Effect of Entamoeba histolytica infection on gut microbial diversity and composition in diarrheal patients from New Delhi.

During amoebiasis, colonization of the gut by Entamoeba histolytica can lead to alterations of the host microbiota. In this study, we have compared the gut microbiota of patients of amoebiasis with healthy controls using 16S rRNA gene variable regions, (V1-V3) and (V3-V5), of the bacterial genome. From this 16S rRNA gene amplicon data, one paired-end and two single-end datasets were selected and compared by the number of OTUs obtained, sequence count, and diversity analysis. Our results showed that the V1-V3-paired-end dataset gave the maximum number of OTUs in comparison to the two single-end datasets studied. The amoebiasis samples showed a significant drop in richness in the alpha diversity measurements and lower intra group similarity compared to the healthy controls. Bacteria of genus Prevotella, Sutterella, and Collinsella were more abundant in healthy controls whereas Escherichia, Klebsiella, and Ruminococcus were more abundant in the E. histolytica-positive patients. All the healthy controls harbored bacteria belonging to Faecalibacterium, Prevotella, Ruminococcus, Subdoligranulum, and Escherichia genera while all the E. histolytica-positive patient samples contained genus Enterobacter. The compositional changes in the gut microbiome observed in our study indicated a higher prevalence of pathogenic bacteria along with a depletion of beneficial bacteria in E. histolytica-infected individuals when compared with healthy controls. These results underline the interplay between E. histolytica and the human gut microbiome, giving important inputs for future studies and treatments.

A Comparative Analysis of COVID-19 IgG Antibody Level and Socio-Demographic Status in Symptomatic and Asymptomatic Population of South Andaman, India.

INTRODUCTION: The serosurveillance of COVID-19 antibody levels and their difference between symptomatic and asymptomatic groups can help in understanding the immune status of the community and the factors affecting it. Hence, the study was undertaken to find the differences between these two groups with respect to antibodies level and other socio-demographic variables in the South Andaman district. METHODS: A population-based serosurveillance study covering more than 4,000 samples was carried out in the South Andaman district. The participants were selected by multistage cluster sampling. The venous blood samples were tested for IgG COVID-19 antibodies by Erba Lisa Elisa kit. RESULTS: 5.3% of total individuals (217) were symptomatic whereas 94.7% (3,872) were asymptomatic. The symptomatic individuals had lower antibodies (33.6%) as compared to asymptomatic individuals (40.1%) (p-value=0.059). In the age group of 31-45 years, antibody positivity in the asymptomatic group was significantly higher than in the symptomatic group (p-value 0.031). The antibody positivity was higher in moderate to severe cases who needed hospital admission. The antibody positivity was found similar in both the groups in front-line workers as well as in non-front-line workers (p-value=0.104, 0.274, respectively). CONCLUSION: The antibody positivity was higher in asymptomatic individuals as compared to symptomatic individuals, particularly in the age group of 31-45 years. The higher level of antibody positivity in asymptomatic individuals reflected a stronger immune response which led to no clinical manifestations. The antibody positivity was also found higher in moderate to severe cases undergoing hospital admission whereas antibodies positivity was found similar in front-line and non-front-line workers.

Clinicopathological analysis of extracranial head and neck schwannoma: A case series.

BACKGROUND: Extracranial head and neck schwannomas are rare tumors which are often clinically misdiagnosed. Preoperative diagnosis of these tumors is challenging but imperative for surgeons so as to avoid nerve damage during excision. MATERIALS AND METHODS: Sixteen patients diagnosed with extracranial head and neck schwannomas over a period of 2 years were retrospectively analyzed. Clinical details including preoperative fine-needle aspiration cytology (FNAC) and/or computed tomography (CT)/magnetic resonance imaging (MRI) findings were retrieved. FNAC smears and formalin-fixed paraffin-embedded sections were evaluated. RESULTS: Among these 16 tumors, 6 (37.5%) were located in the lateral aspect of neck, 4 (25%) in scalp, 2 (12.5%) in orbit, and one each (6.25%) in palate, tongue, submandibular gland and parotid gland. The mean patient age was 31.3 years. FNAC was performed in 14 cases, of which 8 cases (58.3%) showed features of benign nerve sheath tumor (BNST), two cases (14.2%) were inconclusive with possibility of mesenchymal lesion, two cases (14.2%) were inadequate, one case (8.3%) showed features suggestive of schwannoma, and a diagnosis of nerve sheath tumor inconclusive for malignancy was rendered in a single case. The sensitivity of FNAC in diagnosis of BNST was 71.4%. CT or MRI was performed in five cases, of which an accurate diagnosis was rendered only in one case of orbital schwannoma. CONCLUSION: Imaging has a limited role in the preoperative diagnosis of head and neck schwannomas owing to nonspecific radiological features. Cellular aspirate smears are helpful in accurate diagnosis even at unusual locations.

Strain wave elastography in response assessment to neo-adjuvant chemotherapy in patients with locally advanced breast cancer.

OBJECTIVE: The study was conducted to study the role of strain wave elastography in evaluating the response to neo-adjuvant chemotherapy (NACT) in patients with locally advanced breast cancer (LABC). METHODS: In this Institutional review board approved study, 86 patients of LABC were investigated with strain wave elastography. Females receiving NACT had the affected breast scanned by strain wave elastography before each cycle of chemotherapy and immediately before surgery by two independent observers. Changes in elastographic parameters (size ratio, strain ratio) were documented and then compared to clinical and pathologic tumor response as evaluated after mastectomy. RESULTS: Elastographic strain ratio parameters demonstrated high sensitivity and moderate specificity for determining response even after the first cycle of neo-adjuvant chemotherapy [97.7% sensitivity (Sn), 68.7% specificity (Sp)]. Elastographic size ratio parameters showed moderate sensitivity and specificity for response detection after second and third cycle of neo-adjuvant chemotherapy (Sn, Sp: after second cycle of NACT Sn 83.3% Sp 80%; after third cycle of NACT Sn 77.8% Sp 100%). CONCLUSION: Strain ratio is the earliest predictor of treatment response in patients of LABC. Serial imaging with elastography has the potential to predict treatment response early during the course of NACT, which may prove vital in management of patients with breast cancer. ADVANCES IN KNOWLEDGE: Strain wave elastography is a powerful tool to predict chemoresponse early during the course of management, thereby providing an optimal window to change treatment protocols.

Melanotic neuroectodermal tumor of infancy: A rare entity.

Melanotic neuroectodermal tumor of infancy (MNTI) is a rare neoplasm with a predilection for the head-and-neck region. Approximately 472 cases reported in literature till date. We report an unusual case of MNTI in a 1-month old child. A 10 cm × 5 cm × 5 cm nontender, firm, deep-seated swelling was seen involving the right zygomatic and maxillary region. Magnetic resonance imaging was suggestive of rhabdomyosarcoma and immunomorphological assessment of the excision specimen revealed the final diagnosis of MNTI. On follow-up, the patient developed recurrence 4 months after surgery and was reoperated. The present case emphasizes that albeit rare, pediatric surgeons and pathologists must always keep in mind the possibility of MNTI while dealing with maxillofacial tumors in infants. Owing to rather nonspecific clinicoradiological features, histopathology supplemented with immunohistochemistry remains the gold standard for diagnosis. Although considered to be a benign tumor, close clinicoradiological follow-up is strongly recommended given the significant risk of recurrence as highlighted by our case.

Primary Retroperitoneal Teratoma with Predominant Neurogenic Elements Masquerading as Adrenal Tumor.

Primary retroperitoneal teratomas are uncommon extragonadal nonseminomatous germ cell tumors that are composed of well differentiated parenchymal tissues which are derived from more than one of the three embryonic germ cell layers. Here we report an unusual and first of its kind, a case of primary mature cystic retroperitoneal teratoma mimicking as adrenal tumor in a 7-month-old female in which the tumor was predominantly composed of neurogenic tissue histologically which is unlike the usual pattern seen in the teratomas.

Approach to pediatric renal tumors: an imaging review.

Renal tumors comprise 7% of all childhood cancers. A wide variety of renal tumors can affect the pediatric kidneys, which can be broadly classified as primary benign tumors, primary malignant tumors, and metastatic lesions. This article aims to enumerate usual benign and malignant renal tumors that can occur in childhood and emphasizes the characteristic imaging appearances which aid in their differential diagnosis. Additionally, the leading role of the Radiologist in primary diagnosis of renal infiltration by hematological malignancies and contiguous invasion by neuroblastoma is also introduced and unraveled. Imaging protocol comprises initial Ultrasound evaluation with subsequent computed tomography (CT) and/or Magnetic resonance imaging (MRI), all of which are invaluable in confirming the diagnosis, documenting the organ of origin, describing extent of local and distant spread. The complimentary role of nuclear medicine studies in delineating differential renal function, post-operative complications, and metastasis is also highlighted.

Expression of p53, epidermal growth factor receptor, c-erbB2 in oral leukoplakias and oral squamous cell carcinomas.

BACKGROUND: Oral cancer is a leading cause of cancer in India and contributes to 12% deaths worldwide. The identification of high-risk oral premalignant lesions such as leukoplakia and intervention at premalignant stages could result in significant loss of mortality and morbidity among these patients. The most frequently observed genetic aberrations in these lesions are of mutations in p53, c-erbB2, and epidermal growth factor receptor (EGFR). No specific tumor markers have been identified consistently in oral leukoplakias and the available studies show wide variations in their expression. MATERIALS AND METHODS: A total of eighty cases were taken up for study which included forty cases of leukoplakia and forty cases of squamous cell carcinomas (SCCs). RESULTS: There was a significant correlation between the expression of markers p53 and EGFR in leukoplakia and SCC. The expression of p53 was correlated between leukoplakia, SCC, and control and was found to be significant (P ≤ 0.001). Similarly, EGFR expression was significant (P ≤ 0.001) between cases of leukoplakia, SCCs, and controls. c-erbB2 was found to be negative though cytoplasmic positivity was observed in a few cases. Similarly, in SCCs, it was observed that lesser the differentiation, more is the expression of both p53 and EGFR. Similarly, a definite correlation was observed between p53 and EGFR (P ≤ 0.001) but not with c-erbB2 (P ≤ 1.000). CONCLUSION: Thus, the author concludes that p53 and EGFR are useful biomarkers for the diagnosis of leukoplakia and their risk of malignant transformation.

Hodgkin's lymphoma arising in a case of mycosis fungoides: An unusual association.

Mycosis fungoides is a cutaneous T-cell lymphoma with a high risk for developing secondary malignancies, especially B-cell lymphoproliferative disorders. About 40 cases of Hodgkin's lymphoma associated with mycosis fungoides have been reported in literature till date. We report a case of a 35-year-old gentleman who presented with intensely itchy reddish lesions all over the body. Multiple skin biopsies taken from the lesions on scalp and back confirmed the clinical diagnosis of mycosis fungoides. While on treatment, he presented with multiple bilateral cervical, axillary and inguinal lymphadenopathy 9 years after the primary diagnosis of mycosis fungoides. Excision biopsy of a cervical lymph node revealed partial effacement of architecture by a tumor comprising polymorphous background. Histopathology and immunohistochemistry revealed a diagnosis of Hodgkin's lymphoma - nodular sclerosis subtype. The patient was started on chemotherapy for stage IV Hodgkin's lymphoma. Our case emphasizes the importance of keeping secondary Hodgkin's lymphoma in mind while dealing with a patient of mycosis fungoides. Our case immunohistochemically supports the distinct etiopathogenesis of Epstein-Barr virus-negative Hodgkin's lymphoma vis-à-vis cutaneous mycosis fungoides.

Diagnostic Utility and Efficacy of Conventional Versus SurePath® Liquid-based Cytology in Head and Neck Pathology: A Study in an Indian Tertiary Care Hospital.

BACKGROUND & OBJECTIVE: Liquid-based cytology (LBC) is an emerging pathological method for better establishment of the diagnosis in almost all the organs of the body. It is currently used both for the gynecological and non-gynecological (fine-needle aspirates (FNAs)/fluid) specimens in most of the developed and few developing countries. The current study aimed at assessing and illustrating the cytological morphology on SurePath® LBC technique when used on FNAs from head and neck lesions, compared to the conventional smears (CS). METHODS: In the current prospective study, a total of 1000 FNAs obtained from swellings of head and neck region were simultaneously processed both by the standard conventional and SurePath® LBC techniques. Both of these preparations were studied, compared with a semi-quantitative scoring system, and statistically analyzed. P-value <0.05 was considered statistically significant. RESULTS: LBC smears were better, compared to CS ones, due to the presence of evenly dispersed cells (P≤0.001), clearance of obscuring elements / background debris (P≤0.001), and better cellular details (P≤0.001). However, these abilities of LBC often became its own nemesis and made the interpretation difficult. CONCLUSION: LBC, though costly, is an acceptable, simple, and valuable technique. However, CS still cannot be considered inferior to it, and it is recommended that in most of the cases LBC, along with CS, should be reported before reaching a final diagnosis. This is beneficial especially in the developing countries such as India where most of the centers are devoid of LBC technique and hence, are not familiar with many cytomorphological features and potential diagnostic pitfalls unique to it.

Osteosarcoma Arising in Carcinosarcoma De Novo Parotid Gland in a Young Man: An Unusual Case with Review of Literature.

Carcinosarcoma of the parotid gland, a true malignant mixed tumour is extremely rare. It may occur in a pre-existing pleomorphic adenoma or arise de novo. We report a case of carcinosarcoma de novo harbouring an osteosarcomatous element in a 35-year-old man along with review of the reported cases. Excision was done and histopathologic examination confirmed the diagnosis. Long term follow up has been recommended for these tumours owing to their high propensity of recurrence and metastasis. Our case discusses the importance of histopathology and limitation of preoperative imaging in the diagnosis of such an aggressive neoplasm; emphasizing the fact that possibility of carcinosarcoma should be kept in mind while dealing with salivary gland lesions even at a younger age.

Utility of Cluster of Differentiation 5 and Cluster of Differentiation 117 Immunoprofile in Distinguishing Thymic Carcinoma from Pulmonary Squamous Cell Carcinoma: A Study on 1800 Nonsmall Cell Lung Cancer Cases.

BACKGROUND: Mediastinum harbors a mixed bag of neoplastic lesions with varied therapeutic and prognostic implications. Distinguishing pulmonary squamous cell carcinoma from thymic carcinoma is a challenging task owing to rather nonspecific clinicoradiological features and a considerable overlap in histomorphological features. Thus, we evaluated the diagnostic utility of cluster of differentiation 5 (CD5) and CD117 immunohistochemical markers in distinguishing these tumors. MATERIALS AND METHODS: The archives of department of histopathology were retrospectively reviewed from June 2012 to May 2016. Formalin-fixed paraffin-embedded blocks of 1800 cases diagnosed as nonsmall cell lung carcinoma were retrieved, and immunohistochemical expression of CD5 and CD117 was evaluated in these cases. RESULTS: Adenocarcinoma (980; 54.44%) was the most common histological subtype of lung carcinoma observed in our study. CD117 was positive in 171 out of 1800 cases (9.5%) of which 120 cases (70.17%) were adenocarcinoma, followed by 40 cases (23.4%) of squamous cell carcinoma. Immunoreactivity for CD5 was observed in 209 cases (11.61%), 200 (95.7%) cases of which were diagnosed as adenocarcinoma. None of the cases diagnosed as squamous cell carcinoma on histomorphology showed CD5 immunoexpression. CONCLUSION: While thymic squamous cell carcinomas are well known for CD5 and CD117 coexpression, none of the cases of squamous cell carcinoma arising in lung express CD5. These markers are a diagnostic tool to distinguish a primary lung squamous cell carcinoma from thymic carcinoma, particularly in the setting of a central pulmonary lesion with mediastinal involvement.

Synchronous Oral and Breast Malignancies: A Rare Presentation.

Multiple malignancies may represent metastasis from one location to another or independent primary tumors. The distinction is important because the prognosis and treatment are different. Existence of two malignancies having different histopathologies at anatomically distinct sites is a rare event to occur in an individual. We present one such unusual case of a 40-year-old Indian woman who presented with left breast lump along with a simultaneously occurring growth floor of the mouth. Fine needle aspiration cytology and histopathology revealed features of infiltrating ductal carcinoma breast and adenoid cystic carcinoma of floor of the mouth. This rare organ combination was further managed by surgery and chemo-radiation. To the best of our knowledge, this is the first documentation in the world literature of such a presentation.

Subcutaneous Phaeohyphomycosis Caused by Pyrenochaeta romeroi in a Rheumatoid Arthritis Patient: A Case Report with Review of the Literature.

Pyrenochaeta romeroi is a rare fungal agent of chronic, suppurative subcutaneous infections leading to mycetoma. It is an unusual cause of deep, non-mycetomatous infections. We herein present review of the literature along with a case of 61-year-old Indian female with rheumatoid arthritis who developed subcutaneous phaeohyphomycosis caused by Pyrenochaeta romeroi. It posed a diagnostic challenge, as the culture from fine-needle aspirate revealed a non-sporulating dematiaceous mould, which was the only supportive tool for its diagnosis and initiation of the therapy. However, it was the molecular sequencing which played the pivotal role in clinching the final aetiological diagnosis. To the best of our knowledge, this is the 20th case of Pyrenochaeta species infection occurring worldwide and first case report of subcutaneous phaeohyphomycosis caused by Pyrenochaeta romeroi in a rheumatoid arthritis patient.

Massive Broad Ligament Cellular Leiomyoma with Cystic Change: A Diagnostic Dilemma.

Leiomyomas are known to arise from uterus, but rarely from broad ligament. Further, cellular leiomyoma of broad ligament is the least common variant reported in literature. The diagnostic dilemma arises when leiomyomas undergo degenerative changes. This poses both clinical and radiological difficulty in differentiating with an ovarian tumour. We present an unusual case of a huge broad ligament mass measuring 29x19x09cm, mimicking an ovarian tumour both clinically and radiologically. Histopathology revealed cellular leiomyoma of broad ligament with cystic and myxoid degeneration hereby being the second case reported in literature. This case is being presented not only because of the rare incidence but also due to its diagnostic confusion with ovarian malignancy on clinical evaluation and radiological findings.

Occult Adenoma in Patent Vitellointestinal Duct Presenting as an Umbilical Fistula: Cause for Concern?

INTRODUCTION: Prevalence of vitellointestinal duct anomalies varies from 2-4%. Though a completely patent vitellointestinal duct is a common symptomatic embryological defect with a prevalence of 0.0063-0.067%, other vitellointestinal abnormalities are rarely reported. Ours is the first case to describe histopathological features of an umbilical fistula harboring an occult tubular adenoma. CASE REPORT: We report a case of one-month old child, presenting with umbilical fistula for which excision and ileal anastomosis was performed. Routine histopathologic examination revealed an occult tubular adenoma in tip of the fistula. CONCLUSION: Adenoma arising in an umbilical fistula at such an early stage of infancy has never been reported before. Detection of occult adenoma warrants screening GI endoscopy, genetic testing for syndromic gastrointestinal adenomatosis and carcinomas and lifelong surveillance. Our case highlights the importance of routine histopathologic examination in detection of occult premalignant lesions as it significantly affects the patient management and prognosis.

Phaeohyphomycosis Due to Exophiala jeanselmei: An Emerging Pathogen in India--Case Report and Review.

We present a rare case of a 30-year-old woman who presented with a swelling on the lateral aspect of her left forearm, present since 6 months, adjacent to a 16-year-old burn scar. X-ray of elbow joint and forearm revealed the subcutaneous nature of the swelling. Giemsa and periodic acid-Schiff-stained smears and potassium hydroxide mount of fine-needle aspirate of the swelling revealed dematiaceous, branching, and septate fungal hyphae. Fungal culture of the aspirated pus showed growth of Exophiala jeanselmei. Histopathological examination revealed brown-coloured hyphae with foreign body giant cell reaction and palisading granulomas in the surrounding tissue. The patient was successfully treated with surgical excision of the swelling. All the cases of phaeohyphomycosis due to Exophiala spp. in India are also reviewed.

Aggressive angiomyxoma of vulva in a 13-year-old female.

Aggressive angiomyxoma is a rare mesenchymal neoplasm that typically affects females of reproductive age. It involves preferentially pelvic and perineal regions and was first described by Steeper and Rosai in 1983. Peak age of incidence for this tumor is in the fourth decade with very few cases reported in young girls. We present a case of this rare tumor in a 13-year-old female.