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Medical practitioners in peripheral remote areas face challenges in treating patients, that are much different from those who are working in an institute or accessible regions. We are discussing two cases, which were clinically diagnosed at our centre and were biopsy proven at a tertiary care institute. First case is of a benign adnexal neoplasm while the second is dreaded midline granuloma. Both the patients received satisfactory consultation and management. [ABSTRACT FROM AUTHOR]

Inroduction: Mucinous cystic neoplasms are rare tumors. They may originate from either ovaries, pancreas, or other intra-abdominal sites, but rarely from the mesentery. Case History: A 22-year-old nulliparaous woman, who had undergone laparascopic bilateral cystectomy for recurrent ovarian mass, presented with pain in abdomen, backache, and menstrual irregularities. Provisionally diagnosed as ovarian carcinoma, she underwent bilateral salpingo-oophorectomy and sigmoid colectomy. However, the histopathological examination revealed mucinous cystic neoplasm of the mesentery. Discussion: Thus, complete resection of the cysts with meticulous gross and histopathological examination remains the gold standard to differentiate mucinous cystic neoplasm (MCN) of the mesentery from its mimics, especially malignant counterparts, enabling clinicians to adequately manage such patients. Here, we present a case of recurrent MCN of mesentery (mesocolon), mimicking as ovarian carcinoma confirmed on histopathological examination, in a young adult. [ABSTRACT FROM AUTHOR]

Synchronous Tumours (ST) are defined as two or more neoplasms originating within six months of diagnosing the first neoplasm. Due to the rarity of synchronous cervical Squamous Cell Carcinoma (SCC) and ovarian Brenner tumours, their pathology has been poorly understood. These patients usually present with symptoms related to cervical cancer and are often diagnosed early. Since many synchronous tumours are incidentally discovered postoperatively, it is important to conduct thorough grossing and histopathological examinations. The primary differential diagnosis for synchronous tumours is multiple metastases from a single primary tumour. The management of multiple tumours is not well-defined and depends on various factors. In the present case, authors present a rare occurrence of synchronous neoplasms: cervical SCC and preoperatively undiagnosed benign Brenner tumour of the left ovary in a 52-year-old postmenopausal female. Immunohistochemistry helped rule out metastasis from a single primary and metastasis from cervical cancer to the ovary. The ovarian tumour showed immunoreactivity for GATA Binding Protein 3 (GATA) but was negative for Carcinoembryonic Antigen (CEA). The cervical SCC was immunopositive for CEA and p40, while no immunoreactivity was observed with GATA 3. [ABSTRACT FROM AUTHOR]

Yolk sac tumors (YST) (or endodermal sinus tumors) are rare neoplasms of germ cell origin that have been reported in gonadal sites (testis and ovary). Extragonadal YST are uncommon and are extremely rare in the extracranial head-and-neck regions. Here, we present a rare case of a 1-year-old male with isolated YST of the right parotid gland initially diagnosed as malignant epithelial neoplasm with possibilities of mucoepidermoid carcinoma and epithelial–myoepithelial carcinoma. [ABSTRACT FROM AUTHOR]

Background: The molecular profile of juvenile nasopharyngeal angiofibroma (JNA) is extremely variable. In absence of established molecular signature the molecular targeting seems difficult for this heterogeneous disease. To establish a basic molecular signature, this paper analyses the interaction of 7 markers according to their ranks as per the decreasing scale of molecular expression.Materials and methods: Fourteen samples of JNA were obtained following surgical excision and mRNA expressions were established through real-time polymerase chain reaction (RT-PCR) for vasculoendothelial growth factor (VEGF), fibroblastic growth factor (FGF), c-Kit, c-myc, Ras, platelet-derived growth factor (PDGF) and tumor suppressor gene p53. Nasal polyp was taken as control. The quantitative expressions for every marker were ranked on a decreasing scale and were compared by Spearman's rank correlation test to define the statistically significant interaction. An attempt was also made to overview the basic clinical parameters (age, duration of symptoms, radiological staging, intraoperative haemorrhage and tumor-volume/weight) associated with enhanced molecular expressions for every marker. Results: Five significant molecular interactions were identified on the basis of rank-correlation: (1) FGF/VEGF (p < 0.01); (2) Ras/FGF (p < 0.01); (3) Ras/VEGF (p < 0.001), (4) FGF/c-Kit (p < 0.05); (5) c-Myc/p53 (p < 0.05). These basic 'molecular signatures' suggested a preliminary 'molecular classification'. The implication of the interactions between FGF, VEGF and Ras were the most outstanding observation that not only revealed a direct relationship but were also consistent with the clinical behaviour. In addition, a non-significant interaction was identified with c-Myc/PDGF and also an inverse relationship between FGF/c-Kit.Conclusions: FGF, VEGF, and Ras being significantly interrelated seemed to be the 'most soft' molecular targets for JNA. The other targets observed included FGF/c-Kit and c-Myc/p53 interactions that seemed equally important but only after VEGF/FGF/Ras complex per se. These preliminary signatures are likely to provide a background for further expansion of the molecular classification of JNA. [ABSTRACT FROM AUTHOR]

The literature on microvessel density (MVD) signifying neoangiogenesis/tumour-activity in juvenile nasopharyngeal angiofibroma (JNA) is limited. Accordingly, this study evaluates and correlates MVD characteristics with clinical parameters/aggressiveness/recurrence. Sixty-two paraffin blocks of JNA were studied histopathologically and MVD was assessed following immunohistochemistry using VEGF and CD34 as vascular markers. A clinical correlation of MVD was undertaken in 43 cases. MVD scores of VEGF and CD34 showed strong inter-correlation. The 'age', 'duration of disease' and 'haemoglobin%' were the only clinical parameters that revealed significance with MVD. Significantly higher MVD scores were appreciated in recurrent cases as well as some other clinical differences from upfront cases. This is the first study of MVD with CD34 and VEGF simultaneously depicting clinical correlation. The strong correlation, supports a prognostic role of MVD scores in JNA and this can be better established in a larger multicentre study involving comprehensive examination of tumour dimensions. [ABSTRACT FROM AUTHOR]

Multiple myeloma is a plasma cell neoplasm seen usually in patients over 50 years of age. Some cases may be asymptomatic initially and are detected during a routine test like complete blood count. They only require a close follow-up and monitoring. However, around 1% of these monoclonal gammopathy of undetermined significance progress to multiple myeloma every year and then they need to be taken care of by chemotherapy, targeted therapy, bisphosphonates and 6 monthly urine and bone examinations. Here, we present a case of 35-year-old female with an initial symptom of a vague backache along with a left subcutaneous supra-orbital swelling which was diagnosed as multiple myeloma by aspiration cytology and confirmed by ancillary tests. She has since been on treatment with bortezomib and prednisone and is responding well. [ABSTRACT FROM AUTHOR]

Introduction: Bronchoalveolar Lavage (BAL) is a minimally invasive procedure that allows for the sampling of distal airways and the alveolar environment to diagnose infectious and non infectious respiratory tract diseases. It is a safe and reliable method considered for diagnosis. Aim: To evaluate the concordance of BAL cytology with the histopathology report of biopsied cases concerning cancer diagnosis. Materials and Methods: The study was a cross-sectional observational study conducted in the Department of Respiratory Medicine at King George's Medical University, Lucknow, Uttar Pradesh, India, which is a tertiary care teaching hospital in northern India. Reported BAL cytology cases for one year, from September 2022 to September 2023, were retrieved from records and consecutive histology was followed for cytohistological correlation. The sensitivity, specificity, Negative Predictive Value (NPV) and Positive Predictive Value (PPV) of BAL cytology were calculated with reference to the identification of malignancy. Histological diagnosis was considered the gold standard and the specificity, sensitivity, positive predictive value and NPV of BAL were calculated. Results: The BAL was performed in 261 cases with a mean age of 56.79 years. The adequacy of BAL cytology was 88.12% (230/261). Of the 261 cases, eight were positive for epithelial malignancies, three were suspicious for malignancies, 219 were reported as negative for malignant cells and 31 cases were deemed inadequate. A biopsy was performed in 56 out of 261 cases (21.45%) and 32 of these cases were found to have epithelial malignancy. A total of 13 cases were reported negative for malignancy, of which 12 were in concordance with BAL results. Three cases were reported as suspicious for malignancy and three were diagnosed as non epithelial malignancies on biopsy, which were deemed inadequate on cytology. Based on the interpretation of the data, the specificity of BAL cytology with respect to histology was 100%, with a PPV of 100%; however, the sensitivity was 14.28% and the NPV was 28.57. Conclusion: The present study results clearly show that BAL cytology is a specific test for malignant diagnosis in lung lesions, in addition to its role in inflammatory conditions. However, due to its low sensitivity, it may not serve as a good screening method. BAL fluid cytology primarily samples the lower respiratory tract, which may not always be affected by malignancy. The low sensitivity may also be attributed to procedural and interpretation limitations. It can serve as a complement to bronchial brushings and histology for the diagnosis of lung cancers. [ABSTRACT FROM AUTHOR]

Background: Oral carcinogenesis is a multistage process with epithelial dysplasia as a premalignant condition. There is a significant inter-observer variation in diagnosing and grading the oral epithelial dysplasia. As human papillomavirus (HPV) is believed to have à strong relationship with oral carcinogenesis, using P16 as a biomarker may help in identifying the cells which may be undergoing the malignant transformation. However, due to the low specificity of P16, dual staining test P16INK4/Ki67 might be a better promising marker for identifying the transformed cells. This study was designed to evaluate the dual expression of P16 and Ki67 as a promising biomarker for dysplasia and their correlation with clinicopathological factors.Materials and Methods: Immunohistochemical analysis for p16 and ki67 was performed on 30 premalignant oral lesions and 36 oral squamous cell carcinoma (OSCC) by dual staining using the CINtec PLUS kit.Results: CINtec positivity was observed only in leukoplakia with dysplasia (46.7%) and squamous cell carcinoma (25%). None of the cases of leukoplakia without dysplasia or oral submucosal fibrosis stained positive for CINtec plus staining. In leukoplakia with dysplasia, there was no significant association with any of the clinicopathological parameters studied. In OSCC cases, alcohol intake showed statistically significant association with CINtec positivity.Conclusion: P16INK4/Ki67 assessment by dual staining is a promising biomarker for identifying dysplasia in cases with diagnostic dilemmas. [ABSTRACT FROM AUTHOR]

The article presents a case study of 31‑year‑old man who presented with nonhealing wound at wrist for two years. His diagnosis shows clinical differentials such as fungal infection, malignancy and tuberculosis. She was prescribed erythromycin, gentamycin and fluconazole for the treatment of bacterial infection.

Although both pulmonary and extrapulmonary tuberculosis (TB) are commonly encountered in developing countries, tenosynovitis is an uncommon presentation of musculoskeletal TB. TB mimics a lot of other conditions and causes diagnostic dilemma in day-to-day practice. We present the case of a 30-year-old male who presented with the complaints of swelling of right index finger which was initially suspected to be giant cell tumour of the flexor tendon sheath but on histological examination turned out to be tuberculous tenosynovitis. [ABSTRACT FROM AUTHOR]

Context: The worldwide prevalence of rheumatoid arthritis (RA) is about 1%, whereas in India, it is approximately 0.75%. The current therapy for RA includes nonsteroidal anti-inflammatory drugs corticosteroids, disease-modifying anti-rheumatic drugs and some recently developed biologic agents, but all of these are associated with adverse effects. Some herbal drugs, such as Boswellia serrata, have been reported to possess anti-inflammatory activity. Aims: The aim of this study is to evaluate the anti-arthritic activity of Boswellia serrata extract (BSE) in complete Freund's adjuvant (CFA)-induced arthritis in rats. Materials and Methods: Thirty-six Wistar rats were divided into six equal groups. RA was induced by intradermal injection of 0.1 ml CFA in hind paw. Body weight, ankle diameter, paw volume, arthritic index, tumor necrosis factor-α (TNF-α), and histopathological examination were assessed. The experimental data were statistically assessed by one-way analysis of variance (ANOVA). Statistical Analysis Used: The recorded data were analyzed using paired t-test and ANOVA test using SPSS. The data were analyzed and represented as mean difference. Value of P < 0.05 was considered statistically significant. Results: BSE at dose 180 mg/kg showed statistically significant improvement in body weight and decrease in ankle diameter and arthritic index (P < 0.05); however, there was insignificant change in paw volume (P = 0.056). This improvement was comparable with Indomethacin. The level of TNF-α did not show any statistically significant change (P = 0.076). Histopathological results also exhibited a reduction in inflammatory parameters. Conclusions: BSE might have usefulness as an adjunct to conventional therapy of RA. [ABSTRACT FROM AUTHOR]

Introduction: E-cadherin is a glycoprotein cell adhesion molecule, which is important for maintenance of epithelial integrity and its loss is a useful biomarker for diagnosis and prognosis of preneoplastic and neoplastic squamous cell lesions. Aim: To evaluate and compare the expression of E-cadherin in oral and cervical premalignant and malignant squamous cell lesions. Materials and Methods: A total of 66 specimens (nine normal, 32 premalignant and 25 malignant) were obtained from oral cavity and cervix including 41 female and 25 male patients, which were divided into Group-I (control), Group-II (premalignant) and Group-III (malignant). Tumour grading and staging was performed. Immunohistochemical staining was done using monoclonal mouse antibody, E-cadherin as per manufacturer’s instruction. Analysis was performed using SPSS software version 17.0. Results: E-cadherin expression showed significantly (p=0.006) higher grades of expression in Group-I as compared to Group II and group III. Expression of E-cadherin was homogenous with membranous pattern in 100% cases of group I and was found in basal and parabasal layers of epithelium. Among group III, welldifferentiated squamous cell carcinoma showed strong staining (++) in 92.3% of cases as compared to moderately/poorly differentiated tumours (16.7% of cases). As tumour become poorly differentiated cytoplasmic staining was predominant pattern in 50% of cases of moderately/poorly differentiated tumour. Overall comparison of E-cadherin expression between oral and cervix lesions showed insignificant difference (p>0.05). Conclusion: E-cadherin expression was found to inversely correlate with the loss of cell differentiation. It can be used as prognostic marker for both oral and cervical premalignant and malignant squamous cell lesions. [ABSTRACT FROM AUTHOR]

• For the Lung cancer risk, this study compared the smoking habit with residential exposure of air pollution (Air Quality Index of the city). • Increased levels of IDH1 and CEA in Chronic Smoker-poor AQI/moderate indicates towards aggressiveness and poor prognosis. • Increased levels of TPA and Cyfra21-1, in non-smokers-poor/moderate AQI indicates LUSC histology. • This study concludes that poor air quality can be as injurious as chronic smoking for lung cancer. Smoking tobacco is the major hazard for lung cancer in Indian subcontinent especially men, compare to woman where, other important risk factors such as air pollutions are responsible. So, the aim of the study is to compare chronic smokers (CS) and non-smokers living in areas with air quality categorized as poor (AQI 201–300) or moderate (AQI 101–200). We measured the expression of non-small cell lung cancer (NSCLC) biomarkers;. IDH1, CEA, Cyfra21-1 , and TPA through quantitative Real-Time PCR (qRT-PCR) and compared the levels of upregulation of the transcripts in stage IIIa NSCLC over control benign tissues among the smoking and AQI settings. Though the all biomarkers were significantly up-regulated in tumor tissues compared to control benign tissues, the fold change increase of IDH1 and CEA was highest in CS-poor/moderate AQI, followed by non-smokers-poor AQI and non-smokers moderate AQI. This indicates the aggressiveness and poor prognosis in CS living in either poor or moderate AQI areas. The level of Cyfra21-1 was lower in in the CS groups in comparison to non-smokers in the poor AQI area. This suggest higher Lung Squamous cell carcinoma histology in non-smokers living areas with poor AQI. Hence, we conclude that poor air quality can be as injurious for lung cancers as chronic smoking. [ABSTRACT FROM AUTHOR]