Archive for the ‘ Pathology ’ Category



Ewing sarcoma/ PNET of the orbit is usually a metastatic tumor. Primary orbital Ewing sarcoma/ PNET is extremely rare with only 17 reported cases as per literature. One such rare case of a primary extraskeletal Ewing sarcoma/PNET of the orbit, which is an  extraordinary site for its occurrence in a 4year old boy, is presented here.



Introduction : India achieved the elimination goal of leprosy, at the national level with prevalence rate of 0.88/10, 000.In coastal districts of Andhra Pradesh the annual new case detection rate is 1.4/10,000. In District leprosy centers of Andhra Pradesh the diagnosis of leprosy is based on the number of patches¬† and nerve involvement .Bacillary load is not done routinely in all the cases by slit skin smears at the District leprosy centers. Early cases and atypical presentation of Hansen’s disease are likely to be missed at the District leprosy centers.

Aim :
1. To know the distribution of Hansen’ disease in the
three districts of coastal Andhra Pradesh.
2. To assess the
role of histopathology and Fite faraco stain in diagnosing various types of Hansen’ disease in correlation with
clinical features.

Materials and Methods : This is a prospective study for a period of one year from January 2008 to December 2008.The newly registered cases at the District leprosy centers were reviewed. The data was obtained from the records of respective district leprosy centers of the three districts of coastal Andhra Pradesh; Visakhapatnam, Vizianagaram and Srikakulum. Total number of new cases
registered in these three districts was 1050. These cases were analyzed with respect to modalities of diagnostic methods adopted and response to therapy. Out of 1050 new cases registered in 915 cases the diagnosis was made by the District Medical Officer with ease basing on the WHO guidelines using the clinical criteria of number of patches. These 915 cases were administered multidrug
therapy and were followed up at District leprosy center, with good response to therapy. In 135 cases the medical officers at District leprosy centers found it difficult to evaluate and manage the cases, hence the cases were referred to the dermatology department at the Medical College for evaluation and management. At the Medical College out of 135 cases referred from District leprosy center, in 92 cases a definitive diagnosis of leprosy was possible with clinical picture and slit skin smears. In 43 cases the results of slit skin smears did not correlate with clinical findings, hence skin biopsy was done in these forty three cases and sent for histopathological examination to the Department of pathology. The sections were stained with Hematoxylin and Eosin and modified Ziehl Neelsen’s (Fite- faraco) stain.

Results : In these three districts the newly registered cases of leprosy for a period of one year was 1050. Adult to child ratio was 4.4:1 and male to female ratio was1.3:1. In 87.14% of cases the diagnosis of leprosy was possible at the District leprosy centers basing on the WHO classification. In rest of the cases (12.85%), the diagnosis was not possible at District leprosy units and was referred to the tertiary care centre. Out of 135 cases referred from District leprosy units to the dermatology department at the Medical College, in
92 cases diagnosing of leprosy was made based on the clinical features and slit skin smears. Out of these 92 cases, in 37 cases the diagnosis was lepromatous leprosy and in 55 cases the diagnosis was tuberculoid leprosy. In 43 cases definitive diagnosis could not be made out, with the help of slit skin smears and these cases were biopsied and sent for histopathological examination. The overall
clinico histopatholgical correlation was 67.4%. Maximum number of cases showing clinico histopathological correlation were lepromatous leprosy (77.7%) followed by borderline tuberculoid (70.83%) and borderline lepromatous (66.6%). In fourteen cases
(32.5%), clinical diagnosis did not correlate with histopathology and bacillary index. In eight cases with clinical diagnosis of borderline lesions (borderline lepromatous and borderline tubercuolid) and two cases with clinical diagnosis of lepromatous leprosy, turned out
to be indeterminate leprosy on histopathology with bacillary index. One old case of treated Hansen’s disease ten years back, presented with a small nodule on the back with clinical diagnosis of dermatofibroma, histopathology combined with bacillary index showed the features of Histoid Hansen’s. Three cases with clinical diagnosis of leprosy turned out to be chronic dermatitis on histopathology
with negative bacilli.

Conclusion : Diagnosing polar groups of leprosy by clinical criteria at district leprosy center is very high but for accurate subtyping of borderline lesions, detecting early lesions of leprosy, histopathological examination and bacillary index is very essential. Hence in view of the decline in the prevalence of leprosy after multidrug therapy, and the basis of diagnosing leprosy being mainly on clinical  features, all the newly detected cases of leprosy registered at the District leprosy centers should undergo histopathological examination and measure the bacillary index in order to accurately subtype the lesions.



Introduction: Renal allograft biopsies have been used as a good marker for monitoring kidney transplant function. Histological analysis permits diagnosis of the cause of allograft dysfunction. Such an evaluation leads to the avoidance of the use of additional immunosuppressive drugs. Objectives: To evaluate the morphological patterns of percutaneous biopsies in renal allografts & to list and analyze the causes of graft dysfunction in this series of biopsies. Material &Methodology: Data from 35 biopsies (from 26 patients) over a period of 3 years and 9 months starting from Jan 2003 up to Sept 2006 in the department of Pathology, Salmaniya Medical Complex,Bahrain. Biopsy was done using discardable Tru-cut Travenol needles and examined by light microscopy following Hematoxylin & Eosin, Periodic acid-Schiff, Masson’s trichrome and Jones silver stains. The indications were graft dysfunction and oliguria in 17 cases, increased serum creatinine&blood urea in 6 cases, suspected cyclosporine / tacrolimus toxicity in 2 cases, and persistent fever with signs of sepsis in one case. Proteinuria was not taken as an indicator for allograft biopsy. Seven patients had more than one biopsy. A follow-up on the patients was done till December 2008. Results: Sex ratio: M: F 15:11. Acute cellular rejection in 11 biopsies was the most frequent diagnosis observed, followed by chronic allograft nephropathy in 11 biopsies, cyclosporine toxicity in 09 biopsies, glomerulonephritis in 04 biopsies, acute tubular necrosis was observed in 03 instances (overlap of cases). Vascular thrombosis / infarction were additional findings. Conclusion: Serum creatinine level is a useful indicator for the follow-up of kidney transplants. However this does not permit a differentiation between rejection and any other cause of allograft dysfunction. A renal allograft biopsy is therefore to date the gold standard in assessing the cause of renal allograft dysfunction.



Inflammatorymyofibroblastic tumor (IMT) of the colon is an extremely rar neoplasm. We report one such occurrence in a 55 year old male who presented with peritonitis and clinical diagnosis of carcinoma – caecum. On laparotomy, focal gangrene in caecum and ascending colon associated with perforation of the ascending colon were observed. Histological features were consistent with IMT of colon. A review of literature revealed the rarity of these lesions especially at an extrapulmonary site like gastrointestinal tract. While rare cases of IMTs in stomach and rectum have been reported, caecum is an extremely rare site. Recognition of these distinctive myofibroblastic neoplasms is very important considering their better prognostic implications as compared to sarcomas for which they are frequently mistaken. Besides this, because of their tendency for local recurrence, these cases should have a long term follow up and hence need to be distinguished and promptly identified.



Papillary cystadenocarcinoma of salivary glands is a rare tumor that generally arises in the major salivary gland, though its occurrence in minor salivary gland has also been reported. It is a malignant tumor that is known for recurrences. We report here a case of 58 years old male who presented with parotid swelling. Fine needle aspiration was performed on the recurrent lesion which
was reported as papillary cystadenocarcinoma.The diagnosis was subsequent l y confirmed on histopathology.

oral lichen planus- a report of two cases and review of the literature


Lichen planus, also known as Lichen RuberPlanus, is a common dermatosis that occurs on the skin and oral mucous membranes. Oral lichen planus(OLP) is a chronic inflammatory disease with a strong indication that its physiopathologic mechanism is autoimmune. The disease can affect any part of the oral cavity; however the lesions are frequently detected in the buccal mucosa. The mouth is involved in only one third of the cases, while another one third lesions are both oral and cutaneous.Lichen planus is considered to be a precancerous condition. In most cases, malignant transformation to carcinoma in situ (28.5%) and microinvasive carcinoma (30-38%) is observed, less frequently stage I and II arcinoma. Here we describe two different clinical types of OLP which has been diagnosed, treated and is under
follow up.

intestinal atresia secondary to ileal knotting of undescended testis


Intestinal atresia in a newborn is a known occurance. But intestinal atresia due to undescended testis is a very rare occurrence. Here we report a case of undescended testis which caused atresia of ileal segment of intestine.

neurofibromatosis in a 13 year old child -a case report


Neurofibromatosis is the term used to describe a group of¬†genetic disorders that primarily affect the cell growth of¬†neural tissues. At least eight forms of neurofibromatosis¬†have been recognized, the most common form being¬†neurofibromatosis type I (NF-I), or von Recklinghausen’s¬†disease of the skin. This report represents a case of¬†solitary neurofibroma with cafe au lait macules in a
13year old child.

cavernous hemangioma of the uterine cervix:a rare case report with review of literature


Despite the relatively common occurrence elsewhere,hemangiomas of the uterine cervix are extremely rare benign lesions. We present one such rare case in a 37 years old women who presented with menorrhagia. Per speculum examination revealed a cervical polyp.On microscopy, cervical polyp revealed a tumour composed of large dilated, irregular spaces filled with blood and
lined by endothelial cells suggestive of haemangioma.Most of them are reported as asymtomatic incidental findings, but it may cause abnormal uterine bleeding whichmaysometimes be uncontrollable.

Congenital leukemia in a newborn with down syndrome; a case report with review of literature


Congenital leukemia is a very rare disorder accounting for less than 1% of all c h i l d h o o d l e u k e m i a s . Tr a n s i e n t
Myeloproliferative Disorder (TMD) occurs in 4 to 10% of infants with Down Syndrome (DS) characterized by numerous circulating blast cells and spontaneous resolution within a few weeks. We present a 3day old male baby with DS presenting with clinical features of shock and  high percentage of blast cells in peripheral smear. This case is presented to highlight the clinical and laboratory diagnostic dilemma.

Histomorphological study of degenerative changes in leiomyoma of myometrium


Degenerative changes are encountered relatively frequently in uterine leiomyomas. The nature of the change varies according
to the degree and rapidity of onset of vascular insufficiency and is found in one or several of a group of fibroids. In some
instances degeneration is associated with acute and severe symptoms. All these features maybe encountered in malignant tumours and therefore thorough sampling of lesions with unusual gross appearance is imperative. Further, in the presence of extensive degeneration, it is difficult to identify the smooth muscle nature of the lesion. The present study is proposed to be
undertaken, because the gross and microscopic appearances of degeneration may simulate malignant tumors, the diagnosis of these tumors carry better prognosis requires detailed morphological study.