International Journal of Innovative Research in Medical Science
Endometriosis refers to the extrauterine presence of hormonally active endometrial glands and str... more Endometriosis refers to the extrauterine presence of hormonally active endometrial glands and stroma. This ectopic endometrial tissue exhibits cyclic bleeding, inflammation, fibrosis and leads to formation of adhesions. Endometriosis affects about 10% to 15% of women between 15 to 45 years of age. Clinical presentations vary from infertility, dysmenorrhoea, chronic pelvic pain, deep dyspareunia and even bleeding at external sites like the umbilicus. Besides involving fallopian tubes, bowel, liver, thorax, pericardium, pleura etc, the most commonly affected areas in the gastrointestinal tract are the descending colon, rectosigmoid, appendix, and ileo-caecum in descending order of frequency. This case series highlights some unusual presentations of endometriosis along with co-existence of other ovarian pathologies which are not frequently encountered in clinical practice. This series also highlights the role of preoperative radiology for an adequate clinical diagnosis and complete sur...
Indian Journal of Pathology and Microbiology, 2020
Background: Morphea or localized scleroderma is characterized histopathologically by sclerosis, f... more Background: Morphea or localized scleroderma is characterized histopathologically by sclerosis, fibrosis, and atrophy of the skin and subcutaneous tissue. Various authors have named the characteristic findings seen in histopathology of morphea and have labeled them as specific signs, including line sign, cookie-cutter sign, and square biopsy sign. Besides, other findings mentioned include high eccrine glands and the presence of interstitial mucin. The present study was undertaken to assess the sensitivity of these tests in the histopathological diagnosis of morphea. Methods: All cases clinically diagnosed and histopathologically reported as morphea in the last 3 years (September 2016 to August 2019) were included. The slides were reviewed by two independent investigators for the presence of line sign, cookie-cutter sign, square biopsy sign, high eccrine glands, and mucin. The sensitivity of these signs in accurately diagnosing morphea was assessed. Besides, specificity, positive predictive value, and negative predictive value of these signs were assessed using 40 random histopathology slides as controls. Results: The highest sensitivity was of high eccrine glands (82.5%) followed by the presence of mucin in the dermis (77.5%). Cookie-cutter sign and square biopsy signs were seen in 70% and 62.5% patients, respectively. Line sign was least sensitive of all, seen in 45% of biopsy specimens, but was most specific (82.5%). Conclusion: A fair number of biopsies of morphea displays the presence of high eccrine glands, mucin, cookie-cutter sign, square biopsy sign, and line sign. These signs thus can be of immense help to the dermatopathology trainees.
Annals of Medical and Health Sciences Research, 2018
Background: Psoriasis is a chronic, relapsing, inflammatory, and hyperproliferative skin disease.... more Background: Psoriasis is a chronic, relapsing, inflammatory, and hyperproliferative skin disease. The growth of keratinocytes is regulated by a delicate balance between molecules controlling cell survival (such as Bcl2) and cell death (such as p53). The study was conducted to observe the clinical and histopathological effect of Methotrexate on psoriatic lesions. Materials & Methods: The immunohistochemical expression of pro-apoptotic (p53) and anti-apoptotic (Bcl2) proteins was correlated with histomorphological changes (epidermal thickness, munro microabscess, granular layer, lymphocytic infiltrate, blood vessels) in the psoriatic skin. Results: A total of 35 cases of psoriasis were studied. Male predominance was seen and trunk was the initial site of involvement in 40% cases. There was a significant reduction in PASI (Psoriasis Area Severity Index) score, grade 3 cases of psoriasis and mean expression of p53 in all the histomorphological parameters in the subsequent 2 and 6 weeks ...
Abstract: Tuberculosis was said to be the disease of poor, being more common in the developing co... more Abstract: Tuberculosis was said to be the disease of poor, being more common in the developing countries. It is obvious that tuberculosis of the gall bladder is a rare condition as the literature reveals only about 100 cases till date. Due to the inhibitory effect of concentrated bile acids with its high alkalinity in the lumen, the gallbladder mucosa remains highly resistant to tubercular infection. Cholelithiasis and cystic duct obstruction have been considered as the most important factors in the development of gallbladder tuberculosis. We present a rare case of isolated tubercular cholecystitis. Key words: Gall bladder, tuberculosis, cholecystitis
Hailey-Hailey disease is a bullous disorder characterized by the development of flexural erosions... more Hailey-Hailey disease is a bullous disorder characterized by the development of flexural erosions, blisters and warty papules. We report the case of a middle aged male presenting with multiple bullae all over the body with discharging sinuses in axilla. Characteristic histopathological findings with negative Immunofluorescence confirmed the diagnosis of Hailey-Hailey disease. This case merits interest because of it’s rarity and unusual presentation.
Journal of the College of Physicians and Surgeons Pakistan, 2019
Congenital erythropoietic porphyria, also called Günther's disease, is a very rare genetic autoso... more Congenital erythropoietic porphyria, also called Günther's disease, is a very rare genetic autosomal recessive disease affecting less than 1 per 1,000,000 children. Pathogenesis involves genetic mutation encoding uroporphyrinogen-III cosynthase which leads to accumulation of porphyrin in many tissues, leading to extreme skin photosensitivity, red cell lysis, splenomegaly and reduced life expectancy. Herein, we report a 12-year mentally challenged girl with multiple blisters and scars on sun exposed sites since birth. She had hepatomegaly, erythrodontia, severe anaemia with haemolytic blood picture and mildly elevated liver enzymes. Skin biopsy showed deposition of amorphous eosinophilic porphyrins in the dermis, thus confirming a diagnosis of congenital erythropoietic porphyria.
Hereditary segmental neurofibromatosis (SNF) is an extremely rare form of SNF with nine families ... more Hereditary segmental neurofibromatosis (SNF) is an extremely rare form of SNF with nine families reported till date. SNF is considered to be a result of mosaicism and hereditary transmission is possibly explained by increased susceptibility of mutations at neurofibromatosis gene loci. We report here three members of an Indian family with SNF. Our index case, a 20-year-old woman had multiple soft to firm papules and nodules over right shoulder associated with severe intermittent pain. Her father had three similar nodules over left upper arm and elder sister had two such nodules over right upper arm. The father and elder sister were incidentally diagnosed and they had never sought medical advice considering their lesions to be a familial trait. In the absence of symptoms, many familial cases of SNF are missed thus making any systematic analysis to ascertain its genetic basis difficult.
Inflammatory pseudo tumor (IPT) also known as inflammatory myofibroblastic tumor (IMT) or plasma ... more Inflammatory pseudo tumor (IPT) also known as inflammatory myofibroblastic tumor (IMT) or plasma cell granuloma (PCG) is mostly reported in viscera, with very rare primary cutaneous involvement. Its clinical presentation mimics non-melanoma skin cancers. This neoplasm, though considered benign, actually has intermediate biologic potential. We report a case of 52-year-old female who presented with a nodular lesion with central scab on face and hard sub mental lymph node. As patient refused for biopsy, FNAC was done, which showed highly atypical cells suggestive of squamous cell carcinoma from nodular lesion and reactive hyperplasia from lymph node. Patient underwent excision biopsy and supra-omohyoid lymph node dissection. Biopsy report showed it as inflammatory pseudo tumor of the skin and cervical lymph nodes showed non-caseating granuloma. We present review of this entity.
Granulocytic sarcoma is an extramedullary tumor of primitive granulocytic cells. It can develop a... more Granulocytic sarcoma is an extramedullary tumor of primitive granulocytic cells. It can develop at any anatomic site and is often a prelude to the development of Acute MyelogenousLeukaemia. Granulocytic sarcoma of the small intestine presents with abdominal pain and obstruction. We report a case of a 17 year old boy who presented with epigastric pain. His endoscopy revealed nodular duodenal mucosa and an area of ulcerated exophytic growthin the small bowel. Histopathology and flowcytometery confirmed the diagnosis of granulocytic sarcoma associated with acute myelogenousleukaemia. This case merits interest because of rarity of presentation and thorough clinical and laboratory work up.
International Journal of Innovative Research in Medical Science
Skin manifestations have always been alarming to the patient and often warrant complete clinical ... more Skin manifestations have always been alarming to the patient and often warrant complete clinical evaluation. A thorough understanding of relationship between gastrointestinal (GI) disorders and skin diseases can alert the clinician to an underlying occult GI disorder. The aim of the study was to review the cutaneous changes in patients with co-existent, often masked GI diseases and to observe the underlying pathophysiology of such lesions. This was a retrospective, record based observational study. The archived histopathology reports & medical records of patients over a period of 5 years were searched and all patients who underwent skin biopsy with co-existent GI diseases were included. Out of a total of 218 patients of GI diseases who had dermatological manifestations, only 44 were biopsied. Pruritis (n=175), koilonychia (n=52) and erythematous rash (n=35) were the most common clinical features. Psoriasis (n=4), vasculitis (n=4), Dermatitis Herpetiformis (n=3) and pyoderma gangreno...
Decidual change is a key process required by the uterus to make itself ready for implantation. Pr... more Decidual change is a key process required by the uterus to make itself ready for implantation. Presence of ectopic decidual tissue outside the uterine cavity is known as deciduosis.The clinical presentation can vary from being totally asymptomatic and subtle to presenting in the form of life-threatening emergencies like hemoperitoneum, recurrent pneumothorax, or even bowel perforation. Here, we present a case of ectopic deciduosis of cervix presenting in the form of severe life-threatening antepartum hemorrhage in second trimester of pregnancy.
Introduction: Drug rash with eosinophilia and systemic symptoms (DRESS) is a severe cutaneous adv... more Introduction: Drug rash with eosinophilia and systemic symptoms (DRESS) is a severe cutaneous adverse drug reaction (cADR) associated with significant systemic involvement and greater mortality. Variable patterns of inflammation are reported in the histopathology of DRESS. However, the role of histopathology in predicting systemic involvement and thus final outcome remains elusive. In the present study, we aim to review clinical and histopathological characteristics of patients with DRESS and compare their histopathology with that of maculopapular drug rash. Materials and Methods: A retrospective analysis of cases of cADRs diagnosed from July 2014 to July 2020 at a single tertiary care institute was performed. A RegiSCAR score of ≥4 was used to recruit patients as DRESS. Patients with a probable/definite diagnosis of cADR on the basis of Naranjo criteria and presenting with exanthem attaining a RegiSCAR score of ≤3 were categorized as MPDR. Correlation of histopathology characteristics with the investigative profile of patients with DRESS was done. MPDR and DRESS were also compared for histopathological characteristics using Chi-square test. Further histopathology of patients with drug rash (both DRESS and MPDR) having systemic involvement was compared with those without systemic involvement to identify specific predictors. Results: Eighteen patients of DRESS and 20 of MPDR fulfilled the inclusion criteria. Most common drugs implicated were anticonvulsants (27.8%). Characteristic findings seen on histopathology in patients with DRESS were epidermal spongiosis (94.5%), epidermal dyskeratosis (33.3%), lymphocytic exocytosis (88.9%), interface vacuolization (77.8%), papillary dermal edema (100%). and perivascular lymphocytic infiltrate (100%). Findings in favor of DRESS compared to MPDR were lymphocytic exocytosis (P < 0.001), interface vacuolization (P = 0.002), severe spongiosis (P = 0.046), severe papillary dermal edema (P = 0.018), and higher density of dermal infiltrate (P = 0.005). Lymphocyte exocytosis and distribution and density of dermal inflammatory infiltrate correlated significantly with deranged kidney function. Conclusion: Histopathology revealing prominent basal vacuolization, spongiosis, and dense dermal infiltrate suggests DRESS. Lymphocyte exocytosis and distribution and density of dermal inflammatory infiltrate predict renal involvement.
Histoplasmosis is a rare tropical disease caused by Yeast-like dimorphic fungus Histoplasma capsu... more Histoplasmosis is a rare tropical disease caused by Yeast-like dimorphic fungus Histoplasma capsulatum. Granulomatous diseases caused by infectious agents are being encounted more frequently nowadays. Infection by histoplasma capsulatum is one such granulomatous disease. In non-endemic areas, histoplasmosis poses a diagnostic challenge, especially since the presenting lesions can mimic carcinoma. The clinician should keep in mind histoplasmosis as a differential diagnosis when dealing with granulomatous lesions of oral cavity, oropharynx and larynx in both immunocompetent and immunocomparised patients. The histopathologist must be informed about the possibility of histoplasmosis, because special dyes have to be used to confirm this diagnosis. The treatment is mainly medical with Amphotericin B which remains the gold standard for treatment of this disease. The rarity of this disease in this part of country and variable clinical presentation prompted the authors to report this case.
Nodular fasciitis, is a benign, pseudo sarcomatous proliferative lesion of the soft tissue, which... more Nodular fasciitis, is a benign, pseudo sarcomatous proliferative lesion of the soft tissue, which is frequently misinterpreted as sarcoma, both clinically and microscopically. It is a reactive lesion composed of fibroblasts/myofibroblasts and most commonly found in extremities and trunk. NF has been described in the head and neck region in 10-20% of cases. Many pathologists do not consider NF in the differential diagnosis of soft tissue masses arising in the Head neck region. NF that occurs in otherwise healthy individuals usually presents with a history of rapid growth, and is commonly found in the upper extremities and on the chest and trunk. The importance of otolaryngologists being aware of the existence of this entity in this area of the body is stressed. It has a confirmed perfectly benign clinical course, and simple excision, as tissue-sparing as possible, is the treatment of choice. A case of NF over the neck in a 05-year-old female not associated with trauma who presented w...
Cutaneous smooth muscle hamartoma is an uncommon, benign tumor developing in the dermis as a resu... more Cutaneous smooth muscle hamartoma is an uncommon, benign tumor developing in the dermis as a result of disorganized hyperproliferation of arrector pili muscle fibers. We present a 1‐month‐old infant with a congenital smooth muscle hamartoma together with the dermoscopic findings of the case. Dermoscopy can be a helpful non‐invasive tool in diagnosing congenital smooth muscle hamartoma due to its distinct findings that help to differentiate it from close mimickers like solitary mastocytoma.
Introduction: Human papillomavirus (HPV) is emerging as a risk factor for esophageal squamous car... more Introduction: Human papillomavirus (HPV) is emerging as a risk factor for esophageal squamous carcinoma. The prognostic value of the HPV status has been investigated. However, the results are much controversial. Aim: This study aims to document the association of HPV infection and mutation of p53 gene in esophageal squamous cell carcinoma (ESCC) and its impact on treatment outcome. Subjects and Methods: The study was conducted over a period of 12 months. A total of 30 cases of ESCC who were primarily to be treated with radiotherapy/chemoradiotherapy were included in the study. All the tissue samples for biopsy were subjected to immunohistochemistry to study p53 and p16 expression, which is a surrogate marker for HPV. The patients were treated by radiotherapy alone or concurrent chemoradiotherapy depending on performance status and stage of disease. The impact of p16 and p53 on overall survival (OS) and disease-free survival (DFS) was determined. Results: The median OS of HPV-positive patients was 22 months (95% confidence interval [CI] 12–31) as compared to 13 months (95% CI 7–18) for HPV-negative patients (P = 0.298). The median DFS for HPV-positive patients was 16 months (95% CI 7–24) as compared to 5 months (95% CI 4–6) for HPV-negative patients (P = 0.048). The median OS of p53-positive patients was 13 months (95% CI 6.7–19) as compared to 22 months (95% CI 12.7–31.2) for p53-negative patients (P = 0.080). The median DFS for p53-positive patients was 5 months (95% CI 3.7–6.2) as compared to 22 months (95% CI 15.7–29.4) for p53-negative patients (P = 0.014). Conclusion: Clinical findings of our result can be used to sum up that both HPV infection and p53 mutation status are reliable biomarkers and can help clinicians to predict treatment outcome and prognosticate patients better.
International Journal of Innovative Research in Medical Science
Endometriosis refers to the extrauterine presence of hormonally active endometrial glands and str... more Endometriosis refers to the extrauterine presence of hormonally active endometrial glands and stroma. This ectopic endometrial tissue exhibits cyclic bleeding, inflammation, fibrosis and leads to formation of adhesions. Endometriosis affects about 10% to 15% of women between 15 to 45 years of age. Clinical presentations vary from infertility, dysmenorrhoea, chronic pelvic pain, deep dyspareunia and even bleeding at external sites like the umbilicus. Besides involving fallopian tubes, bowel, liver, thorax, pericardium, pleura etc, the most commonly affected areas in the gastrointestinal tract are the descending colon, rectosigmoid, appendix, and ileo-caecum in descending order of frequency. This case series highlights some unusual presentations of endometriosis along with co-existence of other ovarian pathologies which are not frequently encountered in clinical practice. This series also highlights the role of preoperative radiology for an adequate clinical diagnosis and complete sur...
Indian Journal of Pathology and Microbiology, 2020
Background: Morphea or localized scleroderma is characterized histopathologically by sclerosis, f... more Background: Morphea or localized scleroderma is characterized histopathologically by sclerosis, fibrosis, and atrophy of the skin and subcutaneous tissue. Various authors have named the characteristic findings seen in histopathology of morphea and have labeled them as specific signs, including line sign, cookie-cutter sign, and square biopsy sign. Besides, other findings mentioned include high eccrine glands and the presence of interstitial mucin. The present study was undertaken to assess the sensitivity of these tests in the histopathological diagnosis of morphea. Methods: All cases clinically diagnosed and histopathologically reported as morphea in the last 3 years (September 2016 to August 2019) were included. The slides were reviewed by two independent investigators for the presence of line sign, cookie-cutter sign, square biopsy sign, high eccrine glands, and mucin. The sensitivity of these signs in accurately diagnosing morphea was assessed. Besides, specificity, positive predictive value, and negative predictive value of these signs were assessed using 40 random histopathology slides as controls. Results: The highest sensitivity was of high eccrine glands (82.5%) followed by the presence of mucin in the dermis (77.5%). Cookie-cutter sign and square biopsy signs were seen in 70% and 62.5% patients, respectively. Line sign was least sensitive of all, seen in 45% of biopsy specimens, but was most specific (82.5%). Conclusion: A fair number of biopsies of morphea displays the presence of high eccrine glands, mucin, cookie-cutter sign, square biopsy sign, and line sign. These signs thus can be of immense help to the dermatopathology trainees.
Annals of Medical and Health Sciences Research, 2018
Background: Psoriasis is a chronic, relapsing, inflammatory, and hyperproliferative skin disease.... more Background: Psoriasis is a chronic, relapsing, inflammatory, and hyperproliferative skin disease. The growth of keratinocytes is regulated by a delicate balance between molecules controlling cell survival (such as Bcl2) and cell death (such as p53). The study was conducted to observe the clinical and histopathological effect of Methotrexate on psoriatic lesions. Materials & Methods: The immunohistochemical expression of pro-apoptotic (p53) and anti-apoptotic (Bcl2) proteins was correlated with histomorphological changes (epidermal thickness, munro microabscess, granular layer, lymphocytic infiltrate, blood vessels) in the psoriatic skin. Results: A total of 35 cases of psoriasis were studied. Male predominance was seen and trunk was the initial site of involvement in 40% cases. There was a significant reduction in PASI (Psoriasis Area Severity Index) score, grade 3 cases of psoriasis and mean expression of p53 in all the histomorphological parameters in the subsequent 2 and 6 weeks ...
Abstract: Tuberculosis was said to be the disease of poor, being more common in the developing co... more Abstract: Tuberculosis was said to be the disease of poor, being more common in the developing countries. It is obvious that tuberculosis of the gall bladder is a rare condition as the literature reveals only about 100 cases till date. Due to the inhibitory effect of concentrated bile acids with its high alkalinity in the lumen, the gallbladder mucosa remains highly resistant to tubercular infection. Cholelithiasis and cystic duct obstruction have been considered as the most important factors in the development of gallbladder tuberculosis. We present a rare case of isolated tubercular cholecystitis. Key words: Gall bladder, tuberculosis, cholecystitis
Hailey-Hailey disease is a bullous disorder characterized by the development of flexural erosions... more Hailey-Hailey disease is a bullous disorder characterized by the development of flexural erosions, blisters and warty papules. We report the case of a middle aged male presenting with multiple bullae all over the body with discharging sinuses in axilla. Characteristic histopathological findings with negative Immunofluorescence confirmed the diagnosis of Hailey-Hailey disease. This case merits interest because of it’s rarity and unusual presentation.
Journal of the College of Physicians and Surgeons Pakistan, 2019
Congenital erythropoietic porphyria, also called Günther's disease, is a very rare genetic autoso... more Congenital erythropoietic porphyria, also called Günther's disease, is a very rare genetic autosomal recessive disease affecting less than 1 per 1,000,000 children. Pathogenesis involves genetic mutation encoding uroporphyrinogen-III cosynthase which leads to accumulation of porphyrin in many tissues, leading to extreme skin photosensitivity, red cell lysis, splenomegaly and reduced life expectancy. Herein, we report a 12-year mentally challenged girl with multiple blisters and scars on sun exposed sites since birth. She had hepatomegaly, erythrodontia, severe anaemia with haemolytic blood picture and mildly elevated liver enzymes. Skin biopsy showed deposition of amorphous eosinophilic porphyrins in the dermis, thus confirming a diagnosis of congenital erythropoietic porphyria.
Hereditary segmental neurofibromatosis (SNF) is an extremely rare form of SNF with nine families ... more Hereditary segmental neurofibromatosis (SNF) is an extremely rare form of SNF with nine families reported till date. SNF is considered to be a result of mosaicism and hereditary transmission is possibly explained by increased susceptibility of mutations at neurofibromatosis gene loci. We report here three members of an Indian family with SNF. Our index case, a 20-year-old woman had multiple soft to firm papules and nodules over right shoulder associated with severe intermittent pain. Her father had three similar nodules over left upper arm and elder sister had two such nodules over right upper arm. The father and elder sister were incidentally diagnosed and they had never sought medical advice considering their lesions to be a familial trait. In the absence of symptoms, many familial cases of SNF are missed thus making any systematic analysis to ascertain its genetic basis difficult.
Inflammatory pseudo tumor (IPT) also known as inflammatory myofibroblastic tumor (IMT) or plasma ... more Inflammatory pseudo tumor (IPT) also known as inflammatory myofibroblastic tumor (IMT) or plasma cell granuloma (PCG) is mostly reported in viscera, with very rare primary cutaneous involvement. Its clinical presentation mimics non-melanoma skin cancers. This neoplasm, though considered benign, actually has intermediate biologic potential. We report a case of 52-year-old female who presented with a nodular lesion with central scab on face and hard sub mental lymph node. As patient refused for biopsy, FNAC was done, which showed highly atypical cells suggestive of squamous cell carcinoma from nodular lesion and reactive hyperplasia from lymph node. Patient underwent excision biopsy and supra-omohyoid lymph node dissection. Biopsy report showed it as inflammatory pseudo tumor of the skin and cervical lymph nodes showed non-caseating granuloma. We present review of this entity.
Granulocytic sarcoma is an extramedullary tumor of primitive granulocytic cells. It can develop a... more Granulocytic sarcoma is an extramedullary tumor of primitive granulocytic cells. It can develop at any anatomic site and is often a prelude to the development of Acute MyelogenousLeukaemia. Granulocytic sarcoma of the small intestine presents with abdominal pain and obstruction. We report a case of a 17 year old boy who presented with epigastric pain. His endoscopy revealed nodular duodenal mucosa and an area of ulcerated exophytic growthin the small bowel. Histopathology and flowcytometery confirmed the diagnosis of granulocytic sarcoma associated with acute myelogenousleukaemia. This case merits interest because of rarity of presentation and thorough clinical and laboratory work up.
International Journal of Innovative Research in Medical Science
Skin manifestations have always been alarming to the patient and often warrant complete clinical ... more Skin manifestations have always been alarming to the patient and often warrant complete clinical evaluation. A thorough understanding of relationship between gastrointestinal (GI) disorders and skin diseases can alert the clinician to an underlying occult GI disorder. The aim of the study was to review the cutaneous changes in patients with co-existent, often masked GI diseases and to observe the underlying pathophysiology of such lesions. This was a retrospective, record based observational study. The archived histopathology reports & medical records of patients over a period of 5 years were searched and all patients who underwent skin biopsy with co-existent GI diseases were included. Out of a total of 218 patients of GI diseases who had dermatological manifestations, only 44 were biopsied. Pruritis (n=175), koilonychia (n=52) and erythematous rash (n=35) were the most common clinical features. Psoriasis (n=4), vasculitis (n=4), Dermatitis Herpetiformis (n=3) and pyoderma gangreno...
Decidual change is a key process required by the uterus to make itself ready for implantation. Pr... more Decidual change is a key process required by the uterus to make itself ready for implantation. Presence of ectopic decidual tissue outside the uterine cavity is known as deciduosis.The clinical presentation can vary from being totally asymptomatic and subtle to presenting in the form of life-threatening emergencies like hemoperitoneum, recurrent pneumothorax, or even bowel perforation. Here, we present a case of ectopic deciduosis of cervix presenting in the form of severe life-threatening antepartum hemorrhage in second trimester of pregnancy.
Introduction: Drug rash with eosinophilia and systemic symptoms (DRESS) is a severe cutaneous adv... more Introduction: Drug rash with eosinophilia and systemic symptoms (DRESS) is a severe cutaneous adverse drug reaction (cADR) associated with significant systemic involvement and greater mortality. Variable patterns of inflammation are reported in the histopathology of DRESS. However, the role of histopathology in predicting systemic involvement and thus final outcome remains elusive. In the present study, we aim to review clinical and histopathological characteristics of patients with DRESS and compare their histopathology with that of maculopapular drug rash. Materials and Methods: A retrospective analysis of cases of cADRs diagnosed from July 2014 to July 2020 at a single tertiary care institute was performed. A RegiSCAR score of ≥4 was used to recruit patients as DRESS. Patients with a probable/definite diagnosis of cADR on the basis of Naranjo criteria and presenting with exanthem attaining a RegiSCAR score of ≤3 were categorized as MPDR. Correlation of histopathology characteristics with the investigative profile of patients with DRESS was done. MPDR and DRESS were also compared for histopathological characteristics using Chi-square test. Further histopathology of patients with drug rash (both DRESS and MPDR) having systemic involvement was compared with those without systemic involvement to identify specific predictors. Results: Eighteen patients of DRESS and 20 of MPDR fulfilled the inclusion criteria. Most common drugs implicated were anticonvulsants (27.8%). Characteristic findings seen on histopathology in patients with DRESS were epidermal spongiosis (94.5%), epidermal dyskeratosis (33.3%), lymphocytic exocytosis (88.9%), interface vacuolization (77.8%), papillary dermal edema (100%). and perivascular lymphocytic infiltrate (100%). Findings in favor of DRESS compared to MPDR were lymphocytic exocytosis (P < 0.001), interface vacuolization (P = 0.002), severe spongiosis (P = 0.046), severe papillary dermal edema (P = 0.018), and higher density of dermal infiltrate (P = 0.005). Lymphocyte exocytosis and distribution and density of dermal inflammatory infiltrate correlated significantly with deranged kidney function. Conclusion: Histopathology revealing prominent basal vacuolization, spongiosis, and dense dermal infiltrate suggests DRESS. Lymphocyte exocytosis and distribution and density of dermal inflammatory infiltrate predict renal involvement.
Histoplasmosis is a rare tropical disease caused by Yeast-like dimorphic fungus Histoplasma capsu... more Histoplasmosis is a rare tropical disease caused by Yeast-like dimorphic fungus Histoplasma capsulatum. Granulomatous diseases caused by infectious agents are being encounted more frequently nowadays. Infection by histoplasma capsulatum is one such granulomatous disease. In non-endemic areas, histoplasmosis poses a diagnostic challenge, especially since the presenting lesions can mimic carcinoma. The clinician should keep in mind histoplasmosis as a differential diagnosis when dealing with granulomatous lesions of oral cavity, oropharynx and larynx in both immunocompetent and immunocomparised patients. The histopathologist must be informed about the possibility of histoplasmosis, because special dyes have to be used to confirm this diagnosis. The treatment is mainly medical with Amphotericin B which remains the gold standard for treatment of this disease. The rarity of this disease in this part of country and variable clinical presentation prompted the authors to report this case.
Nodular fasciitis, is a benign, pseudo sarcomatous proliferative lesion of the soft tissue, which... more Nodular fasciitis, is a benign, pseudo sarcomatous proliferative lesion of the soft tissue, which is frequently misinterpreted as sarcoma, both clinically and microscopically. It is a reactive lesion composed of fibroblasts/myofibroblasts and most commonly found in extremities and trunk. NF has been described in the head and neck region in 10-20% of cases. Many pathologists do not consider NF in the differential diagnosis of soft tissue masses arising in the Head neck region. NF that occurs in otherwise healthy individuals usually presents with a history of rapid growth, and is commonly found in the upper extremities and on the chest and trunk. The importance of otolaryngologists being aware of the existence of this entity in this area of the body is stressed. It has a confirmed perfectly benign clinical course, and simple excision, as tissue-sparing as possible, is the treatment of choice. A case of NF over the neck in a 05-year-old female not associated with trauma who presented w...
Cutaneous smooth muscle hamartoma is an uncommon, benign tumor developing in the dermis as a resu... more Cutaneous smooth muscle hamartoma is an uncommon, benign tumor developing in the dermis as a result of disorganized hyperproliferation of arrector pili muscle fibers. We present a 1‐month‐old infant with a congenital smooth muscle hamartoma together with the dermoscopic findings of the case. Dermoscopy can be a helpful non‐invasive tool in diagnosing congenital smooth muscle hamartoma due to its distinct findings that help to differentiate it from close mimickers like solitary mastocytoma.
Introduction: Human papillomavirus (HPV) is emerging as a risk factor for esophageal squamous car... more Introduction: Human papillomavirus (HPV) is emerging as a risk factor for esophageal squamous carcinoma. The prognostic value of the HPV status has been investigated. However, the results are much controversial. Aim: This study aims to document the association of HPV infection and mutation of p53 gene in esophageal squamous cell carcinoma (ESCC) and its impact on treatment outcome. Subjects and Methods: The study was conducted over a period of 12 months. A total of 30 cases of ESCC who were primarily to be treated with radiotherapy/chemoradiotherapy were included in the study. All the tissue samples for biopsy were subjected to immunohistochemistry to study p53 and p16 expression, which is a surrogate marker for HPV. The patients were treated by radiotherapy alone or concurrent chemoradiotherapy depending on performance status and stage of disease. The impact of p16 and p53 on overall survival (OS) and disease-free survival (DFS) was determined. Results: The median OS of HPV-positive patients was 22 months (95% confidence interval [CI] 12–31) as compared to 13 months (95% CI 7–18) for HPV-negative patients (P = 0.298). The median DFS for HPV-positive patients was 16 months (95% CI 7–24) as compared to 5 months (95% CI 4–6) for HPV-negative patients (P = 0.048). The median OS of p53-positive patients was 13 months (95% CI 6.7–19) as compared to 22 months (95% CI 12.7–31.2) for p53-negative patients (P = 0.080). The median DFS for p53-positive patients was 5 months (95% CI 3.7–6.2) as compared to 22 months (95% CI 15.7–29.4) for p53-negative patients (P = 0.014). Conclusion: Clinical findings of our result can be used to sum up that both HPV infection and p53 mutation status are reliable biomarkers and can help clinicians to predict treatment outcome and prognosticate patients better.
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Papers by Nadia Shirazi