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Author(s): Pooja Gupta [1]; Fouzia Siraj (corresponding author) [1]; K.B Shankar [2]; Manish Rawat [2]; Dipanker S. Mankotia [2]; Vivek Yadav [2]; Amit Dagar [2] INTRODUCTION Small round cell tumors [...], Background: Small round cell tumors (SRCTs) are a group of malignant neoplasms with minimal or no differentiation, characterized by the presence of round cells with high nuclear-cytoplasmic ratio. Although SRCTs can occur in any part of the body, involvement of central nervous system (CNS) is uncommon. Aim: We aimed to study the clinicopathological spectrum of cranial SRCT diagnosed in our institute over a period of four years (2016-2019). Material and Methods: A retrospective review of medical records (2016-2019) with a morphological diagnosis of cranial SRCT was made. Both intra-axial and extra-axial tumors were included. A total of 60 cases were retrieved, and the clinical and histopathological features were studied. Special cytochemical staining and immunohistochemistry were performed, where needed. Results: The mean age at presentation was 18.4 years (range, 1-60 years), with a male-to-female ratio of 2.5:1. The most common site was posterior fossa of brain (n = 28, 47%), followed by dorso-lumbar spine (n = 9, 15%). The most common type of tumor was medulloblastoma (n = 29, 48.3%), followed by Ewing sarcoma (ES)/peripheral primitive neuroectodermal tumor (pPNET) (n = 11, 18.3%), non-Hodgkin lymphoma (NHL) (n = 9, 15%), neuroblastoma (n = 3, 5%), and CNS embryonal tumor, NOS (n = 2, 3.3%). One case each of atypical teratoid rhabdoid tumor (ATRT), rhabdomyosarcoma, pineoblastoma, melanoma, rhabdomyosarcoma, and undifferentiated pleomorphic sarcoma was also documented. Conclusions: SRCTs have a variable age of presentation. Their incidence in CNS is low as compared to other organ systems. On light microscopy, the histopathology of these lesions is overlapping, posing a great diagnostic dilemma for the pathologist. The use of ancillary techniques like immunohistochemistry helps in arriving at the correct diagnosis. Treatment strategy and tumor prognosis also vary along the entire spectrum of SRCT, thus making exact characterization essential for proper management. Keywords: Atypical teratoid rhabdoid tumor, central nervous system, embryonal tumors, peripheral primitive neuroectodermal tumor (pPNET), small round cell tumor

Author(s): Rabish Kumar [1]; Varuna Mallya (corresponding author) [1]; Shramana Mandal [1]; Reena Tomar [1]; Nita Khurana [1]; Lalit Maini [2] INTRODUCTION Giant cell tumor (GCT) or osteoclastoma accounts for [...], Background: Giant cell tumor (GCT) of the bone is a locally aggressive primary bone tumor, that can rarely metastasize. Arising mostly in epiphysis of the long bones in young adults, the tumor is composed of mononuclear cells that are admixed with osteoclastic giant cells(OLGCs), which express RANK ligand and RANK respectively. Denosumab a monoclonal antibody against RANK ligand has been shown to reduce the tumor by causing bone lysis by inhibiting RANKL. Histological changes in 11 patients of GCT who were treated with denosumab are presented here. Materials and Methods: Clinical records and slides of 11 patients of GCT who had been administered neoadjuvant denosumab were included in the study. Evaluation of pre and post therapy GCT specimens was performed by two pathologists (RK and VM). There were 4 males and 7 females. Their mean age was 30 years. All the patients received 120 mg denosumab subcutaneously every week with additional 120 mg on days 8 and 15 of therapy. The histological slides were reviewed and following points noted: 1) degree of ossification,2) fibrosis,3) loss of osteoclastic giant cells,4) proliferation of mononuclear cells,5) atypia,6) Permeation of osteoid by malignant cells. Results: Out of 11 cases, 2 cases did not show any significant histological improvement. 7 cases showed reduction in giant cells, increased fibrosis, enhanced mononuclear cell proliferation and ossification consistent with a pathological response. Atypia and osteoid permeation were noted in 2 cases which showed transformation to osteosarcoma. Conclusion: Denosumab treated giant cell tumor show dramatic histological changes. The post therapy lesions may bear no resemblance to pretherapy lesion. There may be complete resolution or may be confused with benign or malignant lesions Rarely they may show sarcomatous transformation. It is imperative that the pathologist is aware of these changes to prevent diagnostic pitfalls as it poses therapeutic and prognostic implications. Keywords: Bone, denosumab, giant cell tumor, regression

Author(s): Ridhi Bhola (corresponding author) [1]; Anjali Narwal [2]; Mala Kamboj [2]; Anju Devi [2]; Rahul Anand [2]; Shreya Chatterjee [2] INTRODUCTION Head and neck cancer has become a substantial [...], Background: Oral squamous cell carcinoma (OSCC) is one of the most established oral cancers in India, with high morbidity and mortality. The most common etiological agent associated with it is tobacco (in any form), which releases chemical carcinogens that affect not only the oral epithelial lining but also deep stromal structures such as minor salivary glands. They may cause changes in ductal or acinar part of gland depending on tumor grade, thus providing a fertile soil for tumor growth and recurrence. Aims and Objective: To observe the frequency of minor salivary gland changes associated with tobacco as well as to measure the length and depth of ductal involvement in routine tissue sections of OED and OSCC. Materials and Methods: A total of 94 hematoxylin and eosinstained archival slides which included cases of well, moderate, and poorly differentiated OSCC and oral epithelial dysplasia were histopathologically evaluated to observe changes in different components of minor salivary gland. Ductal hyperplasia, ductal metaplasia, mucous pooling within duct, acinar degeneration, pattern of malignant cell invasion (single/clusters), inflammatory infiltrate, eosinophilic cuffing around the gland, and glandular/vascular involvement were evaluated in each slide and correlated with different grades of OSCC. Results: Ductal hyperplasia, inflammatory cell infiltrate, mucous pooling, and pattern of malignant cell infiltration came out to be statistically significant with the highest percentage of changes being observed in poorly differentiated squamous cell carcinoma > moderately differentiated squamous cell carcinoma> well differentiated squamous cell carcinoma>oral epithelial dysplasia. Further, the results of this study suggest that extension of dysplasia or squamous cell carcinoma from overlying oral epithelium along salivary gland ducts is an uncommon finding. Conclusion: Hence, histopathological interpretation for OED and OSCC should also include changes related to associated minor salivary gland tissue as detection and eradication of the putative precursors are the best way of decreasing the overall morbidity caused by tumors. Keywords: Aberrations, minor salivary glands, oral squamous cell carcinoma, tobacco

Author(s): Gayatri Gogoi [1]; Swagata Dowerah (corresponding author) [1]; Akankshya S. Kashyap [1]; Monika Terangpi [1] INTRODUCTION Papillary lesions of the breast encompass a heterogeneous group of diseases which are [...], Papillary carcinoma of the breast is a rare malignant tumor, constituting 1-2 of all breast carcinomas in women. We studied a total of 6 cases of papillary cancer breast of which five were in female patients, and one was a male patient. Three were invasive papillary carcinoma while one was encapsulated papillary carcinoma without invasion, one was encapsulated papillary carcinoma with invasion and one was a solid type of papillary carcinoma. The median age of the patients was 45.5 years. All the tumors except one were seen in the left breast. Grossly, the size of the tumors ranged from 2 cm x 2 cm x 1.5 cm to as large as 6 cm x 10 cm x 4 cm. Three of the cases had positive axillary nodes. To conclude, papillary carcinoma is a rare tumor with a better prognosis as compared to Infiltrating duct carcinoma breast, and hence, it is important to be aware of the different subtypes and diagnostic pitfalls of this tumor to correctly diagnose it. Keywords: Encapsulated, histopathology, immunohistochemistry, papillary carcinoma

Author(s): Ranjana Giri (corresponding author) [1]; Subhransu Kumar Hota [1]; Subrat Kumar Sahu [2]; Urmila Senapati [1] INTRODUCTION Oral cancer constitutes the sixth most common cancer worldwide.[sup.[1]] Its incidence is [...], Background: This study aimed to evaluate the expression of TP53 in oral squamous cell carcinoma (OSCC) and to correlate its expressions with adverse histopathological features like depth of invasion (DOI), lymphovascular invasion (LVI), perineural invasion (PNI), extranodal extension (ENE), and margin status which significantly affect the prognosis. Methodology: This cross-sectional study included 48 patients of OSCC who underwent surgical resection. All the histopathological adverse features such as DOI, LVI, PNI, ENE, margin status were noted. Immunohistochemical expression of TP53 was noted and a correlation of TP53 with histopathological adverse features was done. Statistical analysis was performed using SPSS software. Results: TP53 immunopositivity was seen in 45.83 (22/48) of cases. TP53 has a statistically significant correlation with margin status (P = 0.002). Similarly, TP53 expression is more in cases with LVI (100 cases) though the value is not statistically significant. TP53 expressions are more in positive margin cases and less if the margin is >5 mm. Similarly, TP53 expression is more in cases with LVI (100 cases) though the value is not statistically significant. Conclusion: Few parameters that did not show the correlation of TP53 with adverse histopathological features could be attributed to a small sample size. Further studies with a large number of cases and using other ancillary molecular diagnostic techniques would throw further light on the exact alteration of TP53 in our population and their association with histopathological prognostic features. Keywords: Adverse histopathological features, oral squamous cell carcinoma, TP53