Cell cannibalism: a diagnostic and prognostic marker of breast cancer

Background: Cell cannibalism (cytophagocytosis) is defined as a tumor cell within a tumor cell, such that smaller tumor cells are found in the cytoplasm of larger tumor cells with crescent shaped nuclei. Aims and Objectives were to study the cytomorphological characters of cell cannibalism in primary and metastatic breast cancer, to correlate the histologic type and grade of tumors with positive rate of cannibalism and to study the role of Cannibalism as an independent prognostic factor in breast cancer.Methods: The study was conducted during the period of July 2003 to June 2005 in the Department of Surgery and Pathology, JNMCH, Aligarh. A total of 42 cases were included in the study. A minimum of 3 FNAC smears per case were assessed for cytophagocytosis. Presence of metastasis was also noted to establish the cytological grade and aggressiveness of the tumor.Results: Out of 42 cases, significant cannibalistic activity was noted in 30 (71.42%) cases. All grade III (33.4%) breast tumors were found positive for cytophagocytosis (4.28/smear), while the rate was much lower (2.33/smear) in grade II and (1.63/smear) in grade I tumors. LN metastasis was confirmed by histopathological examination in all high grade tumors showing significant cannibalistic activity.Conclusions: Cannibalism in breast carcinoma is an indicator of both the anaplastic grade and invasiveness. The rate of cytophagocytosis may have a prognostic significance.

Chediak Higashi Syndrome with Recurrent Upper Respiratory Tract Infection.

A four-year old child presented with history of recurrent infections since birth, mostly upper respiratory tract infections or sino-pulmonary involvement and moderate grade fever with symptomatic relief on antibiotics and antipyretic medications. We present this case which was diagnosed as respiratory tract infection with neutropenia consistent with Chediak-Higashi syndrome(CHS), with a brief review of this rare genetic clinical entity.

The significance of microbiopsies in cytological smears.

Background: The role of fi ne needle aspiration cytology (FNAC) in the diagnosis of malignant lesions is well documented. Conventionally obtained fi ne needle aspiration (FNA) smears frequently contain well preserved viable intact tissue fragments (microbiopsies). Aims: The present study was aimed at evaluating the microbiopsies and carrying out further cyto-histopathologic correlation in order to assess what additional information they could provide. Materials and Methods: A total of 116 FNA smears from clinically suspected malignant lesions were examined, of which 81 smears (70.0%) contained representative tissue fragments of the tumors. Histopathological details were available in 75 cases. Immunocytochemistry (ICC) was applied in selected smears as and when required. Results: Tumors in which microbiopsies aided in diagnosis chiefl y included soft tissue malignancies (12 cases), typed into malignant peripheral nerve sheath tumor, fi brosarcoma, spindle cell sarcoma and malignant melanoma; lung tumors (14 cases) classifi ed as small cell carcinoma, large cell carcinoma, squamous carcinoma and adenocarcinoma; breast tumors (08 cases), typed into ductal, medullary and lobular carcinoma; and lymph node metastasis (19 cases) from primaries in lung, larynx and thyroid. The cyto-histopathologic concordance was raised from 81.2% in the absence of microbiopsies to 93.2% in their presence. Conclusions: FNA smears containing microbiopsies are of ample help in establishing fi rm diagnosis, tumor typing, and predicting possible primary sites in metastatic tumors which were not possible by cytology alone. Hence, this technique can be utilized to enhance the diagnostic accuracy of FNAC, if put into practice in evaluation of routine cytology smears, without increasing any fi nancial burden on patients.

Osteosarcoma of the Clavicle in an Adolescent Child.

Clavicle is an unusual site for any primary bone tumour, including osteogenic sarcoma. Although a rare site of affection, most clavicular tumours tend to be malignant. We present a case report of osteosarcoma of the clavicle in a twelve-year-old male child who presented with a huge swelling of the left clavicle for the last six months.

Screening children with severe short stature for celiac disease using tissue transglutaminase.

Objective. To determine the prevalence of anti-tissue transglutaminase in children and adolescents with severe short stature (<-3 SD). Methods. All children in age group of 1-18 years having height less than -3 SD for their age and sex, were included. For each child age and sex matched healthy control (height more than -2 SD) was taken. The included subjects (study & control group) were subjected to anti tissue transglutaminase (tTG) (IgA) antibody assay estimation. Results. Of the 112 cases, 23 were tTG positive, giving a prevalence of 20.5% for seropositivity among cases of short stature while all the controls were seronegative for tTG. All the 23 had tTG values above 40 U/ml and 11 had values above 100 U/ ml. On univariate analysis we found that the presence of chronic diarrhea (OR = 2.55, 95%CI - 1.08-5.98), bulky stools (OR = 3.03, 95%CI - 1.52-6.05), hemoglobin < 7 gm/dl (OR = 3.12, 95%CI - 1.55 - 6.29) and more severe short stature (<-4 SD) (OR = 0.41, 95%CI - 0.17- 0.95) had significant association with the tTG positivity. On logistic regression analysis in all cases, hemoglobin < 7gm/dl (OR = 0.090, 95%CI = 0.024-0.342) and bulky stools (OR=0.212, 95%CI = 0.069-0.649) were significantly associated with tTG positivity. Conclusion. More than one fifth of all severe short stature are seropositive for tTG and the chances of seropositivity increases if severe anemia and bulky stool are also associated.

Pindborg Tumor in an Adolescent- An Atypical Presentation.

Calcifying epithelial odontogenic tumor (Pindborg tumor), is a rare benign odontogenic neoplasm representing about 0.4-3% of all odontogenic tumors. This tumor more frequently affects adults in an age range of 20- 60 years, with a peak incidence in the 5th decade of life. Calcifying epithelial odontogenic tumour has a much lower recurrence rate than ameloblastoma and malignant transformation with metastasis is rare.

Giant Cell Tumor along with Secondary Aneurysmal Bone Cyst of Scapula: a rare Presentation

Giant cell tumor (GCT) is a distinctive lesion characterized by the proliferation of multinucleate giant cells in a stroma of mononuclear cells; it is generally seen in skeletally mature individuals. GCT of bone is usually found in the long bones around the knee or in the distal radius of young adults and is unusual in the flat bones. We report a case of GCT of the acromion of the scapula; with a secondary aneurysmal bone cyst; in a 30-year-old female. Based on our review of the eng language medical literature; it appears that the occurrence of a GCT along with a secondary aneurysmal bone cyst in flat bones (e.g.. the scapula) is very rare

Alpha-1 antitrypsin deficiency among Indian children with liver disorders.

AIMS: To determine the frequency of alpha-1 antitrypsin (AAT) deficiency in children with chronic liver disease (CLD) and neonatal cholestasis syndrome (NCS). METHODS: All children with NCS (n=23) or CLD (n=35) attending the Pediatric Gastroenterology Clinic between November 2003 and July 2005 were screened for AAT deficiency using phenotyping through isoelectric focusing of plasma. RESULTS: Of the 58 children studied, 57 had normal PiMM phenotype. One child with CLD had the M1E type of normal variant. None of the patients had the abnormal phenotype PiZZ. CONCLUSION: AAT deficiency is infrequent among children with CLD and NCS in our region.

Fine Needle Aspiration Cytology in the Management of Tumors and Tumor like Lesions of Bone

FNAC should be considered as the part of routine preliminary investigation of orthopaedic patients presenting with musculoskeletal tumorous lesions. A total of 110 cases were screened cytologically in the background of clinical, radiological findings and biochemical tests. Primary malignant tumor formed the major entity accounting for 56% of the cases, while benign tumors comprised 8% only. Overall success rate of needle aspiration cytology in diagnosing tumors and tumor like lesions was 92%. Giant cell tumors of bone was the most common malignant lesion observed in 15 cases (30%), followed by Ewing's Sarcoma in 5 cases (10%). Cytologic diagnosis was completely compatible with the final histopathologic diagnosis in 82.3% of cases.

Significance of apoptosis in prostatic intraepithelial neoplasia and carcinoma.

This study was carried out to assess the significance of apoptosis in prostatic intraepithelial neoplasia (PIN) and prostate cancer. A total of 120 prostatic specimens were studied in the department of Pathology [corrected] JNMC, Aligarh. The rate of apoptosis in PIN and prostate cancer was examined by quantifying the number of apoptotic bodies per hundred cells (apoptotic index) on haematoxylin and eosin stained histological sections [corrected] A significant correlation was noted between increasing apoptotic indices and increasing Gleason grades within a cancer.

Bilateral lower zone shadows on chest radiograph - A clinicopathological profile.

Background: The initial suspected diagnosis in bilateral lower zone lung involvement made clinically can be compared and correlated with the final diagnosis obtained after percutaneous FNA cytology, BAL fluid examination and transbronchial biopsy. Aim: To study diseases presenting with bilateral lower zone shadow on chest radiograph and compare the initial clinical diagnosis to the final diagnosis. Methods: Fifty six patients were studied by routine hematological, sputum and pleural fluid examination along with PCNA and TBNA cytology, bronchial aspirate/ BAL fluid examination and transbronchial biopsy after a detailed clinical history and thorough physical examination. Results: Initially suspected diagnosis included tuberculosis in 32.1% cases, pneumonia in 30.4%, malignancy in 10.7%, pulmonary oedema in 5.4%, bronchiectasis in 8.9%, ILD in 7.1%, TPE in 3.6% and bilateral hydatid disease of lung in 1.7% of cases. The final diagnosis revealed tuberculosis in 25.0% cases, pneumonia in 23.2%, malignancy in 16.1%, bronchiectasis in 8.9%, pulmonary oedema and ILD in 7.1% each, sarcoidosis and TPE in 3.6% each, while pulmonary candidiasis, pulmonary alveolar proteinosis and bilateral hydatid disease of the lung in 1.7% case each respectively. Conclusion: Majority of cases can be diagnosed by a detailed clinical profile along with a chest radiograph. However, FNAC and fibreoptic bronchoscopy are of high value for pathological and microbiological confirmation of the diagnosis and provides a significant yield.

Transbronchial needle aspiration in undiagnosed radiographic shadows.

Background: Transbronchial needle aspiration (TBNA) is diagnostic in benign and malignant pulmonary lesions. The technique of TBNA has made mediastinal and hilar nodes accessible. In addition to its usefulness in central airway lesions, TBNA has been found to increase the diagnostic yield in peripheral lesions also. Aim: To evaluate the role of transbronchial needle aspiration (TBNA) in cases of unconfirmed radiographic shadows. Material and Methods: A detailed clinical history was recorded in all the 54 patients, who presented with an unconfirmed radiographic shadow. Thereafter, fibreoptic specimens of bronchial aspirate and TBNA were collected, and subjected to Ziehl-Neelsen staining, Graim’s staining, fungal smear, culture for pyogenic organisms and acid fast bacilli and cytological examination by H & E stain and Papanicolaou staining.Bronchial biopsy was collected in cases wherever feasible and specimens were paraffin embedded cut into 3-5 mm thickness and stained with H & E stain. Results: Out of 54, 48.1% were diagnosed to be having bronchogenic carcinoma, 20.4% each pneumonia and tuberculosis, while one patient had primary fungal infection (Candida abbicaus). The overall diagnostic yield was highest with TBNA (85.2%) followed by transbronchial biopsy (48.2%) and bronchial aspiration (42.7%) cases. Conclusion: TBNA offers an unique opportunity to make a pathological diagnosis at the time of bronchoscopy. It is equally effective in diagnosing various infective conditions like pneumonia and tuberculosis.