Paari Murugan - Academia.edu (original) (raw)

Papers by Paari Murugan

Research paper thumbnail of Cystic pleomorphic adenoma presenting with metaplastic epithelial changes, particularly squamous metaplasia with keratinization, often is a diagnostic dilemma for cytopathologists and histopathologists. Preoperative Cytodiagnosis of Cystic Pleomorphic Adenoma with Squamous Metaplasia and Choleste...

Research paper thumbnail of Performance Validation in Anatomic Pathology: Successful Integration of a New Classification System Into the Practice Setting Using the Updated Lung Non–Small Cell Carcinoma Recommendations

Archives of Pathology & Laboratory Medicine, 2014

The new, international, multidisciplinary classification of lung adenocarcinoma, from the Interna... more The new, international, multidisciplinary classification of lung adenocarcinoma, from the International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society, presents a paradigm shift for diagnostic pathologists. To validate our ability to apply the recommendations in reporting on non-small cell lung cancer cases. A test based on the new non-small cell lung cancer classification was administered to 16 pathology faculty members, senior residents, and fellows before and after major educational interventions, which included circulation of articles, electronic presentations, and live presentations by a well-known lung pathologist. Surgical and cytologic (including cell-block material) reports of lung malignancies for representative periods before and after the educational interventions were reviewed for compliance with the new guidelines. Cases were scored on a 3-point scale, with 1 indicating incorrect terminology and/or highly inappropriate stain use, 2 indicating correct diagnostic terminology with suboptimal stain use, and 3 indicating appropriate diagnosis and stain use. The actual error type was also evaluated. The average score on initial testing was 55%, increasing to 88% following the educational interventions (60% improvement). Of the 54 reports evaluated before intervention, participants scored 3 out of 3 points on 15 cases (28%), 2 of 3 on 31 cases (57%), and 1 of 3 on 8 cases (15%). Incorrect use of stains was noted in 23 of 54 cases (43%), incorrect terminology in 15 of 54 cases (28%), and inappropriate use of tissue, precluding possible molecular testing, in 4 out of 54 cases (7%). Of the 55 cases after intervention, participants scored 3 out of 3 points on 46 cases (84%), 2 of 3 on 8 cases (15%), and 1 of 3 on 1 case (2%). Incorrect use of stains was identified in 9 of 55 cases (16% of total reports), and inappropriate use of tissue, precluding possible molecular testing, was found in 1 of the 55 cases (2%). The study results demonstrated marked improvement in the pathologists' understanding and application of the new non-small cell lung cancer classification recommendations, which was sufficient to validate our use of the system in routine practice. The results also affirm the value of intensive education on, and validation of, pathologists' use of a classification or diagnostic algorithm.

Research paper thumbnail of Perivascular Epithelioid Cell Tumor of the Uterus with Ovarian Involvement: A Case Report and Review of the Literature

American Journal of Case Reports, 2016

BACKGROUND Perivascular epithelioid cell tumors (PEComas) are a rare group of neoplasms composed ... more BACKGROUND Perivascular epithelioid cell tumors (PEComas) are a rare group of neoplasms composed of epithelioid cells that express both melanocytic and myoid markers. When considering PEComas of the female genital tract, the uterus is the most common location. Involvement of the ovary in the context of a primary uterine PEComa, in the absence of systemic disease associated with tuberous sclerosis, however, has only been reported in 1 previous case. CASE REPORT We report a case of a PEComa of the uterus with metastasis to the left ovary in a 61-year-old Caucasian woman. Gross examination of the uterus revealed a 10.7×10.5×10.2 cm tan-brown, mostly solid, partially cystic mass. Microscopic examination showed epithelioid cells with clear to eosinophilic cytoplasm, arranged in fascicles. Intranuclear pseudoinclusions were also noted. The tumor cells were smooth muscle actin, caldesmon, and desmin positive (diffuse); HMB-45 positive (focal); and Melan-A, AE1/AE3, CD10, and S100 negative by immunohistochemistry. CONCLUSIONS Distinguishing among mesenchymal neoplasms, including PEComas, endometrial stromal sarcomas, and leiomyosarcomas, can be difficult. Careful analysis of morphologic and immunohistochemical features is of the utmost importance. Differential diagnosis, including morphologic features and immunohistochemical patterns, is also discussed.

Research paper thumbnail of Intratumoral morphologic and molecular heterogeneity of rhabdoid renal cell carcinoma: challenges for personalized therapy

Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc, Jan 26, 2015

Rhabdoid histology in clear-cell renal cell carcinoma is associated with a poor prognosis. The pr... more Rhabdoid histology in clear-cell renal cell carcinoma is associated with a poor prognosis. The prognosis of patients with clear-cell renal cell carcinoma may also be influenced by molecular alterations. The aim of this study was to evaluate the association between histologic features and salient molecular changes in rhabdoid clear-cell renal cell carcinoma. We macrodissected the rhabdoid and clear-cell epithelioid components from 12 cases of rhabdoid clear-cell renal cell carcinoma. We assessed cancer-related mutations from eight cases using a clinical next-generation exome-sequencing platform. The transcriptome of rhabdoid clear-cell renal cell carcinoma (n=8) and non-rhabdoid clear-cell renal cell carcinoma (n=37) was assessed by RNA-seq and gene expression microarray. VHL (63%) showed identical mutations in all regions from the same tumor. BAP1 (38%) and PBRM1 (13%) mutations were identified in the rhabdoid but not in the epithelioid component and were mutually exclusive in 3/3 c...

Research paper thumbnail of Percentage of sarcomatoid component as a prognostic indicator for survival in renal cell carcinoma with sarcomatoid dedifferentiation

Urologic oncology, Jan 21, 2015

Renal cell carcinoma with sarcomatoid dedifferentiation (sRCC) is associated with higher stage of... more Renal cell carcinoma with sarcomatoid dedifferentiation (sRCC) is associated with higher stage of presentation and worse survival. The objective of this study was to examine the clinicopathologic characteristics associated with overall survival (OS), specifically examining the percentage of sarcomatoid component (PSC). We reviewed clinicopathologic data for all nephrectomized patients with confirmed sRCC. Histologic slides were rereviewed by dedicated genitourinary pathologists to ascertain PSC. Patient characteristics were tabulated overall and by disease stage. Cutpoints in the PSC providing a meaningful difference in OS were identified by recursive partitioning analysis (RPA). Factors selected included age group, gender, race, clinical stage, tumor histology, presurgical systemic therapy, lymphovascular invasion, and tumor size. The Kaplan-Meier method and log-rank test were used to assess differences in OS. Among 186 patients with sRCC, 64 (34%) had localized, and 122 (66%) had ...

Research paper thumbnail of Aldo-keto reductase family 1 member C3 (AKR1C3) is expressed in adenocarcinoma and squamous cell carcinoma but not small cell carcinoma

International journal of clinical and experimental pathology, 2012

Human aldo-keto reductase family 1 member C3 (AKR1C3) was initially identified as a critical enzy... more Human aldo-keto reductase family 1 member C3 (AKR1C3) was initially identified as a critical enzyme in reducing 5α-dihydrotestosterone (5α-DHT) to 5α-androstane-3α,17β-diol (3α-diol) and oxidizing 3α-diol to androsterone. Based on these enzymatic activities, AKR1C3 was originally named type 2 3α-hydroxysteroid dehydrogenase (HSD)/type 5 17β-HSD. Additionally, AKR1C3 was demonstrated to be capable of metabolizing other steroids including estrogen and progesterone. Subsequently, AKR1C3 was shown to possess 11-ketoprostaglandin reductase activity in metabolizing prostaglandins and dihydrodiol dehydrogenase x (DDx) activity in metabolizing xenobiotics. Tissue distribution of AKR1C3 has been detected in both sex hormone-dependent organs such as the testis, breast, endometrium, and prostate as well as sex hormone-independent organs including the kidney and urothelium. Although prominent expression of AKR1C isozymes has been reported in human non-small cell lung carcinoma (NSCLC), the expr...

Research paper thumbnail of Madras Medical College: 175 years of medical heritage

The National medical journal of India

Research paper thumbnail of Origin of an Anomalous Left Coronary Artery from a Left Hilar Pulmonary Artery

Pediatric Cardiology, 2011

Anomalous coronaries arising in nontruncal regions of the pulmonary artery are exceedingly rare. ... more Anomalous coronaries arising in nontruncal regions of the pulmonary artery are exceedingly rare. We report an autopsy case of an anomalous left coronary artery that arose from the distal pulmonary artery at the hilum of the left lung in an infant with complex congenital heart disease. To the best of our knowledge, this is the first such report. This previously unknown coronary malformation led to a fatal intraoperative complication during a pulmonary angioplasty procedure.

Research paper thumbnail of Osseous metaplasia in renal cell carcinoma: Report of a rare case

Indian J Pathol Microbiol, 2008

Focal calcifications are frequently seen in renal masses including renal cell carcinoma (RCC). Os... more Focal calcifications are frequently seen in renal masses including renal cell carcinoma (RCC). Osseous metaplasia, on the other hand, is a rare finding in RCC. We report a case of RCC with radiological evidence of speckled calcification that showed osseous metaplasia on histopathological examination. The clinical and pathologic differential diagnosis for this tumor is discussed along with a review of the literature on this unusual phenomenon.

Research paper thumbnail of ALL presenting with a massive, lymphoid-rich, pericardial effusion is extremely rare. Cytologic Aspects of T-Cell Acute Lymphoblastic Leukemia Presenting as a Massive Pericardial Effusion A Case Report

Research paper thumbnail of Unusual ovarian malignancies in ascitic fluid: a report of 2 cases

Acta cytologica

Ovarian tumors of germ cell and sex-cord stromal derivation rarely exfoliate malignant cells in s... more Ovarian tumors of germ cell and sex-cord stromal derivation rarely exfoliate malignant cells in serous effusions. A precise tissue diagnosis in these cases may be possible on serous body fluid cytology with a combined clinical and cytopathologic approach. Ascitic fluid samples from 2 young women aged 23 and 25 years presenting with abdominal mass were cytologically analyzed, with relevant histochemical and immunohistochemical stains performed on cell block/histologic sections. Cytologically, the cases were interpreted as, or suspected to be, adenocarcinomas. However, subsequent histopathologic examination showed them to be yolk sac tumor (YST) and juvenile granulosa cell tumor (JGCT). Following histopathologic diagnosis, cytologic materials were reviewed, which revealed certain features such as hyaline globules in YST and distinct tubular structures in JGCT. These cytologic findings in view of the younger age of the patients should have prompted the correct diagnosis. This study emp...

Research paper thumbnail of Renal adenocarcinoma presenting as a groin swelling: a case report

The Indian journal of surgery, 2008

Renal cell carcinoma (RCC) is known to have myriad presentations due to the extremely vascular na... more Renal cell carcinoma (RCC) is known to have myriad presentations due to the extremely vascular nature of the organ. RCC are known to metastasize extensively to various organs of the body. We report a case of a 70-years-old male who presented with multiple inguinal lymph node enlargements which on excision biopsy showed metastatic adenocarcinomatous deposit. Search for the primary revealed a RCC arising from the left kidney. Inguinal lymph nodal metastasis, an uncommon site of distant metastasis in renal neoplasm, as a fi rst clinical sign leading to the diagnosis is not yet reported in literature.

Research paper thumbnail of Gelatinous transformation of bone marrow in acquired immunodeficiency syndrome

Pathology, 2007

... 3 Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry,... more ... 3 Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India. † Address for correspondence: Debdatta Basu, E‐mail: ddbasu@satyam.net.in. ... Ray R., Bhoria U., Varma N., Bambery P., Dash S. Gelatinous transformation of bone marrow. ...

Research paper thumbnail of Extraosseous Ewing’s sarcoma of the pancreas

International Journal of Clinical Oncology, 2012

The Ewing's family of tumors (EFT) comprises a molecularly defined group of ''small round blue ce... more The Ewing's family of tumors (EFT) comprises a molecularly defined group of ''small round blue cell tumors'', consisting of Ewing's sarcoma of bone (ESB), extraosseous Ewing's sarcoma (EES), peripheral primitive neuroectodermal tumor (pPNET), and Askin's tumor. Characteristic translocations that disrupt the EWSR1 gene located at 22q12 create novel fusion genes that are central to the pathogenesis. The EFT also shares certain clinical characteristics, such as a peak incidence during the teenage years, a tendency to spread rapidly, and responsiveness to the same chemotherapeutic regimens and radiation therapy. Nearly all patients have occult disseminated disease at diagnosis; hence, chemotherapy is routinely used. Improvements in multimodality treatment have had a dramatic impact on outcomes. EES/pPNET has been reported in a variety of sites, including the pancreas, though this is extremely rare. We describe a case of pancreatic EES/ pPNET in a 35-year-old woman and provide a brief review of the relevant literature.

Research paper thumbnail of Immunohistochemical distinction between mesothelial and adenocarcinoma cells in serous effusions: A combination panel-based approach with a brief review of the literature

Indian Journal of Pathology and Microbiology, 2009

The prognostic and therapeutic significance of differentiating adenocarcinoma (AC) from reactive ... more The prognostic and therapeutic significance of differentiating adenocarcinoma (AC) from reactive mesothelium (RM) in effusions cannot be overemphasized. To avoid diagnostic errors, ancillary techniques like immunohistochemistry are employed. However, results vary and no universal standard has been accepted so far. To study the combined diagnostic efficacy of epithelial membrane antigen (EMA), carcinoembryonic antigen (CEA), E-cadherin (EC), calretinin (CAL), desmin (DES) and vimentin (VIM) in distinguishing RM from AC cells in serous effusions. Unequivocally diagnosed cases of 39 adenocarcinomatous and 38 RM populations were studied using sections from 49 formalin-fixed, paraffin-embedded cell blocks. The immunomarkers were applied on cell block sections using the avidin-biotin peroxidase technique. The distribution/intensity of immunostaining in mesothelial and AC cells were graded semiquantitatively. Fischer's exact test was used to calculate the efficacy of individual markers and their combinations. EMA was the best single marker for AC, with 100% sensitivity and 97.37% specificity. For the mesothelial cells, CAL exhibited 100% sensitivity and 92.31% specificity. DES was more specific than CAL but had a poor sensitivity of 55.26%. EC, CEA and VIM had unsatisfactory predictive values precluding their use as individual diagnostic markers. Among the combinations, two panels--EMA+ AND (CAL- OR DES-) for ACs and CAL+ AND (EMA- OR CEA-) for RM had 100% specificities and sensitivities. Most panel studies on fluid cytology are based on the arbitrary use of individual markers with the best statistical values, leading to a less than accurate diagnostic assessment. We believe that statistical parameters calculated in combination provide for a more practical and objective evaluation as well as allowing for meaningful comparative studies.

Research paper thumbnail of Osseous metaplasia in renal cell carcinoma: Report of a rare case

Indian Journal of Pathology and Microbiology, 2008

Focal calcifications are frequently seen in renal masses including renal cell carcinoma (RCC). Os... more Focal calcifications are frequently seen in renal masses including renal cell carcinoma (RCC). Osseous metaplasia, on the other hand, is a rare finding in RCC. We report a case of RCC with radiological evidence of speckled calcification that showed osseous metaplasia on histopathological examination. The clinical and pathologic differential diagnosis for this tumor is discussed along with a review of the literature on this unusual phenomenon.

Research paper thumbnail of Nonspecific granulomatous prostatitis with prostatic adenocarcinoma

Indian Journal of Pathology and Microbiology, 2010

Granulomatous prostatitis is an infrequently seen entity in routine practice. One of its most com... more Granulomatous prostatitis is an infrequently seen entity in routine practice. One of its most common subtypes is nonspecific granulomatous prostatitis (NSGP), the etiology of which is still under debate. Such cases may be mistaken for adenocarcinoma clinically and radiologically. Histological resemblance to adenocarcinoma may arise when there is a xanthogranulomatous pattern or a prominence of epithelioid histiocytes. However, NSGP may rarely coexist with adenocarcinoma and it is critical to sample these cases thoroughly to exclude the presence of malignancy.

Research paper thumbnail of Cytologic diagnostic pitfall of dermatofibrosarcoma protuberans masquerading as primary parotid tumor: A case report

Diagnostic Cytopathology, 2009

We report the cytology of a rare case of dermatofibrosarcoma protuberans (DFSP) involving the par... more We report the cytology of a rare case of dermatofibrosarcoma protuberans (DFSP) involving the parotid region.

Research paper thumbnail of Significance of intercellular spaces (windows) in effusion fluid cytology: A study of 46 samples

Diagnostic Cytopathology, 2008

The presence and nature of intercellular windows were studied on 46 body cavity fluid samples cho... more The presence and nature of intercellular windows were studied on 46 body cavity fluid samples chosen on the basis of an unequivocal diagnosis on May-Grünwald-Giemsa (MGG)/Papanicolaou-stained smears and cell blocks. Of these, 24 cases had adenocarcinoma (AC) and seven had reactive mesothelium (RM) with 15 having distinct populations of both. Mucicarmine and PAS stains were used wherever indicated. The specificity of windows for predicting reactive mesothelium was evaluated. Intercellular windows were found in all cases of reactive mesothelium coinciding with the presence of the fuzzy peripheral microvillous borders. Surprisingly, as many as 17/39 (44%) of the adenocarcinomas also exhibited this feature, of which 13 had a distinctly visible evenly distributed ciliated cell membrane. In addition, 30/39 (77%) cases of AC exhibited a "window-like" appearance caused by cytoplasmic vacuolation. None of the adenocarcinoma clusters with true window formation showed positivity for the mucin stains, whereas all the clusters with pseudowindows caused by vacuolation were stained. Thus the specificity of intercellular windows for RM was merely 56%, though the sensitivity was 100%. On the other hand, the absence of windows was 100% specific for adenocarcinoma. Intercellular windows, though a feature of reactive mesothelial cell populations, can also be found in cases of ciliated adenocarcinomas and may not have a significant predictive value.

Research paper thumbnail of Clear cell sarcoma of the soft parts arising in the rectus abdominis in a child – aspiration cytology of a rare case

CytoJournal, 2007

Background: Clear cell sarcoma of soft parts is most commonly found associated with the tendons a... more Background: Clear cell sarcoma of soft parts is most commonly found associated with the tendons and aponeuroses of distal extremities in young adults with a peak incidence in the third decade. Location in the abdominal wall and in a child is very rare.

Research paper thumbnail of Cystic pleomorphic adenoma presenting with metaplastic epithelial changes, particularly squamous metaplasia with keratinization, often is a diagnostic dilemma for cytopathologists and histopathologists. Preoperative Cytodiagnosis of Cystic Pleomorphic Adenoma with Squamous Metaplasia and Choleste...

Research paper thumbnail of Performance Validation in Anatomic Pathology: Successful Integration of a New Classification System Into the Practice Setting Using the Updated Lung Non–Small Cell Carcinoma Recommendations

Archives of Pathology & Laboratory Medicine, 2014

The new, international, multidisciplinary classification of lung adenocarcinoma, from the Interna... more The new, international, multidisciplinary classification of lung adenocarcinoma, from the International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society, presents a paradigm shift for diagnostic pathologists. To validate our ability to apply the recommendations in reporting on non-small cell lung cancer cases. A test based on the new non-small cell lung cancer classification was administered to 16 pathology faculty members, senior residents, and fellows before and after major educational interventions, which included circulation of articles, electronic presentations, and live presentations by a well-known lung pathologist. Surgical and cytologic (including cell-block material) reports of lung malignancies for representative periods before and after the educational interventions were reviewed for compliance with the new guidelines. Cases were scored on a 3-point scale, with 1 indicating incorrect terminology and/or highly inappropriate stain use, 2 indicating correct diagnostic terminology with suboptimal stain use, and 3 indicating appropriate diagnosis and stain use. The actual error type was also evaluated. The average score on initial testing was 55%, increasing to 88% following the educational interventions (60% improvement). Of the 54 reports evaluated before intervention, participants scored 3 out of 3 points on 15 cases (28%), 2 of 3 on 31 cases (57%), and 1 of 3 on 8 cases (15%). Incorrect use of stains was noted in 23 of 54 cases (43%), incorrect terminology in 15 of 54 cases (28%), and inappropriate use of tissue, precluding possible molecular testing, in 4 out of 54 cases (7%). Of the 55 cases after intervention, participants scored 3 out of 3 points on 46 cases (84%), 2 of 3 on 8 cases (15%), and 1 of 3 on 1 case (2%). Incorrect use of stains was identified in 9 of 55 cases (16% of total reports), and inappropriate use of tissue, precluding possible molecular testing, was found in 1 of the 55 cases (2%). The study results demonstrated marked improvement in the pathologists' understanding and application of the new non-small cell lung cancer classification recommendations, which was sufficient to validate our use of the system in routine practice. The results also affirm the value of intensive education on, and validation of, pathologists' use of a classification or diagnostic algorithm.

Research paper thumbnail of Perivascular Epithelioid Cell Tumor of the Uterus with Ovarian Involvement: A Case Report and Review of the Literature

American Journal of Case Reports, 2016

BACKGROUND Perivascular epithelioid cell tumors (PEComas) are a rare group of neoplasms composed ... more BACKGROUND Perivascular epithelioid cell tumors (PEComas) are a rare group of neoplasms composed of epithelioid cells that express both melanocytic and myoid markers. When considering PEComas of the female genital tract, the uterus is the most common location. Involvement of the ovary in the context of a primary uterine PEComa, in the absence of systemic disease associated with tuberous sclerosis, however, has only been reported in 1 previous case. CASE REPORT We report a case of a PEComa of the uterus with metastasis to the left ovary in a 61-year-old Caucasian woman. Gross examination of the uterus revealed a 10.7×10.5×10.2 cm tan-brown, mostly solid, partially cystic mass. Microscopic examination showed epithelioid cells with clear to eosinophilic cytoplasm, arranged in fascicles. Intranuclear pseudoinclusions were also noted. The tumor cells were smooth muscle actin, caldesmon, and desmin positive (diffuse); HMB-45 positive (focal); and Melan-A, AE1/AE3, CD10, and S100 negative by immunohistochemistry. CONCLUSIONS Distinguishing among mesenchymal neoplasms, including PEComas, endometrial stromal sarcomas, and leiomyosarcomas, can be difficult. Careful analysis of morphologic and immunohistochemical features is of the utmost importance. Differential diagnosis, including morphologic features and immunohistochemical patterns, is also discussed.

Research paper thumbnail of Intratumoral morphologic and molecular heterogeneity of rhabdoid renal cell carcinoma: challenges for personalized therapy

Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc, Jan 26, 2015

Rhabdoid histology in clear-cell renal cell carcinoma is associated with a poor prognosis. The pr... more Rhabdoid histology in clear-cell renal cell carcinoma is associated with a poor prognosis. The prognosis of patients with clear-cell renal cell carcinoma may also be influenced by molecular alterations. The aim of this study was to evaluate the association between histologic features and salient molecular changes in rhabdoid clear-cell renal cell carcinoma. We macrodissected the rhabdoid and clear-cell epithelioid components from 12 cases of rhabdoid clear-cell renal cell carcinoma. We assessed cancer-related mutations from eight cases using a clinical next-generation exome-sequencing platform. The transcriptome of rhabdoid clear-cell renal cell carcinoma (n=8) and non-rhabdoid clear-cell renal cell carcinoma (n=37) was assessed by RNA-seq and gene expression microarray. VHL (63%) showed identical mutations in all regions from the same tumor. BAP1 (38%) and PBRM1 (13%) mutations were identified in the rhabdoid but not in the epithelioid component and were mutually exclusive in 3/3 c...

Research paper thumbnail of Percentage of sarcomatoid component as a prognostic indicator for survival in renal cell carcinoma with sarcomatoid dedifferentiation

Urologic oncology, Jan 21, 2015

Renal cell carcinoma with sarcomatoid dedifferentiation (sRCC) is associated with higher stage of... more Renal cell carcinoma with sarcomatoid dedifferentiation (sRCC) is associated with higher stage of presentation and worse survival. The objective of this study was to examine the clinicopathologic characteristics associated with overall survival (OS), specifically examining the percentage of sarcomatoid component (PSC). We reviewed clinicopathologic data for all nephrectomized patients with confirmed sRCC. Histologic slides were rereviewed by dedicated genitourinary pathologists to ascertain PSC. Patient characteristics were tabulated overall and by disease stage. Cutpoints in the PSC providing a meaningful difference in OS were identified by recursive partitioning analysis (RPA). Factors selected included age group, gender, race, clinical stage, tumor histology, presurgical systemic therapy, lymphovascular invasion, and tumor size. The Kaplan-Meier method and log-rank test were used to assess differences in OS. Among 186 patients with sRCC, 64 (34%) had localized, and 122 (66%) had ...

Research paper thumbnail of Aldo-keto reductase family 1 member C3 (AKR1C3) is expressed in adenocarcinoma and squamous cell carcinoma but not small cell carcinoma

International journal of clinical and experimental pathology, 2012

Human aldo-keto reductase family 1 member C3 (AKR1C3) was initially identified as a critical enzy... more Human aldo-keto reductase family 1 member C3 (AKR1C3) was initially identified as a critical enzyme in reducing 5α-dihydrotestosterone (5α-DHT) to 5α-androstane-3α,17β-diol (3α-diol) and oxidizing 3α-diol to androsterone. Based on these enzymatic activities, AKR1C3 was originally named type 2 3α-hydroxysteroid dehydrogenase (HSD)/type 5 17β-HSD. Additionally, AKR1C3 was demonstrated to be capable of metabolizing other steroids including estrogen and progesterone. Subsequently, AKR1C3 was shown to possess 11-ketoprostaglandin reductase activity in metabolizing prostaglandins and dihydrodiol dehydrogenase x (DDx) activity in metabolizing xenobiotics. Tissue distribution of AKR1C3 has been detected in both sex hormone-dependent organs such as the testis, breast, endometrium, and prostate as well as sex hormone-independent organs including the kidney and urothelium. Although prominent expression of AKR1C isozymes has been reported in human non-small cell lung carcinoma (NSCLC), the expr...

Research paper thumbnail of Madras Medical College: 175 years of medical heritage

The National medical journal of India

Research paper thumbnail of Origin of an Anomalous Left Coronary Artery from a Left Hilar Pulmonary Artery

Pediatric Cardiology, 2011

Anomalous coronaries arising in nontruncal regions of the pulmonary artery are exceedingly rare. ... more Anomalous coronaries arising in nontruncal regions of the pulmonary artery are exceedingly rare. We report an autopsy case of an anomalous left coronary artery that arose from the distal pulmonary artery at the hilum of the left lung in an infant with complex congenital heart disease. To the best of our knowledge, this is the first such report. This previously unknown coronary malformation led to a fatal intraoperative complication during a pulmonary angioplasty procedure.

Research paper thumbnail of Osseous metaplasia in renal cell carcinoma: Report of a rare case

Indian J Pathol Microbiol, 2008

Focal calcifications are frequently seen in renal masses including renal cell carcinoma (RCC). Os... more Focal calcifications are frequently seen in renal masses including renal cell carcinoma (RCC). Osseous metaplasia, on the other hand, is a rare finding in RCC. We report a case of RCC with radiological evidence of speckled calcification that showed osseous metaplasia on histopathological examination. The clinical and pathologic differential diagnosis for this tumor is discussed along with a review of the literature on this unusual phenomenon.

Research paper thumbnail of ALL presenting with a massive, lymphoid-rich, pericardial effusion is extremely rare. Cytologic Aspects of T-Cell Acute Lymphoblastic Leukemia Presenting as a Massive Pericardial Effusion A Case Report

Research paper thumbnail of Unusual ovarian malignancies in ascitic fluid: a report of 2 cases

Acta cytologica

Ovarian tumors of germ cell and sex-cord stromal derivation rarely exfoliate malignant cells in s... more Ovarian tumors of germ cell and sex-cord stromal derivation rarely exfoliate malignant cells in serous effusions. A precise tissue diagnosis in these cases may be possible on serous body fluid cytology with a combined clinical and cytopathologic approach. Ascitic fluid samples from 2 young women aged 23 and 25 years presenting with abdominal mass were cytologically analyzed, with relevant histochemical and immunohistochemical stains performed on cell block/histologic sections. Cytologically, the cases were interpreted as, or suspected to be, adenocarcinomas. However, subsequent histopathologic examination showed them to be yolk sac tumor (YST) and juvenile granulosa cell tumor (JGCT). Following histopathologic diagnosis, cytologic materials were reviewed, which revealed certain features such as hyaline globules in YST and distinct tubular structures in JGCT. These cytologic findings in view of the younger age of the patients should have prompted the correct diagnosis. This study emp...

Research paper thumbnail of Renal adenocarcinoma presenting as a groin swelling: a case report

The Indian journal of surgery, 2008

Renal cell carcinoma (RCC) is known to have myriad presentations due to the extremely vascular na... more Renal cell carcinoma (RCC) is known to have myriad presentations due to the extremely vascular nature of the organ. RCC are known to metastasize extensively to various organs of the body. We report a case of a 70-years-old male who presented with multiple inguinal lymph node enlargements which on excision biopsy showed metastatic adenocarcinomatous deposit. Search for the primary revealed a RCC arising from the left kidney. Inguinal lymph nodal metastasis, an uncommon site of distant metastasis in renal neoplasm, as a fi rst clinical sign leading to the diagnosis is not yet reported in literature.

Research paper thumbnail of Gelatinous transformation of bone marrow in acquired immunodeficiency syndrome

Pathology, 2007

... 3 Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry,... more ... 3 Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India. † Address for correspondence: Debdatta Basu, E‐mail: ddbasu@satyam.net.in. ... Ray R., Bhoria U., Varma N., Bambery P., Dash S. Gelatinous transformation of bone marrow. ...

Research paper thumbnail of Extraosseous Ewing’s sarcoma of the pancreas

International Journal of Clinical Oncology, 2012

The Ewing's family of tumors (EFT) comprises a molecularly defined group of ''small round blue ce... more The Ewing's family of tumors (EFT) comprises a molecularly defined group of ''small round blue cell tumors'', consisting of Ewing's sarcoma of bone (ESB), extraosseous Ewing's sarcoma (EES), peripheral primitive neuroectodermal tumor (pPNET), and Askin's tumor. Characteristic translocations that disrupt the EWSR1 gene located at 22q12 create novel fusion genes that are central to the pathogenesis. The EFT also shares certain clinical characteristics, such as a peak incidence during the teenage years, a tendency to spread rapidly, and responsiveness to the same chemotherapeutic regimens and radiation therapy. Nearly all patients have occult disseminated disease at diagnosis; hence, chemotherapy is routinely used. Improvements in multimodality treatment have had a dramatic impact on outcomes. EES/pPNET has been reported in a variety of sites, including the pancreas, though this is extremely rare. We describe a case of pancreatic EES/ pPNET in a 35-year-old woman and provide a brief review of the relevant literature.

Research paper thumbnail of Immunohistochemical distinction between mesothelial and adenocarcinoma cells in serous effusions: A combination panel-based approach with a brief review of the literature

Indian Journal of Pathology and Microbiology, 2009

The prognostic and therapeutic significance of differentiating adenocarcinoma (AC) from reactive ... more The prognostic and therapeutic significance of differentiating adenocarcinoma (AC) from reactive mesothelium (RM) in effusions cannot be overemphasized. To avoid diagnostic errors, ancillary techniques like immunohistochemistry are employed. However, results vary and no universal standard has been accepted so far. To study the combined diagnostic efficacy of epithelial membrane antigen (EMA), carcinoembryonic antigen (CEA), E-cadherin (EC), calretinin (CAL), desmin (DES) and vimentin (VIM) in distinguishing RM from AC cells in serous effusions. Unequivocally diagnosed cases of 39 adenocarcinomatous and 38 RM populations were studied using sections from 49 formalin-fixed, paraffin-embedded cell blocks. The immunomarkers were applied on cell block sections using the avidin-biotin peroxidase technique. The distribution/intensity of immunostaining in mesothelial and AC cells were graded semiquantitatively. Fischer's exact test was used to calculate the efficacy of individual markers and their combinations. EMA was the best single marker for AC, with 100% sensitivity and 97.37% specificity. For the mesothelial cells, CAL exhibited 100% sensitivity and 92.31% specificity. DES was more specific than CAL but had a poor sensitivity of 55.26%. EC, CEA and VIM had unsatisfactory predictive values precluding their use as individual diagnostic markers. Among the combinations, two panels--EMA+ AND (CAL- OR DES-) for ACs and CAL+ AND (EMA- OR CEA-) for RM had 100% specificities and sensitivities. Most panel studies on fluid cytology are based on the arbitrary use of individual markers with the best statistical values, leading to a less than accurate diagnostic assessment. We believe that statistical parameters calculated in combination provide for a more practical and objective evaluation as well as allowing for meaningful comparative studies.

Research paper thumbnail of Osseous metaplasia in renal cell carcinoma: Report of a rare case

Indian Journal of Pathology and Microbiology, 2008

Focal calcifications are frequently seen in renal masses including renal cell carcinoma (RCC). Os... more Focal calcifications are frequently seen in renal masses including renal cell carcinoma (RCC). Osseous metaplasia, on the other hand, is a rare finding in RCC. We report a case of RCC with radiological evidence of speckled calcification that showed osseous metaplasia on histopathological examination. The clinical and pathologic differential diagnosis for this tumor is discussed along with a review of the literature on this unusual phenomenon.

Research paper thumbnail of Nonspecific granulomatous prostatitis with prostatic adenocarcinoma

Indian Journal of Pathology and Microbiology, 2010

Granulomatous prostatitis is an infrequently seen entity in routine practice. One of its most com... more Granulomatous prostatitis is an infrequently seen entity in routine practice. One of its most common subtypes is nonspecific granulomatous prostatitis (NSGP), the etiology of which is still under debate. Such cases may be mistaken for adenocarcinoma clinically and radiologically. Histological resemblance to adenocarcinoma may arise when there is a xanthogranulomatous pattern or a prominence of epithelioid histiocytes. However, NSGP may rarely coexist with adenocarcinoma and it is critical to sample these cases thoroughly to exclude the presence of malignancy.

Research paper thumbnail of Cytologic diagnostic pitfall of dermatofibrosarcoma protuberans masquerading as primary parotid tumor: A case report

Diagnostic Cytopathology, 2009

We report the cytology of a rare case of dermatofibrosarcoma protuberans (DFSP) involving the par... more We report the cytology of a rare case of dermatofibrosarcoma protuberans (DFSP) involving the parotid region.

Research paper thumbnail of Significance of intercellular spaces (windows) in effusion fluid cytology: A study of 46 samples

Diagnostic Cytopathology, 2008

The presence and nature of intercellular windows were studied on 46 body cavity fluid samples cho... more The presence and nature of intercellular windows were studied on 46 body cavity fluid samples chosen on the basis of an unequivocal diagnosis on May-Grünwald-Giemsa (MGG)/Papanicolaou-stained smears and cell blocks. Of these, 24 cases had adenocarcinoma (AC) and seven had reactive mesothelium (RM) with 15 having distinct populations of both. Mucicarmine and PAS stains were used wherever indicated. The specificity of windows for predicting reactive mesothelium was evaluated. Intercellular windows were found in all cases of reactive mesothelium coinciding with the presence of the fuzzy peripheral microvillous borders. Surprisingly, as many as 17/39 (44%) of the adenocarcinomas also exhibited this feature, of which 13 had a distinctly visible evenly distributed ciliated cell membrane. In addition, 30/39 (77%) cases of AC exhibited a "window-like" appearance caused by cytoplasmic vacuolation. None of the adenocarcinoma clusters with true window formation showed positivity for the mucin stains, whereas all the clusters with pseudowindows caused by vacuolation were stained. Thus the specificity of intercellular windows for RM was merely 56%, though the sensitivity was 100%. On the other hand, the absence of windows was 100% specific for adenocarcinoma. Intercellular windows, though a feature of reactive mesothelial cell populations, can also be found in cases of ciliated adenocarcinomas and may not have a significant predictive value.

Research paper thumbnail of Clear cell sarcoma of the soft parts arising in the rectus abdominis in a child – aspiration cytology of a rare case

CytoJournal, 2007

Background: Clear cell sarcoma of soft parts is most commonly found associated with the tendons a... more Background: Clear cell sarcoma of soft parts is most commonly found associated with the tendons and aponeuroses of distal extremities in young adults with a peak incidence in the third decade. Location in the abdominal wall and in a child is very rare.