Clinical and Histopathological Characteristics in Women With Postmenopausal Bleeding: A Study of 120 Women in a Tertiary Care Hospital in Punjab.

Background Postmenopausal bleeding (PMB) is defined as blood loss from the genital tract occurring 12 months or more after an individual's last menstrual period. It is important for women to recognize abnormal symptoms during menopause, with PMB being one of the most critical. PMB is a common clinical presentation and can be indicative of endometrial carcinoma. A thorough clinical assessment and endometrial histopathology can ensure early diagnosis and treatment of malignancy in high-risk patients. Materials and Methods This study included 120 women with PMB. Their clinical and histopathological characteristics were studied, and correlations between the characteristics were investigated. Patients were evaluated according to their age, parity, duration of menopause, and socioeconomic status. Various comorbidities such as diabetes mellitus, hypertension, and obesity were noted. Results The patients ranged in age from 45 to 80 years, with a mean age of 54.97 ± 5.86 years. Fifty-nine (49.16%) of the patients presented with PMB within 3 years of menopause. PMB was seen most commonly in patients with parity 3, accounting for 37 (30.83%) of the cases. Endometrial thickness was increased in 100 (83.33%) cases. The most common causes of PMB were simple hyperplasia without atypia (SHWOA) in 36 (36%) patients and atrophic endometrium in 14 (14%) patients. Twelve (10%) of the patients had endometrial carcinoma. Benign causes of PMB were present in 91 (75.3%) cases, whereas 29 (24.1%) had a malignant cause. Weakly positive, but significant correlations (P < 0.05) were seen between the development of malignancy and increasing age (Pearson correlation coefficient, r = 0.263) parity (r = 0.244), and body mass index (r = 0.272). Conclusions PMB is considered abnormal. Benign causes are more common, but malignant causes are possible. In the current study, endometrial carcinoma was the most common malignant cause of PMB. Endometrial carcinoma incidence increased with greater endometrial thickness and more years since menopause. Histopathological examination remains the criterion standard for the correct diagnosis. Initiatives are recommended for increasing awareness about PMB to support prompt medical attention for a better prognosis.

Outlook of Gleason score in prostate carcinoma and correlation with PSA levels: A study in a tertiary care hospital.

Introduction: In India, prostate carcinoma is the fifth most common cause of carcinoma in men, and the fourth in cancer mortality. Incidence of prostate malignancy is increasing in India by one percent every year. Prostate carcinoma is graded using the Gleason scoring system. The Gleason score is very useful for predicting the prognosis of prostate carcinoma. The collaborative use of clinical features, combined with the size of the prostate, prostate-specific antigen levels, and histopathological features helps in making an accurate and early diagnosis of the patients. Material and Method: This present prospective study included all histologically proven cases of prostate carcinoma in the Department of Pathology, Guru Gobind Singh Medical Hospital over a period of one year. A detailed histopathological examination of the H and E stained sections is carried out under light microscope including histological typing, Gleason scoring and grading. The Gleason grade was correlated with serum PSA levels. Results: Out of 80 cases, 28 (35%) were reported as Gleason grade group 3 with a Gleason score of 7 (4 + 3). 12 cases (15%) showed a Gleason grade group 2 with a Gleason score of 7 (3 + 4). Grade group 4 (Gleason score 8) and grade group 5 were observed in 22 cases (27.5%) and 18 cases (22.5%), respectively. Whereas, no case of Gleason grade group 1 with Gleason score of 6 (3 + 3) was seen. Conclusion: Gleason's Group Grade 3 outnumbered all the group grades, contributing 35% (28 cases) of the total cases of prostatic adenocarcinoma. Serum PSA levels were raised (>10 ng/ml) in 100% of cases. Henceforth, it signifies the importance of serum PSA levels in prostate carcinoma. Lymphovascular invasion was associated with higher group grade of prostatic adenocarcinoma.

Metaplastic breast carcinoma with mesenchymal differentiation: A case series.

ABSTRACT: The metaplastic breast carcinoma is a rare malignancy with an incidence of 5% of all breast tumors. Metaplastic carcinoma of the breast with mesenchymal differentiation (MCMD), previously known as carcinosarcoma, is a very rare and aggressive tumor that has been recently classified as a subtype of metaplastic breast carcinoma. It accounts for 0.08%-0.2% of all breast cancers, with only a few cases reported in the literature. Metaplastic breast carcinoma most often affects women over 50 years of age, with an average age between 55 and 60 years. We report three cases of metaplastic breast carcinoma with mesenchymal differentiation presented at our hospital. Patients were in their 4th decade. All patients presented with a fast-growing large mass and were treated surgically (mastectomy), with the final histopathological diagnosis of MCMD.

Clinico-hematological profile of pancytopenic adult patients in a tertiary care teaching hospital.

OBJECTIVE: The causes of pancytopenia vary in different populations depending on age, gender, nutrition, geographic location, standard of living, and exposure to certain infections and drugs. As the severity of pancytopenia and its underlying etiology determine the management and prognosis, identifying the correct etiology in a given case is crucial and helps in implementing timely and appropriate treatment. The objectives of this study were to study the clinical profile and hematological parameters of pancytopenic adults and to identify different etiologies of pancytopenia. This observational study was conducted in the Medicine department of a tertiary care teaching hospital. MATERIALS AND METHODS: The study was conducted on 100 adult patients aged 18-65 years presenting with pancytopenia. All the participants were subjected to detailed clinical examination and relevant investigations including bone marrow (BM) examination. Categorical variables were presented in number and percentage (%). Qualitative variables were correlated using the Chi-square test. A P =0.05 was considered statistically significant. RESULTS: A female preponderance was observed, and the majority of patients were aged between 18 and 40 years. The most common clinical features were generalized weakness, fever, and pallor. Seventy-four percent of patients were vegetarians; 58% had vitamin B12 deficiency, 25% had folic acid deficiency and 19% had a deficiency of both. The most common cause of pancytopenia was megaloblastic anemia (MA) (37%), followed by dimorphic anemia (DA) (26%), aplastic anemia (AA) (20%), and hematological malignancies (11%). CONCLUSION: MA, DA, and AA are the most prevalent etiologies of pancytopenia. BM examination is of utmost importance in the definitive diagnosis of pancytopenia and is useful in initiating timely treatment as a significant number of causes of pancytopenia are potentially curable.

Superinfection of mature ovarian cystic teratoma in a child: An unusual presentation.

Mature cystic teratoma is the most common type of ovarian germ cell tumor. The presentation ranges from its asymptomatic nature to various complications such as torsion, rupture, and malignant change. The present case summarizes the rarest complication in the form of superinfection in a young girl without preexisting risk factors.

Synchronous Primary Endometrial Carcinoma and Metastatic Malignant Melanoma in Cervical Lymph Node.

The occurrence of dual malignancies is not rare but concurrent occurrence of two malignancies with different histogenesis and different anatomical sites is not known. In the studies which have been conducted so far, none of them has shown the simultaneous occurrence of metastatic malignant melanoma and primary endometrial carcinoma. We report herein a case of a 42-year-old female diagnosed with metastatic malignant melanoma in cervical lymph node with unknown developing primary endometrial carcinoma within two months. No foci of primary malignant melanoma were found in uterus. Dual primary malignancy is being suggested by the presence of two malignancies in a patient with different morphological picture on histopathological examination, at anatomically distinct sites. Malignant melanoma and endometrial carcinoma, being a rare combination, prompted us to report the case.

Isolated Vaginal Neurofibroma Presenting as Vaginal Wall Cyst: A Rare Case Report With Review of Literature.

Neurofibromas commonly involve peripheral nervous system. Isolated neurofibroma of vagina is very rare tumor and usually associated with Von Recklinghausen's disease. Vulva is the most frequent location of neurofibroma of genital tract followed by clitoris and labia. We present a rare case of neurofibroma of vaginal wall presented as vaginal cyst in a 52 year old female with no history of any other symptoms related to Recklinghausen's disease. Excision biopsy was done and on the histopathological examination non-encapsulated, well circumscribed mass composed of spindle shaped cells with wavy nuclei and bland nuclear chromatin was noted. Immunohistochemistry revealed strong positivity with S-100.

Rapid transformation of chronic lymphocytic leukemia to acute lymphoblastic leukemia: A rare case report.

Chronic lymphocytic leukemia (CLL) is characterized by the accumulation of mature-appearing lymphocytes in blood, bone marrow, lymph nodes, and spleen with a median lymphocyte count of 20-30 × 10(9)/L at the time of diagnosis. In half of the patients, the lymphocyte count doubles over a period of 1-year and cyclic rise up to 50 × 10(9)/L can occur in untreated patients while in others the count may remain stable for years. Based on the cytogenetic and molecular studies, it has been demonstrated that multiple clones may occur in CLL and clonal evolution is a frequent occurrence. The transformation of CLL to a high-grade non-Hodgkin's lymphoma such as diffuse large B cell lymphoma, Hodgkin lymphoma, and prolymphocytic leukemia is well documented. Whereas the transformation of CLL to acute leukemia occurs in <1% cases and this contrasts the almost invariable progression in patients with chronic myeloid leukemia. Here, we report a rare case of a 55-year-old lady, a diagnosed case of CLL transforming into B-cell acute lymphocytic leukemia over a very short interval of 1 week period.

Postchemotherapy histopathological evaluation of ovarian carcinoma: a 40-case study.

Ovarian carcinomas are conventionally treated with primary debulking surgery followed by chemotherapy. Nowadays neoadjuvant chemotherapy followed by surgery is an upcoming treatment modality for ovarian carcinoma. This study highlights the histopathological changes observed after neoadjuvant chemotherapy. Present study is a 40-case study stressing five histological parameters: residual tumour, fibrosis, necrosis, inflammation, and psammoma bodies. All these parameters carry prognostic significance and they are easily reproducible. Fleiss kappa statistics were used to measure intraobserver agreement between pathologists which was found to be substantial to almost perfect with κ ranging between 0.621 and 1.00. This study highlights easily reproducible parameters and their incorporation in histopathology report, thus helping in patient management.

Benign Vulvar Adnexal Tumours - A 5 year Study in a Tertiary Care Hospital.

Despite of the fact that the vulva contains a high density of apocrine and anogenital mammary glands in addition to eccrine glands and folliculosebaceous units, the benign vulvar adnexal tumours are rare. Though the varied clinical presentation and diverse histopathological spectrum of vulvar neoplasms has amazed the pathologists, only few studies have been reported in literature. The present five year study consists of only five cases of benign vulvar neoplasms depicting their rarity. Hidradenoma papilliferum and syringoma were the most common entities followed by Chondroid syringoma. The aim of our study is to explore and highlight the histopathological diversity of benign vulvar adnexal tumours reflecting the relative frequency of these structures.

Vulvar syringoma: a rare case report.

Syringoma is a benign eccrine sweat gland tumour affecting mostly females at puberty as multiple soft papules usually 1-2 mm in diameter. The sites of predilection are lower eyelids, cheeks. Syringoma of the vulva is a rare disorder. Only few cases have been reported in the literature. We report here a case of 46-year-old female who presented to gynecology department with vulvar papules associated with vulvar itching and burning since two years. Microscopic examination of the punch biopsy revealed numerous small ducts lined by two layers of epithelial cells embedded in a fibrous stroma. Some of the ducts showed small comma like tails of epithelial cells imparting them a tadpole shape. Despite being a rare diagnosis, vulvar syringoma should be kept in differential diagnosis with vulvar pruritus.

Histopathological audit of 373 nononcological hysterectomies in a teaching hospital.

Hysterectomy, the most common gynecological surgery, provides a definitive cure to various diseases like DUB (dysfunctional uterine bleeding), leiomyoma, adenomyosis, chronic pelvic pain, prolapse, and malignancy. However, with advent of effective medical and conservative treatment modalities for nononcological causes it is now posing question mark on justification of hysterectomy. Therefore, an audit is required to assess the correlation between preoperative diagnosis and histopathological examination of specimen for justification of the procedure. In this study over period of one year (April 2013 to March 2014) 373 hysterectomies specimens were received in the department of pathology for nononcological causes. The age of patients ranged from 22 to 85 years with mean 45 ± 9.2 years. All cases were divided into five categories on the basis of age and audit was done. In this study the most common finding was leiomyoma (43.7%) followed by adenomyosis (19.3%). Almost 50% of hysterectomies causes were justified as preoperative diagnosis matched with histopathology. Cohen kappa statistics were used to measure agreement between preoperative and postoperative histopathological diagnosis which was found to be fair with κ value being 0.36. This study highlights that regular audit of surgeries can help improve quality of health care services and provide safe conservative option to patients.

A clinicopathological and immunohistochemical correlation in cutaneous metastases from internal malignancies: a five-year study.

Cutaneous metastases from internal malignancies are uncommon and occur in 0.6%-10.4% of all patients with cancer. In most cases, cutaneous metastases develop after the initial diagnosis of the primary internal malignancy and late in the course of the disease. Skin tumors are infrequent in Asian population and cutaneous metastases are quite rare. Cutaneous metastases carry a poor prognosis with average survival of few months. In the present five-year study 1924 malignant tumors were screened which included only nine cases of cutaneous metastatic deposits. A wide range of site and clinical presentations including nodules, plaques, and ulcers was noted. Histopathological findings were significant and corresponded with the primary internal malignancy. Cutaneous metastases from breast carcinoma (44.4%) were the most common finding followed by non-Hodgkin lymphoma and renal cell carcinoma (22.2% each) and carcinoma cervix (11.1%). The aim of our study is to classify the cutaneous metastases and to evaluate their clinicopathologic and immunohistochemical correlation with the primary tumor.

Tuberculous otitis media and lupus vulgaris of face: an unusual association.

Tuberculous otitis media is a rare extra-pulmonary presentation of tuberculosis. Tuberculous otitis media is usually associated with pulmonary tuberculosis or tuberculosis involving nasopharynx and oropharynx. Lupus vulgaris is the most common morphological variant of cutaneous tuberculosis. The disease often affects the face and may be associated with nasal or nasopharyngeal tuberculosis. Lupus vulgaris associated with tuberculous otitis media is not reported in English literature. We report a case of 40 year old female patient who presented with symptoms of chronic suppurative otitis media and non-healing skin lesion of face. The biopsy of skin lesion showed granulomatous pathology and helped us to reach a diagnosis of tuberculous otitis media.