Breast cancer is the most prevalent cancer among women worldwide. The Bloom Richardson grading has been applied to most breast cancers. There are different biologic subtypes of breast cancer according to immunohistochemistry (IHC). Clinically, these subtypes are characterized on the basis of expression of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2). Among them, Triple Negative Breast Cancer (TNBC) which lacks expression of the ER, PR, and HER-2-neu, is most aggressive form. TNBC cases have worse prognosis, require aggressive chemotherapy and are difficult to manage. The advent of neoadjuvant chemotherapy has highlighted the importance of IHC, Breast Ca and TNBC. The aim and objective of this study is to find prevalence of TNBC in Breast Cancer patients in North Maharashtra. This is a 3- Year ambiceptive analysis done to study the incidence of TNBC among Breast Cancer cases. Out of 58 Breast Cancer cases diagnosed in our institute, 30 cases in which IHC was done were included in this study. Postmortem breast cancer cases, core needle biopsies and mastectomies in which IHC was not done were excluded. Among 30 cases studied, 53.33% cases were TNBC, 23.33% cases were ER and PR positive, 10% cases were only HER-2-neu positive, 6.66% cases were only ER positive, 3.33% cases were only PR positive, and 3.33% cases were all three ER, PR and HER-2 neu positive. To conclude, India has considerably higher prevalence of TNBC, as compared to the Western countries. This finding has significant clinical relevance as it may have contributed to poor outcomes in patients with breast cancer in India. With advent of neoadjuvant chemotherapy, use of Modified Bloom- Richardson Grading & IHC is of crucial importance. To understand the determinants of TNBC in India additional research is needed for diagnosis and treatment follow-up.
Hematological manifestations of rheumatoid arthritis (RA) are very common. Blood dyscrasias and other hematological abnormalities are sometimes the rst sign of rheumatic disease. In addition, novel anti-rheumatic biological agents may cause cytopenias. It is crucial that hematologists be aware of these presentations so that they are diagnosed and treated in a timely manner. A logical approach using easily available tests should allow straightforward decisions about diagnosis and therapy to be made, even in patients with some of the rarer hematological manifestations. An observational study was done in RA patients in a tertiary care hospital to study the prevalence and the type of hematologic manifestations from a pathologist's perspective. It was observed that anemia is the most common hematologic nding seen in RA, iron deciency being the commonest cause of anemia, however hemolytic anemia was not seen. Leucocytosis was more common with predominant neutrophilia. Elevated platelet count, bicytopenia and pancytopenia were observed in RA along with raised ESR. Coagulation parameters were however within normal range. Bone marrow ndings (where studied) included tuberculosis and plasma cell neoplasm. Summary: This study was conducted to estimate the proportion of patients with hematological abnormalities as the manifestation of RA and to study the nature of these various hematological problems, so that the empirical treatment can be started and also to inform the clinical rheumatologists about the common and rarer hematological manifestations of RA.
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