Trucut Biopsy Specimens Research Articles

Histopathological features of prostatic carcinoma in a Southwest tertiary institution in Nigeria

Background: The diagnosis of prostatic adenocarcinoma is often straightforward, in some cases there may be benign lesions that mimic prostatic cancer histologically. This study aimed to describe the morphological features of prostatic carcinoma from laboratory specimens. Methods: This was a retrospective study using histologically diagnosed cases of prostatic carcinoma from prostatectomy and trucut biopsy specimens. The histological sub-typing of the tumors according to WHO classification scheme of 2003 was done. The tumors were graded and scored using Gleason’s scoring scheme revised and modified at the consensus conference of the international society of urological pathology (ISUP), in 2005. Results: Prostate cancer constituted 18.7% of all malignant tumors and 4.4% of all neoplastic diseases. The majority of cases were small acinar adenocarcinoma 275 (73.7%). Others include pseudo-hyperplastic variant 47 (12.6%), atrophic variant 35 (9.3%), foamy gland carcinoma 16 (4.2%) and signet ring/colloid carcinoma 1(0.2%). More than half were classified as well-differentiated Gleason prognostic group A tumors. There was a statistically significant association between the age of the patient and the Gleason histologic grade and the histologic grade and histologic variant p<0.05. Conclusions: Prostatic carcinoma was thought to be a malignancy associated with elderly men but people of younger age less than fifty years are now diagnosed with the malignancy. Accurate diagnosis with the right grade and scores will go a long way in the management of the malignancy.

Role of SOX10 Immunohistochemical Expression in Diagnosing Triple Negative Breast Cancer and Its Correlation With Clinicopathological Features.

Triple-negative breast cancer (TNBC) poses a diagnostic challenge for histopathologists due to the reduced frequency of breast-specific markers. SOX10 has emerged as a useful diagnostic marker for TNBC. The aim of our study was to determine the frequency of SOX-10 immunohistochemical (IHC) expression in our cohort and assess its correlation with clinicopathological and histological features. We included 72 primary TNBC cases. Specimens includedtru-cut biopsies and excision specimens. We stained whole slide sections of these specimens with SOX10 antibody and calculated its frequency (%) of expression and H-score. We applied the chi-square test to assess the correlation between SOX10 expression and clinicopathological and histological features such as the patient's age, specimen type, tumor size, histological type, histological grade, nuclear pleomorphism, mitotic count, tumor-infiltrating lymphocytes (TILs), necrosis, calcification, lymphovascular invasion (LVI), lymph node involvement, T stage, and N stage. SOX10 expression was observed in 42 (58.3%) cases with a median H-score of 57.5. The expression was significantly higher in tru-cut biopsy specimens as compared to excision specimens (73.5 vs 41.7%) and TILsnegative tumors as compared to TILs positive tumors (64.3% vs 27.3). Metaplastic carcinoma showed reduced expression when compared with non-metaplastic tumors (35.7% vs 63.8%), but statistical significance was not achieved. No correlation was observed with the patient's age, tumor size, histological type, histological grade, nuclear pleomorphism, mitotic count, necrosis, calcification, LVI, lymph node involvement, T stage, and N stage. SOX10 was expressed in more than half of the TNBC cases of our study which not only highlights its diagnostic utility but advocated its application in combination with other breast-specific markers. The expression didn't correlate with the majority of clinicopathological and histological features, but correlation with tru-cut biopsy specimens and absence of TILs draws attention towards possible roles of proper fixation and host immunity, respectively.

Identification of novel phosphoproteomic biomarkers in patients with advanced hepatocellular carcinoma (HCC).

e15155 Background: HCC is one of the leading causes of cancer deaths worldwide. Despite increasing systemic therapy options for patients with advanced HCC, there are currently no predictive biomarkers to guide therapy selection. Phosphoproteomics has been successfully used to identify accurate predictive biomarkers in other cancers from frozen clinical samples (Dokal et al., 2021 ASCO Annual Meeting). In this study, we test the feasibility of biomarker discovery using phospho- and whole-proteomics analyses on formalin fixed and paraffin embedded (FFPE) tru-cut liver biopsies from patients with HCC. Methods: FFPE tru-cut biopsies (n = 29) were obtained from separate cohorts of 15 HCC patients [tumor (T)] and 14 patients with chronic liver disease with varying levels of cirrhosis, fibrosis or steatosis but without cancer [non-tumor (NT)]. T samples were from advanced HCC patients with varied aetiology (chronic viral hepatitis, alcohol or NAFLD). Proteins were extracted from 10 x 10µm sections; crosslinks reversed before digestion to peptides; and multiple clean-up/enrichment steps before analysis. Peptides were quantified by mass spectrometry and performance assessed using multi-variate and enrichment analyses. Results: Overall, 4978 phosphopeptides and 3721 proteins were quantified across all samples. Multi-variate analyses based on the relative expression of phosphopeptides or proteins showed a clear separation between T and NT samples, as well as phenotype-distinct separation (i.e according to differentiation) within the T group. Subsequent testing also verified that the method could reproducibly measure these HCC-differentiating phosphorylation sites (and proteins). Proteins associated with HCC were regulated as expected in T vs NT, e.g. ASS1 (log2-fold change (FC) = -1.75, p < 0.001), BDH2 (log2-FC = -1.97, p < 0.001). Known drug targets were found to be significantly upregulated in poorly-differentiated HCC, e.g. PARP1 (log2-FC = 1.7, p < 0.001) and AKT1 (log2-FC = 1.5, p < 0.001), as well as previously described phosphorylation sites, e.g. p-CDK1 T14 (log2-FC = 5.95, p = 0.007) and p-MCM2 S139 (log2-FC = 2.98, p = 0.046). Kinase substrate enrichment analysis (Casado et al., Science Signaling 2013) showed increased activity for several kinases in T vs NT, including A-RAF (z-score = 3.2, p < 0.001), MAPK3 (z-score = 2.1, p = 0.022) and TNK2 (z-score = 2.1, p = 0.003). Conclusions: We successfully adapted (phospho-)proteomics to FFPE tru-cut biopsy specimens, enabling reproducible identification of novel and known (phospho-)proteins that distinguished differentiation status. A prospective study utilising this phosphoproteomic analysis pipeline is now underway, recruiting patients with advanced HCC receiving first line standard of care therapy with immune checkpoint inhibitor combinations or tyrosine kinase inhibitors to identify potential predictive biomarkers of response.

CHEMOTHERAPY INDUCED HISTOPATHOLOGICAL CHANGES IN MASTECTOMY SPECIMENS - STUDY AT A TERTIARY CARE CENTRE

Background: Pathological complete response (pCR) to Neo adjuvant chemotherapy (NACT) is a signicant prognostic marker in breast cancer, so accurate diagnosis and grading of pathological chemo response of tumour is needed for an effective planning of treatment regimen. To study the various histopathological Aims: changes in Mastectomy specimens following NACT and to evaluate the pathological response of tumour to NACT, also to compare the expression of ER, PR, and HER2 in biopsies and post NACT mastectomy specimens by Immunohistochemistry (IHC). Methods And Materials: 50 breast carcinoma cases, who was diagnosed on trucut biopsies and treated with preoperative NACT followed by mastectomy was included. In post NACT mastectomy specimens, the chemoresponse was classied according to Union for International Cancer Control (UICC) guidelines. ER, PR, and HER2/ neu receptor expression was compared between trucut biopsy specimens (pre- NACT) and resection specimens (post- NACT). Results were analysed by Chi square test and McNemar chi square test. Among 50 cases, patients presented with lump, Results: involved more on the right and in upper outer quadrant. Most common stage at presentation is stage III A. Histologically all belong to IDCC -NST histological subtype. Signicant reduction in mean tumour size by 52.7% after NACT was observed. pCR, pPR and pNR was observed in 20 %, 58 % and 22 %of the cases respectively. Most common histological change seen in post NACT is necrosis, desmoplasia, brosis, lymphocytic inammatory response. Discordance in ER expression (17.5 %), PR expression (20%) and HER2 /neu (12.5 %) before and after NACT. But these were statistically insignicant. CONCLUSIONS: Pathological evaluation of chemo response of tumour is the gold standard. The discordance rate of ER, PR and HER-2/neu expression following NACT was statistically insignicant, larger studies needed to analyse their impact in patient management.

A clinico histomorphologic study of spectrum of benign breast diseases

Context: Breast an organ which is constantly under the influence of sex hormones, is one of the frequent site of neoplasm in the human body. Benign breast diseases comprise a heterogeneous group of lesions that present with varying symptoms or detected incidentally.Aims: To evaluate histopathological features of benign breast diseases and proliferative lesions having potential to progress to malignancy.Materials & Methods: All lumpectomy and trucut biopsy specimens referred to the Central Diagnostic Laboratory of the Pathology Department at a tertiary care hospital for histopathological evaluation were enrolled in the study. This was a four year study which included two year retrospective and two year prospective study. H & E sections were studied, special stains and IHC was made use of wherever required.Results: A total of 100 cases were studied. The most common lesion was fibroadenoma (29%) followed by benign followed by benign proliferative breast disease (11%), Gynaecomastia (10%) and fibrocystic change (7%). The proliferative lesions were more common in age group of 40-50 years. In patients with Black Chabon Score of 3, 4 (18.75%) were at increased risk for malignancy.Conclusion: Breast tissue forms one of the major specimens received for histopathological examination. It is thus recommended that all women above the age group of 40 years presenting with a palpable breast lump or a suspicious non-palpable abnormality on screening mammogram to have their lump excised even though the lump is suspected to be benign.

Utility of tru-cut biopsy in diagnosis of palpable pediatric soft tissue neoplasms.

Soft tissue neoplasms are infrequent in children with sarcomas accounting for approximately 7% of all pediatric malignancies. Morphologic diagnosis is challenging due to overlapping features. Subtyping and categorization of these lesions are difficult on fine-needle aspiration cytology (FNAC) alone owing to tumor heterogeneity and limited material in some cases. Tru-cut biopsies obtain adequate tumor tissue for ancillary studies besides conventional histology. The study aims to explore the role of tru-cut biopsy to arrive at a definitive diagnosis. The study also highlights the correlation between FNAC and histopathology on tru-cut biopsy besides explaining the significance of a panel of immunohistochemistry (IHC) markers for histological categorization and subtyping. A total of 61 children from infancy to 18 years were included in the study. Closed biopsy procedures like FNAC and tru-cut biopsy were performed, and the tru-cut biopsy specimen was subjected to a panel of immunohistochemical markers. Fisher's exact test for sensitivity and specificity towards detection of malignancy was 83% and 86%, respectively for FNAC. For tru-cut biopsy, sensitivity was 94% and specificity was 91%. The two-sided P value (<0.0001) was extremely significant. Cohen's Kappa coefficient value for tru-cut biopsy was 0.772 suggesting a substantial strength of agreement. Tru-cut with IHC had a Kappa value of 0.866 suggesting greater agreement with histopathology. Tru-cut biopsy is a simple, safe, and reliable adjunct to the FNAC. Instead, immunohistochemistry enhances the diagnostic accuracy.

EGFR analysis on scrapings from cytology smears in lung carcinoma, an effective alternative to testing on trucut biopsies.

Lung carcinomas are a leading cause of cancer morbidity and mortality. Many cases present at an advanced stage of disease where definitive treatment by surgical resection is not feasible. Molecular testing using materials derived from minimally invasive procedures aid in targeted therapy with least iatrogenic burden to the patient. Cases diagnosed as non-small cell lung carcinoma (NSCLC) on cytology were included in the study. Scrapings from the smears with adequate tumor cell load were submitted for molecular testing. The DNA was extracted and quantified. Mutations in exons 18, 19, 20, and 21 of the EGFR gene were detected using Sanger sequencing. DNA quantity and EGFR mutation status on equal number of consecutive trucut biopsy specimens were also analyzed. Seventy cases of NSCLC tested for EGFR mutation had a median DNA concentration of 40.2ng/μl and 31% cases showed mutation. Majority of mutations (14/21, 66.66%) were identified in exon 19. Among 70 trucut biopsy samples, DNA concentration was 41.42 ng/μl and 30% cases showed mutation. No significant difference was seen in DNA quantity and EGFR mutation between cytology smears and trucut biopsies. EGFR testing on cytology smears provides adequate DNA yield with minimal invasiveness and is equally effective as biopsies. Testing on samples like pleural effusion allows for concomitant diagnosis, staging, and molecular testing in one procedure. Tests done on the smears rather than on cell block or trucut biopsies ensures superior quality DNA from the tumor cells as they are unexposed to cross linking formalin fixative.

Clinico-pathological spectrum of breast lesions in females over a period of three years in a tertiary care centre

Aim: The aim of this study is to evaluate the clinic-pathological spectrum of breast biopsies for a period of three years. Materials and Methods: This study includes 529 breast pathology cases received by histopathology laboratories of Department of pathology, Government Medical College, Srinagar between January 2017 to January December 2019. The samples included mastectomies, lumpectomies, core needle biopsy and tru cut biopsy specimens. Results: In the present study, out of 529 cases there were 56 (10.58%) inflammatory lesions, 287 (54.2%) benign lesions and 186 (35.16%) malignant lesions. Fibroadenoma was the most common benign breast lesion. Among the malignant breast lesions, infiltrating duct cell carcinoma was the most common. Conclusion: The pattern of breast lesions observed showed higher prevelance of non-malignant breast lesions over malignant lesions. Awareness and screening of these entities can facilitate early diagnosis and management.

Our sentinel lymph node experience in patients diagnosed with DCIS and microinvasive breast carcinoma

Aim: Along with the increased availability of radiologic imaging methods, early identification of tumor tissue, and patient surveillance programs; ductal carcinoma in situ (DCIS) and microinvasive DCIS became more commonly identified in the tru-cut biopsy specimens and resected samples of patients. Pathological examinations of the excision materials from these patients reveal invasive tumors, microinvasions or DCIS alone. Recently, it has become debatable whether to perform a sentinel lymph node biopsy (SLNB) in patients diagnosed with DCIS or microinvasive DCIS. In this present study, we evaluated the diagnosis made by examining the excision material, any presence of lymph node metastases, and the relationship of hormone profile to the presence of metastases in the patients diagnosed with DCIS or microinvasive DCIS by the examination of tru-cut biopsy specimens. Based on our study results, we discussed the requirement for SLNB in patients with a tru-cut diagnosis of DCIS or microinvasive DCIS.Materials and Methods: The study included 172 patients, who underwent surgical excision and SLNB after receiving a tru-cut biopsy diagnosis of DCIS and microinvasive DCIS in our hospital from the year 2010 to 2018.Results: Tru-cut biopsy diagnoses were DCIS and microinvasive DCIS in 69.8% (120 patients) and 30.2% (52 patients) respectively. SLNB metastases were identified in 35.8% (n=43) of the DCIS positive patients and 44.2% (n=23) in the microinvasive DCIS positive patients. The diagnosis of invasive ductal carcinoma after mastectomy was made at a rate of 90.0% (n=108) among the DCIS positive patients and 92.3% (n=48) among the microinvasive DCIS positive patients. Conclusion: SLNB metastases were found in 35.8% (n=43) and 44.2% (n=23) of the DCIS positive patients and microinvasive DCIS positive patients, respectively. We conclude that SLNB should be favorably proper to perform in the patients with tru-cut diagnoses of DCIS and microinvasive DCIS because a high rate of SLNB metastases was detected in our DCIS and microinvasive DCIS patients and a high rate of invasive ductal carcinoma diagnosis was made after examining the excision material of these patients.

Diagnostic utility of tru-cut biopsy in the assesment of breast lesions

Aim: This report aims to assess the diagnostic utility of Tru-Cut biopsy in the diagnosis of breast mass in patients admitted to our breast unit in our clinic.Material and Methods: Between March 2013 and June 2018, In Ortadogu Private Hospital, Adana, 13.660 participants visited the breast unit and 472 participants of them aged 22-91 years experienced Tru-Cut biopsy(TCB) because of clinical doubt and/ or BI-RADS ( Breast Imaging Reporting and Data System ) III– V categorization. TCB specimens were compared with the histopathological reports of follow-up procedures including surgical procedures. When the pathology document was not compatible with clinical / image uncertainties, a biopsy was performed as a diagnostic method to exclude carcinoma.Results: The histopathological diagnosis of the TCB specimens showed that 237 cases (50.2%) were benign lesions, 219 (46.4%) were malignant lesions and 16 (3.4%) of them were disconcordance. Of the patients who underwent Tru-Cut biopsy, 256 (54.2%) had palpable and 216(45.8%) had nonpalpable lesions. Pathological results were not compatible with clinical / imaging suspicion in 3.4% of cases. TCB exhibited a sensitivity of 95.4%, 100% specificity, PPV of 100%, NPV of 96.1%, and diagnostic accuracy of 97.8%. There were no cases with false positivity.Conclusion: This study shows that Tru-Cut biopsy can safely be applied as a component of triple evaluation of suspected breast lesions. Multidisciplinary teamwork is crucial to implement the Tru-Cut biopsy, which replaces the present surgical approach to treat breast lesion and prevent from diagnostic inaccuracies.Keywords: Tru-Cut Biopsy; Breast Carcinoma; Disconcordance.

Expression of breast cancer type 1 and its relation with expression of estrogen receptors, progesterone receptors, and human epidermal growth factor receptor 2/neu in breast carcinoma on trucut biopsy specimens.

(1) The objective is to study the immunohistochemical expression of Breast cancer type 1 (BRCA1) in breast carcinoma on trucut biopsy specimens and (2) To relate its expression with that of estrogen receptors (ER), progesterone receptors (PR), and human epidermal growth factor receptor 2 (HER-2)/neu and the clinicopathological parameters. A cross-sectional hospital-based study was performed in Lady Hardinge Medical College and Shrimati Sucheta Kriplani Hospital, New Delhi, with collaboration of the Departments of Pathology and Surgery from the period of November 2008 to March 2010. The study group included 54 cytologically proven cases of breast carcinoma. The immunohistochemical expression of BRCA1 was studied and related with expression of ER, PR, and HER-2/neu on their trucut biopsies. The altered expression of BRCA1 (i.e., reduced or absent expression) was seen in 44.4% cases of breast carcinoma while 55.6% had positive expression. About 83% of breast carcinomas with altered BRCA1 expression were larger than 3 cm in size. The breast carcinomas showing altered expression were found to be mostly high grade (63.6%). This was statistically significant. The ER and PR negativity were seen in 62.5% and 79.2% breast carcinomas with altered BRCA1 expression, respectively. The score 3 positivity of HER-2/neu was more common among carcinomas with altered BRCA1 expression (21% vs. 16.7%). The triple negativity was found in 41.7% breast carcinomas having altered BRCA1 expression. This was statistically significant. The combination of immunohistochemical expression of BRCA1, ER, PR, and HER-2/neu and clinicopathological details may be helpful in predicting the individuals more likely to carry BRCA1 mutations and thus selecting the candidate and family members for genetic screening for BRCA1 mutations.

Diagnstic accuracy of Computed Tomography- guided Fine Needle Aspiration Cytology of thoracic mass lesions-A study of 33 cases

Aim: The mediastinum harbors a mixed bag of tumors, which may create significant diagnostic dilemmas. These tumors have widely variable therapeutic and prognostic implications. Correct pre-operative cytological diagnosis and trucut biopsy if indicated, may obviate the need of surgical excision of many of these lesions. A stepwise algorithmic approach such as clinical history, radiological localization, salient cytomorphology and ancillary test helps in correct diagnosis of these tumors. This paper discusses the stepwise diagnostic algorithm for fine needle aspiration cytology diagnosis of mediastinal tumors. Materials and methods: Prospectively thirty-three patients were studied over a year (July 2015 to June 2016) for their age, sex, and topographic distribution, cytological diagnosis and histopathological diagnosis on tru cut biopsy specimen. Thereafterthe diagnosis on the basis of Cytology smears and histological sections were evaluated in all patients. Results: Among 33 patients, 27 were male and 6 were female. Most mediastinal neoplasm was identified in 3 rd to fifth decade of life. Lymphoma and Germ cell tumor are the most common Mediastinal neoplasm. Adequate tissue material was obtained in 32 of 33 cases by CNB. Of these 32 patients, 26(78.79%) cases were diagnosed correctly by FNAC, whereas 7(21.21%) cases were not diagnosed definitely by FNAC. The sensitivity of CNB for mediastinal neoplasm was 87.88%, significantly higher than FNAC (78.79 %) (P<0.05). Mediastinum is the common site and tissue diagnoses of mediastinal mass are very important for correct therapeutic decision.

Immunohistochemical expression of Ets-related gene-transcriptional factor in adenocarcinoma prostate and its correlation with Gleason score.

Prostate carcinoma is the second leading cause of cancer-related deaths in males worldwide. The burden is expected to grow 1.7 million new cases and 499,000 new deaths by 2030. In developing countries such as India, prostate carcinoma will show an increase by 140% in the next few years. Although the diagnosis of prostate carcinoma can usually be made on histological features, now a days many immunohistochemical (IHC) markers are used to distinguish it from benign mimickers as well as in predicting prognosis and treatment. Out of these markers, Ets-related gene (ERG product) is a proto-oncogene which participates in chromosomal translocations and is frequently over expressed in prostate carcinoma which harbors ERG-transmembrane protease, serine 2 fusion. Fifty cases of carcinoma prostate diagnosed in needle biopsies and prostatic chips, in the Department of Pathology of a tertiary care teaching hospital in Punjab, India, were included in the present study. The slides were observed under the light microscope, and Gleason scoring was done using the 2005 International Society of Urological Pathology modified Gleason system. IHC study for ERG expression was done on all the cases, for which anti-ERG monoclonal rabbit clone antibody EP111 (Dako, Denmark) was used. Lymphocytes and endothelial cells were taken as in built positive controls for staining. The intensity of ERG positivity was scored as no staining (0), weak staining (+1), moderate staining (+2) and intense staining (+3). The H score was then calculated by multiplying the intensity of the stain with the percentage (0-100) of the cells showing that staining intensity. The H-score has a range of 0-300. The relationship between IHC expression and clinico-pathological parameters was compared and analyzed using Chi-square test. P < 0.05 was considered statistically significant. Majority of patients included in the study were in the age group of 61-80 (84% of the total). When ERG expression was studied with age-specific rates, it was not found to be statistically significant. The most common pattern noted in the present study was 4 + 3, constituting 36% of total, followed by 3 + 4 constituting 32%. Calculating the score, the majority of patients had a Gleason score of 5-8, constituting 76% of total. Out of the total fifty cases of prostate carcinoma, ERG was positive in 29 cases (58%) and negative in 21 cases (42%). Fourteen out of 21 (48%) of the ERG positive cases had an intensity score of 3. When the ERG intensity was correlated with the Gleason score group, it was seen that patients having Gleason score 7-8 showed ERG positivity in 19 out of 38 cases (50%), with 11/19 (57%) cases showing an ERG intensity score of 3. The Gleason score group 9-10 showed ERG positivity in 83% (10/12) cases, 20% (2/10) cases showing intensity score of 3. This correlation was found to be statistically significant. ERG immunostaining was performed in a small Indian cohort of prostate cancer patients, diagnosed in trucut biopsy specimens and prostatic chips. ERG expression was found in 58% patients. An increase in the ERG expression was observed with an increase in Gleason score. The intensity of ERG expression, however, decreased with an increasing Gleason score.

A novel flexible cryoprobe for EUS-guided pancreatic biopsies

EUS-guided FNA (EUS-FNA) is an established technique for the cytologic diagnosis of pancreatic disease. Attempts to obtain adequate histologic specimens have yielded variable and mostly insufficient results. To evaluate the safety, feasibility, and quality of histologic biopsy specimens obtained by using a new cryobiopsy probe and to compare them with standard EUS-FNA and (laparoscopic) trucut biopsy specimens of pancreatic tissue. Animal non-survival study. Eighty-four pancreatic biopsy specimens (12 per group) were obtained in 4 anesthetized pigs by using one of the following the 18-gauge flexible cryoprobe; a conventional, 19-gauge, EUS-FNA needle; or a rigid, trucut biopsy device (18 gauge). The latter, used in laparoscopic surgery, was considered as the criterion standard for obtaining histology specimens. Specimens were evaluated for artifacts and specimen quality by a blinded pathologist who used a 7-point Likert scale to assess histologic adequacy. Biopsy size and bleeding time after biopsy also were recorded. The new cryoprobe was equivalent to the rigid, trucut needle and superior (P < .001) to the conventional 19-gauge FNA needles with respect to artifacts, quality of the specimen, biopsy specimen size, and bleeding. Animal model. EUS-guided cryobiopsy was associated with better specimen quality for histologic analysis and a shorter bleeding time compared with a conventional 19-gauge FNA needle in the animal model. It is a promising new technique for histologic examination of pancreatic tissue.

Gleason′s grading in Tru-Cut biopsy specimens of prostate carcinoma

Background: Prostate cancer is an important growing health problem presenting a challenge to urologists, radiologists, pathologists, and oncologists. Many men have incidental microscopic foci of prostate cancer at postmortem that did not manifest during life time. However, some cancers are aggressive with a rapidly worsening course. The objective of this study was to diagnose prostate carcinoma in Tru-Cut biopsy specimens, determine Gleason's grading and correlate clinicopathological findings and prostate specific antigen (PSA) level. Materials and Methods: Tru-Cut biopsies were performed on 100 clinically highly suspicious patients of prostate carcinoma. Eight to 10 cores of prostatic tissue were obtained. The samples were formalin-fixed and paraffin-embedded. The prostatic tumors were diagnosed and assigned Gleason scores using hematoxylin and eosin (H and E) stained sections. Results: Microscopic examination revealed adenocarcinoma in 59, benign prostatic hyperplasia (BPH) in 35, and inadequate biopsy in five cases. The age distribution of these 59 cases with adenocarcinoma revealed that 28 were in the 8 th decade, followed by 7 th , 6 th , and 9 th decades, respectively. The mean age was 68.20 years. The Gleason score was 5-7 in 37 patients, 2-4 in 14 cases, and 8-10 in eight cases. The highest PSA level was in Gleason's score of 8-10. Thus, the PSA levels are more in patients with high Gleason grade. Conclusion: Adenocarcinoma is the most common type of prostate carcinoma. The majority of patients had a Gleason score of 5-7, followed by 2-4, and 8-10. The more anaplastic type of cancers were present in the least number of cases.

Evaluation of clinico: Pathologic findings of breast carcinoma in a general hospital in Southern India

Breast cancer is the second most common cancer in the Indian female population. As per our hospital data, breast cancer is also found to be the second leading malignancy in women. Hence, we undertook this study to evaluate the clinical profile, histopathologic types, grade, stage and the prognosis of the disease in our patients. Majority of our patients are from rural areas. This study was undertaken over a period of three years comprising of 178 patients who underwent modified radical mastectomy following preliminary diagnosis of carcinoma on fine needle aspiration cytology or histopathological examination of the lumpectomy or trucut biopsy specimens. Clinico-pathological evaluation was done in all of these cases following standard protocols. The study comprised of 175 female patients and 3 male patients in the age range of 28 to 76 years. Majority (111/62.3%) of the cases were within the age range of 31-50 years of age with mean age of 48.7 years. Two females had bilateral breast cancer and one female had synchronous papillary serous cystadenocarcinoma of the ovary. Invasive ductal carcinoma no special type was the most common histopathologic pattern, and was seen in 172 (95.5%) cases. Most tumors were Scarff Bloom Richardson grade II and American Joint Committee on Cancer pathologic stage II. Prognostically, majority of tumors (49.5%) was assessed as 'good' as per the Nottingham prognostic index score. This study gave an insight to the clinico-pathological profile of breast cancer in our area. Long term study with follow up of the patient is needed for better understanding of the case.

A Novel Flexible Cryoprobe for EUS-Guided Pancreatic Biopsies

Background EUS-guided FNA (EUS-FNA) is an established technique for the cytologic diagnosis of pancreatic disease. Attempts to obtain adequate histologic specimens have yielded variable and mostly insufficient results. Objective To evaluate the safety, feasibility, and quality of histologic biopsy specimens obtained by using a new cryobiopsy probe and to compare them with standard EUS-FNA and (laparoscopic) trucut biopsy specimens of pancreatic tissue. Design Animal non-survival study. Intervention Eighty-four pancreatic biopsy specimens (12 per group) were obtained in 4 anesthetized pigs by using one of the following the 18-gauge flexible cryoprobe; a conventional, 19-gauge, EUS-FNA needle; or a rigid, trucut biopsy device (18 gauge). The latter, used in laparoscopic surgery, was considered as the criterion standard for obtaining histology specimens. Main Outcome Measurements Specimens were evaluated for artifacts and specimen quality by a blinded pathologist who used a 7-point Likert scale to assess histologic adequacy. Biopsy size and bleeding time after biopsy also were recorded. Results The new cryoprobe was equivalent to the rigid, trucut needle and superior ( P Limitations Animal model. Conclusion EUS-guided cryobiopsy was associated with better specimen quality for histologic analysis and a shorter bleeding time compared with a conventional 19-gauge FNA needle in the animal model. It is a promising new technique for histologic examination of pancreatic tissue.

A male infant presenting with acute urinary retention

A 3-month-old male infant was admitted to the emergency department for acute urinary retention. A voiding cystourethrogram was performed because urethral valves were suspected. After bladder catheterization, the plain radio - graph prior to filling of the bladder showed an abnormal course of the urinary catheter tip together with focal absence and displacement of bowel gas out of the pelvis. Early contrast opacification of the bladder (Fig. A) demonstrated an abnormal cranial position of the lumen and an extrinsic impression on the bladder base, which became obscured after further distension of the bladder (Fig. B). These findings suggested presence of a pelvic mass, which was confirmed sonographically. CT and MRI were performed for better tumor delineation and tissue characterization. Both demonstrated a sharply delineated presacral soft tissue mass with homogeneous enhancement and DWI showed diffusion restriction. Sagittal T2-weighted image (Fig. C) nicely exhibits upward elevation of the bladder caused by a homogeneous presacral mass. Serum analysis showed increased neuron specific enolase and increased catecholamine metabolites were found in the urine. Tru-cut biopsy specimens confirmed neuroblastoma. CT and MIBG scan revealed no distant sites outside the pelvis while a bone scinti - graphy ruled out bone metastases. The tumor was macroscopically completely removed by means of a median laparotomy, and the infant recovered well after therapy.

CDNA Microarray Analysis of Serially Sampled Cervical Cancer Specimens From Patients Treated With Thermochemoradiotherapy

To elucidate changes in gene expression after treatment with regional thermochemoradiotherapy in locally advanced squamous cell cervical cancer. Tru-Cut biopsy specimens were serially collected from 16 patients. Microarray gene expression levels before and 24 h after the first and second trimodality treatment sessions were compared. Pathway and network analyses were conducted by use of Ingenuity Pathways Analysis (IPA; Ingenuity Systems, Redwood City, CA). Single gene expressions were analyzed by quantitative real-time reverse transcription-polymerase chain reaction. We detected 53 annotated genes that were differentially expressed after trimodality treatment. Central in the three top networks detected by IPA were interferon alfa, interferon beta, and interferon gamma receptor; nuclear factor kappaB; and tumor necrosis factor, respectively. These genes encode proteins that are important in regulation cell signaling, proliferation, gene expression, and immune stimulation. Biological processes over-represented among the 53 genes were fibrosis, tumorigenesis, and immune response. Microarrays showed minor changes in gene expression after thermochemoradiotherapy in locally advanced cervical cancer. We detected 53 differentially expressed genes, mainly involved in fibrosis, tumorigenesis, and immune response. A limitation with the use of serial biopsy specimens was low quality of ribonucleic acid from tumors that respond to highly effective therapy. Another "key limitation" is timing of the post-treatment biopsy, because 24 h may be too late to adequately assess the impact of hyperthermia on gene expression.

Comparison of EUS‐guided FNA and Trucut biopsy for diagnosing and staging abdominal and mediastinal neoplasms

The objective of this study was to evaluate endoscopic ultrasound Trucut biopsy (TCB) specimens and compare these findings to fine needle aspiration (FNA) specimens for the diagnosis of neoplasia. FNA and TCB specimens were reviewed in blinded fashion by a cytopathologist from patients (N = 93) who had EUS-guided FNA and TCB specimens collected between July 2000 and January 2005. Specimens were categorized as nondiagnostic, negative, suspicious for stromal neoplasm, suspicious for malignancy, positive for stromal neoplasm, or positive for malignancy. Standard final diagnosis based on clinical and/or pathologic follow-up was available for 86 of 93 patients. The final diagnoses comprised malignancy (n = 55), stromal neoplasm (n = 19), and benign findings (n = 12). The combination of FNA and TCB results combined were significantly (P < 0.001) more sensitive that FNA alone for the detection of both malignancy (78% vs. 55%) and stromal neoplasia (79% vs. 19%) without a significant change in overall specificity (92% vs. 100%, P = 1.00). A positive FNA specimen with a negative/nondiagnostic TCB result was established in seven patients with malignancy. A positive TCB diagnosis with a negative/nondiagnostic FNA result was noted in five patients with malignancy. A suspicious FNA result was upgraded to positive in conjunction with TCB specimen evaluation in eight patients with malignancy. The results of this study suggest that TCB is a useful adjunctive technique when used in tandem with FNA for malignancy and stromal neoplasia detection. Additional data are needed to firmly establish practice guidelines for the use of EUS-guided TCB specimens in clinical practice.