An adding up of an exceptionally rare case report: Primary Squamous cell carcinoma of Jejunum from North India.

Squamous cell carcinoma (SCC) of lower gastrointestinal tract is a rare tumor and duodenum is the most common site of involvement. In addition, involvement of jejunum by SCC is further exceptionally rare, and only nominal cases are present world literature. Being a very infrequent finding, a clinician and a pathologist must be aware of this rare entity. Diagnosis requires histopathology along with clinico-radiological correlation since merely histopathology is unable to differentiate between primary and metastatic tumor. Treatment modality is totally different in primary and secondary tumor of lower gastrointestinal tract. Being an extremely rare case of primary SCC of jejunum in an elderly female makes it eligible to be acknowledged at the global platform of medical literature.

Immunoexpression of PD-L1 and PD-1 and Its Clinicopathological Correlation in Urothelial Carcinomas.

Introduction Urothelial carcinomas are the most common types of bladder tumors that have recently shown a changing trend in treatment protocols with the introduction and approval of immune checkpoint inhibitors. The most important immune checkpoint lies with the PD-1-PD-L1 axis. Although multiple drugs have been approved, there is uncertainty about patient selection criteria and diagnostic assays. Recent studies related to the laboratory-developed tests have opened up the horizon of PD-1 and PD-L1 immunohistochemistry even at resource-constrained laboratories. We propose to study these immunohistochemistry markers in our laboratory using newer clones. Materials and Methods We selected 116 consecutive cases of transurethral bladder tumor resection from our laboratory archive and applied PD-1 and PD-L1 immunohistochemistry. The study was approved by the institution's ethics committee. Results We found high expression of PD-1 and PD-L1 in urothelial carcinoma even with different cut-offs of PD-L1. Muscle invasion, lamina invasion, and grade of carcinoma had a statistically significant effect on the expression; however, age and sex did not affect the expression. Conclusion Based on our current study, we can conclude that the clones used in our study show high expression in urothelial carcinoma and can aid in patient selection and treatment protocol, irrespective of age and sex.

Primary Neuroendocrine Tumor of Urinary Bladder: A Case Report of an Unusual Occurrence.

Pheochromocytomas are tumors arising from catecholamine secreting cells of adrenal glands. Extra adrenal gland pheochromocytomas are called paragangliomas. They account for 15% of all pheochromocytomas. Paraganglioma arising in the urinary bladder is extremely rare accounting for 0.06% of all urinary bladder tumor cases. We present a case of a 55-year-old female patient who complained of pain in abdomen and intermittent haematuria subsequently. Magnetic resonance imaging (MRI) pelvis was done which gave the possibility of paraganglioma. An excision of bladder mass was done and sent for histopathology. On histopathology accompanied by immunohistochemistry, a final diagnosis of paraganglioma was given. The patient is on regular follow-up.

Comparison of Positivity Rates of Rapid Antigen Testing and Real-Time Polymerase Chain Reaction for COVID-19 During the First and Second Waves of the Pandemic in Eastern Uttar Pradesh, India.

Background The advent of the second wave of coronavirus disease 2019 (COVID-19) in India caused a new range of challenges in diagnosing the virus. Various point-of-care tests have been introduced for rapid diagnosis. Although rapid antigen tests are the most commonly used, the false-negative rates are high. Therefore, the purpose of this study was to compare the positivity rate of real-time polymerase chain reaction (RT-PCR) testing in rapid antigen-negative cases of COVID-19 during the first and second waves of the COVID-19 pandemic. Methodology This was an observational study conducted in the Department of Microbiology, All India Institute of Medical Sciences, Gorakhpur. Results In total, 2,168 patients were tested. The percentage positivity rate of the RT-PCR tests among the antigen-negative samples was 4.34% in the first wave of the pandemic whereas it was 8.08% in the second wave. Conclusions The main conclusion of this study was that antigen tests should never be used alone for the diagnosis of COVID-19. Instead, they should be confirmed with a RT-PCR test.

Interobserver reproducibility of The Paris System of Reporting Urine Cytology on cytocentrifuged samples.

BACKGROUND: The Paris System of Reporting Urine Cytology aims to screen samples for HGUC and to provide a universally acceptable reporting format for urine cytology specimens. However, studies detailing the reproducibility of this system, especially on cyto-centrifuge preparations, are lacking. METHODS: 149 voided urine samples received in Department of Pathology were reviewed independently by five cytopathologists. To estimate the overall agreement, Gwet's AC and AC1statistics between each pair of raters were used. To measure the random error component, polychoric correlations were used. To assess the systematic error, Friedman test was used. RESULTS: There was moderately good inter-rater agreement between the raters. Gwets AC2 ranged between 0.67 and 0.89 for the classification of the cases once the sample was found adequate for assessment, while the Gwet's AC1 ranged between 0.61 and 0.94 in assessing for adequacy. There were significant systematic differences between raters in their thresholds for the different categories as well as in differentiating between an adequate and inadequate sample (P value by Friedman test <.001). The association between pathologists was moderately high (polychoric correlations ranging from 0.67 to 0.93). In the majority (108 of 149, 72.5%) of the cases, the range of differences between raters were of one category or less, suggesting satisfactory agreement, but having large disagreements in minority. CONCLUSION: The interobserver reproducibility for the Paris System is moderately good, and is suitable for adoption. It is limited by the lack of agreement as to what constitutes an adequate specimen and differing threshold for categorizing the lesions in differing groups.

Diagnostic pitfall of a rare variant of angiomyolipoma, epithelioid angiomyolipoma - a case report.

Angiomyolipoma of the kidney is a common benign mesenchymal neoplasm of kidney. A rare variant, epithelioid angiomyolipoma, however, may show malignant behavior. We report a case of epithelioid angiomyolipoma in a patient not having tuberous sclerosis which was initially misdiagnosed as renal cell carcinoma. A 39-year-old woman presented with a history of flank pain. Ultrasonography revealed a left renal mass. Contrast-enhanced computed tomography (CECT) abdomen revealed mass involving hilum of the kidney. On core biopsy a possibility of renal cell carcinoma was suggested. The patient underwent radical nephrectomy. After immunohistochemical analysis, a final diagnosis of epithelioid angiomyolipoma was made. Renal epithelioid angiomyolipoma without adipocytic component is extremely rare. It is pivotal to keep a possibility of epithelioid angiomyolipoma whenever an epithelioid renal tumor is encountered showing marked pleomorphism and mitosis. The use of melanocytic markers and specific markers of renal cell carcinoma will aid the diagnosis.