Immunohistochemical Expression of the Stem Cell Marker CD133 in Colorectal Carcinoma.

Background Colorectal carcinoma (CRC) is the second-leading cause of cancer-related death. Despite the combined (surgery, chemotherapy, radiotherapy, and immunotherapy) modalities of treatment, the prognosis remains poor, mostly because of recurrence and distant metastasis. Cancer stem cells (CSC) are thought to be responsible for the development and spread of tumors. Hence, targeted therapy against these cells hopes to reduce the chance of recurrence and metastasis and improve the prognosis. Many immune markers have been identified to detect CSC in CRC. Here, we tried to assess the immunohistochemical expression of the stem cell marker CD133 in colorectal carcinoma and its correlation with various pathological parameters. Methodology A total of 51 cases of CRC were analyzed. Immunohistochemistry for CD133 was done after standardization in our laboratory. Expression status was decided based on the total score obtained by multiplying the intensity score by the percentage score. CD133 expression was correlated with the age and gender of the patient, tumor location, histological grade, extent of invasion, lymphovascular invasion (LVI), perineural invasion (PNI), and nodal status. Results High CD133 expression was seen in 21 (41.17%) cases. There was no significant association between CD133 expression and the pathological parameters except the tumor site. CD133 expression was significantly higher as we moved from the proximal colon to the rectum. Conclusions CD133 expression was significantly higher in the distal part of the large intestine as compared to the proximal part. But there was no linear correlation between CD133 expression and histological grade, extent of invasion, or nodal status.

Mammary not otherwise specified-type sarcoma with CD10 expression.

Although mammary carcinoma is one of the most common malignancies among women, sarcoma taking origin from the breast tissue is extremely rare. Most of the mammary sarcomas represent a specific entity such as malignant phyllodes tumor, liposarcoma, or angiosarcoma. However, some cases do not fit into any specific category of sarcoma. These cases are diagnosed with breast sarcoma-not otherwise specified (NOS) type. They constantly express CD10 and are called as NOS type sarcoma with CD10 expression. Herein, we report a case of primary mammary sarcoma-NOS type with CD10 expression in an 80-year-old male. It was misdiagnosed with carcinoma breast on fine-needle aspiration. However, on histology, it was a high-grade tumor without any specific differentiation. Immunohistochemical results showed diffuse strong expression of vimentin and CD10, whereas pancytokeratin, desmin, and CD34 were negative. These tumors are considered a variant of sarcoma with myoepithelial differentiation.

Effect of megaloblastic anemia on hemoglobin A2 and diagnosis of ß-thalassemia trait.

Context: ß-thalassemia trait is usually diagnosed by raised hemoglobin A2 (HbA2). The presence of megaloblastic anemia can cause an increase in HbA2 and create a diagnostic dilemma. Here, we have analyzed the effect of vitamin B12 and folic acid supplementation on HbA2 and diagnosis of ß-thalassemia trait in cases of megaloblastic anemia with raised HbA2. Materials and Methods: Cases of megaloblastic anemia with raised HbA2 on high-performance liquid chromatography (HPLC) were supplemented with vitamin B12 and folic acid. Post-treatment evaluation was done after 2 months. Cases showing adequate hematological response were subjected to statistical analysis. Based on post-treatment HbA2 value, the cases were diagnosed as normal, borderline raised HbA2, or ß-thalassemia trait. Pre- and post-treatment values of red cell parameters and HbA2 were analyzed. Results: There was a significant decrease in HbA2 value after vitamin B12 and folic acid supplementation. The diagnosis was changed in 70.97% of the cases after treatment. The chance of inconclusive diagnosis was decreased from more than 50% to less than 10%. Pre-treatment mean corpuscular volume (MCV) and HbA2% showed a significant difference between the thalassemic and normal groups. Conclusions: Megaloblastic anemia can lead to false-positive diagnosis of ß-thalassemia trait on HPLC. Repeat HPLC should be done after adequate supplementation of vitamin B12 and folic acid in cases of megaloblastic anemia with raised HbA2. Red cell parameters are not helpful to suspect ß-thalassemia trait in presence of megaloblastic anemia. However, HbA2% on HPLC can be a useful parameter to suspect or exclude ß-thalassemia trait in cases of megaloblastic anemia.

Accuracy of cytological grading in the carcinoma breast and its correlation with pathological prognostic parameters.

BACKGROUND: Breast carcinoma is a significant contributor to cancer deaths worldwide. Tumor grade is an important parameter in planning out the treatment. Histology is the gold standard for grading the carcinoma breast. However, fine-needle aspiration cytology (FNAC) is still an important first-line diagnostic procedure in many parts of the world. Grading on cytology will help in pre-operative management. Although cytological grading of the carcinoma breast is a topic of research for many years, it is not yet included as a part of routine cytology reports. MATERIALS AND METHODS: A prospective study was conducted over a period of 1 year at Kalinga Institute of Medical Sciences. A total of 42 cases of carcinoma breast, diagnosed on FNAC and subsequently confirmed on histology, were included. Cytological grading was performed using Robinson's grading system, and the results were compared with the histological grade. Also, the cytological grades were correlated with various pathological prognostic parameters such as tumor size, lymph node status, lympho-vascular invasion, estrogen and progesterone receptor status, Her-2-neu expression, and Ki-67 index. The kappa measure of agreement and Fisher's exact test were used for statistical analysis. RESULTS: A moderate kappa measure of agreement (k = 0.415) was found between cytological and histological grades with an overall concordance rate of 66.67%. The accuracy of cytological grading was higher with increasing cytological grade. Except for estrogen receptor expression, none of the other prognostic parameters have a statistically significant correlation with cytological grade. CONCLUSIONS: Tumor grading on cytology can be helpful in planning treatment, especially in resource-constrained settings. Subjective variation in assessing different parameters and non-inclusion of mitosis in this system might be the reasons behind wrong grading in some cases. Inclusion of mitosis in the scoring system can improve the accuracy of cytological grading and its importance in prognosis.

Estimation of Total Platelet Count From Peripheral Blood Smear Needs a Correction Factor.

Background Despite many advances in platelet counting by cell counters, the problem of falsely low or falsely high total platelet counts (TPC) is common. Many laboratories estimate platelet count on the peripheral smear to cross-check the platelet counts. However, due to the lack of a standard calculation method, discrepant results are obtained from different laboratories leading to confusion among clinicians. We aimed to formulate a standard estimation method for platelet count on peripheral smear. Methodology In the first step (in 100 blood samples), we determined the ratio of the TPC obtained by the automated cell counter and the total number of platelets per oil immersion field (filed size: 0.22 mm) of the corresponding blood smears. The mean of the ratios thus obtained was designated as the "multiplication factor" to be used for visual platelet count estimation on the peripheral blood smear. In the subsequent step, validation of the same was done on another 100 samples. TPC on the peripheral smears of these samples was estimated using the above "multiplication factor" and compared with the corresponding TPC obtained on the automated cell counter. Results The "multiplication factor" obtained was 9.4 x 103 in the first set of 100 blood samples. It was used to estimate the platelet value of the second set of 100 blood samples. Conclusions We found an excellent agreement between the platelet counts obtained by automated cell counters and the estimation method. We suggest the multiplication factor 9.4 x 103 may be used with correction for microscopic field size to estimate platelet count on peripheral smears. This method is, however, not so reliable for very low platelet counts.

Unusual Presentation of Systemic Lupus Erythematosus in a Young Male: A Case Report.

Hepatic involvement in systemic lupus erythematosus (SLE) is common but described infrequently. Liver is usually never the primary organ to be affected in lupus. Again hepatic involvement probably does not carry much prognostic importance though it may correlate with lupus activity. We here report a case of 21-year-old man with no prior comorbidity or addiction who presented to us with acute hepatic illness with jaundice. He also had malar rash and arthralgia. Viral markers were negative. Antinuclear antibody and anti-double-stranded DNA (dsDNA) were strongly positive. Liver biopsy was consistent with autoimmune hepatitis, whereas skin biopsy was suggestive of SLE. He had a brisk and complete recovery with prompt use of immunosuppressive agents (corticosteroids and azathioprine). Cyclophosphamide was started latter in view of lupus nephritis. This is probably the fourth reported case of SLE presenting as acute hepatic illness with jaundice.

Angiomyofibroblastoma of the Vulva: A Rare Case Report with Brief Review of Literature.

Angiomyofibroblastoma is an unusual tumor of pelvic and vulval region. It is often diagnosed in the middle-aged women. Although benign owing to its location and morphology, it has a few benign and malignant mimics. Here, we present such a case where a 42-year-old female presented with a vulval mass.