Cubilin is a large endocytic receptor serving such diverse functions as the intestinal absorption of the intrinsic factor-B(12) complex and the renal proximal tubule reabsorption of filtered proteins including albumin, transferrin, vitamin D-binding protein and other important plasma carriers. Cubilin is a structurally unique, peripheral membrane protein, which depends on the membrane protein amnionless (AMN) for correct apical translocation. In addition, AMN appears important for efficient internalization of intrinsic factor-B(12) in the intestine, whereas in the proximal tubule cubilin interacts with another endocytic receptor, megalin, for effective reabsorption. The importance of cubilin has been demonstrated in several animal models of cubilin deficiency as well as in a variety of human diseases. Recent demonstration of cubilin in podocytes from various species awaits further clarification with respect to the functional role as well as its role in pathology.

From bowel to kidneys: the role of cubilin in physiology and disease

Background: Abnormal uterine bleeding (AUB) interferes with the quality of life of an otherwise healthy woman. Until the pathology underlying menorrhagia is, accurately diagnosed, proper therapy is hardly possible. The objective of the study was to analyze different histopathological patterns of endometrium in AUB and observe the incidence of various pathologies in different age groups and their relation to parity.Methods: This two-year prospective studywas done in the department of pathology in atertiary care centre, which included 250 cases of clinically diagnosed AUB patients were evaluated. Histopathological examination of endometrial biopsies and hysterectomy specimens were done, followed by clinical correlation.Results: Out of 250 cases of AUB, Premenopausal bleeding was seen in 216 cases (86.4%) and 34 cases (13.6%) had postmenopausal bleeding. The commonest finding observed in the study was proliferative phase endometrium (37.2%), followed by secretory endometrium (34%) and endometrial hyperplasia (16%). Disordered proliferative endometrium was seen in 2.4% of patients. Endometrial carcinoma was seen in 4 (1.6%) cases. Endometrial hyperplasia was seen mostly in the age group 41-50 years (27 cases). Two cases of endometrial carcinomas were presented after age 60 years.Conclusions: Our study revealed the highest incidence of AUB in the perimenopausal age group (41-50 years). Hence a thorough histopathological workup and clinical correlation are mandatory in cases of abnormal uterine bleeding.

Histopathological spectrum of endometrium in abnormal uterine bleeding

Talaromycosis is a disseminated disease caused by Talaromyces (Penicillium) marneffei, mainly seen in acquired immunodeficiency syndrome (AIDS) patients. Its distribution is restricted to southeast Asian countries; a small pocket of endemicity exists in the northeast Indian state of Manipur. Here, we present a series of five cases presenting to our tertiary care hospital, originating from non-endemic states neighboring Manipur. In addition to the geographical distinction, a variety of unique features were noted in our cases, including human immunodeficiency virus (HIV)-negative hosts, the absence of typical skin lesions, presentation as pneumonia and generalized lymphadenopathy. Our series highlights the importance of distinguishing this disease from histoplasmosis and tuberculosis, both endemic in India.

Talaromyces marneffei Outside Endemic Areas in India: an Emerging Infection with Atypical Clinical Presentations and Review of Published Reports from India

Introduction: Endometrial biopsies and curettings constitute an important tool for diagnosis of endometrial pathology; whether benign, pre-malignant and malignant, and help the gynecologist to decide appropriate therapeutic strategy. The present study was carried out to document the histopathological appearances seen in endometrial biopsies, and their age–wise distribution in patients with infertility and abnormal (irregular, excessive or continuous) uterine bleeding due to endometrial causes.
Materials and Methods: A total of 214 specimens of endometrial curettings and biopsies from patients with abnormal uterine bleeding due to endometrial causes and inability to conceive, received in the Pathology department, Gian Sagar Medical College and Hospital, Banur, Rajpura, over a period of two years from January 2012 upto December 2013, were retrieved and analyzed retrospectively, and their findings were documented. The tissue had been received in 10% formalin, processed routinely, and the slides had been stained with Hematoxylin and Eosin.
Results and Conclusion: The most common histopathological diagnosis was proliferative endometrium seen 33% cases. Products of conception were confirmed histologically in 12% cases. Endometrial hyperplasias were seen in 09% cases, and disordered proliferative endometrium in 06%. Secretory endometrium was seen in 07% cases. 02% biopsies showed atrophic endometrium. Luteal phase defects were seen in 07% of the specimens. 01% cases showed tubercular endometritis and adenocarcinoma each. The most common finding in patients of infertility was proliferative endometrium indicating anovulatory cycles.
Endometrial biopsy is a valuable tool in assessment of endometrial status in infertility, as well as benign and malignant pathology in abnormal uterine bleeding due to relative ease and accessibility of procedure and rapid availability of results.

Keywords: Abnormal uterine bleeding, Infertility, Dysfunctional uterine bleeding, Hyperplasia, Ca

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A two year histopathological study of endometrial biopsies in a teaching hospital in Northern India

Xeroderma pigmentosum, or XP, is an autosomal recessive genetic disorder in which the ability to repair DNA damage caused by ultraviolet (UV) light is deficient. In extreme cases, all exposure to sunlight must be forbidden, no matter how small. As such, individuals with the disease are often colloquially referred to as 'Children of the Night'. Mutations in XP genes that regulate nucleotide excision repair, not only predispose persons with xeroderma pigmentosum to multiple malignancies, but also promote premature cutaneous and ocular ageing, and in some cases promote progressive neurodegenerative changes. There is a great involvement of many parts of the body, especially head and neck. The oral manifestations are mainly related to the occurrence of malignant tumors in the lips, tongue and buccal mucosa. This paper reports a rare case of XP in a 40-year-old female presenting with dermatological, oral and ophthalmological involvement.

Xeroderma pigmentosum: A rare case report with review of literature

Background: Abnormal uterine bleeding (AUB) is a common gynecological complaint associated with considerable morbidity and significantly affects the patient's family, personal and social life. The aim of the study was to analyze the histomorphological patterns of endometrium in patients presenting with AUB and also to determine the incidence of AUB in various age groups. Materials and Methods: This is a prospective study, conducted in the Department of Pathology, in a tertiary care teaching hospital, Mangalore from October 2011 till date. All cases of AUB with a probable endometrial cause were included in the study. Data was entered in Microsoft Excel and managed in Statistical Package for the Social Sciences (SPSS) version 16. Analysis was done in the form of percentages and proportions and represented as tables where necessary. Results: A total of 156 cases were analyzed. Patients' age ranged from 23-78 years. AUB was most prevalent in the perimenopausal age group. The most common presenting complaint was menorrhagia (47%). Endometrial hyperplasia was the most common histopathological finding and was seen in 25% patients, followed by secretory endometrium in 16.7% patients, and proliferative phase pattern and disordered proliferative endometrium were seen in 12.2% patients each. Malignancy was detected in 6.4% of cases and endometrial carcinoma was the most common lesion (4.5%). Conclusions: Histopathological evaluation of endometrial samples is especially indicated in women over the age of 35 years to rule out malignancy and preneoplasia. Among the patients with no organic pathology, normal physiological patterns with proliferative, secretory, and menstrual changes were observed. The most common endometrial pathology in this series was endometrial hyperplasia.

Study of histopathological patterns of endometrium in abnormal uterine bleeding

Imerslund Grasbeck syndrome (IGS) is a rare autosomal recessive childhood disorder characterized by selective Vitamin (vit) B 12 malabsorption with asymptomatic proteinuria without any structural renal pathology. The patients stay healthy for decades with life-long parenteral vit B12. We report a case of young female who presented with pancytopenia and proteinuria, evaluated in local hospitals as chronic hemolytic anemia (autoimmune cause), finally diagnosed as IGS on complete evaluation. She was treated with injectable vit B12 (1000 μg cyanocobalalmin) and showed drastic recovery. IGS should be considered in patients with megaloblastic anemia not responding to oral vit B12 and associated proteinuria.

Unusual cause of childhood anemia: Imerslund grasbeck syndrome

Rhinosporidiosis is a chronic granulomatous lesion caused by Rhinosporidium seeberi It frequently involves nasopharynx and ocular region Presenting as cutaneous and subcutaneous mass is extremely rare This report describes the FNA cytology of rhinosporidiosis occurring as a soft tissue mass in the right mid thigh region We present a rare case of a 71-year-old male, who presented with multiple subcutaneous soft tissue mass lesions in the posteromedial aspect of mid right thigh region since 2 weeks Local examination revealed multiple firm to hard mass with skin over the swelling was unremarkable CT of the right thigh showed a heterogeneous lesion with infiltrative margins in the thigh Clinically soft tissue sarcoma was considered Diagnostic FNAC was performed showing numerous mature and immature sporangias with giant cell reaction Hence, an excision biopsy confirmed the rhinosporidiosis To conclude, the FNAC diagnosis of rhinosporidiosis is specific Preoperative diagnosis is possible even in cases with unusual clinical presentations

Subcutaneous rhinosporidiosis masquerading as soft tissue tumor: diagnosed by fine-needle aspiration cytology.

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Xeroderma pigmentosa with multiple cutaneous malignancies– a rare case report and review of literature

Filariasis is disabling parasitic disease which is prevalent worldwide and caused by various species of filarial organism. Wuchereria bancrofti (W. Bancrofti) is responsible for 90% of cases of filariasis and is found throughout the tropics and in some sub-tropical areas. Cytology has an important role in the diagnosis of subclinical filariasis. Microfilaria is frequently detected in association with neoplasm, although the role in tumorogenesis is controversial. The early detection of the disease could thus mean the difference between a productive healthy life and a lifetime of chronic disability. The identification of microfilaria in body fluids is a rare scenario. We are presenting here with three cases of microfilaria, which was detected in the pleural fluid, bronchoalveolar lavage, pericardial fluid, and in semen with different clinical scenarios. The purpose of this paper was to illustrate these examples and to review the appropriate literature in order to make physicians aware of this uncommon entity.

Harish S Permi

Papers

Study of histopathological patterns of endometrium in abnormal uterine bleeding

Unusual cause of childhood anemia: Imerslund grasbeck syndrome

Subcutaneous rhinosporidiosis masquerading as soft tissue tumor: diagnosed by fine-needle aspiration cytology.

Xeroderma pigmentosa with multiple cutaneous malignancies– a rare case report and review of literature

Filariasis in body fluids: Report of three cases