Papers by Pushpa Mahadevan
Journal of Medical Science, Jun 29, 2023
Background. Neuroendocrine neoplasms are diverse in terms of sites of origin, functional status, ... more Background. Neuroendocrine neoplasms are diverse in terms of sites of origin, functional status, and degrees of aggressiveness. Since neuroendocrine cells are ubiquitous in the human body, these neoplasms can arise in different organs, with gastrointestinal tract being most frequently involved. The past few years have seen a surge in the diagnosis of these neoplasms, which were earlier considered to be rare. Their nomenclature, classifi cation, and diagnostic criteria are revamped frequently, as new knowledge emerges. Aim. To study the histopathological spectrum of neuroendocrine neoplasms of gastrointestinal tract and assess the immunohistochemical expression of neuroendocrine markers in them. Material and methods. Ours is a descriptive study of the distribution and pathologic characteristics of gastrointestinal neuroendocrine neoplasms in a tertiary care hospital in Kerala, over a three year period. Neoplasms were categorised based on 2019 updated WHO classifi cation. Results. Among the 59 cases, we observed a male predominance. (Male to female ratio-1.8:1). Most patients were in 6 th and 7 th decades of life. Duodenum was most frequently involved followed by rectum and appendix. NET G2 and G1 constituted the predominant histologic grades (47% and 24% respectively). NEC and MiNEN were infrequent. All cases were positive for synaptophysin, with variable positivity for chromogranin. Ki67 helped establish the histologic grade. We also came across a rare case of neuroendocrine tumor with coexisting mucinous neoplasm in appendix. Conclusions. With evolving knowledge and advanced imaging modalities, the incidence of these neoplasms is increasing with time. Histopathology is the mainstay of diagnosis and plays a decisive role in influencing management protocols and prognosis.
Indian journal of pathology and oncology, Apr 15, 2024
Background: Gastrointestinal infections, caused due to various viruses, bacteria, fungi, and para... more Background: Gastrointestinal infections, caused due to various viruses, bacteria, fungi, and parasites, are a major global health concern, causing significant morbidity and mortality. Aims & Objectives: The present study was undertaken to study the histopathological spectrum of infectious diseases of the gastrointestinal tract detected from endoscopic mucosal biopsies at our tertiary care hospital, as well as review the available, relevant clinical details. Materials and Methods: This retrospective study included biopsies over a period of 1 year (January 2022
PubMed, Aug 21, 2007
We report a 56-year-old man with chronic calcifying pancreatitis of the tropics (tropical calcifi... more We report a 56-year-old man with chronic calcifying pancreatitis of the tropics (tropical calcific pancreatitis) who had been asymptomatic and on follow up developed a pancreatic mass that was identified as intraductal papillary mucinous neoplasm. He has been asymptomatic after distal pancreatectomy.
Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology
Brunner's gland adenoma is a benign tumor of the duodenum. We report a 58-year-old man who pr... more Brunner's gland adenoma is a benign tumor of the duodenum. We report a 58-year-old man who presented with abdominal pain, vomiting and weight loss. The patient underwent Whipple resection along with lymph node clearance. The resected tumor, 4 cm long, showed hypertrophied Brunner's glands.
Indian Journal of Cancer, 2016
Renal cell carcinoma (RCC) accounts for approximately 90% of all renal malignancies. The rates of... more Renal cell carcinoma (RCC) accounts for approximately 90% of all renal malignancies. The rates of kidney cancers are high in developed countries and low in eastern countries and Africa. The objective was to conduct a survival study among Indian population following nephrectomy for RCC as there was a paucity of Indian studies in medical literature. We conducted a follow-up study of eighty RCC patients who had nephrectomy between January 2003 and December 2010. These patients had pathological diagnosis after nephrectomy. The follow-up was done up to December 2015. The survival statistics were compiled according to Kaplan-Meier survival curves. The overall survival of eighty patients was 77%. The patients with tumor size ≤7 cm and the patients with tumor size> 7 cm showed significant statistical difference at 5-year survival (P < 0.0001). The patients with low nuclear grade (1 and 2) and the patients with high nuclear grade (3 and 4) showed significant statistical difference at 5-year survival (P < 0.0001). The patients with tumor node metastasis stage below T3 and the patients with clinical stage above or equal to T3 showed significant statistical difference at 5-year survival (P = 0.003). This study has demonstrated the importance of factors such as tumor size, nuclear grade, and stage in the assessment of prognosis of RCC patients. More studies in India with more patients are needed to demonstrate the importance of these prognostic factors.
Indian Journal of Cancer, 2015
OBJECTIVE Cancer is a major health problem in many countries including India. Since Cancer Regist... more OBJECTIVE Cancer is a major health problem in many countries including India. Since Cancer Registries are incomplete in India, only a few epidemiological studies have been done so far. The objective was to determine the leading causes of cancer in a tertiary care hospital and compare the incidences of different types of cancer with the incidences in India and developed countries. MATERIALS AND METHODS An epidemiological study was done to collect data from pathology records of 1003 cancer cases during 6-month period in the year 2010. The data was collected in a computer and the data was utilized to make tables and histograms. RESULTS Of the 1003 cases, the leading cancer site was breast, followed by colon and rectum, lymph node and stomach. The leading cancer site for men was colon and rectum and for women was breast. CONCLUSION Cancer incidence is now low in India, a developing country, compared to developed Western countries. However, some cancers, like breast and colon and rectum cancers are increasing every year. IMPACT The findings of this study support that cancer incidence is increasing in India and more epidemiological studies are needed.
American Journal of Gastroenterology
Indian Journal of Gastroenterology
Journal of Gastrointestinal and Abdominal Radiology
Undifferentiated embryonal sarcoma (UES) is a highly malignant hepatic neoplasm, which occurs mos... more Undifferentiated embryonal sarcoma (UES) is a highly malignant hepatic neoplasm, which occurs mostly in pediatric population. There is a link between embryonal sarcoma and mesenchymal hamartoma as evidenced by clinicopathological overlap and similar genetic abnormality. Here, we report a case of UES in a young female in a background of mesenchymal hamartoma of liver.
Indian Journal of Radiology and Imaging
Hypersecretion of gastrin from duodenal or pancreatic gastrinomas results in a rare clinical enti... more Hypersecretion of gastrin from duodenal or pancreatic gastrinomas results in a rare clinical entity called Zollinger–Ellison syndrome (ZES). It mostly presents with abdominal pain and diarrhea. ZES may be sporadic or occur in association with multiple endocrine neoplasia type 1. Usually, ZES manifests between 20 and 50 years.We report two cases of patients who presented with abdominal pain, vomiting, watery diarrhea, and significant weight loss.
Context Pancreatic stellate cell (PSC) is known to be the source of fibrosis in pancreatic pathol... more Context Pancreatic stellate cell (PSC) is known to be the source of fibrosis in pancreatic pathology of various etiologies. However, there is no published data on activation of PSCs in tropical calcific pancreatitis. Objectives The present study was undertaken to estimate the proportion of activated stellate cells, in a semi-quantitative manner, in normal pancreas and pancreatic fibrosis due to, tropical calcific pancreatitis, alcoholic chronic pancreatitis and pancreatic adenocarcinoma. Patients Surgically resected specimen from patients with tropical calcific pancreatitis (n=22), alcoholic chronic pancreatitis (n=16), adenocarcinoma of pancreas (n=20) and normal pancreas (n=20) were included. Main outcome measures Expression of CD34, and alpha-smooth muscle actin (α-SMA) was assessed by immunohistochemistry. Morphometry was performed by a point counting procedure and CD34 positive areas were excluded from α-SMA positive areas for estimating activated PSCs. Statistics The one-way A...
The National Medical Journal of India
Background Anti-tuberculosis drugs are thought to account for about 50% of drugs that cause liver... more Background Anti-tuberculosis drugs are thought to account for about 50% of drugs that cause liver injury in India. We show that the spectrum of drugs is much wider than previously reported. Methods We evaluated all patients with unexplained acute liver injury presenting during 2006–2016 using a structured proforma for drug-induced liver injury (DILI). The Roussel Uclaf Causality Assessment Method was used to assess causality. Results DILI was found in 143 of 2534 patients with acute liver injury. Nineteen patients had probable ayurvedic DILI. The other common causes of DILI were statins (16 patients) and anti-tuberculosis drugs (11 patients). Eight patients had DILI post-liver transplant. Fluconazole was the most common cause of post-liver transplant DILI. Chronic DILI (abnormal liver function test after 12 months of stopping the suspected drug) was found in 2 patients. Conclusion In otherwise unexplained acute liver injury, DILI due to ayurvedic drugs should be sought. DILI should ...
American Journal of Gastroenterology
Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology, Nov 24, 2018
Inflammatory bowel disease (IBD) is considered uncommon in Asia. The aim of this study was to doc... more Inflammatory bowel disease (IBD) is considered uncommon in Asia. The aim of this study was to document the demographic characteristics and clinical aspects of ulcerative colitis (UC) and Crohn's disease (CD) in Kerala, India. A survey of IBD in Kerala was performed. All gastroenterologists in the region were invited. From May 2013 to October 2015, data were collected in a standardized pro-forma. Forty-seven doctors in 34 centers contributed data. A total of 2142 patients were analyzed. This is the largest state-wide survey of IBD in India. Ulcerative colitis was diagnosed in 1112 (38 new), Crohn's disease in 980 (53 new), and 50 were unclassified (5 new). The district-wise distribution of IBD cases correlated with the District-wise Gross State Domestic Product (r = 0.69, p < 0.01). Three percent was below the age of 18. Patients with UC had more diarrhea (73% vs. 51%), bleeding PR (79% vs. 34%), and intermittent flares (35% vs. 13%) (all p < 0.01). Patients with CD had...
Digestive Surgery, 2002
Original Papers 280 Immunocytochemical Detection of Tumour Cells in the Thoracic Duct of Patients... more Original Papers 280 Immunocytochemical Detection of Tumour Cells in the Thoracic Duct of Patients with an Adenocarcinoma of the Oesophagus
Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology, 2008
BACKGROUND Crohn's disease is increasingly encountered in India. This paper reviews our exper... more BACKGROUND Crohn's disease is increasingly encountered in India. This paper reviews our experience with surgery for small bowel involvement in Crohn's disease. METHODS Retrospective analysis of prospectively collected data of patients who underwent surgical resection for Crohn's disease during a period of 8.8 years from 1997-2006 at a tertiary care center. RESULTS Twenty-eight patients (mean age 31.2 years; 18 men) underwent surgical treatment for Crohn's disease. The diagnosis was made only after surgery in 17 patients; 5 of them were receiving anti-tuberculosis treatment. The most common indication for elective surgery was subacute intestinal obstruction (n=15) followed by enterocutaneous fistula (3) and protein-losing enteropathy (2). Emergency surgery was performed in 4 patients who presented with perforation and peritonitis. Resection of the maximally involved segment and primary anastomosis was done in all elective cases. Resection and exteriorization of resect...
Tropical Gastroenterology, 2020
Indian Journal of Nuclear Medicine
Malignant transformation Paget's disease of bone to sarcoma is relatively rare, occurring in ... more Malignant transformation Paget's disease of bone to sarcoma is relatively rare, occurring in approximately 1% of these patients. Although few clinical and imaging findings may help in prediction of malignant transformation, most of them are nonspecific. We describe a case of carcinoma vocal cord and Paget's disease of bone with sarcomatous transformation, where 18F-fluorodeoxyglucose (FDG) positron emission tomography-computed tomography was helpful in accurate diagnosis by demonstrating differential intense FDG uptake in transformed areas of pagetic bone and also FDG-avid osteoblastic pulmonary metastasis.
BJR|case reports
Collision tumour is the coexistence of two adjacent, but histologically distinct tumours without ... more Collision tumour is the coexistence of two adjacent, but histologically distinct tumours without histologic admixture. Collision tumours are rare in the ovary. It is mostly a histopathological diagnosis often missed in preoperative imaging. The radiologist, gynaecologists and pathologists should be aware of such a combination of tumours to avoid misdiagnosis. We describe the finding of a rare collision tumour, mature cystic teratoma and ovarian fibroma complicated by torsion.
Indian Journal of Gastroenterology
We present three patients with uncontrolled metabolic syndrome and acute-on-chronic liver failure... more We present three patients with uncontrolled metabolic syndrome and acute-on-chronic liver failure in whom, after meticulous evaluation, the acute event was found to be a severe and exacerbated form of nonalcoholic steatohepatitis (NASH), a novel entry in the natural history of non-alcoholic fatty liver disease. This novel disease entity was described partially, 17 years before by Caldwell et al. We discuss current literature, pertinent features, and outcomes associated with a severe form of NASH, which is associated with high mortality.
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Papers by Pushpa Mahadevan