Expression of BRCA1 by immunohistochemistry and its association with ER, PR, Her2neu status in infiltrative ductal carcinoma of breast.

BACKGROUND: Breast cancer is a heterogeneous disease, which differs in its clinical behaviors and responses to treatment and outcome. The prognosis of breast cancer depends on histopathological parameters and molecular subtypes. Among more than 300 genes, which are involved in the pathogenesis of breast cancer tumor suppressor gene such as BRCA1 is known to play a significant role in hereditary cancers. However, its role in sporadic cases of infiltrating ductal carcinoma is yet to be established. AIMS AND OBJECTIVES: To evaluate the expression of BRCA1 in infiltrative ductal carcinoma and to analyze the association of BRCA1 with histopathological parameters and estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor2 (Her2) neu expression. MATERIALS AND METHODS: This was a laboratory-based exploratory study in which 56 patients with infiltrative ductal carcinoma who underwent radical mastectomy from October 2019 to July 2021 were included. Patients with chemotherapy and radiotherapy, trucut biopsies, and incomplete patient details were excluded. Immunostaining for BRCA1 was performed. Individual clinicopathological parameters were compared with the BRCA1 mutation. Statistical analysis was done using SPSS 22. A P value of < 0.05 was considered statistically significant. RESULTS: Among 56 cases of IDC, 18 cases (32.1%) showed BRCA1 mutation. BRCA1 mutation was associated with postmenopausal age, larger tumor size, lower tumor grade, and higher tumor staging. When we analyzed the biomarkers with BRCA1 mutation, it showed a negative association with ER, PR, and Her2 neu and a high Ki67 proliferation index. No family history of breast carcinoma was seen in 34/56 patients where history was available. CONCLUSION: Our study showed BRCA1 mutation in 32.1% and associated with postmenopausal age group, larger tumor size, and higher staging and negative hormonal status of breast carcinoma.

Effect of Moringa oleifera leaves on hematological profile of fluorosis affected rats.

Fluorosis is a metabolic disease that is endemic in nearly 25 countries with India being one of the most affected. It primarily affects the bone and the teeth. Moringa oleifera (MO) leaves are known to reduce the effect of fluorosis on various tissues. Therefore, it is of interest to document the effect of Moringa oleifera leaves on the hematological profile of fluorosis affected rats. Twenty four Sprague Dawley rats were housed two per cage in a room with 12 hours light and 12 hours dark cycle. The rats were allowed to adjust to the laboratory environment for about one to two weeks before the beginning of the study. This study reveals that MO leaves is effective in reducing the plasma fluoride content. It also helps in improving the Hb % and RBC count in fluorosis affected rats. Data shows that Moringa olifera leaves powder is effective in reducing the plasma fluoride content. It also helps in improving the Hemoglobin percentage & Red Blood Cell count in fluorosis affected rats.

Effectiveness of topical green tea against multidrug-resistant Staphylococcus aureus in cases of primary pyoderma: An open controlled trial.

BACKGROUND: Antimicrobial activity of green tea against Staphylococcus aureus both in vitro and in vivo has been reported recently. Studies on clinical efficacy and safety of green tea as antibacterial agent against S. aureus in human cases are rare. OBJECTIVES: To evaluate the clinical effectiveness and safety of topical green tea on primary pyoderma caused by S. aureus. We also attempted to determine the minimum inhibitory concentration of green tea against S. aureus and methicillin-resistant S. aureus. METHODS: Open label, prospective, placebo-controlled study included community-acquired primary pyoderma cases caused by S. aureus. Severity grading was done on a scale of 1-5. Green tea ointment 3% and placebo ointment were used. Cure was defined on the basis of negative culture and assessment of clinical improvement. Minimum inhibitory concentration was determined by agar dilution method. Data were analyzed using Statistical Package for Social Sciences (SPSS) software version 16. RESULTS: Of the 372 patients, 250 received green tea and 122 received placebo. Multidrug-resistant S. aureus was isolated in 89.1% in green tea group and 81.1% in placebo group, respectively. Methicillin-resistant S. aureus was isolated in 24 patients. Cure was seen in 86% in green tea group and 6.6% in placebo group which was statistically very significant. The number of days for comprehensive cure in green tea group was 9.2 ± 6.4 days. All patients with methicillin-resistant S. aureus infection in the green tea group were cured. Minimum inhibitory concentration of green tea against S. aureus was 0.0265 ± 0.008 µg/ml and against methicillin-resistant S. aureus was 0.0205 ± 0.003 µg/ml. LIMITATIONS OF THE STUDY: Comparative trial was not conducted in the same patient with different lesions; children less than seven years were not considered as the school authorities did not permit for younger children to be included in the study and true randomization and blinding of investigators were not done. CONCLUSIONS: Green tea has a significant antibacterial effect against multidrug-resistant S. aureus. Minimum inhibitory concentration of green tea is established and is promising in methicillin-resistant S. aureus infections.

Evaluation of histomorphological and immunohistochemical parameters as biomarkers of cervical lymph node metastasis in squamous cell carcinoma of oral cavity: A retrospective study.

INTRODUCTION: Oral squamous cell carcinoma (OSCC) is seen worldwide but is more common in India. Lymph node (LN) metastasis has been shown to be the strongest prognostic factor in OSCC. Many histopathological and immunohistochemical markers have been studied to predict the LN metastasis. AIMS: To identify clinicopathological factors and immunohistochemical (IHC) biomarkers which predict cervical metastasis in OSCC patients. STUDY AND DESIGN: A total of 105 cases of OSCC were taken up for our study. Histopathological parameters such as tumor thickness, depth, degree of differentiation, pattern of invasion (POI), lymphovascular and neural invasion were assessed. IHC was done on all cases using antibodies against Ki-67, cyclin D, E-cadherin, p53, CD31 and each antibody was assessed according to the standard protocol. STATISTICAL ANALYSIS: To calculate the relation between clinical, histopathological parameter, IHC marker and the occurrence of LN metastasis, chi-square test was used. Variables were tested using multivariate logistic regression method to assess the predictive significance. RESULTS: Out of 105 cases studied, 29 cases showed LN metastasis. Maximum numbers of cases affected were females with involvement of buccal mucosa. We found significant association of cervical LN metastasis with high grade of differentiation, lack of E-cadherin expression, high Ki-67 and cyclin D1 expression. In our study; tumor depth, thickness, extent of peritumoral lympho-plasmacytic infiltration, presence of eosinophils, tumor nest type, p53 and microvessel density (MVD) showed no significant correlation. CONCLUSION: Significant association of cervical LN metastasis with high grade of differentiation, lack of E-cadherin expression, high Ki-67 and cyclin D1 expression was seen.

Inexplicable Co- Existence of Eccrine Spiradenoma and Lichen Planus in an old Case of Basal Cell Carcinoma.

Eccrine spiradenoma is a rare benign adnexal tumour usually seen in the head, neck or upper trunk in young adults. It is rare in the lower extremities and in the elderly. Co- existence of eccrine spiradenoma with other lesions like cylindroma, trichoepithelioma, hidradenoma and chondroid syringoma has been documented in literature. But, concomitant occurrence of eccrine spiradenoma with a non- neoplastic lesion like lichen planus in an old and treated case of basal cell carcinoma has not been documented in literature till date. We present a rare case of eccrine spiradenoma occurring on the right thigh in an elderly female along with lichen planus over the left breast. The lady had been diagnosed with basal cell carcinoma 10 years ago and treated with wide local excision. A brief review of literature is also included.

Primary neuroendocrine carcinoma of male breast: A cytologically diagnosed rare entity.

Primary neuroendocrine (NE) carcinoma of the male breast is very rare. NE breast cancers encompass a heterogeneous group of tumors exhibiting morphological features similar to those of NE tumors of the gut and lung. They express one or more NE markers in at least 50% of the tumor cells. They are rare lesions representing about 2-3% of all breast cancers and more frequently affecting elderly patients. The present case report deals with a NE breast carcinoma in an 80-year-old male who presented with a right breast mass and axillary lymphadenopathy. The cytological features were suggestive of NE carcinoma. A thorough clinical evaluation helped confirm the primary nature of the tumor. The histopathology and immunohistochemistry helped confirm the cytological diagnosis. The histogenesis and prognostic implications of this rare breast tumor with predominant NE differentiation, unusually occurring in a male, is discussed here.

Micronuclei in breast aspirates. Is scoring them helpful?

BACKGROUND: Micronuclei scoring can be used as a biomarker of genotoxic and chromosomal damage. AIMS: 1. To score the spontaneously occurring micronuclei in the baseline population (fibroadenomas) and infiltrating ductal carcinoma, 2. Compare micronuclei frequency in benign tumors and various grades of infiltrating ductal carcinomas. MATERIALS AND METHODS: Study was done at a tertiary hospital where 40 cases of fibroadenoma and 40 cases of infiltrating ductal carcinoma were taken up. May Grunwald Giemsa stained smears were analyzed for micronuclei scoring. STATISTICAL ANALYSIS: Independent sample test (Student t test) was done to look for significant difference occurring between the controls among all grades of infiltrating ductal carcinoma. RESULTS: Mean micronuclei range in fibroadenoma was 1.8 ± 1.9. It was 12.1 ± 9.2, 27.4 ± 27.2 and 100 ± 36.5 in grade I, grade II and grade III carcinomas respectively. CONCLUSION: An increase in micronuclei values was seen from fibroadenoma to infiltrating ductal carcinoma. Micronuclei scoring can be used as a biomarker on fine needle aspiration cytology smears of breast carcinoma.

Cytomorphological patterns of tubercular lymphadenitis revisited.

BACKGROUND: Tubercular lymphadenitis is one of the most common causes of lymph node enlargement in developing countries. Fine needle aspiration cytology (FNAC) plays an important role in diagnosing Tubercular lymphadenitis and prevents unnecessary surgical intervention. AIM: To study the cytomorphological patterns of tubercular lymphadenitis in our study population and correlate the bacillary load by acid fast staining with cytomorphological patterns. MATERIALS AND METHODS: A total of 150 cases of cytological proven granulomatous lymphadenitis and cases without granuloma, but positive acid fast bacilli (AFB) on Ziehl Neelson (ZN) stain were included in our study. Cytomorphological patterns were categorized into four patterns. Pattern A - Epithelioid granuloma without necrosis, Pattern B - Epithelioid granuloma with necrosis, Pattern C - Necrosis without epithelioid granuloma with neutrophilic infiltrate. Pattern D - with numerous macrophages. Chi-square test was done to correlate cytomorphological pattern and bacillary load. A 2 × 2 analysis was done to test the degree of one hypothesis. A P < 0.05 was considered as significant. RESULTS: PATTERNS AND THE NUMBER OF CASES OBSERVED ARE AS FOLLOWS: Pattern A - 29 cases, Pattern B - 84 cases, Pattern C - 34 cases. A distinct D Pattern with abundant foamy macrophages was seen in three immunodeficient patients. Positive ZN staining was seen in 81/150 54% of cases. The cytological patterns of AFB positive cases Pattern A: 6/29 (21%), Pattern B: 46/84 (55%), Pattern C: 25/34 (73.5%), Pattern D: 4/4 (100%). CONCLUSION: FNAC is useful in diagnosing tubercular lymphadenitis. Maximum bacillary load was seen in Pattern C. A distinct D Pattern was seen in immunodeficient patients.

Nasopharyngeal mucoepidermoid carcinoma - a common entity at an uncommon location.

Mucoepidermoid carcinomas mostly occur in the major salivary glands, the minor salivary glands of oral cavity and in the lacrimal glands. These tumours rarely occur in the sino-nasal tract. When they occur in the sino-nasal tract, the most frequent site is the maxillary antrum, followed by the nasal cavity, the nasopharynx and the ethmoidal sinuses. As per review of literature, nasopharyngeal mucoepidermoid carcinomas account for 0.6% of salivary gland tumours and 4.8% of mucoepidermoid carcinomas. Extensive literature search revealed 21 cases of nasopharyngeal mucoepidermoid carcinomas reported till date. These cases showed an age incidence ranging from 20 to 60 years with a female preponderance. In contrast to nasopharyngeal carcinomas, these tumours show low positivity rates for Ebstein-Barr virus serological test. Histochemical positivity for mucin may be demonstrated in the glandular and mucinous components of these tumours. High grade mucoepidermoid carcinoma of nasopharynx is treated with surgical excision combined with radiotherapy and is associated with poor survival. Therefore, early diagnosis and prompt treatment are of utmost importance. This case report highlights the rare occurrence of a high grade nasopharyngeal muco-epidermoid carcinoma in a 70-year-old male and is presented for its unusual occurrence in the nasopharynx which is the most infrequent location for this lesion.

Expression of vimentin in breast carcinoma, its correlation with Ki67 and other histopathological parameters.

CONTEXT: Vimentin is a mesenchymal marker, known to express in some epithelial carcinomas. AIMS: 1. To find out the expression of vimentin in infiltrating ductal carcinoma of breast (not otherwise specified), 2. To find out the correlation between expression of vimentin and prognostic markers such as tumor size, tumor grade, lymph node status, proliferation index (measured by Ki 67), and Nottingham prognostic index (NPI). MATERIALS AND METHODS: Study was done at Department of Pathology; 50 cases of infiltrating ductal carcinoma (NOS) were studied for tumor grade; immunohistochemistry was done using antibodies against vimentin and Ki 67. Percentages of positive cells were documented. An immunoscore was also calculated for vimentin. Vimentin expression was correlated with tumor size, lymph node status, Nottingham prognostic index, and Ki 67. STATISTICAL ANALYSIS USED: statistical correlation was done using Pearson's chi-square test. A P value less than 0.01 was considered significant. RESULTS: Vimentin expression was seen in 18% of cases. Its expression correlated with high tumor grade and high growth fraction (P value < 0.01). It did not correlate with lymph node status, tumor size, and NPI. CONCLUSIONS: Increased vimentin expression is associated with bad prognostic factors. Immunohistochemistry with vimentin may be helpful in knowing the prognosis in cases of infiltrating ductal carcinoma of breast (NOS).

Rare retro-orbital intraconal occurrence of benign schwannoma - a case report.

Schwannomas otherwise referred to as neurilemmomas are benign, slowly progressing, encapsulated tumors arising from Schwann cells in the peripheral nerve sheath. They may grow along any peripheral or cranial nerve. Amongst the cranial nerve schwannomas, the eigth cranial nerve is the commonest site. But orbit is a rare site for their occurrence. Solitary orbital schwannomas account for 1% of orbital neoplasms. Orbital schwannomas arise from 3(th), 4(th), 6(th) cranial nerves and ciliary ganglion. Since complications like optic nerve compression and atrophy are likely to occur, early diagnosis is imperative for appropriate management. The present case deals with the rare occurrence of a retro-orbital, intraconal schwannoma in a 23-year-old lady who was clinically and radiologically diagnosed to have a retro-orbital cavernous hemangioma. The variable presentation and location of this tumor can certainly make the diagnosis difficult which may be confirmed only by histopathological examination as in the present case. Our patient underwent a successful complete surgical excision before any complications could ensue.

MFH Mimic in Breast: A High-Grade Malignant Phyllodes Tumor.

Malignant phyllodes tumor is usually diagnosed by the presence of benign duct-like epithelium and malignant mesenchymal tissue. In addition to the usual fibrosarcomatous features, the mesenchymal component may show areas resembling osteogenic sarcoma, chondrosarcoma, liposarcoma, leiomyosarcoma, rhabdomyosarcoma, malignant mesenchymoma, and, very rarely, malignant fibrous histiocytoma. We present one such rare case of malignant phyllodes tumor with malignant fibrous histiocytoma-like stromal differentiation.

Significance of micronucleus in cervical intraepithelial lesions and carcinoma.

BACKGROUND: The micronuclei (MNi) test on exfoliated cells has been successfully used to screen population groups at risk for cancers of oral cavity, urinary bladder, cervix and esophagus. Their frequency appears to increase in carcinogen-exposed tissues long before any clinical symptoms are evident. There are only limited numbers of studies on MN scoring in cervical pre-neoplastic and neoplastic conditions. AIMS: To compare the micronucleus (MN) score in the whole spectrum of cervical lesions including normal, inflammatory, abnormal squamous cells of undetermined significance (ASC-US), abnormal squamous cells cannot exclude HSIL (ASC-H), low-grade squamous intraepithelial lesion (LSIL), high-grade squamous intraepithelial lesion (HSIL) and invasive cancer (IC) and to evaluate the role of MN as a biomarker in different pre-neoplastic and neoplastic lesions. MATERIALS AND METHODS: A total of 221 slides, comprised of normal (32), inflammatory (32), ASC-US (31), ASC-H (31), LSIL (32), HSIL (31) and IC (32), were studied. All the cases were reviewed by two pathologists independently. Histopathological correlation was done in a few cases of ASC-US, ASC-H, HSIL and IC which were available in the department. Two observers separately and independently counted the number of micronucleated cells per 1,000 epithelial cells in oil immersion magnification and were expressed as MN score per 1,000 cells. RESULTS: The mean MN scores ± SD in normal, inflammatory, ASC-US, ASC-H, LSIL, HSIL and IC cases of cervical lesions were 0.84±0.68, 1.06±0.84, 3±0.73, 4.78±1.43, 4.06±1.13, 8.03±1.64 and 10.5±2.01, respectively. MN scores of IC and HSIL were significantly high compared to normal (P<0.000), inflammatory (P<0.000), ASC-US (P<0.000), ASC-H (P<0.000) and LSIL (P<0.000) group (analysis of variance test). LSIL showed significant difference with the normal (P<0.000), inflammatory (P=0.001), ASC-US (P=0.028), HSIL (P<0.000) and IC (<0.000), but not with the ASC-H (P=0.64) group. CONCLUSIONS: MN scoring on the epithelial cells of cervix could be used as a biomarker in cancer screening. This is an easy, simple, reliable, reproducible and objective test which can be performed on routinely stained pap smears.

Lipoprotein (a) and other Lipid Profile in Patients with Thrombotic Stroke: Is it a Reliable Marker?

BACKGROUND: Cerebrovascular disease (CVD) and coronary heart disease (CHD) cause 40%-50% of deaths in developed countries with CVD causing 10%-12% of deaths. Though increased Lipoprotein (a) is a risk factor in developing CHD, its role is poorly defined in etiopathogenesis of CVD. AIMS: To find the association of lipoprotein (a) and lipid profile in thrombotic stroke patients after acute phase. SETTINGS AND DESIGN: The study was conducted at Kasturba Medical College, Manipal. Twenty one cases of thrombotic stroke and 18 cases of age and sex matched controls were taken for the study. Informed consent was taken from both case and control. MATERIALS AND METHODS: Overnight fasting sample was collected from both case and control. Serum was separated and parameters such as total cholesterol, triglycerides, high density lipoproteins-C, low density lipoprotein-C, lipoprotein (a), fasting blood sugars were estimated. STATISTICAL ANALYSIS: Data were analyzed by SPSS software, Student's t-test, standard deviation (SD), and standard error of mean (SEM), P-value <0.05 is considered to be significant. RESULTS: In this study, we found no statistical significant differences in serum lipid and lipoprotein (a) profile between controls and thrombotic stroke patients. CONCLUSIONS: Highest frequency (38%) of stroke was found in the age group of 7080 years. There were other associated risk factors such as diabetes in five cases (24%), hypertension in nine cases (43%), and family history of stroke in four cases. However, further studies are required to evaluate the importance of serum Lp(a) estimation in the assessment as a risk factor for thrombotic stroke.

Endometrial aspiration cytology by various techniques.

The demand for testing endometrium for detecting pathological as well as hormonal status is increasing and cytodiagnosis is extended very rapidly in malignant and non-malignant conditions. The gynaecologists have responded to this trend by providing cost effective care without compromising the quality. With this in mind, uterine aspiration curettage, ambulatory procedure, for endometrial sampling was studied. Dilatation and curettage (D&C) is probably most commonly performed gynaecological surgery. It accounts for large proportion of hospital bed use and operating room time, the cost is significant and patient also risks the complication of anaesthesia. Consequently various alternative procedures for endometrial sampling like endometrial brush, uterine lavage, jet wash vabra aspiration and endometrial biopsy have been reported.

Metaplastic carcinoma of the breast-a rare neoplasm with transitional cell differentiation: an exceptional feature.

Metaplastic carcinomas of the breast are malignant breast neoplasms composed of a mixture of both epithelial and mesenchymal elements. The rarity of this tumor is exemplified by the fact that it accounts for only about 0.2% of all breast carcinomas. It can present histologically with diverse differentiation and the exact histogenesis of these tumors is unknown. The present case is reported for its rarity and for the presence of transitional cell differentiation along with the other usual components of metaplastic carcinoma. Transitional cell differentiation in a metaplastic carcinoma has not been documented in the literature. Besides this, it highlights the importance of special stains and immunohistochemistry in evaluating these carcinomas and the need for early diagnosis and excision of these tumors as these carcinomas generally have a poorer prognosis as compared to breast carcinomas without metaplasia, with the tumor size having an important bearing on the outcome of this condition.

Paratesticular myxoid liposarcoma: a case report.

Liposarcoma of the paratesticular region is a rare malignant soft tissue neoplasm. Out of all the possible sites of liposarcoma, the incidence in spermatic cord is rare, accounting for only 5% of these neoplasms. Among the various subtypes of liposarcoma described in the paratesticular region, myxoid variant of liposarcoma is seen very rarely. One such case is we ported here for its rarity and also to draw attention to the fact that, early diagnosis and complete excision carry better prognostic value.