Tropical Journal of Pathology and Microbiology

Epidemiology of Mycotic Infections: Experience From A Tertiary Care Center Of Uttarakhand, India

2021-05-31T18:49:01+0530

Introduction: The overall changing epidemiology of fungal infections in the current scenario is because of an increase in immunocompromised population including cancer patients, Human immunodeficiency virus (HIV)-infected patients, transplant receipts, and prolonged hospitalization with overuse of antimicrobial agents. These infections are challenging to diagnose and subsequently manage as their clinical symptomatology often mimics other common diseases like tuberculosis. Rapid diagnosis is limited and culture is often delayed due to slow growth rates of the causative agents.

Objective: This is a retrospective study to know the spectrum and burden of mycotic infections in a tertiary care hospital.

Methods: All samples collected from clinically suspected cases of fungal infections were sent to the Microbiology department over one year. The common specimens received were respiratory samples, scrapings from cornea, skin, and nail. All samples were first observed under direct microscopy using Potassium hydroxide (KOH) examination for the presence of fungal elements and Gram stain for yeasts. India Ink examination was performed for sterile fluids. Fungal culture was done on Sabouraud's dextrose agar.

Result: A total of 900 samples from various departments were included, KOH examination was positive for 380 samples (42%) and fungal growth was obtained in 144 samples (16%). Rare fungi like Trichosporon dohaense (blood culture), Cladophialophora bantiana (brain abscess), Scedosporium apiospermum and Candida auris (blood culture) were also isolated.

Conclusion: Similar studies are needed to estimate the actual burden of the fungal infections in tertiary care health facilities, to help decrease the morbidity and mortality associated with underdiagnosed mycotic infections.

Aberrant expression of E-cadherin in infiltrating ductal and lobular breast carcinomas and its correlation with clinicopathological parameters – A hospital-based study

2021-07-03T12:05:49+0530

Introduction: Breast carcinoma is one of the commonest malignant tumours in women, leading to premature deaths and morbidity. E-cadherin is a 120kDa calcium-dependent transmembrane glycoprotein encoded by the CDH1 gene located on chromosome 16q21 and is expressed in most epithelial cells. Loss of E Cadherin expression implies cell discohesion and favours metastasis. The study aims to evaluate the expression of E-cadherin in breast carcinoma and its association with various histomorphological and clinicopathological parameters.

Materials and Methods : A total of 30 cases of breast carcinomas were studied, over two years. Histological grade and type were assessed by staining the paraffin-embedded sections with H & E. Using IHC technique, E-cadherin antigen was retrieved by Heat-Induced Epitome Retrieval method, and immunostaining was scored semiquantitatively. Cases were grouped as ‘preserved,’ when positivity was strong membranous, and occurred in more than 75% of the neoplastic epithelial cells and ‘aberrant’ in all the remaining cases. The scores were then correlated with the histopathological grade, histological type of tumour and clinicopathological parameters.

Results: E-cadherin was found to be preserved in 46.7% of all the breast carcinomas and aberrant in 51.7% of invasive ductal carcinomas (IDC) alone, while 100% of invasive lobular carcinomas showed aberrant expression. No significant correlation was found with E-cadherin grading and histological type of carcinoma, histopathological grade or involvement of deep surgical margin.

Conclusion: Differentiation between invasive ductal and invasive lobular carcinoma based on the loss of E-cadherin has to be done cautiously given its aberrant expression in ductal carcinomas as well.

Parasites in histopathology: A tertiary care hospital experience

2021-07-03T13:24:42+0530

Background: Parasitic infections are a major public health problem worldwide with one quarter of world’s population is suffering from it. Intestinal and extraintestinal parasitic infestation are raising in developing countries. There is raise in immunocompromised state in which tissue parasitic infestation are increasing which necessitates this type of study.

Method: A retrospective descriptive study with data collected from histopathology register from January 2018 to December 2020, all cases diagnosed as parasitic infestation with age, gender , location and histopathological evaluation with tissue response was analysed.

Results: Over the period of 3 years 11 parasitic infestation was identified. 3(27.3%) cases of hydatid cyst, 5(45.5%) cases of Enterobius vermicularis, 2 (18.2%)case of cysticercosis and 1(9%) case of hard tick was identified. Most common age group affected was <25 years of age(54.5%). Most common parasite found is enterobius vermicularis in our study.

Conclusion: A careful histopathological examination to identify parasitic infestations in tissue sections will help to decrease morbidity and mortality by providing specific treatment to the patient.

Manifestations of Bone Marrow Abnormalities of HIV/AIDS Patients

2021-07-04T18:55:09+0530

Background: Human immunodeficiency virus can involve almost any organ system. Anemia is the most common hematological manifestation in HIV/AIDS patients. Bone marrow changes include varying degrees of dysplasia in one or more cell lines, plasmacytosis, opportunistic infections and hematological malignancies. There are only a few studies where hematological manifestations of HIV/AIDS patients had been described. Hence, the present study was aimed to study hematological manifestations along with the morphological study of the bone marrow of HIV/AIDS patients.

Materials and Methods: 100 HIV positive patients, aged between 12-65 years were enrolled in this hospital-based cross-sectional study. The study was conducted from March 2016 to March 2018. A complete blood count, CD4 counts were done, besides a thorough history and clinical examination. HIV positive patients were classified as those having AIDS and Non-AIDS, according to NACO criteria. Written informed consent was taken from patients and bone marrow aspiration was done. Smears were stained with Leishman stain for morphological study and Perl’s Prussian blue for iron stores.

Results: Total number of patients included in the study was 100. We were able to do a CD4 count of 91 patients. As per criteria, out of 91 patients, 37 cases had AIDS. The most common hematological abnormality was anemia, seen in 95.45%of patients. Bone marrow was normocellular in 86.48% of AIDS and 85.18% of non-AIDS, hypocellular in 8.10% of AIDS and 9.25%o f non- AIDS, hypercellular in 5.40% of AIDS and 5.55% of non-AIDS patients. Dysplasia was statistically and significantly associated with anemia. The commonest dysplastic features are seen in the granulocytic and erythroid series. L.D. bodies were seen in 2 cases and Histoplasma was found in one case. Gelatinous transformation of marrow was detected in 2 cases.

Conclusion: Normocytic normochromic anemia was the most common peripheral smear finding. Hypocellular bone marrow was more common than hypercellular marrow in an advanced stage of the disease. Dysplastic changes were more common in AIDS than Non-AIDS. Granulocytic dysplasia was the most common type of dysplasia. There was evidence of opportunistic infections and gelatinous transformation were detected in our study.

Role of Fine Needle Aspiration Cytology in Effective Management of Patients with Granulomatous Inflammation in Neoplastic and Non-Neoplastic Lesions

2021-07-29T11:52:46+0530

Background: Granulomatous inflammation is a common diagnosis given in fine-needle aspiration cytology (FNAC) and it is a type of chronic inflammation in which tissue reaction appears following cell injury.

Aims: To assess the usefulness of the cytological study in the diagnosis of granulomatous lesions.

Materials and Methods: An observational study is done based on cytomorphological evaluation of 156 cases of granulomatous inflammation diagnosed at the Department of Pathology, in Surat Municipal Institute of Medical Education & Research over 18 months from February 2018 to July 2019.

Results: Out of the total of 156 cases of granulomatous inflammation, tuberculosis was the most common finding in 111 cases (71.15%), followed by fungal infection (05 cases). The male to female ratio was 1.0 to 1.4. The most commonly affected age group was 21 to 30 years.

Conclusions: All the cases of granulomatous inflammations are analysed for definitive diagnosis to provide early and proper treatment of underlying diseases, malignancies or lymphoma.

Cutaneous cystic lesions: its clinicopathological correlation with emphasis on unusual findings.

2021-07-06T13:10:49+0530

Background: Cutaneous cysts are the most common lesions encountered in surgical practice with cosmetic and psychological concern to the patient.

Aim: To establish the clinicopathological correlation of these lesions and also the importance of histological evaluation for the prevention of misdiagnosing a benign-appearing malignant lesion.

Methods: A retrospective descriptive study with data collected from archives of histopathology from January 2018 to December 2020 of clinically diagnosed cutaneous cyst along with age, gender, location and histopathological evaluation were analysed.

Results: 88 cases that were clinically diagnosed as cutaneous cysts had a higher female proportion 52.3%. The most common clinical diagnosis is epidermal/ sebaceous cyst. 35.2% of cases were clinically diagnosed accurately but 64.8% of cases did not correlate with clinical diagnosis. 4 malignant lesions were misdiagnosed as benign cutaneous cyst clinically.

Conclusion: Most often clinically diagnosed cutaneous cysts are not sent for histopathological evaluation which is a very important tool to confirm the diagnosis.

The spectrum of palpable breast lesions- A cytopathological study of 1193 cases

2021-07-08T12:19:35+0530

Introduction- The vast majority of the lesions that occur in the breast are benign. Much concern is given to malignant lesions of the breast because female breast cancer has now surpassed lung cancer as the leading cause of global cancer incidence in 2020. Fine needle aspiration cytology (FNAC) has good sensitivity, specificity and accuracy in the diagnosis of both neoplastic and non-neoplastic breast lump thereby assisting in early diagnosis and further management. The current study was done to study the incidence and the different cytomorphological patterns of palpable breast lumps by FNAC and consequently compare the results with studies in the literature.

Materials and methods- This is a retrospective study conducted from January 2018 to December 2020 in a tertiary care hospital. The three-year data is obtained from the records maintained in the FNA clinic. The patients were counselled before the procedure and informed consent was taken.

Results- A total of 1193 breast lump cases were analysed in this 3-year study, there were 19 male patients all of them presented with gynaecomastia and 1177 female patients. The patient’s age group ranged from 12 to 86 years. The commonest age group with the lesions 31-40 years comprising 326 cases (27.32%) followed 21-30 years age group in the second place with 307 cases (25.7%).

Conclusion- In this study the most common benign neoplastic and malignant neoplastic breast lumps are fibroadenoma and infiltrating ductal carcinoma respectively. Fibrocystic disease of the breast is the most common non-neoplastic breast lump.

A Comparative Study of Coagulation Profile and Haematological Parameters in Pregnancy Induced Hypertension (PIH).

2021-07-29T19:19:52+0530

Aim: To evaluate the changes in PIH (Pregnancy Induced Hypertension) by using haematological and coagulation parameters like platelet count, MPV, PDW, PT and APTT.

Materials and methods: A total of 150 cases comprising 75 control groups and 75 cases group (pregnancy-induced hypertension) were enrolled in the study. Hematological parameters like platelet count, MPV, PDW and coagulation parameters like PT and APTT were studied in these patients. Data entry was done in an excel spreadsheet and by using SPSS (version -20).

Results: The hematological parameter - Platelet count was markedly reduced in patients with preeclampsia compared to normal pregnant patients. MPV, PDW, PT and APTT were increased which is statistically significant.

Conclusion: The abnormalities about hematological and coagulation parameters in preeclampsia are the prognostic markers used as an additional diagnostic criterion for preeclampsia in rural hospitals

A Rare Case of Rhinosporidiosis in Popliteal Fossa

2021-07-03T13:16:23+0530

We hereby present a rare case of rhinosporidiosis in the popliteal fossa. Rhinosporidiosis is a chronic granulomatous infection caused by the fungus-like organism Rhinosporidium seebrii most commonly in the nasal cavity, followed by ocular and cutaneous lesions. The following case is of a 45-year-old female who presented to the laboratory with a pedunculated mass which on histopathology revealed a typical sporangium with numerous endospores. The report provides an insight into the clinical suspicion that needs to be kept while handling such cases.