Background & Objective:Breast cancer (BC) is the most common cancer and a leading cause of cancer-related deaths among Indian women. Inflammation and the tumor microenvironment have a significant influence on cancer development, progression, immune surveillance, and response to therapy. The neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) are simple, measurable markers of subclinical inflammation. This study aimed to evaluate the association of NLR and PLR with the molecular subtypes and clinicopathological parameters of BC. Methods:A hospital-based study was conducted on 228 BC patients. Cases were classified into four molecular subtypes, which were further divided into Group A with a good prognosis (Luminal A and Luminal B) and Group B with a poor prognosis (HER2-enriched and TNBC). Cutoff values for NLR and PLR were calculated using the ROC curve. Results:The cutoff values for NLR and PLR were 2.64 and 90, respectively. NLR was significantly higher (≥2.64) in TNBC (70.6%) and lower (<2.64) in Luminal A (79.2%). Elevated NLR and PLR were associated with clinical T stage (P=0.005 and P=0.028), high PI (P=0.006 and P=0.029), and advanced stage (P=0.002 and P=0.026). A high PLR (≥90) was observed in 60.3% of advanced BC cases, compared to 39.7% of early BC cases. NLR and PLR were negatively correlated with ER and PR (P<0.05). Conclusion:A significant correlation was observed between high NLR and PLR and adverse prognostic clinico-pathological factors in breast cancer. NLR and PLR could serve as valuable, cost-effective markers for prognosis and prediction in breast cancer.

Primary ovarian leiomyoma is extremely uncommon, with a low incidence rate of 0.5-1% of benign ovarian tumors. Due to its rarity, it poses a diagnostic dilemma and needs to be differentiated from other spindle cell neoplasms of the ovary. We report a case of a large symptomatic primary ovarian leiomyoma in a postmenopausal woman, which was misdiagnosed as fibroma of the ovary both clinically and radiologically. Microscopy revealed a spindle cell tumor arranged in short intersecting fascicles, which were positive for SMA and h-caldesmon on immunohistochemistry. is a useful adjunct for definitive diagnosis and confirming smooth muscle origin. While malignant solid ovarian tumors are much more common, the consideration of ovarian leiomyoma as a differential diagnosis of solid ovarian tumors is essential, as the treatment modality is surgical resection. Diagnosing ovarian leiomyoma before and during surgery is challenging. It is advisable to perform both histopathological examination and immunohistochemical analysis.

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.

Introduction: Pharmacogenomics, the study of genetic variations that influence drug responses, is a crucial component of personalised medicine. Despite its growing importance, integration into healthcare in India faces challenges, including limited awareness, restricted access to genetic testing, and inadequate infrastructure. This study aimed to assess knowledge and awareness of pharmacogenomics among undergraduate MBBS students at AIIMS Jodhpur. Methods: A cross-sectional survey was conducted in December 2024 using a self-administered, pre-validated questionnaire. The tool assessed sociodemographic details and pharmacogenomics knowledge. Descriptive statistics were performed using SPSS version 21. Results: Of 358 students approached, 324 completed the survey (response rate: 90.5%). The mean age was 19.6 years, and 71.9% of the participants were male. Most participants were aware of the basic concept (85.8%) and professional relevance (85.2%) of pharmacogenomics. However, knowledge gaps were evident: only 60.8% were aware of the USFDA pharmacogenomic labelling requirements, and 59% believed it could reduce drug development costs. While 80.9% supported its role in diagnosis and treatment, just 71.3% favoured its inclusion in the MBBS curriculum. Discussion: The findings indicate that students possess a strong foundational understanding of pharmacogenomics but have limited awareness of its clinical, regulatory, and economic implications. Similar studies from India and abroad highlight comparable gaps, underscoring the need for structured education. Integrating pharmacogenomics into undergraduate curricula through case-based modules and CME sessions could bridge deficiencies and enhance preparedness for precision medicine. Medical students demonstrated good baseline knowledge but lacked deeper insights. Strengthening curricular integration is crucial for equipping future clinicians to effectively apply pharmacogenomics in practice.

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.

Cancer remains a leading global cause of morbidity and mortality. While conventional therapies such as chemotherapy and radiation are essential, growing evidence supports the adjunctive use of nutraceuticals-bioactive compounds from natural food sources-with anticancer potential. To synthesize current evidence on the mechanisms, therapeutic roles, and clinical challenges of nutraceuticals in cancer chemotherapy. A narrative review was conducted by searching literature from 2015 to 2024 across PubMed, Scopus, and Web of Science. Studies were included based on relevance to cancer patients, nutraceutical interventions, and reported therapeutic or supportive outcomes. No formal meta-analysis was performed; findings were thematically grouped and summarized. Nutraceuticals such as curcumin, resveratrol, flavonoids, and vitamins D and E exert antioxidant, anti-inflammatory, pro-apoptotic, and immune-modulatory effects. Many demonstrate synergy with chemotherapy, enhancing efficacy and reducing toxicity. Probiotics and omega-3 fatty acids, in particular, show promise in alleviating chemotherapy-induced side effects. However, clinical utility is limited by inconsistent trial results, variable dosing, low bioavailability, and lack of regulatory oversight. Some supplements may interfere with standard therapies or pose safety concerns if used indiscriminately. Nutraceuticals offer promising adjunctive benefits in cancer care, but their integration requires cautious, evidence-based application. Standardized formulations, better clinical trial designs, and regulatory clarity are needed to ensure their safe and effective use in oncology.

BACKGROUND:Programmed death ligand ( PD-L1 ) binds to its receptor PD-1 on T-cells and inhibits the immune response of T-lymphocytes. Cancer cells evade immune surveillance by upregulating PD-L1 expression, leading to tumor progression. Anti- PD-L1 immunotherapy has emerged as a new treatment modality in various solid carcinomas. Food and Drug Administration (FDA) has approved PD-1 / PD-L1 axis immunotherapy for immunohistochemically PD-L1 positive cervical cancer. In India, cervical cancer accounts for approximately 17% of all cancer deaths among women between 30 and 70 years. More than three-fourths of patients are diagnosed at an advanced stage. MATERIALS AND METHODS:A hospital-based, cross-sectional prospective study was conducted over five years. 119 histologically proven cases of cervical carcinoma meeting the inclusion criteria were included in the study. Sections were stained with PD-L1 antibody clone SP263 as recommended on Ventana Benchmark XT. RESULTS:Of 119 cases, PD-L1 expression was found in 42 cases (35%). Patients over 45 years (75.6%) had higher PD-L1 positivity compared to those under 45 years (24.4%). 31% of squamous cell carcinoma was PD-L1 positive compared to adenocarcinoma (29%). PD-L1 expression was more frequent in poorly differentiated carcinoma (37.5%). CONCLUSION:A significant proportion of cervical cancers expressed PD-L1 . Increased PD-L1 expression was seen with increasing age and poorly differentiated histological grade. Anti- PD-L1 immunotherapy can be an option in PD-L1 -positive cervical cancer. The findings of our study support the requirement for further investigation of anti- PD-L1 immunotherapy for the treatment of PD-L1 -positive cervical carcinomas.

Primary non-Hodgkin lymphoma (NHL) of the urinary bladder in the paediatric age group is an unusual neoplasm. Patients mostly present with haematuria, lower urinary tract symptoms and abdominal pain. The clinical, radiological and histological findings are non-specific. It is difficult to differentiate it from more common congeners in this age bracket, such as rhabdomyosarcoma, on the basis of imaging. The diagnosis is made on the basis of histopathological characteristics and is confirmed by immunohistochemical (IHC) analysis. Herein, we report a case of a six-year-old male child who presented with lower urinary tract symptoms and abdominal pain for a duration of two months. He was further evaluated using cross-sectional imaging, and histopathological examination with immunohistochemistry confirmed the diagnosis of NHL (Burkitt lymphoma). He was treated with one cycle of COP (cyclophosphamide, oncovin and prednisone), followed by one cycle of COPDAM (cyclophosphamide, oncovin, prednisone, doxorubicin (Adriamycin) and methotrexate). Follow-up contrast-enhanced computed tomography (CECT) revealed a 60% reduction in tumour size. This case highlights the importance of early diagnosis based on histopathology and IHC, and demonstrates that timely initiation of appropriate chemotherapy can lead to favourable outcomes in NHL.

Background:Non-secretory multiple myeloma (NSMM) is defined as clonal bone marrow plasma cells ≥10% or biopsy proven plasmacytoma, evidence of end-organ damage due to underlying plasma cell dyscrasia, namely hypercalcemia, renal insufficiency, anaemia, bone lesions and lack of serum and urinary monoclonal protein on electrophoresis and immunofixation. They represent 3-5% of multiple myeloma (MM). With the advent of serum free light chain (s FLC) measurement, most of NSMMs have been classified as Light chain Multiple myeloma (LCMM). Thus, the proportion of true NSMM, meaning MM that secretes no monoclonal protein (complete immunoglobulin, heavy or light chain) is close to 1-2% of all myelomas. There is a need to distinguish between the true non-secretory from the other forms of oligo-secretory (OSMM) and secretory form of myeloma like LCMM with use of advanced diagnostic tools such as s FLC assay as the former has a good prognosis. Case Presentation:We discuss a case of a 65-years-old female who presented with chronic chest pain since one year. Cardiac and musculoskeletal involvement were ruled out. Monoclonal gammopathy was suspected in view of imaging abnormalities. Surprisingly, SPE and IFE reported absence of M band. A provisional diagnosis of NSMM was made based on biopsy features. However, diagnosis of NSMM was later changed to LCMM in view of a positive sFLC ratio. Conclusions:It is well-known that the sequence of diagnostic investigations plays a crucial role in the timely diagnosis and management of patients. However, in this case it was a faulty sequence of ordering investigations which prolonged the hospital stay and delayed therapeutic intervention for the patient concerned. Serum Protein Electrophoresis (SPE), Immunofixation electrophoresis (IFE) and sFLC are simple blood-based tests which can help diagnose a majority of cases of monoclonal gammopathies. They need to be included as first line tests in our approach to evaluating a suspected case of monoclonal gammopathy.

Gallbladder (GB) adenocarcinoma accounts for 10

Breast leiomyoma is a rare neoplasm, accounting for less than 1

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.

Objective: Gallstone disease (GSD) and non-alcoholic fatty liver disease (NAFLD) share common risk factors. NAFLD can progress to non-alcoholic steatohepatitis (NASH), which may lead to severe liver conditions. This study aimed to assess the prevalence of NASH and associated factors in patients with GSD and fatty liver undergoing cholecystectomy. Material and Methods: This prospective observational study was conducted from March 2021 to June 2023 and included 134 patients diagnosed with GSD and fatty liver based on preoperative ultrasound. Core liver biopsies were obtained during cholecystectomy. Preoperatively, clinical, anthropometric, demographic, biochemical variables, and FibroScan parameters were recorded. Results: NASH was found in 21 (15.67%) patients, while 50 (37.31%) patients had probable NASH, and 63 (47.01%) had non-NASH scores. Metabolic syndrome was present in 63.6% of the patients. Univariate analysis revealed significant differences in AST and ALT values between the NASH and nonNASH groups. In multivariate analysis, AST was statistically significant (p= 0.041). Mean controlled attenuation parameter in patients with non-NASH was 219.40 +/- 60.44 dB/m, and in patients with NASH, it was 265.48 +/- 63.47 dB/m (p= 0.006). Fibrosis was present in 33 of the 82 slides examined, with 17 patients having grade 2 and two patients with grade 3 fibrosis. Conclusion:The The high prevalence of NASH among GSD patients highlights a significant public health issue, prompting consideration for liver biopsy in individuals with NAFLD and GSD undergoing laparoscopic cholecystectomy.

Ossifying fibroma is a type of fibro-osseous lesion categorised into cemento-ossifying fibroma and juvenile ossifying fibroma. Malignant transformation of fibro-osseous lesions is documented especially for fibrous dysplasia, but scarcity is seen when we search for malignant transformation of ossifying fibroma. Thus, we are presenting an extremely rare case of cemento-ossifying fibroma transforming into osteosarcoma with long sequential radiographic details.

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.

Usually, symptomatic ovarian cysts in pregnancy require surgical removal in the second trimester. However, occasionally, large ovarian cysts may be encountered in the third trimester, which might hinder normal vaginal delivery. Herein, we present one such case to highlight the challenges of managing a large ovarian cyst in a full-term pregnancy.

The incidence of febrile neutropenia secondary to high-dose methotrexate is not an uncommon adverse reaction in hematology patients. However, acute kidney injury (AKI) following the combination of piperacillin and vancomycin in pediatric patientsis a relatively uncommon adverse drug reaction. In this report, an 11-year-old male patient in the pediatric hematologydepartment presented with febrile neutropenia and mucositis postchemotherapywith high dose methotrexate for B-ALL (acute lymphoblastic leukemia) as induction therapy. For that, he was treated with a combination (piperacillin-tazobactam + vancomycincombination) of antibiotics along with supportive treatment. Two days after theinitiation of this combination, the patient presented with derangement of renal parameters and serumpotassium levelsand developedacute kidney injury. After the combination of antibiotics was stopped andthe antibiotics were switched to teicoplanin and cefoperazone-sulbactam combination, the patient’s renal parameters recovered in the subsequent 3—4 days, and the patient was discharged with a normal hematological and renal profile in stable condition. This case report highlights the incidence of acute kidney failure with hyperkalemia as an adverse drug reaction secondary to combination antibiotic therapy consisting of piperacillin-tazobactam + vancomycin. This adverse drug reaction can be considered “possible” according to the WHO casualty assessment.

Background: Primary malignant melanoma rarelyoccurs in the oral cavity. The tongue is a particularly unusual primary site; lesions may be pigmented or amelanotic. Primary malignant melanoma is frequently mistaken for squamous cell carcinoma.Case Report: A 27-year-old male presented with a large, painless, ulceroproliferative mass on the dorsal surface of the tongue for 6 months. Squamous cell carcinoma was suspected, and the lesion was biopsied. Histopathology was compatible with primary amelanotic malignant melanoma. The patient had no cutaneous lesions consistent with malignant melanoma, and no definitive metastatic lesions were found. Ultrasound and computed tomography did not reveal any evidence of regional draining lymph node metastasis or suspicious lesions anywhere else in the body. The patient underwent composite resection of the tongue tumor and bilateral neck lymph node dissection, had an uneventful postoperative recovery, but was lost to follow-up.Conclusion: Primary oral amelanotic malignant melanoma is a highly aggressive, potentially fatal tumor and because of its rarity, presents a diagnostic challenge. The ideal treatment modality for primary malignant melanoma of the tongue is poorly defined, but surgery is regarded as the most effective course of therapy.