Introduction: Extragonadal teratomas are uncommon tumors and are less common in adults than children. They are mostly retroperitoneal. Primary adrenal teratomas are even rarer. Objective: We report an unusual case of primary adrenal teratoma in a young adult. Case Summary: A 29 year old male presented with complains of intermittent right sided flank pain for 6 months, dull aching, radiating to groin. On CT Abdomen a large heterogenous mass was seen having predominantly fat component and punctuate calcification in right suprarenal region. Histopathology confirmed a diagnosis of adrenal teratoma. Conclusions: Adrenal teratomas are difficult to diagnose clinically or on imaging as these mimic other lipomatous lesions. Although rare this should be considered as a differential diagnosis for adrenal tumors.

The pathophysiology of Chronic Rhino-Sinusitis with Nasal Polyposis (CRSwNP) showed distinct ethnic and geographic differences whereas the Western Caucasian population revealed Th2 eosinophilic inflammation in contrary to the Asian Mongolian population with Th1-Th17 non-eosinophilic inflammatory pattern. Prospective Observational study was undertaken from December 2019 to December 2021 on 50 patients who were diagnosed to have sinonasal polyposis. The collected polyp tissue was sent to the histopathological department for further microscopic evaluation. The types of inflammatory cell infiltrate studied in the tissue specimens obtained during surgery included lymphocytes, eosinophils, neutrophils, mast cells, and plasma cells. The age of patients ranged from 11 to 70 years with a mean age of 31.80±17.69 years. The male to female ratio was 1.3:1. The 62% of patients showed the predominance of eosinophil which was of grade III and grade IV category, Lymphocyte infiltrate of grades III and IV was present in 46% of cases, Mast cell was 30% and 10% of grade III and Grade IV respectively, and the Neutrophils were found only in 22% and 105 of cases of grade III & Grade IV, respectively which was the least of all inflammatory cells found in polyp tissue. The cellular predominance was shifted toward the Th2 type of inflammation with the predominance of Eosinophil, Lymphocytes, Plasma cells, and mast cells in the Asian Aryan sub origin population contrary to the Th17 type of inflammation as indicated by the least infiltration of Neutrophils as reported in Asian Mongolian Populations.

Adrenal myelolipomas are rare benign adrenal tumour composed of mature adipocytes intermixed with myeloid tissue. They are second most common cause after adrenal adenomas and comprise 6-16% of all the adrenal incidentalomas. They are often asymptomatic and therefore rarely detected but in recent times due to radiological advancements, these cases are increasingly being detected and therefore treated. Extra-adrenal myelolipoma are the myelolipomas, detected outside the adrenal gland but occurs rarely. Three cases (53 years old male patient, 60 years old male patient and 46 years old female patient) of clinically and radiologically suspected cases of symptomatic adrenal myelolipoma are discussed here. The first case described, presented with right flank pain radiating to back which was suspected as adrenal mass by Computed Tomography (CT) evaluation. The second case presented with right flank pain, haematuria and weight loss which was suspected on Ultrasonography (USG) and Contrast Enhanced Computed Tomography (CECT) as an adrenal mass. The third patient presented with bilateral pedal oedema and suspected adrenal mass was found on USG. All three cases were histopathologically confirmed as adrenal myelolipoma and managed by surgical excision. The uniqueness of the case lies in its early detection due to technological advancements and hence proper management of the patients.

Aims and Objectives: To study the demographic distribution and histomorphological variations of Whipple’s pancreaticoduodenectomy specimens in regard to tumour site, size, type, grade, marginal status, lymph node metastasis, perineural invasion (PNI) and lymphovascular invasion (LVI). This study will also highlight the incidental pathological lesions occurring in Whipple’s specimens. Hence it will further facilitate to analyse the prognostic significance of all these parameters in order to co-relate the overall spectrum of these cases. Study Design and Place of Study: An observational retrospective time bound descriptive study conducted at Indira Gandhi Institute of Medical Sciences (IGIMS), Patna after approval of ethical committee. Materials and Methods: A total of 150 Whipple’s resection specimens received in the Department of Pathology, IGIMS, Patna from January 2015 to December 2020 were selected as per inclusion and exclusion criterias. Details were collected from histopathology request forms and hospital record sheets. Gross and microscopic features were analysed and recorded. Slides were reviewed and the parameters were calculated. Results: Statistical analysis showed that out of 150 Whipple’s pancreaticoduodenectomy specimens, 141 (94%) cases were malignant tumours, 6(4%) cases had low malignant potential and 3 (2%) cases were of benign nature. Periampullary carcinomas were the predominant malignant tumours (78.66%), followed by ampullary carcinomas (14%) and pancreatic endocrine tumours (1.33%). Tumours with low malignant potential were constituted by SPN (solid pseudopapillary neoplasm of the pancreas) (2.67%), GIST (gastrointestinal stromal tumours) (0.67%) and mucinous cystic neoplasm of the pancreas (0.67%). Mean age incidence was 49.57 years with a male to female sex ratio of 1.4:1. Most of the malignant tumours (more than 75%) were moderately differentiated and were in stage 2 category. Out of the total 141 malignant tumours, 71 (50.35%) cases showed LVI, 50 (35.46%) cases had PNI and 84 (81.67%) had tumour deposits in the lymph nodes. Conclusions: Our study emphasizes the importance of tumour grade, tumour stage, presence of LVI, PNI, positive margins and lymph node metastasis as strong prognostic factors for patient survival. This is well corroborated by the significant P value in our study. Most of our cases were diagnosed at a locally advanced stage. Hence a more precise assessment and clinical evaluation can lead to early detection of cancer, improving the survival rates.

Background: Breast cancer (BC) has now surpassed lung cancer as the leading cause of global cancer incidence in 2020, with an estimated 2.3 million new cases, representing 11.7% of all cancer cases. It is a highly heterogeneous disease with a variety of morphologic and clinical manifestations which results in a range of responses to treatment. Recently, targeted therapies based on the genetic, hormonal, or immunohistochemical (IHC) subtypes of breast cancer have been used. Objective: The study was a prospective hospital-based observational study with a sample size of 150 cases. The study aimed to determine the distribution of various molecular subtypes of breast carcinoma and also correlate the expression status of ER, PR, Her2neu, and Ki 67 with the patient's age, tumor size, tumor type, histological grade, lymph node status, and TNM staging. Results: 96.7% of cases were invasive ductal carcinoma (NOS). Most of the grade 1 tumors (68.8%) were both ER and PR positive. Grade 2 tumors had almost equal distribution with 39.4% of patients being ER & PR positive and 43.7% being both ER & PR negative. Almost all grade 3 tumors (88.9%) were both ER and PR -negative. Conclusion: IHC markers are cost-effective and easily available worldwide even in resource-poor countries like India. A greater understanding of the molecular classification of breast carcinoma based on triple markers will help in the development of targeted therapies that will lead to increased efficacy, decreased toxicity, increased disease-free survival, and better selection of patients who will benefit from treatment.

Gliomatosis Peritonei (GP) is a rare condition characterized by the presence of neuroglial implants throughout the peritoneum. It is a benign lesion with a potential for malignant transformation. Its association with ovarian teratomas has been sparsely reported in the literature. As GP is a rarity, it lacks forth set and accepted guidelines for management. Here, we report three intriguing cases of histopathologically confirmed GP in association with ovarian teratoma. All three patients were young females between 18 and 22 years of age and presented with abdominal swelling and ascites. On evaluation, they had raised tumor markers (CA-125, Agence France-Presse, and lactate dehydrogenase) and radiological findings were in favor of ovarian malignancy. Two of them underwent primary debulking surgery, whereas one received neoadjuvant chemotherapy in view of recurrent ovarian tumor of nonseminal germ cell nature followed by interval debulking surgery. Intraoperative findings in all three cases were almost similar. Unexpectedly, the histopathological findings were reported as immature teratoma in two cases and mature teratoma in one along with GP.

Background: Blood is an important sterile body fluid, which is essential for human survival.Transfusion of blood and blood components is an integral part of health care practice.Injudicious use of blood and its products among patients causes unnecessary burden to patients as well to the blood bank.Objectives: The aim of this study is to evaluate the utilization of blood and blood components by various departments in a tertiary care hospital.Materials and Methods: We carried out a cross-sectional study on patients requiring transfusion of blood and its components from January 2018 to December 2018.Data was retrieved from monthly collection register and utilization of blood and blood components was taken from the requisition forms and blood issue registers.Results: Total whole blood units collection was16439.A total of 20088 units were utilized which included whole blood and blood components.Whole blood was the most utilized product followed by Packed red blood cells (PRBC), platelet concentrates and the least utilized product was fresh frozen plasma (FFP).Regional cancer centre (RCC) wards utilized maximum 17.8% of total issued whole blood and blood component units followed by Emergency/Trauma department.Conclusion: Formulation of strict guidelines for transfusion practices will improve the appropriate use of blood and its products.Periodic evaluation of utilization pattern by various departments and demand for different blood products also helps to maintain the bloodstock.It is important to create awareness among clinicians regarding advantages of component therapy over whole blood transfusion

BACKGROUND Health care workers because of their contact with patients and with potentially infectious materials have risk of exposure to infectious diseases, some of which are preventable by vaccination. The goal of immunisation for appropriate intervention in the health workforce is critical to prevent and control infections. Antibodies-HBs indicate presence of immunological memory. Their persistent negativity indicates the need to complete the vaccination series with two additional doses followed by a new serological testing after one month. The objective of this study is to evaluate anti-HBs antibody titre among vaccinated health care workers and to determine awareness level of antibody titre among HCW at IGIMS, Patna. MATERIALS AND METHODS A prospective study was carried out. A total of 92 nursing staffs, laboratory technicians, paramedical staffs, doctors and students were tested to evaluate their immunity toward hepatitis B. The anti-HBs antibody levels were detected using the anti-HBs ELISA test (enzyme immunoassay diagnostic kit for in vitro qualitative detection of antibody to hepatitis B surface antigen in human serum or plasma). Inadequate immune response to HBV vaccination was considered if quantitative anti-HBs level was <10.0 mIU/mL according to the Centre for Disease Control (CDC). RESULTS Of the 92 vaccinated health care workers, anti-HBs antibody titre was noted and only 47 (51.08%) had protective titre. CONCLUSION Our study represents one of the first experience in IGIMS regarding the level of anti-HBs antibody titre in health care workers. The low titre emphasises the need for monitoring vaccination status among health care workers.

BACKGROUNDTumours of salivary glands constitute less than 5% of head and neck tumours and are diverse in nature.Some of the tumours pose diagnostic challenge to a pathologist, especially the malignant lesions with poor differentiation.In the present study, we aim to acknowledge the various histological types of salivary gland tumours that we encountered in our institute in a period of 5 years with special emphasis on a few cases posing as a diagnostic dilemma.Aims and Objectives-1.To study the histopathological spectrum of salivary gland tumours, identify tumours which pose a diagnostic dilemma and try to classify those tumours with the help of immunohistochemistry. 2. To compare and observe the results of this study with other studies in the contemporary literature.

BACKGROUND Solid Pseudopapillary Tumour (SPT) of the pancreas is a distinctive tumour of low malignant potential with a predilection for females in the second and third decades of life. We report here 3 cases because of its rarity and we attempt to briefly review the literature of this distinctive lesion. MATERIALS AND METHODS A total of 3 cases were diagnosed and treated in our institute over a 2-year period. A retrospective study of these cases was performed with respect to age group most frequently affected, sex ratio, common presenting symptoms and signs, investigative protocols, pathological features, treatment offered, outcome and prognosis. All the three patients were females with the age of presentation of 20 yrs., 14 yrs. and 15 yrs. respectively. The commonest presenting symptom was abdominal pain. The patients underwent distal pancreatectomy, Whipple's resection and pancreaticoduodenectomy with appendicectomy respectively. Histological diagnosis was made by performing haematoxylin-eosin staining and confirmed by immunohistochemistry. RESULTS All the patients were females in the age group of 13-25 years. Pre-operative imaging is not diagnostic. Pathological examination is the mainstay in the diagnosis. No metastasis or recurrence was detected during followup. CONCLUSION Solid pseudopapillary tumour of the pancreas is a rare entity, therefore proper diagnosis, evaluation and formulation of treatment protocols is difficult. A high index of clinical suspicion is necessary to suspect and diagnose it. Surgical excision offers the best chance for cure and should always be attempted irrespective of the magnitude of the resection involved. The results of immunohistochemical and ultrastructural studies indicate that it must be regarded as a tumour of uncertain histogenesis and undetermined differentiation.

BACKGROUNDCentral nervous system (CNS) tumours comprise 2-5% of all tumours in the body. Incidence of CNS tumours varies within different age groups. The aim of this article is to give an overview of the burden of CNS tumours in different age groups in our region and to study the major histologic subtypes of brain tumours.MATERIALS AND METHODSThis study was done at CNS Hospital, Patna and Indira Gandhi Institute of Medical Sciences (IGIMS), Patna from March 2008 to July 2014.RESULTSTotal 394 patients between 2-80 years of age with histologically confirmed CNS tumours were included in this study. Commonest tumour was glioma accounting for 44.7% of all tumours followed by meningioma (25.8%). Metastatic tumours constituted 5.1% of all operated tumours.CONCLUSIONThis study will help to evaluate the epidemiological and pathological characteristics of the tumour and to identify various genetic and environmental factors responsible for them.

OBJECTIVETo study the advantage of Core Needle Biopsy (CNB) over Fine Needle Aspiration Cytology (FNAC) in palpable breast lumps by comparing the diagnostic accuracy in terms of sensitivity, specificity, positive and negative predictive values considering the histopathological diagnosis of incised or excised specimen as the gold standard. METHODSA prospective study of 100 female patients with palpable breast lump was conducted in the Department of Pathology of a tertiary care teaching hospital of Northern part of India.All the patients were randomly selected, irrespective of their age, religion, marital status, occupation or social status for FNAC following a thorough clinical check-up.During the study period, 54 patients were selected for core needle biopsy on the basis of insufficient FNAC material for making definitive diagnosis and for sub-typing the tumours.All core biopsy samples were subjected for histopathological examination.The diagnostic findings were compared with the histopathological findings of the lumpectomy or mastectomy specimen and with those of FNAC findings for each and every patient. RESULTSThe sensitivity of FNAC and CNB was 96.29% and the specificity for malignant lesions was 100%.The positive predictive value was 100% and the negative predictive value was 95.12%. CONCLUSIONThere is no significant difference in the diagnostic accuracy between core needle biopsy and FNAC.

A 23-year-old girl presented with an insidious gradually progressing swelling over the right knee for one year with occasional pain. There was no history of any injury and laboratory studies were normal. On fine needle aspiration cytology, a probable diagnosis of pigmented villonodular synovitis was made, confirmed on biopsy. The lesion was excised and the patient has not had a recurrence in one year. This case report emphasises that the diagnoses of pigmented villonodular synovitis should be considered in any case of chronic joint effusion.

We report a rare case of virilizing cystic juvenile granulosa cell tumour of the ovary diagnosed by histopathological examination in a 17-year-old female presented with mass abdomen for two months, growing of the hairs on the face and abdomen and deepening of voice for one year.

Laryngeal squamous cell carcinoma (SCC) in adolescents is a rare clinical entity and behaves aggressively. The mechanism of laryngeal oncogenesis is complex. Further studies need to be done to know the role that human papilloma virus plays in laryngeal SCC in adolescents.We report a rare case of laryngeal SCC in a 12-year-old boy presenting with cutaneous forehead metastasis.

Background: Prevalence of methicillin-resistant Staphylococcus aureus (MRSA) and Coagulasenegative staphylococcus (CONS) is reported to be increasing globally. Objectives: To find the magnitude of staphylococci infection and current susceptibility pattern in a tertiary care teaching hospital in Pondicherry. Materials and Methods: This cross sectional study comprised of 550 coagulase-positive and coagulase-negative staphylococci isolated from various clinical specimens (pus, sputum, body fluids, high vaginal swab, wound swabs and tracheal aspirates) from patients at our hospital over a period of 1 year. The antimicrobial susceptibility test was performed for the isolates as per Clinical and Laboratory Standards Institute (CLSI) guidelines. Methicillin resistance was detected using oxacillin and cefoxitin disc diffusion method, and oxacillin screen agar method. Results: Most of the staphylococcal isolates were from patients admitted in surgery wards, followed by orthopedics and obstetrics and gynecology. Of the total 550 Staphylococcus isolates, 284 (51.63%) were methicillin sensitive Staphylococcus aureus (MSSA), 59 (10.7%) were methicillin resistant Staphylococcus aureus (MRSA) and 207 (49.09%) were CoNS. Methicillin resistance was seen in 17.2% (59/ 343) isolates of S. aureus and 23.2% (48/ 207) of CoNS. The sensitivity of MRSA to vancomycin and clindamycin were 100% and 78% respectively. The resistance of MRSA was very high for co-trimoxazole (88.1%) and ciprofloxacin (81.4%). The MR-CoNS showed very high resistance for co-trimoxazole (79.2%) and erythromycin (72.9%). Conclusion: Regular surveillance of hospital- associated infection and monitoring of antibiotic susceptibility pattern is required to reduce prevalence of methicillin resistance among Staphylococci.

Lipomatous uterine tumours are unusual benign neoplasms. We report here two cases of uterine lipoleiomyoma because of its rarity and we attempt to briefly review the literature of this distinctive lesion. These two lipoleiomyoma occurred in post-menopausal women aged 58 and 60 years and size ranged from 1.5 to 9.5 cm. Histologically, they were composed of variable amounts of smooth muscle, fat cells, and fibrous tissue. In one case, there was widespread infiltration of the lipleiomyoma by numerous small mature lymphocytes.

BackgroundDermatologic disorders are common in many countries but the spectrum varies greatly. The objective of this study was to determine the histopathological profile of non-neoplastic dermatological lesions, to study the morphology and attempt to find the etiology of granulomatous lesions on skin biopsies . MethodsThis is a retrospective study over a period of two years in the department of pathology, IGMC &RI. Out of a total of 248 skin biopsies received, 112 cases with non-neoplastic skin lesions were included in the study. Incisional biopsy, excision biopsy and punch biopsy were done to obtain tissue for histopathological examination. Slides stained with routine stain and special stains like Ziehl Neelsen stain, Periodic Acid Schiff, Alcian blue and Fite faraco were reviewed. Data entry and analysis were done using statistical software SPSS for Windows Version 16.0 (SPSS Inc., Chicago, IL, USA). Percentages were calculated for categorical variables. Chi-square test was used for comparison of proportions of different groups. Chi-square test for trend was used for studying the linear trend in occurrence of various skin lesions with age. All p values < 0.05 were considered significant, while p values between 0.05 and 0.10 were considered marginally significant . ResultsA total of 112 patients were included in the study, 61 cases (54.5%) males and 51 cases (45.5%) females. In males, the commonest lesions were nonspecific dermatoses (n=17, 27.9%) followed by granulomatous lesions (n-14, 23%) and in females the commonest lesions were granulomatous lesions (n= 12, 23.5%) followed by nonspecific dermatoses (n= 11, 21.6%)(Table 1). The sex distribution of various non-neoplastic lesions was of no statistical significance except for vasculitis which was commoner in females (p value-0.0175). Miscellaneous lesions included cases of Hidradenitis suppurativa , folliculitis and lichen sclerosus et atrophicus. The prevalence of calcinosis cutis was highest in the age-group 41-60 years (p = 0.0117) (Table 2). All cases of nonspecific ulcers (p = 0.0389) and vasculitis ( 0.0679) were also higher in the same age group. Calcinosis cutis and vasculitis showed a statistically significant increasing linear trend with age (p value 0.0025 and 0.0140, respectively) (Figure 1). Similarly, lichen planus showed a statistically significant decreasing linear trend with age (p value= 0.0378) (Figure 1). 26 out of 112 (23.2%) skin biopsies, were found to have a granulomatous reaction pattern. The commonest etiology of granuloma in our study was leprosy accounting for 12 cases followed by 11 cases of tuberculosis. Less common causes included erythema nodosum and granuloma annulare (Table 3). The typified 5 cases of tuberculosis were lupus vulgaris (3 cases) and tuberculosis verrucosa cutis (2 cases). Special stain for AFB were positive in 11.5% of all cases. ConclusionsSkin biopsies with non-neoplastic lesions constituted 45% of the total number of skin biopsies at our institute. The age distribution pattern indicated highest percentage in the 41-6o year age group (36.6%). The sex distribution pattern revealed a male preponderance of 54.5% compared to 45.5 % females. Granulomatous dermatoses are still rampant, infections forming an important cause of granulomatous dermatitis with leprosy and tuberculosis as the leading causes. Majority of the cases of leprosy were borderline tuberculoid (BT), followed by tuberculoid (TT) leprosy . Demonstration of acid fast bacilli by ZN stain is specific, however, they are not detected with ease thereby further emphasizing the significance of adequate clinical data and workup which helps in elucidation of specific etiology.