Online teaching of undergraduates in pathology during COVID-19 pandemic: An opportunity to grab or dismiss?

Introduction: Covid 19 pandemic has brought human life one on one with the pace of growth. The indispensable lockdown and social distancing norms have posed challenges to continue education in various fields. Distance learning via online teaching has emerged as a savior in the pandemic. In the current scenario, it is very important to keep learners in the loop and obtain feedback from students at the end of online teaching, for understanding its strength and weaknesses which will eventually assist in developing strategies to improve its quality. We intend to share our experience with the online teaching. Materials and Methods: The study was conducted from March 2020 to Feb 2021, which includes 8 months of online teaching classes and practicals, one online examination (mid term exam), and 1 offline examination (final professional exam). The marks obtained by the students who attended online classes (batch II) in 2020-21 session was compared with previous batch i.e 2019-20 (batch I). Also the marks obtained by batch I during online exam (mid-term exam) were compared with their marks during offline exam (final professional exam). Results: Batch II scored higher marks than batch I in theory and practical (p-value < 0.05). However, the marks of viva for both batches were equitable. Conclusions: We feel that the online teaching is a reasonable alternative to conventional teaching in the current scenario.

Nevus Lipomatosis Cutaneous Superficialis - A clinicopathologic study of the solitary type.

BACKGROUND: Nevus Lipomatosis Cutaneous Superficialis (NLCS) is a rare, benign hamartomatous lesion characterized by the ectopic presence of mature adipocytes in the reticular dermis not associated with the underlying subcutaneous tissue. Two clinical forms-classical and solitary occur. The solitary form is relatively uncommon, due to which these lesions are commonly clinically misdiagnosed. The aim was to study the clinical and histopathological features of the solitary type of NLCS. METHODS: Seven cases of histopathologically documented solitary type of NLCS which presented at our institute between August 2013 and June 2014 were retrospectively analysed for clinical data and histopathological findings. Haematoxylin and Eosin (H&E) and Elastic Van Gieson (EVG) stained slides were studied in all cases. RESULTS: Mean age of the patients was 42.5 years. These lesions were more common in adult females (5/7). Thigh was the commonest location (4/7). The mean duration of these lesions was 2.0 years. Clinical diagnosis was papilloma (4/7) and acrochordon (3/7). Histopathology revealed the presence of varying amounts of mature ectopic adipocytes in the dermis located around dilated, ectactic blood vessels. Disorganised dermal collagen bundles and atrophic pilosebaceous units were seen. CONCLUSION: This study is a first from the Indian subcontinent and highlights the need for awareness of this rare clinical condition both by the dermatologists and the surgeons. Histopathology is essential for diagnosis as clinically they may mimic papillomas or skin tags. An early diagnosis may permit a more conservative resection of the tumour.

Interleukin-1 Gene Polymorphisms and their Relation with NFκB Expression and Histopathological Features in Psoriasis.

BACKGROUND: Psoriasis is a chronic inflammatory disease driven by exaggerated production of pro-inflammatory cytokines and interleukins. Various genetic polymorphisms including IL-1 are implicated in pathogenesis of psoriasis. The exact role of IL-1 gene polymorphisms and their interaction with NFκB is not yet determined. We aimed to study various genetic polymorphisms of IL-1 in psoriasis and their influence on NFκB and histopathological features. MATERIALS AND METHODS: 112 newly diagnosed cases of psoriasis vulgaris were included in this prospective study. Histology was done on sections and genotyping was done for the IL-1ß and IL-1 receptor antagonist (IL-1RA) genetic polymorphisms. In addition, NFκB immunostaining was performed on 89 sections and the intensity of staining was evaluated in the epidermis, basal cells, and the lymphocytes. RESULTS: A strong association of IL-1ß 511 C/T polymorphism was found with both genotypes and alleles in psoriasis. A strong correlation was also detected between the IL-1ß genotype and the grade of NFκB immunostaining in the epidermis (P = 0.012). The grade of NFκB lymphocyte staining showed a strong correlation with the IL-1RA genotype (P = 0.025) but not with the IL-1ß genotype (P = 0.226). The genetic polymorphisms did not show any correlation with the histological features. CONCLUSIONS: IL-1 genetic polymorphisms may not play a very direct role in pathogenesis of psoriasis. However, their interaction with NFκB appears to be a significant factor in this direction as NFκB is activated by pro-inflammatory genetic polymorphisms and therefore may influence the severity of psoriasis.

Intravascular papillary endothelial hyperplasia: An unusual histopathological entity.

Intravascular papillary endothelial hyperplasia (Masson's tumor) is a benign lesion of the skin and subcutaneous tissue consisting of a reactive proliferation of endothelial cells with papillary formations related to a thrombus. It poses a diagnostic challenge as the clinical signs and symptoms are nonspecific and may mimic a soft tissue sarcoma. The diagnosis is based on histopathology. Here we report two cases of Masson's hemangioma occurring on the upper lip and on the left hand.

Pseudohyperplastic variant of adenocarcinoma as a component of α-methyl-CoA-racemase (AMACR negative) carcinosarcoma of the prostate.

Carcinosarcoma (CS) or Sarcomatoid carcinoma (SC) of the prostate is a very rare malignant tumor of the prostate having an aggressive clinical course and dismal prognosis. The adenocarcinomatous element is usually of the acinar type and closely admixed with a sarcomatous component. We report a case of α-methyl-CoA-racemase (AMACR)-negative pseudohyperplastic variant of adenocarcinoma in CS. To the best of our knowledge, there have been no published case reports of this variant in CS till date. An accurate diagnosis is essential as this uncommon, aggressive cancer has limited therapeutic options.

Diagnostic utility of p63 and α-methyl acyl Co A racemase in resolving suspicious foci in prostatic needle biopsy and transurethral resection of prostate specimens.

AIM OF THE STUDY: The objective is to assess the utility of the p63 and α-methylacyl CoA racemase (AMACR) in resolving suspicious foci in prostatic needle biopsy and transurethral resection of prostate (TURP) specimens. MATERIALS AND METHODS: A total of 470 cases are selected. These included 310 TURP specimens, 157 needle biopsies and 03 radical prostatectomy specimens. All the cases are reviewed and divided into three categories. Benign (370), cases with suspicious foci (40 cases) and malignant (60 cases). Immunohistochemistry (IHC) was carried out using monoclonal AMACR and p63 antibodies in the 40 suspicious cases along with positive and negative controls. RESULTS: This study showed AMACR had a sensitivity of 95%, specificity of 92.5%, whereas p63 had a sensitivity of 90%, specificity of 100%. All the 40 suspicious cases were resolved using a combination of morphology and IHC expression p63 and AMACR. In 13 (32.5%), of the 40 suspicious cases there was change of diagnosis based of morphology, clinical details and staining with p63 and AMACR, In the 11 cases (11/40), diagnosis was changed from the benign to malignant. In one case benign to high grade prostatic intraepithelial neoplasia (1/40) and in one case from malignant to benign (1/40). This change was statistically significant with P value of 0.013. CONCLUSIONS: Combination of p63 and AMACR is of great additional value in combating the morphologically suspicious cases and should be used on case to case basis especially in prostatic needle biopsies and small foci lesions.

Expression of tumor necrosis factor-α and nuclear factor-kappaB/RelA and the pathogenesis of psoriasis.

CONTEXT: Tumor necrosis factor-α (TNF-α) is an important mediator in the pathogenesis of psoriasis. Nuclear factor-kappaB (NF-κB) is a transcription factor that regulates the activity of the proinflammatory genes. Psoriasis is an inflammatory disease and the role of TNF-α and NF-κB, should be considerable. AIMS: We studied the role of TNF-α and NF-κB in psoriasis. MATERIALS AND METHODS: A total of 61 cases of psoriatic skin biopsies were studies and the grade of TNF-α and NF-κB, staining was correlated with the histopathological indices of severity. STATISTICAL ANALYSIS USED: Pearson's correlation coefficient and Chi-square test. Statistical Package for Social Sciences version 13 was used. RESULTS: The TNF-α immunostain in the cytoplasm of the epidermal cells and basal cells showed a strong inverse correlation with the grade of epidermal hyperplasia (P -0.019 and P -0.009, respectively). The epidermal cytoplasmic positivity and lymphocyte positivity for TNF-α did not correlate with the grade of NF-κB immunostaining in the epidermal cell nuclei, basal cells or lymphocytes. The basal cell cytoplasmic positivity for TNF-α correlated with the grade of NF-κB immunostaining in the nucleus of basal cells at a P - 0.005. There was a strong correlation between the epidermal cytoplasmic TNF-α immunostaining with the lymphocyte immunostaining (P -0.08); however, there was no correlation between the TNF-α expression in the other two locations. CONCLUSIONS: The study outlines the relationship between NF-κB and TNF-α and their combined role in the development of the characteristic histopathological changes in psoriasis. We hypothesize that NF-κB is involved in stimulating the release of TNF-α which would account for the characteristic histopathological changes of psoriasis. However, it is likely that NF-κB can act independently of TNF-α also in the pathogenesis of psoriasis.

Morphometric study of nuclei and microvessels in gliomas and its correlation with grades.

INTRODUCTION: Modifications of nuclear morphology in conjunction with alteration in microvascular configuration are essential features encountered during the progression of glial tumors. In order to gain more insight into tumor biology of gliomas, objectives of the study were selected (a) to correlate morphometrically evaluated nuclear parameters [nuclear area (NA), nuclear perimeter (NP), nuclear density (ND), percentage of total nuclear area (%TNA)] and microvessel parameters [microvessel density (MVD), microvessel caliber (VC), microvessel cross sectional area (VCSA), total microvessel boundary density (TVBD), percentage of total VCSA (%TVCSA)] with WHO grading; (b) extend such correlations to the ratio parameters: ratio of MVD to ND (MDV/ND), ratio of TVBD to %TNA (TVBD/%TNA) and ratio of %TVCSA to %TNA (%TVCSA/%TNA); and (c) to correlate microvessel and ratio parameters with NP and ND. MATERIALS AND METHODS: A total of thirty gliomas managed at this institute during 2009-2012 were evaluated for various nuclear and microvessel parameters by image morphometry using a computerized digital photomicrograph system. For assessment of microvessel parameters CD34-immunostained sections were used while nuclear morphometry was performed on routine hematoxylin-eosin-stained sections. Appropriate statistical analysis was performed in correlation studies. RESULTS: All nuclear morphometric parameters showed strong positive correlation with tumor grades (r>0.7). In contrast, though all microvessel parameters exhibited positive correlation with grades, the parameters TVBD and %TVCSA showed strong positive correlation. The ratio parameters (MVD/ND) and (TVBD/%TNA) showed negative correlation with grades, whereas (%TVCSA/%TNA) did not exhibit meaningful correlation with grades. Further, while all microvessel parameters showed positive correlation with NP and ND; ratio parameters showed negative correlation with them. CONCLUSION: This study indicates that the parameters related to tumor growth (NA, NP, ND, %TNA), and angiogenesis showed increasing trend with tumor grades simultaneously; whereas the parameters related to supply of nutrients per nucleus showed decreasing trends with tumor grades, nuclear size and nuclear density. Thus, the former accounts for increased cellularity, mitosis, and vascular proliferation, while the latter culminates in tumor necrosis, all of which are essential components for grading of gliomas. The present study will therefore have a vital role as surrogate markers of grading of tumor.

Correlation of histomorphologic prognostic markers and proliferative index with loss of heterozygosity 1p/19q and MGMT status in diffusely infiltrating gliomas.

BACKGROUND: Loss of heterozygosity (LOH)1p/19q, and epigenetic silencing of O(6)-methylguanine-DNAmethyltransferase (MGMT) gene, displayed promising role as predictive and prognostic markers in brain tumours. The present study correlated both with conventional histomorphologic prognostic markers and proliferative index in diffusely infiltrating gliomas (DIG). METHODS: Tissues from 45 patients were evaluated for LOH1p/19q using polymerase chain reaction based microsatellite analysis; and for MGMT using immunohistochemistry. Results were correlated with age, histologic type, WHO grade, and proliferation index. RESULTS: Mean MIB-1 LI showed significant correlation with tumour grade. MGMT-staining in grade II and IV tumours were 31.1% and 16.8%, respectively, while in DA and GBM it was 88.2% and 19.0%, respectively, which were statistically significant. Sixteen cases showed LOH 1p and/or 19q of which 10 (5 oligodendroglial, 3 GBM, AA, DA) had combined LOH; while three each showed 1p (all GBM) and 19q (2 DA and GBM) loss. In the MIB-1LI ≤ 5% and >5% groups LOH 1p and/or 19q was encountered in 6 and 10 cases, respectively. A significant inverse association was noted between LOH with MGMT. CONCLUSIONS: LOH1p/19q and MGMT shows good correlation with conventional histomorphologic and proliferation markers, and should constitute part of the optimal diagnostic workup of DIG.

Pure red cell aplasia in systemic onset juvenile idiopathic arthritis.

Common causes of anemia in juvenile idiopathic arthritis are anemia of chronic disease and iron deficiency. We report a 4 year old boy with biopsy proven systemic onset juvenile idiopathic arthritis and severe anemia. Bone marrow aspiration revealed pure red cell aplasia without evidence of hemophagocytosis. This rare, unexplained but well known entity responded to corticosteroids.

Clonality assessment of lymphoproliferative lesions using the polymerase chain reaction: an analysis of two methods.

BACKGROUND: Lymphoid malignancies are a heterogeneous group of disorders which may be difficult to differentiate from reactive proliferations even after immunohistochemistry. Polymerase chain reaction (PCR) is believed to be a good adjunct tool for diagnosis. MATERIALS AND METHODS: We examined 24 cases of neoplastic and non-neoplastic lymphoproliferative lesions in this study and evaluated the PCR as an additional tool in the confirmation of the diagnosis. Two different PCR methodologies were evaluated. RESULTS: In the evaluation of the T-cell PCR, it was seen that the correlation using both the commercial kits and the custom-synthesized primers was highly significant at a P value of <0.05. In the evaluation of the B-cell PCR, it was seen that the correlation using both the commercial kits and the custom-synthesized primers was not significant using either method (P > 0.05). CONCLUSIONS: Both the methods showed an excellent concordance for T-cell γ gene rearrangements, However, the same was not seen in the B-cell receptor rearrangements. This may be because of the small sample size or the inability of consensus V primers to recognize complementary DNA sequences in all of the V segments.

A Study of the Newer Prognostic Markers in Diffuse Large B Cell Lymphomas.

INTRODUCTION: Diffuse large B cell lymphomas (DLBCL) encompass a pathogenetically heterogeneous group of aggressive tumours that are rapidly fatal if untreated. Gene expression profiling studies have identified distinct molecular subtypes of DLBCL, one with an expression profile similar to normal germinal centre B cells (GCB subtype) and a second mimicking activated peripheral blood B cells (ABC subtype) having different prognostic significance allowing risk stratification of lymphoma patients and development of specific therapeutic strategies. METHODS: Twenty cases of DLBCL were included in the study and categorized into germinal centre and non germinal centre subtypes using the following antibody panel. CD10, Bcl-6, MUM1 and CD138. The germinal centre and non germinal centre subtypes were defined as under Germinal centre (DLBCL) CD10 + and/or Bcl-6 +, MUM1 -, CD138 - and Non germinal centre (DLBCL) CD10, Bcl-6 ±, MUM1 ±, CD138 ±. RESULT: In our study of twenty cases thirteen were germinal centre DLBCL while seven of the twenty cases were non germinal centre type of DLBCL. 75% of the nodal cases and 62.5% of extra nodal cases were germinal centre B cell type. Overall survival in the GCB and non GCB groups was 91% and 14% respectively and the difference was highly significant statistically. CONCLUSION: This study validates the existence of prognostic subgroups of DLBCL in the Indian population.

Comparison of aspiration vs non-aspiration techniques in fine-needle cytology of thyroid lesions.

AIM: To compare the efficacy of fine-needle non-aspiration cytology (FNNAC) with that of fine-needle aspiration cytology (FNAC) of thyroid lesions. MATERIALS AND METHODS: FNAC and FNNAC techniques were studied in 50 cases of thyroid lesions. All the needle-sampling procedures were done by a single operator. The samples were assessed cytologically and evaluated using five parameters, that is, background blood or clot, amount of cellular material, degree of cellular degeneration, and degree of cellular trauma and retention of appropriate architecture. STATISTICAL ANALYSIS: Wilcoxon signed rank test was performed using SPSS14 software. Differences between all the individual parameters as observed in FNAC and FNNAC smears were insignificant. RESULTS AND CONCLUSION: After evaluation of FNAC and FNNAC on the basis of these scores, greater numbers of diagnostically superior samples were obtained by FNNAC; however, by FNAC more number of diagnostically adequate smears were observed. The numbers of unsuitable smears were also more by FNNAC technique.

Aneurysmal bone cyst of the calcaneum: an expansile locally destructive lesion.

Aneurysmal bone cyst (ABC) is a benign but locally destructive lesion affection of which in the calcaneum has rarely been reported in the literature. We report an unusual case of ABC of the calcaneum in a 17-year-old-male, who presented with painful ankle swelling with difficulty in walking. Radiology revealed benign cystic calcaneal lesion, without any evidence of fracture. Biopsy was characterized by formation of osteoid along with the presence of ecstatic blood-filled channels, consistent with ABC. However, this being an uncommon site for ABC, histopathology needs to be used to differentiate it from other benign and malignant entities, and a definitive diagnosis warrants clinical and radiological correlation. Most of the ABCs require surgical curetting and bone engraftment of the surgical defect.

Pulmonary carcinosarcoma masquerading as a cryptic disseminated malignancy.

Pulmonary carcinosarcoma is an aggressive rare malignant tumor comprising a mixture of carcinoma and sarcoma components containing differentiated mesenchymal elements, such as malignant cartilage, bone, and skeletal muscle. We report a case which presented with unusual clinical features and proved cryptic until death. At autopsy, it was a stage IV lung malignancy and histopathology revealed a carcinosarcoma comprising an adenocarcinoma and an osteosarcoma with metastasis to the heart, lymph nodes, and both adrenals. To our knowledge, this is the first case of this subtype with metastasis to the heart. The present case had an unusual clinical presentation and its elusive nature towards diagnosis despite dissemination is noteworthy and unique in the literature.

Acute cortical necrosis in Falciparum malaria: an unusual manifestation.

The spectrum of acute renal failure in Falciparum malaria varies from mild urinary abnormalities to acute renal failure. Acute tubular necrosis has been reported in 1% patients, and acute cortical necrosis has rarely been reported. We present a case of acute cortical necrosis in a young patient with Falciparum malaria who had a prolonged oligo-anuric course followed by partial recovery of renal function.