Indian Journal of Pathology: Research and Practice

The unprecedented success of COVID-19 vaccine development has transformed not only infectious disease control but also revealed unexpected implications for cancer immunotherapy. Emerging preclinical and clinical evidence suggests that SARS-CoV-2 vaccines, particularly mRNA-based platforms, can enhance antitumor immunity through mechanisms that overlap with immune checkpoint blockade and cancer vaccination. These vaccines activate dendritic cells, induce interferon signalling, and prime cytotoxic CD8⁺ T lymphocytes, the key mediators of tumor regression and immune reprogramming. Reports of spontaneous tumor regression, improved immunotherapy outcomes, and increased rogression-free survival in vaccinated cancer patients underscore the immunomodulatory potential of COVID-19 vaccination. Moreover, studies demonstrate that mRNA vaccines can reshape the tumor microenvironment, converting “cold” tumors into “hot” immune-responsive phenotypes via enhanced antigen presentation and trained innate immunity. While these findings herald a new frontier in oncoimmunology, variability in vaccine responsiveness among different cancer types and treatment regimens warrants cautious optimism. The integration of vaccine induced immune modulation with established and emerging immunotherapeutic strategies could redefine the landscape of precision oncology. Ultimately, the pandemic’s legacy extends beyond viral containment offering a translational blueprint for harnessing vaccine platforms in cancer prevention and therapy.

The emergence of the NB.1.8.1 variant of COVID-19 in India marks another critical juncture in the ongoing trajectory of the pandemic. A progeny of the Omicron BA.2.86 lineage, NB.1.8.1 harbours multiple mutations in the spike protein, particularly in the receptor-binding domain(RBD), like F486P, E484K, N501Y, which raise concerns about increased infectivity and potential immune escape. Although it has not been designated a Variant of Concern by the World Health Organisation (WHO), its genetic profile warrants close monitoring. Clinically, the variant primarily presents with mild upper respiratory and systemic symptoms; however, high-risk individuals remain vulnerable to complications. Current diagnostic modalities, including RT-PCR and antigen-based assays, remain effective, while genomic surveillance is essential for accurate variant detection. Early reports suggest no increase in severity; however, high transmissibility of the NB.1.8.1 variant could still place significant strain on healthcare systems. Vaccination continues to provide strong protection against severe illness, though booster uptake remains suboptimal, particularly among the elderly and immunocompromised patients. While reinfection is possible, hybrid immunity and T-cell-mediated response offer a degree of protection. As NB.1.8.1 spreads, India must respond with scientific vigilance rather than complacency by strengthening surveillance, updating vaccines, reinforcing public health measures, and maintaining community awareness. Adaptive, evidence-based strategies are urgently required to address the dynamic mutational landscape of the SARSCoV-2 virus.

Angiolipoma is a benign variant of lipoma characterized by a prominent vascular component and is typically associated with painful subcutaneous nodules. While solitary angiolipomas are common, multiple lesions are relatively uncommon and usually involve the extremities. Truncal predominance is rarely emphasized in literature. We report a case of a 30-year-old male presenting with multiple, nontender subcutaneous swellings predominantly involving the trunk and forearm. Ultrasonography suggested benign lipomatous lesions; however, histopathological examination revealed features consistent with angiolipoma. This case highlights an unusual distribution pattern and absence of pain, leading to a diagnostic dilemma. Awareness of such atypical presentations is important to avoid misdiagnosis and ensure appropriate management.

Castleman disease is a rare, benign lymphoproliferative disorder that often poses a diagnostic dilemma due to its clinical and radiological resemblance to lymphoma. We report a case of unicentric Castleman disease of the cervical lymph node in a young patient, emphasizing the importance of histopathological examination and immunohistochemistry in establishing a definitive diagnosis. The patient presented with a long-standing, painless cervical lymphadenopathy without constitutional symptoms. Radiological evaluation revealed an isolated enlarged lymph node, raising suspicion of a neoplastic lymphoid disorder. Fine needle aspiration cytology showed a polymorphous lymphoid population but was inconclusive. Excision biopsy demonstrated partial effacement of nodal architecture with numerous small regressed germinal centers surrounded by concentric layers of mantle zone lymphocytes, imparting an “onion-skin” appearance. Prominent hyalinized blood vessels penetrating the follicles were noted, forming characteristic “lollipop” lesions. Interfollicular areas showed increased vascularity without sheets of plasma cells. On immunohistochemistry, lymphoid follicles were highlighted by CD20, interfollicular T cells were CD3 positive, BCL2 showed positivity in mantle zone lymphocytes, CD5 showed focal interfollicular positivity, and Cyclin D1 was negative, effectively excluding mantle cell lymphoma. A final diagnosis of unicentric Castleman disease, hyaline vascular type, was rendered. The patient underwent complete surgical excision with no recurrence on follow-up. This case underscores the importance of considering Castleman disease in the differential diagnosis of isolated cervical lymphadenopathy and highlights the pivotal role of histomorphology and immunohistochemistry in avoiding misdiagnosis and overtreatment.

Adrenocortical carcinoma (ACC) is a rare and aggressive malignancy arising from the adrenal cortex, often presenting diagnostic challenges, particularly when encountered as a retroperitoneal mass with unclear adrenal origin.4 These tumors have high prediliction for female gender.4 We report a case of ACC presenting as a large retroperitoneal lesion, in which initial core needle biopsy posed significant diagnostic difficulty due to overlapping histomorphologic features with other retroperitoneal malignancies. Definitive diagnosis was achieved following surgical excision and comprehensive histopathological and immunohistochemical evaluation. This case highlights the limitations of core biopsy in diagnosing ACC and underscores the importance of clinicoradiologic correlation and immunohistochemistry.

Introduction: Metastatic oral squamous cell carcinoma (OSCC) is an invasive, high-risk cancer commonly spreading to cervical lymph nodes (regional) and the lungs, liver, or bone (distant). Metastasis significantly reduces survival by nearly 50%, requiring aggressive, multidisciplinary treatment. Distant skeletal metastasis from OSCC is uncommon (roughly 2% of cases), with the spine, pelvis, and ribs being more frequent sites and scapula is extremely rare. Case Report: A 36-year-old male presented to the surgical outpatient of our hospital with a history of pain and swelling over right scapula with restricted mobility. PET-CT report revealed lytic erosions in right scapula. Patient is a treated case of carcinoma tongue. CT guided Fine needle aspiration of cyst fluid and biopsy from cyst wall taken and same discussed in this report. Conclusion: Active surveillance combined with early intervention and histopathological confirmation help to facilitate disease containment and increase survival rate.

Retroperitoneal masses in adult males present a significant diagnostic dilemma due to their deep location, varied etiologies, and nonspecific clinical manifestations.1 Germ cell tumors, particularly seminoma, may rarely present primarily as retroperitoneal disease, especially in association with cryptorchidism, leading to delayed or erroneous diagnosis.2,3 We report the case of a 42-year-old male who presented with prolonged constitutional symptoms including back pain, abdominal distension, anorexia, intermittent fever, and generalized weakness for over one year. Radiological evaluation revealed a large retroperitoneal preand paravertebral mass suggestive of lymphadenopathy.2 Initial ultrasoundguided fine needle aspiration cytology (USG‑FNAC) was interpreted as metastatic adenocarcinoma. Repeat FNAC demonstrated dispersed medium-to-large atypical cells with vesicular nuclei, prominent nucleoli, pale cytoplasm, and a characteristic tigroid background. Immunocytochemistry showed strong positivity for placental alkaline phosphatase (PLAP) and negativity for AFP, cytokeratin, leukocyte common antigen, and carcinoembryonic antigen, confirming the diagnosis of seminoma.5 Subsequent clinical examination revealed absence of the left testis in the scrotum, consistent with an undescended testis, explaining the unusual presentation.3 The patient showed marked response to radiotherapy. This case highlights the critical role of USG-FNAC combined with immunocytochemistry in diagnosing seminoma at an unusual site, emphasizes the importance of careful clinical correlation, and underscores the need to consider germ cell tumors in the differential diagnosis of retroperitoneal masses in adult males.1,6

Background: Epidermal inclusion (epidermoid) cysts are rare benign intracranial lesions that account for less than 1% of all intracranial tumors. Their occurrence within the fourth ventricle is exceptionally uncommon and may lead to significant mass-effect symptoms. Case Presentation: A 45-year-old female presented with a one-year history of intermittent headache with recent worsening, followed by progressive vertigo and projectile vomiting. Neuroimaging (CT and MRI) demonstrated a wellcircumscribed cystic lesion occupying the fourth ventricle with extension into the bilateral cerebellar hemispheres and foramina of Luschka and Magendie, producing marked compression of the pons, medulla, and cerebellar hemispheres. The lesion was surgically excised. Histopathological examination revealed a cyst lined by stratified squamous epithelium containing abundant keratin flakes, confirming the diagnosis of an epidermal inclusion cyst. The postoperative period was uneventful, and the patient experienced complete resolution of symptoms. Conclusion: Fourth ventricular epidermal inclusion cysts are rare lesions that may mimic other posterior fossa tumors. Radiological features combined with histopathological evaluation are essential for accurate diagnosis. Surgical excision remains the treatment of choice and is associated with favourable outcomes when critical neurovascular structures are preserved.

Sodium-glucose cotransporter 2 (SGLT2) inhibitors have evolved from a new glucose-lowering medication class to essential treatments for managing cardiovascular and kidney diseases. The review investigates SGLT2 inhibitors through their operational mechanisms and their strong clinical results and their growing medical use cases. The study examines the effects of these inhibitors on disease progression for both diabetic and non-diabetic patients. Background: Sodium-glucose cotransporter 2 inhibitors started as glucose-lowering medications but now serve as drugs that protect both heart and kidney function for every patient who has cardiovascular disease or chronic kidney disease and also present benefits beyond their blood sugar-lowering properties. Objectives: The review studies SGLT2 inhibitors through their cardiovascular and renal benefits together with their operational mechanisms and major clinical trial results, while showing its increasing usage among people who do not have diabetes. Methods: The researchers conducted a complete literature review through PubMed and clinicaltrials.gov to discover important randomized controlled trials and metaanalyses and mechanistic investigations which studied cardiovascular results and heart failure and chronic kidney disease and treatment comparison studies from 2015 until 2025. Key Findings: The trials from EMPA-REG OUTCOME DAPA-HF EMPERORReduced DAPA-CKD and CREDENCE show that SGLT2 inhibitors decrease cardiovascular mortality and heart failure-related hospital admissions and advancing kidney disease at rates between 25 to 39 percent for people with diabetes and those without. Patients start to see advantages within weeks after starting treatment, which continue to exist for an extended period. The cardioprotective mechanisms function through four main processes which include natriuresis, enhanced cardiac energy metabolism, oxidative stress reduction, and decreased myocardial fibrosis. SGLT2 inhibitors provide higher kidney protection to patients than GLP-1 receptor agonists do. Limitations: The majority of clinical studies enrolled white participants, while there was insufficient evidence to study acute coronary syndromes and heart failure with preserved ejection fraction in non-diabetic patients. Conclusions: SGLT2 inhibitors have developed into essential treatment for heart failure and chronic kidney disease because their primary function has changed from glucose reduction. The medication serves as the initial treatment option for protecting heart and kidney health because it demonstrates excellent safety results and strong cardiovascular and kidney protection effects.

Background: Primary CNS tumors show wide clinical, histomorphological, and immunohistochemical variation. Distinguishing these lesions from each other and from reactive process can be challenging due to overlapping cell morphology. So, the diagnosis and categorization of primary CNS tumors, is essential for planning the management and to determine the prognosis. Objectives: To evaluate the clinico-radiological features in diagnosing CNS tumors; to study the occurrence of CNS tumors in relation to age, sex, and anatomical sites, and the histopathological features of various CNS tumors and to evaluate the role of immunohistochemistry in diagnosing as well as classifying various CNS tumors according to CNS5. Materials and Methods: This study included a total of 242 case’ biopsy of primary CNS tumors received in the Department of Pathology over 5 years from 2020 to 2024. All specimens were examined grossly, processed routinely, stained with H&E, and evaluated using a panel of IHC markers (IDH1, ATRX, p53, Ki-67, GFAP, Synaptophysin, EMA, PR, etc.). Results: Out of 242, the most common age group was 15-39 years with male: female ratio of 1.3:1 with most common site- cerebrum. Majority of the cases were non-malignant (61%), while 39% cases were malignant. The most frequent tumors were gliomas, followed by meningiomas, schwannoma, pituitary adenomas, and medulloblastomas. IHC significantly assisted in differentiating astrocytic tumors, subtyping meningiomas, and confirming embryonal tumors. Ki‑67 index correlated with the tumor grade. Conclusion: A combined clinico-pathological and IHC approach markedly improves diagnostic accuracy of primary CNS tumors.