p16 expression in urothelial carcinoma: Experience from a tertiary care center in coastal South India.

Background: Urothelial carcinomas (UC) account for 6 and 2% of all cancers in men and women, respectively. Human papillomavirus (HPV) is one of the causative agents in cancers of the uterine cervix and head and neck. The role of HPV is also being studied in cancers of the urinary bladder, penis, and prostate. As p16-INK4a is a surrogate marker for high-risk HPVE7 oncoprotein, this study aims to highlight the utility of p16 immunohistochemistry (IHC) in the evaluation of HPV-associated UC. Materials and Methods: A retrospective study was conducted on UC of the bladder received in the Pathology department between January 2013 and December 2018. Bladder biopsies from non-neoplastic lesions served as controls. IHC was done for the detection of the p16 antigen. The p16 staining was recorded as positive, when there was strong staining in >50% of tumor nuclei. The p16 positive and negative tumors were compared based on age, gender, tumor size, grade, and muscle invasion. P value <0.05 was considered statistically significant. Results: The expression of p16 was analyzed in 72 UC and compared with 20 non-neoplastic cases, of which 26.4% of the cases showed p16 expression. The p16 expression was absent in the non-neoplastic lesions. While the majority (87.5%) of the low-grade tumors were negative for p16 expression, 43.8% high-grade tumors were positive. Similarly, a larger proportion of invasive carcinomas (38.8%) expressed p16 as compared to non-invasive carcinomas (13.8%). Thus, p16 expression showed a significant association with grade and stage in these malignancies (P < 0.05). Conclusion: The p16 expression was associated with high-grade and muscle-invasive UC. The p16 was absent in all non-neoplastic and precursor lesions. Thus, it can provide essential information not only about HPV association but also on the prognostic implications for the patients.

"Read" and 'Tailor' Your Treatment.

INTRODUCTION: The sinonasal tract is an area that may be affected by various types of neoplastic lesions with more variety than what is encountered in other parts of the upper airway and food passage. CASE REPORT: An elderly gentleman of 65 years complained of nose block on both sides for 3 months. On examination, he had firm polypoidal masses arising from the middle meatus and septum on both sides. Computed tomography scan of the sinuses revealed polypoidal mucosal thickening in bilateral sinuses with bilateral concha bullosa. The patient underwent functional endoscopic sinus surgery with the complete excision of the masses from the lateral wall and septum under general anesthesia. The results of the histopathological examination showed inflammatory changes in polypoidal tissues from the right maxillary, bilateral ethmoidal sinuses, and bilateral septal masses. The lesion in the left middle meatus showed the features of respiratory epithelial adenomatoid hamartoma (READ). The case had no evidence of residual or recurrent lesion during 6 months after the surgery. CONCLUSION: The READ is a rare lesion observed in the sinonasal tract. It is a diagnostic dilemma for clinicians as it can be misdiagnosed as neoplastic lesions, such as inverted papilloma or adenocarcinoma, which would warrant radical surgery or sinonasal polyposis and be treated inadequately.

Clinicopathological spectrum of solitary Plasmacytoma: a single center experience from coastal India.

BACKGROUND: Plasma cell disorders are a rare group of hematological malignancies that accounts for 10% of all hematological neoplasms. Solitary plasmacytomas are rarer entities accounting for less than 5% of all the plasma cell dyscrasias. They encompass three subtypes - Solitary Plasmacytoma of Bone (SPB) and Solitary Extramedullary Plasmacytoma (SEP) and multiple solitary plasmacytomas (MSP). In this study, we discuss the clinical, histopathological and immunohistochemical characteristics of solitary plasmacytomas. METHODS: A 13 year retrospective analysis of solitary plasmacytomas was performed from a single tertiary care center. Bone marrow evaluation was done concurrently at the time of diagnosis to rule out the presence of multiple myeloma. RESULTS: A total of 29 cases fulfilled the diagnostic criteria for SP during the study period. SPB accounted for 55.2%, SEP for 44.4% and MSP for 3.4% of the cases. The most common sites involved were the paranasal sinuses and vertebrae. Other infrequent sites included lymph node, tonsil and lungs. The mean age of presentation of SPB was a decade later than SEP. A male preponderance was observed in both subtypes. CONCLUSION: Solitary plasmacytoma is a rare entity, the diagnosis of which requires a systematic approach. There is limited data available in the literature on the clinico-pathological characteristics of SP from India.

Utility of fine-needle aspiration cytology in the diagnosis of HIV lymphadenopathy.

BACKGROUND: India, being a developing country, harbors the third largest human immunodeficiency virus (HIV)-infected population in the world, and HIV-associated lymphadenopathy is commonly encountered. HIV lymphadenopathy is more commonly generalized and pathology ranges from reactive lymphoid hyperplasia to infections like tuberculosis to neoplasms such as lymphoma and Kaposi sarcoma. The study intended to assess the utility of fine-needle aspiration (FNA) cytology in HIV lymphadenopathy. MATERIALS AND METHODS: A retrospective FNA slide review of HIV-infected cases with lymphadenopathy received over a period of 2 years in the cytopathology department was performed. The clinicopathological characteristics, absolute lymphocyte count (ALC), and CD4 counts were analyzed. RESULTS: Seventy-nine lymph node aspirates were received from HIV patients over 2 years. The mean age at presentation was 39 years with a male:female ratio of 2.4:1. Cervical lymph nodes (62%) were more commonly affected. Tuberculous lymphadenitis was the commonest lesion (41.8%), followed by reactive lymphadenitis (24%), nonspecific granulomatous lymphadenitis (14%), suppurative lymphadenitis (8%), cryptococcal lymphadenitis (2%), lymphoma (9%), and metastasis (1%). CONCLUSION: Lymph node FNA in HIV/AIDS is not only useful in identifying those cases that require further evaluation, but also aids in categorizing various etiologies such as opportunistic infections, non-neoplastic, and neoplastic lesions. FNA is a less expensive, expeditious minimally invasive method for an early diagnosis that abets in deciding the treatment strategy, thus curtailing the associated morbidity and mortality.

Image-guided Fine Needle Aspiration Cytology of Intrathoracic Lesions.

BACKGROUND: Percutaneous, image-guided transthoracic fine needle aspiration cytology (TTFNAC) is a rapid, yet accurate, and well-established diagnostic method used in the cytological evaluation of intrathoracic lesions. The study was done to determine the utility of image-guided TTFNAC in diagnosis of intrathoracic lesions. SUBJECTS AND METHODS: A retrospective analysis of all cases who underwent image-guided TTFNAC of a suspected intrathoracic lesion, in a tertiary care hospital was done over a period of 3 years. RESULTS: During the study period, 124 cases of image-guided FNAC of intrathoracic lesions were obtained. The mean age at presentation was 60.5 years with M:F: 3.6:1. Neoplastic lesions (71.5%) outnumbered the nonneoplastic lesions (28.5%). The most common tumor was adenocarcinoma (25%) followed by squamous cell carcinoma (SCC, 11%), and small cell carcinoma (5%). There was one case each of anaplastic carcinoma, plasmacytoma, bronchoalveolar carcinoma, and non-Hodgkin lymphoma (NHL). Most of the lesions were found on the right side and upper lobe. Among the mediastinal lesions, we found two cases of thymoma and one case each of NHL)/primitive neuroectodermal tumor (PNET), NHL, and small cell carcinoma metastasis to lymph node followed by ten cases of inflammatory lesions and seven cases of tuberculosis (TB). CONCLUSION: Image-guided TTFNAC of intrathoracic lesions is a safe method when done by well-trained medical personnel with lesser rate of complications. An early accurate diagnosis of malignancy can be made based on the cytological features; however, further subtyping of the malignancy may sometimes be difficult due to overlapping cytological features. TTFNAC can be a diagnostic tool for identifying nonneoplastic lesion such as TB. Hence, image-guided FNAC aids in early diagnosis and management of patients with intrathoracic lesions.

Case reports of basaloid squamous cell carcinoma--an aggressive variant of squamous cell carcinoma.

Basaloid squamous cell carcinoma (BSCC) is a high grade variant of Squamous Cell Carcinoma with a predilection for the aero-digestive tract. The typical microscopic features of carcinoma with a basaloid pattern in intimate association with a squamous component helps in diagnosis of this tumour. There are few reports in the Indian literature and we report three cases, including one in the sinonasal region. This study discusses the differential diagnosis of BSCC, as recognition of this tumour may have therapeutic implications.