Tn Suresh

Malignant peripheral nerve sheath tumor with divergent differentiation.

A malignant peripheral nerve sheath tumor (MPNST) is an uncommon spindle cell sarcoma accounting for approximately 5% of all soft tissue sarcomas. A 55-year-old female with a right suprarenal tumor showed MPNST with additional foci of epithelioid, rhabdomyoblastic, osteogenic and lipogenic differentiation. Although the capacity of MPNST to undergo epithelioid, rhabdomyoblastic, osteogenic and very rarely lipogenic differentiation is reported in literature, the occurrence of all these differentiation in one case has not been described in literature before. To the best of our knowledge, this is only the second MPNST case with lipomatous differentiation.

Expression of vimentin in breast carcinoma, its correlation with Ki67 and other histopathological parameters

CONTEXT Vimentin is a mesenchymal marker, known to express in some epithelial carcinomas. AIMS 1. To find out the expression of vimentin in infiltrating ductal carcinoma of breast (not otherwise specified), 2. To find out the correlation between expression of vimentin and prognostic markers such as tumor size, tumor grade, lymph node status, proliferation index (measured by Ki 67), and Nottingham prognostic index (NPI). MATERIALS AND METHODS Study was done at Department of Pathology; 50 cases of infiltrating ductal carcinoma (NOS) were studied for tumor grade; immunohistochemistry was done using antibodies against vimentin and Ki 67. Percentages of positive cells were documented. An immunoscore was also calculated for vimentin. Vimentin expression was correlated with tumor size, lymph node status, Nottingham prognostic index, and Ki 67. STATISTICAL ANALYSIS USED statistical correlation was done using Pearsons chi-square test. A P value less than 0.01 was considered significant. RESULTS Vimentin expression was seen in 18% of cases. Its expression correlated with high tumor grade and high growth fraction (P value < 0.01). It did not correlate with lymph node status, tumor size, and NPI. CONCLUSIONS Increased vimentin expression is associated with bad prognostic factors. Immunohistochemistry with vimentin may be helpful in knowing the prognosis in cases of infiltrating ductal carcinoma of breast (NOS).

Evaluation of histomorphological and immunohistochemical parameters as biomarkers of cervical lymph node metastasis in squamous cell carcinoma of oral cavity: A retrospective study

Introduction: Oral squamous cell carcinoma (OSCC) is seen worldwide but is more common in India. Lymph node (LN) metastasis has been shown to be the strongest prognostic factor in OSCC. Many histopathological and immunohistochemical markers have been studied to predict the LN metastasis. Aims: To identify clinicopathological factors and immunohistochemical (IHC) biomarkers which predict cervical metastasis in OSCC patients. Study and Design: A total of 105 cases of OSCC were taken up for our study. Histopathological parameters such as tumor thickness, depth, degree of differentiation, pattern of invasion (POI), lymphovascular and neural invasion were assessed. IHC was done on all cases using antibodies against Ki-67, cyclin D, E-cadherin, p53, CD31 and each antibody was assessed according to the standard protocol. Statistical Analysis: To calculate the relation between clinical, histopathological parameter, IHC marker and the occurrence of LN metastasis, chi-square test was used. Variables were tested using multivariate logistic regression method to assess the predictive significance. Results: Out of 105 cases studied, 29 cases showed LN metastasis. Maximum numbers of cases affected were females with involvement of buccal mucosa. We found significant association of cervical LN metastasis with high grade of differentiation, lack of E-cadherin expression, high Ki-67 and cyclin D1 expression. In our study; tumor depth, thickness, extent of peritumoral lympho-plasmacytic infiltration, presence of eosinophils, tumor nest type, p53 and microvessel density (MVD) showed no significant correlation. Conclusion: Significant association of cervical LN metastasis with high grade of differentiation, lack of E-cadherin expression, high Ki-67 and cyclin D1 expression was seen.

Clinicopathological study of surgical margins in squamous cell carcinoma of buccal mucosa

Objective To evaluate the margins of resected specimen of oral squamous cell carcinoma (SCC) and to document the surgical margin (measured at the time of resection) and margins at the time of pathological examination (after immersion of the specimen in formalin). Methods Patients who were diagnosed and confirmed with squamous carcinoma of buccal mucosa were included in the study. Patients underwent resection of the tumor with a margin of 1 cm. Soon after resection, the distance between outermost visible margin of the tumor and the margin of the specimen was measured and documented. Specimens were fixed in 10% formalin and submitted for gross and histopathological examination. The closest histopathologic margin was compared with the in situ margin (10 mm) to determine and document any shrinkage of the margin and the percentage of discrepancy if any. Results A total of 52 specimens were collected from patients between January 2014 and December 2014. All specimens were obtained from the oral cavity (n = 52) of which 43 (82.7%) were squamous cell carcinoma and 9 (17.3%) were verrucous variant of squamous cell carcinoma. The average decrease in tumor margins measured after fixation in formalin was found to be statistically significant (P < 0.05) in 65% of cases. Conclusion Tumor margin shrinks significantly after formalin fixation by about 25%. The operating surgeon and pathologist should be well aware of such changes while planning for further management thereby ensuring adequate margin of resection and adjuvant treatment wherever required to prevent possible local recurrence of the disease.

Impact of the Bethesda System in Reporting Thyroid Cytopathology

Context: Fine needle aspiration cytology (FNAC) has emerged as one of the well-established first-line diagnostic techniques in the evaluation of thyroid lesions as well as solitary thyroid nodule. But in the cytological diagnosis of borderline lesions, various diagnostic criteria have led to confusion and differences in reporting between cytopathologists and clinicians. To overcome this situation, the Bethescda System of Reporting Thyroid Cytopathology (TBSRTC) 2007 recommended by the National Cancer Institute put down six general diagnostic categories. Aims: The current study evaluates diagnostic utility, reproducibility, and prognostic significance of TBSRTC and report the malignancy risk for FNA of thyroid lesions. Settings and Design: Retrospective study. Materials and Methods: It is a retrospective study of FNAC in 178 patients presenting with thyroid swelling from January 2013 to December 2013 to cytopathology section at our rural based tertiary care center. Distribution of cases in different age groups, sex, size, and type was analyzed. FNAC slides were reviewed and reported by both conventional and TBSRTC method. Diagnostic efficacy was assessed by comparing subsequent histopathological examination wherever possible. Statistical Analysis Used: SPSS version 14. Results: Among the 178 thyroid FNAs, 60 were followed by surgical resection. The overall surgical yield of malignancy was 23.3%. The malignancy rate for the six diagnostic categories was as follows: Nondiagnostic: 33.3%, benign: 2.1%, atypia of undetermined significance: 50%, suspicious for follicular neoplasm: 1%, suspicious for malignancy: 67% and malignant: 100%. Conclusion: TBSTRC has been proven to be an efficient and robust thyroid classification scheme to guide the clinical treatment of patients with thyroid nodules.