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The immunological assessment at molecular profiling of K-Ras, p53 and Ki-67 along with EGFR, BRAF and others like BCL-2 has been the focus of several workers. The incidence of colorectal adenomatous polyp with dysplastic changes and colorectal carcinoma per se in the context of Indian population as per the ICMR registry, New Delhi, India, is significant. We wanted to study precancerous lesions (adenoma, polyp) and adenocarcinoma of colorectum for the expression of K-Ras, p53 and Ki-67 in biopsy or surgical specimen of colon by immunohistochemistry for its occurrence. We also wanted to study the intratumor heterogeneity of aforesaid expression for the purposes of prognostication and correlation with other clinicopathological parameters. MethodsThis is a cross sectional study conducted in the Surgical Pathology and Division of Immunohistochemistry, Department of Pathology, Jawaharlal Nehru Medical College, Sawangi (Meghe), Wardha, Maharashtra, India, for a duration of 2 years. Total seventy patients of all ages and genders suspected of 1) precancerous lesions of adenomas and polyps (35 cases) and 2) adenocarcinoma on colonoscopic biopsy or surgical specimens (35 cases) were included in the study. The expression of K-Ras, p53 and Ki-67 as primary objectives along with EGFR, BRAF and others like BCL-2 as secondary objectives were recorded, tabulated and compared for the purposes of predictive parameters in colorectal neoplastic lesions. ResultsMost of the cases of CRC were over the age of 50 years and Male:Female ratio was 5:3.Twenty-five cases of group 2 (CRC) showed positive IHC for K-Ras. p53 was detected in 28 cases and high Ki-67 index was observed in all 32 cases of CRC. The comparative statistics in the pilot study showed that the immunoexpression of K-Ras, p53 and Ki-67 is significantly higher in group 2 (CRC) compared to cases in group 1 (polyps) and group 3 (normal). ConclusionsExpression of K-Ras, p53 and Ki-67 is likely to be the distinguishing tissue biomarkers between benign and malignant colorectal disease process as well as have prognostic and predictive value in colorectal cancer. The addition of EGFR, BRAF and BCL-2 would help in determining the pathogenesis and offer targeted therapeutic intervention.
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Background: Mild microcytic hypochromic anaemias due to iron deficiency (IDA) and beta thalassemia trait(β-TT) continue to be a cause of significant burden to the society, particularly in the poorer developing countries. The objective of the present study was to study the RBC based indices in patients of marked anisopoikilocytosis in determining the etiology of it, to standardize few automated red cell parameters, and also objective grading of RBC morphology on peripheral smear and interpreting its utility in indicating a diagnosis. Also, to establish a relation between value of RBC indices with that of degree of anisocytosis.Methods: A total of 500 patients diagnosed with mild microcytic hypochromic anaemia on complete blood count and peripheral blood film were included in the study. Hb, RBC count, MCV, MCH and RDW obtained from the electronic cell counter were used to calculate discrimination indices by various mathematical formulae. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and Youden’s index (YI) were calculated.Results: Green and King index demonstrated the lowest sensitivity of 70.51%. Mentzer index demonstrated the highest specificity of 96.80%. The highest and lowest PPV were found for Mentzer index (97.09%) and Sehgal index (92.81%) respectively. Sehgal’s index demonstrated the highest NPV of 95.96% and lowest NPV was exhibited by G and K (87.9%). The highest and the lowest values for Youden’s index were shown by Sehgal’s index (87.82%) and G and K index (68.47%).Conclusions: Sehgal’s index followed by Mentzer index are highly sensitive and reasonably specific in differentiating β-TT from IDA and none of the indices is 100% sensitive and specific. Though HbA2 estimation is the gold standard for diagnosing β-TT, in developing countries, Sehgal index followed by Mentzer et al, index can be used to screen mild microcytic hypochromic anaemia cases to eliminate as many false positive cases as possible to reduce the financial cost.
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Leprosy is a chronic disease of ancient world and is still afflicting patients in many parts of world mainly Asia and Africa. Leprosy is one of the most dreaded diseases of humankind. We wanted to study the various microscopic patterns and subtypes of Leprosy. We also wanted to study the Bacterial Index in the region of Sawangi, Meghe.METHODS80 skin biopsies after adequate fixation in 10% of formalin, were routinely processed and were stained with H and E, Fite-Faraco stain and Modified Rapid Acid-Fast Bacilli (MRAFB staining) method, were studied microscopically and bacterial index was calculated.RESULTSA total of 80 skin biopsies were obtained from patients of department of dermatology over a period of two years from 2017 to 2019. Among them Lepromatous leprosy were 43 cases, Tuberculoid leprosy were 23 cases, Borderline lepromatous leprosy were 09 cases, Borderline tuberculoid leprosy were 03 cases, histoid leprosy were 01 case and ENL were 01 case. With an age range of 6 - 85 years, majority were in 31-40 years of age group, with male to female ratio of 2.47:1. LL was the most common type of leprosy (53.75%).CONCLUSIONSAccurate diagnosis of leprosy purely on clinical grounds is extremely difficult. Hence, there can be false positive and false negative diagnosis. Since histopathology is confirmatory, with application of Fite-Faraco and MRAFB staining it can also evaluate the bacterial load. Hence in all suspected cases of leprosy, histopathology along with Fite-Faraco and MRAFB staining should compulsorily be done.
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Liver plays a central role in the maintenance of haemostasis. Impairment of liver parenchymal cell function disturbs haemostasis resulting in the development of multiple coagulation abnormalities. We wanted to study the coagulation profile and haemostatic dysfunction in liver disease patients so as to prevent bleeding related complications and evaluate the relationship between bleeding tendencies and coagulation profile abnormalities in such patients.METHODSThis was a cross sectional study conducted in the Department of Pathology, JNMC, A.V.B.R.H, Sawangi, Wardha, from August, 2017 to July 2019 among 102 patients of liver diseases. PT, D-dimer, and platelet count were assessed in different liver diseases. Data was entered in MS Excel spreadsheet and analysis was done using Statistical Package for Social Sciences (SPSS) version 21.0. A p value of <0.05 was considered statistically significant.RESULTSA total of 102 patients were included in the study. Mean age of the patients was 40.07 ± 15.21 years. 69.61% patients were males. Fever with abdominal distension was the most common complaint. Mean with SD of Child Pugh score was 8.31±2.3 and Mean with SD of MELD score was 13.1±8.24. For predicting cirrhosis and other chronic liver disorders, out of all coagulation parameters, D-Dimer showed the best diagnostic accuracy.CONCLUSIONSPresent study showed an overall good diagnostic power of coagulation parameters in assessing different liver diseases and also showed that D-dimer may be regarded as a stable and good predictor for chronic liver diseases.
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Background: The liver is a common site for primary and secondary tumors; most often from malignant tumors within the abdomen and from extra-abdominal primary malignant neoplasm, but also for sarcomas and lymphomas. The main indication of fine-needle aspiration cytology (FNAC) of the liver is diagnosis of single or multiple space occupying lesions. This study aims to evaluate the cyto-morphology of primary and secondary neoplasms of liver and non-neoplastic conditions in the smears of ultrasound guided fine needle aspiration of SOL of liver, to evaluate the cytomorphologic features and to evaluate the erroneous diagnosis when compared with cell block preparation of aspirate (tissue diagnosis).Methods: This study is hospital-based prospective study including 57 patients with space occupying lesion of the liver mass. FNAC were carried out under the guidance of sonography and/or computed tomography. The staining performed were conventional for smears of the aspirate. The cell blocks were prepared from the aspirates by the established procedures. The values of correlation were bought out.Results: Males predominated over females. The distribution of cases for cyto-diagnosis were as follows; cirrhosis with hepatic granulosa (3 cases),pyogenic abscess (3 cases), hepatic adenoma (2 cases), Focal nodular hyperplasia (2 cases), hepatoblastoma (1 case), hepatocellular carcinoma (17 cases), adenocarcinoma deposits (20 cases), deposits of small cell carcinoma (3 cases), deposits of ductal carcinoma (2 cases) and 1 case each of deposits of squamous cell carcinoma, non-Hodgkin’s lymphoma, neuroendocrine tumor and adeno-squamous carcinoma. Values of correlation were as follows: sensitivity 97.61%, specificity 100%, PPV 100%, NPV 97.82% and diagnostic accuracy of 98.85%.Conclusions: FNAC is concluded to be first rank diagnostic procedure in diagnosis of SOL of liver of varied etiology with high values of NPV and PPV. It is also concluded that it helps in staging of metastatic malignancies.
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Background: The aim was to study the cytomorphology of neoplastic lesions of brain and spinal cord by intraoperative squash cytology, compare it with the histopathological diagnosis on excision biopsy/surgical specimen and establish a correlation. The causes of erroneous diagnoses achieved at squash cytology of intracranial and spinal cord tumors were ascertained. Tumor types having the advantage of diagnostic certainty by squash cytology of intracranial and spinal cord lesions was also determined. Methods: Squash preparations of 70 patients suspected to have neoplasia were made and stained with rapid hematoxylin and eosin stain and rapid Papanicolaou stain. A few squash smears were also dry fixed and stained with Giemsa stain. The smears were typed according to the cytomorphological criteria and the cytodiagnoses was compared with the histopathological diagnoses and a correlation was established. Results: A positive predictive value for intraoperative squash cytology for diagnosis of intracranial and spinal cord tumors was seen to be 100% and a negative predictive value of 97.22% were established by this study. The sensitivity was found to be 97.22% and the specificity was 100%. Thus, the accuracy of the study was 98.57%. Conclusions: Squash smear cytology of the brain and spinal cord tumors performed intraoperatively for diagnostic consultation fulfills all the determinants of an excellent diagnostic modality.
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Background: Regular screening of levels of glycosylated hemoglobin and microalbuminuria, diabetic nephropathy can be prevented. The aim was to assess and compare the levels of glycosylated hemoglobin, microalbuminuria and serum creatinine in type 2 diabetic patients divided in groups of those on default antidiabetic treatment compared with those on regular antidiabetic treatment and to assess its correlation in type 2 of diabetic nephropathy. Methods: Two hundred diabetic patients above 40 years of age and 200 age matched control subjects with levels of glycosylated hemoglobin < 6.5% and on regular antiglycemic therapy were selected. Fasting plasma sugar was estimated by the glucose oxidase (GOD) - glucose peroxidase (POD). Glycosylated hemoglobin and microalbuminuria level was measured by the immunoturbidimetric method and serum creatinine estimation was done by the Jaffe’s kinetic method. p value was drawn using the student’s paired t-test. Results: There is a strong correlation between the increase in the levels of glycosylated hemoglobin with the corresponding rise in the levels of microalbuminuria and serum creatinine. Conclusion: Periodic surveillance of the levels of microalbuminuria should be carried out in the type 2 diabetic patients to prevent further damage by early detection of diabetic nephropathy.
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Background: Intra-operative consultation by frozen section is a high risk procedure with important consequences. Therefore it is critical to determine efficiency of frozen section performance periodically. This study was performed to determine accuracy of frozen section. Methods: In this prospective study, we compared the results of 100 consecutive cases of frozen section with their final permanent section diagnosis in a teaching hospital of Jawaharlal Nehru Medical College, Wardha, Maharashtra during July 2012 to June 2014. Results: A total of 100 cases were studied on frozen section while one case was deferred for permanent paraffin section (deferral rate 01%). The overall accuracy of frozen section was 96.96% with false positive and false negative rates of 1.01% and 2.02% respectively. Sensitivity, specificity, positive predictive value and negative predictive value were 97.22%, 96.30%, 98.59% and 92.86% respectively. The turn-around time of 18 minutes was observed in the present study. Conclusions: The accuracy of frozen section diagnosis at our institute can be interpreted as comparable with most international quality control statistics for frozen sections. The overall error rate and deferral rates are within the range previously published studies. The results suggest specific measures should be taken to reduce the number of discrepancies.
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Chronic tophaceous gout classically occurs after 10 years or more of recurrent polyarticular gout. However, tophi can also occur as first sign of the disorder. Here we report a 20-year-old male presenting with multiple subcutaneous nodules on bilateral feet and toes, left palm, right elbow, helix of left ear since last one and half year prior to any other manifestation of gout. He was having mild intermittent arthritis since last six months. Fine Needle Aspiration Cytology of one tophus showed monosodium urate crystals, which are pathognomonic for gout. His serum uric acid was normal and ultrasound revealed bilateral nephrocalcinosis. So far as we know, this is the first case report from India, demonstrating tophi as the initial clinical presentation of gout.