Publications by authors named "Akash Pramod Sali"

9 Publications

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Strategies to ensure efficient laboratory functioning while navigating through the COVID-19 crisis in developing countries: An early experience from a tertiary care centre in India.

J Cancer Res Ther 2021 Apr-Jun;17(2):551-555

Department of Radiotherapy, Homi Bhabha Cancer Hospital and Research Centre, Punjab (A Unit of Tata Memorial Centre), India.

Background: The coronavirus disease 2019 (COVID 19) is a zoonotic viral infection that originated in Wuhan, China, in December 2019. It was declared a pandemic by the World Health Organization shortly thereafter. This pandemic is going to have a lasting impact on the functioning of pathology laboratories due to the frequent handling of potentially infectious samples by the laboratory personnel. To deal with this unprecedented situation, various national and international guidelines have been put forward outlining the precautions to be taken during sample processing from a potentially infectious patient.

Purpose: Most of these guidelines are centered around laboratories that are a part of designated COVID 19 hospitals. However, proper protocols need to be in place in all laboratories, irrespective of whether they are a part of COVID 19 hospital or not as this would greatly reduce the risk of exposure of laboratory/hospital personnel. As part of a laboratory associated with a rural cancer hospital which is not a dedicated COVID 19 hospital, we aim to present our institute's experience in handling pathology specimens during the COVID 19 era.

Conclusion: We hope this will address the concerns of small to medium sized laboratories and help them build an effective strategy required for protecting the laboratory personnel from risk of exposure and also ensure smooth and optimum functioning of the laboratory services.
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http://dx.doi.org/10.4103/jcrt.JCRT_613_20DOI Listing
June 2021

Application and comparison of Fuhrman nuclear grading system with the novel tumor grading system for chromophobe renal cell carcinoma and its correlation with disease-specific events.

Indian J Urol 2021 Apr-Jun;37(2):147-152. Epub 2021 Apr 1.

Department of Pathology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India.

Introduction: The grading system of chromophobe renal cell carcinoma (ChRCC) is not well established. In this study, we aimed to compare the application of Fuhrman nuclear grade (FNG) with the novel chromophobe tumor grade (CTG). We also evaluated the correlation of these two grading systems with the clinical outcome.

Materials And Methods: Consecutive cases of ChRCC diagnosed on nephrectomy during 2005-2014 were identified. The clinical details of the patients were retrieved. Histopathology slides were reviewed and the nuclear grading was assigned using standard FNG and the CTG system. The CTG and FNG gradings were correlated with clinical outcome.

Results: A total of 80 cases were retrieved. Distribution of FNG was as follows: FNG-1, 1 (1.3%); FNG-2, 23 (28.3%); FNG-3, 44 (55.0%); and FNG-4, 12 (15%). CTG distribution was as follows: CTG-1, 48 (60.0%); CTG-2, 20 (25.0%); and CTG-3 12 (15.0%). Follow-up data was available in 46 cases; the median follow-up was 23.9 months (range 1-96.4 months). The median time to recurrence/metastasis was 17.2 months (range 3.2-31.2 months). Mean disease-free survival (DFS) was 68.5 months. Both CTG ( < 0.001) and FNG ( = 0.001) correlated with DFS; however, only CTG retained this significance when only the nonsarcomatous cases were analyzed. On receiver operating characteristics curve analysis, CTG had higher predictive accuracy for DFS for the entire group, while FNG lost the statistical significance when the nonsarcomatous cases were analyzed. CTG ( = 0.001) but not FNG ( = 0.106) correlated with the disease-specific adverse events in non-sarcomatous cases.

Conclusions: It is possible to apply CTG in ChRCC. It is a better predictor of DFS and disease-specific adverse events. CTG is more appropriate and applicable than the FNG in grading ChRCC.
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http://dx.doi.org/10.4103/iju.IJU_633_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8173929PMC
April 2021

Parathyroid Carcinoma: A Single-Institution Experience with an Emphasis on Histopathological Features.

Head Neck Pathol 2021 Jun 5;15(2):544-554. Epub 2020 Nov 5.

Department of Pathology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, 8th Floor, Annexe Building, Dr. E. Borges Road, Parel, Mumbai, 400012, India.

Parathyroid carcinoma (PC) is a rare malignancy that poses a diagnostic challenge on histologic examination. We analyzed various clinicopathologic features of PC. Pathology reports and slides were reviewed to evaluate the diagnostic histopathologic features of archived cases of PC from the years of 2004-2018. The study cohort comprised twenty cases of PC. The median age was 49 years (range 21-73 years) with equal gender distribution (M:F = 1:1). Most patients presented with symptoms of hypercalcemia (n = 7, 54%). Serum calcium and serum parathyroid hormone were elevated in all but one patient. The right inferior parathyroid was commonly involved (n = 8/14, 57%). The mean tumor size was 2.4 cm (range 0.8-3.5 cm). On frozen section examination, PC was diagnosed in 8 out of 9 cases. Vascular (n = 19/20, 95%) and soft tissue invasion (n = 10/20, 50%) were the most common characteristic histologic findings. Capsular invasion was identified in all cases. Perineural invasion or metastasis at presentation was absent in all cases. Other histological features noted were intratumoral fibrous bands (70%), nodular growth pattern (70%), moderate nuclear atypia (30%), prominent nucleoli (20%), and necrosis (20%). Regional lymph nodes were negative for metastatic disease in all cases (n = 10). Eight out of 16 patients received adjuvant radiotherapy. Follow-up was available in 16 cases (median 21.5 months). Two patients died of disease. Vascular and soft tissue invasion are the most common diagnostic histologic features of PC. Capsular invasion is important to distinguish PC from its benign counterparts. Intraoperative frozen section examination can be used for accurate diagnosis and surgical management.
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http://dx.doi.org/10.1007/s12105-020-01244-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8134611PMC
June 2021

Atypical Teratoid/Rhabdoid Tumor: Revisiting Histomorphology and Immunohistochemistry With Analysis of Cyclin D1 Overexpression and Amplification.

Int J Surg Pathol 2021 Apr 24;29(2):155-164. Epub 2020 Jul 24.

29436Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India.

. Atypical teratoid/rhabdoid tumor (AT/RT) is a rare malignant pediatric brain tumor, characterized by inactivation of INI1/hSNF5 gene and loss of its protein. We studied the histomorphological and immunohistochemical spectrum of this tumor including cyclin D1 expression and gene amplification. . Cases with INI1 loss by immunohistochemistry (IHC; from 2005 to 2018) were retrieved, reviewed, and evaluated for cyclin D1 expression by additional IHC and fluorescence in situ hybridization for genes. . A total of 66 cases were identified. Age ranged from 1 to 20 years (≤3 years, 44 cases; >3 years, 22). Male to female ratio was 1.7:1. Tumor locations were as follows: posterior fossa: 30; supratentorial: 31; spinal: 5. AT/RT in patient ≤3 years was frequently located in the posterior fossa, composed of primitive embryonal morphology ( = .02), rarely had ample rhabdoid cells ( = .05), and had a negative impact on overall survival ( = .04). The rhabdoid cells was a conspicuous component of posterior fossa tumors compared with the supratentorial ones ( = .06). The supratentorial tumors ( = .06), absence of rhabdoid cells ( = .06), and the presence of immunological divergent differentiation ( = .11) had a comparatively better outcome. Cyclin D1 overexpression (n = 46) was noted in 32 cases and was frequently seen in the posterior fossa tumors ( = .02). (n = 42) amplification was seen in 1 case and the (n = 42) amplification in none. . AT/RT can occur in the noninfantile age group, at nonconventional sites and frequently overexpress cyclin D1. The alterations are almost nonexistent in AT/RT.
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http://dx.doi.org/10.1177/1066896920943289DOI Listing
April 2021

Anaplastic thyroid carcinoma with rhabdoid phenotype: An unusual case and a comprehensive review.

Diagn Cytopathol 2020 Nov 9;48(11):1125-1130. Epub 2020 Jun 9.

Department of Pathology, Homi Bhabha Cancer Hospital (A Unit of Tata Memorial Centre), Sangrur, Punjab, India.

Anaplastic thyroid carcinoma (ATC) is a highly aggressive thyroid malignancy predominantly affecting the elderly with a fatal outcome. ATC with rhabdoid phenotype is a rare variant, with only a few cases reported in the literature to date. We herein report a case of a 44-year old female diagnosed as ATC with rhabdoid phenotype. She had a slow-growing neck mass with no gross extrathyroidal extension (ETE) or nodal/distant metastasis at presentation. Computed tomography of the neck showed a well-defined heterogeneously hypodense nodule in the right lobe of the thyroid. On cytology, a diagnosis of papillary thyroid carcinoma (PTC) with possible anaplastic transformation was made based on the presence of vague papillae with focal nuclear features of PTC and atypical pleomorphic/rhabdoid cells. The total thyroidectomy specimen showed a relatively circumscribed lesion with no gross ETE. Histopathological examination revealed sheets of rhabdoid cells with a focus of poorly differentiated thyroid carcinoma. On immunohistochemistry, rhabdoid cells were positive for AE1/AE3, focally positive for PAX8 and were negative for TTF-1, synaptophysin, desmin, myogenin, S100P, and SMA. The neck lymph nodes were non-metastatic. The patient was further treated with adjuvant radioactive iodine. Four-months post-operatively, the patient developed pulmonary metastasis which on biopsy examination revealed metastatic ATC. Apart from being a rare tumor type, this case is unusual with its presentation too; wherein, unlike described earlier in the literature the patient had a relatively mitigated clinical course with no gross ETE or nodal/distant metastatic disease. We also review the relevant literature along with this case.
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http://dx.doi.org/10.1002/dc.24516DOI Listing
November 2020

Pericardial Fluid Cytology: A Rosettey Affair….

Acta Cytol 2020 6;64(5):507-510. Epub 2020 Apr 6.

Department of Pathology, Homi Bhabha Cancer Hospital, Sangrur, India,

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http://dx.doi.org/10.1159/000506726DOI Listing
October 2020

The Rare Phenomenon of Loss of INI1 Expression at Recurrence/Progression of Primary Central Nervous System Tumors: Report of 3 Cases.

Int J Surg Pathol 2020 May 3;28(3):341-347. Epub 2019 Nov 3.

Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India.

It is extremely rare for loss of immunohistochemical expression of INI1 to occur primarily at recurrence/progression with retained expression at the primary/initial presentation of central nervous system (CNS) tumor. In this article, we present 3 such cases showing loss of INI1 expression primarily at recurrence. All patients were males, aged 7 years (case 1), 11 years (case 2), and 35 years (case 3), diagnosed with low-grade glial/glioneuronal tumor, not otherwise specified (case 1), craniopharyngioma (case 2), and glioblastoma (case 3); all showed retained INI1 protein expression. Case 1 at 12 months recurrence showed a high-grade tumor with relative undifferentiated morphology, case 2 after 104 months showed a sarcomatous progression, and case 3 recurred after 4 months with the presence of relative undifferentiated round cells. All these recurrences showed loss of INI1 expression. Loss of gene function resulting in complete loss of INI1 protein expression is not a well-accepted genetic mechanism for transformation/progression as this series emphasizes.
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http://dx.doi.org/10.1177/1066896919883942DOI Listing
May 2020

Chromoblastomycosis of the leg.

Pol J Pathol 2017;68(2):182-184

Case Report: We herein report a case of chromoblastomycosis presenting as a verrucous lesion over the leg. A 56-year-old male patient was a known case of carcinoma larynx and was treated for the same. At presentation to our hospital, the patient, in addition to the recurrent local disease, was suspected to have second primary in the form of verrucous carcinoma of the leg. Histopathological examination of the skin biopsy revealed the presence of characteristic pigmented sclerotic bodies with pseudoepitheliomatous hyperplasia of the overlying epithelium. The case was reported as chromoblastomycosis and the patient responded well to anti-fungal chemotherapy in the form of itraconazole.
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http://dx.doi.org/10.5114/pjp.2017.69695DOI Listing
December 2017

Quiz. What is your diagnosis?

Pol J Pathol 2017;68(1):96

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http://dx.doi.org/10.5114/pjp.2017.67624DOI Listing
July 2017
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