Yookarin Khonglah

Analysis of Human Papilloma Virus 16/18 DNA and its Correlation with p16 Expression in Oral Cavity Squamous Cell Carcinoma in North-Eastern India: A Chromogenic in-situ Hybridization Based Study

BACKGROUND The incidence of head and neck squamous cell carcinoma (HNSCC) is quite high in North Eastern India. Apart from the traditional risk factors like tobacco and alcohol consumption, human papilloma virus (HPV) is now considered an established causative agent. These HPV related tumour have a clinico-pathological profile that is quite divergent from conventional non-HPV related tumours. Association of HPV in oral cancers has not been explored in north-east India. MATERIALS AND METHODS Thirty-one patients with oral cavity squamous cell carcinoma (OSCC) on treatment from October 2010 to January 2013 were included in the study. Patients who received neo-adjuvant chemotherapy were excluded. HPV 16/18 DNA was evaluated using Chromogenic in-situ Hybridization (CISH). Presence of nuclear signals was taken as positive HPV expression. p16 was evaluated using immunohistochemistry and was considered positive if ≥ 80% of the tumour cells showed strong and diffuse nuclear/cytoplasmic immunostaining. The results were analysed using Fisher exact test and confidence interval was calculated where required. RESULTS The study group age ranged from 30 to 80 years (median age- 54.2 years). The most common site was gum, with well differentiated squamous cell carcinoma being the most common histology. HPV 16/18 DNA was positive in 29% (95% CI: 13.03% - 44.97%) cases and had a clear tendency towards statistical significance with non-smoker cases (p=0.05), lymph node metastasis (p=0.05) and a significant correlation with p16 overexpression (p=0.04). There was no significant correlation with other clinico-pathological parameters. CONCLUSION HPV 16/18 is associated with OSCC, commonly seen among non-smokers and may be related to nodal metastasis. So, HPV may be used as a prognostic factor in OSCC and p16 may be considered as a surrogate marker for HPV.

Immunohistochemical Analysis of P53 and PRB in Esophageal Squamous Cell Carcinoma

BACKGROUND Esophageal squamous cell carcinoma (ESCC) is one of the fatal cancers with a high incidence rate in Asia. Many genes including p53 and pRb play an important role in its carcinogenesis. Expressions of p53 and pRb proteins have been associated with prognosis of ESCC. OBJECTIVE The study was undertaken to analyze the expressions of p53 and pRb with the various clinicopathological characteristics including stage and grade of ESCC. MATERIALS AND METHODS We examined 30 biopsy samples of ESCC for p53 and pRb protein expressions using immunohistochemistry. Immunointensity was classified as no immunostaining (-), weakly immunostaining (+), weak immunostaining (++) and strongly positive immunostaining (+++). RESULTS Significant association was seen between positive p53 expression and tumor size (p=0.042), invasion to adventitia (p=0.009) and lymph node metastasis (p=0.014), and negative pRb expression was associated with invasion to the adventitia (p=0.015) and lymph node metastasis (p=0.003) There was significant association of p53+/ pRb- (n=11) with tumor invasion to adventitia (p=0.001), lymph node metastasis (p=0.0007) and TNM staging (p=0.042). CONCLUSION The study shows that p53 and pRb proteins, individually as well as synergistically, may serve as putative prognostic markers in ESCC.

Extensive tonsure pattern trichotillomania-trichoscopy and histopathology aid to the diagnosis.

Trichotillomania manifests as a compulsive desire to pull out own hair. The clinical presentation of trichotillomania is usually characteristic, with varying length hair distributed within areas of alopecia on otherwise normal scalp. In severe forms, tonsure pattern of baldness results, involving the entire scalp sparing the hair at the margins. Extensive tonsure pattern trichotillomania is rare and difficult to differentiate from other nonscarring alopecias on clinical grounds alone. Trichoscopy and histopathology of scalp play a corroborative role in definitive diagnosis. We hereby report two cases of extensive tonsure pattern trichotillomania, with special reference to their trichoscopic and histopathological features.

Pancytopenia: An Etiological Profile

Pancytopenia is the deficiency of all 3 cellular elements of blood, resulting in anemia, leucopenia, and thrombocytopenia. Pancytopenia may arise due to a number of disease processes that vary according to population, age, nutritional status, and the prevalence of infections [1]. Pancytopenia is a common hematological condition of varied etiology; however, only a few studies on pancytopenia from the northeastern region of India have been published [2].We analyzed the clinical details, hematological profile, and bone marrow findings in 80 patients that fulfilled the diagnostic criteria for pancytopenia between January 2007 and December 2009 in order to discern its etiology. The results of ancillary tests performed to confirm the etiology were also recorded The frequency of symptoms

Locally Advanced Askin’s Tumour in a Child—a Rare Case Report and Review of the Literature

Askin’s tumor is a primitive neuroectodermal tumor (PNET) developing from the soft tissues of the chest wall and mainly occur in children and adolescents. The management approach is complex and requires a multidisciplinary team. We report a case of locally advanced Askin’s tumour in a child because of its rarity and also to highlight the importance of keeping the possibility of PNET tumours in mind while dealing with cases of chest wall tumour in children.

A multivessel umbilical cord with a single umbilical artery.

Umbilical cord abnormalities are known to be associated with congenital anomalies, chromosomal abnormalities and potential complications during pregnancy. We are reporting a case of a multivessel umbilical cord which comprised two umbilical veins alongwith a single umbilical artery.

Concurrent Lesions in Oesophagus: an Approach to Diagnosis with a Case Report

Carcinomas of the oesophagus are the ninth most common malignancy globally and the sixth most common malignancy in males. Squamous cell carcinoma (SCC) is, by far, the most common type of malignancy arising in the oesophagus [1]. Neuroendocrine carcinomas (NEC) of the oesophagus are rare and aggressive neoplasms, presenting at an advanced stage, usually with metastasis [2]. NEC of the oesophagus may also present as a collision tumour, with another tumour growing in its close proximity and getting juxtaposed with the NEC [3, 4], or as a composite tumour, with the NEC showing differentiation towards other malignancy, commonly SCC or adenocarcinoma [5]. These possibilities are rare, and rarer was our case scenario in which NEC and SCC were present at two different anatomical sites of the oesophagus, but neither as a composite nor as a collision tumour. Various possible differentials need to be considered in the work-up of such a case to reach at a conclusion. This is especially true when the treatment modality does not include radical surgery, and the tumour is not available in toto for histopathological examination (HPE). Case Report

Role of fine needle aspiration cytology in the diagnosis of papillary carcinoma thyroid: A retrospective study from north-east India

Background: Thyroid cancer is the most common endocrine malignancy, and 85% of thyroid cancers are papillary thyroid carcinoma (PTC) making it the most common malignant tumor among all thyroid cancers. Objectives: To analyze the efficacy of fine needle aspiration cytology (FNAC) as the first-line diagnosis of PTC. Materials and Methods: A retrospective study was conducted over a period of 10 years 6 months from January 2007 to June 2017. All the cases of thyroid nodules, which are suspected to have thyroid malignancy from history and clinical examination, and morphologically proven cases of PTC either on FNAC or histopathology were included in the study. FNAC results were compared with the definitive histological diagnosis, which was considered the gold standard. The cytological evaluation and reporting of thyroid lesions were done in accordance with the Bethesda system of reporting thyroid cytopathology. Results: A total of 106 cases were included in the study. Out of the 106 cases, FNAC was inadequate in 8 cases (7.54%), benign in 18 cases (16.98%), atypia of undetermined significance/follicular lesion of undetermined significance in 2 cases (1.88%), follicular neoplasm (FN)/ suspicious for FN in 8 cases (7.54%), suspicious for malignancy in 27 cases (25.47%), and malignant in 43 cases (40.56%). Out of the 106 cases, 75 cases (70.75%) were PTC, which had histopathological correlation. The sensitivity and specificity of FNAC were 87.14% and 77.27%, respectively. Conclusion: FNAC is helpful in triaging the suspicious thyroid lesions for further management. FNAC is quite useful in diagnosis of PTC.

Natural Killer Cell Lymphoma: A Case with Classification Dilemma

Non-Hodgkins lymphoma of the Natural Killer (NK) cell type is rare. World Health Organisation recognises 3 NK-cell phenotypic entities; extranodal NK/T cell lymphoma, nasal type (ENK/TL); aggressive NK cell leukaemia (ANKL); and chronic lymphoproliferative disorders of NK cells (CLPD-NK) which is classified as a provisional entity. Though specific clinical, morphological and immunophenotypic criteria have been laid down to diagnose these conditions there may however, be considerable variations in the clinical presentation making diagnosis difficult. We present a case with contrasting clinical and haematopathological findings posing difficulty in its diagnosis and classification, and despite the aggressive presentation showing favourable response to treatment.

Cord Blood Screening of Haemoglobinopathies in the Newborn from North East India

Thalassaemia and haemoglobinopathies are major public health problems worldwide. Among them HbE is common in South East Asia, prevalence reaching up to 30–40%. In the present study, 117 (23.21%) babies out of 504 showed the presence of haemoglobinopathies with Haemoglobin E heterozygous being the commonest form. We emphasize the need for an appropriate screening strategy for early diagnosis.