BACKGROUND:There is an overall surge of malignancies in most of the developing countries including India. Dearth of data from Kashmir prompted us to embark upon a study on burden and pattern of cancer in Kashmir over previous 5 years. METHODS:Data acquisition from January 2016 to December 2020 was accomplished from the departmental archives of a large tertiary care institute of Kashmir valley. All histologically proven malignant cases were included for the present study. Information regarding the age, gender, site of primary malignancy and histological diagnosis was obtained. RESULTS:A total of 5,392 cases of malignancies were considered for final analysis with a mean age at diagnosis of 56.73 years (SD = 15.96). Maximum number of cases were recorded in the age group of 60-69 years. Maximum number of malignancies were encountered in year 2018 with substantial drop in subsequent years. Gastrointestinal malignancies constitute more than one-third of total number of malignancies across both genders. In males, stomach was the common site of malignancy followed by lung and colorectal region whereas in females most common sites were breast, colorectal, and stomach. CONCLUSION:This study portrays close reflection of the cancer patterns within the valley in recent years which is strikingly different from rest of the country and world.

Background: Xanthogranulomatoussalpingo-oophoritis is an uncommon form of chronic inflammation in the genitourinary tract. Its symptoms and radiological findings mimic ovarian malignancy. Aim of this study was to evaluate the clinicopathological pattern of xanthogranulomatous salphingo oophoritis.Methods: This study was conducted in the department of pathology, Government Medical College, Srinagar. It was a retrospective study done over a period of 5 years, November 2014 to November 2019.Results: The study was done to evaluate the clinicopathological pattern of 6 cases of rare entity xantogranulomatous salphingo oophoritis diagnosed at a tertiary care hospital. All patients, presented with pain abdomen. All patients were operated due to radiological suspicion of ovarian malignancy. Histopathological examination proved the lesion as xanthogranulomatous salphingo oophoritis.Conclusions: Xanthogranulomatoussalpingo-oophoritis is a rare condition that is often mistaken for ovarian malignancy clinically and radiologically. Oophorectomy is the recommended treatment but most women are “over treated” with staging laparotomies and hysterectomies that render them infertile.

09Mar 2020 Diagnostic Accuracy Of Fine Needle Aspiration Cytology In Salivary Gland masses Farzana Manzoor , Bilal Ahmad Sheikh , Ruby Reshi , Arshi Beg , Saymah Rashid and Bilques Khurshid Senior Resident, Department of Pathology, Govt. Medical College, Srinagar. Professor, Department of Pathology, Govt. Medical College, Srinagar. Professor and Head, Department of Pathology, Govt. Medical College, Srinagar. Senior Resident, Department of Pathology, Tata Memorial Hospital, Srinagar. Postgraduate, Department of Pathology, Govt. Medical College, Srinagar.

Choroidal Melanoma is the most common primary intra-ocular malignancy. Incidence of primary choroidal melanoma is about 6 cases per 1 million population. It disseminates hematogenously. The most common site of metastasis is liver. Metastatic melanoma involving the bone marrow is rare, occurring in 5% of patients with disseminated disease. However, Choroid melanoma with bone marrow involvement is very rare. Only a few case reports are published in literature. Authors present a case of bone marrow metastasis from choroid melanoma in 55 years old female who has been treated for primary choroidal melanoma by enucleation of left eye three years back. In the evaluation of symptomatic anemia, features suggestive of bone marrow infiltration by choroidal melanoma were observed on bone marrow aspiration and biopsy. The diagnosis was confirmed by positivity of immune-histochemistry markers HMB-45 and Melana.

The oncogenic activation of BRAF is commonly reported in human cancers; however, it is an understudied research area in breast cancer. In this study, we took the initiative to screen breast cancer patients for the most prevalent hotspot BRAFV600E mutation and discuss its clinical implications. Mutational screening was performed using a highly sensitive technique, mutation allele‑specific multiplex PCR (MASMP), the results of which were previously confirmed by sequencing the product and sensitivity compared to direct DNA sequencing. In total, BRAFV600E mutation status was analysed in 50 breast tumour samples and an equal number of adjacent normal tissues. Mutational screening by MASMP revealed its presence in 12% of the breast cancer patients. Association analysis revealed that BRAFV600E mutation was significantly present in oestrogen receptor (ER)/progesterone receptor (PR)‑negative (χ2=4.36, P=0.03) and mostly in triple‑negative breast cancers (TNBCs) (χ2=2.5, P=0.11). In addition, although not significant, BRAFV600E‑positive breast cancers were mostly found in older‑aged (χ2=1.10, P=0.29) and in post‑menopausal women (χ2=1.10, P=0.29). No significant association was found between BRAFV600E‑mutated breast cancers and traditional poor prognostic factors, such as clinical tumour stages III and IV (χ2 0.036, P=0.84) and a poorly differentiated (PD) histopathological grade (χ2 0.04, P=0.82).On the whole, positivity for BRAFV600E was noted in a fraction of elderly post‑menopausal women, predominantly of the ER/PR‑negative and/TNBC molecular subtype. MASMP was found to be a simple, sensitive and effective method for the rapid detection of BRAFV600E‑mutated breast cancers. For these types of breast cancers, BRAF‑targeted therapies in place of endocrine therapy, at least in BRAFV600E‑positive ER/PR‑negative/TNBC, may be considered as possible targeted therapy in the future.

Introduction: Parotid tumors affect 1in100,000 people, representing 2-3%of tumors of the head and neck and 80% of salivary gland tumors. The literature estimates that approximately 80% of these tumors are benign, with pleomorphic adenoma being the most common followed by Warthin’s tumor. Among the malignant tumors mucoepidermoid carcinoma is the commonest, followed by adenoid cystic carcinoma. Material methods: It was a retrospective study done from January 2016 to December 2017 in the department of pathology Government Medical college Srinagar. Results: our study included 42 cases of parotid gland tumors. Out of 42 cases 25 were female and 17 were male patients. Thus the male to female ratio observed was 1:1.4. Pleomorphic adenoma (twenty cases) was the most frequent benign tumor followed by warthin’s tumor (five cases) while as mucoepidermoid carcinoma was the most frequently identified malignant tumor. Conclusion : pleomorphic adenoma is the most prevalent benign histological type while as mucoepidermoid carcinoma is commonest malignant tumor. Malignant tumors are more common in 5th decade while as benign lesions are commoner in 4th decade of life. Key words: pleomorphic adenoma , warthins tumor , mucoepidermoid carcinoma. Introduction: Tumours of salivary glands are rare constituting less than one percent of all tumors and 3% to 10% of the neoplasms of head and neck region (1). Parotid tumors affect 1in100,000 people, representing 2-3%of tumors of the head and neck and 80% of salivary gland tumors (2). The literature estimates that approximately 80% of these tumors are benign, with pleomorphic adenoma being the most common followed by Warthin’s tumor (3). The parotid gland has a superficial lobe, lateral to the facial nerve, that comprises 4/5 of the glandular parenchyma, and a smaller deep lobe. As 90% of the tumors are located in the superficial lobe and thus, do not affect the facial nerve hence superficial parotidectomy with facial nerve preservation is the most often indicated surgical procedure, (4). The most common manifestation of pleomorphic adenoma is the presence of a solitary, solid, firm, lobulated, painless, mobile nodular lesion with well-defined margins (5). Among the malignant tumors mucoepidermoid carcinoma is the commonest, followed by adenoid cystic carcinoma. The presence of pain, facial paralysis, rapidly growing tumor with ill-defined margins, and skin infiltration should raise the suspicion of malignancy (4). The first diagnostic imaging assessment for parotid tumors is usually ultrasonography (5). Fine-needle aspiration cytology (FNAC), whether or not guided by ultrasound, can be used as a complementary diagnostic test, especially when a non-characteristic manifestation of pleomorphic adenoma is suspected. The purpose of FNA is to differentiate benign from malignant lesions, as it usually does not establish the definitive histological diagnosis. However, histopathology remains the gold standard as it avoids diagnostic pitfalls of FNAC (3,4). Material methods: It was a single institute retrospective study done from January 2016 to December 2017 in the department of pathology Government Medical college Srinagar. Clinical data and gross features of tumours were recorded and tabulated. Haematoxylin and eosin (H&E) stained sections and corresponding paraffin tissue blocks were retrieved from the archives of the department and reviewed. The tumors were categorized according to the WHO classification. Results: During the period of two years a total of 69 salivary gland surgeries were performed, which included 42 (60.8%) parotidectomies. Thus, our study included only these 42 cases of parotid gland tumors. The demographic analysis is given in (Table.1). Out of 42 cases 25 were female and 17 were male patients. Thus the male to female ratio observed was 1:1.4. At presentation, the main finding was a tumor mass measuring >2cm in size in 73.8% of all cases reported in our study. Superficial lobe of parotid gland was the commonest site involved in Pleomorphic adenoma (twenty cases) (fig-1) was the most frequent benign tumor followed by warthin’s tumor (fig-2) (five cases) while as mucoepidermoid carcinoma (fig-3) was the most frequently identified malignant tumor (three cases) (Table.2). The most relevant clinical characteristics of the benign and malignant tumors are shown in Table 3.The ratio between men and women for malignant tumors was1:2, while for benign tumors it was 1:1.4. The mean age for the presentation of benign tumors was 46 years and for malignant tumors was 58 years.

Gall bladder carcinoma accounts to be the 5th most common cancer of digestive tract. The clinical manifestations of gall bladder carcinoma are generally indistinguishable from those associated with cholecystitis or cholelithiasis. Incidental GBC (IGBC) refers to GBC not suspected before or at operation and not even on gross examination of the GB specimen and is only detected for the first time on histo-pathological examination. Study was conducted in the department of pathology Government medical college Srinagar Jammu and Kashmir and was two year retrospective study. The main aim was to study the frequency of incidental carcinoma of gall bladder in patients undergoing routine cholecystectomy. We found the incidence of IGBC to be 0.5% in our population.

Background: Bone marrow aspiration and trephine biopsy are two most important techniques which are complementary for diagnosing both neoplastic and non- neoplastic haematological diseases. The present study was conducted in the department of pathology to compare the role of bone marrow aspirate and trephine biopsy for diagnosing the haematological diseases.Methods: The study was conducted in the department of pathology government medical college Srinagar over a period of 2 years from Feb 2016 to Jan 2018. The study was one-year retrospective and one year prospective. Bone marrow aspiration was done in 626 cases out of which biosy was done in 300 cases.Results: Out of the selected 300 cases were both aspiration and trephine biopsy were available, diagnostic material on bone marrow aspirate was adequate in 288 cases. 12 cases were aparticulate. Biopsy was inadequate in 8 cases. Overall megaloblastic anaemia (26.6%) was most common followed by dual deficiency anemia. Multiple myeloma was the most common neoplastic pathology (13%) followed by followed by acute leukaemia’s (6%) and Chronic lymphoproliferative disorders (CLPDS) (5%). 1 case each of visceral leishmaniasis and malarial parasite were also noted. 4 cases (1.3%) of granulomatous pathology and 2 cases (0.6%) of Hodgkins lymphoma were diagnosed exclusively on bone marrow biopsy.Conclusions: Bone marrow aspiration and biopsy are complimentary to each other in diagnosing hematological disorders with biopsy being gold standard in the assessment of cellularity, pattern, extent of tumor infiltration and focal infiltration. It is more helpful in diagnosing granulomatous pathology and metastatic deposits of tumors eliciting fibrotic response.

Background: Salivary gland tumors are common neoplasms of head and neck region.These tumors are complex and some of them exhibit great deal of morphologic overlap .The majority of these neoplasms are benign.These tumours can occur in both major and minor salivary glands.80% of major salivary gland tumours occur in the parotid glands, while most minor salivary tumours are located in the palate.As a general rule in clinical practice, the smaller the salivary gland is, the more likely the tumour is malignant.Objective: This study was carried out to study the histopathological spectrum of salivary gland tumors and to know their pattern of distribution.Material and Methods:-This is a two year retrospective study which was conducted in the Post graduate department of pathology Government Medical College Srinagar from January 2015 to December 2016 .Post surgical specimens were studied in detail to know the histological patterns.In each patient, age, sex, site and histopathological diagnosis was seen from record section of the department.The histological diagnosis of each individual tumor was based on the 2005 WHO classification of salivary gland tumors.Results:-During two year ( from January 2015 to December 2016), 100 cases of salivary gland tumors were diagnosed with peak incidence in third to fourth decade (48%).Among these, 63(63%) cases were benign and 31(31%) cases were malignant.The commonest site was parotid gland (68%) followed by submandibular glands (19%) and minor salivary gland tumors were 1 3%.

Background: Ovary is a complex structure and its neoplasms show a wide spectrum of histological types and clinical behaviour. The present study was done with the aim of studying the histopathological pattern of the ovarian tumours in women of various age groups.Methods: This was prospective study conducted over a period of 2 years from Jan 2015 to Dec 2016 and included 193 cases of ovarian neoplasms.Results: Of 193 cases 155 (80.3%) were benign, 8 (4.1%) were borderline and 30 (15.5%) were malignant tumours. Surface epithelial tumours constituted majority of the tumours (64.7%). Mature cystic teratoma (30.6%%) was the most common benign tumour followed by serous cyst adenoma (26.9%). Serous cyst adenocarcinoma (7.8%) was the most common malignant tumour of the ovary. While tumours were seen over a wide range of 6-75 years, >80% of benign tumours were seen in patients of <40 years and 60% of malignant tumours were seen in patients of >40 years of age.Conclusions: The findings of present study are comparable to the published data from the subcontinent.

A wide variety of both benign and Malignant tumours arise from different components of the renal parenchyma, notably tubular epithelium[1-4].Renal tumours comprise a diverse spectrum of neoplastic lesions with patterns that are relatively distinct for children and adults[1-4]

INTRODUCTION:Scrape cytology is an important diagnostic tool. It has been used in many tissue types as an adjunct or replacement for frozen section/ intra operative consultation.AIM:This study was done to evaluate the role of scrape cytology in the diagnosis of thyroid lesions, its role as an adjunct to Fine Needle Aspiration Cytology (FNAC) and application of this technique for intra-operative consultation.MATERIALS AND METHODS:A prospective study on 50 thyroid neoplasms received over a period of 18 months (Nov 2014- March 2016) was conducted. Scrapings obtained from the fresh cut surface of thyroid specimens before formalin fixation, were smeared uniformly on to glass slides, and immediately fixed in 95% ethyl alcohol for rapid Haematoxylin and Eosin (H&E). Cytological findings were compared with pre-operative FNAC findings and histopathological diagnosis. Variables taken in to consideration while assessing the smears included cellularity, nuclear, cytological details and amount of colloid.RESULTS:There were total of 50 patients. Out of the 50 patients, 15 were diagnosed as benign on scrape; of which 100% of cases were true negative for malignancy and five malignant cases were diagnosed as benign-false negative rate of 16.1%; four (8%) were deferred (non-diagnostic) with a true positive rate of 83.3%. Histopathological correlation was available in all cases. The overall diagnostic accuracy of scrape cytology was 89.1% with sensitivity and specificity of 83.87% (C.I.; 66.27% to 94.55%) and 100% (C.I; 76.84% to 100.00%) respectively. Fine Needle Aspiration results were available in 41 cases of which 2 were non-diagnostic. Of the remaining 39 cases 19 were benign and 20 were malignant with false negative rate of 40% and true positive rate of 60%. The overall diagnostic accuracy of FNAC was 64.1% with sensitivity and specificity of 60% (C.I.; 40.6% to77.3 %) and 77.78% (C.I; 39.9% to 97.1%) respectively.CONCLUSION:We conclude that scrape cytology can act as a useful adjunct to FNAC and is a good procedure for intra-operative consultation. It is especially helpful in neoplasms diagnosed as suspicious for papillary carcinoma on aspiration and may obviate the need for a second procedure for completion thyroidectomy.

Fine needle aspiration cytology (FNAC) of thyroid plays a significant crucial role in cytopathology worldwide. Thyroid FNAC is extremely useful in identifying a substantial proportion of thyroid nodules as benign and reducing unnecessary surgery for patients with benign disease. The present study was done with the aim of stratifying thyroid cytology smears by The Bethesda System For Reporting Thyroid Cytopathology (TBSRTC) into various diagnostic categories, analyze their cytological features using TBSRTC monograph, convey brief management plan to the clinicians, and correlate with histology of surgical specimens received Methods: This was a prospective study done on 600 cases of fine needle aspirations of thyroid nodules over a period of two years from July 2013 to June 2015. Results: Mean age of the patients included in the study was 36 years(11–73) and male to female ratio was 2:6. Out of total 600 cases, 40 cases were non diagnostic (Bethesda Category I), 492 cases were diagnosed as benign (Bethesda category II) and 12 were Bethesda category III while 41 cases were categorized as either malignant or suspicious for malignancy (Bethesda category V and VI). Histopathologic correlation was available in 113 cases. Conclusion: TBSRTC is an excellent reporting system for thyroid cytopathology. It also provides clear management guidelines to clinicians to go for follow up FNA or surgery and also the extent of surgery.

Objective To evaluate any association between various ABO blood types and different dermatoses, viz, psoriasis, vitiligo, alopecia areata and pemphigus vulgaris. Methods This hospital-based, case-control study involved evaluation of ABO blood typing of 140 cases of psoriasis, 76 vitiligo, 84 alopecia areata and 30 pemphigus vulgaris, and 2067 controls. Results O blood group was found in 37.1% patients of psoriasis, followed by blood type B (30%) and blood group A (25.7%), without any significant difference between cases and controls. In vitiligo patients, B blood group was found in 47.4% patients, followed by blood group O (36.8%) and blood group A (10.5%). The results between vitiligo patients and controls regarding blood group A and B were statistically significant. In alopecia areata patients, blood group B was found in 45.2% patients, followed by blood group O (28.6%) and blood group A (19%), the difference being not statistically significant. In pemphigus vulgaris patients, O and B blood group were found in 40% patients each, followed by blood group A (20%), but this was not statistically significant. Conclusions In psoriasis patients in our study, blood group O was the most common, but without any statistical significance than the controls. In vitiligo patients, B blood group was the most common and this was statistically significant. Difference in the blood group A, although found less frequently than B and O blood group, was also statistically significant between study group and controls. In alopecia areata, B blood group was the most common, but this finding was not statistically significant when compared to controls. In pemphigus patients, blood group O and B were equally common, but this was not statistically significant than the controls.

30Nov 2016 HISTOPATHOLOGICAL STUDY OF CYSTOSCOPIC BLADDER BIOPSIES AND CYSTECTO MY SPECIMEN FROM KASHMIR. Bilal Ahmed Sheikh , Bushra Rashid Sahaf , Rukhsana Akhter , Farzana Manzoor , Arshi Beig , Saymah Rashid and Ruby Reshi. Associate professor, Department of Pathology, Govt Medical College, Srinagar. Demonstrators, Department of Pathology, Govt Medical College, Srinagar. Post Graduate Scholar, Department of Pathology, Govt Medical College, Srinagar. Professor and Head, Department of Pathology, Govt Medical College, Srinagar.

A variety of non-neoplastic and neoplastic conditions involve the nasal cavity and paranasal sinuses which are commonly encountered in clinical practice. The nose and paranasal sinuses are exposed to a variety of infections, chemically irritating, antigenically stimulating, traumatic and undoubtedly many other influences and consequences of these multifaceted deleterious exposures result in the formation of tumour-like and truly neoplastic conditions. To study histopathological pattern of sinonasal lesions and association of Human Papilloma Virus (HPV) with sinonasal papillomas and squamous cell carcinomas. The present study was a hospital based observational study conducted over a period of three years from January, 2010 to January, 2013 in the Department of Pathology, Government Medical College, Srinagar which included 181 cases of non-neoplastic and neoplastic lesions of nasal cavity and paranasal sinuses followed by study of association of HPV with sinonasal papillomas and squamous cell carcinomas by polymerase chain reaction (PCR). Out of total 181 cases, 114 were non-neoplastic and 67 were neoplastic. Out of 67 neoplastic lesions, 46 were benign and 21 were malignant. Nasal polyp was most common among non neoplastic lesions. Inverted sinonasal papilloma was most common benign lesion and squamous cell carcinoma was most common malignant lesion seen. Out of a total of 181 sinonasal lesions 101 (55.8%) were present in males and 80 (44.2%) were present in females with male to female ratio being 1.26:1. The age range of patients with sinonasal lesions varied from 5-75 years with a mean age being 34.67 (SD +/- 16.58) years. HPV positivity was seen in 4 (13.33%) out of 30 cases of inverted papillomas, 3 out of 6 (50%) exophytic papillomas tested positive for HPV. Out of 9 squamous cell carcinomas HPV positivity was seen in 2 (22.2%) cases. Categorizing the sinonasal lesions according to histopathological features into various types helps us to know the clinical presentation, clinical outcome and prognosis of the disease. Also low risk HPV types 6 and 11 show an association with sinonasal papillomas and oncogenic HPV types 16 and 18 with squamous cell carcinomas.

BACKGROUND:The histological categorization of lymphoma has been a source of controversy for many years for both clinicians and pathologists. Clinicopathologic information of gastrointestinal lymphomas in Indian subcontinent is lacking. We studied histopathological spectrum of Primary Gastrointestinal Lymphomas (PGIL) and attempted to classify the G.I. lymphomas based on the recent WHO classification in to major histological types and immunological categories.MATERIAL AND METHODS:This study was done to evaluate the clinicopathological pattern of 100 cases with a histopathological diagnosis of primary gastrointestinal lymphoma at a tertiary care hospital. All patients of primary gastrointestinal lymphomas were included with the help of medical records over a 11-years period that is, January 2005 to December 2015.RESULTS:The study included 100 cases (60 males, 40 females; mean age 51.43 years; age range 4.5-90 years). The disease involved stomach in 82 (82%), small intestine in 8 (8%), large bowel and rectum in 8 (8%), gall bladder in 1 (1%) and oesophagus in 1 (1%). 82 (82%) of the 100 cases were Diffuse Large B cell lymphomas; 12 (12%) were Extra Nodal Marginal Zone Lymphomas (ENMZL of MALT type) 2 (2%) IPSID 2 (2%) of Mantle cell lymphoma morphology, 1 (1%) Burkitt's and 1(1%) enteropathy associated T cell lymphoma. The commonest presenting symptom was abdominal pain. 99 (99%) of 100 tumours were classified as B-cell lymphomas immunohistochemically and majority exhibited monoclonal light chain restriction on kappa/lambda staining. In addition; Burkitt's lymphoma showed positivity for CD 10. One tumour (1%) showed positivity for T-cell markers. The data demonstrated that primary GI NHL is more common among males, mainly in their fifth decade. Abdominal pain is the most common presenting symptom, with stomach being the most commonly involved site. Diffuse large cell lymphoma is the most frequent histologic subtype, followed by extranodal marginal-zone B cell lymphoma (MALT type). H. Pylori infection was observed in cases with low grade MALT lymphomas. Striking was the observation of two cases of IPSID (a disease commonly found in Mediterranean countries) and one case of enteropathy associated T cell lymphoma.CONCLUSION:EGD, imaging, light microscopic examination and immunohistochemical workup for B and T cell markers and staining for light chains to assist documentation of monoclonality are of precise diagnostic value in gastrointestinal lymphomas and form a part of the diagnostic workup.