Copy number variations in male breast cancer

Common copy number variations often contain cancer-related genes and are likely to play a role in carcinogenesis. Different mechanisms of tumorigenesis are suggested in female and male breast cancer because of different molecular profiles. The cytogenetic analysis of GTG-banded chromosomes was performed in six male patients with infiltrating ductal carcinoma and six healthy male controls matched for age. Single-nucleotide polymorphism (SNP) array analysis was performed in male breast cancer (MBC) patients. Cytogenetic analysis found aberrations previously implicated in cancer. SNP array analysis in patients revealed a gain of Xp11.23, 8p23.2, Yq11.221, Yq11.3 (AZF region), 12p11.21, 18q12.1, and 17q21.3; a loss of Yq11.222 and 7q11.21; and a loss of heterozygosity of 4p16.3, 6p12.3, 6p22.2-p21.31, 7p14.2-14.1, 18q11.2-q12.1, 20p11.23-11.1, 20q11.21-11.23, 1q25.2-q25.3, 2q11.1-q11.2, 5q23.1-23.2, 11p15.4-15.3, and 22q13.1-13.31. Some of these variations, especially those of the Y-chromosome, have not been reported earlier. Chromosomal loci identified by SNP array harbor genes were reported to be associated with cancer progression and metastasis, indicating their involvement in MBC also.

Expression of Cyclin-D1 and p53 as Prognostic Markers in Treatment of Oral Squamous Cell Carcinoma

Cyclin D1 and p53 play an important role in tumorigenesis of human cancers. The present study aims to evaluate cyclin D1 and p53 expression in resectable OSCC, and to determine their prognostic significance at the end of 5 year follow-up: A total of 100 patients aged 31-74 years, stage 3/4 were recruited. Cyclin D1 and p53 expression in the tumour tissue was estimated by IHC and was statistically correlated with demographic and clinicopathological data and prognosis was evaluated at the end of 5 year outcome. The positive expression rate of cyclin D1 was 50% and p53 it was 40% and they neither showed any statistical significant correlation with each other nor with demographic or clinicopathological data. The OS was 32%.Negative and weak expression predicted better outcomes with regard to DFS and OS. DFS and OS were significantly worse in patients of overexpressed cyclin D1 (p < 0.001) and p53 (p = 0.008). Cyclin D1 is a better prognostic marker as compared to p53 for both DFS and OS. p53 expression (high versus low) for disease free non-survival and overall nonsurvival showed an OR of 3.576 (p = 0.003) and 8.803(p < 0.001) respectively for strong expression while in case of cyclin D1 it showed an OR of 13.067(p < 0.001) and 37.465(p < 0.001) for strong expression.So higher the level of expression of tumour markers higher is the odds ratio so poorer is the prognosis. Overexpression of cyclin D1 and p53 was significantly associated with poor prognosis in terms of DFS and OS.

RAD51 135G>C polymorphism in esophageal cancer and meta-analysis in gastrointestinal tract cancers

Background

A functional single-nucleotide polymorphism (SNP), 135G>C in the 5'UTR of the RAD51 gene, affects gene transcription activity with implications for the repair of damaged DNA related to tumorigenesis. Previous limited reported genetic studies to link the 135G>C polymorphism of RAD51 gene to the risk of gastrointestinal tract (GIT) cancers, especially esophageal cancer (EC), have been inconclusive.

Materials and Methods

The polymorphism was evaluated by RFLP-PCR in 252 EC patients and 252 healthy controls from Amritsar, Punjab, India, for case-control study. For a meta-analysis, a total of 78 studies on GIT cancers were assessed, out of which 14 eligible studies (including the present study) comprising 2842 cases and 3224 controls were included. Odds ratios (ORs) with 95% confidence intervals (CIs) and Chi-square test were used to assess the association in different inheritance models.

Results

The GC genotype (OR: 0.45, 95% CI: 0.29-0.68) and C allele (OR: 0.52, 95% CI: 0.36-0.75) were significantly lower (P = 0.0005) in cases as compared to controls. There was no significant association with any genetic model in the meta-analysis.

Conclusion

C allele provides protection for EC in the studied population contrary to previous reports in Polish, Chinese population probably due to ethic differences. Compared with previous meta-analysis on individual GIT cancers, present meta-analysis included all GIT cancers but found no association.

Association of VEGF haplotypes with breast cancer risk in North-West Indians

BACKGROUND

Angiogenesis is a complex and coordinated process regulated by different growth factors and is one of the hallmark features of cancer. VEGF is one of the most important endothelial cell mitogen and has a critical role in normal physiological and tumor angiogenesis. The objective of this study was to investigate the potential association of haplotypes of six VEGF polymorphisms with breast cancer risk in North-West Indians.

METHODS

Samples of 250 breast cancer patients and 250 age and sex matched controls were genotyped for VEGF -2578C/A, -2549I/D, -460T/C, +405C/G, -7C/T and +936C/T polymorphisms. Haplotypes were generated to determine the better contribution of VEGF polymorphisms to breast cancer risk.

RESULTS

Haplotypes CDTCCC (OR = 0.56, 95%CI, 0.38-0.81; p = 0.003) and CDTGCC (OR = 0.63, 95%CI, 0.44-0.92; p = 0.018) of VEGF -2578C/A, -2549I/D, -460T/C, +405C/G, -7C/T and +936C/T polymorphisms were significantly associated with decreased risk of breast cancer. CDTCCC haplotype was also significantly associated with reduced risk of breast cancer in pre and post menopausal as well as both obese and non obese patients. Haplotype CDTGCC was marginally associated (p = 0.07) with reduced risk of breast cancer in non-obese patients as compared with non-obese controls where as haplotype AICGTC was marginally associated (p = 0.09) with reduced risk of breast cancer in obese patients when compared with non-obese patients. The CDTGCC haplotype was significantly associated with increased risk of breast cancer in premenopausal obese patients (OR = 1.98, 95%CI, 1.10-3.56; p = 0.02).

CONCLUSIONS

Our data indicated that CDTCCC and CDTGCC haplotypes of VEGF -2578C/A, -2549I/D, -460T/C, +405C/G, -7C/T and +936C/T polymorphisms were significantly associated with breast cancer risk in North-West Indians. Further studies on multiethnic groups with larger sample size are required to confirm our results.

Cyclin D1 expression and its correlation with clinicopathological variables in colorectal carcinoma

Background: This study was conducted to evaluate the expression of Cyclin D1 in colorectal carcinoma, and to correlate Cyclin D1 positivity with the grade of the tumor along with other parameters such as age, tumor location, lymph node metastasis, and vessel invasion.Materials and Methods: The present cross-sectional study was conducted on 40 proven cases of colorectal carcinoma from October 2015 to October 2017. The tissues were fixed, processed, and stained with hematoxylin and eosin followed by immunohistochemical staining with Cyclin D1 using monoclonal antibodies.Results: 75% of the cases were conventional adenocarcinoma while the rest were mucinous adenocarcinoma. Of the total colorectal carcinomas,12.5% were Grade I, 50% were Grade II and 37.5% cases were Grade III. Cyclin D1 positivity was seen in 60% of cases with the most positivity in grade II tumors. A statistically significant correlation of Cyclin D1 was seen with age group (5th- 6th decade) and histological type of tumor. No significant correlation was seen of Cyclin D1 with lymph node involvement, depth of invasion, vascular invasion, or perineural invasion. A significant statistical correlation was seen with Crohn’s-like reaction and peritumoral lymphocytic response.Conclusions: Thus, it was concluded that a highly statistically significant correlation was seen with age group (5th- 6th decade) and histological type of tumor. No significant correlation was seen with Cyclin D1 expression with lymph node involvement, depth of invasion, vascular invasion, or perineural invasion.

In silico pathway analysis based on chromosomal instability in breast cancer patients

BACKGROUND

Complex genomic changes that arise in tumors are a consequence of chromosomal instability. In tumor cells genomic aberrations disrupt core signaling pathways involving various genes, thus delineating of signaling pathways can help understand the pathogenesis of cancer. The bioinformatics tools can further help in identifying networks of interactions between the genes to get a greater biological context of all genes affected by chromosomal instability.

METHODS

Karyotypic analyses was done in 150 clinically confirmed breast cancer patients and 150 age and gender matched healthy controls after 72 h Peripheral lymphocyte culturing and GTG-banding. Reactome database from Cytoscape software version 3.7.1 was used to perform in-silico analysis (functional interaction and gene enrichment).

RESULTS

Frequency of chromosomal aberrations (structural and numerical) was found to be significantly higher in patients as compared to controls. The genes harbored by chromosomal regions showing increased aberration frequency in patients were further analyzed in-silico. Pathway analysis on a set of genes that were not linked together revealed that genes HDAC3, NCOA1, NLRC4, COL1A1, RARA, WWTR1, and BRCA1 were enriched in the RNA Polymerase II Transcription pathway which is involved in recruitment, initiation, elongation and dissociation during transcription.

CONCLUSION

The current study employs the information inferred from chromosomal instability analysis in a non-target tissue for determining the genes and the pathways associated with breast cancer. These results can be further extrapolated by performing either mutation analysis in the genes/pathways deduced or expression analysis which can pinpoint the relevant functional impact of chromosomal instability.

Screening of BRCA1 variants c.190T>C, 1307delT, g.5331G>A and c.2612C>T in breast cancer patients from North India

The polymorphic variants of BRCA1, which lead to amino acid substitutions, have a known pathogenic role in breast cancer. The present study investigated in North Indian breast cancer patients the association of risk with four reported pathogenic variants of BRCA1: c.190T>C (p.Cys64Arg), 1307delT, g.5331G>A (p.G1738R) and c.2612C>T (p.Pro871Leu). Genotyping was done by PCR-RFLP method in 255 clinically confirmed breast cancer patients and 255 age and gender matched healthy individuals. For c.190T>C, 1307delT and g.5331G>A, all the patients and controls had the wild-type genotype indicating no association with breast cancer risk. For c.2612C>T polymorphism, the frequency of the CC, CT, and TT genotypes was 14.5 vs 15.7%, 59.6 vs 53.7% and 25.9 vs 30.6% in breast cancer patients and controls respectively. The frequency of heterozygotes (CT genotype) was higher in cases than controls but the difference was not statistically significant. Genetic model analysis showed no association of the four analyzed BRCA1 variants with breast cancer risk with any model. The studied variants were not associated with the risk of breast cancer in Punjab, North west India, suggesting a need for further screening of other BRCA1 variants. It is the first reported study on these 4 variants from India.

Association of XRCC1, XRCC2 and XRCC3 Gene Polymorphism with Esophageal Cancer Risk

Aim

The X-ray repair cross-complementing (XRCC) gene polymorphisms influence esophageal carcinogenesis by altering the DNA repair capacity. The present study was designed to screen five single nucleotide polymorphisms (SNPs) of XRCC genes for their susceptibility to esophageal cancer (EC) risk. There is no previous report on these polymorphisms for EC from India, where EC frequency is high.

Methods

The present study included 497 subjects (213 EC patients and 284 healthy controls). The polymorphisms were screened using the PCR-RFLP method and allele and genotype distribution were compared using chi-square test. Association analysis was done by haplotype analysis and linkage disequilibrium (LD) analysis. Gene–gene interactions were identified using multifactor dimensionality reduction (MDR). The risk was calculated using binary logistic regression.

Results

For XRCC1 p.Arg399Gln, a decreased risk for EC was associated with the AA genotype [OR (95% CI): 0.53 (0.3–0.95), p=0.03] even after adjusting for various covariates [OR (95% CI): 0.49 (0.26–0.9), p=0.024] and with the recessive model [OR (95% CI): 0.49 (0.27–0.8), p=0.016]. The GA genotype of p.Arg280His was associated with an increased risk for EC [OR (95% CI): 1.7 (1.0–2.82), p= 0.045] after adjustments. The two XRCC1 polymorphisms, p.Arg399Gln and p.Arg194Trp were in slight LD among EC patients (D̍́=0.845, r²=0.042). XRCC2 and XRCC3 polymorphisms were not associated with EC risk.

Conclusion

XRCC1 p.Arg399Gln plays a protective role in the development of the EC. The study is the first report from India, providing baseline data about genetic polymorphisms in DNA repair genes XRCC1, XRCC2 and XRCC3 modulating overall EC risk.

Linkage disequilibrium and haplotypes of five TP53 polymorphisms in oesophageal cancer patients

The aim of present study was to evaluate the linkage disequilibrium (LD) of p.R72P, PIN3 Ins16bp, p.P47S, p.R213R and r.13494g[a polymorphism of TP53 and their haplotypes association with oesophageal cancer risk in patients from Punjab, northwest India. A total of 466 samples, including 233 oesophageal cancer patients and 233 healthy individuals were analysed. Data analysis revealed the gender specific association. In female group, arginine-proline (RP) genotype (P = 0.08) and P allele (P = 0.07) of p.R72P polymorphism was marginally associated with increased risk of oesophageal cancer. A1A2 genotype (P = 0.06) and A2 allele (P = 0.07) of PIN3 Ins16bp polymorphism was marginally associated with decreased risk of oesophageal cancer in male group. A1A2-GA genotype combination (P = 0.04) of PIN3 and r.13494g[a polymorphisms was significantly associated with decreased risk of oesophageal cancer in male group. In female group, PP-GA genotype combination (P = 0.02) of p.R72P and r.13494g[a polymorphisms and RP-A1A1-GG genotype combination (P = 0.04) of p.R72P, PIN3 and r.13494g[a polymorphisms was significantly associated with increased risk of oesophageal cancer. We observed moderate LD between two intronic polymorphisms PIN3 Ins16bp and r.13494g[a (D´ = 0.90; r₂ = 0.68). Haplotype analysis revealed that none of the haplotype combination was associated with oesophageal cancer risk when both the genders were considered. Stratification on the basis of gender showed that P-A2-P-A-A haplotype of p.R72P, PIN3 Ins16bp, p.P47S, p.R213R and r.13494g[a polymorphisms was marginally associated with reduced oesophageal cancer risk in male group (P = 0.08). Replication of these findings in independent cohorts may be insightful for the role of TP53 in oesophageal cancer pathogenesis.

Risk Factor Analysis for Breast Cancer in Premenopausal and Postmenopausal Women of Punjab, India

OBJECTIVE

Amritsar, the second largest town of agrarian state of Punjab, India reports high number of breast cancer cases every year. The present study investigated the etiology of breast cancer using various obesity indices and other epidemiological factors among breast cancer patients residing in and around Amritsar city.

METHODS

In this case control study, risk factors for breast cancer were analyzed in 542 female subjects: 271 females with breast cancer patients and 271 unrelated healthy females matched for age as control females.

RESULTS

Bivariate analysis for risk factors in cases and controls showed a lower risk (OR=0.65, 95% CI 0.43-0.99, p=0.04) in obese cases with BMI≥25kg/m2 as compared to subjects with normal BMI. Risk factor analysis showed that parameter which provided risk for cancer in postmenopausal women was obesity and in premenopausal women was parity. Postmenopausal women with BMI (overweight: OR=0.39, 95% CI 0.17-0.92, p=0.03; obese: OR= 0.26, 95% CI 0.13-0.52, p=0.00), WC (OR=0.17, 95% CI 0.05-0.52, p=0.00) and WHtR (p=0.02) had highr risk. Premenopausal women with 3 or less than 3 children had a higher risk (OR=5.54, 95 % CI 2.75-11.19, p=0.00) than postmenopausal women when compared to women with more than 3 children. Binary logistic regression analysis revealed that low parity (≤3) substantially increased the risk for breast cancer (OR=4.80, 95% CI 2.34-9.85, p=0.00) in premenopausal women.

CONCLUSION

Obesity, parity associated breast cancer risk and reduced breastfeeding cumulatively predispose the premenopausal women of this region to higher risk of breast cancer.
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Correlation between histopathological and endoscopic findings of non-malignant gastrointestinal lesions: an experience of a tertiary care teaching hospital from Northern India

Background: Gastrointestinal tract endoscopy along with biopsy is an established procedure for investigating a wide range of gastrointestinal conditions especially inflammatory and malignant diseases. The aim was to study and categorizing the morphological lesions of non-malignant origin at various sites of gastrointestinal tract and to compare with its endoscopic findings.Materials and Methods: This study was conducted on 280 benign GI biopsies received in the Department of Pathology of Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, Punjab, India.Results: Maximum cases (39%) were observed in the age group of 41-60 years. Male patients outnumbered the females (male to female ratio was 1.4:1). There were total 33 esophageal biopsies amongst which the most common lesion was non-specific esophagitis with least common being Barrett’s esophagus. Correlating the results of endoscopic and histopathological features of acute and chronic gastritis a positive predictive value of 80% with sensitivity of 44.4% was seen. Total 83 duodenal biopsies were analyzed with non-specific duodenitis being the most commonly diagnosed lesion followed by celiac disease. Correlation of endoscopic and histopathological findings in celiac disease revealed a sensitivity of 50% and positive predictive value of 42.86%. In both sigmoid colon and rectum, non-specific colitis was the commonest diagnosis followed by ulcerative colitis. Endoscopic findings were correlated with the histopathological features in ulcerative colitis, revealing a sensitivity of 57.14% along with the positive predictive value of 80%.  Conclusion: Histopathology remains the gold standard for diagnosing a case along with endoscopic findings and endoscopic findings alone cannot make the final diagnosis.

Can p53 expression and staining intensity correlate with histopathological prognostic parameter and clinical staging in head and neck squamous cell carcinoma?

Background: In recent years, p53 has emerged as an important tool for not only diagnosis and predicting prognosis in head and neck squamous cell carcinoma. The aim of this study was to find the role of p53 staining intensity in determining prognosis. Materials and Methods: Fifty histopathologically proven cases of squamous cell carcinoma of head and neck were studied. The findings of the study were analyzed particularly in reference to p53 expression and their correlation with age, sex, anatomical site, tumor size, histological grading, vascular, peri-neural, muscle invasion, lymph node metastasis and staining intensity.Results: Immunopositivity rate of p53 was 64% with percentage positive cells varying from 5-76% with mild, moderate and strong staining intensity. A positive correlation of p53 independently was seen with oral cavity, grade, lymph node metastasis and pathological staging.Conclusion: p53 immunoexpression is an important independent variable of prognostication.

Pituitary Chondrosarcoma presenting as a sellar and suprasellar mass with parasellar extension: An Unusual presentation

Chondrosarcoma is a mesenchymal tumor composed of tumor cells producing cartilage. It is more common in older age and often affects the axial skeleton. We report a rare case of chondrosarcoma mimicking a sellar and suprasellar mass with parasellar extension. A 40 yr woman presented with decreasing visual acuity and headache. Magnetic resonance (MR) image revealed a cystic sellar and suprasellar mass with parasellar extension showing mild enhancing solid component. It favored the diagnosis of craniopharyngioma. The patient underwent trans-sphenoidal partial resection of the tumor resulting in removal of the sellar mass. However, the suprasellar mass could not be excised completely due to limited surgical field. The pathologic diagnosis was chondrosarcoma. Eight months after the operation, pterional approach was performed to remove the remaining mass. Intraoperative findings confirmed that the mass originated from dorsum sellae.

No association of hypoxia inducible factor-1α gene polymorphisms with breast cancer in North-West Indians

BACKGROUND

Hypoxia inducible factor-1 alpha (HIF-1α) is the key regulator of cellular responses to hypoxia and plays a central role in tumour growth. Presence of Single nucleotide polymorphisms (SNPs) in the critical regulatory domains of HIF-1α may result in the overexpression of the protein and subsequent changes in the expression of the downstream target genes. The aim of study was to investigate the association of three SNPs (g.C111A, g.C1772T and g.G1790A) of HIF-1α with the risk of breast cancer in North Indian sporadic breast cancer patients.

MATERIALS AND METHODS

A total of 400 subjects, including 200 healthy controls and 200 patients with breast cancer were recruited in this study. Genotypes were determined using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method.

RESULTS

The CC and CA genotype frequency of HIF-1α g.C111A polymorphism was 100 vs 99% and 0 vs 1% in breast cancer patients and healthy controls respectively. The frequencies of CC, CT and TT genotype of g.C1772T polymorphism were 76 vs 74.5%, 19 vs 21% and 5 vs 4.5% in breast cancer patients and control individuals respectively. There was no significant difference in genotype and allele frequencies of HIF-1α g.C1772T polymorphism between cases and control individuals (p>0.05). For g.G1790A genotypes, all patients and controls had only GG genotype.

CONCLUSIONS

The three HIF-1α polymorphisms (g.C111A, g.C1772T and g.G1790A) are not associated with breast cancer risk in North-West Indian patients.

TP53 polymorphisms in sporadic North Indian breast cancer patients

BACKGROUND

The purpose of this study was to evaluate the potential association of five (p.P47S, p.R72P, PIN3 Ins16bp, p.R213R and r.13494g>a) polymorphisms of TP53 with the risk of developing breast cancer in North Indian Punjabi population.

METHODS

We screened DNA samples of 200 sporadic breast cancer patients (197 females and 3 males) and 200 unrelated healthy, gender and age matched individuals for the polymorphisms.

RESULTS

For the p.P47S polymorphism, we observed the PP genotype in 99.5% of the patients and PS genotype in only 1 patient. All the controls had the wild type PP genotype. The frequency of RR, RP and PP genotype of p.R72P was 23.5% vs 33.5%, 51.5% vs 45.5% and 25% vs 21% in patients and controls respectively. Heterozygous (RP) genotype was increased in breast cancer patients as compared to controls (51.5 vs 45.5%) and showed 1.61 fold significantly increased risk for breast cancer (OR=1.61, 95% CI, 1.01-2.58, p=0.04). In breast cancer patients the frequencies of A1A1, A1A2 and A2A2 genotypes of PIN3 Ins16bp polymorphism were 67%, 26% and 7% respectively whereas in controls the genotype frequencies were 68.5%, 27.5% and 4% respectively, with no significant difference. For p.R213R (c.639A>G), all individuals had homozygous wild type genotype. The frequencies of GG, GA and AA genotypes of TP53 r.13494g>a polymorphism were 62 vs 67.5%, 33 vs 28% and 5 vs 4.5% in patients and controls respectively, again without significant difference. We observed that RP- A1A1 genotype combination of p.R72P and PIN3 Ins16bp and RP-GG combination of p.R72P and r.13494g>a polymorphism showed significant risk of breast cancer (OR=1.65, 95%CI: 0.98-2.78, p=0.05; OR=1.72, 95%CI: 1.01-2.92, p=0.04).

CONCLUSION

The results of present study indicated that among the five TP53 polymorphisms investigated, the p.R72P polymorphism, and the RP-A1A1 and RP-GG genotype combination contribute to breast cancer susceptibility in North Indians.

No Association between the CCR5Δ32 Polymorphism and Sporadic Esophageal Cancer in Punjab, North-West India

BACKGROUND

Chemokines and their receptors influence carcinogenesis and cysteine-cysteine chemokine receptor 5 (CCR5) directs spread of cancer to other tissues. A 32 base pair deletion in the coding region of CCR5 that might alter the expression or function of the protein has been implicated in a variety of immune-mediated diseases. The action of antiviral drugs being proposed as adjuvant therapy in cancer is dependent on CCR5 wild type status. In the present study, distribution of CCR5Δ32 polymorphism was assessed in North Indian esophageal cancer patients to explore the potential of using chemokine receptors antagonists as adjuvant therapy.

MATERIALS AND METHODS

DNA samples of 175 sporadic esophageal cancer patients (69 males and 106 females) and 175 unrelated healthy control individuals (69 males and 106 females) were screened for the CCR5Δ32 polymorphism by direct polymerase chain reaction (PCR).

RESULTS

The frequencies of wild type homozygous (CCR5/CCR5), heterozygous (CCR5/Δ32) and homozygous mutant (Δ32/Δ32) genotypes were 96.0 vs 97.72%, 4.0 vs 1.71% and 0 vs 0.57% in patients and controls respectively. There was no difference in the genotype and allele frequencies of CCR5Δ32 polymorphism in esophageal cancer patients and control group.

CONCLUSIONS

The CCR5Δ32 polymorphism is not associated with esophageal cancer in North Indians. As the majority of patients express the wild type allele, there is potential of using antiviral drug therapy as adjuvant therapy.

Comparative Changes Noted in Renal Biopsies on Light Microscopy of ANCA Positive Vs ANCA Negative Serology

OBJECTIVES

Pauci-immune glomerulonephritis is the commonest cause of rapidly progressive glomerulonephritis (RPGN) which is associated with increased mortality and morbidity. More than 90% of these patients have serological presence of either antineutrophil cytoplasmic antibodies (ANCA), of cytoplamic (C) or perinuclear (P) type. "Immunofluoresence studies" exhibiting minimal or no fluorescence is diagnostic in all such cases. The present study aims to study the differences between renal biopsies of serologically ANCA negative versus ANCA positive individuals.

MATERIALS AND METHODS

One hundred and twenty renal biopsies (of clinically suspected cases of systemic vasculitis) were sub-divided sub-divided under the heading of serologically ANCA positive and serologically ANCA negative; and scoring them by means of a semi-quantitative scoring system devised at the beginning of the study to identify statistically significant, specific light microscopic features in the sub-components of renal biopsy.

RESULTS

Fifteen parameters were found to be statistically significantly (p-value <0.05) in ANCA positive serological cases. These were glomerular capillary loop infiltration by neutrophils, cellular crescents, fibro-cellular crescents, glomerular fibrinoid necrosis, glomerular sclerosis, peri-glomerular infiltration, interstitial oedema, interstitial eosinophils, tubular atrophy, tubular necrosis, tubulitis, arterial hyalinization, arterial necrosis, arterial vessel wall polymorpho nuclear infiltrate and myointimal hypertrophy.

CONCLUSION

The presence of above parameters in a renal biopsy report of a patient (in absence of facilities of autoimmune serology and immunofluoresence) can alert both nephrologist and nephropathologist to keep a possibility of renal symptoms arising out of systemic vasculitis.

Association of VEGF and VEGFR1 polymorphisms with breast cancer risk in North Indians

The aim of present study was to evaluate the relationship between vascular endothelial growth factor (VEGF) -2578C/A, -2549I/D, -460T/C and -7C/T and VEGFR1 -710C/T polymorphisms with risk to breast cancer in North Indians. A total of 204 sporadic breast cancer patients and 204 controls were recruited for this case-control study. Significantly increased frequency of II genotype of -2549I/D polymorphism was observed in patients as compared to control individuals (odds ratio (OR) = 2.76, 95 % confidence interval (CI), 1.55-4.92; p = 0.0005). VEGF -2578AA genotype (OR = 2.87; 95 % CI, 1.61-5.10; p = 0.0003) and A allele (OR = 1.65, 95 % CI, 1.25-2.18; p = 0.0004) were found to be associated with increased risk for breast cancer. Individuals carrying CC genotype (OR = 2.23, 95 % CI, 1.25-3.97) and C allele (OR = 1.42, 95 % CI, 1.07-1.87) of VEGF -460T/C polymorphism were at higher risk of breast cancer. There was no significant difference in genotype and allele distribution of VEGF -7C/T and VEGFR1 -710C/T polymorphisms between cases and control individuals (p > 0.05). Linkage disequilibrium analysis showed a strong linkage between VEGF -2549I/D and -2578C/A polymorphisms (Lewontin's [Formula: see text] = 0.99; r (2) = 0.97), -2549I/D and -460T/C ([Formula: see text] = 0.94; r (2) = 0.84), and -2578C/A and -460T/C polymorphisms ([Formula: see text] = 0.93; r (2) = 0.83). In the present study, we concluded that VEGF -2549I/D, -2578C/A and -460T/C polymorphisms are associated with risk to breast cancer in Punjab, North India.

Association of +405C>G and +936C>T polymorphisms of the vascular endothelial growth factor gene with sporadic breast cancer in North Indians

BACKGROUND

Vascular endothelial growth factor (VEGF), an endothelial cell specific mitogen, has been implicated as a critical factor influencing tumor related angiogenesis. The aim of present study was to evaluate the relationship between VEGF +936C>T and +405C>G polymorphisms of VEGF with risk of breast cancer in Punjab, India.

MATERIALS AND METHODS

We screened DNA samples of 192 sporadic breast cancer patients and 192 unrelated healthy, gender and age matched control individuals for VEGF +936C>T and +405C>G polymorphisms using the PCR-RFLP method.

RESULTS

For the VEGF +405C>G polymorphism, we observed significantly increased frequency of GG genotype in cases as compared to controls and strong association of +405GG genotype was observed with three fold risk for breast cancer (OR=3.07; 95%CI 1.41-6.65; p=0.003). For the +936C>T polymorphism, significant associations of CT and combined CT+TT genotypes were observed with elevated risk of breast cancer (p=0.021; 0.023). The combined genotype combinations of GG-CC and GG- CT of +405C>G and +936C>T polymorphisms were found to be significantly associated with increased risk of breast cancer (p=0.04; 0.0064).

CONCLUSIONS

The findings of the present study indicated significant associations of VEGF +936C>T and +405C>G polymorphisms with increased breast cancer risk in patients from Punjab, North India.

Analysis of TP53 polymorphisms in North Indian sporadic esophageal cancer patients

BACKGROUND

To investigate the relationship of five TP53 polymorphisms (p.P47S, p.R72P, PIN3 ins16bp, p.R213R and r.13494g>a) with the esophageal cancer (EC) risk in North Indians.

MATERIALS AND METHODS

Genotyping of p.P47S, p.R72P, PIN3 ins16bp, p.R213R and r.13494g>a polymorphisms of TP53 in 136 sporadic EC patients and 136 controls using polymerase chain reaction and PCR-RFLP.

RESULTS

The frequencies of genotype RR, RP and PP of p.R72P polymorphism were 16.91 vs 26.47%, 58.82 vs 49.27% and 24.27 vs 24.27% among patients and controls respectively. We observed significantly increased frequency of RP genotype in cases as compared to controls (OR=1.87, 95% CI, 1.01-3.46, p=0.05). The frequencies of genotype A1A1, A1A2 and A2A2 of PIN3 ins16bp polymorphism were 69.12 vs 70.59%, 27.20 vs 25% and 3.68 vs 4.41% among patients and controls. There was no significant difference among genotype and allele distribution between patients and controls. The frequencies of genotype GG, GA and AA of r.13494g>a polymorphism were 62.50 vs 64.70%, 34.56 vs 30.15% and 2.94 vs 5.15% among patients and controls respectively. No significant difference between genotype and allele frequency was observed in the patients and controls. For p.P47S and p.R213R polymorphisms, all the cases and controls had homozygous wild type genotype. The RP-A1A1-GG genotype combination shows significant risk for EC (OR=2.01, 95%CI: 1.01-3.99, p=0.05).

CONCLUSIONS

Among the five TP53 polymorphisms investigated, only p.R72P polymorphism may contributes to EC susceptibility.

Cytological diagnosis of follicular carcinoma thyroid metastasis in pelvic muscles-a rare and unusual site

Distant metastasis of thyroid neoplasm as an initial presentation is rarely encountered. The present case report describes a chance diagnosis of follicular carcinoma thyroid (FCT) metastasis in a 75-year-old female who was presented with symptoms related to pelvic mass. This is a rare site of reporting as only three cases have been reported previously at the first diagnosis. It is important to identify the presence of distant metastasis as it is the most important prognostic indicator (associated with 50% mortality). This is significant as this has a direct bearing upon its treatment and managing the patient. Hence more awareness is required by both diagnosticians and clinicians regarding this.

Vascular endothelial growth factor (VEGF) gene polymorphisms and breast cancer risk in Punjabi population from North West India

The purpose of this study was to evaluate the association of seven VEGF promoter polymorphisms with breast cancer risk in Punjabi population from North West India. We screened DNA samples of 102 sporadic breast cancer patients and 102 unrelated healthy, gender, and age-matched individuals for seven VEGF promoter polymorphisms [-417 C/T (rs833062), -172 C/A (rs59260042), -165 C/T (rs79469752), -160 C/T, -152 G/A (rs13207351), -141 A/C (rs28357093) and -116 G/A (rs1570360)] by direct sequencing. The frequency of GG, GA, and AA genotype of -152 G/A polymorphism was 26.47 vs 38.34%, 46.08 vs 51.96%, and 27.45 vs 9.80%, in patients and controls, respectively. VEGF -152 AA genotype was significantly associated with increased risk for breast cancer (OR = 4.04, 95%CI, 1.69-9.68, p = 0.001; recessive model OR = 3.48, 95%CI, 1.59-7.63, p = 0.001). For VEGF -116 G/A polymorphism, G and A allele frequencies were 65.2 vs 76.47% and 34.8 vs 23.53% in patients and controls, respectively. Individuals having -116 AA genotype (OR = 3.40; 95%CI, 1.24-9.37; p = 0.014) and A allele (OR = 1.73; 95%CI, 1.12-2.67; p = 0.012) were associated with increased risk for breast cancer. VEGF -165 C/T and -141 A/C polymorphisms were associated with reduced risk for breast cancer. There was significantly decreased frequency of CT genotype (4.90 vs 18.63%; p = 0.002) and T allele (2.45 vs 9.31%; p = 0.003) of -165 C/T polymorphism among breast cancer patients as compared to controls. VEGF -141 A and C allele frequency were 96.57 vs 91.18% and 3.43 vs 8.82% in patients and controls, respectively. Significant reduced risk for breast cancer was observed with AC genotype (OR = 0.34, 95%CI, 0.14-0.86; p = 0.019) and C allele (OR = 0.37; 95%CI, 0.15-0.89; p = 0.023) of -141 A/C polymorphism. We did not observe association of VEGF -417 T/C, -172 C/A, -160 C/T polymorphisms with breast cancer risk in the studied subjects (p > 0.05). The VEGF -152 G/A and -116 G/A polymorphisms were found to be significantly associated with increased risk for breast cancer while -165 C/T and -141 A/C polymorphisms were found to be associated with decreased risk for breast cancer in Punjabi population from North West India.

Prominent Intracytoplasmic Crystals in Alveolar Soft Part Sarcoma (ASPS): An Aid in Cytological Diagnosis

Alveolar soft part sarcoma (ASPS) is a rare neoplasm of unknown histogenesis with poor prognosis. Due to the epithelioid appearance of the neoplastic cells, ASPS may resemble many neoplastic conditions, such as metastatic epithelial cell tumours with clear cell change, metastatic renal cell carcinoma, granular cell tumour, epithelioid sarcoma, malignant melanoma and even paragangliomas. Presence of abundant, rod like crystals in the cytoplasm of tumour cells is an important finding characteristic of this tumour, which helps in differentiating it from the other entities. The case study highlights the importance of correlating cytological features that help in reaching the diagnosis such as the background, cell morphology and presence of characteristic rod shaped crystals as immunohistochemical studies are often non-conclusive. The case also is unique as it demonstrates presence of intra-cytoplamic crystals in such abundance.

Immunohistochemical (IHC) Analysis of Non-Hodgkin's Lymphoma (NHL) Spectrum According to WHO/REAL Classification: A Single Centre Experience from Punjab, India

INTRODUCTION

The distribution of the major subtypes of non-Hodgkin's lymphoma (NHL) differs across geographic regions. This study, from the north Indian state of Punjab, has incorporated immunophenotypic findings while investigating the distribution of NHL subtypes based on World Health Organization (WHO)/ Revised European-American Classification of Lymphoid Neoplasms (REAL) system of classification.

PATIENTS AND METHODS

Over all seventy seven cases of lymphoma over a period of one year (between April 2012 and April 2013) were diagnosed in the Department of Pathology, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar (Punjab). Of these 30 cases (39%) were of Hodgkin's Lymphoma (HL) and 47 cases (61%) were of Non Hodgkins lymphoma NHL. Of the total of cases of lympho-proliferative disorders, the diagnosis of NHL was done by light microscopy alone. All the cases diagnosed provisionally as NHL were taken up for immunophenotyping with Immunohistochemical (IHC) studies. There was 100 % concordance between the light microscopy and IHC studies. The individual NHL cases were classified according to the WHO/REAL classification according to the positive or relevant negative immonophenotypic expression and tabulated to ascertain the morphological spectrum of NHL in this part of the country.

RESULTS

B-cell lymphomas formed 89.3%, whereas T-cell lymphomas formed 10.7% of the NHLs. Diffuse Large B-Cell Lymphoma (DLBCL) was the most common subtype (46.8% of all NHLs). B-cell small lymphocytic lymphoma, Mantle-Cell Lymphoma (MCL), marginal zone B-cell lymphomas (including MALT lymphomas), Diffuse, mixed small cleaved cell and large-cell type and Follicular centre-cell lymphomas amounted to 17%, 12.8%, 2.1%, 2.1% and 4.3%, respectively. Among the T-cell lymphomas, T-cell lymphoblastic lymphoma, anaplastic large-cell lymphomas of T/null-cell type, and Angioimmunoblastic T-cell lymphoma (AITL) accounted for 6.4%, 2.1%, and 2.1% of all NHL cases, respectively.

CONCLUSIONS

The distribution of NHL subtypes in India shows disparity with those from the rest of the world. Follicular Lymphoma (FL) and MCL are less common in India compared to Europe and the USA. Peripheral T-cell lymphomas and T/NK-cell lymphomas of nasal and nasal types, which are common in many other Asian countries, are also less prevalent. T-cell lymphoblastic lymphoma and anaplastic large T/null cell lymphoma are more prevalent in India.

NESTROFT - A Valuable, Cost Effective Screening Test for Beta Thalassemia Trait in North Indian Punjabi Population

BACKGROUND AND OBJECTIVES

Beta-thalassemia continues to be a cause of significant burden to the society, particularly in the poorer developing countries. The objective of the present study was to evaluate the validity of "NESTROFT" (Naked Eye Single Tube Red Cell Osmotic Fragility Test) as a useful screening tool in the diagnosis of beta thalassemia trait.

MATERIAL AND METHODS

The present study was conducted on 150 subjects in the department of haematology in a tertiary health care center in north Indian state of Punjab. In group I, 111 cases diagnosed as microcytic hypochromic anaemia were selected. In group II, 39 individuals (the family members of known cases of beta thalassemia major) were selected. Complete haemogram, NESTROFT and HbA2 levels by electrophoresis were done and the results were tabulated and analyzed statistically.

RESULTS

Of the 111 cases in group I, 20 (18%) gave positive results with NESTROFT while 91 cases (82%) tested negative. In group II, out of 39 cases, 30 (76.92%) tested positive with NESTROFT while 9 gave a negative result. In group I, out of 20 NESTROFT positive cases, only 3 had HbA2 levels more than 3.5%. In group II, all the 30 NESTROFT positive cases had HbA2 levels more than 3.5%. The test showed a sensitivity of 100%, specificity of 85.47%, a positive predictive value of 66% and a negative predictive value of 100%.

CONCLUSION

Thus, NESTROFT is a valuable, cost-effective screening test for beta thalassemia trait and appears to be a valid test in rural setting with financial constraints.

Low density microfilaraemia as a causative agent in a case of unexplained ascitis of suspicious nature

It is estimated that 120 million people worldwide are affected by filariasis. In the South East and South Asian region, Wuchereria bancrofti is the most prevalent parasite causing filariais in 99.4 % of cases. In the present case the parasite was a cause of unexplained ascitis in a young female whose previous cytological report was suspicious in nature. Extensive physical and radiological assesment was not able to determine the cause of ascitis. Repeat cytological examinantion revealed a few microfilariae of Wuchereria bancrofti. The patient was diagnosed as a case of low density microfilaremia and was put on anti-filarial therapy subsequent to which ascitis of the patient regressed. In this case, the clinical picture did not give a clue regarding the aetiology of the ascites. There was no evidence suggestive of filariasis, such as lymphoedema or hydrocele except mild eosinophilia. Circumstantialtial evidence regarding the aetiology of the effusion in our patient included her recovery following antifilarial therapy. The cytological diagnosis of Mf in this patient avoided further expensive investigations and the patient responded to antifilarial therapy.

Giant inflammatory variant of well differentiated liposarcoma: a case report of a rare entity

An inflammatory liposarcoma is a rare variant of a well-differentiated liposarcoma. A case of a giant variety of an inflammatory well-differentiated liposarcoma is being reported. CT scan revealed a large abdomino-pelvic mass which had displaced the gut loops to left and posteriorly and urinary bladder and uterus to right. FNAC yielded mature adipocytes with no evidence of atypical cells. The large bossilated and irregular fibro-fatty mass which weighed 23 kg was excised. Microscopy revealed mature adipocytes with foci of fibrosis and abundant inflammatory cell infiltrates of eosinophils, lymphocytes, plasma cells and few neutrophils, along with few atypical cells. Only a few cases of a giant inflammatory variant of a well-differentiated liposarcoma have been reported in the world literature and this is first of its kind from the Indian sub-continent. A rare giant variant of a inflammatory well-differentiated liposarcoma with abundant eosinophils is being reported here, along with review of literature.

Reproducibility of 'The Bethesda System for reporting Thyroid Cytopathology': A MultiCenter Study with Review of the Literature

BACKGROUND

To achieve the standardization of the thyroid FNA reporting, the National Cancer Institute (NCI) hosted the "NCI Thyroid Fine Needle Aspiration State of the Science Conference", which led to the formation of 'The Bethesda System for Reporting Thyroid Cytopathology' (TBSRTC).

MATERIAL AND METHODS

The present study was undertaken by 2 experts in thyroid FNA, who in a double blinded fashion, examined and re-classified 80 random FNA cases according to the 6 levels of TBSRTC for an inter-observer review, to study and assess the new terminology for ease of reproducibility and to note the rate of disagreement overall or in any particular category. The FNAs were reclassified in a double blinded fashion according to the 6 levels of TBSRTC which are: non diagnostic (ND); benign; atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS); follicular neoplasm/suspicious for a follicular neoplasm (FN/SFN), Hurthle cell type/suspicious for a follicular neoplasm, Hurthle cell type (FNHCT/SFNHCT); suspicious (SUS), and malignant.

RESULTS

In the present study, the maximum number of cases was reclassified under the benign category (61.25% cases), followed by the FN/ SFN category and the AUS/FLUS category (11.25% and 10.00% respectively). An agreement was reached in 66 cases (82.5%); the experts disagreed in 14 cases-17.5% (where 1 expert did not agree with the other). Individually; a 93.87% agreement was noted for the lesions in the benign category, for 50% lesions in the AUS/FLUS category, for 66.66% lesions in the FN/SFN and the SUS categories, for 71.42% lesions in the FNHCT/ SFNHCT categories and for 100% lesions in the ND and the malignant categories. Thus, the maximum disagreement was noted in the AUS/FLUS category.

CONCLUSION

The implementation of TBSTRC which stands for a unique, international and a universal terminology for reporting the thyroid cytology; should be encouraged in our country, because of its relative ease of reproducibility. Although there was a great deal of agreement in implementing TBSTRC in the present study; disagreements were seen in the categories of AUS/FLUS and FN/SFN in the study which was conducted at our centre. This corroborated with the findings of the studies which were done elsewhere.

Carcinosarcoma of the gallbladder: a case report and review of the literature

A carcinosarcoma is a rare type of gallbladder malignancy, the diagnosis of which requires the presence of both malignant epithelial and mesenchymal components. The prognosis of this disease is extremely poor because it normally presents at advanced stages.We are reporting a case of carcinosarcoma of the gallbladder in a 45 year-old woman who was treated by cholecystectomy, as the tumour was confined to the gall bladder only.

Association of -2549 insertion/deletion polymorphism of vascular endothelial growth factor with breast cancer in North Indian patients

AIMS

The aim of the present study was to assess the role of the vascular endothelial growth factor (VEGF) -2549 insertion/deletion (I/D) polymorphism in susceptibility to sporadic breast cancer.

METHODS

DNA samples of 94 breast cancer patients and 94 unrelated healthy control individuals with matched age and gender from the same geographical region of Punjab, North West India were screened for the -2549 I/D polymorphism. Serum VEGF-C (sVEGF-C) levels of breast cancer patients and healthy controls were measured using an enzyme-linked immunosorbent assay.

RESULTS

The frequency of the II, ID, and DD genotype was 23.40 versus 10.64%, 48.94 versus 52.13%, and 27.66 versus 37.23%, in patients and controls, respectively. A statistically significant difference was observed for genotype distribution among the patients and controls (χ(2)=6.039, p=0.049). There was a significant increase in the I allele frequency in the patients as compared with controls (47.86 versus 36.70%, p=0.028). The sVEGF-C levels were also considerably higher in patients as compared to healthy controls (p<0.01).

CONCLUSIONS

The VEGF -2549 I/D polymorphism has a role in the susceptibility to breast cancer in the Amritsar region of Punjab, India.

Changes in megakaryocytes in cases of thrombocytopenia: bone marrow aspiration and biopsy analysis

BACKGROUND

Thrombocytopenia (platelet counts less than 150,000/μl) is commonly encountered in various hematological disorders including myelodysplastic syndromes as well as various non-myelodysplastic hematological conditions.

AIM

The present study was undertaken to calculate the prevalence of various conditions associated with thrombocytopenia and to record the megakaryocytic alterations in various cases of thrombocytopenia. Apart from this by means of statistical analysis it was tried to analyze whether a significant difference existed in megakaryocytic alteration noted in myelodysplastic versus non- myelodysplastic conditions.

MATERIALS AND METHODS

A prospective series of 60 bone marrow aspirations along with concomitant bone marrow biopsies was conducted in a tertiary care centre catering to both urban as well as rural population in north India.

STATISTICAL ANALYSIS

The distribution of morphological changes in cases of non myelodysplastic conditions and myelodysplastic were compared using Chi-Square test. A p-value less than 0.05 was considered significant.

RESULTS

The commonest cause of thrombocytopenia for which bone marrow examination was sought was dimorphic anaemia (18 cases, 30%), followed by myelodysplastic syndrome (06 cases, 10%) which was followed equally by acute lymphocytic leukemia and blast crisis of chronic myeloid leukemia (CML). Of all the non-MDS conditions apart from dimorphic anaemia, idiopathic thrombocytopenic purpura and chronic myeloid leukemia (blast crisis); megakaryocytic dysplastic forms were not noted in any other condition. In cases of myelodysplasia; dysplastic forms, bare megakaryocytic nuclei, hypogranular forms and micromegakaryocytes were seen. Comparison between frequencies of normal, high and low number of nuclear lobes among MDS (n=9) and non MDS (n=68) conditions were found to be statistically significant.

CONCLUSION

Further studies on the evaluation of megakaryocytic alteration and their contribution to thrombocytopenia can provide growing knowledge to the pathogenesis of numerous hematopoietic disorders that may identify broader clinical applications of the newer strategies to regulate platelet count and functioning.

The Immunohistochemical Expression of the Oestrogen Receptor (ER), HER-2/NEU and Cytokeratin 8/18 and 5/6 in Invasive Breast Carcinoma

INTRODUCTION

Carcinoma is the most common malignancy of the breast and breast cancer is the most common non-skin malignancy in women. Ideally, prevention or very early detection of breast cancer reduce both morbidity and mortality of the disease. Effective use of tumour markers might permit the application of screening and treatment more efficiently.

MATERIALS AND METHODS

Immunohistochemical study was done in 39 cases of invasive breast carcinoma for further sub-classification for predicting prognosis and therapeutic approach. The cases were evaluated for expression of cytokeratin Ck 8/18, ER & Her-2/neu and 28 cases were subjected to cytokeratin Ck 5/6 including especially the cases negative for all the three markers.

RESULTS

ER was positive in seven cases with Her-2/neu being positive in eight cases and cytokeratin 8/18 positive in 33 cases. Cytokeratin 5/6 was positive in seven cases with four cases showing Ck 5/6 and Ck8/18 positivity, three cases showing positivity for Ck 5/6 only and three cases were negative for all the four markers.

CONCLUSION

Thus classifying them to be luminal A, luminal B, combined, basal and null type respectively. Luminal A tmours show the best prognosis while luminal B tumours , combined , basal and null type are associated with less favouable outcome. Thus it is important to categorise them according to the cell of origin for prognosis and treatment.

Fine needle aspiration diagnosis of ipsilateral synchronous neoplasm - mucoepidermoid carcinoma with warthin tumor in parotid gland

Warthin tumor (WT) owing to its heterogeneous appearance, biological behavior and multicentricity poses a diagnostic challenge to cytologists worldwide. We report a rare double pathology of mucoepidermoid carcinoma (MEC) with WT which was diagnosed by fine needle aspiration (FNA). Cytological smears revealed sheets of epithelial cells and small clusters of squamous cells in a background of mucoid material along with a few small groups and scattered oncocytic cells and inflammatory cells (mainly lymphocytes). In view of the cytological findings various differentials such as oncocytic lesions, benign lesions of the parotid with extensive lymphoid reaction, necrotizing sialometaplasia, WT with extensive squamous/mucoid metaplasia, metastatic squamous cell carcinoma (SCC) with or without cystic change, oncocytic variant of MEC and a possibility of a synchronous MEC with WT were considered. By means of extensive review of the smears and clinic-pathological meets as discussed below, 2 differential diagnoses were given- MEC with WT versus an oncocytic variant of MEC with "?" lymphoid (tumor response) reaction. Subsequent histopathological examination confirmed the diagnosis of MEC with WT. Recent discovery of t(11; 19) translocation generating a novel fusion gene CRTC1/MAML2 which has been demonstrated in both MEC and WT has helped in providing the missing link in confirming the genetic relatedness and proof of development of a subset of WT with concomitant MEC. The case discusses the FNA findings of a rare collision tumor (MEC with WT), its possible differentials and highlights the importance of noting the background material in a case of double pathology on FNA.

Cytokeratin 5/6 expression in benign and malignant breast lesions

BACKGROUND

Cytokeratin s (CK) are used for the fingerprinting of carcinomas in general. In breast tissue, the luminal epithelial cells express CK 8/18, CK 7 and CK 19, while basal/myoepithelial cells express CK 5/6, CK 14 and CK 17.

MATERIAL AND METHODS

Immunohistochemical staining for cytokeratin 5/6 was applied on cell block sections of 23 cases of benign and 25 cases of malignant breast lesions using avidin biotin peroxidase technique. The distribution and intensity of staining was recorded and graded semiquantitatively.

RESULT

All benign lesions showed positive immunoreaction, with the staining index varying from 6-9, except lactating adenoma. The malignant lesions comprised three cases of ductal carcinoma in situ (DCIS) and 22 cases of infiltrating ductal carcinoma, not otherwise specified, IDC (NOS). None of the DCIS cases showed a positive immunoreaction. Among the IDC (NOS) lesions, six cases of grade III breast carcinoma exhibited a positive immunohistochemical reaction, the staining index of which varied from 2-6. The staining reaction in the malignant lesions was only cytoplasmic and the intensity was significantly less than that of benign lesions.

CONCLUSION

CK 5/6 expression breast carcinoma implies a 'basal like' molecular phenotype and is associated with poor prognosis. This antibody is also used as a component of panels to differentiate benign and malignant breast lesions.

Testicular biopsy in cases of male infertility: a retrospective study

One hundred testicular biopsies performed during the period of 1983-90 were reviewed to reappraise the value and utility of testicular biopsy in cases of male infertility. All the biopsies were categorised into the following 7 types and their relative incidences were determined. There were 16% normal cases. Hypospermatogenesis was found in 42% cases, maturation arrest in 18% cases, Sertoli cell-only syndrome in 17% cases, Klinefelter's syndrome in 3% cases, orchitis in 3% cases and tubular sclerosis in 1% case. Testicular biopsy findings were correlated with semen analysis reports. Azoospermia was represented by all the above 7 types whereas oligospermia was represented hypospermatogenesis and maturation arrest varieties. Testicular biopsy is most useful in azoospermia but its value is limited in oligospermia.