Publications by authors named "Lavleen Singh"

54 Publications

Histological analyses of trucut liver biopsies from patients with noncirrhotic portal fibrosis and extra-hepatic portal vein obstruction.

Indian J Pathol Microbiol 2021 Jun;64(Supplement):S127-S135

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

Background: Both noncirrhotic portal fibrosis (NCPF) and extrahepatic portal venous obstruction (EHPVO) are important causes of noncirrhotic portal hypertension (PH) in the Asian region. In this study, we analyzed the histopathological changes of liver needle-core biopsies from patients with NCPF and EHPVO.

Patients And Methods: The patients were diagnosed as per the Asia Pacific Association for the Study of Liver (APASL) criteria. Minimum adequacy criteria for liver core biopsies were defined, and finally, 69 liver biopsies from patients with NCPF and 100 liver biopsies from patients with EHPVO were analyzed. All histological parameters were predefined, and three experienced pathologists analyzed the biopsies after reaching consensus. Institute ethics committee clearance was taken.

Results: Although some histological features were overlapping, phlebosclerosis of intra-hepatic branches of the portal vein (PV), periportal aberrant vascular channels, remnant portal tracts, and hepatic fibrosis beyond the portal tracts without the formation of complete hepatic nodules (P < 0.001 for all) were common histological characteristics of NCPF on core-needle liver biopsies; while maintained lobular architecture, nonspecific dilatation of PV branches, absence of intra-hepatic PV phlebosclerosis, aberrant vascular channels, and significant fibrosis were characteristics of EHPVO.

Conclusions: Despite the considerable histological overlap between NCPF and EHPVO, careful histological evaluation, supplemented by clinical features, radiological and biochemical findings can help in making a conclusive diagnosis. Patients with NCPF and EHPVO with clinical jaundice show transaminitis, high serum alkaline phosphatase level, more variceal bleed, and histological evidences of nodular regenerative hyperplasia.
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http://dx.doi.org/10.4103/IJPM.IJPM_387_20DOI Listing
June 2021

Best practices of handling, processing, and interpretation of small intestinal biopsies for the diagnosis and management of celiac disease: A joint consensus of Indian association of pathologists and microbiologists and Indian society of gastroenterology.

Indian J Pathol Microbiol 2021 Jun;64(Supplement):S8-S31

Department of Pathology, MLN Medical College, Allahabad, Uttar Pradesh, India.

The Indian Association of Pathologists and Microbiologists (IAPM) and Indian Society of Gastroenterology (ISG) decided to make a joint consensus recommendation for handling, processing, and interpretation of SI biopsies for the diagnosis and management of celiac disease (CD) recognizing the inhomogeneous practice of biopsy sampling, orientation, processing, and interpretation. A modified Delphi process was used to develop this consensus document containing a total of 42 statements and recommendations, which were generated by sharing the document draft, incorporating expert's opinion, followed by three cycles of electronic voting as well as a full-day face-to-face virtual ZOOM meeting and review of supporting literature. Of the 42 statements, 7 statements are on small intestinal (SI) biopsy in suspected patients of CD, site and the number of biopsies; 7 on handling, fixative, orientation, processing, and sectioning in pathology laboratories; 2 on histological orientation; 13 statements on histological interpretation and histological grading; 3 on the assessment of follow-up biopsies; 2 statements on gluten-free diet (GFD)-nonresponsive CD; 4 on challenges in the diagnosis of CD; 2 statements each on pathology reporting protocol and training and infrastructure in this area. The goal of this guideline document is to formulate a uniform protocol agreed upon both by the experienced pathologists and gastroenterologists to standardize the practice, improve the yield of small bowel biopsy interpretation, patients' compliance, overall management in CD, and generate unified data for patient care and research in the related field.
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http://dx.doi.org/10.4103/IJPM.IJPM_1405_20DOI Listing
June 2021

Clinico-Etiologic Profile of Macroscopic Hematuria in Children: A Single Center Experience.

Indian Pediatr 2021 Jan 28. Epub 2021 Jan 28.

Department of 1Pediatrics and 2Pathology, Chacha Nehru Bal Chikitsalaya, Geeta Colony, Delhi, India.

Objectives: To study the demographic, clinical and etiological profile of macroscopic hematuria in children presenting to a tertiary care hospital.

Methods: This prospective observational study, conducted between January, 2018 and December, 2019, enrolled children aged 3 months to 12 years, presenting with gross hematuria.

Results: Among the 62 children (44 males) enrolled, with mean (SD) age of 7.3 (2.6) years, glomerular hematuria was seen in 59.7%. Post-infectious glomerulonephritis was the commonest etiology of glomerular hematuria; hypercalciuria and renal calculi predominated among non-glomerular hematuria. After a median (IQR) follow up of 8 (6,14.2) months, microscopic hematuria persisted in 10 (7, glomerular hematuria) children. The median time to resolution of gross as well as microscopic hematuria tended to be longer in glomerular etiologies.

Conclusions: Majority of children with gross hematuria had glomerular etiologies, thus requiring monitoring and follow-up.
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January 2021

Renal Pelvic Cholesteatoma: An Uncommon Finding in Children.

J Indian Assoc Pediatr Surg 2020 Nov-Dec;25(6):408-410. Epub 2020 Oct 27.

Department of Pathology, Chacha Nehru Bal Chikitsalaya, Delhi, India.

Renal cholesteatoma or keratinizing desquamative squamous metaplasia is infrequent in adults and rare in children. We report a case of renal cholesteatoma in a 4-year-old male child who was referred to us as a case of multiple renal calculi with hydronephrosis. We also discuss his management with a review of relevant literature.
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http://dx.doi.org/10.4103/jiaps.JIAPS_20_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7815026PMC
October 2020

Differentiating Biliary Atresia From Idiopathic Neonatal Hepatitis: A Novel Keratin 7 Based Mathematical Approach on Liver Biopsies.

Pediatr Dev Pathol 2021 Mar-Apr;24(2):103-115. Epub 2021 Jan 13.

Department of Pediatrics, Maulana Azad Medical College, Lok Nayak Hospital, New Delhi, India.

Background And Aims: Differentiating biliary atresia (BA) from idiopathic neonatal hepatitis (INH) is vital in routine pediatric practice. However, on liver biopsy, few cases offer a diagnostic challenge to discriminate these entities with certainty. Bile ductular reaction (DR), intermediate hepatobiliary cells (IHBC) and extra-portal ductules (EPD) indicate progenitor cell activation, as a response to various hepatic insults. The present study aims to quantify DR, IHBC and EPD by Keratin 7 (CK7) immunohistochemistry (IHC) in BA and INH and to devise a mathematical approach to better differentiate the two, especially in histologically equivocal cases.

Methods: A total of 98 cases were categorized on biopsy as BA, INH or equivocal histology, favoring BA or INH. CK7 DR mean, IHBC mean and EPD mean values were compared between BA and INH. A formula was derived to help distinguish these two entities, the cut-off value, sensitivity and specificity of which were determined by receiver operating characteristic (ROC) curve. This formula was applied and validated on histologically equivocal cases.

Results: Univariate logistic regression revealed significant difference between BA and INH with respect to CK7 DR and CK7 EPD mean (p < 0.001 in both); however, CK7 IHBC mean was not significant (p = 0.08). On multivariate logistic regression, only CK7 DR had significant impact on diagnosis (p < 0.001). A formula: (CK7 DR) + (CK7 EPD)/(CK7 IHBC) was derived to help distinguish BA from INH. Cut off value of 10.5 and above, determined by ROC curve, favored a diagnosis of BA (sensitivity= 93.4%, specificity= 94.6%). Histologically equivocal and discrepant cases could be correctly categorized using this formula.

Conclusions: Formula using CK7 IHC parameters may aid pathologists better distinguish BA from INH, especially in histologically equivocal cases.
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http://dx.doi.org/10.1177/1093526620983730DOI Listing
January 2021

Pediatric fine-needle aspiration cytology: An audit of 266 cases of pediatric tumors with cytologic-histologic correlation.

Cytojournal 2020 2;17:25. Epub 2020 Nov 2.

Department of Cytopathology, ICMR-National Institute of Cancer Prevention and Research, Noida, Uttar Pradesh, India.

Objectives: Fine-needle aspiration cytology (FNAC), a well-accepted minimally invasive diagnostic technique utilized in adults, is gradually gaining ground for pediatric patients as well. However, there are very few comprehensive reports in the literature on utility of FNA in pre-operative diagnosis of pediatric tumors.

Material And Methods: An observational study was conducted at a cancer research center and a pediatric tertiary care hospital over a 5-year period. A cytologic-histologic correlation was performed for FNACs performed in pediatric patients for a clinical diagnosis of neoplastic lesions at both the centers. Relevant clinical details and histopathology, wherever available, were retrieved. Sensitivity, specificity, and accuracy of FNAC in diagnosis of malignant lesion were calculated from the cases with available histologic correlation.

Results: Of the 266 cases included, there was a slight male predominance with lymphadenopathy being the most common presentation and non-Hodgkin's lymphoma as the most frequent diagnosis in cases clinically suspected to have a neoplasm. Histologic correlation was available in 112 cases with 100% concordance in liver and kidney tumors. Few rare cytologic diagnoses such as papillary renal cell carcinoma, mesenchymal hamartoma of the liver, and thymolipoma could be accurately rendered on FNAC smears in conjunction with the clinic-radiologic features. The sensitivity, specificity, and accuracy of FNA in diagnosing malignant pediatric tumors were found to be 100%, 92.6%, and 97.7%, respectively.

Conclusion: The present study underscores the high sensitivity and accuracy of FNAC in diagnosis of pediatric tumors, both in superficial and deep-seated locations. Awareness of the cytomorphologic features and clinic-radiologic correlation may assist the cytopathologists in rendering a precise diagnosis of rare pediatric tumors as well.
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http://dx.doi.org/10.25259/Cytojournal_101_2019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7708969PMC
November 2020

An Unusual Presentation of a Dermoid Cyst Mimicking a Chalazion.

J Pediatr Ophthalmol Strabismus 2020 Jun 23;57:e41-e42. Epub 2020 Jun 23.

The authors report the case of a 6-year-old boy who presented to their outpatient department with complaints of progressively increasing swelling on the left upper eyelid since birth. The swelling was excised and was found to be firmly attached to the tarsus. Histopatho-logical examination reported a cyst lined by stratified squamous epithelium with presence of adnexal structures in the subepithelium. Therefore, the diagnosis of tarsal dermoid cyst was made. [J Pediatr Ophthalmol Strabismus. 2020;57:e41-e42.].
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http://dx.doi.org/10.3928/01913913-20200527-04DOI Listing
June 2020

Reliable cerebrospinal fluid cytology reporting over an extended period: Is it possible by adding formol saline and ethylenediaminetetraacetic acid as cell preservative?

Diagn Cytopathol 2020 Aug 13;48(8):745-751. Epub 2020 May 13.

Department of Pathology, Chacha Nehru Bal Chikitsalaya, Delhi, India.

Background: Reporting cerebrospinal fluid (CSF) cytology within a narrow time frame is crucial as it is often indicated in critically ill patients and moreover, the cells in CSF are highly labile and tend to decline rapidly on standing. However, due to various logistic issues, delay in reporting is inevitable at times, especially if ancillary tools are required. In this study, we examine the effect of using formol saline and ethylenediaminetetraacetic acid (EDTA) as a preservative on the cellular composition of CSF at 18, 24, and 48 hours of preservation.

Methods: Thirty CSF specimens were examined within 2 hours of collection and this reading was recorded as time zero reading. The CSF specimens were then divided in three tubes with: (a) preservative:CSF ratio of 1:1; (b) preservative:CSF ratio of 1:5; and (c) no preservative. Total and differential leucocyte counts and immunocytochemistry were performed on the three specimens at 18, 24, and 48 hours and were compared with the readings at 0 hour.

Results: Preserved CSF (in the ratio of 1:5) showed no significant decrease in the number of cells at 18 hours (P = .4), 24 hours (P = .3), and 48 hours (P = .1). Cellularity decreased by 8.5%, 22%, and 40% at 18, 24, and 48 hours, respectively. Cell morphology and antigenicity were well preserved at all the three time intervals.

Conclusion: Formol saline and EDTA, when mixed with the CSF in the ratio of 1:5, can preserve significant cellularity for up to 24 hours.
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http://dx.doi.org/10.1002/dc.24471DOI Listing
August 2020

Benign vascular anomalies: A transition from morphological to etiological classification.

Ann Diagn Pathol 2020 Jun 13;46:151506. Epub 2020 Mar 13.

Department of Radiodiagnosis, Chacha Nehru Bal Chikitsalaya, Geeta Colony, Delhi 110031, India.

The International Society for the Study of Vascular Anomalies (ISSVA) devised a multidisciplinary etiopathogenesis based approach to classify benign vascular anomalies into tumors and malformations. This classification scheme has major therapeutic and prognostic implications as treatment modalities differ for both the categories. Inappropriate usage of the term "hemangioma" for etiopathogenetically distinct entities is commonly seen in clinical practice leading to delivery of incorrect treatment to the patients. We aimed to study the histomorphological and immunohistochemical features of benign vascular anomalies for their precise histopathological classification. A total of 48 cases diagnosed over a period of 3.5 years were reviewed and reclassified into vascular tumors and malformations based on ISSVA classification and prototypical histopathological features. Biopsies were reviewed based on 5 histopathological criteria viz. endothelial morphology, mitotic activity, intralesional nerve bundles, intralesional inflammation, and prominent vessel type. A panel of GLUT-1, WT-1, and Ki-67 was performed in each case. Seven cases of infantile hemangioma, 4 cases each of non-involuting congenital hemangioma and pyogenic granuloma, and 33 cases of vascular malformations were diagnosed. Endothelial cell morphology (p < 0.001), mitotic activity (p < 0.001), and intralesional nerve bundles (p < 0.001) were found to be statistically significant in differentiating hemangioma from malformations. GLUT-1 (p < 0.001) and Ki-67 labeling index (p < 0.001) were useful to distinguish infantile hemangioma from vascular malformations. To conclude, the ISSVA classification of benign vascular anomalies can be reliably done on histopathology. However, every case must be interpreted in the light of clinical and radiological features.
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http://dx.doi.org/10.1016/j.anndiagpath.2020.151506DOI Listing
June 2020

Non-malignant fibroblastic/myofibroblastic tumors in pediatric age group: Clues and pitfalls to the cytological diagnosis.

Cytopathology 2020 03 7;31(2):115-121. Epub 2020 Feb 7.

Department of Paediatric Surgery, Chacha Nehru Bal Chikitsalaya, New Delhi, India.

Introduction: Fibroblastic/myofibroblastic tumors constitute 12% of all pediatric soft tissue tumors with the majority of them belonging to the benign and intermediate prognostic categories. They are often misdiagnosed owing to their variable clinical presentation and unusual microscopic features. The diagnosis, specially cytological diagnosis of benign and intermediate categories is difficult due to paucity of cellular component and increased amount of extracellular matrix as compared to malignant ones. We hereby discuss the Fine needle aspiration cytology (FNAC) findings of non-malignant fibroblastic/myofibroblastic lesion in the pediatric age group encountered at our institute.

Methods: All the benign and intermediate fibroblastic/myofibroblastic/fibroadipocytic lesions (age 0-12 years) diagnosed on FNAC over a period of 3½ years (Jan 2016- July 2019), with availability of corresponding histopathology were included in the study.

Results: A total of seven pediatric benign and intermediate fibroblastic/myofibroblastic lesions with histopathological confirmation were identified which included Infantile digital fibromatosis (IDF) (n = 2), Lipofibromatosis (n = 1), Fibrous hamartoma of infancy (FHI) (n = 1), Fibromatosis colli (FC) (n = 2) and myofibroma/myofibromatosis (n = 1). FNAC smears were mainly paucicellular with presence of benign spindle shaped cells in a collagenous stroma common to almost all the cases. A few additional findings such as degenerated skeletal muscle fibres, muscle giant cells and mature adipose tissue were also present in some cases.

Conclusion: Fibroblastic/myofibroblastic tumors although uncommon, form an important category that must be considered in the differential diagnosis of pediatric soft tissue tumors. FNAC cytology features when assessed in a proper clinical setting (specially the age and site of presentation) are helpful in suggesting probable preoperative diagnosis in these lesions.
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http://dx.doi.org/10.1111/cyt.12786DOI Listing
March 2020

Langerhans Cell Histiocytosis Presenting With Late-Onset Sporadic Ataxia.

Mov Disord Clin Pract 2019 Nov 18;6(8):716-718. Epub 2019 Sep 18.

Department of Neurology All India Institute of Medical Sciences New Delhi India.

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http://dx.doi.org/10.1002/mdc3.12830DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6856461PMC
November 2019

Myofibromatosis.

Fetal Pediatr Pathol 2021 Apr 18;40(2):166-173. Epub 2019 Nov 18.

Department of Pathology, Chacha Nehru Bal Chikitsalaya, Delhi, India.

Introduction: Myofibromatosis is a distinctive mesenchymal disorder occurring predominantly in childhood, which on microscopy shows peripheral light areas of spindle cells and central cellular areas of primitive oval to spindle cells arranged around hemagiopercytomatous vessels. PDFGRB mutations in the familial and multifocal sporadic forms and fusions in the cellular variants have been identified. The index case is being presented to discuss the clinico-pathological features, differential diagnosis, and management of the lesion.

Case Presentation: An 11-year-old male presented with an infraorbital mass of 3 months duration. The mass was excised and microscopy revealed the morphological features of myofibroma with tram-track SMA immunopositivity. Nodular fasciitis and fibromatosis were the differentials considered.

Conclusion: The gene fusion may represent a subset that in the future may be used to differentiate these myofibromas/myopericytomas from the fusion myopericytomas, and may be used to perhaps separate out familial myofibromas from other myofibromas.
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http://dx.doi.org/10.1080/15513815.2019.1686785DOI Listing
April 2021

Intraoral Foregut Cystic Developmental Malformations: Three cases with a brief review of literature.

Sultan Qaboos Univ Med J 2019 Aug 5;19(3):e257-e261. Epub 2019 Nov 5.

Department of Pathology, Chacha Nehru Bal Chikitsalya, Delhi, India.

Foregut cystic developmental malformations (FCDM) are a type of rare cystic lesion. The occurrence of FCDM is exceedingly uncommon in the intraoral location. We report three cases of FCDM with intraoral location who presented at Chacha Nehru Bal Chikitsalaya, New Delhi, India, in 2016, 2017 and 2018 with symptoms of respiratory distress and feeding difficulties. Two patients were male and one was female with an age range of 29 days to eight years. The clinical differential diagnosis included mucocele, ranula, dermoid, lymphangioma, teratoma, thyroglossal duct cyst, etc. All patients were treated with simple surgical excision and diagnosed, based on histopathology, with FCDM. These should be considered as differential diagnosis of head and neck midline cystic mass lesions. This case report aimed to discuss differential diagnosis and appropriate terminology for these cystic masses as there is varied and ambiguous nomenclature.
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http://dx.doi.org/10.18295/squmj.2019.19.03.014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6839678PMC
August 2019

Lipofibromatosis: Clues to the cytological diagnosis of a rare tumour.

Cytopathology 2019 11 1;30(6):667-670. Epub 2019 Aug 1.

Department of Paediatric Surgery, Chacha Nehru Bal Chikitsalaya, New Delhi, India.

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http://dx.doi.org/10.1111/cyt.12749DOI Listing
November 2019

Lipofibromatosis.

Fetal Pediatr Pathol 2019 Dec 2;38(6):490-495. Epub 2019 Jun 2.

Chacha Nehru Bal Chikitsalaya, Delhi, India.

Lipofibromatosis is a benign pediatric soft tissue tumor arising preferentially in the distal extremities. Histologically, the tumor shows abundant adipose tissue admixed with a spindle cell component, often concentrated in septal and perimysial locations. The index case is being presented to discuss the histopathological and immunohistochemical clues to differentiate it from other fibrofatty tumors of childhood. An 11-month-old male child presented with a slowly growing mass on the upper back. MRI findings were suggestive of an adipocytic tumor. Microscopy revealed a lesion composed of mature adipocytes and intervening fibrous bands with infiltration into the adjacent skeletal muscle, features of lipofibromatosis. Lipofibromatosis should be considered in the differential diagnosis of a pediatric fibrofatty tumor. Accurate diagnosis is essential for proper patient management as incomplete removal of the tumor may result in recurrence.
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http://dx.doi.org/10.1080/15513815.2019.1619206DOI Listing
December 2019

Large Congenital Epulis in a Newborn: Diagnosis and Management.

Ear Nose Throat J 2020 Aug 27;99(7):NP79-NP81. Epub 2019 May 27.

Department of Pathology, Chacha Nehru Bal Chikitsalaya, Delhi, India.

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http://dx.doi.org/10.1177/0145561319851498DOI Listing
August 2020

Infantile digital fibromatosis: Clues and pitfalls for cytological diagnosis.

Cytopathology 2019 09 1;30(5):565-566. Epub 2019 Jul 1.

Department of Paediatric Surgery, Chacha Nehru Bal Chikitsalaya, New Delhi, India.

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http://dx.doi.org/10.1111/cyt.12734DOI Listing
September 2019

Monoclonal gammopathy of renal significance with heavy-chain deposition disease in renal allograft: challenges in the diagnosis and management.

Transpl Int 2019 Jul 31;32(7):769-770. Epub 2019 May 31.

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

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http://dx.doi.org/10.1111/tri.13461DOI Listing
July 2019

Glomerular C4d Staining Does Not Exclude a C3 Glomerulopathy.

Kidney Int Rep 2019 May 13;4(5):698-709. Epub 2019 Feb 13.

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

Introduction: C4d, an early product in the classical/lectin complement pathway has shown potential in the evaluation of C3 glomerulopathy where its absence would support an alternative pathway abnormality. As autoimmune/genetic complement testing is not readily available to most parts of the world, glomerular C4d staining may serve as a useful additional step toward the diagnosis.

Methods: To test this hypothesis, C4d staining was performed on a large cohort of C3 glomerulopathy. Archival cases from 2011 to 2017 were reviewed and immunohistochemistry for C4d was performed, scored (scale of 0 to 3+), and correlated with the immunofluorescence and ultrastructural findings. Paraffin immunofluorescence was performed in cases of "discordant C4d" to unmask Igs.

Results: Twenty-seven cases of dense deposit disease (DDD) and 14 cases of C3 glomerulonephritis (C3GN) were retrieved. C4d demonstrated a range of staining intensities with negative/traces in only 22% of DDD and 64% of C3GN. Lower-intensity C4d staining (1 to 2+) was mostly concordant with similar amounts of Igs/C1q. Discordant 3+ staining was noted in approximately 50% of cases of DDD and 20% of cases of C3GN. Among them, paraffin immunofluorescence unmasked polyclonal Igs in 2 of 5 cases of DDD and 1 of 3 cases of C3GN.

Conclusion: This observational study suggests that the presence of glomerular C4d should not exclude a C3 glomerulopathy. In lower intensities, it appears to represent overlying classical/lectin pathway activation with concordant Ig/C1q deposits. A subset of cases, however, displays intense and discordant C4d staining, which raises the possibility of an associated lectin pathway abnormality, a potential future area of study.
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http://dx.doi.org/10.1016/j.ekir.2019.02.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6506704PMC
May 2019

Correlating the treatment outcome with tumor staging, grading, and various treatment modalities in patients with esthesioneuroblastoma.

South Asian J Cancer 2019 Apr-Jun;8(2):124-126

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

Objective: Although till date no management protocol for esthesioneuroblastoma (ENB) has been standardized due to tumor rarity, still multimodality approach shows better treatment outcomes as compared to surgery alone. The objective of this study was to analyze the clinicopathological spectrum of ENB and to correlate treatment response with tumor staging, histopathological grading, and various treatment modalities.

Materials And Methods: Twenty-one consecutive patients with biopsy-proven ENB were studied and evaluated for response to treatment in the form of complete tumor resolution. Results were analyzed and correlated with stage and grade of tumor and form of therapy received.

Results: There was male preponderance (3.2:1) with age ranging between 7 and 63 years (median of 25 years). Survival rates significantly dropped with increasing tumor stage (63.6% in stages A and B vs. 30% in stages C and D) and grade (100% in Grades 1 and 2 vs. 31.25% in Grades 3 and 4). The recurrence rate was 80% in surgery alone group, which came down to 43.7% if surgery was supplemented with other modalities. In cases where multimodality treatment plan was used, endoscopic procedures fared equally as open surgical procedures.

Conclusion: Hyam's grade and Kadish stage are important prognostic indicators of treatment outcome, with survival rates dropping with increasing tumor stage and grade. Multimodality treatment protocols have improved the disease outcome, making endoscopic surgery equivalent to radical surgeries regarding result outcomes and giving other advantages such as better cosmesis, less treatment-related morbidities, decreased hospital stay, and better cost-effectiveness.
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http://dx.doi.org/10.4103/sajc.sajc_273_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6498716PMC
May 2019

Ultrasound guided aspirate from a paediatric retroperitoneal mass: A diagnostic dilemma.

Cytopathology 2019 09 23;30(5):560-562. Epub 2019 May 23.

Department of Pathology, Chacha Nehru Bal Chikitsalaya, New Delhi, India.

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http://dx.doi.org/10.1111/cyt.12710DOI Listing
September 2019

Unusually large nodular masses over elbows and knee in a 6-year-old boy.

Arch Dis Child 2020 Aug 17;105(8):730. Epub 2019 Apr 17.

Orthopedic Surgery, Chacha Nehru Bal Chikitsalaya, New Delhi, India.

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http://dx.doi.org/10.1136/archdischild-2019-316875DOI Listing
August 2020

Subcutaneous Fat Necrosis of the Newborn: Is Fine Needle Aspiration Cytology Diagnostic?

Acta Cytol 2019;63(1):75-77. Epub 2018 Dec 13.

Department of Paediatric Surgery, Chacha Nehru Bal Chikitsalaya, Delhi, India.

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http://dx.doi.org/10.1159/000494501DOI Listing
March 2019

Retinal Anlage Tumor of Epididymis: A Diagnostic Challenge on Cytology.

Acta Cytol 2019;63(1):73-74. Epub 2018 Nov 19.

Department of Paediatric Surgery, Chacha Nehru Bal Chikitsalaya, Delhi, India.

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http://dx.doi.org/10.1159/000494124DOI Listing
March 2019

Childhood Phimosis Secondary to Lichen Sclerosus: Is There a Spatial Pattern of Histopathological Changes?

Am J Dermatopathol 2018 Nov;40(11):824-828

Pediatric Surgery, Chacha Nehru Bal Chikitsalaya, Delhi, India.

Introduction: The accurate histopathological diagnosis of the phimotic prepuce is indispensable because early diagnosis, treatment, and close follow-up are crucial in genital dermatosis such as lichen sclerosus (LS). This study analyzes the histopathological spectrum of childhood phimosis with special emphasis on LS. We also highlight a peculiar pattern of histopathological evolution in LS, prepuce.

Material And Methods: The histopathology slides of all the pediatric preputial circumcision specimens performed for the indication of pathological phimosis (n = 43) during the study period (2012-2017) were analyzed. Eight histopathological features viz. hyperkeratosis, hypergranulosis, epidermal atrophy, acanthosis, dermoepidermal cleft, upper dermal edema and homogenization, mid dermal lymphocytic band, and interface dermatitis were studied in each case, separately in inner preputial surface, tip, and outer preputial surface. On the basis of evolution of the disease and histopathological features, the lesions of LS were classified into early, established, and advanced.

Result: LS was found in 32 cases, whereas 11 cases showed nonspecific inflammation and fibrosis. The upper dermal homogenization (n = 29), dermoepidermal cleft (n = 28), and mid dermal band (n = 27) were the commonest histopathological changes. The established and advanced changes were confined to the inner preputial surface (n = 31), and the outer preputial skin surface was unaffected in all the cases. A peculiar histopathological evolution pattern was seen with established or advanced lesions, early lesion, and normal histology on the inner preputial surface, mucocutaneous junction, and outer preputial skin, respectively.

Conclusions: LS is a common cause of childhood phimosis. It shows a peculiar histopathological evolution that mandates the thorough analysis of inner mucosal surface.
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http://dx.doi.org/10.1097/DAD.0000000000001248DOI Listing
November 2018

Hemophagocytic lymphohistiocytosis in an infant with multiple triggers!!

Asian J Transfus Sci 2018 Jan-Jun;12(1):85-88

Department of Pediatrics, Chacha Nehru Bal Chikitsalaya, New Delhi, India.

Hemophagocytic lymphohistiocytosis (HLH) is a disorder of immune dysregulation secondary to a massive unregulated cytokine storm and its downstream consequences. HLH is being increasingly recognized as a cause of pyrexia of unknown origin, unexplained cytopenias, and hepatic dysfunction. However, this potentially treatable condition is often missed due to lack of suspicion, variable, and nonspecific presentations, inability to fulfil all the diagnostic criteria and availability of diagnostic tests in resource limited settings. Both familial and acquired forms of HLH can be triggered by multiple factors in a susceptible patient. We report a 9-month old infant who developed HLH in association with Stevens-Johnson syndrome following massive blood transfusion.
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http://dx.doi.org/10.4103/ajts.AJTS_142_16DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5850706PMC
March 2018

Proliferative glomerulonephritis with monotypic IgA-kappa deposits in a 10-year-old.

Kidney Int 2017 09;92(3):765-766

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

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http://dx.doi.org/10.1016/j.kint.2017.04.045DOI Listing
September 2017

Is dengue emerging as important cause of acute liver failure in endemic regions?

World J Clin Cases 2017 Jul;5(7):303-306

Lavleen Singh, Amitabh Singh, Mitali Agarwal, Sataroopa Mishra, Department of Pathology, Chacha Nehru Bal Chikitsalaya, Geeta Colony 110031, New Delhi, India.

Dengue virus infection continues to be major public health problem in large part of world. The epidemiology of dengue viral infection is becoming increasingly complex and has substantially changed over almost past six decades not only in terms of prevalent strains and geographical locations but also in terms of disease severity and atypical presentations. Though liver is the most common organ affected but is generally asymptomatic. We present a case of infant with severe dengue who died of fulminant hepatic failure and showed pan lobular necrosis on post mortem liver biopsy. The case is being presented to highlight life threatening complication of dengue in young children, and dengue viral infection as a cause of acute liver failure in endemic areas. Thus dengue fever should also be considered as one of the differential diagnosis in children presenting with fever and fulminant hepatic failure in endemic regions.
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http://dx.doi.org/10.12998/wjcc.v5.i7.303DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5530800PMC
July 2017

Delayed Treatment Response in a Neonate with Multisystem Langerhans Cell Histiocytosis Case report and review of literature.

Sultan Qaboos Univ Med J 2017 May 20;17(2):e225-e228. Epub 2017 Jun 20.

Department of Pediatrics, Chacha Nehru Bal Chikitsalya, New Delhi, India.

Langerhans cell histiocytosis (LCH) is a rare proliferative disorder of the Langerhans cells, which are part of the mononuclear phagocytic system. The disorder varies in terms of the extent of the disease, its natural course and patient outcomes. While skin rashes are a common presentation of neonatal LCH, other systems or organs may also be involved. Delays in the diagnosis of neonatal LCH may occur due to its non-specific presentation and a lack of awareness of the condition among doctors. We report a two-month-old male neonate who presented to the Chacha Nehru Bal Chikitsalya hospital, New Delhi, India, in 2016 after the onset of pulmonary symptoms. He had been noted to have a generalised rash which had progressively worsened from 15 days of age. Following a skin biopsy and chest imaging, he was diagnosed with multisystem LCH with risk organ involvement. There was a delayed response to combined chemotherapy with no major side-effects.
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http://dx.doi.org/10.18295/squmj.2016.17.02.016DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5488827PMC
May 2017

Infantile Tumoral Calcinosis.

Indian Pediatr 2017 Jun;54(6):521

Departments of #Pathology and Pediatrics, Chacha Nehru Bal Chikitsalaya, Geeta Colony, New Delhi, India.

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http://dx.doi.org/10.1007/s13312-017-1062-xDOI Listing
June 2017
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