Department Of Pathology Research Articles

Assessment of Conjunctival Surface Changes in Post COVID Patients by Impression Cytology

Abstract Background The conjunctiva is a transparent, clear, thin membrane that covers part of the eye’s front surface and the inner surface of the eyelids. It is divided into three regions: the palpebral or tarsal conjunctiva, the bulbar or ocular conjunctiva, and the conjunctival fornices. The novel coronavirus (COVID-19), named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was first identified in December 2019 after a series of acute atypical lung disease cases occurred in Wuhan, China. Aim of the Work The aim of the our study is assessment of the inflammatory and neoplastic changes that happened on the ocular surface especially the conjunctiva according to Nelson staging system in post-COVID-19 patients and evaluated by impression cytology. Patients and Methods This study was conducted on a selected sample of patients attending the Ophthalmology outpatient clinic of Ain Shams University Hospitals in Cairo, specimens of impression cytology were stained and examined in the Pathology department of Ain Shams University. Results In the present study, comparison between cases and controls groups as regards epithelial cells showed that in cases group there was normal, small, round cells in 19(59.4%) cases, slightly larger, more polygonal cell in 11(34.4%), and Larger, polygonal cells in 2(6.3%), and in controls group, there was normal, small, round cells in 25(78.1%) cases, slightly larger, more polygonal cell in 7(21.9%), there was no statistically significant difference between the two groups as regards epithelial cells (p > 0.05). Furthermore, As regards N/C ratio where in cases group the ratio was 1:2 in 19(59.4%) cases, 1:3 in 11(34.4%), and 1:4-1:5 in 2(6.3%), and in controls group, it was 1:2 in 25(78.1%) cases, 1:3 in 7(21.9%), there was no statistically significant difference between the two groups as regards N/C ratio. In the current study, as regards Keratinization where 6(18.8%) cases had mild keratinization in cases group in comparison to 2(6.3%) cases in controls group. There was no statistically significant difference between the two groups as regards Keratinization (p > 0.05). Moreover, we found that there was no dysplasia in both cases and controls groups. The comparison between cases and controls groups as regard Goblet cells where in cases group the goblet cells was stage 0 in 17(53.1%) cases, others was stage 1 in 13(40.6%), and the cells was stage 2 in 2(6.3%), and in controls group, there was stage 0 cells in 22(68.8%) cases, stage 1 in 10(31.3%), there was no statistically significant difference between the two groups as regard goblet cells density. Conclusion There is non significant inflammatory or neoplastic changes that have been occurred in conjunctival surface in post-COVID-19 patients. Except for lymphocytes infiltration.

Role of the IL-8/CXCR2 axis in promoting vasculogenic mimicry in triple-negative breast cancer through epithelial-mesenchymal transition

Vasculogenic mimicry (VM) — a phenomenon where tumor cells form de novo vascular networks independent of endothelial cells — supports the growth of highly aggressive tumors, including triple-negative breast cancer (TNBC). Evidence indicates that the interleukin 8 (IL-8)/CXCR2 axis and epithelial-mesenchymal transition (EMT) independently promote VM in TNBC. This study tested the hypothesis that the IL-8/CXCR2 axis promotes VM via EMT. Tissue samples from 71 female breast cancer cases (age range: 50 – 55 years), comprising 37 TNBC and 34 non-TNBC cases, were retrieved from the Department of Pathology at the University of Ghana Medical School. Out of the 37 TNBC tissues, 10 expressed either IL-8, CXCR2, or vimentin exclusively; three expressed all three markers; and 14 did not express any of these markers. For the non-TNBC tissues, 31 expressed CXCR2 (alone or co-expression with IL-8 and/or vimentin), 27 co-expressed IL-8 with CXCR2 and/or vimentin, and two expressed all three markers. Notably, 24 of the 37 non-TNBC tissues co-expressed IL-8 and CXCR2. A phi coefficient analysis displayed an inverse relationship between CXCR2 or IL-8 expression and TNBC and a positive correlation between vimentin expression and TNBC. Inhibiting the IL-8/CXCR2 axis with the CXCR2 antagonist SB225002 suppressed VM in MDA-MB-231 breast cancer cells. In addition, inhibiting the IL-8/CXCR2 axis using SB225002 and siRNA-mediated CXCR2 knockdown suppressed EMT by upregulating E-cadherin expression and downregulating N-cadherin and vimentin expression. Our findings suggest that the IL-8/CXCR2 signaling axis promotes VM in TNBC by facilitating EMT. Therefore, therapies targeting IL-8/CXCR2 may be used to suppress EMT and VM in TNBC simultaneously.

Germline BRCA1 Mutation inSquamous Cell Carcinoma of Oesophagus: Driver versus Passenger Mutation

We report a rare case of 62-year-old South Asian women who visited the Molecular Pathology and Genomics Department for hereditary germline cancer genetic testing after being diagnosed with oesophageal cancer, reported as invasive keratinizing squamous cell carcinoma metastasized to the lymph nodes. Her personal history revealed that she was diagnosed with triple-negative breast cancer five years before oesophageal cancer. Germline cancer testing showed pathogenic variants in BRCA1 gene c.68_69delAG, which proved it a hereditary breast and ovarian cancer syndrome. She was started on PARP inhibitors but developed some secondary respiratory failure and succumbed to death. Less than 10 cases have been reported in the literature of the association of germline BRCA1 and Squamous cell Carcinoma – the esophagus. The article focuses on the probable pathogenesis of BRCA1 mutation with non-classic malignancies and the response of Poly adenosine diphosphate ribose polymerase inhibitors (PARP) inhibitors in such a scenario. We report an unusual manifestation of the BRCA1 gene with second primary oesophageal squamous cell cancer occurring five years later to triple-negative breast cancer.

Correlation of Ki-67 Proliferating Index with Histological Types and Characterization of Mucin in Colorectal Carcinoma

Background: Colorectal carcinoma is a major cause of cancer associated with a high rate of morbidity and mortality in the western world. One of the pathologic features considered to be important for prognosis is mucin production. Many authors confirmed that colon carcinomas with high mucin content tend to recur locally and carry a poor prognosis. Aim: Correlation of Ki-67 proliferating index with different type of colorectal carcinoma as well as characterization of mucin. Method: This cross sectional study was conducted at Sir Salimullah Medical College, Department of pathology from July 2014 to June 2016. Ninety eight patients with colorectal carcinoma was enrolled in this study who underwent surgical resection of colon, adenocarcinomas. For histological classification we used the WHO recommendation (2000) and to be more accurate we sub-classified mucinous adenocarcinomas by morphometrical analysis in three categories: pure mucinous, with extracellular mucin more than 80% of the tumoral volume; mixed type, with 50–80% extracellular mucin; and mixed type with less than 50% extracellular mucin and their correlation with Ki-67 proliferating index . For histochemical investigation, we used stains such as: D- PAS and Alcian Blue. A technique of manual tissue array was employed to see Ki-67 expression by IHC method. Ki-67 is a proliferation associated nuclear antigen which can be recognized by MIB-1 monoclonal antibody. Result: It was observed that Ki-67 labeling index was high in nonmucinous tumor compared to mucinous adenocarcinoma and signet ring cell carcinoma which is statistically significant (P<0.05). Histochemical stain of mucin where both D-PAS and Alcian Blue positive cases(mixed type) are more than the Only D-PAS positive cases(pure type). Ki-67 proliferating index was also high in mixed type mucinous adenocarcinoma (<50%) compared to pure (>80%) and mixed type (50-80%). The result was statistically significant (p<0.05). Correlation of Ki-67 proliferating index with histologic type as well as mucin characterization and thereby provide information to clinician to better understanding of the treatment as well as prognosis.

Harnessing the Power of Big Data Analytics-Estimation of Reference Intervals for Neonatal Serum TSH in Pakistan Using RefineR Algorithm.

To estimate the population-specific reference intervals (RIs) for neonatal thyroid stimulating hormone (TSH) in Pakistani neonates, utilising the refineR algorithm. Observational study. Place and Duration of the Study: Department of Pathology and Laboratory Medicine, The Aga Khan University Hospital, Karachi, Pakistan, from 17th May to 30th November 2023. A data mining analysis was conducted on serum TSH results of neonates (≤1 month) over a period of six years, following approval from the Institutional Ethical Review Committee. Two subgroups were assessed based on the age as 0 - 5 days and 6 - 30 days. The refineR algorithm was implemented using refineR package (version 1.0.0), ensuring accurate analysis and insights. A total of non-duplicate 82,299 neonatal serum TSH tests were retrieved, including 70,788 (88%) aged 0 - 5 days and 11,511 (12%) aged ranging from 6 - 30 days. The estimated RI was from 0.67 µIU/mL (90% CI 0.641 - 0.72) to 15.0 µIU/mL (90% CI 13.2 - 17.3) for the first age group and 0.65 µIU/mL (90% CI 0.6 - 0.84) to 8.6 µIU/mL (90% CI 8.05 - 9.71) for the second age group. Reference intervals for neonatal serum TSH of the Pakistani population were estimated, considering the genetic differences of this demographic in comparison to the Western population. Results aligned with global literature, validating the refineR indirect approach's applicability. Reference intervals, Neonatal, Thyroid stimulating hormone, RefineR algorithm, Big data, Pakistan.

Histopathological spectrum of round cell tumors in a tertiary care center of Chhattisgarh, India

Abstract Background and Objectives: The term “round cell tumors” (RCTs) refers to a diverse group of neoplasms that share similar histopathological features, including uniform, small, round cells with round nuclei, fine chromatin, and scanty clear or eosinophilic cytoplasm. This study assesses the spectrum of RCTs across different age and sex groups. Materials and Methods: The study included all histologically diagnosed cases of RCT from the Department of Pathology over 5 years. Results: The results revealed that 107 RCT cases were diagnosed through histopathology and further analyzed using immunohistochemistry (IHC). The patients’ ages ranged from 1 to 75 years, with the highest incidence (34%) occurring in the 16–45 years age group. Of the 107 cases, 54 (51%) were males and 53 (49%) were females. Thirteen different types of RCTs were identified, with non-Hodgkin’s lymphoma being the most common (29.90%). Most cases (46%) were in the head and neck region. Interpretation and Conclusion: This study concludes that RCTs are widespread in their anatomical distribution and exhibit diverse patterns of round cells morphologically, making histopathological diagnosis challenging. IHC is highly valuable for diagnosis, though some cases require molecular diagnosis for confirmation.

Significance of Combined Immuno-histochemical Expression of P63 & CD56 in Papillary and Follicular Thyroid Carcinoma

Background: Thyroid neoplasm is the commonest endocrine neoplasm. More than 80% of thyroid malignancies are papillary thyroid carcinoma (PTC) followed by follicular carcinoma (FC). The diagnosis of papillary thyroid carcinoma is based on characteristic nuclear morphology of a thyroid neoplasm. In contrast, follicular variant of PTC may cause, if the nuclear features of PTC are insufficiently appreciated, severe problems in differentiating from follicular thyroid carcinoma. Several immunohistochemical (IHC) markers such as P63 and CD56 have been recommended to differentiate between this two thyroid malignancies with overlapping histomorphology. Objectives: Our aim was to identify the possible diagnostic role of P63 and CD56 immunoexpression that distinguish PTC, including the follicular variant from follicular thyroid carcinoma. Methods: This cross-sectional descriptive study was conducted in the Department of Pathology, Rajshahi Medical College from March 2020 to February 2022. A total of 44 cases, histologically confirmed as papillary and follicular thyroid carcinoma were included in the study. Immunohistochemistry was done for P63 and CD56 from selected paraffin blocks. Results: Histologically, 39 cases were diagnosed as papillary thyroid carcinoma (27 were classical PTC & 12 were FVPTC) and the rest 5 were follicular thyroid carcinoma. In this study, mean age of the patients was 40.86 ± 6.57 years (SD) and male to female ratio was 1:2.4. P63 showed 74.4% positivity with papillary thyroid carcinoma. Positive immunoreactivity of P63 was highly significant in distinguishing papillary from follicular thyroid carcinoma (P=0.003). Combined P63 positive CD56 negative (P=0.048) and P63 negative CD56 negative immunoexpression (P=0.039) were statistically significant in differentiating papillary from follicular thyroid carcinoma. Conclusion: This study suggested that the use of P63 and CD56 may be helpful in the diagnosis of papillary and follicular thyroid carcinoma along with histopathological examination and their combination may also help in this purpose.

A study on histomorphological analysis of gestational trophoblastic disease

Abstract Background: Gestational trophoblastic disease (GTD) represents a diverse group of conditions characterized by abnormal trophoblastic proliferation within the placenta. GTD includes benign and malignant lesions, ranging from complete and partial hydatidiform moles to more severe forms like invasive moles, choriocarcinoma, placental site trophoblastic tumors (PSTTs), and epithelioid trophoblastic tumors. Given that neoplastic GTD lesions respond remarkably well to chemotherapy, early and accurate histopathological diagnosis is crucial as it directly influences treatment and prognosis. Aim and Objectives: This study examined the histomorphological features of various types of GTD alongside key clinical factors such as age, parity, and gestational period. Materials and Methods: The study was conducted in the Department of Pathology over the course of10 years, from January 2014 to January 2024. All cases of GTD confirmed through histopathological examination of hematoxylin and eosin-stained slides were included in the analysis. Results: Out of 60 diagnosed cases of GTD, 34 (56.66%) were complete hydatidiform moles, 22 (36.67%) were partial hydatidiform moles, 1 (1.67%) was an invasive mole, 1 (1.67%) was choriocarcinoma, and 2 (3.33%) were PSTTs. The age of the affected patients ranged from 18 to 45 years, with the highest incidence observed in the 20–25 year age group (30 cases, 50%). Most cases (33, 55%) occurred during the first trimester, with a predominance among primigravida patients (28 cases, 46.66%). The most common clinical presentation was per vaginal bleeding, reported in 56 cases (93.33%). Conclusion: Although GTD can lead to serious complications, including metastasis, it is treatable. In this study, the complete hydatidiform mole was the most frequently encountered lesion and is associated with a higher risk of severe complications such as persistent GTD, invasive moles, and choriocarcinoma. Thus, early and accurate histopathological diagnosis is vital for the timely initiation of therapy, ultimately reducing the mortality rate. This study highlights the various categories and histomorphological features of GTD, emphasizing the importance of understanding its clinical presentation to mitigate disease burden and complications.

Significance of Runt-related transcription factor 1 and Notch1 expression in non-small-cell lung cancer: involvement in epithelial-mesenchymal transition and epidermal growth factor receptor-tyrosine kinase inhibitor therapy resistance

Objective One of the main obstacles to treating patients with non-small-cell lung cancers (NSCLC) is the emergence of drug resistance to epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitor (TKI) therapy. Aim To investigate the prognostic relevance of Runt-related transcription factor 1 (RUNX1) and Notch1 in NSCLC and to evaluate their potential involvement in induction of epithelial-mesenchymal transition and resistance to EGFR-TKI therapy. Materials and methods Immunohistochemical study of RUNX1, Notch1, E-cadherin, and hypoxia-inducible factor 1α (HIF-1α) was conducted upon 83 cases diagnosed as NSCLC. The research was conducted in the departments of pathology, chest, and medical oncology of the Faculty of Medicine, Benha University. Results A significant relation was found between RUNX1 and sex (P=0.001), smoking history (P=0.002), and tumor grade (P=0.002). High RUNX1 expression was associated with poor OS and DFS (P=0.003 and 0.005), respectively. Cases with positive Notch1 expression were significantly associated with tumor grade (P=0.005) and tumor stage (P=0.024). A significant association was detected between Notch1 expression and poor OS and DFS (P=0.025 and 0.011), respectively. A statistically significant correlation was found between RUNX1 and Notch1 expressions (P=0.040). Moreover, high RUNX1 and positive Notch1 expressions were significantly associated with negative E-cadherin and positive HIF-1α expressions. Resistance against EGFR–TKI therapy was significantly associated with high RUNX1, positive Notch1, negative E-cadherin, and positive HIF-1α expressions, in EGFR-mutated cases. Conclusions RUNX1 and Notch1 may be involved in therapy resistance through the induction of epithelial–mesenchymal transition and may serve as prognostic markers in patients with NSCLC.

Histomorphological Patterns of Lesions in Lymph Node Biopsies in a Tertiary Care Hospital

Background: Lymphadenopathy is one of the most common presentations of inflammatory and neoplastic disorders. Detailed assessment is required to reveal an underlying pathology. Clinical features along with radiology images may not be sufficient for diagnosis of lymph node enlargement. Hence, lymph node biopsy has become a mandatory tool to arrive at a definitive diagnosis. Methods: This cross-sectional retrospective study was conducted in the Department of Pathology, Rajshahi Medical College over a period of one year from July 2022 to June 2023. A total of 130 cases of lymph node biopsies were included in this study as the study subjects purposively. Specimen of tissue was fixed with 10% formalin and stained with haematoxyline and eosin stain, followed by histopathological examination. Statistical analysis was performed using Microsoft Excel. Result: A total of 130 lymph node biopsies were studied with ages ranging from 13 to 72 years. Most of the cases (54%) belonged to 21-40 years. Female patients were 52% and male patients were 48%. Reactive hyperplasia was the commonest lesion accounting for 37% of cases (48 cases), followed by metastatic deposits showed in 36 cases (28%).Reactive hyperplasia was common in early age group while 69% of metastatic deposits were found in age group above 40 years. Duct cell carcinoma was the commonest metastatic carcinoma (42%) in this present study. Conclusion: To establish the causes of lymphadenopathy, lymph node biopsy plays an important role. It is less expensive than other tests when investigating the cause of enlarged lymph nodes.

Inoculation of pleural fluid in blood culture bottles could be a routine practice in pleural infection

Background Worldwide, pleural infections are becoming more common. Overuse of empirical antibiotics has been linked to longer hospital stays and higher death rates, causing the emergence of antibiotic-resistant pathogens. So, proper care requires the identification of the pathogenic bacteria using pleural fluid culture. In addition to normal culture, pleural fluid inoculation in blood culture bottles enhances the proportion of patients with detectable infections in less time. Aim To assess whether inoculating pleural fluid into a blood culture bottle will increase the yield of isolated pathogens compared to routine culture techniques in evaluating pleural infection. Also, to compare the time of pathogen detection when comparing the detection by blood culture bottle versus the routine microbiological culture technique. Recognize the distribution of isolated bacteria from our center and their susceptibility profile to different antibiotics and predict the most effective empirical antibiotics. Patients and methods Cross-sectional analytical prospective study conducted at the Department of Pulmonology and Clinical Pathology in Cairo University Hospitals. It included 70 patients with infected pleural effusion. Under ultrasound supervision, pleural fluid was extracted and transported to the laboratory for routine microbiological culture. At the same time, an automated blood culture bottle was inoculated with 5–10 ml to be incubated. All the detected pathogens were identified and tested for antimicrobial susceptibility according to CLSI. Results The mean age of our patients was 47.1 ± 15.6 years. Empyema was documented in 16 (22.9%) of our patients, whereas 54 (77.1%) had exudative pleural effusion. Positive aerobic infection in blood culture bottle was seen in 37 patients, compared to 21 patients in direct pleural culture. A statistically significant difference was found between the culture positive rate in aerobic blood culture bottles and direct pleural culture (P=0.001). Conclusion Blood culture bottle inoculation of infected pleural fluid increases the sensitivity of microbial yield in a shorter time than standard culture.

Study of non-invasive follicular thyroid neoplasm: A borderline entity

ABSTRACT Background: Non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) is a newly added entity in the fourth edition of the WHO Classification of Tumors of Endocrine Organs (2017). It is regarded as a neoplasm with very low malignant potential, thus affecting further treatment of the patients. Aims: To study the recently diagnosed entity, NIFTP, as not many cases have been reported of the same. Materials and Methods: A retrospective analysis of all thyroid neoplasms received in the Department of Pathology of our institute over two years was done. Out of the 188 cases that we reported, 38 were of non-invasive follicular neoplasms. Results: Thirty-two patients were female, whereas six patients were male. Thirty-five patients presented with solitary thyroid nodule and the others had an ill-defined thyroid swelling. Thirty-four patients had normal thyroid profile while two patients each presented with hypothyroidism and hyperthyroidism. Conclusion: It is crucial to carefully study the histopathological features of solitary thyroid swellings and correlate with clinical and radiological findings. The recently added diagnostic category of NIFTP helps clinicians prevent over-treatment of a group of low-risk thyroid tumors.

Comparison of clinicopathological features between cerebral cystic and alveolar echinococcosis: analysis of 27 cerebral echinococcosis cases in Xinjiang, China

BackgroundCerebral echinococcosis is relatively rare, and it is important to distinguish cerebral cystic echinococcosis (CCE) from cerebral alveolar echinococcosis (CAE) in terms of pathological diagnosis. We aim to describe the different clinicopathological features among patients with CCE and CAE.MethodsWe collected 27 cases of cerebral echinococcosis which were diagnosed in the Department of Pathology of the First Affiliated Hospital of Xinjiang Medical University from January 1, 2012, to June 30, 2023. We compared the patients’ clinical characteristics, MRI features, and pathologic manifestations of CCE and CAE.ResultsAmong 27 cases of cerebral echinococcosis, 23 cases were CAE and 4 cases were CCE. The clinical manifestations of both CCE and CAE patients mainly included headache (21 patients, 77.78%), limb movement disorders (6 patients, 22.22%), epileptic seizures (4 patients, 14.81%) and visual disturbances (2 patients, 7.41%). The average onset age of CAE cases was 34.96 ± 11.11 years, which was 9.00 ± 7.26 years in CCE cases. All CAE patients presented with multiple involvements in the brain and extracranial organs while all CCE patients observed a solitary lesion in the brain and 3 CCE cases had no extracranial involvement. Lesions of CCE in MRI showed a single isolated circular, which was well demarcated from the surrounding tissues and with no obvious edema around the lesions, whereas CAE lesions presented as multiple intracranial lesions, with blurred edges and edema around the lesions, and multiple small vesicles could be observed in the lesions. The edge of CAE lesions could be enhanced, while CCE lesions have no obvious enhancement. CCE foci were clear cysts with a wall of about 0.1 cm. Microscopically, the walls of the cysts were characterized by an eosinophilic keratin layer, which was flanked on one side by basophilic germinal lamina cells, which were sometimes visible as protocephalic nodes. While the CAE lesion was a nodular structure with a rough and uneven nodule surface, and the cut section was cystic and solid; microscopically, the CAE lesion had areas of coagulative necrosis, and the proto-cephalic nodes were barely visible. Inflammatory cell areas consisting of macrophages, lymphocytes, epithelioid cells, plasma cells, eosinophils, and fibroblasts can be seen around the lesion. Brain tissues in the vicinity of the inflammatory cell areas may show apoptosis, degeneration, necrosis, and cellular edema, while brain tissues a little farther away from the lesion show a normal morphology.ConclusionsWith the low incidence of brain echinococcosis, the diagnosis of echinococcosis and the differential diagnosis of CAE and CCE are challenging for pathologists. Grasping the different clinical pathology characteristics of CAE and CCE is helpful for pathologists to make accurate diagnoses.

Clear cell adenocarcinoma of the cervix and its mimickers - A series of 19 cases from a tertiary care referral centre in India.

Clear cell adenocarcinoma (CCAC) of cervix is a rare subtype of endocervical adenocarcinoma that accounts for 4% of all cervical adenocarcinoma with many morphological mimickers. Retrospectively study cases of cervical clear cell adenocarcinoma of the cervix. Clinical profile and pathological features of CCAC of the cervix diagnosed between 2018-2022 were retrospectively analyzed.The database of the Department of Pathology of our institute was systematically searched for patients diagnosed with clear cell adenocarcinoma of the cervix during 2018-2022.A total of 19 patients were studied with the mean age of patients being 53.72 years (range 25 -84 yrs,standard deviation-25.9) and median tumor size being 5.6cm. Lymph node metastasis was identified in 33.3% and distant metastasis were seen in 20% of the cases. Staging could not be done in 4 cases.FIGO staging of the cases included IB1(2 cases), IB2(2 cases), IIB (3 cases),IIIA (1 case)IIIB(4 cases),and IV(3 cases). On histopathological evaluation, heterogeneous architectural pattern comprising of tubulocystic, solid, and papillary patterns were seen in 13 cases (13/19,68.4%). Pure tubulocystic (3/19,15.7%), pure papillary (2/19,10.5%), and pure solid patterns (1/19,5.3%) were also identified. Tumor cells with clear cytoplasm ranged from 5% to 95%. Nuclear atypia was moderate to marked in all the cases (19/19,100%). Mitotic activity varied from 1/10hpf to 20-22/10hpf. By immunohistochemistry, tumor was positive for Napsin A in all the cases,p16INK4a was negative in majority of cases (15/19,78.9%) and ER was negative in 14 cases (14/19,73.7%) .p53 showed wild type staining except for one case . Clear cell adenocarcinoma being a rare subtype of cervical adenocarcinoma, needs to be differentiated from other Human Papilloma Virus(HPV) independent adenocarcinomas (gastric and mesonephric types) and benign entities such as endocervical glandular Arias-Stella reaction. Judicious use of a panel of immunostains is often helpful.

Comparative Evaluation of Honey Versus Alcohol as a Fixative in Cytological Samples: An Institutional Study.

Fixation plays an important role in fixing the cells, making them amenable for evaluation. Ethanol (95%) has been used as a standard cytological fixative. Honey can be introduced as a natural fixative. 1. To study cytomorphological features of smears fixed in 20% unprocessed honey. 2. To study the efficacy of honey as a fixative when compared with ethanol in both hematoxylin and eosin (H and E) stain and Papanicolaou (PAP) stain for cytological samples. A cross-sectional study was done in the Department of Pathology for 2 months on 100 cytological samples consisting of body fluids (peritoneal and pleural), cervical smears, and FNACs. These smears were fixed separately in 95% ethanol and 20% unprocessed honey for 5 minutes and were stained with both PAP and H and E stain. The cytomorphologies of both the smears were compared based on five parameters, clarity of staining, uniformity of staining, overall morphology, nuclear details, and cytoplasmic details, and the final score was calculated by adding all the scores: Total Score ≤2, poor score; 3-4, good score; 5, excellent score. Cervical smears fixed in honey showed similar features to ethanol-fixed smears. Fluid smears fixed in honey and stained with PAP yielded superior results compared to those stained with H and E, as shown by a kappa value of 0.259. However, neither of the smears demonstrated statistical significance. The FNAC samples stained with H and E and PAP exhibited nearly identical results, with a kappa value of 0.688 and 0.647, respectively. FNAC and PAP smears were the next two most successful cytological smear types, with cervical smears exhibiting the best results of the three. In honey-fixed smears, we can easily observe all cellular features with clarity. It enhances safety and the working environment in the laboratory. Honey can serve as an effective substitute in situations where resources are limited.

Gingival acquired lymphangiectasia as a long-term effect of post-oncology intervention: A 20-year institutional audit

Abstract Background: Gingiva is a keratinised mucosa akin to the skin and is exposed in all modalities of treatment of oral cancer. Acquired lymphangiectasia are acquired dilatations of lymphatic channels secondary to an external cause. They are extremely rare in the oral cavity despite that oral cancers are treated with different treatment modalities. Methods: The archives of the Oral and Maxillofacial Pathology Department of our institute were retrospectively reviewed from 2001 to 2021. Of the 9566 cases of oral biopsies, 4596 were confirmed cases of oral cancer including salivary gland carcinoma. These cases were followed up for the presence of post-neoplastic and post-therapeutic gingival lesions. Results: Of the 4596 patients, <10% patients reported recurrence or new primary of squamous cell carcinoma in the gingiva. Two patients were histopathologically diagnosed with acquired lymphangiectasia of gingiva after 12 years following surgery and radiation therapy as treatment for oral squamous cell carcinoma and mucoepidermoid carcinoma, which has been described in our report for the first time in the literature. Conclusion: Even though acquired lymphangiectasia of gingiva is very rare, lymphatic malformations should be included in the clinical differential diagnosis of post-therapeutic gingival proliferative pathologies in order to ensure appropriate treatment and prevent over-diagnosis of this benign condition.

The Clinical Predictors of Malignancy in the Prostate Gland and Their Correlation With Prostate-Specific Antigen (PSA) Levels.

Background and objective The prostate gland, which plays a crucial role in the male reproductive system, has a complex structure and function. Prostate enlargement, often benign but occasionally malignant, poses significant health concerns, particularly in aging populations. Prostate-specific antigen (PSA) serves as a vital biomarker, reflecting changes in prostate architecture and aiding diagnostic stratification. Elevated PSA levels correlate with prostate pathology and standard grading systems such asGleasongrading help guide treatment decisions. This study aimed to investigate the correlation between prostate enlargement, PSA levels, and Gleasongrades, particularly within the Indian context. Materials and methods This study was conducted over one and a half years at the Department of Pathology, Rajendra Institute of Medical Sciences, Ranchi, and involved 100 cases of clinically enlarged prostates. Clinical data, including age, symptoms, and relevant features, were collected, and histopathological analysis was performed on biopsy specimens. Statistical analysis was conducted using Microsoft Excel and SPSS Statisticsversion 20.0 (IBM Corp., Armonk, NY). Results Our study identified possible links between several factors and prostate conditions. Non-vegetarian diets showed a potential association with increased adenocarcinoma prevalence (p = 0.179). Urinary symptoms like hesitancy, incomplete voiding, retention, frequency, and urgency were significantly more common in men with adenocarcinoma (p<0.05). Additionally, bone pain and abnormal digital rectal examination (DRE) findings strongly correlated with adenocarcinoma (p<0.001). As expected, age showed a positive correlation with prostate weight and PSA levels (p<0.01). Interestingly, bone pain was associated with a lower likelihood of other prostate symptoms (p = 0.023). Conclusions Our findings provide key insights into the clinical factors associated with prostate pathology and highlight the need fora comprehensive approach to diagnosis in these patients, integrating clinical evaluation and histopathological assessment.

Clinicopathological study of thyroid gland cancer among selected sample Basrah province between 2019-2022

Background. Thyroid cancer (TC) is the most prevalent cancer within the endocrine system and the head and neck region. Its incidence has been on the rise in Iraq over the past few decades, primarily owing to papillary thyroid carcinoma. This study’s objective is to explore the pathological variants, frequency, and demographic characteristics of TC in a sample of Basrah’s population and subsequently compare these elements with data from other regions in Iraq and globally. Methods. This study is a single-institutional retrospective review conducted at the Department of Pathology within Ports Teaching Hospital in Basrah, Iraq. We analyzed slides of thyroid tumors stained by Hematoxylin and Eosin (H&amp;E) and biometric data gathered from histopathological reports. The cases for this study were identified between 2019 and 2022. Results. In this study, 51 cases were examined, comprised of six males and 45 females. The average age and histopathology patterns were analyzed, finding that the most common type of TC was the classic form of papillary thyroid carcinoma, as seen in 16 cases. The study noted a predominant female presence, accounting for 88.2% of the cases, while males comprised 11.8%. The median age among all subjects was 38 years. Conclusions. A review of all slides featuring thyroid tumors stained with H&amp;E, combined with biometric data from histopathological reports, shows an increasing incidence of TC in Basrah City, Iraq. Predominantly, cases of papillary thyroid carcinoma outnumber those of follicular carcinoma.

Role of Fluorescent Staining and Ziehl-Neelsen Techniques in The Detection of Mycobacterium Tubercle Bacilli in Lymph Node Aspirate

Background Tuberculosis is the important disease of infectious etiology especially in the developing nations. It is a major health issue in India. FNAC is an economic and rapid tool having high diagnostic accuracy for LN tuberculosis. Present study was conducted to describe the role of fluorescent staining and Ziehl- Neelsen techniques in detecting Mycobacterium tubercle bacilli on FNAC samples of tubercular lymphadenitis.MethodsThis prospective study was carried out at Department of Pathology, Muzaffarnagar Medical College, U.P. It included 100 patients having enlarged lymph nodes which were suspected of TB. After FNAC, cytological examination was done and smears prepared were stained with ZN stain and Auramine Rhodamine (AR) stain.ResultsTwenty eight (28.0%) cases were found in 21-30 years age group followed by 20 cases (20%) in 31- 40 year age group and 11-20 year age group. Most were females forming female to male ratio 1.7:1. Cytomorphologically, four patterns were observed– Necrotizing granulomatous lymphadenitis in 41% cases, Granulomatous lymphadenitis in 29% cases, only Necrotizing lymphadenitis in 19% cases and Necrotizing lymphadenitis with suppuration in 11% cases. ZN staining showed AFB in 35% cases while AFB was not seen in 65% cases. Out of these 65% cases, fluorescent staining was positive in 29%, indicating significant association of fluorescent staining with ZN method. Conclusions Only with the cytological findings of lymph node, it is difficult to arrive at confirmatory diagnosis of TB. Fluorescence Microscopy (FM) increases the sensitivity for diagnosing TB in underdeveloped nations with high tuberculosis prevalence, such as India.

Morphological and Clinical Analysis of Colorectal Cancer: Findings from a Cross-Sectional Study

Background: Colorectal cancer (CRC) is a leading cause of cancer-related morbidity and mortality worldwide, with increasing incidence in developing countries like Pakistan. This study aims to evaluate the distribution patterns of colorectal cancer morphologies among patients treated at Liaquat University of Medical &amp; Health Sciences (LUMHS) Jamshoro. Methodology: This descriptive, cross-sectional study was conducted over two years (January 2022 to December 2023) at the Department of Gastroenterology, Asian Institute of Medical Sciences, in collaboration with the Department of Pathology, LUMHS Jamshoro. A total of 150 patients diagnosed with CRC and who underwent surgical resection were included in the study. Data were collected on socio-demographic characteristics, clinical presentations, histopathological types, tumor grading, and staging. Statistical analysis was performed using SPSS version 25, with Fisher’s exact test applied to assess associations between variables. Results: The mean age of the patients was 58.7 years (± 11.2), with the majority being male (60%). Most tumors were classified as non-mucinous adenocarcinomas (56%), followed by mucinous adenocarcinomas (28%) and signet-ring cell carcinomas (16%). A strong positive correlation was found between tumor size and Dukes' staging (ρ = 0.42, p &lt; 0.001), as well as between Dukes' staging and tumor grading (ρ=0.46, p&lt;0.001). Rectal bleeding was significantly associated with advanced Dukes’ stages (ρ=0.44, p &lt;0.001). Conclusion: This study highlights the aggressive nature of colorectal cancer in the studied population, with significant associations between age, tumor size, staging, and grading. The findings underscore the need for early detection strategies and tailored treatment approaches to address CRC in this region. Keywords: Colorectal Cancer, Dukes’ Staging, Histopathology, Tumor Grading.