Aparna Narasimha

Significance of Hematological Scoring System (HSS) in Early Diagnosis of Neonatal Sepsis

Neonates are easily prone for bacterial infection. Diagnosis of neonatal septicemia may be difficult as the early signs of sepsis may be subtle and different at different gestational ages. The present study was undertaken to assess the significance of the hematological scoring system (HSS) for early detection of neonatal sepsis. About 50 peripheral blood smears of all newborns collected were analysed for neonatal sepsis using the HSS of Rodwell et al. (J Pediatr 112:761–767, 1988). Analysis in our study found that an abnormal immature to total neutrophil ratio (I:T) followed by an abnormal immature to mature neutrophil ratio (I:M) were the most sensitive indicators in identifying infants with sepsis. The HSS is a simple, quick, cost effective tool which can be used as a screening test for early diagnosis of neonatal sepsis.

Significance of nuclear morphometry in benign and malignant breast aspirates

Background: Breast carcinoma is one of the most common cancers occurring in the female population world-wide. Normal cells gradually transform to form the cancer cells through several stages. Nuclear changes occurring during these transformational steps need to be assessed objectively. Hence nuclear morphometry can be used as a diagnostic tool. Aim: To compare the nuclear morphometric parameters of benign and malignant breast aspirates. Study Design: Cytology was used to categorize aspirates from the breast lumps in to malignant (30 cases), and benign (30 cases). Nuclear parameters were calculated using the Image J 1.44C morphometric software. Several nuclear size parameters were analyzed. Results: The nuclear area, perimeter, diameter, compactness, and concave points were found to be statistically significant (P < 0.05) parameters in differentiating benign, and malignant aspirates. Conclusion: Nuclear morphometry was thus, a useful objective tool in the differentiating benign, and malignant breast lesions.

Retroperitoneal cystic schwannoma: A case report with review of literature

The occurrence of retroperitoneal schwannoma is uncommon and its presence may only be expressed by insidious onset of nonspecific symptoms such as vague abdominal pain. Imaging modalities like computed tomography and magnetic resonance imaging may demonstrate the tumor, but due to heterogeneity and degeneration in some tumors, it may mimic malignancy. So, fine needle aspiration cytology followed by tissue sampling through needle biopsies may be essential to confirm the diagnosis prior to the surgery. This case is reported for its rare clinical presentation, having duration of more than 40 years with cystic degenerative changes.

Giant chondroid syringoma with divergent differentiation: Cyto-histo-immuno correlation

Chondroid syringoma is a rare benign skin adnexal tumor of eccrine/apocrine origin affecting commonly the head and neck region. It is also called as mixed tumor of skin because of the presence of both the epithelial and mesenchymal components. There are very few case reports of chondroid syringoma diagnosed on fine needle aspiration cytology (FNAC). We hereby report a case of giant chondroid syringoma occurring over the lower back in a 50-year-old male, diagnosed initially on cytology and confirmed by histopathology. This case is reported for its unusual size and site of occurrence. We describe the clinical features, cytology, histopathology, immunohistochemistry, and differential diagnosis of giant chondroid syringoma along with review of literature.

Gastric adenocarcinoma deposits presenting as multiple cutaneous nodules: a case report with review of literature.

Metastases to the skin from internal tumors are uncommon, yet they may be the first presentation of such malignancies. They usually arise from the breast, lung and large bowel. Cutaneous metastases from gastric adenocarcinoma are extremely rare. We report a case of gastric adenocarcinoma that at presentation had multiple clinically benign looking skin nodules. Fine needle aspiration cytology of the cutaneous nodule revealed metastatic deposits. The current literature on cutaneous metastases of gastric carcinoma is reviewed in this case report.

Negative staining of mycobacteria - A clue to the diagnosis in cytological aspirates: Two case reports

Large amounts of lipids present in the cell wall of mycobacteria render them impermeable to dyes used in routine stains. Special staining techniques like Ziehl-Neelsen (ZN), Auromine Rhodamine are needed to demonstrate them. However, they may appear as negatively stained ghosts in Leishman, Giemsa, Hematoxylin and Eosin stain (H and E) and Gram stained smears. Awareness of this feature prompts one to look for mycobacteria by special techniques, even in the absence of cytological features of tuberculous infection like epithelioid granulomas and caseous necrosis. In this paper, we aim to present two cases showing negatively stained images in the lymphnode aspirates of Human Immunodeficiency Virus (HIV) positive patients. A study has been done of two cases of HIV positive patients with cervical lymphadenopathy. Fine needle aspiration cytology (FNAC) was carried out for them from the enlarged lymph nodes which revealed purulent material. Smears of FNAC material were prepared for histopathological examination. Fixed smears were stained with Papanicolaou stain and air dried smears were stained with Giemsa and ZN-stain and studied. Smear study showed scant cellularity, cells composed of neutrophils, lymphocytes, plasma cells and macrophages. Background was necrotic. Giemsa stained smears showed, in addition to cells mentioned, negatively stained ghostly rod shaped structures in the cytoplasm of macrophages and also in the background. ZN-stain showed numerous acid fast bacilli. Both the aspirates were signed out as tuberculous lymphadenitis. In both the cases, cultures grew Mycobacterium avium Intracellulare. Classical cytological features of tuberculosis may not be present in immunocompromised patients and on the contrary there may be suppuration rich in neutrophils or sheets of histiocytes in tuberculosis. One may miss these cases if mycobacteria are not looked for specifically by special stains. Negatively stained ghost images of Tuberculous bacilli on different types of strains are a very helpful finding in such cases.

Clear cell hidradenocarcinoma of the eyelid: a case report with a review of the literature

Clear cell hidradenocarcinomas are extremely rare neoplasms, with very few well-documented cases reported in the literature. The most common sites are the head and neck regions. These tumors are histologically malignant but are not always aggressive. They are known for recurrence and may metastasize widely. Treatment is wide local resection. We report on a case of clear cell hidradenocarcinoma occurring over the eyelid together with a review of the literature.

Anticoagulant induced artefacts in peripheral blood smears.

Microscopic evaluation of a peripheral blood smear is one of the most beneficial test. But anticoagulant induced artefacts could lead to misinterpretation of the smears. The present study was undertaken to identify the anticoagulant induced artefacts and avoid misinterpretation of peripheral blood smears. The blood samples were collected using Ethylene Diaminetetraacetic acid (EDTA) and Sodium citrate, mixed thoroughly and smears were made immediately as well as 1hr apart for 6 hrs, stained and examined under oil immersion microscope. Direct smears were used as controls. Significant morphological artefacts were observed in our study. Artefacts were marked at the end of 2 hrs with EDTA but seen almost immediately with citrate blood. At 6 hrs, artefacts were marked but more severe with citrates than EDTA. Thus the practice of making blood smears before addition of anticoagulant is recommended and a delay up to 1hr is permissible with EDTA blood but not beyond.