Significance of immune-inflammatory markers in predicting clinical outcome of COVID-19 patients.

Background: The epidemic of coronavirus disease 2019 (COVID-19) has been rapidly spreading on a global scale affecting many countries and territories. There is rapid onset of generalized inflammation resulting in acute respiratory distress syndrome. We, thus, aimed to explore the potential of immune-inflammatory parameters in predicting the severity of COVID-19. Materials and Methods: Age, neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), platelet-to-lymphocyte ratio (PLR), Lactate Dehydrogenase (LDH), C-reaction protein (CRP), and procalcitonin (PCT) of 611 patients with laboratory-confirmed COVID-19 were investigated and compared. Patients were divided on the basis of severity and survival into two groups. Data were expressed as mean or median values and percentages. The receiver operating characteristic curve was applied to determine the optimal cut-off values of these biomarkers. Results: The median age was 50 years and the male to female ratio was 3.7:1. The mean NLR, LMR, PLR, LDH, CRP, and Procalcitonin for the non-severe group were 4.16, 10.8, 133.7, 666.1, 49.9, and 0.15, respectively. In the severe group mean values of the above-mentioned immune-inflammatory markers were 17.8, 4.69, 268.2, 1277, 158.6, and 3.05, respectively. Elevated levels were significantly associated with disease severity. In ROC curve analysis, NLR had the largest area under the curve at 0.923 with the highest specificity (0.83) and sensitivity (0.88). Conclusion: This study shows that NLR, PLR, LDH, CRP, and Procalcitonin may be a rapid, widely available, useful predictive factor for determining the severity of COVID-19 patients.

Uncommon Metastasizing Site of Adrenocortical Carcinoma.

Adrenocortical carcinoma (ACC) is a very rare tumor having a poor prognosis. Approximately 25% of these cases may present with metastases at the time of diagnosis. Common sites of metastasis are lung, liver, and lymph nodes. The bone metastases in ACC are less frequent. We report a case of a 35-year-old male presented with right parotid region swelling, rendered with a diagnosis of ACC metastasizing to the mandible ramus, which is an uncommon site.

Cervical Neuroendocrine Carcinoma: A Rare Case Report.

Neuroendocrine carcinoma is a rare tumor in the uterine cervix with a dismal prognosis. Clinically, it is difficult to differentiate from other cervical malignancies. Clinical presentation varies from vaginal bleeding, discharge per vaginum and cervical mass. For better clinical outcomes, it is vital to diagnose promptly and accurately. We report a 35-year-old female presented with whitish discharge per vaginum and lower abdominal pain for six months. Per speculum reveals an irregular, firm mass measuring 4x3 cm involving both the cervical lips, which turned out to a small cell neuroendocrine carcinoma.

Association of Ki-67 With Clinicopathological Factors in Breast Cancer.

Background Carcinoma of the breast is one of the most common cancer in females, with preponderance among urban females. The patient's age, tumor size, lymph node status, histological type, histological grade, lymphovascular invasion, hormonal receptor status, human epidermal growth factor receptor 2 (Her2neu) expression, and Ki-67 labeling index for proliferation rate can help determine the appropriate management strategy in these patients. The authors conducted this descriptive retrospective study to assess the association of Ki-67 with clinicopathological parameters in a newly established institute. This may help guide treatment planning in developing countries. Methodology Patients diagnosed with primary breast cancer in our institute between January 2017 and March 2020 were included in this study. The clinicopathological prognostic factors were retrieved from the records. Results A total of 129 cases of core needle biopsy and mastectomy specimens were included in this study. The patient's mean age and median age were 47.41 and 47 years, respectively. Only 56 specimens of mastectomy were received. T2 (26/56) was the most common tumor size. Grading was done in 46 cases, and grade 2 (23/46) was the most common. Estrogen, progesterone, and Her2neu were positive in 65, 61, and 59 cases, respectively. Only estrogen receptor (ER) expression (p = 0.035) and Her2neu (p = 0.035) overexpression were significantly correlated with Ki-67. Conclusions Ki-67 expression was correlated with clinicopathological factors. Only ER expression and Her2neu overexpression were significantly associated with Ki-67. Hence, patients with high Ki-67 expression may have better responses to hormonal therapy and chemotherapy.

Carcinoma Breast-Like Giant Complex Fibroadenoma: A Clinical Masquerade.

Fibroadenoma (FA) is a benign, painless, solid breast tumor that commonly occurs in young adult females. The term complex FA is used when it is associated with any of the following: cyst >3 mm, epithelial calcifications, sclerosing adenosis, or papillary apocrine metaplasia. FAs of size more than 5 cm or weighing more than 500 g are considered as giant FAs. Giant FAs are rare, and because of hormonal sensitivity, they commonly occur in pregnant or lactating women. We report the case of a 26-year-old female with a large breast mass that was clinically as well as grossly masquerading as breast carcinoma and turned out to be a giant complex FA on microscopy.

Giant Endometrial Polyp in a Postmenopausal Woman.

Endometrial polyps are the benign localized overgrowth of endometrial tissue composed of a variable amount of gland, fibroblast-like spindle cells stroma, and thick-walled blood vessels. They develop as a result of unbalanced estrogens and progestin. Polyps greater than 4 cm are considered giant polyps. We report a case of giant endometrial polyp in a postmenopausal woman who presented with postmenopausal bleeding without any history of hormone or drug intake. However, the possible cause may be the age and use of phytoestrogens in the daily routine diet for a long time.

Association of Peripheral Blood Parameters With Outcomes of COVID-19 Infection in a Tertiary Care Setting of Eastern India: An Institute-Based Study.

Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) caused the Coronavirus DISEASE 2019 (COVID-19) pandemic. Blood investigations play a vital role in providing information regarding the inflammatory process. Previous studies have shown that complete blood count parameters have clinical importance in predicting disease outcomes. However, there is a scarcity of literature published from our region in India. Aims The present study was conducted to describe the epidemiological, clinical, and hematological characteristics and outcomes of COVID-19 confirmed cases. Material and methods All real-time reverse transcriptase-polymerase chain reaction (RT-PCR) confirmed SARS-CoV-2 cases admitted in our institute over three months, from July to September 2020, were included in the study population. The blood samples of SARS-CoV-2 positive cases were analyzed for complete blood counts and coagulation profile on admission and at the time of discharge (most recent in case of mortality). Results A total of 252 RT-PCR confirmed SARS-CoV-2 cases were included in the study. The most common age group affected was 46 to 60 years, and the male-to-female ratio was 2.45:1. The most common clinical symptom was dyspnea, and the commonest comorbidity was hypertension. The statistical analysis showed a significant association of age, absolute neutrophil count (ANC) D-dimer, neutrophil-to-lymphocyte ratio (NLR), and platelets-to-lymphocyte ratio (PLR) with intensive care unit (ICU) admission and death. Gender, dyspnea, and absolute eosinophil count (AEC) showed significant association with ICU patients only, while liver disease and absolute lymphocyte count (ALC) had a significant association with death. Conclusion There are many notable clinical and hematological manifestations of COVID-19. Age, gender, dyspnea, comorbid liver disease, ANC, ALC AEC, NLR, PLR, and D- dimer may help clinicians predict the disease progression and reduce mortality risk.

Pigmented Malignant Lesion of Central Arch Gingiva of Mandible.

Primary oral malignant melanoma (OMM) is a rare malignant lesion with a relatively poor prognosis. The clinical presentation may be nodular, macular, or mixed type, with or without pigmentation. The pigmented lesions in the oral cavity may be either melanocytic or non-melanocytic and neoplastic or non-neoplastic lesions. For all the pigmented lesions of the oral cavity, clinicians must consider OMM as a differential diagnosis. Hence, a histopathological examination is required. Herein, we report a case of pigmented growth over the central arch and gingival mucosa, which turned out to be an OMM.

Warthin-Like Variant of Papillary Thyroid Carcinoma: An Uncommon Variant.

Papillary thyroid carcinoma (PTC) is one of the most common thyroid malignancy with various histologic variants. Acknowledging the correct histological variant of PTC helps to know about the tumor's nature and prognosis. The Warthin-like variant of papillary thyroid (WLPTC), a newly described histologic variant of PTC, is relatively uncommon. A 16-year-old female presented with complaints of painful thyroid swelling for two years. Fine needle aspiration cytology (FNAC) from the lobes showed lymphocytic thyroiditis features with Hurthle cell change. Sections from the left lobe revealed a diagnosis of a Warthin­like variant of PTC without nodal metastasis. WLPTC is a rare variant having a favorable outcome due to the absence of lymph node metastasis, extra-thyroidal extension, and a low recurrence rate. The correct cytological and histomorphological features are of utmost importance to render the diagnosis of WLPTC for better management.

Ovarian Carcinoid Misinterpreted as Endometrioid Adenocarcinoma in Mature Cystic Teratoma.

Mature cystic teratoma (MCT) is the most common benign germ cell tumor of the ovary and contains the different tissues that originate from the endoderm, mesoderm, and ectoderm. The monodermal teratoma has a component of only the germ layer. Ovarian carcinoid is rare and considered as a monodermal teratoma. We report a case of carcinoid tumor arising in MCT in a 60-year-old postmenopausal woman.