Comparative Evaluation of Tubex TF (Inhibition Magnetic Binding Immunoassay) for Typhoid Fever in Endemic Area.

BACKGROUND: Typhoid fever remains a significant health problem in endemic countries like India. Various serological tests for the diagnosis of typhoid fever are available commercially. We assessed the usefulness of rapid test based on magnetic particle separation to detect Immunoglobulin against Salmonella typhi O9 lipopolysaccharide. AIM: Aim of this study was to compare the sensitivity and specificity of widal test, typhidot and tubex TF test for the diagnosis of typhoid fever in an endemic country like India. MATERIALS AND METHODS: Serum samples collected from 50 patients of typhoid fever, 50 patients of non typhoid fever and 100 normal healthy individuals residing in Amritsar were subjected to widal test, typhidot test and tubex TF test as per manufacturer's instructions. Data collected was assessed to find sensitivity and specificity of these tests in an endemic area. RESULTS: Significant widal test results were found positive in 68% of patients of typhoid fever and only 4% of non typhoid fever patients. Typhidot (IgM or IgG) was positive in 72% of typhoid fever patients and 10% and 6% in non typhoid fever and normal healthy individuals respectively. Tubex TF showed higher sensitivity of 76% and specificity of 96-99% which was higher than typhidot and comparable to widal test. CONCLUSION: This was the first evaluation of rapid tubex TF test in northern India. In countries which can afford high cost of test, tubex TF should be recommended for the diagnosis in acute stage of the disease in clinical setting. However, there is urgent need for a highly specific and sensitive test for the diagnosis of typhoid fever in clinical settings in endemic areas.

Uranium-Toxicity and Uranium-Induced Osteosarcoma Using A New Regimen and Surgery : A First-Time Experience.

Uranium isotopes have always been problematic to mankind since many centuries. Different studies all over the world have been unable to reveal causal relationship between uranium and its toxic effects on kidneys, bone and lungs. In this case report, we present a rare association of uranium toxicity with renal dysfunction and possibility of induction of osteosarcoma by an unknown mechanism. The presentation of the 12-year-old patient was reduction in urine output along with joint pains, seemed like that of diabetes mellitus, as he was already on insulin. The patient later diagnosed to have uranium toxicity. This case is an instance of strong association between medicine and public health. With complete history, physical examination and required investigations, all common causes like NSAID toxicity, aminoglycoside toxicity and exacerbation of diabetes were ruled out. Uranium investigations were done lastly based on the toxicology report of drinking water (South African toxicologist, Caron Smith). In the management strategy, the new regimen CBMIDA, supported by studies in Europe, was used. However, to our surprise, joint symptoms tracked their way to a diagnosis of osteosarcoma, which was later operated upon by our orthopaedic surgery team. Histopathologically, it was found to be a chondroblastic type of osteosarcoma.

Cytological diagnosis of follicular carcinoma thyroid metastasis in pelvic muscles-a rare and unusual site.

Distant metastasis of thyroid neoplasm as an initial presentation is rarely encountered. The present case report describes a chance diagnosis of follicular carcinoma thyroid (FCT) metastasis in a 75-year-old female who was presented with symptoms related to pelvic mass. This is a rare site of reporting as only three cases have been reported previously at the first diagnosis. It is important to identify the presence of distant metastasis as it is the most important prognostic indicator (associated with 50% mortality). This is significant as this has a direct bearing upon its treatment and managing the patient. Hence more awareness is required by both diagnosticians and clinicians regarding this.

Subcutaneous dermatofibroma: a rare case report with review of literature.

A purely Sub-cutaneous benign fibrous histiocytoma (BFH; dermatofibroma) is rarely reported, as it is usually a dermally located mesenchymal tumour and in absence of supportive immunohistochemical (IHC) studies, it is often misdiagnosed. We are describing a case of a 19-year-old female who presented to the skin outpatient department with a painful swelling on the medial side of her thigh. Fine needle aspiration (FNA) revealed a sub-cutaneous spindle cell (mesenchymal) lesion which was corroborated on histopathology, with differentials of BFH and dermatofibrosarcoma protruberans (DFSP). BFH constitutes a diagnostic dilemma for both clinicians and pathologists, because the lesions share common clinical symptoms, radiological characteristics and histological features with many varied entities. For its subtyping and confirmation; immunohistochemical (IHC) studies were undertaken. In the present case, positivity of IHC markers, vimentin and smooth muscle actin emphatically proved that BFH arose exclusively from the subcutaneous region, with no dermal origin. Also, a negative CD34 immunostaining, along with low B-cell lymphoma 2 (Bcl-2) expression ruled out DFSP (both are strongly expressed in DFSP), MFH and other malignant mesenchymal lesions. Negative CD 68 staining ruled out giant cell lesions and their congeners. This case is worth reporting, as it not only describes a rare case presentation of BFH, but as it also highlights the importance of IHC, thus helping to comprehensively clinch the diagnosis by systematically ruling out other differentials.

Prominent Intracytoplasmic Crystals in Alveolar Soft Part Sarcoma (ASPS): An Aid in Cytological Diagnosis.

Alveolar soft part sarcoma (ASPS) is a rare neoplasm of unknown histogenesis with poor prognosis. Due to the epithelioid appearance of the neoplastic cells, ASPS may resemble many neoplastic conditions, such as metastatic epithelial cell tumours with clear cell change, metastatic renal cell carcinoma, granular cell tumour, epithelioid sarcoma, malignant melanoma and even paragangliomas. Presence of abundant, rod like crystals in the cytoplasm of tumour cells is an important finding characteristic of this tumour, which helps in differentiating it from the other entities. The case study highlights the importance of correlating cytological features that help in reaching the diagnosis such as the background, cell morphology and presence of characteristic rod shaped crystals as immunohistochemical studies are often non-conclusive. The case also is unique as it demonstrates presence of intra-cytoplamic crystals in such abundance.

Immunohistochemical (IHC) Analysis of Non-Hodgkin's Lymphoma (NHL) Spectrum According to WHO/REAL Classification: A Single Centre Experience from Punjab, India.

INTRODUCTION: The distribution of the major subtypes of non-Hodgkin's lymphoma (NHL) differs across geographic regions. This study, from the north Indian state of Punjab, has incorporated immunophenotypic findings while investigating the distribution of NHL subtypes based on World Health Organization (WHO)/ Revised European-American Classification of Lymphoid Neoplasms (REAL) system of classification. PATIENTS AND METHODS: Over all seventy seven cases of lymphoma over a period of one year (between April 2012 and April 2013) were diagnosed in the Department of Pathology, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar (Punjab). Of these 30 cases (39%) were of Hodgkin's Lymphoma (HL) and 47 cases (61%) were of Non Hodgkins lymphoma NHL. Of the total of cases of lympho-proliferative disorders, the diagnosis of NHL was done by light microscopy alone. All the cases diagnosed provisionally as NHL were taken up for immunophenotyping with Immunohistochemical (IHC) studies. There was 100 % concordance between the light microscopy and IHC studies. The individual NHL cases were classified according to the WHO/REAL classification according to the positive or relevant negative immonophenotypic expression and tabulated to ascertain the morphological spectrum of NHL in this part of the country. RESULTS: B-cell lymphomas formed 89.3%, whereas T-cell lymphomas formed 10.7% of the NHLs. Diffuse Large B-Cell Lymphoma (DLBCL) was the most common subtype (46.8% of all NHLs). B-cell small lymphocytic lymphoma, Mantle-Cell Lymphoma (MCL), marginal zone B-cell lymphomas (including MALT lymphomas), Diffuse, mixed small cleaved cell and large-cell type and Follicular centre-cell lymphomas amounted to 17%, 12.8%, 2.1%, 2.1% and 4.3%, respectively. Among the T-cell lymphomas, T-cell lymphoblastic lymphoma, anaplastic large-cell lymphomas of T/null-cell type, and Angioimmunoblastic T-cell lymphoma (AITL) accounted for 6.4%, 2.1%, and 2.1% of all NHL cases, respectively. CONCLUSIONS: The distribution of NHL subtypes in India shows disparity with those from the rest of the world. Follicular Lymphoma (FL) and MCL are less common in India compared to Europe and the USA. Peripheral T-cell lymphomas and T/NK-cell lymphomas of nasal and nasal types, which are common in many other Asian countries, are also less prevalent. T-cell lymphoblastic lymphoma and anaplastic large T/null cell lymphoma are more prevalent in India.

Pleomorphic adenoma of external auditory canal.

Pleomorphic adenoma comprises about 80% of the benign salivary gland tumours and is characterised by a slow growth and a clinically benign course. This tumour is known to occur at various other anatomical locations apart from the major salivary glands. Case reports of this tumour arising from the nasal septum, tongue, turbinate, upper lip, lungs, trachea and lacrimal glands have been found in the literature. But case reports of pleomorphic adenoma from the external auditory canal have been extremely few.