Coinfection with HBV and HCV may lead to serious consequences. The present study was done to find out the prevalence of coinfection in patients with chronic liver disease. From patients with hepatitis and chronic liver disease 1673 samples were received and analysed for HBsAg by ELISA. 1342 samples were analysed for anti HCV by third generation ELISA. 493 samples positive for HBsAg were also analysed for Anti HCV to see the prevalence of coinfection. 15(3.0%) were found positive for both HBsAg and anti HCV. Out of 15 patients with coinfection 4 (26.6%) had HCC. Prevalence of HCC in patients with coinfection was higher than either infection alone i.e. HBV-9.1% and HCV-16.5%.

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Pilomatricoma (calcifying epithelioma of Malherebe) is an uncommon skin tumour that occurs predominantly in young people. No studies are available from the Indian subcontinent on pilomatricoma. We analyzed records of 18 cases of pilomatricoma seen during 5 years period (1995-99). There were 16 females and 2 males and their age ranged from 5 to 60 years. All patients had solitary lesions in 10 out of 18 cases (55.5%), the tumour was located in head and neck region including 5 cases (27%) where it involved orbital margin and eye-brow. In only 2 out of 18 cases, a clinical diagnosis of pilomatricoma was suggested. In addition to the secondary changes described in previous studies, we observed additional changes like myxoid change, oedema fluid and necrosis with karyorrhectic debris in few of these tumours. Making a clinical diagnosis of pilomatricoma can be difficult. The final confirmation is by histopathological examination only.

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Schistosomiasis or Bilharziasis caused by S. hematobium is endemic in Africa, Egypt, southern tips of Europe and Japan. Though not unknown in India, it is a much less common occurrence. Schistosomiasis of the bladder is known to be a causative factor for bladder carcinoma; which is usually of the squamous type. These cancers are usually of a higher grade and the average initial stage is higher than those for transitional cell carcinomas. We present a case of schistosoma induced squamous carcinoma of the bladder as this is not a common association in India.

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A 48 years old male patient presented with a mass in the supratemporal quadrant of orbit. Fine needle aspiration (FNAC) revealed a cellular tumour with a chondrimyxoid background and epithelial cells intermingled with mesenchymal cells in a fibrillary matrix. A diagnosis of pleomorphic adenoma of the lacrimal gland was made which was confirmed on histopathology. FNA is a rapid and accurate method in diagnosis of lacrimal gland tumours.

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A 30 year old muslim housewife presented with foreign body sensation to start with and later noticed white patch in the left eye with blurred vision since 3 days. KOH preparation of corneal scrapings revealed fungal elements. Culture isolate is identified as Fusarium oxysporum by standard methods. Fusarium oxysporum causing keratomycosis is reported for its rarity.

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Mucinous carcinoma of the male breast is a very rare tumour. So far only about 8 cases have been reported in the literature most of which were diagnosed after surgical resection. Fine-needles aspiration biopsy even though a well established procedure for the evaluation of breast masses in female there are only occasional reports of aspirates form male breast masses. We herein-present one case of mucinous carcinoma of breast in a 65 year old male diagnosed by fine needle and confirmed by histopathology.

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A total of 326 high vaginal swabs from infertile women attending the Institute of Reproductive Medicine were cultured from June 1999 to May 2000. Candida species was isolated from 42(12.88%) patients. Candida albicans (40.47%) followed by Candida glabrata (38.09%) were the most common isolates. Other species included Candida tropicalis (14.28%) and Candida krusei (7.14%). All isolates were tested for sensitivity by disc diffusion method on Yeast Nitrogen Agar base towards four antifungals. Seven (16.7%) candida strains showed resistance to Fluconazole and 19(45.23%) of the strains showed resistance to Itraconazole, and 4(9.5%) strains showed resistance to Nystatin. There was no resistance to Amphotericin B. Of the 7 strains resistant to Fluconazole, 3 were Candida krusei, 3 were Candida glabrata and 1 was Candida tropicalis.

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The microbial flora of 75 patients with chronic tonsillitis were sudied to identify the commonest organism causing chronic tonsillitis and to compare surface swab, fine needle aspiration (FNA) and core swab in isolating the pathogens. Staphylococcus aureus was the predominant isolate from surface core swab FNA and surface swab. In our study the correlation between surface swab with core swab was 47.9% and between surface swab with FNA 57.3%. The correlation between FNA with core swab of 69.3% showed that FNA for culture was superior to surface swab in predicting the core culture. Hence FNA of the tonsil has more advantage over the routinely performed surface swab in representing the core pathogen. Thus the rationale of treating chronic tonsillitis medically should be based on the knowledge of the common core pathogen.

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PSA is emerging as the best marker in oncology and had a profound impact on all aspects of prostate cancer care. From clinically suspected prostate tumor, 395 serum samples were taken out and estimated for serum PSA. Among elevated serum PSA, 98 were correlated with histologic findings. 42(42.8%) cases were BHP among 98 cases and 78.7% had serum PSA level within 10 ng/ml. 5 patients (5.1%) had PIN histologically, 3(60%) of which had PSA level upto 10 ng/ml and 2(40%) had serum PSA upto 20 ng/ml. 51(52%) were adenocarcinoma prostate of different grades and PSA level varies from less than 10 ng/ml to more than 50 ng/ml which almost correlates with the tumor grades.

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A case of recurrent sino-naso-orbital fungal infection due to Pseudallescheria boydii described in a 28 yrs. old man, who appeared immunocompetent, and was found negative for HIV I and II by ELISA tested on two occasions. The fungal culture was negative. It is very essential to identify P boydii as Miconazole is the only antifungal drug of choice for this fungus. The pathologist plays an important role in identifying this fungus when fungal culture fails to yield the growth. The pathologist has to look for clinching clues such as "intercalary conidia" and "chlamydoconidia" to distinguish P boydii from Aspergillus.

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Sarcomas in the uterine cervix are rare, the incidence being 0.5% to 1% of all cervical malignancies. This is a report of cervical mullerian adenosarcoma, which was encountered in a hysterectomy performed for prolapse. The tumor was composed of benign glandular elements and malignant stromal component, thus justifying its nomenclature. We wish to emphasize the distinctive morphological features of this rare cervical tumor.

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In this study, we have developed and evaluated a simple indirect immunofluorescence test (IIFT) to detect rabies antibodies in a two-step immunofluorescence assay. One hundred and eighty five serum samples from people who had taken different rabies vaccines and 8 pairs of serum and CSF samples from confirmed paralytic rabies cases were tested by IIFT and results evaluated in comparison to standard mouse neutralization test (MNT). Though the titres of rabies antibodies obtained with IIFT were 2-4 times lesser in comparison to MNT, a significant correlation was seen between the two tests (R = 0.883). The specificity of this IIFT was found to be 97.9% and the sensitivity was 97.2%. These results indicate that this simple and rapid IIFT can be used to screen large number of serum samples to monitor sero-conversion after pre or post exposure vaccination and may also assist in rapid ante-mortem diagnosis of atypical human rabies.

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Two antral biopsies each from 104 patients of leprosy and 100 controls were studied to find out the prevalence of H. pylori and associated histopathological changes. Sections were stained with hematoxylene and eosin, AB/PAS (Ph 2.5) and Loeffler's methylene blue stains. Infection by H. pylori, inflammation and atrophy were found to be significantly more in leprosy patients as compared to controls (p < 0.01, < 0.005 and < 0.02 respectively). On comparing the histopathological changes in various subgroups of leprosy, H. pylori, inflammation and activity showed a statistically decreasing trend from tuberculoid to lepromatous subgroups (p < 0.05, < 0.001, < 0.01 respectively). Atrophy showed a significant increasing trend from tuberculoid to lepromatous group (< 0.001), it is concluded that despite a low prevalence of H. pylori and associated gastritis in patients with lepromatous leprosy, gastric epithelial damage is more marked due to altered immune response.

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Cytological evaluation of leprosy skin lesion was done to evaluate cytohistological correlation. Twenty five clinically suspected patients of leprosy were evaluated by performing fine needle aspiration (FNA) in nodular lesions and slit skin smear technique in flat lesions to classify across R-J scale. May-Grunwald-Giemsa (MGG) and Ziehl-Neelsen stain were employed on slit skin smears and fine needle aspiration material. Histopathological assessment of slides from same lesion was done. The overall diagnostic accuracy of fine needle aspiration was 76.1% and that of slit skin smear 50%. However, on adequate material diagnostic accuracy of slit skin smear was high, 100% as compared to 81.8% of fine needle aspiration smears. In cases of polar leprosy cytological findings paralleled histopathological diagnosis. Within the constraints of cytological interpretation the cases in borderline unstable spectrum of leprosy can be classified broadly.

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Upper GI endoscopy was performed in 50 adult patients attending the gastroenterology OPD with gastroduodenal diseases. Gastric antral mucosal brushings were taken for cytological evaluation and urea broth test followed by antral biopsy. The slides prepared were stained with Wright Giemsa (WG), Hema toxylin & Eosin (H&E) and Papanicolaou (Pap). Brush Cytology Smears were compared with biopsy sections for detection of Helicobacter pylori and the staining techniques were evaluated to see which stain was easiest to perform and interpret on routine basis. H&E stained sections were examined for histomorphological parameters associated with H. pylori infection. Brush cytology was rapid and simple with observed sensitivity of 90% and specificity of 100%. On evaluating the various stains, M.B. and W.G. were found to the rapid and easy to perform and the bacteria stood out very well against the background. Of the histomorphological parameters studied, presence of actively and lymphoid aggregates and absence of intestinal metaplasia correlated positively with the presence of the bacteria. Cytological brushing urea broth test was not very sensitive (55.2%) and specific (51%) for detection of the bacteria.

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Prevalence of covert bacteriuria in patients of nephrotic syndrome admitted for kidney biopsy was studied in 205 patients. Age ranged from 10 years to 65 years. 148 patients were male and 57 were female. Prevalence of covert bacteriuria was found in 38 patients (18.53%). In bacteriuric patients 30 were male, 8 were female. Escherichia coli was the commonest organism grown in bacteriuric patients (30 or 78.9%). Serum albumin was low and 24-hour urinary protein excretion was high in bacteriuric patients in comparison to abacteriuric patients. In bacteriuric patients membranous nephropathy was the commonest histopathological finding present in 15 patients (39.47%).

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A study was undertaken in Mangalore, South Kanara District of Karnataka, India to evaluate the rising prevalence of coronary artery diseases in our country. Seventy hearts were analysed, at post-mortem, between December 1996 and December 1997. The coronary arteries and the myocardium were examined, both grossly and histologically, to relate them with regard to the age and gender of the deceased. Fifty five hearts were from males and 15 were from females. Forty eight (68.59%) hearts were proven to be afflicted with coronary atherosclerosis. Twenty seven of these had three or four vessel disease. A total of 192 sections from the four major epicardial arteries of the 48 hearts were examined. Of these, 124 showed atherosclerosis (with 37 in advanced stages), of which 103 were occlusive lesions while the remaining 21 were fatty streaks. Severe stenosis (grade III or IV) was commonest in the left anterior descending artery. Twenty one (30%) of the 70 hearts showed histological evidence of myocardial ischaemia. Of these 6 were from females and 15 were males. Myocardial ischaemia was found to have no correlation to the severity of stenosis.

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Apoptotic count was assessed in 38 cases of squamous cell carcinoma of oral cavity by light microscopy and correlated with TNM stage, histological grade and survival. A direct correlation with the TNM stage (p = 0.0166) and an inverse correlation with the histological grade (p = 0.03) was found, however no correlation was found with the survival. Apoptotic count was significantly different between well and moderately differentiated carcinoma (p = 0.347) and well and poorly differentiated carcinoma (p = 0.0190). Thus apoptotic count may have prognostic value particularly in combination with staging and histological grade.

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All though extremely rare 10 years ago, antifungal drug resistance is becoming a major problem in certain populations, especially in those infected with HIV. This study was undertaken to study the resistance of Candida species isolated in our hospital to Fluconazole using Chrom agar Candida. The Candida strains which were routinely isolated from clinical specimens like blood, urine, sputum, pus, fluid and homograft isolates were included in the study. 142 Candida isolates were tested by using Chrom agar Candida incorporated with Fluconazole. 16 strains were found to be resistant to Fluconazole and 126 strains sensitive to Fluconazole. Nine were C. tropicalis, 3 C. krusei, 2 C. guillermondii, 1 Geotrichum candidum and one was an unidentified strain of Candida. The MIC of the 16 strains were done using RPMI 1640 medium by macro broth dilution method. MIC of 9 strains was 64 & > 64 ug/ml of 6 strains 32 ug/ml and 1 strain 16 ug/ml.

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Desmoplastic cerebral astrocytoma of infancy (DCAI) is a rare tumor which shows spindle cells embedded in an extremely desmoplastic stroma. We describe a case of DCAI seen in the frontoparietal region of brain in a three-month-old infant. Microscopically classic histology of DCAI was seen. On immunohistochemistty the tumor showed strong Vimentin, S-100 and Glial Fibrillary Acidic Protein (GFAP) positivity. The brain adjacent to the tumor-showed multi-cystic transformation and the tumor formed a solid area in the wall of this cystic structure. This adjacent brain showed mild disarray of architecture and gliosis. Three months after surgery this infant was alive and well.

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A case of cystic granulosa cell tumor of ovary in a 32 year old woman is described. The patient presented with abdominal mass without any signs and symptoms of hyperestrinism and virilization. Ultrasonographically and grossly a diagnosis of benign cystadenoma was considered. Histopathology confirmed the diagnosis of cystic granulasa cell tumor.

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Myxoid leiomyoma is an extremely rare tumor, presenting as a scrotal mass. We report a case of 60 years male, who presented with a painless scrotal mass and operated as secondary hydrocoele. This lesion should be differentiated from other myxoid tumors and tumors with myxoid degeneration.

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Epithelioid haemangioendothelioma is a rare primary malignant tumour of the bone that accounts for less than 1% of all primary bone malignancies. The case discussed here is of a 35 years old male who presented with gradually increasing left infrascapular mass attached to 10th rib. X-ray showed an expansile lytic lesion in 10th rib. On FNA the diagnOsis of fibrous dysplasia or fibrous-histiocytic lesions was suggested. The lesion was excised along with adjacent rib. Histopathological examination showed features of epithelioid haemangioendothelioma. Immunohistochemistry revealed focal factor VIII related antigen positivity.

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Pulmonary infection due to Trichosporon beigelii is uncommon. A case of Pneumonia in a 28 year old male patient with positive HIV status, secondary to Trichosporon beigelii is reported.

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Haemophilia in a female is very rare. We report a case of haemophilia in a female with a male sex chromosome pattern.

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Myelodysplastic syndrome (MDS) is a disease of elderly patients but, rarely can be encountered in pediatric age group. The present case of MDS (RAEB subtype) was reported in a child who presented with proptosis and unique and rare feature of haemophagocytosis by myeloid series of cells.

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Telepathology is the most recent addition to the pathologist's diagnostic tools. It is the acquisition of macroscopic and microscopic images for electronic transmission for diagnosis, consultation and/or education. With the addition of the personal computer at the pathologist's desktop, the stage has been set for one of the greatest advantages the Internet has to offer. Telepathology in India is in infancy, and we at PathoIndia (www.Pathoindia.com) have started a series of publication images from interesting cases in the form of weekly quiz. After cases are published, hundreds of pathologists from around the world are invited by e-mail to send in their diagnosis and comments. The responses to this quiz suggest that telepathology is catching on in the pathology community. Another intention of this series is to identify and select qualified international and Indian pathologists who would be willing to help colleagues from India requesting second opinions online.

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Bleeding is a common manifestation of inherited and acquired disorders of haemostasis. Acquired disorders of haemostasis can be of varied etiology like liver disease, DIC, haemorrhagic disease of newborn and inhibitors to coagulation factors. Inhibitors to coagulation factors are an unusual cause of bleeding which can be superimposed on inherited factor deficiencies or sometimes resembles them. The clinical and haematological profile to two cases of factor VIII inhibitors are being presented here, one of which was a known haemophiliac receiving factor VIII therapy and another was a elderly lady with no other apparent underlying disorder. Hence any case of factor VIII deficiency who becomes refractory to factor VIII replacement therapy or those who are detected to have factor deficiency late in life should be investigated for inhibitors.

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True synovial based hemangiomas are rare lesions and should be differentiated from mass lesions especially pigmented villonodular synovitis. A case of 4 years old male child, presenting with recurrent painful swelling, is described in the present article. The differential diagnosis is also discussed.

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We report a case, with foamy histocytes in the bone marrow and eye movement abnormalities which is characteristic for Niemann Pick disease Type-C.

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Cystic change in Schwannoma is uncommon with very few cases reported in literature till date. We present a case clinically mimicking a soft tissue sarcoma but diagnosed on histopathology as cystic schwannoma.

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Renal leimyoma is an uncommon benign tumour, which pose a challenging diagnostic and therapeutic problem. When multiple (leiomyomatosis) they are preoperatively mistaken for malignant tumors. We herein-present one case of renal leiomyomatois developing in a 50 year old male, which was clinically diagnosed as renal cell carcinoma and one case of renal leiomyoma in a 37 year old male.

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A rare case of pituitary adenoma with spheroid amyloid deposits encountered in a 40 year old male is presented.

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A case of leiomyoma of the urinary bladder in a 35-year old female is reported on account of its rarity. The tumor was responsible for urinary compliants which disappeared after the neoplasm was excised.

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Twenty-five cases of Ductal carcinoma in situ(DCIS), of breast with an associated invasive component were selected for this study. The aim was to identify the percentage of malignant cases having DCIS component, to analyse the distribution of DCIS according to architecture and cytonuclear grading and evaluate the correlation between grade of DCIS with that of associated invasive component. The DCIS component was classified according to traditional architectural classification and Van-Nuys cytonuclear classification. The grading of the invasive component was done according to Nottingham's modification of Bloom-Richardson system. Architecturally 72% of DCIS components were of pure form, 28% were of mixed pattern. According to cytonuclear grading 24% cases had grade-I, 28% grade-II and 48% grade-III DCIS. The invasive component showed 16% cases in grade-III. After correlating the grade of DCIS and invasive component 91% positive correlation was found in grade-III cases followed by 66.6% in grade-I and 57.1% in grade-II cases.

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The present study deals with a total of 28 cases of Wilson's disease, 50 normal individuals alongwith siblings and parents of eight cases. Male predominance (18 out of 28 cases), a median age of 11 years and universal presence of Kayser-Fleischer (K. F.) ring marked the cardinal features. Furthermore, 11 patients had hepatic-neural presentation while two had only the K. F. Ring without clinical abnormality. Single Radial Immunodiffusion (SRID) as the absolute quantitative procedure revealed a profound deficiency of ceruloplasmin with the levels ranging anywhere between 0.5 mg/dI to 23 mg/dI amongst the patients of Wilson's disease. The data from siblings and parents also revealed deficiency in 15 out of 23 serum samples when subjected to disc electrophoresis-benzidine screening procedure.

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Various prognostic factors viz. clinical details, histologic features including subtypes, elastosis, desmoplasia, in situ carcinoma, perineural and vascular invasion, Nottingham Prognostic Index (NPI), and menopausal status were evaluated in Infiltrating Lobular carcinoma (ILC) in the context of patient survival. 138 patients had presented with ILC over a period of 20 years. Histological subtypes of ILC and vascular invasion played a role in the biologic behaviour of the tumour. Interestingly premenopausal status protected against the risk for relapse, while being postmenopausal, increased the risk. NPI was demonstrated as an independent significant prognostic factor and was a good predictor for relapse. This study underlines the role of the pathologist in determination of the prognostic groups in Infiltrating lobular carcinoma.

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Histopathological study of endoscopic gastric mucosa obtained from 251 patients with acid peptic diseases were studied in relation to the degrees of inflammation and the degree of H. Pylori density. Haematoxylin-Eosin and modified Giemsa stains were used. Gastritis grading was done according to Warren and Marshall with slight modification and H. Pylori grading according to our criteria. In this study no definite relationship could be observed between histological grading of chronic gastritis with that of H. Pylori density.

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