Gayatri Gogoi

Pancreatic paraganglioma: An extremely rare entity and crucial role of immunohistochemistry for diagnosis.

Paragangliomas are rare neuroendocrine neoplasms arising in extra-adrenal chromaffin cells of autonomic nervous system and histologically akin to chemodectomas. They are rare, affecting about 1 in 2,000,000 population. It is a generic term applied to tumors of paraganglia regardless of the location. In rare instances, paragangliomas present around and involve the pancreas, thereby mimicking any one of the more common primary pancreatic lesions. Pancreatic paraganglioma is an extremely rare tumor. It grows slowly, so radical resection is recommended to achieve curability with good prognosis. These neoplasms present considerable diagnostic difficulty not only for the clinician and radiologist but also for the pathologist. Here, we report a case of a 55-year-old woman who presented with a left-sided abdominal swelling for 3 months duration, initially having clinical suspicion of an ovarian tumor. The radiological imaging revealed a lesion in the tail of pancreas with a differential diagnosis of pancreatic carcinoma and metastatic tumor. Only after exploratory laparotomy, the diagnosis was made as a rare case of pancreatic paraganglioma on the basis of histological examination and immunohistochemistry.

Educational levels and delays in start of treatment for head and neck cancers in North-East India.

BACKGROUND There are various patient and professional factors responsible for the delay in start of treatment (SOT) for head and neck cancers (HNC). MATERIALS AND METHODS This retrospective study was conducted on data for HNC patients registered at the hospital cancer registry in North-East India. All cases diagnosed during the period of January 2010 to December 2012 were considered for the present analysis. Educational levels of all patients were clustered into 3 groups; illiterates (unable to read or write), qualified (school or high school level education), and highly qualified (college and above). RESULTS In the present analysis 1066 (34.6%) patients were illiterates, 1,869 (60.6%) patients were literates and 145 (4.7%) of all patients with HNC were highly qualified. The stage at diagnosis were stage I, seen in 62 (34.6%), stage II in 393 (12.8%), stage III in 1,371 (44.5%) and stage IV in 1,254 (40.7%) . The median time (MT) to the SOT from date of attending cancer hospital (DOACH) was, in illiterate group MT was 18 days, whereas in the qualified group of patients it was 15 days and in the highly qualified group was 10 days. Analysis of variance showed there was a significant difference on the mean time for the delay in SOT from DOACH for different educational levels (F=9.923, p=0.000). CONCLUSIONS Educational level is a patient related factor in the delays for the SOT in HNCs in our population.

Descriptive Epidemiology of Common Female Cancers in the North East India - a Hospital Based Study

BACKGROUND Cancers of the breast, uterine cervix and ovary are common cancers amongst females of North East India. Not much is known about the descriptive epidemiology of these cancers in our population. The present retrospective analysis was therefore performed. MATERIALS AND METHODS The data set available at the hospital based cancer registry of a regional cancer center of North-East India, containing information on patients registered during the period of January 2010 to December 2012, was applied. A total of 2,925 cases of breast, uterine cervix and ovarian cancer were identified. RESULTS Of the total, 1,295 (44.3%) were breast cancers, 1,214 (41.5%) were uterine cervix and 416 (14.2%) ovarian cancer, median age (range) for breast, uterine cervix and ovary were 45 (17-85), 48 (20-91) and 45 years (7-80), respectively. Some 43.5% of cases with uterine cervix patients were illiterate, 5.4% and 5.7% stage I in breast and cervix respectively and 96.4% of ovarian cancers in advanced stage. CONCLUSIONS Improvement of female education can contribute to increase the proportion of early stage diagnosis of breast and uterine cervix in our population. Any population-based intervention for the detection of cancers of breast, uterine cervix and ovarian cancer should be started early in our population.

A Study on Schwannomas: Morphology Alone is Insufficient

Schwannomas constitute one of the most common benign peripheral nerve sheath tumors. Schwannomas can occur anywhere in the body occasionally with unusual presentation. FNB does not appear to provide an accurate preoperative diagnosis. Complete excision of the mass should be the goal of surgical excision. In this case series, we studied various clinicomorphological features of schwannomas for duration of one year. Immunostaining were done using anti-S100 protein and a panel of antibody to confirm the diagnosis cases as well as in cases whose histological picture simulated schwannoma. Out of the 9 cases in our study, two cases showed unusual presentations. Schwannoma often gives a differential diagnosis of similar benign soft tissue tumors. All cases were benign schwannoma except one case with rectal growth turned out to be gastrointestinal stromal tumor on immunohistochemistry. Herein, we are discussing about the various histological pictures of schwannoma, diagnostic difficulties encountered in histopathology and the indispensable role of immunohistochemistry in confirmation. Classic schwannoma picture in histology is insufficient to confirm the diagnosis. Cellular schwannoma often posed a differential diagnosis of other tumors in histology such as spindle cell tumor. Palisading of nuclei is not unique to schwannoma as seen in the case of gastrointestinal stromal tumor. It can also occur in leiomyoma, leiomyosarcoma, gastrointestinal stromal tumor, calcifying aponeurotic fibroma, and even in non-neoplastic smooth muscle lesion. Gastrointestinal stromal tumor may harbor a picture of classic schwannoma and should be careful in gastro intestinal site.

Missing Clinical Work Up Leading to Misdiagnosis of a Case of Germ Cell Tumour

Background: The large majority of primary testicular tumours originate from germ cells. Cryptorchidism remains the most common risk factor for testicular germ cell tumors. Approximately 10% of the cases are associated with past (corrected) or present cryptorchidism. Seminoma is the most frequent GCT and frequently occurs in undescended testes (5% to 8%). Case report: A 30-year male attended surgery OPD with a mass in the right lumbar region. CT scan revealed a small intestinal mass which was also verified by the surgeons intraoperatively. On histopathological examination of the resected specimen a diagnosis of neuroendocrine tumour (Carcinoid) was offered. The patient came to us requesting immunohistochemistry for confirmation but it showed CK and chromogranin negativity. Further marker study showed the tumour to be positive for CD117. Revised histomorphology along with immunohistochemistry favoured the diagnosis of extragonadal germ cell tumour (seminoma). Surgeons later confirmed the soft tissue mass to be that of undescended testis, thereby leading to a final diagnosis of seminoma. Conclusion: Cryptorchid patients have approximately a fourfold elevated risk of testicular germ cell tumors. The histopathological diagnosis at times is sufficient when proper background information is available to the pathologist. In the absence of such information, the use of adjunct studies helps us to arrive at a correct diagnosis.

The grey zone of thrombocytopenia: accuracy of automated analyser vs manual method

Reliability of platelet estimation is essential to make clinical decision specially when platelet transfusion is considered (Figure 1). It is widely accepted that automation in hematology yield high precision and accuracy in haematological parameters in normal individuals.1–5 However, automated counting is still very controversial in cases of thrombocytopenic patients in which other small particles could generate electrical or optical signals that are similar to platelets, such as debris and red cell fragments.4,6–11

Pancreatic Paraganglioma: An Extremely Rare Entity with Unusual Age Presentation and Uncommom Site

Introduction: Paraganglioma are rare neuroendocrine neoplasm, affecting about 1 in 2,000,000 populations, which arise in the extra-adrenal chromaffin cells of the autonomic nervous system. It is a generic term applied to all tumors of paraganglia regardless of the location. In rare instances, paragangliomas present around and involve the pancreas, thereby mimicking one of the common primary pancreatic lesions.

Invasive lobular carcinoma of male breast: What we don't know-A report of 5 cases

Male breast carcinoma is a very rare malignancy. It mostly has invasive ductal histology while invasive lobular histology is exceptionally uncommon constituting no more than 1–2% of male breast cancer cases. Here we present five cases of invasive lobular breast carcinoma arising in male breasts which were diagnosed by histological examination. Immunohistochemistry was performed to evaluate the hormonal receptor status. Early diagnosis of breast carcinoma in males have prognostic implication in patients’ survival and show better response to hormonal therapy when it is reactive for estrogen and progesterone receptors. Therefore it is mandatory for the pathologists to keep this rare condition in their minds while evaluating any case of male breast lump and to perform a vigorous search for any small focus of this tumour in circumstances of male breast lump including gynaecomastia. Majority of information regarding treatment of male breast cancer is retrospective in nature and is derived mainly from small single-institution series; thus, the choice of treatment modalities is generally guided by extrapolation of data from female breast cancer. Due to paucity of data and the extreme rarity, male breast carcinoma should be considered and managed as a distinct entity. The invasive lobular carcinoma perhaps with an added advantage for being reactive of hormonal receptors, which could be treated by adjuvant Tamoxifen. It is hoped that a long term multicentric studies will help us to know the prognostic implication of uncommon invasive lobular histology, as well as trials could be strategically designed to optimize the treatment.

Profile of molecular subtypes of breast cancer with special reference to triple negative: A study from Northeast India

Background: Different molecular classes of breast cancer (BRCA) correlate with prognosis and response to therapy. Triple-negative breast cancer (TNBC) is a newer concept and very limited studies were carried out in India. The aim of this study was to profile the molecular types with a particular emphasis on TNBCs. Materials and Methods: Prospectively evaluated descriptive study for 2 years from June 2014 to March 2016, was carried out in the Department of Pathology and Surgery in a tertiary care institute. Cases included were of invasive breast carcinoma in females, confirmed by histopathology. Ethical clearance was received. Data were analyzed using Statistical SAS software. Results: A total of 123 cases of invasive BRCA were studied and mean age was 44.64 years. The peak age group was 36–45 years (43.9%). Tumor sizes ≥2 cm was 30%, between 2 and 5 cm was 50.40%, over 5 cm was 19.51%. Invasive duct carcinoma was 82.11% and invasive lobular carcinoma 8.13%. Only 21% of subjects presented as early breast carcinoma. Cases of 1–3 nodes were 22.8%, 4–5 nodes 21.1%, more than five nodes were 34%. Histologic Grade 3 was 50.4%, Grade 2 was 41%, and Grade 1 was only 8.1. The American Joint Committee on Cancer, Stage 1 (17.9%) in Stage 2 (29.3%) Stage 3 was 46.3%, Stage 4 was 6.5%. Estrogen receptor was in 40.62%, progesterone receptor 35.77%, Her2/Neu 18.69% luminal A (19.51%), luminal B (21.13%), Her2/Neu type (17.88%), and triple negatives (38.21). Conclusion: The present study showed significantly higher TNBC with poor prognostic factors in younger women in a background of peculiar ethic spectrum in this geographical region.

Abstract 935: Oral cancer cells may hijack stem cell altruism to survive during extreme hypoxia, and exposure to chemotherapeutic drugs

The mechanism of tumor hypoxia induced reprogramming of cancer cells are not understood well. Hypoxia might activate evolutionary preserved cellular defense mechanism that could contribute to tumor progression and metastasis. We recently described that during hypoxia/oxidative stress, human embryonic stem cells (hES) exhibit an altruistic defense mechanism, where a few cells reprogram to a highly undifferentiated state, and secrete glutathione to protect rest of the community of cells from oxidative stress induced DNA damage (Das B et al, Stem Cells, 2012). The altruistic stem cells phenotype exhibited high HIF-2alpha and low p53 activity. After a few weeks, the reprogrammed cells, although highly fit to survives, underwent spontaneous apoptosis/differentiation by re-activating the p53/MDM2 oscillation. Thus, the reprogrammed cells sacrificed its own fitness to enhance the fitness of the rest of the community, an altruistic behavior (Das B et al. Stem Cells, 2012). Here, we investigated the potential hijacking of the altruistic defense mechanism by oral cancer cells during exposure to hypoxia. We exposed the four oral cancer cell lines SCC-25, SCC-15, SCC-9 and SCC-5 to extreme hypoxia followed by re-oxygenation for 72 hours. We found that while majority of cancer cells underwent apoptosis, a few cancer cell lines survived, exhibited side-population (SP) phenotype, high level of HIF-2alpha, Nanog, Sox-2 and MYC. The SP cells exhibited migratory activity, as well as high tumorigenic and metastatic activity in NOD/SCID mice. ChIP assay indicated that HIF-2alhpa interact with MYC and NOTCH1. The conditioned media of SP cells exhibited high level of glutathione, and ability to protect non-SP cells from cisplatin-induced toxicity. These results indicate that HIF-2alpha and MYC may cooperate to reprogram a few oral cancer cells to altruistic stemness phenotype. The altruistic phenotype that exhibited cytoprotective activity against cisplatin mediated toxicity. Thus, similar to bacteria, where altruistic biofilm exhibit novel drug resistance mechanism, stem cell altruism may serve as a novel drug resistance mechanism in oral cancer. Citation Format: Rashmi Bhuyan, Hong Li, Sukanya Gayan, Bidisha Pal, Reza Bayat-Mokhtari, Jyotirmoy Phukan, Debabrata Baishya, Anupam Sarma, Joyeeta Talukdar, Manaf Muhammad Alkurdi, Wael Tasabehji, Seema Bhuyan, Gayatri Gogoi, Ista Pulu, Herman Yeger, Bikul Das. Oral cancer cells may hijack stem cell altruism to survive during extreme hypoxia, and exposure to chemotherapeutic drugs. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 935.