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Human epididymis protein 4 (HE4) is a secretory protein encoded by the WFDC2 gene. The potential use of HE4 as a tumor marker has been supported by an increasing number of studies demonstrating an upregulation of HE4 in a range of malignant neoplasm. The aim of the study was to examine the association between the serum levels of HE4 and the clinico-pathological variables and to assess the potential use of circulatory HE4 for the diagnosis of breast cancer. An observational case-control study was carried out in P.G. Department of General Surgery, MLN Medical College, Prayagraj. Forty patients with breast cancer were taken as cases, and thirty healthy individuals were taken as controls. HE4 and CA125 were measured using ELISA test. There was a statistically significant strong positive correlation between CA125 and serum HE4 (rho = 0.7, p < 0.001) with sensitivity for predicting case of 93.33% and a specificity of 80.00% with AUROC of 0.8483. Serum HE4 does not change with progression of stages of malignancy. Serum HE4 had good diagnostic performance, and it can be used as a diagnostic marker of breast malignancy. [ABSTRACT FROM AUTHOR]

Objective: Thoracocentesis is a less invasive and expensive procedure than pleural biopsy, enabling sample collection for cytological evaluation. Cell blocks prepared from these samples provide histopathological diagnoses; further, immunohistochemistry (IHC) can be performed for subtyping malignancies, guiding the clinician in choosing the appropriate treatment modality for the patient. We aimed to determine the various histological subtypes of malignancies using cell block IHC and compare the cell block and conventional cytology methods for diagnosing malignant pleural effusion. Material and Methods: All pleural fluid samples from the clinically suspicious cases of malignancy collected at the Department of Pathology, Government Medical College Kottayam, India, during 18 months, except duplicate and inadequate samples, were included in this prospective observational study. IHC was performed on cell blocks that were positive for malignancy. Results: This study analyzed 630 samples, of which 121 cell blocks demonstrated the presence of malignancy. Overall, 80%, 13%, and 7% of cases were negative, suspicious, and positive for malignancy based on conventional cytology, and 81%, 0%, and 19% were negative, suspicious, and positive for malignancy based on cell blocks, respectively. Among all malignancies, adenocarcinomas from the lung (56%) were the most common, followed by adenocarcinomas from the breast (6%), squamous cell carcinomas (5%), and adenocarcinomas from the ovary (3%). Cell blocks helped detect more malignancies (19%) than conventional cytology (7%), despite a moderate agreement between both methods. Conclusion: Adenocarcinomas were the most common cause of malignant pleural effusions, and the most frequent site of origin was the lungs. Cell blocks helped diagnose more malignancies than conventional cytology. [ABSTRACT FROM AUTHOR]

Background and aim: Giant abdominal mass has not been a common presentation in the era of advanced radiological diagnostic modalities especially in socio-educationally well developed societies. In developing nations like India, patients with Giant abdominal masses do present, requiring surgical consultation/interventions. Majority of the times these are cystic masses, but solid giant abdominal masses are also encountered. A thorough clinical examination coupled with imaging and some tumour markers is essential to make a proper diagnosis and to provide adequate and proper treatment. Materials and Methods: A total of thirty cases of giant abdominal masses presented to our unit from April 2016 to December 2021. Results: Ovarian cyst followed by Adnexal cyst/mass were the common diagnosis. Retroperitoneal sarcoma and Mesenteric cyst also presented as giant abdominal masses. CT scan played important role in defining the lesion. MRI was used in selected patients. All pathologies were treated successfully surgically followed by chemoradiation wherever required. Conclusions: In the era of advanced health awareness and widely available diagnostic radiological modalities, patients with giant abdominal mass do present in the surgical clinics with diverse pathologies but the ovary and adnexa still remain the commonest sites followed by mesentery. GIST and retroperitoneal tumours are also encountered as giant abdominal masses and all these can be diagnosed by various available imaging modalities followed by surgical treatment and chemoradiations on case to case basis. [ABSTRACT FROM AUTHOR]

Background: Fine needle aspiration cytology (FNAC) is very useful for the pre-operative diagnosis of breast cancer. The efficacy of FNAC to determine the prognosis in breast carcinomas has to be explored. Aims: The present study is designed to determine the prognostic role of FNAC by correlation of the cytological features of Invasive Ductal carcinoma of Breast (IDC) with the axillary lymph nodal metastasis, which is a known prognostic marker. Materials and Methods: A total of 68 cases of IDC of breast diagnosed on FNAC with subsequent modified radical mastectomy in our hospital were included in the study group. Both FNAC and histopathology slides were retrieved for all the cases. The FNAC smears were assigned cytological grades according to Robinson's grading system. The histopathological sections of axillary lymph nodes were assessed for metastasis. Correlation was done between cytological grade and lymph nodal metastasis. Results: Cytological grading of IDC and axillary lymph nodal metastasis showed a statistically significant correlation (P <0.05). Individual features like nuclear size, cell uniformity, nucleoli and nuclear margin showed positive correlation with axillary lymph node metastasis (P < 0.05). Conclusion: Positive correlation is observed between Robinson's cytological grading of IDC on FNAC with axillary lymph nodal metastasis, hence cytological grading on FNAC can be used as a prognostic tool. Possibility of axillary lymph nodal metastasis in cases with high cytological grade of IDC on FNAC must be considered by the treating oncologist for the adequate patient management. [ABSTRACT FROM AUTHOR]

Background: Any treatment protocol that leads to complete elimination of surgery may lead to a better patient acceptance of breast cancer treatments. Objectives: We conducted this study to assess the feasibility of preoperative vacuum-assisted biopsies in identifying pathological complete response (pCR) and its accuracy in correlation to final histopathology report (HPR), in an Indian setting. Methods: This was a prospective study conducted between October 1, 2019, and March 31, 2021. Patients with early breast cancer, estrogen and progesterone receptors negative and either Her2 positive or negative, and who were fit to undergo marker placement at the centre of the tumour and to receive third-generation chemotherapy (4 cycles of 3 weekly doxorubicin and cyclophosphamide followed by 4 cycles of 3 weekly docetaxel) were included in the study. Following the enrolment, a tissue marker was placed at the centre of the tumour and appropriate chemotherapy was started. Patients who achieved clinical complete response were subjected to ultrasound-guided vacuum-assisted biopsy (VAB) from the tumour bed before surgery. Pathology results of the VAB and resected specimen were then compared. Descriptive statistics were used in the study. Results: Eighteen patients were enrolled in the study, with a mean age of 43.6 ± 9.8 years. However, only 10 were eligible for VAB procedure, and sensitivity and specificity were calculated based on the results of these 10 patients only. Vacuum-assisted biopsy showed sensitivity of 50% and specificity of 100% in identifying pCR. Combination of mammography, ultrasonography, and VAB showed sensitivity of 77.8% and specificity of 66.7% in identifying pCR. Conclusion: Vacuum-assisted biopsy of tumour bed may not be sensitive enough to eliminate surgery even in patients who have had exceptional response to neo-adjuvant chemotherapy. [ABSTRACT FROM AUTHOR]

Objectives: Using an established proxy measure of intra‐utero testosterone and estrogen levels—the ratio of second‐ and fourth‐digit lengths—we estimated its association with the oral cancer risk among a population from Southern India. Material and methods: In a hospital‐based case–control study, incident oral cancer cases (N = 350) and non‐cancer controls (N = 371), frequency‐matched by age and sex, were recruited from two major referral hospitals in Kerala, India. Structured interviews collected information on several domains of exposure via detailed life course questionnaires. Digit lengths were measured using a ruler in a standardized manner. Unconditional logistic regression was performed to estimate the odds ratios and 95% confidence intervals. Results: Second‐ and fourth‐digit ratio lower than 1, which indicates relatively higher intra‐utero level of testosterone and lower intra‐utero level of estrogen, was associated with higher oral cancer risk (OR = 1.60, 95% CI: 1.02–2.52), after accounting for several confounders. Conclusion: Our findings suggest that intra‐utero hormonal levels measured by second‐ and fourth‐digit ratio are associated with oral cancer risk. Further studies in different population should confirm these results. [ABSTRACT FROM AUTHOR]

Improper diet and physical inactivity are environmental risk factors for breast cancer (BC). This study evaluated the association of dietary risk factors and physical activities with different molecular subtypes of BC. We conducted a case-control study among 130 cases of BC and 150 age-matched controls. Demographic data and tissue marker status were obtained. Diet was assessed using Food Frequency Questionnaire and physical activity was determined using Physical Activity Questionnaire. The association between diet and physical activity with the cancer status was evaluated by Pearson’s Correlation. Among the various dietary factors, refined oil displayed a weak albeit significant positive correlation (r=0.344) to Luminal B subtype of BC. Consumption of all kinds of non-vegetarian food exhibited significant elevation in BC risk with OR > 1.9 (95% CI 0.825–2.707). A higher odds ratio (>1.66) was observed in individuals who had a limited intake of fruits. Furthermore, a strong association was found between low physical activity and breast cancer risk, with around 14.6% of cases being distinctly linked to this risk (OR = 3.33, 95% CI 1.158–9.403, p<0.01). In essence, while dietary factors exhibited a negative correlation with breast cancer risk, the risk was heightened by physical inactivity [ABSTRACT FROM AUTHOR]

Introduction: People affected by leprosy are at increased risk of impairments and deformities from peripheral nerve damage. This mostly occurs if diagnosis and treatment is delayed and contributes to continued transmission within the community. Champa district of Chhattisgarh state in India is an endemic area with the highest national annual case detection and disability rates for leprosy. The Replicability Model is a system strengthening intervention implemented by the Leprosy Mission Trust India in Champa that aims to promote early diagnosis and treatment of leprosy, improve on-going management of the effects of leprosy and improve welfare for the people affected by leprosy. This protocol presents a plan to describe the overall implementation of the Replicability Model and describe the barriers and facilitators encountered in the process. We will also quantify the effect of the program on one of its key aims- early leprosy diagnosis. Methods: The replicability model will be implemented over four years, and the work described in this protocol will be conducted in the same timeframe. We have two Work Packages (WPs). In WP1, we will conduct a process evaluation. This will include three methods i) observations of replicability model implementation teams' monthly meetings ii) key informant interviews (n = 10) and interviews with stakeholders (n = 30) iii) observations of key actors (n = 15). Our purpose is to describe the implementation process and identify barriers and facilitators to successful implementation. WP2 will be a quantitative study to track existing and new cases of leprosy using routinely collected data. If the intervention is successful, we expect to see an increase in cases (with a higher proportion detected at an early clinical stage) followed by a decrease in total cases. Conclusion: This study will enable us to improve and disseminate the Replicability Model by identifying factors that promote success. It will also identify its effectiveness in fulfilling one of its aims: reducing the incidence of leprosy by finding and tracking cases at an earlier stage in the disease. [ABSTRACT FROM AUTHOR]

Purpose of the Study: To assess the association of inflammatory markers with known risk factors and short-term outcome of well-differentiated thyroid cancer. Materials and Methods: Well-differentiated nonmetastatic thyroid cancer patients diagnosed and treated between September 2015 and December 2019 at Kasturba Hospital, Manipal, India, were retrieved for the study. Patients' presurgical blood parameters were noted, and neurtrophil-to-lymphocyte ratio (NLR) and lymphocyte-to-monocyte ratio (LMR) were calculated. Clinicopathological details along with tumor markers at baseline and at 6 months' follow-up were tabulated. Patients were categorized as complete disease clearance if their clinical examination was normal, stimulated thyroglobulin (Tg) was <1 ng/ml, Anti-thyroglobulin antibodies <65 IU/L or showing a decreasing trend, and follow-up I-131 whole-body scan was negative. The association of the inflammatory markers with known risk factors and short-term outcomes were compared. Results: A total of 272 patients were analyzed in the study. The median NLR in our study cohort was 2.55 (mean = 3.96 with standard deviation [SD] =4.20) and the median LMR was 3.72 (mean = 3.79 with SD = 1.94). The disease clearance rate of our study cohort was 73.9%. The median NLR (2.4 vs. 3.1) and LMR (3.13 vs. 3.93) were significantly different among the patients with complete disease clearance and those with persistent disease (P = 0.008 and P = 0.003, respectively). The known risk factors such as multifocality (P = 0.04), tumor size (P = 0.013), lymph node metastases (P = 0.001), and baseline Tg (P ≤ 0.001) were significantly associated with persistent disease at 6 months. The NLR showed a positive correlation and LMR had a negative correlation with the known risk factors, however, the associations were not statistically significant. Conclusions: The NLR and LMR are simple yet potential prognostic tools in well-differentiated thyroid cancer. [ABSTRACT FROM AUTHOR]

Introduction: Prostate cancer usually affects older men and accounts for considerable cancer-associated mortality in men globally. In India, there is a rise in prostate cancer, and the published literature to determine age-specific prostate-specific antigen (PSA) is limited by a small sample size. The objective of our study was to determine age-specific PSA for Indian men based on a very large cohort of apparently healthy men undergoing health screening. Methods: This was a retrospective study using the hospital-based database of men who had undergone PSA blood tests as a part of health screening at two tertiary referral centers in South India between January 1, 2011, and August 31, 2018. Anonymous data were extracted, and statistical analysis was performed. Results: During this period, 99,386 men underwent PSA blood tests. Non-Indian patients and patients with PSA levels either <0.2 or >20 were excluded from the study, leaving 86,728 patients who were further analyzed. Seventy percent of patients were below 60 years of age, and the mean PSA for the study cohort was 1.2 ng/mL (standard deviation 1.74), with a median PSA of 0.7 ng/mL (interquartile range 0.4--1.1). The 95th percentile serum PSA level was 1.40, 1.70, 3.10, 5.80, 8.82, and 11.31 ng/mL for age groups of ≤40, 41--50, 51--60, 61--70, 71--80, and >80 years, respectively. The mean, median, and 95th percentile PSA reportedly increased for each decade of life ( P = 0.0005). Conclusions: Results of this study indicated a positive correlation between serum PSA level and age in Indian men. These values are lower than the age-specific PSA defined for Caucasian men. These findings provide a basis for establishing new age-specific reference ranges of PSA for Indian men which will help in clinical decision-making. [ABSTRACT FROM AUTHOR]

Background: The molecular makeup of a head and neck squamous cell carcinoma (HNSCC) could vary as per the geography and corresponding variability in prevalent etiopathological factors. The objective of this study was to analyze the expression pattern of E-cadherin (E-cad), a transmembrane glycoprotein with tumour suppressor function, in a cohort of HNSCC treated at a tertiary care medical centre in the southern part of India. Material and methods: After obtaining the institutional ethics committee's permission, the expression of E-cad in HNSCC was assessed by using immunohistochemistry on retrospectively collected tumour specimens, obtained by a surgical cohort of cases operated between September 2018 and July 2019. The E-cad expression was then correlated with various clinical and pathological characteristics of HNSCC, retrieved via the medical records of corresponding patients. Results: A total of 60 patients of HNSCC were included, most of whom had lesion in the oral cavity, in an advanced stage. The majority had a strong or moderate expression of E-cad on the surface. On analyzing further, oral cavity tumours had significantly less expression of E-cad compared to laryngeal and hypopharyngeal tumours taken together, and primary tumours had less E-cad expression than recurrent cases. Multivariate analysis with proportional odds regression showed the significant associations of low expression of E-cad expression with the moderate/poor differentiation of tumours and with the extranodal extension. Conclusions: Among the HNSCC, the loss of E-cad expression was mostly associated with primary tumours of the oral cavity, moderate/poorly differentiated tumours, and in those HNSCCs that had an extranodal extension. [ABSTRACT FROM AUTHOR]

Cancer is an abnormal, heterogeneous growth of cells with the ability to invade surrounding tissue and even distant organs. Worldwide, GLOBOCAN had an estimated 18.1 million new cases and 9.6 million death rates of cancer in 2018. Among all cancers, Oral cancer (OC) is the sixth most common cancer worldwide, and the third most common in India, the most frequent type, oral squamous cell carcinoma (OSCC), tends to spread to lymph nodes in advanced stages. Throughout the past few decades, the molecular landscape of OSCC biology has remained unknown despite breakthroughs in our understanding of the genome-scale gene expression pattern of oral cancer particularly in lymph node metastasis. Moreover, due to tissue variability in single-cohort studies, investigations on OSCC gene-expression profiles are scarce or inconsistent. The work provides a comprehensive analysis of changed expression and lays a major focus on employing a liquid biopsy base method to find new therapeutic targets and early prediction biomarkers for lymph node metastasis. Therefore, the current study combined the profile information from GSE9844, GSE30784, GSE3524, and GSE2280 cohorts to screen for differentially expressed genes, and then using gene enrichment analysis and protein–protein interaction network design, identified the possible candidate genes and pathways in lymph node metastatic patients. Additionally, the mRNA expression of discovered genes was assessed using real-time PCR, and the Human Protein Atlas database was utilized to determine the protein levels of hub genes in tumor and normal tissues. Angiogenesis was been investigated using the Chorioallentoic membrane (CAM) angiogenesis test. In a cohort of OSCC patients, fibronectin (FN1), C-X-C Motif Chemokine Ligand 8 (CXCL8), and matrix metallopeptidase 9 (MMP9) were significantly upregulated, corroborating these findings. Our identified significant gene signature showed greater serum exosome effectiveness in early detection and clinically linked with intracellular communication in the establishment of the premetastatic niche. Also, the results of the CAM test reveal that primary OC derived exosomes may have a function in angiogenesis. As a result, our study finds three potential genes that may be used as a possible biomarker for lymph node metastasis early detection and sheds light on the underlying processes of exosomes that cause a premetastatic condition. [ABSTRACT FROM AUTHOR]

The Immunoglobulin G4-related disease (IgG4-RD) is a multisystem inflammatory condition. Pancreaticobiliary manifestations often present as mass lesions that mimic malignancies. The diagnosis is confirmed by histopathological examination, that shows lymphoplasmacytic infiltration, storiform fibrosis, obliterative phlebitis, and positive immunohistochemistry for IgG4. We encountered 3 such patients in a tertiary care hospital in India. Two patients presented with obstructive jaundice and the third with pain abdomen. They had resectable lesions involving the pancreatic head, the right hepatic duct, and gallbladder fundus, respectively, on imaging. Tumor markers were not significantly elevated in any of them. All 3 patients underwent radical surgeries, suspecting malignancy. Surgical specimens showed typical features of IgG4-RD on histomorphology. Serum IgG4 level was elevated in first 2 patients but was normal in sclerosing cholecystitis patient. To conclude, IgG4-RD is a malignant mimicker; hence, on clinical suspicion, liberal attempts for tissue diagnosis may avoid radical surgeries. [ABSTRACT FROM AUTHOR]

The fibroadenoma is considered as a manifestation of aberration in normal development and involution (ANDI); however, its exact etiopathogenesis is poorly understood. We investigated the role of oestrogen (ER) and progesterone receptors (PR) in Fibroadenoma, to assess the ER and PR expression in epithelium and stroma of fibroadenoma and to co-relate this expression with the response to centchroman therapy. Fifty ladies with 65 fibroadenomas were investigated. Tissue from core biopsy of lesions was stained for estimating the ER and PR expression in the epithelial cells and in stroma. Patients received tablet centchroman 30 mg daily for 3 months, and the response to therapy was evaluated. A regression ≥ 30% in largest dimension of fibroadenoma on sonography was considered a significant response. The association between the response and ER and PR expression in epithelium and stroma was assessed. In the epithelium: ER positivity = 62.5%; PR positivity = 93.75%. In the stroma, the ER positivity = 2% and PR positivity = 8.3%. Response to centchroman was observed in 33/48 = 68.7%. Among the 33 responders, 23 lesions expressed ER in epithelium, while 10 lesions were ER negative. The relative risk of regression with "ER positivity of epithelium" as exposure = 1.38 (95% CI; 1.35–1.40, p = 0.12). Among responders, 30/33 exhibited PR positivity in epithelium. Expression of ER and PR in the epithelium of fibroadenoma is associated with significant regression in size with 3 months of therapy with centchroman. [ABSTRACT FROM AUTHOR]

Varicose veins represent one of the most frequent vascular diseases. Their pathogenic mechanisms are not well understood. Role of inflammation in pathophysiology of varicose veins is an area of ongoing research. In varicose veins, there are increased levels of inflammatory markers. The purpose of study was to evaluate role of inflammatory marker, neutrophil to lymphocyte ratio (NLR), and IL-6 in blood in disease progression, development of complications, and recurrence after treatment in patients with varicose veins. This study was conducted in the Department of General Surgery, Banaras Hindu University, Varanasi. A total of 40 patients with varicose veins were enrolled between June 2018 and September 2020. Serum concentration of IL‐6 was determined by DIA source Immuno Assays, Belgium IL-6 ELISA kit KAP126. This kit is based on the standard sandwich enzyme‐linked immunosorbent assay technology which employs a monoclonal antibody specific for human IL‐6 coated on a 96‐well plate. This ELISA kit showed no cross-reactivity with other relevant proteins. Complete blood counts were done in automated analyzer. Blood smear was stained, fixed, and differential leucocyte counts calculated using microscopy. In our study, mean NLR at presentation in patients with and without postoperative complications was 4.33 ± 0.40 and 3.22 ± 0.80 respectively, with statistically significant difference (p = 0.001). Mean serum IL-6 levels at presentation in patients with and without postoperative complications were 4.02 ± 0.54 and 2.65 ± 1.32 pg/ml respectively, with statistically significant difference (p = 0.007). Thus, NLR and IL-6 levels at presentation may have a role as a prognostic factor. NLR and IL-6 levels can be utilized to screen patients likely to develop postoperative complications and recurrence. [ABSTRACT FROM AUTHOR]

Mycobacterium Tuberculosis (MTB) primarily infects the lungs and spreads throughout the body after the initial infection. This dissemination occurs through the reactivation of a dormant focus, which is preceded by lymphohaematogenous spread. It can also spread through the bloodstream from active lung or miliary tuberculosis. Tuberculosis is the leading cause of amenorrhoea in young females in developing countries like India. Although disseminated tuberculosis with osteoarticular involvement is a rare occurrence, a 20-year-old female presented to Acharya Vinoba Bhave Rural Hospital (AVBRH) with primary complaints of amenorrhoea and swelling in the right knee joint, which were the primary symptoms of disseminated tuberculosis. The present case is exceptional because it lacks the typical pulmonary symptoms. The predominance of gynaecological symptoms over pulmonary involvement may have led to an incorrect diagnosis of malignancy instead of tuberculosis. Additionally, the suspicion of tuberculosis was delayed due to elevated ovarian tumour markers. [ABSTRACT FROM AUTHOR]

Primary retroperitoneal Teratomas are very rarely encountered in clinical practice and account only for 4% of all primary Teratomas. Commonly found in childhood, they are generally asymptomatic, producing symptoms after they attain a large size. The mainstay of treatment is a complete en bloc surgical resection which also provides a definitive diagnosis. We report a unique case of primary retroperitoneal mature teratoma in a 12 year old boy who was managed at a district hospital in North-east India. [ABSTRACT FROM AUTHOR]

Introduction: Oral cancer, one of the most common cancers worldwide constitutes a major public health problem and is one of the leading cancer sites among men and women in India. Increased uptake of glucose in cancer cells are mediated by glucose transporters. Among 14 isoforms of glucose transporters, Glucose transporter 1 (GLUT-1) isoform expression predominate Oral squamous cell carcinoma (OSCC). Aim: To emphasize the expression of GLUT-1 in OSCC and to assess its role in tumor progression and prognosis. Materials and Methods: Hand searching and electronic databases such as PubMed/Medline, Google scholar and Science-Direct were done for mesh terms such as OSCC, GLUT-1, prognosis, tumor markers, prognostic marker and risk predictor. Studies were pooled and relevant articles were evaluated. Results: Final analysis identified thirteen articles after considering the inclusion and exclusion criteria. These studies evaluated 926 OSCC cases and 70 healthy controls for GLUT-1 immunoexpression. The data was extracted and evaluated manually. GLUT-1 expression was found to be elevated in OPMDs and OSCC than in healthy controls. The pattern of expression of GLUT-1, its correlation with clinico-pathological features, role in tumour progression and prognosis, expression in tumor invasive front, correlation with other markers and role in therapeutics are also discussed in detail. [ABSTRACT FROM AUTHOR]

Background: Carcinoma of lung is the most common cause of cancer-associated mortality worldwide. About 70% of lung cancer cases are unresectable and present in advanced stages. So, cytology and small core needle biopsy specimen are available for diagnostic as well as prognostication workup. Subtyping of non-small cell lung cancer (NSCLC) is essential for the treatment and further workup study. For this, immunocytochemistry (ICC) plays a crucial role that helps in early diagnosis. Subtyping of NSCLC from cytology samples using ICC markers like TTF-1, Napsin-A, and p63 and their clinicopathological correlation are the aims of the study. Materials and Methods: This ambispective study was conducted in the pathology department of a tertiary care hospital of eastern India for a 2-year period from 2018 to 2020. In our study, 46 cytologically diagnosed cases of NSCLC were included. Subtyping was done by cytomorphology and correlated with ICC expression, histopathology, and clinicopathological parameters. Results: In our study, adenocarcinoma (ADC) was the most common (32.61%) cancer. Most cases of ADC showed positive expression of TTF-1 and Napsin-A, and p63 was positive in most cases of squamous cell carcinoma (SCC). Concordance with cytomorphology and ICC was 87.50% and 81.81% with ADC and SCC, respectively. Cyto-ICC-histo concordance was observed in 85.51% of ADC and 66.66% of SCC cases. Sensitivity was 100%, 93.1%, and 100% for TTF-1, Napsin-A, and p63, respectively. Specificity of both TTF-1 and Napsin-A was 88.2% and for p63 was 93.8%. Conclusion: In small biopsy along with cytology samples, ICC is cost-effective and plays an important role in early diagnosis along with management of NSCLC. [ABSTRACT FROM AUTHOR]

Colorectal carcinoma (CRC) is rising exponentially in Asia, representing 11% of cancer worldwide. This study analysed the influence of CRC on patients' life expectancy (survival and prognosis factors) via clinicopathology data and comorbidity status of CRC patients. Methodology: A retrospective study performed in HUSM using clinical data from the Surgery unit from 2015 to 2020. The demographic and pertinent clinical data were retrieved for preliminary analyses (data cleansing and exploration). Demographics and pathological characteristics were illustrated using descriptive analysis; 5-year survival rates were calculated using Kaplan–Meier methods; potential prognostic variables were analysed using simple and multivariate logistic regression analysis conducted via the Cox proportional hazards model, while the Charlson Comorbidity Scale was used to categorize patients' disease status. Results: Of a total of 114 CRC patients, two-thirds (89.5%) were from Malay tribes, while Indian and Chinese had 5.3% each. The 50–69.9 years were the most affected group (45.6%). Overall, 40.4% were smokers (majorly male (95.7%)), 14.0% ex-smokers, and 45.6% non-smokers (p-value = 0.001). The Kaplan–Meier overall 5-year median survival time was 62.5%. From the outcomes, patients who were male and >70 years had metastasis present, who presented with per rectal bleeding and were classified as Duke C; and who has tumour in the rectum had the lowest survival rate. Regarding the prognosis factors investigated, "Gender" (adjusted hazard ratio (HR): 2.62; 95% CI: 1.56–7.81, p-value = 0.040), "Presence of metastases" (HR: 3.76; 95% CI: 1.89–7.32, p-value = 0.010), "Metastasis site: Liver" (HR: 5.04; 95% CI: 1.71–19.05, p-value = 0.039), "Lymphovascular permeation" (HR: 2.94; 95% CI: 1.99–5.92, p-value = 0.021), and "CEA-level" (HR: 2.43; 95% CI: 1.49–5.80, p-value = 0.001) remained significant in the final model for multiple Cox proportional hazard regression analyses. There was a significant mean association between tumour grades and the patient's comorbidity status. Conclusions: Histopathological factors (gender, metastases presence, site of metastases, CEA level, and lymphovascular permeation) showed the best prognosis-predicting factors in CRC. [ABSTRACT FROM AUTHOR]

Background: In India, Oral cancer is one of the most common cancers. Despite advances in treatments, prognosis for oral cancer has remained poor with a five-year survival rate of 40–50%. Therefore, it is necessary to develop effective diagnostic methods for early diagnosis and better prognosis. Homocysteine (Hcy) has been reported as a 'tumour marker' in various cancers such as breast cancer, colorectal cancer, lung cancer, cervical cancer. Aim: To study the levels of serum Hcy in oral squamous cell carcinoma (OSCC) patients. Objectives: To assess the clinical utility of serum Hcy as a potential tumour marker for OSCC cases. Methodology: Serum Hcy levels were studied and compared between patients with OSCC and healthy individuals. Results: Serum Hcy levels were higher in patients having OSCC. Conclusion: Serum Hcy levels could be utilized as a biological marker in the diagnosis and the prognosis of OSCC patients. [ABSTRACT FROM AUTHOR]

Background and Aim: India is the third most common country being entitled as "The Oral Cancer Capital of the World." Around one-third cancer deaths are due to tobacco use. In India, oral cancer ranks first among all cancers in men and second among all cancers in women. p53 over-expression has been widely demonstrated to be a reliable predictor of progression to oral squamous cell carcinoma (OSCC). Ki67 expression is strictly associated with cell proliferation and used as a proliferation marker. Oral cancer was studied in Bundelkhand region with special reference to Gutkha (a form of tobacco) chewing and relative risk. p53 and Ki 67 expression was assessed in premalignant and malignant oral and oropharyngeal lesions and their correlation was evaluated. Materials and Methods: A descriptive study including both prospective and retrospective studies carried over a period of 18 months (April 2019–September 2020) at Department of Pathology, Maharani Laxmi Bai Medical College, Jhansi, India. Immunohistochemical evaluation was done by using markers: anti p53 and anti K67 markers with positive control, i.e. p53 – colon and Ki 67 – tonsil) sections stained omitting primary antibody were taken as negative control. Results: OSCC and premalignant oral lesions are at high incidence in Bundelkhand region, India. Tobacco is found to be most identifiable risk factor with risk ratio of 0.45. Conclusion: The over/co-expression of p53 and Ki67 plays a pivotal role in labeling and predictive marker for malignant transformation as their intensity and pattern of staining increases with increasing grade (highly statistically significant; Pearson's correlation applied). [ABSTRACT FROM AUTHOR]

Purpose of Study: Aim of the study was to evaluate the role of 68Gallium-DOTANOC positron emission tomography/computed tomography (68Ga-DOTANOC PET/CT), a pan somatostatin receptor (SSTR) analog in the clinical management of patients with neuroendocrine tumors (NETs) and its correlation with conventional imaging. Materials and Methods: We retrospectively evaluated 69 patients of known/suspected NETs who underwent 68Ga-DOTANOC PET/CT scan for tumor localization (n = 15), stage modification (primary staging, n = 26 and restaging, n = 25) and therapy monitoring (n = 3). We also compared PET scan with conventional imaging as reference standard and evaluated the impact of PET/CT in the clinical management of patients. Results: The concordant findings on 68Ga-DOTANOC PET/CT and conventional imaging seen in 33 and discordant in 36 patients. Among discordant group, disease was upstaged in 32 patients; down staged in 3 patients; no stage change in one patient. PET/CT localized primary tumor in 4 patients. Among patients with raised tumor markers (39/69), PET was positive in 29 and negative in 10 patients. Patients were followed for mean duration of 27 months to assess management. We found strong agreement between positive PET and raised tumor markers (Kappa value = 0.8). Sensitivity and specificity of PET/CT for primary tumor localization, stage modification, and therapy monitoring was >90% (P < 0.05). Conclusions: Study shows that DOTANOC, a broad spectrum SSTRs binding peptide labeled with Ga-68 in PET/CT scan is an excellent modality in the management of NETs patients. [ABSTRACT FROM AUTHOR]

Introduction: The incidence of suspicious ovarian masses in pregnancy is on the rise due to the increased use of ultrasonography in recent times. However little is known about their management during pregnancy due to the lack of large randomised trials. Aim: To evaluate the incidence, nature and management of suspicious adnexal masses diagnosed during pregnancy at our institution. Materials and Methods: This was a retrospective study of 33 pregnant women who presented with suspicious ovarian masses at the Department of Gynaec Oncology at the Institute of Obstetrics and Gynaecology, Madras Medical College, Chennai, Tamil Nadu, India, from August 2018 to September 2020. Patients were evaluated with imaging studies as per the International Ovarian Tumour Analysis (IOTA) ultrasound rules along with Magnetic Resonance Imaging (MRI) and tumour markers and surgical intervention were performed for cases with definite indications. The Statistical Package for Social Science (SPSS) version 28.0 was used for statistical analysis. Results: Mean age of the patients was 26.1±2.1 years (20-33 years). Most common gestational age of presentation was the 2nd trimester of pregnancy (mean-18.9 weeks). Out of 33 patients, 27 were benign (81.82%) and 6 (18.18%) malignant. Surgical intervention was done for 18 cases (54.55%) and 15 (45.45%) patients were kept under observation. Five were primary ovarian and one was metastatic from carcinoma stomach. Conclusion: Thorough clinical evaluation with personalised imaging and appropriate timely intervention aid in the diagnosis and management of suspicious adnexal masses in pregnancy. [ABSTRACT FROM AUTHOR]

Introduction: Prostate-specific antigen (PSA) >20 ng/mL in isolation is a criterion for classification as "high-risk" prostate cancer (PCa). However, among Indian men, PSA elevation is often seen even in the absence of PCa and patients with PSA as the sole criterion for the high-risk disease may have different outcomes from those categorized as high risk due to adverse pathological features. We compared the operative, oncological, and functional outcomes after robot-assisted radical prostatectomy (RARP) in men with high-risk PCa categorized using PSA alone versus clinical and histopathological findings. Materials and Methods: In an Institute Review Board-approved study, men undergoing RARP with high-risk PCa with at least 2-year follow-up were categorized into those with PSA >20 ng/ml being the sole criteria for being high risk (Group A) versus those with Gleason score ≥8 or ≥T2c disease but any PSA level (Group B). The two groups were compared for perioperative, oncological, and functional outcomes. Results: Fifty-three patients with high-risk disease were included. Twenty-six patients (48.9%) were classified into Group A while 27 patients (50.9%) were classified into Group B. The median PSA was significantly higher in Group A (31 [26--35] ng/ml in Group A vs. 21 [12--34] ng/ml in Group B, P = 0.006) and on histopathology of radical prostatectomy specimen, 24 (92.3%) patients had GG ≤3 disease in Group A versus 10 (37%) patients in Group B ( P < 0.001). Patients in both the groups had similar perioperative and continence outcomes. However, Group A had significantly lower biochemical recurrence rate (3/26 [11.5%]) as compared to Group B (11/27 [40.7%]) ( P = 0.012). Conclusions: PSA >20 ng/ml is the single most common criterion for stratification as high-risk PCa. However, men with PSA >20 ng/ml in isolation, without another adverse criterion, have better outcomes than men with adverse clinical or pathological criteria for high-risk disease. [ABSTRACT FROM AUTHOR]

Background: Tumour induced lymphangiogenesis plays a crucial role in metastasis and tumour progression. The intratumoural and peritumoral lymphatics are supposed to have different biological effects. The aim of present study was to investigate the correlation of intratumoral lymphatic vessel density (I LVD), peritumoral lymphatic vessel density (P LVD), intratumoral mast cell density (I MCD) and peritumoral mast cell density (P MCD) with prognostic parameters in primary breast carcinoma. Methods: Lymphangiogenesis was detected using D2-40 monoclonal antibody and mast cell by using toludine blue stain in 50 cases of primary breast carcinoma. Positively stained lymphatic vessels were counted at 40 x in dense lymphatic vascular foci (hot-spot) within the tumour. Chi square, ANOVA test and Pearson’s correlation was applied to determine the relationship amongst various variables, with statistical significance set at p <0.05. Results: Mean P LVD was significantly higher than I LVD (6.25±21 vs 2.75±2.27, p <0.005). Significant correlation was noted between I LVD and P LVD and age, tumour laterality, tumour size and overall staging. However, there was no correlation between I LVD and P LVD with other important clinicopathologic prognostic markers like grade, lymph node status and lymphovascular invasion. MCD was higher in both intratumoral and peritumoral location as compared to normal tissue. There was an association noted between P MCD with pathological staging and perineural invasion. However, there was no significant association of I MCD and P MCD with other prognostic markers like grade and lymphnode status. No significant correlation was noted between I LVD, P LVD, I MCD and P MCD. Conclusion: The evidence from our study supports the utility of D2-40 stain in determining the lymphatic density in IBC. The study findings also establish the existence of lymphangiogenesis in both intratumoral and peritumoral location. For now, the data presented herein do not permit us to promote the utility of LVD and MCD as predictors of prognosis in invasive breast carcinoma. [ABSTRACT FROM AUTHOR]

Objective: To assess the prevalence of early T precursor‐acute lymphoblastic leukaemia (ETP‐ALL), study its clinicopathological features and devise a 'flow score' based on immunophenotypic profiles. Material Methods: This was a retrospective study where clinical and laboratory data of all consecutive T‐ALL cases were analysed to identify features differentiating ETP from non‐ETP‐ALL. The utility of a flow score based on the five commonly used markers in leukaemia panels for T‐ALL (CD34, CD8, CD5, CD13 and CD33) was evaluated to differentiate ETP from non‐ETP‐ALL. Results: Early T precursor‐acute lymphoblastic leukaemia constituted 24.2% (n = 29) of all T‐ALL cases. It was significantly more common in adults (30.2%) as compared to paediatric (17.5%) patients (P =.046). The median age of presentation was significantly higher than the non‐ETP group. (24 vs 19 years; P =.01). Patients with ETP‐ALL usually presented with organomegaly, lymphadenopathy, lower levels of haemoglobin, total leucocyte count, peripheral blood blast proportion and LDH levels as compared to non‐ETP‐ALL. The majority of ETP‐ALL cases had L2 morphology with a moderate amount of cytoplasm showing frequent blebbing. A flow score cut‐off value of ≥3 on ROC curve analysis had a sensitivity and specificity of 100% and 94.6% respectively. Conclusion: Early T precursor‐acute lymphoblastic leukaemia had unique clinical and laboratory features. The prevalence of this entity is more common in the adult population. A flow score based on a minimum of five widely used markers can confidently identify ETP‐ALL and should be included in the primary panel of markers used for flow cytometric analysis. [ABSTRACT FROM AUTHOR]

According to global cancer statistics 2018 (GLOBOCAN 2018), cancer is the second leading cause of death globally. Estimated 18.1 million new cancer cases and 9.6 million cancer deaths. It is most common in India, accounting for 120000 with 90% of oral squamous cell carcinoma (OSCC). The incidence and mortality rate of cancer has shown a sharp increase over the last two decades. Most oral cancers are not diagnosed at an early stage even though they are easily accessible under direct visual examination. Mortality rates remain unchanged despite vast advances in the field of oncology. Therefore, more intense efforts are required to fight against life-threatening diseases and to reduce morbidity and mortality rates. Biomarkers are powerful diagnostic tools that can be measured in bodily fluids such as blood, serum, plasma, and body secretions such as saliva. They release certain biochemical substances that are expressed in large quantities at the cell surface by malignant cells. The anatomical proximity of salivary biomarkers to oral cancer makes it the most accurate and specific diagnostic tool and it is a non-invasive alternative to serum testing. More than 100 salivary biomarkers have already been identified, including cytokines (IL-8, IL-1β, and TNF-a), P53, transferrin, DUSP, MMP, and LDH. In recent years due to the revolution in molecular biology, the development of valid biomarkers has been a breakthrough in the field of cancer research and care. Substantial progress has been made in the development and clinical application of biomarkers and matched targeted therapies. The recent emergence of highly selective technologies has provided global information to observe genetic and proteomic alterations and to facilitate the discovery of new biomarkers with improved sensitivity and specificity. The use of biomarker-based diagnostics for cancer includes non-invasive screening for early-stage disease, detection and localization, risk assessment, disease stratification and prognosis, response to therapy and, for those in remission, screening for disease recurrence. The current chapter aims to elaborate on the importance of biomarkers as an early diagnostic tool in detecting oral squamous cell carcinoma. [ABSTRACT FROM AUTHOR]

Background: Oral squamous cell carcinoma (OSCC) remains as one of the leading causes of death in many of the developing countries including India. Early detection helps in improving the prognosis and survival rates. Over the years, tumor markers continue to play an important role in diagnosing and monitoring cancer progression. The ectopic production human chorionic gonadotropin-β (hCG-β) is one such marker that is seen in various nontrophoblastic cancers and serves as a marker for tumor prognosis. Few immunohistochemical studies have shown the presence of hCG-β in oral cancers too. The present study investigated the immunohistochemical expression, levels of hCG-β in saliva and urine of various grades of OSCC patients and correlated it with their histopathological grading. Materials and Methods: Tissue sections of 50 histologically confirmed OSCC were subjected to immunohistochemical staining by using hCG-β antibody (well differentiated – 21, moderately differentiated – 21 and poorly differentiated – 8). The levels of hCG-β in saliva and urine were estimated in these individuals, by using Beckman Coulter Access 2 automated immunoassay system and comparisons drawn. Results: hCG-β immunopositivity was seen in 8 (38%) of 21 well-differentiated, 11 (52%) of 21 moderately differentiated and 6 (75%) of 8 poorly differentiated OSCC specimens. The levels of hCG-β in both saliva and urine were increased in poorly differentiated (0.40 and 1.19 mIU/ml) than moderately (0.3 and 0.76 mIU/ml) and well-differentiated (0.36 and 0.48 mIU/ml) OSCC patients. Conclusion: Immunohistochemical expression, salivary and urine levels of hCG-β could serve as an independent prognostic indicator in OSCC patients. [ABSTRACT FROM AUTHOR]

Objective: This research compared the effectiveness of Papanicolaou (Pap) smears with biopsies for diagnosing atypical squamous cells of undetermined significance (ASCUS) accurately in postmenopausal women. Another goal was to determine the diagnostic value of Kiel(Ki)–67 expression to exclude negatives in atypical Pap smears of postmenopausal women. Materials and Methods: A prospective study was conducted in the departments of gynecology and pathology of the Indira Gandhi Medical College and Research Institute, in Puducherry, India. Eighty postmenopausal women were examined with liquid-based cytology (LBC), and this was compared with conventional cytology for detection of histologically confirmed cases. Ki-67 immunocytochemistry (ICC) was performed on atypical smears of postmenopausal women to determine its diagnostic value for detecting abnormal smears. Results: There was a reduction in the frequency of ASCUS in LBC, compared to conventional Pap smears in postmenopausal women. The specificity of LBC (82.7%) was higher than conventional Pap smears (51.7%) for diagnosing ASCUS accurately. Ki-67 ICC staining in atypical smears showed 100% sensitivity and specificity as diagnostic biopsy shows. Conclusions: In comparison to a conventional Pap smear, a liquid-based Pap smear has high specificity, and Ki-67 expression with LBC can exclude false positivity, which can substantially reduce diagnostic biopsies and subsequent Pap smears in postmenopausal women with atypical Pap smears. [ABSTRACT FROM AUTHOR]

Metaplastic Breast Carcinoma (MBC) is a rare heterogeneous group of tumors, the incidence of which is less than 1% of breast tumors. These are a unique set of tumors with varying subtypes, poor prognosis, and an increased chance of distant metastasis. We aimed to study the clinical, histomorphological, and immunohistochemical (IHC) features of Metaplastic Breast Carcinoma (MBC). This was a descriptive study of cases diagnosed as MBC at a tertiary care center in Southern India from January 2015 to December 2019. A total of 20 cases were diagnosed whose clinical, histomorphological, and IHC features were studied. PD‐L1and CD8 IHC were performed and analyzed in 12 cases. The median age of presentation was 50 years. Seventy percent (14/20) patients were postmenopausal women. On excision, 75% (15/20) showed mixed typed MBC, the remainder showing epithelial type MBC. Metastasis to axillary lymph node was seen only in 20% (4/20) of the cases. Thirty percent (6/20) of the cases belonged to stage 3 disease and 5% (1/20) of the cases belonged to stage 4 disease with liver metastasis. Estrogen receptor (ER), Progesterone receptor (PR) were negative in all the cases, Her2neu was positive in three cases. Ki67 labeling index was greater than 14% in all the cases. PD‐L1was positive in 41.5% of the cases and intratumoral CD8 positive lymphocytes were increased in 83.3% of the cases. MBCs are tumors occurring in elderly postmenopausal women, presenting with large tumor size, have lesser chances of lymph node metastasis, and a higher chance of recurrence and hematogenous spread. They are negative for ER, PR, Her‐2 neu, with a high Ki67 index and a strong PDL‐1 expression. [ABSTRACT FROM AUTHOR]

The term mucosubstances is used to denote all tissue components other than glycogen, rich in carbohydrates, which are present in connective tissue or as secretion of certain epithelial structures. Connective tissue mucosubstances are called "mucopolysaccharides", while those secreted by epithelia are referred as "mucins". Objectives: To show the usefulness of PAS staining in identification of carbohydrates in normal and malignant lesions of mammary gland and endocervical gland . Methodology: This is a retrospective, observational, analytical, case control study aimed to evaluate mucin histochemical pattern in normaland diseased lesions of mammary and endocervical glands. Twenty five histologically proven blocks of normal and Intraductal carcinoma of mammary gland, normal and adenocarcinoma of endocervical glands were taken. Tissue sections were stained by PAS technique. Results: Results were tabulated according to colour intensity into different grades ranging from + to ++++. PAS staining of normal endocervical glands showed presence of PAS +ve substances like carbohydrate & mucins. PAS stain for adenocarcinoma cervix gave mild reaction with focal magenta shade, suggestive of presence of few neutral mucosubstances. PAS staining of normal mammary gland and of Intraductal carcinoma showed similar results. Ducts and lobules stained with magenta showed the presence of PAS positive substances like carbohydrate and neutral mucins. Conclusion: Mucin histochemical patterns serve as valuable, cost-effective tool for diagnosis in histopathology and for the researchers in histology, where a slight change in the mucin pattern may help in the early diagnosis of disease process. PAS technique is perhaps the most versatile and widely used of techniques for the demonstration of glycoproteins, carbohydrates and mucins. [ABSTRACT FROM AUTHOR]

Context: Medullary thyroid carcinoma (MTC), being an aggressive disease, requires meticulous follow-up and multidisciplinary management. The clinical presentation, management, outcome of MTC varies among different populations. Aims: An audit was conducted to evaluate the demography, clinical presentation, management, and outcome of MTC in a tertiary care center in South India. Settings and Design: A retrospective analysis was conducted of data from hospital records of patients with MTC treated at our center from 2004 to 2019. Statistical Analysis: All analyses were performed with SPSS software (version 16). Results: Among the 82 patients (M 42, F 40), mean age was 42.07 years (SD 14.5), 46 were operated at our center and 36, outside. Follow-up data were not available for all patients. Median duration of the disease was 36 months and median follow-up was 28 months. Lymphnode dissection was more common (37/46) in patients operated at our center than outside operated patients (17/36) (P < 0.01). At presentation, more than half of the patients had stage IV disease and 8 had distant metastases. Bone, lung, and liver were the common sites of metastases. Persistent hypercalcitoninemia >50 pg/mL was seen in 49.9%. Salvage surgeries of the neck were necessary in 29 patients (38.2%). Mean survival was 66 months and 10-year survival was 35%. Male gender (P = 0.008) and Stage IV disease at presentation (P = 0.038) were associated with poorer survival. Conclusion: MTC, in our population, presented at an advanced stage. Male gender and stage IV at presentation had poor survival. Early diagnosis, aggressive initial neck clearance, close follow-up with tumor markers, appropriate imaging, along with prompt surgical intervention will help to improve outcome. [ABSTRACT FROM AUTHOR]

Introduction: Adnexal masses have a wide spectrum with respect to the age of presentation, signs and symptoms, imaging findings, and histopathology report. Materials and Methods: This is a cross-sectional diagnostic study, conducted at All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India. The data were collected from department of gynecology over a period of 1½ years from June 2017 to December 2018. All women who were diagnosed to have an adnexal mass irrespective to age, parity, and menopausal status were included in the study. Ultrasonography of the abdomen with the pelvis was ordered in all patients followed by contrast-enhanced computed tomography or magnetic resonance imaging in selective patients. Tumor markers such as Ca-125 was measured, and risk of malignancy index (RMI) was calculated for each tumor. The clinical and imaging findings were correlated with intra-operative findings and finally with the histopathology examination report. Results: A total of 171 women were included in the study who were diagnosed to have adnexal mass. A total of 137 women (80.1%) had benign tumor (Group B), whereas 34 women (19.9%) were found to have malignant tumor (Group M). Mean age in Group B was 35.85 ± 12.46 and in Group M was 46.12 ± 13.46 (P = 0.001). Ca-125 was significantly higher in Group M (1350 U/ml) than Group B (175 U/ml) (P = 0.008). The RMI score was also found to significantly increased in Group M than Group B (P = 0.007). Conclusion: With respect to adnexal masses, both Ca-125, as well as RMI scoring, are important diagnostic tools. RMI scoring has a better overall diagnostic performance than Ca-125 in predicting malignancy. [ABSTRACT FROM AUTHOR]

Background: Malignant mixed germ cell tumors of ovary are rare aggressive cancers affecting young adolescent girls. The commonest combination reported in literature is dysgerminoma and endodermal sinus tumors but in our study the most common combination was immature teratoma and endodermal sinus tumor which is exteremely rare. Preservation of future fertility is a concern. Fertility sparing surgery followed by combination chemotherapy is the current treatment of choice but treatment must be individualized depending upon the nature of the tumor. Methods: A retrospective study on five patients with these tumors was conducted on patients at Guru Gobind Singh Medical College and Hospital (Punjab, India) between September 2009 to January 2018. Results: Median age of patients was 15.6 years. Histopathological combination was immature teratoma and endodermal sinus tumor (n=3), endodermal sinus tumor and embryonal carcinoma (n=1), and mature and immature teratoma (n=1). Tumor markers AFP, beta HCG and LDH were raised in all except the patient with mature and immature teratoma. All patients underwent surgery followed by combination chemotherapy. Three patients developed metastasis within six months of treatment and died. In the remaining two, no reccurrence was reported till date. Conclusion: Malignant mixed germ cell tumors of ovary are extremely rare tumors and have poor prognosis. Fertility preservation is a concern as these patients are usually young adolescent girls but fertility sparing treatment must be individualized on the basis of tumor type, surgical staging, and availability of combination chemotherapy. Considering high recurrence rate and mortality, total hysterectomy with bilateral salpingo-oophorectomy with complete surgical staging followed by combination chemotherapy should be perfomed at advanced stage and aggressive tumor biology. Preservation of fertility must be held secondary. [ABSTRACT FROM AUTHOR]

The management and prognosis of oral squamous cell carcinoma (OSCC) depend on tumor stage and lymph node (LN) metastasis status. Early-stage (T1/T2 N0M0) OSCC comprises a heterogeneous group. We evaluated the role of histological parameters including worst pattern of invasion (WPOI) and tumor budding to determine the risk of LN metastasis in cases of OSCC and to determine the risk of recurrence and death in early-stage OSCC in north Indian patients. All cases of buccal mucosa and tongue SCC which underwent excision over 4 and half years were reviewed for histological parameters including histologic grade, WPOI, tumor budding, lymphovascular emboli (LVE), perineural invasion (PNI), depth of invasion (DOI), host lymphocyte response, and stromal response and compared to LN metastasis. Clinical follow-up of early-stage tumor was obtained and compared. A total of 126 cases of OSCC were included, of which 48 showed LN metastasis. Histological grade, WPOI, tumor budding (≥3/×40 field), LVE, and PNI were significantly associated with risk of LN metastasis. On multivariate analysis, WPOI and tumor budding were 2 most significant factors. Among the early-stage tumors with available follow up (n = 48), DOI, WPOI, tumor budding, and LVE were associated with a shorter overall survival, although it was not statistically significant. To conclude, WPOI and tumor budding are important risk factors for predicting LN metastasis in all stages of OSCC and associated with a poorer outcome in early-stage tumors. These are easy and reliable prognostic factors and should be included in the histopathological reporting guidelines. [ABSTRACT FROM AUTHOR]

About 12% of the Indian population present with a thyroid nodule to the surgeon, who is then faced with a clinical dilemma if the fine needle aspiration cytology (FNAC) is inconclusive or indeterminate, and the ultrasonogram of the neck is also not contributory. The extent of surgery and the need for a second surgery always weighs on the mind of the surgeon and the patient. We attempt, in our study, to identify a few pathological features in a hemithyroidectomy specimen which would predict the occurrence of malignancy in the opposite lobe. To determine the pathologic predictors of malignancy in the contralateral thyroid lobe, in patients of differentiated thyroid cancer (DTC) who underwent hemithyroidectomy. A retrospective review of the case records of all patients who underwent thyroid surgery in our Institute between January 2010 and December 2014 was undertaken. Various pathologic parameters were analyzed with respect to their predictive power regarding the occurrence of malignancy in the opposite lobe. Three hundred eighty-nine patients underwent thyroid surgery during the above period, of which 91 patients underwent completion thyroidectomy, as they were found to have malignancy in the hemithyroidectomy specimen. The effect of age, gender, and tumor size on bilaterality could not be established statistically. Other variables such as perithyroidal spread and perineural invasion also did not demonstrate statistical significance. Multifocality of the tumor in the hemithyroidectomy specimen, lymphovascular invasion, and capsular invasion were the pathologically significant factors determining the presence of malignancy in the contralateral lobe. Multifocality, lymphovascular invasion, and capsular invasion can be used as additional markers to decide on performing a completion thyroidectomy in a patient of differentiated thyroid cancer. [ABSTRACT FROM AUTHOR]

BACKGROUND: Ovarian tumors are one of the leading cancers in females with variable pathological types. This study describes the distribution, clinical and pathological details of various histopathological types of ovarian tumors in a tertiary care hospital in North India. MATERIALS AND METHODS: A retrospective data of 3 years were collected for ovarian tumors submitted to the pathology department of a tertiary care hospital. Data were classified according to the latest World Health Organization (WHO) Classification into epithelial tumors, germ cell tumors, sex cord-stromal tumors, and others. RESULTS: A total of 212 cases of ovarian tumors were studied, 186 were unilateral and 26 were bilateral. Resection specimen, part of specimen, and block review formed 80.2%, 15.1%, 4.7%, respectively. Epithelial tumors formed the majority in 71.7% of cases followed by germ cell tumors (22.2%), sex cord-stromal tumors (3.8%) and others (2.3%). Maximum number of cases in the respective groups occurred in the age groups 31-40, 21-30, 51-60, and 41-50 years, respectively. Overall, benign tumors were 63.7%, malignant tumors were 31.1%, and borderline were 5.2%. The most common histopathological type of benign and malignant tumor was benign serous cystadenoma (18.8%) and serous carcinoma (9.9%), respectively. CONCLUSION: In the present study, ovarian tumors were classified according to the WHO classification, epithelial and germ cell tumors were the major types of ovarian tumors. Benign epithelial tumor formed the majority with 46.2% cases. Serous cystadenoma and mature cystic teratoma were the predominant type of epithelial and germ cell tumors, respectively. [ABSTRACT FROM AUTHOR]

Background: The spectrum of BRCA mutations that predispose to development of breast/ovarian cancer in Indian population remains unexplored. We report incidence and various types of pathogenic, likely pathogenic and variants of unknown significance (VUS) mutations in BRCA1 and BRCA2 genes observed at a tertiary cancer center in North India. Materials and methods: A total of 206 unrelated breast and/or ovarian cancer patients, who met the National Comprehensive Cancer Network (NCCN) guidelines for genetic testing, were screened for germline BRCA1/BRCA 2 mutations on high-throughput sequencing platform; large genomic rearrangements were assessed by multiple ligation probe assay. Mutations were mined in mutational databases, PubMed, and discerned into classes. Furthermore, the clinicopathological correlation of BRCA mutation status with prognostic markers in breast cancer and tumor histology in ovarian cancer was performed. Results: In total, 45/206 and 17/206 cases showed positivity for BRCA1 and BRCA2 mutations, respectively, whereas 1/206 was positive for a mutation in both the genes. Altogether, 33 distinct BRCA1 mutations were observed, among which 27 were deleterious (12 frameshifts, 8 nonsense, 1 missense, 3 splice-site variants, 2 big deletions and 1 large duplication) and 6 were VUS. Five novel BRCA1 mutations (c.541G>T, c.1681delT, c.2295delG, c.4915C>T and exon 23 deletion) were identified. Seven mutations (c.2214_2215insT, c.2295delG, c.3607C>T, c.4158_4162delCTCTC, c.4571C>A, splicesite_3 (C>T) and exon 21–23 duplication) occurred more than once, whereas 16 distinct BRCA2 mutations were noted – 9 were lethal (6 frameshifts, 2 nonsense and 1 big deletion) and 7 VUS. One unique pathogenic BRCA2 mutation (c.932_933insT) was recognized. Two mutations (c.9976A>T and c.10089A>G) recurred twice. No significant difference in hormone receptor status was observed among BRCA1 carriers, BRCA2 carriers and noncarriers. Conclusion: We have documented various pathogenic and VUS mutations in BRCA1 and BRCA2 genes observed in the cohort. Six novel mutations were identified. The knowledge shared would assist genetic testing in enabling more focused site-specific screening for mutations in biological relatives. [ABSTRACT FROM AUTHOR]

Context: Efficacy of immunocytochemistry (ICC) in determining molecular biomarkers like estrogen receptor (ER), progesterone receptors (PRs), and human epidermal growth factor receptor-2 (HER2). Aims: To evaluate biomarkers using ICC in breast cancer as per American Society of Clinical Oncology/College of American Pathology (ASCO/CAP) guidelines. Settings and Design: The study was conducted over a period of 2 years from September 2012 to August 2014 and is the first such study in eastern India. Materials and Methods: Fine needle aspiration cytology (FNAC) was done for suspected cases of breast cancers and slides were prepared using ThinPrep (TP) technology of liquid-based cytology (LBC) for ICC and corresponding biopsy specimens were processed as formalin fixed paraffin embedded (FFPE) sections for comparison. Both the LBC slides and tissue sections were subjected to immunostaining for ER, PR, and HER2. ICC was evaluated by Allred Scoring and IHC by Quick Scoring. Statistical Analysis Used: Statistical analysis done by Wilconxon Signed rank test on the SPSS program, Chicago, Illinois, USA. The results of ICC and IHC were compared by evaluation of sensitivity, specificity, kappa-value (k-value), positive predictive value (PPV), and negative predictive value (NPV). Results: The comparison of ICC with immunohistochemistry (IHC), ER, and PR showed very good correspondence rate, sensitivity, specificity, NPV, PPV, and agreement with k-value; whereas for HER2 the results were only good. Conclusion: ICC using LBC can be a useful tool in assessing biomarkers in advanced cases of breast cancer where surgery is not possible or cases where ASCO/CAP guidelines for management are not followed. [ABSTRACT FROM AUTHOR]

Purpose: Cyclophosphamide and doxorubicin (adjuvant chemotherapy) are commonly used to treat breast cancer patients. Variation in the genes involved in pharmacodynamics and pharmacokinetics of these drugs plays an important role in prediction of drug response and survival. The present study was carried out with an aim to evaluate the variation in all the genes involved in pharmacokinetic and pharmacodynamics pathways of cyclophosphamide and doxorubicin, and correlate specific variants with disease outcome in breast cancer patients from the Malwa region of Punjab.Methods: A total of 250 confirmed breast cancer patients were involved in the study. Genotyping was performed on an Illumina Infinium HD assay platform using a Global Screening Array (GSA) microchip. GenomeStudio (Illumina, Inc.) was used for data preprocessing and a p value less than or equal to 5 × 10-8 was considered statistically significant. To rule out the influence of confounding risk factors, a step-wise multivariate regression analysis was carried out to evaluate the association of genotype with overall clinical outcome.Results: Two gene variants, CYP2C19 (G681A) and ALDH1A1*2 (17 bp deletion), were found to be significantly associated with the disease outcome, including overall survival, recurrence and metastasis, in breast cancer patients on adjuvant therapy. Both these genes are involved in the pharmacokinetics of cyclophosphamide. However, none of the variants in the genes involved in pharmacokinetics and pharmacodynamics of doxorubicin were found to have any significant impact on disease outcome in the studied group.Conclusion: CYP2C19 (G681A) variant and ALDH1A1*2 emerged as two important biomarkers associated with bad outcome in breast cancer patients on adjuvant therapy. [ABSTRACT FROM AUTHOR]

Aim: Routine assessment of cell proliferation is recommended in the pathologic evaluation for all breast cancers. Considering the poor reproducibility and interobserver variability in mitotic counts, Ki-67 is an easily available and reliable substitute for mitotic counts and has been shown to have a significant relationship with the histologic grade of malignancy and the mitotic activity of tumors. Our study aimed at exploring Ki-67 expression and studying its correlation with other established prognostic parameters.Materials and Methods: Seventy-five cases of primary breast cancer undergoing radical or modified radical mastectomy constituted the study group. Estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2)/neu, and Ki-67 was assessed in each case. Ki-67 labeling index (Ki-67-LI) was estimated as the number of positive nuclei divided by total number of nuclei scanned counting a minimum of 1000 cells in 10 selected high power fields that displayed the highest immunoreactivity and was expressed as percentage. Ki-67 expression was correlated with various clinicopathologic prognostic parameters including age, tumor size, tumor type, axillary lymph node status, and histologic tumor grade.Results: A statistically significant direct association was observed between Ki-67-LI and tumor size, histologic grade and Nottingham prognostic index. A statistically significant inverse association was observed between Ki-67-LI and ER and PR expression. However, no association was observed between Ki-67-LI and menopausal status, lymph node involvement and HER2/neu expression.Conclusion: Based on our results, we concluded that modified Bloom-Richardson (MBR) grading has been recognized as a treatment related indicator. The accuracy and reliability in grading have always been a matter of concern, hence, the reproducibility of grading should be enhanced. Ki-67-a proliferation marker is easily identified and provides comparable accurate information. In contrast to poor reproducibility of mitotic counts, Ki-67 can achieve high agreement between pathologists; is more reproducible; adds complementary value to the MBR grading system and correlates well with other clinicopathologic parameters. It may act as a significant prognostic indicator for routine clinical use and be helpful for selection of adjuvant treatment. It can also add value in categorizing Grade II tumors into two prognostic subgroups with prognosis equivalent to Grades I and III, respectively. [ABSTRACT FROM AUTHOR]

There are more than 10 million persons with epilepsy (PWE) in India. Despite availability of antiepileptic drugs (AEDs), there is a large treatment gap varying from 50 to 70% among PWE. For treatable epilepsy, this gap can be attributed to poor education, poverty, cultural beliefs, stigma, and poor healthcare infrastructure; whereas for chronic epilepsy, this gap can be attributed to lack of proper diagnosis and treatment. To prevent, treat, and cure epilepsy, researchers worldwide have made exciting advances across all areas of epilepsy research. Studies carried out in India have also shown substantial progress; however, most of them are focused on the epidemiological aspects of epilepsy, genetic associations, identification, and validation of new AEDs in animal models of epilepsy.Very few studies are reported on understanding the process of epileptogenesis, a dynamic process by which neurons begin to display abnormal firing patterns that cause epileptic seizures. Animal epilepsy models can be used for in depth studies; however, studies conducted on resected brain tissues from epilepsy patients are clinically relevant. Finally, more funding support from government and collaborations among basic research institutes, medical institutes, as well as industries is required to raise the standards of epilepsy research in India.This review focuses on the evaluation of the current status of epilepsy research in India and the need to identify potential anti-epileptogenic interventions. [ABSTRACT FROM AUTHOR]

Background: In India, carcinoma breast is the most common cancer among urban women population and second most common cancer after carcinoma cervix in rural areas. One in 22 women in India develops carcinoma of the breast in their lifetime. Fluorine-18-fluoro-2-deoxy-D-glucose (18F-FDG) uptake in breast cancer usually indicates the degree of tumor metabolism and hence can predict its behavior and prognosis. On the other hand, the estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor-2 (HER-2) or neu state of breast cancer is a biomarker that provides important prognostic information in addition to predicting response to therapy.Aims: The main objective of this study is to assess whether a correlation exists between 18F-FDG uptake in untreated cases of breast cancer, their receptor status (ER, PR, and HER-2 or neu), tumor histology, and tumor size.Subjects and Methods: Sixty consecutive female patients, with biopsy-proven primary breast cancer, were enrolled in this prospective study for whom 18F-FDG positron emission tomography-computed tomography scan was done in the Department of Nuclear Medicine. Results obtained were analyzed using appropriate statistical tests (t-test and Pearson Chi-square tests), and interpretation was made with 95% confidence level.Results: In our series, a positive correlation between tumor size, high tumor grade, and standardized uptake value (SUV) was found. Tumors with positive receptor status for estrogen, progesterone, and HER-2/neu receptors had statistically insignificant lower maximum SUV (SUVmax) values than their negative counterparts. Triple-negative breast tumors (ER-, PR-, and no overexpression of HER-2/neu) are currently a subject of major interest because of their aggressiveness, poor prognosis, and lack of targeted therapy. Based on receptor status when the SUVmaxof the group with triple-negative receptor status (ER-/PR-/HER-2/neu-) was compared to rest of the patient group, it was seen that patients with negative receptor status had significantly higher mean SUVmaxvalues.Conclusions: We have inferred that in patients with breast cancer, various biological parameters such as tumor size, grade, histology, and hormonal receptor status have different impact on tumor metabolic activity. [ABSTRACT FROM AUTHOR]