Ml Harendra Kumar

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.

Malignant peripheral nerve sheath tumor with divergent differentiation.

A malignant peripheral nerve sheath tumor (MPNST) is an uncommon spindle cell sarcoma accounting for approximately 5% of all soft tissue sarcomas. A 55-year-old female with a right suprarenal tumor showed MPNST with additional foci of epithelioid, rhabdomyoblastic, osteogenic and lipogenic differentiation. Although the capacity of MPNST to undergo epithelioid, rhabdomyoblastic, osteogenic and very rarely lipogenic differentiation is reported in literature, the occurrence of all these differentiation in one case has not been described in literature before. To the best of our knowledge, this is only the second MPNST case with lipomatous differentiation.

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.

Expression of vimentin in breast carcinoma, its correlation with Ki67 and other histopathological parameters

CONTEXT Vimentin is a mesenchymal marker, known to express in some epithelial carcinomas. AIMS 1. To find out the expression of vimentin in infiltrating ductal carcinoma of breast (not otherwise specified), 2. To find out the correlation between expression of vimentin and prognostic markers such as tumor size, tumor grade, lymph node status, proliferation index (measured by Ki 67), and Nottingham prognostic index (NPI). MATERIALS AND METHODS Study was done at Department of Pathology; 50 cases of infiltrating ductal carcinoma (NOS) were studied for tumor grade; immunohistochemistry was done using antibodies against vimentin and Ki 67. Percentages of positive cells were documented. An immunoscore was also calculated for vimentin. Vimentin expression was correlated with tumor size, lymph node status, Nottingham prognostic index, and Ki 67. STATISTICAL ANALYSIS USED statistical correlation was done using Pearsons chi-square test. A P value less than 0.01 was considered significant. RESULTS Vimentin expression was seen in 18% of cases. Its expression correlated with high tumor grade and high growth fraction (P value < 0.01). It did not correlate with lymph node status, tumor size, and NPI. CONCLUSIONS Increased vimentin expression is associated with bad prognostic factors. Immunohistochemistry with vimentin may be helpful in knowing the prognosis in cases of infiltrating ductal carcinoma of breast (NOS).

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.

Pseudovascular adenoid squamous cell carcinoma of oral cavity: A mimicker of angiosarcoma

Pseudovascular adenoid squamous cell carcinoma (PASCC) is an uncommon histological variant of squamous cell carcinoma that can mimic vascular neoplasms, particularly angiosarcoma, in its morphologic characteristics. PASCC has been reported in the head and neck, as well as in the other organs such as the breast, lungs, urinary bladder, vulva, and uterine cervix. Only two cases of PASCC arising from the upper aerodigestive tract have been reported so far. We report a case of PASCC of oral cavity in a 40-year-old man, which mimicked an angiosarcoma initially. Immunohistochemical analysis led to a conclusive diagnosis of PASCC.

Evaluation of histomorphological and immunohistochemical parameters as biomarkers of cervical lymph node metastasis in squamous cell carcinoma of oral cavity: A retrospective study

Introduction: Oral squamous cell carcinoma (OSCC) is seen worldwide but is more common in India. Lymph node (LN) metastasis has been shown to be the strongest prognostic factor in OSCC. Many histopathological and immunohistochemical markers have been studied to predict the LN metastasis. Aims: To identify clinicopathological factors and immunohistochemical (IHC) biomarkers which predict cervical metastasis in OSCC patients. Study and Design: A total of 105 cases of OSCC were taken up for our study. Histopathological parameters such as tumor thickness, depth, degree of differentiation, pattern of invasion (POI), lymphovascular and neural invasion were assessed. IHC was done on all cases using antibodies against Ki-67, cyclin D, E-cadherin, p53, CD31 and each antibody was assessed according to the standard protocol. Statistical Analysis: To calculate the relation between clinical, histopathological parameter, IHC marker and the occurrence of LN metastasis, chi-square test was used. Variables were tested using multivariate logistic regression method to assess the predictive significance. Results: Out of 105 cases studied, 29 cases showed LN metastasis. Maximum numbers of cases affected were females with involvement of buccal mucosa. We found significant association of cervical LN metastasis with high grade of differentiation, lack of E-cadherin expression, high Ki-67 and cyclin D1 expression. In our study; tumor depth, thickness, extent of peritumoral lympho-plasmacytic infiltration, presence of eosinophils, tumor nest type, p53 and microvessel density (MVD) showed no significant correlation. Conclusion: Significant association of cervical LN metastasis with high grade of differentiation, lack of E-cadherin expression, high Ki-67 and cyclin D1 expression was seen.

Malignant hypertension, dissection of aorta, cardiac tamponade and monoparesis—Unusual presentation of Takayasu's arteritis: Clinicopathological correlation

We report a case of a 24-year-old woman with an unremarkable past medical history who was presented to the emergency department with acute onset of breathlessness and weakness of right lower limb. Clinical examination was suggestive of malignant hypertension with acute left ventricular failure and acute ischemia of right lower limb. Colour Doppler and CT findings were consistent with dissection of entire aorta with extension into its major branches. She died in less than 18 h after admission following cardiac tamponade. Autopsy revealed left renal artery stenosis with features of Takayasus arteritis with intimal rupture in the abdominal aorta with Stanford type A dissection of aorta extending to all the major branches of aorta, and hemopericardium. This case demonstrates a rare example Takayasus arteritis involving left renal artery leading to secondary hypertension presenting as malignant hypertension with fatal dissection of aorta with cardiac tamponade and emphasizes the varied presentations of this disease and importance of early diagnosis and interventions to prevent these fatal complications.

Vulval schwannoma: A cytological diagnosis

Schwannomas are the most common peripheral nerve sheath tumors, the frequent sites of involvement being the head and neck, the flexor aspect of the limbs, especially near the elbow, wrist, knee, and trunk. Involvement of the female genital tract is extremely rare. We present one such rare case of a solitary vulval schwannoma which was diagnosed by fine needle aspiration cytology in a 48 year-old female, and confirmed by histopathological examination.

Primary testicular lymphoma with rupture: An unusual presentation

Primary testicular lymphoma usually presents as a unilateral testicular mass with occasional bilateral involvement. The tumor show contiguous spread to rete testis, epididymis spermatic cord and rarely to tunica albuginea. We report a case of primary testicular lymphoma which showed rupture of tunica albuginea with involvement of inguinal lymph node which is unusual. A 50-year-old male patient presented with right inguinal swelling and right side scrotal swelling of five months’ duration. Fine needle aspiration of the right inguinal lymph node was done and was suggestive for lymphoma/seminoma. Histopathology of right orchiectomy revealed non-Hodgkins lymphoma (NHL). Further investigations did not reveal any other organs involved with non-Hodgkins lymphoma. Primary testicular lymphoma usually shows spread to extranodal sites like skin, central nervous system and Waldeyers ring at presentation and at relapse. Whereas, less common sites are lung, bone, liver, gastrointestinal system and nodal sites, especially the paraaortic lymph nodes. Testicular lymphoma with involvement of the inguinal lymph node is unusual. Clinical presentation of such cases may mimic germ cell tumors.