shilpi saxena - Academia.edu (original) (raw)

Papers by shilpi saxena

Research paper thumbnail of Utility of HLA‐DR in screening panel for inborn errors of immunity

Scandinavian Journal of Immunology

Research paper thumbnail of Rare findings in a common tumor: A case of complex fibroadenoma with secondary changes in a young female

Indian Journal of Pathology and Oncology, 2020

Fibroadenoma (FA) is one the most common breast tumours seen in adolescent and young women. Altho... more Fibroadenoma (FA) is one the most common breast tumours seen in adolescent and young women. Although, in the postmenopausal females FA regresses, becomes hyalinised and shows calcification these findings are rare in the younger and reproductive age group. Complex FA is defined as FAs with cysts, sclerosing adenosis, epithelial calcifications or papillary apocrine changes. We present a case of multiple synchronous FAs in a young female with uncommon findings at her age like extensive hyalinization, coarse calcification and cystic changes. No evidence of ductal hyperplasia, carcinoma in situ or invasive carcinoma was seen. Very few such cases have been reported in literature in young females. Despite these unusual findings, recent large cohort studies concluded that complex FA is not an independent risk factor for carcinoma breast.

Research paper thumbnail of Rare Case of Spindle Cell Carcinoma in Inverted Papilloma

An International Journal of Otorhinolaryngology Clinics, 2017

Aim: The aim of this case report is to sensitize about the possibility of early malignant transfo... more Aim: The aim of this case report is to sensitize about the possibility of early malignant transformation in an inverted papilloma (IP) and presence of rare spindle cell carcinoma (SPCC) in IP, which can masquerade as a benign lesion. Background: Inverted papillomas are benign tumors of sinonasal tract with characteristic histological features. Though benign, these lesions show recurrence, are locally aggressive, and have potential for malignant transformation. Case report: A case of IP is described, which recurred following wide local excision and underwent malignant transformation into aggressive spindle cell variant of squamous cell carcinoma. A 48-year-old male presenting with unilateral nasal obstruction and serosanguinous discharge was detected to have reddishgray nasal mass arising from lateral wall of right nasal cavity. The histopathological examination was suggestive of IP. A medial maxillectomy and excision was done. However, recurrence was detected within 6 months. There was subsequent rapid malignant transformation into SPCC, which is a rare type of squamous cell carcinoma and even rarer in malignant transformation of IP. Conclusion: The patient was managed promptly with radiotherapy after diagnosis of malignant transformation was made and is under follow-up. The case highlights the importance of follow-up care in IP, as early recurrence can be there. Moreover, malignant transformation, especially rarer type of SPCC, made the case more challenging. Clinical significance: The diagnosis of SPCC required a high index of suspicion as it is a rare variety of squamous cell carcinoma arising as malignant transformation of IP and mimics many other reactive or mesenchymal lesions.

Research paper thumbnail of Evaluation of iron status in patients of chronic kidney disease - A study to assess the best indicators including serum transferrin receptor assay

Indian Journal of Nephrology, 2019

Anemia is an early complication of chronic kidney disease (CKD). The iron deficiency is an import... more Anemia is an early complication of chronic kidney disease (CKD). The iron deficiency is an important contributor, more so in the Pakistani population. As routine standalone iron tests do not accurately reflect the actual status in the complex environment of CKD, there is a need to study better indicators. Serum iron, ferritin, total iron-binding capacity (TIBC), and serum transferrin receptor (sTfR) levels were estimated in 100 primary iron deficiency anemia (IDA) patients (controls-Group 1) and 68 newly diagnosed CKD cases. The CKD patients were divided into two groups: Serum ferritin <=100 μg/L (Group 2) and >100 μg/L (Group 3). The values of percentage saturation, log of ferritin (log_ferritin), and the ratio of sTfR to log ferritin (sTfR/log_f or sTfR index) were calculated. The CKD cases were further divided depending on ferritin cutoffs of 30, 50, 70, and 100 μg/L and statistically analyzed including ROC and AUC, to choose the best diagnostic parameter for accurate assessment of iron status in CKD cases. The mean serum ferritin was 11.34 μg/L, 28.70 μg/L, and 281.81 μg/L, and the mean sTfR was 2.34 μg/ml, 1.82 μg/ml, and 1.28 μg/ml in Groups 1, 2, and 3. Among all groups, the difference was found to be significant for serum iron, log_ferritin, and sTfR/log_f. The sTfR and sTfR/log_f showed good discrimination between IDA and Anemia of chronic disease in CKD cases, but sTfR/log_f gave the best discrimination at all cutoff levels of ferritin. At a ferritin cutoff of 50 μg/L, the sTfR/log_f value of 0.83 had a sensitivity of 93.5% and specificity of 95.45%, and at a ferritin cutoff 100 μg/L, the same value of 0.83 had a sensitivity of 95.5% and specificity of 86.5%. The ratio of sTfR/log_f is the best indicator for assessing iron status in CKD.

Research paper thumbnail of A study of BRAF mutation in colorectal carcinoma in Indian population

Journal of Cancer Research and Therapeutics, 2017

Context: BRAF mutation has been extensively studied and associated with various tumors. Targeted ... more Context: BRAF mutation has been extensively studied and associated with various tumors. Targeted therapeutic intervention against BRAF mutation is established modality against many such tumors. Various studies have estimated that the prevalence of BRAF mutation in colorectal carcinoma (CRC) is 5%–25%. Considering epidemiology differences from Western population and paucity of studies on BRAF mutation in CRC in Asian patients, the present study was done to study the BRAF mutation in CRC in Indian population. Aims: The aim is to study the distribution of BRAF mutation and its correlation with the American Joint Committee on Cancer (AJCC) stage, grade, and other clinicopathological parameters in CRC. Settings and Design: This was a cross-sectional study. Subjects and Methods: Immunohistochemistry study was done using BRAFV600E monoclonal antibody (Clone VE1) for 65 consecutive cases of CRC in a tertiary care center. The results were statistically analyzed using SPSS version 2.0. Results: This study found that BRAF mutation is not significantly present in CRC as only 4.6% of cases were positive for BRAFV600E mutation. However, there was statistically significant relation between increasing AJCC stage and BRAF mutation. Conclusions: This study concluded that BRAF mutation is not prevalent in Indian population with CRC. However, it is significantly related with advanced AJCC stages.

Research paper thumbnail of Leiomyoma of the vulva: a diagnostic challenge

International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2018

Smooth muscle tumours of vulva are rare and therefore can be missed clinically. Our patient, 48-y... more Smooth muscle tumours of vulva are rare and therefore can be missed clinically. Our patient, 48-year-old lady presented with lump in the left vulva that was clinically diagnosed as Bartholin duct cyst. The lumpectomy was done under local anaesthesia and the lesion was sent for pathological examination. On gross examination the mass was 3.5 cm in diameter. The microscopic examination revealed the lump to be leiomyoma and no necrosis or atypia was present. The final diagnosis of “vulval leiomyoma” was given. Postoperative period was uneventful, and the patient is on regular follow up and there has been no recurrence. Leiomyoma should be kept as a differential diagnosis when a lady presents in late reproductive age group with unilateral swelling in vulvar region which is firm in consistency and the lump must be sent for histopathological examination for definitive diagnosis and rule out malignancy. The pathologists play a critical role in recognition and management of smooth muscle tum...

Research paper thumbnail of Utility of HLA‐DR in screening panel for inborn errors of immunity

Scandinavian Journal of Immunology

Research paper thumbnail of Rare findings in a common tumor: A case of complex fibroadenoma with secondary changes in a young female

Indian Journal of Pathology and Oncology, 2020

Fibroadenoma (FA) is one the most common breast tumours seen in adolescent and young women. Altho... more Fibroadenoma (FA) is one the most common breast tumours seen in adolescent and young women. Although, in the postmenopausal females FA regresses, becomes hyalinised and shows calcification these findings are rare in the younger and reproductive age group. Complex FA is defined as FAs with cysts, sclerosing adenosis, epithelial calcifications or papillary apocrine changes. We present a case of multiple synchronous FAs in a young female with uncommon findings at her age like extensive hyalinization, coarse calcification and cystic changes. No evidence of ductal hyperplasia, carcinoma in situ or invasive carcinoma was seen. Very few such cases have been reported in literature in young females. Despite these unusual findings, recent large cohort studies concluded that complex FA is not an independent risk factor for carcinoma breast.

Research paper thumbnail of Rare Case of Spindle Cell Carcinoma in Inverted Papilloma

An International Journal of Otorhinolaryngology Clinics, 2017

Aim: The aim of this case report is to sensitize about the possibility of early malignant transfo... more Aim: The aim of this case report is to sensitize about the possibility of early malignant transformation in an inverted papilloma (IP) and presence of rare spindle cell carcinoma (SPCC) in IP, which can masquerade as a benign lesion. Background: Inverted papillomas are benign tumors of sinonasal tract with characteristic histological features. Though benign, these lesions show recurrence, are locally aggressive, and have potential for malignant transformation. Case report: A case of IP is described, which recurred following wide local excision and underwent malignant transformation into aggressive spindle cell variant of squamous cell carcinoma. A 48-year-old male presenting with unilateral nasal obstruction and serosanguinous discharge was detected to have reddishgray nasal mass arising from lateral wall of right nasal cavity. The histopathological examination was suggestive of IP. A medial maxillectomy and excision was done. However, recurrence was detected within 6 months. There was subsequent rapid malignant transformation into SPCC, which is a rare type of squamous cell carcinoma and even rarer in malignant transformation of IP. Conclusion: The patient was managed promptly with radiotherapy after diagnosis of malignant transformation was made and is under follow-up. The case highlights the importance of follow-up care in IP, as early recurrence can be there. Moreover, malignant transformation, especially rarer type of SPCC, made the case more challenging. Clinical significance: The diagnosis of SPCC required a high index of suspicion as it is a rare variety of squamous cell carcinoma arising as malignant transformation of IP and mimics many other reactive or mesenchymal lesions.

Research paper thumbnail of Evaluation of iron status in patients of chronic kidney disease - A study to assess the best indicators including serum transferrin receptor assay

Indian Journal of Nephrology, 2019

Anemia is an early complication of chronic kidney disease (CKD). The iron deficiency is an import... more Anemia is an early complication of chronic kidney disease (CKD). The iron deficiency is an important contributor, more so in the Pakistani population. As routine standalone iron tests do not accurately reflect the actual status in the complex environment of CKD, there is a need to study better indicators. Serum iron, ferritin, total iron-binding capacity (TIBC), and serum transferrin receptor (sTfR) levels were estimated in 100 primary iron deficiency anemia (IDA) patients (controls-Group 1) and 68 newly diagnosed CKD cases. The CKD patients were divided into two groups: Serum ferritin <=100 μg/L (Group 2) and >100 μg/L (Group 3). The values of percentage saturation, log of ferritin (log_ferritin), and the ratio of sTfR to log ferritin (sTfR/log_f or sTfR index) were calculated. The CKD cases were further divided depending on ferritin cutoffs of 30, 50, 70, and 100 μg/L and statistically analyzed including ROC and AUC, to choose the best diagnostic parameter for accurate assessment of iron status in CKD cases. The mean serum ferritin was 11.34 μg/L, 28.70 μg/L, and 281.81 μg/L, and the mean sTfR was 2.34 μg/ml, 1.82 μg/ml, and 1.28 μg/ml in Groups 1, 2, and 3. Among all groups, the difference was found to be significant for serum iron, log_ferritin, and sTfR/log_f. The sTfR and sTfR/log_f showed good discrimination between IDA and Anemia of chronic disease in CKD cases, but sTfR/log_f gave the best discrimination at all cutoff levels of ferritin. At a ferritin cutoff of 50 μg/L, the sTfR/log_f value of 0.83 had a sensitivity of 93.5% and specificity of 95.45%, and at a ferritin cutoff 100 μg/L, the same value of 0.83 had a sensitivity of 95.5% and specificity of 86.5%. The ratio of sTfR/log_f is the best indicator for assessing iron status in CKD.

Research paper thumbnail of A study of BRAF mutation in colorectal carcinoma in Indian population

Journal of Cancer Research and Therapeutics, 2017

Context: BRAF mutation has been extensively studied and associated with various tumors. Targeted ... more Context: BRAF mutation has been extensively studied and associated with various tumors. Targeted therapeutic intervention against BRAF mutation is established modality against many such tumors. Various studies have estimated that the prevalence of BRAF mutation in colorectal carcinoma (CRC) is 5%–25%. Considering epidemiology differences from Western population and paucity of studies on BRAF mutation in CRC in Asian patients, the present study was done to study the BRAF mutation in CRC in Indian population. Aims: The aim is to study the distribution of BRAF mutation and its correlation with the American Joint Committee on Cancer (AJCC) stage, grade, and other clinicopathological parameters in CRC. Settings and Design: This was a cross-sectional study. Subjects and Methods: Immunohistochemistry study was done using BRAFV600E monoclonal antibody (Clone VE1) for 65 consecutive cases of CRC in a tertiary care center. The results were statistically analyzed using SPSS version 2.0. Results: This study found that BRAF mutation is not significantly present in CRC as only 4.6% of cases were positive for BRAFV600E mutation. However, there was statistically significant relation between increasing AJCC stage and BRAF mutation. Conclusions: This study concluded that BRAF mutation is not prevalent in Indian population with CRC. However, it is significantly related with advanced AJCC stages.

Research paper thumbnail of Leiomyoma of the vulva: a diagnostic challenge

International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2018

Smooth muscle tumours of vulva are rare and therefore can be missed clinically. Our patient, 48-y... more Smooth muscle tumours of vulva are rare and therefore can be missed clinically. Our patient, 48-year-old lady presented with lump in the left vulva that was clinically diagnosed as Bartholin duct cyst. The lumpectomy was done under local anaesthesia and the lesion was sent for pathological examination. On gross examination the mass was 3.5 cm in diameter. The microscopic examination revealed the lump to be leiomyoma and no necrosis or atypia was present. The final diagnosis of “vulval leiomyoma” was given. Postoperative period was uneventful, and the patient is on regular follow up and there has been no recurrence. Leiomyoma should be kept as a differential diagnosis when a lady presents in late reproductive age group with unilateral swelling in vulvar region which is firm in consistency and the lump must be sent for histopathological examination for definitive diagnosis and rule out malignancy. The pathologists play a critical role in recognition and management of smooth muscle tum...