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   2020| January-March  | Volume 63 | Issue 1  
    Online since January 31, 2020

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Clinicopathologic spectrum of necrotizing lymphadenitis
Indu R Nair, Suma Balan, Pooja Phalak, Menila Daniel
January-March 2020, 63(1):60-63
DOI:10.4103/IJPM.IJPM_622_19  PMID:32031124
Background: Necrotizing lymphadenitis represents a group of diseases characterized by non-granulomatous inflammation and necrosis of the lymph node, caused by a variety of infective and inflammatory diseases, most common being Kikuchi-Fujimoto disease, acute Epstein Barr viral infection and systemic lupus erythematosis (1). Objectives: To study the morphological features in lymph nodes in cases of necrotizing lymphadenitis, to correlate them with specific etiological conditions.Materials and methods-58 cases of necrotizing lymphadenitis were reviewed and categorized into different etiological sub types, i.e. acute EBV lymphadenitis, lupus lymphadenitis and the rest as Kikuchis lymphadenitis. Morphological features studied were presence of vascular proliferation, periadenitis, foamy macrophage, neutrophil and plasma cell infiltrate. Clinical follow up was done. Results: 62.2% of cases were Kikuchis lymphadenitis. Both lupus and Kikuchis had a female preponderance (78% and 62% respectively). Among the morphological parameters, plasma cell infiltration and vascular proliferation showed significant association with lupus lymphadenitis. Kikuchis and EBV lymphadenitis showed self-limiting course, with only 2 cases of Kikuchis developing recurrence .4 cases developed complications. All cases of lupus lymphadenitis needed long term therapy. Conclusion: Kikuchis lymphadenitis is the most common cause of necrotizing lymphadenitis, followed by lupus and acute EBV lyphadenitis.Young females were commonly affected in the first 2 groups. It is worthwhile to classify the cases of necrotizing lymphadenitis into etiological subgroups as the prognosis and treatment differ (2). Among the morphological features studied, plasma cell infiltrate and vascular proliferation were significantly associated with lupus lymphadenitis, hence can be used to predict etiology.
  16,056 315 2
Ki 67: Are we counting it right?
Prateek Kinra, Ajay Malik
January-March 2020, 63(1):98-99
DOI:10.4103/IJPM.IJPM_770_19  PMID:32031132
  10,121 188 2
A clinicopathological study of granulosa cell tumors of the ovary: Can morphology predict prognosis?
Prerna Guleria, Lalit Kumar, Sunesh Kumar, Neerja Bhatla, Ruma Ray, Seema Singhal, Jyoti Meena, Sandeep R Mathur
January-March 2020, 63(1):53-59
DOI:10.4103/IJPM.IJPM_403_19  PMID:32031123
Objective: Granulosa cell tumors (GCT) are low-grade malignant sex cord-stromal tumors (SCST) with late metastasis/recurrences and long disease-free periods. We performed a clinicopathological evaluation of GCT to ascertain features having prognostic impact. Materials and Methods: All cases of GCT of ovary from January 2006 to December 2018 were assessed for architectural patterns, nuclear grooves, and Call-Exner bodies. Each feature was graded on frequency of occurrence: not present (0)–very frequent (3). Anisonucleosis, necrosis, and inflammation were noted. Cases were grouped on mitotic count; <10 mitosis/10 High power field (HPF) or >=11 mitoses/10 HPF and Ki-67 index; <10% Ki-67 and >=11% Ki-67. Results: GCT formed 60.1% of SCST. Sixty cases' ages were in the range of 15–78 years (median 45). Clinical details were available in 37. Commonest presentation was abnormal uterine bleeding. Serum CA125 was raised in 16.1% and Inhibin in 58.8%. Seventy percent were in stage I. Disease recurrence was associated with higher stage (P = 0.007). The most frequent pattern was diffuse sheets (47%). Call-Exner bodies were absent in 22.2%. Grooves with score 1, 2, and 3 were seen in 35.8%, 23.5%, and 13.6%, respectively. Anisonucleosis was present in 26.7%, necrosis in 11.1%, and lympho-plasmacytic infiltrate in 43%. Out of total, 93.3% had <10 mitosis/10 HPF and 43.2% had recurrence, most with high Ki-67 (P = 0.064). Conclusion: Our study outlines histomorphological spectrum of GCT and emphasizes its frequent occurrence in lower stages with late recurrences. The presence of grooves may indicate granulosa-cell origin. Call-Exner bodies are not a necessity. Histomorphological features are not prognostically important. However, prognostic value of Ki-67 cannot be excluded. Limitation of the study was a small number of cases with follow-up.
  5,506 244 1
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January-March 2020, 63(1):166-167
  5,179 138 -
Chorioamnionitis: Establishing a correlation between clinical and histological diagnosis
Khaldoon Aljerian
January-March 2020, 63(1):44-48
DOI:10.4103/IJPM.IJPM_464_19  PMID:32031121
Introduction: Chorioamnionitis that is associated with high rates of morbidity and mortality needs an early diagnosis for effective treatment. However, views are conflicting on the effectiveness of a clinical versus a histological diagnosis of the disease. The accuracy of clinical diagnoses should be evaluated by determining their correlation with histopathological data. Methods: A total of 696 placental records from single and multiple pregnancies between January 2011 and February 2018 were collected and reviewed to determine if chorioamnionitis was present. Results: Of the 696 records, 255 had histological data available, and of these, histological evidence for chorioamnionitis was recorded in 135 (52.9%). Clinical chorioamnionitis diagnosis was insensitive (26.7%; 95% confidence interval 19.43%–34.96%) and inaccurate (61.1%; 95% confidence interval 54.90%–67.19%). As well, 73.3% of histologically positive chorioamnionitis cases were missed using clinical indicators. Discussion: Clinical diagnosis for chorioamnionitis is inaccurate; in our study, most of the positive cases were not diagnosed using clinical indicators. However, of the clinical indicators examined, maternal and fetal tachycardia were the most reliable.
  4,271 124 2
The role of tumor budding in colorectal adenocarcinoma: Possible involvement of the intestinal cancer stem cell marker Lgr5
Shaymaa A Sadek, Dalia M A. Rehim, Sohaila Fatima
January-March 2020, 63(1):32-37
DOI:10.4103/IJPM.IJPM_154_19  PMID:32031119
Background: Tumor budding (TB) is a promising prognostic factor in colorectal cancer (CRC) that is independent of tumor-node-metastasis (TNM) staging. Leucine-rich repeat-containing G-protein-coupled receptor 5 (Lgr5) is a stem cell marker and a member of the canonical Wnt-signaling cascade. It is involved in colorectal carcinogenesis. However, its role in CRC progression and TB needs to be clarified. Materials and Methods: TB was assessed in both H and E and CK immunostained sections of 92 CRC cases. Associations between TB grade and different clinicopathological parameters were evaluated. Lgr5 expression in CRC cases and its association with TB grade and other clinicopathological features was also evaluated. Results: H and E stained sections revealed low- and high-grade budding in 55 (59.8%) and 37 (40.2%) tumors, respectively, whereas Cytokeratin Immunohistochemistry (CK-IHC) showed low- and high-grade budding in 31 (33.7%) and 61 (66.3%) tumors, respectively. TB grade (in H and E and CK stained sections) was significantly associated with adverse pathological prognostic variables including vascular invasion (P = 0.03 and 0.001), lymph node metastasis (P = 0.001 and 0,001), advanced Dukes (P = 0.000 and 0.000), and TNM (P = 0.001 and 0.000) stages and inversely associated with Tumor infiltrating lymphocytes (TILS) (P = 0.02 and 0.0001) which is known to be a good prognostic indicator. Lgr5 protein was positively expressed in 52.2% (48/92) of the CRCs. Immunoreactivity of Lgr5 was significantly associated with histological grade (P = 0.01), lymph node metastasis (P = 0.002), vascular invasion (P = 0.02), TNM stage (P = 0.000), Dukes stage (P = 0.000), and TILS (P = 0.03). Furthermore, Lgr5 was found to be significantly associated with TB estimated in both H and E and CK stained tumors (P = 0.003 and 0.001 respectively). Conclusion: This study supported the relevance of TB in the assessment of CRC aggressiveness. It also revealed that Lgr5 expression is related to morphologic features in the invasive front of CRC. Lgr5 could have an important role in forming a morphologic feature at the invasive front associated with the aggressiveness of the tumor.
  3,868 147 1
Association of different patterns of expression of beta-catenin and cyclin D1 with pathogenesis of breast carcinoma
Kachnar Varma, Aprajita Chauhan, Mudita Bhargava, Vatsala Misra, Sapan Srivastava
January-March 2020, 63(1):13-18
DOI:10.4103/IJPM.IJPM_419_19  PMID:32031116
Background: Beta-catenin and cyclin D1 have attracted considerable attention in recent studies as potential proto-oncogenes in many human cancers especially colonic cancer. Beta-catenin plays multiple roles within the cell such as canonical Wnt signaling where cyclin D1 has been identified as one of its target genes. The role of beta-catenin and cyclin D1 in breast cancer has been evaluated in many studies but not established yet. Materials and Methods: The expression of beta-catenin and cyclin D1 was evaluated in 82 cases of breast carcinoma (BCa) and 32 cases of ductal carcinoma in situ(DCIS) by immunohistochemistry (IHC). Their relationship with clinicopathological features was also investigated. Statistical analysis was done to establish an association. Results: Abnormal expression of beta-catenin (ABE) was seen in 80.2% cases of invasive ductal carcinoma (IDC) and 47% cases of DCIS, while the cyclin D1 positive expression rate was 60.9% and 50%, respectively. In the cases showing ABE, cyclin D1 positivity was 88.1%. ABE showed significant association with high-grade BCa. The most common pattern of ABE was loss of membrane with nuclear positivity which is associated with worst prognosis. In addition, ABE in cases of BCa and DCIS showed concordant patterns. Conclusion: Therefore, an association exists between ABE and cyclin D1 in BCa and its precursor lesions implying that Wnt/beta-catenin oncogenic pathway may have a definite role in breast carcinogenesis and can be used for targeted therapy. Also, different patterns of beta-catenin expression may have prognostic and predictive value.
  3,332 198 5
Clear cell sarcoma like tumor of gastrointestinal tract: Experience of three cases and review of literature
Mukin Kumar Sonai, Sameer Rastogi, KS Madhusudhan, Siddhartha D Gupta, Prasenjit Das
January-March 2020, 63(1):90-95
DOI:10.4103/IJPM.IJPM_195_19  PMID:32031130
Clear cell sarcoma-like tumor of the gastrointestinal tract (CCSGT) is a rare, aggressive tumor with many histological mimickers. Herein, we have documented our experience of three cases of CCSGT and reviewed the literature. The index cases were identified in male patients in their twenties, one in jejunum and two in the distal colon. Histomorphological examination revealed the characteristic heterogeneous histomorphology with patchy immunohistochemical positivity with S100 protein and negative melanocytic markers. The fluorescence in-situ hybridization test showed translocation of the EWSR1 (22q12) gene in >80% tumor cells. While one of our patients died after 2 years with lung metastasis, the other two patients are still alive on 1.5 years and 3 months follow up, respectively. CCSGT is a rare malignant tumor of the gastrointestinal tract. Although characteristic morphology, use of a judicial panel of immunohistochemical stains, and translocation study for EWSR1 gene can establish the diagnosis, experience in adjuvant therapy is still limited.
  3,295 86 3
Molecular mechanisms of tobacco induced oral and oropharyngeal cancer: Results of a tissue microarray and immunohistochemistry-based study from a tertiary cancer center in India
Arjun Agarwal, Cheena Garg, MS Ganesh, Sreekanth Reddy
January-March 2020, 63(1):7-12
DOI:10.4103/IJPM.IJPM_783_18  PMID:32031115
Background: It is well established that chronic exposure to tobacco induces head and neck cancers but the exact etiopathogenesis is not known. Though studies have shown expression of TIMP1, EPS8 and AXL in cancers, their role in tobacco-induced cancers is not known. We aimed this study to evaluate the role of these molecules in oral and oropharyngeal squamous cell cancers (SCC). Materials and Methods: In this single institutional study, 31 patients of oral and oropharyngeal SCC with history of chewing tobacco were included. Smokers were excluded from the study. After informed consent biopsies were taken from affected and contralateral normal mucosa. Paraffin blocks were made and tissue microarray (TMA) were constructed using these blocks. Immunohistochemistry (IHC) for TIMP1, EPS8, AXL kinase was carried out on these tissue microarrays. The intensity of staining was scored from 0 to 3+, related to expression of each of the three molecules. Results: The expression of TIMP1, EPS8 and AXL kinase was significantly more in the cancerous mucosa versus non-cancerous mucosa (P = 0.000 in all three) in oral and oropharyngeal SCC exposed to chewing tobacco. Conclusion: Immunohistochemical expression of these molecular markers in oral and oropharyngeal SCC correlated with their molecular based studies. Significant IHC expression of TIMP1, EPS8 and AXL establishes their role in the pathogenesis of oral and oropharyngeal squamous cell carcinomas. Novel targeted therapies may be researched that can detect and target these molecules at an earlier stage of pathogenesis of these tumors.
  2,860 224 1
Comparison between Fluorescence in-situ Hybridization (FISH), Reverse Transcriptase PCR (RT-PCR) and fragment analysis, for detection of t (X; 18) (p11; q11) translocation in synovial sarcomas
Omshree Shetty, Trupti Pai, Mamta Gurav, Bharat Rekhi
January-March 2020, 63(1):64-72
DOI:10.4103/IJPM.IJPM_851_18  PMID:32031125
Background: Synovial sarcoma (SS) is an aggressive, but a relatively chemosensitive soft tissue sarcoma, characterized by a specific, t (X;18)(p11;q11) translocation, leading to formation of SS18–SSX chimeric transcript. This translocation can be detected by various techniques, such as fluorescence in-situ hybridization (FISH), reverse transcriptase PCR (RT-PCR) and fragment analysis. Objectives: To compare the results of detection of t (X;18)(p11;q11) translocation, across three different platforms, in order to determine the most optimal and sensitive technique. Methods: Formalin-fixed paraffin embedded (FFPE) tissue sections of 45 soft tissue sarcomas were analyzed, including 16 cases of SS confirmed by histopathology, immunohistochemistry and molecular technique (s)(Group 1); 13 cases, wherein SS was one of the differential diagnosis, preceding molecular testing (Group 2) and 16 cases of various other sarcomas (Group 3). Various immunohistochemical (IHC) markers studied, including INI1/SMARCB1. All cases were tested for t (X;18) translocation, by fragment Analysis, FISH and RT-PCR. Results: There were 23 cases of SS, including 16 of group 1 and 7 of group 2. By fragment analysis, t (X;18)(p11;q11) translocation was detected in 22/23 cases (95.6%). By FISH, SS18 gene rearrangement was detected in 18/22 cases (78.2%), whereas by RT-PCR, SS18-SSX transcripts were detected in 15/23 cases (65.2%). Immunohistochemically, a unique “weak to absent”/reduced INI1 immunostaining pattern was exclusively observed in 12/13 cases of SS (92.3%). Fragment analysis and FISH were relatively more sensitive techniques. Unique “weak to absent”INI1 immunoexpression significantly correlated with positive t (X;18) translocation results (P = 0.0001). Conclusion: The present study constitutes first such study from our subcontinent. Fragment analysis is a promising technique for detection of t (X;18)(p11;q11) translocation. FISH and INI1 immunostaining pattern were also relatively more sensitive, over RT-PCR.
  3,011 68 1
Retiform hemangioendothelioma: An uncommon vascular neoplasm
Anindita Mondal, Mou Das, Uttara Chatterjee, Chhanda Datta
January-March 2020, 63(1):122-124
DOI:10.4103/IJPM.IJPM_237_19  PMID:32031140
Retiform hemangioendothelioma is a rare vascular neoplasm of intermediate grade, the diagnosis of which can be challenging. We report a case of 35-year-old man with swelling in the postauricular region. He had undergone FNAC which had revealed blood only. Microscopic examination showed narrow, arborizing, vascular channels resembling normal rete testis. Evidence of mitoses or cytological atypia were lacking. Immunohistochemistry showed diffuse and strong staining for CD34 along with CD31 positivity. Immunostains for D240 and GLUT1 were negative. A diagnosis of retiform hemangioendothelioma was made. Histologically, it should be distinguished from Kaposiform hemangioendothelioma, Dabska tumor, epithelioid hemangioendothelioma, and angiosarcoma.
  2,724 61 1
Sinonasal NUT midline carcinoma: A new histological entity
Pragya N Vakani, Jainil Maheshwari, Mukesh Maheshwari, Bhoomi Shah
January-March 2020, 63(1):103-105
DOI:10.4103/IJPM.IJPM_373_19  PMID:32031134
Nuclear protein in testis (NUT) midline carcinoma is poorly differentiated carcinoma defined by rearrangement of NUT gene on 15 to other genes, usually BRD4 on 19. It is first described in 1991. These tumors are most commonly seen in the mediastinum and 35% occur in head and neck. It is a highly aggressive tumor with a median survival of 7 months because of ineffective chemotherapy and undefined treatment. Hence, we must differentiate these tumors from other poorly differentiated tumors. Here, we present a case of NUT midline carcinoma of 44-year male, who presented with headache and dizziness, confirmed by immunohistochemistry of NUT antibody. The aim of this case report is to increase the awareness about this entity in adults with brief review of relevant literature.
  2,649 81 -
Comparison of liquid-based cytology with conventional cytology in the evaluation of abdominal masses
Monisha Choudhury, Archna R Pahwa
January-March 2020, 63(1):73-77
DOI:10.4103/IJPM.IJPM_363_19  PMID:32031126
Context: Liquid-based cytology. Aims: Utility of liquid-based cytology (LBC) was compared to conventional smear cytology in ultrasound-guided fine-needle aspirates of abdominal masses. Settings and Design: This was a prospective comparative study conducted in collaboration with surgery and pediatrics surgery departments of our institute. Subjects and Methods: Thirty patients presenting with evidence of abdominal mass were enrolled for the study and underwent fine-needle aspiration cytology. The material was processed for the preparation of conventional smears and residual material was rinsed into cytolyt for LBC by Thin Prep method and into cell block fluid. The smears prepared from both the methods were compared by two independent and experienced pathologists for adequacy, cellularity, architectural pattern, cytoplasmic preservation, nuclear preservation, and background. Results: Cellularity was frequently higher in the conventional smears than on Thin Prep slides (P value = 0.025). Recognition of architecture was better on the conventional smears (P value = 0.001). Cytoplasm was better preserved on the conventional smears (P value = 0.001) but difference in the preservation of nuclear details was not statistically significant on slides prepared from both the techniques. The background of Thin Prep slides is significantly cleaner than direct smears (P value = 0.001). Non epithelial elements such as mucin and neurofibrillary tangles were better preserved on direct smears (P value = 0.001) but diagnostic accuracy of both the methodologies showed no statistically significant difference (P value = 0.226). Conclusions: The Thin Prep technique utilizes expensive equipment and reagents. It also generates certain morphological artefacts in slides with which a cytologist needs to get familiar. When used in isolation, it may not consistently provide any added advantage in the diagnosis of such lesions and should be used as an adjunct to conventional smears. It may be preferred in situations where material has to be transported for processing or is required for ancillary tests.
  2,424 182 -
Neonatal hemochromatosis: A rare cause of liver failure in infancy
Priyanka M Chaudhuri, Bappa Mandal, Aniket Halder, Ranajoy Ghosh, Uttara Chatterjee, Suchandra Mukherjee
January-March 2020, 63(1):138-139
DOI:10.4103/IJPM.IJPM_526_18  PMID:32031146
  2,413 64 -
Predatory publishing on the rise
Ranjan Agrawal
January-March 2020, 63(1):5-6
DOI:10.4103/0377-4929.277433  PMID:32031114
  2,176 132 -
CD57 as a routine neuroendocrine marker for liver metastasis
Adriana Caroli-Bottino, Almir S Mauricio, Vera L N. Pannain
January-March 2020, 63(1):38-43
DOI:10.4103/IJPM.IJPM_119_19  PMID:32031120
Background: The characterization of hepatic metastases as having neuroendocrine origins is essential and the main markers currently used are chromogranin A (CgA) and synaptophysin (Syn). However, these markers may exhibit certain limitations, and the use of CD56 and CD57 can also be considered, although, due to low specificity, their use is discouraged. Aim: This study sought to compare the immunohistochemical expression of these markers in hepatic metastases of neuroendocrine neoplasms (NEN). Materials and Methods: Eighteen samples, were used for immunohistochemical staining with CgA, Syn, CD56, and CD57 antibodies. The immunostaining reactions were compared according to its intensity (I), the percentage of labeled cells (P), and a final score (I × P). Statistical agreement between the markers was also evaluated. Results: CD57 was expressed in the highest number of cases and also showed the most intense expression. CgA showed the highest number of cases with more than 80% positively stained area (72.2%), followed by CD57 (61.1%). The highest average score (I × P) was obtained for CD57 (9.1 ± 4.1). The best indices of agreement were between CgA and CD57 with respect to positivity (P = 0.021) and score (P = 0.014). According to the primary site, stomach/duodenum, lungs, and undetermined subgroups showed the highest average scores for CD57, followed by CgA. For the small bowel subgroup, the highest average score was obtained for CgA, followed by CD57. Conclusion: Our results highlight the importance of CD57 in the evaluation of hepatic metastases of NEN and indicate that this marker should be included with CgA and Syn in routine diagnostic panels.
  2,156 115 1
EBV-positive T/NK-associated lymphoproliferative disorders of childhood: A complete autopsy report
Jonathan Y Keow, William M Stecho, Aaron R Haig, Nikhil A Sangle
January-March 2020, 63(1):78-82
DOI:10.4103/IJPM.IJPM_510_19  PMID:32031127
Introduction: Epstein-Barr Virus (EBV)-associated systemic T-cell lymphoproliferative disorder of childhood is a rare but severe manifestation of chronic EBV infection. Despite several case reports characterizing this rare hematological neoplasm, the literature describes extensive heterogeneity in the presentation of this disease. Case presentation: Here we present a complete autopsy of a 16-year-old girl who ultimately succumbed to EBV-associated systemic T-cell lymphoproliferative disorder of childhood. Her clinical presentation demonstrated a non-specific pharyngitis with positive mono spot test, evolving into fulminant multi-organ failure, disseminated intravascular coagulopathy, sepsis, and ultimately death. Conclusions: Post-mortem findings included extensive hemorrhage, and infiltration of the liver, spleen, lymph nodes and bone marrow with neoplastic T-cells. There was extensive hemophagocytic lymphohistiocytosis (HLH) within these organs, suggesting overlap between the EBV-associated systemic T-cell lymphoproliferative disorder of childhood and EBV-associated HLH. We hope these findings provide a more comprehensive overview of several possible manifestations of EBV-associated systemic T-cell lymphoproliferative disorder of childhood.
  2,170 49 -
Can peripheral blood findings predict bone marrow infiltration in Hodgkin lymphoma?
Sreejesh Sreedharanunni, Ram V Nampoothiri, Sweta Rajpal, Gaurav Prakash, Ashim Das, Pankaj Malhotra, Neelam Varma
January-March 2020, 63(1):156-158
DOI:10.4103/IJPM.IJPM_381_19  PMID:32031155
  2,019 82 -
First case report of tongue squamous cell carcinoma in a neurofibromatosis type 1 patient and review of pathogenesis of carcinoma in neurofibromatosis type 1
Sandip Ghose, Debasish Pramanick, Anjana Mazumdar
January-March 2020, 63(1):112-115
DOI:10.4103/IJPM.IJPM_61_19  PMID:32031137
Neurofibromatosis type 1 (NF1), also known as von Recklinghausen's disease, is a type of genodermatoses having an autosomal dominant inheritance pattern and is recently considered as a RASopathy. Such patients are very much prone to develop mesenchymal tumors. However, carcinomas are quite rare in NF1 patients. This case study is the first case of oral squamous cell carcinoma (SCC) in tongue of an NF1 patient. A 35-year-old male reported to the Department of Oral Pathology in a tertiary care center with a chief complain of a painful ulcer on tongue for last 1 month. For confirmation of diagnosis of NF1, the “Diagnostic Criteria for Neurofibromatosis Type 1” was followed. Biopsied specimen of the tongue lesion was examined under microscope and histopathological features were suggestive of infiltrating SCC. Immunohistochemistry with Pan CK and beta-catenin was positive. RASopathy, WNT–beta-catenin pathway alteration, heat shock factor 1 production, and miRNA activity are investigated to explain the pathogenesis of malignancies in NF1 patients. In this first case of tongue SCC, we have found out the altered WNT–beta-catenin pathway.
  2,031 57 2
Comparison of the efficiency of transgelin, smooth muscle myosin, and CD31 antibodies for the assessment of vascular tumor invasion and free tumor deposits in gastric, pancreatic, and colorectal adenocarcinomas
Betul Ogut, Ozgur Ekinci, Bulent Celik, Emel Rodoplu Unal, Ayse Dursun
January-March 2020, 63(1):25-31
DOI:10.4103/IJPM.IJPM_109_19  PMID:32031118
Background: This study aimed to compare CD31, smooth muscle myosin (SMM), and transgelin antibodies for their efficiency in detecting venous invasion (VI) and the nature of free tumor deposits (TDs) in gastric, pancreatic, and colorectal adenocarcinomas. Materials and Methods: Eleven Whipple, 5 gastrectomy, and 3 colectomy specimens and 1 low anterior resection specimen were reviewed and examined, revealing 254 probable foci. Foci were reviewed and divided into 3 types: Type A, the “orphan artery” pattern; Type F, free TDs in the periorgan adipose and connective tissue without an unaccompanied artery; and Type X, a focus that could be detected only with the immunohistochemical procedures mentioned. Results: No foci were positive for CD31. Transgelin staining was more sensitive than SMM staining in all focus types, Type A only and Type F only (P < 0.001, P = 0.001, and P = 0.10, respectively). In free TDs (Type F), 35.7% of the samples were negative for all four stains, and 64.2% of the samples were positive for SMM and transgelin. We did not make the distinction between a metastatic lymph node and VI in positive foci. Conclusion: We conclude that hematoxylin and eosin (H and E) staining is inadequate and that smooth muscle markers, such as transgelin and/or SMM, are more effective than endothelial markers, such as CD31, in revealing VI and lymph node/large extramural invasion.
  1,910 67 2
Monotypic angiomyolipoma of the nasal cavity: An extremely rare cause of nasal mass with recurrent epistaxis
Vinita Pandey, Yasmeen Khatib, Prajakta Gupte, Rahul Pandey, Manisha S Khare
January-March 2020, 63(1):106-108
DOI:10.4103/IJPM.IJPM_681_18  PMID:32031135
Monotypic angiomyolipoma is usually found in the kidneys and is composed predominantly of epithelioid cells which show positivity for melanocyte and smooth muscle markers. It can pose a diagnostic challenge due to a range of differential diagnosis. We report the second case of monotypic angiomyolipoma of nasal cavity and first from India in a 54-year-old male who presented with a nasal polyp. Grossly the tumor was well circumscribed and un-encapsulated. Microscopy showed a large number of epithelioid cells mixed with a few spindle cells, varying sized blood vessels, and focal areas of adipose tissue. Immunohistochemistry was positive for smooth muscle actin (SMA) and human melanoma black (HMB-45) stains. It is important to identify this tumor as it can sometimes be mistaken for malignancy and only needs endoscopic resection.
  1,906 44 3
Non seminomatous mixed germ cell tumor of the testis with predominant component of somatic type malignancy (Rhabdomyosarcoma) – A rare occurrence
Mayur Kothiya, Sonal Bhandare, Shaila Khubchandani
January-March 2020, 63(1):125-127
DOI:10.4103/IJPM.IJPM_796_18  PMID:32031141
Testicular germ cell tumors (GCT) are a diverse group of neoplasms, broadly divided into seminomatous and non seminomatous types, with varying histomorphology. Mixed germ cell tumors express more than one germ cell component. Somatic type malignancy occurring in testicular GCT is rare. Most often these components present as metastasis, particularly following chemotherapy, rather than primarily involving the testis. We describe a rare case of a young adult with no significant past history, who presented with testicular mass which on histology revealed a non-seminomatous mixed germ cell tumor with additional somatic type malignancy component of a rhabdomyosarcoma.
  1,881 40 2
Glandular-type inverted papilloma of urinary bladder – Report of a unique case with immunohistochemistry
Archana Sundaram, Kirti Gupta, Sonal Singla, Shrawan K Singh
January-March 2020, 63(1):96-97
DOI:10.4103/IJPM.IJPM_456_18  PMID:32031131
Inverted papilloma of urothelium is a rare benign tumour accounting for 1–2% of all the urothelial lesions. Morphologically, these are of two main subtypes – trabecular and glandular, of which the former subtype is most frequently encountered compared to the latter. The glandular subtype closely mimics cystitis glandularis and urothelial carcinoma with inverted growth pattern. We discuss a case of a 27-year-old male presenting with hematuria. On cystoscopy, he was found to have a bladder mass which was diagnosed as glandular-type of inverted papilloma on histopathology. The image illustrates the histopathology for easy identification and early diagnosis of this rare entity.
  1,847 49 1
Papillary tumor in pineal region: Immunohistochemistry meeting the diagnostic challenge
Shruti Dogra, Prajwala Gupta, Purnima Malhotra, Minakshi Bhardwaj
January-March 2020, 63(1):100-102
DOI:10.4103/IJPM.IJPM_102_19  PMID:32031133
Papillary tumor of pineal region (PTPR) is extremely rare and poses diagnostic challenge with other central nervous system tumors having papillary architecture. Immunohistochemistry is crucial for a definitive diagnosis of PTPR.
  1,765 75 -
Expression of alpha-methylacyl-CoA racemase in vaginal gastric-type adenocarcinoma and uterine clear cell carcinoma
Junbo Hu, Yanju Lu, Na Tang, Li Li, Peng Guo, Yanli Zhang
January-March 2020, 63(1):49-52
DOI:10.4103/IJPM.IJPM_525_19  PMID:32031122
Background: Alpha-methylacyl-coenzyme A racemase (AMACR, P504S) is a commonly used marker in immunohistochemical diagnosis of prostate cancer. Recent studies identified P504S markers of the clear cell histotype in the ovary and/or endometrium. Gastric-type adenocarcinoma (GAS) is difficult to diagnose histologically, particularly when there is crossover with clear cell carcinoma (CCC). However, the significance of P504S for differentially diagnosing GAS and CCC is unclear. Aim: To evaluate P504S as a potential diagnostic marker of GAS and CCC. Settings and Design: We analyzed P504S expression in 48 cervical carcinomas (32 GAS and 16 CCC), as well as the expression of other markers including hepatocyte nuclear factor-1 beta (HNF-1β) and NapsinA. Material and Methods: The expression differences of HNF-1β, NapsinA, and P504S in GAS and CCC were detected by immunohistochemistry. Immunohistochemical histoscores based on the intensity and extent of staining were calculated. Results: The positive rates of HNF-1β in GAS and CCC were 90.32% and 75%, respectively. (χ2 = 2.251, P = 0.663). The positive rates of NapsinA in GAS and CCC were 19.36% and 81.25%, respectively. (χ2 = 47.332, P < 0.01). The positive rates of P504S in GAS and CCC were 16.13% and 81.25%, respectively. (χ2 = 41.420, P < 0.01). HNF-1β was frequently expressed in GAS and CCC, while NapsinA and P504S were frequently expressed in CCC, and reduced or lost in GAS. Conclusion: NapsinA and P504S can be used to differentiate between GAS and CCC.
  1,734 47 -
Importance of MACC1 expression in breast cancer and its relationship with pathological prognostic markers
Nevroz A Söyleyici, Figen Aslan, Ayla S Avcıkurt, Gizem A Akgün
January-March 2020, 63(1):19-24
DOI:10.4103/IJPM.IJPM_658_19  PMID:32031117
Background: Metastasis associated colon cancer gene 1 (MACC1) is a gene that was first described as a c-Met transcription regulator causing the progression of colon cancer. In this study, protein and messenger RNA (mRNA) expression of MACC1 in breast cancer and its relationship with clinicopathological prognostic parameters were investigated. Methods: Sixty-six cases with tumors underwent radical mastectomy for invasive ductal carcinoma and 25 control cases operated for mammoplasty were included in the study. In paraffin blocks of tumor and control tissues, MACC1 expression was investigated by the immunohistochemical method and Real-time polymerase chain reaction (Real-Time PCR). In addition, vascular endothelial growth factor (VEGF) expression was examined immunohistochemically in tumor tissues. The relationship between MACC1 expression in tumor tissues, clinicopathological prognostic parameters, and VEGF was investigated. Results: In this study, protein and mRNA expressions of MACC1 were found to be higher in tumor tissues compared with normal breast tissues. MACC1 protein expression was also associated with significant poor prognostic markers, such as high histologic grade, ER negativity, and HER2 positivity. However, there was no correlation between MACC1 expression and VEGF. Conclusion: According to these results, MACC1 expression may be a marker of breast carcinoma as well as an independent predictor of poor prognosis. In addition, MACC1 may not affect angiogenesis in breast cancer or even if it has an effect, it may not be associated with VEGF. However, it would be appropriate to support these results in a larger series by investigating in vivo and in vitro studies.
  1,775 2 2
Cellular cardiac myxoma: New histopathological subtype?
Sudheer Arava, Devajit Nath, Rajashekar Palleti, Ruma Ray
January-March 2020, 63(1):144-145
DOI:10.4103/IJPM.IJPM_610_19  PMID:32031149
  1,693 59 -
Use of smooth muscle markers is better than the endothelial cell markers for identification of tumor venous invasion and extramural tumor deposits in gastrointestinal tract tumors
Prasenjit Das, Vandana Baloda
January-March 2020, 63(1):3-4
DOI:10.4103/IJPM.IJPM_284_19  PMID:32031113
  1,574 117 -
Coexistence of sclerosing polycystic adenosis and dysgenetic polycystic disease of parotid, Report of a case
Devrim Kahraman, Pınar Yalavaç, Eylem Akar, Özgür Özen, Ömer Günhan
January-March 2020, 63(1):109-111
DOI:10.4103/IJPM.IJPM_502_18  PMID:32031136
Sclerosing polycystic adenosis (SPA) is a rare benign salivary gland lesion. Dysgenetic polycystic disease (DPD), which is a histologically similar lesion, may cause a lattice-like gross appearance with bilateral enlargement of the entire salivary glands. In this report, we present a case of SPA in the right parotid and coexistent DPD involving the both parotid.
  1,641 37 1
Cellular mesenchymal epithelial transition (C-MET) gene copy number variation in gastric adenocarcinoma: A pilot search for new marker for targeted therapy in HER-2/neu resistance
Pragya Jain, Neelam Wadhwa, Mohit K Joshi, Manish Jain, Ashutosh Halder, Kiran Mishra
January-March 2020, 63(1):86-89
DOI:10.4103/IJPM.IJPM_396_19  PMID:32031129
Increasing HER-2/neu resistance in gastric carcinoma has encouraged search for new biomarkers for targeted therapy. Cellular mesenchymal epithelial transition (C-MET) is one such tyrosine kinase inhibitor proposed for personalized salvage treatment. We determined frequency of C-MET gene copy number variation (CNV) by Fluorescent in-situ hybridization (FISH) in gastric adenocarcinoma (GAC) and sought its correlation with conventional clinicopathologic parameters. Dual-coloured FISH was done on 32 GAC cases. C-MET gene and centromere 7 signals were counted under fluorescent microscope and ratio was calculated for each case. Correlation between C-MET CNV and conventional clinic-pathologic parameters was done by Fischer exact test. CNV was identified in the form of amplification and polysomy (3.1% each) and associated with poorer prognostic parameters. Our pilot study highlights limited subset of patients that may benefit from anti-C-MET-targeted therapy and thus could be a novel biomarker for targeted intervention in GAC.
  1,591 49 -
Leptomeningeal involvement by relapsed follicular lymphoma detected by flow cytometry despite exceedingly low white blood cell counts in cerebrospinal fluid: A case report
Safina Hafeez, Woo Cheal Cho, Peter Shen
January-March 2020, 63(1):131-133
DOI:10.4103/IJPM.IJPM_67_19  PMID:32031143
Follicular lymphoma is usually an indolent non-Hodgkin lymphoma that rarely involves the central nervous system (CNS) and flow cytometric detection of such lymphoma in cerebrospinal fluid (CSF) is often challenging because of low cellularity and viability of CSF samples. Here, we report our experience in a 52-year-old man whose relapsed follicular lymphoma with leptomeningeal involvement was confirmed by flow cytometric analysis of CSF, despite an exceedingly low white blood cell count (3/cumm).
  1,548 35 -
Idiopathic calcinosis cutis in a young male: A cytological diagnosis with histopathological correlation
Anupama Arya, Gaurav Shelgaonkar, Sahibinder S Bhatti, Dilip Kumar, Poonam Das
January-March 2020, 63(1):140-141
DOI:10.4103/IJPM.IJPM_206_19  PMID:32031147
  1,525 42 -
Uncommon affliction of a common disease - primary tuberculosis of thyroid gland
Anusree Majumder, Debraj Sen
January-March 2020, 63(1):83-85
DOI:10.4103/IJPM.IJPM_719_18  PMID:32031128
Tuberculosis (TB) continues to be a major public health problem in India. With an annual incidence rate of 2.8 million new cases, India accounts for a quarter of the global TB burden. Primary thyroid TB still remains a rare entity even in this era of global TB pandemic. Here we discuss a case of primary thyroid TB in a 22-year-old immunocompetent male patient presenting with a thyroid swelling followed by non-healing sinus tract after fine-needle aspiration cytology (FNAC) procedure. TB is a known common cause for development of chronic sinuses and ulcers. However, the primary involvement of thyroid gland along with formation of non-healing sinus tract post FNAC make it a most unusual case posing a diagnostic challenge to the unsuspecting physician.
  1,506 56 -
Myeloma co-existing with prostatic carcinoma: Clues from a “non-coagulable” prothrombin time
Jasmita Dass, Suchi Mittal, Nitin Gupta, Jyoti Kotwal
January-March 2020, 63(1):151-153
DOI:10.4103/IJPM.IJPM_320_18  PMID:32031153
  1,466 36 -
Amyloidosis masquerading as gastric carcinoma - A case report
Janani Mathialagan, S Sowmya
January-March 2020, 63(1):119-121
DOI:10.4103/IJPM.IJPM_258_19  PMID:32031139
The authors here present a rare case of systemic amyloidosis with multiple myeloma. The patient was a 55-year-old man who presented with complaints of dysphagia and skin lesions. From clinical examination and endoscopic findings, gastric carcinoma was suspected and biopsy was taken from the gastric lesion. Histopathological examination of gastrointestinal biopsy revealed amyloid deposits. The patient also had multiple skin lesions, which also showed cutaneous amyloidosis. Owing to the presence of gastric amyloidosis, the patient was investigated further with serum electrophoresis and bone marrow biopsy, which revealed multiple myeloma.
  1,432 56 -
Uncommon presentation of a common tropical infection
Ujjwayini Ray, Soma Dutta, Syamasis Bandyopadhyay, Susovan Mondal
January-March 2020, 63(1):161-163
DOI:10.4103/IJPM.IJPM_306_18  PMID:32031157
  1,422 63 -
A histopathological rarity: Primary signet ring cell carcinoma arising within a colonic villous adenoma
Sunitha Jacob, Najah R Zayyani
January-March 2020, 63(1):136-137
DOI:10.4103/IJPM.IJPM_811_18  PMID:32031145
  1,382 38 -
Green plasma in a female blood donor taking oral contraceptive pill
Manish Raturi, Divya Rai
January-March 2020, 63(1):142-143
DOI:10.4103/IJPM.IJPM_287_19  PMID:32031148
  1,306 69 2
From Editor's desk
Ranjan Agrawal
January-March 2020, 63(1):1-2
DOI:10.4103/0377-4929.277437  PMID:32031112
  1,305 64 -
Giant variant of acquired perforating dermatosis, clinically masquerading as a sarcoma: A report of a rare case
Lalani De Silva, MD S. Lokuhetty
January-March 2020, 63(1):128-130
DOI:10.4103/IJPM.IJPM_837_18  PMID:32031142
Acquired perforating dermatosis is a group of disease characterized by transepidermal elimination of altered dermal constituents of unknown pathogenesis. The giant variant was first described in 2006, as an emerging entity with seven reported cases to date. Here is an 83-year-old male presented with a 4-year history of gradually enlarging soft tisssue mass with ulcerartions at the left knee joint. Imaging revealed an extra-articular, single, heterogeneous, multinodular mass, suspicious for a soft tissue sarcoma. Wide local excision of the mass showed fleshy, hemorrhagic nodules communicating with epidermal ulcers. Microscopy showed cystic spaces straddling dermis and subcutis, containing eosinophilic, amorphous, granular material extruding through epidermal craters, surrounded by exuberant myofibroblastic proliferation. Trichrome and van-Gieson stains confirmed that the extruded material is collagen and the histology was compatible with the giant variant of acquired perforating collagenosis. Awareness of histological appearance prevents misdiagnosis and overtreatment of this entity, masquerading as a sarcoma clinically.
  1,333 33 -
Myelomatous ascites: Flow cytometric diagnosis and evolution of phenotype
Jasmita Dass, Gaurav Dhingra, Nitin Gupta, Jyoti Kotwal
January-March 2020, 63(1):154-156
DOI:10.4103/IJPM.IJPM_450_18  PMID:32031154
  1,259 42 -
Bronchogenic cyst presenting as content of omphalocele – A case report
Kusuma Venkatesh, Karishma Pillarisetty
January-March 2020, 63(1):116-118
DOI:10.4103/IJPM.IJPM_841_18  PMID:32031138
Bronchogenic cyst (BC) is a very rare congenital anomaly occurring due to budding of the primitive foregut, and its common location is the posterior mediastinum. BC when diagnosed prenatally can be treated if it is encroaching on the development of lungs. BC has been reported in other locations such as cervical, thoracic, abdominal sites and also as subcutaneous lesions. Omphalocele is a congenital malformation occurring due to a central defect in the abdominal wall with herniation of the viscera. The nonentity documented here was found in a female fetus with 20 weeks of gestational age. The mother was a primigravida who had antenatal ultrasound scan rendering diagnosis of a live fetus having abdominal wall defect with omphalocele. This case is exceptionally rare as the content of omphalocele was BC having a classical wall lined by pseudostratified ciliated columnar epithelium overlying band-like cartilage. The extensive search in the literature did not reveal another similar case.
  1,239 38 1
Synchronous malignancies: A tale of two different tumors
Manju Kaushal, Poojan Agarwal, Nishit Srivastava, Deborshi Sharma, Minakshi Bhardwaj, Arvind Ahuja
January-March 2020, 63(1):147-149
DOI:10.4103/IJPM.IJPM_468_18  PMID:32031151
  1,219 50 -
Tender migratory nodules on lower limb – A case report of human subcutaneous dirofilariasis
Anuradha Kakkanatt Babu
January-March 2020, 63(1):159-160
DOI:10.4103/IJPM.IJPM_218_19  PMID:32031156
  1,186 34 -
Primary adenocarcinoma of ciliary body: An exceptional rare tumor
Dilip K Mishra, Swathi Kaliki
January-March 2020, 63(1):134-135
DOI:10.4103/IJPM.IJPM_37_19  PMID:32031144
  1,164 49 -
Metastatic hepatocellular carcinoma in brain masquerading as rhabdoid CNS tumor – A case report
Harish Kumar, Prateek Kinra, Ajay Malik
January-March 2020, 63(1):145-147
DOI:10.4103/IJPM.IJPM_86_19  PMID:32031150
  1,162 50 -
The chicken or the egg: An intriguing case of Ewing's sarcoma/primitive neuroectodermal tumor, adrenal to breast or vice versa?
Ritika U Bhat, Ketan D Ingle, S Sudhamani, Prakash M Roplekar
January-March 2020, 63(1):150-151
DOI:10.4103/IJPM.IJPM_326_19  PMID:32031152
  1,168 36 1
Catechism (Quiz 7)
Bharat Rekhi, Munita Bal
January-March 2020, 63(1):164-164
  698 102 -
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