Iranian Journal Of Pathology
Volume:10 Issue: 1, Winter 2015

Rapid processing of histopathological specimens and decreased turnaround time is important to fulfill the needs of clinicians treating sick patients, so the present study was conducted to compare the time taken and quality of sections in processing of prostatic tissue by rapid microwave and conventional techniques using morphometry. Four to five mm thick paired prostate tissue pieces of fifty cases of prostatectomy specimens were taken. One tissue piece of the pair was processed routinely overnight by conventional tissue processing and the other by microwave processing. Time taken for processing by both conventional technique and microwave technique was noted and compared. Then, both were stained with conventional method of hematoxylin and eosin staining and examined for histological typing and grading. Morphometric study was done on slides of prostatic tissue processed by both conventional and microwave technique. The prostatectomy specimens included both benign (86%) and malignant (14%) prostatic lesions in the age range of 46-85 years. The time taken for steps of dehydration, clearing and impregnation in microwave technique was significantly less as compared to histoprocessing done by conventional technique. Morphology, staining patterns of prostatic tissue processed within minutes by microwave technique, whether benign or malignant, were comparable to those sections which were processed in days using standard technique. Domestic microwave oven can be used for histoprocessing to accelerate the processing with preservation of morphology and is cheaper than commercially available microwave ovens and processing time was considerably reduced from days to minutes.

Multiple sclerosis is an inflammatory disease of the central nervous system. This is due to migration of peripherally activated lymphocytes to central nervous system leading to inflammatory lesions. However, liver has an anti-inflammatory microenvironment. Myelin expression in the liver of transgenic mice suppresses inflammatory lesions within central nervous system. Considering the notion that the inflammatory events originate from periphery, we investigated if the liver was affected in an animal model for multiple sclerosis. Experimental autoimmune encephalomyelitis was induced in male Lewis rats using guinea pig spinal cord and complete Freund’s adjuvant. Weight, clinical score, and survival rate were evaluated for 14 days post immunization. Liver sections were taken and stained with Hematoxylin and Eosin and examined with an Olympus microscope. Mortality was accompanied by liver damage. Sinusoidal congestion, pycnotic nuclei within hepatocytes, hepatocyte necrosis, and severe widespread congestion along with fat accumulation within hepatocytes (fatty degeneration) were observed in liver tissue sections. Liver damage occurs in experimental autoimmune encephalomyelitis. The perpetuation of self antigen leading to continuous migration of extrahepatically activated T cells makes an inflammatory milieu in the liver. It follows migration and development of more inflammatory cells and may paralyses tolerance inducing mechanisms. Apart from central nervous system lesion, liver injury may act as synergistic factor for debilitation and mortality.

Tubular adenomas are rare benign epithelial tumours of breast affecting predominantly females of child bearing age group. Till now, very small number of cases havebeen reported in the literature.Present study was carried out to evaluate the clinico-pathological features of tubular adenoma cases diagnosed during three years study period along with discussion of possible differential diagnoses. Overall, 346 female breast biopsies were diagnosed as benign lesions in three years (2010-2012), of which 10 cases of tubular adenomas were identified. Available clinical, radiological and cytological data of these cases were analysed retrospectively in detail.Tubular adenomas were identified from 16 to 48 years of age with a predilection to younger age group (60% within 30 years). Most of the tubular adenomas were small and circumscribed mimicking fibroadenoma in almost all the cases. Diagnosis of tubular adenoma in each case was possible only after histological examination. Pre-operative diagnosis of tubular adenoma was not established by cytological and radiological evaluation in any case. Tubular adenomas are clinically indistinguishable from other benign breast neoplasms and it should be considered as potential differential diagnosis during histopathological evaluation of breast biopsies.

Breast cancer is the commonest cancer of Indian women. Estrogen and Progesterone expression is seen in benign breast lesions and in breast carcinoma associated with good prognostic parameters and it correlates well with response to hormone therapy. Although a lot of studies have been conducted in the past on hormone receptor expression in breast cancer and few have correlated them with other prognostic parameters of breast cancer, the present study was intended to document the prevalence of hormone receptor positive breast carcinomas in our population; their importance in benign breast diseases; to document a reliable scoring system of hormone receptors expression by Quick scoring; to correlate them with most of the proven prognostic parameters of breast carcinoma. Tissue specimens from 25 patients with benign breast disease and 50 patients with breast carcinoma were assayed for estrogen (ER) and progesterone (PR) receptors using Quick scoring. ER/PR expression in breast carcinomas was correlated with various prognostic parameters including patients’ age, menopausal status, tumor size, type, MBR grade, NPI, lymphatic vessel invasion, lymph node stage, lymphomononuclear invasion, elastosis and HER2/neu status. Scoring of steroid receptors paralleled intensity of hyperplasia in benign breast diseases but in breast carcinoma, it was inversely correlated with grade of tumor, NPI, HER2/neu status, tumor necrosis, lymphomononuclear infiltrate and elastosis. We found no relationship with tumor size, lymph node status or age. Assessment of hormone receptors for clinical management of breast cancer patients is strongly advocated to provide prognostic information and best therapeutic options.

Sputum smear staining for acid-fast bacilli is initial approach to the diagnosis of pulmonary tuberculosis (PTB) but more than 50% of cases are sputum smear-negative. This study was aimed to investigate the diagnostic value of fiberoptic bronchoscopy (FOB) guided bronchoalveolar lavage (BAL) in patients suspected to have tuberculosis. This prospective cross-sectional study was carried out on 290 sputum smear-negative patients who were clinically suspicious for PTB in 2006-12. All patients were subjected to FOB andBAL,then BAL specimens stained and cultured. Of the 290 patients, 173 cases (59.7%) were men and 117 cases (40.3%) were women with the age of 52.6±19.1 years (ranged 20-76 years). Of the total 290 BAL specimens, 110 specimens (38%) were positive for acid-fast bacilli. Sensitivity, specificity, PPV and NPV was 60%, 91%, 89% and 64%, respectively. Also, LR+ and LR- was 64.6% and 0.44%, respectively. FOB guided BAL is a reliable, rapid and useful method for establishing the diagnosis of smear negative PTB with minimal complications.

Breast cancer is the most common malignancy in women throughout the world. There are controversial reports on the role of human papillomavirus (HPV) infection in breast carcinogenesis. The aim of this study was to assess the presence of HPV-DNA in invasive breast carcinoma to determine the association between HPV infection and breast carcinoma. The study included formalin-fixed paraffin-embedded tissue samples of 100 cases with invasive ductal carcinoma of breast and 50 control tissues of mammoplasty specimens. HPV-DNA was purified and amplified through GP5+/GP6+ and MY09/MY11 primers. All tested carcinomas as well as normal tissues were negative for all types of HPV in PCR assay. Our results do not support the association between HPV infection and breast carcinoma. Further studies involving larger number of cases are required to elucidate the role of HPV infection in breast carcinogenesis.

Fine needle aspiration cytology (FNAC) is an established out- patient procedure used in primary diagnosis of palpable thyroid lesions. A modified technique fine needle capillary sampling (FNCS) obviates the need of suction, is less painful, patient friendly and reported to overcome the problem of inadequate and bloody specimens. The aim of our study was to compare the efficacy and quality of FNCS with that of conventional FNAC in the lesions of thyroid. One hundred patients, presenting between January 2011 to December 2012 at Cytopathology Department of M M Institute of Medical Sciences and Research, Mullana, with diffuse and nodular thyroid lesions were enrolled with both the techniques being executed on the patients, beginning with FNA followed by FNCS. The smears were scored using five objective parameters i.e. background blood, cellular material, cellular degeneration, cellular trauma, and retention of appropriate architecture, in a single blind setting by a cyto-pathologist. The results were analyzed using Student’s test for paired data and chi- square analysis. A highly significant differences (P<0.001) in favor of FNCS was observed for the background blood, cellular material and retention of architecture while total score favored FNA for cellular degeneration and degree of cellular trauma. Total scores and average score per case for FNCS was significantly better (P<0.001) than FNA. FNCS technique yielded more diagnostically superior and lesser number of unsatisfactory smears whereas greater number of diagnostically adequate samples was obtained by FNA technique. FNCS offers more number of diagnostically better quality smears. Both techniques could be supplementary on many occasions and substitutive on a few. Combination of the two techniques could offer better diagnostic accuracy.

Urinary tract infections (UTI) are one of the most common infectious diseases with different microbial agent and antimicrobial resistant pattern in hospitalized patients and outpatients. In order to assess the adequacy of therapy, knowledge of prevalence and resistance pattern of the bacteria is necessary. The main aim of this study was to evaluate the prevalence and the antimicrobial resistance pattern of main bacterial responsible for UTI in order to establish an appropriate empirical therapy. All urine samples were referred to Imam Hospital Laboratory, Tehran, Iran during 2011-2012, urine culture isolated and bacteria were identified and the profile of antibiotic susceptibility was characterized. From 1851 urine cultures, UTI was more frequent in woman (68%) E. coli was as usual the most common pathogen implicated in UTI. Most susceptibility was to imipenem (98.9%). nitroforantoin (96%) and amikacin (94.1%) and increased resistance to penicillin (66.6%), nalidixic acid (62.1%) ampicilin (60.1%) and cotrimoxazole 54.3%. The most common isolated pathogen was E. coli. According to antibiogram susceptibility, the recommended antimicrobial drugs are nitroforantoin and imipenem. nalidixic acid and cotrimoxazole are not recommended because drug resistance is high.

One of the unusual variant of ovarian tumor is sex cord stromal tumor with annular tubules (SCTAT). The recurrence in case of malignant ovarian SCTAT ranges from 3mo to 20yr. This report describes the case of recurrence of SCTAT in a 35yr old woman after 4yr of hysterectomy with bilateral salphingo-Oopherectomy. Microscopic examination revealed features of SCTAT. Because of its unusual behavior evidenced by delayed recurrence in spite of bland cellular features, proper long term follow–up is essential.

Eccrine porocarcinoma is a rare malignant adnexal tumor of ductal portion of eccrine sweat gland. It occurs commonly in the lower extremities and rarely in scalp, face, ear, trunk and upper extremities. This survey presents a classic case of eccrine porocarcinoma of scalp in a 58 yr old male patient, presenting as cauliflower like growth over parietal aspect of scalp.

Cutaneous leiomyosarcoma is a relatively rare tumor accounts for about 2-3% of superficial soft tissue sarcomas. It occurs more frequently in males in fifth and sixth decades with a predilection for extremities.We report a 27 years old male with cutaneous leiomyosarcoma of thigh, previously diagnosed as pleomorphicfibroma. The tumor composed of pleomorphic spindle shaped cells with blunt ended nuclei and high mitotic activity. Smooth muscle actin was positive.In this case, the young age of the patient and previous misdiagnosis of the tumorare interesting.Subtle histologic features of low grade leiomyosarcomacan be a pitfall in diagnosis and so affects the optimal management of the patient as it occurred in previous sample of this case.

Malignant peripheral nerve sheath tumor (MPNST) is a rare nerve sheath tumor derived from Schwann cells or pleuripotent cells of neural crest. Neurogenic tumors make about 10-20% of all mediastinal tumors. Incidence of MPNST is 0.001% in general population and 0.16% in patients with neurofibromatosis I (NF I). We report a case of 60 year female presenting with progressive cough and breathlessness for2 years. The CECT revealed multiple focal enhancing lesions along inferior mediastinal pleural surface and along lateral pleural surface. A thoracotomy and tumor excision was done and MPNST was diagnosed on microscopy and immunohistochemistry. This case highlights that this unusual tumor may involve lung parenchyma. So this possibility should be kept in mind in patients with intrathoracic mass.