Crescentic Glomerulonephritis (CGN) is produced by many factors like Antineutrophilic Cytoplasmic Antibody (ANCA), Anti Glomerular Basement Membrane Antibodies (Anti GBM Ab) or immune complexes (IC). Aim of the study was to see prevalence of ANCA in CGN and subtypes of CGN.Total 50 cases of CGN were studied from February 2016 to July 2017. All auto antibodies (ANCA, ANA, DNA) were performed by ELISA method. Formalin fixed, paraffin embedded tissue was used for histopathology.In 50 cases of CGN (26 males, 24 females) age range was 13 – 86 years. ANCA was positive in 72%. About 60% cases were of Type III (Pauci-immune) followed by Type IV (combined type 1 and type 3), Type V (ANCA, immune-complex and anti GBM negative) (12% each), Type I (Anti GBM Ab mediated) and Type II (immune complex mediated) (8% each).About 14% patients were below 14 years of age, 52% were between 21 to 40 years, 24% were between 41 to 60 years and 10% were above 61 years of age.In Type III CGN, 53.33% were MPO positive, 40% were PR3 positive and 6.7% were both MPO and PR3 positive, while in Type IV CGN, 83.33% were MPO positive and 16.66% were PR3 positive. Small vessel vasculitis was found in 83.3% of the patients of Type V, 69.9% patients of Type III and 50% of patients of Type I and Type IV and 25% of patients of Type II CGN. Vasculitis of medium sized blood vessels was seen in 50% of Type IV, 20% of Type III CGN, 25% of Type I and 16.7% of Type V CGN.About 41 cases of CGN, suspected highly for small vessel vasculitis, were subjected for CD34 staining. In H&E stain, only 58% of the cases showed vasculitis and peritubular capillaritis; but after CD 34 staining, all cases showed arteriolitis and peritubular capillaritis. About 33.33% of Type IV and 26.6% of Type III had granulomas in glomeruli; while 26.6% of Type III, 25% of Type I and IV each, 16% of Type IV and V each had granulomas in interstitium. Two cases (66.6%) of Type III had granulomas in blood vessels. Out of 50 cases of CGN, 14 cases (28%) after investigations turned out to be cases of Lupus nephritis with ANCA positivity in 85.5% of the cases. MPO ANCA was positive in 50%, PR3 ANCA in 28.57% and in one case both ANCA and anti GBM Ab were positive. Granulomatous Polyangitis (GPA) was seen in 8 cases while Eosinophilic Granulomatous Polyangitis (EGPA) was found in one case and rest of the cases were of microscopic polyangiitis (MPA). PR3 ANCA was positive in 87.5% cases of GPA, whereas in EGPA, MPO ANCA was positive.SLE can also be associated with ANCA mediated CGN. ANCA produces small vessel vasculitis which can be better visualised after CD34 staining. Detection of ANCA will help the clinicians for planning aggressive immunosuppressive therapy.
Anaplastic thyroid carcinoma (ATC) presenting with cutaneous metastasis is rare and only few cases have been reported so far. Commonly involved sites are the cervical region and the thorax. Anaplastic thyroid carcinoma has poor prognosis and no standard treatment has been documented however extensive surgery with curative treatment often with adjuvant radiation and chemotherapy are effective. Most common genetic mutation in ATC is P53 (20-83% cases), RAS mutation (up to 50%), BRAFV600E mutation (25%) p13KCA mutation (12-23%) and copy gain leading to Akt activation (38-61%). Case Presentation: In our study, we have reported a case of a 66 years old male patient who presented with thyroid, back and the ribs (right side) swelling with a radiological diagnosis of malignant thyroid lesion, FNAC was done from all of the above mentioned sites. FNAC smears from all sites showed pleomorphic atypical cells. A diagnosis suggestive of High Grade Epithelial Neoplastic lesion was given with a possibility of Anaplastic thyroid carcinoma with cutaneous metastasis. Conclusion: Anaplastic thyroid carcinomas (ATC) with cutaneous metastasis often present with solitary or multiple swellings as seen in many studies. Very few cases has been reported which has been diagnosed on FNAC. The case reported highlights multiple nodular swelling in neck, right side back and ribs. Cytomorphologically it was suggestive of anaplastic thyroid carcinoma with cutaneous metastasis, which is rare and only few cases documented.
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