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Papers by Shrinivas Somalwar

International Journal of Surgical Pathology

Introduction. COVID-19 is an infection caused by severe acute respiratory syndrome corona virus-2... more Introduction. COVID-19 is an infection caused by severe acute respiratory syndrome corona virus-2 (SARS-CoV-2) which may be associated with a wide range of bacterial and fungal co-infections. Mucormycosis is an opportunistic fungal infection occurring in post COVID-19 patients. Objectives. To study the role of histopathology in mucormycosis and the predisposing factors associated in development of mucormycosis in post COVID-19 patients. Materials and methods. A prospective observational study was conducted in our hospital in the pathology department over a period of 3 months on 200 patients with mucormycosis who were infected with SARS-CoV-2 virus. Results. Out of the 200 patients with mucormycosis studied in post COVID-19 patients, age ranged from 21–80 years, of which 132 were men and 68 were women. Sites involved by mucormycosis were sinuses, orbit, cranium, and cutaneous. Ethmoid sinus was most involved, followed by maxillary sinus. Diabetes was present in 162 patients and hyper...

Parathyroid Adenoma is the commonest cause of primary hyperparathyroidism. Majority of adenomas a... more Parathyroid Adenoma is the commonest cause of primary hyperparathyroidism. Majority of adenomas arise from eutopically positioned parathyroid glands. However in 10% of the cases they can be from ectopic parathyroid glands. Aberrant migration during development may lead to ectopic locations of parathyroid glands. Proper pre operative localization is crucial for successful surgical outcome. We describe a case of primary hyperparathyroidism due to parathyroid adenoma in mediastinum, which was excised using sternotomy.

Splenic epithelial cysts are rare. We present such a case in a 14 year old boy who underwent sple... more Splenic epithelial cysts are rare. We present such a case in a 14 year old boy who underwent splenectomy. The cyst had multiple septations and satellite lesions prompting a provisional diagnosis of a parasitic cyst on radiology. The diagnosis of epithelial cyst was made on histopathological examination.

An 18 Year old girl presented to the thoracic surgery department with a left sided chest wall swe... more An 18 Year old girl presented to the thoracic surgery department with a left sided chest wall swelling of 10 years duration. On physical examination the lesion appeared to be a benign lesion. The patient was investigated and she underwent resection of the swelling. The Histopathology report of the resected specimen revealed it to be a synovial sarcoma. Synovial sarcoma of the chest wall is extremely rare, with only few cases described in literature.

Annals of Pathology and Laboratory Medicine, 2016

Background: Meningiomas are indolent tumors and their grading is based on histopathological param... more Background: Meningiomas are indolent tumors and their grading is based on histopathological parameters which have inherent limitations. Adjunct immunohistochemical markers are often used to overcome these limitations. Objective: To investigate the role of Ki67 and P63 immunoexpression in various grades of meningiomas. Methods: A retrospective analysis of 144 biopsies of intracranial and spinal meningothelial and nonmeningothelial tumors operated from January 2011 to May 2016 was carried out. Intraoperative squash smears were stained by 1% aqueous toluidine blue and rapid H&E method. Ki67 and p63 immunohistochemical staining was performed on paraffin sections of 125 histologically proven meningiomas cases. Grading was done according to the modified 2016 World Health Organization classification of CNS neoplasms .The results were analysed using statistical methods. Results: The total number of biopsy samples received was from144 cases. There was a female preponderance accounting for 68...

Journal of Evidence Based Medicine and Healthcare, 2017

BACKGROUND GIST is a subset of mesenchymal tumours arising from interstitial cells of Cajal. GIST... more BACKGROUND GIST is a subset of mesenchymal tumours arising from interstitial cells of Cajal. GIST has become very important since the availability of specific pathogenesis targeted treatment with the KIT/PDGFRA tyrosine kinase inhibitor, imatinib mesylate. MATERIALS AND METHODS It is a prospective and retrospective study. The study was conducted at the Upgraded Department of Pathology, Osmania General Hospital, Hyderabad, from 2013-2015 on 40 tumour samples. Immunohistochemistry using CD117, DOG1 and Ki67 was done on all cases along with routine histopathological assessment on H and E stained slides. RESULTS The immunopositivity of various markers is observed in different grades depending upon the tumour grade and locations. CONCLUSION CD117, DOG1 and Ki67 are important key diagnostic and prognostic biomarkers in the assessment of GIST across all the mesenchymal tumours of GIT.

Journal of Evidence Based Medicine and Healthcare, 2017

BACKGROUND CDX2 is a nuclear homeobox transcription factor that belongs to the caudal-related fam... more BACKGROUND CDX2 is a nuclear homeobox transcription factor that belongs to the caudal-related family of CDX homeobox genes. The gene encoding CDX2 is a nonclustered hexapeptide located on chromosome 13q12-13. Homeobox genes play an essential role in the control of normal embryonic development. CDX2 is crucial for axial patterning of the alimentary tract during embryonic development and is involved in the processes of intestinal cell proliferation, differentiation, adhesion and apoptosis. 1 It is considered specific for enterocytes and has been used for the diagnosis of primary and metastatic colorectal adenocarcinoma. MATERIALS AND METHODS This is a prospective study done at a tertiary hospital over a 2 year period from 2014 to 2016. 115 surgically resected and biopsy specimens of intestinal lesions of this period were included in the study. RESULTS Demographic data, clinical details and histopathology of these subjects were studied. Routinely processed formalin fixed paraffin embedded serial section of 3µm was subjected to immunohistochemistry with CDX2. CONCLUSION CDX2 could be used in conjunction with other intestinal tumour markers to enhance the prognostic utility in these tumours. Hence, CDX2 should always be used as a part of a broader immune histochemical panel.

Indian Journal of Pathology and Oncology, 2018

Introduction: Meningiomas account for 13%-25% of primary intracranial tumours and ~25% of intrasp... more Introduction: Meningiomas account for 13%-25% of primary intracranial tumours and ~25% of intraspinal tumors and histological grading has prognostic and therapeutic implications. However, histological criteria are sometimes not fulfilled to predict the biological behaviour of meningiomas, necessitating use of adjunct ancillary techniques like immunohistochemical markers. The aim of the study was to assess the correlation between the p63 protein expression with MIB-1 labelling index in different histological grades. Materials and Methods: This was a retrospective and prospective study of patients with intracranial and intraspinal meningiomas diagnosed during the period 2009-2014. The H& E Stained histological sections of the entire meningioma tumour were graded according to WHO 2007 criteria. Immunohistochemistry was performed using p63 protein and Ki-67. Result: The age of the patients ranged from 4-75 years including seven children. Out of 135 cases, 46 (34.07) cases occurred in males and the remaining 89(65.92%) cases were females. There were 125 grade I, 06 grade II, 04 grade III meningiomas. Amongst Grade I tumours (n =125) 16% (n=20) exhibited nuclear positivity for p63 protein. Among Grade II (n= 06) and Grade III (n= 04), all showed strong immune expression for p63. Statistical significant increase in mean labelling index (MIB1) was noted between Grade I to II and Grade II to III. Conclusion: Increased p63 expression and Ki-67 labelling index is associated more with high grade Meningioma and possible recurrence.

Journal of Evidence Based Medicine and Healthcare, 2019

BACKGROUND Tuberculosis and Malaria are among the leading causes of infectious disease-related de... more BACKGROUND Tuberculosis and Malaria are among the leading causes of infectious disease-related deaths worldwide. Plasmodium falciparum is almost always responsible for the most severe cases of malaria, leading to multi organ failure and higher mortality rates among the plasmodium species. India has the highest burden of TB in the world, an estimated 2 million cases annually, and accounting for approximately one fifth of the global incidence. Despite the availability of effective treatment for most cases, tuberculosis is still a cause of death in our environment; as in some cases, the diagnosis of tuberculosis may not be established until after the patient had died and an autopsy has been performed.

Journal of Evidence Based Medicine and Healthcare, 2018

BACKGROUND Kimura's disease is a rare chronic inflammatory condition of unknown aetiology which h... more BACKGROUND Kimura's disease is a rare chronic inflammatory condition of unknown aetiology which has been most commonly reported in Asian population, with young male preponderance. It is a benign disease which has an indolent course & gradually increases in size over months or years. It primarily involves the head and neck region, presents as subcutaneous masses and is often accompanied by regional lymphadenopathy, salivary gland involvement along with lymphadenopathy or presents with only lymphadenopathy. Peripheral blood eosinophilia and elevated serum immunoglobulin E (IgE) levels are characteristic features. Microscopy reveals lymphoid proliferation with eosinophilic infiltration. For years, Kimura's disease was believed to be identical to or part of the same disease spectrum as angiolymphoid hyperplasia with eosinophilia (ALHE). Recent reports, however, have confirmed that the two are, in fact, separate entities. MATERIALS AND METHODS It was a retrospective study undertaken over a period of one year from November 2016 to November 2017 in the Department of Pathology, Government ENT Hospital, Hyderabad. We report a study of eight (8) cases of Kimura's disease with usual and unusual sites of presentation and rare histomorphological features / microscopic features in one of the cases. Initially FNAC was performed with 22 gauge needle; smears were fixed in ether-95% alcohol solution and stained with Haematoxylin and Eosin stain, whereas air dried smears stained with toluidine blue stain. Subsequently excised specimens of those swellings and lymph nodes received were subjected to routine processing, cutting, staining and histopathological features were analysed. Haemogram, serum IgE levels and renal parameters of all these patients were studied. RESULTS Both cytomorphological and histomorphological features were in favour of Kimura's disease. CONCLUSION We report characteristic cytomorphological and histomorphological findings associated with peripheral eosinophilia and elevated serum IgE levels in eight patients with Kimura's disease.

Journal of Evidence Based Medicine and Healthcare, 2018

BACKGROUND Blood transfusion is the transfusion of whole blood or blood components (packed cells ... more BACKGROUND Blood transfusion is the transfusion of whole blood or blood components (packed cells or plasma only) into the blood stream or directly into the bone marrow. 1 It is carried out between individuals with compatible / identical blood groups, failure of which results in adverse transfusion reactions. An ATR (Adverse Transfusion Reaction) is an unfavourable reaction to the transfused blood/ blood component, the severity of which differs from person to person depending on the patient's susceptibility, degree of incompatibility and the type of reaction. 2

International Journal of Surgical Pathology

Introduction. COVID-19 is an infection caused by severe acute respiratory syndrome corona virus-2... more Introduction. COVID-19 is an infection caused by severe acute respiratory syndrome corona virus-2 (SARS-CoV-2) which may be associated with a wide range of bacterial and fungal co-infections. Mucormycosis is an opportunistic fungal infection occurring in post COVID-19 patients. Objectives. To study the role of histopathology in mucormycosis and the predisposing factors associated in development of mucormycosis in post COVID-19 patients. Materials and methods. A prospective observational study was conducted in our hospital in the pathology department over a period of 3 months on 200 patients with mucormycosis who were infected with SARS-CoV-2 virus. Results. Out of the 200 patients with mucormycosis studied in post COVID-19 patients, age ranged from 21–80 years, of which 132 were men and 68 were women. Sites involved by mucormycosis were sinuses, orbit, cranium, and cutaneous. Ethmoid sinus was most involved, followed by maxillary sinus. Diabetes was present in 162 patients and hyper...

Parathyroid Adenoma is the commonest cause of primary hyperparathyroidism. Majority of adenomas a... more Parathyroid Adenoma is the commonest cause of primary hyperparathyroidism. Majority of adenomas arise from eutopically positioned parathyroid glands. However in 10% of the cases they can be from ectopic parathyroid glands. Aberrant migration during development may lead to ectopic locations of parathyroid glands. Proper pre operative localization is crucial for successful surgical outcome. We describe a case of primary hyperparathyroidism due to parathyroid adenoma in mediastinum, which was excised using sternotomy.

Splenic epithelial cysts are rare. We present such a case in a 14 year old boy who underwent sple... more Splenic epithelial cysts are rare. We present such a case in a 14 year old boy who underwent splenectomy. The cyst had multiple septations and satellite lesions prompting a provisional diagnosis of a parasitic cyst on radiology. The diagnosis of epithelial cyst was made on histopathological examination.

An 18 Year old girl presented to the thoracic surgery department with a left sided chest wall swe... more An 18 Year old girl presented to the thoracic surgery department with a left sided chest wall swelling of 10 years duration. On physical examination the lesion appeared to be a benign lesion. The patient was investigated and she underwent resection of the swelling. The Histopathology report of the resected specimen revealed it to be a synovial sarcoma. Synovial sarcoma of the chest wall is extremely rare, with only few cases described in literature.

Annals of Pathology and Laboratory Medicine, 2016

Background: Meningiomas are indolent tumors and their grading is based on histopathological param... more Background: Meningiomas are indolent tumors and their grading is based on histopathological parameters which have inherent limitations. Adjunct immunohistochemical markers are often used to overcome these limitations. Objective: To investigate the role of Ki67 and P63 immunoexpression in various grades of meningiomas. Methods: A retrospective analysis of 144 biopsies of intracranial and spinal meningothelial and nonmeningothelial tumors operated from January 2011 to May 2016 was carried out. Intraoperative squash smears were stained by 1% aqueous toluidine blue and rapid H&E method. Ki67 and p63 immunohistochemical staining was performed on paraffin sections of 125 histologically proven meningiomas cases. Grading was done according to the modified 2016 World Health Organization classification of CNS neoplasms .The results were analysed using statistical methods. Results: The total number of biopsy samples received was from144 cases. There was a female preponderance accounting for 68...

Journal of Evidence Based Medicine and Healthcare, 2017

BACKGROUND GIST is a subset of mesenchymal tumours arising from interstitial cells of Cajal. GIST... more BACKGROUND GIST is a subset of mesenchymal tumours arising from interstitial cells of Cajal. GIST has become very important since the availability of specific pathogenesis targeted treatment with the KIT/PDGFRA tyrosine kinase inhibitor, imatinib mesylate. MATERIALS AND METHODS It is a prospective and retrospective study. The study was conducted at the Upgraded Department of Pathology, Osmania General Hospital, Hyderabad, from 2013-2015 on 40 tumour samples. Immunohistochemistry using CD117, DOG1 and Ki67 was done on all cases along with routine histopathological assessment on H and E stained slides. RESULTS The immunopositivity of various markers is observed in different grades depending upon the tumour grade and locations. CONCLUSION CD117, DOG1 and Ki67 are important key diagnostic and prognostic biomarkers in the assessment of GIST across all the mesenchymal tumours of GIT.

Journal of Evidence Based Medicine and Healthcare, 2017

BACKGROUND CDX2 is a nuclear homeobox transcription factor that belongs to the caudal-related fam... more BACKGROUND CDX2 is a nuclear homeobox transcription factor that belongs to the caudal-related family of CDX homeobox genes. The gene encoding CDX2 is a nonclustered hexapeptide located on chromosome 13q12-13. Homeobox genes play an essential role in the control of normal embryonic development. CDX2 is crucial for axial patterning of the alimentary tract during embryonic development and is involved in the processes of intestinal cell proliferation, differentiation, adhesion and apoptosis. 1 It is considered specific for enterocytes and has been used for the diagnosis of primary and metastatic colorectal adenocarcinoma. MATERIALS AND METHODS This is a prospective study done at a tertiary hospital over a 2 year period from 2014 to 2016. 115 surgically resected and biopsy specimens of intestinal lesions of this period were included in the study. RESULTS Demographic data, clinical details and histopathology of these subjects were studied. Routinely processed formalin fixed paraffin embedded serial section of 3µm was subjected to immunohistochemistry with CDX2. CONCLUSION CDX2 could be used in conjunction with other intestinal tumour markers to enhance the prognostic utility in these tumours. Hence, CDX2 should always be used as a part of a broader immune histochemical panel.

Indian Journal of Pathology and Oncology, 2018

Introduction: Meningiomas account for 13%-25% of primary intracranial tumours and ~25% of intrasp... more Introduction: Meningiomas account for 13%-25% of primary intracranial tumours and ~25% of intraspinal tumors and histological grading has prognostic and therapeutic implications. However, histological criteria are sometimes not fulfilled to predict the biological behaviour of meningiomas, necessitating use of adjunct ancillary techniques like immunohistochemical markers. The aim of the study was to assess the correlation between the p63 protein expression with MIB-1 labelling index in different histological grades. Materials and Methods: This was a retrospective and prospective study of patients with intracranial and intraspinal meningiomas diagnosed during the period 2009-2014. The H& E Stained histological sections of the entire meningioma tumour were graded according to WHO 2007 criteria. Immunohistochemistry was performed using p63 protein and Ki-67. Result: The age of the patients ranged from 4-75 years including seven children. Out of 135 cases, 46 (34.07) cases occurred in males and the remaining 89(65.92%) cases were females. There were 125 grade I, 06 grade II, 04 grade III meningiomas. Amongst Grade I tumours (n =125) 16% (n=20) exhibited nuclear positivity for p63 protein. Among Grade II (n= 06) and Grade III (n= 04), all showed strong immune expression for p63. Statistical significant increase in mean labelling index (MIB1) was noted between Grade I to II and Grade II to III. Conclusion: Increased p63 expression and Ki-67 labelling index is associated more with high grade Meningioma and possible recurrence.

Journal of Evidence Based Medicine and Healthcare, 2019

BACKGROUND Tuberculosis and Malaria are among the leading causes of infectious disease-related de... more BACKGROUND Tuberculosis and Malaria are among the leading causes of infectious disease-related deaths worldwide. Plasmodium falciparum is almost always responsible for the most severe cases of malaria, leading to multi organ failure and higher mortality rates among the plasmodium species. India has the highest burden of TB in the world, an estimated 2 million cases annually, and accounting for approximately one fifth of the global incidence. Despite the availability of effective treatment for most cases, tuberculosis is still a cause of death in our environment; as in some cases, the diagnosis of tuberculosis may not be established until after the patient had died and an autopsy has been performed.

Journal of Evidence Based Medicine and Healthcare, 2018

BACKGROUND Kimura's disease is a rare chronic inflammatory condition of unknown aetiology which h... more BACKGROUND Kimura's disease is a rare chronic inflammatory condition of unknown aetiology which has been most commonly reported in Asian population, with young male preponderance. It is a benign disease which has an indolent course & gradually increases in size over months or years. It primarily involves the head and neck region, presents as subcutaneous masses and is often accompanied by regional lymphadenopathy, salivary gland involvement along with lymphadenopathy or presents with only lymphadenopathy. Peripheral blood eosinophilia and elevated serum immunoglobulin E (IgE) levels are characteristic features. Microscopy reveals lymphoid proliferation with eosinophilic infiltration. For years, Kimura's disease was believed to be identical to or part of the same disease spectrum as angiolymphoid hyperplasia with eosinophilia (ALHE). Recent reports, however, have confirmed that the two are, in fact, separate entities. MATERIALS AND METHODS It was a retrospective study undertaken over a period of one year from November 2016 to November 2017 in the Department of Pathology, Government ENT Hospital, Hyderabad. We report a study of eight (8) cases of Kimura's disease with usual and unusual sites of presentation and rare histomorphological features / microscopic features in one of the cases. Initially FNAC was performed with 22 gauge needle; smears were fixed in ether-95% alcohol solution and stained with Haematoxylin and Eosin stain, whereas air dried smears stained with toluidine blue stain. Subsequently excised specimens of those swellings and lymph nodes received were subjected to routine processing, cutting, staining and histopathological features were analysed. Haemogram, serum IgE levels and renal parameters of all these patients were studied. RESULTS Both cytomorphological and histomorphological features were in favour of Kimura's disease. CONCLUSION We report characteristic cytomorphological and histomorphological findings associated with peripheral eosinophilia and elevated serum IgE levels in eight patients with Kimura's disease.

Journal of Evidence Based Medicine and Healthcare, 2018

BACKGROUND Blood transfusion is the transfusion of whole blood or blood components (packed cells ... more BACKGROUND Blood transfusion is the transfusion of whole blood or blood components (packed cells or plasma only) into the blood stream or directly into the bone marrow. 1 It is carried out between individuals with compatible / identical blood groups, failure of which results in adverse transfusion reactions. An ATR (Adverse Transfusion Reaction) is an unfavourable reaction to the transfused blood/ blood component, the severity of which differs from person to person depending on the patient's susceptibility, degree of incompatibility and the type of reaction. 2