Sarojini Raman

Background: Neoplastic lesions in cutaneous and subcutaneous region comprise a large group of benign and malignant entities of different lineage. Clinical, morphological features and prognosis of these lesions differ a lot. For diagnosis FNAC (Fine needle aspiration cytology) is the first technicque applied followed by histology, immunohistochemisty (IHC) and so on. Aim: Cytological evaluation of cutaneous and subcutaneous neoplasms and correlate with histopathology and IHC. Settings and Design: Study of all palpable cutaneous and subcutaneous swellings presenting to cytology OPD (Out patient department) with further histopathological correlation in the three-year duration. Materials and Methods : FNA cytosmears of the cases stained with leishman stain in most of cases. Histopathological and IHC correlation done in available cases. Statistical Analysis : The data are expressed in descriptive statistics measures such as percentages and proportions. Results: Out of 1032 total cases, most of the cases were benign (94.3%) with fewer malignant cases (5.7%). Lipomas 562(56.31 %) were the largest group among benign lesions followed by benign spindle cell lesions 286(28.65%). Metastatic (22, 64.7%) lesions were more in number than primary cutaneous malignancies (12,35.2%). Among adenocarcinomas, 4 metastatic cases (0.38%) from lung and breast each and among squamous cell carcinomas (SCC), 7(0.67%) primary SCC were seen. Biopsy correlation was available in 134(12.98%) cases and IHC done in 14(1.35%) cases. Conclusion: Cutaneous neoplasms though benign in most of the cases, can be of critical aetiology with dismal prognosis. Hence they should not be taken lightly and diagnosed specifically with the help of imaging and cyohistological study whenever needed.   Keywords: Biopsy, Cytodiagnosis, Skin neoplasm

Background: Microscopic Enteritis (ME) is characterized by increase in intraepithelial lymphocytes (IEL) in intestinal mucosa. It represents a common feature of broad group of diseases including gluten mediated and non gluten related diseases. Duodenal biopsies play an important role in diagnosing these group of disorders. Aim: To compare IEL counts in Hematoxylin and eosin (H & E) stain and CD3 immunohistochemical (IHC) stain in duodenal biopsies of suspected malabsorption cases and compare them with clinical, immunological and biochemical parameters. Setting & Design: This was a prospective study of two years. Materials and Methods: 164 patients were studied. IEL counted at villous tip and base in H&E sections and IHC were compared in duodenal biopsy. Data of clinical history, other parameters were collected and correlated whenever available. Statistical Analysis: To compare any two variables, Chi - square test and independent T test was used. Statistical significance was defined as p < 0> Results: Out of 164 cases,105 cases had increased IEL. The age range was 4 to 94 years with mean age of 43.29 ± 17.96 years. Males (56, 53.3%) were affected more than females (49, 46.6%). The clinical and histological parameters showing statistical significance with raised IEL were pallor, dyspepsia, loss of appetite, crypt architecture, blunting, ulcer, villous crypt ratio, exudates, reactive atypia and edema with P< 0> Conclusion: ME should be investigated and diagnosed in correlation with a detail clinical history, complete haematological, biochemical and serological findings.   Keywords: Biopsy, Intestinal mucosa, Intraepithelial lymphocytes, Malabsorption syndromes

Rhabdoid tumor of kidney is one of the uncommon pediatric renal neoplasms with highly aggressive clinical course. We are presenting a case of 1 year child with abdominal distension and hematuria. On Contrast enhanced computed tomography (CECT) a heterogenous mass in lower pole of kidney was detected. Histopathological and immunohistochemical study after radical nephrectomy revealed Malignant rhabdoid tumor of kidney. It has a tendency to metastasize early and it is associated with synchronous presence of other malignancies. No definite effective treatment for this tumor is available till now. This further necessitates the early diagnosis and prompt management which can be life saving for the patient.  We are presenting this case to emphasize on its rarity and aggressive clinical behaviour. Keywords: Rhabdoid tumor, Kidney neoplasm.

Background: Duodenal endoscopic biopsy is a common useful test advised for patients presenting with various malabsorption syndromes. Aim: To study the histopathological changes observed in suspected malabsoption cases including Celiac disease (CD) with emphasis upon the Intraepithelial Lymphocytes (IELs) and to have a clinico-pathologic correlation. Settings & Design: This was a 2 year prospective study of cases presenting to gastrology OPD with suspected malabsorption selected for duodenal biopsy. Materials and Methods : Haematoxylin and Eosin (H&E) stain was used for study of histological parameters. IEL counts were correlated in CD3 immunohistochemical (IHC) stain. Clinical and laboratory parameters were correlated wherever available. Statistical Analysis: The variables were expressed as mean SD. Chi - square test or independent T test was used for comparison of variables. p value was < 0> Results: Out of 164 duodenal biopsies,105 cases had raised IEL.11 patients had CD (10.47%), rest were non celiac disease (NCD) of differen t aetiologies.Liver function tests, Endoscopy, Architecture of mucosa, crypt architecture, blunting, villous crypt ratio showed statistically significant correlation between CD and nonceliac disease groups with p values (P~0.034), (P~0.000),P~0.002),(P~0.000), (P~0,000) and (P~0.000) respectively. The specificity and positive predictive value (PPV) of villous tip IEL in both H&E & CD3 IHC were 100% in CD cases in our study. Conclusion: A complete clinical, endoscopic, serological and histopathological evaluation is essential for diagnosis of CD cases. Raised IEL in duodenal biopsies can be a very useful initial indicator for detecting many latent or subclinical CD cases. Keywords: Biopsy, Celiac Disease, Intraepithelial lymphocytes, Malabsorption.

Background: Skin adnexal tumours are heterogenous group of uncommon tumours having distinct histological features. They have varied clinical presentation and morphological differentiation towards one or more types of adnexal structures found in normal skin. The aim of this study was to study the different histomorphological patterns of appendageal tumours and correlate them with clinical presentations. Materials and Methods: This was a retrospective study of three year duration of all cases clinically diagnosed to be appendageal tumours and confirmed by histopathology in our department. The tumours were classified according to their differentiation after a detailed histopathological examination in haematoxylin and eosin sections. Results: The total number of cases in the study were 43,in which 28 were males and 15 females. Most of the tumours (97.7 %)were benign and there was only one case sebaceous carcinoma. The majority of the tumours had an eccrine differentiation (30.9%), nodular hidradenoma among them being the most common lesion (20.9%). Trichilemmal cyst (30.2%) constituted the maximum cases of pilar origin. Conclusion: Skin adnexal tumours are relatively rare with benign ones being more common than the malignant tumours. Proper clinical correlation and histopathological study helps in reaching a correct diagnosis. Keywords: Appendageal, Skin tumour, Eccrine, Nodular hidradenoma, Sebaceous carcinoma.

Background: A wide range of inflammatory as well as neoplastic lesions can present as nodular, soft, mobile subcutaneous swellings all over the body. FNAC(fine needle aspiration cytology) is considered to be the first reliable technique for diagnosing them. Aim: To study the cytomorphological patterns of subcutaneous nodular lesions and correlate with histopathology. Materials and Methods: A three year prosective study of all palpable subcutaneous swellings presenting to cytology section with histopathological correlation. Statistical Analysis: The data are expressed in descriptive statistics measures such as percentages and proportions. A continuous data was presented as mean and standard deviation (SD). Results: Out of 1427 total cases, most common were benign lesions (97.4%) including lipomas (35.24%) followed by benign spindle cell lesions (17.02%). Malignant cases comprised only 2.7%. Many rare lesions like gouty tophi, calcinosis cutis, filariasis, myositis ossificans were also encountered. Biopsy correlation could be done in 12% of cases. Conclusion: Small subcutaneous swellings though appear benign in most of the cases, can be due to an interesting and grave aetiology which must be kept in mind of clinicians as well as cytopathologists. Keywords: Biopsy, Cytodiagnosis, Subcutaneous nodule.