bluuebunny/crossref_metadata_2025_split huggingface dataset:
Immunoexpression of PTEN, HER2/neu, and Ki-67 in endoscopic gastric carcinoma biopsies; their correlation with histological subtypes and one-year survival
Authors: Acharya Seema , Thakur Brijesh , Mittal Richa 
Published: August 2024

Background:
Gastric carcinoma is a major cause of cancer-related morbidity and mortality worldwide. Gastric neoplasms arise from genetic and epigenetic changes in various genes. Present study evaluates the immunoexpression of PTEN, HER2/neu, and Ki-67 in endoscopic gastric carcinoma biopsies and correlates the expression of these proteins with clinicopathological features.

Material and Methods:
Adequate endoscopic biopsies of 27 cases of gastric carcinoma were evaluated for World Health Organization (WHO) and Lauren's classification subtypes along with HER2/neu, PTEN, and Ki-67 immunoexpression. HER2/neu immunostaining was scored as proposed in the Trastuzumab for gastric cancer (ToGA) trial while PTEN staining and downregulation were assessed using an immunoreactive score. The cut-off for Ki-67 expression was taken as 90th percentile of the values in adjacent non-neoplastic tissue. All statistical analysis was done at 5% level of significance with SPSS v22 statistical software.

Results:
Tubular adenocarcinoma was the commonest WHO histological subtype and 56% of cases were of intestinal type as per Lauren's classification. 55.6% of cases showed a complete loss of PTEN expression in neoplastic tissue. 17 of the 19 cases with adjacent non-neoplastic tissue showed PTEN downregulation in neoplastic tissue. 81.5% of cases had a high Ki-67 index and HER2/neu overexpression was noted in 36% of cases. All the four cases who died had high Ki-67 proliferation indices; 3 patients had loss of PTEN expression and HER2/neu overexpression.

Conclusion:
We conclude that these immunomarkers can play important role in the behavior of gastric carcinomas and can be targeted for new therapies.
Ependymosarcoma presenting as recurrence in a primary left parieto-occipital ependymoma
Authors: Prasad Pallavi , Baranwal Harshita , Gupta Neelima 
Published: August 2024

ABSTRACT
Ependymomas are glial tumors that may arise from the supratentorial, posterior fossa, and spinal compartments. Conventional ependymomas belong to WHO grade 2. Gliosarcoma is described as a variant of IDH-wildtype glioblastoma, comprising a biphasic tissue pattern with alternating areas displaying glial and mesenchymal differentiation. It may develop in an ependymoma, in addition to astrocytomas. This sarcomatous transformation portends a more aggressive behavior; hence, this entity should be kept in mind during the management of lesions with atypical imaging features on diagnosis. We report a rare presentation of ependymosarcoma presenting nearly 1.5 years later after the excision of a conventional ependymoma in a young female. Upon presentation as recurrence, the patient developed symptoms and atypical imaging findings. Histopathological and immunohistochemical examination of the excised tumor specimens revealed sarcomatous change occurring in an operated prior conventional ependymoma.
Primary diffuse large B-cell lymphoma of the prostate: Histopathological diagnosis of a rare entity in the prostate
Authors: Sharma Richa , Bansal Sumit , Gangoli Aparna 
Published: August 2024

ABSTRACT
Lymphoma of the prostate is rare whether it is primary extranodal lymphoma or secondary involvement of the prostate by primary lymphoma elsewhere. Of all the lymphomas of the prostate, primary lymphomas of the prostrate are very rare. Although less frequent, it should be a differential diagnosis when evaluating prostate tumors. Here, we report a case of a 61-year-old man who presented with hematuria with clot retention. A cystoscopy with clot removal and transurethral resection of the prostate (TURP) was performed. This biopsy was sent for histopathological examination at an external center, where a diagnosis of benign prostatic hyperplasia was given. Fifteen days later, the patient presented with hematuria again. On examination, clots were present in the bladder. There was significant prostatomegaly. A re-resection of the prostate was performed and sent for another review to us. The biopsy was reported as high-grade round cell neoplasm, most likely lymphoma. Immunohistochemistry (IHC) was recommended for confirmation. Tumor cells showed immunoreactivity for CD20, B-cell Lymphoma (BCL)-2, BCL-6, Myelocytomatosis (c-Myc), and multiple myeloma 1 (MUM1). Cluster Differentiation (CD)10 was negative. Kiel-67 was high. A final diagnosis of double-expressor diffuse large B-cell lymphoma (DLBCL) of non-germinal center type was made. We share this case to emphasize the fact that primary lymphoma of the prostate is primarily a histopathological diagnosis as the clinical presentation is not unique. Owing to its rarity, the clinical and histopathological suspicion is low. Hence, keeping the differential in mind while evaluating prostate biopsy is beneficial in a timely diagnosis of the entity as the management of prostatic carcinoma and lymphoma is different.
A comparative histological analysis of early and late graft dysfunction in different time zones following living donor liver transplantation
Authors: Rastogi Archana , Patil Nayana , Srivastava Sphurti , Ramakrishna Gayatri , Maiwal Rakhi , Kumar Guresh , Choudhary Ashok K. , Alam Seema , Bihari Chhagan , Pamecha Viniyendra 
Published: August 2024

Background:
Liver biopsy plays a crucial role in evaluating allograft dysfunction. Comprehensive analysis of the histological spectrum of complications, particularly rejection, in different time zones is lacking.

Aim:
To evaluate the histological spectrum of rejection, in four time zones, in a large Living donor liver transplant series.

Patients and Methods:
Retrospective analysis of 313 biopsies for the last 10 years of living donor liver transplantation (LDLT) recipients. 123 of which had rejection as diagnosis, were redistributed in four time zones [1-early (<3), 2-intermediate (3–6), 3 and 4-late (6–12 and > 12) months] and were assessed for sixteen histological parameters.

Results:
Biopsies in time zone 1 (26.5%), 2 (20.7%), 3 (24.6%), and 4 (28.1%)] were nearly equal. Multiple coexistent complications existed in 12% of the cases. Rejection diagnosed in time zone groups: 1 = 22 (17.9%), 2 = 27 (22%), 3 = 36 (29.3%), and 4 = 38 (30.9%). Portal inflammation mixed type (P < 0.000), portal vein (P = 0.001) and hepatic vein endothelialitis (P < 0.000), portal eosinophils (P = 0.001), and lymphocytic bile duct damage (P = 0.01) were most pronounced in group 1. Perivenulitis without hepatic vein endothelialitis was observed (P = 0.03) in groups 3, whereas bile duct atypia (P = 0.01) and duct loss (P < 0.000) were observed in group 4. Multiple episodes of rejection displayed significant association with central perivenulitis (P = 0.002) and bile duct loss (P < 0.001).

Conclusions:
Histological analysis in large series of LDLT recipients highlights the spectrum of complications in different time zones. Late acute and chronic rejection occurred as early as 3 months posttransplant. Central perivenulitis and bile duct atrophy were associated with repeated episodes of rejection and deterioration.
Primitive myxoid mesenchymal tumor of infancy, an enigmatic entity: A case report
Authors: Goswami Malini 
Published: August 2024

ABSTRACT
Primitive myxoid mesenchymal tumor of infancy (PMMTI) is a rare soft tissue neoplasm of intermediate malignant potential occurring predominantly in infants and younger children. It can show aggressive local infiltration of surrounding structures and frequent relapses but rare metastasis. Morphologically, it is characterized by a proliferation of immature mesenchymal cells in a myxoid background with mild cytologic atypia and branching vessels. The tumor cells demonstrate immunoreactivity with vimentin and BCOR, however, are negative for more specific lineage markers. Its molecular hallmark is BCOR-internal tandem duplication. Previously classified as infantile fibrosarcoma/undifferentiated sarcoma, the association with BCOR-ITD has led to its reclassification as part of a distinct entity—”Sarcoma with BCOR Genetic Alterations”—in the 2020 WHO Classification of Soft Tissue Tumours. Here is a report of a case of a 2-year-old boy with a recurrent scalp mass identified as a primitive myxoid mesenchymal tumor of infancy.
Comparison of circulating DNA in malignant neoplasia from diverse locations
Authors: Kumari Swati , Mishra Sridhar , Husain Nuzhat , Verma Tripti , Tiwari Vandana , Kaif Mohamed , Agarwal Akash , Rastogi Madhup , Shukla Saumya , Sonkar Abhinav Arun 
Published: August 2024

Context:
Circulating free DNA (cfDNA) analysis has emerged as novel noninvasive diagnostic biomarker in several solid tumors. Raised levels have been reported in several malignancies and may correlate with clinicopathological and treatment response. The current study was designed to assess the diagnostics of cfDNA in different tumor types of malignancies correlating with tumor (T), nodes (N), and metastases (M) stage.

Design:
Serum samples were collected from treatment naïve cases with histologically diagnosed tumors including 23 brain tumors, 48 breasts, 50 gallbladder carcinoma (GBC), 13 lungs, 68 oral squamous cell carcinoma (OSCC), and 25 normal controls. CfDNA was quantified with real-time polymerase chain reaction (PCR), Invasive ductal carcinoma (IDC) using beta-globin gene amplification. Cut off values for diagnostics were calculated using receiver operating curve analysis.

Results:
Contrary to other cfDNA studies where it was postulated that cfDNA would not cross the blood–brain barrier and reach the systemic circulation, we found detectable cfDNA in glioma with median (Q1–Q3) of 349.22 ng/ml (19.87–1276.58). Median cfDNA concentration in breast, gallbladder, lung, oral and normal controls was 328.72 (128.38–624.44), 778.50 (589.88–1864.35), 348.73 (194.67–483.61), 386.27 (47.88–959.67), and 74.12 (49.66–120.00), respectively. Grades I and II glioma had significantly lower levels compared to Grades III and IV (P = 0.0001). Significant difference in median cfDNA values in IDC and GBC was observed with increasing tumor grades, stage, T stage, nodal stage and metastasis and with stage of OSCC cases.

Conclusion:
CfDNA levels showed good diagnostic discrimination in glioma, GBC, breast, lung carcinoma, and OSCC. Significant increase in titers was evident with increase in cancer stage from I to IV in breast, GBC and OSCC.
Diagnostic value of different interleukins and procalcitonin in critically ill patients admitted with suspected sepsis
Authors: Mehra Simmi , Tiwari Aseem Kumar , Aggarwal Geet , Mehta Swati Pabbi , Chauhan Rajni , Rajvanshi Chhavi , Govil Deepak 
Published: August 2024

Background:
Many biomarkers have now been studied such as C-reactive Protein (CRP), procalcitonin (PCT), etc., and are widely used for the diagnosis of sepsis in clinical practice which may determine the appropriate antibiotic treatment. A flowcytometric cytokine bead array (CBA) assay has now been used to determine multiple interleukins (IL), simultaneously. The aim of this study was to determine the cytokine (IL2, IL4, IL6, IL10, TNFα, INFγ, and IL17) profiles of interleukins in plasma of sepsis patients by using multiplex Flowcytometric CBA array assay.

Materials and Method
s: A total of 99 consecutive patients admitted with the suspected sepsis were studied. PCT concentrations were measured by using the enzyme-linked fluorescent immunoassay (ELFA) technique and flow cytometry-based BD™ CBA Cytokine Kit was used to evaluate levels of 7 cytokines [IL-2, IL-4, IL-6, IL-10, Tumour Necrosis Factor (TNF), Interferon- γ (IFN-γ), and IL-17A].

Results:
Microbiologically defined infection (MDI) demonstrated a positive culture report in 79/99 (79.7%) of patients. The IL6 [1873.7 (4-5000)] and IL10 [(154.7 (0-1764)] levels were significantly higher in septic patients than those in the negative MDI IL6 [901 (4-5000)] and IL10 [110.4 (4-1372)] levels. The AUROC value of IL6 [0.66 (0.53-0.79)] was found to be the highest among all followed by IL10 [0.65 (0.51-0.79)], IFNγ [0.63 (0.51-0.77)], PCT [0.61 (0.48-0.75)], and TNFα [0.55 (0.42-0.69)].

Conclusion:
Our study suggests that that IL6 is substantially more economical and can reduce the investigation cost to half as compared with the procalcitonin assay.
The unraveling of a rare case of prostate adenocarcinoma presenting as orbital mass
Authors: Kadkol Girish A. , Pol Jaydeep N. , Ratnakar Ashwini V. , Patil Kunal U. 
Published: August 2024

ABSTRACT
Prostate adenocarcinoma (PC) is commonly known to have bone metastasis but its orbital metastasis is rare accounting for only 8.5% of cases. Most of the reported cases of orbital metastasis are in previously diagnosed PC cases. However, orbital metastasis as a sole manifestation of presentation is extremely rare, and to our knowledge, only three cases have been published similar to our present case. A 72-year-old male presented with diplopia and pain in the right eye for six months. On examination, right eye proptosis was noted. A computed tomography (CT) scan showed an enhancing, destructive soft tissue lesion involving the right orbit. The histopathological evaluation revealed a metastatic adenocarcinoma possibly of prostatic origin. Immunohistochemistry (IHC) confirmed the above diagnosis. We report this unique case of metastatic PC presenting with only ocular manifestation, emphasizing the crucial role played by diagnostic modalities like histopathology and IHC in unraveling such occult dilemmatic scenarios.
Molecular subtypes of invasive breast carcinoma of no special type, their correlation with histopathological features, Ki 67 index and tumor budding
Authors: Radhakrishnan Neelima , Mathews Anitha , Rajeev KR , Nair P Sindhu , Bhargavan Rexeena , Viswanathan Ammu Jayanthi 
Published: August 2024

Context:
Tumor budding (TB), poorly differentiated clusters (PDCs), and Ki 67 index are proven adverse prognostic factors in breast carcinoma. Though the relation of Ki 67 index with molecular subtypes of breast carcinoma have been extensively studied, there is very limited information on the role of TB and PDCs.

Aims:
To grade TB, PDCs, and Ki 67 index and assess histological features and relationship of all these with molecular subtypes of invasive breast carcinoma of no special type.

Methods and Material:
Retrospective study of 148 cases from 1/1/2019 to 30/12/2019. Division of molecular groups – Luminal A, Luminal B, Her2 neu positive, and triple-negative breast carcinomas (TNBC), and Ki 67 index grades based on St Gallen criteria, intratumoral and peritumoral TB and PDC grades as per the International Tumor Budding Consensus Conference (ITBCC) criteria for colon and correlation between these and other histological features with the molecular subtypes were done.

Statistical Analysis:
Chi-square test, univariate and multivariate logistic regression models were used.

Results:
Significant correlation was seen between TB and lymphovascular emboli, Luminal B tumors with high-grade TB and PDCs, Her 2 neu positive and TNBC tumors with low-grade TB, circumscribed tumor margins, tumor necrosis, and Luminal B, Her 2 neu positive and TNBC tumors with larger tumor size and high nuclear grades.

Conclusions:
TB and PDCs are useful in the prognostication of Luminal A and B tumors when the Ki 67 index values are low/intermediate. Her 2 neu positive and TNBC tumors have a high nuclear grade with necrosis and no association with TB or PDCs.
Thymectomy for myasthenia gravis
Authors: Bansod Shweta , Vaideeswar Pradeep , Ravat Sangeeta , Panandikar Gajanan 
Published: August 2024

Background:
Myasthenia gravis (MG) is a prototypic T-cell-dependent antibody-mediated autoimmune disease that leads to ocular or generalized muscular weakness. The disease is most commonly caused by antibodies to the acetylcholine receptors, often with underlying thymic pathology.

Aims:
This study is aimed at analyzing the pathological spectrum of the excised thymuses in patients with myasthenia.

Materials and Methods:
This was a retrospective 10-year study of 68 thymectomy specimens performed as a part of the treatment of patients with MG.

Statistical Analysis:
Nil.

Results:
There were 47 males and 21 females (male to female ratio of 2.2:1) with a mean age of 41 years. Only three patients presented with ocular myasthenia. The thymus was normal in 9 patients (13.2%) and atrophic in 17 patients (25%). Follicular hyperplasia and thymomas were seen in 6 and 36 patients, respectively.

Conclusion:
The thymectomies performed in patients of MG had a fairly variable spectrum on histology; the thymic tumors were predominantly of the cortical phenotype.
After-school Clubs: Fostering Protective Factors
Authors: Aarzoo  , Bhartiya Shibal , Singh Tarundeep 
Published: August 2024

Background:
Affiliation to gangs becomes analogous to the need for belongingness; a leader or member of the gang can substitute a primary caregiver, or act as a parent figure or a role model. Children and youth associated with gangs lean toward antisocial activities compared to their nongang counterparts. After-school clubs (ASCs) probably demote gang membership providing support in various aspects of self-growth and thereby compassing the need for affiliation.

Objectives:
The aim of the study was to assess the relationship between risky behavior and gang membership in children and compare the gender differences for the same.

Materials and Methods:
This cross-sectional, observational study was conducted using purposive sampling approaching the children enrolled in an ASC run for children who had dropped out of the school. The participants were 97 children (male and female) attending the ASC between the age range of 6–18 years. They were assessed on sociodemographic and academic profiles; Social, Academic, and Emotional Behavior Risk Screener (SAEBRS); and Gang Membership Inventory (GMI).

Results:
It was observed that the SAEBRS score range of female participants implied “not at risk,” while male participants scored “at risk” scores on social and emotional domains. On GMI, only male participants’ scores showed gang affiliation. The model explained that 76% of the variance in GMI was contributed by the SAEBRS.

Conclusion:
ASC contributed valuably in integrating a vulnerable population into the productive national mainstream. Affinity with ASC can enhance the protective factors and minimize the risk of gang membership. Studies in the future can explore parental factors and resilience of this population along with socioeconomic factors to delve into risky as well as protective behaviors.
The current role of adjuvant radiotherapy in management of medullary thyroid carcinoma: A single institute analysis
Authors: Bhuvana J. , Shivhare Vinay , Rath Satyajeet , Parikh Ankita , Kunikullaya U. Suryanarayan 
Published: August 2024

ABSTRACT

Objectives:
Medullary thyroid carcinoma (MTC) accounts for only about 5% of total thyroid cancers. It usually presents as an advanced disease carrying a poor prognosis than well-differentiated thyroid cancers. While the treatment of choice is surgery, the role of adjuvant radiotherapy is still unclear. This retrospective study aims to understand the role of adjuvant radiotherapy in MTC and its effect on survival.

Materials and Methods:
We did a retrospective two study to estimate the effect of adjuvant external beam radiotherapy (EBRT) on survival outcomes in MTC. A total of 30 patients who were diagnosed with nonmetastatic MTC during the period 2015 to 2020 were included in the study. Fifteen patients underwent only total thyroidectomy with cervical lymph node dissection. Rest 15 patients received adjuvant EBRT following surgery. A median dose of 60 Gy in 30 fractions, 2 Gy per fraction, 5 days per week, was given by conventional radiotherapy technique. Survival outcomes were estimated using Kaplan–Meier method. A univariate analysis using log rank test was performed to estimate the association of various prognostic factors including age, sex, tumor size, nodal involvement, and surgical resection status on survival outcomes.

Results:
Median age of presentation in our study is 47 years (inter quartile range: 36-55 years). Median follow-up time is 4 years. Male to female ratio is 2:3—70% of patients presented with T3 lesions and 77% with N1b disease. There was no significant difference in overall survival (OS) in patients who received adjuvant RT following surgery in comparison to patients who underwent only surgery (92.9% vs. 71.4% P value = 0.202). Similarly, there was no improvement in locoregional recurrence-free survival (LRFS) (100% vs. 85.7%, P value-0.157), Distant metastasis-free survival (DMFS) (64.3% vs. 71.4%, P value = 0.725), and Disease-free survival (DFS) (64.3% vs. 64.3%, P value = 0.91). Age, gender, nodal involvement, and surgical resection status (R0, R1, R2) did not have any effect on survival outcomes. DFS (100% vs. 63.6% P value = 0.008), LRFS (100% vs. 94.7% P value = 0.002), and DMFS (100% vs. 63.2% P value = 0.006) were significantly better in T2 lesions compared to advanced lesions.

Conclusion:
Adjuvant EBRT failed to show any significant improvement in survival outcomes and locoregional control in MTC. Further prospective randomized clinical trials are needed to validate the role of EBRT in MTC. Clinicians should proceed with caution before advising adjuvant radiotherapy in MTC and make an informed decision after weighing the pros and cons of giving adjuvant EBRT.
Trastuzumab emtansine induced hyponatremia in breast cancer - A case report
Authors: Pareeth Firoz , Babu Geethu , Mathew Beela Sarah 
Published: August 2024

ABSTRACT
Trastuzumab emtansine (T-DM1) is an antibody-drug conjugate of trastuzumab and the cytotoxic agent emtansine (DM1), approved for use as an adjuvant treatment for patients with residual disease after neoadjuvant chemotherapy and antihuman epidermal growth factor receptor 2 (HER-2) therapy and in metastatic HER-2–positive breast cancer. Previous studies have shown that T-DM1 has a favorable safety profile, with few high-grade toxicities reported so far. We describe a patient who developed profound hyponatremia—which has not been reported previously—following treatment with adjuvant T-DM1 for HER-2+ breast cancer.