Clinical profile of patients with esophageal carcinoma: A multicentric study from North India

Background: Carcinoma esophagus is the 6th most common cancer in India with an incidence of 5.04% It most commonly affects older age individuals, with incidence peaking in seventh and eighth decades of life. Adenocarcinoma (AC) and Squamous cell carcinoma (SCC) are the two main histological variants. Our aim was to study the risk factors, clinical and epidemiological profile of patients diagnosed with Esophageal Cancer from two tertiary care centres located in North India.Methods:This was a retrospective study carried in departments of gastroenterology of two tertiary care hospitals North India. Data was collected from respective institutes for the previous 1 year i.e. from 1st October 2020 to 30th September 2021. All patients presenting to Gastroenterology OPD or emergency with dysphagia who were diagnosed as having Carcinoma esophagus were included in the study.Results:A total of 106 patients were included in this study. There were 44 females & 66 males. The most common presenting complaint was Dysphagia (48%) followed by Loss of weight (26.4%), Vomiting (in 23.6%) and Odynophagia (22.6%). Involvement of the lower one third of the oesophagus was the most common (37.7%). SCC (Squamous Cell Carcinoma) was the most common type of oesophageal carcinoma in this study, seen approximately in 80% of cases.Conclusion:Our study from North India suggested poor oral hygiene as a strong risk for carcinoma esophagus Males were more commonly affected and SCC was the predominant variant.

Morphological Typing of Lymphomas with Immunohistochemistry.

Lymphoid malignancies (LM) are a heterogeneous group of disorders that are broadly divided into Hodgkin disease (HD) and Non-Hodgkin Lymphoma (NHL). Diagnosing lymphoid malignancies based on morphology in conjunction with immunohistochemistry (IHC) forms the basis of WHO classification and this has prognostic implications.With this background this study was designed thus including all the lymphoid malignancies both NHL and HD. Materials and Methods: This study was conducted at a tertiary centre in Uttarakhand and included a total of 116 cases of lymphoid malignancies. Of these 41 cases were of Hodgkin disease and 75 cases were of NHL. These cases were initially diagnosed on morphology employing Hematoxylin and Eosin (H&E) and special stains like Reticulin. Subsequently, a preliminary panel of monoclonal antibodies using CD3, CD15, CD20, CD30, and CD45 were employed. All the cases were then classified using WHO classification. Results: HD- Of the 41 cases of Hodgkin’s disease the commonest subtype was Nodular Sclerosis seen in 26 cases (48.78%). Reed Sternberg in reactive milieu is diagnostic of Hodgkin disease. In all cases except one Reed Sternberg cells exhibited positivity for both CD15 and CD30. NHL – Of the 75 cases of NHL an initial classification based on morphology was done. All the cases were classified according to International Working Formulation initially. Subsequently, IHC was employed using CD3, CD15, CD20 and CD45. The disease was then classified according to WHO classification and broadly divided into B or T cell types. B cell expression was seen in 60 cases (80%) and T cell expression in 15 cases (20%). The commonest B cell subtype was Diffuse Large B cell Lymphoma (26.4%).

Transbronchial needle aspiration with rapid on-site evaluation: A prospective study on efficacy, feasibility and cost effectiveness.

Background. Transbronchial needle aspiration (TBNA) has an established role in diagnosis of hilar and mediastinal lesions. Rapid on-site evaluation (ROSE) of TBNA smears can determine the adequacy of TBNA smears that can obviate the need for repeat procedures, thus avoiding added cost. There is paucity of data from India showing efficacy and cost-effectiveness of ROSE. Hence, this study was carried out to assess the efficacy, feasibility and cost implications of ROSE assisted TBNA. Methods. Forty consecutive patients undergoing TBNA were enrolled and ROSE was performed on TBNA smears. The results were analysed using a comparative study design. Results. It was found that 45% of patients would have required a repeat bronchoscopy due to inadequacy of material, if ROSE was not used. Inadequate smears were more common in benign aetiologies than malignant ones. TBNA of mass lesions and lesions with endoluminal bulge give better results than TBNA of lymph nodes and without endoluminal bulge. Conclusions. ROSE was found to increase the yield of TBNA and help to prevent repeat procedures. It proved to be simple, cost-effective and feasible in Indian settings.

Comparative Analysis of the Distribution of Various Subtypes of Lymphoid Malignancies in Uttarakhand with other Regions in India.

Lymphoid malignancies (LM) form an umbrella term comprising both Hodgkin Disease (HD) and Non Hodgkin Lymphoma (NHL). A number of studies conducted in India and worldwide suggests that the disease exhibits similar pattern with contrasting regional variations. Examining regional variations is important as it may provide an insight to the etiological factor and pathogenesis of the disease. Aim: The aim of our study was to investigate the current pattern of lymphoid malignancies both HD and NHL in Uttarakhand and subsequently compare the results with other regions. Materials and Methods: We analyzed 116 cases of Lymphoid Malignancies that were reviewed over a period of 18 months. Both HD and NHL were diagnosed morphologically and then Immunohistochemistry (IHC) using CD3, CD15, CD20, CD30, and CD45 was employed to further subtype disease according to current WHO classification. Results: The lymphoid malignancies were further subdivided into HD and NHL. Nodular Sclerosis (NS) was the dominant subtype of HD in Uttarakhand (48.78%) and was comparable with results from other regions. Statistical analysis regarding distribution of various subtypes of HD in Uttarakhand and its comparison with three distinct geographical regions also showed p value < 0.241832 which was not statistically significant. However, amongst NHL Diffuse Large B cell Lymphoma (DLBCL) (54.66%) was the commonest subtype. Besides, a significant number of cases of Anaplastic Large Cell Lymphoma (12%) were also observed. Furthermore, statistical analysis showed that the distribution of various subtypes of NHL in Uttarakhand when compared to three distinct geographical regions was statistically significant (P value < 0.002808). Conclusion: Geographic differences in the incidence and histologic subtypes of Lymphomas do exist.

Pattern of cancers amongst patients attending Himalayan Institute of Medical Sciences, Dehradun.

This hospital-based study seeks to find out the most common cancers amongst the patients attending Himalayan Institute of Medical Sciences (HIMS), Dehradun, situated in Uttaranchal, which has inadequate health care facilities and low socio-economical status. In our study, of the 20,247 cases reported in the pathology department from July 1996 to Dec. 2003, 18.57% cases were malignant. Male to female ratio was 1.7:1.Top five cancers in males were those of lung, larynx, non-Hodgkins lymphoma, oesophagus & stomach. Top five cancers in females were those of breast, cervix, gall bladder, ovary & oesophagus. Tobacco and alcohol related cancers predominated in males. Skin and soft tissue cancers and were also common amongst both genders. Patients mostly reported with cancers in advanced stages, which could be attributed to poor medical facilities and health awareness in this region.