Inking in Surgical Pathology: Does the Method Matter? A Procedural Analysis of a Spectrum of Colours.

OBJECTIVE: Proper identification of surgical margins along with margin status holds utmost importance in histopathology. Inking margins is one way. India ink has long been used but it can ink only one margin. On other hand acrylic colours, available in variety of colours can be used for inking multiple margins along with many more advantages. The present study was undertaken to analyse acrylic colours and Indian ink for inking surgical margins via three different methods for optimum results. MATERIAL AND METHOD: Thirteen acrylic colours along with India ink were evaluated via three different methods on radical specimens of breast and colon after preliminary requisites of grossing were completed. In Method 1, coloured inks were applied to an overnight formalin fixed specimen and representative sections were taken. In Method 2, the specimen was inked and kept for overnight fixation. The specimen was sampled following day. In Method 3, the specimen was inked and kept for overnight fixation. The following day, it was re-coloured with the same colours as of the previous day and subsequently sections were taken. Coloured inks were assessed on different parameters for their performance as surgical ink and given scores. RESULTS: Acrylic shades #04, #22, #06, #01, #02 and India ink had very good to excellent score on microscopy in all three methods. Shades #64, #18, #09, #23 had poor microscopic visibility in all three methods. Shade #09 showed loss of colour and the shade #23 showed penetration into deeper tissues on microscopy. Results were best with Method 3 followed by Method 1 and 2, respectively. CONCLUSION: Acrylic colours have more advantages compared to India ink. Method 3 is recommended for inking. Few acrylic shades meet the criteria of surgical inks in all three methods.

The spectrum of histopathological lesions in scarring alopecia: a prospective study.

INTRODUCTION: The aim of the article was to study the histopathological features of various lesions of Scarring Alopecia (SA) and to classify Primary SA on the basis of the predominant type of inflammatory cell component. Scarring or cicatricial alopecias are those that are produced as a result of the malformation, damage or destruction of the pilosebaceous follicles, which are replaced by cicatricial tissue, in such a way that they cannot again produce hair. MATERIAL AND METHODS: This prospective study included 32 biopsy - proven cases of SA, who had attended our hospital. Primary SA was classified according to the North American Hair Research Society. The informed consents of the subjects and the institutional ethical clearance was obtained for the study. The SPSS, version 14 software was used to analyse the data. Frequencies and percentages were used to describe the data. RESULTS: During the study period, 32 cases of scarring alopecia were diagnosed, of which 24 were primary SA and 8 were secondary SA. Among the primary SA, there were 23 cases of lymphocyte associated primary scarring alopecias, of which, 19 of lupus erythematosus, 3 of lichen planopilaris (LPP) and one case of non specific SA. 1 case of neutrophil associated primary scarring (folliculitis decalvans) was also noted and among the secondary SA, there were 4 cases of morphea and 1 case each of lupus vulgaris, congenital absence of skin, burn and sarcoidosis. CONCLUSION: To conclude, histopathology is a dependable tool for identifying the underlying cause in scarring alopecia, which is helpful for an early diagnosis and treatment.

An Extra-adrenal Pheochromocytoma Presenting as Malignant Hypertension-A Report of two cases.

Malignant hypertension is a complication of hypertension characterized by elevated blood pressure (200mm/140mm Hg), is considered a medical emergency and is rarely secondary to paraganglioma. Malignant hypertension is unique in its relationship to a catecholamine secreting paraganglioma. We present two rare cases of malignant hypertension associated with paraganglioma of tonsil and urinary bladder.

A hairy cell leukaemia variant - a rare case report.

The aim of the article is to present a rare case of Hairy cell leukaemia variant (HCl-V) which is a distinct clinico-pathological entity with intermediate features between classical HCl (HCl-C) and B-cell prolymphocytic leukaemia. It is an uncommon disorder accounting for approximately 0.4% of chronic lymphoid malignancies and 10% of all HCl cases. A 58 year old woman presented with pain abdomen and loss of weight. On examination she had massive splenomegaly. Peripheral smear was reported as chronic lymphoproliferative disorder (? Hairy cell leukemia or splenic lymphoma with villous lymphocytes). On Bone marrow examination, differential diagnosis was given as splenic lymphoma with villous lymphocytes (SLVL) and prolymphocytic variant of Hairy cell leukemia. On flow cytometric analysis, these cells were positive for CD11c, CD19, CD20, and CD22. Based on the clinical, peripheral smear, bone marrow and flow cytometry findings, a diagnosis of hairy cell leukaemia variant was confirmed. The differential diagnosis should always include SLVL, HCL-C and Japanese variant HCL because they have different clinical and biological features, particularly regarding their response to purine analogue-based treatment or splenectomy.

A Clinico-Pathological Study of Lichenoid Tissue Reactions-A Tertiary Care experience.

INTRODUCTION: The aim of this article was to study the spectrum of clinico-histopathological lesions with an age and sex distribution in various lichenoid reactions of the skin. The spectrum of clinical diseases which is related to the lichenoid tissue reaction is wider. There is a recent increase in the relatively new subgroups of the lichenoid clinical picture. MATERIAL AND METHODS: This was a one and a half year prospective study which was conducted in the Dermatopathology Section of the Department of Pathology, from January 2011 to June 2012. All the patients who visited the Dermatology Outpatients/ Inpatients Department and presented with lichenoid tissue reactions were included in the study. The selected patients' clinical findings were noted and their informed consents and an institutional ethical clearance were taken. Light microscopy was used for the histopathological diagnosis. The SPSS, version 14 software was used to analyze the data. Frequencies and percentages were used to describe the data. RESULTS: During the study period, 107 cases were clinically diagnosed as lichenoid reactions, of which 84 cases were concordant on histopathology and 6 cases were diagnosed, solely based on the histology. So, a total of 90 cases were diagnosed histologically, of which 42 were of the Lichen planus type and 48 were lichenoid eruptions. Females were affected more commonly than the males. CONCLUSION: In our study, the lichenoid reactions were more common in children and the most common prototype was Lichen planus. So, we conclude that histopathology is a dependable tool for identifying the underlying cause in lichenoid reactions.