Ultrasound guided fine needle aspiration cytology of gall bladder mass and mural thickening: a radio-pathological correlation

Background: Carcinoma of the gall bladder (GB) is the commonest malignancy of the biliary tract. Ultrasound (US) guided Fine Needle Aspiration Cytology (FNAC) plays a major role in early detection of malignancy in a suspicious GB lesion. The aim of this study was to evaluate the safety and diagnostic accuracy of US guided FNAC in detection of GB malignancy, to find the association of gall stones with GB malignancy, to study the ultrasound pattern of GB malignant mass and demographic profile of the disease in North eastern India.Methods: The study was conducted retrospectively in Dr. B. Borooah Cancer Institute, Guwahati from January 2016 to December 2017. A total number of 173 patients suspected to have GB malignancy were subjected to US guided FNAC.Results: Total 161 patients were positive for malignancy with significant female majority. There were 124 female (77.02%) and 37 males (22.98%) in the range of 29 to 82 years. Male female ratio was 1:3.5. One was diagnosed as xanthogranulomatous cholecystitis and another was chronic cholecystitis. FNAC remained inconclusive in 2 patients. There was no major procedure related complication. Adenocarcinoma was the most common malignancy found in 146 patients (98.68%). Cholelithiasis was associated in 88.19% of malignant lesions.Conclusions: US-guided FNAC is a safe, highly accurate and reliable procedure for early detection of GB malignancy.

Value of urinary microalbumin test in cancer patients with borderline serum creatinine level.

Background: Micralbuminuria (MA) is an early sign of incipient renal damage and cancer patients are at the risk of developing kidney diseases due to the use of nephrtoxic chemotherapeutic agents. Methods: A pilot study of urinary microalbumin on 41 patients with borderline serum creatinine was carried out at regional cancer centre of North-East India during the period from June to August 2014. The patients whose serum creatinine levels were between 1.2 mg/dl to 1.3 mg/dl were considered as borderline for the present study. The assays were performed with a dimension Rxl max random access biochemistry analyzer. Results: Out of 41 cases, 22 (53.6%) had MA, M:F = 1.75, <45 years 3 (13.6%) patients, in 45 years - 65 years 17 (77.2%) patients, and >65 years 2 (9.0%) patients were detected with urinary microalbumin. Chi square test showed P = 0.695 (Fisher’s exact P value). Conclusion: Testing of urinary microalbumin can be done in cancer patients with borderline serum creatinine level in order to identify patients at risk of developing kidney disease.

Rosai-Dorfman disease in a child with involvement of extra-nodal wrist joint.

Rosai-Dorfman Disease (RDD) is a benign condition primarily affecting the lymph nodes. The term sinus histiocytosis with massive lymphadenopathy was first used. There may be extra-nodal presentation of RDD with or without constitutional symptoms. A 10-year-old boy presented with massive bilateral cervical lymphadenopathy which mimicked the diagnosis of lymphoma. We describe here a case of RDD in a child with extra-nodal bone involvement of the wrist joint, its diagnosis by histopathological examination supported by immunohistochemistry and consequent initial management.

Profiles of gall bladder cancer reported in the hospital cancer registry of a Regional Cancer Center in the North-East India.

Background: The incidence of gall bladder cancer (GBC) is very high in this part of the world and there is little information on the descriptive epidemiology of GBC from our population. Methods: A retrospective study on the data set of hospital cancer registry was analyzed. The data set consisted of patient information registered during the period of January 2011 to December 2012. The cases included for the present study were histologically confirmed and radiologically diagnosed cases of GBC. All the cases were retrospectively analyzed for gender, age, urban-rural residences, religion of patients and their educational levels. Descriptive statistics was calculated and Chi square test was done to see the significance differences among categories. Results: A total of 837 cases of GBC were registered, F:M was 2.33, median age in females and males was 54 and 50 years respectively, majority of cases in both the genders were seen in 50-59 years of age, 81.1% patients were from rural areas and 18.8% from urban areas, Chi square on comparison with other cancers showed p<0.05, and there was no major religious and educational pattern of GBC seen in our population. Conclusion: In our population females are at high risk especially past 40 years of age and rural population with its varied environmental, lifestyles and infective agents should be investigated for possible risk factor in the causation of GBC.

Burden of head and neck cancers in Kamrup urban district cancer registry of Assam, India: a retrospective study.

Background: Head and Neck cancers are basically squamous cell carcinomas. It is the fifth most common cancer and the sixth most common cause of cancer mortality in the world. Incidence of cancer as a whole for all sites is fourth highest in Kamrup Urban District (KUD) in males (AAR 185.2) and second highest (AAR 156.3) in females out of all Population Based Cancer Registries (PBCR) in India. Incidence of head and neck cancers in KUD is quite high both nationally and internationally. This retrospective study was carried out to assess the incidence pattern of head and neck cancers in Kamrup Urban District of Assam, India for the period of 2009-2011. Methods: Cancer is not notifiable in India, so method of collecting information on cancer was active in PBCR Guwahati. A total of 4416 cases were registered during the three years (1st January 2009- 31st December 2011) of which 2508 were male and 1908 female. Statistical analysis used: Age Adjusted Rate (AAR), Crude Rate (CR) and Population pyramids are provided by NCRP-ICMR. Results: The relative proportion of head and neck cancers of total cancer cases registered in KUD constitutes 26% (654/2508) and 12% (225/1908) in male and female respectively. In males cancer of hypopharynx (AAR 14.7) was most common followed by tongue (AAR 9.4) and mouth (AAR 7.7). In females cancer of mouth (AAR 7.6) is most common followed by cancer of tongue (AAR 3.2). Conclusion: The pattern and incidence of various head and neck cancers is of utmost importance for primary prevention and early detection to adequately manage these cancers comprehensively in the community.

A retrospective study of post-operative gall bladder pathology with special reference to incidental carcinoma of the gall bladder.

Background: Surgical removal of gall bladder for its diseases is common. However, not much is known about the incidence of incidental carcinoma in such patients in our population. Objective of current study was to analyze the different pathological entities of post-operative gall bladder specimen with particular emphasis on incidental carcinoma. Methods: This retrospective study was carried out at a multi-specialty hospital in eastern India from the pathology records for the period from August 2005 to July 2008. The records were analyzed for gender, age group distribution, and pathological types with different histology. Results: Out of 863 records, chronic cholecystitis 51.2% was the most common histology and malignancy was seen in 2.7% (23/863) both pre-operative and post-operative diagnosis. In the neoplastic group incidental carcinoma was diagnosed in 1.9% (17/23) of cases Conclusion: Histopathological examination of gallbladder specimen helps to identify non-neoplastic conditions with its complications and also, for the detection of incidental carcinoma. Thorough sampling of all gallbladder specimens is a must to detect focal neoplastic changes.

Copy number polymorphism of glutathione-S-transferase genes (GSTM1 & GSTT1) in susceptibility to lung cancer in a high-risk population from north-east India.

Background & objectives: Genetic polymorphisms in glutathione-S-transferase genes (GSTM1 and GSTT1) have been studied intensively for their potential role in lung cancer susceptibility. However, most of the studies on association between the polymorphisms and lung cancer do not distinguish between genotypes with one or two copies of the genes. The present study investigates the gene dosage effects of GSTT1 and GSTM1 copy number and their environmental interactions to examine the association of lung cancer risk with trimodular genotypes of the GSTs in a high-risk population from north-east India. Methods: A total of 154 lung cancer cases and 154 age and sex matched controls from the high risk region of north-east India were analyzed by multiplex real-time PCR to determine the trimodal genotypes (+/+, +/- and -/-) in both the genes (GSTM1 and GSTT1). Results: No significant association and gene dosage effect of GSTM1 gene copy number with lung cancer risk (Ptrend=0.13) were found. However, absence of GSTT1 conferred 68 per cent (OR=0.32;95%CI=0.15-0.71;P=0.005) reduced risk compared to the two copy number of the gene. tThere was evidence of gene dosage effect of GSTT1 gene (Ptrend=0.006). Tobacco smoking was a major environmental risk factor to lung cancer (OR=3.03;95%CI=1.73-5.31;P<0.001). However, its interaction with null genotype of GSTT1 conferred significant reduced risk to lung cancer (OR=0.30;95%CI=0.10-0.91;P=0.03). Further in only tobacco smokers, null genotype was associated with increased reduced risk [0.03(0.001-0.78)0.03; Ptrend=0.006]. No effect modification of GSTM1 was observed with lung cancer risk by environmental risk factors. Interpretation & conclusions: The results suggest that absence of GSTT1 null genotype may be associated with a reduced risk of lung cancer and the effect remains unchanged after interaction with smoking.