Fever work-up unfolds a rare diagnosis of native valve endocarditis caused by Mycobacterium abscessus.

Endocarditis caused by Mycobacterium abscessus is rare and often missed without appropriate blood cultures. It does not respond to standard antitubercular treatment and is also resistant to many other antibiotics. The course of the disease may be indolent and often results in a fatal outcome. Accurate identification and sensitivity, combination therapy, and prolonged duration of antibiotics are, therefore, important for a successful outcome.

Cytological diagnosis of small cell osteosarcoma of the bone.

Small cell osteosarcoma (OS) is a rare histological variant of OS that poses unique diagnostic difficulties. We present a case of a 10-year-old child who underwent fine needle aspiration cytology (FNAC) from a mass in the right thigh. The cytological findings were those of a malignant small round cell tumor, closest to small cell OS. The FNAC findings were confirmed on histopathology.

Spectrum of nonhematological pediatric tumors: A clinicopathologic study of 385 cases.

BACKGROUND: The aim of this study is to understand the epidemiology of tumors in children in our region due to a paucity of studies on the histologic review of the childhood tumors in general and benign tumors in particular. MATERIALS AND METHODS: The records of all the tumors diagnosed histopathologically in children <14 years of age during a period of 8-year (2005-2012) were reviewed. RESULTS: A total of 385 tumors were seen in the age range of 1 month-14 years with 231 (60%) in boys and 154 (40%) in girls. Highest number of cases, 224 (58.18%) were in the age group of 10-14 years. Benign tumors comprised 275 (71.43%) cases while the malignant tumors accounted for 110 (28.57%) cases. In benign tumors, vascular tumors were in majority with 68 cases, while in malignant category bone tumors were most common with 36 cases. CONCLUSIONS: Although the exact incidence rate cannot be provided by this hospital-based study, the information is useful in showing patterns of childhood tumors. We included both benign and malignant tumors, while most of the studies in the past have focused mainly on malignant tumors in children.

Clinico-pathological study of glomerular diseases in patients with significant proteinuria in North India.

Proteinuria is a common manifestation of renal disease. The present study was carried out to analyze the clinic-pathological correlation, assess the value of histopathology and immunofluorescence (IF) as well as note the spectrum of renal diseases in patients with significant proteinuria. Fifty consecutive patients having proteinuria >1 g/24 h underwent ultrasound-guided percutaneous renal biopsy. Clinical information was correlated with the pathological findings and the results were analyzed. The patients were in the age range of 12-79 years. Males (60%) outnumbered females (40%) in all the disease categories except lupus nephritis and IgA nephropathy. The most common clinical presentation was the nephrotic syndrome, seen in 31 cases (62%). Primary glomerular diseases (72%) were more common than secondary glomerular diseases (24%) and tubulointerstitial diseases (4%). Overall, the most common pathological diagnosis was focal and segmental glomerulosclerosis (FSGS) (20%), followed by membranous glomerulonephritis (MGN) (18%). In young patients (age <20 years), minimal change disease (36.4%) was the most common diagnosis while in adults it was MGN (23.5%) and in elderly patients (age >60 years) it was FSGS (60%). IF modified the diagnosis in 12% of the cases. The concordance between clinical diagnosis and pathological diagnosis was 66%. The difference between clinical diagnosis and final diagnosis was statistically significant. Our study further reinforces the knowledge that renal biopsy helps in accurate diagnosis and, thus, helps in appropriate management of the patients. IF provides additional information that can make the morphologic diagnosis considerably more precise.

Tuberculosis prevalence at autopsy: a study from North India.

Tuberculosis (TB) is an important cause of morbidity and mortality. This study attempts to determine the prevalence of TB in autopsies. Of 768 autopsies, 39 cases were diagnosed as TB. These were retrieved and re-examined. It was noted that in a significant number of patients with TB was only revealed after autopsy. This has important implications as they may well have been a source of transmission to the general public and health-care providers.

Nodal tuberculosis revisited: a review.

Lymphadenitis is the most common extrapulmonary manifestation of tuberculosis. Tuberculous lymphadenitis is considered to be the local manifestation of the systemic disease, whereas lymphadenitis due to nontuberculous mycobacteria is truly a localized disease. A high index of suspicion is needed for the diagnosis of tuberculous lymphadenitis which is known to mimic a number of pathological conditions. Over the last two to three decades, fine needle aspiration cytology (FNAC) has emerged as a simple out-patient diagnostic procedure for the evaluation of tuberculous lymphadenitis and has replaced lymph node biopsy for histopathology. A number of molecular methods have also been introduced in diagnostics which have greatly improved the diagnostic accuracy. This article provides a review of epidemiology, clinical manifestations, and pathogenesis and emphasizes current trends in pathologic diagnosis of nodal tuberculosis.

Inflammatory pseudotumor of the spleen: a rare case diagnosed on FNAC.

Inflammatory pseudotumor (IPT) is a rare space-occupying lesion of unknown etiology that can mimic malignancy on clinic-radiological and pathological examination. We present a case of IPT of the spleen which was clinically suspected to be malignant. This case was initially suggested accurately on fine needle aspiration (FNA) of the mass and subsequently confirmed on histopathology of the resected specimen.

FNA in diagnosis of orbital lesions causing proptosis in adults.

The orbit is affected by a wide range of pathologic lesions, for which a morphologic diagnosis is needed to allow adequate therapy. With increasing use of fine needle aspiration (FNA) in diagnostic pathology, the procedure has been applied for the diagnosis of space occupying lesions of the orbit. We present the cytomorphological diagnosis on orbital FNA in adult patients presenting with proptosis. Records of seven adult patients who had presented with proptosis and had undergone orbital FNA were retrieved and analysed. FNA was performed from the palpable mass in six cases and under ultrasound guidance in one case. No complication during or after FNA was reported in any of the cases. Histopathological diagnosis was available in 5 cases. Out of the 7 cases, 3 were non-neoplastic (2 inflammatory lesions, 1 reactive lymphoid hyperplasia) and 4 were neoplastic (2 primary tumors and 2 secondary involvement). Both the primary tumors were non Hodgkin's lymphoma (NHL) B-cell type. Metastases included one case of uterine sarcomatoid carcinoma and one case of secondary involvement by extension of olfactory neuroblastoma. In all the neoplastic cases, cytological diagnosis corresponded with the histopathological diagnosis. It can be concluded that cause of proptosis among adults are different from those among children and include secondary malignancies. FNA is a simple and important preliminary diagnostic modality in the assessment of adult proptosis prior to any surgical intervention.

Non-neoplastic salivary gland lesions: a 15-year study.

The spectrum of salivary gland lesions is wide and the relative incidence of neoplastic versus non-neoplastic lesions is variable in different studies. A series of non-neoplastic salivary gland lesions is reviewed to analyze their spectrum and their relative frequency. This is a retrospective study of salivary gland excisions and biopsies received in our department from January 1994 to December 2008. Routine hematoxylin and eosin-stained sections of all the salivary gland excisions and biopsies received were analyzed. Of the 393 salivary gland excisions and biopsies received, 216 cases were reported as non-neoplastic (55%) and formed our study group; 177 (45%) were neoplastic. Non-neoplastic lesions were more frequent in major salivary glands (65.7%) and submandibular gland was the most commonly involved (66.2%). Lip was the most frequent site (81.7%) for minor salivary gland lesions. Inflammation was the predominant pathological finding (49.5%), of which non-specific chronic sialadenitis constituted the majority (86.9%). Sialolithiasis was present in 22 cases (20.6%); all of these cases were of non-specific chronic sialadenitis. Cysts were second in frequency (36.6%), of which mucocele was the most common (54.5%). There were 5.6% cases of benign lympho-epithelial lesions, while normal salivary gland tissue was seen in 6.5% cases. Non-neoplastic salivary gland diseases are more common than neoplastic diseases and have a wide disease spectrum.

Primary adenocarcinoma of ureter mimicking pyelonephritis.

Tumors of the ureter are rare. We present a case of primary mucinous adenocarcinoma of the ureter diagnosed as chronic pyelonephritis preoperatively. This tumor is postulated to arise from metaplastic glandular mucosa in response to chronic irritation of the urothelium.