Upcoming World Health Organization system for reporting lymph node cytopathology-A preliminary outline.

Purple book for WHO reporting for lymph node cytopathology - 2023. Lymph node cytopathology reporting system may use standardized nomenclature and usage of the terminologies harmonizing with the WHO Blue Book on hematolymphoid tumors.

World Health Organization reporting system for lung cytopathology-A brief correspondence.

The WHO lung cytopathology reporting system has been published recently and is now a five-tier category system without any subcategorization. WHO reporting system also encourages the application of ancillary diagnostic tests like cell block preparation, immunocytochemistry, and rapid on-site evaluation for better categorization of specimens and further management. This correspondence aims to provide a brief outline of the lung reporting system. Lung cytopathology reporting system use standardized nomenclature and usage of the terminologies harmonizing with the WHO Blue Book, and table and flow diagram may be helpful for the readers.

Human epidermal growth factor receptor 2/neu expression in urothelial carcinomas.

Introduction: Urothelial carcinomas of the bladder are more common in males, making them the sixth-most common cancer in men and the tenth-most common cancer overall, worldwide. Current guidelines do not recommend routine testing for human epidermal growth factor receptor (HER2/neu) expression on the biopsy specimens of patients with urothelial carcinoma. This study was aimed at determining the expression pattern of HER2/neu and its usefulness in muscle-invasive and nonmuscle-invasive urothelial carcinoma. Methods: HER2/neu expression was assessed in 89 specimens of urothelial cancer by immunohistochemistry (IHC), and equivocal cases were subjected to fluorescent in situ hybridization (FISH). Results: On IHC for HER2/neu, 17.9% (7/39) of the muscle-invasive bladder cancers (MIBCs) showed a 3+ expression, whereas 22% (11/50) of the non-muscle invasive cancers were positive with a score of 3+. A significant correlation between HER2/neu status and muscle invasion could not be established in the current study (P = 0.74, Fisher's exact test). Three cases of muscle-invasive (7.7%) and 2 cases (4%) among nonmuscle invasive cancers showed equivocal expression. All the cases with equivocal (2+) expression on IHC were subjected to FISH and none showed gene amplification on hybridization and were considered as negative. Conclusion: Overexpression of HER-2/neu was seen in 17.9% of MIBCs and 22% of non-MIBCs. There are no norms for routine testing of HER2/neu expression in the biopsy specimens of urothelial carcinoma. There is an unmet need to establish guidelines for HER2/neu scoring, similar to that for breast and gastric cancers, to determine the proportion of positive cases and help in identification of those who may benefit from targeted therapies.

A Comprehensive Review of the Newest World Health Organization (WHO) Cytopathology Reporting Systems.

World Health Organization cytopathology reporting system systems have proposed for the pancreatobiliary tract, lung, lymph node, and soft tissue aligned with the updates in the World Health Organization classification of Tumor series. Among them, the pancreatobiliary tract and lung specimen reporting system have been published recently and are now a 7-tier and 5-tier category system, respectively, without any subcategorization. World Health Organization reporting systems also encourage the application of ancillary diagnostic tests like cell block preparation, immunocytochemistry, and rapid on-site evaluation for better categorization of specimens and further management, especially in indeterminate (atypical and suspicious for malignancy) and malignant cytology categories. In this brief review, we aim to provide a brief outline of both the systems and their clinical risk-based management strategies.

A challenging diagnosis of mammary analogue secretory carcinoma (MASC) on fine needle aspiration cytology and cell block: A cytopathologist's perspective.

Mammary analogue secretory carcinoma (MASC) is a recently described salivary gland carcinoma that resembles the secretory carcinoma of the breast and is characterised by t(12;15) (q13;q25) translocation, which results in an ETV6-NTRK3 gene fusion product. On cytomorphology, it is characterised by papillary fragments, clusters, and singly dispersed tumour cells. These tumour cells are large and have abundant vacuolated cytoplasm. Acinic cell carcinoma of the salivary gland is the most common differential diagnosis of MASC. Other differentials include mucoepidermoid carcinoma, salivary duct carcinoma, pleomorphic adenoma, and oncocytic salivary gland neoplasms. Immunohistochemistry and morphology are critical in establishing the correct diagnosis. We present a case of a 46-year-old male patient diagnosed as MASC of the parotid gland on fine needle aspiration cytology and cell block.

Jejunal mucinous adenocarcinoma: Unusual presentation of a rare pathology.

Mucinous adenocarcinoma of jejunum is a rare tumor of the gastrointestinal tract. Patients usually present after fifth decade of their life with non-specific symptoms. Delayed diagnosis is commonplace and often the reason for advanced disease and poor prognosis. These tumors may masquerade as other common malignancies, with a conclusive diagnosis only after the final histopathological examination. We present a case of jejunal mucinous adenocarcinoma, disguised as cecal malignancy, in an old female patient, managed with radical resection and adjuvant chemotherapy. The report reiterates that the mucinous variant of jejunal adenocarcinoma is a rare pathology with an unusual advanced presentation.

Adenoid basal carcinoma cervix - A rare epithelial neoplasm.

ABSTRACT: Adenoid basal carcinoma of the uterine cervix is a rare epithelial neoplasm. Adenoid basal carcinoma constitutes less than 1% of all cervical adenocarcinomas and has a favorable prognosis. Adenoid basal carcinoma is assumed to arise from a multipotential basal or reserve cell layer in the cervical epithelium. We report a case of adenoid basal carcinoma of the uterine cervix with complaints of bleeding per vagina in a 40-year-old female. The carbohydrate antigen 125 level was elevated (100 U/ml), and the MRI abdomen and pelvis revealed increased signal intensity in the anterior lip of the cervix. The local examination revealed thickening of the anterior lip of the cervix and induration in the left fornix. The patient was diagnosed with carcinoma cervix stage IB2 (FIGO Stage). The patient was operated by a radical robotic hysterectomy. Microscopic examination revealed small basaloid tumor cell nests with peripheral cell palisading and microcyst formation. The tumor cells showed p63 immunoreactivity in basaloid tumor cells and were negative for CD117 and S-100P. This tumor should be differentiated from adenoid basal cell hyperplasia, which has a favorable outcome, and adenoid cystic carcinoma, with a dismal course.

Epithelioid Mesothelioma of Peritoneum Masquerading as Peritoneal Carcinomatosis.

INTRODUCTION: Mesothelioma is an insidious neoplasm that develops from mesothelial cells. About 80% of mesotheliomas originate in the pleural cavity. Other sites where it has been reported are the peritoneal cavity, tunica vaginalis, and the pericardium. CASE PRESENTATION: A 45-year-old female complained of abdominal distention and pain for three months. There was a significant weight loss of approximately 15 kg in the past three months, and there was no family history of any malignancy, tuberculosis, substance abuse, or asbestosis exposure. Physical examination revealed signs of muscle wasting, loss of subcutaneous fat, and hollowing of the eye sockets. There was pitting edema in the bilateral lower limbs; per abdomen examination revealed abdominal distension with umbilicus in the midline. No visible peristalsis or dilated veins were seen all over the abdomen. Hernial sites were normal. Gross ascites were present, and no organomegaly, definitive mass, or lump was palpable. The dull note was heard all over the abdomen, and fluid thrill was noted on percussion. Bowel sounds were normal on auscultation. The ascitic fluid examination revealed the presence of atypical cells. An omentectomy was done and it was sent for histopathological examination. CONCLUSION: The specimen of omentectomy was in multiple fragments and measured 17x16x3cm; a few of the fragments were nodular, soft to firm on palpation. The cut section of mass was gray and white with areas of necrosis. Microscopic examination showed sheets of malignant cells. These tumor cells were immunoreactive to EMA, cytokeratin, vimentin, calretinin, WT-1, and D2-40 and immune negative to desmin (highlighting only the entrapped reactive mesothelial cells), inhibin, BerEP4, TTF-1, CD 68, napsin, ER, CEA, CDX2, PR, PAX-8, and SALL4. Ki67 labelling index was 15%. The features were of epithelioid mesothelioma.

Mucormycosis presenting as intestinal perforation: A pathologist perspective.

Mucormycosis is a life-threatening fungal infection mostly involving the ocular region, sinuses and brain. It is mostly seen in the immunocompromised host. Gastrointestinal (GI) mucormycosis is rare and mostly present as hematemesis, abdominal pain and melena. Here, we present a case of intestinal mucormycosis who presented as cecal perforation. Surgical resection was done, and the diagnosis was made by histopathology. Our case is unique in the way that GI mucormycosis is itself a rare entity and even rarer in an immunocompetent host.

Role of Fine Needle Aspiration Cytology in Paratesticular Neoplasms-A Case Reports-Based Systematic Review.

INTRODUCTION: The cytology features of neoplastic paratesticular lesions are mostly documented as case reports. Thus, we conducted a case report-based literature review to identify the characteristics of paratesticular neoplasms and tried to determine the significance of FNAC in these tumors. METHODS AND MATERIALS: The studies were searched using PubMed and Scopus. The quality assessment was done using the JBI critical appraisal checklist for case reports. The articles that received an overall rating of "Include" underwent data extraction. The data were extracted from the articles and analyzed. RESULTS: We included 34 case reports from 33 published articles. The mean age of patients was 44.74 (13-85) years, and the most common clinical manifestation was scrotal swelling (70.59%, 24/34). Lesions were commonly observed on the right side (65.63%, 21/32), and the most common tumor site was epididymis (35.29%, 12/34). A total of 38.24% (13/34) cases were nonmalignant, and 61.76% (21/34) were malignant on the cytological diagnosis. The adenomatoid tumor (53.85, 7/13) was the most common nonmalignant tumor. Other entities were schwannoma, benign spindle cell neoplasm with atypia, nerve sheath tumor, lipoma, undifferentiated pleomorphic sarcoma, rhabdomyosarcoma, epithelioid sarcoma, liposarcoma, malignant rhabdoid tumor, pigmented neuroectodermal tumor of infancy and mesothelioma. Considering the malignant and nonmalignant groups, the sensitivity, specificity, and diagnostic accuracy of cytology were 95.00%, 84.62%, and 90.91%, respectively. CONCLUSION: Cytopathologists should be familiar with the cytological features of various malignant and nonmalignant paratesticular tumors to prevent unnecessarily invasive surgical management. The current systematic review emphasizes usefulness of FNAC in the preoperative cytological identification of paratesticular tumors.

Undiagnosed Intra-articular Synovial Hemangioma: A Rare Cause of Knee Pain and Swelling.

INTRODUCTION: Synovial hemangioma is a benign soft-tissue tumor of vascular origin. Hemangioma only accounts for 1% of all bone lesions and is mostly an incidental finding among the primary skeleton tumors. A delay in diagnosis results in joint degeneration and osteoarthritic damage because of infiltrating tumor growth. CASE PRESENTATION: We presented a rare case of an intra-articular synovial hemangioma in a 13- year-old pediatric patient who was asymptomatic for 5 years. She attended orthopedics OPD at AIIMS, Mangalagiri. Surgical excision of the mass and partial synovectomy was done. Synovial hemangioma came out to be the diagnosis following a histologic study. CONCLUSION: As radiography has limited diagnostic ability, synovial hemangiomas are difficult and challenging to identify on an outpatient basis. Histological examination and magnetic resonance imaging are extremely helpful. To minimize the hemarthrosis risks, early complete excision can be used as the best treatment modality.

Recalcitrant ulcerative genital herpes in an immunocompetent individual treated successfully with imiquimod.

BACKGROUND: This case report describes the successful use of imiquimod to treat genital herpes in an immunocompetent individual with acyclovir-resistant HSV. CASE REPORT: A 32 year old male patient, presented with asymptomatic non-healing ulcers over the genital region for 2 years. The ulcers initially responded to acyclovir but became persistent after a few months. He also received multiple courses of antibiotics. On examination, the patient had bilateral inguinal lymphadenopathy and multiple painless ulcers over the coronal sulcus. Routine investigations were normal. The patient was treated with oral and intravenous acyclovir but showed no response. He was then started on topical imiquimod cream applied on alternate days. After one week, the patient presented with pain, redness, burning sensation, and fresh ulcer over the glans which were suspected to be imiquimod-induced irritant reaction or ulcer. Imiquimod was withheld for one week and then restarted at a twice-weekly schedule. After 1 month and 7 days of treatment with imiquimod at a twice-weekly schedule, there was healing of the ulcers. CONCLUSION: This case report illustrates the efficacy of imiquimod cream as a topical treatment for genital herpes simplex in an immunocompetent patient who had previously been unresponsive to treatment with acyclovir.

CRISPR/Cas9-mediated homology donor repair base editing system to confer herbicide resistance in maize (Zea mays L.).

Weed infestation is a significant concern to crop yield loss, globally. The potent broad-spectrum glyphosate (N-phosphomethyl-glycine) has a widely utilized herbicide, acting on the shikimic acid pathway within chloroplast by inhibiting 5-enolpyruvylshikimate-3-phosphate synthase (EPSPS). This crucial enzyme plays a vital role in aromatic amino acid synthesis. Repurposing of CRISPR/Cas9-mediated gene-editing was the inflection point for generating novel crop germplasm with diverse genetic variations in essential agronomic traits, achieved through the introduction of nucleotide substitutions at target sites within the native genes, and subsequent induction of indels through error-prone non-homologous end-joining DNA repair mechanisms. Here, we describe the development of efficient herbicide-resistant maize lines by using CRISPR/Cas9 mediated site-specific native ZmEPSPS gene fragment replacement via knock-out of conserved region followed by knock-in of desired homologous donor repair (HDR-GATIPS-mZmEPSPS) with triple amino acid substitution. The novel triple substitution conferred high herbicide tolerance in edited maize plants. Transgene-free progeny harbouring the triple amino acid substitutions revealed agronomic performances similar to that of wild-type plants, suggesting that the GATIPS-mZmEPSPS allele substitutions are crucial for developing elite maize varieties with significantly enhanced glyphosate resistance. Furthermore, the aromatic amino acid contents in edited maize lines were significantly higher than in wild-type plants. The present study describing the introduction of site-specific CRISPR/Cas9- GATIPS mutations in the ZmEPSPS gene via genome editing has immense potential for higher tolerance to glyphosate with no yield penalty in maize.