Breast fibroepithelial lesions (FELs) include heterogeneous pathological tumors, involving indolent fibroadenoma (FAD) to potentially aggressive phyllodes tumors (PTs). The current grading system remains unreliable in differentiating these tumors due to histological heterogeneity and lack of appropriate markers to monitor the sudden and unpredictable malignant transformation of PTs. Thus, there exists an imminent need for a marker-based diagnostic approach to augment the conventional histological platform that could lead to accurate diagnosis and distinction of FELs. The high- throughput quantitative proteomic analysis suggested that FAD and PTs form distinct clusters away from borderline and malignant though there exist marked differences between them. Interestingly, over-expression of extracellular matrices (ECM) related proteins and epithelial-mesenchymal transition (EMT) markers in borderline PTs led us to hypothesize a model of deposition and degradation leading to ECM remodeling and EMT acquisition triggering its malignant transformation. We also identified three candidate biomarkers such as MUCL1, HTRA1, and VEGDF uniquely expressed in FAD, borderline, and malignant PTs, respectively, which were further validated using immunohistochemistry. The present work shed light on a brief mechanistic framework of PTs aggressive nature and present potential biomarkers to differentiate overlapping FELs that would be of practical utility in augmenting existing diagnosis and disease management for this rare tumor.
Benign Metastasising Leiomyoma (BML) is defined as the benign proliferation of smooth muscle in organs such as lung or lymph node etc. in a patient with benign uterine smooth muscle tumour. BML is a rare condition. It is more prevalent in women of late childbearing age. The aetiology is unknown. But there are several theories explaining the pathophysiology. 1 Two important theories are: (1) Metastasis from an existing leiomyoma or (2) Multicentric leiomyomatous growths rather than actual metastases. 1 Most of the patients with BML have a history of uterine leiomyoma and/ or myomectomy. Steiner was the first to describe this disease in detail in 1939. 2,3 The most common site of metastasis is lung. Other important sites are paraaortic lymph nodes, abdominal lymph nodes, heart, breasts, liver, oesophagus, trachea, limb, striated muscles, skeletal muscle, skin, scars and central nervous system. 2,4,5,6,7 BML shows positivity for both oestrogen and progesterone receptors.Our case is that of metastasis to pancreas and adrenal, which developed 11 years after hysterectomy for leiomyomas. Literature review did not reveal any such case.A 51-year-old multiparous female was referred from a peripheral hospital for complaints of upper abdominal pain and back ache of 2 months' duration. There was no history of loss of appetite, loss of weight, jaundice, melena or haematuria. She has past history of hysterectomy, which was done 11 years ago. There were no other abnormal menstrual history or relevant past medical history and family history. On examination, abdomen was soft and there was mild tenderness in the epigastrium. All other systems were within normal limits. Radiological investigations of abdomen and pelvis revealed well defined space occupying lesion in the neck of pancreas and right adrenal gland.
BACKGROUND The coronavirus disease 2019 (Covid-19), caused by severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), is a global public health emergency. Data on the effect of coronavirus disease 2019 in pregnancy is limited to few case series. The purpose of this study was to describe the histopathological findings in the placentas of women with Covid-19 during pregnancy. METHODS Pregnant women with Covid-19 who delivered between August 1, 2020 and May 10, 2021, at Government Medical College, Trivandrum were considered for the study. Handling of specimens were carried out using Indian council of medical research (ICMR) guidelines for Covid-19 specimens. Placentas underwent routine clinical examination and processing. Clinical information was retrieved from the medical records. Histological examination was performed and features classified into maternal vascular malperfusion (MVM) and fetal vascular malperfusion (FVM). RESULTS 50 placentas from patients with severe acute respiratory syndrome coronavirus 2 were examined [33 patients delivered at term, 12 patients were preterm, 4 cases were intrauterine fetal demise and 1 case was medical termination of pregnancy (MTP)]. Patients with risk factors for maternal and fetal vascular malperfusion were excluded. 8 cases showed features of maternal vascular malperfusion and 11 cases showed features of fetal vascular malperfusion. Among intra uterine fetal death (IUFD) cases, 2 cases showed features of vascular malperfusion, 7 cases showed low grade acute inflammatory pathology which needs further studies with a greater number of cases to establish relationship with Covid-19 virus. CONCLUSIONS Covid-19 placentas showed increased rates of maternal and fetal vascular malperfusion. These changes may reflect a hypercoagulable state influencing placental pathology and hence an increased antenatal surveillance for women diagnosed with SARS–CoV-2 infection may be warranted. Further studies with control groups are necessary to determine the reproducibility and significance of these initial findings. KEYWORDS Covid-19, Pregnancy, Maternal Vascular Malperfusion, Fetal Vascular Malperfusion.
BACKGROUND Breast cancer is a heterogenous disease, and this term encompasses a variety of entities with distinct morphological features and clinical behaviour. Even the tumours with the same histological type show remarkably different clinical behaviour. And this was found to be due to the aberrations at the molecular level. The objective of this study is to do molecular characterisation of carcinoma breast using surrogate markers. METHODS This is an Observational Diagnostic Study done in the Department of Pathology, Government Medical College, Thiruvananthapuram, during a period of 1 year and 2 months. The study period was from July 2015 to September 2016. During this period all breast cancer cases were taken fulfilling the inclusion criteria. The surrogate markers used in this study were ER, PR, HER2, CK5/6, EGFR & Ki-67. Immunohistochemistry was done at our laboratory using standard controls. The IHC stained slide was read using standard protocols. RESULTS There were 1916 various breast specimens received in the department (Government Medical College, Trivandrum). Of this, 558 specimens were included in our study (satisfying inclusion criteria). In our study, we found that Luminal-A was the most predominant type comprising about 43%, followed by Triple Negative and HER2 Positive types which makes 21%. Least dominant was the Luminal-B type which accounts for only 13% of all breast cancer. The Triple Negative cancers included the basal-like and the Non-Basal-like tumours. Of this 76.85% showed a basal like phenotype (CK5/6 & EGFR +ve) and 23.14% was negative for even basal markers. CONCLUSIONS So, we could conclude that the surrogate markers are efficient enough to be used for subtyping breast carcinoma at molecular level in most institutions for effective "Patient-Tailored Treatment" plans. The panel of 6 markers, as used in our study, has indeed got an upper hand in more accurately and precisely subtyping the "Multifaceted" breast carcinoma.
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