Spectrum of Breast Diseases: Histopathological and Immunohistochemical Study from North India.

INTRODUCTION: Breast disorders commonly present as masses, which are mostly benign. However, breast cancer is the most common form of cancer and second leading cause of death among women. The study aimed at analyzing the spectrum of breast diseases especially breast cancers and assess the estrogen and progesterone receptor (ER/PR) and Her2/neu status of breast cancers on immunohistochemistry (IHC). MATERIALS AND METHODS: This was a descriptive study of 2 years (Jan 2014 - Dec 2015). All specimens of primary breast diseases received during this period at the Department of Pathology, Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly, UP, India, were analyzed. RESULTS: A total of 148 breast specimens from 10 males and 133 females, (age range, 15 - 75 years; mean age, 36 years) were selected. Majority of patients presented in 4th (29.7%) and 3rd (27.7%) decades with breast lumps (97.3%), affecting mostly right breast (52%). Benign diseases (60.1%) were the commonest followed by malignant (28.4%) and inflammatory lesions (11.5%). Fibroadenoma (52.6%) and fibrocystic change (21.8%) were the commonest benign diseases and granulomatous mastitis (23.5%), the commonest inflammatory lesion. Malignancy contributed 30.6% of female breast lesions (age range, 25-75 years and mean age, 48.2 years) with 97.6% of cases being infiltrating ductal carcinomas. ER expression was seen in 58%, PR in 54.8% and Her2/neu positivity in 45.2% cases. In males, gynecomastia was the most common breast lesion (90.9%). CONCLUSION: Breast diseases affected mostly young people with fibroadenoma and infiltrating ductal carcinoma being the commonest diseases. Malignant breast diseases affected females only. ER/PR hormone receptor expressions are lower compared to western countries.

Genetic biodiversity of Mycobacterium tuberculosis isolates from patients with pulmonary tuberculosis in India.

Spoligotyping was performed on 540 Mycobacterium tuberculosis isolates in order to evaluate the genetic biodiversity of tubercle bacilli in India. One hundred and forty seven patterns were unique and 393 were grouped in 48 clusters. Comparison with an international spoligotype database showed that the most predominant clades among tuberculosis (TB) isolates were Central Asian (CAS) and East-African Indian (EAI) with shared-types (ST) ST26 and ST11 alone being responsible for 34% of all TB cases. Twenty one (3.8%) isolates belonged to the Beijing genotype. Marked variations were observed among circulating strains, STs belonging to CAS family predominated in the North, whereas the EAI family was more common in the Southern India. TB in India is predominantly caused by strains belonging to the principal genetic group 1 (PGG1), suggesting that most of the TB burden in India may be traced to ancestral clones of the tubercle bacilli. This study gives an insight into the global M. tuberculosis genetic biodiversity in India, the predominant spoligotypes and their impact on disease transmission.

Spoligotyping of Mycobacterium tuberculosis DNA from Archival Ziehl-Neelsen-stained sputum smears.

Spoligotyping was applied to old (5-11 years) Ziehl-Neelsen (ZN)-stained smears for strain identification and differentiation and to predict the utility of the technique in epidemiological studies. Among 57 DNA samples extracted from ZN slides lying stored at room temperature, 93% (53) amplification was achieved for mpt64 gene. Spoligopatterns were generated from 77.7% (41/53) DNA samples, whereas negative controls did not yield any spoligopatterns. All slides with 2+ (n=20) and 3+ (n=13) positivity while 42% (11/26) of slides with low positivity (< or 1+) showed a good signal and a reproducible pattern. This technique may have application in identification of spoligotypes in control programme implemented areas remote from research laboratory and would also increase our knowledge about the clonal structure of Mycobacterium tuberculosis in the population, when applied to old samples in different locations.

rpoB gene sequencing and spoligotyping of multidrug-resistant Mycobacterium tuberculosis isolates from India.

Multi drug-resistant Mycobacterium tuberculosis (MDR TB) has been well studied in outbreaks in settings of low endemicity in developed countries. However, the characteristics of MDR TB in the community with high endemicity such as India have not been well investigated. Mutations in the 81-bp rifampicin resistance-determining region of the rpoB gene were analyzed by DNA sequencing of 187 M. tuberculosis clinical isolates (149 resistant and 38 sensitive) from different parts of India. 146-Point mutations and two insertions were found in 146 of 149 resistant isolates in seven codons. The most common mutations were in codons 531 (59%), 526 (22%), and 516 (11.5%). Mutations were not found in three (2%) of the resistant isolates. N-terminal sequencing in these isolates showed no mutation at codon V176. None of the drug-susceptible isolates showed any mutation in the 437-bp rpoB gene segment sequenced. Genotypic analysis revealed a total of 80 different spoligotypes. A unique pattern was found in 65 (43.6%) isolates, whereas 84 (56.4%) were in 15 clusters. Comparison with an international spoligotype database showed ST26, Delhi type (18.1%), ST1, Beijing type (9.4%), and ST11 (5.4%), as the most common. The majority of isolates in the Beijing genotype (13/14) were associated with mutation 531TTG and similar drug-resistance patterns while other major clusters showed that the nature and frequency of occurrence of mutations in the rpoB gene were independent of spoligopatterns.

Histopathological correlation of adenomyosis and leiomyoma in hysterectomy specimens as the cause of abnormal uterine bleeding in women in different age groups in the Kumaon region: A retroprospective study.

OBJECTIVE: To study adenomyosis and leiomyoma as the cause of Abnormal Uterine Bleeding AUB in hysterectomy specimens. STUDY METHOD: A descriptive study was carried out on 184 hysterectomy specimens of patients with AUB during the period of Jan 2010 to Dec 2011. Data including age, parity, symptoms and clinical indication for hysterectomy was collected for the study. The specimens were processed routinely and stained with hematoxylin and eosin stain and examined microscopically. RESULTS: Women in the perimenopausal age (40-50 years) accounted for the highest number of cases (44.56%) presenting with symptoms of AUB. In this age group adenomyosis was the found to be the commonest cause of AUB (46.34%). CONCLUSION: Adenomyosis was found to be the most common cause of abnormal uterine bleeding in women of perimenopausal age group.

Sociodemographic profile of breast cancer patients diagnosed by FNAC.

The study included 431 patients who underwent breast FNAC over a period of five years between 2003 and 2008. The required clinical details were obtained from the requisition forms. The Information about the level of education and occupation were collected by interviewing the subjects. The number of cases of breast carcinoma was significant constituting 14.84% (n = 64). The study showed that the peak age for breast carcinoma was between 41 and 50 years. This correlates with the national figure where most of the cases observed belonged to the reproductive age group. Most of the females were married (93.75%) and were multiparous (92.18%). Maximum number of patients had only received primary education. There was not much difference in the number regarding whether they lived in urban or rural areas. Middle and lower socioeconomic class contributed the bulk of the cases and it were the housewives who were in majority (85.93%).

Predominant tuberculosis spoligotypes, Delhi, India.

One hundred five Mycobacterium tuberculosis clinical isolates from the Delhi area were typed by spoligotyping; 45 patterns were identified. Comparison with an international spoligotype database showed type 26, Delhi type (22%), type 54 (12%), and type 1, Beijing type (8%), as the most common. Eighteen spoligotypes did not match any existing database pattern.