Rajalakshmi V

Abstract

Introduction: The lymph node biopsy plays an important role in establishing the cause of lymphadenopathy. The distribution of lymphomas is varied in different geographic regions. The 2016 revision World Health Organization classification of lymphoid neoplasms is used to classify lymphomas. Aims: To study retrospectively the spectrum of histopathological diagnosis in lymph nodes at our institution, diagnostic utility of immunohistochemical markers in the subtyping of both nodal and extranodal lymphomas and to correlate the histopathology and immunohistochemistry. Materials and Methods: We retrospectively reviewed lymph nodes between 2012 and 2017, analysed the distribution of cases and classified lymphoma according to the revised 2016 World Health Organization classification of lymphoid neoplasms and compared with other studies. Results: The distribution of various cases from 235 lymph nodes were as follows: 27% of granulomatous lymphadenitis, 25% of reactive lymphoid hyperplasia, 24% of metastatic deposit, 17% of lymphoma, and 7% of miscellaneous category that included progressive transformation of germinal centres, Kimuras disease, extramedullary hematopoiesis, kikuchi lymphadenitis, neuroendocrine tumor, schwannoma. B-cell lymphomas outnumbered T- cell lymphomas. The statistical parameters were compared between histopathology and immunohistochemistry. Sensitivity, specificity, diagnostic accuracy, positive predictive value and negative predictive value were calculated. Conclusions: Lymph node biopsy helps in establishing the cause of lymph node enlargement. The distribution of lymphomas in India is varied when compared to the rest of the world. Immunohistochemistry plays an important role in subtyping lymphomas. Keywords: Lymphoma, WHO classification, Immunohistochemistry, Lymph node.

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Abstract

Introduction: The aim of this study was to review the clinicopathological features of lymphomas of stomach and intestine, reported in a tertiary care hospital, for a period of two years. Among the total 454 reported cases of gastrointestinal malignancies, 60 cases were categorized as poorly differentiated neoplasms of stomach and intestine, were included in the study. Immunohistochemical analysis was done in all cases, by using carcinoembryonic antigen, CD 20, synaptophysin and chromogranin A. Results were analysed, in the total 60 cases of poorly differentiated malignancies, 12 cases were proved to be B – cell non-Hodgkins lymphomas with the stomach being the most common site. Keywords: Gastrointestinal malignancies, Poorly differentiated neoplasms, Carcinoembryonic antigen, CD20, Poorly differentiated adenocarcinomas, Non-Hodgkins lymphomas.

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Introduction: Frozen section (FS) helps the surgeon in the surgical management of the patient by helping in the intraoperative diagnosis of tumors, margins and lymphnode assessment, and organ identification. Audits of the frozen section consultations help in identifying the pitfalls and to carry out appropriate preventive measures for its optimal usage. We report the results of the study of our FS consultations. Materials and Methods: A retrospective study of 518 specimens from 132 consecutive cases of FS consultations was carried out. The FS report and formalin fixed tissue reports were compared and analyzed. The results were categorized into concordant, discordant and deferred consultations. Causes of discrepancy were analysed and diagnostic accuracy, diagnostic error rates, sensitivity, specificity, indications, tissue type, turnaround time and limitations were noted. Results: An average of 3.92 specimens per patient was received with 80(60.61%) males and 52(39.39%) females. Age ranged from 15 to 80 years. Male and female general surgical departments were the major contributors with 64 (48.48%) and 25 (18.94%) consultations respectively. Oropharyngolaryngeal region (48.84%) was the main site sampled. The main indication was margin status assessment (52.27%). Accuracy rate was 98.65% with an error rate of 1.35% was observed. The discordant cases had misinterpretation error in 5 cases and sampling errors in the remaining 2 cases. Three cases (0.58%) were deferred. Sensitivity (90.91%) and specificity (96.59%) was obtained. Conclusions: The study turned out as a quality check and identified the areas requiring improvement to reduce the error rates. Keywords: Frozen section, Retrospective study, Accuracy, Error, Margin status, Sensitivity.

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