Browsing by Author "Tomar, Reena"

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    Cytological diagnosis of cutaneous granular cell tumor: Rare tumor with rare presentation
    (Wolters Kluwer - Medknow, 2024-04) Verma, Nidhi; Tomar, Reena; Khurana, Nita; Vindal, Anubhav
    Granular cell tumors (GCTs) are uncommon soft tissue tumors, which are difficult to diagnose merely by clinical examination. Fine?needle aspiration cytology (FNAC), being an effective first?line investigation, plays a significant role in the preoperative diagnosis of GCT. However, the tumor can mimic certain other lesions; hence, a cytopathologist needs to be aware of its characteristic morphology. We report here a case of GCT, presented as a subcutaneous nodule in the first finger web. A differential diagnosis of lipoma/neurofibroma was made clinically. FNAC was done and showed characteristic features of granular cell tumor along with intranuclear inclusions and subsequently, it was confirmed on histopathology.
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    Endometrial stromal tumors: A clinico-histomorphological spectrum of endometrial stromal tumors with review of literature
    (Wolters Kluwer - Medknow, 2024-01) Verma, Ankita; Tomar, Reena; Chaturvedi, Anubhuti; Dhankar, Nimisha; Mallya, Varuna; Khurana, Nita
    Background: Endometrial stromal tumors (ESTs) are rare subset of mesenchymal uterine neoplasms. There are heterogeneous morphological, immunohistochemical, and genetic features. Approximately 50% of ESTs occur in perimenopausal women. In 2020, WHO sub?categorized ESTs into four groups: endometrial stromal nodule (ESN), low?grade endometrial stromal sarcoma (LGESS), high?grade endometrial stromal sarcoma (HGESS), and undifferentiated uterine sarcoma (UUS). Objective: To review the morphological spectrum of endometrial stromal tumors. Method: This retrospective study reviewed the histomorphological features of 15 endometrial stromal tumors with respect to atypia, necrosis, mitosis, collagen bands, whorling around vessels, myometrial invasion, and inflammatory cells. Immunohistochemistry markers (CD10, SMA, and ER) along with special stains (Masson’s trichrome, toluidine blue) were also studied. Results: The age of the patients ranged from 32 to 60 years. Three patients were postmenopausal. The most common presenting symptom was vaginal bleeding. Five patients were operated with a clinical diagnosis of uterine fibroid. One patient presented with prolapse with no other complaint. All the 15 patients had total abdominal hysterectomy and salpingo?oophorectomy. One case showed necrosis, eight cases showed collagen bands, all the 15 cases showed whorling around vessels, one case showed vascular emboli, and seven cases showed inflammatory cells. In low?grade cases, one case showed focal atypia and one case showed focal coagulative necrosis indicating infarction. Thirteen cases were LGESS, and one case of ESN and HGESS. All cases were positive for ER and CD10. Conclusion: Endometrial stromal tumors demonstrate extensive permeation of the myometrium as irregular islands with frequent vascular invasion, whorling around vessels, collagen bands, and inflammatory cells. All these features should be observed thoroughly on microscopy by pathologists to clearly differentiate the low?grade and high?grade endometrial stromal tumors, and to understand the overlapping gray areas morphologically as it affects the prognosis of the patient.
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    Incidental isolated renal mucormycosis in immunocompetent patient: a rare and atypical presentation
    (Medip Academy, 2020-04) Ghuliani, Deepak; Puttaswamy, Rajshekar; Sahni, Kartik; Tomar, Reena
    Mucormycosis is a group of clinical syndromes resulting from infection by one of a group of related filamentous fungi. It is an opportunistic fungal infection that rarely occurs in immunocompetent individual. Isolated involvement of any organ is rare and only a few cases of renal mucormycosis have been reported. We present a case report of atypical presentation of a case of renal mucormycosis in a healthy adult with no predisposing factors. A 48 year non diabetic immunocompetent patient underwent right nephrectomy for painful non-functioning kidney. Biopsy showed chronic pyelonephritis with broad non-septate hyphae suggestive of mucormycosis. Post op followup of patient is normal. Mucormycosis of kidney causes extensive infarction and necrosis due to direct angioinvasion and vascular thrombosis leading to fulminant acute renal failure. The disease mimics pyogenic infection leading to delay in diagnosis and hence resulting in high mortality. High index of suspicion is needed for early diagnosis. Urine and blood cultures are usually sterile. Characteristic CT findings include diffuse enlargement of the kidney with absence of contrast excretion and multiple low-density areas in the renal parenchyma representing fungal abscess. Whenever suspected, FNAC or biopsy is strongly advocated as no imaging can confirm the diagnosis. Nephrectomy or debridement of necrotic tissue along with IV Amphotericin B consist the principal treatment. Renal mucormycosis presenting an indolent course and found incidentally after nephrectomy is extremely rare. In an incidentally found mucormycosis, the role of further investigations to find the source and the role of antifungals have to be further studied.
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    Psychological problems and burnout among healthcare workers: Impact of non-pharmacological lifestyle interventions
    (Elsevier, 2024-12) Gupta, Mohit Dayal; Kunal, Shekhar; MP, Girish; Chalageri, Ekta; Kumar, Deepak; Singh, Vivek; Bansal, Ankit; Batra, Vishal; Yusuf, Jamal; Tomar, Reena; Gupta, Akshita; Gupta, Anubha
    Objective: To evaluate role of rajyoga meditation (RYM) versus stress management counselling (SMC) in addressing burnout syndrome and resultant improvement in electrocardiogram (ECG) so as to automate burnout prediction from raw ECG data with machine learning (ML). Methods: Healthcare providers were assigned to two groups: RYM (n = 100) or SMC (n = 102). Subjects in RYM received rajyoga for 3 months including one week offline and thereafter, virtual mode. SMC group received counselling for 1 day in offline mode and thereafter, received positive thoughts on a weekly basis. All subjects were assessed for psychological (depression, anxiety, stress scale-21 (DASS-21) and burnout syndrome (Mini Z questionnaire) along with 12-lead ECG at baseline after 4 weeks, and after 12 weeks. Based on response on question 3 of the Mini-Z questionnaire, participants were classified either as burnout or satisfied. Results: RYM group showed significant reduction in depression, anxiety, and stress in comparison to SMC group. Burnout results display significant reduction in the RYM group in comparison to SMC group. Reduction in burnout and enhancement in satisfaction from visit-1 to visit-3: burnout visit-1 (27.2 %), visit-2 (23.8 %), visit-3 (19.3 %) and, satisfaction visit-1 (72.8 %), visit-2 (76.2 %), and visit-3 (80.7 %). ML algorithms could identify burnout patients using the raw ECG data with time-series features based classifier performing better than Ultra Short HRV features based ML classifier model. Conclusion: AI based early diagnosis of hearts healthy status using ECG analysis may prevent development of cardiovascular disorder in the long run.
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    Relevance of synovial cells in gouty tophus on fine needle aspiration cytology.
    (2014-07) Tomar, Reena; Srivastava, Ruchi; Arora, Vinod Kumar