Pemphigus vulgaris (PV) is a vesiculobullous lesion that produces intraepithelial blisters in skin and mucous membrane. The oral mucosa is often the first site to be affected by the disease. Although oral PVis a well characterized condition, the detailed clinical and histopathological study in Malabar population has not been reported. A clinicopathologic study of 20 cases of oral PV observed over a span of 2 years from January 2004 to January 2006 is reported. For these 20 cases, the mean age was 42.3 years and male:female ratio was 2:3. The most commonly affected sites were the buccal mucosa and palate. Histopathologic examination with direct immunofluorescence was the method of diagnosis in all cases. Suprabasilar clefting with acantholytic cells can be seen histopathologically and IgG positivity in direct immunofluorescence in all cases that have been studied.

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The histological differentiation of Hepatocellular carcinoma (HCC) from cholangiocarcinoma (CC) and metastatic adenocarcinoma (MA) of the liver is difficult in some cases and immunohistochemistry (IHC) is necessary for the diagnosis. HepPar-1 is a recently available antibody which seems to be very specific and sensitive for the diagnosis of HCC. MOC31 is an antibody directed against a cell surface glycoprotein and has been shown to be helpful in distinguishing between HCC and CC or MA as a negative marker in HCC. In this study we tried to apply these two markers for the diagnosis of HCC cases as a simple, useful and reliable panel. We selected 101 liver tumors which had proven diagnosis by several antibodies and cilinicopathologic correlation. The tumors with confirmed histologic diagnosis including 35 HCC, 58 MA, 7 CC and 1 combined HCC-CC.. HepPar-1 was positive in 30 of 35 cases of HCC; none of the other tumors were reactive for HepPar1 except for a case of metastatic gall bladder adenocarcinoma which showed areas of hepatoid differentiation in the H&E slides. MOC31 was positive in 5 of the HCC cases and stained 60 of 65 cases of MA. There were 4 cases of HCC with clear cell morphology, in most of which, IHC pattern was not diagnostic and further investigation was needed. As a conclusion the combination of positive Hepar1 and negative MOC31 is highly suggestive for HCC except for the clear cell variant. These two reliable markers are recommended for the initial step of differential diagnosis between HCC and MA and for the confirmation of the histologic diagnosis.

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The spectrum of HIV pathological lesions encountered in the placenta has not been well documented in the literature. To address this issue, we examined 51 placentae of HIV positive mothers, prospectively over a one year period and compared the pathology of the cases treated with zidovudine (AZT) or nevirapine (NVP) with untreated cases. We also correlated the placental pathology with the HIV status of the neonates. The maternal to child transmission rate was 4.44%. A lower fetal / placental weight ratio was seen in normal birth weight neonates compared to low birth weight neonates. No significant gross lesions were encountered and the placental disc did not show any significant decrease in dimensions. The commonest inflammatory lesion seen was chorio-amnionitis 31.37% and the commonest non-inflammatory lesion was cytotrophoblastic hyperplasia 76.47%. There was no significant decrease in the incidence of the lesions following anti-retroviral therapy in our study, and we did not find any correlation between the incidence of placental lesions and the HIV status of the newborn.

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To identify the etiology of thrombocytosis in various age groups and to evaluate the effectiveness of platelet indices in differentiating reactive and clonal thrombocytosis, an observational, prospective review of patients with platelet count of 600 x 10(9)/L or more performed by using coulter counter STKS (Coulter Electronic, Kerfeld, Germany). Extreme thrombocytosis defined as platelet count of 1000 x 10(9)/L or more. Of 1068 patients, 91.8% had reactive and 8.2% had clonal thrombocytosis. Frequent causes of reactive thrombocytosis were infections (44.9%), tissue injury (11.4%) and rebound thrombocytosis (10.2%). Fifty-five patients had extreme thrombocytosis, main aetiologies were secondary and clonal thrombocytosis that seen in 72.7% and 27.3% of cases respectively. Comparison of platelet indices showed; that cases with reactive thrombocytosis had low mean platelet volume and platelet distribution width. We concluded that thrombocytosis could be a response to various physiological and pathological processes. Low MPV and PDW in patients with high platelet counts strongly suggest reactive etiology.

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Penicillium marneffei (PM), the only dimorphic species of the genus penicillium is the etiological agent of penicilliosis marneffei. This opportunistic fungal infection occurs among human immunodeficiency virus (HIV) infected and other immunocompromised patient in several regions of South-east Asia, where the infection is considered as an indicator disease of AIDS. A case of penicilliosis marneffei is reported in a patient whose HIV status was unknown and later turned to be in the late stage of AIDS. This demonstrates that it is indeed an indicator disease of AIDS. In India, penicilliosis has been reported among the inhabitants of Manipur state where the prevalence of HIV infection / AIDS is very high. The causative agent was first isolated from a captive bamboo rat. Investigation of the prevalence of the organism among bamboo rats of different countries of South East Asia revealed four species of bamboo rats to be harboring the organism. These four species of bamboo rats are Rhizomys sinensis, R. pruinosus, R. sumatrensis and Cannomys badius. In Manipur, Penicillium marneffei has been isolated from Cannomys badius. Any patient presenting with penicilliosis marneffei should be subjected to HIV counselling and testing if the HIV status is not known and further study regarding the ecology and epidemiology of the fungus is needed.

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Congenital epulis, also known as congenital gingival granular cell tumor, is a rare benign intraoral tumor found only in the new born. It can be solitary or multiple and may occur in the mandible, maxilla or tongue and may or may not be associated with other congenital anomalies. The size of the mass varies and if very large may interfere with respiration and feeding at birth, thus necessitating the immediate surgical resection at birth to maintain patency of the airways. Antepartum detection by careful imaging and coordination of multidisciplinary team of maternal-fetal medicine, neonatal-perinatal medicine, anesthesiology and otolaryngology and finally the histopathologists who confirm the diagnosis is essential as the histology differentiates it from other congenital intraoral masses like haemangioma, fibroma, rhabdomyoma, rhabdomyosarcoma, lymphangioma, osteogenic and chondrogenic sarcomas.

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The foetus, placenta and mother form a composite triad of dynamic equilibrium, and dysfunction of any one of them can affect the others. The aim of the present study was to appreciate qualitatively and to assess quantitatively the pathological features of placentas associated with pregnancy induced hypertension (PIH) with and without intrauterine growth retardation (IUGR) & also IUGR placentas without PIH and to compare them with the normal placentas and to evolve plausible explanation for the outcomes of PIH and IUGR. The study evaluated 40, 51, 58 placentas of PIH with IUGR (category I), PIH without IUGR (category II), IUGR without PIH (category III) respectively and compared them with 118 normal placentas. The basic conclusions of the study were that PIH is common among primigravida and probably the main factor in the genesis of IUGR and reduced placental weight. There was a high prevalence of inflammation, infarction, ischemia, intervillous hemorrhage, and syncytial knots in PIH with IUGR placentas as also in PIH without IUGR (category II) and IUGR without PIH (category III) placentas. Acute atherosis was a characteristic finding of PIH placentas (both category I & II).

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Infections due to atypical mycobacteria are infrequent in renal transplant recipients but they cause serious morbidity. These pathogens are common in patients with acquired immune deficiency syndrome (AIDS). We report four proven cases of infections caused with atypical mycobacteriae from 1997 to 2003, by different organisms namely, M. chelonei, M.fortuitum, M. abcessus and M. terrae in renal transplant recipients. Infection with M. terrae documented here is the first occurrence in a renal transplant patient. Histopathological examination of aspirates or biopsy specimens from involved areas and staining and culture for mycobacteriae are essential for diagnosis. Treatment involves antimycobacterial therapy, reduction in immunosuppression and surgery, if indicated. Atypical mycobacterial infections, though currently uncommon, are significant and could prove to be an emerging pathogen in renal transplant recipients in the context of the AIDS epidemic in India.

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Contrary to the popular perception, hydatosis does not remain restricted to certain geographical locales but is a global health concern, particularly in the rural countryside. Although liver and lung involvement account for the majority of the lesions, primary breast, bone, kidney and soft tissue hydatosis with features of cystic echinococcosis are extremely rare. We report four such rare cases of cystic echinococcosis which were diagnosed and treated in our institute.

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Ectopic cervical thymoma is a rare tumour that probably arises from thymic tissue trapped during the migration of the thymus into the anterior mediastinum from the third and fourth pharyngeal pouches. As it occurs in the region of the thyroid gland it mimics thyroid lesions and can cause confusion to the clinician, sonologist and cytologist. Misinterpretation of frozen sections can also occur if knowledge of this entity is not present. We are reporting a case of this rare entity in an elderly lady who presented with a neck mass that mimicked a thyroid lesion. Ectopic cervical thymoma should be considered in the list of differential diagnosis of neck masses in the elderly.

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The authors present a case of duodenal angiomyolipoma. Angiomyolipoma is a benign neoplasm, the most common site being the kidney. Extrarenal angiomyolipomas are rare. Only one case of duodenal angiomyolipoma has been reported. A 66 year old man presented with GI bleeding for two years. Endoscopy revealed a duodenal polyp which on histopathology revealed features of angiomyolipoma. On immunohistochemistry, smooth muscle component was positive for Smooth Muscle Actin. HMB-45 showed mild focal positivity. Patient had no history of tuberous sclerosis. Surgical excision of angiomyolipoma is usually curative with rare cases of local recurrence.

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Klebsiella pneumoniae has long been a prominent cause of nosocomial infections and outbreaks have been observed in the intensive care units and in high risk groups. We present here a brief report on an outbreak of Klebsiella pneumoniae which occurred in a neonatal intensive care unit in our teaching hospital. As neonates are at highest risk for acquisition of Klebsiella pneumoniae producing extended spectrum beta-lactamase, infection control policies and procedures should be strictly followed to prevent such outbreaks.

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Spinal paragangliomas are uncommon neoplasms and subject of much debate regarding the factors governing their biological behaviour. We describe the clinicopathological and immunohistochemical (IHC) features of six cases of spinal paraganglioma. The mean age of patients was 40 years (range 20-60 years) with a male to female ratio of (2:1). Majority presented with low backache, sphincter disturbances and sensory symptoms. All tumors were intradural in the cauda region one of them extending to the filum. Only one showed focal extradural extension on microscopy. Gross total resection of tumors was possible in all cases. Histologically four showed classical 'zell-ballen' pattern and two revealed an ependymal morphology. On immunohistochemistry, in all the six cases the chief cells were intensely labeled by antibody to chromogranin but not for GFAP while staining for synaptophysin was less intense and variable in five. Sustentacular cells in all cases showed strong expression for S-100 protein and chief cells were stained light in three cases. Low MIB-1 labeling index of 0.01-2% was noted in five cases and in the sixth it was 5%. None of the tumours recurred. Immunohistochemistry assisted in differentiating these relatively benign neural crest tumours from the more aggressive spinal ependymomas.

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Metastatic carcinoma, which is a common malignant tumor seen in the central nervous system is often difficult to distinguish from glioblastoma multiforme. In general, neoplastic cells maintain fidelity in the expression of parent cell intermediate filament and immunohistochemistry remains the mainstay in diagnosis. A panel consisting of GFAP (usually positive for astrocytic tumors) and cytokeratin (usually positive for metastatic carcinomas) is most commonly used for this purpose. However, co-expression of two or more classes of intermediate filament proteins by neoplasms is a widespread phenomenon and there are reports of glial neoplasms expressing keratin markers. Our aims and objectives were to analyse the expression of both cytokeratin and GFAP in different glial tumors and metastatic carcinomas. Cases were collected for a period of two years. All the cases were diagnosed as primary or metastatic intracranial tumors. Formalin-fixed paraffin-embedded thin sections were taken on egg-albumin coated slides and immunostaining with GFAP and polyclonal cytokeratin was done. Forty-five tumors were analysed, including 35 glial neoplasms and 10 metastatic carcinomas of which 7 of the 32 astrocytic neoplasms (22%) showed focal immunoreactivity with pancytokeratin. All of the glial tumors but none of the metastatic carcinomas were positive with GFAP. So our conclusion was that co-expression of GFAP and CK is a fairly common phenomenon, especially in case of undifferentiated and high grade gliomas and this must be kept in mind while differentiating these cases from metastatic carcinoma, as CK positivity does not rule out the diagnosis of a glial neoplasm. Further studies with an expanded panel of CK is most useful for this.

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In this case report we describe a rare tumor--Oncocytic variant of Mucoepidermoid carcinoma of the submandibular salivary gland with a review of the literature. Oncocytic metaplasia in salivary glands is a benign change that is associated with increasing age and also seen in a few salivary gland neoplasms', which include oncocytoma, Warthin's tumor, and the rare, oncocytic carcinoma. Oncocytic differentiation in mucoepidermoid carcinoma (MEC) is uncommon. Only twelve well-documented cases of oncocytic MEC have been reported previously all of which occurred in the parotid gland. To the best of our knowledge this is the first case of oncocytic mucoepidermoid carcinoma involving the submandibular salivary gland. The recognition of this entity is important, since most of the other primary oncocytic lesions of the salivary gland are benign.

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Nerve sheath tumors occurring in the adrenal gland are uncommon. Although schwannomas originating in retroperitoneal and juxta-adrenal locations have been reported, those occurring in adrenal gland are rare. Till date no such case has been documented in the Indian literature.

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To analyze the significance of comparative evaluation of cytohistomorphological grading of infiltrating ductal carcinoma with specific reference to lymphnode metastasis status and apoptotic index. 50 patients who underwent FNAC and mastectomy for infiltrating ductal carcinoma were included in the study. Concordance between cytological and histological grades was calculated. Cytological smears were also evaluated for apoptotic rates and lymph node metastasis and then compared with the histological grades using regression analysis. Histological and cytological grades were comparable and statistically significant difference was found in the lymphnode metastasis rate and apoptotic index in the three cytological grades of the tumor. Moreover, by considering the apoptotic rates, the sensitivity of cytological grading significantly rose in relation to histological grade. With histological grade taken as the standard, cytology was found to be comparable but less sensitive for grading infiltrating ductal carcinoma. However, by considering lymphnode status and apoptotic rates as calculated on cytology, the sensitivity of cytological grading rose significantly in relation to histological grade. Therefore, apoptotic index incorporated with cytological grade may provide relevant information on the aggressiveness of invasive ductal carcinoma of breast and could be a useful parameter to take into consideration when selecting neo-adjuvant therapy.

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Bone marrow involvement in Hodgkin's disease alters the stage and hence the prognosis and treatment modality. Seventy-six patients of biopsy proven Hodgkin's disease in whom a bone marrow aspiration and biopsy were done simultaneously at the time of diagnosis were included in the study. Bone marrow involvement was seen in 14 (18%) cases. All 14 cases were diagnosed on biopsy. Only one aspirate was suspicious of involvement. Rest was either diluted (28%) or was normal (64%). Eleven patients were upstaged from stage I, II and III to stage IV. All patients had cytopenia of one or more cell line. Increased fibrosis, necrosis and a polymorphic cellular infiltrate were associated findings in the marrow. We wish to highlight the importance of bone marrow trephine biopsy over aspirate in staging even clinically early stage Hodgkin's disease.

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To study the occurrence of leukemia as a second malignancy following various primary solid and hematological malignancies. Total 11 cases of leukemia presenting as a second malignancy were studied over a period of 15 years from 1990 to 2005. The primary malignancies included carcinoma breast (4), multiple myeloma (3) and one each of Hodgkin's lymphoma, mediastinal germ cell tumor, papillary carcinoma thyroid and myxopapillary ependymoma. Ten patients had received chemotherapy with combination radiotherapy in six patients. The commonest type of leukemia was AML-M2. The cyogenetic test results were available in three cases. The secondary leukemia showed aggressive behaviour and all patients on follow-up died within a period of one month. The risk benefit ratio of chemotherapy and radiotherapy should be considered before starting the patients on treatment. A high degree of suspicion and follow up with hematological parameters is required for therapy related complications.

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Antiretroviral therapy has played an important role in improving the quality of life and extending the life span of HIV positive patients. In the present study 17 naive HIV positive patients out of a total of 23 positive cases from local population who had absolute CD4+ counts below 300 were given ARV therapy and followed for 1 year. The patients showed an overall improvement in CD4+T lymphocyte counts at one year survival. The values of CD3+ & CD8+ T lymphocytes also changed as expected.

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Erythrocyte sedimentation rate (ESR) is one of the most frequently ordered laboratory test. ESR analyzers were developed to provide a quick and efficient measure of ESR. We compared the results of ESR obtained by an ESR analyzer with those by the Westergren method in a group of 75 patients Linear regression analysis showed a good correlation between the two results (r = 0.818, p < 0.01). The intra class correlation was 0.82. The analyzer method had the advantages of safety, decreased technician time and improved patient care by providing quick results.

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von Willebrand disease is a common inherited bleeding disorder and the problem is undefined in developing countries due to limitation of its diagnostic facilities. The aim of the study was to diagnose vWD in patients with history of muco - cutaneous bleeding and characterization into its variants by multimeric analysis. 224 patients presenting with history of muco - cutaneous bleeding were selected. In all patients, platelet count, BT, PT, APTT, PF3 availability, clot solubility and factor VIII assay were done. Diagnosis of vWD was confirmed by RIPA, vWF: Ag, and vWF: RCo and its sub-characterization was done by multimeric analysis. 64 patients were diagnosed to have vWD. Of these, 21.9% were of type 1 vWD, 43.7% type 2 vWD, 1.6% acquired vWD and 32.8% type 3 vWD. By multimeric analysis, 2 patients had supranormal HMW multimers and two patients had normal distribution of vWF multimers were diagnosed as type 2M 'Vicenza'; and type 2M vWD respectively. It is concluded, that vWD is not an uncommon condition amongst Indian population.

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Bone marrow mastocytosis, though infrequently documented in Indian patients, may be observed in association with many non mast cell hematological neoplasms, including acute myeloblastic leukemia (AML) and myelodysplastic syndromes (MDS). We report three cases of acute myeloid leukemia with excess of mast cells in the bone marrow (BM) samples. Mast cell hyperplasia may remain under diagnosed due to shortcoming of morphological identification and diagnostic workup.

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This paper describes the clinical, radiological and cytomorphological findings of tumoral calcinosis in a twelve-year old boy with normal serum calcium levels and simultaneous involvement of the right shoulder and the left hip. The aim of presentation is to highlights the fact that clinicoradiological correlation and correct interpretation of cytologic findings can alleviate patients' anxiety and avoid unnecessary mutilating surgery in this uncommon but completely benign condition.

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Angiomyolipomas are the most common benign mesenchymal tumours of the kidney. Most of the angiomyolipomas in adults are asymptomatic and discovered incidentally. We report a case in a symptomatic 55 yrs old male who had a huge retroperitoneal mass abdomen and in whom diagnosis and organ of origin remained unclear until operation and histopathological study was performed. Radiological and fine needle aspiration cytology (FNAC) report of a malignant retroperitoneal tumour was given, but histological examination of the respective tumorous mass showed a benign renal tumour - angiomyolipoma. Our emphasis by reporting this case is to make cytopathologists and radiologists aware of such kind of diagnostic pitfall encountered while reporting retroperitoneal masses.

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A 53-year-old male presented with a right inguinal mass of one-year duration. The fine needle aspiration of the inguinal mass showed a highly cellular tumor composed of sheets and isolated, large round to polygonal cells with moderate pleomorphism. Many bare nuclei were seen with occasional intranuclear inclusions. A provisional diagnosis of metastasis probably of testicular tumour was made. The orchidectomy showed a brown tumor replacing the entire testis and infiltrating the epididymis. The histological features showed Leydig cell tumor without Reinke crystalloids.

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Autopsy was performed on a fetus of 6 months gestation with sonologic features of skeletal dysplasia to arrive at a pathological diagnosis. Radiograph of fetus was taken which showed short limb bones, curved femora, flattened vertebral bodies with wide intervertebral spaces, bell-shaped chest, short ribs with flared ends which are features described in Thanatophoric dysplasia. This was confirmed by histopathological findings in the epiphyseal growth plate. In this paper, we attempt to describe the radiological and pathological findings of our case with a discussion on comparative literature.

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Macrodystrophia lipomatosa is a rare congenital form of localized gigantism, characterized by an increase in all mesenchymal elements, particularly fibroadipose tissue. The areas of predilection are segments supplied by the median or plantar nerves. We report such a rare case in a thirty four year old male patient, who presented with a swelling of the right upper limb and a marked increase in the size of the right thumb, index finger and radial half of the right hand, present since birth, with progressive increase to the present size. Amputation of the right thumb and debulking of the palm was done. The specimen measured 26 x 18 x 12 cms. and the thumb alone measured 13 x 7 x 7 cm. histology revealed hypertrophy of adipose tissue in the subcutaneous compartment and infiltration into the nerve sheaths and muscles.

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Temporal or giant cell arteritis is the most common vasculitis affecting the temporal artery. We encountered an unusual case of involvement of the temporal artery, which showed marked proliferating capillaries admixed with a dense infiltrate of eosinophils affecting all layers of the vessel. It was concluded that these changes were those of an epithelioid hemangioma of the temporal artery.

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IgM nephropathy is characterised on light microscopy (LM) by variable features of normal glomeruli to mesangial hypercellularity; and immunofluorescence (IF) deposits of LgM. Our aim was to study the incidence of IgM nephropathy in adults with primary glomerular disease, with correlation to electron microscopy (EM) features. All adults presenting with proteinuria glomerular hematuria underwent renal biopsy. We excluded patients with systemic diseases and post-infectious glomerulonephritis. All the specimens were evaluated by LM, IF and EM. Our series had 146 cases. Of the 42 cases diagnosed on LM as minimal change disease, mesangial deposition of IgM was present in 11 cases. In addition there were seven cases of mesangioproliferative glomerulonephritis with mesangial IgM deposition. Thus, there were a total of 18 cases of IgM nephropathy (12.3%). Only six of these 18 cases showed typical electron dense deposits in the mesangium on EM. We feel that IgM nephropathy is probably a separate pathological entity, comprising 12.3% of all adults with primary chronic glomerulopathy. Electron dense deposits are seen in only about a third of these cases.

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Mitochondrial myopathy is the term applied to a clinically and biochemically heterogeneous group of disorders which have multisystem involvement. The concept was introduced by Luft in 1962. These are due to genetic defects in the respiratory chain enzymes which are detected by histochemical, immunohistochemical stains, molecular biological studies and ultrastructural studies on muscle biopsy. Classification of the disorders can be genetic, based on defects of respiratory enzyme complexes or on the basis of the clinical syndromes. Due to the extremely variable clinical presentations of these disorders, a complete clinical and laboratory workup involving strict diagnostic criteria is essential.

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Kikuchi's disease (KD) is a necrotizing lymphadenopathy with a self-limiting course commonly affecting young people. We conducted a clinico-pathological study of 20 cases of KD received at our department between July 2000 and December 2003. Our study confirmed that KD commonly involves the cervical lymph nodes of young adults, with a female predominance. One patient had associated cutaneous involvement. The hematological parameters were non-specific. The histological features were distinctive and included easy fragmentation on handling, karyorrhexis, crescentic histiocytes and the absence of neutrophils. The differential diagnosis on histology is also discussed.

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To evaluate the expression of HER-2/neu in various ovarian lesions, 75 cases of ovarian tissues (25 cases of benign lesions and 50 cases of carcinoma) were studied in the department of pathology, Pt. B.D. Sharma PGIMS, Rohtak. Besides conventional H&E staining, representative sections were processed for immunohistochemical staining for HER-2/neu detection. Two (8%) of benign cases were 1+ positive and 19 (38.0%) of malignant lesions were positive for HER-2/neu staining with intensity 1+/2+ in 16 cases (32.0%), 3+ in 2 cases (4%) and 4+ in 1 case (2%). It was observed that HER-2/neu expression was significantly associated with high grade ovarian tumours, however intensity of positivity did not correlate with the grade of tumour.

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A variety of changes in placental villi are known to occur in Pregnancy Induced Hypertension. In this study an attempt is made to study 49 placentae from PIH and its correlation to perinatal outcome. Quantification of villous lesions was carried out. The striking villious changes were cytotrophoblastic proliferation, paucity of vasculosyncytial membrane, trophoblastic basement membrane thickening and fibrinoid necrosis of villi. The changes were directly proportional to the severity of disease and perinatal outcome was worse with advancing grades of PIH.

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Two hundred and thirty three cases of ovarian tumours and tumour like lesions were studied. Of these 233 cases, 96 cases were of ovarian tumours and 137 were tumour like lesions of the ovary. Of the 96 cases of ovarian tumours, 72.9% were benign, 4.1% were borderline and 22.9% were malignant. Histologically surface epithelial tumours were the commonest (48.8%) followed by germ cell tumours (23.9%), sex cord stromal tumours (8.3%) and metastatic tumours (2.0%). Ultrasound guided FNAC done in cases of ovarian tumours showed an accuracy of 100% for malignant lesions and 100% for benign and borderline lesions when compared with histopathological diagnosis. Of the non neoplastic lesions follicular cysts and corpus leuteal cysts were commonest (80.2%). Tuberculosis constituted (2.9%) cases and was the major cause of clinical diagnostic pitfalls for cases in which a clinical diagnosis of ovarian neoplasm was made.

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We report 2 cases of Follicular Dendritic Cell Sarcomas of Oral Cavity in two elderly patients. The patients presented with oral cavity tumors. Initial tru-cut biopsies in both cases revealed spindle cell neoplasms. One of them was of low grade malignancy and showed positivity for of Vimentin. Few cells showed positivity for keratin and were negative for S-100 protein, CD 34, CD 68, EMA, SMA, HMB-45. A possible diagnosis of low grade fibrohistiocytic tumor was made. He underwent Lt total maxillectomy. Three years later he presented back with regional nodal metastasis. The regional lymph nodes showed features of follicular dendritic cell sarcoma. The second case revealed high grade spindle cell neoplasm and showed positivity for vimentin and S100 protein and was negative for EMA, keratin, CD-34, desmin, muscle actin and HMB-45. He was offered initial radio-therapy followed by hemifacial resection. The histology along with immuno histochemistry favoured a diagnosis of follicular dendritic cell sarcoma. He presented with local recurrence two months later. Both the cases are discussed in detail.

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Ectopic pregnancy after total abdominal hysterectomy is rare and, for this reason, delay in diagnosis may occur when such patient present with abdominal pain.

[ABSTRACT]   Full text not available    [CITATIONS]  [PubMed]

A case of massive ovarian edema and polycystic ovaries in a 15 years old girl is being reported for its rarity. Definitive preoperative diagnosis is often not achieved and there by the patient is at a risk of losing the ovary(ies). Thus a definitive preoperative diagnosis should be ascertained to save the organ. A review on the previously reported cases with probable etiopathogenesis and emphasis on the radiological and morphological diagnosis for appropriate management has been discussed.

[ABSTRACT]   Full text not available    [CITATIONS]  [PubMed]

Placental site trophoblastic tumour (PSTT) is a rare form of trophoblastic disease accounting for < 2% of all gestational trophoblastic neoplasms. Most of the cases follow a normal pregnancy and a small number have a preceeding molar pregnancy or spontaneous abortion. It can occur as early as several weeks or as late as 15 years after normal delivery, molar pregnancy or abortion. Excessive intermediate trophoblastic activity is the most important diagnostic criterion of this tumour originating from non villous trophoblast. But the possibility of a PSTT should be considered when there is excessive intermediate trophoblastic activity despite the presence of chorionic villi as in the present case. This case report highlights the unusual features like rarity of the tumour (< 2%), occurrence following spontaneous abortion which happens only in a minority of cases, and presence of chorionic villi in the tumour despite the fact that the tumour is of non villous trophoblastic origin.

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Myofibroblastoma of the breast is a very rare benign neoplasm usually seen in elderly male and is of very small size. A 40 year old nulliparous woman was admitted with chief complain of massive enlargement of left breast. The case was clinically diagnosed as Phyllodes tumor Left mastectomy was done. The tumor was histopathologically and immunohistochemically diagnosed as Myofibroblastoma. The case is reported because of its rarity and very rare clinical presentation.

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Cervical thymic cysts are rare benign lesions. It should be considered in the differential diagnosis of cervical cysts in paediatric age group. This paper presents a case of a 6 years male child who presented with gradually increasing painless mass on right side of neck. Surgical excision was done. Histopathological study revealed features diagnostic of thymic cyst. It was clinically diagnosed as branchial cleft cyst. Though rare, thymic cysts should be included in the differential diagnosis of neck masses, especially in children.

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OBJECTIVE: To report an interesting case of meningitis caused by Listeria monocytogenes meningitis in an HIV seropositive individual. MATERIALS & METHODS: A previously healthy 45 years old HIV seropositive man, presented with atypical clinical features of meningitis. Blood and Cerebrospinal fluid (CSF) were obtained for biochemical and microbiological investigations. RESULTS: CSF analysis showed pleocytosis with lymphocytic predominance. Gram stain of CSF was negative; however culture yielded growth of gram positive bacilli with tumbling motility. Based on relevant biochemical tests the isolate was identified as Listeria monocytogenes. Patient was treated with i.v. ampicillin and recovered completely. CONCLUSION: Listeriosis is relatively rare in HIV/AIDS among the immunodeficient populations. Atypical clinical and laboratory findings make the diagnosis difficult and these infections may go undiagnosed. Since it is easily treated with readily available antibiotics, it is important to diagnose them at the earliest and thereby prevent treatment failure.

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Lymphangioma is a benign tumor like condition which is a developmental anomaly, involving any site but rarely involves retroperitoneum and abdomen (< 5%). Intraabdominal lymphangiomatosis is an even rarer entity that too occurring in a siamese twins. No such reports have been found in literature, although other congenital anomalies do coexist in Siamese twins and have been reported such as biliary tract and respiratory tract anomalies.

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Primary broad ligament carcinomas unassociated with either uterine or ovarian disease are extremely rare. This case report deals with such a rare occurrence of primary broad ligament carcinoma of the serous papillary type with foci of transitional differentiation in a 40 yr old woman with a clinical diagnosis of multiple fibroids of uterus. The highlight of this case is that besides being a rare tumor occurring in an unusual site such as the broad ligament the papillary serous carcinoma reported here also has a unique feature of transitional cell differentiation.

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Mucoepidermoid lung tumours are uncommon neoplasms comprising of 0.2% of all the lung tumours and historically included under the term bronchial adenomas. This is a case report of a bronchial tumour in the hilar region present since 3 years. The neoplasm could be easily classified as a mucoepidermoid tumour of low malignant potential, as it resembled the histologically identical lesion in the main salivary glands. The case is reported for its rarity and for the histological evaluation of the malignant potential in an apparently clinically benign neoplasm.

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Epithelioid sarcomas (ES) are rare tumors of soft tissue that have a propensity to occur in the extremities. Epithelioid sarcomas are known to metastatise to draining lymph nodes and commonly to the lungs. Herein, a case of epithelioid sarcoma which recurred in an unusual site namely the distal phalanx of left middle finger, six months post amputation of the primary lesion in the left foot is being reported. The ipsilateral inguinal lymph node showed metastatic deposits. The tumor at both these sites had similar histology and an identical immunohistochemical (IHC) pattern showing reactivity to cytokeratin (CK), epithelial membrane antigen (EMA), vimentin (Vim) and CD34. This case is presented to record an unusual occurrence of ES in the distal phalanx of middle finger with an ES of foot. The metastasis of ES to the distal acral bones has not been documented till date.

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Adamantinoma of the long bones are uncommon, slow growing tumors with a predilection for the tibia. A special rare variant known as the osteofibrous dysplasia-like adamantinoma or differentiated adamantinoma is thought to be a precursor of the classic adamantinoma. We report a case in a 24 year old female who presented with pain and lytic lesion of the left tibia. Microscopy showed a tumor composed predominantly of osteofibrous dysplasia-like areas with focal cytokeratin positive epithelial islands. This case is highlighted because of its rarity, its association with good prognosis and possible misdiagnosis as osteofibrous dysplasia.

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Malignant nodular hidradenomas are rare variants of sweat gland carcinomas characterized by aggressive clinical behaviour. We report a case of 42-year-old female with 3 x 2 x 1 cm nodule on her foot followed by cutaneous and regional lymph node metastasis. Flow cytometry showed S-phase fraction of 72.6% and 15.8% of aneuploid cells corroborating with its aggressive nature.

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Immunofluorescence (IF) studies are important diagnostic tool in understanding pathogenesis involved in graft injury. Acute humoral rejection (AHR) associated with circulating donor-specific cytotoxic antibodies, is a poor prognosticator for graft survival. It can be diagnosed by staining for C4d antibody using indirect IF technique. C4d staining required to diagnose AHR was made mandatory for reporting renal allograft biopsies in 7th Banff conference. We present 2 years experience of IF studies using C4d polyclonal antibody on 546 renal allograft biopsies belonging to two groups of patients; 464 from group A (tolerance induction protocol) and 82 from group B (controls). We observed C4d focal positivity in 4 (0.9%) biopsies from group A and 4 (4.9%) from group B. We conclude that it is advisable to collect simultaneous core biopsy samples for IF studies and light microscopy to give better definition of allograft injury and thereby support in clinical management.

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Solitary fibrous tumour (SFT) is a rare spindle cell neoplasm arising at pleural and extrapleural sites. Five cases of SFT diagnosed at our institution over a five year period were reviewed. Haematoxylin and eosin stained histological sections, immuno-histochemical markers including CD34 and electron microscopy were the different methods used to study these tumours. Three histological features were consistently observed in all the tumours: the tumours were composed of short spindle cells separated by dense collagen bands and arranged in alternate hypocellular and hypercellular areas. CD34 positivity was seen in all the cases. SFT's have been reported to behave in an unpredictable fashion and hence prolonged follow up is essential. Histology, CD34 positivity and electron microscopy are useful tools in diagnosing SFT. While the pleural tumours can be diagnosed based on histology, this must be substantiated by ancillary techniques in case of extrapleural tumours.

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A 61 year old man presented with an inguinal hernia with no other significant symptoms. Histopathological examination of the hernial sac revealed metastatic deposits of a mucin secreting adenocarcinoma which was confirmed by subsequent tumor marker levels. Patient was put on chemotherapy for disseminated adenocarcinoma and is tolerating it well. This case emphasizes the need to carefully examine all hernial sacs received for pathological examination.

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A case of glomus tumor of lesser omentum occurring in a 24 years old male is being reported for its rarity.

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Primary orbital lymphoma is an extremely rare entity; most of the reported cases being MALT lymphoma. Herein we report a case of extranodal primary diffuse large B cell lymphoma in a 17 years old boy who presented with proptosis. The patient responded well to chemotherapy; presently he is in remission with no residual disease.

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Calcifying fibrous pseudotumors of the testicular and paratesticular soft tissue are relatively rare. We would like to report the first documented case of calcifying fibrous pseudotumor of the tunica vaginalis in Indian medical literature. This is a case of a 55 year old male who presented with a painless scrotal mass of 10 years duration. Histological sections showed dense hyalinised bands of collagen with focal collections of plasma cells and lymphocytes. Multiple round to oval concentrically laminated psammomatous bodies were seen.

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Congenital amegakaryocytic thrombocytopenia (CAMT) is an uncommon cause of thrombocytopenia in children. Mutations in the thrombopoietin (Tpo) receptor gene C-mpl were found to be the likely cause of thrombocytopenia and complete marrow failure. Two types are identified: CAMT with or without congenital anomalies. We report a case of the latter type for its extreme rarity.

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Impaired lobulation of neutrophils together with exaggerated clumping of chromatin, characteristic of Pelger-Huet anomaly was seen as an incidentalfinding in a 43-year old man who presented with depression. Peripheral blood and bone marrow findings and cytochemistry of the abnormal cells are described and the disease entity discussed.

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A total of 709 isolates of Citrobacter species were recovered from different clinical specimens at Kasturba Medical College, Mangalore. The antimicrobial susceptibility testing of the isolates was performed using Kirby-Bauer's method of disk diffusion. All the isolates were susceptible to Imipenem (100%) and 100% resistance to Ampicillin was recorded. Susceptibility to third generation cephalosporins varied between 29 - 43%. The beta-lactamase inhibitor combination used along with beta-lactam antibiotics increased their sensitivity. The minimum inhibitory concentration (MIC) of cephotaxime to Citrobacter species was determined by agar dilution method (MIC value = or < 8 microg/ml are considered susceptible). Two hundred and fifty three strains were found to be completely susceptible, 71 strains showed intermediate susceptibility and 385 strains were completely resistant to Cephotaxime.

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A rare species i.e. A. nidulans is reported as a causative agent of allergic fungal rhinosinusitis in this study. It is an increasingly recognized type of chronic recurring hypertrophic sinus disease. There are more than 185 species of aspergillus and over 95% of all infections are caused by A. fumigatus, A. flavus and A. niger. A. fumigatus alone accounts for the large majority of cases of both invasive and non invasive aspergillosis. A young immunocompetent lady presented with bilateral nasal obstruction due to multiple polypoid mass at Sheth Vadilal Sarabhai General Hospital, Ahmedabad. Provisional diagnosis of sinonasal polyposis possibly due to fungal cause with infiltration in to nasal cavity was made. Bilateral functional endoscopic sinus surgery with polypectomy was done. The specimen was examined by standard methods and the fungus was identified as A. nidulans by slide culture.

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Translocation (8;21) is associated with few typical morphological features and favorable prognosis. All patients of AML and MDS with increased blasts (N = 35) according to FAB criteria, presenting (between Jan 2004 to June 2005) to the Department of Hematology, AIIMS were studied. RT-PCR was done for the AML1-ETO fusion transcript in all cases. Overall incidence of AML1-ETO was 28.57% and no correlation was found between AML1-ETO positivity and clinical or hematological parameters except for a direct correlation with absolute blast count (ABC) (a lower ABC in the AML1-ETO positive cases). Interestingly, 1/3 MDS cases were positive for the same fusion transcript and thus, it appears worthwhile to look for AML1-ETO in all cases of MDS with increased blasts. Objective morphological evaluation using a scoring system based on morphological features was not helpful in predicting positivity for AML1-ETO. The effect of this translocation on long-term survival could not be determined by the present study.

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