Is there any correlation between tumor infiltrating lymphocytes and expression of EGFR in squamous cell carcinoma of head and neck? A retrospective observational study.

Background: : The dismal survival of one of the commonest malignancies of the world, head neck squamous cell carcinomas (HNSCC), has prompted researchers to probe into its various characteristics, especially those which reflect the outcome. Over the years, even though epidermal growth factor receptor (EGFR) and tumor-infiltrating lymphocytes (TIL) have emerged as useful biomarkers of the disease, the two parameters have rarely been considered in conjunction. Aims and Objectives: The study aimed to assess if there is any correlation between TIL levels (both stromal and intratumoral) and site, grade, stage, and EGFR score of HNSCC. Materials and Methods: A retrospective observational study was conducted in which histopathologically confirmed cases of HNSCC were included. The site of tumor, grade, stage, stromal and intratumoral TIL levels, and EGFR score were noted for each case. The data were analyzed using standard statistical tests. Results: The study population consisted of 122 patients with a mean age of 53.8 ± 9.2 years. The oral cavity was the commonest site of tumor (109 cases, 89.3%). Most cases were moderately differentiated (75, 61.5%). Pathological staging showed 66 cases (54%) to be in pT1, and 92 cases (75.4%) to be in pN0. In 68 cases (55.7%), stromal TIL level was high, and intratumoral TIL was low in 102 cases (83.6%). A statistically significant correlation was found between TIL levels and site, grade, pathological stage, and EGFR score of HNSCC. Conclusion: This pioneering study is unique in its exploration of the correlation between two significant biomarkers of HNSCC - TIL and EGFR score.

Tumor infiltrating lymphocytes in head and neck squamous cell carcinoma - Evaluation and clinical impact.

Background: Head-and-neck squamous cell carcinomas (HNSCCs) are one of the most common malignancies worldwide. Emerging evidence reveals that tumor-infiltrating lymphocytes (TIL) provide valuable prognostic information in various malignancies, including HNSCC. Aims and Objectives: The present study aimed to evaluate a simple yet accurate method of counting TILs in HNSCCs. It was also done to determine if there is any correlation between different clinicopathological parameters of HNSCC and TIL counts. Materials and Methods: A.retrospective institutional-based, observational study was undertaken for 1 year. Patients with histologically proven HNSCCs were included. All clinicopathological parameters were noted, and evaluation of TIL was meticulously done both in the stromal and intratumoral regions for each case. Standard statistical methods were employed for data analysis. Results: The present study included 81 patients, among which 51 (63%) were male and the rest (30, 37%) were female. The mean age of the patients was 55.3 ± 10.5 years. Most tumors were located in the oral cavity (73, 90.1%). The most common histologic type was moderately differentiated (MD) squamous cell carcinoma (SCC) (50 cases, 61.7%). Stromal TIL score was high in 45 cases (55.6%). In 69 cases (85.2%), the intratumoral TIL level was low. A statistically significant correlation was found between TIL levels (both stromal and intratumoral TIL) and tumor differentiation, pT stage, and lymphovascular invasion. The correlation between intratumoral TIL level, age of patients, and pN stage was also statistically significant. Conclusion: TIL evaluation is an inexpensive, simple, and reproducible method, which furnishes relevant prognostic data. It has the potential for consideration of its inclusion in routine histopathological reports of HNSCCs.

Clinicopathological study and immunohistochemical analysis of expression of annexin A5 and apelin in human placentae of gestational diabetes mellitus.

BACKGROUND AND AIMS: Gestational diabetes mellitus (GDM) is one of the commonest medical complications of pregnancy. Annexin A5 (ANXA5) is a protein, found in apical surfaces of syncytiotrophoblasts, which prevents fetal and placental vascular thrombosis in GDM. Apelin is a bioactive peptide which has been linked to GDM. The aim of the present study was to correlate macroscopic as well as microscopic changes and immunohistochemical expression of ANXA5 and apelin in placentae of GDM with maternal and neonatal clinical features and also to compare the results with those in matched controls. METHODS: This prospective observational study was undertaken for a period of one year from April 2020 to March 2021. It comprised of 42 patients of GDM. Gross features, microscopic features and intensity and grade of expression of ANXA5 and Apelin were analyzed in placentae of GDM. RESULTS: Morphological changes detected in GDM placentae included increased immature villi (16 cases, 38%), increased syncytial knots (36, 86%), perivillous fibrin deposition (20, 48%), fibrosis of villous stroma (20, 48%), presence of nucleated red blood cells (12, 28.5%) and hypervascularity (34, 81%). The extent of histopathological changes noted in GDM placentae was significantly higher than that in matched controls. GDM placentae showed significantly reduced expression of ANXA5 and Apelin in terms of grade and intensity when compared with matched controls. Reduced expression (mild intensity) of ANXA5 was noted in 22 GDM cases (52.3%) whereas apelin expression was of weak intensity in 26 (61.9%) cases. Among GDM patients, statistically significant association was noted between ANXA5 intensity and neonatal resuscitation, apelin grade and preterm birth as well as low birth weight and apelin intensity and requirement of treatment in sick neonatal care unit. CONCLUSION: The placental expression of the proteins, ANXA5 and Apelin, is altered in GDM though their exact pathogenetic mechanisms are yet to be understood. They can be targets for development of prophylactic and therapeutic agents in future.

Clinicopathological Study of Meibomian Carcinoma of Eyelids - An Experience of Two Years in a Tertiary Care Center.

PURPOSE: Meibomian carcinoma is a rare and aggressive malignant neoplasm of the eyelids. The clinical presentation often mimics benign conditions thereby making the diagnosis challenging. The aim of the study was to analyze cases of meibomian carcinoma, the specimens of which were received, in the past 2 years in the pathology department. METHODS: This retrospective observational study was undertaken for 2 years and included 9 patients of meibomian carcinoma. For each case, detailed history and clinical findings were retrieved from the hospital records. Histopathological examination was undertaken in all cases after preparing hematoxylin and eosin-stained slides from tissue blocks preserved in the department. RESULTS: The mean age of the patients was 55 ± 15 years. Six (66.7%) patients were females, and the other three (33.3%) were male. Following surgery, gross examination of the specimens revealed that the mean size of the excised tumors was 2.45 ± 1.45 cm. The tumors were classified based on histopathological features according to growth pattern, cell type, and cytoarchitecture. Most cases had lobular growth pattern (5, 55.6% cases), consisted of epidermoid cells (5, 55.6% cases), and exhibited infiltrative cytoarchitecture (8, 88.9% cases). CONCLUSION: Early diagnosis of meibomian carcinoma is important to reduce mortality from the aggressive tumor. The knowledge of clinicopathological aspects of the tumors that were biopsied in the department of pathology in the past 2 years will help in diagnosis and management of such tumors in future.

Clinicopathological study of annexin A5 & apelin in pre-eclamptic placentae with emphasis on foetal outcome.

Background & objectives: Pre-eclampsia has remained an elusive disease with serious impacts on both maternal and foetal health. Two novel markers, annexin A5 (ANXA5) and apelin are currently of considerable interest. The present study aimed to determine the placental expression of ANXA5 and apelin in pre-eclamptic placentae and also to elucidate if there is any correlation between the expression of these markers and the clinical features of both, mother and neonate. The comparison between gross and histopathological features of pre-eclamptic placentae and controls was another objective. Methods: A prospective, observational study was undertaken for one year. Placentae of pre-eclamptic patients and matched controls (matched for age, ethnic and socio-economic background) were collected along with the clinical data. Gross and histopathological analyses were done and immunohistochemical study of placental sections with ANXA5 and apelin was also undertaken. Results: 79 pre-eclamptic patients and equal numbers of matched controls were included in the study. The difference in weight and dimensions of placentae between the pre-eclampsia group and matched controls was significant. Histopathological features noted in the pre-eclamptic placentae included decidual vasculopathy, infarction, perivillous fibrin deposition, increased syncytial knots and distal villous hypoplasia. There was a significant reduction in the expression of both ANXA5 and apelin in pre-eclamptic placentae compared to controls. Among pre-eclamptic patients, the intensity of ANXA5 and apelin expression showed a significant association with respect to neonatal resuscitation. Furthermore, the intensity of apelin showed expression a significant correlation with the requirement of sick neonatal care unit treatment. Interpretation & conclusions: The results of the present study suggest that both ANXA5 and apelin levels are reduced in pre-eclamptic placentae. Hence, it is recommended to further explore the impact of these markers on pregnancy outcomes by undertaking randomized controlled trials.

Shifting trend of tubercular lymphadenitis over a decade - A study from eastern region of India.

BACKGROUND: The incidence of tuberculosis (TB) is changing in India. The commonest extra pulmonary manifestation of TB is tuberculous lymphadenitis. AIMS AND OBJECTIVES: To detect changes in occurrence of TB lymphadenitis by comparing current data with that from 10 years back. METHODS: Fine Needle Aspiration Cytology (FNAC) findings of patients presenting with lymphadenopathy between January 2014 and December 2015 were included in the study as current data. Cases of TB lymphadenitis were analysed for cyto-morphological patterns and frequency of acid fast bacilli (AFB) positivity. Cytological data of patients with lymphadenopathy between January 2002 and December 2003, were collected from records. Subsequently, comparison was done between previous data and current observation. RESULTS: Total 302 cases of lymphadenopathy were included in 2014 and 2015. Tuberculous lymphadenitis accounted for 96 (31.7%) cases, among which AFB was present in 47 (49%) cases. Data collected from registers of the years 2002 and 2003 included 318 cases where tuberculous lymphadenitis accounted for 161 (50.6%) cases and AFB was detected in 101 (63%) patients. Maximum AFB positivity was found in smears with caseous necrosis only. CONCLUSION: Presently occurrence of TB lymphadenopathy has reduced compared to the period of 2002-2003. Despite this declining trend, the disease continues to be one of the leading causes of lymphadenopathy in both periods.

Comparative Study of Imprint Cytology and Histopathology of Soft Tissue Tumors.

BACKGROUND: The components of soft tissue are fibroblasts, collagen, vascular structures, fatty tissue, skeletal muscles, smooth muscles, and neural tissue. The real incidence of soft tissue tumors (STTs) is difficult to estimate because most of them are benign (Benign: Malignant-100:1). AIMS: The aim of the present study was undertaken to note the patterns of presentation of patients with STTs and to evaluate the findings of imprint cytology (IC) and histopathological examination (HPE) of STTs. MATERIALS AND METHODS: The present study was undertaken for 1 year. A total of 41 patients with clinically and radiologically diagnosed STTs were included in the study. Following surgery, imprint smear was taken for each tumor, before delivering the tissue to 10% formalin. HPE was subsequently performed. RESULTS: The age of the patients ranged from 4 months to 80 years with a mean of 35.6 ± 17.5 years. The ratio of males to females was 1.05:1. HPE revealed that 21 (51.2%) tumors were benign and 20 (48.8%) malignant. Imprint smears revealed 16 (39%) tumors to be benign and 20 (48.8%) malignant. IC was inconclusive in 5 (12.2%) cases. The sensitivity of IC was found to be 89.5% and specificity 82.35%. The positive predictive value of IC was 85%. The accuracy of IC for diagnosis of both benign and malignant tumors was found to be 75%. CONCLUSION: IC of STTs is a rapid and simple method of intraoperative diagnosis, and it can serve as a viable alternative to frozen section biopsy, particularly in rural settings.

Role of Histomorphology and Chronic Inflammation Score in Chronic Dacryocystitis.

INTRODUCTION: Diseases of lacrimal drainage system account for nearly 3% of visits to eye clinic. Chronic dacryocystitis is a frequently encountered disorder among these patients. Histomorphology of specimens obtained after Dacryocystorhinostomy (DCR) is a pertinent indicator of prognostic outcome. AIM: The aim of the study was to evaluate histopathology of specimens obtained after DCR and to elucidate patterns and score of chronic inflammation encountered. MATERIALS AND METHODS: The study was conducted for a period of one year. Total of 50 patients who were clinically diagnosed as Chronic Dacryocystitis and underwent DCR were included. Following DCR, specimens of lacrimal sac, nasal mucous membrane and nasal bone were collected. Histopathological slides were examined for chronic inflammatory cell infiltration, fibrosis and capillary proliferation and were graded according to severity, in each specimen. A Chronic Inflammation Score (CIS) was recorded for each case. RESULTS: The average age of patients was 39.04±14.22 years and their age ranged between 13 and 62 years. There were 28 (56%) females and 22 (44%) males in the study group. The nasal bone did not reveal any abnormality in any case. The nasal mucous membrane showed mild chronic inflammatory cell infiltration in 46 (92%) cases and moderate degree in 4 (8%) patients. Chronic inflammation with granulation tissue formation was noted in lacrimal sacs of all patients. The CIS revealed that 14 (28%) cases belonged to "mild" group, 26 (52%) to "moderate" group and 10 (20%) to "severe" category. CONCLUSION: The inclusion of CIS in histomorphological evaluation of DCR specimens is recommended since it is one of the parameters that influence course of the disease.

A clinicopathological study of mediastinal masses operated in a tertiary care hospital in Eastern India in 3 years with special reference to thymoma.

INTRODUCTION: The mediastinum is the central portion of the thoracic cavity, limited by pleural cavities laterally, thoracic inlet superiorly, and the diaphragm inferiorly. Housing numerous organs, it is a veritable Pandora's box, within which various lesions may develop. This study was conducted to assess the epidemiologic profile, clinicoradiological features, cytological, and histopathological findings in patients presenting with mediastinal masses in a tertiary care hospital over a period of 3 years. MATERIALS AND METHODS: This is a retrospective study of cases presenting with mediastinal masses attending the Cardiothoracic Surgery Department of Medical College, Kolkata between May 2011 and April 2014. Detailed history, physical, and radiological findings were noted. Fine needle aspiration cytology (FNAC) was performed when feasible. Following surgery, histopathological, and immunohistochemical (IHC) examinations of the specimens were undertaken. RESULTS: Of the 22 cases included in our study, ten were anterior, seven middle, and five posterior mediastinal masses. Fifteen cases were male and seven were female. Thymic pathology was detected in seven cases, lymphoma in five, extragonadal germ cell tumor (GCT) in three, schwannoma and pericardial cyst in two cases each and neurofibroma, ganglioneuroma, and retrosternal thyroid in one case each. The age group of the patients for each diagnostic category was found to be of significance. FNAC was done in 15 cases. IHC was required for classification of lymphoma cases (CD45, CD15, CD30, CD20, CD3, Tdt, CD34, and Ki-67). CONCLUSION: This study reflects the incidence of different mediastinal masses in West Bengal with their clinicopathologic correlation.

Etiology of Pancytopenia: An Observation from a Referral Medical Institution of Eastern Region of India.

BACKGROUND: Pancytopenia is a relatively common hematological condition, the etiological factors of which vary widely in different geographic location. Determining the specific etiology is of immense importance for appropriate management. AIMS AND OBJECTIVES: The present study was undertaken to delineate etiological factors leading to pancytopenia in a Tertiary Care Hospital of West Bengal from Eastern Region of India. MATERIALS AND METHODS: A prospective study was conducted for a period of 2 years in which 248 patients were included. After obtaining a relevant clinical history, physical examination was done followed by complete blood count including peripheral blood smears examination, relevant biochemical, and radiological investigations. Afterward, bone marrow aspiration and biopsy were performed and microscopically examined. RESULTS: Among 248 patients studied, 156 (62.9%) were males and 92 (37.09%) were females. The mean age of the patients was 33 years. Aplastic anemia was the most common cause of pancytopenia that was observed in 83 cases (33.47%) followed by megaloblastic anemia in 52 cases (20.97%), leishmaniasis in 34 patients (13.71%), hypersplenism also in 34 patients (13.71%), and tuberculosis and other connective tissue disorders in 18 cases (7.26%). The occurrence of aplastic anemia was statistically significant in pediatric (≤15 years) age group. CONCLUSION: Aplastic anemia was found to be the most common cause of pancytopenia in this study, which is in contrast to studies conducted from other regions of India. Delineation of etiologies of pancytopenia in various regions can help in defining diagnostic and therapeutic strategies, which is expected to contribute toward the better management of such patients.

Carcinosarcoma of ovary with its various immunohistochemical expression: Report of a rare case.

Ovarian carcinosarcoma is an extremely rare tumor with an incidence of <2%. A report of such a rare case in a 40-year-old multiparous woman is being presented here. The patient complained of abdominal pain and distension. Abdominal computed tomography revealed a variegated mass in the right adnexal region. The CA-125 level was 1635 U/ml. The patient underwent laparotomy and the tumor was removed. Microscopic examination of the tumor showed presence of both carcinomatous and sarcomatous elements. Immunohistochemical analysis revealed that the carcinomatous component was positive for cytokeratin and estrogen receptor and negative for progesterone receptor. The sarcomatous component was positive for vimentin. Ki-67 was positive in 60% cells. A final diagnosis of ovarian carcinosarcoma was rendered. This case is significant owing to extreme rarity of the tumor. Records of similar cases must be maintained for future reference with regard to impact of treatment protocol followed on prognosis.

Cytodiagnosis of myxoid adrenocortical carcinoma and role of immunocytochemistry to differentiate it from renal cell carcinoma.

Adrenocortical carcinoma (ACC) is a rare malignancy and cytodiagnosis of this tumor is not routinely encountered by a cytopathologist. Here, we report a case of ACC initially diagnosed by computed tomography (CT)-guided fine needle aspiration cytology (FNAC) with the help of immunocytochemistry. A 48-year-old lady presented with flank pain and abdominal mass for the last 6 months. A CT scan of her abdomen revealed a large mass arising from the upper part of the left kidney. CT-guided FNAC was performed. Cytologic smears showed pleomorphic large cells arranged discretely and in small aggregates against a myxoid background. The cells had a high nucleocytoplasmic ratio, anisonucleosis and conspicuous nucleoli. Based on cytomorphology, differential diagnoses of ACC and renal cell carcinoma (RCC) were made. On immunocytochemistry, the tumor cells were synaptophysin, inhibin, vimentin and Melan-A positive but cytokeratin and epithelial membrane antigen negative. Thus, a cytodiagnosis of myxoid ACC was made and histopathologic examination was suggested. Subsequent histologic examination and immunohistochemistry proved the case to be myxoid ACC.

Is there any role of mast cell density and microvessel density in cervical squamous cell carcinoma? A histologic study with special reference to CD-34 immunomarker staining.

BACKGROUND: Mast cells are involved in induction of angiogenesis in the early-stages of tumor development and in modulating blood vessel growth in the later stages of tumor progression. AIMS AND OBJECTIVES: This study was carried out to evaluate the association between mast cell density (MCD) and microvessel density (MVD) in carcinoma in situ (CIS), microinvasive carcinoma (CA) and invasive squamous cell CA of cervix. MATERIALS AND METHODS: Six cases of CIS, four cases of microinvasive CA and 38 cases of invasive CA were studied over a period of 2 years from August, 2011 to June, 2013. Ten control samples were included in the study. Routine histologic examination was done. Toluidine blue stain was used for MCD determination. Immunohistochemical analysis with CD-34 was done for assessing MVD. Student's t-test was used to calculate the statistical significance of MCD and MVD. RESULTS: Both MCD and MVD increased from normal samples through CIS to invasive cervical CA. In the four cases of microinvasive CA, the MCD and MVD were more than that of the control samples, but less than that of the six cases of CIS. CONCLUSION: There is a correlation between mast cell accumulation and angiogenesis in CIS, microinvasive CA and invasive cervical squamous cell CA. MCD and MVD in invasive CA exceed those in CIS and microinvasive CA. It gives us an opportunity to postulate that therapeutic strategies against mast cell mediators and angiogenesis may be of benefit in patients of early-stage cervical CA.

Visceral leishmaniasis with pleural effusion in an immunocompetent patient.

Visceral leishmaniasis (VL) is usually characterized by splenomegaly, pallor and fever. Pleural effusion is an uncommon feature of this disease, which is encountered in immunocompromised patients. Here, we report a case of VL with pleural effusion in an immunocompetent patient. Pulmonary symptoms in VL are usually related to bacterial lung infection, vagal nerve compression by splenomegaly, and hypoalbuminaemia with mild pulmonary edema. Our patient presented with cough and chest pain. The clinical features of this case were baffling since they mimicked that of pulmonary tuberculosis. This case report emphasizes the need to recognize the diverse nature of presentation of this curable yet fatal infectious disease.

Histopathological study of adrenocortical carcinoma with special reference to the Weiss system and TNM staging and the role of immunohistochemistry to differentiate it from renal cell carcinoma.

BACKGROUND: Adrenocortical carcinomas (ACC) are rare tumors with an incidence of 1-2/million/year. They account for 0.05-0.2% of all malignancies. AIMS AND OBJECTIVES: This study was aimed to evaluate the Weiss system to diagnose ACCs and to compare it with TNM staging. The role of immunohistochemistry (IHC) was also evaluated to differentiate ACC from other differential diagnoses especially, renal cell carcinoma (RCC). MATERIALS AND METHODS: A total of 10 ACCs were included from April, 2000 to March, 2012. All the relevant information like weight, tumor size, gross features was recorded. Multiple sections were taken for histologic examination. Immunomarkers like vimentin, synaptophysin, Melan-A, calretinin, inhibin, EMA, cytokeratin, and Ki-67 were used. RESULTS: Out of 10 cases of ACCs (diagnosed by the Weiss system), the tumors were in TNM stage I (1 case), stage II (2 cases), stage III (5 cases), and stage IV (2 cases). The Weiss score in stages I-IV was 4; 5-7; 6-8; and 5-9 respectively. ACCs were positive for vimentin, inhibin, Melan-A, calretinin and negative for EMA and cytokeratin. Proliferative index (Ki-67/MIB-1) was ≥ 20 % (20-65%). CONCLUSION: Both the Weiss system and TNM staging are useful in predicting the malignant behavior and prognosis of ACC. Weight and tumor size, though originally not included in the Weiss system, are also important parameters. In lower stages (stages I and II), the Weiss score is low (4-7) while the score is high (6-9) when the tumor is in higher stages (stages III and IV). IHC plays a vital role to confirm the diagnosis and to exclude the possibility of RCC.

Mature cystic teratoma of the lung.

Intrathoracic teratomas are usually seen in the mediastinum; they rarely occur in the lung as intrapulmonary teratomas. The criteria for pulmonary origin are the exclusion of a gonadal site or other extragonadal primary sites and the exclusive origin of the tumour from the lung. Lung teratomas, for reasons unknown, commonly involve the upper lobe. Here, we report the case of a mature cystic teratoma (dermoid cyst) in the right middle lobe of the lung in a 22-year-old man. We present the clinical and radiological features, as well as histopathological findings, and discuss the relevant literature.