Expression of epithelial membrane antigen and cytokeratin among Indian workers exposed to cotton fibre dust in textile industries

Background: In India, around 20 million workers are engaged in the textile industries. However, the prevalence of byssinosis has been little reported. Aims: To determine the prevalence of byssinosis and other respiratory disorders among workers exposed to cotton dust in textile mills in Delhi, India. Methods: Sputum samples were collected from 156 workers employed in 15 cotton textile mills, and expression of epithelial membrane antigen (EMA) and cytokeratin (CK) marker proteins was investigated. Information regarding respiratory symptoms, certain personal characteristics and occupational history was also gathered. Results: Symptoms were observed in 56.41% of the workers. Expression of EMA and CK was observed in 27.5% and 50% of the workers, respectively. Expression of EMA and CK was significantly associated with smoking and duration of employment. Conclusion: Measures are needed to reduce dust levels in the workplace, and to discourage smoking and alcohol consumption among the textile workers.

Primary monophasic breast synovial sarcoma in a female patient

Synovial sarcoma (SS) is a rare soft tissue sarcoma usually arising in the deep soft tissues of the limbs, trunk, and head and neck region. Due to its rarity, diagnosis can be difficult to establish, especially when it involves an uncommon location like the breast. In this case report, we describe a young woman who was found to have primary SS of the breast. Initial immunohistochemistry staining was focally positive for cytokeratin and S100 and she was misdiagnosed with atypical spindle cell carcinoma. Due to the unusual presentation, further testing was performed which showed TLE1 and epithelial membrane antigen positivity, establishing the diagnosis of SS of the breast. A FISH was later sent out and was positive for SS18-SSX fusion transcript. This case highlights the importance of considering rare histopathology in breast lesions and using additional staining and cytogenetics to confirm diagnosis.

Perfil Anatomopatológico e Imuno-histoquímico de Gliomas de Pacientes da Região de Maringá-PR

Introdução: Os gliomas representam 80% dos tumores do sistema nervoso central. A Organização Mundial da Saúde (OMS) adicionou, em 2016, critérios moleculares na classificação dos gliomas. A fisiopatologia e os fatores de risco desses tumores ainda não são totalmente conhecidos. Objetivo: Realizar uma análise retrospectiva dos laudos anatomopatológicos e imuno-histoquímicos de gliomas. Método: Estudo transversal, retrospectivo e descritivo, a partir de exames anatomopatológicos e imuno-histoquímicos realizados entre janeiro de 2014 e dezembro de 2018 em um laboratório de anatomia patológica na cidade de Maringá-PR. Dos 234 laudos relacionados com o termo glioma, 204 foram selecionados para este estudo. Resultados: Foram encontrados tumores astrocitários, ependimários e oligodendrogliais, sendo que os astrocitomas corresponderam a maioria (86,8% dos casos encontrados). A média de idade ao diagnóstico foi de 51,8 anos e houve maior prevalência desses tumores no sexo masculino. Também foram analisadas mutações detectáveis por imuno-histoquímica como p53 (mutada em 66,7% dos testados), isocitrato desidrogenase (IDH) (28,6% mutados), X-linked alpha-thalassemia mental retardation (ATRX) (21,0%) e marcadores diagnósticos como o epithelial membrane antigen (EMA) positivo em todos os ependimomas analisados. Conclusão: E inegável a necessidade de novas pesquisas sobre os gliomas tanto no campo epidemiológico, tendo em vista a nova classificação, quanto no escopo fisiopatológico e clinico, com o objetivo de melhorar o entendimento sobre a patologia e o tratamento dos pacientes.

Sarcomatoid Squamous Cell Carcinoma of the Conjunctiva: A Rare Entity and A Brief Review of Literature

Sacrcomatoid variant of squamous cell carcinoma has been known to involve numerous tissues like an aerodigestive tract, skin. A reddish mass of the left bulbar conjunctiva, with intraocular extension on ultra-bio-microscopy (UBM) was present. Histopathologic examination showed the characteristic spindle-shaped cells in continuity with the overlying epithelium with positive immunostains for cytokeratin, epithelial membrane antigen and vimentin. The presence of such an entity in the conjunctiva is rare and here we report such a case, this being the 37th case to be documented in literature. We also give a brief review of literature.

Epithelial Membrane Antigen, Vimentin, Desmin, Calretinin, E-Cadherin on Cell Block Preparations to Distinguish Well Differentiated Adenocarcinoma from Benign, Reactive, Atypical Mesothelial Cells

BACKGROUND Inconclusive cytomorphology often results due to failure to distinguish between adenocarcinoma cells from benign, reactive, atypical mesothelial cells in effusion specimens. To resolve such dilemmas, auxiliary techniques like immunohistochemistry were utilised to reach a definitive diagnosis for better treatment and management of patients. We wanted to compare cytodiagnosis achieved on cell block preparations with the cytodiagnosis on conventional smear and perform immunohistochemistry for epithelial membrane antigen (EMA), calretinin, desmin, vimentin and E-cadherin on cell block preparation of the fluids in cases of indistinguishable cytomorphology of adenocarcinoma and reactive, atypical, and benign mesothelial hyperplasia. METHODS The immunohistochemical markers namely EMA, calretinin, vimentin, desmin and Ecadherin were applied on cell blocks employing streptavidin-biotin method. Immunohistochemistry was interpreted by giving scores to the percentage of stained cells. RESULTS EMA and E-cadherin had 100 % sensitivity in diagnosing adenocarcinoma whereas calretinin, vimentin and desmin were 100 % sensitive in diagnosing reactive, atypical mesothelial carcinoma on the cell block preparations. CONCLUSIONS Immunocytochemistry of fluid should be carried out on the cell block preparation where cytological diagnosis on conventional smear and cell block fails to detect malignant cells in the preparation. KEY WORDS Cell Block, Adenocarcinoma, Mesothelial Cells, Immunohistochemistry, EMA, Calretinin, Vimentin, Desmin, E-Cadherin

Ovarian female adnexal tumor of probable Wolffian origin – Case report

Background During embryonic development in women, a regression of temporary embryonic structures – mesonephric (Wolffian) ducts occurs. Adnexal tumors of Wolffian duct origin (FATWO) are rare. Case report We presented the case of a 64-year-old female patient who was diagnosed with FATWO. After the surgical treatment, the uterus with bilateral adnexal structures was submitted for histopathological analysis. The left ovary was occupied by a tumor measuring 80 × 60 × 50 mm, with smooth, shiny, whitish surface. Tumor cells were medium-sized, relatively uniform, round, and polygonal, with eosinophilic cytoplasm and centrally laid nucleus with fine chromatin, organized into solid, trabecular, and tubular formations. Tumor cells were positive for pancytokeratin (CK), CK7, CD10, neuron-specific enolase (NSE), synaptophysin, calretinin, progesterone, estrogen, and epithelial membrane antigen (EMA). Conclusion This case adds a report of a rare tumor to the literature. We must think of it in the differential diagnostic algorithm to make an accurate diagnosis for selecting the best treatment modality.

Epithelial-Stromal Polyps of the Colon Are Not Perineuriomas

Objectives Some colorectal polyps contain serrated or tubular crypts surrounded by whorls of spindle cells that expand the mucosa. These epithelial-stromal polyps have been termed benign fibroblastic polyps or, more commonly, perineuriomas. We hypothesized that these lesions are pathogenetically heterogeneous polyps that share in common exuberant fibroblastic proliferations derived from the pericryptal sheath. Methods Forty-six epithelial-stromal polyps containing serrated crypts (n = 21) and nonserrated crypts (n = 25) were evaluated with epithelial membrane antigen and BRAF V600E immunohistochemical stains, and a subset was subjected to next-generation sequencing for BRAF mutations. Polyp morphology and immunohistochemical results were correlated with clinical information. Results Epithelial-stromal polyps containing serrated crypts were significantly associated with other sessile serrated polyps (43%, P = .01) and hyperplastic polyps (29%, P = .006). They also showed BRAF V600E abnormalities (95%) and strong, patchy epithelial membrane antigen staining of spindle cells (95%). In contrast, polyps with nonserrated crypts lacked BRAF alterations and infrequently showed robust EMA staining of stromal cells (16%, P < .01). Conclusions Benign epithelial-stromal polyps with serrated epithelium are biologically similar to sessile serrated polyps and should be classified as such to ensure appropriate clinical surveillance. The nature of polyps without serrated crypts is less clear, but evidence that they are perineuriomas is circumstantial at best.

Novel t(1;8)(p31.3;q21.3) NFIA-RUNX1T1 Translocation in an Infant Erythroblastic Sarcoma

Objectives Pure erythroid leukemia (PEL) is exceptionally rare in the pediatric setting. Four pediatric PEL cases with t(1;16)(p31;q24) NFIA-CBFA2T3 were reported previously. We present a case of an infant with PEL presenting with erythroblastic sarcoma and harboring a novel t(1;8)(p31.3;q21.3) NFIA-RUNX1T1 fusion detected by RNA sequencing and conventional karyotype. Methods Bone marrow (BM) and abdominal mass biopsies from the patient were evaluated with extensive immunohistochemical, flow cytometric, cytogenetic, and molecular studies. Results The patient was a female infant who presented between 2 and 5 months of age with cytopenias and an enlarging abdominal mass. Blasts in the BM and abdominal mass expressed CD71 and CD117 with focal expression of CD43, E-cadherin, epithelial membrane antigen, and hemoglobin A. They were negative for additional myeloid, lymphoid, and nonhematolymphoid markers. These findings were most consistent with PEL and erythroblastic sarcoma. RNA sequencing revealed the novel NFIA-RUNX1T1 fusion. Conclusions Along with the previously reported PELs with NFIA-CBFA2T3 fusions, we describe a subset of PELs that occur in children, that frequently display extramedullary disease, and that harbor rearrangements of NFIA with core binding factor genes. We hypothesize that, together, these cases represent a rare but distinct clinicopathologic group of pediatric PELs with recurrent genetic abnormality.