Urmila N Khadilkar

Fine Needle Aspiration Diagnosis in HIV-Related Lymphadenopathy in Mangalore, India

OBJECTIVE To evaluate the usefulness of fine needle aspiration (FNA) study of lymph nodes in HIV-positive patients. STUDY DESIGN The study was conducted at Kasturba Medical College, Mangalore, India. Samples from lymph nodes of 48 HIV-positive patients were taken and air dried, and wet smears were made. After staining with routine cytologic stains and special stains, detailed cytomorphologic study was conducted. RESULTS Tuberculosis accounted for nearly half (48%) the cases,followed by HIV lymphadenitis (36%), lymphoma (10%), suppurative lymphadenitis (2%), Mycobacterium avium-intracellulare lymphadenitis (2%) and metastases (2%), in descending order of their frequency. A suppurative picture, which was found in 13% of cases of tuberculous lymphadenitis in AIDS patients, occasionally was misleading without the help of acid fast bacilli stain. CONCLUSION FNA is a useful tool in the diagnosis of lymphadenopathy in HIV-positive patients provided that proper safety measures are taken to avoid contracting the infection.

Fine needle aspiration cytology of the Ewing's sarcoma family of tumors.

OBJECTIVE To study the cytomorphologic features of the Ewings sarcoma (ES) family of tumors. STUDY DESIGN During a period of eight years (1990-1997), 123 soft tissue tumors and 65 bone tumors were evaluated by fine needle aspiration cytology (FNAC); 14 cases were diagnosed as in the ES family of tumors. The ages of the patients ranged from 8 to 30 years. All the cases were histologically confirmed. RESULTS Of 14 cases of the ES family of tumors, 7 were ES, 3 extraosseous ES (EOE), 2 peripheral primitive neuroectodermal tumor (PPNET) and 2 Askin tumor. Cytologically, smears from all the cases showed round tumor cells with a high nuclear/cytoplasmic ratio. On detailed examination, subtle differentiating features were observed. The cells in ES had finer nuclear chromatin in comparison to those of PPNET and Askin tumor, and punched-out clear cytoplasmic vacuoles were present. PPNET showed nuclear molding, unipolar cytoplasmic tags and Homer-Wright rosettes. Histologically, all cases of ES and EOE and one case of Askin tumor showed periodic acid-Schiff-positive inclusions. CONCLUSION FNAC features coupled with clinical findings enable a rapid diagnosis of the ES family of tumors, from which treatment modalities can be determined.

Acute haemorrhagic pancreatitis – A case of sudden death

Sudden death in young individuals is relatively uncommon and acute haemorrhagic pancreatitis as a cause of sudden and unexpected death is a rare phenomenon. A case of sudden death due to acute haemorrhagic pancreatitis is reported in a young doctor who ignored the radiating pain of acute pancreatitis for gastritis, and resorted to self-medication. The condition was discovered only at autopsy.

Bone marrow biopsy in non-Hodgkin lymphoma: A morphological study

CONTEXT Bone marrow (BM) biopsy is an integral part of staging work-up for non-Hodgkin lymphoma (NHL). AIMS To study the characteristics of BM involvement in NHL with respect to incidence, histologic pattern and morphology of infiltration and its discordance with the histology of primary anatomic site. SETTINGS AND DESIGN Forty-nine cases of NHL in which BM biopsy was performed for staging were included in this study, the primary site being classified according to the WHO classification for NHL. MATERIALS AND METHODS A prospective study of 49 cases was conducted. Bilateral BM biopsy was obtained from the posterior superior iliac spine. The biopsies were fixed in 10% buffered formalin solution and decalcified using 10% formal - formic acid for 4 - 6 h followed by routine processing. The serial sections were stained by hematoxylin and eosin and reticulin stains. RESULTS BM biopsy showed involvement by lymphoma in 27 cases (55.10%). Unilateral positivity was found in four cases (14.81% cases). The overall incidence of marrow involvement by NHL was 55.1%. The incidence of involvement was higher in T-cell lymphomas when compared with B-cell lymphomas and predominant pattern of involvement was mixed. Diffuse large B-cell lymphomas had the lowest incidence in all the B-cell lymphomas. A discordant histology between BM and primary anatomic site was found in 29.63% (8/27) of the cases, where it was seen more in follicular lymphomas and diffuse large B-cell lymphomas. CONCLUSIONS Critical examination of BM biopsies can increase the diagnostic accuracy, thereby contributing to the prognosis and appropriate treatment modalities.

Cutaneous dirofilariasis presenting as an eyelid swelling

Dirofilariasis is a common filarial infection occurring in domestic and wild animals as a result of arthropod bites. However, it can be transmitted to humans after mosquito bites. Here, we report a case of a 54-year-old lady who developed an unilateral eyelid swelling secondary to Dirofilaria repens.

Retroperitoneal Schwannoma: An Atypical Presentation

Schwannoma is a rare tumour arising from Schwann cells in myelinated neural sheath of the nerves. They can arise in various places like head, neck, extremities, adrenal, retro peritoneum, psoas muscle. We here present a case of 33-year-old male who came with features of acute pancreatitis, with incidentally detected mass in presacral region on ultrasonography. Investigations like CECT and MRI were suggestive of neurofibroma, radical excision of the mass was done which showed solitary encapsulated tumour and cut sections showed areas of necrosis, and histopathologically it was proven as schwannoma. Most of the schwannomas are benign, but rarely malignant transformation can occur. It can be associated with von Recklinghausen disease. Benign tumours have excellent prognosis, malignant tumours can present at later date with metastasis after excision also. Radiology plays a key role in diagnosis and follows up. Treatment is radical excision of tumour; recurrence is most common and has to be carefully followed up.

A clinicopathological study of interface dermatitis.

BACKGROUND Interface dermatitis (ID) refers to a pattern of skin reaction characterized by an inflammatory infiltrate that appears to obscure the dermo-epidermal junction when observed at low power examination and referred to as lichenoid tissue reaction. A wide range of inflammatory skin diseases exhibits interface change with considerable overlap of histological features. The aim of the present study was to study the clinical features and microscopic features of ID. MATERIALS AND METHODS The material for the present study consisted of skin biopsy samples collected from patients attending the outpatient Department of Dermatology. The study was conducted for a period of 3 years from 2007 to 2010. During this period, a total of 125 cases was studied. RESULTS In the present study, a total of 125 cases of ID was studied which presented clinically as papulosquamous disorders. Majority of the cases of ID were seen in women (57.6%). Majority of ID were lichen planus (LP) and its variants (63.2%). Clinicopathological concordance was seen in 109 cases (87.2%) and discordance in 16 cases (12.8%). CONCLUSION The mere presence of an interface lichenoid inflammatory reaction should not be the sole criterion for the diagnosis of LP or one of its many variants, as now seems to be the case. A clinicopathologic correlation is absolutely essential for a conclusive diagnosis of ID.

Morphological Spectrum of Basal Cell Carcinoma in Southern Karnataka.

INTRODUCTION Basal Cell Carcinoma (BCC) is the most common skin cancer worldwide, which appears over sun-exposed skin as slow-growing, locally invasive lesion that rarely metastasizes. Many phenotypic presentations are possible. BCCs are more common in males and tend to occur in older people. Majority is found on the head and neck. Many histopathological subtypes have been defined including nodular, micronodular, cystic, superficial, pigmented, adenoid, infiltrating, sclerosing, keratotic, infundibulocystic, metatypical, basosquamous and fibroepitheliomatous. Mixed patterns are common. AIM The aim was to study morphological spectrum of BCC in a tertiary care hospital in southern Karnataka. MATERIALS AND METHODS This was a retrospective analysis of 100 cases of BCCs reported in the Department of Pathology over a 9-year period from 2006 to 2014. RESULTS The mean age of presentation was 62 years. There was slight female preponderance (56%). The most common location was face (65%) and the most common presentation was ulceration (45%). Of the 100 BCCs, 50% were nodular, 13% infiltrating, 6% basosquamous, 4% superficial, 3% keratotic, 3% multinodular and 1% mixed. CONCLUSION BCC, besides being the commonest cutaneous cancer, is also known for its numerous histological patterns which are shown to have prognostic implications. This study reveals the frequency of the various histological patterns of BCC in southern Karnataka, where it has been rarely studied before.

Unusual lesions of the mediastinum

Objectives: To study unusual lesions in the mediastinum, which do not originate from the thymus, lymph nodes, neural tissues or germ cells, and tissues that normally engender pathologic lesions in the mediastinum. Materials and Methods: Of the 65 cases seen, 12 unusual lesion were encountered in a 5½ year period from 2006 to 2011. Results: Two cases of nodular colloid goiter and one each of the mediastinal cyst, undifferentiated carcinoma, and Langerhans cell histiocytosis (LCH) affected the anterosuperior mediastinum. In the middle mediastinum, one case each of the mesothelioma, malignant gastrointestinal stromal tumor (GIST), squamous cell carcinoma (SCC), solitary fibrous tumor (SFT), and pleomorphic sarcoma (PS) was seen. One case of meningeal melanocytoma (Mme) and primary pleural liposarcoma (PL) involved the posterior mediastinum. Persistent disease was seen in LCH after 2 years. Of all the cases with malignant lesions, only the patient with SCC was alive after 1 year. Conclusion: The cases of primary and SCC, LCH, melanocytoma, liposarcoma and PS, and GIST are unexpected and very rarely have paradigms in the mediastinum. Radiologic impression and knowledge of the compartment where these lesions arose from hardly assisted in arriving at a definitive opinion as the lesions were not typical of this location. A high index of suspicion and the immunohistochemical profile facilitated the final diagnosis.

Rare association of papillary carcinoma of thyroid with adult T-cell lymphoma/leukemia

Papillary carcinoma is the most common malignant tumor of the thyroid, especially in countries with adequate or excess iodine in diet. Many studies indicate that a sizable number of papillary cancer cases occur in a setting of chronic thyroiditis. But the tumor that arises more frequently in thyroiditis is malignant lymphoma. We report a rare association of papillary carcinoma of thyroid in an elderly lady with adult T-cell lymphoma/leukemia. Fine needle aspiration of the thyroid, neck nodes and evaluation of the bone marrow and peripheral blood helped in the diagnosis of papillary cancer coexisting with adult T-cell lymphoma/leukemia.