European Journal of Molecular & Clinical Medicine

Identification of a patient with regional neck node metastasis and treating them accordingly is very important so as to reduce the mortality associated with head and neck malignancies. The study was conducted in a tertiary care center in Maharashtra. Determination of neck node metastasis is important in cancer bearing patients especially when it comes to deciding the further line of management and also is of prognostic significance. The aim of this study was to correlate the evidence of neck node metastasis on both clinical as well as histopathological examination. The most common tumour and nodal staging at presentation were also found out
Methodology: A proforma was filled out for each patient with head and neck malignancy from the medical registry that has underwent any type of neck dissection along with resection of primary tumour.
Results: The sensitivity and specificity of clinical examination for neck node metastases was found to be 70.59% and 60.61% respectively. The positive and negative predictive values for the same is 48% and 80% respectively. Most of the patients presented with a tumor stage of T2 but when it came to nodal staging alone, 50% of the patients did not have any clinically palpable cervical lymph nodes.
Conclusion: The study showed how important is it do address the neck electively in a case of head and neck malignancy along with resection of primary tumor as even in cases where neck nodes were not palpable clinically there was evidence of neck node metastasis on histopathological examination.

Pleural effusion is a collection of fluid in the Pleural space. Determining the cause of a pleural effusion is greatly facilitated by analysis of the pleural fluid. Etiological diagnosis in of those cases is a diagnostic challenge to the clinician because even after all cumbersome work-ups some cases remain undiagnosed. Pleural effusion remains undiagnosed after routine tests in pleural fluid in many patients. so, we need a simple and safe investigative tool to evaluate undiagnosed effusion. This study is designed to diagnose the cases of undiagnosed effusions by a simple and safe investigative tool.
Materials & Methods: A hospital based prospective study done in 30 patients with exudative pleural effusion remain undiagnosed after pleural fluid analysis in department of respiratory medicine at government medical college, Bhilwara, Rajasthan during one-year period. Pleural fluid sent for basic biochemical and microbiological investigations. Pleural biopsy was performed using ABRAM’S pleural biopsy needle under strict aseptic precaution under local anesthesia and the specimen was sent for the following investigations such as histopathological examination, rt-PCR and culture for Tuberculosis by BACTEC.
Results: Histopathological examination diagnosed 46.66% of biopsy specimens as tuberculosis and 23.33% as malignancy. The rest 30% of case were left undiagnosed after histopathological examination of Pleural biopsy. Reverse Transcriptase Polymerase Chain reaction was positive in16.66% of the cases and was negative in 83.33% of the cases. Our study shows that tuberculous pleural effusion is more common in the younger age group and malignant pleural effusion more common in the elder age in both males and females. There were no false positive results with histopathological examination, BACTEC & rt PCR making the specificity and positive predictive value as 100%. The sensitivity was 70%, 10% & 25% respectively and negative predictive value was60%, 35% & 40% respectively in tuberculosis patients

Hoarseness is defined as a change in the quality of voice which is caused by abnormal vocal cord movement. Present study was aimed to study clinical profile, incidence of common etiological factors and the association of common predisposing factors for hoarseness of voice. Material and Methods: Present study was single-center, prospective, observational study, conducted in patients of age 6-70 years, either gender, presenting with hoarseness of voice. When the findings were inadequate to arrive at a clinical diagnosis, direct laryngoscopic examination with or without biopsy, microlaryngoscopy with or without biopsy, flexible endoscopy with or without biopsy was performed. Results: In present study, 112 patients presented with hoarseness of voice were studied. Majority cases were from 51-60 years age (28.57 %) & 41-50 years age (25.89 %), mean age was 52.97 ± 14.64 years. Male to female ratio was 2.3:1, male (68.75 %) outnumbered females (31.25 %). Common habits observed in patients were tobacco components (36.61 %), smoking (28.57 %), alcohol (23.21 %) & vocal abuse (9.82 %), while no habits noted in 45 patients (40.18 %). After complete evaluation, clinical diagnosis was finalized. Common diagnosis was chronic laryngitis (21.43 %) followed by malignancy (17.86 %), v0cal cord palsy (14.29 %), acute laryngitis (12.5 %), vocal cord nodules (9.82 %), vocal polyp (8.04 %), Reinke’s edema (5.36 %), vocal cord cyst (5.36 %), functional voice disorder (2.68 %), tubercular laryngitis (1.79 %) & reflux laryngitis (0.89 %). Among malignancies, carcinoma supraglottis (9.82 %), carcinoma glottis (5.36 %) & carcinoma subglottis (2.68 %) were noted. Conclusion: Hoarseness of voice as a symptom should never be ignored as its etiology may range from simple infection to malignancy. Early diagnosis is the key to improve the outcome of treatment.

Background: Childhood cancer survivors may face growth impairment due to late effects of childhood cancer therapies. Present study was aimed to study the impact of various modalities of treatment on growth of children with malignancy.
Material and Methods: Present study was Prospective observational hospital-based study, conducted in children between age group 1-18 years, diagnosed with Haematological malignancy or any solid tumour and are on treatment/follow-up in Pediatric hematoncology unit, at least on 4 occasions (4-6 months apart).
Results: Out of 45 children, 30 (66.7%) were boys, mean age of the children enrolled was 5.4 ± 3.684 years. 29 (64.4%) had Leukaemia, 31 (68.8%) received only chemotherapy, 12 (26.6%) received surgery and chemotherapy, 10 received radiotherapy and chemotherapy (22.2%) and 8 (17.8%) of them received all 3 modes of treatment. Among 29 children with leukaemia, there was significant weight gain as well as increase in height at each follow up compared to baseline.  There was no statistically significant gain in weight or height in children with lymphoma at all 3 follow ups. In children with solid organ tumor significant weight gain is observed at each follow up compared with baseline weight which was taken at initiation of chemotherapy. Significant gain in height & weight at each follow up was observed among all 31 children who received only chemotherapy, there was gain in weight & height observed in all children who received both chemotherapy and underwent surgery.  No significant weight gain but a significant gain in height in all 13 children who received both chemotherapy and radiotherapy.
Conclusion: Weight is more affected in children who received radiotherapy along with chemotherapy and in children who received all 3 modes of treatment that is chemotherapy, radiotherapy and underwent surgery for excision of tumour when compared with children who received chemotherapy alone

Background: To study and analyze the structural and functional component of PALM COEIN of AUB in Perimenopausal women and its correlation with the Histopathology where ever applicable especially PALM component.
Materials and Methods: This is a prospective observational study carried out on 100 non gravid women of perimenopausal and postmenopausal age groups who came to Gynaecology OPD with complaints of AUB. The data was analysed considering the inclusion and exclusion criteria. The PALM- COEIN classification was used to classify causes of AUB.
Results: In our study most of the patients were in the age group of 41-50 years (45%). So that AUB is most common in late reproductive years and perimenopausal age groups. Most women with AUB were multiparous. More than half of the women were overweight and obese. So that high BMI is a risk factor for AUB. Most common presenting complaint was heavy menstrual bleeding (44%). Most cases of AUB were due to structural (PALM) abnormalities (61%) &67% based on HPE. Most common cause of AUB was leiomyoma (30%) and more cases were seen in the age group of 31- 50 years .most of the cases of leiomyoma were. Sub mucosal type. 2nd most common cause of AUB was ovulatory dysfunction (17%). In endometrial polyps the D & C reports showed more cases of proliferative endometrium showing that estrogen regulates the growth of the polyps. More cases of AUB-A, AUB-M, AUB-A,L were detected on histopathological examination. Malignancy and hyperplasia is mostly seen after 51 years and mostly these are post-menopausal.
Conclusions: In our study more cases of AUB-A,AUB-M,AUB-A,L were detected more than that of clinical case after histopathological examination, which is more accurate in detecting the pathology. Hence, a proper and adequate clinico histopathological workup of perimenopausal patients helps in accurate diagnosis which aids in better management of AUB.

Background: Accumulation of pericardial fluid (exudate, leaks, or blood) in the pericardial space in a quantity sufficient to cause serious obstruction to the inflow of blood to the ventricles results in cardiac tamponade. Present study was aimed to study clinico-etiological profile of patients with cardiac tamponade at a tertiary care center.
Material and Methods: Present study was single-center, prospective, observational study, conducted in patients with cardiac tamponade diagnosed by clinical and echocardiography criteria and admitted to our hospital.
Results: In present study, total 104 patients were evaluated. Majority of them were from 61-70 years (22.12 %) & from 31-40 years (20.19 %). Male (56.73 %) were outnumbered females (43.27 %). Common symptoms among study subjects noted were dyspnea (92.31 %), fatigue (51.92 %), chest pain (36.54 %) & fever (31.73 %). Clinical signs noted were tachypnea (99.04 %), hypotension (85.58 %), tachycardia (52.88 %), JVP elevated (46.15 %), hypoxia (41.35%). Laboratory findings were anemia (77.88 %) & leukocytosis (33.65 %). Common causes of cardiac Tamponade in present study were malignancy (32.69 %), tuberculosis (25.96 %), idiopathic (10.58 %), post-surgical (7.69 %), hypothyroidism (5.77 %) & post mi (4.81 %), ECG findings noted were sinus tachycardia (55.77 %), low voltage QRS (53.85 %) & electrical alternans (37.50 %). In present study, transthoracic echocardiography findings were RA collapse (81.73 %), IVC plethora (75.96 %), trans mitral flow variation (50 %), swinging heart (46.15 %), RV collapse (41.35 %) & strands in pericardium (29.81 %), On Pericardiocentesis, aspirated fluid quantity among majority cases was 500-1000 ml (58.65 %), followed by <500 ml (20.19 %), 1000-1500 ml (18.27 %) & >1500 ml (2.88 %). Conclusion: Malignancy followed by tuberculosis were most common cause of cardiac tamponade

Background: The proper evaluation of ascitic fluid helps in narrowing the diagnostic dilemma faced by the physicians and helps in better management of the patients. Early and accurate diagnosis often depends on appropriate ascitic fluid analysis. The aim of this study to correlate the cytological features of the ascitic fluid with clinical data at newly established tertiary care center.
Materials & Methods: A prospective study was conducted in the Department of Pathology, in a tertiary health care centre over a period of one year. Cytological examination was performed to reveal important information regarding the causes of ascites and classified as benign (with or without infection/ spontaneous bacterial peritonitis), suspicious or malignant conditions. Cytomorphology of the cells was studied and documented paying attention to cellular arrangement, cytoplasmic features and nuclear characteristics. Clinical information of the patient and cytomorphological features of the smears were studied and the samples were categorized into benign (with or without infection/ SBP), suspicious of malignancy or malignant.
Results: Our study showed that the mean age was 55.67 years. Out of 30 cases, 14 were males and 16 were females, with male to female ratio being 7:8. Out of 30 samples, 26 (86.66%) were benign, 2 (6.66%) were suspicious of malignancy, and 2 (6.66%) were positive for malignancy. The most frequent clinical diagnosis was Alcoholic Liver disease comprising of 8 (26.66%) cases. The predominant cell type was Lymphocyte in 14 (46.66%) of cases, Neutrophil in 9 (30%) of cases, Reactive mesothelial cell in 5 (16.66%) of cases and atypical/malignant cells in 2 (6.66%) of cases. Histiocytic cells were also seen.
Conclusion: We concluded that non neoplastic and neoplastic conditions causing ascites can be diagnosed on ascitic fluid cytology. Increased neutrophil count is strongly suggestive of spontaneous bacterial peritonitis (SBP). The careful cytomorphological examination of ascitic fluid is a valuable, simple, rapid, inexpensive and reliable technique in the differential diagnosis of ascites, particularly in resource limited settings.

Background: Fine needle aspiration cytology (FNAC) is a simple and rapid diagnostic technique and because of early availability of results, simplicity, minimal trauma and complication, the aspiration cytology is now considered as a valuable diagnostic aid. It also helps in giving proper direction for appropriate investigations.
Aims: The aim of the present study was to study the lymph node lesions in various diseases by fine needle aspiration cytology, to categorize the various lymph node lesions into inflammatory or neoplastic lesions and to study lesions in various aspects like age, gender, etiological factors, etc.
Material and Methods: The present study of ‘FNAC’ was carried out in Cytopathology laboratory of Department of Pathology, tertiary care Hospital, during the January 2014 to July 2015.

Prostatic pathology is deceptively simple. Benign prostatic Hyperplasia, prostatitis and prostatic carcinoma are the three principal conditions involving the prostate accounting for more than 95% of lesions. Though the morphologic diagnosis of prostatic lesions, separating benign from malignant is relatively straight forward, there are several benign proliferations and normal histo-anatomic structures of prostate which mimic malignancy and their awareness is essential to avoid diagnostic pit falls.

Background: Conventional smear is a less complicated procedure than that of cell block technique, it has lower sensitivity due of overcrowding of cells, cell loss, lack of architecture and also abundance of inflammatory cells and scarcity of representative cells contribute to appreciable difficulties in creating conclusive diagnosis on conventional smears. The aim of this study was to check the diagnostic yields of cell block technique in the cytodiagnosis of serous fluids.
Material and Methods: Present study was cross-sectional observational study, conducted in samples of ascitic fluid, pleural fluid, pericardiac fluid that were received in the cytology section, collected from patients clinically and radiologically diagnosed as having serous effusion. After reporting the conventional cytological smear the representative received samples were processed for cell block preparations.
Results: Findings of cellularity differs significantly, indicating better yield of cellularity in cell blocks as compared to conventional smear method. Distribution of findings of background obscured by blood or proteinaceous material differs significantly, indicating less degree of background obscured by blood or proteinaceous material on cell block preparation. Distribution of findings of morphology differs significantly, morphology is better appreciated with the help of cell blocks as compared to conventional smear method. Distribution of findings of architecture differs significantly, indicating better appreciation of architecture on cell blocks. Conclusion: Cell block method, concentrates cellular rich material, and it can increases cellular yield for diagnosis. Cell block increases cellular architecture pattern like acini, cells in sheets, papillae, which has helped to identify possible type or primary site of malignancy

Oral submucous fibrosis(OSMF) is a potentially malignant disorder of oral mucosa affecting mainly the population in south and southeast Asia. OSMF is precancerous condition caused by areca nut chewing characterised by restricted mouth opening, burning sensation and stiffness and blanching of oral mucosa.Complete regression of the condition had not been achieved in all cases with any of the present treatment regimen.The aim of the study was to assess the knowledge among dental students about the significance of Oral Submucous Fibrosis and it’s management. The questionnaire based study was conducted among 100 participants. A self administered questionnaire was used. The questionnaire based study was conducted through an online forum , google form software. The questions were formed to observe knowledge,attitude,and practical approach of dental students towards treating OSMF patients attending private dental hospitals .The data collected were stored and results were analysed by SPSS software. Out of 100 participants, 55% participants reported that females have an increased prevalence of OSMF compared to male. Majority of participants were aware that betel quid were the most common habits and blanching mucosa were the common features associated with OSMF. 60 % of participants were aware that stopping gutka / pan chewing habits alone will not resolve the problem in patients having trismus. Within the limits of the present study, students showed good knowledge on the various clinical and diagnosis aspects of Oral submucous fibrosis, however the knowledge on the management aspect of oral submucous fibrosis was moderate. A better knowledge of OSMF will endure safer health care services for the population.