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Introduction Cancer stem cell markers are now being tried in various cancers as prognostic markers including GI cancer but these kinds of studies are sparse in Indian population. Materials and Methods This study conducted over a period 50 months. Hematoxylin and eosin-stained slides were screened for grading of the tumor, extent of invasion of tumor, confirmation of metastasis, and staging was done. Immunohistochemical expression of CD44 was graded on the basis of percentage of tumor cells positive for staining. Statistical analysis was done and results were tabulated. Results : A total of 40 cases of GI cancer were studied. Ascending colon (37.5%) was the common site involved, 37 cases (92.5%) showed invasion beyond the muscularis externa. Most tumors were poorly differentiated (37.5%). Also, 50% of lymph nodes showed tumor deposits. The majority of the cases were in stage II (40%). There was a significant correlation between histopathological type of differentiation with lymph node metastasis and staging of tumor, lymph node metastasis also had significant association with staging. Grade 2, CD 44 expression was most common followed by Grade 3. Significant association was observed between histopathological differentiations of tumor with CD44 expression. Tumors that are invading beyond muscularis externa and lymph node-positive cases showed moderate to high CD44 expression. Conclusion CD44 expression was significantly noted in poorly differentiated tumors. Increased expression was also noted in cases of tumors invading beyond muscularis externa and lymph node metastasis. Combination of CSC markers will increase the sensitivity and specificity and predict better overall survival in GI tumors.

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BACKGROUND: Early and accurate diagnosis followed by timely treatment are the key prerequisites to fight tuberculosis (TB) and reduce its global burden. Despite scientific advances, the rapid and correct diagnosis of both pulmonary and extrapulmonary tuberculosis remains a challenge because of traditional reliance on detection of the elusive bacilli. Mycobacterium tuberculosis (Mtb)-specific host immune activation and cytokine production have shown significant promise as alternative means of detecting and distinguishing active disease from latent infection. We queried the diagnostic ability of phenotypic markers on Mtb-specific cytokine-producing immune cell subsets for identifying active TB. METHODS: Subjects belonging to the following groups were recruited: pulmonary and extrapulmonary TB, latent TB, cured TB, sick controls, and healthy controls. Polychromatic flow cytometry was used to identify host immune biomarkers in an exploratory cohort comprising 56 subjects using peripheral blood mononuclear cells. Clinical performance of the identified biomarker was evaluated using whole blood in a blinded validation cohort comprising 165 individuals. RESULTS: Cytokine secreting frequencies of Mtb-specific cluster of differentiation 4-positive (CD4+) T cells with CD38+CD27- phenotype clearly distinguished infected individuals with active tuberculosis from those without disease. Tumor necrosis factor-α (TNF-α) secretion from CD38+CD27-CD4+ T cells upon stimulation with ESAT6/CFP10 peptides had the best diagnostic accuracy at a cutoff of 9.91% (exploratory: 96.67% specificity, 88.46% sensitivity; validation: 96.15% specificity, 90.16% sensitivity). Additionally, this subset differentiated treatment-naive patients with TB from individuals cured of TB following completion of anti-TB therapy. CONCLUSIONS: Mtb-specific CD38+CD27-TNF-α +CD4+ T-cell subset is a robust biomarker both for diagnosing TB and assessing cure.

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Introduction Mucinous carcinoma (MC) is a rare form of breast cancer. It accounts for 1 to 7% of the cases and characterized by the presence of extracellular mucin (ECM). Depending on the amount of mucin, it is classified into pure mucinous carcinoma (> 90%, PMC) and mixed mucinous carcinoma (MMC; < 90%). In comparison to most common subtypes, MC is having better prognosis. There exist clinicopathological differences among PMC and MMC and also MC and IDC-NOS. Materials and Methods MCs diagnosed between January 2012 and December 2017 were included. Fine needle aspiration cytology smears were screened for cellularity, ECM, nuclear pleomorphism, signet ring cells (SRC), mucinophages, and myxovascular fragments (MVF). Histopathology slides were screened to confirm the diagnosis. Immunohistochemistry slides were graded as per the standard protocol. Statistical analyses were performed by SPSS software. Results In the present study, MC constituted 3.3%. The mean age of the patients was 50.9 years. ECM, mucinophages, and SRC were the key diagnostic cytological features. The PMC and MMC were clinicopathologically distinct with respect to gross findings and lymph node status. MMCs were highly proliferative. The mean duration of follow-up was 24.5 months. Complications were more common in MMC than PMC. Lymph node involvement is the key prognostic factor and it is independent of other prognostic factors like age, size, and hormonal receptor status. Conclusion PMC are rare subtype of breast cancer. The diagnostic cytological features are ECM, MVF, and SRC. MMC and PMC are clinicopathologically and genetically distinct.

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Diprosopus is a rare congenital anomaly, characterized by partial or complete duplication of the craniofacial structure. It constitutes 0.4% of all congenital anomalies. Complete duplications are invariably associated with systemic anomalies. Here, we present such a case of diprosopus with complete duplication of face in a 24-week-old male fetus, associated with anencephaly and spinal rachischisis. Proposed theory of embryogenesis and associated anomalies are also discussed.

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INTRODUCTION: Peripheral nerve sheath tumors (PNSTs) are neuroectodermal in origin. Now these tumors are classified under World Health Organization (WHO) classification of tumors of soft tissue and bone 2013. OBJECTIVE: To study the morphological spectrum of PNST and to study the secondary degenerative changes associated with it. MATERIALS AND METHODS: This study was conducted from January 2010 to June 2015. The gross details of tumor and patient's demographic profiles were reviewed. The hematoxylin and eosin stained slides were reassessed and the lesions were categorized and classified as per the WHO 2013 classification. The tumors were also assessed for secondary degenerative changes. RESULTS: Our study comprised 143 cases of PNST. Age of the patients ranged from 5 to 75 years. 21-30 years is the most common age of occurrence with head and neck being the most common site. The PNSTs observed in the present study were neurofibroma (NF) (61.5%), schwannoma (36%), malignant PNST (2%), and granular cell tumor (0.5%). Nearly 10% of NF fulfilled the criteria for neurofibromatosis 1 (NF1). Rare tumors such as plexiform schwannoma and granular cell tumor were also observed. Malignant tumors were larger in dimension than benign. Myxoid, cystic, and hyaline changes were commonly associated with benign tumors while necrosis, hemorrhage, and mitotic activity were seen with malignant tumors. CONCLUSION: This series highlights the pathological variants of PNST along with their morphological changes and NF1 association. It is essential to be familiar with all these variants of PNST for accurate diagnosis as they have varied biological behavior.

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Chronic myelogenous leukemia (CML) is the most common of all leukemia constituting 15-20% of all leukemia. The clinical course of the diseases runs in two to three phases, initial chronic phase followed by accelerated phase or blast phase. Blast phase most commonly presents clinically as fever, splenomegaly, and bone pain. Here, we present a case of CML in blast phase presenting with central nervous system manifestation in a 55-year-old patient with a brief review of the literature.

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BACKGROUND: The examination of the cerebrospinal fluid (CSF) for proteins, glucose, and leukocytes still remains the basic gold standard investigation for the initial diagnosis of meningitis. Early diagnosis and initiation of antibiotics within 3 h can reduce the mortality and morbidity associated with meningitis. Hence, we conducted this study to document the usefulness of urinary reagent strip for the semi-quantitative analysis of CSF chemistry and cellularity. MATERIALS AND METHODS: All clear CSF samples were subjected for two types of tests, the definitive test and the index test. CSF microscopy and biochemical values are considered as definitive. Combur-10 urinary reagent strip was used as the index test for proteins, glucose, and leukocytes. The diagnostic accuracy of each index test was calculated using different cut-off levels (leukocyte esterase positivity 1+ vs. CSF granulocytes ≥10/cumm, proteins 1+ and 2+ vs. CSF protein ≥30 mg/dl and ≥100 mg/dl, respectively, and glucose 0 vs. ≤40 mg/dl and ≤50 mg/dl). Statistical analysis was performed to derive the specificity, sensitivity, positive predictive value, negative predictive value, likelihood ratio (LR)+, LR-, and area under curve (AUC). RESULTS: The study subjects comprised 103 cases. The strip showed a high sensitivity and specificity for leukocytes ≥10 cells/cumm. The strip showed a sensitivity of 96% and a specificity of 87.1% for proteins at a cut-off ≥100 mg/dl while the strip was less specific at a cut-off of ≥30 mg/dl. With respect to glucose, the strip was highly specific (100%) and less sensitive at both the cut-off levels. The AUC for leukocytes ≥10 cells/cumm was 99.05%; for proteins ≥30 mg/dl and ≥100 mg/dl, it was 84.86% and 95.69%, respectively; and, for glucose ≤40 mg/dl and ≤50 mg/dl, it was 86.51% and 76.99%, respectively. CONCLUSION: The routinely used urinary reagent strip can be utilized for the rapid analysis of CSF. If implemented, this technique will be useful in rural areas. It would also decrease the turnaround time in centers where the facility is available.

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While tuberculosis is still the leading opportunistic infection among human immunodeficiency virus-seropositive patients, extra-pulmonary tuberculosis is more common than pulmonary tuberculosis, with lymph nodes being a common site. Axillary lymph node pathology such as tuberculosis and lymphoma rarely mimics inflammatory breast carcinoma by producing lymphatic obstruction. We report a case of axillary lymph node tuberculosis in a 40-year-old immune-compromised woman, clinically presenting as inflammatory breast carcinoma.

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We present two unusual cases of carcinoma of palatine tonsil in elderly patients. Both the cases were initially diagnosed as squamous cell carcinoma of the tonsil, second case, in addition, showed lung metastasis. On subsequent follow-up, the first case developed cutaneous metastasis in the right frontoparietal region while second case showed granulocytosis as paraneoplastic manifestation. The association of cutaneous metastasis and paraneoplastic granulocytosis with carcinoma of tonsil is rare. Cutaneous metastasis has been described only once in the literature while paraneoplastic granulocytosis is being reported for the first time. Both the conditions need long-term follow-up as they manifest at the extreme edges of the neoplastic process.

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Ectodermal dysplasia are group of inherited disorders involving the developmental defects of ectodermal structures like hair, teeth, nails, sweat glands, and others. X-linked recessive inheritance is most common. Here we describe perinatal autopsy findings in a case of de novo ectodermal dysplasia in a female fetus. To the best of our knowledge, this is the first fetal autopsy description in a case of ectodermal dysplasia.

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INTRODUCTION: Fine needle aspiration cytology is a simple, rapid procedure routinely employed for the diagnosis of tuberculosis lymphadenitis. Positivity for acid fast bacilli (AFB) in Ziehl-Neilsen stained smear is still considered as gold standard for diagnosis of Tuberculosis, but all lesions may not yield AFB, thus pose diagnostic problems. Few cytomorphological changes i.e. Eosinophilic structure (ES) in the stained smears correlates with the presence of AFB thus, helping us in rapid diagnosis. AIM: To evaluate the correlation between AFB and ES in necrotic lymph node aspirates. MATERIALS AND METHODS: This is a retrospective study conducted from January to December 2014. Lymphnodes upon purulent aspiration which were reported as granulomatous lymphadenitis suggestive of tuberculosis were included in the study. All the stained smears (H&E, MGG and ZN Stains) for each case were retrieved from the files and rescreened for the presence of ES, granulomas and AFB. Presences of ES were correlated with AFB. STATISTICAL ANALYSIS: Stastistical analysis was done using Chi-square test. RESULTS: Our study included 103 cases. The common age group involved was 21-40 years, with female predominance. Cervical lymph nodes were most commonly involved. In relation to ES and AFB, four different cytological pictures were seen i.e., ES and AFB-(31%); ES-AFB+(16.5%); ES+, AFB+(39%); ES+AFB-(14.5%). Chi-square test showed a highly significant stastistical association between ES and AFB with p=0.001. CONCLUSION: Eosinophilic structure is one of the cytomorphological features to be considered in necrotic lymph node aspirate which has a significant correlation with AFB in the smears. Hence pathologist should search for this, and it should be included in routine cytology reporting of tuberculosis lymphadenitis.

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Iniencephaly is a rare form of neural tube defect with an incidence of 0.1-10 in 10,000 pregnancies. It is characterized by the presence of occipital bone defects at foramen magnum, fixed retroflexion of head, spinal dysmorphism, and lordosis of cervicothoracic vertebrae. It is usually associated with central nervous system, gastrointestinal, and cardiovascular anomalies. We present radiological and autopsy findings in a series of 3 cases of iniencephaly (gestational ages 29.3, 23, and 24 weeks) first fetus in addition showed omphalocele, pulmonary hypoplasia, two lobes in right lung, accessory spleen, atrial septal defect, bilateral clubfoot, ambiguous genitalia, and single umbilical artery. Second fetus was a classical case of iniencephaly apertus with spina bifida. Third fetus had colpocephaly and bifid spine.

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Sirenomelia, a developmental defect involving the caudal region of the body, is associated with several internal visceral anomalies. We report a detailed spectrum of anomalies in an autopsy study of four fetuses with sirenomelia (gestational ages - 20, 21, 22.4, and 22.5 weeks). Three of the fetuses had single umbilical artery, with genitourinary and gastrointestinal anomalies. Central nervous system anomalies were evident in two of the fetuses, with alobar holoprosencephaly in one and lumbar meningomyelocele in another. The most common gastrointestinal anomaly was blind ended gut (imperforate anus), while esophageal atresia and omphalocele were noted in one case each. Renal hypoplasia was seen in two fetuses, renal agenesis in one and cystic renal dysplasia was noted in one case. Literature regarding pathogenesis of this condition is briefly discussed.

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We present autopsy findings of a case of limb body wall complex (LBWC). The fetus had encephalocele, genitourinary agenesis, skeletal anomalies and body wall defects. The rare finding in our case is the occurrence of both cranial and urogenital anomalies. The presence of complex anomalies in this fetus, supports embryonal dysplasia theory of pathogenesis for LBWC.

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Congenital cystic adenomatoid malformations (CCAM) also known as congenital pulmonary airway malformation is a developmental, non-hereditary, hamartomatous abnormality of lung with unknown etiology. It is a rare disease with an incidence of 1 in 25,000 to 1 in 35,000. It is a disease of infancy with most of the cases diagnosed within first 2 years of life. We report autopsy findings of two fetuses with congenital cystic adenomatoid malformation (Stocker Type II and I) with brief review of literature.

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We report a case of cutaneous swelling found on the left anterior axillary fold of a 41-year-old man. Gross examination of specimen excised from the dermis showed a well-circumscribed nodule histologically composed of spindle cells with interspersed ganglion cell like cells. On hematoxylin and eosine (H and E) staining it was diagnosed as ganglioneuroma. Ganglioneuromas are rare, benign, fully differentiated tumors that contain mature schwann cells, ganglion cells, fibrous tissue, and nerve fibers. They are commonly found along the paravertebral sympathetic ganglia and sometimes in the adrenal medulla. However primary cutaneous ganglioneuroma is an extremely rare tumor. Immunohistochemical workup revealed a fibroblastic origin and hence the case was diagnosed as fibromatosis with ganglion cell like fibroblasts. This case report suggests that the features considered diagnostic of ganglioneuromas can occur in other cutaneous lesions and, therefore, this diagnosis cannot be offered only on the basis of H and E.

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We report a case of papillary carcinoma of the thyroid that arose in a branchial cyst. The patient, a 45-year-old woman, presented with a left lateral neck mass of 3 months' duration. The cyst was removed intact. Because we could not rule out the possibility that a small primary malignancy was present within the gland, we performed a total thyroidectomy; however, no occult primary tumor of the thyroid was found. The patient was placed on thyroid hormone replacement therapy, and she was well at 2 years of follow-up. We briefly review the literature regarding the possible embryologic origin of such a phenomenon and the role of fine-needle aspiration cytology in differentiating a branchial cyst from a metastatic lymph node. To the best of our knowledge, this is only the 11th reported case of a thyroid papillary carcinoma arising in ectopic thyroid tissue within a branchial cyst, and the second such report from India.

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BACKGROUND: Accurate assessment of gestational age of fetuses is essential from both clinical and medico-legal point of view. Crown-rump length, crown-heel length, foot length, and the weight of the fetus are the commonly used parameters for fetal age assessment. However, this estimate often lacks accuracy and sometimes is necessary to combine other data. An analysis of the embryological development of nephrons in the kidney can assist in this determination. OBJECTIVE: To correlate the gestational age with the histological study of sequential development of nephrons in fetal kidney. MATERIALS AND METHODS: This study included 176 fetuses delivered between June 2009 and June 2011 and aged from 12 to 40 weeks. The number of glomerular generations counted in hematoxylin and eosin-stained microscopic sections of the kidneys were correlated with the reported period of gestation based on obstetrical methods. Regression analysis was used to determine the statistical significance of the correlation. RESULTS: A high degree of statistically significant correlation was observed between the period of gestation and the number of glomerular generations (P value < 0.0001). CONCLUSION: The histological assessment of the number of glomerular generations in kidney can be used as a reliable method of estimating fetal age.

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