Objective:
To evaluate the association of tumor budding (TB) with prognostic histomorphological parameters in oral squamous cell carcinoma (OSCC) and to investigate the correlation of TB intensity with epithelial to mesenchymal transition (EMT).
Material and Method:
A total of 200 cases diagnosed as OSCC were selected and their TB status was reviewed using Hematoxylin and eosin (H and E) and Immunohistochemistry (IHC). Correlation with histomorphological prognostic parameters was done. Also, IHC for Vimentin and E-cadherin was performed to look for EMT.
Results:
On H and E examination, TB was observed in 154/200 (77%). About 88/154 (57.14%) cases showed a high TB (>5 TB/10 hpf) which increased to 100/154 (64.9%) cases on IHC staining. The intensity of TB was significantly associated with tumor grade and depth of invasion. It was also significantly associated with reduced expression for E-Cadherin and upregulation of Vimentin establishing a pathogenetic correlation between the TB and EMT.
Conclusion:
Therefore, our results suggest that TB is associated with poor prognosis and histologically represents EMT in OSCC which further adds to the aggressiveness of the tumor.
A large majority of microcytic hypochromic anemia have defects in cellular hemoglobin synthesis due to either iron deficiency or thalassemia trait; both differing in management and prognosis. HPLC and serum iron profile as confirmatory tests are unavailable at health care centers. Blanket therapy of iron supplements is therefore given in all such cases which may cause iron overload in thalassemia cases. Easy to use and cost effective screening methods are desirable. The present study was undertaken to evaluate the diagnostic accuracy of twelve indices to effectively screen cases of thalassemia trait and differentiate them from iron deficiency anemia. Routine samples from the hematology lab with Hb \ 13 gm/dl, MCV \ 80 fl and MCH \ 27 pg were screened. Taking HPLC and serum ferritin as gold standard, out of total 1353 cases, 98 cases of thalassemia trait (HbA2 [ 3.5 on HPLC) and 1102 cases of iron deficiency anemia (serum ferritin \ 12 g/ml) were evaluated using discrimination indices. Diagnostic accuracy for each index was calculated. While few indices showed a sensitivity of 100%, their specificity was low which meant more number of false positive cases. Based on Youden's Index, which measures the diagnostic tests ability to balance sensitivity and specificity, the best three indices in the decreasing order of their efficacy in our study were Ricerca Index (RI), Green and King Index (GKI) and Mentzer Index (MI). MI is considered a reliable index by many clinicians since a long time, however RI and GKI were found to have a better diagnostic accuracy based on our study.
Background: Though Granulosa cell tumors (GCTs) are the most common ovarian sex cord stromal tumors, they are very rare in extra ovarian sites with a handful of cases reported in retroperitoneum, broad ligament, fallopian tube, mesentery and even in the adrenals. Female Adnexal Tumor of probable Wolffian Origin (FATWO), which is also a very rare tumor comes up as its closest differential because of a significant overlap of topographic, morphologic, and immunohistochemical (IHC) features. Case Summary: Present case is of a post-menopausal female who complained of abdominal swelling and post-menopausal bleeding. On CT, she was shown to have a broad ligament mass (fibroid) which was excised. On histopathological reporting the tumor showed mainly the lesser known morphological variants of GCT that lead to difficulty in reaching at the exact diagnosis and a differential of an extraovarian GCT [eGCT] vs. FATWO was given which on IHC finally turned out to be an eGCT. Conclusion: Broad ligament is the site of two very rare tumors of the female genital tract, i.e. eGCT and FATWO which are close mimickers of each other not only on topography, but also on morphology and immunohistochemistry. Hence distinguishing between these two entities may be quite challenging for a pathologist, but aid of certain features can be taken to arrive at the diagnosis many a times.
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