Marjorie Correa

Estrogen Receptor Negative Breast Cancer in India: Do We Really Have Higher Burden of this Subtype?

ER negative and Triple negative breast cancers carry a poorer prognosis and are not amenable to hormone therapy. It has been previously observed that Indian patients with breast cancer have a higher tendency to have these tumours. Whether this is due to inherent biological differences in the tumours of our patients is a matter of much debate. We have analysed 250 patients of breast cancer for hormone receptor status, compared them with western series, and attempted to support the hypothesis that the higher ER negativity and triple negativity is indeed due to different tumour biology.

Pilomatricoma: A tumor with hidden depths

BACKGROUND Pilomatricoma is a benign tumor of hair matrix differentiation and has been classically described as comprising of basaloid and shadow cells admixed with multinucleated giant cells and areas of calcification. However, there are a diverse range of histologic features this tumor displays that are often unrecognized. AIMS This study was undertaken to record the histopathologic features of pilomatricoma with an emphasis on the occurrence of other forms of differentiation. METHODS The study included all skin biopsy specimens over a 13-year period from 1995 to 2007 that had a histologic diagnosis of pilomatricoma. Hematoxylin and eosin-stained slides were reviewed. RESULTS This study included 21 cases of pilomatricoma. Supramatrical differentiation was seen in all cases and three-quarters of the cases showed matrical differentiation. Also observed in some of the cases were clear cell differentiation toward the outer root sheath, infundibular differentiation, calcification, ossification and secondary inflammation with a foreign body giant cell reaction. Epidermal induction in the form of a downward plate-like growth of the epidermis was seen in a few cases. CONCLUSION Pilomatricoma, although considered a tumor of hair matrix differentiation, can show cellular evolution toward the other parts of the hair follicle, such as the outer and inner root sheaths, sebaceous and infundibular components and, therefore, can be considered a panfollicular neoplasm.

An audit of cervicovaginal cytology in a teaching hospital: Are atypical glandular cells under-recognised on cytological screening?

Background: Cervical cytology screening for carcinoma of the cervix in India is mainly opportunistic in nature and is practiced mainly in urban centres. The effectiveness of cervical cytology screening depends on various factors. The quality of cervicovaginal cytology service is assessed by various quality indices and by cyto-histology correlation, which is the most important quality assurance measure. Aims: To describe the cervical cytology diagnoses, estimate the quality indices, and evaluate the discrepant cases on cytohistological correlation. Settings and Design: Retrospective observational study from a tertiary care centre in South India. Materials and Methods: Using a database search, all the cervicovaginal cytology reported during the period of 2002-2006 was retrieved and various diagnoses were described. The data was analysed to assess the quality indices. The cytohistologically discrepant cases were reviewed. Results: A total of 10,787 cases were retrieved, of which 98.14% were labeled negative and 1.36% were unsatisfactory for evaluation. A few (0.81%) of the cases were labeled as squamous intraepithelial lesions and 0.38% as atypical squamous cells. The ASCUS: SIL ratio was 0.5. Cytohistological correlation revealed a total of ten cases with significant discrepancy. The majority of these were carcinomas that were misdiagnosed as atypical glandular cells. These cytology smears and the subsequent biopsies were reviewed to elucidate the reasons for the discrepancies. Conclusions: The cervical cytology service at our centre is well within the accepted standards. An increased awareness of cytological features, especially of glandular lesions, a good clinician-laboratory communication and a regular cytohistological review would further improve the diagnostic standards.

Cervical lymph node metastases in head & neck malignancy - A Clinical /ultrasonographic/ Histopathological comparative study.

A study was conducted on the value of Ultrasound (US) in the detection of cervical lymph node metastases in cases of Head and Neck malignancy; and its usefulness in planning surgical management. The clinical, ullrasonographic and histopathological examination (HPE) findings were compared in 20 patients as a preliminary assessment of this ongoing study. Clinically and ultrasonogiaphically, patients were assessed for presence of nodes, their size, shape, mobility and overall positivity for malignancy. All patients then underwent neck dissection, and individual nodes from the specimens were assessed by HPE.It was found that US, when compared with clinical examination had a sensitivity of 47.62% versus 43.75%, specificity of 77.78% versus 25.0% and an accuracy of 61.54% as opposed to 38.9%. US proved valuable in detecting sub-clinical nodes, central necrosis, extra-capsular spread, pressure on large vessels - all indicators of metastatic spread. Hence, US was found to be efficient and cost-effective pre-operatively, in planning surgical management.

Chylothorax in gastric adenocarcinoma: A case report and systematic review of the English literature

Background: Chylothorax is a rare complication of gastric adenocarcinoma and data on its identification, prevalence and outcomes are scant. Objectives: To enable identification of gastric carcinoma as a cause of chylothorax. Methods: A case report and a systematic review were conducted of all reported cases of gastric adenocarcinoma with chylothorax as the presenting complaint in the English literature. Results: Chylothorax is a rare presenting complaint of gastric adenocarcinoma. There are only 18 case reports in the world literature, of which six are in English. Chylothorax occurred variably in gastric adenocarcinoma, either as a presenting feature or as a complication of therapy. Here, we analyze the index case and six patients in whom gastric carcinoma presented with chylothorax as the initial symptom. Respiratory features of cough and dyspnea preempted any abdominal complaint. Bilateral chylothorax (66%) with associated chylous ascites (50%) was common. Four of the six patients had skin lymphedema also as a prominent feature. The chylothoraces have been treated by therapeutic pleurocentesis, intercoastal tube drainage and restriction of oral intake. Gastric adenocarcinoma was associated with high mortality (50%) and morbidity. Conclusions: Chylothorax can be the presenting feature of gastric adenocarcinoma. A thorough search for this life-threatening disease should be done before labeling the chylothorax as idiopathic.

Rhino-orbital mucormycosis and aspergillosis: differences in outcome, clinical and imaging characteristics

With reference to the report titled “Rhino-orbital-cerebral mucormycosis and aspergillosis: diVerential diagnosis and treatment” by Arndt et al. [1], we would like to highlight further points of diVerences between the two main groups of invasive fungal diseases of the paranasal sinuses and their surrounding structures, observed while treating these conditions. At our hospital, a multispecialty tertiary care center we are in the process of reviewing all cases of invasive fungal infections of the paranasal sinuses and orbit. We have found that the incidence of mucormycosis far exceeds the occurrence of invasive aspergillosis. From 2002 to 2008, we have treated about 25 cases of ROCM and only three cases of invasive aspergillosis. The occurrence of allergic aspergillus fungal sinusitis was found to be far more common whose treatment and outcome are very diVerent from invasive aspergillosis. Most infections have been secondary to uncontrolled diabetes with and without ketoacidosis unlike the above-mentioned report where the altered immune status was secondary to hematological malignancies which are more resistant to reversal with treatment. Our outcomes are also diametrically opposite to the outcomes reported by Arndt et.al. The prognosis for life in rhino-orbital mucormycosis has improved from that reported in the previous study [2]; while the outcomes have been dismal with mortality occurring in all three patients with invasive aspergillosis although the management has been similar in both groups with the early administration of intravenous amphotericin B, repeated surgical debridement of paranasal sinuses, orbits and areas of intracranial spread. One patient with aspergillosis died despite the administration of oriconazole systemically along with amphotericin B. Other than the demonstration of bony erosions of the paranasal sinus on computed tomography, there is a paucity of Wndings in mucormycosis, even when clinical Wndings and intraoperative Wndings are of advanced orbital disease. Soft tissue Wndings in the orbit and intracranium are better delineated on MRI scanning in mucormycosis [3]. In contrast, invasive aspergillosis of the orbit was well delineated on CT scanning itself. Moreover in two patients with aspergillosis, intraoperatively in the orbit it was very diYcult to delineate the diseased structures from the involved structures, although biopsies obtained from the anatomical areas delineated on CT scan as abnormal, showed evidence of invasive aspergillosis. At present times, we have no logical explanation for the apparent contradictory Wndings on imaging and intraoperative Wndings in these two fungal infections. Further characterization of the clinical, imaging and intraoperative Wndings of invasive mucormycosis and aspergillosis is necessary.