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Introduction Squamous cell carcinoma (SCC) is the most common type of penile cancer, and infection with human papillomavirus (HPV) is one of the most highly associated risk factors. The WHO classification for penile SCC (2022) strongly recommends and advocates penile SCC to be reported as HPV-associated or HPV-independent type in pathology reports. Further, p16 immunohistochemistry (IHC) is recommended to classify SCC into the above major types, although it is not completely reliable for HPV infection. Although there are no established differences in the prognosis or treatment between HPV-associated and HPV-independent penile tumours, there is recent evidence to suggest that HPV-associated SCC may respond better to radiation therapy, immunotherapy, etc. Aim and objectives This study aims to = analyse the clinicopathological features of penile squamous cell carcinoma and reclassify penile SCC into HPV-associated and HPV-independent types to align with the WHO classification of penile carcinoma (2022) and study the expression of p16 by immunohistochemistry. Additionally, we studied the prognostic significance of HPV-associated and independent SCC based on histology and p16 immunostaining. Materials and methods This is a five-year retrospective single-institution study that included all diagnosed cases of penile SCC. Clinicopathological features and p16 expressions were studied and analysed. Results A total of 72 cases of penile SCC were included during the study period. The mean age of occurrence of penile SCC was 58 years. The most common site of the tumor was the glans penis (50.74%). We encountered only 6 cases (8.3%) of HPV-associated type of penile SCC, while the majority belonged to the HPV-independent type (91.7%) based on histology. p16 immunohistochemistry showed positivity in 15 cases (21%) and negativity in 57 cases (79%). Most of the tumors showed favorable features– histological grade I, pathological T1 stage with a low incidence of nodal metastasis. There was a strong association between histological subtyping into HPV-associated and independent SCC with p16 IHC expression ( p  = 0.015). Classification of penile SCC by histology and p16 expression into HPV associated and independent type showed no prognostic significance with pathological stage but was significant with histological grade and lymph node metastasis.

Background Blastoid mantle cell lymphoma (B-MCL) is a rare aggressive lymphoma. It is characterized by blastoid morphology with high proliferation and inconsistent immunohistochemistry (IHC), making it a diagnostic challenge for the pathologist. Methods This is a retrospective analytical cohort study. We reviewed biopsy confirmed cases of B-MCL diagnosed over a period of 10 years (January 2012 to December 2022). The clinical presentation, histopathological and IHC findings, treatment received, and survival outcomes were studied. Randomly selected cases of classic MCL (n=12), diagnosed during the same period served as controls. Results A total of 12 cases were studied. Four cases were transformed from previously diagnosed MCL; 8 cases arose de novo. Mean age was 61.17 years and the male: female ratio was 5:1. Half of the cases showed extra nodal extension and 81.8% had bone marrow involvement. Gastrointestinal tract was the most common site of extra nodal involvement. Histopathological examination showed diffuse involvement of the lymph node with medium sized cells. On immunohistochemistry, one of the cases showed loss of CD5 expression while the other had aberrant CD10 expression. Mean Ki-67 index was 58.09% in the cases and 16.33% in controls and was statistically significant ( p=0.005). The median overall survival (OS) for cases was 2 years vs 8 years in controls. The p53 over expression (>30% nuclear positivity) was seen in 66.6% cases (4/6). Conclusion There are several factors that contribute to the aggressiveness of B-MCL, and new treatment approaches might be required to improve patient outcomes.

Background Muscle-invasive bladder carcinomas (MIBCs) exhibit significant heterogeneity, with diverse histopathological features associated with varied prognosis and therapeutic response. Although genomic profiling studies have identified several molecular subtypes of MIBC, two basic molecular subtypes are identified - luminal and basal, differing in biological behaviour and response to treatment. As molecular subtyping is complex, surrogate immunohistochemical (IHC) markers have been used to determine the molecular subtypes with good correlation to genomic profiling. Methods We analysed the clinicopathological features of 66 cases of MIBCs received over a 5-year study period. IHC expression was determined using GATA3 and CK5/6 to classify MIBC into luminal, basal and double-negative subtypes. The association between clinicopathologic variables and molecular subtypes were analysed using Chi-square test. Results The mean age at diagnosis of MIBC was 65.91 years with a male predominance. Based on IHC expression of GATA3 and CK5/6, MIBCs were classified into luminal, basal and double negative subtypes in 62.1%, 30.3% and 7.6% respectively. The luminal subtype occurred at an older age and showed predominantly conventional urothelial carcinoma with papillary morphology. Basal subtype occurred at earlier age, showed greater association with smoking and was more commonly associated with urothelial carcinoma with non -papillary morphology and exhibiting divergent differentiation as well as pure squamous cell carcinoma on histopathological examination. The double-negative subtype was found exclusively in males and exhibited a non-papillary morphology. Notably, all diagnosed neuroendocrine carcinomas were classified as double-negative type. While there was no statistically significant difference in tumour stage in cystectomy specimens between the molecular subtypes, lympho-vascular invasion and lymph node metastasis was more commonly associated with the basal type ( p  < 0.05) There was no significant difference in recurrence rates, metastasis and death between luminal and basal subtypes. Conclusion A simple two-antibody panel using GATA3 and CK5/6 could help in classifying MIBC into basic molecular subtypes of MIBC with distinctive histopathological features that can provide insights into the corresponding molecular subtype. Greater association of lymphovascular invasion and lymph nodal involvement in cystectomy specimens in basal type and distant metastasis in the double-negative subtype suggests a more aggressive clinical behaviour of these, necessitating more intensive treatment.

Background HER2-positive breast carcinomas are a heterogeneous group with various clinicopathological characteristics depending on hormone receptor (HR) status. This study aimed to analyze and compare the clinical and histopathological features of HER2-positive breast carcinomas across three subgroups: Group 1: Triple-positive (ER+/PR+/HER2+), Group 2:ER-positive only (ER+/PR-/HER2+), and Group 3: HER2-enriched (ER-/PR-/HER2+). Methods This was a single-institution, retrospective, cross-sectional study conducted over 42 months (January 2021–June 2024) at a tertiary care center comprising of 117 HER2-positive breast carcinoma cases. The demographic, clinical, and histopathological parameters were studied retrospectively. Statistical analysis was performed via SPSS Version 29.0, employing ANOVA and chi-square tests, with p < 0.05 considered significant. Results Among 117 HER2-positive breast cancer patients, left and right breast involvement was nearly equal. Most were diagnosed via core biopsy (83.8%), with the upper outer quadrant most commonly affected (42.9%). Invasive breast carcinoma of no special type was the predominant subtype. The HER2-enriched group (Group 3) had the highest mean age (57.28 years; p = 0.001) and the most Grade 3 tumors (36.1%; p = 0.005). Although Group 2 (ER-positive) had the largest mean tumor size (4.31 cm), the difference was not statistically significant ( p = 0.143). Lymphovascular invasion, necrosis, Ductal carcinoma in situ (DCIS), and skin involvement showed no significant differences across groups. ANOVA showed significant variation in age and grade, and post-hoc analysis confirmed that Group 1 vs Group 3 differed significantly in both age ( p = 0.001) and grade ( p = 0.004). Conclusion HER2-positive breast carcinomas show variability by HR status. The HER2-enriched subtype is associated with older age, higher histological grade, and advanced nodal stage, suggesting a more aggressive phenotype. Recognizing these patterns aids in accurate prognostication and guiding individualized therapy.

Conn’s syndrome is an important endocrine cause for secondary hypertension. Hypokalaemia paralysis and rhabdomyolysis with accelerated hypertension may be the presenting symptoms of Conn’s syndrome. Here, we present one such case of a 38-year-old woman presenting with accelerated hypertension and acute onset quadriplegia. On biochemical evaluation, she was found to have severe hypokalaemia, metabolic alkalosis and elevated creatinine phosphokinase. Further evaluation revealed an elevated aldosterone renin ratio suggestive of primary hyperaldosteronism which was localised to left adrenal adenoma on contrast-enhanced CT. Patient’s blood pressure and serum potassium levels normalised after resection of the adrenal adenoma.

Background: Transurethral resection of bladder tumour (TURBT) is the traditional technique of choice for endoscopically suspected bladder tumours. Cold En Bloc Excision (CEBE) using novel Zedd scissors is proposed for endoscopic treatment of patients with non-muscle invasive bladder cancer (NMIBC). The aim of this study was to evaluate feasibility and safety of CEBE of bladder tumours using Zedd scissors. Methods: A pilot prospective study of patients who underwent a CEBE of suspicious bladder tumours using Zedd scissors was conducted. A total of 23 patients underwent CEBE for suspected bladder tumours using Zedd scissors. New and recurrent tumours <3 cm were included in the study. The outcome measures were the presence of detrusor muscle (DM) and obturator nerve reflex (ONR), bladder perforation rates, specimen cautery artefacts, recurrence rates and complication rates. The mean age was 64 years ± 10.41 (range: 49–83 years). The median follow up was 4 months (range 1–9 months). The mean tumour size was 1.8 cm ± 0.40 (range: 0.8–2.6 cm). Tumours were located in the lateral wall (n = 11), dome (n = 2), posterior wall (n = 6), trigone (n = 2), anterior wall (n = 4) and the junction of lateral and posterior wall (n = 4). Results: There was no ONR or bladder perforation and none of the patients had any complications. DM was present in 21 patients (91%). There was no tumour identified at the circumferential margins. There was no cautery artefact reported in any case. No patients had a recurrence at first follow up cystoscopy and two patients had out of field recurrence at subsequent cystoscopies. Conclusion: CEBE with Zedd scissors is a promising en bloc excision technique for bladder tumour. It is a safe and feasible for excision of tumours less than 3 cm. The early oncological outcomes are comparable with existing en bloc resection techniques (ERBT) for NMIBC.

Description A 35-year-old woman presented with raised red lesions over the elbow at the site of a prior injury from a road traffic accident which had occurred 3 years ago.

Xanthogranulomatous inflammation, which is known to occur in several viscera, is rarely found to affect the pancreas. We report a case of xanthogranulomatous pancreatitis (XGP) occurring in a 60-year-old man who presented with epigastric pain and vomiting. Physical examination did not reveal any abnormality. Contrast-enhanced CT of the abdomen revealed an ill-defined, heterogeneous mass lesion in the uncinate process of the pancreas, suggestive of malignancy. Whipple's pancreaticoduodenectomy was performed and the final pathological diagnosis was XGP. The patient's postoperative course was uneventful. When a pancreatic mass does not show clinicoradiological features typical of common pancreatic neoplasms, XGP should be considered for a differential diagnosis and duodenum preserving surgery can be considered.

Bowen's disease is generally regarded as premalignant dermatoses. The disease affects both skin and the mucosa and has the potential to progress to invasive squamous cell carcinoma. There are descriptions of several histological variants of Bowen's disease like psoriasiform, atrophic, pagetoid, etc. Acantholysis of anaplastic keratinocytes with bullae/cleft formation is described in premalignant condition like actinic keratosis and adenoid variant of squamous cell carcinoma, but there is lack of report describing this phenomena in Bowen's disease. We present a case of unusual acantholytic variant of Bowen's disease with focus of micro-invasive carcinoma.

Background Myoepitheliomas account for less than 1% of salivary gland tumors. They mostly affect the parotid glands of adults during the third to fifth decades. Case presentation A 10-year-old Indian boy reported a small swelling in the roof of his mouth of 10 days’ duration. History revealed that the lesion was painless and not associated with bleeding or pus discharge. On examination, a purplish well-circumscribed growth was noted on his posterior hard palate. Magnetic resonance imaging was suggestive of a well-encapsulated hemangioma. An excisional biopsy was performed and histopathology along with immunohistochemistry analysis showed that the lesion was a spindle cell variant of benign myoepithelioma. Conclusion Palatal myoepitheliomas are rare and their occurrence in young individuals is rarer.