Journal of Cytology & Histology

Hairy cell leukemia is a chronic B-cell lymphoid leukemia characterized by pancytopenia, splenomegaly, myelofibrosis and the presence in peripheral blood, bone marrow and spleen of atypical lymphoid cells with a hairy aspect and a particular immunophenotypic profil. The association HCL and tuberculosis has been established, but only few cases have been reported. We report a case of bone marrow tuberculosis with concomitant HCL. Initially, the histopathology of bone marrow led to a diagnosis of tuberculosis and myelofibrosis, without sufficient evidence for HCL. The anti-bacillary treatment was then started. Three months later, aspiration, biopsy and immunophenotyping of bone marrow were performed, a lymphoid population evoking hairy cells, was found. The patient received chemotherapy based pentostatin. The outcome was favorable.

Objective: To report a series of epithelial malignancies arising within ovarian teratomas along with clinical followup. Some previously unreported combinations of malignant component with MCT are also being reported.
Material and Methods: Clinico-pathological details and clinical follow up of twenty six cases reported during January 2000 to March 2014 in the Section of Histopathology, of a tertiary care hospital of Pakistan are included.
Results: Total 1418 cases of MCTs were reported, 26 (1.8%) of them showed epithelial malignancies. The mean age at presentation was 42.5 years (range; 15-70 years). Commonest clinical presentation was with abdominal pain and mass. All the patients underwent surgery as first line treatment. Malignant transformation in form of Squamous cell carcinoma was seen in 20 cases. In one case, in addition to squamous cell carcinoma, atypical proliferative serous tumor and high grade sarcomatous component was also present. Adenosquamous carcinoma, Poorly differentiated carcinoma, Endometrioid adenocarcinoma and Adenocarcinoma with mucinous differentiation represented malignant components in additional 4 cases respectively. Cases demonstrating endometrioid features and atypical proliferative serous tumor represent collision tumors. Two of the cases had papillary carcinoma (follicular variant) of thyroid arising within monodermal teratoma (struma ovarii). Clinical follow up was available in 13 cases and it is noted that patients with squamous cell carcinoma had a worse outcome. Conclusions: Malignancy occurring in a MCT is an extremely rare occurrence. It is very challenging to diagnose this malignant transformation clinically.

Background: Squamous cell atypia suggesting high-grade lesion (ASCH) is a cytological lesion, related to a high-grade lesion. Guidelines recommend performing a colposcopy in these cases, without HPV testing.
Objective: Here we sought to determine the value of the HPV test in ASCH cases and to correlate morphological data, the HPV test results, and the follow-up.
Methods: Ninety-six patients were diagnosed with ASCH using liquid-based cytology (Thin-Prep®). Hybrid Capture II was the HPV test used. The patients were followed up for 6 to 48 months (mean 24 months). The following cytological data were included: isolated cells; dyskeratosis; hyperchromasia; coarse chromatin; nuclear membrane irregularity; 3D alterations; and molding.
Results: The mean age of the patients was 37 years (range 15-78). Thirty-seven cases were 30 years old or younger. Follow-up was not available for 11 cases. Seventy two cases were HPV+. None of HPV- cases developed HSIL. The following cytological data showed statistical significance: coarse chromatin and HPV positivity (p = 0.007); nuclear membrane irregularity and HSIL in the follow-up (p = 0.015); and molding and HSIL in the follow-up in HPV+ cases (p = 0.046).
Conclusions: The HPV test is useful for ASCH cases. Some nuclear alterations in ASCH can predict HPV positivity and HSIL in the follow-up.

Background: Aspiration of coelomic fluids from coelomic cavities is a simple and relatively, non-invasive technique to achieve a diagnosis. Pleural effusion, pericardial effusion and peritoneal effusion are commonly encountered problem by general physicians and chest physician. Effusion often present as a common diagnostic dilemma as no cause can be found in many cases inspite of careful evaluation. A better knowledge of spectrum of clinical history and clinical signs of pleural effusion, pericardial effusion and peritoneal effusion along with radiological, biochemical and cytological evaluation of the fluids helps in narrowing the diagnostic dilemma faced by physicians and helps in better management of patients. Objective: This study was undertaken to evaluate the coelomic fluids and its clinical correlation with cytologic diagnosis. Method: This was a prospective study conducted on 70 patients of pleural, pericardial and peritoneal effusions, satisfying inclusion criteria during the period between January 2012 to May 2013, presenting to the department of pathology, College of medical Sciences-Teaching hospital, Bharatpur. A detailed clinical history of the patient was obtained from the clinical protocol of hospital records in the proforma. Fluid from the pleural, pericardial and peritoneal cavity was obtained by thoracocentesis, pericardiocentesis and paracentesis performed by clinicians and analyzed for cytological diagnosis. Then, the cytological findings and clinical diagnosis were correlated. Statistical analysis was done using SPSS (Statistical Package for Social Sciences). The body fluids submitted from different department of COMS-TH were evaluated by cytological study and its clinical correlation was done. The prime objective of this study was to convey a diagnosis which would guide a clinician to correct diagnosis, hence the therapy. Results: The present study includes 70 cases of pleural fluid, pericardial fluid and peritoneal fluid and analysis was done. Out of 70 cases, 34 cases are of peritoneal fluid, 31 cases are of pleural fluid and five cases are of pericardial fluid. Age of the patients ranged from eight years to ninety years with males to female ratio of 1.6:1 with a mean age of 50.36 years. The most common presenting complain were abdominal distension, swelling of lower limbs and yellowish discoloration of sclera (42.9%) followed by cough, fever, chest pain, shortness of breath, loss of appetite and loss of weight (30%) followed by abdominal distension, swelling of lower limbs, yellowish discoloration of sclera, loss of appetite and loss of weight (12.9%) followed by chest pain, shortness of breath, loss of appetite and loss of weight (7.1%) followed by cough, fever, and chest pain (5.7%) followed by loss of appetite and loss of weight (1.4%). Out of 70 cases, 59 cases diagnosed as chronic effusion (84.28%). Six cases are diagnosed as inflammatory effusion (8.57%) and five cases are of malignant effusion (7.14%) on cytological evaluation. Out of five cases of malignant effusion two cases are of malignant mesothelioma. Of the total 70 cases of effusion, 50% were turbid, 47% were clear and 2.9% were hemorrhagic in appearance. 52.9% of effusions were exudative and 47.1% of effusion were transuadative. The mean fluid glucose level on transudative effusion were in the range of 80.15 ± 21.19 mg/dl which was higher as compared to exudative effusion and this difference was statistically highly significant (p value = 0.010). The mean fluid total protein levels in transudative effusion were in the range of 2.08 ± 0.43 gm/dl which can be classified as transudative form as compared to exudative form and this is highly statistically significant (p value = 0.001). The total leukocyte count ranged from 57 to 1,50,000 cells/mm3. The estimated mean ± SD of pleural, peritoneal, pericardial fluid cell count of all 70 cases were 3151.5 ± 17974.06. This was statically not significant (p value = 0.141). The average cell count in malignant effusion, chronic effusion and inflammatory effusion was 620 cells/mm3, 520 cells/mm3 and 31,141 cells/mm3 respectively.

Epithelioid hemangioendothelioma (EHE) is a rare vascular tumor of low malignant potential that occurs mostly in soft tissue. So far, only two cases of EHE involving the intestine have been recorded. Here, we describe a rare case of cecal EHE due to a subsequent metastasis from the primary liver tumor three years after initial diagnosis. A 74- year-old man had sudden onset of epigastralgia for 24 hours. The abdominal CT revealed an ileocecal mass with a small bowel obstruction, and extensive tumor involvement in the liver was noted. He received an emergent right hemicolectomy for relief of the ileus. Unfortunately, he expired four days later due to septic shock. The pathologic diagnosis of EHE prompted a molecular study for a WWTR1-CAMTA1 fusion. The Sanger sequencing results showed the fusion involved exon 4 of WWTR1 with exon 8 of CAMTA1. There is no standard treatment for hepatic EHE because of its rarity and variable clinical outcome. The decision on a treatment strategy should be individualized for each patient. Since the patient received supportive care only for the liver tumor, this case demonstrated a natural course of hepatic EHE with a survival of more than 3.3 years.

The aim of the present investigation was cytological and protein comparison among three species within the genus Trifolium. The results revealed, Idiogram of the haploid complements of T. alexandrinum, T. refeigratum and T. repens. Besides T. refeigratum and T. repens have 16 pairs of chromosomes with a pair of satellites located at the end of their short arm in chromosome 16. T. alexandrinum has 8 pairs of chromosomes whose karyotyping formula is 2 nsm (+), 10 nsm (-) + 4 nm. The T. alexandrinum was clustering alone as well as having polymorphic bands that were different from T. refeigratum and T. repens.

Honey contains a variety of phytochemicals and other substances, such as organic acids, vitamins and enzymes, which may serve as a source for dietary antioxidants. Antioxidants shows improve insulin level and protect insulin resistant in diabetes mellitus. Honey bee venom reduces blood glucose level as well as lipid profile through increased insulin secretion and glucose take-up. For that reason, honey could be considered as a potential remedy for diabetes as well as Cardiovascular Disease (CVD). The objective of this study was to determine the medicinal activity of honey and its role on antihyperglycemic, antihyperlipidemic, hepatoprotechtive activity and histopathological analysis of natural honey in Streptozotocin- induced diabetic rats. The experimental rats were divided into six groups (n = 6). Diabetes Mellitus (DM) was induced by single intraperitoneal injection (65 mg/kg BW) of freshly prepared Streptozotocin hydrate solution in 0.9% saline solution. Hyperlipidemic was induced by mixture of cholesterol (1.5%) and cholic acid (0.5%) with diet of rats. At the end of treatment, the blood glucose level and lipid profile was measured by using commercial kits. Histopathology of liver and heart were performed of observed any changes in the cellular structures (degradation and regeneration) of the rats after receiving the sample for 28 consecutive days with respect to control group. Honey bee-treatment significantly decrease blood glucose level in diabetic rats. TC, TG, LDL, VLDL are significantly (p < 0.05) decrease whereas HDL significantly increase (p < 0.001). The SGPT and SGOT were significantly decrease (p < 0.05) which showed hepatoprotective activity of honey. Honey has favorable effect on the histopathological changes in Streptozotocin- induced diabetic rats. On the basis of above findings, it can be concluded that, supplementation of honey could significantly contribute to control blood glucose level as well as lipid profile in diabetic subjects. Honey showed prevent various complications of diabetes and improve some haematological parameters.

Background: Stem cell based therapy is a new paradigm for treatment of many abnormal conditions such as cartilage lesions. Although this method has many beneficial therapeutic effects, the serious adverse event of stem cell transplantation such as tumorigenic capacity is not deniable. Thus, other strategy such as differentiated cells transplantation instead of stem cells transplantation has been proposed. Overall, before cell transplantation, in vitro cell isolation in order to raise the purity of transplanted cells is necessary. So, the aim of this study is to identifying a unique CD “signature” that could be ascribed specifically to the chondrocyte before cell transplantation.
Methods: Human adipose derived stem cells (hADSC) were isolated from lipoaspirate samples and were subjected to osteogenic and chondrogenic differentiation in culture medium which supplemented with specific materials. In addition, Human articular cartilages were obtained from shoulder joint and chondrocytes isolation was carried out. Finally, Flow cytometry technique was done in order to specify of CD expression in stem cells, human articular chondrocyte and differentiated cells.
Results: Our findings showed that hADSCs have the ability to differentiate into osteoblasts and chondrocytes. In addition, flow cytometry analysis indicated that 0.24 ± 0.31 percent of hADSCs expressed CD14/45 and 0.34 ± 0.11 percent of them expressed CD3/19 markers which are specific marker of chondrocytes. Whereas, one week after chondrogenic differentiation 99.92 ± 0.14 percent of differentiated cells expressed CD14/45 and 99.88 ± 0.12 of them expressed CD3/19 markers. Moreover, two weeks post differentiation; the expression of these markers not changed and was similar to human articular chondrocytes.
Conclusion: During chondrogenesis and before cell transplantation, CD14/45 and CD3/19 markers can beused to identify differentiated chondrocytes from undifferentiated stem cells.

Background: Appendicular osteosarcoma is the main primary malignant and non-hematopoietic bone tumor in dogs. It appears spontaneously in the appendicular skeleton with a relevant incidence both in dogs and in human children. Unfortunately, it is an aggressive neoplasm with high rates of metastasis regardless of the species and that afflicts, among other organs, the lungs. The high rate of lethality is due to the terrible survival prognosis for patients with lung metastasis and due to chemotherapy. Traditionally, amputation is the therapeutic indication, followed by chemotherapy. For human patients, the chemotherapeutic treatment, based on a prior anatomopathological diagnosis referencing even the degree of aggressiveness, results in a better rate of survival as it reduces metastases. However, this approach is not often explored in veterinary medicine, which features amputation as the traditional approach, followed by chemotherapy.
Objective: Verify the morphological expression of the parameters used in the cytopathological diagnosis through fine needle aspiration cytology of spontaneous osteosarcomas in dogs from varying breeds, including mixedbreeds. The study also aims the analysis of possible concordances between cytopathological and histopathological parameters in osteosarcomas.
Methods: This study verified, through optical microscopy, the morphological expression of parameters used in the cytopathological diagnosis of osteosarcomas in twenty dogs of different breeds, including mixed-breeds, and then conducted an analysis of possible concordances between these parameters. The cytological assay was conducted through fine needle aspiration cytology, using Giemsa and Papanicolaou stain on the microscope slides. The histopathological assay was conducted through the use of biopsies of surgical specimens, which were processed according to the standard procedures and stained with hematoxylin-eosin. The tumors were classified based on the guidelines proposed by the World Health Organization.
Results: There were malignancy criteria significantly repeated both at cytopathological and at histopathological assays.
Conclusion: These findings show us that the cytopathological assay through aspiration may be used as a trustworthy diagnostic method for osteosarcomas in dogs.

Xeroderma pigmentosum (XP) is a rare genetic disease associated with hypersensitivity to ultraviolet radiation resulting in cutaneous, ocular and neurological abnormalities. Ocular involvement typically includes photophobia, keratitis, corneal opacity and atrophy of the eyelids, along with carcinomas and melanomas. We report a rare case of conjunctival dysplasia and atypical secondary acquired melanosis in a patient with XP. A 9 year old Indian boy with a history of XP presented with conjunctival lesions over the course of one year. The ocular involvement manifested as conjunctival actinic keratosis/epithelial dysplasia and atypical secondary acquired melanosis. To the best of our knowledge, atypical secondary acquired melanosis has not previously been reported in association with XP in the literature. We present our clinical and histopathological findings of conjunctival dysplasia and atypical secondary acquired melanosis in this patient. Although acquired melanosis with atypia is known to occur and is often reported as a cutaneous manifestation of XP, it is rarely reported as a conjunctival manifestation in XP. It is possible that the early acquired melanosis is overshadowed by more visible conjunctival intraepithelial neoplasia (CIN) lesions.

Mitral annular calcification is an asymptomatic chronic degenerative process of the mitral valve, which can occur in the elderly population, associated with atherosclerosis. When it is extensive it is termed caseous calcification of the mitral valve annulus. We illustrate the pathology of this entity in the heart in an 80-year-old man, in whom it presented as a large intramyocardial cystic mass found at autopsy.

Enchondromas are common bone tumors that preferentially affect fingers. It is essential to know that 10% of chondrosarcomas are secondary to preexisting lesions. We present the case of a patient followed up for 30 years for a chondroma of a finger. Following increasing pain, curettage associated with radius bone graft was performed. However, the pain persisted postoperatively and inflammation and edema of the wrist and fingers appeared. Excisional biopsy was performed and the anatomopathologic results confirmed the sarcomatous transformation of the enchondroma and its dissemination to the radius. The oncological rules of surgery must be applied, even if the tumor appears to be benign in order to avoid dramatic consequences for the functional and vital prognosis of the patients.

Aging represents a major risk for vascular diseases. Diseases of the aorta causes serious back effects on the heart. This study aims to detect the histological changes of the aged aorta and to understand their underlying mechanisms to help in development of the prophylactic and treatment measures. Ten adult and ten aged male albino rats were used. Specimens from their thoracic aorta were prepared and stained with Hematoxylin and Eosin, Orcein for elastic laminae, and anti-actin antibody. Morphometric measurements for the thickness of the tunica intima and elastic laminae of the tunica media were performed. Aged aorta showed thickening of the tunica intima, thinning and fragmentation of elastic laminae, proliferation of medial smooth muscle with reduction of their actin myofibrils, and fibrosed tunica adventitia. Atherosclerosis was also detected with epithelioid changes in the medial smooth muscle and focal thickening of the intima. It is concluded that, aging is a risk factor for aortic atherosclerosis. Intimal thickening and proliferation of medial smooth muscle are the earliest signs. Thinning and fragmentation of elastic laminae, decreased contractile myofibrils of the aortic smooth muscle, and fibrosis of the tunica adventitia lead to aortic stiffness which interferes with its active function and shares in the age-related arterial remodeling.

Ovarian hemangiomas are rare tumors. We report a case of ovarian hemangioma with unusual presentation. Here, we report a 60 year female presented with massive ascites and high CA125. Abdominopelvic computed tomography (CT) showed a right adnexal mass 8 × 7 cm. The radiological impression was of a right ovarian tumor. Microscopically, benign vascular lesion composed of small capillary sized vessels.

Our study was undertaken to assess the protective effect of Spirodela polyrhiza against sodium arseniteinduced toxicity in experimental model. Animals were divided into six groups. The first group was used as control group while the other groups were treated with S. polyrhiza, sodium arsenite (10 ppm), 10 ppm As plus S. polyrhiza, sodium arsenite (30 ppm), and 30 ppm As plus S. polyrhiza respectively. Organs (kidney, spleen and heart) were collected at the end of the experiment for conducting histopathological analysis and measuring the amount of deposited arsenic. Tubular epithelium necrosis was seen affecting less than 50% of all renal specimens, on the other hand slightly enlarged white pulp region in splenic tissue were found in the groups of Wistar rat where S. polyrhiza and arsenic was administered concomitantly. Moreover, the observed moderate tissue changes (edema and muscle necrosis) in cardiac specimens of arsenic treated groups were found to be mild in the S. polyrhiza +arsenic treated groups. It is noteworthy to mention that S. polyrhiza not only reversed the arsenic-induced toxicity but also reduced the tissue arsenic load in Wistar rats to a considerable extent. Overall, the results indicated that S. polyrhiza might become useful in mitigating the toxic effects of arsenic.

Shoe polishes product consists of a complex mixture of chemical compounds. Some of these chemical are known to be absorbed into the body. In this study 50 shoe workers in Khartoum state and 50 controls were tested for cellular abnormalities in buccal mucosa. The age group of the tested individuals ranged between 14 to 49 years. For this a questionnaire based survey was conducted. Simultaneously, buccal smears were collected from oral cavity of the selected individuals and tested for nuclear anomalies. The results of the study showed high frequency of Micronuclei, Karyolysis and Binucleated cells among shoe workers group. These findings indicate the possible role of shoe cleaner products as a source of abnormal changes in buccal mucosa.

Lipid distribution has been extensively studied in the plasma membrane of the male gamete due to its relevant role in sperm physiology. However, there are controversial reports about their distribution. Because of different reports about this topic, the aim of this work was define cholesterol and GM1 ganglioside location by simultaneous detection during sperm maturation, capacitation and the acrosome reaction in CF1 mouse sperm. We observed that throughout the epididymis, cholesterol detected by filipin III or complex and GM1 ganglioside by cholera toxin, colocalized in the acrosomal domain of the head and midpiece of the flagellum. During sperm capacitation, a decrease of cholesterol can be observed like diffuse pattern on the whole head, while GM1 ganglioside was restricted to the apical acrosome. Capacitated sperm incubated with acrosome reaction inducers showed a diffuse location on the head with both probes after acrosomal exocytosis. Also, both probes did not show different locations on the flagellum. These findings indicate that cholesterol and GM1 ganglioside have a dynamic behaviour during the life of the sperm, which could indicate that a continuous assembly or disassembly of the lipid raft could be involved in the responsiveness of the sperm to different environments. Thus, during sperm capacitation and acrosome reaction there is a redistribution of the lipids. However, there are not apparent changes during sperm maturation. Cholesterol efflux, a characteristic event of sperm capacitation, could be analyzed through diffuse pattern described by filipin, and GM1 ganglioside patterns observed by the cholera toxin could be interesting when it is needed to evaluate sperm capacitation and the acrosome reaction in fixed sperm.

Endometrial stromal sarcoma (ESS) is a mesenchymal neoplasm that usually occurs as a primary tumor of the uterine corpus, but rarely arises in other sites, such as the ovary, pelvic cavity, mesentery, omentum and intestine. Endometrial stromal sarcoma is a malignant subtype of endometrial stromal tumor arising from the stroma (connective tissue) of the endometrium rather than the glands. There are three grades for endometrial stromal tumors. All the cases yet reported in literature had a history of previous hysterectomy with or without a diagnosis of ESS. Here we present a unique case of Low grade ESS where the patient presented with vague abdominal pain, loss of weight and anemia. On evaluation with USG and CT demonstrated a lobulated mass in mesentery which led to the diagnosis of a GIST from small bowel. Intraoperatively the lesion was in omentum with no attachment to mesentery. The enlarged uterus with fibroids were also removed along with the omental mass after a clinicopathological discussion which suggested the possibility of ESS with primary in the uterus. The histopathology demonstrated Low grade Endometrial sarcoma which was supported by immunohistochemistry

Lymphomatoid papulosis is a very rare skin disorder, defined as a chronic, recurrent, self-healing papulonodular or papulonecrotic skin eruption with suggestive histopathological features of a cutaneous lymphoma. We report a case of a 47-year-old male with an 8 years history of recurrent papulonodular lesions, some ulcerated, located on the face, trunk and extremities. The patient has been diagnosed primary with staphylococcal infection based on the clinical features and then, after a skin biopsy with anaplastic large cell lymphoma with CD30 positive cells and treated with CHOP. When he stopped the therapy, the lesions reappeared. A second skin biopsy was performed. Histological examination revealed an infiltrate of dyscohesive atypical lymphoid cells at the dermal-epidermal junction extending in the deep dermis. These atypical lymphoid cells varied in size and had pale abundant cytoplasm. Mitoses including atypical forms were prominent. Small mature appearing lymphocytes admixed with neutrophils and eosinophils were scattered throughout the tumor. Immunohistochemical studies demonstrated that the atypical lymphoid cells expressed CD30, Bcl-2 and Ki-67 (90%). Considering also the clinicopathological correlation, the morphological and immunohistochemical stains were suggestive for the diagnosis of lymphomatoid papulosis type A. Keywords: Lymphomatoid papulosis

Schizophrenia is treated by second-generation antipsychotic drugs, which are mostly D2 and 5-HT2A antagonists, and partly by first-generation antipsychotic drugs. Extrapyramidal symptoms, for example dyskinesia, dystonia or parkinsonism can occur as a consequence of the D2 receptor blockade. The functions of classical neurotransmitters in the mesolimbic and extrapyramidal systems are described, and neural networks are added. A D2 receptor blockade leads to a dopaminergic-cholinergic neurotransmitter imbalance in the extrapyramidal system. Pharmacologial options to treat transiently extrapyramidal symptoms are M4 antagonists, GABAA agonists and NMDA antagonists. The development of newer second-generation antipsychotic drug such as aripiprazole and cariprazine reduces the frequency and severeness of extrapyramidal symptoms, because these antipsychotic drugs have a partial agonism at the D2 receptor.