Ankit Jitani

Analysis of Human Papilloma Virus 16/18 DNA and its Correlation with p16 Expression in Oral Cavity Squamous Cell Carcinoma in North-Eastern India: A Chromogenic in-situ Hybridization Based Study

BACKGROUND The incidence of head and neck squamous cell carcinoma (HNSCC) is quite high in North Eastern India. Apart from the traditional risk factors like tobacco and alcohol consumption, human papilloma virus (HPV) is now considered an established causative agent. These HPV related tumour have a clinico-pathological profile that is quite divergent from conventional non-HPV related tumours. Association of HPV in oral cancers has not been explored in north-east India. MATERIALS AND METHODS Thirty-one patients with oral cavity squamous cell carcinoma (OSCC) on treatment from October 2010 to January 2013 were included in the study. Patients who received neo-adjuvant chemotherapy were excluded. HPV 16/18 DNA was evaluated using Chromogenic in-situ Hybridization (CISH). Presence of nuclear signals was taken as positive HPV expression. p16 was evaluated using immunohistochemistry and was considered positive if ≥ 80% of the tumour cells showed strong and diffuse nuclear/cytoplasmic immunostaining. The results were analysed using Fisher exact test and confidence interval was calculated where required. RESULTS The study group age ranged from 30 to 80 years (median age- 54.2 years). The most common site was gum, with well differentiated squamous cell carcinoma being the most common histology. HPV 16/18 DNA was positive in 29% (95% CI: 13.03% - 44.97%) cases and had a clear tendency towards statistical significance with non-smoker cases (p=0.05), lymph node metastasis (p=0.05) and a significant correlation with p16 overexpression (p=0.04). There was no significant correlation with other clinico-pathological parameters. CONCLUSION HPV 16/18 is associated with OSCC, commonly seen among non-smokers and may be related to nodal metastasis. So, HPV may be used as a prognostic factor in OSCC and p16 may be considered as a surrogate marker for HPV.

Brush Cytology and AgNOR in the Diagnosis of Oral Squamous Cell Carcinoma

Objective: We aimed to evaluate the role of brush cytology in the screening of oral lesions with malignant suspicion and compare it with histopathology in north-eastern India. Study Design: Brush cytology samples taken from 48 patients were processed for conventional cytology (CC) and liquid-based cytology (LBC), and biopsy samples were also obtained. LBC samples were also stained to assess the argyrophilic nucleolar organizer region (AgNOR). The cytology was compared with histopathology, both individually and in combination with AgNOR. The smear quality was compared with histopathology for evaluating their diagnostic accuracy. Results: The sensitivity of diagnosing oral cavity squamous cell carcinoma by LBC and CC alone was 75 and 85%, respectively, which improved on combining with the AgNOR count, with a cutoff of 6.5. The presence of round cells on cytology was significantly associated with high-grade lesions. LBC provided clearer cytomorphology but compromised the background information in high-grade lesions. Conclusion: Brush cytology is a minimally invasive tool for screening oral lesions with malignant suspicion. LBC and CC are complementary techniques for cytological screening and combining them with AgNOR can increase the diagnostic yield. With objective criteria for assessment, cytology can be an indispensable tool for screening oral lesions in a resource-limited set-up, especially in high-incidence regions.

Concurrent Lesions in Oesophagus: an Approach to Diagnosis with a Case Report

Carcinomas of the oesophagus are the ninth most common malignancy globally and the sixth most common malignancy in males. Squamous cell carcinoma (SCC) is, by far, the most common type of malignancy arising in the oesophagus [1]. Neuroendocrine carcinomas (NEC) of the oesophagus are rare and aggressive neoplasms, presenting at an advanced stage, usually with metastasis [2]. NEC of the oesophagus may also present as a collision tumour, with another tumour growing in its close proximity and getting juxtaposed with the NEC [3, 4], or as a composite tumour, with the NEC showing differentiation towards other malignancy, commonly SCC or adenocarcinoma [5]. These possibilities are rare, and rarer was our case scenario in which NEC and SCC were present at two different anatomical sites of the oesophagus, but neither as a composite nor as a collision tumour. Various possible differentials need to be considered in the work-up of such a case to reach at a conclusion. This is especially true when the treatment modality does not include radical surgery, and the tumour is not available in toto for histopathological examination (HPE). Case Report

Natural Killer Cell Lymphoma: A Case with Classification Dilemma

Non-Hodgkins lymphoma of the Natural Killer (NK) cell type is rare. World Health Organisation recognises 3 NK-cell phenotypic entities; extranodal NK/T cell lymphoma, nasal type (ENK/TL); aggressive NK cell leukaemia (ANKL); and chronic lymphoproliferative disorders of NK cells (CLPD-NK) which is classified as a provisional entity. Though specific clinical, morphological and immunophenotypic criteria have been laid down to diagnose these conditions there may however, be considerable variations in the clinical presentation making diagnosis difficult. We present a case with contrasting clinical and haematopathological findings posing difficulty in its diagnosis and classification, and despite the aggressive presentation showing favourable response to treatment.

Subungual Glomus Tumour Excision with Transungual Approach with Partial Proximal Nail Avulsion.

The general and systemic physical examination was within normal limit. On local examination, there was a violaceous spot on the lunula and longitudinal ridging on the nail plate [Figure 1a]. The love test (applying pressure to the suspected area with a pinhead, which elicits exquisite localised pain) was positive. The posterior‐anterior and lateral view of X‐ray left hand was normal [Figure 1c]. Magnetic resonance imaging of the left thumb revealed T1 hypointense, T2/T2‐FS hyperintense spherical mass showing intense enhancement on the post‐contrast study of distal phalanx suggestive of glomus tumour [Figure 1d].

Post-traumatic ectopic nail.

416 A 38-year-old woman presented with a keratotic lesion on the left thumb for 1 year. Six months before the lesion was noted, she had sustained a cut on the medial-third of the distal nail of left thumb extending to the base of the distal phalanx. Examination revealed a 1 cm × 0.5 cm, keratotic, nail-like lesion [Figure 1a]. There was a longitudinal split on the medial third of the left thumb and the scar of the previous cut injury on the distal phalanx. The lesion was excised under distal digital block [Figure 1b]. Histopathological examination revealed nail plate and nail matrix confirming the diagnosis of ectopic nail.

Renal cell carcinoma and sarcoid-like epithelioid granuloma: Case report of a rare association

Noncaseating epithelioid granuloma, also designated as sarcoid-like granuloma, has been described in association with malignancies. These granulomas are rare in carcinoma, more so when associated with renal cell carcinoma. Here, we describe an association between clear cell renal cell carcinoma and noncaseating granulomas in a 50-year-old female. We also discuss the differential diagnosis that should be considered before establishing such diagnosis, which might have therapeutic and prognostic implications.