Effect of intraoperative trypan blue on lens epithelial cells - Histomorphological analysis.

INTRODUCTION: Trypan Blue is an acid azo dye commonly used as a stain to distinguish viable from non-viable cells. It is a vital stain used intra operatively during cataract surgery to stain the external surface of the anterior lens capsule for better visualization. AIM: To analyze the histomorphological effects of trypan blue on Lens Epithelial cells and the Basement Membrane on direct exposure by staining the internal surface of the anterior lens capsule during Small Incision Cataract Surgery. METHODS: Analytical cross sectional case control study. Anterior capsule specimens of 14 Patients undergoing small incision cataract surgery at Department of Ophthalmology, Govt Medical College Hospital, Thrissur were studied. Two specimens of anterior capsule taken from the same eye form the case and control. Control specimen (sample A) was removed first, after the routine external staining with trypan blue 0.06% (w/v) for 10 seconds. The stain was washed off by balanced salt solution in every case. Then trypan blue was injected under the remaining anterior capsule and case (Test) specimen (sample B) was obtained after direct contact of trypan blue to the internal surface (lens epithelial cells) for 1 minute. Histomorphological (qualitative and quantitative) examination of both specimens done. RESULTS: Qualitative data analysis was done by EPI INFO software.v.7. Intactness of LECs throughout the length was statistically significant in Sample A (p = 0.000027). Partial and complete detachment of Lens Epithelial Cells, degeneration, and nuclear smudging were significantly higher in Sample B. Qualitative analysis of the basement membrane showed significant edema of the basement membrane in sample B. Basement membrane splitting observed in sample B was not statistically significant. Quantitative data analyzed using independent t test. There was a statistically significant decrease in cell density in sample B with p value less than 0.05. DISCUSSION: Our study demonstrated that direct staining of the internal surface of anterior capsule with trypan blue affected LECs and the basement membrane. There were reduction in cell density, irreversible degeneration of Lens Epithelial Cells and basement membrane edema. Hence treating the internal surface of capsular bag with trypan blue may reduce incidence of Posterior capsular opacification.

Renal angiomyoadenomatous tumour.

Renal angiomyoadenomatous tumour is a newly described rare neoplasm. This tumour is characterised microscopically by admixture of three components- epithelial cells arranged in tubules and nests, angiomyomatous stroma and capillary sized interconnecting vascular channels in close association with the epithelial cell clusters. Microscopically it has wide range of differential diagnoses which include mixed epithelial and stromal tumour of kidney, angiomyolipoma and clear cell renal cell carcinoma with angiomyolipomatous/angiomyoadenomatous areas. Renal angiomyoadenomatous tumour should be differentiated from these tumours. Till now, only 10 cases have been reported in English medical literature. Here, we are reporting a case of renal angiomyoadenomatous tumour in a 29 year- old female patient who presented with hematuria and low backache and describing its main features so as to differentiate this entity from other renal tumours. To the best of our knowledge, this is the first case to be reported from India.

Assessment of Pathological Response of Breast Carcinoma in Modified Radical Mastectomy Specimens after Neoadjuvant Chemotherapy.

Aim. Paclitaxel based neoadjuvant chemotherapy regimen (NAT) in the setting of locally advanced breast cancer (LABC) can render inoperable tumor (T4, N2/N3) resectable. The aim of this study was to assess the status of carcinoma in the breast and lymph nodes after paclitaxel based NAT in order to find out the patient and the tumor characteristics that correspond to the pathological responses which could be used as a surrogate biomarker to assess the treatment response. Materials and Methods. Clinical and tumor characteristics of patients with breast carcinoma (n = 48) were assessed preoperatively. These patients were subjected to modified radical mastectomy after 3 courses of paclitaxel based NAT regimen. The pathological responses of the tumor in the breast and the lymph nodes were studied by using Chevallier's system which graded the responses into pathological complete response (pCR), pathological partial response (pPR), and pathological no response (pNR). Results. Our studies showed a pCR of 27.1% and a pPR of 70.9% . Clinically small sized tumors (2-5 cms) and Bloom Richardson's grade 1 tumors showed a pCR. Mean age at presentation was 50.58 yrs. 79.2% of cases were invasive ductal carcinoma NOS; only 2.1% were invasive lobular carcinoma, their response to NAT being the same. There was no downgrading of the tumor grades after NAT. Ductal carcinoma in situ and lymphovascular invasion were found to be resistant to chemotherapy. The histopathological changes noted in the lymph nodes were similar to that found in the tumor bed. Discussion and Conclusion. From our study we conclude that histopathological examination of the tumor bed is the gold standard for assessing the chemotherapeutic tumor response. As previous studies have shown pCR can be used as a surrogate biomarker to assess the tumor response.

Diagnostic challenges in cytology of mucoepidermoid carcinoma: Report of 6 cases with histopathological correlation.

BACKGROUND: Mucoepidermoid carcinoma (MEC) is a malignant salivary gland neoplasm with extreme morphologic heterogeneity and hence rendering a definitive fine needle aspiration cytology (FNAC) diagnosis of this neoplasm is really challenging. The present study was undertaken to elucidate the cytological features of MEC and explore the diagnostic accuracy and pitfalls by comparing with subsequent histopathology. MATERIALS AND METHODS: The present study was conducted over a period of 2 years wherein we obtained six histopathologically confirmed cases of MEC. These patients were initially subjected to FNAC. The cytologic features studied included presence of mucous cells, intermediate cells, and squamous cells. Presence of background mucinous material was also noted. The cytological features were compared with the subsequent histopathology. RESULTS: Of the 6 cases of MEC, a definite cytological diagnosis was possible only in 2 cases. Of the remaining 4 cases, 2 cases were broadly diagnosed in cytology as neoplasm with cystic degeneration and 2 cases were underdiagnosed as pleomorphic adenoma. CONCLUSIONS: A satisfactory aspirate with all three types of cells; mucous, intermediate and squamous cells may not be obtained in all cases of MEC for providing a definite diagnosis. Hence, a good clinicoradiological correlation, a high index of suspicion and repeated aspirations especially in cystic lesions may be particularly helpful in difficult cases. In addition, while dealing with mucinous cystic lesions with low cellularity, the importance of early excision should be communicated to the clinician since the possibility of low-grade MEC cannot be excluded.

A Case of Recurrent Eccrine Porocarcinoma with Regional Lymph Nodal Metastasis, Arising on a Bowen's Disease Patch.

Eccrine carcinomas are very rare, comprising only less than 0.005 % of all cutaneous carcinomas, as reported by Goellner et al. (Cancer 56:1147-1162, 1985). We are reporting a case of recurrent eccrine porocarcinoma (EPC) with regional lymph nodal metastasis, which arose on a Bowen's disease patch. Wide local excision of the lesion with lymph node dissection and excision of the Bowen's disease was done.

A rare combination of pheochromocytoma and gastrointestinal stromal tumour in a patient with neurofibromatosis 1 syndrome-a case report.

Neurofibromatosis 1 is a rare inherited autosomal dominant syndrome. It comprises 90 % of neurofibromatosis cases. These patients may develop various types of tumours in early age, especially multiple neurofibromas with a high risk of developing malignant peripheral nerve sheath tumours. Other tumours can also develop like pheochromocytoma, optic nerve and brain stem gliomas, carcinoids and rarely gastrointestinal stromal tumours. A combination of pheochromocytoma and gastrointestinal stromal tumour is very rare. Only a few cases have been reported. Here, we are reporting a case of NF1 syndrome with a combination of pheochromocytoma and gastrointestinal stromal tumour with additional findings of multiple clear cell nodules and brown fat in the periadrenal connective tissue.

Estrogen and progesterone receptor status in breast cancer: a cross-sectional study of 450 women in Kerala, South India.

BACKGROUND: Hormone receptor status is an important prognostic and therapeutic tool in breast cancer. The objectives of our study were to create a database of breast cancer patients in Central Kerala between January 2010 and December 2012 and analyze the proportions of estrogen receptor and progesterone receptor positivity in premenopausal and postmenopausal women with breast cancer. METHODS: Estrogen and progesterone receptor status were evaluated by immunohistochemistry. The chi-square test was used for statistical analysis. RESULTS: The median age at diagnosis was 50 years while the mean age was 51.92 (SD = 11.78). 56.1% of premenopausal and 47.4% of postmenopausal patients were found to be ER positive, while PR positivity was 47.7% and 34.7% respectively in the premenopausal and postmenopausal age groups. CONCLUSIONS: The proportions of ER and PRnegative tumors were found to be lower than reported in earlier studies on Indian populations. Contrary to expectations, the proportions of ER and PRpositivity were found to be higher in the premenopausal age group.

Pigmented epidermal cyst with dense collection of melanin: A rare entity - Report of a case with review of the literature.

Epidermal cyst is a very common benign cystic lesion of the skin. It is usual to find ulceration of the lining epithelium, rupture of the cyst wall with chronic inflammation and foreign body giant cell reaction. But, it is very rare to see an epidermal cyst with marked accumulation of melanin pigment. Only a few cases of pigmented epidermal cyst with dense collection of melanin pigment have been published in the literature. Here, we are reporting a case of ruptured epidermal cyst with keratin granuloma formation and showing dense collection of melanin pigment.

Postmastectomy-postirradiation atypical vascular lesion of the skin: report of 2 cases.

The spectrum of vascular lesions developing in breast or chest wall skin following lumpectomy or mastectomy and radiation is wide and ranges from atypical vascular lesions with a benign clinical behaviour to frankly malignant, angiosarcoma ranging histologically from well to poorly differentiated variety. Postmastectomy-postirradiation atypical vascular lesions (AVLs) are rare and develop in the skin adjacent to the mastectomy scar. About hundred cases have been reported in the literature so far. AVLs have also been reported in patients after breast conservation surgery within the breast parenchyma or in the skin around the scar. The incidence appears to be rising. The exact reason for this is not known. The newer modalities of radiation therapy may be contributory to the pathogenesis. More studies have to be done in this area to prove the causal relationship. We are reporting the cases of 2 patients with carcinoma of breast who developed postmastectomy-postirradiation atypical vascular lesions. The cases were received in our department within a 6-month period.

Ovarian fibroma with serous cystadenoma-an unusual combination: a case report.

Surface epithelial tumors account for more than 90% of ovarian tumors, of which serous tumors comprise 46%. Sex-cord stromal tumors constitute 8% of ovarian tumors, fibroma being the commonest, comprising 70% in this category. Combination of different types of tumors can occur in ovary with most common being Mucinous cystadenoma and Brenner tumour. We report a case of a very rare combination of ovarian tumour-Fibroma with Serous cystadenoma of the ovary. This combination is not mentioned in any standard textbooks or reference books of gynaecologic pathology. Extensive search of the English Literature showed only one reported case with this combination of ovarian tumors. To the best of our knowledge, this is the second case to be reported in English Literature.

"Segmental necrotizing granulomatous neuritis": a rare manifestation of hansen disease-report of 2 cases.

Segmental necrotizing granulomatous neuritis (SNGN) is a rare condition affecting the nerves of Hansen disease patients. This is usually seen as a complication in association with the skin lesions of Hansen disease. Though very rare, it can also be the first presenting symptom of pure neuritic leprosy. We hereby report 2 cases of SNGN-one case of pure neuritic leprosy with initial presentation as SNGN and another, a treated case of borderline tuberculoid leprosy which relapsed with skin lesions and associated SNGN in the peripheral nerve.