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   2016| September-October  | Volume 5 | Issue 5  
    Online since January 9, 2017

 
 
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ORIGINAL ARTICLES
Evaluation of stromal myofibroblasts in epithelial dysplasia and oral squamous cell carcinoma: An immunohistochemical study
Priya Shirish Joshi, Jitendra Patil, Madhuri Chougule, Mahesh Dudanakar, Bhagyalaxmi Praveen Hongal
September-October 2016, 5(5):441-446
DOI:10.4103/2278-0513.197886  
Background: Among the cancers, oral cancer occupies tenth position, and the incidence is rising alarmingly with more than 300,000 new cases being detected every year. The expression of myofibroblast (MF) has been demonstrated in various malignant lesions and is considered an important participant in the invasive process. We have attempted to analyze the distribution and possible association of MF in epithelial dysplasia and squamous cell carcinoma by immunohistochemistry. Materials and Methods: Histopathologically confirmed twenty cases each of epithelial dysplasia and oral squamous cell carcinoma and ten cases of normal mucosa comprised the study group. MFs were detected by immunostaining with alpha-smooth muscle actin (α-SMA). Blood vessels and normal oral mucosa acted as an internal and external control respectively. Results: Of twenty cases of epithelial dysplasia, six (30%) were positive, all cases of squamous cell carcinoma and normal mucosa were positive and negative for α-SMA expression respectively. No statistical significance was observed between the patterns of MF distribution. Statistically significant results of α-SMA expression were noted in severe grades of dysplasia (P = 0.000) and between epithelial dysplasia and squamous cell carcinoma (P = 0.000). Conclusion: Analysis of α-SMA expression for MF proliferation can be used as a stromal marker for predicting behavior in oral precancer and cancer.
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CASE REPORTS
Bilateral spontaneous pneumothorax in osteogenic sarcoma due to occult pulmonary metastases
Ashok Kuwal, Naveen Dutt, Nishant Kumar Chauhan, Puneet Pareek, Lokesh Kumar Saini, Saurabh Samdariya
September-October 2016, 5(5):483-485
DOI:10.4103/2278-0513.197862  
Spontaneous pneumothorax (SPTX) is an uncommon complication of osteogenic sarcoma. Most of these SPTX associated with osteogenic sarcoma are due to detectable pulmonary metastasis. Development of SPTX without any evidence of pulmonary metastasis is extremely rare. Herein, we report a case of a young girl with osteosarcoma of the right femur that developed pneumothorax on both sides following treatment with combination chemotherapy without any obvious pulmonary metastases, bullae, or blebs.
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ORIGINAL ARTICLES
A study of correlation between molecular subtypes of breast cancer and site of metastasis
Akshay Chauhan, Praveendra Kumar Sachan, Neena Chauhan
September-October 2016, 5(5):393-397
DOI:10.4103/2278-0513.197864  
Context: Studies have correlated the presence or absence of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (Her2/neu) with metastatic spread and ultimate clinical outcomes in breast cancer. However, the influence of molecular subtype on the pattern of disease spread is not well known. Aims: The aim of this study is to evaluate the role of various molecular subtypes as a predictor of metastatic distribution in breast carcinoma. Settings and Design: This was a prospective observational study. Subjects and Methods: One-hundred and ten patients of infiltrating ductal carcinoma of breast with distant metastasis were included in the study. Evaluation for metastasis was done using radiodiagnostics. Pathological data were obtained from previous mastectomy specimens. Tumor marker status (ER, PR, and Her2/neu) was assessed, and patients were classified into Luminal A, Luminal B, Her2 enriched, and triple negative. Chi-square test was used to check the relationship between metastasis and different molecular subtypes (P < 0.05 was considered statistically significant). Statistical Analysis Used: Chi-square test was performed. Results: About 44.6% cases were Luminal A, followed by Luminal B (26.4%), triple negative (18.2%), and Her2 enriched (10.9%). Metastasis was seen in bones (62.7%), lungs (38.2%), liver (27.3%), and brain (10.9%). Luminal A breast cancers metastasized most commonly to bones (71.4%), lungs (36.7%), liver (18.4%), and brain (8.2%) (P = 0.0001). Luminal B type spread to bones in 62.1% cases, followed by liver (37.9%), lungs (34.5%), and brain (10.3%) (P = 0.001). Triple negative type cancers involved bones (60%), lungs (50%), liver (20%), and brain (10%) (P = 0.002). Her2-enriched cancers spread to liver (50%), followed by bones and lungs (33.3% each) and brain (25%) (P = 0.630). Conclusions: The major molecular subtypes in breast cancer are evidently different with regard to their ability to metastasize to different organs.
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Correlation of degree of dysplasia in potentially malignant disorders with tobacco use: A cross-sectional study
Monika Aroquiadasse, Mariappan Jonathan Daniel, Subramanian Vasudevan Srinivasan, Vannathan Kumaran Jimsha
September-October 2016, 5(5):398-402
DOI:10.4103/2278-0513.197870  
Background: Oropharyngeal malignancies are the sixth leading cause of cancer worldwide. However, in India, oral and pharyngeal cancers are the most common cancer among men. It has been well established that virtually all oral cancer are preceded by a visible oral precursor lesions. Furthermore, the incidence of oral malignancies is higher among persons who use tobacco. We aimed to study the association between the degree of dysplasia in potentially malignant disorders (PMDs) with the type and duration of tobacco use. Materials and Methods: A record based cross-sectional study was conducted during February 2015. We included all the PMDs diagnosed and biopsied in our institute between 2006 and 2013. The study variables such as sex, age, type, and duration of tobacco habit were retrieved from the registers maintained in the Department of Oral Medicine and Radiology, and the histopathological diagnosis was retrieved from the biopsy reports of the PMDs documented in the Department of Oral Pathology. Lesions were classified as high-risk lesions (HRLs) or low-risk lesions (LRLs) based on the grade of cellular atypia and architectural features. The data were analyzed using EpiData software. Results: Out of total 112 cases, 80 (71%) were males and majority were older than 45 years (58%). About 64 (57%) reported use of any form of tobacco product. Of the tobacco users, 39 (65%) patients had reported tobacco use for 10 or more years. About one-fifth had HRL, and the remaining had LRL. Increasing age, any form of tobacco use (chewable or smoke form), tobacco smoking and longer duration of tobacco use were significantly associated with the development of HRLs (P < 0.05). Conclusion: By this retrospective study, we concluded that HRLs were more common among people who use any form of tobacco, either chewable or smoke form. Clearly, there is an increasing proportion of HRL with advancement in age and the duration of tobacco use.
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Role of neoadjuvant chemotherapy and radiotherapy in locally advanced carcinoma of the cervix
Rajshree Dayanand Katke, Rewadkar Mahesh Shivhar, Priyanka Pagare
September-October 2016, 5(5):365-368
DOI:10.4103/2278-0513.197888  
Aim: To study the outcome and complications of neoadjuvent chemotherapy in locally advanced Carcinoma of Cervix in Indian patients. To study the outcome and complications of Radiotherapy in locally advanced Carcinoma of Cervix in Indian patients. Materials and Methods: It is a Prospective analytical study of 95 (n=95) patients registered in the Out-patient section (OPD) of Department of Radiation Therapy and Oncology and indoor patients in gynaec oncology ward in tertiary care institute with histopathologically proven carcinoma of cervix were included in the study. Study duration was from August 2012 to August 2014. Patients with Histologically confirmed cases of carcinoma of cervix with FIGO stage IIB to IVA who were suitable for chemoradiotherapy were included in the study. The baseline characteristics Age, Parity, Weight, Height, Body Surface Area, Socioeconomic Status, FIGO Staging, Histological Variety of Carcinoma Cervix, pre and post treatment ECOG score were noted. The median follow up period was 18 months. All patients were given 3 cycles of Neoadjuvent chemotherapy with each cycle 3 weeks apart, consisting of the drugs dose calculated according to body surface area, Injection Paclitaxel was given as intravenous infusion in a dose of 175 mg /m2 on day 1 of chemotherapy cycle whereas Injection Cisplatin was given in a dose of 60 mg /m2 intravenous infusion in two divided doses on day 1 and day 2 of neoadjuvent chemotherapy cycle. NACT was followed by concurrent chemoradiotherapy which included conventional fractionated radiotherapy (CFR) with weekly injection cisplatin 35mg/m2, EBRT of total dose 50Gy (Gray) in 25 fractions, 200cGy (centigray) per fraction daily for 5 days a week and brachytherapy i.e. Intracavitary Radiation Therapy (ICRT) was given. Results: RECIST 1.0 criterion was used for assessment of the response to treatment. Out of 95 patients, 72 patients (75.78%) had complete response. Partial response was seen in 13 patients (13.68%). Stable disease was seen in 7 patients (7.3)%. 3 patients (3.15%) had progressive disease. Subjective response was evaluated after asking the patient about status of their presenting symptoms one month after completion of whole treatment. Out of 90 patients who had vaginal discharge, 80 patients (88.89%) got relief after complete treatment. Out of 65 patients who had vaginal bleeding, 59 patients (90.76%) were free of this symptom at the completion of treatment. Out of 36 patients who suffered with pelvic discomfort at the start of therapy, 16 patients (44.44%) got symptomatic improvement. During the course of treatment, 56 patients (58.94%) developed Nausea and Vomiting, 30 patients (31.57%) had diarrhoea, 10 patients (10.52%) had cystitis, 7 patients (7.36%) had proctitis, 9 patients (9.47%) developed peripheral neuropathy, 15 patients (15.78%) suffered fever and rash. Renal complications occurred in 7 patients (7.36%). Hematological side effects including anemia neutropenia and thrombocytopenia were noted in 25 patients (26.31%) Median follow-up period for patients was 18 months. Overall survival rate at 1 year after treatment was 74.73% whereas Disease free survival rate at 1 year after treatment was 69.47%. Conclusions: We conclude that, the study has demonstrated a good response rate to NACT followed by CRT in patients with locally advanced carcinoma of cervix with regard to tumour response, overall and disease free survival. The combination of paclitaxel with cisplatin for use in neoadjuvnant chemotherapy showed acceptable adverse effects.
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Comparative analysis of six cytological grading systems in breast carcinoma
Shirish S Chandanwale, Neha Mishra, Supreet Kaur, Sourabh Paranjape, Aditi Pandey, Megha Jha
September-October 2016, 5(5):409-415
DOI:10.4103/2278-0513.197858  
Background: Fine-needle aspiration cytology (FNAC) gives the necessary information of various breast lesions for surgical management of patients and can be extremely useful for establishing the best neoadjuvant therapy in patients where surgical removal of tumor is not the best option. The National Cancer Institute, Bethesda sponsored conference recommended that the tumor grading on FNAC should be incorporated in reports for prognostication. Objective: The purpose of this study is to determine the correlation between cytomorphologic and histomorphological features and to evaluate the utility of different cytological grading systems and to determine which cytology grade corresponds best to the histology grade. Materials and Methods: The present prospective study included fifty cases of breast carcinoma diagnosed on FNAC and confirmed on histopathology. Detailed cytomorphological features were studied. Cytology grading was done using six grading systems. Detailed histological features were studied, and carcinomas were graded as per modified Scarff-Bloom-Richardson's histopathological grading system. Cytology grading was correlated with histology grading. Results: Out of fifty cases of breast carcinomas, the 29 (58%) cases of each Robinson's cytological grading and Fisher's modification of Black grading correlated with histological grading. The cytological features, namely, nuclear chromatin, nuclear pleomorphism, cell size, nuclear margins, and naked tumor nuclei used in grading correlated well with histological grade. Conclusion: Cytology grading adds to objectivity, reproducibility, and authenticity to the report. The cytology features such as nuclear chromatin, nuclear pleomorphism, cell size, nuclear margins, and naked tumor nuclei had influential role in predicting the final cytology grade. Among the six cytology grading systems, Robinson's system is simple to interpret, more objective, takes less time, and is reproducible and correlates precisely with histological grade as evident from our study. It should be used for routine evaluation of aspirates of breast carcinoma.
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CASE REPORTS
Renal hemangiopericytoma with lung metastasis: A rare case report
Amitabh Jena, Naru Ramana Reddy, Rashmi Patnayak, Amarchala Yadagiri Lakshmi
September-October 2016, 5(5):447-450
DOI:10.4103/2278-0513.197878  
Hemangiopericytoma (HPC) is an unusual vascular neoplasm. Renal HPC is very rare. Only a few cases of renal HPC with distant metastasis have been described in the literature. In the absence of specific clinical signs and symptoms and imageological findings, histopathology remains the cornerstone of diagnosis. The present case is a 56-year-old female who presented with abdominal lump and pain of 1-month duration. Her contrast-enhanced computed tomography abdomen and chest showed a large well-defined lobulated heterogeneously enhancing soft tissue density lesion arising from the lower pole of the kidney with central calcification. Nodular opacities were noted in both lungs. It was reported as renal cell carcinoma (RCC) with lung metastasis. She underwent left nephrectomy because of the suspicion of RCC. The histopathology along with immunohistochemistry was reported as HPC. This is an additional case of metastatic renal HPC.
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A rare co-occurrence of Sweet's syndrome and leukemia cutis as a presenting feature of B-cell chronic lymphoid leukemia: Probably a first reported case
Siddheshwar Virbhadraappa Birajdar, Sheshrao Sakharam Chavan, Sanjay Arun Mundhe, Ashish Kumar Jain
September-October 2016, 5(5):451-453
DOI:10.4103/2278-0513.197883  
Sweet's syndrome (SS), also known as acute febrile neutrophilic dermatosis, is characterized by tender, red inflammatory papules or nodules with fever that occur in association with infection, malignancy, connective tissue disease, or drug exposure. Malignancy-related SS has been described mainly in patients with acute myeloblastic leukemia. Leukemia cutis (LC) is the infiltration of neoplastic leukocytes or their precursors into epidermis, dermis, or subcutis, resulting in clinically identifiable cutaneous lesions. LC and its co-occurrence with SS have been described as presenting feature of acute myeloblastic leukemia. There are only few case reports describing SS in patients of chronic lymphocytic leukemia (CLL). However, through literature search, we could not find out cases describing co-occurrence of SS and LC in patients of CLL. Here, we report a rare co-occurrence of SS with LC in case of B-cell CLL, probably first reported case.
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Primary primitive neuroectodermal tumor of spinal cord
Ashutosh Das Sharma, Jyoti Poddar, Ubrangala Kunikullaya Suryanarayan
September-October 2016, 5(5):454-456
DOI:10.4103/2278-0513.197865  
Primarily spinal primitive neuroectodermal tumors are rare neoplasm. A 28-year-old female presented with complaints of pain in lower back, radiating to both lower limbs. Magnetic resonance imaging scan of the lumbosacral spine showed an intradural extramedullary space-occupying lesion. The patient underwent L2–L5 laminectomy with excision of the lesion. Histopathology and immunohistochemistry reports confirmed the diagnosis of primitive neuroectodermal tumor while a thorough metastatic workup ruled out secondary to the spinal cord. The patient developed recurrence at local site within a month after surgery, even before the adjuvant treatment could be started. She is being treated with chemotherapy (human resources protocol).
  - 1,677 15
Pyopneumopericardium in a child with acute leukemia
Rahul Jain, Amitabh Singh
September-October 2016, 5(5):457-459
DOI:10.4103/2278-0513.197872  
Pyopneumopericardium is a rare condition with high mortality. Most cases are the result of a fistulous communication between the pericardial cavity and the gastrointestinal or the respiratory tract. Rarely, the condition may arise spontaneously. We describe a 7-year-old boy, a diagnosed case of acute lymphoblastic leukemia, on chemotherapy who developed pyopneumopericardium without pneumothorax and responded well to conservative management.
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Squamous cell carcinoma of the conjunctiva: A rare case report
Anubhav Chauhan, Shashi Datt Sharma
September-October 2016, 5(5):460-462
DOI:10.4103/2278-0513.197887  
Ocular surface squamous neoplasia is a term that describes neoplastic changes of the cornea and conjunctiva ranging from squamous dysplasia to invasive squamous cell carcinoma (SCC). SCC of the conjunctiva is a rare tumor mainly affecting the elderly age group. Resemblance to common conditions such as pterygium and pinguecula may result in a wrong diagnosis on the part of an ophthalmologist. We present a rare case of SCC of the conjunctiva in a 41-year-old female.
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Chondroblastic variant of extraskeletal osteosarcoma of thigh: A rare case report
Shivani Sood, Ashish Chaudhary, Vijay Kaushal
September-October 2016, 5(5):463-465
DOI:10.4103/2278-0513.197867  
Extraskeletal osteosarcoma (ESOS) is a rare, malignant neoplasm comprising 1% of mesenchymal tumors. We hereby report a case of ESOS of the thigh which was diagnosed on histopathology. Magnetic resonance imaging showed two lobulated markedly heterogeneous masses in the subcutaneous fat of the lateral aspect of thigh measuring 5 cm × 4.2 cm × 4.2 cm and 7.1 cm × 5.7 cm × 6.0 cm. Femur and major neurovascular bundles were unremarkable. Excision biopsy revealed a circumscribed tumor comprising sheets and fascicles of spindle cells and abundant osteoid produced directly by malignant cells. Malignant cartilage and extensive areas of calcification were also seen. Hence, a diagnosis of ESOS was given. Prompt diagnosis and surgical resection are mandatory, because unlike conventional osteosarcoma, ESOSs are more aggressive and do not respond to chemotherapy.
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Congenital cystic adenomatoid malformation of lung: Report of three cases and review of this rare entity
Mallika Pal, Indranil Das, Rathin Hazra, Susmita Mukhopadhyay, Soumyee Bandyopadhyay
September-October 2016, 5(5):466-469
DOI:10.4103/2278-0513.197868  
Congenital cystic adenomatoid malformations (CCAMs) are rare congenital, developmental, nonhereditary, hamartomatous pulmonary airway malformations. Etiology is unknown. It is a rare disease with an incidence of 1 in 11,000 to 1 in 35,000. It is a disease of infancy with most of the cases diagnosed within the first 2 years of life. We report cases of three infants with CCAM (Stocker Type II and I) with brief review of literature.
  - 1,020 15
Limbal carcinoma: Common malignancy at uncommon site
Shailja Puri, Sarita Asotra, Ram Lal Sharma, Neelam Gupta
September-October 2016, 5(5):470-472
DOI:10.4103/2278-0513.197873  
Limbus is the region of the eye between the cornea on one side and the sclera on the other. Limbus houses the stem cells. Neoplastic growths in limbus are the most common among growths of cornea and conjunctiva owing to the transition nature of the limbus. Although squamous cell carcinoma (SCC) is the most common carcinoma of limbus, its incidence is only 0.2–3.5/100,000. We present a 65-year-old patient with a limbal growth over a long period initially diagnosed as limbal stem cell deficiency. The patient sequentially developed epithelial dysplasia and then SCC. The complete excision of eyeball had to be done due to the recurrent nature of the lesion. The need for early detection of limbal mass and its prompt treatment cannot be overemphasized. Limbal growths have a good prognosis when treated early since they do not invade cornea and conjunctiva readily. Treatment is both surgical and medical. We present this case because of its rarity with a review of literature.
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Diffuse large B-cell lymphoma presenting as bilateral parotid enlargement, mimicking Sjögren's syndrome
Mona Akshay Agnihotri, Pragati Aditya Sathe, Kanchan Snehal Kothari, Leena Praveen Naik
September-October 2016, 5(5):473-475
DOI:10.4103/2278-0513.197885  
Parotid gland lymphomas are rare with an incidence of 2% of all salivary gland tumors and are therefore commonly overlooked. They can occur de novo, arise in the background of a preexistent Sjögren's syndrome, or can be involved in disseminated non-Hodgkin's lymphoma (NHL). We report here a case of a 45-year-old female patient with disseminated NHL, presenting as bilateral parotid enlargement, clinically thought to be Sjögren's syndrome, diagnosed on fine needle aspiration cytology. A high index of suspicion and distinction from its more common mimics such as Sjögren's syndrome is needed to provide a quick and correct diagnosis as well as appropriate management.
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All uterine enlargements are not fibroids!
Reena Jatin Wani, Shweta Ashok Shah, Yasmeen Sahir Khatib, Archana Laxman Khade
September-October 2016, 5(5):476-478
DOI:10.4103/2278-0513.197859  
Endometrial stromal sarcomas are rare mesenchymal tumors observed in pre- and peri-menopausal age group. The diagnosis is made postoperatively, but a high index of suspicion is needed. The usual presentation is lump in abdomen and abnormal vaginal bleeding. Endometrial sampling, ultrasound, and magnetic resonance imaging help in preoperative diagnosis. Total abdominal hysterectomy with bilateral salpingo-oophorectomy is the main line of management. This article describes its occurrence in a young woman, who presented without the usual clinical features of lump or abnormal vaginal bleeding. The diagnosis was established postoperatively and was confirmed with specialized tests such as immunohistochemistry and mutation studies.
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Primary ovarian squamous cell carcinoma occurring in mature cystic teratoma
Ankita Mehta, Rojaramani Potluri, Prathima Shivajirao, Shivarudrappa Alilaghatta Siddalingappa
September-October 2016, 5(5):479-482
DOI:10.4103/2278-0513.197882  
Mature cystic teratoma (MCT) is a common benign tumor of the ovary in females. Malignant transformation in a MCT of the ovary is a rare condition and accounts for only 1%–2% cases. The most common malignancy is squamous cell carcinoma (SCC), which comprises about 75% of malignant transformations. We report a case of a 52-year-old postmenopausal female who presented with complaint of pain and mass per abdomen for 4 months. She underwent bilateral salpingo-oophorectomy, and histopathological examination revealed primary ovarian SCC arising in a MCT. Later, she underwent chemotherapy, total hysterectomy, and omentectomy with iliac lymph node dissection.
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Granular cell tumor: A rare tumor at rare location
Sonia Hasija, Shilpa Bairwa, Shilpa Garg, Shivani Kalhan, Shilpa Tomar, Satya Dutta
September-October 2016, 5(5):486-488
DOI:10.4103/2278-0513.197879  
Granular cell tumor (GCT) is a rare tumor affecting the middle-aged people with an incidence of 0.017–0.029%. In 1926, Abrikossoff was the first to describe this tumor as myoblastoma as it was arising from muscle in the tongue. Common sites are the tongue, skin, and subcutaneous tissue. Here in, a 29-year-old female presented with a swelling on the ring finger of the right hand. Excision biopsy was performed. Histological features were suggestive of GCT. This case is of particular interest due to the atypical location and clinical presentation.
  - 1,406 15
Mucinous carcinoma of breast in a 30-year-old female: A rare case report and discussion
Banyameen Mohamad Iqbal, Bedarshi Banerjee
September-October 2016, 5(5):489-491
DOI:10.4103/2278-0513.197890  
Mucinous carcinoma (MC) (colloid carcinoma) is a particular, rare type of breast carcinoma. It is characterized by the presence of extracellular mucin. MC of the breast generally presents as a lobulated, moderately well-circumscribed mass on mammography, sonography, and magnetic resonance imaging. It has a favorable prognosis due to the low incidence of axillary lymph node metastasis and poor adherence to bottom fascia and poor infiltration of overlying skin. It has high incidence of estrogen receptor and progesterone receptor positivity. The incidence of MC in females under 35 years of age is only 1%. Here, we report a case of MC of right breast in a 30-year-old female.
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Cherubism: A rare case diagnosed on fine-needle aspiration cytology
Pooja Srivastava, Kusum Gupta, Sachin Kolte
September-October 2016, 5(5):492-494
DOI:10.4103/2278-0513.197874  
Cherubism is a rare self-limiting nonneoplastic disease of the bone characterized by bilateral painless enlargement of the jaws giving a cherubic appearance to the patient. It is an autosomal-dominant disorder due to mutations in the SH3 domain-binding protein 2 gene on chromosome 4p16.3, but may occur sporadically. Here, we describe the clinical, radiological, and cytological features of cherubism in a 12-year-old girl.
  - 624 15
Rare presentation of breast carcinoma in an old burn scar
Mirza Qaiser Baig, Rahat Hadi, Mohammad Azam, Mohammad Ali
September-October 2016, 5(5):495-497
DOI:10.4103/2278-0513.197875  
Malignancies from old burn scars (BSs) have been documented in literature but are rarely encountered in our day-to-day practice. Adenocarcinoma is an extremely uncommon while squamous cell carcinoma is the most common malignant entity seen as BS neoplasm. Breast cancer arising from an old BS is rarely reported in literature. Till now, to the best of our knowledge, only four cases have been reported in literature. Here, we are reporting an interesting case of 38-year-old female with a history of burn injury on her chest wall including left breast and axilla 20 years back which was left to heal secondarily, i.e., without any active intervention. Later, she developed an ulceroproliferative growth over her left breast for which she consulted a local physician. A diagnosis of infiltrating ductal carcinoma breast of the left side was made after biopsy and was referred to our hospital. Metastatic workup was negative, i.e., chest X-ray posteroanterior view, ultrasound sonography abdomen and pelvis with blood investigations were found to be normal. Right side breast, axilla, and supraclavicular region along with abdomen were found to be normal. Clinically, she was staged as T4b, N0, M0, Stage III B carcinoma breast left side. She was managed with upfront surgery, i.e., a simple mastectomy followed by adjuvant chemotherapy and radical radiotherapy. After completing the radical treatment, she was kept on tamoxifen 20 mg once daily for 5 years. At present, the patient is doing well with locoregional complete response after 6 years of regular follow-up.
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Small-cell neuroendocrine carcinoma cervix: A case report of an aggressive tumor
RK Spartacus, Rohitashwa Dana, Nirupama Kothari, Rajan Paliwal
September-October 2016, 5(5):498-500
DOI:10.4103/2278-0513.197880  
Neuroendocrine tumors comprise a broad family of tumors that arise from the diffuse neuroendocrine cell system. Small-cell neuroendocrine carcinoma cervix is a rare tumor, accounting for up to 2% of cervical carcinomas. These are highly aggressive tumors, characterized by early distant metastasis and worse prognosis compared to other histological types occurring in the cervix. Distant sites of recurrence including lung and bone are more common (28%) than local failure (13%). We report a case of a 60-year-old woman whose disease progressed during treatment with an eventual fatal outcome.
  - 1,342 15
Extranodal natural killer/T-cell lymphoma, nasal type with central nervous system and bone marrow involvement: Report of a rare case with review of literature
Jayasudha Arundhathi Vasudevan, Rekha Appukuttan Nair, Nileena Nayak, Renu Sukumaran
September-October 2016, 5(5):501-503
DOI:10.4103/2278-0513.197881  
Extranodal natural killer (NK)/T-cell lymphoma is the predominant type of primary nasal lymphoma, especially in the Asian population. Only a few studies have specifically reported on the incidence of cerebrospinal fluid (CSF) and bone marrow involvement in peripheral T-cell lymphomas. We report a case of extranodal NK/T-cell lymphoma with CSF and bone marrow involvement which is a rare occurrence.
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Multiple cutaneous metastasis of renal cell carcinoma: A rare presentation
Hema Udawat, Deepti Sukheeja, Meenu Vijayvargiya, Shilpa Jalan
September-October 2016, 5(5):504-506
DOI:10.4103/2278-0513.197889  
Apart from breast carcinoma, malignancies rarely spread to the skin. Although renal cell carcinoma (RCC) has a high metastatic potential, metastasis to the skin is extremely rare. We present a case of a 50-year-old male with multiple nodular cutaneous metastases. Four months postnephrectomy, he was diagnosed cytologically and confirmed histopathologically. Such patients must be subjected to long-term clinical observation. Clinicians should pay attention to cutaneous lesions appearing in the patients with known case of internal malignancies. Prompt diagnosis and treatment will have its bearing on the eventual outcome.
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ORIGINAL ARTICLES
Study of cervical cytology and its correlation with clinical and histopathological findings
Sunita Arvind Bamanikar, Dadaso Baravkar, Shirish Chandanwale, Arpana Dharwadkar, Sourabh Paranjape
September-October 2016, 5(5):403-408
DOI:10.4103/2278-0513.197869  
Background: Cancer of the cervix is the second most common cancer among women in the world. It accounts for 12% of all cancers in females. This study aims to evaluate the pattern of cervical cytology and its correlation with clinical and histopathological findings. Materials and Methods: This is 10 years retrospective and prospective study, in which all the Papanicolaou (Pap) smears were reported as per the 2001 Bethesda system. Clinical and histopathological correlation was done in cases where cervical biopsy or total hysterectomy specimens were available. Results: A total of 3791 Pap smears were studied with respect to age group, clinical signs and symptoms, and cytology findings. Cervical biopsy correlation was done in 200 cases. Most of the patients were in age group of 31–40 (35.61%) years. The Pap smear findings revealed 88.02% as negative for intraepithelial lesion or malignancy (NILM), 5.99% epithelial cell abnormality (ECA), and 5.99% were unsatisfactory. ECA comprised atypical squamous cells of undetermined significance (ASCUS) with 2.98%, low-grade squamous intraepithelial lesion with 1.19%, and high-grade squamous intraepithelial lesion with 0.66%. There were 36 cases (0.95%) of malignancy. Sensitivity, specificity, and positive predictive value of Pap smear in diagnosing ECA and malignancy were 89.47%, 88.70%, and 82.92%, respectively. Conclusion: Pap smear test is ideal screening method for cervical carcinoma. Nonspecific inflammation and ASCUS were most common finding among NILM and ECA group, respectively. Biopsy is considered to be the gold standard for carcinoma cervix provided that it is taken from representative areas.
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St. Gallen's molecular subtypes in primary breast carcinoma in Indian population
Ashima Batra, Nisha Marwah, Sanjay Marwah, Sumiti Gupta, Deepak Dharembra, Rajeev Sen
September-October 2016, 5(5):416-423
DOI:10.4103/2278-0513.197860  
Aim: Immunohistochemical (IHC) markers have been used as surrogates for DNA-microarray in subtyping breast cancer, which lead to new biological insights and eventually to better-targeted therapies. Our study aimed at studying the distribution of the St. Gallen's molecular subtypes in our population and to evaluate their association with traditional prognostic features. Materials and Methods: Seventy-five cases of primary breast cancer undergoing radical or modified radical mastectomy were classified into five subtypes based on their IHC profile using estrogen receptor, progesterone receptor, human epidermal growth factor receptor 2 (Her2)/neu, and Ki-67 as per St. Gallen's guidelines. IHC subtypes were correlated with various clinicopathologic prognostic parameters including age, tumor size, tumor type, axillary lymph node status, and histologic tumor grade. Results: The proportion of each subtype in our population was: luminal A 28%, luminal B Her2− 18.7%, luminal B Her2+ 9.3%, Her2/neu+ 17.3%, basal cell-like (BCL) 26.7%. The majority of luminal A cases were well differentiated (Grade I) whereas luminal B Her2− was mostly moderately differentiated (Grade II) and luminal B Her2+ constituted mainly well differentiated and moderately differentiated tumors. Both subtypes of luminal B showed lymph node metastasis in majority of the cases. Her2/neu+ and BCL subtype were high-grade tumors comprising mainly of moderately differentiated and poorly differentiated tumors. The majority of luminal A cases were negative for Ki-67 whereas all the luminal B Her2− tumors expressed Ki-67, 50% being highly positive. BCL subtypes revealed highest proliferation index with 80% of the cases being high positive Ki-67. A statistically significant difference of modified Bloom–Richardson grade and Ki-67 distribution (χ2 = 42.974; P< 0.001) between various IHC subtypes was observed.
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Expression of human epidermal growth factor receptor 2 and p53 in gastric cancer patients: Clinical and prognosis relevance
Dorra Ben Ayed-Guerfali, Najla Abid, Abdelmajid Khabir, Hela Mnif, Afef Khanfir, Salah Boujelbène, Mounir Frikha, Raja Gargouri, Tahya Sellami Boudawara
September-October 2016, 5(5):424-429
DOI:10.4103/2278-0513.197866  
Background: Increased evidence showed that human epidermal growth factor receptor 2 (HER2) and p53 play an important role in gastric cancer development and could have a prognostic relevance. We aimed to study the expression of HER2 and p53 in gastric adenocarcinomas and to investigate the correlation with clinicopathological parameters as well as the overall survival in Tunisian patients. Patients and sMethods: A total of 95 patients who had undergone gastrectomy for gastric adenocarcinoma at Sfax University Hospital of Tunisia were included in this study. The expression of HER2 and p53 in tumor tissues was performed by immunohistochemistry. Results: Positive expression of HER2 was observed in 17.89% of cases while p53 nuclear expression was negative in 40%, moderate in 38.94%, and intense in 21.05% of tumor tissues. The expression of HER2 correlated significantly with patient's age (P = 0.011), histological type (P = 0.005), tumor differentiation (P = 0.009), and tumor node metastasis (TNM) stage (P = 0.048). On the other hand, the expression of p53 correlated with patient's age (P = 0.028), gender (P = 0.022), and TNM stage (P = 0.029). With regard to the prognostic value, negative nuclear expression of p53 alone or associated with loss of HER2 expression correlated significantly with prolonged overall survival (P log rank = 0.019 and 0.002, respectively). Conclusion: Our findings highlight the importance of HER2 and p53 proteins as predictive markers for prognosis allowing a better management of patients with gastric adenocarcinoma.
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Immunohistochemical characterization of molecular classification of breast carcinoma and its relation with Ki-67
Shabnam Karangadan, Anuradha Ganesh Patil, Sainath Karnappa Andola
September-October 2016, 5(5):430-436
DOI:10.4103/2278-0513.197876  
Background: Breast carcinoma is the leading cause of cancer deaths in women. Molecular classification of breast carcinoma along with Ki-67 index is considered a better predictive factor for prognosis and treatment than routine histopathology. Aims: To classify breast carcinoma into the four molecular subtypes defined by immunohistochemical expression of triple markers: Luminal A (estrogen receptor/progesterone receptor-positive [ER/PR+] and human epidermal growth factor receptor 2 HER2/neu), luminal B (ER/PR + and HER2/neu+), triple negative (ER/PR − and HER2/neu−), and HER2 positive (ER/PR−, HER2/neu+), and to correlate the expression of ER, PR, HER2/neu, and classification with Ki-67. Materials and Methods: The present study includes sixty breast carcinoma cases studied over a 3-year period. The expression patterns of ER, PR, HER2/neu, and Ki-67 were studied. Clinical features, pathologic features such as size, grade, and lymph node status, and correlation with Ki-67 of the four subtypes were compared. Results: Out of sixty cases, most common molecular subtype was triple negative (40.00%) followed by luminal B (23.33%). Most of the tumors showed low proliferative index (low Ki-67); however, triple negative and HER2 positive subtype showed high proliferative index. Most common histological subtype was ductal carcinoma which was mainly triple negative. All medullary carcinoma cases were triple negative. One case of lobular carcinoma and mucinous carcinoma each was HER2 positive and luminal B, respectively. Single case of carcinoma of male breast was luminal B subtype. Conclusion: Correlation of molecular classification with age, histological grade, and Ki-67 was statistically significant (P < 0.05). ER/PR also correlated with histological grade and Ki-67 (P < 0.01). These results emphasize the fact that molecular subtypes correlate with prognosis and aid in targeted therapy.
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Clinicopathological pattern of brain tumors: A 3-year study in a tertiary care hospital in India
Sajeeb Mondal, Rajashree Pradhan, Subrata Pal, Biswajit Biswas, Arindam Banerjee, Debosmita Bhattacharyya
September-October 2016, 5(5):437-440
DOI:10.4103/2278-0513.197861  
Background: Brain tumors are heterogeneous group of neoplasms, affecting different age groups. Although some studies have been published regarding pathological pattern of brain tumors from different countries of the world and also from India, comprehensive clinicopathological studies from Eastern India is lacking. Aims: The aim of this study was to observe recent incidence of different brain tumors and to study clinical and histopathological spectrum of brain tumors in Eastern India. Materials and Methods: The present study was a cross-sectional observational study involving 130 cases of brain tumors which were diagnosed during the 3-year study period (January 2010–December 2012). Data regarding clinical presentation and radiological features of all cases were collected from all patients. Histopathological diagnosis was correlated with clinical and radiological diagnosis. Results: We found 130 cases of brain tumor with a male preponderance. The cases were distributed in a wide age range from 4 years to 78 years with the mean age of 42.38 years. Most common tumor type in our study was neuroepithelial tumor (92 cases, 70.76%). Among the neuroepithelial tumors, most frequent subtype was astrocytic tumor (54 cases, 41.5%). The second most frequent brain tumor was meningioma (20 cases, 15.3%). We found higher incidence of oligodendroglial tumor (8.46%) and medulloblastoma (7.69%) in our series. Conclusion: Males are more predispose to brain tumors in comparison to females. Astrocytic tumors are most common subtype in Eastern India. However, the WHO Grade I neoplasms are more frequent brain tumors.
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Clinical profile, treatment, and outcomes of patients with mantle cell lymphoma treated in a tertiary care center in South India
Kadabur Nagendrappa Lokesh, Sunny Garg, Lakshmaiah Chinnagiriyappa Kuntegowdanahalli, Govinda Babu Kanakasetty, Premalata Chennagiri Srinivasamurthy, Suparna Ajit Rao, Linu Abraham Jacob, Loknatha Dasappa, Suresh Babu Mallekavu Chikkadasappa, Rudresha Antapura Halleshappa, Rajeev Lakkavalli Krishnappa
September-October 2016, 5(5):369-373
DOI:10.4103/2278-0513.197863  
Introduction: Mantle cell lymphoma has an aggressive course, with unfavorable outcomes. Subjects and Methods: A retrospective analysis was undertaken and 77 cases were identified between 2009 and 2014. Results: Median age was 55 years with a male to female ratio of 6:1. Patients with pure nodal disease at presentation were fewer than with extranodal disease (53.2%). Most common extranodal site was bone marrow. A number of patients with low-, low-intermediate, high-intermediate, and high-risk International Prognostic Index (IPI) scores were 6, 24, 22, and 25. Treatment consisted of cyclophosphamide,hydroxydaunorubicin, oncovin, prednisolone (CHOP) or R-CHOP regimens. Median survival was 21 months. Median overall survival with early and advanced disease was 31 and 18 months (P = 0.02). Patients who received R-CHOP survived better than those given CHOP, 30 and 16 months (P = 0.0002). There was no difference in survival with respect to age, gender, extranodal, or bone marrow involvement. Conclusions: Most patients presented with extranodal disease, advanced stage, and high IPI. Although rituximab has improved survival, intensive chemotherapy would be required to improve survival.
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Profile of molecular subtypes of breast cancer with special reference to triple negative: A study from Northeast India
Gayatri Gogoi, Mondita Borgohain, Projnan Saikia, Syed Abul Fazal
September-October 2016, 5(5):374-383
DOI:10.4103/2278-0513.197871  
Background: Different molecular classes of breast cancer (BRCA) correlate with prognosis and response to therapy. Triple-negative breast cancer (TNBC) is a newer concept and very limited studies were carried out in India. The aim of this study was to profile the molecular types with a particular emphasis on TNBCs. Materials and Methods: Prospectively evaluated descriptive study for 2 years from June 2014 to March 2016, was carried out in the Department of Pathology and Surgery in a tertiary care institute. Cases included were of invasive breast carcinoma in females, confirmed by histopathology. Ethical clearance was received. Data were analyzed using Statistical SAS software. Results: A total of 123 cases of invasive BRCA were studied and mean age was 44.64 years. The peak age group was 36–45 years (43.9%). Tumor sizes ≥2 cm was 30%, between 2 and 5 cm was 50.40%, over 5 cm was 19.51%. Invasive duct carcinoma was 82.11% and invasive lobular carcinoma 8.13%. Only 21% of subjects presented as early breast carcinoma. Cases of 1–3 nodes were 22.8%, 4–5 nodes 21.1%, more than five nodes were 34%. Histologic Grade 3 was 50.4%, Grade 2 was 41%, and Grade 1 was only 8.1. The American Joint Committee on Cancer, Stage 1 (17.9%) in Stage 2 (29.3%) Stage 3 was 46.3%, Stage 4 was 6.5%. Estrogen receptor was in 40.62%, progesterone receptor 35.77%, Her2/Neu 18.69% luminal A (19.51%), luminal B (21.13%), Her2/Neu type (17.88%), and triple negatives (38.21). Conclusion: The present study showed significantly higher TNBC with poor prognostic factors in younger women in a background of peculiar ethic spectrum in this geographical region.
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The predictive role of thrombocytosis in identifying patients with advanced lung carcinoma in an urban medical center
Alpa Patel, Yazan Abdeen, Ram Katpally, Sugabramya Kuru, Hamid Shaaban, Mohammed Al Halawani, Richard Miller
September-October 2016, 5(5):384-387
DOI:10.4103/2278-0513.197877  
Study Objectives: Lung carcinoma is leading cause of death from cancer, thus an important subject for review. Lung carcinoma is associated with various prognostic factors including both clinical and objective findings; therefore, a review of thrombocytosis regarding predicting stage at initial diagnosis was prompted. Materials and Methods: A retrospective chart review of 180 patients diagnosed with lung carcinoma at Saint Michael's Medical Center between 2009 and 2013 and comparison with platelet level at time of diagnosis. The pathological diagnosis of lung cancer was made by either trans-bronchial or CT guided biopsy. Design: A retrospective chart review of 180 patients diagnosed with lung carcinoma at Saint Michael's Medical Center between 2009 and 2013 and comparison with platelet level at time of diagnosis. Results: No statistical significance was determined between advanced (including advanced staging of small cell lung cancer [SCLC] and Stage IIIb-IV of non-SCLC [NSCLC]) lung cancer staging and elevated platelet level (P = 0.078 and confidence interval [CI] of −89.103–4.774). However, on a subgroup analysis of cases including only NSCLC showed a statistically significant difference between limited and advanced stages (P = 0.0.18 and CI of −95.756–9.104). Conclusions: Thrombocytosis is associated with various neoplasms, included lung cancer as indicated in this retrospective study. In fact, thrombocytosis has been implicated with advanced staging of both SCLC and NSCLC, therefore indicating poor outcomes and mortality.
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HIV-associated lymphomas: A clinicopathological study from India
Anuradha Ananthamurthy, Divya Supari
September-October 2016, 5(5):388-392
DOI:10.4103/2278-0513.197884  
Background: Although there is a high burden of HIV-positive cases in India, there is very little published data on the prevalence and pathological profile of malignancies occurring in these patients. Aims: The current study was undertaken to analyze the clinicopathological profile of HIV-positive patients with Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL). Materials and Methods: This was a retrospective study over a 6-year period consisting of histopathology slide and clinical chart review of HIV-positive patients with lymphomas. Results: Of a total of 3470 HIV-positive patients during the 6-year period of study, the number of HIV patients diagnosed with lymphomas was 26. The mean duration between HIV seropositivity and development of lymphoma was 12 months. Seven patients were diagnosed as HIV positive during the course of investigations after a lymphoma diagnosis. The male to female ratio was 5.5:1 and the mean CD4 count, 171/mm3. Among the 26 cases, 3 were diagnosed with classical HL and the rest with NHL. B-cell lymphomas predominated with 19 cases. Among the NHLs, plasmablastic lymphoma and diffuse large B-cell lymphoma were the common subtypes with no cases of either Burkitt Lymphoma or primary CNS lymphoma. The median duration of follow-up was 1 year. Ten cases died during the course of treatment, 11 cases achieved complete remission. Conclusions: This is one of the few studies from India documenting the clinicopathological features of HIV-associated lymphomas. It is interesting that in many cases, HIV positivity was detected during the course of investigations after a lymphoma diagnosis.
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