Category: Statistics

Indian J Pathol Microbiol. 2023 Oct-Dec;66(4):804-809. doi: 10.4103/ijpm.ijpm_1146_21.

ABSTRACT

BACKGROUND: Cyclic adenosine monophosphate (cAMP) is an intracellular signal transmitter involved in the regulation of melanocyte growth, proliferation, and melanogenesis. R21 is a monoclonal antibody against the soluble adenylyl cyclase (sAC) protein. Various nuclear and cytoplasmic R21 expression patterns in melanocytic lesions have been previously reported. Pan-nuclear staining was defined as specific for melanoma and was found supportive in the assessment of surgical margins.

AIMS: The aim of this study is to evaluate the different expression patterns of R21 immunostain and investigate its effectiveness in the differential diagnosis of cutaneous malignant and benign melanocytic lesions.

SETTINGS AND DESIGN: Fifty invasive cutaneous melanoma and 50 benign melanocytic proliferation were included in the study.

MATERIALS AND METHODS: Paraffin blocks that best reflected tumor morphology were studied via immunohistochemical staining for R21. For all patterns, the cases showing staining in 25% or more tumor cells were considered as positive.

STATISTICAL ANALYSIS USED: Yates’ Chi-square, Pearson Chi-square exact test, Spearman correlation were used.

RESULTS AND CONCLUSIONS: Dot-like Golgi staining was characteristic for nevi (12/50) and seen only in one melanoma. Pan-nuclear staining was striking for melanoma (36/50). This pattern was observed in 2 dysplastic and 3 common melanocytic nevi too. None of the Spitz nevi expressed R21 in pan-nuclear pattern. For the diagnosis of melanoma, sensitivity and specificity of the pan-nuclear expression were 72% and 90%, respectively. Positive and negative predictive values were found as 87% and 76%. R21, a second-generation immunohistochemical marker, can be used in the differential diagnosis of benign and malignant melanocytic lesions.

PMID:38084536 | DOI:10.4103/ijpm.ijpm_1146_21

Indian J Pathol Microbiol. 2023 Oct-Dec;66(4):799-803. doi: 10.4103/ijpm.ijpm_1183_21.

ABSTRACT

CONTEXT: Squalene epoxidase (SQLE) is overexpressed in a variety of tumors, which may play an important role in their tumorigenesis, development, and prognosis.

AIMS: The aim of this study is to investigate the expression of SQLE and explore its clinicopathological significance in gastric cancer.

SETTINGS AND DESIGN: The correlation between its positive expression and the pathological characteristics of patients (such as sex, age, tumor size, survival, tumor differentiation, TNM staging, and lymph node metastasis) was analyzed.

MATERIALS AND METHODS: Immunohistochemical method was used to detect its expression in 107 cases of gastric carcinoma and 34 cases of tumor-adjacent tissues.

STATISTICAL ANALYSIS USED: Counting data were analyzed by Chi-square test. Its overall survival was analyzed by Kaplan-Meier method and log-rank test. Its hazard factors were analyzed by Cox multivariate analysis.

RESULTS: The positive rate of SQLE in gastric cancer is 67.3%, which is higher than that in tumor-adjacent tissues (17.6%), <0.001. Expression of SQLE is closely related to tumor differentiation, TNM staging and lymph node metastasis (P = 0.030, P = 0.009, and P = 0.011, respectively). Furthermore, compared with those low expression of SQLE, the patients of overexpression had worse overall survival by Kaplan-Meier analysis (P = 0.025). Cox multivariate analysis shows that lymph node metastasis, tumor differentiation, SQLE, and TNM staging are independent factors for prognosis of gastric cancer (P = 0.003, 0.020, 0.018, and P = 0.001 respectively).

CONCLUSIONS: SQLE is overexpressed in gastric cancer. It could be used for the diagnosis and prognosis of the gastric cancer patients.

PMID:38084535 | DOI:10.4103/ijpm.ijpm_1183_21

Indian J Pathol Microbiol. 2023 Oct-Dec;66(4):780-785. doi: 10.4103/ijpm.ijpm_1230_21.

ABSTRACT

BACKGROUND: Though the recommended sampled lymph node number in colorectal carcinomas is at least 12, due to shrinkage after preoperative neoadjuvant chemoradiotherapy (NCRT), it can be difficult to attain that number.

AIM: Our aim is to increase the lymph node number by applying alcohol fixation on the formalin-fixed resection materials of the patients that received or not received neoadjuvant therapy and to evaluate the changes in staging due to obtained lymph nodes.

SETTINGS AND DESIGN: Non-randomized controlled trial.

MATERIALS AND METHODS: Lymph node dissection was performed in the resection materials with rectum tumor which were formalin- and afterwards, alcohol-fixed. The number of lymph nodes obtained by both of the methods and status of metastasis were evaluated statistically.

RESULTS: Of the total 76 rectal tumors, 57 had and 19 had not received NCRT. The number of lymph node was adequate in 89.5% cases with no NCRT and in 63.2% cases with NCRT. While no change was observed after the alcohol fixation in the cases fulfilling adequacy criterion among those with no NCRT (p = 1.000), the adequacy rate increased from 63.2% to 87.7% in those with NCRT (p < 0.001). Although statistically insignificant, there was a change in pN stage in eight cases. In three of them, the stage varied from pN0 to pN1c, and in five cases, from pN1a to pN1b.

CONCLUSION: Using solutions as alcohol during fixation might facilitate the identification of metastatic lymph nodes, might change the stage of the disease and therefore, might affect the patient-based therapy.

PMID:38084532 | DOI:10.4103/ijpm.ijpm_1230_21

Indian J Pathol Microbiol. 2023 Oct-Dec;66(4):775-779. doi: 10.4103/ijpm.ijpm_389_22.

ABSTRACT

BACKGROUND: Microscopic examination of cells and tissues requires the preparation of very thin and good-quality sections mounted on glass slides and appropriately stained to demonstrate normal and abnormal structures. Before this step, the tissue must undergo preparatory treatment known as tissue processing. The various stages of tissue processing are dehydration, clearing, impregnation, and embedding, each with a particular duration for proper completion of the process. Xylene is the most frequently used clearing agent whose carcinogenic potential is well documented. Hence, attempts were made to substitute xylene with a biosafe clearing agent. The present study aimed to evaluate and compare the efficacy of hematoxylin and eosin stain (H and E stain) when xylene is completely replaced by turpentine or kerosene oil.

MATERIALS AND METHODS: A total number of 50 tissue samples were taken in the study, which included 40 study samples and 10 controls. All the samples were randomly separated into three groups and routine tissue processing and H and E staining were performed. The result was further subjected to statistical analysis by using Fisher’s exact test. Group-1: Ten tissue samples were processed and H and E staining was done in xylene. Group-2: Twenty tissue samples were processed and H and E staining was done in turpentine oil. Group-3: Twenty tissue samples were processed and H and E staining was done in kerosene oil.

RESULTS: Nuclear staining, cell morphology, and uniformity of staining were better in kerosene sections, while cytoplasmic and clarity of staining of turpentine sections were comparable with xylene sections.

CONCLUSION: Turpentine and kerosene as clearing agents can be used in the future with certain modifications in their concentration and routine staining protocol.

PMID:38084531 | DOI:10.4103/ijpm.ijpm_389_22

Indian J Pathol Microbiol. 2023 Oct-Dec;66(4):758-763. doi: 10.4103/ijpm.ijpm_126_22.

ABSTRACT

BACKGROUND: As the world has been going through a pandemic of coronavirus disease 2019 (COVID-19) for the past two years, a safe and effective vaccine was urgently needed. Vaccination against the disease was launched in India on January 16, 2021 with healthcare workers, frontline workers, and the elderly above 60 years being the first beneficiaries. Vaccines being used in India are Covishield and Covaxin.

MATERIALS AND METHODS: Fifteen healthcare workers (HCWs) who were vaccinated with Covishield or Covaxin were included in the study, and T cell, B cell and antibody response of the HCWs were analyzed. Blood samples collected from every subject were sent for antibody analysis, hematological workup for cell counts, and flow cytometry was performed for various subsets of lymphocytes. Hematological variables in naïve HCWs (who never had any natural infection) and recovered HCWs (those recovered from natural infection) were compared.

RESULTS: Antibody index among recovered HCWs was significantly higher than the naïve HCWs. All the leucocyte parameters showed a higher median value in the recovered group except total leucocyte count (TLC), T helper cell count (Th cell), T helper cell to T cytotoxic cell (Th cell: CTL) ratio and natural killer (NK) cell. But only Th: CTL ratio showed a statistically significant difference.

CONCLUSION: This study shows that the antibody index among individuals who had both vaccination and COVID-19 infection is significantly higher than those who just had vaccination. T helper cell to T cytotoxic cell ratio is lowered in the recovered HCWs as compared to the naïve HCWs and this finding is statistically significant.

PMID:38084528 | DOI:10.4103/ijpm.ijpm_126_22

Indian J Pathol Microbiol. 2023 Oct-Dec;66(4):744-750. doi: 10.4103/ijpm.ijpm_357_22.

ABSTRACT

BACKGROUND: Combined hepatocellular-cholangiocarcinoma (cHCC-CCA) is an uncommon form of primary liver carcinoma. It is heterogenous in terms of morphology, immunohistochemistry, radiology, and clinical features; making it a challenging entity for diagnosis.

AIMS: The purpose of the present study was to evaluate clinicopathological characteristics of patients with cHCC-CCA.

SETTINGS AND DESIGN: Retrospective observational study.

MATERIALS AND METHODS: The patients diagnosed with cHCC-CC were identified from hepatic surgical specimens and were evaluated.

STATISTICAL ANALYSIS: Survival was estimated as per Kaplan-Meier method.

RESULTS: Out of six patients, five had undergone resection while one had liver transplant. Five were male and one was female and the mean age was 52 years. Tumor markers revealed raised serum alfa-fetoprotein and CA19.9 in four and three patients, respectively. Five of the liver specimens were cirrhotic. Diagnosis was predominantly based on tumor morphology. All cases were of Allen and Lisa type B and cHCC-CCA as per WHO (2019) classification. Stem cell features <5% were noted in two cases. Immunohistochemistry for programmed death 1/programmed death ligand 1 (PD1/PDL1) was negative in both the hepatocellular and cholangiocellular components in all six cases. Mismatch repair (MMR) protein expression was retained in two and deficient in four cases. The median follow-up after surgery was 21.3 months (range, 5-46.2 months). Five patients had intrahepatic and/or extrahepatic recurrence on follow-up after surgery. The median recurrence-free survival was estimated at 13.1 months (95% CI 5.67-20.6). Three patients had received salvage treatment. The median overall survival was estimated at 20 months (95% CI 0-45.3).

CONCLUSIONS: The present study highlights the role of morphology in the diagnosis of cHCC-CCA. The choice of locoregional and/or systemic therapy after surgery may be individualized based on the clinicopathological characteristics.

PMID:38084526 | DOI:10.4103/ijpm.ijpm_357_22

Indian J Pathol Microbiol. 2023 Oct-Dec;66(4):740-743. doi: 10.4103/ijpm.ijpm_528_22.

ABSTRACT

BACKGROUND: Non-thrombotic pulmonary embolism, an uncommon entity, is defined as the embolization of tissues, microorganisms, air, or foreign material. One subset in this non-thrombotic category is septic pulmonary embolism (SPE) that refers to embolism of microorganisms with or without a thrombotic mantle into the pulmonary vasculature. This condition is often recognized on the basis of imaging with a clinical correlation. Unfortunately, data regarding the pathological features are meager. This has prompted to review such cases at autopsy.

AIMS: To study the pathological features of SPE at autopsy.

MATERIALS AND METHODS: Ten-year (2012 to 2021) autopsy records of the hospital were retrospectively reviewed. The diagnosis was based on the identification of acute necrotizing pulmonary arteritis with peri-bronchoarterial consolidation. These cases were analyzed with reference to the demographics, clinical characteristics, and pulmonary/extrapulmonary findings at autopsy.

STATISTICAL ANALYSIS: Nil.

RESULTS: According to the inclusion criterion, 19 cases demonstrated the presence of SPE. There were 11 men and 8 women with a mean age of 32.1 years. The major source of infection included infection arising from skin and musculo-skeletal system (11 patients, 59.7%). The common clinical presentation included fever, dyspnea, chest pain, hemoptysis, and altered sensorium. The cause of death was mainly due to septicemia and/or confluent lung consolidations. A large number of bacterial colonies were seen in all; Candida species were also identified in two cases. Other lung findings included diffuse alveolar damage, fresh arterial thrombosis, infarction, arterial pseudo-aneurysms, abscess formation, and pyogenic pleuritis.

CONCLUSION: Presence of an extrapulmonary infection with persistent fever, bacteremia, and pulmonary complaints should raise suspicion for this entity, particularly in resource-poor settings, to prevent grave pulmonary complications.

PMID:38084525 | DOI:10.4103/ijpm.ijpm_528_22

Indian J Pathol Microbiol. 2023 Oct-Dec;66(4):732-739. doi: 10.4103/ijpm.ijpm_178_22.

ABSTRACT

BACKGROUND: The information on the pathophysiology of infection in high-risk contacts of SARS-CoV-2 is limited.

AIMS: The aim of the present study was to assess the various factors and their elucidation in the protection of SARS- CoV-2 infection in high-risk contacts.

SETTINGS AND DESIGN: Cross-sectional descriptive clinical study.

MATERIALS AND METHODS: A total of 136 subjects were recruited in the present study including 100 high-risk subjects and 36 control subjects. Out of 100 high-risk subjects, 44 subjects were found positive for SARS-CoV-2 RNA. Further, absolute blood counts of total T-cells (CD3+), T-helper cells (CD4+), T-cytotoxic cells (CD8+), B lymphocytes (CD19+) Natural Killer (NK) Cells (CD16+, CD56+), cytokines, and other parameters were measured in the samples of study subjects.

STATISTICAL ANALYSIS USED: The continuous variables were analyzed by unpaired ‘t’ test, analysis of variance and ‘Tukey test’ for multiple comparisons.

RESULTS: A significant reduction of total leukocyte counts and absolute lymphocyte count was found in the acute SARS-CoV-2 positive group as compared to control group (<0.05). Interestingly, IL-4 level was significantly elevated in SARS-CoV-2 negative high-risk subjects as compared to control and acute SARS-CoV-2 positive group (p < 0.05). A significant decrease of T-cytotoxic, B-cells, and NK cells were found in acute SARS-CoV-2 positive subjects as compared to control groups.

CONCLUSION: The findings of this study may augment our knowledge about the pathogenesis of SARS-CoV-2 infection that could help in making future strategies to control its infection.

PMID:38084524 | DOI:10.4103/ijpm.ijpm_178_22

Indian J Pathol Microbiol. 2023 Oct-Dec;66(4):727-731. doi: 10.4103/ijpm.ijpm_99_22.

ABSTRACT

BACKGROUND: Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance with the onset or first recognition during pregnancy and is the most common metabolic complication of pregnancy. Significant maternal and fetal complications can result from undiagnosed or inadequately treated GDM.

AIM: To investigate the difference in the expression of the CD-68 marker in the Hofbauer cells (HCs) and their distribution within the villi in the placentas of diabetic and non-diabetic mothers.

MATERIALS AND METHODS: Sixty placentas were included in the study, 30 as controls and 30 from mothers with diagnosed GDM as cases. Full-thickness cross sections of placentas were obtained. Tissue processing was done, followed by haematoxylin and eosin (H&E). A study of CD68 markers (placental macrophages) was done using standard protocols of immunohistochemistry.

STATISTICAL ANALYSIS: Frequencies and percentages of Hofbauer cells (HCs) found in case and control placental tissue were calculated. Student’s t-test was used to compare two groups using SPSS 13.0 software. When P is 0.0001, differences were considered statistically significant.

RESULTS AND CONCLUSION: We studied the distribution and number of fetal macrophages (CD68+) in diabetic and non-diabetic placentas. The immunostained CD68+ cell count was identified to be significantly higher in the GDM placenta. In relation to fetal blood vessels in the villus stroma of the GDM placenta in comparison to control, CD68+ cells were found more frequently. This study shows a significant increase in the number of Hofbauer cells in the placenta of mothers with GDM in comparison to control (P < 0.0001). An increase in macrophages in these placentae might be related to the protective mechanism against inflammation. Further studies are required to investigate the mechanism in detail.

PMID:38084523 | DOI:10.4103/ijpm.ijpm_99_22

Indian J Pathol Microbiol. 2023 Oct-Dec;66(4):720-726. doi: 10.4103/ijpm.ijpm_95_22.

ABSTRACT

BACKGROUND: Bladder cancer, the most common malignancy of the urinary tract is a leading cause of morbidity and mortality. But cystoscopy, which is till now the mainstay of screening, is an invasive, high-cost method with low sensitivity especially for flat lesions.

AIM: To find a non-invasive and effective screening method with liquid-based cytology (LBC) using The Paris System (TPS) and CK20 immunocytochemistry.

MATERIALS AND METHODS: It was a prospective study including the patients with clinical or cystoscopic diagnosis of urinary bladder space occupying lesions (SOL). Both conventional (CC) and liquid-based cytology slides were prepared from urine samples. Slides were evaluated by two trained pathologists and categorized according to TPS guidelines. CK20 immunocytochemistry (ICC) was also performed. Consequent formalin-fixed paraffin embedded sections were blindly examined by another pathologist and was taken as gold standard for comparison.

STATISTICAL ANALYSIS: All the statistical analysis were done using MedCalc version 15.8 [Mariakerke, Belgium: MedCalc Software 2015].

RESULTS: The study included 150 cases with a mean age of 62.4 years. Five cases revealed unsatisfactory smears. Rest of the cases were categorized as the following: 18.1% as NH-GUC, 8% as LGUN, 22.1% as AUC, 15.4% as SH-GUC, 32.9% as HGUC. Kappa value of CC and LBC were strong (0.854). LBC alone showed very low specificity (58%) and PPV (74.8%) which improved on application of ICC (specificity: 97.4%, PPV: 96.3%).

CONCLUSION: We conclude that CK20 ICC offers potential for accurate, non-invasive detection and surveillance of bladder cancer and is a better tool when combined with liquid-based cytology, reported using The Paris System.

PMID:38084522 | DOI:10.4103/ijpm.ijpm_95_22