Gastric glomus tumour (GGT) is a mesenchymal tumour composed of modified smooth muscle cells, which is the neoplastic counterpart of perivascular glomus bodies. Preoperative diagnosis of GGT is challenging due to its clinical and imaging similarities with other common submucosal tumours, such as gastrointestinal stromal tumours (GISTs). We report a case of a woman in her early 40s with a large well-defined submucosal gastric tumour. Imaging studies and preoperative clinical diagnosis suggested GIST. Surgical resection revealed a tumour measuring 17 cm in greatest dimension, one of the largest GGTs documented in the English literature. Histopathology showed tumour cells forming nests or trabeculae and surrounding dilated thin-walled vessels. Immunohistochemistry was positive for smooth muscle actin and vimentin and negative for desmin, CD117 and DOG1, confirming a diagnosis of GGT. While most GGTs are benign, close follow-up is crucial for large tumours for early detection of recurrence or metastasis.

Background: Epithelial ovarian carcinoma (EOC) is the most lethal gynecological malignancy, often presenting at advanced stages. Molecular markers such as CD44, a stem cell-associated adhesion molecule, and PD-L1, an immune checkpoint regulator, have been implicated in tumor progression, chemoresistance, and immune evasion. Understanding their expression patterns and correlation with clinicopathological features may aid prognostic stratification and therapeutic decision-making. Aim was to assess CD44 and PD-L1 expression in EOC and analyze their association with clinicopathological parameters. Methods: A hospital-based cross-sectional study was conducted over 5 years (2018-2023) in the department of pathology, AIIMS Patna. A total of 132 histologically confirmed cases of EOC were included. Immunohistochemistry (IHC) for CD44 and PD-L1 was performed, and expression was scored semi-quantitatively. Associations with age, histological subtype, tumor grade, stage, and lymph node involvement were evaluated. Statistical analysis was performed using chi-square and logistic regression. Results: CD44 positivity was observed in 79/132 cases (59.8%), while PD-L1 was expressed in 62/132 cases (47.0%). Co-expression of both markers was found in 38 cases (28.8%). High CD44 expression was significantly associated with high-grade serous carcinoma (p=0.01), advanced FIGO stage (p=0.03), and lymph node metastasis (p=0.04). PD-L1 positivity correlated with advanced stage (p=0.02) and presence of ascites (p=0.03). Co-expression was linked to poor differentiation and advanced disease. Multivariate analysis showed CD44+/PD-L1+ tumors had 2.6-fold higher odds of lymph node metastasis. Conclusions: CD44 and PD-L1 are frequently expressed in EOC and show significant association with adverse pathological features. Their combined expression may serve as a prognostic biomarker and highlight potential candidates for targeted and immune checkpoint therapies in ovarian carcinoma.

Gallbladder (GB) adenocarcinoma accounts for 10

The primary goal of breast conservation surgery (BCS) is to achieve tumour-free margins. However, it is known that in 20% patients, a tumour-free margin may not be obtained. Positive margins frequently lead to re-operation and are the strongest predictors of local recurrence. We therefore evaluated the performance of ultrasound (US) and frozen section (FS) in predicting the margin status of lumpectomy specimens of ultrasound-detectable breast carcinoma patients undergoing BCS. In our prospective study on 54 patients who underwent lumpectomy, the margins were analyzed by ultrasound and frozen section. Patient-wise and margin-wise diagnostic parameters were calculated for both modalities.

Introduction: SARS-CoV-2 infected a wide range of age groups and caused significant morbidity and mortality. Even after constant efforts to combat the virus, it could spread rapidly and infected large groups of people worldwide. Pregnant females were always at risk of acquiring the disease and the coagulopathy caused by the virus may compromise the placental circulation. Materials and Methods: In this study, we compared histopathological findings of 61 placentas delivered from SARS-CoV2 positive mothers with 34 placentas of SARS-CoV2 negative mothers. Results: No significant difference was found between SARS-CoV2 positive and SARS-CoV2 negative placentas in terms of period of gestation, placental weight, preterm delivery, or intrauterine fetal death. Microscopically, placentas of SARS-CoV2 positive mothers were significantly associated with features of maternal and fetal vascular malperfusion. The predominant feature of fetal malperfusion was chorangiosis and maternal malperfusion was villous agglutination & atherosis. Increased perivillous fibrin deposition was also found significantly associated with the disease. Conclusion: COVID 19 disease is related to excessive perivillous fibrin deposition, villous edema, maternal and fetal malperfusion. However, these changes are not specific for the disease, as these changes can be found in other conditions as well. No significant adverse fetal outcome was reported in our study. Keywords: COVID-19, Fetal vascular malperfusion, Maternal vascular malperfusion, Placenta, perivillous fibrin, SARS-CoV2.

Background & Objective:Fine-needle aspiration cytology (FNAC) is a minimally invasive, rapid, and relatively safe diagnostic method for the initial evaluation of lymphadenopathy of unknown origin. In May 2020, the Sydney System was proposed to provide recommendations for diagnostic categorization, FNAC of lymphadenopathy, pathology reporting, and related practices. This study aimed to analyze the applicability of the Sydney System in lymph node FNAC and to evaluate diagnostic accuracy and risk of malignancy (ROM) for each diagnostic category. Methods:A 2-year retrospective diagnostic study was conducted from January 2019 through December 2020. Sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy (DA), and ROM were calculated using histopathology as the gold standard. Results:A total of 632 lymph node FNAC cases were included, with histopathological follow-up available in 45 cases. The median age of patients was 26 years, with a male-to-female ratio of 1.2:1. Cervical lymph nodes were most frequently involved (367 cases, 58.1%). Overall sensitivity, specificity, and diagnostic accuracy were 66.7%, 85.0%, and 76.3%, respectively. ROM by diagnostic category was: nondiagnostic (25%), benign (5.2%), atypia of undetermined significance (AUS) (50%), suspicious (80%), and malignant (88.8%). Conclusion:FNAC demonstrated high diagnostic efficacy when applied using the proposed Sydney System, supporting the utility of this standardized reporting scheme for lymph node cytology.

Introduction Vaginal masses accompanied by bleeding in infant girls may stem from various benign causes. However, it's crucial to promptly conduct examinations, utilize imaging techniques, and consider excision, especially when rhabdomyosarcoma is a potential concern. Case detail A 18-month girl presented with vaginal bleeding and a mass that had been present since the age of five months. A friable soft mass originating from the posterior vaginal wall was surgically excised, and histopathologically diagnosed as a fibromyxoma, a benign soft tissue tumor. Discussion In prepubertal girls, additional causes of vaginal bleeding and the presence of a mass may include vaginal polyps (fibroepithelial), congenital anomalies, rhabdomyosarcoma, foreign bodies, and urethral prolapse. Fibromyxoma is a type of soft tissue tumor that can manifest in various locations apart from the vagina. It is notable for its propensity for local recurrence even following surgical excision. Therefore, it is crucial to provide parental counseling regarding the necessity for regular follow-up examinations. Notably, the occurrence of fibromyxoma in the vaginal location during infancy has not been previously reported.

Phyllodes tumors (PTs) are rare neoplasms of the breast that are a challenge in clinical practice. Though mostly benign, they are notorious for local recurrence, requiring adjuvant treatments. This study was planned to report the clinicopathological features and outcomes of patients with PT treated at our center. Details of all patients who underwent surgery for PT in the last 6 years (December 2017–December 2023) were obtained from our prospectively maintained database. The demographic, clinical, radiological, pathological, and follow-up details were recorded and analyzed. Statistical analyses were carried out with Jamovi version 2.3.18. Out of 61 suspected PTs by triple assessment, 9 were excluded due to a non-phyllodes diagnosis on histopathology. We included 52 women with a mean age of 38.2 ± 11.0 years, most of whom were premenopausal (57.7

Since its discovery in Wuhan, China, in December 2019, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread rapidly around the world with being declared a pandemic in March 2020 by the World Health Organization (WHO). Comorbidities are one of the most concerning clinical considerations for mortality. Materials and Methods: This was a retrospective observational study conducted at the All India Institute of Medical Sciences in Patna, Bihar, from June 2020 to December 2020. It included adult patients who succumbed to coronavirus disease 2019 (COVID-19) during this period, and their relevant information, such as demographic information hospital stay duration, haematological parameters and comorbidities, was gathered. Results: The mean age of the study group was 63.5 (11.8) years. Of 150 cases, 126 men (about 84 per cent) and 24 women were involved (16 per cent). In our study, hypertension (HTN) was shown to be the most frequent comorbidity at 68.7% (103/150), followed by diabetes mellitus (DM) at 61.3% (92/150). The most prevalent haematological disorder identified in our investigation was anaemia and leucocytosis. Conclusion: The categorisation of patients who would need extra measures including early hospitalisation, heightened monitoring and intense therapy would be made easier by identifying patient traits and conditions.

Medulloblastoma (MB) is a common malignant intracranial neoplasms in children. The treatment and prognosis of this tumor depends on histology and molecular subtypes. Survivin, implicated in various malignancies, may hold prognostic significance. We investigated survivin and p53 immunoreactivity in different histological subtypes in 20 MB cases from January 2018 to June 2021. Immunohistochemistry revealed survivin expression in 75% (15/20) of cases, with cytoplasmic (10 cases), nuclear (four cases), or combined expression (one case). p53 nuclear expression was present in 35% (7/20) of cases. Classical variant MB exhibited predominant p53 and cytoplasmic survivin expression. Given the association of survivin and p53 expression with poor prognosis, especially in the prevalent classical variant, targeted therapies may hold promise for MB treatment advancement.

Purpose: There has been a sudden increase in the number of rhino-orbital mucormycosis cases, primarily affecting patients recovering from COVID-19 infection. The local health authorities have declared the current situation an epidemic. In this study, we assess the role of exenteration in preventing disease progression and improving survival in patients with rhino-orbital mucormycosis. Methods: The patients undergoing exenteration were grouped into the exenteration arm and those denying exenteration were grouped into the nonexenteration arm. The patients were followed at 1 month and 3 months. The 6-month survival data were collected telephonically. Continuous data were presented as Mean ± SD/Median (IQR) depending on the normality distribution of data, whereas the frequency with percentages was used to present the categorical variables. Kaplan–Meier survival curves were created to estimate the difference in survival of patients with exenteration in rhino-orbital mucormycosis versus those without exenteration. Results: A total of 14 patients were recruited for our study based on the inclusion and exclusion criteria. All the patients were qualified for exenteration; however, only eight patients underwent exenteration and six patients did not consent to exenteration. At the end of 3 months in the exenteration group, four (50%) patients died. Two patients died within a week of exenteration, whereas two patients died after 2 weeks of exenteration. The deaths in the first week were attributed to septic shock and the deaths happening beyond 2 weeks were attributed to severe meningitis. The Kaplan–Meier survival analysis showed the cumulative probability of being alive at 1 month in the exenteration arm to be 85%, and it decreased to 67% by 53 days and subsequently remained stable until the end of 3 months. Conclusion: The Kaplan–Meier survival analysis did not show a survival benefit of exenteration at 3 months and 6 months in COVID-associated rhino-orbital mucormycosis.

ABSTRACT Synovial sarcoma is a rare and malignant soft tissue tumor, comprising 5%–10% of such cases. This tumor primarily afflicts adolescents and young adults, with slight male bias, often near large joints like the knee and hip. Intra-articular synovial sarcoma, an even rarer subset, can delay diagnosis due to its slow growth and vague clinical signs. We present a unique case of primary knee intra-articular synovial sarcoma in a 24-year-old female. Imaging revealed a distinct lesion adjacent to the medial femoral condyle and patellofemoral joint, initially suggestive of synovial haemangioma. However, histopathology confirmed biphasic synovial sarcoma, characterized by spindle and gland-like epithelial components. Immunohistochemistry further supported the diagnosis. Reviewing documented cases, we find that synovial sarcoma can affect a wide age range but often occurs in the knee joint, emphasizing the need for vigilance. Early detection and intervention are crucial for improved treatment outcomes in this rare but challenging malignancy.

Introduction: Salivary gland neoplasms account for approximately 5% of head and neck tumours. The cytomorphology of fine needle aspiration material helps determine the preoperative assessment and risk stratification. The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) was developed to improve communication between the laboratory and treatment provider.Aims and objective: In the present study, we stratified all salivary gland lesions ac- cording to the MSRSGC and evaluated each category's concordance and risk of ma lignancy (ROM).Materials and methods: This was a 5 year retrospective study. First, all cases were assigned to one of the six MSRSGC categories. Then, following cytohistological cor- relation, the concordance rates and ROM were calculated based on the final histopa- thology report.Results: A total of 354 cases were identified, with ages ranging from 2 to 88 years and the commonest age group was the 3rd to 4th decades. Categories I, II, III, IVA, IVB, V, and VI comprised 5.37% (19/354), 26.84% (95/354), 1.13% (04/354), 51.41% (182/354), 1.98% (07/354), 1.13% (04/354), and 12.15% (43/354) of the cases, re- spectively. The overall concordance rate between the cytological and histopatho- logical diagnoses was 81.25% (65 out of 80 cases), with the sensitivity, specificity, positive predictive value, and negative predictive value at 43.48%, 96.49%, 83.33%, and 80.88%, respectively. Conclusion: The MSRSGC provides a better objective and structured way to com- municate with the health care provider. In our study, the overall concordance rate was observed in 62/80 cases, with maximum concordance seen in categories III, IVB, and V of the MSRSGC.

Monocytes and macrophages are implicated in inflammation and atherosclerosis, whereas monocytes are involved in psoriasis lesion formation. We previously reported a psoriatic inflammation-associated significant decrease in the membrane protein caveolin-1 (CAV-1) in psoriasis patient monocytes. However, the phenotype of circulating monocytes and their macrophage differentiation in psoriasis patients remain unclear.We sought to clarify circulating monocyte and monocyte-derived macrophage (MDM) phenotypes in psoriasis patients with and without comorbidities.Thirty-one patients with psoriasis vulgaris and 28 control subjects were included. Surface macrophage markers and inflammatory status were examined in circulating monocytes and MDMs from both groups. Expression of CD36, which mediates macrophage uptake of oxidized low-density lipoprotein (oxLDL), was evaluated in these cells. CAV-1-silenced monocytes were differentiated into macrophages to investigate the effects of CAV-1 downregulation on psoriatic inflammation and atherosclerosis.Macrophage surface markers were detectable in circulating monocytes. A significant M1 shift was detected in monocytes and MDMs in psoriasis patients, including those without cardiovascular disease risk factors, as compared to controls. MDMs of psoriasis patients had more CD36-expressing cells, which are associated with atherosclerosis risk. Additionally, CAV-1-silencing in monocytes increased the likelihood of M1-biased macrophage differentiation and increased pro-inflammatory cytokine production.Monocytes from psoriasis patients were more likely to differentiate into M1-dominant macrophages, correlating with inflammatory status and CAV-1 expression. These aberrant inflammatory monocytes not only contribute to psoriatic inflammation by producing psoriatic cytokines, but also have a phenotype that could increase atherosclerosis risk by uptake of oxLDL and formation of foam cells.

Neuroendocrine neoplasm (NEN) of the cervix is a malignant tumor and is classified into low and intermediate-grade neuroendocrine tumor (NET), and high-grade small cell neuroendocrine carcinoma (SCNEC), and large cells neuroendocrine carcinoma (LCNEC). SCNEC of the cervix is an Infrequent tumor with an incidence of less than 1% of all gynecological malignancies. It is characterized by small to medium-sized tumor cells with scant cytoplasm and neuroendocrine differentiation. Most cases of SCNEC of the cervix manifest in pure forms, and only cases show coexisting, non-neuroendocrine component of HPV-associated adenocarcinoma or squamous cell carcinoma. In this report, reviewing the literature, we present one such unique case of SCNEC of the cervix with adenocarcinoma and high-grade squamous intraepithelial neoplasia.

Malignant melanoma is an aggressive neoplasm, its metastasis to bone marrow is rare phenomenon. Here, we are presenting a case of metastatic malignant melanoma to bone marrow with unknown primary in 40 years old patient along with review of literature. This case is diagnosed as metastatic malignant melanoma in bone marrow aspirate and biopsy specimen first. Diagnosis was done on the basis of classical histological features and with the help of immunohistochemistry. Radiological investigations were done to know primary site. Multiple metastasis in liver and vertebra were also identified. USG guided fine needle aspiration cytology of liver and biopsy of vertebral lesion were also performed, which confirms the diagnosis of malignant melanoma metastasis. In our case, patient died within one month after diagnosis. Early diagnosis of metastatic malignant melanoma will help clinicians to better understanding of course of disease, so they can provide best possible patient care and management. Clinicians must be aware of progression of disease, clinical manifestations of metastatic malignant melanoma.

Background: The epidemic of coronavirus disease 2019 (COVID-19) has been rapidly spreading on a global scale affecting many countries and territories. There is rapid onset of generalized inflammation resulting in acute respiratory distress syndrome. We, thus, aimed to explore the potential of immune-inflammatory parameters in predicting the severity of COVID-19. Materials and Methods: Age, neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), platelet-to-lymphocyte ratio (PLR), Lactate Dehydrogenase (LDH), C-reaction protein (CRP), and procalcitonin (PCT) of 611 patients with laboratory-confirmed COVID-19 were investigated and compared. Patients were divided on the basis of severity and survival into two groups. Data were expressed as mean or median values and percentages. The receiver operating characteristic curve was applied to determine the optimal cut-off values of these biomarkers. Results: The median age was 50 years and the male to female ratio was 3.7:1. The mean NLR, LMR, PLR, LDH, CRP, and Procalcitonin for the non-severe group were 4.16, 10.8, 133.7, 666.1, 49.9, and 0.15, respectively. In the severe group mean values of the above-mentioned immune-inflammatory markers were 17.8, 4.69, 268.2, 1277, 158.6, and 3.05, respectively. Elevated levels were significantly associated with disease severity. In ROC curve analysis, NLR had the largest area under the curve at 0.923 with the highest specificity (0.83) and sensitivity (0.88). Conclusion: This study shows that NLR, PLR, LDH, CRP, and Procalcitonin may be a rapid, widely available, useful predictive factor for determining the severity of COVID-19 patients.

Cytological features such as papillary configuration, pseudostratification, and large rosette‐like clusters without any nuclear features of PTC hint at the CCVPTC diagnosis. The presence of papillary configuration, pseudostratification, and large rosette‐like clusters without any nuclear features of PTC hint at CCVPTC.

Abstract Pritanjali Singh Background  Wilms' tumor (WT) is the most common kidney tumor of the pediatric age group. The outcome of WT has improved due to the evolution of the treatment approach. A prospective observational study was conducted at All India Institute of Medical Sciences (AIIMS), Patna, to analyze the clinical profile along with the response and outcome to neoadjuvant chemotherapy according to the International Society of Pediatric Oncology (SIOP) protocol. Materials and Methods  In total, 28 patients of WT visited the radiotherapy department from January 2015 to December 2019. Results  Gender distribution showed male preponderance with a median age at diagnosis was 31 months. The abdominal lump was the dominant clinical presentation. The median volume of tumor at diagnosis was 359.48 mL (52.67–1805.76). Radiological staging workup shows that stage I, II, III, IV, and V were 7.1%, 39.3%, 39.3%, 10.7%, and 3.6% respectively. Neoadjuvant chemotherapy (NACT) was received by all patients. Also, 71.4% of patients showed > 50% of tumor volume reduction, while 28.6% of patients showed < 50% of tumor mass reduction. There was a statistically significant decrease in the tumor volume reduction following neoadjuvant chemotherapy ( p  < 0.001). There was a statistically significant stage down ( p  = 0.018) of the disease. Bivariate correlation studies showed recurrence was correlating statistically significantly with age < 24 months ( p  = 0.049), locoregional lymph nodes ( p  = 0.008), histopathological subtypes ( p  < 0.001), stage of the disease ( p  = 0.003), and risk groups ( p  < 0.001). In addition, 25% of patients developed recurrence during the median follow-up of 25 months. The median disease-free survival (DFS) and overall survival (OS) were not reached. The mean DFS and OS were 48 and 59.13 months, respectively. One- and 3-year DFS were 100% and 64.1%, respectively. One- and 3-year OS were 100% and 75% respectively. Conclusion  Our study suggests that most of the patients presented at an advanced stage, thus rendering most of the cases difficult to undergo surgery at presentation. Neoadjuvant chemotherapy followed by surgery may be considered a well-balanced approach with a comparable response and survival outcomes.

Background: Adenomyosis is a common disorder in women of reproductive age. The gold standard for diagnosis is histopathological examination of hysterectomy specimen. However, only a small percentage of women undergo surgery as treatment is primarily hormonal. Non-invasive methods of diagnosis include transvaginal sonography and magnetic resonance imaging. Patient management in adenomyosis is often based on ultrasonographic diagnosis alone, highlighting the importance of a uniform, reproducible, clinically relevant and validated sonological classification and scoring system. Although a few investigators have proposed classification and scoring system for diagnosis of adenomyosis, none of those have been validated yet. This study aimed to propose and validate a new sonological classification and scoring system for adenomyosis. Methods: This was a prospective observational pilot study. A new sonological classification and scoring system of adenomyosis was proposed based on topography, type, size and extent, which was validated by comparing the sonological reporting with histopathological reporting. The main outcome measures that were measured were rate of agreement (Cohen’s kappa) between the findings of sonologist and pathologist; and diagnostic accuracy of the sonological classification of adenomyosis. Results: This pilot study included 30 women who underwent hysterectomy over a time period of one year with ultrasonographic diagnosis of adenomyosis. The rate of agreement (Cohen’s kappa) between the findings of sonologist and pathologist showed substantial agreement (0.703) for topography and almost perfect agreement for type (0.896), extent (0.892) and size (0.898). Conclusions: Our newly proposed sonological classification and scoring system for adenomyosis is valid and can be used for clinical application in interpersonal communication between clinicians, to prognosticate patients about the disease severity, to assess the candidates for surgical management and in further studies to correlate with symptoms severity and effectiveness of medical therapies.