Inuganti Venkata Renuka

Plasma cell myeloma is characterized by monoclonal proliferation of plasma cells, causing destructive bone lesions and other systemic manifestations. The disease spans a clinical spectrum from asymptomatic to highly aggressive disease. M protein caused by myeloma cells results in type III ABO discrepancy, in which rouleaux formation can be misinterpreted as agglutination. We present a case of a 54year old male admitted in our hospital with breathlessness, severe pallor and fever. Blood transfusions were advised as the haemoglobin was low. Initially there was a discrepancy between forward and reverse grouping which resolved with saline washes. On further investigations like peripheral smear and bone marrow examination, the patient was diagnosed as a case of plasma cell myeloma. In our case the blood grouping revealed type III ABO discrepancy which upon further investigation was found to be a case of plasma cell myeloma. Key Messages: Plasma cell myeloma has varied presentations. In our case, the patient presented with severe anaemia, plasma cells in peripheral blood and type III ABO discrepancy. Rouleaux formation should not be interpreted as agglutination. Careful vigilance by technicians in blood bank and thorough knowledge regarding various discrepancies will help in the management of the patient. Keywords: ABO discrepancy, Agglutination, Anaemia, Plasma cell myeloma, Rouleaux.

Introduction: Diseases affecting lymph nodes form a wide range of spectrum, from simple infection to malignant pathology. A panel of IHC markers is decided based on morphologic differential diagnosis. Aims and Objectives: To study the incidence of lymph nodal lesions with respect to age and sex and their different histopathological patterns. To use Immunohistochemistry (IHC) for sub typing of neoplastic lesions. Materials and Methods: This study was done for a period of two and a half years in the Department o f Pathology, from Jan 2017 to June 2019. All the specimens received were fixed in 10% formalin and routinely processed and stained with Hematoxylin and Eosin (H&E.) Results: A total of 230 lymph node biopsies were studied. Age distribution varied from 3 to 83 years with female preponderance. Non – Neoplastic lesions were common comprising of 120 cases (52%) while neoplastic lesions were 110 (48%). Among non neoplastic lesions reactive lymphadenitis (23%) was common followed by tuberculous lymphadenitis (21%). In neoplastic lesions, metastatic diseases (20%) predominated. IHC was done wherever necessary for subtyping of lymphomas and also to differentiate lymphoma from carcinoma. Conclusion: Lymph node biopsy with IHC plays an important role in establishing the cause for lymphadenopathy and thus aids in therapy. Keywords: Lymph node, Immunohistochemistry, Non-neoplastic, Neoplastic.

Introduction: Multiple myeloma accounts for 1% of all cancers and 10-15% of all hematologic malignancies. It is characterized by bone marrow infiltration with clonal plasma cells, production of monoclonal immunoglobulin, and associated end-organ damage. The study aims to find out the incidence of multiple myeloma and to study the clinico-hematological profile along with radiological features. Materials and Methods: The present study was done both retrospectively and prospectively in 26 patients of multiple myeloma diagnosed over a period of 2 years from June 2017 to June 2019 in our teaching hospital. Data from hematological, biochemical, and radiological investigations were collected. For evaluation of each case, revised International Myeloma Working Group criteria were applied. Results: 26 patients were diagnosed during the study period, with the majority of them in the 6th decade with age range was 41-74 years. The male to female ratio was 1.3:1. Most common clinical feature was fever (50%) followed by bone pains (42%) and generalized weakness (42 %). Anemia was the most common hematological manifestation. All the patients had ‘M band’ on serum electrophoresis, and 27% of patients had urinary Bence Jones proteins. Among the skeletal system, the spine (63%) is the most common site of involvement. Conclusion: Among the 26 patients, various clinical presentations observed were pathological fracture, infections, renal impairment, generalized weakness in addition to anemia, and bone pains. Multiple myeloma should be considered as a differential diagnosis in old age patients presenting with such complaints. Keywords: Myeloma, Anemia, M band lytic lesions, Bence Jones protein.

Introduction: Retroperitoneum can show a wide spectrum of diseases, including a variety of rare benign and malignant neoplasms that can be either primary or metastatic. Most retroperitoneal tumors are malignant, and soft tissue sarcomas account for one third of the cases. The most common sarcomas occurring in the retroperitoneum are Liposarcomas, Malignant Fibrous Histiocytomas, and Leiomyosarcomas. Subtyping of these tumors is important for the different targeted therapeutic options available. Aims and Objectives: To study the distribution of benign and malignant retroperitoneal tumors. Materials and Methods: Study design – Prospective study done in the department of Pathology from January 2013 to December 2017. Immunohistochemistry (IHC) was done wherever necessary. Results: A total of 62 retroperitoneal tumours were studied of which 19 were benign & 43 were malignant. Rare benign tumors encountered were Adrenal Myelolipoma, Benign Fibrous Histiocytoma, Fibrolipomatous Hamartoma and multiple Paragangliomas. Rare malignant tumors were adult onset Wilms’ tumor, De-differentiated Liposarcoma, Epithelioid GIST, malignant GIST of the mesentery and Carcinosarcoma of Kidney. Conclusion: Amongst the retroperitoneal tumors received, malignant tumors were higher in distribution than benign tumors. The commonest epithelial tumor being Renal Cell Carcinoma and mesenchymal tumor being Liposarcoma. The study of rare malignant tumors was done with the help of IHC markers. Keywords: Retroperitoneum, Sarcoma, Immunohistochemistry, Epithelial, Mesenchymal, Rare tumors.

Context: Tumor budding refers to single or small cluster of tumor cells detached from the main tumor mass in histological sections. In colon cancer high tumor budding is associated with worse prognosis, correlates with metastatic lymph nodes and is included in the protocol for reporting colectomy specimens. We studied tumor budding in mastectomy specimens of cases of breast carcinoma of no special type (NST)to evaluate its utility as a prognostic factor by correlating tumor budding, both intratumoral and peripheral tumoral, with other known prognostic markers of breast cancer like lymph nodal metastasis, tumor size, lymphovascular emboli and grading. Aims:To evaluate tumor budding in invasive ductal carcinoma (IDC) NST with: l.ymph node metastasis; 2.lymphovascular invasion (LVI); 3.Grading by Nottingham modification of Bloom-Richardson (NBR) and other prognostic parameters like age, tumor size, and ER status. Methods and Material: The present study is a prospective study of all Modified Radical Mastectomy (MRM) specimens received and examined from 1st January 2018 to 30thJuly 2018. Along with tumor budding various prognostic parameters were evaluated. Immunohistochemical marker Pancytokeratin was utilized for counting the tumor buds, wherever necessary. Statistical Analysis: Chi Square test was utilized to study significant differences between variables. A p value < 0> Results: A greater number of tumor buds both intratumoral (ITB) and peritumoral (PTB) were associated with lymph node metastasis and lymphatic invasion whereas ITB also correlated with NBR grading. Conclusion: In our study we detected the association of high tumor budding, both ITB and PTB in invasive ductal carcinoma (NST) and also noted association with known poor prognostic markers. Hence our results highlight the importance of tumor budding as a prognostic factor and submit that this histological feature could be included indiagnostic protocols just as in carcinoma of the colon. Keywords: Breast cancer, No special type, Tumor budding, Prognosis, Lymphatic invasion.

Introduction: Polyps begin as small elevations of the mucosa and polyps are most common in the colorectal region. The neoplastic polyps are important because they have a risk of transformation into malignancy. The role of the Pathologist is to identify any dysplastic changes and inform the clinician regarding the risk of development of carcinoma. Materials and Methods: This is a retrospective analysis of polyps and polypoid lesions of 5 year duration from January 2013 to December 2017. The biopsies were stained with Haematoxylin & Eosin and studied under light microscope. Results: 107 cases of gastrointestinal polyps and polypoid lesions were included in our study. Hyperplastic polyps were the most common polyps found in our study. The most common site was rectum and stomach. Variety of lesions included in our study are multiple Peutz Jeghers (PJ) polyps, adenocarcinoma arising in PJ polyp, neuroendocrine tumours, and an angiomatous polyp. Conclusion: Gastrointestinal polyps are divergent lesions. Differentiation of neoplastic polyps from non-neoplastic polyps is important in view of adenoma- carcinoma sequence developing in neoplastic polyps. Identification of hamartomatous polyps is also crucial since they are associated with syndromes and may unusually transform in to cancers. Pathologists play a key role in diagnosis of neoplastic polyps and polyps associated with syndromes. In our study hyperplastic polyps were most common with a variety of other lesions. Keywords: Gastrointestinal polyps, Peutz Jeghers polyp, Peutz jeghers syndrome, Polypoid lesions.

Introduction: Histopathology reports should provide clinicians with diagnostically accurate and medically useful information to afford the best management to the patients. Aim and Objectives: To make a comparative assessment of interpretation and use, of the common descriptive phrases found in histopathology reports between clinicians and pathologists, to interpret the degree of certainty among these phrases and to know the preferable phrase by clinicians and the most common phrase used by the pathologists. Materials and Methods: A questionnaire was constructed using eight most commonly used descriptive phrases found among 1500 randomly selected histopathology reports from 2017 histopathology register, department of Pathology. This was to compare the interpretation, use and preferences of the descriptive phrases found in histopathology reports. Four groups with 25 members in each were included in the questionnaire and were asked to assign a score from 0 to 5 for these phrases to know the diagnostic level of certainty. The groups were consultant clinicians, consultant pathologists, clinical postgraduate students and pathology post graduate students. Statistical analysis was done by calculating standard deviation, student t-test and by p value. Results: There was a wide variation in individual interpretation of phrases among the groups. The preference of usage of these phrases by pathologists and by clinicians was diverse. Conclusion: The adoption of limited number of descriptive phrases that are mutually understood and acceptable for use by both the pathologists and clinicians is recommended to avoid interpretive ambiguity in histopathology reports. Keywords: Ambiguity, Histopathology reports, Phraseology, Questionnaire.

Introduction: In addition to its primary benefit as a cancer screening test, other benefits of Pap test include detection of cervicovaginal microorganisms. Very few studies have been performed in our country to compare Liquid based cytology (LBC) and Conventional papanicolaou smear (CPS) for detection of cervicovaginal infection by microorganisms. Materials and Methods: Our study focuses on non neoplastic findings which correlate to the presence of Microorganisms- Trichomonas Vaginalis, Candida Species, Bacterial Species, Actinomycosis Species, and Herpes simplex virus. Papanicolaou smear by conventional and liquid based cytology have been used to study effectiveness of each method in diagnostic cytology. A comparative prospective study from March 2017 to May 2017 of 45 split samples for comparing effectiveness of liquid based Thin-layer preparation with that of conventional papanicolaou (Pap) smears to demonstrate microorganisms in cervicovaginal smears was undertaken. These two methods have been compared for reporting the presence of microorganisms, essential for a complete diagnostic evaluation of cervicovaginal specimens by the 2001 Bethesda system under the specific category of "Organisms". Results: Altered Flora (AF) Bacterial Vaginosis (BV) in CPS and by LBC were reported. Candidal infection, Trichomonas infection and Leptothrix were compared in CPS and LBC preparations. The comparison showed that Candidal hyphae were more easily seen on LBC while the Candidal yeast forms are more easily detected on CPS. Trichomonas & shift of vaginal flora are detected more easily on CPS than on LBC preparations. Conclusion: Our findings suggest utility of both methods for the detection of microorganisms commonly seen in cervical cytology practice. Keywords: Papanicolaou, Smear, organisms, Bethesda, Liquid based.