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Introduction and Aim: Various non-neoplastic and neoplastic lesions occur in the kidney. Pathological assessment of gross and microscopic features in nephrectomy specimens is essential for diagnosis and predicts the prognosis in malignant tumours. Materials and Methods: Case records of 46 nephrectomy specimens received between two-year periods were retrieved. Detailed gross and histopathological and immunohistochemical features were studied, and malignant tumours were analysed using CAP protocol. Results: Out of 46 nephrectomy specimens, 17 were non-neoplastic and 29 neoplastic. Males constituted 32 cases and females 14 cases. The commonest non-neoplastic kidney lesion was chronic pyelonephritis with hydronephrosis (29%). The mixed epithelial and stromal tumour was the frequently encountered benign tumour (50%). Renal cell carcinoma was the most common malignant tumour in adults (70%) and Wilms tumour in children (4%). Conclusion: Histopathological examination of nephrectomy specimens helps in diagnosing, staging, and planning the management.

INTRODUCTION: The medical education in India is moving towards competency-based medical education (CBME) with many cognitive and psychomotor skills needed to be taught and assessed in the various subjects of the undergraduate medical curriculum. In the Pathology subject, psychomotor skills such as haemoglobin estimation, blood grouping, urine examination, liver function test/cerebrospinal fluid interpretation, histopathology and haematology slide interpretation are taught and assessed for many years. Skill assessment by the conventional method, which is followed since many years, is subjective in nature and lack of scope for direct observation of the performance of skills. Objective structured practical examination (OSPE) is one of the methods to minimize the variations in subjectivity, thus enhancing the objectivity. Due to a technicality and labour intensity, it is implemented only in a few medical colleges and universities across India. Because of CBME curriculum on the roll, the assessment of practical skills in medical education needs to be shifted from conventional subjective methods to more objective OSPE methods. MATERIAL AND METHODS: After institutional ethical clearance, the second-year medical students appearing for practical in Pathology were selected for the study. Practical skills of the students were assessed by both the conventional way and OSPE after obtaining the written consent. Among 104 students, 89 students were assessed by both methods. Adequate instructions about the pattern of the examination were given in both assessment methods. For the OSPE group, specific instructions about the role of observer, response stations and method of scoring were given. Practical performance of haemoglobin estimation and blood grouping by slide method was assessed, and scores were compared. Student and faculty perception regarding OSPE was assessed by a prevalidated questionnaire. RESULTS: In the conventional group, the mean score of 6.91 ± 1.08 was obtained, while in OSPE, it was 8.43 ± 1.41. In comparing both, a p value of > 0.001 was obtained, which is found to be significant. Student’s perceptions appeared to favour the OSPE format rather than the traditional examination. CONCLUSION: This study showed a significant difference in scores obtained by OSPE in comparison with conventional practical examination. Thus, this information suggests that OSPE format was perceived better by the students, and resulted in a higher average score. Hence, the use of OSPE as a formative assessment tool will help in modifying teaching-learning strategies so that it is beneficial to students and teachers.

Hepatocellular carcinoma (HCC) metastasizing to the esophagus and mimicking as a primary tumor of the esophagus is extremely rare, being present in

Glomangiopericytoma belongs to a spectrum of lesions which include myofibromatosis, myofibroma, and subset of sinonasal hemangiopericytomas. [1, 2] Stout and Murray in 1942 initially reported GPC as hemangiopericytoma, the tumors displaying a characteristic well developed ‘staghorn’ branching vascular pattern [2] Over the years this definition has been questioned and hemangiopericytoma was better considered as a diagnosis of exclusion, as it appeared that this growth pattern was non-specific, shared by numerous, unrelated benign and malignant lesions and that GPC and SFT belongs to category of lesions which are individualised within the heterogeneous group of hemangiopericytoma – like neoplasms. [2] GPC characteristically has a component of cells with glomus type features including cuboidal cells, distinct cell borders, clear to eosinophilic cytoplasm and central round nuclei. Glomus tumors involving, internal organs are very rare and most often situated in GIT. In GIT, tumors usually involve the stomach but tumor developing in the omentum have not been reported. [3] We report a case of GPC of omentum and challenges we faced in immunohistochemistry interpretation based on literature review.

Background: Kimura's disease is an uncommon cause of lymphadenopathy in pediatric age group. Case characteristics: Usually presents as a triad of lymphadenopathy, hyper eosinophilia and hyper IgG. Kimura's presenting as a neck swelling is rare. Intervention: Excised mass was sent for histopathology. Message: To reduce concerns of malignancy.

Background and Objective: Type 2 diabetic individuals are highly prone to liver function test abnormalities than non-diabetic individuals. Increased activities of liver enzymes such as aspartate aminotransferase (AST), alanine aminotransferase (ALT), and ?- glutamyl transpeptidase (GGT) are indicators of hepatocellular injury. Increased activity of these markers is associated with insulin resistance [1], metabolic syndrome, and type 2 diabetes. Diabetes mellitus burden is one of the key concerns in developing countries like India. In this study, we evaluated the relationships between markers of liver function and the onset of type 2 diabetes. Materials and Methods: This study was conducted after the approval from institutional ethical committee. Twenty five patients reporting to the OPD of K. S. Hegde Hospital diagnosed for type 2 diabetes between the age group of 40-50 years of both sex and 25 healthy age and sex matched individuals were included in the study. Under aseptic precautions blood samples were collected and centrifuged to get serum and was used for estimation. Data were expressed as the mean ± SD. Spearman's correlation coefficients were calculated to evaluate the relationship between serum glucose and liver function enzymes. Result: The results of the present showed that the ALT, AST and GGT levels in Type 2 Diabetic patients was increased significantly (p Conclusion: In this study, we found an association between the level of liver enzymes, ALT, AST and GGT in type 2 diabetes. Thus these liver enzyme levels can be used as a biomarker for the assessment of type 2 diabetes.

Dirofilariasis is a zoonotic filarial parasitic infestation. Its prevalence has increased in recent times. Hence, it is described as an emerging zoonosis. However, not many cases of subcutaneous manifestation of the disease have been reported in the literature. Here, we are presenting two cases of dirofilariasis manifesting as a breast mass causing a diagnostic dilemma in treating clinician. We present two cases of dirofilariasis in the breast tissue mimicking a tumor initially, and on histopathology, it was diagnosed as a Dirofilaria infestation. The increased incidence of Dirofilaria infestation in the Southern part of the country has created a need for increased awareness among the population living in endemic areas to reduce the load of the parasite. Hence it is an ideal time to initiate the primary preventive measures to reduce the incidence of Dirofilaria infestation.

Fibrous dysplasia (FD) is a benign disorder affecting one or more bones seen in all age groups and shows no geographical, racial and sex predilection. Fibrocartilaginous dysplasia (FCD) is a type of fibrous dysplasia where there is extensive cartilaginous differentiation. Our patient was a young girl with a 2 year history of pain in the right forearm and hip. Imaging studies showed multiple lucent lesions in the femur, humerus and radius. Microscopic examination of the curetted fragments from the lesion showed predominant cartilaginous components with focal fibro-osseous areas and areas of enchondral ossification. We present this case due to its rarity and the importance of distinguishing FCD from other benign and malignant cartilaginous tumors as it mimics these in clinical and histological features.

Granulomatous inflammation is a distinctive pattern of chronic inflammation that is encountered in a limited number of infectious and non-infectious conditions. Recognisation of granulomatous pattern and finding the etiology in a biopsy specimen is very important for specific treatment and outcome of the disease. We aimed at finding the etiology of all granulomatous lesions on tissue biopsy sent for histopathogical examination. A study was done at K S Hegde Medical Academy of Nitte University, Mangalore from January 2009 to December 2010. All the cases which were diagnosed as granulomas on Hematoxylin and Eosin stained sections were selected. Special stains like Ziehl-Neelsen stain, Gomori's Methenamine silver, PAS, Fite Faraco were done whenever required. We encountered 275 granulomatous lesions in our study. The most common sites were skin and subcutaneous tissue, lymph nodes, bones and joints. The commonest cause of granulomas was tuberculosis, followed by leprosy, foreign body granulomas, fungal infections, rhinoscleroma, parasites, tumor granulomas and actinomycosis. The morphological features and special staining helped us to find the specific etiology of granulomas in 253 cases whereas it could not be determined in 22 cases even after special stains. Thus we conclude that histopathological examination of granulomatous lesions helped us to find the exact etiology of granulomas in 92 % of cases. The correlation of histopathology with polymerase chain reaction (PCR) serological tests and culture correlation would have helped to find the specific etiology in the remainder of cases.

Oxygen free radicals and products of oxidative cell damage are known as biomarkers that escalate in the pathophysiology of many diseases. The aim of this study is to evaluate association between blood donation and total antioxidant capacity and lipid peroxidation product malondialdehyde(MDA). The levels of MDA and total antioxidant capacity(TAC) were studied in serum of 90 male voluntary blood donors aged from 20 to 45 years attending K. S. Hegde charitable hospital, Blood bank, for determination of lipid peroxidation and antioxidant status, respectively. The donors were divided into nine groups depending on number of blood donation. With increase in number of blood donation the serum MDA level were significantly reduced (p>0.01) but total antioxidant activity was significantly increased (p>0.01). High frequency of blood donors had evidence of decreased lipid peroxidation and enhanced activity of total antioxidants when compared with low frequency blood donors. which can be considered as one of the fringe benefits of regular blood donation.

Filariasis is disabling parasitic disease which is prevalent worldwide and caused by various species of filarial organism. Wuchereria bancrofti (W. Bancrofti) is responsible for 90% of cases of filariasis and is found throughout the tropics and in some sub-tropical areas. Cytology has an important role in the diagnosis of subclinical filariasis. Microfilaria is frequently detected in association with neoplasm, although the role in tumorogenesis is controversial. The early detection of the disease could thus mean the difference between a productive healthy life and a lifetime of chronic disability. The identification of microfilaria in body fluids is a rare scenario. We are presenting here with three cases of microfilaria, which was detected in the pleural fluid, bronchoalveolar lavage, pericardial fluid, and in semen with different clinical scenarios. The purpose of this paper was to illustrate these examples and to review the appropriate literature in order to make physicians aware of this uncommon entity.

Langerhans cell histiocytosis most commonly occurring in children, demonstrates a broad spectrum of clinical and radiologic features that may mimic those of infection as well as benign and malignant tumors. Osseous involvement is the most common manifestation. Recognition of the skeletal alterations is important so that the disease is considered as differential diagnosis. This disease is of unknown aetiology, non-specific clinical and imaging findings with diagnosis possible only on histopathological examination, will always pose a diagnostic challenge to the orthopaedic surgeon. Here by we are reporting two cases of eosinophilic granuloma that has presented with lytic lesion in the tibia and scapula. The clinico-radiological suspicion was either infection or tumour of the affected bones. Hence, core biopsy was done confirmed as eosinophilic granuloma on histopathology and immunohistochemistry.

Scrotal calcinosis is a benign disease characterized by multiple calcified scrotal nodules. The nodules develop slowly over many years and patients usually do not seek for treatment, until they grow to large size. Histopathological examination shows deposition of basophilic amorphous material surrounded by giant cell granulomatous reaction. We report two cases of scrotal calcinosis occurring in 27 year and 45 year old males who presented with multiple scrotal swellings. Clinical diagnosis was multiple sebaceous cysts. On histopathology, excised swellings showed deposition of calcium with giant cell reaction. On regular follow up both are doing fine without any recurrence.

Liposarcoma in the inguinal region though rare are clinically significant lesions. Preoperative diagnosis is difficult since the clinical findings are very similar to that of inguinal hernia. We report a rare case of Liposarcoma of the spermatic cord in 85 year old male, clinically diagnosed as left sided indirect inguinal hernia. Surgical excision specimen showed multiple globular lipomatous masses which were yellowish and grey tan with areas of myxoid degeneration and necrosis seen. Microscopic examination showed adipocytes arranged in lobules with numerous blood vessels, lipoblasts and myxoid stroma confirming the diagnosis of myxoid liposarcoma. He is on regular follow up since two years without any recurrence or metastasis. Our case report highlights the importance of sampling and examination of fatty masses in the inguinal region to rule out the possibility of liposarcoma as they are mistaken for lipoma at surgery.

Necrobiotic xanthogranuloma is a rare granulomatous disease involving skin and subcutaneous tissues. A 61 year old woman presented with a 5 year history of enlarging plaques around both eyelids.it was associated with diminished vision in both eyes. The lesions are often bilateral,symmetrical and ophthalmologic complications are observed. A histopathological examination showed features of necrobiotic xanthogranuloma. Necrobiotic xanthogranuloma is usually associated with paraproteinemia which was not seen in our case.The pathogenesis remains unclear. Although there is no first line of treatment, reports have shown variable benefits with chemotherapeutic agent and steroids.

Malignant melanoma is very rare accounting for 1% of all anorectal malignancies. Long term survival is rare, as most patients die of disseminated disease. A 64-year old female presented with the history of bleeding per rectum and constipation since 2 months with recto-sigmoidoscopy showing an exophytic growth measuring 4x3 cms obstructing the lumen of the rectum. Biopsy showed malignant spindle cell tumor, with possibilities of spindle cell variant of squamous cell carcinoma, leiomyosarcoma and malignant melanoma. The tumor cells were immunoreactive for S-100 and HMB-45, confirming malignant melanoma. MRI showed a tumor just behind the anal verge, without evidence of invasion in the sphincter or enlarged lymph nodes. An abdominal perineal resection was performed with colostomy. On four years of follow up, the patient is doing well without recurrence or metastasis. We report this case because of its rarity, diagnostic dilemmas, early diagnosis and treatment of this aggressive malignancy for better outcome and long term survival. Keywords : primary, anorectal melanoma, HMB-45.

Multilocular cystic renal cell carcinoma (MCRCC) is an uncommon low- grade tumor with unique morphologic features and excellent prognosis. Currently it is classified as subtype of clear cell renal cell carcinoma. We report a case of multilocular cystic renal cell carcinoma presented with right renal mass. Computed tomography showed heterogeneously enhancing partly cystic mass lesion in right kidney. Patient underwent right nephrectomy. Microscopic features were suggestive of multilocular cystic renal cell carcinoma. Patient is doing well with no evidence of recurrence.

Zoonotic filariasis due to Dirofilaria repens (D. repens) is prevalent in several regions of the world. In view of recent rise of human D. repens infections in Europe, Africa and Asia, it is considered an emerging zoonosis in these continents. Most of the documented cases of human dirofilariasis recorded in India had ocular infections, but very few subcutaneous dirofilariasis have been reported. We hereby report two cases of subcutaneous human dirofilariasis due to D.repens with varied clinical presentations.

Cystic neoplasms account for approximately 10 to 15 % of all cystic lesions of the pancreas and malignant cystic lesions form less than 1 % [1–3]. Early identification of asymptomatic cases is now possible due to easy availability of better imaging techniques. These neoplasms are divided into two major groups: serous cystadenomas and mucinous cystic neoplasms [2–5]. Unlike mucinous cystadenomas which are known to be precancerous, malignant transformation of serous cystadenomas is not common. Only 25–30 cases have been reported so far in the literature [3–7]. We report a case of 57-year-old female who progressed from benign pancreatic serous microcystic adenoma (SMA) to pancreatic adenocarcinoma in a follow-up span of 9 months.

Introduction: Tumors of the cutaneous appendages are uncommon. They are categorized into sweat gland tumors, hair follicle tumors and sebaceous gland tumors. Benign adnexal neoplasm’s are more common than the malignant tumors. Aim: To study the spectrum of adnexal tumors of skin with respect to age, sex, site and histopathological pattern. Methodology: We conducted a retrospective analysis of 40 histopathologically confirmed cases of cutaneous adnexal tumors in a tertiary hospital of South India during three years. All the specimens of cutaneous adnexal tumors received during this period were analysed and lesions were categorized according to WHO classification system for Skin Adnexal Tumors. Result: 40 cases of Skin adnexal tumors were diagnosed during the study period. 21 cases (55%) were benign, while 19 cases (45%) were malignant. Skin adnexal tumors were most common in the age group of 31-50 years (35%), with equal sex distribution. The head and neck region was the most common site affected (37.5%) with 45% located on the face. The sweat gland tumors formed the largest group involving 55% cases followed by the hair follicle tumors (25%), followed by 10% each of apocrine gland and sebaceous gland tumors. Pilomatricoma was the most common benign tumor and malignant nodular hidradenoma was the most frequent malignant adnexal tumor in our study. Conclusion: Histopathological examination is the gold standard in the diagnosis of cutaneous adnexal tumors due to their wide spectrum and frequency of differentiation along two different lines within the same lesion. Keywords: Adnexal tumors, Histopathology, Skin, Pilomatricoma, syringocystadenoma

Bilateral breast cancer is a rare event accounting for 2-5% of all breast malignancies. A second tumor in contralateral breast may be either synchronous or metachronous lesion. Synchronous bilateral invasive ductal carcinoma is known but medullary carcinoma is rare. The etiology of bilateral breast cancer is uncertain and prognosis in these cases once thought to be poor but recent data suggest a similar survival compared to unilateral disease. We report a case of triple negative synchronous bilateral medullary carcinoma in a 38-year-old female who presented with lump in both the breasts for three months. Multidetector computed tomography breast scan revealed bilateral heterogeneously enhancing well-defined lesion in both the breasts. Fine needle aspiration cytology from both the breast lump was suggestive of malignancy. Patient underwent bilateral modified radical mastectomy with axillary clearance in a single sitting. Histopathology showed synchronous bilateral medullary carcinoma of breast with ER, PR and HER- 2/ neu negativity. Patient was treated with chemoradiation and she is on regular follow up for one year without any recurrence or metastasis.

Solitary thyroid nodule is common in clinical practice but a nodular intrathyroid metastasis is rare and may be underestimated.[1, 2] There are reports of metastasis to thyroid from kidney, lung, breast, sarcoma and melanoma. Secondary neoplasm of the thyroid mimicking as primary is a rare finding and difficult to diagnose without a past history of malignancy. Among carcinomas metastatic to the thyroid, renal cell carcinoma constitute 50% of cases.[1–5] Oesophageal carcinoma metastasis to the thyroid is uncommon. Secondary tumours of the thyroid are seen almost always with metastases of other organs and systems. The metastasis to the thyroid gland is usually considered as a terminal event, and the effectiveness of the conventional treatment has been questioned. The surgical resection is rarely performed in such cases; hence metastasis to thyroid gland is rarely seen on the routine pathology practice.[5–8] We hereby report a case of 64 year old female who presented with solitary nodule thyroid, on further evaluation diagnosed as oesophageal carcinoma with metastasis to thyroid.

Primary amelanotic melanoma of the vulva is extremely rare and it is a unique variant which is difficult to differentiate from other epithelial and nonepithelial malignancies due to absence of melanin pigmentation. It can be easily mistaken for other malignancies both clinically and pathologically. The difficulties in diagnosis and treatment aggravate the poor prognosis. This case highlights the rare case of vulval amelanotic melanoma occurring in a young lactating female.

Adenocarcinoma is the most frequently diagnosed histological subtype of bronchogenic carcinoma in women and nonsmokers [1]. Extrathoracic metastasis is found at autopsy in over 80% of patients with adenocarcinoma. Metastasis to bones is common occurrence in patients with advanced carcinomas, particularly in those with lung, breast or prostate [2]. Metastasis to bone marrow from prostate, breast, pancreas, gastric adenocarcinoma and small cell carcinoma lung have been frequently reported. Bone marrow involvement in pulmonary adenocarcinoma is rare [1]. Here we are reporting a case of adenocarcinoma lung with bone marrow involvement as its first manifestation.

Cervical region teratoma is a rare disease, accounting for 3-5% of all teratomas in the children. Teratomas of the head and neck due to their obscure origin, unpredictable behavior, and often manifest as a clinical surprise. Airway obstruction is the most serious postnatal complication of cervical teratoma. Prenatal diagnosis is crucial for early recognition of the neck masses that could obstruct the airway. We present a case of 4-month-old female child at age of 4 th month with right submandibular region swelling. Computed tomography neck showed ill-defined, multiloculated cystic lesion with enhancing thick septations in the right side of the neck. Excision biopsy revealed Grade I--immature teratoma--cervical region. On 1-year of close follow-up, no evidence of local recurrence or metastasis was seen. Unlike adults, teratomas in children are often congenital and very rarely turn malignant. The treating consultant should be aware of their natural history, clinical features, pathology, and principles of management.

Background: Abnormal uterine bleeding (AUB) is a common gynecological complaint associated with considerable morbidity and significantly affects the patient′s family, personal and social life. The aim of the study was to analyze the histomorphological patterns of endometrium in patients presenting with AUB and also to determine the incidence of AUB in various age groups. Materials and Methods: This is a prospective study, conducted in the Department of Pathology, in a tertiary care teaching hospital, Mangalore from October 2011 till date. All cases of AUB with a probable endometrial cause were included in the study. Data was entered in Microsoft Excel and managed in Statistical Package for the Social Sciences (SPSS) version 16. Analysis was done in the form of percentages and proportions and represented as tables where necessary. Results: A total of 156 cases were analyzed. Patients′ age ranged from 23-78 years. AUB was most prevalent in the perimenopausal age group. The most common presenting complaint was menorrhagia (47%). Endometrial hyperplasia was the most common histopathological finding and was seen in 25% patients, followed by secretory endometrium in 16.7% patients, and proliferative phase pattern and disordered proliferative endometrium were seen in 12.2% patients each. Malignancy was detected in 6.4% of cases and endometrial carcinoma was the most common lesion (4.5%). Conclusions: Histopathological evaluation of endometrial samples is especially indicated in women over the age of 35 years to rule out malignancy and preneoplasia. Among the patients with no organic pathology, normal physiological patterns with proliferative, secretory, and menstrual changes were observed. The most common endometrial pathology in this series was endometrial hyperplasia.