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   Table of Contents - Current issue
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January-March 2022
Volume 10 | Issue 1
Page Nos. 1-35

Online since Monday, March 21, 2022

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ORIGINAL ARTICLES  

Epithelial atrophy, fibrosis and vascularity correlation with epithelial dysplasia in oral submucous fibrosis, a prospective study p. 1
Ruchika Kapoor, Kaustubh Sansare, Sandhya Tamgadge, Freny Karjodkar, Archana Mehra, Isha Mishra, Rajiv Desai, Anuradha Sinha
DOI:10.4103/JMAU.JMAU_36_20  
Background: The pathogenesis of oral submucous fibrosis (OSF) still remains conflicting and has been linked to alterations in epithelial thickness, fibrosis, and vascularity. Although changes in these individual parameters have been extensively studied in relation to epithelial dysplasia their combined relation with dysplasia has not been studied much. Any such relation, if present, may further help in understanding this disease process. Therefore, the aim of this study was to assess the relationship between epithelial thickness, fibrosis, and vascularity with dysplasia in OSF. Materials and Methods: The study consisted of 30 OSF patients. Incisional biopsy was taken from the most fibrosed area of the buccal mucosa. Hematoxylin–Eosin-stained slides were assessed for epithelial thickness, fibrosis, and vascularity using image analysis software. The slides were also assessed for epithelial dysplasia. Relationship of epithelial atrophy, fibrosis, and vascularity with dysplasia was assessed using one-way ANOVA. Pearson's correlation coefficient was used for evaluating the relationship between epithelial thickness, fibrosis, and vascularity. Results: Epithelial dysplasia was found in all patients. Eleven patients had mild (36. 67%), thirteen had moderate (43.33%), and six had severe (20%) dysplasia. None of the parameters were found to have a significant relationship with dysplasia. However, moderate and positive correlation was found between epithelial thickness and fibrosis. This relation was statistically significant. Conclusion: Positive correlation between epithelial thickness and fibrosis in present study therefore contradicts the hypothesis of fibrosis induced epithelial atrophy. As dysplasia is influenced by multiple factors therefore habits and burning sensation needs to be incorporated in future studies assessing dysplasia in OSF.
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Open-source smartphone adapter in digital photomicrography p. 7
Himel Mondal, Shaikat Mondal
DOI:10.4103/JMAU.JMAU_45_20  
Background and aim: Smartphones can be used to capture images from the microscope. There are commercial and homemade adapters that can be used to overcome the difficulty of focusing on a smartphone camera. We conducted this study to test if the usage of a homemade adapter reduces the time and effort of the operator in comparison to the free-hand technique in smartphone photomicrography. Materials and Methods: We made a simple smartphone adapter for digital photomicrography. Thirty-two operators first captured the image on the smartphone with the free-hand technique and then with the adapter thrice from a microscope. The time for focusing was compared statistically by paired t-test. A survey was conducted to know operators' opinions on adapter-assisted photomicrography. Result: All the participants were able to capture images from the microscopes. The average time for focusing with adapter was (11.89 ± 4.19 seconds) significantly (P = 0.0001) lower than the free-hand technique (25.56±11.81 seconds). However, the images yielded from both techniques were of equal quality. The majority of the participant found the method to be easy and reduce their effort in focusing and capturing an image. Conclusion: Low-cost homemade smartphone adapter helps in reducing the time required for capturing an image from the microscope. It decreases the effort of the operator in comparison to the free-hand technique. Hence, it may be a good choice for those who need to capture images from the microscopes frequently for either telemedicine or research purpose in resource-limited settings.
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The extent of expression of thyroid transcription factor 1, cytokeratin 7, and anaplastic lymphoma kinase in lung adenocarcinoma p. 10
Ihab Shafek Atta
DOI:10.4103/JMAU.JMAU_42_20  
Background: New forms of genetic alteration were developed giving a new era of lung adenocarcinoma (AdC) with diverse clinical and pathological features. Aim and Objectives: The aim is to investigate the ALK-rearranged gene as one of these genetic alterations in AdC. The role of TTF-1 and CK7 is to exclude the metastases. Material and Methods: Paraffin-embedded 50 AdC specimens were cut into 4-mm thick sections and stained with the primary antibody, using an anti-TTF-1 antibody, (all at a 1:200 dilution, mouse monoclonal antibody; Dako, Denmark), anti-CK 7 antibody (DAKO, Carpentaria, CA), and the rabbit monoclonal anti- ALK antibody (D5F3) (Ventana, USA). Positive reactivity was considered as brown nuclear immunostaining for TTF-1 and cytoplasmic for CK 7and both cytoplasmic and nuclear for ALK. Results: The median age was 56±2, with male to female ratio 7:3. Forty-four cases revealed a mixed pattern (88%), with focal intraluminal mucin. Forty-one cases (82%) were positive for TTF-1, of these; weak (13; %), moderate (16; %) and strong (12; %). Regarding CK7; 48 cases (96%) were positive; weak (7 cases; 14.5; %), moderate (18 cases; 37.5%) and strong (23 case; 47.9 %) of the positive cases. Regarding D5F3; five cases (10%) were positive; weak (1 case; 20 %), moderate (2 cases; 40 %) and strong (2 cases; 40%) out of the positive cases. Four ALK-positive cases were male and ALK-positive patients ranged from 42-55 years with median 48. Conclusion: Despite the incidence of ALk-AdC is uncommon, it might be suspected in lesions of lower age group especially with mucinous foci.
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Knowledge and attitudes regarding the self-use of pain medications in Saudi Arabia: A cross-sectional study p. 15
Rania M Magadmi, Fatemah O Kamel, Magda M Hagras, Hwraa I Alhmied, Walla H Aljumaiy, Doaa F Saqat, Mawadah M Magadmi
DOI:10.4103/JMAU.JMAU_47_20  
Objective: The objective of the study was to examine the knowledge and attitudes of the population in the Kingdom of Saudi Arabia regarding the use of over-the-counter (OTC) analgesics. Methods: A prospective cross-sectional study used an electronic survey questionnaire comprising 18 questions. An electronic survey was distributed through social networking sites during the period from November 1 to November 15, 2014, followed by data analysis. Results: Data from 1808 questionnaires were collected and analyzed. The results showed that 61% of the participants used analgesics without prescription; 67% used analgesics only for severe pain; 72% stated that analgesics could be administered with other medications; 68% reported that analgesics had an antipyretic effect; and only 1% reported that they had an anti-inflammatory effect. Further, 80% of the participants had the habit of reading drug product information and 77% were careful about the expiry date. Conclusions: The general population showed inadequate knowledge and attitudes toward OTC analgesics. Therefore, more programs to increase awareness and health education among patients are needed.
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Tyrosine hydroxylase-immunopositive cells and melanin in the mesencephalon of yugan black-bone fowl p. 20
Meng Chu, Yangquan Liu, Yu Si, Hang Yu, Yaqiong Ye, Haiquan Zhao, Hui Zhang
DOI:10.4103/JMAU.JMAU_50_20  
Background: The Yugan blackbone fowl (YBF) is a special poultry with hyperpigmentation in various organs, including feather. However, the mechanism of hyperpigmentation is limited, and the melanic information of other organs except skin is rare. Aims and Objectives: In this study, we attempt to get an insight of the mechanism of melanogenesis of birds. Materials and Methods: The mesencephalon of YBF was observed by light microscopy with hematoxylineosin and tyrosine hydroxylase (TH) immunohistochemistry. Results: The TH immunopositive cells were found in the mesencephalon. Moreover, the melanin was also observed in the connective tissue of the mesencephalon. Conclusion: Our results confirmed the existence of melanin and TH immunopositive cells in the mesencephalon of YBF. These results provide a reference for further study on the mechanism of melanogenesis/hyperpigmentation in birds.
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Assessing the quality of long-term stored tissues in formalin and in paraffin-embedded blocks for histopathological analysis p. 23
Hariyabbe Rangaswamy Likhithaswamy, GS Madhushankari, Manickam Selvamani, KP Mohan Kumar, Ganganna Kokila, Saibaba Mahalakshmi
DOI:10.4103/JMAU.JMAU_53_20  
Introduction: Formalin is the most commonly used fixative which enables for long-term storage of specimens and preserves morphologic features allowing the microscopic evaluation for future research analysis. Archival collections of the tissue serve as a reliable tool for diagnostic research purpose. They have an important role in on-going patient care, allows for evaluation of recurrent cases for diagnostic purpose and rare case specimens can also be used as an educational tool as well as for further biomedical research purposes. However, studies assessing quality and their usefulness for such purposes are scanty. Hence, the present study is aimed at evaluating and comparing the tissue changes after long-term storage in formalin as well as in paraffin-embedded blocks. Methodology: Three study groups include specimens stored in formalin for a minimum of 5 years (long-term fixed tissue) and their corresponding paraffin-embedded old tissue blocks along with freshly fixed tissues taken as controls which were subjected to routine histopathological procedures and were assessed for macroscopic and microscopic evaluation. Chi-square test and Z-proportion tests were considered for statistical analysis. Results: Prolonged storage of the tissues in formalin showed variation in color and consistency, difficulty in cutting during grossing with inadequate sectioning characters, loss of tissue integrity and architecture, and inadequate nuclear and cytoplasmic details. Conclusion: On histological analysis, prolonged formalin-stored specimens showed deleterious effects than archival blocks. Hence, it can be proposed that tissues are better preserved in paraffin blocks rather than in formalin for further biomedical research purposes.
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CASE REPORTS Top

Clear cell variant of squamous cell carcinoma of eyelid, mimicking sebaceous carcinoma: A rare case report p. 30
Sonali Dixit, Priyanka Gogoi, Preeti Diwaker
DOI:10.4103/JMAU.JMAU_70_20  
Clear cell variant of squamous cell carcinoma (SCC) is an extremely rare neoplasm. Here, we report a case of clear cell variant of SCC which presented as an eyelid nodule. A 56-year-old male presented with a painless, small, pedunculated nodule in the left upper eyelid. On microscopic evaluation, tumor cells were arranged in nests and lobules with few foci of necrosis. Tumor cells were polygonal in shape, having abundant clear and vacuolated cytoplasm with peripherally pushed hyperchromatic nuclei. Two main differential diagnoses considered were sebaceous carcinoma and clear cell variant of SCC. On immunohistochemistry, tumors cells were negative for androgen receptor. A final diagnosis of clear cell variant of SCC was made. In a malignant eyelid tumor with clear cell morphology, a differential diagnosis of clear cell variant of SCC should be kept in mind before making a diagnosis of sebaceous carcinoma because sebaceous carcinoma possesses a poorer prognosis.
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Diagnosis of idiopathic granulomatous mastitis in a sudanese woman p. 33
Ahmed O Almobarak, Samar B Siddig, Ahmed Hassan, Mohamed H Ahmed
DOI:10.4103/JMAU.JMAU_51_20  
Idiopathic granulomatous mastitis (IGM) is a relatively rare specific chronic inflammatory process of unknown etiology, that diagnostically overlaps with common breast pathologies in Sudan, namely breast cancer (BC) and tuberculous mastitis (TBM). We report the case of a 34-year-old female who presented with a 1-month history of a painful lump in the lower outer quadrant of her left breast. A tru-cut biopsy showed features of granulomatous inflammation suggestive of IGM. Four months later, she presented with similar features and fine-needle aspiration cytology (FNAC) confirmed the presence of IGM and excluded the presence of both, BC and TBM. Histology once again confirmed the diagnosis of granulomatous mastitis with no evidence of breast cancer. Grocott's Methenamine Silver, Ziehl–Neelsen stain, and polymerase chain reaction were negative and accordingly the possibility of fungal infection and TBM were excluded. To our knowledge, this is the first case report of IGM in Sudan. FNAC helped in correct diagnosis of our case and importantly, conditions such as BC and TBM were both excluded as common mimickers of IGM. Although breast biopsy is the main golden approach in the diagnosis of IGM in addition to the usefulness of adjunct ancillary microbiological techniques, still further research is needed to establish whether FNAC can be a reliable tool in the diagnosis of IGM with the common practice of this diagnostic tool in Sudan.
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