Unravelling the Significance of Immunohistochemistry in Differentiating Neoplastic Lesions of Liver Biopsy: A Cross-sectional Study

Background: Ultrasonography (USG)-guided fine-needle aspiration cytology (FNAC) of the liver is a primary diagnostic procedure for primary and metastatic hepatic lesions. It is a minimally invasive and accurate technique and renders timely diagnosis for further management. Aims and Objectives: The purpose of the study was to evaluate the cytomorphological features of primary and metastatic hepatic lesions. Materials and Methods: This retrospective study was conducted in the Department of Pathology of a tertiary care hospital over a period of 2 years. 50 cases of clinically suspicious cases for hepatic malignancy were radiologically confirmed by USG and were subjected to FNAC under USG guidance with simultaneous cell block preparation in 35 cases. Relevant biochemical and serological data were retrieved from laboratory investigation archives. Results: The study was conducted on 50 cases of hepatic lesion. Majority of cases were male patients. All liver lesions were diagnosed on USG scan. Out of 50 cases diagnosed cytomorphologically, 8 cases (16%) were diagnosed as hepatocellular carcinoma. Among metastatic lesions, more prevalent lesions were adenocarcinoma 20 (40%). The rest of metastatic deposits included poorly differentiated carcinoma 12 (24%), mucinous carcinoma 4 (8%), malignant lymphoma 3 (6%), neuroendocrine tumor 2 (4%), and malignant melanoma 1 (2%). Primary site for metastatic lesions was diagnosed in 22 cases (52.4%) and unknown in 20 cases (47.6%). Conclusion: FNAC is a quick, feasible, and reliable procedure which enables the interpretation of cytological features of malignant hepatic masses.

Background: Ultrasonography (USG)-guided fine-needle aspiration cytology (FNAC) of the liver is a primary diagnostic procedure for primary and metastatic hepatic lesions. It is a minimally invasive and accurate technique and renders timely diagnosis for further management. Aims and Objectives: The purpose of the study was to evaluate the cytomorphological features of primary and metastatic hepatic lesions. Materials and Methods: This retrospective study was conducted in the Department of Pathology of a tertiary care hospital over a period of 2 years. 50 cases of clinically suspicious cases for hepatic malignancy were radiologically confirmed by USG and were subjected to FNAC under USG guidance with simultaneous cell block preparation in 35 cases. Relevant biochemical and serological data were retrieved from laboratory investigation archives. Results: The study was conducted on 50 cases of hepatic lesion. Majority of cases were male patients. All liver lesions were diagnosed on USG scan. Out of 50 cases diagnosed cytomorphologically, 8 cases (16%) were diagnosed as hepatocellular carcinoma. Among metastatic lesions, more prevalent lesions were adenocarcinoma 20 (40%). The rest of metastatic deposits included poorly differentiated carcinoma 12 (24%), mucinous carcinoma 4 (8%), malignant lymphoma 3 (6%), neuroendocrine tumor 2 (4%), and malignant melanoma 1 (2%). Primary site for metastatic lesions was diagnosed in 22 cases (52.4%) and unknown in 20 cases (47.6%). Conclusion: FNAC is a quick, feasible, and reliable procedure which enables the interpretation of cytological features of malignant hepatic masses.

Background. A higher Ki-67 labeling index is associated with a poorer prognosis in gastroenteropancreatic neuroendocrine neoplasms. It has also been proposed that the Ki-67 labeling index may increase during disease progression from the primary site to metastatic sites. Although biopsy specimens are used to measure the Ki-67 labeling index, heterogeneity in lesions is thought to affect the assessment of the Ki-67 labeling index. To overcome tumor heterogeneity, we evaluated the variability in the Ki-67 labeling index between primary lesions and hepatic metastases by analyzing only surgically resected specimens. Methods. We conducted a single-center retrospective study to analyze the variability in the Ki-67 labeling index and the change in tumor grade between the primary site and metastatic hepatic sites in 19 patients diagnosed with gastroenteropancreatic neuroendocrine neoplasms at the Cancer Institute Hospital of the Japanese Foundation for Cancer Research from 1998 to 2018. Both the primary site and metastatic hepatic sites were surgically resected. Results. Among the 19 patients with gastroenteropancreatic neuroendocrine neoplasms, 12 patients (63%) showed higher levels of the Ki-67 labeling index at metastatic hepatic sites than at the primary site. The median Ki-67 labeling index levels for the primary lesion and metastatic hepatic lesions were 5% and 10%, respectively. The Ki-67 labeling index levels were significantly elevated in the metastatic hepatic lesions compared to the primary lesion (P = .002). Conclusions. This study addressed the heterogeneity of the Ki-67 labeling index by analyzing only surgically resected specimens. We observed a statistically significant increase in the Ki-67 labeling index in hepatic metastases compared to the primary lesion.

Background: Various types of pathologies from inflammation to carcinoma are known to affect breast tissue in females. Some lesions are common in young females while others are more common in elderly age group. Accurate diagnosis is essential to relieve anxiety of patients. In case of carcinoma, early and accurate diagnosis can save the patient from metastases, thus reducing mortality and morbidity. Aims and objectives: This study is aimed to analyse the histopathological spectrum of various breast lesions and to study the distribution of breast diseases in different age groups and gender in our institute. Materials and Methods: It is a prospective study performed in the Department of pathology at Government Medical College/Government General Hospital Anantapuramu over a period of four years from January 2015 to December 2018. During this period a total of 310 breast specimens were received in the Department of pathology. Histopathological examination of specimens was done to know the spectrum of breast lesions. Results: Out of 310cases, 290cases were female and 20 cases were male. 185 cases were benign breast neoplasms, 123 cases were malignant neoplasms and 02 cases were inflammatory lesions. Among the 185 cases of benign breast neoplasms, 141 cases were fibroadenoma which was the most common benign breast lesion. Out of 123 malignant breast lesions, 2 cases were Duct cell carcinoma in situ and 121 cases were invasive malignant breast lesions. Out of which 97 cases were Invasive ductal carcinoma –NOS subtype which was the most common lesion. Conclusion: 59.68% of breast lesions were benign breast lesions proving to be the majority in incidence. 39.68 % of lesions were malignant breast lesions and 0.64% were inflammatory lesions. Benign lesions were common in second to fourth decade and malignancy in fifth and sixth decades.

Fontan-associated liver disease.

Asymptomatic Liver Mass

Background and Purpose In several breast cancer analyses of targeted gene panels, there was considerable concordance of mutations observed between primary tumors and matched metastases. We are to investigate to gain an understanding of the underlying genetics leading to BC metastasis to compare genomics data using paired biopsies between primary breast and several metastatic sites. Methods We performed CancerSCANTM of forty-eight patients with paired primary and metastatic tumors, which is 380-gene targeted panel sequencing using HiSeq 2500 sequencing platform (Illumina). We made variant calls using Mutect for SNV, Pindel for INDEL, Contra for CNV, and in-house software for Fusion with default parameters. Tumor mutational burden (TMB) was measured by number of mutations per megabase (mb), and TMB was divided into two groups: high TMB (>=20mutations/mb) and low TMB (<20mutations/mb). Mutational signatures were estimated using R deconstructSigs package, and divided into high and low group by each signature’s median value. Twelve patients among this cohort were performed whole-transcriptome sequencing with TruSeq RNA prep kit (Illumina) on primary and/or metastatic fresh-frozen tumors. Results Seven among 48 patients (14.6%) showed discordant subtypes between primary and metastatic tumors, discordant patterns were diverse. Lung and pleural was the most frequent organ in metastatic tumors, and liver and lymph node were followed. There were 15 shared, 6 primary-specific, 4 metastatic-specific mutations per patient on average, and no significant difference in overall survival (OS) with respect to mutation-sharing patterns. TMB and number of mutations related to mismatch-repair (MMR) genes such as NF1 (P=0.0398) and PMS2 (P=0.1020) tended to be reduced in metastatic tumors compared to paired primary tumors. Mutational signature 3 (BRCA1/2) was increased in metastatic tumors, and signature 5 (General Cancer) was decreased (P>0.05). defect in MMR genes (P=0.0445) and germline BRCA mutation (P=0.0186) were significantly associated to OS, but TMB status, and mutational signature related to MMR respectively were not significant variables for OS according to the molecular profiles in primary tumors. Patients with PMS2 (P=0.156) and NF1 (P=0.0734) multi-hit mutations were better prognosis. Combining molecular profiles in primary tumors such as TMB and mutational signature 6 (MMR) and signature 13 (APOBEC) showed significant differences in OS: low TMB with high signature 6 plus 13 as worse, high TMB as intermediate, and low TMB with low signature 6 plus 13 as better prognosis (P=0.0228). Conclusions With the combination of TMB and MMR-related molecular profiles, we could stratify patients into three groups according to OS. Citation Format: Kyung Hee Park, Eunjin Lee, Seri Park, Se Kyung Lee, Seok Won Kim, Jeong Eon Lee, Seok Jin Nam, Ji-Yeon Kim, Hee Kyung Ahn, Woong-Yang Park, Yeon Hee Park. Analysis of the targeted sequencing with RNA Seq. results between primary breast cancer and metastatic sites: Matched paired analysis [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 2520.

Background: The bone marrow examination is an essential investigation for the diagnosis and management of many disorders of the blood and bone marrow. The aspirate and trephine biopsy specimens are complementary and when both are obtained, they provide a comprehensive evaluation of the bone marrow. The present study was conducted to compare the role of trephine biopsy with bone marrow aspiration for effectively diagnosing wide spectrum of hematological diseases. Few studies have compared the relative value of aspirate with trephine biopsy.Materials & method: This is a three year observational study undertaken in Dept. of Pathology, MKCG MCH, Berhampur,Odisha. A total of 370 cases presented with haematological disorders, of which only 126 patients had undergone trephine biopsy and correlation was done with aspiration in these patients.Results: Of a total 370 patients, both BMA & BMB were performed on 126 patients (71 male & 55 female). Commonly encountered diseases were AML (17%), IDA (11%), ALL (9%), others (9%), CML (8%), MA (6%) accounted for maximum no. of cases. Others group included TB, NPD, Metastatic Diseases such as SRBCT, NHL& Neuroblastoma. Patients from 2 months to 80 years old were encountered in the study. BMB was diagnostic in 100% cases. In comparison BMA, a positive diagnosis was made in 80% (101) cases, suggestive in 6.3%(8) cases &negative in 13.4% (17) cases. BMB was superior to BMA in diagnosis of MF (2%), ALL (4%), Others (9%) where BMA aspirations yielded a dry tap / diluted marrow. In the present study BMB was advantageous in diagnosis & staging in 19%(25) cases. Additional advantages of BMB noted in the present study were assessment of cellularity, detection of ALIP, assessment of fibrosis, nodular/diffuse/focal patterns of involvement, metastatic deposits, and granuloma could be identified in BMB.Conclusion: The decision whether to perform a BMA alone or in combination with BMB rests on the diagnostic possibilities. In IDA, ITP & Acute leukaemia’s where cellular morphology is desired aspiration is best. BMB is superior when assessment of cellularity, detection of ALIP, assessment of fibrosis, nodular/diffuse/focal patterns of involvement, metastatic deposits, granuloma, with the use of IHC on BMB samples the accuracy in diagnosis of Lymphoma, AML/ALL, MM & Metastatic Diseases can be made. Thus BMA & BMB should always go hand in hand.DOI:10.21276/APALM.1627

Benign smooth muscle tumours of the female genital tract are relatively common lesions, but they are not often encountered in other tissues. All the histopathological specimens received in the Department of Pathology at SCB Medical College, Cuttack, Odisha, India, were examined from March 2023 to March 2024. Cases histopathologically diagnosed as leiomyomas, excluding uterine leiomyomas, were included in the study and analysed. Complete history, clinical and radiological details, and preoperative investigation findings of all cases were collected and analysed. The mean age of the patients was 43.9 years, with male-to-female ratio of 7:4. A 70% of the cases involved skin. A few extrauterine cases were detected in breast, esophagus, colon, and ovary. Majority were solitary, non tender, with gradual course of presentation indicating benign nature, hence requiring no further treatment following surgical intervention. Accurate diagnosis and classification of smooth muscle tumours is important, as they can exhibit a varied range of clinical behaviour and may be associated with underlying syndromes.

Biologic and Clinical Features of Benign Solid and Cystic Lesions of the Liver

Background: The liver biopsy is considered by many experts to be the most specific diagnostic tool used to assess the nature and severity of liver diseases such as hepatitis C. Liver biopsies are important for many reasons, such as accurate diagnosis or ruling out any coexisting liver diseases, staging and grading the severity of liver disease, treatment decisions, patient and provider reassurance, and as a benchmark for gauging future progression. Methods: In this observational study, 50 patients were recruited from different Medicine units of Dhaka Medical College Hospital, Dhaka, from May, 2008 to June, 2009. After preliminary selection of patients, a specific protocol was followed which include patients’ particulars, clinical features and clinical diagnosis, biochemical parameters, radiological and other investigative procedures and finally percutaneous needle biopsy of liver was done. The objective of the study was to establish the correlation of clinical presentation of chronic parenchymal liver disease with histopathological findings and establish liver biopsy as a tool for diagnosis. SPSS version 16.0 was used to analyze the data. Quantitative data were presented in the form of tables and figures. Chi-square test and student t test was done to find out the statistical significance. Results: Histopathologically chronic liver disease (CLD) was found to be the commonest lesion (pd”0.05), which was 24 (48%) followed by hepatocellular carcinoma 13(26%) and secondary deposit 02(4%). Eleven cases consist of other findings including normal. CLD commonly presented with loss of appetite (82%), Jaundice (74%), Weight loss (68%), hepatic facies (54%).Hepatocellular carcinoma commonly presented with hepatomegaly (100%), jaundice (61.84%), weight loss (76.92%), and ascites (53.85%). Hepatomegaly was constant feature (100%) of all secondary metastasis. Among two cases of secondary carcinoma one (50%) was adenocarcinoma and another one (50%) was anaplastic type. Out of 29 cases of clinically diagnosed chronic liver disease 24 cases were confirmed histopathologically which was statistically significant (pd”0.05). Conclusion: For the establishment of diagnosis and treatment it is mandatory to have a good correlation between clinical features and histopathological finding. Histopathology could detect diseases which were not considered clinically and specific management could only be done depending on histopathology. Therefore, if there is no contraindication, for confirmation of diagnosis liver biopsy still remains the corner stone modality. DOI: http://dx.doi.org/10.3329/jdmc.v22i2.21520 J Dhaka Medical College, Vol. 22, No.2, October, 2013, Page 120-124

We analyzed metastatic liver tumors received in the department of pathology in a tertiary care center over a 3-year period. There were 509 metastatic liver tumors; counterintuitively, there were as many resections (235 cases) as biopsies (274 cases). This unexpected finding reflects contemporaneous organ-specific paradigms for diagnosis and management of metastatic liver disease in oncologic practice, and the association of our practice with a National Cancer Institute-designated comprehensive cancer center with expertise and specialization in liver surgery. We receive a large number of resections for metastatic liver tumors because metastasectomy from a variety of primary tumors is associated with improved overall, and in many instances, disease-free, long-term survival. Metastatic colorectal carcinomas, metastatic neuroendocrine tumors, and metastatic gastrointestinal stromal tumors constituted 78% of resections because the largest body of literature and cumulative experience exists for these lesions. In contrast, breast carcinomas and pancreatic carcinomas, which are the next common metastatic liver tumors were biopsied but rarely resected, because metastasectomy is not the standard of care for these tumors. Immunohistochemistry was performed in less than a quarter of the total number of cases (23%), because the primary tumor site was known in the vast majority of cases. Of the 42 cases with unknown primary tumor, it was elucidated in 50% of the cases by immunohistochemical and clinical work-up. Of the cases with known primary tumor, immunohistochemistry was performed mostly in metastatic breast, colon, and lung carcinomas. In these cases, biomarker analyses provided additional information relevant to clinical management.

Background: Gallbladder is one of the most frequently surgically resected organs which stores and concentrates the bile and is involved by both non neoplastic as well as neoplastic diseases. Chronic calculous cholecystitis is the most common benign lesion of gallbladder and pain abdomen is the commonest clinical presentation. Both non neoplastic and neoplastic lesions have similar clinical presentation and overlapping radiological findings. Methods: Total 550 cholecystectomy specimens were received in pathology department. Grossly, formalin fixed specimens were examined carefully and section were given from neck, fundus and body of gallbladder. Whenever it was necessary, additional sections were given. After processing, the H&E stained sections were studied thoroughly. All the clinical details were taken from case papers. Result: The commonly seen non neoplastic lesions were chronic calculous cholecystitis (405 cases), chronic cholecystitis (85 cases), Acute on chronic cholecystitis with or without stones (18 and 3 cases), acute necrotizing cholecystitis (2 cases), eosinophilic cholecystitis (3 cases), follicular cholecystitis (3cases), lymphoplasmacytic cholecystitis (1case), xathogranulomatous cholecystitis (9 cases), cholesterosis (4 cases), mucocele of gall bladder (2 cases), adenomyomatosis (3 cases) and gallbladder cholesterol polyp with cholecystitis (2 cases). Among neoplastic lesions 1 case was adenoma with severe dysplasia and 9 cases were adenocarcinoma. Conclusion: Chronic calculous cholecystitis was the most common lesion and out of 9 cases of carcinoma, 7 cases were diagnosed incidentally. Therefore, histopathological evaluation plays a critical role in identifying incidental gallbladder carcinoma for proper management of patients.

Objective To investigate the value of 18F-FDG PET/CT in diagnosis of brain metastases from unknown primary tumor.Method The 18F-FDG PET/CT findings of 17 patients with brain metastases from unknown primary tumor were retrospectively analyzed.Results Primary tumors of the seventeen cases were confirmed by biopsy,the accuracy rate was 100％.There were thirteen cases with primary lung cancer,accounted for 76％,including two cases of lung cancer which were found in the second PET/CT examination,two cases with liver cancer,accounted for 12％,one case with cardia cancer,accounted for 6％,one case with the ascending colon cancer,accounted for 6％.On the base of founding the primary tumor,18F-FDG PET/CT also found 10 cases accompanied by lung metastasis (2 cases),lymph node metastases (3 cases),bone metastases (2 cases)and other sites of metastases (3 cases),a total of 61 lesions were detected.Two cases of liver cancer patients with single brain metastases had cerebral apoplexy.Conclusion 18F-FDG PET/CT contributes important value in finding brain metastases from unknown primary tumor,and is very helpful for clinical staging and treatment. Key words: Neoplasms, unknown primary; Tomography, X-ray computed; Tomography-emission computed; Fluorodeoxyglucose F18; Brain metastases

Evaluation of Ultrasonically Guided Biopsies of Mediastinal Masses