Publications by authors named "Atin Singhai"

26 Publications

  • Page 1 of 1

Plantar Lichen Planus: An Atypical Presentation at a Young Age.

Cureus 2021 Sep 9;13(9):e17851. Epub 2021 Sep 9.

Pathology, King George's Medical University, Lucknow, IND.

Lichen planus is a chronic lichenoid dermatosis commonly encountered by dermatologists worldwide, affecting skin, mucosa, and scalp. The current case describes a rare variant of lichen planus, plantar lichen planus, in a 17-year-old male who presented with erythematous scaly plaques on the sole for two years associated with walking discomfort. The lesion was subjected to skin biopsy and a diagnosis of lichen planus was made considering the histopathological and clinical findings. Plantar lichen planus can often be misdiagnosed. Treating plantar lichen planus can be a therapeutic challenge and, thus, more insight is needed regarding treatment protocol or outcome of such cases.
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http://dx.doi.org/10.7759/cureus.17851DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8502756PMC
September 2021

Oxidative Stress Enhances Autophagy-Mediated Death Of Stem Cells Through Erk1/2 Signaling Pathway - Implications For Neurotransplantations.

Stem Cell Rev Rep 2021 Dec 6;17(6):2347-2358. Epub 2021 Sep 6.

Laboratory for Stem Cell & Restorative Neurology, Department of Biotechnology, Era's Lucknow Medical College Hospital, Era University, Sarfarazganj, Lucknow, 226003, India.

Stem cell therapies are becoming increasingly popular solutions for neurological disorders. However, there is a lower survival rate of these cells after transplantation. Oxidative stress is linked to brain damage, and it may also impact transplanted stem cells. To better understand how transplanted cells respond to oxidative stress, the current study used HO. We briefly illustrated that exogenous HO treatment exaggerated oxidative stress in the human dental pulp and mesenchymal stem cells. 2',7'-Dichlorofluorescin diacetate (DCFDA), MitoSOX confirms the reactive oxygen species (ROS) involvement, which was remarkably subsided by the ROS inhibitors. The findings showed that HO activates autophagy by enhancing pro-autophagic proteins, Beclin1 and Atg7. Increased LC3II/I expression (which co-localized with lysosomal proteins, LAMP1 and Cathepsin B) showed that HO treatment promoted autophagolysosome formation. In the results, both Beclin1 and Atg7 were observed co-localized in mitochondria, indicating their involvement in mitophagy. The evaluation of Erk1/2 in the presence and absence of Na-Pyruvate, PEG-Catalase, and PD98059 established ROS-Erk1/2 participation in autophagy regulation. Further, these findings showed a link between apoptosis and autophagy. The results conclude that HO acts as a stressor, promoting autophagy and mitophagy in stem cells under oxidative stress. The current study may help understand better cell survival and death approaches for transplanted cells in various neurological diseases. The current study uses human Dental Pulp and Mesenchymal Stem cells to demonstrate the importance of HO-driven autophagy in deciding the fate of these cells in an oxidative microenvironment. To summarise, we discovered that exogenous HO treatment causes oxidative stress. Exogenous HO  treatment also increased ROS production, especially intracellular HO. HO stimulated the ErK1/2 signaling pathway and autophagy. Erk1/2 was found to cause autophagy. Further, the function of mitophagy appeared to be an important factor in the HO-induced regulation of these two human stem cell types. In a nutshell, by engaging in autophagy nucleation, maturation, and terminal phase proteins, we elucidated the participation of autophagy in cell dysfunction and death.
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http://dx.doi.org/10.1007/s12015-021-10212-zDOI Listing
December 2021

Electron microscopy of juvenile nasopharyngeal angiofibroma: clinical and histopathological correlates.

Eur Arch Otorhinolaryngol 2021 Apr 29. Epub 2021 Apr 29.

Department of Otorhinolaryngology-Head and Neck Surgery, King George's Medical University, Lucknow, India.

Background: The histological and electron-microscopic (EM) characteristics of juvenile nasopharyngeal angiofibroma (JNA) have been described but no study has compared them with one another or with clinical features. The objective is to compare ultrastructural characteristics of JNA with clinical parameters.

Methods: This prospective study included histology of 21 samples of which only 13 underwent transmission-EM. Four clinical parameters (age, duration, epistaxis, recurrence), three radiological-staging, 13 histological and 15 EM characteristics were considered. A descriptive analysis for association of these characteristics and also with clinical parameters was attempted. Furthermore statistical analysis of clinical and radiological categories with respect to frequencies of ultrastructural characteristics was also undertaken.

Results: Dense-intranuclear-inclusions (DNI) and peripheral-nuclear-irregularities were universally encountered while other very prominent features were nuclear-blebs-and-pockets, myoid-features, thin-vessel-wall (TnVW), irregular-vascular-contour (IVC) and fibrous-stroma (FS). Statistical significance was obtained between recurrence with histology (p = 0.04) and Fisch staging with EM (p = 0.001). While muscle-in-vessel-wall, thick-vessel-wall, mast-cells, stellate-stromal-cells and cellular-stroma predominated in recurrent cases, the upfront disease showed predominance of scar-like-stroma, fusiform-stromal-cells, IVC, TnVW, FS, organised-collagen-bundles and less-cellular-stroma. A very unique Rod-like-structures were appreciated in the cytoplasm of the fibroblast for the first time.

Conclusions: While histological parameters of recurrence need further validation, a larger sample may better define histopathological surrogate for predicting intracellular dynamics that may further correlate with underlying cellular stresses. Hence an 'ultrastructural staging' may better customise treatment protocol and prognosis. Furthermore 'characteristic' unique rods need to be further investigated along with validation of viral aetiology for DNI.
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http://dx.doi.org/10.1007/s00405-021-06815-4DOI Listing
April 2021

Follicular Dowling-Degos Disease and Blepharophimosis-Ptosis-Epicanthus Inversus Syndrome: A Chance or Significant Association.

Indian J Dermatol 2021 Jan-Feb;66(1):100-101

Department of Dermatology, Venereology and Leprosy King George's Medical University (KGMU), Lucknow, Uttar Pradesh, India E-mail:

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http://dx.doi.org/10.4103/ijd.IJD_184_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8061470PMC
April 2021

Case Report of Cutaneous Squamous Cell Carcinoma at the Wrist Joint and the Public Health Crisis of Arsenicosis.

J Health Pollut 2021 Mar 2;11(29):210314. Epub 2021 Mar 2.

Department of Pathology; King George's Medical University, Lucknow, Uttar Pradesh, India.

Context: Arsenicosis is caused by long term (6 months plus) ingestion of arsenic above a safe dose, characterized by skin lesions and possible involvement of internal organs. Arsenicosis is common in India and Bangladesh where naturally occurring high concentrations of arsenic in the earth's crust contaminate ground water, causing adverse health effects.

Case Presentation: We report a case of a 55-year-old Indian male, resident of a known arsenic endemic region of Uttar Pradesh who suffered from characteristic pulmonary and cutaneous features of chronic arsenic toxicity which included radiological findings of interstitial lung disease, hyperkeratotic lesions over the palms and soles, rain drop like pigmentation over the trunk, and carcinomatous changes at the wrist joint. The patient was started on chelating agents (d-penicillamine) and oral retinoids (isotretinoin) followed by the surgical excision of the carcinoma.

Discussion: Environmental contamination with arsenic is a well-known health hazard in South Asian countries. The main source is consumption of contaminated ground water for domestic purposes. Cutaneous lesions, internal organ involvement including interstitial lung disease and carcinomas as observed in our patient have been reported in the literature. Various mechanisms like epigenetic changes and arsenic-induced immune suppression have been proposed for the development of cutaneous carcinomas with prolonged exposure to arsenic.

Relevance To Clinical Practice: Among the various causes of palmo-plantar hyperkeratosis, arsenicosis should be kept in mind when presenting in combination with pigmentary changes and carcinomatous growth from an arsenic-endemic region.

Conclusions: People residing in arsenic-endemic regions should be made aware of arsenic-related health hazards. Rainwater harvesting and good nutrition are the simplest measures which could be adopted by the exposed population in affected areas. Several methods have also been employed by governmental and non-government organizations to separate arsenic from contaminated water to combat arsenic-related diseases and carcinomas.

Competing Interests: The authors declare no competing financial interests.
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http://dx.doi.org/10.5696/2156-9614-11.29.210314DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8009643PMC
March 2021

Promoter hypomethylation as potential confounder of Ras gene overexpression and their clinical significance in subsets of urothelial carcinoma of bladder.

Mol Biol Rep 2021 Mar 23;48(3):2183-2199. Epub 2021 Feb 23.

Department of Biochemistry, University of Lucknow, Lucknow, 226007, India.

Overexpression of normal Ras and its aberrant CpG island methylation in the promoter regions have been shown to direct cells for uncontrolled abnormal growth and bladder tumor formation and therefore, fetched recent attention as a marker of diagnosis and prognosis to predict the biological behavior of urothelial carcinoma of bladder (UCB). Methylation pattern at CpG islands of the promoter regions of rat sarcoma (Ras) gene homologues namely Kristen-Ras (K-Ras), Harvey (H-Ras), and Neuroblastoma (N-Ras) were examined by methylation specific polymerase chain reaction (MSP). Real time-quantitative polymerase chain reaction (RT-qPCR) was done to determine transcriptomic expressions of these Ras isoforms in the prospective series of 42 NMIBC (non-muscle invasive bladder cancer) and 45 MIBC (muscle invasive bladder cancer) biopsies. CpG loci in H-Ras and K-Ras were observed to be more hypomethylated in MIBC, whereas more hypomethylation in N-Ras was noted in NMIBC. Strong association of hypomethylation index with tumor stage, grade, type and size validate them it as marker of diagnosis in UCB patients. Differential overexpression of H-Ras, N-Ras and K-Ras genes in NMIBC and MIBC and their association with patients' demographics identify them as important diagnostic markers in pathogenesis of UCB. Given the reported ability of promoter hypomethylation to activate Ras expression, correlation studies examined positive significant association between hypomethylation index and expression. Study concludes that promoter hypomethylation of N-Ras and K-Ras could be a potential confounder of their increased expression in NMIBC. Biological significance of simultaneous presence of higher expression and promoter hypomethylation of Ras gene isoforms in MIBC is difficult to resolve in a given cohort of patients.
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http://dx.doi.org/10.1007/s11033-021-06227-xDOI Listing
March 2021

A curious case of two brothers with recurrent chronic skin ulceration.

Int J Dermatol 2021 Jun 30;60(6):e242-e244. Epub 2020 Dec 30.

King George's Medical University, Lucknow, UP, India.

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http://dx.doi.org/10.1111/ijd.15403DOI Listing
June 2021

Mutational analysis of hotspots in patients with urothelial carcinoma of the bladder.

World J Clin Oncol 2020 Aug;11(8):614-628

Department of Biochemistry, University of Lucknow, Lucknow 226007, India.

Background: Mutational activation of genes is established as a prognostic factor for the genesis of a constitutively active RAS-mitogen activated protein kinase pathway that leads to cancer. Heterogeneity among the distribution of the most frequent mutations in isoforms is reported in different patient populations with urothelial carcinoma of the bladder (UCB).

Aim: To determine the presence/absence of mutations in isoforms in patients with UCB in order to predict disease outcome.

Methods: This study was performed to determine the mutational spectrum at the hotspot regions of , and genes by polymerase chain reaction - restriction fragment length polymorphism (PCR-RFLP) and DNA sequencing followed by their clinical impact (if any) by examining the relationship of mutational spectrum with clinical histopathological variables in 87 UCB patients.

Results: None of the 87 UCB patients showed point mutations in codon 12 of gene; codon 61 of gene and codons 12, 13 of gene by PCR-RFLP. Direct DNA sequencing of tumor and normal control bladder mucosal specimens followed by Blastn alignment with the reference wild-type sequences failed to identify even one nucleotide difference in the coding exons 1 and 2 of , and genes in the tumor and control bladder mucosal specimens.

Conclusion: Our findings on the lack of mutations in , and genes could be explained on the basis of different etiological mechanisms involved in tumor development/progression, inherent genetic susceptibility, tissue specificity or alternative dysfunction such as gene amplification and/or overexpression in a given cohort of patients.
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http://dx.doi.org/10.5306/wjco.v11.i8.614DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7443835PMC
August 2020

Severe acute respiratory illness pandemics: coronavirus disease 2019 and other viral etiologies in the 21st century.

Med J Armed Forces India 2020 Jul 26;76(3):361-363. Epub 2020 May 26.

Additional Professor (Pathology), King George's Medical University, Lucknow, India.

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http://dx.doi.org/10.1016/j.mjafi.2020.04.015DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7250060PMC
July 2020

Facial giant malignant melanoma in xeroderma pigmentosum.

Int J Dermatol 2019 Jun 19. Epub 2019 Jun 19.

King George's Medical University, Lucknow, UP, India.

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http://dx.doi.org/10.1111/ijd.14561DOI Listing
June 2019

Clinicohistopathological implications of phosphoserine 9 glycogen synthase kinase-3β/ β-catenin in urinary bladder cancer patients.

World J Clin Oncol 2019 Apr;10(4):166-182

Department of Biochemistry, Lucknow University, Lucknow 226007, India.

Background: Aberrant activation of phosphorylated form of glycogen synthase kinase-3β [pS9GSK-3β (Serine 9 phosphorylation)] is known to trigger Wnt/β-catenin signal cascade but its clinicohistopathological implications in bladder carcinogenesis remain unknown.

Aim: To investigate the diagnostic and prognostic relevance of expressions of pS9GSK-3β, β-catenin and its target genes in the pathobiology of bladder cancer.

Methods: Bladder tumor tissues from ninety patients were analyzed for quantitative expression and cellular localization of pS9GSK-3β by immunohistochemical (IHC) staining. Real time-quantitative polymerase chain reaction and IHC were done to check the expression of β-catenin, Cyclin D1, Snail and Slug at transcriptome and protein level respectively. Clinicohistopathological variables were obtained from histology reports, follow up and OPD visits of patients. Expressions of the markers were statistically correlated with these variables to determine their significance in clinical setting. Results were analysed using SPSS 20.0 software.

Results: Aberrant (low or no membranous/high nuclear/high cytoplasmic) expression of pS9GSK-3β was noted in 51% patients and found to be significantly associated with tumor stage and tumor grade ( = 0.01 and 0.04; Mann Whitney test). Thirty one percent tumors exhibited aberrant co-expression of pS9GSK-3β and β-catenin proteins and showed strong statistical association with tumor stage, tumor type, smoking/tobacco chewing status ( = 0.01, 0.02 and 0.04, Mann-Whitney test) and shorter overall survival probabilities of patients ( = 0.02; Kaplan Meier test). Nuclear immunostaining of Cyclin D1 in tumors with altered pS9GSK-3β/β-catenin showed relevance with tumor stage, grade and type.

Conclusion: β-catenin and pS9GSK-3β proteins are identified as markers of diagnostic/prognostic significance in disease pathogenesis. Observed histopathological association of Cyclin D1 identifies it as marker of potential relevance in tumors with altered pS9GSK-3β/β-catenin.
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http://dx.doi.org/10.5306/wjco.v10.i4.166DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6506422PMC
April 2019

Diagnostic utility of GATA3 immunohistochemical expression in urothelial carcinoma.

Indian J Pathol Microbiol 2019 Apr-Jun;62(2):244-250

Department of Pathology, King George Medical University, Lucknow, Uttar Pradesh, India.

Aims: This study aims to explore the utility of GATA binding protein 3, a zinc finger transcription factor, expression in genitourinary carcinoma, especially urothelial carcinoma.

Settings And Design: It is a prospective study where 74 consecutive cases of urothelial carcinoma along with 10 cases each of prostatic adenocarcinoma (PC) and conventional clear cell renal cell carcinoma were included between August 2016 and January 2017.

Methods And Materials: All the cases were histopathologically evaluated and immunohistochemically stained for GATA binding protein 3. Only nuclear positivity was considered as positive. Immunoreactivity score for GATA expression was calculated based on the staining intensity as well as percentage.

Statistical Analysis Used: The statistical analysis was done using Statistical Package for Social Sciences Version 15.0 statistical analysis software. P value of <0.05 was considered statistically significance.

Results: GATA3 expressions were seen in 77% of the cases of urothelial carcinoma, whereas none of the clear cell renal cell carcinoma and prostatic adenocarcinoma cases was GATA3 positive. GATA3 expression significantly correlated with histological grade and muscle invasion with a weaker or negative expression in high-grade muscle invasive tumor as compared to low-grade and noninvasive neoplasm. Significantly weaker expression of GATA3 was found in cases with severe nuclear pleomorphism, mitosis >10/10 hpf, presence of necrosis, and tumor-infiltrating lymphocytes. No significant change in the status of GATA3 expression was seen in follow-up cases between initial Transurethral resection of bladder tumor (TURBT) and post-recurrence TURBT or radical cystectomy specimens.

Conclusions: GATA3 as a sensitive and specific marker for urothelial carcinoma can be effectively used to exclude other genitourinary malignancies, PC, and renal cell carcinoma, at metastatic site. This marker can also be effectively used in predicting the probable grade and invasion in biopsy material with poor morphological characteristics, thereby helping in appropriate management in such cases.
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http://dx.doi.org/10.4103/IJPM.IJPM_228_18DOI Listing
August 2019

A case of bullous pyoderma gangrenosum.

BMJ Case Rep 2019 Mar 31;12(3). Epub 2019 Mar 31.

Department of Pathology, CSMMU (ERSTWHILE KGMC), Lucknow, Uttar Pradesh, India.

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http://dx.doi.org/10.1136/bcr-2018-228772DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6453296PMC
March 2019

Alteration in lipid composition differentiates breast cancer tissues: a H HRMAS NMR metabolomic study.

Metabolomics 2018 09 3;14(9):119. Epub 2018 Sep 3.

Centre of Biomedical Research, Formerly Centre of Biomedical Magnetic Resonance (CBMR), Sanjay Gandhi Postgraduate Institute of Medical Sciences Campus, Rae Bareli Road, Lucknow, 226014, India.

Introduction: Breast cancer is the most frequent diagnosed cancer among women with a mortality rate of 15% of all cancer related deaths in women. Breast cancer is heterogeneous in nature and produces plethora of metabolites allowing its early detection using molecular diagnostic techniques like magnetic resonance spectroscopy.

Objectives: To evaluate the variation in metabolic profile of breast cancer focusing on lipids as triglycerides (TG) and free fatty acids (FFA) that may alter in malignant breast tissues and lymph nodes from adjacent benign breast tissues by HRMAS H NMR spectroscopy.

Methods: The H NMR spectra recorded on 173 tissue specimens comprising of breast tumor tissues, adjacent tissues, few lymph nodes and overlying skin tissues obtained from 67 patients suffering from breast cancer. Multivariate statistical analysis was employed to identify metabolites acting as major confounders for differentiation of malignancy.

Result: Reduction in lipid content were observed in malignant breast tissues along with a higher fraction of FFA. Four small molecule metabolites e.g., choline containing compounds (Chocc), taurine, glycine, and glutamate were also identified as major confounders. The test set for prediction provided sensitivity and specificity of more than 90% excluding the lymph nodes and skin tissues.

Conclusion: Fatty acids composition in breast cancer using in vivo magnetic resonance spectroscopy (MRS) is gaining its importance in clinical settings (Coum et al. in Magn Reson Mater Phys Biol Med 29:1-4, 2016). The present study may help in future for precise evaluation of lipid classification including small molecules as a source of early diagnosis of invasive ductal carcinoma by employing in vivo magnetic resonance spectroscopic methods.
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http://dx.doi.org/10.1007/s11306-018-1411-3DOI Listing
September 2018

Type 1 Papillary Renal Cell Carcinoma Presenting as an Infected Benign Renal Cyst: an Uncommon Presentation.

Indian J Surg Oncol 2018 Jun 27;9(2):265-267. Epub 2018 Apr 27.

1Department of Pathology, King George's Medical University, Lucknow, Uttar Pradesh India.

We describe an unusual presentation of papillary renal cell carcinoma in a 40-year old male where radiological evaluation revealed a Bosniak type 2 cyst (probably benign), and clinical signs as well as symptoms also suggested an infected cyst l. However, on histopathological examination, an intra cystic type 1 papillary renal cell carcinoma was diagnosed. This is an extremely rare presentation of papillary renal cell carcinoma because it usually present as a heterogenous mass. Hence, even the radiologically benign cyst should be evaluated and managed cautiously.
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http://dx.doi.org/10.1007/s13193-018-0757-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5984868PMC
June 2018

Retroperitoneal teratoma simulating giant adrenal myelolipoma: a diagnostic puzzle.

BMJ Case Rep 2017 Sep 28;2017. Epub 2017 Sep 28.

Department of Pathology, King George's Medical University, Lucknow, Uttar Pradesh, India.

Teratoma is a germ-cell tumour that is common in para-axial regions. Retroperitoneal teratoma is rare and comprise only about 1% of all teratomas. We present a 21-year-old female who presented with a lump in the abdomen. After radiological investigations, she was diagnosed as case of adrenal myelolipoma which on excision turned out histologically to be retroperitoneal teratoma. Our case highlights the limitation of radiological investigations in preoperative diagnosis of teratoma.
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http://dx.doi.org/10.1136/bcr-2017-221762DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5652637PMC
September 2017

Establishing a deceased donor program in north Indian region: lessons learnt.

Clin Transplant 2016 May 18;30(5):633-40. Epub 2016 Apr 18.

Department of Human Organ Transplant, KGMU, Luknow, India.

Introduction: Living-related donors are the source of almost all organ transplants in India. However, these donations fall far short of current needs, and there remains a huge disparity between demand and supply of organs. In the last five yr, a consistent increase in deceased donor transplant activity has been observed in some southern Indian states. This report describes our experience of establishing a new deceased donor program in the state of Uttar Pradesh in north India.

Methods: We describe our experience on counseling families of all brain-dead patients admitted to our center from October 2013 to September 2014 and data on retrieving and transplanting organs.

Results: A total of 99 brain-dead patients were identified, of which 67 were medically eligible as donors. Fourteen patients developed cardiac arrest before the counseling could begin. Only eight families agreed for multi-organ donation.

Conclusion: Lack of consensus among the family members, mistrust of the medical system, fear of mutilation of the body, and delay in the funeral were identified as the main reasons behind negative consent. Conversely, mass media campaign, proper ICU care of brain-dead patients, rapport with the family and streamlining all medico legal processes were associated with positive consent.
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http://dx.doi.org/10.1111/ctr.12730DOI Listing
May 2016

Parapelvic solitary neurofibroma of the kidney.

BMJ Case Rep 2015 Jun 10;2015. Epub 2015 Jun 10.

Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India.

A middle-aged man presented with intermittent gross haematuria and dull aching left flank pain for 1 month. He was a chronic smoker for 15 years. Contrast-enhanced CT scan of the abdomen detected a 4.5×3.0×2.5 cm, heterogeneous and poorly contrast-enhancing mass in the left renal sinus and upper ureteric region causing narrowing of the pelviureteric junction and upper ureter. Considering it to be a transitional cell carcinoma of upper urinary tract, the patient underwent laparoscopic radical nephroureterectomy. Histopathology revealed the mass to be a neurofibroma in the renal sinus extending around the upper ureter.
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http://dx.doi.org/10.1136/bcr-2014-208357DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4480129PMC
June 2015

Molecular profiling of ETS and non-ETS aberrations in prostate cancer patients from northern India.

Prostate 2015 Jul 23;75(10):1051-62. Epub 2015 Mar 23.

Michigan Center for Translational Pathology, University of Michigan Medical School, Ann Arbor, Michigan.

Background: Molecular stratification of prostate cancer (PCa) based on genetic aberrations including ETS or RAF gene-rearrangements, PTEN deletion, and SPINK1 over-expression show clear prognostic and diagnostic utility. Gene rearrangements involving ETS transcription factors are frequent pathogenetic somatic events observed in PCa. Incidence of ETS rearrangements in Caucasian PCa patients has been reported, however, occurrence in Indian population is largely unknown. The aim of this study was to determine the prevalence of the ETS and RAF kinase gene rearrangements, SPINK1 over-expression, and PTEN deletion in this cohort.

Methods: In this multi-center study, formalin-fixed paraffin embedded (FFPE) PCa specimens (n = 121) were procured from four major medical institutions in India. The tissues were sectioned and molecular profiling was done using immunohistochemistry (IHC), RNA in situ hybridization (RNA-ISH) and/or fluorescence in situ hybridization (FISH).

Results: ERG over-expression was detected in 48.9% (46/94) PCa specimens by IHC, which was confirmed in a subset of cases by FISH. Among other ETS family members, while ETV1 transcript was detected in one case by RNA-ISH, no alteration in ETV4 was observed. SPINK1 over-expression was observed in 12.5% (12/96) and PTEN deletion in 21.52% (17/79) of the total PCa cases. Interestingly, PTEN deletion was found in 30% of the ERG-positive cases (P = 0.017) but in only one case with SPINK1 over-expression (P = 0.67). BRAF and RAF1 gene rearrangements were detected in ∼1% and ∼4.5% of the PCa cases, respectively.

Conclusions: This is the first report on comprehensive molecular profiling of the major spectrum of the causal aberrations in Indian men with PCa. Our findings suggest that ETS gene rearrangement and SPINK1 over-expression patterns in North Indian population largely resembled those observed in Caucasian population but differed from Japanese and Chinese PCa patients. The molecular profiling data presented in this study could help in clinical decision-making for the pursuit of surgery, diagnosis, and in selection of therapeutic intervention.
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http://dx.doi.org/10.1002/pros.22989DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4832366PMC
July 2015

Carcinoma of breast metastasising to mandible.

BMJ Case Rep 2015 Jan 20;2015. Epub 2015 Jan 20.

Department of Radiodiagnosis & Imaging, Chhatrapati Shahuji Maharaj Medical University, Lucknow, Uttar Pradesh, India.

Metastatic tumours to oral cavity from distant sites are rarely seen. Bones are frequently involved as compared to soft tissues. Clinical presentation may vary according to site and size of metastatic tumour. We present a case of carcinoma of breast in a 50-year-old woman, metastasising to mandibular ramus, condyle and surrounding soft tissue structure presenting as osteomylitis of condyle.
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http://dx.doi.org/10.1136/bcr-2014-206571DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4307092PMC
January 2015

Cheek metastasis from a bladder tumor: unusual presentation of an aggressive disease.

Urologia 2013 Sep-Dec;80(4):317-21. Epub 2013 Jun 24.

1 Department of Urology, King George's Medical University, Lucknow - India.

Transitional cell carcinoma (TCC) has been well described for its propensity to metastasize to distant sites. Metastases to the soft tissues of the oral cavity from a bladder cancer are extremely rare. We present the case of a 65-year-old man who presented with history of hematuria for 1 month and was found to have high-grade TCC of the bladder. He developed a cheek lesion after 3 weeks, which was diagnosed as metastatic nodule along with pulmonary metastases from high-grade bladder TCC. The patient received chemotherapy followed by the radiotherapy of the cheek lesion, but he succumbed after 3 months due widespread metastatic disease. We also presented a review of the literature regarding this rare presentation.
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http://dx.doi.org/10.5301/urologia.5000022DOI Listing
April 2015

Multilocular cystic renal cell carcinoma: a rare entity.

BMJ Case Rep 2013 Apr 3;2013. Epub 2013 Apr 3.

Department of Pathology, King George's Medical University, Lucknow, Uttar Pradesh, India.

Multilocular cystic renal cell carcinoma (MCRCC) is an uncommon subtype of clear cell renal cell carcinoma that appears to have a favourable prognosis. Literature reports a very low incidence of 1-2% of MCRCC among the renal neoplasms. The first such reported case was in 1957 by Robinson. In 1998, Eble et al suggested following diagnostic criterion for MCRCC: (1) an expansile mass surrounded by a fibrous capsule; (2) interior of tumour entirely composed of cysts and septa with no expansile nodule or solid component confined to more than 10% of entire tumour and (3) septa containing aggregates of clear epithelial cells. We report a case of MCRCC in a 60-year-old male patient who presented with abdominal lump and after suspicion of renal malignancy underwent nephrectomy. The patient was perfectly well till last follow-up of 3 months postoperatively.
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http://dx.doi.org/10.1136/bcr-2012-008457DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3644964PMC
April 2013

Testicular metastasis of colorectal carcinoma: an unusual presentation.

BMJ Case Rep 2013 Feb 25;2013. Epub 2013 Feb 25.

Department of Pathology, KGMU, Lucknow, Uttar Pradesh, India.

Metastasis of colorectal carcinoma to testis is rare. The authors report a case of 35-year-old man with right testicular mass. Contrast-enhanced CT scan (CECT) of testes showed testicular mass with ascitis and enlargement of retroperitoneal lymphnodes. Thus, a provisional diagnosis of disseminated primary testicular tumour was made. On subsequent high orchidectomy pathological examination revealed mucinous adenocarcinoma with CDX2 positivity thereby suggesting the possibility of metastasis from adenocarcinoma. Further, the diagnostic evaluation revealed a colorectal mass, which was inoperable (stage IV) and found to be primary colorectal mucinous adenocarcinoma. The authors conclude that occult colorectal carcinoma may rarely metastasise to testis and this unusual presentation may produce diagnostic dilemma. Although rare, metastases to testes should be considered as a differential diagnosis, especially where symptoms are unusual for primary malignancy.
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http://dx.doi.org/10.1136/bcr-2012-007849DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3604314PMC
February 2013

Single-center experience on renal transplantation in primary focal and segmental glomerulosclerosis using hematopoietic stem cell transplantation in thymus, bone marrow, portal and peripheral circulation.

Saudi J Kidney Dis Transpl 2013 Jan;24(1):15-21

Department of Pathology, IKDRC-ITS, Ahmedabad, India.

Recurrence of primary focal segmental glomerulosclerosis (FSGS) is an important cause of graft loss after renal transplantation (RTx). We report our experience in 34 patients with primary FSGS who underwent RTx between April 1999 and June 2009, using hematopoietic stem cell transplantation (HSCT). They belonged to four groups: group 1 (n = 12) received high-dose HSCT in periphery, thymus, bone-marrow, and portal circulation with low-dose non-myeloablative conditioning; group 2 (n = 7) was modified with HSCT without marrow/thymic infusion; and group 3 (n = 3) received HSCT and proteasome inhibitor Bortezomib replacing conditioning. Group 4 (n = 12), were controls who opted for RTx under standard triple-drug immunosuppression. Patient/donor demographics were comparable in all. No recurrence was noted in group 1 with mean follow-up of 8.1 years, whereas 28.6% of group 2, 33.3% of group 3, and 36.4% of group 4 had recurrence over mean follow-up of 2.6, 1.1, and 6.5 years, respectively. Mean serum creatinine was 1.62, 1.69, 1.41, and 1.73 mg%, respectively. Rejections were noted in 41.7%, 28.6%, 0%, and 45.5% grafts, respectively. Groups 1 and 4 had 25% patient loss each, group 2 had 28.6% loss, and no loss was observed in group 3. Graft loss was noted in 33.3% in group 1, 14.3% in group 2, nil in group 3, and 16.7% in the last group. Recurrent FSGS was prevented in RTx with HSCT in thymic, marrow infusion under low-dose non-myeloablative conditioning compared to controls and Bortezomib group, thus suggesting potential role of central tolerance in FSGS.
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http://dx.doi.org/10.4103/1319-2442.106232DOI Listing
January 2013

Clinicopathoradiological findings in SEGA: A rare astroglial tumor.

Indian J Med Paediatr Oncol 2012 Jul;33(3):192-3

Department of Pathology, C.S.M. Medical University, (Formerly King George Medical University), Lucknow, Uttar Pradesh, India. E-mail:

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http://dx.doi.org/10.4103/0971-5851.103158DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3523486PMC
July 2012

Clear cell sarcoma of kidney: A rare entity.

Indian J Med Paediatr Oncol 2011 Jul;32(3):157-9

Department of Pathology, Era's Lucknow Medical College, Lucknow, Uttar Pradesh, India.

Clear cell sarcoma of the kidney is an uncommon renal neoplasm of childhood. It represents one of the most common unfavorable tumors included in National Wilms' Tumor Study Group clinical protocols. We came across this rare tumor in a 2-year-old male child. The case report is followed by discussion, stating the differentiating features between Wilms' and clear cell sarcoma, histological details, treatment, and prognostication.
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http://dx.doi.org/10.4103/0971-5851.92817DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3342723PMC
July 2011
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