Mehar Aziz

Prognostic Significance of Circulating Immune Complexes in Cancer Patients

Circulating immune complexes (CIC) were estimated in 100 cancer patients and 25 healthy control volunteers by means of the polyethylene glycol (PEG) precipitation test and latex agglutination inhibition (LAI) test. Pathological levels of CIC were found in 47% of the patients by PEG precipitation test and in 59% of the patients by LAI test; both tests were positive in 33% of the patients. Consequently, the use of the two assays resulted in 73% seropositivity for CIC. The PEG precipitation test detects antigen‐antibody complexes formed in the ratio of 2:1 (Ag2Ab), while the LAI test could detect immune complexes formed over an extended range of antigen‐antibody ratio including complexes as small as SS. CIC values were significantly higher by combined assays (P < 0.001) as compared to individual assays (P < 0.01) when compared with the control group. It was found that 75% of post‐operative follow‐up patients became seronegative for CIC in the combined assays, whereas the 25% of post‐operative patients who remained seropositive for CIC showed recurrence within three months after surgery. Immune‐complex deposition was demonstrated on malignant cells in vitro by direct immunofluorescence studies in 73.3% of patients, while 60% of patients revealed complement‐fixing antigen‐antibody complexes. It was found that 20% of patients showing positive immunofluorescence with anti‐C3‐antisera had decreased levels of CIC. Complement‐mediated cytotoxic injury results in reduction of tumor cell mass and subsequent decrease in CIC. Necrotizing and leucocytoclastic vasculitis in the tumor mass was initiated by raised CIC levels in vivo in 71% of patients. Necrosis of malignant tumors was seen in 58% of patients, and hemorrhage in 36% of patients. These changes were considered to be an aftermath of immuno‐complex vasculitis initiated by CIC.

Adenomatoid tumour of testis

Adenomatoid tumour is a rare neoplasm of mesothelial origin commonly seen in male and female genital tract. In this case report, the authors present a case of adenomatoid tumour in a 35-year-old male who presented with 1-year history of scrotal swelling. A clinical diagnosis of testicular neoplasm was made but final diagnosis of adenomatoid tumour was made after excisional biopsy.

Tubercular dactylitis and multifocal osteoarticular tuberculosis--two rare cases of extrapulmonary tuberculosis.

Involvement of small bones of hand and feet leading to tuberculous dactylitis involvement is a rare presentation of extrapulmonary tuberculosis. Even rarer is the association of tuberculous dactylitis with multifocal skeletal involvement, even in countries like ours, where tuberculosis is endemic. The authors report two cases, one of tuberculous dactylitis in a 55-year-old male and another of multifocal skeletal tuberculosis in a 4-year-old male. Both the patients were effectively treated with antitubercular drugs.

Role of Circulating Immune-Complexes as Prognostic Indicators of Lympho-Reticular and Mesenchymal Malignancies in Children

Circulating immune complexes (CIC) were estimated in 28 cases of Non-Hodgkins lymphomas, Hodgkins disease, bone and soft tissue sarcomas in the pediatric age group by polyethylene glycol (PEG) precipitation and latex agglutination inhibition (LAI) techniques. Results were compared with 25 age-matched controls. Highly significant CIC values were obtained by LAI technique (P less than 0.01) as compared to PEG pptn technique (P less than 0.05) in malignancy. However, seropositivity for CIC in lymphomas and Hodgkins disease was 85.71 per cent by LAI test as compared to 57.14 per cent by PEG pptn test. In sarcoma group, seropositivity for CIC was 57.11 per cent by LAI test and 28.57 per cent by PEG pptn test. Combination of both these tests increases the sensitivity of immune complex detection in serum of cancer patients. CIC begin to rise in serum in early stages of neoplastic transformation, and the level of CIC is directly proportional to proliferating tumour mass in vivo.

Primary low-grade diffuse small lymphocytic lymphoma of the central nervous system

A 45-year-old Indian woman presented in neurosurgery outpatient with seizures, headache and vomiting for the past 1 month. MRI of the brain was suggestive of a malignant central nervous system (CNS) tumour. Histological and immunohistochemical examinations of stereotactic biopsy of the tumour were diagnostic of a low-grade diffuse small lymphocytic lymphoma of the CNS. No evidence of any occult systemic lymphoma was observed, confirming its ‘primary’ origin in the CNS. The diagnosis of a low-grade primary CNS lymphoma (PCNSL) is difficult as clinical and neuroradiological features are wide and variable. The clinical course is more indolent than a high-grade PCNSL and thus, a less aggressive and localised targeted treatment could be sufficient rather than the high dose, neurotoxic methotrexate-based chemotherapeutic treatment, recommended for high-grade PCNSL. Histological and immunohistological confirmation is therefore mandatory for early, appropriate treatment and prognostic implications.

Rare disease: Steatocystoma multiplex

A 40-year-old man presented with multiple papules on his head and neck. The lesions had been present for about 15 years. The patient was treated for acne for 6 months, but no improvement was noted. A biopsy was performed and microscopic findings were consistent with steatocystoma multiplex.

Radiologically guided fine needle aspiration cytology of retroperitoneal and spinal lesions

Aim: This study was undertaken to assess the role of image-guided, fine needle aspiration cytology (FNAC) in the diagnosis of retroperitoneal and spinal lesions. Materials and Methods: Over a period of one year, ultrasonography and computerized tomography-guided FNAC was performed in 55 cases who had presented clinically with signs and symptoms related to the retroperitoneum and spine. Histopathological confirmation was available in 27 out of 55 cases. Results: Of the 55 cases, 39 were males and 16 were females. Malignant and benign lesions accounted for 58.2 and 29.1% respectively. Among the cases on whom radiologically guided FNAC was performed, the spine contributed the largest proportion of cases (32.7%), followed by renal lesions (20%). Among the malignant lesions, renal cell carcinoma was the most commonly found malignancy, followed by metastasis to the spine. In the benign and inflammatory category, tuberculosis of the spine and the lymph nodes was the most common lesion accounting for 68.7% of all cases. On correlating clinical, radiological, and cytologic features, the sensitivity, specificity, and overall accuracy of guided FNAC obtained in this study were 97.1, 84.2, and 92.4% respectively. Conclusions: Radiologically guided FNAC is a fairly accurate and safe procedure in diagnosing the most difficult cases in the region of the retroperitoneum and the spine.

Kaposi sarcoma presenting as dermal nodule.

Kaposi sarcoma (KS) is a rare tumour caused by human herpes virus 8. It is a systemic disease which can present with skin lesions with or without internal involvement. We are presenting here a case of classic subtype of KS in a 60-year-old male who presented with a 4-month history of nodular lesion over right hand.

Cerebellar haemangioblastoma: a rare entity.

A 45-year-old female presented with headache, nausea, vomiting and ataxia of 4-month duration. CT head showed a posterior fossa tumour which was diagnosed as a case of haemangioblastoma on microscopic examination.

Profile of Non-Hematological Pediatric Tumors: A Clinicopathological Study at a Tertiary Health Care Centre

ABSTRACT Background: Tumors in pediatric age group are biologically different from tumors in adults and emerging as a significant contributor to morbidity/mortality in children. Objectives: This study evaluated the epidemiological profile of pediatric solid tumors in 0–18 years of age over a period of 5 years in a general hospital in India. Results: A total of 510 cases of tumors were included, which accounted for 5.1% of the total tumor burden of the hospital. Benign tumors were more common than malignant tumors. Most common age group affected was 14–18 years. Among benign tumors, vascular tumors were the most common, while malignant bone tumors outnumbered all other malignant tumors. Neuroblastomas comprised only 0.9% of our malignancies. Conclusion: Our study provides an insight into the patterns of childhood tumors for which exists little literature in India. With lack of a dedicated pediatric cancer registry from India, tracking of the diverse histological spectrum of tumors is difficult.