Evaluation of the category high-grade squamous intraepithelial lesion in The Bethesda System for reporting cervical cytology.

BACKGROUND: High grade squamous intraepithelial lesion (HSIL) is a category of The Bethesda System (TBS) for reporting cervical cytology that is in vogue since the introduction of the said system in 1988 and it was not modified in 2001 modification of TBS. The term includes moderate dysplasia (CIN II), severe dysplasia (CIN III) and squamous cell carcinoma in situ. Terms like ASC-US used in TBS are being considered to be not very useful in the prediction about the possible behavior of the pathological status of the cervix. After more than 10 years of use the term HSIL also needs fresh evaluation as in this category two entities of potentially different outcome are clubbed. AIMS: The aim was to find out whether it is justified to have a term like HSIL which includes different points of the spectrum of intraepithelial pathology of cervix from moderate hyperplasia through carcinoma in situ, all having different significance. MATERIALS AND METHODS: In this study 619 cases of cervical cytology reported by TBS were evaluated by comparing them with biopsy reports of the same lesion for the assessment of the sensitivity, specificity and positive predictive value of HSIL as a category of diagnosis in TBS. RESULTS: As a category, HSIL had the diagnostic sensitivity of 96.4%, specificity of 87.5%. The positive predictive value was 96.4%. CONCLUSION: HSIL as a diagnostic category shows a very good predictive accuracy, which implies that it provides a very high probability of the accurate diagnosis collectively of all the conditions in the disease spectrum from moderate dysplasia through in situ carcinoma. Hence, HSIL was found to be a very useful diagnostic category in TBS that conveys proper message to the clinician.

Vanishing bone disease (Gorham's disease) - a rare occurrence of unknown etiology.

A 20-year-old male patient presented with painful swelling around left elbow joint. Radiographic examination revealed osteolytic lesion with pathological fracture of lower end of humerus and upper radius. Upper end of ulna was completely absent along with bony erosion. Histopathology of the bony tissue revealed hemangioma-like lesion composed of vascular channels lined by benign endothelium replacing bone. The diagnosis of Gorham's massive osteolysis was made. Gorham's disease is a benign self-limiting condition affecting any age, may involve any part of the skeleton and is characterized by replacement of bone by hemangiomatous tissue resulting in formation of lesions exhibiting massive osteolysis, which may be to the extent of disappearance of the affected bone in radiograph. This nonhereditary case was not associated with nephropathy, which is often a coexistent condition. The case is being reported for its rarity.

Study of histopathological features and proliferation markers in cases of Wilms' tumor.

CONTEXT: The spectrum of pediatric renal tumors is different from adult renal tumors, and Wilms' tumor (WT) forms the majority. The histological type and clinicopathological staging are the two important prognostic parameters. The role of newer prognostic factors is not clear. AIMS: This study was performed to analyze the histopathological spectrum of pediatric renal tumors and to study the expression of proliferation markers (Ki-67 and p53) in WT and correlate its expression in epithelial and blastema components in different stages. MATERIALS AND METHODS: Twenty-seven cases of pediatric renal tumors were collected over 2 years. Hematoxylin-eosin staining was used for diagnosis. Immunostaining was performed for Ki-67 and p53. Ki-67 proliferation index (PI) and p53 expression were determined in each case and for the epithelial and blastema components separately. STATISTICAL ANALYSIS AND RESULTS: We had 20 cases of WT (74.1%), three cases of mesoblastic nephroma (11.1%), three cases of clear cell sarcoma (11.1%) and one case of rhabdoid tumor (3.7%). It was observed that the PI of the epithelial component (57.2%) was significantly higher than that of blastema (39.53%) in all stages. The PI in Stage II is significantly higher than that in Stage I. Statistical analysis could not be performed in Stages III and IV due to the small number of cases. p53 expression did not show any significant difference in the epithelial and blastema components. There was also no significant difference between the stages. CONCLUSION: In this study, we found the differences between PI of different tissue components of WT, with the epithelial component having a higher PI, which correlated with the stage of advancement of the disease.

Endodermal sinus tumor of the vagina in children: a report of two cases.

Malignant tumors of the vagina in infants and children are rare, with primary germ cell tumor (endodermal sinus tumor [EST]) being rarer, which carries a dismal prognosis. This tumor is often clinically mistaken as botryoid rhabdomyosarcoma and, on histopathological examination, is often misdiagnosed as clear cell adenocarcinoma. Two cases of EST of the vagina in infants aged 9 and 17 months are reported. Both the patients presented with bleeding per vagina and clinically and by ultrasonography were diagnosed as sarcoma botryoides. Both were diagnosed as primary yolk sac tumors. The serum alfa fetoprotein (AFP) level was 4325 and 9328 ng/ml, respectively. One patient aged 9 months expired 2 months after receiving chemotherapy. The other, aged 17 months, was given chemotherapy followed by surgery with reduction of the AFP levels.

Sulfur free radical reactivity with curcumin as reference for evaluating antioxidant properties of medicinal zingiberales.

Rhizome extracts of some members of the medicinal Zingiberales are widely used in dietary intake as well as in the traditional system of medicine. Curcumin, the chrome orange-yellow coloring compound present in turmeric rhizomes, has long been known to possess antioxidant property. Crude methanol extracts of the rhizomes of 11 species--Alpinia allughas, A. galanga, Curcuma amada, C. caesia, C. leucorrhiza, Hedychium coronarium, H. coccineum, H. flavescens, Kaempferia galanga, Zingiber cassumunar, and Z. officinale--were evaluated for their antioxidant properties using sulfur free radical reactivity with curcumin as a reference indicator. Sulfur free radicals (GS.) are generated by irradiating 15 mM glutathione (GSH) solution using a 5100 Ci cobalt-60 gamma irradiator. As reference indicator for the reactivity with sulfur free radicals, we used the depletion of pure curcumin sample in vitro as determined by a simple spectrophotometric method. The addition of the supernatant from crude rhizome extracts to the reaction mixture significantly decreased the depletion of curcumin, indicating that these crude extracts possessed antioxidant properties. The relative curcumin protection by different crude extracts against GS. showed that Z. cassumunar gave the highest degree of radioprotection. Our results reveal the potential medicinal use of rhizomes of medicinal Zingiberales as dietary agents.