Study of ascitic fluid cytology in ovarian tumors

Background: The objectives of this study were to examine the validity of ascitic fluid cytology in the detection of pathological findings, to examine the percentage of false positive and false negative results in the cytology of ascitic fluid and to determine the validity of peritoneal cytology in relation to the histopathological type of the ovarian tumour.Methods: This retrospective study, over a period of 6 months, included 106 peritoneal cytology findings. The experimental group included 106 cytology findings obtained from patients who presented with an abdominal lump/mass with ascites and diagnosed with ovarian tumors clinically. They included 88 benign ovarian tumours (83%) and 18 malignant ovarian tumors (17%). Patients with other causes of ascites were excluded from the study.Results: The sensitivity of peritoneal cytology is 90%, specificity is 96.5%, positive predictive value is 85.7%, and negative predictive value is 97.6%. In 1.8% of patients, the peritoneal cytology showed false negative results, while in 2.8%, the results were false positive. False negative results were found in one case of teratoma with squamous cell carcinoma and one case of yolk sac tumor. False positive results were found in 2 cases of tuberculous-salpingo- oophoritis and one case of chronic salpingo-oophoritis due to reactive mesothelial proliferation, mistaken for adenocarcinoma.Conclusions: Peritoneal cytology of ascitic fluid is highly specific and sensitive for detection of ovarian malignancies, particularly in grade 3 and grade 4 disease, since most of the patients with ovarian malignancies present to us at advanced stage of the disease

Clinicopathological and IHC study (estrogen receptors, progesterone receptor, HER2/NEU) in malignant ovarian tumors

Background: Ovarian cancer is the second most common gynaecologic malignancy, most common cause of gynaecologic cancer death and has worst prognosis among all gynecological malignancies. The clinical significance of ER and PR content in ovarian carcinomas has not been well established in the literature.Methods: A prospective study was conducted over a period of 2 years (2013-2015) in the department of pathology, Andhra Medical College, Visakhapatnam, Andhra Pradesh, India. The study includes 42 cases of ovarian cancers. Representative 3-4μm sections were taken and IHC was performed with specific antibodies.Results: The mean age at presentation was 39.5 years, majority of the ovarian carcinomas occurred in the age group of third and fifth decade (20/42). The commonest clinical presentation was mass per abdomen. The commonest histological type was malignant surface epithelial tumors (25/42, 59.55%) of which serous cystadenocarcinioma was the predominant tumor followed by germ cell tumors (9/42, 21.42%). Ascites was associated with higher grade and higher stage of tumors. Majority of the ovarian carcinomas were of grade 2 (57.14%) and stage 3 (35.7%).  ER was positive in (9/42) 21.42%, PR was positive in (10/42) 23.8% and Her2/neu was equivocal in (3/42) 7.14% of ovarian carcinomas. ER, PR and Her2 showed similar expression, with higher expression in cases of advanced disease.Conclusions: The expression of steroid hormonal receptors in ovarian cancers paves way for antihormonal therapy/ targeted therapy and this requires more number of studies with larger sample size.

Clinicohistopathological study of astrocytomas along with Ki-67 proliferative index

Background: Astrocytomas form the largest group of gliomas (>75%) and diffusely infiltrating    accounting for more than 60% of all the primary brain tumors. The ki67 proliferative index is a potent biologic marker that estimates the growth of neoplasms quantitatively and thus will aid in identifying the prognosis for patients with neoplasms.  The aim of the research work was to study various histopathological and clinical features of Astrocytomas in detail, to evaluate Ki-67 proliferative index in patients of Astrocytomas and to compare the results of Immunohistochemistry with histological grade of Astrocytomas.Methods: A   total   number   of    40 cases of   Astrocytomas were included in the study.  Ki-67 immunostaining was done on all cases and compared with WHO histological grading of astrocytomas.Results: The mean Ki‑67 LI in Grade I astrocytomas was 4.66, range 4-5 ,  in Grade II astrocytomas mean was 8.07, range 5-12 ,in Grade III astrocytomas mean was 13.5 , range 8-20,  in Grade IV astrocytomas mean was 22.93, range 15-50. There was a highly significant correlation between the histopathological grade of astrocytomas and Ki-67 LI (p<0.05).Conclusions: The monoclonal antibody Ki-67 has proven its prognostic and diagnostic power in astrocytic tumors. Ki-67 LI is the simplest and the most reliable method for evaluating cell proliferation. Ki-67 LI increased with histological grade and the difference between low grade (I and II astrocytomas) and high grade (grade III and IV) is significant. In the present study Ki-67 LI is not dependent on factors like age and sex and is solely dependent on histological grade

Patterns of cancer occurrence in a tertiary care centre

Background:This study is an attempt to know the incidence of cancer in a tertiary care centre. Statistics for all newly diagnosed cancer cases by correlation with factors like age, gender & organ systems involved with complete histopathological evaluation is presented. Emphasis is given to segregating each cancer and grouping them into their respective order for statistical analysis. Objectives of the study was to conduct a prospective statistical analysis, computing and comparing rates, ratios and percentages of cancer incidence in relation to epidemiological parameters like age, gender, organ system and site involved, etc. and correlating with other national and international studies.Methods: All newly diagnosed cancer cases from various surgical and medical specialities were consolidated into a core database and various statistical outputs were worked out, like cancer incidence comparative rate, ratios and percentages for parameters like age distribution to gender wise, system wise, organ wise, etc.  Results: Out of total 2278 cancer cases, in males (1003 cases/44.03%), tumors of head and neck (468 cases/20.54 %) were most common, and among which oral cavity cancers (278 cases/59.4 %) were most common. In females (1273 cases/55.9 %), cervical cancers (314 cases/13.7 %) were most common followed by breast cancers (218 cases/9.56 %). In children (69 cases/3.03 %) hematopoietic neoplasms (17 cases/30.3 %) were most common.Conclusions: The current study mainly summarizes the different patterns of cancer incidence in the tertiary care centre region. Cancer incidence is increasing gradually among the population and there is raise of cancer incidence in females compared to their counterparts

Leydig cell tumor of ovary with primary hyperparathyroidism: A rare association

Leydig cell tumors of ovary are extremely rare sex cord stromal tumors that account for <0.2% of ovarian cancers. Most of these tumors can cause hyperandrogenism. A 54 year old multiparous postmenopausal woman, known diabetic and hypertensive, presented with progressive virilization, bone pains and depressed mood for 2 years. Diagnostic evaluation revealed markedly elevated testosterone with normal dehydroepiandrosterone sulphate. Computerized tomography of abdomen showed right ovarian mass with multiple cysts in both kidneys. Biochemical investigations revealed hyperglycemia, hypercalcemia, hypophosphatemia and elevated parathormone (PTH) levels. Sestamibi scan for parathyroids was suggestive of right inferior parathyroid adenoma. Histopathology of the resected right ovarian tumor was consistent with leydig cell tumor of ovary. Postoperatively serum testosterone and blood glucose levels were normalized, but PTH levels remained high. PTH levels were normalized after resection of parathyroid adenom

Matrix metalloproteinase-9 (MMP-9) as prospective histopathological and molecular biomarker for oral squamous cell carcinoma

Background: Despite the advance of therapeutic approaches, the morbidity and mortality of oral squamous cell carcinoma have not improved significantly. The invasion potential of oral squamous cell carcinoma is conferred by their ability to utilize Matrix metalloproteinase that are produced by the host’s stromal cells. In the present study an effort was made to analyse the role of clinical features and risk factors in the causation of oral squamous cell carcinoma and expression of Matrix metalloproteinase-9 (MMP-9) was studied in various grades of squamous cell carcinoma with its role in metastasis.Methods: The present study is an hospital based prospective study for a period of two years at the department of pathology from August 2014 to July 2016 consisting of 88 cases of oral squamous cell carcinoma. Tissue for H and E sections were fixed in 10% formalin and subjected to routine paraffin embedded processing and stained with hematoxylin and eosin.Results: Total number of cases of oral squamous cell carcinoma analyzed were 88, out of which 65 cases were subjected to MMP 9 expression by random selection on Immunohistochemistry. Majority of cases occurred in the age group of 41-50 years with male: female ratio of 1.4:1. In stage I and II the expression of MMP-9 is low in 37 cases (82.22%) and in stage III the expression is high in 14 cases (70%) with P value <0.05 (significant).Conclusions: Matrix metalloproteinases could act as a therapeutic target and could play an important role in effective treatment strategies of oral cancer

Role of CB-NAAT in diagnosing extra pulmonary tuberculosis in correlation with FNA in a tertiary care center

Background: The diagnosis of extra-pulmonary tuberculosis (EPTB) is challenging due to the pauci-bacillary nature of disease. Recently, WHO recommends GeneXpert/CBNAAT to be used as the initial diagnostic test in patients suspected extra-pulmonary tuberculosis (EPTB). The study was done to assess the role of Cartridge Based Nucleic Acid Amplification Test (CB-NAAT) in the diagnosis of EPTB. Aims and objectives was to study the role of FNAC, CBNAAT and Fluorescent LED in diagnosing extra-pulmonary tuberculosis (EPTB).Methods: This is a descriptive observational study carried out over a period of 12 months (April 2017 to March 2018) at department of Pathology, Andhra Medical College. All presumptive cases of extrapulmonary tuberculosis and purulent aspirates from the various sites between the age group of <10yrs to 60 years of age were included in the study. FNA was done and material sent to CBNAAT and fluorescent LED (Light-emitting Diode) microscopy in all the cases and results tabulated.Results: The total number of cases with presumptive extra pulmonary Tb were 289. Majority of the aspirates are from lymph nodal and cervical swellings 94.1% (272/289). CBNAAT has detected 6.5 % of cases (19/289) which were not detected by FNA and 9.3% of cases (27/289) LED negative cases. Resistant to rifampicin was identified in 2.1% (3/142 cases) of CBNAAT positive cases.Conclusions: FNA still remains the cheapest test to diagnose TB. In cases with Granulomatous lymphadenitis and purulent aspirates CBNAAT has an important role in diagnosing EPTB. In addition it offered rapid detection of rifampicin-resistant M. tuberculosis strains which is an added advantage

Prospective study of uterine corpus lesions over a period of one year in tertiary care centre

Background:Hysterectomy is the most commonly performed gynaecological surgery throughout the world. Few studies have been performed describing the pathologic findings in hysterectomy specimens and examining the relationship between the preoperative clinical indication, gross findings and pathologic diagnosis. This study was undertaken to identify the different types of pathologies in hysterectomy specimens and to correlate the findings with the clinical indications and gross findings.Methods: In the present study, five hundred and forty four cases were studied over a period of one year. Surgical specimens were formalin fixed and the tissue was adequately processed for histopathological examination. The sections were stained routinely with hematoxylin and eosin stain.Results: Menorrhagia and fibroid uterus were the most common clinical indications for hysterectomy. Of the 544 cases, 52.75% cases were encountered in the age group of 40 - 49 years which was the most common age group.  The most common pathology identified was leiomyoma in myometrium. Histopathological examination confirmed the clinical and gross diagnosis in majority of the cases.Conclusions: The present study provides a fair insight into the histological patterns of lesions in hysterectomy specimens in our institution. A wide range of lesions are encountered when hysterectomy specimens are subjected to histopathological examination. Though the histopathological analysis correlates well with the clinical and gross diagnoses, a few lesions were also encountered as incidental findings and mismatch diagnoses. Hence, it is mandatory that every hysterectomy specimen should be subjected to detailed gross and histopathological examination to ensure proper postoperative management of patients.

Comparative study of effectiveness of pap smear versus visual inspection with acetic acid for mass screening of lesions of cervix

Background: Cervical cancer is a leading cause of morbidity and mortality among women worldwide and more over in the developing countries, so there is a need to develop screening test with high specificity and sensitivity. Aim of the study was to evaluate the effectiveness of Papanicolaou (PAP) smear versus visual inspection acetic acid (VIA) for screening cervical lesions in patients and to determine and compare their sensitivity and specificity.Methods: The present study is a hospital based prospective study for a period of two years at the department of pathology from August 2014 to July 2016 consisting of 500 patients attending gynaecology outpatient clinic. Papanicolaou (Pap) smear tests and visual inspection acetic acid were employed along with complete clinical history record. The results of VIA were correlated with that of pap smear on the basis of sensitivity, specificity and positive and negative predictive value.Results: Out of 500 cases, most common age group was 21 to 40 years of age consisting of 305 cases - 61%. VIA was positive in 156 cases-31.2%, PAP smear positive for epithelial cell abnormalities were 60 cases-12%. VIA showed higher sensitivity (52.38%) compared to Pap smear (40%) whereas Pap smear showed higher specificity (93.2%) compared to VIA (92.4%).Conclusions: Papanicolaou test is a better screening test for epithelial cell abnormality than VIA. However, in countries with low resource settings where cytology-based screening programs are not available, VIA is a promising alternative

Cytology of Paediatric lesions: a tertiary care centre experience during COVID-19

Background: Paediatric lesions are worrisome and need immediate attention with early diagnosis. Fine needle aspiration cytology (FNAC) is safe, cost effective, minimally invasive method which helps in diagnosis and guides for treatment of various paediatric lesions.Methods: This was an observational study done during the pandemic of COVID-19 at department of pathology in Andhra Medical College, Visakhapatnam from March 2020 to October 2020 .The total number of cases were 91 who underwent fine needle aspiration (FNA) during this period. USG guided aspiration and fluids are also included in the study. Slides were fixed in 95% isopropyl alcohol and stained with Haematoxylin and Eosin. May Grunwald Giemsa stain, CBNAAT for acid fast bacilli and correlation with histopathology was done wherever required and results were tabulated.Results: In the present study the lesions were more common in female children (68.13%) and in the age group of 11-15 years (35.16%).Benign lesions (80.91%) were more common than malignant lesions. Majority of benign lesions were reactive lymphadenitis (32.5%) followed by tuberculous lymphadenitis (23.75%). The common malignant lesions were lymphoblastic and Hodgkin’s lymphoma, metastatic nasopharyngeal carcinoma, malignant peripheral nerve sheath tumour (MPNST), Langerhans cell Histiocytosis and Ewing’s sarcoma.Conclusions: Extra pulmonary tuberculosis in children is highly variable in severity and rate of progression with long term sequelae. The spectrum of malignancies in children is variable and region based. FNAC helped in early diagnosis and management of these cases