Indian Journal of Pathology and Microbiology
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Year : 2019  |  Volume : 62  |  Issue : 5  |  Page : 18-19
KCBM Award Papers Abstracts

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Date of Web Publication13-Dec-2019

How to cite this article:
. KCBM Award Papers Abstracts. Indian J Pathol Microbiol 2019;62, Suppl S1:18-9

How to cite this URL:
. KCBM Award Papers Abstracts. Indian J Pathol Microbiol [serial online] 2019 [cited 2022 Aug 16];62, Suppl S1:18-9. Available from: https://www.ijpmonline.org/text.asp?2019/62/5/18/272756

   KCBM01: Exploration of intestinal stem cell niche in duodenal biopsies of patients with celiac disease Top

Sudha Nagavalli Battu

AIIMS, Delhi, India

Introduction: Villous flattening is one of classically identifiable histological features in duodenal biopsies from patients with celiac disease (CeD). Improvement of villous dimension after allogenic bone marrow derived stem cell transplantation create interest regarding the resident intestinal stem cells (ISC) in duodenum in patients with CeD. Patients and Methods: A total 92 duodenal biopsies (D2 & D3) from patients with CeD and 37 control biopsies were included. In 49 patients follow up duodenal biopsies were available, taken 9 months after starting the gluten free diet (GFD). Routine serological screening and histological analysis was done. Immunohistochemical stains for markers of ISCs : Lgr5+ CBC and Bmi 1+ position 4+ TA cells; paneth cell marker: β-Defensin; marker of Wnt pathway: activator- R- spondine-1; mediator- transcription factor 4 (TCF4), negative regulator- BMP receptor1A (BMPR1A); ECM marker- Fibronectin L1; apoptosis marker- H2AX; and proliferative marker- Ki67 were performed in all. The stains were interpreted by calculating H scores (area of positivity x stain intensity) and were compared among the groups. Results: In biopsies from patients with CeD in comparison to the controls, though H2AX expression was significantly more in crypts and the LGR5+ ISC were increased, the Bmi1+ TA cells were not increased. The Ki67 LI was also found to be significantly low in patients with CeD (P <0.001). Though, BMPR1A was downregulated in biopsies from patients with CeD (P <0.001), RSPO and TCF4 expressions were either reduced or not increased, in disease biopsies than in controls. Defensin expression was not significantly different in biopsies from treatment naïve patients of CeD and controls. Fibronectin expression was significantly downregulated in periepithelial stromal cells in CeD, than in controls. In biopsies taken after 9 months of GFD, though H2AX expression decreased and modified Marsh grades improved in 24 out of the 49 followup biopsies available, no significant difference of expression of ISC markers, LGR5 and Bmi1 was noted in comparison to the treatment naïve biopsies. The periepithelial stromal fibronectin expression also did not significantly increase in follow-up biopsies. Also the markers of WNT pathway activator, mediator and inhibitor did not change significantly in follow-up biopsies. Conclusions: This study brings out an important observation that integrity of the extra-cellular matrix around the ISC niche is vital to support the stemness of these cells. Disintegration of the extracellular matrix around the ISC niche results in intestinal crypt failure and villous flattening in celiac disease.

   KCBM02: Significance of PD-L1 immune checkpoint inhibitor in epithelial ovarian/tubal carcinoma Top

Akriti Bansal

PGIMER, Chandigarh, India

Background: High Grade Serous carcinoma [HGSC] is one of the most common and most lethal carcinomas among females. The immune check point inhibitors like PD-L1 play an important role in inhibiting the tumor infiltrating lymphocytes [TILs] and thus helping the tumor cells in evading the host immune response. It has therefore become an important target for immunotherapy. Our study aims at studying the expression of PD-L1 in HGSC along with the overall immune landscape of tumor. Materials and Methods: Tissue microarrays containing 100 cases of HGSC (50 cases that underwent upfront surgery and 50 post-NACT IDS specimens along with their pre-NACT ascitic fluid specimens) and 16 cases of clear cell carcinoma were evaluated by immunohistochemistry for expression of PD-L1, and other immune cells by CD4, CD8, CD68 and PD-1. The cases were then divided into four immunotypes based on the expression of PD-L1 and CD8+T cells. The data so obtained was correlated with the survival of patients. Results: PD-L1 was expressed on tumor cells as well as tumor associated macrophages [TAMs], and had a direct linear correlation with presence of CD4+TILs, CD8+TILs and CD68+ TAMs [p=0.00001, 0.00002 and 0.00002 respectively]. In the post-NACT HGSC cases, there was high concordance of PD-L1 expression between the pre-NACT ascitic fluid and and post-NACT IDS specimens. There was no difference in disease free survival between the PD-L1 positive and negative cases [p=0.9], however, the cases with expression of both PD-L1 and CD8+ T cells (Immunotype I) had the worst disease free survival as compared to other immunotypes [p=0.04]. Conclusion: Immunotyping on the basis of PD-L1 and CD8+ T cell positivity can help stratify patients for therapy in a better way than stratifying them on PD-L1 expression alone. The patients with Type I status with presence of both CD8+ T cells and PD-L1 will likely be the most suitable candidates for anti PD-L1 therapy.

   KCBM03: Detection of paroxysmal nocturnal hemoglobinuria clones in pediatric aplastic anaemia using flowcytometry Top

Shubham Sharma

Lady Harding Medical College, Delhi, India

Acquired Aplastic Anemia and Paroxysmal Nocturnal Hemoglobinuria (PNH) are closely related bone marrow failure disorders. It has long been recognized that de novo PNH can evolve to AA, conversely PNH clones may appear in AA. Aims: The study was done to study the expression of PNH clones in Pediatric AA patients by FLAER based Flowcytometry and to correlate PNH clone size with various clinico-hematological parameters showing evidence of hemolysis in these patients. Materials and Methods: The expression of PNH clones was studied in 50 pediatric aplastic anemia cases by Beckman Coulter cytomics FC500 from November 2017 to March 2019 in a tertiary care center Hospital. Statistical Analysis: All the results were prepared using software version of SPSS 21. Results: Out of 50 pediatric AA,27 (54%) showed PNH clones in both neutrophils and monocytes. PNH clone positivity was more in monocytes(median-0.88) as compared to neutrophils(median-0.60). On comparing hematological and biochemical parameters between positive and negative PNH clone groups, only LDH values showed statistical significant difference(p< 0.001). In PNH positive subgroups, bilirubin levels showed statistically significant difference(p=0.017). Evidence of hemolysis was seen in 2 patients with large clone size. On serial follow up of clone size in18 PNH positive AA cases, only 1case was negative for PNH clone whereas 11 cases showed expansion, 5 cases showed reduction and 1 case showed persistence. Conclusion: PNH clone should be monitored in all patients with aplastic anaemia using flowcytometry along with haematological and biochemical tests, specially LDH for timely therapy.

KEYWORDS: Aplastic anaemia, FLAER, flowcytometry, paroxysmal nocturnal hemoglobinuria

   KCBM04: Ultrastructural study of vitiligo reveals novel insights about the disease Top

Amit Yadav

Safadarjung Hospital, Delhi, India

Background: Vitiligo is an acquired pigmentary disorder of uncertain etiopathogenesis. Currently, there is a lot of interest in the cellular players at the basal epidermis and dermo- epidermal junction. There is extreme paucity of literature on ultrastructural changes in vitiligo. Aim: The study was carried out to evaluate the ultrastructural features of skin biopsies in vitiligo patients and to compare the ultrastructural features of vitiliginous skin with normal skin. Materials and Methods: A total of 15 cases of vitiligo were included. Skin punch biopsies (3 mm) were processed for electron microscopy as per standard protocol. The sections were examined under transmission electron microscope (TEM). The parameters observed were keratinocyte degeneration, type of degeneration, number of melanosomes and lamina densa thickness. Statistical Analysis: The results were statistically analysed using SPSS version 21. Results: The study included 15 vitiligo patients (8 unstable and 7 stable). Vitiliginous skin showed wide areas of vacuolar degeneration in the keratinocytes. Two distinct types of keratinocyte degeneration were observed. Electron-lucent degeneration with intracellular cytoplasmic vacuolations and electron-dense (dark) degeneration. The thickness of lamina densa layer of the basal lamina was found to be increased. Mean number of melanosomes were found to be decreased in lesional skin. Melanocytes were found to be absent in vitiliginous skin. Conclusion: The present study adds a multicellular perspective to the understanding of vitiligo pathogenesis. It demonstrates widespread damage to the epidermal melanin unit in vitiligo rather than a simple loss of melanocytes.

KEYWORDS: Keratinocyte, melanocyte, ultrastructure, vitiligo

   KCBM05: Histomorphology of the lesions of the umbilicus: Are we naive about the navel? Top

Saranya Singarel

Mumbai, Maharashtra, India

Context: Due to the extreme rarity of umbilical lesions, general surgical pathologists may not be familiar with them. Accurate diagnosis is essential for definite treatment. Aims: To study histopathology of the umbilical lesions and review pertinent literature on the embryological basis of the lesions. Settings and Design: Ten (10) year retrospective study of surgically excised umbilical lesions received for histopathology in a paediatric tertiary care hospital. Materials and Methods: We reviewed cases of umbilical lesions and classified them as a developmental and others. Developmental cases were subclassified as those due to defect in closure of body wall, defect in closure of the umbilical ring, persistence of embryonic remnants, failure of epithelization. Persistence of embryonic remnants were subdivided into omphalomesenteric duct (OMD) or urachal remnants and further into fistula, sinus and cyst. Histology of all the cases was studied. Statistical Analysis Used: Descriptive statistics were used. Results: Sixty-six (66) cases in the age range 1 day to 13 years were studied. Male preponderance was noted. OMD remnants and among them sinuses (arising from the distal tract) were found to be the most common. Histological examination of the OMD remnants showed enteric, colonic, gastric and pancreatic tissue. Conclusions: Larger studies on embryology and development are indicated. The possibilities raised in terms of regenerative medicine are also exciting.

KEYWORDS: Omphalocele sac, omphalomesenteric duct, vitelline duct, urachus, umbilical granuloma

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