Publications by authors named "Asit Ranjan Mridha"

64 Publications

Dermoscopic features of cutaneous metastases from breast carcinoma: A report of three Indian patients.

Indian J Dermatol Venereol Leprol 2021 Mar-Apr;87(2):273-278

Pathology, All India Institute of Medical Sciences, New Delhi, India.

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http://dx.doi.org/10.25259/IJDVL_453_20DOI Listing
April 2020

Rare case of juvenile ossifying fibroma of the lumbar spine causing vertebra plana.

BMJ Case Rep 2021 Jan 18;14(1). Epub 2021 Jan 18.

Pathology, All India Institute of Medical Sciences, New Delhi, Delhi, India.

Juvenile ossifying fibroma (JOF) is a rare benign fibro-osseous tumour occurring in craniofacial bones of children and young adults. An 8-year-old girl presented with low back pain since 10 months. Plain radiographs revealed a vertebra plana-like lesion of L3 vertebra. CT scan showed an osteolytic lesion with areas of ground-glass appearance interspersed with bone flecks involving the entire body, pedicles and laminae of L3 with well-circumscribed cortical margins. Biopsy was done-histopathological findings showed cellular fibrous stroma with bony trabeculae-which, on corroboration with clinical and radiological findings noted previously, confirmed the diagnosis of JOF. The patient underwent preoperative angioembolisation, curettage and posterior stabilisation. At follow-up of 15 months, the patient was asymptomatic-imaging revealed residual tumour in pedicles-which however did not progress radiologically. The case raises the importance of including this rare condition as a differential diagnosis in children and reports successful outcome with subtotal resection.
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http://dx.doi.org/10.1136/bcr-2020-239097DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7813401PMC
January 2021

Bilateral Symmetric Sporadic Osteofibrous Dysplasia: an Unusual Case.

Indian J Surg Oncol 2020 Sep 8;11(Suppl 2):307-310. Epub 2020 Oct 8.

Department of Pathology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029 India.

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http://dx.doi.org/10.1007/s13193-020-01236-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7732948PMC
September 2020

Unilateral carpal tunnel syndrome: an unusual presentation of nodular fasciitis.

BMJ Case Rep 2020 Nov 30;13(11). Epub 2020 Nov 30.

Pathology, All India Institute of Medical Sciences, New Delhi, Delhi, India.

Nodular fasciitis is a benign, self-limiting proliferative disorder of fibroblast of uncertain aetiology, occurs frequently in the forearm. Nodular fasciitis in hand inducing carpal tunnel syndrome is exceptional. There are four cases of non-intraneural nodular fasciitis causing peripheral neuropathy that has been reported previously. We present the case of a 38-year-old man with features of unilateral carpal tunnel syndrome. Decompression of the median nerve performed subsequently along with excision of the lesion in a piecemeal fashion. Histopathological and immunohistochemical findings were consistent with nodular fasciitis. There were complete resolution of symptoms and no sign of recurrence at the end of 1 year after surgery.
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http://dx.doi.org/10.1136/bcr-2020-236142DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7705373PMC
November 2020

Primary intimal sarcoma of the pulmonary artery misdiagnosed as pulmonary thromboembolism: A case confirmed at medicolegal autopsy.

J Forensic Sci 2021 Jan 8;66(1):403-406. Epub 2020 Oct 8.

Department of Forensic Medicine & Toxicology, All India Institute of Medical sciences, New Delhi, India.

Misdiagnosed PAS confirmed at medicolegal autopsy Pulmonary artery sarcoma (PAS) is a rare disease and usually indistinguishable from acute or chronic thromboembolic disease of the pulmonary arteries. We present a case of pulmonary artery sarcoma in a 54-year-old male, who was clinically misdiagnosed as pulmonary thromboembolism. The patient died of disease; however, the actual diagnosis of PAS was made after a medicolegal autopsy. PAS can be a diagnostic challenge for both clinicians and pathologists. In an autopsy case with a clinical suspicion of pulmonary thromboembolism, if there is an abnormal gross appearance in the pulmonary artery, the forensic pathologist should have a high index of suspicion of PAS, which should be ruled out by a histopathologic examination.
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http://dx.doi.org/10.1111/1556-4029.14592DOI Listing
January 2021

Histopathological Differentiation of Antemortem and Postmortem Electrical Burn Mark Produced by Low Voltage.

Am J Forensic Med Pathol 2021 Mar;42(1):16-22

Department of Pathology, All India Institute of Medical Sciences, New Delhi, India.

Abstract: The study was undertaken to differentiate antemortem electrical (AME) and postmortem electrical (PME) burn marks with the help of histopathology. The electrical burn mark was produced on 25 dead bodies. Alongside 25 cases of electrocution deaths were included for comparison. Slides were prepared and stained with hematoxylin-eosin stains. Intraepidermal and subepidermal separation; coagulative necrosis of the epidermis; nuclear elongation and hyperchromasia of epidermal cells; homogenization of the dermis; nuclear elongation and hyperchromasia of hair follicles, sweat glands, sebaceous glands, and blood vessel endothelium were studied for histopathological changes and graded. The findings of the study suggest that the histopathological changes in electrical burn marks are due to the physical effect of heat produced by the electric current. The classical histopathological features of electrical burn mark cannot differentiate between AME and PME burn marks. However, careful evaluation of grading of the dermal changes can be helpful in differentiating AME and PME burn marks. Highest grade of dermal thickness homogenization and highest grade of nuclear elongation of dermal appendages were significantly more in the antemortem electrical burn marks than PME burn marks.
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http://dx.doi.org/10.1097/PAF.0000000000000611DOI Listing
March 2021

"Sign of groove" in Hodgkin's lymphoma.

Indian J Dermatol Venereol Leprol 2020 Aug 5. Epub 2020 Aug 5.

Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India.

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http://dx.doi.org/10.4103/ijdvl.IJDVL_1016_19DOI Listing
August 2020

Multifocal giant cell tumors of tendon sheath along a single tendon: A case report with review of literature.

J Clin Orthop Trauma 2020 Jul-Aug;11(4):690-693. Epub 2020 Jun 1.

Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India.

The giant cell tumor of tendon sheath (GCTTS) or nodular tenosynovitis arises as discrete solitary nodule in the tendon sheath near joints of toes and fingers. Multifocal giant cell tumor of tendon sheath is a rare entity, of which the etiology is not yet fully understood and it is different from diffuse type of GCTTS. Diffuse type of GCTTS occurs around large joints having a main mass from which a small satellite nodule may arise. Multifocal GCTTS along a single tendon is a more rare entity. Herein, we describe a case of multifocal GCTTS along the tendon sheath of flexor digitorum profundus tendon of index finger. The patient was managed by surgical excision of the tumor swellings with no recurrence at two years follow up.
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http://dx.doi.org/10.1016/j.jcot.2020.05.034DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7355089PMC
June 2020

Effect of Drilling Techniques on Microcracks and Pull-Out Strength of Cortical Screw Fixed in Human Tibia: An In-Vitro Study.

Ann Biomed Eng 2021 Jan 13;49(1):382-393. Epub 2020 Jul 13.

Department of Pathology, All India Institute of Medical Sciences, New Delhi, India.

The strength between the cortical screw and bone following an orthopaedic implant surgery is an important determinant for the success of osteosynthesis. An excessive axial cutting force during drilling produces microcracks in the bone surface, resulting in reduced strength between the screw and bone, resulting in loosening of implant. The present work, investigates the influence of drilling parameters on microcracks generated in the drilled surface and pull-out strength of screw fixed in cortical bone of human tibia. The holes were drilled by two different techniques: conventional surgical bone drilling (CSBD) and rotary ultrasonic bone drilling (RUBD), by a recently developed operation theatre (OT) compatible machine. Cutting force generated in drilling of human tibia using RUBD was 30-40% lesser than that of CSBD. Scanning electron microscopy (SEM) also revealed that RUBD produced significantly lesser and thinner microcracks than that of CSBD in human bones. Biomechanical pull-out test results showed that, the pull-out strength of screws inserted into drilled holes by RUBD was much higher (100-150%) than that of CSBD. A significant difference in pull-out strength (p < 0.05) between RUBD and CSBD was revealed by statistical analysis at 95% confidence interval.
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http://dx.doi.org/10.1007/s10439-020-02565-2DOI Listing
January 2021

Nonhealing ulcer on the fingertip.

Indian J Dermatol Venereol Leprol 2020 Jun 13. Epub 2020 Jun 13.

Department of Pathology, All India Institute of Medical Sciences, New Delhi, India.

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http://dx.doi.org/10.4103/ijdvl.IJDVL_448_19DOI Listing
June 2020

Effects of rotary ultrasonic bone drilling on cutting force and temperature in the human bones.

Proc Inst Mech Eng H 2020 Aug 3;234(8):829-842. Epub 2020 Jun 3.

Department of Pathology, All India Institute of Medical Sciences (AIIMS), New Delhi, India.

Efficacy and outcomes of osteosynthesis depend on various factors including types of injury and repair, host factors, characteristics of implant materials and type of implantation. One of the most important host factors appears to be the extent of bone damage due to the mechanical force and thermal injury which are produced at cutting site during bone drilling. The temperature above the critical temperature (47 °C) produces thermal osteonecrosis in the bones. In the present work, experimental investigations were performed to determine the effect of drilling parameters (rotational speed, feed rate and drill diameter) and techniques (conventional surgical bone drilling and rotary ultrasonic bone drilling) on cutting force and temperature generated during bone drilling. The drilling experiments were performed by a newly developed bone drilling machine on different types of human bones (femur, tibia and fibula) having different biological structure and mechanical behaviour. The bone samples were procured from male cadavers with the age of second to fourth decades. The results revealed that there was a significant difference ( < 0.05) in cutting force and temperature rise for rotary ultrasonic bone drilling and conventional surgical bone drilling. The cutting force obtained in rotary ultrasonic bone drilling was 30%-40%, whereas temperature generated was 50%-55% lesser than conventional surgical bone drilling process for drilling in all types of bones. It was also found that the cutting force increased with increasing feed rate, drill diameter and decrease in rotational speed, whereas increasing rotational speed, drill diameter and feed rate resulted in higher heat generation during bone drilling. Both the techniques revealed that the axial cutting force and the temperature rise were significantly higher in femur and tibia compared with the fibula for all combinations of process parameters.
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http://dx.doi.org/10.1177/0954411920925254DOI Listing
August 2020

Morphological Changes in the Ligamentum Flavum in Degenerative Lumbar Canal Stenosis: A Prospective, Comparative Study.

Asian Spine J 2020 Dec 21;14(6):773-781. Epub 2020 May 21.

Department of Orthopaedics, Jai Prakash Narayan Apex Trauma Centre, New Delhi, India.

Study Design: Prospective, comparative.

Purpose: To compare the histopathological and electron microscopic changes in the ligamentum flavum (LF) between degenerative lumbar canal stenosis (LCS) and lumbar disk herniation (LDH).

Overview Of Literature: The LF has been implicated as a key structure in the pathogenesis of LCS. With aging, the LF undergoes morphological changes-a decrease in the elastic component and an increase in the collagen component, in addition to other focal changes. By comparing the histopathological and electron microscopic picture of the LF in elderly patients with LCS with that in young patients with LDH, the role of this ligament in the pathogenesis of LCS may be clarified.

Methods: Forty patients were prospectively recruited and divided into two groups: group 1 included 20 patients with degenerative LCS aged >55 years and group 2 included patients with LDH aged <35 years. The ligament flava were collected during the patients' surgery. The features noted on histopathological examination included the fibrosis score, the loss of elastic fibers, calcification, chondroid metaplasia, mucinous degeneration, vascularization, long septa, clefts, granulation tissue, and ganglion-like cysts. The features noted on electron microscopic examination included the elastic fiber thickness, the quality of elastic fibers, the elastic:collagen ratio, calcification, melanin fibers, remnants of necrotic cells, and electron-dense material in the LF. All parameters were compared between group 1 and group 2.

Results: On histopathological examination, the two groups exhibited significant differences regarding three parameters: chondroid metaplasia, long septa, and ganglion-like cysts. On electron microscopy examination, significant differences were observed between the two groups regarding two parameters: the quality of elastic fibers and the elastic:collagen ratio.

Conclusions: Characteristic morphological changes may be noted on histopathological and electron microscopic examination that mark the degenerative changes in the LF that contribute to the occurrence and pathogenesis of degenerative LCS.
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http://dx.doi.org/10.31616/asj.2020.0041DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7788376PMC
December 2020

An in-vitro study of temperature rise during rotary ultrasonic bone drilling of human bone.

Med Eng Phys 2020 05 13;79:33-43. Epub 2020 Mar 13.

Department of Pathology, All India Institute of Medical Sciences, New Delhi, India.

Temperature rise in surgical bone drilling is an important factor that leads to death of the bone cells, known as Osteonecrosis, and results into poor osteosynthesis i.e. implant failure. The present work aims to study the temperature rise during bone drilling by a recently developed operation theatre (OT) compatible machine. The temperature during the drilling process was recorded from K-type thermocouple devices, which were embedded in the human tibial bone at four different positions (at 0.5 mm, 1.0 mm, 1.5 mm, and 2.0 mm) from the drilling site. Comparative study revealed that rotary ultrasonic bone drilling (RUBD) technique produced lesser temperature (40 - 50%) than conventional drilling on human tibia. Statistical model was developed to predict the temperature rise in RUBD process using response surface methodology (RSM), and the optimum parameters were determined using Genetic Algorithm. Analysis of variance (ANOVA) was carried out at a confidence interval of 95 percent (α = 0.05) to determine the influence of various drilling parameters such as rotational speed, feed rate, drill diameter and abrasive particle size on temperature rise. It was observed that the rotational speed was responsible for the maximum temperature rise (51.8%) followed by drill diameter (18.8%), and abrasive particle size (14.3%); whereas, the feed rate contributed minimal (4%) temperature rise.
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http://dx.doi.org/10.1016/j.medengphy.2020.03.002DOI Listing
May 2020

Experimental investigations and statistical modeling of cutting force and torque in rotary ultrasonic bone drilling of human cadaver bone.

Proc Inst Mech Eng H 2020 Feb 21;234(2):148-162. Epub 2019 Nov 21.

Department of Mechanical Engineering, Indian Institute of Technology, New Delhi, India.

Cutting force and torque are important factors in the success of the bone drilling process. In the recent past, many attempts have been made to reduce the cutting force and torque in the bone drilling process. In this work, drilling on human cadaver bones has been performed using rotary ultrasonic bone drilling process to investigate the effect of drilling parameters on cutting force and torque. The experimental work was carried on a recently developed rotary ultrasonic bone drilling machine for surgical operations. The experimental work was performed in two phases. The first phase includes a comparative study between rotary ultrasonic bone drilling and conventional surgical bone drilling, to study the influence of various drilling parameters (rotational speed, drill diameter, and drilling tool feed rate) on the cutting force and torque. The results revealed that the cutting force and torque produced during drilling operations in rotary ultrasonic bone drilling were lesser (30%-40%) than conventional surgical bone drilling. In the second phase, response surface methodology was used to perform the statistical modeling of cutting force and torque in rotary ultrasonic bone drilling process. Analysis of variance was performed at a confidence interval of 95% to analyze the significant contribution ( < 0.05) of process parameters (drilling speed, feed rate, drill diameter, and abrasive particle size) on the responses (cutting force and torque). The confirmatory experiments were performed to validate the developed statistical models. It was found that both cutting force and torque decrease with increase in drilling speed and increases with the increasing drill diameter, feed rate, and abrasive particle size.
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http://dx.doi.org/10.1177/0954411919889913DOI Listing
February 2020

Biochemical findings in sudden unexpected death in epilepsy: Hospital based case-control study.

J Forensic Leg Med 2020 Jan 9;69:101884. Epub 2019 Nov 9.

Department of Forensic Medicine, All India Institute of Medical Sciences, New Delhi, India.

Purpose: A review study on the biochemistry of epilepsy showed that in epileptic patients, serum glucose and cholesterol concentrations are low, sodium is unaffected, potassium increases, glucose is high and mild hypocalcemia. We have conducted a biochemical study on sudden unexpected death in epilepsy (SUDEP) cases in an attempt to establish the characteristic biochemical values to diagnose these deaths.

Methods: This was a hospital based case-control study done at All India Institute of Medical Sciences, New Delhi for one year. Twenty SUDEP cases and 20 age- and sex-matched controls were included in the study. Femoral blood, cerebrospinal fluid, vitreous humor, and pericardial fluid were biochemically analyzed for sodium, potassium, calcium, glucose, N-acetyl- cysteine activated creatine kinase (CK-NAC) and isoenzyme CK-MB.

Result: Serum sodium, CK-MB and CK-NAC level was found significantly increased and potassium level was found decreased in SUDEP cases in comparison to non-epileptic deaths. Likewise, in CSF, sodium and CK-NAC was found increased and potassium level was found decreased in SUDEP cases. In vitreous humor, sodium and CK-MB level was found increased and potassium level was found decreased in SUDEP cases in comparison to non-epileptic deaths. In pericardial fluid, sodium, CK-NAC and CK-MB level was found increased and potassium level was found decreased in SUDEP cases in comparison to non-epileptic deaths.

Conclusion: It concludes that high sodium level and low potassium level could be associated with SUDEP. However, this is a small size study, a larger study is needed to verify the findings. Furthermore, it is difficult to conclude whether these findings are exclusive to SUDEP.
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http://dx.doi.org/10.1016/j.jflm.2019.101884DOI Listing
January 2020

Processing Techniques for Scanning Electron Microscopy Imaging of Giant Cells from Giant Cell Tumors of Bone.

Microsc Microanal 2019 12;25(6):1376-1382

Department of Anatomy, All India Institute of Medical Sciences, New Delhi 110029, India.

Giant cell tumor (GCT) of bone is a common benign lesion that causes significant morbidity due to the failure of modern medical and surgical treatment. Surface ultra-structures of giant cells (GCs) may help in distinguishing aggressive tumors from indolent GC lesions. This study aimed to standardize scanning electron microscopic (SEM) imaging of GC from GCT of bone. Fresh GCT collected in Dulbecco's Modified Eagle Medium was washed to remove blood, homogenized, or treated with collagenase to isolate the GCs. Mechanically homogenized and collagenase-digested GCs were imaged on SEM after commonly used drying methodologies such as air-drying, tetramethylsilane (TMS)-drying, freeze-drying, and critical point-drying (CPD) for the optimization of sample processing. The collagenase-treated samples yielded a greater number of isolated GC and showed better surface morphology in comparison to mechanical homogenization. Air-drying was associated with marked cell shrinkage, and freeze-dried samples showed severe cell damage. TMS methodology partially preserved the cell contour and surface structures, although the cell shape was distorted. GC images with optimum surface morphology including membrane folding and microvesicular structures on the surface were observed only in collagenase-treated and critical point-dried samples. Collagenase digestion and critical point/TMS-drying should be performed for optimal SEM imaging of individual GCs.
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http://dx.doi.org/10.1017/S1431927619014855DOI Listing
December 2019

Pazopanib efficacy and toxicity in a metastatic sarcoma cohort: Are Indian patients different?

Indian J Cancer 2019 Jul-Sep;56(3):207-210

Department of Medical Oncology, Dr. B.R Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India.

Purpose: There is no study till date determining the spectrum of adverse events of pazopanib in Indian patients with advanced sarcoma.

Materials And Methods: We conducted a retrospective study by analyzing the case records of metastatic sarcoma patients treated with pazopanib from January 2016 to July 2017 in sarcoma medical oncology clinic. Toxicity was assessed according to CTCAE v.4.03 criteria. SPSS version 23 was used for statistical evaluation.

Results: A total of 33 patients received pazopanib. The median age was 41 years (range, 19-75 years), with a male predominance (54.5%). Twenty-six patients (78.8%) had ECOG performance status 1 at the time of pazopanib initiation. The most common type of sarcoma was synovial sarcoma, and the mean duration of pazopanib intake in patients was 4.12 months. The median follow-up was 13 months. Median progression-free survival was 5 months, and median overall survival was 18 months. Overall response rate was 6.0%. Out of the 33 patients, 42.4% (n = 14) received it after first line of therapy. Six patients (18.2%) required dose reductions due to toxicity. Thirteen (39.4%) patients experienced CTCAE grade 3 or 4 toxicities. Most common grade 3 and 4 toxicities experienced among patients were hand-foot skin reaction (18.2%) and proteinuria (9.1%). No significant difference was seen when analyzed for variables such as age, sex, ECOG performance status, comorbidities, and number of previous lines received in patients experiencing grade 3 and 4 toxicities.

Conclusions: The spectrum of adverse events in Indian patients at doses lower than the recommended dose is distinctly different from the western population. However, this unique toxicity profile needs to be validated in prospective studies.
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http://dx.doi.org/10.4103/ijc.IJC_105_18DOI Listing
January 2020

Lipoleiomyosarcoma of spermatic cord: an unusual presentation.

BMJ Case Rep 2019 Aug 4;12(8). Epub 2019 Aug 4.

Pathology, All India Institute of Medical Sciences, New Delhi, India.

Spermatic cord malignancies are very rare tumours. Less than 100 cases of cord liposarcoma have been reported in the literature. Divergent differentiation into leiomyosarcoma and liposarcoma is a rare phenomenon but can occur. Lipoleiomyosarcoma usually represents the well-differentiated subtype of this entity. We report such a rare case in spermatic cord with an unusual presentation as a recurrent inguinal hernia in a 62-year-old man.
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http://dx.doi.org/10.1136/bcr-2018-228952DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6685382PMC
August 2019

Lipoleiomyosarcoma of spermatic cord: an unusual presentation.

BMJ Case Rep 2019 Aug 4;12(8). Epub 2019 Aug 4.

Pathology, All India Institute of Medical Sciences, New Delhi, India.

Spermatic cord malignancies are very rare tumours. Less than 100 cases of cord liposarcoma have been reported in the literature. Divergent differentiation into leiomyosarcoma and liposarcoma is a rare phenomenon but can occur. Lipoleiomyosarcoma usually represents the well-differentiated subtype of this entity. We report such a rare case in spermatic cord with an unusual presentation as a recurrent inguinal hernia in a 62-year-old man.
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http://dx.doi.org/10.1136/bcr-2018-228952DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6685382PMC
August 2019

ATP-binding cassette transporter A1 (ABCA1) expression in adipose tissue and its modulation with insulin resistance in obesity.

Diabetes Metab Syndr Obes 2019 25;12:275-284. Epub 2019 Feb 25.

Department of Biochemistry, All India Institute of Medical Sciences, New Delhi, India,

Purpose: Adipose tissue dysfunction is at the center of metabolic dysfunctions associated with obesity. Through studies in isolated adipocytes and mouse models, ATP-binding cassette transporter A1 (ABCA1) expression in the adipose tissue has been shown to regulate high-density lipoprotein (HDL) cholesterol levels in the circulation and insulin sensitivity at both adipose tissue and whole-body levels. We aimed to explore the possible link between ABCA1 expression in the adipose tissue and metabolic derangements associated with obesity in humans.

Patients And Methods: This exploratory study among individuals who were lean (body mass index [BMI]: 22.3±0.34 kg/m, n=28) and obese (BMI: 44.48±5.3 kg/m, n=34) compared the expression of ABCA1, adiponectin and GLUT4 (SLC2A4) in visceral and subcutaneous adipose tissue using quantitative real-time PCR and immunohistochemistry. Homeostatic model assessment for insulin resistance (HOMA-IR) and adipose tissue insulin resistance (adipo-IR) were used as insulin resistance markers.

Results: Visceral adipose tissue from individuals who were obese had significantly lower ABCA1 (=0.04 for mRNA and protein) and adiponectin (=0.001 for mRNA) expression compared to that from lean individuals. Subcutaneous adipose tissue did not show any significant difference in the expression. When individuals were divided into insulin-sensitive (IS) and insulin-resistant (IR) groups based on HOMA-IR, IR individuals had lower ABCA1 (=0.0001 for mRNA and =0.009 for protein) expression compared to IS individuals in visceral adipose tissue, but not in subcutaneous adipose tissue. The difference was significant after adjusting for age, gender and BMI. ABCA1 mRNA expression in visceral adipose tissue correlated negatively with both HOMA-IR (=-0.44, =0.0003) and adipo-IR (=-0.35, =0.005) after adjusting for age, gender and BMI. ABCA1 expression in either visceral or subcutaneous adipose tissue did not have any significant correlation with HDL cholesterol levels or mean adipocyte area.

Conclusion: Obesity and insulin resistance are associated with lower expression of ABCA1 in visceral adipose tissue in humans.
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http://dx.doi.org/10.2147/DMSO.S186565DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6395069PMC
February 2019

Unsatisfactory response to sirolimus in Maffucci syndrome-associated spindle cell hemangiomas.

Dermatol Ther 2019 05 20;32(3):e12851. Epub 2019 Feb 20.

Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India.

Maffucci syndrome is characterized by multiple benign vascular anomalies and enchondromas present on the distal extremities. Effective treatment options are currently not available for Maffucci syndrome-associated vascular lesions. Sirolimus is a mTOR pathway inhibitor, and has been tried successfully in the treatment of various vascular anomalies. We treated a 23-year-old female with Maffucci syndrome-associated spindle cell hemangiomas with oral sirolimus (2mg/day, 0.04mg/kg/day). There was improvement in pain, but no change in colour or size of the vascular nodules. In view of unsatisfactory response and treatment-related adverse effects (oral aphthae, mild transaminitis), sirolimus was stopped after 6 months.
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http://dx.doi.org/10.1111/dth.12851DOI Listing
May 2019

Nora's lesion of 2nd metacarpal treated by wide excision, autologous fibular grafting and metacarpophalangeal joint replacement: A rare case report.

J Clin Orthop Trauma 2018 Jun 24;9(Suppl 2):S58-S62. Epub 2017 Aug 24.

Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India.

Bizarre paroxysmal osteochondromatous proliferation (BPOP) is a rare benign neoplastic lesion predominantly affecting small bones of the hand and known for its recurrence after local excision. We describe a rare case of BPOP involving second metacarpal of the dominant hand which was treated using a novel technique. Wide excision and reconstruction with non-vascularised fibular autograft was performed along with metacarpophalangeal joint replacement. At a follow up of two years, there was no evidence of recurrence and patient had good functional outcome. Hence this modality of treatment could be considered in dealing such cases of BPOP involving the small bones of hand.
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http://dx.doi.org/10.1016/j.jcot.2017.08.014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6008605PMC
June 2018

Glottic neurogenic tumor: A highly uncommon site for schwannomas.

J Cancer Res Ther 2018 Apr-Jun;14(3):687-689

Department of Pathology, All India Institute of Medical Sciences, New Delhi, India.

Schwannomas are benign encapsulated neurogenic tumors, arising from Schwann cells embedded in neurilemal sheath as multinucleated syncytial network. Head and neck schwannomas account for 25%-45% of all schwannomas, majority developing in parapharyngeal space. Laryngeal schwannoma in itself is a rarity, and a glottic origin further complicates its diagnosis. To the best of our knowledge, this is the second case of glottic schwannoma being reported in medical literature. Symptomatology is attributable to mass effect of a slow-growing laryngeal tumor, ranging from sore throat to stridor. The gold standard method for their excision is still debatable. For small tumors, endoscopic or direct laryngoscopic approach is preferred, but for large glottic tumors, external approach is advocated for better exposure and facilitating mucosal grafting. Index case is being presented not only for its rare site of origin, but also to stress on the importance of meticulous histopathological examination to advocate appropriate treatment.
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http://dx.doi.org/10.4103/jcrt.JCRT_878_14DOI Listing
November 2018

Carcinoma showing thymus like elements: Report of a case with EGFR T790M mutation.

Diagn Cytopathol 2018 May 8;46(5):413-418. Epub 2017 Nov 8.

Department of Pathology, All India Institute of Medical Sciences, New Delhi 110029, India.

Carcinoma showing thymus-like differentiation of the thyroid (CASTLE) is a rare tumor involving the thyroid and perithyroidal soft tissues. It shares morphological, immunohistochemical and molecular similarities with thymic carcinomas. Due to its relatively better prognosis, it needs differentiation from other primary and metastatic tumors of this region. A 40-year-old lady presented with a gradually progressive anterior neck swelling for one year. Imaging showed bulky right and left lobes of thyroid along with a solid soft tissue mass in the pretracheal region. Fine needle aspiration smears showed features of poorly differentiated carcinoma. Total thyroidectomy with excision of the mass revealed histopathological features characteristic of CASTLE, with evidence of thyroiditis in adjoining thyroid. Epidermal growth factor receptor (EGFR) assay revealed presence of EGFR T790M somatic mutation in exon 20. The same was not detectable on direct sequencing. We present a rare case of CASTLE, occurring in association with Hashimoto thyroiditis, with emphasis on cytological features and report for the first time the presence of a low level somatic mutation in EGFR (EGFR T790M mutation).
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http://dx.doi.org/10.1002/dc.23859DOI Listing
May 2018

Primary Intraosseous Malignant Peripheral Nerve Sheath Tumor of Metacarpal Bones of the Hand in a Patient Without Neurofibromatosis 1: Report of a Rare Case.

Indian J Med Paediatr Oncol 2017 Apr-Jun;38(2):232-235

Department of Pathology, All Institute of Medical Sciences, New Delhi, India.

Malignant peripheral nerve sheath tumor (MPNST) usually arises in peripheral nerve sheath cells. The intraosseous location of MPNST is rare. Mandible is the most common site of bony involvement. Involvement of bones of the hand is quite unusual. We report a case of MPNST involving metacarpal bones of the left hand treated with surgery followed by adjuvant radiation and chemotherapy and review the pertinent literature.
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http://dx.doi.org/10.4103/ijmpo.ijmpo_5_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5582569PMC
September 2017

Solid Variant of Aneurysmal Bone Cyst Masquerading as Malignancy.

J Clin Diagn Res 2017 Jul 1;11(7):ED35-ED36. Epub 2017 Jul 1.

Assistant Professor, Department of Pathology, AIIMS, New Delhi, India.

Solid Variant of Aneurysmal Bone Cyst (SVABC) is an uncommon neoplasm seen in young patients. The lesion presents clinically as well as on radiology like a malignant bone tumour. The aggressive features in most of the cases lead to a wrong diagnosis. Radiologically, it is expansile osteolytic with cortical breach being seen in many of the cases. We report two cases of SVABC which were misdiagnosed as malignant bone tumours. Both cases were seen in long bones. Radiologically both lesions were expansile, osteolytic, solid cystic, with destruction of cortex and were diagnosed as osteosarcomas. Both the cases were referred to us for further management and were subsequently diagnosed as SVABC. Being extremely rare these tumours have a high chance of getting misdiagnosed and knowledge of this entity along with close correlation with clinical, radiological and histopathological findings plays a critical role in accurately diagnosing this condition. An accurate diagnosis is of utmost importance as this changes the treatment drastically avoiding mutilating surgeries and unnecessary chemo radiotherapy.
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http://dx.doi.org/10.7860/JCDR/2017/25950.10306DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5583895PMC
July 2017

Alveolar soft part sarcoma of orbit: A rare diagnosis.

J Egypt Natl Canc Inst 2017 Sep 23;29(3):167-170. Epub 2017 Aug 23.

Department of Pathology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India. Electronic address:

Objective: Alveolar soft part sarcoma (ASPS) is an aggressive, rare tumour with unique morphological and histopathological features.

Methods: We report a rare case of orbital ASPS and its management in a young male who presented with painless proptosis and progressive loss of vision.

Result: Twenty-two year male presented with a history of gradually increasing proptosis with loss of vision since 12months. He underwent radical re-excision of mass with right orbital exenteration and reconstruction using temporalis muscle flap. Adjuvant radiotherapy to a dose of 64Gy in 32 fractions over 6.5weeks was planned in view of positive surgical margins. Patient is free of disease and currently under follow up in multidisciplinary clinic.

Conclusion: Function preserving surgery remains the standard treatment approach in localised disease however the complex anatomy and locally aggressive nature makes it difficult to achieve clear surgical margin. Adjuvant radiotherapy has shown to improve local control in patients with positive surgical margins.
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http://dx.doi.org/10.1016/j.jnci.2017.07.001DOI Listing
September 2017

Autoimmune haemolytic anaemia and haemophagocytic lymphohistiocytosis in an adolescent boy with tuberculosis: an unusual association.

Trop Doct 2017 07;47(3):249-253

5 Professor, Department of Paediatrics, All India Institute of Medical Sciences, New Delhi, India.

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http://dx.doi.org/10.1177/0049475516643438DOI Listing
July 2017

hyperinfection: An often missed but potentially fatal cause of anemia and hypoalbuminemia in leprosy patients on long-term steroid therapy.

Indian J Dermatol Venereol Leprol 2017 May-Jun;83(3):381-383

Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India.

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http://dx.doi.org/10.4103/ijdvl.IJDVL_347_16DOI Listing
November 2018

Complete androgen insensitivity syndrome with concomitant seminoma and Sertoli cell adenoma: an unusual combination.

BMJ Case Rep 2016 Dec 30;2016. Epub 2016 Dec 30.

Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India.

Androgen insensitivity syndrome is a rare disorder of sex development and its clinical manifestations vary from subtle male infertility to an overt complete androgen insensitivity syndrome (CAIS) with a female phenotype. CAIS is often diagnosed at puberty or in adolescence during investigation for primary amenorrhoea. Undiagnosed patients have an increased risk of development of malignancy in the harboured testes. Inguinal hernia is the commonest mode of presentation of CAIS in childhood and various screening methods are available during the initial herniorrhaphy procedure. Controversy exists in the need to screen and the methods of screening in all cases of premenstrual girls with inguinal hernia. Abnormal observation in a suspicious case requires karyotyping for confirmation. We describe a case of CAIS with simultaneous presence of seminoma and a Sertoli cell adenoma in a 17-year-old patient who had a history of surgery for inguinal hernia at age of 5 years.
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http://dx.doi.org/10.1136/bcr-2016-217229DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5237798PMC
December 2016