Comparative efficacy of imprint and squash cytology in diagnosing lesions of the central nervous system.

INTRODUCTION: Central nervous system lesions can be localized precisely with the help of computerized tomography (CT). However, rapid cytological diagnosis of lesions by imprint and/or squash smear technique is useful to assist the operating surgeon to avoid unnecessary craniotomy. The present study was conducted with the aim to study the sensitivity, specificity and diagnostic accuracy of the two types of smears in central nervous system lesions while taking histology as gold standard. MATERIALS AND METHODS: In the present study 149 lesions of the central nervous system were studied by squash and imprint smear techniques and results were compared with histology. Cytology smears were stained with May-Grunwald-Giemsa and Pap stain. Histopathology smears were stained with haematoxylin and eosin stain. RESULTS: Out of 149 cases, 85 were malignant and 64 cases were either benign or non-neoplastic lesions. The sensitivity, specificity and diagnostic accuracy by squash smear were 90.6%, 87.5% and 89.3% respectively and that of the imprint smears were found to be 92.9%, 90.6% and 92.0%. The combined sensitivity, specificity and diagnostic accuracy of both techniques were even greater (95.3%, 93.8% and 94.6%). CONCLUSIONS: The present study showed that imprint smear examination is superior to the squash smear for diagnosing lesions of the central nervous system.

Pleomorphic lobular carcinoma in a male breast: a rare occurrence.

Carcinoma of male breast is uncommon as it accounts for 0.7% of total breast cancer. The pathology of male breast cancer is remarkably similar to that of cancers seen in women. The same histological subtypes of invasive cancer are present, although papillary carcinomas (both invasive and in situ) are more common and lobular carcinomas are less common. The predominant histological type, in males, as in females, reported in large series has been infiltrating ductal carcinoma with scattered reports of infiltrating lobular carcinoma, all of them of classical type except for a single case of pleomorphic infiltrating lobular carcinoma. Herein, we describe a case of pleomorphic lobular carcinoma occurring in male breast.

Morphometric analysis in potentially malignant head and neck lesions: oral submucous fibrosis.

OBJECTIVE: The objective of this study is to analyze cases of oral submucous fibrosis (OSMF) Grade I, II, III and IV morphometrically with regard to epithelium, vasculature and fibrosis and determine any correlation with histological grading after Pindborg and Sirsat. MATERIALS AND METHODS: Eighty three oral submucous fibrosis cases were analyzed morpometrically using an interactive image analysis system in the Department of Pathology, M.L.N Medical College, Allahabad, U.P, India. Paraffin embedded sections of 3-4 microm thickness were stained with hematoxylin/eosin, Van Gieson's picric acid and acid fuchsin stain and Masson's trichrome stains. Image analysis was performed with specific software (Image Pro Plus 6.0) and data obtained were finally transported to Excel sheets for calculation of average values for each parameter. RESULTS: With the grading criteria applied, 9 cases of OSMF were grade I, 32 grade II, 39 grade III and 3 grade IV. Clinical trismus was most frequent in Grade IV followed by Grade III, II and I respectively. OSMF Grade I cases did not show any measurable amount of collagenization, whereas it showed a significant increase with OSMF I and II grades [Pearson's chi2 test= 85.72; p= 0.051] and OSMF-III and IV [Pearson's chi2 test=188.74; p<0.001]. Numbers of endothelial cells per low power field consistently decreased with the increasing grade. CONCLUSIONS: We concluded that mean blood vessel area and the mean vessel diameter showed a marked increase in grade II and a marker decrease in grade IV and the grade III, collagen thickness (mum) increases according to increasing grade while density of endothelial cells decreases.

Role of intraoperative imprint cytology in diagnosis of suspected ovarian neoplasms.

BACKGROUND: The present study was conducted to assess whether cytology can help in rapid diagnosis of ovarian neoplasms and thus facilitate individualised treatment. METHODS: A prospective investigation was performed on 30 cases of suspected ovarian neoplasms. Imprint smears were made intraperatively from fresh samples from various representative areas, and stained with Leishman Giemsa for air-dried smears, and with hematoxylin and eosin and Papanicolaou for alcohol-fixed smears. A rapid opinion regarding the benign or malignant nature of the lesion and the type of tumour was given. RESULTS: The overall sensitivity was 96.2%, specificity 75%, positive predictive value 96.3%, and diagnostic accuracy of 83.3%. Characteristic cytological patterns were noted in various epithelial and germ cell tumours. CONCLUSIONS: Imprint cytology can be used as an adjunct to histopathology for rapid and early diagnosis in the operation theatre, thus helping better management of patients.

Giant benign schwannoma on scalp causing 'double-head'.

Abstract- Schwannomas are tumors derived from Schwann cells. They are usually small and comparatively rare on scalp. A 25-year old woman presented with huge mass on posterior side of the scalp that gave the appearance of 'double-head'. The mass was excised and reconstruction was achieved by primary closure. Histology proved to be a benign schwannoma. The patient is well at 6-months of follow up. Giant benign schwannoma on scalp is extremely rare. Clinicians that came across the giant tumors of the scalp should suspect this possibility as these tumors have favorable prognosis.

Adenosine Deaminase (ADA) Level in Tubercular Pleural Effusion.

STUDY OBJECTIVE: To study the value of adenosine deaminase level in tuber-cular pleural effusion. DESIGN: A hospital based observational study. SETTING: Out and In patients service of department of Tuberculosis & Chest Diseases, MLN Medical College Allahabad. PATIENTS: 50 consecutive patients of pleural effusion, who were above the age of 12 years, were studied. RESULTS: Pleural fluid adenosine deaminase was more than 36 IU/L (36 to 229.7 IU/L) in tubercular pleural effusion (34 patients). In case of malignancy no. of patients was 08 and pleural fluid adenosine deaminase was more than 18.5 IU/L (18.5 to 87.6 IU/L). While in one case of hypoprotenemiea pleural fluid adenosine deaminase was 8.21 IU/L. If 36 IU/L is taken as cut of limit the sensitiv-ity and specificity of ADA for tuberculosis is 100 % and 77.7 %. More than 100 IU/L was exclusively seen in tubercular pleural effusion. CONCLUSION: ADA > 100IU/L was observed in TB only.

Disseminated peritoneal leiomyomatosis: a case report.

Disseminated peritoneal leiomyomatosis (DPL) is an exceedingly rare condition that simulates metastatic tumour and mostly occurs in women of reproductive age group subjected to an altered hormonal milieu, usually pregnancy. Here we report a case of a pregnant 28 year female with DPL, spontaneously regressing after pregnancy.

Giardia lamblia trophozoites in gastric biopsies.

To assess the prevalence of gastric giardiasis in gastric biopsies of patients with carcinoma stomach and in patients taking treatment for duodenal ulcer. Gastric biopsy specimens from 54 patients of carcinoma stomach and 100 antral biopsies from patients taking treatment for duodenal ulcer were included in the study. Sections were stained with haematoxylin and eosin, methylene blue and May Grunwald-Giemsa stains and examined for presence of Giardia lamblia trophozoites. Eight out of 54 (14.9%) biopsies of gastric carcinoma patients harboured trophozoites of Giardia lamblia. Associated H. pylori infection was present in all biopsies (8/8; 100%). Atrophy and intestinal metaplasia was present in 62.5% (5/8) and 25% (2/8) cases respectively. Sections from seven out of 35 patients (20%) taking treatment for duodenal ulcer showed presence of G. lamblia. H. pylori infection, gastritis and atrophy were found in 85.7% (6/7), 71.4% (5/7) and 28.6% (2/7) cases respectively. First gastric biopsy in these patients was negative for G. lamblia but 2nd and 3rd biopsies were positive. A careful search for G. lamblia trophozoites should be made while examining the gastric biopsies, especially in patients with carcinoma stomach, intestinal metaplasia, atrophic gastritis and those taking treatment for duodenal ulcer. This may help in indirect diagnosis of clinically unsuspected cases of intestinal giardiasis and may explain persistence of vague upper gastrointestinal tract (UGIT) symptoms despite clearance of H. pylori in patients on anti-ulcer therapy.

Extramedullary blast crisis in chronic myeloid leukemia--a case report.

Presence of focal poliferation of myeloblasts at an extramedullary site even when peripheral blood/bone marrow blast count is less than 20% in a case of chronic myeloid leukaemia leads to a diagnosis of blast crisis. A case of focal extramedullary blast crisis with chronic myeloid leukaemia is reported here.

Inflammatory fibroid polyp of small intestine in a child.

Inflammatory fibroid polyps are rare lesions that are usually solitary and affect adults. We report an inflammatory fibroid polyp in a 7-year-old boy who presented with intestinal obstruction. He recovered after excision of the affected segment of ileum.

Schwannoma of maxillary sinus.

Schwannoma, also known as neurilemmoma, is a solitary, encapsulated peripheral tumour of neuroectodermal derivation that originates from schwann cells of neural sheath of motor/ sensory peripheral nerves or sympathetic nerves. About one- third of all schwannomas occur in head and neck region but nose and paranasal sinuses, are rare sites. We report a case of schwannoma arising from the maxillary sinus and eroding the orbital floor. To the best of our knowledge, this is the sixth; case of schwannoma solely arising in the maxillary sinus, reported in the literature.

Pleomorphic lipoma of the tonsillar fossa--a case report.

Pleomorphic lipoma is a benign adipocytic tumor, commonly located in the shoulder and posterior neck region. The presence of bizarre, hyperchromatic stromal cells along with multinucleated giant cells often poses difficulty in diagnosis, especially when it arises at an unusual site like tonsillar fossa.

Spectrum of Head-Neck cancers at Allahabad.

A retrospective study of Head-Neck malignancy was conducted at Allahabad over a period of twenty two years from 1975 to 1996. During this period, 5,386 new Head-Neck Cancer cases were reported. Peak presentation of males was in sixth decade and in females it was in fifth decade of life. The sex ratio in this series was 3∶6∶1 while reverse sex ratio was observed in malignancies of thyroid, alveolus-gingiva, nasal cavity and post-cricoid region. Oral cavity lesion was the predominant cancer followed by larynx and oropharyngeal malignancy. Histologically, majority (89.97%) were squamous cell carcinoma with varied differentiation. Factors responsible for the high incidence of Head-Neck Cancers are discussed. An argent need is felt for the prevention and cessation strategies to achieve the goal of smoke free society by the year 2000 as expressed by Dr. Knoop so as to revert back the present trend of preventable Head-Neck Cancers.

Clinico-histopathological concordance in leprosy.

Histopathological examination of biopsies from 111 patients with clinically diagnosed leprosy was carried out in order to observe the clinico-histopathological correlation. Clinical diagnosis was based on Ridley and Jopling (R-J) classification and World Health Organization (WHO) classification. The concordance rate between the two clinical classifications was 73.8%. Sections were stained with haematoxylin and eosin (H&E) and Ziehl-Neelsen's (Z-N) stains. The histological classification was as per the R-J criteria. Skin biopsy showed evidence of leprosy in 104 cases (93.69%). Overall concordance was observed in 58.6% (R-J) and 85.6% (WHO classification). The kappa test, when applied, showed significant agreement between clinical and histopathological diagnosis (z=11.775; P<0.001). Individual subtypes showed variable concordance rates which were again higher using WHO classification. When some of the subtypes were combined, the concordance rate was 83.02% for TT+BT; 72.58% for BT+BB+BL; 73.91% for BL+LL; 80.77% for BL+HL and 100% for LL+HL. (See Introduction for definitions of abbreviations.) The present study highlights the importance of histopathological examination for exact subtyping of leprosy, so as to facilitate the institution of accurate mode of therapy and regular follow-up of patients to prevent undesirable complications.

Histological changes to palatal and paratubal muscles in oral submucous fibrosis.

Oral submucous fibrosis (OSMF) is prevalent in the Indian subcontinent. In a large number of patients conductive deafness due to eustachian tube dysfunction has been found. The present study was, therefore, planned to assess the histopathological changes in palatal and paratubal muscles in oral submucous fibrosis. Incisional biopsy from the soft palate was taken in clinically proven cases of OSMF. In most of the cases, signs of chronic inflammation and fibrosis were seen in the submucosa. Dysplasia was noticed in seven (13.2 per cent) patients. Degenerative changes in palatal/paratubal muscles were found in the form of loss of cross striations in seven (13.2 per cent), oedematous muscle fibres in five (9.4 per cent) and atrophy in five (9.4 per cent) cases. It was concluded that there was definite involvement of palatal and paratubal muscles in OSMF. This could explain the eustachian tube dysfunction in these patients.

Gall stones and carcinoma gall bladder.

One hundred and fifty surgically resected gall bladder specimens were included in the study to evaluate the relationship between the prevalence of gall stones and histochemical alteration in sequential changes of metaplasia, dysplasia and neoplasia in gall bladder epithelium. Multiple sections were processed and stained with haematoxylin and eosin, Periodic acid Schiff's stain, Alcian blue (pH 2.5)/Periodic acid, Orcein/Alcian blue (pH 2.5) and Alcian Blue/Periodic acid/Potassium borohydride saponifications stains. Details of gall stones present were also noted. Prevalence of gall stones in gall bladders with metaplastic, dysplastic and neoplastic mucosal changes was significantly higher (P < 0.001) than those gall bladders which had no epithelial changes. Increase in sialomucin with a corresponding decrease in sulphomucin was observed from metaplasia to malignancy. Neutral mucin increased in metaplastic cells but was significantly reduced in neoplastic cells. Loss of O-acylation in sialmucin was also present in neoplastic cells. The histochemical changes suggest that chronic injury due to cholelithiasis induces appearance of neutral mucin positive metaplastic cells, which may further dedifferentiate to sialomucin containing dysplastic or neoplastic cells if the stimulation persists.

Evaluation of the one-minute ultra-rapid urease test for diagnosing Helicobacter pylori.

To determine the diagnostic accuracy of the one-minute ultra-rapid urease test for diagnosing Helicobacter pylori infection, two biopsies were taken from both the gastric corpus and antrum from 1000 patients undergoing upper gastrointestinal endoscopy. All the biopsies were subjected to the one-minute ultra-rapid urease test before imprint smears were prepared from them. Thereafter, the biopsies were fixed in 10% formalin and histological sections were examined for the presence of H pylori by a pathologist who was not aware of the clinical details or the results of the urease test. The prevalence of H pylori in the gastric antrum and corpus was 86.7% and 53.3%, respectively. The sensitivity, specificity, positive and negative predictive value and the overall diagnostic accuracy of the ultra-rapid urease test to diagnose H pylori infection in the gastric antrum were 92%, 100%, 100%, 66%, and 93%, respectively. The corresponding figures for the gastric corpus were 83%, 100%, 100%, 85%, and 91%, respectively. It is concluded that the one-minute ultra-rapid urease test has a high sensitivity and specificity and may be used as a rapid and cheap method to diagnose H pylori infection.

Preoperative sonographic diagnosis of acute appendicitis caused by Ascaris lumbricoides.

Acute appendicitis caused by Ascaris lumbricoides is an uncommon variant of a common disease. We describe a case in which sonography was used for preoperative diagnosis of ascaris appendicitis.