Background: Adnexal torsion accounts for 2.7% of gynecological emergencies. Early diagnosis can help prevent irreversible damage to ovary. Objective of this study was to analyze the clinical, radiological and pathological characteristics of surgically proven cases of ovarian torsion. Methods: Observational study was carried out from January 2006 to June 2014. Medical records of 38 cases of adnexal torsion were selected and analyzed retrospectively for age, parity, risk factors, clinical presentation, presence of leukocytosis, gray scale ultrasound and colour Doppler features, management, pathological results and postoperative outcome. Results: Adnexal torsion occurred most commonly in reproductive age group (mean 27.89 years) of whom 3 were pregnant. 42% had known risk factors commonly prior pelvic surgery (52.63%) and prior tubal ligation (31.58%). Symptoms include sudden abdominal or pelvic pain (94.74%), vomiting (60.53%) and fever (21.05%). Gray scale USG showed mixed echogenic mass (36.84%), homogenously echogenic cyst (34.21%) anechoic cyst (26.32%) and free fluid (23.68%). Doppler showed absent arterial and venous flow in 52.63%. Cases were managed by detorsion & cystectomy (42.11%), unilateral salpingooophorectomy (47.37%), bilateral salpingooophorectomy (5.26%) and TAH with BSO (5.26%). Histopathology revealed benign serous epithelial tumors (31.58%), mucinous tumors (21.05%), mature teratoma (10.53%), corpus luteal cyst (5.26%), follicular cyst (2.63%) paraovarian cyst (13.16%), endometriotic cyst (2.63%) and ovarian hemangioma (2.63%). Conclusions: High index of suspicion &prompt surgical intervention is necessary to preserve ovarian function even if Doppler shows vascularity. Though detorsion and cystectomy is the choice, salpingooophorectomy may be needed in infracted ovaries and older women. Higher incidence of serous & mucinous tumors in our study suggests reappraisal of ovary sparing surgery for all patients as advocated by few.
Introduction: The spectrum of follicular patterned thyroid lesions vary from benign to malignant, their categorisation based solely on morphology can often be equivocal. Diagnostic value of immunohistochemistry as a useful ancillary technique is researched in detail, but there is no consensus for use of a marker of diagnostic utility in differentiated thyroid carcinoma. Aim: To evaluate the differential immunohistochemical expression of galectin-3, CK19 and CD56 in benign and malignant thyroid neoplasms. Materials and Methods: The present descriptive cross-sectional study was carried out in the Department of Pathology of a tertiary care centre, Government Medical College, Ernakulam, Kerala, India, from January 2018 to January 2019. Immunohistochemistry staining of galectin-3, Cytokeratin 19 (CK19) and Cluster Differentiation 56 (CD56) was done in 47 thyroid neoplasms. Cytoplasmic and nuclear staining of galectin-3, cytoplasmic or membranous staining of CK19 and loss of membranous expression of CD56 in more than 10% neoplastic cells were taken as positive expression. The data was analysed using IBM Statistical Package for the Social Sciences (SPSS) software version 22.0. Diagnostic test evaluation for markers done by calculating sensitivity and specificity. Results: Out of total 47 neoplasms, 26 were malignant and 21 were benign neoplasms. Of these, galectin-3 positivity was seen in 22 (84.61%) malignant neoplasms and in 2 (9.52%) benign neoplasms. Cytokeratin 19 positivity was seen in 26 (100%) malignant neoplasms and in 7 (33.33%) benign neoplasms. Loss of CD56 expression was observed in 24 (92.3%) malignant neoplasms and in 4 (19.04%) benign neoplasms. Considering histopathology as the gold standard, the sensitivity for detecting malignancy for the 3 markers, galectin-3, CK19 and CD56 was 84.62%, 100%, 92.3% and specificity was 90.48%, 66.67%, 80.95%, respectively. The diagnostic accuracy of galectin-3, CK19 and CD56 was 92.3%, 80.95%, 87.23%, respectively. Diagnostic Odd’s ratio for Galectin-3 was 2.3% in the present study. Conclusion: Galectin-3 was found to be a reliable marker for thyroid papillary carcinoma and for differentiating malignancy. The panel consisting of galectin-3 and CD56, is valuable and complementary when used in two marker combination. CK19 was found to be the least specific diagnostic marker of thyroid malignancy.
Background: Abnormal uterine bleeding (AUB) is defined as bleeding pattern that differs in frequency, duration and amount from the normal cyclical flow. Endometrium in AUB vary depending on etiology and age. The present study attempts to categorize the histopathology of endometrium in abnormal uterine bleeding in women of various age groups.Methods: A hospital based prospective study was carried out in 220 cases of abnormal uterine bleeding. Paraffin processed endometrial biopsies analyzed correlating the clinico-radiological data. Endometrial samples of infertility and pregnancy related bleeding were excluded.Results: 220 cases of AUB from 25 years to 78 years of age were evaluated under three groups, reproductive (23%), perimenopausal (52%) and postmenopausal (25%). AUB was most common in the perimenopausal group. The predominant pattern seen was physiological cyclical endometrium (67.2%). Disordered proliferative endometrium (18.63%) was the predominant abnormal pattern. Malignant lesions were (99.5%) in postmenopausal age and disordered proliferative endometrium seen predominantly (65.85%) in perimenopausal age group. As per PALM-COEIN classification, uterine structural abnormalities (PALM) were found in 70 (31.9%), non-structural causes (COEIN) in 150 (68.1%). Endometrial thickness >16 mm on radiology were seen in endometrial carcinoma.Conclusions: Endometrial morphology vary with ovulatory abnormalities, anovulation and uterine abnormalities. Acronym PALM-COEIN is useful in categorizing AUB. The incidence of disordered proliferation, hyperplasia and malignancy seen in extremes of age, reiterates that early clinic-radiological workup and endometrial study are the mainstay in early detection of lesions.
Introduction: Breast cancer is the second leading cause of cancer deaths in women after lung cancer. Breast cancer survival varies by racial and ethnic factors, stage at diagnosis, tumour grade, molecular subtypes and the treatment received. Molecular subtyping provides prognostic and predictive information about the risk of recurrence and is an essential tool in formulating guidelines in therapy. Aim: To identify the histopathological variants of Carcinoma (Ca) breast in women and to determine the various molecular subtypes by Immunohistochemistry (IHC). Materials and Methods: A cross-sectional study from January 2019 to December 2020 was done on 100 cases of invasive carcinoma breast at the Department of Pathology in a tertiary care center of Government Medical College, Ernakulam, Kerala. IHC was done on paraffin processed tissue sections of tumour using anti-Oestrogen Receptor (ER), anti-Progesterone Receptor (PR), anti-Human Epidermal growth factor Receptor 2 (HER2/ neu) and Ki-67 antibodies. Molecular subtypes of Luminal-A, Luminal-B, HER2 enriched and triple negative (basal-like) were determined. The association between molecular subtypes and tumour grade, size, stage was analysed using IBM Statistical Package for the Social Sciences (SPSS) version 21.0 software. Chi-square test used for categorical variables, p-value <0.05 assumed to be significant. Results: Total 100 female cases of invasive carcinoma breast with mean age 49.3±12.2 years were included. Histologic subtypes of carcinoma were: Invasive Ductal Carcinoma (IDC) of No Special Type (NST) (89%), Invasive Lobular Carcinoma (ILC) (1%), Invasive ductal with Lobular carcinoma (IDC-L) (1%), metaplastic (2%), papillary (4%), IDC with medullary like features (3%). Tumour size was pT1 in 27%, pT2 in 38%, pT3 in 33%, pT4 in 2%. Tumour grades were: grade-I (28%), grade-II (29%) and grade-III (43%). Lymph node metastasis was seen in 52% cases. Positive expression of Oestrogen (ER) in 46%, Progesterone (PR) in 38%, HER2/neu in 23% and low Ki-67 labeling index (<14%) in 32% cases were observed. The molecular subtypes were Luminal-A (32%), Luminal-B (14%), HER2 enriched (16%) and triple negative (38%) in the present study. Conclusion: The most common molecular subtype was triple negative. Luminal-A subtype was associated with lower histologic grade and non luminal subtypes were associated with higher histologic grades. To determine molecular subtypes, IHC is useful as a surrogate for molecular testing.
Introduction: Fine Needle Aspiration Cytology (FNAC) is a valuable diagnostic aid for evaluation of lymph node pathology. The new Sydney System (2020) for classification and reporting of lymph node FNAC has put forth guidelines for a categorical classification using uniform terminology and morphologic criteria, a major step towards standardisation. Aim: The study was aimed to evaluate cytopathology of lymph node lesions during 2 year period by applying the proposed Sydney system and to assess the category wise Risk Of Malignancy (ROM) by comparing with histopathology diagnosis in available cases. Materials and Methods: A retrospective observational study was conducted in 2021 December, on lymph node aspirates obtained during two-year period from January 2018 till January 2020 in the department of Pathology of a tertiary care centre. FNAC of 250 lymph node aspirates were evaluated. Smears were reviewed and categorised as per the Sydney System of reporting as, L1: non diagnostic/inadequate, L2: benign, L3: atypical cells/atypical lymphoid cells of undetermined significance, L4: suspicious for malignancy, L5: malignant. The diagnostic accuracy of cytology and ROM in each category was assessed comparing with the gold standard histopathology diagnosis where available. Results: Category wise distribution of 250 cytological diagnosis of lymphadenopathy reclassified in Sydney system were L1-14 (5.60%); L2-159 (63.60%); L3-04 (1.60%); L4-05 (2%); and L5-68 (27.20%) cases. Using histopathology as gold standard available in 53 cases, the ROM in each category was found to be 0%, 3%, 66.66%, 100% and 100%, respectively. The sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV) and diagnostic accuracy of cytological diagnosis was found to be 95.65%, 96.29%, 95.65%, 96.29% and 96%, respectively. Reactive lymphadenitis in 86 (34.40%) and metastatic carcinoma in 61 (24.40%) cases were the most common benign and malignant lesions respectively. Conclusion: The Sydney system of structured reporting in lymph node cytology provides a clear-cut terminology, uniformity, and reproducibility of reports. It enhances the role of FNAC by alerting the clinician for follow-up and ancillary studies in atypical and equivocal cases. In the non diagnostic L1 category, repeat procedure or biopsy should be recommended to avoid False Negative (FN) diagnosis.
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