS compared withLBC smears as CS was most sensitive (93.18%) and accurate (91.75%) method for analysis of thyroid while LBC method is sensitive (89.04%) and accuracy (86.59%).Conclusion: Conventional smear is more sensitive, specific and accurate than LBC because LBC introduce more cytological artifacts to thyroid aspirates.

Aggressive Angiomyxoma of Vagina: A Rare Case Report

Aggressive angiomyxoma is a rare, locally invasive mesenchymal tumor predominantly presenting in women of reproductive age and also having a moderate-to-high risk for local relapse. Hence, it needs to be differentiated from other mesenchymal tumors occurring in this region. We present here a case of a 47 Year old female, with chief complaints of prolapsed uterus since 6 months. During clinical examination, posterior vaginal wall swelling was also identified. Total Abdominal Hysterectomy with Bilateral Salpingoophrectomy was done along with removal of posterior vaginal wall swelling. On histopathology, diagnosis of aggressive angiomyxoma was made. We report this case because of its rarity.

Infiltrating Intramuscular Lipoma: A Rare Case Report

ipomas are the common benign tumors of adipose tissue, but sometimes clinically and grossly they simulate malignancy. Lipomas can also occur in deep soft tissues. One of its rare subtype is Intramuscular lipoma which arise within the skeletal muscle fibers. Most common site is trunk, but can also occur in thigh and head and neck. 20 % recur due to incomplete excision. Histopathology is must for confirmation of the diagnosis. Prognosis of intramuscular lipoma is very good and marginal excision is the treatment of choice. We report a case of a 23 Year old female, who presented in surgery OPD with chief complaint of swelling at upper right side of back since 1 year. She got operated for the same 8 months back but presented with similar complaint at same site after 4 months. Excision of the swelling was done and sent for histopathology. On gross examination skin covered soft tissue piece, grayish brown in color was received. Histopathology revealed Infiltrating intramuscular lipoma. The case was reported because of its rarity.

Adenomatoid Tumor of Epididymis: A Rare Case Report

Adenomatoid tumors are rare benign neoplasms of the paratesticular region, most commonly occurring at the tail of the epididymis. We present a case of adenomatoid tumor in a 65 year old male, known case of prostatic adenocarcinoma, who presented in Urology OPD with painless swelling in testis. Bilateral orchidectomy was done with clinical suspicion of testicular carcinoma. On histopathology, diagnosis of adenomatoid tumor of epididymis was made. Due to its rarity, it is important for the physician and pathologist to be aware of this interesting entity in order to make a correct diagnosis.

Study of Ascitic Fluid by Liquid Based Cytology and Its Comparision with Conventional Cytosmears and Cell Block Preprations.

Background: Ascites refers to increased volume of fluid collecting within peritoneal cavity which becomes clinically detectable when atleast 500 ml has accumulated. Cytological examination of ascitic fluid gives information about inflammatory and noninflammatory lesions including malignancies, which is done by conventional cytosmears, SurePath liquid based cytological smears and cell block preparations. Aims: The aim of our study was to study the different causes of ascites and their comparison on liquid based cytology with conventional cytology and cell blocks. Methods: Ascitic fluid was obtained from 75 patients of either sex. Microscopic examined was carried out by SurePath liquid based cytology, conventional fixed sediment smears, and cell blocks. Results: Observations were categorised into inflammatory, malignant and inconclusive. Out of 75 cases examined by conventional smears, cytological diagnosis of inflammatory or benign was rendered in 45(60%), 7(9.3%) were diagnosed as malignant and 5(6.7%) were given suspicious of malignancy and 18(24%) were inconclusive. By liquid based cytology 53(70.7%) were rendered inflammatory or benign, 12 (16%) as malignant, 2(2.7%) as suspicious of malignancy and 8(10.7%) were rendered inconclusive. By cell block methodology 52(69.3%) were rendered inflammatory or benign, 11(14.7%) as malignant and 12(16%) as inconclusive. Statistical analysis: Revealed that liquid based cytology was most sensitive (85.71%) and accurate (97.33%) method for analysis of ascitic fluid and conventional smears were least sensitive (50%) and accurate (90.67%). Conclusion: Liquid based cytology showed more sensitivity and accuracy than conventional cytosmears and cell block methods in diagnosing malignant lesions.

Histopathological Pattern of Soft Tissue Tumours in 200 Cases.

Background: Soft tissue tumors are a diverse and fascinating group of lesions that arise from the supporting soft tissue of the body. Although pathologically diverse, they frequently exhibit similar clinical presentations and radiological features. Correct histopathological diagnosis is therefore crucial. This study aims to analyze the histopathological findings of soft tissue tumors and their distribution according to age, sex and site of occurrence in patients. Methods: This study comprised of minimum of 200 cases. All soft tissue tumors received in the Department of Pathology, Govt. Medical College, Patiala were analysed. Their gross features, microscopic findings were analysed in detail. Soft tissue tumors were divided into benign and malignant categories and their further sub typing were done according to WHO Classification. The distribution of soft tissue tumors according to the age, sex and site of occurrence was studied. Results: Out of 200 cases of soft tissue tumors, 169 cases (84.5%) were benign, 20 cases (10.0%) were malignant and 11 (5.5%) were classified under intermediate category. Adipocytic tumors formed the largest group constituting 92 cases (46%).Vascular tumors were the second commonest (18%) followed by peripheral nerve sheath tumors (10.5%). The benign tumors were seen in younger age as compared to malignant tumors. Conclusion: Benign tumors were more common than malignant. The most common benign tumors were lipoma followed by hemangioma (14.0%) and schwannoma (5.5%).There is wide range of their distribution according to age, sex and site. The benign tumors were seen in younger age as compared to malignant tumors.

Extrapleural Solitary Fibrous Tumor (SFT) at Dorsum Foot - A Rare Case Report.

Solitary fibrous tumor is a benign tumor. But it has tendency for local recurrence as well as metastasis. WHO classifies it under the category of fibroblastic/myofibroblastic tumor. It most commonly occurs in pleura and very rare in extra-pleural site such as sub-cutaneous or deep soft tissue of extremity, head and neck, mediastinum, retroperitoneum, etc. Histologically SFT show patternless hypercellular and hypocellular areas of fibroblast proliferation, collagen deposition, hemangiopericytoma like areas with myxoid change or fibrosis. This tumor needs to be differentiated from other spindle cell tumors with immunohistochemistry. It is a rare entity with only a few cases reported. We report a case of 60 years old male with well circumscribed painless, swelling dorsum foot. It was clinically diagnosed as inverted papilloma, but microscopy was consistent with typical features of SFT. This was confirmed by CD 34 & CD99 positivity. This case is being presented for its rare location.