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   2020| April-June  | Volume 63 | Issue 2  
    Online since April 18, 2020

 
 
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GUEST EDITORIALS
COVID-19 and lung pathology
Amita Jain
April-June 2020, 63(2):171-172
DOI:10.4103/IJPM.IJPM_280_20  PMID:32317509
  4,586 449 -
Why is SARS-CoV-2 testing not possible in every medical laboratory?
Prashant Gupta
April-June 2020, 63(2):173-174
DOI:10.4103/0377-4929.282722  PMID:32317510
  1,895 257 -
CASE REPORTS
Lung metastasis, an incidental finding in maxilla – A case report
Sandhya Tamgadge, Treville Pereira, Sandeep Kale, Subraj Shetty, Avinash Tamgadge
April-June 2020, 63(2):273-275
DOI:10.4103/IJPM.IJPM_325_19  PMID:32317531
The aim of this article was to present an asymptomatic lesion with insignificant clinical findings which turned out to be metastatic lesion in the jaws with primary in lung. The most common site of lung metastasis in the orofacial region is the mandible, but in our case it was seen in the maxilla. Metastases to the jaw bones occur in later stages. Hence, a careful examination of patients with jaw bone lesions is strongly suggested. Metastasis to the jaw should be considered while doing oral examination as observed in the current case because such lesions usually develop at terminal stage of cancer.
  1,387 282 -
REVIEW ARTICLE
Clear cell lesions in pathology: Histomorphologic approach to diagnosis
Asaranti Kar, Kaumudee Pattnaik, Tushar Kar, Priyadarshini Biswal, Chandraprava Mishra, Lilabati Guru
April-June 2020, 63(2):177-187
DOI:10.4103/IJPM.IJPM_791_19  PMID:32317512
There has been remarkable progress in the field of surgical pathology; however, histomorphology has remained the most important and essential tool of the surgical pathologist in everyday practice till now. It is surprising that the hematoxylin–eosin (H and E) stain, introduced more than a century ago, has still remained the gold standard stain for histological examination and diagnosis of human diseases. Besides different findings or clues observed in histopathology sections like inclusions, granules, grooving, globules, halo, or clearing, which would enable the pathologist to provide a precise and accurate diagnosis; observation of clear cells is one of the important findings and clue for reporting. It may also sometimes lead to difficulties and delays in establishing the diagnosis. It can be focal or extensive and primary or rarely it may be secondary. Clear cell changes may be observed in many non-neoplastic, benign, or malignant tumors of diverse origin. Clear cell tumors contain a preponderance of clear cells. It can be seen in almost all the organs of human body and can be classified according to location or biological behavior. Commonly seen clear-cell tumors are usually malignant and common organs involved are female genital tract, urogenital tract, head and neck areas, central nervous system, skin, and rarely in bone and soft tissues. For approach to clear cell lesions, one has to decide if the change is artifactual, a mimic of clear cell tumors, or a clear cell tumor in reality. Once the mimics and artifactual/degenerative changes have been ruled out, a tumor either primarily of clear cell origin or showing secondary change has to be decided. The tumor next is to be diagnosed as benign/malignant and epithelial/mesenchymal based on morphology.
  966 293 -
EDITORIAL INSIGHT
Plagiarism
Ranjan Agrawal
April-June 2020, 63(2):175-176
DOI:10.4103/0377-4929.282724  PMID:32317511
  1,055 145 -
EDITORIAL
From Editor's desk
Ranjan Agrawal
April-June 2020, 63(2):169-170
DOI:10.4103/0377-4929.282723  PMID:32317508
  921 86 -
CASE REPORTS
A case of giant anastomosing hemangioma of the kidney with extramedullary hematopoiesis: A great mimicker
Vidhya Manohar, Shantha Krishnamurthy, Jyothi Ranganathan, Vishwas D Pai
April-June 2020, 63(2):292-294
DOI:10.4103/IJPM.IJPM_434_18  PMID:32317537
Anastomosing hemangioma (AH) are rare mesenchymal neoplasms affecting kidney with about 50 cases reported in English literature. In general, they are accidentally detected during examination or imaging done for nonspecific symptoms or wellness check-up. There are no key diagnostic features on the imaging modalities. The most common preoperative diagnosis has been a malignant primary renal carcinoma. Surgical resection remains the mainstay of treatment and of choice in symptomatic lesions. We are presenting a rare case of giant AH of the kidney mimicking a renal cell carcinoma on imaging. The lesions are characterized by anastomosing sinusoidal-like vascular spaces lined by banal endothelial cells with occasional hobnail morphology and associated with extramedullary hematopoiesis. The treatment of choice could be a conservative approach in small and asymptomatic lesions and patients with pre-existing renal dysfunction; hence, this entity should be in the differential of vascular renal neoplasms considering its proclivity to the urogenital tract. This is the first case in Indian literature to the best of our knowledge.
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ORIGINAL ARTICLES
Frequency and clinical significance of red cell antibodies in pregnancy – A prospective study from India
Soumya Das, Shamee Shastry, Lavanya Rai, Poornima B Baliga
April-June 2020, 63(2):241-246
DOI:10.4103/IJPM.IJPM_737_19  PMID:32317523
Background: For appropriate management of hemolytic disease of the fetus and newborn (HDFN), it is important to detect irregular red cell antibody in the antenatal period. Though it is a simple one-step method, it is not part of routine antenatal screening in many developing countries. To reiterate the importance of antenatal antibody screening, we have assessed the frequency and clinical significance of irregular red cell antibodies in our patient population. Materials and Methods: A prospective study was carried out from October 2013 to May 2015 at a tertiary care center from south India. All antenatal samples received by the laboratory for red cell antibody screening were screened using a commercial three-cell screening panel. Antibody identification along with further Immunohematological techniques as required were performed for cases with positive screening results. Neonates of the alloimmunized cases were followed up to determine the clinical significance of the antibody. Results: A total of 2336 antenatal mothers were screened for red cell antibodies. The overall rate of alloimmunization in the study group was 2.27%. Alloimmunization rate among RhD-negative pregnancies was 6.9%. Other than anti-D (49%), we identified anti-D + anti-C (5%), anti-G (5%), anti-c (5%), anti-E (2%), anti-e (2%), anti-H (Bombay phenotype) (7%), anti-M (2%), anti-Lea (2%), anti-Leb (12%), and autoantibodies (9%) in the maternal serum. Anti-D, anti-D + anti-C, anti-G, anti-c, and anti-H were found to be clinically significant in this study. Conclusion: This study showed that 1 in 125 RhD-positive pregnancies can develop red cell alloantibodies. Hence, implementing routine antenatal antibody screening irrespective of RhD status is essential.
  697 72 -
A comparison between unifocal papillary thyroid microcarcinoma with noninvasive follicular thyroid neoplasm with papillary-like nuclear features and other patterns: A retrospective clinicopathological study
Emel Cakir, Ismail Saygin, Savas Kisioglu
April-June 2020, 63(2):188-193
DOI:10.4103/IJPM.IJPM_586_19  PMID:32317513
Background: Papillary thyroid microcarcinoma (mPTC) is defined as a tumor with low malignancy potential. Different treatment protocols have been used at different centers for analyzing this tumor which has common recurrence and metastasis rates. Consequently, in 2016, the definition of noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) was accepted which included the lesions > cm. It is important to explain the clinical course and appropriate treatment options for mPTC and its subtypes. Aims: In this study, we aimed to describe the clinical course of mPTC with and without NIFTP and to determine different risk groups among these subtypes. Material and Methods: We performed microscopic reexamination of about 280 unifocal mPTCs retrieved from our archives between 2007–2018 and analyzed the results of morphological and clinical comparison among these cases that had 0–11-years of clinical follow-up. Results: Among 280 unifocal mPTCs, 127 cases (45.4%) had classical morphology, 58 (20.7%) had NIFTP, 53 (18.9%) had infiltrative pattern, 27 (9.6%) had oncocytic pattern, 12 (4.3%) showed capsular invasion, and 3 (1.1%) showed other morphologies. Seven patients were detected with lymph node metastasis and one with distant metastasis at diagnosis. Lymph node metastasis (recurrence) was postoperatively detected in five patients. All patients with recurrence were women. Moreover, three of these patients were in their 30s and two in 70s. The median diameter of the tumor was 3 mm. Both invasive and noninvasive cases have recurred. Conclusion: Contrary to the results of the previous studies, the results of our study did not confirm the indolent course of mPTC with NIFTP. However, metastasis was detected both at the time of diagnosis and during the postoperative period. The malignancy potential of these tumors may not be low. Therefore, more clinicopathological and molecular studies are needed to determine the biological behavior of mPTC cases with different histology.
  572 132 -
Dual-color dual-hapten in situ hybridization (D-DISH) – Comparison with fluorescence in situ hybridization (FISH) for HER2/neu testing in breast cancer
Pooja K Gajaria, Sonali Tambe, Trupti Pai, Asawari Patil, Sangeeta B Desai, Tanuja M Shet
April-June 2020, 63(2):194-199
DOI:10.4103/IJPM.IJPM_861_19  PMID:32317514
Context: HER2/neu testing in breast cancer is a mandate due to availability of trastuzumab, a monoclonal antibody targeted against this biomarker. Dual-color dual-hapten in situ hybridization (D-DISH) is a new test for assessment of HER2/neu gene overexpression on light microscopy. Aims: This was a validation study for D-DISH in our laboratory and was conducted to study the concordance between fluorescence in situ hybridization (FISH) and D-DISH for HER2/neu testing in breast cancer. Materials and Methods: In all, 150 cases of invasive breast carcinoma requested for FISH analysis were selected. Immunohistochemistry by Ventana PATHWAY anti-HER2/neu (4B5) antibody, FISH by ZytoLight SPEC ERBB2/CEN17 Dual Color Probe, and D-DISH using the Ventana INFORM HER2 Dual ISH DNA Probe Cocktail Assay was carried out. Statistical Analysis: Cohen's kappa coefficient was used to calculate concordance between FISH and D-DISH assays. The ratios and average number of signals were compared with Lin's concordance correlation coefficient. Results: About 93.1% of the cases showed concordance between FISH and D-DISH results. Cohen's kappa correlation coefficient was 0.836, indicating almost perfect level of agreement. Lin's concordance correlation coefficient (ρc) showed moderate strength of agreement for HER2/chromosome 17 ratios between FISH and D-DISH assays (ρc 0.9452). As per the American Society of Clinical Oncology/College of American Pathologists (ASCO/CAP) 2018 updated guidelines, four of the cases that were nonamplified on FISH showed low-level amplification on D-DISH due to counting errors caused by faint signals or background dust. Genomic heterogeneity and larger red chromosome 17 signals on D-DISH led to discordance of the six cases amplified by FISH. D-DISH failure rate was 3.33%. Conclusion: Overall, D-DISH showed good concordance with FISH but needs expertise for reporting.
  510 67 -
Expression of p53 in epithelial ovarian tumors
Nihad Abdul Razak Amanullah, Usha Poothiode, Letha Vilasiniamma
April-June 2020, 63(2):235-240
DOI:10.4103/IJPM.IJPM_526_19  PMID:32317522
Background: Ovarian cancers remain the most lethal of all gynecological malignancies despite major developments in their treatment. Objectives: To study the rate of expression and staining patterns of p53 in various histological types and grades of epithelial ovarian tumors (EOT). Materials and Methods: Sixty EOTs received in a tertiary care center were studied for gross, microscopy, and p53 immunohistochemistry (IHC) expression patterns. Parameters such as age, laterality of tumor, ascites, capsule rupture, tumor size, stage at presentation, metastasis, tumor grade, and number of mitosis were correlated. Results: Of the sixty cases studied, 23 (38.3%) were malignant. Serous carcinomas were the largest group with 17 cases (74%) followed by mucinous with 4 cases (17%) and 2 clear cell carcinomas (9%). All benign and borderline EOT were p53 negative. 65.2% of the malignancies were p53 positive and all of them were serous malignancies. 15 out of 16 high-grade serous carcinomas were p53 positive (94%), while one case was negative (6%). 10 cases (63%) showed intense diffuse positivity of more than 60% of the nucleus, while 5 cases (31%) showed aberrant null staining <5% staining of the nucleus. All mucinous, clear cell carcinomas, and the only low-grade serous carcinoma in the study were p53 negative. P53 staining had positive correlations with variables like capsule rupture, ascites, laterality, and CA 125. Conclusions: The study highlights the different rates of expression and staining patterns of p53 and the need for correct interpretation of p53 IHC for the diagnosis of various EOT.
  469 93 -
CASE REPORTS
Cerebral hemispheric glioblastoma with PNET-like morphology and histone H3.3 G34 mutation in younger patients: Report of three rare cases and diagnostic pitfalls
Yuanyuan Cheng, Weiqi Bao, Qian Wu
April-June 2020, 63(2):262-266
DOI:10.4103/IJPM.IJPM_544_19  PMID:32317528
Recurrent mutations in H3F3A that encodes the histone 3 variant H3.3, lead to amino acid substitutions including K27M and G34R/V-which are observed in high-grade gliomas (HGGs) of children and young adults. Previous studies have focused on gliomas with K27M mutation, whereas gliomas with G34R/V mutation have received little attention. Herein, we report three rare cases of glioblastoma (GBM) with H3.3 G34 mutation arising from a cerebral hemisphere in two children and one young adult. All three cases showed microscopic characteristics of central nervous system primitive neuroectodermal tumor (CNS-PNET, called CNS embryonal tumors in WHO 2016 Revised 4th Edition) and presented H3.3 G34 mutation. H3.3 G34-mutant brain tumors were formerly a group of histopathologically distinct neoplasms, involved in GBM, CNS-PNET, and astroblastoma. However, recent studies have demonstrated that different CNS tumors with H3.3 G34 mutation display coherent epigenetic signatures, implying a single biological origin. Correspondingly, our three cases showed high consistency in tumor location, histological morphology, and molecular phenotype. Their immunophenotypes are similar to astrocytoma, with ATRX loss and TP53 mutation. Therefore it suggests that these H3.3 G34-mutant brain tumors may be a rare entity of HGG.
  517 35 -
ORIGINAL ARTICLES
Microvessel density and vascular endothelial growth factor receptors in breast carcinoma under the influence of rapamycin and platelet factor 4
Muhammad Shahidan Muhammad Sakri, Wan Faiziah Wan Abdul Rahman, Tengku Ahmad Damitri Al-Astani Tengku Din, Fauziah Mohd Idris, Hasnan Jaafar
April-June 2020, 63(2):205-209
DOI:10.4103/IJPM.IJPM_496_19  PMID:32317516
Background: Vascular endothelial growth factor receptors (VEGFRs) are major endothelial growth factor receptors that influence the growth of a tumor. Microvessel density ( MVD) is the quantification method of various aspects of tumor vasculature that indicates angiogenic activity. This study aims to analyze the correlation between MVD to the expression of VEGFRs on breast cancer tissue. Materials and Method: A total of 60 N-methyl-N-nitrosourea (MNU)-induced breast carcinomas in rats were suppressed by using antiangiogenic drugs. The rats were then sacrificed, and the tumor was fixed in 10% formalin, paraffin embedded, and immunohistochemistry stained using VEGFRs and CD34. Result: One-way ANOVA test showed a significant difference in all markers that have been used (P < 0.05) on MNU-breast tumor treated with rapamycin (M= 90.1664, SD= 7.4487), PF4 (M= 93.7946, SD= 7.1303) and rapamycin + PF4 (M= 93.6990, SD= 1.8432). We obtained a significant reduction of MVD count on breast carcinoma for rapamycin group (M= 25.6786, SD= 9.7075) and rapamycin + PF4 group (M= 30.5250, SD= 13.6928) while PF4 group (M=47.7985, SD=4.8892) showed slightly increase compared to control (M= 45.1875, SD= 4.4786). There was a moderately strong, positive correlation between angiogenic markers; Flt-1 (r= 0.544, n=60, P < 0.005) and Flt-4 (r= 0.555, n= 60, P < 0.005) while Flk-1 (r= 0.797, n= 60, P < 0.005) showed a strong, positive correlation with MVD. Conclusion: MVD was strongly correlated to the VEGFRs expression on breast carcinoma.
  491 36 -
Quantitative mast cell analysis and hormone receptor study (ER, PR and HER2/neu) in invasive carcinoma of breast
Rama D Pyla, RM Potekar, Vijayalaxmi S Patil, Anil K Reddy, KV Sathyashree
April-June 2020, 63(2):200-204
DOI:10.4103/IJPM.IJPM_155_19  PMID:32317515
Context: Breast cancer constitutes nearly one third of cancers among women. Immune responses caused by neoplastic cells lead to the accumulation of inflammatory cells like mast cells (MCs), macrophages, lymphocytes, and plasma cells around the tumor tissue forming the tumor microenvironment. Aim: The study aims at quantifying the role of MCs in different grades of invasive carcinoma of breast with respect to estrogen receptor (ER), progesterone receptor (PR), and Human Epidermal growth factor Receptor 2 (HER2/neu). Materials and Methods: This study included 60 cases of invasive carcinoma of breast. Toluidine blue staining was used for quantitative MC analysis and correlated with immunohistochemistry analysis for hormonal markers' positivity—ER, PR and HER2/neu. Results: The mean age was 52 years (range: 25–75 years). The average number of MCs in Grade I, II, and III were 24.05, 18.4, and 7.9, respectively, with a significant P value. ER, PR, and HER2/neu positivity was found in 60%, 55%, and 32% of the cases, respectively. ER positivity with mean MC count of 23.55 was found in 36 cases, and 33 cases were positive for PR with a mean MC count of 24.18 and a significant P value. HER2 positive cases were 28 with a mean MC count of 20.82. Conclusion: The presence of MCs in breast cancer is inversely proportional to the grade of tumor, i.e., a maximum number of MCs were seen in low grade tumors. In addition, there is a positive correlation between ER and PR receptor positivity with the presence of MCs in the stroma of breast cancer.
  446 78 -
Anti-glomerular basement membrane disease: A clinicomorphological study of 16 cases
Srinivasrao Vavilapalli, Nishika Madireddy, Megha S Uppin, Karthik Kalidindi, Swarnalatha Gudithi, Gangadhar Taduri, Sree Bhushan Raju
April-June 2020, 63(2):226-229
DOI:10.4103/IJPM.IJPM_712_18  PMID:32317520
Introduction: Antiglomerular basement membrane disease manifests as rapidly progressive glomerulonephritis and alveolar hemorrhage. It encompasses 10–15% of crescentic glomerulonephritis and is associated with poor outcome. In this study, we have elaborated on the clinical details, morphological features, and outcome of anti-GBM glomerulonephritis. Materials and Methods: All the consecutive biopsy-proven cases of anti-GBM glomerulonephritis over a period of 4½ years were analyzed, retrospectively. Results: Sixteen cases were diagnosed as anti-GBM glomerulonephritis during the study period. Twelve patients presented with rapidly progressive renal failure of which four patients required hemodialysis at the time of presentation. Goodpasture's syndrome was noted in two patients. Thirteen cases were positive for circulating anti-GBM antibodies and two patients showed double positivity for both anti-GBM antibodies and ANCA. Fifteen biopsies revealed crescentic glomerulonephritis with linear deposition of IgG along the glomerular basement membrane in all the 16 cases. Conclusion: Renal biopsy analysis is important in the diagnosis of Anti GBM nephritis. Morphology is an important predictor of disease progression.
  403 60 -
Diagnosis of pulmonary tuberculosis from gastric aspirate samples in nonexpectorating pediatric patients in a tertiary care hospital
Shiwangi Sharma, Anuradha Shulania, Arvind Achra, Hishmi Jeram, Stuti Kansra, Nandini Duggal
April-June 2020, 63(2):210-213
DOI:10.4103/IJPM.IJPM_694_19  PMID:32317517
Objectives: The aim of this study was to assess the utility of Xpert assay, Ziehl–Neelsen (ZN) staining, and Mycobacteria Growth Indicator Tube (MGIT™) culture for diagnosis of pediatric pulmonary tuberculosis from gastric aspirate (GA) samples and to compare Xpert assay and ZN staining with MGIT rapid liquid culture. Materials and Methods: GA samples from 210 nonexpectorating children, aged between 6 months to 12 years, presenting to the pediatric out-patient department (OPD) with clinical suspicion of tuberculosis (TB) were collected. The samples were tested by GeneXpert, ZN staining, and MGIT liquid culture. Results: GeneXpert is a more sensitive method for rapid and early diagnosis of pediatric TB when compared with microscopy.
  375 75 -
Immunohistochemical expression of interlukin10 (IL10) and heat shock protein-90 (HSP-90) in prostatic carcinoma
Wasan Abdul-ilah Bakir, Hiba Ahmed Gaidan, Methaq Mueen Al-kaabi
April-June 2020, 63(2):230-234
DOI:10.4103/IJPM.IJPM_460_19  PMID:32317521
Background: Specific cytokines are related to pathologically changed prostate, propose that the balance in cytokine differs in normal and pathological prostate. Of these cytokines the interleukins 10, due to its “pleiotropic” actions in inflammation and angiogenesis, and HSP-90 due to its expression in tumor cells at high levels, suggesting that it has an important role for growth and/or survival of tumor cells. Aims: Evaluation of HSP-90 and IL10 immunoreactivity in benign prostatic hyperplasia (BPH) and prostatic carcinoma and to correlate this expression with clinicopathological parameters. Settings and Design: A retrospective study in which 83 Paraffin-embedded tissue specimens including (43) BPH, (40) prostatic carcinoma and (20) normal prostate as control were included between the period of January 2015 and January 2017. Patients, Material and Methods: All the cases were evaluated histopathologically and stained immunohistochemically for IL10 and HSP-90. Only cytoplasmic staining was considered as positive. Immunoreactivity scoring for both markers expression was calculated based on both staining intensity and percentage. Statistical Analysis: Was done using SPSS Version 21 statistical analysis software. P value of <0.05 was considered statistically significant. Result: Statistical analysis of HSP-90 and IL10 expression revealed a highly significant correlation of expression of these two markers in advanced Gleason grading and tumor, node, and metastasis (TNM) staging cases of prostatic carcinoma. Conclusion: High expression of IL10 and HSP-90 is associated with high grade and stage of prostatic carcinoma. This provides a base for further studies and researches on the role of these investigated proteins as prognostic markers immunotherapy targets for carcinoma of the prostate.
  369 57 -
HER-2/neu over expression in gall bladder adenocarcinoma: A quest for potential therapeutic target
Pragya Jain, Surbhi Goyal, Geeta Chauhan, Kaushik Majumdar, Shahajad Ali, Puja Sakhuja, Anil K Agarwal
April-June 2020, 63(2):214-220
DOI:10.4103/IJPM.IJPM_664_19  PMID:32317518
Background: Gall bladder carcinoma (GBC) is an aggressive malignancy with high mortality and aggressive course, with palliation as the only available option. Objectives: To evaluate frequency of HER-2/neu overexpression in GBC and to seek its correlation, if any with conventional clinicopathological parameters and survival. Methods: Immunohistochemistry (IHC) was performed on 200 cases of GBC, 32 cases of dysplasia, and 100 cases of chronic cholecystitis. Fluorescent in situ hybridization (FISH) was performed on 30 randomly selected cases of GBC to validate IHC. HER-2/neu overexpression (IHC 3+/FISH amplification ≥2.2) was correlated with clinicopathological parameters by Chi-square test.P < 0.05 was considered significant. Survival analysis was done by log-rank test and Kaplan-Meier analysis. Results: HER-2/neu overexpression was seen in 14% (28/200) GBC cases but was not found in dysplasia and chronic cholecystitis. Majority of these cases were ≤grade 2 and in advanced stage, however this was not statistically significant. A lower mean survival in HER-2/neu positive group as compared to HER-2/neu negative group (17.1 ± 2.3 month versus 67.6 ± 8.5 month, respectively) was observed. Concordance between IHC and FISH was seen in 18/19 cases. Conclusion: This study delineates a subset of GBC patients with HER-2/neu overexpression, in whom targeted therapy can offer a survival benefit.
  330 76 -
Loss of ASXL1 expression is associated with lymph node metastasis in colorectal cancer
Jun H Lee, Ju-Hee Lee, Byung K Ahn, Seung S Paik, Hyunsung Kim, Kang H Lee
April-June 2020, 63(2):221-225
DOI:10.4103/IJPM.IJPM_822_19  PMID:32317519
Context: The function of ASXL1 in colorectal cancer (CRC) has not been investigated yet. Aims: The purpose of this study was to investigate the clinicopathological and prognostic impact of ASXL1 expression on CRC. Settings and Design: The intensity of expression was scored as 0–3, and the extent of staining was scored as 0–4, based on the percentage of positive cells. The immunoreactivity score (IRS) was calculated by multiplying the two scores. Materials and Methods: We performed immunohistochemical staining of ASXL1 using tissue microarrays of 408 CRCs, 46 normal colonic mucosae, 48 adenomas, and 92 metastatic lymph nodes. Statistical Analysis Used: Clinicopathological variables were compared using Fisher's exact test, χ2-test, or unpaired Student's t-test, depending on the nature of the data. Results: A negative expression of ASXL1 was observed in 10.9% of normal mucosae, 27.1% of adenomas, 55.6% of adenocarcinomas, and 71.7% of metastatic lymph nodes (P < 0.001). With respect to the IRS cut-off score, lymph node metastasis and lymphatic invasion were more frequent in the IRS 0–6 group than in the IRS 8–12 group (56.3% vs. 33.3%, P = 0.034; 56.0% vs. 33.3%, P = 0.035). The 5-year disease-free survival rate was significantly lower in patients with IRS 0–6 group than those with IRS 8–12 group (78.7 ± 2.5 vs. 100%, P = 0.034). Conclusion: ASXL1 might act as a tumor suppressor in CRC. The loss of ASXL1 expression might be associated with lymph node metastasis and lymphatic invasion in CRC.
  338 46 -
BRIEF COMMUNICATIONS
Development and applicability of a smartphone torch based emergency light source for microscopy
Himel Mondal, Shaikat Mondal, Debasish Das
April-June 2020, 63(2):258-261
DOI:10.4103/IJPM.IJPM_263_19  PMID:32317527
Background: Modern microscopes are equipped with built-in illuminator. However, during a power outage, microscopy is not possible with extra mirror system if an alternative light source is not available. Smartphone torch can serve as a light source. Holding it under the microscope is difficult when both hands are engaged in microscopy. Aim: The aim of the study was to develop a stand for smartphone torch and to check the applicability of smartphone torch-based light source in microscopy. Materials and Methods: A stand was made with cardboard for keeping the smartphone on it. An optical diffuser was made with white polyethylene plastic. Smartphone with the stand and optical diffuser can serve as a soft light source. A convenient sample of 16 faculty member rated 11 slides first under the microscope with its built-in light source and then twice with the new device as a light source on 10-point Likert type scale. Applicability of the device was checked by validity and reliability by Intraclass Correlation Coefficients (ICC) with α = 0.05. Results: The raters were able to examine the slides under the microscope with the new devices as a light source. An overall score (11 slides, 16 observers) for the image quality was 9.36 ± 0.86 (range 6-10). Interrater, intrarater, and test-retest ICC were 0.939 (P < 0.001), 0.853 (P = 0.003), and 0.889 (P < 0.001) respectively which indicate “good” to “excellent” level of reliability. Conclusion: Developed smartphone torch stand with an optical diffuser can serve as an emergency light source in microscopy. This may be a useful tool for settings with a frequent power outage.
  295 44 -
CASE REPORTS
Non-bullous neutrophilic lupus erythematosus—Muted bullous disease?
Purnima Malhotra, Preeti Singh, Bijit K Kundu, Minakshi Bhardwaj
April-June 2020, 63(2):305-308
DOI:10.4103/IJPM.IJPM_704_19  PMID:32317541
Non-bullous neutrophilic lupus erythematosus is a rare form of cutaneous lupus erythematosus (LE). We hereby present a case of 24-year-old female, known case of discoid LE (DLE) with negative ANA stabilized on hydroxychloroquine for 2 years. She reported new occurrence of erythematous, mildly pruritic, papular lesions and painful mucosal ulceration. The ANA became strongly positive by ELISA and urine showed proteinuria. A provisional diagnosis of Rowell syndrome was made, skin biopsy was taken, and patient started on steroids. Histopathology showed interface vacuolar change and many neutrophils in the dermis with leukocytoclasia without any bulla formation. The skin lesions responded promptly to addition of dapsone following biopsy report. We conclude that the presence of neutrophils associated with interface pathology on biopsy represents a muted form of bullous LE, especially in patients on immunosuppression. This case highlights the importance of histopathologic examination in the evaluation of any new skin lesions in a patient of lupus on therapy.
  312 21 -
Myxoid meningioma: A case report of an extremely rare subtype of metaplastic meningioma
Seema Rahar, Arvind Ahuja, Purnima Bharati, Minakshi Bhardwaj, Ajay Chaudhary
April-June 2020, 63(2):267-269
DOI:10.4103/IJPM.IJPM_111_19  PMID:32317529
Myxoid meningioma is a rare histological variant of meningiomas grouped into the subtype of metaplastic meningiomas (World Health Organization grade I) characterized by the presence of myxoid areas and meningothelial cells along with unique ultrastructural features that help distinguish it from other meningiomas. Hereby, we report a case of a myxoid meningioma in a 40-year-old female who presented with altered sensorium and loss of consciousness. Imaging studies showed a dura-based solitary mass located in the left frontal lobe. The tumor was excised completely. Histopathology revealed a benign appearing myxoid neoplasm with uniform elongated cells, without any atypia and a very low mitotic activity. Immunohistochemical stains showed positivity for vimentin and epithelial membrane antigen confirming the diagnosis of myxoid meningioma. Only seven cases of myxoid meningioma have been reported till date in the literature and ours is the eighth case.
  280 45 -
Ocular basidiobolomycosis – Rare presentation: A case report
Vasant Baradkar, Nirjhar Chatterjee, Jayanthi S Shastri, Manoj U Vedpathak
April-June 2020, 63(2):270-272
DOI:10.4103/IJPM.IJPM_687_19  PMID:32317530
Basidiobolus ranarum is an uncommon pathogen in ocular infections. It has been previously reported from subcutaneous and gastrointestinal infections. Here, we report a rare case of ocular infection caused by B. ranarum. A 21-year-old male patient presented with visual loss and pain in the right eye due to corneal abscess following an injury while welding. KOH mount performed was indicative of fungal hyphae. Fungal culture revealed growth of B. ranarum. Meanwhile, the patient was treated with antifungal (topical natamycin and oral ketoconazole) along with total corneal transplantation. B. ranarum is a fungus very uncommonly causing ocular pathogenesis. This results in diagnostic confusion leading to poor treatment outcomes. Hence, a mycology laboratory has to be aware about this fungus and need to consider it as a differential diagnosis in patients with infectious corneal abscess.
  289 36 -
NEW HORIZON
Catechism (Quiz 8)
Mona Agnihotri, Kanchan Kothari, Ameya Khadilkar
April-June 2020, 63(2):342-344
DOI:10.4103/IJPM.IJPM_15_20  PMID:32317555
  263 60 -
IMAGES
Oncocytic variant of papillary renal cell carcinoma: A rare or underreported entity?
Ashutosh Rath, Wonchibeni T Murry, Varuna Mallya, Nita Khurana, Sudhir Kumar Jain
April-June 2020, 63(2):327-329
DOI:10.4103/IJPM.IJPM_424_18  PMID:32317548
  272 34 -
BRIEF COMMUNICATIONS
Utility of grey zone testing strategy in transfusion transmissible infection testing in blood bank is of limited value!
Gunjan Bhardwaj, Aseem K Tiwari, Dinesh Arora, Geet Aggarwal, Swati Pabbi, Divya Setya
April-June 2020, 63(2):255-257
DOI:10.4103/IJPM.IJPM_404_19  PMID:32317526
Several blood banks use grey zone (GZ) phenomenon (defined as samples with optical density within 10% below the cut off in enzyme immuno-assay [EIA]/chemiluminescence immunoassay [CLIA]) to further augment blood safety. There is paucity of data regarding usefulness of GZ sample and its application in Transfusion Transmissible Infection (TTI) screening procedures in blood transfusion services. We looked at our GZ sample results and their confirmatory test results to verify if it adds to blood safety in our set-up? We performed a prospective analytical study on blood donors' samples over two years. All the donors' samples were screened for TTI using CLIA. Samples with signal/cut-off ratio between ≥0.90 and <1.00 were classified under GZ. They were re-tested in duplicate and submitted to confirmatory testing: Neutralization Test for HBsAg, Immunoblot for HCV, and Western blot for HIV. Among the 50,064 blood donors donating the blood during study period, 573 (1.14%) donors were reactive for HBsAg, HCV, and HIV. Forty-seven (0.1%) TTI samples were GZ, but none was “confirmed positive.” The utility of GZ testing seems to be limited. However, this may be continued for sake of “erring on the side of caution” and since this only results in negligible wastage (0.1%) of blood units.
  266 36 -
CASE REPORTS
A progressive neurological condition with acquired sea-blue histiocytosis further the diagnosis of Niemann-Pick type C1 in a 10-year-old boy
Li Wang, Jingmin Sun, Xiaoyan Xu, Longxiang Tao, De Wu, Ying Zhang
April-June 2020, 63(2):312-314
DOI:10.4103/IJPM.IJPM_728_19  PMID:32317543
Sea-blue histiocytes in bone marrow can be associated with a number of conditions and have indeed often been reported in Niemann-Pick diseases, mostly in Niemann-Pick type B, but also Niemann-Pick type C. Rarely, it was reported to be related to a progressive neurological condition. In this work, early bone marrow aspirations in a boy following the discovery of hepatosplenomegaly at 1 month of age and later isolated splenomegaly did not reveal abnormal cells (which is not uncommon). Numerous sea-blue histiocytes were found in a repeated exam when the child was 10-year old, at a time he had developed a progressive neurological condition with frequent falls, clumsiness, slow and slurred speech, intellectual disability, dystonic movements, and dysphagia. Acquired sea-blue histiocytes should be considered initially on the basis of clinical symptoms. Whole-exome sequencing identified two variants in the NPC1 gene, leading to the diagnosis of Niemann-Pick type C1. This case points out the presence of sea-blue histiocytes in the bone marrow and has helped to reach a diagnosis of NPC1 which was very difficult to establish even after years of study. Given the rarity of this pathology and the variety of clinical presentations, it is important to communicate the possible forms of presentation of this syndrome.
  297 5 -
IMAGES
Colonic malakoplakia in a cardiac transplant recipient: A case report
Sadiya Shafijan
April-June 2020, 63(2):322-324
DOI:10.4103/IJPM.IJPM_144_19  PMID:32317546
  260 34 -
ORIGINAL ARTICLES
Comparative analysis of “APTT vs RVVT” based activated protein C resistance assay in the diagnosis of Factor V Leiden mutation
Mirza Asif Baig
April-June 2020, 63(2):247-250
DOI:10.4103/IJPM.IJPM_899_19  PMID:32317524
Background: Thrombophilia is a hypercoagulable state characterized by increased venous thrombosis. The most common cause of heritable thrombophilia is Factor V Leiden (FVR506Q) homozygous state, with a relative risk of 10–80 times as compared to normal individuals and Lupus anticoagulant is the most common cause of acquired thrombophilia. The main objective of this study is to compare the sensitivity of activated partial thromboplastin time (APTT) vs dilute Russell viper venom test (DRVVT) based APCR assays with predilution in Factor V-deficient plasma for diagnosis of Factor V Leiden mutation. Materials And Methods: The coagulometer used for APCR test was Sysmex CS-5100. APTT reagent used is Pathrombin SL supplied by Siemens. All data were expressed as mean ± SD. Statistical analysis was done using unpaired students t-test and a P value <0.05 was considered as statistical significance. Results: A total of 300 cases of APCR (200 cases of Factor V Leiden mutation was confirmed by PCR and 100 acquired) were studied. The sensitivity of screening APTT-based APCR for detection of Factor V Leiden mutation is 67% and for the noncarrier state, it is 62%. The sensitivity of modified APTT and DRVVT with predilution in FV-deficient plasma for detection of Factor V Leiden mutation is 82% and 84%, respectively and for acquired causes, it is 48% and 86%, respectivelyConclusion: Screening APTT test has increased in activated protein C resistance (APCR) due to Factor V Leiden mutation as well as acquired causes such as patients on direct-acting oral anticoagulants, warfarin, lupus anticoagulants, and oral contraceptive pills which are independent risk factors of venous thrombosis. Modified DRVVT with predilution in FV-deficient plasma is more sensitive than screening and modified APTT-based APCR test in the diagnosis of Factor V Leiden mutation and the former test can distinguish homozygous and heterozygous states from normal individuals.
  274 20 -
LETTERS TO EDITOR
A rare case of therapy-associated acute megakaryoblastic leukemia
Roshini Shekhar, Amit Rauthan, Swati Pai
April-June 2020, 63(2):339-341
DOI:10.4103/IJPM.IJPM_579_18S  PMID:32317554
  251 36 -
CASE REPORTS
Hansen's disease with lepra reaction presenting with IgA dominant infection related glomerulonephritis
Elayaperumal Indhumathi, Jeyachandran Dhanapriya, Thanigachalam Dineshkumar, Ramanathan Sakthirajan, Natarajan Gopalakrishnan
April-June 2020, 63(2):289-291
DOI:10.4103/IJPM.IJPM_654_17  PMID:32317536
Various renal abnormalities in leprosy have been described largely in literature but the occurrence of IgA dominant infection related glomerulonephritis in leprosy with type 2 lepra reaction has not been reported so far. We present here a 60-year-old man with a history of leprosy in the past admitted with type 2 lepra reaction, rapidly progressive glomerulonephritis with severe renal failure requiring dialysis and diagnosed to have IgA dominant infection related glomerulonephritis.
  264 19 -
A rare case of small cell neuroendocrine tumor of the urinary bladder
B Praveen, Jophy Varghese, H Krishnamoorthy, Biju S Pillai
April-June 2020, 63(2):298-300
DOI:10.4103/IJPM.IJPM_692_18  PMID:32317539
Small cell neuroendocrine tumor of the bladder is a rare tumor characterized by poor differentiation and high aggressiveness. Very few cases worldwide have been reported till date. Recent literature shows equivalent survival data for localized disease treated with chemoradiotherapy combined with either bladder sparing surgery or radical cystectomy. We report a case of small cell neuroendocrine carcinoma of the bladder diagnosed after transurethral resection of bladder tumor, then followed by adjuvant chemotherapy for six cycles and awaiting radical cystectomy.
  254 28 -
BRIEF COMMUNICATIONS
Management of transfusion needs in a case of immunizing anti-M antibody in a patient with acute myeloid leukemia
Anisha Navkudkar, Priti Desai, Rajesh Thakkar, Sunil Rajadhyaksha
April-June 2020, 63(2):251-254
DOI:10.4103/IJPM.IJPM_166_19  PMID:32317525
Anti-M is a relatively common “naturally occurring” antibody. Unexpected alloantibodies in patient's serum other than ABO isoagglutinins (e.g., anti-M) may cause a discrepancy in the reverse grouping. As long as anti-M does not react at 37°C, it is clinically insignificant for transfusion. However, we found this antibody to be of “immunizing” type which was reactive at 37°C and AHG phase and showing problems in blood grouping and crossmatch. This antibody had both IgM and IgG components. When “M” antibodies active at 37°C are encountered, antigen-negative or red cells that are compatible with an indirect antiglobulin test should be provided.
  250 27 -
CASE REPORTS
Primary low-grade mucinous adenocarcinoma spleen resulting in Pseudomyxoma peritonei: A case report
Bhumika Gupta, Richa Jindal, Molly Joseph, Kuldeep Kaur, Shikha Chopra, Lipakshi Lakhiani
April-June 2020, 63(2):286-288
DOI:10.4103/IJPM.IJPM_624_19  PMID:32317535
A 61-year-old man presented with complaints of abdominal pain, loss of weight, and splenomegaly since past 6 months. On computed tomography, the spleen was totally replaced by multiloculated cysts and splenectomy was performed. Pathological examination revealed a low-grade mucinous adenocarcinoma. Postoperative PET scan was negative, and in the absence of a primary tumor elsewhere, we considered this tumor to be primary in the spleen, and it was presumed that the tumor arose from invaginated capsular mesothelium of the spleen.
  251 18 -
Solitary intraosseous neurofibroma of the mandible: Report of an extremely rare histopathologic feature
Samira Behrad, Shabnam Sohanian, Arash Ghanbarzadegan
April-June 2020, 63(2):276-278
DOI:10.4103/IJPM.IJPM_28_19  PMID:32317532
Neurofibroma (NF) is a benign tumor derived from the peripheral nerve sheath. Neurofibromas may present either as solitary lesions or as part of the generalized syndrome of neurofibromatosis or von Recklinghausen's disease of the skin. The intraosseous variant of NF is very rare. We report a case of a 32-year-old female who was diagnosed with a solitary intraosseous neurofibroma of the mandible. The present case is rare with respect to its unique histopathologic feature.
  248 20 -
Does IgG4 level evaluation in pancreatic mass play role in avoiding major surgery in uncertain presentation: A case report
Rakesh Kumar Gupta, Puja Sakhuja, Hari Govind, Anil Kumar Agarwal
April-June 2020, 63(2):282-285
DOI:10.4103/IJPM.IJPM_289_19  PMID:32317534
A 66-year-old male presented with chief complaints of anorexia associated with mild dull, intermittent epigastric pain for 6 months. The patient was a known diabetic on oral hypoglycemic and on routine checkup was found to have deranged liver function profile. On radiology, an ill-defined hypoechoic enhancing lesion involving head, neck, and uncinate process of pancreas was noted. Whipple's pancreaticodudenectomy was done and reported as IgG4-related autoimmune pancreatitis. Later, IgG (slightly) and IgG4 were found to be markedly raised. We report this case to highlight the importance of IgG4 evaluation prior to major surgery in uncertain pancreatic mass.
  245 13 -
LETTERS TO EDITOR
Squamous cell carcinoma larynx with concurrent Warthin's tumor of the submandibular gland: A rarely reported co-existence
Utpal Kumar, Bindu Rajkumar, Arvind Kumar, Sanjeev Kishore, Bhinyaram Jat
April-June 2020, 63(2):331-333
DOI:10.4103/IJPM.IJPM_436_19  PMID:32317550
  235 23 -
CASE REPORTS
Cytological diagnosis of primary cutaneous histoplasmosis with hemophagocytosis in immunocompetent patient – A rare case from non endemic region
Smita Chandra, Manveer K Raina, Dushyant S Gaur, Vinish K Agarwal
April-June 2020, 63(2):309-311
DOI:10.4103/IJPM.IJPM_792_18  PMID:32317542
Histoplasma capsulatum is an opportunistic dimorphic fungus caused by inhalation of spores present in the soil. It is extremely rare in the northern Himalayan region of India and is usually asymptomatic. It may rarely progress to disseminated histoplasmosis which is usually observed in immunocompromised patients associated with malignancy, acquired immunodeficiency syndrome or diabetes. The present case is being reported because of unusual cutaneous presentation of disseminated histoplasmosis in an immunocompetent patient of non-endemic region. The case also highlights the importance of fine needle aspiration cytology for its precise early diagnosis and avoiding of further complications.
  236 17 -
Spindle cell lipoma, dorsum of hand in a 4 year old child: A rare entity
Parveen Kumar, Nidhi Mahajan, Rishabh Jain, Arti Khatri
April-June 2020, 63(2):301-304
DOI:10.4103/IJPM.IJPM_475_19  PMID:32317540
Lipogenic tumors are an uncommon entity in children. There are several variants of lipoma, of which spindle cell lipoma is an extremely rare and accounts for only 1.5% of all lipoma diagnosis. Spindle cell lipoma rarely involves distal extremities. We report a 4-year old boy with swelling over dorsum of hand operated for aesthetic purposes. The report also highlights the salient cytological features, which can help differentiate this entity from other closer mimics on aspiration cytology, guiding the surgeon for appropriate management.
  220 26 -
Sinusoidal hemangioma with secondary intravascular papillary endothelial hyperplasia
Radhika Yajaman Gurumurthy, Nadig Siddharth Shankar, CS Mohan Raj, Nadig Sriram
April-June 2020, 63(2):279-281
DOI:10.4103/IJPM.IJPM_230_19  PMID:32317533
In this case report, we present a case of a 47-year-old man with sinusoidal hemangioma with secondary intravascular papillary endothelial hyperplasia arising in the subcutaneous tissue. To the best of our knowledge, there are only two cases of sinusoidal hemangioma with secondary intravascular papillary endothelial hyperplasia reported till date, both of which were intramuscular hemangiomas. These are rare entities that also have overlapping histomorphological features with that of various other vascular tumors making histopathological diagnosis troublesome at times. Careful histopathological examination aided by immunohistochemical studies in difficult cases is essential to avoid these diagnostic pitfalls.
  211 24 -
IMAGES
Bubbly bowel: A life-threatening condition
Divya S Shetty, Leena P Naik, Anjali D Amarapurkar
April-June 2020, 63(2):325-326
DOI:10.4103/IJPM.IJPM_474_19  PMID:32317547
  212 19 -
CASE REPORTS
Granuloma in marrow with lurking “Leuk”: Two happenstances
Saraswathy Sreeram, Sridevi Hanaganahalli Basavaiah, Nirupama Murali, Prashantha Balanthimogru
April-June 2020, 63(2):315-318
DOI:10.4103/IJPM.IJPM_96_19  PMID:32317544
Granulomas are described very rarely in marrow biopsies. They have hardly been reported in association with acute lymphoblastic leukemia. We herein report two cases of ALL associated with granulomas each at different stage of their clinical course that led to a diagnostic and therapeutic dilemma. First case was of a 42-year-old woman diagnosed with tuberculosis who presented with bleeding gums during anti-tubercular therapy. In the second scenario, a 51-year-old man presented with pyrexia of unknown origin and splenomegaly who was put on a trial of ATT. Peripheral smear showed only 1–2% abnormal cells, however, bone marrow aspiration and flow cytometry pattern was diagnostic of ALL. Both the patients received chemotherapy and have been on remission so far. These case scenarios put forward a relevant question on this rare coexistence, as the implications on management are manifold.
  209 19 -
Anomalies in milk line: Case report of two cases
Mani Krishna, Taiba Khan, Asim Khan
April-June 2020, 63(2):319-321
DOI:10.4103/IJPM.IJPM_281_18  PMID:32317545
Congenital anomalies of breast, especially polymastia and polythelia, confuse clinicians because of their varied presentations, associated renal anomalies, and pathologies arising in them. Case 1: A 30-year-old Asian Indian female presented with swelling in left inguinal region since 2 years, increased in size in last 2 months with history of milk discharge. Diagnosis of ectopic breast tissue inguinal region with lactational changes was made on fine-needle aspiration cytology (FNAC). Case 2: A 28-year-old female presented with complaints of bilateral axillary mass for 2 years which is gradually increasing in size and associated with pain and discomfort along with intrareolar polythalia (left breast). FNAC was done from both axillary swelling which came out to be the fibroadenoma in ectopic breast tissue. Both the cases are discussed because of their rarity and to screen ectopic breast tissue for any pathology during routine screening of breast.
  217 11 -
LETTERS TO EDITOR
Intraconal dermoid cyst – A common condition at uncommon location and age
Archana N Rijhsinghani, Nikhil K Majethia
April-June 2020, 63(2):330-331
DOI:10.4103/IJPM.IJPM_590_18  PMID:32317549
  191 31 -
Amyloidosis presenting as right adrenal mass—diagnosed on endoscopic ultrasound-guided fine needle aspiration
Abha Thakur, Haimanti Sarin, Narendra S Choudhary, Ishani Mohapatra, Rajesh Puri, AS Soin
April-June 2020, 63(2):335-337
DOI:10.4103/IJPM.IJPM_575_19  PMID:32317552
  197 23 -
CASE REPORTS
Endometrial and cervical osseous metaplasia with extramedullary haematopoiesis presenting as amenorrhea: Report of three cases
Iffat Jamal, Rakesh K Gupta, Surabhi Raj, Punam P Bhadani
April-June 2020, 63(2):295-297
DOI:10.4103/IJPM.IJPM_574_18  PMID:32317538
Endometrial and cervical osseous metaplasia (OM) is a rare phenomenon seen mostly in reproductive age group. Patients generally present with complaints of secondary infertility. Although few cases of endometrial OM have been described in literature, to the best of our knowledge, only six cases of OM in cervix have been reported so far. We report three cases of endometrial OM with extramedullary hematopoiesis, presented with complaints of amenorrhea and secondary infertility. In addition, one of the patients also had cervical OM.
  200 14 -
LETTERS TO EDITOR
A rare case of primary signet ring-like cell carcinoma of prostate in an elderly male
Avinash Gupta, Hanni Vasudev Gulwani
April-June 2020, 63(2):338-339
DOI:10.4103/IJPM.IJPM_172_18  PMID:32317553
  180 26 -
Brunner's gland hamartoma presenting as large duodenal polyp
Smita Nath, Gadadhar Panda, Rahul Karna, Naresh Kumar, Ravindra K Saran, Premashis Kar
April-June 2020, 63(2):334-335
DOI:10.4103/IJPM.IJPM_650_18  PMID:32317551
  172 22 -
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