T cell rich B cell lymphoma (TCRBCL) is a recently described variant of diffuse non Hodgkin's lymphoma (NHL), the acronym of which has gained wide acceptance among hematopathologists in a relatively shorter period of time. The recognition of this entity requires immunohistochemical facilities especially on paraffin embedded tissues. TCRBCL is one of the many examples in the diagnostic anatomic pathology which emphasizes the need of immunocytochemistry and availability of this technique at least in referral laboratories. One of the differential diagnosis in this case includes lymphocyte predominance Hodgkin's disease (LPHD) which is the most favorable prognostic histologic subtype of Hodgkin's disease (HD) while TCRBCL is an aggressive B Cell NHL and should be treated as high grade large cell lymphoma. The other close differential includes peripheral T cell non-Hodgkin's lymphoma (PTCL). We reported sixteen (16) cases of TcRBCL diagnosed during a period of two and a half years (January 1995 to June 1997). HD and PTCL were the main differential diagnoses in most of these cases. The median age at diagnosis was 39 years and male to female ratio was equal. TCRBCL was nodal in location in 15 cases and a single case in extranodal site presenting as spinal tumor. The mean neoplastic B cell population was 12%, while that of reactive T cells was 82%. A significant polymorphous inflammatory cellular background was noted in 5 cases. Reed-Stenberg like cells were observed in 3 cases. Immunoglobulin light chain restriction studies were performed in fourteen cases and revealed lambda light chains in ten cases while in four cases kappa light chains were present.

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Red cell indices and discriminant functions were studied in 463 heterozygous beta-thalassaemics (337 without iron deficiency, 126 with iron deficiency) and 195 patients of iron deficiency anaemia (IDA) to ascertain their utility in the detection of betathalassaemia trait (BTT). Majority of traits in both groups had an elevated RBC count (> or = 5.0 x 10(12)/L). The counts were significantly higher than of patients with IDA, only 4.6% of whom had this degree of erythrocytosis. Mean Hb concentration was significantly higher in traits as compared to iron deficient subjects (p < 0.0001). Mean MCV and MCH were significantly (p < 0.0001) lower in traits more so in those with ID as compared to patients of IDA. MCV < 80 fl and MCH < 27 pg were found to be sensitive markers in the detection of traits even in the presence of ID. Of the four discriminant functions studied MCSQ was found to be most sensitive in detection of BTT and it identified 97.9% traits. DF of England and Fraser was most specific for BTT being < 8.4 in only 6.2% patients with IDA. Detection of erythrocytosis especially in the presence of mild anaemia and calculation of discriminant functions derived from red cell indices were found to play an important role in screening for BTT even in the presence of ID and helped identify those patients who required further laboratory evaluation.

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A total of 1010 clinically suspected cases of mycotic keratitis were studied from 1988 to 1996 for evidence of fungal infection and for identification of the aetiologic agents of keratitis in Mumbai. Of these 367 cases were reported positive by microscopy and culture. Seventy nine percent of the cases were between the ages 21 and 50 years. Male patients were more often affected than females. Eighty eight percent of patients were farmers or construction workers and 89.92% of cases gave a definite history of antecedent corneal trauma. A single fungal isolate was obtained in 307 cases and multiple isolates in 20 cases. Mixed isolates of bacteria and fungi were grown in 40 cases. The predominant isolate was Aspergillus species in 219 cases, followed by Candida species (36), Fusarium species (33) and Penicillium species (34). Filamentous fungal isolates from 22 cases remained unidentified. Mycotic keratitis should be suspected in every patient with a corneal lesion and should be ruled out before commencing steroids and antiboitics.

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The present study was carried out to establish the normal bacterial oral flora and the aerobic and anaerobic bacterial flora from deep seated dental caries, and to determine the antimicrobial sensitivity of the clinical isolates so obtained Streptococcus mutans (48%) and Streptococcus sanguis (20%) were the main aerobic isolates whereas Lactobacillus spp. (52%), Veillonella spp. (24%) and Actinomyces spp. (12%) were the major anaerobic isolates. Hundred percent of the samples from dental caries yielded polymicrobial isolates while in two samples from healthy individuals S. mutans was the sole isolate. As the flora changed from healthy tooth to dental caries it changed from one predominated by anaerobic gram-positive cocci to anaerobic gram-positive bacilli. All the anaerobes isolated were sensitive to metronidazole and cefotaxime, whereas all the isolated streptococci were sensitive to penicillin, erythromycin and clindamycin. Incorporation of the antibiotics in baseline restoration, if technically feasible, has been advocated.

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160 clinical samples were collected from 40 infertile couples with unexplained infertility. The samples collected included serum and seminal plasma of the male partners and serum and cervical mucus samples of the female partners. 25 fertile healthy couples were investigated as controls. All the samples collected were then tested for class-specific antisperm antibodies by an Enzyme linked immunosorbent assay (ELISA). Antisperm antibodies were detected in 30% of the infertile couples which included 25% female and 10% male partners. Amongst the cases positive for antisperm antibodies, antibodies were detected most frequently in female sera 58.4% followed by male sera 33% and 25% in cervical mucus. The isotyping of antisperm antibodies in various samples showed IgG to be the most frequent type specific antibody followed by IgM & IgA types of antibodies. ELISA has provided a relatively simple, reliable and highly reproducible method of detection of antisperm antibodies. Thus application of antisperm antibody testing especially in cervical mucus should become an integral part of the investigation of immunologic infertility.

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An attempt was made to classify 61 cases of gastric carcinomas according to Lauren's classification from the period January 1992-December 1993. All the gastrectomy specimens resected for carcinoma of stomach were included in the study. Of 61 cases, 57 were classifiable according to Lauren's criteria. 38 (62.3%) were of intestinal type and 19 (31.1%) were of diffuse type. 4 cases could not be classified into either group. There were significant correlation of type III intestinal metaplasia with intestinal type gastric carcinoma.

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We studied renal lesions at biopsy (20 cases) and at autopsy (21 cases) among patients with the acquired immune deficiency syndrome (AIDS). Nephrotic syndrome with concomitant renal insufficiency was most common indication for biopsy. 85 percent of biopsies showed features of HIV associated nephropathy (HIVAN) which include: Focal segmental glomerulosclerosis (FSGS), glomerular collapse and mesangial hyperplasia. These glomerular changes were always accompanied by tubular microcysts and ultrastructurally, tubuloreticular inclusions (TRI) within the glomerular endothelium were often noted. Changes of HIVAN were also seen in two cases who were HIV negative at the time of biopsy but were positive on repeat testing. Minimal change disease, mesangiocapillary glomerulonephritis and diffuse proliferative lupus nephritis were other biopsy lesions. Autopsy findings were HIVAN (33 percent), tubular necrosis and opportunistic infections. We conclude that HIVAN is a distinct clinicopathologic entity that may sometimes be the first manifestation of the underlying disease state.

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Two cases of cystic nephroma (multilocular cyst of the kidney), and one case each of cystic partially differentiated nephroblastoma (CPDN) and rhabdomyomatous Wilms' tumour are described. All were male and in the pediatric age group. Grossly tumours were unilateral, unicentric and multiloculated. The need for proper designation of these lesions is highlighted because of difference in the treatment and prognosis of these tumours.

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Thrombocytopenia associated with acute Septicaemia has been reported which may be due to Disseminated Intravasscular Coagulation (DIC), but has also been reported even without any evidence of it. An immunological cause has been suggested to explain this observation. The present study involved the investigation of 50 patients with clinical and bacteriological evidence of Septicaemia. By Direct Platelet Suspension Immunofluorescence Test (PSIFT) antiplatelet antibodies were detected in 54% patients with septicaemia and 67.5% with those having thrombocytopenia. The septicaemic patients were treated with antibiotics (mean 14 days). After successful treatment, i.e., when there was no bacteriological evidence of septicaemia, there was in increase in the platelet count (> 150 x 10(9)/L) with a corresponding fall in "PSIFT" positivity in 17 cases (P < 0.001). Hence an immunological process is considered to play a significant role in the pathogenesis of thrombocytopenia in these patients with septicaemia.

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The aim of the study was evaluation of the utility of ELISA test using antigen A60 for rapid diagnosis of tuberculous menigitis (TBM) in paediatric age group. ELISA test based on mycrobacterial antigen A60 (Anda biological, France) was used to estimate specific IgM and IgG antibodies in the sera and CSF of 20 suspected cases of TBM which were selected on the basis of numerous parameters and were smear negative on concentrated smear of CSF. Sera of 20 Montoux negative healthy children was taken as control by detecting IgM and IgG antibodies to A60 antigen. Response to anti-tubercular treatment was observed in all the suspected cases of TBM. This study showed that specificity for diagnosis of TBM by detecting IgM and IgG antibodies in sera was 90% and 80% respectively. Sensitivity of the test by detecting IgM and IgG antibodies in sera was 85% and 80% respectively with positive predictive value of 89.47% for IgM antibody and 80% for IgG antibody. In CSF IgM and IgG antibodies were found in 75% and 60% cases respectively. Both were positive only in 60% of cases. It is concluded from this study that 80-85% cases of TBM in paediatric age group have eigher IgM or IgG antibodies in sera whereas 60-75% have antibodies in CSF.

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Three cases of Phlegmonous inflammation of gastrointestinal tract detected at necropsy are described. Predisposing factors were seen in all three cases. These were chronic alcoholism with submissive hepatic necrosis (HbsAg and HbcAg positive) in Case 1, Indian Childhood cirrhosis in Case 2 and acute on chronic Budd Chiari syndrome in Case 3. In case 1 and 3 the inflammation was limited to the large intestine where as in Case 2 it was seen both in the stomach and large intestine. In two of the three cases blood culture grew Staphylococcus aureus (Case 1) and gram negative organisms (Case 2).

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This is a case of a 25 year old unmarried women who presented with intermittent fever and lower abdominal pain. Laparotomy revealed a large cystic left sided tuboovarian mass adherent to surrounding structures and containing foul smelling fluid. Microscopy showed extensive replacement of the ovary by a chronic inflammatory exudate composed predominantly of foamy macrophages.

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Twenty seven ANA and dsDNA positive cases were selected from surgical files from years 1986 to 1997. Clinical, biochemical, morphological and immunofluorescence findings were correlated. Routine Haematoxylin and Eosin, Per iodic-Acid-Schiff and Methaneamine-Silver stains were used for all cases. Direct immunofluorescence was done whenever possible. Morphologically cases were grouped as per WHO criteria. Morphologically cases were quantified into Austin's chronicity and activity indices. Twenty one to thirty years was common age group. M:F:: 1:4.4. Anemia, skin rash and arthralgia were common extra-renal manifestations. There were 1,5,7,10 and three cases as per WHO class I to V respectively. All cases of class IV had active urine sediments and proteinuria. Four cases had high BUN and Serum creatinine levels. All (12) cases of immunofluorescence revealed group specific patterns. Five cases died. Infection was common cause of death. Twenty to thirty years, males, High BUN and Creatinine levels and high activity and chronicity indices were associated with poor prognosis.

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The cytologic features of a case of adenoid cystic carcinoma of breast diagnosed on fine needle aspiration cytology (FNAC) in a 52 years old female are described. FNAC was carried out on outer quadrant of breast. The characteristic cytological features were numerous single to branching small round to Avoid cells at places forming microacini. Numerous pink hyaline globules of variable sizes were seen along with finger like projections containing basement membrane material.

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Kidneys from 55 cases (20 with HIV infection and 35 with AIDS) were studied by routine Haematoxylin and Eosin stains and special stains (PAS, PASM GMS, ZN, Mucicarmine and Congo red) to evaluate, glomerular, interstitial and vascular pathology. Twenty-four of the 35 (68.6%) cases of AIDS showed infective aetiology which included 17 cases (48.5%) of tuberculosis, 5 cases (14.4%) of fungal infection (3 cryptococcus neoformans and 2 candida species) and 2 cases (5.7%) of CMV infection. Other lesions noted were amyloidosis and tubular calcinosis. HIV associated nephropathy (HIVAN) was not detected in any of the cases. Intravenous drug abuse was not a risk factor in our cases which probably explains the absence of HIV associated nephropathy in the present study.

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Sclerosing stromal tumour (SST) of the ovary is a rare, benign tumour of the ovary, distinct from thecoma-fibroma group of tumours because of predominant occurrence below 30 years of age, lack of hormonal manifestations and histologic heterogenity. A case of 17-year-old female patient is described in the present article. The differential diagnosis is also discussed.

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A retrospective analysis of fine needle aspirates of 132 cases of cysticercosis presenting as palpable nodule is presented. In 98 cases, larval parts, detached hooklets and scolex established the diagnosis; in another 34 cases, the background inflammatory pattern was helpful in suggesting the diagnosis of a parastic lesion.

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Secretory carcinoma is the currently preferred designation for a unique neoplasm earlier thought to be exclusive to the adolescent/pre-menarchal breast. The neoplasm has a predilection for juveniles and young adults (< 30 years of age), becoming progressively less common with advancing age. This report is of one such instance in a 52 year old female, a rare occurrence in the elderly (> 50 years of age), with only five earlier cases on record in the English literature.

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