Endometrial Histopathology in Abnormal Uterine Bleeding and Its Relation With Thyroid Profile and Endometrial Thickness.

INTRODUCTION: Abnormal uterine bleeding (AUB) is a common complaint in postmenopausal and perimenopausal women, caused by a range of disorders, including structural and systemic diseases. The evaluation of endometrial thickness (ET) via radiological methods, followed by a histopathological examination of the endometrium, is useful for proper diagnosis. Among systemic diseases, thyroid dysfunction, specifically hypothyroidism and hyperthyroidism, contribute significantly to AUB cases. MATERIALS AND METHODS: This descriptive cross-sectional study was conducted at Sri Aurobindo Medical College, Indore, Madhya Pradesh, India, over a period of 16 months, from May 2021 to September 2022. Patients presenting with abnormal uterine bleeding and undergoing thyroid function tests (TFTs), ultrasonography, and endometrial biopsy/hysterectomy at the gynecological outpatient department were included. Hospital records were used to obtain clinical details and investigation results. Endometrial thickness and thyroid status were recorded, and descriptive statistics were used to analyze the collected data. RESULTS: This study included 150 patients with abnormal uterine bleeding, with a mean age of 44 years and 80.6% of patients in the premenopausal age group. A total of 48% of patients had a deranged thyroid profile, with hypothyroidism being more common (91.6%). Structural causes of AUB were identified in 81.3% of cases, with adenomyosis (33.65%), concomitant adenomyosis and leiomyoma (31.5%), and leiomyoma (14.8%) being the most common. Endometrial polyps (4.6%) and endometrial carcinoma (0.6%) were also observed and were consistent with the final histopathology. The remaining 18 patients had no structural causes and were categorized as cases of dysfunctional uterine bleeding (DUB). Increased ET was more commonly observed in postmenopausal patients (4.3%) compared to premenopausal patients (0.7%) among those with AUB, while the reverse was true for patients with DUB. Increased ET was commonly associated with hypothyroidism in both groups. Histopathological examination of endometrial biopsies/hysterectomy specimens revealed additional findings in some patients, including hyperplasia of the endometrium with (0.7%) and without atypia (4%), leading to a more accurate diagnosis. CONCLUSION: AUB is a prevalent condition affecting women in both pre-menopausal and postmenopausal stages, frequently caused by structural anomalies. However, thyroid dysfunction, especially hypothyroidism, is also a significant contributing factor. As such, thyroid function tests (TFTs) are an effective and economical means of identifying potential underlying causes of AUB. Hypothyroidism is frequently associated with increased endometrial thickness, and histopathological examination remains the gold standard for determining the precise cause of AUB.

Evaluation of Thyroid Lesions by Fine-needle Aspiration Cytology According to Bethesda System and its Histopathological Correlation.

BACKGROUND: The Bethesda system is a uniform reporting system for thyroid cytology that facilitates the clarity of communication among cytopathologists, radiologists, and surgeons and facilitates cytohistologic correlation for thyroid diseases. OBJECTIVE: This study was carried out to evaluate thyroid lesions by fine-needle aspiration cytology (FNAC) based on Bethesda system of reporting and to correlate the cytological findings with histopathology. MATERIALS AND METHODS: A total of 606 patients with thyroid lesions were studied by FNAC at our institute between January 1, 2006, and January 31, 2016, and results were compared with histopathology wherever possible. RESULTS: Based on the Bethesda system of classification of thyroid lesions, out of 580 satisfactory samples; 501 lesions were diagnosed as benign (Group 1), five were in category of atypical follicular lesion of atypia undetermined significance (Group 2), 55 were diagnosed as suspicious for follicular neoplasm (Group 3), 7 as suspicious for malignancy (Group 4), and 12 cases were malignant (Group 5). 26 aspirates were nondiagnostic even after reaspiration. In the present study, cytohistopathological correlation was done in 148 benign and 18 malignant lesions. The sensitivity of FNAC was 85.7%, specificity 98.6%, and diagnostic accuracy 97.7%. CONCLUSION: Reviewing the thyroid FNAs with the Bethesda system for reporting allowed precise cytological diagnosis. It represents standardization and reproducibility in reporting thyroid cytology with improved clinical significance and greater predictive value. Nature of the disease, experience of cytopathologist, and understanding of certain limitations determine its diagnostic utility.

Aggressive angiomyxoma in pregnancy: A rare and commonly misdiagnosed entity.

Aggressive angiomyxoma (AAM) is an uncommon mesenchymal tumor that predominantly involves the pelvis and perineum of young females. It is often clinically mistaken for more common superficial lesions such as vaginal cysts, labial cysts, and lipomas. A review of the medical literature reveals very few cases of AAM reported in pregnancy. We describe a rare case of AAM in pregnancy, clinically misdiagnosed as prolapsed cervical fibroid.

Hepatitis C Virus: Unnoticed and on the Rise in Blood Donor Screening? A 5 Years Cross-sectional Study on Seroprevalence in Voluntary Blood Donors from Central India.

CONTEXT: The ultimate goal of a blood transfusion service is the provision of safe and adequate supply free from transfusion-transmitted infections (TTIs). TTIs not only threaten the recipient's safety, but they also increase disease burden. Seroprevalence of TTIs in healthy blood donors indirectly reflects the prevalence of these infections in the general healthy population. AIM AND OBJECTIVES: To study the seroprevalence of human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) in healthy donors at a tertiary care hospital-based blood bank. To know the yearly and age-group prevalence of these TTIs as compared with other studies across India. SETTINGS AND DESIGN: This is 5 years observational cross-section study conducted in a tertiary hospital-based teaching institute of Central India (Malwa region). MATERIALS AND METHODS: The results of serological testing of TTIs and donor variables were analyzed during 2011-2015. STATISTICAL ANALYSIS USED: Chi-square test and Chi-square for trend analysis on TTIs prevalence. RESULTS: A total of 58,998 donors were screened for TTIs with dominance of male donation (99.7%). The overall cumulative seroprevalence was 1.14% in our study. The seroprevalence of HIV, HBV, and HCV was 0.09%, 0.98%, and 0.07%, respectively. We found a statistically significant increasing trend for HCV seropositivity during the study. CONCLUSION: Our study reflects an increasing trend of HCV seroprevalence over time. Thus, efforts are needed to increase the awareness and to educate the population in reducing risk factors for HCV infection.

Clinicopathological spectrum of teratomas: An 8-year retrospective study from a tertiary care institute.

BACKGROUND: Teratomas are tumors that contain tissues derived from three different germ cell layers and having a wider range of differentiation with different site and age at presentation. The aim of the present study was to know the frequency of teratomas in various sites and to analyze their clinicomorphological features. MATERIALS AND METHODS: The present study is a retrospective study conducted in tertiary care hospital of Central India. All the cases diagnosed as teratoma in the period of 8 years were included and studied with reference to age, sex, site, size, gross, and microscopic features. RESULTS: A total of 92 cases were retrieved. The most common teratoma was ovarian (78.26%) followed by intracranial/intraspinal and sacrococcygeal in frequency of 7.61% each. Out of 92 cases, 89 were mature and benign, 2 cases were immature teratoma each in ovary and in sacrococcyx, and 1 case of teratocarcinoma in testis. CONCLUSION: Teratomas have much diversity in their age at presentation, location, gross features, and in degree of differentiation. The prognosis and treatment also depends on the histological grading of teratomas. Thus, pathologists have an important role in establishing a reliable prognostic profile.

Comparison of efficacy of cell block versus conventional smear study in exudative fluids.

INTRODUCTION: Cytological examination of serous effusions helps in staging, prognostication and management of patients with malignancy. The method has disadvantage of lower sensitivity in differentiating reactive atypical mesothelial cells from malignant cells. AIM: The aim of this study is to compare the cytological features of pleural and peritoneal exudative fluids by conventional smear (CS) method and cell block (CB) method and also to assess the utility of a combined approach for cytodiagnosis of these effusions. MATERIALS AND METHODS: One hundred and fifty-three pleural and peritoneal exudative fluid samples were subjected to evaluation by both CS and CB methods over a period of 2 years. Cellularity, architecture patterns, morphological features and yield for malignancy were compared, using the two methods. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy for diagnosing malignancy were calculated by both methods, using histology as a gold standard. RESULTS: CB method provided higher cellularity, better architectural patterns and additional yield for malignancy as compared to CS method (P < 0.005). Sensitivity, specificity, PPV, NPV, and accuracy by CS method were 69.2%, 95%, 56.25%, 97.08% and 92.8%, while by CB method were 92.30%, 99.2%, 92.30%, 99.28% and 98.6%. CONCLUSION: The present study shows that it is advisable to routinely make CBs before discarding specimens that are suspicious for malignancy by smear examination.

Human ex-vivo oral tissue imaging using spectral domain polarization sensitive optical coherence tomography.

We report the use of spectral domain polarization sensitive optical coherence tomography for ex-vivo imaging of human oral mandibular tissue samples. Our results show that compared to the changes observed in the epithelium thickness and the decay constant of A-scan intensity profile, a much larger degree of change was observed in the phase retardation for tissue sites progressing from normal to the malignant state. These results suggest that monitoring of tissue retardance can help in better differentiation of normal and cancerous oral tissue sites.

Adult Wilms' tumor: A case report with review of literature.

Wilms' tumor presents a diagnostic problem due to its rare occurrence in adults. Most of the cases of adult Wilms' tumor are diagnosed unexpectedly following nephrectomy for renal cell carcinoma. We are reporting herein a rare case of Adult Wilms' tumor of kidney with triphasic histology and distant metastasis to lung.

Primary right atrial sarcoma.

Primary malignant tumors of heart are rare with unfavorable prognosis and are mostly diagnosed on autopsy. They have varied presentation and are difficult to diagnose. Most of the cases are benign and others are sarcomas. Here we present a case of primary cardiac sarcoma which had varied presentation and was undiagnosed due to non specific symptoms. Diagnosis of atrial tumor was confirmed on histopathological examination of tissue obtained after thoracotomy. Being inoperable, the patient was given palliative chemotherapy with which we could provide her a better quality of life.