bluuebunny/crossref_metadata_2025_split huggingface dataset:
Expression of TLE1, INI1, β-catenin, Claudin1, CK7, CK19, SS18 and calponin in synovial sarcoma
Authors: Madakshira Manoj Gopal , Radotra Bishan Dass , Kaman Lileswar , Saikia Uma Nahar 
Published: May 2024

Background and Objectives:
Synovial sarcomas (SS) are enigmatic soft tissue tumors, which are yet to have a defined cell of origin. SS have a variety of differential diagnosis depending upon the age of the patient and the site of presentation. This makes diagnosis cumbersome unless the specific fusion SS18:SSX is identified by reverse transcription-polymerase chain reaction (RT-PCR) or fluorescence in situ hybridization (FISH). Immunohistochemistry is a useful tool in resource-poor settings in helping to narrow the differentials and help diagnose this tumor. This study set about assessing possible candidate immunohistochemical markers in their utility to recognize SS.

Methods:
Forty cases of SS, proven by FISH were included. A tissue microarray (TMA) was constructed, and immunohistochemistry was done using antibodies – TLE1 (OTI1F5), β-catenin (14), INI1 (MRQ-27), CK7 (OV-TL), CK19 (polyclonal), SS18 (polyclonal), calponin (CALP), and claudin1 (Polyclonal). The expression was analyzed to arrive at sensitivity and specificity.

Results:
TLE1 had a sensitivity of 92.5% and a specificity of 100%; β-Catenin had a sensitivity of 17.5% and specificity of 100%; Calponin had a sensitivity of 97.5% and a specificity of 81.25%; SS18 had a sensitivity of 95% and specificity of 100%; INI1 had a sensitivity of 95% and specificity of 100%; CK7 had a sensitivity of 90% and specificity of 87.5%; CK19 had a sensitivity of 90% and a specificity of 59.38%; and Claudin had a sensitivity of 85% and a specificity of 78.12%.

Interpretation and Conclusions:
The study showed both TLE1 and SS18 are robust diagnostic markers of synovial sarcoma with a sensitivity of 92% and 95%, respectively. INI1 can be used to discriminate SS from nonepithelioid and nonrhabdoid differentials. Calponin expression is helpful to differentiate poorly differentiated SS from its mimics. CK7 is a better marker than CK19 and can be used as a replacement for EMA in the initial screening panel. The use of claudin1 was restricted to delineating the epithelial component. β-Catenin had poor sensitivity, restricting its utility in SS.
The role of R21 expression in differential diagnosis of melanocytic lesions
Authors: Turcan Didem , Paşaoğlu Özgül , Arik Deniz 
Published: May 2024

ABSTRACT

Background:
Cyclic adenosine monophosphate (cAMP) is an intracellular signal transmitter involved in the regulation of melanocyte growth, proliferation, and melanogenesis. R21 is a monoclonal antibody against the soluble adenylyl cyclase (sAC) protein. Various nuclear and cytoplasmic R21 expression patterns in melanocytic lesions have been previously reported. Pan-nuclear staining was defined as specific for melanoma and was found supportive in the assessment of surgical margins.

Aims:
The aim of this study is to evaluate the different expression patterns of R21 immunostain and investigate its effectiveness in the differential diagnosis of cutaneous malignant and benign melanocytic lesions.

Settings and Design:
Fifty invasive cutaneous melanoma and 50 benign melanocytic proliferation were included in the study.

Materials and Methods:
Paraffin blocks that best reflected tumor morphology were studied via immunohistochemical staining for R21. For all patterns, the cases showing staining in 25% or more tumor cells were considered as positive.

Statistical Analysis used:
Yates’ Chi-square, Pearson Chi-square exact test, Spearman correlation were used.

Results and Conclusions:
Dot-like Golgi staining was characteristic for nevi (12/50) and seen only in one melanoma. Pan-nuclear staining was striking for melanoma (36/50). This pattern was observed in 2 dysplastic and 3 common melanocytic nevi too. None of the Spitz nevi expressed R21 in pan-nuclear pattern. For the diagnosis of melanoma, sensitivity and specificity of the pan-nuclear expression were 72% and 90%, respectively. Positive and negative predictive values were found as 87% and 76%. R21, a second-generation immunohistochemical marker, can be used in the differential diagnosis of benign and malignant melanocytic lesions.
The expression of squalene epoxidase in human gastric cancer and its clinical significance
Authors: Ma Yong-Chao , Jin Shao-Ju , Gu Guo-Jian , Zhao Li-Fang , Xu Song-Tao 
Published: May 2024

ABSTRACT

Context:
Squalene epoxidase (SQLE) is overexpressed in a variety of tumors, which may play an important role in their tumorigenesis, development, and prognosis.

Aims:
The aim of this study is to investigate the expression of SQLE and explore its clinicopathological significance in gastric cancer.

Settings and Design:
The correlation between its positive expression and the pathological characteristics of patients (such as sex, age, tumor size, survival, tumor differentiation, TNM staging, and lymph node metastasis) was analyzed.

Materials and Methods:
Immunohistochemical method was used to detect its expression in 107 cases of gastric carcinoma and 34 cases of tumor-adjacent tissues.

Statistical Analysis Used:
Counting data were analyzed by Chi-square test. Its overall survival was analyzed by Kaplan-Meier method and log-rank test. Its hazard factors were analyzed by Cox multivariate analysis.

Results:
The positive rate of SQLE in gastric cancer is 67.3%, which is higher than that in tumor-adjacent tissues (17.6%), <0.001. Expression of SQLE is closely related to tumor differentiation, TNM staging and lymph node metastasis (P = 0.030, P = 0.009, and P = 0.011, respectively). Furthermore, compared with those low expression of SQLE, the patients of overexpression had worse overall survival by Kaplan–Meier analysis (P = 0.025). Cox multivariate analysis shows that lymph node metastasis, tumor differentiation, SQLE, and TNM staging are independent factors for prognosis of gastric cancer (P = 0.003, 0.020, 0.018, and P = 0.001 respectively).

Conclusions:
SQLE is overexpressed in gastric cancer. It could be used for the diagnosis and prognosis of the gastric cancer patients.
Two case reports of mixed epithelial and stromal renal tumor of kidney in children and literature review analysis
Authors: Wei Xia , Wang Yizhen , Fang Yuan , Chen Lian 
Published: May 2024

ABSTRACT
Mixed epithelial and stromal tumor of the kidney (MESTK) occurs almost exclusively in perimenopausal women while rarely in children. Only five pediatric patients have been described previously. Herein, we report a girl and a boy with MESTK, aged 3- and 4-years-old, respectively. The two patients presented with hematuria or an abdominal mass. Histologically, the tumors were both composed of epithelial and stromal elements. Immunohistochemical staining of tumor cells expressed epithelial and mesenchymal component markers. They were diagnosed with MESTK by histology and immunohistochemistry after surgery. The patients were at good condition after surgery. To our knowledge, these are the youngest reported cases of MESTK. And the glandular luminal structure formed by the epithelium was lined with urothelium, which expanded the histological map of MESTK.
Adjunctive role of immunohistochemical expression of Nucleostemin in differentiation of grade II and III diffuse astrocytomas
Authors: Arik Deniz , Özen Alaattin , Özkara Emre , Yılmaz Evrim , Canaz Funda , Yıldırım Güneş D. 
Published: May 2024

Aims:
Astrocytomas are common tumors and grade is an important parameter in determining the treatment modalities. Tumor proliferation activity should be determined for the differentiation of grades II and III tumors. In difficult cases, an auxiliary parameter is required. Nucleostemin (NS) is nucleolar Guanosine triphosphate (GTP)-binding protein 3. It has important roles in cell proliferation, cell cycle regulation, self-renewal, and apoptosis. In this study, we investigated whether the level of NS expression is different in grades II and III astrocytomas.

Settings and Design:
Adults diagnosed with grades II and III astrocytomas were included in the study.

Material and Methods:
Paraffin blocks that best reflected tumor morphology were studied via immunohistochemical staining for NS. Only nuclear staining was evaluated; cytoplasmic staining was not considered.

Statistical Analysis Used:
Fisher's exact test, continuity corrections, and Pearson's Chi-square tests were used in the crosstabs. The survival analysis was based on the Kaplan-Meier method.

Results:
Only 20% (6/30) of grade II tumors had high intensity staining, while 54,2% (13/24) of grade III tumors had high staining intensity. NS was significantly more intense in grade III tumors than grade II tumors. In cases with high NS expression, survival was significantly shorter than the cases with low expression.

Conclusion:
NS is significantly higher expressed in grade III tumors than grade II tumors. In difficult cases, it can be used as a useful proliferation marker in the differentiation of grades II and III astrocytomas.
Role of orthopedia homebox protein in subclassification of pulmonary carcinoid tumors: Retrospective analysis of 110 cases
Authors: Çetin Mehmet , Fındık Göktürk , Demirağ Funda , Türk İlteriş , Aydoğdu Koray 
Published: May 2024

ABSTRACT

Background:
Orthopedia homeobox protein (OTP), highlighted as a sensitive and specific marker for pulmonary carcinoids, may provide a more objective criterion for subclassification.

Materials and Methods:
A total of 110 patients who underwent surgery for pulmonary carcinoids (2009–2019) were included. Gender, age, application complaint, tumor diameter and location, typical and atypical tumor type, lymph node involvement, stage, recurrence, and survival data were evaluated retrospectively with OTP nuclear staining.

Results:
The sensitivity of OTP was 66.4%. OTP in subclassifying pulmonary carcinoids was not significant. There was no significant relationship between OTP and lymph node involvement, recurrence, and survival.

Conclusion:
OTP does not provide significant results in the subclassification of typical and atypical carcinoid tumors and the evaluation of recurrence and survival of carcinoid tumor cases.
Primary cutaneous amyloidosis
Authors: Sinha Akanchha , Manjunath G. V. , Basavaraj Vijaya 
Published: May 2024

Background:
Primary cutaneous amyloidosis (PCA) comprises several forms of localized cutaneous amyloidosis characterized by amyloid deposits occurring at or near dermal–epidermal junctions. Immunohistochemical studies have shown the expression of cytokeratin (CK) suggesting that it has an epidermal origin.

Objectives:
To study the clinicopathological features of PCA and expression of CK5/6 and correlate it with Congo red stain.

Materials and Methods:
A total of 30 histologically proven cases of PCA were studied. Congo red staining and immunohistochemical expression of CK5/6 were analyzed.

Statistical Analysis:
The qualitative data has been expressed as proportions and the quantitative data has been expressed as mean ± SD. All data was analyzed using the Statistical Package for Social Sciences (SPSS) software version 22.

Results:
Deposits of amyloid in papillary dermis were seen in all 30 cases. Mild focal basal cell vacuolar degeneration and apoptotic bodies in epidermis were seen in six cases. The presence of pigment cells in dermis were seen in 26 cases. CK5/6 showed weak/mild immunopositivity in nine cases, moderate in 20 cases, and strong in one case.

Conclusion:
The presence of dermal melanophages interspersed within eosinophilic deposits gives a clue to the diagnosis. Congo red stain highlights the deposits and visualization under polarized light gives apple green birefringence which is diagnostic of amyloid. Staining of amyloid deposits by CK5/6 proves that the amyloid is of keratinocyte origin. There was 100% sensitivity with Congo red and CK5/6. Thus, CK5/6 can be used as an adjunct tool to Congo red stain in the diagnosis of primary cutaneous amyloidosis.
Nine cases of soft tissue keratocysts arising from buccal mucosa and lateral fascial deep region
Authors: Khare Parul , Sun Jingjing , Wang Lizhen , Tian Zhen , Zhang Chunye , Hu Yuhua , Xia Ronghui , Li Jiang 
Published: May 2024

Background:
Soft tissue keratocysts (SKC) are extremely rare and show similar microscopic morphology to keratocystic odontogenic tumor. The aim was to investigate immunohistochemical (IHC) features and origin of SKCs developing in buccal mucosa and lateral facial deep region.

Material and Methods:
Expression of CK19, CK10/13, Ki67, Cyclin D1 and Osteopontin (OPN) of 9 SKCS were investigated using IHC. Forty different types of cysts in jaw/soft tissue were used as control. Follow-up was performed.

Results:
CK10/13 positivity occurred more frequently and intensely in SKC and intraosseous parakeratinized odontogenic keratocysts (COKC). However, OPN positivity was observed only in COKC.

Conclusion:
This is the largest case series of SKCs; along with first attempt to investigate the expression of OPN on SKC. Given the microscopic and immunohistochemical features, we prefer the view that SKC is odontogenic origin but represents the soft tissue counterpart of COKC, since their expressions of OPN were extremely different.
A study to analyze the pattern of synovial lesions from synovial biopsies in a tertiary care centre
Authors: Tevatia Manvir Singh , Goyal Neeti , Baranwal Ajay Kumar , Mishra P.S. , Gupta Arun , Sharma Vyom , Agarwal Mohit , Gupta Prashant Sen , Dangwal Vidhu 
Published: May 2024

Introduction:
Synovium has been documented as a primary site of inflammation and a major effector organ in a variety of joint diseases. Study of simple technique like synovial biopsy can help in early diagnosis and treatment of diseases significantly improving outcome of patient in cases of rheumatoid arthritis, osteoarthritis, etc., Only limited data exist on utility of synovial biopsies.

Aim and Objectives:
To analyze the pattern of synovial lesions to differentiate between different kinds of arthritis. Also, to identify early stages of arthritis so as to prevent unnecessary invasive surgical procedure.

Materials and Methods:
It's a retrospective study to analyze 103 cases of synovial lesions diagnosed in last five years at a tertiary care orthopedic center. All synovial biopsies obtained mainly by open method and few by arthroscopic method, that came to the Dept of Pathology were included. Lesions were classified into four categories that is, inflammatory joint diseases, degenerative joint diseases, tumor-like conditions and tumors.

Results:
Age group most affected was between 61 and 70 years, with male predominance. Osteoarthritis (OA) was the most common histopathological diagnosis. Early OA tissues showed greater lining layer thickness, vessel proliferation, and inflammation, while surface fibrin deposition along with fibrosis was noted in later stages.

Conclusion:
The histo-morphological observations made in this study may have important therapeutic implications for some patients during the early evolution of arthritis and could prevent unnecessary operative intervention of later stages.
Follicular Dendritic cell sarcoma of caecum in a young boy presenting as Intussusception
Authors: Jagdale Rakhi V. , Pol Jaydeep N. 
Published: May 2024

Background:
Follicular dendritic cell sarcoma (FDCS) is a rare tumor derived from follicular dendritic cells (FDC) occurring in lymph nodes and extranodal sites. It is usually regarded as an indolent tumor with a tendency of local recurrence but a low risk of metastasis. Common extranodal sites are liver, lung, tonsil, spleen, soft tissue, and mediastinum. Extranodal FDCS of gastrointestinal tract (GIT) is exceedingly rare, with just 36 cases reported in the literature.

Methods:
We report an unusual case of FDCS of caecum in a 13-year-old boy who presented as intussuception. On histology, it posed a diagnostic challenge for us. An inconclusive initial immunohistochemistry (IHC) lead us to suspect FDCS which was confirmed by FDC markers.

Conclusions:
The diagnosis of FDCS at extranodal site like GIT is all the more challenging because of its rarity, morphologic heterogeneity, and lack of awareness.
Helping medical students to learn pathology more effectively
Authors: Bhusnurmath Shivayogi R. , Bhusnurmath Bharti S. , Goyal Shefali B. 
Published: May 2024

Context:
Teaching methods in pathology for undergraduate medical students are not effective.

Aims:
To document measures that can be adopted by individual teachers that can excite the interest, participation of the students and help them learn pathology in a clinical reasoning context.

Settings and Design:
Medical students in a large international medical school with class sizes of 700–900 were taught the pathology course in a period of sixteen weeks for two cohorts of students each year over a period of twenty years.

Subjects and Methods:
Specific learning objectives were devised to achieve higher levels of cognitive domain including interpretation, analysis and problem solving of clinical data of patients related to the objectives. The teaching sessions were modified to provide for maximum active participation by students with effective feedback at multiple points. Additional learning tools like concept maps, clickers, modified essay questions, flipped classrooms, clinicopathological conferences, directed self-learning activities were included. Learning objectives and assessment tools for professional behavior and communication skills were included.

Results:
The students actively participated in all the learning activities with enthusiasm and achieved the objectives as reflected in the performance in the in-house examinations and the USMLE step one examination which tests clinical vignette-based problem-solving principles of which around 70% are related to pathology.

Conclusions:
The teaching sessions in pathology were useful and effective with adaptation to interactive, clinical reasoning platforms for teaching and assessment.
Role of HER2neu expression in gastric cancer
Authors: Sukanya J. S. , Raj Pavithra Vittal , Thanka J. 
Published: May 2024

Background:
Gastric cancer is one of the most common cancers in the world and is responsible for over a million deaths. Gastric cancer broadly consists of two main histological types, diffuse and intestinal, and can be further classified as proximal (cardia) and distal (corpus and pylorus) cancers. The presence of Her2neu in certain cancers including gastric cancers has helped in throwing some light on the prediction of prognosis of the tumours. This study was carried out to assess and evaluate the role of Her2neu immunohistochemical expression in gastric cancers.

Methodology:
This study was carried out as a retrospective study on paraffin blocks of 70 gastrectomy specimens in the pathology department of our hospital. After the histological assessment and interpretation of data, appropriate blocks were chosen and sections of 3 micron thickness were cut and immunohistochemical staining of Her2neu was done and scoring was carried out.

Results:
We found that gastric cancer occurred predominantly in men as compared to women. Antrum was the most common site involved in gastric cancer (60%). In our study Grade 2 predominated (54%) than Grade 1 (4.2%) and Grade 3 (41%). According to the scoring system of Her2neu expression by immunohistochemistry in gastric cancer it was positive (3+) in 8 cases (11.4%), equivocal (2+) in 10 cases (14.3%) and negative (0+,1+) in 52 cases (74.3%). Her2neu was seen positive 13.7% of intestinal type tumours and in only 5.3% of diffuse type of tumours (P < 0.05).

Conclusion:
Her2neu testing in gastric adenocarcinomas especially in histologically identified early gastric carcinoma is recommended.
HER2 testing by immunohistochemistry in breast cancer
Authors: Md Pauzi Suria Hayati , Masir Noraidah , Yahaya Azyani , Mohammed Fazarina , Tizen Laim Nur Maya Sabrina , Mustangin Muatamarulain , Aizudin Azimatun Noor , Talib Arni , Teoh Kean-Hooi , Karim Norain , Oy-Leng Jacqueline Wong , Rajadurai Pathmanathan 
Published: May 2024

Background:
Human epidermal growth factor receptor 2 (HER2) over-expression in breast cancer is associated with aggressive tumor behavior and predicts response to targeted therapy. Accurate HER2 result is paramount for optimal patient management. However, routine HER2 immunohistochemistry (IHC) testing are subjected to intra- and inter-laboratory variability.

Objective:
This study aims to determine inter-laboratory variation in HER2 IHC testing through a slide-exchange program between five main reference laboratories.

Method:
A total of 20 breast carcinoma cases with different known HER2 expression and gene status were selected by the central laboratory in five testing rounds. Three unstained tissue sections from each case were sent to participating laboratories, which immunostained and interpreted the HER2 immunohistochemistry result. One of the stained slides was sent to one designated participating laboratory for evaluation. Results were analyzed by the central laboratory.

Results:
A complete concordance was achieved in six IHC-positive and six IHC-negative cases, its gene status of which was confirmed by in-situ-hybridization (ISH) study. The discordant results were observed in six equivocal cases, one negative case and one positive case with a concordance rate of 50–88.3%. Interestingly, the negative discordant case actually displays tumor heterogeneity. Good inter-observer agreement was achieved for all participating laboratories (k = 0.713-1.0).

Conclusion:
Standardization of HER2 testing method is important to achieve optimum inter-laboratory concordance. Discordant results were seen mainly in equivocal cases. Intra-tumoral heterogeneity may impact the final HER2 IHC scoring. The continuous quality evaluation is therefore paramount to achieve reliable HER2 results.
Traumatic Perforation of Tympanic Membrane
Authors: Puttamadaiah G. M. , Bhanuprakash P. N. , Viswanatha B. , Patil Kartik Irappa , Menon P. Architha 
Published: May 2024

Introduction:
Traumatic perforation of tympanic membrane (TM) is caused by increase in air pressure due to slapping, road traffic accident, blast injury, syringing, trauma by ear buds, etc., The incidence has been increased in recent times due to increased domestic violence and road traffic accidents. Hence, there is a need for early identification, evaluation, and management to reduce the morbidity.

Objectives:
The objective of the study was to describe etiologies of traumatic perforation of TM, to assess the findings of pure tone audiometry (PTA) among patients with traumatic perforation of TM, and to determine the outcome.

Materials and Methods:
This study was done between November 2017 and May 2019 in the department of ENT at Bangalore Medical College and Research Institute on 88 patients with traumatic perforation of TM who were subjected to otoscopic examination, tuning fork tests, and PTA. Patients were followed up on weekly basis.

Results:
Out of 88 patients, 33 patients (37.5%) were in the age group of 21–30 years. Fifty-four were males (61.36%) and 34 were females (38.63%). Slapping is the most common mode of injury with 50 (56.8%) patients. Left ear 55 (62.5%) was more commonly involved than right ear 33 (37.5%). Small perforation 55 (62.5%) was more common followed by medium-sized perforation 25 (28.4%) and large perforations were the least 8 (9.1%). Multiple quadrants were involved in 33 patients (37.5%). Posteroinferior quadrant was most commonly involved. Deafness (75%) was the most common symptom involving 66 patients. Average time taken for spontaneous healing was 37 days. Mean hearing improvement compared between hearing loss at the time of trauma and after 3 months was 13.18 ± 7.05 dB, which is statistically significant (P = 0.0001).

Conclusion:
Traumatic perforation of TM spontaneously healed in 80 participants (90.90%), whereas eight participants (9.09%) underwent surgery, i.e., tympanoplasty.