Aysha Mubeen

Branched chain in situ hybridization for albumin as a marker of hepatocellular differentiation: evaluation of manual and automated in situ hybridization platforms.

Albumin, widely recognized as a highly sensitive and specific marker of hepatocellular carcinoma (HCC), is currently unavailable in the diagnostic laboratory because of the lack of a robust platform. In a prior study we detected albumin mRNA in the majority of intrahepatic cholangiocarcinomas using a novel branched chain RNA in situ hybridization (ISH) platform. We now explore the utility of albumin ISH as a marker of hepatocellular differentiation in HCCs, and compare its sensitivity with Hep Par 1 and Arginase-1. We evaluated 93 HCCs and its mimics including neuroendocrine tumors of the gastrointestinal tract (n=31), neuroendocrine tumors of the pancreas (n=163), melanoma (n=15), and gallbladder carcinoma (n=34). We performed ISH for albumin and immunohistochemistry for Hep Par 1 and Arginase-1. Five previously uncharacterized hepatic neoplasms from our files were also evaluated. Immunohistochemistry for Arginase-1 was performed on 59 intrahepatic cholangiocarcinomas. In addition, 43 HCCs evaluated on the manual platform were also examined on the automated instrument. Fifty-five percent of HCCs were moderately differentiated and 39% poorly differentiated. The sensitivity of ISH for albumin was 99%, with 92 of 93 HCCs staining positive for albumin. In contrast to ISH, the sensitivity of immunohistochemistry for Hep Par 1 and Arginase-1 was 84% and 83%, respectively. The sensitivity of albumin for poorly differentiated HCCs was 99%, whereas that for Arginase-1 and Hep Par 1 was 71% and 64%, respectively. Ninety-seven percent of the HCCs showed albumin positivity in >50% of tumor cells using the ISH platform, as compared with 76% and 70% for Hep Par 1 and Arginase-1 immunohistochemistry, respectively. Three of the 5 previously uncharacterized neoplasms were positive for albumin ISH. Automated albumin ISH platform performed equivalently to the manual format, with albumin reactivity in >50% of tumor cells in all 43 cases that were tested on both platforms. All non-HCCs were negative for albumin. All 59 intrahepatic cholangiocarcinomas were negative for Arginase-1. In conclusion, branched chain ISH performed on manual and automated mode is a robust assay for detecting albumin with sensitivity for poorly differentiated HCCs superior to Arginase-1 and Hep Par 1. When interpreted in conjunction with Arginase-1, albumin ISH offers a high level of sensitivity and specificity.

The Role of Intraoperative Cytology in the Diagnostic Evaluation of Ovarian Neoplasms

Objective: To determine the role of intraoperative cytology (IOC) in the diagnostic evaluation of ovarian neoplasms. Methods: The present study was conducted in the Department of Pathology, Jawaharlal Nehru Medical College, AMU, Aligarh, India, over a time span of 18 months. Depending on the consistency of the lesion, touch, scrape or crush techniques were used to prepare cytological smears. Smears were fixed in 95% ethyl alcohol and then stained with hematoxylin and eosin or Papanicolaou stains. Cytological results were compared with the histological diagnosis taking the latter as the gold standard. Results: Of 50 lesions studied by IOC, 25 lesions were labeled as benign, 24 lesions as malignant and 1 lesion was inconclusive. Final histological diagnoses labeled 25 lesions as benign and 25 lesions as malignant. Comparing the diagnosis of cytology smears with histology sections, 47 of 50 cases were concordant. Sensitivity, specificity and diagnostic accuracy were 95.8, 96.0 and 95.8%, respectively. Conclusions: IOC is a good complement to histopathology in the study of ovarian neoplasms, particularly in developing countries like ours, where the facility of frozen sections is often not available, since a rapid preliminary diagnosis may help in surgical management planning.

Duplication of appendix: an accidental finding

Duplication of appendix is extremely rare anomaly. The reported incidence is 0.004–0.009%. In most of the cases the finding is accidental. Here the authors are presenting a case of type A duplex appendix in a 25-year male patient.

Hydatid cyst in tail of pancreas

The authors present a case of hydatid cyst in tail of pancreas in a 35-year-male who presented with 6-month history of dull aching pain in abdomen. Radiologically, a differential diagnosis of cystic pancreatic neoplasm and pseudocyst was made which was confirmed after histopathological examination.

Idiopathic lymphocytoma cutis: a diagnostic dilemma.

Lymphocytoma cutis, also known as cutaneous B cell pseudolymphoma, represents a spectrum of disease that shares similar clinical and histological features and simulates cutaneous lymphoma clinically and histologically. Clinically it is manifested as asymptomatic, indolent, nodular lesions of different sizes varying between 2 and 5 cm, usually solitary, mainly on exposed area of the body like face and neck. The presence of polymorphous cell infiltrates comprising of T and B lymphocytes, plasma cells, oeosinophils, histiocytes and dendritic cells along with lack of atypical lymphocytes after incisional biopsy support diagnosis of pseudolymphoma. Final diagnosis is made on immunohistochemistry.

Ewing's sarcoma of scapula: a rare entity

Ewings sarcoma is the second most common malignant bone tumour of childhood and adolescence. It may affect any bone, but it is frequent in the femur, ilium and the tibia. Here the authors are reporting a case of Ewings sarcoma involving scapula in a 14-year-old boy presenting with pain and swelling around the shoulder. Swelling was removed which on histopathological examination showed solid sheets closely packed, poorly differentiated small cells that have a high nuclear-cytoplasmic ratio, fine chromatin and small nucleoli. A tentative diagnosis of Ewings sarcoma was made which was confirmed by immunohistochemistry.

The role of sediment cytology in ovarian neoplasm.

Objective: It was our aim to study the role of sediment cytology in a diagnostic evaluation of ovarian neoplasm. Methods: The present study was conducted in the Department of Pathology, Jawaharlal Nehru Medical College, AMU, Aligarh, India, over a span of 22 months. Cytological smears were prepared by centrifuging the sediment of fluid from the bottom of a container in which surgical specimens were received. Smears were fixed in 95% ethyl alcohol and then stained using hematoxylin-eosin and Papanicolaou stains. The cytological results were compared with histological diagnosis, taking the latter as gold standard. Results: Out of 54 lesions studied by sediment cytology, 22 lesions were labeled as benign, 26 lesions as malignant and 6 lesions were inconclusive. Final histological diagnoses labeled 24 lesions as benign and 30 lesions as malignant. Comparing the diagnosis of the cytology smear with the histological section, 44 out of 54 cases were concordant. A sensitivity, specificity and diagnostic accuracy of 90.3, 92.3 and 90.3% was achieved, respectively. Conclusion: Biopsy sediment cytology is a good complementary method to histopathology in the study of ovarian biopsy material. In developing countries like ours, where the facility of frozen section is not available at many centers, this simple and cheap technique can be of much help in rapid diagnosis.

Solitary Plasmacytoma of Clavicle - A Rare Case Presentation

Plasmacytoma is a localized collection of malignant plasma cells. The disease is divided into Solitary plasmacytoma of the bone (SPB) and extramedullary plasmacytoma (EMP) which are both distinct entity. SPB usually occur in the bones characteristically affected in multiple myeloma and EMP was most frequently located in the oronasopharynx and paranasal sinuses, with a 15-30% incidence of regional lymph node involvement. We report a case of Solitary plasmacytoma of medial end clavicle resulting in pain and swelling of left clavicle in a 28 year old farmer. SPB can involve any bone in the body but involvement of medial end of clavicle though reported is a very rare presentation.

Thymoma with Coexisting Undifferentiated Pleomorphic Sarcoma: A Case Report

We report here a case of thymoma simultaneously associated with undifferentiated pleomorphic sarcoma. A 45-year-old male presented with axillary lump. Radiographic studies showed a mediastinal mass. On fine needle aspiration cytology and histopathological examination, a diagnosis of thymoma with coexisting undifferentiated pleomorphic sarcoma was made. Although thymomas are associated with many extrathymic malignancies, its association with undifferentiated pleomorphic sarcoma is rare. This case is being reported on to reinforce that clinicians should bear in mind the possibility of extrathymic malignancies in patients with thymomas.

Giant cell tumour of first metacarpal bone

Giant cell tumour (GCT) or osteoclastoma is a benign locally aggressive tumour with a tendency for local recurrence. 85–90% of cases occur in long bones; the sites most commonly affected being lower end of femur, upper end of tibia, lower end of radius and proximal humerus in descending order of frequency. Only 2% of GCT occurs in hand. GCT of bone accounts for 5% of all primary bone tumour. 80% of patients are above the age of 18 years, and it occurs commonly in adults between ages of 20 and 40 years. The authors report a case of GCT of first metacarpal which is very rare site for such tumour and only few cases reported in literature so far.