Nidhi Verma

Prevalence of cervical dysplasia in western Uttar Pradesh.

Introduction: Cervical intraepithelial neoplasia and cervical cancer remain important health problems. Cervical cytology by Papanicolaou (Pap) smears is an effective means of screening for cervical premalignant and malignant conditions. Aim: The aim of this study was to assess the prevalence of cervical dysplasia in pre- and postmenopausal women in western Uttar Pradesh and to find out risk factors as far as possible. Materials and Methods: A total of 4,703 cases were enrolled, cervical scrape smears were collected and stained using Papanicolaous method and hematoxylin and eosin stain. The emphasis was put on epithelial abnormalities and smears were classified according to The Bethesda System 2001. Results: 81.06% (3812) smears were satisfactory according to The Bethesda System. Maximum numbers of cases (40.37%) were in age group 30-39 years. The epithelial abnormalities constituted 3.23% of all cases. Low-grade squamous intraepithelial lesion (LSIL) formed the largest number (1.36%), while high-grade squamous intraepithelial lesion (HSIL) formed 0.91%. Eleven cases of squamous cell carcinoma (SCC) were detected. The study has shown a relatively high prevalence of epithelial abnormalities in cervical smears with increasing age, parity, early age at first coitus (<20 year), and lower socioeconomic status in symptomatic women with clinical lesions on per speculum examination. Conclusion: Epithelial abnormalities of cervix are not uncommon in our setup and are associated with early age at marriage and parity.

Ultrasound guided fine needle aspiration cytology in the diagnosis of retroperitoneal masses: A study of 85 cases

Background: The diagnosis of retroperitoneal lesions is one of the most difficult areas in surgical pathology. The retroperitoneal space allows both primary and metastatic tumors to grow silently before the appearance of clinical signs and symptoms. Fine needle aspiration cytology has shown promising role in establishing the diagnosis in this region. Objectives: This study was undertaken to evaluate the reliability of ultrasonography (USG)-guided fine needle aspiration cytology (FNAC) in distinguishing between benign and malignant lesions in the retroperitoneum, and to correlate the diagnosis by cytology of retroperitoneal masses with the results obtained by histology. Materials and Methods: The study was carried out on 85 patients presenting over the last five years with retroperitoneal masses on ultrasound. Results: Out of 85 cases, 32 were of kidney, 27 of lymph nodes, 24 of retroperitoneal soft tissues, and two were of the adrenals. Malignant lesions (47) were more common than nonmalignant lesions (38). In the kidney, the maximum number of cases were of renal cell carcinoma (12-38%), followed by Wilms tumor (6-19%), pyonephrosis (5-16%), renal cyst (4), angiomyolipoma (2), cortical pseudotumor (2), and tuberculosis (1). Out of 27 cases of retroperitoneal lymphadenopathy, 12 cases (44%) were of metastatic carcinoma followed by non-Hodgkins lymphoma (8-30%), tuberculosis (6-22%), and Hodgkins lymphoma (1). The two cases of the adrenals were of angiomyolipoma and metastatic carcinoma. Among the 24 soft tissue tumors in the study, seven (29%) were malignant and 17 (71%) were benign (lipoma being the most common benign neoplasm). Results from histopathological investigations were available in 47 cases, out of which 45 were consistent with the FNAC-based diagnoses. Two cases for which the histopathological results were inconsistent with the FNAC diagnoses, were of renal cell carcinoma, which had been diagnosed as renal cysts on cytology. Conclusions: USG-guided FNAC is an inexpensive, rapid, safe, and accurate procedure for the diagnosis of retroperitoneal masses.

Depression and thyroid function tests

The thyroid hormone plays an important role in regulating the mood and cognitive functions of the body. Studies have revealed that although a majority of the cases of depression are associated with euthyroidism, thyroid dysfunction has commonly been seen associated with depression. The most commonly seen thyroid abnormality in the thyroid patients are raised levothyroxine (T4), decreased tri-iodothyronine (T3), and raised thyrotropin release hormone (TRH) levels, and a blunted thyroid stimulating hormone (TSH) response. A majority of the patients with abnormal thyroid function tests are associated with subclinical hypothyroidism. It is also believed that T3 supplementation, even in the euthyroid patients with depression, is associated with improvement in their depression scores.

Xanthogranulomatous pyelonephritis: An uncommon entity with review of literature

Xanthogranulomatous pyelonephritis (XGP) is an uncommon entity affecting predominantly females between the ages 45-55 years. The disease is usually associated with urinary tract infection and the patient presents with flank pain, dysuria and fever. It has to be differentiated from various benign and malignant conditions including tuberculosis (TB) and renal cell carcinoma. Surgery is the definitive treatment of choice. Hereby, a case of 45-year-old, hypertensive female, who presented with uncommon condition is being reported.

Incidence of bone tumors and tumor like lesions at a tertiary centre - a study of 64 cases

Background: Primary bone tumors are uncommon lesions constituting less than 1% of all cancers. Although open biopsy has high accuracy, it increases risk of tumor dissemination in patients with highly malignant tumors. FNAC eliminates the complications that may occur in surgical procedures and also gives quick results. This study was conducted to determine the spectrum and demographic characteristics of bone tumors and tumor like lesions at a tertiary care centre in western Uttar Pradesh and also to assess the role of FNAC in their diagnosis. Methods: This is a three-year, retrospective as well as a prospective study done on a total of 64 cases. All the cases were subjected to detailed history, physical examination and radiological investigations. FNAC smears were stained with Giemsa and Papanicolaou stain. H and E staining was done for histopathology. Results: Mean age affected was 26 years. Male-female ratio was 2.8:1. Out of total 64 cases of bone tumors and tumor like lesions, maximum was chondrogenic tumors (17; 26.56%), followed by osteogenic tumors (15; 23.44%). Osteochondroma (08; 47.06%), Osteosarcoma (07; 46.66%) and Aneurysmal bone cyst (04; 50.0%) were the most common chondrogenic tumor, osteogenic tumor and tumor like lesion respectively. The most common bone affected was tibia (16; 25.0%), followed by femur (15; 23.4%). Sensitivity and specificity of FNAC as a diagnostic modality were 90.0% and 91.67% respectively. Conclusions: A good correlation is observed between cytological and histological diagnoses which implies that FNAC can be used as a preliminary diagnostic approach to bone tumors, although histopathology remains the gold standard.

Clinico-pathological correlation of ovarian tumors and tumor like lesions with role of CA125 and HE4 as biomarkers for discrimination of benign and malignant ovarian tumors

Background: Ovarian tumors and tumor like lesions of ovary frequently form pelvic masses and are associated with hormonal manifestations. Clinically or surgically they can mimic malignancy but pathologically they could be benign tumors or tumor like lesions. Methods: The aim of present study is to do clinico-histopathological correlation of ovarian tumors and tumor like lesions of ovary and also evaluate the role of serum CA125, HE4 and calculate risk of ovarian malignancy algorithm (ROMA), for differentiation of benign and malignant ovarian tumors.233 cases of ovarian tumors and tumor like lesions were studied. Tumors were classified according to WHO classification. Clinical and histological findings were compiled on proforma and subjected to analysis. Results: In present study, out of total 233 cases, 41.2% were ovarian tumors and 58.8% tumor like lesions of ovary. Among tumor like lesions, follicular cyst was commonest lesion while among ovarian tumors, benign serous surface epithelial tumor was commonest. In patients with ovarian tumors, blood samples were collected, before and after the treatment for analysis of CA125, HE4 and ROMA. Conclusions: Serum values of CA125and HE4 as well as ROMA were highly elevated in women with malignant epithelial tumors as compared to women with benign lesions. Also, all the parameters i.e. HE4, CA125 and ROMA showed significant difference before and after surgery. Hence measuring serum HE4 and CA125 along with ROMA calculation may provide higher accuracy for detecting malignant epithelial ovarian tumor.

A Comparative study between conventional method and the Bethesda system for reporting thyroid cytopathology (TBSRTC)

Background: FNAC is widely used for the diagnosis of thyroid lesions. TBSRTC was introduced to streamline the reporting of thyroid aspirates. Objectives was to study the spectrum of various thyroid lesions in and around Meerut and comparison of conventional method and TBSRTC. Methods: A total of 464 patients were evaluated both by conventional system and TBSRTC. Results: As per conventional system of reporting, maximum number of cases were diagnosed as benign (87%), followed by malignant (6.4%), follicular neoplasia (2.5%), equivocal (2.1%) and inadequate (1.7%). As per TBSRTC, maximum number of cases were reported as category 2, 86.2% followed by category 6, 6%, category 1, 2.5% and cat 3,2.5%, category 4, 1.5% and category 5, 1%. Among benign category, maximum number of cases were of colloid goiter/multinodular goiter (MNG) (65%) followed by Hashimoto`s thyroiditis (15%), Grave`s disease (6%). Among the malignant category, maximum number of cases were of papillary carcinoma thyroid (PCT) (5.3%) followed by medullary carcinoma thyroid (MCT) (0.43%), non-Hodgkin`s lymphoma NHL (0.21%), metastatic carcinoma (0.21%), and anaplastic carcinoma (0.21%) of each. Conclusions: In present study it was found that there is an excellent agreement between the conventional system and TBSRTC. Results of both systems of reporting are comparable. In some cases, TBSRTC is almost equivalent to the conventional system in the pattern of reporting (viz. benign and malignant cat) while in some cases, TBSRTC is better in reporting (viz. FN and equivocal cat). The sensitivity of TBSRTC (93%) is slightly more as compared to the conventional system (90%) while its specificity (86%) slightly less as compared to conventional system (88%). Thus, as compared to the conventional system, TBSRTC may be viewed as a better screening test for thyroid lesions, though at the cost of specificity.

Cyto-histo correlation of a very rare tumor: Superficial angiomyxoma

Superficial angiomyxoma (SA) is one of the superficially located myxoid soft tissue tumor. Because of the rarity of this tumor, there is paucity of fine needle aspiration cytology (FNAC) findings. Here, we present a case of SA in a 14-year-old girl who presented with a left leg swelling. The cytology of the lesion along with the histopathologic correlation is presented.

Can peripheral blood smear examination be totally replaced by automated hematology analyser - with special reference to anemia?

Background: The aims and objectives of present study was to correlate typing of anemia based on RBC indices obtained from an automated analyzer with peripheral blood smear (PBS) examination and also to find out whether the number of PBS examination can be reduced with the help of automated hematology analyzer. Methods: A total of 2500 blood samples showing anemia as per WHO reference range were collected in central pathology lab of SVBP Hospital attached to L.L.R.M. Medical College, Meerut, Uttar Pradesh, India over a period of one year. Samples were reported by auto-analyzer and PBS examination simultaneously. Results: Out of total 2500 cases, there were 1623 females (64.9%) and 877 males (35.1%) with male: female ratio 0.54:1. By auto-analyzer and PBS examination, MCHC anemia (49.8%) was the commonest anemia followed by NCNC anemia (36.5%) and Macrocytic anemia (4.2%). Discordant typing of anemia between two methods was found in 284 (11.4%) cases only. These cases were diagnosed as normocytic normochromic (NCNC) anemia with raised RDW by autoanalyzer while as Dimorphic Anemia (DA) on PBS examination. Also morphological changes such as RBC inclusions, spherocytes, RBC fragments, schistocytes, nucleated RBCs were seen only on PBS examination. Conclusions: The Study concluded that even today PBS examination is very important and cannot be totally replaced by automated analyzer and both methods are complementary to each other.

A clinicopathologic study of various breast lesions with cytohistological correlation

Context: Most of the females suffer from breast diseases during their life at some time or the other. Confirmation of breast diseases by clinical examination and pathological confirmation by fine needle aspiration cytology (FNAC) and histopathologic examination has been found to be an important part of diagnostic workup in breast diseases. Aims: To establish a clinicopathologic correlation in patients suffering from breast diseases. Settings and Design: We conducted a prospective study from December 2008 to August 2010. One hundred and twenty-one cases were enrolled using simple random sampling methods. Materials and Methods: Data including age, complaints, and clinical examination was collected from patients presenting for FNAC with breast complaints. Results: A total of 128 cases were studied which included 101 benign cases, 21 malignant cases, and 6 inadequate cases. The final 122 cases included 3 (2.5%) cases of acute mastitis, 2 cases (1.6%) of tubercular mastitis, 44 cases (36.1%) of fibroadenoma, 42 cases (34.4%) of benign breast disease with non-specific descriptive diagnosis, 2 cases (1.6%) of fibrocystic disease, 3 cases (2.5%) of galactocele, 1 (0.9%) case of lactational adenoma, 2 cases (1.6%) of cellular fibroadenoma, and 2 cases (1.6%) of phyllodes tumor. Apart from this, there were 21 cases (17.21%) of ductal carcinoma. Majority of benign cases were between 30 and 39 years of age (43.6%). Majority of malignant cases fell between 50 and 59 years of age (47.6%). Majority (61.5%) of lumps (>3 cm) were malignant, whereas 94.8% of lumps (<3 cm) were benign. Left breast was commonly involved (49.18%) than the right breast (44.26%). Superolateral quadrant (63.1%) was the most commonly involved quadrant. Histology was available for 35 benign cases (34.65%) and out of total malignant cases (21), histology was available for 14 cases (66.66%). No discrepancy was noted.