Sumit Mitra

Fine needle aspiration cytology of supraclavicular lymph nodes: Our experience over a three-year period

Aims: This study was taken up with the aim to investigate the pattern of supraclavicular lymphadenopathy among patients presenting to our tertiary care institution, evaluate the diagnostic efficacy of fine needle aspiration cytology (FNAC), and analyze the diagnostic pitfalls. Materials and Methods: A total of 215 patients were subjected to FNAC of supraclavicular lymph nodes over a three-year period (August 2006 to July 2009). Since in 18 patients as either the aspirate was inadequate or the opinion was equivocal, we analyzed the remaining 197 cases. Results: Malignant pathology accounted for 79.7% (157/197) of the cases. These were mostly cases of metastatic squamous cell carcinoma (79/197, 40.1%), adenocarcinoma (47/197, 23.9%), small cell carcinoma (12/197, 6.1%) and lymphoma (10/197, 5%). There were 28 (14.2%) cases of tuberculosis. Out of these 197 patients, 92 patients were biopsied. The opinion based on FNAC was erroneous in 6 cases but corroborated with the final histopathology findings in the remaining 86 cases. Conclusion: FNAC is an excellent first line of investigation; and when used with a proper combination of experience and diligence, it can greatly reduce the number of errors.

Squash preparation: A reliable diagnostic tool in the intraoperative diagnosis of central nervous system tumors.

Background: Intraoperative cytology is an important diagnostic modality improving on the accuracy of the frozen sections. It has shown to play an important role especially in the intraoperative diagnosis of central nervous system tumors. Aim: To study the diagnostic accuracy of squash preparation and frozen section (FS) in the intraoperative diagnosis of central nervous system (CNS) tumors. Materials and Methods: This prospective study of 114 patients with CNS tumors was conducted over a period of 18 months (September 2004 to February 2006). The cytological preparations were stained by the quick Papanicolaou method. The squash interpretation and FS diagnosis were later compared with the paraffin section diagnosis. Results: Of the 114 patients, cytological diagnosis was offered in 96 cases. Eighteen nonneoplastic or noncontributory cases were excluded. Using hematoxylin and eosin-stained histopathology sections as the gold standard, the diagnostic accuracy of cytology was 88.5% (85/96) and the accuracy on FS diagnosis was 90.6% (87/96). Among these cases, gliomas formed the largest category of tumors (55.2%). The cytological accuracy in this group was 84.9% (45/53) and the comparative FS figure was 86.8% (46/53). In cases where the smear and the FS diagnosis did not match, the latter opinion was offered. Conclusions: Squash preparation is a reliable, rapid and easy method and can be used as a complement to FS in the intraoperative diagnosis of CNS tumors.

Role of Centella asiatica on cerebral post-ischemic reperfusion and long-term hypoperfusion in rats

Centella asiatica (CA), a well known adaptogenic agent in Indian system of Medicine (Ayurveda), is believed to have beneficial effects in improving memory, treating anxiety and eczema. It also possesses antioxidant, cognitive enhancing and antiepileptic properties. Acute ischemia followed by reperfusion is known to bring about biochemical and histopathological alterations. In the present study the effect of Centella asiatica on acute cerebral reperfusion and long-term cerebral hypoperfusion in rats was investigated. Transient cerebral ischemia was induced under Ketamine anaesthesia by blocking bilateral common carotid arteries (BCCAO) for 30 min and then reperfusion was allowed for 45 min by releasing the block. Lipid peroxidation, superoxide dismutase (SOD) and brain protein were estimated, behavioral and histopathological studies were done for both acute ischemia-reperfusion and chronic hypoperfusion studies. One way ANOVA followed by post hoc Tukey test was used. In the present study, acute ischemia-reperfusion induced increases in lipid peroxidation and superoxide SOD activity. CA pre-treatment (100 mg/kg p.o. for 5 days) attenuated the reperfusion induced biochemical alterations. Long-term cerebral hypoperfusion in rats caused a propensity towards anxiety and listlessness (open field paradigm and elevated plus maze test) accompanied by deficits in learning and memory (Morris’ water maze testing) and tendency towards depression (Porsolts swim test). Additionally, histopathological observations in forebrain revealed changes like gliosis, astrocytosis, cellular edema and inflammatory changes. CA treatment (100 mg/kg p.o. for 28 days) alleviated these behavioral, cognitive and histopathological changes. The results suggest that CA may be useful in cerebrovascular insufficiency conditions. Key words: Centella asiatica, cerebral hypoperfusion, ischemia-reperfusion injury

Amoeboma of colon mimicking colonic carcinoma

Entamoeba histolytica is a major cause of diarrhea in the developing countries and it can present with a wide range of gastrointestinal symptoms depending on the phase of the infection. We describe a case of 65-year-old male patient presented with abdominal pain and vomiting. On the clinical and radiological examination provisional diagnosis of colonic carcinoma was suspected. After resection of perforated caecal growth, histopathological sections showed numerous trophozoites of E. histolytica in a background of abundant necrosis. This case revealed differentiation between amoeboma and carcinoma is critical.

Role of discrimination indices in screening of beta-thalassemia trait in West Bengal, India: An institutional experience on 10,407 subjects

Background: Beta-thalassemia trait (BTT) is a common genetic disorder of hemoglobin and imposes a significant burden on global healthcare. Screening of this disorder is immensely important epidemiologically as it can reduce the future incidence of thalassemia major in newborns. The present study was carried out to evaluate the role of six discrimination indices to differentiate cases of BTT from others.Materials and Methods: A single-center, cross-sectional study was conducted on consecutive 10,407 participants. In addition to common diagnostic statistics association, concordance and receiver-operating characteristic curves were assessed to judge the role of discrimination indices. Results: Shine and Lal index, Mentzer index, and Srivastava index had revealed better discriminative function compared to England and Fraser index, red cell distribution width index, and Green and King index. Conclusion: Discrimination indices are rapid, reliable, and easy tools to suspect a case of BTT and send the subject for further high-performance liquid chromatography evaluation. But the cut-off value for these indices needs to be revised to achieve the best combination of sensitivity and specificity in this population.

Expression of CDX-2 and Ki-67 in different grades of colorectal adenocarcinomas

BACKGROUND CDX2 is a caudal homeobox gene essential for intestinal differentiation and is specifically expressed in colorectal adenocarcinomas. Its role in colorectal carcinogenesis is not fully elucidated. AIMS AND OBJECTIVES To study the expression pattern of CDX2 and Ki-67 in different grades of colorectal adenocarcinomas and to observe the relationship of their staining patterns in various tumor stages and to look for correlation if any, between Ki-67 labeling index (Ki-67 LI) and CDX2 expression. MATERIALS AND METHODS A total of 74 cases were enrolled. Detailed clinical profile, peroperative findings, histological grading and staging were noted. Immunohistochemistry for CDX2 and Ki-67 was done, and Ki-67 LI was calculated. CDX2 staining was graded semi-quantitatively, and statistical analysis was done. RESULT Age of presentation ranged from 20 to 75 years, and the male:female ratio was 1.83:1. There were 8, 47 and 13 cases of well, moderate and poorly differentiated adenocarcinomas, respectively. The mean Ki-67 LI of well, moderate and poorly differentiated adenocarcinomas were 14.25, 31.34 and 43.08 respectively, and their difference was statistically significant, correlation was also noted with stage. CDX2 expression appeared to be stronger in poorly differentiated cases, but there was no significant difference in its expression in the different grades and stages. There was no correlation between Ki-67 LI and CDX2 immunostaining pattern. The lymph node metastasis showed CDX2 positivity in all the cases. CONCLUSION Expression of CDX2 does not significantly change with the grade of colorectal adenocarcinomas. However, it is an important diagnostic marker in metastatic colonic lesions. The Ki-67 LI, on the other hand, showed a strong correlation with histopathological grades.

Synchronous Occurrence of Endometrial Stromal Nodule with Papillary Serous Carcinoma of Ovary: Report of a Case and Brief Review of Literature

Synchronous primary malignant neoplasms of the uterus are uncommon. We report a case where a 36-year-old lady diagnosed with ovarian carcinoma underwent hysterectomy after having received three cycles of chemotherapy. Endometrial stromal nodule (ESN), which is the rarest of the three types of endometrial stromal neoplasms [1], was an incidental finding occurring concomitantly with papillary serous carcinoma of ovary. An extensive literature search yielded no previous such report.