Background: Neoadjuvant chemotherapy (NACT) is widely used in the management of locally advanced breast carcinoma to downstage tumors and improve surgical outcomes. Histopathological evaluation of post-NACT specimens and assessing pathological response using the Miller–Payne grading system provides critical information regarding therapeutic response and prognosis.Methods: This cross-sectional study included 50 patients with biopsy-proven breast carcinoma who received two or more cycles of neoadjuvant chemotherapy followed by surgical excision. Post-therapy specimens were examined for nuclear, stromal, and inflammatory changes using routine hematoxylin and eosin staining. Tumor regression was graded according to the Miller–Payne system. Statistical analysis was performed using SPSS version 20, with p < 0.05 considered statistically significant. Result: The mean age of patients was 52.78 ± 10.43 years. Invasive ductal carcinoma, no special type, was the most common histological subtype (88%). A significant reduction in tumor size was observed following neoadjuvant chemotherapy, with mean tumor size decreasing from 4.87 ± 1.14 cm pre-NACT to 1.94 ± 1.16 cm post-NACT (p < 0.0001). Histomorphological changes included nuclear alterations in 60% of cases, stromal fibrosis or sclerosis in 52%, tumor necrosis in 64%, and inflammatory infiltrate in 90%. Pathological complete response was achieved in 14% of cases, while partial response was observed in 64%.Conclusion: Histopathological evaluation remains the most reliable method for assessing response to neoadjuvant chemotherapy in breast carcinoma. Therapy-induced nuclear and stromal changes correlate with pathological response and have important prognostic implications.
Introduction: Granulomatous appendicitis is rare, with infectious etiologies such as tuberculosis being significant especially in endemic regions. Schaumann bodies are classically associated with sarcoidosis and occasionally Crohn's disease but rarely reported in gastrointestinal tuberculosis. The coexistence of tuberculous granulomatous appendicitis and Schaumann bodies without granulomas in the intestine is exceptionally unusual. Case Report: A young male in his late thirties presented with acute appendicitis and incidental proximal ileal thickening. Histopathology of the appendix revealed non-caseating epithelioid granulomas and positive Ziehl-Neelsen staining, confirming tuberculosis. The patient commenced anti-tubercular therapy. Approximately 100 days later, he developed ileal stricture with perforation requiring resection and ileostomy. Histology of the ileal segment demonstrated distinctive Schaumann bodies within muscularis propria giant cells. However granulomas were not noted in the intestine. Typical histologic features of Crohn's disease as well as systemic features of sarcoidosis were absent.Discussion: This case highlights a rare presentation of tuberculous granulomatous appendicitis with concomitant Schaumann bodies in the small intestine, expanding the pathological spectrum of abdominal tuberculosis. Recognition of such histological findings is essential for accurate diagnosis and management in tuberculosis-endemic areas.
Aims: To investigate the prevalence and histopathological spectrum of renal lesions in autopsy cases at a tertiary care center to identify subclinical and unsuspected renal diseases.Methods: A retrospective descriptive study of 420 autopsy cases was conducted between January and December 2023. Renal tissues were fixed in 10% neutral buffered formalin, embedded in paraffin, and stained with hematoxylin and eosin (H&E) for microscopic evaluation.Results: Definitive renal pathology was identified in 140 cases (33.33%). Tubulointerstitial lesions were the most frequent findings (45%), with acute kidney injury (AKI) accounting for 38.57% of pathological cases. Other incidental findings included simple cysts (7.85%), glomerulosclerosis (5%), renal infarction (1.42%), and metastatic carcinoma (0.71%).Conclusions: Autopsy remains a critical tool for identifying silent renal pathologies, such as subclinical AKI and incidental malignancies, which contribute to improved clinicopathological correlation and quality assurance.
Background: Rheumatoid arthritis (RA) is a chronic autoimmune disorder that affects synovial joints. Monitoring the disease activity is essential for effective treatment and remission. While the Disease Activity Score 28 (DAS28) is commonly used, recent studies have suggested that haematological parameters from a complete blood count (CBC) may also indicate disease activity. This study evaluated parameters such as haemoglobin (Hb), red and white blood cell counts, platelets, and ratios (NLR, PLR, and MPV) across different levels of RA activity and assessed their predictive accuracy using ROC analysis.Methods: A cross-sectional study was conducted from January to April 2024 in patients with RA meeting the ACR/EULAR 2010 criteria. Patients with coexisting autoimmune diseases, infections, or hematologic disorders were excluded from the study. The CBC and DAS28 scores were reviewed. The patients were classified into four groups: remission, low, moderate, and high disease activity. Statistical analyses involved Kruskal-Wallis tests and multivariate logistic regression analyses. Receiver operating characteristic (ROC) curves were used to determine diagnostic performance. Result: Multivariate analysis identified Hb level, NLR, and MPV as independent predictors of RA activity. ROC analysis showed AUCs of 0.717 for Hb, 0.608 for NLR, and 0.679 for MPV, indicating moderate diagnostic value. CBC-derived parameters, particularly Hb level, MPV, and NLR, are correlated with RA disease activity. Their integration into routine assessment can enhance disease monitoring, cost-effectiveness, and wide accessibility.Conclusion: CBC-derived markers low haemoglobin with elevated NLR and MPV reflect increased inflammatory burden in RA. As these tests are inexpensive and widely available, they can complement DAS28 to improve accessible and cost-effective RA disease monitoring.
Background Gallbladder carcinoma is an uncommon but highly aggressive malignancy that frequently presents at an advanced stage due to nonspecific clinical manifestations. In a significant number of patients, the diagnosis is made incidentally following histopathological examination of gallbladder specimens removed for benign indications. Case Report A 62-year-old female presented with clinical features of acute cholecystitis and underwent cholecystectomy. Preoperative imaging did not reveal any evidence of malignancy. Gross examination of the gallbladder specimen showed inflammatory changes without a distinct mass. However, histopathological evaluation revealed a moderately differentiated adenocarcinoma infiltrating the gallbladder wall up to the subserosal layer, consistent with pT2 disease. Conclusion This case emphasizes the indispensable role of routine histopathological examination of all cholecystectomy specimens, as incidental gallbladder carcinoma may remain undetected on clinical and radiological evaluation alone.
Introduction Synovitis is a common manifestation of diverse inflammatory and non-inflammatory joint disorders. While clinical, radiological, and serological investigations aid diagnosis, they may be inconclusive, necessitating histopathological evaluation. Synovial biopsy remains the gold standard for etiological classification of synovitis. This study aimed to assess the histopathological spectrum of synovitis at a tertiary care hospital. Methods A cross-sectional study was conducted over 18 months, including 130 synovial biopsy specimens. Biopsies obtained by open or image-guided techniques were fixed in 10% neutral buffered formalin, routinely processed, and stained with hematoxylin and eosin. Special stains were performed where required. Data were analyzed using descriptive statistics. Results The mean age of patients was 33.06 ± 18.6 years, with a male predominance (60%). The knee joint was the most commonly involved site. Histopathological evaluation revealed septic arthritis as the most frequent diagnosis (29.23%), followed by tubercular synovitis (22.31%) and chronic non-specific synovitis (20%). Osteoarthritis (11.54%), rheumatoid arthritis (5.38%), and other less common entities constituted the remainder. Conclusion Synovitis demonstrates a wide histopathological spectrum, with infectious etiologies predominating in this cohort. Histopathological examination of synovial biopsy plays a pivotal role in definitive diagnosis and guides appropriate patient management.
Background: Transfusion-transmissible infections (TTIs) remain a significant concern for blood safety in developing countries. Monitoring TTI prevalence among blood donors reflects underlying community infection levels and supports safer transfusion practices. The study aimed at determining the seroprevalence, temporal trends, and demographic distribution of major TTIs (HBV, HCV, HIV, syphilis, malaria) among blood donors over a 5-year period.Methods: A retrospective observational study was conducted at a licensed blood bank in Haryana, India, from September 2020 to August 2025. A total of 2,896 donors were screened using standard serological assays. Prevalence rates with 95% confidence intervals (CI) and χ² tests were applied to assess associations with demographic variables. Result: The overall TTI seroprevalence was 1.87% (95% CI: 1.39–2.35). HBV was the most prevalent infection (1.00%), followed by HCV (0.69%), syphilis (0.14%), and HIV (0.03%). No malaria cases were detected. TTI positivity was significantly higher among males (χ² = 3.91; p = 0.048). The 18–30-year age group accounted for 68.5% of TTI-positive donors. An apparent increase in HBV and HCV seropositivity was observed during 2024–2025. No co-infections were observed.Conclusion: This study demonstrates a low but persistent TTI burden, with HBV and HCV predominating. Strengthened surveillance, improved donor selection, and consideration of nucleic acid testing (NAT) may further enhance transfusion safety.
Aneurysmal bone cyst (ABC) is a rare benign lesion of bone. It most commonly involves meta-diaphysis of the long bones and posterior elements of the vertebrae. Solid variant of ABC (sABC) is extremely rare. It is benign but aggressive tumor thus requires early diagnosis and treatment. We report a case of sABC occurring in 20 yr male which involved proximal phalanx (pp) of the great toe. Magnetic Resonance Imaging (MRI) demonstrated an expansile osteolytic lesion with cortical thinning of medial aspect of base of pp and mild marrow edema of the great toe. Curretage was done and on histopathological examination (hpe) revealed large number of multinucleated osteoclast like giant cells with fibroblastic proliferation, areas of hemorrhage, hemosiderin-laden macrophages and woven bone along with few blood-filled cystic spaces and cartilaginous tissue. The diagnosis was established through a multimodal approach integrating radiological assessment and biopsy findings. Early intervention can lead to better prognosis.
Background: Diabetes mellitus is a global health crisis affecting major population. There are various prognostic factors related to the disease. This study was done to assess the correlation between serum ferritin levels and fasting blood sugar (FBS) and glycated hemoglobin (HbA1c) in T2DM patients compared to normal control.Methods: A case-control study involving 100 participants (50 T2DM patients and 50 healthy controls) was conducted. Serum ferritin, fasting blood sugar (FBS), and glycated hemoglobin (HbA1c) levels were measured. Statistical analysis included t-tests for group comparisons and Pearson's correlation to assess associations between variables. Data were analyzed using SPSS v17. Continuous variables were expressed as mean ± standard deviation (SD). Statistical significance was set.Results: Serum ferritin levels were significantly higher in T2DM patients (113.13 ± 44.29 ng/mL) compared to controls (24.38 ± 11.04 ng/mL, p
Background: Gastrointestinal neuroendocrine neoplasms (GI-NENs) are rare and arise from enterochromaffin/Kulchitsky cells and exhibit variable clinical, morphological, and biological behavior. Their diagnosis and grading rely heavily on histopathology and proliferation indices as per the WHO 5th edition classification. Early diagnosis and surgical resection has better outcome.Aim: To describe the histopathological features, grading, immunohistochemical profile, and short-term outcomes of five GI-NENs.Materials and Methods: Five cases of GI-NENs diagnosed over nine months were retrospectively analysed. Clinical details, tumour location, gross findings, histomorphology, mitotic activity, Ki-67 index, and immunohistochemistry (IHC) profiles were analyzed. All details taken from clinical case and laboratory records. Classification and grading were performed using the WHO 2022/5th edition criteria.Results: Patients ranged from 16 to 54 years (mean 39 years) with female predominance. Duodenum was the most common site (three cases), followed by ileum (one case) and appendix (one case). Four tumours were well-differentiated NETs, low grade (three G2, one G1) and one was a poorly differentiated large-cell neuroendocrine carcinoma (NEC). Most NETs demonstrated strong Synaptophysin and Chromogranin A positivity. Ki-67 index ranged from
We report a rare case of matrix-producing metaplastic carcinoma (MPMC) of the breast in a 50-year-old postmenopausal woman presenting with a rapidly enlarging recurrent breast mass and axillary lymphadenopathy. The tumor showed dominant chondroid differentiation without definitive carcinomatous or spindle cell elements, resulting in major diagnostic challenges. Nodal metastasis, rapid recurrence, and aggressive clinical progression ultimately confirmed the diagnosis of matrix-producing metaplastic carcinoma. This case highlights the diagnostic challenges and emphasizes the importance of correlating clinicopathological features when conventional histomorphology and epithelial markers are lacking.
Background: According to the World Health Organization, sudden and unexpected death is defined as death occurring in an individual not known to have any serious disease, injury, or poisoning, within 24 hours of the onset of terminal illness. Such deaths are usually considered non-suspicious in older individuals but may raise medico legal concerns when occurring in younger persons.Methods: A record-based observational study was conducted at Sir T Hospital, Bhavnagar, from 1 January 2020 to 31 July 2022. All cases labeled as sudden death and received in the autopsy section during the study period were included.Results: A total of 62 sudden death cases were analyzed. Most deaths occurred in the 30–60-year age group (66.12%), with a marked male predominance (83.87%). Sudden unconsciousness was the most common presenting symptom (40.32%). The cardiovascular system was involved in (61.29%) of cases, and Coronary Arterial Heart Disease was the leading cause of death (45.16%).Conclusion: Sudden deaths predominantly affected individuals over 30 years of age, representing a significant public health concern. Cardiac causes, particularly atherosclerosis related coronary artery disease, accounted for majority of cases. These findings emphasize the importance of regular health check-ups after 30 years of age to facilitate early detection of cardiovascular risk factors and reduce sudden mortality.
Background: Ensuring the accuracy of biochemical tests in clinical labs is crucial for diagnosis. Six Sigma evaluates test result deviation from targets; higher values indicate fewer errors. Some tests perform poorly with sigma values below 4. This study uses Six Sigma, the Quality Goal Index (QGI), and Root Cause Analysis (RCA) to identify and improve performance issues.Methods: Data were collected daily for IQC at two levels and monthly for external assessments over four months. CV, bias, and Total Allowable Error were used to calculate sigma values for 16 biochemical analytes. QGI analysis identified discrepancies, and RCA uncovered reasons for poor results.Results: Urea, protein, phosphate, high-density lipoprotein, alanine aminotransferase, and iron had sigma values ≤4.0. Glucose, creatinine, albumin, uric acid, and triglyceride in Level 1, and albumin, triglyceride, and alanine aminotransferase in Level 2, showed sigma values of 4–5. Level 2 glucose, creatinine, uric acid, and cholesterol were in the 5–6 sigma range. Ten analytes across Levels 1 and 2 had sigma values ≥6. For σ < 4 analytes, QGI showed inaccuracy. IQC reconstitution, storage temperature, and air bubbles affected performance.Conclusion: Six Sigma methodology improves laboratory testing quality. Regular monitoring and addressing root causes lead to more accurate results and better patient care.
Background: Conventional tissue processing in histopathology requires 16-24 hours, creating longer turn-around time in routine histopathology laboratory work. Microwave-assisted tissue processing (MTP) has emerged as a promising alternative for rapid histopathological diagnosis.Objective: To evaluate the diagnostic utility and efficiency of domestic microwave-assisted tissue processing and staining in comparison to routine histopathology method.Methods: This prospective, cross-sectional analytical study compared conventional and microwave-assisted tissue processing using 350 paired tissue specimens (700 total) over three years. Tissues were sectioned into two equal halves, with one processed conventionally and the other using a Samsung domestic microwave (300W for processing, 180W for staining). Quality parameters including cellular details, cytoplasmic preservation, nuclear clarity, and staining characteristics were blindly evaluated using a scoring system (0-40 points). Result: Microwave processing reduced turnaround time from 16 hours 20 minutes to 81 minutes (processing: 67 minutes vs 16 hours; staining: 14 minutes vs 20 minutes). Statistical analysis revealed superior performance in cellular outline, nuclear-cytoplasmic contrast, nuclear/nucleolar clarity, chromatin preservation, and color intensity (p<0.05). Both methods showed equivalent performance in tissue integrity and nuclear membrane clarity. Special stains (PAS, Alcian blue, Masson's trichrome, Fontana-Masson) and immunohistochemistry demonstrated comparable results.Conclusion: Domestic microwave-assisted tissue processing produces diagnostic quality equivalent or superior to conventional methods with reduction of turnaround time. This technology enables same-day diagnosis, particularly beneficial for critically ill patients and small biopsies, representing a paradigm shift toward efficient, environmentally conscious histopathology practice.
Background: Ovarian tumours exhibit a wide morphological spectrum and remain one of the most common neoplasms encountered in gynaecologic pathology. Understanding their prevalence and histopathological patterns is essential for improved diagnostic accuracy and clinical management.Objective: To evaluate the incidence, age distribution, laterality, and histopathological spectrum of ovarian tumours in Upper Assam over a 12-year period using the WHO classification.Materials and Methods: This is a retrospective study conducted in a stand-alone diagnostic laboratory located in Upper Assam. A total of 53,351 surgical pathology specimens were reviewed, out of which 1,354 cases were identified as ovarian tumours. Data on patient age, laterality, and histopathological subtype were collected.Results: Epithelial tumours constituted the largest group (61.23%, n=829), followed by germ cell tumours (34.93%, n=473), sex cord-stromal tumours (2.95%, n=40), metastatic tumours (0.81%, n=11), and mesenchymal tumours (0.07%, n=1). The majority of tumours occurred in the 20–39 year peak reproductive age group (48.97%, n=663). Laterality analysis showed 88.26% unilateral and 11.74% bilateral cases. The most common benign tumours were serous cystadenoma (33.1%, n=448 cases) followed by mature cystic teratoma (18.5%, n=251 cases), while the most common malignant epithelial tumours were serous cystadenocarcinoma (4.1%, n=56 cases) and mucinous cystadenocarcinoma (1.6%, n=22 cases).Conclusion: Ovarian tumours in Upper Assam are predominantly epithelial, followed by germ cell tumours. The peak incidence in reproductive-age women and the relatively high proportion of germ cell tumours underscore the importance of early detection and accurate morphological diagnosis.
Introduction: Healthcare professionals are more likely to contract hepatitis B, hepatitis C, and HIV. Hepatitis B is the most dangerous of them and is also quite contagious. One important preventive measure is to be immunized. Aim & Objective: The purpose of this study is to measure the anti-HbsAb titer among the nursing, laboratory technician, intern and Physiotherapy students of tertiary care hospital. To evaluate knowledge, practice and attitude of them about Hepatitis B & importance of its vaccination.Materials and Methods: This is a cross-sectional study. A predesigned self-administered questionnaire (via Google form) concerning hepatitis B knowledge and awareness was distributed to all the Para-medical students. The data were collected, tabulated, and analyzed by Microsoft Excel version 10. The results were expressed in numbers and percentages. Anti-HbsAb titers were estimated by Enzyme Immunoassay (ELISA) kit.Results: Only 76 students voluntarily participated in the study. Majority of the students (77.1%) were aware of HBV infection. Many students knew that blood transfusion (89.4%) and use of contaminated needles and syringes (96%) are major modes of transmission. However, the students had good knowledge about other modes of transmission. More than 50% of the students lacked in their knowledge about clinical features and complications of hepatitis B infection. Majority of students (93.4%) were aware of HBV vaccination. However, 11.8% students did not know their vaccination status, 53.1% students show protective hepatitis vaccine antibody titer after two or three doses of vaccine.Conclusions: This study found that paramedical students have good knowledge on hepatitis B, still only 14% students are fully vaccinated. Proper documentation of such important event must be there as in cases where they might get exposed to positive cases this information is useful for taking therapeutic decision.
Background: Colorectal cancer (CRC) is the third most common malignancy worldwide and the second leading cause of cancer-related deaths, mainly due to late-stage diagnosis and recurrence. Lymphovascular invasion (LVI), particularly extramural vascular invasion (EMVI), is a strong prognostic marker linked to metastasis and poorer survival outcomes. However, EMVI detection is often underreported due to variability in diagnostic techniques, making accurate identification crucial for guiding adjuvant therapy decisions. This study aims to compare the efficacy of hematoxylin and eosin (H&E) staining, Verhoeff Van Gieson (VVG) elastic staining, and CD34 immunohistochemistry (IHC) in detecting EMVI in colorectal cancer specimens.Methods: This is a cross-sectional study of 72 colorectal cancer patients conducted at a tertiary referral center in Kerala, South India, over a period of 18 months. EMVI was assessed using H&E, VVG, and CD34 stains, and detection rates were compared using SPSS 23.0 version. Result: H&E staining identified EMVI in 10 cases (14%), VVG in 15 cases (21%), and CD34 IHC in 7 cases (9.7%), with significant differences between methods. VVG staining had the highest detection rate and was significantly associated with lymph node metastasis (p=0.024) and advanced AJCC stages (p=0.017).Conclusion: VVG elastic staining enhances EMVI detection in colorectal cancer compared to H&E. The use of CD34 IHC, while less effective and more resource-intensive, is not recommended for routine EMVI detection due to its lower sensitivity and technical complexity.
Fungi, though rare, are increasingly being recognised as causative agent of rhino-sinusitis. Invasive fungal sinusitis (IFS) is commonly seen in immunocompromised patients, the common culprits being *Aspergillus* and *Mucor*. These can cause rapid intracranial spread causing various systemic complications. Reported cases of IFS caused by *Candida* are few and far between. *Candida* is a yeast like fungus and a commensal in the oral cavity and skin. We report an exclusive case of invasive sphenoidal sinusitis caused by *Candida tropicalis* leading to compression of cavernous sinus causing ophthalmoplegia in a healthy patient and responded well to antifungals.
Background: The spectrum of Hepatitis B virus (HBV) and Hepatitis C virus (HCV) infection ranges from self-limiting to acute fulminant to chronic hepatitis. The Laboratory diagnosis of HBV is by detection of various sero-markers and HCV is by indirect and direct tests. HBV and HCV have same modes of transmission and can be co-transmitted simultaneously or by superinfection with significant clinical implications. Hence, this study is undertaken to estimate seroprevalence of HBV and HCV and its coinfection among general population attending hospital.Methods: This retrospective observational study was carried out from Jan to Dec 2022 on OPD and IPD specimens tested for HBV and HCV screening by HBsAg ELISA and anti-HCV ELISA. Seroprevalence was calculated as proportion of samples positive amongst tested and Chi Square test was used for statistical analysis. Result: Out of 36873 samples tested for HBV ELISA, 747 were positive with 2.0% seroprevalence, and 36500 samples tested for HCV ELISA, 361 were reactive with 0.99% seroprevalence. Male to female ratio for HBV was 2:1, HCV 1.2:1 and for coinfection 4.6:1. The most affected age group was 18-40 years. There is a significant difference in sample seropositivity between OPD and IPD. In co-infection maximum positivity was from Nephrology, followed by GI medicine.Conclusion: Emphasis on awareness about preventive measures, and curtailing high risk behaviours among young adults should be stressed. Effective HBV Vaccination coverage with more data on HBV and HCV coinfection needs to be obtained.
Background: Ovarian cancer is the third most common cancer in Indian women. Biochemical analysis of ovarian and peritoneal fluid, especially lactate dehydrogenase (LDH) and cholesterol level is shown to be elevated in cases of malignancy. Peritoneal fluid LDH levels were also found to be of prognostic significance. To assess the diagnostic utility of LDH and cholesterol levels of ovarian cyst fluid and peritoneal fluid in cystic ovarian neoplasms by correlating with histopathological examination. Material and Methods: Prospective cohort study carried out in a tertiary care hospital. Ovarian cyst fluid and/or peritoneal fluid in resected ovarian neoplasms were processed on automated biochemistry analyzers.Results: Seventy-nine ovarian neoplasms with their corresponding ovarian cyst fluid and/or peritoneal fluid were studied. The accuracy rate for diagnosis of malignant tumors by ovarian fluid LDH and cholesterol levels was found to be 100% and 90.14% respectively, while that of peritoneal fluid LDH and cholesterol levels was 88.88% and 80.55% respectively.Conclusion: Biochemical analysis (LDH and cholesterol) of peritoneal fluid can be used in pre-operative and post-operative management of ovarian malignancy. Ovarian fluid LDH was the most sensitive and specific parameter followed by peritoneal fluid LDH for differentiating ovarian malignancy from benign ovarian tumors.
