Relevance of Tumor Budding and Pattern of Invasion in Oral Squamous Cell Carcinoma.

Background: Standard histopathological parameters such as depth of invasion (DOI), lymphovascular invasion (LVI), and perineural invasion (PNI) are known parameters that can correlate with the prognosis and aggressiveness of oral squamous cell carcinomas (OSCCs). Tumor budding (TB) (≤5 tumor cells at infiltrating borders) and pattern of invasion (POI) are emerging histopathological parameters that have shown promising results as reliable risk factors in predicting nodal metastasis in early OSCCs. Aim: The aim of the study was to assess TB and POI in OSCCs. Materials and Methods: A total of 33 surgical resection specimens of OSCC, including buccal mucosa and tongue with neck dissection, were selected. TB and POI along with standard parameters such as grade, DOI, LVI, PNI, lymph node status, and pathological staging were evaluated. These parameters were analyzed in comparison with lymph node involvement and pathological stage of the tumor using the Chi-square and Fischer's exact test. The SPSS software, v21, was used for statistical analyses. Results: Most of OSCC were moderately differentiated tumors (63.64%). TB was present in 23 cases, in which 69.57% of cases showed low TB (<5 buds), while 30.43% of cases had higher TB (>5 buds). The worst POI (Patterns 4 and 5) was seen in 75.76% of cases. TB, POI, grade, PNI, DOI, and stromal pattern were significantly associated with the pathological stage of the tumor. Conclusion: TB and POI are important and reliable in histopathological parameters in OSCCs.

Pretreatment hematological parameters as predictors of tumor granulocyte-colony-stimulating factor expression in patients of head-and-neck squamous cell carcinoma.

Background: Tumor secreting granulocyte-colony-stimulating factor (G-CSF) and/or G-CSF therapy has been documented as a poor prognostic factor. Tumor G-CSF study is a relatively costly and sparsely available investigation. Therefore, this study was undertaken to predict tumor G-CSF score from pretreatment hematological parameters (PTHP) in patients of head-and-neck squamous cell carcinoma (HNSCC). Materials and Methods: This pilot study was performed after institutional ethics committee approval. Consecutive nonmetastatic HNSCC patients of oral cavity, oropharynx, hypopharynx, and larynx registered from February to December 2019 were analyzed. Patients whose PTHP and formalin-fixed-paraffin-embedded tissue were available, were included. PTHP (absolute neutrophil count [ANC], absolute monocyte count [AMC], absolute lymphocyte count [ALC], neutrophil-to-lymphocyte ratio [NLR], and platelet-to-lymphocyte ratio [PLR]) done before any active oncology treatment, were noted. A semiquantitative tumor G-CSF score was calculated. Tumor G-CSF score and PTHP were correlated with clinicopathological factors. Statistical analysis was performed using SYSTAT version 12. Results: Data of 47 eligible patients were analyzed. The median age at presentation was 60 years. The male-to-female ratio was 43:4. The most common head-and-neck subsite was oropharynx (31.92%), and majority of patients presented with Stage IVA disease (51.1%). Higher tumor G-CSF score was significantly associated with a higher T-stage (P = 0.013). Tumor G-CSF score was directly proportional to ANC, AMC, and ALC while it was inversely proportional to NLR and PLR. Regression equations to predict the tumor G-CSF score when PTHP are known, were determined. Conclusions: PTHP can predict the tumor G-CSF score which may guide G-CSF-directed therapy. Future studies with large number of patients are needed to elucidate its clinical use.

Evaluation of cases of membranoproliferative glomerulonephritis according to newer classification: A retrospective record-based study.

BACKGROUND: Membranoproliferative glomerulonephritis (MPGN) has traditionally been classified on electron microscopy (EM) into different types based on the location of the immune complexes. Sethi et al. subsequently suggested a more relevant etiology-based and clinically useful classification based on immunofluorescence. METHODS: In this retrospective study, 18 diagnosed cases of MPGN over a one-year period for which direct immunofluorescence (DIF) study results were available, were selected. Cases without archived records of immunofluorescence photographs/reports were excluded. Histological diagnosis of MPGN was confirmed and DIF results were analyzed with reference to antibodies to IgG, IgA, IgM, C3, C1q, kappa, and lambda light chains. RESULTS: Evaluation of cases revealed 8 males and 10 females with age range from 11 to 66 years. Fifteen cases presented with nephrotic syndrome. On evaluation, 88.89% cases (16/18) were immune complex mediated while two (11.11%) were of complement mediated type of MPGN. Among immune complex-mediated cases, a single case of monoclonal gammopathy associated or light chain mediated MPGN was present. CONCLUSION: The classification described by Sethi et al. is easy to use since it relies on DIF instead of EM which is not readily available. Most of the cases were immune complex mediated whereas incidence of complement mediated MPGN, that is, C3 glomerulopathy was low (11.11%). Application of the new classification allows more relevant categorization of cases based on etiology and without the requirement of EM.