Study of Hematological Alterations in Malaria at a Tertiary Health Care Center of South Gujarat, India

Background: Malaria is a disease with a great global burden. It is one of the most prevalent parasitic infection common intropical, subtropical countries, particularly Asia and Africa. Malaria causing plasmodia is parasites of blood and hence induceshematological alterations. The hematological changes that have been reported to accompany malaria include anemia,thrombocytopenia, leukocytosis as well as leukopenia, mild-to-moderate atypical lymphocytosis, monocytosis, eosinophilia,and neutrophilia. Hence, the present study is undertaken to evaluate the various hematological parameters affected in malariaand to observe the variations, if any, in Plasmodium falciparum, Plasmodium vivax, and mixed infections.Materials and Methods: The present study was carried out in the Department of Pathology at Tertiary Health Care Centerof South Gujarat from August 2018 to October 2018. A total of 480 smear-positive malaria cases were analyzed and varioushematological parameters were studied.Results: Out of 480 smear-positive cases, P. vivax was positive in 77% of cases, P. falciparum was positive in 22% of casesand mixed infection in 1% of cases. Most of the cases were seen in the age group of 21–40 years. Anemia was seen in 53.1%of cases. Normocytic normochromic blood picture was the most common type in anemic patients (46.6%). Thrombocytopeniawas seen in 84.58% of the patients. Out of which, 75.86% were affected by P. vivax, 23.15% were affected by P. falciparum,and 0.98% were affected by the mixed infection. About 28.75% of cases showed hematological features of leukopenia, and5.2% of cases were having leukocytosis.Conclusions: Various hematological findings can help in early diagnosis of malaria which is essential for timely and appropriatetreatment which can limit the morbidity and prevent further complications

Histomorphological Spectrum of Ovarian Lesions in a Tertiary Care Institute in Gujarat with Special Emphasis on Ovarian Tumors

Introduction: Ovarian cancer is the third most common cancer among women of India. Microscopic examination is the goldstandard for diagnosing ovarian tumors and plays an important role in determining prognosis.Purpose: The aim of the study is to assess the frequency of non-neoplastic and neoplastic lesions in ovarian specimens andbiopsies and to study the histomorphological spectrum, gross features, and age distribution of the ovarian tumors.Materials and Methods: The present study was an observational retrospective study conducted over a period of 1 year(February 2019–January 2020) in the Department of Pathology in a Tertiary Care Hospital in South Gujarat. A total of cases (8ovarian biopsies and 82 ovarian specimens) were analyzed. Tumors were classified according to the WHO classification 2014.Results: Of 90 cases, eight were of non-neoplastic lesions, 13 were tumor-like lesions, and nine neoplastic lesions. Amongneoplastic lesions, 43 cases (62.3%) were benign, 3 (4.4%) were borderline, while 23 (33.3%) cases were malignant.Histopathologically, surface epithelial tumors (76.7%) were the most common subtype followed by germ cell tumors (13.3%)and then sex cord tumors (10%). Malignant surface epithelial tumors constitute 78.2% of the total malignant ovarian tumors. Themost common neoplastic lesion was serous cystadenoma. 30–39 years age group was the most common age group overall inovarian tumors. Benign tumors were most common in the 30–39 years age group, while malignant tumors were most commonin the 60–69 years age group. Bilaterality was seen in 10 (16.4%) of 61 gross specimens of ovarian tumors.Conclusion: The frequency of malignant ovarian tumors was higher in our institute. Accurate histopathological diagnosis isessential for management and determining prognosis

Calcifying fibrous tumour: a rare case report of an exceptional lesion localized in retroperitoneum, mesentery and pelvis

Calcifying fibrous tumours are rare benign lesions affecting mostly children and young adults. A 17-year-old female presented with abdominal pain and abdominal distention. Physical examination revealed intra-abdominal mass occupying retro peritoneum and right iliac fossa. Excisional biopsy from peritoneum and mesentery were performed. Histopathologically, it was composed of hypocellular hyalinised collagenized stroma, spindle cells, psammomatous and dystrophic calcification and mononuclear inflammatory cell infiltration. Authors are here in reporting a case of calcifying fibrous tumour and discussing its clinical and morphological features with regard to the literature.

Plasmablastic lymphoma of transverse colon: a rare case report

Plasmablastic lymphoma (PBL) is a rare aggressive subtype of non-Hodgkin's lymphoma with large neoplastic cells. It is usually associated with human immunodeficiency virus (HIV) infection but also identified in patients with solid organ transplantation and in immunocompetent patients. It frequently presents as a mass in oral cavity, but has also been described in other extra-oral sites like gastrointestinal track, skin, genitourinary track, nasal cavity, paranasal sinuses, etc. It is characterized by plasmablastic features and an immunoprofile close to plasma cells, Epstein–Barr virus (EBV) positivity and MYC gene dysregulation. We report a case of a 40 year old HIV positive male who presented with intestinal obstruction having mass in transverse colon. Histopathological examination of the excised mass revealed submucosa and muscularis propria infiltrated by monotonous population of medium to large sized lymphoid cells with plasmacytic differentiation. The tumour cells were immunoreactive for EMA, CD138 and Vimentin and immunonegative for LCA, CK, S-100, Chromogranin, CD20, CD30, CD3. Thus the final diagnosis of Non-Hodgkins Lymphoma – Consistent with Plasmablastic Lymphoma was made. PBL should be carefully differentiated from Plasmablastic Plasma cell myeloma, other CD20 negative B-cell neoplasma i.e. primary effusion lymphoma, anaplastic lymphoma Kinase (ALK)-positive large B-cell lymphoma, large B-cell lymphoma arising in human herpesvirus 8 (HHV-8)-associated multicentric Castleman disease.

Pattern distribution of abnormal hemoglobin variants by cation exchange High Performance Liquid Chromatography: a study of 9,116 subjects

Background: The present study was conducted to identify pattern distribution of abnormal haemoglobin variants by using HPLC method in a tertiary care hospital, Surat, Gujrat, India.Methods: A cross sectional study of one-year duration was conducted including 9,116 patients screened for the presence of abnormal haemoglobin variants. Blood samples were initially tested for solubility test and run on automated haemoglobin analyzer for complete haemogram. All the suspected and family study cases were processed for HPLC (Bio-Rad Variant II) for conclusive diagnosis. Patients with a history of recent blood transfusion of less than 3 months duration were excluded from the study.Results: A total of 9,116 cases (1390 males, 7726 females) were included in the present study. The age group of patients ranged from 1 month to 95 years. Solubility test and complete haemogram were performed in all the cases. Out of the 9,116 cases, 8409(92.24%)cases had normal HPLC pattern. 492(5.40%)cases were diagnosed as sickle cell trait, 176(1.93%) cases as sickle cell disease, 29(0.32%) cases as β thalassaemia trait, 1(0.01%) case as β thalassaemia major, 2(0.02%)cases as Hb E heterozygous and 03 (0.07%) cases as Hb D Punjab heterozygous. One case of double heterozygous for Hb E-β thalassaemia was also found.Conclusions: HPLC is a rapid, accurate and useful method for diagnosing haemoglobinopathies. It serves as an reliable tool in diagnosing the presence of abnormal haemoglobin variants in suspected cases on routine haematology in developing countries like India, where the resources for detection of haemoglobinopathies are limited. Early diagnosis may help in proper management of patients.

Utility of Papanicolaou’s smears in the diagnosis of premalignant and malignant lesions of the cervix in a tertiary care centre of South Gujarat, India

Background: "Preventable but not prevented", this is the reality of cervical cancer today, at least in developing countries. 80% of all the cases of cervical cancer occur in these developing countries. In India, cervical cancer is the leading cause of cancer related deaths in women. The Papanicolaou test is simple, quick, and painless. It is capable of detecting cervical cancer at an early stage and is used widely in developed countries, where it has decreased both the incidence and mortality of cervical cancer. Objective of the study was conducted to determine the importance of conventional Pap smears for the diagnosis of inflammatory, premalignant and malignant lesions of the cervix.Methods: This cross-sectional study was conducted from January 2017 to June 2018 on 2000 women coming for a Pap smear examination in Government Medical College attached to New Civil Hospital, Surat. After doing Pap stain, all cases were reported as per the 2014 Bethesda system.Results: A total of 2000 cases of Pap smears were received out of which 1914(95.7%) cases were satisfactory for evaluation, 86(4.3%) cases were unsatisfactory. The frequency of epithelial abnormalities was 3.66%. The age group of 51-60 years showed the highest epithelial abnormalities. The frequency of epithelial abnormalities in asymptomatic women was 2.3%. Out of the 1844 cases, 103(5.6%) showed changes of atrophy, 1011(54.8%) cases showed inflammatory/reactive changes, whereas organisms were seen in 558(30.3%) cases.Conclusions: Pap smear happens to be an economical, safe and pragmatic diagnostic tool for early detection of cervical cancer.

Role of HRCT temporal bone in pre operative evaluation of choesteatoma.

Background: Cholesteatoma is potentially dangerous condition as it can extend and erode into adjacent structures and can cause various serious complications. HRCT temporal bone very clearly depicts the anatomy of various small important structures in middle and inner ear cavity. Hence it is an excellent modality and investigation of choice in diagnosing and defining the extent of cholesteatoma. It has become essential investigation in preoperative planning for surgeon. Present study shows good correlation of various preoperative HRCT findings with intraoperative findings. Aims & Objective: To study the role of HRCT temporal bone in pre-operative evaluation of cholesteatoma. Material and Methods: Total 35 cases with clinically suspected cholesteatoma were selected for this study. All the patients were from Sir Sayajirao General Hospital, Vadodara and were scanned at the CT scan, Radiology Department of the hospital. The important intra-operative surgical findings were correlated with pre-operative HRCT findings. The results were analyzed, studied and compared with similar studies of the past. Results: Present study shows good correlation between the preoperative findings of cholesteatoma by HRCT temporal bone and intraoperative surgical findings. Conclusion: In present study HRCT enabled the pre-operative delineation of the cholesteatoma and the recognition of its manifestations and complications. HRCT is confirmed to be valuable in the diagnosis and in guiding the surgical management of cholesteatoma.