Shyamoli Dutta

Abdominal Tuberculosis: A Diagnostic Dilemma.

BACKGROUND Abdominal tuberculosis (TB) is the sixth most common form of extra-pulmonary site of infection after lymphatic, genitourinary, bone and joint, miliary and meningeal TB with a rising incidence in recent years. TB can affect any part of the gastro-intestinal (GI) tract including anus, peritoneum and hepato-biliary system. The clinical manifestations of abdominal tuberculosis are non-specific and mimic various GI disorders and cause delay in diagnosis and management. AIM To evaluate the various clinical, radiological and microbiological findings of abdominal tuberculosis and to define the role of histopathological examination in establishing the diagnosis in resource poor settings and to analyze the compliance and response to anti-tubercular treatment. MATERIALS AND METHODS A five year retrospective study (January 2010 to December 2014) was done in a tertiary teaching hospital in Northern India and all the cases diagnosed as abdominal tuberculosis during the study period, were included. The relevant clinical informations, laboratory results, microbiological and radiological investigations were recorded. Histopathological examination of all the resected / excised specimens was done and Ziehl-Neelsen (ZN) staining to detect the tubercular bacilli and Periodic acid-Schiff (PAS) stain to rule out fungal infection was done in all the cases. RESULTS Out of 48 cases with abdominal tuberculosis, the average age of presentation was 27.4 years with a slight male predominance (Male:Female=1.4:1). Abdominal pain (100%) was the most common presenting symptom followed by anorexia (98%), fever (88%) and intestinal obstruction (88%). The ileum was the most common site of involvement. All the 45 resected / excised tissue specimens (34 cases of intestinal resection and 11 cases of intesinal, omental and lymph nodes biopsies) showed epithelioid granulomas along with necrosis (in 38 cases) and Langhans giant cells (in 42 cases). Acid Fast Bacilli (AFB) positivity was seen in 5 tissue specimens only. All patients were put on anti-tubercular treatment and majority showed good response to therapy. CONCLUSION Abdominal tuberculosis should be considered as a differential diagnosis in patients with vague GI symptoms. Study of histopathological findings can aid in the diagnosis in the settings where advanced molecular methods of diagnosis are not available, leading to early diagnosis and management.

Cytomorphological Aspects of Hashimoto’s Thyroiditis: Our Experience at a Tertiary Center

Introduction Hashimotos thyroiditis is the most common form of acquired hypothyroidism. Fine needle aspiration cytology is one important tool in diagnosing Hashimotos thyroditis, along with clinical, biochemical, immunological and ultrasonographical modalities. The present study examines cytological aspects of Hashimotos thyroiditis along with their correlation with clinical, biochemical and immunological findings, whenever available. Materials and Methods This is a retrospective study of 50 cases of Hashimotos thyroiditis. Cytological findings were reviewed and correlated with clinical, biochemical and immunological findings whenever available. Results The majority of the patients were middle-aged females, with a female to male ratio of 6.14:1. Most patients presented with diffuse thyromegaly (68%) and/or hypothyroidism (56.09%). The antibody profile was available in 22% of patients. Of these, anti-thyroid peroxidase antibodies were raised in 81.81% of patients and anti-thyroglobulin antibodies were raised in 63.63% of patients. In the present study, high lymphoid to epithelial cell ratio was seen in 78% of cases, and 74% of cases showed Hurthle cell change. Follicular atypia was seen in 36% of cases. Lymphoid follicle formation was seen in seen in 54% of cases. Follicular cell infiltration by lymphocytes, eosinophils and neutrophils was seen in 72%, 48% and 26% of cases, respectively. Plasma cells were seen in 18% of cases. Conclusion Thyroid function tests and immunological tests cannot diagnose all cases of Hashimotos thyroiditis. Fine needle aspiration cytology continues to be a diagnostic tool of significance in diagnosing Hashimotos thyroiditis. The presence of inflammatory cells, particularly lymphocytes and eosinophils, was detected in a significant proportion of cases.

Brooke-spiegler syndrome: a rare entity.

Brooke-Spiegler syndrome is a rare entity. It is an autosomal dominant syndrome in which multiple trichoepitheliomas, cylindromas, or other adnexal tumors are seen. Very few cases of Brooke-Spiegler syndrome are reported in the literature. We came across a 40 -year-old female in which multiple trichoepitheliomas and cylindromas were seen on scalp. In view of clinical history and histopathological examination it was diagnosed as Brooke-Spiegler syndrome. We report this case because of its rarity.

Evaluation of fine needle aspiration biopsy as a diagnostic tool in pediatric head and neck lesions

correspondence: Deepti Agarwal Department of Pathology, Teerthanker Mahaveer Medical college, Moradabad, India Tel +91 983 700 5696 email deeptiagarwal@rocketmail.com Background: Fine needle aspiration (FNA) biopsy is a well accepted diagnostic procedure and considered to be a valuable test for initial assessment of head and neck swellings in adults. The technique has gained popularity in the pediatric population over the last decade, with varying degrees of acceptance rates, accuracy, and results among pathologists. Objective: This study was performed to evaluate the utility of aspiration cytology as a first-line diagnostic tool in palpable head and neck masses in children, taking into account the diversity of lesions observed in this subset of the population. Cytologic analysis was correlated with histologic results for evaluating diagnostic accuracy wherever possible. The applicability of FNA biopsy in diagnosing pediatric malignant lesions was also evaluated. Methods: This retrospective study conducted from January 2008 to December 2009 screened all pediatric cases referred to the departments of pathology at two tertiary care hospitals in India. Data from a total of 662 children aged 0–15 years presenting with head and neck masses who underwent FNA biopsy were collected. Cytologic results were interpreted and analyzed according to anatomic site. The lesions were then categorized into inflammatory, infective, and neoplastic. Results: Of the 662 lesions, 23 cases were excluded due to inadequate material, thus the data for 639 cases were finally evaluated. Lymph node lesions predominated, accounting for 570 cases (89.2%), of which 412 (72%) cases were diagnosed as reactive and 91 (16%) cases as tubercular lymphadenitis. Other lesions aspirated were thyroid (18 cases, 2.8%), salivary gland (12 cases, 1.8%), and miscellaneous surface lumps (39 cases, 6.1%). Of all the cases, 628 (98.27%) were reported as benign and 11 (1.67%) as malignant. The positive predictive value of cytologic analysis in diagnosing malignancy was 100%, although exact typing of lesions was possible only on histopathologic examination. Conclusion: FNA biopsy is a sensitive and minimally invasive first-line investigation in the diagnosis of head and neck masses in children. It is highly accurate in isolating and determining potentially neoplastic lesions, thus guiding the way for cases which truly require excision biopsy or other second-line investigations.

Seroprevalence of Transfusion Transmitted Infections in Healthy Blood Donors in Specific Class of Kuppuswamy’s Socio-Economic Status Scale

Background: Blood transfusion has profound role to play in specific illness, but still due to unsafe and careless practices the peril of transfusion transmissible infections (TTIs) such as human immunodeficiency virus (HIV), hepatitis C virus (HCV), hepatitis B virus (HBV), syphilis and malaria prevails. Objective: To study the seroprevalence of TTIs in healthy blood donors in specific Kuppuswamys socio-economic scale at a Blood Bank of a tertiary care teaching hospital in north India, to enhance the awareness about transfusion related risks and to implement better strategic measures to prevent TTI, in high risk groups. Material and Method: Total 10,569 blood units were collected from Jan-2014 to Septmeber-2015. All donors were categorised according to the Kuppuswamys Socio-economic Status Scale (KSESS) followed by screening of all sera samples for hepatitis B surface antigen (HBsAg), antibodies to HCV, HIV types 1 and 2 using enzyme-linked immunosorbent assays (ELISA) and for malaria antigen and Treponema pallidum by using immunochromatographic tests and Rapid Plasma Reagin test (RPR) respectively. All the samples found reactive for HIV, HBsAg, and HCV were again confirmed by second ELISA. Results: The overall seroprevalence was HCV 2.06 % (218/10569) > HBV 1.71% (181/10569) > HIV 0.03% (3/10569). No donor was found positive for Malaria and VDRL. The prevalence of transfusion transmissible diseases in specific socio economic class was as follows-:Upper lower class (IV) 248/2261 (10.96%) > Lower class (V) 34/483 (7.03%) > Lower Middle class (III) 97/5789 (1.67%) > Upper middle class (II) 22/1552 (1.42%) > Upper class (I) 1/484 (0.20%) and seroprevalence of transfusion transmissible diseases in each socio economic class, out of total donations was as follows-: Upper lower class (IV) 248/10569 (2.35%)> Lower middle class (III) 97/10569 (0.92%) >Lower class (V) 34/10569 (0.32%)> upper middle class (II) 22/10569 (0.21) >Upper class (I) 1/10569 (0.009%). Conclusion: Maximum positive TTIs had association with low socio-economic status people with increased medical and behavioral risk factors. Hence, we conclude that awareness among the high risk population group, strict and skillfulness selection of donors and use of effective laboratory screening tests is the prerequisite for the safe donation!!

Twisted Fimbrial Cyst (Paraovarian Cyst): A Rare Cause of Acute Abdomen

We present a case of a 22-year-old female who presented with acute abdomen and amenorrhea. Emergency laprotomy was done with a clinical diagnosis of ectopic pregnancy. On laprotomy, twisted fimbrial cysts were found. Thus, although fimbrial cysts are rarely twisted, they should be considered as a cause of acute abdomen in a female of reproductive age group.