Evaluation of Sensitivity and Specificity of Napsin A and P40 in Non Small Cell Lung Cancer Patients

The majority lung tumors are classified as Non-Small Cell Lung Carcinomas (NSCLCs) and Small Cell Carcinomas (SCCs). NSCLC needs to be further subclassifed into adenocarcinoma and squamous cell carcinoma for better treatment options. Napsin A and P40 are emerging as potential markers for the subclassification of adenocarcinoma and squamous cell carcinoma. So the present study evaluated expression of Napsin A and P40 in lung adenocarcinoma and SCC patients so as to evaluate its diagnostic utility, and correlate and check its sensitivity and specificity along with other diagnostic lung cancer markers. Expression of Napsin A and P40 was evaluated in 25 adenocarcinoma and 25 squamous cell carcinoma patients by Immunohisotochemistry. Napsin A expression was observed in 42% and P40 in 64% of the patients. The expression of Napsin A was significantly higher in adenocarcinoma patients with a positive correlation with adenocarcinoma markers Thyroid Transcription Factor 1(TTF-1) and Cytokeratin 7(CK7); and inverse correlation with squamous cell marker Cytokeratin 5/6(CK5/6) with a specificity of 76% which was highest and sensitivity of 60%, which was lower than that of CK7, Carcino Embryogenic antigen(CEA) and TTF-1 in adenocarcinoma patients. The expression of P40 was significantly higher in squamous cell carcinoma and patients with metastasis, along with higher incidence in patients with increased tumor size and advanced disease stage. P40 showed positive correlation with squamous cell marker p63 and CK 5/6 with a specificity of 52% and sensitivity of 80% in squamous cell carcinoma patients but was lower than CK5/6 and p63. Napsin A was found be most specific adenocarcinoma marker, but its sensitivity was low. Further, P40 failed to reach highest level of sensitivity and specificity in our set of patients which may be due to the less number of patients analyzed in the study and urges a need to be evaluated in a large cohort

Secondary Malignancies Developing After Acute Lymphoblastic Leukemia And Its TreatmentWith Constitutional Mismatch Repair Deficiency Syndrome In Siblings.

Background & Objectives: Acute Lymphoblastic Leukemia (ALL) is the most common childhood malignancy, with an annual rate of 3 to 4 cases per 1,00,000 children. ALL patients are treated with chemotherapeutic agents and cranial irradiation. Long-term sequelae of treatment are impaired intellectual and psychomotor functioning, neuroendocrine abnormalitites, impaired reproductive capacity, cardiotoxicity and second malignant neoplasms are being reported with increased frequency in the survivors. Among second neoplasms observed after treatment of ALL, central nervous system (CNS) tumors in patients treated with cranial irradiation are the most common. Others are Lymphoma, Acute Myeloid Leukemia (AML) and Thyroid Cancer. Methodology & Results: We are reporting four cases ,who developed ALL at the age of 8,6,4 and 25 years respectively(among that case 1 & case 2 are siblings) and were treated with chemotherapy and cranial irradiation. They developed Astrocytoma Grade-4 , Alveolar Soft-Part Sarcoma(ASPS) , Anaplastic Large Cell Medulloblastoma & Ewing’s Sarcoma at, 12 , 15, 8, 12 & 26 years of age respectively. Conclusion: Oncologists should make sure about the radiation doses before starting treatment and they should keep CMMR-D as a possibility in pediatric patients with siblings having h/o malignancy.

Evaluation of central nervous system metastases with immunohistochemistry correlation.

Context: Brain metastases are the most common intracranial neoplasms. They are often the first symptom of systemic malignancy. Hence, immunohistochemistry (IHC) is of importance in evaluating the origin of brain metastases. Aims: The aim was to detect the primary site of brain metastases and evaluate the role of IHC in diagnosing the same. Materials and Methods: Data of 74 patients of brain metastases with unknown primary was analyzed. IHC was performed in these cases. The histopathological findings were correlated with clinical and radiological data. Results: Of 74 cases in which IHC was done; the most common primary site was lung (51 cases). Even after applying IHC, the primary could not be diagnosed in 10 cases. Conclusion: Brain metastases are often the first indicator of systemic malignancy. Lung is the most common primary site in cases with unknown primary, as deduced by IHC findings.

Granular cell ameloblastoma of mandible.

Ameloblastoma is a neoplasm of odontogenic epithelium, especially of enamel organ-type tissue that has not undergone differentiation to the point of hard tissue formation. Granular cell ameloblastoma is a rare condition, accounting for 3-5% of all ameloblastoma cases. A 30-year-old female patient presented with the chief complaint of swelling at the right lower jaw region since 1 year. Orthopantomogram and computed tomography scan was suggestive of primary bone tumor. Histopathologically, diagnosis of granular cell ameloblastoma of right mandible was made.

Spermatocytic seminoma associated with undifferentiated sarcoma: A rare case report.

The presence of sarcomatous element transforms the usually innocuous spermatocytic seminoma into a highly aggressive neoplasm. We report a case of spermatocytic seminoma with undifferentiated sarcomatous component in a 43-year-old male, presented with testicular mass since two and a half years. Orchidectomy was performed and after 9 months, the patient presented with recurrent scrotal mass with bilateral pulmonary metastases.

Granulosa cell tumor arising in an ovary with mature teratoma.

Granulosa cell tumor (GCT) with synchronous mature teratoma is extremely rare and only eight cases are documented in the literature. GCT is low-grade malignancy and need a close follow up for recurrences which may be late. We report a case of GCT and mature teratoma occurring synchronously in the same ovary in a perimenopausal woman.

A unilateral teratoid Wilms' tumor with raised serum alpha-fetoprotein level.

Teratoid Wilms' tumor with raised serum alpha-fetoprotein level is an unusual type of tumor. We, here, describe a twelve month old boy presenting with lumbar mass. Clinical features, radiological findings, gross examination, and histomorphological features are studied, and various differential diagnoses like Wilms' tumor with heterologous elements, intrarenal teratoma and metastatic germ cell tumor are taken into consideration.

Accuracy of cytologic diagnosis of central nervous system tumours in crush preparation.

The aim of this study was to assess the usefulness and accuracy of cytologic smears by making crush preparation as a diagnostic method, in central nervous system tumors. 278 patients with central nervous system tumors were investigated. In 98 cases, material was obtained intraoperatively during craniotomy and in 180 cases stereotactic biopsies were done. In all the cases crush preparations were made, and cytologic diagnosis was correlated with final histologic diagnosis. 244 out of 278 patients showed correlation with histopathological diagnosis. So, in present study diagnostic accuracy was 87.76%. In 18 cases no definite diagnosis was made due to inadequate material. Majority of the patients were in age group 31 to 40 years (72 cases). The youngest patient was three years old and the eldest was 87 years old. The most common tumor in intracranial cavity was astrocytoma (56.68%), followed by meningioma (6.88%), medulloblastoma (5.66%) and ependymoma (5.56%). The most common tumor in intraspinal cavity was ependymoma (38.46%), followed by meningioma (23.07%) and schwannoma (23.07%). In conclusion, crush preparation is an effective, simple, rapid, relatively safe and reliable technique for the diagnosis of central nervous system tumors. Diagnostic accuracy of cytology with final histopathological report is established with accuracy rate of 87.76%.

Primary mucinous carcinoma of urachus--a case report.

The authors describe a case of primary mucinous carcinoma of urachus in 65 years old male. Patient presented with hematuria with suprapubic mass. The patient underwent total cystectomy with en bloc excision of the tumor mass and umbilicus. Histological examination showed features of mucinous carcinoma of urachus. A clinicopathological study and brief review of literature is presented.

Subcutaneous metastases of sarcomatoid mesothelioma with its differential diagnosis on fine needle aspiration--a case report.

Metastasis of mesothelioma of the pleura, to the skin and subcutis is an extremely rare occurrence. A 25 year old woman, who had undergone chemotherapy, partial excision of tumor followed by radiotherapy of sarcomatoid mesothelioma of the pleura, presented three months later with painless widespread subcutaneous nodules. FNAC of these nodules reveled pleomorphic malignant spindle shaped cell with epithelioid morphology. The subcutis is a particularly rare site of metastatic sarcomatoid mesothelioma. It is essential to differentiate neoplasm metastatic to the skin and subcutis from primary and benign lesions of the same region. FNAC is accurate and efficient, in conjugation with clinical history, and it also prevents surgical biopsy in the diagnosis of metastatic subcutaneous lesion. To our knowledge, this is the first case, reported till date, in which the sarcomatoid mesothelioma metastasized to the subcutaneous tissue and was diagnosed by fine needle aspiration cytology (FNAC).

Clinicopathological prognostic factors of adult granulosa cell tumor of the ovary--a study of 37 cases.

Adult granulosa cell tumor (GCT) of the ovary is the most common malignancy amongst the sex cord stromal tumors. Clinical stage, age, tumor size, residual disease and several histologic factors have been reported to be of prognostic significance. There were 839 ovarian malignancies at our institute during the period from 1998 to 2002. Out of 54 granulosa cell tumors, 40 cases were evaluable which includes 37 cases of adult GCT and 3 cases of juvenile GCT. They were studied retrospectively. Majority of patients presented with abdominal symptoms and FIGO stage I. All patients were treated surgically and 62.1% of adult GCTs were given post-operative chemotherapy. Clinical stage, presence of residual disease and tumor volume were the most important prognostic factors. Age of patient, menstrual status, post-operative chemotherapy, mitosis or histological patterns were of little significance in our study.

Fine needle aspiration cytology of hepatoblastoma: a study of 20 cases.

Hepatoblastoma (HBL) is the most common primary malignant hepatic tumor in children. The aim of the present study is to describe cytological findings of HBL, to subclassify it, and to discuss differential diagnoses. Twenty cases were taken from records of Cytopathology department, Gujarat Cancer and Research Institute, Ahmedabad. The aspiration smears were stained with Papanicolaou stain andlor Giemsa stain. Cytological and architectural criteria were applied to aspiration smears. Fifteen cases (75%) of HBL were diagnosed in the patients below the age of two years. The commonest presentation was found to be lump in abdomen. On the basis of cytoarchitectural features, HBL was classified in two groups undifferentiated and differentiated. Morphologically, the tumor cells were commonly arranged in acinar pattern, papillary pattern, or in sheets. FNA cytology alone had some limitations in the diagnosis of HBL. Hence, cytoarchitecture in combination with clinicalfeatures, imaging techniques and serum a-fetoprotein levels were helpful for specific diagnosis of HBL and to rule out various others differential diagnosis of small round cell tumor. The cytological differential diagnosis between differentiated HBL and Hepatocellular carcinoma (HCC) was found to be very difficult.

An unusual localization of mucormycosis diagnosed by fine needle aspiration cytology: a case report.

Mucormycosis is an uncommon fungal infection, occurring mainly in patients with acidosis, chronic illnesses and malignancies. The most frequent site of involvement in patients of hematological malignancies is the respiratory tract. Isolated subcutaneous localization of mucormycosis in such patients is extremely rare. We report a case of a young patient of non-Hodgkin's lymphoma on chemotherapy who presented with a subcutaneous swelling on the anterior aspect of right thigh. Fine needle aspiration cytology (FNAC) smears from the swelling revealed numerous characteristic broad, irregularly contoured and pleomorphic hyphae of mucormycosis. This fungus seldom grows in culture and confirmation of the diagnosis depends on cytological or histological examination of infected tissues. Our case report documents a rare site of isolated mucormycosis infection and emphasizes the role of FNAC as a simple, rapid, accurate, and useful method of diagnosing fungal infections.