A retrospective study of post-operative gall bladder pathology with special reference to incidental carcinoma of the gall bladder

Background:Surgical removal of gall bladder for its diseases is common. However, not much is known about the incidence of incidental carcinoma in such patients in our population. Objective of current study was to analyze the different pathological entities of post-operative gall bladder specimen with particular emphasis on incidental carcinoma.Methods:This retrospective study was carried out at a multi-specialty hospital in eastern India from the pathology records for the period from August 2005 to July 2008. The records were analyzed for gender, age group distribution, and pathological types with different histology.Results:Out of 863 records, chronic cholecystitis 51.2% was the most common histology and malignancy was seen in 2.7% (23/863) both pre-operative and post-operative diagnosis. In the neoplastic group incidental carcinoma was diagnosed in 1.9% (17/23) of casesConclusion:Histopathological examination of gallbladder specimen helps to identify non-neoplastic conditions with its complications and also, for the detection of incidental carcinoma. Thorough sampling of all gallbladder specimens is a must to detect focal neoplastic changes

Sinonasal teratocarcinosarcoma - A rare case report

Sinonasal teratocarcinosarcoma is a rare and highly malignant tumor characterized by complex admixture of teratomatous andcarcinosarcomatous component. Here, we report a case of 72-year-old male presented with complaints of epistaxis, recurrent sinusitis,nasal stuffiness, and nasal blockade for past 5-6 months and his computed tomography report revealed as an inflammatory sinonasaldisease with polyposis. Histopathology examination showed fragments of upper respiratory mucosa admixed with fragments oftumor composed of benign and malignant counterparts of both epithelial and mesenchymal components in a variety of histologicpatterns. Also noted were the characteristic squamous epithelium with “fetal-type” clear cells, areas of necrosis, mitotic figure andsheets of undifferentiated blastemal like cells. Immunohistochemistry demonstrated positive staining for cytokeratin, epithelialmembrane antigen, vimentin, synaptophysin, S-100, chromogranin, and CD99. This polyimmunophenotypic characteristic anddiverse histological differentiation provided the basis for the diagnosis. Knowing its highly aggressive behavior, the patient shouldbe treated aggressively and followed up closely

Profiles of gall bladder cancer reported in the hospital cancer registry of a Regional Cancer Center in the North-East India

Background: The incidence of gall bladder cancer (GBC) is very high in this part of the world and there is little information on the descriptive epidemiology of GBC from our population.Methods: A retrospective study on the data set of hospital cancer registry was analyzed. The data set consisted of patient information registered during the period of January 2011 to December 2012. The cases included for the present study were histologically confirmed and radiologically diagnosed cases of GBC. All the cases were retrospectively analyzed for gender, age, urban-rural residences, religion of patients and their educational levels. Descriptive statistics was calculated and Chi square test was done to see the significance differences among categories.Results: A total of 837 cases of GBC were registered, F:M was 2.33, median age in females and males was 54 and 50 years respectively, majority of cases in both the genders were seen in 50-59 years of age, 81.1% patients were from rural areas and 18.8% from urban areas, Chi square on comparison with other cancers showed p<0.05, and there was no major religious and educational pattern of GBC seen in our population.Conclusion: In our population females are at high risk especially past 40 years of age and rural population with its varied environmental, lifestyles and infective agents should be investigated for possible risk factor in the causation of GBC.

Value of urinary microalbumin test in cancer patients with borderline serum creatinine level

Background: Micralbuminuria (MA) is an early sign of incipient renal damage and cancer patients are at the risk of developing kidney diseases due to the use of nephrtoxic chemotherapeutic agents.Methods: A pilot study of urinary microalbumin on 41 patients with borderline serum creatinine was carried out at regional cancer centre of North-East India during the period from June to August 2014. The patients whose serum creatinine levels were between 1.2 mg/dl to 1.3 mg/dl were considered as borderline for the present study. The assays were performed with a dimension Rxl max random access biochemistry analyzer.Results: Out of 41 cases, 22 (53.6%) had MA, M:F = 1.75, 65 years 2 (9.0%) patients were detected with urinary microalbumin. Chi square test showed P = 0.695 (Fisher’s exact P value).  Conclusion: Testing of urinary microalbumin can be done in cancer patients with borderline serum creatinine level in order to identify patients at risk of developing kidney disease.

Correlation between ABO blood groups and various cancers in the north eastern region of India: a retrospective observational study

Background: Numerous studies have documented the association of the ABO blood groups with the occurrence of cancers. Aim was to find out an association of ABO blood groups and various cancers in the North Eastern region of India.Methods: The study was a retrospective observational study that included 1000 cases and 1000 controls. The data included the ABO blood typing of the selected cancer sites which were head and neck, esophagus, stomach, breast, cervix, and ovary. Patients who attended blood bank of regional cancer center with requisition for blood transfusion from 2014 to 2016 were included. The control group was healthy blood donors. Chi square test was used to assess the difference among the compared groups. Risk was calculated by regression analysis. P value <0.05 was considered as statistically significant at 95% confidence interval.Results: Out of 1000 cases and 1000 controls, O blood group were seen in 377 (37.7%) and 395 (39.5%) cases and control, respectively. Significant reduced odds ratio (OR) in non O blood groups for head and neck, esophagus, stomach, and breast was observed. In case of carcinoma cervix, OR for B group was 1.5 (P=0.05), and for blood group A OR=2.2 (P=0.02) was seen in carcinoma ovary.Conclusions: In the studied population, patients with O blood group are at an increased risk of developing head and neck, esophagus, stomach, and breast cancers

Rosai-Dorfman disease in a child with involvement of extra-nodal wrist joint

Rosai-Dorfman Disease (RDD) is a benign condition primarily affecting the lymph nodes. The term sinus histiocytosis with massive lymphadenopathy was first used. There may be extra-nodal presentation of RDD with or without constitutional symptoms. A 10-year-old boy presented with massive bilateral cervical lymphadenopathy which mimicked the diagnosis of lymphoma. We describe here a case of RDD in a child with extra-nodal bone involvement of the wrist joint, its diagnosis by histopathological examination supported by immunohistochemistry and consequent initial management

Ultrasound guided fine needle aspiration cytology of gall bladder mass and mural thickening: a radio-pathological correlation

Background: Carcinoma of the gall bladder (GB) is the commonest malignancy of the biliary tract. Ultrasound (US) guided Fine Needle Aspiration Cytology (FNAC) plays a major role in early detection of malignancy in a suspicious GB lesion. The aim of this study was to evaluate the safety and diagnostic accuracy of US guided FNAC in detection of GB malignancy, to find the association of gall stones with GB malignancy, to study the ultrasound pattern of GB malignant mass and demographic profile of the disease in North eastern India.Methods: The study was conducted retrospectively in Dr. B. Borooah Cancer Institute, Guwahati from January 2016 to December 2017. A total number of 173 patients suspected to have GB malignancy were subjected to US guided FNAC.Results: Total 161 patients were positive for malignancy with significant female majority. There were 124 female (77.02%) and 37 males (22.98%) in the range of 29 to 82 years. Male female ratio was 1:3.5. One was diagnosed as xanthogranulomatous cholecystitis and another was chronic cholecystitis. FNAC remained inconclusive in 2 patients. There was no major procedure related complication. Adenocarcinoma was the most common malignancy found in 146 patients (98.68%). Cholelithiasis was associated in 88.19% of malignant lesions.Conclusions: US-guided FNAC is a safe, highly accurate and reliable procedure for early detection of GB malignancy

Primary cutaneous tuberculosis associated with reactive cervical lymphadenopathy: a case report

Tuberculosis (TB) is a mycobacterial infection that most frequently occurs due to infection with Mycobacterium tuberculosis, an acid-fast bacillus. Cutaneous lesions are relatively uncommon manifestations of TB, occurring in only 1 to 2 percent of all infected patients.  Cutaneous tuberculosis can be acquired either exogenously or endogenously .We present here a case of primary cutaneous tuberculosis with reactive cervical lymphadenopathy.  A high index of suspicion is necessary for prompt diagnosis and treatment

Burden of head and neck cancers in Kamrup urban district cancer registry of Assam, India: a retrospective study

Background: Head and Neck cancers are basically squamous cell carcinomas. It is the fifth most common cancer and the sixth most common cause of cancer mortality in the world. Incidence of cancer as a whole for all sites is fourth highest in Kamrup Urban District (KUD) in males (AAR 185.2) and second highest (AAR 156.3) in females out of all Population Based Cancer Registries (PBCR) in India. Incidence of head and neck cancers in KUD is quite high both nationally and internationally. This retrospective study was carried out to assess the incidence pattern of head and neck cancers in Kamrup Urban District of Assam, India for the period of 2009-2011.  Methods: Cancer is not notifiable in India, so method of collecting information on cancer was active in PBCR Guwahati. A total of 4416 cases were registered during the three years (1st January 2009- 31st December 2011) of which 2508 were male and 1908 female. Statistical analysis used: Age Adjusted Rate (AAR), Crude Rate (CR) and Population pyramids are provided by NCRP-ICMR.Results: The relative proportion of head and neck cancers of total cancer cases registered in KUD constitutes 26% (654/2508) and 12% (225/1908) in male and female respectively. In males cancer of hypopharynx (AAR 14.7) was most common followed by tongue (AAR 9.4) and mouth (AAR 7.7). In females cancer of mouth (AAR 7.6) is most common followed by cancer of tongue (AAR 3.2).Conclusion: The pattern and incidence of various head and neck cancers is of utmost importance for primary prevention and early detection to adequately manage these cancers comprehensively in the community.

Multiple Analytical Approaches Reveal Distinct Gene-Environment Interactions in Smokers and Non Smokers in Lung Cancer

Complex disease such as cancer results from interactions of multiple genetic and environmental factors. Studying these factors singularly cannot explain the underlying pathogenetic mechanism of the disease. Multi-analytical approach, including logistic regression (LR), classification and regression tree (CART) and multifactor dimensionality reduction (MDR), was applied in 188 lung cancer cases and 290 controls to explore high order interactions among xenobiotic metabolizing genes and environmental risk factors. Smoking was identified as the predominant risk factor by all three analytical approaches. Individually, CYP1A1*2A polymorphism was significantly associated with increased lung cancer risk (OR = 1.69;95%CI = 1.11–2.59,p = 0.01), whereas EPHX1 Tyr113His and SULT1A1 Arg213His conferred reduced risk (OR = 0.40;95%CI = 0.25–0.65,p<0.001 and OR = 0.51;95%CI = 0.33–0.78,p = 0.002 respectively). In smokers, EPHX1 Tyr113His and SULT1A1 Arg213His polymorphisms reduced the risk of lung cancer, whereas CYP1A1*2A, CYP1A1*2C and GSTP1 Ile105Val imparted increased risk in non-smokers only. While exploring non-linear interactions through CART analysis, smokers carrying the combination of EPHX1 113TC (Tyr/His), SULT1A1 213GG (Arg/Arg) or AA (His/His) and GSTM1 null genotypes showed the highest risk for lung cancer (OR = 3.73;95%CI = 1.33–10.55,p = 0.006), whereas combined effect of CYP1A1*2A 6235CC or TC, SULT1A1 213GG (Arg/Arg) and betel quid chewing showed maximum risk in non-smokers (OR = 2.93;95%CI = 1.15–7.51,p = 0.01). MDR analysis identified two distinct predictor models for the risk of lung cancer in smokers (tobacco chewing, EPHX1 Tyr113His, and SULT1A1 Arg213His) and non-smokers (CYP1A1*2A, GSTP1 Ile105Val and SULT1A1 Arg213His) with testing balance accuracy (TBA) of 0.6436 and 0.6677 respectively. Interaction entropy interpretations of MDR results showed non-additive interactions of tobacco chewing with SULT1A1 Arg213His and EPHX1 Tyr113His in smokers and SULT1A1 Arg213His with GSTP1 Ile105Val and CYP1A1*2C in nonsmokers. These results identified distinct gene-gene and gene environment interactions in smokers and non-smokers, which confirms the importance of multifactorial interaction in risk assessment of lung cancer