Objectives Prognostic significance of stromal tumor infiltrating lymphocytes; sTILs is evaluated to identify a responsive subset of TNBC in an Indian cohort of breast cancer patients. Methods A retrospective cohort of breast cancer patients from a single onco-surgeon breast cancer clinic treated with uniform treatment strategy across is evaluated for sTILs. FFPE tissue of primary tumor of invasive breast carcinoma are collected with ethical approvals. Tumor sections blinded for subtypes are stained with H&E and scored for sTILs by a pathologist following Immuno-Oncology TILs working groups scoring guidelines. Results Analysis of 144 primary breast tumors for sTILs scores re-enforces significantly higher infiltration in TNBC tumors than HER2+ve and ER+ve tumors. Higher sTILs scores co-relate with gradually incremental pathological response to therapy specifically in TNBC subset and with better disease-free survival outcomes. Within TNBC, older and post-menopausal patients harbor higher scores of sTILs. Conclusion Despite a small cohort of breast cancer patients, TNBC subtype reflected significantly higher scores of sTILs with better response to therapy and disease-free outcomes as compared to other breast cancer subtypes. A larger number of breast cancer patients from an Indian cohort will strengthen the findings to establish sTILs as a marker to identify a responsive subset of TNBC.

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Background: Renal transplant patients in JIPMER undergo a systematic post-transplant follow-up in order to identify any new co-morbidity as well as detect abnormalities in graft function at the earliest and institute appropriate management. The renal allograft biopsy is one of the principal tools used by the nephrologists to diagnose any such episodes of graft dysfunction.Objective: The aim of this study were to identify the chief causes of end stage renal disease and co-morbid conditions, to study the number of biopsies taken for each patient as a function of time and to assess the usefulness of an allograft biopsy.Materials & Methods: A total of 120 renal transplants were carried out in JIPMER in a period of 5 years from March 2012 to March 2017. 78 patients who underwent renal allograft biopsies were included in the study, serial measurement of serum creatinine and change in dose of immunosuppressant were recorded and correlated with the biopsy findings.Results: In exactly two-thirds of the patients (52) the cause for ESRD (End-Stage Renal Disease) could not be determined; in the remaining 26 secondary FSGS was the leading cause for ESRD. Systemic Hypertension (59%) was found to be the major co-morbidity in renal transplant patient, 82% patients underwent renal biopsy within the first 3 months after transplant and elevation in serum creatinine was the indication for most of the biopsies. A large fraction of the patients (64%) improved upon instituting appropriate treatment measures based on biopsy findings in correlation with other clinical and laboratory data. Conclusion:Our findings suggest that for our setting renal allograft biopsy is the major modality of diagnosing the cause for derangement in graft function, especially in the early post-transplant period. Management course decided on the basis of biopsy findings results in improved patient outcome in a majority of cases.

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Eyelid metastases are relatively rare, and they can occasionally lead the way to an unknown primary malignancy elsewhere. The authors report a case of 65-year-old diabetic gentleman with a right-sided eyelid lesion that was present for 1 month and turned out to be a presenting sign of a previously undiagnosed pancreatic adenocarcinoma. The eyelid mass had been treated elsewhere for 2 weeks for a presumed infectious lesion, using systemic antibiotics and was then referred to us in view of no response. The right-sided lesion involving the subbrow and eyelid area was tender and showed surface ulceration, as well as induration with scabbing. An incision biopsy of the mass was performed followed by computed tomography imaging. Histopathologic findings were suggestive of adenocarcinoma of a probable secondary origin. A whole-body positron emission tomography (PET) scan along with raised serum tumor markers (carcinoembryonic antigen 125 [CEA 125] and carbohydrate antigen 19-9 [CA-19-9]) was helpful in diagnosing a stage IV probable primary carcinoma of the pancreas, with metastasis to paraaortic nodes, liver, lungs, and eyelid. After a detailed systemic work-up, the patient was put on systemic chemotherapy with carboplatin and capacitabane. He responded well to the treatment. At a follow up of 12 months, upon clinical examination and PET imaging, he showed a complete resolution of eyelid, lung, and liver disease and a near-complete resolution of the pancreatic lesion. This case delineates the role of a prompt biopsy and histopathologic evaluation of an atypical eyelid mass in diagnosing asymptomatic primary malignancy.