Shanmugasamy K

Histoplasmosis is a dimorphic fungus which is widely distributed among western countries like America and in some parts of the tropical region. It is acquired by inhaling microconidia. Depending on the immune status patient may develop acute or chronic pulmonary diseases or disseminated infection. The disseminated form of nasopharyngeal region can present as ulceration, rhino sinusitis, nasal obstruction, dyspnoea, hoarseness of voice and clinically it can mimic carcinoma. Microscopically, the differential diagnosis of histoplasmosis includes Leishmaniasis, Cryptococci neoformans, Candida glabrata, Pneumocystis jiroveci and Penicillium marneffei infections. The diagnosis of histoplasma is dependent on histopathological examination and demonstration by special stains, where the latter serves the gold standard in demonstrating organism on light microscopy. Keywords: Fungal infection, Histoplasmosis, Nasopharyngeal lesion, Paediatric age.

A 70 year old male was admitted with abdominal pain, weight loss, vomiting, difficulty in eating both solid and liquid food & malena for 20 days. On clinical examination patient’s conjunctiva is pale and his blood investigation shows Hemoglobin of 6 g/dl and Normocytic normochromic anemia in peripheral smear. Upper GI endoscopy shows ulceroproliferative growth in the antrum extending into pylorus with complete Gastric outlet obstruction Endoscopic gastric biopsy shows mucinous adenocarcinoma with invasion into muscularis propria. Abdominal CT scan shows a hyper vascular tumor in the Left kidney measuring 9x6x5 cms. Further subtotal gastrectomy and Radical left nephrectomy were performed. Final pathology report was Gastric adenocarcinoma (T2a) with renal cell carcinoma (T3a). Post operative period was uneventful. Elderly people with early gastric cancers have a relative higher probability of developing a synchronous tumour than younger people. The incidence of synchronous gastric cancer and RCC is quite low, and concomitant surgery is rare. It is appreciated that simultaneously both Subtotal gastrectomy and Radical nephrectomy can be performed without any major surgical complications. Our case report also alerts the treating physician to search for any synchronous cancers in the patient suffering from gastric cancer. Keywords: Synchronous cancers, Gastric cancers, Renal cancers,

Malignant mixed Mullerian tumour commonly known as carcinosarcoma is a rare and aggressive biphasic tumour with epithelial and mesenchymal components. In this reported case, a 68 year old post menopausal, nulliparous female, presented with complaints of difficulty in breathing and abdominal discomfort. Clinical evaluation and radiological findings were consistent with malignancy of left ovarian origin. Patient was taken up for total abdominal hysterectomy with bilateral salpingo-oophorectomy. But intraoperatively, the tumour was found as a single large retroperitoneal mass with no connection to ovaries or other pelvic organs. Histopathological examination of the specimen revealed features of malignant mixed Mullerian tumour. Immunohistochemical markers showed positivity for CK 20, Pan CK and EMA in carcinomatous areas and vimentin in sarcomatous areas. ER and PR were found to be negative. Patient was on regular follow-up and responded well to chemo and radiotherapy. Primaries in retroperitoneum also have poor prognosis similar to carcinosarcomas of female genital tract. Keywords: Biphasic tumour, Carcinosarcoma, Mixed Mullerian tumour, Retroperitoneum.

Introduction: The laboratory Turn Around Time(TAT) can be defined differently according to the test type (stat vs. routine), analyte, and institution. It is commonly defined as the time from when a test is ordered until the result is reported. The total TAT for laboratory assays includes the entire interval from ordering of the test to the clinician’s awareness of the result (i.e., “brain-to-brain”). Six Sigma has been characterized as the latest management fad to repackage old quality management principles, practices, and tools/techniques. Sigma methodology can be applied wherever an outcome of a process is be measured. A poor outcome is counted as an error or defect, which is quantified as Defects Per Million (DPM). Six Sigma is a methodology targeting zero error (3.4 errors per million events). Materials and Methods: Samples received in the haematology laboratory are processed in 8 part haematologyAutoanalyser. Results are reported as per routine procedure in the lab. Turn Around Time (TAT) for complete blood count parameters are calculated for one month. The standard Turn Around Time for the complete blood counts are 4 hours. Sigma value is calculated for complete blood count parameters for one month using the formula Sigma (s ) = [TEa - bias)/CV]. Six sigma is calculated by Defects Per Million (DPM). Reduce the error rate by guiding the laboratory technician on analytical part of sample processing and value for the same parameters. Repeat the Turn Around Time and Six sigma value after training for one month and compare the error rate. Keywords: Quality indicators, Turn Around Time, Six sigma, Quality management.

Introduction: Foetal development mainly depends on normal placental development. Mother, Placenta and Foetus are related to each other during the course of the pregnancy. Pregnancy induced hypertension shows considerable changes in the histopathology of placenta. Therefore the main aim of the present study is to evaluate the morphological changes of placenta in case of Pregnancy Induced Hypertension (PIH) and to correlate the findings with severity of toxaemia of pregnancy. Materials and Methods: The present study includes 61cases of placenta out of which 51 are in the study group and 10 cases are in the control group. Our study was descriptive study conducted in the Department of Pathology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidhyapeeth University, Puducherry during the period of July 2015-June 2018. The study group were further divided into four categories. All the placenta are grossed according to the institute protocol and the slides were examined for various morphological changes and correlated with the severity of pre-eclampsia and eclampsia. Descriptive statistics were used to evaluate the results. Results: The most prominent lesion seen in the toxaemia of pregnancy were villous cytotrophoblastic proliferation and villous fibrinoid necrosis which accounts to 78% and 75% respectively. Villous stromal fibrosis constitutes 71% of the study group cases. Increased villous vascularity was seen in 39% of the placenta of toxaemia of pregnancy. 69% of the cases shows villous basement membrane thickening in the study group placenta. Conclusion: Our study helps in evaluating the various morphological changes in placenta in the hypertensive disorder of pregnancy. This study helps in anticipating the occurrence of changes in the subsequent pregnancy induced hypertension cases. Keywords: Pregnancy, Eclampsia, Cytotrophoblastic cell proliferation, Fibrinoid necrosis.

Introduction: Breast cancer is the leading cause of morbidity & mortality worldwide. Breast being a surface organ, is easily palpable for aspiration. Diagnosis is often done by correlating fine-needle aspiration cytology (FNAC) findings with mammography. The aim of this study was to evaluate the FNAC in the diagnosis of breast lesions and to correlate cytological findings with histopathology findings along with mammography. Methodology: Over a period of three years, 329 aspirations were performed, 158 (48.03%) cases that had followed up by histopathological examination were included in the study. Results: Among the 158 cases studied, 154 (97.47%) cases were females and 4 (2.53%) cases were males. The incidence of breast lesions was maximum in the range of 21 to 30 years of age (24.68%). Most commonly encountered benign breast lesion was fibroadenoma (70.53%). Most commonly encountered malignant breast lesion was IDC (30.95%).Taking histopathology as the golden standard for diagnosis, we calculated the sensitivity, specificity, diagnostic accuracy, positive predicitve value, negative predictive value of FNAC and mammography. The sensitivity, specificity, positive predicitve value, negative predictive value of a mammogram were found to be 98.68%, 78.12%, 98.17% and 83.33% respectively while that of FNAC were found to be 87.23%, 100%, 96.05%, 100% and 94.87% respectively. Conclusion: From present study it is evident that benign breast lesions are common than malignant lesions. The simplicity, rapidity, lack of morbidity, high sensitivity, high specificity and cost effectiveness of FNAC makes it the most valuable tool in the evaluation of both neoplastic and non-neoplastic breast lesions. Keywords: FNAC, Biopsy, Fibroadenoma.