Mixed adenoneuroendocrine tumour with squamous differentiation: a case report

Mixed adenoneuroendocrine carcinoma is a rare neoplasm with both epithelial and neuroendocrine components. To date, only a few cases of this neoplasm have been reported in the literature among which gastric mixed adenoneuroendocrine carcinoma is very rare. We are reporting a case of gastric mixed adenoneuroendocrine carcinoma with squamous cell differentiation. Histopathological features, biological behaviour and the treatment of this rare tumour type have been discussed briefly.

A study of hematological parameters in patients with COVID-19 infection at a tertiary care centre

Background: The corona virus disease 2019 is caused by the virus SARS-CoV-2 and is declared as a global pandemic by World Health Organization. Alterations in various hematological parameters have been recently documented in the world literature in SARS-Cov-2 infection. However, still there is paucity of hematological data in these patients. Hence this study is an attempt to evaluate the pattern of the hematological parameters in COVID-19 patients in the Indian population in our region. The objective of the study is to see the pattern of alteration in hematological parameters with emphasis on total leukocyte count, absolute lymphocyte count and platelet count in COVID 19 positive patients.Materials and Methods: This is an observational study in 50 patients with laboratory-confirmed COVID-19 status admitted to G.K. General Hospital & Gujarat Adani Institute of Medical Sciences, Bhuj, from 1st April 2020 to 30th June 2020. Statistical analysis of the data was carried out, and relevant findings were presented.Results: Among the 50 patients, there were 35 (70%) males and 15 (30%) females with an age range from 6 months to 82 years with twenty-five patients above 50 years. There was lymphopenia in 18 patients (36%), leukopenia in 2 patients (4%) and thrombocytopenia in 8 (16%) patients.Conclusions: Majority of the patients were elderly, and there was a male predominance. There was moderate to severe lymphopenia and mild thrombocytopenia.

Neuronal hyperplasia in clinically diagnosed acute appendicitis: A histopathological study in tertiary care centre

Background: Acute appendicitis is one of the most common general surgical emergencies. Around 20-25% of patients who have an appendectomy done are found not to have acute appendicitis on histopathological examination. There is increasing evidence of the involvement of the enteric nervous system, in the immune regulation and monitoring the inflammatory responses. The present study was done to elucidate if neuronal changes in the appendix could be the cause of clinical acute.Materials and methods: Hospital records of 60 cases who were diagnosed as acute appendicitis clinically and who underwent appendectomy either laparoscopic or open, were reviewed. Histopathological records of these resected appendices submitted to the department of histopathology, GAIMS, G.K. General Hospital Bhuj were reviewed for one year for the presence or absence of acute appendicitis or neuronal hyperplasia. Routine Haematoxylin and Eosin stain and S-100 protein staining was done on all these 60 cases.Results: Out of these 60 specimens of appendices received, histopathological examination revealed neuronal hyperplasia in the submucosa and muscularis layer on all the 60 cases. Grading of neuronal hyperplasia was done in all the cases. Out of these 60 specimens of appendices, histopathological examination revealed 48 cases of histopathologically positive acute appendicitis and 12 cases of histopathologically negative acute appendicitis.Conclusions: Neuronal hyperplasia has an important role in the pathogenesis of appendiceal colic in patients with both histopathologically positive acute appendicitis and histopathologically negative acute appendicitis

Isocitrate dehydrogenase 1and 2 gene mutation status– a critical parameter in the diagnosis and prognosis of adult gliomas

Isocitrate dehydrogenase 1 and 2 mutations are known to be early events in gliomagenesis and have a definite role in tumor progression.Isocitrate dehydrogenase1/2 mutation status is considered to be one of the most powerful independent positive predictor of outcome amongst all molecular markers described in association with gliomas. The inclusion of this parameter in the 2016 update of the World Health Organization Classification of Tumors of The Central Nervous System reinforced its importance in glioma classification and prognostication. As a result, now there is enough evidence to prove that Isocitrate dehydrogenase-mutant and Isocitrate dehydrogenase- wildtypegliomas are two biologically distinct categories of gliomas with likely different pathways of tumorigenesis, different clinical outcomes, and respond differently to similar treatment strategies. Increasing knowledge aboutthe role of IDH1/2 mutation in gliomagenesis has resulted in many novel targeting strategies being developed and evaluated forusefulness in the clinical setting. This literature review aims to highlight the diagnostic and prognostic importance of Isocitrate dehydrogenase1/2 gene mutations in adult gliomas.

Blood glucose concentration measured in EDTA/F plasma and serum in a referral clinical laboratory in Nepal

Background: Sodium fluoride tubes or serum separator tubes are mostly used for blood glucose estimation in the clinical laboratories of Nepal. The study aimed to investigate the stability of glucose in samples collected in serum separator tubes and sodium fluoride/sodium ethylenediaminetetraacetic tubes by comparing the glucose concentration at 30 minutes and 4 hours collected and handled differently to simulate prolonged sample transport between venipunctures, centrifugation, and measurement.Materials and Methods: Samples were collected from healthy volunteers into two different serum separator tubes and two different sodium fluoride/sodium ethylenediaminetetraacetic tubes. Glucose concentration was measured at 30 minutes after venipuncture and compared with results from the same samples analyzed at four hours and with the results from tubes centrifuged with a delay of 4 hours. Differences between baseline and respective delayed analyzed glucose values for each tube type were tested using the Student’s paired t-test and Deming regression.Results: When comparing plasma glucose at 30 minutes, glycolysis caused a relative reduction of the glucose concentration in serum at 30 minutes of 3.1 %, which is only slightly less than at 4 hours (3.7 %). This is still substantially more than the reduction in plasma at 4 hours (1.3 %). Surprisingly, the difference between plasma glucose at 30 minutes and serum glucose at 4 hours was only 1.9% which is not clinically significant.Conclusions: The Na-F/Na2 EDTA tubes and serum separator tubes can be used interchangeably for analysis of blood glucose up to 4 hours if centrifuged within 30 minutes.

Histopathological spectrum of salivary gland lesions in rural India

Background: Salivary gland lesions are of a wide spectrum and affect all the major and minor salivary glands in varying proportions. This study, performed in a rural medical college in Maharashtra, India is intended to see the histopathologic spectrum of salivary gland lesions in the rural population and how it is related to the data from other parts of the country and of the world. Materials and Methods: This is a retrospective study done in the Department of Pathology of a rural-based medical college, Indian Institute of Medical Science and Research, Warudi, Maharashtra, India for a period of 6 years, from January 2014 to January 2020. Age, sex, location of the lesion, gross and microscopic findings were noted.Results: A total of 71 lesions were received in the department of pathology during this period. Samples were received from age 11 years to 75 years. Female preponderance with a male: female ratio of 1:1.15 was seen. 57.7% (n=41) were benign, 15.5% (n=11) were malignant and the rest (n=19) were inflammatory in nature. A maximum number of lesions (50.7%) were detected in the Parotid gland. The most common lesion seen was Pleomorphic adenoma (36.62%, n=26) and the most common malignant lesion was Mucoepidermoid carcinoma.Conclusions: Present study showed benign and non-neoplastic lesions outnumbering the malignant lesions, with female predominance, and a low mean age for malignant lesions of 38.2years. Comparison with other studies within and outside India showed a similar pattern of distribution of salivary gland lesions in the rural population.

Study of histomorphological spectrum of eyelid lesions

Background: Eyelid pathologies are the most common surgical specimens encountered among all of the ophthalmic lesions and constitute a wide range of diseases by their unique histologic features. This study aims to find out the histopathological spectrum of eyelid lesions, their demographic distribution, and preferential location prevalent in our community.Materials and Methods: This is an observational study in which we retrospectively evaluated the data of 692 patients retrieved from the histopathology department of National Reference Laboratory, Kathmandu, from May 2016 to April 2019.Results: A total of 701 histologic diagnoses comprised of benign, precursor, and malignant lesions and accounted for 86.6%, 2.6%, and 10.8% respectively with preponderance in females. The common benign lesions included melanocytic nevus (17.7%), epidermal cyst (11%), hemangioma (8.9%), dermoid cyst (8.2%), chalazion (6.7%), and squamous papilloma (6.4%). Tumour of epidermal origin was the most common neoplastic lesion accounting for 31.2%. Basal cell carcinoma (50%) followed by sebaceous carcinoma (27.6%) and squamous cell carcinoma (14.5%) constituted the majority of malignant lesions prevalent above the age of 60 years with the preferential site of the upper eyelid for basal cell carcinoma and squamous cell carcinoma; and lower eyelid for sebaceous carcinoma.Conclusions: Benign eyelid lesions are more prevalent than malignant ones with overall female preponderance. Epidermal tumours are common among neoplasms. A malignant tumour, a disease of an elderly individual, is predominated by basal cell carcinoma followed by sebaceous carcinoma, an aggressive tumour with a high recurrence rate in our population.

Identification of types and frequency of pre-analytical errors in hematology laboratory at a tertiary hospital of Nepal

Background: In the laboratory, errors can occur at any stage of sample processing; pre-analytical, analytical, and post-analytical. Since the pre-analytical phase is the most common source of laboratory errors, the goal of this study is to identify the types and frequency of pre-analytical errors in the hematology laboratory.Materials and Methods: This is a cross-sectional descriptive study done at Nepal Medical College Teaching hospital for a duration of nine months (January 2020 to September 2020). All blood samples received at the hematology laboratory were included whereas biochemistry and special tests blood samples were excluded. Samples were checked for misidentification (incorrectly labeled vials/vials without labels/incorrectly filled forms), incorrect samples (wrong choice of vials), clotted samples, inadequate samples, diluted samples, hemolyzed samples. The errors that occurred in these samples (both inpatient and outpatient) were noted down and measures were taken accordingly before analyzing the sample.Results: The total number of samples received was 15,337. Pre-analytical errors were seen in 857 samples (5.5%). Inadequate samples (25%) were the most common error followed by incorrect samples (20%), hemolyzed samples (20%), misidentification (14%), clotted samples (12%), and diluted samples (9%). Complete blood count test was most affected. Samples from the inpatient department were most affected.Conclusions: The preanalytical error rate in the hematology unit was 5.5% with an inadequate sample being the commonest error. Most of the errors were seen in the test requested for a complete blood count. Samples from the inpatient department showed the most errors.

Clinicopathological study of lepromatous leprosy and histoid leprosy in a tertiary care institute

Background: Lepromatous leprosy is a clinical course seen in patients with inefficient cellular immunity against Mycobacterium leprae, resulting in anergy. A highly bacilliferrous type of lepromatous leprosy is histoid leprosy. Histoid leprosy was initially reported to manifest after the failure of long-term dapsone monotherapy, irregular therapy, or inadequate therapy. However, it is now well known that histoid leprosy develops de-novo as well. This study was undertaken to know the incidence and clinicopathological characteristics of lepromatous leprosy and histoid leprosy.Materials and Methods: This was a combined (both retrospective and prospective) study of lepromatous and histoid Leprosy, undertaken in the Department of Pathology, Karnataka Institute of Medical Sciences, Hubballi, over 42 months from January 2013 to June 2016.Results: Out of the 16 clinically diagnosed lepromatous leprosy cases, only 5 were histologically proven to be the same. Of the seven clinically diagnosed histoid leprosy cases, 4 were histoid leprosy on histopathology and the remaining 3 were lepromatous leprosy. All 4 patients of histoid leprosy were cases of De- Novo histoid leprosy. The commonest skin lesion encountered were erythematous patches (9/16) in lepromatous leprosy and nodules (5/7) in histoid leprosy.Conclusions: Lepromatous leprosy when diagnosed in an early stage, interrupts the epidemiological chain and avoids the associated disabilities and psychological effects for the patient and family. Histoid leprosy is a rare entity that can also present with no history of prior anti-leprosy treatment, the diagnosis of “de-novo histoid leprosy” should be kept in mind.

Hemogram components and platelets count variation in anemic patients attending Birat Medical College and Teaching Hospital, Morang, Nepal

Background: Anemia being the expression of the underlying disease is a global public health problemaffecting both developing as well as developed countries. The RBC indices and platelet count variationamong anemic patients are important to know their association for clinical implications.Materials and Methods: A hospital-based cross-sectional study among anemic patients with hemoglobin<10 gm%, attending Birat Medical College Teaching Hospital, Nepal from 15 May to 15 July 2020 wereanalyzed for RBC indices and platelet count variation. Demographic data, RBC indices, platelet countvariation, and types of anemia were evaluated. Pearson’s correlation coefficient was used for correlatingthe platelet count with RBC indices. A Chi-square test was used to know about the association betweenthe types of anemia and platelet count variation.Results: Out of 150 anemic patients, the female to male ratio was 1.5:1, with the most common agegroup between 40-49 years. There exist high differences between minimum and maximum individualRBC indices (Hb, MCV, MCH, MCH) and platelet count values. The platelet count variation with RBCvalues and MCV had a statistically significant positive and negative correlation respectively. However,the correlation between platelet count variation with hemoglobin concentration level and type of anemiawas positive but statistically not significant.Conclusion: Findings suggest that platelet count variation with RBC indices and types of anemiacorrelated well among anemic patients. Such association will enable the clinicians for diagnosing andtreatment purposes.