Gallbladder carcinoma presenting with disseminated bony metastasis.

Gallbladder cancer (GBC) is the 23rd most common cancer worldwide and one of the three leading cancers in North and Northeast India. GBC has inferior outcomes due to its advanced presentation and poor response to chemotherapy. The approximate 5-year survival rate for metastatic GBC is less than 5%, with a median survival of around 6 months. Distant metastases from GBC to the bones happen in the later part of the natural history of the disease. Presentation with bony metastasis is infrequent, and less than 25 cases have been reported. Our case was an elderly man in his 70s who presented with back pain and, on workup, was detected to have adenocarcinoma of the gall bladder with disseminated lytic bony metastasis without any visceral metastasis. This case describes the natural history of such cases and discusses the role of bone scan or fluorodeoxyglucose positron emission tomography in the workup for GBC.

Diagnostic Accuracy of the International Academy of Cytology Yokohama System versus the Modified Masood's Scoring Index in Categorization and Diagnosis of Palpable Breast Lesions.

INTRODUCTION: Fine-needle aspiration cytology (FNAC) is a simple, minimally invasive, and effective tool that can be used to accurately diagnose benign and malignant lesions of the breast. The International Academy of Cytologists Yokohama system and Modified Masood's Scoring Index (MMSI) are two important systems to categorize palpable breast lesions on FNAC. The goal of the present study was to evaluate the IAC Yokohama system and MMSI in the cytological diagnosis and classification of diverse breast lesions and to compare the diagnostic accuracy of both systems through cyto-histological correlation. METHODS: A retrospective cross-sectional study was done within the 3-year period from 2019 to 2021. Seven hundred and ninety cases of FNAC breast lesions were included and were categorized following the recommendations by the International Academy of Cytologists Yokohama system and MMSI. The sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy for both systems were calculated, taking histopathology as the standard. Additionally, the risk of malignancy (ROM) of each category was calculated in the Yokohama system. RESULTS: The IAC Yokohama system's sensitivity, specificity, PPV, NPV, and diagnostic accuracy were 96.8, 95.8%, 96%, 96.6%, and 96.3%. The MMSI had sensitivity, specificity, PPV, NPV, and diagnostic accuracy of 95.8%, 98.4%, 98.3%, 96.1%, and 97.1%, respectively. The ROM for insufficient, benign, atypical, suspicious for malignancy, and malignant categories were 12.5%, 1.8%, 20%, 90.4%, and 97.5%, respectively. CONCLUSION: The categorization of breast lumps using the MMSI is more accurate and more specific in diagnosing malignant cases, and thus, the MMSI system is more precise and accurate at diagnosing malignant cases.

Impact of COVID-19 Pandemic on Pathology Residency Program: An Experience from India.

OBJECTIVE: To study the impact of the COVID-19 pandemic on pathology residents through a questionnaire-based survey. MATERIAL AND METHOD: We designed a Google survey questionnaire with 20-questions and distributed it to the pathology residents across India via e-mail and WhatsApp. All the responses collected were analysed using appropriate statistical methods. RESULTS: We received a total of 81 responses. The majority (n=55, 68.8%) of the residents were aged 26-30 years with a male-female ratio of 1:2.2. Residents reported a significant decrease in classes as compared to pre-covid times. However, most institutions (90%) shifted to the virtual method for various teaching sessions. About 94.7% of the residents felt a fall in the quality of training due to Covid. A significant number of junior residents (76.92%) reported an inability to complete the target thesis enrolment. The residents saw a substantial decrease in the number of peripheral smears, bone marrow, cytology, and histopathology cases compared to pre-Covid times (p value < 0.001 for all). An overwhelming 83.8% of the pathology residents were posted for COVID-19 duties. About 48.8% turned Covid positive. About 77.5% (n=62) of residents felt that the necessary training period would be extended. CONCLUSION: The COVID-19 pandemic has immensely affected the training and teaching of pathology residents in India. Similarly, this pandemic must have affected pathology residents all across the globe. Therefore, institutions can consider offering an extended period of up to one year, depending upon residents' requests.

Expression of Neuron-Specific Enolase and Other Neuroendocrine Markers is Correlated with Prognosis and Response to Therapy in Non-Hodgkin Lymphoma.

Objective Non-Hodgkin lymphoma (NHL) is a common hematological malignancy. There is very little known about the expression of neuroendocrine immunohistochemical markers and their clinical significance in NHL due to the paucity of studies. Our objective was to study the expression of neuroendocrine immunohistochemical markers in NHL and correlate with clinical parameters. Materials and Methods All cases diagnosed as NHL on morphology and immunohistochemistry (World Health Organization, 2016 classification) were included in the study. Immunohistochemistry for neuron-specific enolase (NSE), synaptophysin, and chromogranin A was performed. The results were correlated with clinical parameters and response to chemotherapy. Results A total of 66 cases were included in the study with a male-to-female ratio of 3.1:1. The most frequent subtypes observed were diffuse large B-cell lymphoma not otherwise specified and follicular lymphoma. Among the neuroendocrine markers, positivity was observed only for NSE, whereas the other markers were uniformly negative. It was positive in both B- and T-cell lymphomas and in many different subtypes. No relation with the age and sex of the patients was observed. However, NSE-positive cases, more frequently, presented in the advanced stage as compared with NSE negative (61 vs. 38%). All NSE-positive cases showed remission with chemotherapy. Conclusion Among the neuroendocrine immunohistochemical markers, positivity was observed only for NSE. This isolated positivity suggests cross-binding of NSE antibodies with some other isoenzyme of NSE. NSE positivity was associated with higher stage and better response to therapy. Despite this apparent paradox, it is recommended that NSE should be part of routine immunohistochemical panel for NHL.