Suvradeep Mitra

Gastric perforation secondary to recurrent trichobezoar

A rare case of 10-year-old female child with recurrent trichobezoar stomach is reported, which presented with features of gastric outlet obstruction with perforation.

Intermediate filament: structure, function, and applications in cytology.

Intermediate filament (IF) constitutes an important cytoskeletal component in nearly all the vertebrate cells. IFs are present both in the cytoplasm and in the nucleus. They play an important role in providing mechanical strength of the cell and tissue, growth and regeneration, cell survival and apoptosis, and finally cell migration. IFs are also expressed differentially in different body tissues. Therefore, judicious use of IF may provide the diagnosis and confirmation of different malignancies. This is particularly helpful in the diagnosis of metastatic malignant tumor from an unknown primary. Expression of IFs particularly cytokeratin and vimentin is also related to prognosis of tumors. In this review, we have discussed the basic structure, dynamics, distribution of IF in cells, and its role in diagnosis of cytology. Possible prognostic roles of IF are also discussed. Diagn. Cytopathol. 2014;42:628–635.

Fine-needle aspiration and core biopsy in the diagnosis of breast lesions: A comparison and review of the literature.

In recent times, the diagnosis of breast lesions has mostly become dependent on core needle biopsies (CNBs) with a gradual reduction in the rate of performing fine-needle aspiration cytology (FNAC). Both the procedures have their pros and cons and outsmart each other taking into account different parameters. Both the methods are found to be fraught with loopholes, taking into account different performance indices, diagnostic accuracy and concordance, patient benefit, and cost-effectiveness. Unlike the popular belief of an absolute superiority of CNB over FNAC, the literature review does not reveal a very distinct demarcation in many aspects. We recommend judicious use of these diagnostic modalities in resource-limited settings and screening programs taking into account parameters such as palpability and availability of an experienced cytopathologist.

Arteriovenous malformation of knee masquerading as juvenile arthritis.

This is a rare case of involvement of knee joint by an arteriovenous malformation. A nine year old girl had recurrent monoarticular pain and swelling of long duration and had been treated as juvenile rheumatoid arthritis. Angiographic and histological features suggested an arteriovenous malformation of lower thigh with knee joint involvement.

A Rare Case of Primary Sarcomatous Hepatocellular Carcinoma Without Previous Anticancer Therapy

Primary sarcomatous hepatocellular carcinoma (PSHCC) is a rare and aggressive variety of hepatocellular carcinoma (HCC). The recent evidence suggests that anticancer therapy promotes the dedifferentiation of the carcinomatous component and is largely responsible for this aggressive variant of HCC. However, in the absence of any anticancer therapy, occurrence of PSHCC is extremely rare. Herein, we present a rare case report of a 65 year old male patient, with a hepatitis B positive status, presenting with PSHCC without any history of anticancer therapy. Detailed immunohistochemical evaluation of the tumor was performed with comparison of morphological and immunohistochemical features of the sarcomatous and carcinomatous components. This appears to be the first documented case of PSHCC from India, to the best of our knowledge.

A molecular marker of disease activity in autoimmune liver diseases with histopathological correlation; FoXp3/RORγt ratio

Autoimmune liver diseases (AILDs) encompass a group of diseases with variable clinicopathological manifestations. Th17 and Treg cells have roles in the pathogenesis of AILDs with a balance shifted towards a relative increase in activity of the Th17 cells. In this study, the balance between the transcription factors of Treg and Th17 cells (FoXp3 and RORγt) was sought as a molecular marker of disease activity and to highlight the pathogenesis. The peripheral blood samples of 46 treatment‐naive patients were collected and RNA was extracted. Real time PCR was performed and the ratio of gene expression was calculated. Histopathology of 18 patients was obtained and the activity score of these biopsies were also corroborated with their respective molecular (FoXp3/RORγt) (FRGT=FoXp3‐ROR Gamma T) ratio. The FRGT ratio in healthy individuals was close to 1 and in disease the ratio changed significantly. This ratio (FRGT) was not significantly different in different varieties of AILD or in adult or paediatric form of the disease. However, the ratio remained consistently below 1 (mean 0.3) in acute disease and high (mean 224.7) in chronic or asymptomatic form of the disease (p < 0.001). The histopathological activity score also significantly correlated with the ratio. This signified the relative excess of Th17 (RORγt) in active disease as compared to Treg (FoXp3) and the reverse in chronic form. This ratio can be an important peripheral molecular marker to assess the disease activity without the necessity of performing a liver biopsy.

Drug idiosyncrasy due to pirfenidone presenting as acute liver failure: Case report and mini‐review of the literature

Idiosyncratic drug‐induced liver injury (DILI) is ranked among the top most common etiologies of acute liver failure (ALF). It carries poor transplant‐free survival. Pirfenidone is an anti‐inflammatory and antifibrotic drug that is commonly used for the treatment of idiopathic pulmonary fibrosis (IPF). Hepatotoxicity due to pirfenidone is rare and generally manifests as a mild rise in serum aminotransferases. In this mini‐review, we report an unusual case of idiosyncratic DILI due to pirfenidone presenting as ALF, with emphasis on the definition, classification, diagnostic criteria, histopathology, molecular markers, and treatment options for DILI and related ALF. A 77‐year‐old man with known Parkinsons disease and IPF presented with jaundice for 7 days and altered mental status for 4 days. His long‐term medications included a levodopa/carbidopa combination with a recent addition of pirfenidone over the previous 1 month; there was no monitoring of liver function tests. The evaluation suggested features of acute liver failure with grade III hepatic encephalopathy, acute kidney injury, and metabolic acidosis. The diagnostic workup ruled out viral, toxic, ischemic, and other etiologies for acute liver failure. Based on a Roussel Uclaf Causality Assessment Method score of 7 and possible DILI‐ALF, pirfenidone was withdrawn. He was evaluated for liver transplantation but was declined. Despite all supportive measures in intensive care, organ failure progressed and he succumbed to the illness on day 4. Postmortem liver biopsy revealed findings consistent with DILI (final Roussel Uclaf Causality Assessment score, 10). Conclusion: DILI‐ALF carries poor prognosis, and liver transplantation should be considered early in the course. Characterization, reporting, monitoring, and labeling of pirfenidone‐related hepatotoxicity is vital given its common use in IPF. (Hepatology Communications 2018;2:142–147)

Fulminant Amoebic colitis: A Rarity in the Pediatric Population

Although amoebiasis is a common parasitic infection, fulminant amoebic colitis remains a very rare complication, especially in the paediatric age group. It is necessary to diagnose this entity as it is associated with high morbidity and mortality and timely intervention may be proved to be life-saving.

Urothelial Carcinoma With Villoglandular Differentiation A Rare Entity

Urothelial neoplasms are the commonest neoplasms of the urinary bladder. Many variants of urothelial neoplasms have been described in the literature with diagnostic, therapeutic, and prognostic significance. We describe a rare case of urothelial neoplasm with villoglandular differentiation along with its immunohistochemical profile arising in an elderly male. Its poor prognosis signifies its need to be recognized.

Ectopic Immature Renal Tissue Associated with Lipomeningomyelocele and Enteric Duplication Cyst: A Report of Two Cases

Abstract Ectopic immature renal tissue (EIRT) is a lesion rarely described in the literature. It shows the components of a nephrogenic rest including the blastema, epithelia, and stroma. We report two cases of EIRT in a 3-year-old female and an 8 months male child, associated with lipomeningomyelocele and an enteric duplication cyst, respectively, along with detailed immunohistochemical profile. Though there are a few cases of EIRT associated with teratoma, only two cases of EIRT associated with lipomeningomyelocele have been described in the English literature. Moreover, extensive literature search did not reveal any previous case report where EIRT had been documented in an enteric duplication cyst.