Assessment of Utility of Fine Needle Aspiration Cytology in Patients of Peripheral Lymphadenopathy- Experience of A Tertiary Care Hospital

Background: Fine needle aspiration cytology (FNAC) is a quick, sensitive, safe, reliable and cost-effective outdoor procedure that has a lower risk of complications as compared to a surgical biopsy. This study was conducted to analyse the various cytomorphological patterns establishing the diagnosis on FNAC in peripheral lymphadenopathy patients along with their clinical presentation.Methods: This study included 300 patients of peripheral lymphadenopathy in a tertiary care hospital of north-central Haryana. FNAC was done under all aseptic conditions and various cytomorphological patterns were analysed.Result: On stratification of lymph node lesions, 240/300 cases (80%) were reported as non-neoplastic and 60/300 cases (20%) as neoplastic lesions. Among the non-neoplastic lesions, granulomatous pathology was the commonest lesion encountered in 137/240 cases (57.1%), followed by reactive lymphoid hyperplasia and suppurative lymphadenitis. Metastatic involvement of lymph node was the commonest pathological finding diagnosed in 52/60 of malignant neoplastic cases (86.66%). Overall, the cervical lymph nodes were most commonly involved in 68.66% patients, followed by other lymph nodes.Conclusion: Lymphadenopathy can have varied etiologies ranging from non-neoplastic to neoplastic conditions. FNAC as a first line investigative procedure in lymphadenopathy patients obviates the need for surgical excision and guides subsequent patient therapy and management. The cervical group of lymph nodes are most commonly involved in both non neoplastic as well as neoplastic lymph node lesions. In younger age group (<30 years) non neoplastic causes of lymphadenopathy are more common whereas in elderly the malignant neoplastic causes are more common. The secondary metastatic carcinoma is more common than primary lymphoma of the lymph nodes.

Histopathological Study of Epithelial, Melanocytic And Adnexal Tumors Of Skin- A Retrospective Study In A Tertiary Care Centre

Background and objectives: To classify and identify various skin tumors and study their variations according to age and sex. The most common predisposing factors being fair skin, sun exposure, chemical exposure, HPV infection in the setting of immunosuppression. Methods: This was an observational study carried out in the Department of Pathology at private Medical College of coastal Andhra from July 2018 to June 2020. Result: The present study included histopathological study of 71 cases of tumors of skin and its adnexae over a period of two years. Out of the 71 tumors, 43 were diagnosed as benign and 28 as malignant tumors of skin constituting 61% and 39% respectively. The ratio of benign to malignant tumors was 1:0.63. Among the 43 benign tumors 20 (46.5%) were tumors of skin appendages, 15 (34.9%) were tumors of epidermis, 8 (18.6%) were of melanocytic origin. Among the 28 malignant tumors 25 (89.3%) were tumors of epidermis, 2 (7.1%) were melanocytic tumors and 1 (3.6%) was tumor of skin appendages. Among the malignant epidermal tumors squamous cell carcinoma was the most common constituting 42.9% (12 cases). Conclusion: The present study concludes that benign tumors are most common when compared to malignant tumors of skin. Among the malignant tumors, Squamous cell carcinoma falls as the most common variety of skin followed by Basal cell carcinoma and verrucous carcinoma. Among the benign tumors, tumors of epidermal origin are most frequent followed by tumors of sweat gland and adnexal-hair follicle origin.

Application of IAC Yokohama System For Reporting Breast Fine Needle Aspiration- A Retrospective Study

Background: Breast cancer is one of the most common cancers worldwide in females and is an important cause of mortality and morbidity. FNAC is a safe, reliable, sensitive, specific, time saving and cost effective procedure useful in the diagnosis of carcinoma breast. It helps the surgeon in planning the treatment, and thereby reducing the delay in treatment. The primary aim of this study is to find out the spectrum of breast lesions on fine needle aspiration cytology based on IAC Yokohama system in a tertiary care hospital of north central Haryana.Methods: This is a retrospective study carried out in a tertiary care hospital of north-central Haryana and included 417 patients of palpable breast lumps presented in the Department of Pathology for FNAC during January 2018 to December 2019. FNAC was done under all aseptic conditions and various cytomorphological patterns were analysed according to the IAC Yokohama system for reporting breast fine needle aspirations.Result: Of the 417 cases included in the study, 328 cases were benign, 04 were atypical probably benign, 04 were suspicious for malignancy, 64 cases were malignant and 17 cases were inadequate for opinion. Fibroadenoma was found to be the most common breast lesion. Overall benign breast lesions are much more common than malignant lesions. Conclusion: FNAC is a useful tool to diagnose malignant lesions of the breast and help the surgeon in differentiating benign and malignant lesions. Early diagnosis aid in effective management of malignant lesions of the breast and thereby reducing the mortality in these patients.

Malignant Germ cell Tumor of Ovary: An Unusual Combination and An Irony of Fate

Malignant mixed ovarian germ cell tumors are very rare malignant ovarian germ cell tumors, with a very high degree of malignancy. They are aggressive cancers affecting young adolescent girls. The commonest combination reported in literature is dysgerminoma and endodermal sinus tumors. Fertility sparing surgery followed by combination chemotherapy is the treatment of choice. The objectives of this case report are the advanced age of presentation, unusual histopathological combination, and the irony of infertility treatment. We report a rare case of 40-year-old woman with Malignant mixed germ cell tumor comprising of components of endodermal sinus tumor, immature teratoma, dysgerminoma and embryonal carcinoma. Patient was on hormonal therapy for the cause of infertility, presented with complains of lower abdominal pain, constipation and incomplete evacuation of bladder for 2months. Transvaginal ultrasonography and CT scan showed a large multicystic space occupying lesion with predominant solid component in midline abdominopelvic location. Tumor markers i.e., AFP, Prolactin and CA125 were raised. Total abdominal hysterectomy and bilateral salpingoophorectomy, pelvic and retroperitoneal node resection, peritonectomy and omentectomy was performed.

Fungal Infection of Paranasal Sinus After COVID-19 Infection: A Tale of Two Fungi

Coronavirus disease (COVID-19) is an infection caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). Many twists and turns have occurred regarding its various aspects since the time it was first detected especially medical management. The COVID-19 symptom array has been ever expanding and recently secondary fungal infection has emerged as a top-up to the trouble. Post COVID-19 secondary fungal infections caused by Mucor have recently emerged as a cause of concern. However, infection caused by a combination of two fungal moulds from a site barring the lungs as a sequalae to the coronavirus disease comes as a surprise.

Polymorphous Adenocarcinoma of Lacrimal Gland: A Rare Case Report

Polymorphous adenocarcinoma is a slow growing malignant tumor of minor salivary glands. The most common location of these tumors is palate, buccal mucosa, upper lip, floor of mouth and retromolar region. This malignant neoplasm is characterized by cytological uniformity, architectural diversity and infiltrative growth pattern. This is a case report of polymorphous adenocarcinoma occurring in lacrimal gland. They are seldom reported in this location and propose unique diagnostic challenges.

A Study Depicting Histomorphology of Third Trimester Placenta in SARS-Cov-2 Positive Women

Background: This study aims to detect association of SARS-COV-2 infection in terms of histopathological changes in the third trimester placenta. Methods: SARS COV 2 positive placenta cases received in Department of Pathology, Gandhi Medical College and Hamidia Hospital, Bhopal, Madhya Pradesh. 7 cases were sent for histopathological examination. Clinical details, history, details of relevant investigation like D-dimer, blood reports etc. was taken from the electronic medical records and requisition form received in the Department of Pathology. Histopathological findings were analyzed and recorded. Result: This is a case series depicting various histopathological changes in term placenta of 7 SARS Corona Virus 2 (COV-2) positive women in the age group of 20 years to 35 years exhibiting symptoms ranging from mild to severe degree. The major histopathological finding noticed is under perfusion of placenta of maternal side in greater extent as compared to fetal side under perfusion followed by signs of inflammation of membranes viz chorionitis and chorioamnionitis. Hence, through the study, we want to highlight micro vasculopathy as one of the pathophysiological features of SARS Corona Virus 2 (COV-2) which might be leading to these histopathological findings and its correlation with elevated levels of D – Dimer. Conclusion: Covid 19 positive women with third trimester of placenta do not express any specific histomorphological findings. Our study shows only signs of maternal and fetal vascular under perfusion with mild acute chorionitis which might have a relationship to a microvascular disease induced by SARS COVID 19 virus, yet this cannot be ruled out consistently proven several associated factors.

Fungal Infections Masquerading as Gastrointestinal Tract Malignancies – A Series of Three Cases

Fungal infections of the gastrointestinal tract (GIT) are not rare, but get missed due to their misleading clinical features. Here we report three GIT fungal infections at different locations with varied symptoms. We received surgical resection specimens with the clinical suspicion of malignancy for all. The first was a case of Aspergillosis, at an uncommon site, esophageal, in a 60year diabetic male with a suspicion of carcinoma in view of presence of dysphagia and a stricture on CT. The second was a 60-year male, a case of stomach Zygomycosis with no definite immunosuppression, who presented with an intra-operative suspicion of malignancy, and showed fungal angio-invasion and ischemic perforation. Third was a 32year immunocompetent male, a case of GI histoplasmosis with an uncommon presentation, showing obstructive symptoms due to an ileocaecal mass with a clinical suspicion of TB/malignancy. Thus, a high index of suspicion for fungal a etiology in GIT is essential, because misdiagnosis can lead to a radical surgery. Timely treatment with appropriate antifungal therapy is crucial as high mortality is associated with certain fungi.

Pleomorphic Adenoma of Lacrimal Gland: A Rare Entity

Among the various tumours affecting the lacrimal gland, pleomorphic adenomas though most common can present clinically and radiologically as worrisome tumours. Histopathologic diagnosis hence is very critical for these tumours. We present a case of pleomorphic adenoma of the lacrimal gland which we encountered at our institutes. The patient was a 46-year-old male who came with complaints of a gradually progressing swelling in the right eye not associated with much pain or significant loss of vision. MRI revealed a large lobulated extrachoanal mass causing mass effect and scalloping of the adjacent bony structures. An excision biopsy was done and sent for histopathological examination. Histologically the tumour showed a biphasic morphology comprising of epithelial (ductal and myoepithelial) and chondromyxoid stromal components. Immunohistochemistry showed positivity for pan CK and CK 7 in ductal epithelial cells, p63 and S100 in myoepithelial cells and a low Ki67 index. On the basis of immunohistochemistry profile along with clinicoradiological correlation a final diagnosis of pleomorphic adenoma of the lacrimal gland was made. The patient post-surgery was doing well but was lost to follow up. It can thus be seen that is it absolutely necessary to accurately diagnose these benign but clinically misconceiving rare tumours of the lacrimal gland for appropriate management of such patients.

Childhood Onset Systemic Lupus Erythematosus with Direct Coombs Test Positive in the Absence of Hemolytic Anemia – A Rare Case Report

Systemic Lupus Erythematosus being a chronic autoimmune multisystem inflammatory disease, affects predominantly women of reproductive age group. Childhood – Onset Systemic Lupus Erythematosus is a rare disease with an incidence of 10% - 20%. Positive direct Coombs test in the absence of hemolytic anemia indicates high disease activity and severe renal damage. Herein we report a case of 11-year-old female child diagnosed as Systemic Lupus Erythematosus with positive direct Coombs test in absence of hemolytic anemia which is very rare.