Diagnostic utility of ki67 and p53 immunostaining on solitary thyroid nodule - A cytohistological and radionuclide scintigraphic study.

Background: For management of thyroid nodules, distinction between benign and malignant tumors is essential. Present study was undertaken to differentiate between benign and malignant lesions by using Ki-67 and p53 immunostaining and radionuclide perfusion scan. Materials and Methods: Study comprised of 25 prospective and 25 retrospective cases of solitary thyroid nodules. Fine needle aspiration was done on 25 prospective cases, which was correlated with histopathological diagnosis in 24 surgically excised cases. Immunostaining for p53 and Ki-67 was put on histopathological sections of 25 retrospective and 24 prospective cases. Radionuclide perfusion scan was performed and vascularity patterns were compared with their pathological nature to differentiate between benign and malignant nodule. Results: Cytohistological correlation was present in 80% of cases. On immunostaining, significant difference in mean value of Ki67 positivity was found between benign and malignant nodules (P < 0.05). On p53 immunostaining significant difference was observed in counts of benign and malignant lesions (P = 0.037). On radionuclide perfusion scan mean of difference between maximum and minimum perfusion activity between benign and malignant nodules was found to be statistically significant (P = 0.04), however there was no correlation between perfusion patterns and antigenic characteristics. Conclusions: P53 and Ki-67 immunostaining along with radionuclide perfusion scan appears to be useful tools to differentiate between benign and malignant lesions in solitary thyroid nodule; however, more studies are needed to confirm this observation.

A cytohistological study of Ki-67 expression in ovarian tumors.

Background and Objective: The study was conducted to evaluate the diagnostic accuracy of imprint cytology in ovarian neoplasms, and to investigate the biological significance of Ki-67 antigen expression in benign and malignant ovarian tumors and correlate it with histological type, grade, and stage of malignant tumor. Materials and Methods: A total of 50 cases including 25 prospective and 25 retrospective cases were studied. Imprint cytology was performed on 25 ovarian tumors and compared with histopathological diagnosis. Ki-67 immunohistochemistry was performed on all 50 cases. Results: On immunohistochemistry, benign tumors had a mean Ki-67 index of 3.2 ± 3.7 while malignant tumors had a mean Ki-67 index of 33.1 ± 16.7, the difference being statistically significant. Significant correlation was observed between the Ki-67 index and stage of the tumor; however, there was no correlation between the grade of differentiation and histological type of tumor with the Ki-67 index. Conclusions: In the present study, the Ki-67 index was higher in advanced stage tumors; hence a higher Ki-67 index points toward the aggressive behavior and poorer clinical outcomes.

Expression of cyclin D1 in endometrial hyperplasia and endometrial carcinoma.

This study investigates the role of cyclin D1 in 30 uterine surgical resection and endometrial biopsy specimens from 30 patients with simple hyperplasia (10 cases), complex hyperplasia (6 cases) and endometrial carcinoma (14 cases). Cyclin D1 immunohistochemistry was performed on 2-4 mm thick paraffin sections using labelled streptavidin biotin kit. Cyclin D1 expression was present in 2/6 (33%) cases of complex hyperplasia, 7/14 (50%) cases of endometrial carcinoma and none in simple hyperplasia. Difference in cyclin D1 immunopositivity in simple hyperplasia and endometrial carcinoma was statistically significant (p = 0.018) but the difference in cyclin D1 immunopositivity between complex hyperplasia and endometrial carcinoma was not statistically significant. Our study suggests that cyclin D1 over-expression may be an early event in endometrial carcinogensis. Since there was no difference in extent and intensity of cyclin D1 expression between complex hyperplasia and endometrial carcinoma, it appears that deregulation is maximal in complex hyperplasia.

Neonatal gastrointestinal mucormycosis--a case report.

Mucormycosis is a rare opportunistic fungal infection. It occurs mainly in immunocompromised patients and is usually fatal in children. This fungus can affect central nervous system, nasopharynx, lungs, skin and gastrointestinal tract. It invades the blood vessels and causes thrombosis, leading to infarction of the surrounding tissues. The diagnosis depends mainly on histopathological examination and demonstration of the fungus in the tissue sections, therefore a high index of suspicion and early exploration is required. We report a case of malnourished child who presented with perforation peritonitis. Investigations revealed very low total serum proteins and raised serum creatinine and blood urea levels. On exploratory laparotomy three perforations were located in the gastrointestinal tract. Histopathlogical examination of the perforation edge sections showed characteristic fungal hyphae confirming the diagnosis of gastrointestinal mucormycosis.

Clinicopathological profile of an unusual case of chondroid syringoma: a case report.

Chondroid syringoma or mixed tumor of the skin is an uncommon tumor that typically presents as small, solitary, slow growing, firm, subcutaneous or intracutaneous nodule. It presents commonly in the head and neck region. This is a case report of 45-year-old female who presented with multiple masses in the flank, chest wall, arm, -thigh and neck measuring 10, 6, 3.5, 2 and 1 cm in maximum dimension. FNAC and excision biopsy revealed benign chondroid syringoma. This is a rare case of chondroid syringoma exhibiting large size, multiplicity and unusual locations in flank, chest wall and thigh.

Detection of HPV16 and 18 by in situ hybridization in precancerous and cancerous lesions of cervix.

Fifty cervical biopsies from women with preinvasive and invasive malignancies of uterine cervix and ten normal cervical biopsies were examined for the presence of human papilloma virus (HPV) 16 and 18 DNA sequences by in situ hybridization (ISH) method with biotinylated DNA probes. The overall positivity of HPV DNA was 48% (24/50). The positivity of HPV 16 DNA for low grade squamous intraepithelial lesion (LSIL), high grade squamous intraepithelial lesions (HSIL) and squamous cell carcinoma (SCC) were 33.33%, 45.45%, 42.30% respectively. The positivity for HPV 18 DNA for LSIL, HSIL and SCC were 0%, 18.18%, 30.76% respectively. Two cases of cervical adenocarcinomas showed positivity for HPV 18 DNA only.

Ki-67 immunostaining in Pap smears of cervix: assessment of proliferation in preinvasive and invasive squamous epithelial lesions.

Ki-67 is a novel proliferation marker. Its use has been extensively studied in biopsy sections of preinvasive and invasive squamous epithelial lesions of cervix. However, only limited work has been done on its application on Pap smears of cervix. We applied Ki-67 immunostaining on cytology smears of various grades of squamous epithelial lesions of cervix. Sixty cases were chosen for immunostaining by Peroxidase antiperoxidase method using DAB as a chromogen. High level of Ki-67 labelled proliferation was measured in squamous cell carcinomas of cervix. Statistically significant difference was observed between preinvasive and invasive squamous epithelial lesions of cervix. Ki-67 could prove as a useful adjunctive test to routine Pap smear in triage of patients harboring lesions of cervix.

Proliferative activity in squamous intraepithelial and invasive lesions of cervix: analysis by AgNOR staining.

Proliferation potential of squamous intraepithelial lesions of cervix is the main factor affecting the biological aggressiveness of the lesion. The present study was aimed at assessing the proliferation in preinvasive and invasive squamous epithelial lesions of cervix using a simple and inexpensive proliferation marker: AgNOR (Argyrophilic nucleolar organizer regions). Fifty biopsy sections of various grades of preinvasive and invasive squamous epithelial lesions of cervix were taken for AgNOR staining. Single step staining technique using gelatin in formic acid solution was employed. Counting was done with the help of 'CAMERA LUCIDA' drawings. AgNOR counts/nucleus in parabasal and basal layer showed progressive rise in their mean value with increasing grade of lesion. Amongst invasive malignancies, highest mean of AgNORs/nucleus was observed in poorly differentiated squamous cell carcinoma of cervix. In conclusion, AgNORs can prove to be a simple inexpensive and reliable proliferation marker in lesions of cervix.

Proliferation in squamous cell carcinoma of cervix: a comparative assessment by two markers.

The study was aimed at assessing the cell proliferation in various grades of squamous cell carcinoma of cervix using two proliferation markers: AgNORs and Ki-67. 18 biopsy sections of various grades of SCC of cervix were chosen. AgNORs staining was done by single step staining technique using gelatin. Ki-67 immunostaining was done by Avidin--Biotin technique using DAB as a chromogen. Highest mean number of AgNORs was found in poorly differentiated squamous cell carcinoma and statistically significant difference was observed between well and poorly differentiated SCC and between moderately and poorly differentiated SCC. Highest mean Ki-67 LI was seen in poorly differentiated SCC. We observed correlation between histological grade and Ki-67 and AgNORs separately but no statistically significant correlation was found between Ki-67 and AgNOR counts. AgNORs and Ki-67 are both simple and easily performed techniques. They may prove to be a useful adjunct in estimating tumor proliferation and hence in determining the management strategy of the patients.

Ki-67 labelling as a proliferation marker in pre-invasive squamous epithelial lesions of cervix.

Study was conducted to evaluate proliferation in squamous intraepithelial lesions of cervix. 36 cases of cervical biopsies were chosen including unremarkable cervix, basal cell hyperplasia, cervical intraepithelial neoplasia (CIN I, CIN II, CIN III). Ki-67 immunostaining was performed by peroxidase-antiperoxidase method. Ki-67 labelling index in basal and parabasal layers of cervix showed progressive rise with increasing grade of lesion but may not be helpful in classification of individual lesion. Also extent of staining from the basement membrane increases with increasing grade. High basal Ki-67 reactivity might be of greater biological significance than surface differentiation.

Evaluation of invasive and non-invasive diagnostic modalities for Helicobacter pylori infection in children.

Invasive and non invasive tests for Helicobacter pylori performed on 31 children were evaluated as diagnostic modalities. Investigations included upper gastrointestinal endoscopy and endoscopic grasp biopsy (EGB) from antrum and corpus (for rapid urease test, impression smear, histology and culture), antral brushings, serum ELISA for IgG antibodies, rapid blood test, and IgG antibodies in unstimulated saliva. Our results suggested that amongst the invasive methods brush cytology was more sensitive than histology and impression smear. Best interpretation of urease test was possible at 4 hours incubation. Culture of EGB sample constitutes the most specific way to establish the diagnosis of infection but is not easy. Hence, non-invasive modalities like serum ELISA, rapid blood test and salivary ELISA can be used in children for the detection of H pylori infection.