Jehangir Hospital

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Cryptococcus neoformans, an opportunistic fungal pathogen, predominantly affects immunocompromised individuals, such as those with HIV/AIDS or on long-term corticosteroid therapy. A 50-year-old Indian male with longstanding diabetes mellitus presented with persistent left scapular pain. Initial management with antitubercular therapy, based on a paravertebral cold abscess and granulomatous inflammation, led to worsening pain, bilateral lower limb weakness, and tingling extending to the toes. Computed tomography (CT) revealed lytic lesions involving the D1 and D2 vertebrae, ribs, and a prevertebral soft tissue mass causing spinal cord compression at T1–T2. Histopathology following corpectomy and spinal fusion confirmed C. neoformans through culture. Following surgical intervention, transition to antifungal therapy with oral fluconazole resulted in lesion resolution, significant pain reduction, and complete resolution of neurological symptoms within 12 weeks.

Objectives: Ki-67 labeling index (LI) is a crucial prognostic and predictive biomarker in breast carcinoma, but its clinical utility is limited by a lack of standardization in scoring methods. This study evaluates the hotspot, average, and tumor edge methods for Ki-67 LI assessment in core needle biopsies and resection specimens. Material and Methods: A combined retrospective and prospective observational study was conducted on 200 cases of primary invasive breast carcinoma. Ki-67 LI was determined using immunohistochemistry and counted through the three methods. Correlations with histological grade, estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) status were analyzed. Results: Mean Ki-67 LI was highest with the hotspot method (51.9% in biopsies, 50.5% in resections), followed by tumor edge (46.8%, 46.9%) and average (44.5%, 40.3%) methods ( p < 0.001 for inter-method differences). All methods correlated significantly with higher histological grades and negative ER/PR/HER2 status ( p < 0.001). Intraclass correlation coefficient values exceeded 0.9, indicating strong concordance, with hotspot and tumor edge methods showing the highest agreement. Categorization into low (<20%) and high (≥20%) Ki-67 groups revealed minimal differences in biopsies but a higher prevalence of low-Ki-67 tumors with the average method in resections ( p < 0.05). Conclusion: The hotspot method yields consistently higher Ki-67 LI and better concordance across specimen types.

OBJECTIVE:The aim of the study was to explore the role of KELIM as a potential clinical biomarker to help select patients who would benefit with the addition of Hyperthermic intraperitoneal chemotherapy(HIPEC) at interval cytoreductive surgery following neoadjuvant chemotherapy. METHODS:This was a multi-institutional, retrospective observational study of 265 patients with Stage IIIC and Stage IV A high grade serous epithelial ovarian cancer who had undergone interval cytoreductive surgery following neoadjuvant chemotherapy. Propensity score matching was performed to reduce confounding by indication for HIPEC. Matching variables were age, FIGO stage, surgical PCI, and NACT cycles. Univariable and multivariable cox-regression models were created to assess predictors of survival. Survivals were analysed using Kaplan-Meier curves. RESULTS:The median OS and median DFS of patients with Low KELIM score and who received HIPEC was 38 months and 18.9 months respectively as compared to Median OS = NR and DFS of 39.7 months respectively in patients with a high KELIM score who received HIPEC. Patients with low KELIM did worse with the addition of HIPEC (3 year OS-61%, DFS 15%) as compared to patients with High KELIM and HIPEC (3 year OS 90%, DFS- 54%). CONCLUSION:KELIM may help to identify patients who are likely to benefit from the addition of HIPEC at interval cytoreductive surgery. However, these findings require validation in larger prospective studies.