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BACKGROUND Abnormal Uterine Bleeding (AUB) is defined as any bleeding that does not correspond with the frequency, duration or amount of blood flow of a normal menstrual cycle. It is the commonest presenting symptom and major gynaecological problem responsible for as many as one-third of all outpatient gynaecologic visit. Aim of the present study was to find out the histopathological pattern of endometrium in Abnormal Uterine Bleeding (AUB). METHODS Specimens received as endometrial curettage, and hysterectomy specimens were studied followed by correlation of histopathology with age, parity and clinical presentation. RESULTS The patients were mainly from the age group of 41 - 50 years (43.25%). Most of the patients were multiparous (81.2%). The most common menstrual disorder was menorrhagia (57.12%). In abnormal uterine bleeding the most common histological pattern of endometrium was proliferative endometrium (38.7%) followed by secretory phase (22.1%) and disordered proliferative endometrium (13.3%). Endometrial carcinoma cases were 0.5% and there was one case (0.2%) of carcinosarcoma. CONCLUSIONS Histological study of endometrium, along with a thorough clinical history and detailed physical examination, should be promptly done for every case of abnormal uterine bleeding, especially in peri- and post-menopausal women.

Background Cysticercosis is a zoonotic disease. It is caused by the larval form of the pork tapeworm Taenia solium. This disease is a public health problem in a country like India, but its incidence is underestimated. With the advent of fine needle aspiration cytology with rapid on-site evaluation, early detection of this disease is possible, especially when the lesion is in anatomically approachable superficial locations. Case report We had four cases of cysticercosis diagnosed by fine needle aspiration cytology with on-site evaluation using toluidine blue stain, followed by Giemsa and Papanicolaou stain. Our cases included three Hindu male patients of age 30 years, 23 years, 17 years and an 26 year old Hindu female. Conclusion Fine needle aspiration cytology diagnosis of cysticercosis can be easily made provided the reporting cytologist is aware of the morphological criteria. Rapid on-site evaluation can further help in taking additional material and caution during staining process.

BACKGROUND Myeloperoxidase (MPO) staining is a cytochemical stain was the first step in morphological characterization of two basic types of Acute leukemia.1,2 Until recently when the procedure was eliminated from the diagnostic protocol because of the proven carcinogenic potentiality of Benzidine. In advanced laboratories the procedure is now replaced by immunocytochemical demonstration of MPO. The main disadvantage of immunocytochemical stain is cost associated with the procedure, hence it is not possible for use in developing and under-developed countries. Besides the carcinogenic threat, the routine MPO staining procedure is also time consuming. The present study was aimed at, evaluating the new method that, successfully removes the use of the benzidine by DAB which has uncertain carcinogenic potentiality. MATERIALS AND METHODS 130 blood smears both peripheral blood smears and bone marrow aspirate smears were stained by the routine benzidine method and new DAB method and evaluated for stain intensity, cell morphology and background by two pathologists and each parameter was graded from 1 to 3. The total score for each case was calculated and compared using statistical formulae. RESULTS The new test has the additional advantage of being simple and less time consuming with excellent staining properties. CONCLUSION The newer technique using DAB was found to be a better procedure with good staining qualities, easy to perform as the liquid solution is stable and it is not an established carcinogen.

Background: The bone marrow examination is an essential investigation for the diagnosis and management of many disorders of the blood and bone marrow. The aspirate and trephine biopsy specimens are complementary and when both are obtained, they provide a comprehensive evaluation of the bone marrow. The present study was conducted to compare the role of trephine biopsy with bone marrow aspiration for effectively diagnosing wide spectrum of hematological diseases. Few studies have compared the relative value of aspirate with trephine biopsy.Materials & method: This is a three year observational study undertaken in Dept. of Pathology, MKCG MCH, Berhampur,Odisha. A total of 370 cases presented with haematological disorders, of which only 126 patients had undergone trephine biopsy and correlation was done with aspiration in these patients.Results: Of a total 370 patients, both BMA & BMB were performed on 126 patients (71 male & 55 female). Commonly encountered diseases were AML (17%), IDA (11%), ALL (9%), others (9%), CML (8%), MA (6%) accounted for maximum no. of cases. Others group included TB, NPD, Metastatic Diseases such as SRBCT, NHL& Neuroblastoma. Patients from 2 months to 80 years old were encountered in the study. BMB was diagnostic in 100% cases. In comparison BMA, a positive diagnosis was made in 80% (101) cases, suggestive in 6.3%(8) cases &negative in 13.4% (17) cases. BMB was superior to BMA in diagnosis of MF (2%), ALL (4%), Others (9%) where BMA aspirations yielded a dry tap / diluted marrow. In the present study BMB was advantageous in diagnosis & staging in 19%(25) cases. Additional advantages of BMB noted in the present study were assessment of cellularity, detection of ALIP, assessment of fibrosis, nodular/diffuse/focal patterns of involvement, metastatic deposits, and granuloma could be identified in BMB.Conclusion: The decision whether to perform a BMA alone or in combination with BMB rests on the diagnostic possibilities. In IDA, ITP & Acute leukaemia’s where cellular morphology is desired aspiration is best. BMB is superior when assessment of cellularity, detection of ALIP, assessment of fibrosis, nodular/diffuse/focal patterns of involvement, metastatic deposits, granuloma, with the use of IHC on BMB samples the accuracy in diagnosis of Lymphoma, AML/ALL, MM & Metastatic Diseases can be made. Thus BMA & BMB should always go hand in hand.DOI:10.21276/APALM.1627

BACKGROUND Among the unexpected and undiagnosed sudden deaths, incidence of Ischaemic Heart Disease (IHD) is very high. Appearance of characteristic morphological and histopathological changes in the myocardium due to IHD is often delayed. As such, opining as to the cause of death at autopsy also becomes very difficult. The objective of the present study is to evaluate the role of gross morphological, histopathological and biochemical (Cardiac Troponin I) parameters in ascertaining the cause of death to IHD. MATERIALS AND METHODS The present study was a prospective study carried out on a total of 63 consecutive bodies received for post-mortem examination with the history of sudden deaths. After opening the thoracic cavity, blood sample was collected from the cardiac chambers and used for cardiac Troponin I level estimation. A thorough gross examination was done in all the cases and tissue bits from representative sites were histopathologically evaluated. RESULTS Out of the total 63 cases, 38 had past history suggestive of IHD. Characteristic gross morphological changes were found only in 58% of cases whereas with the addition of histopathological findings 84% cases could be diagnosed. Cardiac Troponin I level was elevated i.e. tests positive in all the 38 cases with history suggestive of IHD whereas the remaining 25 cases without prior history of IHD were found to be negative. CONCLUSION Estimation of serum Cardiac Troponin I levels has been found to be a very useful and sensitive marker of early ischaemic damage to the heart particularly when there is lack of gross morphological and histopathological findings. This could be a significant diagnostic parameter coupled with gross morphological and histological changes in sudden deaths relating to IHD.

BACKGROUND Breast carcinoma is the most common non-skin malignancy in women. More recently, it has been suggested that extracellular proteinase regulates growth factors and cytokines that might contribute to tumour progression. Since CD10 is a cell surface metalloproteinase which inactivates various biologically active peptides, it might facilitate cancer cell invasion and/or metastasis. MATERIALS AND METHODS 48 cases of Invasive Breast Carcinomas were taken up for the study along with 5 cases of benign tumour as a control group (fibro adenoma and phyllodes). Statistical Analysis: For all statistical data chi-square test was applied using IBM SPSS Statistics 20. RESULTS CD10 was found to be positive in 89% (n=43) cases of which 30.3% (n=13) cases showed weak immunoreactivity whereas strong immunoreactivity was observed in 69.7% (n=30) cases. Stromal CD10 expression correlated with well-established prognostic markers, i.e. higher tumour grade (P

BACKGROUND Anaemia is the most common symptom in the developing countries including India where under nutrition is prevalent besides haemoglobinopathy is also prevalent in this geographic region. Haemoglobinopathies especially thalassaemia minor present in the paediatric age group with microcytic hypochromic anaemia and hence often misdiagnosed and treated wrongly as iron deficiency anaemia. Simpler cost-effective techniques like study of haematological indices by performing Complete Blood Count (CBC) and in suspicious cases haemoglobin electrophoresis the exact diagnosis can be established at the earliest. MATERIALS AND METHODS Under aseptic condition, 5 mL of blood collected in K2EDTA Vacutainer. One part was analysed in cell count analyser. Other part was used to prepare hemolysate and subsequently gel electrophoresis. RESULTS Gel Electrophoresis is done in 210 cases of microcytic hypochromic anaemia which is detected by haemogram assay, 21% of cases were diagnosed to be thalassaemia and 79% were iron deficiency anaemia. CONCLUSION Iron-Deficiency Anaemia (IDA) is the commonest cause of microcytic hypochromic anaemia, the second being thalassaemia. Differential diagnosis is based on complete haemogram and peripheral smear. Serum iron profile study and haemoglobin electrophoresis are must for confirmation of diagnosis.

Background: Hemoglobin disorders are the leading health concern in the world including India. There is a paucity of literature on the spectrum of hemoglobin disorders in southern districts of Odisha state. This study was undertaken to elucidate the occurrence of different hemoglobin disorders in a tertiary health care facility of Odisha state, India. Methods: The study cases were suspected patients of all age groups advised for screening of different hemoglobin disorders. Hemoglobin disorders were screened by sickling slide test and high-performance liquid chromatography (HPLC) using the Variant-II hemoglobin testing system as per the manufacturer's guidelines. Results: Over 2 years, 2332 blood samples (including 1102 pediatric and 1230 adult cases) were investigated, out of which, 1380 (59.2%) of cases had abnormal hemoglobin disorders. The most common was sickle cell disorders (48.67%, 1135/2332) followed by β-thalassemia (11.32%, 264/2332). Some rare variants were detected as hemoglobin D-Punjab, hemoglobin E, hemoglobin Lepore, hereditary persistence of fetal hemoglobin, hemoglobin with high P2 window, hemoglobin with high P3 window etc, Among the cases with abnormal hemoglobin disorders, 744 (53.9%), 545 (39.5%) and, 91 (6.6%) cases were found to have the heterozygous, homozygous and, double heterozygous state. Of the 188 ante-natal cases screened, 31.4% of cases had abnormal hemoglobin variants with sickle cell disorders being the most prevalent one. Conclusion: Along with the high occurrence of sickle cell disorders in the study area, some other rare hemoglobin disorders are also prevalent which calls for a large community-based cohort study.

Carotid body tumors (CBTs) are paragangliomas which arise from the chief cells of the carotid body, usually located at the bifurcation of the common carotid artery. A 45-year-old male presented with swelling over the right cervical region for 1 year. Based on location, FNA and radiologic investigations, the diagnosis of CBT was made; later, confirmed on histopathology. Although FNA is seldom suggested due to its location and possibility of severe bleeding complications for the diagnosis of CBT, it can however be detected incidentally. Our case, the diagnosis was incidental cytological diagnosis on rapid onsite staining.

PJS is an autosomal dominant genetic disease associated with melanin pigment spots on the oral mucosa, lips, nasal alae, palm and soles, as well as hamartomatous polyps in the alimentary canal. Polyps are often a cause of intussusception in the affected patients. Cancers of gastrointestinal system, uterus and breast are common in patients with PJS. Long-term follow-up is required to prevent intussusception in children and cancer in adults. We report a classical case of Peutz–Jeghers syndrome presenting with jejunoileal intussusception in a 9year old child.

Background: Hydatidosis is parasitic infestations caused by the larva of tapeworm Echinococcus species. Its relevance lies in its wide geographic distribution with high prevalence rate and its significant morbidity. Case presentations: We report two cases of hydatid cyst 1) orbit and 2) spleen. In both the cases there was no clinical suspicion of any parasitic origin. Conclusions: The purpose of this paper is to emphasize the fact that this disease should be suspected in cystic lesions in all organs of the body, especially in endemic areas of the world. Keywords: Hydatid cyst, Echinococcus, Orbit, Spleen

BACKGROUND Infertility continues to be a significant problem since ages. Studies suggest that the problem affects 8-12% of couples across the globe, and among these affected couples, approximately 50% cases are contributed by the male partner. Semen analysis is the first investigation that indicates towards male factor in infertility. Finding the cause of infertility in cases of severe oligozoospermia and azoospermia by evaluating testicular biopsies has now become essential with the availability of Assisted Reproductive Techniques (ART), which gives information about the level of spermatogenesis. The present study was undertaken to detect the histological findings in cases of male infertility in this geographic region. MATERIALS AND METHODS A prospective cross-sectional study was undertaken in which testicular biopsies received from 52 infertile male patients with seminogram impressions of very severe oligozoospermia and azoospermia constituted the study group. Detailed clinical data including the LH. FSH and testosterone hormone levels were recorded. Tissue samples were routinely processed and Haematoxylin and Eosin stained were made. Modified Johnsen scoring was used to categorise each case. RESULTS 86.5% cases in the study group were found to have azoospermia and rest 13.5% cases had severe oligozoospermia. All the cases were histologically classified into six categories- obstructive pathology 25 of 52 cases (48.1%), pure germ cell aplasia 14 of 52 cases (26.9%), maturation arrest 7 of 52 cases (13.5%), atrophic testis 4 of 52 cases (7.7%), hypospermatogenesis 1 of 52 cases (1.9%) and inconclusive in 1 of 52 cases. Serum FSH and serum LH levels were found significantly raised in cases of pure germ cell aplasia and atrophic testis in contrast cases of obstructive aetiology had normal levels. Modified Johnsen scoring values were 9 in cases with obstructive pathology, 1/2 only in cases of pure germ cell aplasia and atrophic testes and 3 to 6 in cases of maturation arrest. CONCLUSION The present study concludes that testicular biopsy is of value in determining the level of spermatogenesis as well as the cause of infertility. The former information will help in deciding the mode of assisted reproductive technology suitable for the individual.

Primary squamous cell carcinoma (SCC) of the vagina is a rare entity in gynecological oncology. The tumor should be considered as primary vaginal carcinoma when the cervix is not involved. We report a case of primary squamous cell carcinoma of the vagina in a 62-year-old lady by histopathology. Cervix, endometrium and ovaries were meticulously examined to rule out a primary in these organs. She was then treated by radiotherapy. The rarity of the tumor and extremely strict criteria for diagnosis of primary squamous cell carcinoma in vagina tempted us to report the case.

Background Filariasis is a common cause of morbidity in certain parts of India, especially in the Coastal Districts. Repeated episodes of fever with chills and rigor, lymphadenopathy are the initial manifestations which gradually progress to elephantiasis. Wuchereria bancrofti is the most common parasite causing lymphatic filariasis in India. Detecting microfilaria in peripheral blood with or without Diethylcarbamazine citrate provocation is the common diagnostic modality in suspected cases. However microfilaria has been accidentally detected in fine needle aspirates, aspirated body fluids and even in bronchial washings. Case presentation We report a case of 65-year old female presented with back ache. On investigation she had leuco-erythroblastic blood picture in the peripheral smear and metastatic deposits in the bone marrow aspirate. W. bancrofti microfilariae was an incidental finding in the bone marrow aspirate. Conclusion Finding of microfilariae in the bone marrow aspirate in the absence of clinical features of lymphatic filariasis is extremely uncommon and mostly are incidental findings. The peripheral blood may or may not reveal the microfilariae and eosinophilia in the peripheral blood is absent in majority of the cases. All the bone marrow aspirates must be screened for microfilariae in the endemic areas to identify the asymptomatic carriers.

Nodular hidradenoma or clear cell hidradenoma are tumors of sweat gland usually seen in 20-50 years age group with female preponderance. We report a case of 45 year old female who came for FNA with a clinical suspicion of sebaceous cyst. Cytosmears showed fairly cohesive groups of uniform, oval to polygonal cells some of which showed cytoplasmic clearing. The cells were lying in a mucoid background along with good number of cyst macrophages. Cytological impression was benign adnexal tumor possibly cystic eccrine hidradenoma which was confirmed on histology as nodular hidradenoma. Cytohistological correlation readily allows differentiation of this unusual neoplasm from other benign and malignant mimics of skin tumours. The prognosis is excellent following excision.

Breast cancer is the first in the incidence of malignancies among women. The documented frequency of osseous metastasis from breast cancer is about 12.8 %. Although breast cancer cells have been documented in the bone marrow in autopsy, haematological manifestations due to metastatic disease to the marrow is rare. The prognosis of these cases is dismal and improper management worsen the condition further. IHC for ER, PR & Her 2/neu status plays a vital role in ascertaining the treatment protocol both in primary tumors as well as metastatic or recurrent tumors. Receptor conversion has been documented in metastatic and recurrent cases. We report a case of 65 year female with a history of ER, PR positive and Her 2/neu negative carcinoma breast 3½ years back, presented with anemia and low back ache diagnosed as metastatic breast carcinoma to bone marrow with receptor conversion.

Background The increased incidence of fungal diseases in humans is most likely due to indiscriminate use of broad-spectrum antibiotics and increased numbers of immunocompromised patients. Although Aspergillus species are ubiquitous and normally nonpathogenic, they can be opportunistic pathogens in immunocompromised individuals. Case A 22-year-old immunocompetent man presented with a gradually increasing subcutaneous swelling near the root of his nose for previous 6 months. The mass was soft to firm, solid, nontender and immobile. There was no superficial skin ulceration and no local signs of inflammation. Proptosis of the left eye was present without any visual impairment. An osteolytic lesion that was contiguous with the subcutaneous mass, with the opacities of both the fontal sinuses was observed radiographically. Fine needle aspiration cytology (FNAC) demonstrated presence of branching hyphae in the cytoplasm of multinucleated giant cells along with mixed inflammatory cells. The species was identified by culture in Sabouraud's agar with chloramphenicol and wet mount with lactophenol cotton blue stain. Conclusion Aspergillosis can remain dormant over a long period. Although uncommon, it can occur in immunocompetent patients. FNA is a very useful tool in establishing the diagnosis.

Tuberculosis is caused by Mycobacterium tuberculosis and affects primarily the lungs. Breast tuberculosis is a rare disease with an incidence of

Medullary breast carcinomas (MBCs) represent

Langerhans cell histiocytosis (LCH) also known as Histiocytosis X is a clinico-pathologic entity characterized by proliferation of Langerhans cells (LCs) throughout the body including the reticulo-endothelial system, bone& skin. LCs is currently considered as a distinct type of histiocytic cell, not primarily phagocytic in nature. Fine needle aspiration (FNA) is helpful in achieving a rapid and accurate diagnosis in an appropriate clinical and radiological setting. This can avoid unnecessary biopsy and guide the management especially where access to histopathology is limited. We report two cases of LCH in a 3 ½ year old & 6year old patients based on FNA from the site of swelling.

Enchondroma is a benign hyaline cartilage neoplasm arising in the medullary region of the bone. Most commonly involves short tubular bones. Most of the lesions are asymptomatic slow-growing lesions detected accidentally on the radiological examination or presents with pain secondary to pathological fracture. Fine-needle aspiration (FNA) is a quick, less invasive procedure and is of help in diagnosing these lesions. We report three cases of enchondroma, two involving phalanges of hand, one in humerus diagnosed by FNA and confirmed by histopathological study. The triad of clinical, radiological and cytological evaluation is imperative for the cytodiagnosis of this well-established entity.

Ancient schwannomas are rare benign encapsulated tumors of long standing duration. These tumors are usually solitary and may grow to a large size before detection of notable degenerative changes. The term “ancient schwannoma” is used to describe a schwannoma that has undergone changes such as relative loss of Antoni Type A tissue, perivascular hyalinization, calcification, cystic necrosis, hemorrhage and the presence of degenerative nuclear changes that may be misinterpreted as sarcomatous change. We report a case of ancient schwannoma in the left side neck.

Bone marrow necrosis (BMN) is a rare clinicopathologic entity caused by hypoxemia after the failure of microcirculation that frequently manifests with bone pain, fever, and peripheral cytopenia. In most reported cases of BMN resulting from extrapulmonary tuberculosis (TB), the presence of marrow granulomas, pulmonary infiltrates and/or extrapulmonary involvement are common. We report a case of an extensive BMN from miliary TB whose initial presentation was only mild anemia and multiple bone lesions.