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Author(s): Carolyne Lallawmzuali [1]; Adil Aziz Khan [1]; Sana Ahuja [1]; Sufian Zaheer (corresponding author) [1] INTRODUCTION Adrenal cortico-medullary mixed tumors (CMMTs) are rare tumors, comprising of adrenal cortical and [...], Synchronous tumors comprising of cortical as well as medullary differentiation are rare in the adrenal gland. Collision tumors comprise of two independent neoplasms arising from the cortex and the medulla without any histological admixture. Adrenal cortico-medullary mixed tumors are rare tumors comprising of adrenal cortical and chromaffin cells intermixed with each other. Ganglioneuroma is a rare benign tumor originating from the paravertebral sympathetic ganglia and is rarely seen in the adrenal medulla. The presence of a synchronous ganglioneuroma with an adrenal cortical adenoma in the ipsilateral adrenal gland is exceedingly rare. We report a collision tumor comprising of an adrenal cortical adenoma and a ganglioneuroma detected as an incidental finding in a pediatric patient who presented with hypertension and palpitations.

Context: The Modified Masood Scoring Index (MMSI) categorizes breast fine needle aspirates into four categories non‐proliferative breast diseases (PBD), PBD without atypia, PBD with atypia and carcinoma in situ/carcinoma. The International Academy of Cytology Yokohama System classifies the aspirates into five categories – inadequate, benign, atypical, suspicious, and malignant. Very few studies have been conducted so far to compare the diagnostic accuracy of this system. Aims: The objectives of the study were to classify breast fine needle aspirates according to the MMSI and IAC Yokohama and assess their risk of malignancy (ROM) and performance parameters. Materials and Methods: All breast FNAs received from June 2020 to May 2023 were classified according to the MMSI and IAC Yokohama. Using histopathological diagnosis as the gold standard, ROM and performance parameters were calculated. Results: Out of the 559 breast fine needle aspirates, the histopathological correlation was available for 337 cases. The ROM for non‐PBD, PBD without atypia, PBD with atypia and carcinoma in situ/carcinoma categories were 0%, 1.2%, 9.1% and 93%, respectively. The ROM for each of the categories of Yokohama system was 16.6%, 1.1%, 4.3%, 86.2% and 97.6%, respectively. The values for the sensitivity, specificity, PPV, NPV and diagnostic accuracy were slightly higher for IAC Yokohama (97.3%, 97.2%, 94.7%, 98.6% and 97.2%, respectively) than the MMSI (96.4%, 96.2%, 93%, 98.1% and 96.3%, respectively). Furthermore, another shortfall of MMSI is the inability to compare the Inadequate category of the Yokohama system. Conclusion: Overall Yokohama system proved to be a better system for categorizing breast lesions on FNAB as the scoring system provides more objective categorization and minimizes false positive and false negative cases. [ABSTRACT FROM AUTHOR]

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HER2 (human epidermal growth factor receptor 2) status in breast cancer spans a spectrum from HER2-positive to ultra-low HER2, each category influencing prognosis and treatment decisions differently. Approximately 20 % of breast cancers overexpress HER2, correlating with aggressive disease and poorer outcomes without targeted therapy. HER2 status is determined through immunohistochemistry (IHC) and fluorescence in situ hybridization (FISH), guiding therapeutic strategies. HER2-positive breast cancer exhibits HER2 protein overexpression or gene amplification, benefiting from HER2-targeted therapies like trastuzumab and pertuzumab. In contrast, HER2-negative breast cancer lacks HER2 overexpression and amplification, treated based on hormone receptor status. HER2-low breast cancer represents a newly recognized category with low HER2 expression, potentially benefiting from evolving therapies. Ultra-low HER2 cancers, characterized by minimal expression without gene amplification, challenge conventional classifications and treatment paradigms. Their distinct molecular profiles and clinical behaviors suggest unique therapeutic approaches. Recent diagnostic guideline updates refine HER2 assessment, enhancing precision in identifying patients for targeted therapies. Challenges remain in accurately classifying HER2-low tumors and optimizing treatment efficacy, necessitating ongoing research and innovative diagnostic methods. Understanding the heterogeneity and evolving landscape of HER2 status in breast cancer is crucial for advancing personalized treatment strategies and improving patient outcomes. [ABSTRACT FROM AUTHOR]

Oral squamous cell carcinoma is one of the most common cancers of the head and neck region. Tumor-infiltrating lymphocytes are naturally occurring mononuclear cells that infiltrate the tumor microenvironment. The aim of the present study is the evaluation of stromal tumor-infiltrating lymphocytes (TILs) in oral squamous cell carcinoma and its association with clinicopathological parameters like age, gender, site, tumor stage, nodal status, grade, lymphovascular and perineural invasion. A total of 51 patients of oral cavity squamous cell carcinomas who underwent resection were included in the study. Assessment of the stromal TILs was done on sections stained with Hematoxylin and eosin using the scoring criteria proposed by the International Immuno-Oncology Biomarker Working Group. TILs were assessed in percentages as continuous scores and subsequently categorized into low TILs (<20%) and high TILs (≥20%). The association between TILs and clinicopathological parameters was evaluated using the Fischer exact/Chi-square test. Among the 51 cases evaluated in the present study, low and high TILs were found in 25.5% and 74.5% of cases respectively. TILs were found to show a significant association with tumor size and lymphovascular invasion. However, no significant association was found with age, gender, nodal status, grade, perineural invasion, and site in the oral cavity. The evaluation of TILs as proposed by the International Immuno-Oncology Biomarker Working Group is a simple, inexpensive test. Morphological evaluation of TIL can provide valuable prognostic information in oral cavity squamous cell carcinoma cases and can be incorporated as a part of routine histopathological reporting. [ABSTRACT FROM AUTHOR]

Background : To study the outcome of endoscopic third ventriculostomy (ETV) Methods: In this observational study an endoscopic third ventriculostomy was applied in patients who suffered from hydrocephaly. The diagnosis of hydrocephalus was determined by physical, neurological and neuro-radiological criteria. Patients with obstructed hydrocephalus whether congenital or acquired, with a dilated 3rd ventricle were included. Linear incision was given 2cm anterior to the coronal suture in mid pupillary line. Right frontal burr hole is made. For ETV, burr hole is placed on a line joining the foramen of monro and inter-peduncular line. Floor of the third ventricle was punctured close to or over the dorsum sellae. Membrane was dilated with balloon. Balloon was inflated and subsequently was taken out from puncture site. It ensured easy visibility of basilar artery and its perforators. Result: Age of patients ranged from 06 months to 24 years, with a mean age of 4 years . Fourteen patients had posterior fossa tumour's with dilated third ventricle, sixty four patients had aqua ductal stenosis, two patients with CSF ascites as complication of ventriculo-peritoneal shunt, eleven patients had blocked lower end of ventriculoperitoneal shunt. Seven patients had CSF leak. Time taken to complete endoscopic third ventriculostomy was from 20 to 40 min as compared to 1 hour to 1.30 hours, taken in a VP shunt. Patients who had ETV performed had a mean hospital stay of 3 days, where as patients in whom a VP shunt was performed stayed in the ward for an average of 5 to 10 days, depending on how eventful the post op period was. The cost incurred to the VP shunt patient who remained admitted for an average of 5 days was between Rupees 16,000 to 25,000, as compared to Rs: 2000 for the patient who underwent endoscopic third ventriculostomy. Conclusion: Patients of ETV, with less per operative time, had decreased length of stay. ETV also was less expensive to the patient and he did not have to buy the shunt apparatus with less rehospitalization rates, compared to patients who had undergone shunt. [ABSTRACT FROM AUTHOR]

Background: To determine the impact of time taken on the surgical outcome of extradural hematoma in patients with road traffic accidents. Methods: Sixty adult patients with history of road traffic accident with extradural hematoma on axial images of CT scan brain were included. All patients were allocated into three groups with 20 patients in each group. Patients in Group I were those in whom time from the occurrence of trauma to the surgical evacuation of hematoma was < 1 hour, 1 to 6 hours in group II and > 6 hours in group III. Results: In group I, majority (90 %) showed favourable outcome. In group II, 70 % showed favourable outcome. In group III, 50 % showed favourable outcome. Significant association was found between outcome and time of surgery (p<0.05). Conclusions: Frequency of favourable outcome after surgical evacuation was significantly higher in patients in whom surgery was performed within one hour after the trauma (P<0.05). [ABSTRACT FROM AUTHOR]

Colorectal carcinoma (CRC) is the second most common cancer and third leading cause of cancer-related deaths worldwide. Although the staging system provides a standardized guidance in treatment regimens, the clinical outcome in patients with colon cancer at the same TNM stage may vary dramatically. Thus, for better predictive accuracy, further prognostic and/or predictive markers are required. Patients who underwent curative surgery for colorectal cancer in past 3 years at a tertiary care hospital were retrospectively included in this cohort study to evaluate the prognostic indicators, tumor-stroma ratio (TSR) and tumor budding (TB) on histopathological sections and correlated them with pTNM staging, histopathological grading, tumor size, and lymphovascular and perineural invasion in patients with colo-rectal cancer. TB was strongly associated with advanced stage of the disease along with lympho-vascular and peri-neural invasion and it can be used as an independent adverse prognostic factor. TSR showed a better sensitivity, specificity, PPV and NPV as compared to TB in patients having poorly differentiated adenocarcinoma than those with moderately or well differentiated. [ABSTRACT FROM AUTHOR]