Correlation of Clinico-pathological Classification of Hansen's Disease in a South Indian City

Hansen's Disease (HD) presents itself in different forms depending on the individual's immune status, and based on this Ridley-Jopling classified the disease into five sub-groups. The aim of this study was to evaluate the role of histopathology and bacteriological index (BI) in accurate staging of HD with clinical correlation. Fifty HD patients with clinical diagnosis confirmed by histopathology were included. Patients in reaction and on treatment were excluded. Case records and histopathological slides were viewed and BI was recorded. In 10/50 cases, a diagnosis of HD was made or suspected, but were not clinically classified. In these, histopathology proved useful in diagnosis and classification. Indeterminate HD was the most common histopathological diagnosis (6 cases). The remaining 40 patients, were clinically classified using the Ridley-Jopling classification, as Indeterminate Leprosy (IL) in 10/40 (25%), Tuberculoid Leprosy (TT) 5/40 (12.5%), Borderline Tuberculoid (BT) 16/40 (40%), Borderline Lepromatous (BL) 4/40 (10%) and Lepromatous Leprosy (LL) 5 (12.5%). HD was common in males with male to female ratio of 1.66:1 and affected the younger individuals (maximum in 21 to 30 years). On histopathology BT was the most common type (40%) followed by IL (27.5%), BL (12.5%), TT (10%) and LL (10%). No case of Mid-Borderline (BB) type was diagnosed clinically or histopathologically. Overall concordance between clinical and histopathological diagnosis was 65% (26/40 cases) and for each type was IL = 80%, TT = 20%, BT = 75%, BL = 50% and LL = 60%. Where classification seemed difficult as in cases of BT and BL, II played an important role. The overall concordance between clinical classification and histopathological diagnosis of DO is 65% in this study. Th *discordance that is observed is between BT and TT, the paucibacillary type and BL andILL the multibacillary type and hence the treatment is not affected. Overall, IL was a common diagnosis on histopathology in this study'(11/40 cases and 6/10 cases). If clinically warranted, a repeat deeper punch of skin biopsyrmay be required for a proper categorization of the cases.

Pseudomembranous colitis in a pregnant woman

Pseudomembranous colitis in association with pregnancy has not been well described in English literature. Recent studies show a drastic increase in the incidence and severity of Pseudomembranous colitis in pregnant women, who were once thought to be at low risk. We report here a case of Pseudomembranous colitis in a young healthy immunocompetent pregnant lady. An early suspicion of this entity with the characteristic appearance of pseudomembranes on colonoscopy and histology confirmed the diagnosis enabling prompt treatment and complete recovery without any serious consequences.

Primary pulmonary Hodgkin's disease: a distinct entity

A 30-year-old lady presented with fever, dry cough and weight loss for the preceding five months. Radiological investigations revealed a solitary nodular lesion in the lingula of the left lung. Guided fine needle aspiration cytology failed to yield any diagnostic material. Bronchoscopic cytology was also not contributory. As a last resort open lung biopsy was done and a diagnosis of Hodgkin's disease was made. Hilar and pre aortic lymph node biopsies showed only reactive change. The final diagnosis was primary pulmonary Hodgkin's disease.

Choroid plexus papilloma diagnosed by crush cytology

In a 32-yr-old man, an infratentorial cystic lesion with a mural nodule was interpreted to be either a hemangioblastoma or a cystic astrocytoma on CT scan. Intraoperative crush cytology revealed it to be a choroid plexus papilloma (CPP). The utility of crush cytology in the rapid diagnosis of central nervous system (CNS) tumors and the differential diagnosis of CNS papillary lesions are highlighted in this report.

Holoacardius acephalus-myelecephalus

Holoacardius acephalus is a rare anomaly occurring in twin pregnancy. This case was an amorphic monstrous mass with only lower limb buds showing five digits and no definite human form unlike those reported in the Indian literature which either showed the presence of other body parts like thorax, abdomen and head and neck structures or were totally undifferentiated. The other twin had intra uterine growth retardation. This case came to the hospital in labour. As this condition can be recognised in the antenatal period, diagnosis of this anomaly is important for better perinatal outcome.

Ovarian strumal carcinoid--report of a case that matastasized

Ovarian teratomas are known for their ability to form a wide variety of tissues. One unusual example of this potential is the strumal carcinoid in which the thyroid tissue is found in intimate association with carcinoid tumor. Although considered as a malignant transformation of struma ovarii, it is almost always benign. We report a rare case of strumal carcionid in a 44 year old lady who had metastasis in the contralateral ovary, myometrium and lungs.

Primary papillary carcinoma in a thyroglossal duct cyst

A rare case of primary thyroid papillary carcinoma arising in a thyroglossal duct cyst occuring in a 46 year old man is reported. The diagnosis was not suspected preoperatively. On gross examination of the excised specimen the presence of a papillary tumour in the cystic mass suggested the diagnosis which was proved histopathologically. The thyroid gland was normal on physical examination and scintigram thus ruling out the possibility of metastasis from a primary tumour in the thyroid gland.

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

OBJECTIVE

To study the cytomorphologic features of the Ewing's 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.

Neovascularization of nucleus pulposus. A diagnostic feature of intervertebral disc prolapse

STUDY DESIGN

Seventy-five surgically excised prolapsed intervertebral discs were histopathologically evaluated. Fifteen prospective normal cadaveric discs were used as control specimens.

OBJECTIVE

To compare the morphologic features between the prolapsed and normal discs.

SUMMARY OF BACKGROUND DATA

The histologic criteria were edge neovascularization of the fibrocartilage, chondrocyte cloning, fibrillation with fraying, and granular change.

METHODS

Sections stained with hematoxylin and eosin, Van Gieson's, and toluidine blue were studied. The presence or absence of edge neovascularization was noted. The other criteria were graded based on a semiquantitative scoring system.

RESULTS

Edge neovascularization was observed in 56% of the discs in the test group and in none of the control specimens. Fibrillation with fraying was the most significant finding in the test group (P < 0.001). Although the mean grades were higher in the test group, they did not predict the presence of edge neovascularization.

CONCLUSIONS

Edge neovascularization was the most significant finding to confirm disc prolapse. Fibrillation with fraying, was observed more frequently in prolapsed intervertebral discs and the grades of fibrillation with fraying, chondrocyte cloning, and granular change were significantly higher in the test group. Pathologists can usually agree on the presence or absence of a particular histologic characteristic but are rarely consistent when they estimate the degree. Simple, reproducible agreed-on criteria are needed before semiquantitative evaluations become reliable.

Mast cell profile in prostatic lesions

Mast cell profile in common prostatic lesions was analysed in this study. 17B consecutive prostatic biopsy specimens specimens were categorised broadly into nodular hyperplasia without prostatitis (101), nodular heperplasia with prostatitis (50, prostatic intraepithelial neoplasia (2) and adenocarcinoma (25). Toluidine blue stain (0.1%) was used to demonstrate the mast cells and their count was expressed per square millimeter. Mast cell count was significantly higher in the fibromuscular stroma when compared to the glandular areas in nodular hyperplasia (p < .05). The mast cell counts were very significantly lower in inflammatory lesions (p < 0.0001) probably due to degranulation. Absence or a low count was the most significant finding in adenocarcinoma irrespective of the grade of the tumour with concentration of mast cells around the tumour. This study shows the variations in mast cell distribution in commonly encountered prostatic lesions. There is paucity of such studies in the literature and the possible utility of mast cell count to differentiate malignant from benign and atypical conditions needs further evaluation.

Parathyroid cyst--a rare case report

A rare case of parathyroid cyst in a forty six-year-old lady diagnosed clinically as solitary thyroid nodule is reported. An intra-operative diagnosis of parathyroid cyst was made which was confirmed histopathologically. The clinicopathologic aspects, diagnostic methods and treatment modalities of this unusual condition are briefly discussed.

Extramedullary plasmacytoma diagnosed by fine needle aspiration cytology. A report of four cases

BACKGROUND

Fine needle aspiration cytology (FNAC) diagnosis of plasmacytoma is rare.

CASES

Four cases of plasmacytoma were diagnosed by FNAC. The patients had clinically palpable lesions in more than one anatomic site. The sites of aspiration included lymph nodes, soft tissue swellings and a bony mass. The ages of the patients ranged from 42 to 80 years (mean, 62 years), and all the patients were male. All four cases showed a monomorphous population of well-differentiated myeloma cells in aspiration smears. Serum electrophoresis demonstrated an M spike in all cases, and Bence Jones protein was detected in the urine sample in one case. Radiologic and bone marrow findings also substantiated the diagnosis of multiple myeloma.

CONCLUSION

FNAC diagnosis of plasmacytoma at extramedullary sites offers the opportunity for noninvasive verification of widespread involvement.

Primary carcinoma of the fallopian tube. A clinicopathologic study

Five cases of primary fallopian tube carcinoma were located in 30 years retrospective study (1965-1994) from the Department of Pathology, Kasturba Medical College, Mangalore, Karnataka. Abnormal vaginal bleeding was the presenting symptom in all the cases. Pelvic mass was palpable in four cases. The diagnosis was not suspected preoperatively in any case. All patients underwent surgical treatment. Laparotomy revealed the presence of a macroscopic growth in the fallopian tube which was confirmed to be adenocarcinoma histopathologically in all the cases. In three cases follow-up is available. Only one patient received postoperative radiotherapy and chemotherapy.

Unilocular cystic sebaceous lymphadenoma of the parotid gland

Unilocular Cystic Sebaceous Lymphadenoma of the parotid gland also described as benign lymphoepithelial parotid cyst with sebaceous differentiation is an unusual tumour which histogenetically resembles Warthin's tumour. We present two such cases reported in the department of Pathology, Kasturba Medical College with review of the literature on histogenesis.

Reduction in caseload after multidrug therapy in an urban leprosy control programme--a retrospective study in Bombay

A fall in the active registered case prevalence rate together with a fall in the active caseload per worker after the introduction of multidrug therapy (MDT) is becoming a managerial issue in leprosy control. A retrospective analysis was undertaken to assess the caseload per paramedical worker with reference to active cases for treatment (3341), cases for surveillance (2227) and cases for care after cure (165) at the end of December 1989. All these cases were under the care of 24 paramedical workers. The analysis showed that the caseload per worker was 239 (active cases 139, plus surveillance cases 93, plus care after cure cases 7), though active registered case prevalence rate declined from 1.82/1000 (before starting MDT) to 0.79/1000 by the end of December 1989. The case detection rate was 0.49/1000 by the end of 1989. So, although the active registered case prevalence rate declines, the worker will have enough to do because of the need for surveillance and the detection of relapses, early neuritis, early disabilities and care after cure. Simultaneously, new case detection and treatment must be continued. All these aspects need to be considered when programme managers are reviewing leprosy control strategy.

Three years assessment of multidrug therapy in multibacillary leprosy cases

Analysis of Bacteriological Index (BI) of 584 multibacillary leprosy patients who had completed multidrug therapy (MDT) as per the recommendations of World Health Organization (WHO) and Indian Association of Leprologists (IAL) showed smear conversion rates of 56% at 24 doses and 66% at 36 doses. Taking BI as a parameter of judgement, the results indicate distinct improvement over the performance achieved through dapsone monotherapy during earlier period. IAL regimen consisting of daily initial administration of rifampicin for 21 days did not show any distinct advantage over WHO regimen. Bacteriological decline was uniformally noticeable in all patients though in cases with high initial BI, smear conversion rate was much less. All the six patients with BI more than 5, and 59 patients (70%) with BI 1 to 4.9 and 87 patients (64%) with BI 3 to 3.9 have not been rendered negative even after three years of treatment. On the contrary seventeen patients whose skin smears were still positive after receiving 24 supervised doses became bacteriologically negative subsequently, and remained so though chemotherapy was stopped. Such studies on large number of patients for a longer period is essential to establish whether chemotherapy should necessarily be continued up to the point of negativity.

Granulomatous lesions of the skin

Background: Granulomatous skin lesions often present as a diagnostic challenge to dermatopathologists due to various modes of presentation and identical histological picture produced by several causes. The aim of the study was to study different granulomatous skin lesions and to determine the relative frequency, the level of clinicopathologic concordance and to compare our results with those of other workers. Materials and Methods: A retrospective analysis of skin biopsies received over a period of two years from January 2007 to December 2008; was performed, and cases of granulomatous dermatitis reported on histopathological examination were reviewed along with special stains. Results: Out of a total of 1590 skin biopsies 106 (6.67%) cases were found to have a granulomatous reaction. It was common in males (63.21%) with most occurring in the fourth to fifth decades. Majority of cases (79 cases, 74.5%) were categorized as infectious granulomatous lesions with predominance of leprosy (63 cases, 79.7%) followed by tuberculosis (6 cases, 7.6%). An overall clinicopathologic concordance was seen in 97% of cases of leprosy. Conclusion: In this study leprosy is the most common cause of granulomatous skin lesions. It can be concluded that histopathology plays an important role in classification of leprosy, and in diagnosis and management of a variety of granulomatous skin diseases. Special stains play a supportive role in infectious granulomas. Keywords: Granulomatous skin lesion; Leprosy; Skin biopsy DOI: http://dx.doi.org/10.3126/jpn.v1i2.5397 JPN 2011; 1(2): 81-86