The significance of expression of Her2neu in squamous cell carcinoma of uterine cervix

Background: Cervical cancer is one of the leading causes of cancer related deaths among females. It arises from precursor lesions i.e. squamous intraepithelial lesions which are closely associated with infection by HPV. The ERBB2 protooncogene encodes for a cellular transmembrane protein (erb-b2) which has tyrosine kinase activity and has been implicated in the regulation of cellular growth and proliferation in various cancers. Application of monoclonal antibodies against Her2neu has shown higher response and improved survival. The aim of the study was to evaluate the expression of Her2neu in squamous cell carcinoma of cervix in relation to tumor characteristics and to compare the expression with normal control subjects.Methods: It was a cross-sectional analytical study. Paraffin embedded tissue blocks from 30 cases of squamous cell carcinoma were obtained from the archives. Twenty age matched cases of normal cervix removed for lesions other than that related to cervix (like leiomyoma) were taken as control. Tumour characteristics were noted from the records. Her2neu immunostaining was done. Her2neu expression was scored as positive or negative according to the American Society of Clinical Oncology and the College of American Pathologists (ASCO/CAP) scoring system for Her2neu. The Chi-square test was used to compare and find association between the variables. Student t-test was used to compare the variable between cases and controls.Results: Her2neu was positive in 20% and negative in 80% cases of the study group. Her2neu positivity is not associated with size, histological grade and FIGO stage of the tumor. We found that all Her2neu positive cases showed no lymph node metastasis. This association between Her2neu positivity and lymph node status was statistically significant.Conclusions: Her2neu immunoexpression is variable across various categories of squamous cell carcinoma. Her2neu positivity might be negatively associated with lymph node metastasis. However, a more comprehensive study encompassing various factors related to Her2neu overexpression is required to validate these results.

Capillary haemangioma of fallopian tube: a rare but dangerous incidental finding

Haemangiomas are tumors of vascular origin. They are frequently observed in soft tissue and skin. Vascular tumors of female pelvic organs are extremely rare. Although, majority of these lesions are detected incidentally, they can mimic various benign and malignant lesions clinically and radiologically. Fallopian tube capillary haemangioma is very rare benign neoplasm. Only one case of capillary haemangioma of fallopian tube has been reported. A 44-year-old female with menorrhagia, underwent hysterectomy with bilateral salpingoopherectomy. Both the fallopian tubes were grossly unremarkable. Microscopic examination revealed a well circumscribed vascular neoplasm, consistent with capillary haemangioma, CD34 immunostaining highlighted the vascular endothelium.  Although benign in nature, haemangioma of the fallopian tube can present with complications. Rupture of the haemangioma can be lethal when present with hemoperitoneum.

Molecular phenotypes of ductal carcinoma-in-situ and invasive ductal carcinoma: A comparative study.

Aims and Objectives: This study was aimed at analyzing the prevalence of molecular phenotypes in invasive ductal carcinoma (IDC) and coexisting ductal carcinoma-in-situ (DCIS) and to correlate with clinicopathological features. Materials and Methods: In this study, 75 cases of IDC with coexisting DCIS were included. Molecular phenotype was determined using expression of estrogen receptor, progesterone receptor, HER2/neu, and cytokeratin 5/6. Statistical analysis was performed for correlation between molecular phenotypes and clinicopathologic parameters. Results: Of the 75 cases, the invasive component in all cases was IDC-not otherwise specified. About one-third of our patients were post-menopausal. The most common molecular phenotype was luminal A (45.3%) followed by HER2-expressing type (24%). In all cases, the molecular phenotype was identical in DCIS and the invasive component. HER2-expressing tumors were found to be larger in size with frequent nodal involvement. On statistical analysis, tumor size and grade were found to correlate with the molecular phenotype. Conclusion: In conclusion, the molecular phenotype in DCIS correlates well with that of coexisting IDC, suggesting that DCIS is a precursor lesion in these tumors. This correlation of molecular phenotype can be utilized in prediction of phenotype of the invasive component in a case with in-situ carcinoma.

Predictors of histological activity and fibrosis in chronic Hepatitis C infection: A study from North India.

Background and Aims: The role of hepatitis C virus (HCV) genotypes in the severity of liver disease is still debatable and there is an occasional published report from India. The aim of this study is to assess the role of HCV genotypes in severity of liver disease in Indian patients. An attempt has also been made to perform a multivariate analysis to identify the predictors of severity of liver disease in chronic HCV infection. Materials and Methods: In this study, 31 newly diagnosed cases of chronic HCV infection over a period of two years were included. Age, sex and serum alanine transaminase (ALT) levels were recorded for each patient. HCV genotypes were identified using Line Probe assay (INNO-LiPA HCV II kit, Innogenetics, Belgium). Histological activity was graded and fibrosis was staged. Univariate and multivariate analysis was done to identify predictors of histological severity and fibrosis. Results: By univariate analysis, age of the patient, serum ALT levels and absence of genotype 3 (i.e., presence of HCV genotype other than genotype 3) showed association with histological activity score; whereas age and histological activity score showed association with fibrosis. However, on multivariate analysis, only serum ALT levels and absence of genotype 3 correlated well with activity score; while only activity score remained a significant predictor of stage of fibrosis. Conclusions: This study emphasizes the significant correlation of HCV genotype with severity of liver disease in chronic HCV infection. The stage of fibrosis showed correlation only with activity score as an independent factor. These results would further help in outlining algorithms for therapeutic stratification of patients with HCV infection.

Leiomyoma of the prostate--a rare mesenchymal tumor: a case report.

Prostatic enlargement due to benign adenomatous hyperplasia is very common in elderly males. However, benign mesenchymal tumors, especially true leiomyoma, are rare in prostate. True prostatic leiomyoma has been defined by Kaufman and Berneike as a smooth muscle tumor within the prostate or juxta-prostatic in position, devoid of glandular elements. The recognition of leiomyoma is important because of the potential of malignancy in such cases, and histopathology is the only tool to do so. We describe the case of a 65-year-old male presenting with urinary obstruction for eight months. Per rectal examination revealed an enlarged firm prostate, a trucut biopsy from which showed only stromal tissue. A suprapubic prostatectomy was performed, and histopathological examination revealed a benign smooth muscle tumor (confirmed by immunohistochemistry), in absence of glandular hyperplasia. Thus, a diagnosis of true leiomyoma of the prostate was made. True leiomyoma is a rare tumor in prostate, which can be diagnosed only on histopathological examination. In addition, careful intra-operative and extensive pathologic assessment is mandatory for predicting the potential behaviour.

Clinico-pathological profile of 22 cases of cystic renal dysplasia.

Renal dysplasia is one of the major renal developmental anomaly characterized by abnormal structural organization and development of metanephric elements. It is usually detected antenatally or in early childhood. The kidney may be multicystic, aplastic, hypoplastic or duplex. We studied 22 cases of cystic renal dysplasia diagnosed over a period often years to identify the spectrum of morphological changes in dysplastic kidney, with special emphasis on mesenchymal changes. Clinical, radiological and gross morphologicalfeatures were noted. Microscopic features were studied in detail, including the epithelial and mesenchymal changes. Twenty-one of the 22 cases studied were children. One case was a 21-year-old adult, which is a rare age at presentation. Male to female ratio was 1.1:1. One of our patients had contra-lateral ureteric stenosis, a rare anomaly reported with renal dysplasia. Ten patients, all autopsy cases, had multi-system congenital anomalies. As cystic renal dysplasia is not a hereditary disease, it must be differentiated from polycystic kidney disease. Other differential diagnoses are cystic nephroma and cystic partially differentiated nephroblastoma. Histopathological examination is the final diagnostic tool since radiological features alone may not be sufficient to exclude other cystic renal lesions. Cartilage may not be seen in all cases of renal dysplasia. Once diagnosed, other associated anomalies should also be looked for.

Complete gastric duplication cyst.

We report a 13-year-old boy who was detected to have an abdominal mass on ultrasonography. A possibility of tuberculous lymph nodes was considered in view of history of pain, low fever, and anorexia. Histology of the excised mass showed complete gastric duplication cyst.

Multicystic nephroma--report of two cases.

Multicystic Nephroma (MCN) is an uncommon renal pathology, characterized by the presence of usually unilateral circumscribed focal lesion consisting of multiple thin walled cysts. The etiology and pathogenesis of multicystic nephroma is not clear, and it is considered as a neoplastic lesion by many authors. To the best of our knowledge it has not yet been reported from India. We report first two pediatric cases of MCN from India. Computerized Tomography (CT) scan in both the cases revealed a unilateral cystic lesion in the lower pole of kidney. Keeping in mind the age, clinical presentation and radiological appearance, a possibility of Wilm 's tumour with cystic change could not be ruled out preoperatively and both children underwent nephrectomy. Since MCN has a benign behaviour it must be differentiated from focal cystic neoplastic lesions, including Cystic Partially Differentiated Nephroblastoma (CPDN), which has a low but distinct capability for local recurrence, and from Wilm's tumour with cystic change. Segmental form of unilateral renal dysplasia also needs to be considered in the clinical and radiological differential diagnoses.

Distribution of hepatitis C virus genotypes in patients with chronic hepatitis C infection in India.

BACKGROUND & OBJECTIVES: Hepatitis C virus (HCV), an important cause of chronic hepatitis, cirrhosis and hepatocellular carcinoma, shows a considerable genetic heterogeneity among hepatitis C virus isolates from all over the world. At least six main groups of sequence variants are recognized. The natural history of disease and response to treatment may be related to the genotype of HCV in a particular patient. Antigenic differences between genotypes also have implications for optimal design of serological sequencing and confirmatory assays for HCV. The present study was undertaken with the objective to find out various genotypes of hepatitis C virus prevalent in Indian patients with chronic hepatitis C infection. METHODS: Thirty six consecutive newly diagnosed patients with chronic hepatitis C infection were included in the study. HCV RNA was extracted from the serum by standard guanidinium thiocyanate method. Following reverse transcription and amplification, the HCV genotypes were determined by line probe assay (INNO-LiPA HCV II). RESULTS: Of the 36 patients, genotype 3 was found in 24 (66.6%). Of these 24 patients, 3a was seen in 5 patients (13.8%), 3b in two (5.5%) and mixed subtype 3a and 3b in 17 patients (47.2%). Genotype 1 was found in 5 patients (13.8%), with 1b in 1 and 1a in rest four cases. Two patients (5.5%) were infected with genotype 2 (subtype 2a and mixed subtype 2a, 2b respectively). One (2.7%) was infected with genotype 4 (4a). Mixed genotype infection was found in 4 patients (11.1%). INTERPRETATION & CONCLUSION: The present findings showed that genotype 3 of hepatitis C virus was the most prevalent genotype in patients with chronic hepatitis C in this part of India.

Congenital cystic adenomatoid malformation of lung--report of three cases.

Congenital cystic adenomatoid malformation (CCAM) of the lung is a rare anomaly of fetal development of terminal respiratory structures. We report three cases of congenital cystic adenomatoid malformation (CCAM) of lung Stocker's type I. All the cases presented with progressive neonatal respiratory distress. One case developed hyaline membrane because of ventilator therapy. No other congenital malformation was found in any of our cases. Two of our cases were suspected on antenatal ultrasonography. Routine prenatal ultrasonography has increased the frequency of prenatal diagnosis of congenital cystic lung malformation including CCAM. The pathogenesis, management and prognosis of CCAM are discussed along with a review of literature.