Reetu Kundu

Objectives: To detect micrometastasis of head and neck squamous cell carcinoma (HNSCC) and explore the diagnostic utility of modified Papanicolaou (PAP) stain in comparison to cytokeratin (CK) immunohistochemistry (IHC).Materials and Methods: Negative nodes (382 lymph nodes) from 30 patients of histopathology-proven HNSCC undergoing tumor excision with neck lymph node dissection were subjected to serial sectioning, IHC for CK, and staining with modified PAP stain. Chi-square and Fisher's exact test were applied for categorical variables. Group comparisons for skewed data were made with the Kruskal-Wallis test. A p-value of

Background: Several immunohistochemical markers are available for demonstrating hepatocytic differentiation, thereby confirming the diagnosis of hepatocellular carcinoma (HCC). Clusterin is a new marker of malignant hepatocytes, not evaluated in fine needle aspiration biopsy (FNAB) samples. Hence, we evaluated its diagnostic utility in FNAB cell blocks (CB) and core biopsy samples.Methods: A total of 47 cases of HCC diagnosed on FNAB with CB (41)/core biopsy (6) were retrieved. For comparison, CB from metastatic adenocarcinoma (15) and cases with incidental benign hepatocytes (12) were included. Immunohistochemistry (IHC) for clusterin was performed and the 3 groups were compared to derive its sensitivity and specificity. Canalicular expression was considered positive for hepatocytic differentiation.Results: The cohort comprised 47 cases of HCC, with 43 (91.5%) male and 4 (8.5%) female patients with an age range of 20–78 years. On clusterin IHC, benign hepatocytes showed a track‐like canalicular pattern whereas in HCC, typical enhanced canalicular positivity (3+ intensity) was seen in 32/47 (68%) cases, 17 of which additionally showed cytoplasmic positivity. Only cytoplasmic positivity was noted in 7 HCC cases and was considered negative. All cases of well differentiated (6/6), 67.6% (25/37) of moderately differentiated, and 25% (1/4) of poorly differentiated HCC showed enhanced canalicular positivity, whereas metastatic adenocarcinoma showed cytoplasmic (2/15) or nucleocytoplasmic (1/15) positivity only.Conclusion: IHC for clusterin with enhanced canalicular pattern of expression revealed 68% sensitivity and 100% specificity for HCC, aiding its distinction from metastatic adenocarcinoma and benign hepatocytes in FNAB samples, thereby confirming its diagnostic utility.

Zoonotic diseases are caused by viruses, bacteria, fungi and parasites and they comprise about 75% of all emerging infectious diseases. These can be transmitted via the direct (scratches on skin or animal bites) or indirect mode (through environmental shedding of infectious agent by the infected animal) of transmission. Environmental changes, whether in the form of urbanization, industrialization or destruction of wildlife habitats, lead to more human invasion in wildlife areas, subsequently leading to an increased passage of animals towards human dwellings and more exposure to animals, making humans susceptible to these infections. Climate change is another major factor. Global warming and the evolving thermotolerance of fungi, adapting more to human body temperature than their saprophytic nature, is leading to the emergence of humans as new hosts for fungi. The domestication of animals, rising populations, enhanced tourism, migratory populations, intrusions into wildlife, etc., are other known factors. Zoonotic fungal infections have long been neglected and are now gaining due attention. In this review, we briefly discuss the various aspects currently known for zoonotic fungal infections and bring forth the importance of this particular issue to be addressed in a timely manner.

Myoepithelial carcinoma (MC) arises from the myoepithelial cells. It is a rare tumor with a predilection for salivary glands. MC in soft tissue is uncommon. Soft tissue MC exhibits dual epithelial and smooth muscle phenotype. The extremities and limb girdles are commonly affected. We present cytological findings of retroperitoneal MC with an accurate diagnosis being rendered with the aid of immunocytochemistry on the cell block and demonstration of EWSR1 rearrangements by fluorescence in situ hybridization on cytology smear. The smears were cellular, showing loose clusters and sheets of tumor cells embedded in dense eosinophilic to myxoid matrix material. The cells were oval to polygonal, with focal areas showing moderate nuclear pleomorphism, vesicular to coarse chromatin, and vacuolated cytoplasm with clearing. On immunocytochemistry, tumor cells were positive for epithelial membrane antigen, pan‐cytokeratin, calponin, smooth muscle actin, and S‐100. A literature review shows only a handful of cases of soft tissue MC. The current report emphasizes the need for cytomorphological awareness with the employment of ancillary testing for accurately diagnosing this rare tumor at an uncommon location. We also discuss the diagnostic challenges and troubleshooting.

Neuroendocrine neoplasms (NENs) of the liver represent a rare entity. Amongst this group of uncommon diseases primary hepatic neuroendocrine neoplasm (PH‐NEN) represent only 0.3% of all NENs. Moreover, PH‐NEN has very rarely been reported in pregnancy. We report a 28‐year‐old young patient with metastatic small cell neuroendocrine carcinoma of the liver complicated with pregnancy. She was evaluated and managed through a multidisciplinary team approach and received two cycles of chemotherapy with a cisplatin/etoposide regimen during the antenatal period and delivered at 37 weeks period of gestation (POG). This case highlights the importance of major challenges faced during the diagnosis and management of this very rare disease in pregnancy and the successful fetomaternal outcome.