A REVIEW OF LABORATORY TECHNIQUES FOR DETECTING LEPTOSPIROSIS

Occupational and recreational exposure to leptospirosis occurs in both the developed and developing countries. Timely laboratory confirmation of the disease is necessary to ensure a favourable clinical outcome and it is not possible to diagnose leptospirosis with certainty, on clinical grounds alone due to its inconsistent manifestations. Dark-field microscopy has multiple limitations. Many serological tests are easy to perform with minimum skills and laboratory facilities. To make a reliable diagnosis, it is essential to use multiple techniques together or in succession. Microscopic agglutination test is considered the gold standard†but requires paired sera, maintenance of live cultures of leptospires and is not useful for guiding early clinical management. Though the Polymerase Chain Reaction requires special equipment and expertise, it is useful for diagnosing leptospirosis in the first week of illness. Culture provides definite proof of leptospiral infection and helps in identifying locally pathogenic serovars. However, it is not useful as a diagnostic tool because by the time diagnosis is made by culture, antibodies are already detectable by serological techniques. Sero-surveillance helps in identifying high-risk individuals, high-risk geographical areas, outbreaks, animal reservoirs, new serological variants and their geographical distribution. This review discusses various techniques for laboratory diagnosis of leptospirosis compared the technical limitations in terms of sensitivity, specificity and turnaround time. Based on the discussed facts, clinicians can decide the suitable technique of detections on case to case basis

Cytomorphological variables of hepatic malignancies in fine needle aspiration smears with special reference to grading of hepatocellular carcinoma

Background: The evaluation and management of discrete hepatic masses is a clinical problem. Ultrasound guided fine needle aspiration cytology (FNAC) is a rapid, accurate and safe diagnostic procedure that can be used in various neoplastic and non-neoplastic diseases of the liver. Aim: To evaluate the cytomorphological features of hepatocellular carcinoma. Materials and Methods: Ultrasound-guided fine needle aspiration was performed on 52 patients clinically suspected of having hepatic lesion. Results: Malignancy was detected in 50 cases. The primary malignancies consisted of 15 cases of hepatocellular carcinoma (HCC), 4 cases of cholangiocarcinoma and 2 of hepatoblastoma. There were 29 metastatic lesions, which included 26 cases of adenocarcinoma, 2 cases of squamous cell carcinoma and 1 of lymphoma. The key diagnostic features for HCC were trabecular arrangement, polygonal cells with eosinophilic and granular cytoplasm, hyperchromatic nuclei with macronucleoli. Atypical naked hepatocytic nuclei and malignant cells separated by sinusoidal capillaries were also commonly seen. The sensitivity and specificity of FNA for malignancies was found to be 96% and 100% respectively, yielding a positive predictive value of 100% and negative predictive value of 50%. Conclusions: There was a very good correlation of cytological criteria and histopathological diagnosis in hepatocellular carcinoma of various grades as well as in differentiating primary from metastatic tumors. It is recommended that image directed FNAC should be the primary diagnostic modality for assessing potential malignancy in any patient with a localized hepatic mass

Skeletal angiomatosis - rare cause of bone destruction: A case report with review of literature

Classification of skeletal angiomatosis into aggressive and nonaggressive types is on the basis of their clinical behavior and pattern of skeletal involvement (regional and disseminated). Gorham′s disease (massive osteolysis) is an aggressive form of skeletal angiomatosis that shows regional involvement, frequently involving the shoulder and hip areas. Cystic angiomatosis is a nonaggressive form of skeletal angiomatosis with multifocal involvement, predominantly affecting the trunk bones. The imaging modalities gave the diagnosis of cystic angiomatosis of humerus showing multicystic lytic areas. The histopathological differential diagnosis was cystic angiomatosis and Gorham′s disease, as microscopically both are indistinguishable from each other. Both represent a complex network of dilated thin-walled capillaries growing in the marrow space associated with the destruction of bone and infiltration into the adjacent soft tissues. The case is presented because of its extreme rarity and due to the diagnostic dilemma, whether to label it as Gorham′s disease or as cystic angiomatosis. Considering the site involved and its aggressiveness, the diagnosis is in favor of Gorham′s vanishing bone disease as cystic angiomatosis is multicentric and nonaggressive, involving mostly vertebrae and skull with multicystic lytic lesions

A study of clinico-hematological profile of pancytopenic patients in Central India

Background: To segregate the causes of pancytopenia which are easily treatable, from those requiring sophisticated investigations & vigorous treatment, based on clinico-hematological profile of the patients and affordable diagnostic mathods. Materials and Methods: 180 Pancytopenic patients were evaluated clinically along with hematological parameters, peripheral smears and bone marrow aspiration in the Department of Pathology, GMC, Bhopal for 3 years. Result: Age range was 5 months-70 years (mean- 26.6 years), with Male preponderance (M: F: 1.76:1). Commonest symptoms were weakness (97.8%), breathlessness (75%) and signs were pallor (98.3%) and splenomegaly (25.5%). Patients who presented with per rectal bleeding, in 46.2% diagnosis was dimorphic anemia thus per rectal bleeding was cause of associated iron deficiency. Commonest peripheral smear finding was microcytic hypochromic picture (27.22 %) & bone marrow was hypercellular (70.00%). Bone marrow aspiration revealed commonest cause was megaloblastic anemia (25%) followed by dimorphic anemia (17.2%) and infections (17.2%). In our study MCV was <100 fl in 12/45 (26.66%) cases of megaloblastic anemia so even if a patient presents with MCV < 100 fl megaloblastic anemia should not be ruled out only on this basis. Sensitivity of peripheral smear for dimorphic anemia was very low 35.48% and specificity was 82.55%, so bone marrow examination should be investigation of choice for inconclusive peripheral smears. Conclusion: Common causes of pancytopenia were easily treatable and reversible & can be detected by early and affordable diagnostic methods therefore should be considered at higher order in differential diagnosis of pancytopenia

Altered PTEN expression as a diagnostic marker for the earliest endometrial precancerous changes

Introduction: Study was planned to investigate PTEN gene expression in endometrial hyperplasia and carcinoma as analyzed by immunohistochemistry. Material and Method: This study was conducted on 80 endometrial samples in the Department of Pathology, Gandhi Medical College, Bhopal (January 2012 to August 2016) Results: 5 out of 5 cases of proliferative endometrium, 3 out of 5 cases of secretory endometrium, 37 [84%] out of 44 cases of simple and complex endometrial hyperplasia without atypia, 8 out of 15 cases of simple and complex endometrial hyperplasia with atypia and 3 out of 11 cases of endometrial carcinoma showed positive PTEN expression. Conclusion: PTEN is a major gene involved in the pathogenesis of endometrial carcinoma. Our data suggest that decreased PTEN expression was a marker of earliest endometrial pre-cancer lesion and we propose that use of PTEN immunostaining in a clinical setting may be informative in identifying premalignant lesions that are likely to progress to carcinoma

Expression of estrogen receptor, progesterone receptor and KI 67 in epithelial ovarian tumors and their histopathological correlation

Introduction: Expression of ER, PR and Ki 67 in epithelial ovarian tumors and their histopathological correlation analyzed by immunohistochemistry. Methods: This study was conducted on 60 ovarian specimens received in Department of Pathology, Gandhi Medical College, Bhopal for ovarian tumors from 1st January 2012 -31st august 2016. Results: The expression of ER was more in malignant tumor 21/26 than borderline 5/9 and benign tumors 5/25. The PR expression was more in benign tumors 14/25 than malignant 13/26 and borderline 2/9 tumors. The Ki67 expression was more in malignant tumors 22/26 than borderline 7/9 and benign 1/25 tumors. Conclusion: In our study ER and Ki-67 positivity was maximally seen in malignant cases. This shows that ER was enhanced in ovarian carcinoma and Ki67 was proliferative marker. PR expression was maximally seen in benign tumors. This showed protective role of PR marker in ovarian carcinoma

Diagnostic and prognostic role of Ki-67 and cytokeratin-5 expression in BPH and carcinoma prostate

Background: Cytokeratin-5 which stains the basal cell layer of the of the prostatic glands and Ki-67 which is a proliferation marker and stains the proliferative population of the lesion has been employed as markers of two different categories viz. basal cell marker and proliferative markers respectively in various studies. Aim of this study was to evaluate the utility of cytokeratin-5 and Ki-67 in differentiating and diagnosing the benign lesion like Benign prostatic hyperplasia and malignant lesion i.e. Carcinoma Prostate. Material and Methods: 90 cases of prostatic adenocarcinoma, BPH and prostatic inflammatory conditions were taken. Immunohistochemical staining for Ki67 and CK-5 was performed along with appropriate positive controls for each marker. Ki67 scoring classified as Negative, Low grade & High grade. Cytokeratin-5 scoring classified as Diffuse, Focal & Negative. Results: Cytokeratin-5 expression was found positive in 96.71% cases of BPH. Out of these 78.68% cases were diffusely positive and 18.03% cases were focal positive. Expression of Cytokeratin-5 in Carcinoma Prostate was 40%, 6.66% and 0% in well, moderate and poorly differentiated carcinomas respectively, whereas no expression of the marker in 60%, 93.33% and 100% cases of well, moderate and poorly differentiated carcinomas respectively. Ki-67 showed low grade expression in mere 8.20% cases of BPH. In Carcinoma Prostate Ki67 expression was shown by 60%, 79% and 100% cases of well, moderate and poorly differentiated carcinomas respectively. Conclusion: Diffuse Cytokeratin-5 expression was found in majority of BPH cases, while maximum Carcinoma prostate cases were negative. Ki-67 expression was found positively correlated with increasing Gleason’s grade in carcinoma prostate, while expression in benign lesion was not significant

ISSN 2347-954X (Print) Spectrum of Non Neoplastic Skin Diseases: A Histopathology Based Clinicopathological Correlation Study

Abstract: Skin, the largest organ of our body, is extraordinarily vibrant with regard to the diversity and complexity of the protective functions it serves. Many skin diseases can be diagnosed by a simple clinical examination, but sometimes relatively simple diagnostic procedures are required for additional valuable information towards reaching final diagnosis. A few such procedures are Skin biopsy. Potassium hydroxide preparation for fungal infections, Tzanck smear (cytological technique), examination under Wood's light. Skin biopsy is an especially useful procedure. It can be obtained in various ways like Punch biopsy, scalpel biopsy, shave biopsy and curettage biopsy. The choice of technique is according to the nature of the lesion, but a punch biopsy is the standard procedure. The correlation between the gross and histological appearances is often essential in understanding the pathogenesis and formulating the diagnosis. In the present study, over a period of 5 years 795 skin biopsies were received for different neoplastic and non neoplastic skin lesions. Out of 795 skin biopsies, 270 were clinically diagnosed as non neoplastic skin lesions. Definitive histopathological diagnosis was possible in 209 cases. In rest of the 61 cases, no histopathological diagnosis could be made as in 22 cases biopsy was inadequate to comment upon while in 39 cases no specific pattern of disease was observed which were analyzed and confirmed histologically

Immunohistochemical expression of Ki-67 in invasive breast carcinoma and its correlation with prognostic parameters

Background: Ki-67 expression is strictly associated with cellular proliferation and is an excellent marker for determining the growth fraction of a given cell population. It may be considered as alternative to mitotic counts in grading schemes and as a single parameter that can be used in fine needle aspirates and small biopsies. The aim of this study was to evaluate proliferative fraction of Ki67 expression in invasive breast carcinoma and to find out the correlation between Ki67 expression and clinico-pathological prognostic factors such as tumor size, lymph node status, histological grade and Nottingham prognostic index. Materials and Methods: Seventy cases of infiltrating ductal carcinoma breast were studied. Immunohistochemistry using the anti-Ki-67 antibody [MIB-1] was performed on all cases and Ki-67 staining was categorized as low and high grade. Result: High expression of Ki-67 was found in 71.05% cases of breast tumor with positive lymph node metastasis and 92.31% cases of Grade III tumor. Ki-67 expression was significantly associated with nodal status (p<0.0001) and poorly differentiated tumor (p<0.0001). Although, Ki-67 expression was associated with tumor size, but their correlation was not statistically significant (p= 0.065). Conclusion: High Ki-67 expression was associated with a higher grade of malignancy. Conclusively, proliferative activity determined by Ki-67 expression may reflect the aggressive behavior of breast carcinoma. Ki-67 detection provides valuable information about proliferative activity of cells so, it is necessary to combine this with other parameters for better prognosis