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Sathya A, Goyal-Honavar A, Chacko AG, Jasper A, Chacko G, Devakumar D, Seelam JA, Sasidharan BK, Pavamani SP, Thomas HMT. Is radiomics a useful addition to magnetic resonance imaging in the preoperative classification of PitNETs? Acta Neurochir (Wien) 2024; 166:91. [PMID: 38376544 DOI: 10.1007/s00701-024-05977-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 01/18/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND The WHO 2021 introduced the term pituitary neuroendocrine tumours (PitNETs) for pituitary adenomas and incorporated transcription factors for subtyping, prompting the need for fresh diagnostic methods. Current biomarkers struggle to distinguish between high- and low-risk non-functioning PitNETs. We explored if radiomics can enhance preoperative decision-making. METHODS Pre-treatment magnetic resonance (MR) images of patients who underwent surgery between 2015 and 2019 with available WHO 2021 classification were used. The tumours were manually segmented on the T1w, T1-contrast enhanced, and T2w images using 3D Slicer. One hundred Pyradiomic features were extracted from each MR sequence. Models were built to classify (1) somatotroph and gonadotroph PitNETs and (2) high- and low-risk subtypes of non-functioning PitNETs. Feature were selected independently from the MR sequences and multi-sequence (combining data from more than one MR sequence) using Boruta and Pearson correlation. Support vector machine (SVM), logistic regression (LR), random forest (RF), and multi-layer perceptron (MLP) were the classifiers used. Data imbalance was addressed using the Synthetic Minority Oversampling TEchnique (SMOTE). Performance of the models were evaluated using area under the receiver operating curve (AUC), accuracy, sensitivity, and specificity. RESULTS A total of 222 PitNET patients (train, n = 149; test, n = 73) were enrolled in this retrospective study. Multi-sequence-based LR model discriminated best between somatotroph and gonadotroph PitNETs, with a test AUC of 0.84, accuracy of 0.74, specificity of 0.81, and sensitivity of 0.70. Multi-sequence-based MLP model perfomed best for the high- and low-risk non-functioning PitNETs, achieving a test AUC of 0.76, accuracy of 0.67, specificity of 0.72, and sensitivity of 0.66. CONCLUSIONS Utilizing pre-treatment MRI and radiomics holds promise for distinguishing high-risk from low-risk non-functioning PitNETs based on the latest WHO classification. This could assist neurosurgeons in making critical decisions regarding surgery or alternative management strategies for PitNETs after further clinical validation.
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Affiliation(s)
- Sathya A
- Quantitative Imaging Research and Artificial Intelligence Lab, Department of Radiation Oncology Unit II, Ida B Scudder Cancer Centre, Christian Medical College, Vellore, India
| | | | - Ari G Chacko
- Department of Neurosurgery, Christian Medical College, Vellore, India
| | - Anitha Jasper
- Department of Radiodiagnosis, Christian Medical College, Vellore, India
| | - Geeta Chacko
- Department of General Pathology, Christian Medical College, Vellore, India
| | - Devadhas Devakumar
- Department of Nuclear Medicine, Christian Medical College, Vellore, India
| | | | - Balu Krishna Sasidharan
- Quantitative Imaging Research and Artificial Intelligence Lab, Department of Radiation Oncology Unit II, Ida B Scudder Cancer Centre, Christian Medical College, Vellore, India
| | - Simon P Pavamani
- Quantitative Imaging Research and Artificial Intelligence Lab, Department of Radiation Oncology Unit II, Ida B Scudder Cancer Centre, Christian Medical College, Vellore, India
| | - Hannah Mary T Thomas
- Quantitative Imaging Research and Artificial Intelligence Lab, Department of Radiation Oncology Unit II, Ida B Scudder Cancer Centre, Christian Medical College, Vellore, India.
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Goyal-Honavar A, Chacko G, Chacko AG. Supratentorial primary paraganglioma with good long-term outcome following radical excision. Br J Neurosurg 2023; 37:1766-1769. [PMID: 33754919 DOI: 10.1080/02688697.2021.1902476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 03/08/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Paragangliomas are tumours of extra-adrenal paraganglia. They may metastasize to the brain but primary paragangliomas are exceedingly rare in the supratentorial region and long-term outcomes after surgery is largely unknown. This description of an excellent outcome 13 years following surgery in a 40-year-old gentleman with a primary paraganglioma near the falx provides an important perspective on the value of gross total resection in these tumours. We also review the options for adjuvant therapy in tumours that cannot be excised completely. CASE DESCRIPTION We describe a supratentorial paraganglioma in the parasagittal region in a 40-year-old gentleman who presented with clinical and radiological features suggestive of a right parafalcine meningioma. Histopathological examination following gross total excision of the tumour revealed histological and immunochemical features of a paraganglioma. A detailed search for a systemic primary was negative and the patient remains disease-free 13 years after the surgery. CONCLUSIONS Differentiating between tumours arising primarily and those that are metastatic deposits in the central nervous system requires long-term follow-up and monitoring for the appearance of occult primary tumours. Gross total resection is likely to provide good long-term outcomes.
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Affiliation(s)
| | - Geeta Chacko
- Section of Neuropathology, Department of Neurological Sciences, Christian Medical College, Vellore, India
| | - Ari G Chacko
- Section of Neurosurgery, Christian Medical College, Vellore, India
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Abarna R, J R, Chacko G, Pai R. Droplet digital PCR (ddPCR) using FFPE DNA to assess methylation status of MGMT gene among patients with IDH mutant astrocytoma and IDH wild-type glioblastoma. J Clin Pathol 2023; 76:860-864. [PMID: 37709490 DOI: 10.1136/jcp-2023-208953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 08/21/2023] [Indexed: 09/16/2023]
Abstract
MGMT promoter methylation analysis in formalin-fixed paraffin-embedded (FFPE) tissues can be challenging since the DNA obtained is often fragmented. Bisulfite conversion, which is essential to determine methylation status, further degrades DNA. While conventional methylation-specific PCR (MSP) and pyrosequencing assays have long been used to determine the methylation status of MGMT, this study was designed to determine the utility of one-tube DNA extraction method coupled with a droplet digital PCR (ddPCR) assay, to study the epigenetic changes in the promoter region of the MGMT gene using DNA obtained from FFPE.The FFPE blocks of 30 (n=30) patients with Central Nervous System (CNS) WHO grade 4 tumours, previously tested by MSP (2011-2021) were retrieved; DNA was extracted using one-tube extraction method and bisulfite converted. All converted samples were analyzed for methylation status of the MGMT promoter region with a laboratory designed Methylation-Specific ddPCR (MS ddPCR) using degenerate primers and probes that were labelled with FAM or HEX flurocein dye.Of the 30 cases, 20 cases were MGMT methylated and 10 cases were unmethylated by MS ddPCR. The results of MS ddPCR were then compared with those obtained by MSP and found to be concordant in 93.3% (28/30) of the cases and discordant in 2 cases. The Cohen's kappa coefficient (κ) was 0.84. The sensitivity, specificity, positive predictive value and negative predictive value of the assay in detecting the methylation status was found to be 95%, 90%, 95% and 90%.The results show that MS ddPCR is a valuable tool to detect the methylation status of MGMT in FFPE with high sensitivity. This method is cost-effective and easy to perform and could be an attractive alternative to the routine method of MSP.
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Affiliation(s)
- Rajadurai Abarna
- Pathology, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
| | - Ranjani J
- Pathology, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
| | - Geeta Chacko
- Pathology, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
| | - Rekha Pai
- Pathology, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
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Goyal-Honavar A, Gupta A, Chacko G, Chacko AG. Trigeminal hybrid nerve sheath tumor - a case report and literature review. Br J Neurosurg 2023; 37:1326-1329. [PMID: 34151661 DOI: 10.1080/02688697.2020.1867061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 12/17/2020] [Indexed: 10/21/2022]
Abstract
BACKGROUND Hybrid nerve sheath tumors (HNST) contain elements of more than one established sub-type of nerve sheath tumor and have been recently recognized in the 2016 WHO classification of central nervous system tumors. While common in the peripheral nerves and extracranial branches of cranial nerves, only one case has been previously documented of an intracranial HNST arising from a cranial nerve. CASE DESCRIPTION We describe a large, multi-compartmental intracranial hybrid nerve sheath tumor arising from the trigeminal nerve in a 22-year-old lady who presented with clinical and radiological features suggestive of a right cerebellopontine angle mass. Histopathological examination following retrosigmoid excision of the tumor revealed histological and immunohistochemical features of a schwannoma and a perineurioma. CONCLUSIONS HNSTs are likely to be underreported in the intracranial region. The clinical course of these tumors and the reason for their occurrence in this location are not known.
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Affiliation(s)
| | - Ankush Gupta
- Department of Neurosurgery, Christian Medical College, Vellore
| | - Geeta Chacko
- Department of Pathology, Christian Medical College, Vellore
| | - Ari G Chacko
- Department of Neurosurgery, Christian Medical College, Vellore
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Kaswala C, Schmiedel Y, Kundu D, George MM, Dayanand D, Devasagayam E, S AM, Kumar SS, Michael JS, Ninan MM, Chacko G, Zachariah A, Sathyendra S, Hansdak SG, Iyadurai R, Christopher DJ, Gupta R, Karthik R, Abraham OC, Varghese GM. Accuracy of Xpert MTB/RIF Ultra for the diagnosis of tuberculosis in adult patients: a retrospective cohort study. Int J Infect Dis 2022; 122:566-568. [PMID: 35811084 DOI: 10.1016/j.ijid.2022.07.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/04/2022] [Accepted: 07/04/2022] [Indexed: 10/17/2022] Open
Abstract
OBJECTIVES The value of the "trace" result in Xpert Ultra for diagnosing active tuberculosis (TB) remains unclear. Our study evaluated the diagnostic accuracy of Xpert MTB/RIF Ultra (Xpert Ultra) (Cepheid, Sunnyvale, USA) over Xpert MTB/RIF (Xpert) (Cepheid, Sunnyvale, USA) and mycobacterial culture when compared with a composite reference standard (CRS). METHODS A retrospective single-center observational study was conducted in a tertiary care hospital in South India. Over three months, patients (aged ≥15 years) data on Xpert Ultra tests and mycobacterial culture of pulmonary and extrapulmonary samples were extracted from their electronic medical records. Patients were defined as TB cases based on the CRS criteria. Sensitivity, specificity, positive and negative predictive values of diagnostic tests were calculated by comparing them to the CRS. RESULTS Xpert Ultra was more sensitive (87.8%) than Xpert (72.1%) and culture (44.1%). The specificity of Xpert Ultra was lower (98.1%) than those of Xpert (100%) and culture (100%). The sensitivity (92%) and specificity (100%) of Xpert Ultra were highest when performed on pus samples. CONCLUSIONS Xpert Ultra with the trace category is superior to the conventional Xpert, and mycobacterial culture in identifying TB.
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Affiliation(s)
- Chintan Kaswala
- Department of Infectious Diseases, Christian Medical College, Vellore, Tamil Nadu, India
| | - Yvonne Schmiedel
- Department of Infectious Diseases, Christian Medical College, Vellore, Tamil Nadu, India
| | - Debasree Kundu
- Department of Infectious Diseases, Christian Medical College, Vellore, Tamil Nadu, India
| | - Mithun Mohan George
- Department of Infectious Diseases, Christian Medical College, Vellore, Tamil Nadu, India
| | - Divya Dayanand
- Department of Infectious Diseases, Christian Medical College, Vellore, Tamil Nadu, India
| | - Emily Devasagayam
- Department of Infectious Diseases, Christian Medical College, Vellore, Tamil Nadu, India
| | - Abi Manesh S
- Department of Infectious Diseases, Christian Medical College, Vellore, Tamil Nadu, India
| | - Selwyn Selva Kumar
- Department of Infectious Diseases, Christian Medical College, Vellore, Tamil Nadu, India
| | - Joy S Michael
- Department of Clinical Microbiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Marilyn M Ninan
- Department of Clinical Microbiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Geeta Chacko
- Department of Pathology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Anand Zachariah
- Department of Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Sowmya Sathyendra
- Department of Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Ramya Iyadurai
- Department of Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Richa Gupta
- Department of Respiratory Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Rajiv Karthik
- Department of Infectious Diseases, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - George M Varghese
- Department of Infectious Diseases, Christian Medical College, Vellore, Tamil Nadu, India.
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Gandham EJ, Goyal-Honavar A, Beno D, Pai R, Balakrishan R, Jasper A, Gowri M, Moorthy RK, Chacko AG, Chacko G. Impact of Grade on Survival in Pleomorphic Xanthoastrocytoma and Low Prevalence of BRAF V600E Mutation. World Neurosurg 2022; 164:e922-e928. [PMID: 35618235 DOI: 10.1016/j.wneu.2022.05.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 05/16/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND The prevalence of BRAFV600E mutations in pleomorphic xanthoastrocytoma (PXA) World Health Organization (WHO) Grade 2 and PXA WHO Grade 3 reported varies from 60% to 80%, yet the prognostic implications remain unclear. METHODS We reviewed the demographic and clinicoradiologic data of 20 PXAs WHO Grade 2 and 13 PXAs WHO Grade 3, operated between 2007 and 2020, to ascertain extent of excision, recurrence, progression-free survival (PFS), and overall survival (OS). PXAs WHO Grade 3 were defined by the presence of >5 mitoses/high-power field. PXAs WHO Grade 3 received adjuvant radiation therapy and chemotherapy whereas PXAs received radiation therapy if subtotally excised. All samples were analyzed for the presence of BRAFV600E mutation using DNA obtained from paraffin blocks using droplet-digital polymerase chain reaction. RESULTS The median patient age at diagnosis was 22 years with a male preponderance. BRAFV600E mutations were noted in 30% of tumors; 8 PXAs WHO Grade 2 and 2 PXAs WHO Grade 3. Recurrence occurred in 6 of 13 PXA WHO Grade 3 (55%) and 1 of 20 PXAs WHO Grade 2 (5%). At median follow-up of 45 months, the OS was 54 months and 33 months in the PXA WHO Grade 2 and PXA WHO Grade 3 groups, respectively (P = 0.02). OS and PFS did not differ between BRAF-mutated and BRAF-negative tumors. CONCLUSIONS BRAFV600E mutations are less frequent in our population than reported in the literature. The BRAF mutation does not significantly impact OS and PFS. PXAs WHO Grade 3 are a distinct clinical entity, associated with worse PFS and OS than PXAs WHO Grade 2.
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Affiliation(s)
- Edmond Jonathan Gandham
- Section of Neurosurgery, Department of Neurological Sciences, Christian Medical College, Vellore, India
| | - Abhijit Goyal-Honavar
- Section of Neurosurgery, Department of Neurological Sciences, Christian Medical College, Vellore, India
| | - Daniel Beno
- Department of Pathology, Christian Medical College, Vellore, India
| | - Rekha Pai
- Department of Pathology, Christian Medical College, Vellore, India
| | - Rajesh Balakrishan
- Department of Radiation Oncology, Christian Medical College, Vellore, India
| | - Anita Jasper
- Department of Radiology, Christian Medical College, Vellore, India
| | - Mahasampath Gowri
- Department of Biostatistics, Christian Medical College, Vellore, India
| | - Ranjith K Moorthy
- Section of Neurosurgery, Department of Neurological Sciences, Christian Medical College, Vellore, India
| | - Ari George Chacko
- Section of Neurosurgery, Department of Neurological Sciences, Christian Medical College, Vellore, India
| | - Geeta Chacko
- Department of Pathology, Christian Medical College, Vellore, India.
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Balakumar S, Pai R, Chacko AG, Patel B, Nancy R, Balakrishnan R, Sarkar S, Sampath G, Chacko G. Telomerase Reverse Transcriptase Promoter Mutations in A Cohort Of Adult Gliomas - Clinicopathological Correlates. Neurol India 2022; 70:953-959. [PMID: 35864624 DOI: 10.4103/0028-3886.349649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Introduction: Gliomas were previously classified histologically, although now the latest WHO classification incorporates several molecular markers to classify these. Detection of TERT promoter mutations is assuming increased importance due to its relevance to prognostication. OBJECTIVE : The aim of this study was to determine the frequency of TERT promoter mutations, association of TERT promoter mutations with other molecular alterations and to assess the role of TERT promoter mutations in overall survival and progression-free survival in relation to histological and molecular glioma subtypes. MATERIALS AND METHODS This study analyzed a cohort of 107 adult patients with diffuse gliomas, WHO grades II and III and glioblastoma, by immunohistochemistry for IDH and ATRX mutations, FISH for 1p/19q co-deletions and PCR sequencing for TERT promoter mutation. Further, five glioma molecular sub-groups were derived using three molecular alteration and included the sub-groups with: i) IDH mutations only, ii) IDH and TERT mutations only, iii) IDH and 1p/19q co-deletion only, iv) Triple negative, and v) Triple positive. RESULTS IDH mutations and 1p/19q co-deletions were individually and significantly associated with an improved progression free (P = 0.001 and P = 0.002, respectively) and overall survival (P = 0.000 and P = 0.005, respectively) in the present cohort of gliomas. TERT promoter mutations occurred frequently in anaplastic oligodendrogliomas (94%), oligodendrogliomas (87.5%) and glioblastomas (54%). Sub-division into molecular sub-groups showed that the triple-positive tumors carried the best prognosis, followed by IDH only, triple negative and finally the TERT mutation only tumors (P < 0.000). CONCLUSION : This indicates that sub-classification using these molecular markers separates tumors into prognostically relevant categories.
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Affiliation(s)
- Shailaja Balakumar
- Department of General Pathology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Rekha Pai
- Department of General Pathology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Ari G Chacko
- Department of Neurosurgery, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Bimal Patel
- Department of General Pathology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Rachel Nancy
- Department of General Pathology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Rajesh Balakrishnan
- Department of Radiotherapy, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Sauradeep Sarkar
- Department of General Pathology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Gowri Sampath
- Department of Biostatistics, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Geeta Chacko
- Department of General Pathology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
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Goyal-Honavar A, Jayachandran R, Chacko G. Meningiomas - transition from traditional histological grading to molecular profiling in WHO CNS5: A Review. INDIAN J PATHOL MICR 2022; 65:S83-S93. [PMID: 35562138 DOI: 10.4103/ijpm.ijpm_1085_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023] Open
Abstract
Despite being the most common primary intracranial tumor, meningiomas are classified largely based on histological features. The current system of grading has been shown to be unsatisfactory due to its poor reproducibility as well as the considerable variability within grades. With the increasing availability of genomic and epigenomic profiling, several markers have been suggested to correlate with the location, histological subtype, and clinical behavior of meningiomas. These developments have enabled the development of targeted therapy, as well as individualized use of currently available adjuvant methods. These include copy number alterations (CNAs), specific genetic abnormalities (germline and sporadic), and genome-wide methylation profiles. In this review, we recapitulate the changes in the classification of meningiomas thus far, discuss the various histological subtypes recognized, and present the available literature on the genetic and epigenetic profiles of meningiomas. The recognition and further study of these markers have the potential to usher in an era of personalized therapy in the management of meningiomas, vastly improving outcomes as has been observed in the case of several other tumors.
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Affiliation(s)
| | | | - Geeta Chacko
- Department of Pathology, Christian Medical College, Vellore, Tamil Nadu, India
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Franklyn J, Ramesh S, Madhuri V, Patel B, Dhivya A, Nair PD, Kumar A, Chacko G, Samarasam I. Abdominal Wall Reconstruction with Tissue-Engineered Mesh Using Muscle-Derived Stem Cells in an Animal Model. Regen Eng Transl Med 2022. [DOI: 10.1007/s40883-022-00253-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Goyal-Honavar A, Balasundaram A, Thayakaran IP, Babu M, Pai R, Joseph J, Jayachandran R, Chacko AG, Mathew LG, Balakrishnan R, Rajshekhar V, L J, Sudarsanam TD, Chacko G. ZFTA-fusion in supratentorial ependymomas: low prevalence in South Asians and no correlation with survival. World Neurosurg 2022; 164:e82-e90. [PMID: 35378317 DOI: 10.1016/j.wneu.2022.03.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 03/28/2022] [Accepted: 03/29/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND - Supratentorial ependymomas (STEs) are an aggressive group of ependymoma, topographically distinct from their posterior fossa and spinal counterparts. ZFTA fusion-positive cases have been reported to account for the majority of STEs, although data on its association with poorer outcomes is inconsistent. MATERIALS AND METHODS - We assessed the prevalence of the ZFTA-fusion by RT PCR and FISH in a cohort of 61 patients (68 samples) with STE. Our primary outcome was to determine the role of the ZFTA-fusion on progression-free and overall survival of patients with STE. Our secondary objectives were to assess the impact of ZFTA-fusion on NF-kB pathway signalling via surrogate markers of this pathway, namely COX-2, CCND1 and L1CAM. RESULTS - ZFTA-fusion was noted in 21.3% of STEs in our cohort. The presence of this rearrangement did not significantly impact the PFS or OS of patients with STEs and was not associated with upregulation of markers of the NF-kB pathway. Only gross total resection was significantly associated with better progression-free survival. CONCLUSION - In contradiction to prior reports from across the world, the ZFTA-fusion is far less prevalent among our population. It does not appear to drive NF-kB signaling or significantly affect outcomes. Gross total resection (GTR) must be attempted in all cases of STE and adjuvant radiation and/or chemotherapy employed when GTR is not achieved.
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Abraham AP, Pai R, Beno DL, Chacko G, Asha HS, Rajaratnam S, Kapoor N, Thomas N, Chacko AG. USP8, USP48, and BRAF mutations differ in their genotype-phenotype correlation in Asian Indian patients with Cushing's disease. Endocrine 2022; 75:549-559. [PMID: 34664215 DOI: 10.1007/s12020-021-02903-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 10/06/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To estimate the prevalence of USP8, USP48, and BRAF mutations in patients with Cushing's disease (CD) from the Indian subcontinent, and determine their genotype-phenotype correlation. METHODS We prospectively recruited 46 patients with CD who underwent surgery between September 2015 and July 2019 at our institute. Fresh frozen tumour tissue was obtained in all patients. Using Sanger sequencing, the presence of somatic USP8 mutations was documented and the frequency of USP48 and BRAF mutations in USP8 wild-type corticotroph adenomas was determined. Clinical, hormonal, and surgical data were then compared between USP8-, USP48- and BRAF-variant carriers and patients with wild-type tumours. RESULTS Signature USP8 mutations were detected in 17 (37%) patients. Of the 29 USP8 wild-type adenomas, 4 (13.8%) harboured USP48 mutations, one of them being a splice-site mutation that has previously not been described. BRAF mutations were not found in any of the 29 patients. Corticotroph adenomas with USP8 mutations had a higher incidence of Crooke's hyaline change than wild-type tumours (70.6 vs. 37.9%, p = 0.032). Adenomas with USP48 mutations had a higher rate of cavernous sinus invasion than their wild-type counterparts (50 vs. 4%, p = 0.042). No other significant phenotypic difference could be established between mutant and wild-type tumours. CONCLUSIONS The prevalence of USP8 mutations in our series of patients with CD was 37%. The prevalence of USP48 mutations in USP8 wild-type adenomas was 13.8%, including a novel splice-site mutation. BRAF mutations were not found in any USP8 wild-type tumour. USP8-mutants showed significantly more Crooke's hyaline change and USP48-mutants were more likely to demonstrate cavernous sinus invasion.
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Affiliation(s)
- Ananth P Abraham
- Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India
| | - Rekha Pai
- Department of Pathology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Daniel L Beno
- Department of Pathology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Geeta Chacko
- Department of Pathology, Christian Medical College, Vellore, Tamil Nadu, India.
| | | | - Simon Rajaratnam
- Department of Endocrinology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Nitin Kapoor
- Department of Endocrinology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Nihal Thomas
- Department of Endocrinology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Ari G Chacko
- Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India
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Chacko AZ, Prashanthy TAM, Gopinathan V, George AJP, Kumar S, Chacko G. Adult renal angiomyolipomas: A retrospective analysis of the histological subtypes and their clinicoradiological correlates. Urol Ann 2022; 14:365-371. [PMID: 36505984 PMCID: PMC9731195 DOI: 10.4103/ua.ua_129_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 10/29/2021] [Indexed: 12/15/2022] Open
Abstract
Background Renal angiomyolipomas (AMLs) are rare, benign mesenchymal tumors of the kidney. Asian data on the prevalence of the subtypes of AMLs and their association with tuberous sclerosis are sparse prompting us to evaluate the clinicopathological characteristics of these tumors. Materials and Methods We included cases diagnosed from 2001 to 2021 extracting demographic details, clinical presentation, syndromic association with tuberous sclerosis, and preoperative clinicoradiological features from the electronic medical records. Results Ninety-five cases of adult renal AML were diagnosed among 2402 renal tumors, a prevalence of 3.95%. Forty tumors (42%) were detected incidentally; two patients had life-threatening retroperitoneal hemorrhage. Tuberous sclerosis complex (TSC) was associated with ten cases (10.5%). These patients were a decade younger than those in the non-TSC group (P = 0.008) and had bilateral, multiple, and larger tumors (P = 0.0009, 0.001, and 0.047, respectively). Microscopically, classic and epithelioid subtypes were seen in 87 (91.6%) and 8 cases (8.4%), respectively. Hemorrhage was more common in the epithelioid subtype (P = 0.13). HMB-45, melan-A, and smooth muscle actin immunohistochemistry were useful in cases which lacked the prototypical classic histology and for confirming a diagnosis of epithelioid AML. Conclusions The prevalence of renal AML in our series was four times higher, and the mean age at diagnosis was a decade earlier than that reported in Western literature but similar to data from two Asian countries. Similar studies from other countries will help ascertain if these differences in prevalence can be attributed to ethnic differences.
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Affiliation(s)
- Arman Z. Chacko
- Department of Urology, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Vikramraj Gopinathan
- Department of General Pathology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Arun J. P. George
- Department of Urology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Santosh Kumar
- Department of Urology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Geeta Chacko
- Department of General Pathology, Christian Medical College, Vellore, Tamil Nadu, India,Address for correspondence: Prof. Geeta Chacko, Department of General Pathology, Christian Medical College, Vellore - 632 004, Tamil Nadu, India. E-mail:
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Goyal-Honavar A, Balakrishnan R, Chacko G, Chacko AG. Radiation-Induced Intravascular Papillary Endothelial Hyperplasia in a Cavernous Sinus Hemangioma. Neurol India 2022; 70:359-362. [PMID: 35263914 DOI: 10.4103/0028-3886.338715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Cavernous sinus hemangiomas are benign vascular tumors of the cavernous sinus. Intravascular papillary endothelial hyperplasia (IPEH), also known as Masson's angioma is a rare, aberrant thrombus organization occurring independently or in pre-existent lesions, and information on its occurrence in the intracranial region, or its management is sparse. OBJECTIVE We aim to describe a case of IPEH occurring in a pre-existing cavernous sinus hemangioma, treated with surgical excision and radiation therapy, providing insight into the appropriate treatment of these tumors and their response to therapy. MATERIALS AND METHODS We describe a right cavernous sinus hemangioma, recurring after initial radiation therapy and requiring surgical excision, at which point the presence of IPEH was noted. A sellar recurrence following partial excision was treated with hypofractionated Stereotactic radiotherapy (SRT), and this provided an excellent long-term outcome. CONCLUSIONS Cavernous sinus hemangiomas are treated with surgical excision or primary radiation therapy. IPEH must be looked for in all excised specimens, as there are no radiological features that indicate its presence, and it may resemble the original lesion histologically. When detected, adjuvant radiation must be administered as the IPEH responds well to the use of radiation therapy.
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Affiliation(s)
| | - Rajesh Balakrishnan
- Department of Radiation Oncology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Geeta Chacko
- Department of Pathology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Ari G Chacko
- Department of Neurosurgery, Christian Medical College, Vellore, Tamil Nadu, India
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14
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Gupta A, Chacko G, Chacko AG. Prevalence and Pattern of Leptomeningeal Pigmentation in the Human Brain and Its Role in the Safe Surgical Excision of Extra-Axial Brain Tumors. Neurol India 2021; 69:1204-1209. [PMID: 34747785 DOI: 10.4103/0028-3886.329529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Although leptomeningeal melanin pigmentation is well-known, it is not described in the neurosurgical literature. Dark pigmentation native to these transparent membranes might have microsurgical relevance in identifying a plane of dissection. Objective To describe the prevalence of leptomeningeal pigmentation and determine whether its recognition helps during microsurgical excision of extra-axial brain tumors. Materials and Methods : This was a prospective cross-sectional observational study in cadavers and neurosurgical patients. Eight adult cadaveric brains were examined for leptomeningeal pigmentation and biopsies taken for histological studies. A total of 126 patients undergoing surgery for cerebellopontine angle and suprasellar lesions were included in the clinical study. The surgeon determined whether the recognition of pigmentation was useful during microneurosurgical arachnoid dissection. Results Seven of 8 cadavers (87.5%) had leptomeningeal pigmentation on the ventral pons, optic chiasm, lamina terminalis, olfactory tract, and gyrus rectus and infrequently on the cerebral convexities. The prevalence of pigmentation was 76.9% in the clinical study, was seen in all pediatric patients, and was significantly higher in males (P = 0.009), with no significant association with skin color. Immunochemistry identified the pigmentation as melanin. Recognition of this pigmentation was deemed to be useful during tumor excision in 78% of the cases. Conclusions Leptomeningeal melanin pigmentation has a prevalence of 76% to 87% in the Indian population and is more often seen in younger males. It is most commonly identified overlying the ventral brain stem and optic chiasm. Recognition of its presence is helpful during arachnoid dissection during most cerebellopontine angle and suprasellar tumor resections.
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Affiliation(s)
- Ankush Gupta
- Section of Neurosurgery, Department of Neurological Sciences, Christian Medical College Hospital, Vellore, Tamil Nadu, India
| | - Geeta Chacko
- Pathology, Department of Neurological Sciences, Christian Medical College Hospital, Vellore, Tamil Nadu, India
| | - Ari G Chacko
- Section of Neurosurgery, Department of Neurological Sciences, Christian Medical College Hospital, Vellore, Tamil Nadu, India
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15
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Ajith A, Mondal S, Chattopadhyay S, Kumar A, Sthanikam Y, Chacko AG, Prabhu K, Chacko G, Vanjare HA, Rajesh RV, Banerjee S. Mass Spectrometry Imaging Deciphers Dysregulated Lipid Metabolism in the Human Hippocampus Affected by Temporal Lobe Epilepsy. ACS Chem Neurosci 2021; 12:4187-4194. [PMID: 34657435 DOI: 10.1021/acschemneuro.1c00587] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Temporal lobe epilepsy (TLE) is the most prevalent form of human epilepsy, often accompanied by neurodegeneration in the hippocampus. Like other neurological diseases, TLE is expected to disrupt lipid homeostasis. However, the lipid architecture of the human TLE brain is relatively understudied, and the molecular mechanism of epileptogenesis is poorly understood. We performed desorption electrospray ionization mass spectrometry imaging of 39 fresh frozen surgical specimens of the human hippocampus to investigate lipid profiles in TLE with hippocampal sclerosis (n = 14) and control (non-TLE; n = 25) groups. In contrast to several previous studies on animal models of epilepsy, we report reduced expression of various important lipids, notably phosphatidylcholine (PC) and phosphatidylethanolamine (PE), in the human TLE hippocampus. In addition, metabolic pathway analysis suggested the possible dysregulation of the Kennedy pathway in TLE, resulting in striking reductions of PC and PE levels. This revelation opens up opportunities to further investigate the associated molecular mechanisms and possible therapeutic targets for TLE.
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Affiliation(s)
- Akhila Ajith
- Department of Chemistry, Indian Institute of Science Education and Research Tirupati, Tirupati 517507, India
| | - Supratim Mondal
- Department of Chemistry, Indian Institute of Science Education and Research Tirupati, Tirupati 517507, India
| | - Sutirtha Chattopadhyay
- Department of Chemistry, Indian Institute of Science Education and Research Tirupati, Tirupati 517507, India
| | - Anubhav Kumar
- Department of Chemistry, Indian Institute of Science Education and Research Tirupati, Tirupati 517507, India
| | - Yeswanth Sthanikam
- Department of Chemistry, Indian Institute of Science Education and Research Tirupati, Tirupati 517507, India
| | - Ari George Chacko
- Department of Neurological Sciences, Christian Medical College, Vellore 632004, India
| | - Krishna Prabhu
- Department of Neurological Sciences, Christian Medical College, Vellore 632004, India
| | - Geeta Chacko
- Department of General Pathology, Christian Medical College, Vellore 632004, India
| | | | | | - Shibdas Banerjee
- Department of Chemistry, Indian Institute of Science Education and Research Tirupati, Tirupati 517507, India
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16
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Goyal-Honavar A, Sarkar S, Asha HS, Kapoor N, Balakrishnan R, Vanjare H, Chacko G, Chacko AG. A clinicoradiological analysis of silent corticotroph adenomas after the introduction of pituitary-specific transcription factors. Acta Neurochir (Wien) 2021; 163:3143-3154. [PMID: 34181087 DOI: 10.1007/s00701-021-04911-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 06/10/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Silent corticotroph adenomas (SCAs) are a rare subtype of non-functional pituitary adenoma. While it has been suggested that they are more aggressive and recur more frequently following excision, there is limited literature on the optimum treatment strategy for these tumors, especially regarding the role of radiation therapy in incompletely resected tumors. METHOD We assimilated data from 62 SCAs and 238 other non-functional adenomas (ONAs), defined according to the WHO 2017 criteria that incorporates transcription factor analysis. We compared their clinicoradiological characteristics, such as hormonal levels, tumor configuration, size, and invasiveness. For 52 SCAs and 205 ONAs with serial follow-up imaging, we studied outcomes for progression after subtotal resection with or without radiation therapy or recurrence after gross total resection. Kaplan Meier analysis for recurrence or progression was used to determine the need for a differential treatment strategy for SCAs compared with other non-functional adenomas specifically concerning the role of radiotherapy. RESULTS Patients with SCAs present at a younger age than ONAs (43.9 years vs. 48.2 years, p = 0.014), with larger (14.9 cc vs. 9.7 cc, p = 0.006) and more invasive adenomas (61.2% vs. 45.8%, p = 0.021). Overall, SCAs are more likely to recur or progress (48.7 vs. 15.7%, p < 0.001) following excision than ONAs, with significantly poorer event-free survival (Log rank test p < 0.001). Early adjuvant radiotherapy provides favorable outcomes among SCAs with postoperative residual tumor, on par with ONAs. Multivariate analysis identified male gender (HR: 2.217; p = 0.017), MIB index ≥ 3% (HR: 2.116; p = 0.012), and SCA tumor pathology (HR: 3.787; p < 0.001) as factors predicting recurrence. CONCLUSIONS Based on the results of this retrospective, single-center review of 300 non-functional adenomas, we conclude that silent corticotroph adenomas are an aggressive subtype of non-functional pituitary adenomas that are larger, more likely to be invasive, and tend to recur more frequently after a subtotal excision compared with other non-functional adenomas. A gross total resection must be attempted whenever possible and earlier adjuvant radiation is recommended when re-surgery for residual tumor is difficult.
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Goyal-Honavar A, Sarkar S, Chacko G, Balakrishnan R, Asha HS, Chacko AG. Growth hormone storm following infarction of a residual growth hormone secreting pituitary macroadenoma. Br J Neurosurg 2021:1-4. [PMID: 34615430 DOI: 10.1080/02688697.2021.1988055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 09/15/2021] [Accepted: 09/28/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Thyrotroph pituitary adenomas have been reported to be a rare cause of 'thyroid storms', causing myriad metabolic and autonomic disturbances. In this case, we describe the second reported case in literature of a 'GH storm' in an infarcted somatotroph adenoma.Case description: We describe a residual invasive somatotroph macroadenoma that underwent infarction, producing a dramatic elevation in serum GH levels. While infarction of adenomas may in some cases lead to remission, the patient went on to require re-surgery and re-radiation due to growth of the residual viable tumour.Conclusions- 'GH storms' are rare but interesting events that may occur in somatotroph adenomas. Infarction or apoplexy must be considered when managing residual adenomas.
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Affiliation(s)
| | - Sauradeep Sarkar
- Department of Neurosurgery, Christian Medical College, Vellore, India
| | - Geeta Chacko
- Department of Pathology, Christian Medical College, Vellore, India
| | | | - H S Asha
- Department of Endocrinology, Christian Medical College, Vellore, India
| | - Ari G Chacko
- Department of Neurosurgery, Christian Medical College, Vellore, India
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18
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Thakur RS, Selvamani D, Matharsa S, Chacko G, Francis P, Papasavvas T. Early mobilization as a new pathway to improve functional mobility of cardiac patients in High dependency Unit. Eur J Cardiovasc Nurs 2021. [DOI: 10.1093/eurjcn/zvab060.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Funding Acknowledgements
Non funded project
Background
Early mobilization as a multidisciplinary team approach in cardiac High Dependency Unit-B (HDU B) helps to reduce loss of muscle strength, decrease hospital length of stay, improve functional capacity, cognitive levels, enhances the quality of care, and helps to decrease the hospitals costs.
Purpose
Early mobilization means reducing the time of bed rest from admission to first activity. Based on this definition the project aimed to mobilize more than 95% of cardiac patients within 24 hours of admission by September 2019 in HDU B unit.
Methods
HDU B Initiated Early mobilization program as a part of Value improvement project (VIP). Experts from multidisciplinary team (MDT) worked together to improve the functional mobility of patients. A cross section survey was conducted to identify barriers for early mobility in the unit followed by analyzing barriers through Pareto chart. An early mobility flow chart (Level1-Passive, Level 2-Active assisted, Level 3-Active) framed in order to standardize the practice of mobilizing patients in HDU B. New changes were tested by using methodology of Plan Do Study Act. Staff education, training given regarding the implementation of early mobility protocol. Patients with mobility level 1 and 2 were identified by nurses, requested for Physiotherapy referral by Physicians. Nursing staff education on mobility assessment given an easy access of data about mobility level of patients in handoff communication, which guided the staff to decide on the need of PT consultation for each patient. In coordination with MDT team referral were also given even during weekend for the patients with mobility level 2. To engage patient and family in the early mobility program a new concept of END PYJAMA PARALYSIS was introduced. Patients with mobility level 3 were identified and encouraged to wear their own dress and move outside their room under supervision.This concept aims to build confidence in patients making them feel that they are ready to go home.
Results
With support and co-operation of the MDT, this project became a highly successful project in VIP. Initially 50% of the patients has been mobilized when the program was introduced in the ward during March 2019 which increased gradually to 90% at the end of the month. After introducing the flow chart, there was increase in 93.3% by April 2019. In addition to Physio referral it went to 100% at the end April 2019. End pyjama paralysis and weekend physio referral sustained the 100% compliance to Early mobility till the end of July 2019. Active interventions of the team helped to early mobilize by 100% till the end of September 2019 and currently it is in sustainable phase.
Conclusion
Early mobilization in HDU-B brought significant change in the culture of mobilization. Commitment, cooperation of MDT, a structural system and End pyjamas paralysis program are key factors of the success for the program that promoted patient safety and prevented adverse events.
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Affiliation(s)
- RS Thakur
- Hamad Medical Corporation, Doha, Qatar
| | | | | | - G Chacko
- Hamad Medical Corporation, Doha, Qatar
| | - P Francis
- Hamad Medical Corporation, Doha, Qatar
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Goyal-Honavar A, Sarkar S, Asha HS, Kapoor N, Thomas R, Balakrishnan R, Chacko G, Chacko AG. Impact of Experience on Outcomes After Endoscopic Transsphenoidal Surgery for Acromegaly. World Neurosurg 2021; 151:e1007-e1015. [PMID: 34023462 DOI: 10.1016/j.wneu.2021.05.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 05/10/2021] [Accepted: 05/11/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Acromegaly is a syndrome of metabolic alterations secondary to increased growth hormone levels from a somatotroph pituitary adenoma. A multidisciplinary approach beginning with surgery, followed by adjuvant radiation or medical therapy for residual disease, is considered standard of care. Several factors affect the likelihood of remission after surgery, but the impact of surgical experience on remission rates has not been adequately assessed. METHODS Retrospective review of 203 patients, divided into 2 eras (era 1, 102 patients; era 2, 101 patients) of patients who underwent transsphenoidal surgery for acromegaly by a single surgeon over 11 years, was performed, determining the effect of surgical experience on rates of remission and various complications. Remission was defined according to the 2014 Endocrine Society Clinical Practice Guideline. RESULTS The rate of surgical remission was 40.6% (62.9% among noninvasive adenomas). Rates of surgical remission significantly improved in the latter half of this cohort (31.2% in the first half vs. 50% in the second half), despite other factors being comparable. On multivariate analysis, surgeon experience, cavernous sinus invasion, and preoperative growth hormone levels affected the rates of surgical remission. Rates of cerebrospinal fluid leak and hypopituitarism were lower in the second half, whereas resolution of acromegaly-associated comorbidities was increased. CONCLUSIONS We report, in this large single-surgeon review of endoscopically operated acromegaly cases, increased rates of surgical remission and reduced complications with increasing surgeon experience. The overall experience of the treating team in dealing with perioperative and intraoperative factors also contributes to improved outcomes.
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Affiliation(s)
| | - Sauradeep Sarkar
- Department of Neurosurgery, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Nitin Kapoor
- Department of Endocrinology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Regi Thomas
- Department of Otorhinolaryngology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Rajesh Balakrishnan
- Department of Radiation Oncology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Geeta Chacko
- Department of Pathology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Ari G Chacko
- Department of Neurosurgery, Christian Medical College, Vellore, Tamil Nadu, India. ]
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Abstract
The classification of tumors of the pituitary gland has seen several changes in recent years. The 4th edition of the World Health Organization Classification of Tumours of Endocrine Organs, published in 2017, saw the introduction of a classification based on cell lineage using immunohistochemistry for both pituitary specific hormones as well as pituitary specific transcription factors. The term "hormone-producing" was thus replaced by "-troph." The other major change was that the entity of "atypical adenoma," which was introduced in the 2004 classification, to identify tumors with a poor prognosis, was removed as it failed to identify aggressive tumors. Instead, assessment of markers of proliferation, clinical parameters, such as invasive status and histological subtypes were recommended to identify tumors with aggressive potential. The diagnostic criteria for pituitary carcinoma, however, remained unchanged and continued to be defined as a tumor of adenohypophyseal cells that metastasize craniospinally or systemically. Null cell adenomas were more clearly defined as tumors that did not show any cell-type differentiation, lacking immunoexpression of hormones as well as transcription factors. Since 2017, the classification has continued to evolve with the identification of aggressive histological variants. There is more recently a proposal to change the terminology from pituitary adenoma to pituitary neuroendocrine tumor (PitNET). This review summarizes the recent advances in the classification of pituitary adenomas.
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Affiliation(s)
- Rima Sathyakumar
- Department of Neuropathology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Geeta Chacko
- Department of General Pathology, Christian Medical College, Vellore, Tamil Nadu, India
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21
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Sathyakumar K, Mani S, Pathak GH, Prabhu K, Chacko AG, Chacko G. Neuroimaging of pediatric infratentorial tumors and the value of diffusion-weighted imaging (DWI) in determining tumor grade. Acta Radiol 2021; 62:533-540. [PMID: 32539423 DOI: 10.1177/0284185120933219] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Diffusion-weighted imaging (DWI) provides information about the cellular density of tumors. This feature is useful in grading and identifying different tumor types. PURPOSE To assess the value of diffusion restriction and apparent diffusion coefficient (ADC) values in differentiating pediatric infratentorial tumors. MATERIAL AND METHODS This was a retrospective review of the magnetic resonance imaging (MRI) of 82 children (age range 1-16 years) with infratentorial tumors. Histopathological grading after surgical excision/biopsy was categorized as low grade (WHO grades I and II) (n = 31; 29 pilocytic astrocytomas, 2 ependymomas) and high grade (WHO grade III and IV) (n = 51; 40 medulloblastomas, 8 anaplastic ependymomas, 1 anaplastic astrocytoma, 2 atypical rhabdoid teratoid tumors [ATRT]). MRI features and ADC values were compared among tumor types and grades using a two-tailed t test, Mann-Whitney U test for continuous data and Chi-square test for categorical variables. RESULTS Diffusion restriction and low ADC value was a feature of high-grade tumors (P<0.001). The mean ADC values of the low-grade and high-grade tumors were 1.567 × 10-3mm2/s and 0.661 × 10-3mm2/s, respectively. Using 0.9 × 10-3mm2/s as the cut-off value, the sensitivity, specificity, positive and negative predictive values for differentiating the grades was 87%, 100%, 100%, and 81.8%, respectively. Significant differences were found between the mean ADC values of the individual tumor types (P<0.05), except between medulloblastoma and ATRT. CONCLUSION ADC values and visual assessment of diffusion restriction are useful in tumor grading. The individual tumor types can be identified by an algorithmic approach, using DWI in conjunction with other described MRI features.
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Affiliation(s)
- Kirthi Sathyakumar
- Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Sunithi Mani
- Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Krishna Prabhu
- Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India
| | - Ari George Chacko
- Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India
| | - Geeta Chacko
- Department of Pathology, Christian Medical College, Vellore, Tamil Nadu, India
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22
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Abarna R, Nancy R, Chacko A, Chacko G, Pai R. Diagnostic utility of droplet digital PCR to detect TERT promoter mutations among glioblastoma samples using 7-deaza-dGTP. J Clin Pathol 2021; 75:140-142. [PMID: 33766956 DOI: 10.1136/jclinpath-2021-207402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/18/2021] [Accepted: 03/01/2021] [Indexed: 11/03/2022]
Affiliation(s)
- Rajadurai Abarna
- Pathology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Rachel Nancy
- Pathology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Ari Chacko
- Division of Neurosciences, Christian Medical College, Vellore, Tamil Nadu, India
| | - Geeta Chacko
- Pathology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Rekha Pai
- Pathology, Christian Medical College, Vellore, Tamil Nadu, India
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Jabarkheel R, Amayiri N, Yecies D, Huang Y, Toescu S, Nobre L, Mabbott DJ, Sudhakar SV, Malik P, Laughlin S, Swaidan M, Al Hussaini M, Musharbash A, Chacko G, Mathew LG, Fisher PG, Hargrave D, Bartels U, Tabori U, Pfister SM, Aquilina K, Taylor MD, Grant GA, Bouffet E, Mankad K, Yeom KW, Ramaswamy V. Molecular correlates of cerebellar mutism syndrome in medulloblastoma. Neuro Oncol 2021; 22:290-297. [PMID: 31504816 DOI: 10.1093/neuonc/noz158] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Cerebellar mutism syndrome (CMS) is a common complication following resection of posterior fossa tumors, most commonly after surgery for medulloblastoma. Medulloblastoma subgroups have historically been treated as a single entity when assessing CMS risk; however, recent studies highlighting their clinical heterogeneity suggest the need for subgroup-specific analysis. Here, we examine a large international multicenter cohort of molecularly characterized medulloblastoma patients to assess predictors of CMS. METHODS We assembled a cohort of 370 molecularly characterized medulloblastoma subjects with available neuroimaging from 5 sites globally, including Great Ormond Street Hospital, Christian Medical College and Hospital, the Hospital for Sick Children, King Hussein Cancer Center, and Lucile Packard Children's Hospital. Age at diagnosis, sex, tumor volume, and CMS development were assessed in addition to molecular subgroup. RESULTS Overall, 23.8% of patients developed CMS. CMS patients were younger (mean difference -2.05 years ± 0.50, P = 0.0218) and had larger tumors (mean difference 10.25 cm3 ± 4.60, P = 0.0010) that were more often midline (odds ratio [OR] = 5.72, P < 0.0001). In a multivariable analysis adjusting for age, sex, midline location, and tumor volume, Wingless (adjusted OR = 4.91, P = 0.0063), Group 3 (adjusted OR = 5.56, P = 0.0022), and Group 4 (adjusted OR = 8.57 P = 9.1 × 10-5) tumors were found to be independently associated with higher risk of CMS compared with sonic hedgehog tumors. CONCLUSIONS Medulloblastoma subgroup is a very strong predictor of CMS development, independent of tumor volume and midline location. These findings have significant implications for management of both the tumor and CMS.
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Affiliation(s)
- Rashad Jabarkheel
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
| | - Nisreen Amayiri
- Department of Oncology, King Hussein Cancer Center, Amman, Jordan.,Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Derek Yecies
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
| | - Yuhao Huang
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
| | - Sebastian Toescu
- University College London, Great Ormond Street Institute of Child Health, London, UK
| | - Liana Nobre
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Donald J Mabbott
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Psychology, University of Toronto, Toronto, Ontario, Canada.,Programme in Neuroscience and Mental Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sniya V Sudhakar
- Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Prateek Malik
- Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Suzanne Laughlin
- Division of Neuroradiology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Maisa Swaidan
- Department of Diagnostic Radiology, King Hussein Cancer Center, Amman, Jordan
| | | | - Awni Musharbash
- Department of Surgery, King Hussein Cancer Center, Amman, Jordan
| | - Geeta Chacko
- Department of Pathology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Leni G Mathew
- Department of Pediatrics, Christian Medical College, Vellore, Tamil Nadu, India
| | - Paul G Fisher
- Departments of Neurology & Pediatrics, Stanford University, Palo Alto, California, USA
| | - Darren Hargrave
- University College London, Great Ormond Street Institute of Child Health, London, UK
| | - Ute Bartels
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
| | - Uri Tabori
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
| | - Stefan M Pfister
- Hopp Children's Cancer Center Heidelberg, Division of Pediatric Neurooncology, German Cancer Research Center, German Cancer Consortium, and Department of Pediatric Hematology and Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Kristian Aquilina
- Neurosurgery Department, Great Ormond Street Hospital for Children, London, UK
| | - Michael D Taylor
- Division of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada.,Programme in Developmental and Stem Cell Biology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Gerald A Grant
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
| | - Eric Bouffet
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Kshitij Mankad
- Department of Radiology, Great Ormond Street Hospital for Children, London, UK
| | - Kristen W Yeom
- Department of Radiology, Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, California, USA
| | - Vijay Ramaswamy
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada.,Programme in Developmental and Stem Cell Biology, Hospital for Sick Children, Toronto, Ontario, Canada
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Sarkar S, Chacko SR, Korula S, Simon A, Mathai S, Chacko G, Chacko AG. Long-term outcomes following maximal safe resection in a contemporary series of childhood craniopharyngiomas. Acta Neurochir (Wien) 2021; 163:499-509. [PMID: 33078364 DOI: 10.1007/s00701-020-04591-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 09/18/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The optimal management of pediatric craniopharyngiomas remains controversial. This study aimed to characterize long-term outcomes in a contemporary cohort of children undergoing surgery for craniopharyngiomas. METHODS This was a retrospective review of 37 consecutive children who underwent surgery for craniopharyngioma with a median follow-up duration of 79 months (range 5-127 months). Patients were stratified by extent of resection (EOR) and need for adjuvant radiation therapy (RT). Imaging studies were reviewed to grade extent of hypothalamic involvement. Data on functional outcomes, pituitary function, and obesity were analyzed. RESULTS Gross total resection was achieved in 16 patients (43.2%), near total resection in six patients (16.2%), and subtotal resection (STR) in 15 patients (40.5%). The recurrence-free survival rate was 81.1% and 70.3% at 5- and 10-year follow-up, respectively. Survival analysis showed superior disease control in patients undergoing STR + RT (p = 0.008). Functional outcomes were independent of EOR, postoperative RT or recurrence. Diabetes insipidus was present in 75% and 44.4% of patients required >2 hormone replacements at last follow-up. Obesity was present in 36.1% patients after treatment, and was associated with preoperative obesity (p = 0.019), preoperative hypothalamic involvement (p = 0.047) and STR + RT (p = 0.011). CONCLUSIONS Gross or near total resection may be achieved safely in almost 60% of cases; however, radical surgery does not eliminate the risk of recurrence. Over long-term follow-up, STR + RT offers the best disease control rates. Patients with preoperative hypothalamic involvement, obesity, and those with tumors not amenable to radical resection are at risk for developing obesity on long-term follow-up.
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Benjamin RN, Thomas M, Muthusamy K, Yoganathan S, Mathew V, Chacko AG, Prabhu K, Chacko G. Age-Dependent Reduction in Severity and Discrete Topographical Patterns in Rasmussen Encephalitis: A Link to Cortical Maturation? Pediatr Neurol 2020; 112:25-33. [PMID: 32911260 DOI: 10.1016/j.pediatrneurol.2020.07.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 06/30/2020] [Accepted: 07/25/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Autopsy studies in Rasmussen encephalitis reveal areas of sparing within the affected hemisphere. Clinical progression and inflammation are milder with an older onset. We sought to demonstrate radiological corroboration for these patterns. METHODS In our retrospective study, 38 cases were dichotomized into severe pan-hemispheric (all lobes involved) and sub-hemispheric groups (others) to identify age demographics and other severity predictors. The extent and patterns of radiological pathology in the cortex and subcortical structures were assessed by structured visual grading. Relevant clinical data were also reported. RESULTS Children with pan-hemispheric involvement were younger at onset (P < 0.001) and were more likely to present with status epilepticus (odds ratio 8.5, 95% confidence interval 1.5 to 50.0, P = 0.022). A history of perinatal asphyxia/hospitalization (P < 0.001) and delayed milestones (P = 0.013) were encountered exclusively in this group, and progression to a low-amplitude record background on electroencephalography, suggesting that cortical damage was identified frequently (P = 0.038, odds ratio = 5.7, 95% confidence interval 1.3 to 25.0). Visual grading revealed significant differences among both cortical (P < 0.001) and subcortical (P < 0.001) regions. On multivariate analysis, the odds for pan-hemispheric disease decreased per year of age at onset (P = 0.022, odds ratio 0.51, 95% confidence interval 0.085 to 0.725). Epilepsy surgery (n = 14) was associated with Engel Class 1 seizure control (P < 0.001). Immunosuppressive therapy (n = 20) did not demonstrate a significant seizure remission (P = 0.157, odds ratio 0.39, 95% confidence interval 0.10 to 1.55). CONCLUSIONS Our case series confirms the presence of specific topographical patterns of macroscopic radiological pathology over the affected hemisphere with a marked age-associated reduction in the odds for severe pan-hemispheric disease.
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Affiliation(s)
- Rohit Ninan Benjamin
- Associate Professor, Neurology, Department of Neurosciences, Christian Medical College, Vellore, India.
| | - Maya Thomas
- Professor and Head, Paediatric Neurology, Department of Neurosciences, Christian Medical College, Vellore, India
| | - Karthik Muthusamy
- Professor, Paediatric Neurology, Department of Neurosciences, Christian Medical College, Vellore, India
| | - Sangeetha Yoganathan
- Professor, Paediatric Neurology, Department of Neurosciences, Christian Medical College, Vellore, India
| | - Vivek Mathew
- Professor and Head, Neurology, Department of Neurosciences, Christian Medical College, Vellore, India
| | - Ari George Chacko
- Professor, Neurosurgery, Department of Neurosciences, Christian Medical College, Vellore, India
| | - Krishna Prabhu
- Professor, Neurosurgery, Department of Neurosciences, Christian Medical College, Vellore, India
| | - Geeta Chacko
- Professor of Neuropathology and Head, General Pathology, Department of General Pathology, Christian Medical College, Vellore, India
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Rose JS, Lalgudi S, Joshua A, Paul J, Thambaiah A, Wankhar S, Chacko G, Kuriakose T, Korah S. An experimental study to test the efficacy of Mesenchymal Stem Cells in reducing corneal scarring in an ex-vivo organ culture model. Exp Eye Res 2020; 190:107891. [DOI: 10.1016/j.exer.2019.107891] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 11/26/2019] [Accepted: 12/02/2019] [Indexed: 10/25/2022]
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Valmiki RR, Venkatesalu S, Chacko AG, Prabhu K, Thomas MM, Mathew V, Yoganathan S, Muthusamy K, Chacko G, Vanjare HA, Krothapalli SB. Phosphoproteomic analysis reveals Akt isoform-specific regulation of cytoskeleton proteins in human temporal lobe epilepsy with hippocampal sclerosis. Neurochem Int 2019; 134:104654. [PMID: 31884041 DOI: 10.1016/j.neuint.2019.104654] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 12/03/2019] [Accepted: 12/23/2019] [Indexed: 01/04/2023]
Abstract
Akt is one of the most important downstream effectors of phosphatidylinositol 3-kinase/mTOR pathway. Hyperactivation and expression of this pathway are seen in a variety of neurological disorders including human temporal lobe epilepsy with hippocampal sclerosis (TLE-HS). Nevertheless, the expression and activation profiles of the Akt isoforms, Akt1, Akt2, and Akt3 and their functional roles in human TLE-HS have not been studied. We examined the protein expression and activation (phosphorylation) patterns of Akt and its isoforms in human hippocampal tissue from TLE and non-TLE patients. A phosphoproteomic approach followed by interactome analysis of each Akt isoform was used to understand protein-protein interactions and their role in TLE-HS pathology. Our results demonstrated activation of the Akt/mTOR pathway as well as activation of Akt downstream substrates like GSK3β, mTOR, and S6 in TLE-HS samples. Akt1 isoform levels were significantly increased in the TLE-HS samples as compared to the non-TLE samples. Most importantly, different isoforms were activated in different TLE-HS samples, Akt2 was activated in three samples, Akt2 and Akt1 were simultaneously activated in one sample and Akt3 was activated in two samples. Our phosphoproteomic screen across six TLE-HS samples identified 183 proteins phosphorylated by Akt isoforms, 29 of these proteins belong to cytoskeletal modification. Also, we were able to identify proteins of several other classes involved in glycolysis, neuronal development, protein folding and excitatory amino acid transport functions as Akt substrates. Taken together, our data offer clues to understand the role of Akt and its isoforms in underlying the pathology of TLE-HS and further, modulation of Akt/mTOR pathway using Akt isoforms specific inhibitors may offer a new therapeutic window for treatment of human TLE-HS.
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Affiliation(s)
- Rajesh Ramanna Valmiki
- Neurophysiology Laboratory, Department of Neurological Sciences, Christian Medical College, Vellore, 632004, Tamilnadu, India.
| | - Subhashini Venkatesalu
- Neurophysiology Laboratory, Department of Neurological Sciences, Christian Medical College, Vellore, 632004, Tamilnadu, India
| | - Ari George Chacko
- Neurosurgery, Department of Neurological Sciences, Christian Medical College, Vellore, 632004, Tamilnadu, India
| | - Krishna Prabhu
- Neurosurgery, Department of Neurological Sciences, Christian Medical College, Vellore, 632004, Tamilnadu, India
| | - Maya Mary Thomas
- Department of Pediatric Neurology, Christian Medical College, Vellore, 632004, Tamilnadu, India
| | - Vivek Mathew
- Neurology, Department of Neurological Sciences, Christian Medical College, Vellore, 632004, Tamilnadu, India
| | - Sangeetha Yoganathan
- Department of Pediatric Neurology, Christian Medical College, Vellore, 632004, Tamilnadu, India
| | - Karthik Muthusamy
- Department of Pediatric Neurology, Christian Medical College, Vellore, 632004, Tamilnadu, India
| | - Geeta Chacko
- Neuropathology, Department of General Pathology, Christian Medical College, Vellore, 632004, Tamilnadu, India
| | | | - Srinivasa Babu Krothapalli
- Neurophysiology Laboratory, Department of Neurological Sciences, Christian Medical College, Vellore, 632004, Tamilnadu, India
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Santosh V, Sravya P, Gupta T, Muzumdar D, Chacko G, Suri V, Epari S, Balasubramaniam A, Radotra BD, Chatterjee S, Sarkar C, Jalali R. ISNO consensus guidelines for practical adaptation of the WHO 2016 classification of adult diffuse gliomas. Neurol India 2019; 67:173-182. [PMID: 30860119 DOI: 10.4103/0028-3886.253572] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Introduction Recent advances in the molecular biology of adult diffuse gliomas have brought about a paradigm shift in their diagnostic criteria, as witnessed in the World Health Organization (WHO) 2016 guidelines for central nervous system tumors. It is now mandatory to perform several molecular tests to reach a definitive integrated diagnosis in most of the cases. This comes with additional cost and higher turnaround time, which is not always affordable in developing countries like India. In addition, the non-uniform distribution of advanced research and diagnostic testing centers adds to the difficulty. Methods The Indian Society of Neuro-oncology (ISNO) multidisciplinary expert panel consisting of neuropathologists, neurosurgeons, and radiation/medical oncologists convened to prepare the national consensus guidelines for approach to diagnosis of adult diffuse gliomas. Results Algorithms for arriving at an integrated diagnosis of adult diffuse gliomas predominantly using immunohistochemistry and with minimum possible additional molecular testing were agreed upon, thus addressing the problems of cost, accessibility, and turnaround time. Mandatory and optional tests were proposed for each case scenario. Conclusion This document represents the consensus of the various neuro-oncology disciplines involved in diagnosis and management of patients with adult diffuse gliomas. The article reflects a practical adaptation of the WHO recommendations to suit a resource constrained setup.
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Affiliation(s)
- Vani Santosh
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Palavalasa Sravya
- Department of Clinical Neurosciences, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Tejpal Gupta
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Dattatraya Muzumdar
- Department of Neurosurgery, King Edward Memorial Hospital, Mumbai, Maharashtra, India
| | - Geeta Chacko
- Department of Neuropathology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Vaishali Suri
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Sridhar Epari
- Department of Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Anandh Balasubramaniam
- Department of Neurosurgery, Yashoda Superspeciality Hospitals, Secunderabad, Telangana, India
| | - Bishan Dass Radotra
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sandip Chatterjee
- Department of Neurosurgery, Park Clinic, Kolkata, West Bengal, India
| | - Chitra Sarkar
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Jalali
- Department of Radiation Oncology, Apollo Proton Cancer Centre, Chennai, Tamil Nadu, India
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Affiliation(s)
- Geeta Chacko
- Department of Neuropathology, Christian Medical College, Vellore, Tamil Nadu, India
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30
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Jabarkheel R, Amayiri N, Yecies DW, Huang Y, Toescu S, Mabbott D, Sudhakar S, Malik P, Laughlin S, Chacko G, Mathew L, Fisher P, Taylor MD. Predictors of Posterior Fossa Syndrome: Results From an International Multicenter Cohort Study of Molecularly Characterized Medulloblastoma Patients. Neurosurgery 2019. [DOI: 10.1093/neuros/nyz310_198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abraham AP, Sarkar S, Mannam P, Chacko G, Chacko AG. A rare case of a giant tentorial bicompartmental cystic schwannoma unrelated to the cranial nerves. Neurol India 2019; 67:932-933. [PMID: 31347598 DOI: 10.4103/0028-3886.263175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Ananth P Abraham
- Department of Neurological Sciences, Christian Medical College, Vellore Tamil Nadu, India
| | - Sauradeep Sarkar
- Department of Neurological Sciences, Christian Medical College, Vellore Tamil Nadu, India
| | - Pavithra Mannam
- Department of Radiology, Christian Medical College, Vellore Tamil Nadu, India
| | - Geeta Chacko
- Department of Pathology, Christian Medical College, Vellore Tamil Nadu, India
| | - Ari G Chacko
- Department of Neurological Sciences, Christian Medical College, Vellore Tamil Nadu, India
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Mahalingam HV, Mani SE, Patel B, Prabhu K, Alexander M, Fatterpekar GM, Chacko G. Imaging Spectrum of Cavernous Sinus Lesions with Histopathologic Correlation. Radiographics 2019; 39:795-819. [DOI: 10.1148/rg.2019180122] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Harsha Vardhan Mahalingam
- From the Departments of Radiology (H.V.M., S.E.M.), Pathology (B.P., G.C.), Neurosurgery (K.P.), and Neurology (M.A.), Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu 632004, India; and the Department of Radiology, NYU Langone Medical Center, New York, NY (G.M.F.)
| | - Sunithi E. Mani
- From the Departments of Radiology (H.V.M., S.E.M.), Pathology (B.P., G.C.), Neurosurgery (K.P.), and Neurology (M.A.), Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu 632004, India; and the Department of Radiology, NYU Langone Medical Center, New York, NY (G.M.F.)
| | - Bimal Patel
- From the Departments of Radiology (H.V.M., S.E.M.), Pathology (B.P., G.C.), Neurosurgery (K.P.), and Neurology (M.A.), Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu 632004, India; and the Department of Radiology, NYU Langone Medical Center, New York, NY (G.M.F.)
| | - Krishna Prabhu
- From the Departments of Radiology (H.V.M., S.E.M.), Pathology (B.P., G.C.), Neurosurgery (K.P.), and Neurology (M.A.), Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu 632004, India; and the Department of Radiology, NYU Langone Medical Center, New York, NY (G.M.F.)
| | - Mathew Alexander
- From the Departments of Radiology (H.V.M., S.E.M.), Pathology (B.P., G.C.), Neurosurgery (K.P.), and Neurology (M.A.), Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu 632004, India; and the Department of Radiology, NYU Langone Medical Center, New York, NY (G.M.F.)
| | - Girish M. Fatterpekar
- From the Departments of Radiology (H.V.M., S.E.M.), Pathology (B.P., G.C.), Neurosurgery (K.P.), and Neurology (M.A.), Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu 632004, India; and the Department of Radiology, NYU Langone Medical Center, New York, NY (G.M.F.)
| | - Geeta Chacko
- From the Departments of Radiology (H.V.M., S.E.M.), Pathology (B.P., G.C.), Neurosurgery (K.P.), and Neurology (M.A.), Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu 632004, India; and the Department of Radiology, NYU Langone Medical Center, New York, NY (G.M.F.)
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Christudoss P, Chacko G, Selvakumar R, Fleming JJ, Pugazhendhi S, Mathew G. Expression of Metallothionein after Administration of Aspirin, Vitamin C or Zinc Supplement in the DMH Induced Colon Carcinoma in Rat. Asian Pac J Cancer Prev 2018; 19:3237-3244. [PMID: 30486626 PMCID: PMC6318414 DOI: 10.31557/apjcp.2018.19.11.3237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background: Chemoprevention refers to the use of specificnatural or synthetic chemical agents to suppress the development and progression to carcinoma. The purpose of this study was to assess the effect of aspirin, vitamin C or zinc on the metallothionein (MT) mRNA gene expression as well as MT protein content byimmunohistochemistry andradioimmunoassay (RIA) in 1, 2-dimethyl hydrazine (DMH) induced cancerous colonic tissuein rats. Methods: Rats were randomly divided into three groups, group 1 (aspirin), group 2 (vitamin C) group 3 (zinc), each of which was further sub divided into two groups and given subcutaneous injections of DMH (30 mg/kg body weight) twice a week for 3 months and sacrificed at either 4 months (A-precancer model) or at 6 months (B-cancer model). The control groups were administered 0.5 ml saline subcutaneously. All the 3 groups were simultaneouslyadministered aspirin, vitamin Cor zinc supplement respectively from the beginning till the end of the study. Results: It was observed that rats co-treated with aspirin, vitamin C or zinc resulted in a significant increase in the colonic MT mRNA expression in the precancer and cancer model as compared to the saline only controls. MT protein expression showed a 60%, 64% and 78% immunopositivity in the co-treated groups respectively. The mean MT content in the precancer and the cancer model was restored to near normal levels in all the three co-treated groups. Conclusion: These results suggest that co-administration of aspirin, vitamin C or zinc resulted in a significant increase in MT mRNA gene expression, MT protein expression and MT protein content which could possibly be one of the reasons for a chemo protective effect against progression to colonic cancer in a chemically induced DMH model in rat. Zinc supplement had a greater effect on metallothionein expression than aspirin or vitamin C.
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Affiliation(s)
- Pamela Christudoss
- Department of Clinical Biochemistry, Christian Medical College, Vellore, Tamil Nadu, India.
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Sigamani E, Chandramohan J, Nair S, Chacko G, Thomas M, Mathew LG, Pulimood S, Manipadam MT. Lymphomatoid granulomatosis: A case series from South India. INDIAN J PATHOL MICR 2018; 61:228-232. [PMID: 29676363 DOI: 10.4103/ijpm.ijpm_471_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Context Lymphomatoid granulomatosis (LYG) is a rare B-lymphoproliferative disorder characterised by an angiocentric and angiodestructive pattern along with Epstein - Barr virus (EBV) association. It is one of the diagnostic challenges in lymphoma pathology. Deregulation of EBV immune surveillance is one of the narrated hypotheses in the literature. Extrapulmonary manifestations are rare with LYG. Morphological grading is done based on the number of EBV-positive B cells, which is useful to strategize treatment protocol. Aims We report here a series of nine cases of LYG to discuss the clinical, histological, and immunohistochemistry findings. Settings and Design This is the first case series from India in published literature. Subjects and Methods We reviewed cases of LYG diagnosed at our center for the past 11 years (2006-2016). A total of nine cases were included in this study. Histomorphology was studied in conjunction with immunohistochemistry and clinical details. Cases without classical morphology and negative for EBV immunostain were excluded from the study. Results There were nine patients in our study (7 males and 2 female; M:F ratio 3.5:1). The age of these patients ranged from 4 years to 57 years (mean age: 30 years). The most common site involved was the lung (4, 44%), followed by the skin (2, 22%), central nervous system (2, 22%) and lymph node (1, 11%). One patient had primary immunodeficiency. Another patient had undergone renal transplant 11 years before the development of the lesion. Angiocentricity and angioinvasion were appreciated in all nine cases (9/9) with necrosis in four cases (44%) and ill-defined histiocytic aggregates in three cases (33%). The histological features were as follows: Grade 1(4 cases, 44%), Grade 2(2 cases, 22%), and Grade 3(3 cases, 33%). Conclusion LYG is a rare EBV driven angiodestructive disease with predominantly lung involvement as well as isolated extrapulmonary sites as seen in our study. It is often progressive and ultimately fatal in the absence of appropriate treatment. Grading of the lesion helps to initiate the appropriate treatment of choice.
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Affiliation(s)
- Elanthenral Sigamani
- Department of Pathology, Christian Medical College Hospital, Vellore, Tamil Nadu, India
| | - Jagan Chandramohan
- Department of Pathology, Christian Medical College Hospital, Vellore, Tamil Nadu, India
| | - Sheila Nair
- Department of Pathology, Christian Medical College Hospital, Vellore, Tamil Nadu, India
| | - Geeta Chacko
- Department of Pathology, Christian Medical College Hospital, Vellore, Tamil Nadu, India
| | - Meera Thomas
- Department of Pathology, Christian Medical College Hospital, Vellore, Tamil Nadu, India
| | - Leni Grace Mathew
- Department of Pediatric Oncology, Christian Medical College Hospital, Vellore, Tamil Nadu, India
| | - Susanne Pulimood
- Department of Dermatology, Christian Medical College Hospital, Vellore, Tamil Nadu, India
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Affiliation(s)
- S Divyashree
- Department of Infectious Diseases, Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu, India
| | - Rajiv Karthik
- Department of Infectious Diseases, Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu, India
| | - Krishna Prabhu
- Department of Neurosurgery, Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu, India
| | - Geeta Chacko
- Department of Pathology, Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu, India
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Manesh A, Mani RS, Pichamuthu K, Jagannati M, Mathew V, Karthik R, Abraham OC, Chacko G, Varghese GM. Case Report: Failure of Therapeutic Coma in Rabies Encephalitis. Am J Trop Med Hyg 2018; 98:207-210. [PMID: 29141755 PMCID: PMC5928693 DOI: 10.4269/ajtmh.17-0153] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Accepted: 08/31/2017] [Indexed: 12/25/2022] Open
Abstract
Rabies encephalitis is a fulminant, almost universally fatal infection involving the central nervous system. A unique treatment protocol, including anti-exicitotoxic therapy and induced coma was credited with the survival of a vaccinated teenager with bat rabies encephalitis in 2005. However, multiple efforts to replicate this expensive and intense protocol have not been successful. In this article, we report the failure of the protocol in Indian patients with canine-acquired rabies and elucidate the potential explanations for the failure of the protocol in our patients.
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Affiliation(s)
- Abi Manesh
- Department of Infectious Diseases, Christian Medical College, Vellore, Tamil Nadu, India
| | - Reeta Subramaniam Mani
- Department of Neurovirology, WHO Collaborating Centre for Reference and Research on Rabies, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Kishore Pichamuthu
- Division of Critical Care, Christian Medical College, Vellore, Tamil Nadu, India
| | - Manjeera Jagannati
- Department of Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Vivek Mathew
- Department of Neurological Sciences, Neurology Unit, Christian Medical College, Vellore, Tamil Nadu, India
| | - Rajiv Karthik
- Department of Infectious Diseases, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Geeta Chacko
- Section of Neuropathology, Department of Neurological Sciences & Pathology, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
| | - George M. Varghese
- Department of Infectious Diseases, Christian Medical College, Vellore, Tamil Nadu, India
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Chacko G, Geevar T, Pai R, Malepathi K, Patel B, John J, Chacko A, Balakrishnan R, John S. Molecular profile of tumors with oligodendroglial morphology: Clinical relevance. Neurol India 2018; 66:1726-1731. [DOI: 10.4103/0028-3886.246275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Sarkar S, Philip VJ, Cherukuri SK, Chacko AG, Chacko G. Implications of the World Health Organization definition of atypia on surgically treated functional and non-functional pituitary adenomas. Acta Neurochir (Wien) 2017; 159:2179-2186. [PMID: 28573325 DOI: 10.1007/s00701-017-3223-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 05/11/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND The World Health Organization (WHO) defines atypical pituitary adenomas as tumours with a MIB-1 labelling index ≥3%, p53 positivity and increased mitotic activity. Although a few reports have described the clinical and radiological correlates of atypia in pituitary adenomas, its impact on postoperative outcomes is not clearly defined. METHOD We reviewed preoperative and postoperative records of patients undergoing surgery for pituitary adenomas. Postoperative outcomes for functional adenomas (FPAs) were assessed according to contemporary definitions of remission and recurrence. For non-functional pituitary adenomas (NFPAs), extent of resection and disease progression were defined on the basis of postoperative magnetic resonance imaging. RESULTS Of 394 patients included for analysis, 29 cases (7.4%) fulfilled criteria for atypia. Patients with atypical tumours were significantly younger than those with typical adenomas. Remission was possible in 47.4% of FPAs, and was unrelated to the presence of atypia. In NFPAs, local invasiveness was negatively associated with extent of resection (OR, 0.255; 95% CI, 0.086-0.753; p < 0.001). In 93 NFPAs followed postoperatively with serial imaging over a mean duration of 37.5 months, disease progression/recurrence was significantly associated with the presence of atypia (OR, 5.058; 95% CI, 1.273-20.098; p = 0.021) on multivariate analysis. CONCLUSIONS Patients with atypical non-functional pituitary adenomas are at risk for postoperative recurrence and disease progression, suggesting a need for adjuvant therapy. However, only a small fraction of pituitary tumours demonstrate atypia, as defined by the WHO, limiting its clinical utility.
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Wood MD, Tihan T, Perry A, Chacko G, Turner C, Pu C, Payne C, Yu A, Bannykh SI, Solomon DA. Multimodal molecular analysis of astroblastoma enables reclassification of most cases into more specific molecular entities. Brain Pathol 2017; 28:192-202. [PMID: 28960623 DOI: 10.1111/bpa.12561] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 09/14/2017] [Indexed: 12/26/2022] Open
Abstract
Astroblastoma is a rare and controversial glioma with variable clinical behavior. The diagnosis currently rests on histologic findings of a circumscribed glioma with astroblastomatous pseudorosettes and vascular hyalinization. Immunohistochemical studies have suggested different oncogenic drivers, such as BRAF p.V600E, but very few cases have been studied using genome-wide methodologies. Recent genomic profiling identified a subset of CNS embryonal tumors with astroblastoma-like morphology that harbored MN1 gene fusions, termed "CNS high-grade neuroepithelial tumors with MN1 alteration" (CNS-HGNET-MN1). To further characterize the genetic alterations that drive astroblastomas, we performed targeted next-generation sequencing (NGS) of 500 cancer-associated genes in a series of eight cases. We correlated these findings with break-apart fluorescence in situ hybridization (FISH) analysis of the MN1 locus and genome-wide DNA methylation profiling. Four cases showed MN1 alteration by FISH, including two pediatric cases that lacked other pathogenic alterations, and two adult cases that harbored other cancer-associated gene mutations or copy number alterations (eg, CDKN2A/B homozygous deletion, TP53, ATM and TERT promoter mutations). Three of these cases grouped with the CNS-HGNET-MN1 entity by methylation profiling. Two of four MN1 intact cases by FISH showed genetic features of either anaplastic pleomorphic xanthoastrocytoma (BRAF p.V600E mutation, CDKN2A/B homozygous deletion and TERT promoter mutation) or IDH-wildtype glioblastoma (trisomy 7, monosomy 10, CDK4 amplification and TP53, NRAS and TERT promoter mutations) and these cases had an aggressive clinical course. Two clinically indolent cases remained unclassifiable despite multimodal molecular analysis. We conclude that astroblastoma histology is not specific for any entity including CNS-HGNET-MN1, and that additional genetic characterization should be considered for astroblastomas, as a number of these tumors likely contain a methylation profile or genetic alterations that suggest classification as other tumor entities. Our heterogeneous molecular findings help to explain the clinical unpredictability of astroblastoma.
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Affiliation(s)
- Matthew D Wood
- Department of Pathology, Division of Neuropathology, University of California, San Francisco, CA
| | - Tarik Tihan
- Department of Pathology, Division of Neuropathology, University of California, San Francisco, CA
| | - Arie Perry
- Department of Pathology, Division of Neuropathology, University of California, San Francisco, CA.,Department of Neurological Surgery, University of California, San Francisco, CA
| | - Geeta Chacko
- Department of Pathology, Division of Neuropathology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Clinton Turner
- Anatomical Pathology, LabPLUS Auckland City Hospital, Auckland, New Zealand
| | - Cunfeng Pu
- Department of Pathology, Allegheny General Hospital, Pittsburgh, PA
| | - Christopher Payne
- Department of Neurosurgery, Allegheny General Hospital, Pittsburgh, PA
| | - Alexander Yu
- Department of Neurosurgery, Allegheny General Hospital, Pittsburgh, PA
| | - Serguei I Bannykh
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
| | - David A Solomon
- Department of Pathology, Division of Neuropathology, University of California, San Francisco, CA
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Joseph S, Janakiraman R, Chacko G, Jayaraj R, Thomas M, Thomas M, Mukhopadhyay S. Predictability of Recurrence using Immunohistochemistry to delineate Surgical Margins in mucosal Head and Neck Squamous Cell Carcinoma ( PRISM-HNSCC): study protocol for a prospective, observational and bilateral study in Australia and India. BMJ Open 2017; 7:e014824. [PMID: 29038175 PMCID: PMC5652552 DOI: 10.1136/bmjopen-2016-014824] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES Treatment failure and poor 5-year survival in mucosal head and neck squamous cell carcinoma (HNSCC) has remained unchanged for decades mainly due to advanced stage of presentation and high rates of recurrence. Incomplete surgical removal of the tumour, attributed to lack of reliable methods to delineate the surgical margins, is a major cause of disease recurrence. The predictability of recurrence using immunohistochemistry (IHC) to delineate surgical margins (PRISM) in mucosal HNSCC study aims to redefine margin status by identifying the true extent of the tumour at the molecular level by performing IHC with molecular markers, eukaryotic initiation factor, eIF4Eand tumour suppressor gene, p53, on the surgical margins and test the use of Lugol's iodine and fluorescence visualisation prior to the wide local excision. This article describes the study protocol at its pre - results stage. METHODS AND ANALYSIS PRISM-HNSCC is a bilateral observational research being conducted in Darwin, Australia and Vellore, India. Individuals diagnosed with HNSCC will undergo the routine wide local excision of the tumour followed by histopathological assessment. Tumours with clear surgical margins that satisfy the exclusion criteria will be selected for further staining of the margins with eIF4E and p53 antibodies. Results of IHC staining will be correlated with recurrences in an attempt to predict the risk of disease recurrence. Patients in Darwin will undergo intraoperative staining of the lesion with Lugol's iodine and fluorescence visualisation to delineate the excision margins while patients in Vellore will not undertake these tests. The outcomes will be analysed. ETHICS AND DISSEMINATION The PRISM-HNSCC study was approved by the institutional ethics committees in Darwin (Human Research Ethics Committee 13-2036) and Vellore (Institutional Review Board Min. no. 8967). Outcomes will be disseminated through publications in academic journals and presentations at educational meetings and conferences. It will be presented as dissertation at the Charles Darwin University. We will communicate the study results to both participating sites. Participating sites will communicate results with patients who have indicated an interest in knowing the results. TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trials Registry (ACTRN12616000715471).
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Affiliation(s)
- Sheela Joseph
- Northern Territory Medical Program, Centre for Remote Health, Flinders University, Alice Springs, Northern Territory, Australia
- Engineering, Health, Science and the Environment, Charles Darwin University, Alice Springs, Northern Territory, Australia
| | | | - Geeta Chacko
- Department of Pathology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Rama Jayaraj
- Faculty of Engineering, Health, Science and the Environment, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Mahiban Thomas
- Department of Maxillofacial Surgery, Royal Darwin Hospital, Tiwi, Northern Territory, Australia
| | - Meera Thomas
- Department of Pathology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Sramana Mukhopadhyay
- Department of Pathology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
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Jonathan GE, Nair BR, Joseph V, Mani S, Chacko G. Lumbar extradural arteriovenous malformation mimicking a schwannoma in a child: Rare presentation of neurofibromatosis type-1. Neurol India 2017; 65:900-902. [PMID: 28681780 DOI: 10.4103/neuroindia.ni_585_16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Gandham E Jonathan
- Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India
| | - Bijesh R Nair
- Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India
| | - Vivek Joseph
- Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India
| | - Sunithi Mani
- Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Geeta Chacko
- Department of Neuropathology, Christian Medical College, Vellore, Tamil Nadu, India
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Philip SS, Kuriakose T, Chacko G. Successful surgical management of bilateral epiretinal membrane in a child with only café-au-lait spots. Indian J Ophthalmol 2017. [PMID: 28643724 PMCID: PMC5508470 DOI: 10.4103/ijo.ijo_649_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 6-year-old boy diagnosed as anisometropic amblyopia, with only café-au-lait spots and a family history of neurofibromatosis, presented with decrease in vision in the both eyes. Dilated fundus examination showed epiretinal membrane in both eyes over the macula. He underwent successful surgical management of the epiretinal membrane.
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Affiliation(s)
- Swetha Sara Philip
- Department of Ophthalmology, Christian Medical College and Hospital, Vellore, Tamil Nadu, South India
| | - Thomas Kuriakose
- Department of Ophthalmology, Christian Medical College and Hospital, Vellore, Tamil Nadu, South India
| | - Geeta Chacko
- Department of Pathology, Christian Medical College and Hospital, Vellore, Tamil Nadu, South India
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Abstract
Carcinomatous meningitis is a rare manifestation of malignancy. It is increasingly being recognized in lung carcinoma, breast carcinoma, melanomas, gastrointestinal malignancies, lymphomas, and leukemia and it is almost never seen in gallbladder malignancies. We present a case whose primary presentation was as a carcinomatous meningitis that was subsequently found to be secondary to a gallbladder primary.
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Affiliation(s)
- Nisha Jose
- Department of General Medicine, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Harsha Teja Perla
- Department of General Medicine, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Ramya Iyadurai
- Department of General Medicine, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Geeta Chacko
- Department of Pathology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
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Christudoss P, Chacko G, Selvakumar R, Fleming JJ, Pugazhendhi S, Mathew G. Expression of metallothionein in dimethylhydrazine-induced colonic precancerous and cancerous model in rat. J Cancer Res Ther 2017; 12:1307-1312. [PMID: 28169244 DOI: 10.4103/0973-1482.179107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIM Metallothionein (MT) is a small protein with a high affinity for divalent heavy metals and has a function in zinc homeostasis. The purpose of this study was to assess the MT mRNA gene expression as well as the MT protein content by immunohistochemistry and radioimmunoassay (RIA) in 1,2-dimethylhydrazine (DMH)-induced precancerous and cancerous colonic tissue in rats. MATERIALS AND METHODS Six-week-old rats were given subcutaneous injections of DMH twice a week for 3 months and sacrificed at 4 months (precancerous model) and 6 months (cancerous model). We determined MT mRNA expression by reverse transcription polymerase chain reaction and MT protein content by both immunohistochemical expression and cadmium-109 RIA. RESULTS MT mRNA expression in the large intestine showed statistically significant decrease in the precancerous (P < 0.01) and the cancerous (P < 0.001) model as compared with controls. Immunohistochemical expression of MT showed statistically significant decrease (P < 0.05) in the colonic cancerous tissue. MT content in the large intestine showed statistically significant decrease in precancerous (P < 0.005) and cancerous (P < 0.001) model as compared with controls. CONCLUSION This study suggests that a decrease in the colonic MT mRNA expression, MT protein expression, and content in DMH-induced colonic cancer model is associated with the development of preneoplastic lesions and further progression to carcinoma in the colon results in a greater reduction in the levels of each of these parameters.
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Affiliation(s)
- Pamela Christudoss
- Department of Clinical Biochemistry, Christian Medical College, Vellore, Tamil Nadu, India
| | - Geeta Chacko
- Department of Neuropathology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Ratnasamy Selvakumar
- Department of Clinical Biochemistry, Christian Medical College, Vellore, Tamil Nadu, India
| | - Jude Joseph Fleming
- Department of Clinical Biochemistry, Christian Medical College, Vellore, Tamil Nadu, India
| | - Srinivasan Pugazhendhi
- Department of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu, India
| | - George Mathew
- Department of General Surgery, Christian Medical College, Vellore, Tamil Nadu, India
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Ralph R, Gupta RD, Chacko AG, Chacko G, Thomas N. Growth Hormone–Secreting Pituitary Carcinoma Presenting With Isolated Leptomeningeal Involvement: A Challenging Diagnosis. AACE Clin Case Rep 2017. [DOI: 10.4158/ep15987.cr] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Gupta N, Chacko G, Chacko AG, Rajshekhar V, Jayprakash M. Fluorescence in situ hybridization for chromosome 14q deletion in subsets of meningioma segregated by MIB-1 labelling index. Neurol India 2016; 64:1256-1263. [PMID: 27841196 DOI: 10.4103/0028-3886.193768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIM To correlate histopathological grading of meningiomas segregated into subgroups based on the MIB-1 labelling index (MIB-1 LI) with chromosomal loss of 14q using fluorescence in situ hybridization (FISH). SETTINGS AND DESIGN Retrospective study conducted in a tertiary hospital. METHODS AND MATERIAL Forty-six cases from January to December 2011 were segregated into 5 categories based on the MIB-1 LI. Slides were reviewed to ascertain the grade. Immunohistochemical staining for MIB-1 was performed using a Ventana Benchmark XT autostainer. Commercially available FISH paraffin pretreatment kit and SpectrumOrange fluorophore labelled probe were used. The Statistical Package for the Social Sciences version 16.0 for Windows was used for statistical analysis. RESULTS There were 21 World Health Organisation (WHO) grade I, 24 grade II, and 1 grade III meningiomas. There was a statistically significant difference between the mean duration of symptoms, maximum dimension, and the MIB-1 LI of grade I and grade II meningiomas. 33.3% grade I cases showed 14q deletion, compared to 84% of grade II and III meningiomas. Histologically, hypercellularity, small cell formation, prominent nucleoli, and sheet-like growth were significantly associated with 14q deletion. All brain invasive meningiomas had 14q deletion. As MIB-1% increased, the prevalence of deletions was significantly higher. The mean MIB-1 of the 7 grade I meningiomas that had 14q deletions was 8.86 ± 1.95% when compared to 4.14 ± 1.35% for those without 14q deletions. CONCLUSIONS A strong association existed between histologic grade, MIB-1 LI, and the presence of chromosome 14q deletion. Association of high MIB-1 LI with 14q deletions, even in meningiomas with a Grade I histology, defines a distinct subset of benign meningiomas.
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Affiliation(s)
- Noopur Gupta
- Department of General Pathology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Geeta Chacko
- Department of General Pathology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Ari G Chacko
- Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India
| | - Vedantam Rajshekhar
- Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India
| | - Muyilil Jayprakash
- Division of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu, India
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Ganapule AP, Varghese SS, Chacko G, Aparna I, Viswabandya A. Glioblastoma Multiforme in a Post Allogeneic Stem Cell Transplant Patient. A Case Report and Literature Review of Post Transplant Neurological Tumors. Indian J Hematol Blood Transfus 2016; 32:192-5. [PMID: 27408389 PMCID: PMC4925482 DOI: 10.1007/s12288-015-0500-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 01/05/2015] [Indexed: 10/24/2022] Open
Abstract
Seventeen year old boy, a case of relapsed acute lymphoblastic leukemia 10 years post allogeneic transplantation, presented to us with acute onset of right hemiparesis. The imaging revealed contrast enhancing lesion in the frontal lobe, biopsy of the same was consistent with glioblastoma multiforme (GBM). He had received total body irradiation (TBI) based conditioning regimen prior to transplant. GBM was treated with left parietal craniotomy and parietal excision of tumour, followed by radiation therapy with concurrent and adjuvant chemotherapy. Disease progressed while was on adjuvant chemotherapy and patient succumbed to his illness 8 months after the diagnosis of GBM. We report here a here unusual case of GBM in a post transplant patient who received TBI based conditioning regimen.
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Affiliation(s)
- Abhijeet P. Ganapule
- />Department of Haematology, Christian Medical College and Hospital, Ida Scudder Road, Vellore, 632004 Tamil Nadu India
| | - Sunita Susan Varghese
- />Depatment of Radiotherapy, Christian Medical College and Hospital, Ida Scudder Road, Vellore, 632004 Tamil Nadu India
| | - Geeta Chacko
- />Department of Pathology, Christian Medical College and Hospital, Ida Scudder Road, Vellore, 632004 Tamil Nadu India
| | - I. Aparna
- />Department of Radiology, Christian Medical College and Hospital, Ida Scudder Road, Vellore, 632004 Tamil Nadu India
| | - Auro Viswabandya
- />Department of Haematology, Christian Medical College and Hospital, Ida Scudder Road, Vellore, 632004 Tamil Nadu India
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Manesh A, Barnabas R, Karthick R, Chacko G, Kannangai R, Varghese G. HIV-mediated CD8 encephalitis: An under recognised entity. Int J Infect Dis 2016. [DOI: 10.1016/j.ijid.2016.02.588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Kurien NA, John D, Chacko G, Jacob P. Granulocytic Sarcoma in an Adult with Relapsed Acute Myeloid Leukaemia. J Clin Diagn Res 2016; 10:ND03-4. [PMID: 26894103 DOI: 10.7860/jcdr/2016/15215.7093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 11/07/2015] [Indexed: 11/24/2022]
Abstract
Granulocytic sarcoma is an extramedullary tumour consisting of malignant granulocytic precursor cells that is common among children with acute myeloid leukaemia (AML). We report a case of orbital granulocytic sarcoma in an adult with relapsed undifferentiated AML-M0. It presented as bilateral medial canthal swellings. An incisional biopsy confirmed the diagnosis of granulocytic sarcoma. The swelling resolved with re-induction chemotherapy.
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Affiliation(s)
- Neethu Ann Kurien
- Resident, Department of Ophthalmology, Christian Medical College , Vellore, Tamil Nadu, India
| | - Deepa John
- Associate Surgeon, Department of Ophthalmology, Christian Medical College , Vellore, Tamil Nadu, India
| | - Geeta Chacko
- Professor, Department of Pathology, Christian Medical College , Vellore, Tamil Nadu, India
| | - Pushpa Jacob
- Professor, Department of Ophthalmology, Christian Medical College , Vellore, Tamil Nadu, India
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Mitra S, Gunasekaran K, Chacko G, Hansdak SG. Leprous neuromyositis: A rare clinical entity and review of the literature. Indian J Med Microbiol 2016; 34:95-7. [PMID: 26776128 DOI: 10.4103/0255-0857.174120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Mycobacterium leprae, the causative agent of leprosy (Hansen's disease), is a slow growing intracellular acid-fast bacillus that affects the skin, peripheral nerves and respiratory tract. In patients with suppressed cell-mediated immunity, the infiltration of the Bacilli can produce disseminated illness such as leprous neuromyositis. We reported a case of 56-year-old gentleman presenting with pyrexia of unknown origin, asymmetric sensory motor axonal polyneuropathy and was on chronic exogenous steroid therapy. On evaluation, his skin, muscle, nerve and bone marrow biopsy showed numerous globi of acid-fast Bacilli suggestive of leprous neuromyositis, a rare form of disseminated Hansen's disease. We reported this case in view of its rarity, atypical manifestation of a relatively rare disease and literature review on poor electrophysiological correlation in the diagnosis of leprous neuromyositis as compared to the histopathological examination.
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Affiliation(s)
- Shubhanker Mitra
- Department of Medicine, Christian Medical College, Vellore, Tamil Nadu, India
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