Day 1 :
Keynote Forum
Nidhi Anand
Dr. Ram Manohar Lohia Institute of Medical Science, India
Keynote: DIAGNOSTIC VALUE OF BRAFV600E IMMUNOCYTOCHEMISTRY IN THYROID ASPIRATES IN BETHESDA CATEGORY IV AND PAPILLARY CARCINOMA THYROID.
Biography:
Dr. Nidhi Anand, currently working as Associate Professor in Department of Pathology at Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow. She completed her MBBS and Post graduation from one of the most prestigious instututes in India. She is an able histopathologist with keen interest in Endocrine and Head & Neck Pathology. She is involved in the field of research and actively participates in both undergraduate and post graduate teaching. She has published papers in national and international journals.
Abstract:
AFFILIATION: 1.Department of Pathology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow UP, India, 2. Department of Endocrine Surgery, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, UP, India.
INTRODUCTION AND OBJECTIVE: The BRAFV600E is a common mutation in papillary thyroid carcinoma (PTC) associated with aggressive behaviour. In Bethesda category III, IV and V of thyroid cytology, the use of immunocytochemistry (ICC) and molecular testing is recommended to refine the diagnosis. The present study aimed to assess BRAFV600Eexpression in thyroid aspirates and corresponding histology specimens and to evaluate the diagnostic efficacy of conventional FNAC vs FNAC with BRAFV600E testing in Bethesda category IV and V, VI of PTC.
METHODOLOGY: This study prospectively enrolled 40 cases with thyroid aspirate of Bethesda category IV and V, IV of PTC. IHC for BRAFV600E was performed on cell blocks and corresponding histology sections. The diagnostic efficacy in the diagnosis of these lesions was assessed.
RESULTS: Our results included 25 lesions in category IV and 15 in category V &VI. The diagnostic sensitivity of ICC in thyroid aspirates was 81.82%, specificity 100%, positive predictive value 100%, negative predictive value 93.55% and accuracy 95%.
DISCUSSION & CONCLUSION: In category III, IV and V BRAFV600Emutation analysis is needed to better define the extent the initial surgery. BRAFV600Emutation can be druggable using BRAFV600E inhibitor molecules in some selected patients that improves disease free and overall survival in BRAFV600E positive cases. All BRAFV600E negative cases on cytology with Bethesda category IV, V and VI; BRAFV600E testing should be repeated on corresponding histology samples to ensure accurate mutation status.
ACKNOWLEDGEMENT: Financial assistance to intramural research grant IEC 3/16
KEYWORDS: BRAFV600Emutation, Cyto-diagnosis, Diagnostic efficacy, Bethesda category
Keynote Forum
Anurag Gupta
Dr.Ram Manohar Lohia Institute of Medical Sciences, India
Keynote: Role Of PAX8 in the Screening Immunocytochemistry Panel for Carcinomatous Effusions in Women
Biography:
Dr. Anurag Gupta has completed his MD at the age of 31 years from Allahabad University and did senior residency from All India Institute of Medical Sciences, New Delhi, India. He is the Professor of Pathology at Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India. He is incharge of cytopathologfy laboratory with special interest in cytopathology, breast pathology and oncopathology. He has published more than 15 papers in reputed journals and has been serving as secretary Indian Academy of Cytologists- U.P. Chapter.
Abstract:
Introduction and Objectives: Many of malignant effusion cases with unknown primary have cytomorphological overlap. Due to this diagnostic difficulty, immunocytochemistry (ICC) on cell block can be used to get insight into the primary site. It was aimed to evaluate addition of PAX8 in the screening ICC panel for carcinomatous effusions in women.
Methods & Materials: Total 892 effusion samples were evaluated, out of which 75(8%) (50 women & 25 men) comprised of carcinomatous effusion. Study included 44/50 (88%) (38 peritoneal & 6 pleural) samples with adequate cell blocks. Primary panel of ICC markers comprised of calretinin, CK7, CK20, CDX2, WT1, mammoglobin, CK 5/6 and PAX8.
Results: On follow up, the commonest site of primary malignancy (35/44) was ovary with sensitivity, specificity, positive predictive value and negative predictive value of CK 7- 97.14%,11.11%, 80.95 & 50%, of WT-1-51.4%,100%, 100% & 34.6%, of PAX8 71.43%,100%, 100% & 47.37% and of combined WT-1 & PAX8 74.29% ,100 %, 100% & 50% respectively.
Conclusion: Most common cause of carcinomatous effusion among women was was ovary followed by Breast, gall bladder and GIT. WT-1 is a highly sensitive and specific marker for ovarian malignancies, however its sensitivity is lesser than PAX-8. WT-1 is also expressed in mesothelium and is unable to detect mucinous and clear cell adenocarcinoma of ovary, however PAX-8 can identify all Müllerian derived benign or malignant epithelial neoplasms. Since ovarian carcinoma is the commonest cause of malignant effusion among women, it is worth to include Pax-8 with other markers in the screening ICC panel.
- Hematopathology, Anatomical Pathology, Clinical Pathology, Dermatopathology
Location: Webinar
Session Introduction
NAMRATA PUNIT AWASTHI
RAM MANOHAR LOHIA INSTITUTE OF MEDICAL SCIENCES, India
Title: Structural parameters for WBC in Adult Sepsis
Biography:
Namrata P Awasthi has completed her MD at the age of 29 years from King George’s Medical University, Lucknow, India and senior residency in Lab Hematology from SGPGIMS, Lucknow. She is Professor of Pathology (Hematopathology), at Dr RMLIMS, Lucknow, India, a premier Tertiary Health Care Teaching Institute in North India. She has published more than 30 papers in reputed journals and has been serving as reviewer for reputed journals. Her areas of interest include Leukemia, Lymphoma, Myeloma, Flow cytometry, Circulating tumor cell detection, DNA ploidy in in Liquid based Cytology.
Abstract:
Background and Purpose: Newer hematology analyzers offer structural parameters for WBC (SPW) obtained from a routine blood count and can provide quantitative information about the inflammatory reaction of the patient’s immune system. SPW obtained from Sysmex XN1000 automated hematology analyzer were evaluated as prospective biomarkers for sepsis diagnosis in adult patients.
Methodology: Adult patients admitted in (ICU n=52) were included in the study. Acute change in SOFA score of 2/more with clinical suspicion and/or culture positivity formed the basis of sepsis diagnosis. Whole blood sample in EDTA for blood counts was collected within 24hours of clinical suspicion for infection. Other investigations were performed as per the standard protocol in ICU. Following structural WBC parameters related to side scatter, side fluorescence, forward scatter and distribution width obtained from Sysmex XN1000 analyzer were evaluated: NE-SSC, NE-SFL, NE-FSC, MO-X, MO-Y, MO-Z, MO-WX, MO-WY and MO-WZ. Data was analyzed on SPSS software and represented as mean±SD. Difference in mean calculated by unpaired t test.
Results and discussion: Cases were categorized into Sepsis n=27 and Disease control n=25. Mean ±SD (p) for NE-SFL(neutrophil fluorescence) and NE SSC(neutrophil side scatter) in sepsis vs. disease control were 69.62±7.10 vs. 60.11±6.12( p=0.000) and 155.76±3.24vs. 151.58±5.44(p=0.002) respectively. For Monocyte parameters, only MO-X(Monocyte side scatter) was significantly different in both the groups (125.66±4.60 vs 120.81±3.12, p=0.000).
Conclusion: We observed that certain SPW revealed remarkable changes in patients of sepsis as compared to non-sepsis patients admitted in ICU. A combination of SPW along with biomarkers of sepsis like Procalcitonin and QCRP may add valuable information for early diagnosis of sepsis before culture results.
JOANNA SAWICKA
College of Medical Sciences of University of Rzeszów, Poland
Title: Ischemic stroke complicating transsphenoidal pituitary macroadenoma resection.
Biography:
Joanna Sawicka is a fourth year medical student of College of Medical Sciences of University of Rzeszów. Macroadenomas are common beningn hypophyseal tumours, that may cause disruption of visual field [1] or other symptoms by mass effect [2]. Following the diagnosis a trans-sphenoid tumor removal is the treatment of choice in patients with visual field impairment [3]. We would like to present a rare case of a patient with ischemic stroke being an macroadenoma resection complication.
Abstract:
Introduction:
Macroadenomas are common beningn hypophyseal tumours, that may cause disruption of visual field [1] or other symptoms by mass effect [2]. Following the diagnosis a trans-sphenoid tumor removal is the treatment of choice in patients with visual field impairment [3]. We would like to present a rare case of a patient with ischemic stroke being an macroadenoma resection complication.
Case report:
A 47-year old female was admitted to the Clinic of Neurosurgery for removal of a nonfunctioning macroadenoma of pituitary gland causing progressive decrement of visual field. A trans-sphenoidal resection was performed with the tumor incomplete resection. Sudden dysarthria and right side hemiplegia have been observed in 24h post-operative period. The MRI revealed an ischemic area of left subcortical region and intrapituitary hemorrhage with substantial regional edema. Several days after surgery prominent mixed aphasia appeard and enlargement of ischemic area to entire left MCA supply territory. Compression of distal ICA or proximal MCA by sudden volumetric expansion of the macroadenoma as a result of bleeding inside the tumor was considered the most probable mechanism of ischemia.
Conclusions:
Transsphenoidal surgery is a procedure of choice for removal of the pituitary macroadenoma. It is considered safe, but occasionally serious complications of surgery can occur, with pituitary apoplexy being one of them. The postoperative hemorrhage into residual adenoma may cause compression of adjacent structures including optic chiasm, cranial nerves and distal portion of ICA. The latter complication is extremally rare and was reported in only few case reports.
Biography:
Dr. Innocent Emmanuel is a 39 years old Medical Doctor, a graduate of the University of Jos Medical School (2007), a fellow of Nigerian Postgraduate Medical College (2014), a fellow of the West African College Of Physicians (2015), and Just Completed a Masters degree in Public Administration at the National Open University of Nigeria. He is a Senior Lecturer with the University of Jos and has published 28 articles in reputable journals. He is also a Consultant Pathologist at the Jos University Teaching Hospital since 2015.
Abstract:
Introduction: The developing world is arguably characterized by backwardness or rudimentary political, social, and economic systems of which the health system is not immune to resulting in worst health indices. Pathology services in these climes which are characterized by system delay in obtaining and processing biopsy samples and reporting the results, with consequent delay the starting of treatment. The broad objective of this research study is to determine the impact of service delivery on the turn-around time of histopathological surgical biopsies in Nigerian public Health sector with reference to the Jos University Teaching Hospital. Specifically, the objectives of this research study are to investigate the impact of reliability, assurance, tangibility, empathy and responsiveness on the turn-around time of the laboratory.
Methodology: To meet these objectives, the original SERVQUAL instrument created by Parasuraman et al in 1985 with its 5 dimensions of service delivery and 22 questions thereof was adopted with some modifications. This questionnaire was distributed to 308 patients that sought the service of the Histopathology laboratory department in the hospital.
Result: The research revealed a turn-around time of 3days to 30days with a mean of 12.83+3.14 days. The research established positive influence of tangibility and reliability (two of the five dimensions of service delivery) on turn-around time. The research also revealed that the remaining three dimensions of service delivery (assurance, empathy, and responsiveness) had no significant impact on turn-around time.
Conclusion: This study has shown that the SERVQUAL tool of service delivery can be used in assessing turn-around time in the histopathological laboratory. This is novel as to the best our knowledge this tool has never been employed in this regard. Furthermore, it brings to the fore the importance of tangibles and reliability as two important service delivery dimensions that have significant impact on the turn-around time of surgical biopsies in histopathological laboratories.
Subrat Chandra
, Dr.Ram Manohar Lohia Institute of Medical Sciences, India
Title: Malignant soft tissue neoplasms diagnosed on cytology and with cell block immunocytochemistry
Biography:
Dr. Subrat Chandra has completed his MD from Himalyan Institute of Medical Sciences, Jolly Grant,Dehradun ,India in year 2006 at the age of 27 years and did senior residency and as lecturer from UP Rural Institute of medical Sciences, Saifai, Etawah UP,India. He is the Professor of Pathology at Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India. He is incharge and Head of Department of Transfusion Medicine laboratory. He has published more than 15 papers in reputed journals and has been serving as member Indian Academy of Cytologists- U.P. Chapter and Indian association of Pathology and Microbiology.
Dr. Subrat Chandra, Professor of Pathology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Vibhuti Khand, Gomti Nagar, Lucknow-226010.
Abstract:
Introduction and Objectives: Soft tissue neoplasms (STNs) are uncommon tumors and present with difficulties in diagnosis and classification. Assigning a pathologic type or grade to an individual sarcoma as a means of predicting clinical behavior is often difficult.
Methods & Materials: The objective of this study was to assess the diagnostic value of cytology with cell-block immunocytochemistry as an adjunct to cytomorphology in the diagnosis and sub typing soft tissue tumors. The study included case series of 60 cases of clinically suspected malignant STTsin which FNA was done from swellings,smears were prepared from aspirated material and sample was also procured for cell-block and cell block immunocytochemistry (CB- ICC).
Results: The study included 60 cases of clinically suspected malignant STNs. Males were more commonly affected with maximum cases presenting in fifth to sixth decade. Histopathological confirmation in 49 cases, gave a diagnostic accuracy of 93.33%, with sensitivity of 95.12% and specificity of 75%. Spindle cell tumors (47%) accounted for the majority of the cytodiagnosed cases in our series. Sub-typing on cytomorphology alone was possible in 28.20% cases, which further increased up to 64.10% with application of CB-ICC.
Conclusion: The present study concluded that FNAC can be used as a reliable diagnostic tool for preoperative triaging of benign and malignant STN with fair sensitivity, specificity, and accuracy, and if supplemented with CB-ICC, even further sub-typing is possible in good number of cases.
.
Subrat Chandra
, Dr.Ram Manohar Lohia Institute of Medical Sciences, India
Title: Malignant soft tissue neoplasms diagnosed on cytology and with cell block immunocytochemistry
Biography:
Dr. Subrat Chandra has completed his MD from Himalyan Institute of Medical Sciences, Jolly Grant,Dehradun ,India in year 2006 at the age of 27 years and did senior residency and as lecturer from UP Rural Institute of medical Sciences, Saifai, Etawah UP,India. He is the Professor of Pathology at Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India. He is incharge and Head of Department of Transfusion Medicine laboratory. He has published more than 15 papers in reputed journals and has been serving as member Indian Academy of Cytologists- U.P. Chapter and Indian association of Pathology and Microbiology.
Dr. Subrat Chandra, Professor of Pathology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Vibhuti Khand, Gomti Nagar, Lucknow-226010.
Abstract:
Introduction and Objectives: Soft tissue neoplasms (STNs) are uncommon tumors and present with difficulties in diagnosis and classification. Assigning a pathologic type or grade to an individual sarcoma as a means of predicting clinical behavior is often difficult.
Methods & Materials: The objective of this study was to assess the diagnostic value of cytology with cell-block immunocytochemistry as an adjunct to cytomorphology in the diagnosis and sub typing soft tissue tumors. The study included case series of 60 cases of clinically suspected malignant STTsin which FNA was done from swellings,smears were prepared from aspirated material and sample was also procured for cell-block and cell block immunocytochemistry (CB- ICC).
Results: The study included 60 cases of clinically suspected malignant STNs. Males were more commonly affected with maximum cases presenting in fifth to sixth decade. Histopathological confirmation in 49 cases, gave a diagnostic accuracy of 93.33%, with sensitivity of 95.12% and specificity of 75%. Spindle cell tumors (47%) accounted for the majority of the cytodiagnosed cases in our series. Sub-typing on cytomorphology alone was possible in 28.20% cases, which further increased up to 64.10% with application of CB-ICC.
Conclusion: The present study concluded that FNAC can be used as a reliable diagnostic tool for preoperative triaging of benign and malignant STN with fair sensitivity, specificity, and accuracy, and if supplemented with CB-ICC, even further sub-typing is possible in good number of cases.
.
Subrat Chandra
, Dr.Ram Manohar Lohia Institute of Medical Sciences, India
Title: Malignant soft tissue neoplasms diagnosed on cytology and with cell block immunocytochemistry
Biography:
Dr. Subrat Chandra has completed his MD from Himalyan Institute of Medical Sciences, Jolly Grant,Dehradun ,India in year 2006 at the age of 27 years and did senior residency and as lecturer from UP Rural Institute of medical Sciences, Saifai, Etawah UP,India. He is the Professor of Pathology at Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India. He is incharge and Head of Department of Transfusion Medicine laboratory. He has published more than 15 papers in reputed journals and has been serving as member Indian Academy of Cytologists- U.P. Chapter and Indian association of Pathology and Microbiology.
Dr. Subrat Chandra, Professor of Pathology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Vibhuti Khand, Gomti Nagar, Lucknow-226010.
Abstract:
Introduction and Objectives: Soft tissue neoplasms (STNs) are uncommon tumors and present with difficulties in diagnosis and classification. Assigning a pathologic type or grade to an individual sarcoma as a means of predicting clinical behavior is often difficult.
Methods & Materials: The objective of this study was to assess the diagnostic value of cytology with cell-block immunocytochemistry as an adjunct to cytomorphology in the diagnosis and sub typing soft tissue tumors. The study included case series of 60 cases of clinically suspected malignant STTsin which FNA was done from swellings,smears were prepared from aspirated material and sample was also procured for cell-block and cell block immunocytochemistry (CB- ICC).
Results: The study included 60 cases of clinically suspected malignant STNs. Males were more commonly affected with maximum cases presenting in fifth to sixth decade. Histopathological confirmation in 49 cases, gave a diagnostic accuracy of 93.33%, with sensitivity of 95.12% and specificity of 75%. Spindle cell tumors (47%) accounted for the majority of the cytodiagnosed cases in our series. Sub-typing on cytomorphology alone was possible in 28.20% cases, which further increased up to 64.10% with application of CB-ICC.
Conclusion: The present study concluded that FNAC can be used as a reliable diagnostic tool for preoperative triaging of benign and malignant STN with fair sensitivity, specificity, and accuracy, and if supplemented with CB-ICC, even further sub-typing is possible in good number of cases.
.