Publications by authors named "Surbhi Goyal"

33 Publications

Epstein-Barr Virus-associated Mixed Lymphoepithelioma-like Carcinoma and Adenocarcinoma of the Gall Bladder: An Unusual Entity.

Korean J Gastroenterol 2021 Sep;78(3):188-194

Department of Gastrointestinal Surgery, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi, India.

Schmincke described lymphoepithelioma as an undifferentiated carcinoma with abundant lymphoid stroma in the nasopharynx. Tumors with a similar histomorphology in extrapharyngeal areas have been referred to as lymphoepithelioma-like carcinoma (LELC). The association of an Ebstein-Barr virus (EBV) infection with lymphoepithelioma is well established in the nasopharynx but not so well at the extrapharyngeal sites. Only four cases of LELC have been reported in the gall bladder, of which all were negative for the EBV. This paper reports the first case of an EBV-associated mixed gall bladder carcinoma exhibiting a distinct phenotype of LELC and adenocarcinoma with mucinous differentiation. The EBV was confirmed by the strong granular membranous and cytoplasmic expression of LMP-1 (latent membrane protein-1) on immunohistochemistry and nuclear EBER RNA on chromogen in-situ hybridization in the tumor. This is the first case of LELC positive for EBV in the gall bladder. LELC has a more favorable prognosis than conventional adenocarcinoma or squamous cell carcinoma, irrespective of the site. Although a higher T stage and nodal metastasis were exceptional in the present case in contrast to the previous cases, the EBV-associated lymphocytic response might limit the disease spread and confer better overall survival and prognosis in these patients. Nevertheless, more prospective studies with a larger cohort will be needed to understand the pathogenesis, biological behavior, and prognosis of this rare entity.
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http://dx.doi.org/10.4166/kjg.2021.045DOI Listing
September 2021

WHO classification of soft tissue tumours 2020: An update and simplified approach for radiologists.

Eur J Radiol 2021 Oct 28;143:109937. Epub 2021 Aug 28.

Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India.

The WHO classification of soft tissue tumours categorizes the lesions based on histological differentiation. In the recent fifth edition (2020), many new entities have been introduced, based on their distinct biological behaviour, genetics and morphology. With the recent advances and better understanding of molecular genetics, several novel recurrent genetic alterations have been incorporated in this edition. These may serve as reliable diagnostic and prognostic markers for various soft tissue tumours. Though predominantly a pathologist's game; the radiologists must be aware of the recent updates to contribute towards the optimal diagnosis and management of soft tissue tumours. The imaging features of the new entities have not yet been described but are expected to be explored in the coming years. We hereby present a concise review of the updates in the recent WHO classification of soft tissue tumours. We have tried to emphasize the novel molecular genetics and their surrogate immunohistochemical markers which have brought a paradigm shift in the diagnosis, therapeutics, and prognosis of soft tissue tumours. We also present simplified diagnostic algorithms to characterize soft tissue tumours based on the clinico-radiological features.
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http://dx.doi.org/10.1016/j.ejrad.2021.109937DOI Listing
October 2021

Autoimmune pancreatitis: Current perspectives.

Indian J Pathol Microbiol 2021 Jun;64(Supplement):S149-S159

Department of Pathology, GIPMER, New Delhi, India.

Over the last two decades, our knowledge and understanding regarding the pathogenesis and biology of autoimmune pancreatitis (AIP) have improved tremendously. Type 1 AIP or IgG4-related pancreatitis (IgG4-RP) is now believed to be the prototype of the multisystemic IgG4-related disease. In view of clinical features like obstructive jaundice and mass-forming lesions in the pancreas in elderly men, type 1 AIP often mimics pancreatic cancer. IgG4-related sclerosing cholangitis concomitantly involving the extrahepatic and intrahepatic biliary tree is the most common extrapancreatic involvement seen in up to 80% of these patients, which needs to distinguish from cholangiocarcinoma. Histology is characterised by lymphoplasmacytic inflammation, abundant IgG4 positive plasma cell infiltration, storiform fibrosis and obliterative phlebitis. Apart from histology, high serum IgG4 levels, pancreatic parenchymal and duct imaging findings and other organ involvement aid in diagnosis especially in cases where definitive histology is not evident. Also, these parameters lay the foundation of various diagnostic criteria proposed over last few years. On the contrary, histology alone is the mainstay for establishing diagnosis of idiopathic duct-centric pancreatitis (IDCP) as it lacks any specific serological marker or imaging. Since both types of AIP respond dramatically to corticosteroid treatment, a biopsy is crucial to establish the preoperative diagnosis and to exclude malignancy so as to avoid unnecessary surgery. This review discusses the morphologic spectrum, treatment and prognosis of IgG4-RP and IDCP with an emphasis on approach to diagnosis with relevant histologic features, differential diagnoses and the challenges faced during biopsy interpretation.
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http://dx.doi.org/10.4103/ijpm.ijpm_59_21DOI Listing
June 2021

Red carpet of filiform polyposis!

Postgrad Med J 2021 Feb 9. Epub 2021 Feb 9.

Gastrointestinal Surgery, GB Pant Hospital, New Delhi, Delhi, India.

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http://dx.doi.org/10.1136/postgradmedj-2020-139245DOI Listing
February 2021

Immunoproteomics approach revealed elevated autoantibody levels against ANXA1 in early stage gallbladder carcinoma.

BMC Cancer 2020 Dec 1;20(1):1175. Epub 2020 Dec 1.

Laboratory of Molecular Oncology, ICMR- National Institute of Pathology, Safdarjung Hospital Campus, New Delhi, 110029, India.

Background: Early diagnosis is important for the timely treatment of gallbladder carcinoma (GBC) patients and may lead to increased survival outcomes. Here, we have applied serological proteome analysis (SERPA), an immunoproteomics approach, for the detection of 'tumor-associated antigens (TAAs) that elicit humoral response' in early stage GBC patients.

Methods: Total protein from pooled tumor tissue of GBC patients (n = 7) was resolved by two-dimensional gel electrophoresis (2-DE) followed by immunoblotting using pooled blood plasma from healthy volunteers (n = 11) or gallstone disease (GSD) cases (n = 11) or early stage GBC (Stage I and II) (n = 5) or GBC stage IIIA (n = 9). 2-D gel and immunoblot images were acquired and analyzed using PDQuest software to identify immunoreactive spots in GBC cases in comparison to controls. Proteins from immunoreactive spots were identified by liquid chromatography- tandem mass spectrometric analysis (LC-MS/MS). Autoantibody levels for two of the functionally relevant proteins were investigated in individual plasma samples (52 cases and 89 controls) by dot blot assay using recombinant proteins.

Results: Image analysis using PDQuest software identified 25 protein spots with significantly high or specific immunoreactivity in GBC cases. Mass spectrometric analysis of 8 corresponding protein spots showing intense immunoreactivity (based on densitometric analysis) in early stage GBC or GBC stage IIIA cases led to the identification of 27 proteins. Some of the identified proteins include ANXA1, HSPD1, CA1, CA2, ALDOA and CTSD. Among the two proteins, namely ANXA1 and HSPD1 verified using a cohort of samples, significantly elevated autoantibody levels against ANXA1 were observed in early stage GBC cases in comparison to healthy volunteers or GSD cases (unpaired t-test, p < 0.05). Receiver operating characteristic (ROC) curve analysis for ANXA1 showed an Area under the Curve (AUC) of 0.69, with 41.7% sensitivity against a specificity of 89.9% for early stage GBC. IHC analysis for ANXA1 protein showed 'high' expression levels in 72% of GBC cases whereas all the controls showed 'low' expression levels.

Conclusions: The study suggests that the ANXA1 autoantibody levels against ANXA1 may be potentially employed for early stage detection of GBC patients. Other proteins could also be explored and verified in a large cohort of clinical samples.
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http://dx.doi.org/10.1186/s12885-020-07676-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7709428PMC
December 2020

HER-2/neu over expression in gall bladder adenocarcinoma: A quest for potential therapeutic target.

Indian J Pathol Microbiol 2020 Apr-Jun;63(2):214-220

Department of Gastro-Surgery, GIPMER, Jawaharlal Nehru Marg, 64 Khamba, New Delhi, India.

Background: Gall bladder carcinoma (GBC) is an aggressive malignancy with high mortality and aggressive course, with palliation as the only available option.

Objectives: To evaluate frequency of HER-2/neu overexpression in GBC and to seek its correlation, if any with conventional clinicopathological parameters and survival.

Methods: Immunohistochemistry (IHC) was performed on 200 cases of GBC, 32 cases of dysplasia, and 100 cases of chronic cholecystitis. Fluorescent in situ hybridization (FISH) was performed on 30 randomly selected cases of GBC to validate IHC. HER-2/neu overexpression (IHC 3+/FISH amplification ≥2.2) was correlated with clinicopathological parameters by Chi-square test.P < 0.05 was considered significant. Survival analysis was done by log-rank test and Kaplan-Meier analysis.

Results: HER-2/neu overexpression was seen in 14% (28/200) GBC cases but was not found in dysplasia and chronic cholecystitis. Majority of these cases were ≤grade 2 and in advanced stage, however this was not statistically significant. A lower mean survival in HER-2/neu positive group as compared to HER-2/neu negative group (17.1 ± 2.3 month versus 67.6 ± 8.5 month, respectively) was observed. Concordance between IHC and FISH was seen in 18/19 cases.

Conclusion: This study delineates a subset of GBC patients with HER-2/neu overexpression, in whom targeted therapy can offer a survival benefit.
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http://dx.doi.org/10.4103/IJPM.IJPM_664_19DOI Listing
January 2021

Benign vascular anomalies: A transition from morphological to etiological classification.

Ann Diagn Pathol 2020 Jun 13;46:151506. Epub 2020 Mar 13.

Department of Radiodiagnosis, Chacha Nehru Bal Chikitsalaya, Geeta Colony, Delhi 110031, India.

The International Society for the Study of Vascular Anomalies (ISSVA) devised a multidisciplinary etiopathogenesis based approach to classify benign vascular anomalies into tumors and malformations. This classification scheme has major therapeutic and prognostic implications as treatment modalities differ for both the categories. Inappropriate usage of the term "hemangioma" for etiopathogenetically distinct entities is commonly seen in clinical practice leading to delivery of incorrect treatment to the patients. We aimed to study the histomorphological and immunohistochemical features of benign vascular anomalies for their precise histopathological classification. A total of 48 cases diagnosed over a period of 3.5 years were reviewed and reclassified into vascular tumors and malformations based on ISSVA classification and prototypical histopathological features. Biopsies were reviewed based on 5 histopathological criteria viz. endothelial morphology, mitotic activity, intralesional nerve bundles, intralesional inflammation, and prominent vessel type. A panel of GLUT-1, WT-1, and Ki-67 was performed in each case. Seven cases of infantile hemangioma, 4 cases each of non-involuting congenital hemangioma and pyogenic granuloma, and 33 cases of vascular malformations were diagnosed. Endothelial cell morphology (p < 0.001), mitotic activity (p < 0.001), and intralesional nerve bundles (p < 0.001) were found to be statistically significant in differentiating hemangioma from malformations. GLUT-1 (p < 0.001) and Ki-67 labeling index (p < 0.001) were useful to distinguish infantile hemangioma from vascular malformations. To conclude, the ISSVA classification of benign vascular anomalies can be reliably done on histopathology. However, every case must be interpreted in the light of clinical and radiological features.
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http://dx.doi.org/10.1016/j.anndiagpath.2020.151506DOI Listing
June 2020

Clinicopathological analysis of extracranial head and neck schwannoma: A case series.

J Cancer Res Ther 2019 Jul-Sep;15(3):659-664

Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.

Background: Extracranial head and neck schwannomas are rare tumors which are often clinically misdiagnosed. Preoperative diagnosis of these tumors is challenging but imperative for surgeons so as to avoid nerve damage during excision.

Materials And Methods: Sixteen patients diagnosed with extracranial head and neck schwannomas over a period of 2 years were retrospectively analyzed. Clinical details including preoperative fine-needle aspiration cytology (FNAC) and/or computed tomography (CT)/magnetic resonance imaging (MRI) findings were retrieved. FNAC smears and formalin-fixed paraffin-embedded sections were evaluated.

Results: Among these 16 tumors, 6 (37.5%) were located in the lateral aspect of neck, 4 (25%) in scalp, 2 (12.5%) in orbit, and one each (6.25%) in palate, tongue, submandibular gland and parotid gland. The mean patient age was 31.3 years. FNAC was performed in 14 cases, of which 8 cases (58.3%) showed features of benign nerve sheath tumor (BNST), two cases (14.2%) were inconclusive with possibility of mesenchymal lesion, two cases (14.2%) were inadequate, one case (8.3%) showed features suggestive of schwannoma, and a diagnosis of nerve sheath tumor inconclusive for malignancy was rendered in a single case. The sensitivity of FNAC in diagnosis of BNST was 71.4%. CT or MRI was performed in five cases, of which an accurate diagnosis was rendered only in one case of orbital schwannoma.

Conclusion: Imaging has a limited role in the preoperative diagnosis of head and neck schwannomas owing to nonspecific radiological features. Cellular aspirate smears are helpful in accurate diagnosis even at unusual locations.
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http://dx.doi.org/10.4103/jcrt.JCRT_1125_16DOI Listing
November 2019

Ultrasound guided aspirate from a paediatric retroperitoneal mass: A diagnostic dilemma.

Cytopathology 2019 09 23;30(5):560-562. Epub 2019 May 23.

Department of Pathology, Chacha Nehru Bal Chikitsalaya, New Delhi, India.

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http://dx.doi.org/10.1111/cyt.12710DOI Listing
September 2019

Melanotic neuroectodermal tumor of infancy: A rare entity.

J Oral Maxillofac Pathol 2019 Feb;23(Suppl 1):134-137

Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.

Melanotic neuroectodermal tumor of infancy (MNTI) is a rare neoplasm with a predilection for the head-and-neck region. Approximately 472 cases reported in literature till date. We report an unusual case of MNTI in a 1-month old child. A 10 cm × 5 cm × 5 cm nontender, firm, deep-seated swelling was seen involving the right zygomatic and maxillary region. Magnetic resonance imaging was suggestive of rhabdomyosarcoma and immunomorphological assessment of the excision specimen revealed the final diagnosis of MNTI. On follow-up, the patient developed recurrence 4 months after surgery and was reoperated. The present case emphasizes that albeit rare, pediatric surgeons and pathologists must always keep in mind the possibility of MNTI while dealing with maxillofacial tumors in infants. Owing to rather nonspecific clinicoradiological features, histopathology supplemented with immunohistochemistry remains the gold standard for diagnosis. Although considered to be a benign tumor, close clinicoradiological follow-up is strongly recommended given the significant risk of recurrence as highlighted by our case.
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http://dx.doi.org/10.4103/jomfp.JOMFP_237_16DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6421908PMC
February 2019

Acute amoebic appendicitis: An unusual presentation of a usual infection.

Indian J Pathol Microbiol 2019 Jan-Mar;62(1):169-170

Department of Pediatric Surgery, Chacha Nehru Bal Chikitsalaya, New Delhi, India.

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http://dx.doi.org/10.4103/IJPM.IJPM_576_17DOI Listing
May 2019

Childhood Phimosis Secondary to Lichen Sclerosus: Is There a Spatial Pattern of Histopathological Changes?

Am J Dermatopathol 2018 Nov;40(11):824-828

Pediatric Surgery, Chacha Nehru Bal Chikitsalaya, Delhi, India.

Introduction: The accurate histopathological diagnosis of the phimotic prepuce is indispensable because early diagnosis, treatment, and close follow-up are crucial in genital dermatosis such as lichen sclerosus (LS). This study analyzes the histopathological spectrum of childhood phimosis with special emphasis on LS. We also highlight a peculiar pattern of histopathological evolution in LS, prepuce.

Material And Methods: The histopathology slides of all the pediatric preputial circumcision specimens performed for the indication of pathological phimosis (n = 43) during the study period (2012-2017) were analyzed. Eight histopathological features viz. hyperkeratosis, hypergranulosis, epidermal atrophy, acanthosis, dermoepidermal cleft, upper dermal edema and homogenization, mid dermal lymphocytic band, and interface dermatitis were studied in each case, separately in inner preputial surface, tip, and outer preputial surface. On the basis of evolution of the disease and histopathological features, the lesions of LS were classified into early, established, and advanced.

Result: LS was found in 32 cases, whereas 11 cases showed nonspecific inflammation and fibrosis. The upper dermal homogenization (n = 29), dermoepidermal cleft (n = 28), and mid dermal band (n = 27) were the commonest histopathological changes. The established and advanced changes were confined to the inner preputial surface (n = 31), and the outer preputial skin surface was unaffected in all the cases. A peculiar histopathological evolution pattern was seen with established or advanced lesions, early lesion, and normal histology on the inner preputial surface, mucocutaneous junction, and outer preputial skin, respectively.

Conclusions: LS is a common cause of childhood phimosis. It shows a peculiar histopathological evolution that mandates the thorough analysis of inner mucosal surface.
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http://dx.doi.org/10.1097/DAD.0000000000001248DOI Listing
November 2018

Primary Leiomyosarcoma of Breast Presenting with Metastasis: An Atypical Presentation with Dismal Prognosis.

Indian J Med Paediatr Oncol 2017 Oct-Dec;38(4):535-537

Department of Pathology, VMMC and Safdarjung Hospital, New Delhi, India.

Leiomyosarcoma is an extremely uncommon subtype of breast sarcoma, with <50 cases reported in the English literature till date. Patients usually present at an early stage and follow an indolent course. We reported an unusual case of leiomyosarcoma of breast in a post -menopausal female,presented with right side breast lump and pain right side hip. Histomorphological evaluation and immunohistochemistry confirmed the diagnosis. The patient received palliative radiotherapy 20 Gy in 5 fractions to right iliac bone and was started on chemotherapy comprising of docetaxel and epirubicin. Leiomyosarcoma of breast is known to have local recurrence and hematogenous metastasis, usually 10-15 years after the primary diagnosis. Aggressive behavior of leiomyosarcomas in the form of such a rapidly growing, fungating mass of 15 cm in greatest dimension with hematogenous metastasis at the time of initial presentation, as seen in our case, is extremely unusual.
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http://dx.doi.org/10.4103/ijmpo.ijmpo_139_16DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5759077PMC
January 2018

Hodgkin's lymphoma arising in a case of mycosis fungoides: An unusual association.

Indian J Dermatol Venereol Leprol 2018 May-Jun;84(3):292-297

Department of Pathology, Vardhman Mahavir Medical College, Safdarjung Hospital, New Delhi, India.

Mycosis fungoides is a cutaneous T-cell lymphoma with a high risk for developing secondary malignancies, especially B-cell lymphoproliferative disorders. About 40 cases of Hodgkin's lymphoma associated with mycosis fungoides have been reported in literature till date. We report a case of a 35-year-old gentleman who presented with intensely itchy reddish lesions all over the body. Multiple skin biopsies taken from the lesions on scalp and back confirmed the clinical diagnosis of mycosis fungoides. While on treatment, he presented with multiple bilateral cervical, axillary and inguinal lymphadenopathy 9 years after the primary diagnosis of mycosis fungoides. Excision biopsy of a cervical lymph node revealed partial effacement of architecture by a tumor comprising polymorphous background. Histopathology and immunohistochemistry revealed a diagnosis of Hodgkin's lymphoma - nodular sclerosis subtype. The patient was started on chemotherapy for stage IV Hodgkin's lymphoma. Our case emphasizes the importance of keeping secondary Hodgkin's lymphoma in mind while dealing with a patient of mycosis fungoides. Our case immunohistochemically supports the distinct etiopathogenesis of Epstein-Barr virus-negative Hodgkin's lymphoma vis-à-vis cutaneous mycosis fungoides.
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http://dx.doi.org/10.4103/ijdvl.IJDVL_744_16DOI Listing
September 2018

Intestinal GIST masquerading as an ovarian mass: Diagnosed on FNAC.

J Cytol 2017 Jul-Sep;34(3):159-161

Department of Obstetrics and Gynaecology, University College of Medical Sciences and GTB Hospital, New Delhi, India.

The preoperative diagnosis of metastatic intestinal gastrointestinal stromal tumors (GIST) on cytology can be quite difficult at times. The present case characterizes the cytomorphological and immunocytochemical features of GIST, emphasizing the utility of fine-needle aspiration cytology (FNAC) in the evaluation of spindle cell tumors of gastrointestinal tract. An accurate and early diagnosis of GIST affects the treatment, primarily allowing the use of tyrosine kinase inhibitors in unresectable or metastatic cases. Presence of highly cellular fragments of spindle-to-oval cells with variable degree of pleomorphism, atypia, and necrosis supplemented by immunocytochemistry can render a cytological diagnosis of GIST in dilemmatic clinical situations. Our case highlights the diagnostic role of FNAC in the evaluation of a pelvic mass, which was clinicoradiologically misdiagnosed as ovarian carcinoma.
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http://dx.doi.org/10.4103/0970-9371.208104DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5492755PMC
July 2017

Osteosarcoma Arising in Carcinosarcoma De Novo Parotid Gland in a Young Man: An Unusual Case with Review of Literature.

J Clin Diagn Res 2017 Apr 1;11(4):ED08-ED10. Epub 2017 Apr 1.

Director Professor, Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.

Carcinosarcoma of the parotid gland, a true malignant mixed tumour is extremely rare. It may occur in a pre-existing pleomorphic adenoma or arise de novo. We report a case of carcinosarcoma de novo harbouring an osteosarcomatous element in a 35-year-old man along with review of the reported cases. Excision was done and histopathologic examination confirmed the diagnosis. Long term follow up has been recommended for these tumours owing to their high propensity of recurrence and metastasis. Our case discusses the importance of histopathology and limitation of preoperative imaging in the diagnosis of such an aggressive neoplasm; emphasizing the fact that possibility of carcinosarcoma should be kept in mind while dealing with salivary gland lesions even at a younger age.
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http://dx.doi.org/10.7860/JCDR/2017/25259.9636DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5449799PMC
April 2017

Cutaneous basal cell carcinoma with mixed histology: Cytomorphological features of two unusual cases.

J Cytol 2017 Apr-Jun;34(2):115-118

Department of Dermatology and STD, University College of Medical Sciences and GTB Hospital, Delhi, India.

Cutaneous basal cell carcinoma (BCC) is a slow growing locally aggressive malignant tumor. It is usually diagnosed on histopathological examination of the excised biopsy. Recently, fine needle aspiration cytology (FNAC) is emerging as a simple alternative technique for rapid diagnostic work of nodular and plaque-like skin lesions. We report the cytomorphological features of two cases of cutaneous BCC having unusual clinical presentation and mixed histology (MH); emphasizing the diagnostic difficulties encountered on cytology, the plausible explanation and the precautions to keep in mind to avoid misdiagnosis.
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http://dx.doi.org/10.4103/0970-9371.203566DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5398019PMC
May 2017

Diagnostic utility of Wilms' tumour-1 protein (WT-1) immunostaining in paediatric renal tumours.

Indian J Med Res 2016 May;143(Supplement):S59-S67

Department of Pathology, University College of Medical Sciences, Delhi, India.

Background & Objectives: Renal tumours constitute about 7 per cent of all neoplasms in children. It is important to differentiate Wilms' tumour (commonest tumour) from non-Wilms' tumours. The aim of this study was to evaluate the immunoexpression and diagnostic role of Wilms' tumour-1 protein (WT1) in paediatric renal tumours.

Methods: A total of 53 cases of renal tumours in children (below 18 yr) who underwent total nephrectomy were included in this retrospective study. WT1 immunostaining was done using mouse monoclonal WT1 antibody (clone: 6F-H2).

Results: Of the 53 cases, 38 (72%) were of Wilms' tumour. Non-Wilms' group (15) included six cases of mesoblastic nephroma (MN), two each of clear cell sarcoma (CCSK), renal cell carcinoma (RCC) and peripheral neuroectodermal tumour (PNET) and one each of angiomyolipoma (AML), rhabdomyosarcoma (RMS) and malignant rhabdoid tumour (MRT). Proportion of WT1 positivity in Wilms' tumour was 100 per cent in contrast to 26.7 per cent in non-Wilms' tumours ( P<0.001). Epithelial and blastemal components of Wilms' tumour showed moderate (2+) nuclear and cytoplasmic staining in 80 (24/30) and 75 per cent (24/32) cases, respectively. MN, PNET, CCSK and AML were negative for WT1. RMS, RCC and MRT showed cytoplasmic staining, strongest in RMS. No significant association was seen between WT1 expression and NWTSG (National Wilms' Tumor Study Group) stage.

Interpretation & Conclusions: WT1 helps to differentiate Wilms' tumour from other paediatric renal tumours. It may help in differentiating the two subgroups of Wilms' tumour which have distinct molecular pathogenesis and biological behaviour, however, further prospective studies are required for validation of this hypothesis.
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http://dx.doi.org/10.4103/0971-5916.191776DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5080930PMC
May 2016

Pleomorphic rhabdomyosarcoma of the left atrium mimicking myxoma.

Indian J Pathol Microbiol 2016 Jul-Sep;59(3):379-81

Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.

Primary rhabdomyosarcoma (RMS) of the heart is a rare malignant tumor which has poor prognosis and survival despite surgery and adjuvant chemotherapy. The preoperative diagnosis is often difficult in view of nonspecific clinicoradiological findings. This report describes a case of a 60-year-old woman who was clinically diagnosed as left atrial myxoma. A diagnosis of pleomorphic RMS was made on histopathology after excision. Our case discusses the clinicopathological features and treatment options of cardiac RMS emphasizing the fact that histopathology and immunohistochemistry are essential to confirm the diagnosis of such an aggressive malignant tumor.
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http://dx.doi.org/10.4103/0377-4929.188138DOI Listing
March 2017

Occult Adenoma in Patent Vitellointestinal Duct Presenting as an Umbilical Fistula: Cause for Concern?

Fetal Pediatr Pathol 2016 9;35(4):272-6. Epub 2016 May 9.

a Department of Pathology , Vardhman Mahavir Medical College & Safdarjung Hospital , New Delhi , India.

Introduction: Prevalence of vitellointestinal duct anomalies varies from 2-4%. Though a completely patent vitellointestinal duct is a common symptomatic embryological defect with a prevalence of 0.0063-0.067%, other vitellointestinal abnormalities are rarely reported. Ours is the first case to describe histopathological features of an umbilical fistula harboring an occult tubular adenoma.

Case Report: We report a case of one-month old child, presenting with umbilical fistula for which excision and ileal anastomosis was performed. Routine histopathologic examination revealed an occult tubular adenoma in tip of the fistula.

Conclusion: Adenoma arising in an umbilical fistula at such an early stage of infancy has never been reported before. Detection of occult adenoma warrants screening GI endoscopy, genetic testing for syndromic gastrointestinal adenomatosis and carcinomas and lifelong surveillance. Our case highlights the importance of routine histopathologic examination in detection of occult premalignant lesions as it significantly affects the patient management and prognosis.
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http://dx.doi.org/10.3109/15513815.2016.1173145DOI Listing
March 2017

Disseminated Renal Burkitt Lymphoma With Malignant Inferior Vena Caval Thrombosis in a Child.

Urology 2016 Sep 15;95:180-3. Epub 2016 Mar 15.

Department of Medical Oncology, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India.

The most common causes of renal mass with malignant venous thrombosis are Wilms' tumor and renal cell carcinoma. Although renal involvement may occur in disseminated lymphomas, primary renal Burkitt lymphoma (BL) is rare. Vascular tropism is not a usual feature of lymphoma; thus, primary renal BL with venous extension is distinctly unusual. However, it is important to diagnose this entity because such patients respond well to medical management and may not require surgery. We report a pediatric case of primary renal BL with malignant vascular thrombus and systemic dissemination where biopsy was diagnostic and enabled appropriate treatment.
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http://dx.doi.org/10.1016/j.urology.2016.03.015DOI Listing
September 2016

Diagnostic role and limitations of FNAC in oral and jaw swellings.

Diagn Cytopathol 2015 Oct 14;43(10):810-8. Epub 2015 Jul 14.

Department of Pathology, University College of Medical Sciences, Dilshad Garden, Delhi, 110095, India.

Background: Fine-needle aspiration cytology (FNAC) of oral lesions has not been widely utilized for diagnosis due to rarity and diversity of lesions, peculiar anatomy of maxillofacial region, difficulty in aspirating these lesions, and limited experience. Aim of this study was to determine the role of FNAC in the diagnosis of oral and jaw swellings.

Materials And Methods: One hundred and forty two patients underwent FNAC over a period of 7 years (2007-2013), of which 127 (89.4%) aspirates were diagnostic. Histopathologic correlation was available in 83 cases and diagnostic accuracy of FNAC was calculated.

Results: Of the minor salivary gland lesions, 41 out of 55 lesions (74.5%) were benign and 14 (25.4%) were malignant. Mucocele was the most common lesion in oral cavity (30 cases) and pleomorphic adenoma was the commonest salivary gland neoplasm (9 cases). Of the 72 non-salivary-gland lesions, 22 lesions were inflammatory, 4 were epidermal inclusion cysts, 21 were neoplastic, and the remaining 25 presented as radiolucent jaw bone lesions. Diagnostic accuracy of FNAC in our study was 91.6% with 6 false negatives and 1 false positive. Four glandular malignancies and one case of cystic ameloblastoma were misdiagnosed as false negative on cytology.

Conclusion: Cytological features are diagnostic in certain inflammatory lesions of infective etiology and neoplastic conditions like Langerhans cell histiocytosis, lymphoma, plasmacytoma, Ewing's tumor, and squamous cell carcinoma. However, accurate subtyping of giant cell lesions, salivary gland tumors, odontogenic tumors, and cystic lesions may not be always feasible on FNAC. FNAC is highly accurate in early diagnosis of oral and jaw lesions.
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http://dx.doi.org/10.1002/dc.23308DOI Listing
October 2015

Neurocristic Hamartoma With Lymph Node Involvement: A Diagnostic Dilemma.

Am J Dermatopathol 2015 Jul;37(7):e87-92

*Department of Pathology, University College of Medical Sciences and GTB Hospital, Delhi, India; †Department of Dermatology, Ram Manohar Lohia Hospital and PGIMER, Delhi, India; and Departments of ‡Dermatology and STD, and §Surgery, University College of Medical Sciences and GTB Hospital, Delhi, India.

Neurocristic hamartoma (NH) is a rare dermal melanocytic lesion that is formed due to the aberrant development of neural crest-derived melanocytes during their course of migration through the dermis at the time of embryogenesis. Here, we describe a case of NH in a 6-year-old boy who clinically presented with diffuse plaque-type blue nevus on his scalp with a contiguous extension into the cervical region and lymph node involvement. A subcutaneous nodule displaying a marked histological heterogeneity with lymph node involvement is a very unusual and diagnostically challenging presentation of NH. The importance of an accurate diagnosis of NH lies in the fact that malignant transformation can rarely occur within these lesions over an unpredictable time course and remain undetected, rendering clinical management difficult. Although our child had a benign course after a follow-up of 5 years despite lymph node involvement, the possible risk of development of malignant melanoma in such a lesion warrants long-term surveillance. This case report highlights the unusual clinical presentation and histopathological features of this rare entity along with a relevant review of the literature. The present case also underscores the concept that sentinel lymph node involvement in certain melanocytic lesions in children must not be mistaken for malignant melanoma.
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http://dx.doi.org/10.1097/DAD.0000000000000155DOI Listing
July 2015

An unusual large abdominal malakoplakia following trauma: Diagnosed on FNAC.

Diagn Cytopathol 2015 Jun 19;43(6):490-4. Epub 2015 Feb 19.

Department of Pathology, University College of Medical Sciences & GTB Hospital, Delhi, India.

Malakoplakia is a rare chronic granulomatous inflammatory disease, related to immune deficiency and impaired bactericidal macrophage activity. Common sites of involvement include urinary bladder and kidney followed by gastrointestinal tract. We present an unusual case of abdominal malakoplakia diagnosed preoperatively on ultrasound-guided fine-needle aspiration cytology (FNAC). It presented as a large locally aggressive mass with extensive involvement of multiple bowel loops in an 18-year-old boy following blunt trauma to the abdomen. The demonstration of calcified laminated intracytoplasmic Michaelis-Gutman bodies in histiocytes is a reliable diagnostic feature of malakoplakia on FNAC smears, which can guide an appropriate medical management.
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http://dx.doi.org/10.1002/dc.23267DOI Listing
June 2015

Role of FNAC in the diagnosis of intraosseous jaw lesions.

Med Oral Patol Oral Cir Bucal 2015 May 1;20(3):e284-91. Epub 2015 May 1.

Department of Pathology, University College of Medical Sciences & GTB Hospital, University of Delhi, Shahdara, Delhi-110095, India,

Background: FNAC of intraosseous jaw lesions has not been widely utilized for diagnosis due to rarity and diversity of these lesions, limited experience and lack of well established cytological features. Aim of the study was to determine the role of FNAC in the diagnosis of intraosseous jaw swellings.

Material And Methods: 42 patients underwent FNAC over a period of 7 years (2007-2013), of which 37 (88.1%) aspirates were diagnostic. Histopathology correlation was available in 33 cases and diagnostic accuracy of FNAC was calculated.

Results: Lesions were categorized into inflammatory 3, cysts/hamartomas 15 and neoplasms 19. Mandibular and maxillary involvement was seen in 21 and 16 patients respectively. Of these, benign cysts and malignant lesions were commonest, accounting for 27% lesions (10 cases) each. One case of cystic ameloblastoma was misdiagnosed as odontogenic cyst on cytology. Overall, sensitivity and specificity of FNAC were 94.7% and 100% respectively with a diagnostic accuracy of 97.3%. Definitive categorization of giant cell lesions, fibro-osseous lesions, odontogenic tumors and cystic lesions was not feasible on FNAC.

Conclusions: FNAC is a simple, safe and minimally invasive first line investigation which can render an accurate preoperative diagnosis of intraosseous jaw lesions, especially the malignant ones in the light of clinic-radiological correlation.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4464915PMC
http://dx.doi.org/10.4317/medoral.20274DOI Listing
May 2015

Angiokeratoma of vulva mimicking genital warts.

J Obstet Gynaecol India 2014 Dec 12;64(Suppl 1):148-9. Epub 2014 Apr 12.

UCMS & GTB Hospital, Dilshad Garden, Delhi, 110095 India.

Angiokeratoma of vulva is a relatively rare lesion which is occasionally misdiagnosed as melanoma, pyogenic granuloma, seborrheic keratosis, or genital warts. We report a case of vulvar angiokeratomas which were diagnosed and managed as genital warts. All asymptomatic dull red-colored papules over vulva should be subjected to astute clinical and histological examination to diagnose angiokeratoma and differentiate it from other lesions.
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http://dx.doi.org/10.1007/s13224-014-0518-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4228019PMC
December 2014

Role of FNAC in palpable chest wall lesions in developing country.

Diagn Cytopathol 2014 Aug 15;42(8):653-9. Epub 2014 Mar 15.

Department of Pathology, University College of Medical Sciences, Dilshad Garden, Delhi, 110095, India.

Palpable chest wall lesions are unusual manifestation of an underlying thoracic pathology and it is difficult to diagnose them with their diverse spectrum ranging from benign to malignant. Considering the exposure of patient to invasive biopsy/excision and the risk of local complications, FNAC is now being increasingly used in the primary assessment of these lesions. Objectives of this study were to report the spectrum of chest wall lesions in the population of a developing country and evaluating the diagnostic role of FNAC. All the patients who presented with palpable cutaneous or subcutaneous chest wall swelling during a period of January 2003 to August 2010 were reviewed retrospectively. May Grunwald Giemsa and Papanicolaou stained aspirates were examined, along with special stains. Seven hundred seventy-three cases were subjected to chest wall FNAC, of which 726 (93.9%) cases were satisfactory. Age ranged from 1 to 93 years with M:F = 0.92:1. 358 (49.3%) were diagnosed as inflammatory and 368 (50.7%) were neoplastic lesions. Two-hundred thirty four cases (32.2%) were diagnosed as mycobacterial abscess (likely tuberculous). Of the neoplastic lesions, 153 were malignant with carcinomas being predominant (88.2%). Malignant cases comprised of scar site recurrence in breast carcinoma (73 cases), metastatic carcinomas (62 cases), primary sarcomas (eight cases), hematological neoplasms (six cases), and miscellaneous group (four cases). Overall malignant lesions accounted for 21.1% (153/726) of satisfactory chest wall aspirates. FNAC is very useful and simple investigation for early diagnosis of chest wall abscesses, cutaneous metastases from visceral malignancies, and scar site recurrence in breast carcinoma.
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http://dx.doi.org/10.1002/dc.23101DOI Listing
August 2014

Correlation of mitotic indices, AgNor count, Ki-67 and Bcl-2 with grade and stage in papillary urothelial bladder cancer.

Urol J 2014 Mar 3;11(1):1238-47. Epub 2014 Mar 3.

Department of Surgery, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India.

Purpose: To evaluate the mutual inter-relationship of mitotic indices, argyrophilic nuclear organizer regions (AgNOR) count, Ki-67 and B-cell lymphoma 2 protein (bcl-2) in papillary urothelial bladder cancer (pUBC), and their correlation with grade and stage. To establish the cut-off values of these markers to detect high grade and muscle invasive bladder cancer.

Materials And Methods: Fifty-four patients with primary pUBC who underwent transurethral resection / radical cystectomy were analyzed retrospectively. Cell proliferation was assessed by Ki-67 labelling index, mean AgNOR count, mitotic count, mitotic activity index and mitosis/ volume index. Immunohistochemistry was done to see bcl-2 and Ki-67 expression. Correlation of these indices with tumor grade and stage and amongst themselves was assessed. The receiver operating characteristic (ROC) curves were drawn to establish the cut-off values.

Results: We found a strong positive correlation of mitotic indices and Ki-67 with tumor grade (P = .000), stage (P < .05) and bcl-2 (P = .000). AgNOR count correlated positively with the grade (P = .006), mitotic indices and Ki-67 (P = .032) but not with tumor stage and bcl-2. Cytoplasmic bcl-2 immunopositivity was seen in 42.3% of low grade pUBC and 85.7% of high grade pUBC cases (P = .001). bcl-2 positivity was seen in 85% of muscle invasive pUBC as compared to only 52.9% of superficial cases. Ki-67 ≥ 32.5%, ≥ 14 mitoses/10 high power fields (hpf), ≥ 11.20 mitoses/mm2, ≥ 0.75 mitoses/100 tumor cells and AgNOR ≥ 11.55 are 100% specific for high grade bladder carcinoma. Ki-67 ≥ 59% and mitoses ≥ 36.50 per 10 hpf can indicate muscle invasion with 100% specificity.

Conclusion: Cut-off values for Ki-67, mitotic indices and AgNOR can confirm high grade bladder carcinoma in equivocal cases. Ki-67 and mitotic count can serve as potential and reliable indicators of muscle invasion.
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March 2014

Juvenile ossifying fibroma diagnosed on fine needle aspiration cytology: a diagnostic challenge.

Diagn Cytopathol 2015 Jan 3;43(1):75-9. Epub 2014 Mar 3.

Department of Pathology, University College of Medical Sciences, Delhi, India.

Preoperative diagnosis of jaw lesions is not always possible on the basis of clinico-radiological findings alone and needs to be confirmed before attempting any surgical intervention. Fibro-osseous lesions of the jaw comprise a spectrum of diseases which include cement-osseous dysplasia, fibrous dysplasia, and ossifying fibroma. The cytomorphological distinction between these individual entities is difficult. We present a case of maxillary fibro-osseous lesion in an adolescent girl diagnosed and categorized as juvenile ossifying fibroma preoperatively on cytology and confirmed on histopathology. Although aspirates are usually paucicellular in fibro-osseous lesions, certain cytological features if present in cellular cytosmears can offer further categorization and a definitive diagnosis may be possible in light of clinico-radiological correlation.
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http://dx.doi.org/10.1002/dc.23136DOI Listing
January 2015

Comparative evaluation of bone marrow aspirate with trephine biopsy in hematological disorders and determination of optimum trephine length in lymphoma infiltration.

Mediterr J Hematol Infect Dis 2014 Jan 2;6(1):e2014002. Epub 2014 Jan 2.

Department of Pathology, University College of Medical Sciences, Dilshad Garden, Delhi, India.

Introduction: Bone marrow examination is an indispensable diagnostic tool to evaluate neoplastic and non neoplastic hematological diseases.

Aims: To compare bone marrow aspirate with trephine biopsy in hematological disorders. To determine the optimum trephine preprocessing length in lymphoma infiltration.

Methods: Diagnostic comparison was done between simultaneous bone marrow aspirates and trephine biopsies in 449 patients. Biopsies were fixed in formalin, decalcified in 5.5% EDTA and routinely processed. Concordance rates and validity parameters for aspirate were calculated. Three deeper sections of trephine biopsy, cut at 0.1-0.2 mm intervals, were assessed for lymphoma involvement. Proportion of biopsies showing marrow infiltration by lymphoma cells was plotted against trephine length and correlation was assessed.

Results: Aspirate had a high sensitivity for acute leukemia (89.4%) and multiple myeloma (88.5%), moderate for NHL (67.6%) and nonhematopoietic metastases (58.3%) and low for aplastic anemia (38.5%) and Hodgkin lymphoma (5%). Aspirate has no role in granulomatous myelitis and myelofibrosis. Lymphoma positivity increased with trephine length, with maximum positivity (68.9%) seen in 17-20 mm group and no further gain beyond 20 mm. (lymphoma positivity ≤16mm=40.3% and ≥17mm=66.1%, p=0.0011).

Conclusion: Aspirate has a high specificity; its sensitivity depends upon the type of disease. Apart from few conditions, in which aspirate alone is sufficient, biopsy is mandatory in most. Preprocessing trephine length of 17-20 mm examined at multiple deeper levels was found optimal for assessing lymphoma positivity.
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http://dx.doi.org/10.4084/MJHID.2014.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3894839PMC
January 2014
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