Spectrum of Fungal Infections in a Tertiary Care Centre of North India: Pre-COVID and COVID Scenario and Implications.

Background Rhino orbital mucormycosis is a rare and very aggressive entity. A sudden rise of this entity has been noticed with the insurgence of the COVID-19 pandemic both among immunocompromised and immuno-competent patients. This study was done to determine any possible correlation between these two deadly diseases. Materials and Methods This was a retrospective observational study done in the pathology department of a tertiary care center in North India over a three-year period (January 2019 - December 2021). Patient details along with relevant clinical data were retrieved from the patient's record file. Hematoxylin and eosin-stained slides of diagnosed cases were taken from the department records. Results A total of 45 patients (34 males, 11 females) were included in the study, seven of which were ophthalmic exenteration specimens. The mean age of the patients was 52.68 years. Fifteen cases showed COVID-19 reverse transcription-polymerase chain reaction (RT-PCR) positivity. Histopathology revealed the presence of mucormycosis in all the cases. There were six cases showing granuloma formation and 14 cases revealed mixed fungal infection. Optic nerve involvement was seen in six cases of exenteration specimens. Conclusions The present study showed a sudden resurgence of secondary fungal infections, especially during the second wave of the COVID-19 pandemic. Associated co-morbid conditions and injudicious use of steroids and antibiotics have been the cause of depressed immunity leading to the infections. One must be aware of such co-infections to facilitate timely medical management to reduce morbidity and mortality.

Incidental Gallbladder Neoplasms: A Growing Global Burden.

Background The increasing trend of laparoscopic procedures has made cholecystectomies one of the most common surgical specimens received for histopathological evaluation. This has also led to an increasing trend of finding incidental gallbladder malignancies for a presumed benign disease. The present study describes the histopathological spectrum of neoplastic lesions of the gallbladder along with the historadiological correlation with special emphasis on incidental gallbladder carcinomas (IGBC). Materials and methods All the cholecystectomies received over a span of two and a half years were studied. Demographic details, imaging findings, gross features, and microscopic findings of premalignant and malignant lesions were noted. Special stains were done as and when required. Results Of the 1253 cholecystectomies received during the study period, 50 gallbladders (3.9%) showed neoplastic pathology and were included in the present study. The age range was 40 to 60 years with female predominance. Ultrasonography revealed nonspecific wall thickness in both premalignant and incidental gallbladder carcinomas. Gallstones were seen in 74% of the cases (37/50). Gross and imaging findings in 17 (34%) of the malignant cases were in concordance with microscopic features, whereas the dysplastic lesions (21) and IGBC cases showed evidence of chronic cholecystitis on the same. Microscopic examination revealed focal dysplasia (low and high grade) in 21/50 (42%) cases. Invasive malignancy was seen in 28/50 (56%) of the cases, of which 11 cases (22%) were IGBC. Pancreaticobiliary type of adenocarcinoma was the most common morphology seen in almost all the cases. There was also one case each of intracholecystic papillary neoplasm (ICPN) and carcinosarcoma. Conclusion GBC is an unusual malignancy and its preoperative diagnosis is not so definitive. The incidental form of GBC presents as a radiological disguise and a histopathological surprise. Hence, the present study warrants a complete and scrupulous histopathological examination of all the cholecystectomy specimens for proper and further management of the case.

Revisiting a Case of Parathyroid Adenoma With Bilateral Staghorn Calculus.

Parathyroid gland adenoma is responsible for approximately 80%-85% cases of primary hyperparathyroidism. Although not much is diagnostic on clinical examination, the blood investigations of the patients reveal raised serum calcium and serum parathyroid hormone levels. We present a case of chronic kidney disease with bilateral staghorn calculi and a right parathyroid adenoma localized on ultrasonography. Parathyroid adenoma was surgically excised by minimally invasive parathyroidectomy.

Indian Academy of Cytologists National Guidelines for Cytopathology Laboratories for Handling Suspected and Positive COVID-19 (SARS-CoV-2) Patient Samples.

COVID-19, caused by the SARS-CoV-2 virus, has been declared a pandemic by the World Health Organization. This scenario has impacted the way we practice cytopathology. Cytology laboratories receive fresh and potentially infectious biological samples including those from the respiratory tract, from COVID-19 positive or suspected patients. Hence, the Indian Academy of Cytologists thought it necessary and fit to bring forth appropriate guidelines starting from transportation, receipt, processing, and reporting of samples in the COVID-19 era. The guidelines are prepared with the aim of safeguarding and protecting the health care personnel including laboratory staff, trainees and cytopathologists by minimizing exposure to COVID-19 so that they remain safe, in order to able to provide a continuous service. We hope that these national guidelines will be implemented across all cytopathology laboratories effectively.

Value of ancillary studies in the evaluation of fine-needle aspiration specimens: Our experience.

BACKGROUND: The cytological diagnosis of poorly differentiated tumors is challenging because the tumor cells may have morphologically difficult presentations in materials obtained by fine-needle aspiration cytology (FNAC). With the application of FNAC in primary diagnosis of malignant lesions, there has been a significant increase in the use of ancillary studies in the aspirated material. AIMS: We evaluated the value of ancillary studies, namely cell blocks, immunocytochemistry (ICC) and electron microscopy (EM), in the final interpretation of FNAC smears. MATERIALS AND METHODS: Sixty-nine cases of neoplastic swellings were subjected to FNAC. Material acquired was divided for ICC, consisting of immunoperoxidase staining of direct smears, and/or cellblocks and EM, in addition to routine light microscopy (LM). Correlation with the available histological material with immunohistochemistry and/or pertinent clinical information was used as a "gold" standard. RESULTS: Five (7.2%) cases were excluded from the study, the material being necrotic or insufficient. Cell blocks were available in 46/64 (71.8%) cases, ICC evaluation was performed in 41/64 cases (64%) and EM studies were done in 57/64 cases (89%). Diagnostic accuracy of LM alone was 32/64 (50%). Cell blocks improved the diagnoses in 8/46 (17%) cases. The ICC data were diagnostic in 18/41 (43.9%) cases, helpful in 8/41 (19.6%) cases and non-helpful in 15/41 (36.5%) cases. EM studies were diagnostic in 22/57 (38.5%) cases, helpful in 18/57 (31.5%) cases and non-helpful in 17/57 (30%) cases. In 34/64 (53.1%) cases, all ancillary techniques (cell blocks, ICC and EM) were applied and their diagnostic accuracy was compared. CONCLUSIONS: With appropriate case selection, ancillary studies performed on aspirated material can provide useful information in FNAC.