Rajesh Nachiappa Ganesh

Role of p16, CK17, p63, and Human Papillomavirus in Diagnosis of Cervical Intraepithelial Neoplasia and Distinction From Its Mimics

Background. Diagnosis of cervical intraepithelial neoplasia (CIN), the precursor forms of cervical cancer, can be tricky and it has led to discrepancy between pathologists in distinguishing them from its mimics such as atypical immature metaplasia (AIM), immature squamous metaplasia (ISM), reactive atypia (RA), atrophy, and basal cell hyperplasia (BCH). To overcome this problem this study aims at using immunohistochemical (IHC) markers p16, p63, CK17, and human papillomavirus (HPV) to differentiate CIN from its mimics. Materials and methods. This study analyzed 350 cervical samples with histomorphological diagnosis of CIN and its mimics and the utility of IHC markers p16, p63, CK17, and HPV in distinction was analyzed. Results. p16 showed 67.76% sensitivity and 99.4% specificity whereas HPV showed 57.9% sensitivity and 91.6% specificity in detecting CIN. CK17 and p63 did not show any significance in distinguishing CIN from its mimics. After IHC of AIM cases, 66.7% were reclassified as CIN III, 27.8% as ISM with reactive atypia (ISMRA), and 5.5% case as immature condyloma. In total, 3.7% of diagnosis was upgraded to CIN and 0.6% of pre-IHC diagnosis was downgraded from CIN to reactive lesions. Conclusion. IHC panel comprising p16, p63, CK17, and HPV are useful adjuncts in distinguishing CIN from its mimics particularly when histomorphology has overlapping morphological features.

Diffuse alveolar hemorrhage in IgA nephropathy: case series and systematic review of the literature.

To describe the spectrum of pulmonary involvement in immunoglobulin A nephropathy (IgAN).

Novel presentation of lepromatous leprosy in an erythema gyratum repens-like pattern.

Leprosy can have diverse cutaneous and occasionally perplexing presentations. We report an unusual case of lepromatous leprosy (LL) with annular lesions resembling erythema gyratum repens.

Phosphatase and tensin analog expression in arterial atherosclerotic lesions

CONTEXT Phosphatase and tensin analog (PTEN) gene mutation has been proven for pro-inflammatory property and proliferative potential through tyrosine kinase pathway. We studied mutated PTEN for its pathogenetic association in arterial atherosclerosis. AIMS The objective was to study mutation of PTEN by immunohistochemical method in arterial atherosclerotic lesions and correlate with grades of atherosclerosis, smooth muscle migration in intima, degree of inflammation and Framingham heart study risk factors. SETTINGS AND DESIGN Human, Prospective Clinical study. MATERIALS AND METHODS We studied patients with arterial occlusive disease diagnosed by Doppler ultrasonography over a 2-year period. Immunohistochemistry was performed with mouse monoclonal antibodies for PTEN and smooth muscle actin (SMA). STATISTICAL ANALYSIS USED Chi-square test. RESULTS AND CONCLUSION Aorta was the single most common vessel affected (21%). Mean age of patients studied was 48.6 years and 80% were male. Mutant PTEN was associated with higher grades of atherosclerotic lesions (P < 0.0001) graded by American Heart Association classification and with smooth muscle proliferation and migration in intima (P < 0.0001). No statistically significant association with the vessel wall inflammation and other risk factors of atherosclerosis.

Over expression of PI3K-AkT reduces apoptosis and increases prostate size in benign prostatic hyperplasia

INTRODUCTION Even though the role of the phosphatidylinositol 3-kinase (PI3K)/AKT pathways and apoptosis has been well established in prostate cancer, there are no studies regarding alteration in the gene expression of PI3K/AKT pathway and protein expression of apoptotic components and their association with prostate size in Benign prostatic hyperplasia (BPH). Hence the study was designed to analyze the expression pattern of PI3K/AKT and apoptotic components in patients with BPH. MATERIALS AND METHODS A total of 27 BPH patients aged between 55 and 75 years were recruited in the study and prostatic tissues were obtained after transurethral resection of the prostate. Gene expression levels of PI3K and AKT were assessed by q-PCR. Apoptotic components like BcL-2, caspase-3, caspase-9, BAD, and p-BAD were analyzed by western blotting and immunohistochemistry. RESULTS Gene expression of PI3K (p85-A) (p = .02), AKT1 (p < .01) and AKT2 (p < .01), and protein expression of BcL-2 (p < .01) and caspase-9 (p < .01) were significantly increased in BPH patients with larger prostate size compared to smaller prostate size. CONCLUSIONS Overexpression of PI3K/AKT pathway and BcL-2 were associated with reduced apoptosis and increased prostate size in BPH.

Bronchial brush cytology of primary anaplastic large cell lymphoma of lung

Primary pulmonary lymphoma is defined as clonal lymphoid proliferation affecting one or both lungs in a patient with no extrapulmonary involvement at the time of diagnosis or during the subsequent 3 months. Anaplastic large cell lymphoma (ALCL) is a rare T‐cell neoplasm which occurs as two distinct clinical entities—cutaneous and systemic variant. Primary lung involvement is extremely uncommon. It can be classified on the basis of being positive or negative for ALK rearrangement which carries prognostic significance. The 2016 revision of World Health Organization (WHO) classification of lymphoid neoplasm recognizes three types of ALCL namely ALK‐positive, ALK‐negative, and breast implant associated. Here, we report a case of primary pulmonary ALK‐1 positive ALCL which was initially recognized in bronchial brushing cytology based on distinct morphologic clues.

Diagnosis of pseudo-gout (calcium pyrophosphate deposition disease) clinched on cytology

Calcium pyrophosphate dihydrate (CPPD) deposition disease is a metabolic arthropathy which results from deposition of calcium pyrophosphate crystals in and around joints especially the hyaline cartilage and disc material. This metabolic disease in uncommon in the smaller joints and multiple diagnostic modalities along with biochemical investigations would be necessary for definite diagnosis. We highlight the case of a 48 year old male who presented with a painful mass at the base of left thumb and was clinic‐radiologically suspected as malignancy. Cytological examination (fine needle aspiration cytology [FNAC]) showed numerous extracellular rods shaped and rhomboid blunt‐ended crystals along with foreign body type of giant cells. The main emphasis here is on the pivotal role played by FNAC in accurately diagnosing the disease where other modalities like radiology and histopathology failed to do so. The exact categorization of crystals is important from treatment point of view to avoid any major deformities in the joints/systemic manifestation.

Ciliary body tumour as the presenting manifestation of metastatic non-small cell adenocarcinoma of lung

We report a rare case of ciliary body metastasis from adenocarcinoma of the lung. Although the metastatic nodule was seen over the surface of the iris near the angle of anterior chamber, ultrasonography confirmed its origin from the ciliary body. Uveal metastasis may be the first sign of lung cancer.

Emphasizing the pivotal role of fine-needle aspiration cytology in a case of recurrent malignant chondroid syringoma

Fine-needle aspiration cytology (FNAC) features of malignant chondroid syringoma (MCS) are rarely documented. Here, we report a case of recurrent MCS, highlighting its interesting clinicopathologic features. Initially, we received cytology and histopathology slides (for review) of a 57-year-old woman who had undergone resection for an occipital MCS and later presented with recurrence. On reviewing the slides, cytology was consistent with recurrent MCS. However, tissue sections showed features of a malignant epithelial tumor with comedonecrosis and sebaceous differentiation owing to which a diagnosis of metastatic adenocarcinoma/malignant adnexal tumor was suggested. Due to an ambiguous histology, a repeat FNA was performed to perform immunocytochemistry (ICC) and oil-red O stains, which confirmed the diagnosis of MCS with sebaceous differentiation. Thus, in a situation where histology was inconclusive due to lack of representative sections, FNAC played a major role in resolving the diagnostic dilemma and facilitating an appropriate clinical management.

A retrospective audit of skin biopsies done in a tertiary care center in India

Skin biopsies are an invaluable tool in the diagnostic armamentarium of a dermatologist and have several factors that determine outcome.