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Giant cell tumor (GCT) is a primary bone tumor of long bones, which can rarely involve the vertebrae. Contiguous vertebral involvement by GCT is a rare presentation and poses a diagnostic dilemma on imaging. We report a case of GCT involving three contiguous lumbar vertebrae causing vertebral collapse along with a large soft tissue component. Considering the site and clinical presentation, possibilities of a round cell tumor with large extraosseous soft tissue component and malignant neurogenic tumor were suggested on initial radiological examination but histopathology confirmed the diagnosis of GCT. It is important to diagnose this entity correctly because of totally different lines of management. In our case, initial surgical management was excluded in view of high surgical morbidity and, thereby, adjuvant therapy with denosumab was planned.

Introduction: Nonhematologic tumors in children differ biologically and histologically from adults in terms of incidence, type of tumor, and tendency to regress spontaneously. The study was aimed to evaluate the pattern, frequency, and histopathological spectrum of solid tumors and to correlate histopathological findings with immunohistochemistry (IHC) wherever feasible. Materials and Methods: This observational study was a retrospective analysis of all solid tumors of children less than 18 years, conducted over a period of 5 years. The specimens were analyzed grossly and microscopically with IHC wherever feasible. All leukemias and myeloproliferative neoplasms/myeloproliferative disorders were excluded from the study. Results: A total of 261 solid tumors were seen in the age of 2 days to 17 years with the median age being 10.41 years. The M: F ratio was 1.6:1. Benign tumors were more common (59.39%), with soft tissue tumors being more frequent. Lymphomas and reticuloendothelial cell tumors constituted the majority (27%) of malignant tumors. Conclusion: This institution-based study depicted the pattern of childhood tumors. As most of the studies have focused on malignant tumors, data on the prevalence of benign pediatric tumors is scarce. Pediatric tumors need to have a dedicated pediatric cancer registry for assessing the magnitude of the problem. This study provides useful insight into the pattern of benign and malignant pediatric tumors in the northwest region of India, which can be utilized in planning health policies. The present study also proves the importance of IHC in making the final diagnosis.

Background: Celiac Disease involves the small intestine patchily affecting more frequently the proximal small bowel but the histological changes have been observed till terminal ileum. Of late in addition to D2, the duodenal bulb (D1 region) biopsies have been found helpful in identifying a small group of patients with CD. Therefore, multiple site biopsies are recommended as histological changes are not uniform throughout small intestine. Methods: During this present 1.5 years prospective study, we evaluated 84 cases of suspected celiac disease with respect to the light microscopy (D1, D2, and D3 biopsy) and serology (anti tTg and or EMA). Histological examination was done according to Modified Marsh grading system. Results: Out of 84 cases with raised anti tTg, the segmental biopsies significantly increased the diagnostic accuracy from 39/44 cases (88.6%) to 43/44 cases (97.7%) and 44/44 cases (100%) when D2 alone, D1 + D2 and D1 + D2 + D3 biopsies were evaluated, respectively. Of the suspected cases of celiac disease patients (tTg > 10 ULN and associated weight loss, diarrhea), additional D3 biopsy increased the diagnostic yield by 2.1%, compared to D1, D2 region biopsy and 6.38% compared to standard D2 biopsy alone. Of the 28 cases (tTg > 10 times ULN + EMA positive and associated weight loss, diarrhea), the potential celiac disease (histologically Type 1/Normal) cases reduced from 28.5% (standard D2 region alone) to 21.4% and 17.8% when additional biopsies were taken from D1 region and D3 region, respectively, and additional D3 biopsy increased the diagnostic yield by 10.8% (compared to standard D2 biopsy alone) and 3.7% (compared to D1 and D2 biopsy). Conclusion: We believe multiple sites duodenal biopsies including D3 region biopsies might increase the diagnostic accuracy of adult celiac disease in addition to sensitive and specific serologic tests.

Background: There is a huge spectrum of skin tumors which can be confused clinically with malignancies, particularly when they are pigmented or inflamed, and histopathological examination of a biopsy specimen is required to establish a definitive diagnosis and to facilitate appropriate intervention and follow up. Aim: To evaluate all skin tumors and categorize them according to their origin. Methods: The present study was conducted over a period of 4 years (July 1, 2013 to June 31, 2017) comprising of 1.5 years prospective and 2.5 years retrospective analysis in the departments of Dermatology and Pathology, at a tertiary hospital in North India. All specimens of skin tumors were analyzed grossly and microscopically. Immunohistochemistry was done wherever possible. Results: A total of 232 skin tumors were seen; of which 123 cases were benign (53.0%) and 109 cases were malignant (47.0%). The mean age of patients with benign and malignant skin tumors was 40.3 ± 19.9 and 60.8 ± 14.8 years, respectively. The most common site was face (n = 106; 45.7%) followed by limbs (n = 44; 19.0%). The male:female ratio of benign and malignant tumors was 1.01:1 and 1.31:1, respectively. Among the benign tumors, keratinocytic tumors were the commonest (n = 57; 46.3%) followed by the melanocytic tumors (n = 37; 30.1%) and appendageal tumors (n = 29; 23.6%). The most common malignant skin tumors were the keratinocytic tumors (n = 87; 79.8%) followed by 12 cases (11%) of hematolymphoid tumors and five cases (4.6%) each of melanocytic and appendageal tumors. Limitations: The lack of clinical and dermatoscopic correlation and inclusion of retrospective data are the limitations of this study. Conclusions: Skin tumors affect people of all ages. The benign tumors are seen in the younger age group as compared to malignant tumors. Face is the most common site and keratinocytic tumors are the most common skin tumors in both benign and malignant categories.

Purpose Erythrocyte sedimentation rate (ESR) is a widely used indicator of inflammation and a routinely done hematology investigation to monitor patients of autoimmune and infectious diseases. We aimed to compare the ESR results obtained by Roller 20LC automated instrument and standard reference Westergren method and analyzed the effect of anemia (hematocrit) on ESR measurements through the automated method. Methods We analyzed 1377 random anemic OPD patients (hematocrit [HCT] < 35%) for ESR levels measured by Roller 20LC using EDTA blood and Westergren method using citrated blood for a one and half year period from January 1, 2018 to June 30, 2019. Fabry’s formula was used to correct the Westergren ESR. Results The total number of samples after evaluation were divided into low (n = 232), intermediate (n = 417), high (n = 406), and very high range of ESR (≥100 mm/hr; n = 422). Mean difference between values of corrected and automated ESR for the low, intermediate, high and very high ESR range was 2.33 ± 5.03, 10.95 ± 8.04, 28.22 ± 19.11 and 43.3 ± 19.22 mm/hr, respectively. The 95% limit of agreement calculated by the Bland–Altmann analysis between the two methods for low-ESR range was −7.53 to 12.2 (highest correlation coefficient –0.65), while for very high ESR, range was −5.1 to 81.5 (least coefficient of 0.18) (p < 0.001). Conclusion In laboratories with high-sample load and where manual measurement may be tedious, the automated method of ESR measurement can safely replace the Westergren method for low-ESR values in patients with low hematocrit. While for high-ESR values, validation by the standard Westergren method may be needed.

Background Primary extranodal lymphomas are less frequently encountered and difficult to diagnose in routine practice. The histopathological and immunohistochemical studies are essential in addition to clinical details to diagnose. The incidence is varied in different parts of India along with variation in histopathological spectrum. Methodology The clinical features and histopathological findings of patients diagnosed with primary extranodal lymphoma over 3-year period were retrieved from archives of pathology department and analyzed. Results During the 3-year study period, a total of 135 cases of non-Hodgkin lymphomas were evaluated, and of these, 41.4% (56/135) of cases presented with primary extranodal involvement. The mean age of primary extranodal lymphoma presentation was 61.3 ± 17.5 with M:F ratio of 1:1.1 Most common extranodal site involved was gastrointestinal tract 32.1%, 18/56 (small intestine [17.8%, 10 cases] and large intestine [8.9%, 5 cases]). Non-Hodgkin lymphomas of B cell type were the predominant subtype (48/56, 85.7%), while 8/56 (14.2%) cases were of T cell lineage. Of the B cell non-Hodgkin lymphoma diffuse, large B cell lymphoma was the predominant subtype constituting ~83.3% (40/48). Conclusion Primary extranodal lymphomas exhibit varied histomorphological and clinical presentation. The present study is first such analysis from Punjab that intends to compare with studies from other parts of India.

Echinococcosis is a common cause of pulmonary cavities. Aspergillus fumigatus, a saprophytic fungus, can colonise pulmonary cavities caused by tuberculosis, sarcoidosis, echinococcosis, bronchiectasis and neoplasms. Infection by Aspergillus is often seen in immunosuppressed cases. However, co-infection of Aspergillus with pulmonary echinococcosis is unexpected and very unusual, especially in an immunocompetent patient. We present the case of a 45-year-old immunocompetent male who came with non-resolving pneumonia and fever for 8 months and dyspnoea since 15 days accompanied by recurrent episodes of hemoptysis since 5 days. Chest X Ray and Computed Tomography scan showed a cystic lesion in the middle lobe of the right lung. Middle lobectomy with video-assisted thoracoscopic surgery was performed and histopathology revealed ectocyst of Hydatid cyst which was also colonised by septate fungal hyphae exhibiting acute angled branching, morphologically consistent with Aspergillus. Gomori Methanamine Silver and Periodic Acid Schiff stains highlighted the hyphae of Aspergillus as well as the lamellated membranes of ectocyst and an occasional scolex of Echinococcus. Sections from surrounding lung parenchyma also showed these fungal hyphae within an occasional dilated bronchus. Thus a diagnosis of dual infection of Aspergillosis and Pulmonary Echinococcosis was established. The possibility of dual infection by a saprophytic fungus must be kept in mind while dealing with a case of a cavitary lesion in long-standing and non-resolving pneumonia, even in an immunocompetent patient. Establishing the correct diagnosis of Aspergillosis with Echinococcosis is essential for proper and complete management.

Introduction: Cytogenetics has become an integral part of Multiple Myeloma (MM) diagnosis and prognostication. A combination of conventional cytogenetics and interphase Fluorescence In-Situ Hybridisation (FISH) is currently used to stratify tumours into high, intermediate and standard risk disease. Aim: To compare the morphological details of plasma cells with cytogenetic abnormalities. Materials and Methods: The present retrospective crosssectional study was conducted at Department of Pathology Dayanand Medical College and Hospital, Ludhiana in three and a half year duration (1st January 2014 to 30th June 2017). All the diagnosed MM patients in whom cytogenetic was available were included and descriptive analysis was done using ChiSquare test and relevant statistical analysis using SPSS 21 version. Correlation was done with various morphological pattern (plasmacytic, plasma blastic). Results: Cytogenetic studies were performed on 42 cases using FISH technique (n=31, 81.6%) and GTG (Giemsa) banding (n=4, 10.5%). Three (7.9%) patients were tested with both methods. In the present study, all the patients (n=2,100%) with plasmablastic morphology who got tested with cytogenetics had del13q14.3 and none of the patients with normal genome (n=22) had plasmablastic morphology. Conclusion: Morphologic patterns of plasma cells and cytogenetic studies correlate well and can together help in better prognostication of MM patients.

Background: The only effective treatment for celiac disease (CeD) is gluten free diet (GFD). However, GFD is restrictive and efforts are being made to explore alternative therapies including safer wheat varieties. Wheat variety C273 has been previously identified to have reduced load of intact T-cell stimulatory epitopes via in silico and in vitro analysis. Methods: Adult patients diagnosed with CeD and recovered on GFD were included in the study. Patients were randomised into two groups in a 2:1 ratio. Patients in group I had graded introduction of C273 wheat in diet, maintained for 24 weeks; in Group II, wheat was restricted with continuation of GFD. Clinical symptoms, serology [anti-tissue transglutaminase (anti-tTG), anti-endomysial antibody (anti-EMA)], circulating inflammatory biomarkers [intestinal fatty-acid binding protein (I-FABP), plasma citrulline, interferon-γ (IFN-γ)] and histology were evaluated periodically. Final evaluation was performed at week 28. Results: A total of 15 patients were enrolled (Group I: n = 10, Group II: n = 5). All patients except two in Group I remained compliant. None of the remaining eight patients in group I developed symptoms. No significant changes in serology (anti-tTG, anti-EMA) and histology were observed between the two groups at 28 weeks ( p > 0.05). Significant changes in plasma citrulline(29.87 ± 8.98 versus 36.58 ± 3.09, p = 0.049) and IFN-γ (44.56 ± 9.74 versus 33.50 ± 3.68; p = 0.031) were observed in Group I. Conclusion: Consumption of C273 wheat did not result in development of symptoms or evident changes in serology and histology at 28 weeks. However, variations in circulating inflammatory markers were noted. Larger randomised trials are needed to corroborate these findings. Clinical Trials Registry-India: CTRI/2018/06/014521.

Background: The incidence of coronary artery disease (CAD) has risen considerably in developing world due to industrialization, urbanisation and lifestyle changes, especially among Indians and South Asians. The onset of CAD has been seen to occur at an early age and the severity of the disease and mortality associated with CAD has also increased. The pathology of atherosclerosis needs to be re-evaluated to develop targeted therapy which can contain the disease process at the earliest stage. Aims and Objectives: Most of the morphological studies on atherosclerosis have been done on autopsy cases. In this study, we have analysed the morphological spectrum of atherosclerotic lesions in live patients. Materials and Methods: We retrospectively analysed the histopathology slides of 85 cases whose endarterectomy plaques were received in the Department of Pathology over a period of three and half years (January 2014 to June 2017) and classified the lesions according to Modified American Heart Association classification of atherosclerosis. Results: The average age of patients was 60 years and male to female ratio of 4.3:1. Left anterior descending artery was the commonest vessel involved (52.4%). Majority of the cases had fibrocalcific plaques,followed by fibrous cap atheroma and calcified nodules. Conclusion: Coronary artery plaques were found even in patients less than 40 years old. Aggressive lipid defense therapy needs to be the cornerstone of management of CAD.

Background and Objective: Xanthogranulomatous oophritis is an uncommon, non-neoplastic, chronic process in which the affected organ is destroyed by massive cellular infiltration of foamy histiocytes admixed with multinucleated giant cells, plasma cells, fibroblasts, neutrophils, and foci of necrosis. The etiology of this entity is unknown, but it shares histopathological findings similar to those of xanthogranulomatous change occurring in various organs, including the gallbladder and kidney.Case Report: The current case was a 20-year-old female presenting with a tubo-ovarian mass with suspicion of malignancy on clinicoradiological findings and final diagnosis of xanthogranulomatous oophritis established on histopathology.Conclusion: Clinically and radiologically, xanthogranulomatous oophritis mimics tumor of the ovary and fallopian tube, thereby making it an important entity. A vigilant histopathological evaluation is important to diagnose the disease.

Entamoeba histolytica has been rarely reported as superadded infection over carcinomatous growth on rectal brushings. We present a case of 68-year-old male who presented with abdominal pain and bleeding per rectum who was found to have an ulceroproliferative growth on sigmoidoscopy. Rectal brushings revealed coexistence of E. histolytica with malignant cells of adenocarcinoma. No organism was detected on biopsy of the tumor, which also showed adenocarcinoma, because of possible surface colonization of the tumor by Entamoeba. This case highlights the role of rectal brushings in detecting superadded infection in a case where both brushings and biopsy were performed. It is always important to report infection superadded on malignancies for optimum management of the patients.

Background & objective: Introduction: First detection of any solid tumour as metastatic deposits in bone marrow directs clinicians to start searching for the primary tumour. Detection of bone marrow metastasis determines the stage of the malignancy, prognosis, mode of treatment, chemotherapeutic response and follow-up in case of relapse. The aim of the current study was to analyse the clinico-haematological presentation and morphological pattern of infiltration of solid tumours detected first as metastatic deposits on bone marrow examination. Methods:Three-year retrospective analysis of MGG-stained bone marrow aspiration smears and touch imprints of the bone marrow biopsy and Hematoxylin and Eosin (H&E) stained histopathological sections of biopsies was performed at the Department of Pathology at a tertiary care institute (January 2014 to December 2016). The morphological pattern of metastatic deposits and haematological profiles of the patients were analysed. Exclusion criterion was the presence of hematolymphoid malignancies. Results: In 22 cases, bone marrow was the first site of detection of metastasis. The age of the patients ranged from 3 years and 10 months to 82 years, with equal gender predilection. Overall, 16 cases had cytopenias, 9 cases each had leucocytosis and leukoerythroblastic presentation. The metastasis was from Ewing’s sarcoma, prostate carcinoma, gastric adenocarcinoma invasive duct carcinoma breast, gallbladder carcinoma, lacrimal duct carcinoma and invasive papillary urothelial carcinoma. Conclusions: Bone marrow examination is a cheap and reliable investigation to detect metastasis in an unsuspecting case. Bilateral trephine biopsies are recommended to increase the efficacy of detecting bone marrow metastasis.

Background/AimsThe therapeutic goal for treating ulcerative colitis (UC) patients has shifted to achieving mucosal healing over the past few years. However, at present, limited data is available on the correlation between endoscopic findings and histological remission in patients with endoscopic mucosal healing.MethodsThis was a prospective observational study conducted over a period of 18 months (January 2014 to June 2015) at Dayanand Medical College and Hospital, Ludhiana, Punjab, India. Patients diagnosed with UC who had been in clinical remission (n=76) for at least 6 months were evaluated for endoscopic remission. Those in endoscopic remission (Mayo score ≤1; 46/76, 60.5%) were subjected to multiple biopsies from the rectosigmoid region and histological remission, which was then defined as grade 0/1 as per the Geboes criteria.ResultsOf the 46 patients in endoscopic remission (age, 18–73 years; male:female=1.5:1.0), majority had E1 (proctitis) disease (21/46, 45.6%) followed by E2 (left sided colitis) (18/46, 39.1%) and E3 disease (pancolitis) (7/46, 15.2%) at baseline. Histological remission was noted in 67.3% (31/46) of the patients, while 32.7% (15/46) still retained the histologically active disease in the form of infiltration of the lamina propria by eosinophils and neutrophils (13/15, 86.6%), cryptitis (14/15, 93.3%), and crypt abscesses (8/15, 53.3%). On follow-up, after 1 year, 87.1% (27/31) of the patients who had been in histological remission remained clinically asymptomatic, while 12.9% (4/31) had relapsed. Among the 15 histologically active patients, 46.6% (7/15) remained in clinical remission, while 53.3% (8/15) had relapsed.ConclusionsHistological remission, rather than endoscopic remission, predicts a sustained clinical remission and allows monitoring of therapy for the subsequent disease course in patients with UC.

Context: Peer-assisted teaching and learning (PTL) is being experimented in different medical universities worldwide. It is a learner-centered approach involving students through active learning strategies. Aims: To study the student perception of PTL in methods such as group-led seminars and fishbowls, in classroom through various interactive activities; compare and find out the student acceptability and efficacy of each of these methods in learning conceptual topics such as various types of anemia. Subjects and Methods: Medical students of second-year professional course were subjected to PTL in classroom during allotted teaching hours for 10 successive sessions using group-led modified seminars, fishbowls, and different formality-level interactive activities such as street plays, prop sessions, quiz sessions, to make them understand the clinical features and presentation of different types of anemia through understanding of etio-pathogenesis. To ascertain the aspects that influenced learning, focus group discussions were conducted in small groups consisting of 14 students and one facilitator in each group. Qualitative thematic analysis was performed on transcripts of the audio recordings by authors. Results: The emerging themes from qualitative analysis of transcripts were pertaining to teacher, student, and organization. We found motivation, interest, and involvement of peer teacher, student behavior and collaboration, contact time between students and facilitator, preparation time, coherence with other curricular activities, group size and composition, suitability of topic for the kind of activity, and availability of material for preparation as few sub-aspects affecting learning. Conclusion: For PTL to be effective, adequate transfer of knowledge through good peer teacher involvement, learner receptiveness, and adequate contact time is needed. Proper preparation with suitability of topics for the type of activity, alignment of seminars with other activities, and course coherence are prerequisites for the same.

Celiac Disease (CD) is a multifactorial, autoimmune enteropathy activated by cereal proteins in genetically predisposed individuals carrying HLA DQ2/8 genes. A heterogenous gene combination of the cereal prolamins is documented in different wheat genotypes, which is suggestive of their variable immunogenic potential. In the current study, four wheat varieties (C591, C273, 9D, and K78) identified via in silico analysis were analyzed for immunogenicity by measuring T-cell proliferation rate and levels of inflammatory cytokines (Interferon-γ and Tumor Necrosis Factor-α). Peripheral Blood Mononuclear Cells and biopsy derived T-cell lines isolated from four CD patients in complete remission and two controls were stimulated and cultured in the presence of tissue transglutaminase activated pepsin-trypsin (PT) digest of total gliadin extract from test varieties. The immunogenicity was compared with PBW 621, one of the widely cultivated wheat varieties. Phytohaemagglutinin-p was taken as positive control, along with unstimulated cells as negative control. Rate of cell proliferation (0.318, 0.482; 0.369, 0.337), concentration of IFN- γ (107.4, 99.2; 117.9, 99.7 pg/ml), and TNF- α (453.8, 514.2; 463.8, 514.2 pg/ml) was minimum in cultures supplemented with wheat antigen from C273, when compared with other test varieties and unstimulated cells. Significant difference in toxicity levels among different wheat genotypes to stimulate celiac mucosal T-cells and PBMC's was observed; where C273 manifested least immunogenic response amongst the test varieties analyzed.

Background: Quality assurance in the hematology laboratory is a must to ensure laboratory users of reliable test results with high degree of precision and accuracy. Even after so many advances in hematology laboratory practice, pre-analytical errors remain a challenge for practicing pathologists. This study was undertaken with an objective to evaluate the types and frequency of preanalytical errors in hematology laboratory of our center. Methods: All the samples received in the Hematology Laboratory of Dayanand Medical College and Hospital, Ludhiana, India over a period of one year (July 2013-July 2014) were included in the study and preanalytical variables like clotted samples, quantity not sufficient, wrong sample, without label, wrong label were studied. Results: Of 471,006 samples received in the laboratory, preanalytical errors, as per the above mentioned categories was found in 1802 samples. The most common error was clotted samples (1332 samples, 0.28% of the total samples) followed by quantity not sufficient (328 sample, 0.06%), wrong sample (96 samples, 0.02%), without label (24 samples, 0.005%) and wrong label (22 samples, 0.005%) Conclusion: Preanalytical errors are frequent in laboratories and can be corrected by regular analysis of the variables involved. Rectification can be done by regular education of the staff.

Introduction: Nephrectomy is a common surgical procedure done for a variety of neoplastic and nonneoplastic diseases. This study has been taken up to analyze kidney diseases histopathologically and various lesions of the kidney and their subtypes and record the various lesions which have lead to partial nephrectomy, total nephrectomy, unilateral and bilateral nephrectomies. Aim: To study spectrum of diseases in nephrectomy specimens, histological sub typing of neoplastic conditions and evaluation of histopathological prognostic features like capsular invasion, vascular invasion and nuclear grade. Materials and Methods: This was an retrospective and prospective analysis done over the period of 4 years (2006-2009). A nephrectomy specimens received in the Department of Pathology Dayanand Medical College and Hospital, Ludhiana were analyzed with respect to gross and microscopic features. Results: Out of a total number of 155 cases, 82 were neoplastic, 73 were non-neoplastic males were 98 and females 57 with a M:F ratio 1.7:1. Out of the 82 neoplastic cases, Renal cell carcinoma (Clear cell type) was commonest (57 cases) followed by Transitional cell carcinoma (07 cases), Papillary RCC (03 cases), Oncocytoma (03 cases), Wilm’s tumour (02 cases), RCC with sarcomatoid change (02 cases), RCC unclassifiable (03 cases) and 01 case each of Chromophobe RCC, Multicystic RCC, Collecting duct carcinoma and small round cell tumour respectively. Of the 73 non-neoplastic cases, chronic pyelonephritis with hydronephrosis constituted 42 cases, emphysematous pyelonephritis (16 cases), xanthogranulomatous pyelonephritis (02 cases), acute or chronic pyelonephritis (09 cases), polycystic kidney (02 cases), cystic renal dysplasia and tuberculosis (01 case each). Conclusion: Radical nephrectomy is the common surgical procedure done for both neoplastic disorders as well as non neoplastic lesions. Detailed histopathological examination is necessary for diagnosis and the prognostication of the lesions.

Basal cell carcinoma (BCC) commonly affects the elderly and is mostly confined to the head and neck region. Only 10% of all cases occur on the trunk. We presented a case of bullous lesion on the abdomen in a young male, initially diagnosed by clinicians as a vascular nevus. Histopathological examination and immunohistochemistry (IHC) revealed it to be Nodular cystic variant of BCC. This rare variant of BCC morphologically resembles benign skin adnexal tumor of Eccrine syringofibroadenoma. Ber Ep4 positivity on IHC established the correct diagnosis. This case highlights that nodular cystic variant of BCC can be a diagnostic dilemma for clinicians and pathologists.

Aplastic anemia (AA) is nowadays considered to be a clonal disorder arising from a defective hematopoietic stem cell developing after a generalized insult to bone marrow. Immunosuppressive treatment (IST) of AA causes suppression of the target dominant population of haematopoietic cells allowing the defective non targeted clones to expand. This may give rise to acute leukemia. Cytogenetic studies for chromosomal aberrations such as trisomy and monosomy may help in detecting such conversions. We present a case of acquired AA in a 60-year-old male presenting with pancytopenia and hypoplastic marrow treated with antithymocyte globulin, converting into myelodysplastic syndrome and later on acute promyelocytic leukemia after being in remission for 4 years. The patient was found to have trisomy 8 on fluorescence in situ hybridization and karyotyping.

Histoplasma capsulatum is no longer confined to certain geographic areas and should always be considered in the differential diagnosis of lymphadenopathy and organomegaly in HIV-positive patients. We present an unusual case of a 20-year-old immunocompromised male of African origin presenting with fever, jaundice, hepatosplenomegaly, and retroperitoneal and cervical lymphadenopathy. Fine needle aspiration (FNA) smears from the cervical lymph node revealed numerous yeast forms of histoplasma in macrophages. The patient succumbed to the fulminant infection. Postmortem liver biopsy also revealed infiltration by histoplasma, confirming the diagnosis of disseminated histoplasmosis. This case highlights the variable nature of the clinical presentation of disseminated histoplasmosis which can mimic tuberculosis, leishmaniasis, or lymphoma. FNA cytology is a rapid, cost-effective, and reliable diagnostic tool for early detection and prompt management of histoplasmosis.

Mucormycosis is an opportunistic invasive fungal infection caused by Mucorales of class Zygomycetes. It is commonly seen in immunosuppressed cases. Gastrointestinal infection (GI) is very uncommon among adults and is diagnosed only on histopathological examination of biopsy or resection specimens. Due to non-specific clinical presentation, intestinal mucormycosis is diagnosed late. We report a series of six cases of intestinal mucormycosis in adults. Three years retrospective analysis of ileal and colonic resection specimens was performed in our tertiary care institute. All the cases had mucosal ulceration and necrosis on microscopic examination and one case also exhibited angioinvasion. Histopathology is the cornerstone of diagnosis and prompt management of invasive mucormycosis which may follow a rapid and fatal course in the absence of timely and optimum management. The clinicians need to keep the possibility of this vasculotropic fungus in mind in all cases presenting with abdominal symptoms.

Background With an increasing number of ileal intubations, isolated terminal ileal ulcers (ITIU) are frequently found during colonoscopies. The present study aimed at studying the etiology and clinical significance of these ulcers in patients having gastrointestinal symptoms. Methods This was a prospective observational study performed on consecutive patients who underwent ileocolonoscopy for various gastrointestinal symptoms between 1 January 2014 and 31 December 2014. Clinical, endoscopic, and histological findings of patients with ITIUs were assessed to determine the etiology and they were treated accordingly. Symptom resolution was assessed within 3 – 6 months of initial diagnosis, and colonoscopy was repeated for consenting patients. Results Among 74 (4.9 %) of 1497 patients who had ITIUs on ileocolonoscopy, 41 (55.4 %) had specific etiologies on initial testing. After 3 – 6 months follow-up, definitive diagnosis was ascertained in 44 (59.5 %) patients [Crohn’s disease (CD): 19 (25.7 %), NSAID-induced ulcers: 11 (14.9 %), intestinal tuberculosis (ITB): 9 (12.2 %), and eosinophilic enteritis: 5 (6.8 %)], and 30 patients (40.5 %) had nonspecific ulcers. After treatment, symptomatic and endoscopic resolution were noted in 55/60 patients (91.7 %) and 28/36 patients (77.8 %), respectively. Of 5/60 patients who remained symptomatic, three were initially diagnosed with nonspecific ulcers and two with CD, and they were finally diagnosed with CD and ITB respectively, and treated accordingly. Conclusions In patients with gastrointestinal symptoms, more than half of the ITIUs have specific etiologies, and timely diagnosis and appropriate treatment can prevent serious complications. Nonspecific ulcers can be managed with symptomatic treatment, but need close monitoring and re-evaluation in the case of persistence of symptoms.

Female Genital Tract (FGT) involvement with hematologic neoplasms is uncommon and the hematologic malignancies which involve the female genital organs are usually non-Hodgkin’s lymphoma. Involvement of the uterus and cervix with Acute Lymphoblastic Leukaemia (ALL) is extremely rare, and ovarian involvement is even rarer. We report the case of a young lady who presented with tubo-ovarian mass, excessive post-operative bleeding (post-total abdominal hystrerctomy and bilateral salpingo-oophorectomy) and was diagnosed to have ALL with blood and tissue involvement by histopathology and flow cytometry.

Splenic epidermoid cysts are rare non-parasitic true cysts affecting the spleen. We report a five-year-old child who presented with an abdominal lump associated with pain of 15 days. Ultrasonography of the abdomen showed a huge cystic lesion of obscure origin. At laprotomy a huge unilocular cyst involving upper part of spleen containing pultaceous fluid was seen and its removal necessitated splenectomy. Histopathological findings were consistent with splenic epidermoid cyst. Thus histopathology helped in elucidating the aetiology and diagnosis.

Multiple myeloma is a disorder of plasma cells which can involve kidneys in the form of cast nephropathy. Neoplastic plasma cells produce either complete immunoglobulins or fragments of immunoglobulins leading to a monoclonal spike in the serum and/or Bence Jones proteinuria. Very few patients present as non-secretory myeloma when no immunoglobulins (M spike) are produced or only light chains are secreted which can only be detected in urine. Acute renal failure due to cast nephropathy can rarely be the first presentation of multiple myeloma. We here in report a case in which primary diagnosis of multiple myeloma was made on renal biopsy due to its characteristic histomorphology. The diagnosis was later on supported by presence of neoplastic plasma cells in the aspirate and biopsy of bone marrow.

Primary Hyperparathyroidism (PHPT) due to solitary parathyroid adenoma followed by parathyroid hyperplasia and carcinoma are the most frequent cause of hypercalcaemia. The most common granulomatous disorders causing hypercalcaemia are sarcoidosis and tuberculosis. We have reported a case where unexplained granulomas were seen along with parathyroid adenoma.

Background/Aim: Ulcerative colitis is a chronic inflammatory disease of unknown etiology characterized by periods of remission and relapses. This study has been carried out in a group of North Indian patients, where the disease has shown an increasing prevalence and frequent relapses. Hence, there is a need to predict relapse for better management and to reduce morbidity. To assess the importance of biological and histological parameters in predicting relapse when the disease is in quiescent phase. Materials and Methods: A prospective study of twenty-six patients with quiescent ulcerative colitis was carried out in Dayanand Medical College and Hospital,Punjab. Only patients with clinical and endoscopic remission at the time of screening visit were included. Hemoglobin, erythrocyte sedimentation rate (ESR), C- reactive protein (CRP) and serum Interleukin-6 (IL-6) levels were measured. The baseline colonoscopic mucosal biopsies were retrieved and studied. Follow-up was conducted for one year at monthly interval or earlier if relapse occurred. Results: Fifteen out of twenty-six patients (57.69%) had evidence of clinical relapse during the follow-up. Hemoglobin, ESR, CRP and IL-6 levels were not found to be significant predictors of relapse. Increased number of eosinophils and neutrophils in the lamina propria were observed to be associated with significantly higher relapse rate. Conclusion: A higher risk of relapse in patients with quiescent colitis can be predicted by the presence of increased number of eosinophils and neutrophils in the lamina propria.

Glandular odontogenic cyst (GOC) is a rare developmental odontogenic cyst. It is a slow growing and asymptomatic swelling, usually affecting middle aged men and has tendency to reoccur. Here, we report a case of GOC in the anterior portion of mandible diagnosed by histopathology.

Retroperitoneal leiomyosarcomas are rare sarcomas, with an incidence of less than 2 per million population. Cutaneous metastases from sarcoma account for only 1-2.6% of metastatic skin lesions. Cutaneous and subcutaneous metastasis from retroperitoneal leiomyosarcoma is a very rare entity. We present a case of 72-year-old male with scalp nodule and subcutaneous swelling in left posterior axillary fold. Fine needle aspiration cytology from both these sites revealed a sarcoma, which was positive for Smooth Muscle Actin and negative for S100 on cell block immunohistochemistry (IHC). The past history revealed surgical resection of a retroperitoneal mass in 2010 which was diagnosed on histopathology and IHC as leiomyosarcoma. A final diagnosis of metastatic deposits from leiomyosarcoma was made. Retroperitoneal leiomyosarcoma presenting as scalp and subcutaneous metastasis is an unusual presentation. Adequate clinical history and a high index of clinical suspicion is required to detect cutaneous and subcutaneous metastatic deposits occurring five years after surgical resection.

Eosinophilic angiocentric fibrosis is a rare pathology of the sinonasal tract and the upper respiratory system characterised by fibrosis with poorly understood pathogenesis. A 47-year-old male presented with a swelling over the dorsum of the nose. The possibility of fungal granuloma was being suggested on Magnetic Resonance Imaging (MRI). Histopathology showed thick collagen bundles whorling around vessels giving an onion skin appearance with focal area of vasculitis. An inflammatory reaction rich in eosinophils along with a fibrotic stroma was seen which was highly characteristic of eosinophilic angiocentric fibrosis. Clinically & microscopically it mimics Granuloma faciale, Wegener’s Granulomatosis, Churg-Strauss Syndrome, Kimura’s disease and few other granulomatous conditions thus making diagnosis difficult. A probable allergic origin is being suggested because of the typical eosinophil-rich inflammatory reaction. Finally the diagnosis of Eosinophilic Angiocentric Fibrosis was given. It is a diagnosis of exclusion having characteristic histomorphological findings thus biopsy is always required to distinguish it from other lesions whose treatment differs.

Background: Haematological abnormalities are common in acute febrile tropical illnesses. Malaria is a major health problem in tropics. In endemic areas especially in the post monsoon season, it is not practical to manually screen all peripheral blood films (PBF) for malarial parasite. Automated analysers offer rapid, sensitive and cost effective screening of all samples. Aim: The study was done to evaluate the usefulness of automated cell counters analysing their histograms, scatter-grams and the flaggings generated in malaria positive and negative cases. The comparison of other haematological parameters were also studied which could help to identify malaria parasite in peripheral blood smear. Materials and Methods: The blood samples were analysed using Beckman coulter LH-750. The abnormal scatter grams and additional peaks in WBC histograms were observed diligently & compared with normal controls. Haematological abnormalities were also evaluated. Statistical Analysis: Statistical analysis was done by using software Epi-Info version 7.1.4 freely available from CDC website. Fisher exact test was applied to calculate the p-value and value < 0.05 was considered as significant. Final identification of malarial parasite species was done independently by peripheral blood smear examination by two pathologists. Results: Of all the 200 cases evaluated abnormal scatter grams were observed in all the cases of malaria while abnormal WBC histogram peaks were noted in 96% cases demonstrating a peak at the threshold of the histogram. The difference between number of slides positive for abnormal WBC scatter gram and abnormal WBC histogram peaks were statistically highly significant (p=0.007). So abnormal WBC scatter gram can better give idea of malarial parasite presence. Of the haematological parameters thrombocytopenia (92% cases) emerged as the strongest predictor of malaria. Conclusion: It is recommended for haematopathologists to review the haematological data and the scatter plots on the analyser along with peripheral blood smear examination.

Solitary fibrous tumour (SFT) is a rare spindle cell tumour of mesenchymal origin most commonly encountered in pleura. It can affect the orbital region but SFT of lacrimal gland is rare. We hereby report of a SFT of lacrimal gland in a 50-year-old male presenting with slow growing swelling in left superolateral orbital region. The preliminary fine needle aspiration cytology (FNAC) could not reveal any definite diagnosis. Excision biopsy and immunohistochemistry (IHC) confirmed the diagnosis. Therefore, clinician and pathologist should be aware of this entity and biopsy along with IHC is required to rule out other entities which can mimic it clinically and histopathologically.

Wnt/β-catenin signaling plays an important role in normal development. However, its aberrant activation is associated with several cancers. The aim of this study is to examine the Wnt/β-catenin pathway in patients with advanced pancreatic adenocarcinoma (n = 31). Paraffin sections from tumors (n = 16) and normal pancreata (n = 3) were used to determine the localization of β-catenin. An additional 15 frozen tumors, adjacent normal pancreata (n = 5), or normal pancreata (n = 4) were utilized for protein isolation. Tumors were also examined for mutations in exon 3 of the CTNNB1 gene. More than 65% of the tumors showed an increase in total β-catenin, consistent with its enhanced membranous, cytoplasmic, and nuclear localization, but only two showed mutations in CTNNB1. The majority of the remaining tumors demonstrated concurrent increases in Wnt-1 and frizzled-2 (positive regulators) and a decrease in Ser45/Thr41-phospho-β-catenin. Electrophoretic mobility shift assay demonstrated β-cateninT-cell factor binding in tumors only. Adenomatous polyposis coli and axin, which are both negative regulators, remained unchanged. Unexpectedly, total glycogen synthase kinase-3β protein was elevated in these tumors. Elevated levels of E-cadherin were also observed, although E-cadherin-β-catenin association in tumors remained unaffected. Thus, Wnt/β-catenin activation was observed in 65% of pancreatic adenocarcinomas, independently of β-catenin gene mutations in most tumors.

Ovarian-type surface epithelial carcinomas of testis and paratestis are very rare. These tumors develop from mesothelial inclusions or abnormalities in the development of coelomic epithelium. The diagnosis of these lesions can be difficult, both clinically and radiologically, as morphological, immunohistochemical and ultrastructural features overlap with serous tumors arising in the female genital tract. The pathologist should be aware of the histopathological features and immunostains which help in reaching definite diagnosis. To the best of our knowledge only one such case has been reported in Indian literature. We hereby report a case of young male with this unusual lesion diagnosed on histopathology.

This is a report of a case of epithelial cyst of the spleen in an 8-year-old boy. The cyst showed squamous metaplasia on histology. The risk of malignant transformation is discussed.

Gangliocytic paragangliomas are rare benign tumors which are usually encountered in the second portion of the duodenum. Histogenesis of these tumors is incompletely understood. Patients usually present with upper gastrointestinal bleeding. The endoscopic features of gangliocytic paraganglioma do not differ from those of other submucosal tumors. Therefore, they can be diagnosed histologically by the presence of epithelioid, spindle, and ganglion cells, which is similar to that observed for paraganglioma. We herein report a case of gangliocytic paraganglioma due to the rarity of the lesion and the characteristic histopathologic findings.

Hemangioendotheliomas are rare vascular tumors that can arise from soft tissue or bone. The former comprises hemangioma, epithelioidhemangioma, hemangiomatosis and massiveosteolysis or Gorham′s disease (which mimics malignantneoplasm due to aggressive osteolytic destruction). The rarer malignant counterparts are epithelioidhemangioendothelioma, hemangioendothelioma and angiosarcoma in increasing order of malignancy. The diagnosis of these lesions is difficult both clinically and radiologically. Hereby we report an unusual case which was mistaken for metastasis and was diagnosed with the help of histopathology.

Coccidioidomycosis is a fungal disease found only in the Western Hemisphere. In recent years, the incidence of the disease has increased in California and Arizona, which may be partially due to the rapid immigration of previously unexposed persons from states outside the endemic areas. The disease in the nonendemic areas is usually imported. Determining a history of exposure is critical for performing the diagnosis of coccidioidomycosis in these cases. Histopathological examination is the key to the diagnosis when fungal culture and molecular studies are not available. We hereby report an imported case of cutaneous coccidioidomycosis, which to the best of our knowledge is the first case report from North India.