Amit Kumar Chowhan

Hormone receptor status (estrogen receptor, progesterone receptor), human epidermal growth factor-2 and p53 in South Indian breast cancer patients: A tertiary care center experience

Breast cancer, in India, is the second commonest cancer in females. Receptor status with ER/PR/Her 2 is now routinely done in patients with invasive carcinoma. The tumour suppressor gene, p53, is also present in most breast cancers. Proteins produced by a mutated p53 gene, accumulate in the nucleus of tumour cells and are detected by immunohistochemistry (IHC). We have undertaken this study with the aim to evaluate the ER, PR, HER-2 and p53 expressions in invasive breast carcinomas by IHC and to compare the HER-2 expression with various clinicopathological parameters. Materials and Methods: In this retrospective single institutional study from January 2001 to December 2010, 389 cases of histopathologically diagnosed infiltrating carcinoma of breast were evaluated taking into account various parameters like age, tumour size, grade, lymph node involvement, ER and PR. HER-2 and p53 was done in 352 cases. Results: The age range was 23-90 years with a mean of 50.7 years. Majority of tumours were T2 (79.6%) and Grade II (60.9%). Our data showed overall 47.6% ER, 48.8% PR, 29.6% HER-2 and 69.2% p53 positivity. There was no significant correlation between HER-2 and age, tumour size, lymph node status, ER, and PR. There was significant correlation between HER-2 and tumour grade (P = 0.031), p53 (P < 0.001). There was no inverse correlation between HER-2 and combined ER, PR status. Triple-negative breast cancers which constituted 22.7% of our cases did not reveal any correlation with various parameters. Conclusion: In our study, ER status was low, and incidence of p53 was high. These findings suggest that many of the tumours in Indian females may be of an aggressive type, and novel treatment approaches may be tried. We conclude that the assessment of all four markers is desirable.

Primary extragastrointestinal stromal tumors: A clinicopathological and immunohistochemical study—A tertiary care center experience

BACKGROUND Extra gastrointestinal stromal tumors (EGIST) are uncommon compared to their gastrointestinal counterparts. EGISTs involve omentum, mesentery, retroperitoneum, pancreas, and pelvis. MATERIALS AND METHODS Ten EGISTs were analyzed in this study from January 1995 to November 2011. They were analyzed with respect to clinical features, imageological, histopathological, and immunohistochemical findings. The immunohistochemical stains used were Smooth muscle actin (SMA), Desmin, S-100 protein, CD34 and CD-117. RESULTS There was slight female preponderance with wide age range. Four of the tumors were in retroperitoneum, three in mesentery, and two in omentum and one in pelvis. Histopathologically majority were spindle cell tumors. Immunohistochemically CD117 was consistently positive followed by CD34. Smooth muscle actin was positive in eight cases, S-100 protein and desmin were positive in two cases each. CONCLUSION EGISTs are rare and should be considered in the differential diagnosis of the mesenchymal tumors and immunohistochemistry helps to confirm the diagnosis. Further study with better follow-up is desired to characterize these uncommon tumors.

Epithelioid hemangioendothelioma of nasal cavity

We present a rare case of epithelioid hemangioendothelioma (EHE) in the nasal cavity of a 40-year-old Indian male who presented with history of intermittent epistaxis. The lesion was tested for a panel of immunohistochemical markers like vimentin, CD31, CD34, Factor VIII, vascular endothelial growth factor (VEGF) and Ki67. Immunohistochemically, the neoplasm showed striking positivity for vimentin, CD31, CD34 and weak positivity for VEGF; positivity was also noted for Factor VIII especially in the miniature intracytoplasmic vascular lumina.

Thyrolipomatosis: an inquisitive rare entity

It is rare to find diffuse presence of mature adipose tissue inside thyroid gland which defines thyrolipomatosis. We report a case of a 32-year-old hyperthyroid female on suppression therapy since the past 2 years presenting with diffuse thyroid swelling. She underwent total thyroidectomy and the histopathology revealed features of thyrolipomatosis. As fat containing lesions of thyroid include not only non-neoplastic lesions but neoplasms also, including an occasional malignant one, rendering a correct diagnosis is essential.

Salivary duct carcinoma of parotid gland.

A 40-year old male presented with rapidly growing swelling in the right parotid region. Based on the fine needle aspiration cytology report of adenocarcinoma not otherwise specified, superficial parotidectomy was performed, which showed the features of salivary duct carcinoma by histopathological examination. The smears were reviewed to identify the potential pitfalls in the cytological diagnosis of salivary duct carcinoma.

Submucous lipoma of sigmoid colon: a rare entity.

Sir, Lipoma of colon is a rare entity. So far to best of our knowledge, only 254 cases have been reported in the literature.[1] It may be asymptomatic to mildly symptomatic depending upon the size of the lesion (larger than 20 mm).[2] Though the diagnosis can be made easily at surgery or autopsy, but before that it may lead to many differential diagnostic problems, such as polypoidal carcinoma. We report a case of submucous lipoma sigmoid colon in a woman who underwent left hemicolectomy with clinical suspicion of malignancy.

Histopathological and Immunohistochemical Evaluation of Meningiomas with Reference to Proliferative Markers p53 and Ki-67.

INTRODUCTION Meningiomas are slow growing primary central nervous system (CNS) tumours attached to the duramater, which arise from the meningothelial cells of the arachnoid. Grading of meningioma based on histological findings assisted with supplementary immunohistochemical studies, predicts the prognosis of meningioma with good precision. AIM To evaluate proliferative markers and correlate with various histological subtypes and grade. MATERIALS AND METHODS A total of 224 meningiomas, diagnosed between January1995 and October 2011were graded according to WHO 2007 criteria. Immunostaining for p53 and Ki-67 markers were performed on 100 cases. RESULTS There was female predominance. There were 194 Grade I, 24 Grade II and 6 Grade III meningiomas. Brain invasion noted in 18(8%) meningiomas predominantly in grade III followed by grade II. Recurrence was seen in 7 (3.1%) cases, most common in psammomatous followed by angiomatous meningioma. Immunostaining showed p53 positivity in 72.5% of grade I, 83.3% of grade II and all the cases of grade III tumours. Ki-67 Labelling Index (LI) consistently increased from grade I to grade III tumours. CONCLUSION p53 and Ki-67 LI correlated well with increasing histological grade and biological behaviour of meningioma.

Should we apply suction during fine needle cytology of thyroid lesions? A prospective study of 200 cases.

INTRODUCTION Fine needle aspiration cytology (FNAC) is a well-established first line diagnostic tool in evaluating palpable thyroid lesions. However, the technique depends on suction and thus is at times painful, sometimes traumatic and yield haemorrhagic material for cytological study. In more recent times, a modified technique called fine needle sampling without aspiration (FNS) has come into vogue which obviates the use of suction and therefore is more patient friendly. AIMS/OBJECTIVES To investigate whether fine needle sampling without aspiration (FNS) gives quantitatively and qualitatively superior cytologic material as compared to the conventional technique of fine needle aspiration (FNAC) in thyroid lesions. MATERIALS AND METHODS It is a prospective study of 200 cases carried out in the Department of Pathology during two years period. Both techniques were executed on the same thyroid swelling / nodule in the same clinical session beginning with FNS followed by FNAC. The observation recorded by two pathologists were based on the scoring system proposed by Mair et al., Statistical analysis was done by Students paired t-test using SPSS 13 software. Observation/Results: A total of 200 cases were studied. The non-aspiration technique yielded less diagnostically adequate but more diagnostically superior smears when compared with aspiration technique. The average score per case was 5.31 by aspiration technique and 6.35 by non-aspiration technique. CONCLUSION Both the techniques have their own merits and demerits and neither is absolutely superior to the other. A combination of both the technique gives better result.

Solid and cystic papillary neoplasm of pancreas: A clinic-pathological and immunohistochemical study: A tertiary care center experience.

Background: Solid pseudopapillary tumor of the pancreas (SPT) is a rare tumor of low malignant potential, mostly described in young women. Materials and Methods: In this retrospective study from January 2000 - December 2010, there were 50 pancreatic tumors. In this period, four SPTs were encountered, which were analyzed with respect to clinical, imaging, histopathological, and immunohistochemical findings. Results: There was a female preponderance with mean age of 22.2 years. Two of the tumors were located in head of the pancreas and two in the body and tail region. On imaging, majority were large cystic tumors. Histopathologically, they exhibited extensive necrosis and presence of pseudo papillae in viable areas. Immunohistochemically, they were positive for alpha-1-anti-trypsin, alpha-1-anti-chymotrypsin, vimentin, CD10, and CD99. Progesterone receptor and p53 exhibited mild positivity in all of the four cases, whereas neuron specific enolase (NSE), synaptophysin, and chromogranin showed focal positivity in one case. Conclusion: Despite its non-specific clinical, imaging, and even immunohistochemical features, characteristic gross and microscopic findings provide reliable diagnosis of SPTs.

Myxoid chondrosarcoma of sphenoid bone.

The myxoid variant of chondrosarcoma is usually seen in soft tissues where it is known as chordoid sarcoma or parachordoma. Rarely, it involves bone and when it does, cranial bones are the preferred location. This tumor is frequently amalgamated with the chondroid variant of chordoma, especially when the lesion occurs in the sphenoid bone/spheno-occipital region, because of their similar clinical presentations, anatomical locations, radiological findings, and mistaken histopathological features. It is essential to distinguish myxoid chondrosarcoma from the chondroid variant of chordoma, because of the different treatment protocol and prognostic importance. We present such a location-based diagnostic dilemma, solved successfully with ancillary immunohistochemistry.