Utility of P63 in Differentiating Giant Cell Tumor from Other Giant Cell-Containing Lesions

OBJECTIVE

To assess P63 expression in giant cell-containing lesions of the bone (GCLB) and to determine its utility in differentiating giant cell tumor of the bone (GCTB) from other GCLBs.

MATERIAL AND METHOD

Cases diagnosed as GCLB on histopathology were included in the study. P63 immunohistochemistry was performed in all the cases. The percentage of cells showing nuclear positivity was assessed in the non-giant cell component. Statistical analysis was performed using the Mann-Whitney U test.

RESULTS

Of the total 53 cases studied, the majority were GCTBs (23), followed by 12 cases of chondroblastomas (CBL) and 18 other giant cell lesions (GCLs). All giant cell-containing lesions except one case of CBL and brown tumor of hyperparathyroidism (BTH) showed P63 staining in the non-giant cell component. However, the mean P63 labeling of GCT (52.6%) was higher compared to CBL (28.3%), aneurysmal bone cyst (ABC) (15.2%), non-ossifying fibroma (NOF) (24.5%), giant cell lesion of small bones (GCLSB) (11%), BTH (6.8%) and chondromyxoid fibroma (CMF) (12.3%), with a p-value of < 0.001.

CONCLUSION

Although p63 was present in majority of the GCLBs, its percentage positivity was significantly higher in GCTB compared to the other GCLBs. The diagnosis of GCTB is likely if cut-off value of > 50% is applied.

To compare the optimal cytoreduction rate in advanced epithelial ovarian cancer stage III/IV after 3 versus 6 cycles of neoadjuvant chemotherapy

This study aimed to compare the impact of 3 versus 6 cycles of neoadjuvant chemotherapy (NACT) on the optimal cytoreduction in patients of advanced ovarian malignancy during interval debulking surgery (IDS). Thirty patients with advanced-stage IIIc/IV epithelial ovarian cancer, fallopian tube cancer, and primary peritoneal cancer were randomly allocated to receive 6 cycles in the late IDS group versus 3 cycles in early IDS before undergoing interval debulking surgery. A higher percentage of patients achieved optimal cytoreduction in the late IDS group compared to the early IDS group (60 versus 23%) which was statistically significant (p = .010). Giving 6 cycles of NACT before surgery increased the odd of optimal cytoreduction by 10 than giving 3 cycles of NACT which was statistically significant (p = 0.046) Thus, we conclude that administering 6 cycles of neoadjuvant chemotherapy before debulking surgery helps in achieving optimal cytoreduction in a higher number of patients with lesser surgical morbidity.IMPACT STATEMENTWhat is already known on the subject? Currently, there are no established criteria that would help to determine the number of chemotherapy cycles before debulking surgery in patients with advanced ovarian malignancy.What do the results of this study add? Administering 6 cycles of neoadjuvant chemotherapy before debulking surgery helps in achieving optimal cytoreduction in a higher number of patients with lesser surgical morbidity in cases of advanced epithelial ovarian cancer.What are the implications of these findings for clinical practice and/or further research? We conclude that late interval debulking may be used as a treatment option in the advanced stage IIIc/stage IV. However, the findings need to be studied in a larger study group with a longer follow up period.

Allosteric Regulation of Cyclin-B Binding by the Charge State of Catalytic Lysine in CDK1 Is Essential for Cell-Cycle Progression

Cyclin-dependent kinase 1 (CDK1) is essential for cell-cycle progression. While dependence of CDK activity on cyclin levels is well established, molecular mechanisms that regulate their binding are less understood. Here, we report for the first time that CDK1:cyclin-B binding is not default but rather determined by the evolutionarily conserved catalytic residue, lysine-33 in CDK1. We demonstrate that the charge state of this lysine allosterically remodels the CDK1:cyclin-B interface. Cell cycle-dependent acetylation of lysine-33 or its mutation to glutamine, which mimics acetylation, abrogates cyclin-B binding. Using biochemical approaches and atomistic molecular dynamics simulations, we have uncovered both short-range and long-range effects of perturbing the charged state of the catalytic lysine, which lead to inhibition of kinase activity. Specifically, although loss of the charge state of catalytic lysine did not impact ATP binding significantly, it altered its orientation in the active site. In addition, the catalytic lysine also acts as an intra-molecular electrostatic tether at the active site to orient structural elements interfacing with cyclin-B. Physiologically, opposing activities of SIRT1 and P300 regulate acetylation and thus control the charge state of lysine-33. Importantly, cells expressing acetylation mimic mutant of Cdc2/CDK1 in yeast are arrested in G2 and fail to divide, indicating the requirement of the deacetylated state of the catalytic lysine for cell division. Thus, by illustrating the molecular role of the catalytic lysine and cell cycle-dependent deacetylation as a determinant of CDK1:cyclin-B interaction, our results redefine the current model of CDK1 activation and cell-cycle progression.

Current Microbiological Trends of Chronic Suppurative Otitis Media in a Tertiary Care Centre, Mysuru, India

The aim of the study was to re- evaluate the current bacteriological profile of chronic suppurative otitis media and to know their antibiotic sensitivity pattern to commonly used antibiotics. To provide a guideline for empirical antibiotic therapy when culture facilities are not available. Observational study. Patients who presented to Ear, Nose and Throat department with chronic or recurrent ear discharge and on clinical examination found to have actively discharging ears were selected. Patients who did not receive antimicrobial therapy (topical or systemic) for the last 7 days were included. Out of the 106 ear swabs processed, bacterial growth was found in 100 samples (94.33%), while 6 samples (5.66%) showed no growth. The results revealed Pseudomonas aeruginosa as the most isolated bacteria (49%), followed by Staphylococcus aureus (18%). Antibiotic susceptibility-Pseudomonas aeruginosa was sensitive to Cefoperazone-Sulbactam (96%), Imipenem (82%), Piperacillin-Tazobactam (82%), Amikacin in 82% and Gentamicin (76%). It was found that Pseudomonas was sensitive to Ciprofloxacin in only 57% of the cases. Staphylococcus aureus isolates were sensitive to Vancomycin in 90%, Gentamicin in 81%, Clindamycin in 72%, and Erythromycin in 45%. It was found that 100% of the isolates were resistant to Ciprofloxacin. Our findings highlight the importance of continuous and periodic evaluation of microbiological pattern and antibiotic sensitivity of isolates in chronic suppurative otitis media patients to decrease the potential risk of complications by early institution of appropriate treatment.

Reliability of the ultrasound classification system of thyroid nodules in predicting malignancy

AIM

This study aims to evaluate the reliability of the Ultrasound (U) Classification system in predicting thyroid malignancy by using pathology diagnosis as the reference standard.

MATERIALS AND METHODS

It was a cross sectional study carried out at Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Malaysia. Records of patients with focal thyroid nodules on ultrasound (US) for which US guided fine needle aspiration cytology (FNAC) was performed and pathology results were available, from January 2014 to May 2016 were selected for review. Correlation of the U Classification with pathology results was assessed. Sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, predictive value, negative predictive value and accuracy were calculated in a conservative and nonconservative method. The threshold for statistical performance was set at 0.05. Each sonographic feature was also compared with its pathology results.

RESULTS

A total of 91 patients with 104 nodules were eligible. 12 nodules out of 104 (11.5%) were malignant. The sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, positive predictive value, negative predictive value and accuracy were 100%, 91.3%, 11.5, 0.0, 60%, 100% and 92.3%, and 100%, 91.4%, 11.7, 0.0, 78.6%, 100% and 93.5%, for the non-conservative and conservative method of calculations respectively.

CONCLUSION

The U Classification is reliable in predicting thyroid malignancy. More evidence is nevertheless necessary for widespread adaptation and use.

The follow-up of post-mastectomy patients: Should the ipsilateral side be assessed with both mammogram and ultrasound?

AIM

This study aimed to determine findings of axillary view mammogram (MMG) and ultrasound (USG) of the ipsilateral side in post-mastectomy patients and to document difficulty level in performing the axillary view and patients' pain level during the procedure.

METHODS

Post-mastectomy patients who had MMG and USG on follow-up during an 18-months period were included. The MMG and USG findings of 183 patients were reviewed and histology results were recorded when available. Radiographers' difficulty and patients' pain level during the axillary view MMG were charted.

RESULTS

On MMG, 172 cases were normal, eight cases were benign (Category 2) and three cases indeterminate (Category 3). On USG, 175 cases were normal, three cases were benign (Category 2) and five cases indeterminate (Category 3). Malignant lesions detected in two out of 183 patients (1%) were metastatic carcinoma in bilateral axillary lymph nodes and leiomyosarcoma at the mastectomy site. These two cases were Category 3 on USG with negative MMG findings. In majority of cases (79%), the radiographer had no difficulty performing the axillary view compared with contralateral MMG. Majority of patients (80%) experienced similar pain during axillary view compared to contralateral MMG.

CONCLUSION

Follow-up imaging of post-mastectomy patients should include (i) USG of the mastectomy site, both axillary regions, and the contralateral breast, and (ii) MMG of the contralateral side. Ipsilateral axillary view MMG is not necessary.

Significance of epithelial cell clusters in pseudomyxoma peritonei

BACKGROUND

Pseudomyxoma peritonei (PMP) is a rare clinical syndrome characterised by distension of the peritoneum by jelly-like ascites. Cytological evaluation of peritoneal fluid is often an initial diagnostic test for possible ovarian and/or appendiceal primary tumours.

AIMS AND OBJECTIVES

The present work was conducted to study the usefulness of peritoneal fluid cytomorphology in the early diagnosis of PMP and to evaluate the significance of the presence of epithelial cell (EC) clusters and their prognostic implications.

MATERIALS AND METHODS

We evaluated the detailed cytological features of 21 cases of PMP retrospectively. Both conventional and liquid-based cytology smears of peritoneal fluid were reviewed, cytological features were compared with histological findings and cases were classified into disseminated peritoneal adenomucinosis (DPAM) and peritoneal mucinous carcinomatosis (PMCA).

RESULTS

In our study, the common causes of PMP were primary gastrointestinal malignancies (appendix and colorectal, 57.14%), followed by primary ovarian mucinous neoplasms (28.57%) and synchronous ovarian and appendicular tumours (14.28%). Thick mucinous material was present in all cases (100%). ECs were present in 18 of 21 (85.17%) patients, with mild nuclear atypia in the majority of cases. Histiocytes, mesothelial cells and fibroblast-like, spindle-shaped cells with entrapped mucin were also noted in the background. The cases of PMCA showed greater numbers of EC clusters in cytology smears and these patients had recurrent episodes of PMP.

CONCLUSION

On cytomorphology, high-grade tumours were more cellular and frequently showed EC clusters with moderate to severe atypia, prominent nucleoli and mitosis, and were more prone to PMCA.

Role of high resolution ultrasound in ulnar nerve neuropathy

AIM

This study was conducted to measure the cross sectional area (CSA) of the ulnar nerve (UN) in the cubital tunnel and to evaluate the role of high-resolution ultrasonography in the diagnosis of ulnar nerve neuropathy (UNN).

MATERIALS AND METHODS

This was a cross sectional study with 64 arms from 32 patients (34 neuropathic, 30 nonneuropathic). Diagnosis was confirmed by nerve conduction study and electromyography. The ulnar nerves were evaluated with 15MHz small footprint linear array transducer. The ulnar nerve CSA was measured at three levels with arm extended: at medial epicondyle (ME), 5cm proximal and 5cm distal to ME. Results from the neuropathic and nonneuropathic arms were compared. Independent T-tests and Pearson correlation tests were used. P value of less than 0.05 was considered significant.

RESULTS

Mean CSA values for the UN at levels 5cm proximal to ME, ME and 5cm distal to ME were 0.055, 0.109, 0.045 cm(2) respectively in the neuropathic group and 0.049, 0.075, 0.042 cm2 respectively in the non-neuropathic group. The CSA of the UN at the ME level was significantly larger in the neuropathic group, with p value of 0.005. However, there was no statistical difference between the groups at 5cm proximal and distal to the ME, with p values of 0.10 and 0.35 respectively.

CONCLUSION

There is significant difference in CSA values of the UN at ME between the neuropathic and non-neuropathic groups with mean CSA value above the predetermined 0.10cm(2) cut-off point. High-resolution ultrasonography is therefore useful to diagnose and follow up cases of elbow UNN.

Delayed onset renal failure in a patient on tenofovir based antiretroviral regimen

Tenofovir is recommended as one of the first line agents in combination with other antiretroviral drugs for management of human immunodeficiency virus (HIV). It is known to cause renal failure after exposure for a median duration of 5 months. We report tenofovir induced adverse drug reaction in a 56-year-old female patient who was diagnosed to have HIV 1 infection since 10 years. The combination antiretroviral treatment included tenofovir, emtricitabine and ritonavir/lopinavir regimen since the last 6 years. She presented with recent onset renal failure and renal biopsy showed interstitial nephritis which could probably attributable to tenofovir.

Mean gestation at delivery and histological chorioamnionitis correlates with early-onset neonatal sepsis following expectant management in pPROM

This prospective observational study was carried out in India among 100 women with preterm pre-labour rupture of membranes (pPROM) between 26(0/7)-33(0/7) weeks on expectant management in order to correlate early-onset neonatal sepsis (EONS) with various features of chorioamnionitis. The incidence of pPROM during the study period of 1.5 years was 7%. The mean gestation at pPROM was 30(6/7) ± 1.8 weeks and at delivery was 32(1/7) ± 1 weeks. Features of chorioamnionitis in the form of clinical, microbiological, histological or a combination of these were observed in 70/100 women. Clinical chorioamnionitis was seen in 16%, bacterial isolates were present in 30% on cervical swab and in 39% on placental membrane culture and 19% had histological chorioamnionitis. EONS was present in 23/97 (24%). Clinical chorioamnionitis (p = 0.069), bacterial isolates on cervical swab (p = 0.56) or placental membranes (p = 0.39) were not found to predict EONS; whereas histological chorioamnionitis (p = 0.002) and lower gestation at delivery (p = 0.013) were significantly associated with EONS.

The comparative accuracy of ultrasound and mammography in the detection of breast cancer

AIM

This study was performed to determine the accuracy of ultrasound (USG) as compared to mammography (MMG) in detecting breast cancer.

METHODS

This was a review of patients who had breast imaging and biopsy during an 18-month period. Details of patients who underwent breast biopsy were obtained from the department biopsy record books and imaging request forms. Details of breast imaging findings and histology of lesions biopsied were obtained from the hospital Integrated Radiology Information System (IRIS). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of USG and MMG were calculated with histology as the gold standard.

RESULTS

A total of 326 breast lesions were biopsied. Histology results revealed the presence of 74 breast cancers and 252 benign lesions. USG had a sensitivity of 82%, specificity of 84%, PPV = 60%, NPV = 94% and an accuracy of 84%. MMG had a sensitivity of 49%, specificity of 89%, PPV = 53%, NPV = 88% and an accuracy of 81%. A total of 161 lesions which were imaged with both modalities were analyzed to determine the significance in the differences in sensitivity and specificity between USG and MMG. Sensitivity of USG (75%) was significantly higher than sensitivity of MMG (44%) (X(2)1=6.905, p=0.014). Specificity of MMG (91%) was significantly higher than specificity of USG (79%) (X(2)1=27.114, p<0.001). Compared with MMG, the sensitivity of USG was 50% (95% CI 10%-90%) higher in women aged less than 50 years (X(2)1=0.000, p=1.000) and 27% (95% CI 19%-36%) higher in women aged 50 years and above (X(2)1=5.866, p=0.015). Compared with MMG, the sensitivity of USG was 40% (95% CI 10%-70%) higher in women with dense breasts (X(2)1=0.234, p=0.628) and 27% (95% CI 9%-46%) higher in women with non-dense breasts (X(2)1=4.585, p=0.032).

CONCLUSION

Accuracy of USG was higher compared with MMG. USG was more sensitive than MMG regardless of age group. However, MMG was more specific in those aged 50 years and older. USG was more sensitive and MMG was more specific regardless of breast density. In this study, 20% of breast cancers detected were occult on MMG and seen only on USG.

Electric-field-induced switchable dark conglomerate phases in a bent-core liquid crystal exhibiting reverse columnar phases

Electric-field-induced transitions into switchable dark conglomerate (DC) phases from two types of reverse columnar mesophases have been observed in the bent-core (BC) compound 2,7-naphthylene bis[4-(3-methyl-4-n-tetradecyloxybenzoyloxy)] benzoate. Optical and x-ray studies show that the higher temperature columnar phase corresponds to the orthogonal B(1rev) phase, whereas the lower temperature columnar phase is a variant of the B(1revtilt) phase. As the layer fragments in this phase are modulated in order to relieve the steric hindrance caused by an anticlinic tilting in adjacent blocks, it has been named B(1revtiltM). The shape of the chiral domains are different in the DC phases viz. DC-B(1rev) and DC-B(1revtiltM) obtained by applying the electric field in the B(1rev) and B(1revtiltM) phases, respectively. While the chiral domains in the DC-B(1rev) phase appear similar to those observed in other DC phases, the shape of the domains in the DC-B(1revtiltM) phase appear to have some similarity to the domains in the banana leaf texture in the B(1revtiltM) phase implying that the detailed structure in this DC phase may be different. Optical observations, electro-optics, and dielectric studies show that the DC-B(1rev) and DC-B(1revtiltM) phases are both switchable and possess a local SmC(S)P(F) type of structure. As the temperature is decreased the switching behavior changes from ferroelectric to antiferroelectric. The temperature at which this changeover starts occurring coincides with the temperature at which the layer modulation occurs to overcome anticlinic tilt and the B(1rev) to B(1revtiltM) phase transition takes place without the application of the electric field. The change in switching behavior is attributed to a transformation into flat layers with the SmC(A)P(A) type of structure as also evidenced by the nucleation of bright regions alongside the chiral domains.

Large pulmonary hamartoma with "popcorn" like calcification

-

Adrenal histoplasmosis: An unusual cause of adrenomegaly

Histoplasmosis is a geographically restricted form of fungal infection. Adrenal involvement is seen in disseminated disease but sometimes it may be the only site of demonstrable disease. Early diagnosis and treatment may save the patient from catastrophic adrenal insufficiency. We present two patients showing bilateral adrenomegaly on ultrasonography and contrast-enhanced CT, and was diagnosed to have histoplasmosis on fine-needle aspiration cytology.

Polar switching in the smectic- A(d)P(A) phase composed of asymmetric bent-core molecules

We have studied mesogenic properties in the smectic- A(d)P(A) phase of an asymmetric bent-core liquid crystal by means of polarizing optical microscopy, second-harmonic generation (SHG), electro-optical (EO), and dielectric measurements. In homeotropically aligned cells, EO switching is clearly observed from a schlieren texture with both four- and two-brush defects to a uniform bright domain under the application of very low in-plane electric field below 1 V/microm. The phase is SHG active under an electric field, i.e., SHG gradually increases without a threshold and saturates with the increasing field. In homogeneous cells, by applying triangular wave field at saturated voltage, the splitting of the polarization switching current peak is observed, indicating that the mesophase is antiferroelectric. The dielectric studies indicate a Debye-type relaxation of the transverse dipoles associated with the rotation of the molecules about their long axis. The dc bias-dependent dielectric relaxation time and the dielectric strength suggest that a field-induced antiferroelectric-ferroelectric phase transition occurs continuously beyond 1.2 V/microm and is reversible. The field-dependent texture observation is consistent with the dielectric measurements. Two possible models are proposed to interpret the continuous phase transition.

Endodermal sinus tumor: a rare cause of calcified peritoneal implants

Calcified peritoneal implants have been attributed to various malignant and benign causes. We present an interesting case of a 32-year-old woman who presented with abdominal pain, distension and vaginal bleeding. Contrast-enhanced computed tomography revealed calcified peritoneal implants with a malignant ovarian mass. Histopathology showed an endodermal sinus tumor, a rare cause of calcified peritoneal carcinomatosis.