Role of histopathology in diagnosis of ovarian neoplasms: Our experience in a Tertiary Care Hospital of Kolkata, West Bengal, India.

CONTEXT: Ovarian tumours are known to be diverse biologically, varying from non-malignant to malignant tumours having implication on course of the management and prognosis. To address the paucity of such study on ovarian neoplasm from our region of West Bengal, we planned and executed this study. The aim of the study was to analyse the distribution of various ovarian tumours and classify them according to the biological behaviour, age, laterality, and mode of the presentation. SETTING AND DESIGN: It was a retrospective study done in a tertiary care center of Kolkata, India. METHODOLOGY: A retrospective data of 4 years comprising 84 cases were included in the study from January 2016 to December 2019. All the slides were retrieved from the archives and re-evaluated and cross-checked with patients' clinical history, demographic, and macroscopic findings. RESULTS: Out of these 84 tumours, maximum cases were of surface epithelial neoplasms (69%) followed by germ cell tumours (26.1%). Age interval of 19-40 years accounted for the highest number of individuals with equal predominance of both sites of the ovary. Serous cyst adenocarcinoma was the most common malignant tumour. CONCLUSION: Histological examination remains the mainstay in the early diagnosis of ovarian tumours and facilitates timely appropriate management of patients, and hence, reduces overall mortality in women.

Role of image-guided fine needle aspiration cytology of lung lesions in diagnosis and primary care of patients: Experience in a Government Medical College of Eastern India.

CONTEXT: Lung cancer is the most common cancer affecting males worldwide. Its incidence in females is also on an increasing trend. Other conditions affecting lung-like tuberculosis are on a rise in middle-east countries due to overcrowding and poor living conditions. In developing countries, image-guided fine-needle aspiration cytology (FNAC) of lung lesions is a cost-effective method for early detection and apt treatment of patients by physicians. AIM: The main aim of this study is to identify the importance of computed tomography (CT)guided FNAC as an accurate and cost-effective tool in early diagnosis of lung lesions. SETTINGS AND DESIGN: It was prospective and retrospective study done in a government medical college of West Bengal, India. MATERIAL AND METHODS: Over a period of two years, 42 cases were included in the study. These were further subjected to evaluation of pulmonary mass lesions by CT guided transthoracic fine needle aspiration cytology. RESULTS: Out of these 42 cases majority were males with cough being most common clinical presentation. On CT guided FNAC of pulmonary lesions 69% of cases were malignant. Cytoradiological correlation in this study was 90.4%. CONCLUSION: CT guided FNAC of lung lesions is an accurate, cost effective and quick technique for early diagnosis, referral and appropriate treatment of patients in developing countries.

Hepatitis C Virus: Unnoticed and on the Rise in Blood Donor Screening? A 5 Years Cross-sectional Study on Seroprevalence in Voluntary Blood Donors from Central India.

CONTEXT: The ultimate goal of a blood transfusion service is the provision of safe and adequate supply free from transfusion-transmitted infections (TTIs). TTIs not only threaten the recipient's safety, but they also increase disease burden. Seroprevalence of TTIs in healthy blood donors indirectly reflects the prevalence of these infections in the general healthy population. AIM AND OBJECTIVES: To study the seroprevalence of human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) in healthy donors at a tertiary care hospital-based blood bank. To know the yearly and age-group prevalence of these TTIs as compared with other studies across India. SETTINGS AND DESIGN: This is 5 years observational cross-section study conducted in a tertiary hospital-based teaching institute of Central India (Malwa region). MATERIALS AND METHODS: The results of serological testing of TTIs and donor variables were analyzed during 2011-2015. STATISTICAL ANALYSIS USED: Chi-square test and Chi-square for trend analysis on TTIs prevalence. RESULTS: A total of 58,998 donors were screened for TTIs with dominance of male donation (99.7%). The overall cumulative seroprevalence was 1.14% in our study. The seroprevalence of HIV, HBV, and HCV was 0.09%, 0.98%, and 0.07%, respectively. We found a statistically significant increasing trend for HCV seropositivity during the study. CONCLUSION: Our study reflects an increasing trend of HCV seroprevalence over time. Thus, efforts are needed to increase the awareness and to educate the population in reducing risk factors for HCV infection.

Raised adenosine deaminase in the cerebrospinal fluid: A tool for the diagnosis of tuberculous meningitis in developing countries.

CONTEXT: The rapid diagnosis followed by the early treatment of tuberculous meningitis (TBM) is important in preventing fatal outcomes. The mainstay of diagnosis lies in cerebrospinal fluid (CSF) analysis, radiological investigations, and clinical findings. AIM: The present study was conducted to determine the efficacy, sensitivity, and specificity of raised adenosine deaminase (ADA) level in CSF to differentiate TBM from non-TBM cases as a rapid, cost-effective, and noninvasive test. PATIENTS AND METHODS: This was a retrospective study conducted over a 1-year period in a tertiary teaching institute of Malwa region, India. A total of 143 patients presented with symptoms and signs of meningitis were included and divided into TBM and non-TBM groups on the basis of the diagnostic criteria. CSF ADA estimation was drafted and analyzed by using ≥10 U/L as a cutoff value. A statistical comparison of the ADA levels between the study groups was made by using unpaired Student's t-test. RESULTS: Out of the 143 cases, 40 were TBM, and 103 were non-TBM. The mean ADA level in TBM and non-TBM cases was 17.18 ± 9.59 and 6.33 ± 2.48, respectively, and the difference was statistically significant. Using a cutoff level ≥10 U/L, CSF ADA had a sensitivity of 92.5% and a specificity of 89.32%. Positive and negative likelihood ratios of the test were 8.66 and 0.08, respectively, and positive and negative predictive values, were 77.08 and 96.84%, respectively. CONCLUSION: The present study reflects the importance of a CSF ADA level ≥10 U/L in the diagnosis of TBM. Thus, it can be used as an adjunctive diagnostic tool to differentiate TBM from other non-TBM cases, when there is a diagnostic dilemma.

Histopathological Trends of Testicular Neoplasm: An Experience over a Decade in a Tertiary Care Centre in the Malwa Belt of Central India.

INTRODUCTION: Testicular and para-testicular neoplasm are rare type of tumours affecting adolescents and young adults, reflected by the paucity of published data in India. AIM: This study was undertaken to estimate the epidemiological characteristics and histological types and subtypes of testicular neoplasm according to the WHO classification in our patient group. Identification of histopathological pattern of testicular tumour is immensely important for improved management protocols. MATERIALS AND METHODS: This was a retrospective study done over a period of ten years from 2004 to 2014 in a tertiary care centre. All relevant clinical data including patient's age, laterality, history of risk factors and serum tumour markers were collected from records. Histopathological slides were retrieved and reviewed for tumour and its subtype and classified according to WHO classification (2004). RESULTS: A total of 37 cases of testicular and paratesticular neoplasm were encountered in our study with a mean age of 38.1 years. Right testis was affected in 70.3% of cases. The most common clinical presentation was scrotal swelling with heaviness. Germ cell tumour was the most common type accounting for 77.1% followed by lymphomas (17.1%). Germ cell tumours were categorized into seminomatous (48.2%) and non-seminomatous tumours (51.8%). The most common subtype of non-seminomatous tumours was mixed germ cell tumour accounting for 85.8%. CONCLUSION: The incidence of testicular neoplasm among general population in Asian countries is low, as reflected in the very few studies that have been performed and published in literature. Epidemiological and histomorphological spectrum of our study was comparable to most of the countries except for some African and Western countries.

Massive ovarian edema: A case report presenting as a diagnostic dilemma.

Massive ovarian edema is a rare clinical entity, posing a significant clinical challenge as it can be easily mistaken for neoplasm. Our case was a 20-year-old young woman who presented with a self-limiting episode of abdominal pain along with large solid pelvis mass. On physical examination, she had abdominal tenderness with guarding. Ultrasound examination revealed large solid ovarian mass with moderate ascites. With the diagnosis of ovarian neoplasm, laparotomy was performed, and intraoperative frozen section excluded malignancy with differentials suggesting of fibromatosis/massive ovarian edema. The patient underwent unilateral salpingo-oophorectomy. Histopathological examination confirmed the diagnosis of massive ovarian edema. Massive ovarian edema should be suspected in women at the fertility age range with solid enlargement of the ovary so that these young patients can be treated conservatively where fertility preservation is mandatory.

Role of radiological-assisted cytology in intra-abdominal lesions: A 3 years' experience in a tertiary care center.

BACKGROUND: Fine needle aspiration (FNA) with assistance of radiological tools such as ultrasonography (USG) and computed tomography (CT) is an effective and safe technique for diagnosing intra-abdominal neoplastic and nonneoplastic lesions. AIMS AND OBJECTIVES: (1) To assess the utility of image-guided cytology in the diagnosis of intra-abdominal lesions. (2) To categorize various intra-abdominal lesions according to their site of occurrence and study their cytomorphological features. MATERIALS AND METHODS: A cross-sectional study was conducted in the Department of Pathology between January 2012 and January 2015. A total of 174 cases with intra-abdominal lesions were included in the study. RESULTS: In our study, diagnostic yield was 84.5%. The mean age was found to be 52 years with M: F ratio 1.1:1. We found that 92 (52.87%) cases were in hepatobiliary region, 33 (18.96%) in adnexa, 13 (7.47%) in pancreatic-ampullary region, 14 (8.04%) in unknown abdominal lumps, 8 (4.6%) in lymph nodes, 6 (3.4%) in renal, 5 (2.87%) in retroperitoneum, 2 (1.1%) in omental nodules, and 1 (0.5%) in splenic mass. Of total 174 cases, 106 (61%) cases were malignant, 10 (5.7%) benign, 16 (9.1%) inflammatory, 27 (15.5%) inadequate, and 15 (8.7%) suspicious for malignancy. CONCLUSION: Ultrasound and CT-guided FNA cytology had a significant role in diagnosis of palpable and nonpalpable intra-abdominal lesions. Being a relatively quick and safe method, it also avoids invasive diagnostic procedures.

Reconstruction in oral malignancy: Factors affecting morbidity of various procedures.

AIMS AND OBJECTIVE: (1) To study the age and sex distribution of patient with oral malignancies. (2) To analyze various types of surgery performed. (3) Evaluation of reconstruction and factors affecting complications and its relation to the type of reconstruction. MATERIALS AND METHODS: Cases of oral malignancies, undergoing surgery for the same in Sri Aurobindo Medical College and PG Institute, Indore from the period from October 1, 2012, to March 31, 2015. RESULTS: Out of analysis of 111 cases of oral malignancy, 31 (27.9%) cases were in the fifth decade of life with male to female ratio 1.9:1. The commonest site of cancer was buccal mucosa. Forty-seven cases (43.2%) were in stage IVa. Diabetes was the most common co-morbidity reported, accounting for 53.9% of cases with reported morbidity. Tobacco chewing was the common entity in personal habits. All the cases underwent neck dissection along with resection of the primary. Hemimandibulectomy was the most preferred form of primary resection accounting for 53.15% (59 cases), followed by wide resection of primary 27% (30 cases). Pectoralis major myocutaneous (PMMC) flap only was the most common reconstruction across the study population. PMMC alone accounted for 38.7% (43 cases). The infection rate was 16.21%. PMMC alone accounted for 5 out of 18 (27.8%) of total infection rate, and 4.5% of the total study population. PMMC + deltopectoral accounted for 5 out of 18 (27.8%) of total infection rate, and 4.5% of the total study population. CONCLUSION: PMMC is a major workhorse for reconstruction with better functional outcome and acceptance among operated patients.

Spectrum of second primary malignant neoplasms in central india: case series from a tertiary care centre.

BACKGROUND: Cancer survivors are at an increased risk for developing second cancers than the general population. In recent times detection of a new second primary following the index primary has increased due to refinement of existing diagnostic tools and development of newer modalities of diagnosis combined with better understanding of patterns of inheritance, risk factors and environmental influences. Today with improvement in Cancer management the average lifespan of cancer survivors have increased along with the increase in detection of both synchronous and metachronous malignancy with increase in disease free survival. With the improved cancer survival, second primary malignancy has become an important issue among cancer survivors and an increased burden on the treating oncologists and health care system. AIMS AND OBJECTIVE: To report the trends of second malignancy in a tertiary care centre in Central India with review of relevant literature. METHODS: A hospital based retrospective collection of data of patients diagnosed with second primary malignancy based on Warren and Gates Criteria (1932) over 2 years in the Department of Surgical Oncology of a tertiary care centre in Central India. CONCLUSION: Secondary primary malignancy needs to be separated from metastasis as the latter implies progression in disease and portends poor survival. Operable synchronous secondary primary malignancy can be tackled in the same sitting thereby reducing the load on the overburdened healthcare system in India. Increase in awareness of secondary primary malignancy leads to better chances of detection management and hence chances of improved survival.

Alveolar soft part sarcoma of tongue in 14-year-old boy.

Alveolar soft part sarcoma (ASPS) is a rare, aggressive malignancy of uncertain histological origin with propensity of vascular invasion and distant metastasis. ASPS demonstrates strong predilection for adolescents and young adults with a female preponderance. The head and neck region is the commonly affected region in the pediatric population with orbit and tongue being most common. The indolent clinical course and asymptomatic nature often leads to misdiagnosis and delayed treatment. Herein, we present a case of ASPS affecting the tongue in 14-year-old boy which clinically mimicked hemangioma, common benign vascular tumor of tongue.