Annals of Pathology and Laboratory Medicine

Expression of PDL-1 and Its Correlation with TIL in Triple Negative Cases of Breast Carcinoma

Neha Sharma — 2021-06-30

Background: In the present study, we aimed to determine the expression of PDL1 and its correlation with TIL in Triple Negative (ER, PR and Her 2neu negative) cases of breast carcinoma (immune-histochemical study)

Methods: Expression of PD-L1 was seen on 40 proven triple negative cases of breast carcinomas (TNBC) and to correlate it with other parameters affecting prognosis of the disease. All the cases were infiltrating ductal carcinoma NOS (not otherwise specified)

Result: Maximum cases were Grade III (67.5%) followed by Grade II (32.5%). PD-L1 positivity was seen in 32.5% cases whereas TIL was positive for PD-L1 in 27.5 %. 5 cases were positive for both epithelial cell and TIL. Out of 13 PD-L1 positive tumors, 38.5% cases showed TIL positivity whereas out of 27 PD-L1 negative tumors, only 22.2% were TIL positive. PD-L1 expression in TIL was seen in 38.5% of cases however there was no statistically significant correlation between PD-L1 positivity and TIL positivity. PDL-1 positivity was more in Grade III (33.3%) as compared to Grade II (23%) lesions. Thus, it was observed that PD-L1 positivity increased from grade II to grade III lesions.

Conclusion: Intra-tumoral expression of PD-L1 is directly proportional to histological grade, aggressive subtypes in TNBC cases however there was no statistically significant correlation between PD-L1 positivity in tumor cells and TIL positivity. We thus postulate that measurement of PD-L1 expression in TNBC cases could enhance the accuracy of predicting patient prognosis and allow for optimal treatment selection.

The Clinicopathologic Evaluation of Eosinophilic Cholecystitis: A Retrospective Observational Study in a Tertiary Care Center

Senay Erdogan-Durmus — 2021-06-30

Background: Eosinophilic cholecystitis (EC) is a rare form of cholecystitis that is diagnosed histopathologically. The aim of this study to evaluate the patient demographic features, laboratory findings and histopathologic characteristics of EC. The aim of this study to evaluate the patient demographic features, laboratory findings and histopathologic characteristics of EC.

Design and setting: Retrospective observational study conducted in Erzurum, Turkey.

Methods: Between June 2014 and June 2017 3,178 cholecystectomy specimens were reviewed retrospectively. Nineteen EC cases were included to the study. Parameters such as sex, age, clinical information, laboratory findings were obtained from information system of hospital. And the data of EC group were compared with a control group of 50 non-specific chronic cholecystitis patients (CC).

Result: Out of 3,178 cholecystectomy specimens, 19 cases were diagnosed as EC (0.59%). Patients’ age ranged from 22-84 years and female to male ratio was 1.7:1. The average eosinophil count was 139.7 U/L in EC group. 11.7% of EC group had high level for eosinophils. In the EC group there were statistical significances between high eosinophil percentages and aspartate transaminase (AST), alkaline phosphatase (ALP) values (P<0.05, P<0.05). The EC group eosinophil levels were slightly higher than CC. Histopathologically, dense, severe infiltrates composed of eosinophils were seen.

Conclusion: EC is a rare entity that can only diagnosed by histopathology. There were certain high levels in liver function tests and eosinophils in correlation with non-specific cholecystitis. Although the presentation may be similar to non-specific cholecystitis, if a postoperative histopathological diagnosis of EC is made, then the patient must be investigated thoroughly to rule out other associated disease conditions.

Clinicopathological Evaluation of Metastatic Carcinomas of Bone Marrow Presenting as Cytopenia

Pavani Poosarla — 2021-07-01

Background – Metastatic carcinomas can involve bone marrow and may lead to subsequent marrow fibrosis and failure. The Bone marrow examination is important in patients diagnosed or patients on chemotherapy for cancer, who presented with peripheral cytopenia. The metastasis of bone marrow by these tumors is a sign of advanced stage of disease with poor prognosis.

Methods – Our study is a retrospective study, in which we reviewed a total of 702 bone marrow procedures, out of which 118 bone marrow procedures done in patients with a diagnosis of cancer or patients on chemotherapy presented as cytopenia in Great Eastern Medical College and Hospital during a period of 10 years.

Result – In our study of 118 patients 74 males and 44 females. Peripheral smear examination of these cases - 24 out of 32 (75%) presented with anemia, which was the commonest clinical presentation. Others were, thrombocytopenia in 18 (50%), bleeding manifestations in 10 (31.2%), Pancytopenia in 9 (28.1%), bi-cytopenia in 4 (12.5%). During this study period, among 118 malignancies reported in histopathology, 32 cases show bone marrow metastasis. 17.1% were carcinoma breast, 25% were carcinoma stomach 33.3% were carcinoma prostate and carcinoma urinary bladder, 23.5% were SCC carcinoma lung, 0% carcinoma Cervix, all cases of Ewing’s sarcoma, neuroblastoma and poorly differentiated carcinoma show bone marrow metastasis.

Conclusion - Bone marrow examination is valuable tool in the diagnosis and staging of hematologic and nonhematological disease, as well as in the assessment of overall bone marrow cellularity, pattern of marrow involvement in metastatic carcinomas.

Lipid Indices vs Anthropometric Indices in Metabolic Syndrome and Type 2 Diabetes Mellitus

Asha Augusthy — 2021-06-30

Background: Diabetes mellitus is a metabolic disease known by chronic hyperglycemia which results from defective insulin action and secretion. Metabolic Syndrome consists of a constellation of metabolic abnormalities that confer increased risk of diabetes mellitus. The aim of our study is to find out whether non-invasive, clinically measurable surrogates could be useful in identifying body fat distribution and help predict metabolic syndrome and diabetes risk and to compare the performance of anthropometric indices with lipid indices in identifying metabolic syndrome and diabetes.

Methods: 50 individuals with metabolic syndrome ,50 individuals with type 2 diabetes mellitus and 50 controls were selected by purposive sampling technique. For cases and controls history was taken, physical examination was done .Fasting blood sugar, Serum High density lipoprotein and Serum Triglyceride levels were estimated. Body mass index, a body shape index, visceral adiposity index, lipid accumulation factor was calculated.

Results: The mean values visceral adiposity index, lipid accumulation factor were significantly increased (p<0.001) in cases compared to controls.

Conclusion: Our study concluded that lipid indices visceral adiposity index, lipid accumulation factor is better than anthropometric indices like body mass index, a body shape index in predicting metabolic syndrome and type 2 diabetes mellitus. Anthropometric indices when used should be correlated with metabolic variables and clinical symptoms.

Histopathological Spectrum of Upper Gastrointestinal Endoscopic Biopsies in a Tertiary care centre

Anjana M.L — 2021-06-30

Background: Upper GI endoscopy is an established procedure for investigating a wide range of upper GI conditions especially inflammatory and malignant diseases of stomach and esophagus. A good correlation in diagnosis can be achieved by complementing endoscopic findings with histopathology of biopsy specimens.

Methods: Both retrospective and prospective study of upper GI endoscopic biopsy was carried out at department of pathology, KIMS, Hubli during January 2016 to December 2018. Samples were received in 10% formalin; routine processing was followed with H & E staining. Special stain like Giemsa was done for detection of H. Pylori. 396 endoscopic mucosal biopsies were analyzed and evaluated.

Result: Out of 396 cases, 250 cases were esophageal biopsies, 104 cases were gastric biopsies & 42 cases were duodenal biopsies. The male: female ratio was 1:9:1. The highest number of cases was seen between 61 to 70 years. Dyspepsia was the common symptom seen in 61.3%. The most common lesions encountered in the esophagus were carcinomas (67%) followed by esophagitis (16%). The commonly encountered gastric lesion was chronic gastritis in 54.8% with H. pylori gastritis being positive in 38.18%. Among the duodenal biopsies, non-neoplastic lesions were most common (59.5%) followed by neoplastic lesions (26%).

Conclusion: Upper GI endoscopy is an effective and appropriate preliminary investigation to assess patients with dysphagia, dyspepsia, vomiting. Endoscopy without biopsy is incomplete and that the combination of methods offers a strong diagnostic tool for better patient care.

Sarcomatoid Squamous Cell Carcinoma of the Conjunctiva: A Rare Entity and A Brief Review of Literature

Sahil Agrawal — 2021-06-30

Sacrcomatoid variant of squamous cell carcinoma has been known to involve numerous tissues like an aerodigestive tract, skin. A reddish mass of the left bulbar conjunctiva, with intraocular extension on ultra-bio-microscopy (UBM) was present. Histopathologic examination showed the characteristic spindle-shaped cells in continuity with the overlying epithelium with positive immunostains for cytokeratin, epithelial membrane antigen and vimentin. The presence of such an entity in the conjunctiva is rare and here we report such a case, this being the 37th case to be documented in literature. We also give a brief review of literature.