Safia Rana

Morphological spectrum of endometrial pathology in middle-aged women with atypical uterine bleeding: A study of 219 cases.

Background: Perimenopause, also called the menopausal transition, is the interval in which a womans body makes a natural shift from more-or-less regular cycles of ovulation and menstruation toward permanent infertility, or menopause. Materials and Methods: A retrospective age specific comparative analysis of 219 perimenopausal women presenting with abnormal uterine bleeding was done who underwent endometrial sampling during a 4-year period from January 2008 to April 2012 at the Hakeem Abdul Hameed Centenary Hospital. Endometrial tissue collected by sampling procedures such as dilatation and curettage (D and C), endometrial biopsy and fractional curettage had been sent to the pathology laboratory for evaluation. Results: The most common clinical presentation was represented by menorrhagia (46.4%) followed by metrorrhagia (20%), menometrorrhagia, polymenorrhea, polymenorrhagia among others. Evaluation of the endometrium revealed various patterns on histopathology, functional causes accounted for majority of the diagnosis. Secretory endometrium seen in 71 cases (32.4%) was the most common. While proliferative endometrium on histopathology was the second most common diagnosis; seen in 67 patients (30.5%). Endometrial hyperplasia was seen in 24 (10.9%) cases out of which simple hyperplasia without atypia was seen in 19, complex hyperplasia without atypia was seen in 4 and complex hyperplasia with atypia was seen in 1 case. The other diagnoses, which accounted for the rest of the functional causes of atypical uterine bleeding, were disordered proliferative endometrium 15 cases (6.8%), luteal phase defects 3 cases (1.3%). Conclusion: Atypical uterine bleeding in perimenopausal women is most commonly dysfunctional in origin. In addition, a significant number show underlying organic pathologies thereby highlighting the importance of endometrial curetting and biopsy as a diagnostic procedure in the evaluation.

An Analysis of Hematological Parameters as a Diagnostic test for Malaria in Patients with Acute Febrile Illness: An Institutional Experience.

OBJECTIVES Hematological changes are among the most common complications encountered in malaria. This study analyzes and statistically evaluates the hematological changes as a diagnostic test for malaria in patients with acute febrile illness and whether these could guide the physician to institute specific antimalarial treatment. METHODS The present study was an observational study, conducted from January to December 2012. A total of 723 patients presenting with acute febrile illness at our hospital were evaluated. A complete blood count and malarial parasite microscopy were performed for each patient. RESULTS The findings showed that 172 out of 723 patients (24%) were diagnosed to have malaria by positive smear report. There were 121 males and 51 females with a male to female ratio of 2.3:1. Maximum number of cases were seen in the 20-30 years age group. There was a statistically significant reduction in hemoglobin (p<0.005), platelet count (p<0.001) and total leukocyte count (p<0.001) levels in patients with malaria compared to those without the disease. Likelihood ratios for a positive result of platelets (6.2) and total leukocyte count (3.4) was relevant as compared to hemoglobin (1.61) and Red cell distribution width (1.79). The negative predictive values for hemoglobin (79%), total leukocyte count (86%), platelets (94%) and Red cell distribution width (93%) were significant. Red cell distribution width values were found to be higher in patients with malaria than in patients without malaria (p<0.001). CONCLUSION This study revealed that routinely used laboratory findings such as hemoglobin, leukocytes, platelet counts and even red cell distribution width values can provide a diagnostic clue in a patient with acute febrile illness in endemic areas, thus increasing the probability of malaria and enhancing prompt initiation of treatment.

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.

Primary intestinal hodgkin's lymphoma: An uncommon presentation

Primary intestinal lymphoma is a rare lymphoproliferative neoplasm of the small intestine. The primary nature is established on the basis of lack of evidence of lymphoma on chest X-ray, computerized tomographic scan, peripheral blood or bone marrow puncture. Tumor involvement is limited to the gastrointestinal tract, the criteria for inclusion are that the symptoms related to the small intestine are predominant or the only symptoms at the time of laparotomy. Hodgkins lymphoma (HL) primarily in the small intestine is a rare entity and an uncommon presentation of the disease. Ileum is the more common site of infliction than the jejunum because of its abundant lymphoid follicles. Here, we present a case of primary intestinal HL, in a 30-year-old male.

Adenoid basal cell carcinoma and its mimics

Basal cell carcinoma (BCC) is the most common malignant tumor of skin. The most common site (80%) is head and neck. BCC exhibits a varied morphology such as adenoid, keratotic, sebaceous, basosquamous, apocrine, eccrine or fibroepithelial. Tumors with a similar histopathological picture are cutaneous adenoid cystic carcinoma and primary cutaneous cribriform apocrine carcinoma. Immunohistochemistry, along with clinical findings, acts as an adjunct in reaching an accurate diagnosis. Here, we present an interesting case of adenoid BCC in a 55-year-old man.

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.

Cellular leiomyoma versus endometrial stromal tumor: A pathologists' dilemma

Uterine smooth muscle tumors and endometrial stromal tumors (ESTs) are the two major types of mesenchymal tumors of the uterus, the latter being fairly uncommon. Among these, endometrial stromal sarcoma (ESS) accounts for 0.2-1.5% of all uterine malignancies. Although routine histopathological examination is sufficient to distinguish between ESS and smooth muscle tumors in most of the cases, the distinction between ESTs and highly cellular leiomyomas (CMs), on several occasions becomes a great diagnostic challenge for the pathologist. The differentiation between EST and CM is necessary on account of the variable clinical course and slight variation in the therapy. However, this is difficult due to the tendency of endometrial stromal cells to differentiate into well-developed smooth muscle cells as well as overlapping immunohistochemical profile in some cases. We hereby report a series of cases which posed a diagnostic challenge to us as to whether they are CMs or ESTs. We therefore discuss the histological features which helped us resolve this dilemma as well as the utility of immunohistochemistry (IHC) as a diagnostic aid in arriving at a final diagnosis in such problematic cases.

Renal Leiomyoma: An Uncommon Differential Diagnosis of Renal Masses with a Clinical Relevance

Renal leiomyomas are an extremely rare neoplasm which account for 1.5% of the benign lesions and 0.29% of all treated renal tumours, with autopsy evidence of 4.2% to 5.2%. Given their exceptional incidence, they are rarely included in the differential diagnosis of renal masses, despite their capacity to grow to a considerable size. The definitive diagnosis of a leiomyoma is only possible after histopathological examination, most of the times of a nephrectomy specimen. However, due to the rising number of diagnosis resulting from improved medical imaging and interventions, renal leiomyomas should gain importance in the differential diagnosis of renal masses, specialy with respect to kidney sparing surgery. Hereby, we report a case of 60-year-old male patient with a large well circumscribed left renal mass, diagnosed as Renal cell carcinoma on imaging.

Coexistent colonic tuberculosis and mucinous adenocarcinoma: A causal or a casual link?

Tuberculosis (TB) is known to involve any part of the body. Intestinal TB accounts for the majority of extrapulmonary TB, ileocecal region is the most common site with involvement of the sigmoid colon a rare occurrence. TB has been known to be associated with various types of malignancy. The most common association is malignancy and pulmonary TB. However, association of extra pulmonary TB and malignancy at the same site is relatively uncommon and cases of colonic TB associated with mucinous adenocarcinoma are extremely rare. Involvement of sigmoid colon is even rarer and to the best our knowledge, the present case is the first reported case from India of coexistent adenocarcinoma and TB in the sigmoid colon. We report here an interesting case of coexistent colonic TB and malignancy in a 23-year-old female presenting to the emergency room with features of intestinal obstruction.

Poorly differentiated carcinoma of thyroid: Case report of an uncommon entity

Malignant thyroid tumors of follicular origin comprise a spectrum, with the indolent well-differentiated thyroid carcinoma (WDTC) at one end and lethal anaplastic thyroid carcinoma (ATC) at the other. Poorly differentiated thyroid carcinoma (PDTC) lies intermediately between WDTC and ATC in terms of morphology and prognostic standpoint. This thyroglobulin producing neoplasm accounts for 4–7% of all thyroid malignancies. PDTC has been controversial due to lack of defined diagnostic criteria. We hereby report a case of PDTC in a 42-year-old female presenting with neck swelling, pain, and dysphagia for 10 months. She was diagnosed as colloid goiter on fine-needle aspiration cytology. On imaging, a large complex thyroid with central neck nodes was seen. Total thyroidectomy and central neck node dissection were done. Based on the morphology, immunostaining, and the diagnostic criteria, a diagnosis of PDTC was made. PDTC is a diagnostic challenge due to its rarity and previous equivocal diagnostic criteria.