Correlation of microvessel density with histopathological parameters of carcinoma breast.

BACKGROUND OBJECTIVES: Microvessel density (MVD) is a surrogate measure of tumour angiogenesis, and is well known for over two decades to identify individuals with a high risk of recurrence with greater prevision than traditional markers. This study aims to assess the utility of MVD and its correlation with the Nottingham Prognostic Index (NPI) and other routine histopathological parameters in carcinoma breast. METHODS: This two year retrospective, cross-sectional and analytical study evaluated 143 women with breast cancer presenting to rural tertiary hospital in central India. These women were graded histopathologically, the immunophenotype was determined using ER (estrogen receptor), PR (progesterone receptor), Her2 neu (human epidermal growth factor receptor 2 neu) and Ki-67 proliferation index (Kiel-67) immunohistochemical markers and anti-CD34 antibody to stain the endothelial cell clusters displaying the microvessels. The NPI was generated for each participant based on the tumour size, histologic grade and involvement of lymph node. The parameters were compared with the CD34 scores. Differential and inferential statistics, including the independent t test, analysis of variance, Pearson's correlation coefficient, Spearman's rank correlation coefficient and point biserial correlation coefficient, were used for statistical analysis. RESULTS: This study showed that CD34 values ranged from 6-36 microvessels/hpf, with 24.16±6.77 microvessels/hpf as the mean. The mean microvessel counts showed a significant positive correlation with the Bloom-Richardson histological grade, vascular invasion, LN (lymph node) positivity and NPI. However, there was no significant correlation of CD34 values with the participant's age, tumour size neither any significant association of CD34 values with the individual's immunophenotype. INTERPRETATIONS CONCLUSIONS: A positive linear correlation of the microvessel counts and the NPI scores suggest that with an increase in tumour angiogenesis, there was increased proliferative potential. Based on the significant correlation between the microvessel counts and the vascular invasion of the tumour masses in this study, it can be assumed that there will be vascular invasion if the microvessel count is higher and vice-versa. Although it is established that angiogenesis and neovascularization are required for the expansion of the solid tumour tissue, the heterogeneous nature of this entity makes it difficult for obtaining a linear correlation. Hence, it is suggested that though neovascularization permits advanced tumour spread it, however, does not guarantee it.

A Comprehensive Review of Artificial Intelligence in Prostate Cancer Care: State-of-the-Art Diagnostic Tools and Future Outlook.

Prostate cancer remains a significant global health challenge, characterized by high incidence and substantial morbidity and mortality rates. Early detection is critical for improving patient outcomes, yet current diagnostic methods have limitations in accuracy and reliability. Artificial intelligence (AI) has emerged as a promising tool to address these challenges in prostate cancer care. AI technologies, including machine learning algorithms and advanced imaging techniques, offer potential solutions to enhance diagnostic accuracy, optimize treatment strategies, and personalize patient care. This review explores the current landscape of AI applications in prostate cancer diagnostics, highlighting state-of-the-art tools and their clinical implications. By synthesizing recent advancements and discussing future directions, the review underscores the transformative potential of AI in revolutionizing prostate cancer diagnosis and management. Ultimately, integrating AI into clinical practice can potentially improve outcomes and quality of life for patients affected by prostate cancer.

Exploring the Usefulness of Tumor Budding as a Histopathological Marker Compared to Tumor-Node-Metastasis (TNM) Staging in Breast Cancer.

BACKGROUND:  Tumor budding, defined as small clusters of tumor cells at the invasive front of carcinomas, has gained attention as a potential prognostic marker in various cancers. This study aimed to evaluate the utility of tumor budding as a histopathological marker in breast cancer and compare it to traditional prognostic markers such as histological grading, tumor-node-metastasis (TNM) staging, and molecular subtypes. METHODS:  A prospective, cross-sectional study was conducted over two years (June 2022 to May 2024) in the Department of Pathology at Jawaharlal Nehru Medical College, Wardha. Seventy-two female patients diagnosed with breast carcinoma who underwent modified radical mastectomy were included. Tumor budding was assessed through histopathological analysis and categorized as high or low. Statistical correlations were established between tumor budding and tumor size, histological grade, lymph node involvement, vascular invasion, and molecular subtypes (estrogen receptor, progesterone receptor, human epidermal growth factor receptor 2, and triple-negative breast cancer, TNBC). The chi-square test and multiple regression analyses were applied to assess significance. RESULTS:  High tumor budding was observed in 68.1% of patients and was significantly associated with larger tumor size (p = 0.040), higher histological grade (p = 0.009), lymph node metastasis (p = 0.002), and vascular invasion (p = 0.003). The postmenopausal age group (>55 years) demonstrated a higher prevalence of high budding (p = 0.010). No significant correlation was found between tumor budding and molecular subtypes (p = 0.39), although high budding was more frequent in TNBC cases. CONCLUSION:  Tumor budding is significantly associated with more aggressive tumor characteristics in breast cancer. Incorporating tumor budding into routine pathological assessments alongside TNM staging and histological grading may enhance the ability to identify high-risk patients and guide treatment strategies. Further large-scale, multicenter studies are warranted to confirm its prognostic value.

Various Markers of Neuroendocrine Tumor: A Narrative Review.

Neuroendocrine tumors (NETs) are uncommon tumors that develop from specialized endocrine cells. Thyroid medullary carcinoma, phaeochromocytomas, pituitary tumors, carcinoid, and gastroenteropancreatic NET are just a few examples of the diverse group known as NET. In recent times, they have garnered significant interest due to their ease of palliation and ability to reveal the long-term impact of the specific hormone raised. Neuroendocrine indicators, particularly chromogranin A, are very helpful in the diagnostic process. Accurate biomarkers that can be employed for NET diagnosis, prognosis and follow-up, therapy stratification, and treatment response evaluation are greatly needed. Due to the great diversity of neuroendocrine neoplasms, particular biomarkers must be developed in order to diagnose, treat, and identify them. The several NET biomarkers covered in this review will aid in the fight against this uncommon illness.

Tumour Budding in Oral Squamous Cell Carcinoma: A Narrative Review.

Tumour budding is an emerging prognostic factor in oral squamous cell carcinoma (OSCC) that reflects the invasive behaviour of the tumour. This narrative review aims to provide a comprehensive overview of the role of tumour budding in OSCC, synthesizing current research and clinical findings. We explore the definition and characterization of tumour budding, its correlation with histopathological features, and its impact on patient outcomes. Tumour budding is associated with increased local invasion, lymph node metastasis, and poor overall survival, highlighting its potential as a key marker for aggressive disease. This review also discusses the methods used to assess tumour budding, including histological scoring systems and the challenges in standardizing these assessments. By integrating findings from recent studies, we offer insights into the clinical relevance of tumour budding in OSCC management and propose future research directions to enhance its application in personalized treatment strategies.

To study the utility of HER2 and Ki-67 as immunohistochemical prognostic markers in comparison to histopathological parameters and tumour, node and metastasis staging in colorectal carcinoma.

Colorectal Carcinoma (CRC) ranks among the most prevalent cancers globally, with significant variability in incidence rates across different regions. A shift towards a Westernized diet has been implicated in rising cancer rates, particularly in emerging nations. By 2020, CRC is projected to represent a notable proportion of global cancer cases and deaths. In India, CRC primarily affects individuals aged 45 to 84, with a higher incidence in males, commonly occurring in the rectum and sigmoid colon. Risk factors such as obesity, dietary factors, sedentary lifestyle, smoking, and alcohol use contribute to CRC development, especially in aging populations. Diagnosis involves various imaging modalities and histological assessments using Tumour, node and metastasis (TNM) and American Joint Committee on Cancer classifications. Recent advancements in targeted therapies like monoclonal antibodies against HER2 have shown promise in treating metastatic CRC. Immunohistochemistry markers like Ki-67 and HER2 play crucial roles in prognostic assessment and treatment planning. This study aims to investigate Ki-67 and HER2 expression in CRC, correlating with histological characteristics and prognostic factors.

Navigating the Diagnostic and Therapeutic Challenges of Central Neurocytoma: A Case Report.

Central neurocytoma, a rare intracranial tumor predominantly located in the lateral and third ventricles, presents a diagnostic and therapeutic challenge due to its varied clinical manifestations. We report the case of a 53-year-old male presenting with right upper and lower limb weakness, headaches, blurred vision, and tingling sensations, leading to the diagnosis of central neurocytoma with associated hydrocephalus. Initial evaluation, including magnetic resonance imaging (MRI) and subsequent computed tomography (CT) scans, revealed characteristic features of the tumor. The patient underwent a two-stage surgical intervention, including tumor excision and ventriculoperitoneal shunting, followed by a tracheostomy due to respiratory complications post-surgery. Histopathological examination confirmed the diagnosis of central neurocytoma, prompting multidisciplinary management and further referral for long-term follow-up. This case underscores the importance of comprehensive evaluation, multidisciplinary collaboration, and continued research in optimizing the diagnosis and management of central neurocytomas.

A Rare Case of Vulval Leiomyoma.

Vulval leiomyomas are exceedingly rare benign smooth muscle tumours, with limited cases reported in the literature. They often present a diagnostic challenge due to their uncommon location and nonspecific clinical presentation, mimicking other vulval pathologies. We present the case of a 40-year-old female who reported a painless, slowly enlarging mass on the left side of the vulva. An excisional biopsy was performed, and histopathological analysis confirmed the diagnosis of vulval leiomyoma. Vulval leiomyomas are rare and may be misdiagnosed due to their similarity to other vulval lesions such as Bartholin cysts, lipomas, or fibromas. The standard treatment is surgical excision, which is often curative.

Insights Into Colorectal Carcinoma: A Comprehensive Review of MicroRNA Expression Patterns.

Colorectal carcinoma (CRC) remains a significant contributor to cancer-related morbidity and mortality worldwide. MicroRNAs (miRNAs) have emerged as crucial regulators of gene expression and play critical roles in various biological processes, including carcinogenesis. This comprehensive review aims to elucidate the role of miRNAs in CRC by analyzing their expression patterns and functional implications. An extensive literature review identified dysregulated miRNAs associated with different stages of CRC progression, from initiation to metastasis. These miRNAs modulate key signaling pathways in tumor growth, invasion, and metastasis. Furthermore, we discuss the potential of miRNAs as diagnostic biomarkers and therapeutic targets in CRC management. Future research directions include elucidating the functional significance of dysregulated miRNAs using advanced experimental models and computational approaches and exploring the therapeutic potential of miRNA-based interventions in personalized treatment strategies for CRC patients. Collaboration among researchers, clinicians, and industry partners will be essential to translate these findings into clinically impactful interventions that improve patient outcomes in CRC.

Navigating the Future: A Comprehensive Review of Artificial Intelligence Applications in Gastrointestinal Cancer.

This comprehensive review explores the transformative role of artificial intelligence (AI) in the realm of gastrointestinal cancer. Gastrointestinal cancers present unique challenges, necessitating precise diagnostic tools and personalized treatment strategies. Leveraging AI, particularly machine learning and deep learning algorithms, has demonstrated remarkable potential in revolutionizing early detection, treatment planning, prognosis, and drug development. The analysis of current research and technological advancements underscores the capacity of AI to unravel intricate patterns within extensive datasets, providing actionable insights that enhance diagnostic accuracy and treatment efficacy. The transformative impact of AI on the landscape of gastrointestinal cancer is emphasized, signaling a paradigm shift towards more precise and targeted cancer care. The conclusion emphasizes the need for sustained research efforts and collaborative initiatives among AI researchers, healthcare professionals, and policymakers. By fostering interdisciplinary collaboration, we can navigate the evolving field of gastrointestinal cancer care, embracing the potential of AI to improve patient outcomes and contribute to a more effective and personalized approach to cancer management.

Mucinous Carcinoma of the Breast With Neuroendocrine Differentiation: A Case Report of Cyto-Histopathology Findings.

Mucinous breast carcinoma is a rare neoplasm. A minority of breast neoplasms exhibit a mucinous component, with purely mucinous cases being less frequent. It is more typically found in postmenopausal women. The etiology is multifactorial and involves dietary factors, reproductive factors, and hormonal factors. Mucinous carcinoma can grow to a large size at the time of diagnosis, although it typically grows slowly and palpable. Transcriptomic genetic studies have explained that mucinous tumors are of luminal A molecular subtype. Mucinous A tumors have different transcriptome characteristics than mucinous B tumors, which have a gene expression pattern resembling neuroendocrine (NE) carcinomas. Diagnosis of mucinous carcinoma with NE differentiation by fine needle aspiration cytology (FNAC) is reported infrequently. Histopathology is mandatory in the evaluation of mucinous breast carcinoma. NE carcinoma of the breast is an underestimated subtype of BC which has characteristics of heterogenicity, rarity, and poor differentiation. In this instance, we present a case of breast carcinoma exhibiting NE differentiation. A postmenopausal woman aged 63, with no family history of breast cancer, presented with a firm mass in the upper lateral quadrant of her right breast. This lump, causing discomfort for the past two years, was accompanied by nipple retraction and the discharge of bloody fluid. The clinical examination revealed the palpable presence of the lump. Ultrasonography-guided FNAC suggested Mucinous breast carcinoma with NE differentiation. The patient underwent a modified radical mastectomy, and the tissue was evaluated by immunohistochemistry which confirmed the diagnosis.

Role of Dietary Antioxidant Supplements in Male Infertility: A Review.

Infertility, which affects around 70 million couples globally, is the inability to conceive after at least a year of continuous, unprotected sexual activity. Male-related elements are involving half of all infertility cases globally. Male infertility has various characteristics, including oligospermia, asthenozoospermia, and teratozoospermia. The purpose of this study was to assess the impact of antioxidant-rich food supplements on the properties of semen, like concentration of sperm, morphology, motility, fertility rate, and damage of DNA. Terms such as coenzyme Q10, antioxidants, folic acid, vitamin C, vitamin E, male infertility, selenium and others, were used to search for relevant research papers in the PubMed database. The findings of this study demonstrated beneficial improvements in semen parameters among infertile men who consumed dietary supplements, particularly combining antioxidants like coenzyme Q10, vitamin C, and vitamin E.

Sinonasal Carcinoma Presenting with Proptosis and Visual Impairment: A Case Report.

Sinonasal carcinoma is a rare but aggressive malignancy arising from the nasal cavity and paranasal sinuses. We present a case of a 40-year-old female who presented with a three-month history of headache, diminution of vision, and proptosis. Imaging studies revealed soft tissue density with bony erosion and extraconal extension in the left orbit. Histopathological examination confirmed sinonasal carcinoma with anaplastic changes. The patient underwent surgical excision of the tumor and received post-operative care in the neuro-ICU. Her visual acuity improved post-surgery, and she was discharged with stable neurological status. This case highlights the challenges in the diagnosis and management of sinonasal carcinoma and underscores the importance of multidisciplinary care for optimal outcomes. Early diagnosis and intervention are crucial in preventing complications and achieving favorable outcomes in patients with this aggressive malignancy.

Primary Adenocarcinoma of the Urinary Bladder: A Case Report on a Rare Malignancy.

Of all primary bladder cancers, primary adenocarcinoma is an uncommon tumor. When considering all tumor origin areas, secondary bladder involvement from carcinoma, whether by direct extension or metastasis, is actually more prevalent than primary adenocarcinoma, despite its rarity. The most common source of subsequent bladder tumors is endometrial, lung, colon, prostate, breast, or other organ adenocarcinomas. Primary bladder adenocarcinoma is thought to result from urothelial metaplasia, which is frequently linked to persistent irritation or inflammation. Bladder exstrophy, recurrent urinary tract infections, long-term irritation from calculi or foreign bodies, and history of schistosomiasis are risk factors. A portion of these malignancies are associated with urachal remnants, where the tumor originates at the dome of bladder. Here we present a case of primary adenocarcinoma in a 44-year-old female patient that originated from the dome of urinary bladder.

Addressing the Digital Divide in Health Education: A Systematic Review.

The disparity in access to essential healthcare resources and services is exacerbated by the digital divide, which presents a significant obstacle to health education. Effective tactics to advance digital equity and provide equitable access to resources for telehealth and digital health are needed to close this gap. Digital databases such as PubMed, MEDLINE, Scopus, Web of Science, and Google Scholar were used to conduct a systematic review. Keywords and Boolean operators including "digital divide," "health education," "digital equity," "telehealth," "digital health literacy," and "strategies" were used in the literature search process. Only peer-reviewed English-language papers that addressed methods for bridging the digital divide in health education were accepted after being screened in accordance with the preset inclusion and exclusion criteria. The results were compiled using a narrative synthesis method after data were retrieved and synthesized with the aid of suitable quality assessment tools. After satisfying the inclusion criteria, seven papers were added to the systematic review. The results emphasized the complexity of the digital divide in health education and provided a range of approaches to mitigate disparities in access to digital health technologies and resources. The importance of digital equality and universal design, continuous intervention evaluation and monitoring, and enduring obstacles to Internet access and healthcare technology availability were among the major themes. This systematic study emphasizes how critical it is to put evidence-based tactics into practice in order to close the digital divide in health education. Through the promotion of universal design principles, ongoing evaluation of treatments, and digital equity, stakeholders can mitigate health disparities, improve population health, and guarantee equitable access to telehealth and digital health services.

Askin's Tumour: A Report of a Rare Case.

Primitive neuroectodermal tumours (PNETs) are rare, malignant tumours arising from primitive nerve cells. PNET of the chest wall is rare and is observed in children and young adults. Askin defined Askin's tumour as a PNET of the thoracopulmonary area. It develops from the soft tissues of the chest wall, particularly in the paravertebral region. Here, we report a case of Askin's tumour, a rare neoplasm occurring in the thoracopulmonary region in a 13-year-old girl. She came with complaints of fever, cold, cough with mucoid expectoration, breathlessness for 15 days, and generalized weakness for three months. A high-resolution computed tomography (HRCT) thorax scan was also done, which suggested a large right pleural-based mass with vertebral metastasis. Through diligent diagnostic evaluation involving imaging studies and histopathological examination, the tumour was accurately identified.

Unmasking the Rarity: A Case Report on Type B Lactic Acidosis in Pediatric Acute Lymphoblastic Leukemia.

Acute lymphoblastic leukemia (ALL) is the most prevalent pediatric malignancy, accounting for approximately 25% of childhood cancers. Despite significant advancements in treatment protocols, ALL remains a complex disease, often presenting with various complications, including the rare metabolic disturbance of type B lactic acidosis. This case report details the clinical journey of a 14-year-old female with ALL who developed type B lactic acidosis during treatment. The patient presented with intermittent fever, abdominal pain, jaundice, and hepatosplenomegaly, accompanied by severe anemia and thrombocytopenia. Initial management included supportive care and chemotherapy initiation. Despite aggressive interventions, the patient's condition deteriorated, with escalating lactic acidosis and respiratory distress, leading to a critical need for tailored management strategies. This report underscores the importance of early recognition and comprehensive management of type B lactic acidosis in pediatric ALL, highlighting its multifactorial etiology and potentially life-threatening consequences. Enhanced clinical awareness and a multidisciplinary approach are crucial for improving outcomes in such complex cases.

Reviving medical education through teachers training programs: A literature review.

The art of teaching in undergraduate and post graduate medical curriculum was revised in last century with targeted programs to equip the medical faculty with advanced teaching technologies. Medical education units (MEUs) were established by the medical council to train the existing medical faculty of the country in teaching methodologies. This study aimed to evaluate the MEU's impact on teachers' training and compare the status of trained teachers before and after the MEU era. Published literature and statistics on the MCI website were compiled to compare teachers' training status over time empirically. MEU, R.C., and N.C. have been highly efficient in improving the proportion of teachers trained from 5.38 to 50.32% across the country, especially after the upgradation of MEU in 2009. Proportion of the teachers trained increased from 5.38% to 50.32% due to the programs organized by various MEU, regional and nodal centres, especially after the upgradation of MEU in 2009. Lack of trained resource persons and administrative support were the common challenges faced. Properly organized MEU and planned activities should be emphasized in every institute. for effective development of the faculties.

Review on Scrub Typhus: An Important Etiology of Acute Undifferentiated Fever Illness.

One of India's predominant public health issues is acute undifferentiated fever illness (AUFI), a typical response to an infectious agent. Diagnosis becomes challenging when the disease has been reported with fever as the primary symptom. Among the cases presenting at a tertiary care hospital in central India, 88% had an acute undifferentiated fever, the most common being dengue infection. In India, rural communities are at more risk from AUFI than cities. Most of those in danger are those who reside in remote areas, and one of the most significant risks is for those who reside close to forests. AUFI is a complex condition for physicians to deal with and is one of the most frequent clinical conditions for which empirical treatment is required. Nowadays, AUFI can be managed by a syndromic approach with the judicial use of antibiotics. Symptoms of AUFI, along with myalgia, headache, and anorexia, can be caused by various illnesses. Patients are recommended to undertake a battery of investigations, which may delay the therapy and increase expenses because many diseases may present with the same symptoms. In the developed world, viral illness is the primary cause of AUFI. However, in developing countries like India, it can also be brought on by potentially curable but life-threatening conditions such as malaria, leptospirosis, hantavirus infection, and Japanese encephalitis. Lack of knowledge of the locally prevalent illnesses, which might be the cause of AUFI, and lack of preliminary screening and diagnostics at the point of care to identify the etiologies make it difficult to control these generally curable causes of the burden of AUFI, especially in tropical and subtropical countries. A deeper understanding of AUFI is required to develop better diagnostics and cures for various etiologies, especially scrub typhus.

Malakoplakia of the Gallbladder: A Case Report.

Histiocytes are cells that are involved in the immune responses of the body. They are unable to properly break down the bacterial material in malakoplakia, a chronic granulomatous histiocytic disease that occurs in immunocompromised patients and autoimmune conditions. Very few reports of these lesions exist, as those that occur in the gallbladder. It typically affects the urinary bladder, alimentary tract, cutaneous, hepato-biliary, and male and female genital systems. These lesions are usually incidental findings that result in patients being misdiagnosed. A 70-year-old female presented with right lower quadrant abdominal pain, and malakoplakia of the gallbladder was diagnosed. Histopathology findings revealed malakoplakia of the gallbladder, and the same was confirmed with special stains such as periodic acid-Schiff (PAS). This case highlights the role of gross and histopathology findings as a clue to the diagnosis, which helps the surgeon with further management.