Carbimazole-induced atypia - A mimicker of malignancy in fine-needle aspiration cytology.

A 20-year-old female presented with complaints of thyroid swelling and showed signs and symptoms of thyrotoxicosis and fine-needle aspiration cytology (FNAC) was requested by the surgeon. On examination of FNAC smear, it showed thyroid follicular cells with atypical features like bizarre giant cells, pseudo nuclear inclusions, and mitotic figure. Correlation between clinical history and cytomorphologic features was done and it was reported as atypical changes in thyroid probably due to carbimazole-induced changes. It helped the patient, as radical surgery and its untoward complications were avoided.

Immunohistochemical expression of beta-catenin in hepatoblastoma and its clinical significance.

Background: Primary hepatic malignancies account for 0.5-2% of all solid tumours in childhood. Hepatoblastoma, a rare embryonic tumour in the general population, represents the most frequent primary hepatic malignancy in the paediatric age group, with an incidence of one new case per million under 15 years of age, median age at diagnosis being 1 year. Aberrant activation of the Wnt/beta-catenin signalling pathway is likely to result in tumorigenesis of hepatoblastoma. The nuclear and intra-cytoplasmic accumulations of beta-catenin correlate with the likely prognosis of the disease. Nuclear expression of beta catenin is associated with a shorter survival, higher stage, and seen in embryonal/undifferentiated types. Aim: To study the expression of beta-catenin in hepatoblastoma by immunohistochemistry and correlate it with the tumour histology and survival outcome. Materials & Methods: This is a retrospective study of 11 children over a period of 5 years with the diagnosis of hepatoblastoma. These children underwent partial hepatectomy or liver transplantation at the Department of Paediatric Surgery. The clinical, histological and survival data were collected. Immunohistochemical analysis with beta-catenin was done and analysed. Results: Mean birth weight of the children was 2.75kg.63.6% had an epithelial type of histology.Beta catenin expression by IHC was studied in 11 cases and found to be positive in 4 cases. Nuclear positivity was noted in 2/4 cases of embryonal type and Cytoplasmic and membranous positivity was seen in the other 2/4 cases. Normal liver showed a membranous pattern of positivity in one case. Negative staining was seen in 6 out of 11 cases. Conclusion: Beta catenin is considered to be an useful tool for assessing the prognosis of patients with hepatoblastoma and its expression is associated with a poor survival outcome. There are no validated biomarkers for prognosis so far. However, larger studies incorporating molecular profiling is warranted to establish prognostic factors for planning effective treatment strategies.

Role of HER2neu expression in gastric cancer.

BACKGROUND: Gastric cancer is one of the most common cancers in the world and is responsible for over a million deaths. Gastric cancer broadly consists of two main histological types, diffuse and intestinal, and can be further classified as proximal (cardia) and distal (corpus and pylorus) cancers. The presence of Her2neu in certain cancers including gastric cancers has helped in throwing some light on the prediction of prognosis of the tumours. This study was carried out to assess and evaluate the role of Her2neu immunohistochemical expression in gastric cancers. METHODOLOGY: This study was carried out as a retrospective study on paraffin blocks of 70 gastrectomy specimens in the pathology department of our hospital. After the histological assessment and interpretation of data, appropriate blocks were chosen and sections of 3 micron thickness were cut and immunohistochemical staining of Her2neu was done and scoring was carried out. RESULTS: We found that gastric cancer occurred predominantly in men as compared to women. Antrum was the most common site involved in gastric cancer (60%). In our study Grade 2 predominated (54%) than Grade 1 (4.2%) and Grade 3 (41%). According to the scoring system of Her2neu expression by immunohistochemistry in gastric cancer it was positive (3+) in 8 cases (11.4%), equivocal (2+) in 10 cases (14.3%) and negative (0+,1+) in 52 cases (74.3%). Her2neu was seen positive 13.7% of intestinal type tumours and in only 5.3% of diffuse type of tumours (P < 0.05). CONCLUSION: Her2neu testing in gastric adenocarcinomas especially in histologically identified early gastric carcinoma is recommended.

Clinicopathological profile of hepatoblastoma: An experience from a tertiary care center in India.

BACKGROUND: Hepatoblastoma is the most common primary hepatic malignancy in the pediatric population. Advances in pathological evaluation, imaging, risk stratification, neo-adjuvant chemotherapy, and surgery including transplantation have improved survival of these children in the western countries. However, a successful outcome in developing countries such as India with limited resources poses great challenges to the clinician and the family. Histology plays a major role in determining the prognosis of these patients. METHODS: A retrospective study was done on 10 children diagnosed with hepatoblastoma between January 2010 and December 2015 in our institution. Clinical, laboratory, radiological, histopathological diagnoses, treatment, and outcome data were collected and analyzed. RESULTS: The median age of these children at diagnosis was 11 months, and only 1 child was premature at birth. Most children were presented with abdominal distension. One child had lung metastasis at presentation. Elevated alpha fetoprotein levels were present in 90% of the children. The histological types were fetal, embryonal, macrotrabecular, and mixed epithelial-mesenchymal types. SIOPEL risk stratification was done, which showed 40% of the children to be of high risk. Three children had PRETEXT 1, 2, and 4, respectively. CONCLUSION: Our study is significant with respect to the information on PRETEXT staging, risk status, and histological favorability. In developing countries with limited resources and low-socioeconomic status, it is important to have a multidisciplinary team approach and tailor treatment to manage these patients effectively and improve the overall survival.

Fatty acid oxidation disorder as a cause of sudden infant death syndrome (SIDS)--a case report.

Although the cause of sudden infant death syndrome (SIDS) remains unknown, extensive studies over the last 10 years have begun to shed some light on this family tragedy. 5% of all cases of SIDS are caused by fatty acid oxidation disorders. We report a case of fatty acid oxidation disorder causing SIDS.

An animal model for laryngotracheal injuries: an experimental study.

OBJECTIVES/HYPOTHESIS: To establish an animal model for post-intubation laryngotracheal injuries resulting in significant laryngotracheal insult without compromising the survival of the animal for a minimum period of 12 weeks post-extubation. To study the extent of injury based on morphometric and histopathological change seen at 12 weeks post-extubation. STUDY DESIGN: Randomized block, single-blinded, experimental study. METHODS: Twelve New Zealand white rabbits were used in this study. The rabbits were randomly divided into three groups depending on the duration of intubation (6 hours, 4 hours, and 2 hours, respectively). The technique of intubation was standardized. Post-extubation, these rabbits were humanely sacrificed after observation for 12 weeks or when they developed severe respiratory distress. The larynx and trachea were subjected to gross and histopathological examination. RESULTS: Histopathological examination and statistical analysis showed significant subglottic injury in all group B rabbits (intubated for 4 hours), and all of them survived for 12 weeks. CONCLUSION: In this study, an animal model for inducing and studying laryngotracheal injuries due to endotracheal intubation has been established. This study has the potential applications in research on etiopathogenesis and management of post-intubation laryngotracheal injuries.

Chronic lower limb ulcer? No--chloroma!

Extra medullary deposits are often associated with myeloproliferative disorders, especially with myeloid neoplasia. These are called granulocytic sarcoma, aleukemic leukemia cutis, myeloblastoma, chloroleukemia, extra-medullary myeloid tumor, and chloroma. They commonly present in the bone, periosteum, soft tissue, lymph nodes, and the skin but can occur anywhere. The authors present their experience with a patient with no history of neoplasm presented with a nonhealing ulcer of the lower limb that was a chloroma associated with chronic myeloid leukemia.

Bilateral renal papillary necrosis due to Candida infection in a diabetic patient presenting as anuria.

A 38 years insulin-dependent diabetic male, with nephropathy on antituberculous treatment presented with painless frank hematuria followed by anuria for a day which was associated with fever. Ultrasonogram of the abdomen showed bilateral hydroureteronephrosis. Necrotic papillae were retrieved after ureteroscopy which on histopathological examination and culture showed Candida albicans. This was successfully treated with fluconazole and ureteroscopic removal of necrotic papillae.

Sub-acute toxicity profile of a modified resveratrol supplement.

Longevinex, a nutraceutical formulation containing Resveratrol as the main component along with other polyphenolics exhibits diverse health benefits but systemic safety studies are lacking. Hence, to test the safety of Longevinex use for therapeutic purposes, 50 Sprague Dawley rats were randomly divided into five groups (n=10; 5M, 5F) wherein group I as vehicle treated control, group II and group III received 50 mg and 100 mg of plain Resveratrol respectively and group IV and group V received 50 mg and 100 mg of Longevinex respectively for a period of 28 days. All toxicological parameters were analyzed as per OECD-407 guidelines. Results showed treatment with Resveratrol and Longevinex did not result in any mortality of rats neither did they exhibit any clinical signs of toxicity. Hematological and biochemical analysis of serum enzymes and metabolites were not significantly altered between Longevinex and control rats. Likewise, histopathological analysis for various organs did not reveal significant changes in the vital organs of the treated rats. The study revealed that there were no significant treatment related adverse effects in rats exposed to Longevinex for 28 days and considered safe at the given dose where compared to plain Resveratrol.

Modulation of inflammatory markers by the ethanolic extract of Leucas aspera in adjuvant arthritis.

AIM OF THE STUDY: To investigate the anti-inflammatory and antioxidant potential of ethanolic extract of Leucas aspera (EELA) in adjuvant arthritis. MATERIALS AND METHODS: Complete Freund's adjuvant served to induce arthritis. EELA was administered in two doses along with vehicle control (0.1% carboxymethyl cellulose) and positive control (Diclofenac). Levels of tumour necrosis factor (TNF-)-α, C-reactive protein (CRP), Interleukin-2 (IL-2), Cathepsin D, activities of antioxidant enzymes superoxide dismutase (SOD), glutathione peroxidase (GPx) and catalase (CAT) were estimated in plasma/hemolysate and tissue. HPLC analysis of EELA was also performed. RESULTS: EELA exhibited significant anti-inflammatory (p<0.001) and antioxidant activity (p<0.001). It did not show mortality up to 2000 mg/kg body weight. Histopathological studies confirmed complete cartilage regeneration and near normal joint in EELA2 treated arthritic rats. CONCLUSION: This study highlighted the antioxidant and anti-inflammatory potential of Leucas aspera. Three major families of compounds present in EELA may explain these activities: catechins (epicatechin, beta epicatechin), flavonoids (procyanidin), phytosterols (beta-sitosterol) apart from glycosides, phenolic compounds and tannins.

Extramedullary relapse of acute lymphoblastic leukemia in breast: a rare presentation.

Unusual sites of relapses following allogenic hematopoietic stem cell transplantation (HSCT) for acute lymphoblastic leukemia (ALL) are rarely reported. Our report describes a thirty-two-year old female, who developed extramedullary (EM) breast relapse after allogenic HSCT for pre B cell Philadelphia chromosome negative ALL. She had no evidence of leukemia in her marrow demonstrating 100% full donor chimerism, while she had ALL relapse in her breast.

Ductal carcinoma in a multiple fibroadenoma: diagnostic inaccuracies.

We present the diagnostic inaccuracies encountered in a case of multiple fibroadenoma with malignant transformation. A 30-year-old lady presented with lump in the right breast of one month duration which on clinical examination, X-ray mammogram, sonomammogram were suggestive of multiple fibroadenomas. Fine needle aspiration cytology of the largest lump revealed features of malignancy and a core biopsy showed pleomorphic cells that could not be categorized. Due to the clinical, radiological and pathological diagnostic ambiguity, lumpectomy was performed and frozen section showed features of only conventional fibroadenoma. Representative bits on routine processing showed only features of fibroadenoma. Hence, complete submission of all lumps was done, which revealed fibroadenoma with invasive ductal carcinoma in one. Patient underwent modified radical mastectomy which showed multiple fibroadenomas, focal fibrocystic disease with a focus of residual invasive tumor and metastatic deposit in one axillary lymph node. This case report highlights the diagnostic challenges in detecting malignancy in fibroadenoma and a need for extensive tissue sampling in multiple fibroadenomas to detect the rare occurrence of carcinoma.