Annals of Pathology and Laboratory Medicine

Immunohistochemical Analysis of Expression of GATA3 in Carcinoma Breast and its Correlation with Prognostic Parameters

Tanvi Suri — 2021-02-28

Background: GATA3 plays an essential role in the normal development and function of the mammary gland where it promotes the luminal transcriptional program. Its loss is implicated in the pathogenesis of breast cancer. We proposed to study the expression of GATA3 in carcinoma breast by immunohistochemistry and determine its correlation with prognostic parameters.

Methods: The expression pattern of GATA3 was evaluated by immunohistochemistry in 30 cases of invasive breast carcinoma. GATA3 scoring was done and a score of ≥ 1+ was considered positive. Patient characteristics, including age, tumour laterality, tumour size, lymph node status, tumour grade, histological type, molecular subtypes were collected. The relationships between protein expression and clinicopathological variables were analysed. Statistical significance was determined by Pearson’s chi-square test and Mann Whitney U test (for age).

Result: 46.7% of cases (14/30) scored positive for GATA3 expression in tumour cells including 63% of luminal subtypes, 14% of Her-2 neu enriched carcinomas and 20% of triple negative carcinomas. Most positive cases (35.7%) demonstrated 3+ staining. GATA3 expression showed an inverse association with histological grade (P = 0.012) and HER-2 overexpression (P = 0.038), and a direct association with ER expression (P =0.017) and PR expression (P =0.009).

Conclusion: GATA3 is luminal marker as it shows strong association with ER and PR in breast cancers. High GATA3 expression is also correlated good prognostic parameters like low tumour grade. Our findings advocate for GATA3 as a promising new breast-specific immunomarker.

Frozen Section Diagnosis: Accuracy and Errors; with Emphasis on Reasons for Discordance

Roopam Kishore Gidwani — 2021-02-28

Background: Frozen section is a multistep process involving surgical resection, intraoperative preparation of slides and their microscopic examination. It is important to assess concordant, discordant and deferred diagnosis rates from intra-operative frozen section diagnosis with final diagnosis on paraffin section and to determine the reasons for discordance. An integral part of quality assurance in surgical pathology entails the correlation of intra-operative frozen section diagnosis with final diagnosis on permanent section.

Methods: A retrospective analysis of 117 cases of frozen section biopsy was carried out which were reported in the Histopathology department between July 2007 to June 2012. The correlation between the frozen section diagnosis with final histological diagnosis was performed in order to check the accuracy of the technique. The number and type of discrepancies were compared, causes for the discrepancies were analyzed in order to decrease the avoidable errors and improve on the frozen section diagnoses.

Results: The overall accuracy of frozen section diagnoses over 5years was 90.60% with false positive rate of 0.85%, false negative rate of 6.84% and 1.71% of deferred diagnosis. Sensitivity was 87.69% and Specificity was 98%. The discrepancies were mainly due to the interpretation error, sampling error and technical artefacts.

Conclusions: Gross inspection, sampling by pathologist, frozen section complemented with cytological and histological review and cooperation between consultants can avoid certain limitations and provide rapid, reliable, cost effective information necessary for optimum patient care.

Utility of p63 and AMACR in Differentiating Benign and Malignant Prostatic Lesions

Ashily Koshy — 2021-02-28

Background: Prostate cancer is the sixth most common cancer in the world. Since treatment options and prognosis of prostatic adenocarcinomas and benign lesions differ significantly, so, the current study using p63and AMACR was carried out with aim to evaluate the utility of immunohistochemistry in resolving ambiguous lesions of prostate.

Methods: The study was conducted on 130 prostatic specimens which included prostate biopsy, TURP and prostatectomy specimens. Routine hematoxylin and eosin staining and immunohistochemical staining using AMACR, p63 monoclonal antibody marker were performed.

Results: Total of 130 cases of prostate samples were studied out of which benign lesions were seen in 102 cases (78.5%) and malignant carcinoma in 28 cases (21.5%). This study showed p63 had a sensitivity of 92.86% and specificity of 100% whereas AMACR has a sensitivity of 96.4% and specificity of 95%. BPH with prostatitis was a common finding in majority of benign lesions. All cases of LGPIN 15 cases (11.5%) were histologically associated with BPH, showing complete positivity in 12 cases (80%) and partial positivity in 3 cases (20%) with p63 immunostaining. HGPIN (1.5%) were associated with prostatic adenocarcinoma showing focal positivity whereas adenocarcinoma showed complete negativity of p63 expression (100%) and positive cytoplasmic staining with AMACR. Comparative study done between DRE, PSA, final histopathological diagnosis, expression of p63 and AMACR immunostaining gives highly significant p value of 0.001(<0.05).

Conclusion: p63 and AMACR are reliable markers which can be used in morphologically difficult cases.

Efficacy of Bronchial Wash Cytology and its Correlation with Histopathology in Diagnosis of Lung Carcinoma in a Tertiary Care Hospital

Shilpa Tomar — 2021-02-28

Introduction: Cytological evaluation is an important, usually initial diagnostic modality in patients with suspected malignant lung masses. Bronchoscopic washing, bronchoalveolar lavage, bronchial brushing and fine needle aspirations may complement tissue biopsies in the diagnosis of lung cancer. This study was undertaken to compare the efficacy of bronchial wash cytology and to correlate it with histopathology in diagnosis of suspected cases of lung cancer at a tertiary care hospital.

Material and methods: Bronchial washings and bronchial biopsy were collected from total 60 clinically suspected cases of carcinoma lung. Bronchial washing smears were stained with MGG and H&E stain and were categorized as unequivocally positive / unequivocally negative for malignancy and atypical (equivocal for diagnosis). Biopsy sections were examined for histopathological diagnosis.

Results: Cytomorphologically, 30 cases were reported as positive for malignancy, 28 cases were negative for malignancy and 02 cases were atypical. On histopathology, lung carcinoma was diagnosed in 48 patients out of them 35 cases were of squamous cell carcinoma, 7 cases were of small cell carcinoma and 6 were of large cell carcinoma.

Conclusion: Maximum diagnostic yield can be obtained by combining biopsy with cytological procedures of washing rather alone.

Histomorphological and Immunohistochemical Study of Extra Nodal Lymphoma

B R Vani — 2021-02-28

Background: NHL are heterogeneous group of hematolymphoid malignancy occurring in nodal and extra nodal sites. Extra nodal lymphoma (ENL) is distinct from nodal lymphomas due to varied anatomical location, morphological diversity.

Methods: A retrospective observational study was conducted in the department of pathology from January 2011 till December 2019. Clinical details and other investigations were recorded. Gross morphological features were noted. Slides are reviewed microscopically and blocks were subjected to IHC for further typing cases were selected as per Dawson et al criteria.

Result: During study period, ENL constituted 25 cases (29.4%) of the 85 cases of all NHL. Age range is 05 to 63 years with a mean age of 42.5 years. Male to female ratio is 2.2 :1.Head and neck is the most common site of ENHL constituting 19 cases(76%), next commonest location is in the GIT with 3 cases (12%). We had one each case of ENHL in testis, breast and spine (4% each). On IHC, 92% cases (23 cases) exhibited B cell phenotype and the remaining 08 % (02 cases) were of T cell phenotype.

Conclusion: Lymphomas in the extra nodal sites are rare but has the propensity to occur in any anatomic site. Hence a differential of lymphoma to be considered in extra nodal site. Histology with IHC enables to differentiate from poorly differentiated carcinoma as the treatment modalities and prognosis varies.

Clinico-morphological Profile of Cutaneous Fungal Infections: An Experience from a Tertiary Care Government Hospital in North India

Ekta Jain — 2021-02-28

Background: Cutaneous fungal infections are predominantly seen in hot tropical countries like India. In the past decade, there has been an escalation in recurrent and chronic fungal infections. Skin biopsy may play a critical role in rapid identification of these infections.

Methods: Fifteen cases of cutaneous fungal infections over a period of 6 years were included. Formalin-fixed tissue was subjected to hematoxylin and eosin and histochemical staining including Gomori Methanamine Silver and Periodic Acid Schiff . Results of KOH smear test and fungal culture were included wherever available. The clinico-morphological patterns in various cutaneous fungal infections was evaluated.

Results: Most patients were between 25 to 40 years of age and commonly presented as skin ulceration, followed by nodular swelling and multiple discharging sinuses. Candidiasis and Mycetoma infections were the commonest infections. Others included: Cryptococcosis, Dermatophytosis, Chromoblastomycosis and Mucormycosis. The predominant histopathologic patterns were perivascular and interstitial inflammation. Eleven cases were confirmed by KOH examination and culture.

Conclusion: The morphologic spectrum of cutaneous fungal infections is varied. Initial presentations of these fungal infections may be indicative of the onset of a life-threatening systemic mycoses. Thus, the histopathologic evaluation of skin tissue specimens is critical for their rapid and accurate diagnosis.

Screening of Donated Blood for Transfusion Transmitted Infections by Serology and Response Rate to Notification of Reactive Results: A Tertiary Care Institutional Experience

Rohit Vasantbhai Bhalara — 2021-02-28

Background: Safety for blood Transfusion begins with healthy donors. A basic part of preventing transfusion transmitted infections (TTIs) is to notify and counsel reactive donors. This study analysed trends in the prevalence of transfusion-transmissible infectious pathogens among blood donors and notify them as well as to assess response rate among them. Donor notification and counselling protect the health of the donor and stop secondary transmission of infectious diseases.

Methods: 38707 blood donations were screened for TTIs, namely, HIV, HBV, HCV, and syphilis, Malarial Parasite by serology. ELISA testing for anti-HIV antibody, anti-HCV antibody and HBsAg and RPR test for syphilis, Rapid card test for Malarial Parasite. All reactive donors were retested in duplicate and notified of their status by communicating through telephone.

Result: We evaluated 341 (0.88%) cases with reactive screening test results (0.617% HBV, 0.016% HCV, 0.134% HIV, 0.08% syphilis, 0.031% Malaria ). Only 179 donors (52.5%) responded to notification. The response among voluntary donors was better as compared to the replacement donors (54.1 % versus 40.7 %). Only 101 (57.22%) responsive donors followed their first attendance at referral clinic.

Conclusion: Our study provides prevalence rate of TTIs among blood donors and importance of proper donor counselling and notification of TTI status to all reactive donors who opt to receive this information.

A Rare Case of Mixed Ductal Neuroendocrine Tumor of the Pancreas

Vidya Viswanathan — 2021-02-28

Collision tumors are tumors that have at least two types of tumors in the same anatomical site with no area of mixing within the transition zone. In 2010 WHO classification of neuroendocrine tumors consists of an adenocarcinoma component and a neuroendocrine carcinoma component in which each of the components accounts for 30% of the tumor. Such tumors are defined as mixed adenoneuroendocrine carcinomas. Occurrence of exocrine and endocrine tumors of the pancreas is extremely rare. The aim of our study was to describe a case in a 60 years old male who was diagnosed with this rare tumor. Gross, microscopic features and immunohistochemistry were used to diagnose this rare condition. Immunohistochemistry markers such as synaptophysin, chromogranin, EMA and Pan CK were used to come to a definitive diagnosis. Synaptophysin and chromogranin were found to be positive in the neuroendocrine component. EMA and Pan CK were found to be positive in the ductal component. Hence a diagnosis of mixed ductal neuroendocrine tumour (collision tumor) was made.

Secondary Hemophagocytic Lymphohistocytosis in COVID-19

Stephanie Lilia Pushpam Jetty — 2021-02-28

We present case of a 53-year-old lady who is a known case of rheumatoid arthritis and hypertension in Karnataka, South India, who presented with Severe Acute Respiratory Infection (SARI) like symptoms (fever, cough and breathlessness) due to COVID-19. During the course of treatment further investigations revealed evidence of Hemophagocytic Lymphohistocytosis (HLH). This case emphasizes the need for a thorough workup to identify the etiology of HLH as it may unmask a treatable entity in a COVID-19 patient.

Atypical Cervical Stromal Cells Masquerading as Malignancy

Shraddha Avinash Kurekar — 2021-02-28

Atypical stromal cells (ASCs) of the female genital tract are uncommon and found in various polypoid lesions of the vulva, vagina, cervix and endometrium. Although they are benign; they can be misinterpreted as a malignant. Hence it is important for a pathologist to identify the ASCs in the specimens or biopsies of lower Female genital tract and avoid over diagnosis as a malignancy. We present a case of atypical cervical stromal cells in a 45-year-old female. On microscopy, Atypical stromal cells were stellate, enlarged in size, with moderate to severely atypical hyperchromatic, multilobulated nuclei without any mitoses. Their chromatin was dense often with prominent nucleoli. This report highlights the significance of awareness about the occurrence of these cells in the female reproductive tract.

Metastatic Breast Carcinoma to The Uterine Cervix - An Unusual Presentation

Maymol P Varghese — 2021-02-28

Uterine cervix involvement as a site of metastasis from a distant primary tumor is rare. Metastasis from breast carcinoma in a patient undergoing treatment is even rarer. The present case report is of a 47-year-old lady with history of carcinoma breast on treatment and who was referred to our hospital with complaints of lower limb oedema, low backache and postmenopausal whitish discharge per vaginum. Per vaginal examination revealed a lesion arising in the cervix extending up to the anterior vaginal wall suggestive of a clinical diagnosis of carcinoma cervix. Subsequent biopsy from the lesion showed malignant cells arranged in Indian file pattern and focal alveolar pattern, hinting at a diagnosis of Invasive lobular carcinoma metastasis. The neoplasm was positive for ER, PR and GATA-3 and negative for Her2/neu and E-cadherin confirming our diagnosis. Although rare, the poor outcome in such patients makes it even more important for its identification and the need for them to undergo careful routine gynecologic examination.