Geeta Dev

Evaluation of clinico-radiological, bacteriological, serological, molecular and histological diagnosis of osteoarticular tuberculosis

Background: The diagnosis of osteoarticular tuberculosis is clinico-radiological in endemic areas. However every patient does not have the classical picture. Osteoarticular tuberculosis is a paucibacillary disease hence bacteriological diagnosis is possible in 10-30% of the cases. The present study is undertaken to correlate clinico-radiological, bacteriological, serological, molecular and histological diagnosis. Materials and Methods: Fifty clinico-radiologically diagnosed patients of osteoarticular tuberculosis with involvement of dorsal spine (n = 35), knee (n = 8), shoulder (n = 1), elbow (n = 2) and lumbar spine lesion (n = 4), were analyzed. Tissue was obtained after decompression in 35 cases of dorsal spine and fine needle aspiration in the remaining 15 cases. Tissue obtained was subjected to AFB staining, AFB culture sensitivity, aerobic/anaerobic culture sensitivity histopathological examination and polymerase chain reaction (PCR) using 16srRNA as primer. Serology was performed by ELISA in 27 cases of dorsal spine at admission and one and three months postoperatively. Results: AFB staining (direct) and AFB culture sensitivity was positive in six (12%) cases. Aerobic/anaerobic culture sensitivity was negative in all cases. Histology was positive for TB in all the cases. The PCR was positive in 49 (98%) cases. All dorsal spine tuberculosis cases showed fall of IgM titer and rise of IgG titer at three months as compared to values at admission. Conclusion: Histopathology and PCR was diagnostic in all cases of osteoarticular tuberculosis. The serology alone is not diagnostic.

Chronic epididymitis (epididymal nodule) mimicking an adenomatoid tumor--case report with review of literature.

Aim: To describe and review the differential diagnosis of epididymal nodules and chronic epididymitis so as to have a broad view of this pathology. We have suggested a possible diagnostic algorithm for the workup of an epididymal nodule.Methods/results: We have reported a case of a 35-year-old patient with a symptomatic palpable nodular mass in the tail of the left epididymis. Fine needle aspiration suggested an adenomatoid tumor while the surgical excision histology was reported as chronic epididymitis.Conclusions: Epididymal nodules are frequently encountered in the epididymis. Their differential diagnosis includes chronic granulomatous epididymitis, adenomatoid tumor and benign paratesticular neoplasms. We consider that it is important to distinguish epididymal nodules from benign inflammatory lesions and the threshold for a surgical excision should be low as it is therapeutic and provides a definite diagnosis. Whilst the FNAC alone may not be always adequate to confirm diagnosis, an epididymectomy may be curative as well as diagnostic in selected cases.

Acquired uterine arteriovenous malformation developing in retained products of conception: A diagnostic dilemma

Abnormal uterine bleeding in the postabortal period requires meticulous diagnostic work‐up to decide proper management. Imaging modalities including Doppler sonography and magnetic resonance imaging in concert with clinical and laboratory findings are useful to narrow the differential diagnoses but are not definitive. Presence of increased uterine vascularity and arteriovenous shunting is non‐specific and can be detected in a variety of conditions including retained trophoblastic tissue, gestational trophoblastic disease, arteriovenous malformation (AVM), placental polyp and vascular neoplasm. We present here a case of a multiparous woman with unexplained postabortal bleeding posing a diagnostic challenge. Excluding the possibility of AVM before attempting dilatation and curettage in such a clinical scenario is crucial to prevent catastrophic bleeding.

Postmenopausal bleeding: squamous cell carcinoma of cervix with coexisting endometrial tuberculosis.

Case reportA case of squamous cell carcinoma of cervix co-existent with endometrial tuberculosis presenting as postmenopausal bleeding is being reported for its rarity. The atrophic postmenopausal endometrium is thought to be poorly supportive of tubercle bacilli. Following a radical Wertheim’s hysterectomy patient had a hectic postoperative period, which responded to antitubercular treatment. Diagnosis of tuberculosis in this case was made on histopathology postoperatively and confirmed by polymerase chain reaction (PCR) on scrapes from the granulomas obtained by microdissection.ConclusionTuberculosis complicating malignant disease may occur in regions with a high prevalence of disease; with a resurgence of tuberculosis worldwide this association may not be uncommon. The diagnosis and treatment of tuberculosis in a patient with cancer assumes importance as a high mortality has been seen in patients with co-existent disease.

Early Biologic Behavior of Bone Grafts

OBJECTIVE: To conceptualize, with fine needle aspiration cytology (FNAC), the early cellular events occurring in and around fresh autogenous and allogenic bone grafts during the first 40 postimplantation days. STUDY DESIGN: Forty-eight cases of bone grafts were studied by FNAC at serial intervals of 10, 20, 30 and 40 postimplantation days. Twenty patients were recipients of autogenous grafts, 16 received 0.6N HCI partially decalcified allogenic bone implants, and 4 received combined autogenous and allogenic bone grafts (included in the allograft group). There were eight control cases of closed fracture shaft femur, which were managed conservatively. RESULTS: The initial cellular responses in autogenous grafts, allografts and controls appear to be a part of the nonspecific reparative process followed by a more specific phase, with a steady increase in relative lymphocyte count from the 20th day onwards. Osteogenesis, as judged by osteoblasts and osteoclasts, was also comparable. CONCLUSION: Partially decalcified allografts appear to be a good substitute for autogenous bone grafts in clinical practice when adequate autogenous material is not available. FNAC is a good technique for studying bone graft responses without interfering with graft uptake. It is helpful in the early detection of subclinical infection or any other pathology at the graft site.

Multicentric extraskeletal myxoid chondrosarcoma of uterine adnexa in a young female: an unusual presentation.

Extraskeletal myxoid chondrosarcoma is a rare soft-tissue sarcoma, mostly occurring in the proximal extremities and limb girdle. Majority of the patients are in fifth and sixth decades of life with male preponderance. We report here a case of primary extraskeletal myxoid chondrosarcoma of the uterine adnexa involving the broad ligament and fallopian tube synchronously without any evidence of uterine/ovarian involvement in a young multiparous female of 27 years. After the histopathological diagnosis, re-excision of the tumor bed with wide local margins was recommended. Since the tumor has an aggressive course, with propensity for late recurrence and metastases to lungs, the patient must be considered for long-term follow-up.