AIM:To automate breast cancer diagnosis and to study the inter-observer and intra-observer variations in the manual evaluations. METHODS:Breast tissue specimens from sixty cases were stained separately for estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor-2 (HER-2/neu). All cases were assessed by manual grading as well as image analysis. The manual grading was performed by an experienced expert pathologist. To study inter-observer and intra-observer variations, we obtained readings from another pathologist as the second observer from a different laboratory who has a little less experience than the first observer. We also took a second reading from the second observer to study intra-observer variations. Image analysis was carried out using in-house developed software (TissueQuant). A comparison of the results from image analysis and manual scoring of ER, PR and HER-2/neu was also carried out. RESULTS:The performance of the automated analysis in the case of ER, PR and HER-2/neu expressions was compared with the manual evaluations. The performance of the automated system was found to correlate well with the manual evaluations. The inter-observer variations were measured using Spearman correlation coefficient r and 95% confidence interval. In the case of ER expression, Spearman correlation r = 0.53, in the case of PR expression, r = 0.63, and in the case of HER-2/neu expression, r = 0.68. Similarly, intra-observer variations were also measured. In the case of ER, PR and HER-2/ neu expressions, r = 0.46, 0.66 and 0.70, respectively. CONCLUSION:The automation of breast cancer diagnosis from immunohistochemically stained specimens is very useful for providing objective and repeatable evaluations.

We report a rare case of trichilemmal cyst involving the bulbar conjunctiva. A 55-year-old female presented with a history of a painless, progressive swelling in the left bulbar conjunctiva adjacent to the nasal limbus of 3 years duration. Wide excision biopsy was performed. Histopathologic examination findings were consistent with those of trichilemmal cyst. Trichilemmal cyst should be considered as differential diagnosis in a case of limbal nodule.

A 34-year-old woman came to gynaecology outpatient department with the complaint of infertility. She was married for 10 years. Her menstrual cycles were regular but were associated with dysmenorrhoea. As part of investigation for infertility, ultrasonogram was done which revealed a left ovarian tumour with adhesions. MRI showed an enhancing lesion with solid and cystic components measuring 11 cm x 9.8 cm x 6 cm in left adnexa with extensions anteriorly upto the anterior abdominal wall, posteriorly infiltrating the uterus and laterally upto the left ileus muscle. Left salphingooophorectomy was performed and specimen was sent for histopathology. Tumour arising from left ovary showed broad papillary excrescences (Tombstone appearance) with a solid, yellowish cut surface [Table/ Fig-1].

BACKGROUND Chronic Liver Disease (CLD) is a disease process causing progressive destruction and regeneration of liver parenchyma leading to fibrosis and cirrhosis. It is frequently associated with haematological abnormalities and causes complications including bleeding and infection which can increase morbidity and mortality rate. Dietary deficiencies, bleeding, alcoholism and abnormalities in hepatic synthesis or proteins used for blood formation or coagulation add to the problem of liver disease. Therefore, wide range of haematological abnormalities is seen in liver disease. This study studies the correlation between abnormalities in haematological parameters and severity of chronic liver disease. METHODS 100 chronic liver disease patients were studied retrospectively and prospectively for a period of one year from January 2018 to December 2018. In all cases, patients age, gender and relevant clinical history were obtained. RESULTS In chronic liver disease patients, all haematological parameters were decreased except MCV and MCH which were increased. However, it was not statistically significant. Prolonged PT and abnormal peripheral smears were also seen. A table of all haematological parameters studied by mean, interquartile range, median and standard deviation was prepared. Mann Whitney test was used to calculate p value. CONCLUSIONS Chronic liver disease patients are frequently associated with haematological and biochemical abnormalities showing anaemia, leucopenia and thrombocytopenia along with derangement in liver enzymes and decrease in renal function test. Prolonged prothrombin time and abnormal peripheral smear are also seen in these patients. It is associated with increased morbidity and mortality. In our study, haematological parameters (Hb, RBC, PCV MCHC, platelet, PT) all were decreased except MCV and MCH which were increased. However, MCH was statistically not increased. MCV was reduced significantly and biochemical parameters like deranged liver function test were all increased except total protein, albumin and renal function test. S. Urea and Creatinine were reduced. Thus, the complete blood count picture had shown the picture of anaemia, leucopenia and thrombocytopenia. Highly significant p values <0.001 were seen.

Leiomyoma though a common entity encountered in our daily practise, its occurrence in breast is extremely uncommon. There are a very few reported cases of leiomyomas occurring in breast parenchyma. This tumour clinically simulate commonly occurring tumours of breast. This case report is of such a case of a mesenchymal neoplasm occurring in breast of a woman of child bearing age. The histopathological diagnosis requires careful differentiation from lesions that have smooth muscle proliferation, especially leiomyosarcoma. The most commonly performed treatment is resection of the lesion with free margins. Although breast leiomyoma is rare, it should be considered among the differential diagnoses for breast nodules of benign appearance.