Repercussions of Denosumab in Patients With Giant Cell Tumor of Bone: An Observational Study.

BACKGROUND AND OBJECTIVES: The advent of denosumab has rendered giant cell tumors (GCT) of the bone amenable. It makes sense to evaluate its effect on the patient's symptoms and the histopathological outcomes. The aim of the study is to ascertain the effect of 24-week neoadjuvant denosumab therapy on the following parameters: visual analogue scale (VAS), musculoskeletal tumor society (MSTS) scores, tumor size, and the number of giant and stromal cells. MATERIAL AND METHODS: This observational study was conducted from February 2022 to April 2023 at SCB Medical College and Hospital, India. Fifty-four GCT participants had their VAS and MSTS scores assessed at baseline and then every four weeks for the next 24 weeks. At 24 weeks, changes in their tumor size and the number of giant and stromal cells per high-power field (hpf) were also evaluated. RESULTS: Fifty-four (82%) out of the 66 enrolled participants completed the study. Among those 54, 29 (54%) participants were female. The study population had a mean age of 39.0 ± 4.7 years. The median VAS scores were (female: 7.0, male: 7.0; p = 0.51) at baseline and (female: 2.0, male: 2.0; p = 0.39) at 24 weeks. The median MSTS scores at baseline and 24 weeks were (female: 8.0, male: 8.0; p = 0.41) and (female: 15.0, male: 16.0; p = 0.66), respectively. The median reductions in tumor size, the number of giant, and stromal cells (per hpf) were (female: 6.0 mm, male: 5.0 mm; p = 0.11), (female: 25, male: 27; p = 0.07), and (female: 1200, male: 2100; p < 0.001), respectively. CONCLUSION: After receiving neoadjuvant denosumab for 24 weeks, the study participants' clinical symptoms and histological indicators improved. With the exception of the stromal cells, there was no statistically significant difference between the male and female participants.

Histomorphological study of prostatic adenocarcinoma and its mimics.

CONTEXT: Prostate adenocarcinoma (PC) is one of the common cancers in India and world over. Numerous prostatic, nonprostatic lesions, and normal structures can be very similar to adenocarcinoma. A pathologist's awareness of the benign mimics is important for the diagnosis of PC. AIM: The aim of this study was to determine the prevalence, clinical, and histopathological features of PC, and its common mimics, and to study the criteria for their distinction from PC. MATERIALS AND METHODS: A prospective study of histopathological features of radical prostatectomy and transurethral resection of the prostate specimens, sent to the department of pathology in a medical college, for a period of 2 years was done. A brief clinical history followed by a clinical examination, including per-rectal findings and serum prostate-specific antigen (PSA) levels, was noted. RESULTS: After excluding all the cases of benign hyperplasia of prostate without any associated findings, 50 cases of operated surgical specimens of prostate were studied. PC was the most frequent diagnosis in 28 patients of 50 cases (56.0%). Basal cell hyperplasia formed the predominant mimic (26.0%), followed by prostatic intraepithelial neoplasia (8%), prostate atrophy (4%), clear-cell cribriform hyperplasia(4%),, and one case of atypical adenomatous hyperplasia (2%). Serum PSA was >4 ng/mL in all the cases of PC. In three of the mimics, PSA was >4 ng/mL and in the rest it was <4 ng/mL. Immunohistochemistry (IHC) was not applied in our study. CONCLUSION: Biopsy still remains a gold standard for diagnosis of PC and its mimics. All the lesions in the above study were diagnosed on routine hematoxylin and eosin staining. IHC is useful especially for lesions in the grey zone but not in routine histopathological study and should not be used as a screening test but should be applied in specific selected cases only.

Variability of Iron Load in Patients of Sickle Cell Anaemia (HbSS): A study from Eastern India.

INTRODUCTION: Sickle Cell Anaemia (SCA) is one of the commonest haemoglobinopathies due to a point mutation (A→T) of the ß-globin gene. Out of five haplotypes, the Arab-Indian haplotype present in India is one of the least severe phenotype and least studied also. It is characterized by lifelong haemolytic anaemia requiring red cell transfusion leading to iron overload. In contrast, there is very high incidence of deficiency of iron, folic acid and vitamin B12. AIM: Our objective was to access the Iron status of SCA patients and to find its correlation with various parameters like red cell transfusion, haemolysis and serum hepcidin. MATERIALS AND METHODS: This was a cross-sectional study conducted on 208 patients for a period of five years. Complete Blood Count (CBC), iron profile, haemolytic parameters and transfusion requirement were studied and data compared with 52 healthy controls. RESULTS: Few patients (9.6%) revealed significant iron overload (Serum ferritin > 1000 ng/ml). In majority (80.8%) it was either normal or border line raised (300 to 1000 ng/ml) or iron deficiency was noted in a small fraction (9.6%). Frequency of transfusion is the principal factor which positively correlated with level of iron load (p<0.001) while parameters of haemolysis and serum hepcidin level play an insignificant role in this context (p= 0.0634). CONCLUSION: This study supports the notion that the presentation of SCA patients in India is of "Viscosity - Vaso-Occlusive Crisis (VOC) phenotype" with high incidence of VOC, low haemolytic rate and transfusion requirement. Iron deficiency may be present in SCA patients requiring Iron supplementation. We suggest further studies to establish the role of hepcidin, ferroportin and other factors that control iron absorption in these patients.

Peritoneal Keratin Granuloma Masquerading as Disseminated Carcinoma.

Peritoneal keratin granuloma is a rare lesion included under granulomatous lesions of the peritoneum. It can be of infectious and non-infectious etiology. The lesion presents as a large intra-abdominal necrotic mass often misinterpreted clinically as a disseminated carcinoma. We report a case of peritoneal keratin granuloma in a 50-year-old male following peritonitis. Histomorphology revealed laminated keratin deposits with giant cell reaction. Follow-up data of this granuloma suggests that it has no prognostic significance.

Adenoid cystic carcinoma in the uterine cervix: a case report.

BACKGROUND: Adenoid cystic carcinoma, a variant of adenocarcinoma of the uterine cervix, is an extremely rare neoplasm. This report describes a case of primary adenoid cystic carcinoma of the uterine cervix and includes the cytopathologic and histopathologic findings. CASE: A 55-year-old woman presented with postmenopausal bleeding for 2 months. Speculum examination showed a firm mass in the uterine cervix. A Pap smear was obtained, which showed small epithelial cells with hyperchromatic nuclei and coarse chromatin dispersed and adhered around hyaline stromal globular material, along with a few atypical squamous cells. The diagnosis of adenoid cystic carcinoma was confirmed by the histopathologic examination of the biopsy specimen as well as the excised specimen, which characteristically revealed the presence of a cribriform pattern of the tumor cells. CONCLUSION: We reported a case of a rare and unusual variant of adenocarcinoma of the uterine cervix by considering the characteristic cytologic features of the globules of pale, translucent material surrounded by halos of cells in cribriform adenoid cystic carcinoma.

Cytodiagnosis of granular cell tumor: a case report.

A young male aged 28 years presented with a subcutaneous nodule in the left arm. Fine needle aspiration diagnosis was benign granular cell tumor which was confirmed by histopathology. Since it is an uncommon tumor, of controversial histogenesis, it is being reported here.

Endovascular papillary angioendothelioma in an elderly female.

Endovascular papillary angioendothelioma (EPA) is a rare vascular tumor of low grade malignancy, encountered primarily in children. However some cases have also been reported in adults. A sixty year old female with EPA is described here. She presented with a swelling in the neck. Total surgical excision was performed. Histomorphology revealed anastomosing lymphatic channels showing intraluminal papillary fronds with hyaline vascular cores and hobnailing of endothelial cells. A diagnosis of EPA was made based on this picture. This tumor is recurrent and nodal metastasis has been reported in some cases.