D Dimer – Prognostic indicator for disease severity in patients hospitalised with COVID 19

Patients of Covid 19 infections present with different severity. Levels of D Dimer in these patients can be correlated with disease severity for management and prognosis. To evaluate the usefulness of D-Dimer levels in blood to correlate with disease severity in COVID 19 patients. Retrospective study was done in Department of Pathology of Secondary Care hospital that became designated covid hospital from May 2021 to June 2021 on 60 COVID 19 positive admitted patients. D dimer levels were analysed and correlated with clinical severity of disease. Out of total 60 patients, 33 were in mild, 23 in moderate and 4 were in severe category. In mild cases D Dimer varies from 43 ng/ml to 183 ng/ml. In moderate cases D Dimer varies from 270 ng/ml to 991 ng/ml. In severe cases D Dimer varies from 1043 ng/ml to 2463 ng/ml. The study suggests cut off levels for D Dimer as up to 200 ng/ml for mild, 200-1000 ng/ml for moderate and more than 1000 ng/ml for severe category in COVID 19 patients. D dimer helps in identifying severe disease and can be used as an essential biomarker in developing the management protocol for COVID 19 patients.

Histopathologic pattern of ovarian masses in Usmanu Danfodiyo university teaching hospital, Sokoto, Nigeria

Diseases of the ovary are diversely arising from the different parenchymal tissue components. This span between reactive functional cysts to more debilitating ovarian carcinoma. Ovarian carcinoma is the sixth most common cancer and one of the leading cause of cancer death among female. This study aims to determine the epidemiological and histopathological patterns of ovarian masses in our setting.The study material was all the ovarian tissues biopsy specimen submitted to the Department of Histopathology, Usmanu Danfodiyo University Teaching Hospital, Sokoto over five years. These were fixed in 10% formal saline embedded in paraffin wax, tissue blocks formed and were sections and stained with hematoxylin and eosin on the glass slides. Request cards and case folders were used to extract clinical information. These were reviewed, analysed and presented as frequency distribution figures.There were 112 ovarian biopsies during the study period. Their ages ranged between 13 and 67 years and peaked in the fourth decade of life. Fifty per cent of all the cases were seen between the ages of 21 and 40 years. Benign neoplastic diseases formed 50% of the ovarian masses and matured cystic teratoma was the most common. Others were reactive and functional ovarian cysts (24.1%), malignant neoplastic conditions (14.3%) and inflammatory / infectious diseases (11.6%). Overall mature cystic teratoma constitutes 27% of the entire ovarian masses. Matured cystic teratoma was the most common disease of the ovary in our setting, afflicting young female, while malignant tumours dominated by serous cystadenocarcinoma affect the older age group. The fourth decade of life was the most common age of affectation. We advocate for proper histopathologic evaluation of all ovarian masses to arrive at a definitive diagnosis to offer an appropriate treatment modality.

Eosinophilic endometrial metaplasia - case report and brief literature review on its immunohistochemical characteristics

Endometrial epithelial metaplasia is described as transition of the normal endometrial epithelial cells by benign complex proliferation of cells. These metaplastic changes have been frequently reported as associated changes in endometrial hyperplasia and adenocarcinoma more than non-neoplastic samples and are also known to appear atypical occasionally, and hence can be a diagnostic challenge. Eosinophilic cell change is one of the most frequently encountered endometrial metaplasias. Eosinophilic syncytial change is a form of eosinophilic endometrial metaplasia, and is known to mimic endometrial serous carcinoma, again posing a diagnostic challenge. In this article, we have presented a case of endometrial eosinophilic metaplasia in a 47-year-old patient along with a brief discussion on immunohistochemical characteristics of eosinophilic syncytial change that could help pathologists to differentiate them from malignancies in challenging scenarios.

Pleomorphic lipoma: A rare entity

Pleomorphic lipoma is a rare neoplasm that is considered as a variant of spindle cell lipoma. It predominantly occurs in the dermis or subcutis of the posterior neck, upper back, and shoulders. Pleomorphic lipoma may clinically present as a slow-growing and well-circumscribed subcutaneous mass. Though it is a benign tumour it may contain atypical cells for which it may mimick sarcoma or other malignant soft tissue tumours. So histopathological diagnosis is vital for preventing unnecessary surgery. Here we report a case of a pleomorphic lipoma on upper back in a 55yr old patient.

Update: Primary immunodeficiency disorders among north Indian children

Primary immunodeficiency disorders (PIDs) are a group of genetic abnormalities characterized by defectin one or more constituents of the immune system.This group of disorders are largely undiagnosed and unreported worldwide due to lack of awareness among the medical practitioners,parents as well as lack of state of art diagnostic facilities. Earlier we had reported the distribution pattern of various categories of PID in children of north India; in this report we are appending the data with current findings.In this retrospective study we pooled data from PIDs workup of 706 children with suspected PIDs, below the age of 18Yrs, in the period of May 2017 October 2019. The clinical assessment and presentation of these children was suggestive of PID. The peripheral blood of these children was used for flow cytometry based immunophenotyping of immune cells. PIDs were classified according to the International Union of Immunological Societies’ (IUIS) criteria.A total of 133 (18.38%) children were diagnosed with one or other form of PID with overall median age was 3.25 years (male: 2.3 and female: 4.2Yrs). Chronic infection, persistent diarrhea and retarded growth were the common warning signsin these patients. Combined humoral and cellular immunodeficiency was observed in 32%, phagocytic defect in 23%, antibody defect in 17%, dysregulated innate immunity in 19% and other well defined syndromes in 9% of total diagnosed PID children. Around 15.78% of PID cases were seen in coupleswithconsanguineous marriage, past family history of PID in 20.30% and families with sibling death of unknown cause in 24.06%. The cause of death of the sibling was not known. PID diagnosed children received prophylactic antibiotics and/or antifungals in addition tospecific therapy for the underlying immune deficiency.The field of PID remainsunexplored worldwide. The awareness in the developed countries is more than that of developing countries like India. The developing countries face several challenges in the diagnosis of PIDs such as awareness among patients and medical practitioners, mostly in the rural settings, lack of sufficient number of tertiary care centres, lack of equipped immunological laboratory to diagnose the disease.

Histochemical Localization of Bio-macromolecules in Cestode (Raillietina sp.) infected country fowls (Gallus domesticus) in India

In Indian GDP, veterinary sector plays a major role in contribution wherein poultry meat plays good protein source. But the health status is less studied in case of country fowl.Indian country fowl are highly infected with producing emaciation, reduced growth rate, highly morbidity with enteritis.After confirmation by gross and microscopy, samples undergone histopathology study using Haematoxylin and Eosin stain (H&E). Thereafter, the samples also processed for detection of carbohydrate by McManus method using PAS stain and mucoprotein was detected using congo red method.Adult possesses carbohydrate, protein and fat. Histologically the mature, immature and gravid segments were differentiated whereas the histochemical techniques qualifies the biomacromolecules. The lipid droplet showed a clear vacuole preferably in and around the periphery portion. The glycogen distributed in an even manner. Subsequently, the protein was deposited mostly at the periphery in the body surfaces as well as in the egg.

Serous borderline tumour of the peritoneum- A rare entity

Serous borderline tumor is a rare entity of peritoneum which can lead to diagnostic dilemma due to its resemblance with reactive lesions of peritoneum and ovarian borderline and malignant neoplasms. Complete clinical details, histopathological evaluation and immunohistochemistry aid in arriving at correct diagnosis. Recognizing this entity is important as it carries good prognosis.

Retroperitoneal teratoma with malignant somatic transformation: Tumor within a tumor

Extra-gonadal teratomas are rare and occur at various sites with the retroperitoneum being an unusual site. We report a case of an adenocarcinoma arising in a mature retroperitoneal teratoma with bilateral lung metastasis in a young female. Around less than 20 such cases have been reported in literature with the present case being probably second in the Indian scenario and the first to have adenocarcinomatous component matastasize to lungs. We hereby emphasize on the importance of looking for such suspicious areas in a teratoma in order to tailor subsequent management.

Ki67 and P53 expression in breast cancer and their correlation with clinicopathological parameters

Breast carcinoma is the most common malignancy in females and is a leading cause of death. Treatment depends upon various pathological and prognostic markers like lymph node status, size, type and grade of the tumour which influences the outcome of breast cancer. Markers like Ki-67 and p53 have been studied extensively and their roles in breast cancer are yet to be established.We evaluated the expression of Ki67 and P53 in breast cancer and their association with other clinico-pathological factors was studied. Ki67 and P53 expression was assessed in 60 breast cancer cases admitted to our hospital over a period of one year. Association with other prognostic parameters was evaluated. Statistical analysis was done by Chi square test and a p value of <0.05 was taken as significant. 43.33% cases had low proliferative Ki-67 score whereas 56.67% of the cases were highly proliferative. p53 expression was seen in 41.66% cases. Ki-67 and p53 expression were not significantly related to age, menopausal status, and tumour size whereas a significant correlation was seen with positive axillary lymph node status, high histological grade, negative hormone receptor status (ER, PR) and positive HER2/neu expression. Significant association was seen between Ki-67 and p53 expression.Ki67 and P53 may be considered as a valuable biomarker in breast cancer patients which can help in planning treatment strategies.

Cystic lymphangioma over the sternum: An extremely rare and atypical localization

Cystic lymphangioma is a benign lymphatic system malformation that occurs usually in children. Most common site being cervicofacial region followed by axilla; the cases in the chest wall are very rare. We report a case of male infant with cystic lymphangioma occurring at an unusual site- over the sternum.