A rare case of Pleuropulmonary blastoma type III with Immunohistochemical Study.

Here we intend to document a rare case of PPB type III in a 2-year male presenting with an extensive tumor occupying the right hemithorax with immunohistochemical (IHC) study. Pleuropulmonary blastoma (PPB) is a rare variably aggressive, dysodontogenetic, childhood primary intrathoracic malignancy which in up to 25% of cases can be extrapulmonary with attachment to the parietal pleura. It is found in pediatric population under 5 years of age. It was initially proposed as a distinct entity by Manivel et al. in 1988. PPB is a proliferation of primitive mesenchymal cells that initially form air-filled cysts lined by benign-appearing epithelium (type I, cystic). Later on, the mesenchymal cells outgrow the cysts with formation of focal solid areas (type II, solid and cystic) and finally, mainly solid mass (type III, solid PPB).

A rare case of primary giant myxoid liposarcoma of the pericardium.

Primary pericardial neoplasms account for 6.7-12.8% of all primary tumors arising in the cardiac region. Pericardial tumors are most likely to be metastatic and are an extension of the primary tumors from the surrounding structures. Sarcomas of the pericardium are rare. Myxoid liposarcoma (ML) represents about 5% of all the soft-tissue sarcomas in adults. They are usually located in the deep soft tissues of the extremities. There have been less than 20 cases of pericardial liposarcomas reported on PubMed since 1973. Here, we present a rare case of primary giant pericardial myxoid liposarcoma (ML) in a 46-year-old female diagnosed on frozen section and later was confirmed histopathologically.

Immunohistochemical Study of p16INK4A, MIB-1 and CK17 in Pre-neoplastic and Neoplastic Epithelial Lesions of Cervix.

BACKGROUND: Cervical intraepithelial neoplasia (CIN) II and CIN III have a high progression rate to invasive squamous cell carcinoma (SCC). Histopathological assessment is known to have intra and inter-observer diagnostic discrepancies even among two panels of pathologist. Subsequently, to improve on the accuracy of histopathological examination, various IHC biomarkers have been evaluated in the biopsy of cervix. AIM: The present study was undertaken to evaluate the immunoexpression and interrelationship of p16INK4A, MIB-1 and CK17 in histopathologically diagnosed cases of CIN and invasive cervical carcinoma (ICC) which could aid in differentiating CIN and ICC from benign cervical lesions. MATERIALS AND METHODS: This study included 120 cases of cervical lesions; out of which 20 cases were each of negative for malignancy/dysplasia (NED), CIN I and CIN III, 10 cases of CIN II and 50 cases of ICC. A technique of manual tissue microarray was employed for the study of immunohistochemical markers such as p16INK4A, CK17 and MIB-1 in all cases. Results were subjected to statistical analysis. RESULTS: The difference in p16 immunoexpression between NED (0/20, 0%) and CIN+ICC (97/100, 97%) cases was statistically highly significant. (p<0.01) The sensitivity, specificity, positive and negative predictive value and diagnostic accuracy of p16 immunoexpression in comparison to histopathological diagnosis was 97%, 100%, 100%, 86.96% and 97.5% respectively. The overall agreement of p16 staining with histopathological diagnosis was 97.5% (?=0.9151 i.e. very good) The difference in MIB-1 immunoexpression between CIN-I (6/20, 30%) and CIN II+III (30/30, 100%), CIN (36/50,72%) and ICC (50/50, 100%) cases was statistically highly significant. (p<0.01) The difference in MIB-1 immunoexpression between NED (0/20, 0%) and CIN+IC (86/100, 86%) cases was statistically highly significant. (p<0.01) The sensitivity, specificity, positive and negative predictive value and diagnostic accuracy of MIB-1 immunoexpression in comparison to histopathological diagnosis was 86%, 100%, 100%, 58.82% and 88.33% respectively. The overall agreement of MIB-1 staining with H&E diagnosis was 88.33%. (?=0.6719 i.e. good) The difference in CK17 immunoexpression between CIN-I (11/20, 55%) and CIN-II+III (26/30, 86.67%) cases was statistically significant. (p=0.030) The difference in CK17 immunoexpression between CIN (37/50, 74%) and ICC (46/50, 92%) cases was statistically significant. (p=0.033) The difference in CK17 immunoexpression between NED (0/20, 0%) and CIN+ICC (83/100, 83%) cases was statistically highly significant. (p<0.01) The sensitivity, specificity, positive and negative predictive value and diagnostic accuracy of CK 17 immunoexpression in comparison to histopathological diagnosis was 82%, 100%, 100%, 52.63% and 85% respectively. The overall agreement of CK 17 staining with histopathological diagnosis was 85% (?=0.6029 i.e. moderate) The agreement between p16 and MIB-1 immunostaining was 89.16%. (?= 0.7 i.e., good) The agreement between CK17 and MIB-1 immunostaining was 86.6%. (?= 0.683 i.e., good) The agreement between p16 and CK17 immunostaining was 84.16%. (?= 0.5908 i.e., moderate) Conclusion: The findings of the present study indicate that the IHC report of p16, MIB-1 and CK-17 in CIN and ICC cases if included in each histopathology report could aid in accurate diagnosis which could facilitate in better patient management.

Prevalence of age-related macular degeneration in rural central India: the Central India Eye and Medical Study.

PURPOSE: To evaluate the prevalence of age-related macular degeneration (AMD) in the adult population of rural central India. METHODS: The population-based Central India Eye and Medical Study was conducted in rural central India and included 4,711 subjects (aged ≥30 years). Age-related macular degeneration was defined by the international classification of the Wisconsin age-related maculopathy grading system. RESULTS: Fundus photographs were available for 4,542 subjects (96.4%). In subjects aged ≥40, ≥50, and ≥60 years, prevalence of early AMD was 6.1 ± 0.4% (95% confidence interval [CI]: 5.3-6.9%), 8.2 ± 0.6% (95% CI: 7.0-9.4%), and 8.3 ± 0.8% (95% CI: 6.8-9.9%), respectively, and that of late AMD was 0.2 ± 0.8% (95% CI: 0.1-0.4%), 0.2 ± 0.1% (95% CI: 0.1-0.4%), and 0.6 ± 0.2% (95% CI: 0.2-1.0%), respectively. The prevalence of early AMD increased from 1.3 ± 0.3% per subject in the 30-year-old to 40-year-old group, to 3.6 ± 0.5% in the 41-year-old to 50-year-old group, to 7.9 ± 0.9% in the 51-year-old to 60-year-old group, to 10.0 ± 1.1% in the 61-year-old to 70-year-old group, to 8.3 ± 0.2% in the 71-year-old to 80-year-old group, and to 8.0 ± 5.5% in the ≥81-year-old group. Age-related macular degeneration was causative for visual impairment (best-corrected visual acuity in the better eye: <20/60 and ≥20/400) in 3 of 342 subjects (0.9%) and for blindness (visual acuity <20/400) in 0 of 17 subjects. CONCLUSION: After age adjustment, AMD was found less frequently in the adult population of rural central India than in European populations. Accordingly, visual impairment because of AMD was relatively uncommon in rural central India.

Central corneal thickness and its association with ocular and general parameters in Indians: the Central India Eye and Medical Study.

PURPOSE: To evaluate the distribution of central corneal thickness (CCT) and its associations in an adult Indian population. DESIGN: Population-based study. PARTICIPANTS: The Central India Eye and Medical Study is a population-based study performed in a rural region close to Nagpur in Central India; it included 4711 subjects (ages 30+ years) of 5885 eligible subjects (response rate, 80.1%). METHODS: The participants underwent a detailed ophthalmic and medical examination, including 200 standardized questions on socioeconomic background, lifestyle, social relations, and psychiatric depression. This study was focused on CCT as measured by sonography and its associations. Intraocular pressure was measured by applanation tonometry. MAIN OUTCOME MEASURES: Central corneal thickness and intraocular pressure. RESULTS: Central corneal thickness measurement data were available on 9370 (99.4%) eyes. Mean CCT was 514+/-33 microm (median, 517 microm; range, 290-696 microm). By multiple regression analysis, CCT was associated significantly with younger age (P<0.001), male gender (P<0.001), higher body mass index (P = 0.006), lower corneal refractive power (P<0.001), deeper anterior chamber (P = 0.02), thicker lens (P = 0.02), and shorter axial length (P = 0.006). Central corneal thickness was not associated significantly with refractive error (P = 0.54) or cylindrical refractive error (P = 0.20). If eyes with a corneal refractive power of 45 or more diopters were excluded, the relationship between CCT and axial length was no longer statistically significant (P>0.05), whereas all other relationships remained significant. Intraocular pressure readings increased significantly (P<0.001) with both higher CCT and higher corneal refractive power. CONCLUSIONS: Indians from rural Central India have markedly thinner corneas than do Caucasians or Chinese, and, as in other populations, CCT is greater in men. CCT was associated with younger age, higher body mass index, lower corneal refractive power, deeper anterior chamber, thicker lens, and shorter axial length. Intraocular pressure readings were associated with CCT, with high readings in those eyes that had thick corneas or steep corneas. Central corneal thickness and steepness of the anterior corneal surface may thus both have to be taken into account when applanation tonometry is performed. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Refractive error in central India: the Central India Eye and Medical Study.

OBJECTIVE: To evaluate the refractive error and its associations in the adult population of rural Central India. DESIGN: Population-based study. PARTICIPANTS: The Central India Eye and Medical Study is a population-based study performed in a markedly rural region in Central India. It included 4711 subjects (aged 30 years or older) of 5885 eligible subjects (response rate, 80.1%). METHODS: The participants underwent a detailed ophthalmic and medical examination, including standardized questions on the socioeconomic background, lifestyle, and social relations. This study was focused on the refractive error, the prevalence of hyperopia and myopia, and its factors. MAIN OUTCOME MEASURES: Refractive error. RESULTS: After exclusion of pseudophakic or aphakic eyes, 9076 (96.3%) eyes of 4619 (98.0%) subjects (2472 females) were included into the study. The mean refractive error was -0.20+/-1.51 diopters (D). Myopia of more than -0.50 D, -1.0 D, more than -6.0 D, and more than -8 D occurred in 17.0+/-0.6%, 13.0+/-0.5%, 0.9+/-1.4%, and 0.4+/-0.1% of the subjects, respectively. Hyperopia of more than 0.50 D was detected in 18.0+/-0.6% of the subjects. Refractive error was associated significantly (i.e., became more hyperopic) with lower age (P<0.001), lower best-corrected visual acuity (P<0.001), lower corneal refractive power (P<0.001), and shorter axial length (P<0.001). In multivariate analysis, refractive error was not significantly associated with the level of education (P = 0.56). High myopia (>-8 D) was associated significantly with male gender (P = 0.03) and lower best-corrected visual acuity (P<0.001). Mean anisometropia was 0.41+/-1.02 D. It was associated significantly with age (P<0.001), myopic refractive error (P<0.001), and lower best-corrected visual acuity (P<0.001). The mean astigmatic error was 0.29+/-0.60 D and was associated significantly with higher age (P<0.001), level of education (P = 0.01), lower best-corrected visual acuity (P<0.001), and higher corneal refractive power (P<0.001). CONCLUSIONS: The rural population of Central India has not experienced a myopic shift as described for many urban populations at the Pacific Rim. Correspondingly, the relatively low level of education was not associated with myopia. Urbanization may be a major factor for myopization. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.

Ocular axial length and its associations in an adult population of central rural India: the Central India Eye and Medical Study.

PURPOSE: To investigate the normal distribution of axial length of the globe, which is a major measurement of the eye, and its associations with other ocular and systemic parameters. DESIGN: Population-based study. PARTICIPANTS: The Central India Eye and Medical Study is a population-based study performed in a rural region of central India. The study comprised 4711 subjects (aged 30+ years) of 5885 eligible individuals (response rate, 80.1%). METHODS: A detailed ophthalmic and medical examination was performed. The axial length was measured sonographically. MAIN OUTCOME MEASURES: Axial length. RESULTS: Axial length measurements were available on 4698 study participants (99.7%). Their mean age was 49.4+/-13.4 years (range, 30-100 years), and the mean refractive error was -0.18+/-1.48 diopters (range, -20.0 to +7.25 diopters). Mean axial length was 22.6+/-0.91 mm (range, 18.22-34.20 mm). In multivariate analysis, axial length was significantly (P<0.001) associated with the systemic parameters of increased age, taller body height, greater body mass index, and higher level of education, and with the ocular parameters of lower best-corrected visual acuity, lower corneal refractive power, deeper anterior chamber, thicker lens, and more myopic spherical power and cylindrical refractive power. Within the highly myopic group, as defined by an axial length that exceeded 26.5 mm, none of these associations (except for the association between axial length and spherical refractive power) were statistically significant (P>0.15) in univariate or multivariate analysis. CONCLUSIONS: In a rural population of central India, the mean ocular axial length was 22.6+/-0.91 mm, which was shorter than that of other populations. Axial length was associated with the systemic parameters of increased age, taller body height, greater body mass index, and a higher level of education, and with the ocular parameters of lower best-corrected visual acuity, lower corneal refractive power, deeper anterior chamber, thicker lens, and more myopic spherical and cylindrical refractive power. These associations were valid only for those eyes that were not highly myopic, whereas axial length was associated with refractive error only in highly myopic eyes. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.

Body height and ocular dimensions in the adult population in rural Central India. The Central India Eye and Medical Study.

BACKGROUND: To investigate associations between anthropomorphic parameters and ocular dimensions in a typical rural society untouched by the effects of urbanization. METHODS: The Central India Eye and Medical Study performed in rural Central India included 4,711 participants aged 30 or more years. The participants underwent a detailed ophthalmic and medical examination. RESULTS: After controlling for age, gender, level of education, and body mass index (BMI), taller subjects were more likely to have larger eyes with a longer axial length (+0.23 mm for each 10 cm increase in height), lower corneal refractive power (-0.50 diopters for each 10 cm increase in height), deeper anterior chambers (+0.03 mm for each 10 cm increase in height), and longer vitreous cavity (+0.20 mm for each 10 cm increase in height). Central corneal thickness (P = 0.97) and lens thickness (P = 0.08) were not significantly associated with body height. After controlling for age, gender, level of education and height, subjects with a higher BMI had shorter globes (-0.02 mm for each unit increase in BMI), flatter corneas (-0.03 diopters for each unit increase in BMI) and thicker corneas (+0.49 µm for each unit increase in BMI), thicker lenses and longer vitreous cavities. Body height as compared with the BMI had a stronger influence on the ocular biometric data. After correcting for age, gender, level of education and axial length, for each increase in body height by 10 cm or for each increase in BMI by one unit, the refractive error significantly increased by 0.23 diopters (P < 0.001) and by 0.40 diopters (P < 0.001) respectively. CONCLUSIONS: In the rural population of Central India without urbanization-associated myopization, body height and size of the eye were associated with each other: taller subjects had larger eyes with a flatter cornea. An increase in body height per 10 cm was associated with an increase in anterior chamber depth by 1% and an increase in vitreous cavity length by 1%. Subjects with a higher body mass index had shorter eyes, flatter and thicker corneas, and thicker lenses. Taller subjects and subjects with a higher BMI were more hyperopic. Since the occurrence of some ocular diseases depends on eye size and refractive error, the results may be helpful for screening examinations and for elucidating pathogenic associations.

Study of ER, PR, HER2/neu, p53, and Ki67 expression in primary breast carcinomas and synchronous metastatic axillary lymph nodes.

BACKGROUND: Breast cancer (BCA) is the second most common cancer among women in India and accounts for 7% of global burden of BCA. The axillary lymph node status is an independent prognostic factor. The combined estrogen receptor (ER), progesterone receptor (PR), and HER2/neu biomarker expression is a predictor of BCA status for therapeutic guidance. Studies have demonstrated that these biomarkers are unstable throughout their tumor progression. Varying concordance and discordance rates in the biomarker expression between primary breast carcinoma (PBC) and metastatic axillary lymph node (MALN) status are reported. AIM: This study was conducted for studying and comparing the expression of immunohistochemistry (IHC) markers, i.e., ER, PR, HER2/neu, p53, and Ki67 between PBC and their corresponding MALN for prognostication and therapeutic purpose. METHODS: Sixty cases of PBC with metastasis to axillary lymph nodes diagnosed between years 2008 and 2014 were included in the study. A technique of manual tissue array was employed for cases subjected to IHC. Analyses of the expression of IHC markers were attempted between the PBC and their corresponding synchronous MALN and classified as concordant or discordant. Results were subjected to statistical analysis. RESULTS: Substantial agreement was observed for biomarker ER, PR, HER2/neu, p53, and Ki67 expression between PBC and MALN with k-value 0.79, 0.75, 0.89, 0.7, and 0.6, respectively. CONCLUSION: There was high concordance for the IHC markers: ER, PR, HER2/neu, p53, and Ki67 expression in matched pairs of PBC and corresponding synchronous MALN. However, the discordance noted in small subgroups cannot be overlooked. Thus, there is a need to perform ER, PR, HER2/neu, p53, and Ki67 IHC studies routinely in both PBC and MALN to help design therapies that are tailored to target the specific tumor clones and render maximum benefit to patients.

Rare Case of Primary Clear Cell Carcinoma of the Urinary Bladder.

Cancers of the urinary bladder account for about 3.2% of all cancers worldwide. Clear cell adenocarcinomas (CCAs) of urinary bladder are rare. CCA must be differentiated from benign condition such as nephrogenic adenoma (NA) as well as malignant conditions such as urothelial carcinoma with clear cells, metastasis from ovary and kidney, and urinary bladder myomelanocytic tumor. The diagnosis is based on characteristic histopathological and immunohistochemical features. We present a rare case of CCA of urinary bladder with aggressive clinical behavior in a 72-year-old female.

Immunohistochemical Expression of Vimentin in Invasive Breast Carcinoma and Its Correlation with Clinicopathological Parameters.

INTRODUCTION: Breast carcinoma (BCa) is one of the most common cancers among women globally. Increased vimentin expression has been reported in various epithelial cancers. AIM: This study examines the expression of vimentin in BCa and its correlation with various prognostic factors such as tumor size, histological grade, lymph node status, estrogen receptor (ER), progesterone receptor (PR), HER2/neu, and Ki67 status. MATERIALS AND METHODS: Seventy cases of BCa diagnosed between 2014 and 2015 were included in the study. A technique of manual tissue microarray was employed for the analysis of expression of immunohistochemical (IHC) markers such as vimentin, ER, PR, HER2/neu, and Ki67. Results were subjected to statistical analysis. RESULTS: Vimentin was found positive in 53 (75.7%) cases of BCa, of which 18 cases (25.7%) were triple-negative BCa (TNBC). Positivity for ER, PR, Her2, and Ki67 was 32.8%, 31.4%, 60%, and 99%, respectively. Vimentin expression was significantly associated with ER negativity. All 53 cases expressing vimentin showed positive Ki67 labeling index; however, this was not statistically significant. Maximum vimentin expression was observed in the age group >50 years, postmenopausal women, BCa cases showing lymphovascular invasion (LVI), axillary lymph node metastasis, higher stage and higher grade of tumor, negative PR expression, and positive HER2/neu expression. However, this was not statistically significant. In TNBC, vimentin expression was significantly associated with histological grade and LVI. CONCLUSION: Vimentin expression was associated with well-established poor prognostic factors of BCa. Vimentin expression if routinely included in histopathology report would aid in better understanding of tumor behavior.

Stromal expression of CD10 in breast carcinoma and its correlation with clinicopathological parameters.

INTRODUCTION: Breast cancer is the foremost cause of death in women worldwide with more than one million cases occurring annually. AIM: This study was conducted to study the stromal CD10 expression in breast carcinomas (BCa) and its correlation with various prognostic factors such as tumor size, histological grade, lymph node status, estrogen receptor (ER), progesterone receptor (PR), HER2neu, and Ki67 status. MATERIALS AND METHODS: Sixty cases of BCa diagnosed between 2013 and 2015 were included in the study. Stromal expression of CD10 was studied on entire section of selected BCa blocks for all cases. A technique of manual tissue microarray was employed for the analysis of expression of immunohistochemical markers ER, PR, and HER2/Neu and Ki67 in all cases. Results were subjected to statistical analysis. RESULTS: Stromal CD10 positivity was seen in 78.3% cases, out of which 53.3% of cases were strongly positive, and 25.0% cases were weakly positive. Positivity for ER, PR, HER2, and Ki67 was 31.7%, 33.3%, 65%, and 75%, respectively. Stromal expression of CD10 was found to be significantly associated with increasing tumor grade, lymph node status, HER2neu positivity, ER negativity, and Ki67 positivity. CD10 stromal expression was seen mainly in PR negative BCa cases; however, it was statistically insignificant. It was noted that CD10 stromal positivity increased with increasing grade. CONCLUSION: CD10 can be used as an independent prognostic marker and should be included in routine histopathology report. CD10 could act as a potential target for newer drug development.

Fine-needle Aspiration Cytology of Abdominal Wall Endometriosis: A Meaningful Adjunct to Diagnosis.

Fine-needle aspiration cytology (FNAC) is a simple, non-invasive diagnostic modality which can be performed with ease on any superficially palpable lesion. Surgical scar endometriosis is a rare entity which presents as an abdominal lump in women of reproductive age. It is often a diagnostic pitfall for clinicians due to its nonspecific symptoms. It displays characteristic morphology, which needs to be identified and recognized by a cytopathologist for accurate diagnosis. FNAC can be used as a key diagnostic tool in cases of abdominal wall mass for appropriate patient management, thereby avoiding unnecessary diagnostic procedures. Here, we report the case of a 35-year-old woman who presented with an abdominal lump where FNAC played a vital role in the patient's management.

Clinicopathological Study of Carcinoma of the Ampulla of Vater with Special Reference to MUC1, MUC2 and MUC5AC Expression.

INTRODUCTION: The ampulla of Vater consists of papilla, common channel, distal common bile duct and the distal main pancreatic duct. Ampullary carcinomas arise from two different types of mucosa, reflecting their broad histomorphological spectrum. Adenocarcinomas originating in the ampulla of Vater are classified as having either 'Intestinal' or 'Pancreatobiliary' type of differentiation. Pancreatobiliary type has consistently shown a worse prognosis. Various types of mucins are distributed in normal tissues and gastrointestinal tumours. MUC1, MUC2 and MUC5AC are known to be the most important amongst all. AIM: To study clinicopathological features of different types of carcinoma of ampulla with MUC1, MUC2 and MUC5AC expression. MATERIALS AND METHODS: We included 20 cases of ampullary adenocarcinoma in this study, diagnosed after radical surgery. The histopathological slides were reviewed and the tumours were classified into intestinal type, pancreatobilliary and other types. Representative block of tumours was subjected to immunohistochemical (IHC) study with MUC1, MUC2 and MUC5AC antibodies. Results were subsequently analysed. RESULTS: Pancreaticobiliary type of ampullary carcinoma cases predominated (50%) over intestinal type (25%). Carcinomas of "other types" included one case each of mucinous carcinoma, adenosquamous carcinoma and undifferentiated carcinoma and well differentiated neuroendocrine tumours. Pancreatobiliary type of carcinomas was associated with higher tumour stage and grade and lymph node metastasis. All the pancreatobiliary type expressed MUC1 and all intestinal type carcinomas expressed MUC2. MUC 5AC expression was seen predominantly in pancreatobiliary type of ampullary carcinomas. CONCLUSION: Mucin markers are associated with two different subtypes of ampullary carcinomas which have different prognosis. Immunohistochemical study of mucin expression can define the different types of carcinomas of ampulla of Vater with better objective criteria.

Immunohistochemical Study of MUC1 and MUC5AC Expression in Gall Bladder Lesions.

INTRODUCTION: Immunohistochemical (IHC) markers of mucin family are associated with various Gallbladder Lesions (GBLs). AIM: To study the distribution of GBL with respect to age and sex as well as to analyse the IHC profile of MUC1 and MUC5AC in GBLs and attempt correlation with clinical and histopathological findings. MATERIALS AND METHODS: The present study was conducted over a period of six years. A technique of manual tissue array was employed for cases subjected to IHC using MUC1 and MUC5AC. Results were statistically analysed using software program "The Primer of Biostatistics 5.0". RESULTS: A total of 629 GBL were encountered. Out of 605 of non-neoplastic lesions, 32 (5.29%) expressed MUC1 while 515 (85.12%) cases expressed MUC5AC. Out of 24 cases of neoplastic GBL, 20 cases (83.33%) showed positivity for MUC1 and 9 cases (37.5%) were positive for MUC5AC. The rate of MUC1 expression was significantly higher in Gall Bladder Cancer (GBC) {18GB carcinoma (ca) +3 Carcinoma In Situ (CIS)} (85.71%) than chronic cholecystitis (4.71%). The positive rate of MUC5AC expression was significantly lower in GBC (28.57%) than chronic cholecystitis (87.19%). The percentage of cases showing MUC1 expression increased as the severity of disease progressed from hyperplasia to CIS. The percentage of cases showing MUC5AC expression decreased as the severity of disease progressed from hyperplasia to CIS. CONCLUSION: In this study, 96.18% cases were non neoplastic GBL of which chronic cholecystitis (87.77%) was predominant. 3.81% of the GBL constituted for neoplastic lesions of which 75% were GBC. MUC1 showed higher rates of expression in neoplastic GBL. MUC5AC showed higher rates of expression in non neoplastic GBL. Expression of MUC1 and MUC5AC might be closely related to pathogenesis of neoplastic and non neoplastic GBL.

Immunohistochemical Study of ER, PR, Ki67 and p53 in Endometrial Hyperplasias and Endometrial Carcinomas.

INTRODUCTION: Endometrial carcinoma is the second most common gynecologic malignancy in the developing countries. Endometrial Hyperplasia (EH) is a precursor to Endometrioid Adenocarcinoma (EMAC). A 23% of Atypical Hyperplasias (AEH) progress to EMAC. AIM: This study was undertaken to analyse ER, PR, p53 and Ki67 in EH and endometrial carcinomas and attempt correlation with clinical and histopathological findings. MATERIALS AND METHODS: The present study was conducted over a period of seven years. A manual tissue array technique was employed for cases subjected to IHC. Analysis of the expression of IHC markers (ER, PR, p53, Ki67) in EH and endometrial carcinoma was attempted. Results were subjected to statistical analysis. The results were considered to be significant when the p-value <0.05. RESULTS: A total of 85 cases of EH and 28 cases of endometrial carcinoma were included in the study. EH (75.22%) was more common than endometrial carcinoma (24.78%). Among 28 cases of endometrial carcinomas, EMAC was most common (78.57%) followed by Clear Cell Carcinoma (CCC) (14.28%), and Uterine Serous Carcinoma (USC) (7.14%). ER and PR expression decreased as lesion progressed from EH to EMAC. ER and PR expression was negative in USC and CCC. The p53 expression and mean Ki67 labelling index increased as the severity of lesion increased from EH to endometrial carcinoma. CONCLUSION: The ER, PR, p53, Ki67 IHC markers may be included in every case of endometrial carcinoma to understand the tumour biological behavior which in turn could help individual treatment strategies.

Role of CD10 Immunoexpression in Grading Phyllodes Tumour of the Breast.

INTRODUCTION: Fibroepithelial tumours are a heterogeneous group of biphasic neoplasms consisting of a proliferation of both epithelial and stromal components. Fibroadenoma (FA) and Phyllodes Tumour (PT) constitute the major entities. It is crucial to distinguish benign from borderline PT (low grade malignant PT), because the former do not metastasize, have a lesser risk of local recurrence and initial local recurrences are histologically benign in almost all instances. Multiple Immunohistochemical (IHC) markers are being studied to find their utility in grading the PT accurately for planning proper treatment. AIM: To study, the IHC expression of CD10 in the stromal cells of a series of PTs and FA, with the aim of determining whether the degree of CD10 expression in the stromal cells is related to the grade of the tumour. MATERIALS AND METHODS: Records of 28 cases of PT and 35 cases of FA received in the Department of Pathology in a tertiary care hospital were obtained. Histopathology reports and slides of all the cases were reviewed and clinical data such as age and histomorphological features such as tumour cellularity, stromal overgrowth, mitotic count and nuclear atypia were noted. Representative block of the tumour with maximum cellularity was subjected to CD10 staining. For FA and benign PT a technique of tissue microarray was used. For borderline and malignant PT, representative section was used. Stromal cell staining was assessed, using cytoplasmic staining of the breast myoepithelium as internal control. RESULTS: Present study included 35 cases of FA, 20 cases of benign PT, five cases of borderline PT and three cases of malignant PT. The mean age of the patients increased with the increasing tumour grade of PT and this was also observed for FA and benign PT. The mean age increased with increase in tumour grade of PT and was statistically significant (p<0.05). The mean size did not increase with the increasing tumour grade of PT and was statistically insignificant (p=0.0429). Mean tumour size was more in benign PT as compared to FA and was highly statistically significant (p<0.01). CD10 staining was diffuse (Grade-3) and strong in malignant PT. The staining intensity was strong but patchy (Grade-2) in borderline PT. Weak and patchy (Grade-1) CD10 staining was seen in four benign PT and six FA. Other cases of benign PT and FA were negative for CD10 immunoreactivity. CONCLUSION: Our study showed that CD10 expression strongly correlates with the PT grade, which can help in the differentiation between benign and malignant variants of PT.

Immunohistochemical Study of MUC1, MUC2 and MUC5AC Expression in Primary Breast Carcinoma.

INTRODUCTION: Breast Cancer (BC) is the second most common cancer among women in India and accounts for 7% of global burden of BC and one-fifth of all Cancers (CA) among women in India. AIM: This study was conducted for studying the expression of MUC1, MUC2 and MUC5AC in breast carcinoma. MATERIALS AND METHODS: Fifty cases of primary breast carcinoma diagnosed between years 2013 to 2015 were included in the study. Manual tissue array technique was applied for cases subjected to Immunohistochemistry (IHC). An analysis of the expression of IHC markers (MUC1, MUC2, MUC5AC, ER, PR and HER2/neu) was attempted. Results were subjected to statistical analysis. They were considered to be significant when the p-value was less than 0.05. RESULTS: The positivity for MUC1, MUC2 and MUC5AC in BC was 58%, 8% and 6% and for ER, PR and HER2 was 48%, 36% and 64% respectively. There was a significant correlation between MUC1 expression and ER and PR positivity. There was a significant correlation between MUC2 expression and ER positivity. No significant association was observed between MUC2 and PR expression, MUC5AC expression and ER and PR positivity. There was statistically significant correlation between negative MUC2 and MUC5AC expression and histopathological grade. It was noted that MUC2 and MUC5AC negative tumours were associated with higher tumour stage though not statistically significant. It was noted that MUC5AC negative tumours showed higher frequency of lymphovascular invasion though not statistically significant. CONCLUSION: Our experience with the present study highlights the role of mucins in the development and progression of BC.

A rare case of extraskeletal Ewing's sarcoma/primitive neuroectodermal tumor developing in maxillary sinus of an old patient.

Ewing's sarcoma/primitive neuroectodermal tumor (ES/PNET) family of tumors is an uncommon group of malignant neoplasms that may present in both skeletal and extraskeletal sites. PNET outside the central nervous system is called peripheral PNET (pPNET) developing from migrating embryonal cells of the neural crest. Very few cases of pPNET of the maxilla are reported in English literature. These tumors may be difficult to diagnose due to their primitive morphology. These tumors occur predominantly in infancy or early childhood. The occurrence of extraskeletal ES/PNET in the maxillary sinus in an old age is very rare. We report a case of extraskeletal ES/PNET developing in maxillary sinus in a 60-year-old woman. The ES/PNET should be included in the differential diagnosis of a small round cell tumor and immunohistochemical analysis with a panel of immunomarkers should be done for correct diagnosis and proper treatment.