Original Article - Classification of thymic neoplasms: Observations on the WHO 1999 classification based on 56 cases

Background: The World Health Organization (WHO), in 1999, laid down histological criteria for thymoma sub-classification (Type A, AB, B1, B2, B3 and C). This study aims to assess the ease of application of this classification and to evaluate any relationship with the clinical stage. Material and Methods: A total number of 56 cases from the Tata Memorial Hospital, Mumbai were studied. Results: The age of the patients ranged from 17 to 71 years (mean 48.6 years) and the male to female ratio was 3:1. The number of cases in each of the WHO tumour types were Type A-10, Type AB-20, Type B1-6, Type B2-11, Type B3-3, and Type C-6 cases. Invasive tumours were seen in 25%, 23%, 75%, 60%, 100% and 100% of Type A, AB, B1, B2, B3 and C tumours, respectively. Conclusion: It can be concluded that the WHO Classification is histologically reproducible and there is a good correlation between the WHO subtypes and tumour invasiveness

A study of histopathological features of medullary carcinoma of the thyroid: Cases from a single institute in India

BACKGROUND: The microscopic features of medullary carcinoma have been described in world literature, together with its behavior and molecular biology. However, no large study has been reported from India. AIMS: This study aims to analyse the clinical, and especially the pathological features of medullary carcinoma of the thyroid, and the surrounding thyroid. MATERIALS AND METHODS: In this study a total of 234 cases of medullary thyroid carcinoma (MTC) were gathered over a period of 3 decades. The clinical presentation, the microscopic features and the clinical outcome were analyzed. RESULTS: MTC was found to be twice as common in men as in women and for some reason it occurred 10 years earlier in women. The histology revealed certain interesting features like the presence of apoptosis in over half of the tumors, in addition to the other common and not so common histological findings (encapsulated variant, small cell variants, follicular pattern, rosettes, oncocytic change, osteosarcoma-like pattern, and cribriform pattern). The adjacent thyroid in about 19% of the cases showed optically clear nuclei in the follicles that were close to the tumor cells. These features were similar to those seen in papillary thyroid carcinoma. CONCLUSIONS: The thyroid adjacent to MTC showed nuclear changes, which are also found in papillary carcinoma of the thyroid. The occasional concurrent occurrence of these two tumors and the involvement of the RET gene in both medullary and papillary carcinomas, makes this observation worth discussing and studying further

Original Article - A study of histopathological features of medullary carcinoma of the thyroid: Cases from a single institute in India

BACKGROUND: The microscopic features of medullary carcinoma have been described in world literature, together with its behavior and molecular biology. However, no large study has been reported from India. AIMS: This study aims to analyse the clinical, and especially the pathological features of medullary carcinoma of the thyroid, and the surrounding thyroid. MATERIALS AND METHODS: In this study a total of 234 cases of medullary thyroid carcinoma (MTC) were gathered over a period of 3 decades. The clinical presentation, the microscopic features and the clinical outcome were analyzed. RESULTS: MTC was found to be twice as common in men as in women and for some reason it occurred 10 years earlier in women. The histology revealed certain interesting features like the presence of apoptosis in over half of the tumors, in addition to the other common and not so common histological findings (encapsulated variant, small cell variants, follicular pattern, rosettes, oncocytic change, osteosarcoma-like pattern, and cribriform pattern). The adjacent thyroid in about 19% of the cases showed optically clear nuclei in the follicles that were close to the tumor cells. These features were similar to those seen in papillary thyroid carcinoma. CONCLUSIONS: The thyroid adjacent to MTC showed nuclear changes, which are also found in papillary carcinoma of the thyroid. The occasional concurrent occurrence of these two tumors and the involvement of the RET gene in both medullary and papillary carcinomas, makes this observation worth discussing and studying further

RISK FACTORS FOR COPD EXACERBATION DURING HOSPITALIZATION AND THEIR IMPACT ON INPATIENT MORTALITY

INTRODUCTION: Although the risk factors for COPD exacerbation have been identified, risk factors associated with COPD exacerbation during hospitalization and their impact on inpatient mortality remain to be studied. We conducted a retrospective data analysis to identify the most common admitting diagnoses among COPD patients who experienced an exacerbation during their hospitalization and studied their impact on inpatient mortality. METHODS: Data from Health Care Utilization Project\u27s National Inpatient Sample (NIS) 2019 were analyzed. The ICD-10 codes were used to identify the admitting diagnosis for all discharges with a secondary diagnosis of COPD exacerbation. We omitted discharges for patients under the age of 40 to avoid misclassification. The Rao-Scott Chisquare test was used to compare categorical variables. The odds ratios were calculated using multivariable logistic regression. National estimates were based on sample weights. RESULTS: A total of 1,018,715 discharges had a secondary diagnosis of COPD exacerbation. The top admitting diagnoses were respiratory failure (20.4%), septicemia (17.9%), heart failure (HF) (14.4%), pneumonia (12.7%), bronchiectasis (4.8%), acute myocardial infarction (AMI) (2.2%), influenza (2.1%), cardiac dysrhythmias (1.9%), and aspiration pneumonitis (1.7%). All-cause mortality for all discharges with COPD exacerbation was 3.9%. Among discharges that experienced COPD exacerbation during hospitalization, higher mortality was noted for admitting diagnosis of septicemia (7.2%), AMI (5.6%), and aspiration pneumonitis (5.6%) (p\u3c 0.0001 for all). In regression analysis, admitting diagnoses of septicemia (aOR:1.8;95% CI: 1.7-1.9; p\u3c 0.0001) and AMI (aOR:1.3; 95% CI: 1.2- 1.5;p\u3c 0.0001) were associated with higher odds of inpatient mortality. CONCLUSIONS: The most common admission diagnoses associated with COPD exacerbation during hospitalization were respiratory failure, septicemia, heart failure, and pneumonia. In addition, patients admitted for septicemia and AMI who experienced COPD exacerbation had a higher likelihood of inpatient mortality. COPD patients admitted for septicemia and AMI should be closely monitored for early identification of COPD exacerbations

Intraosseous myoepithelioma: A rare, distinct tumor entity

Primary musculoskeletal myoepithelial tumors (METs) are distinctly rare tumors and are being increasingly recognized as a result of improved diagnostic criteria and objective confirmation with immunohistochemical markers, including epithelial markers. Recent studies have unraveled distinct molecular mechanisms underlying these tumors. Herein, we present our second diagnosed case of an intraosseous MET that occurred in the tibia of a 37-year-old lady. The case is discussed with regards to current clinicopathological perspectives on these rather uncommon tumors, including our personal experience

BURDEN OF SUBSTANCE USE AMONG U.S. POPULATION WITH CHILDHOOD AND ADULTONSET ASTHMA

INTRODUCTION: Asthma is the most common chronic childhood disease. Substance use is associated with increasing severity of asthma symptoms and a major risk factor for status asthmaticus or asthma-related death. In the last decade, there is no nationwide literature showing prevalence of various substance use among asthmatics. Aim of this study is to identify the burden of substance use in US population with childhood onset asthma (COA) and adult-onset asthma (AOA) METHODS: We conducted a retrospective cross-sectional study using NHANES data from 2013 to 2018. AOA and COA assessed using questionnaire MCQ010 and MCQ025. Drug use variables were summarized and univariate analysis was performed using Mann Whitney test and Chi-square test to determine association between asthma and drug use. Mix-effect multivariate survey logistic regression analysis was performed to identify predictors of AOA and COA. RESULTS: Out of a total of 402,167 participants, prevalence of COA was 10.51% (42,275) and AOA was 4.79% (19,245). Prevalence of methamphetamine use (42.03% vs 41.99% vs 39.34%, p\u3c.0001), was higher in AOA, than COA and no asthma. Smoking (21.41% vs 18.12% vs 16.09%, p\u3c.0001), high alcohol intake (50.98% vs 44.02% vs 47.33%, p\u3c.0001), cocaine use (97.14% vs 93.53% vs 95.30%, p\u3c.0001), marijuana use (62.22% vs 55.42% vs 51.67%, p\u3c.0001) and heroin use (18.89% vs 18.74% vs 14.50%, p\u3c.0001) were more prevalent in COA than AOA and no asthma. In regression analysis, AOA was associated with higher prevalence odds of marijuana use (aOR 2.53, 95%CI 2.53-2.54, p\u3c.0001) and heroin use (1.82, 1.82-1.83, p\u3c.0001) whereas COA was associated with higher prevalence odds of smoking (1.19, 1.19-1.19, p\u3c.0001), alcohol abuse (1.06, 1.06-1.06, p\u3c.0001), cocaine use (67.99, 67.67-68.31, p\u3c.0001) and methamphetamine use (1.67, 1.67-1.67, p\u3c.0001). CONCLUSIONS: Substance use is common in childhood and adult asthmatics. Given the high risk of association between asthma and substance use, policy makers and community programs should be built in a way to help improve the compliance in asthma care and decrease rates of substance use disorders in this population. Our study was limited with recall bias, absence of causality, absence of severity and follow up of asthma, and quantification of substance use

Coexistence of KRAS mutation with mutant but not wild-type EGFR predicts response to tyrosine-kinase inhibitors in human lung cancer

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