Histopathology Laboratory Research Articles

Necrotic and Inflammatory Changes on Acute Studies of Siam Leaf (Chromolaena Odorata) Alcoholic Extract on Lead Induced Toxicity of Cardio-Pulmonary Morphology of Adult Albino Wistar Rats.

Human exposure to lead and its compounds occurs mostly in lead related occupations with various sources like leaded gasoline, industrial processes such as smelting of lead and its combustion, pottery, boat building, lead- based painting, lead containing pipes, battery recycling, grids, arm industry, pigments, printing of books, etc. Though its widespread use has discontinued in many countries of the world, it is still used in many industries like car repair, battery manufacturing and recycling, refining, smelting, etc. Lead is a highly poisonous metal affecting almost every organ in the body. Of all the organs, the nervous system is the mostly affected target in lead toxicity, both in children and adults. The toxicity in children is however of a greater impact than in adults. This is because their tissues, internal as well as external, are softer than in adults. Long-term exposure of adults can result in decreased performance in some tests of cognitive performance that measure functions of the nervous Cardio-pulmonary system. Cardio-pulmonary effects of alcoholic leaf extract of Chromolaena odorata, a plant commonly used for traditional medications, was evaluated using male Wistar albino rats. Acute and sub chronic toxicity was evaluated after 14 days of exposure. The LD50 was 2154mg/kg. Alcoholic leaf extract of Chromolaena odorata used in traditional and were not treated with any of the extracts. Group B were administered Lead intraperitoneally. Groups C were fed and administered intraperitoneally with Lead and treated with 800mg/Kg body weight of alcoholic extract respectively. Group D were also fed with food, water, dose of Lead and alcoholic Extract of C. Odorata with 400mg/kg body weight and Group E were given food, water and a high dose of the alcoholic Extract which was 800mg/kg body weight respectively. Both doses of extracts were administered daily to the rats using oro-gastric tube in line with body weights. The duration of this study was (21) twenty-one days after which the rats were sacrificed under sedation with chloroform. Organs were collected, fixed in 10% formal saline, processed, sectioned and stained using Haematoxylin and Eosin staining procedure at the Histopathology laboratory of Niger Delta Teaching Hospital (NDUTH), microscopically examined at X10 and X40 magnifications for histopathological diagnosis. Results showed degenerative changes in the heart and lungs of some of the experimental adult albino wistar rats.

An audit of requisition forms received at a histopathological laboratory: how compliant are submitting clinicians?

An audit of requisition forms received at a histopathological laboratory: how compliant are submitting clinicians?

A new reliable method for tissue preservation

Studying and developing preanalytical tools and technologies for preserving high-quality tissues for histological assays is a constantly growing field because preserving biological samples always poses a challenge. Formalin fixation and paraffin embedding (FFPE) remains a key component of long-term tissue preservation in the histopathology and pathology laboratory, despite its known carcinogenic effect and poor preservation of nucleic acids. Over the years, some other methods have been described to preserve biological tissues such as plastination. However, the current techniques do not consent further dissection or histopathologically based studies. The present study describes the applicability of a new method for tissues preservation after surgery or endoscopic removal, to preserve specimens for subsequent histopathological examination and tissue banking as well as for immunohistochemistry, preserving the nucleic acids and protein integrity. This method, protected by patent (EP 18185364.9A) is able to restore tissues to the state prior to drying, thereby allowing them to be further processed for histologic, cytological, immunologic, and/or genetic analyses. This new technique offers an alternative to classic tissue preservation, featuring an innovative and cost-effective process, available locally, to obtain fully preserved samples for longer periods without toxic procedures. In conclusion this new method can be successfully applied in any pathological institute, responding to the increasing demands for reliable tissue preservation in the expanding field of histological, molecular diagnostic and forensic medicine

Isolated pathologies of Tensor Fasciae Latae: Retrospective cohort analysis from a tertiary referral centre

IntroductionTensor Fasciae Latae (TFL) and the iliotibial band (ITB) act as a single functional unit in maintaining pelvic stability whilst standing, walking, or running in human beings. The Tensor Fasciae Latae (TFL) muscle acts across the hip and the knee joint. Consequently, though its pathologies traditionally present with lateral hip pain, identifying the precise clinical diagnosis can be a challenge. Patients and methodsA retrospective search for the keyword ‘Tensor Fasciae Latae’/iliotibial band (ITB) was performed of our Radiology Information System (RIS) and Picture Archiving and Communication System (PACS), Computerised Radiology Information System (CRIS) at our tertiary orthopaedic referral centre of a for orthopaedic oncology over a period of 13 years (2007–2020). Data was collected from RIS, oncology database and local histopathology laboratory records. Patient demographics, clinical characteristics, complementary imaging and clinical management outcome were documented. ResultsWe identified 35 patients with a mean age of 66 years (range 19–94 years). There were 18 female and 17 male patients. Lateral hip lump and pain were the most frequent clinical finding/presentation features. A variety of pathologies such as benign and malignant tumours, including vascular and tumour mimic lesions involving the TFL muscle were identified. Atrophy and pseudohypertrophy of TFL was the commonest pathology found; accounting for two thirds of the cases. ConclusionTensor Fasciae Latae (TFL) can be afflicted with a broad spectrum of pathologies. Radiological imaging especially cross-sectional imaging modality is crucial in guiding appropriate patient management of TFL conditions. Our analysis suggests isolated TFL lesion are more likely to be benign conditions, presenting commonly as hip pain and swelling.

Assessment of knowledge, attitude, and practice of tissue preservation among dentists practicing at Navi Mumbai and Mumbai

Background: In histopathology laboratory various steps are carried to obtain a histopathological, cytological, or molecular diagnosis. Two major go hand in hand in laboratories, one is research activities conducted in laboratories which has an enormous importance second is diagnostic procedures. Any diagnosis given by pathologist majorly depends upon the visual interpretation. Hence these procedures are supposed to be followed dutifully. Fixation and prefixation is one of the steps which helps to sustain the tissue vitality and if performed well fixation preserves pathological and molecular tissue archives. Material and methods: A self-designed questionnaire were administered to 202 dentists practicing in Navi Mumbai and Navi Mumbai, consisting of 21 questions stating about their demographic data, professional aspects and knowledge, attitude and practice about preservation of tissue samples. Statistical analysis: Descriptive statistics like frequencies and percentage for categorical data, Mean & SD for numerical data has been depicted. Comparison of frequencies of categories of variables with groups was done using chi square test.

Immunohistochemical Analysis of Expression of Cyclin D1 in Different Grades of Oral Squamous Cell Carcinoma

Aims: The present study aimed to evaluate the expression of cyclin D1 in oral squamous cell carcinoma and to find association of expression of cyclin D1 with different histological grades of oral squamous cell carcinoma.
 Study Design: It is a cross sectional study.
 Place and Duration of Study: Oral squamous cell carcinoma samples were collected histopathology laboratory of Ziauddin Hospital, North Nazimabad Karachi. Immunohistochemistry was performed in multiple disciplinary research laboratory of Ziauddin University, Karachi. The duration of study was from January 2021 to January 2022.
 Methodology: The present study included taking biopsy samples from oral squamous cell carcinoma patients. Patients with history of other oral cavity tumors, patients with history of any other treatment of oral cancer were excluded from the study. Immunohistochemistry was performed on a total of 150 samples using anti cyclin D1 antibodies.
 Results: A total of 150 samples were part of study. Expression of cyclin D1 was found to be present in 77.3% of cases where as 22.7% of cases did not show expression of cyclin D1. A statistically significant association was shown between different grades of oral squamous cell carcinoma and intensity scoring (p value 0.004). Association between labelling index score for cyclin D1 and different grades of oral squamous cell carcinoma showed statistically significant p value (0.003). Association of total scores of cyclin D1 with different grades of oral squamous cell carcinoma was also found to be statistically significant (p value 0.003).
 Conclusion: The present study shows that oncogenic effects on cyclin D1 by mutations caused by oral squamous cell carcinoma can be detected by immunohistochemistry in the form of its overexpression. The association between overexpression of cyclin D1 and different histological grades can be utilize in predicting the oncogenic behavior of oral squamous cell carcinoma.

Evaluation of Immunohistochemical Expression of Topoisomerase II Alpha Protein in Patients with Breast Cancer and Its Correlation with Different Prognostic Factors

Background: There are indications to support the knowledge about the prognosis of breast cancer. One of these markers is regarded as a prognostic factor and related to the proliferation rate. Topoisomerase IIα (TOP2A), encoded by the TOP2A gene, is a molecular target for anthracycline therapy. Aims: The aim of this article is to establish any association of the status of topoisomerase IIa immunohistochemistry with different prognostic clinicopathological and molecular parameters in breast cancer. Settings and Design: A cross-sectional retrospective study was carried out in the Department of Pathology and Forensic Medicine, Faculty of Medicine, Babylon University, during the period from January 2020 through December 2020. Materials and Methods: Fifty cases with invasive breast carcinoma have been obtained from surgical modified radical mastectomy specimens from the Laboratory of Histopathology in Al-Kafeel Specialized Hospital, Karbala for the last 3 years (2017–2019). Different clinicopathological variables were estimated. The expression of TOP2A was stained by using the PathnSitu PolyExcel Detection System of Immunostaining. Statistical Analysis Used: Immunostaining with TOP2A expression used a cut-off value of 10%. The results were considered statistically significant if the P-value was ≤ 0.05. Results: Fifty cases of TOP2A overexpression were classified as follows: 28 cases (56%) had 3+ expression, 4 cases (8%) with 2+ expression, and 4 cases (8%) with 1+ expression, whereas 14 cases had no expression of TOP2A (28%). TOP2A overexpression was shown to be associated with a higher grade (P = 0.023) and molecular subtypes (P = 0.057), but not with other clinicopathological parameters (age of patients, type of histology, number of lymph nodes involved, tumor size). Conclusion: According to these results, TOP2A plays a major role in the aggressive nature of tumors. This may support the suggestion to be used as a prognosis marker.

IMMUNOHISTOCHEMICAL EXPRESSION LEVELS OF CYCLIN E1 IN THREE HISTOLOGICAL GRADES OF ORAL SQUAMOUS CELL CARCINOMA

Objective: The objective of this study is to assess and compare the immunohistochemical expression levels of Cyclin E1 in three histological grades of oral squamous cell carcinoma. Material and Methods: A descriptive cross-sectional study was designed. Sample size was 90 and categorised into three groups as i.e., well, moderate and poorly differentiated oral squamous cell carcinoma (OSCC) with 30 cases in each group. Specimens were collected from Histopathology Laboratories at Pakistan Institute of Medical Sciences (PIMS) and Foundation University Dental College and Hospital (FUDC&H) Islamabad, to evaluate the expression levels of Cyclin E1 (CCNE1) with the help of immunohistochemical (IHC) staining. Statistical analysis was performed using the statistical analysis software, SPSS version 25. Results: In OSCC cases, average age of patients was 61.1±10.2 years. Over all age range of patients was 40-79 years (min – max) which was statistically significant (p=0.02). Male to female ratio was 1.1:1 (p=0.003). The most common site of development of OSCC was Buccal mucosa (p= < 0.001). According to immunoreactive scoring system (IRS) value of CCNE1 expression levels was low in 42.2% of cases and high in 57.7% of cases. The high final score of 6 and 9 was found in 80% cases of poorly differentiated OSCC cases and the results were found statistically significant (p<0.001) Conclusion: It is concluded that increased expression levels of Cyclin E1 significantly correlated with lack of differentiation in OSCC. Key Words: Cyclin E1, Immunohistochemistry, Oral squamous cell carcinoma.

Implementation of an interactive virtual microscope laboratory system in teaching oral histopathology

Laboratory course acts as a key component of histopathology education. Recent trends of incorporating visual and interactive technology in active and inquiry-based learning pedagogical methods have led to significant improvement of histopathology laboratory courses. The present work aimed to describe interactive virtual microscope laboratory system (IVMLS) as a virtual platform for teaching histopathology in order to improve the quality and efficiency of teaching. The system is based on interactive technology and consists of interactive software, slide-reading software, teaching resources and integrated auxiliary equipment. It allows real-time interaction between teachers and students and provides students with a wealth of learning and review materials. In order to evaluate the effectiveness of the system, we conducted a comparative study with the use of light microscope (LM) as a method. Specifically, we compared the results of six assignments and one laboratory final exam between IVMLS group and LM group to analyse the impact of IVMLS on students' academic performance. A questionnaire survey was also conducted to obtain students' attitudes and views on this system. There was no overall difference in assignment performance between IVMLS group and LM group. But laboratory final test grades increased from a mean of 62% (43.8–80.0, 95% CI) before to 83% (71.0–94.2, 95% CI) after implement IVMLS, suggesting highly significant (p < 0.001) improvement on students' histopathology laboratory performance. Feedback of the questionnaire was positive, indicating that students were satisfied with the system, which they believed improved student communication and teacher-student interaction, increased learning resources, increased their focus on learning, and facilitated their independent thinking process. This study proves that IVMLS is an efficient and feasible teaching technology and improves students' academic performance.

Comparison of Diagnostic Accuracy of Appendicitis Inflammatory Response Score and Alvarado Score in Diagnosis of Acute Appendicitis Taking Histopathology as Gold Standard

Objective: To compare the diagnostic accuracy of appendicitis inflammatory response score and Alvarado score in diagnosis of acute appendicitis taking histopathology as gold standard. Study Design: It is a Cross Sectional Study Study setting and Duration: This study conducted at the Department of General Surgery, Abbasi Shaheed Hospital, Karachi from September 2018 To March 2019. Methods: Alvarado and Appendicitis inflammatory response scores were used to evaluate all patients. For the Alvarado scoring system, a score of 7 or more was considered a high chance of acute appendicitis, while the AIR scoring system required a score of 9 or higher. The findings of the histopathology lab were compared to the test results. Both tests' results were analysed to determine their sensitivity, specificity, and diagnostic accuracy. Results: For Alvarado score Sensitivity (80.1%), Specificity (92.3%) and accuracy was 81.7%. For AIR score Sensitivity (72.6%), Specificity (94.2%), and accuracy was 75.5%. There were 66.9% male and 33.1% female patients. Right iliac fossa pain was 76.8%, pain migration to right iliac fossa was 63.5%, anorexia was 90.9%. Conclusion: Higher sensitivity and specificity of the Appendicitis inflammatory response score and the Alvarado score were found to outperform the histological findings in appendicitis. Keywords: Appendicitis, Appendicitis Inflammatory Response Score, Diagnostic Accuracy, Acute Appendicitis, Histopathology, Alvarado Score,

Auditing Histopathology Processes to Augment Reporting Quality: An Objective Analysis in a Tertiary Care Neuropathology Laboratory

Background: Laboratory audits are an integral component of the continuous quality improvement process and one of the key elements of quality control in the laboratories. These audits are primarily concerned with the everyday aspects of laboratory services and are a means of providing feedback to the users of the laboratory and its staff. These audits measure the performance of laboratory services against established standards that are evidence based and established by the audit team itself. This original study was initiated with an objective to audit all those histopathology processes that are involved in the generation of a quality histopathology report. The purpose was to detect the gaps which in turn maybe used to reduce and avoid errors in the processes, thus improvising the quality assurance practices of the histopathology laboratory.&#x0D; Materials and Methods: In this retrospective cross- sectional study, total twenty standards were audited, including the clinical details, the pre-analytical, analytical and post-analytical laboratory processes.&#x0D; Results: Overall, out of the 20 standards audited it was found that in the first audit, full compliance was observed in 10 standards, whereas the re-audit showed full compliance in 11 standards. Undoubtedly the compliance showed an improving trend in the re-audit.&#x0D; Conclusion: such laboratory-based audits not only form an integral component of the quality assurance programs but definitely add on to the quality of patient care, as the reports generated by the histopathology laboratories do help the treating team in deciding or modifying the treatment plan in central nervous system and spinal tumours.

Clinicians’ compliance with requirements on surgical pathology laboratory request forms

Background: Early and accurate diagnosis has a major impact on outcome of diseases. Prompt delivery by the laboratory on requests sent by clinicians is fundamental to this. For useful laboratory outcomes, clinicians should provide comprehensive information, as required in laboratory request forms. The aim of this study was to analyze how well clinicians complete laboratory request forms. Methods: This is a retrospective descriptive study from January 1 to December 31, 2017. Laboratory request forms submitted with laboratory requests were retrieved and reviewed for completeness of required information. Results: An error prevalence of 12.2% was observed from the analyzed requests, and the average number of errors per request was 1.7. Surgical specialties contributed by far the most errors (t=-7.571; p=0.0000), and biodata information was the group that was mostly omitted from laboratory forms. Conclusion: This study revealed that clinicians submit requests with various irregularities, including suboptimal information, to the histopathology laboratory of our hospital. Regular interaction between clinicians and pathologists is needed in order to enlighten clinicians on the importance of providing necessary information regarding their requests to the laboratory.

Endometriosis in an indigenous African women population.

Endometriosis is the existence of endometrial tissue outside the endometrial cavity. It has high prevalence in women living in developed countries but is believed to be rare among indigenous African women. This study aimed to determine the prevalence and characteristics of endometriosis in an indigenous African women population. Gynaecological specimens received and diagnosed as endometriosis in a teaching hospital's Histopathology laboratory over a 5-year period was retrospectively reviewed. Data obtained were analysed by simple statistical methods. There were 25 diagnosed cases of endometriosis representing 0.9% of gynaecological specimens received in the period. Patients' average age is 38.4±8.4 years; peak age was 31- 40 years (n=10; 40%). Myometrium is the most common site (n=16; 64%), other sites include umbilicus and round ligament etc. Pelvic pain, 36% and irregular uterine bleeding, 28% are most common symptoms. There was primary and secondary infertility in 20% and 16% of cases respectively. The umbilical and suprapubic masses had symptoms that synchronised with the patient's menstrual cycle. Endometriosis has low prevalence in our population. Women presenting with chronic pelvic pain, infertility and menstrual disorders should be evaluated for endometriosis. Population-based study is required to further characterize the condition in our population.

Laboratory Atmospheric Levels of Formaldehyde in Selected Laboratories used by Medical Students in a Tertiary Institution in Edo State, Nigeria

This study was conducted to measure the laboratory atmospheric levels of formaldehyde in selected laboratories used by medical students in a tertiary institution in Edo state, Nigeria during the course of their medical training using a formaldehyde gas meter (EXTECH FM 200) ensuring that the laboratories served as the test groups while the lecture theatre served as the control. Data obtained from this study shows that medical students are exposed to various levels of formaldehyde in the different laboratories (Anatomy laboratory 1.71±0.11ppm; Histopathology laboratory 1.96±0.02ppm; Medical Biochemistry laboratory 0.07±0.003ppm and Physiology laboratory 0.05±0.002ppm) and these values are above the recommended limit prescribed by standard organizations. Hence, it was therefore concluded that measures should be taken to ensure reduction of formaldehyde air levels in the Anatomy and Histopathology laboratories in order to protect the medical students from the harmful effect of formaldehyde.

A promising deep learning-assistive algorithm for histopathological screening of colorectal cancer

Colorectal cancer is one of the most common cancers worldwide, accounting for an annual estimated 1.8 million incident cases. With the increasing number of colonoscopies being performed, colorectal biopsies make up a large proportion of any histopathology laboratory workload. We trained and validated a unique artificial intelligence (AI) deep learning model as an assistive tool to screen for colonic malignancies in colorectal specimens, in order to improve cancer detection and classification; enabling busy pathologists to focus on higher order decision-making tasks. The study cohort consists of Whole Slide Images (WSI) obtained from 294 colorectal specimens. Qritive’s unique composite algorithm comprises both a deep learning model based on a Faster Region Based Convolutional Neural Network (Faster-RCNN) architecture for instance segmentation with a ResNet-101 feature extraction backbone that provides glandular segmentation, and a classical machine learning classifier. The initial training used pathologists’ annotations on a cohort of 66,191 image tiles extracted from 39 WSIs. A subsequent application of a classical machine learning-based slide classifier sorted the WSIs into ‘low risk’ (benign, inflammation) and ‘high risk’ (dysplasia, malignancy) categories. We further trained the composite AI-model’s performance on a larger cohort of 105 resections WSIs and then validated our findings on a cohort of 150 biopsies WSIs against the classifications of two independently blinded pathologists. We evaluated the area under the receiver-operator characteristic curve (AUC) and other performance metrics. The AI model achieved an AUC of 0.917 in the validation cohort, with excellent sensitivity (97.4%) in detection of high risk features of dysplasia and malignancy. We demonstrate an unique composite AI-model incorporating both a glandular segmentation deep learning model and a classical machine learning classifier, with excellent sensitivity in picking up high risk colorectal features. As such, AI plays a role as a potential screening tool in assisting busy pathologists by outlining the dysplastic and malignant glands.

Restraining SARS-CoV-2 in histopathology laboratory amid COVID-19 pandemic.

Medical laboratory personnel encounter diverse health and workplace-related hazards leading to severe health challenges including the ravaging SARS-CoV-2 infection, which is the causal agent of COVID-19. It was first announced in Wuhan, China in December 2019 but started to spread globally by late January 2020. COVID-19 pandemic and subsequent global spreading poses additional danger to healthcare personnel particularly the laboratorians. Other health practitioners may engage patients by observing social / physical distancing, but how laboratory staff observe or apply same rule to infectious samples remain a notable question. Activities of laboratorians result in repeated exposure at close interactions to patient's samples including SARS-CoV-2 infected specimens, which make them susceptible to COVID-19. Therefore, it is imperative to review mitigating measures in restraining possible exposure and spreading of SARS-CoV-2 in the best interest of laboratory staff and pathologists. It is against this backdrop that this paper intends to update readers on measures to restrain SARS-CoV-2 invasion in histopathology laboratory and deduce precautionary measures for observation by healthcare providers in COVID-19 era. Also discussed, is health hazards associated with histopathology laboratory with the objective of encouraging safety consciousness and safe laboratory practices in the face of COVID-19 pandemic.

Beetroot and Turmeric as Alternative Dyes for Haematoxylin and Eosin in Histological Staining

Dyes are referred to as stains which are used to add color to tissues and microbes to make them optical distinct. The dyes are both synthetic and natural, the synthetic ones may be harmful, hazardous to health and are costly to obtain. Natural dyes are eco-friendly, not costly and not hazardous to health as compared to synthetic dyes. In this study, various procedures such as H and E which serves as control as normal routine staining in histopathology laboratory was used to compare Beetroot and Eosin (B and E), Haematoxylin and Turmeric (H and T). Beetroot and Turmeric (B T) Beetroot and Eosin stains collagen fibre almost similar to H and E, that shows beetroot can be used as alternative for Haematoxylin in H and E staining technique. Haematoxylin and Turmeric stained the tissue almost similar to H and E which shows that Turmeric can replace Eosin. However, B and T poorly stained collagen fibre when compared with H and E. The conclusion came out that, Beetroot containing Betanin which gives it a red color has the same ability of staining Nuclei Bluish purple because of its basic content and may require a mordant (Vineger) as attain enhancer for most of the tissues. Turmeric exhibits the basophilic-like effect on collage fibre, it stains the cytoplasm fairly yellowish, because of its curcumin that makes it yellow. Beetroot and Turmeric as a direct replacement of H and E staining technique in Histopathology laboratory should further be studied with adequate concentration and mordant as the features is suggestive that B and T can replace H and E.

Comparing the use of Xylene and Cedarwood oil and its Efficacy in Hematoxylin and Eosin Staining. An Investigational Study

Background: The use of xylene as a cleaning agent is required for hematoxylin and eosin staining. On the other hand, there is cause for concern when it comes to the dangers of xylene exposure. Xylene has been replaced with a variety of solutions, including essential oils, during tissue processing. The objective of this research was to see whether Cedarwood oil, an essential oil, could be utilised as a substitute for Xylene in Hematoxylin and Eosin staining. Materials and Methods: The study was carried out in the Histopathology and Microbiology Department. The department's archives yielded thirty blocks of paraffin from the regular biopsy material. For my diffuser combination, I purchased cedar wood oil from an organic and natural goods store in my neighbourhood. The 30 tissue samples that were processed, each of the 30 tissue samples that was processed was washed with an essential oil (utilised 8 percent cedarwood oil) or xylene before being sliced into four-micron-thick slices and stained with E and H stain. They were rated based on the uniformity, clarity, and transparency of the stained sections. Results: The three staining quality indicators tested showed a strong link between cedarwood oil and xylene. Conclusions: It is our opinion that cedarwood oil may be used as a xylene substitute in the histopathology laboratory. Keywords: H and E stain, xylene, histo-techniques,

A rare diagnostic case of angioimmunoblastic T-cell lymphoma

Angioimmunoblastic T-cell lymphoma is a malignancy of mature T-cells. A 45 years old Sudanese female with generalized lymphadenomegalyreferred from Tayba hospital to Al-tayseer reference medical cent in histopathology and cytology laboratory department (Sudan) for her lymph node histopathology analysis. A surgical lymph node biopsy for histopathology analysis stained by H&amp;E was performed and sections showed effacement of normal architecture of lymph node with disappearance of follicles and germinal center composed of polymorphic infiltrate of small tumour cells and large tumour cells. The small tumour cells showed irregular nuclei and clear cytoplasm. In this case report, we state that the delay of diagnosis was mainly a consequence of an insufficient clinical history, which led to an incomplete histological analysis, delay of reporting and need for second opinions for interpretation. We also strongly recommend that to obtain an accurate and precise diagnosis for AITL, PAS stain should be performed firstly to recognize the capillary invasion which facilitate the early diagnosis.

Evaluation of forkhead-box C1 expression in breast cancer

Background Forkhead box C1 (FOXC1) is considered an important member of forkhead-box transcription factors. Previous studies have shown that FOXC1 is associated with tumor progression and represents a poor prognostic indicator in triple-negative basal-like breast cancer. Method This is a retrospective study conducted on 187 cases of invasive breast carcinoma obtained from Histopathology Laboratory in Oncology Center, Faculty of Medicine, Mansoura University, starting from 2012. Aim and objectives In this study, we aimed to study FOXC1 protein expression in molecular subtypes of breast cancer and to correlate its expression with other prognostic parameters using immunohistochemistry and tissue microarrays. Results FOXC1-positive expression was seen in 26.7% of cases. Positive FOXC1 expression was most common in triple-negative basal-like breast cancer and HER2-enriched subtypes. Positive FOXC1 expression was higher in ER-negative cases than ER-positive cases (39 vs. 21%) with statistical significance (P = 0.01). Similarly, positive FOXC1 was higher in PR-negative cases than PR-positive cases (37.5 vs. 20%), this was statistically significant (P = 0.009). In our series, FOXC1 expression was not associated with survival. Conclusion FOXC1 expression is associated with negative hormonal-receptor status in breast cancer. FOCX1 is not a prognostic indicator of disease-free survival in our patient series.