Role of HER-2/neu in Premalignant and Malignant Lesions of Uterine Cervix.

INTRODUCTION: In light of literature and controversy that exists in various cervical lesions, this prospective study was designed to explore the expression of Human Epidermal Growth Factor Receptor-2 (HER-2/neu) in the cervical lesions and its correlation with the histopathological grade and type of tumour. Immunohistochemistry (IHC) was performed to evaluate HER-2/neu expression as it is the most reliable method of detecting overexpression of HER-2/neu. AIM: To assess the role of HER-2/neu expression in premalignant and malignant lesions of uterine cervix. MATERIALS AND METHODS: Seventy cases of premalignant and malignant cervical lesions received in our department from January 2015 to December 2016, were included in study and Polyclonal Rabbit Anti-Human c-erbB-2 oncoprotein from DAKO was used. Standard streptovidin-biotin peroxidase method of IHC was followed. A golden brown membrane and cytoplasmic staining was taken as a positive reaction and intensity of expression was graded according to the 2014 ASCO/CAP guidelines for HER-2/neu reporting. RESULTS: Out of total 70 cases, HER-2/neu expression scores were 0 in 64.3% {23 cases of Cervical Intraepithelial Neoplasia (CIN) and 22 of Squamous Cell Carcinoma (SCC)}, +1 in 22.9%, (04 cases of CIN and 12 of SCC) +2 in 10% (06 cases of SCC and 01 of adenosquamous carcinoma) and +3 in 2.9% (02 cases of adenocarcinoma) cases. HER-2/neu overexpression rate was significantly higher in malignant (48.8%) as compared to pre malignant (14.8%) cases (p=0.004) and expression scores were higher (+2 and +3) in 20.9% of malignant cases as compared to none of pre malignant cases (p=0.020). Significant higher HER-2/neu scores are seen (+2 and +3) in all the adenocarcinoma cases as compared to 15% cases of SCC (p<0.001). Among malignant cases, HER-2/neu expression was statistically significantly higher in {Moderately Differentiated (MD) + Poorly Differentiated (PD)} 59.09% as compared to {Well Differentiated (WD)} 38.09% cases (p=0.090). CONCLUSION: Study shows that expression of HER-2/neu is relatively lower in cervical lesions. However, the results of our study show that with shift from well to poorly differentiated lesions; the HER-2/neu expression rate shows an incremental trend.

Role of Multivoxel Intermediate TE 2D CSI MR Spectroscopy and 2D Echoplanar Diffusion Imaging in Grading of Primary Glial Brain Tumours.

INTRODUCTION: Preoperative tumour grading is imperative owing to difference in invasive, aggressive tendencies of different grades of glial tumours implying varied prognosis, therapeutic options. Histopathological examination has inherent sampling errors. Magnetic Resonance Spectroscopy (MRS) and Diffusion Weighted Imaging (DWI) can provide non invasive information about internal mileu hence, aiding in tumour grading by adding to information provided by conventional MRI sequences. AIM: To evaluate the role of multivoxel intermediate TE 2D CSI MRS and 2D echoplanar diffusion imaging in grading of primary glial brain tumours. MATERIAL AND METHODS: A prospective study was conducted in Department of Radiology, Teerthanker Mahaveer Medical College and Research Centre, Uttar Pradesh, India, from April 2015 to August 2016 after obtaining necessary approvals from Institutional Ethical Committee and written informed consent from all participants on histopathological proven cases of glial brain tumours that underwent multivoxel MRS using intermediate TE 2D chemical shift imaging and DWI using 2D echoplanar imaging. Tumour grade calculated on MRI using MRS and DWI was compared with histopathological grading. Positive Predictive Value (PPV), Negative Predictive Value (NPV), Sensitivity, specificity and accuracy were calculated for each parameter and statistical significance was evaluated using two tailed Pearson test. RESULTS: Choline: N Acetyl aspartate (Cho: NAA) and Choline: creatinine (Cho: Cr) ratios from MRS as well as Apparent Diffusion Coffecient (ADC) values from DWI were significantly higher with increasing severity of tumour grade. Accuracy of 58.6% was obtained with DWI while it was 83% with MRS. MRS and DWI used together provided 88.4% accuracy. All parameters evaluated showed statistical significance. CONCLUSION: Both DWI as well as MRS were found to have statistically significant roles in grading of glial brain tumours. MRS was found to be more useful than DWI.

Abdominal Tuberculosis: A Diagnostic Dilemma.

BACKGROUND: Abdominal tuberculosis (TB) is the sixth most common form of extra-pulmonary site of infection after lymphatic, genitourinary, bone and joint, miliary and meningeal TB with a rising incidence in recent years. TB can affect any part of the gastro-intestinal (GI) tract including anus, peritoneum and hepato-biliary system. The clinical manifestations of abdominal tuberculosis are non-specific and mimic various GI disorders and cause delay in diagnosis and management. AIM: To evaluate the various clinical, radiological and microbiological findings of abdominal tuberculosis and to define the role of histopathological examination in establishing the diagnosis in resource poor settings and to analyze the compliance and response to anti-tubercular treatment. MATERIALS AND METHODS: A five year retrospective study (January 2010 to December 2014) was done in a tertiary teaching hospital in Northern India and all the cases diagnosed as abdominal tuberculosis during the study period, were included. The relevant clinical informations, laboratory results, microbiological and radiological investigations were recorded. Histopathological examination of all the resected / excised specimens was done and Ziehl-Neelsen (ZN) staining to detect the tubercular bacilli and Periodic acid-Schiff (PAS) stain to rule out fungal infection was done in all the cases. RESULTS: Out of 48 cases with abdominal tuberculosis, the average age of presentation was 27.4 years with a slight male predominance (Male:Female=1.4:1). Abdominal pain (100%) was the most common presenting symptom followed by anorexia (98%), fever (88%) and intestinal obstruction (88%). The ileum was the most common site of involvement. All the 45 resected / excised tissue specimens (34 cases of intestinal resection and 11 cases of intesinal, omental and lymph nodes biopsies) showed epithelioid granulomas along with necrosis (in 38 cases) and Langhans giant cells (in 42 cases). Acid Fast Bacilli (AFB) positivity was seen in 5 tissue specimens only. All patients were put on anti-tubercular treatment and majority showed good response to therapy. CONCLUSION: Abdominal tuberculosis should be considered as a differential diagnosis in patients with vague GI symptoms. Study of histopathological findings can aid in the diagnosis in the settings where advanced molecular methods of diagnosis are not available, leading to early diagnosis and management.

Brooke-spiegler syndrome: a rare entity.

Brooke-Spiegler syndrome is a rare entity. It is an autosomal dominant syndrome in which multiple trichoepitheliomas, cylindromas, or other adnexal tumors are seen. Very few cases of Brooke-Spiegler syndrome are reported in the literature. We came across a 40 -year-old female in which multiple trichoepitheliomas and cylindromas were seen on scalp. In view of clinical history and histopathological examination it was diagnosed as Brooke-Spiegler syndrome. We report this case because of its rarity.

Cytomorphological Aspects of Hashimoto's Thyroiditis: Our Experience at a Tertiary Center.

INTRODUCTION: Hashimoto's thyroiditis is the most common form of acquired hypothyroidism. Fine needle aspiration cytology is one important tool in diagnosing Hashimoto's thyroditis, along with clinical, biochemical, immunological and ultrasonographical modalities. The present study examines cytological aspects of Hashimoto's thyroiditis along with their correlation with clinical, biochemical and immunological findings, whenever available. MATERIALS AND METHODS: This is a retrospective study of 50 cases of Hashimoto's thyroiditis. Cytological findings were reviewed and correlated with clinical, biochemical and immunological findings whenever available. RESULTS: The majority of the patients were middle-aged females, with a female to male ratio of 6.14:1. Most patients presented with diffuse thyromegaly (68%) and/or hypothyroidism (56.09%). The antibody profile was available in 22% of patients. Of these, anti-thyroid peroxidase antibodies were raised in 81.81% of patients and anti-thyroglobulin antibodies were raised in 63.63% of patients. In the present study, high lymphoid to epithelial cell ratio was seen in 78% of cases, and 74% of cases showed Hurthle cell change. Follicular atypia was seen in 36% of cases. Lymphoid follicle formation was seen in seen in 54% of cases. Follicular cell infiltration by lymphocytes, eosinophils and neutrophils was seen in 72%, 48% and 26% of cases, respectively. Plasma cells were seen in 18% of cases. CONCLUSION: Thyroid function tests and immunological tests cannot diagnose all cases of Hashimoto's thyroiditis. Fine needle aspiration cytology continues to be a diagnostic tool of significance in diagnosing Hashimoto's thyroiditis. The presence of inflammatory cells, particularly lymphocytes and eosinophils, was detected in a significant proportion of cases.

Twisted fimbrial cyst (paraovarian cyst): a rare cause of acute abdomen.

We present a case of a 22-year-old female who presented with acute abdomen and amenorrhea. Emergency laprotomy was done with a clinical diagnosis of ectopic pregnancy. On laprotomy, twisted fimbrial cysts were found. Thus, although fimbrial cysts are rarely twisted, they should be considered as a cause of acute abdomen in a female of reproductive age group.