Tumor-Induced Osteomalacia: A Case Report.

Tumor-induced osteomalacia (TIO) is a rare paraneoplastic syndrome with a variable presentation. We present a case of a 55-year-old female who presented with pain in the bilateral hip region for the last two years. On routine biochemical evaluation, she was found to have hypophosphatemia with an X-ray of the bilateral hip region showing an acute stress fracture in the bilateral intertrochanteric region of the femur. An evaluation for the cause of hypophosphatemia revealed renal phosphate loss with low percentage tubular reabsorption of phosphate (% TRP) of 83% (reference range: 85-95%), with tubular maximum phosphate reabsorption per unit glomerular filtration rate (TmP/GFR) of 2.07 mg/dL (reference range: 2.5-4.5 mg/dL (0.67 mmol/L; range: 0.84-1.23 mmol/L)). Further evaluation revealed elevated levels of intact fibroblast growth factor, 445.7 pg/mL (reference range: 23-95 pg/mL). A 68-Gallium DOTA-1-Nal3-octreotide (DOTANOC) PET-CT revealed a focal increased tracer uptake with a lytic lesion at the lateral metaphyseal aspect of the proximal right tibia, suspicious of somatostatin receptor avid mesenchymal tumor, leading to the diagnosis of TIO. Definitive treatment with complete surgical excision of the tumor was done. Postoperatively, her phosphorus level was within the normal target range even without oral phosphate supplementation. While it is a rare condition, a proper and systemic workup can lead to timely diagnosis and management of this debilitating benign condition.

Mammary not otherwise specified-type sarcoma with CD10 expression.

Although mammary carcinoma is one of the most common malignancies among women, sarcoma taking origin from the breast tissue is extremely rare. Most of the mammary sarcomas represent a specific entity such as malignant phyllodes tumor, liposarcoma, or angiosarcoma. However, some cases do not fit into any specific category of sarcoma. These cases are diagnosed with breast sarcoma-not otherwise specified (NOS) type. They constantly express CD10 and are called as NOS type sarcoma with CD10 expression. Herein, we report a case of primary mammary sarcoma-NOS type with CD10 expression in an 80-year-old male. It was misdiagnosed with carcinoma breast on fine-needle aspiration. However, on histology, it was a high-grade tumor without any specific differentiation. Immunohistochemical results showed diffuse strong expression of vimentin and CD10, whereas pancytokeratin, desmin, and CD34 were negative. These tumors are considered a variant of sarcoma with myoepithelial differentiation.

Expression of TP53 in oral squamous cell carcinoma and its correlation with adverse histopathological features.

Background: This study aimed to evaluate the expression of TP53 in oral squamous cell carcinoma (OSCC) and to correlate its expressions with adverse histopathological features like depth of invasion (DOI), lymphovascular invasion (LVI), perineural invasion (PNI), extranodal extension (ENE), and margin status which significantly affect the prognosis. Methodology: This cross-sectional study included 48 patients of OSCC who underwent surgical resection. All the histopathological adverse features such as DOI, LVI, PNI, ENE, margin status were noted. Immunohistochemical expression of TP53 was noted and a correlation of TP53 with histopathological adverse features was done. Statistical analysis was performed using SPSS software. Results: TP53 immunopositivity was seen in 45.83% (22/48) of cases. TP53 has a statistically significant correlation with margin status (P = 0.002). Similarly, TP53 expression is more in cases with LVI (100% cases) though the value is not statistically significant. TP53 expressions are more in positive margin cases and less if the margin is >5 mm. Similarly, TP53 expression is more in cases with LVI (100% cases) though the value is not statistically significant. Conclusion: Few parameters that did not show the correlation of TP53 with adverse histopathological features could be attributed to a small sample size. Further studies with a large number of cases and using other ancillary molecular diagnostic techniques would throw further light on the exact alteration of TP53 in our population and their association with histopathological prognostic features.

Tumour budding in invasive breast carcinoma and its correlation with histopathological prognostic parameters and hormone receptor status.

INTRODUCTION: Tumor Budding (TB) is emerging as an important sensitive indicator of aggressiveness over traditional histopathological variables such as lymph node metastasis and lymphovascular invasion because TB at the invasive front was postulated as the first step of invasion and metastasis. But the role of TB in breast carcinoma is not yet standardized. AIM: This study aims to assess the prognostic significance of TB in breast carcinoma. OBJECTIVES: To study and grade TB in invasive breast carcinoma and correlate it with known histopathological prognostic markers and hormone receptor status. MATERIALS AND METHODS: In this ambispective study, 51 cases of invasive breast carcinoma undergoing radical surgery were studied from September 2017 to September 2021. Tumor buds were defined as a single or cluster of up to four tumor cells at the invasive front of the tumor and were counted by using IHC Pancytokeratin in 200X and graded into a three-tier grading system. The correlation between TB with established histopathological parameters and hormone receptor status was studied. A Chi-square test was used and a P value < 0.05 was considered significant. RESULTS: TB was seen in all cases of invasive breast carcinoma. Grade 1 TB was seen in 37.26% (19/51) of cases and Grade 2 TB and Grade 3 TB in 31.37% (16/51) of cases each. There was a lack of significant correlation between TB with histologic grade, lymph node status, and HER2 neu. Correlation between TB with Estrogen receptor (ER), Progesterone receptor (PR), and American Joint Committee on Cancer (AJCC) Prognostic stage group was noted but it was not statistically significant. CONCLUSION: Although several studies have confirmed the prognostic value of TB in breast carcinoma, they had used several different methods of assessment. So, there is a need for a standardized method for the assessment of TB in breast carcinoma. Further standardization of TB may add its value as a prognostic factor.

Giant adrenal myelolipoma in a young male double heterozygous for HbS and beta-thalassemia trait, clinically simulating retroperitoneal sarcoma.

ABSTRACT: A 57-year-old male had abdominal pain and distension for 6-7 months with a palpable swelling in the right lumbar region. Contrast-enhanced computed tomography abdomen showed a large heterogeneous lesion with fat density measuring 22 cm ´ 16.5 cm in the right suprarenal region. Laparotomy was done which showed an encapsulated mass measuring 21 cm ´ 14 cm ´ 5 cm. Cut section revealed yellowish areas admixed with hemorrhage and large areas of necrosis. Microscopy revealed adrenal myelolipoma. The patient was found to have sickling positive. High-performance liquid chromatography showed double heterozygous for HbS and beta-thalassemia trait. The association of giant adrenal myelolipoma with double heterozygous for HbS and beta-thalassemia trait is rare, and as clinically it simulates retroperitoneal sarcoma, awareness of this rare entity is critical for its accurate diagnosis and proper management.

Neutrophil-to-lymphocyte ratio as a prognostic factor in oral squamous cell carcinoma - A single-institutional experience from a developing country.

BACKGROUND: Cell-mediated inflammatory response, neutrophils, lymphocytes and monocytes are being recognized as an important role in carcinogenesis. Neutrophil-to-lymphocyte ratio (NLR) has been used as an independent prognostic factor in varieties of cancers. NLR can be easily determined from complete blood count, and it could be considered as a simple and inexpensive prognostic marker. AIM: In this study, we evaluate the prognostic significance of NLR in patients with oral squamous cell carcinoma (OSCC). MATERIALS AND METHODS: Clinical and epidemiological data of all biopsy-proven nonmetastatic OSCC treated between 2014 and 2018 were taken into consideration. Pretreatment absolute neutrophil and lymphocyte counts were used to get NLR. Using univariate and multivariate analysis, the impact of NLR on overall survival (OS) and progression-free survival (PFS) was investigated. RESULTS: A total of 50 patients of OSCC with median pretreatment NLR ratio of 2.52 were identified. Based on the median NLR as a cutoff, patients were classified into two groups, i.e., high NLR and low NLR. Elevated NLR was significantly associated with lymph node metastasis (P = 0.01). Four-year OS and PFS were significantly better for patients with low NLR when compared with high NLR group (51.4% vs. 100%, P = 0.001). Four-year PFS for high and low NLR groups was 38.8% and 87.8% (P = 0.002). Multivariate analysis confirmed that NLR is an independent prognostic factor (P = 0.003). CONCLUSION: Pretreatment NLR provides a simple, cheap and early predictor of outcome in this group of patients. However, an optimal cutoff value of NLR should be determined, for which larger sample size and prospective studies are required.

Salivary amylase crystalloids in Warthin's tumor: An aspiration cytodiagnosis.

Crystalloids may be seen in a variety of salivary gland lesions, but their presence is not common. Among various types of crystalloids, amylase crystalloids are usually found in benign lesions of the salivary gland. Here, we report a case of a 76-year-old male with swelling on the angle of the mandible left side for 15 days. Local examination showed a solitary soft-to-firm swelling of size 4.7 cm × 4.1 cm × 2.8 cm. Ultrasonography (USG) showed a well-defined cystic lesion with the solid component. Fine-needle aspiration cytology cytosmears showed predominantly mixed inflammatory cells; few epithelial cell clusters with numerous crystalloids which are rectangular to rhomboid shape with nonparallel sides. Cytological features are suggestive of benign cystic sialadenitis with amylase crystalloids. However, after 3 months of follow-up, as the swelling did not subside, excisional biopsy was done and histopathology showed features of Warthin's tumor with crystalloids. The presence of amylase crystalloids in any type of salivary gland lesion with cystic change; multiple aspirations followed by histopathological examination should be done to rule out neoplastic etiology.

Primary lymphangioma of palatine tonsil.

Lymphangiomas are benign congenital tumors of the lymphatic system. Tonsillar lymphangiomas are extremely rare. Histopathological confirmation is essential to make the correct diagnosis. We report a case of primary lymphangioma of the left tonsil in a 17-year-old male patient who presented with difficulty in swallowing and was clinically diagnosed as a tonsillar cyst.

MicroRNA-130b functions as a tumor suppressor by regulating RUNX3 in epithelial ovarian cancer.

AIM: To evaluate the clinical significance of microRNA (miR)-130b-Runt domain transcription factor (RUNX3) axis and its effects on oncogenic phenotypes of human epithelial ovarian cancer (EOC). METHODS: QRT-PCR was performed to detect the expression of miR-130b and RUNX3 mRNA in 100 EOC and 20 normal ovarian tissues. The associations between miR-130b and/or RUNX3 expression and various clinicopathological features of EOC patients were statistically analyzed. Then, the effects of miR-130b-RUNX3 axis on migration and invasion of EOC cells were assessed in vitro. RESULTS: miR-130b expression was downregulated, while RUNX3 mRNA was upregulated, in EOC tissues compared to normal ovarian tissues (both P=0.001). Importantly, the expression level of miR-130b in EOC tissues was negatively correlated with that of RUNX3 mRNA significantly. Additionally, miR-130b-low and/or RUNX3-high expression were all closely correlated with advanced International Federation of Gynecology and Obstetrics (FIGO) stage (all P<0.05). Moreover, overexpression of miR-130b reduced the expression of RUNX3 and inhibited cancer cell migration and invasion of EOC cells, whereas knockdown of miR-130b increased the expression of RUNX3 and promoted cancer cell migration and invasion of EOC cells. After that, the impaired motility of the miR-130b overexpression cells was recovered partly by the expression of RUNX3. Furthermore, the knockdown of RUNX3 also gave rise to a decrease in cell migration and invasion. CONCLUSION: Our data reveal that the dysregulation of miR-130b-RUNX3 axis may play important roles in EOC development and progression, and the loss of miR-130b may contribute to the malignant biological behavior of EOC cells via regulating the expression of RUNX3, implying their potentials as promising markers for predicting EOC progression and as candidate targets for gene therapy.