Sabina Khan

Utilization of blood and components in a tertiary care hospital

PurposeBlood transfusion is an important part of patient management. Indications for blood use must be clear in the mind of ordering clinicians, to avoid its misuse and also to avoid unnecessary exposure of the patient to donor blood antigens, adverse reactions and transfusion transmissible diseases.MethodsIn a retrospective pilot study, details of whole blood and components transfused were noted and correlated with the patient’s diagnosis and indications for transfusion, during 1 month.ResultsThe blood units supplied were 720. Whole blood was the most utilized product; followed by packed red blood cells. Supply of blood was maximum to the surgical wards. The patients of trauma followed by malignancy and surgery required whole blood mostly. Anemia was the most common indication for blood products.ConclusionsPeriodic review of blood component usage is very important to assess the blood utilization pattern in any hospital.

Orbital oculomotor nerve schwannoma extending to the cavernous sinus: A rare cause of proptosis

PURPOSE To report a case of orbital oculomotor nerve schwannoma extending to the cavernous sinus through the superior orbital fissure presenting with proptosis, but without any neurological sign. CASE REPORT A 32-year-old man presented with axial proptosis of his left eye. Visual acuity and other ocular examinations were normal. Orbital magnetic resonance imaging revealed a well-defined fusiform retrobulbar lesion in the left orbit extending into the superior orbital fissure and left cavernous sinus measuring 43 mm × 21 mm × 19 mm and causing superomedial displacement of the optic nerve and axial proptosis. The patient was scheduled for surgery, and gross total excision was done. Postoperatively, the patient developed total third nerve palsy. Pre and postoperative third nerve deficit confirmed the origin of the tumor from the oculomotor nerve. Histopathological examination revealed schwannoma. CONCLUSION Orbital oculomotor nerve schwannoma, although rare, can be the cause of proptosis. Diagnosis can be confirmed histopathologically. It is a benign tumor; however, it can extend intracranially without any neurological symptoms. Therefore, neuroimaging is essential to rule out intracranial extension. Early surgical removal is mandatory.

Gall bladder lymphoid hyperplasia: Masquerading as lymphoma

Lymphoid hyperplasia of the gall bladder is an extremely rare condition that may be missed on associated radiological or clinical evaluation but is diagnosed on biopsy. We are reporting hereby, a case of reactive lymphoid hyperplasia masquerading as a lymphoma on histopathology. A 58-year-old male was referred to our hospital with complaints of pain abdomen infrequently since last one year. Ultrasonography revealed the presence of single calculus along with features of chronic cholecystitis. Laparoscopic cholecystectomy was performed and the gall bladder was sent for routine histopathological evaluation. On microscopic examination, there were sheets of cells, lymphoid in origin and numerous lymphoid follicles spread throughout the wall of the gall bladder. It was diagnosed as a case of reactive lymphoid hyperplasia with chronic cholecystitis on histopathology.

An Incidental Primary Papillary Carcinoma Arising in a Thyroglossal Duct Cyst: Report of a Rare Finding.

The thyroglossal duct cysts (TGDCs) are the most common congenital anomaly of the thyroid, usually manifested as painless midline neck mass. Malignancy is very rare and is reported in around 1% of cases as an incidental finding after histopathological evaluation of resected cyst. Papillary carcinoma is the most common carcinoma reported in TGDC. Here, we report a case of 17-year-old-female, who presented with a gradually increasing midline neck mass which moves with swallowing. On imaging a diagnosis of infected TGDC was made. The Sistrunk operation was done and a diagnosis of primary papillary carcinoma arising in a TGDC was rendered histopathologically. The contemporary appearance of papillary carcinoma thyroid was reported in about 20% cases of TGDC carcinoma, thus it is essential to differentiate primary papillary carcinoma arising in a TGDC from those of metastatic papillary carcinoma thyroid by strict diagnostic criteria.

Fibromatosis colli - a rare cytological diagnosis in infantile neck swellings.

Fibromatosis colli or sternocleidomastoid tumour is a rare cause of benign neck mass in infants. It is a self limiting fibroblastic lesion usually presenting with torticollis and a history of birth trauma.It is one of the few causes in which Fine Needle Aspiration Cytology (FNAC) is indicated in a neonate to confirm the diagnosis and to differentiate it from other congenital, inflammatory and neoplastic causes. FNAC provides a rapid, cost-effective, reliable, non invasive method of diagnosis resulting in conservative management of these lesions. We present two interesting cases of neck swelling in infants where FNAC performed as the first diagnostic procedure was instrumental in establishing the diagnosis of fibromatosis colli thus avoiding unnecessary surgical intervention.

Isolated lingual cysticercosis: A rare case diagnosed on cytology

Cysticercosis is caused by larval stage of Taenia solium called cysticercus cellulosae. Cysticercosis most commonly infects skeletal muscles, subcutaneous tissues, brain and ocular tissue. On extensive search of literature, only around 64 cases of lingual cysticercosis have been reported till date. We report a case of cysticercosis of tongue in a 35‐year‐old male who presented with a painless, slowly growing swelling over the lateral border of tongue. Fine needle aspiration cytology revealed wavy integument of cysticercus cellulosae alongwith inflammatory cells. The findings were confirmed on histopathology. No other cystic swelling was encountered in the body on retrospective examination and investigations. This case is being presented on account of its rarity as well as the utility of FNAC as a primary diagnostic technique in evaluation of parasitic lesions.

Angiomatosis: A rare vascular proliferation of head and neck region

Angiomatosis is a diffuse vascular lesion which clinically mimics hemangioma or vascular malformation. It usually involves multiple tissues and is histopathologically characterised by proliferation of vessels of varying calibre intimately admixed with large amount of adipose tissue. Its surgical removal is very difficult because of its infiltrative nature. Therefore, a precise histopathological diagnosis is of utmost importance. It is usually seen in females in the first two decades and commonly involves lower extremities. Angiomatosis of head and neck region is very rare. Here we present a rare case of angiomatosis of the lower face involving right cheek and lip in a 4-year-old boy clinically diagnosed as hemangioma. Histopathological differential diagnosis of angiomatosis is also discussed.

Accessory breast tissue mimicking pedunculated lipoma.

Accessory breast tissue is an uncommon condition which occurs in 0.4–6% of women. It is mostly located in the axilla where it can cause diagnostic difficulty, especially if it is unilateral and large. Usually it is bilateral and presents as an asymptomatic mass during pregnancy or lactation. The diagnosis of ectopic breast tissue is important as it can undergo the same pathological changes that occur in a normal breast, such as mastitis, fibrocystic disease and carcinoma. We present a case of a large right-sided accessory breast in a 32-year-old woman that was clinically diagnosed as pedunculated lipoma. However, subsequent histopathological examination proved it to be an accessory breast tissue with lactational changes.

Spectrum of histopathological lesions in cholecystectomy specimens: A study of 360 cases at a teaching hospital in South Delhi

Background: Gallstone disease is a common surgical problem requiring cholecystectomy. It is known to produce diverse histopathological changes in the gallbladder ranging from acute or chronic inflammation to metaplasias and even malignancies. The aim of this study was to emphasize the importance of a detailed microscopic examination and to study the diverse range of histopathological lesions in cholecystectomy specimens. Materials and Methods: This is a retrospective study of 360 cholecystectomy specimens received in the Department of Pathology over a period of 2 years from November 2010 to October 2012. Clinical details and histopathological data were retrieved from the records. The variety of morphological changes in the diseased gall bladder were correlated with the clinical findings. Results: Overall, there were 360 cases consisting of 74 (21%) males and 286 (79%) females. Maximum number of patients was between 31 and 40 years (30.2%). Most common pathology noted in our study was chronic cholecystitis seen in 280 cases (77.7%). Other benign lesions were cholesterosis in 36 (10%) and acute cholecystitis in 10 (2.7%). Various other associated lesions and variants of cholecystitis were also encountered. A total of nine malignant lesions of gallbladder were observed, which included eight cases of incidental adenocarcinomas and one case showing lymphomatous involvement. Conclusion: Our study emphasizes that a routine cholecystectomy performed for a common condition like gallstone disease can result in a diverse and wide spectrum of histopathological lesions ranging from benign diagnosis to an unexpected gallbladder malignancy.

Infarcted Fibroadenoma: An unusual case with its Cyto-histopathological Correlation

Fibroadenoma is a benign breast lesion of adolescents and young women.It constitute 20% of all benign breast tumours. Fibroadenoma is associated with many secondary changes like calcification, ossification, hyalinization, myxoid and apocrine squamous metaplasia. Spontaneous infarction in fibroadenoma is very rarely seen. We report one such case of spontaneous infarction of fibroadenoma in a 16 year old unmarried female with its cyto-histopathological correlation, that posed us with diagnostic dilemma in early stage. The possibility of this entity should be considered while diagnosing the breast lumps on cytology .The lesion was further confirmed on histology.