Role of Geminin as a Tool for Augmenting Accurate Diagnosis of Cervical Neoplasia.

AIM: To determine the role of geminin as a tool for differentiating various types of cervical intraepithelial neoplasia (CIN) and cervical carcinoma (CC). METHODS: Seventy women newly diagnosed with CIN or CC undergoing cervical biopsy were included; their clinical profile, human papilloma virus (HPV) positivity, and colposcopy findings were noted, and biopsy tissue was analyzed for geminin content. RESULTS: On geminin immunohistochemistry, 100% of women with CIN3 and 96.29% of women with CC had geminin two plus or more. When analyzed as ordinal variables, there was a significant correlation (spearman's rho 0.35, p 0.01) between geminin and biopsy results (CIN1, CIN2, CIN3, and CC). CONCLUSIONS: Screening tests for cervical cancer, like conventional pap smears, liquid-based pap smears, and triaging with HPV, have limitations. It is important to be able to differentiate between high-grade lesions, invasive cancer, and low-grade lesions. The detection of geminin in these cells may aid in the confirmation of the diagnosis and ensure adequate treatment. Cervical intraepithelial lesions and carcinoma cervix demonstrated a correlation between increased geminin expression in CIN1 vs. CC and CIN2 vs. CC. Geminin may be a potential surrogate marker for higher-grade cervical lesions, and further research is needed to corroborate evidence in this direction.

Co-existing pulmonary hydatid cyst with aspergillosis.

Pulmonary hydatid cyst is known to occur, but incidental detection of Aspergillus colonisation in an unruptured cyst wall, especially in immunocompetent patients, is very rare. Presentation can be hemoptysis or asymptomatic, depending upon immune status. Colonisation of the cyst wall may be due to immune dysregulation, structural abnormalities, invasion of fungal organisms through channels between airways and cyst and other mechanisms. Here, we report a rare case of Aspergillus colonisation in the hydatid cyst wall in a young immunocompetent patient and also try to describe the pathogenetic mechanism for the same.

Solitary osteochondroma of the rib: An unusual chest wall tumor in the pediatric age group.

Pediatric chest wall tumors are unusual and can arise from bone structures or from adjacent soft tissues. Osteochondroma is a benign cartilaginous tumor arising from the metaphysis of bone; however, it is more common in extremity rather than in membranous bone. Although benign, osteochondroma of the rib may lead to fatal complications such as pneumothorax, hemothorax, fractures, and pleural or pericardial effusion. Therefore, some form of surgical management becomes necessary to treat these lesions. We present a case of 7-year-old female child with solitary osteochondroma of the rib. The tumor was surgically excised and the child is asymptomatic on follow-up.

A rare case of cerebellar anaplastic pleomorphic xanthoastrocytoma.

Pleomorphic xanthoastrocytoma (PXA) is a low-grade glioma comprising 1% of all astrocytomas with an extremely rare anaplastic counterpart usually found in young adults. These tumors are most often cerebral in origin and their presentation in the elderly signifies poor prognosis. As these tumors are an important differential of glioblastoma, diagnosing them accurately is essential for management. We present a 68-year-male with positive cerebellar signs and clinico-radiological impression of cerebellar metastatic deposits, subsequently diagnosed as cerebellar PXA with anaplastic features. The case in discussion is unique in its age, site, and grade of presentation, with key histological features rebuking the clinical and radiological diagnosis of metastasis. The rarity and ambiguous management protocol of these tumors make their documentation an important addition to the existing literature with emphasis on possibility of late presentation and at sites other than the cerebrum.

Role of breast ultrasonography in predicting accurate tumor dimensions in correlation with histopathology and its impact on staging of breast carcinoma.

BACKGROUND AND OBJECTIVES: Estimation of the preoperative size of a breast tumor is of primary importance in deciding the treatment modality. Hence, clinical examination of the lump aided by the imaging is necessary. Our study is instrumental in correlating the size of breast tumor by high-resolution ultrasonography (USG) with the morphological size and also in comparing clinical staging of breast carcinoma against the gold standard pathological staging. METHODS: It is a cross-sectional study of correlating the size of tumor on USG with the morphological size of biopsy proven invasive ductal carcinoma when received after excision. The size of the tumor was measured grossly and was compared with the USG measurements and palpatory findings. RESULTS: Seventy percent of cases had good correlation between the USG and morphological size. In 50% of cases, the size on physical examination corroborated with the USG findings and only in 40% of the cases size on physical examination matched with morphological findings. In 65% of cases, the clinical staging of the breast carcinoma matched with the pathological staging. Our study reflected that USG promised to be the most useful radiological tool in predicting the accurate preoperative size of the tumor. INTERPRETATION AND CONCLUSION: We observed that USG has proved to be a very useful conjunct to clinical examination as only palpation was not found to be very accurate in predicting the actual tumor size. It proved to be safer and cheaper and effectively instrumental in meting out an effective management at pre- and postoperative level to the patient.

The immunohistochemical biomarker B-cell lymphoma-2 expression in malignant and premalignant lesions of the uterine cervix and its association with human papillomavirus infection.

Introduction: Cervical cancer is one of the leading causes of cancer deaths among women. It results due to human papillomavirus (HPV) infection. Cervical intraepithelial neoplasia (CIN) is the preinvasive condition of cervical cancer. Various objective immunohistochemical (IHC) markers have been studied for cervical cancer. This study is aimed at studying the expression of B-cell lymphoma-2 (Bcl-2) IHC marker among preinvasive and invasive lesions of cervical cancer and its association with HPV infection. Methodology: This prospective study was conducted over a period of 1 year in a tertiary care hospital in central India, included 73 women suffering from CIN and cancer cervix. The expression of Bcl-2 and the presence of HPV genotypes were studied. Results: Out of 73 patients, 34 had cancer cervix, out of which 15 (44%) had Bcl-2 positivity, 24 had CIN 1, out of which 13 (54%) had Bcl-2 positivity, 10 had CIN 2, out of which 4 (40%) had Bcl-2 positivity and 5 had CIN 3, out of which 3 (60%) had Bcl-2 positivity. No significant difference was found in Bcl-2 positivity among CIN-1, CIN-2, CIN-3, and cancer cervix cases with a Chi-square value of 1.116 and P = 0.77. HPV positivity was found in 41 (56%) out of 73 patients where HPV 16 subtype was the most common (31.5%), followed by HPV 18 (13.7%). No significant association between HPV positivity and Bcl-2 positivity was found with P = 0.34. Conclusion: Bcl-2 IHC seems to have variable expression among CIN cases. Although its expression is low among invasive cancer cases when compared with preinvasive lesions, the difference is not significant. Similarly, no significant association was found between Bcl-2 expression and HPV infections.

Differentiation between various types and subtypes of intracranial meningiomas with advanced MRI.

Background: Meningiomas are the most prevalent of all intracranial tumours. Although they are mostly benign, about 20% of meningiomas are atypical or malignant. Knowledge of their histologic grade can be clinically useful while planning surgery. Objectives: To differentiate between various grades and subtypes of meningiomas with advanced MR parameters. Method: We assessed the advanced MR imaging characteristics of 27 histopathologically confirmed meningiomas on a 3T MRI, of which 23 were grade I meningiomas (2 fibroblastic, 9 meningothelial, 9 transitional, 3 unspecified) and 4 were grade II/III meningiomas (2 atypical, 1 papillary, 1 anaplastic). Analysis of the ADC, FA, λ1, λ2, λ3 and mean diffusivity was performed using standard post-processing software. Results: The mean size of atypical meningiomas (5.9 cm ± 0.7 cm) was significantly higher (p = 0.038, 95% confidence interval [CI]) than that of typical meningiomas (4.6 cm ± 1.6 cm) with a cut-off value of 6.05 cm (75% sensitivity and 87% specificity). The mean cerebral blood flow (CBF) (ASL) of atypical meningiomas (286.70 ± 8.06) was significantly higher (p = 0.0000141, 95% CI) than that of typical meningiomas (161.09 ± 87.04) with a cut-off value of 276.75 (66.7% sensitivity and 75% specificity). Among the typical meningiomas, transitional subtypes had the lowest ADC. High FA and planar coefficient (CP) values and low λ3 and spherical coefficient (CS) values were seen in fibroblastic meningiomas. Fibroblastic meningiomas also showed the lowest vascularity among typical meningiomas. Conclusion: Tumour size and ASL perfusion are two parameters that could differentiate between typical and atypical meningiomas while ADC, FA, λ3, CP, CS, rCBF and rCBV may be helpful in distinguishing different subtypes of typical meningiomas.

Relapse of pemphigus foliaceus initiating at the site of irradiation in an elderly male with laryngeal carcinoma: Illustrating the concept of immunocompromised cutaneous district.

Radiotherapy-induced or -aggravated pemphigus is not a common occurrence with only a few cases reported so far. The radiation disrupts the local immune regulation and alters the antigenicity of keratinocytes, but the exact etiology is not clear. We report a case of an elderly man operated for laryngeal carcinoma who presented with recurrence of pemphigus foliaceus lesions starting at the irradiation site. The appearance of vesiculobullous lesions at the site of irradiation should be evaluated thoroughly to rule out immunobullous diseases.

Extra-Axial supratentorial anaplastic ependymoma: Unusual location of an aggressive tumor, A case report.

Introduction: Ependymomas are more common in the pediatric population, in whom they are commonly infratentorial. Extra axial location of a supratentorial ependymoma is extremely rare. Diagnosis: Radiologically these tumors are often misdiagnosed as meningioma or other extra axial lesions owing to their unusual location and lack of any pathognomonic features. Hence, histopathological examination becomes imperative for proper evaluation and an adequate diagnosis. Case: Herein we report a case of a supratentorial extra axial anaplastic ependymoma misdiagnosed as a metastatic tumor on radiological examination and mimicking meningioma intra operatively, located in the frontal and temporal region in a 20 year old man.

Serum testosterone level and semen quality in male patients with sickle cell disease in outpatient department of Chhattisgarh: a case-control study.

INTRODUCTION: Infertility issues in men with sickle cell disease (SCD) have been studied more frequently than those in women. Semen analysis of men with SCD often shows sperm abnormalities in up to 91%. No such study has been conducted in India so far, and Chhattisgarh being a state with a high incidence of male infertility as well as SCD, this study holds significance. OBJECTIVES: 1. To identify whether male patients attending All India Institute of Medical Sciences Outpatient Department with SCD have abnormal testosterone and/or poor semen quality. 2. Counseling of infertile male patients with SCD regarding future childbearing, prognosis, fertility preservation, and management options. METHODS: This study was an age-matched case-control study; 58 participants of age between 18-45 years were assigned in each group. RESULTS: The sperm count was higher in HbSS, while volume and pH were greater in HbAA. However, no significant difference (P>0.05) was found in total motility or progressive motility. A highly significant difference (P<0.001) was observed in pH, sperm count, total motility, and normal morphology. There was a significant difference (P=0.005) in volume. The values of the HbSS subjects were higher than the standard reference values. The values of the HbAA subjects were higher than the standard reference value. However, no significant difference (P>0.05) was found in sperm count or vitality. CONCLUSION: Men in Chhattisgarh with SCD do not suffer from any reproductive disorders such as delayed sexual maturity, low serum testosterone, poor semen quality, or hypogonadism.

POEMS Syndrome: Skin Lesions Bringing the Jigsaw Puzzle Together.

A 47-year-old man presented to the outpatient department with multiple asymptomatic, erythematous and violaceous, soft, dome-shaped papulonodular lesions that had been present for 3 years. The lesions were vascular and were about 1 cm in diameter. They were present over the face, trunk, arms and legs (Figures 1 and 2). The patient gave history of recurrent ascites and progressive difficulty in walking for last two years.

Pleomorphic Adenoma of the Orbital Ectopic Lacrimal Gland: An Extremely Rare Occurrence with Review of Literature.

Only three cases of pleomorphic adenomas (PAs) of ectopic lacrimal gland mass in deep orbital location have been reported in the literature. This report describes a case of PA of the ectopic lacrimal gland situated deep in the orbit leading to proptosis, which was managed successfully by supraorbital orbitotomy via eyebrow incision. A 60-year-old female presented with complaints of gradually progressive, painless proptosis of the right eye. Imaging revealed a well-defined circumscribed mass lesion in the right orbit located predominantly in the postero-superior aspect of the globe. The patient underwent complete excision through supraorbital orbitotomy approach, using eyebrow incision. There was no clinical evidence of recurrence at eight months follow up. In orbit, PAs of the ectopic lacrimal gland are extremely rare, and the success of the treatment depends on the removal of the tumor with its capsule.

Blunt cardiac rupture due to physical assault: An autopsy-based case series.

Background: The literature reports cases of ventricular rupture in blunt chest trauma following motor vehicle accidents. It rarely describes cardiac tamponade due to rupture of the heart following blunt thoracic trauma in a physical assault. There are rare cases where fatal cardiac tamponade results from a ruptured ventricle without externally visible injuries to the chest. It is also rare for the cardiac rupture to occur on the posterior side. In our case series, the first case involved a direct blow to the left side of the chest by a projectile (brick), causing rupture of the left ventricle's base with intact pericardium. In the second case, a direct blow to the left side of the chest led to rupture of the right ventricle's posterior wall. Case presentation: Here, we report two autopsy-based case series of isolated right and left ventricular rupture with cardiac tamponade in blunt thoracic trauma with a specific history and background information of assault. The first case is a 35-year-old male assaulted with a brick thrown at his chest in a moving bus; he was declared dead on arrival after a one-hour journey. The second case is a 55-year-old male assaulted with double punches in his chest and declared dead on arrival at the hospital after 30 minutes. A medicolegal autopsy and thorough investigation, in both cases, revealed cardiac tamponade due to ventricular rupture with no underlying pathology. Conclusion: This case series underlines the importance of systematic and complete cardiac examination in all death cases following blunt chest trauma even with minimal or no evidence of a visible injury to the chest. Rarely cardiac rupture is noticed on the posterior surface or apex of the heart. The case series illustrates a rare occurrence of cardiac rupture that requires apt investigation and certification of medicolegal causes of death to determine how the death was caused.

A review and case report of enigmatic superficial endometrial spread of cancer of the uterine cervix: Need for vigilance in the primary care setting.

Cervical cancer is a leading cause of cancer-related morbidity and mortality. It usually spreads via direct invasion and lymphatics. Few cases with superficial spread to the uterine endometrium, fallopian tubes, and ovaries have been observed. The staging of these cases, as well as management, is not yet clear due to limited data. The Federation of Gynecology and Obstetrics (FIGO) staging disregards uterine spread to upstage the disease, and it also fails to provide clear guidelines regarding the superficial extension to the ovaries and tubes which is not uncommon in these cases. A 63-year-old female with postmenopausal bleeding was diagnosed with squamous cell carcinoma on a pap smear. Ultrasound and magnetic resonance imaging revealed a predominant endometrial lesion. Histopathology after Wertheim's hysterectomy revealed a squamous cell carcinoma of the endocervix, stage 1B2, that had spread superficially to the endometrium. A total of 48 cases of cervical cancer with superficial spread were identified. The commonest complaint was postmenopausal bleed in 39.39%. In 50% of the cases, the disease was carcinoma in situ, and 70.45% of the women had disease of stage 1B or less. In many cases, the disease had reached the tubes, 36.66%, and ovaries 23.33%. All women with stage 2A or lesser disease except for one were alive at 6 months after surgery. Superficial spread of cervical cancer is a distinct entity. Endometrial pathology must be ruled out before planning management in these women, especially when managing early-stage disease with conservative therapy.

Genetic analysis of human papilloma virus 16 E6/E7 variants obtained from cervical cancer cases in Chhattisgarh, a central state of India.

Human papilloma virus genotype 16 (HPV-16), a predominant etiological cause of cervical cancer (CC) vary in inflicting oncogenicity according to their geographical distribution and mutational changes. With no published data from central India, the present study aimed to genetically analyze HPV-16 E6/E7 variant obtained from CC women of Chhattisgarh. In twenty one CC patients, PCR amplified E6/E7 genes were decoded by DNA sequencing to study phylogenetic relatedness, mutational changes and their in-silico effect on protein structure. E6 analysis revealed nineteen sequences exhibited intratypic variation. L83V mutation was observed in 76.2% sequences followed by S71C seen in 28.6% sequences. Mutations of E41G, A46G, F47V, R77S, L99V and Q107K were observed in three sequences each. C140 Stop codon mutation has caused early truncation of E6 in three sequences to produce the conformational structural change. In contrast, E7 was relatively more conserved showing D4E (4.7%), G88R (23.8%), I93T (9.5%) and C94S (9.5%) mutations. Other than L83V and S71C, E6 and E7 mutations were reported for the first time from India. E6/E7 nonsynonmous mutations have a spectrum of biological effect in progression of CC. Phylogenetic analysis revealed ten sequence belonged to Asian while eleven to European sublineage to show CC cases in Chhattisgarh are a mix of Asian and European lineage. Asian sequences showing higher frequency of L83V mutations and exclusive presence of S71C and C140 Stop codon mutations may be linked with higher oncogenicity. Various E6/E7 mutational data may prove useful for development of better diagnostic and vaccine for the region of Chhattisgarh.

Uterine scar rupture at the site of the placenta accreta presenting as a case of sudden death.

Uterine rupture during pregnancy is a known complication of placenta accreta. This paper presents a case of sudden maternal death in the 27th week of gestation due to a ruptured uterine scar at the site of placenta accreta with a short inter-pregnancy period of 6 months with previous two C-sections. Autopsy findings revealed a massive hemoperitoneum and a thinned out anterolateral uterine wall. Internal examination revealed clotted and fluid blood in the peritoneal cavity with rupture of the anterior uterine wall at the site of the placenta accreta in a healed cesarean section scar. Placenta accreta is a rare complication of pregnancy. However, it is becoming more frequent and a significant risk factor with the increasing rate of C-section.

Methylenetetrahydrofolate reductase polymorphisms as genetic markers to predict homocysteinemia and clinical severity in sickle cell disease.

Aim: The present study observed the relationship between the methylenetetrahydrofolate reductase genotypes and clinical outcome in children with sickle cell disorder. Methodology: A total of 249 children were recruited for the study and evaluated clinically for calculating severity score, homocysteine levels and C677T and A1298C genotyping. Results: The frequencies of variant genotypes were 28.1% CT/TT677 and 69.1% AC/CC1298. Plasma homocysteine was significantly elevated in variant groups (p < 0.001). Both the genotypes accorded significant association with homocysteinemia (p < 0.001). Vascular crisis (p = 0.04), frequency of hospitalization (p < 0.001) and severity score (p = 0.02) revealed association with C677T and not with A1298C. The CT/TT677 genotypes showed 3.39-times (p = 0.032) increase in a higher score for severity. Conclusion: C677T depicted significant association with clinical severity in study population.