Mall Mania in India: Changing Consumer Shopping Habits

For the current generation of consumers, the meaning of shopping has changed. It is not just a mere necessity, as it was earlier, but much more than that. The factors that affect store choice and draw customers to the shopping centre include space, ambience, and convenience and moreover an array of choice under one roof. The growth of integrated shopping malls, retail chains and multi-brand outlets is evidence of consumer behaviour being favourable to the growing organized segment of the business. Space, ambience and convenience are beginning to play an important role in drawing customers. Malls, which are now anchored by large outlets such as Westside and Lifestyle and are resided by a lot of Indian and international brands, are also being seen as image benchmarks for communities. Thus, this dissertation aims at studying the changing shopping trends of consumers in the Indian economy. For doing this, semi structured interviews from the Indian retailers as well as consumers have been used as a tool. Various factors on which the Indian consumers base their choice of going to the shopping mall or the unorganized markets have been analyzed in this research

Progressive Multifocal Leukoencephalopathy Presenting as Transverse Myelitis

Progressive multifocal leukoencephalopathy (PML) is a rare demyelinating disease caused by reactivation of JC virus affecting typically subcortical and periventricular white matter of immunocompromised hosts (HIV infection, hematologic malignancies). We present an unusual case of PML predominantly affecting cervical spinal cord and brainstem in an immunocompetent host. A 65-year-old female presented with vertigo, hemiparesis and right sided weakness. MRI of the brain without contrast showed T2 signal abnormality involving the medulla extending into the upper cervical cord to C2-C3 level. Further work up showed positive ANA, elevated SS-A/Ro and SS-B/La antibodies consistent with Sjögren Syndrome. The patient deteriorated rapidly, expiring eight days after onset of acute respiratory failure. Autopsy showed multifocal white matter lesions with perivascular lymphocytic cuffing, microglial nodules, influx of activated microglial and numerous oligodendroglial nuclei with ground glass inclusions in the spinal cord, brain stem, cerebellum and cerebral hemisphere. The inclusions were immunoreactive with Simian virus-40 (SV-40), P53 and MIB-1 immunostains. The distributions of the lesions were predominantly in the medulla and upper cervical cord, correlating with pre-mortem MRI. A rare subset of PML cases can occur in association with connective tissue disorders (Sjögren in this case), Systemic Lupus Erythematosus (SLE) being the most common. Predominantly spinal involvement by PML is also rare. PML should be considered in the differential diagnosis of spinal cord/brainstem lesions, particularly in the patients with connective tissue disorders. This highlights the importance of post-mortem examination in selected cases without definite clinical diagnosis.https://scholarlycommons.henryford.com/merf2019caserpt/1068/thumbnail.jp

Unusual presentation of fibrolamellar carcinoma: A rare case report

Fibrolamellar hepatocellular carcinoma (fHCC) is a distinct type of first time used hence- hepatocellular carcinoma affecting particularly young patient with no gender predilection. However, there is increasing evidence of occurrence of this tumor in elderly patients also. Abdominal imaging with pre-operative biopsy provides accurate diagnosis. However, in difficult situations, CD68, cytokeratin 7, HepPar1, etc., immunohistochemical stains provide accurate diagnosis to differentiate this condition from other malignancies. Hereby, we present a case of fHCC in a 55-year-old female with equivocal imaging features and diagnosis was made by histopathology aided by immunohistochemistry

Pathological Staging of Renal Cell Carcinoma: A Review of 300 Consecutive Cases

Aims: Pathological staging of renal cell carcinoma (RCC) can be challenging compared to other cancer types, as invasion often manifests as finger‐like protrusions into vascular spaces or renal sinus tissue. Although prior studies have shown larger tumour size to be correlated highly with renal sinus invasion, prospective data on evaluating pathological stage are limited. We evaluated a large series reported by one urological pathologist. Methods and results: Three hundred consecutive specimens were reviewed. Tumours larger than 5 cm were routinely sampled extensively or grossly re‐reviewed when no extrarenal extension was identified on initial examination. Apparent multifocal disease was assessed critically for intravascular spread. Retrograde venous invasion was reported in 15 of 300 (5%) cases, 13 of 15 of which were clear cell RCC. Of a total of 163 specimens with clear cell histology, only five of 34 (15%) tumours 7 cm or larger were reported as pT2, all of which had an explanatory comment indicating the absence of definitive extrarenal spread. In contrast, 15 of 20 (75%) pT2 tumours were non‐clear cell histology (papillary, chromophobe and translocation‐associated). Comparing pT3a or higher tumours, the median tumour size in cases with retrograde venous invasion was 8.0 cm, compared to 6.2 cm in cases without retrograde venous invasion (P = 0.005). ConclusionsOur findings support that retrograde venous invasion should be considered carefully before diagnosing multifocal clear cell RCC, which is rare in the sporadic setting. In the absence of vascular invasion, multifocal clear cell papillary RCC can be a mimic. pT2 occurs more frequently with non‐clear cell histology (particularly papillary or chromophobe RCC).https://scholarlycommons.henryford.com/merf2019basicsci/1002/thumbnail.jp

A critical appraisal of mucormycosis in COVID- 19 patients in a tertiary care centre in India

Background and Purpose: Morbidity and mortality of opportunistic fungal infections in COVID-19 patients are less studied and defined. The patients receiving immunosuppressive therapy, broad-spectrum antibiotics, corticosteroids, and invasive and non-invasive ventilation are the high-risk groups.Materials and Methods: The demographic profile as well as clinical and radiological findings of all the patients with COVID-19 suspected of Mucormycosis (MM) were recorded. The tissue samples from all the patients were sent for microbiological (KOH mount and culture) and histopathological analysis for confirmation of MM.Results: In total, 45 COVID-19 patients suspected of MM were included in the study an MM was confirmed in 42 patients. The mean age of the patients was 50.30±14.17 years with a female: male ratio of 1.1:1. The most common symptom was headache (52.38%) followed by purulent nasal discharge (38.09%) and facial pain in 33.33% of the cases. The ocular symptoms included a diminution of vision (33.33%) and redness of the eye (2.38%).The most common site of involvement was rhino-orbital (42.85%) followed by sinonasal (23.80%) and rhino cerebral (19.04%). Majority (38.09%) of the patients were diagnosed with stage II of Rhino-orbital-cerebral Mucormycosis (ROCM) based on radiology. A history of diabetes mellitus and steroids was present in 97.61% and 85.71% of the cases, respectively. Moreover, KOH was positive for MM in 97.61% of the cases while the culture was positive in only 35.71% of the cases. In addition, on histopathology, MM was confirmed in 64.28 % of the cases. Mixed growth with Aspergillus species and Rhizopus species was observed in 14.28% of the cases in culture and 11.90% of the cases in histopathology test. Furthermore, angioinvasion was found in 23.80% of the cases according to the histopathology test.Conclusion: Based on the results, the most common conditions associated with MM in COVID-19 patients were diabetes mellitus and steroid therapy. A high level of clinical suspicion aided with diagnostic tests, including KOH mount, culture, histopathology, and radiology which helped the early detection of opportunistic fungal infection in COVID-19 patients to ensure timely treatment

Clear Cell Renal Cell Carcinoma With a Poorly-Differentiated Component: A Novel Variant Causing Potential Diagnostic Difficulty

Background: Several variant histologic patterns of clear cell renal cell carcinoma (RCC) are well known, especially those with sarcomatoid and rhabdoid features. However, we have encountered rare cases in which a high-grade adenocarcinoma or urothelial carcinoma-like component would be difficult to appreciate as clear cell RCC. DesignWe retrieved 26 tumors with histologically typical clear cell RCC juxtaposed to a high-grade non-clear cell component.High grade non-clear cell component was defined as non-sarcomatoid, non-rhabdoid areas that would be difficult to assign as renal cell in origin if viewed in isolation. Tumors were studied with immunohistochemistry and fluorescence in situ hybridization (FISH) or sequencing.ResultsMedian percentage of poorly differentiated component: 50%(IQR20-70). All tumors showed abrupt transition from clear cell carcinoma to poorly-differentiated (non-sarcomatoid/non-rhabdoid) areas, which showed micropapillary (7/26; 27%), urothelial-like (10/26; 39%), and adenocarcinoma NOS features (9/26; 35%). 19 tumors had necrosis. Carbonic anhydrase IX (CA-IX) was uniformly positive in well-differentiated component (20/20); poorly differentiated component showed a median positivity of 82.5% (IQR 65-100). Poorly differentiated component was positive for CK7 (5/19; 26%), CK20 (3/12; 25%), AMACR (7/12; 58%), PAX8 (12/15; 80%), and showed intact FH (6/6; 100%). CDX2 was uniformly negative. Chromosome 3p loss or VHL mutation was present in 8/13 (62%), tested with either FISH (n = 9) or sequencing (n = 4). All tested cases were negative for TFE3 (0/11) and TFEB (0/9) rearrangements on FISH. 5/21 (24%) patients were alive with metastatic disease and 5/21 (24%) had died of disease on follow up. One metastasis was composed only of the poorly-differentiated component and was near-negative for CA-IX. Conclusion: Clear cell RCC with a poorly differentiated component resembling adenocarcinoma or urothelial carcinoma is a novel source of morphologic heterogeneity that has not been previously well characterized. Potential pitfalls include decreased or absent CA-IX staining the high-grade component and aberrant positivity for cytokeratin 7 or 20. With the increasing use of renal mass biopsy and biopsies of metastatic sites for targeted therapy, pathologists should be aware of this entity and consider the possibility of clear cell RCC even for morphologically unusual tumors.https://scholarlycommons.henryford.com/merf2019caserpt/1069/thumbnail.jp

Mall Mania in India: Changing Consumer Shopping Habits

For the current generation of consumers, the meaning of shopping has changed. It is not just a mere necessity, as it was earlier, but much more than that. The factors that affect store choice and draw customers to the shopping centre include space, ambience, and convenience and moreover an array of choice under one roof. The growth of integrated shopping malls, retail chains and multi-brand outlets is evidence of consumer behaviour being favourable to the growing organized segment of the business. Space, ambience and convenience are beginning to play an important role in drawing customers. Malls, which are now anchored by large outlets such as Westside and Lifestyle and are resided by a lot of Indian and international brands, are also being seen as image benchmarks for communities. Thus, this dissertation aims at studying the changing shopping trends of consumers in the Indian economy. For doing this, semi structured interviews from the Indian retailers as well as consumers have been used as a tool. Various factors on which the Indian consumers base their choice of going to the shopping mall or the unorganized markets have been analyzed in this research

Persistent challenges in nuclear grading of clear cell renal cell carcinoma

Background: The World Health Organization (WHO) and International Society of Urological Pathology (ISUP) grading system for renal cell carcinoma now focuses on nucleolar prominence as the main criterion. We aimed to investigate how this system is implemented in certain scenarios. Design: An online survey was circulated via e-mail to a group of genitourinary pathology specialists (GU) and shared publicly via social media (including via Twitter and 3 Facebook pathology groups, 2 focusing on urologic pathology and 1 large general surgical pathology group). The survey included a mixture of descriptive questions and images. Results: In total, 91 responses were received from non-trainee pathologists, 77 self-identified as GU and 14 as non-GU. The vast majority reported using the ISUP/WHO system rather than Fuhrman (92% GU, 79% non-GU). Most reported not requiring nucleoli to be eosinophilic when determining visibility (77% GU and 72% non-GU). Most indicated that nucleoli visualized at high magnification at all (40×, composing an entire high-power field), would be considered grade 2, even if nucleoli are not eosinophilic / large (67% GU and 57% non- GU). Distinguishing grade 2 from 3 (10× magnification) yielded a similar response with 63% GU and 61% non-GU. When shown a photomicrograph taken at 40× magnification with visible but relatively small basophilic nucleoli (Figure A), most reported grade 2 (93% GU and 79% non-GU). For an image with more prominent nucleoli described as visible at 10×, 82% of GU and 71% non-GU reported grade 3. Respondents estimated using grade 1 in 5% or less of resection cases (73% GU, 57% non-GU, with one-third estimating 2% of cases or less). For multinucleated cells with bland individual nuclei (Figure B), most (84% GU, 86% non-GU) would not consider this grade 4. (Figure presented) Conclusions: The ISUP/WHO grading system for renal cell carcinoma has gained relatively widespread acceptance; however, some uncertainty remains regarding the degree of nucleolar prominence that warrants a higher grade. Despite the official descriptions requiring nucleoli to be eosinophilic, most pathologists do not require this in practice. Most respondents estimate that they use grade 1 very rarely. It is not entirely clear how tumor cells with multiple, non-bizarre nuclei should be handled, although most do not consider this inherently grade 4

Updates in Pathologic Staging and Histologic Grading of Renal Cell Carcinoma

The most important prognostic parameter in renal cell carcinoma is tumor stage. Although pathologic primary tumor (pT) categories are influenced by tumor size (pT1-pT2), critical elements (≥pT3) are dictated by invasion of structures, including renal sinus, perinephric fat, and the renal vein or segmental branches. Because this invasion can be subtle, awareness of the unique characteristics of renal cell carcinoma is critical for the pathologist to aid in clinical decision making. This review addresses challenges in pathologic stage and grade reporting and updates to the World Health Organization and American Joint Commission on Cancer classification schemes

Renal cell carcinoma staging: pitfalls, challenges, and updates

Renal cell carcinoma (RCC) is unusual among cancers in that it often grows as a spherical, well-circumscribed mass. Increasing tumour size influences the pathological pT stage category within pT1 and pT2, with cutoffs of 40, 70 and 100 mm; however, with increasing size also comes a sharp increase in the likelihood of renal sinus or renal vein tributary invasion, such that clear cell RCC rarely reaches 70 mm without invading one of these. To clarify some previous challenges in assigning tumour stage, the American Joint Committee on Cancer 2016 tumor-node-metastasis classification has removed the requirements than vein invasion be recognised grossly and that vein walls contain muscle for the diagnosis of vein invasion. Renal pelvis invasion has also been added as an additional route to pT3a. Multinodularity or finger-like extensions from a renal mass should be viewed with great suspicion for the possibility of vein or renal sinus invasion, and, as tumour size increases to over 40-50 mm, thorough sampling of the renal sinus interface should always be undertaken. With increasing interest in adjuvant therapy in renal cancer, the pathologist\u27s role in RCC staging will continue to be an important prognostic parameter and a tool for selection of patients for enrolment in clinical trials