Phaneendra Bv

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.

Rare case of blastemal predominant adult Wilms' tumor with skeletal metastasis case report and brief review of literature

Wilms’ tumor (nephroblastoma) is extremely rare in adults, skeletal metastasis being still rarer. The clinical course of adult Wilms’ tumor is very aggressive. The present case is a rare blastemal predominant adult Wilms’ tumor presenting with skeletal metastasis. We report a case of 19-year-old female presented with severe low backache and colicky left loin pain of 3 months and progressive weakness of 15 days duration. Magnetic resonance image (MRI) of lumbosacral spine was reported as spinal metastasis with right renal mass. The patient underwent right radical nephrectomy and the tumor was histopathologically confirmed as adult Wilms’ tumor. In case of adult Wilms’ tumor, distant metastasis may be the first presentation and this possibility should be considered when an adult patient presents with flank pain and a renal mass.

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.

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.

Plagiarism: Trespassing the grey zone between searching and researching

One of the most heated debates doing rounds in the world of literature today is about plagiarism. Walter Bagehot, physics and politics (1872) once said “The propensity of man to imitate what is before him is one of the strongest parts of his nature.” The following joke definition attributed to Wilson Mizner circulates around the Internet: To copy from one book is plagiarism; from two an essay; from three a compilation; from four a dissertation.

Pathologists in a Net-Savvy World

Sir, Pathology is aptly described as a bridging science as it connects the basic and clinical sciences. It also provides a link between the patients and their physicians. It helps the clinician to determine and decide different modalities of treatment (either medical or surgical) that can be provided to the patients based on the pathologist’s report. Though pathologists seldom directly interact with patients their role in the diagnosis and in providing prognostic information is invaluable. Some clinicians even pronounce the pathologists as judges and themselves as lawyers presenting a case, as pathologists provide the final diagnosis. Computers have changed various aspects of our lives considerably since their arrival. The worldwide web of computers i.e. internet has the capability to influence various aspects of pathology like routine diagnosis, research, training and teaching.[1] Earlier, particularly in the developing countries, people used to ask pathologists whether the report is of cancer or not. But nowadays, in this era of Facebook and Twitter, to name a few, the patients come armed with all kinds of information available on the internet and they have more specific questions regarding their ailments. So what are the pathologists supposed to do to answer these ever-increasing queries? People are well versed with different applications of computers in today’s world. Nevertheless the pathology residents should acquire the skill and get trained at the first available opportunity. Our reports also should answer the patients’ as well as the clinicians’ queries. The era of Web 1.0 is getting fast left behind with the advent of various interactive Web 2.0 social websites like Facebook and Twitter.[2,3] Following suit we need to develop Web 2.0 pathology websites whereby the educated eager patients can be provided with better answers to their queries regarding specific tests, diseases, laboratory reports and prognosis. In view of this we can create relevant, authentic and well-updated links to laboratory test results, thereby minimizing the volume of ancillary text presented.[4] Since the cyber world is a goldmine for data storage, its potential can be explored to achieve a healthy green globe. Simultaneously, one should also provide judicious information keeping in mind the probable legal aspect. Care should be taken to provide separate icons for the patients’ and clinicians’ query as the clinicians would be interested in more in-depth analysis which can be addressed with the use of medical terminology, which patients may not be able to grasp. Furthermore, the patients will be more interested in the prognostic part, which needs to be explained in layman’s words. One way to achieve this is to develop FAQs (Frequently Asked Questions) section with general questions and answers mostly asked by patients. In this regard an article by Epstein JI, “The FAQ Initiative Explaining Pathology Reports to Patients” raises several relevant points.[5] We fully agree with the author that definitely pathologists should take part actively in patient care in days to come. What we feel is gradually we have to expand our FAQs (Frequently Asked Questions) so as to include cases other than malignant ones. Anyway this is a welcome initiative. Definitely with the FAQ initiative the patients will become active participants in their own healthcare and this need not necessarily interfere with the relationship between the patient, clinicians and pathologists.[6]

The maladies of malabsorption.

Malabsorption syndrome (MAS) is a common condition in India. In Indian adults, tropical sprue and celiac disease are leading causes of MAS. Sometimes, the diagnosis of MAS may pose a challenge due to the varied signs and symptoms. We present a case of MAS in a young female, whose presenting symptoms were mainly neurological. She was successfully treated under regular follow-up for the past 6 years without any symptoms.

The role of cell blocks in improving the adequacy of FNA smears.

in Prag und Kliniker in Erlangen ein Ausschwitt ons der Geschichte der deutschen Medizin in der Mitte des 19. München: Jahrhunderts ⁄ von Otto Nitzsche; 1937. 3. Sood R. Medical Laboratory Technology. Methods and Interpretations. New Delhi: Jaypee Brothers Medical Publishers; 1999. 4. Ozgursoy OB, Kemal O, Saatci MR, Tulunay O. Actinomycosis in the etiology of recurrent tonsillitis and obstructive tonsillar hypertrophy: answer from a histopathologic point of view. J Otolaryngol Head Neck Surg 2008;37:865–9. 5. Andreani A, Cavazza A, Marchioni A et al. Bronchopulmonary actinomycosis associated with hiatal hernia. Mayo Clin Proc 2009;84:123–8.