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Background & Objective: Hepatoblastoma encompasses 1% of pediatric malignancies and is the most common liver malignancy in children. Ninety percent of cases are younger than 5 years of age. Clinical and pathological risk stratification forms a crucial role in determining the treatment strategy. This study aimed to assess the clinicopathological profile of hepatoblastoma with risk stratification and follow-up in children. Methods: A retrospective evaluation was performed on all pediatric patients diagnosed as hepatoblastoma between 2016 and 2020 in our institution. Clinical, radiological, biochemical, pathological, and treatment data were analyzed. Cases were stratified based on the SIOPEL protocol and compared with the outcome. Results: The median age of all children was 1 year, the male-to-female ratio was 2.3:1, and elevated α-fetoprotein (AFP) was observed in all cases. SIOPEL risk stratification showed that 50% of children were at high risk. The histopathological types were fetal (30%), embryonal (20%), and macrotrabecular (5%) patterns under epithelial type and mixed epithelial and mesenchymal type (45%) with 1 case showing teratoid features. During the follow-up period, 6 out of the 7 children who died, belonged to the high-risk SIOPEL category, and 5 presented a mixed epithelial and mesenchymal pattern. Conclusion: Our study found a significant correlation between clinicopathological data, histopathological patterns, and outcomes. Accordingly, histopathological patterns could be considered one of the criteria for risk stratification. Histopathological risk stratification indicators (such as SIOPEL and PRETEXT) have strong prognostic and predictive outcomes; hence, our study emphasizes such parameters to aid oncologists.
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Background & Objective: Metaplastic carcinoma is a diverse variant of invasive breast carcinomas (IBC) characterized by dedifferentiation of malignant cells towards squamous and/or mesenchymal elements. It accounts for 0.3-1.2% of all IBC. These tumors are typically triple-negative by hormonal profiling with a high proliferation index and a dismal prognosis. Lymph node metastasis is an unusual feature in metaplastic carcinoma. Methods: The present study analyses 30 cases (26 cases of modified radical mastectomy and 4 cases of lumpectomy) of metaplastic carcinoma over 2018-2020 (3 years). Four oncopathologists reviewed routine histopathologic and immunohistochemical-stained slides. The clinical details were collected from the Medical Records Department of the Cancer Institute. Results: A total of 20 (66.67%) cases were patients >50 years of age, 21(70%) out of which were diagnosed as invasive carcinoma, grade 3 according to the Nottingham histological score. Five (16.7%) cases presented with lymph node metastasis. While immunohistochemically 28 (93.3%) cases were triple-negativeCK5/6, P63, EGFR, and Ki-67 (more than 40%) positivity was noted in 25 (83.3%) , 26 (86,7%) , 20 (66.7%), and 25 (83.3%) cases, respectively. Conclusion: Metaplastic carcinoma is characteristically triple-negative breast malignancies (TNBC) exhibiting a high Ki-67 index and a lower rate of lymph node metastasis. CK5/6, p63, and EGFR are pertinent immunohistochemical markers that may aid in diagnosis. However, those markers are non-specific for the disease and morphologic features are always the key to diagnosis of the process.
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Gastric cancer inflicts significant health issues globally despite its declining incidence. The disease is known to be diagnosed at its advanced stages also corresponding with a poor prognosis for patients. The integral therapeutic choices to cure advanced gastric cancer have progressed swiftly in modern days. The preface of molecularly targeted therapeutic techniques would potentiate the personalized approach depending on patient-specific and tumor-specific features, exasperating the advantages of chemotherapy. Here we have reviewed the modern therapeutics such as immune therapy, chemotherapy, m-RNA based therapeutics, alongside evaluating the influence of age, sex and comorbidities-like factors on the occurrence of gastric cancer. Gastric cancer therapy consolidated target agents comprising inhibitors of programmed death-1(PD-1), human epidermal growth factor receptor 2 (HER2), mRNA, and epidermal growth factor receptor (EPGF). A combination of trastuzumab to platinum-mediated chemotherapy evolved has a typical front-line therapy in advanced gastric cancer. An attempt has been made to epitomize the contemporary-modern research on targeted therapy for advanced gastric cancer.
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BACKGROUND AND OBJECTIVE: Cytogenetic damage in exfoliated buccal epithelial cells due to environmental and occupational exposure is often monitored by micronucleus (MN) assay using liquid based cytology (LBC) preparations. This study was performed to evaluate MN in exfoliated buccal epithelial cells of building construction workers using LBC preparations. METHODS: LBC preparations of exfoliated buccal epithelial cells from 100 subjects [50 building construction workers (cases) and 50 administrative staffs (controls)] was evaluated by May-Grunwald Giemsa, Hematoxylin and Eosin and Papanicolaou stains. Student's t test was used for statistical analysis and a P value of <0.05 was considered as statistically significant. RESULTS: The mean frequencies of MN for cases were significantly higher than controls regardless of staining methods used. There were statistically significant differences between smokers and non-smokers of the controls as well as duration of working exposure (<5 and >5 years) and smokers and non-smokers of cases (P=0.001). However, there were meaningful differences regarding mean frequencies of MN between smokers, non-smokers, those with alcohol consumption or not in cases and controls using various stains (P=0.001). CONCLUSION: There was an increased risk of cytogenetic damage in building construction workers. However, evaluation of MN of exfoliated buccal epithelial cells in building construction workers serve as a minimally invasive biomarker for cytogenetic damage. LBC preparations can be applied for MN assay as it improves the quality of smears and cell morphology, decreases the confounding factors and reduces false positive results.
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BACKGROUND: Liquid-based cytology (LBC) can be used for the evaluation of micronucleus (MN) in exfoliated buccal epithelial cells of populations occupationally exposed to potentially carcinogenic agents. AIM: This study was undertaken to evaluate the frequency of MN of exfoliated buccal epithelial cells using LBC preparation in petrol station workers. MATERIALS AND METHODS: Fifty petrol station workers (cases) and fifty hospital administrative staffs (controls) were recruited and evaluated for MN by May-Grunwald Giemsa, Hematoxylin and Eosin, and Papanicolaou stains using LBC preparation. Statistical analysis was performed with Student's t-test, and P < 0.05 was considered statistically significant. RESULTS: Regardless of staining method used, the mean frequency of MN for cases was significantly higher than that of controls (P < 0.001). CONCLUSION: The present study concluded that petrol station workers are under risk of significant cytogenetic damage. The MN in exfoliated buccal epithelial cells found to be a useful biomarker of occupational exposure to genotoxic chemicals. LBC can be used for sample preparation to evaluate the frequency of MN in those who are occupationally exposed to potentially carcinogenic agents in view of overall improvement on sample preservation and visualization of cell morphology.
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BACKGROUND: In 1996, National Cancer Institute (NCI) proposed five categories for the diagnosis of breast cytology in order to bring a degree of uniformity to the diagnostic reporting. Of these, categories 3 and 4 were sparsely studied. AIMS: The present study was undertaken for the evaluation of the fine needle aspiration cytology (FNAC) categories of C3 and C4 in the breast lump and its histopathological correlation. MATERIALS AND METHODS: In the retrospective study, a total number of 728 FNACs were categorized according to the NCI; of these, 28 cases of category C3 and 65 cases of category C4 were compared with histopathological diagnoses. RESULTS: On histopathological examination of category C3, 18 (64.3%) cases showed benign lesions and 10 (35.7%) cases showed malignancy and among the C4 category, benign lesions found in nine (13.8%) and malignancy found in 56 (86.2%) cases. There was a significant statistical difference between the number of benign and malignant diagnoses for cytological categories of C3 (64.3%) and C4 (86.2%) (P < 0.001). The sensitivity, specificity, positive predictive value, and negative predictive value of C4 category in the diagnoses of malignancy were 84.8%, 66.7%, 86.2%, and 64.3%, respectively. CONCLUSION: FNAC of the breasts is a simple, cost-effective, accurate, quick, and relatively less painful procedure, and it continues to play an integral part in the management of breast lesions. Our study concluded that there was a statistically significant difference between the number of benign and malignant diagnoses for categories of C3 and C4.
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According to the literature available, HER2(human epidermal growth factor 2)status in gastric carcinoma has been studied worldwide, however there is a paucity of published data from India. Hence, this study was taken up to evaluate HER2 overexpression in gastric adenocarcinoma patients and to assess the relationship between its expression and clinicopathological tumor parameters. Prospective study was conducted in a teaching hospital over a period of 27 months. Total or subtotal gastrectomy resection specimens and small biopsies were included in the study. Immunohistochemistry (IHC) was carried out on all the cases to evaluate the expression of HER2 in formalin-fixed paraffin-embedded tissue samples. Fluorescence Insitu Hybridization (FISH) was done for equivocal cases on IHC. The data was analyzed using Chi square test / Fisher's Exact Test. Odds ratio was computed between HER2 and other pathologic variables. HER2 overexpression was confirmed in 16 (27.6 %) cases of which 15 (93.8 %) cases were of intestinal type whereas only 1 (6.2 %) case of diffuse type adenocarcinoma. Hence, HER2 positivity was significantly more common in the intestinal type of gastric cancer compared to the diffuse type (p = 0.045). Positivity of HER2 was more in small biopsies as compared to the resection specimens in this study but the p value was not significant. There was no difference in HER2 overexpression in relation to the age, gender, tumor site, tumor differentiation and stage. HER2 overexpression is more prevalent in the intestinal subtype. The relatively high percentage of HER2 positive tumors may provide a useful target for immunotherapy of these cancers.
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BACKGROUND: One of the most common causes of lymphadenopathy in India is tuberculosis. It can be diagnosed by a minimally invasive procedure known as fine-needle aspiration cytology (FNAC), and thereby unnecessary surgical interventions are avoided. AIM: This study was undertaken to evaluate cytomorphological patterns of tuberculous lymphadenitis including human immunodeficiency virus-positive cases, to correlate the acid-fast Bacilli (AFB) positivity with cytomorphological patterns and also to find out overall AFB positivity. MATERIALS AND METHODS: In this study, a total of 212 cases of cytologically proven tuberculous lymphadenitis were retrieved and analyzed retrospectively between March 2012 and March 2015 for three different cytomorphological patterns (epithelioid granuloma without necrosis [pattern A], epithelioid granuloma with necrosis [pattern B], and necrosis without epithelioid granuloma [pattern C]) and bacillary loads on Ziehl-Neelsen stain (ZN) for AFB. RESULTS: Pattern A through C was observed in 40 (18.9%), 102 (48.1%), and 70 (33%) cases, respectively. AFB positivity was found in 2 (5%) cases of pattern A, 62 (60.8%) cases of pattern B, and 54 (77.1%) cases of pattern C. The highest percentage of AFB positivity (64.7%) was observed in aspirate containing purulent/pus and caseous/cheesy material. The overall AFB positivity was seen in 55.7% (118/212) cases. On grading of AFB positivity, Grade 1+ was observed in 29.7%, Grade 2+ was observed in 28.8%, and Grade 3+ was observed in 41.5% cases. CONCLUSION: FNAC is a sensitive, simple, convenient, safe, minimally invasive procedure to diagnose tuberculous lymphadenitis. Study of both cytomorphological patterns and ZN staining for AFB can improve the diagnostic yield. Regardless of the presence of granuloma, ZN stain must be employed whenever infective pathology is suspected.
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BACKGROUND: The Bethesda system for reporting thyroid cytopathology (TBSRTC) was introduced to standardize the communication of fine-needle aspiration cytology (FNAC) interpretation between clinicians and pathologists. This study was undertaken to evaluate the diagnostic utility of TBSRTC for reporting thyroid FNACs and rate of malignancy in each diagnostic category of TBSRTC. METHODS: A total of 603 thyroid FNAC results were retrieved retrospectively between July 2012 and January 2015 and reclassified according to TBSRTC. Of these, 392 cases had a histopathological follow-up. The FNACs results were compared to the histopathological diagnoses and the malignancy rates of each diagnostic categories of TBSRTC were calculated. RESULTS: Of the 603 FNACs, nondiagnostic were 16 (2.7%), benign were 393 (65.2%), atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) were 60 (10%), follicular neoplasm/suspicious for a follicular neoplasm (FN/SFN) were 64 (10.6%), suspicious for malignancy (SM) were 32 (5.3%), and malignant were 38 (6.3%). In 392 cases, there was follow-up histopathology. The malignancy rate for nondiagnostic, benign, AUS/FLUS, FN/SFN, SM, and malignant categories were 0%, 0.8%, 24.4%, 28.9%, 70.8%, and 100%, respectively. CONCLUSION: Our study validated the efficacy of TBSRTC. In conclusion, the malignancy rate of AUS/FLUS in this study was higher than the risk mentioned in TBSRTC and other published studies. Hence, AUS/FLUS category patients in our setup warrant further workup including ultrasound and/or thyroid scan in addition to immediate repeat FNAC.
