Clinicopathological Correlation Of Gastric Endoscopic Biopsies In A Tertiary Care Hospital In Rural Area In Haryana

The study included gastric endoscopic biopsies received in the department of pathology, MMIMSR,Mullana, Haryana. 130 gastric biopsies were included in the study. The most common presentingcomplaint was pain abdomen. The neoplastic lesions commonly presented as carcinoma whereas thenon-neoplastic lesions presented as inflammatory lesions on endoscopy. Non-neoplastic lesions werefound to be common out of which gastritis was the most common lesion. Associated conditions werefound to be H. Pylori and intestinal metaplasia with gastritis. Majority of the lesions were nonneoplastic, presenting with pain abdomen & inflammatory findings on endoscopy. The neoplasticlesions comprised of adenocarcinoma & signet ring cell carcinoma. 4 cases of signet ring cell carcinomawere noted. Percentage of concordance between endoscopic & histologic diagnoses was calculatedwherein cases of gastritis, ulcer, polyps & carcinoma showed 100%, 96.3%, 71.4% & 100%concordance respectively.The conclusion of the study was that histological examination in adjunct with endoscopy should beconsidered as much more valuable diagnostic tool rather than endoscopy alone.

Clinicopathological Correlation of Endoscopic Duodenal Biopsies in a Tertiary Care Hospital in Haryana

The study included endoscopic duodenal biopsies received in the department of pathology, MMIMSR,Mullana, Haryana. 44 biopsies were included in the study. The most common presenting complaintwas pain abdomen followed by diarrhea. The neoplastic lesions commonly presented as carcinomawhereas the non-neoplastic lesions presented as inflammatory lesions on endoscopy. Non-neoplasticlesions were found to be common with villous atrophy predominating the list. Majority of the lesionswere non-neoplastic, presenting with pain abdomen & inflammatory findings on endoscopy. Theneoplastic lesions comprised of adenocarcinoma. A single case of ampullary carcinoma was alsonoted. Percentage of concordance between endoscopic & histologic diagnoses was calculated whereinduodenitis, scalloping, polypoidal & carcinomatous lesions showed 100%, 60.7%, 0% & 100%concordance between the two diagnostic modalities respectively. The conclusion of the study wasthat endoscopic examination alone might miss out in diagnosing majority of the lesions. So, histologicalexamination in adjunct with endoscopy should be considered as much more valuable diagnostic toolrather than endoscopy alone.

Progression of hepatic aspergillosis following second renal transplantation in a patient with recurrent glomerulonephritis.

Invasive aspergillosis is a serious complication in renal transplant recipients. Hepatic involvement, although seen in liver transplant recipients, has not been reported following renal transplantation. We describe here an interesting occurrence of hepatic Aspergillus infection in a renal transplant recipient. The infection responded to anti-fungal therapy, but there was re-activation following a second renal transplant. In addition, the patient had recurrence of the underlying membrano-proliferative glomerulonephritis following both transplants. The relevant existing literature relating to these problems has been reviewed.

Renal histology in pauci-immune rapidly progressive glomerulonephritis: 8-year retrospective study.

Context: The need to perform reporting of renal biopsies of antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitides in a more uniform manner required relook at our eight-year data. Aims: To document detailed renal histopathology of pauci-immune rapidly progressive glomerulonephritis (RPGN) and also to seek any significant differences in renal histology of C-ANCA-positive, P-ANCA-positive, and ANCA-negative patients. Materials and Methods: A detailed analysis of the histopathologic features of renal biopsies of 48 patients in whom a diagnosis of pauci-immune glomerulonephritis was concluded on renal biopsy and who presented clinically as rapidly progressive renal failure was done. Statistical Analysis Used: One-way ANOVA and Pearson Chi square tests. Results: Compared with ANCA +ve patients, the ANCA -ve patients were much younger (46.85 ± 16.12 years vs 34.28±15.94 years). No significant differences were found between renal lesions of C-ANCA, P-ANCA, and ANCA-negative patients, except for diffuse tubular atrophy which was more severe and more frequently present with P-ANCA positivity (P value=0.013). Conclusions: Pauci-immune RPGN (irrespective of ANCA status) is a relatively rare disorder in patients who are undergoing the renal biopsy at our institute, constituting 2% of all renal biopsies submitted. It is mandatory to have ANCA serology status during reporting of a kidney biopsy showing pauci-immune crescentic or necrotizing glomerulonephritis. Also, if a uniform reporting strategy is followed throughout the country, the studies from this vast country will be comparable.

Spectrum of pulmonary adenocarcinoma with ultrastructural correlation: an autopsy study from northern India.

BACKGROUND: In the present study, we have evaluated the use of electron microscopy in subtyping pulmonary adenocarcinomas, comparing the ultrastructural findings with the diagnosis rendered by light microscopy. MATERIALS AND METHODS: The gross and histologic features of 16 autopsy cases of pulmonary adenocarcinoma were analyzed and compared with electron microscopic features. The cytologic phenotypes of these cases of well-differentiated pulmonary adenocarcinoma were determined by electron microscopic examination. More than 200 cells in each case were examined, and the tumors were classified according to the predominant feature noted. RESULTS: Eight cases were of Clara cell origin and one case each of type II pneumocyte and bronchial surface cell type. The remaining 6 cases lacked definite discernible features of differentiation towards any specific cell type, other than presence of small nuclear clefts in occasional nuclei. Tumors with Clara cell differentiation were low cuboidal with apical snouts. Type II pneumocyte tumor failed to reveal any characteristic definable as light microscopic feature. CONCLUSION: Ultrastructural examination is the only definite means of identification of various cell types in the respiratory epithelium and hence forms an invaluable tool in classification of pulmonary adenocarcinoma.

Carcinosarcoma of urinary bladder mimicking vesical calculus: a case report.

We report a 50 year old male who presented with a short history of gross hematuria. An ultrasonogram detected a mass arising from the right lateral wall of the urinary bladder. Computed tomography of the abdomen revealed that the mass was a calcified lesion mimicking a bladder stone. Cystoscopy confirmed the presence of the calcified lesion and biopsy revealed a rare biphasic tumor of the urinary bladder comprising of osteosarcoma and a papillary urothelial neoplasm of low malignant potential. The rarity of this tumor and its associated exuberant calcification make this case an interesting one.

Clinically unsuspected bilateral malignant pheochromocytoma.

Pheochromocytoma is an uncommon tumor and occurrence of bilateral malignant tumor is extremely rare. Labile hypertension is the common presenting feature of pheochromocytomas. Herein we describe one such case ofbilateral malignant pheochromocytoma, which was clinically silent except for pain and mass in hypochondrium. Histopathology showed features of malignancy along with hyaline globules, which are less described with malignant tumors. Electron microscopy showed neurosecretory granules in tumor cells.

Osteoarthritic femoral articular cartilage of knee joint in man.

Osteoarthritis is the most common of the various articular disorders affecting man. The present study was conducted to observe the microstructure of osteoarthritic human femoral articular cartilage by light microscopy. Fifteen osteoarthritic cartilage specimens obtained from patients with primary osteoarthritis (52-80 years) undergoing total knee replacement were processed for paraffin sections. 5 m thick sections were observed under light microscope. The articular surface appeared to be very irregular and fibrillated in all the specimens. The cartilage did not show the normal zonation. Various changes seen were different in all specimens and they were not related to age. Most common feature of the osteoarthritic articular cartilage was the presence of large clusters of cells in 60.0% specimens. Detached parts of the degenerating cartilage were present in the joint cavity in the form of loose bodies. The collagen fibres appeared to be coarser and irregular even near the non-fibrillated areas. Numerous tangential, oblique and vertical splits were also observed. Osteoblastic and osteoclastic activity was seen in the subchondral bone and the osteolytic cyst appeared to invade the cartilage from the subchondral bone. Blood vessels from the subchondral bone were also seen invading the cartilage in 20.0% specimens. The various changes seen in the osteoarthritic cartilage could be an effort of cartilage repair but such attempts are severely counteracted by the osteoarthritic wear process.

Filiform papillae in the mucosa of the human vaginal wall.

BACKGROUND & OBJECTIVE: While giving the gross anatomy of the mucosa of the vagina, textbooks of Anatomy and Obstetrics and Gynaecology describe the presence of a median longitudinal ridge on its anterior wall (columna rugarum anterior) and another similar ridge (columna rugarum posterior) on its posterior wall is described, and transverse rugae separated by sulci of variable depth, extend bilaterally from these ridges. While conducting autopsy of female cases the routine examination of vaginal mucosa did not show the presence of longitudinal ridges. In addition, some small areas bearing filiform papillae were seen in the lower third of the vagina in young subjects. As these papillae have not been described earlier, it was decided to study them in detail using scanning electron microscopy. METHODS: A total of 215 vaginal specimens were studied. At autopsy the vagina was slit open on the lateral sides up to the upper ends of the lateral fornices. The anterior vaginal wall was turned up over the uterus and mucosa of both walls examined macroscopically. In 16 subjects, small pieces of vaginal mucosa bearing filiform papillae were cut out and processed for examination under scanning electron microscope (SEM) and a light microscope. In addition, vaginae of 55 married women (20-40 yr age) with complain of lower abdominal pain or infertility were examined particularly for the median longitudinal ridges on the vaginal walls. RESULTS: At autopsy, the two median longitudinal ridges were not seen in any instance. Small variable areas of the lower third of the vagina showed the presence of filiform papillae on the two walls and at sides; they were prominent in the young individuals and tended to become absent in multipara and in old age. They were 2 to 3 in number on each wall. Histologically the papilla showed a core of highly vascular connective tissue covered by non-keratinized squamous epithelium. Immunoperoxidase staining with S-100 showed a large number of small nerve fibres in the subepithelial tissue which seemed to be more than in the surrounding areas not covered with papillae. INTERPRETATION & CONCLUSION: Anterior and posterior median longitudinal ridges were not seen on the vaginal mucosa in the autopsy specimens. In all autopsy specimens of young subjects between the ages of 15 and 40 yr, variable areas bearing filiform papillae were observed on the mucosa of the lower third of the vagina. Further studies need to be done to throw light on the role of these papillae.

Histopatholgical spectrum of thymic neoplasms: twelve-year experience at a referral hospital in north India.

This study was undertaken to determine the histopathological spectrum and clinical profile of thymic neoplasms at a tertiary referral care centre. A total of 96 thymectomy specimens were received during the study period (1992-2004), which consisted of 54 neoplasms and 42 benign lesions. Among the neoplasms there were 48 thymic epithelial tumors, 3 thymolipomas and 3 thymic carcinoids. The former comprised of 36 male (75%) and 12 female patients (25%) ranging in age from 2-70 years (mean 37 years). Among paraneoplastic syndromes in thymic epithelial tumours, 27 out of 48 (56.25%) cases were associated with myasthenia gravis and one case was associated with pure red cell aplasia. The most frequent histological subtype was cortical thymoma (43.24%) followed by predominantly cortical (24.32%) and well-differentiated thymic carcinoma (18.92%). On staging, all cases of mixed and predominantly cortical subtype were stage 1 whereas one medullary and 2 cortical thymomas and 4 well differentiated thymic carcinoma (WDTC) showed pleural and pericardial invasion (stage III). This study has revealed that half of thymic epithelial tumours presented as myasthenia gravis. The cortical thymoma was the most frequently encountered histologic subtype and most commonly associated with myasthenia gravis.

Unusual eosinophilic variant of chromophobe cell renal carcinoma--an ultrastructural diagnosis.

A case of eosinophilic variant of chromophobe cell renal carcinoma (EVCCRC), an uncommon variety of renal cell carcinoma, occurred in a 72 year old male. The most problematic differential diagnosis was renal oncocytoma, as the two entities share overlapping features on histology, yet differ completely in biological behavior. EVCCRC is a potentially malignant neoplasm whereas renal oncocytoma is totally benign. Staining with Hale's Colloidal Iron using modified Mowry's technique showed granular cytoplasmic positivity. The diagnosis was confirmed by ultrastructural examination of the tumor which revealed unique features of EVCCRC like presence of numerous cytoplasmic microvesicles along with mitochondria displaying tubulo-vesicular cristae. This case delineates the role of electron microscopic examination as the sole means to differentiate EVCCRC from renal oncocytomas.

Fetal rhabdomyoma in a neonate.

Rhabdomyoma is a rare benign tumour, majority arising from the cardiac muscle. Seventy to 90 percent of extra cardiac rhabdomyomas are found in the head and neck region, usually within the upper aero digestive tract. We report a case of rhabdomyoma of anterior neck in a neonate. Although rhabdomyomas of posterior neck have been reported, those reported in anterior triangle are infrequent. The lesion has not recurred one year after complete excision. There are no similar reports in Indian literature.

Pathological spectrum of cytomegalovirus infection of renal allograft recipients-an autopsy study from north India.

This is a retrospective study of autopsy material to highlight the histo-morphological changes in cytomegalovirus (CMV) infection amongst renal allograft recipients. Nineteen out of 80 patients (23.75%) autopsied during a seventeen-year period (1985-2001) had CMV infection. Pulmonary infection was present in 14 out of 19 cases of which four had isolated lung involvement. Likewise, there were two cases each of isolated oesophageal and renal involvement; one case with isolated colonic involvement. The other 10 cases had multi-organ involvement and the organs involved were kidneys (4), esophagus (6), stomach (1), colon (5), adrenals (3), pancreas (3), liver (1) and spleen (1). Pulmonary infection with CMV was associated with acute pneumonitis in 3 cases and lymphocytic interstitial pneumonitis in 9 instances. Four out of 6 cases had acute tubulo-interstitial nephritis induced by CMV and only two cases had no significant inflammatory response. Glomerular involvement in the form of CMV inclusions in the glomeruli was present in only one case. Gastrointestinal CMV infection (15) presented as acute necrotizing ulceration because of predominant endothelial involvement. Post transplant survival period varied from one month to three years, with majority (14) of the patients having survived for less than one year.

Viral infections of renal allografts--an immunohistochemical and ultrastructural study.

Viral infections have been recognized as an integral part of both graft injury and rejection. On routine histology, viral infections are diagnosed only when fully established, by the presence of viral inclusions or cytopathic effect. Although renal transplants are routinely done in many centres in India, the incidence of viral infections is largely unkown. This study was aimed at detecting 5 viral infections namely, cytomegalovirus (CMV), BK polyoma Virus (BKV), Herpes Simplex Virus1 and 2 (HSV1 and 2) and Epstein Barr Virus (EBV) in renal biopsies from 321 renal allograft patients, using immunohistochemical and electron microscopic studies. Sixty two biopsies were selected from a total of 414 (belonging to 321 patients) for immunostaining on the basis of features suspicious of viral infections in hematoxylin and eosin stained sections. Immunostaining confirmed CMV infection in 8 biopsies, BKV infection in 31 biopsies and HSV1 in only 2 biopsies. HSV2 and EBV were not detected in any biopsy. Two biopsies showing CMV immunopositivity and 5 of BKV were further processed for electron microscopy, which supported the diagnoses. Thus, the study highlights the prevalence of BKV and CMV infections in renal transplant patients having graft dysfunction, to be 9.3% and 1.9%, respectively. Besides, only one case each was diagnosed as CMV infection and BKV infection in routine histopathological reporting, establishing the importance of immunohistochemical studies in early diagnosis of these viral infections.