Frequency of gall bladder metaplasia and its distribution in different regions of gall bladder in routine cholecystectomy specimens

Background: In India, gall stone disease is more common in women in the north, north east and east as compared to other zones in the country. Gall bladder metaplasia has been documented as the precursor lesion of dysplasia and therefore carcinoma. Present study was conducted to ascertain the frequency and type of metaplasia along with distribution in different regions of gall bladder.Methods: All the post cholecystectomy gallbladder samples submitted for histopathology comprised the study material. Three sections were from body, fundus, and neck each. The five microns thick paraffin sections were cut with microtome and stained with Hemotoxylin and Eosin (H and E).Results: The present study was conducted on 119 cholecystectomy specimens submitted for histopathological examination. Amongst premalignant lesions, cholecystitis with metaplasia was seen in 55 (46.2%) cases. Pyloric metaplasia without intestinal metaplasia was most common metaplasia (30.2%) followed by combined metaplasia (12.60%) and only intestinal metaplasia (3.36%). Out of 55 cases, fundus showed metaplasia in 47 followed by body (44) and neck (36).Conclusions: Very high frequency of metaplasias was observed (46.2%) in routine cholecystectomy specimen with pyloric metaplasia as the predominant type and intestinal metaplasia was accompanied with pyloric metaplasia in most of the cases. Metaplasia was found to be more or less equally distributed in different regions of gall bladder

Non-alcoholic fatty liver disease may not be a severe disease at presentation among Asian Indians

Aim: To evaluate the clinical and biochemical profile of patients with non alcoholic fatty liver disease (NAFLD) and to assess their histological severity at presentation. Methods: Consecutive patients presenting to the liver clinic of All India Institute of Medical Sciences (AIIMS) with raised transaminases to at least 1.5 times upper limit of normal, and histologically confi rmed non-alcoholic fatty liver disease were included. Patients who had significant alcohol intake or positive markers of other liver diseases or who were taking drugs known to produce fatty liver were excluded. The clinical, biochemical and histological profi le of this group was studied. Results: Fifty-one patients with NAFLD formed the study population. Their median age and BMI were 34(17-58) years and 26.7(21.3-32.5) kg/m2 respectively and 46 (90.1%) were males. The majority of the patients had mild inflammation, either grade 1 [32 (63%)] or grade 2 [16 (31%)] and only 3 (6%) patients had severe (grade 3) infl ammation. Twenty-three (45%), 19 (37%), 8(16%) and 1(2%) patient had stage 0, 1, 2 and 3 fi brosis respectively on index biopsy and none had cirrhosis. On univariate analysis, triglyceride levels more than 150 mg % (OR = 7.1; 95% CI: 1.6-31.5, P = 0.002) and AST/ALT ratio > 1 (OR = 14.3; 95% CI: 1.4-678.5, P = 0.008) were associated with high grades of inflammation and none was associated with advanced fibrosis. On multivariate logistic regression analysis, hypertriglyceridemia >150 mg% was the only factor independently associated with presence of high grade of infl ammation (OR = 1.6; 95% CI: 1.3-22.7, P = 0.02), while none was associated with advanced fi brosis. Triglyceride levels correlated positively with infl ammatory grade (r = 0.412; P = 0.003). Conclusion: NAFLD in North Indian patients is a disease of young over-weight males, most of whom are insulin resistant and they tend to have a mild histological disease at presentation

Primary extra-gastrointestinal stromal tumor of the omentum

Gastrointestinal stromal tumors (GISTs) are mesenchymal tumors originating from interstitial cells of Cajal or related stem cell-like precursors present in the wall of the gastrointestinal tract. However, identical tumors originating from areas other than the gastrointestinal tract have been reported which are histologically identical to the usual GISTs. We are reporting a case of primary omental GIST in a 57-year-old female

Enterobius vermicularis infestation leading to Meckel’s diverticulitis in an adolescent boy: An extremely rare presentation

Enterobius vermicularis is an intestinal nematode commonly affecting children worldwide. Its transmission is by feco-oral route. Meckel's diverticulitis due to E. vermicularis infestation is an extremely rare presentation. An 11-year-old boy presented with acute abdomen. During surgery inflamed Meckel's diverticulum (M.D) was seen. Histopathology examination of specimen revealed E. vermicularis. Till date, only one case of E. vermicularis infestation of M.D is reported around five decades ago. This histopathological confirmation is extremely important as the required treatment (Mebendazole) of the infected case along with household contacts can prevent the spread of infection and may avoid surgery in known contacts

Mucinous tubular and spindle cell carcinoma of kidney: A case report of an unusual tumor

Mucinous tubular and spindle cell carcinoma (MTSCC) is a rare and unusual variant of renal cell carcinoma (RCC). It is important to differentiate this from the other variants particularly papillary RCC since MTSCC is generally low-grade, has low malignant potential and favorable prognosis. We are reporting a 40-year-old female presenting with right flank pain and well-circumscribed renal mass confined to the lower pole. Tumor consisted of tubules and cords separated by pale mucinous material in some areas, whereas other areas showed dense cellularity without significant mucin. The tumor cells were cuboidal or spindle and did not show significant atypical features. The patient underwent nephrectomy and is asymptomatic clinically and radiologically after 2 years

Pediatric clear cell renal cell carcinoma with pelvicalyceal system invasion and contiguous extension upto bladder : novel and bizarre tumor behaviour

BACKGROUND: Paediatric renal cell carcinoma (RCC) is a rare neoplasm which differs significantly in its clinico-pathological behaviour from the adult variant. The clear cell variant constitutes a relatively small histological subset of this neoplasm. CASE REPORT: We present a very unusual, pathologically proven case of clear cell variety of pediatric RCC which showed invasion into the pelvicalyceal system with contiguous extension up to the urinary bladder. Such a novel manifestation of paediatric RCC has not been described previously in literature. A relevant review of literature is included. CONCLUSIONS: The aggressive biological behaviour of the paediatric RCC in our case and the consequent atypical imaging findings are distinctly unusual. These findings may represent a new aggressive variant of this rare neoplasm. The radiologist and clinician should be aware of these novel manifestations of paediatric clear cell RCC

School based oral health promotional intervention: Effect on knowledge, practices and clinical oral health related parameters

Background: No organized school oral health program is existent in India. Aim: The aim of this study is to test the feasibility and efficacy of an economical school oral health promotional intervention with educational and preventive components. Settings and Design: School oral health promotional intervention carried out in one of the randomly selected school and evaluated through short duration prospective model. Materials and Methods: A total of 100 children with an age range of 10-12 years with no previous history of dental intervention were enrolled. Interventions comprised of oral health education (delivered through lecture and demonstrations by an undergraduate dental student) and topical antibacterial therapy (fluoride varnish and povidone iodine). Outcomes consisted of Knowledge and practices (KAP) regarding oral health, clinical oral health related parameters such as plaque index (PI), gingival index (GI) and caries activity as per Modified Snyder′s test. These were reported at baseline, 3 weeks and 6 months follow-up examination by a calibrated examiner. Statistical Analysis: McNemar Bowker′s test, Student′s t-test, Pearson Chi-square tests were used. Results: Highly significant (P < 0.001) improvements in KAP scores, PI scores, GI scores and caries activity were reported at 3 weeks and 6 months follow-up examination. Conclusion: This small economical school oral health program positively influenced oral health related practices and parameters of oral health such as oral cleanliness, gingival health and caries activity