bluuebunny/crossref_metadata_2025_split huggingface dataset:
Acute rheumatic fever – A pathological analysis of clinically missed cases
Authors: Goyal Ashutosh , Vaideeswar Pradeep , Daga Pawan , Bhargav Rishi 
Published: May 2024

Background:
Acute rheumatic fever (ARF) and its post-inflammatory sequel chronic rheumatic heart disease (RHD) are endemic in the Indian setting. Despite the updated Jones criteria, many cases of ARF remain undiagnosed or are missed.

Aims:
This study aims to analyze pathological profiles of such cases and their importance in context of clinical presentation and Jones criteria.

Materials and Methods:
A 22-year retrospective observational study of ARF was conducted in the Department of Pathology in a tertiary care institute. The cases were categorized as 1. Those fulfilling and 2. those partially or not fulfilling the Jones Criteria. Based on the autopsy findings, the lesions were classified as categorized mitral stenosis and/or regurgitation (MS ± MR) and pure mitral regurgitation (MR).

Statistical Analysis:
Nil.

Results:
In 22 years, among 697 cases of autopsied cases of RHD, there were 59 cases (8.5%) of ARF. Among them, seven cases fulfilled the Jones criteria; five of them were clinically diagnosed. The remaining 52 cases (88.1%, 34 with MS ± MR and 18 with MR) did not fulfill or partially fulfilled the Jones criteria and were not diagnosed. A total of 18 patients (30.5%) had the first attack of ARF, whereas recurrences were noted in the remaining patients (69.5%).

Conclusions:
The study indicates that the typical manifestations of ARF under Jones criteria may not be present, especially in cases with recurrence. Hence, a presumptive or possible diagnosis of ARF can be made with presence of minor criteria or strong clinical suspicion in such cases.
Histomorphology of the lesions of the umbilicus
Authors: Singaravel Saranya , Yadav Poonam C. 
Published: May 2024

Context:
Twelve-year retrospective study of surgically excised umbilical lesions received for histopathology in a pediatric tertiary care hospital.

Aims:
To study histopathology of the umbilical lesions and review pertinent literature on the embryological basis of these lesions.

Subjects and Methods:
We reviewed cases of umbilical lesions and classified them as “developmental” and “others.” Developmental cases were sub-classified based on the mechanism as those due to defect in the closure of body wall, defect in the closure of the umbilical ring, persistence of embryonic remnants, or failure of epithelization. Persistent embryonic remnants were subdivided into fistula, sinus, and cyst. Histology of all the cases was studied and the different types of tissue in omphalomesenteric ducts (OMD) remnants were identified.

Statistical Analysis Used:
Descriptive statistics were used as required.

Results:
Seventy-one cases in the age range of 1 day to 13 years were studied and male preponderance was noted. The developmental lesions included 4 omphalocele sacs with dense acute inflammation, 2 umbilical hernial sacs with fibrocollagenous tissue, 30 OMD remnants, 10 allantoic duct remnants, 19 umbilical granulomas, and 2 cases showing more than one developmental mechanism. Four cases were classified as “others” including 3 epidermal inclusion cysts and 1 skin tag. Among OMD remnants, sinuses (arising from the distal tract) were found to be the most common. Histological examination of the OMD remnants showed enteric (18), enteric and gastric (5), colonic (4), enteric and colonic (2), and pancreatic and enteric and gastric mucosae (1).

Conclusion:
Accurate diagnosis is essential for definite treatment of these lesions.
A tale of monoclonal immunoglobulin
Authors: Maity Priyanka , Dasgupta Saugat , Basu Keya , Sengupta Moumita , Chowdhury Arpita Roy , Bandopadhyay Manimoy 
Published: May 2024

Background:
Proliferative glomerulonephritis with monoclonal immunoglobulin deposit (PGNMID) is an entity with a variable clinical and histological spectrum, which mimics immune-complex mediated glomerulonephritis on light microscopy. In this article, we aim to describe the clinical and pathological features of six cases of PGNMID that we encountered during our routine practice.

Materials and Methods:
The study was of the prospective type carried out from February 2018 to August 2019. The renal biopsies that we received in our department, were processed for light microscopy, immunofluorescence microscopy, and electron microscopy. Light microscopic findings were carefully re-evaluated by two experienced renal pathologists. Key diagnostic features were 1) Monoclonal staining of glomeruli for one immunoglobulin (Ig) subclass and single light chain, 2) Membranoproliferative glomerulonephritis (MPGN) pattern (rarely membranous or crescentic), 3) Subendothelial and mesangial (rarely subepithelial) deposits.

Results:
We diagnosed five cases of IgG PGNMID and one case of IgA PGNMID with a mean age 53 ± 10.33 years. The most common histological pattern, seen in three cases was MPGN. IgG3 deposits were identified in five cases out of which k light chain restriction was present in four cases and λ light chain restriction was present in one case. IgA deposits were identified in one case that had λ light chain restriction. One patient suffered from multiple myeloma.

Conclusions:
The renal biopsy especially immunofluorescence analysis is the key modality for diagnosis of PGNMID where it shows staining of the glomerulus for a single heavy-chain subclass and a single light-chain isotype. Electron microscopic evaluation is necessary to differentiate PGNMID from other renal diseases with monoclonal immunoglobulin deposits.
Phenotyping of lymphocyte subsets, Th-1/Th-2 cytokines and other parameters in high-risk contacts of SARS-CoV-2
Authors: Chandra Kailash , Das Ayan Kumar , Banday Sumeera , Dhyani Neha , Upadhyay Bhumika , Dang Arjun , Joshi Santosh , Dudeja Mridu 
Published: May 2024

ABSTRACT

Background:
The information on the pathophysiology of infection in high-risk contacts of SARS-CoV-2 is limited.

Aims:
The aim of the present study was to assess the various factors and their elucidation in the protection of SARS- CoV-2 infection in high-risk contacts.

Settings and Design:
Cross-sectional descriptive clinical study.

Materials and Methods:
A total of 136 subjects were recruited in the present study including 100 high-risk subjects and 36 control subjects. Out of 100 high-risk subjects, 44 subjects were found positive for SARS-CoV-2 RNA. Further, absolute blood counts of total T-cells (CD3+), T-helper cells (CD4+), T-cytotoxic cells (CD8+), B lymphocytes (CD19+) Natural Killer (NK) Cells (CD16+, CD56+), cytokines, and other parameters were measured in the samples of study subjects.

Statistical Analysis Used:
The continuous variables were analyzed by unpaired ‘t’ test, analysis of variance and ‘Tukey test’ for multiple comparisons.

Results: A significant reduction of total leukocyte counts and absolute lymphocyte count was found in the acute SARS-CoV-2 positive group as compared to control group (<0.05). Interestingly, IL-4 level was significantly elevated in SARS-CoV-2 negative high-risk subjects as compared to control and acute SARS-CoV-2 positive group (p < 0.05). A significant decrease of T-cytotoxic, B-cells, and NK cells were found in acute SARS-CoV-2 positive subjects as compared to control groups.

Conclusion:
The findings of this study may augment our knowledge about the pathogenesis of SARS-CoV-2 infection that could help in making future strategies to control its infection.
Differentiating biliary atresia from other causes of infantile cholestasis: An appraisal of the histomorphological changes on liver biopsy
Authors: Halder Aniket , Patra Sabita , Mandal Bappa , Ray Gautam , Ghosh Ranajoy , Mukherjee Suchandra , Chatterjee Uttara 
Published: May 2024

ABSTRACT

Background:
Cholestatic disorders are a significant cause of morbidity and mortality in infants. Characterization of these disorders and differentiating biliary atresia (BA) from other causes of intrahepatic cholestasis is an age-old problem.

Objectives:
To study the spectrum of different infantile cholestatic disorders in our population, to differentiate BA from other causes of neonatal cholestasis (NC) on a liver biopsy, and validation of the available scoring system for the characterization of these disorders.

Materials and Methods:
This is an observational cross-sectional study performed over a period of 3 years between 2018 and 2021, done on neonates and infants presenting with cholestatic jaundice. The changes on liver biopsy were evaluated by different histological parameters and available scoring systems to differentiate BA from non-BA causes. Correlation with clinical, biochemical, and imaging findings was done in all cases.

Results:
This study included 87 cases of NC, of which BA comprised 28 cases (32%), whereas idiopathic neonatal hepatitis (INH) comprised only 12 cases (14%). Portal neutrophilic inflammation (P = 0.000053), ductal cholestasis (P < 0.001), neoductular bile plugs (P < 0.001) and bile ductular proliferation (P < 0.0001) were significantly more in BA, whereas lobular lymphocytic inflammation (P = 0.001) and giant cell transformation of hepatocytes (P = 0.0024) were more frequent in the non-BA group. Using the Lee and Looi scoring system, a histologic score ≥7 was helpful in identifying BA with 85.7% sensitivity, 92.6% specificity, and 90.6% accuracy.

Conclusion:
BA is the commonest cause of NC in neonates, whereas the frequency of INH is declining. Detailed histomorphologic analysis of liver biopsy, aided with IHC, is the cornerstone for the diagnosis of these disorders.
The impact of SARS-CoV-2 infection on term placentae
Authors: Karthikeyan T. M , Sundari Abinaya A , Veenaa N. N , Shivapriya R , Prema N 
Published: May 2024

Background:
Coronavirus 2019 infection (COVID 19) is an ongoing pandemic caused by pathogenic RNA viruses called severe acute respiratory syndrome coronavirus-2 (SARS-COV-2). It has affected people of all ages, with high morbidity and mortality among the elderly and immunocompromised population. Limited information is available on the effects of COVID-19 infection on pregnancy.

Aim:
To describe the histopathological changes in the placental tissue of SARS-CoV-2 infected term mothers with no comorbidities and to correlate with neonatal outcome.

Materials and Methods:
This observational study was conducted in the Department of Pathology, KMCH institute of health sciences and research, Coimbatore from May 1, 2020 to November 30, 2020 for 6 months. Placental tissues of all COVID-19-positive term mothers with no comorbidities were included in this study. Histopathological examination of placentae was carried out and clinical data of mothers and newborn babies were obtained from medical records.

Results:
Histopathological examination of 64 placental tissue of COVID-19 mothers showed predominantly the features of fetal vascular malperfusion like stem villi vasculature thrombus, villous congestion, and avascular villi. No significant correlation was obtained in comparison with parity and symptomatic status of the mothers. However, histopathological changes were more prominent among symptomatic patients. The newborn babies born to these mothers showed no adverse outcome.

Conclusion:
This study concluded that though COVID-19 infection in normal term pregnant women was associated with increased prevalence of features of fetal vascular malperfusion, there was no significant morbidity in the health status of both COVID-19 mothers and their neonates.
The role of cyclin D1, BCL-2, p53 and Ki-67 in epithelial cells in the etiopathogenesis of pterygium
Authors: Süren Elçin , Nergiz Döndü , Bilgin Burak , Çoban Deniz Turgut , Akgündüz Zelal , Sadullahoğlu Canan , Süren Dinç 
Published: May 2024

Context:
Pterygium is a degenerative disease that consists of conjunctival epithelia and fibrovascular tissue. Some studies suggest that there is a defect in the regulation of apoptosis in the epithelial cell cycle characterized by the development of the disease. But, still this matter being debated.

Aims:
In this study, the clinical, histopathological data, and the expression of the cell cycle regulator Cyclin D1, anti-apoptotic BCL-2, tumor suppressor p53, and cell proliferation marker Ki-67 were searched in pterygium samples.

Subjects and Methods:
The study enrolled 62 cases of primary pterygium who underwent excision between 2014 and 2017. Recurrent and pseudo-pterygium cases were excluded from series. The clinical data were obtained from the patient files and the slides were reevaluated for the histopathological data. Slides of all were stained by Cyclin D1, BCL-2, and Ki-67 by the immunohistochemical method. For each immunohistochemical marker, first the staining was determined as negative or positive. Then if there is a staining, the hot zone (the area containing more positive cells) was determined and staining percentage (SP) was assessed by counting positive cells/100 epithelial cells).

Results:
Solar elastosis, edema, inflammation, and epithelial dysplasia were found statistically different between the control group and the patient group (P value <0.001, <0.001, <0.001 <0.001, respectively). A significant difference was found for staining percentage (SP) of Ki-67, p53, BCL-2 between the control group and the patient group (P values <0.001, 0.002, <0.001, respectively). There were no significant differences in the SP of Cyclin D1 between the two groups (p: 0,133).

Conclusions:
Our results indicate an abnormal expression of p53, BCL-2 and elevated proliferation measured by Ki-67 in pterygium samples when compared to normal conjunctiva. Besides the mesenchymal changes, the increased proliferation and the failure of apoptosis in the epithelial cells participate in the development of pterygium, as well.
FISH for EWSR1 in Ewing's sarcoma family of tumors
Authors: Murthy Sudha S. , Gundimeda Sandhya Devi , Challa Sundaram , Manjula V , Fonseca Daphne , Rao Vishal B. , Rajappa Senthil J. , N Raju K. V. V. , Rao T. Subramanyeshwar 
Published: May 2024

Background:
Molecular confirmation of histologic diagnosis has become mandatory for the diagnosis of Ewing sarcoma family of tumors (ESFT).

Aim:
To validate the diagnosis made by morphology and immunohistochemistry (IHC) by fluorescence in-situ hybridization (FISH) for EWSR1 rearrangement on formalin fixed paraffin embedded (FFPE) tissues. Settings and design: A retrospective and prospective observational study. Material and methods: All patients who had FISH studies for EWSR1 rearrangement for small round cell tumors during 10 years period were included. Demographic, clinical and radiological details were obtained from medical records. Morphology was reviewed with IHC by CD99, FLI1 and others. FISH studies were performed using the break apart probe. Additional molecular studies and IHC were done to resolve the diagnosis in EWSR1 rearranged tumors. Final diagnosis was made by integrating clinical, morphology, IHC and molecular features.

Results:
There were 81 patients (M: F 45:36, median age 21 years) with 32 skeletal and 49 extra skeletal tumors. CD 99 was positive in 94.52%. FISH for EWSR1 were positive in 59, negative in 13 and failed in 9. The final diagnosis was made as ESFT in 67, angiomatoid fibrous histiocytoma in 3, desmoplastic small round cell tumor in 3, myxoid chondrosarcoma in 2, unclassified in one, synovial sarcoma in 3, and one each of lymphoma and small cell neuroendocrine carcinoma. FISH was positive for ESFT in 89.83% of EWSR1 rearranged tumors. FISH validated the diagnosis made on IHC in 79.10%. FISH resolved the diagnosis in 1.49% CD99 negative tumors.

Conclusion:
FISH is a reliable ancillary technique for the diagnosis of ESFT on FFPE tissues.
Modified improvised pre-embedding method for core needle biopsies
Authors: Sunny Nikita , Thomas Anupa , Manjunath Suraj , Kini Usha 
Published: May 2024

Background:
An optimal core needle biopsy (CNB) is expected to balance between tissue diagnosis, the accuracy of negative sampling, and concordance with reports from resected specimens to select the appropriate treatment. Though various techniques for CNBs are available, no guidelines exist for processing CNB, with practices varying from lab to lab for transport and processing. This prospective study aims to design a cost-effective, user-friendly pre-embedding method for CNBs to yield intact cores.

Objective:
To compare the outcomes of CNBs by a conventional method with those processed by the modified pre-embedded processing protocol over 2 years.

Material and Methods:
Presurgical CNBs from SOL in various organs were subjected to the conventional free-floating method in formalin (control) for histopathology diagnosis. CNBs from the corresponding, freshly resected SOLs (test) were taken, inked with coloring inks if multiple, placed between two 2 × 2 cm polyurethane foam meshes fitted inside cassettes, fixed in formalin, and transported to the laboratory. The two CNB groups were coded and scored independently for intactness, tissue processing, ease of embedding, and ease of cutting sections. Data obtained were statistically analyzed.

Results:
Test CNB cores were better processed, intact, linear, and aligned, compared to control CNBs. With four CNBs in one block, the number of blocks and sections were cut-down by one-fourth.

Conclusion:
CNBs processed using polyurethane foam and coloring inks were superior and economical against conventional free-floating CNBs. This technique can be practiced by surgeons at the bedside.
The Ring-and-Sling complex – Does it “Ring” true?
Authors: Ray Manjusha , Sathe Pragati , Vaideeswar Pradeep , Marathe Supreet P 
Published: May 2024

Background:
The “Ring-and-Sling” complex (RSC) comprises congenital tracheal stenosis and an abnormal origin/course of the left pulmonary artery. Based on clinical and imaging studies, the luminal narrowing is assumed to be as a result of rings cartilage (forming an “O”).

Aims:
This is a postmortem based study of tracheal histology in infants after an autopsy encounter of a case of RSC.

Subject and Methods:
RSC was identified in an infant at autopsy. The tracheal histomorphology revealed the presence of cartilaginous plates (instead of rings) and fibro-elastotic proliferation at the site of trachealis muscle. These changes prompted a study on variations in the histology of the trachea (with no known anomaly) in 35 autopsied neonates and infants. The transverse sections of the trachea were taken at one or more levels (Level 1 – at the level of the thyroid, Level 2 – midway between the thyroid and the carina, and Level 3 – just above the carina.

Statistical Analysis:
Epi-info software (v1.4.3, CD, US).

Results:
On histology, 83 sections showed the trachealis muscle on the posterior aspect. A single semicircular cartilage was identified in only 17 of the 83 sections studied (20.5%, 6 in level 1, 9 in level 2 and 2 in level 3). In the remaining 66 sections (79.5%), the cartilage was disposed as multiple plates, ranging in number from 2 to 10. No significant association was found between semicircular cartilage rings and age, sex, gestational age, and level of section (P < 0.05). However, 14 cases with sectioning at all three levels were taken into account; all levels showed more cartilaginous plates compared to single rings, which were more common at level 1 (P > 0.05).

Conclusions:
The “ring” in RSC and normal infantile tracheas show cartilage plates with intermittent semicircular cartilage rings. These findings may have surgical implications for tracheal anomalies and bode favorable surgical outcomes.
Histiocytic and follicular dendritic cell sarcoma
Authors: Patra Sanjiban , Trivedi Priti , Kaur Kanwalpreet 
Published: May 2024

Background:
Follicular dendritic cell sarcomas (FDCSs) and histiocytic sarcomas (HSs) are exceedingly rare tumors. Most of the data on those entities are based on case reports or small case series. The natural history and response to different treatment modalities have not been well established.

Aims:
To analyze the clinicopathologic features, immunophenotypic profile, treatment responses and to add to the existing data on FDCS and HS.

Study Design:
Retrospective descriptive study.

Materials and method:
The study was conducted at the department of Oncopathology at a tertiary care cancer hospital in India, retrospectively within the time period of four years (2016-2019). Total eight (8) cases were diagnosed: four cases of FDCS and four cases of HS involving nodal and extra-nodal sites. Clinical, histopathological, immunohistochemistry (IHC) and therapeutic data of the eight cases were retrieved and analyzed.

Statistics:
Descriptive statistics.

Result:
Among the four patients of FDCS, two had nodal and two had extra-nodal disease. Mean tumor size was 6 cm. Tumor cells expressed CD23, CD21, CD45, CD68 and S100. One patient received adjuvant chemotherapy (Gemcitabine and Docetaxel). Median survival was 36 months. None of them developed distant metastasis. Two of the patients having HS, developed bone metastasis. Median survival was 8.5 months. CD68 was consistently expressed in all cases of HS. Other applied IHC markers were negative in all the eight cases.

Conclusion:
FDCS and HS are under-recognized and easily prone to a wrong diagnosis. Therefore, considering these rare entities in differential diagnoses and inclusion of proper IHC biomarkers are necessary to avoid potential misdiagnosis.
Serum CA 19-9 and CA 125 as a diagnostic marker in carcinoma of gallbladder
Authors: Bind Manoj K. , Mishra Ravi R. , Kumar Varsha , Misra Vatsala , Singh Premala A. 
Published: May 2024

Background:
Gall bladder carcinoma is endemic in North India along the Ganges belt. Most of the cases usually present in late stage when prognosis is poor. That mandates a necessity for proper screening in these areas for gall bladder lesions. Tumor markers CA 19-9 and CA 125 have been studied in various GI cancers and may also help in the screening, diagnosis and evaluation of gall bladder carcinoma. Aims: To assess serum CA19-9 and serum CA125 in patients with gall bladder lesions and find out a cut off value for diagnosis of carcinoma gallbladder.

Methods and Material:
Study included 118 cases, with female: male ratio of 4:1. Out of it, 91 (77 %) cases were benign and 27 (23 %) were malignant. Patients' sera was collected and analyzed for CA19-9 and CA 125 by CMIA method.

Results:
The Mean (SD) value of CA19-9 for benign and malignant cases was found to be 12.86 (17.54) and 625.35(186.52) U/ml. For CA 125 it was found to be 17.98(13.69) and 239.63(73.72) U/ml respectively. The difference was statistically significant (P< 0.001). When Mean - 2SD value of malignant lesions were taken as cut off a value of CA 19-9 and CA 125 were found be 252.31 U/ml & 92.19U/ml respectively, found to be significant to suggest /diagnose a case of carcinoma gall bladder along with clinicoradiological findings. Taking these value as cut off Sensitivity & Specificity for CA 19-9 and CA 125 in detecting malignant cases were found to be 100% & 98.90% and 100% & 94.50% respectively.

Conclusions:
It is concluded that both serum CA 19-9 and serum CA 125 may act as a good adjunct for diagnosis of cases of carcinoma gallbladder along with imaging studies. However, changes in CA19-9 are more significant than CA 125.