Correlation of Nuclear Morphometry with Clinicopathologic Parameters in Malignant Breast Aspirates.

Shilpa GargBackground Nuclear size, shape, chromatin pattern, and nucleolar size and number have all been reported to change in breast cancer. Aim The aim of the study was to quantify nuclear changes on malignant breast aspirates using morphometry and to correlate the morphometric parameters with clinicopathologic features such as cytologic grade, tumor size, lymph node status, mitotic index, and histopathologic grade. Materials and Methods Forty-five cases of carcinoma breast diagnosed on cytology were included in this study. Cytologic grading was performed as per the Robinson's cytologic grading system. Nuclear morphometry was done on Papanicolaou stained smears. One hundred nonoverlapping cells per case were evaluated. Both geometrical and textural parameters were evaluated. Results Comparison of cytologic grades with most morphometric features (nuclear area, perimeter, shape, long axis, short axis, intensity, total run length, and TI homogeneity) was highly significant on statistical analysis. Correlation with tumor size yielded significant results for nuclear area, perimeter, long and short axes, and intensity with p < 0.05. The study of lymph node status and morphometry showed a highly significant statistical association with all the parameters. Mitotic count was significantly associated with all the geometric parameters and one textural parameter (total run length). On correlation of ductal carcinoma in situ and histopathological Grades 1 to 3 with morphometry, it was found that all the parameters except long-run emphasis were highly significant with p < 0.001. Conclusion Morphometry as a technique holds immense promise in prognostication in breast carcinoma.

Correlation of Nuclear Morphometry with Clinicopathologic Parameters in Malignant Breast Aspirates.

Objectives The primary objective of this study was to correlate nuclear morphometric parameters with clinicopathologic features such as cytologic grade, tumor size, lymph node status, mitotic index, and histopathologic grade. Secondary objective was to quantify nuclear changes on malignant breast aspirates using morphometry. Material and Methods Forty-five cases of carcinoma breast diagnosed on cytology were included in this study. These were graded into cytologic grades 1, 2, and 3 as per Robinson's cytologic grading system. Nuclear morphometry was done in all cases on smears stained with Papanicolaou stain. Clinicopathologic parameters including cytological grade, tumor size, lymph node status, mitotic count, and histological grade were correlated with nuclear morphometric parameters, namely, area, perimeter, shape, long axis, short axis, intensity, long-run emphasis, total run length, and T1 homogeneity. Results There were 9 cases in cytologic grade 1, 26 in grade 2, and 10 cases in cytologic grade 3. Histopathology showed 42 cases of infiltrating duct carcinoma, not otherwise specified (IDC, NOS) and 3 cases (6.7%) of ductal carcinoma in situ (DCIS). IDC (NOS) included 6, 27, and 9 cases in grades 1, 2, and 3, respectively. Majority of our cases had a tumor size less than 5 cm ( n = 38, 84.4%) and had positive nodes ( n = 30, 66.7%). Correlation of cytologic and histopathologic grades (including DCIS) with all morphometric features except long-run emphasis was statistically significant. Correlation of morphometry with tumor size yielded significant results for nuclear area, perimeter, long and short axes, and intensity with p < 0.05. Study of lymph node status (positive/negative) versus morphometry showed a highly significant statistical association with all the geometric as well as textural parameters. Mitotic count was significantly associated with all the geometric parameters and one textural parameter (total run length). Statistics Continuous variables were presented as mean ± standard deviation and compared using the two-tailed, independent sample t -test and one-way analysis of variance test. Tests were performed at significance level of 0.05. Conclusion Morphometry is an objective technique which holds immense promise in prognostication in breast carcinoma.

Study of prevalence of ocular manifestations in HIV positive patients.

INTRODUCTION: HIV/AIDS is a disorder which affects multiple systems in our body but ophthalmic manifestations do occur in 70-80% of patients sometime during their lifetime. Eye is affected either directly by HIV virus or indirectly through various opportunistic infections. HIV related ophthalmic manifestations are wide and can affect any part of eye from a dnexal disorders to posterior segment diseases including the optic nerve and the optic tract. This study was done to know the prevalence of ocular manifestations in the known HIV positive case & to correlate the ocular manifestations in HIV positive patients with their CD4+ lymphocyte count and duration of disease. MATERIAL & METHODS: In the present study, we examined 200 known cases of HIV infection who attended the Out Patient Department of Government Eye Hospital, Amritsar, Punjab. Detailed ocular examination was done and the findings were correlated with CD4+ count and duration of the disease. RESULT: In the present study it was found that dry eye and HIV retinopathy were amongst the most common ocular manifestations accounting for 20.5% and 20% of the total cases. Next in the series was neuro ophthalmic complications which include dpapilledema, optic nerve atrophy, papillitis and also third nerve abnormalities. It consisted of 5.5% of the total cases. Almost equal in incidence was anterior uveitis consisting of 5% of the total. Next of importance was CMV retinitis of which 5 cases were seen which constituted 2.5% of the total and all these cases were observed in the patients with CD4+ count less than 50/mm3. p value for this was 0.008 which was statistically significant. Few cases of blephar it is, conjunctivitis, cellulitis, herpes zoster ophthalmic us and keratitis were also found which consisted of 2.5%, 0.5%, 1%,3%, and 2% respectively. CONCLUSION: Any HIV-infected person who at any stage experiences ocular symptoms also should get competent ophthalmologic care at the earliest. Any delay in treatment can lead to permanent visual loss. An improved coordination between two branches of ophthalmology and HIV medicine will need long coordination against this dreadful disease.

Frontal bone metastasis from an occult follicular thyroid carcinoma: Diagnosed by FNAC.

Metastatic deposits in skull bones from follicular thyroid carcinoma is rare, and metastatic disease in skull being the presenting symptom without obvious thyroid lesion (occult primary) is even rarer. A 60-year-old female patient presented with a mass in the frontal region of the skull. Fine needle aspiration cytology was done which revealed an adenocarcinoma with repeated follicular pattern, reminiscent of follicular neoplasm of thyroid, which on immunocytochemistry revealed positivity for thyroglobulin. Patient was investigated further for primary thyroid malignancy, and imaging revealed a nodule in the left lobe of thyroid. Neuroimaging showed osteolytic lesion involving the cranium.

Intrathoracic Malignant Peripheral Nerve Sheath Tumor: Histopathological and Immunohistochemical Features.

Malignant peripheral nerve sheath tumor (MPNST) is a rare nerve sheath tumor derived from Schwann cells or pleuripotent cells of neural crest. Neurogenic tumors make about 10-20% of all mediastinal tumors. Incidence of MPNST is 0.001% in general population and 0.16% in patients with neurofibromatosis I (NF I). We report a case of 60 year female presenting with progressive cough and breathlessness for 2 years. The CECT revealed multiple focal enhancing lesions along inferior mediastinal pleural surface and along lateral pleural surface. A thoracotomy and tumor excision was done and MPNST was diagnosed on microscopy and immunohistochemistry. This case highlights that this unusual tumor may involve lung parenchyma. So this possibility should be kept in mind in patients with intrathoracic mass.

Immunohistochemical expression of glial fibrillary acidic protein and CAM5.2 in glial tumors and their role in differentiating glial tumors from metastatic tumors of central nervous system.

BACKGROUND AND OBJECTIVES: Immunohistochemistry (IHC) has become an important tool in the diagnosis of metastatic brain tumors. The judicious use of a panel of selected immunostains is unquestionably helpful in diagnostically challenging cases. In our study, the best combination of immune markers useful in differentiating metastatic carcinoma from high-grade gliomas in central nervous system (CNS) are glial fibrillary acidic protein (GFAP) and cytokeratin (CK) (CAM5.2). MATERIALS AND METHODS: The study was conducted on 80 cases of glial tumors including metastatic tumors to the CNS. Histopathological diagnosis was established on routine hematoxylin and eosin staining of the sections. Special IHC markers, GFAP, and CAM5.2 were used to differentiate glial from metastatic tumors. RESULT: Of total 80 cases, 40 cases of astrocytic tumors, 2 cases of ependymoma, 2 cases of mixed glial tumors, and 16 cases of glioblastoma multiforme were positive for GFAP. Twelve cases of oligodendroglioma were negative for GFAP. The sensitivity of GFAP in glial tumors was statistically significant as 81.1% and specificity 100%, whereas sensitivity and specificity of CAM5.2 in metastatic tumors were 100%. CONCLUSION: IHC plays an important role in diagnosing tumors of CNS and markers such as GFAP and CK (CAM5.2) are quite effective in differentiating glial tumors from metastatic tumors of CNS.

Progressive muscular dystrophy of heart: diagnosis easily missed by clinicians.

Muscular dystrophy connotes a heterogeneous group of inherited disorders characterized by progressive wasting and weakness of the skeletal muscles. In several forms of muscular dystrophy, cardiac dysfunction occurs, and cardiac disease may even be the predominant manifestation of the underlying genetic myopathy. We present a case of progressive muscular dystrophy of the heart in which the initial and only manifestation was sudden death in a young man.

Infected mature teratoma of mesentery in a child.

Mesenteric teratomas are extremely rare in children. We report a case of 5-year-old girl with abdominal mass and fever. At operation, a multicystic mass with variable consistency found within the leaves of the mesentery of jejunum with pus in it. Histopathology examination showed mature infected teratoma of the mesentery.

Ectopic parapharyngeal meningioma: diagnosis of a rare entity on FNAC.

Meningioma is a tumour most commonly located intracranially that may rarely extend extracranially. Ectopic meningioma presenting as parapharyngeal mass is a rare entity. We report a case of an 18-year-old female who presented with a complaint of swelling below the right angle of mandible associated with difficulty in swallowing for the last 3 months. The swelling measured 1.5 × 1 cm and was firm, fixed, non-pulsatile, non-transilluminant and non-tender. Computer tomography revealed a heterogenous enhancing mass with foci of calcification in parapharyngeal space without any intracranial component. Intraoral fine needle aspiration cytology was performed. A cytological diagnosis of spindle cell lesion of neural origin with the closest possibility of meningioma was rendered. Excision biopsy confirmed the diagnosis of ectopic parapharyngeal meningioma. It is important for clinicians and pathologists to be aware of this entity at the unusual site.