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2013| October-December | Volume 56 | Issue 4
Online since
January 18, 2014
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ORIGINAL ARTICLES
Perforating disorders of the skin
Kalpana Arora, Kalpana A Hajirnis, Smita Sawant, Vinayak Sabnis, Nirmala Gaikward
October-December 2013, 56(4):355-358
DOI
:10.4103/0377-4929.125289
PMID
:24441221
Background:
Perforating disorders of the skin, is an often overlooked entity characterized by transepidermal elimination of material from the upper dermis and are classified histopathologically according to the type of epidermal disruption and the nature of the eliminated material. They include Kyrle's disease, perforating folliculitis, reactive perforating collagenosis, and elastosis perforans serpiginosa.
Aim:
The aim of this study was to delineate the clinical and histopathological features of perforating disorders of the skin.
Materials and Methods:
In our study, we reviewed last 2 years skin biopsies received by us. Hematoxylin and eosin sections were re-examined and histochemical stainings (elastic van Gieson and Masson trichrome stains) were also used for histopathological evaluation.
Results:
We reviewed five cases of perforating disorders of skin which included two cases of Kyrle's disease, two cases of reactive perforating collagenosis and a single case of perforating folliculitis. Two patients had family history of perforating dermatosis in their siblings and three had associated systemic disease.
Conclusion:
Perforating disorders of the skin should be considered when ulcer with keratotic plugs is found.
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1
LETTERS TO EDITOR
Multiple lymphoepithelial cysts from oral mucosa of a healthy woman: Case report and literature review
Filipe N Chaves, Sthefane G Feitosa, Karuza MA Pereira, Fábio WG Costa
October-December 2013, 56(4):473-474
DOI
:10.4103/0377-4929.125385
PMID
:24441255
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ORIGINAL ARTICLES
Bacterial profile and patterns of antimicrobial drug resistance in intra-abdominal infections: Current experience in a teaching hospital
Neetu Shree, Balvinder S Arora, Ravinder S Mohil, Dimple Kasana, Indu Biswal
October-December 2013, 56(4):388-392
DOI
:10.4103/0377-4929.125321
PMID
:24441227
Context:
Bacterial isolates from intra-abdominal infections, in particular, peritonitis and their unpredictable antimicrobial resistance patterns, continue to be a matter of concern not only globally but regionally too.
Aim:
An attempt in the present study was made to study the patterns of drug resistance in bacterial isolates, especially gram negative bacilli in intra-abdominal infections (IAI) in our hospital.
Materials and Methods:
From 100 cases of peritonitis, identification of isolates was done as per recommended methods. Antimicrobial susceptibility and extended-spectrum beta-lactamase (ESBL) testing were performed following the CLSI guidelines.
Results:
A total of 133 clinical isolates were obtained, of which 108 were aerobes and 22 anaerobes. Fungal isolates were recovered in only three cases.
Escherichia coli
(47/108) emerged as the most predominant pathogen followed by
Klebsiella spp.
(27/108), while
Bacteroides fragilis
emerged as the predominant anaerobe (12/22). Among coliforms, 61.7%
E. coli
and 74.1%
Klebsiella spp.
were ESBL positive. A high level of resistance was observed for beta lactams, ciprofloxacin, amikacin, and ertapenem. Ertapenem resistance (30-41%) seen in coliforms, appears as an important issue. Imipenem, tigecycline, and colistin were the most consistently active agents tested against ESBL producers.
Conclusion:
Drug resistance continues to be a major concern in isolates from intra-abdominal infections. Treatment with appropriate antibiotics preceded by antimicrobial resistance testing aided by early diagnosis, adequate surgical management, and knowledge of antibiotic - resistant organisms appears effective in reducing morbidity and mortality in IAI cases.
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LETTERS TO EDITOR
Limitation of HPLC methodology for HBA1c estimation
Arpita R Dam, Aparna J Ahuja, Moharpal Singh, Rajdeep Singh
October-December 2013, 56(4):483-484
DOI
:10.4103/0377-4929.125413
PMID
:24441262
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ORIGINAL ARTICLES
Clinico-pathological spectrum of primary ovarian malignant mixed mullerian tumors (OMMMT) from a tertiary cancer institute: A series of 27 cases
Santosh Menon, Kedar Deodhar, Bharat Rekhi, Rahul Dhake, Sudeep Gupta, Jaya Ghosh, Amita Maheshwari, Umesh Mahantshetty, Shyam Shrivastva, Atul Budukh, Hemant B Tongaonkar, Rajendra Kerkar
October-December 2013, 56(4):365-371
DOI
:10.4103/0377-4929.125293
PMID
:24441223
Aims and Objectives:
To study the clinico-pathological characteristics of primary ovarian malignant mixed mullerian tumor (OMMMT) and assess the prognostic factors associated with treatment outcome and survival.
Materials and methods:
The pathology database was searched for primary ovarian carcinosarcoma diagnosed and/or managed at our institute from period of January 2004 to July 2010. The histological sections were reviewed, with emphasis on type and grade of epithelial and sarcomatous components. The medical records were retrospectively analyzed for clinical details and follow up.
Results:
A total of 27 cases of primary ovarian carcinosarcoma were identified. The median age at diagnosis was 51 years. Fourteen patients had advanced stage (stage III and IV) at presentation. Cytoreductive surgery was done in 18 cases, and 7 had received upfront chemotherapy. Histologically, 10 cases had epithelial predominance (> 50% epithelial component) and 11 had sarcoma predominance. The most frequent epithelial component was endometroid type, and most common sarcoma component was rhabdomyosarcomatous. Hyaline droplets within sarcomatous stroma were seen prominently in 15 cases. Three cases showed germ cell /yolk sac-like areas. Eighteen cases had follow up with a median of 15 months (4-40 months). The recurrence-free survival in advanced stage and sarcoma predominant was 10.5 months in comparison to 13 months in early stage and epithelial predominant OMMMT.
Conclusion:
Primary ovarian carcinosarcoma is a rare biphasic malignancy with variable proportions of epithelial and spindle elements. Presence of hyaline droplets within spindle sarcoma in a biopsy from ovarian mass should alert the pathologists regarding MMMT. Advanced stage, suboptimal cytoreduction, and sarcoma predominant tumors are likely to have a worse outcome in ovarian MMMT.
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CASE REPORTS
Cystic panfolliculoma of the scalp: Report of a very rare case and brief review
Hisham Mohammed Said Alkhalidi, Ahmed Abdullah Alhumaidy
October-December 2013, 56(4):437-439
DOI
:10.4103/0377-4929.125363
PMID
:24441242
Panfolliculoma is an exceeding rare follicular benign neoplasm with differentiation toward both upper and lower segments of the hair follicle. In this report, we present a case of cystic panfolliculoma in the occipital region of the scalp of a 19-year-old female. We describe the histopathological and immunohistochemical features of the tumor and briefly discuss the differential diagnoses of this rare entity.
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ORIGINAL ARTICLES
Vascular endothelial growth factor expression and angiogenesis in various grades and subtypes of meningioma
Priya Dharmalingam, VR Roopesh Kumar, Surendra Kumar Verma
October-December 2013, 56(4):349-354
DOI
:10.4103/0377-4929.125286
PMID
:24441220
Background:
Vascular endothelial growth factor (VEGF) expression has been extensively studied in astrocytoma, whereas relatively less literature exists on VEGF expression in meningioma.
Materials and Methods:
Patients operated for meningioma from 2006 to 2011 (
n
= 46) were included. Tumor was subtyped and graded as per WHO grading. Immunohistochemistry was performed for MIB labeling index, VEGF, and CD 34 staining. The patterns of VEGF expression in various histological subtypes and grades and its correlation with microvascular density were analyzed.
Results:
This series consisted of 40 Grade I meningioma, 4 Grade II tumors, and 2 Grade III tumors. While 14 (30.4%) tumors showed no staining with VEGF antibody, 32 (69.6%) were positive for VEGF. Sixty five percent of Grade I tumors showed VEGF positivity, while 100% of Grade II and Grade III tumors were VEGF positive (
P
= 0.157). The mean microvascular density in VEGF-negative tumors was 9.00, while that of VEGF-positive tumors was 17.81(
P
= 0.013). There was a gradual increase in microvascular density from tumors which are negative for VEGF to tumors which expressed moderate to strong VEGF, the difference being statistically significant (
P
= 0.009).
Conclusions:
VEGF expression correlated with the microvascular density in meningioma irrespective of tumor grade, with a gradual increase in microvascular density in relation to the VEGF score.
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6,603
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12
IMAGES
Lipid lymphadenopathy
Smiley Annie George, Francis Issam
October-December 2013, 56(4):468-469
DOI
:10.4103/0377-4929.125379
PMID
:24441252
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CASE REPORTS
Coexistence of atypical adenoma, adenoma with bizarre nuclei and follicular variant of papillary carcinoma of the thyroid
Teresa Pusiol, Maria Grazia Zorzi, Doriana Morichetti
October-December 2013, 56(4):399-401
DOI
:10.4103/0377-4929.125342
PMID
:24441230
Coexistence of atypical adenoma, adenoma with bizarre nuclei and follicular variant of papillary carcinoma is described in the same thyroid, with study of p53 expression. A 72-year-old woman presented to the endocrinology out-patient unit for a routine follow-up visit. Patient underwent a total thyroidectomy. Histological examination revealed a solid nodular neoplasm with the longest diameter of 0.8 cm in the upper pole of the left lobe. The neoplasm showed the histological features of follicular variant of papillary carcinoma with moderate diffuse immunoreactivity for p53. The lower pole of the right lobe showed two adjacent nodules with histological features respectively of atypical adenoma and adenoma with bizarre nuclei, with strong diffuse immunoreactivity for p53.
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Benign signet ring cells in pseudomembranous colitis: A diagnostic trap
Sunitha Jacob, Najah R Zayyani
October-December 2013, 56(4):413-415
DOI
:10.4103/0377-4929.125356
PMID
:24441235
A 71-year-old female patient was admitted with intractable diarrhea and abdominal distention following several courses of broad spectrum antibiotic therapy. Colonic biopsy revealed pseudomembranous colitis with foci of signet ring cell (SRC) change. The SRCs possessed bland nuclei and were confined to the basement membranes of the crypts with no infiltration into the lamina propria. Benign SRCs in pseudomembranous colitis is an uncommon phenomenon. Awareness of this rare, but potential pitfall is of utmost importance to avoid a misdiagnosis of SRC carcinoma.
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Angiolymphoid hyperplasia with eosinophilia: A rare benign vascular tumor of breast
Neelima Tirumalasetti
October-December 2013, 56(4):405-407
DOI
:10.4103/0377-4929.125352
PMID
:24441232
Angiolymphoid hyperplasia with eosinophilia typically involves head and neck with rare involvement of other sites like breast. A 27year old female presented with a painless swelling in the upper and outer quadrant of left breast. Fine needle aspiration cytology showed sheets of lymphoid cells along with numerous eosinophils. Subsequent histopathological examination showed eosinophilic plump and vacuolated endothelial cells in small groups and sheets within a fibrous background, typically accompanied by lymphoid aggregates and eosinophils, suggestive of angiolymphoid hyperplasia with eosinophilia. Vascular tumors of the breast are extremely rare. The goal of this case report is to advert to this unusual clinical picture, to review and discuss diagnostics, differential diagnoses and treatment options.
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Diffuse large B-cell lymphoma of the kidney: A rare neoplasm
Ram Narayan Das, Shatavisha Dasgupta, Soumya Mondal, Debraj Saha, Uttara Chatterjee
October-December 2013, 56(4):449-452
DOI
:10.4103/0377-4929.125368
PMID
:24441246
Primary renal lymphoma is a rare neoplasm, but it should be kept in mind in the differential diagnosis of renal neoplasms. A middle aged man presented with symptoms of weight loss, anorexia and fullness of the abdomen after meals. On clinical and radiological examination, a renal mass was revealed and operated upon. A diagnosis of primary high grade renal lymphoma was made on histopathological examination and immunohistochemically it was further classified as diffuse large B-cell lymphoma. Unfortunately, the patient died after 5 months of diagnosis in spite of three cycles of chemotherapy following surgery. The pathological details of rare tumor are presented here.
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Simultaneous occurrence of chronic myeloid leukemia and chronic lymphocytic leukemia: Report of an unusual case
Khaliqur Rahman, Seena George, Sriyash Mangal, Anurag Mehta
October-December 2013, 56(4):453-456
DOI
:10.4103/0377-4929.125369
PMID
:24441247
The coexistence of chronic myeloid leukaemia(CML) and chronic lymphocytic leukemia(CLL) has been reported occasionally in literature, with only seven cases of simultaneous occurrence of these two diseases. We present here a case of 57 yr male patient where a complete blood count and differential done using volume conductivity scatter (VCS) technology suggested a diagnosis of CML with CLL. It was further confirmed by immunophneotyping and cytogenetic analysis. The patient was started on tyrosine kinase inhibitor, 400 mg once daily. Four months after the treatment, patient is doing fine with a count of 22 × 10
9
/L and 64% lymphocytes.
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ORIGINAL ARTICLES
Increased accumulation of dendritic cells in celiac disease associates with increased expression of autophagy protein LC3
Paramaguru Rajaguru, Kim Vaiphei, Biman Saikia, Rakesh Kochhar
October-December 2013, 56(4):342-348
DOI
:10.4103/0377-4929.125282
PMID
:24441219
Background:
Celiac disease (CD) an immune-mediated disorder associates with accumulation of dendritic cell (DC) in duodenal mucosa. Autophagy has recently been implicated in autoantigen formation. However, its role in CD is still unknown.
Aim:
To examine role of autophagic protein LC3 expressed by activated DC in CD.
Materials and Methods
: Thirty CD patients were analyzed at initial presentation and after 6 months of gluten-free diet (GFD). Duodenal biopsies were studied for histological changes and CD11c, CD86, and MAP1LC3A expressions by double immunohistochemistry (IHC). Masson's trichrome (MT) staining was used to assess basement membrane (BM) thickness and Oil Red O (ORO) staining for mucosal lipid deposit. Polymerase chain reaction (PCR) was performed for HLA-DQ system. Statistical analysis was done using paired and unpaired
t
test, chi-square test, Fisher's exact test, and McNemar-Bowker test. A
P
-value <0.05 was considered statistically significant.
Results:
HLA-DQ2 and HLA-DQ8 alleles were present in all studied patients. Increased BM thickness was observed in 63% and 73% had ORO-positive lipid in surface lining epithelium. Pre-treatment biopsies showed increased DCs expressing LC3, which were significantly less in follow-up biopsies. The follow-up biopsies had shown significant reduction in BM thickness and ORO.
Conclusion
: Histological improvement in duodenal biopsies was associated with reduction in activated DCs expressing autophagic protein, which probably play important role in pathogenesis of an autoimmune disorder like CD.
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Red cell alloimmunization and infectious marker status (human immunodeficiency virus, hepatitis B virus and hepatitis C virus) in multiply transfused thalassemia patients of North India
Raj Nath Makroo, Jatinder Singh Arora, Mohit Chowdhry, Aakanksha Bhatia, Uday Kumar Thakur, Antony Minimol
October-December 2013, 56(4):378-383
DOI
:10.4103/0377-4929.125295
PMID
:24441225
Background:
Patients with thalassemia major are largely transfusion dependent and are thus exposed to a variety of risks such as transmission of infectious diseases, iron overload and alloimmunization. This study was performed to determine the prevalence of human immune deficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV) and red cell antibodies among multiple-transfused thalassemic patients in and around the national capital region.
Materials and Methods:
The Department of Transfusion Medicine, Indraprastha Apollo Hospitals, conducted this study in collaboration with the National Thalassemia Welfare Society over a period of 1 year starting February2011. Blood samples from the patients were tested for blood group, red cell alloantibody/ies, anti-HIV, anti-HCV and hepatitis B surface antigen (HBsAg) by ELISA and for the respective viral ribonucleic acid (RNA) or deoxyribonucleic acid (DNA) by nucleic acid testing (NAT).
Results:
A total of 462 thalassemics which consists of 290 males and 172 females were tested. The overall alloimmunization rate was 4.1% and anti-Kell was the most common antibody identified. Thirteen cases (2.8%) were positive for HBsAg by ELISA, 107 (23.1%) were reactive for anti HCV and 11 (2.38%) for anti HIV antibodies. Further screening and discriminatory assays by NAT confirmed the presence of HBV DNA in 11 cases, HIV RNA in 7 cases and HCV RNA in 48 cases.
Conclusion:
In spite of advances in Immunohematology and infectious marker testing in recent years, the rates of alloimmunization and infectious marker positivity remains high among multiply transfused patients like thalassemics. Provision of safe and adequate blood supply to these patients is a key to improving their quality-of-life and longevity.
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11
CASE REPORTS
Perianal bronchogenic cyst: A report of two cases
Liancheng Liu, Yuru Zhang, Zhongtao Zhang, Liying Si
October-December 2013, 56(4):411-412
DOI
:10.4103/0377-4929.125355
PMID
:24441234
Cutaneous presentations of bronchogenic cysts are rare in all age groups, particularly in adults. Previous reports showed that cutaneous manifestations of bronchogenic cysts were frequently presented above abdominal region. Here we present two cases of a perianal bronchogenic cyst. To the best to our knowledge, this is the first report of a bronchogenic cyst in this area.
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ORIGINAL ARTICLES
Association of Epstein Barr virus deoxyribonucleic acid with lung carcinoma
Amir Hossein Jafarian, Abbsali Omidi-Ashrafi, Nema Mohamadian-Roshan, Mahdi Karimi-Shahri, Kiarash Ghazvini, Samaneh Boroumand-Noughabi
October-December 2013, 56(4):359-364
DOI
:10.4103/0377-4929.125290
PMID
:24441222
Context:
Lung cancer is the leading cause of cancer death worldwide. In addition to smoking, a variety of other contributing factors, including viral infection, have been suggested in tumorigenesis. Epstein Barr virus (EBV), which is linked to various malignancies, seems to be a good candidate.
Aims:
The aim of this study was to investigate the association of EBV with lung carcinomas.
Settings and Design:
A total number of 90 formalin fixed paraffin embedded lung tissue samples including 48 cases of lung cancers (18 squamous cell carcinomas [SCCs], 18 adenocarcinomas and 12 small cell carcinomas) and 42 non-tumoral samples (control group), were retrieved from the pathology archive.
Materials and Methods:
Following deoxyribonucleic acid extraction, polymerase chain reaction (PCR) was performed using an EBV-Eph PCR kit. The positive cases were studied immunohistochemically for the expression of EBV-late membrane protein-1 (EBV-LMP-1) in tumoral tissues.
Statistical Analysis Used:
The
t
-test and Fisher exact test were used and
P
< 0.05 was considered statistically significant.
Results:
Five of our cases, including four SCCs and one adenocarcinoma and two control samples showed a positive reaction in PCR. All positive tumoral cases showed diffuse staining with LMP-1 in immunohistochemistry.
Conclusions:
We found a significant difference in the presence of the EBV genome in cases of lung SCC compared to other lung lesions (
P
=
0.02). According to our data, EBV is not at major play in the non-lymphoepithelioma-like cancers of the lung in general, but may have a role in the tumorigenesis of some lung SCCs.
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Is necropsy obsolete - An audit of the clinical autopsy over six decades: A study from Indian sub continent
Nikhil Moorchung, Vikram Singh, Ankit Mishra, Seema Patrikar, Sunita Kakkar, Vibha Dutta
October-December 2013, 56(4):372-377
DOI
:10.4103/0377-4929.125294
PMID
:24441224
Introduction:
Several studies have documented a decrease in the autopsy rate. This study was taken up to analyse the cause of mortality, the discrepancies between the ante mortem and post mortem diagnosis and the discrepancies between diagnoses according to the type of the disease over a period of six decades.
Materials and Methods:
Autopsy reports and medical records were retrospectively analyzed over a 63 year period from 1947 to 2010.
Results:
In our study, there was a steady increase in the percentage of neoplastic cases from 1947 to 1994 after which there has been a significant drop. The cases dying due to infection has also shown a steady decline over the years until 1994. After 1994, there has been a significant increase in the deaths until 2010 (
p
< 0.05). Death due to cardiac causes has shown an increase until 1962 which has been followed by a steady decline. There has been a sudden rise in the number of cases dying due to renal causes between 1994 and 2000 (
p
< 0.05). There has been a statistically significant decrease in the discrepancies between the ante mortem and the post mortem diagnosis over the years.
Discussion:
This study shows that therapeutic and preventive measures correctly instituted have significantly reduce the mortality, particularly with reference to cardiac and infectious causes. The discrepancy between antemortem and post-mortem diagnosis in 2010 is still very high at 9.30 percent. The autopsy will continue to remain relevant especially in elucidating the molecular cause of disease.
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5
CASE REPORTS
Co-infection of
Mycoplasma genitalium
and
Chlamydia trachomatis
in an infertile female patient with genital tuberculosis
Prathyusha Kokkayil, Jyoti Rawre, Neena Malhotra, Benu Dhawan
October-December 2013, 56(4):457-459
DOI
:10.4103/0377-4929.125371
PMID
:24441248
Genital tuberculosis is a common cause of female infertility in India. But, it is important to screen for other agents like Chlamydia trachomatis and genital Mycoplasmas as well to avoid persistence of infection and its long-term sequelae. Timely diagnosis of these infections using nucleic acid amplification tests and institution of appropriate therapy will improve the conception rates in infertile women. We report a case of co-infection of Mycoplasma genitalium and Chlamydia trachomatis in an infertile female patient with genital tuberculosis. The infections were diagnosed using polymerase chain reaction, and the patient responded to a combination of antituberculosis therapy and 1 g single-dose Azithromycin.
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4,950
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4
Chronic suppurative joint effusion due to
burkholderia pseudomallei:
A case report
Madhavi Deshmukh, Shailendra Mundhada
October-December 2013, 56(4):460-463
DOI
:10.4103/0377-4929.125373
PMID
:24441249
Burkholderia pseudomallei,
a Gram-negative bacillus is the causative agent of Melioidosis, a glanders-like disease, primarily a disease of animals. Melioidosis has been only a rare and sporadic disease in humans outside its endemic region. Currently, diagnosis of
B. pseudomallei
in the clinical laboratory is very difficult, owing to low awareness of physicians to the nonspecific clinical manifestations, lack of responsiveness among microbiologists outside endemic areas, identification systems in the average sentinel laboratory, and the biosafety conditions necessary to process these organisms. We report a case of chronic left hip joint effusion in a known case of diabetes mellitus. Gram stain of computed tomography (CT)-guided aspirate from the joint revealed Gram-negative bacilli along with pus cells. Culture was confirmed as
Burkholderia pseudomallei
on
Vitek2C
, which was sensitive to ceftazidime and trimethoprim/sulfmethoxazole. Unfortunately, patient could not be started on appropriate antibiotics due to delay in detection and patient succumbed to severe septicemia. This case is reported to highlight importance of automated identification and sensitivity especially in nonendemic areas and unusual antibiogram of this organism for which disc diffusion method is not standardized.
[ABSTRACT]
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4,987
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4
Nodular lymphocyte predominant Hodgkin lymphoma and diphenylhydantoin: Report of a case and review of the literature
Shobhna Sharma, Hari Menon, Manju Sengar, Sumeet Gujral
October-December 2013, 56(4):440-442
DOI
:10.4103/0377-4929.125364
PMID
:24441243
A variety of lymphoma types have been reported in patients being treated with anticonvulsant therapy. Non-Hodgkin lymphomas have been reported twice as frequently as Hodgkin lymphomas. Association of nodular lymphocyte predominant Hodgkin lymphoma (NLPHL) with dilantin therapy is extremely uncommon. We report a case of Hodgkin lymphoma in a 25-year-old male patient who had been treated with diphenylhydantoin sodium for generalized tonic clonic seizures for 15 years. Patient presented with left cervical and axillary lymphadenopathy persisting for more than 2 years after cessation of treatment with diphenylhydantoin. Computerized tomography scan of thorax, abdomen and pelvis revealed no significant lymphadenopathy or any organomegaly. Diagnosis of NLPHL was made on excision biopsy of the cervical lymph node. Although the association between diphenylhydantoin therapy and the development of immunosuppression and lymphoma is well-documented, the role of the drug in the etiology of these disorders is still controversial.
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4,816
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2
ORIGINAL ARTICLES
Hepatitis C virus genotypes: A plausible association with viral loads
Salma Ghulam Nabi, Ghazal Zaffar, Nadeem Islam Sheikh, Khalid Hassan, Usman Hassan
October-December 2013, 56(4):384-387
DOI
:10.4103/0377-4929.125319
PMID
:24441226
Background and Aim:
The basic aim of this study was to find out the association of genotypes with host age, gender and viral load.
Material and Methods:
The present study was conducted at Social Security Hospital, Pakistan. This study included 320 patients with chronic hepatitis C virus (HCV) infection who were referred to the hospital between November 2011 and July 2012. HCV viral detection and genotyping was performed and the association was seen between genotypes and host age, gender and viral load.
Results
: The analysis revealed the presence of genotypes 1 and 3 with further subtypes 1a, 1b, 3a, 3b and mixed genotypes 1b + 3a, 1b + 3b and 3a + 3b. Viral load quantification was carried out in all 151 HCV ribonucleic acid (RNA) positive patients. The genotype 3a was observed in 124 (82.12%) patients, 3b was found in 21 (13.91%), 1a was seen in 2 (1.32%), 1b in 1 (0.66%), mixed infection with 1b + 3a in 1 (0.66%), 1b + 3b in 1 (0.66%) and 3a + 3b was also found in 1 (0.66%) patient. Viral load quantification was carried out in all 151 HCV RNA positive patients and was compared between the various genotypes. The mean viral load in patients infected with genotype 1a was 2.75 × 10
6
, 1b 3.9 × 10
6
, 3a 2.65 × 10
6
, 3b 2.51 × 10
6
, 1b + 3a 3.4 × 106, 1b + 3b 2.7 × 106 and 3a + 3b 3.5 × 10
6
. An association between different types of genotypes and viral load was observed.
Conclusion
: Further studies should be carried out to determine the association of viral load with different genotypes so that sufficient data is available and can be used to determine the type and duration of therapy needed and predict disease outcome.
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CASE REPORTS
Desmin-related restrictive cardiomyopathy in a pediatric patient: A case report
Shruti Sharma, Rajnish Juneja, Gautam Sharma, Sudheer Arava, Ruma Ray
October-December 2013, 56(4):402-404
DOI
:10.4103/0377-4929.125349
PMID
:24441231
Restrictive cardiomyopathies in the pediatric population have diverse etiologies, including storage diseases like hemosiderosis, glycogenoses and desmin with its associated proteins. Desmin-related myopathy is a rare familial disorder of the cardiac and skeletal muscle characterized by intrasarcoplasmic accumulation of desmin-reactive deposits in the muscle cells. The patients commonly present with cardiac involvement such as conduction blocks and/or restrictive cardiomyopathy. Diagnosis of desmin cardiomyopathy depends on light microscopic evaluation of endomyocardial biopsy, where abnormal deposition of desmin can be documented on immunohistochemistry and ultrastructural examination. The index report presents the clinical, light microscopic and ultrastructural findings of desmin cardiomyopathy.
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4,758
97
1
Chondroid lipoma of the thigh: A case report
Parasappa Joteppa Yaranal, Vijayakumar Hegde
October-December 2013, 56(4):464-465
DOI
:10.4103/0377-4929.125374
PMID
:24441250
Chondroid lipoma is an unusual, unique benign lipomatous tumor. We present a case of chondroid lipoma of right thigh in 46-year- old female to highlight the distinct morphological simily, it is important to distinguish it from extraskeletal chondrosarcoma and myxoid liposarcoma. The review of the literature has been discussed.
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4,671
114
2
Dumb-bell shaped poorly differentiated pelvic synovial sarcoma with molecular confirmation: A rare presentation of an uncommon disease entity
Roumina Hasan, Sandeep Kumar, Lakshmi Rao
October-December 2013, 56(4):396-398
DOI
:10.4103/0377-4929.125336
PMID
:24441229
Pelvic localization of synovial sarcoma is a rare phenomenon and to the best of our knowledge its presentation as a large "dumb-bell"-shaped abdomino-pelvic mass showing extension to the thigh has never been reported in the literature. We report a case of a young adult presenting with retention of urine and was found to have a large abdomino-pelvic mass causing bony destruction and compression of pelvic viscera. A biopsy revealed a cellular tumor composed of spindle to oval cells arranged in a hemangiopericytomatous pattern. Histopathology was suggestive of poorly differentiated synovial sarcoma. Immunohistochemistry (IHC) was positive for vimentin, CD 99, Bcl2, Mic2 and focally for EMA and negative for CD 34, CK, desmin, synaptophysin, and WT1. Due to equivocal IHC findings molecular analysis was done which confirmed the diagnosis as synovial sarcoma.
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4,567
95
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LETTERS TO EDITOR
Epibulbar dermolipoma
Neeraj Garg, Nirupma Panikar
October-December 2013, 56(4):477-478
DOI
:10.4103/0377-4929.125393
PMID
:24441258
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4,342
77
1
CASE REPORTS
Epithelioid hemangioma of the testis
Xibo Liu, Ruifen Wang, Wenbin Guan, Lifeng Wang
October-December 2013, 56(4):422-424
DOI
:10.4103/0377-4929.125359
PMID
:24441238
Testicular hemangioma is a very rare benign vascular neoplasm, there are only less than 30 cases of testicular hemangiomas reported in the literature. We report a case of epithelioid hemangioma of the testis in a 53-year-old man who presented with painless mass in the right testis. An orchiectomy was performed, The 1 cm tumor was composed of prominent proliferation of small, capillary-sized vessels lined by plump, epithelioid endothelial cells. Immunohistochemically, the epithelioid endothelial cells reacted with antibodies to factor VIII-related antigen, CD31, CD34 and Vimentin, but not CK, EMA, CEA, S-100 and CD68. Although it is a rare tumor, we should be aware of it and avoid confusion with other vascular neoplasm.
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4,288
83
4
Primary gastric adenosquamous carcinoma in an Indian male
Rinkesh Kumar Bansal, Praveen Sharma, Ramneet Kaur, Anil Arora
October-December 2013, 56(4):416-418
DOI
:10.4103/0377-4929.125357
PMID
:24441236
Adenosquamous carcinoma (ASC) of the stomach is a very rare tumor comprising less than 0.5% of all stomach malignancies. Here, we report a case of a 37-year-old male, who presented with upper gastrointestinal bleeding in the form of hematemesis and malena. A subtotal gastrectomy was done in view of massive uncontrolled bleed. Histology showed evidence of ASC of the body and antrum with metastasis to the liver, perigastric lymph nodes and peritoneal and pleural cavity.
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4,235
122
1
Primary subcutaneous mixed-type liposarcoma of the thigh showing three simultaneous dedifferentiations: Report of an unusual case
Shashikant C.U Patne, Mohan Kumar, Anjali Vishwanath, Manoj Pandey
October-December 2013, 56(4):419-421
DOI
:10.4103/0377-4929.125358
PMID
:24441237
Liposarcoma most commonly occurs in deep soft tissues of the limb and the retroperitoneum; however, its occurrence in the subcutaneous tissue is rare. Mixed-type liposarcoma (MTL) is the rarest subtype. We herein describe a unique case of MTL with three simultaneous dedifferentiations occurring in subcutaneous tissue of left thigh in a 45-year-old male. We briefly review the pertinent literature and report this case because of extreme rarity.
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4,279
75
1
T-lineage acute lymphoblastic leukemia and parvovirus infection in a child with neurofibromastosis-1
Pallavi Agarwal, Shano Naseem, Neelam Varma, RK Marwaha
October-December 2013, 56(4):446-448
DOI
:10.4103/0377-4929.125366
PMID
:24441245
Neurofibromatosis (NF-1) patients have an increased risk of developing malignancies most commonly rhabdomyosarcomas, optic gliomas, brain tumors and non-lymphocytic leukemias. Acute lymphoblastic leukemia (ALL) has been infrequently reported in association with NF-1. We describe a rare association of NF-1, T-lineage ALL and parvovirus infection in a 12-year-old child. In addition, it is also to emphasize that a high index of suspicion should be kept for parvovirus B19 infection as a cause of bicytopenia/pancytopenia in ALL patients following induction chemotherapy.
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4,204
95
2
Sebaceous carcinoma with apocrine differentiation: A rare entity with aggressive behavior
Nishat Afroz, Noorin Zaidi, Syed Ali Raza Rizvi
October-December 2013, 56(4):408-410
DOI
:10.4103/0377-4929.125354
PMID
:24441233
Sebaceous carcinomas are rare neoplasms but have aggressive behavior. Although they can be found anywhere in the body ocular region is the most common site which comprises 75% of all cases of sebaceous carcinomas. Due to their rarity, varied histopathological features, and diverse clinical presentation, their diagnosis is often delayed, sometimes by a year. They are divided on the basis of histological differentiation into well and poorly differentiated. Apocrine differentiation is a still rarer finding and only two cases have been reported in the literature so far. We report a case of sebaceous carcinoma with apocrine differentiation in a 60-year-old male who presented with a painless swelling in right upper eyelid for 2 months which was gradually progressive. Computed tomography (CT) scan was performed and a provisional diagnosis of hemangioma was made. The mass was excised and histopathological examination revealed it to be sebaceous carcinoma. However, there were areas with decapitation secretions and granular eosinophilic cytoplasm. These were positive for cytokeratin (CK) 7 and CK 19 which confirmed their apocrine nature. Therefore, a final diagnosis of sebaceous carcinoma with apocrine differentiation was made. Thus, it can be concluded that ocular sebaceous carcinomas with apocrine differentiation are extremely rare and have significant clinical importance since they can mimic a benign lesion and the nature of surgical intervention and follow up is more aggressive than that of simple sebaceous carcinoma alone.
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4,082
95
2
Conventional renal cell carcinoma with renal capsular leiomyoma: A diagnostic dilemma
Vijay K Maneesh, Ranjit Kumar, Sandeep Aggarwal, Prasenjit Das
October-December 2013, 56(4):393-395
DOI
:10.4103/0377-4929.125329
PMID
:24441228
Primary renal leiomyomas are very rare benign tumors of the kidney, arising from smooth muscle cells of the renal capsule, pelvis or blood vessels. Simultaneous occurrence of a leiomyoma with conventional renal cell carcinoma (RCC) in the same kidney is an extremely rare incidence. Herein we describe a case, which to the best of our knowledge is the second reported case in the English literature. This 70-year-old female presented in surgical out-patient department with the complaints of hematuria and abdominal pain. Subsequently, on computed tomography a multifocal mass was noted in the right kidney, measuring 4.5 cm Χ 3 cm Χ 2 cm and 1 cm Χ 0.5 cm Χ 0.5 cm respectively. A radical nephrectomy was performed with the clinical diagnosis of a multifocal RCC. Histopathological examination revealed a conventional RCC in the larger nodule, whereas the smaller nodule showed a sub capsular leiomyoma, which was immune-positive for smooth muscle actin and HMB45. In the index case, radiology could not differentiate between the RCC and leiomyoma. Apart from being a radiological diagnostic dilemma, rare HMB45 immunostain positivity in capsular leiomyoma may create diagnostic dilemma for histopathologists too. Sole HMB45 positivity should not distract one to diagnose this lesion as an angiomyolipoma, unless the other components are seen.
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4,068
101
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LETTERS TO EDITOR
Tuberculosis of the parapharyngeal space: A rare case report
Malini Jagannatha Rao, Ramya Sablur Narayan Gowda, BL Umapathy, BV Navaneeth
October-December 2013, 56(4):480-481
DOI
:10.4103/0377-4929.125400
PMID
:24441260
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4,034
100
5
A case of multi-drug-resistant, intracranial tuberculomas, presenting with headache
Vedat Ali Yurekli, Onur Kaya, Fidan Incekara Aydin, Haci Ahmet Bircan, Süleyman Kutluhan, Mustafa Kayan, Ibak Gonen
October-December 2013, 56(4):481-483
DOI
:10.4103/0377-4929.125407
PMID
:24441261
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3,882
82
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CASE REPORTS
Novel molecular aberrations and pathologic findings in a tubulocystic variant of renal cell carcinoma
Nikhil A Sangle, Rong Mao, Shashirekha Shetty, Joshua D Schiffman, Christopher Dechet, Lester Layfield, Neeraj Agarwal, Ting Liu
October-December 2013, 56(4):428-433
DOI
:10.4103/0377-4929.125361
PMID
:24441240
Tubulocystic renal cell carcinoma (TRCC) is an indolent type of renal cell carcinoma with a good prognosis based on the limited number of published cases. Herein, we describe the unusual clinical, pathologic and molecular findings in a case of TRCC. Our patient with TRCC had two local recurrences and a brain metastasis following radical nephrectomy. Unusual histologic findings included focal solid growth pattern and cytologic atypia. A genome-wide molecular inversion probe assay identified copy number (CN) loss in three chromosome regions and one region with copy-neutral loss of heterozygosity (copy-neutral LOH). Copy number variations (CNVs) were observed (chromosomes 4p16.1 and 17q21.31-q21.32) in both the tumor and the normal tissue, and most likely represents benign variations. The loss of entire chromosomes 9, 18 and 15 and copy-neutral LOH involving 6p22.1 was observed only in the tumor. The presence of these clinical, pathologic and molecular findings could be related to an increased risk for tumor recurrence and poor prognosis. The novel molecular findings described in TRCC might represent new targets for novel therapies.
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3,789
78
3
LETTERS TO EDITOR
Antibiogram of Salmonella typhi and Salmonella paratyphi A in a tertiary care hospital in 2012
Bhavana Malavalli Venkatesh, Sangeeta Joshi, Ranjeeta Adhikary, Beena Hosdurg Bhaskar
October-December 2013, 56(4):484-485
DOI
:10.4103/0377-4929.125418
PMID
:24441263
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3,546
129
3
CASE REPORTS
Isolated malakoplakia of inguinal lymph node: A rare case report
Rachna Khera, Swetha Narla, Shantveer G Uppin, Megha S Uppin, Roshni T Paul
October-December 2013, 56(4):443-445
DOI
:10.4103/0377-4929.125365
PMID
:24441244
Malakoplakia is rare chronic inflammatory disorder which commonly affects urinary tract. Though it has been reported in several sites outside the urinary tract, isolated lympnode involvement is extremely uncommon. Herein we present a case of 20 year old male with right inguinal lymphnodal mass. Histological findings including special stains and immunohistochemistry findings were characteristic of malakoplakia. This case is being presented to create awareness for inclusion of this entity in the differential diagnosis of lymphadenopathy.
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3,509
87
2
LETTERS TO EDITOR
Utility of Cysteine lactose electrolyte-deficient agar for rapid isolation of Nocardia species
Sarika Jain, Navneet Sharma, Tulsi Das Chugh
October-December 2013, 56(4):485-486
DOI
:10.4103/0377-4929.125420
PMID
:24441264
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3,486
77
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Pleural multicystic mesothelial proliferation: A mimicker of benign peritoneal mesothelioma
Swati Agarwal, Shalini Mullick, Kumud Gupta, Shaleen Prasad
October-December 2013, 56(4):476-477
DOI
:10.4103/0377-4929.125389
PMID
:24441257
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3,384
65
1
Splenogonadal fusion: Pathological features of a rare scrotal mass
Neelaveni Duhli, Vivek Venkatramani, Arabind Panda, Ramani Manojkumar
October-December 2013, 56(4):474-476
DOI
:10.4103/0377-4929.125387
PMID
:24441256
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3,168
81
2
IMAGES
Extensively calcified cystic extraventricular neurocytoma
Aparna Govindan, Vijayan Peettakkandy, Jacob Paul Alapatt
October-December 2013, 56(4):470-470
DOI
:10.4103/0377-4929.125381
PMID
:24441253
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3,144
70
2
CASE REPORTS
Primary intratesticular pleomorphic leiomyosarcoma: A rare case report
Rajshri Pisaram Damle, Kishor H Suryawanshi, Nandkumar V Dravid, Dhananjay V Newadkar
October-December 2013, 56(4):425-427
DOI
:10.4103/0377-4929.125360
PMID
:24441239
Intratesticular leiomyosarcoma is an extremely rare tumor of the genitourinary system. We report a case of intratesticular pleomorphic leiomyosarcoma in a 68-year-old male who presented with gradual painless enlargement of the right scrotal mass over a period of 1-2 years. Radiological examination revealed a right testicular tumor.Right radical orchiectomy was performed with high ligation of the spermatic cord. Histopathological examination along with immunohistochemistry confirmed the diagnosis of a pleomorphic leiomyosarcoma of the testis. This is, to the best of our knowledge, the 13
th
case of primary intratesticular leiomyosarcoma and the third case of high-grade (pleomorphic) intratesticular leiomyosarcoma in an elderly male reported in the literature.
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3,081
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IMAGES
Xp11 translocation renal cell carcinoma
Kanchan S Kothari, Pragati A Sathe, Leena P Naik, Bhuvaneshwari M Kandalkar
October-December 2013, 56(4):471-472
DOI
:10.4103/0377-4929.125383
PMID
:24441254
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3,075
95
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LETTERS TO EDITOR
Primary primitive neuroectodermal tumor of lung: A case report
Radhakrishnan Nair Amita, Samvedam Sandhyamani, Kavumkal Rajagopalan Balasubramoniam
October-December 2013, 56(4):479-480
DOI
:10.4103/0377-4929.125397
PMID
:24441259
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3,036
79
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IMAGES
Isolated eccentric lingual diphtheria: A relevance
Basavaraj P Belaldavar, Nitin R Ankle, Ashwin V Gajendran, Ratkal Kedarnath
October-December 2013, 56(4):466-467
DOI
:10.4103/0377-4929.125377
PMID
:24441251
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3,027
82
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CASE REPORTS
Immunohistochemical analyses of a case of extralobar pulmonary sequestration with chest pain in an adult
Yuji Ohtsuki, Masashi Uomoto, Yasuki Hachisuka, Mutsuo Furihata
October-December 2013, 56(4):434-436
DOI
:10.4103/0377-4929.125362
PMID
:24441241
Computed tomography of a Japanese man in his mid-forties with a complaint of right-side chest pain showed a dome-shaped smooth-surfaced mediastinal mass, which was extirpated. The cut surface was highly hemorrhagic and necrotic and not related to the original pulmonary tissues. Although routine sectioning detected bronchial cartilage, immunohistochemical analyses clearly showed the presence of alveolar type II cells; only the alveolar type II cells located at the periphery of this mass showed positive staining for cytokeratins, thyroid transcription factor 1, surfactant protein A, epithelial membrane antigen and Krebs von den Lungen-6. Thus, these analyses are useful for the detection of pulmonary components, even in severely hemorrhagic and necrotic tissues with marked sequestration. The clinical diagnosis was a rare, adult type of extralobar pulmonary sequestration accompanied by chest pain.
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EDITORIAL
From Editor's desk
Vatsala Misra
October-December 2013, 56(4):341-341
DOI
:10.4103/0377-4929.125278
PMID
:24441218
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2,550
93
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© 2008 Indian Journal of Pathology and Microbiology | Published by Wolters Kluwer -
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Online since 5
th
April, 2008