Histopathological study of endometrial stromal sarcomas

Background: Endometrial stromal sarcomas (ESSs) are rare malignant uterine tumours comparatively affecting younger women and the mean age is 42 to 58 years. The World Health Organization (WHO) classification categorises endometrial stromal neoplasms and related tumors as: endometrial stromal nodule (ESN), low-grade endometrial stromal sarcoma (LG-ESS), high-grade endometrial stromal sarcoma (HG-ESS), and undifferentiated uterine sarcoma (UUS).Methods: Present study is a retrospective one and includes 6 patients with histologically proven endometrial stromal sarcoma for a period of 3 years. Authors examined every slide available from each case and new HE-stained slides generated from formaline-fixed, paraffin-embedded tissue were reviewed to confirm the diagnoses. Demographic information, pathologic, and treatment information were collected from the clinic and hospital charts. All had primary surgical management in the form of total abdominal hysterectomy and salpingo-oophorectomy.Results: The mean patient age was 41 years. All of the patients had presented with abnormal uterine bleeding. Diffuse growth of small cells closely resembling those of the normal proliferative endometrial stroma was the characteristic feature of these tumors. All of these patients had a low grade ESS on histopathology. They had regular follow-up visits until the end of study.Conclusions: Endometrial stromal sarcomas are rare malignant tumors of the uterus and a proper preoperative diagnosis is difficult. Their differential diagnosis from typical submucosal uterine myomas or benign endometrial polyps can be difficult. The histological examination of the specimen is necessary to exclude malignancy and establish the final diagnosis

Metabolic Syndrome in Adults with Nonalcoholic Fatty Liver Disease

Nonalcoholic fatty liver disease (NAFLD) is associated with insulin resistance, obesity, and other features of metabolic syndrome. It is identified as the most common cause of liver enzyme derangement. Lately, NAFLD has generated interest in exploring treatment options, including weight loss and dietary interventions. An association of NAFLD with metabolic syndrome has been suggested in contemporary literature. In this study, we attempted to look into the association of NAFLD with metabolic syndrome. In this study, 80 adult NAFLD patients were recruited from a tertiary care hospital. Among these, 42 were males and 38 females with a mean age of 44.46±13.146 years (range 18–82 years). Grades of fatty liver and presence or absence of metabolic syndrome were studied in this patient population. Patients who did not qualify for the criteria of metabolic syndrome were placed in Group 1 and those who fulfilled the stated criteria were considered in Group 2. There were 29 (36.25%) patients in Group 1 and 51 (63.75%) in Group 2. All the patients in Group 1 were having Grade I fatty liver whereas patients in Group 2 were found to having varying grades of fatty liver, with six patients having Grade III fatty liver. We found statistically significant difference in various parameters of study (liver enzymes, high-density lipoprotein (HDL), triglycerides, and blood pressure) between Group 1 and Group 2. Ultrasound evidence of a fatty liver should be considered as a predictor of metabolic syndrome, and these patients must be investigated for the different components of metabolic syndrome so as to have early diagnosis and intervention to alter development of long-term metabolic disorders and their inherent complications

Primary renal leiomyosarcoma: a rare entity

Background: Primary leiomyosarcoma of the kidney is an exceptionally rare tumor with an aggressive behavior. However, reported literature is very limited. Since the prognosis for a renal sarcoma is extremely poor, differentiation from sarcomatoid renal cell carcinoma (RCC) is necessary. Histopathology and immunohistochemistry are the only modes of diagnosing these sarcomas as they have no specific diagnostic features clinically and radiologically. Objectives was to evaluate the clinicopathological pattern of leiomyosarcomas arising from kidney.Methods: This study was conducted in the Department of Pathology, Government Medical College, Srinagar. It was a retrospective study done over a period of 3 years, July 2014 to June 2017. A total of 4 patients, who underwent surgery and were diagnosed with primary LMS of the kidney, were included in the present study.Results: The study was done to evaluate the clinicopathological pattern of 4 cases of primary renal LMS diagnosed at a tertiary care hospital. Age of the patients ranged from 35-64 years with a mean age of 53.5 years. Sex ratio of 1:1 was observed. Major presenting symptom was flank pain (75%) followed by mass abdomen (50%). Also, one of the patients presented with spontaneous rupture of kidney. Radical nephrectomy was done in all patients. On gross examination tumor had originated from renal pelvis (50%) in 2 patients, renal vein (25%) in one patient whereas, renal capsule (25%) appeared to be the site of origin in other patient. Histopathological examination and immunohistochemistry proved the lesion as primary leiomyosarcoma of kidney.Conclusions: Being a rare tumour, renal leiomyosarcoma needs to be considered in the differential diagnosis of renal masses even in patients younger than 40 years

Automobile Paint Reducer Induced Acute Kidney Injury: A Case Series

The various aspects of the automobile industry also carry with it the risk for occupational health hazards with it. Toluene has also evolved as a commonly used drug by substance abusers. Accidental exposure or self-poisoning with these substances has been reported in literature. These substances can also cause distal renal tubular acidosis (RTA), acute tubular necrosis, glomerulonephritis and interstitial nephritis, rhabdomyolysis and myoglobinemia. In this series, we report about three patients who developed renal manifestations because of organic solvents. Two of the three patients had ingested the paint reducer substance and the third one was addicted to sniffing the toluene based paint reducer. All the patients had in taken these substances s with suicidal intent and developed acute kidney injury (AKI) and severe metabolic acidosis. One of the patients had features of rhabdomyolysis as well. The third patient was a substance abuser and had inhaled higher than usual dose and developed severe and refractory acidosis and mild kidney injury and required Renal Replacement Therapy (RRT) for acidosis. All the patients eventually recovered their kidney functions and were doing well during their follow-up. Toluene based organic solvents lead to acute neurological symptoms, accompanied by severe metabolic alterations, organ injury and dysfunction. An association of the development of hypokalemic paralysis and metabolic acidosis with toluene intoxication has been observed. The management of acute toluene toxicity is mainly conservative, consisting of electrolytes correction, acid-base and fluid abnormalities and renal replacement therapy in severe AKI. Organic solvent exposure may result in acute tubular necrosis, rhabdomyolysis, RTA and AKI irrespective of the intake route. Clinical suspicion of organ dysfunction and failure and timely induction of supportive care leads to a good outcome

Clinicopathologic Spectrum of Xanthogranulomatous Pyelonephritis: A Single Center Experience over 8 Years

Xanthogranulomatous pyelonephritis (XGP) is a chronic pyelonephritis subtype in which destruction of the renal parenchymal occurs, resulting in progressive loss of kidney functions. Although middle age is the predominant age group affected, but it can be spotted at any age. There is accumulation of macrophages (lipid-laden), leading to renal parenchymal destruction and fibrosis. In this study, we present our data of 15 patients who had undergone nephrectomy and had biopsy-proven XGP. XGP constituted 4.53% of the 331 nephrectomies performed for infective causes over a period of 8 years. All our patients had undergone unilateral total nephrectomy. Demographic and clinical data were analyzed after taking consent from all the patients. The age range of patients in our study was 18–65 years with a mean age of 43.93 ± 13.86 years. Ten (66.6%) of our patients were females. Diabetes was present in 40% of the patients. Three patients had imaging, suggestive of pyonephrosis, 3 had perinephric collection and 9 patients (60%) had concomitant nephrolithiasis. All the kidneys were grossly enlarged and were nonfunctional on renal scintigraphy. XGP is a form of chronic pyelonephritis, which, although less common, is devastating because of destruction of the renal parenchyma and associated morbidity. Clinicoradiologic correlation cannot be overemphasized. Definitive diagnosis is established through histopathologic examination

Histopathological spectrum of ovarian tumours from a referral hospital in Kashmir valley, Jammu and Kashmir, India

Background: Ovary is a complex structure and its neoplasms show a wide spectrum of histological types and clinical behaviour. The present study was done with the aim of studying the histopathological pattern of the ovarian tumours in women of various age groups.Methods: This was prospective study conducted over a period of 2 years from Jan 2015 to Dec 2016 and included 193 cases of ovarian neoplasms.Results: Of 193 cases 155 (80.3%) were benign, 8 (4.1%) were borderline and 30 (15.5%) were malignant tumours. Surface epithelial tumours constituted majority of the tumours (64.7%). Mature cystic teratoma (30.6%%) was the most common benign tumour followed by serous cyst adenoma (26.9%). Serous cyst adenocarcinoma (7.8%) was the most common malignant tumour of the ovary. While tumours were seen over a wide range of 6-75 years, >80% of benign tumours were seen in patients of 40 years of age.Conclusions: The findings of present study are comparable to the published data from the subcontinent

Histopathological Spectrum of Nephrectomies; a Single Centre Experience of over 14 Years

Nephrectomy is conducted either as an open or a laparoscopic procedure for a variety of clinical indications. These include both neoplastic and non-neoplastic conditions, such as the non-functioning kidney. In many patients the final diagnosis is established on the histopathology of the retrieved kidney. In this study, retrospective analysis of data of last 14 years was studied pertaining to the number and indications of nephrectomy at the present study centre. Demographic and clinical details were assessed. Gross and microscopic histopathological details were recorded. Diagnosis was established on the basis of clinical features and histopathology. A total of 638 total nephrectomy specimens were received. Of these, 280 cases were of neoplastic and 358 of non-neoplastic lesions, with a male-to-female ratio of 1.21:1. The age range varied widely according to clinical manifestations. The age range in the present study was 5–84 years. Patients operated for non-neoplastic disorders were younger (mean age: 38.1 years) than those operated for neoplastic disorders (mean age: 54.4 years). Clear renal cell carcinoma (RCC) was the commonest RCC type (150 patients) followed by papillary RCC (51 cases). Nephrectomy is done due to both benign and malignant clinical indications as observed in this study. The most common indication was chronic pyelonephritis with the non-functioning kidney

Clinicopathological study of testicular tumors: an experience in a tertiary care hospital in Kashmir valley, Jammu and Kashmir, India

Background: Testicular and paratesticular neoplasia are rare type of tumors affecting adolescents and young adults in India, as observed by paucity of published data. This study was undertaken to analyze the patterns of testicular tumors at a tertiary level hospital in Kashmir valley, Jammu and Kashmir, India highlighting the patient’s demography, clinical presentation, diagnostic evaluation and pathological finding.Methods: This 5-year (retrospective and prospective) study was performed in the Department of Pathology, Government Medical College Srinagar, Jammu and Kashmir, India from January 2012 to December 2016. For the retrospective study, all cases of testicular tumors, their histopathological reports and required clinical details were searched from records maintained in the Department of Pathology, GMC Srinagar, Jammu and Kashmir, India. For the prospective study, the orchiedectomy specimens received in our department were subjected to routine histopathological processing followed by a detailed gross and microscopic examination. Tumour typing and subtyping was done according to WHO classification (2004).Results: A total of 37 cases of testicular and paratesticular neoplasia were included in present study with a mean age of 35.1 years. Out of these 37 cases, 31 (83.78%) were malignant and 6 cases (16.22%) were benign. Right testis was affected in 70.3% of cases. The most common clinical presentation was scrotal swelling. Germ cell tumor was the most common type accounting for 89.2% of tumors followed by lymphomas (8.1%).Conclusions:It is concluded that despite new techniques in imaging and tumor marker assay, the diagnosis of testicular tumors is dependent upon histopathological examination. The present study fairly provides an insight into the clinical presentations, prevalence and patterns of testicular tumors.

Uric acid level and its correlation with glycemic control in diabetics with normal renal function

Introduction: Limited studies have evaluated the relationship between uric acid and diabetes mellitus (DM), with different studies reporting varying findings. We aimed to investigate the association between levels of uric acid and glycemic control in type 2 DM (T2DM) in our patient cohort. Materials and Methods: We analyzed 200 consecutive patients in the age group of 30–70 years suffering from T2DM with normal renal functions (glomerular filtration rate >60 ml/min/1.73 m2), after excluding patients taking medications for lowering uric acid levels or diuretics. Fasting blood glucose (FBG), random blood glucose (RBG), glycated hemoglobin (HbA1c), and serum uric acid levels were measured in all the patients. Results: The mean age of the study population was 55.25 ± 12.05 years. There was no statistically significant difference in mean age, FBG, RBG, serum uric acid, and HbA1c levels or between males and females in our study cohort. There was a statistically significant negative correlation (P < 0.05) between uric acid levels and HbA1c (r = −0.189) and FBG (r = −0.114). Conclusion: We report an inverse correlation between uric acid levels and glycemic control in diabetic patients with normal renal function, irrespective of gender

Intravenous Albumin and Diuretic in Nephrotic Syndrome with Severe Edema: Our Experience and Literature Review : Albumin infusion

Background and Aim: Steroids are the mainstay of initial treatment in children with Idiopathic Nephrotic Syndrome (INS). The role of diuretics in children with NS is less clear in comparison to adults. In cases with severe or refractory edema, furosemide is often combined with albumin infusion (0.5 to 1 g/kg) to provide symptomatic relief. Methods: This study was a retrospective chart review of 17 patients with a diagnosis of Steroid Dependent Nephrotic Syndrome (SDNS) admitted for relapse of NS with severe edema who were resistant to diuretic therapy alone. The patients were treated as per unit protocol with an infusion of 100 ml intravenous albumin 20% over 4 hours and 2 doses (one in the morning at 10 AM and the other in the evening at 6 PM) of furosemide 1mg/kg for 3 days. Response to therapy and adverse events were evaluated. Results: The mean age of the study population was 10.58±1.5 years. All of the patients had severe edema and none of them had responded to intravenous diuretics alone. After co-administration of intravenous albumin infusion and furosemide, the mean weight loss per day per patient was 0.87±0.16 kg. Conclusion: A significant improvement was noted in all of the patients following co-administration of albumin and furosemide without any adverse events