Publications by authors named "Mukta Pujani"

84 Publications

Dysphagia and Hoarseness of Voice: What is the Diagnosis?

Dysphagia 2021 Mar 2. Epub 2021 Mar 2.

Department of Pathology, ESIC Medical College and Hospital, Faridabad, Haryana, India.

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http://dx.doi.org/10.1007/s00455-021-10272-wDOI Listing
March 2021

The effect and correlation of smoking with platelet indices, neutrophil lymphocyte ratio and platelet lymphocyte ratio.

Hematol Transfus Cell Ther 2020 Sep 13. Epub 2020 Sep 13.

IBS Ashwani Hospital, Faridabad, Haryana, India.

Introduction: Smoking is associated with the occurrence and progression of cardiovascular diseases, inflammatory disorders and malignancies.

Objective: To study the platelet indices, neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) in smokers and their correlation with smoking pack-years.

Method: A total of 110 smokers and 110 non-smokers were included. The smokers were grouped into three groups: mild (<5 pack-years), moderate (5-10 pack-years) and heavy (>10 pack-years). The platelet count, plateletcrit (PCT), mean platelet volume (MPV) and platelet distribution width (PDW) were noted. The NLR and PLR were calculated and the statistical analysis was made using the Student's T-test, Analysis of Variance (ANOVA) and Spearman's correlation coefficient.

Results: The platelet count, PCT and PDW were significantly higher with mean values: 218.56 ± 121.31 vs 203.23 ± 80.35 (p-value = 0.038), 0.27 ± 0.10 vs 0.26 ± 0.10 (p-value = 0.041) and 12.54 ± 1.45 vs 11.99 ± 1.70 (p-value = 0.001) in smokers and non-smokers, respectively. The PLR differed significantly with mean values: 119.40 ± 84.81 in smokers and 181.99 ± 313.09 in non-smokers, with a p-value of 0.045. A significant positive correlation was found between pack-years of smoking and platelet count and PLR with the Pearson correlation coefficient of 0.250 and 0.198 and p-values, 0.008 and 0.037, respectively. The Platelet Count, PCT, MPV and PDW varied significantly between mild, moderate and heavy smoker groups, with p-values of 0.045, 0.010, 0.015 and 0.017, respectively.

Conclusion: The platelet indices and inflammatory markers NLR and PLR are derived from routine blood investigations, which are easily available and inexpensive. The monitoring of platelet indices, along with the PLR, can be used as early predictors of morbidity in smokers.
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http://dx.doi.org/10.1016/j.htct.2020.07.006DOI Listing
September 2020

Xanthogranulomatous change in a pleomorphic adenoma: An extremely rare variant/degenerative change. Is it fine needle aspiration induced?

Diagn Cytopathol 2021 Feb 21;49(2):E71-E74. Epub 2020 Aug 21.

Department of Pathology, ESIC Medical College & Hospital, Faridabad, Haryana, India.

Pleomorphic adenoma (PA) is the most common benign salivary gland tumor characterized by morphological diversity, metaplastic changes, degeneration, cystic change, altered differentiation, and rarely malignant transformation, thereby may create a diagnostic dilemma on cytology. Xanthogranulomatous (XG) inflammation within a PA could be due to XG sialadenitis coexistent with PA or preoperative fine-needle aspiration cytology (FNAC) induced histologic alteration. The argument in favor of this hypothesis is that the changes seen in the histopathology would not be present in the cytology, implying that the alterations were most likely due to the traumatic injury of needling rather than spontaneous change of the lesions themselves. These FNAC induced changes are focal in most of the cases, so the underlying lesion is readily identifiable, but on rare occasions they are so extensive that it can masquerade as a malignancy. We report a case of XG change in a PA in a 39-year-old male of 8 years standing. Through this case we wish to emphasize that knowledge of a previous FNAC and its potential effects on histology of the subsequent surgical specimen is necessary to avoid potential misdiagnosis.
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http://dx.doi.org/10.1002/dc.24585DOI Listing
February 2021

Granular Cell Tumor Breast Masquerading as a Malignancy Cytologically: a Rare Case Presenting a Diagnostic Dilemma.

Indian J Surg Oncol 2020 Jun 26;11(2):321-324. Epub 2020 Mar 26.

Department of Surgery, ESIC Medical College, Faridabad, Haryana India.

Granular cell tumor (GCT) also known as Abrikossoff's tumor is an uncommon soft tissue tumor of neurogenic origin. GCT of the breast accounts for < 0.1% of breast tumors and 6% of all reported cases of granular cell tumor. Although GCT is a benign tumor, malignant GCT can be seen in 1% v of the cases. GCT of the breast is diagnostically challenging as it can imitate carcinoma clinically and radiologically but need to be differentiated from breast malignancy since they have totally different approach in treatment and prognosis. GCT has a great ability to mimic a variety of lesions from benign histiocytic to malignant epithelial/mesenchymal lesions, thereby presenting a diagnostic challenge to the practicing cytopathologist. We report a case of GCT of breast cytologically masquerading as a malignancy in a 45-year-old female. Although, fine needle aspiration (FNA) is a first-line diagnostic tool, the present case reemphasizes the role of histopathology as the gold standard for a definite diagnosis clubbed with ancillary techniques like immunohistochemistry and special stains.
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http://dx.doi.org/10.1007/s13193-020-01055-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7260310PMC
June 2020

Evaluation of Tumor infiltrating lymphocytes in breast carcinoma and their correlation with molecular subtypes, tumor grade and stage.

Breast Dis 2020 ;39(2):61-69

Department of Community Medicine, ESIC Medical College, Faridabad, Haryana, India.

Background: Tumour infiltrating lymphocytes (TILs) exhibit the local immune response directed against tumor growth and metastasis. TILs have emerged as a tool to assess immune-reactivity in various malignancies including colon, ovary, lung, bladder, breast etc as well as independent marker of favourable prognosis in many tumors. TILs in breast cancer (BC) play a role in tumor response to therapy in the adjuvant and neoadjuvant settings, especially in triple-negative cancers.

Material & Methods: This cross sectional study comprised of 101cases of invasive breast carcinoma. For each case, a representative 5 μm H&E stained section was selected and the clinicopathological details were recorded. To establish the molecular subtype of breast cancer, immunohistochemistry for ER, PR and Her2neu was done. Both stromal (sTIL) and intratumoral (iTIL) TILs were assessed based on the recommendations of the International TIL Working Group (ITILWG).

Results: A statistically significant difference was observed in the mean sTIL as well as iTIL scores and tumor grade, size, molecular type and lymph node metastasis. A signification correlation was observed between stromal TIL and tumor grade, lymph node metastasis, molecular subtype and mitosis. Intratumoral TIL showed a significant correlation with tumor size, mitosis, tumor grade, distant metastasis, stage and lymph node metastasis. Moreover, stromal and intratumoral TIL showed a highly significant correlation with each other.

Conclusion: The ITILWG recommendations are reproducible and reliable for the evaluation of sTILs and iTILs. TILs, as evaluated on Hematoxylin and eosin (H&E) slides, has been shown in numerous studies now to be a reliable, reproducible, inexpensive and readily available marker of pre-existing antitumor immunity in breast cancer. We suggest that TILs should be evaluated for each case of breast carcinoma and should be part of histopathology report.
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http://dx.doi.org/10.3233/BD-200442DOI Listing
January 2020

A Clinicopathological Correlation of International Federation of Gynecology and Obstetrics's PALM-COEIN Classification of Abnormal Uterine Bleeding: Indian Scenario.

J Midlife Health 2019 Jul-Sep;10(3):147-152

Department of Community Medicine, ESIC Medical College, Faridabad, Haryana, India.

Background: Abnormal uterine bleeding (AUB) is a common problem affecting the women of reproductive age group and may also have a significant impact on their physical, social, and emotional aspects directly affecting their quality of life. The International Federation of Gynecology and Obstetrics (FIGO) devised a universally acceptable system of nomenclature and classification, namely PALM-COEIN classification of AUB in the year 2011. The objective of the present study was to analyze the structural (PALM) and functional (COEIN) component of FIGO system in the Indian scenario.

Materials And Methods: Three hundred patients with complaints of AUB were taken. A clinical diagnosis according to PALM-COEIN system was made after thorough history and clinical examination. Additional investigations if required were done, and endometrial sampling or hysterectomy was done whichever indicated. A histological diagnosis was made, and each case was allocated a category according to PALM-COEIN classification. A clinicopathological correlation was done in the hysterectomy cases for structural causes (PALM).

Results: Leiomyoma (30%) was the most common cause of AUB closely followed by adenomyosis (29.66%) overall. The clinicopathological correlation in hysterectomy cases was good with concordance rate of 85.03%. The concordance between clinical and pathological diagnoses for AUB-L, AUB-A, AUB-M, and AUB-A, L was statistically significant with < 05 in positive cases. However, additional finding of adenomyosis was diagnosed in 48.2% of the cases apart from primary clinical diagnosis.

Conclusion: A good clinicopathological correlation was seen in the cases when classified according to PALM-COEIN classification. The system also provides for consideration of multiple etiologies contributing toward AUB both clinically and histopathologically. However, histopathology remains the cornerstone in establishing the accurate diagnosis as the cases without specific symptoms can be missed clinically.
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http://dx.doi.org/10.4103/jmh.JMH_128_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6767954PMC
October 2019

IAC standardized reporting of breast fine-needle aspiration cytology, Yokohama 2016: A critical appraisal over a 2 year period.

Breast Dis 2019 ;38(3-4):109-115

Department of Pathology, ESIC Medical College & Hospital, NIT 3, Faridabad, India.

Background: Breast cytology is a significant component of the "Triple approach" for pre-operative diagnosis of breast lumps, the other two being clinical assessment and radiological imaging. The role of Fine needle aspiration cytology (FNAC) as a first line investigation in diagnosing breast lesions is well documented, however histopathology is the gold standard. Cyto-histopathological correlation is of great relevance and also increases precision.AIMS \& OBJECTIVES:The present study was conducted with the aim to categorize breast lesions according to the latest standardized reporting system proposed by International academy of cytologists (IAC) in 2016. Evaluation of diagnostic accuracy, sensitivity and specificity of FNAC in diagnosing breast lesions and cyto-histopathological correlation was planned.

Materials And Methods: All FNAs of breast lesions over a period of 2 years were included in the study. The cases were grouped into five standardized categories proposed by the International academy of cytology: Category I (Insufficient material), Category II (Benign), Category III (Atypical, probably benign), Category IV (Suspicious, probably in situ or invasive) & Category V (Malignant) respectively. Specificity, sensitivity, diagnostic accuracy, negative and positive predictive value of FNAC were calculated and cyto-histopathological correlation assessed wherever possible.

Results: Out of 468 breast lesions reported on FNAC, the category wise distribution was - Category I, II, III, IV & V accounting for 23(4.9%), 342(73.07%), 7(1.5%), 11(2.35%) and 85(18.16%) respectively. Histopathology was performed in 331/468 cases with cyto histological concordance of 98.4% and a type agreement rate of 90.9%. The sensitivity, specificity, positive and negative predictive value and diagnostic accuracy was 98.90%, 99.16%, 97.82%, 99.58% and 99.09% respectively.

Conclusion: FNAC is a simple, reliable, cost effective, first line diagnostic procedure for all breast lumps. In collaboration with physical examination and imaging studies (triple approach), FNAC is a highly sensitive diagnostic tool. Adopting a universally acceptable standardized reporting system for breast cytology can enhance the diagnostic accuracy of FNAC.
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http://dx.doi.org/10.3233/BD-190393DOI Listing
March 2020

Medullary carcinoma of thyroid mimicking Hurthle cell neoplasm on cytology: a diagnostic dilemma.

Diagn Cytopathol 2019 Sep 13;47(9):943-947. Epub 2019 Jun 13.

Department of Pathology and ENT, ESIC Medical College & Hospital, Faridabad, Haryana, India.

Medullary carcinoma of thyroid (MCT) is a neuroendocrine neoplasm derived from the parafollicular cells or C cells. It constitutes 5% of thyroid carcinomas. We present a case of 36-year-old female with a left lower lobe thyroid swelling since 8 to 9 years. Swelling was smooth, nontender, and moving with deglutition. Contrast-enhanced computed tomography (CECT) findings were suggestive of malignant thyroid nodule. Fine-needle aspiration cytology (FNAC) smears were highly cellular comprising predominantly Hurthle cells arranged in sheets, clusters, and follicles with few singly scattered cells. Background was hemorrhagic with scant colloids. An impression of follicular neoplasm or suspicious of follicular neoplasm was given with an additional note mentioning that the possibility of Hurthle cell neoplasm could not be excluded. Left hemithyroidectomy was done and sections showed a well-circumscribed tumor suggestive of MCT, which was confirmed based on immunohistochemistry for calcitonin and carcinoembryonic antigen. It is difficult to differentiate MCT from Hurthle cell neoplasm. There may be cellular pleomorphism within a single aspirate, but the presence of mixed cell population is a diagnostic pointer for MCT. In the presence of predominant Hurthle cell population, distinguishing these entities by cytomorphology alone is difficult. Hence, clinical findings and histopathology with immunohistochemistry are mandatory in such cases to reach to a correct diagnosis to ensure proper management.
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http://dx.doi.org/10.1002/dc.24220DOI Listing
September 2019

A correlation between platelet indices and preeclampsia.

Hematol Transfus Cell Ther 2019 Apr - Jun;41(2):129-133. Epub 2018 Dec 31.

Employees State Insurance Corporation Medical College, Faridabad, Haryana, India.

Background: Preeclampsia is one of the major health problems causing maternal morbidity and mortality, complicating 3-8% of pregnancies. It has been suggested that the alterations in the coagulation and fibrinolysis play a role in the pathogenesis of preeclampsia. The markers of platelet activation include platelet count, platelet distribution width, mean platelet volume and plateletcrit.

Study Design: It was a case-controlled study which included a total of 60 patients (30 cases and 30 controls). Blood samples were collected and the platelet indices - platelet count, plateletcrit, mean platelet volume and platelet distribution width - were evaluated using the Sysmex XN1000 and compared between the two groups.

Results: The MPV and PDW also showed a significant difference (p>0.05) between the two groups, with a significant positive correlation with increasing blood pressure (MPV - r=+0.6126, p<0.05 and PDW - r=+0.6441, p<0.05). The PC and PCT had lower values in the preeclampsia patients, however the difference between the two groups was not statistically significant.

Conclusion: The MPV and PDW showed a significant difference between the two groups and increasing values with increasing BP. However, the PC and PCT in our study did not show a significant correlation with preeclampsia. Thus, the platelet indices, mainly the MPV and PDW, which are economical and easily available, can be reliable in the prediction and early diagnosis of preeclampsia, as well as a marker for the severity of preeclampsia.
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http://dx.doi.org/10.1016/j.htct.2018.08.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6517612PMC
December 2018

Association of coagulation profile with microvascular complications and glycemic control in type 2 diabetes mellitus - a study at a tertiary care center in Delhi.

Hematol Transfus Cell Ther 2019 Jan-Mar;41(1):31-36. Epub 2018 Jun 11.

Department of Community medicine, Employees State Insurance Corporation (ESIC) Medical College, Faridabad, Haryana, India.

Introduction: Type 2 diabetes mellitus, characterized by insulin resistance, corresponds to approximately 90% of cases of diabetes worldwide. Hyperglycemia in diabetes contributes to hyperfibrinogenemia and activates the coagulation cascade thereby producing atherothrombotic events.

Objectives: This study was designed to evaluate the coagulation profile (activated partial thromboplastin time, prothrombin time and fibrinogen) in Type 2 diabetes and to analyze correlations between body mass index, fasting blood glucose, glycated hemoglobin and duration of diabetes with coagulation parameters.

Methods: This study included 60 type 2 diabetics and 30 controls. Diabetic patients were grouped in two sets based on the presence or absence of microvascular complications. The demographic profile and clinical details were recorded. Fasting blood glucose, glycated hemoglobin, coagulation parameters such as prothrombin time, activated partial thromboplastin time and fibrinogen along with other biochemical parameters were investigated.

Results: There were statistically significant differences in the coagulation parameters between the two groups of diabetics (with and without complications). The present study also found significant correlations between age and the duration of diabetes with and without complications and coagulation parameters such as the activated partial thromboplastin time, which was found to be significantly lower, and fibrinogen, which was found to be significantly higher in subjects with complications compared to subjects without complications.

Conclusion: Clinical tests for prothrombin time, activated partial thromboplastin time and fibrinogen are relatively inexpensive and readily available. The present study shows that shortened prothrombin time, activated partial thromboplastin time and increased fibrinogen levels might be useful hemostatic markers in diabetic patients, especially in those at high-risk for thrombotic complications.
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http://dx.doi.org/10.1016/j.htct.2018.05.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6371197PMC
June 2018

Masood's and Modified Masood's Scoring Index: An Evaluation of Fine Needle Aspiration Cytology of Breast Lesions with Histopathological Correlation.

Acta Cytol 2019 13;63(3):233-239. Epub 2019 Feb 13.

Department of Pathology, ESIC Medical College, Faridabad, India.

Objective: As fine needle aspiration cytology (FNAC) is the primary tool for evaluation of breast lesions, it is essential to segregate lesions with low and high risk of malignancy. To address this, Masood proposed a cytological scoring system for categorization, Masood's Scoring Index (MSI), which was modified later (Modified Masood's Scoring Index [MMSI]). This study analyses the effectiveness of MMSI over MSI and assesses the concordance between cytological scoring and histopathology.

Study Design: All breast FNACs over a period of 2 years were categorized based on MSI and MMSI by 2 reviewers independently. The agreement rate along with specificity, sensitivity, positive predictive value, negative predictive value and diagnostic accuracy were calculated. Correlation and concordance analyses between cytological and histopathological categories were conducted.

Results And Discussion: Out of 415 cases of breast FNACs, histopathology was available for 310 for which MSI and MMSI were evaluated. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy were 95, 100, 100, 97.6 and 98.3%, respectively. The difference between the concordance rate of MSI and of MMSI for various cytological categories was found to be statistically significant.

Conclusion: MMSI has a better concordance with histopathological diagnosis than MSI. MMSI can serve as a uniform standardized scoring system for breast cytology for better categorization of proliferative breast diseases.
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http://dx.doi.org/10.1159/000496139DOI Listing
June 2019

Are all Granulomatous Mastitis Cases Tuberculous?: A Study on the Role of Cytology in Evaluation of Granulomatous Mastitis.

Turk Patoloji Derg 2019 ;35(2):128-133

Department of Pathology, ESIC Medical College and Hospital, NIT 3, FARIDABAD, INDIA.

Objective: Granulomatous mastitis is a rare inflammatory condition of the breast clinically mimicking breast carcinoma and pyogenic abscess, thereby creating a diagnostic dilemma. Tuberculous mastitis is a rare clinical entity accounting for approximately 3% of all mammary lesions. All cases of granulomatous mastitis diagnosed cytologically over a period of 3 years were evaluated to ascertain the cases with tuberculous etiology.

Material And Method: Fine needle aspiration cytology of the breast lump was performed and all the cytological parameters were evaluated. Wherever histopathology was available, the diagnosis was confirmed on Hematoxylin & Eosin stained sections and the Ziehl Neelsen (ZN) stain was applied.

Results: A total of 10 cases of granulomatous mastitis were diagnosed on cytology during the 3-year period. On cytological smears, four cases showed presence of ill-formed granulomas and one case had scattered epithelioid histiocytes; however, the rest of the cases had well-formed granulomas. Finally, four out of ten cases were labeled as tuberculous mastitis based on the ZN stain/Tuberculosis-Polymerase chain reaction (TB-PCR) and the other six cases were granulomatous mastitis.

Conclusion: Cytology plays a significant role in the diagnosis of granulomatous mastitis. This study re-emphasizes the role of the cytopathologist in the accurate and early diagnosis of these lesions so that unnecessary surgery can be avoided, and also highlights the fact that all granulomatous mastitis cases are not tuberculous.
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http://dx.doi.org/10.5146/tjpath.2018.01442DOI Listing
September 2019

A critical appraisal of the Milan system for reporting salivary gland cytology (MSRSGC) with histological correlation over a 3-year period: Indian scenario.

Diagn Cytopathol 2019 May 12;47(5):382-388. Epub 2018 Nov 12.

Department of Pathology, ESIC Medical College, Faridabad, Haryana, India.

Background: Fine needle aspiration cytology (FNAC) is the first line investigation for pre-operative diagnosis of salivary gland lesions, but due to its inherent limitations remains a challenge for the cytopathologists. The recently proposed international risk stratification scheme, the Milan System for Reporting Salivary Gland Cytology (MSRSGC) aims to promote and standardise the communication between cytopathologist and clinician thereby improving patient care.

Methods: A retrospective study of all salivary gland cytology cases was performed over a 3-year period, reviewed by pathologists and categorised into 1 of the 6 diagnostic categories according to MSRSGC, namely, non-diagnostic, non-neoplastic, atypia of undetermined significance (AUS), benign neoplasm, and salivary gland neoplasm of undetermined significance (SUMP), suspicious for malignancy (SFM), and malignant neoplasm. Cyto- histological correlation was done wherever possible. Risk of malignancy (ROM) was calculated for each diagnostic category.

Results: Out of a total of 150 salivary FNAC cases, histopathology was available for 64 cases. The sensitivity of FNAC was 81.8%, specificity was 100% while the diagnostic accuracy was 96.9%. The positive and negative predictive values were 100% and 96.4% respectively. The ROM for non-diagnostic, non-neoplastic, AUS, benign neoplasm, SUMP, SFM, and malignant categories were 0%, 10%, 50%, 2.5%, 50%, 100%, and 100% respectively.

Conclusion: MSRSGC fulfils the critical need for a uniform, internationally acceptable reporting system with ROM specified for each category. However, large scale multi centre studies need to be conducted before its reliability and validity is proven.
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http://dx.doi.org/10.1002/dc.24109DOI Listing
May 2019

Encapsulated Follicular Variant of Papillary Thyroid Carcinoma Arising in a Follicular Adenoma: a Diagnostic Dilemma.

Indian J Surg Oncol 2018 Sep 13;9(3):414-417. Epub 2018 Aug 13.

2Department of ENT, ESIC Medical College, Faridabad, Haryana India.

Papillary thyroid carcinoma (PTC) arising within follicular adenoma is a rare histological subset of papillary carcinoma. A 24-year-old female (euthyroid and asymptomatic) presented with a solitary mass in the right lobe of thyroid for 2 years. Fine-needle aspiration cytology (FNAC) suggested features of hyperplasia of thyroid. Hemithyroidectomy was performed. Histopathological examination revealed two distinct areas and was reported as encapsulated variant of papillary carcinoma along with follicular adenoma. Papillary carcinoma was confirmed by positive immunohistochemistry for HBME-1. CT head and neck region ruled out metastasis and the patient was kept on follow-up. There have been reports of medullary and papillary carcinomas occurring together; however, there is a paucity of literature on co-existing follicular neoplasm and papillary carcinoma. We hereby report a rare case of follicular variant of papillary carcinoma arising within follicular adenoma of the thyroid.
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http://dx.doi.org/10.1007/s13193-018-0801-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6154354PMC
September 2018

Malignant Spindle Cell Tumor Breast-a Diagnostic Dilemma.

Indian J Surg Oncol 2018 Sep 16;9(3):387-390. Epub 2018 Apr 16.

3Department of Pathology, ESIC Medical College, Faridabad, Haryana India.

Primary malignant spindle cell tumors are rare constituting 1.0% of breast malignancies. Spindle cell lesions occurring in soft tissues can occur in breast with overlapping morphologies. It can present as benign lesion and have inconclusive cytological findings, so easily missed if not properly dealt with. Stromal sarcoma should be diagnosed only after thorough sectioning and negative staining for p63, broad spectrum, and high molecular weight keratin. We present a case of right breast lump. Cytological features revealed fibro histiocytic lesion. There were no areas of necrosis, hemorrhage, or calcification. Histopathologically, it showed partially encapsulated tumor with cells arranged in sheets, composed of oval to epithelioid cells with spindling at places with moderate pleomorphism (mitotic activity 6-7/10 hpf). Differential diagnosis of primary stromal sarcoma, metaplastic sarcoma, and phyllodes was made. Immunohistochemistry revealed vimentin positivity with focal positivity of S-100. Desmin, cytokeratin and smooth muscle actin, p63, ER, PR, and Her2-neu were negative. A final diagnosis of primary breast sarcoma of neural origin was established with the help of histopathology and immunohistochemistry. To conclude, it is of utmost importance to identify primary stromal sarcomas as they are known to spread very rapidly and have a poor prognosis.
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http://dx.doi.org/10.1007/s13193-018-0750-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6154355PMC
September 2018

Small-Cell Neuroendocrine Carcinoma of the Cervix Masquerading as a Cervical Fibroid: Report of a rare entity.

Sultan Qaboos Univ Med J 2018 Feb 4;18(1):e100-e103. Epub 2018 Apr 4.

Department of Obstetrics & Gynaecology, Employees State Insurance Corporation Medical College & Hospital, Faridabad, Haryana, India.

Primary neuroendocrine tumours of the cervix are extremely rare, with an incidence of only 0.5-1%; as such, these entities can present a clinical and diagnostic challenge. Small-cell neuroendocrine carcinomas of the cervix are highly aggressive tumours that have a tendency to metastasise. We report a 44-year-old woman who presented to the Gynaecology Clinic of the Employees State Insurance Corporation Medical College & Hospital, Faridabad, India, in 2016 with . Based on a clinical examination, she was provisionally diagnosed with a cervical fibroid. However, a biopsy revealed features of a small-cell neuroendocrine carcinoma of the cervix which was subsequently confirmed via immunohistochemistry. An accurate diagnosis of a neuroendocrine carcinoma is vital as it forms the basis for treatment decisions as well as informing predictions for long-term survival.
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http://dx.doi.org/10.18295/squmj.2018.18.01.017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5892798PMC
February 2018

Solitary nodular lesion on forehead in a 56-year-old woman.

Indian J Dermatol Venereol Leprol 2019 Sep-Oct;85(5):555-558

Department of Pathology, ESIC Medical College, Faridabad, Haryana, India.

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http://dx.doi.org/10.4103/ijdvl.IJDVL_1141_16DOI Listing
February 2020

Intramuscular Hibernoma of the Scapular Region Misdiagnosed on Cytology as a Malignant Lesion: A Report of a Rare Case.

Iran J Pathol 2017 1;12(4):406-409. Epub 2017 Oct 1.

Department of Oncosurgery, RJSP Cancer Hospital, Ranchi, India.

Hibernomas are extremely rare benign tumors of adipose tissue characterized by an admixture of brown fat cells with granular, multivacuolated cytoplasm and white fat cells. Hibernomas account for 1.6% of benign adipose tissue tumors and approximately 1.1% of all adipocytic tumors. Around 10% of these cases are intramuscular. It was initially described in the early 1900s as being composed of brown fat. Hibernomas usually occur in third to fourth decades of life and the most frequent sites being thigh, trunk, shoulder, back etc. Cytological differential diagnoses of hibernoma include well differentiated liposarcoma, myxoid/round cell liposarcoma, chondroid lipoma and benign granular cell tumor. Due to its abundant vascularity evident on angiography, it can sometimes mimic a malignant lesion, from which it needs to be distinguished as complete surgical excision is the only treatment required for a hibernoma. Moreover, it has no malignant or metastatic potential. We presented a rare case of intramuscular hibernoma of the scapular region in a 34-year-old male, in which cytology was reported as pleomorphic fibrolipomatous malignant lesion.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5844688PMC
October 2017

Correlation of Hormone Receptor and Human Epidermal Growth Factor Receptor-2/neu Expression in Breast Cancer with Various Clinicopathologic Factors.

Indian J Med Paediatr Oncol 2017 Oct-Dec;38(4):483-489

Department of Pathology, King George's Medical University, Lucknow, Uttar Pradesh, India.

Background: A significant development in the breast carcinoma management is the correlation between the presence of hormone receptors in the tumor and response to hormonal therapy and chemotherapy. Human epidermal growth factor receptor-2/neu (Her-2/neu) overexpression also serves as a very useful parameter to predict response to herceptin.

Aim Of Study: The study was conducted to correlate immunohistochemical expression of markers such as estrogen receptor (ER), progesterone receptor (PR), and Her-2/neu with various clinicopathologic parameters.

Materials And Methods: The study included 509 cases of breast carcinoma over a period of 5 years (from May 2009 to May 2014). Immunohistochemistry (IHC) for ER, PR, and her-2/neu was performed.

Results: ER positivity was observed in 42.8% (218/509) cases, PR positivity in 31.8% (194/509) cases whereas her-2 neu positivity was seen in 40.7% (203/509) cases. Triple marker (ER, PR, and Her-2/neu) negative cases were 23.6% (120/509) cases. ER and PR expression was found to have a statistically significant correlation with tumor grade. Statistically significant correlation was observed between tumor size and tumor grade and her-2/neu expression. Her-2/neu expression showed statistically significant association with tumor stage. As the tumor grade increased, the proportion of triple-negative cases went on increasing, which was statistically significant.

Conclusion: IHC has an increasingly important prognostic role in determination of factors that affect clinicopathologic features. Nevertheless, the results of this large series showed different patterns of findings with respect to clinicopathologic features.
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http://dx.doi.org/10.4103/ijmpo.ijmpo_98_16DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5759069PMC
January 2018

Scar Endometriosis with Rudimentary Horn: An Unusual and Elucidative Report of a Case Diagnosed on Histopathology and Immunohistochemistry.

J Midlife Health 2017 Oct-Dec;8(4):196-199

Department of Obstetrics and Gynecology, ESIC Medical College and Hospital, Faridabad, Haryana, India.

Endometriosis is defined as the presence of functioning endometrial tissue outside the endometrial cavity. Scar endometriosis, also known as spontaneous abdominal wall endometriosis, is an unusual clinical presentation which often goes unnoticed. It usually develops after pelvic operations. The incidence has been estimated to be only 0.03%-0.15% of all cases of endometriosis. It can be either asymptomatic or present as abdominal wall pain at the site of surgical incision. It is most commonly diagnosed clinically or on ultrasonography. The treatment of choice predominantly remains surgical excision. We present a case of a 24-year-old female (known case of bicornuate uterus) who presented with chief complaints of abdominal pain for 1 month and 6 months after metroplasty. The patient was clinically diagnosed as a case of scar endometriosis with rudimentary horn and fistulous tract and taken up for surgery. Both the scar tissue and fistulous tract were removed and histopathology revealed only endometrial glands without stroma or hemosiderin-laden macrophages. Diagnosis of scar endometriosis was established on positive immunohistochemistry for estrogen and progesterone receptor in endometrial glands. Timely diagnosis and surgical excision of scar endometriosis along with close follow-up are necessary to prevent complications and recurrence.
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http://dx.doi.org/10.4103/jmh.JMH_69_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5753504PMC
January 2018

Isolated lingual cysticercosis: A rare case diagnosed on cytology.

Diagn Cytopathol 2018 Mar 10;46(3):277-279. Epub 2017 Oct 10.

Hamdard Institute of Medical Sciences and Research (HIMSR), New Delhi, India.

Cysticercosis is caused by larval stage of Taenia solium called cysticercus cellulosae. Cysticercosis most commonly infects skeletal muscles, subcutaneous tissues, brain and ocular tissue. On extensive search of literature, only around 64 cases of lingual cysticercosis have been reported till date. We report a case of cysticercosis of tongue in a 35-year-old male who presented with a painless, slowly growing swelling over the lateral border of tongue. Fine needle aspiration cytology revealed wavy integument of cysticercus cellulosae alongwith inflammatory cells. The findings were confirmed on histopathology. No other cystic swelling was encountered in the body on retrospective examination and investigations. This case is being presented on account of its rarity as well as the utility of FNAC as a primary diagnostic technique in evaluation of parasitic lesions.
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http://dx.doi.org/10.1002/dc.23828DOI Listing
March 2018

Apocrine carcinoma of breast: A rare entity posing cytological challenge.

Diagn Cytopathol 2017 Dec 21;45(12):1156-1158. Epub 2017 Sep 21.

Department of Surgery, ESIC Medical College, Faridabad, Haryana, India.

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http://dx.doi.org/10.1002/dc.23819DOI Listing
December 2017

Unusual Histology in Hodgkin's Lymphoma: Report of an Interesting Case.

Indian J Surg Oncol 2017 Jun 9;8(2):181-184. Epub 2016 Dec 9.

Hamdard Institute of Medical Sciences and Research (HIMSR), New Delhi, India.

Hodgkin's lymphoma has a significant presence in the Indian subcontinent. Microscopically, the hallmark of Hodgkin's lymphoma (HL) is the Hodgkin and Reed-Sternberg (HRS) cell, which is usually surrounded by a cellular infiltrate of non-malignant inflammatory cells that constitute the majority of the tumor tissue. Cells which are known to be histologic mimics of HRS cells include immunoblasts, plasmablasts and rarely dendritic cells. We report a case of a 70-year-old male who presented with fever and lymphadenopathy. In the present case, the large cells with prominent nucleoli stained positively for both CD15 and CD30 and hence the possibility of angioimmunoblastic lymphadenopathy which was considered on the H&E-stained sections was excluded. In addition, noteworthy microscopic features in this case were angiogenesis and the presence of mast cells, both associated with a poor prognosis. The clinical impression was that of disseminated tuberculosis, but on histopathology, the final opinion was 'Hodgkin's lymphoma not classifiable with an unusual histology'. The aim of reporting this case is to highlight the unusual presentation in the form of prominent angiogenesis and mast cell infiltration in a case of HL, which is indicative of a poor prognosis.
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http://dx.doi.org/10.1007/s13193-016-0602-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5427034PMC
June 2017

Coexistence of tuberculosis and malignancy: a mere coincidence or a causal association.

Trop Doct 2017 Apr 10;47(2):101-104. Epub 2016 Jul 10.

5 Assistant Professor, Department of Pathology, Hamdard Institute of Medical Sciences and Research (HIMSR), New Delhi, India.

Tuberculosis (TB) and malignancy are among the most important current global health problems. Many authors suggest that their coexistence is a chance association owing to their high prevalence. There is, however, enough evidence that one condition may predispose the other. In our retrospective report of two cases, TB in draining lymph nodes was discovered incidentally on histopathology, following surgical resection for malignancy. The possibility of coexistent lesions, especially in regions endemic for TB, mandate a detailed histopathological examination to prevent the chances of diagnostic failure and thus therapeutic error.
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http://dx.doi.org/10.1177/0049475516652316DOI Listing
April 2017

Carcinoma ex pleomorphic adenoma: A diagnostic challenge on cytology.

Diagn Cytopathol 2017 Jul 6;45(7):651-654. Epub 2017 Mar 6.

Department of Pathology, ESIC Medical College, Faridabad, Haryana, India.

Carcinoma ex pleomorphic adenoma (Ca ex PA) is a malignant neoplasm arising from primary or recurrent benign pleomorphic adenoma. It is rare with an annual incidence rate of 0.17 tumors per million. Histopathology remains the gold standard for the diagnosis of Ca ex PA, with only a handful of cases reported on cytology. In our case a 66-year-old male presented with the right parotid mass for 5 years rapidly increasing for the last 3 months. Fine needle aspiration cytology (FNAC) smears showed malignant tumor cells in clusters along with benign myoepithelial cells in chondromyxoid background. Histopathologically, highly pleomorphic malignant epithelial cells in sheets along with foci of comedonecrosis and areas corresponding to benign pleomorphic adenoma were observed on careful scrutiny. Immunohistochemistry revealed positivity for cytokeratin (CK 7) and gross cystic disease fluid protein 15 (GCDFP-15) while CK5/6 and high molecular weight CK (34 βE12) were negative in the malignant tumor cells. So, the final impression was Ca ex PA with salivary duct carcinoma as malignant component. We hereby report this case to highlight the significance of FNAC in the diagnosis of Ca ex PA which can be easily missed on cytopathology. However, it is important to corroborate the cytological findings with clinical suspicion of malignancy as well as radiology. Diagn. Cytopathol. 2017;45:651-654. © 2017 Wiley Periodicals, Inc.
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http://dx.doi.org/10.1002/dc.23704DOI Listing
July 2017

Laryngeal actinomycosis with dysplasia in a young male with a recurrent laryngeal polyp.

Trop Doct 2017 04 8;47(2):183-185. Epub 2017 Feb 8.

4 Assistant Professor, Dept of Otorhinolaryngology, Hamdard Institute of Medical Sciences and Research (HIMSR), New Delhi, India.

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http://dx.doi.org/10.1177/0049475516688161DOI Listing
April 2017

Tuberculosis 'The Great Imitator': A usual disease with unusual presentations.

Indian J Tuberc 2017 01 4;64(1):54-59. Epub 2016 Jul 4.

Lecturer, Dept. of Pathology, Hamdard Institute of Medical Sciences and Research, Jamia Hamdard, New Delhi, India.

Background: A number of infectious diseases have been referred to by the phrase 'The Great Imitator', of which the oldest is syphilis; others include Lyme disease, nocardiosis, etc. Tuberculosis has been described as the second great imitator as it can imitate various other disease processes. An awareness of the atypical clinical manifestations of tuberculosis is important, especially in regions where tuberculosis continues to be a major public health problem, such as India. Extrapulmonary tuberculosis (EPTB) constitutes about 15-20% of all cases of tuberculosis in immunocompetent patients and accounts for more than 50% of the cases in human immunodeficiency virus (HIV)-positive individuals.

Methods: We hereby report 4 cases of tuberculosis at unusual sites, which were not suspected clinically and were subsequently diagnosed by pathological examination and by ancillary techniques.

Observations And Results: In all the four cases, the involvement was extrapulmonary in nature and at unusual sites. Three cases were diagnosed by a positive Ziehl Neelsen stain while culture for Mycobacterium tuberculosis was positive in three cases. All the four patients tested negative for HIV status on serology.

Conclusions And Implications: Unusual presentations, which mimic many diverse conditions, as seen in this series, highlight the importance of a high index of suspicion in the timely diagnosis of tuberculosis. Evidence of systemic or lung involvement may not always be present and laboratory and radiological findings play an important role.
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http://dx.doi.org/10.1016/j.ijtb.2016.01.001DOI Listing
January 2017

Primary Nasal Tuberculosis: Resurgence or Coincidence - A Report of Four Cases with Review of Literature.

J Lab Physicians 2017 Jan-Mar;9(1):26-30

Department of Pathology, Hamdard Institute of Medical Sciences and Research, Jamia Hamdard, New Delhi, India.

Background: Primary nasal tuberculosis (TB) is a rare form of TB even in areas with high TB incidence. It is timely diagnosis and proper management are often delayed due to its rarity and nonspecific clinical presentation.

Aim: The aim of the study was to review histopathologically diagnosed cases of nasal TB over a period of 1 year and to describe its clinical presentation, diagnostic workup, the importance of histopathological diagnosis along with a brief review of the literature.

Materials And Methods: This was a retrospective study done in the Department of Pathology of a Tertiary Care Hospital of Delhi over a period of 1 year where all the cases with histopathological diagnosis of nasal TB were reviewed. Patients' clinical details, investigations and treatment details along with follow-up were obtained from the medical records section. For each case, routine hematoxylin and eosin stain were studied along with Ziehl-Neelson staining.

Results: A total of four patients were diagnosed with nasal TB histopathologically. Patients' age ranged from 5 to 34 with an equal male to female ratio. All patients were immunocompetent. Primary nasal TB was seen in all of the four cases. None of the cases, it was clinically suspected, and histopathology was the mainstay of diagnosis. All the cases were treated with antituberculous treatment and showed considerable improvement.

Conclusions: Although nasal TB is rare, it should be considered in the differential diagnosis of chronic nasal symptoms and granulomatous lesions of the nose. Histopathology plays an important role in the diagnosis of these clinically unsuspecting cases of nasal TB.
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http://dx.doi.org/10.4103/0974-2727.187921DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5015494PMC
January 2017

Expression of Human Epidermal Growth Factor Receptor (Her 2/neu) and Proliferative Marker Ki-67: Association with Clinicopathological Parameters in Gallbladder Carcinoma.

Asian Pac J Cancer Prev 2016 ;17(8):3903-9

Pathology, ESIC Medical College, Faridabad, Haryana (Previously, Hamdard Institute of Medical Sciences and Research), New Delhi, India E-mail :

Purpose: To evaluate the expression of Her2/neu and Ki-67 in benign and malignant gallbladder lesions, and to establish correlations with clinico-pathologic parameters.

Materials And Methods: A retrospective analysis was conducted on formalin fixed paraffin embedded (FFPE) benign (n=25) and malignant gallbladder (n=25) tissue samples. Hematoxylin and eosin stained slides of each case were reviewed for: type of malignancy (whether adenocarcinoma, squamous cell carcinoma, or any other type); grade (well, moderate, and poor); depth of invasion; and pre-neoplastic changes in adjacent mucosal epithelium like metaplasia and dysplasia. Immunohistochemistry for Her 2 neu and Ki-67 was performed and data analysis was conducted using SPSS 17 software. Chi-square test was used to compare categorical/dichotomous variables. A P value of ≤0.05 was considered significant.

Results: The difference of Her 2 neu expression and Ki67 index between benign and malignant groups was found to be statistically significant. Her2/neu positivity did not have any significant correlation with various clinicopathological parameters other than liver involvement. Five cases of gallbladder cancer showed both Her2/neu and Ki67 positivity. Ten cases were Ki67 positive but Her2/neu negative while one case was Her2/neu positive but Ki67 negative.

Conclusions: The present study demonstrated overexpression of Her2/neu and Ki67 in gallbladder cancer. A trend of decreasing Her2/neu expression with increasing grade of tumor was observed. Furthermore, greater Ki67 positivity was found in cases with lymph node metastasis and distant metastasis. Future studies with a larger number of patients will be required to precisely define the correlation of Her2/neu expression and Ki67 positivity with clinicopathological parameters. The results however are encouraging and suggest evaluation of Her2/neu as a candidate for targeted therapy.
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February 2017