Assessment of nutritional status, physical fitness and physical activity of school going adolescents (12-15 years) in Delhi.

BACKGROUND: Adolescence is a distinct period that is crucial for setting the foundation for long-term health. OBJECTIVE: To assess the nutritional status, physical fitness, and physical activity of adolescents. METHODS: The present cross-sectional study recruited 100 adolescents purposively. Information regarding general profile and lifestyle-related factors was collected using a questionnaire. Anthropometric data such as height, weight, BMI, and body fat% were collected using appropriate equipment. Physical fitness was assessed using a battery adapted from FITNESSGRAM® and PAQ-A assessed the physical activity. Dietary intake was analysed using a 2-day 24-hour dietary recall. RESULT: The study revealed, 19% of the participants were overweight and 6% were obese. The majority (74%) were physically inactive and 15% had high body fat %. There was lower consumption of energy, carbohydrates, iron, and calcium, than the recommendations. Also, physical activity scores were negatively associated with macronutrient intake and trunk lift (strength and flexibility) [p < 0.05]. Data showed lower physical fitness scores. BMI and hand-grip strength was positively correlated [p < 0.05]. Push Ups (endurance) and Standing Broad Jump (power) showed a negative correlation with body fat%. Tennis ball throw and PACER (cardiorespiratory fitness) were positively associated with protein intake. A multiple regression analysis significantly showed that a unit increase in cell phone usage increases body fat% by 11.64 units. Standing broad jump increases by 38.6 cm and decreases with 28.76 cm with a unit increase in playing outside and tuitions timings respectively. CONCLUSION: Poor nutritional status, physical fitness, and physical activity were reported among adolescents. It is imperative to plan intervention strategies to improve the overall health of adolescents.

A Curious Case of Omental Oxalate Crystals in a Patient With Struma Ovarii: Pointers to an Unusual Clinicopathological Scenario.

Percutaneous image-guided biopsies are becoming increasingly common in routine pathology practice, with the greater omentum emerging as a common target. We present herein an account of a middle-aged lady with a complex ovarian mass, omental thickening, and raised serum CA125; clinically suspected to have advanced ovarian malignancy. Fine needle aspiration cytology (FNAC) from the ovarian mass was inconclusive. Omental biopsy revealed only refractile, birefringent crystalline material with surrounding foreign body giant cell reaction; thus surprising the clinical team. Subsequent resection of the ovarian mass showed a teratoma composed exclusively of thyroid tissue, diagnosed as struma ovarii. The omental crystals, interpreted as calcium oxalate crystals, were possibly a consequence of colloid seeding during the ovarian mass FNAC.

Adenosquamous carcinoma lung radiologically mimicking pneumonia: A potentially disastrous diagnostic challenge in an unusual malignancy.

Lung cancer is among the most frequently diagnosed cancers and the world's leading cause of cancer-related death. Radiology remains the mainstay for timely diagnosis; however, atypical radiologic patterns are known, and these may be misdiagnosed as infectious or inflammatory pathology, particularly in the absence of smoking history. We report herein an account of an older male nonsmoker who presented radiologically with bilateral diffuse pulmonary infiltrates, simulating pneumonia, but was eventually diagnosed with adenosquamous lung carcinoma. The delay in diagnosis and subsequent unfortunate rapid deterioration of our patient serves as a reminder for clinicians to consider lung cancer in patients with clinical/radiologic findings suggestive of pneumonia, especially in nonsmokers or cases refractory to antibiotic therapy.

Amelanotic Melanoma: A Great Masquerader.

Malignant melanoma is an aggressive, notorious tumor showing great variability in morphological and immunohistochemical expression, thus commonly leading to an erroneous diagnosis. Within the melanoma group, amelanotic melanoma, with its wide clinical presentations, lack of pigmentation, and varied histological appearances, has taken on a new persona as a master masquerader. Use of immunohistochemistry in the diagnosis of malignant tumors, including melanoma, is primordial and indispensable. However, the problem gets compounded in scenario of aberrant antigenic expression. The present case posed multiple diagnostic challenges in form of atypical clinical presentation, variant morphology, as well as aberrant antigenic expression. Here, we present the case of a 72-year-old male who, upon his initial presentation, was thought to be sarcomatoid anaplastic plasmacytoma, but 5 months later another biopsy from a different site revealed the actual diagnosis of amelanotic melanoma.

Extrapelvic "Uterus Like Mass" Following Laparoscopic Morcellation Hysterectomy - a Consequence of Iatrogenic Implantation?

Uterus-like mass is a rare form of endometriosis, which shows striking structural similarity to the normal uterus. Formation of a mass lesion raises clinical concern for malignancy, and pathologic examination is necessary for accurate diagnosis. We describe herein, a middle aged woman who presented with a mesenteric mass six years post hysterectomy, which was initially suspected to be a gastrointestinal stromal tumor. The resected was specimen was grossly pear shaped with microscopy showing a central endometrial glands and stroma lined cavity, surrounded by a thick muscular wall reminiscent of uterine myometrium. Histogenesis of this entity is unclear, and several theories are proposed regarding the etiology, including congenital anomaly theory, metaplasia and heterotopia theories. Our clinical scenario developed a few years after uterine morcellation, indicating a possibility of another "iatrogenic implantation" theory behind the pathogenesis of this rare lesion.

Primary neurolymphomatosis presenting as foot drop: A rare case report.

ABSTRACT: Neurolymphomatosis (NL) is the direct infiltration of the peripheral nervous system (PNS) by lymphoma cells and represents the least common form of PNS involvement by lymphoma. Clinical presentation is varied, and early diagnosis remains challenging. Nerve biopsy remains the diagnostic gold standard, use of magnetic resonance imaging (MRI) and fluorodeoxyglucose-positron emission tomography (FDG-PET) may help in diagnosis and selecting targets for biopsy. We report an account of an older male patient who presented with subacute onset multifocal neuropathy involving bilateral lower limbs and left foot drop. The patient was initially misdiagnosed as chronic inflammatory demyelinating polyneuropathy; however radiological assessment revealed fusiform thickening of the L5 nerve root and biopsy from the site revealed extensive infiltration by diffuse large B cell type non-Hodgkin lymphoma (NHL). High index of suspicion is vital to ensure correct diagnosis, timely treatment, and to improve patient survival.

Retrospective histopathology audit of thymectomy specimens: A clinicopathological study of 303 cases spanning the non-neoplastic, benign and malignant spectrum.

Aims: Thymectomy specimens are uncommon in routine histopathology practice. However, awareness of various pathologic entities and definite reporting of these specimens is paramount to optimal patient management. Our objective was to determine the histomorphologic spectrum of thymectomy specimens spanning the non-neoplastic, benign to malignant spectrum. Methods and Results: Thymectomies received over an 8-year period were retrospectively analyzed by reviewing clinical details and histologic findings in detail, incorporating the latest World Health Organization (WHO) 2015 histologic classification. A total of 303 thymectomy specimens (179 males/124 females, mean age 45.3 years [3-84 years]) were included. Around 51.2% (n = 155) patients had associated myasthenia gravis (MG), while 17.5% (n = 53) had incidentally detected anterior mediastinal mass (AMM). Non-neoplastic and benign pathologies comprised 31% (n = 94) cases and showed stronger association with MG (P = 0.009). Thymic follicular hyperplasia (TFH) was the commonest non-neoplastic pathology (n = 32), while the benign tumor group included thymic hemangioma/lymphangioma, thymolipoma, and ectopic parathyroid adenoma. Thymic epithelial tumors (TETs) comprised 64.7% cases, with majority being thymomas (185/303; 61.1%). Thymoma type B2 was the commonest histologic subtype and Stage I/T1 was the most frequent stage. Type A and AB thymomas affected older patients (P = 0.005) and were in lower stage (both Masaoka and American Joint Committee on Cancer [AJCC]) than type B thymomas (P = 0.007). No significant association between MG and thymoma subtype, patient sex or Masaoka stage was seen (P > 0.05). Thymic carcinomas comprised 11 cases and showed no association with MG (0/11, P < 0.001); squamous cell carcinoma was the commonest histologic type (8/11; 72.7%). Conclusion: TETs are the commonest thymic lesions; however, a diverse spectrum of pathologic processes can affect the thymus.

Radiation Induced Liver Injury: Collateral Damage Radiologically Simulating Interval Metastasis in Carcinoma Esophagus; a Diagnostic Dilemma Resolved Through Liver Biopsy.

F-18-fluorodeoxyglucose positron emission tomography (18-FDG PET/CT) is increasingly being used in patients with cancer, both for baseline staging and for evaluation of treatment response. However, in patients with incidental irradiation of the liver during radiotherapy, particularly for lower gastrointestinal tract cancers, increased focal F-18-fluorodeoxyglucose positron emission tomography avidity may be the result of collateral radiation induced liver damage rather than metastases. Awareness of this pathologic entity and correlation with with other imaging, clinical and laboratory findings including liver biopsy is vital to avoid misinterpretation and overstaging of the carcinoma in these patients. We encountered such a scenario in an elderly female patient with distal esophageal squamous cell carcinoma patient, who developed F-18-fluorodeoxyglucose positron emission tomography avid left lobe liver lesion post neoadjuvant radiotherapy, simulating interval metastasis. A liver biopsy ruled out malignancy and helped to clinch the correct diagnosis of radiation induced liver injury.

Micronodular Thymoma With Lymphoid Stroma: A Trio of Cases, With Diverse-associated Histological Features.

Introduction. Micronodular thymoma with lymphoid stroma (MNTLS) is a rare thymoma subtype characterized by distinctive histological appearance, unique clinical profile, and indolent course with good prognosis. In addition to its distinctive morphology, MNTLS may be associated with diverse histological features, such as thymic cysts and conventional thymoma, complicating the diagnostic picture further. Materials and methods. We report herein an account of 3 elderly patients (male-02; female-01), who presented with anterior mediastinal mass, and underwent robotic thymectomy. Microscopic examination revealed MNTLS in all 3 cases. In addition, 2 cases showed associated histological features in the form of a multilocular thymic cyst and conventional (type B2) thymoma, respectively. All 3 patients are doing well without recurrence or metastasis at 34, 28, and 19 months postsurgery. Conclusions. Awareness of this rare thymoma subtype is vital among pathologists to avoid misdiagnosis and ensure appropriate patient management. To date, only a few cases of this rare thymoma subtype have been reported in the literature, mostly as single case reports.

Sinusoidal dilatation and congestion in post-transplant liver biopsies from patients presenting with transaminitis.

AIMS: Sinusoidal dilatation and congestion (SDC) in liver biopsy may be obstructive (due to venous outflow impairment) or non-obstructive in nature. The significance of this finding in the post-liver transplant setting remains unexplored. METHODS: We herein retrospectively analysed all post-transplant liver biopsies showing SDC and examined histopathological features in detail. Association with transaminitis and concurrent graft rejection was assessed. RESULTS: A total of 30 post-transplant liver biopsies from 27 patients showed SDC with atrophy of hepatocyte cords (SDC; incidence 7.4%). All patients had transaminitis. Most patients (n=22; 81.5%) were asymptomatic with deranged liver function tests (LFTs) detected during routine follow-up, raising clinical suspicion of graft rejection. SDC was non-obstructive in 19 (70.4%) and obstructive (due to sinusoidal obstruction syndrome (SOS)) in 8 (29.6%) cases. The incidence of SOS was 2%. SDC was mild, moderate and severe in 18 (66.7%), 7 (25.9%) and 2 (7.4%) cases, respectively. Perivenular and centrilobular sinusoidal fibrosis was seen in the obstructive SDC group (n=3, 11.1%). Concurrent graft rejection was present in 7 (25.9%) cases, of which acute cellular rejection comprised 5 (18.5%), and late acute rejection accounted for 2 cases (7.4%). Serum tacrolimus levels ranged from normal (n=14) to below and above normal (n=5 each). Modulation of immunosuppressive therapy led to normalisation of LFTs in one patient. CONCLUSION: Obstructive and non-obstructive SDC in post-liver transplant patients presenting with transaminitis mimics graft rejection clinically and may represent a form of drug-induced liver injury. Liver biopsy plays a crucial role in the diagnosis.

Neuroendocrine tumor in a lesser sac bronchogenic cyst - A hitherto unreported entity made rarer by concomitant hepatic hydatid cyst.

Intra-abdominal bronchogenic cysts are rare entities and only a handful of cases occurring within the lesser sac have been described. Further, the development of malignancy in a bronchogenic cyst is exceptional and one arising in a lesser sac has so far not been reported. We present herein an account of a 44-year-old man who presented with recurrent upper abdominal pain. Investigations revealed a mass in the lesser sac and a hydatid cyst in the liver. The histopathological examination of the excised mass showed bronchogenic cyst, with a neuroendocrine tumor of intermediate grade arising in its wall. Concomitant presence of hydatid cyst in the liver made this case even more unusual.

Nodular regenerative hyperplasia - An under-recognized vascular disorder of liver.

INTRODUCTION: Nodular regenerative hyperplasia (NRH) is a rare hepatic vascular disorder which is often associated with wide variety of systemic diseases. Intrahepatic microvascular injury and subsequent altered perfusion state leads to development of non-cirrhotic portal hypertension in many of these patients. Diagnosis of NRH often remains unsuspected clinically and liver biopsy is essential for the diagnosis and exclusion of fibrosis. We herein, present clinicopathological features of 22 NRH cases. In addition we assessed CK7 and CD34 expression in hepatocytes and sinusoidal endothelial cells respectively. RESULTS: Most of the cases were associated with systemic disorders, predominantly immunological, inflammatory and drug-related injuries. Signs and symptoms of portal hypertension were found in 86.4 % patients. Majority of the patients showed a predominant mild cholestatic pattern of liver function tests. Nearly all the (21/22) cases showed CK7 positivity in centrizonal hepatocytes which ranged from <10 % cells to diffuse perivenular positivity extending into the midzonal areas. CD34 positivity in sinusoidal endothelial cells was seen in all the cases, which was prominent in periportal areas in all cases; while perivenular (n = 20) and midzonal (n = 14) areas also showed CD34 positive sinusoidal endothelial cells. CONCLUSION: This study highlights the role of pathologist in the diagnosis of NRH and stresses upon the need for awareness of NRH as a cause of unexplained portal hypertension in patients with underlying systemic diseases. The altered perfusion state in NRH leads to phenotypic shift in centrizonal atrophic hepatocytes and sinusoidal endothelial cells (as depicted by IHC) which may be responsible for development of portal hypertension.

Role of Immunohistochemistry in the Subtyping of Periampullary Adenocarcinoma.

Context. Subtyping of periampullary adenocarcinoma into intestinal and pancreatobiliary subtypes has emerged as an important prognostic factor with potential therapeutic implications. This distinction on morphology alone is often difficult with significant interobserver variability. Objective. To analyze the usefulness of a panel of immunohistochemistry (IHC) markers as an aid to morphologic subtyping of periampullary adenocarcinoma. Design. A total of 172 periampullary adenocarcinomas were classified morphologically by 3 study pathologists. Interobserver agreement was assessed in each case. Cases were then typed using a predetermined IHC panel (comprising CK7, CK20, MUC1, and CDX2). Results. Morphologically, 66 (38.4%) cases were intestinal, 56 (32.6%) pancreatobiliary, 25 (14.5%) mixed, 16 (9.3%) poorly differentiated, 6 (3.5%) mucinous, and 3 (1.7%) signet ring cell adenocarcinoma. Concordant diagnosis was reached in 138 cases (80.2%) with moderate overall interobserver agreement (κ = 0.47). Concordance was higher in morphologically distinct mucinous (100%; κ = 0.94) and signet ring cell subtypes (100%; κ = 1.0) than in intestinal (84.6%; κ = 0.47) and pancreatobiliary (82.1%; κ = 0.43) types. Concordance was poor for mixed (64%; κ = 0.27) and poorly differentiated (68.8%; κ = 0.76) tumors. IHC subtyped 79 cases (46%) as pancreatobiliary, 73 (42.4%) as intestinal, and was inconclusive in 20 cases (11.6%). IHC helped classify 21 out of 25 (84%) mixed and 10 out of 16 poorly differentiated (62.5%) adenocarcinomas. Combination of histology and IHC classified 161 of the total 172 cases (93.6%). Conclusion. Use of an IHC panel aids in subtyping of periampullary adenocarcinomas, especially in tumors with mixed morphology and poor differentiation.

Vasoformative Lesions in Mediastinal Mixed Germ Cell Tumors: an Interesting Account of Two Cases Spanning the Benign to Malignant Spectrum.

Extragonadal germ cell tumors are most commonly encountered in the anterior mediastinum. The presence of sarcomatous malignancies in these tumors is a rare phenomenon that adversely impacts patient prognosis because of poor response to conventional cisplatin-based chemotherapy. Even more unusual is the presence of florid benign somatic proliferations that overshadow the germ cell component, often resulting in misdiagnosis and inappropriate management. Two young male patients aged 17 and 28 years respectively presented with mass in the anterior mediastinum. Histopathology of both cases revealed mixed germ cell tumor admixed with prominent vascular component. Interestingly, one case showed malignant vasoformative neoplasm (angiosarcoma) while in the other the vascular proliferation was of benign nature (venous hemangioma).

Duodenal gangliocytic paraganglioma: A rare cause for gastrointestinal polyp.

Duodenal gangliocytic paragangliomas are rare neoplasms often arising in the duodenum in close proximity to the ampulla of Vater. These neoplasms are considered to have a benign behavior with lymph node metastases being a rare phenomenon and distant metastases even more so. Although a standardized treatment has not been determined, a margin-free tumor resection seems to be the best treatment modality. We report herein the case of a 36-year-old female who presented with abdominal pain and was found to have a polyp in the second part of duodenum which was excised endoscopically. Histopathology and immunohistochemistry revealed characteristic features of this rare tumor.

Bullous Erythema Nodosum Leprosum as the First Manifestation of Multibacillary Leprosy: A Rare Phenomenon.

Erythema nodosum leprosum (ENL) may uncommonly present before treatment in patients with multibacillary leprosy. Atypical manifestations are known in ENL and may be clinically misleading. Such wide variations in the clinical presentation of leprosy in reaction make histopathology an important tool for supporting clinical diagnosis. We report bullous ENL presenting as the first manifestation of leprosy in a 30-year-old Indian man diagnosed using histopathology.

Primary dorsal spine primitive neuroectodermal tumor in an adult patient: Case report and literature review.

Primary spinal primitive neuroectodermal tumor (psPNET) is a rare entity with few cases reported in literature. We report a case of a 50-year-old female who presented to us with paraplegia and was diagnosed with extradural dorsal spine psPNET. The diagnosis was not suspected at presentation or on radiology but was established on histopathological examination. It is important to distinguish it from central nervous system primitive neuroectodermal tumors and from other spinal tumors since it follows a different clinical course and therapeutic outcome.

Nutrition assessment and its effect on various clinical variables among patients undergoing liver transplant.

BACKGROUND: Malnutrition is highly prevalent in patients undergoing liver transplantation and has been associated to various clinical variables and outcome of the surgery. METHODS: We recruited 54 adult patients undergoing living donor liver transplant (LT) as study sample. Nutrition assessment was performed by body mass index (BMI), BMI for ascites, albumin, subjective global assessment (SGA) and anthropometry [mid upper arm circumference (MUAC), mid arm muscle circumference (MAMC), and triceps skin-fold (TSF)], Hand Grip strength, and phase angle of the body. Prevalence and comparison of malnutrition was performed with various clinical variables: aetiology, Child Turcotte Pugh scores and model for end stage liver disease (ESLD) grades, degree of ascites, blood product usage, blood loss during the surgery, mortality, days [intensive care unit (ICU), Ventilator and Hospital], and Bio-impedance analysis [weight, fat mass, fat free mass (FFM), muscle mass and body fat%]. RESULTS: Assessment of nutrition status represents a major challenge because of complications like fluid retention, hypoalbuminemia and hypoproteinemia. Different nutrition assessment tools show great disparity in the level of malnutrition among ESLD patients. In the present study recipient nutrition status evaluation by different nutrition assessment tools used showed malnutrition ranging from 3.7% to 100%. BMI and anthropometric measurements showed lower prevalence of malnutrition than phase angle and SGA whereas hand grip strength showed 100% malnutrition. Agreement among nutrition assessment methods showed moderate agreement (κ=0.444) of SGA with phase angle of the body. Malnutrition by different assessment tools was significantly associated to various clinical variables except MELD and days (ICU, Ventilator and Hospital). SGA was significantly (P<0.05) associated to majority of the clinical variables like aetiology, child Turcotte Pugh grades, degree of ascites, blood product usage, blood loss during the surgery, BIA (fat mass, FFM, muscle mass and body fat%). CONCLUSIONS: The different nutrition assessment tools showed great variability of results. SGA showed moderate agreement with phase angle of the body and was associated with various clinical and prognostic variables of liver transplantation.