Evaluation of tumor-infiltrating lymphocytes (TILs) in molecular subtypes of an Indian cohort of breast cancer patients.

OBJECTIVES: Evaluation of tumor-infiltrating lymphocytes (TILs) distribution in an Indian cohort of breast cancer patients for its prognostic significance. METHODS: A retrospective cohort of breast cancer patients from a single onco-surgeon's breast cancer clinic with a uniform treatment strategy was evaluated for TILs. Tumor sections were H&E stained and scored for the spatial distribution and percent stromal TILs infiltration by a certified pathologist. The scores were analysed for association with treatment response and survival outcomes across molecular subtypes. RESULTS: Total 229 breast cancer tumors were evaluated. Within spatial distribution categories, intra-tumoral TILs were observed to be associated with complete pathological response and lower recurrence frequency for the entire cohort. Subtype-wise analysis of stromal TILs (sTILs) re-enforced significantly higher infiltration in TNBC compared to HER2-positive and ER-positive tumors. A favourable association of higher stromal infiltration was observed with treatment response and disease outcomes, specifically in TNBC. CONCLUSION: Intra-tumoral TILs showed a higher proportion with favourable association with better patient outcomes in an Indian cohort, unlike western cohorts where both stromal and intra-tumoral TILs show similar association with prognosis. With further validation, TILs can be developed as a cost-effective surrogate marker for treatment response, especially in a low-resource setting such as India.

Sebaceous Lymphadenoma of Parotid: Case Report of a Rare Entity.

Sebaceous differentiation can be normally seen in salivary glands. An entity first described by Hamperi. Sebaceous components are present in several salivary gland tumors like Warthin's tumor and mucoepidermoid tumor. But, if the sebaceous component predominates, it is known as a sebaceous adenoma. If lymphatic stroma in the background is prominent, it qualifies as sebaceous lymphadenoma. The term was coined and properly described by McGavran et al., differentiating it from similar appearing tumors like Warthin's tumor, sebaceous adenoma, and mucoepidermoid tumor. Clinicians, as well as pathologists, need to be aware of this entity as it is known to undergo malignant degeneration. Since it is a benign entity, the most common symptom is painless parotid swelling. The patient in this case also presented with painless parotid swelling and underwent preoperative FNAC and MRI. But, the diagnosis was made after surgical excision. The patient recovered well after surgery and is being followed. Since this disease is known for malignant degeneration and recurrence careful diagnosis is required. Histopathological picture may be confused with other common entities like Warthin also known as papillary cystadenoma lymphomatosum since both have sebaceous and lymphoid components. McGavran differentiated between both entities. Sebaceous lymphadenoma can convert to sebaceous adenocarcinoma and is thus important to know the correct diagnosis, even if it is postoperative since recurrence may be associated with malignant changes. Sometimes, the picture may be confused with lymphoma and in that case, immunotyping can come as a rescue for diagnosis. The authors of this report intend to report this rare entity and emphasize the need for clinicians and pathologists being aware of it and keeping it as a differential while dealing with a similar parotid tumor.

Eyelid Lesion as a Presenting Sign of Pancreatic Adenocarcinoma.

Eyelid metastases are relatively rare, and they can occasionally lead the way to an unknown primary malignancy elsewhere. The authors report a case of 65-year-old diabetic gentleman with a right-sided eyelid lesion that was present for 1 month and turned out to be a presenting sign of a previously undiagnosed pancreatic adenocarcinoma. The eyelid mass had been treated elsewhere for 2 weeks for a presumed infectious lesion, using systemic antibiotics and was then referred to us in view of no response. The right-sided lesion involving the subbrow and eyelid area was tender and showed surface ulceration, as well as induration with scabbing. An incision biopsy of the mass was performed followed by computed tomography imaging. Histopathologic findings were suggestive of adenocarcinoma of a probable secondary origin. A whole-body positron emission tomography (PET) scan along with raised serum tumor markers (carcinoembryonic antigen 125 [CEA 125] and carbohydrate antigen 19-9 [CA-19-9]) was helpful in diagnosing a stage IV probable primary carcinoma of the pancreas, with metastasis to paraaortic nodes, liver, lungs, and eyelid. After a detailed systemic work-up, the patient was put on systemic chemotherapy with carboplatin and capacitabane. He responded well to the treatment. At a follow up of 12 months, upon clinical examination and PET imaging, he showed a complete resolution of eyelid, lung, and liver disease and a near-complete resolution of the pancreatic lesion. This case delineates the role of a prompt biopsy and histopathologic evaluation of an atypical eyelid mass in diagnosing asymptomatic primary malignancy.