Uterine leiomyoma presenting with unusual pathological features: a series of two cases

Leiomyomas are benign and most common smooth muscle neoplasms that can occur in any organ, most commonly in uterus, small bowel and esophagus. Leiomyomas may have unusual presentations either in form of location or various secondary changes like hyaline, myxoid, red degeneration, chondroid metaplasia, sarcomatous change, etc. We present two unusual cases of leiomyomas, one involving an unusual location (giant cervical fibroid) and the other a uterine leiomyoma with rare pure chondroid metaplasia. Both these entities are rare and hold importance in the differential diagnosis because it is imperative to differentiate the giant cervical fibroid from any ovarian neoplasm or procidentia and chondroid metaplasia from any other mesenchymal/mixed uterine tumor. Moreover giant leiomyomas require expert hands during surgical removal

The significance of expression of Her2neu in squamous cell carcinoma of uterine cervix

Background: Cervical cancer is one of the leading causes of cancer related deaths among females. It arises from precursor lesions i.e. squamous intraepithelial lesions which are closely associated with infection by HPV. The ERBB2 protooncogene encodes for a cellular transmembrane protein (erb-b2) which has tyrosine kinase activity and has been implicated in the regulation of cellular growth and proliferation in various cancers. Application of monoclonal antibodies against Her2neu has shown higher response and improved survival. The aim of the study was to evaluate the expression of Her2neu in squamous cell carcinoma of cervix in relation to tumor characteristics and to compare the expression with normal control subjects.Methods: It was a cross-sectional analytical study. Paraffin embedded tissue blocks from 30 cases of squamous cell carcinoma were obtained from the archives. Twenty age matched cases of normal cervix removed for lesions other than that related to cervix (like leiomyoma) were taken as control. Tumour characteristics were noted from the records. Her2neu immunostaining was done. Her2neu expression was scored as positive or negative according to the American Society of Clinical Oncology and the College of American Pathologists (ASCO/CAP) scoring system for Her2neu. The Chi-square test was used to compare and find association between the variables. Student t-test was used to compare the variable between cases and controls.Results: Her2neu was positive in 20% and negative in 80% cases of the study group. Her2neu positivity is not associated with size, histological grade and FIGO stage of the tumor. We found that all Her2neu positive cases showed no lymph node metastasis. This association between Her2neu positivity and lymph node status was statistically significant.Conclusions: Her2neu immunoexpression is variable across various categories of squamous cell carcinoma. Her2neu positivity might be negatively associated with lymph node metastasis. However, a more comprehensive study encompassing various factors related to Her2neu overexpression is required to validate these results

Avascular necrosis of humeral head in an elderly patient with tuberculosis: a case report

<p>Abstract</p> <p>Introduction</p> <p>Osteonecrosis (avascular necrosis) is known to be caused by high-dose corticosteroid therapy, alcoholism and rarely by infections. However, a tubercular etiology of this condition is very rare. A review of the literature yielded only a few cases of polyarticular tuberculosis with osteonecrosis in immunosuppressed individuals. No case of monoarticular tubercular osteonecrosis diagnosed by aspiration cytology was found. Since tuberculosis is a curable disease, an early and accurate diagnosis is essential.</p> <p>Case presentation</p> <p>A 60-year-old Indian man presented with diffuse swelling and pain in the left shoulder for the previous 6 months. A computed tomography scan of the left shoulder revealed crescentic lucency in the humeral head, suggestive of osteonecrosis. Fine needle aspiration cytology smears from the swelling showed features of an acute suppurative lesion. Stain for acid-fast bacillus was positive and thus, a final clinico-pathological diagnosis of osteonecrosis of humeral head with tubercular etiology was rendered. The patient was initiated on anti-tuberculous therapy with symptomatic improvement in his condition.</p> <p>Conclusion</p> <p>Osteonecrosis, a debilitating disease, may rarely occur due to tuberculosis, especially in endemic areas. Fine needle aspiration cytology is an effective and inexpensive modality for an early diagnosis of the tubercular etiology of osteonecrosis.</p

Role of thalassemia screening in prevention and control of thalassemia - a 5 year experience

Background: Thalassemia is a commonest genetic blood disorder in India which can be prevented by antenatal screening and prenatal diagnosis. Aim of the study was to screen antenatal women and their spouses to detect “couples at risk” of thalassemia major births and offering them genetic counseling and option of prenatal diagnosis thereby preventing the birth of thalassemia major babies.Methods: Thalassemia screening for antenatal women was done by NESTROFT test and RBC Indices (MCV, MCH, and RBC count). Confirmation of diagnosis was done by HPLC test. Husbands of women testing positive on HPLC were also tested and couples at risk detected. They were counseled and referred for prenatal genetic diagnosis. Women carrying thalassemia major fetus were advised termination and those with normal and thalassemia minor fetus were advised to continue pregnancy.Results: A total of 93871 patients were screened and HPLC was done on 10983 patients. 7.07% had one or the other hemoglobinopathies and 5.8% had beta thalassemia trait. Among antenatal beta thalassemia trait was found in 5.02%, HbD in 0.36%, HbE in 0.58% and HbS 0.05%. Forty two “at risk couples” (both husband and wife thalassemia trait) were identified, 16 of these underwent prenatal diagnosis and 3 thalassemia major births were terminated.Conclusions: Lack of awareness, late registration, husbands not coming/turning up for their test and “at risk couples” opting out of prenatal diagnosis are the cause of thalassemia major births which can be prevented if awareness is generated amongst masses, screening and prenatal genetic diagnosis services are made widely available

Angiogenesis in Non-Hodgkin's Lymphoma: An Intercategory Comparison of Microvessel Density

Background. This study was aimed at comparing angiogenesis, seen as microvessel density (MVD) in subtypes of non-Hodgkin's lymphoma (NHL). Methods. In this study, 64 cases of NHL diagnosed over a three-year period were included along with 15 lymph node biopsies of reactive hyperplasia. NHLs were classified using REAL classification, and immunohistochemistry was performed for CD34 in all cases. CD34-stained sections were evaluated for “hot spots,” where MVD was assessed and expressed as per mm2. Appropriate statistical methods were applied. Results. There were 6 cases of well-differentiated lymphocytic lymphoma (SLL), 21 diffuse large B-cell lymphoma (DLBCL), 15 follicular lymphoma, 10 lymphoblastic lymphoma, 7 MALToma, and 5 peripheral T-cell lymphoma (PTCL). Mean MVD was highest in reactive hyperplasia (191.92 ± 12.16 per mm2) compared to all NHLs. Among NHLs, PTCL demonstrated the highest MVD (183.42 ± 8.24) followed by DLBCL (149.91 ± 13.68). A significant difference was found in MVD between reactive and individual lymphoma groups. SLL had significantly lower MVD than other lymphoma subtypes. Conclusion. Angiogenesis, assessed by MVD, showed significant differences among subtypes of NHL, especially the indolent types like SLL. The higher MVD in aggressive lymphomas like PTCL and DLBCL can potentially be utilized in targeted therapy with antiangiogenic drugs

Capillary haemangioma of fallopian tube: a rare but dangerous incidental finding

Haemangiomas are tumors of vascular origin. They are frequently observed in soft tissue and skin. Vascular tumors of female pelvic organs are extremely rare. Although, majority of these lesions are detected incidentally, they can mimic various benign and malignant lesions clinically and radiologically. Fallopian tube capillary haemangioma is very rare benign neoplasm. Only one case of capillary haemangioma of fallopian tube has been reported. A 44-year-old female with menorrhagia, underwent hysterectomy with bilateral salpingoopherectomy. Both the fallopian tubes were grossly unremarkable. Microscopic examination revealed a well circumscribed vascular neoplasm, consistent with capillary haemangioma, CD34 immunostaining highlighted the vascular endothelium.  Although benign in nature, haemangioma of the fallopian tube can present with complications. Rupture of the haemangioma can be lethal when present with hemoperitoneum

Lichen planus of uterine cervix - the first report of a novel site of occurrence: a case report

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Tubercular dactylitis: fine needle aspiration cytology as a diagnostic modality

Objective To evaluate the efficacy of aspiration cytology in the early diagnosis of tuberculous dactylitis and describe the spectrum of cytomorphologic features in these cases. Study Design We studied 12 cases of dactylitis diagnosed as of tubercular etiology by fine needle aspiration cytology (FNAC) over a period of 6 years and assessed the clinicoradiologic features. The stained slides were reviewed and the spectrum of features noted. Results The most common clinical presentation was an indurated swelling of the involved digit (100%). On radiography, most often an expansile, lytic lesion along with soft tissue swelling was noted in 83% of cases. However, the clinical diagnosis did not consider a TB etiology. FNAC of these cases showed variable features; the most common was granulomas with or without necrosis (75% in total). Two cases showed acute suppurative cytology and 1 revealed only fibroblasts and a few neutrophils. On the basis of suspicion, staining for acid-fast bacilli (AFB) was done in all cases, and bacilli were identified in all of them after a thorough search.These patients were soon started on antituberculous therapy, with significant improvements. Conclusion FNAC can serve as an inexpensive and comparatively less invasive procedure for early diagnosis of TB dactylitis, permitting timely initiation of specific therapy. This study also highlighted the unusual cytomorphology in some cases. Clinicians and pathologists should maintain a high index of suspicion in cases of dactylitis and stain for AFB in all cases

Recurrent calcifying epithelial odontogenic tumor of the maxilla: report of a case with cytologic diagnosis

Background Calcifying epithelial odontogenic tumor (CEOT) occurs rarely in the maxilla and lacks classical clinicoradiologic features. The cytologic features in conjunction with the radiologic picture can be helpful in making a preoperative diagnosis and guiding management. Case A young man with a progressively increasing left cheek swelling and proptosis of the left eye was referred for fine needle aspiration cytology. The smears were paucicellular and showed clusters of mildly pleomorphic squamoid cells; abundant, amyloidlike, pink material; and occasional concentric calcification. A provisional diagnosis of CEOT was given and confirmed on histo-pathology. Conclusion The characteristic cytologic findings in association with radiologic features can help the cytopathologist in rendering a firm preoperative diagnosis of CEOT even at atypical sites such as the maxilla

Impact of El-Nino and La-Nina Episodes on Rainfall Variability and Crop Yield

El Nino and La Nina events have an impact on the Indian monsoon in terms of less rainfall than average and more rainfall in La Nina years. El-Nino events are more likely to see rainfall variability during the monsoon and depressions over the Bay of Bengal (July-August). ENSO is a disruption in ocean surface temperatures and atmospheric circulation over the Pacific Ocean leading to wide spread changes in rainfall/precipitation regimes around the world. El Nino years' effects on crop production in India as a result of lower rainfall during the south-west monsoon. In the kharif season (June to September), crops suffer from moisture and have lower yields in El-Nino years, but the opposite in La-Nina years. The El Nino is associate with the possibility of drought like situation at many occasions and La Nina is the opposite of El-Nino events