Biopsy Cases Research Articles

English

BACKGROUND In a developing country like India, vast difference exists in people’s religion, culture, and socio-economic condition and along with it, there exists a significant difference in their dietary habits. This has led to an incidence of a large spectrum of gastrointestinal (GI) diseases which is different in different geographical locations. The study was undertaken for studying the spectrum of various histopathological lesions of gastrointestinal tract with the help of endoscopic biopsy. METHODS This cross-sectional study was carried out in a span of 2 years in the histopathology division. The study included 105 patients who had GI complains and underwent endoscopic biopsies for the same. RESULTS The present study included a total of 105 cases out of which there were 64 cases (61 %) of upper GI tract biopsies and remaining 41 cases (39 %) were of lower GI tract biopsies. Among 64 (100 %) cases of upper GI biopsies, reflux oesophagitis (4.67 %) was the most common in non-neoplastic lesions while well differentiated squamous cell carcinoma (20.31 %) was the most common neoplastic pathology. In gastric biopsies, chronic atrophic gastritis (3.12 %) was the most common condition in a non-neoplastic category, while gastric adenocarcinoma (15.61 %) was the malignant lesion which was found. Among duodenal biopsies, the most common lesion was eosinophilic enteritis / duodenitis (14.06 %). Among 41 (100 %) colonoscopic biopsies, the most common lesion was chronic non-specific inflammation (12.19 %) under non-neoplastic category, while well differentiated adenocarcinoma (46.34 %) was most common entity under malignant category in our study. Non-neoplastic lesions were more common in upper GI endoscopic biopsies whereas, neoplastic lesions were more frequently seen with lower GI endoscopic biopsies. CONCLUSIONS Performing endoscopy alone is an incomplete investigative modality for the diagnosis. While performing endoscopy and simultaneously taking biopsy for histopathological evaluation helps in giving an accurate diagnosis. KEY WORDS GIT, Endoscopy, Endoscopic Biopsy

Nationwide Survey of Post-Transplant Glomerular Diseases, Based on the Japan Renal Biopsy Registry (J-RBR).

BackgroundNationwide data on allograft kidney biopsies have been limited in number, in contrast to the large amount of accumulated data on native kidney biopsies. In this context, we have surveyed transplant biopsy data based on the nationwide database, the Japan Renal Biopsy Registry (J-RBR).Material/MethodsA total of 2430 transplant biopsy cases were registered in the web-based J-RBR from January 2007 to January 2018. We categorized the entries regarding both the purpose of the biopsy and pathological diagnosis, and confirmed transplant glomerular diseases based on the clinical and pathological diagnosis.ResultsOf the 2430 total transplant biopsy cases, 637 cases, including 9 cases of baseline biopsy, 216 cases of protocol biopsy, and 232 cases of episode biopsy, had a pathological diagnosis, including glomerular diseases, rejection, calcineurin inhibitor nephropathy, and interstitial fibrosis and tubular atrophy. Of these, 127 cases presented with glomerular disease, including 8 cases of baseline biopsy, 23 of protocol biopsy, 59 of episode biopsy, and 37 of unknown purpose). A total of 127 biopsies with glomerular disease revealed a high prevalence of immunoglobulin A nephropathy (n=38, 29.9%), followed by mesangial proliferative glomerulonephritis (n=29, 22.8%) and focal segmental glomerulosclerosis (n=8, 6.3%) when focused on protocol and episode biopsies.ConclusionsThe nationwide transplant biopsy database demonstrated the pathological characteristics of 637 cases, including 127 cases of post-transplant glomerular disease. The protocol and episode biopsies included high prevalence rates of IgAN, followed by FSGS.

Oro-facial tuberculosis - Is it still an enigmatic entity?

The objective of this study was to analyze and review the clinical and histopathological aspects of oro-facial tuberculosis. Sixteen cases of oral mucosal biopsies diagnosed as granulomatous pathology consistent with tuberculosis were retrieved from the data base and clinical information and histopathological findings were analyzed retrospectively. Of the total 16 cases, 12 were males while 4 were females. The age ranged from 15-70 years (mean of 39.6 years). Buccal mucosa, as an involved site, was seen in 31% of cases, while tonsil and soft palate constituted 3 cases each. Duration of symptoms ranged from 01-12 months (mean of 5.3 months). Oral examination revealed ulceroproliferative lesions in majority of the cases. Of sixteen cases, six cases (37.5%) each primarily as well as secondarily involved oral cavity while in 25% (4/16) of cases the status could not be evaluated. On histopathology, caseating granulomas were seen in 7 of 16 cases (43.75%) and non-caseating granulomas were seen in rest 56.25% of cases. Ziehl Neelsen stain for acid fast bacilli was positive in 31.25% (5/16) of cases. Though unusual, tuberculosis should always be included in the differentials of oral lesions in a country endemic to tuberculosis like India. Histopathological evaluation of the biopsy remains the indispensible tool to diagnose oro-facial tuberculosis.

POS-822 NEPHROLOGY IMMERSION: A SUCCESSFUL NATURAL EXPERIMENT IN THE COVID ERA

The story began in January 2009 when General Internal Medicine Resident 1 expressed an interest in kidney medicine and began working on Nephrology research tasks with the last author as an undergraduate student. This all emerged unintentionally, not conceived of as an experiment until the present first author began doing similar Nephrology research tasks in January 2018 as a premed student and decided to test this immersion approach to learning kidney medicine and kidney pathology before medical school, after receiving the required privacy training. This method stands out as distinct from the usual stepwise acquisition of knowledge in classical medical education in medical school because it allows the student to be fully “immersed” into the world of nephrology without yet having adequate background in medicine in general. Just like other immersive education, nephrology immersion was established by the inclusion of premedical students in a renal pathology and nephrology lab. The student had the opportunity to work with pathologists and clinicians on a daily basis, gaining knowledge of the specialty by attending weekly nephrology/pathology rounds, regularly studying renal biopsies from the hospital, and completing online and in-person curricula meant for nephrology trainees (eg. the American Society of Nephrology Kidney Week Early Program ‘Fundamentals of Renal Pathology’). The student demonstrated a good understanding of kidney pathology and nephrology material in several ways: through successful completion of standardized curricula, weekly preparation and presentation of kidney biopsy cases at pathology/nephrology rounds, and training new pathology fellows. A necessary component of the nephrology immersion program is that the students must suspend belief that they have truly mastered the subject until they are in medical school and learn the surrounding context of related subjects necessary to fully understand nephrology. However, once that happens the students are very likely to choose a career in Nephrology because they have already been exposed to the specialized knowledge in the field. Standardized curricula make it easy to assess the knowledge of such immersion students and they perform at a level comparable to current nephrology fellows, despite lacking full “medical” understanding of the subjects. Immersion is an effective education technique in many other areas of human endeavor and represents an additional innovative approach to kidney medicine education, which is something the International Society of Nephrology (ISN) is seeking in several of its programs. In the pandemic era it may make sense to delay entry into medical school until such time as more face to face experiences are available. Meanwhile we are proving it is possible to learn selected aspects of medicine before medical school. We would emphasize that we are not advocating a return to the apprenticeship approach to medical training which preceded the Flexner Report. Mastery of the information and skills of medicine is key, and some of that is only attainable through medical school.

EXFOLIATIVE CYTOLOGICAL FINDINGS IN ORAL POTENTIALLY MALIGNANT DISORDERSMALIGNANT DISORDERS

Objective: Patients with oral potentially malignant disorders (OPMDs) are at risk for development of malignancy and tobacco use contributes in its transformation. This study was designed to assess exfoliative cytological findings in OPMD cases using tobacco and healthy controls with no history of tobacco use. The aim was to screen OPMD cases for biopsy with the help of brush cytology.
 Materials and Methods: This comparative cross-sectional study was conducted at Histopathology Laboratory of Peshawar Medical College, Peshawar for which samples were collected from two dental hospitals and private dental clinics of Peshawar. The study included 20 cases of clinically diagnosed Oral Potentially Malignant Disorders (OPMDs) with history of tobacco use; including 10 cases of leukoplakia and 10 cases of oral lichen planus (OLP), and 20 age and gender matched healthy controls with no history of tobacco use, after observing a strict inclusion and exclusion criteria. A pre-designed proforma was used to collect the data, which was later analyzed in SPSS version 21.
 Results: A total of 40 participants had a mean age of 48.25±10.01 years with gender distribution of 32(80%) males and 8(20%) females, giving a male to female ratio of 4:1. The duration of tobacco use in cases had a mean of 22.95 ± 9.17 years, while duration of lesion had a mean of 2.3±4.4 years. As per Oral Bethesda Criteria, 18 (90%) OPMD cases were Negative for Intraepithelial Lesion/Malignancy (NILM). Buccal mucosa 12(60%) was the most common site of lesions. On Oral Exfoliative Cytology (OEC), OPMDs showed mild to moderate cytological changes as compared to healthy controls.
 Conclusion: This study concluded that most of the OPMD cases show mild to moderate cytological changes as compared to healthy controls. Dysplastic changes were seen only in 10% of OPMD cases that needed further assessment through biopsy.

Clinico-Histological presentation of Head and Neck Lesions in a Tertiary Care Hospital

Objective: This study aimed to see the clinical presentation and histological pattern of various head and neck lesions.Materials and Methods: This descriptive study was conducted in the Department of Pathology, Bannu Medical College in association with the Department of Surgery and ENT, Khalifa Gul Nawaz Teaching Hospital, Bannu. A total of 184 cases of head and neck lesions biopsy were subjected to histopathological diagnosis. Patients' age, gender, anatomical location, and other relevant necessary clinical findings were recorded on an already designed proforma. All biopsies were received in 10% buffered formalin, fixed overnight, and processed for histopathological examination and diagnosis. Inclusion criteria were patients with head and neck lesions including skin, salivary gland, lymph node, and oral cavity of any age and gender. Exclusion criteria were thyroid, nasal cavity lesions, autolysed, and insufficient biopsy specimen. Results: In this study, the mean age was 28.58 ± 17.34 years, and the age range was from 10 to 80 years. The male-to-female ratio was 1.3:1. The most common age group was 36-45 years followed by 46-55 years and 26-35 years etc. The most common inflammatory lesion was granulomatous lymphadenitis 14.67% followed by reactive lymphoid hyperplasia 9.23%. Common benign lesions were pleomorphic adenoma 5.97% followed by lipoma and hemangioma 3.80% and 3.26% respectively. Amongst malignant lesions basal cell carcinoma 23.91% of the face was the commonest lesion followed by squamous cell carcinoma 22.28% of the oral cavity. Conclusion: This study show spectrum of lesions from inflammatory to benign and malignant, occurring in the head and neck region. Malignant lesions are more common as compared to benign and inflammatory lesions, basal cell carcinoma of the skin is the commonest malignant lesion followed by squamous cell carcinoma of the skin and oral cavity.

Horizons in Veterinary Precision Oncology: Fundamentals of Cancer Genomics and Applications of Liquid Biopsy for the Detection, Characterization, and Management of Cancer in Dogs.

Cancer is the leading cause of death in dogs, in part because many cases are identified at an advanced stage when clinical signs have developed, and prognosis is poor. Increased understanding of cancer as a disease of the genome has led to the introduction of liquid biopsy testing, allowing for detection of genomic alterations in cell-free DNA fragments in blood to facilitate earlier detection, characterization, and management of cancer through non-invasive means. Recent discoveries in the areas of genomics and oncology have provided a deeper understanding of the molecular origins and evolution of cancer, and of the “one health” similarities between humans and dogs that underlie the field of comparative oncology. These discoveries, combined with technological advances in DNA profiling, are shifting the paradigm for cancer diagnosis toward earlier detection with the goal of improving outcomes. Liquid biopsy testing has already revolutionized the way cancer is managed in human medicine – and it is poised to make a similar impact in veterinary medicine. Multiple clinical use cases for liquid biopsy are emerging, including screening, aid in diagnosis, targeted treatment selection, treatment response monitoring, minimal residual disease detection, and recurrence monitoring. This review article highlights key scientific advances in genomics and their relevance for veterinary oncology, with the goal of providing a foundational introduction to this important topic for veterinarians. As these technologies migrate from human medicine into veterinary medicine, improved awareness and understanding will facilitate their rapid adoption, for the benefit of veterinary patients.

Safety assessment of intraparenchymal central nervous system biopsies: Single institution healthcare value review

The study objective was to evaluate a single institution experience with adult stereotactic intracranial biopsies and review any projected cost savings as a result of bypassing intensive care unit (ICU) admission and limited routine head computed tomography (CT). The authors retrospectively reviewed all stereotactic intracranial biopsies performed at a single institution between February 2012 and March 2019. Primary data collection included ICU length of stay (LOS), hospital LOS, ICU interventions, need for reoperation, and CT use. Secondarily, location of lesion, postoperative hematoma, neurological deficit, pathology, and preoperative coagulopathy data were collected. There were 97 biopsy cases (63% male). Average age, ICU LOS, and total hospital stay were 58.9 years (range; 21–92 years), 2.3 days (range; 0–40 days), and 8.8 days (range 1–115 days), respectively. Seventy-five (75 of 97) patients received a postoperative head CT. No patients required medical or surgical intervention for complications related to biopsy. Eight patients required transfer from the ward to the ICU (none directly related to biopsy). Nine patients transferred directly to the ward postoperatively (none required transfer to ICU). Of the patients who did not receive CT or went directly to the ward, none had extended LOS or required transfer to ICU for neurosurgical concerns. Eliminating routine head CT and ICU admission translates to approximately $584,971 in direct cost savings in 89 cases without a postoperative ICU requirement. These practice changes would save patients’ significant hospitalization costs, decrease healthcare expenditures, and allow for more appropriate hospital resource use.

Excisional Biopsy of Verrucous Carcinoma of Tongue using Diode Laser

Oral verrucous carcinoma (OVC) is a subtle variant of oral squamous cell carcinoma with some peculiar features. It is locally invasive growth which rarely metastasizes. Verrucous carcinoma rarely affects the tongue. Herein, we report a case of excisional biopsy of a grayish-white lesion on the left lateral surface of the tongue performed with a 940-nm diode laser, which upon histopathological examination was diagnosed as OVC.

A CLINICOPATHOLOGICAL STUDY ON DISSEMINATED HISTOPLASMOSIS WITH SPECIAL REFERENCE TO ATYPICAL CASES IN A TERTIARY CARE CENTRE -IN EASTERN INDIA.

INTRODUCTION: Untreated Histoplasmosis is fatal for all, immunocompetent or immunocompromised. Histoplasmosis has seen a steady increase in incidence from a single recorded case in Kolkata, India in 1954 to 388 cases from 2004-17 and 161 from 2017-till date all over India. Yet, it has been consistently relegated to a niche of opportunistic infections without a proper diagnostic protocol. To study the clinical OBJECTIVES: features and natural history of disseminated histoplasmosis(DH) and analysis of cases with atypical clinical presentation of Histoplasmosis simulating malignancy in search of a consolidated and efcient diagnostic algorithm in a tertiary care centre. MATERIALS AND METHODS: The retrospective institution-based study was conducted in the Department of Pathology, CSTM from February 2011 to July 2019 in collaboration of Dept. of Tropical Medicine on specimens collected from 33 cases of Skin biopsy, Lymph node biopsy and FNAC aspirate from enlarged lymphnodes, slit skin smear followed by BM Aspirate analysis done in cases of disseminated histoplasmosis, Bone Marrow Biopsy was done in selected cases. Histoplasma capsulatum like yeast cells were detected with Leishman Giemsa stained slit skin smears in 9 cases and in FNA smears in 13cases and they were PAS positive. Diagnosis were conrmed in Histopathological examination along with special stain for fungus in all cases. Radiological investigations (CXR, USG, CT), Routine investigations (Haemogram, LFT, RFT, Electrolytes) along with CD4 count in ART clinic and microbiological tests like Gram stain of SSS, India Ink, KOH preparation, Cryptococcal Ag testing, urine C/S) were corroborated with. RESULTS: All 33 cases FNAC (13),slit skin smear(9) and HPE on rest of the specimen show small, oval yeast cells on LG stain. Biopsy showed histiocytic phagocytosis of yeast cells with foamy macrophages and PMN inltration with NO granulomas in seroposive cases. Gomori Methenamine Silver stain of BM biopsy showed black intracellular yeast consistent with . PAS stained FNAC smears Histoplasma capsulatum showed yeast cells with chromatin dot and surrounding halos with no kinetoplasts. Mycological cultures were in agreement. Here, in most cases, CD4 count and Disseminated Histoplasmosis ndings were not in accordance. DH CONCLUSION: is not uncommon in India and is being increasing day by day and it should be considered in the diagnosis of patients with prolonged fever, weight loss, oropharyngeal ulcers, hepatosplenomegaly, lymphadenopathy and adrenal enlargement. Correct diagnosis by well designed analytical studies utilising appropriate diagnostic modalities in an immunocompromised patient even with minimum suspicion of opportunistic infection, a consolidation of selective investigations like FNAC, HPE and relevant microbiological tests into a diagnostic design for maximum utilization of nances, resources and time, all of which can help to understand the epidemiology of this neglected disease for accurate treatment leading to a favourable outcome.

DIAGNOSTIC UTILITY OF BRONCHOALVEOLAR LAVAGE (BAL) AND COMPARISON OF THE BAL AND TRANS BRONCHIAL LUNG BIOPSY (TBB) IN DIAGNOSIS OF LUNG CARCINOMA

Background: Lung cancer is the leading cause of death in developed countries and is increasing at alarming rates in developing countries also.1 This study is designed to determine accuracy of bronchoalveolar lavage (BAL) as compare to the gold standard histology examination of lung biopsy. Materials and Methods: A retrospective study was conducted,total 46 cases of BAL which were suspected for lung carcinoma and 17 cases of lung biopsy (cases who need confirmation after BAL) were received at G.K general hospital, Bhuj from a period of 2.5 years. Conclusion: Our study conclude that BAL cytology has diagnostic yield of 50%,sensitive of 66.67%,specificity of 100% and efficacy of 64%.

English

BACKGROUND “Lymphadenopathy’’ refers to nodes that are abnormal in size, consistency, or number. It is designated as generalised’’ if lymph-nodes are enlarged in two or more non-contiguous areas. Approximately three fourths of patients presenting with unexplained lymph-node enlargement have localised lymphadenopathy, whereas one fourth have generalised lymphadenopathy. In the present study an attempt is made to identify and categorise various neoplastic versus nonneoplastic lesions in patients presenting with generalised lymphadenopathy in a tertiary care centre.METHODS A cross sectional study of 100 lymph-node biopsies was conducted. After adequate fixation in 10 % formalin, tissues were routinely processed and stained with haematoxylin and eosin (H & E). Special stains like Ziehl-Neelsen and reticulin were employed whenever indicated. Immunohistochemistry (IHC) was performed for all neoplastic lesions and for some cases of non-neoplastic lesions. RESULTS Amongst 100 cases of lymph node biopsies analysed in this study, 71 cases were non-neoplastic and 29 were neoplastic. The most common non-neoplastic lesion observed was granulomatous lymphadenitis (32 cases), followed by reactive lymphadenitis (20). 25 cases of non-Hodgkin lymphoma (NHL) and 4 cases of Hodgkin lymphoma were observed in the neoplastic group. In the age range of 4.5 to 77 years included in the study, major bulk of cases was found in the age group of 11 - 20 years; out of this, 78.9 % were non neoplastic and 21.1 % were neoplastic. It was observed that 100 % of cases in the age group below 10 years were non-neoplastic, whereas in the age group above 70 years, all cases were neoplastic. CONCLUSIONS Granulomatous lymphadenitis was the most common lesion observed, probably because of high incidence of tuberculosis in this part of state. Morphological evaluation by light microscopy supplemented by special stains and IHC are necessary for establishing final diagnosis of generalised lymphadenopathy. KEYWORDS Generalised Lymphadenopathy, Haematoxylin and Eosin, IHC, Granulomatous Lymphadenitis, Kikuchi Fujimoto Lymphadenopathy, Hodgkin Lymphoma, NonHodgkin Lymphoma

Free-Hand Transperineal Prostate Biopsy Under Local Anesthesia in the Office Without Antibiotic Prophylaxis: Experience with 304 Cases.

Background: We present our series of free-hand transperineal prostate biopsy (fTP-Bx) using a novel coaxial needle introducer guide. All cases were performed in the office under local anesthesia (LA) without sedation. The majority received no prophylactic antibiotics. Materials and Methods: We retrospectively reviewed the electronic medical records of 242 consecutive fTP-Bx cases using the PrecisionPoint™ Transperineal Access System (PPTAS) performed under LA without sedation by a single urologist (R.J.S.) at Kaiser Permanente Southern California. We compared complication rates of this series of cases to our initial series of 62 fTP-Bx cases without the PrecisionPoint as well as 133 transrectal prostate biopsy cases performed before we adopted the transperineal approach. Results: Of the 242 consecutive free-hand transperineal biopsies performed between August 26, 2016 and December 31, 2018, 212 (88%) received no antibiotic prophylaxis. Medians for age, prostate-specific antigen, prostate volume, prostate-specific antigen density, and cores sampled were 63 years, 7.2 ng/mL, 50 mL, 0.15 ng/mL/cc, and 20 cores, respectively. Detection rates of overall and clinically significant prostate cancer averaged 43.4% (105/242) and 14% (35/242), respectively. Average visual analog scale pain rating was 3.9 and average procedure time was 20 minutes. Complication rates of sepsis, acute urinary retention, clot retention, and perianal abscess were 0.0% (0/242), 0.4% (1/242), 1.2% (3/242) and 0.4% (1/242), respectively. Conclusions: This series of office-based free-hand transperineal biopsy under LA without sedation performed with the PPTAS contains a large number of cases in which prophylactic antibiotics were not administered, yet there were no complications of postbiopsy sepsis. However, there was one case of a delayed perianal abscess. fTP-Bx under LA enables the easy integration of transperineal biopsy into a normal outpatient clinic workflow.

CORRELATIVE STUDY OF HISTOPATHOLOGICAL DIAGNOSIS WITH CLINICAL & ENDOSCOPIC DIAGNOSIS IN UPPER GASTROINTESTINAL ENDOSCOPIC BIOPSY AT TERTIARY CARE CENTER

Lesions of Upper gastrointestinal tract (GIT) is commonly seen in surgical department patients. These patients are subjected to endoscopic examination and biopsy is taken for further histopathological diagnosis. A clinical, endoscopic and histopathological diagnosis is made. This study was done to compare and correlate the results of histopathological diagnosis with endoscopic and clinical findings.
 Study Designed: A total 50 Upper Gastrointestinal tract biopsy cases received in histopathology lab were analyzed. 
 Material and Method: All endoscopic biopsies from upper GIT were received and processed. Paraffin blocks were made and sections were cut at 4 microns thickness and stained with routine hematoxylin and eosin stain. Their clinical and endoscopic reports were collected and compared with histopathological diagnosis.
 Result: After analyzing statistically the data, we found that endoscopy results were better than clinical diagnosis and more closer to histopathological diagnosis.
 Conclusion: Relation of histopathological diagnosis with endoscopic findings & clinical diagnosis was done in our study. We conclude that endoscopy is incomplete without histopathological examination of biopsy & so, the combinations of both plays an important role in diagnosis & management of upper gastrointestinal tract disorders. Histopathological examination remains the gold standard.
 Keywords: Histopathology, endoscopy, gastrointestinal lesions.

Histomorphological Spectrum of Glomerulopathies: A Review

Renal disease and dysfunction is a worldwide public health problem. The underlying pathology in most renal disease is glomerulopathy, largely referred to as glomerulonephritis. It can be primary or secondary to other diseases. A range of morphological patterns was observed in this condition, each with different etiopathogenetic mechanisms, diverse clinical presentation, disease progression and therapeutic responses. We searched the literature using Hinari, PubMed and Google Scholar, for appropriate studies. This review was conducted by employing specified methods and structures using histopathology-confirmed data during the year 2011 to 2020. Thirty-five studies consisting of 13,423 reported renal biopsy cases were covered in this review. The most common indication of the renal biopsy was nephrotic syndrome followed by proteinuria and nephritic syndrome. Focal segmental glomerulosclerosis, minimal change disease, and mesangio-capillary glomerulonephritis among others, were the most frequently reported primary patterns of glomerulopathies. Glomerular diseases remain poorly characterized due to the scarcity of data on histo-morphological patterns of glomerulopathies. The development of registries regarding renal biopsy may offer a chance to characterize the pervasiveness and patterns of glomerulopathies and have a positive impression on chronic/end stage renal disease analysis and treatment since most glomerular diseases are complaisant to treatment.

IMMUNOHISTOCHEMICAL EXPRESSION OF P53 AND CYCLIN D1 IN SQUAMOUS CELL CARCINOMAAND EPITHELIAL HYPERPLASIA OF ORAL MUCOSA.

Oral cancer is among the top three types of cancers in India. Most invasive oral carcinomas are preceded by a pre-invasive stage, that may last for many years. . Understanding the molecular mechanisms involved in the initiation and progression to malignancy of oral cancer will help to improve its prognosis and in the elaboration of new forms of treatment. The most common genetic alterations, include gene amplication and overexpression of oncogenes such as myc, erbB-2, Epidermal Growth Factor Receptor (EGFR), Cyclin D1 and mutations, deletions and hypermethylation leading to p16 and p53 tumor suppressor gene inactivation. There still remains the problem of differentiating epitheliomatous hyperplasia from squamous cell carcinoma (SCC) especially on biopsies. AIMS: 1. To study and evaluate the expression of p53 and Cyclin D1 in oral SCC and epithelial hyperplasia. 2. To correlate the expression of p53 and Cyclin D1 in different grades of oral SCC. SETTINGS AND DESIGN:Cross-sectional study conducted over a period of 18 months. METHODS AND MATERIAL: 30 cases (n=30) of oral squamous cell carcinoma & 30 cases (n=30) of epithelial hyperplasia diagnosed on H & E were included in this study. All these cases of oral SCC were further classied into different histological grades according to BRODERS' HISTOLOGICALGRADE. STATISTICAL ANALYSIS: The data was collected and the association between different groups was analysed by using Chi square test and quantitative variables were compared using Independent Ttest/Mann-Whitney Test (when the data sets were not normally distributed) between the two groups and ANOVA/Kruskal Wallis test between three groups. Ap value of ≤0.05 was considered statistically signicant. RESULTS: There was a signicant increase in the expression of p53 in oral SCC compared to epithelial hyperplasia. The results were statistically signicant (p value <0.0001). Similarly , Cyclin D1 also showed an increased expression in cases of SCC in contrast to epithelial hyperplasia (p value <0.0001). The expression of p53 signicantly increased with increase in grade of the tumor. The results being statistically signicant, p value=0.004. Similarly, poorly and moderately differentiated SCC also showed an increased expression of Cyclin D1 compared to well differentiated SCC (p value=0.03, statistically signicant). CONCLUSION: Thus the author concludes that the expression of both p53 and Cyclin D1 is increased in oral SCC compared to epithelial hyperplasia of oral mucosa and these markers can be used to differentiate between these two lesion especially on biopsy cases.

A Prospective Validation and Observer Performance Study of a Deep Learning Algorithm for Pathologic Diagnosis of Gastric Tumors in Endoscopic Biopsies.

Gastric cancer remains the leading cause of cancer-related deaths in Northeast Asia. Population-based endoscopic screenings in the region have yielded successful results in early detection of gastric tumors. Endoscopic screening rates are continuously increasing, and there is a need for an automatic computerized diagnostic system to reduce the diagnostic burden. In this study, we developed an algorithm to classify gastric epithelial tumors automatically and assessed its performance in a large series of gastric biopsies and its benefits as an assistance tool. Using 2,434 whole-slide images, we developed an algorithm based on convolutional neural networks to classify a gastric biopsy image into one of three categories: negative for dysplasia (NFD), tubular adenoma, or carcinoma. The performance of the algorithm was evaluated by using 7,440 biopsy specimens collected prospectively. The impact of algorithm-assisted diagnosis was assessed by six pathologists using 150 gastric biopsy cases. Diagnostic performance evaluated by the AUROC curve in the prospective study was 0.9790 for two-tier classification: negative (NFD) versus positive (all cases except NFD). When limited to epithelial tumors, the sensitivity and specificity were 1.000 and 0.9749. Algorithm-assisted digital image viewer (DV) resulted in 47% reduction in review time per image compared with DV only and 58% decrease to microscopy. Our algorithm has demonstrated high accuracy in classifying epithelial tumors and its benefits as an assistance tool, which can serve as a potential screening aid system in diagnosing gastric biopsy specimens.

Characteristics of disease distribution for the 1 370 renal biopsy cases in two hospitals from Guilin and Jining.

To analyze the constitution and distribution characteristics of renal pathological disease spectrum in the 2 hospitals from Guilin city and Jining city in recent 5 years. The pathological results of inpatients with renal biopsy in the 2 hospitals from Guilin city and Jining city from April 1, 2014 to August 15, 2018 were retrospectively analyzed. A total of 1 370 renal biopsy cases were collected, including 706 cases in Affiliated Hospital of Jining Medical College (Jiyi) and 664 cases in Affiliated Hospital of Guilin Medical College (Guiyi). There was no significant difference in gender, age, seasonal distribution and the total proportion of primary and secondary glomerular diseases between the 2 hospitals (all P>0.05). The ratio of male to female in the 2 hospitals was 1.18 (Jiyi) and 0.98 (Guiyi). IgA nephropathy (IgAN) was the major disease in 14-30 years old patients, and membranous nephropathy (MN) was the most common in 40-50 years old patients. There are 15 kinds of same diseases and 10 kinds of different diseases in the 2 hospitals. Among them, three pathological diseases (3 cases) including obesity-related nephropathy, primary Sjogren's syndrome renal damage, and pregnancy-induced hypertensive renal damage only appeared in Jiyi, while 7 diseases (55 cases) including focal segmental glomerulosclerosis (FSGS), focal proliferative glomerulonephritis (FGN), proliferative sclerosing glomerulonephritis (PSGN), endocapillary proliferative glomerulonephritis (EPGN), multiple myeloma renal damage, eosinophilic tumor renal damage and angiomyolipoma renal damage only appeared in Guiyi. Primary glomerular diseases (82% in Jiyi/79% in Guiyi) were higher than secondary nephropathy. The top two diseases in biopsy rate were MN and IgAN. The incidence rate of some diseases in Jiyi was higher than that in Guiyi, and these diseases included MN (48.87%, 31.78%), minimal change disease (MCD) (11.47%, 2.71%), allergic purpura nephritis (Henoch-Schlein purpura nephritis, HSPN) (3.97%, 1.51%), hypertensive renal damage (3.12%, 0.15%), diabetic nephropathy (DN) (2.97%, 1.36%). The incidence rate of other diseases in Guiyi were higher than that in Jiyi, and these diseases included IgAN (22.59%, 19.14%), mesangial proliferative glomerulonephritis (MsPGN) (11.45%, 0.99%), lupus nephritis (LN) (8.58%, 4.67%), hepatitis B virus associated nephritis (HBVGN) (7.53%, 1.84%), there were significant difference between the 2 hospitals in the above diseases (all P<0.05). The disease distribution of renal biopsy cases in the 2 hospitals displays both similarities and characteristics. Primary glomerular disease is still the main disease. MN has surpassed IgAN and jumped to the first place. The high incidence age of MN is 40-50 years old, and IgAN is 14-30 years old. The incidence rates of MN, MCD, HSPN, hypertensive renal damage, DN and other related diseases of air quality and lifestyle in Jiyi are higher than those in Guiyi. IgAN, MsPGN, LN, HBVGN and other diseases related to infection and tumor factors were higher in Guiyi than those in Jiyi. The prevention and control strategies in the 2 regions need to be adapted to local conditions. More attention should be paid to the impact of environment and lifestyle on kidney health in East China. We should pay attention to the damage to kidney caused by infectious diseases in Southern China, especially in female patients.

Endobronchial Biopsies in the Diagnosis of Lung Lesions — A Study of 204 Consecutive Cases from a Single Center in Southern India

Objectives: The objective of this study is to evaluate the diagnostic yield of endobronchial biopsy in various neoplastic and nonneoplastic lung lesions. Patients and Methods: A total number of 204 consecutive cases of fiberoptic bronchoscopic-guided endobronchial biopsies was analyzed. The bronchial wash (BW) samples collected simultaneously during the biopsy were correlated with final histopathology diagnosis. Results: The bronchoscopic findings mainly included endobronchial mass, increased mucosal vascularity, and mucosal irregularities. Of the 184 adequate biopsy samples, 32.3% were neoplastic, 20.5% nonneoplastic, and remaining 41.3% revealed normal histology. The nonneoplastic lesions included mainly nonspecific inflammation, granulomatous inflammation followed by few cases of squamous metaplasia, one case each of tracheobronchopathia osteochondroplastica, mycobacterium spindle cell pseudotumor, and cytomegalovirus infection. Among the malignant tumors, adenocarcinoma (ADC) was the most common followed by squamous cell carcinoma (SQCC) and non-small cell carcinoma-not otherwise specified. On immunohistochemistry, Napsin-A showed better sensitivity than thyroid transcription factor-1 for ADC. P40 was found to be most sensitive and specific markers for SQCC. Neuroendocrine tumors included seven small cell carcinoma and three carcinoids. Both chromogranin and synaptophysin were found to be equally sensitive neuroendocrine markers. The bronchoscopically normal airways mostly revealed normal histology with few showing mild nonspecific inflammation. On the contrary, all except one case of neoplasm had mass lesions on bronchoscopy. Conclusion: EBB provides sufficient tissue for morphological and immunohistochemical characterization of malignant lesions. BW cytology has poor concordance with EBB in the diagnosis of malignancies with nearly 70% cases being false negative.

Dual–Posteromedial Portal Technique for Complex Arthroscopy in the Posterior Knee

Arthroscopy in the posterior knee continues to improve as new techniques arise. Traditionally, posterior techniques included posteromedial and posterolateral portals. Although frequently used, these techniques do have some limitations. We propose the use of dual posteromedial portals for complex arthroscopy cases to improve access and instrumentation in the posterior knee. Applications include, but are not limited to, resection of tumors or masses in the posterior knee, meniscal posterior horn repair, ramp lesion repair, repair of posterior cruciate ligament avulsions, and use as accessory portals for arthroscopic posterior cruciate ligament reconstruction. We describe a technique for establishing dual posteromedial portals for complex arthroscopy in the posterior knee, specifically in relation to a case of a posterior knee mass biopsy and resection.