Gynecologic Pathology
Saumya Shivakumar; Kausalya Kumari Sahu; Ranjitha Rao; Chaithra GV; Cheryl Sarah Philipose; Sharada Rai
Abstract
Background & Objective: Endometrial Carcinoma (EC) is the most common gynecological cancer with a global incidence of 23.2 per 1 lakh population. Histological subclassification of EC is extremely crucial for the diagnosis, proper management strategies, and prognosis. This study was conducted in a ...
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Background & Objective: Endometrial Carcinoma (EC) is the most common gynecological cancer with a global incidence of 23.2 per 1 lakh population. Histological subclassification of EC is extremely crucial for the diagnosis, proper management strategies, and prognosis. This study was conducted in a tertiary care institute to analyze the expression pattern of a minimum panel of 4 markers (ER, p53, CEA, Napsin A) with emphasis on their utility in the routine histological subtyping, aberrant expression, and correlation with various clinicopathological parameters.
Methods: A time-bound cross-sectional observational and analytical study was conducted, which includes cases diagnosed in our laboratory from January 2016 to April 2021.
Results: Sixty cases diagnosed as EC during the study period formed the sample cases. The ER was expressed in 85% (53/60) of cases in the current study. Among them, 94% (50/53) were endometrioid endometrial carcinomas (EECs). A negative correlation was found between ER intensity and age (r= -1.48). Of 60 EC cases, 10 (16%) cases expressed p53. The tumors positive for p53 with higher intensity were negative for ER and vice versa. The expression pattern of ER and p53 was statistically significant (P=-0.021). On IHC, 84.6% (11/13) of CEA-positive cases expressed both ER and CEA, suggesting mucinous differentiation. Napsin A was expressed in two cases of EEC, FIGO grade I, and one case of serous carcinoma.
Conclusion: An inverse association was found between ER and p53 expression. The CEA is valuable in identifying EEC with mucinous differentiation.
Biochemistry
Morteza Hassandokht Mashhadi; Fahimeh Taheri; Sadaf Irani; Arshiya Mesbah Mousavi; Ali Mehri; Hossein Javid
Abstract
The effectiveness of immunotherapy for most cancer patients remains low, with approximately 10–30% of those treated surviving. Thus, much effort is being put into finding new ways to improve immune checkpoint therapy. Our review concludes that the inhibition of proprotein convertase subtilisin/Kexin ...
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The effectiveness of immunotherapy for most cancer patients remains low, with approximately 10–30% of those treated surviving. Thus, much effort is being put into finding new ways to improve immune checkpoint therapy. Our review concludes that the inhibition of proprotein convertase subtilisin/Kexin type 9 (PCSK9), which plays a critical role in regulating cholesterol metabolism, can cause T cells to move toward tumors, with increased sensitivity to immune checkpoint therapies.We searched PubMed, NCBI, Scopus, and Google Scholar for the published articles without limitations on publication dates. We used the following terms: “PCSK9”, “Cancer”, “Immune Checkpoint”, and “Cancer Prognosis” in the title and/or abstract. Our search initially revealed 600 records on the subject and stored them in the used databases under EndNote X8 management software. We selected about 161 articles that were carefully read and among them, 76 were included in our research.We concluded that PCSK9 reduces the number of LDL receptors (LDL-R) on the cell surface, which is linked to its ability to regulate cholesterol levels in the body. Also, we discuss how suppressing PCSK9 leads to the MHC-1 accumulation on the surface of cancer cells, which results in T lymphocyte invasion. Finally, we believe that inhibiting PCSK9 may be an effective strategy for improving cancer immunotherapy.
Breast Pathology
KUMARGURU B N; RAMASWAMY A S; ARATHI C A; SWATHI D
Abstract
Background & Objective: Invasive breast carcinoma (IBC) is the most commonly diagnosed cancer among women in India. The conventional visual method of evaluation of Tumor-Stroma Ratio (TSR) and Stromal Tumor-Infiltrating Lymphocytes (sTIL) appears to be subjective. The present study aims to evaluate ...
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Background & Objective: Invasive breast carcinoma (IBC) is the most commonly diagnosed cancer among women in India. The conventional visual method of evaluation of Tumor-Stroma Ratio (TSR) and Stromal Tumor-Infiltrating Lymphocytes (sTIL) appears to be subjective. The present study aims to evaluate the utility of the indigenously designed square grid method for the evaluation of tumor-stroma ratio and stromal tumor-infiltrating lymphocytes in invasive breast carcinoma by assessing the inter-observer variability.
Methods: This was a retrospective study conducted at a rural tertiary care referral institute from July 2018 to June 2020. In each case, microphotographs were taken from 10 representative fields in H&E-stained sections for evaluating TSR in low-power and sTIL in high-power. Both the parameters were evaluated employing an indigenously designed square grid applied onto microphotographs in the power-point slides by making use of principles of the Pythagorean theorem. Both parameters were separately evaluated by two pathologists. Cohen kappa statistics was the statistical tool used to analyze inter-observer variability.
Results: Thirty cases were analyzed. Invasive breast carcinoma of no special type (IBC-NST) was the most common histopathological type (26 cases (86.67%)). For TRS evaluation, a Kappa value of 0.78 suggested substantial agreement with an agreement of 91.67%. For sTIL evaluation, a Kappa value of 0.51 suggested moderate agreement with an agreement of 88.33%. The P-values were statistically highly significant (P<0.001).
Conclusion: Square grid method is a novel technique for evaluating TSR and sTIL in invasive breast carcinoma. It can be considered an example of the application of Pythagoras’ theorem in Pathology.
Biology & Genetic
Malihe Ram; Ali Najafi; Mohammad Taghi Shakeri
Abstract
Background & objective: Microarray and next generation sequencing (NGS) data are the important sources to find helpful molecular patterns. Also, the great number of gene expression data increases the challenge of how to identify the biomarkers associated with cancer. The random forest (RF) is used ...
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Background & objective: Microarray and next generation sequencing (NGS) data are the important sources to find helpful molecular patterns. Also, the great number of gene expression data increases the challenge of how to identify the biomarkers associated with cancer. The random forest (RF) is used to effectively analyze the problems of large-p and small-n. Therefore, RF can be used to select and rank the genes for the diagnosis and effective treatment of cancer. Methods: The microarray gene expression data of colon, leukemia, and prostate cancers were collected from public databases. Primary preprocessing was done on them using limma package, and then, the RF classification method was implemented on datasets separately in R software. Finally, the selected genes in each of the cancers were evaluated and compared with those of previous experimental studies and their functionalities were assessed in molecular cancer processes. Result: The RF method extracted very small sets of genes while it retained its predictive performance. About colon cancer data set DIEXF, GUCA2A, CA7, and IGHA1 key genes with the accuracy of 87.39 and precision of 85.45 were selected. The SNCA, USP20, and SNRPA1 genes were selected for prostate cancer with the accuracy of 73.33 and precision of 66.67. Also, key genes of leukemia data set were BAG4, ANKHD1-EIF4EBP3, PLXNC1, and PCDH9 genes, and the accuracy and precision were 100 and 95.24, respectively. Conclusion: The current study results showed most of the selected genes involved in the processes and cancerous pathways were previously reported and had an important role in shifting from normal cell to abnormal.
Sunita Singh; Megha Ralli; Sonia Hasija; Renuka Verma
Abstract
Malignant peripheral nerve sheath tumor (MPNST) is a rare nerve sheath tumor derived from Schwann cells or pleuripotent cells of neural crest. Neurogenic tumors make about 10-20% of all mediastinal tumors. Incidence of MPNST is 0.001% in general population and 0.16% in patients with neurofibromatosis ...
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Malignant peripheral nerve sheath tumor (MPNST) is a rare nerve sheath tumor derived from Schwann cells or pleuripotent cells of neural crest. Neurogenic tumors make about 10-20% of all mediastinal tumors. Incidence of MPNST is 0.001% in general population and 0.16% in patients with neurofibromatosis I (NF I). We report a case of 60 year female presenting with progressive cough and breathlessness for 2 years. The CECT revealed multiple focal enhancing lesions along inferior mediastinal pleural surface and along lateral pleural surface. A thoracotomy and tumor excision was done and MPNST was diagnosed on microscopy and immunohistochemistry. This case highlights that this unusual tumor may involve lung parenchyma. So this possibility should be kept in mind in patients with intrathoracic mass.
Shelly Sehgal; Prashant Goyal; Soumyesh Ghosh; Deepti Mittal; Sompal Singh
Volume 9, Issue 4 , October 2014, , Pages 237-244
Abstract
In patients with malignancy, the common etiologies of granuloma formation are tumor related sarcoid reaction, sarcoidosis, tuberculosis and other granulomatous diseases. Often, the finding of granulomas in malignant patients may obscure the primary malignancy or may mislead towards treatment of infectious ...
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In patients with malignancy, the common etiologies of granuloma formation are tumor related sarcoid reaction, sarcoidosis, tuberculosis and other granulomatous diseases. Often, the finding of granulomas in malignant patients may obscure the primary malignancy or may mislead towards treatment of infectious and other etiologies. Hence, their proper recognition and necessary follow up is needed to establish the cause of granulomatous lesions and for proper management of patients.
Mitra Mustaphi Ruplekha; Gon Sonia; Bhattacharyya Roop Narayan
Volume 9, Issue 1 , January 2014, , Pages 1-8
Abstract
Background & Objective: Chronic non healing ulcers or scar undergoing malignant transformation is a rare phenomenon with an estimated incidence of 2%. Though, numerous predisposing factors have been identified, still it is rarely diagnosed and commonly mistaken for a benign condition. The ...
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Background & Objective: Chronic non healing ulcers or scar undergoing malignant transformation is a rare phenomenon with an estimated incidence of 2%. Though, numerous predisposing factors have been identified, still it is rarely diagnosed and commonly mistaken for a benign condition. The objective of this study was to verify the efficacy of the Fine Needle Aspiration Cytology/ Scrape cytology of chronic non healing ulcers, and its use in the early detection of the malignant transformation, thereby facilitating early management. Methods: A total of 10 cases of chronic non healing ulcer with malignant transformation were included in the study where the initial diagnosis was made on Fine Needle Aspiration Cytology/Scrape cytology and later on confirmed on histopathology. Results: Squamous cell carcinoma (7 cases), acantholytic variant of Squamous Cell Carcinoma (1 case), malignant fibrous histiocytoma (1 case) and carcinosarcoma (1 case) was seen. A 100% concordance with histopathology was seen in Squamous cell carcinoma cases. Because of the rarity of the case and unusual transformation, high grade pleomorphic spindle cell carcinoma was the cytological diagnosis in case of Malignant Fibrous Histiocytoma. Conclusion: Marjolin ulcer arising out of chronic non healing ulcers can prove to be a precursor of any different kind of malignancies. Fine Needle Aspiration Cytology/scrape cytology can be used as a first line diagnostic modality for the early diagnosis as it is a fast and safe method with high rate of accuracy, sensitivity and specificity
Nayereh Ghomian; Sakineh Amouian; Fatemeh Tavassoli; Taraneh Arbabzadeh
Volume 9, Issue 1 , January 2014, , Pages 9-16
Abstract
Background & Objective: Chronic non healing ulcers or scar undergoing malignant transformation is a rare phenomenon with an estimated incidence of 2%. Though, numerous predisposing factors have been identified, still it is rarely diagnosed and commonly mistaken for a benign condition. The objective ...
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Background & Objective: Chronic non healing ulcers or scar undergoing malignant transformation is a rare phenomenon with an estimated incidence of 2%. Though, numerous predisposing factors have been identified, still it is rarely diagnosed and commonly mistaken for a benign condition. The objective of this study was to verify the efficacy of the Fine Needle Aspiration Cytology/ Scrape cytology of chronic non healing ulcers, and its use in the early detection of the malignant transformation, thereby facilitating early management. Methods: A total of 10 cases of chronic non healing ulcer with malignant transformation were included in the study where the initial diagnosis was made on Fine Needle Aspiration Cytology/Scrape cytology and later on confirmed on histopathology. Results: Squamous cell carcinoma (7 cases), acantholytic variant of Squamous Cell Carcinoma (1 case), malignant fibrous histiocytoma (1 case) and carcinosarcoma (1 case) was seen. A 100% concordance with histopathology was seen in Squamous cell carcinoma cases. Because of the rarity of the case and unusual transformation, high grade pleomorphic spindle cell carcinoma was the cytological diagnosis in case of Malignant Fibrous Histiocytoma. Conclusion: Marjolin ulcer arising out of chronic non healing ulcers can prove to be a precursor of any different kind of malignancies. Fine Needle Aspiration Cytology/scrape cytology can be used as a first line diagnostic modality for the early diagnosis as it is a fast and safe method with high rate of accuracy, sensitivity and specificity.
Fariba Abassi; Farrokh Ghavam; Farahnaz Norouzinia; Reza Pourali; Monireh Jalvand
Volume 4, Issue 3 , June 2009, , Pages 109-112
Abstract
Background and Objective: Microscopic evaluation of cervicovaginal smears (Pap smear) plays an essential role in detection of preneoplastic and neoplastic lesions of uterine cervix. A wide spectrum of changes is seen in Pap smears. Interpretation of intermediate changes which resulting in observation ...
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Background and Objective: Microscopic evaluation of cervicovaginal smears (Pap smear) plays an essential role in detection of preneoplastic and neoplastic lesions of uterine cervix. A wide spectrum of changes is seen in Pap smears. Interpretation of intermediate changes which resulting in observation of so- called ASCUS is difficult. ASCUS is defined as a cellular change that is more marked than typical reactive change but lack features diagnostic of intraepithelial neoplasia. The aim of this study was determination of reliable cytological parameters to identifying real nature of ASCUS. Patients and Methods: In this descriptive, cross sectional study, all Pap smears with presence of ASCUS, which followed by biopsy samples in Urmia, ShahidMatahari hospital during March 1999 to December 2002 were reviewed. In this regard, 17 parameters of cytoplasm, nuclei and smear background were considered and data were analyzed by SPSS and Chi Square test. Results: Four parameters of irregular nuclear contour, increased nucleo- cytoplasmic ratio, cytoplasmic vacuolization and dirty background are highly suggestive of dysplasia. Conclusion: It is important to consider that to find out the real nature of ASCUS a group of parameters are more helpful than a single one. In addition, a single Pap smear is not enough for this purpose and further investigationis required.
