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Background: Urinary stones are known predisposing factors for upper urinary tract carcinoma (UUTC) which are commonly detected at advanced stage with poor outcome because of rarity and lack of specific criteria for early detection. Aims and objectives: The main aim was to evaluate the impact of age, gender andstone characteristics on risk of developing UUTC in patients with chronic nephrolithiasis. We also discuss the role of aberrant angiogenesis (AA) and immunohistochemical expression of p53, p16INK4a, CK20 and Ki-67 in diagnosis of pelvicalyceal neoplastic (NL) and pre-neoplastic lesions (PNL) in these patients. Materials and Methods: Retrospective analysis of pelvicalyceal urothelial lesions from 88 nephrectomy specimens were carried out in a tertiary care centre from June 2012 to December 2014. Immunohistochemistry (IHC) was performed on 37 selected cases. Computed image analysis was performed to analyse aberrant angiogenesis. Results: All UUTC (5.7%) and metaplastic lesions were found to be associated with stones. Some 60% were pure squamous cell carcinoma and 40% were transitional cell carcinoma. Odd ratios for developing NL and PNL lesions in presence of renal stone, impacted stones, multiple and large stag horn stones were 9.39 (95% CI 1.15-76.39, p value 0.05), 6.28 (95% CI 1.59-24.85, p value 0.000) and 7.4 (95% CI, 2.29-23.94, p value 0.001) respectively. When patient age was ≥ 55, the odds ratio for developing NL was 3.43 (95% CI 1.19-9.88, p value 0.019). IHC analysis showed that mean Ki-67 indices were 3.15 ± 3.63 % for non-neoplastic lesions, 10.0±9.45 % for PNL and 28.0± 18.4% for NL. Sensitivity and specificity of CK20, p53, p16INK4a, AA were 76% and 95.9%; 100% and 27.5%; 100% and 26.5%; 92.3 % and 78.8% respectively. Conclusions: Age ≥55 years, large stag horn stones, multiple stones and impacted stones are found to be associated with increased risk of NL and PNL in UUT. For flat lesions, a panel of markers, Ki 67 index >10 and presence of aberrant angiogenesis were more useful than individual markers.

Background:Liquid based cytology with dual biomarkers has improved sensitivity and specificity in detecting high grade cervical intraepithelial neoplasia (CIN). In low resource settings, especially in organized camps, LBC is costly and immunohistochemistry on conventional pap smears is difficult to standardize with consumption of lots of reagents. In present study, to improve the accuracy of conventional pap smears and reduce the cost of biomarker testing, we evaluated conventional cell blocks (CCBs) preparations with biomarkers to detect high-grade CIN in resource-poor organized screening programs. We also studied feasibility of using CCB as primary screening test.Material and Methods:A total of 350 participants were included in the cross-sectional evaluation of the screening tests. A conventional Papanicolaou (Pap) smear was obtained, and another sample was then collected and placed in 10% neutral buffered formalin for CB preparation. All abnormal Pap tests and CBs were stained for the biomarkers p16INK4a and Ki67. Histopathology with p16INK4a expression was considered the gold standard. Diagnostic tests were compared using MacNemar’s test and receiver operating curves were plotted.Results:The sensitivity, specificity, and diagnostic accuracy of CCB cytology, CB + p16 cytology and CB + p16Ki67 cytology for detecting CIN2+ lesions were 85.71%, 100%, 97.44%; 100%, 93.75%, 94.87%; and 85.71%, 100%, 97.44%, respectively. The Ki67 index could further categorize low grade lesions into lesions with low proliferative index and with high proliferative index (Pearson chi-square p value <0.001).Conclusion:If CB preparation is standardized, CCB cytology with biomarkers can have better diagnostic accuracy than conventional cytology, can classify low grade lesions likely to progress and can be used in field settings as primary screening test.

Aim and objectives: Diagnostic accuracy of post therapy Papanicolaou (pap) tests is low, as it is difficult to differentiate benign from malignant lesions due to post radiation cellular changes. Here we have evaluated the role of biomarker p16INK4a and Ki67on conventional cell blocks (CCBs) in post therapeutic surveillance of cervical cancer to detect residual disease and site recurrence. We have also evaluated CCBs as a primary screening test. Material and Methods: In this cross-sectional study, patients who were diagnosed as cervical cancer before one year were followed between periods of April 2018-April 2019. We collected conventional pap smears and samples in 10% neutral buffered formalin for CCBs. The immunohistochemistry was performed on all cell blocks using Ki67 and p16INK4a as primary antibodies.Results: Out of total 35 cases, recurrences and residual disease were diagnosed in 8 cases. Sensitivity, specificity, diagnostic accuracy for pap, cell blocks and p16INK4a for detecting cervical cancer were 75%, 74.07%, 88.57%; 100%, 88.89%, 91.43% and 37.50%, 96.30% and 82.86% respectively. We observed that Ki67 labeling index ≥ 20% had a diagnostic accuracy of 100%. Conclusion: Our findings suggest that Ki67 labeling index ≥20% on CCBs can differentiate residual and recurrent cancer from post radiation dysplasia in post therapy surveillance cytology (p value <0.001). We also observed that CCBs has better diagnostic accuracy than pap test (Mac Nemar p value, 0.027). We did not found p16INK4A much useful as a biomarker in evaluation recurrence/residual disease.

Aim and objectives: Turnaround time is the main issue for formalin fixed-paraffin embedded-cell block diagnosis. The main objectives of this study were to develop fast and simple method of cell blocks preparation using frozen section technique, to develop a protocol of immunocytochemistry (ICC) on them and to evaluate its utility in clinical practice. Material and method: In this case series, we made frozen cell blocks (F-CB) from fine needle aspirates (FNA) and fluid samples using cryostat and performed ICC on them. Results were compared with histopathology diagnosis using Cohen’s Kappa agreement and Fisher Exact test. Results: Out of 25 cases, F-CB from FNA and fluid samples were made in 15 and 10 cases, respectively. ICC was performed on 20 cases. Only 40% of the cases had confirmed diagnosis on cytology smears. Addition of F-CB + ICC test could give a definitive diagnosis in 24/25 (96%) of cases. Conclusions: Newly developed method of frozen sectioning of cellblocks and ICC on them can give rapid and accurate cell block diagnosis.