Emirates Pathology Utilitarian Conference | Online
The Honorable Dr. David J. Shulkin is the Ninth Secretary of the US Department of Veterans Affairs having been appointed by President Trump. Secretary Shulkin previously served as Under Secretary for Health, having been appointed by President Obama and confirmed twice unanimously by the US Senate.
As Secretary, Dr. Shulkin represented the 21 million American veterans and was responsible for the nation’s largest integrated health care system with over 1,200 sites of care, serving over 9 million Veterans.
Don’t miss the Keynote Presentation by Honorable Dr. David J. Shulkin at EPUCG2021.
Abstract Submission Deadline: March 5, 2021
The Utilitarian Conferences Gathering is glad to invite Pathologists, Dermatologists, Neurologist, Surgeons, Cytopathologists, Dermatopathologists, Gynecologists, Delegates, Exhibitors, Sponsors, Students, Business Persons, Young Researchers to upload their abstracts and papers for oral presentation, poster presentation, workshop, special sessions to be presented at the Emirates Pathology Utilitarian Conference 2021 | Online.
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Keynote Tittle: Metastatic breast carcinoma mimicking a colonic polyp
Keynote Speech Presented By Dr. Kelly Elliott, UK
Keynote Tittle: Pleural effusion cytology at COVID19 lockdown
Keynote Speech Presented By Dr. Andreas Luebke, Germany
Keynote Tittle: Molecular Testing and Precision Medicine in Prostate Cancer
Keynote Speech Presented By Dr. Kirk K Lin, USA
Keynote Tittle: Importance of the Second Opinion in Surgical Breast Pathology & its Therapeutic Implications
Keynote Speech Presented By Dr. Alvaro Ibarra, Chile
Keynote Tittle: Semi-automated digital quantification of hormone receptor (ER, PR, HER2) status & proliferation index marker (Ki67) in invasive carcinoma of the breast: historical review, current status & future potential.
Keynote Speech Presented By Dr. Khalid Daifalla, Germany
Keynote Tittle: Effect of Active Search of Patients in Cancer Control
Keynote Speech Presented By Dr. Beatriz Hornburg, Brazil
Keynote Tittle: “Borderline Breast Disease” An Entity to Minimize Errors in Overdiagnosis of “Low Grade Ductal Carcinoma In Situ” in Breast Pathology
Keynote Speech Presented By Prof. Shahla Masood, USA
Keynote Tittle: Ciliated carcinoma associated with human papiloma virus: presentation as cervical metastasis of unknown primary.
Keynote Speech Presented By Dr. Alvaro Ibarra, Chile
Speech Tittle: Role of Pigmentation marker in Uveal Melanoma and its association with Clinicopathological Parameters
Speech Presented By Ms. Jayanti Jha
Speech Tittle: Atypical Fibroxanthoma-like Melanoma: A Rare Entity
Speech Presented By Dr. Cazzato Gerardo, Italy
Speech Tittle: Array of splenic lesions on splenectomies in Southern India
Speech Presented By Dr. Neetu Vanapalli, India
Speech Tittle: Abnormalities of the duct systems of the pancreas associated with ampullary carcinoma
Speech Presented By Dr. Galiya Setdikova, Russia
Speech Tittle: Incidental gallbladder carcinoma: Study of histopathological evaluation of routine cholecystectomy specimens
Speech Presented By Dr. Inara Abeer, India
Speech Tittle: D2-40/PODOPLANIN marker to distinguish primary skin adnexal tumors from Adenocarcinomas metastatic to skin
Speech Presented By Dr. Archana Bommana, UK
Speech Tittle: The role of digital radiography in histopathological evaluation of surgical breast cancer specimens after neoadjuvant chemotherapy
Speech Presented By Dr. Inessa M. Telezhnikova, Russia
Speech Tittle: Immunophenotyping of Non-Hodgkin Lymphomas : Flow Cytometric Analysis at a Tertiary Health Care Centre
Speech Presented By Dr. Manali Satiza, India
Speech Tittle: Spectrum of histopathological lesions of the oral cavity in a tertiary care hospital in malwa belt with special Emphasis to oral squamous cell carcinoma
Speech Presented By Dr. Arnav Kumar Roychoudhury, India
Speech Tittle: Study of tumor infiltrating lymphocytes and expression of programmed death ligand-1 in carcinoma breast
Speech Presented By Dr. Abhishek Gupta, India
Speech Tittle: Ectopic Primary Breast Carcinoma of the Vulva.
Speech Presented By Dr. Liam Bibo, Co-Author: Dr. Helen Ballal, Australia
Introduction: Primary breast carcinoma can occur at ectopic sites. Primary breast carcinoma of the vulva is an extremely rare entity. The incidence of ectopic mammary tissue is 1% to 6% of the general population (1). The axilla is the most common site of ectopic primary breast carcinoma comprising 91% of cases, but presentation in the vulva is rare (1,2). Ectopic breast tissue in the vulva was first described by Hartung in 1872, with the first case of ectopic breast carcinoma in the vulva reported in 1936 (1). To date there are 36 cases that have been reported in the literature, with 22 of these cases ductal histologic subtype (1). We present a rare case of an ectopic primary breast cancer in the form of labial DCIS.
Keywords: Breast Cancer, Oncology, Surgery
- Ananthula A, Lockwood B, Savage J, et al. Primary Breast Carcinoma of the Vulva Metastatic to Lymph Nodes and Bones: A Case Report and Literature Review. Perm J. 2020;24:19.
- A Lopes A, St Louis J, Balancin ML, Nogueira-Rodrigues A, et al. A Rare Presentation of Primary Breast Carcinoma in the Vulva: A Case Report and Literature Review. Clin Breast Cancer. 2018 Jun;18(3):e291-e294.
Biography: Dr Liam Bibo has completed his M.D. at the University of Notre Dame. He is a Surgical Registrar working at Fiona Stanley Hospital.
Speech Tittle: Histomorphological study of Premalignant lesions of Prostate in TURP samples and evaluating them with the help of IHC markers
Speech Presented By Dr. Swati Sahay, Co-Author: Dr. Aditya Vikram Singh, India
Carcinoma prostate falls next to carcinoma lung in incidence and mortality rate. With increasing age of men incidence of prostatic carcinoma is seen to be increasing. In recent years significant achievement is made in early diagnosis and the detection of carcinoma prostate. Orteil in 1926 gave the first description of premalignant changes in the prostate. The premalignant lesions of prostate include prostatic intraepithelial neoplasia (PIN) and atypical adenomatous hyperplasia (AAH)
It is recommended by-American Urological Association that in general,men 50 years and older with a reasonable certainty of a 10-year life xpectancy should be screened annually or biennially. Patients withan elevated risk of disease (e.g., African Americans and those with a family history) should be screened beginning at an earlier age (45years).. In clinical practice, AAH, HGPIN and PIA remains undetected as mostof these lesions does not reveal any abnormality on clinical (digital rectal examination), biochemical (PSA level analysis and radiological (trans rectal ultrasound) evaluation. Hence, histopathology remains the gold standard for diagnosis of these putative precursor lesions of prostatic carcinoma. Identification of these lesions of prostate will help in early detection of carcinoma and guide the urologist for appropriate management of the patient. Total number of samples collected are 100 from TURP samples and it is then evaluated microscopically and with the help of IHC marker P53 and AMACR for any disruption in basement membrane and PIN lesions.
Amongst the total of 100 cases, 86 cases (86%) were benign, 14 cases (14%) were premalignant. 04 cases amounting to 4% were found to show PIN associated with incidental carcinoma. All these were showing High Grade PIN.
Keywords: BPH; PIN; CARCINOMA; P63; AMACR.
Speech Tittle: Are Covid-19 GI symptoms due to Oxytocin dysfunction?
Speech Presented By Dr. M. Atwan, Co-Author: Dr. M Chapman and Dr. PT. Diep, United Kingdom
Introduction: Covid-19 infects a broad spectrum of the population with approximately 5% of infections being critical. Symptoms are varied and have been found to involve multiple systems including respiratory, cardiovascular, renal and gastrointestinal. Are there any common denominators that link most at risk groups and multi-systemic effects?
Keywords: Covid-19, Oxytocin, GI.
Oxytocin: Evidence shows Oxytocin plasma levels in groups most at risk from Covid-19 are lower than in the general population (1). Further, infection by Covid-19 could reduce Oxytocin function by two pathways. Firstly, by viral cytopathic effects on oxytocin producing neurons (2, 3) and secondly, by viral down-regulation of the Oxytocin receptor (4). Oxytocin receptors have been found throughout the body exerting a wide range of effects including immune modulation, maintenance and repair of tissues. Using the GI system as a microcosm of the body, could severe Covid-19 symptoms be explained by Oxytocin dysfunction?
Covid-19 associated GI symptoms: The GI tract is a potential route of COVID-19 infection (5). A significant proportion of Covid-19 infections are accompanied by GI symptoms (6). Oxytocin receptors are found throughout the GI tract (7). Decreased Oxytocin plasma levels have been found to have the following effects (8);
- Increased stool mass, water content, transit time and macromolecule intestine permeability.
- Decreased GI mucosal cell proliferation, villi height and crypt length, protection against inflammation and mucosal defense against toxins.
Hypothesis: Oxytocin dysfunction contributes to the GI symptoms in Covid-19 infection. Normal Oxytocin function will protect against the GI symptoms produced during Covid-19 infection. Intranasal administration of Oxytocin (established as safe and cheap) could alleviate the GI symptoms produced during Covid-19 infection.
Covid-19 exerts its effects on multiple bodily systems. Oxytocin receptors can be found throughout the body, therefore its healing and protective effects against Covid-19, may also be multi-systemic. Current findings are in keeping with this hypothesis, with oxytocin being linked to cardiovascular protective properties against COVID-19 (9) and growing support that Oxytocin could be considered ‘nature’s medicine’ (10).
 Diep. PT. (2020) Clin. Neuropsychiatry. 3(17): 192-195.
 Diep. PT. (2020) Med Hypotheses. 2020 Nov 11:110360.  Pascual-Goñi. E. et al. (2020) Neurol Neuroimmunol Neuroinflamm. 25; 7.
 Liu, Y. and Conboy, I. (2017) Skeletal Muscle 7, 7.
 Zhang. H. et al. (2020) Gut, 69:1010–8.
 Lin L, et al. (2020) Gut, 69:997–1001.
 Monstein. HJ. et al. (2004) Regul Pept, 119:39–44.
 Welch. MG. et al. (2014) Am J Physiol Gastrointest Liver Physiol, 307(8):G848-G862.
 Wang. SC. and Wang. YF. (2021). Life Sciences retrieved from https://doi.org/10.1016/j.lfs.2021.119130.
 Carter. CS. et al. (2020) Pharmacol Rev. Oct; 72(4):829-861.
Biography: Dr. Manal Atwan completed her medical training at The University of Jordan followed by MRCSed, CCBST and FRCPath in 2012. She is a consultant histopathologist specializing in gastrointestinal pathology and a clinical director for Bowel Cancer Screening at the hospital Trust
Speech Tittle: Spindle cell lesions of the Breast- A Diagnostic Dilemma
Speech Presented By Dr. Monal Trisal, Co-Author: Dr. Sabina Khan and Dr. Sujata Jetley, India
Spindle cell lesions of the breast (SCLB) are very rare and represent an interesting diagnostic problem due to wide differential diagnoses. Diagnosing these lesions is problematic but important when encountered in a needle core biopsy as different entities have different plan of treatment. In the histologic assessment of spindle cell lesions, the simplified approach is to evaluate the spindle cells and the accompanying epithelial cells.
Patients diagnosed with benign and malignant tumors that had a predominant spindle cell components on histopathological examination were included in our study. The patients’ medical records were accessed to obtain the clinical history, follow-up notes, and radiological findings. The Spindle cell lesions of the breast included a varied diagnosis ranging from Benign/Borderline Phyllodes Tumor, Pseudoangiomatous stromal hyperplasia (PASH), Mammary Fibromatosis to malignant etiologies like Metaplastic spindle cell Carcinoma. An algorithmic approach was employed for diagnosing SCLB based on cellular composition, presence and grade of atypia, growth pattern and mitotic activity in conjunction with immunohistochemical features, clinical and radiological features.
WHO classification of breast lesions was used in reaching to a conclusive diagnosis.
By studying the SCLB, the diagnostic difficulties faced on interpreting core needle biopsy versus the histopathological examination of excisional biopsy in each case was highlighted in our study.
Keeping in mind the rarity of the lesion careful histologic examination to identify accompanying epithelial element, focal cohesiveness within the spindle cell area and heterologous elements is of great value along with judicious use of immunohistochemistry which allows correct diagnosis to be made in the majority of cases.
Keywords: Spindle cell lesions, Metaplastic carcinoma, Phyllodes tumor, Mammary fibromatosis
Biography: Dr. Monal Trisal, MD Pathology, a graduate from Yerevan State Medical University, Yerevan, Armenia.
Keynote Tittle: The exotic souvenir – a case report in bone pathology
Keynote Speech Presented By Dr. Andreas M. Luebke, Germany
Introduction: I report the case of a 30 years old woman who complains about pain in her right knee.
History: The patient first noticed the pain half a year ago when she was running. The patient lives and works in northern Germany. During the last year, she traveled a lot, including Goa/India, Canary Islands/Spain, Costa Rica, New York/USA. The pain lasted, and she had light intermittent fever. Other symptoms were not apparent.
Imaging: Conventional X-Ray and CT revealed an inhomogeneous lesion of sclerotic and osteolytic areas in the distal femur. The first clinical impression was suspicious of osteomyelitis (Figure A). A biopsy was taken.
Histology and Microbiology: Microbiology did not present a disease-causing germ, and histology reported osteomyelitis. A second biopsy was taken from the joint space to gain material with infectious organisms to provide a therapeutic regimen. This biopsy revealed osteomyelitis with a few fungal organisms NOS. After three months, the lesion was still suspicious of osteomyelitis, and the patient came to our hospital with the suspicion of a rare mycosis or other rare infection. Histology revealed high-grade osteosarcoma (Figure B). Also, there were round spherules resembling Coccidioides immitis (Figures C and D. The final diagnosis was high-grade osteosarcoma with coincident fungal infection with Coccidioidomyces immitis.
Discussion: The fungus is known to live in the soil in the southwestern United States and parts of Mexico and Central (Costa Rica) and South America. People can get Valley fever by breathing in the microscopic fungal spores from the air, although most people who breathe in the spores don’t get sick. However, certain groups of people are at higher risk to become significantly ill. The hypothesis is that the osteosarcoma was present before the trip to Costa Rica. The osteosarcoma might have created an immunocompromised area in the distal femur, where the coincident infection found a hiding place.
Keywords: Osteosarcoma, Coccidioidomycosis, fungal infection.
Biography: Dr. Andreas M. Luebke is Head of Orthopeadic Pathology and Vice-Head of Cytopathology at the University Medical Center Hamburg-Eppendorf, Hamburg, Germany
Speech Tittle: The Role of Histone Methyltransferase EZH2 in Skeletal Muscle Stem Cells
Speech Presented By Dr. Sabeen Bokhari, United Kingdom
Speech Tittle: Immunophenotyping of non-Hodgkin’s Lymphoma on fine needle aspiration by Flow Cytometry
Speech Presented By Dr. Meena Verma, Co-Author: Dr. Monika Gupta, India
Lymphoma represents one of the major health problems all over the world. Flow cytometry can be used on FNAC from lymph node as an ancillary technique.
Aims and objectives:
Aim of the study was to assess the utility of (FCI) in diagnosis and differentiation of reactive hyperplasia and non- Hodgkin’s lymphoma on fine needle aspirate.
Material and methods:
The study was carried out on 50 cases, 25 each of reactive hyperplasia and suspicious or confirmed NHL on FNAC. FCI was performed with a complete panel of antibodies on FACS Canto II Flowcytometer.
All 25 cases of reactive hyperplasia on FNAC were polyclonal on FCM. FCM could be performed in 22 cases (88%) out of 25 suspicious NHL and in three cases the material was inadequate on aspirate. Out of 22 cases of NHL on FNAC 17 cases (77.30%) were diagnosed as B-NHL on FCM. Light chain restriction was demonstrated in 15/17 cases. With the help of FCI, 6 cases were diagnosed as small cell lymphocytic lymphoma, one case as mantle cell lymphoma, one case as follicular lymphoma ,and 9 cases as B-NHL-NOS. Histopathology diagnosis was available in nine cases and were in concordance to FCM. Sensitivity of combined FNAC and FCM in sub-classification was 77.30% (17/22). Four cases showed discordance between FNAC and FCM.
We concluded that FCM enhances the diagnostic ability of FNA cytology, playing a crucial role in a rapid and accurate differential diagnosis between reactive hyperplasia, B-NHL and T-NHL.
Keywords: non-Hodgkin lymphoma, FNAC, Flow cytometry
Speech Tittle: Mucormycosis in Immunocompetent Child with Atypical Presentation
Speech Presented By Dr. Priyamvada Yadav, Co-Author: Dr. Urmil Chawla, Dr. Virendra Singh & Dr. Meena Verma, India
Background: Mucormycosis is a disease that is usually seen in immunocompromised patients. Orbital mucormycosis is seen as a part of the entity rhino-orbito-cerebral mucormycosis, which usually starts from paranasal sinuses, then spreads to orbit and further spread may occur to brain. The disease has high fatality if not treated in time.
Case Report: We present case of a two year old female child, otherwise immunocompetent who presented with a pre-septal cellulitis not responding to intravenous broad spectrum antibiotics. There was no involvement of the paranasal sinuses or any eschar formation. Imaging studies revealed an orbital mass indenting the globe from inferomedial side. Incisional biopsy suggested presence of mucormycosis along with Pseudomonas. Intravenous amphotericin B along with systemic piperacillin were started. The disease started with inferior orbit , spread to subcutaneous maxillofacial region and further to forehead and post-septal compartment of orbit involving orbital muscles and leading to proptosis with exposure keratopathy. Intravenous liposomal amphotericin B along with syrup posaconazole were continued for approximately 60 days followed by oral antifungal drugs. Surgical debridement was done twice after a histopathological diagnosis of mucormycosis was made. The patient responded well but even after a total of three months from presentation, the disease has not been totally eliminated.
Conclusion: Aggressive mucormycosis can occur even in immunocompetent children and can present with orbital disease alone without prior paranasal sinus involvement. Strong suspicion for its presence in case of non-responding pre-septal or orbital cellulitis with prompt institution of treatment is must for control of the disease.
Keywords: mucormycosis, orbital, atypical
1)Amanati, A., Barzegar, H., Pouladfar, G., Sanaei Dashti, A., Abtahi, M. B., Khademi, B., Ashraf, M. J., Badiee, P., Hamzavi, S. S., & Kashkooe, A. (2020).
Orbital mucormycosis in immunocompetent children; review of risk factors, diagnosis, and treatment
approach. BMC infectious diseases, 20(1), 770. https://doi.org/10.1186/s12879-020-05460-2
2)Navarro-Perea, C., Cañas-Zamarra, I., Mencía- Gutiérrez, E., Revilla-Sánchez, E., Lago-Llinás, M. D., Pérez-Trigo, S., & Bengoa-González, Á. (2019). Rhino- Orbito-Cerebral Mucormycosis: Two Cases with Amaurosis as Presentation, Medical Surgical Management and Follow-Up. Case reports in ophthalmological medicine, 2019, 4215989. https://doi.org/10.1155/2019/4215989
Biography: Dr. Priyamvada Yadav has completed her M.S. Ophthalmology from BJMC, Ahmedabad, Gujarat University, India in 2013. She did fellowship in Comprehensive Ophthalmology from Sankara Eye Care Institutions, India. She is currently working as Senior Resident at Regional Institute of Ophthalmology, Post Graduate Institute of Medical Sciences, UHSR, Rohtak, Haryana, India. She has published multiple papers in different journals and delivered oral presentations at various conferences. She is active participant in continuing medical education series, has delivered many talks and has judged state level e-poster competition at annual state conference. She has keen interest in various subspecialities of Ophthalmology along with academics.
Speech Tittle: Coronavirus Pathogenesis and Treatment Methods
Speech Presented By Dr. Ayça Nur DEMİR, Turkey
Introduction: Coronavirus disease (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a member of the human coronavirus (HCoV) family that targets the lower part of the respiratory tract and causes severe acute respiratory syndrome (SARS).(1) Coronavirus disease 2019 (COVID-19) started as an epidemic in Wuhan in 2019, and has since become a pandemic.(2) SARS-CoV-2 is a member of the Coronaviridae family of enveloped, positive-sense, single-stranded RNA viruses that infect a broad range of vertebrates.(2) SARS-CoV-2 infection is associated with a fatality rate of around 1-3%, which is commonly linked to the development of acute respiratory distress syndrome (ARDS), likely resulting from uncontrolled immune activation, the so called “cytokine storm”.(2)
The virus epidemic is a big problem for humanity healthy and can lead die in special people with background diseases such as chronic obstructive pulmonary diseases, chronic heart failure, diabetes mellitus, and kidney failure. Different medical, social, and engineering methods have been proposed to face the disease include treatment, detection, prevention, and prediction approaches.(3)
The therapies’ methods and antibody solutions have been proposed to treatment and prevention from infecting the disease, whereas they are not yet the definitive approaches against COVID-19.(3) Social distance and quarantine methods had an impressive effect on reducing the probability of infected the disease, which are depended on the individual, ethnic, cultural, and demographic habits.(3) At the same time, scientists around the world work tirelessly, and information about the transmission mechanisms, the clinical spectrum of disease, new diagnostics, and prevention and therapeutic strategies are rapidly developing.(4) Many uncertainties remain with regard to both the virus-host interaction and the evolution of the pandemic, with specific reference to the times when it will reach its peak.(4)
Keywords: COVID-19, treatment, pathogenesis, pandemic
- Berekaa, M.M. (2021) “Insights into the COVID-19 pandemic: Origin, pathogenesis, diagnosis, and therapeutic interventions“, Frontiers in Bioscience, 1;13:117-139.
- Asselah, T., Durantel, T., Pasmant, Lau, G., Schinazi, R.F. (2021) “COVID-19: Discovery, diagnostics and drug development“, Journal of Hepatology, 74(1):168-184.
- Rahmani, A.M., Mirmahaleh, S.Y.H. (2021) “Coronavirus disease (COVID-19) prevention and treatment methods and effective parameters: A systematic literature review“, Sustainable Cities and Society, 64:102568.
- Cascella, M., Rajnik, M., Cuomo, A., Dulebohn, S.C., Napoli, R.D. (2020) “Features, Evaluation, and Treatment of Coronavirus“, Stat Pearls, 2020 Jan. 2020 Oct 4.
Biography: My name is Ayça Nur DEMİR. I live in Turkey. I am studying at Afyonkarahisar Health Sciences University Faculty of Medicine. I am a 5th grade student. I have attended and continue to attend numerous congresses and conferences throughout my university life. I also attend courses and receive training from different fields. By this time, I have obtained more than 70 certificates in total. I am also studying language. I study German and Spanish as well as English education. I have been the editor of the Journal of Pediatric Genetics for 3 years.
Speech Tittle: A Comparison of Nuclear & Cytoplasmic immuno-expression of p16 in Breast Neoplasms
Speech Presented By Dr. Sudipta Naskar, Co-Author: Dr. Nadeem Tanveer, Dr. Sonal Sharma, & Dr. Navneet Kaur, India
Introduction: Being a tumor suppressor molecule the nuclear localization of p16 protein explains its role in cell cycle regulation.1 The cytoplasmic expression in breast carcinoma cells was considered to be non‐specific by some authors, whereas others considered it as a marker of higher grade. The cytoplasmic localization of p16 is not artifactual and has been found to play an important role in other neoplasms.2,3 Our aim was to study intracellular localization of p16 in benign and malignant breast lesions.
Material and Methods: A total of 65 cases were included in the study. These included: 30 cases of invasive carcinoma breast, 30 cases of Fibroadenoma, 4 cases of benign phyllodes tumor and 1 lobular carcinoma in situ case. The immunohistochemical expression for p16 was evaluated separately for nuclear and cytoplasmic localization in the epithelial and stromal compartments of the tumors. For carcinoma cases immunohistochemistry for ER, PR and Her2ν were performed.
Results: Fourteen out of thirty fibroadenoma cases showed strong nuclear p16 expression in epithelial component but no case showed cytoplasmic p16 expression and in 13 cases stromal cells also showed strong nuclear p16 expression. Moderate stromal p16 expression was seen in 3/4 benign phyllodes. In case of carcinoma 17 /30 cases showed moderate to strong nuclear p16 expression and 16/30 cases showed cytoplasmic p16 expression. A statistically significant correlation was found between nuclear p16 immunoexpression and molecular subtypes of breast carcinoma.
Conclusion: In benign conditions like fibroadenoma cytoplasmic localization of p16 (by immunohistochemistry) is not seen (in epithelial components) whereas in case of carcinomas this is often observed. The nuclear p16 expression has a statistically significant correlation with molecular subtypes of breast carcinoma. p16 immunopositivity cannot be used to differentiate fibroadenoma from benign phyllodes as many of fibroadenoma cases also show moderate/strong stromal p16 expression
Keywords: cytoplasmic p16, nuclear p16, fibroadenoma, breast carcinoma, phyllodes
References: 1. Romagosa C, et al. p16(Ink4a) overexpression in cancer: a tumor suppressor gene associated with senescence and high-grade tumors. Oncogene. 2011;30(18):2087-2097.
- Mendaza S et al. Absence of Nuclear p16 Is a Diagnostic and Independent Prognostic Biomarker in Squamous Cell Carcinoma of the Cervix. Int J Mol Sci. 2020;21(6):2125.
- Hu YH et al. Aberrant protein expression and promoter methylation of p16 gene are correlated with malignant transformation of salivary pleomorphic adenoma. Arch Pathol Lab Med. 2011;135:882-889.
Biography: All four authors are affiliated to UCMS & GTB Hospital, Delhi. Dr. Sudipta Naskar is a 3rd year post-graduate resident at Department of Pathology. Dr. Nadeem Tanveer is professor of pathology and has more than 50 publications. Dr. Sonal Sharma is director professor of pathology and has more than 300 publications. Dr. Navneet Kaur is director professor of surgery and has numerous publications in peer reviewed journals.
Keynote Tittle: The perioperative window offers a long overlooked but important opportunity to prevent relapses in breast and perhaps other cancers
Keynote Speech Presented By Dr. Michael Retsky, USA
My colleagues and I have been studying an unexpected bimodal relapse pattern in breast cancer. This project started in 1993 when data from Italy and UK showed that 50 to 80% of all relapses in patients treated only with surgery occurred in an early wave of relapses in the first 3 years post-surgery. We have proposed a reasonable explanation over the years. It appears that the surgery to remove a primary tumor causes systemic inflammation for a week. During that time, dormant single malignant cells and avascular deposits escape from dormancy and appear as relapses within 3 years. The multi-national authors of our reports include medical oncologists, surgeons, anesthesiologists, physicists and other scientists from several fields. A potential solution seems to exist based on our analysis. That therapy is the common inexpensive analgesic ketorolac administered as iv at the time of surgery and perhaps as oral drug for a few days after surgery. We edited a book in 2017 that was published by Springer-Nature (1) and a number of papers including one recently published (2). Other reports support this and suggest mechanisms (3-4). We now show data that suggests this is a process that applies to many solid and other cancers. Based on data from lung cancer, inflammation level on the first day post-surgery predicts outcome. We propose that this disruptive innovation will result in a paradigm shift in oncology. In a recent development we propose a method to reduce late relapses (5).
- Michael Retsky and Romano Demicheli, Editors, Perioperative Inflammation as Triggering Origin of Metastasis Development. Springer Nature 2017.
- Michael Retsky and Romano Demicheli, Editors, Perioperative Inflammation as Triggering Origin of Metastasis Development. Springer Nature 2017.
2.Retsky M, Demicheli R, Hrushesky W, James T, Rogers R, Baum M, Vaidya J, Erhabor O, Forget P. Breast cancer and the Black Swan, eCancer 2020 https://ecancer.org/en/journal/article/1050-breast-cancer-and-the-black-swan
- Krall JA, Reinhardt F, Mercury OA, Pattabiraman DR, Brooks MW, Dougan M, Lambert AW, Bierie B, Ploegh HL, Dougan SK, Weinberg RA. The systemic response to surgery triggers the outgrowth of distant immune-controlled tumors in mouse models of dormancy. Sci Transl Med. 2018 Apr 11;10(436).
- Panigrahy D, Galtung A, Yang J, et al. Preoperative stimulation of resolution and inflammation blockade eradicates micrometastases. J Clin Invest. 2019;129(7):2964-2979. Published 2019 Jun 17. doi:10.1172/JCI127282
- Retsky, M. It may be possible to prevent both early and late relapses in breast cancer; Perhaps this is an opportunity for Sensors and Biosensors to help. Sensors, Dec 2020. https://www.mdpi.com/1424-8220/20/24/7261/pdf
Biography: Michael Retsky completed his PhD in experimental Physics from University of Chicago in 1974. He made a career change to cancer research in 1982. He has published over 100 papers in physics and oncology.
Keynote Tittle: Healthcare innovation with a focus on the use of artificial intelligence in digital pathology as the future of pathology.
Keynote Speech Presented By Dr. David J. Shulkin, USA
Speech Tittle: Metastatic Colorectal Adenocarcinoma Presenting as Anal Skin Tag
Speech Presented By Dr. Manal Atwan, Co-Author: Dr. K. Talash, United Kingdom
Introduction: Colorectal adenocarcinoma most frequently metastasises to the liver and lungs. We discuss what we believe is the first reported case in the literature of primary colorectal adenocarcinoma re-presenting with cutaneous metastasis in the form of an anal skin tag.
Clinical History: A 41 year old female complained of a tender anal lesion which on examination appeared to be a swollen fibrosed skin tag. Her past surgical history of note included anterior resection 11 months previously for a well differentiated rectal adenocarcinoma. The skin tag was excised and sent to histology. Microscopic examination identified a moderately differentiated adenocarcinoma within the dermis of the skin tag, with immunohistochemistry consistent with the initial primary colorectal adenocarcinoma (see figures 1 and 2). Immunohistochemistry also revealed proficient mismatch repair protein (MMR) profile. The case was discussed at the local multidisciplinary team meeting and the patient continued to have appropriate clinical monitoring for disease recurrence.
Conclusion: Cutaneous metastatic colorectal adenocarcinoma is reported to constitute 4-6.5% of metastases  and occurs in the surgical scar, pelvis, trunk, extremities or head and neck areas. It is thought to be a poor prognostic factor, with average survival of 18 months . Although presentations are rare, it is extremely important to have a high level of suspicion with the onset of cutaneous lesions, even if clinically they resemble benign disease, such as an anal skin tag, as highlighted in our reported case. This case also highlights the importance of providing detailed medical and surgical history when specimens are sent for histology, to ensure appropriate investigation are carried out in a timely manner.
Keywords: Metastasis, Colorectal adenocarcinoma
References:  Saeed S. et al. (2004) J Cutan Pathol. 31(6) 419-430.  Nesseris I. et al. (2013) An Bras Dermatol. 88(6 Suppl 1):56-8.
Biography: Dr. Manal Atwan completed her medical training at The University of Jordan and FRCPath in 2012. She is a consultant histopathologist specialising in gastrointestinal pathology and a clinical director for Bowel Cancer Screening at the hospital Trust. Dr Khojasta Talash completed her medical training at the University of Cambridge and is currently training to become a histopathologist.
Speech Tittle: Primary Fibrosarcoma Breast Mimicking Invasive Ductal Carcinoma: A Rare Case Report
Speech Presented By Dr. Pooja Dwivedi, Co-Author: Dr. Madhu Kumar, & Prof. Vijay Kumar, India
Introduction: Breast fibrosarcoma is a rare tumor. It is one of breast sarcomas which are rare, and account 0.1% of malignant breast tumors . Amongst the Primary Breast Sarcoma (PBS), it is the most common subtype, accounting for 16% of all soft tissue sarcomas of the breast . Primary breast sarcoma (PBS) is defined as malignancy originating from mesenchymal tissue of the breast and does not include those arising from skin, muscle, and adjacent bones.
OBJECTIVE: To study an interesting case of primary fibrosarcoma breast mimicking invasive ductal carcinoma.
MATERIALS AND METHODS: A 48 year female presented to us with complaint of painful, recurrent, progressive right breast lump for three years. CT Scan concluded it as right breast carcinoma, showing enhancing soft tissue attenuation mass lesion of size 39 x 31 mm. Small right axillary lymph nodes are also seen. We received the right breast lumpectomy specimen, we processed, sectioned and stained with hematoxylin & eosin and immunohistochemistry was also done.
On gross, a well-defined, grayish white tumor with variegated appearance measuring 3.5 x 2.5 x 2 cm was identified, located in retro-areolar region.
On microscopy sections from growth in breast and nipple areola complex shows a malignant mesenchymal neoplasm disposed in sheets and intersecting fascicles along with focal areas of myxoid degeneration.
Immunohistochemistry was strongly and diffusely positive for Vimentin in tumor cells. Ki 67 index was 10%. Desmin, S 100, CD34, ER, PR, HER2 Neu were negative in tumor cells.
CONCLUSION: Primary breast sarcomas constitute a specific clinicopathologic entity that carry different prognosis and therefore should be differentiated from malignant phyllodes and metaplastic carcinomas. As this is a recurrent, distantly metastasizing tumor so timely correct diagnosis, wide local excision with clear margins and chemo-radiotherapy treatment can prevent this tumor metastasis.
Keywords: Primary Fibrosarcoma Breast, Breast Fibrosarcoma, Breast Pathology
- Surov A, Holzhausen HJ, Ruschke K, et al. Primary breast sarcoma: prevalence, clinical signs, and radiological features. Acta R adiol 2011;52:597-601.
- Pollard SG, Marks PV, Temple LN, Thompson HH. Breast sarcoma. A clinicopathologic review of 25 cases. Cancer. 1990;66(5):941-4.
- Al-Benna S, Poggemann K, Steinau HU, Steinstraesser L, et al. Diagnosis and management of primary breast sarcoma. Breast Cancer Res Treat. 2010;122(3):619-26.
- Chae S Y, Woo O H, Shin H S, Kim C Y. Primary Breast Fibrosarcoma Mimicking Invasive Ductal Carcinoma in a Patient with Interstitial Injection Mammoplasty: Magnetic Resonance Imaging and Pathologic Findings, Iran J Radiol.2017; 14(1):e13475.
- Adem C, Rey nolds C, Ingle JN, et al. Primar y breast sarcoma: clinicopathologic series from the Mayo Clinic and review of the literature. Br J Cancer 2004;91:237-41.
- Jiao Q, Wu A, Liu P, Tang J, Yang M, Fan X, Zheng L. A young woman with a giant breast fibrosarcoma: a case report. Journal of thoracic disease. 2013 Oct;5(5):E199.
Biography: Pooja Dwivedi has completed her M.B.B.S. degree from Sarojini Naidu Medical College Agra affiliated with Dr. Bhimrao Ambedkar University Agra, Uttar Pradesh, India. She is a postgraduate trainee in Department of Pathology at King George’s Medical University Lucknow, Uttar Pradesh, India.
Speech Tittle: High Risk Relapsed Refractory Case Of Aml M2 – A Rare Case Report
Speech Presented By Dr. Jayashree H K, Co-Author: Dr. Priyadarshini D, India
Introduction: Acute myeloid leukemia (AML) is a tumor of hematopoietic progenitors caused by acquired oncogenic mutations that impede differentiation, leading to the accumulation of immature myeloid blasts in the marrow. The replacement of the marrow with blasts produces marrow failure and complications related to anemia, thrombocytopenia, and neutropenia. AML occurs at all ages, but the incidence rises throughout life, peaking after 60years of age. High dose chemotherapy followed by bone marrow transplant remains the mainstay of treatment modality and the prognosis depends on the stage of the disease along with cytogenetic and chromosomal characters associated with it.
Case Report: A 56 year old female known diabetic and hypertensive since 5 years and on regular treatment, presented with fever, UTI, uneasiness, since a week. She had a history of recurrent vaginal candida infection since 1 year which usually subsided on treatment and also significant weight loss. The patient also noticed bruises, purpura and small petechiae in both lower limbs since 1 month. On examination the patient was stable, however she had mild splenomegaly
Work up: After preliminary investigations, a bone marrow aspiration study and flowcytometry was conducted which confirmed the diagnosis of AML M2 ( blast percentage 22-28%). This was followed by cytogenetics which demonstrated multiple complex chromosomal abnormality 45-46, XX, del(5)(q21),add(8)(p22),-12,add(16)(q22)[cp20] and later after three cycle of initial chemotherapy to know disease status MRD panel was done which still showed 0.6% AML MRD of all viable nucleated cells. After transplantation which achieved <0.16%
Conclusion: Refractory AML with p53 mutation is very rare and frequently leads to relapse even after effective chemotherapy. Predicting the prognosis, bone marrow transplantation can be considered over chemotherapy for better outcome in high risk relapsed cases to achieve MRD less than 0.6%.
- Bain B, Bates I, Laffan M, Lewis S. Dacie and Lewis practical haematology. 12th ed. 2016.
- Robbins S, Cotran R, Kumar V, Abbas A, Aster J. Pathologic basis of disease. 10th ed. Philadelphia, PA: Saunders Elsevier; 2020.
Speech Tittle: Correlation of ER & PR with proto-oncogene & grades of invasive duct carcinoma
Speech Presented By Dr. Dupinder Kaur, India
Background & Method: The present study entitled “Correlation of ER & PR with proto-oncogene & grades of invasive duct carcinoma” was conducted in Dept. of Pathology, at SRMSIMS, Bareilly.
Result: The quick scoring of ER & PR is combination of proportion and intensity scoring. Out of 56 cases, 24 cases (42.85%) were ER negative & 22 cases (39.28%) were PR negative while both were negative in 18 cases (32.14%). There was a significant relationship between tumour grading & receptor status. As the grade of tumour increases ER & PR positivity decreases. Most of the tumour of grade 01 were both ER & PR
positive. Here the value of (p<0.05) for both ER & PR which is significant.
Conclusion: For all invasive carcinomas, hormone receptor status is also studied using immunoperoxidase method and
Quick scoring was done. Hormone receptor status was also correlated with other tumor characteristics as histological grading. Both ER & PR positive immune staining was observed in 71.42% cases of grade I, 64.10% cases of grade II were positive for ER & 25% were positive for PR and 20% cases of grade III were found positive for ER & 10% was found positive for PR.
Keywords: ER & PR, Pro-oncogene & Carcinoma
Biography: Dr Dupinder Kaur completed MBBS from Acharya Shri Chander College of Medical Sciences Jammu in 2013. She
did her post-graduation from SRMS Bareilly, Uttar Pradesh, in 2016. She has participated in various CMEs, con-ferences and
presented her research work. Her research work has been published in reputed medical journals. Presently she is working in NABL accredited laboratory in Jammu, India
Speech Tittle: Primary Neuroendocrine Breast Carcinoma: A Rare Case Report
Speech Presented By Dr. Madhu Kumar, India
Speech Tittle: Multiple Recurrent Odontogenic Keratocysts with malignant transformation occurring in a non syndromic setting
Speech Presented By Dr. Maryam Nazar, United Kingdom
Speech Tittle: Immunohistochemical evaluation of Programmed cell Death Ligand 1 (PD-L1) expression in Head and Neck Squamous Cell Carcinoma
Speech Presented By Dr. Diviya.N, Co-Author: Dr. Vinod K Arora, Dr. Preeti Diwaker, & Dr. Vipin Arora, India
Introduction: Recently FDA has approved immune blockade therapy (anti PD-1, anti PD-L1) in recurrent and metastatic HNSCC1,2. PD-L1 evaluation is necessary for selecting patients for immune blockade therapy. But data regarding prevalence of PD-L1 expression in HNSCC cases is not available in India. Our aim was to evaluate PD-L1 expression in HNSCC and its association with HPV.
Material and Methods: A total of 50 cases of HNSCC were analyzed. The immunohistochemical expression for PD-L1 was evaluated in the tumors and mononuclear inflammatory cells. For HPV detection, p16 immunohistochemistry was used as a surrogate marker.
Results: Out of 50 cases of HNSCC, 66% and 76% cases showed PD-L1expression in tumor cells and mononuclear inflammatory cells respectively. p16 positivity seen in 30% of cases. A statistically significant correlation was not found between PD-L1 and p16 (p value-0.318)
In HNSCC, PD-L1 expression were seen in more than 50% of cases in tumor cells. However, no significant association and correlation was found between PD-L1 and p16 expression in HNSCC.
Keywords: HNSCC, PD-L1, PD-1, p16.
References: 1. Cohen EEW, Bell RB, Bifulco CB, Burtness B, Gillison ML, Harrington KJ et al. The Society for Immunotherapy of Cancer consensus statement on immunotherapy for the treatment of squamous cell carcinoma of the head and neck (HNSCC). J Immunother Cancer. 2019;7(1):184.
- Ferris RL, Blumenschein G, Fayette J, Guigay J, Colevas AD,Licitra L, et al. Nivolumab for Recurrent squamous cell carcinoma of the Head and Neck. N Engl J Med. 2016; 375(19): 1856-1867.
Biography: All four authors are affiliated to UCMS & GTB Hospital, Delhi. Dr. Diviya. N is a 3rd year post-graduate resident at Department of Pathology. Dr. Vinod K Arora is director professor and head of department of pathology and has more than 150 publications. Dr. Preeti Diwaker is professor of pathology and has 28 publications. Dr. Vipin Arora is professor of ENT and has 22 publications.
Speech Tittle: Cytological Diagnosis Of Pleomorphic Giant Cell Variant Of Hepatocellular Carcinoma: A Rare Case Report
Speech Presented By Dr. Suraj Jahiruddin Shikalgar, India
Background: Hepatocellular carcinoma is the most common type of primary liver cancer. Pleomorphic giant cell rich variant of hepatocellular carcinoma is a very rare entity. Role of FNAC in diagnosing variants of hepatocellular carcinoma is limited. Here, we report a case of Pleomorphic giant cell rich variant of hepatocellular carcinoma which was diagnosed on cytology. A 56year female presented in the medicine OPD with chief complain of right hypochondrium pain since 6months. Ultrasound and CT scan of abdomen was performed. CT scan revealed a large mass in the region of gall bladder fossa with involvement of adjacent liver parenchyma. USG guided FNA of liver was performed. Slides were stained with Leishman Giemsa and Pap stain. Cytology smears showed neoplastic hepatocytes arranged in cohesive sheets and trabeculae with transgressing blood vessels and endothelial cell cuffing. Many singly scattered tumor cells were also seen. Tumour cells were round to polygonal with large pleomorphic nuclei, prominent one to multiple nucleoli, intranuclear inclusions, atypical mitosis and moderate amount of cytoplasm. Background showed many large multinucleated giant cells, bizarre cells showing emperipolesis and necrosis. Based on these features cytological diagnosis of Hepatocellular carcinoma, Pleomorphic giant cell rich variant was made.
Conclusion: Although histopathology remains as gold standard for diagnosis of variants of hepatocellular carcinoma. But diagnosing Pleomorphic giant cell rich variant of hepatocellular carcinoma by FNAC may help in early diagnosis and management of the patient as this variant of hepatocellular carcinoma shows aggressive clinical course and poor prognosis.
Keywords: Hepato Cellular Carcinoma; Pleomorphic Giant Cell
Speech Tittle: Hairy Projections on a Non Hairy Cell
Speech Presented By Dr. Rhituparna Das, Co-Author: Dr. B. Sriranjan Mukherjee, & Dr. Moumita Sengupta, India
Introduction: Adult T cell leukemia is a neoplasm of mature T cells. It is caused by human retrovirus HTLV-1. The leukemic cells are highly pleomorphic in appearance. Also they have a variable clinical presentation ranging from acute to lymphomatous to chronic to smouldering. Hence their correct diagnosis is based on immunohistochemistry or flow cytometry. The neoplastic cells show monoclonal integration of HTLV 1 and express T cell associated antigens namely CD3, CD2 and CD5. Here we report case of a 45 year old female patient who was diagnosed as case of Adult T cell leukemia, whose leukemic blasts on morphology had hairy projections resembling hairy cell leukemia. However, using the cluster of differentiation marker, this confusion was resolved. This case is reported due to the close mimicry it had with hairy cell leukemia in view of its morphology and presentation.
Keywords: Adult T cell leukemia, hairy projections, cluster of differentiation marker.
 Sabattini E, Bacci F, Sagramoso C, Pileri SA. WHO classification of tumours of haematopoietic and lymphoid tissues in 2008: an overview. Pathologica. 2010 Jun;102(3):83-7..
 Uchiyama T, Yodoi J, Sagawa K, Takatsuki K, Uchino H. Adult T-cell leukemia: clinical and hematologic features of 16 cases. Blood. 1977 Sep 1;50(3):481-92.
 Somasundaram V, Ahuja A, Manivannan P, Ch D, Purohit A, Saxena R. Unusual hairy projections in a case of T-acute lymphoblastic leukemia, a cause for diagnostic dilemma: a case report. Journal of Hematology & Thromboembolic Diseases. 2015 Nov 2.
Speech Tittle: Goblet cell adenocarcinoma of the appendix – case report
Speech Presented By Dr. Răduță Diana-Alexandra, Co-Author: Dr. Filip Mădălin-Cosmin, Romania
Appendiceal goblet cell adenocarcinoma is a distinctive rare subtype of appendix’s carcinoma composed of goblet-like mucinous cells, endocrine cells and Paneth cells with a tubular pattern resembling intestinal crypts. Usually affects patients in the fifth decade of life with a minimum predilection for women in some studies.
This tumor is most often diagnosed incidentally in patients with clinical symptoms of appendicitis, but some cases presents with ovarian metastases.
We are presenting the case of a 63 years old woman, who had a symptomatology beginning approximately 3 days prior consisting of mesogastrium pain which later migrates to the right lower quadrant, nausea and loss of appetite. After further investigations and a surgery, the clinical diagnosis was: appendicular plastron with a local abscess.
After approximately 2 months, the patient comes back with the same symptomatology and she is going under the second surgery, more exactly an appendectomy of a 7 cm phlegmon appendix, the final clinical diagnosis consisting in acute appendicitis with peritoneal abscess. And then a surprise appeared under microscope.
Histology revealed a low-grade amphophilic tumor proliferation arranged in nests and trabeculae, focally fused and branched (<25%), occasionally with tubular pattern, composed of goblet-cells, neuroendocrine and Paneth cells. Proliferation develops circumferentially into lamina propria and submucosa with focal invasion in muscularis propria; rare mitosis (1 mitosis/10HPF).
Immunohistochemistry revealed that:
- Chromogranin was focal positive in tumor cells
- CK7 and CK20 highlighted the epithelial component of the tumor
- CD31 positive in endothelial cells, without evidence of tumor emboli
- S100 and CD56 negative in tumor cells, without neurotropism
Keywords: appendix; adenocarcinoma; goblet cells;
The main differential diagnosis has to be signet ring cell carcinoma due to more aggressive nature, which is characterized by a more disorganized growth arrangement and more cytological atypia (increased mitosis, nuclear pleomorphism, necrosis) than goblet cell adenocarcinoma.
The prognosis depends on tumor grade and stage. Survival rate varies between 7-17 years in low grade tumors and 29-45 months for high grade tumors.
The management of patients with goblet cell adenocarcinoma is challenging due to poorly documented data in the available literature, hence there is a need for standardization to ensure optimal treatment.
 WHO Classification of tumors: Digestive system tumours, 5th edition
 Klein EA, Rosen MH. Bilateral Krunkenberg tumors due to appendiceal mucinous carcinoid. Int J Gynecol Pathol. 1996;15:85-88
 Odze and Goldblum Surgical Pathology of the GI Tract, Liver, Biliary Tract and Pancreas, 3rd edition
Biography: D.A. Răduță has completed her Bachelor MD from Carol Davila University of Medicine and Pharmacy and M.C. Filip has completed his Bachelor MD from University of Medicine and Pharmacy of Craiova. They head Pathology department of Colentina Clinical Hospital, as first year pathology residents. They participated at numerous national and international congresses, for instance bursary rewarded poster at European Congress of Pathology, 2020.
Speech Tittle: Pattern of driver mutation analysis in lung cancer patients single institution study from Kashmir
Speech Presented By Dr. Inara Abeer, India
Speech Tittle: Sonic Hedgehog Signalling in Vasculogenesis and Innervation in a Developing Mouse Molar and in Root Formation in a Bio-Engineered Tooth Unit.
Speech Presented By Dr. Sabeen Bokhari, United Kingdom
Speech Tittle: Use of immunohistochemistry for typing of non-small cell lung carcinomas(NSCLC)
Speech Presented By Dr. Ishani Gupta, Co-Author: Dr. Subhash Bhardwaj, India
Background: Lung cancer is the leading cause of cancer related mortality, accounting for more than 150,000 deaths per year in United States and over 1.3 million deaths worldwide. Majority of non-small cell lung carcinomas (NSCLC) can be diagnosed and further subtyped employing haematoxylin and eosin (H&E) stains. However morphological recognition of poorly differentiated tumours maybe difficult, especially in small biopsies. This study was aimed to distinguish and classify lung tumors employing immunohistochemical markers TTF1(thyroid transcription factor 1), Cytokeratin 5/6, Cytokeratin 20, AE1/3.
Material & Methods: A total of 54 clinically diagnosed cases of lung carcinoma over a period of one year were included in our study. All the cases after being diagnosed on H&E were subjected to Immuohistochemistry (IHC).
Statistical Analysis: The statistical analysis was done using SPSS for Windows 15.0 program. Specificity, sensitivity, positive predictive value, negative predictive value of all these IHC markers was statistically evaluated.
Results: Of 30 cases diagnosed as Squamous cell carcinoma (SCC) on H&E, 27 were CK5/6 positive on IHC. Of 12 cases diagnosed as Primary Adenocarcinoma (ADC) on H&E, 9 were TTF-1 positive. Of 12 cases diagnosed as poorly differentiated carcinoma on H&E, 8 cases were diagnosed as SCC and 4 cases as Metastatic ADC on employing IHC markers. The sensitivity and specificity of CK5/6 and TTF-1 was 100%, 57.1% and 100%, 96.7% respectively.
Conclusion: Application of IHC markers is a useful adjunct to morphological features and clinical parameters for the diagnosis and management of lung tumours. Squamous cell carcinoma- Neoplastic cells showing focal cytoplasmic positivity. ( immunostain CK5/6, 100x);
Keywords- Lung carcinoma, immunohistochemistry, TTF-1, CK5/6
Dr. Ishani Gupta has been a senior resident in the department of Pathology at Government Medical College and Hospital, Jammu since 2019. She received her MD in pathology from HNB University Garhwal, Uttarakhand in 2018. Since 2015, she has been frequently attending conferences and has also presented posters as well as papers in many conferences in India. Currently, she is working on a new research project on molecular profiling of lung carcinomas.
Speech Tittle: Columnar Cell Hyperplasia of the Breast in a Young Girl
Speech Presented By Dr. Samridhi Allhabadi, Co-Author: Dr. Natasha Singh, Dr. Vatsala Gupta, Dr. Shubhangi Gupta, Dr. Jyoti Mishra & Dr. M.S. Bindra, India
Introduction: Breast lesions are characterized by a variably proliferative, cytologically bland columnar epithelium, lining dilated terminal duct-lobular units, often with luminal secretions and cytoplasmic blebs on the lining cells.
- Columnar cell lesions are frequently associated with microcalcifications. They are increasingly being recognized and diagnosed in biopsies of mammographically detected lesions.
- Columnar cell lesions may be associated with or adjacent to ductal carcinoma in situ or invasive carcinoma. More frequently seen in flat epithelial atypia (columnar cell lesions with atypia). May be associated with atypical hyperplasia but otherwise no significantly increased risk of breast carcinoma.
- Involves dilated terminal duct-lobular units
- Lined by columnar cells identical to those seen in columnar cell change
- Lining greater than two cells thick
- May form small mounds, tufts and micropapillations
- Architectural complexity must be short of that seen in low grade ductal carcinoma in situ
- No partial or complete filling of ducts
- Arcades, microacini and micropapillary formations absent or very rare
- No diagnostically useful markers are currently reported.
Case Study: A 15 year old unmarried girl presented with a palpable mass in right breast for 2 years which got increased in size for the last 2 months. There was no nipple discharge or pain in the affected breast. No other significant history.
On clinical examination, 7×5 cmlump in right breast. The lumpwas non tender, fixed and firm in consistency with surrounding skin inflamed.
USG findings were suggestive of Duct Ectasia. FNAC, smears were suggestive of Usual Ductal Hyperplasia (UDH).
Lumpectomy was performed and tissue was submitted for histopathological evaluation. Sections on H& E showed ducts and acini, few cystically dilated, lined by stratified columnar cells with apical cytoplasmic snouts and intraluminal secretions. No nuclear atypia was seen. Final diagnosis of Benign Epithelial Proliferative Breast Disease- Columnar Cell Hyperplasia was rendered.
Keywords: Columnar cell hyperplasia, young patient, cytologically bland
- Logullo, A.F., Nimir, C(2019) Columnar cell lesions of the breast: a practical review for the pathologist. Surg Exp Pathol2,
- Hicks DG, Lester SC (2016) Benign epithelial lesions: Columnar cell change, columnar cell hyperplasia, and flat epithelial atypia. In: Diagnostic pathology: breast, 2nd Elsevier, section 5 p 100–103.
- Lakhani SR, Ellis IO, Schnitt SJ, Tan PH, van de Vijver MJ (2012) In: WHO (ed) WHO Classification of Tumours of the Breast, Fifth ed.
Biography: I, Dr. Samridhi is PG 2nd year PG student, in Dept. in Pathology, School of Medical Sciences and Research, Greater Noida. I have keen interest in Histopathology.
Speech Tittle: Personalized Prognosis Through Artificial Intelligence-Based Quantification of the Colorectal Cancer Microenvironment
Speech Presented By Dr. Peter David Caie, Co-Author: Dr. P. Nearchou, Dr. Kate Lillard, & Dr. Hideki Ueno, United Kingdom
Introduction: The tumor microenvironment (TME) plays a major role in tumor progression and patient survival outcome. Several components of this complex TME have shown to be promising prognostic factors in stage II CRC, however they are traditionally reported in isolation of each other. We demonstrate the ability for machine learning-based image analysis to standardize the reporting of multiple features of the TME by multi-plexed immunofluorescence, tissue registration and automated image analysis. The density and spatial interactions of infiltrating CD3+, CD8+, CD68+ , CD163+ and tumor buds were quantified using Indica Labs HALO® software (Fig 1) across three distinct cohorts from international institutions (Scottish and Japanese hospitals). Machine learning data analysis resulted in a prognostic score compiled of multiple TME features (lymphocyte infiltration, CD68+ /CD163+ macrophage ratio and the spatial proximity of lymphocytes to TBs). In two test set cohorts (one Scottish and one Japanese) the novel score identified a subgroup of patients experiencing 100% 5 year surviva. Furthermore, we will demonstrate the ability of Indica Labs HALO AI™ to automatically identify and quantify the desmoplastic reaction (DR) through deep learning. The DR has been shown to hold prognostic significance. Its reporting is very specialized and the objective reporting of the DR could expedite its translation to the clinic. HALO AI was trained to identify subtypes of the DR (100% specific and 90% sensitive, Fig 2) before analyzing H&E stained whole slide images from 528 stage II and III CRC cancer patients. The AI algorithm was shown to significantly correlate with manual reporting while improving the prognostic significance of the reporting of the DR. This talk will demonstrate multiple methods of image analysis to perform personalized prognostic tests for CRC patients while improving upon current gold-standards of manual classifications.
Keywords: Deep Learning, Digital Pathology, Prognosis, Colorectal Cancer, Tumor Microenvironment
Biography: Dr Caie worked for 9 years as a Senior Scientist in AstraZeneca before completing his PhD from the University of Edinburgh in Digital and Quantitative pathology. He went on to run the Quantitative and Digital Pathology (QUAD) Lab at the University of St Andrews where he published many papers in both machine learning and cancer prognosis in the field of digital pathology. Currently, Dr Caie is Principal Scientist at Indica Labs where he manages the company’s AI based projects involving external collaborators with the aim of translating deep learning algorithms into routine clinical workflow.
Speech Tittle: DNA Ploidy Analysis in Acute leukemia by flow cytometry
Speech Presented By Dr. Shivani Singhal, Co-Author: Dr. Monika Gupta, India
Introduction: DNA ploidy analysis is very useful in patients with Acute leukemia as it has important diagnostic and prognostic significance. It has an impact on response to treatment and hence on the prognosis of certain subtype of patient.1 Though cytogenetics is the standard technique to evaluate ploidy, it is a tedious/ laborious task to perform as compared to Flowcytometry. With the advent of newer diagnostic and therapeutic modalities, flowcytometry has become an indispensable part for diagnosis of leukemia along with morphology as the backbone. Apart from diagnosis, flowcytometry also helps in analysing DNA ploidy which is regarded as a prognostic marker of Acute leukemia.2
MATERIAL AND METHODS: This study was undertaken with the aim to determine the DNA ploidy in all acute leukemia cases by flowcytometry for a period of one year. The 53 new Acute Leukemia cases were diagnosed based on morphology, special stains and immunophenotyping. The DNA index of all 53 cases was determined by flowcytometry and was correlated with other clinicohematological parameters.
RESULTS: In our study, overall incidence of aneuploidy was 32.07%, where 24% were hyperdiploid and 8% were hypoploid. Majority were males (58.8%) among aneuploid population whereas there was female preponderance in diploid cases. We observed ALL patients with hyperdiploidy revealed good prognostic factors i.e, clinicohematological parameters while hypoploidy was associated with poor prognostic factors. AML patients with hyperdiploidy revealed association with poor prognostic factors.
CONCLUSION: These results suggest that it may be beneficial to perform ploidy analysis by flowcytometry in adjunct to immunophenotyping at the time of diagnosis, thus giving us prognostically useful information before starting of induction therapy and evaluating aneuploid leukemia following therapy.
Keywords: DNA ploidy, Acute Leukemia
 Settin, A., et al. (2006) Hematology (2006),341-349.
 Gupta, Nishit, et al. (2019) Cytometry Part B: Clinical Cytometry , 359-367.
Biography: Currently Dr. Shivani Singhal is a Third year resident, pursuing MD Pathology from Pt B.D. Sharma PGIMS, Rohtak, Haryana, India. She did her MBBS from Kasturba Medical College, Manipal, India. She has special interest in hematopathology.
Speech Tittle: Features of TIMP1 expression for different types of Periodontitis
Speech Presented By Dr. Zakharava Viktoryia, Co-Author: Dr. L. A. Kazeko, Dr. J. D. Benesh, & Dr. E. D. Cherstvoy, Belarus
Introduction: Periodontitis is an inflammatory bacterial disease, leading to progressive destruction of the tooth-supporting apparatus and to tooth loss. The dysregulation between an activity of matrix metalloproteinases (MMPs) and their tissue inhibitors (TIMP) plays an important role in a development and progression of inflammation .
Objective. To study features of TIMP1 expression in patients with different types of periodontitis.
Material and methods: A gingival biopsy was analyzed from patients with aggressive (AgP, n=16), chronic simplex (CSP, n=3), chronic complex (CCP, n=23) periodontitis, and a control group (n=6). Morphometric and statistical analysis of the TIMP1 expression was performed using AperioImageScope v22.214.171.12443, Statistica10, p<0.05.
Results: The expression of TIMP1 in the biopsy was obtained in all patients with different forms of periodontitis and in the control group, both in the gingival epithelium and stroma. There was a statistically significant decrease in the intensity and proportion of strong and moderate intensity pixels of epithelial and stromal expression of TIMP1 in all groups of periodontitis compared to healthy tissue (p˂0.05). At the same time, the lowest values of positivity and intensity of both epithelial and stromal expression were found in the CSP group, increased in the AgP (p=0.003 and p=0.0006) and were highest in the CCP group (p=0.001). In the AgP group, compared with the CCP, there were lower levels of intensity parameters (U=27736 and U=23502, p˂0.001) and the proportion of strong and moderate intensity pixels (U=28164/p=0.001 and U=26273/p=0.022) of epithelial and stromal expression of TIMP1, respectively.
Conclusions. A decrease in epithelial and stromal expression of TIMP1 with a dysregulation of MMPs expression [2-3] in different types of periodontitis compared to the healthy tissue supports its importance in the pathogenesis of periodontal inflammation. At the same time, an even greater decrease in TIMP1 expression in the group of aggressive periodontitis compared to chronic complex periodontitis may explain the high aggressiveness of its course, loss of alveolar bone tissue, tooth loss and can be used in the differential diagnosis of these forms at the disease manifestation stage.
Keywords: TIMP1, aggressive periodontitis, immunohistochemistry, gingival biopsy, prognosis.
 Emingil, G. et al. (2014). J Periodontol., 85(8), 1070–1080.
 Kazeko, L. et al. (2019). Biological Markers in Clinical and Experimental Medicine, 3(1), 51-52.
 Kazeko, L. et al. (2019). Biological Markers in Clinical and Experimental Medicine, 3(1), 50-51.
Biography: Kazeko Lyudmila has completed her PhD from Belarusian State Medical University in 1993. She heads the 1st therapeutic dentistry department of Belarusian State Medical University. She has published more than 320 publications in different journals.
Keynote Tittle: Low Budget Strategies for Digital Pathology Education Designed for Low Budget Parts of the World
Keynote Speech Presented By Dr. Zev Leifer, USA
Introduction: Pathology education is expensive. Pathology research is expensive. This talk will explore and recommend a series of approaches to accomplish many of the same goals at a greatly reduced cost. Five “projects” will be presented. First, the use of at-hand or easily obtainable software products to be used with a Pathology Laboratory course using digital pathology, to capture, annotate, preserve and distribute particular Regions of Interest (“value-added slides”). Second, the use of a Wiki by the class, to preserve and share these value-added slides, for classroom study, exam preparation and as a preparation for archival, retrieval and telepathology. Third, the use of Twine and Neocities to generate a website, a Virtual Pathology Lab, for training at the undergraduate and graduate level. Fourth, the use of “3D paper printing” to present a three-dimensional representation of biopsy sample at the microscopic level. Fourth, the use of a paper microscope (Foldscope) in the analysis of crystals found in urinary tract pathologies. For each, applications and advantages will be discussed. All are low budget strategies (free or a few dollars) compared to the usual commercial hardware and software products. This might be suitable for low-budget institutions or regions of the world where price is often prohibitive.
The use of virtual microscopy and a wiki in pathology education: Tracking student use, involvement, and response. J Pathol Inform 2015;6:30.
Dr. Leifer’ Pathology Lab
Virtual patients, Digital Pathology, Tumor Boards and Stories with Alternative Endings (poster). Find in:
Biography: Dr. Zev Leifer has a Master’s Degree in Medical Sciences from Harvard University. He has a Ph.D. from New York University in Microbiology. He was on the faculty of New York Medical College for six years and, for the past 37 years, has been Professor of Microbiology and Pathology at the New York College of Podiatric Medicine. He taught Pathology Lab, as an all-digital course as the field developed in that direction. He founded The Leifer Institute for Molecular and Digital Pathology, www.limdp.org . His research interests involve factors affecting genetic regulation. On the pathology side, he is focused in the training of undergraduate students in the use of the new digital technology.
Speech Tittle: Features of TIMP1 expression for different types of Periodontitis
Speech Presented By Dr. Senthil Kishore, Co-Author: Dr. Sandhya Sundaram, & Dr. Priyathersini, India
Introduction: Ki-67 antigen, identified by Scholzer and Gerdes in 1983 . In Non Hodgkin lymphoma, found to be in high concentrations in rapidly multiplying cells. Due to this property the Ki-67 proliferation index is used in numerous malignancies for grading and staging. Its prognostic value is well studied and documented [2,3,4]. Many methods can be used to count the Ki-67 proliferation index – Eyeballing, Manual counting with microscope, Manual counting in printed image of slide & Automated counting to name a few. In this study we will evaluate all the above mentioned methods of counting Ki-67 proliferation index and correlate one another. 50 Ki-67 proliferation index done on lymph node excision biopsy of Non Hodgkin’s lymphoma collected & calculated by Eyeballing, Manual counting with microscope, Manual counting in printed image of slide & Automated counting (Qupath – 0.2.3) in the same slide. Eyeballing and Manual counting with a microscope is done using Olympus BX43 microscope. Whole slide image (WSI) is captured using Morphle Optimus 6T, the printed image is taken and used for manual counting and the WSI of Ki67 is analyzed using QuPath – 0.2.3. Ki-67 proliferation index calculated using the above 4 methodologies and analysed using Epi Info™ – 7.2. Pearson correlation coefficient was obtained for each methodologies and correlated with each other. Our study demonstrated that all the 4 methodologies were correlating with each other statistically. Hence any of the above methods can be used to calculate the Ki-67 proliferation index. While in comparison with Manual counting with microscope, Manual counting in printed image of slide correlates more than other methods used in this study.
Keywords: Ki-67, Qupath, Non Hodgkin’s lymphoma
 Scholzen T, Gerdes J. The Ki-67 protein: From the known and the unknown [Internet]. Vol. 182, Journal of Cellular Physiology. J Cell Physiol; 2000 [cited 2020 Sep 6]. p. 311–22. Available from: https://pubmed.ncbi.nlm.nih.gov/10653597/
 Ishihara M, Mukai H, Nagai S, Onozawa M, Nihei K, Shimada T, et al. Retrospective Analysis of Risk Factors for Central Nervous System Metastases in Operable Breast Cancer: Effects of Biologic Subtype and Ki67 Overexpression on Survival. Oncology [Internet]. 2013 Jan [cited 2020 Sep 6];84(3):135–40. Available from: https://www.karger.com/Article/FullText/345321
 Ciancio N, Galasso MG, Campisi R, Bivona L, Migliore M, di Maria GU. Prognostic value of p53 and Ki67 expression in fiberoptic bronchial biopsies of patients with non small cell lung cancer. Multidisciplinary Respiratory Medicine [Internet]. 2012 [cited 2020 Sep 6];7(4). Available from: https://pubmed.ncbi.nlm.nih.gov/22978804/
 Josefsson A, Wikström P, Egevad L, Granfors T, Karlberg L, Stattin P, et al. Low endoglin vascular density and Ki67 index in Gleason score 6 tumours may identify prostate cancer patients suitable for surveillance. Scandinavian Journal of Urology and Nephrology [Internet]. 2012 Aug [cited 2020 Sep 6];46(4):247–57. Available from: https://pubmed.ncbi.nlm.nih.gov/22452635/
 Bankhead, P. et al. (2017). QuPath: Open source software for digital pathology image analysis. Scientific Reports. https://doi.org/10.1038/s41598-017-17204-5
Dr. Senthil Kishore is currently undergoing his M.D residency from SRIHER University.
High school: Jawahar higher secondary school (CBSE), Neyveli (2010)
Higher secondary school: Jawahar higher secondary school (CBSE), Neyveli (2012)
M.B.B.S: Sri Manakula Vinayagar Medical College & Hospital, Puducherry (2018)
Speech Tittle: Anaplastic thyroid carcinoma in metastatic lateral cervical neck lymph node. Case Report and review literatures.
Speech Presented By Dr. Doaa Alghamdi, Co-Author: Dr. Rhagad Tallab, Saudi Arabia
Papillary thyroid carcinoma is one of commonest human malignancies. It usually follows an indolent clinical course with a localized disease and rare metastasis . Anaplastic transformation of thyroid carcinoma although rare but is well accepted phenomena. It goes through multiple steps of genetic alterations leading to an ultimate de-differentiation. Most of anaplastic carcinoma occur in the thyroid glands with very aggressive behavior and locally advanced disease . Recently some case reports described anaplastic transformation of thyroid carcinoma in a distant site. It occurred either synchronously or years after diagnosis of thyroid carcinoma.
Keywords; thyroid gland, lateral cervical lymph node, anaplastic thyroid carcinoma.
84 years old male presented with painful right neck swelling since four years, gradually increasing in size. The patient underwent head/neck computerized tomography (CT) scan and it showed an 8.0 cm right neck mass at level IIa/III with a cystic component, central area of necrosis and calcifications. The mass was inseparable from the adjacent sternocleidomastoid muscle (figure1 A&B). Also bilateral thyroid complex cystic nodules were noted with the largest seen within the left lobe measuring 3.1 cm.
A Fine needle aspiration (FNA) biopsies were performed on both neck and thyroid lesions. Both lesions were labeled as “Atypia of undetermined significance”. A subsequent total thyroidectomy and excision of the neck mass were performed with lymph nodes dissection.
Grossly we received total thyroid gland with lobulated surface. Multiple nodules were identified ranging from 0.3 – 2.7 cm with variable solid and cystic cut surface. The neck mass received oriented measuring 12.7 cm in greatest diameter (figure 2). It had a heterogenous solid tan cut surface with cystic spaces and islands of necrosis. It was inseparable from the adjacent identified skeletal muscle.
Histologically: Lateral neck mass showed rime of lymphoid cells and capsule (Figure 3)infiltrated by a malignant neoplasm composed of a sheets of large undifferentiated pleomorphic cells with spindle(Figure 4), plasmacytoid and epithelioid morphology and with abundant eosinophilic cytoplasm(Figure 5). The nuclei were enlarged with obvious nucleoli and frequent mitotic figures. There were multiple foci of necrosis, perineural invasion, lymph-vascular invasion and extensive skeletal muscle invasion.
Broad panel of immunohistochemicall studies were performed on the neck mass and the neoplastic cells came diffusely positive for CKAE1/3, CK7 (Figure 6), CK18 and vimnetin and focally positive for myoepithelial markers. Rare glands like cells (Figure 7) are expressed to Pax-8 stain (Figure 8). The neoplastic cells were negative for squamous marker (p63, CK5/6) and were consistently negative for TTF-1 and thyroglobulin. Other sarcoma, lymphoma and Melanoma markers came also negative. INI-1 nuclear stain was preserved.
The thyroid tissue is submitted entirely for microscopic examination showing papillary microcarcinoma , classical variant limited to thyroid parenchyma (Figure9).
The possibility of anaplastic transformation of metastatic papillary carcinoma was considered and molecular studies were carried on. The molecular tests revealed that the malignant cell were positive for BRAF mutation. Based on the molecular studies, positivity of Pax-8 and the presence of papillary carcinoma in the thyroid this favored the diagnosis anaplastic thyroid carcinoma in lateral neck lymph node.
On follow-up of the patient he developed lung and iliac bone metastasis which wasn’t biopsied because of the poor situation of the patient. Unfortunately, the patient is currently on palliative therapy and signed DNR status due to worsening of his condition.
Anaplastic thyroid carcinoma is the most aggressive thyroid epithelial neoplasm accounting for less than 5% of thyroid malignancies. It represents a terminal form of de-differentiation with high mortality and short survival rate . Most of anaplastic thyroid carcinoma harbor areas of better differentiation and are located within the thyroid itself . Recently some cases described the occurrence of anaplastic transformation of pre-existing well-differentiated thyroid carcinoma in a distant site. These transformations were most frequently encountered in the regional lymph nodes and lung [4, 5]. However, other sites including reteroperitonium , mandible  and even as soft tissue mass were also reported . The anapestic carcinoma didn’t necessarily present in the thyroid gland and in some cases it only appeared in the metastatic sites making a diagnostic confusion. It mostly presents years after the initial diagnosis of thyroid malignancy with a highly aggressive transformed disease . Ito et al described a follow up of five patients with anaplastic transformation in lymph nodes. Their study concluded that long-term survival can be expected for patients with anaplastic transformation in the lymph node if it is curatively resected . Unfortunately, most of the cases presented with advanced disease, multiple metastasis and a dismal prognosis.
In our case the patient had bilateral microscopic papillary thyroid carcinoma. He presented with multiple neck lymph nodes; one with anaplastic transformation, lung and iliac bone metastasis. Even that carcinoma and dedifferentiated occurred synchronously; the carcinoma in the thyroid gland didn’t harbor any areas of high grade transformation and vice versa.
Anaplastic transformation in metastatic thyroid carcinoma is a rare occurrence. However, it should be entered in the differential diagnosis of any high grade tumor of unknown origins. It can present at the same time with the thyroid carcinoma or years following resection. Here we describe a case where the patient had papillary micro-carcinoma and developed anaplastic transformation in metastatic lymph nodes. This might raise a question regarding papillary micro-carcinoma; its potentials and risks.
 Carling T, Udelsman R. Thyroid cancer. Annual Review of Medicine. 2014;65:125–137. doi: 10.1146/annurev-med-061512-105739. https://pubmed.ncbi.nlm.nih.gov/24274180/
 Ragazzi, M., Ciarrocchi, A., Sancisi, V., Gandolfi, G., Bisagni, A. and Piana, S., 2014. Update on Anaplastic Thyroid Carcinoma: Morphological, Molecular, and Genetic Features of the Most Aggressive Thyroid Cancer. International Journal of Endocrinology, 2014, pp.1-13 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4158294/
 Venkatesh, Y., Ordonez, N., Schultz, P., Hickey, R., Goepfert, H. and Samaan, N., 1990. Anaplastic carcinoma of the thyroid: A clinicopathologic study of 121 cases. Cancer, 66(2), pp.321-330.https://pubmed.ncbi.nlm.nih.gov/1695118/
 Al-Qsous, W. and Miller, I., 2010. Anaplastic transformation in lung metastases of differentiated papillary thyroid carcinoma: an autopsy case report and review of the literature. Annals of Diagnostic Pathology, 14(1), pp.41-43. https://pubmed.ncbi.nlm.nih.gov/20123456/
 Sato, K., Waseda, R., Tatsuzawa, Y., Soma, R., Ueda, Y. and Katsuda, S., 2006. Papillary thyroid carcinoma with anaplastic transformation showing a rhabdoid phenotype solely in the cervical lymph node metastasis. Pathology – Research and Practice, 202(1), pp.55-59. https://www.sciencedirect.com/science/article/abs/pii/S0344033805001949
 Solomon, J., Wen, F. and Jih, L., 2015. Anaplastic Transformation of Papillary Thyroid Cancer in the Retroperitoneum. Case Reports in Pathology, 2015, pp.1-4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4553202/
 Ambelil M, Sultana S, Roy S, Gonzalez MM. Anaplastic transformation in mandibular metastases of follicular variant of papillary thyroid carcinoma: a case report and review of the literature. Ann Clin Lab Sci. 2016;46:552–556. https://pubmed.ncbi.nlm.nih.gov/27650625/
 Kaushal S, Sharma MC, Mathur SR, Rastogi S, Bal CS, Chumber S. Anaplastic transformation of metastatic papillary thyroid carcinoma at shoulder mimicking soft tissue sarcoma. Indian J Pathol Microbiol. 2011;54:796–799. https://pubmed.ncbi.nlm.nih.gov/22234114/
 Agnes B. Gunnarsdottir, Birgir A. Briem, Larus Jonasson & Geir Tryggvason (2018) Anaplastic thyroid carcinoma transformation in a lateral neck node metastasis – A case report and a review of the literature, Acta Oto-Laryngologica Case Reports, 3:1, 43-46, DOI: 10.1080/23772484.2018.1506256
 Ito Y, Higashiyama T, Hirokawa M, Fukushima M, Inoue H, Yabuta T, et al. Prognosis of patients with papillary carcinoma showing anaplastic transformation in regional lymph nodes that were curatively resected. Endocr J 2008;55:985-9. https://www.jstage.jst.go.jp/article/endocrj/55/6/55_K08E-148/_pdf/-char/en
Speech Tittle: MMP9 and TGFΒ Expression in Non Small Cell Lung Cancer
Speech Presented By Dr. Zakharava Viktoryia, Co-Author: Dr. M. N. Shapetska, & Dr. O. V. Gulenko, Belarus
Background & objective. An important role in the pathogenesis of non-small cell lung cancer (NSCLC) is applied by growth factors and their receptors, as well as matrix metalloproteinases (MMPs), which are associated with tumor progression.
Objective. To study the features of MMP9 and TGFβ expression in patients with NSCLC.
Methods. A surgical material was analyzed from patients with NSCLC (n=32) and a control group (n=32). Morphometric and statistical analysis of the MMP9 and TGFβ expression was performed using AperioImageScope v126.96.36.19943, Statistica10, MedCalc19.6 software, p<0.05.
Results of the study. The studied cases of surgical material of patients with NSCLC were represented by squamous cell carcinoma (n=16) and invasive non-mucinous adenocarcinoma (n=16) of lung, which was confirmed by the corresponding immunophenotype.
MMP9 expression in tumor cells, regardless of the histological type of lung cancer, was significantly higher than in the alveolar and bronchial epithelium of the control group (U=442/р˂0,000), and also had even higher values of positivity and intensity in the foci of lymph node metastases (U=1935/р=0,003 and U=127/р˂0,000 respectively). The opposite trend was observed in relation to the expression of TGFβ: it was the highest in the control group, decreased both in positivity and intensity in the primary tumors (U=451/р˂0,000 and U=2601/р=0,025, respectively) and even more decreased in lymph node metastases (U=85/р˂0,000 and U=202/р˂0,000, respectively).
It was found following parameters were associated with the cancer-specific survival of patients with NSCLC: the epithelial expression positivity of MMP9>87.5%, the positivity and the share of strong and moderate intensity pixels of epithelial expression of TGFβ ˂1.91% and ˂0.47%, respectively.
Conclusion. The significantly higher expression and activity of MMP-9 and lower – TGFβ in tumor tissue and lymph nodes metastases than in surrounding tissue supports the important role of these markers in the growth and progression of lung cancer, and the possibility of their using as a suggested therapeutic targets.
Keywords: non-small cell lung cancer, immunohistochemistry, MMP9, TGFβ, prognosis
Biography: Mikhail N. Shapetska has completed his PhD from Belarussian State Medical University. He head of oncological investigation group of Belarussian State Medical University. He published more than 50 abstracts in different journals.
Speech Tittle: Primary Sclerosing Encapsulating Peritonitis- A Case report
Speech Presented By Dr. Swati Mishra, India Co-Author: Dr. Vatsala Misra, Dr. Manoj Bind, Dr. Mudita Bhargava, Dr. Kuldeep Chaudhary, Dr. Arun Kumar Yadav, Dr. Satakshee Tiwari, Dr. Sonal Tripathi, Dr. Tejasvita Singh, Dr. Swati Tyagi
Background: Sclerosing encapsulating peritonitis also known as cocoon abdomen is a rare chronic inflammatory condition of the peritoneum in which the bowel loops are encircled by a membrane (cocoon formation) within the peritoneal cavity leading to intestinal obstruction. It can be primary (idiopathic) or secondary (chemotherapy, beta blockers, peritoneal dialysis, shunts, tuberculosis, SLE etc). Symptomatology reported includes recurrent episodes of abdominal pain, distension or mass.
30 yrs old male presented with complains episodes of vomiting and bloating since two weeks. USG findings revealed acute small bowel obstruction due to cocoon formation with suspicion of pneumotosis. CT report showed high grade small bowel obstruction and pneumatosis in trapped ileal loops along with pelvic free fluid and fascial thickening. No significant history of drug and any chronic illness. The patient underwent surgery and resected bowel specimen was received for histopathological examination.
Microscopic examination showed infiltration of lamina propria by dense inflammatory infiltrates and fatty infiltration along with dilated and congested blood vessels, lymphatics and mixed inflammatory infiltrate in the submucosa.
The serosa showed mesenchymal proiliferation.
Conclusion: This case is considered worth for presentation due to its rarity and lack of identification of secondary factors despite extensive investigation.
Speech Tittle: Psoriasis and curcumin in induced psoriatic dermatitis
Speech Presented By Dr. E. Niculet, Co-Author: Dr. C. Onisor, & Dr. A.L. Tatu, Romania
Introduction: Psoriasis, a chronic pathology of the skin with autoimmune basis affecting 16 to 60 year-olds, is one of the most frequent diseases out there. It not only affects the skin, but also the joints, uvea, enthuses, mucosal membranes and nails, with an episodic pattern of evolution (acute and remission phases).
Background: Clinical evaluation of such lesions reveals plaques having an irregular contour, with erythema and silvery-white scales covering the body’s extensor surfaces; the histomorphology of these lesions are characterized by hyperprolipheration of keratinocytes and inflammation.
Current therapeutic approaches are not satisfactory, neither to the patient, nor to the doctor, due to the many side effects and insufficient disease management.
Current research: Research has focused on alternative management therapies, involving natural compounds such as aloe vers, tea tree oil, silymarin, apitherapy or curcumin – one of the most promising ones. Curcumin compounds’ effects have been observed on mouse models of imiquimod-induced psoriasis, with important effects in lowering the hyperprolipherative aspect of psoriasis and its inflammatory component, acting against major interleukin-inflammatory axes such as IL-17/IL-22/IL-23, with the help of its many bioproperties and mechanisms of action.
For this compound to be used on a large scale, it needs to be further researched and applied in clinical trials, on human subjects.
Keywords: psoriasis, curcumin, imiquimod
- Chiricozzi A. et al. (2018) Int. J. Mol. Sci. 19, 179.
- Marco Colonna et al. (2004) Nat Immunol 5(12):1219-26.
- Chattopadhyay I. et al. (2004) Current science, 87, 1.
- Chunhua Ma et al. Fitoterapia (2013) 87, 57–64.
Biography: EN is a PhD candidate at “Dunarea de Jos” University. She is a teaching assistant in the Department of Morphological and Functional Sciences of the Faculty of Medicine and Pharmacy of Galati, Romania. CO is the head of the Cellular Biology Department at the Faculty of Medicine and Pharmacy of Galati, Romania. ALT is the head of the Dermatology Department at the Faculty of Medicine and Pharmacy of Galati, Romania.
Pathology is a specialty not confined only to blood tests as many people believe. Its an ocean of information which is only seen as a still lake by many who do know the kind of information and insight this specialty has given to modern medicine. Pathology is at the forefront of ancient & modern diagnostics and helps the clinicians of all the specialties to diagnose, plan treatment, and assess the prognosis of the majority of the diseases.
Pathology is the study of disease and the ways in which the disease develops and manifests as a result of changes in cells and tissues due to various agents such as microorganisms, carcinogens, chemicals, and many more etiological factors. It also helps in planning the treatment and prognosis of diseases. To be a Pathologist, you have to undergo a formal residency training programs or diplomas throughout the world after finishing MBBS / Medical school.
The subdivisions of Pathology are :
- Anatomic Pathology including Surgical Histopathology
- Blood Banking and transfusion medicine
- Chemical Pathology (i.e Clinical Chemistry)
- Clinical Pathology
- Molecular Pathology
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Digital Pathology means an emerging technology in Pathology with a high potential for widespread application in the Pathology & Healthcare sector.
Digital Pathology has the most potential to organize and maintain the workflow and streamline pathologists and diagnostic laboratories’ efforts, increasing their convenience.
It has additional technical advantages, including time-saving and improvements in drug discovery and development, advanced laboratory tests, exclusive research, and academic purposes.
Digital Pathology is growing widely and providing innovations in the healthcare arena and is expected to be highly beneficial for research, clinical services, and medical education. The advancement in information technology, which facilitates better connectivity, allied to improved healthcare reforms, is the reason for the upturn in the digital pathology systems industry.
The growth of the digital pathology systems industry can be attributed to the increased workload of laboratory technicians and high healthcare costs worldwide. On the other hand, the digital pathology systems industry could be hampered by high setup costs, sampling errors, and strict regulatory compliance, which may restrict these systems’ approval.
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Pediatric Pathology: Paediatric and perinatal pathology is concerned with the identification of disease in the fetus infant and child. It is related to age-specific rather than organ-specific and includes investigation of that organ unique to the fetus, the placenta. The spectrum of disease in this age range is very different from that seen in adults and the interaction of congenital malformation and growth of the child interact to produce unique pathology. Degenerative types of diseases are unusual in children, but tumours are relatively common, albeit the types of tumour are different from those in adults. Because of the smaller numbers of cases involved, perinatal and paediatric pathology departments are concentrated in larger centres.
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Histopathology is the macroscopic and microscopic study of pathological tissues in order to unveil the cause of disease. It should, however, be noted that a good knowledge of the histology of Normal biological tissue is needed to excel in studying pathological tissues.
It is a combination of three Greek words.
Histos means tissue; pathos means disease; logos means study. It is the microscopic study of the changes in the tissues caused by a disease.
Histopathology is lab diagnostic, after the intervention, they make serial sections of tissue and looking under the microscope make a diagnosis.
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Cancer Cytopathology is the study of the body’s individual cells, as opposed to histology, which is the study of whole human tissue itself. Strictly speaking, Cancer Cytopathology is the study of normal cells and Cancer Cytopathology is the examination of cells in the context of disease, which is really what we’ll be talking about but “Cancer Many individuals use cytopathology” term as shorthand for both, so that’s what we’ll do here. Millions of cells inside the human body and can be sampled and looked at under the microscope, after suitable preparation, to help diagnose medical conditions.
This involves looking at the individual cells for abnormal changes of both the nucleus and the cell’s cytoplasm (body). The nucleus contains the genetic material that controls the cell and determines what type of cell it will become and controls its behavior. Gauged by changes in its size, shape, A trained cytologist can assess changes in the nucleus and appearance of the nuclear material (chromatin), which can be used to diagnose possible cancer and pre-cancer. “Pre-cancer” identifies the cell changes or which, if left untreated and did enough damages to develop into cancer. Cancer Cytopathology can also be used to diagnose many non-cancerous medical conditions, such as infections and systemic diseases.
There are two main branches of cytology. There are those involved with the assessment of pre-cancerous and, occasionally, cancerous changes of the cervix (mouth of the womb) such as in cervical cancer screening, which is generally referred to as gynecological cytology.
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Diagnostic Pathology has emerged as a modern topic that aims to pathology with an emphasis on novel morphological and molecular findings that impact the diagnosis of neoplastic and non-neoplastic diseases. New tools in Diagnostic pathology and technologies that are exciting, challenging, and impact pathology practice. In the field of diagnostic pathology by way of novel and interesting reports, research and original and a series of key review in the field that will emphasize the new developments that are disease-specific and highlight contemporary and novel technologies that are changing diagnostic practice pathology.
This is an exciting time in pathology as we are confronted with a new frontier of pathology science and diagnostic technology that continues to evolve and accelerate the discipline of diagnostic pathology. A trusted source of new and exciting developments in the field of diagnostic pathology.
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Breast Pathology means when the breast was biopsied and the samples taken are studied under the microscope and medical equipment by a specialized doctor with many years of training called a certified pathologist. The same pathologist sends your doctor a complete report that gives a diagnosis for each sample taken. Information in this report will be used to help manage your care. The report and information provided by the pathologists are meant to help you understand medical language you might find in the pathology report from a breast biopsy, such as a needle biopsy or an excision biopsy. All labs, tests, and follow-up info should be accessible to you, but the institution may want to charge for ‘copying.’ Also, you can’t really expect the doctor to do this. If they are really nice and have the time, they may make it easier to get the copy. Ancillary staff at the hospital or his office (they should have a copy.) would be the people to ask (…in records, not some other department, unless they refer you to one.) When any tumor is removed from your flesh, the surgeon tries to take only about one layer of cells away from the tumor. It’s almost razor-thin. It’s also terrifying to know this. There should be a report on the lump that is removed and any lymph nodes the surgeon chooses to check at the same time, to determine spread, if any.
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- The Gross Description of Surgical Pathology – the color, texture, shape, measurements, and comments about unusual and/or normal findings in the surgical specimen.
- The Microscopic Description of Surgical Pathology – what the surgical pathologists see microscopically on the tissue slides, prepared in the pathology lab. He describes the cells in great detail, including the nuclei, cytoplasm, and anything he deems abnormal or normal.
- The Microscopic Diagnosis– the determination of disease. Many surgical specimens are totally normal, and this fact is also included.
The main duty of a surgical pathologist is to diagnose tissue removed during surgery. Everything from a mole to a large portion of the intestine must go to pathology for examination and diagnosis.
- The surgical pathologist examines, describes, measures, and chooses the tissue he wants to see microscopically. All of this information is dictated and will be part of the final pathology report.
- The chosen tissue is processed overnight, and then, after many technical procedures, slides of the tissue are prepared by histo-technologists.
- The slides are read microscopically by the surgical pathologist, and he describes the cells and determines and dictates the diagnosis. This information is also included in the final report.
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Ophthalmic Pathology is a branch of medicine that deals with human eyes. Any surgery pertaining to eyes is referred to as an ophthalmic surgery. Such operations include interventions like cataract surgeries and any complications arising out of them, any eye surgery undertaken to correct the vision including those made to reduce myopia, any medical intervention for removal of deposits into the external eye, complications arising out of retinal detachment or its degeneration due to advanced age or due to high blood sugar level and a lot more. This is just an indicative list. Ophthalmic Pathology is a branch of surgery that is advancing rapidly and things that were thought to be either very difficult to achieve or do a few years back are now made possible thanks to technological advancements.
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Renal Pathology: The Renal Pathology of Pathology and Cell Biology specializes in the diagnosis of medical diseases of the kidney and parts related to the kidney. The practice of Renal Pathology centers on diverse kidney disorders affecting the glomerular, tubulo-interstitial, and vascular compartments. Chondrocalcinosis a disease entity by itself (pseudogout) or is it part of the pathology in some arthropathies (Wilson disease, hemochromatosis, renal osteodystrophy, etc.). It may be primary hereditary or sporadic, or secondary to metabolic, endocrine, or other diseases (or a combination of primary and secondary). The core of Renal Pathology is basically the general path and hematology. The important systemic topics are renal pathology, CNS tumors, and vasculitis.
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Anatomic Pathology is a branch and supportive medical specialism helping us understand Pathology, and helping us diagnose specific Pathology and Medical conditions by studying, and demonstrating to us that gone wrong, which has to lead to the disease, these people with their specific knowledge of pathology help us make a diagnosis, essential in diagnosing cancers, but only rarely if ever see a patient, and won’t treat any patient themselves.
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Forensic Pathology means pathology itself is the study of disease and injury, and forensic pathology is taking that study into a forensic context, applying it to the dead. The job of the forensic pathologist is to determine how and why someone died, by doing an autopsy. It is important because we are the people that actually get to state the cause of death on the death certificate, and we also have the power to testify our findings in a court of law. Really, if you break down forensic pathology, that’s exactly what it is, presenting your findings of disease and injury in a court of law. That’s all great, but the reason I love it and think it’s important is that I am a person’s last witness. In my autopsy report, I am detailing the last story they will ever tell. I’m telling the story of their aches and pains, of their health, of lives long-lived and lives cut short, and it’s powerful. You’re connecting with humans in a way so few can, and for me, nothing is more important than that. But I’m being sappy and subjective here so feel free to just take the clinical definition to heart.
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Autopsy Pathology (as a result of a crime or unique circumstances such as disease epidemic of unknown etiology) and medical autopsies where the cause isn’t so cut and dry are long and tedious. This is speaking of a full autopsy. A partial does not entail dissection and toxicology, and samples of bodily fluids -blood, urine, vitreous humor (see below) are always performed. The pathologists and their team must dissect and weigh all the organs. They drill through skulls so they can examine and weigh the brain. A classic Y-incision is made and is necessary in order to gain access to the internal organs in the chest and upper abdomen that are protected by the rib cage. This requires breaking the sternum, a.k.a. the breastbone, which also forms the front of the rib cage. A moon-shaped incision is made from behind one ear to behind the other (picture the way headphones go on your head), and the scalp is pulled back a bit to approximately the eyebrows, in order to get to the brain.
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Hematopathology or hemopathology is the detailed study of infections, diseases, and disorders affecting and found in human blood cells, the production, and any different organs and tissues involved in hematopoiesis, such as bone marrow, the spleen, and the thymus. The complete diagnoses and treatment of various diseases such as leukemia and lymphoma often deal with hematopathology; techniques and technologies include flow cytometry studies and immunohistochemistry. A hematopathologist is a person who is board-certified in both anatomical and clinical pathology and has additional years of training in hematopathology. Hematopathology is the study of disease of the bone marrow and blood. It is also the study of the organs and tissues that use blood cells to perform their physiologic functions. Hematopathology includes the spleen, lymph nodes, thymus, and other lymphoid tissue. The hematopathologist focuses more on the diagnosis of conditions of the hematopoietic and lymphocyte-rich tissues. Its usually made by direct exam of blood and tissue in the lab.
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Gynaecological Pathology often entails the determination of their relationship to the reproductive tract and evaluation of abnormalities in the peritoneal cavity. The Gynaecological Pathologist distinguish which peritoneal disorders are müllerian derived versus originating from other organs. Different diseases affecting the intra-abdominal organs and the peritoneal cavity include entities arising from elements native to the peritoneal cavity (secondary müllerian system, mesenchymal, and mesothelial proliferation), as well as neoplastic and non-neoplastic entities of metastatic nature, or controversial/uncertain origin. Most of these diseases affect the disorders that occur mainly in women. However, Males and females; of their relationship to the reproductive tract.
Uropathology is the close interaction between the pathologist and the urologist is essential for accurate pathological diagnosis of several urological cancers. The adoption of the new grading system in transitional cell carcinoma (TCC) of the bladder introduced by the World Health Organisation in 1998/1999, will improve the accuracy of pathological diagnosis and reports of this cancer beyond the 61% already reported. Frozen section biopsy during cystectomy can be advocated in certain cases for urethral margin and lymph node biopsies, but not for ureteric margin biopsy. With regard to prostate cancer, describes in detail the careful steps required in the taking and handling of biopsy samples in order to maximize the histopathological diagnosis. Uropathology includes a practice that has been advocated for some time—the separating of individual biopsy cores. Testicular cancer is discussed from particularly with regard to intra-testicular and incidentally identified masses and the point of view of preserving the function of the testes.
Liver Pathology terms used by either the pathologist or radiologist to describe the appearance of the liver by biopsy or imaging. The corresponding responses should be considered general in nature, and not specific to any one person; consequently, they are not to be construed as specific medical advice and do not create a doctor/patient relationship. Specific advice on unique to your particular situation, consult a local medical professional. If there is past medical history of liver pathology (Hepatitis C, alcoholic cirrhosis, etc), then you should lean towards ascites. Severe/sudden ascites can feel hard, but in general, fat has thicker, more solid feel to it compared to the fluid of ascites. You can usually grab a handful of flesh if it’s fat; more difficult to do this with ascites. Abdominal fat can be sucked in, to a certain extent; ascites cannot. The abdominal muscles are not forcefully stretched out in the former, while they are in the latter.
Gastrointestinal Pathology thorough workup needs to be done and determine the cause of oedema or any extra fluid that may be accumulating consult a physician and do the necessary investigations. It may point towards a gastrointestinal pathology so that needs to be addressed as well. Fluid retention can also occur in kidney pathology and it is hard to comment without any other pointers.
Molecular pathology is achieved by the two mechanisms: stochastic differentiation and the obligatory asymmetric replication. The stem cell population is maintained by the balance between the stem cell divisions which generate either the two self-renewing stem cells or the two cells that differentiate in the stochastic differentiation. The obligatory asymmetric replication is in which the daughter cells retains its self-renewing capacity with each stem cell division while the other enters a differentiation pathway. Molecular structures in physiological and pathological conditions.
- Minor Oral Surgical Pathology procedures like transalveolar extractions, impactions, implants etc.
- Orthognathic surgeries which is the most important surgical procedure almost exclusively done by them. It include correction of facial deformities. Corrective jaw surgery, craniofacial surgery, facial cosmetic surgery
- Cleft lip and cleft palate surgery can be done by an OMFS
- Facial reconstruction are done almost exclusively by them, Maxillofacial Traumatology dealing with facial fractures.
- Maxillofacial surgeons along with maxillofacial prosthodontist help in arterials replacement of facial parts ears, eye, replacement of jaw after cancer surgery, accidents, gunshots etc.
- They can take a fellowship in head and neck Oncology and perform head and neck cancer surgeries.
- Facial regevenation surgery can be done by an OMFS
- Minor surgery like hair transplant can be done by OMFS.
- Cosmetic surgeries like. Cheek bone implant, Chin surgery, eyelid surgery, Face lift, facial and neck liposuction, forehead or brow lift, lip enhancement, nasal reconstruction, chemical peel, laser treatment etc
- Surgical correction of obstructive sleep apnoea
- Treatment and Correction of several Head And Neck Pathology (Both hard and soft tissue)
And several other major and minor surgical procedures are done by an Oral and Maxillofacial Surgeon
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Neuropathology is a ‘pathology’ in or involving the nervous system. A ‘pathology’ basically just means something is wrong — something is physically disrupted or damaged or parts of the body aren’t working like they normally would in a way which prevents your body from maintaining homeostasis. Homeostasis is a way of referring to the ongoing dynamic balance the mechanisms of the body facilitate so that we can survive, thrive, and react constructively and ably to internal and external influences — being able to adapt successfully to our environment.
Neuropsychology is a point of intersect between neuroscience and psychology. It is an investigation of the connections and relationships between neurological ideas, ideas about the way the nervous system is composed and functioning, and psychological ideas, which cover our mental experiences and social behaviors and such. So, how brain states impact our emotional experiences, for example, and what the physical implications might be for certain psychological stimuli or even traumas.
Neuropsychology is about the relationship of the nervous system to the mind (hence the derivation of ‘psychology’ from “psyche”) whereas neuropathology is about the relationship of the nervous system to functional parameters which uphold our ability to adapt to the physical stressors of life in a healthy manner. There can be overlap when pathologies in the nervous system impact our mental experiences, but neuropsychological phenomena will encompass all physical and mental states, not just ones involving medical problems like illness or injury.
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Nephropathology and kidney biopsies in the current knowledge of kidney diseases. The search for the cause of haematuria and proteinuria stimulated to Richard Bright (1789–1858), the father of nephrology, to observe and evaluate kidney lesions microscopically. Subsequently, and guided by the same interest, in 1914 Volhard and Fhar created the first histopathological classification in which they tried to relate acute, chronic and degenerative lesions with a specific clinical condition. From these early stages, and as has occurred in other fields of medicine, the histopathological study has allowed to generate a classification of kidney diseases, resulting in improved quality of communication among the nephrology experts, and at the same time providing a logical structure for the categorisation of patients for epidemiological, prognostic and therapeutic studies.
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Immunopathology includes all physical, chemical and biological reactions of the organism against the foreign substances. Innate immunity and adaptive immunity are two types of Immune system. Adaptive immunity further divided into two types that is humoral and cell mediated immunity. Immune responses to viral infections are generated by the host in order to survive and ideally to eliminate the virus. This kind of robust antiviral and normal immune responses also by design cause tissue damage. Various Antibodies react with the viral antigens and virus in the fluid phase forming virus–antibody immune complexes that deposit in mesangial cells and macrophages. The cells are designed to make viral progeny thus removing the factories that produce infectious progeny. Most symptoms accompanying viral diseases and infections are caused by these actions and the release of cytokines and chemokines. The balance of immunity system is shifted by immunity medication to excess then immunopathology occurs.
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