Gu Deshpande

SPECTRUM OF NEPHROPATHIES WITH SPECIAL REFERENCE TO PRIMARY GLOMERULOPATHIES

A retrospective study was carried out where histopathology records of Department of Pathology, Armed Forces Medical College, Pune were scrutinised covering a period of 10 years. We came across 325 cases of nephropathies. The sample comprised of 92.6% adults and 7.4% children. 79.7% were males and 20.3% were females. The patient population comprised of 35.1% serving soldiers, 37.8% their family members and 27.1% not related to Armed Forces. The study is based on only light microscopy findings. It was observed that primary glomerular disease was the commonest entity and comprised of 61.5% of all the nephropathies. Acute diffuse proliferative glomerulonephritis was not only the commonest primary glomerulopathy (23.5%) but the commonest nephropathy as well. The other primary glomerulopathies in descending order of frequency were, membranoproliferative glomerulonephritis (22.5%), mesangioproliferative glomerulonephritis (21.5%), chronic glomerulonephritis (9%), minimal change disease (7.5%), membranous glomerulopathy (7%), focal segmental glomerulosclerosis (5%) and crescentic glomerulonephritis (4%). We had only 14 cases (4.3% of all nephropathies) of secondary glomerulopathies, amongst which amyloidosis was the commonest cause. We came across 2 cases (0.6% of all nephropathies) of Alports syndrome. In the other nephropathies, 22.2% were tubulointerstitial diseases and 5.5% were malignant kidney tumors. In 5.8% renal biopsies, no significant pathology was seen on light microscopy.

CORRELATIONSHIP OF HORMONE RECEPTOR STATUS, p53 MUTATION AND c-erb B-2 OVEREXPRESSION WITH NUCLEAR GRADING IN BREAST CANCERS

Thirty cases of infiltrating duct carcinoma of the breast were studied for the expression of estrogen receptor (ER) and progesterone receptor (PR) status; p 53 protein mutation and c-erb B2 overexpression. The results were correlated with the morphological differentiation, as determined by the Nottinghams modification of the Bloom-Richardson system. Hormone receptor positivity was seen in 46.67% cases, whereas p 53 mutation and c-erb B2 overexpression were seen in 50.00% and 60.00% cases respectively. In grade II tumours receptor positivity, p53 mutation and c-erb B-2 overexpression were 57.15%, 42.85% and 52.38% respectively. The corresponding figures for grade III tumours were 33.33%, 83.33% and 66.67% respectively. As grade 1 comprised only 3 cases no statistical correlation could be observed. Thus we conclude that receptor positivity declined, whereas p 53 mutation and c-erb B-2 overexpression increased, with increase in tumour grade.

IMPROVED ACCURACY RATES OF FNAC INTERPRETATION IN BENIGN BREAST LESIONS

We carried out a retrospective study of 194 biopsy proved benign breast lesions comparing the fine needle aspiration cytology (FNAC) diagnosis offered earlier. We reviewed the cytology smears based on recently advocated criteria and offered our fresh diagnosis. It was observed that we still overdiagnosed five cases of fibroadenomas and underdiagnosed four cases of fibrocystic change. However the quantum of such discrepancies decreased considerably than seen earlier. We could correctly diagnose two tubular adenomas and two intraductal papillomas. We also reduced the number of nonspecific diagnosis of benign breast disease from 24 to 08. Hence we could register an overall improvement of accuracy rate to 84.5% as compared to 58.8% achieved earlier.

AGAROSE GEL ELECTROPHORESIS AS SCREENING TEST FOR MULTIPLE MYELOMA CASES

OBJECTIVE To study effectiveness of agarose gel electrophoresis as a screening tool for early detection of multiple myeloma. DESIGN A prospective study in OPD setting. PATIENTS Two hundred and nineteen patients (126 females and 93 males) in the age group of 28-82 year referred to Department of Physical Medicine and Rehabilitation from various departments for treatment of unexplained pains and aches (with or without osteoporosis). They had been investigated and were adjudged organic disease free. INTERVENTION Agarose gel electrophoresis was carried out on sera of these patients. Bone marrow aspiration was done for all those patients whose serum showed a monoclonal protein peak. Characterisation of M peak was also carried out by Immunoelectrophoresis. MAIN RESULT Out of the 219 patients, sera of 29 patients showed a monoclonal protein peak. Immunoelectrophoresis and bone marrow aspiration confirmed the diagnosis of multiple myeloma in these patients. 17 were male and 12 were female patients. All of them were over 50 years of age. CONCLUSION Agarose gel electrophoresis was found to be very sensitive test for early detection of multiple myeloma cases. Hence it was strongly recommended to be used as a screening test for all elderly people who present with unexplained aches and pains with or without osteoporosis.