Palash Kumar Mandal

Malignant lymphoma in Eastern India: A retrospective analysis of 455 cases according to World Health Organization classification

Background: Malignant lymphoma (ML) is one of the most common cancers and is most prevalent in developed countries. The distribution of different subtypes of ML varies in the different geographical locations according to World Health Organization (WHO) Classification. Aims and Objectives: The study was aimed to analyze the different patterns of ML in Eastern India and to compare it with other geographical locations. Materials and Methods: Four hundred and fifty five patients of two large hospitals in Eastern India were included over a period of four years and were categorized according to WHO classification, using the morphology and immunohistochemistry. Results: There were 347 (76.3%) non Hodgkin lymphomas (NHL), and 108 (23.7%) Hodgkin lymphomas (HL). Diffuse large B-cell lymphoma was the most common of the NHL type (35.2%) followed by the follicular lymphoma (19.3%). B-cell lymphoblastic lymphoma was the least common type of NHL (1.4%). Mixed cellularity (33.3%) and nodular sclerosis (26.9%) were the two most common type of HL. Childhood lymphoma comprised of 12.5%of all ML. T-cell NHL and HL were the common lymphomas in this age group. Conclusion: Incidence of follicular lymphoma is lower compared to western studies and mixed cellularity is the most common subtype of HL unlike nodular sclerosis subtype in Western world. Burkitts type NHL though is the most common subtype of childhood ML in many studies. However, in our study, T-cell NHL is the most common type of childhood ML.

Histopathological study of adrenocortical carcinoma with special reference to the Weiss system and TNM staging and the role of immunohistochemistry to differentiate it from renal cell carcinoma.

BACKGROUND Adrenocortical carcinomas (ACC) are rare tumors with an incidence of 1-2/million/year. They account for 0.05-0.2% of all malignancies. AIMS AND OBJECTIVES This study was aimed to evaluate the Weiss system to diagnose ACCs and to compare it with TNM staging. The role of immunohistochemistry (IHC) was also evaluated to differentiate ACC from other differential diagnoses especially, renal cell carcinoma (RCC). MATERIALS AND METHODS A total of 10 ACCs were included from April, 2000 to March, 2012. All the relevant information like weight, tumor size, gross features was recorded. Multiple sections were taken for histologic examination. Immunomarkers like vimentin, synaptophysin, Melan-A, calretinin, inhibin, EMA, cytokeratin, and Ki-67 were used. RESULTS Out of 10 cases of ACCs (diagnosed by the Weiss system), the tumors were in TNM stage I (1 case), stage II (2 cases), stage III (5 cases), and stage IV (2 cases). The Weiss score in stages I-IV was 4; 5-7; 6-8; and 5-9 respectively. ACCs were positive for vimentin, inhibin, Melan-A, calretinin and negative for EMA and cytokeratin. Proliferative index (Ki-67/MIB-1) was ≥ 20 % (20-65%). CONCLUSION Both the Weiss system and TNM staging are useful in predicting the malignant behavior and prognosis of ACC. Weight and tumor size, though originally not included in the Weiss system, are also important parameters. In lower stages (stages I and II), the Weiss score is low (4-7) while the score is high (6-9) when the tumor is in higher stages (stages III and IV). IHC plays a vital role to confirm the diagnosis and to exclude the possibility of RCC.

PNET of kidney : Report of four cases

Primitive neuroectodermal tumor (PNET) of kidney is a rare tumor of kidney with only a few published reports. We report here four cases of PNET of kidney in the age group between 30 and 50 years who had complaints of vague pain and lump in loin. Hematuria was present in one case. Imaging of all cases revealed renal mass. The pathologic findings were consistent with PNET in all cases–confirmed by immunohistochemistry with diffuse membrane positivity of tumor cells of CD99. We could not do fluorescent in situ hybridization to demonstrate EWS-FLI-1 gene fusion. Each case was in the advanced stage. However, after giving postoperative radiotherapy and chemotherapy patients are still alive. Reporting of these cases are important as we got them in a short span of 3 years. In view of its poor prognosis, aggressive nature and different therapeutic approach– renal PNET should be differentiated from other small blue round cell tumors like neuroblastoma, rhabdoid tumor of kidney, nephroblastoma, small cell carcinoma, synovial sarcoma (monophasic, poorly differentiated) and non-Hodgkin lymphoma (NHL) by immunohistochemistry, cytogenetic, and molecular genetics study to see the different gene rearrangements in NHL and 3p deletion in small cell carcinoma.

Parathyroid carcinoma uncovering the enigma: Case report and review of literature

Parathyroid carcinoma is a very rare cause of primary hyperparathyroidism. Pre-operative diagnosis remains a challenge. We report a case referred for a suspicious goiter with a poor general condition associated with hypercalcemia. Cytological findings attributed it to a possible parathyroid neoplasm that must be considered in the differential diagnosis of a nodular thyroid mass by the cytopathologist. Serum parathormone levels were correlated and the patient underwent surgery. Histopathology confirmed the diagnosis of parathyroid carcinoma. There can be a major pitfall, as it may appear indistinguishable from a benign adenoma.

Malignant lymphoma in Eastern India: A retrospective analysis of 455 cases according to World Health Organisation classification

BACKGROUND Malignant lymphoma (ML) is one of the most common cancers and is most prevalent in developed countries. The distribution of different subtypes of ML varies in the different geographical locations according to World Health Organization (WHO) classification. AIMS AND OBJECTIVES The study was aimed to analyze different patterns of ML in Eastern India and to compare it with other geographical locations. MATERIALS AND METHODS Four hundred and fifty five patients of two large hospitals in Eastern India were included over a period of four years and were categorized according to WHO classification, using morphology and immunohistochemistry (IHC). RESULTS There were 347 (76.3%) non Hodgkin lymphomas (NHL), and 108 (23.7%) Hodgkin lymphomas (HL). Diffuse large B cell lymphoma (DLBCL) was the most common of the NHL type (35.2%) followed by the follicular lymphoma (19.3%). B cell lymphoblastic lymphoma was the least common type of NHL (1.4%). Mixed cellularity (33.3%) and nodular sclerosis (26.9%) were the two most common type of HL. Childhood lymphoma comprised of 12.5% of all ML. T cell NHL and HL were the common lymphomas in this age group. CONCLUSION Incidence of follicular lymphoma is lower compared to western studies and mixed cellularity is most common subtype of HL unlike nodular sclerosis subtype in western world. Burkitts type NHL though is the most common subtype of childhood ML in many studies but in our study T cell NHL is the most common type of childhood ML.

A comparative study of Hasford score and Sokal index in prognostication of the novo chronic myeloid leukemia patients and a search for new prognostic markers

INTRODUCTION Chronic myeloid leukemia (CML) is a common myeloproliferative disorder. Based on clinical and hematological parameters, two prognostic scoring systems, i.e., Hasford and Sokal index scoring systems are available to predict survival duration of CML patients on imatinib therapy. AIMS AND OBJECTIVES Our studys objective is to compare Hasford score with Sokal index for the prognostication of de novo CML patients on therapy and find out new prognostic markers. MATERIALS AND METHODS This is a retrospective study. The study population comprised 66 patients who were followed up for 60 months. For each patient, at presentation, scoring was performed as per Hasford and Sokal index and Philadelphia chromosome analysis was carried out by conventional cytogenetics. Thereafter, hematological parameters were assessed 3 monthly and conventional cytogenetics was done yearly. RESULTS Out of these 66 patients, the number of patients belonging to low, intermediate and high risk categories are 21, 33 and 12 respectively by Hasford score and 12, 32 and 22 respectively by Sokal index. Eight patients, who had been categorized into high risk group by Sokal index but intermediate risk group by Hasford score, have shown better survival possibility as monitored by hematological and cytogenetic parameters. Ten cases, categorized into intermediate risk group by Sokal index but low risk group by Hasford score, is doing well till date. CONCLUSIONS This study shows that Hasford score predicts survival of the patients better than Sokal index. However, multicentric study over a large population is needed to give the final verdict.

Is there any role of mast cell density and microvessel density in cervical squamous cell carcinoma? A histologic study with special reference to CD-34 immunomarker staining

Background: Mast cells are involved in induction of angiogenesis in the early-stages of tumor development and in modulating blood vessel growth in the later stages of tumor progression. Aims and Objectives: This study was carried out to evaluate the association between mast cell density (MCD) and microvessel density (MVD) in carcinoma in situ (CIS), microinvasive carcinoma (CA) and invasive squamous cell CA of cervix. Materials and Methods: Six cases of CIS, four cases of microinvasive CA and 38 cases of invasive CA were studied over a period of 2 years from August, 2011 to June, 2013. Ten control samples were included in the study. Routine histologic examination was done. Toluidine blue stain was used for MCD determination. Immunohistochemical analysis with CD-34 was done for assessing MVD. Students t-test was used to calculate the statistical significance of MCD and MVD. Results: Both MCD and MVD increased from normal samples through CIS to invasive cervical CA. In the four cases of microinvasive CA, the MCD and MVD were more than that of the control samples, but less than that of the six cases of CIS. Conclusion: There is a correlation between mast cell accumulation and angiogenesis in CIS, microinvasive CA and invasive cervical squamous cell CA. MCD and MVD in invasive CA exceed those in CIS and microinvasive CA. It gives us an opportunity to postulate that therapeutic strategies against mast cell mediators and angiogenesis may be of benefit in patients of early-stage cervical CA.

Computed tomogram guided fine-needle aspiration cytology of lung mass with histological correlation: A study in Eastern India

Background: Fine-needle aspiration cytology (FNAC) is an important and useful investigation, and is considered next to imaging in the rapid diagnosis of pulmonary mass lesion for the last few decades. Aims: To assess the role of Computed Tomogram (CT) guided FNAC in pulmonary mass lesions; to analyze the results; and to compare with histopathological findings. Materials and Methods: The clinical, radiological, and cytological data of 130 patients were prospectively studied who underwent CT guided FNAC from October 2009 through September 2011. Thereafter these patients underwent bronchoscopic/trucut biopsy/lobectomy, whatever clinically indicated. Smears and tissue sections were evaluated simultaneously to reach at a definite diagnosis. Results: Out of 130 cases, we found adequate FNAC smear and histopathology reports only in 124 cases. The age range varied from 35 to 73 years with the peak in the fifth to sixth decades. The benign lesions were 10 (8.07%) and malignant lesions were114 (91.93%) shown by cytology. The most common tumor was adenocarcinoma (51.72%) followed by squamous cell carcinoma (22.41%) and small cell carcinoma 6.89%. Diagnostic accuracy of CT guided FNAC was 95%. Post procedural complications such as hemorrhage and chest pain were minimal and were noted only in three cases. Conclusion: CT guided FNAC of pulmonary masses provides simple, easy, and reliable method for reaching rapid tissue diagnosis with minimal complication.

Lymph node involvement in histiocytic sarcoma: A report of two cases with previous misdiagnoses

Histiocytic sarcoma (HS) is an unusual rare but controversial neoplasm. Here, we report two cases of HS initially misdiagnosed as other entities and with initial wrong treatment. The first case was a 29-year-old male with right cervical lymphadenopathy. The patient was misdiagnosed as nodular sclerosis variant of Hodgkin disease. The second case was a 12-year-old male child with axillary and mediastinal lymph nodes. This case was misdiagnosed as tuberculosis. Both these two cases were initially treated according to their primary diagnosis, but without any treatment success. Subsequently, repeat biopsies of these cases were done. Histopathologic examination showed these cases to be HS. The tumor cells were immunoreactive for CD68, CD163, and immunonegative for cytokeratin, epithelial membrane antigen, CD15, CD30, and other markers. Focal positivity of S-100 was noted in one case. Thus, confirmed diagnosis of HS was established. Patients were treated for HS and were kept well in 1-year follow-up period.

Cytodiagnosis of myxoid adrenocortical carcinoma and role of immunocytochemistry to differentiate it from renal cell carcinoma.

Adrenocortical carcinoma (ACC) is a rare malignancy and cytodiagnosis of this tumor is not routinely encountered by a cytopathologist. Here, we report a case of ACC initially diagnosed by computed tomography (CT)-guided fine needle aspiration cytology (FNAC) with the help of immunocytochemistry. A 48-year-old lady presented with flank pain and abdominal mass for the last 6 months. A CT scan of her abdomen revealed a large mass arising from the upper part of the left kidney. CT-guided FNAC was performed. Cytologic smears showed pleomorphic large cells arranged discretely and in small aggregates against a myxoid background. The cells had a high nucleocytoplasmic ratio, anisonucleosis and conspicuous nucleoli. Based on cytomorphology, differential diagnoses of ACC and renal cell carcinoma (RCC) were made. On immunocytochemistry, the tumor cells were synaptophysin, inhibin, vimentin and Melan-A positive but cytokeratin and epithelial membrane antigen negative. Thus, a cytodiagnosis of myxoid ACC was made and histopathologic examination was suggested. Subsequent histologic examination and immunohistochemistry proved the case to be myxoid ACC.