Rana K Sherwani

Giant cell tumor along with secondary aneurysmal bone cyst of scapula: A rare presentation

Giant cell tumor (GCT) is a distinctive lesion characterized by the proliferation of multinucleate giant cells in a stroma of mononuclear cells; it is generally seen in skeletally mature individuals. GCT of bone is usually found in the long bones around the knee or in the distal radius of young adults and is unusual in the flat bones. We report a case of GCT of the acromion of the scapula, with a secondary aneurysmal bone cyst, in a 30-year-old female. Based on our review of the English language medical literature, it appears that the occurrence of a GCT along with a secondary aneurysmal bone cyst in flat bones (e.g.. the scapula) is very rare.

Ovarian Steroid Cell Tumour: Correlation of Histopathology with Clinicopathologic Features

Ovarian steroid cell tumours (not otherwise specified) are rare neoplasms of the ovary and are classified under lipid cell tumours. Their diagnosis can be considered as one of exclusion. Histopathologically, the tumour should carefully be evaluated for microscopic features of malignancy, but it is essential for the clinician and the pathologist to remember that in these tumours, pathologically benign histomorphology does not exclude the possibility of clinically malignant behaviour. Our case study focuses on the comparative findings in a postmenopausal female diagnosed with an ovarian steroid tumour (not otherwise specified). A careful correlation between clinical and surgical evaluation and microscopic analysis is necessary, as is a regular followup.

Screening children with severe short stature for celiac disease using tissue transglutaminase

ObjectiveThis prospective study was planned with the aim to determine the prevalence of anti-tissue transglutaminase in children and adolescents with severe short stature (<-3 SD) attending the Pediatric outpatient, inpatient and/or the Pediatric Gastroenterology clinic.MethodsAll children in age group of 1–18 years having height less than -3 SD for their age and sex, were included. For each child age and sex matched healthy control (height more than -2 SD) was taken. The included subjects (study & control group) were subjected to anti tissue transglutaminase (tTG) (IgA) antibody assay estimation.ResultsOf the 112 cases, 23 were tTG positive, giving a prevalence of 20.5% for seropositivity among cases of short stature while all the controls were seronegative for tTG. All the 23 had tTG values above 40 U/ml and 11 had values above 100 U/ml. On univariate analysis we found that the presence of chronic diarrhea (OR = 2.55, 95%CI − 1.08–5.98), bulky stools (OR = 3.03, 95%CI − 1.52–6.05), hemoglobin < 7 gm/dl (OR = 3.12, 95%CI − 1.55–6.29) and more severe short stature (<-4 SD) (OR = 0.41, 95%CI − 0.17–0.95) had significant association with the tTG positivity. On logistic regression analysis in all cases, hemoglobin < 7gm/dl (OR = 0.090, 95%CI = 0.024–0.342) and bulky stools (OR=0.212, 95%CI = 0.069–0.649) were significantly associated with tTG positivity.ConclusionMore than one fifth of all severe short stature are seropositive for tTG and the chances of seropositivity increases if severe anemia and bulky stool are also associated.

The Role of Intraoperative Cytology in the Diagnostic Evaluation of Ovarian Neoplasms

Objective: To determine the role of intraoperative cytology (IOC) in the diagnostic evaluation of ovarian neoplasms. Methods: The present study was conducted in the Department of Pathology, Jawaharlal Nehru Medical College, AMU, Aligarh, India, over a time span of 18 months. Depending on the consistency of the lesion, touch, scrape or crush techniques were used to prepare cytological smears. Smears were fixed in 95% ethyl alcohol and then stained with hematoxylin and eosin or Papanicolaou stains. Cytological results were compared with the histological diagnosis taking the latter as the gold standard. Results: Of 50 lesions studied by IOC, 25 lesions were labeled as benign, 24 lesions as malignant and 1 lesion was inconclusive. Final histological diagnoses labeled 25 lesions as benign and 25 lesions as malignant. Comparing the diagnosis of cytology smears with histology sections, 47 of 50 cases were concordant. Sensitivity, specificity and diagnostic accuracy were 95.8, 96.0 and 95.8%, respectively. Conclusions: IOC is a good complement to histopathology in the study of ovarian neoplasms, particularly in developing countries like ours, where the facility of frozen sections is often not available, since a rapid preliminary diagnosis may help in surgical management planning.

Paraganglioma of the thyroid gland: cytologists' enigma.

Paraganglioma is a neuroendocrine tumour derived from extra-adrenal cells of the neural crest paraganglia of the autonomic nervous system. These rare neoplasms comprise of around 0.012% of head and neck tumours. Paraganglioma arising in the thyroid gland is exceptionally uncommon and can present as a diagnostic challenge on fine-needle aspiration cytology (FNAC). We report a case of primary thyroid paraganglioma in a 19-year-old woman who presented with a solitary thyroid nodule without palpable cervical lymphadenopathy. FNAC from the lesion caused diagnostic dilemma by mimicking follicular neoplasm and C-cell-derived thyroid tumours; final diagnosis was established by histopathology and immunohistochemistry. The main purpose of this case report is to discuss the differential diagnosis and emphasise on the need of immune markers in the diagnosis of thyroid paraganglioma. In view of the uncertain malignant potential of these tumours, a long-term follow-up is recommended.

Prevalence of hepatitis C virus in Aligarh: A seven year experience

Sir, Blood transfusion is life saving, but the chances of transmission of microorganisms remain a potential danger. With proper selection of donors on the basis of detailed clinical history and examination, along with the availability of a sophisticated screening procedure, the chances of transmission of diseases through transfusion have reduced considerably. However, the risk is only minimized and not ruled out. Hepatitis C virus (HCV), the main etiological agent of the clinical entity, formerly known as Non-A, Non-B Hepatitis, was discovered in 1989 by Choo et al.(1) HCV along with Hepatitis B virus (HBV) is responsible for the majority of post-transfusion hepatitis. The present study was done to determine the prevalence rate of HCV antibodies in replacement and voluntary donors attending the Blood Bank of the Jawaharlal Nehru Medical College Hospital, A.M.U., Aligarh, over a period of seven years, from January 2001 to December 2007. Out of 68173 donors, there were 44984 replacement donors and 23189 voluntary donors. No honorary or professional donor was bled. Thereafter, 5 – 10 ml of blood was withdrawn with a 10 ml syringe and subjected to anti-HCV testing, using a commercially available third generation anti-HCV ELISA kit. A majority of the donors were young males in the age group of 30 – 40 years (60%), followed by 30% donors in the age group of 21 – 30 years. HCV positive cases among the apparently healthy blood donors were assessed. In the year 2001; there was no donor who showed positivity for HCV antibody. In the year 2002, there was only one positive case per 8130 donations (0.01%). The year 2003 showed an increase in the number of positive cases for HCV, three positive cases per 9577 donations (0.03%). The year 2004 showed a further increase, with eight positive cases per 10842 donations (0.07%). The scenario in 2005 was somewhat similar to that seen in 2003, with five positive cases per 10990 donations (0.04%). There was a steep rise in 2006, with 13 positive cases per 11068 donations (0.12%). The number of positive cases continued to rise in 2007, with 18 positive cases per 11566 donations (0.15%). A majority of the positive cases belonged to the age group 21 – 30 years, 22 in total (45.83%), followed by 14 cases (29.16%) in the age group 31 – 40 years. There were seven cases (14.58%) in the second decade, while only five positive cases (10.41%) were seen in the fifth decade. The study revealed only three female positive cases out of a total of 48 positive cases (6.25%) during the entire period of study. One reason for this data could be the overall low number of female donors as compared to male donors. Transfusion-associated infections continue to be a big threat to the safety of blood supply, moreso in the developing and underdeveloped countries. Viral infections are the major cause of morbidity and mortality in blood recipients and a majority of transfusion-associated hepatitis is caused by the Hepatitis C virus. With approximately 170 million people worldwide estimated to be infected with HCV, a figure that is four times the HIV infection status, it has the potential to be the next pandemic.(2) The present study was undertaken to determine the prevalence of HCV antibodies in healthy blood donors. The presence of anti-HCV does not constitute a diagnosis of Hepatitis C, but may be indicative of recent and/or past infection by hepatitis C virus. A nonreactive test result does not exclude the possibility of exposure to HCV. Levels of anti-HCV may be undetectable in early infections due to a low titer; polymerase chain reaction (PCR) may play an important role under such circumstances. Even then, screening blood donors for anti-HCV has reduced the incidence of post-transfusion non-A and non-B hepatitis dramatically. Hepatitis C virus (HCV) is a hepatotropic virus of family Flaviviridae and genus Hepacivirus, having a single standard RNA of positive polarity as genomic material. A large number of genotypes have been identified among hepatitis C virus isolates from all over the world. Presently six main groups of sequence variants have been characterized, corresponding to types 1 – 6; each group containing a number of more closely related subtypes (a, b, c, etc.).(3) Genotype 3 is the most prevalent genotype in patients with chronic hepatitis C in North and Central India, and is associated with significant hepatic steatosis and fibrosis.(4) The safety of blood transfusion is compromised in India due to its dependence on replacement donors, endemic hepatitis in this region, high cost of screening, and a lack of funds and trained personnel. Williams et al., in 1992, conducted a study and showed a seroprevalence of 11.1% for antibodies to HCV in multiple transfused thalassemia major patients.(5) This high prevalence could have been because of improper clinical examination and screening of the donors. However, proper pre-donation screening of donors and rejecting volunteers with a past history of viral hepatitis has shown a lower prevalence of post-transfusion Hepatitis C infection (0.07%) in our study, as compared to a higher prevalence of 2.0% reported by Kothari et al.(6) Our study showed an alarming percentage of HCV positive cases in the younger generation, 36 cases (74.9%), with an upward trend of positivity, with time. Routine HCV antibody screening and proper clinical examination should be carried out in blood donors with a thrust toward youth surveillance, which will aid in delivery of safe blood.

Primary squamous cell carcinoma of the parotid gland: a rare entity

Primary squamous cell carcinoma of the parotid gland is a rare aggressive malignancy. It is a rapidly advancing lesion which, if not recognised and treated early, results in high morbidity and mortality. Despite radical surgery and adjuvant radiotherapy, prognosis of this cancer continues to be poor. Careful clinical and histological examination is mandatory to differentiate this tumour from metastatic squamous cell carcinoma and other primary malignancies of the parotid. The authors hereby report the case of a 50-year-old male patient who presented with a progressively increasing, painless mass in parotid region of 6 months duration. An initial fine-needle aspiration cytology and subsequent histopathological examination confirmed that the tumour was squamous cell carcinoma. As no other primary source could be demonstrated in the patient, a final diagnosis of primary squamous cell carcinoma of parotid was offered. Currently the patient is on regular follow-up without any signs of recurrence.

Sister Mary Joseph's nodule: a rare cytologic presentation

Umbilical metastasis is one of the main characteristic signs of extensive neoplastic disease and is universally referred to as Sister Mary Josephs nodule. It indicates neoplasm of inner organs mostly located in the gastrointestinal tract or the pelvis. However, in approximately 15–30% the primary tumor remains occult. In most cases, Sister Mary Josephs nodule appears as an early and sometimes the only symptom of the malignancy. Here we report a rare fine needle aspiration (FNA) cytologic diagnosis of umbilical metastasis of an ovarian carcinoma.

Leiomyoma of scrotum.

Leiomyoma is a benign tumor of smooth muscles. Leiomyoma originating from the scrotum is a rare entity. We report here a case of 50-year-old male who presented with a 4-cm lump in the left side of scrotum. Clinically, it was provisionally diagnosed as sebaceous cyst and was excised. The histopathology showed findings consistent with leiomyoma. There was no cytological atypia or mitosis. The final diagnosis of solitary leiomyoma of scrotum was given. The patient was followed up regularly and is doing fine for last 4 months.

Pindborg Tumor in an Adolescent

Calcifying epithelial odontogenic tumor (Pindborg tumor), is a rare benign odontogenic neoplasm representing about 0.4-3% of all odontogenic tumors. This tumor more frequently affects adults in the age range of 20-60 years, with a peak incidence in the 5th decade of life. Calcifying epithelial odontogenic tumour has a much lower recurrence rate than ameloblastoma and malignant transformation, and metastasis is rare.