Ritu Mehta

Patients with mild enteropathy have apoptotic injury of enterocytes similar to that in advanced enteropathy in celiac disease

BACKGROUND Severity of villous atrophy in celiac disease (CeD) is the cumulative effect of enterocyte loss and cell regeneration. Gluten-free diet has been shown to benefit even in patients having a positive anti-tissue transglutaminase (tTG) antibody titre and mild enteropathy. AIM We explored the balance between mucosal apoptotic enterocyte loss and cell regeneration in mild and advanced enteropathies. METHODS Duodenal biopsies from patients with mild enteropathy (Marsh grade 0 and 1) (n=26), advanced enteropathy (Marsh grade ≥2) (n=41) and control biopsies (n=12) were subjected to immunohistochemical staining for end-apoptotic markers (M30, H2AX); markers of cell death (perforin, annexin V); and cell proliferation (Ki67). Composite H-scores based on the intensity and distribution of markers were compared. RESULTS End-apoptotic markers and marker of cell death (perforin) were significantly up-regulated in both mild and advanced enteropathies, in comparison to controls; without any difference between mild and advanced enteropathies. Ki67 labelling index was significantly higher in crypts of mild enteropathy, in comparison to controls, suggesting maintained regenerative activity in the former. CONCLUSIONS Even in patients with mild enteropathy, the rate of apoptosis is similar to those with advanced enteropathy. These findings suggest the necessity of reviewing the existing practice of not treating patients with mild enteropathy.

Interpretation of ileal biopsies

The ileum is one of the most common sites of intestine to undergo endoscopic biopsy. However, even with the experienced histopathologists, a definite diagnosis can be achieved only in 18% cases. Lack of knowledge about proper tissue handling, tissue orientation, overlapping histological findings, and lack of a standard algorithm based approach results in this low diagnostic yield. In this review article, we have tried to discuss these aspects and give a clear picture how to approach the ileal lesions. It would help the surgical pathologists in effectively interpreting the lesions and to identify the common pitfalls.

Role of urine cytology in bladder neoplasm – Cytopathological correlation and review of literature

Background: Urinary bladder tumors are the second most common tumors affecting males. The aim of the study was to evaluate the various histopathological findings in various bladder tumors and their correlation with exfoliative urine cytology. Design: This is an observational study carried out over a period of 7 years at a tertiary care hospital between January 2010 and January 2017. Materials and Methods: Tumors were divided into invasive and noninvasive urothelial carcinoma and were further classified into high-grade or low-grade urothelial cancer. Urine cytology smears from all these patients were also were studied. Cytological findings were correlated with histopathological findings. Result showed that bladder tumors were commonly seen in males with average age of presentation being the sixth decade. The most common type of carcinoma seen was low-grade urothelial carcinoma-noninvasive type. Urine cytology was positive in 47.46% patients. Sample Size: In our study, 113 cystoscopic biopsies were included over a period of 7 years (85 males and 28 females). Conclusion: Accuracy of diagnosing malignancy in urine cytology varies, and it depends on the presence of diagnostic yield in the urine cytology, processing of the sample, and experience of the cytopathologist. Urine cytology should be reported in a background of detailed clinical information and should always be followed by histopathological examination.

Clinical, endoscopic, and histological differentiation between celiac disease and tropical sprue: A systematic review: Enigma in diagnosing intestinal sprues

While the prevalence of celiac disease (CD) is increasing globally, the prevalence of tropical sprue (TS) is declining. Still, there are certain regions in the world where both patients with CD and TS exist and differentiation between them is a challenging task. We conducted a systematic review of the literature to find out differentiating clinical, endoscopic, and histological characteristics between CD and TS.

Triple approach for diagnosing breast lesions-experience at a Tertiary Care Hospital

Background: Breast lesions are always a diagnostic challenge and range from benign to malignant. Fine-Needle Aspiration Cytology (FNAC) is done in patients with breast lesions. However, to get an accurate and diagnostic yield is difficult at times. Aims: The aim of this study is to highlight the role of triple approach in diagnosing breast lesions. Design and Setting: This is an observational prospective study carried out in the Department of Pathology at a tertiary care hospital over 2 years. Materials and Methods: One hundred and fifty cases of breast lump were studied. Clinical findings, imaging findings, and cytology along with histopathological findings were correlated. Results: Cytological findings were benign in 102 out of 107 patients, who were otherwise clinically and radiologically benign. In rest five patients, Breast Imaging Reporting and Data Systems (BIRADS) BIRADS II category was given on mammography. In four of these five patients, there was cytological atypia. Biopsy in these four patients showed features of fibroadenoma with mild cytological atypia and one patient showed infiltrating duct carcinoma. Mammography was suggestive of malignant breast lump in 43 patients. In three patients, breast lump was diagnosed as benign on cytological examination. However, histopathological examination confirmed the mammography findings of malignancy. Conclusion: FNAC is a well-established procedure for diagnosing breast lesion but has got many pitfalls. Hence for diagnosis a breast lesion, the triple approach consisting of histopathological examination in addition to mammography and FNAC, should be considered.

DysmorphicNeonate: An Approach to Diagnosis in The Current Era

A dysmorphic neonate is a cause of concern and anxiety for the parents and the physician. Making a clinical diagnosis allows a targeted search for a genetic aetiology in order to correctly delineate the healthcare requirements of the infant and also allows the parents to search for and join a ‘support group’. It allows a more accurate estimate of the risk of recurrence and therefore allows genetic counselling. It allows prognostication and permits interventions that may prevent, anticipate or more successfully treat complications. The approach to a dysmorphic neonate is similar to making a diagnosis of a neonate with any systemic illness and relies on a detailed history, a meticulous clinical examination, identifying a syndrome based on a combination of signs, or sometimes ‘by gestalt’. Cytogenetics and molecular techniques improve our ability to make precise syndrome diagnoses. Eventhough there is a certain degree of urgency in making a diagnosis in a dysmorphic neonate, a snap diagnosis should never be made. Around 4,000 malformation syndromes have now been delineated and many are associated with medical problems. Thus making a specific syndrome diagnosis can influence immediate medical management. A detailed history, a physical examination for detailing the major and minor anomalies, recording the growth, examination of previous records and photographs are complemented by cytogenetics and molecular genetic techniques in achieving a diagnosis. Familiarity with dysmorphology databases and cross referencing the anomalies especially the rarer ones helps in narrowing the differential diagnosis. Correspondence to: Vishal Vishnu Tewari, Senior Advisor (Pediatrics and Neonatology), Department of Pediatrics, Army Hospital (Referral and Research), New Delhi, India, Tel: +91-8826118889, E-mail: docvvt_13@hotmail.com

Intracerebral Bleeding in Young Infants due to Rare Etiologies A Report of two Cases

Neonates and young infants are physiologically encumbered by an inadequate hemostatic mechanism. They may also have inherited or acquired bleeding disorders which may have a catastrophic presentation with intracerebral hemorrhage. The need to reach an accurate diagnosis is paramount in order to provide accurate therapy and genetic counseling. We report two infants who presented with unprovoked life threatening massive intracerebral hemorrhage. The first infant was diagnosed and managed for congenital factor V deficiency while the second infant had Glanzmann thrombasthenia.