Indian Journal of Pathology: Research and Practice

Background: p63 is a member of p53 family of transcription factors which have important function in tumorogenesis and oncogenesis. It is involved in cellular differentiation and exposed in nuclei of myoepithelial cells of normal breast. Aim: To study immunoexpresion of p63 in the benign, insitu, and invasive ductal carcinoma of breast. Material and Methods: The present study was conducted on 110 cases of formalin fixed paraffin embedded histological sections of surgically resected breast tissue specimens suspected to have neoplastic lesions and mastectomy specimens already diagnosed as carcinoma on cytology for a period of one year. Result: p63 is strongly expressed in all benign breast lesion in form of continuous peripheral rim around ductal epithelial cells, except atypical ductal hyperplasia in which moderate expression of p63 was noted in form of scattered as less continuous rim of myoepithelial cells similarly moderate to weak expression with focal gaps was described in ductal carcinoma of in situ and no expression was noted in infiltrative ductal carcinoma. Conclusion: p63 is a hallmark of very poorly differential cells or cells component with higher histological grade in breast carcinoma. Hence p63 can be used as an indicator of aggressiveness of breast carcinoma as a marker of choice in differentiating benign and malignant breast lesions. 

Background: HER-2/neu is a gene localized on chromosome 17q21 which encodes a growth factor receptor like molecule with tyrosine kinase activity and is known to encode a transmembrane glycoprotein. Aim: To study the expression of HER2/neu in benign and malignant lesions of cervix. Material and Methods: The present study was conducted on 100 cases of resected cervical tissue specimen suspected to have neoplastic lesions and hysterectomy specimen already diagnosed as carcinoma on cytology for a period of 12 months (September 2018 to August 2019). Results: Majority of benign cases were negative for HER-2/neu except few cases and positivity was higher in malignant than premalignant. Positivity was also higher in adenocarcinoma as compared to squamous cell carcinoma. Conclusion: HER-2/neu serves as a biological marker to identify high risk subgroups and can be useful as target for new treatment modalities.

Context:Multiple myeloma is a malignant neoplasm of plasma cells involving the bone marrow. Before entering into aggressive phase, there is a frequent occurrence of extramedullary manifestations. The sites of predilection for extramedullary plasmacytoma are nasopharynx, larynx and upper respiratory tract. Aims: The aim of this present study is to highlight the importance to have high index of suspicion to consider a diagnosis of plasmacytoma based on histomorphological features even in the absence of classical clinical findings. Settings and Design: This study was done as a retrospective study in Coimbatore Medical College Hospital, Coimbatore over a period of 6 months from November 2017 to April 2018 in cases diagnosed as plasma cell lesions. Methods and Materials: 14 Cases of incidentally diagnosed plasma cell myeloma in a period of 6 months were taken. Out of these, 6 cases presented as soft tissue lesions,
3 cases as viscera - organ involvement and 5 cases as lytic lesios of bone. Immunohistochemical confirmation was done with CD 138, kappa and lambda. Results: Fine Needle Aspiration was done for all soft tissue lesions and was reported as plasmacytoma. Subsequently biopsies also proved the same. CD 138 was positive in all cases, kappa in 3 cases and lambda in 11 cases. Two cases were non secretory myeloma with negative serum M protein and urine Bence Jones protein. Conclusions: Soft tissue lesions in patients over the age of 50years should always include a diagnosis of plasmcytoma when sheets of plasma cells are seen. CD 138 showed 100% sensitivity,
with lambda expression in plasma cell myeloma with multiple bony and subcutaneous lesions. Kappa was positive in cases with visceral involvement. 

Background: Anemia is an important health problem worldwide and particularly in children. It affects their growth and social performance and may lead to morbidity and mortality. The main objective of the study was to determine the morphological types of anemia and to assess their etiological factors by necessary investigations. Material and Methods: Duration of study period was two years from July 2013 to June 2015. The first 100 cases in this period were taken for study. Children within age group from 6 months to 13 years attending NRIGH pediatric and oncology department who were clinically diagnosed as anemic were selected for study. A detailed history was recorded and necessary investigations were done. Results: The maximum number ofpatients were in the age group of 1 year to 5 years (50%). There was a male preponderance (56%) as compared to females (44%). Moderate degree of anemia was found in maximum number of cases and in preschool children, while severe and mild degrees of anemia were seen in school going children. Microcytic hypochromic anemia (61%) was the most common morphological type of anemia and macrocytic anemia (4%) was least common. Iron deficiency anemia (56%) was the common etiological type among nutritional anemias and in hemolytic anemias, β thalassemia major (63.6%) was common. Conclusion: Study of patterns of anemia is essential to direct the investigation since it reflects the underlying etiopathological factors. This aids in better management and treatment of the anemia which goes a long way in improving quality of life.

Context: Endometrial carcinoma is one of the most common malignancies occurring in postmenopausal females. Endometrial carcinomas are of two types, type I and type II. Type I is the most common encountered type of endometrial carcinoma. Aim: The aim of this study was to study the spectrum of histomorphology of endometrial carcinomas with special reference to immunohistochemical findings including ER PR and p 53. Methods and Material: This was a prospective study conducted over a period of eighteen months. Thirty cases of endometrial carcinomas were included in the study. The diagnosis of endometrial carcinoma was confirmed after microscopic examination. Immunohistochemical expression of ER, PR and P53 was studied. Statistical analysis: Correlation between the histopathological results and immunohistochemistry results were calculated by using chi square tests and test of sample proportion. Results: The association of histologic type I of endometrial carcinoma with estrogen receptor and progesterone receptor was significant with the p value less than 0.01 and 0.05 respectively. The association of histologic type II of endometrial carcinoma with p53 was significant with the p value less than 0.05. Conclusion: In the present study, significant association was noted between estrogen and progesterone receptor in type I endometrial carcinoma and between type II endometrial carcinoma and p53. The expression of ER and PR were found to be related to disease recurrence, reports suggest that ER, PR and p53 status, as determined by IHC, can be used as an independent predictor for disease recurrence. 

Introduction: The present study was done to compare the diagnostic accuracy of Fine Needle Aspiration Cytology (FNAC) in differentiating the benign and malignant lesions of palpable breast lumps with histopathological correlation and alsoto study the accuracy of FNAC procedure. Materials and Method: A retrospective study was done for a period of one year from January 2017 to January 2018. Fine needle aspiration was carried out in Department of pathology by pathologist, slides were stained with May-grunwald Giemsa morphology was studied, lumpectomy, wide excision and modified radical mastectomies were received depending on diagnosis on cytology. FNAC and biopsy results were correlated. Results: The most common age group for benign lesions were between 11 to 40 years and for the malignant lesion was 41 to 70 years. Fibroadenoma was most common among benign neoplasms and infiltrating ductal carcinoma (IDC) constituted highest number of cases among malignant neoplasms. Total benign cases were 22 and malignant were 11, premalignant (2 fibrocystic disease with atypia and 1 atypical ductal hyperplasia), and granulomatous mastitis were 2 out of total 38 cases. Conclusion: FNAC of the breast lump is an OPD based diagnostic method for determining the nature of the breast lump. It is safe, minimally painful, without anesthesia. Requiring only syringe, needle, glass slides and fixatives. Repeat FNAC can be performed if necessary. Best screening method required for categorization of different lesions of breast which aids in prevention of cancer and proper management of lesions. 

Background: Diabetes mellitus is one of the most common diseases with hyperglycemia as the main etiological factor. Elevated blood sugars in the body are a predisposing factor for thrombosis. Vascular complications are a cause of the morbidity in diabetics. Mean Platelet Volume and Platelet Distribution Width are the platelet indices which are elevated in a thrombogenic state. Thus we have evaluated the role of these two parameters in type II diabetics. ims: • To calculate the Mean platelet volume and Platelet distribution width in both controls and cases • Correlate these indices with HbA1c, duration of diabetes and the presence of vascular complications in diabetics. Settings and Design study: Prospective. Methods and Material: A one year prospective study was done. 150 subjects were included divided into cases and controls. Cases were again divided into those with vascular complications (23) and those without vascular complications (52). Platelet indices were studied with special emphasis on Mean platelet volume and Platelet distribution width among both cases and controls. These were compared with glycosylated hemoglobin, duration of diabetes and presence of vascular complications. Statistical analysis used: SPSS. Results: Mean platelet volume and Platelet distribution width were elevated in diabetics when compared to non-diabetics and the increase was more relavant in those with complications. Statistical significance was seen with Mean platelet volume but not with Platelet distribution width. Conclusion: Our study thus highlights the differences in platelet indices among diabetics and non diabetics with emphasis on those with vascular complications. 

Background: Fine needle aspiration cytology (FNAC) is applied as the primary tool for the diagnosis in breast masses because of its ease and rapidity. However, it is a largely subjective tool.
The morphological overlap among the sequential lesions from the precancerous group to frank carcinoma further cause “gray zone” in cytology, estimated to constitute 8.9%. Morphometry is the measurement of cell parameters microscopically by image analysis. The present study has been undertaken to evaluate role of nuclear morphometry in benign and malignant breast neoplasms. Aim: To classify breast lumps according to guidelines given by UK National Health Service Breast Screening Program (NHSBSP) and to compare the nuclear morphometry among those categories. Setting and design: A retrospective-prospective study. Material and Methods: Cases with palpable breast lumps were evaluated by FNAC and were cytologically classified according to UKNHSBSP guidelines. Nuclear Morphometric parameters: nuclear area, perimeter, long and short axis and diameter were studied and compared within the various categories. Statistical Analysis used: Student’s t test was used as the test of significance. Result: Mean age was 37.7 years. 47.3% cases belonged to Category C2 (benign), 6.8% cases to Category
C3 (atypia probably benign), 17.6% cases Category C4 (suspicious of malignancy) and 27% belonged to Category C5 (malignant). The nuclear morphometric parameters including nuclear area, perimeter, short axis, long axis and diameter were found to be statistically significant (p<0.05) in differentiating between benign and malignant categories. Conclusion: Nuclear morphometry serves as a valuable method in distinguishing benign and malignant breast aspirates and also correlates well with the cytological categories. 

Introduction: Mast cells in the tumour microenvironment have both pro-tumorigenic and anti-tumorigenic roles and play a major role in determining the progression of the tumour including metastatic potential. The present analysis was undertaken to assess their role in the metastatic potential to regional lymph nodes in gastric carcinoma. Methods: Tissue from fifty three cases of gastricgastric carcinoma including fourteen endoscopic biopsies and fourteen gastrectomy specimens were analyzed and routine histological findings were recorded. Mast cells were clearly demonstrated in tissue using Toluidine Blue stain at pH 2.3. Mast cells were counted using an eyepiece grid and expressed as no. of cells/per sq. mm, i.e., mast cell density (MCD). The distribution of mast cells within all the sampled lymph nodes (with and without metastasis) was recorded. Results: Mast cell density was not statistically significantly different in regional lymph nodes without microscopic metastatic deposits (n= 71; Mean±SD: 1.5±0.67) compared to lymph nodes showing metastatic deposits (n=74; Mean MCD±SD: 1.2±0.42). Conclusions: Our results indicate that the role of mast cells in gastric carcinoma especially metastatic potential to regional lymph nodes is equivocal, in sharp contrast to our previous study in breast carcinoma which indicated a protective role. This could also be explained by the participation of mast cells in the benign inflammatory stages even before the onset of gastric carcinoma, a phenomenon that is not seen in breast carcinoma

Background: Cutaneous adnexal tumor is a collective term for tumors arising from various adnexal units of the skin. These tumors share many common features even though they differentiate along one line. Adnexal tumors are relatively uncommon and they pose a diagnostic difficulty due to morphological overlap. They are classified according to appendageal differentiation. These tumors have to be differentiated from other primary cutaneous neoplasm and cutaneous metastasis. Adnexal tumors are significant because some can give a clue to the association of internal visceral malignancy. Methods: All adnexal tumours showing sweat gland differentiation diagnosed over the period of 5 years was studied. The Haematoxylin and Eosin stained slides were analysed for patterns to differentiate each entity from other cutaneous tumours. Result: Thirty adnexal tumours were diagnosed over a period of 5 years. Clinical presentations varied from discrete swellings and nodules to ulcerated masses. Most of the lesions were distributed in the head, neck and extremities. Histologically 26 cases were benign and 4 cases were malignant. Majority of the tumours were encountered in females (18 out of 30). Commonest tumour encountered was eccrine poroma followed by eccrine spiradenoma and Syringocystadenoma papilleferum. Malignant tumours encountered were Porocarcinoma and hidradenocarcinoma. Conclusion: Cutaneous adnexal tumors are complex due to their diverse origin and varied histological appearance. Sweat gland tumors are the commonest tumors encountered. Many of these entities have morphological overlap. Although majorities of adnexal tumors are benign, malignant counterparts are also rarely encountered, causing further diagnostic difficulties. Hence thorough histopathological examination is required for final diagnosis. 

Background: Neonatal sepsis is one of the important causes of morbidity and mortality in the neonatal period. Objectives: To analyse the hematological findings according to Rodwells hematological scoring system and correlation with blood culture. Materials and methods: A Total of 120 neonates were included in the study. Blood samples from 120 neonates were subjected to blood culture and Hematological scoring system (HSS). They were divided in to 3 groups i.e group 1 (proven sepsis - 32), group 2 (probable sepsis - 56) and group 3 (Normal infant - 32). Results: Out of 120 infants, 32 had positive blood culture. Majority (66.6%) were preterm. Male to female ratio was 1.7:1. Out of 32 sepsis cases, 27 (84.3%) had predominant score was 5 >. Maximum number of cases 31 (55.31%)) showed score with 3-4 in probable sepsis group. Association of hematological parameters and scores was found to be statistically significant (p<0.05). Majority of parameters found to have high sensitivity while platelet count and Total Neutrophils count (TNC) had high specificity. Combination of hematological tests found to have high sensitivity and specificity when compared to single hematological test. Conclusion: Hematological scoring system is easy, cheap and cost effective screening tool for early diagnosis of neonatal sepsis. 

Keywords: Hematological Scoring System; Hematological Parameters; Culture; Neonatal Sepsis.