Brain abscess continues to be a serious medical problem with increasing incidence despite advances in diagnostic and surgical methods, and advent of new antibiotics. This is due to increase in immune suppressed individuals, opportunistic pathogens and resistance to antibiotics. The morbidity, mortality and long term sequelae of brain abscess like cognitive impairment and poor neurological outcome are due to persistent release of proinflammatory mediators by activated microglia, astrocytes and infiltrating inflammatory cells, along with disruption of blood brain barrier. Anti-inflammatory drugs along with specific antimicrobial agents help in minimizing damage to the adjacent brain parenchyma. Identification of microorganisms in the aspirated material or the excised specimen help decide the optimal antimicrobial therapy. Prompt examination of smear and meticulous culture techniques to identify aerobes, anerobes, mycobacteria, actinomycetes, parasites and fungi are of utmost importance in choosing antibiotics. Histology complements culture and plays a key role especially in specific infections. Use of appropriate histochemical stains along with tissue reaction helps in diagnosis. The route of spread, the type and virulence of the organism, thickness of the capsule, location and number of abscesses in the brain, and immune status of the host are important determinants of outcome. Identification of microorganisms and insights into pathogenesis allow appropriate therapeutic interventions to improve outcome.

Medico-legal post-mortems referred to the Department of Pathology, for the histopathological examination, revealed six cases of acute aortic dissection--two in isolation, three in combination with congenital bicuspid aortic valve; and one isolated case of congenital bicuspid aortic valve. One case of isolated aortic dissection was associated with Marfan's syndrome; and one case of aortic dissection with bicuspid aortic valve was associated with polycystic kidneys. History of hypertension could be elicited in two cases. Cystic medial degeneration of aorta was seen in three cases; one of which was associated with Marfan's syndrome. All five cases of aortic dissection belonged to type II of DeBakey classification.

The purpose of the present study was to evaluate the efficacy of mammographic guided stereotactic fine needle aspiration cytology in 136 patients with breast lesions including mammographic features, cytomorphological findings and nuclear grading in malignant cases. Majority of the cases were predictable correctly by combination of the three modalities of diagnosis viz, clinical examination, mammography and cytology.

Fine-needle aspiration (FNA) cytology is successful in identification of benign and malignant breast lesions, but its role in proliferative breast lesions which increase cancer risk is poorly defined. We have analyzed the cytomorphologic features of proliferative breast lesions in conjunction with cytologic scoring system proposed by Masood et al and with histopathology. Sixty two patients (14 cases of fibroadenoma, 15 cases of fibroadenoma with atypia, 11 cases of proliferative breast disease (PBD), 8 cases of PBD with atypia and 14 cases of carcinoma) diagnosed on routine FNA were subjected to scoring following Masood's criteria. All cases with the cytologic diagnosis of fibroadenoma were confirmed on histology. Of 11 cases of PBD on FNA, 10 were PBD without atypia on histology. One case, which showed atypical hyperplasia on histology, was missed by both the scoring system and cytomorphology and one case was over-diagnosed as PBD with atypia by the scoring system. FNA cytology correctly identified all the carcinoma cases, while the scoring system under-diagnosed 2 cases as PBD with atypia. Hence, in cases not suspected to be atypical or confirmed to be cancer on routine cytology, scoring added no information over and above cytomorphology and was not useful. All fourteen cases of fibroadenoma with atypia suspected on routine cytology were fibroadenoma on histology. Scoring system correctly placed 11/14 of these cases as PBD without atypia. Similarly 3/8 cases thought to be PBD with atypia were correctly placed as PBD without atypia by scoring. Only 2/8 cases thought to be PBD with atypia on cytology were confirmed to have atypical hyperplasia on histology. Scoring improved the diagnostic yield to 2/5. Hence, in cases of fibroadenoma or PBD, suspected on FNAC to have cytological atypia, Masood scoring gives additional information by eliminating benign cases and improving diagnostic yield. Application of scoring in a step-wise manner, on atypical aspirates, can help in selection of cases suitable for biopsy.

Diagnosis of hepatocellular carcinoma (HCC) is not always easy on simple hematoxylin and eosin (H&E) stain. The diagnostic problems arise when tumor shows pseudoglandular, pleomorphic or clear cell differentiation. Various tumors markers have been described with varying sensitivity and specificity. Monoclonal antibody Hep Par 1 (OCH1E5) which is specific for hepatocytes offers great help in separation of these tumors. The aim of the present study was to determine utility of Hep Par 1 (OCH1E5) in differentiating HCC from metastatic tumors and cholangiocarcinoma. Total of 62 cases of liver tumors obtained from biopsies, resected or autopsy specimens were included in the study. Slides having representative sections were subjected to immunohistochemistry with monoclonal antibody Hep Par 1 (Dako Corp) using avidin biotin technique with primary antibody dilution of 1:40. Adjacent nontumorous hepatocytes were taken as positive control. Slides were examined by experienced pathologist without any information of clinical or H&E diagnosis. Cases were considered positive for Hep Par 1 if tumor cells showed cytoplasmic brown colored granules. The intensity and distribution (diffuse/ focal) of immunoreactivity was noted. Subsequently immunohistochemistry results were correlated with histology and clinical diagnosis. Hep Par 1 antibody was positive in 26 (42 %) and negative in 36 (58 %) liver tumors. On correlating with H&E sections, out of 26 positive cases, 25 (89.2%) were HCC and one was the case of metastasis of mucin secreting adenocarcinoma. From 36 tumors with negative staining 3 were cases of HCC, 27 metastatic adenocarcinomas and 6 cholangiocarcinomas. Only one case of liver metastasis of mucin secreting adenocarcinoma showed positivity. None of the cases of cholangiocarcinoma showed positivity for Hep Par 1. The three HCCs which did not take up staining for Hep Par 1 were 2 cases of moderately differentiated HCC having pseudoglandular pattern and a case of well differentiated HCC with trabecular arrangement. In 11(44%) cases staining was diffuse while in 14 (56%) it was focal but intense. Hep Par 1 is a useful marker in differentiating HCC from metastaic tumors and cholangiocarcinoma with sensitivity and specificity of 89 % and 97 % respectively and positive predictive value of 96 %. However one should be aware of limitations of immunohistochemistry.

Fifty cervical biopsies from women with preinvasive and invasive malignancies of uterine cervix and ten normal cervical biopsies were examined for the presence of human papilloma virus (HPV) 16 and 18 DNA sequences by in situ hybridization (ISH) method with biotinylated DNA probes. The overall positivity of HPV DNA was 48% (24/50). The positivity of HPV 16 DNA for low grade squamous intraepithelial lesion (LSIL), high grade squamous intraepithelial lesions (HSIL) and squamous cell carcinoma (SCC) were 33.33%, 45.45%, 42.30% respectively. The positivity for HPV 18 DNA for LSIL, HSIL and SCC were 0%, 18.18%, 30.76% respectively. Two cases of cervical adenocarcinomas showed positivity for HPV 18 DNA only.

Rapid diagnosis of histopathological material is becoming increasingly desirable. In neuropathology, crush smear preparation and frozen section diagnosis of tissues removed during operative procedures, have remained as essential tools for rapid diagnosis. Microwave technology has been introduced into the field of tissue processing and staining in past decade. Now-a-days even automated microwave assisted rapid tissue processors are available. In our study we have analysed the use of a domestic microwave (cost approximately Rs.5000) for urgent histoprocessing (30 minutes). This could be useful in small laboratories or the ones which are in the phase of establishing the department as the procedure is much more economical than obtaining a frozen section (which requires a cryostat worth 3-6 lakhs) and the interpretation of the section obtained does not require any extra experience as these resemble the routinely processed tissue sections. The advantages and limitations of the procedure have been discussed.

Helicobacter pylori (H. pylori), infection has been linked to acute and chronic gastritis, non-ulcer-dyspepsia, peptic ulcer, gastric adenocarcinoma and gastric non-Hodgkin's lymphoma of mucosa-associated lymphoid tissue (MALT). The epithelial changes in H. pylori colonized gastric mucosa are easy to recognize in routine Haematoxylin & Eosin stained sections and are so distinctive that they can serve as a helpful histological indicator for the presence of H. pylori in gastric biopsies. The histopathology of seventy-five gastric biopsies showing colonization by H. pylori was studied. Histologically, the H. pylori colonized gastric epithelium showed characteristic changes that were topographically related to the bacteria. These changes included irregular surface, epithelial pits, individual cell dropout and microerosion, which were specific for H. pylori colonization. These were absent in areas not colonized by H. pylori and in 20 consecutive H. pylori negative gastric biopsies seen during the same study period. As specific treatment for H. pylori infection is available, identification of H. pylori colonization in gastric biopsies should be attempted in all cases of gastritis, peptic ulcers and non-ulcer-dyspepsia.

Hepatocellular carcinoma (HCC) is one of the common malignancies worldwide including Asian countries. Chronic viral hepatitis is implicated as an important etiological factor in carcinogenesis of liver. AIM: To study incidence of hepatitis B (HBV) and C (HCV) viruses in HCC and to compare the incidences with that of chronic liver disease. MATERIALS AND METHOD: 40 cases each of HCC (group I) and chronic liver disease including cirrhotic liver (group II) who died of the liver disease. All cases were stained with HBsAg and HBcAb for HBV and RT-PCR for HCV RNA. Different groups were compared using student's t-paired and chi-square tests. RESULTS: Group I--HCC was seen in 37 cirrhotics and 3 non-cirrhotic cases. HBsAg was positive in 32 cases (80%), HBcAb in 22 cases (55%) and HCV in 23 cases (57.5%) (p<0.05). Dysplastic nodule (DN) was seen in 25 cases, HBsAg and HBcAg positivity were seen in 18 and 15 cases respectively. Group II--32 cases were cirrhotic and 8 were non-cirrhotics. HBsAg was positive in 28 (70%), HBcAb in 12 (30%) and HCV in 18 (45%) cases. DN was seen 24 cases, HBsAg and HBcAg postiviy were seen in 16 and 7 cases respectively. HBV and HCV co-infection was seen in 20 and 15 cases, and HCV with HBcAb positivity was seen in 13 and 9 cases in groups I and II respectively. Number of cells in each case showing positivity for HBcAb was also significantly higher in group I (p<0.01). Age and sex distribution did not show any distinctive differences between the two groups. CONCLUSION: the study highlights a high incidence ofHBVand HCV infection in cases of chronic liver disease and HCC. HBcAb positive state appears to be an independent risk factor for HCC.

Fibronectin is a multifunctional large molecular weight glycoprotein that can bind extra-cellular and cellular components. The aim of the present study was to evaluate expression of fibronectin and its significance in cases of hepatocellular carcinoma (HCC). A few previous studies have shown abnormal over- expression of fibronectin in cases of HCC. Expression of the fibronectin protein was studied in eleven cases of HCC by immunohistochemical method. Fibronectin was seen to localize predominantly in perisinusoidal region and strong positivity was noted in other fibrotic areas. Positivity around nests of cells and tumor nodules was noted in 8/11 cases of HCC and faint cytoplasmic positivity in tumor cells was seen in 5/11 cases. Staining pattern of fibronectin in HCC was definitely abnormal but decreased in the present study. The controversial results as seen in few previous studies also have been partially explained in the present article and further studies using larger sample size is suggested to clarify the issue.

The objective of the study is to document the value of fine needle aspiration cytology (FNAC) in the diagnosis of filariasis at all possible sites in both exfoliative cytologic material and fine needle aspirates. Both unguided and guided FNACs of all foci were studied over a period of two years between 1999 to 2000. Total 22 cases of filariasis were detected which included subcutaneous swellings(7), breast(3), thyroid(3), lymphnodes(3), effusions(3), cervical scrape(1), eyeball(1), sputum(1) and bronchial washing(1). In none of these cases was filariasis considered a diagnostic possibility. Cytologic smears showed eosinophils in 9 cases, oval ova and embryonated eggs in 2 cases. Microfilariae were associated with other diseases in 13 cases, including 6 cases of malignancy. Significant adherence of inflammatory cells and macrophages to microfilariae was present in 6 of the 22 cases. In endemic areas,filariasis should be considered one of the differential diagnosis of a swelling. Thus demonstration and identification of the parasite in cytologic smears played a significant role in the prompt recognition of the disease and institution of specific treatment, thus obviating the more severe manifestations of lymphatic frilariasis.

The direct (DAT) and indirect antiglobulin tests (IAT) are one of the most important diagnostic tools used in the investigation of immune mediated disorders. Recently, transfusion laboratories have seen the introduction of column technology in the form of the gel technology (GT). Aim of this study is to compare the conventional tube tests (CTT) and the GT for Coomb's test and to evaluate their sensitivity and specificity. 1656 samples were included in this study, in which 1054 samples were subjected to IAT and 602 samples were subjected to DAT Of the 602 samples tested for DAT, 587 (97.5%) showed concordant DAT results. DAT by the GT could detect 8.6% positivity as compared to 6.1% by CTT. The sensitivity and specificity of the GT was 100% and 97.3% respectively and its negative predictive value was 100%. Among the 1054 samples for IAT, 1041 (98. 8%) showed concordant results. The IAT by the GT showed 6.6% positivity as compared to 5.4% positivity by CTT The sensitivity, specificity and the positive and negative predictive value were 100%, 97.7%, 81.4% and 100% respectively. In conclusion, the GT is a better alternative to the CTT for both DAT and IAT. The GT is highly recommended to be implemented as a routine method of testing in all zonal / regional blood transfusion centers.

Anemia is a common health problem but control of anemia in pregnant women is less well studied. The purpose was to study prevalence of anemia in young pregnant women, correlate with indices and study significance of identification of hemoglobinopathies. Of the 120 pregnant women, Hb was less than 8 g% in 58 (44.2%). Seventy-eight (65%) had iron deficiency, 22 (18.3%) had dimorphic anemia, and 14 (11.6%) had hemolytic anemia. Megaloblastic anemia was present in 6 (5%). Of hemolytic anemia, 50% were thalassemia trait. MCV< 76 fl was observed in 88 (73.3 %) cases. MCV<76 fl and MCH < 27 pg had 100 % sensitivity and 28.7 % specificity for screening of beta-thalassemia trait. NESTROFT had comparable sensitivity but lower specificity (14.9%). Sixty-three percent (60/78) of IDA had increased RDW whereas 78 % (11/14) of hemolytic anemia had RDW value in normal range (p value< 0.05). MCV/RBC of <14 was more specific parameter (96.8%) for beta-thalassemia trait. Four high-risk couples were identified. Thus, moderate to severe anemia was observed in most pregnant women. Hemoglobinopathies should be screened in antenatal clinics to identify the couples that would need a prenatal test. A lower MCV/RBC with RDWin the normal range may be useful in screening for thalassemia trait in pregnant women.

Galectin-3 is a 31kD beta-galactoside binding lectin, which is known to be expressed in various neoplasms including thyroid tumors. This study was conducted to study the role of galectin-3 in differentiating benign from malignant thyroid nodules onfine needle aspirates (FNAC). Galectin-3 immuocytochemistry was performed in 70 cases with adequate smears. The cytology diagnosis of these cases was: papillary carcinoma (25), follicular neoplasm (16), adenomatous goiter (20), hyperplastic nodule (5), medullary carcinoma (5) and anaplastic carcinoma (1). Galectin-3 positivity was seen in 80% of papillary carcinomas, 37.5% offollicular neoplasms and in 60% of benign nodules. The single case of anaplastic carcinoma was positive but all the cases of medullary carcinoma were negativefor galectin-3. Three of thefollicular neoplasms that were diagnosed on histology as carcinoma were positive on cytology and one case offollicular adenoma was also positive. Our study shows that galectin-3 is strongly expressed in smears of papillary carcinoma. However, since it is also expressed in a variety of benign lesions, its role as a pre-surgical markerfor differentiating benignfrom malignant thyroid nodules is limited.

Blood collection is an important preanalytical component of haematological testing. This questionnaire based study was conducted on laboratory personnel to elicit their knowledge and practice regarding blood collection procedures for haematological testing. Questionnaire comprised of 37 multiple choice questions, of which 10 questions each were related to essential and desirable knowledge, 10 to practice and 7 to educational and job profile. Ninety four laboratory personnel participated in the study. Analysis was done on SPSS software. Percentages of unsatisfactory scores were 42.6%, 4.3%, 17% and 6% in the essential knowledge, desirable knowledge, practice and total scoring respectively. 91.5%, however, had a satisfactory total score. Importance needs to be given to blood collection procedures both, individually and collectively. The study highlights the deficient areas which need to addressed by all laboratorians. Such studies should also be conducted among nursing and resident staff- the other groups concerned with blood collection.

A case of a 56 year old lady presenting clinically with a slow growing painless mass of the left lacrimal gland, the histopathplogical examination of which was consistent with a diagnosis of tubercular dacryoadenitis, is described. Tubercular dacryoadenitis is uncommon, with the diagnosis usually made on histological examination of the lacrimal gland. Other cases of tubercular dacryoadenitis reported in literature are also reviewed.

Breast sarcomas are very rare. A 40 year old lady presented with a well-defined hard lump, 6 cm in size, in the left breast. Patient underwent simple mastectomy with axillary clearance following a diagnosis of phylloides tumour on fine needle aspiration cytology. Grossly, it was a circumscribed myxoid tumour. Histopathologically, it fulfilled all the criteria for a diagnosis of myxoid liposarcoma. The absence of epithelial component excluded phylloides tumour.

Idiopathic focal eosinophilic myositis is a rare benign pseudotumor of skeletal muscle of unknown cause, characterized by focal eosinophilic infiltration of striated muscle. It can mimic a soft tissue sarcoma clinically and on gross examination of the specimen. Microscopic examination establishes the diagnosis. It is important to recognize this pseudosarcomatous lesion so as to spare the patient from anxiety.

Endovascular papillary angioendothelioma (EPA) is a rare vascular tumor of low grade malignancy, encountered primarily in children. However some cases have also been reported in adults. A sixty year old female with EPA is described here. She presented with a swelling in the neck. Total surgical excision was performed. Histomorphology revealed anastomosing lymphatic channels showing intraluminal papillary fronds with hyaline vascular cores and hobnailing of endothelial cells. A diagnosis of EPA was made based on this picture. This tumor is recurrent and nodal metastasis has been reported in some cases.

Calcifying fibrous pseudotumor has recently been described in the soft tissues. It is a rare benign lesion characterized by the presence of abundant hyalinized collagen with psammomatous or dystrophic calcification, and lymphoplasmacytic infiltrate. We report one such rare case in an 18 year old female with a nodular mass in the soft palate treated by complete resection. The mass had all the pathologic features of a calcifying fibrous pseudo-tumor.

Mediastinal cysts are rare and classified into thymic cysts, bronchogenic cysts, enteric cysts, pericardial cysts, lymphatic cysts and other rare types. We describe a case of foregut cyst of esophageal type in a 22 day old male infant. The CT scan showed a cystic lesion. Excised cyst was bilocular and was filled with clear fluid. Microscopically, the cyst was lined by columnar epithelium with well formed lamina propria and double layered muscularis. In view of presence of double layer of muscularis and absence of gastric glands, intestinal epithelium or cartilage, it was classified as esophageal cyst. We report this case of esophageal cyst because of its rarity.

MPNST occurring in oral cavity, which is a rare site for the tumour, in a 35 year old female patient with history of swelling underneath the tongue present since one year diagnosed clinically as ranula is presented here. Histopathological examination of the excised mass showed features of spindle cell sarcoma following which a provisional diagnosis of MPNST was offered. The differential diagnosis considered were leiomyosarcoma, rhabdomyosarcoma and spindle cell variant of squamous cell carcinoma (being the commoner tumour in oral cavity). Immunohistochemistry confirmed neural origin of the tumour. The case is reported in view of the rarity of the lesion in oral cavity.

Epithelial myoepithelial carcinoma (EMC) is a rare low grade malignant salivary gland neoplasm that most commonly occurs in the parotid gland but can also arise in minor salivary glands. We report a case of primary epithelial myoepithelial carcinoma of minor salivary gland in a 25 year old women who presented with swelling left cheek of one year duration and bilateral submandibular lymphadenopathy. A mass causing erosion of mandible, thyroid cartilage and masseter muscle was identified on CT scan. This was excised and histological examination revealed a mixture of ductal structures consisting of inner dark cells and outer clear cells seen in solid sheets. Immunohistochemical analysis showed the clear cells to be weakly positive for S100 and smooth muscle actin (SMA) and ductal cells to be positive for cytokeratin (CK) and epithelial membrane antigen (EMA). The characteristic morphological and immunohistochemical features aided in the diagnosis of epithelial myoepithelial carcinoma.

A case of paratesticular liposarcoma in a 60 year male is presented for its rarity. The tumour was a dedifferentiated liposarcoma (DDL) seen in the original excision.

Parathyroid lipoadenoma is a rare variant of parathyroid adenoma showing intermingling of chief/ oxyphil cells with abundant mature adipose cells, the latter comprising 20-90% of the tumour. Approximately thirty-five cases have been reported previously. We report a case of 41-year old woman who presented with clinical manifestations of primary hyperparathyroidism. She had elevated serum calcium and parathyroid hormone levels. Radiological investigations suggested presence of adenoma. Intra-operatively, parathyroid adenoma was found in the neck in an ectopic location behind the carotid sheath and extending into the superior mediastinum. Clinicopathological findings of this rare tumour are discussed.

Solid and papillary epithelial neoplasm (SPENP) of the pancreas is a rare pancreatic tumour of low malignant potential, that is seen mostly in young females. The aetiology and pathogenesis is unclear but it is considered to be arising from primordial pancreatic cells. We report two cases of SPENP who had palpable abdominal lumps and were diagnosed on histopathology. In the first case, the tumour was unresectable and patient died within one year. In the second case, at laprotomy the patient had perineurial as well as capsular infiltration but after wide resection of the growth, patient has been doing well for the past 6 months. Since SPENP is a low grade malignant neoplasm, it should be treated aggressively with complete resection and metastatectomy. Prognosis after adequate surgery is good. A clinicopathological study and brief review of literature is presented.

The authors describe a case of primary mucinous carcinoma of urachus in 65 years old male. Patient presented with hematuria with suprapubic mass. The patient underwent total cystectomy with en bloc excision of the tumor mass and umbilicus. Histological examination showed features of mucinous carcinoma of urachus. A clinicopathological study and brief review of literature is presented.

We report a case of nodular hidradenoma in a 90 year old male, presenting with an eyelid swelling. The cytomorphological features are described with special emphasis on cytoplasmic granularity and tubule formation as an important feature in diagnosing and differentiating eccrine tumors from other adnexal neoplasms on FNAC.

Malacoplakia is one of the rare, chronic inflammatory disorders affecting the epididymis and testis. Diagnosis of the same is important as the treatment differs from the other granulomatous lesions in this area. We present a case of malacoplakia involving both the epididymis and testis with a brief review of literature.

Potter's syndrome is a rare entity with an incidence of 1 in 2000 to 1 in 5000 live births. All babies born with this condition are either stillborn or die very early within neonatal period. We present two autopsy cases which presented with abnormal facies, oligohydramnios, pulmonary hypoplasia and genitourinary abnormality. One case presented with infantile polycystic kidney whereas in the other case both the kidneys were normal but had adenomatoid tumour of left testis. Both the children died few hours after birth. In both the cases pulmonary hypoplasia was the cause of death rather than genitourinary abnormality.

Squamous cell carcinoma of the renal pelvis is a rare tumor, which is usually associated with nephrolithiasis. It is rarely associated with pyonephrosis. We report the case of a 69-year-old man who presented with features of pyonephrosis and underwent nephrectomy. The postoperative histological evaluation revealed an unsuspected squamous cell carcinoma of renal pelvis with a concomitant pyonephrosis. The rarity of this tumor in the absence of renal calculi and its association with pyonephrosis is highlighted.

A case of right sided abdominal lump with pain in a 45 years female was presented. Radiological investigation revealed a multiloculated cystic mass with a few mural nodules arising from right ovary. The tumor was removed by exploratory laparotomy and histopathological examination showed coexistence of dermoid cyst with mucinous cystadenocarcinoma in the same ovary. Left ovary and uterus was healthy and there was no tumor extension or omental deposits. Postoperative period was uneventful.

Chondroid lipoma is a rare fatty tumor of soft tissues, especially in limbs and limb girdles. Though it is clinically benign, the main importance lies in its histological similarity with myxoid liposarcoma and chondrosarcoma, which have poorer prognosis. In our study, classical histological pattern of chondroid lipoma was confirmed on H&E and PAS stains with low mitotic count.

A 42 year old male presented with painless soft tissue mass 8x7x6.5 cm in right scapular region for 2 months. Fine needle aspiration cytology (FNAC) showed a malignant clear cell tumour. Ultrasonography (USG) abdomen revealed a heterogeneous mass m 8.6x7x8.4 at the lower pole of left kidney. USG guided FNAC from left kidney mass showed cytomorphology consistent with RCC.

Retinal dysplasia is an uncommon condition and may be either unilateral or bilateral. It represents disturbed differentiation of neural ectoderm. It can be sporadic or may be associated with genetic defects. A case of unilateral retinal dysplasia in a 2 year old male child is reported.

Atypical stromal cells have been reported in inflammatory lesions of the gastrointestinal tract. We report a case of ulcerative colitis with pseudopolyps, histology of which showed bizarre stromal cells. These atypical stromal cells simulate malignant cells and pose a diagnostic problem for surgical pathologists. It is therefore important to recognize these benign stromal cells as reactive thereby reducing unnecessary surgery.

Gastrointestinal mucormycosis has been reported more frequently in adults than in children. Due to high mortality diagnosis is usually made at autopsy. Only 3 cases of neonates surviving this disease have been described. We report two cases of preterm neonates presenting clinically with symptoms of necrotizing enterocolitis (NEC), but lacking radiological characteristics of NEC where histopathology confirmed the diagnosis of gastrointestinal mucormycosis involving caecum and appendix.

Five cases of tumoral calcinosis were studied during the period of January-february 1999 in MIMER medical college, Talegaon, a rural place 35kms. from Pune. All the Five patients were females residing in nonendemic area for Dracunculosis. They were from 5th-6th decade. They were otherwise healthy and had normal serum calcium and phosphorus levels and no eosinophilia. All had large, hard subcutaneous lump around hip joint. The skin overlying the swelling was normal. Histologically all cases showed similar morphology, the lesions were composed of large and small deposits of calcium. The foreign-body giant cell reaction was seen in two cases. There were no eosinophils and lymphocytes. On multiple sectioning none of the cases revealed any evidence of dead or living parasite. Old and recent necrosis was absent. These cases are presented since the condition is comparatively rare and it appeared in crops in our Institute.

Primary malignant lymphoma of spleen is rare with primary Hodgkin's disease (HD) of spleen being rarer. The diagnosis of primary splenic HD is usually made on the histopathological examination of the splenectomy specimen. We report an interesting case of primary HD of spleen in a child emphasizing its rarity and the role of fine needle aspirate cytology in early diagnosis and non-surgical management of this entity.

A case of plasma cell leukemia showing mostly pleomorphic plasma cells in the form of convoluted and multilobated nuclei with some having bilobed nuclei and internuclear bridges is being reported for its rarity of occurrence. Patient presented with congestive cardiac failure and features of nephropathy. There were no lytic lesions in the bone. Serum electrophoresis did not show any M-band while urine electrophoresis demonstrated Bence Jones protein confirming a light chain only type of myeloma. Patient is in remission 5 months after diagnosis. The significance of recognising such pleomorphic plasma cells is discussed.

A 55 year old male, who presented with a painless swelling of six months duration on his thigh, was clinically diagnosed to have a benign soft tissue neoplasm. Histological examination of the excision biopsy specimen revealed a benign tumour of the vascular smooth muscle, which was diagnosed as angioleiomyoma. Angioleiomyomas are painful lesions that can occur anywhere in the body. We present this case for its atypical clinical presentation and discuss its histologic features with a review of literature.

Diffuse uterine leiomyomatosis (DUL) is a rare entity with an unknown etiopathogenesis. A 24 years old female presented with abdominal discomfort and menorrhagia. Clinical and ultrasonographic examination revealed an enlarged uterus. The hysterectomy specimen showed a symmetrically enlarged uterus with a bosselated external surface. The cut surface showed multiple nodules of varying sizes diffusely involving the myometrium. Microscopically, the nodules were leiomyomas of varying degrees of cellularity. Some of the leiomyomas showed an increased vascularity either in the form of congeries of blood vessels with a lobular arrangement or occasionally as foci of 2-3 vessels. The vessels were surrounded by whorls of spindle cells. On immunohistochemistry the leiomyomas expressed vimentin, smooth muscle actin (SMA), desmin and CD10: the cells whorling around the blood vessels expressed vimentin, SMA and focally desmin and were negative for CD10 and HMB-45. The aim of this paper is to document that CD10 is expressed in diffuse uterine leiomyomatosis and discuss the histogenesis of DUL.

Nonodontogenic cysts have been identified at various locations in oral cavity. These occur primarily in relation to fusion of maxillary process either with its counterpart or different portions of nasal part of frontonasal process. Usually solitary, these primarily affect maxilla alone; can rarely be seen in ramus of mandible. We present a case of multiple non-odontogenic cysts involving both maxilla and mandible.

Adenomas of the parathyroid gland, the majority of which are of the solitary chief cell type, are the most frequent cause of primary hyperparathyroidism (pHPT). Parathyroid adenomas composed predominantly or exclusively of oxyphil cells are rare and most oxyphil cell adenomas of this organ remain clinically silent. We present here a case of hyperfunctioning oxyphil cell adenoma of the parathyroid gland resulting in pHPT, osteitis fibrosa cystica and simultaneous bilateral fractures upper shafts of femora.

Human infections by Chromobacterium violaceum are rare. Till date 6 cases have been reported from southern and eastern parts of India. We report here a case of puerperal sepsis by C. violaceum, probably the first case from Eastern part of Orissa. The patient was successfully treated with amikacin and gatifloxacin.

A 58 year old male, chronic smoker, with diabetes mellitus (Type II), residing in Madhya Pradesh presented with dysphagia, hoarseness, odynophagia and significant weight loss. Microlaryngoscopy showed reddish ulcerated area involving valleculae, and pharyngo-epiglottic fold. Histopathological examination showed foamy macrophages containing Histoplasma capsulatum. Patient initially responded to Azoles, relapsed three months after stopping the treatment and presented with oral lesions. Biopsy showed H. capsulatum, histologically as well as on culture. The mycelial phase converted to yeast phase on B.H.I.A. at 37 degrees C confirming the isolate as H. capsulatum. The patient responded well to amphotericin B.

Over a four months period (June to September, 2003) 111 stool samples from cases of acute diarrhoea were screened for Vibronaceae in department of microbiology, Smt. N. H. L. Municipal medical college, Ahmedabad. All the isolates were identified by standard laboratory technique. A total of 36 species belonging to Vibrionaceae were isolated. Phage typing of all these Vibronaceae were done at National Institute Of Cholera and Enteric Disease, Kolkata. Out of 36 isolates, 35 were Vibrio cholereae and only one was Vibrio mimicus. We report this case because of rare strain.

To study the spectrum of vaginal microflora in postmenopausal women on hormone replacement therapy (HRT) and to compare the efficacy of Papanicolaou (Pap) smears with other methods for their detection. Eighty postmenopausal women were recruited for the study. These included 40 women who had attained spontaneous and were on HRT (User 1); 20 hysterectomised women on only estrogen therapy (User 2) and 20 controls (Non users). Their clinical data was recorded and specimens were collected for vaginal cultures (for aerobic bacteria and fungi), vaginal pH, Gram stain and Pap stain on cervical-vaginal smears and toluidine blue on wet smears. Vaginal pH was significantly lower in Users as compared to Non users. Lactobacilli and Gardnerella were more frequently isolated from Users while Bacteroides and E. coli were more common in Non users. Cultures were significantly more sensitive than Gram stained direct vaginal smears in detection of aerobic bacteria; however, Candida could be detected on Gram stain alone in all the cases. Frequency of detection of organisms significantly improved by application of Gram stain to the cervico-vaginal smears. However, clinically relevant organisms like Candida, Gardnerella and Mobiluncus could be identified on Pap smears alone in >50% cases. Lactobacilli could be readily identified in Pap smears in 98% cases. Wet mounts could detect cocci more easily as compared to Pap smears. Altered vaginal microbial profile in post menopausal women receiving HRT may cause bacterial and fungal vaginitis. Although culture studies remain the gold standard to detect these microorganisms, Pap and Gram stains and wet smears provide useful supplements and may be used as alternative procedures especially in resource limited settings lacking adequate culture facilities.

Dengue is the most important Arbovirus in the world in terms of occurrence and impact. It has been responsible for some devastating outbreaks and accounts for nearly 50-100 million cases of dengue fever and 2-5 lac cases of the dengue hemorrhagic fever worldwide. Dengue is caused by an arbovirus, which belongs to the Flaviviridae and is maintained in nature principally through biological transmission between susceptible vertebrate hosts by hematophagous arthropods. The incidence and global distribution of dengue has greatly increased in recent years and affects almost every country between the topics of Capricorn and Cancer. Although outbreaks of dengue fever has been occurring with regularity all over the country, and there have been 2 reported outbreaks in the neighboring district Mangalore in 1993 and 1996, there has been no reported outbreak in Manipal, which is what is responsible for the present study. In the study, out of the 100 clinically suspected cases of dengue, 44% tested positive for dengue IgM antibody, thus proving current dengue infection. Twenty six cases were from Shimoga district, which indicates increased dengue virus activity in this area and the possible endemicity in the region.

We studied the aerobic bacterial isolates from bile and their susceptibilty pattern in patients with biliary tract disease. Samples of bile collected during endoscopic retrograde cholangio pancreatography (ERCP) and surgery, were inoculated on standard media. Bacterial identification and susceptibility were done by standard techniques. A total of 209 samples were cultured, out of which 128 samples showed growth. Total number of isolates obtained was 221. Poly-microbial infection was detected in 67 patients. Predominant aerobic bacterial isolates obtained were Escherichia coli 30% (67), Klebsiella species 23.98% (53), Enterococcus species 12.21% (27). Multi-drug resistance was noted in 57%. Higher resistance rate was noted among Gram negative bacilli for ampicillin (92.4%), cephalexin (82.46%), ciprofloxacin (68.42%), piperacillin (64.33%). Sensitivity to meropenem was 90.64% and amikacin was 76.61%. Gram positive bacteria showed high resistance to gentamicin (39.53%). Sensitivity to ampicillin was 86.05% and penicillin was 81.4%. Vancomycin and teicoplanin showed 100% sensitivity. From our study we conclude that E. coli, Klebsiella species and Enterococcus species are common pathogens infecting biliary tract. Poly-microbial infection and multi-drug resistance warrants culture and sensitivity to guide antimicrobial therapy. We recommend combination of amikacin and ampicillin for empirical therapy at our institution.

Leptospirosis is perhaps the most common, most wide spread yet under diagnosed zoonosis in the world, Inada et al identified the causal agent in Japan in 1916. Microscopic agglutination test (MAT) developed initially by Martin and Pettit (1918) is the reference method that was successively done after ELISA test to evaluate and compare and make a reliable diagnosis. Blood samples were collected from August 2004 to September 2004 from hospitalized patients of South Gujarat region who were clinically suspected cases of leptospirosis according to WHO case definition. In our setup we separated the sera and carried out ELISA for detection of IgM antibodies and rest of the sera were stored at -20 degrees C. As we do not have the facility for performing MAT test in our centre, we personally carried these sera to Chennai for performing the MAT and identified the serovars prevalent in South Gujarat region. Out of 30 samples tested 16 samples (53.3%) were positive by ELISA and 12 samples (40%) were negative by ELISA. By MAT, 17 samples (56.67%) were found positive and 13 samples (43.33%) were negative. 2 samples were borderline by ELISA and these turned out to be negative by MAT. Cosidering MATas the gold standard the sensitivity of IgM ELISA in this study was 88% and specificity 90.90%. We concluded that IgM ELISA is rapid test and its results are quite similar to MAT. The most common serovars isolated and identified are L. hebdomadis, L. pyrogenes, L. autumnalis and L. grippotyphosa in this part of the country.