Secretory cell outgrowths, p53 signatures, and serous tubal intraepithelial carcinoma in the fallopian tubes of patients with sporadic pelvic serous carcinoma.

Context: High‑grade serous carcinomas of ovarian, tubal, and peritoneal origin are together referred as pelvic serous carcinoma. The fallopian tubes, ovarian surface epithelium, and the tuboperitoneal junctional epithelium are all implicated in pelvic serous carcinogenesis. Aims: The aim of this study is to identify putative precursor lesions of serous carcinoma including secretory cell outgrowths (SCOUTs), serous tubal intraepithelial carcinoma (STIC), and p53 signatures and assign its probable site of origin. Settings and Design: Prospective case–control study of consecutive specimen comprising 32 serous carcinomas and 31 controls (10 normal adnexa, 10 benign and 6 atypically proliferative surface epithelial tumors, and 5 other carcinomas). Subjects and Methods: Sectioning and extensive examination of the fimbrial end (SEE‑FIM) protocol along with immunohistochemistry for Bcl‑2, p53, and Ki‑67 was employed for evaluating invasive carcinoma and precursor lesions in cases versus controls. Results: SCOUT, p53 signatures, and STIC were most frequent in the serous carcinomas. p53 signatures and STIC were always seen in the fimbrial end. STICs were exclusively present in serous carcinomas, more common in ipsilateral tubes of cases with dominant ovarian mass. Multifocal p53 signatures with STIC were seen in 7 (21.9%) cases. STIC was present with or without an invasive carcinoma in 25% and in 6.25% of cases of pelvic serous carcinomas, respectively. The junctional epithelia did not show any lesion in any group. Conclusions: SEE‑FIM protocol is recommended for evaluation of sporadicpelvic (ovarian/tubal/peritoneal) serous carcinoma. Based on the presence of STIC or invasive carcinoma, nearly 60% of all pelvic serous carcinomas are of fallopian tubal origin.

Histopathological yield in different types of bronchoscopic biopsies in proven cases of pulmonary tuberculosis.

Background: Diagnosis of pulmonary tuberculosis (TB) is difficult and often requires a lung biopsy. The goal of this retrospective study was to determine the histopathological parameters useful for diagnosis of pulmonary TB in different types of bronchoscopic biopsies (transbronchial lung biopsy [TBLB], transbronchial needle aspiration [TBNA], and bronchial biopsy [BB]). Materials and Methods: The records of patients diagnosed to have pulmonary TB, over a period of 1‑year were evaluated. Patients with positive acid‑fast bacilli (AFB) culture and with three bronchoscopic biopsies including TBLB, TBNA, and BB were included in the study. Selected (14) histological parameters were evaluated retrospectively in a total of 27 biopsies from 9 patients with TB after hematoxylin‑eosin and Ziehl‑Neelsen staining. Results: Diagnostic yield in TBLBs and TBNA was similar for granulomas detection (66.6% each). Granulomas in TBNA were larger, caseating and confluent as compared to small interstitial granulomas seen in TBLB. AFB was demonstrated in only one patient in TBNA. Lymphocytic cell cuffing was seen around most TBLB granulomas. One patient also showed microfilaria in blood vessel in TBLB. BBs in all patients showed the presence of goblet cell metaplasia and increased peribronchial plasma cell infiltrate with or without eosinophils may be indicative of chronic injury. The yield of granulomas was low in BBs seen in only 2 patients (22.2%). Conclusion: Diagnostic yield of TBNA and TBLB for granulomas was similar; however, caseation was seen more frequently in TBNA than on TBLB. Of other histological parameters, bronchial metaplastic changes and peribronchial plasma cells infiltrate were constant findings in all tubercular biopsies indicative of chronic injury.

Malignant granular cell tumor of the breast; literature review.

Malignant granular cell tumor (MGCT) is rare tumors that comprise 1-2% of all granular cell tumors. They commonly arise on lower extremity, nuchal region, chest wall, gastrointestinal tract, head, and neck but very rarely in breast. We report a case of a MGCT of breast with review of literature. The patient had noticed a breast mass 4 years back which was operated, and wide local excision was done. The tumor was diagnosed as MGCT. The tumor fulfi lled 3 of the 6 criteria of Fanburg-Smith et al. The patient received 8 cycles of chemotherapy thereafter with 4 cycles of antharacycline and 4 of taxanes. However, the tumor reoccurred 4 years after resection and grew rapidly. Contrast-enhanced computed tomography done showed a large lobulated breast mass with axillary lymph node metastasis. She underwent Modifi ed Radical Mastectomy with axillary clearance. The histopathology this time also revealed similar malignant tumor. To the best of our knowledge, only 7 cases have been reported in indexed English literature occurring primarily in breast.

Liquid-based cytology versus conventional cytology for evaluation of cervical Pap smears: Experience from the first 1000 split samples.

Context and Aim: Screening programs using conventional cytology conventional Pap smear (CPS) have successfully reduced cervical cancer, but newer tests like liquid-based cytology (LBC) and human papillomavirus testing might enhance screening. The main aim of the present study was to assess the diagnostic accuracy of LBC versus CPS using “split samples.” Materials and Methods: This was a prospective study comprising of 1000 consecutive cervical “split samples” over a period of 1 year. Split sample was obtained using cervex-brush. CPS was prepared from the brush and the brush head was suspended in the LBC vial and processed by SurePath™ LBC. Results: There were 4.3% unsatisfactory (U/S) cases in CPS and 1.7% in LBC; the main cause is insuffi cient cells, and excess of blood in CPS. About 25/100 (2.5%) split samples had epithelial abnormalities both in CPS and LBC (1.2%-atypical squamous cells of undetermined signifi cance; 0.4%-low grade squamous intraepithelial lesion; 0.2%-high grade squamous intraepithelial lesion; 0.5%-squamous cell carcinoma; 0.1%-atypical glandular cells favouring neoplasia; 0.2%-adenocarcinoma). Infl ammatory organisms were almost equally identifi ed in both techniques but were better seen in LBC samples. Conclusions: LBC technique leads to signifi cant reduction of U/S rate. LBC samples offered better clarity, uniform spread of smears, less time for screening and better handling of hemorrhagic and infl ammatory samples. LBC had equivalent sensitivity and specifi city to CPS.

Blind transbronchial needle aspiration without an on-site cytopathologist: Experience of 473 procedures.

Background. Transbronchial needle aspiration (TBNA) is an established procedure for sampling the mediastinal lymph nodes. Data reported from India are limited on this routine procedure. We describe our experience of the efficacy, diagnostic accuracy and safety of TBNA. Method. We retrospectively reviewed all TBNAs done at our centre between 2006 and 2009. Under local anaesthesia, accessible lymph node stations were sampled thrice without fluoroscopy and without an on-site cytopathologist. Data are presented in a descriptive manner. Results. A total of 4513 diagnostic bronchoscopies were done, of which 473 (10.5%) underwent TBNA. There were 297 men (63%) and 176 women (37%) with a mean (SD) age of 46.2 (13.98) years. The most common clinical diagnoses were sarcoidosis (50.5%), lung cancer (26.8%), tuberculosis (8.7%) and others (14%). The overall efficacy of TBNA in sampling a mediastinal/hilar lymph node was 72%. The accuracy of TBNA in achieving a pathological diagnosis was 40.4%, whereas the diagnostic yield of a successful procedure was 56.8% (lymph nodes were successfully sampled in 193 of 340 procedures). The most common diagnoses on cytology were sarcoidosis and lung cancer. In patients with a clinical diagnosis of lung cancer, the diagnostic accuracy of TBNA was 46.5% (59 of 127), whereas in patients with sarcoidosis it was 38.1% (91 of 239). TBNA provided an additional diagnostic yield in 5.6% (12 of 215) of patients with sarcoidosis who also underwent transbronchial lung biopsy. There were no periprocedural complications. Conclusion. Blind TBNA is a safe and effective procedure that can be routinely done in the bronchoscopy suite.

Retrospective and prospective study of ovarian tumours and tumour-like lesions.

Two hundred and thirty three cases of ovarian tumours and tumour like lesions were studied. Of these 233 cases, 96 cases were of ovarian tumours and 137 were tumour like lesions of the ovary. Of the 96 cases of ovarian tumours, 72.9% were benign, 4.1% were borderline and 22.9% were malignant. Histologically surface epithelial tumours were the commonest (48.8%) followed by germ cell tumours (23.9%), sex cord stromal tumours (8.3%) and metastatic tumours (2.0%). Ultrasound guided FNAC done in cases of ovarian tumours showed an accuracy of 100% for malignant lesions and 100% for benign and borderline lesions when compared with histopathological diagnosis. Of the non neoplastic lesions follicular cysts and corpus leuteal cysts were commonest (80.2%). Tuberculosis constituted (2.9%) cases and was the major cause of clinical diagnostic pitfalls for cases in which a clinical diagnosis of ovarian neoplasm was made.

Pattern of fibronectin in hepatocellular carcinoma and its significance.

Fibronectin is a multifunctional large molecular weight glycoprotein that can bind extra-cellular and cellular components. The aim of the present study was to evaluate expression of fibronectin and its significance in cases of hepatocellular carcinoma (HCC). A few previous studies have shown abnormal over- expression of fibronectin in cases of HCC. Expression of the fibronectin protein was studied in eleven cases of HCC by immunohistochemical method. Fibronectin was seen to localize predominantly in perisinusoidal region and strong positivity was noted in other fibrotic areas. Positivity around nests of cells and tumor nodules was noted in 8/11 cases of HCC and faint cytoplasmic positivity in tumor cells was seen in 5/11 cases. Staining pattern of fibronectin in HCC was definitely abnormal but decreased in the present study. The controversial results as seen in few previous studies also have been partially explained in the present article and further studies using larger sample size is suggested to clarify the issue.

Recurrent endocervical-like mucinous borderline tumor (ELMBT) arising in a case of long-standing endometriosis--a case report.

Endometriosis is a well-known precursor lesion of ovarian malignancies, particularly those of endometrioid and clear-cell types and rarely of serous or mucinous types. The association of endometriosis with mucinous borderline tumors also varies. This case is of a 60 year old female, who had a long history of more than thirty years of endometriosis and developed recurrent endocervical-like mucinous borderline tumor (ELMBT) in endometriotic foci. This case highlights challenges in the management of such complications associated with endometriosis and emphasizes the importance of long-term follow-up in cases of endometriosis.

Prognostic and predictive value of c-erbB2 overexpression in osteogenic sarcoma.

BACKGROUND: Osteogenic sarcoma (OS) is a highly malignant tumor of the bone. There are few reports in the literature regarding determination of c-erb B-2 (HER-2/neu) expression in cases of OS and also the results are quite variable. AIM: The present study was undertaken to correlate the expression of c-erbB2 with the survival of patients of OS. SETTINGS AND DESIGN: A retrospective study of cases of OS, in which the expression of c-erbB-2 by immunohistochemistry (IHC) was studied and correlated with the survival rate of the patients. MATERIALS AND METHODS: Out of a total of 49 cases, proper follow up data in the form of total and disease free survival was available in only 20 cases. IHC for c-erb-B2 was carried out in these 20 cases. RESULTS: The staining pattern was as follows: no staining in 3 cases, 1 + in 5 cases, 2 + in 3 cases, 3 + in 3 cases and 4 + cytoplasmic positivity in 6 cases. Statistical analysis: Spearman rank correlation test was used to correlate the intensity of cytoplasmic staining of c-erbB-2 with survival rate of the patients, response to chemotherapy and metastasis. CONCLUSIONS: Previous studies have shown that c-erbB-2/HER-2 is an independent prognostic factor in osteogenic sarcoma, but in the present study, its expression was not seen to be correlating with survival rate of the patients. Therefore, further studies are needed to reach a consensus regarding the reliability of c-erbB-2 as an independent prognostic factor in OS.

Spermatic granuloma presenting as an epididymal nodule: fine needle aspiration cytological findings and differential diagnosis.

Spermatic granuloma is a granulomatous lesion that presents clinically as a nodular lesion in the region of epididymis. There are only few documented cases of spermatic granuloma in the literature. Fine needle aspiration (FNA) reveals mixed inflammatory cells comprising of plenty of macrophages along with lymphocytes and scattered polymorphs in a fluidy background containing many spermatozoa and sperm heads. Sperm heads are also noted within macrophages. Ill formed to well-formed granulomas were seen in all the cases. FNA has an important role in the differential diagnosis of epididymal nodule as it can rule out malignancy and other benign cytological diagnosis like tuberculosis, acute and chronic epididymo-orchitis. Distinction of spermatic granulomas from the more common tuberculous granulomatous infection is important from the cytopathologist's point of view. By providing an accurate and rapid diagnosis, FNA prevents aggressive and potentially inappropriate surgical procedures.

Myxomatous stromal changes and necrosis of bone marrow--a retrospective study of 3 years.

Myxomatous stromal changes and bone marrow necrosis (BMN) are uncommon histologic findings. These changes have been found in various conditions like disseminated carcinomatosis, postchemotherapy cases, chronic infections, infiltrative disorders of the marrow etc. The present study is a retrospective study of 3 years (Jan, 1999 to Dec. 2001) from Deptt. Of Hematology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh (India). During this period, 3740 bone marrow samples were examined. Myxomatous stromal changes and bone marrow necrosis were noted in 0.43% (16/3740) and 0.45% (17/3740) samples respectively. In addition to common causes of myxomatous stromal changes and bone marrow necrosis as described in the literature, this study highlights the association of these conditions with some of the rarer entities like hyperoxalosis, leishmaniasis, parvovirus induced marrow aplasia and cryptococcal infection. There is paucity of such associations in the literature.

Adenosquamous carcinoma of the rectum: a case report.

Adenosquamous carcinoma is defined as a tumor with well defined malignant glandular and squamous components and the potential for both components to metastases. This tumor is extremely rare in colon and rectum with an incidence of less than 0.2%. Adenosquamous carcinoma of rectum should be distinguished from collision tumor with exemption of all lesions located distal to a level of 7 cm above the dentate line. Here we present a case of rare type adenosquamous carcinoma in rectum in a 29 year old female.

Study of nucleolar organizer regions (NORs) in lesions of gallbladder.

Tissue sections from 100 specimens of gallbladder including 40 cases of chronic cholecystitis, 30 cases of epithelial hyperplasia and 30 cases of well, moderately and poorly differentiated adenocarcinoma of gallbladder were studied for argyrophillic nucleolar organizer regions (AgNORs). The arithmetic mean +/- S.D. were calculated for each category. This showed NOR counts of chronic cholecystitis--(1.89+/-0.96), epithelial hyperplasia--(3.99+/-1.03), well differentiated adenocarcinoma (WDCA)--(7.04+/-1.34), moderately differentiated adenocarcinoma (MDCA)--(7.52+/-0.97) and poorly differentiated adenocarcinoma (PDCA)--(8.37+/-1.27). The study revealed increasing number of AgNORS from cases of chronic cholecystitis to epithelial hyperplasia to carcinoma gallbladder, but a considerable overlap in AgNOR counts of individual cases was observed suggesting that though AgNOR count cannot act as a specific diagnostic parameter for diagnosis of early carcinoma & dysplasia in isolated cases, they may prove to be a good adjunct to presently available imaging techniques and cytology.

Study of prevalence & correlation between HIV and syphilis among blood donors in a teaching hospital, Ludhiana, India.

In the present study, total of 21014 healthy blood donors were screened, out total, 20 (0.095%) were found to be positive for syphilis and 18 (0.086%) were found to be positive for human immunodeficiency virus, So, a positive correlation was seen between the positivity of syphilis & HIV. This supports the idea that syphilis screening of blood donors should be continued.