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Proteinuria is common after renal transplantation and affects between 35%-45% of patients during the same year as their transplant. We report a case of dual pathology in the renal allograft as a cause of severe proteinuria. A 38-year-old male presented with end-stage renal disease. He underwent live related renal allograft transplant. His immediate post-transplant period was unremarkable. He developed rise in serum creatinine (2.1 mg/dl) 6 months after transplant and was biopsied. He was diagnosed as a case of acute cellular rejection type Ib with suspicion for antibody mediated rejection. He was treated with methylprednisolone to which he showed a good response with return of serum creatinine to 1.6 mg/dl. Subsequently, he developed a nephrotic range proteinuria 6 months after this episode of rejection. Repeat biopsy was performed. He was diagnosed as a case of immune complex mediated glomerulonephritis (GN) (morphologically consistent with pattern of membranoproliferative glomerulonephritis) with chronic humoral rejection in the form of transplant glomerulopathy (TG). IHC for C4d and immunofluorescence studies were instrumental making the diagnosis. He was treated with steroids and rituximab to which he showed a good response with remission of proteinuria. This case highlights the importance of picking up dual pathology in an allograft biopsy to ensure appropriate therapy. The role of C4d and its correct interpretation is further highlighted, especially with regard to pattern (granular versus linear) and location (glomerular capillaries versus peritubular capillaries).

COVID-19, caused by the SARS-CoV-2 virus, has been declared a pandemic by the World Health Organization. This scenario has impacted the way we practice cytopathology. Cytology laboratories receive fresh and potentially infectious biological samples including those from the respiratory tract, from COVID-19 positive or suspected patients. Hence, the Indian Academy of Cytologists thought it necessary and fit to bring forth appropriate guidelines starting from transportation, receipt, processing, and reporting of samples in the COVID-19 era. The guidelines are prepared with the aim of safeguarding and protecting the health care personnel including laboratory staff, trainees and cytopathologists by minimizing exposure to COVID-19 so that they remain safe, in order to able to provide a continuous service. We hope that these national guidelines will be implemented across all cytopathology laboratories effectively. [ABSTRACT FROM AUTHOR]

Cytological examination plays an important role in the initial work-up of the serous cavity effusion fluids to find out the possible etiology as benign or malignant. Among malignant effusions, cytology is helpful in determining the exact type, site, and stage of the tumor. However, for reporting effusion cytology specimens, there is no consistent and reproducible reporting system. Aims: The aim of these guidelines is to provide a standardized format for effusion cytopathology right from sample receipt to its ultimate report sign-out for implementation in all cytopathology laboratories. The Indian Academy of Cytologists in consultation with experts across the country has prepared guidelines pertaining to collection, preparation, and diagnostic categories of effusion specimens to reduce reporting variability. The guidelines are made keeping in mind the different areas of practices in India, especially low- and medium-resource settings. The guidelines are broadly divided into essential, optimal, and optional categories for best usage and appropriate allocation of the precious specimens. In referral centers or well-established setups, essential ancillary techniques can be done for accurate and final diagnosis. By adhering to and implementing these uniform guidelines, it is hoped that clinical patient care and management in India will improve and be of uniformly good quality by enabling and facilitating good laboratory practices. [ABSTRACT FROM AUTHOR]

Background: The cytological diagnosis of poorly differentiated tumors is challenging because the tumor cells may have morphologically difficult presentations in materials obtained by fine-needle aspiration cytology (FNAC). With the application of FNAC in primary diagnosis of malignant lesions, there has been a significant increase in the use of ancillary studies in the aspirated material. Aims: We evaluated the value of ancillary studies, namely cell blocks, immunocytochemistry (ICC) and electron microscopy (EM), in the final interpretation of FNAC smears. Materials and Methods: Sixty-nine cases of neoplastic swellings were subjected to FNAC. Material acquired was divided for ICC, consisting of immunoperoxidase staining of direct smears, and/or cellblocks and EM, in addition to routine light microscopy (LM). Correlation with the available histological material with immunohistochemistry and/or pertinent clinical information was used as a "gold" standard. Results: Five (7.2%) cases were excluded from the study, the material being necrotic or insufficient. Cell blocks were available in 46/64 (71.8%) cases, ICC evaluation was performed in 41/64 cases (64%) and EM studies were done in 57/64 cases (89%). Diagnostic accuracy of LM alone was 32/64 (50%). Cell blocks improved the diagnoses in 8/46 (17%) cases. The ICC data were diagnostic in 18/41 (43.9%) cases, helpful in 8/41 (19.6%) cases and non-helpful in 15/41 (36.5%) cases. EM studies were diagnostic in 22/57 (38.5%) cases, helpful in 18/57 (31.5%) cases and non-helpful in 17/57 (30%) cases. In 34/64 (53.1%) cases, all ancillary techniques (cell blocks, ICC and EM) were applied and their diagnostic accuracy was compared. Conclusions: With appropriate case selection, ancillary studies performed on aspirated material can provide useful information in FNAC. [ABSTRACT FROM AUTHOR]

Hansen's disease is on the verge of being eliminated from India and often missed by clinicians due to low index of suspicion. We present an unusual case in which greater auricular nerve thickening masqueraded as enlarged lymph node in the neck. The patient was referred for fine needle aspiration cytology, which revealed epithelioid cell granulomas suggestive of Hansen's disease. Further clinical examination and investigations including the skin biopsy confirmed the disease, highlighting the role of pathologist in the management of such unusual presentation of a common disease. [ABSTRACT FROM AUTHOR]

Normal concentration of WBCs in blood varies between 4000 and 11,000 per microliter and are classified into two variants namely granulocytes and agranulocytes on the basis of presence and absence of granules. Manual methods of calculation of TLC include- Neubauer chamber and estimating WBC on leishman stained slides whereas automated methods are based on impedance or light scattering technology. The study compared the efficacy of both these methods in statistical terms using Chi Square test. 100 cases of leucocytosis analyzed over a period of 1 year at MMIMSR, Mullana, Haryana revealed leucocytosis prevalent in 4-6 decade of life with slight male predominance. The pearson coefficient for TLC came out to be p value =0.215 (not significant) but for DLC, calculations revealed p values for polymorphs, lymphocytes, eosinophils and monocytes to be significant (p value =0.000 each). To conclude, standard manual methods should be advocated as special practice where there is definite need of morphological and quantitative evaluation of WBCs and to validate the automated methods by which the laboratories can optimize patient care and not as a replacement. [ABSTRACT FROM AUTHOR]

Introduction: IgA nephropathy (IgAN) is well known to be the most common form of primary glomerulonephritis throughout the world. The histopathological changes are wide and varied as brought out by the various classification systems like the Haas and Oxford systems. C4d is a well-known biomarker of the complement cascade and has recently been implicated in certain native renal diseases. We attempted to characterize C4d deposition in IgAN and correlate this with histopathology by the Oxford classification system. Patients and Methods: This retrospective study included renal biopsies of 15 cases of IgAN diagnosed on histopathology and immunofluorescence over a period of 2 years. Demographic parameters of age and sex were reviewed. The Oxford classification system was applied to score the cases and immunohistochemistry for C4d was done on all cases to characterize staining pattern and intensity and was correlated with Oxford classification. Results: On histological examination, the cases showed various combinations of lesions ranging from M0E0S0T0 to M1E1S1T1. C4d deposition was found to be occurring mainly in mesangial location (12/15 cases, 80%). Forty percent cases showed C4d deposition in the glomerular capillary walls in a segmental fashion and 26.67% showed global pattern. Other patterns of deposition were arteriolar (53.33%), in peritubular capillaries (26.67%) and in tubular epithelium (20%). Conclusion: On comparing the various patterns of deposition of C4d with the four variables of the Oxford classification system, we found that segmental and global deposition of C4d correlated best with endocapillary proliferation.