ACCURACY AND DIAGNOSTIC UTILITY OF FROZEN SECTION IN THYROID LESIONS: A COMPARATIVE STUDY

Introduction: Many surgeons perform intra operative frozen section to overcome the limitations of FNAC, to differentiate benign lesions from malignant lesions and to determine the extent of surgery. However, the use and cost effectiveness of FS is controversial in follicular lesions. Nevertheless FS is most useful in cases where FNA results are indeterminate or suspicious and it is a cost effective way to avoid second surgical procedure if a total thyroidectomy is indicated. Aim: To study the diagnostic utility of frozen section and fine needle aspiration cytology thyroid lesions utilizing final histopathology diagnosis as gold standard. Methods: The present study was conducted on 237 cases of thyroid tissue submitted for frozen section for a study period of 5 years. Among those, 95 cases had preoperative FNAC done. Results: The sensitivity, specificity and diagnostic accuracy of FNAC was 42.86%, 96.72% and 82.93%, whereas that of FS was comparatively superior (82%, 100% and 95.65% respectively). Conclusion: Thus, the overall sensitivity, specificity and diagnostic accuracy of FS was superior to that of FNAC in the present series. The main limitations of FS and FNAC in our study were- Capsular/ vascular invasion in follicular neoplasm was not detected in many cases and papillary microcarcinomas were missed. Key words: FNAC; Frozen section; Thyroid lesions

ACCURACY AND DIAGNOSTIC UTILITY OF FROZEN SECTION IN THYROID LESIONS: A COMPARATIVE STUDY

Introduction: Many surgeons perform intra operative frozen section to overcome the limitations of FNAC, to differentiate benign lesions from malignant lesions and to determine the extent of surgery. However, the use and cost effectiveness of FS is controversial in follicular lesions. Nevertheless FS is most useful in cases where FNA results are indeterminate or suspicious and it is a cost effective way to avoid second surgical procedure if a total thyroidectomy is indicated. Aim: To study the diagnostic utility of frozen section and fine needle aspiration cytology thyroid lesions utilizing final histopathology diagnosis as gold standard. Methods: The present study was conducted on 237 cases of thyroid tissue submitted for frozen section for a study period of 5 years. Among those, 95 cases had preoperative FNAC done. Results: The sensitivity, specificity and diagnostic accuracy of FNAC was 42.86%, 96.72% and 82.93%, whereas that of FS was comparatively superior (82%, 100% and 95.65% respectively). Conclusion: Thus, the overall sensitivity, specificity and diagnostic accuracy of FS was superior to that of FNAC in the present series. The main limitations of FS and FNAC in our study were- Capsular/ vascular invasion in follicular neoplasm was not detected in many cases and papillary microcarcinomas were missed. Key words: FNAC; Frozen section; Thyroid lesions

Study of HER-2/neu status in adenocarcinoma of stomach and gastroesophageal junction

Background: To study the expression of Human epidermal growth factor receptor 2 (HER-2/neu) in adenocarcinoma of stomach and gastroesophageal junction and to study and describe the association of HER-2/neu expression with various clinicopathological parameters in Indian population.Methods: Immunohistochemical testing was done on 91 cases diagnosed as adenocarcinoma of gastric and gastroesophageal junction by histological examination to determine HER2 status. HER2 amplification was confirmed by fluorescence in situ hybridization (FISH) on cases that had equivocal (immunohistochemistry-IHC score 2+) HER2 expression. The association between HER-2 positivity and clinicopathological parameters was assessed by Chi-square test.Results: The HER-2 IHC results are as follows: score 3+ (positive): 8.79%; score 2+ (equivocal): 10.99%; score 0 and 1+ (negative): 80.22%. Of the 10 cases of equivocal IHC results, 2 cases (20%) showed amplification of HER-2 gene demonstrated by dual probe FISH analysis. The overall prevalence of HER-2 positivity detected using immunohistochemistry and FISH was 10.99% (10/91 cases). HER-2 positivity correlated with the tumor grade (well and moderately differentiated tumor, p=0.013) and intestinal type (p=0.025) but not with age, gender, pathological stage and lymph node metastasis.Conclusions: HER-2 positivity in our study was 10.99%. HER-2 positivity significantly correlated with intestinal type of adenocarcinoma and the grade of the tumor. Two cases with strong HER-2 staining but in less than 10% of the tumor showed gene amplification by FISH

Durvalumab Plus Carboplatin/Paclitaxel Followed by Maintenance Durvalumab With or Without Olaparib as First-Line Treatment for Advanced Endometrial Cancer: The Phase III DUO-E Trial

PURPOSE Immunotherapy and chemotherapy combinations have shown activity in endometrial cancer, with greater benefit in mismatch repair (MMR)-deficient (dMMR) than MMR-proficient (pMMR) disease. Adding a poly(ADP-ribose) polymerase inhibitor may improve outcomes, especially in pMMR disease. METHODS This phase III, global, double-blind, placebo-controlled trial randomly assigned eligible patients with newly diagnosed advanced or recurrent endometrial cancer 1:1:1 to: carboplatin/paclitaxel plus durvalumab placebo followed by placebo maintenance (control arm); carboplatin/paclitaxel plus durvalumab followed by maintenance durvalumab plus olaparib placebo (durvalumab arm); or carboplatin/paclitaxel plus durvalumab followed by maintenance durvalumab plus olaparib (durvalumab + olaparib arm). The primary end points were progression-free survival (PFS) in the durvalumab arm versus control and the durvalumab + olaparib arm versus control. RESULTS Seven hundred eighteen patients were randomly assigned. In the intention-to-treat population, statistically significant PFS benefit was observed in the durvalumab (hazard ratio [HR], 0.71 [95% CI, 0.57 to 0.89]; P = .003) and durvalumab + olaparib arms (HR, 0.55 [95% CI, 0.43 to 0.69]; P < .0001) versus control. Prespecified, exploratory subgroup analyses showed PFS benefit in dMMR (HR [durvalumab v control], 0.42 [95% CI, 0.22 to 0.80]; HR [durvalumab + olaparib v control], 0.41 [95% CI, 0.21 to 0.75]) and pMMR subgroups (HR [durvalumab v control], 0.77 [95% CI, 0.60 to 0.97]; HR [durvalumab + olaparib v control] 0.57; [95% CI, 0.44 to 0.73]); and in PD-L1-positive subgroups (HR [durvalumab v control], 0.63 [95% CI, 0.48 to 0.83]; HR [durvalumab + olaparib v control], 0.42 [95% CI, 0.31 to 0.57]). Interim overall survival results (maturity approximately 28%) were supportive of the primary outcomes (durvalumab v control: HR, 0.77 [95% CI, 0.56 to 1.07]; P = .120; durvalumab + olaparib v control: HR, 0.59 [95% CI, 0.42 to 0.83]; P = .003). The safety profiles of the experimental arms were generally consistent with individual agents. CONCLUSION Carboplatin/paclitaxel plus durvalumab followed by maintenance durvalumab with or without olaparib demonstrated a statistically significant and clinically meaningful PFS benefit in patients with advanced or recurrent endometrial cancer

Myxoid adrenal adenoma with focal pseudoglandular pattern

Adrenal cortical tumors with myxoid change are rare tumors. To our knowledge, only 22 cases have been described so far in literature, which include 13 carcinomas and 9 adenomas. A pseudoglandular pattern has been described in 9 of these tumors. We report a case of a myxoid adenoma of the left adrenal gland in a 67-year-old woman, with a focal pseudoglandular pattern involving about 20% of the studied tumor. Rest of the tumor was composed of anastomosing cords of tumor cells. Abundant myxoid stroma was present, which stained positively with alcian blue and was weakly focally positive with periodic acid Schiff. Immunophenotype was consistent with an adrenal tumor, i.e., positive for vimentin, inhibin, and melan A. Cytokeratin AE1/AE3 and chromogranin were negative. MIB-1 index was < 0.1%

Benign fibrous histiocytoma of the bladder

Mesenchymal tumors of the bladder are rare with leiomyoma accounting for most of these. We present a rare case of a bladder benign fibrous histiocytoma in a 52-year-old male. He presented with history of straining during micturition since two years. The magnetic resonance imaging revealed a large intravesical mass. The mass was excised. It weighed 600g, with a maximum dimension of 13cm. Histology was that of a benign fibrous histiocytoma. To our knowledge, only two cases of this tumor have been reported in the bladder so far. The clinical and pathological features are discussed

Cerebral atypical teratoid rhabdoid tumour arising in a child treated for acute lymphoblastic leukaemia

Atypical teratoid rhabdoid tumours (ATRT) are rare, arising typically in childhood. ATRT arising as a secondary tumour in children treated for acute lymphoblastic leukaemia have not been reported so far. We report a case of ATRT in a 17-year-old boy, 11 years after he was treatment for acute lymphoblastic leukaemia with cranial radiation