Analysis of cytology of germ cell tumors with histopathological and serum tumor marker correlation: a tertiary care centre experience

Background: Germ cell tumors are found primarily in children and young adults usually arising from gonads and rarely from extragonadal sites like mediastinum, retroperitoneum, pineal gland and sacrococcygeal region. Involvement of lymphnodes or bodycavities (pleural/peritoneal cavity) is usually associated with metastatic disease.Methods: This is a retrospective analysis of 96 cases of germ cell tumor for which a primary diagnosis of germ cell tumor was given by cytology from primary and metastatic sites. The study period is from January 1993- December 2013. Pap stained and Romanowsky stained smears and cell block sections (10cases) were studied. Serum tumor markers (LDH, BetaHCG and AFP) were correlated in all cases along with histopathology in available cases.Results: Among 96 cases 34 were diagnosed as seminoma/dysgerminoma,10 as embryonal carcinoma,9 as yolk sac tumor,6 as teratoma and 2 as mixed germ ell tumor. In 25 cases the cytology report was suggestive of germ cell tumor and in 10 cases malignant cells favouring germ cell tumor. Among the 10 cases the serum markers were high in six of the cases and the clinician after discussing with the pathologist treated them as germ cell tumors. 47 cases had histopathology and it correlated with cytology except in 14 cases which showed no residual neoplasm after chemotherapy. 15 cases expired immediately after the diagnosis or during the course of treatment 12cases were lost to follow up. Rest of the cases have completed the treatment. In our study the serum tumor markers showed a sensitivity of 92.75% and positive predictive value was 71.11%.Conclusions: The study highlights the importance of picking up the diagnosis of germ cell tumors by fine needle aspiration cytology so that patient can get an early diagnosis, effective treatment and a multidisciplinary approach is essential in diagnosing a difficult case of germ cell tumor. Previous history, radiology, clinical features and serum tumor markers all aid in the cytological diagnosis of germ cell tumor

Collision tumor of metastatic carcinoma and lymphoma in the bone marrow: Report of an extremely rare and interesting case and review of the literature

Collision tumors are composed of two or more histologically distinct tumor components occurring at the same anatomic location. Collision tumors composed of metastatic carcinoma and lymphoma in the bone marrow is an extremely rare occurrence which is not yet reported in literature. We are reporting a case of 61 year old male patient diagnosed as grey zone lymphoma in the oral cavity (B cell lymphoma unclassifiable with features intermediate between DLBCL and Burkitt lymphoma) and bone marrow showing collision tumor composed of metastatic carcinoma and lymphoma

MicroRNA-31 is required for astrocyte specification

Previously, we determined microRNA-31 (miR-31) is a noncoding tumor suppressive gene frequently deleted in glioblastoma (GBM); miR-31 suppresses tumor growth, in part, by limiting the activity of NF-κB. Herein, we expand our previous studies by characterizing the role of miR-31 during neural precursor cell (NPC) to astrocyte differentiation. We demonstrate that miR-31 expression and activity is suppressed in NPCs by stem cell factors such as Lin28, c-Myc, SOX2 and Oct4. However, during astrocytogenesis, miR-31 is induced by STAT3 and SMAD1/5/8, which mediate astrocyte differentiation. We determined miR-31 is required for terminal astrocyte differentiation, and that the loss of miR-31 impairs this process and/or prevents astrocyte maturation. We demonstrate that miR-31 promotes astrocyte development, in part, by reducing the levels of Lin28, a stem cell factor implicated in NPC renewal. These data suggest that miR-31 deletions may disrupt astrocyte development and/or homeostasis

Status of marine fisheries of Kerala

Kerala with a coastline of 590 km is a significant contributor to the total marine fish landings of the country. A picture of the marine fisheries sector in Kerala during the years 2005 and 2010 is presented below (Table 1). With a continental shelf of about 40,000 km2 marine fisheries plays a vital role in the livelihood of the people

Haploinsufficiency of NFKBIA reshapes the epigenome antipodal to the IDH mutation and imparts disease fate in diffuse gliomas

Genetic alterations help predict the clinical behavior of diffuse gliomas, but some variability remains uncorrelated. Here, we demonstrate that haploinsufficient deletions of chromatin-bound tumor suppressor NFKB inhibitor alpha (NFKBIA) display distinct patterns of occurrence in relation to other genetic markers and are disproportionately present at recurrence. NFKBIA haploinsufficiency is associated with unfavorable patient outcomes, independent of genetic and clinicopathologic predictors. NFKBIA deletions reshape the DNA and histone methylome antipodal to the IDH mutation and induce a transcriptome landscape partly reminiscent of H3K27M mutant pediatric gliomas. In IDH mutant gliomas, NFKBIA deletions are common in tumors with a clinical course similar to that of IDH wild-type tumors. An externally validated nomogram model for estimating individual patient survival in IDH mutant gliomas confirms that NFKBIA deletions predict comparatively brief survival. Thus, NFKBIA haploinsufficiency aligns with distinct epigenome changes, portends a poor prognosis, and should be incorporated into models predicting the disease fate of diffuse gliomas

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

A facile three-component reaction of dicarbomethoxycarbene, aldehydes and o-quinones: synthesis of novel spiro-dioxolanes

Successful trapping of the carbonyl ylides generated from dicarbomethoxycarbene and aldehydes with 1,2-diones is described