Carcinomas & Role of Diagnostic Pathology

The word carcinoma is synonym for cancer or malignancy in medical science. Carcinomas may develop from a variety of epithelial tissues of various sites of human body. Epithelial tissues (layers of body cells lining the wall) of respiratory tract, gastrointestinal tract (GI tract) reproductive tract (vagina, cervix, uterus and fallopian tubes), oral cavity, head & neck, breast and skin may transform as carcinoma due to viral infections, genetic mutations and/or biochemical changes in our body. The histopathological diagnosis based on varied morphology of cells and their nuclei is very challenging for the pathologists. For the accurate differential diagnosis of carcinomas found in the primary organs and at metastatic sites in the biopsy materials/specimens, pathologists have to depend on advanced techniques/methodologies like immonohistochemistry (IHC), in-situ hybridization, molecular genetics, microarray etc.


A variety of panels of tumor specific & cells’ phenotype specific primary antibodies have been chalked-out through worldwide deliberations for accurate diagnosis of carcinomas/malignancies with reference to established literature and WHO classifications of carcinomas/malignancies. An accurate diagnosis provides the direction for the line of treatment or surgical interventions. However, individual results of advanced investigations may vary somewhat within diagnostic centers, probably due to protocols followed. The storage conditions and exhausted lifespan of primary antibodies used for IHC may influence the outcome of final result, so there is need for strict quality assurance at pathological diagnostic centers.

Children’s health, growth and immunization: Our role in preventing preventable diseases

Unless we look after our women and children in a programmed manner in the field of health, we cannot have a happy world around us. Children are still killed or disabled each year by diseases that could have been prevented by immunization. The World Health Organization (WHO) is doing its best to eradicate/eliminate a variety of infectious diseases, but involvement of every citizen of the world is must for compliance of various programs of the WHO. The measles, mumps and rubella triple vaccine (MMR) should be included in the EPI (Expanded Preventable Immunization) program of every country. We should not ignore the facts that measles and mumps can cause considerable morbidity and mortality which could be prevented with optimum immunization. Optimum immunization means full course of vaccination schedule without missing any booster dose.

Apart from vaccination child nutrition and general health must be taken care of. The child health reminds me the efforts of Mr. James P Grant, the Director of United Nations' Children's Fund (UNICEF, 1984), who in 1984 brought out a Report on the State of World's Children, and forwarded a mnemonic GOBI-FFF to remember the techniques which could reduce sadness of the world. In GOBI-FFF, "G" stands for growth monitoring, "O" stands for oral rehydration therapy, "B" stands for breastfeeding, and "I" stands for immunization. The three Fs (FFF) stand for 'family spacing', food supplements and female education. The methods represented by GOBI-FFF are the simplest methods which could help us in tiding over the state of health of children and preventing diseases and saving lives. Consequent upon the compliance of GOBI-FFF, lives of millions of children are saved every year and the health and growth of millions more is protected. Still there is need to protect the children from episodes of common childhood diseases like measles, respiratory infections and diarrhoeal infections.

Various infections also interfere with physiological and psychological development of children. The malnutrition and infections perpetuate each other and may lead to suboptimum brain development. The GOBI methods are not so expensive. Community health workers can be assigned the responsibility of growth monitoring through periodic recording of weight and height of a child. The oral rehydration salts (ORS) should be supplied at cost price to prevent the dehydration caused by diarrhoea. The breastfeeding should be encouraged since it provides ideal nourishment to the child and saves from the infectious hazards of bottle feeding. Immunization against tuberculosis, diphtheria, pertusis (whooping cough) tetanus, polio, measles, mums and rubella protects the child against these serious as well as disabling diseases. Attention should also be given to the health education of mothers. Awareness about the child's health in mothers would definitely make all the healthcare and immunization programs successful. It is well established fact that proper spacing between child births decreases the risks to the heath of the mother and the infant. Food supplements should regularly be supplied to the mothers during pregnancy and vaccination against tetanus should be done. We must put in our best efforts to prevent the preventable diseases since prevention is better than cure.

Common Worm Infestations

Common worm infestations are medically termed helminthiasis. The word 'helminth' has been derived from the Greek word 'helm-in-thos' that means worm. The evolution of helminthiasis is as old as mankind. Helminths or worms are intestinal parasites and their prevalence is very high in developing countries. Over crowding in localities and deteriorating socio-economic conditions are the main cause of worm infestations/infections. Human beings have been documented as the reservoir for nematodes. Though some host-parasite relationships are relatively benign but almost all the worms are capable of causing serious pathological lesions leading to health complications. However, the population density of worms or intestinal helminths, influence their pathogenicity. We find that majority of the infected individuals are asymptomatic. Most of the intestinal helminths do not multiply within the human host.
There are two major groups of intestinal helminths or worms: A)  Nematodes and B)  Cestodes

A)    Nematodes

1. The roundworm or Ascaris lumbricoides is the largest (15-35 cm in length) and most common nematode parasitizing the intestine of humans. The prevalence of roundworm infestation/infection is around 20% worldwide. Treatment with antihelminthics is effective to kill the adult roundworms but fails to kill larvae.
2. Hookworm infestation/infection is common in all tropical and sub-tropical countries. Ancylostoma duodenale and Necator americana are predominant parasites. A single hookworm draws around 0.2 ml blood in 24 hours. Hookworm infestation may cause severe anemia. In such cases, effective means of treatment of anemia would be removal of hookworms by effective drugs before administration of treatment of anemia.
3. The human whipworm, Trichuris trichuria is cosmopolitan in distribution. The whipworm may coexist with roundworm. Small children develop heavy infections due to autoinfection. Effective treatment of trichuriasis is available but self medication is not recommended.
4. Other nematode infestations are Strongyloidiasis and Enterobiasis. Distribution of the intestinal parasites Strongyloides stercoralis and Enterobias vermicularis is worldwide. A number of drugs are available to give 100% cure.

B)    Cestodes (Tapeworm Infections)
        
The distribution of tapeworm infections is worldwide. Man serves as a definitive host for tapeworm species like Taenia saginata, Taenia solium and Hymenolepis nana. For Echinococcus granulousus, man serves as an intermediate host.

Prophylaxis for worm infestations:

• Personal hygiene and sanitation is the chief method of control.
• Administrative measures should be taken up to educate people on personal hygiene.
• Mass treatment of the infected population with medically recommended safe and effective drugs.
• Avoid eating raw vegetables.
• Administrative measures to prevent contamination of drinking water and food stuffs.
• Finger nails should be cut short and hands should be washed thoroughly with soap & water, after toilet and before meals.
• Patient with enterobiasis should wash anal area immediately after waking up to avoid dispersal of eggs.
• The infected person should be advised to sleep alone.
• It is preferable to treat entire family if someone in the family has enterobiasis.

Polyclonal Gammopathies

Excess of any thing is bad, and the same is true for elevated levels of immunoglobulins. The elevated levels of immunoglobulins, i.e. hypergammaglobulinemia could be due to monoclonal gammopathies or polyclonal gammopathies. In fact the polyclonal gammopathy signifies potent immunoglobulin response rather than actually being a disorder. Chronic infections and several chronic diseases affecting the liver and collagen are the cause of polyclonal gammopathies. Once a polyclonal gammopathy is detected, it becomes first and the foremost task to identify the underlying organic disease. Tuberculosis, Osteomyelitis, Syphilis, Chronic Bronchitis, Chronic Fungal infections, Primary Billiary Cirrhosis (PBC), Chronic Active Hepatitis (CAH), infectious hepatitis, Chronic Malaria, Leishmaniasis (Kala Azar), Filariasis, Rheumatoid Arthritis (RA), Systemic Lupus Erythematosus (SLE), Polymyositis, Scleroderma, Metastatic carcinoma, slow healing trauma and Cystic fibrosis have been found to be associated with polyclonal gammopathies.

Serum protein electrophoresis (SPE) will show a broad diffuse increase in the gamma globulin region, indicative of a polyclonal gammopathy. The primary cause of the polyclonal gammopathy may be known or should be determined through conventional investigations to decide the line of treatment. The immunoglobulin excess may be resolved through the adequate treatment of underlying disease responsible for polyclonal gammopathy.