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Introduction: Bladder cancer is the tenth most common cancer worldwide, with 90% of bladder cancers are Urothelial Carcinoma (UC). In India, its incidence is 1.6 per lakh population annually. GATA3 is a recently used immunohistochemical marker which is highly sensitive for UC. Alterations in the p53 pathway play an important role in tumour progression and the assessment of prognosis. Aim: To study the expression of GATA3 and p53 in UC and their association with clinicopathological parameters. Materials and Methods: An ambispective cross-sectional study was conducted in the Department of Pathology, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India, from September 2020 to August 2022. A total of 50 cases of histologically proven UC were subjected to immunohistochemistry with GATA3 and p53. The expression of GATA3 and p53 was evaluated in UC, and their association with clinicopathological parameters like age, gender, personal habits, tumour site, symptoms and signs, histological grade, and invasion into lamina propria and muscle was studied. The Chi-square test was used to determine the relationship between all parameters, with a p-value

Background: Membranoproliferative glomerulonephritis has in the recent past been regrouped into immune complex-mediated (ICM MPGN) disease (driven by the classical complement pathway) and complement-mediated (C3GN) disease (driven by the alternative complement pathway) based on pathogenetic role of alternative complement pathway and immunofluorescence deposits. The proposed regrouping lent therapeutic and prognostic support in managing the disease of MPGN. Aims and Objectives: The present study is undertaken to study the patterns of MPGN based on histopathological and DIF examination and sub-categorize the cases into mainly complement dominant and immune complex-mediated diseases for better prognostic and therapeutic utility. Materials and Methods: This is a prospective observational study carried out in a tertiary care center over a period of 2 yrs. The clinically suspected cases of MPGN were subjected to histopathologic and direct immunofluorescence examination (DIF), and the findings were interpreted in light of complement-mediated and immune complex-mediated MPGN. Results: Out of 620 renal biopsies, diagnosis of MPGN was confirmed both on histopathology and DIF in 36 cases accounting for 5.8% of all biopsies. Based on DIF findings, the various groups comprised 20 cases (55.6%) of immune complex deposits, 11 (30.5%) of C3 dominant picture, and 5 (13.9%) of Nil immune deposits. On analysis of the patterns on DIF, 16 cases (80%) of C3 + Ig group and 6 (54.5%) of C3GN group showed predominantly MPGN pattern. Crescentic glomerulonephritis, global glomerulosclerosis, and interstitial fibrosis were markedly observed in C3GN group. Conclusion: DIF is of immense prognostic and therapeutic value in managing cases of MPGN.

Introduction: The aim of this study was to evaluate the immunohistochemical expression of C4d in native renal biopsies of proliferative glomerular diseases, complement pathways in these diseases, and assess the relationship of C4d with histological and clinicopathological parameters, other complement proteins, and immunoglobulin markers. Methods: This cross-sectional study was conducted during the year 2018-19 involving 107 native renal biopsies with histologically diagnosed cases of proliferative glomerular diseases. C4d immunohistochemical evaluation of renal tissue sections was performed using polyclonal antihuman C4d as the primary antibody. Patients were classified as positive and negative groups based on their glomerular C4d deposition. Results: The overall prevalence of C4d positivity was 80.4% in proliferative glomerular diseases ranging between 60.0% in C3 glomerulonephritis to 92.9% in membranoproliferative glomerulonephritis. Mixed capillary and mesangial deposition were noted in all cases of proliferative glomerulonephritis. Classical pathway was dominantly involved in all glomerular diseases except C3 glomerulonephritis and IgA nephropathy. Multivariate logistic regression analysis revealed that glomerular IgG staining (aOR: 5.86, 95% CI: 1.26–27.14) and IgM staining (aOR: 3.90, 95%CI: 1.07–14.18) were significantly associated with C4d positivity. Conclusion: C4d staining along with immunoglobulin markers such as IgG and IgM and complement proteins can be useful in delineating different complement activation pathways in glomerular diseases and understanding the disease pathogenesis.

Xanthogranulomatous Oophoritis is an uncommon form of chronic inflammation of genitourinary system. The exact aetiology of this entity is unknown, but it shares similar histopathological findings to those occurring in various other organs, including the gallbladder and kidney. It is often mistaken for ovarian malignancy clinically and radiologically. A vigilant histopathological evaluation is important to diagnose the disease. The current case is of 38-year-old, premenopausal female who presented with fever and lower abdominal pain. The case was suspected as bilateral malignant adnexal mass by imaging and tumor marker studies. Final diagnosis of bilateral xanthogranulomatous oophoritis was established after histopathological examination.

Opportunistic infections affecting central nervous system (CNS) have high prevalence in developing countries and cryptococcosis is one of them. It is associated with myriad of signs symptoms and clinical behavior. Though commonly associated with AIDS/HIV infection, it has been reported to be pathogenic in immunocompetent patients. Leptomeningitis is most common presentation in CNS, but unusual tumor like mass lesions have been reported. Lungs are primary site of infection, but it can affect different organs with varied clinical presentations. Therefore, correct diagnosis and proper management is essential in such cases excluding the differentials as fatality rate can be quite high. We report such an unusual case of multiple cryptococcal mass lesions in brain in a healthy immune competent individual with bilateral pulmonary involvement.

Clear Cell Sarcoma of Kidney (CCSK) is a highly malignant renal tumour. The mean age of diagnosis is between 12-36 months. Due to heterogeneous histological appearance and age group affection similar to wilms tumour, it often leads to misdiagnosis. It has a tendency to metastasise distantly to bone and its therapeutic response differs from other childhood kidney tumours. So use of Immunohistochemical (IHC) markers becomes essential in many cases in differentiating CCSK from other paediatric renal neoplasms. It is extremely rare in adults, till now only 26 adult cases have been reported in the medical literature. Here, the case of a 49-year-old male presenting with haematuria and pedal oedema is reported. On radiological examination, he had a large left renal mass with tumour extension to Left Renal Vein (LRV) and Inferior Vena Cava (IVC) as thrombi. Histology and Immunohistochemistry (IHC) study revealed CCSK ruling the other differentials. This case is presented for its rarity in adult patients, unusual clinical feature of widespread vascular invasion rather than bone metastasis, simulating Renal Cell Carcinoma (RCC) and aggressive clinical behaviour. The diagnostic challenges faced by pathologist and clinicians further necessitate the proper diagnosis of the tumour for better management of such cases.

Multiple Myeloma (MM) is characterised by clonal B cell proliferation affecting elderly age group and involving various organ systems namely haematological, renal and skeletal system. Kidney may be affected in 50% of cases of MM. Though, Chronic Kidney Disease (CKD) is usually seen in MM, unusual presentations have been documented. The present case is of a 50-year-old female with complains of breathlessness and vague generalised symptoms. Routine tests showed blood urea level of 90 mg/dL and serum creatinine of 8.3 mg/dL. Further investigations revealed 24 hour protein level 48.5 gm/day, Erythrocyte Sedimentation Rate (ESR)-126 mm/1st hour, cast nephropathy in renal biopsy. Immunohistochemical (IHC) study on renal biopsy revealed kappa light chain deposits in tubules, raised kappa light chains (3280.00 mg/L) in serum Free Light Chain (FLC) assay and MM in bone marrow aspiration and biopsy study. So, MM should be considered in differential diagnosis in elderly patients presenting with acute severe renal failure.

Introduction: Colorectal Cancer (CRC) is third most common malignancy worldwide. Various genomic alterations play fundamental role in initiation and progression of CRC. Among these, p53 mutation has a crucial role in survival and metastasis and its point mutation induces Vascular Endothelial Growth Factor (VEGF) promoting vascular permeability, migration and differentiation. The degree of angiogenesis can be measured by Microvascular Density (MVD) using CD34, which is helpful in identifying high risk patients for recurrence and metastasis. Aim: The aim of the study was to analyse the expression of p53, VEGF and MVD in CRC and their association with clinicopathological parameters. Materials and Methods: The ambispective study of 2 year duration was conducted from September 2015 to July 2017 in the Department of Pathology, Kalinga Institute of Medical Sciences and PBMH, Bhubaneswar. It included CRC resection specimens and archival tissue blocks. Tissue microarray blocks were prepared manually for IHC application in total 70 cases (58 (82.9%) adenocarcinomas and 12 (17.1%) adenomas) which were histologically staged and graded as per American Joint Committee on Cancer (AJCC) and World Health Organisation (WHO) guidelines. Pearson chi-square test and fisher’s-exact method were used to find significance of p53, VEGF and CD34 expression in adenomas and adenocarcinomas with respect to clinicopathological parameters. Results: No significant statistical association was found between p53, VEGF and MVD with tumour grade and nodal status. Majority, 41 (70.69%) cases were hypervascular (MVD-High). Adenomas 9 (75%) cases, were mostly hypovascular (MVD-Low) with p-value of 0.003. There was significant statistical association between VEGF and MVD with a p-value of 0.01. VEGF and MVD were more expressed on left-sided colon cancers. There was significant statistical association (p=0.01) between p53 graded expression and diagnosis in the present study. MVD and tumour nodal status had an inversely significant relationship (p=0.03). Conclusion: p53 and VEGF expressed more on carcinomas than adenomas. Both p53 and VEGF induce angiogenesis which can be effectively measured by CD34 expression (MVD). There is a directly proportional relationship of angiogenesis and malignant transformation. So these three IHC markers together can be considered a significant prognostic factor involved in CRC.

Introduction: Autoimmune bullous lesions are diverse group of diseases characterised by blisters in the skin with or without mucosal lesions. They present with great degree of clinical and histopathological overlap; hence, advanced immunological methods like direct and indirect immunofluorescence techniques have become essential for accurate diagnosis in most of these cases. Aim: To study the pattern, intensity of immunofluorescence among various autoimmune vesiculobullous lesions with clinical correlation. Materials and Methods: This present study was a retrospective one in which 36 cases of vesiculobullous lesions were included. In Direct Immuno Fluorescence (DIF) the type of immunoglobulin expressed, pattern of deposition and its intensity was noted. Statistical method was used to calculate percentages, ratio, sensitivity and specificity. Results: The mean age in the study group was 46.2 years (SD±17.9) with male to female ratio 1.2:1. Most common lesion was pemphigus vulgaris in 12 (33.3%) cases. Most common site of the lesions were trunk 11 cases (30.5%), followed by upper extremity in 8 cases (22.2%). Only in 8 (22.2%) cases histopathological correlation was done. DIF was positive in 31 cases (86.1%). IgG was present in 25 (69.4%) patients, C3 was positive in 14 (38.8%) cases and IgM was present in 6 (16.6%) patients. DIF was inconclusive in 5 (13.8%) cases. Intensity of 3+ IgG was seen in 2 (16.6%) cases of pemphigus vulgaris followed by 2+ intensity in 5 (41.6 %) cases. C3 was positive in 14 (38.8%) cases with 2+ expression seen in 4 (30.4%) cases. Conclusion: DIF is a helpful diagnostic test in autoimmune vesiculobullous lesions even in absence of histopathological correlation.

Cutaneous vesiculobullous lesions have a wide aetiological spectrum ranging from autoimmunity to medications and infections. Systemic Lupus Erythematosus (SLE) is one of most frequent autoimmune diseases with its cutaneous form being very uncommonly encountered. We report a case of Bullous Systemic Lupus Erythematosus (BSLE). Patient presented with fever, arthalgia and widespread blistering eruptions on face, neck and upper chest wall. Skin biopsy revealed subepidermal bulla and Direct Immunofluorescence (DIF) showed deposition of IgG, IgA, IgM, C3, C1q at the dermoepidermal junction. On treatment lesions healed rapidly. So proper clinical acumina is essential for diagnosis and management of such cases excluding the differentials.

Various congenital anomalies of the kidney and urinary tract cause significant morbidity and mortality in children. Renal agenesis, hypoplasia and dysplasia belong to this group of abnormalities. The exact aetiology is still unknown. Imaging modalities like Ultrasonography (USG), Dimercaptosuccinic Acid (DMSA) Radionuclide Scan, Diethylene Triamine Pentaacetic Acid (DTPA) scan and Mercaptoacetyletriglycine (MAG3) scan are useful for assessing the relative functional status, degree of blood flow and any possible obstruction to the kidneys particularly in very young children and in patients with poor kidney function. Management is determined by the severity of cases. We report two cases of hypoplastic dysplasia of kidney, in which one case remained undetected till adulthood. Grossly the affected kidneys were small in size with dilated ureters. Histopathological study showed primitive ducts surrounded by immature mesenchymal tissue representing dysplasia. Radiological and histopathological examination remains the mainstay in diagnosis of such cases.

Introduction: Accommodation is the ability to see over a range of distances by changing the power of the natural lens. With cataract surgery, this ability is partially or completely abolished. Apparent accommodation or pseudo-accommodation is the potential of pseudophakic eyes to sustain a good amount of near vision. Aim: To measure near vision in children with pseudophakia unaided, with distance vision correction alone (mono focal lens) in-situ and to measure the minimum near add (bifocal near segment power) required to read 1M (normal reading print size) at 30 cm and 40 cm. Materials and Methods: A cross-sectional study was conducted among children between 5-15 years of age with pseudophakia. Vision assessment was done using Lea symbol chart, at 3 metres for distance and at 30 cm and 40 cm for near. Near vision assessment was done unaided and with distant vision correction alone in place. Minimum spherical power needed to read 1M and child’s class textbooks were also assessed. Results: Sixty-four children were included in the study. Mean age was 10.5 (±3.12) years. Refractive status showed spherical power ranging from -7.00 DS to +1.00 DS (-0.8 Mean, (±1.33 SD), astigmatism ranging from -4.50 DC to +3.00 DC (-1.29 mean, ±1.37 SD). Unaided near vision assessment showed that 41 (64%) could read