Accuracy of digital mammography, ultrasound and MRI in predicting the pathological complete response and residual tumor size of breast cancer after completion of neoadjuvant chemotherapy

Background: Neoadjuvant chemotherapy (NACT) is the standard of care for the treatment of locally advanced or non-metastatic breast cancer, which may increase the chances of breast conservative surgery (BCS) in place of radical mastectomy without compromising on the overall survival. The aim of this study was to evaluate the accuracy of mammography (MG), ultrasound (US), and magnetic resonance imaging (MRI) in predicting the complete response and to assess the extent of residual breast cancer in women treated with NACT. Materials and Methods: Fifty-six consecutive patients with stage II or III breast cancer, who underwent imaging evaluation of breast with digital mammogram, US, and MRI after NACT and before the breast surgery, were included in the study. For each patient, pathologic complete response (pCR) or residual tumor (non-pCR) was predicted and the maximum extent of the residual tumor was measured on each imaging modality. These measurements were subsequently compared with the final histopathology results. Results: Of 56 patients, 22 showed pCR with MRI having better accuracy for predicting complete response than the MG and US (area under the receiver operating characteristic curve: 0.86, 0.68, and 0.65, respectively; p = 0.0001 for MRI; p = 0.06 for MG, and p = 0.02 for US). The sensitivity of MRI for detecting pCR was 72.7%; specificity and positive predictive value were 100%. For pathological residual tumor, the size measured on MRI showed significantly higher correlation with the pathologic size (correlation coefficient, r = 0.786), than the MG (r = 0.293) and US (r = 0.508) with P < 0.05. Conclusions: Accuracy of MRI for predicting pathological complete response was significantly higher than the MG and US. Pathologic residual tumor size was also more precisely reflected by the longest tumor dimension on MRI with the strong positive correlation coefficient

Proliferative fasciitis of the chin: A report of the rare case and review of literature

Proliferative fasciitis is a pseudo-sarcomatous myofibroblastic proliferation characterized by the presence of unusual giant cells resembling ganglion cells, which usually occurs in the adult population with a mean age of 54 years. It usually affects the upper extremities and is rare in head and neck region with only 11 cases described in the literature so far. Because of rapid growth and histological similarity to various malignant tumors such as rhabdomyosarcoma, recognition of this benign condition is a matter of utmost importance when a pathologist is concerned. In this study, we report a case of a 11-year-old boy presented with a lesion on the right side of chin, along with a literature review involving those cases reported in the head and neck region.

An unusual presentation of ghost cell odontogenic carcinoma: A case report with review of literature

Ghost cell odontogenic carcinoma (GCOC) is a malignant odontogenic epithelial tumor which is an exceedingly rare, highly aggressive, rapidly growing, and infiltrative tumor forming the malignant counterpart of long-standing benign cystic lesions coming in the spectrum of calcifying odontogenic cysts. To date, only a few cases have been reported in the medical literature. A case of unusual presentation of GCOC is presented and the clinical, histopathological, and immunohistochemical features are discussed along with a literature review. Our case report further emphasizes the bizarre biological behavior of this tumor and the need for strict long-term surveillance of the patients as metastasis to distant sites has been reported.

Characterization of phytotoxin producing Alternaria species isolatedfrom sesame leavesand their toxicity.

Sesame (Sesamum indicum L.), is an important oilseed crop in the tropics and subtropics, referred as “Queen of Oilseeds” owing to its high cooking quality and medicinal value. Sesame production, particularly in India, has been declining since last decade and ‘Leaf blight’ caused by Alternaria spp. is reported to cause yield loss up to 30-40%. Here, we investigated the fungal toxin produced by Alternaria and its pathogenicity. A total of 164 Alternaria strainswere isolated on potato dextrose agar media from the infected sesame leaves showing circular concentric rings with dark brown spots symptoms. All the isolates were screened for cultural and morphological characters. Colour of the fungus was grey to dark brown, formed smooth, raised, fluffy, and regular to irregular margins. Among 164 isolates, 43 isolates were moderately growing and 121 were fast in growth. The DNA of the isolate was amplified with ITS primers and sequence of BLAST results confirmed seven different species of Alternaria of NCBI database. Further, toxigenic potentiality of the isolates was tested with dilutions of culture filtrate (1:1 to 1:5) on sesame leaves. Among 164 isolates, 23 showed toxigenicity, varied from highly toxigenic to least toxigenic. Pathogenicity of the isolates showed that they were highly virulent to less virulent when tested by the detached leaf method. Based on the toxigenicity, the toxin was partially purified and brown coloured paste was recovered. Chemistry of the toxin was confirmed based on the IR, UV, NMR and mass spectra analyses, and it resembled the structure of alternariol mono methyl ether and altenuene which are mycotoxins in nature. Further, bioassay of toxin was carried out at different concentrations (50 to 2000 ppm) on seeds and seedlings of sesame. Maximum inhibition of seed germination of 81.1% was observed at 2000 ppm and the least was 6.67% at 50 ppm. With the increase in the concentration of toxin, the manifestation of the symptom was conspicuous and quick such as marginal, veinal necrosis, drooping and yellowing with lesion formation. From the present study, it is found that the species of Alternaria are responsible for the cause of blight disease symptoms and the toxicity of toxin produced by the pathogen was very high. The Alternaria toxin could inhibit the growth of the plant as well as seed germination rate.

Impact of methylene blue staining in the retrieval of lymph nodes in resected colorectal cancer specimens.

Adequate lymph node harvest in resected colorectal cancer (CRC) specimens is important in staging and choosing appropriate therapeutic options. The yield of lymph nodes and metastatic nodes by methylene blue dye injection in 30 randomly selected resected CRC specimens was compared with an equal number of CRC specimens (control) with matched grade and stage.The mean number of lymph nodes retrieved in the study group was 22 ± 9 compared to 17 ± 8 in the control group which was statistically significant (P = 0.04).Methylene blue technique is an effective aid in increasing the yield of lymph nodes in the resected CRC specimens.

Microalgae mediated synthesis of silver nanoparticles and their antibacterial activity against pathogenic bacteria.

Silver nanoparticles is known to have antimicrobial affects. Cyanobacteria isolates from muthupet mangrove includes Aphanothece sp, Oscillatoria sp, Microcoleus sp, Aphanocapsa sp, Phormidium sp, Lyngbya sp, Gleocapsa sp, Synechococcus sp, Spirulina sp with were set in compliance with their cellular mechanism of nano silver creation, and were investigated by UV-VIS spectrophotometer, Energy-dispersive X-ray (EDX) and scanning electron microscopy (SEM). Silver nanoparticles were spherical shaped well distributed without aggregation in solution with an average size of about 40- 80 nm. Synthesised nano silver had antibacterial production on various organisms that provoked various diseases in humans. The cellular metabolites of Microcoleus sp. only created nano silver and it enhanced the antibacterial activity against test pathogenic bacteria from MTCC (Proteus vulgaris, Salmonella typhi, Vibrio cholera, Streptococcus sp., Bacillus subtilis, Staphylococcus aureus, Escherichia coli.) The antimicrobial assay was performed using 0.001 M concentration of nano silver in well diffusion method with positive control of appropriate standard antibiotic discs Cephotaxime, Ampicillin, Tetracyclin, Cephalexin etc. Synthesised silver nanoparticles acted as an effective antimicrobial agent and proved as an alternative for the development of new antimicrobial agents to combat the problem of resistance.

Evaluation of antioxidants and lipid peroxidation status among students.

The study aims to estimate the changes in the plasma levels of lipid peroxidation product malondialdehyde (MDA), non-enzymatic antioxidants: vitamin C and E and enzymatic antioxidant: superoxide dismutase (SOD). The population used were healthy students (100 male, 100 female); mean age 22.4 years, range 18- 25 years. The level of lipid peroxidation was found to be significantly increased among the students which were inversely related to the level of antioxidants (p<0.05). Increased antioxidant levels show a multiple link between fruit and vegetable intake among the study group. Diminished antioxidant status disturbed oxidant-antioxidant balance alleviating oxidative stress state in less fruit and vegetable intake group. Therefore, the alterations in the level of antioxidants in blood plasma could be used as biomarkers for nutritional tribulations.

A novel 11;18 translocation in a case of acute myeloid leukemia with maturation.

Acute myeloid leukemia with maturation (AML-M2) is associated with the 8;21 translocation. For the first time in an adult patient with AML-M2, a novel unbalanced translocation involving the short arm of chromosome 11 and long arm of chromosome18 with new breakpoints is presented. CD82 on band 11p11.2 and GATA 6 on 18q11.2 may play a role in the pathogenesis of de novo AML M2. The report with translocation (11;18)(p11.2;q11.2), as the sole cytogenetic abnormality provides more data on the leukemogenesis of de novo AML M2.

Elucidating pyrazinamide resistance in mycobacterium tuberculosis by molecular docking.

Pyrazinamide (PZA) - an important drug in the anti-tuberculosis therapy, activated by an enzyme Pyrazinamidase (PZase). The basis of PZA resistance in Mycobacterium tuberculosis (Mtb) is owing to mutation in pncA gene coding for PZase. The identification of the structural or functional defects in the mutant enzymes leading to resistance still remains an area to be explored. The Wild-type (WT) and five mutant models Asp8Gly, Lys96Thr, Ser104Arg, Cys138Ser and Cys138Tyr were docked with PZA and its derivatives. In the present study, docking results has aided in predicting the best form of PZA to bind with mutants of PZase to be compounds-10 and 4. These models represent the first in-silico evidence for the binding interaction of PZase with PZA derivatives/analogues. The models may provide useful chemical insights for designing new anti-TB agents in order to overcome the resistance developed with PZA.

Assessment of HER2/Neu status by fluorescence in situ hybridization in immunohistochemistry-equivocal cases of invasive ductal carcinoma and aberrant signal patterns: A study at a tertiary cancer center.

Introduction: HER-2/neu status determines the eligibility for targeted therapy with trastuzumab in breast carcinoma. Evaluation for HER-2/neu protein expression by immunohistochemistry (IHC) and gene amplification by fluorescence in situ hybridization (FISH) has become the gold standard. Aims: Since data on HER-2/neu assessment by IHC and FISH and studies regarding concordance between the results of the two techniques are limited, especially from India, we sought to study HER-2 gene amplification status by FISH in equivocal (2+) cases by IHC and also study aberrant signal patterns. Settings and Design: Mastectomies and breast core biopsies, equivocal for HER-2/neu protein expression, were analyzed for HER-2 amplification by FISH. Materials and Methods: IHC (DAKO) and FISH (PathVysion dual-probe system) tests were performed on 68 of 112 (after exclusion) 10% neutral buffered formalin (NBF)-fixed paraffin-embedded tissues and evaluated according to American Society of Clinical Oncology ASCO guidelines. Statistical Analysis Used: Chi-square (χ2 ) test and the two-tailed P value were applied using Graphpad Quickcels software, version 2006. Results: It was found that 73.5% of the IHC 2+ patients were negative for HER-2/neu amplification, 25% were positive (ratios ranging from 2.3 to 5.6) and 1 patient was equivocal (2.2). Retesting FISH HER-2 equivocal case on another tumor block by IHC demonstrated HER-2 overexpression of protein 3+, thus resolving the equivocal status. Polysomy and HER-2 genetic heterogeneity were seen frequently. Conclusions: The findings reiterate that IHC HER-2 equivocal cases are a heterogenous group and need FISH for further categorization. Low concurrence (25%) rate between both IHC and FISH results in the equivocal scenario can be attributed to tumors with polysomy 17 and HER-2/neu genetic heterogeneity.

Transient cytotoxicity of 131I beta radiation in hyperthyroid patients treated with radioactive iodine.

Background & objectives: Radioiodine (131I) or radioactive iodine in low doses is used worldwide as the first line of management in the treatment of hyperthyroidism. Information is available on the extent and severity of cell damage after a high dose radioiodine (131I) therapy for thyroid cancer, but information is scanty on its cellular effects, its extent and severity of cell damage after a low dose 131I therapy. The present investigation was aimed to study the cytotoxic effects of a low dose 131I therapy in varying doses as is normally being used in routine clinical practice in the treatment of various forms of hyperthyroidism. Methods: Peripheral blood lymphocytes were analyzed in 32 hyperthyroid patients. All of them received 131I in the form of sodium iodide solution orally. Blood lymphocytes were studied for the presence of chromosomal aberrations (CA) and micro nucleus (MN) using micronucleus assay. Blood samples of these patients were drawn prior to the treatment, on 7 thand 30 thdays after the treatment. Results: The results indicated a positive relationship between 131I dose, CA and MN frequency. A statistically significant increase in CA and MN frequency in day 7 post- therapy and a decrease in mean levels of CA and MN on day 30 post-therapy were observed when compared to pre-therapy. Interpretation & conclusions: This study showed that the cytogenetic damage induced by 131I in low doses i.e., less than 555MBq was minimal and reversible. Patients can be motivated to undertake this safe and easy procedure as a first line of therapy in the treatment of hyperthyroidism.

Cryptic PML-RARα positive acute promyelocytic leukemia with unusual morphology and cytogenetics.

Acute Promyelocytic Leukemia (APL) is different from other forms of acute myeloid leukemia (AML), to the reason being the potential devastating coagulopathy and the sensitivity to all-trans retinoic acid (ATRA) and arsenic trioxide (As 2 O 3 ). We hereby present a case of APL, morphologically distinct from the hypergranular APL; however, the flow cytometry revealed a characteristic phenotype showing dim CD45, bright CD13, bright CD33 and dim CD117 positivity. These were negative for CD34, HLA-DR, B-lymphoid and T-lymphoid lineage markers. Conventional cytogenetics revealed a distinct karyotype of a male with translocation t(4;15)(q34.2:q26.3). However, interphase florescence-in-situ hybridization (FISH) revealed PML/RARA fusion signal on chromosome 15 in 90% cells. The cryptic translocations may be missed on conventional cytogenetics, however, need to be picked by other techniques as FISH.

Changing trends in oral cancer.

CONTEXT: No study highlighting the incidence of oral squamous cell carcinoma (OSCC) in young adults has been reported from North Kerala until now. AIMS: To study the cases of OSCC reported at our institution, with emphasis on the clinicopathologic variables in young adults. SETTINGS AND DESIGN: This was a retrospective study of OSCC cases reported from 2002 to 2007. MATERIALS AND METHODS: Data of oral cancer cases reported between 2002 and 2007 were retrieved from the records. The cases in patients below 40 years of age formed a separate study group. The data obtained was tabulated and comparisons drawn on the observed variables between the two groups. RESULTS: Results showed a high incidence of OSCC among young adults. The demographic and anatomic location of these cases showed significant variations from cases of oral cancer in older patients. In addition, a significant number of these cases failed to show any relation with the commonly implicated etiologic agents of oral cancer. CONCLUSION: The findings of our study indicate a high incidence of oral cancer among young adults in our region. The tongue is the most common site in these cases with a significant number showing no possible etiological factors.

Squamous cell carcinoma of tongue in a 19-year-old female.

Squamous cell carcinoma is the most common malignant neoplasm of the Oral Cavity, usually affecting individuals over 50 years of age. It rarely occurs in patients who are less than 40 years old (0.4-5.5%). However, since it is so rare, when cases occur they are often misdiagnosed and inappropriately treated leading to delay in definitive treatment. This report describes a case of squamous cell carcinoma, involving the posterolateral border of the tongue of a 19-year-old female patient, with no deleterious habits usually associated with oral cancer. This report focuses on the etiological factors and prognosis related to the case. Additionally, a brief literature review regarding squamous cell carcinoma in young patients is also included.

Sebaceous differentiation in odontogenic keratocyst.

Sebaceous glands are common in the oral mucosa, but are not normally present with in the jaws. A case of an odontogenic keratocyst with sebaceous glands in the epithelium in a 12-year-old child is presented here, with special emphasis on its histogenesis.

Deferasirox: the new oral iron chelator.

Deferasirox is a new tridentate oral iron chelator developed by computer remodeling recently approved by FDA for children above 2 years. Phase II/III trials have demonstrated similar efficacy to desferrioxamine and better chelation efficiency. Adverse events were minor and growth remained unaffected. Data on cardiac iron chelation is limited although some studies have shown it comparable to deferiprone. The benefit to risk profile of deferasirox is favorable. This promising new drug might decrease the burden of subcutaneous or intravenous infusion improving compliance and hence the life expectation in thalassemic patients.

Oral pemphigus vulgaris: clinicopathologic study of 20 cases.

Pemphigus vulgaris (PV) is a vesiculobullous lesion that produces intraepithelial blisters in skin and mucous membrane. The oral mucosa is often the first site to be affected by the disease. Although oral PVis a well characterized condition, the detailed clinical and histopathological study in Malabar population has not been reported. A clinicopathologic study of 20 cases of oral PV observed over a span of 2 years from January 2004 to January 2006 is reported. For these 20 cases, the mean age was 42.3 years and male:female ratio was 2:3. The most commonly affected sites were the buccal mucosa and palate. Histopathologic examination with direct immunofluorescence was the method of diagnosis in all cases. Suprabasilar clefting with acantholytic cells can be seen histopathologically and IgG positivity in direct immunofluorescence in all cases that have been studied.

Clear cell ameloblastoma in a young child--an enigma in diagnosis.

Clear cell ameloblastoma is an odontogenic tumour with aggressive behaviour usually noticed in 6th decade of life. It is histologically characterized by an ameloblastomatous component intermixed with an extensive clear cell component. Here is a case report of an unusual occurrence in a 5-year-old child. The rarity of this tumour and young age of the patient are some of the rare features, which need documentation. The importance of its diagnosis and various differential diagnoses are discussed.