Immunohistochemical analysis of beta-catenin expression: a probable prognostic marker and potential therapeutic target in renal cell carcinoma.

BACKGROUND AND AIMS: Renal cell carcinoma (RCC) seems to be the most aggressive type of genitourinary neoplasm. Down regulation of normal beta-catenin expression contributes to development of RCC, reflecting the role of beta-catenin/Wnt signaling pathway in pathogenesis. This study aims to evaluate the significance of beta-catenin expression and its correlation with the prognostic parameters. METHODS: A cross-sectional observational study was carried out in a tertiary care center on 58 RCC cases using variables like histological grade and type, tumor stage, necrosis. Formalin fixed, paraffin-embedded blocks were evaluated for beta-catenin expression by immunohistochemistry using scoring system. Data were analyzed by mean ± SD, χ2 test, Pearson's correlation test. RESULTS: Membranous score (MS) had a strong negative correlation with tumor stage (r=-0.407, p=0.044) and grade (r=-0.787, p=<0.001). Mean membranous score difference between low (Stage 1 and 2) vs. high stage (Stage 3 and 4) and low (Grade 1 and 2) vs. high grade (Grade 3 and 4) was statistically significant (p<0.001). Cytoplasmic score (CS) had positive correlation with tumor stage (r=0.586; p=0.002). No significant correlation was evident between cytoplasmic scores and tumor grade, however the mean cytoplasmic score difference between low grade vs. high grade was statistically significant (p < 0.001). CONCLUSION: Beta-catenin may play a crucial role in the pathogenesis of RCC and has a positive correlation with the biological behavior of this tumor. The important role of beta-catenin as a prognostic parameter and probably a critical evaluator of targeted chemotherapy cannot be overemphasized.

Role of Plasma Fibrinogen in Diagnosis and Prediction of Short Term Outcome in Neonatal Sepsis.

The study was carried out to determine the role of plasma fibrinogen in diagnosis of neonatal sepsis and to evaluate its role in predicting short term outcome. Sixty five neonates with clinical features suggestive of neonatal sepsis were included in this study. Seventy five neonates served as the control group. Plasma fibrinogen, prothrombin time, activated partial thromboplastin time and platelet counts were performed in all the neonates. Cut-off value of plasma fibrinogen for diagnosis of neonatal sepsis was determined with the help of receiver operating characteristic curve. Plasma fibrinogen level was found to be significantly higher among neonates with sepsis when compared to neonates in control group (p < 0.0001). It had sensitivity of 70.8 %, specificity of 82.7 %, positive predictive value (PPV) of 72.3 % and negative predictive value (NPV) of 81.6 % for diagnosis of neonatal sepsis at cut-off value of 301.90 mg/dL. When neonates with septic shock and/or disseminated intravascular coagulation (DIC) were excluded from study population, sensitivity and NPV rose to 91.9 % and 95.4 % at the same cut-off value while specificity and PPV remained the same. Lower level of plasma fibrinogen was detected in neonates with septic shock and/or DIC (p < 0.0001) and in neonates who died (p < 0.0001). Hence plasma fibrinogen can serve as an effective tool in diagnostic work up of neonatal sepsis as well as in assessing development of complications and outcome.

Fine needle aspiration cytology of metastatic alveolar rhabdomyosarcoma.

Rhabdomyosarcoma (RMS) is an aggressive malignant soft tissue tumor that arises from primitive striated muscle cells called rhabdomyoblasts. RMS is a rare tumor in adults, and involvement of the sinonasal area is extremely rare, comprising only 1.5% of all reported head and neck RMSs. Alveolar RMS, mainly seen in adults, has the worst prognosis. Incidence of lymph node metastases is more common in this type compared with the other forms. Fine needle aspiration cytology (FNAC) has been used extensively in the diagnosis of metastatic malignancies. However, metastatic soft tissue sarcomas are often overlooked, primarily due to the low frequency with which they occur. Here, we report a rare case of metastatic alveolar RMS in the cervical lymph nodes of an 18-year-old girl that was detected by FNAC. After 6 months, the patient came with a huge mass involving the nasal vestibule and the upper lip. Histology of both the main mass and the lymph nodes revealed alveolar RMS.

Extranodal non-Hodgkin's lymphoma presenting as an ovarian mass.

An 8-year-old female presented with an abdominal lump. A ultrasonography showed a heterogeneous, mainly solid space-occupying lesion with few cystic components and irregular margin in both adnexae measuring 10.5 x 5.2 x 3.5 cm and 9.2 x 4.8 x 3.0 cm. The tumors were removed by exploratory laparotomy and the histopathological report was primary NHL of the ovary. The uterus and cervix were healthy and there was no tumor extension or omental deposit. The patient was referred for chemotherapy.

Cutaneous metastasis from follicular variant of papillary thyroid carcinoma: a case diagnosed on cytology.

A 40-year-old woman presented with a scalp swelling. A careful clinical examination revealed a left-sided deep-seated thyroid nodule. Fine needle aspiration from both sites disclosed a microfollicular architectural pattern on Giemsa stain and pale nuclei with nuclear grooves on Papanicolaou stain, indicating the possibility of follicular variant of papillary thyroid carcinoma with metastasis to the scalp. Histologic tissue evaluation confirmed the diagnosis. Thus, a diligent search for nuclear features should be performed to enable a diagnosis of follicular variant of papillary thyroid carcinoma on cytology. This helps in patient management obviating the need for a second surgical intervention.

Cytodiagnosis of filarial infections from an endemic area.

OBJECTIVE: To throw light on cytologic findings as a possible mode of diagnosis of lymphatic filariasis. STUDY DESIGN: Filariasis has worldwide distribution, but lymphatic filariasis predominantly affects tropical and subtropical regions. Demonstration of microfilaremia, the specific test for diagnosis of lymphatic filariasis, often shows false negative results in endemic areas. The present study, done in an endemic area, showed the presence of microfilariae or adult worms of Wuchereria bancrofti in fine needle aspirates collected from amicrofilariaemic cases. In a few cases the discovery was incidental. A total 4,534 cases undergoing cytologic evaluation were carefully screened for the presence of adult worms or larvae, irrespective of clinical diagnosis. Microfilariae were demonstrated in both clinically suspected cases of filariasis and asymptomatic cases. RESULTS: A total of 1 positive cases were found; in 4 cases the clinical diagnosis was lymphatic filariasis, and 7 cases were asymptomatic. All 11 cases were amicrofilariaemic. CONCLUSION: Various sophisticated investigations are used for diagnosis of lymphatic filariasis without microfilaremia. Fine needle aspiration cytology, being a cheap, simple and easy procedure, may have some role in this field, but further detailed studies are needed before any final claim.

A study of morphometric and histopathological features of muscle biopsies from patients of myopathy.

The aim of this study is to analyse the morphological pattern of different types of myopathies including morphometric data. The cases were diagnosed as myopathy on the basis of clinical details, EMG findings, serum CK values. Muscle biopsies were performed and hematoxylin & eosin stain and Masson's trichrome stain were done. Muscle fiber diameters were measured using an eye piece micrometer of 100 fibers in each biopsy, these values were plotted and histograms were constructed. From this, mean fiber diameter (MFD), standard Deviation (SD), atrophy factor (AF), hypertrophy factor (HF) and variability coefficient (VC) were calculated. Degree of inflammation was scored semiquantitatively and presence of degenerating fibers, regenerating fibers, perifascicular atrophy, perivascular lymphocytic infiltration and vasculitis were noted. Out of 25 patients, 9 patients of inflammatory myopathy were adults, of the 16 patients of dystrophy 9 patients were adults. Along with weakness of limbs, skin rash was seen in 2 patients of dermatomyositis. Degree of inflammation was more in the patients of inflammatory myopathy than in the patients of dystrophy. Necrotic and regenerating fibers were seen in both groups. Perifascicular atrophy was seen in 1 case of dermatomyositis. Atrophy factor was higher in cases of dystrophy and so was hypertrophy factor. Variability coefficient >250 was found on 90% of dystrophy cases and it was <250 in the cases of inflammatory myopathy. Morphometry provides valuable data, which helps in distinguishing dystrophy from cases of myopathy with inflammation.

Recurrent and aggressive chondroblastoma: a case report.

Recurrent chondroblastoma with pulmonary and palatal metastasis is a rare occurrence. We report the cytological and histological findings of such a case in a 33 years old male, where the primary diagnosis of metastatic chondroblastoma was made on FNAC, which was later confirmed on histopathology. The present case highlights that, some chondroblastomas do exist, that are capable of pursuing a malignant course.