Navjeevan Singh

Pearly penile papules: a review

Lesions similar to PPP were described as early as 1700 by Littre. 8 Duhring reported similar lesions in 1888 and thought that they were nerve organs. 8 In 1909, Buschke demonstrated similar lesions in men and boys, and stated that similar structures had been observed in the newborn and even in the orangutan. 4 Later illustrations were reproduced by Dickinson 9 in his atlas. The term PPP was coined by Johnson and Baxter, 1

Masters theses from a university medical college: Publication in indexed scientific journals

Background: The thesis is an integral part of postgraduate medical education in India. Publication of the results of the thesis in an indexed journal is desirable; it validates the research and makes results available to researchers worldwide. Aims: To determine publication rates in indexed journals, of works derived from theses, and factors affecting publication. Settings and Design: Postgraduate theses submitted over a five-year period (2001-05) in a university medical college were analyzed in a retrospective, observational study. Materials and Methods: Data retrieved included name and gender of postgraduate student, names, department and hierarchy of supervisor and co-supervisor(s), year submitted, study design, sample size, and statistically significant difference between groups. To determine subsequent publication in an indexed journal, Medline search was performed up to December 2007. Statistical Analysis: Chi square test was used to compare publication rates based on categorical variables; Students t-test was used to compare differences based on continuous variables. Results: One hundred and sixty theses were retrieved, forty-eight (30%) were published. Papers were published 8-74 (33.7 ± 17.33) months after thesis submission; the postgraduate student was first author in papers from 26 (54%) of the published theses. Gender of the student, department of origin, year of thesis submission, hierarchy of the supervisor, number and department of co-supervisors, and thesis characteristics did not influence publication rates. Conclusions: Rate of publication in indexed journals, of papers derived from postgraduate theses is 30%. In this study we were unable to identify factors that promote publication.

Significance of Cytologic Criteria in Distinguishing Small Cell from Non–Small Cell Carcinoma of the Lung

OBJECTIVE To study the significance of cytologic features in distinguishing small cell carcinoma (SCC) from non-small cell carcinoma (NSCC). STUDY DESIGN Prospective study of 76 patients with lung carcinoma. Percutaneous fine needle aspiration and bronchial washings stained with Papanicolaou and May-Grünwald-Giemsa stain were used for categorization of tumors according to the World Health Organization classification. Each tumor was also scored for the presence or absence of standard cytologic criteria used in the diagnosis of SCC. Data were analyzed for sensitivity, specificity and significance using the chi 2 and Fisher exact tests. Undifferentiated and unclassified tumors were examined immunocytochemically for the presence of neuron-specific enolase, epithelial membrane antigen and leukocyte common antigen. Cytologic diagnoses were compared with histopathologic diagnoses. RESULTS Seventy-six lesions classified on cytomorphology consisted of SCC (15), NSCC (50), non-Hodgkins lymphoma (1), carcinoid (1) and undifferentiated or poorly differentiated carcinomas (9), 2 of which showed nuclear molding and salt-and-pepper chromatin. Immunocytochemistry and biopsy confirmed the diagnosis of SCC in those two patients. CONCLUSION Nuclear molding, cell size and scant, basophilic cytoplasm were highly sensitive and specific by univariate analysis for distinguishing SCC from NSCC. Other features, such as salt-and-pepper chromatin, crush artifact and apoptotic bodies, also had significantly high specificity; however, their low sensitivity precluded their usefulness in separating SCC from NSCC. Thus, morphologic evaluation plays a major role, while immunocytochemistry can make a limited contribution in differentiating SCC from NSCC.

Koilocytosis: correlations with high-risk HPV and its comparison on tissue sections and cytology, urothelial carcinoma.

The aim of this study were (1) To correlate koilocytosis with high risk HPV(HrHPV) DNA in urinary bladder carcinoma and (2) To compare detection of koilocytosis on tissue sections and urine cytology. Biopsy and cytologic specimens from 33 patients of urinary bladder carcinoma were analyzed. HPV DNA was detected by PCR on biopsy specimens using consensus primers MY09 and MY11. Koilocytosis was assessed both on tissue sections and urine cytology. HrHPV DNA was found in 14 of 33 bladder carcinoma. Koilocytosis was seen in tissue sections from 13 patients. Eleven of these were HrHPV DNA positive (positive predictive value 84.6%). Koilocytosis was seen in urine cytology in three patients. All three were positive for HrHPV DNA. To conclude koilocytosis is a good morphological marker for HrHPV DNA in the urothelium. Tissue sections are better than cytologic smears for detection of koilocytes. Diagn. Cytopathol. 2009.

Cytomorphology of Leprosy Across the Ridley-Jopling Spectrum

OBJECTIVE To evaluate the possible role of cytology in classifying leprosy lesions on the Ridley-Jopling scale. STUDY DESIGN A double-blind, prospective study comparing cytologic assessment of 30 clinically diagnosed cases of leprosy with their histopathology. May-Grünwald-Giemsa and Ziehl-Neelsen stain were done on slit skin smears and fine needle aspiration material. RESULTS Cytologic subclassification was possible in 23 cases as tuberculoid leprosy (11), midborderline (3), borderline lepromatous (5) and lepromatous leprosy (4). These correlated with histologic subtypes. CONCLUSION May-Grünwald-Giemsa complements Ziehl-Neelsen stain, yielding information almost comparable to that from histologic examination of skin biopsies.

Cytomorphologic Patterns in Calmette Guerin Bacillus Lymphadenitis

OBJECTIVE To study the cytomorphologic patterns of Calmette Guerin bacillus (BCG) lymphadenitis and compare it to those of tuberculous lymphadenitis. STUDY DESIGN A retrospective cytomorphologic study of 136 cases of clinically diagnosed BCG adenitis. All fine needle aspiration smears of lymphadenitis in the age group 2 months to 2 years during a three-and-half-year period were analyzed. RESULTS Three distinct cytomorphologic patterns were seen in 112 cases. They were acid-fast bacilli in a necrotic background (62), granulomas with necrosis (47) and granulomas in a reactive lymphoid background (3). CONCLUSION The cytomorphologic patterns in BCG lymphadenitis were similar to those seen in tuberculous lymphadenitis; however, an exudative response and high acid-fast bacillus positivity was seen more frequently in BCG lymphadenitis. Moreover, Ziehl-Neelsen staining helped to distinguish these cases from pyogenic abscesses.

Remission of Recalcitrant Epidermolysis Bullosa Acquisita (EBA) with Colchicine Monotherapy

A 42‐year‐old woman with widespread recalcitrant epidermolysis bullosa acquisita (EBA) responded well to colchicine monotherapy after attempts to control her disease with other modalities failed. These included dapsone, tetracycline, prednisolone, and combination of cyclophosphamide/azathioprine with dexamethasone ‘pulse therapy‘. The useful role of colchicine in controlling some difficult cases of EBA, a therapeutically problematic condition, is stressed.

Nodular post‐kala‐azar dermal leishmaniasis: a distinct histopathological entity

Post‐kala‐azar dermal leishmaniasis (PKDL) is an infrequently occurring sequel to treated visceral leishmaniasis. Diagnosis, particularly in non‐endemic areas, is difficult because the clinical appearances may be subtle and simulate lepromatous leprosy. The histopathology of the condition has been a neglected subject. Nodular lesions constitute one of the large variety of lesions that can be seen in PKDL. This paper describes the histopathology of such lesions in 26 patients seen over a period of approximately 8 years in a non‐endemic setting. All the biopsies had strikingly similar light microscopic features with characteristic findings: a dense lymphohistiocytic infiltrate beneath an atrophic epidermis, pronounced follicular plugging, vascular hyalinization and collagen changes and negative Fite stain. Tbese allow a definite diagnosis of PKDL even in the absence of demonstrable Leishman‐Donovan (L‐D) bodies.

Fine Needle Aspiration Cytology of Reactions in Leprosy

OBJECTIVE To define diagnostic cytomorphologic features of reactions in leprosy. STUDY DESIGN Part-retrospective, part-prospective, single-blind, controlled study of the applicability of fine needle aspiration cytology in the diagnosis of reactions in leprosy. Cytomorphologic features were compared in 42 clinically diagnosed patients with reactions in leprosy with those in a control group of patients with nonreactional leprosy. The study groups included type 1 and type 2 reactions in 35 and 9 patients, respectively. May-Grünwald-Giemsa and Ziehl-Neelsen staining methods were employed. RESULTS Statistically significant (P < .01) cytomorphologic features of type 1 reaction were the presence of fragments of collagen and elastin; giant cells; giant cells exhibiting elastin phagocytosis; loose, epithelioid cell granulomas; and fibroblasts. Type 2 reaction was characterized in aspirates by the presence of an abundance of neutrophils in a background of lepromatous leprosy (P < .01). CONCLUSION Criteria that are used in histopathology for the diagnosis of leprosy reactions can be applied satisfactorily to cytologic smears. A good correlation between clinical diagnosis and cytomorphology can be achieved. Multiple-site aspirates from the skin, nerve and lymph nodes are helpful in substantiating the diagnosis.

Fine Needle Aspiration Diagnosis of a Subcutaneous Abscess from Enterobius vermicularis Infestation

BACKGROUND: Extraintestinal infestation by Enterobius vermicularis is uncommon. It has been reported to occur in the peritoneal cavity, ovary, fallopian tube, endometrium, lung, liver and urinary tract. CASE REPORT: Fine needle aspiration diagnosis was made in a case of enterobiasis presenting with a subcutaneous abscess in the natal cleft. Eggs, as well as fragments of cuticle of the adult worm, were found; the morphology of both was best visualized in Papanicolaou-stained smears. Polarizing microscopy highlighted the equally spaced parallel grooves of the cuticle. CONCLUSION: Fine needle aspiration cytology of subcutaneous abscesses due to enterobiasis can be diagnostic when eggs, or eggs with cuticle, are identified in a suppurative or granulomatous inflammation.