Dr. Jagirdar received her M.D. from Calcutta University, India. After completing her residency in AP/CP at Mt. Sinai Medical Center in New York, she stayed on as faculty for 10 years. Following that she worked at New York University for another 11 years. Her area of expertise is in Pulmonary Pathology, both diagnostic and research aspects. She is the HSC Pulmonary Pathology Consultant and has published primarily on lung diseases for the last 20 years.

Research Interest

A. Lung Cancer

Patients with pulmonary neoplasms have an increased risk for developing a second tumor of the lung, either at the same time or different times. It is important to determine if the second tumor represents an independent primary tumor (i.e., a synchronous or a metachronous tumor, depending on whether it is present at the same time or later (recurrence or metastasis), because it will significantly change the management and prognosis. Because the two tumors from the same patient are often morphologically similar, histologic examination alone may not be sufficient to distinguish between the two possibilities. We have attempted to approach this problem by microdissecting malignant cells and comparing patterns of loss of heterozygosity of multiple genes and chromosomal loci between paired tumors. We found the primary tumors of the lung and their metastasis share nearly identical patterns of loss of heterozygosity. In contrast, most synchronous and metachronous tumors as defined by the current arbitrary criteria appeared to be genetically different; therefore, they most likely represent independent primary tumors. Rare synchronous tumors have similar genetic profiles, raising the possibility of recurrence/metastasis.
Our data suggest that molecular analysis can help fingerprint tumors and has the potential to
significantly impact management and prognosis of patients. (Reference-1)

B. Tuberculosis

J Jagirdar, KF Law, H Cohen, WN Rom. Declining CD4+ counts have been associated with
an increased incidence of mycobacterial infection, higher rates of dissemination,
mycobacteremia, and extrapulmonary tuberculosis. Cellular immunity, namely CD4+ cells with a Th1 cytokine profile is thought to play a major role in protective immunity against
mycobacteria. We evaluated the histopathological correlates of low CD4+ counts (number of
AFB and morphology) in tissue biopsies from 36 patients (31 HIV+ and 5 HIV-) with culture-
proven M. tuberculosis. The median CD4+ count was lower in HIV+ group (51/ul; range 4-624, vs HIV- 1179/ul; range 801-1334, p<0.001). Patients with CD4+ ?250/ul (n=23, median CD4+ 35/ul) had significantly more AFB detected in granulomata (91 vs 22%, p<0.001). These patients were more likely to have numerous AFB (>50/HPE) detected in tissue (48 vs 0%, p<0.05). In fact, the finding of numerous AFB was not encountered in any tissue from patients with CD4+ >135/ul. Extrapulmonary disease was more frequent in those with CD4+?250/ul (74 vs 22%, p<0.005). Interestingly, the incidence of necrosis was similar in those who had CD4+ count>250 (89%) compared to those who had CD4+?250/ul (70%). Absence of epitheloid cells and presence of poorly formed granulomas were more frequent in those with CD4+?250/ul. The number of giant cells was similar in both groups (25% and 22%). In summary, there was striking histopthological correlation between declining CD4+ count and the presence of numerous AFB. (Reference-15) Necrosis on the other hand does not offer protection and contributes towards cavity formation and delayed healing. In another study, we have shown that cytotoxic T Cells may contribute to the necrosis. Our current study is evaluating genetically engineered cytokine secreting BCG as a vaccine for mycobacterial infection in an animal model.

Selected Publications

1. Huang J, Behrens C, Dimopulo O, Wistuba I, Gazdar AF, Jagirdar J. Molecular
Analysis of Synchronous and Metachronous Tumors of the Lung: ? Impact on
Management and Prognosis. In press Annals of Diagnostic Pathology, Vol. 5 #6
December 2001

2. Huang J, Behrens C. Wistuba I, Gazdar A, Jagirdar J. Genetic alterations in combined
and collision tumors: Evidence for both convergent and divergent hypothesis. In press to
Arch Pathol and Lab Med, 2001

3. Pascal P, Yang GC, Kumar A, Winkler B, Cohen JM, Melamed J, Scholes J, Jagirdar J.
PNET-like features of Synovial sarcoma of the lung: A pitfall in the cytologic diagnosis
of soft tissue tumors. Diagnostic Cytopathology 2001; 24:283-288

4. Wistuba II, Syed S, Behrens C, Duong M. Milchgrub S, Muller CY, Jagirdar J, Gazdar
AF. Comparison of molecular changes in cervical intraepithelial neoplasia in HIV-
positive and HIV-indeterminate subjects. Gynecol Oncol. 1999 Sep; 74 (3) :519-26

5. Wistuba II, Behrens C, Milchgrub S, Virmani AK, Jagirdar J, Thomas B, Ioachim HL,
Litzky LA, Brambilla EM, Minna JD, Gazdar AF. Comparison of molecular changes in
lung cancers in HIV-positive and HIV- indeterminate subjects. JAMA. 1998 May 20;
279 (19): 1554-9

6. Fasano M, Yousem S, Jagirdar J. MIB-1 as a predictor of response in lung allografts
with moderate acute cellular rejection. Am J Surg Pathol 1998 Jun: 22 (6); 749-54

7. Law KF, Jagirdar J, Weiden MD, Bodkin M and Rom WN: Tuberculosis in HIV-
positive patients: cellular response and immune activation in the lung. Am J Crit Care
Med. 1996; 153:1377-84

8. Cangiarella J, Greco MA, Askin F, Perlman E, Goswami S, Jagirdar J: Congenital
Cystadenomatoid malformation of the lung. Insights into the pathogenesis utilizing
quantitative analysis of vascular marker CD34 (QBEND-10) and cell proliferation marker
MIB-1. Mod Pathol 1995; 8 : : 913-8

9. Moran CA, Suster S, Gil J, Jagirdar J: Morphometric Analysis of Germinal Centers in
Nonthymomatous Patients with Myasthenia Gravis. Arch Pathol Lab Med. 1990;
114:689-691

10. Brandwein M, Choi H, Strauchen J, Stoler M, Federman Q, Tannembaum M, Jagirdar,
J: Spindled atypical mycobacterial infection (SMAI) in AIDS mimicking neoplasia:
Evidence for dual histiocytic and fibroblast-like differentiation of spindle cells.
Virchows Archi A 416:281-286, 1990

11. Jordon D, Jagirdar J, Kaneko M: Lewis x and y blood group expression in the
differential diagnosis of malignant mesothelioma and adenocarcinoma: a study of 28
mesothliomas. Am J Pathol 135:931-937, 1989

12. Jagirdar J, Frydman C, Sakurai H, Dumitrescu O: Mesothelial papillary proliferation of
the pleura associated with radiation therapy: Does it have a role in pathogenesis of
mesothelioma? Mt. Sinai J Med 56:147-149, 1989

13. Rosen-Levin E. Patil R, Jagirdar J: Distinguishing benign from malignant pleural
effusions by lectin immunocytochemistry. Acta Cytologica 33:499-504, 1989

14. Frydman C, Bleiweiss I, Yoo O, Jagirdar J: Diagnosis of cytomegalic infection of the
lung in the acquired immune deficiency syndrome (AIDS) by in situ hybridization. Prog
in AIDS Pathol 1:91-100, 1989

15. Jagirdar J, Law KF, Cohen H, Rom WN: Presence of Numerous M. Tuberculosis in
Tissue Granulomata is an Exclusive Feature of Low CD4+ Counts. AM Rev. Resp. Dis
1995; 151:A246