International Journal of Clinicopathological Correlation

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Before the advent of antibiotic agents, pregnancy was a recognized risk factor for severe complications of pneumococcal pneumonia, including death.The influenza pandemic of 2009 provided a more recent reminder that certain infections may disproportionately affect pregnant women. During pregnancy, several mechanical and pathophysiological changes occur (e.g., a decrease in respiratory volumes and urinary stasis due to an enlarging uterus), and immune adaptations are required to accommodate the fetus. In this article, we review and synthesize new knowledge about the severity of and susceptibility to infections in pregnant women. We focus on the infections for which there is evidence of increased severity or susceptibility during pregnancy that is not fully explained by mechanical or anatomical changes, and we discuss these infections in light of new findings on immunologic changes during pregnancy.

Background: Pathogenic mutations in breast cancer susceptibility gene 1 (BRCA1) are the common causes for germline as well as sporadic aggressive subtypes of breast cancer. This study was conducted to know BRCA1 expression in breast cancer by immunohistochemistry (IHC) testing. Methods: This was a cross-sectional study conducted in the Department of Medical Oncology, Vardhman Mahavir Medical College and Safdarjung hospital, New Delhi, from July 2016 to April 2018. The patients with confirmed diagnosis if breast cancer and aged >18 years were included in the study. BRCA1 expression, estrogen/progesterone receptor (ER/PR) status, and Human epidermal growth factor receptor 2 (Her 2-neu) were evaluated by IHC in all patients. Results: Of the 50 patients enrolled, the mean (± standard deviation) age was 53 (±11.76) years; 17 (34%) were in the range of 41–50 years, while 13 (26%) were in the range of 51–60 years. The distribution of patients with breast cancer according to risk factors showed that family history of cancer was present in 8 (16%), prebenign breast disease in 5 (10%), use of hormone replacement therapy/oral contraceptives pills in 31 (62%), exposure to radiation in 2 (4%) and history of smoking in 15 (30%) patients. Metastasis was seen in 43 (86%) patients and the prevalence of BRCA1 was 8% (n = 4); three patients in the age group of 41–50 years and one patient in the age group of 31–40 years. A negative BRCA1 expression was observed in 46 (92%) patients; 40/46 patients had >40 years and 39/46 patients had no family history of cancer. Similarly, of the 17 and 33 pre- and post-menopausal patients, 16 and 30 patients had negative BRCA1 expression, respectively. BRCA1 expression was negative in all the ER/PR receptor and Her-2-neu-positive patients. Histological Grade II tumors were observed in 26 (52%) patients, of whom 22 patients showed negative BRCA1 expression. Conclusion: The prevalence of BRCA1 among breast cancer patients was 8%. Studies with larger sample size are needed to further assess BRCA1 gene mutations and determine clinical usefulness as a potential biomarker by IHC.

Background: Infertility is a common problem for which the couple seeks gynecological consultation. Endometrial aspiration cytology (EAC) has emerged as a minimally invasive and cost-effective diagnostic procedure for assessing the endometrial status of these patients that can aid in the high-burden and resource-limited settings. Aims: The study was conducted to evaluate the utility of EAC in women with infertility, and the cytological diagnosis was correlated with the histopathology. Materials and Methods: A total of 50 patients presenting with infertility were subjected to EAC using a 5F infant feeding tube attached to 20 cc disposable syringe; later, they also underwent endometrial dilation and curettage. The cytology smears were evaluated for architectural and cytomorphological features. The cytological diagnoses henceforth made were compared with the histopathological diagnosis to calculate sensitivity, specificity, and diagnostic accuracy of EAC. Results: EAC showed a sample adequacy of 80% viz a viz 90% for histopathology. EAC showed a specificity and sensitivity of 97.3% and 100% for assessing the endometrial status in infertility. There was a good overall agreement between cytological and histopathological diagnosis (P value-0.60). Conclusions: EAC is an effective and minimally invasive procedure for the primary investigation of women with infertility.

Aim: The aim of the study is to know the exact effect of Papanicolaou (Pap) staining on the peripheral smear while compared to Leishman's stain on the peripheral smear. Background: Pap staining is discovered and usually used for wet-fixed cytological smears. As a differential stain and using hematoxylin and eosin as a part of the staining solutions, Pap stains also have a principle of acidic and basic pH and contents as other Romanowsky stains. One of the commonly known Romanowsky stains is Leishman's stain, which is usually designed and used for air-dried peripheral smear. This study is designed to find out the effect of wet fixation and Pap stain on the air-dried peripheral smear by comparing it to Leishman's stain. Materials and Methods: The study included randomly selected 20 patients. With the informed consent, two peripheral smears were prepared with the blood samples. First set of samples were fixed with isopropyl alcohol and stained with Pap stain. Second set of smears were routinely air-dried and stained with Leishman's stain. Both the sets were analyzed for staining and morphological characteristics and statistically compared. Conclusion: After the study, it was quite evident that Pap stain does not give desired results on the peripheral smear, making it difficult for examination. Hence, Pap satin is not used for peripheral smear as it causes lysis of cells, change in cellular morphology, nondifferentiable among other cells, and many other complications for a cellular examination. Leishman's stain is the best commercially available stain for the peripheral smear examination.

Study Background: Hyperthermia is a manifestation of disease condition, which may also be as a result of immune response to the presence of infectious agent in the body that can be expressed in the serum/plasma. At times, it is erroneously assumed for Plasmodium infection. Aims and Objectives: This work was designed to express the products of adaptive host immune response to viral agents in hyperthermia pediatric patients receiving malaria treatment and the immunoserologic status of their mothers for effective management and diagnosis. Materials and Methods: One hundred and four hyperthermia children aged 5–9 years receiving treatment in herbal homes were investigated as test, while one hundred age-matched children with normal body temperature were recruited from Owo and Ose local government areas as control subjects. Mothers of the hyperthermia children were also studied. Antihepatitis C virus (HCV), human immunodeficiency virus (HIV) P24 antigen/antibody, anti-HBe, and HBeAg were determined by enzyme-linked immunosorbent assay, Plasmodium by Geimsa thick blood film, and acid-fast bacilli by Ziehl–Neelsen techniques. Results: R Results obtained showed that the frequency of anti-HBe in mothers of hyperthermia patients (10.6% [11]) and in children with normal body temperature (9% [9]) was higher than the frequency of anti-HBe obtained in the hyperthermia herbal home children (4.8% [5]) while the frequency of HBeAg found in hyperthermia herbal home children (14.4% [15]) and their mothers (14.4% [15]) was higher than the results obtained in children with normal body temperature (4% [4]). The frequency of anti-HCV in herbal home hyperthermia children (2.9% [3]) was higher than the results obtained in their mothers (1.9% [2]) and children with normal body temperature (1% [1]). The HIV P24 antigen/antibody expressed by the mothers of herbal home hyperthermia children (3.85% [4]) was higher the results obtained in their children (2.9% [3]), while none of the children with normal body temperature expressed HIV P24 antigen/antibody. The frequency of Plasmodium in mothers of herbal home hyperthermia children (19.2% [20]) was higher than the results obtained in their hyperthermia children (9.6% [10]) and children with normal body temperature (3% [3]). The frequency of HIV in hyperthermia was 2.9% (3), while that of active/replicating hepatitis B virus (HBV) and HCV was 14.4% (HBeAg) and 2.9% (anti-HCV), respectively. Only mothers of hyperthermia herbal home children expressed 1.6% (2) HIV P24Ag/Ab + HBeAg + anti-HBe. None of the mothers of hyperthermia herbal home children expressed HIV P24 antigen/antibody and infected with Plasmodium as against 2.9% (3) and 9.6% (10) obtained in their children. 1.6% (2) of the mothers of hyperthermia herbal home children expressed anti-HCV as against 2.9% (3) of their children who expressed the immunoserologic marker, while the hyperthermia herbal home children and their mothers expressed anti-HBe (4.8%^[5] vs. 4.8% [5]) and HBeAg (14.4%^[15] vs. 14.4% [15]). Conclusion: Products of adaptive host immune response expressed in hyperthermia pediatric patients receiving malaria treatment and the immunoserologic status of their mothers include HIV P24Ag/Ab, HBeAg, anti-HBe, and anti-HCV, while the frequency of HIV in hyperthermia was 2.9% (3) and that of active/replicating HBV and HCV was 14.4% (HBeAg) and 2.9% (anti-HCV), respectively, with only HBV and HCV traceable to the mothers.

A subset of patients with castrate resistant prostate cancer, may evolve into androgen receptor-independent phenotype, clinically characterized by low serum levels of prostate-specific antigen and rapidly progressive disease course, referred to as aggressive variant prostate carcinoma (AVPCa). Essentially, a clinical diagnosis, the increasing incidence has highlighted the need to identify potential targeted therapy options which needs tissue from primary or metastatic site. We present a series of 2 metastatic carcinomas of prostate origin with clinical features and molecular signature of AVPCa. The biopsies of metastatic sites revealed a carcinoma with squamous and neuroendocrine differentiation in one case and the second case showed an adenocarcinoma with neuroendocrine differentiation. Both tumors were negative for prostate-specific markers and positive for neuroendocrine markers. The morphologic heterogeneity and inconsistent immunohistochemistry of AVPCa at the site of metastasis emphasizes the role of interdisciplinary diagnostic approach to confirm prostate origin in this subset of tumors.

Online since 19^th September, 2016