Assessment of Cytokeratin Expression in Carcinoma Breast

Breast cancer is the most common malignancy in females and an important cause of cancer deaths worldwide. With advances in oncopathology, breast cancers are now diagnosed and treated at a molecular level. To distinguish and subdivide the type of cancer with the suitable markers and to foresee its prognosis and therapeutic approach, cytokeratin can be used which is prognostic tumour marker and has a number of different advantages as it is an important IHC marker, cytokeratin (Ck) is epithelial intermediate filament, which is expressed in a tissue specific manner. Expression of the intermediate filaments, predominantly cytokeratins (Ck) reflects the epithelial cell type. In breast, the luminal epithelial cells express CK 8 / 18, CK 7 and CK 19, while basal cell expresses CK 5 / 6, CK 14 and CK 17. Bloom Richardson grading (BR) system has a powerful prognostic value. It is also incorporated in the algorithm for the determination in the use of adjuvant chemotherapy. Moreover, as a tumour marker cytokeratin can accurately predict disease status as it is easy, inexpensive and a reliable tool for efficient management. CK and BR grading can be used as cost effective diagnostic tools in hormone positive breast carcinoma for diagnosis as well as treatment. Very early detection of breast cancer reduces the mortality and morbidity.

p16 promoter methylation, expression, and its association with estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 subtype of breast carcinoma

Objectives: The purpose of the study is to investigate p16 protein expression and promoter methylation of p16 gene and their association with molecular subtypes based on parameter such as estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2). Materials and Methods: A total of 114 breast cancer tissue biopsies were collected for methylation-specific polymerase chain reaction (MSP) and immunohistochemical (IHC) analysis. Results: Seven tissue microarrays were constructed. p16 protein expression was studied in 114 cases, of which 35/114 (30.7%) cases showed strong expression and the majority of them had ER-positive tumor (57.6%), and it was statistically significant (P < 0.0074). Similarly, p16 expression was reduced in the majority of PR-negative tumors (83.9%) and the association was statistically significant (P = 0.0026). p16 methylation was studied in 114 cases and was positive in 71.0% cases. Conclusion: High p16 protein expression was associated with ER-positive, PR-negative, and HER2-negative tumors which is associated with poor prognosis. p16 protein expression may be used as a prognostic indicator to predict treatment response to hormonal therapy.

Maternal outcome of primigravida patient with term pregnancy with engaged versus unengaged foetal head at onset of labour

Background: The primigravida are a group at risk as their capacity of child bearing has never put to the test, “primigravida is a dark and untired horse". The potential for future child bearing is determined by outcome of first labour. Hence, if first pregnancy results in normal healthy child, patient is mentally better prepared for subsequent pregnancies. Foetal head is said to be engaged when its biparietal diameter, the greatest diameter in an occiput presentation, passes through the pelvic inlet. Unengagement of head in primigravida has long been considered a possible sign of cephalopelvic disproportion.Methods: The study had 220 primigravida of which 110 had unengaged head as study group and 110 engaged head as controls. Data collection was done and the course of labour in all the patients recorded on partograph and all the patients were studied in detail. Engagement of the head was defined on the basis of Second Pawlik’s grip and Crichton’s fifth’s formula.Results: Our study shows that higher age group had more number of cases with unengaged head. The patient with engaged head had higher number of vaginal delivery than study group with unengaged head. More number of LSCS i.e. about 39.1% in study group as compared to 21% of controls is statistically significant difference (p value 0.05).Conclusions: We can conclude that primigravida with unengaged foetal head at onset of labour may deliver vaginally with minimal maternal morbidity, if proper   monitoring and maintenance of partogram is done.