Relevance of Partial p16 Immunostaining in Oral Squamous Cell Carcinoma and Co- Relation with HPV DNA Status.

INTRODUCTION: Immunostaining criteria for p16 positivity in oropharyngeal squamous cell carcinoma have been laid down by College of American Pathologists (CAP) and the American Society of Clinical Oncology (ASCO). The staining should be of moderate to strong intensity seen in 70 percent of the tumor cells. Recent studies have pointed out that a small minority of cases are missed using p16 as the surrogate marker at above mentioned cut off. By convention the same criteria have been used for oral squamous cell carcinoma. MATERIAL AND METHODS: The authors revisited the results of their previous study where immunohistochemistry for p16 was found to be positive by AJCC criteria in 139 out of 800 cases of oral squamous cell carcinoma. For this study, all the p16 immunonegative cases (by AJCC criteria) were analysed again for partial staining patterns, defined for this study as cases with 50-75% cells showing 2+/3+ intensity of nuclear p16 immunostaining and for basal predominant pattern of immunostaining. These cases were subjected to HPV DNA PCR. RESULTS: Out of the 661/800 cases found to be negative for p16 immunohistochemistry, a total of 34/800(4.25%) showed partial staining based on the criterion of 50-75% cells showing p16 immunostaining intensity of 2/3+.The basal predominant pattern of immunostaining for p16 was seen in 43/800 (5.38%) cases. When these cases were subjected to HPV DNA analysis, 11/34 (32.35%) of the cases showing partial staining and 02/43 (4.7%) of the cases showing basal predominant pattern of p16 immunostaining were found to be HPV-DNA positive. CONCLUSION: The inclusion of partial immunostaining patterns of p16 in HPV analysis of oral squamous cell carcinoma can improve our understanding of HPV driven oral squamous cell carcinoma.

Cytohistological and Immunohistochemical Correlation of Cutaneous Mixed Tumors: A Series of Four Cases and Review of Recent Molecular Updates.

Fine needle aspiration cytology (FNAC) is an established diagnostic modality today, but its utilization in skin tumors is limited by the fact that most of these lesions are small and easily accessible for clinicians to perform an excision biopsy. As a result, our knowledge of the cytological features of some of the uncommonly encountered skin tumors is still lacking. The aim of this study was to correlate the cytological features of cutaneous mixed tumors (CMTs) with histological and immunohistochemical findings in four cases of CMT in commonly and uncommonly encountered locations. We also review the recent updates highlighting the various genetic rearrangements and newer more specific immunohistochemical markers described so far. This was a retrospective study, and all the slides were taken from our departmental archives. Case 1 was a 25-year-old male who presented with a gradually increasing painless swelling over the right angle of the mouth of 1.5 years duration. Case 2 was a 45-year-old male with swelling on the right forearm for the last three years. Case 3 was a 35-year-old female with a forehead swelling of one year duration. Case 4 was a 55-year-old female with left cheek swelling for two years. On clinical examination, all four nodular swellings were predominantly in the skin/subcutaneous tissue. On cytology, all cases showed abundant chondromyxoid material with clusters of benign epithelial cells and a fair number of predominantly singly scattered myoepithelial cells. The diagnosis of all four cases was further confirmed on histopathology and immunohistochemistry, and the findings correlated well with cytology. The cytological features of CMT closely correlate with their histopathological and immunohistochemical features. Newer immunohistochemistry (IHC) marker pleomorphic adenoma gene 1 (PLAG1) may be helpful in making a definitive diagnosis of CMT on cytology and cell block preparation along with a good clinical correlation. Complete surgical excision is the treatment of choice, and recurrence is rare.

Giant Cell Tumor of Clavicle in an Elderly: Rare Presentation of a Common Tumor with Review of Literature; 1980-2020.

Giant cell tumor (GCT), also known as osteoclastoma, is a locally aggressive benign tumor arising in the epiphysis of bone. It accounts for 3%-8% of all bone tumors. About 75%-90% of GCTs occur in long tubular bones with more than 50% arising in the distal femur and proximal tibia. Flat bone involvements such as ribs, skull, patella, sternum, and clavicle are rare. Sixty-seventy percent of patients with GCT are between 20 and 40 years of age, rarely affecting too young or too old. We present here an unusual case of GCT of the clavicle in a 62-year-old female.

Static smartphone images supplemented by videoconferencing for breast telepathology.

BACKGROUND: Both static images and videoconferencing by smartphone have been tried for telepathology. Combining the two approaches for telepathology might offset some of the limitations of both techniques. METHODS: A total of 150 cases of breast pathology were retrieved and were photographed by a trained junior pathologist using a smartphone camera and binocular microscope and the images were sent as Google photos attachments with email to three pathologists. The pathologists opened the emailed attachments during separate prescheduled google meet videoconferencing sessions and rendered the diagnosis verbally to the junior pathologist. The pathologists were given the option of asking for live dynamic images of the cases during the meet which were transmitted using the rear camera of the smartphone with the video option of google meet. RESULTS: The overall concordance rates for the three pathologists were 96.6%, 99.3% and 98.0% (Mean 98.0%). The reporting pathologists asked for dynamic live images in 23, 20 and 18 cases respectively. Out of these 61 cases, a discrepant diagnosis was made in 7 cases (11.4%). The reporting pathologist was satisfied with the quality of static images (Mean Likert score 4.2/5). However, concerns were raised on the consistency of video quality (Mean Likert score 2.5/5). The screen share option of Google meet was found useful to discuss specific features of the case. (Mean Likert Score 4.6/5) CONCLUSION: The combined approach to telepathology has shown some promise and it is hoped that with adequate training the discordance can be reduced.

Demographic Profile of p16 Immunopositive and HPV DNA PCR Positive Oral Squamous Cell Carcinoma in a Large Cohort of Indian Patients.

BACKGROUND: The Indian subcontinent has the highest incidence of oral cavity squamous cell carcinoma in the world. The high incidence of tobacco chewing habit with or without smoking has been found to be the chief culprit. However in a minor subset of patients Human Papilloma Virus may play a role. MATERIALS AND METHODS: A total of 800 cases of Oral squamous cell carcinoma were included in the study. The patients were given a questionnaire comprising of questions about demographic details and habits. The biopsy samples were routinely processed for immunohistochemistry for p16 (E6H4 clone, CINtec histology, Roche diagnostics). Cases with 2+/3+ positive nuclear staining with more than 75% cells immunopositive were taken as p16 immunopositive as per the AJCC criteria and were further subjected to HPV DNA PCR for which DNA was extracted from the formalin fixed paraffin embedded tissue. RESULTS: Out of 800 OSCC cases 139 (17.37%) showed p16 immunopositivity by AJCC criteria. Out of these, 104 (104/139, 74.8%) cases were positive by HPV DNA PCR for HPV-16/18. Following patient characteristics were associated with a higher proportion of p16 and HPV DNA positivity-urban residence, vegetarian diet, illiteracy, graduate or higher education. No correlation was noted with gender, tobacco smoking or chewing habits, religion, occupation or site of tumor. The p16 immunopositivity was higher in the younger age group with no tobacco habits. CONCLUSION: A significant proportion of OSCC cases in India are associated with HPV infection. A higher percentage of p16 immunopositivity amongst younger patients with no tobacco habits points towards a distinct subset of patients in whom HPV may be the chief culprit and not just playing a supporting role.

A Novel "Work from Home Setup" for Telepathology Second Opinion of Oral Lesions.

The advent of smartphones with high-resolution cameras has opened up new possibilities in the field of telepathology for a second opinion especially in the COVID-19 era. The aim of this study was to evaluate the intraobserver concordance of a novel "work from home setup" with conventional microscopy diagnosis taken as the gold standard. A total of 90 cases of oral biopsies diagnosed by one pathologist were photographed with a smartphone camera. The static images were transferred via Google Drive and viewed on a 40-inch LED television screen connected by an HDMI cable to a laptop by the same pathologist. A wash-off period of 4 months was provided to avoid recall bias. The intraobserver concordance of Google Drive transfer and conventional microscopy was calculated. The cases in which the conventional slide microscopy and smartphone image diagnosis (SPID) via Google Drive were concordant constituted 98.9% (89/90), and the ones with discordant diagnoses made up 1.1% (01/90). Smartphone-assisted telepathology can be useful for a second opinion. The images can be stored on a Google Drive and then downloaded to a personal computer and viewed on large-screen television to attain high levels of diagnostic accuracy.

A Diagnostic Enigma - A Rare Presentation Of Juvenile Fibroadenoma In A Premenarchal Girl.

AIM: Reporting a rare case of a teenage girl, with a bizarre clinical presentation of a benign breast condition, that too is uncommon at her age. CASE: A 14-year-old pre-menarche girl presented with a rapidly progressing lump that involved the entire breast within 3 months. It was associated with ulceration of the overlying skin along with destruction of the nipple-areola complex. RESULTS: During the pre- operative workup, a neoplastic etiology was suspected, but post- operative histopathology revealed it to be giant juvenile fibroadenoma. CONCLUSION: This case emphasizes on the benign character of breast masses in the adolescent age group. Despite the massive volume and appearance, the opportunity of a conservative surgical approach should be sought.

A WhatsApp-based introductory histopathology and cytology course for first-year pathology postgraduate students.

Background The first-year pathology postgraduates can take a long time to learn the basic skills of microscopy, which can become a barrier to learning. Methods A WhatsApp group comprising all 14 postgraduate first-year students with one senior resident and one faculty as group administrators was formed. For the study, 50 routine cases (35 histopathology cases and 15 cytopathology cases) captured by using a smartphone camera and annotated using image-editing software, along with relevant descriptions and weblinks, were sent to the WhatsApp group. A pre- and post-test comprising 15 cases each was conducted and the results were compared by non-parametric Wilcoxon rank test. A feedback form about the effectiveness of this method of learning was circulated at the end of the study. Results The results of the post-test were better than the pre-test by the non-parametric Wilcoxon rank test. Both the active participants (>10 posts) and passive participants of the study group showed statistically significant improvement in the scores and posted a similar number of intellectually thought-provoking posts. The students' responses to the questionnaire also indicated that they liked the new method of instruction. Conclusion This pilot study shows that smartphone-based learning methods can supplant the traditional methods of teaching for pathology postgraduates.

A Rare Case of Nasal Glial Heterotopia in an Infant.

Glial heterotopias are the displacement of neuroglial tissue in extracranial sites. Nasal glial heterotopias can be of three types-extranasal, intranasal and mixed. Root of the nose is the most common location. These are rare anomalies with an incidence of 1 case in 20,000-40,000 live births. Here we report the case of a 6-month-old infant with a congenital mass located at the root of the nose. Non-contrast computed tomography studies showed no evidence of intracranial communication of the lesion. The mass was excised, and on histopathological examination, it showed glial tissue with astrocytes in a fibrillary background and fibroconnective tissue. Masson's trichrome stain showed the red staining of the glial tissue, whereas the background fibrosis was stained blue. On immunohistochemistry, glial fibrillary acidic protein was positive. Hence, the diagnosis of nasal glial heterotropia was made. The patient had an uneventful postoperative period.

Smartphone-assisted tele-gynepathology: A pilot study.

INTRODUCTION: Traditional telepathology techniques like whole slide imaging require expensive equipment and are currently out of reach of the developing countries. However, the improvements in smartphone camera resolution and availability of faster internet have made smartphone-assisted telepathology possible. METHODS: A total of 186 cases pertaining to gynecologic pathology reported by single consultant (NT) were retrieved from the records of the histopathology department. A trained histopathologist then photographed representative areas of each case by using the smartphone camera. After a wash off period of 6 months, the images along with the clinical details were sent by Whatsapp Messenger to the same reporting pathologist. The reporting pathologist replied with the diagnosis of each case by using Whatsapp. RESULTS: The smartphone diagnosis was concordant in 179/186 (96.2%) cases. The intraobserver concordance rates varied with the organ involved - it was highest for endometrial and myometrial pathology (123/126, 97.6%) lowest for ovarian lesions (08/10, 80%). For cervical pathology, it was 97.2% (35/36) and for fallopian tube pathology it was 92.9% (13/14). CONCLUSION: Although the initial results of this pilot study are encouraging, there is a long way to go before smartphone-assisted telepathology can be put to routine use for the second opinion. More experience of the pathologists with this technique and faster internet and better smartphone cameras will further improve the concordance of smartphone-assisted telepathology diagnosis with conventional microscopy diagnosis.