Vandana Raphael

Mucinous adenocarcinoma of the renal pelvis with adenocarcinoma in situ of the ureter

Primary epithelial tumor of the renal pelvis is rare, and adenocarcinomas account for less than 1% of malignancies arising from the epithelium of the renal pelvis. We describe in this study a case of a 56-year old male patient who presented with an abdominal mass and dull aching pain for one year. A diagnosis of hydronephrosis of the right kidney was made based on imaging studies. Grossly, the entire kidney was converted into a cystic mass measuring 16 × 12 × 10 cm and filled with gelatinous material along with staghorn calculi in the pelvis measuring 7 × 4 × 3 cm. Histological examination of the tumor showed glands, cysts, and papillae lined by pseudostratified columnar epithelium with hyperchromatic nuclei. Scattered signet ring-type cells were also seen floating in large pools of extracellular mucin. Sections from the ureter showed a component of adenocarcinoma in situ. No invasive tumor was identified in ureteric tissue. Thus, a diagnosis of mucinous adenocarcinoma of the renal pelvis with in situ adenocarcinoma of the ureter was made.

Extensive tonsure pattern trichotillomania-trichoscopy and histopathology aid to the diagnosis.

Trichotillomania manifests as a compulsive desire to pull out own hair. The clinical presentation of trichotillomania is usually characteristic, with varying length hair distributed within areas of alopecia on otherwise normal scalp. In severe forms, tonsure pattern of baldness results, involving the entire scalp sparing the hair at the margins. Extensive tonsure pattern trichotillomania is rare and difficult to differentiate from other nonscarring alopecias on clinical grounds alone. Trichoscopy and histopathology of scalp play a corroborative role in definitive diagnosis. We hereby report two cases of extensive tonsure pattern trichotillomania, with special reference to their trichoscopic and histopathological features.

Pancytopenia: An Etiological Profile

Pancytopenia is the deficiency of all 3 cellular elements of blood, resulting in anemia, leucopenia, and thrombocytopenia. Pancytopenia may arise due to a number of disease processes that vary according to population, age, nutritional status, and the prevalence of infections [1]. Pancytopenia is a common hematological condition of varied etiology; however, only a few studies on pancytopenia from the northeastern region of India have been published [2].We analyzed the clinical details, hematological profile, and bone marrow findings in 80 patients that fulfilled the diagnostic criteria for pancytopenia between January 2007 and December 2009 in order to discern its etiology. The results of ancillary tests performed to confirm the etiology were also recorded The frequency of symptoms

Brush Cytology and AgNOR in the Diagnosis of Oral Squamous Cell Carcinoma

Objective: We aimed to evaluate the role of brush cytology in the screening of oral lesions with malignant suspicion and compare it with histopathology in north-eastern India. Study Design: Brush cytology samples taken from 48 patients were processed for conventional cytology (CC) and liquid-based cytology (LBC), and biopsy samples were also obtained. LBC samples were also stained to assess the argyrophilic nucleolar organizer region (AgNOR). The cytology was compared with histopathology, both individually and in combination with AgNOR. The smear quality was compared with histopathology for evaluating their diagnostic accuracy. Results: The sensitivity of diagnosing oral cavity squamous cell carcinoma by LBC and CC alone was 75 and 85%, respectively, which improved on combining with the AgNOR count, with a cutoff of 6.5. The presence of round cells on cytology was significantly associated with high-grade lesions. LBC provided clearer cytomorphology but compromised the background information in high-grade lesions. Conclusion: Brush cytology is a minimally invasive tool for screening oral lesions with malignant suspicion. LBC and CC are complementary techniques for cytological screening and combining them with AgNOR can increase the diagnostic yield. With objective criteria for assessment, cytology can be an indispensable tool for screening oral lesions in a resource-limited set-up, especially in high-incidence regions.

Roles of microRNA in prostate cancer cell metabolism

MicroRNAs are non-coding RNA which functions as regulators of genes expression. MicroRNAs have shown their biological functions in cell proliferation, cell cycle, cell metabolism, apoptosis, invasion and metastasis. Cancer cells have the ability to grow in the absence of growth factors by increased metabolic activity. MicroRNAs regulate cell metabolic processes by targeting the key enzymes or transporters and change the metabolic activities by interfering with oncogenes/tumor suppressors, hypoxia, signalling pathways and cell adhesion. This review mainly explains the roles of microRNAs in prostate cancer cell metabolism, such as glucose uptake, glycolysis and lactate secretion, lipid metabolism and interaction with signalling pathways. The relation of microRNAs with hypoxia and cell adhesion in cell metabolism is also highlighted. Therefore, miRNAs help in regulating the metabolism of survived tumor cells, understanding such miRNA-mediated interaction could lead to new avenues in therapeutic application to treat PCa.

An Audit of primary ovarian pregnancy in a tertiary care hospital

Intrauterine contraceptive devices (IUCD) and fertility treatments remain important associated risk factors. Risk factors like previous ectopic pregnancy, pelvic inflammatory disease (PID), and endometriosis have been implicated in the pathogenesis. These pathologies cause damage to epithelial lining of the fallopian tubes that impairs the normal ovum migration. The criteria for diagnosis of primary ovarian pregnancy were originally provided by Spielberg in the year 1878.

Role of fine needle aspiration cytology in the diagnosis of papillary carcinoma thyroid: A retrospective study from north-east India

Background: Thyroid cancer is the most common endocrine malignancy, and 85% of thyroid cancers are papillary thyroid carcinoma (PTC) making it the most common malignant tumor among all thyroid cancers. Objectives: To analyze the efficacy of fine needle aspiration cytology (FNAC) as the first-line diagnosis of PTC. Materials and Methods: A retrospective study was conducted over a period of 10 years 6 months from January 2007 to June 2017. All the cases of thyroid nodules, which are suspected to have thyroid malignancy from history and clinical examination, and morphologically proven cases of PTC either on FNAC or histopathology were included in the study. FNAC results were compared with the definitive histological diagnosis, which was considered the gold standard. The cytological evaluation and reporting of thyroid lesions were done in accordance with the Bethesda system of reporting thyroid cytopathology. Results: A total of 106 cases were included in the study. Out of the 106 cases, FNAC was inadequate in 8 cases (7.54%), benign in 18 cases (16.98%), atypia of undetermined significance/follicular lesion of undetermined significance in 2 cases (1.88%), follicular neoplasm (FN)/ suspicious for FN in 8 cases (7.54%), suspicious for malignancy in 27 cases (25.47%), and malignant in 43 cases (40.56%). Out of the 106 cases, 75 cases (70.75%) were PTC, which had histopathological correlation. The sensitivity and specificity of FNAC were 87.14% and 77.27%, respectively. Conclusion: FNAC is helpful in triaging the suspicious thyroid lesions for further management. FNAC is quite useful in diagnosis of PTC.

Association between lipid profile and platelet indices: the importance of considering the influence of lipid profile while evaluating the clinical utility of platelet indices

Sir, There is a growing interest in the utility of platelet indices like platelet count (PC), mean platelet volume (MPV), plateletcrit (PCT) and platelet distribution width (PDW) in a variety of clinical conditions, most notably cardiovascular disorders (CVDs) [1–4]. However, lipids and lipoproteins are known to interact with platelets and affect their structure and function [5, 6]. These interactions are believed to be mediated by multiple factors like prostaglandins, thromboxanes, CD36, nitric oxide, stromal cell-derived factor-1, thrombopoietin receptor, integrin and exchange of platelet membrane lipids with the extracellular milieu [5–7]. Therefore, it is plausible that lipid profile parameters like total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and triglycerides (TGL) influence the values of platelet indices. Links between platelets and serum lipids may be a reflection of their common and overlapping roles [5]. But, derangements in the components of lipid profile are themselves independent risk factors for disease like CVDs, which may introduce a confounding influence while estimating the utility of platelet indices in such conditions. However, the effects of lipid parameters are seldom adjusted for [2–4]. There is a dearth of information in this regard from human studies. While there have been a few studies on the relationships between some platelet parameters (like platelet count and/or MPV) and some lipid profile components [7–9], studies exploring the relationships of the other platelet indices (like PCT and PDW) with the lipid profile comprehensively are even fewer [10]. With this background, we designed the current study to evaluate the influence of lipid profile on the values of platelet indices in detail. We consecutively screened subjects undergoing routine health check-up in our institute from June to November, 2015 for this purpose. Lipid profile and platelet indices are commonly requested laboratory investigations that are frequently altered in a number of clinical conditions. Hence, we selected healthy individuals of either sex to carry out the present investigation. Subjects with hypertension, diabetes mellitus, obesity, cardiac disease, infections, hepatic disorders, genito-urinary problems and pregnancy were excluded. None of the subjects were on statins or other lipid-modifying medications. After obtaining informed consent, fasting venous blood samples were collected for photometric estimation of lipid profile (Beckman Coulter AU 2700 clinical chemistry autoanalyser, Miami, USA) using homogenous assay kits (Beckman Coulter, USA). Platelet indices were measured in LH750 Hematology Analyser (Beckman Coulter, Miami, USA). Within 30 min of sample collection, peripheral blood smears were also prepared and inspected visually under a microscope. Cases showing giant platelets and/or platelet clumps were excluded. Quality control was performed using commercially available control materials (Randox, UK, and CMC, Vellore, for lipid profile; Beckman Coulter, USA, for haematology analyser). The continuous data were summarized as arithmetic mean with standard deviation (SD) or as geometric mean with 95% confidence interval (CI), depending upon whether they were normally distributed or not (tested by Kolmogorov–Smirnov test). The correlations between the lipid parameters and platelet indices were examined by computing the Pearson’s correlation coefficient (r). These observations were supplemented by multivariate analyses. Multiple linear regressions were used to identify the independent lipid determinants of platelet indices. Platelet count, MPV, PCT and PDW were used as the outcome (dependent) variables. The regression models were constructed separately for each of these platelet indices by including TC, LDL-C, HDL-C, TGL and age as the predictor (independent) covariates. A two-sided P-value of less than 0.05 was considered statistically significant and that less than 0.01 as highly significant. The data were processed and analysed using SPSS 11.5 software package (SPSS Inc., Chicago, USA). The final sample consisted of 477 adult subjects (287 males, 190 females) above 18 years of age. Baseline characteristics of these subjects are presented in Table 1. In the overall sample, values of PC correlated positively

Cord Blood Screening of Haemoglobinopathies in the Newborn from North East India

Thalassaemia and haemoglobinopathies are major public health problems worldwide. Among them HbE is common in South East Asia, prevalence reaching up to 30–40%. In the present study, 117 (23.21%) babies out of 504 showed the presence of haemoglobinopathies with Haemoglobin E heterozygous being the commonest form. We emphasize the need for an appropriate screening strategy for early diagnosis.

Spectrum of renal lesions in systemic lupus erythematosus: Six years' experience at a tertiary health care centre in north east India

A total of 30 patients with SLE and clinical renal disease were diagnosed between 2006-2011. Out of these, three cases were known cases on treatment and 27 cases came to the hospital for the first time. Two cores of renal biopsies taken under ultrasound guidance, after an informed consent, were processed routinely and stained using haematoxylin and eosin stain, Periodic acid Schiffs stain, Gomoris methenamine silver stain and Masson trichrome stain. Immunohistochemical evaluation using IgG, IgA, IgM, C3 and C1q antibodies was done when tissue was adequate.