Twin pregnancy with a complete hydatidiform mole and coexisting foetus

Coexistence of a viable foetus with a complete hydatidiform mole is a rare entity. Traditionally, termination of pregnancy was recommended because of severe maternal and foetal complications. Here we report a case of a 30 year old G2A1 at 27 weeks with a twin pregnancy with a complete hydatidiform mole and coexisting normal foetus who took home a healthy baby without any persistent trophoblastic disease. This case is presented for the rarity of occurrence and good outcome

Pigmented Lesions Of Nonmelanocytic Origin A Pathological Perspective

Many Pigmented lesions of nonmelanocytic origin can mimic clinically melanocytic lesions including malignant melanoma. A histological interpretation by pathology is helpful in the diagnosis and management of these lesions. The cases during a two year period from January 1999 to December 2000 were reviewed to assess the prevalence of lesions with pigmented variants where histopathological examination helped to confirm/refute the clinical diagnosis. The most common lesion presented with such diagnostic difficulty clinically was seborrhoeic keratosis. Other lesions observed in the study included basal cell carcinoma (12), actinic keratosis (3) and dermatofibrosarcoma protuberans (3). The total number of cases studied was 26. Adherence to strict diagnostic criteria helped towards the correct diagnosis. As 50% of the lesions had pigmentation and 30% had a clinical diagnosis of melanoma, histopathologic evolution was crucial to avoid overdiagnosis of melanoma and to provide reassurance in benign lesions

Vascular endothelial growth factor expression in ovarian serous carcinomas and its effect on tumor proliferation

Introduction: Vascular endothelial growth factor (VEGF), an endothelial mitogen, acts through VEGF receptors (VEGFRs) on the endothelial cells. During neoplastic transformation, it is hypothesized that the tumor expresses VEGF and also acquire VEGF receptor, enabling VEGF action in an autocrine and paracrine manner with varied effects on the tumor growth and progression. This study on ovarian serous carcinomas (OSCs) was done to determine the expression of VEGF and to correlate it with tumor proliferation. Material and Methods: Forty cases of OSCs were included. Immunohistochemistry was performed for VEGF and Ki-67. The VEGF slides were assigned an immunohistochemical score based on the staining intensity (a) and the percentage of tumor cells staining (b). The sum of both (a) and (b) ranged from 0-6. VEGF was considered positive when the score was more than 2. For Ki-67, maximally immunostained areas were selected; 500 cells counted and positive fraction determined. Mann Whitney test was used to determine the difference in the median value of Ki-67 between VEGF positive tumors and VEGF negative tumors. Results: Of the 40 cases, 32 cases had a VEGF score of >2 (positive) and 8 cases had VEGF score <2 (negative). The Ki-67 score ranged from 2-98%, with mean of 51%. The median Ki-67 index was much higher in VEGF positive cases as compared to VEGF negative tumors (57.5% vs. 40%). However, the difference in the two categories did not reach statistical significance (P = 0.45, Mann Whitney test). Conclusion: Ovarian serous carcinomas express VEGF in a significant number of cases (80% in the present study) although its potential mitogenic effect on tumor cells was not confirmed

An audit of cervicovaginal cytology in a teaching hospital: Are atypical glandular cells under-recognised on cytological screening?

<b>Background:</b> Cervical cytology screening for carcinoma of the cervix in India is mainly opportunistic in nature and is practiced mainly in urban centres. The effectiveness of cervical cytology screening depends on various factors. The quality of cervicovaginal cytology service is assessed by various quality indices and by cyto-histology correlation, which is the most important quality assurance measure. <b> Aims:</b> To describe the cervical cytology diagnoses, estimate the quality indices, and evaluate the discrepant cases on cytohistological correlation. <b> Settings and Design:</b> Retrospective observational study from a tertiary care centre in South India. <b> Materials and Methods:</b> Using a database search, all the cervicovaginal cytology reported during the period of 2002-2006 was retrieved and various diagnoses were described. The data was analysed to assess the quality indices. The cytohistologically discrepant cases were reviewed. <b> Results:</b> A total of 10,787 cases were retrieved, of which 98.14&#x0025; were labeled negative and 1.36&#x0025; were unsatisfactory for evaluation. A few (0.81&#x0025;) of the cases were labeled as squamous intraepithelial lesions and 0.38&#x0025; as atypical squamous cells. The ASCUS: SIL ratio was 0.5. Cytohistological correlation revealed a total of ten cases with significant discrepancy. The majority of these were carcinomas that were misdiagnosed as atypical glandular cells. These cytology smears and the subsequent biopsies were reviewed to elucidate the reasons for the discrepancies. <b>Conclusions:</b> The cervical cytology service at our centre is well within the accepted standards. An increased awareness of cytological features, especially of glandular lesions, a good clinician-laboratory communication and a regular cytohistological review would further improve the diagnostic standards

Significance of preoperative thrombocytosis in epithelial ovarian cancer

<b>Background:</b> Reactive thrombocytosis is reported in a variety of solid tumors. A few studies have documented preoperative thrombocytosis in ovarian cancer and identified it as a marker of aggressive tumor biology. <b>Aim:</b> To study the incidence of preoperative thrombocytosis (platelets greater than 400x10) in epithelial ovarian cancer and its association with other clinicopathologic factors. <b> Materials and Methods:</b> Sixty-five patients with invasive ovarian epithelial cancer were retrospectively reviewed and analyzed for the association preoperative thrombocytosis with other clinical and histopathological prognostic factors. Means were analyzed by Student&#x2032;s t test; proportions were determined by Chi-square analysis. <b> Results:</b> Twenty of 65 (37.5&#x0025;) patients had thrombocytosis at primary diagnosis. Patients with preoperative thrombocytosis were found to have lower hemoglobin (P &lt; 0.0002), more advanced stage disease (P &lt; 0.05) and higher grade tumors (P &lt; 0.02). Patients with thrombocytosis had greater likelihood of subpotimal cytoreduction. <b> Conclusions:</b> Preoperative thrombocytosis is a frequent finding in ovarian carcinomas and their association with advanced stage disease and higher grade denotes that platelets play a role in the tumor growth and progression

Estrogen and Progesterone Receptor Expression in Endometrioid Endometrial Carcinomas: A Clinicopathological Study

Background: This study assesses the expressions of estrogen and progesterone receptors in endometrioid carcinomas of the endometrium and their association with established clinicopathological prognostic parameters. Methods: We reviewed the pathology and medical records from 45 cases of endometrioid endometrial carcinomas that were seen from 2006 to 2011 for relevant clinical and histological parameters. Grade I and stage IA tumors were analyzed and compared with higher grades and stages IB- IV. Estrogen and progesterone immunostained slides were analyzed. Results: Patients’ age ranged from 32 to 77 years (mean: 58.13 years). Postmenopausal bleeding was the most common presenting complaint seen in 75.6% of cases. Associated co-morbidities such as diabetes, hypertension and other malignancies were seen in 88% of cases. Myometrial invasion of less than 50% of myometrial thickness was seen in 70.5% cases. There were 40% of tumors classified as FIGO grade 1 and 65.85% were FIGO stage IA. Estrogen and progesterone expressions were seen in 40 (90%) cases, predominantly in FIGO stage I disease. However there was no statistically significant association of estrogen and progesterone expression with any of the clinicopathological prognostic factors. In 23 of the 30 cases that had follow up data, there was no evidence of disease. Of these, only one case was negative for both hormone receptors. Progesterone positivity alone was seen in 87% of cases with no evidence of disease. Conclusions: Nuclear immunostaining with estrogen and progesterone was seen in the majority of cases (90%). Although we have observed a linear increase in progesterone receptor positivity with disease-free survival, this finding needs to be confirmed with additional, larger studies