HISTOPATHOLOGICAL PROFILE OF GASTROINTESTINAL NEUROENDOCRINE TUMORS IN A TERTIARY CARE HOSPITAL

Background. Recently there has been a lot of discussion about the terminology and classification of neuroendocrine tumours of the gastrointestinal tract. The WHO has recommended a change of terminology and classification of these tumours. In 2019 a significant update was done in the WHO classification of neuroendocrine tumours of GIT in which neuroendocrine carcinomas (NECs) are all considered high-grade tumours. Previously, grade 1 and 2 tumours were regarded as neuroendocrine tumours (NETs) and grade 3 neoplasms as NECs. The new classification avoids confusion between these two clinically and molecularly distinct notions. Objective. The aim of the research was to study GI neuroendocrine neoplasms and classify them as per location and Histopathological classification of GI neuroendocrine neoplasms according to the recent WHO classification. To use IHC whenever and wherever required for categorization of GI NET’s. Methods. Over a period of 15 years, a total of 85 cases of neuroendocrine neoplasms of GIT were studied. The histopathological material of patients was reviewed and histopathological diagnosis confirmed. Paraffin embedded tissue blocks were used to study and review the material. Sections from tissue blocks were stained. Five-micron sections were cut and stained. The sections were stained using DAKO LSAB-2® system HRP glass slides coated with 0.5% poly-lysine. Results. Out of 85 cases 40 involved male and 45 female patients. The mean age was 46.4 years; age range 9-85 years. In our study, appendix 24 (28.23%) and stomach 11 (12.95%) were the commonest sites of primary involvement followed by colon (10), ileum (10), duodenum (5), GE junction (5), jejunum (3), oesophagus (2), rectum (2) and gall bladder (1). Metastasis to the liver were observed in 12 patients with known and unknown primary diagnosis. Based on the latest WHO classification 5 patients were classified under NECs and the rest under NETs. Conclusions. Neuroendocrine tumours (NETs) are uncommon malignancies of GIT. Appendix followed by stomach was the most common anatomical site. NET Grade 1 was the most common histological type. IHC markers NSE, Synaptophysin and Chromogranin can be used in diagnosis of NETs.

Human Papilloma Virus (HPV) in Sinonasal Papillomas and Squamous Cell Carcinomas: A PCR-based Study of 60 cases

This study was carried out to observe the association of Human Papilloma Virus (HPV) with papillomas and squamous cell carcinomas of the sinonasal region. The present study was a hospital-based study conducted over a period of three years from May, 2014 to May, 2017 in the Department of Pathology, Government Medical College, Srinagar. A total of 196 cases of non-neoplastic and neoplastic lesions of nasal cavity and paranasal sinuses were observed during the study period. Out of total 196 cases, 102 were non-neoplastic and 94 were neoplastic. Of the 94 neoplastic lesions, 58 were benign and 36 were malignant. A total of 60 cases which included 38(63.33%) inverted papillomas, 12(20%) exophytic papillomas and 10 (16.66%) squamous cell carcinomas were included in the present study for HPV association. We studied the association of HPV with sinonasal papillomas and squamous cell carcinomas by polymerase chain reaction (PCR). HPV positivity was seen in 5(13.16%) out of 38 cases of inverted papillomas, whereas 4 out of 12(33.33%) exophytic papillomas tested positive for HPV. Out of 10 squamous cell carcinomas HPV positivity was seen in 2(20%) cases. Low risk HPV types 6 and 11 showed an association with sinonasal papillomas and oncogenic HPV types 16 and 18 with squamous cell carcinomas.

Role of Scrape Cytology as an Adjunct to Fine Needle Aspiration Cytology in Diagnosis of Thyroid Lesions

INTRODUCTION

Scrape cytology is an important diagnostic tool. It has been used in many tissue types as an adjunct or replacement for frozen section/ intra operative consultation.

AIM

This study was done to evaluate the role of scrape cytology in the diagnosis of thyroid lesions, its role as an adjunct to Fine Needle Aspiration Cytology (FNAC) and application of this technique for intra-operative consultation.

MATERIALS AND METHODS

A prospective study on 50 thyroid neoplasms received over a period of 18 months (Nov 2014- March 2016) was conducted. Scrapings obtained from the fresh cut surface of thyroid specimens before formalin fixation, were smeared uniformly on to glass slides, and immediately fixed in 95% ethyl alcohol for rapid Haematoxylin and Eosin (H&E). Cytological findings were compared with pre-operative FNAC findings and histopathological diagnosis. Variables taken in to consideration while assessing the smears included cellularity, nuclear, cytological details and amount of colloid.

RESULTS

There were total of 50 patients. Out of the 50 patients, 15 were diagnosed as benign on scrape; of which 100% of cases were true negative for malignancy and five malignant cases were diagnosed as benign-false negative rate of 16.1%; four (8%) were deferred (non-diagnostic) with a true positive rate of 83.3%. Histopathological correlation was available in all cases. The overall diagnostic accuracy of scrape cytology was 89.1% with sensitivity and specificity of 83.87% (C.I.; 66.27% to 94.55%) and 100% (C.I; 76.84% to 100.00%) respectively. Fine Needle Aspiration results were available in 41 cases of which 2 were non-diagnostic. Of the remaining 39 cases 19 were benign and 20 were malignant with false negative rate of 40% and true positive rate of 60%. The overall diagnostic accuracy of FNAC was 64.1% with sensitivity and specificity of 60% (C.I.; 40.6% to77.3 %) and 77.78% (C.I; 39.9% to 97.1%) respectively.

CONCLUSION

We conclude that scrape cytology can act as a useful adjunct to FNAC and is a good procedure for intra-operative consultation. It is especially helpful in neoplasms diagnosed as suspicious for papillary carcinoma on aspiration and may obviate the need for a second procedure for completion thyroidectomy.

Metastatic lesions: A diagnostic dilemma-retrospective study, Srinagar, Jammu and Kashmir, India

BACKGROUND

Renal clear cell carcinoma (RCC) accounts for about 3% of adult malignancies and about 90% of neoplasms of the kidney. It is most common in men aged 50 to 60 years old. RCC has different manifestations, including metastasis in uncommon sites and paraneoplastic syndromes.

AIMS

To evaluate the clinicopathological pattern of RCC.

MATERIALS AND METHODS

This study was conducted in the Department of Pathology, Government Medical College, Srinagar. It was a retrospective study done over a period of 5 years, November 2009 to November 2014.

RESULTS

The study was done to evaluate the clinicopathological pattern of 6 cases of RCC diagnosed at a tertiary care hospital. All patients were males, presenting with submandibular swellings without any other symptom. Radiological and histopathological examination proved the lesion as metastasis of renal cell carcinoma to the mandible.

CONCLUSION

Being a rare presentation in the head and neck region, metastatic renal cell carcinoma needs to be considered in the differential diagnosis of submandibular swellings even in patients younger than 40 years.

A comparative evaluation of the effects of oral lorazepam, alprazolam and diazepam on venous admixture

OBJECTIVE

To compare the effects of oral diazepam, lorazepam and alprazolam premedication on venous admixture.

MATERIAL AND METHODS

One hundred fifty patients divided in three groups were included in the study. The venous admixture was determined using the ISO-shunt nomogram. The values obtained 90 minutes after administration of the drugs were compared with the values before the drug administration. The Student's t-test was applied to find out the significance.

RESULTS

These were highly significant change in increase in venous admixture (Qs/Qt) in group I patients 90 minutes after premedication as compared to premedication values. There was statistically insignificant difference in venous admixture (Qs/Qt) in group II and group III patients 90 minutes after premedication as compared to premedication values.

CONCLUSION

From the present study it can be concluded that 2 mg of oral lorozepam given 90 minutes before surgery to healthy patients have significant effects on venous admixture. However, the effects of alprazolam and diazepam had no significant effect on venous admixture.