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A story with images: Clues to 4 pathological conditions hidden in the images. Solve the puzzle.


Story of a little orphan child named Annie.

Dr Sampurna Roy MD                 




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It was a dark night, a crescent moon was shining dimly.

A little orphan child named Annie was sitting near a fish tank.

A bright torch light pierced through the darkness and a kind lady took the little orphan child to her home.

What are the 4 pathological conditons hidden in the images?





1) Rapidly Progressive Glomerulonephritis with crescent formation also known as Crescentic glomerulonephritis:

In this form of glomerulonephritis the glomerular epithelial cells proliferate to such an extent as to form a large cellular "crescent" which fills up the Bowman's space and compresses the glomerulus.

2) "Orphan Annie" Eye in Papillary Carcinoma of Thyroid:

In papillary carcinoma of thyroid the nuclei are large, crowded, ovoid, and ground-glass in appearance.

The ground glass appearance is known as "Orphan Annie Eye".

It refers to the empty looking nuclei with scanty dusty chromatin. This nuclear change is present in paraffin section of more than 80% cases.

It is probably an artifact of formalin fixation as it is usually not present in frozen section or cytological specimens.

3)Fish Tank Granuloma:

Granulomatous lesions of the skin and tendon sheaths after exposure to fish tank or aquarium water are frequently caused by non-tuberculous atypical mycobacteria.

Mycobacterium marinum is the species most often isolated from such lesions.

Histopathological examination of the skin shows hyperkeratosis and pseudoepitheliomatous hyperplasia and a prominent suppurative inflammation.

Granulomas, if present, tend to be well defined and non-caseating, but poorly defined granulomatous foci may be present.

Visit: Mycobacterium Marinum Infection

4) TORCH complex:

TORCH complex represents transplacental infection. It includes clinically similar congenital infections caused by:

(T) Toxoplasma gondii ,

(O) Other microbes are also included  such as Trepenoma pallidum

(R) Rubella virus  

(C) Cytomegalovirus

(H) Herpes Simplex Virus , types 1 and 2.

Cutaneous manifestations, including petechiae, purpura, jaundice, and dermal erythropoiesis, are commonly seen in toxoplasmosis, rubella, and cytomegalovirus infections.

In herpes simplex virus infections, infants show cutaneous vesicles, oral ulcers, or conjunctivitis. 

Significant clinical signs in congenital toxoplasmosis include diffuse intracerebral calcification, chorioretinitis, and microcephaly.

Congenital rubella can result in deafness, congenital heart disease, retinopathy, and brain calcification.

Cytomegalic inclusion disease can include hepatomegaly, splenomegaly, paraventricular calcification, and intrauterine growth retardation.

Visit: Toxoplasma gondii ; Herpes Simplex Virus Infection ; Rubella ; Cytomegalovirus infection




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                    "A single rose can be my garden... a single friend, my world. Leo Buscaglia"




Dr  Sampurna Roy  MD

Consultant  Histopathologist (Kolkata - India)







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