Hep-2000 indirect immunofluorescence assay - an emerging screening tool for detection of antinuclear autoantibodies in various connective tissue disorders.

BACKGROUND: Connective tissue disorders (CTD's) are a group of autoimmune disorders having multifactorial etiology, multisystem involvement and overlapping clinical features. Their prevalence has been increasing in India, with Systemic lupus erythematosus (SLE) being the most common CTD, affecting mostly females. Antinuclear Antibodies (ANA) directed against a variety of nuclear antigens detectable in the serum are used for screening, diagnoses, and monitoring of autoimmune diseases, with immunofluorescence assay (IFA) and enzyme-linked immunosorbent assay (ELISA) being the most widely used methods. AIMS: 1.To evaluate the diagnostic significance of IFA in screening of Autoimmune CTDs. 2.To study different titres and patterns shown by ANA positive samples. MATERIALS AND METHODS: For IFA, patient's sera is incubated with substrate cells, and bound antibodies are detected by incubation with a dye-conjugated anti-human immunoglobulin which are visualized by fluorescent microscopy and different ANA titres and patterns were analysed. RESULTS: 57 samples were examined for ANA by Indirect IFA, of which 21 (36.8%) were ANA positive with a female preponderance (71.9%) in the peri-menopausal age group. Most common pattern reported was Speckled followed by Homogenous. The sensitivity & specificity of IIFA was found to be comparable with ELISA. CONCLUSION: CTD's are a group of autoimmune disorders with a plethora of clinical presentations, necessitating the need of a more specific and accurate screening test. ANA by IIFA gives patterns, which are associated with specific antibodies that help in reaching a diagnosis. ANA testing is a cost effective and non-invasive technique that can be used as a reliable screening test for Autoimmune disorders.

Aggressive angiomyxoma in men.

Aggressive angiomyxoma is an uncommon neoplasm that preferentially involves the pelvic and perianal regions of reproductive age females. These tumors are rare in men and merit a wider recognition in male urologic pathology. We report a case of a 65 year old male who presented with a swelling in the left perineal region since 2 years which gradually increased in size to 10 x 10 x 8 cms. CT scan revealed a well defined lobulated heterogenous minimally enhancing mass in the left ischiorectal fossa extending upto the subcutaneous plane. Microscopically stellate to spindle shaped cells arranged in a loose myxoid stroma with numerous thin to thick walled vessels were seen. There was no evidence of pleomorphism, hyperchromatism or mitotic activity. This case is reported because of its rarity in males. It is a benign tumor and requires a wide excisional surgery.