Nandyala Rukmangadha

Hormone receptor status (estrogen receptor, progesterone receptor), human epidermal growth factor-2 and p53 in South Indian breast cancer patients: A tertiary care center experience

Breast cancer, in India, is the second commonest cancer in females. Receptor status with ER/PR/Her 2 is now routinely done in patients with invasive carcinoma. The tumour suppressor gene, p53, is also present in most breast cancers. Proteins produced by a mutated p53 gene, accumulate in the nucleus of tumour cells and are detected by immunohistochemistry (IHC). We have undertaken this study with the aim to evaluate the ER, PR, HER-2 and p53 expressions in invasive breast carcinomas by IHC and to compare the HER-2 expression with various clinicopathological parameters. Materials and Methods: In this retrospective single institutional study from January 2001 to December 2010, 389 cases of histopathologically diagnosed infiltrating carcinoma of breast were evaluated taking into account various parameters like age, tumour size, grade, lymph node involvement, ER and PR. HER-2 and p53 was done in 352 cases. Results: The age range was 23-90 years with a mean of 50.7 years. Majority of tumours were T2 (79.6%) and Grade II (60.9%). Our data showed overall 47.6% ER, 48.8% PR, 29.6% HER-2 and 69.2% p53 positivity. There was no significant correlation between HER-2 and age, tumour size, lymph node status, ER, and PR. There was significant correlation between HER-2 and tumour grade (P = 0.031), p53 (P < 0.001). There was no inverse correlation between HER-2 and combined ER, PR status. Triple-negative breast cancers which constituted 22.7% of our cases did not reveal any correlation with various parameters. Conclusion: In our study, ER status was low, and incidence of p53 was high. These findings suggest that many of the tumours in Indian females may be of an aggressive type, and novel treatment approaches may be tried. We conclude that the assessment of all four markers is desirable.

Thyrolipomatosis: an inquisitive rare entity

It is rare to find diffuse presence of mature adipose tissue inside thyroid gland which defines thyrolipomatosis. We report a case of a 32-year-old hyperthyroid female on suppression therapy since the past 2 years presenting with diffuse thyroid swelling. She underwent total thyroidectomy and the histopathology revealed features of thyrolipomatosis. As fat containing lesions of thyroid include not only non-neoplastic lesions but neoplasms also, including an occasional malignant one, rendering a correct diagnosis is essential.

Histopathological and Immunohistochemical Evaluation of Meningiomas with Reference to Proliferative Markers p53 and Ki-67.

INTRODUCTION Meningiomas are slow growing primary central nervous system (CNS) tumours attached to the duramater, which arise from the meningothelial cells of the arachnoid. Grading of meningioma based on histological findings assisted with supplementary immunohistochemical studies, predicts the prognosis of meningioma with good precision. AIM To evaluate proliferative markers and correlate with various histological subtypes and grade. MATERIALS AND METHODS A total of 224 meningiomas, diagnosed between January1995 and October 2011were graded according to WHO 2007 criteria. Immunostaining for p53 and Ki-67 markers were performed on 100 cases. RESULTS There was female predominance. There were 194 Grade I, 24 Grade II and 6 Grade III meningiomas. Brain invasion noted in 18(8%) meningiomas predominantly in grade III followed by grade II. Recurrence was seen in 7 (3.1%) cases, most common in psammomatous followed by angiomatous meningioma. Immunostaining showed p53 positivity in 72.5% of grade I, 83.3% of grade II and all the cases of grade III tumours. Ki-67 Labelling Index (LI) consistently increased from grade I to grade III tumours. CONCLUSION p53 and Ki-67 LI correlated well with increasing histological grade and biological behaviour of meningioma.

Utility of immunohistochemistry in demonstrating Helicobacter pylori

Background: Helicobacter pylori is the causative organism for chronic active gastritis, duodenal ulcer and also for malignancies like gastric adenocarcinoma and mucosa associated lymphoid tissue lymphoma. It is essential to mention the presence of H. pylori in gastric biopsies as it has an important role in patient care. Though there are several special stains to detect H. pylori in histological sections, their specificity and sensitivity vary greatly. Immunohistochemically H. pylori can be detected by using anti H. pylori antibody, which reacts with somatic antigens of the whole bacteria. The aim of this study was to compare the reliability of routine hematoxylin and eosin (H and E), Giemsa, Warthin-Starry (WS) silver stain and immunohistochemical technique in diagnosing H. pylori. Materials and Methods: In this retrospective 1-year (2009) study, endoscopic gastric biopsies taken from patients during gastrointestinal-endoscopy with histopathological diagnosis of gastritis were studied. Standard H and E staining was performed on 5-μm-sections from paraffin block of each specimen. Microscopic sections of biopsy specimens of patients showing features of gastritis histopathologically in routine H and E stain and where the presence of H. pylori was suspected were also stained with Giemsa, WS, and immunohistochemistry (IHC) using purified polyclonal H. pylori antiserum (BioGenex). We have not included gastric resection specimens in our study. Results: Of the 29 cases, 26 (32.9%) showed presence of H. pylori on H and E, Giemsa and WS stains, whereas 49 (62.0%) cases demonstrated H. pylori on IHC stain. Conclusion: We conclude that H. pylori detection by IHC has advantage over routine H and E staining. However, in the developing countries with financial constraints, routine H and E staining in combination with special staining are fairly reliable in demonstrating H. pylori.

Solid and cystic papillary neoplasm of pancreas: A clinic-pathological and immunohistochemical study: A tertiary care center experience.

Background: Solid pseudopapillary tumor of the pancreas (SPT) is a rare tumor of low malignant potential, mostly described in young women. Materials and Methods: In this retrospective study from January 2000 - December 2010, there were 50 pancreatic tumors. In this period, four SPTs were encountered, which were analyzed with respect to clinical, imaging, histopathological, and immunohistochemical findings. Results: There was a female preponderance with mean age of 22.2 years. Two of the tumors were located in head of the pancreas and two in the body and tail region. On imaging, majority were large cystic tumors. Histopathologically, they exhibited extensive necrosis and presence of pseudo papillae in viable areas. Immunohistochemically, they were positive for alpha-1-anti-trypsin, alpha-1-anti-chymotrypsin, vimentin, CD10, and CD99. Progesterone receptor and p53 exhibited mild positivity in all of the four cases, whereas neuron specific enolase (NSE), synaptophysin, and chromogranin showed focal positivity in one case. Conclusion: Despite its non-specific clinical, imaging, and even immunohistochemical features, characteristic gross and microscopic findings provide reliable diagnosis of SPTs.

Myxoid chondrosarcoma of sphenoid bone.

The myxoid variant of chondrosarcoma is usually seen in soft tissues where it is known as chordoid sarcoma or parachordoma. Rarely, it involves bone and when it does, cranial bones are the preferred location. This tumor is frequently amalgamated with the chondroid variant of chordoma, especially when the lesion occurs in the sphenoid bone/spheno-occipital region, because of their similar clinical presentations, anatomical locations, radiological findings, and mistaken histopathological features. It is essential to distinguish myxoid chondrosarcoma from the chondroid variant of chordoma, because of the different treatment protocol and prognostic importance. We present such a location-based diagnostic dilemma, solved successfully with ancillary immunohistochemistry.

Cutaneous metastasis of transitional cell carcinoma of the urinary bladder: Cytological aspect.

Cutaneous metastasis from transitional cell carcinoma urinary bladder is a rare clinical entity associated with poor prognosis. This case report describes a 51-year-old male who presented with multiple cutaneous metastases arising from high grade transitional cell carcinoma bladder with lamina propria invasion. The prominent cytological features include medium sized to large pleomorphic cells with irregular nuclear outlines, coarse chromatin pattern, and tumor giant cells. An awareness of this rare clinical entity and high index of suspicion is needed for diagnosis.

Well-differentiated fetal adenocarcinoma of the lung in an adult male: Report of an unusual tumor with a brief review of literature

We report a case of a well-differentiated fetal adenocarcinoma (WDFA) of the lung in a 50-year-old male smoker. The literature regarding this uncommon tumor is limited. This rare variant of adenocarcinoma is more common in females, in the third and fourth decades. Microscopically it is composed of neoplastic glands and tubules that resemble the fetal lung. Well-differentiated fetal adenocarcinoma is a low-grade malignancy and surgery is the preferred mode of therapy. This uncommon case of a well-differentiated fetal adenocarcinoma in an adult male patient is reported, with relevant immunohistochemical findings, along with a discussion of the current literature.

Metastasis in central nervous system: Clinicopathological study with review of literature in a tertiary care center in South India

Background: Secondary central nervous system (CNS) tumors are common in Western countries, but in Indian literature, scant data are available. With the advent of newer imaging techniques, the confirmatory histopathological diagnosis has become comparatively easier. Hereby, we have analyzed our data from a single tertiary care center in south India. Materials and Methods: In this retrospective study from January 2000 to December 2010, histopathologically diagnosed secondary CNS tumors were reviewed along with clinical, imaging, and relevant immunohistochemical findings. Meningeal, lymphoproliferative, and myeloproliferative tumors and autopsy data were not included in the study group. Results: There were 40 secondary CNS tumors. Male to female ratio was 2.3:1. Age range was wide (28-75 years). Majority of cases were seen in the fourth and fifth decade. Imaging-wise, (computed tomography and magnetic resonance imaging) majority were single lesions (n = 34, 85%). Most commonly, these single lesions were present in the cerebral hemisphere (n = 20, 50%) followed by cerebellum (n = 10, 25%). Adenocarcinoma accounted for maximum number of cases (n = 25, 62.5%) with lungs being the most common primary. Conclusion: We have noted 25% metastatic adenocarcinomas in cerebellar location, which is higher when compared with available world literature. However, we also encountered a good number of cases (30%) due to unknown primary. Though histopathological examination with use of immunohistochemical markers can reliably distinguish primary from secondary CNS tumors in addition to available clinical and imaging data, particularly in developing countries, still a better work-up with an array of immunohistochemical markers and newer imaging modalities is desirable.

Melanoacanthoma of external ear: Report of two cases

Melanoacanthoma is a rare lesion. Melanoacanthoma of external ear is still rarer. We present two cases of melanoacanthoma of external ear in adults which presented as pigmented growths and clinically were suspected as malignant lesions. Histopathology was diagnostic as it demonstrated the characteristic elevated lesion with abundant melanin pigment. No recurrence of the lesion was reported after four years of initial diagnosis. These cases have been presented because of their uncommon location, highlighting the differential diagnoses.