Cluster of Differentiation 274 Antigen Immunohistochemical Expression in Tumor and Peri-tumor Cells of Hodgkin and Non-Hodgkin Lymphoma and Clinicopathological Relation (Single-center Study)

BACKGROUND: Cluster of differentiation 274 (CD274) antigen has been investigated in tumors to evaluate its regulation and effect as a predictive of targeted therapy. Its expression and effect in lymphoma have raised interest recently. However, results were mixed and showed wide variations. AIM: This study aims to explore and compare CD274 antigen immunohistochemical expression in tumor and peri-tumor cells of classic Hodgkin lymphoma (HL) and diffuse large B cells non-HL (NHL) and its relation with clinicopathological criteria. METHODS: This work was carried out on 78 cases of lymph node excision biopsy (48 HL and 30 NHL). Prepared sections were applied for immunohistochemistry using CD274 monoclonal rabbit anti-human (programmed cell death protein 1 [PD-L1] ZR3-ASR, a Sigma Aldrich company). Assessment of CD274 antigen in tumor cells was considered positive if detected in >10% (membranous staining with cytoplasmic accentuation). Peri-tumor cells were scored as: 0, no positive cells/high-power field (HPF); 1, <10 positive cells/HPF; 2, 10–30 positive cells/HPF; 3, >30 positive cells/HPF. RESULTS: CD274 antigen was expressed in 53.8% of total lymphoma cases with significantly more expression of CD274 antigen in HL than NHL (66.7% vs. 33.3%). Classic HL showed significantly higher expression of CD274 antigen in tumor and peri-tumor cells and significant association with elevated erythrocyte sedimentation rate and lactate dehydrogenase and male gender. INTERPRETATION AND CONCLUSION: There is a more frequent and significant expression of CD274 antigen in classic HL than NHL cases in tumor and peri-tumor cells and a significant association with bad prognostic criteria in classic HL. High expression of CD274 antigen in classic HL proposes its potential use as a marker, especially for prognostic indication.

PERIPHERAL LYMPH NODE EXCISIONAL BIOPSY IN CHILDREN: YIELD IN A TERTIARY CARE CENTRE

AIM: To study the pediatric patients in a developing country undergoing peripheral lymph node excision biopsy in terms of demographics and histopathological ndings and evaluate the diagnostic yield of peripheral Lymph node excision biopsy in children. MATERIALS AND METHODS: A retrospective study of 402 patients was done of the children undergoing peripheral lymph node st st excision biopsy in a tertiary care center from 1 January 2013 to 31 December 2018 (6 years). Demographics, histopathological ndings and yields were studied. RESULTS: Out of the 402 patients, 218 (54.2%) were males and 184(45.8%) were females. Male to female ratio 1.18: 1. Maximum patients belonged to the age group of 4-6years (26.87%) followed by the age group of 2-4years of age (22.89%). Most common group of nodes excised were cervical (77.9%) followed by axillary and inguinal lymph nodes (9.2%) each. The most common etiology was reactive lymphoid hyperplasia (63.18%) in our study followed by tuberculous lymphadenitis(31.84%). Specic ndings were seen in 35.58% and non-specic ndings were seen in 64.42% patients. Malignancy was seen in 8 patients (2%). CONCLUSION: Peripheral Lymphadenopathy in pediatric population is always a diagnostic challenge. While FNAC tends to be investigation of choice for adults, in a developing country with limited resources and high prevalence of tuberculosis, peripheral lymph node biopsy is the gold standard with a good diagnostic yield and should always be considered for patients with persistent lymphadenopathy. Clinical significance: The study highlights the importance of excision biopsy in peripheral lymphadenopathy in children in a developing nation with limited resources and high prevalence of infectious diseases.

Cosmetic Outcome of Wound Closure between Steri-Strips (3M™ Steri-Strip) and Simple Interrupted Nylon 6-0 Sutures in Out-Patient Cervical Lymph Node Excision: A Randomized Controlled Trial

Objective: To compare the aesthetic outcome of cervical lymph node excision skin closure between Steri-Strips closure and simple interrupted sutures using Nylon 6-0. Materials and Methods: The present study was a single-blinded randomized controlled trial of forty patients with cervical lymph node excision. They were randomized into two groups of twenty. The first group was allocated to close the skin by simple interrupted sutures with Nylon 6-0, the other group received the Steri-Strips for skin closure. Complications were observed at the first and second week. The aesthetic outcomes for skin closure were evaluated at 12 weeks postoperatively using the predetermined Sakka’s cosmetic assessment criteria and scoring system. Results: There was no statistically significant difference between the two groups in terms of gender, age, length of surgical wound, and pathology. The Steri-Strips group showed significantly lower Sakka’s aesthetic score compared to the 6-0 Nylon sutures group (6.25±0.85 and 7.75 ±1.33, p<0.001). There was no significant difference in aesthetic outcomes between genders. Moreover, the operative time of the Steri-Strips group was significantly less than that of the 6-0 Nylon sutures group (2.2±0.41 and 4.75±0.44 minutes, p<0.001). Conclusion: Skin closure with Steri-Strips gave better aesthetic outcomes compared to the 6-0 Nylon sutures (p<0.001). However, the aesthetic outcomes were assessed by physicians, so the patients’satisfaction could not be assessed. Keywords: Lymph node biopsy; Hypertrophic scar; Keloid; Cosmetic outcome; Steri-strip

CLINICO PATHOLOGICAL CORRELATION OF EYELID TUMORS AND THEIR SURGICAL OUTCOME

Eyelid tumors are the most common neoplasm in daily ophthalmology practice and encompass a wide variety of benign and malignant tumors. The most common presenting symptoms for skin cancer on the eyelids include a mass or tumor, ulceration, or soreness. It is an institution-based study and the patients were recruited from the OPD and Indoor-wards of Aravind Eye Hospital. Each patient was examined by the slit lamp bio-microscope. The size of the tumor is measured with a detailed examination of the tumor-like margin, the involvement of the other adnexal structure, and the lymph node. Excision biopsies were done and send for histopathological examination. Wound closure with lid reconstruction done according to the size and site of the tumor. Out of 66 patients, the clinical diagnosis of 56(85%) patients was correlated with the histopathological diagnosis but in the remaining 10(15%) patients no correlation was found between histopathological and clinical diagnosis. Proper knowledge of the tumor, anatomy of the lid, and history will help in the appropriate diagnosis of eyelid tumor which can be confirmed by histopathological examination. In the present study, tumors were managed with excision biopsy and lid reconstruction was done depending upon the location and extent of the tumor.

Analysis and outcomes of wrong site thyroid surgery

Background In thyroid surgery, wrong-site surgery (WSS) is considered a rare event and seldom reported in the literature. Case presentation This report presents 5 WSS cases following thyroid surgery in a 20-year period. We stratified the subtypes of WSS in wrong target, wrong side, wrong procedure and wrong patient. Only planned and elective thyroid surgeries present WSS cases. The interventions were performed in low-volume hospitals, and subsequently, the patients were referred to our centres. Four cases of wrong-target procedures (thymectomies [n = 3] and lymph node excision [n = 1] performed instead of thyroidectomies) and one case of wrong-side procedure were observed in this study. Two wrong target cases resulting additionally in wrong procedure were noted. Wrong patient cases were not detected in the review. Patients experienced benign, malignant, or suspicious pathology and underwent traditional surgery (no endoscopic or robotic surgery). 40% of WSS led to legal action against the surgeon or a monetary settlement. Conclusion WSS is also observed in thyroid surgery. Considering that reports regarding the serious complications of WSS are not yet available, these complications should be discussed with the surgical community. Etiologic causes, outcomes, preventive strategies of WSS and expert opinion are presented.

Pre-Operative Localization of Axillary Lymph Nodes with Tattoo Ink: A Preliminary Report

Background: Pre-operative localization options in the axilla are limited. This study aimed to explore the utility of pre-operative localization of axillary lymph nodes using tattoo ink with multidisciplinary correlations.Methods: In this prospective, Institutional Review Board (IRB)-approved study, 19 lymph nodes in 17 patients underwent pre-operative localization with ultrasound-guided injection of Spot tattoo ink. The success rate of intraoperative identification of the tattooed node as well as the frequency in which the tattooed node was also a sentinel node were recorded. Radiologic, surgical and pathologic images were collected. Results: Tattoo ink localization was successful in 16/17 (94.1%) of patients. Tattoo ink did not hinder pathologic evaluation in any cases but was taken up by additional adjacent nodes in 1/17 successful localizations (5.9%). Successful sentinel lymph node biopsy (SLNB) occurred in 13 patients in whom 14 lymph nodes underwent pre-operative tattoo ink localization. Nine of the 14 (64.2%) tattooed lymph nodes were also a sentinel node.Conclusion: In this study, pre-operative localization of axillary lymph nodes with tattoo ink was highly successful In patients undergoing SLNB, a significant number of the tattooed nodes were not sentinel nodes (35.8%), suggesting the importance of targeted lymph node excision in addition to SLNB.

IgG4-related lymphadenopathy – a difficult diagnosis

Background The IgG4-related disease (IgG4-RD) is a systemic immune-mediated non-neoplastic disease associated with IgG4 positive plasma cells and fibrosis that often presents as a mass lesion. Although the disease could affect virtually any anatomical site, there are strong predilections for certain organs. IgG4-related lymphadenopathy can exhibit a broad morphologic spectrum. We describe a patient with IgG4-related lymphadenopathy with overlapping histological features that proved to be a diagnostic red herring. Case presentation A 58-year-old gentleman with multiple co-morbidities presented with obstructive jaundice, elevated transaminases, and bilateral inguinal and left axillary lymphadenopathy. Imaging of the abdomen and pelvis showed circumferential soft tissue thickening resulting in luminal narrowing of common and proximal bile duct with upstream intrahepatic biliary radicle dilatation, multiple enlarged lymph nodes, and homogenous soft tissue lesions in the tail of the pancreas and bilateral renal cortical parenchyma with perinephric soft tissue extension. Left inguinal, and axillary lymph node excision biopsies were suggestive of IgG4-RD. Serum IgG4 levels performed subsequently, were markedly elevated. The patient was treated with prednisone which led to resolutions of his symptoms, reduction in the size of the lesions, and reversal of abnormal laboratory parameters. Conclusion The diagnosis of IgG4-RD in lymph node excision biopsy is a difficult call to make and needs a multidisciplinary team. An early diagnosis renders timely intervention and prevents the progression of the disease and its complications.

Giant Fibroadenoma in a Middle-Aged Woman Requiring Mastectomy: A Case Report

Fibroadenomas are benign tumours of the breast. They are usually single, firm, rubbery masses, slow-growing and well encapsulated. Giant fibroadenomas are fibroadenomas at least 5cm in size or at least 500g in weight. The peculiarities of the index case include the massive size and weight of the breast, causing asymmetry and tissue distortion with little or no normal breast tissue on ultrasound scan. Also, such massive weight has not been reported in the literature as suggested by extensive search on databases such as Pubmed and Google Scholar. The main concern of the patient was the rapid growth over a year, with the attendant risk of malignancy. The mass was firm, lobulated, with a solitary axillary lymph node. An initial clinical diagnosis of phyllodes tumour was made. However, pre-operative Tru-cut biopsy histology suggested fibroadenoma and was confirmed using the excised post-operative specimen. Simple mastectomy with axillary lymph node excision was carried out. In conclusion, a large breast tumour may not be malignant. However, mastectomy may be a treatment option despite the benign nature of the tumour.