Anitha Padmanabhan - Academia.edu (original) (raw)

Papers by Anitha Padmanabhan

IP Archives of Cytology and Histopathology Research

The case report aims to highlight a rare entity called gliomatosis peritonei. We report a case of... more The case report aims to highlight a rare entity called gliomatosis peritonei. We report a case of a 23-year-old female presenting with an ovarian mass along with multiple omental nodules. On histopathological examination, the ovarian mass was diagnosed as mature cystic teratoma and the omental nodules showed features of gliomatosis peritonei. Gliomatosis peritonei is a rare entity characterized by peritoneal or omental implants of mature glial tissue. GFAP (Glial Fibrillary Acidic Protein) was positive in the omental nodules. Gliomatosis peritonei is an exceptional finding and requires long term follow up of the patient.

Annals of Pathology and Laboratory Medicine

Persistent Mullerian duct syndrome (PMDS) is a rare type of male pseudohermaphroditism characteri... more Persistent Mullerian duct syndrome (PMDS) is a rare type of male pseudohermaphroditism characterized by the presence of Mullerian derivatives (uterus, fallopian tubes and upper vagina), cryptorchidism either unilateral or bilateral along with inguinal hernia in a phenotypically and genotypically male person. PMDS is rarely associated with malignancies, the most common being testicular germ cell tumours. Occasional case of Adenocarcinoma arising in the PMD remnant structure is reported. We report an unusual case of male type of PMDS with squamous cell carcinoma (SCC) arising from PMD derivatives and presented with hematuria Also, this patient had karyotype of 47XYY (Jacob syndrome). Both these are hitherto unreported in English literature to the best of our knowledge.

Journal of diagnostic pathology and oncology, May 15, 2022

Prostate sarcomas originate from the mesenchymal tissues including smooth muscle, fibromuscular s... more Prostate sarcomas originate from the mesenchymal tissues including smooth muscle, fibromuscular stroma, paraganglia, nerves, and blood vessels. They account for less than 0.1% of all prostate tumors and often present with obstructive symptoms. Leiomyosarcoma is the most common sarcoma involving the prostate in adults affecting men between the ages of 40 and 78 years. Patients with leiomyosarcoma of the prostate commonly have a poor prognosis and their life expectancy depends on the stage of the disease at the initial diagnosis. Histopathological examination is essential for definitive diagnosis and can be performed at an early stage using guided transrectal prostate biopsy. Since prostate specific antigen (PSA) levels are generally normal, digital rectal examinations are extremely important. Tumor cells commonly express vimentin, smooth muscle actin and desmin, and up to 25% express cytokeratins. We report 3 cases of prostatic leiomyosarcoma with clinical, radiological, histopathological features and immunohistochemistry. This is an Open Access (OA) journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

Annals of Pathology and Laboratory Medicine

Occurrence of multiple primary malignant tumors is very uncommon .Co occuring tumors can be sync... more Occurrence of multiple primary malignant tumors is very uncommon .Co occuring tumors can be synchronous or non synchronous.Tumors presenting within a period less than or equal to 6 months are called synchronous and if they occur after 6 months they are termed as metachronous. Synchronous malignancies are rarer than metachronous. For defining tumors as synchronous both the tumors should show criteria of malignancy, possibility of metastasis must have been ruled out and both the tumors should be pathologically distinct. Breast cancer is the commonest tumor to be associated with other malignancies such as colorectal, endometrial, ovarian carcinoma, yet occurrence of invasive ductal carcinoma with clear cell renal carcinoma is rare. We present a 70 year old female with synchronous Breast carcinoma and Renal clear cell carcinoma .

Major hormonal changes emerge during pregnancy. The pituitary gland is one of the most affected o... more Major hormonal changes emerge during pregnancy. The pituitary gland is one of the most affected organs with altered anatomy and physiology. Sheehan's syndrome also known as Simmonds's syndrome or postpartum anterior pituitary necrosis is due to ischemic necrosis secondary to blood loss and hypovolemic shock after child birth. We report two autopsy cases of postpartum anterior pituitary necrosis with their clinical correlation. Histopathological examination of pituitary in both the cases showed extensive areas of coagulative necrosis involving the anterior pituitary. Both the cases were associated with indirect causes of maternal deaths like infectious etiology.

Annals of Pathology and Laboratory Medicine, 2016

Metastasis to the thyroid gland is very rare. It is very important to differentiate metastasis to... more Metastasis to the thyroid gland is very rare. It is very important to differentiate metastasis to thyroid from primary thyroid malignancy from the treatment point of view. A 48-years-old lady presented with weakness of lower limbs and backache since one and half months. External examinations reveal diffuse, nodular goitre. A fine-needle aspiration (FNA) of the thyroid nodule showed malignant epithelial cells with features characteristic of invasive lobular breast carcinoma. The diagnosis offered on FNAC was metastatic lobular breast carcinoma which was later confirmed on histopathological finding at autopsy. IHC performed on thyroid nodule was positive for: CK7, AE1-AE3, ER and negative for: E-cadherin, confirming its lobular nature. TTF1 was negative. FNA could be useful for diagnosis of thyroid metastasis, but it should be confirmed by immunohistochemistry.

Indian Journal of Pathology and Oncology, 2014

A case of Sarcoidosis, presented initially as bilateral parotid gland enlargement and diagnosed o... more A case of Sarcoidosis, presented initially as bilateral parotid gland enlargement and diagnosed on FNAC is discussed here. Smears showed noncaseating epithelioid cell granulomas and few atrophic salivary gland acini. AFB staining of the aspirate smears were negative and no caseous necrosis was seen. After excluding other granulomatous lesions, a differential diagnosis of Tuberculosis and sarcoidosis was suggested. The Serum ACE levels were elevated and x ray chest showed hilar lymphadenopathy. The patient also had xerostomia and xerophthalmia of right eye. The diagnosis of Sarcoidosis was confirmed based on these findings. FNAC, therefore, may be considered a useful diagnostic modality in cases of sarcoidosis presenting primarily with parotid involvement.

Annals of Pathology and Laboratory Medicine, 2020

Introduction: Persistent albuminuria and glomerular filtration rate are considered as the gold st... more Introduction: Persistent albuminuria and glomerular filtration rate are considered as the gold standard for the diagnosis of Diabetic Nephropathy (DN). Methods: In this autopsy study, we evaluated data from a cohort of 67 patients with Type 2 Diabetes Mellitus. We determined the histological prevalence of DN irrespective of the clinical manifestations of renal disease. Patients were stratified by proteinuria and estimated glomerular filtration rate(eGFR). The glomerular, interstitial and vascular lesions were scored as per the established histopathologic classification for DN. Results: 55 of the 67 patients had clinical as well as histological lesions consistent with DN. 12 patients had histological lesions of DN at autopsy but no clinical evidence of proteinuria, including microalbuminuria in their lifetime.4 of these patients had maintained eGFR. There was no difference in the glomerular lesions in patients with normoalbuminuria regardless of the eGFR. However,50% of the patients ...

A case of Sarcoidosis, presented initially as bilateral parotid gland enlargement and diagnosed o... more A case of Sarcoidosis, presented initially as bilateral parotid gland enlargement and diagnosed on FNAC is discussed here. Smears showed noncaseating epithelioid cell granulomas and few atrophic salivary gland acini. AFB staining of the aspirate smears were negative and no caseous necrosis was seen. After excluding other granulomatous lesions, a differential diagnosis of Tuberculosis and sarcoidosis was suggested. The Serum ACE levels were elevated and x ray chest showed hilar lymphadenopathy. The patient also had xerostomia and xerophthalmia of right eye. The diagnosis of Sarcoidosis was confirmed based on these findings. FNAC, therefore, may be considered a useful diagnostic modality in cases of sarcoidosis presenting primarily with parotid involvement.

Indian Journal of Pathology and Oncology, 2020

A spectrum of renal pathology is observed during pregnancy, so our main objective was to study th... more A spectrum of renal pathology is observed during pregnancy, so our main objective was to study the gross pathology and microscopy of the kidney in cases of maternal death, and to establish a clinico-pathological correlation. This was a crosssectional study of all medical autopsies performed on deaths related to pregnancy at our tertiary care hospital over a period of 7 years. In 166 autopsies, pathology was observed in 42 cases, and the kidneys were unremarkable in 124 cases. The most common renal pathology observed was acute tubular necrosis (22 cases), followed by acute pyelonephritis (7 cases), disseminated intravascular coagulation with fibrin thrombi (7 cases), diabetic nephropathy (3 cases), sickle cell anemia (1 case), tuberculosis kidney (1 case), and thrombotic microangiopathy (1 case). Renal pathology was observed in 25.3% of autopsies performed on maternal death, which contributed to a significant number of maternal mortalities and morbidities. The incidence of acute renal failure was 14.28% in our study. Apart from obstetric complications (e.g. antepartum hemorrhage, postpartum hemorrhage, pregnancy-induced hypertension), infections (e.g. pyelonephritis) were associated with septicemia, deranged renal function tests, and acute renal failure.

Indian Journal of Pathology and Oncology, 2020

Introduction: Fine needle aspiration cytology (FNAC) forms one of the first diagnostic tools in e... more Introduction: Fine needle aspiration cytology (FNAC) forms one of the first diagnostic tools in evaluation of soft tissue lesions. Aim of this study was to evaluate the role of FNAC in the primary diagnosis of soft tissue tumors and tumor like lesions and to assess the effectiveness of FNAC in the histological subtyping and grading of soft tissue tumors. Materials and Methods: We reviewed FNAC smears of 170 soft tissue tumors and tumor like lesions over a 3 years period and correlated with the histopathological features which were available in 117 cases. Conventional Papanicolaou (PAP) and Giemsa staining was done in all cases. Results: 152 out of 170 cases [89.41%] were neoplastic, of which 130 tumors were labelled as benign. Lipoma constituted 83.07% of benign tumors. Based on the predominant cytomorphological features and background, the tumors were classified into myxoid (4), spindle cell (20), pleomorphic (2), small round cell(4), epithelioid /polygonal cell (7), lipomatous (108) and miscellaneous (7). The non-neoplastic lesions included tuberculosis, filariasis, actinomycosis, scar endometriosis and calcinosis cutis. Conclusion: FNAC proved to be helpful in distinguishing between neoplastic and non-neoplastic soft tissue lesions, differentiating metastatic carcinoma and melanoma in soft tissue from primary soft tissue tumors and differentiating benign and malignant soft tissue tumors. Accurate subtyping was possible in many tumors of myxoid category and round cell tumors. Spindle cell tumors of intermediate grade were difficult to grade on FNAC. Pleomorphic sarcomas were of high grade and their subtyping could not be done on FNAC.

Indian Journal of Obstetrics and Gynecology Research, 2020

Aims: The main objective is to study the gross pathology and microscopy of all organs in cases of... more Aims: The main objective is to study the gross pathology and microscopy of all organs in cases of maternal death, establish clinico-pathological correlation, to ascertain the exact cause of death and classify them into direct or indirect causes. Settings and Design: Cross sectional study of all medical autopsies Materials and Methods: A cross sectional study of all medical autopsies performed on deaths related to pregnancy at our tertiary care hospital over a period of four years. A total of 100 cases were studied. Maternal mortality autopsies where medico legal implications were involved or unnatural deaths not related to pregnancy were excluded from the study. Statistical Analysis used: Nil Results: The maximum no. of maternal deaths occurred in the age group 20-24 years (45%) followed by 30-34 years (19%). 62% of patients in our study were multigravidae. Majority of maternal deaths were seen in the postpartum period (75%). In the antepartum period maximum number of maternal deaths occurred in 3 rd trimester (14%) Our study revealed majority of maternal deaths were due to indirect causes (76%), Pregnancy induced hypertension was the most common direct cause of death (9%). The majority of cases were due to infectious aetiology (45%), while the other indirect causes were sepsis (14%), coagulopathy (8%) and hemodynamic (8%). Conclusion: The higher MMR in our study could be attributed to the fact that ours being a tertiary and referral care hospital, where patients are referred late and most of them are complicated cases and in serious condition at the time of admission. The low socioeconomic status of the patients, delay in referral and non-utilisation of the available antenatal care could be the major contributing factors. Our study revealed majority of maternal deaths were due to indirect causes especially respiratory infections and hepatitis Increased incidence of indirect causes reflect the present health care system. So adequate prenatal testing for these causes (infections), improving the nutritional status, sanitation can help in lowering the maternal mortality rate.

AJSP: Reviews and Reports, 2020

Indian Journal of Case Reports, 2017

Major hormonal changes emerge during pregnancy. The pituitary gland is one of the most affected o... more Major hormonal changes emerge during pregnancy. The pituitary gland is one of the most affected organs with altered anatomy and physiology. Sheehan's syndrome also known as Simmonds's syndrome or postpartum anterior pituitary necrosis is due to ischemic necrosis secondary to blood loss and hypovolemic shock after child birth. We report two autopsy cases of postpartum anterior pituitary necrosis with their clinical correlation. Histopathological examination of pituitary in both the cases showed extensive areas of coagulative necrosis involving the anterior pituitary. Both the cases were associated with indirect causes of maternal deaths like infectious etiology.

Annals of Pathology and Laboratory Medicine, 2019

Acute renal cortical necrosis (RCN) most commonly occurs from obstetric complications. However ot... more Acute renal cortical necrosis (RCN) most commonly occurs from obstetric complications. However other rare cause includes medications like antifibrinolytics like tranexamic acid, which is used for acute bleeding. We report a case of 17 years female, operated for left cheek arteriovenous malformation and managed post-operatively by intravenous fluids, diuretics, antibiotics and antifibrinolytics (tranexemic acid). Postoperatively she started complaining of severe abdominal pain, breathlessness, weakness and loss of orientation with increasing levels of serum creatinine and blood urea nitrogen (BUN). Patient succumbed to death on day 6 post operative and complete autopsy was performed. All organs were unremarkable except bilateral lungs showed pulmonary edema and bilateral kidneys showed features of diffuse pattern of cortical necrosis both on gross and histopathological examination. As patient had no obstetric or other related history the cause of RCN was attributed to tranexemic acid. Thus patients on antifibrinolytics must be screened for RCN to avoid its fatal complication.

Saudi Journal of Kidney Diseases and Transplantation, 2018

Indian Journal of Pathology and Microbiology, 2019

We present an autopsy case of a 19 year old male admitted for breathlessness and oliguria. He was... more We present an autopsy case of a 19 year old male admitted for breathlessness and oliguria. He was diabetic since 7 years of age and was on insulin. Patient was on testosterone and anti hypertensives. He was diagnosed of hypocontractile bladder and congenital bilateral megaureter with vesico-ureteric reflux 2 years back. History of hemiparesis 2 years back. CT scan of the brain showed a right fronto- parietal healed infarct. At autopsy, bilateral kidneys showed coarse granularity and scarring. Pelvicalyceal system and both ureters were dilated. A right sided intrabdominal testes was identified. On histology, kidney showed features of diabetic nephropathy and pancreas showed decreased number of islet cells. Correlating the clinical, laboratory and autopsy parameters, our case satisfies the EURO-WABB criteria (1major+2minor) for diagnosis of Wolfram Syndrome, even though genetic confirmation could not be done.[1],[2]

Annals of Pathology and Laboratory Medicine, 2020

On histopathology, a pT2aN0M0, High-grade papillary urothelial carcinoma (WHO 2016 Classification... more On histopathology, a pT2aN0M0, High-grade papillary urothelial carcinoma (WHO 2016 Classification) [fig.2] invading the inner half of muscularis propria was seen.

Annals of Pathology and Laboratory Medicine, 2020

Malakoplakia is a granulomatous inflammatory condition commonly involving the urogenital tract. P... more Malakoplakia is a granulomatous inflammatory condition commonly involving the urogenital tract. Principally it involves the urinary bladder, prostate is a rare site. Clinical and radiological examination sometimes mimics malignancy. Histology remains confirmatory modality for the diagnosis. Hereby we report a case of prostatic malakoplakia in an elderly male who presented with lower urinary tract symptoms in the past fifteen days. Urine routine microscopy showed pus cells; culture report was positive for E. coli. Serum Prostate Specific antigen (PSA) was 4.6 ug/ml. Magnetic Resonance Imaging (MRI) showed a bulky prostate. A 12-core biopsy was done to rule out malignancy and the histopathology showed benign prostatic glands and the stroma with a predominant population of epithelioid histiocytes and the characteristic Michealis-Gutmann bodies. After a course of antibiotic Nitrofurantoin, transrectal ultrasound was repeated which showed reduction in the prostatic volume. Subsequently Trans-Urethral Resection of Prostate (TURP) was done to relieve the persistent lower urinary tract symptoms. Histology showed similar features. Special stains-Von kossa and Prussian Blue highlighted the Michealis-Gutmann bodies.

IP Journal of Diagnostic Pathology and Oncology, 2020

Primitive neuroectodermal tumor (PNET) / Ewing sarcoma of kidney are rare aggressive tumor with p... more Primitive neuroectodermal tumor (PNET) / Ewing sarcoma of kidney are rare aggressive tumor with poor prognosis. It occurs in young adults generally in 2nd to 3rd decade of life Case Reports: We report three cases of PNET/Ewing sarcoma of kidney in patients of age 25and 35 years with complain of hematuria and abdominal pain .CT scan revealed heterogeneously enhancing lesion in kidney and we received radical nephrectomy specimen with variegated appearance on gross. Microscopic examination showed tumor with malignant cells in sheets and pseudorosettes .The diagnosis was given as PNET/ES and was confirmed with immunohistochemistry. Discussion: Renal PNET/ES is a member of Ewing sarcoma family. They are rare tumor originating from the neural crest and are more aggressive than PNET at any other site. The presence of Homer Wright rosettes is less common in extra-osseous Ewing sarcoma and their presence is a sure diagnosis of PNET/ES. The differential diagnosis for these small round cell tumor of kidney other than PNET include malignant lymphoma, renal neuroblastoma,,embryonalrhanbdomyosarcoma, wilms tumor. The immunohistochemical marker CD99 positivity is diagnostic. Other markers positive are S-100, vimentin and NSE (neuron specific enolase). Conclusion: Histopathology and immunohistochemistry remains gold standard for confirming the diagnosis.

IP Archives of Cytology and Histopathology Research

The case report aims to highlight a rare entity called gliomatosis peritonei. We report a case of... more The case report aims to highlight a rare entity called gliomatosis peritonei. We report a case of a 23-year-old female presenting with an ovarian mass along with multiple omental nodules. On histopathological examination, the ovarian mass was diagnosed as mature cystic teratoma and the omental nodules showed features of gliomatosis peritonei. Gliomatosis peritonei is a rare entity characterized by peritoneal or omental implants of mature glial tissue. GFAP (Glial Fibrillary Acidic Protein) was positive in the omental nodules. Gliomatosis peritonei is an exceptional finding and requires long term follow up of the patient.

Annals of Pathology and Laboratory Medicine

Persistent Mullerian duct syndrome (PMDS) is a rare type of male pseudohermaphroditism characteri... more Persistent Mullerian duct syndrome (PMDS) is a rare type of male pseudohermaphroditism characterized by the presence of Mullerian derivatives (uterus, fallopian tubes and upper vagina), cryptorchidism either unilateral or bilateral along with inguinal hernia in a phenotypically and genotypically male person. PMDS is rarely associated with malignancies, the most common being testicular germ cell tumours. Occasional case of Adenocarcinoma arising in the PMD remnant structure is reported. We report an unusual case of male type of PMDS with squamous cell carcinoma (SCC) arising from PMD derivatives and presented with hematuria Also, this patient had karyotype of 47XYY (Jacob syndrome). Both these are hitherto unreported in English literature to the best of our knowledge.

Journal of diagnostic pathology and oncology, May 15, 2022

Prostate sarcomas originate from the mesenchymal tissues including smooth muscle, fibromuscular s... more Prostate sarcomas originate from the mesenchymal tissues including smooth muscle, fibromuscular stroma, paraganglia, nerves, and blood vessels. They account for less than 0.1% of all prostate tumors and often present with obstructive symptoms. Leiomyosarcoma is the most common sarcoma involving the prostate in adults affecting men between the ages of 40 and 78 years. Patients with leiomyosarcoma of the prostate commonly have a poor prognosis and their life expectancy depends on the stage of the disease at the initial diagnosis. Histopathological examination is essential for definitive diagnosis and can be performed at an early stage using guided transrectal prostate biopsy. Since prostate specific antigen (PSA) levels are generally normal, digital rectal examinations are extremely important. Tumor cells commonly express vimentin, smooth muscle actin and desmin, and up to 25% express cytokeratins. We report 3 cases of prostatic leiomyosarcoma with clinical, radiological, histopathological features and immunohistochemistry. This is an Open Access (OA) journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

Annals of Pathology and Laboratory Medicine

Occurrence of multiple primary malignant tumors is very uncommon .Co occuring tumors can be sync... more Occurrence of multiple primary malignant tumors is very uncommon .Co occuring tumors can be synchronous or non synchronous.Tumors presenting within a period less than or equal to 6 months are called synchronous and if they occur after 6 months they are termed as metachronous. Synchronous malignancies are rarer than metachronous. For defining tumors as synchronous both the tumors should show criteria of malignancy, possibility of metastasis must have been ruled out and both the tumors should be pathologically distinct. Breast cancer is the commonest tumor to be associated with other malignancies such as colorectal, endometrial, ovarian carcinoma, yet occurrence of invasive ductal carcinoma with clear cell renal carcinoma is rare. We present a 70 year old female with synchronous Breast carcinoma and Renal clear cell carcinoma .

Major hormonal changes emerge during pregnancy. The pituitary gland is one of the most affected o... more Major hormonal changes emerge during pregnancy. The pituitary gland is one of the most affected organs with altered anatomy and physiology. Sheehan's syndrome also known as Simmonds's syndrome or postpartum anterior pituitary necrosis is due to ischemic necrosis secondary to blood loss and hypovolemic shock after child birth. We report two autopsy cases of postpartum anterior pituitary necrosis with their clinical correlation. Histopathological examination of pituitary in both the cases showed extensive areas of coagulative necrosis involving the anterior pituitary. Both the cases were associated with indirect causes of maternal deaths like infectious etiology.

Annals of Pathology and Laboratory Medicine, 2016

Metastasis to the thyroid gland is very rare. It is very important to differentiate metastasis to... more Metastasis to the thyroid gland is very rare. It is very important to differentiate metastasis to thyroid from primary thyroid malignancy from the treatment point of view. A 48-years-old lady presented with weakness of lower limbs and backache since one and half months. External examinations reveal diffuse, nodular goitre. A fine-needle aspiration (FNA) of the thyroid nodule showed malignant epithelial cells with features characteristic of invasive lobular breast carcinoma. The diagnosis offered on FNAC was metastatic lobular breast carcinoma which was later confirmed on histopathological finding at autopsy. IHC performed on thyroid nodule was positive for: CK7, AE1-AE3, ER and negative for: E-cadherin, confirming its lobular nature. TTF1 was negative. FNA could be useful for diagnosis of thyroid metastasis, but it should be confirmed by immunohistochemistry.

Indian Journal of Pathology and Oncology, 2014

A case of Sarcoidosis, presented initially as bilateral parotid gland enlargement and diagnosed o... more A case of Sarcoidosis, presented initially as bilateral parotid gland enlargement and diagnosed on FNAC is discussed here. Smears showed noncaseating epithelioid cell granulomas and few atrophic salivary gland acini. AFB staining of the aspirate smears were negative and no caseous necrosis was seen. After excluding other granulomatous lesions, a differential diagnosis of Tuberculosis and sarcoidosis was suggested. The Serum ACE levels were elevated and x ray chest showed hilar lymphadenopathy. The patient also had xerostomia and xerophthalmia of right eye. The diagnosis of Sarcoidosis was confirmed based on these findings. FNAC, therefore, may be considered a useful diagnostic modality in cases of sarcoidosis presenting primarily with parotid involvement.

Annals of Pathology and Laboratory Medicine, 2020

Introduction: Persistent albuminuria and glomerular filtration rate are considered as the gold st... more Introduction: Persistent albuminuria and glomerular filtration rate are considered as the gold standard for the diagnosis of Diabetic Nephropathy (DN). Methods: In this autopsy study, we evaluated data from a cohort of 67 patients with Type 2 Diabetes Mellitus. We determined the histological prevalence of DN irrespective of the clinical manifestations of renal disease. Patients were stratified by proteinuria and estimated glomerular filtration rate(eGFR). The glomerular, interstitial and vascular lesions were scored as per the established histopathologic classification for DN. Results: 55 of the 67 patients had clinical as well as histological lesions consistent with DN. 12 patients had histological lesions of DN at autopsy but no clinical evidence of proteinuria, including microalbuminuria in their lifetime.4 of these patients had maintained eGFR. There was no difference in the glomerular lesions in patients with normoalbuminuria regardless of the eGFR. However,50% of the patients ...

A case of Sarcoidosis, presented initially as bilateral parotid gland enlargement and diagnosed o... more A case of Sarcoidosis, presented initially as bilateral parotid gland enlargement and diagnosed on FNAC is discussed here. Smears showed noncaseating epithelioid cell granulomas and few atrophic salivary gland acini. AFB staining of the aspirate smears were negative and no caseous necrosis was seen. After excluding other granulomatous lesions, a differential diagnosis of Tuberculosis and sarcoidosis was suggested. The Serum ACE levels were elevated and x ray chest showed hilar lymphadenopathy. The patient also had xerostomia and xerophthalmia of right eye. The diagnosis of Sarcoidosis was confirmed based on these findings. FNAC, therefore, may be considered a useful diagnostic modality in cases of sarcoidosis presenting primarily with parotid involvement.

Indian Journal of Pathology and Oncology, 2020

A spectrum of renal pathology is observed during pregnancy, so our main objective was to study th... more A spectrum of renal pathology is observed during pregnancy, so our main objective was to study the gross pathology and microscopy of the kidney in cases of maternal death, and to establish a clinico-pathological correlation. This was a crosssectional study of all medical autopsies performed on deaths related to pregnancy at our tertiary care hospital over a period of 7 years. In 166 autopsies, pathology was observed in 42 cases, and the kidneys were unremarkable in 124 cases. The most common renal pathology observed was acute tubular necrosis (22 cases), followed by acute pyelonephritis (7 cases), disseminated intravascular coagulation with fibrin thrombi (7 cases), diabetic nephropathy (3 cases), sickle cell anemia (1 case), tuberculosis kidney (1 case), and thrombotic microangiopathy (1 case). Renal pathology was observed in 25.3% of autopsies performed on maternal death, which contributed to a significant number of maternal mortalities and morbidities. The incidence of acute renal failure was 14.28% in our study. Apart from obstetric complications (e.g. antepartum hemorrhage, postpartum hemorrhage, pregnancy-induced hypertension), infections (e.g. pyelonephritis) were associated with septicemia, deranged renal function tests, and acute renal failure.

Indian Journal of Pathology and Oncology, 2020

Introduction: Fine needle aspiration cytology (FNAC) forms one of the first diagnostic tools in e... more Introduction: Fine needle aspiration cytology (FNAC) forms one of the first diagnostic tools in evaluation of soft tissue lesions. Aim of this study was to evaluate the role of FNAC in the primary diagnosis of soft tissue tumors and tumor like lesions and to assess the effectiveness of FNAC in the histological subtyping and grading of soft tissue tumors. Materials and Methods: We reviewed FNAC smears of 170 soft tissue tumors and tumor like lesions over a 3 years period and correlated with the histopathological features which were available in 117 cases. Conventional Papanicolaou (PAP) and Giemsa staining was done in all cases. Results: 152 out of 170 cases [89.41%] were neoplastic, of which 130 tumors were labelled as benign. Lipoma constituted 83.07% of benign tumors. Based on the predominant cytomorphological features and background, the tumors were classified into myxoid (4), spindle cell (20), pleomorphic (2), small round cell(4), epithelioid /polygonal cell (7), lipomatous (108) and miscellaneous (7). The non-neoplastic lesions included tuberculosis, filariasis, actinomycosis, scar endometriosis and calcinosis cutis. Conclusion: FNAC proved to be helpful in distinguishing between neoplastic and non-neoplastic soft tissue lesions, differentiating metastatic carcinoma and melanoma in soft tissue from primary soft tissue tumors and differentiating benign and malignant soft tissue tumors. Accurate subtyping was possible in many tumors of myxoid category and round cell tumors. Spindle cell tumors of intermediate grade were difficult to grade on FNAC. Pleomorphic sarcomas were of high grade and their subtyping could not be done on FNAC.

Indian Journal of Obstetrics and Gynecology Research, 2020

Aims: The main objective is to study the gross pathology and microscopy of all organs in cases of... more Aims: The main objective is to study the gross pathology and microscopy of all organs in cases of maternal death, establish clinico-pathological correlation, to ascertain the exact cause of death and classify them into direct or indirect causes. Settings and Design: Cross sectional study of all medical autopsies Materials and Methods: A cross sectional study of all medical autopsies performed on deaths related to pregnancy at our tertiary care hospital over a period of four years. A total of 100 cases were studied. Maternal mortality autopsies where medico legal implications were involved or unnatural deaths not related to pregnancy were excluded from the study. Statistical Analysis used: Nil Results: The maximum no. of maternal deaths occurred in the age group 20-24 years (45%) followed by 30-34 years (19%). 62% of patients in our study were multigravidae. Majority of maternal deaths were seen in the postpartum period (75%). In the antepartum period maximum number of maternal deaths occurred in 3 rd trimester (14%) Our study revealed majority of maternal deaths were due to indirect causes (76%), Pregnancy induced hypertension was the most common direct cause of death (9%). The majority of cases were due to infectious aetiology (45%), while the other indirect causes were sepsis (14%), coagulopathy (8%) and hemodynamic (8%). Conclusion: The higher MMR in our study could be attributed to the fact that ours being a tertiary and referral care hospital, where patients are referred late and most of them are complicated cases and in serious condition at the time of admission. The low socioeconomic status of the patients, delay in referral and non-utilisation of the available antenatal care could be the major contributing factors. Our study revealed majority of maternal deaths were due to indirect causes especially respiratory infections and hepatitis Increased incidence of indirect causes reflect the present health care system. So adequate prenatal testing for these causes (infections), improving the nutritional status, sanitation can help in lowering the maternal mortality rate.

AJSP: Reviews and Reports, 2020

Indian Journal of Case Reports, 2017

Major hormonal changes emerge during pregnancy. The pituitary gland is one of the most affected o... more Major hormonal changes emerge during pregnancy. The pituitary gland is one of the most affected organs with altered anatomy and physiology. Sheehan's syndrome also known as Simmonds's syndrome or postpartum anterior pituitary necrosis is due to ischemic necrosis secondary to blood loss and hypovolemic shock after child birth. We report two autopsy cases of postpartum anterior pituitary necrosis with their clinical correlation. Histopathological examination of pituitary in both the cases showed extensive areas of coagulative necrosis involving the anterior pituitary. Both the cases were associated with indirect causes of maternal deaths like infectious etiology.

Annals of Pathology and Laboratory Medicine, 2019

Acute renal cortical necrosis (RCN) most commonly occurs from obstetric complications. However ot... more Acute renal cortical necrosis (RCN) most commonly occurs from obstetric complications. However other rare cause includes medications like antifibrinolytics like tranexamic acid, which is used for acute bleeding. We report a case of 17 years female, operated for left cheek arteriovenous malformation and managed post-operatively by intravenous fluids, diuretics, antibiotics and antifibrinolytics (tranexemic acid). Postoperatively she started complaining of severe abdominal pain, breathlessness, weakness and loss of orientation with increasing levels of serum creatinine and blood urea nitrogen (BUN). Patient succumbed to death on day 6 post operative and complete autopsy was performed. All organs were unremarkable except bilateral lungs showed pulmonary edema and bilateral kidneys showed features of diffuse pattern of cortical necrosis both on gross and histopathological examination. As patient had no obstetric or other related history the cause of RCN was attributed to tranexemic acid. Thus patients on antifibrinolytics must be screened for RCN to avoid its fatal complication.

Saudi Journal of Kidney Diseases and Transplantation, 2018

Indian Journal of Pathology and Microbiology, 2019

We present an autopsy case of a 19 year old male admitted for breathlessness and oliguria. He was... more We present an autopsy case of a 19 year old male admitted for breathlessness and oliguria. He was diabetic since 7 years of age and was on insulin. Patient was on testosterone and anti hypertensives. He was diagnosed of hypocontractile bladder and congenital bilateral megaureter with vesico-ureteric reflux 2 years back. History of hemiparesis 2 years back. CT scan of the brain showed a right fronto- parietal healed infarct. At autopsy, bilateral kidneys showed coarse granularity and scarring. Pelvicalyceal system and both ureters were dilated. A right sided intrabdominal testes was identified. On histology, kidney showed features of diabetic nephropathy and pancreas showed decreased number of islet cells. Correlating the clinical, laboratory and autopsy parameters, our case satisfies the EURO-WABB criteria (1major+2minor) for diagnosis of Wolfram Syndrome, even though genetic confirmation could not be done.[1],[2]

Annals of Pathology and Laboratory Medicine, 2020

On histopathology, a pT2aN0M0, High-grade papillary urothelial carcinoma (WHO 2016 Classification... more On histopathology, a pT2aN0M0, High-grade papillary urothelial carcinoma (WHO 2016 Classification) [fig.2] invading the inner half of muscularis propria was seen.

Annals of Pathology and Laboratory Medicine, 2020

Malakoplakia is a granulomatous inflammatory condition commonly involving the urogenital tract. P... more Malakoplakia is a granulomatous inflammatory condition commonly involving the urogenital tract. Principally it involves the urinary bladder, prostate is a rare site. Clinical and radiological examination sometimes mimics malignancy. Histology remains confirmatory modality for the diagnosis. Hereby we report a case of prostatic malakoplakia in an elderly male who presented with lower urinary tract symptoms in the past fifteen days. Urine routine microscopy showed pus cells; culture report was positive for E. coli. Serum Prostate Specific antigen (PSA) was 4.6 ug/ml. Magnetic Resonance Imaging (MRI) showed a bulky prostate. A 12-core biopsy was done to rule out malignancy and the histopathology showed benign prostatic glands and the stroma with a predominant population of epithelioid histiocytes and the characteristic Michealis-Gutmann bodies. After a course of antibiotic Nitrofurantoin, transrectal ultrasound was repeated which showed reduction in the prostatic volume. Subsequently Trans-Urethral Resection of Prostate (TURP) was done to relieve the persistent lower urinary tract symptoms. Histology showed similar features. Special stains-Von kossa and Prussian Blue highlighted the Michealis-Gutmann bodies.

IP Journal of Diagnostic Pathology and Oncology, 2020

Primitive neuroectodermal tumor (PNET) / Ewing sarcoma of kidney are rare aggressive tumor with p... more Primitive neuroectodermal tumor (PNET) / Ewing sarcoma of kidney are rare aggressive tumor with poor prognosis. It occurs in young adults generally in 2nd to 3rd decade of life Case Reports: We report three cases of PNET/Ewing sarcoma of kidney in patients of age 25and 35 years with complain of hematuria and abdominal pain .CT scan revealed heterogeneously enhancing lesion in kidney and we received radical nephrectomy specimen with variegated appearance on gross. Microscopic examination showed tumor with malignant cells in sheets and pseudorosettes .The diagnosis was given as PNET/ES and was confirmed with immunohistochemistry. Discussion: Renal PNET/ES is a member of Ewing sarcoma family. They are rare tumor originating from the neural crest and are more aggressive than PNET at any other site. The presence of Homer Wright rosettes is less common in extra-osseous Ewing sarcoma and their presence is a sure diagnosis of PNET/ES. The differential diagnosis for these small round cell tumor of kidney other than PNET include malignant lymphoma, renal neuroblastoma,,embryonalrhanbdomyosarcoma, wilms tumor. The immunohistochemical marker CD99 positivity is diagnostic. Other markers positive are S-100, vimentin and NSE (neuron specific enolase). Conclusion: Histopathology and immunohistochemistry remains gold standard for confirming the diagnosis.