Endometrial Secrets Unmasked through Cytology Analysis.

Background: Endometrial aspiration (EA) is an economic, painless technique on an outpatient basis. Present study aimed at cytological evaluation of EA for (a) cellular yield and morphology and (b) utility of cell block (CB) and cytocentrifuge (CC) techniques. Materials and Methods: EA samples were divided into two aliquots. Colorless samples were processed (1000 rpm × 6 min) for conventional smear (CS) and CC, both stained by Papanicolaou. Hemorrhagic samples were processed for CS and CB (paraffin embedding, hematoxylin-eosin stain). Results: Endometrial aspirates from January 2021 to January 2022 were included. Indications comprised abnormal uterine bleeding (AUB; 87), prolapse (eight), and infertility (two). Among 77 hemorrhagic aspirates, the yield was 85.7% by CS and 90.9% by CB. Among 20 colorless aspirates, the yield was 55% by CS and 65% by CC. The yield was 85.7%, 84.4%, and 83.3% with endometrial thickness 1-5, 6-10, and 11-15 mm, respectively. The yield was 83.9%, 50%, and 0% in AUB, prolapse, and infertility, respectively. CS morphology showed the categories of benign (93.5%) and atypia (6.5%). All cases with benign morphology correlated with CB and CC. CB offered architectural evaluation, while CC had a shorter turnaround time. Conclusion: Focusing on menorrhagia cases in secretory phase, nondilution of EA samples, and simultaneous endometrial biopsy can enhance cytology evaluation. In an era where "less should convey more," EA shows potential as a screening technique vis-à-vis invasive "dilatation-curettage" technique.

Pulmonary tumor thrombotic microangiopathy in an unknown primary cancer.

Pulmonary tumor thrombotic microangiopathy (PTTM) is a highly fatal complication of cancer leading to acute cor pulmonale and pulmonary hypertension. We present a case of 47-year-old male patient who developed acute breathlessness and died suddenly. The pulmonary vessels at autopsy on histopathologic examination showed the presence of fibrocellular intimal proliferation, fibrin thrombi and few tumor emboli consisting of malignant adenocarcinoma cells. There was associated lymphangiosis carcinomatosis. No primary visceral tumor was found despite extensive search. The patient had died following acute cor pulmonale with sudden pulmonary hypertension due to PTTM. This entity (PTTM) must be kept as a differential diagnosis in patients presenting with acute breathlessness especially in cases of cancers.

Alfa-fetoprotein secreting ovarian sex cord-stromal tumor.

Ovarian sex cord-stromal tumors are relatively infrequent neoplasms that account for approximately 8% of all primary ovarian tumors. They are a heterogeneous group of neoplasms composed of cells derived from gonadal sex cords (granulosa and Sertoli cells), specialized gonadal stroma (theca and Leydig cells), and fibroblasts. They may show androgenic or estrogenic manifestations. We report such a tumor associated with markedly raised serum alpha-fetoprotein (AFP) levels in a young female presenting with a mass and defeminising symptoms. Serum AFP levels returned to normal on removal of tumor.

Loose cell clusters with vascular coats: Zellballen pattern of paraganglioma on cytology.

Paragangliomas are uncommon tumors arising in paraganglion tissue, which is well represented in the head and neck. A correct pre-operative cytological diagnosis helps in planning early and optimal surgery. Cytologic features in carotid body tumor and extra adrenal paragangliomas have been well described and documented. In addition to the acinar and discrete arrangement of cells, smears also showed a few large loose clusters of cells enveloped by thin vascular channels-the so-called zellballen pattern, a diagnostic feature on histopathology. Zellballen pattern of paraganglioma on cytology is not a common finding and hence is being reported.

Epithelioid sarcoma and squamous cell carcinoma arising in a burn scar.

Development of a malignant tumor is a well known complication of a chronic burn scar. Most of these tumors are squamous cell carcinomas and only 28 cases of burn scar sarcomas have been reported in literature. We report the first occurrence of the combination of squamous cell carcinoma and epithelioid sarcoma arising in a burn scar.

Profiles of Alzheimer's disease-related pathology in an aging urban population sample in India.

Systematic studies on Alzheimer's disease (AD)-related pathology that complement clinical and epidemiological data on dementia from low and middle income countries are rare. We report the first large study on AD-related pathology in autopsy service-derived brains from an urban center in India, a low/middle income country, and compare findings with a similar sample from New York. Amyloid-ß plaques and neurofibrillary tangles were assessed in 91 brain specimens derived from hospital autopsy cases from Mumbai, India (age 60+ years; mean age 71.1 years, ± 8.3 SD; range 60-107 years) and compared with identically examined age-matched sample obtained in New York. These cases had no known clinical history of dementia. Our study showed that in comparison with the New York sample, the mean brain weight of the Mumbai sample was lower (p = 0.013) and mean diffuse plaque density was higher (p = 0.019), while differences in mean density and counts of neurofibrillary tangles and neuritic plaques were not statistically significant (p > 0.05). Our findings indicate that the burden of AD-related pathology was approximately equivalent in Mumbai and New York samples, which is at variance with expected lower AD-related lesion burden based on the clinical/epidemiological studies suggesting lower prevalence of AD in India.

The surgical pathologist and laparoscopic gynecologic surgeries.

BACKGROUND: Laparoscopic surgery is a recent advance in the field of gynecological surgery. There are innumerable reports in literature on its advantages and disadvantages. However, problems faced by the surgical pathologist during grossing and histopathological reporting of these morcellated specimens have never been discussed before. We present our experience and the difficulties faced by a gynecologic pathologist (first author) and try to provide some clues for their solution. MATERIALS AND METHODS: Sample size was 153 consecutive laparoscopic specimens, which varied from in toto uterus with cervix, fibroid or ovarian cyst to morcellated specimens. 153 non-laparoscopic gynecologic specimens constituted controls; 34.0% were ovarian cystectomies and remaining 66.0% were hysterectomies, myomectomies and salpingectomies, of which 36.6% were morcellated, rest were in toto. RESULT: Contents were not seen in majority of the ovarian cystectomies. Many more sections were taken in morcellated specimens, as compared to controls, for identification of endometrium, endocervix and ectocervix. Even then, in occasional cases identification was not possible. Congested bits in morcellated specimens interpreted as endometrium on grossing turned out to be parametrial tissue. Ectocervix could be identified as soft tissue bits covered by whitish membrane. Identification of transformation zone of the cervix was not possible in any of the morcellated hysterectomy specimens. CONCLUSION: The advantage of laparoscopic gynecological surgery to the patient need not prove to be so for surgical pathologist. The present study does not discourage gynecologists from performing laparoscopic surgeries but wishes to highlight the surgical pathologist's problems and limitations.

Vitreous humor: biochemical constituents in estimation of postmortem interval.

Analysis of biochemical constituents of the vitreous humor can be useful in determining the postmortem interval as there is proportionate postmortem rise of potassium and fall in sodium concentration. We studied 120 autopsy cases to determine the utility of potassium, sodium, calcium, and chloride levels, and sodium/potassium ratio in estimating the postmortem interval. There was a linear relationship between vitreous potassium concentration and postmortem interval, whereas an inverse relationship between vitreous sodium/potassium ratio and postmortem interval was noted. Other factors like age, sex, cause of death, season of death, and refrigeration of sample did not influence the vitreous humor potassium values. Using the statistical tools, a new formula was derived to determine the postmortem interval based on the potassium concentration and a review of previous literature is presented. Hence, the findings of this study supported a central role of vitreous humor biochemistry in many postmortem forensic and pathological evaluations.

Metastasis of breast lobular carcinoma in a cervical leiomyoma.

We report here a case of 40-year-old female admitted in view of bilateral ovarian tumors. There was past history of modified radical mastectomy. CT scan revealed a uterine cervicalfibroid in addition to bilateral adnexal masses. Lobular carcinoma metastasis were seen in the leiomyoma as well as in the bilateral ovaries. Metastasis of ductal carcinoma to uterine leiomyoma have been reported in literature. The present case is unique in two ways--(1) metastasis of lobular carcinoma (2) occurring in a cervical leiomyoma.

Role of carotid intima-media thickness in assessment of atherosclerosis: an autopsy study.

BACKGROUND: The non-invasive technique of measuring carotid artery intima-media thickness has generated considerable interest as a marker of atherosclerosis, particularly in predicting clinical coronary events and coronary artery disease. In the present study, a postmortem comparative analysis of intima-media thickness of carotid artery with coronary artery atherosclerosis has been carried out. To date no such morphological tissue studies are available from our country. METHODS AND RESULTS: Right and left common carotid arteries with their branches were removed at postmortem in 40 cases with history of diabetes, hypertension or both. Intima-media thickness was measured and compared with coronary artery atherosclerosis. There were 10 control postmortem cases without history of diabetes or hypertension. Common carotid artery and internal carotid artery intima-media thickness were found to be good predictors of coronary events. There was also significant correlation (by Pearson's correlation formula) between the carotid artery intima-media thickness and the percentage of block in the coronary arteries. CONCLUSIONS: Internal carotid artery along with common carotid artery intima-media thickness measurement is a good predictor of coronary artery disease. However, carotid artery intima-media thickness has no bearing on the status of collateral circulation of the coronary arteries.

Mucosal neuromas and prominent corneal nerves without MEN IIB.

Multiple endocrine neoplasia type II B or the mucosal neuroma syndrome is an autosomal dominant hamartoneoplastic syndrome. This is a report of a 17 year old female who presented with mucosal neuromas at age 7 years and had surgical excision of the lesion. Ten years later (at age 17 years) she had further recurrence of mucosal neuromas which were again surgically excised. She has been thoroughly investigated & followed, however to date she has no evidence of thyroid carcinoma which is a major complication of this syndrome.