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Byline: Siddhi. Sinai Khandeparkar, Maithili. Kulkarni, Smita. Solanke, Prajakta. Shinde Dear Editor, A 45-year female presented to the surgery outpatient department with complaints of abdominal mass and fever on and [...]

Byline: Tejal. Khande, Avinash. Joshi, Siddhi. Khandeparkar, Maithili. Kulkarni, Bageshri. Gogate, Aniket. Kakade, Piyush. Sahu, Chaitnya. Khillare Background: Breast cancer (BCA) is the second most common cancer among women in [...]

Introduction: Mediastinum is the central portion of the thoracic cavity, compartmentalization of which into anterior, middle, and posterior compartments is useful in understanding the vast diversity of pathological lesions in this space. Cysts, inflammatory lesions, various primary, and metastatic tumors are found in this region, which tend to have a predilection for specific area of mediastinum depending on histopathological type. Objective: The objective was to study the clinicoradiological features and histopathological findings in patients presenting with mediastinal masses in a tertiary care hospital over a period of 10 years. Materials and Methods: This is a retrospective cross-sectional study of cases presenting as mediastinal lesions. Detailed clinical history and radiological findings were noted wherever available. Histopathology and immunohistochemical slides were reviewed. The data were analyzed using mean and percentage. Results: Twenty-four cases of mediastinal lesions were found in this study. It included 4 nonneoplastic lesions, 12 benign, and 8 malignant neoplastic cases. The age ranged from 3 months to 79 years. About 18 cases (64%) were located in the anterior mediastinum, and thymoma (8/18) was the most common lesion. One case each of pericardial cyst, bronchial cyst, and Hodgkin's lymphoma were seen in the middle mediastinum. Three cases of schwannoma and one case of neuroendocrine carcinoma were seen in the posterior mediastinum. Pan-cytokeratin, lymphoma panel, neuroendocrine markers, and placental alkaline phosphatase were done in neoplastic lesions to confirm the diagnosis. Conclusion: This study reflects the varied mediastinal lesions and importance of triad of clinical, radiological, and meticulous immunohistopathological examination for arriving at an appropriate diagnosis. [ABSTRACT FROM AUTHOR]

It is critical to extensively sample an OAN as one should discriminate a pure oncocytic tumor either from an ordinary adrenocortical tumor with focal oncocytic changes or its conventional counterpart of the compact cell type in order not to incorrectly apply the Weiss system and accordingly inadequately estimate its biological behavior. Also, an oncocytic tumor can only be labeled as pure after quantifying each individual component (oncocytic and clear) since pure and mixed oncocytic tumors do not seem to share similar clinical outcome.[[4]] The tumor was composed of entirely oncocytic cells in the present case. Adrenocortical tumors are usually solitary lesions and their vast majority occur in adults without sex predilection.[[3]] Bisceglia et al. have proposed categories for OAN as pure oncocytic tumor, if a tumor is exclusively or almost entirely composed (greater than 90%) of oncocytic cells, mixed oncocytic tumor, when a clear cell component is also present (ranging from 10 to 50%), and ordinary adrenocortical tumor with focal oncocytic changes, if the oncocytic component is not a predominant one (less than 50% of the tumor mass). [Extracted from the article]

Introduction: The main objective of pulp therapy in pediatric dentistry is to preserve the integrity of the primary dentition until its natural exfoliation. Applying instruments and techniques that support the dense filling of the whole root canal system is necessary for successful obturation. Various obturating materials are available for pulpectomy, of which Metapex is the most commonly used material. Objective: To analyze and standardize (Metapex) material amount in primary teeth obturation. Methodology: Twelve excised primary canines had access cavities made in them. These were sealed with GIC and sliced at the apices to leave 6 mm of working length. Enlarging the channels, irrigation was carried out using 1% sodium hypochlorite and regular saline. Following a cone beam computed tomography scan of the specimens, the preobturation volume (X) of each tooth was assessed. Next, the teeth were split into two groups at random: Group 1 (Metapex group quantity: 2 ml) and Group 2 (Metapex group quantity: 3 ml). After obturation, a second CBCT was taken to measure the postobturation volume (Y). The percentage of obturated volume was calculated by the following formula: (Postobturation volume/preobturation volume) ×100 ([Y/X] ×100). Results: Intergroup comparison of mean canal volume showed a statistically significant difference between both groups. Conclusion: After analyzing and standardizing the material amount in primary teeth, an efficient obturation outcome in the pulpectomy procedure was observed. [ABSTRACT FROM AUTHOR]

Introduction: Breast carcinoma (BCa) is one of the most common cancers among women globally. Increased vimentin expression has been reported in various epithelial cancers. Aim: This study examines the expression of vimentin in BCa and its correlation with various prognostic factors such as tumor size, histological grade, lymph node status, estrogen receptor (ER), progesterone receptor (PR), HER2/neu, and Ki67 status. Materials and Methods: Seventy cases of BCa diagnosed between 2014 and 2015 were included in the study. A technique of manual tissue microarray was employed for the analysis of expression of immunohistochemical (IHC) markers such as vimentin, ER, PR, HER2/neu, and Ki67. Results were subjected to statistical analysis. Results: Vimentin was found positive in 53 (75.7%) cases of BCa, of which 18 cases (25.7%) were triple-negative BCa (TNBC). Positivity for ER, PR, Her2, and Ki67 was 32.8%, 31.4%, 60%, and 99%, respectively. Vimentin expression was significantly associated with ER negativity. All 53 cases expressing vimentin showed positive Ki67 labeling index; however, this was not statistically significant. Maximum vimentin expression was observed in the age group >50 years, postmenopausal women, BCa cases showing lymphovascular invasion (LVI), axillary lymph node metastasis, higher stage and higher grade of tumor, negative PR expression, and positive HER2/neu expression. However, this was not statistically significant. In TNBC, vimentin expression was significantly associated with histological grade and LVI. Conclusion: Vimentin expression was associated with well-established poor prognostic factors of BCa. Vimentin expression if routinely included in histopathology report would aid in better understanding of tumor behavior. [ABSTRACT FROM AUTHOR]

Introduction: Endometrial carcinoma is the second most common gynecologic malignancy in the developing countries. Endometrial Hyperplasia (EH) is a precursor to Endometrioid Adenocarcinoma (EMAC). A 23% of Atypical Hyperplasias (AEH) progress to EMAC. Aim: This study was undertaken to analyse ER, PR, p53 and Ki67 in EH and endometrial carcinomas and attempt correlation with clinical and histopathological findings. Materials and Methods: The present study was conducted over a period of seven years. A manual tissue array technique was employed for cases subjected to IHC. Analysis of the expression of IHC markers (ER, PR, p53, Ki67) in EH and endometrial carcinoma was attempted. Results were subjected to statistical analysis. The results were considered to be significant when the p-value <0.05. Results: An 85 cases of EH and 28 cases of endometrial carcinoma were included in the study. EH (75.22%) was more common than endometrial carcinoma (24.78%). Among 28 cases of endometrial carcinomas, EMAC was most common (78.57%) followed by Clear Cell Carcinoma (CCC) (14.28%), and Uterine Serous Carcinoma (USC) (7.14%). ER and PR expression decreased as lesion progressed from EH to EMAC. ER and PR expression was negative in USC and CCC. The p53 expression and mean Ki67 labelling index increased as the severity of lesion increased from EH to endometrial carcinoma. Conclusion: The ER, PR, p53, Ki67 IHC markers may be included in every case of endometrial carcinoma to understand the tumour biological behavior which in turn could help individual treatment strategies. [ABSTRACT FROM AUTHOR]

Introduction: Breast Cancer (BC) is the second most common cancer among women in India and accounts for 7% of global burden of BC and one-fifth of all Cancers (CA) among women in India. Aim: This study was conducted for studying the expression of MUC1, MUC2 and MUC5AC in breast carcinoma. Materials and Methods: Fifty cases of primary breast carcinoma diagnosed between years 2013 to 2015 were included in the study. Manual tissue array technique was applied for cases subjected to Immunohistochemistry (IHC). An analysis of the expression of IHC markers (MUC1, MUC2, MUC5AC, ER, PR and HER2/neu) was attempted. Results were subjected to statistical analysis. They were considered to be significant when the p-value was less than 0.05. Results: The positivity for MUC1, MUC2 and MUC5AC in BC was 58%, 8% and 6% and for ER, PR and HER2 was 48%, 36% and 64% respectively. There was a significant correlation between MUC1 expression and ER and PR positivity. There was a significant correlation between MUC2 expression and ER positivity. No significant association was observed between MUC2 and PR expression, MUC5AC expression and ER and PR positivity. There was statistically significant correlation between negative MUC2 and MUC5AC expression and histopathological grade. It was noted that MUC2 and MUC5AC negative tumours were associated with higher tumour stage though not statistically significant. It was noted that MUC5AC negative tumours showed higher frequency of lymphovascular invasion though not statistically significant. Conclusion: Our experience with the present study highlights the role of mucins in the development and progression of BC. [ABSTRACT FROM AUTHOR]

Introduction: Solitary Thyroid Nodule (STN) has provoked increased concern owing to higher incidence of malignancy. The inter and intra observer variation in the histomorphological diagnosis of Papillary Thyroid Carcinomas (PTC) may sometimes pose a diagnostic difficulty. Aim: This study was undertaken to analyse immunohistochemical (IHC) markers (CK-19, CD-56, p53, Ki-67) to differentiate between benign and malignant surgically resected STN along with their utility in the identification of PTC. Materials and Methods: The present cross sectional study was conducted over a period of 4 years. A technique of manual tissue array was employed for cases subjected to IHC. The primary antibodies used were CK-19, CD-56, p53 and Ki- 67. Analysis of the expression of IHC markers (p53, Ki-67) to distinguish between benign and malignant STN was done. Evaluation and correlation of expression of IHC markers (CK-19, CD-56) to determine its utility in reaching definitive diagnosis and assessing prognosis of PTC was tried. Results were subjected to statistical analysis. The results were considered to be significant when the p-value <0.05. Results: Out of the 160 cases of surgically resected STN specimens, 68 cases were non-neoplastic, 24 cases were benign and 68 cases were of malignant tumours (7 cases of follicular carcinoma (FCa), 61 cases of PTC). CK-19 was found to be a sensitive (83.61%) and a highly specific positive marker (100%) for the diagnosis of PTC. The difference in CD- 56 expression between PTC and non-PTC group was found to be highly statistically significant. CD-56 was found to be a sensitive (85.86%) and specific (82.25%) negative marker in differentiating PTC from follicular lesions/neoplasms. The difference in p53 expression between the malignant and nonmalignant STN cases was found to be highly statistically significant with a sensitivity and specificity 85.29% and 70.65% respectively. The statistical difference in mean Ki-67 Labeling Index (LI) was found to be significant between PTC versus FA, PTC versus non-neoplastic lesions, FA versus FCa and FVPTC versus FA. Conclusion: The panel of four IHC markers (CK-19, CD-56, p53, Ki-67) may be used for differentiating doubtful benign STN cases from malignant ones and also for definitive diagnosis of PTC along with histopathological examination. [ABSTRACT FROM AUTHOR]

Cancers of the urinary bladder account for about 3.2% of all cancers worldwide. Clear cell adenocarcinomas (CCAs) of urinary bladder are rare. CCA must be differentiated from benign condition such as nephrogenic adenoma (NA) as well as malignant conditions such as urothelial carcinoma with clear cells, metastasis from ovary and kidney, and urinary bladder myomelanocytic tumor. The diagnosis is based on characteristic histopathological and immunohistochemical features. We present a rare case of CCA of urinary bladder with aggressive clinical behavior in a 72-year-old female. [ABSTRACT FROM AUTHOR]

Background: Triple negative breast cancers (TNBC) are defined by absence of estrogen and progesterone receptors (ER and PR) and absence of overexpression of human epidermal growth factor receptor 2 (Her2). They are associated with poor prognosis. The purpose of this study is to study the clinicopathologic parameters of TNBC such as age, tumor size, stage, grade, and lymph node involvement and compare them with nonTNBC tumors. There are many studies which have shown that TNBC are similar to basal-like breast cancers (BBC). We have found the proportion of BBC in the TNBC group using surrogate immunohistochemical (IHC) markers cytokeratin5 (CK5) and epidermal growth factor receptor (EGFR). Materials and Methods: This is a retrospective study of 102 cases of carcinoma breast. Clinical records of the cases were retrieved. Histopathology slides and the IHC slides (ER, PR, Her2) were reviewed. Thus, two groups of patients were made TNBC and nonTNBC. Using the software SPSS version 16 statistical significance of the difference between clinicopathologic variables of the two groups was calculated. TNBC group was later studied for the presence of basal markers CK5 and EGFR using tissue microarray. Results: Statistically significant difference was found between the two groups in the variables such as mean age at diagnosis, mean tumor size, tumor grade, and the presence of lymphovascular invasion. Conclusions: TNBC formed 23.5% of total cases. Overall, TNBC were high grade tumors with larger size at diagnosis, presenting in younger women and showing lymphovascular invasion in a higher number of cases. 87.5% of TNBC were BBC. [ABSTRACT FROM AUTHOR]

Ewing's sarcoma/primitive neuroectodermal tumor (ES/PNET) family of tumors is an uncommon group of malignant neoplasms that may present in both skeletal and extraskeletal sites. PNET outside the central nervous system is called peripheral PNET (pPNET) developing from migrating embryonal cells of the neural crest. Very few cases of pPNET of the maxilla are reported in English literature. These tumors may be difficult to diagnose due to their primitive morphology. These tumors occur predominantly in infancy or early childhood. The occurrence of extraskeletal ES/PNET in the maxillary sinus in an old age is very rare. We report a case of extraskeletal ES/PNET developing in maxillary sinus in a 60-year-old woman. The ES/ PNET should be included in the differential diagnosis of a small round cell tumor and immunohistochemical analysis with a panel of immunomarkers should be done for correct diagnosis and proper treatment. [ABSTRACT FROM AUTHOR]

Cervical cancer is the most frequent type of cancer in women in many developing countries. Squamous cell carcinoma of the cervix spreads principally by lymphatics and less commonly through blood vessels. The most frequent sites for those who develop distant metastasis include lungs (21%), lumbar and thoracic spine (16%), and para-aortic lymph nodes (7%). Metastasis to the kidney is extremely rare with <10 previously reported cases. We report a case of renal metastasis from squamous cell carcinoma of the cervix detected in end-stage kidney due to hydronephrosis. [ABSTRACT FROM AUTHOR]

Primary giant cell tumors of soft tissues (GCT-ST) are extremely rare soft tissue tumors, located in both superficial and deep soft tissues. They resemble osseous giant cell tumors morphologically and immunohistochemically. The tumor exhibits strong positive immunoreactivity for cluster of differentiation 68 (CD68) within multinucleated osteoclast-like giant cells and focal staining of mononuclear cells. Case reports describing the cytohistological features of this entity are very few. We report a case of GCT-ST of low malignant potential diagnosed on fine needle aspiration (FNA) and confirmed on histological and immunohistochemical studies. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Giant Pilomatricoma of the arm: A diagnostic challenge for cytopathologist" by Siddhi Gaurish in the 2015 issue.

Perifolliculitis capitis abscedens et suffodiens is the least common of the three conditions included in the follicular occlusion triad. It is one of the causes of scarring alopecia in adult males. Clinically it has to be differentiated from other causes of folliculitis affecting the scalp. The histopathology is diagnostic. The treatment is prolonged and the clinical course is characterized by remissions and relapses. [ABSTRACT FROM AUTHOR]

Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome is a rare disorder described as aplasia or hypoplasia of uterus and vagina due to an early arrest in development of mullerian ducts. Women with this syndrome are characterized by the presence of 46 XX karyotype, normal female secondary sex characters, normal ovarian functions, and underdeveloped vagina. The presence of leiomyoma in MRKH syndrome is very rare, and only few cases have been reported in the literature. Here, we report a case of MRKH syndrome with multiple leiomyomas originating from the rudimentary horn of uterus in 25 years married, phenotypically female patient. [ABSTRACT FROM AUTHOR]

Fine-needle aspirations (FNA) have played a crucial role in the diagnosis and follow-up of malignancies including sarcomas. However, relatively low specifi city in the classifi cation of sarcoma is the main limitation of FNA. Epithelioid sarcoma is a rare tumor of soft tissues. Very few individual case reports describing cytological features of epithelioid sarcoma have been documented in the literature. Here, we describe cytological features of epithelioid sarcoma with immunocytohistological correlation. [ABSTRACT FROM AUTHOR]