Histopathological study of adrenocortical carcinoma with special reference to the Weiss system and TNM staging and the role of immunohistochemistry to differentiate it from renal cell carcinoma

Background: Adrenocortical carcinomas (ACC) are rare tumors with an incidence of 1-2/million/year. They account for 0.05-0.2% of all malignancies. Aims and Objectives: This study was aimed to evaluate the Weiss system to diagnose ACCs and to compare it with TNM staging. The role of immunohistochemistry (IHC) was also evaluated to differentiate ACC from other differential diagnoses especially, renal cell carcinoma (RCC). Materials and Methods: A total of 10 ACCs were included from April, 2000 to March, 2012. All the relevant information like weight, tumor size, gross features was recorded. Multiple sections were taken for histologic examination. Immunomarkers like vimentin, synaptophysin, Melan-A, calretinin, inhibin, EMA, cytokeratin, and Ki-67 were used. Results: Out of 10 cases of ACCs (diagnosed by the Weiss system), the tumors were in TNM stage I (1 case), stage II (2 cases), stage III (5 cases), and stage IV (2 cases). The Weiss score in stages I-IV was 4; 5-7; 6-8; and 5-9 respectively. ACCs were positive for vimentin, inhibin, Melan-A, calretinin and negative for EMA and cytokeratin. Proliferative index (Ki-67/MIB-1) was ≥ 20 % (20-65%). Conclusion: Both the Weiss system and TNM staging are useful in predicting the malignant behavior and prognosis of ACC. Weight and tumor size, though originally not included in the Weiss system, are also important parameters. In lower stages (stages I and II), the Weiss score is low (4-7) while the score is high (6-9) when the tumor is in higher stages (stages III and IV). IHC plays a vital role to confirm the diagnosis and to exclude the possibility of RCC

Malignancy and autoimmunity : causally or casually related?

Coexistent malignancy and autoimmune rheumatic disease requires the physician to explore a causal link. Rheumatic manifestations mimicking autoimmune diseases can precede, accompany or follow the onset of neoplastic disease. Identified links include shared environmental factors such as smoking with rheumatoid arthritis and lung cancer, and a common disease such as inflammatory bowel disease with spondyloarthritis and colon cancer. Long-term and often severe immune stimulus of autoimmune disease has been linked to malignancy of the immune system, and paradoxically, long-term suppression of the immune response as exemplified in organ transplantation, is also linked to risk of subsequent malignancy

Malignant lymphoma in Eastern India: A retrospective analysis of 455 cases according to World Health Organisation classification

Background: Malignant lymphoma (ML) is one of the most common cancers and is most prevalent in developed countries. The distribution of different subtypes of ML varies in the different geographical locations according to World Health Organization (WHO) classification. Aims and Objectives: The study was aimed to analyze different patterns of ML in Eastern India and to compare it with other geographical locations. Materials and Methods: Four hundred and fifty five patients of two large hospitals in Eastern India were included over a period of four years and were categorized according to WHO classification, using morphology and immunohistochemistry (IHC). Results: There were 347 (76.3%) non Hodgkin lymphomas (NHL), and 108 (23.7%) Hodgkin lymphomas (HL). Diffuse large B cell lymphoma (DLBCL) was the most common of the NHL type (35.2%) followed by the follicular lymphoma (19.3%). B cell lymphoblastic lymphoma was the least common type of NHL (1.4%). Mixed cellularity (33.3%) and nodular sclerosis (26.9%) were the two most common type of HL. Childhood lymphoma comprised of 12.5% of all ML. T cell NHL and HL were the common lymphomas in this age group. Conclusion: Incidence of follicular lymphoma is lower compared to western studies and mixed cellularity is most common subtype of HL unlike nodular sclerosis subtype in western world. Burkitt′s type NHL though is the most common subtype of childhood ML in many studies but in our study T cell NHL is the most common type of childhood ML

Immunocytochemistry: It′s role in diagnosis of undifferentiated neoplasms by fine needle aspiration cytology

Background: Fine needle aspiration cytology (FNAC) is a rapid, cheap and reliable method for diagnosing any accessible lesion. However, there remains a group of malignant undifferentiated neoplasms, which can only be categorized with the help of immunocytochemistry (ICC). The categorization is important due to their vast difference in treatment and prognosis. Aim: To evaluate the effectiveness of ICC in categorizing the undifferentiated neoplasms diagnosed on routine FNAC smears. Materials and Methods: Thirty six cases of undifferentiated neoplasms were selected from a group of total 78 cytology cases of undifferentiated tumors from different sites like head and neck, lymph node, soft tissue etc. These were then subjected to a panel of ICC markers based on the clinical and cytomorphological features. Results: Of these, 21 were simple, ten were computerized tomography guided and five were ultrasound guided FNACs respectively. All the 78 cases were confirmed by histopathological examination and immunohistochemistry. Of the 36 cytological cases, final diagnosis correlated in 30 cases histologically. The six cases were incorrect either due to inadequate material on the smears (three cases) or false positive staining (three cases). Conclusions: Our study found that ICC is a sensitive and specific method for early and definitive diagnosis of undifferentiated neoplasms. However, selection of antibodies must be judicious to make it cost effective

TGA/DSC study to characterise and classify coal seams conforming to susceptibility towards spontaneous combustion

Thermogravimetric analysis/differential scanning calorimeter (TGA/DSC) technique along with basic coal characteristics study is carried out for eighty coal samples of Indian coalfields, to determine spontaneous combustion propensity behaviour of coal. TGA study of coal samples indicates that there is an increase in the mass of coal samples in the temperature range 150–350 ℃, which may be due to oxygen adsorption and absorption. The correlation and principal component analysis states that the component of proximate analysis (Mad, VMd, FR, and VR) have an acceptable correlation with the TGA experiments results i.e., Tgsh and Tgign. Multiple fixed nonlinear regression analysis shows that thermogravimetry (TG) experiment results Tgign may be the best index to categorise/classify the coal as per their susceptibility towards spontaneous combustion. The authors proposed four groups of classification as per their propensity towards spontaneous combustion depending upon the moisture (Mad), volatile matter (VMd), and TG ignition temperature from differential thermogravimetric (DTG) curve (Tgign) using hierarchal clustering analysis. The coal samples of different seams from Indian coalfield may be classified into four different clusters, viz. very highly/extremely susceptible (Tgign 320 ℃). The field observations and TGA/DSC experiment results with the following statistical analysis substantiate a similar assessment