Study of diagnostic accuracy of fine needle aspiration cytology of lymph nodes over 6 years in a tertiary care hospital

Background: Lymph node fine needle aspiration cytology (FNAC) is the first line investigation for evaluation of lymph node disease. Existing literature reports high degree of correlation between lymph node FNAC and histological examination. The aim of the present study is to re-evaluate the diagnostic accuracy of FNAC in view of frequent discordance between FNAC and diagnosis on biopsy.Methods: Among a total of 495 lymph node FNACs and 291 biopsies, 69 adequate FNACs which were followed up with biopsy were evaluated with standard statistical methods for assessment of diagnostic accuracy.Results: The commonest diagnosis on biopsy was reactive lymph node (34.71%) followed by granulomatous disease (26.12%) and lymphoid neoplasms (20.96%). Reactive lymphadenitis and granulomatous disease were also the two commonest categories on FNAC (34.34% and 24.85% respectively). However, the sensitivity of FNAC in diagnosis of granulomatous disease was found to be 45.83%, which increases to 70.03% if necrosis is included as a marker of granulomatous disease. The greatest sensitivity was achieved in diagnosis of metastatic disease (88.89%), followed by lymphoid neoplasms (69.23%).Conclusions: FNAC is a useful tool for excluding specific categories of lymph node diseases, esp. metastatic disease. However, the technique needs improvement as to sample more representative areas of the node, to improve its sensitivity

Correlation of serology with morphological changes in gastric biopsy of H. pylori infection

Background: Helicobacter pylori is involved in many gastrodeudonal complications and many diagnostic tests are available for its identification. The present study was done with the objective to evaluate the morphological changes induced by H. pylori in the gastric mucosa and to correlate them with the severity of the infection.Methods: This study was conducted in a tertiary care hospital from July 2013 to June 2014. 60 patients with symptoms of dyspepsia and requiring an upper gastrointestinal endoscopy were included in the study. Upper gastrointestinal endoscopy was performed on all patients. Hematoxylin and Eosin staining (H and E), modified Giemsa staining were performed on tissue sections and examined microscopically for gastritis and presence and absence of H. pylori.Results: Out of 60 patients, 33 were male and 27 were females. Serology by immunochromatography technique was positive in 41 patients. Serology was found to have a sensitivity and specificity of 90.90% and 59.25% respectively. H. pylori was positive in 28 cases on H and E. With a sensitivity and specificity of 84.84% and 100% respectively. H. pylori was positive in 33 cases on modified Giemsa with a sensitivity and specificity of 100%.Conclusions: Simultaneous morphologic and serological detection of H. pylori helps in its complete distribution and identification of its precancerous morphological nature

Post-mortem findings in Staphylococcus aureus acute infective endocarditis

Infective endocarditis (IE) is a microbial infection of the heart valves or the mural endocardium that leads to the formation of vegetations composed of thrombotic debris and microorganisms often associated with the destruction of the cardiac tissues. Most of the infections are bacterial (bacterial endocarditis), although fungi and other microorganisms can be etiological agents. Causative organisms differ among the major high-risk groups. Virulent microorganisms like Staphylococcus aureus, commonly found on the skin, can infect normal or deformed valves and are responsible for 20-30% of all IE cases. Staphylococcus aureus is the major offender in IE among intravenous drug abusers. Acute infective endocarditis is typically caused by infection of a previously normal heart valve by a highly virulent organism (e.g., Staphylococcus aureus) that rapidly produces necrotizing and destructive lesions. These infections may be difficult to cure with antibiotics, and despite appropriate treatment, death can ensue within days to weeks. Here we present autopsy findings of a 31-yearold male patient who died of acute infective endocarditis caused by Staphylococcus aureus as the causative organism

Multimodality imaging features of primary breast lymphoma – A rare entity

Primary lymphoma of breast is very rare which has no tell-tale imaging characteristics. Multimodality imaging helps not only in suggesting the possibility of lymphoma but also in its management. We present here one such case which was extensively worked up with various imaging modalities and was histologically proven as primary breast lymphoma

Pilot study of an open-source image analysis software for automated screening of conventional cervical smears

Introduction: The Pap stained cervical smear is a screening tool for cervical cancer. Commercial systems are used for automated screening of liquid based cervical smears. However, there is no image analysis software used for conventional cervical smears. The aim of this study was to develop and test the diagnostic accuracy of a software for analysis of conventional smears. Materials and Methods: The software was developed using Python programming language and open source libraries. It was standardized with images from Bethesda Interobserver Reproducibility Project. One hundred and thirty images from smears which were reported Negative for Intraepithelial Lesion or Malignancy (NILM), and 45 images where some abnormality has been reported, were collected from the archives of the hospital. The software was then tested on the images. Results: The software was able to segregate images based on overall nuclear: cytoplasmic ratio, coefficient of variation (CV) in nuclear size, nuclear membrane irregularity, and clustering. 68.88% of abnormal images were flagged by the software, as well as 19.23% of NILM images. The major difficulties faced were segmentation of overlapping cell clusters and separation of neutrophils. Conclusion: The software shows potential as a screening tool for conventional cervical smears; however, further refinement in technique is required

DISTRIBUTION OF DIFFERENT PML/RARΑ BCR ISOFORMS IN INDIAN ACUTE PROMYELOCYTIC LEUKAEMIA (APL) PATIENTS AND CLINICOHEMATOLOGICAL CORRELATION

Context: Acute promyelocytic leukemia (APL), an  AML subtype, is characterized  morphologically by abnormal promyelocytes. Molecular studies show three possible bcr isoforms of PML- RARα fusion gene . This study undertakes analysis of PML-RARα bcr isoforms and their correlation with  hematological parameters  and  response to treatment in Indian patients. Aims: To study different bcr isoforms in Indian patients and to find any correlation with various hematological parameters and response to treatment Settings and Design: Patients diagnosed as APL on morphology or flowcytometry and confirmed by RQ PCR were  included in the study. Treated APL patients or patients with relapse and  on follow up were excluded from the study. Methods and Material:   Twenty  patients over  thirty one months  period were included. The clinical, hematological & morphological features were analysed, the latter using  routine & special cytochemical stains on    blood and bone marrow . Flow cytometric evaluation  using 4-color Beckman Coulter FC 500  and  molecular studies  using RT PCR FusionQuant® kits for bcr-1, bcr-2  and  bcr-3 on the instrument  Rotor Gene™ 3000 were  performed . Statistical analysis used: Student t test was applied to correlate different bcr isoforms with various haematological parameters and response to treatment. Results: In our study , M:F ratio was 1.5:1 with  median age  42 years, Hb - 8.0 g/dl,  TLC-7900/μl, and platelet – 35000/ μl and varied clinical presentation. Four patients were microgranular variants and rest  hypergranular . MPO and CAE  positivity was   100% and 33.33% for NSE. Molecular analysis revealed bcr1 in 42.85% , bcr2 in 14.28% and bcr 3 in 38.09 % patients. No correlation was found between bcr isoforms , different hematological parameters and response to treatment. Conclusions: Higher incidence of bcr-1 was found in Indian APL patients with no significant correlation between different hematological parameters and response to treatment