BACKGROUND Transitional cell carcinoma also known as urothelial carcinoma accounts for more than 90 % of all primary tumours of urinary bladder. It is the 4 th most common cancer in men and 8 th most common cancer in women in the western world. Nearly 80 % of patients initially present with bladder tumours confined to mucosa or submucosa. Not grading but detection of infiltration is of much value when dealing with invasive urothelial malignancy. When it invades muscle, it dictates more aggressive treatment. This study was undertaken to correlate the clinical, radiological, and pathological findings in the grading and staging of carcinoma bladder. METHODS This prospective study was conducted in the Department of Pathology for a period of two years. 55 patients with clinical features suggestive of carcinoma bladder were included in the study. Radiological and cystoscopic findings were combined to obtain a clinical staging. Materials included were H&E stained sections of biopsies, TURBT and Cystectomy. Special stains were done in indicated cases. Grading was done using WHO / ISUP grading system and staging using AJCC / UICC staging system. RESULTS 55 cases were studied. Most common age group was 60 - 69 years (40 %) with male preponderance (94.5 %). 100 % of patients presented with haematuria. Cystoscopically most common appearance was fronds (69.1 %) involving right lateral wall (40 %). Of the clinically invasive cases 29 (52.7 %), 19 (65.50 %) were pathologically invasive, 3 (10.3 %) were pathologically noninvasive, 7 (24.10) were insufficient for opinion. Of the clinically noninvasive cases (26), 5 (19.20 %) were pathologically invasive 13 (50 %) were noninvasive and rest were insufficient for opinion. CONCLUSIONS Bladder carcinomas are more common in elderly males. All patients presented with haematuria. Most common site of involvement was lateral walls. Clinicopathological correlation was more in highly advanced cases. KEYWORDS Urothelial Carcinoma, Grading, Staging
Rosai-Dorfman disease (RDD) is a rare lymph proliferative disorder with nodal and extranodal involvements. We are presenting this case of Rosai dorfman disease with presentation in pinna of ear and with previous history of Rosai dorfman disease at multiple sites including lymph node. Cytological and histological examination of the submandibular lymph nodes and skin biopsy demonstrated evidences of RDD.
BACKGROUND Helicobacter pylori associated chronic gastritis plays a vital role in the development of majority of gastric adenocarcinomas and most gastric MALT (Mucosa Associated Lymphoid Tissue) lymphomas. Many diagnostic methods are available for the identification of this organism. However, in gastroenterology practice, histopathological examination of biopsy samples provides visual identification of the pathogen and the associated mucosal changes with special stains like Giemsa. The aim of this study was to evaluate the efficacy of three stains H & E- (Haematoxylin and Eosin), Giemsa and IHC (Immunohistochemistry) in the identification of H. pylori. Associated histologic changes were noted and the relationship between the degree of colonisation and the activity and chronicity of gastritis were analysed. METHODS 585 gastric biopsies taken from dyspeptic patients were evaluated for gastritis, based on updated Sydney System. In 250 randomly selected cases, three staining methods were used. RESULTS Out of 585 cases, 413 (70.60 %) had features of chronic gastritis. Mild chronic gastritis was the commonest finding and is seen in most cases of mild H. pylori colonisation. When activity was monitored, mild activity was the most frequent finding [225 (38.46 %)]. Majority of the severe activity cases showed severe H. pylori colonisation. 13.16 %, 4.79 % and 7.35 % showed intestinal metaplasia, atrophy and dysplastic changes respectively. Out of 250 cases, H & E and Giemsa stains showed 45.6 % and 57.2 % positivity while IHC demonstrated maximum number of positivity (156 cases - 62.4 %). Sensitivity and specificity of H & E was found to be 77.90 % and 98.95 %, positive predictive value was 99.13 % and negative predictive value was 69.18 %. For Giemsa stain, sensitivity was 91.67 %, specificity was 100 %, positive predictive value was 100 % and negative predictive value was 87.85 %. DISCUSSION H. pylori gastritis was a frequent finding in dyspeptic patients in southern part of India. When chi-square test was done, a significant statistical relationship between the severity of H. pylori colonisation, activity and chronicity of gastritis was noted. P value was < 0.001. With the use of special stain, Giemsa and ancillary techniques like IHC, the detection rate of H. pylori was enhanced considerably. CONCLUSIONS With increasing number of H. pylori in the mucosa, there was increase in the chronicity and activity of gastritis. Although immunohistochemistry revealed more cases of H. pylori, Giemsa can be a cost-effective substitute, because of its high specificity and positive predictive value. KEYWORDS H. pylori Gastritis, Giemsa, Haematoxylin and Eosin Stain, Immunohistochemistry
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