Significance of platelet parameters in invasive squamous cell carcinoma of uterine cervix.

BACKGROUND: Cervical cancer is the second most common cancer among females worldwide. The role of platelets in cancer progression and metastasis have been evaluated in various cancers. This study is done to assess the association between platelet parameters and invasive squamous cell carcinoma of the cervix. MATERIALS AND METHODS: Eighty cases of squamous cell carcinoma of the cervix were retrospectively collected from the medical record department. Values of platelet parameters such as platelet count, mean platelet volume (MPV), platelet distribution width (PDW), plateletcrit (PCT), platelet-large cell ratio (P-LCR), platelet-lymphocyte ratio (PLR), platelet-neutrophil ratio (PNR), and platelet-monocyte ratio (PMR) are collected from automated hematology analyzer. These values were compared with 80 healthy controls which were randomly selected. Values of platelet parameters were also compared among Federation Internationale de Gynecolgie et d'Obstetrique (FIGO) stages in 80 cases. RESULT: Mean ± standard deviation (SD) for platelet count, MPV, PDW, PCT, P-LCR, PLR, PNR, and PMR among cases were 316 ± 100.37 × 109/L, 9.98 ± 0.96, 11.11 ± 2.27, 0.31 ± 0.092, 24.09 ± 7.62, 179.35 ± 85.53, 63.89 ± 42.10, and 492.29 ± 192.86, respectively, and in controls were 300.30 ± 79.40 × 109/L, 9.97 ± 0.83, 10.97 ± 1.80, 0.59 ± 2.65, 23.94 ± 6.81, 137.72 ± 50.52, 60.07 ± 26.68, and 563.65 ± 602.55, respectively. The PLR between cases and controls was statistically significant. The platelet count and PCT between stages was statistically significant wherein the values increased from stage II to stage IV. CONCLUSION: Platelet parameters are importance in cervical cancer. PLR, platelet count, and PCT are platelet parameters that can be used as predictors and prognostic parameters in cervical cancer. These parameters are cost-effective and can be considered in low resource settings. However, a multicentric study with a larger sample size should be done to extrapolate the findings for patient care.

Analysis of the Six Sigma Principle in Pre-analytical Quality for Hematological Specimens.

Introduction Blood tests are essential for detecting and treating hospitalized individuals with diseases. Laboratory blood tests provide doctors with critical information required to treat their patient's illnesses. The most common sources of error in clinical laboratories are pre-analytical errors. Although quality control measures can remediate analytical errors, there is a requirement for stringent quality checks in the pre-analytical sector as these activities are performed outside of the laboratory. Pre-analytical errors when combined with the sigma value can reflect a better picture as the sigma value represents the laboratory's performance.  Aim In this study, six sigma and the Pareto principle were utilized to assess pre-analytical quality indicators for evaluating the performance of a clinical hematology laboratory.  Methodology  This is a retrospective observational study conducted from 2015 to 2023 (for a period of eight years). Information about the frequency of pre-analytical errors was retrieved from the hematology section of the central diagnostic research laboratory information system and the data was entered into an MS Excel sheet and data was evaluated utilizing SPSS version 23 (IBM Corp., Armonk, NY). Results In the current research, total of 15 pre-analytical errors were noted. Out of the total 15 pre-analytical errors studied, 55.4% of pre-analytical errors were noted among which 80% errors were due to lack of mention of sample type or received time and 20% of errors were attributed to no mention of diagnosis in requisition forms. The next most common errors noted were insufficient samples (8.26%) followed by absence of physician's signature (7%), incomplete request form (5.4%), age (4.2%), unique hospital identification (UHID) number (3.7%), clotted samples and transportation of the samples (3.6%), date and incorrect vials (2.6%). Gender (0.95%), hemolysed (0.85%), and lipemic samples (0.45%). Hemolysed and lipemic samples had a sigma value of 4.4 and 4.6, respectively, whereas gender and age had a sigma value of 4.3 and 3.8, inadequate sample for testing and an incorrect anticoagulant to blood ratio had a sigma value of 3.6, indicating that sample collection has to be improved as the inverse relationship is noted between sigma value and laboratory performance. Conclusion Pareto chart and sigma value can help recognize most common pre-analytical errors, which consequently will help to prevent further recurrence of pre-analytical errors. Adequate training with regard to best practices in phlebotomy for interns, clinicians and technicians must be provided to decrease quantitative errors, which will further enhance total quality management in the laboratory.

Significance of Nuclear Morphometry in Breast Lesions: A Cross-Sectional Study.

Background Fine-needle aspiration cytology (FNAC) is one of the reliable methods in diagnosing breast cancers. Morphometric studies are done in benign and malignant neoplasms of various organs by using software, which measures cellular, cytoplasmic, and nuclear parameters. Nuclear parameters define the behavior of the neoplasm. This study aims to evaluate nuclear morphometry parameters in aspirated smears of breast lesions and determine the association between cytological findings with nuclear morphometry parameters. Methodology It's a retrospective cytology study from July 2020 to June 2022 conducted at a tertiary health care center in Kolar, Karnataka, India. The FNAC smears of breast mass were analyzed cytologically and were subjected to nuclear morphometry study. Nuclear parameters such as nuclear area, nuclear perimeter, nuclear Feret diameter, minimum Feret, and shape factor were captured in Zen software (Zeiss, Oberkochen, Germany) and ImageJ software (National Institutes of Health, Bethesda, MD, USA; Laboratory for Optical and Computational Instrumentation [LOCI], University of Wisconsin-Madison, Madison, WI, USA). The association between nuclear morphometric findings and cytological findings was noted. A descriptive statistical analysis was done. Results Sixty cases of mass in the breast were considered for the study of which 37 cases were benign and 23 were malignant. Nuclear morphometry parameters such as nuclear area, nuclear perimeter, nuclear Feret diameter, minimum Feret, and shape factor for benign breast lesions were 25.16 ± 3.2 µm2, 21.58 ± 1.89 µm, 6.5 ± 0.94 µm, 4.87 ± 0.50 µm, and 0.92 ± 0.02, respectively, and for malignant breast cases were 46.57 ± 12.24 µm2, 27.53 ± 3.26 µm, 10.08 ± 1.18 µm, 6.49 ± 0.88 µm, and 0.93 ± 0.01, respectively. The association of all nuclear parameters between benign and malignant lesions was statistically significant (P = 0.001). Conclusions Nuclear morphometric study in breast lesions is a concept that supplements FNAC findings in differentiating benign from malignant lesions.

Association of P16, Ki-67, and CD44 expression in high-grade squamous intraepithelial neoplasia and squamous cell carcinoma of the cervix.

Background: Stem cells exist in niches in the cervical tissue at squamocolumnar junction, which when infected with HR-Human Papilloma Virus undergo malignant transformation to cancer stem cells and have a role in carcinogenesis and metastasis. The expression of CD44, P16, and Ki67 in high-grade squamous intraepithelial lesion (HSIL) and squamous cell carcinoma (SCC) is assessed in this study. Materials and Methods: Twenty-six cases each of normal cervix, HSIL, and SCC of cervix cases were subjected to immunohistochemistry markers; p16, Ki-67, and CD44. The association of expression of these markers between normal, HSIL, SCC cervix, and clinic-pathological parameters was statistically analyzed. P < 0.05 was considered significant. Results: Of 26 cases of HSIL, 61.5%, 7.7%, and 30.8% cases were positive, ambiguous, and negative respectively for p16 expression. About 11.5%, 53.8%, and 34.6% of cases were strongly positive, positive, and weakly positive, respectively, for Ki-67 expression. About 42.3%, 42.3%, and 15.4% cases were strongly positive, positive, and weakly positive, respectively, for CD44 expression. Among 26 cases of SCC of the cervix 92.3% and 7.7% were positive and ambiguous respectively. About 73.1% and 26.9% of cases were strongly positive and positive, respectively, for Ki-67 expression. 65.4%, 30.8%, and 3.8% of cases were strongly positive, positive, and weakly positive, respectively, for CD44 expression. p16, Ki-67, and CD44 expression between the three groups were statistically significant. p16 expression versus FIGO stage including lymph node involvement and CD44 expression versus lymph node involvement in carcinoma cervix was statistically significant. Conclusion: Expression of p16, Ki-67, and CD44 increases as the lesion progress from normal to HSIL to carcinoma cervix. p16 and CD44 expression increase with lymph node involvement. P16 expression was maximum in Stage II than Stage III.

Outcome-Based Medical Education Implication and Opportunities for Competency-Based Medical Education in Undergraduate Pathology.

Introduction Outcome-Based Education (OBE) is an education model for students that assist the teachers to outline the cause and evaluation with goals in mind to achieve results such as Program Outcome (PO) and Course Outcome (CO) which forms the basis for evaluating student performance. Materials and methods This study was conducted with the participants to discuss the hardships faced while implementing Competency-Based Medical Education (CBME). Need-gap analysis based on CBME guidelines was performed. Detailed discussion was done with department faculty to plan. Results Internal and final evaluations were done for all the students. When compared with conventional didactic lectures remarkable improvement in academic results of the students were noted which were statistically significant with p value less than 0.001. Conclusion CBME is not just adding capabilities but also achieving and strengthening these capabilities with a proper educational approach and efficacious evaluation methods.

Diagnostic utility of CK19 and galectin-3 in differentiating papillary thyroid carcinoma from nonneoplastic lesions of thyroid.

Background: Thyroid neoplasm is one of the most common endocrine neoplasms. The diagnosis and the distinction between malignant and benign neoplasms can be difficult, but it has clinical, therapeutic, and prognostic significance. Hence, it is necessary to make precise diagnosis by using biomarkers. Materials and Methods: This is a laboratory observational study considering histologically diagnosed cases of papillary thyroid carcinoma (PTC) and nonneoplastic thyroid lesions. Immunohistochemistry (IHC) staining was done on tissue sections of all cases for CK19 and galectin-3 using appropriate positive and negative controls. The expression of immunomarkers was evaluated by a semi-quantitative method as negative, weak positive, moderate positive, and strong positive. The data were entered in Microsoft Excel sheet and were analyzed using SPSS 22 version software. Results: A total of 52 cases were considered for the study, of which 26 cases each were PTC and nonneoplastic lesions of thyroid. Among the 26 PTC cases, 6 were classical variant of PTC (CVPTC) and 20 were follicular variant of papillary thyroid carcinoma (FVPTC). Among 26 nonneoplastic cases, 13 each were nodular hyperplasia cases and lymphocytic thyroiditis. There was a statistically significant (P < 0.01) association of CK19 and galectin-3 expression between CVPTC and FVPTC. There was no statistically significant association (P = 0.271) of CK19 expression between PTC and nonneoplastic cases. There was a statistically significant association (P = 0.003) of galectin-3 expression between PTC and nonneoplastic cases. Conclusion: Galectin-3 expression can be used to differentiate PTC from nonneoplastic lesions of thyroid in ambiguous cases. Galectin-3 and CK19 expression can be used to classify PTC into CVPTC and FVPTC.

Significance of platelet parameters in squamous cell carcinoma of oral cavity - A case-control study.

Introduction: Tumor microenvironment plays an important role in cancer progression. Platelets are one of the components of the tumor environment shown to have a role in cancer survival and progression. Materials and Methods: Ninety-six cases of squamous cell carcinoma (SCC) cases of the oral cavity and 96 age/sex-matched healthy controls were considered for the study. Data regarding platelet count, platelet distribution width (PDW), mean platelet volume (MPV), Platelet-Large Cell Ratio (P-LCR), Plateletcrit (PCT), platelet/neutrophil ratio (PNR), platelet/lymphocyte ratio (PLR), and Platelet/Monocyte Ratio (PNR) from automated hematology analyzer records and clinicopathological data from the Department of Pathology were captured. These data were compared between cases and controls and also with tumor size, tumor grade, lymph node status, and tumour node metastasis (TNM) stage of cases. Results: Mean ± standard deviation for platelet count, PDW, MPV, P-LCR, PCT, PNR, PLR and PMR among cases were 315.03 ± 98.26, 10.94 ± 1.66, 9.91 ± 0.77, 23.52 ± 5.64, 0.31 ± 0.086, 62.55 ± 31.51, 149.34 ± 61.32, and 498.67 ± 194.91, respectively, and among controls were 287.88 ± 74.11, 10.84 ± 1.18, 9.89 ± 0.72, 23.45 ± 4.55, 0.29 ± 0.061, 60.27 ± 21.02, 138.71 ± 49.28, and 497.64 ± 172.28, respectively. The association between means of platelet count, PDW, P-LCR, and PCT among cases and controls were statistically significant (P = 0.020, 0.006, 0.030, and 0.000, respectively). No statistically significant association was found between means of platelet count, PDW, MPV, P-LCR, PCT, PNR, PLR, and PMR versus tumor size, lymph node status, and tumor grades. The association between the means of PCT/PMR and TNM Stages I and II were statistically significant (P = 0.029 and 0.016, respectively). Conclusions: Platelet count, morphology, and functions are altered in oral SCC. Platelet activation plays an important role in oral cancer. PCT and PMR can be used to predict the progress of oral SCC as a cost-effective inflammatory marker.

Evaluation of enzyme-linked immunosorbent assay plasma p16INK4a protein in squamous cell carcinoma in uterine cervix: A case-control study.

Background: Cervical cancer is one of the common cancers in females. The common method of screening is Pap test which has low sensitivity. Hence, better methods are explored with different biomarkers, of which estimation of P16 protein can be opted in early detection of cervical cancer. Materials and Methods: Seventy cases and seventy controls were considered for the study. Cases were invasive squamous cell carcinoma (SCC) of cervix confirmed by histopathology. Controls were healthy age-matched females. The blood sample of cases and controls was collected in K2 Ethylenediaminetetraacetic acid vacutainer, and the separated plasma was subjected to estimation of P16 protein by quantitative sandwich Enzyme-Linked ImmunoSorbent Assay method. The data were analyzed for the association between p16 protein in plasma in cases and controls. Results: The age among cases and controls ranged from 30 to 80 years. The P16 levels among cases ranged from 3.4 to 19.6 ng/ml with a mean of 7.24 ± 2.35 ng/ml. The plasma P16 level in controls ranged between 0.9 and 9.7 ng/ml with mean of 4.1 ± 2.22 ng/ml. At cutoff more than 4.8 ng/ml in cases, the sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were 92.86%, 72.86%, 77.4%, 91.1%, and 82.86%, respectively. The specificity increased with increase in plasma p16 levels. The P16 levels were maximum in stage IV disease. Conclusion: This was a pilot study to detect the plasma p16INK4a levels in SCC of cervix. The levels of plasma p16 protein between 3.9 and 5 ng/ml can be considered as the range for the test to be positive. In clinically suspected cases of cervical cancer, levels more than 4.8 ng/ml can be considered for the diagnosis as point of care test.

Pitfalls in Fine-Needle Aspiration Cytology Diagnosis of Ductal Carcinoma in a Lactating Breast.

Breast undergoes hormonal changes, especially during pregnancy and postpartum period and may be associated with benign and malignant lesions. These lesions can arise either de novo or can be an exacerbated change occurring in a preexisting breast lesion. The benign lesion in the lactating breast can show some degree of atypia due to the high levels of progesterone and prolactin which can mimic malignant features microscopically and can be overdiagnosed with breast cancer. On the other hand, breast cancer in the lactating breast can be underdiagnosed when the atypical cytological features are considered as hormonal changes. A few case reports are published in the literature regarding lactating adenoma undergoing malignant transformation. We present a case in 23 years postpartum lactating female with mass in bilateral breasts. Initially, the lesions were diagnosed with hormonal changes on cytology. On follow-up by fine-needle aspiration cytology and biopsy, it was diagnosed with infiltrating ductal carcinoma in both breasts. As far as our knowledge goes, this is the first-case report in the English literature of ductal carcinoma in the bilateral lactating breast arising de novo.

Primary Hemochromatosis Presenting as Type 2 Diabetes Mellitus: A Case Report with Review of Literature.

Hemochromatosis is an autosomal recessive genetic disorder resulting in increased intestinal absorption of iron and eventually to iron overload. The onset of symptoms is usually seen around 40 years of age. Iron overload causes tissue damage in liver, pancreas, skin, joints, heart, and gonads. Approximately 50% of patients diagnosed with hemochromatosis will have either type 1 or type 2 diabetes mellitus (DM) because of selective beta-cell damage due to iron overload and leads to impaired insulin synthesis, release, and insulin resistance. Early diagnosis and treatment of hemochromatosis prevents the development of diabetes. We present a case in a 48-year-old male with a history of DM for 6 months and skin pigmentation over face for 1 year.

Molluscum Contagiosum of Cervix - A Case Report.

Molluscum Contagiosum (MC) is a common viral infection of skin caused by a double stranded DNA Pox virus affecting both adults and children. MC is primarily an infection of school-going children (one to five years), occasionally it affects adults and immunocompromised individuals. Transmission of virus occurs by direct contact with infected persons or contaminated objects. Most common sites are skin of face, trunk and extremities in children, genitals in adults and rarely palms, soles and mucous membranes. The occurrence of MC in genitals is lowest (3%). We present a case report of Molluscum Contagiosum of cervix which is a rare site; only one case has been reported in medical literature till date.

Enterobius vermicularis infestation masquerading as cervical carcinoma: A cytological diagnosis.

Although prevalence of Enterobius vermicularis (EV) infestation in Intestines ranges from 35% to 70%, its prevalence in female genital tract is not known despite several incidental findings. Acute inflammatory cells in the background of cervical Pap smear indicate infestation and should not be neglected as contamination. A 40-year-woman presented with white vaginal discharge persistent for past 1 year. Local examination showed hypertrophied cervix with eversion of both lips and hard consistency of the anterior lip of cervix. A clinical diagnosis of cervical carcinoma was made. However, cervical Pap smear indicated EV eggs in an inflammatory background, treatment to which resulted in completely recovery.

Wilson's disease: A Clinical autopsy case report with review of literature.

Wilson's disease is an autosomal recessive disease resulting in defective copper metabolism, which is usually seen in young adults, predominantly affecting liver and brain. Although it is not uncommon in India, variation in epidemiology, clinical presentation and course are reported. However, community-based incidence and prevalence rates are not available in India and incidences are limited to hospital based reports. Most often, the diagnosis is delayed. We present a clinical autopsy case in a 39 year-old female who had presented with clinical symptoms at 18 years of age. The duration of illness was 21 years. Patient's parent had consanguineous marriage and the younger sibling had died at 5 years of age with similar complaints.

Significance of the plasma lipid profile in cases of carcinoma of cervix: a tertiary hospital based study.

AIMS: To study alterations of plasma lipid profiles in carcinoma cervix and to assess significance compared with controls in different histological grades and stages. MATERIALS AND METHODS: Totals of 99 histopathologically diagnosed cases and 35 controls from a tertiary hospital situated in the southern part of India which caters the rural and semi-urban populations were considered for the study. Fasting blood samples were taken to analyze total cholesterol (TC), triglycerides (TG), high density lipoprotein cholesterol (HDL-C) and low density lipoproteins cholesterol (LDL-C), for comparison of cases, grouped according to histological grades and stages, and controls. One way ANOVA was used for multiple group comparisons and the Student's t test (unpaired) for group wise comparisons. For all tests a 'p' value of 0.05 or less was considered as significant. RESULTS: Out of 99 cases, most (n-39) were seen in the 40-49 year age group followed by 60-69 years (n-22). Serum TG significantly differed between cases and controls but without any relation to differentiation grade. The lipid profile parameters in various grades of cervical cancer were not statistically significant. Statistically significant increase of TC and LDL-C values was observed with increase in stage of the disease. CONCLUSIONS: The study showed TG is elevated in cervical cancer, and that TC and LDL-C are proportional to the spread of cancer as it increases from stage I to stage IV. An in-depth study of molecular changes in lipid metabolism in cervical cancer patients, enzymes/ genes responsible and alterations in LDL receptors is necessary to provide information to decide whether the lipid profile has any diagnostic/prognostic role in cervical cancer.

Significance of blood group and social factors in carcinoma cervix in a semi-urban population in India.

BACKGROUND: To assess the significance of social factors as risk factors for carcinoma cervix and to determine the significance of blood group to prevalence of carcinoma cervix in a semi-urban population of Kolar, Karnataka, India. MATERIALS AND METHODS: One hundred cases of carcinoma cervix were included in the study, along with 200 females of the same ages considered as controls. Case details were collected from the hospital record section regarding social factors and blood groups and the data were analyzed by descriptive statistical methods. RESULTS: Blood group B showed the highest number of cases (55 cases) followed by blood group O (29 cases) in carcinoma cervix which was statistically significant (p<0.001). Age of marriage between 11 to 20 years showed highest number of carcinoma cervix cases (77 cases) and this also was statistically significant (p<0.001). Patients with rural background were 75 (p=0.112, odds ratio: 1.54), parity of more than or equal to two constituted 96 cases (p=0.006, odds ratio: 4.07) and Hindu patients were 95 in number (p=0.220, odds ratio: 1.89). CONCLUSIONS: Blood group B and age of marriage between 11 and 20 years were significantly associated with carcinoma cervix in our population. Region of residence, parity and religion presented with a altered risk for carcinoma cervix.

Pitfalls in diagnosing specific subtypes of carcinoma breast on fine needle aspiration cytology: a report of two cases with review of literature.

Fine needle aspiration cytology (FNAC) is a useful procedure that can be conveniently performed in the outpatient department (OPD) and can be used in the subtyping of breast carcinomas. However, some specific subtypes can cause a hindrance to that. We present two such cases, one of tubulolobular carcinoma breast and the other of squamous cell carcinoma breast that were missed on FNAC, and subsequently diagnosed on histopathology and by immunohistochemistry. A thorough knowledge of the cytological features of the subtypes and the use of immunocytochemistry can appropriately make FNAC a standard, accurate, and simple OPD procedure, thus helping us in arriving at specific diagnosis.