Amitabh Jena

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.

Outcomes of pectoralis major myocutaneous flap in female patients for oral cavity defect reconstruction.

PURPOSE Although much has been mentioned in the literature worldwide regarding the outcome of pectoralis major myocutaneous flaps (PMMFs), hardly any studies are available that mention the outcome of PMMFs in female patients. It has been presumed that complication rates after PMMF reconstruction in female patients are higher because of the presence of more adipose tissue in the flap. The objective of this study was to analyze our data regarding the outcomes of PMMFs in female patients with oral cancer undergoing reconstruction after tumor ablation. MATERIALS AND METHODS In this retrospective study from January 2008 to May 2012, performed in a single institution in south India, we have analyzed our data on PMMFs in 140 female patients with oral cancer. The operative technique used was essentially the same as that described originally by Ariyan. However, to preserve the deltopectoral flap area, the incision was appropriately modified in a manner as described by Schuller. RESULTS The mean age of the patients was 52.36 years, with a range from 30 to 76 years. They presented mostly with ulcers or ulceroproliferative lesions. Most of the patients had a history of tobacco and betel nut chewing. All of them underwent composite resection and reconstruction with PMMF under general anesthesia. Of the patients, 30 (21.4%) had complications, comprising infection (8), superficial flap necrosis (11), combined wound infection and superficial flap necrosis (3), total flap failure (2), and orocutaneous fistula (6). CONCLUSIONS PMMF reconstruction is a reliable and cosmetically acceptable method of reconstruction in female patients for oral cavity defects after tumor ablation.

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.

Multiple primary cancers: An enigma.

Background: Incidence of multiple primary cancers though uncommon, is being frequently reported now-a-days owing to better diagnostic techniques, the prolonged life span and the increased incidence of long-term survival of cancer patients. Materials and Methods: This is a retrospective study. Cases of multiple malignancies diagnosed histopathologically were retrieved from the archives of department of surgical oncology. Clinical data were obtained from the medical records. They were categorized as synchronous malignancies if the interval between them was less or equal to 6 months and metachronous, if the interval was more than 6 months. Results: A total of 13 cases were encountered in the 5 year study period. Out of them two were in the metachronous category and the rest were synchronous as the 2nd malignancy was detected mostly during clinical evaluation of the patients for the primary malignancy. There was female predominance with age range being 43-68 years. Majority of the cases were in the 7th decade. The most common organ involved was breast, followed by cervix. Apart from bilateral breast malignancies, there were combinations like breast with uterine endometrial carcinoma, cervical carcinoma and even papillary thyroid carcinoma. Conclusion: Detection of multiple primary malignancies is becoming increasingly common in day-to-day practice. Greater awareness of this is required among both cancer patients and their treating clinicians.

Rare case of blastemal predominant adult Wilms' tumor with skeletal metastasis case report and brief review of literature

Wilms’ tumor (nephroblastoma) is extremely rare in adults, skeletal metastasis being still rarer. The clinical course of adult Wilms’ tumor is very aggressive. The present case is a rare blastemal predominant adult Wilms’ tumor presenting with skeletal metastasis. We report a case of 19-year-old female presented with severe low backache and colicky left loin pain of 3 months and progressive weakness of 15 days duration. Magnetic resonance image (MRI) of lumbosacral spine was reported as spinal metastasis with right renal mass. The patient underwent right radical nephrectomy and the tumor was histopathologically confirmed as adult Wilms’ tumor. In case of adult Wilms’ tumor, distant metastasis may be the first presentation and this possibility should be considered when an adult patient presents with flank pain and a renal mass.

An unusual case of bilateral hydroureteronephrosis caused by uretero-vesico malakoplakia in a young male: a case report and review of the literature

IntroductionMalakoplakia is an unusual chronic inflammatory disease. Malakoplakia of the bladder and ureter is quite rare.Case presentationWe present a case of a young male diagnosed as malakoplakia of urinary bladder and ureter. He presented with bilateral hydroureteronephrosis. The patient underwent left ureterocystotomy. Again, he was admitted after a gap of ten years and with features of end stage renal disease.ConclusionThis rare case of urinary bladder and ureter malakoplakia in a young male is presented, to stress upon the fact that though it is a chronic inflammatory disease, yet its outcome over the years is dismal.

Unusual presentation of esophageal tuberculosis mimicking malignancy.

Sir, Tuberculosis of the esophagus is rare in both immunocompetent and immunocompromised hosts. Esophageal tuberculosis usually occurs secondary to tuberculous infection of adjacent organs, such as lungs, larynx or mediastinum.[1] More cases of secondary tuberculosis of the esophagus have been reported compared with primary esophageal tuberculosis.[1] The diagnosis may be difficult as due to the lack of characteristic clinical features, imaging studies or laboratory findings. Even histology cannot always establish the diagnosis, usually leading to misdiagnosis as esophageal carcinoma. A 75-year-old man presented with complaints of fever and vomiting of 1-week duration. Fever was intermittent, not nocturnal and not associated with chills and rigor. The patient did not suffer from any immunological disorders, was not on any immunosuppressive drug, and did not have any prior history of tuberculosis. He noticed a scalp swelling of 4-day duration, measuring 1 × 1 cm and soft in consistency. Upper gastrointestinal endoscopy revealed an excavating ulcer with undermined edges. The clinical suspicion was esophageal malignancy with probable scalp metastasis. Fine needle aspiration done from the scalp swelling yielded a pus-like material, the cytology smear of which showed acute and chronic inflammatory cells with epithelioid cell clusters and macrophages. Ziehl-Neelson stain demonstrated many acid-fast bacilli. Subsequently, the endoscopic biopsy specimen taken from the esophagus also revealed epithelioid granulomas. Esophageal tuberculosis has various presentations. It generally affects the middle-third of the esophagus around the carina and is usually caused by direct extension and spread from mediastinal structures. Symptoms such as dysphagia and retrosternal pain are the most common complaints.[1–3] Diagnosing esophageal tuberculosis can be difficult and is usually discovered during surgery. Esophageal tuberculosis is suspected in patients with pulmonary or systemic tuberculosis who later develop dysphagia. Delay in diagnosis and instituting appropriate therapy might induce severe complications.[3,4] Most cases can be successfully treated with antituberculous chemotherapy, even in the presence of fistulous tracts. The patient responded to treatment with antituberculous drugs. In conclusion, it is difficult to distinguish esophageal tuberculosis from malignancy on clinical findings alone. We report an unusual presentation of disseminated esophageal tuberculosis mimicking metastatic malignancy. Fine-needle aspiration cytology demonstrating acid fast bacilli, along with histological demonstration of epitheloid granulomas on endoscopic specimens played an important role in diagnosing this case.

Utility of immunohistochemistry in demonstrating Helicobacter pylori

Background: Helicobacter pylori is the causative organism for chronic active gastritis, duodenal ulcer and also for malignancies like gastric adenocarcinoma and mucosa associated lymphoid tissue lymphoma. It is essential to mention the presence of H. pylori in gastric biopsies as it has an important role in patient care. Though there are several special stains to detect H. pylori in histological sections, their specificity and sensitivity vary greatly. Immunohistochemically H. pylori can be detected by using anti H. pylori antibody, which reacts with somatic antigens of the whole bacteria. The aim of this study was to compare the reliability of routine hematoxylin and eosin (H and E), Giemsa, Warthin-Starry (WS) silver stain and immunohistochemical technique in diagnosing H. pylori. Materials and Methods: In this retrospective 1-year (2009) study, endoscopic gastric biopsies taken from patients during gastrointestinal-endoscopy with histopathological diagnosis of gastritis were studied. Standard H and E staining was performed on 5-μm-sections from paraffin block of each specimen. Microscopic sections of biopsy specimens of patients showing features of gastritis histopathologically in routine H and E stain and where the presence of H. pylori was suspected were also stained with Giemsa, WS, and immunohistochemistry (IHC) using purified polyclonal H. pylori antiserum (BioGenex). We have not included gastric resection specimens in our study. Results: Of the 29 cases, 26 (32.9%) showed presence of H. pylori on H and E, Giemsa and WS stains, whereas 49 (62.0%) cases demonstrated H. pylori on IHC stain. Conclusion: We conclude that H. pylori detection by IHC has advantage over routine H and E staining. However, in the developing countries with financial constraints, routine H and E staining in combination with special staining are fairly reliable in demonstrating H. pylori.

Malignancy in solitary thyroid nodule: A clinicoradiopathological evaluation

Background: Thyroid nodules are common. They can be either benign or malignant. Solitary thyroid nodules (STN) have a high likelihood of being malignant. They should be characterized properly for optimum management. Materials and Methods: In this study, we have analyzed our departmental data over a period of 5 years. All the patients who presented to the outpatient department with a clinically detected STN were included in the study group. Our approach was individualized. Preoperative ultrasonography (USG) and fine-needle aspiration cytology were planned in all these patients. Hemi thyroidectomy and total thyroidectomy with and without neck dissection were performed wherever appropriate. Results: There were 162 cases of clinically detected STN. USG findings were available in 146 cases. Postoperative histopathology was reported as malignant in 58 cases. Malignant STN was more likely in males. Ultrasonographically detected solid STN were more prone for malignancy as compared to multinodular goiter (P = 0.000) Presence of micro calcification and cervical lymphadenopathy were more commonly noted in malignant thyroid swellings. Conclusion: Solitary thyroid nodules do have a high likelihood of harboring a malignancy. Solid echogenicity, micro calcification and cervical lymphadenopathy on USG were seen more frequently in malignant nodules.