Comparative Evaluation of Immunohistochemical Expression of Estrogen Receptor, Progesterone Receptor and HER2 in Fine Needle Aspiration Cell Blocks and Surgical Biopsies in Primary Breast Carcinoma

Introduction: Breast carcinoma is the leading cause ofcancer mortality among females. Estrogen and Progesteronereceptors (ER, PR) and HER2 have been used for theranosticsin breast cancer. Fine needle aspiration cytology (FNAC)can yield highly cellular material for cytological diagnosis.Predictive biomarker assessment can be done on cytologicspecimens to know the patient’s eligibility for endocrinetherapy and anti- HER2- targeted therapy. Cell blocks furthercan increase the diagnostic accuracy through morphology andthe use of immunohistochemistry (IHC). The present studywas undertaken to evaluate immunohistochemical expressionof estrogen receptor, progesterone receptor and HER2 in fineneedle aspiration cell blocks and surgical biopsies in primarybreast carcinoma cases.Material and methods: IHC for ER, PR and HER2 wasassessed on 50 pre chemotherapy breast carcinoma cell blocks(fixed in 10% formalin) and subsequent tissue sections.The scoring for ER/ PR was done according to ASCO/CAPguidelines. Strong circumferential membrane staining ingreater than 10% of tumor cells was considered positive forHER2.Results: Immunostaining assessment on cell block and theircorresponding tumor tissues showed a good concordance: ER(92%), PR (92%) and HER2 (93.75%). Taking histology asthe final outcome, the sensitivity of ER, PR and HER2 on cellblock was 92.30%, 86.36% and 91.67%, respectively, whilespecificity was 92.85%, 96.43% and 94.44%, respectively.Conclusion: IHC on cell blocks from breast carcinoma casesis useful especially when planning neoadjuvant chemotherapy.The pre analytic and analytic variables should be validated tooptimize the diagnostic utility of cell blocks.

Nodular fasciitis: A diagnostic challenge.

Nodular fasciitis is a rare benign soft tissue tumor. The similarity in the cytological appearance of nodular fasciitis to that of pleomorphic adenoma makes it diffi cult to diagnose preoperatively that adds to its peculiarity. We report here a case of a middle-aged female with swelling in the neck that was diagnosed as pleomorphic adenoma on cytology. Surgical excision of the swelling was done and histopathological examination revealed it to be nodular fasciitis. This case is presented to highlight the challenge of correctly diagnosing nodular fasciitis.

Blunt duodenal trauma

Duodenal trauma presents both diagnostic as well as management dilemma. In majority of duodenal trauma cases, primary duodenal repair is sufficient. But in complex duodenal injuries, adjuvant procedures to protect suture line may prove to be helpful. Herein, we share our experience of managing 4 cases of blunt duodenal injuries who presented in emergency at the hospital from 2008 to 2011. All 4 cases had followed road traffic accidents. Their intra-operative findings, operative procedures, complications, and recovery time were recorded and described

Intestinal tuberculosis in a celiac disease patient.

Both intestinal tuberculosis and celiac disease can cause malnutrition and failure to thrive. High index of suspicion is required to diagnose intestinal tuberculosis in a known case of celiac disease as both conditions present with similar complaints. We report a case of celiac disease with intestinal tuberculosis and perforation peritonitis.

Morphological and functional outcome after pancreatic necrosectomy and lesser sac lavage for necrotizing pancreatitis.

BACKGROUND: Immediate outcomes after pancreatic necrosectomy have improved in recent years. This study reviews our short-term to medium-term experience of structural and functional changes in the pancreas after necrosectomy. METHODS: Ten patients (8 males, median age 35 years), discharged after pancreatic necrosectomy for acute necrotizing pancreatitis between 1996 and 1998 were reviewed after a median period of 22 months. Clinical evidence of pancreatic dysfunction was documented at follow-up interview. Patients underwent computed tomography of the abdomen, endoscopic retrograde pancreatography, oral glucose tolerance test, fecal fat estimation and fasting serum C-peptide estimation (CPE). RESULTS: No patient had repeat episodes of pancreatitis during the follow-up period. Three patients developed de-novo diabetes after discharge. No patient had symptoms of steatorrhea. Five patients showed severe changes on CECT. ERCP showed marked changes in six patients, the commonest being an abrupt cut-off of the main pancreatic duct. Glucose tolerance was abnormal in three patients and impaired in two patients while fecal fat excretion was abnormal in 8 patients. CONCLUSIONS: Severe acute pancreatitis and necrosectomy are associated with significant structural and functional changes on medium-term follow-up.