Molecular subtypes of invasive breast carcinoma of no special type, their correlation with histopathological features, Ki 67 index and tumor budding: A retrospective comparative study

Context: Tumor budding (TB), poorly differentiated clusters (PDCs), and Ki 67 index are proven adverse prognostic factors in breast carcinoma. Though the relation of Ki 67 index with molecular subtypes of breast carcinoma have been extensively studied, there is very limited information on the role of TB and PDCs. Aims: To grade TB, PDCs, and Ki 67 index and assess histological features and relationship of all these with molecular subtypes of invasive breast carcinoma of no special type. Methods and Material: Retrospective study of 148 cases from 1/1/2019 to 30/12/2019. Division of molecular groups – Luminal A, Luminal B, Her2 neu positive, and triple-negative breast carcinomas (TNBC), and Ki 67 index grades based on St Gallen criteria, intratumoral and peritumoral TB and PDC grades as per the International Tumor Budding Consensus Conference (ITBCC) criteria for colon and correlation between these and other histological features with the molecular subtypes were done. Statistical Analysis: Chi-square test, univariate and multivariate logistic regression models were used. Results: Significant correlation was seen between TB and lymphovascular emboli, Luminal B tumors with high-grade TB and PDCs, Her 2 neu positive and TNBC tumors with low-grade TB, circumscribed tumor margins, tumor necrosis, and Luminal B, Her 2 neu positive and TNBC tumors with larger tumor size and high nuclear grades.Conclusions: TB and PDCs are useful in the prognostication of Luminal A and B tumors when the Ki 67 index values are low/intermediate. Her 2 neu positive and TNBC tumors have a high nuclear grade with necrosis and no association with TB or PDCs.

Demographic and socioeconomic barriers and treatment seeking behaviors of patients with infectious keratitis requiring therapeutic penetrating keratoplasty

Purpose: To understand demographic and socioeconomic barriers and treatment-seeking behaviors of patients with infectious keratitis requiring therapeutic penetrating keratoplasty (TPK) in a developing country. Methods: This prospective non-comparative questionnaire- based study included all patients presenting to Aravind Eye Hospital, Madurai with infectious keratitis that eventuated to TPK between November 2015 and October 2016. A structured questionnaire was administered on post-operative day 3 to collect data on the demographic details, predisposing factors, prior treatment received, and treatment expenditures. Results: In total, 227 patients underwent TPK between November 2015 and October 2016 for infectious keratitis. The majority of patients were males (n = 132, 58.1%), illiterate (n = 129, 56.8%), and had a family monthly income of less than INR 6000 (n = 142, 62.5%). Most of the patients (n = 163, 71.8%) had prior treatment with an ophthalmologist before presenting to our hospital. The mean distance travelled to reach our centre was 269.2 ± 298.5 km. The mean duration of disease before the presentation was 20.3 ± 21.1 days. Corneal smear was positive for fungus in 163 (88.1%) and Aspergillus was the most commonly isolated fungi in 55 (41.3%) cultures. The mean total cost of treatment was INR 8752.87 ± 7615.39 per patient. There was a positive correlation between the duration of the disease (rho 0.19, P = 0.0034) and the costs of treatment (rho 0.2, P = 0.0024) with the distance travelled by the patient. Conclusion: Patients who travelled a farther distance had a delayed onset of presentation and spent significantly more than their respective counterparts.

Pythium keratitis in South India: Incidence, clinical profile, management, and treatment recommendation

Purpose: To study the demographic profile, clinical features, treatment outcome, and ocular morbidity of microbiologically proven Pythium keratitis in South India. Methods: A retrospective analysis of clinical records of microbiologically proven Pythium keratitis at a tertiary eye care referral center in South India from January 2016 to November 2017 was performed. Demographic details, predisposing risk factors, microbiological investigations, clinical course, and visual outcome were analyzed. Results: Seventy-one patients with microbiologically proven Pythium keratitis were identified. The mean age was 44(±18.2) years with an increase in male preponderance and 50% were farmers. Duration of delay at time of presentation to the hospital was a mean of 14(±7.2) days. The visual acuity at baseline ranged from 6/6 to no light perception (median 2.1 logMAR). A combination of 5% natamycin and 1% voriconazole was given to 42% patients, and natamycin alone was given to 39.4% patients. 1% itraconazole eye drops alone was initiated in 7 (10%) patients and 3 among this group responded. Therapeutic keratoplasty (TPK) was performed in 48 (67.6%) patients. None of the primary grafts remained clear after a period of 1 month. Twenty-six eyes (54.2%) had graft reinfection and all these eyes either developed anterior staphyloma (4) or were eviscerated (3) and 13 eyes became phthisical. The remaining 22 patients who had TPK resulted in failed graft. Among these, re-grafts were performed in 6 patients, of which 5 were doing well at the last follow-up. Conclusion: We report a large series of patients with Pythium keratitis. Promoting early and differential diagnosis, awareness of clinicians and specific treatment options are needed for this devastating corneal disease.

A case of penile zip trap.

A ten year old boy presented with a zip trapping the penis of two days duration. The zip was removed successfully under local anaesthesia. Various methods of removal of a zipper are described

Mitochondrial myopathies--a clinicopathological study.

Mitochondrial myopathies are heterogeneous group of clinical disorders that can affect multiple systems besides skeletal muscles. The mitochondrial abnormalities in the skeletal muscles are morphologically identified by the presence of characteristic Ragged-red fibers (RRF) in the cryostat sections of the muscle stained with modified Gomori's trichrome stain. In this retrospective study, clinical and histopathological features in six patients with mitochondrial myopathies have been analysed. The utility of histochemical methods in confirming the diagnosis of mitochondrial myopathy has been emphasised.

Nucleolar organizer regions in pituitary adenomas.

In this study, thirty-two non-functional and eighteen functional pituitary adenomas were analysed for the presence of argyrophilic nucleolar organizer regions (Ag-NORs) in paraffin sections, using an one-step silver-colloidal staining method. Differences in the mean Ag-NOR numbers of functional pituitary adenomas were statistically significant than those of non-functional pituitary adenomas. It is being emphasised that evaluation of Ag-NOR count is a more reliable index than the presence of mitotic figures in predicting the proliferative activity as well as possibility of recurrence in a patient with pituitary adenoma.

Utility of silver-colloidal staining method in the diagnosis of medulloblastoma.

Histopathological features of medulloblastomas are usually distinctive. However in rare instances, a distinction between the neoplastic cells of medulloblastoma and the neurones in the cerebellar internal granular layer becomes difficult at light microscopic level. In order to distinguish presence of argyrophilic Nucleolar Organizer Regions (Ag-NORs) was analysed in the paraffin sections of medulloblastoma as well as in the cerebellar internal granular layer. The neoplastic cells in medulloblastoma contained a mean 4.78 Ag-NOR per nucleus while the neurones in cerebellar internal granular layer contained a mean Ag-NOR 0.90 +/- 0.12 per nucleus. Compound Ag-NORs were present in the cells of medulloblastoma while they were absent in the neurones of cerebellar internal granular layer. The results of this study indicate that Ag-NOR technique may be useful in an uncommon situation, where a histopathological distinction between cells of medulloblastoma and neurones in the cerebellar internal granular layer becomes difficult.

Application of silver colloidal staining method in the diagnosis of intracranial glioma.

A silver colloidal staining technique for the demonstration of argyrophilic nucleolar organizer regions (Ag-NORs) was used on the paraffin sections of reactive gliosis and grade I astrocytoma tissue. Quantitative as well as qualitative differences of Ag-NORs were found between the cells of reactive gliosis and grade I astrocytoma. In cases of reactive gliosis, the Ag-NOR counts averaged 1.19 +/- 0.16 per nucleus, while in grade I astrocytoma, Ag-NOR counts averaged 2.36 +/- 0.32 per nucleus (P < 0.05). Compound Ag-NORs were also seen in the nuclei of cells in grade I astrocytoma while they were not present in the nuclei of cells in cases of reactive gliosis. The results of the study indicate that Ag-NOR technique is an useful method and can be applied in situations where a distinction between grade I astrocytoma and reactive gliosis becomes difficult at the light microscopic level.

Diagnostic utility of immunohistochemical techniques in intramedullary Schwann-cell tumours.

Histopathologic features in two intramedullary schwann-cell tumours, closely resembled with those of fibrillary astrocytoma and could not be differentiated from each other by the conventional histochemical stains. However application of tumour markers-Glial fibrillary acidic protein (GFAP) and S-100 protein were found to be useful in differentiating these two tumours and thus helped in making an accurate histopathological diagnosis in these two patients.

Immunohistochemical demonstration of mycobacterial antigens in intracranial tuberculoma.

Mycobacterial antigens have been demonstrated immunohistochemically in the paraffin sections of 10 intracranial tuberculous granulomas and the results were compared with the detection of acid fast bacilli by conventional Ziehl-Neelsen method. In none of the 10 specimens, acid fast bacilli were demonstrated while mycobacterial antigens were characterised as diffusely staining granular brownish-pink material within the cytoplasm of giant cells and macrophages. In 14 specimens of granulomatous lesions due to non-tuberculous aetiology, immunohistochemical stains were negative for mycobacterial antigen. Thus demonstration of mycobacterial antigen will be not only useful in establishing mycobacterial aetiology of a caseating intracranial granuloma but also can be used as an alternative method to the conventional Ziehl-Neelsen method.