Publications by authors named "Neena Sood"

103 Publications

Primary Extranodal Non-Hodgkin Lymphomas: A First Tertiary Care Experience from Punjab, North India.

South Asian J Cancer 2020 Oct 14;9(4):230-232. Epub 2021 Jun 14.

Department of Pathology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.

 Primary extranodal lymphomas are less frequently encountered and difficult to diagnose in routine practice. The histopathological and immunohistochemical studies are essential in addition to clinical details to diagnose. The incidence is varied in different parts of India along with variation in histopathological spectrum.  The clinical features and histopathological findings of patients diagnosed with primary extranodal lymphoma over 3-year period were retrieved from archives of pathology department and analyzed.  During the 3-year study period, a total of 135 cases of non-Hodgkin lymphomas were evaluated, and of these, 41.4% (56/135) of cases presented with primary extranodal involvement. The mean age of primary extranodal lymphoma presentation was 61.3 ± 17.5 with M:F ratio of 1:1.1 Most common extranodal site involved was gastrointestinal tract 32.1%, 18/56 (small intestine [17.8%, 10 cases] and large intestine [8.9%, 5 cases]). Non-Hodgkin lymphomas of B cell type were the predominant subtype (48/56, 85.7%), while 8/56 (14.2%) cases were of T cell lineage. Of the B cell non-Hodgkin lymphoma diffuse, large B cell lymphoma was the predominant subtype constituting ~83.3% (40/48).  Primary extranodal lymphomas exhibit varied histomorphological and clinical presentation. The present study is first such analysis from Punjab that intends to compare with studies from other parts of India.
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http://dx.doi.org/10.1055/s-0041-1723073DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8203326PMC
October 2020

Diagnostic utility of multiple site duodenal biopsies in celiac disease.

Indian J Pathol Microbiol 2021 Jun;64(Supplement):S73-S77

Department of Gastroentrology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.

Background: Celiac Disease involves the small intestine patchily affecting more frequently the proximal small bowel but the histological changes have been observed till terminal ileum. Of late in addition to D2, the duodenal bulb (D1 region) biopsies have been found helpful in identifying a small group of patients with CD. Therefore, multiple site biopsies are recommended as histological changes are not uniform throughout small intestine.

Methods: During this present 1.5 years prospective study, we evaluated 84 cases of suspected celiac disease with respect to the light microscopy (D1, D2, and D3 biopsy) and serology (anti tTg and or EMA). Histological examination was done according to Modified Marsh grading system.

Results: Out of 84 cases with raised anti tTg, the segmental biopsies significantly increased the diagnostic accuracy from 39/44 cases (88.6%) to 43/44 cases (97.7%) and 44/44 cases (100%) when D2 alone, D1 + D2 and D1 + D2 + D3 biopsies were evaluated, respectively. Of the suspected cases of celiac disease patients (tTg > 10 ULN and associated weight loss, diarrhea), additional D3 biopsy increased the diagnostic yield by 2.1%, compared to D1, D2 region biopsy and 6.38% compared to standard D2 biopsy alone. Of the 28 cases (tTg > 10 times ULN + EMA positive and associated weight loss, diarrhea), the potential celiac disease (histologically Type 1/Normal) cases reduced from 28.5% (standard D2 region alone) to 21.4% and 17.8% when additional biopsies were taken from D1 region and D3 region, respectively, and additional D3 biopsy increased the diagnostic yield by 10.8% (compared to standard D2 biopsy alone) and 3.7% (compared to D1 and D2 biopsy).

Conclusion: We believe multiple sites duodenal biopsies including D3 region biopsies might increase the diagnostic accuracy of adult celiac disease in addition to sensitive and specific serologic tests.
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http://dx.doi.org/10.4103/IJPM.IJPM_797_20DOI Listing
June 2021

Lymphophagocytosis in Pleural and Pericardial Fluids: An Ominous Finding.

J Lab Physicians 2021 Mar 19;13(1):95-96. Epub 2021 May 19.

Department of Pathology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.

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http://dx.doi.org/10.1055/s-0041-1727582DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8154341PMC
March 2021

A Clinicopathological Study of Skin Tumors from a Tertiary Care Centre in North India.

Indian Dermatol Online J 2021 Jan-Feb;12(1):66-71. Epub 2021 Jan 16.

Department of Pathology, DMCH, Ludhiana, Punjab, India.

Background: There is a huge spectrum of skin tumors which can be confused clinically with malignancies, particularly when they are pigmented or inflamed, and histopathological examination of a biopsy specimen is required to establish a definitive diagnosis and to facilitate appropriate intervention and follow up.

Aim: To evaluate all skin tumors and categorize them according to their origin.

Methods: The present study was conducted over a period of 4 years (July 1, 2013 to June 31, 2017) comprising of 1.5 years prospective and 2.5 years retrospective analysis in the departments of Dermatology and Pathology, at a tertiary hospital in North India. All specimens of skin tumors were analyzed grossly and microscopically. Immunohistochemistry was done wherever possible.

Results: A total of 232 skin tumors were seen; of which 123 cases were benign (53.0%) and 109 cases were malignant (47.0%). The mean age of patients with benign and malignant skin tumors was 40.3 ± 19.9 and 60.8 ± 14.8 years, respectively. The most common site was face ( = 106; 45.7%) followed by limbs ( = 44; 19.0%). The male:female ratio of benign and malignant tumors was 1.01:1 and 1.31:1, respectively. Among the benign tumors, keratinocytic tumors were the commonest ( = 57; 46.3%) followed by the melanocytic tumors ( = 37; 30.1%) and appendageal tumors ( = 29; 23.6%). The most common malignant skin tumors were the keratinocytic tumors ( = 87; 79.8%) followed by 12 cases (11%) of hematolymphoid tumors and five cases (4.6%) each of melanocytic and appendageal tumors.

Limitations: The lack of clinical and dermatoscopic correlation and inclusion of retrospective data are the limitations of this study.

Conclusions: Skin tumors affect people of all ages. The benign tumors are seen in the younger age group as compared to malignant tumors. Face is the most common site and keratinocytic tumors are the most common skin tumors in both benign and malignant categories.
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http://dx.doi.org/10.4103/idoj.IDOJ_257_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7982036PMC
January 2021

Clinical and Molecular Attributes of Patients With BCR/ABL1-negative Myeloproliferative Neoplasms in India: Real-world Data and Challenges.

Clin Lymphoma Myeloma Leuk 2021 Jun 23;21(6):e569-e578. Epub 2021 Feb 23.

Molecular Genetics, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.

Introduction: Classic BCR/ABL1-negative myeloproliferative neoplasms (MPNs) are characterized by clinical and genetic heterogeneity and include 4 distinct constituents. Very little data on clinical presentation and epidemiology of the same is available from the Indian setting.

Patients And Methods: Patients referred to Hematology-Oncology from January 2018 to August 2020 with suspected MPNs were included in the analysis and prospectively followed-up. All patients were initially screened, and only those meeting the updated World Health Organization 2016 criteria were included in the analysis. Epidemiologic, clinical, and molecular characteristics were documented, and patients were followed-up prospectively.

Results: A total of 233 patients were referred for evaluation of MPN, of which 63 were included in the analysis, including 39 males and 24 females. The median age at diagnosis was 57 years (range, 28-82 years), and 38% patients were younger than 50 years of age. The most common presentations were incidental detection in 35 (55.5%), abdominal symptoms in 13 (20%), fatiguability in 7 (11%), and recent vascular events in 6 (9.5%) patients. Final diagnosis was polycythemia vera in 27, essential thrombocytosis (ET) in 21, prefibrotic myelofibrosis in 9, and myelofibrosis in 6 patients. The frequency of driver mutations in polycythemia vera included JAK2 in 75%; in ET, JAK2 in 33%, CALR in 33%, and MPL in 4%; and in prefibrotic myelofibrosis, JAK2 in 66% and CALR in 33%. Aspirin was used for all patients along with risk-adapted cytoreduction with hydroxyurea. Ruxolitinib was reserved for symptoms refractory to hydroxyurea. After a median follow-up of 15 months (interquartile range, 10-28 months) from diagnosis, disease progression was noted in 4 patients. Two patients died at the end of the follow-up period, including 1 with secondary acute myeloid leukemia post myelofibrosis and one with ET and coexistent oral malignancy. The remaining 61 patients are alive and on regular treatment.

Results: This is one of the first systematic descriptions and prospective follow-up of patients with BCR/ABL-negative MPNs from India. Our study indicates a younger median age of presentation and higher proportion of JAK2-unmutated disease across all subtypes. The primary role of bone marrow morphology and supportive role of somatic mutations in differentiating MPN subtypes is indicated.

Conclusions: This study sets the stage for a collaborative registry for defining epidemiologic data and long-term outcomes with MPN in India.
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http://dx.doi.org/10.1016/j.clml.2021.01.017DOI Listing
June 2021

Comparative Analysis of Erythrocyte Sedimentation Rate Measured by Automated and Manual Methods in Anaemic Patients.

J Lab Physicians 2020 Dec 30;12(4):239-243. Epub 2020 Dec 30.

Department of Pathology, Dayanand Medical College & Hospital, Ludhiana, Punjab, India.

 Erythrocyte sedimentation rate (ESR) is a widely used indicator of inflammation and a routinely done hematology investigation to monitor patients of autoimmune and infectious diseases. We aimed to compare the ESR results obtained by Roller 20LC automated instrument and standard reference Westergren method and analyzed the effect of anemia (hematocrit) on ESR measurements through the automated method.  We analyzed 1377 random anemic OPD patients (hematocrit [HCT] < 35%) for ESR levels measured by Roller 20LC using EDTA blood and Westergren method using citrated blood for a one and half year period from January 1, 2018 to June 30, 2019. Fabry's formula was used to correct the Westergren ESR.  The total number of samples after evaluation were divided into low ( = 232), intermediate ( = 417), high ( = 406), and very high range of ESR (≥100 mm/hr; = 422). Mean difference between values of corrected and automated ESR for the low, intermediate, high and very high ESR range was 2.33 ± 5.03, 10.95 ± 8.04, 28.22 ± 19.11 and 43.3 ± 19.22 mm/hr, respectively. The 95% limit of agreement calculated by the Bland-Altmann analysis between the two methods for low-ESR range was -7.53 to 12.2 (highest correlation coefficient -0.65), while for very high ESR, range was -5.1 to 81.5 (least coefficient of 0.18) ( < 0.001).  In laboratories with high-sample load and where manual measurement may be tedious, the automated method of ESR measurement can safely replace the Westergren method for low-ESR values in patients with low hematocrit. While for high-ESR values, validation by the standard Westergren method may be needed.
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http://dx.doi.org/10.1055/s-0040-1721155DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7773442PMC
December 2020

An open-label randomised pilot trial on safety of wheat variety C273 in patients with adult celiac disease.

Therap Adv Gastroenterol 2020 18;13:1756284820944089. Epub 2020 Aug 18.

Department of Gastroenterology, Dayanand Medical College and Hospital, 6-E, Tagore Nagar, Civil Lines, Ludhiana, Punjab 141001, India.

Background: The only effective treatment for celiac disease (CeD) is gluten free diet (GFD). However, GFD is restrictive and efforts are being made to explore alternative therapies including safer wheat varieties. Wheat variety C273 has been previously identified to have reduced load of intact T-cell stimulatory epitopes and analysis.

Methods: Adult patients diagnosed with CeD and recovered on GFD were included in the study. Patients were randomised into two groups in a 2:1 ratio. Patients in group I had graded introduction of C273 wheat in diet, maintained for 24 weeks; in Group II, wheat was restricted with continuation of GFD. Clinical symptoms, serology [anti-tissue transglutaminase (anti-tTG), anti-endomysial antibody (anti-EMA)], circulating inflammatory biomarkers [intestinal fatty-acid binding protein (I-FABP), plasma citrulline, interferon-γ (IFN-γ)] and histology were evaluated periodically. Final evaluation was performed at week 28.

Results: A total of 15 patients were enrolled (Group I:  = 10, Group II:  = 5). All patients except two in Group I remained compliant. None of the remaining eight patients in group I developed symptoms. No significant changes in serology (anti-tTG, anti-EMA) and histology were observed between the two groups at 28 weeks ( > 0.05). Significant changes in plasma citrulline(29.87 ± 8.98 36.58 ± 3.09,  = 0.049) and IFN-γ (44.56 ± 9.74 33.50 ± 3.68;  = 0.031) were observed in Group I.

Conclusion: Consumption of C273 wheat did not result in development of symptoms or evident changes in serology and histology at 28 weeks. However, variations in circulating inflammatory markers were noted. Larger randomised trials are needed to corroborate these findings.

Clinical Trials Registry-india: CTRI/2018/06/014521.
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http://dx.doi.org/10.1177/1756284820944089DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7444119PMC
August 2020

Diagnostic role of fine needle aspiration cytology (FNAC) in the evaluation of gall bladder lesions: an institutional experience.

Diagn Cytopathol 2020 Nov 7;48(11):1081-1085. Epub 2020 Jun 7.

Department of Pathology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.

Background: Carcinoma of the gall bladder is the most common malignancy of the biliary tract. Ultrasonography guided Fine Needle Aspiration Cytology (FNAC) plays a crucial role in early detection of gall bladder (GB) lesions. Early diagnosis of GB lesions is a necessity in view of rising trend in GB carcinoma related mortality in India. The aim of this study is to determine the diagnostic accuracy of pre-operative ultrasonography guided FNAC in the diagnosis of GB masses.

Methods: This was a retrospective observational study performed at a tertiary care university hospital over a period of one and a half years. A total of 47 patients with clinico-radiological suspicion of GB malignancy were subjected to USG guided FNA. 20 of these patients underwent diagnostic Trucut biopsy in addition to FNA.

Results: Forty-one out of 47 patients analyzed were positive for malignancy with female preponderance; MF ratio of 0.6:1. There were 29 females (61.8%) and 18 males (38.2%) in the range of 34 to 85 years. Cytomorphology was inconclusive for malignancy in two patients and unsatisfactory in one case. Two were labeled as chronic cholecystitis and one as acute cholecystitis. Adenocarcinoma was the most common malignancy found in 36 patients (76.6%).

Conclusion: USG guided FNAC is a rapid, safe and successful diagnostic procedure with high sensitivity for diagnosis of GB lesions. In the present scenario of increasing incidence of GB malignancy, FNAC has proved to be a useful first choice of investigation in the detection of GB lesions.
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http://dx.doi.org/10.1002/dc.24517DOI Listing
November 2020

Morphology of COVID-19-affected cells in peripheral blood film.

BMJ Case Rep 2020 05 27;13(5). Epub 2020 May 27.

Department of Cardiology, Dayanand Medical College and Hospital, Ludhiana, India

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http://dx.doi.org/10.1136/bcr-2020-236117DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7276239PMC
May 2020

Synchronous high-grade bladder carcinoma associated with chronic lymphocytic leukemia: A rare entity in Indian literature.

J Cancer Res Ther 2020 Jan-Mar;16(1):180-182

Department of Pathology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.

B-cell chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL) is one of the common lymphoproliferative disorders with an increased risk of developing subsequent neoplasms of epithelial and mesenchymal origin. The decreased immunity and B-cell dysfunction in CLL probably accounts for this emergence of secondary malignancy. Breast, brain, skin and prostate tumors have been reported as usual coincident malignancies of CLL, while in occasional cases CLL may occur with malignancies of other solid organs, such as skin, lung, heart, and prostate. Synchronous CLL with urothelial carcinoma (UC) is an infrequent occurrence. We report this case because of its rarity in Indian literature and interesting hematological, immunophenotypic, histopathological, and cytopathological features of metastatic high-grade UC in a 61-year-old male with CLL.
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http://dx.doi.org/10.4103/jcrt.JCRT_642_16DOI Listing
October 2020

Pancreatic tuberculosis: A close mimicker of malignancy.

Turk J Gastroenterol 2019 11;30(11):1001-1003

Department of Pathology, Dayanand Medical College and Hospital, Ludhiana, India.

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http://dx.doi.org/10.5152/tjg.2019.18832DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6883992PMC
November 2019

Cerebrospinal fluid pleocytosis in immunocompromised patients: Can it be Cryptococcus.

Diagn Cytopathol 2020 Feb 12;48(2):164-168. Epub 2019 Nov 12.

Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh.

Cryptococcal meningitis commonly affects immunocompromised cases and can have varied presentation. In some instances, the presence of a plethora of inflammatory cells on cerebrospinal fluid (CSF) in an immunosuppressed patient can lead to further investigations, which unravel the presence of cryptococcal meningitis. The aim of this retrospective study was to analyze the spectrum of CSF findings of immunosuppressed patients who were diagnosed to have cryptococcal meningitis. Retrospective analysis of CSF cytospin slides exhibiting pleocytosis and belonging to immunocompromised patients was performed, and these cases were found to have cryptococcal meningitis. Out of 932 cases of CSF (January 2016-July 2017), 10 had pleocytosis and 5 of these 10 cases demonstrated spores of Cryptococcus. Male-to-female ratio was 1:1.5. All the patients were immunocompromised and had CSF leukocytosis. Lymphocytes and monocytes were present in all samples while only one case showed plasma cells. Spores of Cryptococcus were also noted in all the cases and highlighted on India Ink Preparation and Gomori Methenamine Silver stain. All the cases were positive for agglutination-based cryptococcal antigen assay, except one where the test was not done. All immunosuppressed patients having pleocytosis in CSF were found to have cryptococcal infection. Therefore, pleocytosis in CSF in any immunosuppressed patient should raise the suspicion of cryptococcal meningitis. The pathologist and the clinician need to be vigilant in such scenarios to rule out any opportunistic infection and investigate the patient thoroughly for any underlying immunosuppression.
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http://dx.doi.org/10.1002/dc.24340DOI Listing
February 2020

Jejunal stricture due to mucormycosis.

Trop Doct 2019 Oct 19;49(4):318-320. Epub 2019 Jul 19.

Professor, Department of Pathology, Dayanand Medical College & Hospital, Ludhiana, Punjab, India.

Mucormycosis is generally considered to be an acute, rapidly progressing, opportunistic fungal infection. Chronic manifestations are extremely rare. Mucormycosis affecting the jejunum is very rare and few cases have been reported. We report a case of mucormycosis causing jejunal stricture in an infant aged six months.
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http://dx.doi.org/10.1177/0049475519864250DOI Listing
October 2019

Feasibility of Masood's cytological index for screening breast lesions in low resource setting.

Breast J 2019 05 10;25(3):434-438. Epub 2019 Apr 10.

Department of Pathology, Dayanand Medical College & Hospital, Ludhiana, India.

Fine needle aspiration cytology has long been an accepted diagnostic modality in combination with physical examination and mammography to investigate breast lesions. In the present era, more proficient methods such as stereotactic mammographically guided breast biopsy is the preferred choice, however, in low resource setting, FNAC still remains the most cost effective and sampling modality to diagnose breast cancer. With the intention to evaluate the efficacy and limitations of FNAC in evaluation of breast lesions in low resource setting, we employed the Masood's cytological staging system to stratify the breast lesions and correlate them with histopathology wherever possible. All breast lesions aspirates were analyzed and classified according to the Masood's cytological scoring system and correlated with histopathological findings wherever adequate material was available. A total of 776 patients were studied of which 23 aspirates were unsatisfactory, 120 aspirates were categorized as inflammatory breast disease. Six hundred and thirty-three cases were classified according to Masood's cytological system. Nonproliferative breast diseases (Group I) encompassed maximum cases with 55% followed by carcinoma in situ and invasive cancers (Group IV) with 39% and proliferative breast disease without atypia (Group II) and with atypia (Group III) which had equal number of cases constituting 2.4% each. Cyto-histopathological correlation done in 102 cases revealed 100% concordance in group IV and 75% concordance in group III while it could not be performed in Group I and II as no histopathological specimen was available in those patients. Masood Cytological grading for breast aspirates is a reliable and an easily reproducible system which can be used to formulate appropriate treatment protocols in cases presenting with breast lesions.
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http://dx.doi.org/10.1111/tbj.13239DOI Listing
May 2019

Variable Immunogenic Potential of Wheat: Prospective for Selection of Innocuous Varieties for Celiac Disease Patients via Approach.

Front Immunol 2019 4;10:84. Epub 2019 Feb 4.

Department of Gastroenterology, Dayanand Medical College, Ludhiana, India.

Celiac Disease (CD) is a multifactorial, autoimmune enteropathy activated by cereal proteins in genetically predisposed individuals carrying HLA DQ2/8 genes. A heterogenous gene combination of the cereal prolamins is documented in different wheat genotypes, which is suggestive of their variable immunogenic potential. In the current study, four wheat varieties (C591, C273, 9D, and K78) identified via analysis were analyzed for immunogenicity by measuring T-cell proliferation rate and levels of inflammatory cytokines (Interferon-γ and Tumor Necrosis Factor-α). Peripheral Blood Mononuclear Cells and biopsy derived T-cell lines isolated from four CD patients in complete remission and two controls were stimulated and cultured in the presence of tissue transglutaminase activated pepsin-trypsin (PT) digest of total gliadin extract from test varieties. The immunogenicity was compared with PBW 621, one of the widely cultivated wheat varieties. Phytohaemagglutinin-p was taken as positive control, along with unstimulated cells as negative control. Rate of cell proliferation (0.318, 0.482; 0.369, 0.337), concentration of IFN- γ (107.4, 99.2; 117.9, 99.7 pg/ml), and TNF- α (453.8, 514.2; 463.8, 514.2 pg/ml) was minimum in cultures supplemented with wheat antigen from C273, when compared with other test varieties and unstimulated cells. Significant difference in toxicity levels among different wheat genotypes to stimulate celiac mucosal T-cells and PBMC's was observed; where C273 manifested least immunogenic response amongst the test varieties analyzed.
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http://dx.doi.org/10.3389/fimmu.2019.00084DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6371638PMC
December 2019

Intraosseous ganglion of the distal tibia: Clinical, radiological, and histopathological highlights.

Indian J Pathol Microbiol 2019 Jan-Mar;62(1):183-184

Department of Pathology and Orthopaedics, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.

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http://dx.doi.org/10.4103/IJPM.IJPM_638_17DOI Listing
May 2019

Xanthogranulomatous Oophoritis: A Rare Case Report.

Iran J Pathol 2018 12;13(3):372-376. Epub 2018 Sep 12.

Dept. of Pathology, Dayanand Medical College and Hospital, Ludhiana, India.

Xanthogranulomatous oophoritis is an uncommon, non-neoplastic, chronic process in which the affected organ is destroyed by massive cellular infiltration of foamy histiocytes admixed with multinucleated giant cells, plasma cells, fibroblasts, neutrophils, and foci of necrosis. The etiology of this entity is unknown, but it shares histopathological findings similar to those of xanthogranulomatous change occurring in various organs, including the gallbladder and kidney. The current case was a 20-year-old female presenting with a tubo-ovarian mass with suspicion of malignancy on clinicoradiological findings and final diagnosis of xanthogranulomatous oophritis established on histopathology. Clinically and radiologically, xanthogranulomatous oophritis mimics tumor of the ovary and fallopian tube, thereby making it an important entity. A vigilant histopathological evaluation is important to diagnose the disease.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6322522PMC
September 2018

Student perception of peer teaching and learning in pathology: A qualitative analysis of modified seminars, fishbowls, and interactive classroom activities.

Indian J Pathol Microbiol 2018 Oct-Dec;61(4):537-544

Department of Social and Preventive Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.

Context: Peer-assisted teaching and learning (PTL) is being experimented in different medical universities worldwide. It is a learner-centered approach involving students through active learning strategies.

Aims: To study the student perception of PTL in methods such as group-led seminars and fishbowls, in classroom through various interactive activities; compare and find out the student acceptability and efficacy of each of these methods in learning conceptual topics such as various types of anemia.

Subjects And Methods: Medical students of second-year professional course were subjected to PTL in classroom during allotted teaching hours for 10 successive sessions using group-led modified seminars, fishbowls, and different formality-level interactive activities such as street plays, prop sessions, quiz sessions, to make them understand the clinical features and presentation of different types of anemia through understanding of etio-pathogenesis. To ascertain the aspects that influenced learning, focus group discussions were conducted in small groups consisting of 14 students and one facilitator in each group. Qualitative thematic analysis was performed on transcripts of the audio recordings by authors.

Results: The emerging themes from qualitative analysis of transcripts were pertaining to teacher, student, and organization. We found motivation, interest, and involvement of peer teacher, student behavior and collaboration, contact time between students and facilitator, preparation time, coherence with other curricular activities, group size and composition, suitability of topic for the kind of activity, and availability of material for preparation as few sub-aspects affecting learning.

Conclusion: For PTL to be effective, adequate transfer of knowledge through good peer teacher involvement, learner receptiveness, and adequate contact time is needed. Proper preparation with suitability of topics for the type of activity, alignment of seminars with other activities, and course coherence are prerequisites for the same.
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http://dx.doi.org/10.4103/IJPM.IJPM_297_17DOI Listing
February 2019

Hepatic fine-needle aspiration cytology: The role of rapid on-site evaluation in the assessment of hepatic lesions.

Turk J Gastroenterol 2018 07;29(4):442-447

Department of Pathology, Dayanand Medical College and Hospital, Punjab, India.

Background/aims: Radiologically guided fine-needle aspiration cytology (FNAC) of internal organs is not cost-effective. Rapid on-site evaluation (ROSE) of smears by a cytopathologist can improve the diagnostic yield of FNACs and save time and money by reducing the need for repeat procedure/biopsy. To determine the role of ROSE in the diagnostic outcome of hepatic lesions by comparative analysis of FNAC with and without ROSE by a cytopathologist.

Materials And Methods: Hepatic FNACs were retrospectively analyzed over two separate time periods from January 2011 to June 2013 and from January 2015 to July 2016. Smears from 2015-2016 were subjected to ROSE by a cytopathologist after staining with toluidine blue for 1 min to assess adequacy of the material. Final report was given after hematoxylin and eosin, May Grünwald Giemsa, and Papanicolaou staining were performed. Chi-square test (non-parametric) was used to determine if there was a statistically significant increase in the diagnostic yield with ROSE.

Results: During 2011-2013, of the 160 radiologically guided FNACs for hepatic lesions, 22 were non-diagnostic, whereas during 2015-2016, of 142 radiologically guided hepatic FNACs, only six were non-diagnostic. With the application of ROSE, there was a statistically significant increase in the diagnostic yield of hepatic FNACs from 86.25% to 95.8% (p=0.015).

Conclusion: ROSE performed by a cytopathologist using toluidine blue can increase the diagnostic yield of hepatic FNACs and reduce the cost of healthcare by eliminating the need for a repeat procedure.
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http://dx.doi.org/10.5152/tjg.2018.17466DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6284638PMC
July 2018

Coinfection of Sarcina ventriculi and Candida in a patient of gastric outlet obstruction: An overloaded pyloric antrum.

Diagn Cytopathol 2018 Oct 27;46(10):876-878. Epub 2018 Jul 27.

Department of Pathology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.

Sarcina ventriculi is a rare gram-positive, anaerobic bacteria, associated with delayed gastric emptying. We report a case of a 45-year-old lady, who presented with features of gastric outlet obstruction, and coinfection of S. ventriculi and Candida was detected on examining gastric brushings and biopsy. S. ventriculi is identified by its peculiar configuration in the form of tetrads and octets. Coexistence of S. ventriculi with other organisms is highly unusual.
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http://dx.doi.org/10.1002/dc.24048DOI Listing
October 2018

Beware of Bone Marrow: Incidental Detection and Primary Diagnosis of Solid Tumours in Bone Marrow Aspiration and Biopsies; A Study of 22 Cases.

Iran J Pathol 2018 ;13(1):78-84

Dept. of Pathology, Dayanand Medical College and Hospital, Tagore Nagar, Ludhiana, India.

Background & Objective: Introduction: First detection of any solid tumour as metastatic deposits in bone marrow directs clinicians to start searching for the primary tumour. Detection of bone marrow metastasis determines the stage of the malignancy, prognosis, mode of treatment, chemotherapeutic response and follow-up in case of relapse. The aim of the current study was to analyse the clinico-haematological presentation and morphological pattern of infiltration of solid tumours detected first as metastatic deposits on bone marrow examination.

Methods: Three-year retrospective analysis of MGG-stained bone marrow aspiration smears and touch imprints of the bone marrow biopsy and Hematoxylin and Eosin (H&E) stained histopathological sections of biopsies was performed at the Department of Pathology at a tertiary care institute (January 2014 to December 2016). The morphological pattern of metastatic deposits and haematological profiles of the patients were analysed. Exclusion criterion was the presence of hematolymphoid malignancies.

Results: In 22 cases, bone marrow was the first site of detection of metastasis. The age of the patients ranged from 3 years and 10 months to 82 years, with equal gender predilection. Overall, 16 cases had cytopenias, 9 cases each had leucocytosis and leukoerythroblastic presentation. The metastasis was from Ewing's sarcoma, prostate carcinoma, gastric adenocarcinoma invasive duct carcinoma breast, gallbladder carcinoma, lacrimal duct carcinoma and invasive papillary urothelial carcinoma.

Conclusions: Bone marrow examination is a cheap and reliable investigation to detect metastasis in an unsuspecting case. Bilateral trephine biopsies are recommended to increase the efficacy of detecting bone marrow metastasis.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5929392PMC
January 2018

: A surprising coexistence with adenocarcinoma - Never brush aside brushings for biopsy.

J Lab Physicians 2018 Apr-Jun;10(2):251-254

Department of Pathology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.

has been rarely reported as superadded infection over carcinomatous growth on rectal brushings. We present a case of 68-year-old male who presented with abdominal pain and bleeding per rectum who was found to have an ulceroproliferative growth on sigmoidoscopy. Rectal brushings revealed coexistence of with malignant cells of adenocarcinoma. No organism was detected on biopsy of the tumor, which also showed adenocarcinoma, because of possible surface colonization of the tumor by . This case highlights the role of rectal brushings in detecting superadded infection in a case where both brushings and biopsy were performed. It is always important to report infection superadded on malignancies for optimum management of the patients.
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http://dx.doi.org/10.4103/JLP.JLP_129_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5896199PMC
April 2018

Pulmonary Hydatid Disease with Aspergillosis - An Unusual Association in an Immunocompetent Host.

Turk Patoloji Derg 2019 ;35(2):166-169

Department of Pathology, Dayanand Medical College and Hospital, LUDHIANA, INDIA.

Echinococcosis is a common cause of pulmonary cavities. Aspergillus fumigatus, a saprophytic fungus, can colonise pulmonary cavities caused by tuberculosis, sarcoidosis, echinococcosis, bronchiectasis and neoplasms. Infection by Aspergillus is often seen in immunosuppressed cases. However, co-infection of Aspergillus with pulmonary echinococcosis is unexpected and very unusual, especially in an immunocompetent patient. We present the case of a 45-year-old immunocompetent male who came with non-resolving pneumonia and fever for 8 months and dyspnoea since 15 days accompanied by recurrent episodes of hemoptysis since 5 days. Chest X Ray and Computed Tomography scan showed a cystic lesion in the middle lobe of the right lung. Middle lobectomy with video-assisted thoracoscopic surgery was performed and histopathology revealed ectocyst of Hydatid cyst which was also colonised by septate fungal hyphae exhibiting acute angled branching, morphologically consistent with Aspergillus. Gomori Methanamine Silver and Periodic Acid Schiff stains highlighted the hyphae of Aspergillus as well as the lamellated membranes of ectocyst and an occasional scolex of Echinococcus. Sections from surrounding lung parenchyma also showed these fungal hyphae within an occasional dilated bronchus. Thus a diagnosis of dual infection of Aspergillosis and Pulmonary Echinococcosis was established. The possibility of dual infection by a saprophytic fungus must be kept in mind while dealing with a case of a cavitary lesion in long-standing and non-resolving pneumonia, even in an immunocompetent patient. Establishing the correct diagnosis of Aspergillosis with Echinococcosis is essential for proper and complete management.
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http://dx.doi.org/10.5146/tjpath.2017.01396DOI Listing
September 2019

Nodular Cystic Basal Cell Carcinoma of the Trunk: a Diagnostic Dilemma in an Unsuspecting Youth.

Iran J Pathol 2017 1;12(4):410-412. Epub 2017 Oct 1.

Department of Skin and venereal diseases, Dayanand Medical College and Hospital, Ludhiana, India.

Basal cell carcinoma (BCC) commonly affects the elderly and is mostly confined to the head and neck region. Only 10% of all cases occur on the trunk. We presented a case of bullous lesion on the abdomen in a young male, initially diagnosed by clinicians as a vascular nevus. Histopathological examination and immunohistochemistry (IHC) revealed it to be Nodular cystic variant of BCC. This rare variant of BCC morphologically resembles benign skin adnexal tumor of Eccrine syringofibroadenoma. Ber Ep4 positivity on IHC established the correct diagnosis. This case highlights that nodular cystic variant of BCC can be a diagnostic dilemma for clinicians and pathologists.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5844689PMC
October 2017

Association of endoscopic and histological remission with clinical course in patients of ulcerative colitis.

Intest Res 2018 Jan 18;16(1):55-61. Epub 2018 Jan 18.

Department of Gastroentrology, Dayanand Medical College and Hospital, Ludhiana, India.

Background/aims: The therapeutic goal for treating ulcerative colitis (UC) patients has shifted to achieving mucosal healing over the past few years. However, at present, limited data is available on the correlation between endoscopic findings and histological remission in patients with endoscopic mucosal healing.

Methods: This was a prospective observational study conducted over a period of 18 months (January 2014 to June 2015) at Dayanand Medical College and Hospital, Ludhiana, Punjab, India. Patients diagnosed with UC who had been in clinical remission (n=76) for at least 6 months were evaluated for endoscopic remission. Those in endoscopic remission (Mayo score ≤1; 46/76, 60.5%) were subjected to multiple biopsies from the rectosigmoid region and histological remission, which was then defined as grade 0/1 as per the Geboes criteria.

Results: Of the 46 patients in endoscopic remission (age, 18-73 years; male:female=1.5:1.0), majority had E1 (proctitis) disease (21/46, 45.6%) followed by E2 (left sided colitis) (18/46, 39.1%) and E3 disease (pancolitis) (7/46, 15.2%) at baseline. Histological remission was noted in 67.3% (31/46) of the patients, while 32.7% (15/46) still retained the histologically active disease in the form of infiltration of the lamina propria by eosinophils and neutrophils (13/15, 86.6%), cryptitis (14/15, 93.3%), and crypt abscesses (8/15, 53.3%). On follow-up, after 1 year, 87.1% (27/31) of the patients who had been in histological remission remained clinically asymptomatic, while 12.9% (4/31) had relapsed. Among the 15 histologically active patients, 46.6% (7/15) remained in clinical remission, while 53.3% (8/15) had relapsed.

Conclusions: Histological remission, rather than endoscopic remission, predicts a sustained clinical remission and allows monitoring of therapy for the subsequent disease course in patients with UC.
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http://dx.doi.org/10.5217/ir.2018.16.1.55DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5797272PMC
January 2018

Pacemaker lead infective endocarditis in immunocompetent host due to : An uncommon occurrence.

Indian J Pathol Microbiol 2017 Jul-Sep;60(3):441-442

Department of Pathology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.

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http://dx.doi.org/10.4103/IJPM.IJPM_257_16DOI Listing
October 2018

Reforming pathology teaching in medical college by peer-assisted learning and student-oriented interest building activities: A pilot study.

Educ Health (Abingdon) 2017 May-Aug;30(2):126-132

Department of Social and Preventive Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.

Background: Peer-assisted learning (PAL) is a teaching-learning method in which students act as peer teachers and help other students to learn while also themselves learning by teaching. PAL through modified interest building activities (MIBAs) is seldom tried in teaching pathology in medical colleges. This study aimed to evaluate the usefulness of peer teaching using MIBA, obtain feedback from students, and compare different activities with each other and with traditional teaching-learning methods.

Methods: An interventional pilot study was conducted in 2 months on the 2nd MBBS undergraduates learning pathology at a medical college in North India. Students acted as peer teachers and performed different MIBAs including role plays, demonstration of pathogenesis through props, student-led seminars such as PowerPoint teaching, blackboard teaching, multiple choice question seminars, case-based learning (CBL) exercises, and quizzes before teaching sessions. Feedback was obtained through structured questionnaires on a 5-point Likert scale. Paired t-test was used to compare traditional teaching with MIBAs, and Friedman test was used to compare among different MIBAs.

Results: Students found ease of understanding and the interaction and involvement of students as the most important benefits of PAL. MIBAs increased voluntary participation, coordination, teamwork, shared responsibility, and group dynamics among students. Quiz sessions followed by PowerPoint seminars and prop demonstrations received highest mean scores from students on most of the parameters. Quizzes, blackboard teaching, prop activities, and CBL helped students understand topics better and generated interest. Learners advocated for making MIBAs and PAL compulsory for future students.

Discussion: PAL complemented by MIBAs may be adopted to make teaching-learning more interesting and effective through the active involvement and participation of students.
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http://dx.doi.org/10.4103/efh.EfH_267_16DOI Listing
April 2018

Histopathological Spectrum of Soft-Tissue Tumors with Immunohistochemistry Correlation and FNCLCC grading: A North Indian Experience.

Niger Med J 2017 Sep-Oct;58(5):149-155

Department of Pathology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.

Introduction: Soft tissue tumors (STT) are mesenchymal neoplasms with a diverse spectrum and overlapping clinical, radiological and histological features. Histopathology and immunohistochemistry (IHC) are essential to make a diagnosis. Fédération Nationale des Centres de Lutte Contre le Cancer (FNCLCC) Sarcoma Group grading system based on tumour differentiation, mitotic rate and necrosis helps in predicting the tumour progression and treatment response.

Aims: The goal of this study was to analyze the incidence, histological spectrum and IHC features of STTs and to grade sarcomas according to FNCLCC grading system.

Material And Methods: This is a four year study conducted in the Department of Pathology of a tertiary care centre from July 2009 to June 2013. All histopathologically diagnosed STTs were evaluated for gross and microscopic appearance. IHC was done wherever needed and clinical correlation was attempted. Sarcomas were graded according to FNCLCC grading system.

Results: Of the total 270 cases studied, benign, intermediate and malignant STTs were 67.0%, 7.0% and 25.9% respectively. Adipocytic, vascular and peripheral nerve sheath tumors (PNST) formed the bulk of overall STTs (34.1%, 18.5% and 11.1% respectively). Sarcomas not otherwise specified were found to be the most common soft-tissue sarcomas followed by smooth muscle sarcomas and tumors with uncertain differentiation (11.5%, 4.1%, and 3.3%, respectively). Benign STTs were seen two decades earlier and were superficial in location as compared to sarcomas. On FNCLCC grading, grade 3 soft tissue sarcomas were slightly higher in number than grade 2 (27 vs 24). On IHC a definitive diagnosis was reached in 33 malignant, all intermediate and nine benign cases.

Conclusion: The incidence of intermediate and malignant STTs is increasing due to early detection and better diagnosis by ancillary techniques like IHC. FNCLCC grading helps to prognosticate the malignant STTs thus guiding further plan of action while in some tumors like MPNST and Angiosarcoma it has no prognostic significance.
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http://dx.doi.org/10.4103/nmj.NMJ_226_16DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6552737PMC
June 2019

Acquired aplastic anemia associated with trisomy eight converting into acute myeloid leukemia.

J Lab Physicians 2017 Jul-Sep;9(3):207-209

Department of Pathology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.

Aplastic anemia (AA) is nowadays considered to be a clonal disorder arising from a defective hematopoietic stem cell developing after a generalized insult to bone marrow. Immunosuppressive treatment (IST) of AA causes suppression of the target dominant population of haematopoietic cells allowing the defective non targeted clones to expand. This may give rise to acute leukemia. Cytogenetic studies for chromosomal aberrations such as trisomy and monosomy may help in detecting such conversions. We present a case of acquired AA in a 60-year-old male presenting with pancytopenia and hypoplastic marrow treated with antithymocyte globulin, converting into myelodysplastic syndrome and later on acute promyelocytic leukemia after being in remission for 4 years. The patient was found to have trisomy 8 on fluorescence hybridization and karyotyping.
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http://dx.doi.org/10.4103/0974-2727.208259DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5496300PMC
July 2017

Symptomatic isolated terminal ileal ulcers: etiology and clinical significance.

Endosc Int Open 2017 Jul 23;5(7):E539-E546. Epub 2017 Jun 23.

Department of Gastroenterology, Dayanand Medical College, Ludhiana, Punjab, India.

Background:  With an increasing number of ileal intubations, isolated terminal ileal ulcers (ITIU) are frequently found during colonoscopies. The present study aimed at studying the etiology and clinical significance of these ulcers in patients having gastrointestinal symptoms.

Methods:  This was a prospective observational study performed on consecutive patients who underwent ileocolonoscopy for various gastrointestinal symptoms between 1 January 2014 and 31 December 2014. Clinical, endoscopic, and histological findings of patients with ITIUs were assessed to determine the etiology and they were treated accordingly. Symptom resolution was assessed within 3 - 6 months of initial diagnosis, and colonoscopy was repeated for consenting patients.

Results:  Among 74 (4.9 %) of 1497 patients who had ITIUs on ileocolonoscopy, 41 (55.4 %) had specific etiologies on initial testing. After 3 - 6 months follow-up, definitive diagnosis was ascertained in 44 (59.5 %) patients [Crohn's disease (CD): 19 (25.7 %), NSAID-induced ulcers: 11 (14.9 %), intestinal tuberculosis (ITB): 9 (12.2 %), and eosinophilic enteritis: 5 (6.8 %)], and 30 patients (40.5 %) had nonspecific ulcers. After treatment, symptomatic and endoscopic resolution were noted in 55/60 patients (91.7 %) and 28/36 patients (77.8 %), respectively. Of 5/60 patients who remained symptomatic, three were initially diagnosed with nonspecific ulcers and two with CD, and they were finally diagnosed with CD and ITB respectively, and treated accordingly.

Conclusions:  In patients with gastrointestinal symptoms, more than half of the ITIUs have specific etiologies, and timely diagnosis and appropriate treatment can prevent serious complications. Nonspecific ulcers can be managed with symptomatic treatment, but need close monitoring and re-evaluation in the case of persistence of symptoms.
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http://dx.doi.org/10.1055/s-0043-100688DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5482744PMC
July 2017
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