Xanthogranulomatous pyelonephritis: Unusual clinical presentation: A case report with literature review

Xanthogranulomatous pyelonephritis (XGP) is rare and aggressive form of chronic infectious pyelonephritis. No single clinical or radiological feature is diagnostic of XGP. A 75-year-old man with prostatic enlargement presented with difficulty and burning micturition fever, abdominal and flank pain. X-ray, ultrasonography and computed tomography scan diagnosis was right kidney pyonephrosis. Intravenous urography revealed non-excretory right kidney. Right nephrectomy was done. Histological diagnosis of XGP was made. In all patients of prostatic enlargement, renal function must be assessed for the extent of damage. Surgery is the treatment choice in most cases. Pre- and post-operative antibiotics are key factors for successful management and better prognosis

Diaphyseal osteosarcoma with varying histomorphologic patterns

Osteosarcoma is the most common primary malignant tumor of the skeleton involving predominantly metaphysis of the long bones. Diaphyseal osteosarcoma is a rare form, which accounts for approximately 10% of all cases of osteosarcomas. Osteosarcoma contains a family of lesions with considerable diversity in histologic features and grade. We present a case of a 29-year-old male with diaphyseal osteosarcoma of the left tibia, who presented with pain and swelling over middle one-third of the left leg. The biopsy of the lesion revealed varied histomorphologic features in a small tissue studied. This prompted us to report the various histologic patterns of osteosarcoma

A focal nodular Hürthle cell hyperplasia in Hashimoto′s thyroiditis: A diagnostic dilemma on fine needle aspiration

Hürthle cells are seen in a variety of nonneoplastic and neoplastic thyroid gland lesions. Number and morphology of Hόrthle cell vary in thyroid aspirate. Occasionally, thyroid aspirate in focal nodular Hόrthle cell hyperplasia in Hashimoto′s thyroiditis exclusively comprise of Hόrthle cells and mimics Hόrthle cell neoplasm. Fine needle aspiration (FNA) diagnosis in such cases is challenging. A 60-year-old female presented with goiter and clinical features of hyperthyroidism. FNA smears showed Hόrthle cells arranged in flat sheets and lying singly with occasional lymphocytes in Hόrthle cell sheets. Repeat aspiration from other site showed lymphocytes, infiltrating the thyroid follicular cells. We conclude that a careful search of lymphocytes in Hόrthle cell sheets in cytology smears, multiple aspirates, associated clinical findings and ancillary techniques reduce the diagnostic pitfall and avoid unnecessary surgery

Role of histochemical stains in differentiating hemangioma and vascular malformation

Background: Benign vascular lesions such as vascular malformation and hemangioma at times pose difficulty in diagnosis both for clinicians and pathologists. Vascular malformations are difficult to treat while hemangiomas resolve spontaneously in most instances. There are instances when vascular malformations, especially arteriovenous malformations (AVMs) have been misdiagnosed as hemangiomas and vice-versa. Clinical and radiological correlation with histopathological confirmation of these anomalies is important for the management of these lesionsAim: The aim was to study the histological characteristics of hemangiomas and vascular malformations and to study the utility of histochemical stains in their diagnosis. Materials and Methods: We retrospectively studied fifty cases retrieved from the records of Department of Pathology which were diagnosed as hemangioma (n=32) and vascular malformation (n=18) on Hematoxylin and Eosin (H and E) stain over a period of 18 months. The cases were analyzed based on findings of histochemical stains such as Verhoeff-van Gieson (VVG), Masson's trichrome (MT), and toluidine blue. Results: After reviewing all the cases with the use of histochemical stains, two of the three cases originally diagnosed as hemangioma turned out to be AVM and one to be venous malformation. An increased number of intra-lesional nerves were found in 16 of 19 cases of AVM and in both cases of venous and lymphatic malformation. Hemangiomas did not show increase in nerve bundles. Mast cells were found to be increased in proliferating hemangiomas and pyogenic granulomas as compared to AVMs. Conclusion: Hemangiomas and vascular malformations should be clearly differentiated to reduce the risk of treatment failure and recurrence. With the use of histochemical stains such as VVG, MT and toluidine blue, the diagnostic difficulty can be reduced and definitive diagnosis is possible

Role of microwaves in rapid processing of tissue for histopathology

Aim: The primary aim of the following study is to study the utility of microwave stimulated rapid processing of tissues for histopathology and the secondary aim is to compare the quality of the final product obtained after microwave stimulated rapid tissue processing with the conventional method. Materials and Methods: During the 3 years period of study, 150 cases were studied which were randomly selected from the tissues sent for histopathology. Tissues were processed by conventional method and by microwave assisted tissue processing. Results: Slides obtained by microwave and conventional tissue processing were statistically analyzed by using Chi-square test. The results obtained showed that the cellular and nuclear features of microwave processed tissues were comparable to conventionally processed tissue. Microwave assisted tissue processing reduced the total time for preparing tissue blocks to about an hour. Conclusion: Microwave stimulated processing provides an attractive alternative over traditional conventional processing

Study of sideroblasts and iron stores in bone marrow aspirates using Perls′ stain

Introduction: A bone marrow examination is a critical part of the evaluation of patients with a variety of hematopoietic and nonhematopoietic diseases. A Perls′ or Prussian blue stain demonstrates hemosiderin in bone marrow macrophages and iron within sideroblasts. Examination of iron stain allows detection not only of an increased or decreased proportion of sideroblasts but also of abnormal sideroblasts. We undertook this study to evaluate the iron stores in bone marrow as judged by Perls′ stain. Materials and Methods: A Prospective analysis of 55 bone marrow aspirates in a tertiary care center. Results: Sideroblasts were present in all the cases. They were decreased in iron deficiency anemia (IDA), and few other chronic diseases whereas normal to increase in megaloblastic anemia. According to Gale′s method, cases of IDA had absent or decreased iron stores while those of megaloblastic anemia or normoblastic marrows showed normal to increased stores. Grading by the recent intensive method showed combined functional and iron stores deficiency. Conclusion: Perls′ stain on bone marrow aspirates is an important tool not only for assessing the iron stores, increased or decreased but also to study abnormal sideroblasts

Clinicopathologic study of malignant ovarian tumors: A study of fifty cases

Background: Malignant ovarian tumors have worst prognosis among all gynecological malignancies and highest case fatality rate. There is a steady increase in the age-standardized incidence rate in India. Most cases are diagnosed late when the symptoms such as abdominal distension become apparent. Objective: The aim is to study the histomorphological features of malignant tumors of the ovary and to find out the frequency of various malignant ovarian tumors with respect to age and clinical features. Subjects and Methods: Fifty malignant ovarian tumors were included in the study. Clinical and histomorphological features were studied and correlated. Results: Maximum number of malignant ovarian tumors occurred in between 50–60 years and 21–30 years of age. Pain and lump in the abdomen was the most common presenting symptom. Right ovary was commonly involved. CA-125 blood levels were elevated in 54% of cases. Ultrasound and color Doppler examinations showed irregular solid tumor, ascites, papillary structures, large multilocular solid tumor, and high Doppler content. Histopathology diagnosis was aided by immunohistochemistry. Maximum malignant tumors (n = 31) were surface epithelial tumors, and serous cystadenocarcinoma was most common. Conclusion: Malignant ovarian tumors are the leading cause of death from gynecologic malignancy in females. Clinical symptoms, radiological findings, and other ancillary investigations such as CA-125 are the keys in establishing the preoperative diagnosis of malignant ovarian tumors. Malignant surface epithelial tumors are most common, and serous cystadenocarcinoma is the most common histological type

Pattern of palpable breast lesions on fine needle aspiration: A retrospective analysis of 902 cases

Background : Breast lumps constitute a significant proportion of surgical cases in women of both developed and developing countries. The aim of this study is to look the frequency distribution of various breast lesions on fine needle aspiration (FNA). Materials and Methods : The 902 patients who presented with palpable breast lump, irrespective of age and sex were included in the study. Frequency distribution of various breast lesions with respect to age and sex was studied. Cytology grading in breast carcinoma was correlated in 69 cases with histology grading. Results : The majority (N = 871) of patients were females with maximum (N = 566) patients between second and third decade. The 773 patients had benign breast lesions and maximum (N = 341) patients were in the second decade. Fibroadenoma was the commonest benign lesion followed by fibrocystic change and mastitis. Out of 119 malignant breast lesions, 31.93% [N = 38] were between 41-50 years of age, 28.57% [N = 34] in 51-60 years and 22.68% [N = 27] in between 31-40 years of age. Out of 119 malignant breast lumps and majority were infiltrating ductal carcinoma (N = 108). Cytology grading correlated maximum with histology grade in Grade I followed by Grade II and Grade III. Conclusion : With experienced hands, FNA is safe, cost effective and a reliable technique for preoperative evaluation of palpable breast lumps. FNA features are more informative when combined with physical and radiology findings (Triple test). Fibroadenoma, fibrocystic change and mastitis form the major bulk of benign breast lesions. Epithelioid cells when seen in inflammatory breast FNA smears, tuberculosis must be ruled out. In India, breast carcinoma arises in younger patients as compared to western countries. Grading of breast carcinomas must be done on FNA smears for selecting neoadjuvent therapy. Clinical breast examination and mammography screening in females should be encouraged in developing countries from the third decade onwards for early detection of breast carcinoma