Utilization of antihepatocyte clone OCH1E5 (Hep Par 1) in histological evaluation of liver tumors.

Diagnosis of hepatocellular carcinoma (HCC) is not always easy on simple hematoxylin and eosin (H&E) stain. The diagnostic problems arise when tumor shows pseudoglandular, pleomorphic or clear cell differentiation. Various tumors markers have been described with varying sensitivity and specificity. Monoclonal antibody Hep Par 1 (OCH1E5) which is specific for hepatocytes offers great help in separation of these tumors. The aim of the present study was to determine utility of Hep Par 1 (OCH1E5) in differentiating HCC from metastatic tumors and cholangiocarcinoma. Total of 62 cases of liver tumors obtained from biopsies, resected or autopsy specimens were included in the study. Slides having representative sections were subjected to immunohistochemistry with monoclonal antibody Hep Par 1 (Dako Corp) using avidin biotin technique with primary antibody dilution of 1:40. Adjacent nontumorous hepatocytes were taken as positive control. Slides were examined by experienced pathologist without any information of clinical or H&E diagnosis. Cases were considered positive for Hep Par 1 if tumor cells showed cytoplasmic brown colored granules. The intensity and distribution (diffuse/ focal) of immunoreactivity was noted. Subsequently immunohistochemistry results were correlated with histology and clinical diagnosis. Hep Par 1 antibody was positive in 26 (42 %) and negative in 36 (58 %) liver tumors. On correlating with H&E sections, out of 26 positive cases, 25 (89.2%) were HCC and one was the case of metastasis of mucin secreting adenocarcinoma. From 36 tumors with negative staining 3 were cases of HCC, 27 metastatic adenocarcinomas and 6 cholangiocarcinomas. Only one case of liver metastasis of mucin secreting adenocarcinoma showed positivity. None of the cases of cholangiocarcinoma showed positivity for Hep Par 1. The three HCCs which did not take up staining for Hep Par 1 were 2 cases of moderately differentiated HCC having pseudoglandular pattern and a case of well differentiated HCC with trabecular arrangement. In 11(44%) cases staining was diffuse while in 14 (56%) it was focal but intense. Hep Par 1 is a useful marker in differentiating HCC from metastaic tumors and cholangiocarcinoma with sensitivity and specificity of 89 % and 97 % respectively and positive predictive value of 96 %. However one should be aware of limitations of immunohistochemistry.

Insulinoma--a case report.

Insulinoma is a rare pancreatic endocrine tumour characterised by hyperinsulinemic hypoglycemia. It is important to surgically remove this tumour as it can cause potentially lethal hypoglycemia. We report a case of insulinoma presenting with unconsciousness following repeated episodes of inability to arise from sleep and convulsions. Biochemical investigation revealed hypoglycemia and hyperinsulinemia. The diagnosis of Insulinoma is often delayed due to misattribution of symptoms to psychiatric or neurological disorders. In this case, same delay lead to fatal outcome for this patient.

Haemophagocytosis in tuberculosis--a case report.

Reactive histiocytosis with hemophagocytosis is most commonly associated with viral infections. Appearance of hemophagocytosis in the tissues is associated with a rapid progression of the underlying disease, and therefore it is important to diagnose and treat the etiological factor at the earliest. Hemophagocytosis is uncommonly associated with tuberculosis and we report one such case.

Neuroendocrine differentiation in hepatocellular carcinoma.

A patient with hepatocellular carcinoma with neuroendocrine features is reported. Identification of this tumor is essential due to its aggressive behavior and the differences in the treatment and clinical control of the patient.

Peliosis of spleen presenting as splenic rupture with haemoperitoneum--a case report.

Peliosis of spleen is usually associated with peliosis of liver. Oval to round markedly dilated blood filled cystic spaces predominantly in parafollicular area is the characteristic feature of peliosis to differentiate it from congested sinuses. Exposure to viruses chemicals, contraceptive steroids or chronic debilitating disorders including malignancies are the various possible etiological factors. Though peliosis may remain asymptomatic, fatal intraperitoneal haemorrhage may occur due to its rupture. We report a case of peliosis of spleen presenting as splenic rupture with haemoperitoneum.

Immunohistochemistry of thyroid carcinoma--an experience with thyroglobulin and calcitonin.

A retrospective immunohistochemical study of 33 cases of primary thyroid carcinomas and 5 cases of metastases to thyroid was carried out. The immunostaining for thyroglobulin and calcitonin was done by peroxidase-anti-peroxidase (PAP) technique. The optimum staining results were obtained by proper standardisation of the staining procedure and reagents. The sections were systematically evaluated for immunostaining intensity and distribution. The observations revealed that thyroglobulin and calcitonin could be useful as sensitive and specific histogenetic markers for follicular and parafollicular cell derived thyroid carcinomas respectively. However, there was no absolute correlation between thyroglobulin positivity and grade of differentiation. The immunostaining could not differentiate follicular adenoma from follicular carcinoma. More extensive study using other markers may be useful for better patient management.

Mammary hamartomas--a report of 15 cases.

The mammary hamartoma is a poorly recognised benign breast neoplasm. For diagnosis one usually correlates the clinical, mammographic, gross and histologic features. This study of fifteen cases emphasises the histomorphologic criteria for diagnosis especially in the absence of mammographic picture, viz. a clinically palpable, well encapsulated mass which on histology shows normal breast epithelium admixed with fat, fibrous tissue and other mesenchymal elements. The epithelium in the hamartomas studied showed changes seen in normal breast especially in the progestational phase of the menstrual cycle. The stroma was either densely collagenous, hyalinised or cellular and admixed with fat in various proportion in thirteen cases, muscle in two cases and thick muscular arteries in four cases. It also showed pseudoangiomatous hyperplasia in seven cases. The importance of this change and probable evolution is discussed therein.

Cytohistomorphology of prostatic lesions--by FNAC & scrape methods.

A pilot study of transrectal fine needle aspiration biopsy was conducted in 44 patients, above the age of 50 years, who presented with features of obstructive uropathy during a one year period between August 1990 and April 1991. Histopathological study was carried out in 23 out of 44 patients, who underwent total prostatectomy or transurethral resection following the aspiration biopsy procedure. In 21 patients FNAB by the transrectal route could not be obtained because of technical difficulties; therefore intraoperative scrape cytology was studied prior to histopathology, of the fresh prostatic specimen. A good cytohistopathological correlation was obtained by both methods; an accuracy of 95.6% and 95.2% with FNAC and scrape respectively. A wide range of benign and malignant lesions were studied.

Malignant melanoma of nasopharynx extending to the nose with metastasis in the neck.

Malignant melanoma is a rare tumor in otorhinolaryngology. In this paper, we have reported the first case of melanoma of nasopharynx which we came across in 20 years of ENT practice. A 55 year old male patient with complaints of swelling of nose and left side of neck, nasal blockage and epistaxis was diagnosed as melanoma of nose with metastasis in the neck based on clinical and radiological examination. The tumour was excised by lateral rhinotomy with supraomohyoid block dissection on the left side. The tumour was found to originate from lateral wall of nasopharynx and middle turbinate. The surgery was followed by radiotherapy. Diagnosis of melanoma was confirmed on histopathology. During 30 months follow-up, no recurrence was noticed.

Experience with bone marrow trephine biopsy.

One hundred and ten bone marrow trephine biopsies were studied from January 1987 to July 1989, using Zenker's acetic acid as fixative and routine paraffin embedding. Trephine biopsies were useful in differential diagnosis of cytopenias, especially when bone marrow aspiration was hypocellular or a dry tap, and in staging of lymphomas and multiple myeloma.