Sateesh Chavan S

Abstract

Aim: To study patterns of granulomatous inflammatory lesions and role of various diagnostic modalities in their diagnosis. Introduction: Granulomatous inflammatory lesions encompass a wide spectrum of common and rare etiologies with diagnostic and management dilemma. Pattern analysis of granulamatous response aid in understanding their pathogenesis, immune responses to infection, regulation of such responses, and their effects on tissues. Newer diagnostic modalities like immunohistochemistry, special stains, polarizing microscopy, serum assays and ELISA aid in establishing the final diagnosis. Materials and Methods: Histopathological study of 300 granulamatous lesions was done. Special stains like ZN, GMS, PAS, FiteFaraco, Auramine Rhodamine stain and polarizing microscopy, tools of molecular biology like IHC, PCR, and ELISA were used wherever required to establish the etiology. Observations: Mean age at presentation was 31.85±14.64 years (range: 2-68yrs) with male preponderance (M: F=1.47:1). Majority of patients were in the 3rd decade between 21-30years (108 cases, 36%). Tuberculosis was the most common cause of granulomatous inflammation followed by tumors, fungal lesions, leprosy, inert substances, parasitic and least was granulomas with unknown etiology. Conclusion: Present study is an attempt to describe the histopathology of various granulomatous inflammatory lesions and their accurate etiological diagnosis. Molecular diagnostic methodology is essential for accurate etiological diagnosis and understanding the pathogenesis of granulomatous inflammation. Keywords: Patterns, Granulomatous, Inflammation, Epithelioid, Tuberculosis, Histiocytic.

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Abstract

Aim: To know the incidence of various gastric neoplastic lesions and their clinical presentation, risk factors and histomorphology. Materials and Methods: Study included all histopathologically confirmed neoplastic lesions of stomach including both endoscopic biopsies and resected specimens, biopsies showing significant dysplasia and intraepithelial neoplasia without inflammatory changes. Results: Of the total 55 gastric specimens (44 endoscopic biopsies & 11 resected specimen), 50 cases were neoplastic (90.90%) and the remaining 5 cases (9.09%) showed intraepithelial neoplasia/dysplasia. Most common age group affected was 6th decade and men affected twice as common as women with M:F ratio being ~ 2:1. Most common presenting complaint was dyspepsia and abdominal pain. Most common site of gastric malignancy was pyloric antrum and least common site being greater & lesser curvatures. Most common growth pattern of gastric malignancies was ’ulcerative’ and least being ‘polypoidal'. Adenocarcinoma (94%) was the most common malignancy followed by lymphoma (4%) and carcinoid (2%). The commonest site of adenocarcinoma was pyloric antrum (64%) followed by cardia (16%) and body (8%). The most common histological type was ‘intestinal type’ (44.68%, 21 cases) and least common being ‘papillary type’ (2%, 1 case). Conclusion: When compared with earlier studies, the incidence of adenocarcinoma in cardia and of signet ring cell carcinoma is on the rise. The present study is not free from limitations such as ‘false’ positives, ‘fewer’number of biopsies from representative area and inadequate ‘follow up’. Keywords: Gastric adenocarcinoma, Signet ring cell carcinoma, Intestinal type, Diffuse type.

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