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Papers by shaan khetrapal

American Journal of Clinical Pathology, 2019

Objectives Multi-institutional studies are required for the validation of the Milan System for Re... more Objectives Multi-institutional studies are required for the validation of the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC). Methods A total of 1,560 fine-needle aspirations of the salivary glands were retrieved from two institutions for a 12-year period. The diagnoses were reclassified based on the MSRSGC. Risk of malignancy (ROM) for each category was calculated based on 694 histologic follow-up cases. Results The ROM for each category was: 18.3% for nondiagnostic, 8.9% for nonneoplastic, 37.5% for atypia of undetermined significance (AUS), 2.9% for benign neoplasm, 40.7% for salivary gland neoplasm of uncertain malignant potential (SUMP), 100% for suspicious for malignancy, and 98.3% for malignant. The sensitivity, specificity, positive predictive rate, and negative predictive rates were 89%, 99%, 98%, and 96%, respectively. Conclusions The results of the current study are in keeping with the MSRSGC. The indeterminate categories of AUS and SUMP showed intermedi...

Journal of Cancer Research and Practice, 2021

Background: To find the association of tumor budding, depth of invasion (DOI), and epithelial-to-... more Background: To find the association of tumor budding, depth of invasion (DOI), and epithelial-to-mesenchymal transition (EMT) markers (E-cadherin and smooth muscle actin [SMA] expression) with prognostic factors of oral squamous cell carcinoma (OSCC). Materials and Methods: A cross-sectional study conducted on 50 cases of histologically proven OSCC were selected for the assessment of TNM staging, tumor budding, DOI, and EMT markers (E-cadherin and SMA expression). Associations were evaluated between established clinical prognostic factors and histological parameters. Statistical analysis was performed using SPSS version 21.0. (IBM, Chicago, Illinois, USA) and P < 0.05 was considered statistically significant. Results: In the study, the median age of distribution was 48.5 years with 86% of males. Tobacco consumption was seen among 90% of patients. A significant association of pathological TNM staging with tumor budding and DOI (P < 0.05). There was a loss of E-cadherin expressi...

National Journal of Laboratory Medicine, 2020

Introduction: Blood transfusion services have an essential role in the resuscitation and manageme... more Introduction: Blood transfusion services have an essential role in the resuscitation and management of patients undergoing elective surgeries and are an integral part of the healthcare system all over the world. Crossmatch to Transfusion Ratio (C:T) is an important national quality indicator used to estimate the appropriate use of services offered by the transfusion laboratory. Aim: To assess blood utilisation practices by analysing Cross Match to Transfusion Ratio (C:T). Materials and Methods: A seven years retrospective and crosssectional study was carried out in a tertiary teaching hospital located in South Delhi catering to low socioeconomic population; study was conducted in the Blood bank of Department of Pathology from January 2012 to December 2018. The department wise utilisation of blood and its components C:T ratio, Transfusion probability (T%) and index (TI) were calculated. Results: Out of the 3952 units prepared, 2850 (72.1%) units were transfused and rest 1102 (27.8%) ...

Shaan Khetrapal1, Zeeba Jairajpuri2, Safia Rana3, Mukta Pujani2, Sujata Jetley4 1Demonstrator, De... more Shaan Khetrapal1, Zeeba Jairajpuri2, Safia Rana3, Mukta Pujani2, Sujata Jetley4 1Demonstrator, Department of Pathology, Hamdard Institute of Medical Sciences and Research, Jamia Hamdard, New Delhi, India, 2Associate Professor, Department of Pathology, Hamdard Institute of Medical Sciences and Research, Jamia Hamdard, New Delhi, India, 3Lecturer, Department of Pathology, Hamdard Institute of Medical Sciences and Research, Jamia Hamdard, New Delhi, India, 4Professor, Department of Pathology, Hamdard Institute of Medical Sciences and Research, Jamia Hamdard, New Delhi, India

DOI: 10.21276/sjpm.2017.2.8.4 Abstract: Primary Squamous cell carcinoma of the gallbladder is ext... more DOI: 10.21276/sjpm.2017.2.8.4 Abstract: Primary Squamous cell carcinoma of the gallbladder is extremely rare and constitutes 0.53% of all gall bladder malignancies. We report a 50-year-old female who presented with vague symptom of right upper quadrant pain. She was operated on a presumptive diagnosis of chronic cholecystitis according to clinical and ultrasonography findings. Histopathological examination showed an infiltrating mass of the gallbladder which revealed well differentiated keratinized squamous cell carcinoma invading full wall thickness. Thorough evaluation revealed no other primary site for the tumor. Pure primary squamous cell carcinoma of the gallbladder is very rarely reported. Clinicians must be aware of its vague clinical presentations.

The Journal of medical research, 2015

Background: FNAC (Fine Needle Aspiration Cytology) is a well accepted technique and plays an impo... more Background: FNAC (Fine Needle Aspiration Cytology) is a well accepted technique and plays an important role in early diagnosis of head and neck lesions. It is a safe and inexpensive outdoor procedure. Material and methods: This was a retrospective observational study of 290 cases of FNACs done on head and neck swellings performed as an outdoor procedure over a 26-month period from January 2011 to February 2013.Results: Aspirates from head and neck lesions in this study were largely from lymph nodes i.e. 185(64.1%), followed by thyroid lesions 49(16.9%), 21 cases were malignant. The largest subgroup among lymph node was of granulomatous lymphadenitis comprising of 91 cases. Out of 290 cases in this study, histopathological correlation was available in 74/290 (25.51%) cases only and was consistent with the cytological diagnoses in 68(91.8%) cases and inconsistent in 6(8.2%) cases, Conclusion: FNAC serves as a guide to the appropriate therapeutic management whether to locally excise a ...

Journal of Medicine, 2017

Background: Amyloidosis is characterized by the deposition of polymeric fibrillar proteins in the... more Background: Amyloidosis is characterized by the deposition of polymeric fibrillar proteins in the extracellular compartment in tissues and organs ultimately leading to damage with functional compromise. Cutaneous amyloidosis is clinically classified into more common macular, papular, and the rarer nodular form. The present study was undertaken with the aim to histopathologically analyze and characterize clinically diagnosed amyloid cases. Methods: The present study was a retrospective analysis of skin biopsies conducted over a one year period. Data on the age and presenting clinical features were retrieved from the accompanying laboratory request forms or patients records wherever available. All skin biopsies with a histologic diagnosis of amyloid were retrieved and reviewed, the pattern of amyloid deposition identified and classified. Special stains including Congo Red stain was done in all the cases. Results: Histopathological confirmation of cutaneous amyloidosis was seen in nine...

International Journal of Medical Science and Clinical invention, 2019

Aim: To evaluate the role of rapid urease test in diagnosis of Helicobacter pylori infection in v... more Aim: To evaluate the role of rapid urease test in diagnosis of Helicobacter pylori infection in various gastro intestinal lesions vis a vis conventional and special staining methods. Materials & Methods: This hospital based cross sectional study was conducted on 50 cases with gastro intestinal lesions. The obtained biopsies were then subjected to rapid urease test for detection of H. pylori by using the Pronto Dry Kit immediately. Further histopathology examination using conventional H & E (haematoxylin and eosin) stain and special Gimenez stain for H. pylori was done. Results: In this study gender wise distribution of patients showed 58% males and 42% females. Chronic gastritis was found to be the most common diagnosis (28%), followed by squamous cell carcinoma (20%) chronic inflammation (16%), H. pylori gastritis and adenocarcinoma stomach (6%), adenocarcinoma esophagus, dysplasia, erosion, esophagitis and perforation in 4%. Least common diagnosis was atrophic gastritis and carci...

International Journal of Clinical and Diagnostic Pathology, 2020

Introduction: Oral cavity is prone to a myriad of changes with advancing age as well as a result ... more Introduction: Oral cavity is prone to a myriad of changes with advancing age as well as a result of the environmental and life style related factors. Genetic abnormalities are the primary cause of dysplastic, metaplastic, and neoplastic changes resulting in an imbalance between molecular mechanisms which regulate apoptosis and cell proliferation. Evaluating these parameters may not only help in identifying the individuals who are at a greater risk of developing carcinomas, but also carry significant prognostic value. Aim: The present study was undertaken with the aim of evaluating the expression profile of Bcl2 and Ki-67 as biomarkers in assessing the apoptotic and proliferative activity of Oral lesions and compare the topographical aspect of these lesions. Material and Methods: A cross sectional study of 31cases of oral lesions, immunohistochemically assessed for Bcl-2 and Ki67 for their expression pattern. Results: Expression of Ki-67 showed a linear increase from normal oral epithelium through various histological grades of Oral squamous cell carcinoma (OSCC). Expression of Bcl-2 was variable, defined by cytoplasmic granular staining in the epithelial cells. A decrease in mean positivity was seen from well differentiated OSCC to Moderately differentiated OSCC. Weak intensity of Bcl2 staining was seen in all the cases except one case of poorly differentiated oral squamous cell carcinoma. Conclusion: The pattern of expression of biomarkers, not only help in diagnosing oral lesion but also in identifying prognostic markers. Alterations in the expression of proteins related to cell proliferation and apoptosis are a strong indicator of the malignant transformation potential of certain lesions.

Acta Scientific Cancer Biology, 2020

Chondroid syringoma is also known as mixed tumor of skin due to its resemblance with mixed saliva... more Chondroid syringoma is also known as mixed tumor of skin due to its resemblance with mixed salivary gland tumor. It was first described by Billroth. It is a biphasic tumor composed of proliferation of epithelial and mesenchymal components. Predominantly seen in middle aged males in head and neck region. Our case report is of a young female who presented with a nodular firm swelling on the back.

International Journal of Applied and Basic Medical Research, 2019

Heterotopic or ectopic tissue is a congenital anomaly, which is defined as the presence of the ti... more Heterotopic or ectopic tissue is a congenital anomaly, which is defined as the presence of the tissue outside its normal location, without neural, vascular, or anatomic connection with the main body of an organ in which it normally exists. This tissue is usually discovered incidentally and may be asymptomatic or may present with nonspecific gastrointestinal (GI) symptoms. Pancreatic and gastric heterotopia are the two predominantly occurring heterotopic tissues in the GI tract.[1],[2] The prevalence of ectopic pancreatic tissue in the GI tract ranges from 0.6% to 13.7% of autopsy series and it can be present anywhere in the GI tract with the most common localizations being stomach (27.5%), duodenum (25.5%), colon (15.9%), esophagus, and Meckel's diverticulum.[3],[4],[5] It is a rare finding in the gallbladder and its prevalence has not been ascertained due to lack of large-scale studies and systematic review of literature. Similarly, heterotopic gastric tissue is common throughout the GI tract from the tongue to the rectum,[6],[7] but it is extremely rare in the gallbladder with only around 34 cases reported in literature so far, while other cases of different types of heterotopic tissues in the gallbladder such as liver tissue and others such as adrenal and thyroid tissues have been described.[8] The most common presentation of ectopic tissue in the gallbladder is colicky pain in the epigastrium or right upper quadrant sometimes associated with nausea and vomiting. Here, we are presenting two incidentally detected cases, each of gastric and pancreatic heterotopias in the gallbladder.

Journal of Cancer Research and Therapeutics, 2019

Brenner tumors of ovary are usually an incidental finding. It is an uncommon tumor which is seen ... more Brenner tumors of ovary are usually an incidental finding. It is an uncommon tumor which is seen affecting women of fifth to sixth decade. It is classified under transitional cell tumors of ovary, which includes benign, borderline, and malignant Brenner tumors and transitional cell carcinoma. These tumors have been associated with synchronous and metachronous neoplasia, most commonly other ovarian epithelial tumors such as mucinous cystadenoma. Occasionally, these tumors may be associated with endometrial hyperplasia or carcinomas which are due to hormones elaborated by the stromal component of Brenner tumor. The hormone produced is estrogen and less commonly androgens, which alters the estrogen and progesterone levels, causing hyperstimulation of endometrium. We present a case of 50-year-old postmenopausal women who presented with coexisting incidental Brenner tumor with leiomyoma and Endometrial adenocarcinoma. Only few authors have reported similar tumor occurrence in the past.

Archives of Medicine and Health Sciences, 2018

The presenting symptoms of RCC (renal cell carcinoma) overlap closely with those of XGP (Xanthogr... more The presenting symptoms of RCC (renal cell carcinoma) overlap closely with those of XGP (Xanthogranulomatous pyelonephritis) and can clinically as well as pathologically be confused with XGP which is an unusual inflammatory disorder. Most of the patients present with varied symptoms from the constellation of flank pain, fever, malaise, weight loss, and hematuria. We hereby report here a case of 52 year old male who presented with right flank pain, diagnosed erroneously as XGP on preoperative CT guided biopsy from the renal mass, on two occasions which eventually turned out to be clear cell variant of renal cell carcinoma. Right radical nephrectomy was done where the final histopathological diagnosis was of clear cell variant of RCC.

Journal of Cancer Research and Therapeutics, 2018

Malignant thyroid tumors of follicular origin comprise a spectrum, with the indolent well-differe... more Malignant thyroid tumors of follicular origin comprise a spectrum, with the indolent well-differentiated thyroid carcinoma (WDTC) at one end and lethal anaplastic thyroid carcinoma (ATC) at the other. Poorly differentiated thyroid carcinoma (PDTC) lies intermediately between WDTC and ATC in terms of morphology and prognostic standpoint. This thyroglobulin producing neoplasm accounts for 4–7% of all thyroid malignancies. PDTC has been controversial due to lack of defined diagnostic criteria. We hereby report a case of PDTC in a 42-year-old female presenting with neck swelling, pain, and dysphagia for 10 months. She was diagnosed as colloid goiter on fine-needle aspiration cytology. On imaging, a large complex thyroid with central neck nodes was seen. Total thyroidectomy and central neck node dissection were done. Based on the morphology, immunostaining, and the diagnostic criteria, a diagnosis of PDTC was made. PDTC is a diagnostic challenge due to its rarity and previous equivocal diagnostic criteria.

Bangladesh Journal of Medical Science, 2018

Background: The frequency of thalassemia trait is about 3% worldwide, while in developing countri... more Background: The frequency of thalassemia trait is about 3% worldwide, while in developing countries like India, it is a major cause of burden on the health care system. Naked eye single tube red cell osmotic fragility test (NESTROFT) used in population screening for beta thalassemia trait. It is a simple, low cost, reliable and most suitable screening test for β BTT, with a sensitivity of 99.8% in regions with high prevalence rates. Material &Methods: The present study was conducted in the Department of Pathology and included a total of 174 antenatal cases, attending the Out Patient Department of Obstetrics and Gynecology of a tertiary health care center in New Delhi between June 2011 to January 2012. The aim of the study was to screen mothers antenatally for early detection of BTT and to test the validity of NESTROFT in detection of thalassemic carriers of this area. Results: 174 pregnant women attending antenatal clinics were screened for detecting hemoglobinopathy with the help of NESTROFT, red cell indices, haemoglobin electrophoresis and HPLC It was seen that only four cases were BTT while ten were of microcytic anaemia and two had normal red cell indices. Conclusion: antenatal diagnosis of BTT is an important screening programme to reduce the burden of birth of children suffering from thalassemia and other hemoglobinopathies.

Journal of laboratory physicians

Tuberculosis (TB) in the developing countries presents with both pulmonary and extrapulmonary man... more Tuberculosis (TB) in the developing countries presents with both pulmonary and extrapulmonary manifestations. Breast TB, however, remains a rare presentation. Its importance lies in the fact that it may mimic malignancy or present as inflammatory lump/abscess. The aim of the present study is to highlight the importance of breast TB and its diagnostic challenges. It was a retrospective study conducted at a tertiary care hospital, over 2 years between 2013 and 2015 during which eight cases of breast lesions were diagnosed as of tubercular origin. Granulomas were seen in five cases while three cases revealed only few epithelioid cells, and necrosis was seen in all cases on fine-needle aspiration cytology. Histopathological evaluation was available in six out of the eight cases, while acid-fast bacilli were positive in three cases, the characteristic granulomas were seen in all the six cases evaluated. Significance of TB breast lies in the fact that it may masquerade as breast malignanc...

Breast disease, Jan 28, 2017

Crystallizing galactocele is a very rare entity which yields a viscous, chalky material on Fine N... more Crystallizing galactocele is a very rare entity which yields a viscous, chalky material on Fine Needle Aspiration Cytology (FNAC). FNAC is used both for diagnosis as well as treatment of this condition. We present here a case of 26 years old lactating female who presented with swelling in the right breast for 8 months. The swelling was firm, discrete, non-tender and mobile involving the upper inner quadrant of right breast. A diagnosis of benign breast disease, possibly fibroadenoma was made clinically. FNAC of the lesion yielded thick, milky and chalky material. Cytological smears showed numerous semitransparent crystals of varying size and shapes with angulated borders in a background of granular and amorphous debris along with frothy appearing micelles. These crystals show positive birefringence. Based on clinical history of lactation and typical cytological findings, a diagnosis of crystallizing galactocele was made. We report this case because of rarity of this condition and to...

Indian Journal of Surgical Oncology, 2016

Hodgkin's lymphoma has a significant presence in the Indian subcontinent. Microscopically, the ha... more Hodgkin's lymphoma has a significant presence in the Indian subcontinent. Microscopically, the hallmark of Hodgkin's lymphoma (HL) is the Hodgkin and Reed-Sternberg (HRS) cell, which is usually surrounded by a cellular infiltrate of non-malignant inflammatory cells that constitute the majority of the tumor tissue. Cells which are known to be histologic mimics of HRS cells include immunoblasts, plasmablasts and rarely dendritic cells. We report a case of a 70-year-old male who presented with fever and lymphadenopathy. In the present case, the large cells with prominent nucleoli stained positively for both CD15 and CD30 and hence the possibility of angioimmunoblastic lymphadenopathy which was considered on the H&E-stained sections was excluded. In addition, noteworthy microscopic features in this case were angiogenesis and the presence of mast cells, both associated with a poor prognosis. The clinical impression was that of disseminated tuberculosis, but on histopathology, the final opinion was 'Hodgkin's lymphoma not classifiable with an unusual histology'. The aim of reporting this case is to highlight the unusual presentation in the form of prominent angiogenesis and mast cell infiltration in a case of HL, which is indicative of a poor prognosis.

Journal of postgraduate medicine, Jan 26, 2015

Borderline ovarian tumors represent 10-20% of epithelial ovarian neoplasms that typically have an... more Borderline ovarian tumors represent 10-20% of epithelial ovarian neoplasms that typically have an excellent prognosis. Both the oncological behavior of this group of tumors and also the diagnostic histological criteria are intermediate between the specific criteria of benign and malignant. They usually occur in the third to fourth decade of women's lives and are limited to the ovary in 80% of cases. Atypical proliferative or borderline ovarian tumors constitute a group of epithelial tumors with an excellent prognosis due to the low aggressiveness, microscopic examination is mandatory in order to establish an accurate histological diagnosis in all cases of borderline ovarian tumors and to differentiate from well differentiated adenocarcinoma. We report a case of a 45 year old female who presented with irregular bleeding per vaginum and underwent hysterectomy with bilateral salpingo-oophorectomy. Atypical proliferative endometrioid tumor of the left ovary was an incidental finding...

International Journal of Applied and Basic Medical Research, 2014

Lymphomas are malignancies of the lymphoid tissues involving cells of the immune system. Primary ... more Lymphomas are malignancies of the lymphoid tissues involving cells of the immune system. Primary systemic anaplastic large cell lymphoma (ALCL) represents an aggressive lymphoma characterized by neoplastic proliferation of lymphoid cells with an anaplastic appearance. Large pleomorphic cells are "hallmark" cells with horseshoe-shaped or kidney-shaped nuclei and a constant expression of the CD30 molecule on all neoplastic cells. There is a vast morphological spectrum posing a challenge to pathologists in the diagnosis of ALCL.