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   2012| April-June  | Volume 55 | Issue 2  
    Online since July 3, 2012

 
 
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LETTERS TO EDITOR
Massive congenital intracranial immature teratoma: An autopsy report
Arun Thakran, Seema Rao, M Sreenivas, Nita Khurana
April-June 2012, 55(2):272-274
DOI:10.4103/0377-4929.97914  
  41,423 104 1
Museum mounting techniques: Revisited econo-mode
Srikant Natarajan, Jyoti Ranjan, Karen Boaz
April-June 2012, 55(2):260-261
DOI:10.4103/0377-4929.97902  
  21,304 875 2
BRIEF COMMUNICATION
Viral markers in patients with hemophagocytosis: A prospective study in a tertiary care hospital
Baijayantimala Mishra, Neelam Varma, Suma Appannanavar, Pankaj Malhotra, Mrinalini Sharma, Anil Bhatnagar, Radha Kanta Ratho, Subhash Varma
April-June 2012, 55(2):215-217
DOI:10.4103/0377-4929.97876  
Background : Hemophagocytic syndrome (HPS) is a rare clinicopathological condition characterized by the activation of macrophages with prominent hemophagocytosis in bone marrow and other reticulo-endothelial systems. HPS can be familial or secondary to infections including viruses. Aim : To study the viral markers in patients with HPS. Materials and Methods : Serum samples of patients with HPS and control group were screened for anti EBV VCA IgM, and IgG, anti-Parvo B19 IgM, and anti-CMV IgM antibodies using commercially available ELISA kits and CMV and ParvoB19 DNA by polymerase chain reaction (PCR). Results and Discussion : The present prospective study reports the profile of viral markers in HPS cases from north India. Among the 14 HPS cases 43% (6/14) were positive for at least one viral marker tested, of which EBV was found to be the most prevalent (3/6: 50%) followed by parvovirus B19(2/6: 33%) and cytomegalovirus (1/6: 17%). Mortality was noted in 33% of virus associated HPS patients. Our study highlights the higher association of Epstein-Barr virus (EBV) with HPS as compared to other viruses along with higher rate of mortality in both parvovirus B 19 and EBV associated HPS.
  13,124 174 8
ORIGINAL ARTICLES
Primary cutaneous amyloidosis: A clinico-pathological study with emphasis on polarized microscopy
B Vijaya, Bibhas Saha Dalal, Sunila , GV Manjunath
April-June 2012, 55(2):170-174
DOI:10.4103/0377-4929.97853  
Background: Primary localized cutaneous amyloidosis (PCA) is a relatively rare condition characterized by amyloid deposition in dermis without systemic involvement. Although, histopathological examination of the lesion reveals amorphous eosinophilic deposits in papillary dermis examination of congo red stained slides under polarized light will give definitive diagnosis Aims: To study the clinicopathological features of cutaneous amyloidosis emphasizing the utility of polarized light in diagnosis. Materials and Methods : A clinicopathological study of primary cutaneous amyloidosis over a period of 8 years was undertaken. All the cases, clinically diagnosed and histopathologically proven as cutaneous amyloidosis were stained with congo red and studied under polarized light. Results and Conclusions: Of the 45 cases of clinically suspected amyloidosis, 32 cases were proven histopathologically as primary cutaneous amyloidosis and confirmed by congo red stain under polarized light which showed apple green birefringence. Among the two types of PCA, lichen amyloidosis was the most common variant accounting to 65.63% with pure cases of macular amyloidosis accounting for only 15.63%. Biphasic amyloidosis was seen in 18.75%. Knee was the commonest site of involvement with pruritis being the most common symptom. Histopathologically, the most common findings were hyperkeratosis, irregular acanthosis and expansion of dermal papillae by amyloid deposits showing apple green birefringence under polarized microscope with congo red staining. Although, H and E stain gives a clue for the diagnosis of amyloid nevertheless congo red staining under polarized light forms a very sensitive and definitive method for confirmation.
  9,491 400 6
In search of the rainbow: Colored inks in surgical pathology
Chandralekha Tampi
April-June 2012, 55(2):154-157
DOI:10.4103/0377-4929.97843  
Introduction: Although surgical pathologists are aware of the multiple advantages that coloured inks contribute to surgical pathology practice, these coloured inks are not available in India and importing them is not a viable proposition. A systematic search for locally available coloring agents was done, and resulted in identifying specific shades within a popular set of children's hobby colors of a particular brand. They retain their bright distinct colors on paraffin blocks and sections. These paints are available all over India, and are cheap, safe, and easy to use. Coloring gross specimen excision margins with different colors, adds precision to margin examination. It allows three-dimensional microscopic reconstruction of the tumor vis-a-vis its various neighboring anatomic structures. It allows postoperative comparison of tissue planes predicted by preoperative imaging. It maintains orientation of grossed and dissected specimens, enabling the pathologist to re-visit the grossed specimen, if required, and confidently allows further sampling if necessary. Aim: A systematic search for indigenous coloring agents was carried out, which included the dyes used in the histopathology laboratory, gelatin, commercially available paints, including acrylic paints and inks. Results: The study identified specific shades within a brand of acrylic colors that are easily available and simple to use, with good results on microscopic examination. Conclusion: Colored inks lend precision to margin examination. A set of easily procurable colors are available in our country, which are easy to use, with distinct bright colors, safe, and reliable.
  8,757 754 3
LETTERS TO EDITOR
Transient abnormal megakaryocytic hyperplasia secondary to all-trans retinoic acid therapy
Monica Jain, Seema Tyagi
April-June 2012, 55(2):268-269
DOI:10.4103/0377-4929.97911  
  7,760 67 -
ORIGINAL ARTICLES
Bacillus Calmette-Guerin lymphadenitis: A 6-year experience in two Saudi hospitals
E Bukhari, M Alzahrani, S Alsubaie, A Alrabiaah, F Alzamil
April-June 2012, 55(2):202-205
DOI:10.4103/0377-4929.97869  
Background : The World Health Organization (WHO) has recommended Bacillus Calmette-Guerin (BCG) vaccination as a part of the global expanded program for immunization. Although the BCG vaccine is usually a safe vaccine, a number of complications with lymphadenitis being the most common complication, can occur. Aim : We evaluated the frequency, the clinical presentation and treatment modalities of lymphadenitis after BCG vaccine in Saudi children. Results : A total of 145 patients with BCG lymphadenitis presented between January 2005 and December 2010. In the majority (103) of the cases, the lymphadenitis involved ipsilateral left axillary nodes. Other sites of involvement included the left supraclavicular lymph nodes in 26 (18%) patients, and both the left axillary and supraclavicular lymph nodes were involved in 7 cases (4.8%). A total of 75 patients (65%) were given antituberculous medication. Eight (27%) patients had positive acid-fast bacilli and positive cultures for Mycobacterium bovis. Conclusion : In light of the findings of this study, it would be advisable to administer the BCG vaccine in Saudi Arabia at a time later than at birth, as the younger children are commonly affected.
  6,564 213 12
LETTERS TO EDITOR
Falsely low HbA1c value due to a rare hemoglobin variant (HEMOGLOBIN J-MEERUT) - A family study
Anjali Sharma, Sadhna Marwah, Gurdeep Buxi, Raj Bala Yadav
April-June 2012, 55(2):270-271
DOI:10.4103/0377-4929.97912  
  6,056 219 3
ORIGINAL ARTICLES
Comparing touch imprint cytology, frozen section analysis, and cytokeratin immunostaining for intraoperative evaluation of axillary sentinel lymph nodes in breast cancer
Akbar Safai, Ali Razeghi, Ahmad Monabati, Negar Azarpira, Abdolrasoul Talei
April-June 2012, 55(2):183-186
DOI:10.4103/0377-4929.97859  
Background: Sentinel lymph node (SLN) biopsy has been applied to the management of breast carcinoma inorder to decrease postoperative complication and morbidity. Touch imprint cytology (TIC), frozen section (FS), scrape cytology, or combination of these methods are used as intraoperative diagnostic methods. However, the sensitivity of these intraoperative modalities for detecting metastatic disease in SLNs is not equivalent to permanent histopathologic examination as a gold standard method. Objectives: The aim of this study was to review our department's results with SLN biopsy using touch imprint and frozen section for intraoperative diagnosis of breast cancer metastasis. Immunohistochemistry for cytokeratin was used on permanent sections. The sensitivities and specificities of TIC with those of FS analysis and IHC were also compared. Materials and Methods: A total of 100 consecutive SLN biopsies from 49 patients performed. The TIC and subsequently frozen were stained using hematoxylin and eosin. The cytological and frozen findings were compared and results were reported to the surgeon during operation. Final pathologic evaluation was performed on the formalin-fixed, paraffin-embedded tissue sections. Analysis of the permanent tissue included evaluation of three-step sections of the lymph node by H&E and immunohistochemical (IHC) staining. The sensitivities, specificities, positive and negative predictive values of TIC, FS and IHC for the detection of metastatic tumor in the SLNs were determined with the corresponding 95% confidence intervals (CIs). Results: One hundred SLNs were examined from 49 patients with invasive breast carcinoma with mean age of 45.29 ° 10.6 years. Intraoperative TIC and FS failed to show metastatic involvement in 10 examined lymph nodes from three patients. No false positive results for TIC and FS was identified. The sensitivity of TIC compared with the final histopathological result, considered the gold standard, was 90% (CI, 68.49-98.81%). Similarly, the sensitivities of frozen sections and permanent were the same respectively. The specificities of TIC, FS, and permanent were 100% (CI, 94.95-100.00). The sensitivity of touch imprint cytology compared with the final histopathological result, considered the gold standard, was 90% (CI, 68.49--98.81%). Similarly, the sensitivities of frozen sections and permanent were the same respectively. The specificities of TIC, FS, and permanent were 100% (CI, 94.95-100.00). Conclusions: Our experience with TI and FS for the intraoperative evaluation of SLNs is similar to the findings from previously reported studies. We detected the same sensitivities for these two methods; however lower sensitivity of TI in detecting metastasis with higher false-negative rate has been addressed in the published literature. The 90% sensitivity of TI and FS with permanent histopathologic examination as the gold standard falls within the range of reported sensitivities: 33-96% for TI and 44-100% for FS. However, variations in patient selection criteria, experience of the pathologist, skill of the technician submitting specimen for intraoperative evaluation, and tumor size are important variables that influence the results.
  5,811 419 6
REVIEW ARTICLE
Review of stem cell deregulation and breast cancer: An emerging hypothesis
Darnal Hari Kumar, Methil Kannan Kutty
April-June 2012, 55(2):147-153
DOI:10.4103/0377-4929.97842  
Cancer is fundamentally a cellular genetic disease capable of transferring the "disease" to the next generation of mutated cells. Similar proliferative and information transferring capacity exists in the stem cells of various organ systems in the human body. Understanding the bio-mechanism of stem cell metabolism and its regulation by signaling molecules and extracellular micro-environment is an important step toward successful prevention and treatment of cancer. According to the cancer stem cell hypothesis, both hereditary and sporadic cancers can arise from deregulation of these cancer stem cells (CSCs), triggered by genetic and environmental factors. It is shown that deregulation of normal self-renewal pathways in undifferentiated breast stem cells or progenitor cells had altered mammary system or progenitor cells, resulting in abnormally differentiated cells in human and rodent breast cancer cell lines. Breakthroughs in molecular pathways have important therapeutic implications. Hence, significant stress is laid on targeting signaling molecules and their micromilieu in breast cancer therapy.
  5,634 414 4
LETTERS TO EDITOR
Hyaline fibromatosis syndrome: New unifying term and surgical approach
Rafael Denadai, Debora Romeo Bertola, Cassio Eduardo Raposo-Amaral
April-June 2012, 55(2):262-262
DOI:10.4103/0377-4929.97903  
  5,943 66 1
ORIGINAL ARTICLES
Philadelphia chromosome detection in chronic myeloid leukemia: Utility of phytohemagglutinin-stimulated peripheral blood culture
Man Updesh Singh Sachdeva, Neelam Varma, Kamer Singh Rana, Subhash Varma
April-June 2012, 55(2):196-201
DOI:10.4103/0377-4929.97867  
Background: The conventional cytogenetic approach to demonstrate Philadelphia (Ph) chromosome at times does not yield enough number of metaphases or are of suboptimal quality. Further, the rapid molecular tests have completely pushed this simple technique into disrepute. Aims: This study aimed to evaluate usefulness of phytohemagglutinin (PHA)-stimulated peripheral blood culture for detection of Ph chromosome in chronic myeloid leukemia (CML) patients. Materials and Methods: Fifty-six patients, including 11 newly diagnosed cases of CML and 45 patients of CML on imatinib therapy showing the presence of Ph chromosome in unstimulated samples, were included in the study. Cytogenetic analysis was done on unstimulated samples, i.e. bone marrow aspirate, 24- and 48-h peripheral blood culture, and compared with PHA-stimulated 72-h peripheral blood culture. Results: The preparations from PHA-stimulated peripheral blood culture samples in all 56 patients yielded high number of good-quality metaphases. All the 11 (100%) newly diagnosed patients and 39/45 (87%) of the patients on imatinib therapy showed the presence of Ph chromosome in PHA-stimulated samples. Addition of PHA-stimulated 72-h peripheral blood culture preparation can be of use for increasing the diagnostic yield in cases of CML with suboptimal results on conventional cytogenetics from bone marrow aspirate sample.
  4,791 253 -
HER 2 status in invasive breast cancer: Immunohistochemistry, fluorescence in-situ hybridization and chromogenic in-situ hybridization
Hemlata S Shirsat, Sridhar Epari, Tanuja Shet, Rajani Bagal, Rohini Hawaldar, Sangeeta B Desai
April-June 2012, 55(2):175-179
DOI:10.4103/0377-4929.97855  
Introduction : HER2/neu gene status in breast cancers can be evaluated by targeting protein and gene - immunohistochemistry (IHC) and fluorescence in-situ hybridization (FISH). Recent studies have shown chromogenic in-situ hybridization (CISH) as a relatively cheaper alternative. Materials and Methods : Forty-three nonconsecutive, randomly selected primary invasive breast cancer cases were evaluated for c-erbB-2 (HER2 protein) by IHC and gene amplification by FISH and CISH. Results of each of the same were compared. Results : CISH showed approximately 90% and 100% concordance for IHC negative and positive cases, respectively; while approximately 94.4% and 91% concordance with FISH amplified and non-amplified cases, respectively. Conclusion : This study showed feasibility of incorporation of CISH as a low cost option in routine management of breast carcinoma in the Indian setting. Secondly, reconfirmation of IHC negative and positive cases can be done by CISH.
  4,389 317 2
CASE REPORTS
In situ follicular neoplasia/lymphoma: Three illustrative cases exemplifying unique disease presentations
Uma Sakhadeo, Ashwini Mane, Tanuja Shet
April-June 2012, 55(2):218-221
DOI:10.4103/0377-4929.97878  
We report three elderly patients with follicular lymphoma in situ (FLIS) each highlighting a unique pattern of disease presentation and progression. The first patient had incidentally detected FLIS with peripheral blood spill and yet had an 11-year uneventful follow up. The second patient with an overt follicular lymphoma (FL) developed high-grade transformation in jejunum with FLIS extensively involving the Payers patches. The third patient had a FLIS but that qualified as higher grade and was treated in spite of lack of overt FL mainly because of higher grade and patient subsequently did develop overt FL. The first case of typical FLIS confirms that peripheral blood spill does not connote poor prognosis in FLIS, the second case illustrates that FLIS may colonize mucosa-associated lymphoid tissue as part of homing in process of a disseminated FL and the third case validates the aggressive nature of high-grade FLIS.
  4,491 144 3
ORIGINAL ARTICLES
Amygdalin inhibits angiogenesis in the cultured endothelial cells of diabetic rats
Hossein Mirmiranpour, Shahnaz Khaghani, Ali Zandieh, O Omid Khalilzadeh, Siavash Gerayesh-Nejad, Afsaneh Morteza, Alireza Esteghamati
April-June 2012, 55(2):211-214
DOI:10.4103/0377-4929.97874  
Background: Angiogenesis contributes to different physiological and pathological conditions. The aim of this study was to investigate for the first time the antiangiogenic effects of amygdalin on the cultured endothelial cells of diabetic rats. Materials and Methods: A total of 20 streptozotocin-induced diabetic rats were divided into two equal groups of control and amygdalin-treated animals. Eight weeks after the induction of diabetes, amygdalin was injected intraperitoneally (3 mg/kg) to the rats of the treatment group. One day later, rats were sacrificed; the aortic arteries were excised and cut as 2 mm rings. Each aortic ring was incubated in a cell-culture well for 7 days. The process of angiogenesis was monitored by counting the number of microvessels and primary microtubules in each well. Results: Optic microscopy showed proliferation and migration of new endothelial cells to the fibrin gels. The endothelial cells produced primary microtubules which gradually made several branches and finally made a vascular matrix. The number of the primary microtubules and microvessels were significantly lower in the amygdalin-treated vs. control group (P < 0.01). Conclusion: Therefore, amygdalin exerts inhibitory effects on angiogenesis in aortic rings of diabetic rats and may pave a new way for treatment of unfavorable angiogenic conditions.
  4,061 74 6
Inhibition of fatty acid synthase supresses osteosarcoma cell invasion and migration
Zhi Li Liu, Yang Zhou, Qing Feng Luo, MinWei Hu, Gao Wang, Shan Hu Huang, Yong Shu
April-June 2012, 55(2):163-169
DOI:10.4103/0377-4929.97849  
Background : Fatty acid synthase (FASN) is overexpressed in a variety of human cancers, and may be involved in cancer metastasis. Hence, the strategies targeted on FASN may have therapeutic potential for treating cancer metastasis. Objectives : The aim of this study is to investigate the correlation of FASN expression with metastasis in human osteosarcoma. Materials and Methods : Human osteosarcoma cell lines U2-OS and osteosarcoma biopsy specimens were employed in this study. The expression of FASN protein in osteosarcoma specimens was detected by IHC (immunohistochemistry) and the relationship with metastasis was analyzed. We performed the cerulenin, an inhibitor of FASN, to inhibit FASN expression in U2-OS cells. Western blot and RT-PCR were performed to investigate the expression of FASN in U2-OS cells. Cells mobility was detected by wound healing and Transwell assays. Results : Results showed that the FASN expression level in the cases with pulmonary metastases was significantly higher than in those without metastasis. In vitro, the invasion and migration of U2-OS cells were suppressed by inhibiting FASN. Our findings suggested that FASN may be involved in osteosarcoma metastasis
  3,917 110 14
CASE REPORTS
Can influenza H1N1 vaccination lead to the membranous glomerulonephritis?
Ali Kutlucan, Ibak Gonen, Esra Yildizhan, Yusuf Aydin, Tansu Sav, Umran Yildirim
April-June 2012, 55(2):239-241
DOI:10.4103/0377-4929.97893  
In 2009 winter, Influenza A (H1N1) monovalent split virus vaccine was used prevalently in the whole world as a result of the pandemic caused by Influenza (H1N1) virus. The vaccine's adverse effects were observed closely and vaccination has been found as safe in most studies. But some reports about immune response related diseases after influenza vaccinations are remarkable. The close relationship between membranous glomerulonephritis and antigens is known, particularly in seconder forms which occur after viral infections and vaccinations. So this case report is about a 56-year-old man, who developed membranous glomerulonephritis 23 days after the vaccination against Influenza A (H1N1) virus.
  3,919 85 1
Keratomycosis caused by Exserohilum rostratum
Noyal M Joseph, M Ashok Kumar, Selvaraj Stephen, Shailesh Kumar
April-June 2012, 55(2):248-249
DOI:10.4103/0377-4929.97896  
We report a case of keratomycosis caused by Exserohilum rostratum. A 46-year-old farmer presented with history of pain, watery discharge and redness of the right eye for the past 2 weeks following trauma with vegetable matter. On ocular examination, a central corneal ulcer of about 8 mm with a greyish-white slough, feathery edges and diffuse corneal edema was seen in the right eye. KOH examination of corneal scrapings revealed thick, brown, branched, septate hyphae. Culture of corneal scrapings on Sabouraud dextrose agar showed velvety greenish-black colony with a black pigment on the reverse. The culture was identified as E. rostratum on the basis of microscopic morphology. The patient responded well to treatment with topical natamycin and oral itraconazole.
  3,697 140 8
ORIGINAL ARTICLES
Detection of paroxysmal nocturnal hemoglobinuria-phenotype in patients with chronic lymphocytic leukemia and multiple myeloma
S Varma, N Varma, VV Reddy, S Naseem, P Bose, P Malhotra
April-June 2012, 55(2):206-210
DOI:10.4103/0377-4929.97871  
Background : Paroxysmal nocturnal hemoglobinuria (PNH) results due to decrease or absence of glycosylphosphatidylinositol-anchored (GPI) molecules, such as CD55 and CD59, from the surface of the affected cells. PNH-phenotype has been described in various hematological disorders, mainly aplastic anemia and myelodysplastic syndromes; recently it has been reported in patients with lymphoproliferative syndromes and multiple myeloma (MM). Materials and Methods : We evaluated the presence of CD55 negative and/or CD59 negative red blood cell (RBC) populations in newly diagnosed treatment naive-54 chronic lymphocytic leukemia (CLL) and 29 MM patients by flow cytometry. Results : PNH-phenotype was not reported in any patient; however, RBC populations deficient in CD55 were detected in 16.66% (9/54) CLL and 6.89% (2/29) MM patients. Clinical presentation or the hematological parameters did not show any relationship with the presence of CD55 deficient RBC population. Conclusion : Our study showed absence of PNH-phenotype in patients with CLL and MM; however, isolated CD55 deficient RBC were identified in both CLL and MM. Larger prospective studies by other centers, including simultaneous analysis of granulocytes for the presence of PNH-phenotype, are needed to corroborate these findings and to work out the mechanisms and the significance of the existence of this phenotype in these patients.
  3,564 211 6
CASE REPORTS
Pericardium: An exceedingly rare site for a primary biphasic synovial sarcoma
Sarathchandra Kodikara
April-June 2012, 55(2):227-229
DOI:10.4103/0377-4929.97884  
Pericardial neoplasms are rare. Among pericardial neoplasms, metastatic spread is more common and primary synovial sarcomas of the pericardium are exceedingly rare. A 61-year-old man was found dead in bed. Autopsy revealed the cause of death as atherosclerotic and hypertensive heart disease. There was a pericardial soft tissue mass lying predominantly over the left atrium. The cut surface was bulging out and grayish white in color with cystic changes. Microscopy showed spindle cells in densely cellular fascicles surrounding the epithelial cells. The epithelial cells were cuboidal and formed glandular structures and cleft-like spaces. Immunohistochemistry demonstrated cytokeratin and vimentin positivity in the spindled areas. Molecular analysis confirmed the diagnosis. Synovial sarcoma may be mistaken for other common neoplasms occurring in the pericardium due to its rarity. In all cases of pericardial tumors, a diligent search for synovial sarcoma by way of histological analysis including, immunohistochemistry and molecular analysis is indicated.
  3,374 91 4
Lipofibromatosis accompanied by several congenital anomalies, report of a rare case
Saeed Marzban, Bita Geramizadeh
April-June 2012, 55(2):242-244
DOI:10.4103/0377-4929.97894  
Lipofibromatosis is a rare tumor of infancy, which has been reported about 10 years ago, and since then very few reports have been published. This tumor has been reported in association with congenital anomalies such as macrosyndactyly, but there is no report of multiple congenital anomalies with lipofibromatosis in the English literature as far as our knowledge goes. Herein, we report a case of this tumor associated with syndactyly, bilateral complete cleft lip and palate, trigonocephaly, and atrial septal defect.
  3,369 82 2
Primary cutaneous marginal zone lymphoma (immunocytoma like) with lymphoepithelioid or Lennert's lymphoma like involvement of nodes
Tanuja Shet, Rajan Basak, Sridhar Epari
April-June 2012, 55(2):222-226
DOI:10.4103/0377-4929.97882  
Primary cutaneous marginal zone lymphomas (PCMZL) have a wide range of morphology from tumors with monocytoid B cells to those composed entirely of plasma cells and the T-cell rich variants. We report a 60-year-old male with a PCMZL rich in plasma cells of the foot with a lymphoepithelioid-like pattern of dissemination to the lymph nodes posing problems in the diagnosis. The patient had a lesion on the dorsum of the foot which histologically revealed dense perivascular collections of lymphoid cells and plasma cells amidst fibrous tissue. Though the plasma cells did show light chain restriction, CD20 and CD3 did not reveal an overwhelming B/T-cell population and hence a diagnosis of a reactive process was offered. Subsequently the patient developed inguinal nodes with diffuse loss of architecture and replacement by epithelioid histiocytes and reactive T cells with few large B cells (lymphoepithelioid-like pattern). On pathology review it was realized that the two lesions may be related and clonality studies were asked for. The skin lesion showed clonally rearranged IgH receptor while the T-cell receptor rearrangement was negative. The patient developed disseminated disease and received six cycles of chemotherapy with partial response and 6 years after the initial presentation was alive with nonprogressive disease. Thus, the polymorphous background in PCMZL is evolving and an immunocytoma-like tumor can show a T-cell rich or Lennert's like growth pattern of spread and early recognition these odd patterns may aid in appropriate management of patients.
  3,300 92 -
Nested stromal epithelial tumor of liver presenting with Cushing syndrome: A Rare case Report
Bita Geramizadeh, Hamidreza Foroutan, Ali Foroutan, Mohammadreza Bordbar
April-June 2012, 55(2):253-255
DOI:10.4103/0377-4929.97898  
Nested stromal and epithelial tumor of the liver is an extremely rare pediatric hepatic tumor. To the best of our knowledge, about 25 cases have been reported in the English literature so far, few of which accompanied with Cushing syndrome. Herein we report our experience with an 8-year-old boy presented with Cushing's syndrome because of ectopic ACTH production by this tumor.
  3,203 80 8
Multifocal histiocytic sarcoma of the gastrointestinal tract
Shirley Sundersingh, Urmila Majhi, Ramakrishnan Ayloor Seshadhri, Gnana Sagar Tenali
April-June 2012, 55(2):233-235
DOI:10.4103/0377-4929.97891  
We report a rare case of extranodal histiocytic sarcoma with multifocal gastrointestinal tract involvement, which has not been documented in the literature so far. A diagnosis of interdigitating dendritic cell/ histiocytic sarcoma was made on the preoperative gastric biopsy. Computed tomography scan revealed multifocal, circumferential gastrointestinal wall thickening involving the stomach and jejunal loops. Patient underwent distal gastrectomy with extended D1 dissection and proximal jejunal resection with gastrojejunostomy. Immunohistochemistry profile of both the gastric and jejunal tumors was similar to the preoperative gastric biopsy. The histiocytic origin of the tumor was confirmed by positive reaction of the tumor cells for CD 163. She received four cycles of CHOP chemotherapy, and is free of disease three years, following surgery.
  3,157 112 5
ORIGINAL ARTICLES
Discriminating thyroid cancers from benign lesions based on differential expression of a limited set of miRNA using paraffin embedded tissues
Rekha Pai, G Arun Nehru, Prasanna Samuel, Ben Selvan, Ramani Kumar, Paul M Jacob, Aravindan Nair
April-June 2012, 55(2):158-162
DOI:10.4103/0377-4929.97845  
Background : Micro-RNAs (miRNAs) are expressed in a tissue-specific manner and are known to demonstrate differential expression even among the various subtypes of a given tumor. This differential expression has been harnessed successfully in the development of diagnostic assays for various malignant tumors. These assays have been found to be relevant and of value as additional diagnostic tools even among thyroid tumors, particularly with regard to thyroid carcinomas of follicular morphology. Materials and Methods : A limited set of miRNA have been assessed as part of this study in an effort to use minimal number of miRNA markers (miR-187, miR-221, miR-222, and miR-224) to differentiate the benign from the malignant thyroid tumors using miRNA derived from paraffin embedded material. Results : While miR-221 and miR-222 were found to provide good accuracy as individual markers (86% and 84%), a combination of the two provided slightly better accuracy (91%). Both miR-221 and 222 were able to significantly differentiate malignant tumors from the benign samples (P< 0.001) individually and as a combination of markers. However, inclusion of miR-187 and miR-224 in the panel did not provide any additional benefit. Conclusion : While a combination of miR-221 and 222 when used in a diagnostic panel could provide fairly good accuracy additional markers may need to be investigated to augment their diagnostic utility.
  3,005 237 5
Human telomerase reverse transcriptase expression in ovarian tumors
Awadh Ali Makhashen Maraei, Ahmad Zailani Hatta, Mohd Sidik Shiran, Geok Chin Tan
April-June 2012, 55(2):187-191
DOI:10.4103/0377-4929.97865  
Background : Ovarian cancer is the 6 th most common cancer among women. In ovarian tumors, the borderline category is not well defined due to the difficulty in assessing stromal invasion. The World Health Organization (WHO) defined it as tumor that lacks obvious invasion of the stroma with mitotic activity and nuclear abnormalities intermediate between clearly benign and unquestionably malignant. Telomerase is expressed in many human cancers and is hence a potential biomarker for cancer. Immunohistochemical study of anti-human telomerase enzyme reverse transcriptase (hTERT) antibody allows direct visualization of its expression. The aim of this study was to determine the expression of hTERT and serum CA-125 level in ovarian epithelial tumors, and their ability to distinguish borderline tumor from malignancy. Materials and Methods : This was a retrospective study on 68 ovarian epithelial tumors, comprising of 41 cystadenocarcinoma, 22 borderline tumor and five cystadenoma. By immunohistochemistry, hTERT expression was graded as negative (0-10%), focal (11-25%), regional (26-75%) and diffuse (>75%) positivity. Results : hTERT protein expression in ovarian cystadenocarcinoma, borderline tumor and cystadenoma were 71.4%, 59.1% and 0%, respectively. hTERT and CA-125 had a linear relationship with tumor grade and stage. hTERT protein is detected as large granules/speckled in the cytoplasm and nuclei of ovarian tumors. Conclusions : hTERT protein was highly expression in ovarian epithelial carcinoma. However, the difference between carcinoma and borderline tumor was not statistically significant (P-value = 0.51). It is not an independent biomarker to differentiate borderline tumor from malignant tumor. We suggest using the combination of hTERT immunohistochemistry and serum CA-125 to evaluate difficult situations where histological evaluation fails to distinguish malignant from borderline ovarian tumor.
  3,035 168 4
Study of parameters to ensure quality control in histopathology reporting: A meta-analysis at a tertiary care center
Asim Qureshi, Asif Loya, Muhammad Azam, Mudassar Hussain, Sajid Mushtaq, Tariq Mahmood
April-June 2012, 55(2):180-182
DOI:10.4103/0377-4929.97857  
Context : When surgical pathology reports are dispatched to patients and clinicians, sometimes they are discovered to have errors, and it is a common practice for the pathologists to issue amended reports. Measuring the rate at which surgical pathology reports are amended can be used as a tool for assuring quality control in histopathology. Aim : The aim of this study was determine the parameters that can be used as an assessment tool to minimize errors in histopathology. Materials and Methods : This study was carried out at a major histopathology center. The duration of this study was from January 2001 through January 2011(ten years). Following parameters were looked for: Interpretational errors, permanent and frozen section correlation, intradepartmental consultation and cases sent for second opinion, cases brought in tissue committee meetings, audits, and cases discussed in hospital meetings. Results : A total of 28,1931 surgical pathology cases were signed out during the ten-year period. On these, addendums were issued on 5730 cases (2.0%). Additional report issued on 3521 (1.3%). Addendum/corrected report issued for 2209 cases, which was 0.7%, representing the true interpretational error. And out of this number, a second opinion was taken for 5980 cases, and 78 were sent abroad for second opinion. Conclusion : Review by a second pathologist is a strong tool to minimize errors in surgical pathology reporting. This may be done prior to or after the report is dispatched and the case is discussed in the hospital for treatment purposes. This analysis concludes that true interpretational error occurred only in 0.7% of cases, which is an attribute to the strong peer review in the department.
  2,898 241 3
CASE REPORTS
Clear cell adenocarcinoma of the male urethral tract
Jatin S Gandhi, Anuj Khurana, Apoorvi Tewari, Anurag Mehta
April-June 2012, 55(2):245-247
DOI:10.4103/0377-4929.97895  
We present a rare case of clear cell adenocarcinoma of the male bulbomembranous urethra. Mostly these tumors have been described in the female urethral tract with its possible origin from mullerian remnants, wolffian remnants or paraurethral glands. Histologically, these tumors have typically tubulocystic pattern comprising of hobnailed cells with clear glycogenated cytoplasm along with well-defined cytoplasmic membranes. This case is being presented due to its rarity, aggressive behavior and to discuss, trauma as its possible etiological factor
  2,983 89 4
LETTERS TO EDITOR
Refractory cytopenia of the childhood
M Chowdhry, RN Makroo, P Srivastava, M Mishra
April-June 2012, 55(2):274-276
DOI:10.4103/0377-4929.97916  
  2,873 158 -
Seroprevalence of Brucellosis: A 10-year experience at a tertiary care center in north India
Suma B Appannanavar, Kusum Sharma, Subhash Verma, Meera Sharma
April-June 2012, 55(2):271-272
DOI:10.4103/0377-4929.97913  
  2,670 304 -
CASE REPORTS
Hepatic solitary fibrous tumor: Report of a rare case
Sushma Patra, Mukul Vij, K Venugopal, Mohamed Rela
April-June 2012, 55(2):236-238
DOI:10.4103/0377-4929.97892  
Solitary fibrous tumor (SFT) of the liver is an extremely rare neoplasm of mesenchymal origin. In the English literature, less than 40 cases of SFTs of the liver have been reported. The present case concerns a 34-year-old female who presented to us with complaint of dyspepsia. On examination, there was hepatomegaly. On ultrasound examination, an SOL in the liver was detected. Large tumor measuring 14.5 × 10 × 8 cm was resected. Microscopic evaluation of the tumor showed a well-circumscribed, low to moderately cellular tumor demonstrating spindle- and fibroblast-like cells within the collagenous stroma. Immunohistochemistry revealed diffuse strong cytoplasmic immunopositivity of CD34, Bcl2, and vimentin. A diagnosis of a benign SFT was given. The patient remained well 4 years after surgery. SFT is a rare mesenchymal neoplasm that occasionally involves the liver in adult patients. Most SFTs are benign, but some may have malignant histological features. With less than 40 reported cases in the literature, little can be said regarding its natural history or the benefits of adjuvant radio chemotherapy. Complete surgical resection remains the cornerstone of its treatment.
  2,777 127 7
LETTERS TO EDITOR
Extraskeletal osteochondroma of the arm masquerading as chondroid syringoma: A diagnostic pitfall on cytology
Neha Singh, Nita Khurana, Shyama Jain
April-June 2012, 55(2):259-260
DOI:10.4103/0377-4929.97901  
  2,673 78 -
CASE REPORTS
Ureteric nephrogenic adenoma: A report of two cases
Mudassar Hussain, Nasir U Din, Haseeb A Khan, Muhammad Tehseen
April-June 2012, 55(2):250-252
DOI:10.4103/0377-4929.97897  
Nephrogenic adenoma is a rare, benign, metaplastic lesion predominantly seen in urinary bladder, which occurs even more rarely in the ureters. We report two such cases, arising in the ureter. Both patients were young adult males. Histology of both cases was similar, showing tubules lined by columnar cells with hobnailing of nuclei. Immunohistochemically, both cases resembled their counterparts in urinary bladder. These lesions are important to recognize, since they can easily be confused with several malignancies.
  2,546 74 -
LETTERS TO EDITOR
Angiosarcoma in recurrent malignant phyllodes tumor of breast
Madhu Kumar, Madhu Mati Goel, Mala Sagar, Sandeep Tiwari
April-June 2012, 55(2):264-265
DOI:10.4103/0377-4929.97905  
  2,422 85 4
IMAGES
Hamazaki-Wesenberg bodies in mesenteric lymph node
Vandana L Gaopande, Sanjay D Deshmukh
April-June 2012, 55(2):256-256
DOI:10.4103/0377-4929.97899  
  2,368 114 -
LETTERS TO EDITOR
"Subnuclear empty vacuolated cell" metaplasia of the gastric mucosa
Teresa Pusiol, Guido Mazzoleni, Esther Hanspeter, Doriana Morichetti, Maria Grazia Zorzi
April-June 2012, 55(2):265-266
DOI:10.4103/0377-4929.97907  
  2,404 58 -
IMAGES
Cutaneous malakoplakia: Diagnosed cytologically
Ruchi Srivastava, Seema Aggarwal, Vinod K Arora
April-June 2012, 55(2):257-258
DOI:10.4103/0377-4929.97900  
  2,263 122 1
LETTERS TO EDITOR
The association of Epstein-Barr virus infection with multiple myeloma
Gulfaraz Khan
April-June 2012, 55(2):266-267
DOI:10.4103/0377-4929.97908  
  2,193 79 -
CASE REPORTS
Primary plemorphic adenoma of bone: Report of a case and literature review
Hong Yu, Xiaojian Liu, Hui Li, Daren Shi, Chaofu Wang
April-June 2012, 55(2):230-232
DOI:10.4103/0377-4929.97890  
Plemorphic adenoma mainly occurs in the salivary glands. A similar tumor arising in the bone is extremely rare, and only three cases have been reported so far. Here, we present an additional case of primary plemorphic adenoma of bone; describe its clinical, pathological and radiological features; and compare them with those of the reported cases.
  2,055 89 -
ORIGINAL ARTICLES
Study of the Murine Double Minute 2 status in patients with gastric and colorectal carcinomas and its correlation with prognostic factors
Siadati Sepideh, Jalali Nadoushan Mohammadreza, Davati Ali, Torabi Parizi Gholamreza, Ghasemi Samira
April-June 2012, 55(2):192-195
DOI:10.4103/0377-4929.97866  
Background: Gastric and colorectal cancers are the second and the fourth most common cancers in Iran, respectively. The presence of Murine Double Minute 2 (MDM2) has been identified in many cancers and its relationship with prognosis is under investigation. This study aimed to assess the status of MDM2 and its relationship with prognostic factors in gastric and colorectal carcinoma. Materials and Methods: This study was performed on 99 paraffin blocks of gastric and colorectal cancers, during the years 2001 to 2007 from Mostafa Khomeini Hospital, Tehran, Iran. Tissue sections were prepared, stained with Hematoxylin and Eosin and immunohistochemistry to evaluate for MDM2 expression. The type of tumor, lymph node involvement and tumor grade was determined. Results: Of the 99 cases, 34.3% and 65.7% cases were diagnosed with gastric and colorectal adenocarcinoma, respectively. The average tumor size was 5.5 cm. MDM2 expression level was 82.4% and 90.8% in gastric and colorectal adenocarcinoma, respectively. No statistical difference was found between MDM2 expression and various prognostic factors; however, significant correlation was observed between gastric (P = 0.03) and colorectal (P = 0.03) tumor size and the percentage of MDM2 immunoreactivity. Conclusion: Considering the role of MDM2 in cell growth and its positive correlation with tumor size (an established prognostic factor), it can be indirectly concluded that MDM2 is also important in prognosis. However, additional investigation is needed.
  1,928 93 1
LETTERS TO EDITOR
Clear cell meningioma of the cauda equina in an adult
Varuna Mallya, Avninder Singh, Karamchand Sharma
April-June 2012, 55(2):262-264
DOI:10.4103/0377-4929.97904  
  1,935 84 2
Microphotometric nuclear DNA analysis of atypical squamous cells of the uterine cervix
Veena Kashyap
April-June 2012, 55(2):267-268
DOI:10.4103/0377-4929.97910  
  1,518 56 -
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