Annals of Pathology and Laboratory Medicine

Clinicohistologic Characteristics of Breast Cancer in Ghanaian Patients

Leonard Derkyi-Kwarteng — 2020-08-26

Background

Breast cancer is the leading cause of cancer morbidity and mortality worldwide. The management and prognosis of breast cancer depend heavily on the different histologic and molecular biologic features of the tumour. The different histologic types describe the distinct growth patterns and cytological features of the tumour.

Methodology

This is a retrospective study of archival breast cancer excision and mastectomy specimen at KBTH from 2012-2016. 729 cases were retrieved over the period and examined by two pathologists independently. Demography of the cases, tumour size, grade, histologic type, stage, mitosis, site of lesion etc. were entered into SPSS and analysed with chi-square done with P-value set at P < 0.05.

Results and Conclusion

The mean age of presentation is 52.45 ± 12.75 years. The commonest histologic type of breast cancer is invasive carcinoma (NOS) forming (87%). Only 1.2% of male presented with breast cancer with the other percentage in females. Most (88%) of the tumours were greater than 5cm at the time of surgery. The tumours are of high grade (II and III) forming 88%. Seventy-eight percent of cases presented with late stage of the disease (≥ stage IIB). There was association between histologic type and vascular invasion (P < 0.000) and lymph node involvement (P = 0.010). Moreover, tumour size showed an association with tumour grade (P < 0.05).

This study has shown that breast cancer among Ghanaian patients has a worse histologic type with poor tumour characteristics giving it poor prognosis.

Diagnostic Utility of Bronchoalveolar Lavage and Bronchial Brush Cytology in Lung Lesions

Jofy George — 2020-08-26

Background: In 1960’s, flexible fiberoptic bronchoscope, was first used to give a better yield to diagnose pulmonary diseases. Bronchial brushing cytology (BBC) and Broncho-alveolar lavage (BAL) are two important adjuncts done along with bronchoscopic biopsy. Bronchial brushings yield better diagnostic material than simple exfoliative cytology. Therefore, both techniques are of much diagnostic value and is widely accepted as it is safe, economical and evaluation requires much less time.

Methods: All the bronchial brush and bronchoalveolar lavage smears obtained from January 2018 to December 2018 were assessed. Correlation was done with histopathology wherever was available.

Result: BBC showed a sensitivity and specificity of 59.28% and 100%. The positive predictive value and negative predictive value were 100% and 47.62%. BAL showed a sensitivity and specificity of 51% and 100%. The positive predictive value and negative predictive value was 100% and 43.18%. The diagnostic accuracy of BBC and BAL were 70.27% and 64.86%.

Conclusion: Universally bronchial washings and bronchial brushings should be considered important adjunct to bronchoscopic biopsies to diagnose pulmonary lesions as both are safe, economical and can will give better diagnostic yield if incorporated together.

Detection of Micrometasteses In Lymph Nodes in Cases of Carcinoma Breast by Immunohistochemistry

Sunita Sharma — 2020-09-01

Background – We evaluated archived lymph nodes of breast carcinoma for micrometastases detection by serial multiple sections (SMS) and immunohistochemistry (IHC) and found increased positive lymph nodes yield which led to change in staging in few cases, treatment and prognosis.

Method – Metastatic free, early breast cancer cases of 36 patients with lymph node status pN0 or pN1 were evaluated. These were the cases had been treated with modified radicle mastectomy and axillary lymph node dissection. All the lymph node was cut at 50µm interval to get 5µm thick serial sections. These serial sections (SMS) were stained with Hematoxyline and Eosin (H&E). Out of these 2 sections were subjected to Immunohistochemistry (IHC). Monoclonal antibodies chosen for IHC were panCK (Cytokeratin) and EMA (Epithelial membrane antigen) to detect micrometasteses.

Results – Total 463 lymph nodes from 36 cases of carcinoma breast were studied. New serial sections (SMS) cut from 435 lymph nodes of breast revealed 16(3.67%) additional positive lymph nodes from 12 cases. Out of 16 positive lymph nodes 4 were macrometasteses and 12 were micrometastases. Immunostaining with CK antibody revealed micrometasteses in 40 of 435 (9.19%) lymph nodes and by EMA antibody 33 of 435 (7.59%). Out of 40 micrometasteses 8 were positive for isolated tumor cells (ITC). We calculated the Z value and corresponding p value between the two methods as H&E versus SMS, H&E versus IHC and SMS versus IHC for carcinoma breasts. The tests revealed that SMS and IHC are definitely the superior methods in detection of a greater number of positive lymph nodes in cases of carcinoma breast.

P value for detection of micrometasteses H&E versus SMS is <0.05 (S), H&E versus IHC <0.01(S) and SMS versus IHC (<0.02). Out of 36 cases 06 cases showed change in staging and 03 out of 06 cases were upstaged from early to advanced stage carcinoma.

Conclusion – Significant number of metasteses are missed by routine processing of lymph nodes on H&E staining. SMS and IHC increase the yield of metasteses in lymph nodes. CK is superior marker than EMA.

Reactive Thrombocytosis – Aetiology And Relationship with Different Hematological Parameters, ESR, CRP in Infections

Bhavana Garg — 2020-09-07

Background: The measurements of platelet count, mean platelet volume (MPV), WBC are routinely available nowadays. The aim of this study was to determine aetiology and relationship of these parameters whether they were associated with the known markers of disease activity, erythrocyte sedimentation rate (ESR) and C- reactive protein (CRP) in infections.

Methods: This descriptive study was done on 500 patients with platelet count > 450,000/ μl and the cause being reactive. Platelet count, WBC, MPV, ESR, and CRP were measured at the time of hospitalization.

Result: Most common cause of reactive thrombocytosis was Infections (28.8%), Tissue damage (16.4%), Iron deficiency anemia (16.2%), Malignancy (9.6%) and Inflammation (9.4%). In infections, bacterial infections (88%) were found to be more common. There was low degree of positive correlation between reactive thrombocytosis and WBC (r = 0.124, P >0.05) , ESR ( r = .147, P= 0.07) , MPV ( r = .077, P >0.05) in infections. There was significant negative correlation between reactive thrombocytosis and CRP in infections (r = -.199, P= 0.017).

Conclusion: This study demonstrated a higher level of platelet count and lower MPV in all the patients having reactive thrombocytosis irrespective of it’s etiology. There was low degree of positive correlation between platelet count and WBC, ESR and MPV in infections and a significant negative correlation with CRP. We propose that platelet parameters may be considered as reliable markers for assessment of disease activity.

Histomorphological Spectrum of Renal diseases: A Prospective Study for A Period of Two Years

Deepthi K N — 2020-09-09

INTRODUCTION: Kidneys are vital organs of the body with multiple functions like excretory, acid base balance and maintenance of blood pressure. Renal parenchyma is mostly subjected to noxious insults but is last to respond. Simple nephrectomy is done for irreversibly damaged kidney. Most common indication for nephrectomy is chronic pyelonephritis. Aim of the study is to analyze the histopathological patterns of renal lesions and to analyze age and sex distribution.

MATERIALS AND METHODS: The study included a total number of 70 cases, during a period of 2 years i.e., from October 2017 to September 2019. All renal biopsies and nephrectomy specimens received in pathology department, SVS Medical College, Mahabubnagar, Telangana, India were included in the study.

RESULTS: In our study, 70 cases were analyzed. Out of which majority of the lesions (25.7 % ) were in the age group of 21-40 years and showed male preponderance (68.5 %). Present study showed chronic pyelonephritis being the most common non-neoplastic lesion. Among malignant tumors renal cell carcinoma was most common.

CONCLUSION: The present study reveals various histological patterns of lesions in renal biopsies and nephrectomy specimens. Our study reveals that non-neoplastic lesions are more commonly encountered lesions.

Spectrum of Synovial Sarcoma-clinicopathological and Immunohistochemical Correlation

Sunandalakshmi GV — 2020-09-09

Background: Synovial sarcoma is the common adult soft tissue sarcomas affects the lower extremities. In poor resource settings, characterization by molecular methods may not be feasible always. This study is aimed to evaluate Sensitivity and Specificity of Transducin-like enhancer of split 1 (TLE1) immunohistochemical expression in Synovial sarcomas (SS) and its histological mimics and to study the clinicopathological features of Synovial sarcoma.

Method: A prospective study of two years duration from September 2013 to September 2015 conducted at the Department of Pathology, MNJ Institute of Oncology and Regional Cancer Centre, Redhills, Hyderabad. Total number of Synovial sarcomas was 30. All original H & E section of the tumor are reviewed and Immunohistochemistry (IHC) analysis was carried out on TLE1 mouse monoclonal antibody (TMA) blocks using TLE1 Antibody.

Results: The Median age was 30 years. The most common site of involvement was lower limbs. The most common mode of presentation was painless swelling. The most common variant of Synovial sarcoma was monophasic Spindle in 19 cases. Total number of TLE1 positive cases of Synovial sarcoma was 93.3%. Total number of SS mimics showing TLE1 positivity was30%. TLE1 showed Sensitivity 93.3% and Specificity- 73.3%. In the present study negative predictive value is 91.6% and the positive predictive value is 77.7%.

Conclusion: All small round blue cell tumors should be kept in mind while diagnosing poorly differentiated SS. TLE1 is a very sensitive marker for synovial sarcoma.TLE 1 is a highly sensitive marker for synovial sarcoma, but is less specific because of its positive expression in other mesenchymal tumors.

Right Ethmoidal Sinus Schwannoma: Case Report of a Common Entity with an Unusual Presentation

Kavitha E M — 2020-09-01

Schwannomas are benign, encapsulated nerve sheath tumors arising from Schwann cells. Approximately, 25-40% of all Schwannomas occur in the head and neck region, acoustic nerve being the most frequent site. The tumors originating from nasal cavity or paranasal sinuses are rare and constitutes only four percent.

A 40-year-old male presented with history of blurred vision of right eye and protrusion of right eye ball since 6 months. It was associated with history of watering and redness. Examination of right eye revealed mild proptosis and ptosis. Computed Tomography [CT] scan showed a large expansile cystic lesion measuring about 5.2x5.6x6.5cm involving entire right ethmoidal sinus. It showed expansion into anterior cranial fossa, roof and medial wall of right orbit. Radiological opinion suggested mucocele of right ethmoidal sinus. Intra-operatively, tissue specimen was sent for squash smear cytology. Cytological smears showed features suggestive of spindle cell tumor. Possibility of Schwannoma was considered. The specimen was subsequently subjected to histopathological examination. Microscopy showed tumor tissue composed of tumor cells arranged in alternate hypercellular and hypocellular pattern. Hypercellular areas showed occasional verocay bodies. Hypocellular areas showed loosely arranged spindle shaped tumor cells. Histopathological features were suggestive of Schwannoma. On Immunohistochemistry (IHC), neoplastic cells were positive for S-100 and negative for EMA.

Ethmoidal sinus schwannoma extending into anterior cranial fossa is an unusual presentation. Clinically, it poses a diagnostic dilemma. Squash smear cytology is challenging, but helpful in establishing the correct diagnosis. Histopathology is confirmatory and immunohistochemistry is supportive.

HMB-45 Negative Adrenal Angiomyolipoma With A Synchronous Adrenal Adenoma – An Unusual Association

Gayathri G Nair — 2020-09-01

Background:

Angiomyolipoma (AML) is an uncommon mesenchymal tumour usually found in the kidney. The most common extrarenal site is usually the liver. We report a case of adrenal AML with a predominant vascular component co-existing with an adrenal adenoma.

Case report:

A fifty-year-old male presented with two months history of dysuria. Computed tomography showed a heterogeneous lesion involving the right adrenal gland abutting the right kidney and adjacent liver capsule. Urine noradrenaline levels were elevated. Adrenalectomy specimen showed an encapsulated mass measuring 8 x 5 x3.5 cm with a lobulated, grey to tan brown cut surface with areas of haemorrhage and tiny cystic spaces. Another yellowish nodule measuring 1.3 x 1.2 x 1 cm was also noted at one pole. Microscopy showed a neoplasm composed predominantly thick-walled vascular channels admixed with foci of smooth muscle bundles and adipocytes. Yellowish nodule showed features of adrenal adenoma. HMB-45 was negative and CD34 positivity highlighted the thick and thin walled vessels.

Conclusion:

We present the very first case of HMB-45 negative adrenal AML with a predominant vascular component and a synchronous adrenal adenoma.

Nodular Lymphocyte Predominant Hodgkin’s Lymphoma with T Cell/ Histiocyte Rich Large B Cell Lymphoma Like Transformation

Sakshi Batra — 2020-09-01

Nodular lymphocyte predominant Hodgkin’s lymphoma (NLPHL) is an uncommon variant form of Hodgkin’s lymphoma with a worldwide incidence of 5%.¹ It has long been recognized that NLPHL can have varied growth patterns, including some with diffuse areas and/or numerous T cells.² NLPHL may evolve to a completely diffuse T-cell–rich proliferation lacking any follicular dendritic cells which would be consistent with a T-cell histiocyte-rich large B-cell lymphoma (THRLBCL) or can be associated with such a proliferation at a separate site. Recent data indicate that progression to a process with features of THRLBCL is associated with a more aggressive clinical course, and requires different management, hence the significance of diagnosing correctly THRLBCL-like transformation of NLPHL. We report a case of THRLBCL-like transformation of NLPHL in an 11-year old male child.

A Rare Case Report of Invasive Ocular Surface Squamous Neoplasm of Conjunctiva

Noopur Subhash Patil — 2020-09-01

Ocular surface neoplasm(OSSN) represent a rare but broad spectrum of disease, including mild dysplasia on one end of the spectrum and invasive Squamous cell carcinoma(SCC) on the other. Thus, the diagnosis completely depends on histopathological examination of the lesion. The incidence of ocular surface neoplasia is strongly associated with factors like solar ultraviolet radiation, HIV and human papilloma virus(HPV) infections. Most lesions occur at the limbus within the interpalpebral fissure particularly the nasal side. Their importance lies in the fact that they mimic benign lesions like pterygium or even chronic conjunctivitis and thus can be misinterpreted and inadequately treated. Red eye and ocular irritation are the most common presenting symptoms. No tumor related deaths or metastasis are generally seen. Surgery with intra-operative control of surgical margins and adjunctive chemotherapy, immunotherapy and cryotherapy result in good tumor control rates, with promising results in aggressive, recurrent and large tumors.