Background: The coronavirus disease 2019 (COVID-19) pandemic has taken the world to different dimensions. With the surge of the second wave in India, the number of cases with mucormycosis has increased. Mucormycosis is a potentially life-threatening, opportunistic, invasive, fungal infection that can occur in immunocompromised states. The aim of the study is to analyze the clinicopathological parameters of patients with mucormycosis in the surge of the second wave of COVID-19.Materials and Methods: All cases of mucormycosis reported in the Department of Pathology in a tertiary care centre in South India from March 2021 to June 2021 were included in the study. The patient details were retrieved from the Medical Records section. The patient characteristics, location, associated comorbidities, management and treatment outcomes were analyzed and compared to similar studies reported worldwide.Results: Of 58 cases, 38 (65%) were males and 20 (35%) were females. The ages ranged from 34 to 77 years. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was detected in 46 patients in reverse transcription polymerase chain reaction (RT-PCR) with high-resolution computed tomography (HRCT) Chest changes noted in 54 patients. Associated comorbidities were noted in 52 patients, with uncontrolled diabetes mellitus (46 patients; 88%) being the most common. Location was commonly in nasal and paranasal sinuses (43%), followed by orbital (2%), cerebral (10%) and pulmonary (8%) areas. Among the paranasal sinuses, the maxillary sinus was commonly involved. Mixed fungal infections (Aspergillus sp. and Candida sp.) were noted in eight (14%) cases. Oxygen therapy was given in 85% of cases; 30% of cases needed ventilator support; corticosteroid therapy was initiated in 49 patients, tocilizumab in six patients as treatment for mucormycosis. Amphotericin B was administered in 59% of patients based on clinical findings alone. After histopathological confirmation, 90% of them received amphotericin. Functional endoscopic sinus surgery (FESS) was done in 96% of cases, among them 45% underwent extensive surgical debridement and 15% underwent orbital decompression. Orbital exenteration (2%) was the other modality of management.Conclusion: Detailed analysis of clinicopathological features suggests the possibilities of immunosuppression (due to diabetes and use of corticosteroids in treatment of COVID-19) and COVID-19 (endothelial damage, cytokine storm) being the pathogenesis associated with the sudden surge of mucormycosis.
Background: Acute appendicitis is the most common abdominal emergency. It is a clinical entity with an ongoing diagnostic challenge. Histopathological examinations are the gold standard for the final diagnosis, which has revealed much unusual, unexpected serious underlying pathology. This study is to analyze the histopathological patterns in appendectomy specimens and to establish the role and importance of histopathological examination in diagnosing various serious incidental pathologies. Materials and Methods: This is a retrospective study comprising of 181 patients, carried out at VMKVMCH, Department of Pathology, over a period of 2 years from September 2017 to August 2019. Clinical data of patients were collected for all the appendectomy specimens received at the pathology department and histopathology slides were reviewed. Results: A total of 181 cases were analyzed. Patients' age ranged from 3 to 77 years. The predominant appendectomy finding was acute appendicitis 86 cases (47.51%) followed by chronic appendicitis 58 cases (32.04%). Among the unusual findings, eosinophilic appendicitis was the commonest 4 cases (2.20%), mucocele, carcinoid and parasite 1 case (0.55%) each respectively. Conclusion: Although most of the cases were diagnosed as acute appendicitis, a few of the essential incidental pathologies were missed out pre-operatively and intra-operatively. Hence these serious incidental diagnoses undeniably support the fact that all appendectomy specimens should be sent routinely for histopathological examination, which is not followed in many hospitals in India.
Background: Cutaneous cysts are the most common lesions encountered in surgical practice withcosmetic and psychological concern to the patient. Aim: To establish the clinicopathologicalcorrelation of these lesions and also the importance of histological evaluation for the prevention ofmisdiagnosing a benign-appearing malignant lesion. Methods: A retrospective descriptive studywith data collected from archives of histopathology from January 2018 to December 2020 ofclinically diagnosed cutaneous cyst along with age, gender, location and histopathological evaluationwere analysed. Results: 88 cases that were clinically diagnosed as cutaneous cysts had a higherfemale proportion 52.3%. The most common clinical diagnosis is epidermal/ sebaceous cyst. 35.2%of cases were clinically diagnosed accurately but 64.8% of cases did not correlate with clinicaldiagnosis. 4 malignant lesions were misdiagnosed as benign cutaneous cyst clinically. Conclusion:Most often clinically diagnosed cutaneous cysts are not sent for histopathological evaluation which isa very important tool to confirm the diagnosis.
Background: Abnormal uterine bleeding (AUB) is a common gynecological complaint, for which histopathological examination of endometrium is the gold standard tool in diagnostics. Aim of this study is to analyze various histomorphological patterns of endometrium in patients belonging to various age groups with abnormal uterine bleeding. Materials and Methods: A retrospective study of 174 patients presenting with abnormal uterine bleeding underwent endometrial sampling during a period of 2 years from September 2017 to August 2019 at VMKVMCH, Department of Pathology, were analyzed. Endometrial tissue received by sampling procedures such as dilatation and curettage (D & C), endometrial biopsy and fractional curettage were all submitted entirely for processing in the Department of Pathology. Patient data were collected, and slides were reviewed. Result: A total of 174 cases were analyzed. Patients' age ranged from 15 to 65 years. The predominant endometrial finding was proliferative endometrium 54 cases (31%) followed by secretory endometrium 50 cases (28.7%). Malignant lesions were seen in 5 cases (2.87%) in patients more than 49 years of age. Among the organic causes, polyps were the commonest 8 cases (4.59%). Adequate samples were obtained from 91% of cases while 9% of cases' samples were inadequate for opinion. Conclusion: Histopathological examination of endometrial samples should be done in patients with abnormal uterine bleeding, especially in women over 35 years of age to rule out malignancy and preneoplasia. Patients with no organic pathology had normal physiological patterns like proliferative endometrium, secretory endometrium and menstrual changes. Most common endometrial pathology in this series was endometrial polyp 8 cases (4.59%).
Background: Skin adnexal tumors are a spectrum of benign and malignant tumors that differentiate toward or arise from the adnexal unit of the skin. These rare tumors pose a challenge in diagnosis, and often, a discrepancy is seen between clinical and histopathological diagnosis. Materials and methods: This single institutional study was carried out among 36 patients who presented with swelling. An initial diagnosis was considered based on the clinical history followed by histopathological examination. Results: Among the 36 patients, only 4 had malignant tumors. Among them, 3 had sebaceous differentiation, and 1 had apocrine and eccrine differentiation. Among the benign, 14 had follicular differentiation, 12 had apocrine and eccrine differentiation, and 6 had sebaceous differentiation. The clinic-pathological correlation was 65%. Conclusions: An accurate diagnosis is not possible with just the clinical features. Histopathologic examination is considered the gold standard for diagnosis and categorization.
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