Bimal Patel | The Tamilnadu Dr. Mgr Medical University (original) (raw)

Papers by Bimal Patel

Research paper thumbnail of Primary Central Nervous System Angiitis Mimicking a Space-Occupying Lesion

Indian Journal of Neurosurgery

Background and Purpose Intracranial space-occupying lesions are a sine qua non for neoplastic les... more Background and Purpose Intracranial space-occupying lesions are a sine qua non for neoplastic lesions; however, occasionally non-neoplastic lesions mimic neoplastic lesions, leading to diagnostic dilemmas. We report our experience with three patients who presented with a progressive hemispheric syndrome and the diagnostic considerations involved in the cases. Materials and Methods In this retrospective study, we included three patients with primary angiitis of central nervous system (PACNS) who underwent craniotomy and biopsy, suspecting it to be mass lesions. Demographic features, clinical features, radiological features, histopathology, treatment, and clinical outcomes were studied. Results Majority were males. The male:female ratio was 2:1. Lobar involvement was common. MR brain with contrast showed features of high-grade glioma. Despite hemispheric involvement, there was no mass effect. Perilesional edema was seen in all cases. All underwent craniotomy and biopsy; histopathology...

Research paper thumbnail of Xanthogranulomatous salpingo-oophoritis: a case report and review of literature

International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2020

Xanthogranulomatous inflammation of ovary is a rare disease that is characterized by presence of ... more Xanthogranulomatous inflammation of ovary is a rare disease that is characterized by presence of large number of lipid laden macrophages with an admixture of neutrophils, lymphocytes, plasma cells and multinucleated giant cells. It is misdiagnosed as ovarian tumour that leads to extensive surgery including hysterectomy. In this report we describe a case of Xanthogranulomatous salpingo-oophoritis along with review of literature.

Research paper thumbnail of Imaging Spectrum of Cavernous Sinus Lesions with Histopathologic Correlation

RadioGraphics, 2019

Cavernous sinuses are paired interconnected venous plexuses situated in the floor of the middle c... more Cavernous sinuses are paired interconnected venous plexuses situated in the floor of the middle cranial fossa on either side of the sella turcica and sphenoid sinus. They are lined by dura mater and consist of multiple venous channels within. The cavernous sinuses are intimately related to the internal carotid artery and its associated sympathetic plexus, the oculomotor nerve, the trochlear nerve, the abducens nerve, and the ophthalmic nerve. Cavernous sinuses are connected to the orbit, the pterygopalatine fossa, the infratemporal fossa, the nasopharynx, and the posterior cranial fossa by various foramina, fissures, and canals in the skull base. A multitude of structures in close relation to the cavernous sinus give rise to a myriad of possible pathologic conditions that can be broadly classified into (a) neoplastic, (b) vascular, (c) infective or inflammatory, or (d) miscellaneous lesions. These pathologic conditions can have overlapping clinical manifestations. Hence, imaging plays a crucial role in identifying the disease, assessing its extent, providing a pertinent differential diagnosis to guide further management, and suggesting a site or route for biopsy. MRI is the modality of choice to depict the cavernous sinuses, with CT and digital subtraction angiography playing supplementary roles in certain situations. In this article, the cavernous sinus lesions encountered in our institution during a 10-year period are reviewed. The purpose of the article is to (a) describe the anatomy of the cavernous sinus; (b) demonstrate the multimodality imaging spectrum of a wide variety of pathologic conditions involving the cavernous sinus, correlating with the histopathologic findings; (c) highlight important imaging clues for differential diagnosis; and (d) help the reader overcome potential pitfalls in interpretation.

Research paper thumbnail of Molecular profile of tumors with oligodendroglial morphology: Clinical relevance

Neurology India

The plethora of biomarkers available for the diagnosis and prognostication of gliomas has refined... more The plethora of biomarkers available for the diagnosis and prognostication of gliomas has refined the classification of gliomas. The new World Health Organization (WHO) 2016 classification integrates the phenotypic and genotyping features for a more robust diagnosis. Fifty gliomas with oligodendroglial morphology according to the WHO 2007 classification were analyzed for isocitrate dehydrogenase 1 and 2 (IDH1/2) mutations by polymerase chain reaction, 1p/19q status by fluorescent in situ hybridization (FISH), and IDH1 and X-linked alpha-thalassemia retardation (ATRX) expression by immunohistochemistry. Tumors were reclassified into oligodendrogliomas, astrocytomas, and glioblastomas (GBMs) according to the new "integrated" diagnostic approach. 30% of previously diagnosed oligodendrogliomas and almost 90% of oligoastrocytomas were reclassified as astrocytomas. Twenty gliomas showed 1p/19q co-deletion, while 18 gliomas showed polysomy of chromosome 1/19. Polysomy of chromoso...

Research paper thumbnail of A study of hematological parameters in patients with COVID-19 infection at a tertiary care centre

Coronavirus; Lymphocytes; Lymphopenia; Thrombocytopenia; Background: The corona virus disease 201... more Coronavirus; Lymphocytes; Lymphopenia; Thrombocytopenia; Background: The corona virus disease 2019 is caused by the virus SARS-CoV-2 and is declared as a global pandemic by World Health Organization. Alterations in various hematological parameters have been recently documented in the world literature in SARS-Cov-2 infection. However, still there is paucity of hematological data in these patients. Hence this study is an attempt to evaluate the pattern of the hematological parameters in COVID-19 patients in the Indian population in our region. The objective of the study is to see the pattern of alteration in hematological parameters with emphasis on total leukocyte count, absolute lymphocyte count and platelet count in COVID 19 positive patients.

Research paper thumbnail of Neurocutaneous Melanosis with Leptomeningeal Melanoma Involving Supratentorium and Infratentorium

Cureus, Jan 10, 2018

Neurocutaneous melanoma is a rare congenital syndrome associated with congenital melanocytic nevi... more Neurocutaneous melanoma is a rare congenital syndrome associated with congenital melanocytic nevi with meningeal melanosis or melanoma. The disease is aggressive and has a high propensity for leptomeningeal metastases. We present the case history of a man with neurocutaneous melanoma managed with radical excision followed by hypofractionated adjuvant radiotherapy. One year, eight months later, he had a recurrence of the condition with leptomeningeal spread and was managed with re-excision of the recurrent lesion. Although our patient was disease-free for 20 months after the initial surgery, he survived only approximately five months after the second surgery, which reflects the associated poor prognosis of the disease.

Research paper thumbnail of Xanthogranulomatous colloid cyst of the third ventricle

Acta Neuropathologica, 1985

This is a case report of a xanthogranulomatous colloid cyst of the 3rd ventricle. Possible etiolo... more This is a case report of a xanthogranulomatous colloid cyst of the 3rd ventricle. Possible etiologies for this rare entity, along with the clinical problems that may be associated with it, and the differential diagnosis are discussed.

Research paper thumbnail of Clinicopathological correlates of primary central nervous system lymphoma: Experience from a tertiary care center in South India

Neurology India, 2015

Primary central nervous system lymphomas (PCNSL) constitute a rare group of extranodal non-Hodgki... more Primary central nervous system lymphomas (PCNSL) constitute a rare group of extranodal non-Hodgkin's lymphomas (NHLs). To study the clinical and immunophenotypic profile of patients with a PCNSL who presented between the years 2000 and 2013 in a tertiary care center in South India. This was a retrospective study. Demographic and clinical data were obtained from the clinical case records. Cases of PCNSL involving brain. Cases of PCNSL involving the spinal cord, meninges and orbit as well as intravascular large B-cell lymphoma, lymphomas with evidence of systemic disease or secondary lymphomas. Archived slides and tissue blocks were retrieved. All cases had hematoxylin and eosin stained sections and immunohistochemistry for CD20, CD3, and MIB-1. Additional immunohistochemistry was performed for CD10, BCL6, and MUM1 on paraffin blocks with sufficient tissue. There were a total of 73 cases with the mean age of presentation being 45.9 years (range 8-71 years) and with a male predominance (male: female (M:F) = 2.3:1). Headache was the commonest presenting complaint. The mean duration of symptoms was 10.6 weeks. All patients were immunocompetent. Most tumors were supratentorial in location. Out of 73 cases, 70 presented with a diffuse large B-cell lymphoma (DLBCL), two with a Burkitt's lymphoma, and one with a lymphomatoid granulomatosis. Only 51 of the DLBCL cases had sufficient tissue for additional studies. Non-germinal center was the most common phenotype seen in 65.7% (33/51) of cases. Germinal center B-cell (GCB) phenotype was seen in 18/51 cases (34.3%). DLBCL constituted the majority of PCNSLs and although non-germinal center was the predominant phenotype, more than a third of the cases were of the GCB phenotype. As the germinal center phenotype is known to have a better prognosis, further studies to explore its relevance in the Asian population are indicated.

Research paper thumbnail of Clinicopathological correlates of primary central nervous system lymphoma: Experience from a tertiary care center in South India

Neurology India, 2015

Primary central nervous system lymphomas (PCNSL) constitute a rare group of extranodal non-Hodgki... more Primary central nervous system lymphomas (PCNSL) constitute a rare group of extranodal non-Hodgkin's lymphomas (NHLs). To study the clinical and immunophenotypic profile of patients with a PCNSL who presented between the years 2000 and 2013 in a tertiary care center in South India. This was a retrospective study. Demographic and clinical data were obtained from the clinical case records. Cases of PCNSL involving brain. Cases of PCNSL involving the spinal cord, meninges and orbit as well as intravascular large B-cell lymphoma, lymphomas with evidence of systemic disease or secondary lymphomas. Archived slides and tissue blocks were retrieved. All cases had hematoxylin and eosin stained sections and immunohistochemistry for CD20, CD3, and MIB-1. Additional immunohistochemistry was performed for CD10, BCL6, and MUM1 on paraffin blocks with sufficient tissue. There were a total of 73 cases with the mean age of presentation being 45.9 years (range 8-71 years) and with a male predominance (male: female (M:F) = 2.3:1). Headache was the commonest presenting complaint. The mean duration of symptoms was 10.6 weeks. All patients were immunocompetent. Most tumors were supratentorial in location. Out of 73 cases, 70 presented with a diffuse large B-cell lymphoma (DLBCL), two with a Burkitt's lymphoma, and one with a lymphomatoid granulomatosis. Only 51 of the DLBCL cases had sufficient tissue for additional studies. Non-germinal center was the most common phenotype seen in 65.7% (33/51) of cases. Germinal center B-cell (GCB) phenotype was seen in 18/51 cases (34.3%). DLBCL constituted the majority of PCNSLs and although non-germinal center was the predominant phenotype, more than a third of the cases were of the GCB phenotype. As the germinal center phenotype is known to have a better prognosis, further studies to explore its relevance in the Asian population are indicated.

Research paper thumbnail of Primary Central Nervous System Angiitis Mimicking a Space-Occupying Lesion

Indian Journal of Neurosurgery

Background and Purpose Intracranial space-occupying lesions are a sine qua non for neoplastic les... more Background and Purpose Intracranial space-occupying lesions are a sine qua non for neoplastic lesions; however, occasionally non-neoplastic lesions mimic neoplastic lesions, leading to diagnostic dilemmas. We report our experience with three patients who presented with a progressive hemispheric syndrome and the diagnostic considerations involved in the cases. Materials and Methods In this retrospective study, we included three patients with primary angiitis of central nervous system (PACNS) who underwent craniotomy and biopsy, suspecting it to be mass lesions. Demographic features, clinical features, radiological features, histopathology, treatment, and clinical outcomes were studied. Results Majority were males. The male:female ratio was 2:1. Lobar involvement was common. MR brain with contrast showed features of high-grade glioma. Despite hemispheric involvement, there was no mass effect. Perilesional edema was seen in all cases. All underwent craniotomy and biopsy; histopathology...

Research paper thumbnail of Xanthogranulomatous salpingo-oophoritis: a case report and review of literature

International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2020

Xanthogranulomatous inflammation of ovary is a rare disease that is characterized by presence of ... more Xanthogranulomatous inflammation of ovary is a rare disease that is characterized by presence of large number of lipid laden macrophages with an admixture of neutrophils, lymphocytes, plasma cells and multinucleated giant cells. It is misdiagnosed as ovarian tumour that leads to extensive surgery including hysterectomy. In this report we describe a case of Xanthogranulomatous salpingo-oophoritis along with review of literature.

Research paper thumbnail of Imaging Spectrum of Cavernous Sinus Lesions with Histopathologic Correlation

RadioGraphics, 2019

Cavernous sinuses are paired interconnected venous plexuses situated in the floor of the middle c... more Cavernous sinuses are paired interconnected venous plexuses situated in the floor of the middle cranial fossa on either side of the sella turcica and sphenoid sinus. They are lined by dura mater and consist of multiple venous channels within. The cavernous sinuses are intimately related to the internal carotid artery and its associated sympathetic plexus, the oculomotor nerve, the trochlear nerve, the abducens nerve, and the ophthalmic nerve. Cavernous sinuses are connected to the orbit, the pterygopalatine fossa, the infratemporal fossa, the nasopharynx, and the posterior cranial fossa by various foramina, fissures, and canals in the skull base. A multitude of structures in close relation to the cavernous sinus give rise to a myriad of possible pathologic conditions that can be broadly classified into (a) neoplastic, (b) vascular, (c) infective or inflammatory, or (d) miscellaneous lesions. These pathologic conditions can have overlapping clinical manifestations. Hence, imaging plays a crucial role in identifying the disease, assessing its extent, providing a pertinent differential diagnosis to guide further management, and suggesting a site or route for biopsy. MRI is the modality of choice to depict the cavernous sinuses, with CT and digital subtraction angiography playing supplementary roles in certain situations. In this article, the cavernous sinus lesions encountered in our institution during a 10-year period are reviewed. The purpose of the article is to (a) describe the anatomy of the cavernous sinus; (b) demonstrate the multimodality imaging spectrum of a wide variety of pathologic conditions involving the cavernous sinus, correlating with the histopathologic findings; (c) highlight important imaging clues for differential diagnosis; and (d) help the reader overcome potential pitfalls in interpretation.

Research paper thumbnail of Molecular profile of tumors with oligodendroglial morphology: Clinical relevance

Neurology India

The plethora of biomarkers available for the diagnosis and prognostication of gliomas has refined... more The plethora of biomarkers available for the diagnosis and prognostication of gliomas has refined the classification of gliomas. The new World Health Organization (WHO) 2016 classification integrates the phenotypic and genotyping features for a more robust diagnosis. Fifty gliomas with oligodendroglial morphology according to the WHO 2007 classification were analyzed for isocitrate dehydrogenase 1 and 2 (IDH1/2) mutations by polymerase chain reaction, 1p/19q status by fluorescent in situ hybridization (FISH), and IDH1 and X-linked alpha-thalassemia retardation (ATRX) expression by immunohistochemistry. Tumors were reclassified into oligodendrogliomas, astrocytomas, and glioblastomas (GBMs) according to the new "integrated" diagnostic approach. 30% of previously diagnosed oligodendrogliomas and almost 90% of oligoastrocytomas were reclassified as astrocytomas. Twenty gliomas showed 1p/19q co-deletion, while 18 gliomas showed polysomy of chromosome 1/19. Polysomy of chromoso...

Research paper thumbnail of A study of hematological parameters in patients with COVID-19 infection at a tertiary care centre

Coronavirus; Lymphocytes; Lymphopenia; Thrombocytopenia; Background: The corona virus disease 201... more Coronavirus; Lymphocytes; Lymphopenia; Thrombocytopenia; Background: The corona virus disease 2019 is caused by the virus SARS-CoV-2 and is declared as a global pandemic by World Health Organization. Alterations in various hematological parameters have been recently documented in the world literature in SARS-Cov-2 infection. However, still there is paucity of hematological data in these patients. Hence this study is an attempt to evaluate the pattern of the hematological parameters in COVID-19 patients in the Indian population in our region. The objective of the study is to see the pattern of alteration in hematological parameters with emphasis on total leukocyte count, absolute lymphocyte count and platelet count in COVID 19 positive patients.

Research paper thumbnail of Neurocutaneous Melanosis with Leptomeningeal Melanoma Involving Supratentorium and Infratentorium

Cureus, Jan 10, 2018

Neurocutaneous melanoma is a rare congenital syndrome associated with congenital melanocytic nevi... more Neurocutaneous melanoma is a rare congenital syndrome associated with congenital melanocytic nevi with meningeal melanosis or melanoma. The disease is aggressive and has a high propensity for leptomeningeal metastases. We present the case history of a man with neurocutaneous melanoma managed with radical excision followed by hypofractionated adjuvant radiotherapy. One year, eight months later, he had a recurrence of the condition with leptomeningeal spread and was managed with re-excision of the recurrent lesion. Although our patient was disease-free for 20 months after the initial surgery, he survived only approximately five months after the second surgery, which reflects the associated poor prognosis of the disease.

Research paper thumbnail of Xanthogranulomatous colloid cyst of the third ventricle

Acta Neuropathologica, 1985

This is a case report of a xanthogranulomatous colloid cyst of the 3rd ventricle. Possible etiolo... more This is a case report of a xanthogranulomatous colloid cyst of the 3rd ventricle. Possible etiologies for this rare entity, along with the clinical problems that may be associated with it, and the differential diagnosis are discussed.

Research paper thumbnail of Clinicopathological correlates of primary central nervous system lymphoma: Experience from a tertiary care center in South India

Neurology India, 2015

Primary central nervous system lymphomas (PCNSL) constitute a rare group of extranodal non-Hodgki... more Primary central nervous system lymphomas (PCNSL) constitute a rare group of extranodal non-Hodgkin's lymphomas (NHLs). To study the clinical and immunophenotypic profile of patients with a PCNSL who presented between the years 2000 and 2013 in a tertiary care center in South India. This was a retrospective study. Demographic and clinical data were obtained from the clinical case records. Cases of PCNSL involving brain. Cases of PCNSL involving the spinal cord, meninges and orbit as well as intravascular large B-cell lymphoma, lymphomas with evidence of systemic disease or secondary lymphomas. Archived slides and tissue blocks were retrieved. All cases had hematoxylin and eosin stained sections and immunohistochemistry for CD20, CD3, and MIB-1. Additional immunohistochemistry was performed for CD10, BCL6, and MUM1 on paraffin blocks with sufficient tissue. There were a total of 73 cases with the mean age of presentation being 45.9 years (range 8-71 years) and with a male predominance (male: female (M:F) = 2.3:1). Headache was the commonest presenting complaint. The mean duration of symptoms was 10.6 weeks. All patients were immunocompetent. Most tumors were supratentorial in location. Out of 73 cases, 70 presented with a diffuse large B-cell lymphoma (DLBCL), two with a Burkitt's lymphoma, and one with a lymphomatoid granulomatosis. Only 51 of the DLBCL cases had sufficient tissue for additional studies. Non-germinal center was the most common phenotype seen in 65.7% (33/51) of cases. Germinal center B-cell (GCB) phenotype was seen in 18/51 cases (34.3%). DLBCL constituted the majority of PCNSLs and although non-germinal center was the predominant phenotype, more than a third of the cases were of the GCB phenotype. As the germinal center phenotype is known to have a better prognosis, further studies to explore its relevance in the Asian population are indicated.

Research paper thumbnail of Clinicopathological correlates of primary central nervous system lymphoma: Experience from a tertiary care center in South India

Neurology India, 2015

Primary central nervous system lymphomas (PCNSL) constitute a rare group of extranodal non-Hodgki... more Primary central nervous system lymphomas (PCNSL) constitute a rare group of extranodal non-Hodgkin's lymphomas (NHLs). To study the clinical and immunophenotypic profile of patients with a PCNSL who presented between the years 2000 and 2013 in a tertiary care center in South India. This was a retrospective study. Demographic and clinical data were obtained from the clinical case records. Cases of PCNSL involving brain. Cases of PCNSL involving the spinal cord, meninges and orbit as well as intravascular large B-cell lymphoma, lymphomas with evidence of systemic disease or secondary lymphomas. Archived slides and tissue blocks were retrieved. All cases had hematoxylin and eosin stained sections and immunohistochemistry for CD20, CD3, and MIB-1. Additional immunohistochemistry was performed for CD10, BCL6, and MUM1 on paraffin blocks with sufficient tissue. There were a total of 73 cases with the mean age of presentation being 45.9 years (range 8-71 years) and with a male predominance (male: female (M:F) = 2.3:1). Headache was the commonest presenting complaint. The mean duration of symptoms was 10.6 weeks. All patients were immunocompetent. Most tumors were supratentorial in location. Out of 73 cases, 70 presented with a diffuse large B-cell lymphoma (DLBCL), two with a Burkitt's lymphoma, and one with a lymphomatoid granulomatosis. Only 51 of the DLBCL cases had sufficient tissue for additional studies. Non-germinal center was the most common phenotype seen in 65.7% (33/51) of cases. Germinal center B-cell (GCB) phenotype was seen in 18/51 cases (34.3%). DLBCL constituted the majority of PCNSLs and although non-germinal center was the predominant phenotype, more than a third of the cases were of the GCB phenotype. As the germinal center phenotype is known to have a better prognosis, further studies to explore its relevance in the Asian population are indicated.