Pleomorphic Xanthoastrocytoma: clinicopathological spectrum of an intriguing neoplasm

Background and Objective: Pleomorphic xanthoastrocytoma [PXA] is a rare primary WHO Grade II astrocytic tumor comprising of < 1% of all astrocytomas. It is generally benign and slow growing however disease progression and malignant transformation with anaplastic features have been infrequently reported. Our objective was to assess clinicopathological characteristics of this rare tumor at our center

Methods: A retrospective study was conducted at Aga Khan University Hospital from January 1992 till January 2016. Data was entered on a proforma including patient demographics, clinical features, tumor location, histological features and follow-up, where available

Results: Forty Seven cases of PXA were retrieved during the study period. The mean age was 23.8 years [SD=15.1] and median age was 19 years. The most frequent symptom was head ache [n=31]. Male were more frequently affected [n=26]. The commonest location was temporal lobe. On microscopic examination, tumors were pleomorphic without mitoses or necrosis, however two cases showed increased mitotic activity, and one case revealed associated gliosarcoma. Follow-up of only 29 cases was available for a period ranging between 2 and 184 months [85 months +/- 56 months]. Outcome was good in 27 patients with the last follow up showing no radiographic or clinical evidence of tumor recurrence

Conclusions: PXA is an infrequent tumor in our population also, with less than 50 cases identified in two decades study period. Due to its rarity and its bizarre histomorphology, it should be diagnosed correctly, as it has got better prognosis than other astrocytic tumors

Olfactory neuroblastoma: a clinicopathological experience of a rare entity from Pakistan

Objectives: To present the clinicopathological experience of Olfactory Neuroblastoma [ONB] with emphasis on histopathological and immunohistochemical features

Methods: A descriptive cross-sectional study was done on 36 cases of ONB, selected by non-probability purposive sampling. Theses cases of ONB were retrieved and reviewed from surgical pathology database of Aga Khan University Hospital reported between January 1993 and March 2015

Results: Tumor size and age of presentation was wide in range without any distinct bimodal distribution. Nasal cavity was most common site along with involvement of paranasal sinuses. More than 50% cases had Kadish stage A. Microscopically, most cases were Grade-1 and majority showed partial or complete lobular architecture. Neurofibrillary matrix was observed in 2/3rd of cases. Among immunohistochemical markers, Neuron Specific Enolase was most frequently expressed. Unusual positive expression of Cytokeratin AE1/AE3 and Cytokeratin CAM5.2 was also seen focally in few cases

Conclusion: The ONB has great variability of histological and clinical presentation, and immunohistochemical markers are useful to differentiate from more common small round blue cell tumours of nasal cavity

Profile of patients with colorectal cancer

To document the profile of patients with colorectal cancer, modes of management and outcome. Cross sectional prospective study. This study was conducted at DUHS and CHK Pakistan from July 2007 to June 2012. Diagnosis was confirmed on histopathology through procto-sigmoidoscopy and colonoscopic biopsy. Abdominal ultrasounds and CT scan were used to stage the disease. Treatment was planned according to the presentation. Surgical procedure was decided according to the site and stage of the tumor. Neoadjuvant chemo-radiation was given for advance and adjuvant therapy for early tumors. A total of 72 patients were included in the study. Majority of patients [n=29 - 40%] presented with advance disease [stage IV]. Carcinoma rectum was diagnosed in 40 [55.5%] cases, sigmoid colon carcinoma in 12[16.6%], caecal cancer in 10[13.8%], ascending colon [n=6 - 8.3%], transverse colon and anal canal [n=2-2.7%] each. Anterior resection [APR] was performed in 20 [27.7%] cases, low anterior resection in two [2.7%], abdomino perineal resection in eight [11%], laparoscopic assisted APR in two [2.7%], Hartmann procedure and only stoma formation in ten [13.8%] each. Histopathology confirmed poorly differentiated adenocarcinoma in 36 [50%] patients. Overall mortality was 9.7% [n=7]. Majority of the patients diagnosed with carcinoma rectum were young and presented with advance disease

Recurrent abscesses following an intra muscular injection of diclofenac sodium

Two young females and one obese male presented with multiple discharging sinuses due to recurrent injection abscesses that burst spontaneously following intramuscular [IM] injections of diclofenac sodium. These abscesses were formed in relation to repeated IM injections given in order to relieve the pain. Multiple discharging sinuses led to disfigurement of the arm that was managed by wide local excision. Skin loss was dealt with skin grafting. Learning the proper technique of administering an intramuscular injection, alternating the injection site and change of analgesic can help to minimize the possibility of these complications from tissue necrosis

Laparoscopic versus inguinal [Ivanissevich] varicocelectomy

To compare the postsurgical outcome of laparoscopic and open inguinal varicocelectomy. Quasi-experimental study. Department of Surgery, Liaquat University of Medical and Health Sciences, Jamshoro, from July 2003 to June 2007. One hundred seven patients underwent either open inguinal or laparoscopic varicocelectomy. Diagnosis was made by clinical examination and color Doppler scan in doubtful cases. Pre-operative semen analysis was done in all patients. Operative time, postoperative analgesic requirement in number of tablets, hospital stay in days, improvement in semen parameters in subfertile subjects, pain on visual analog score, and postoperative complications were recorded and compared between the two groups. There were 50 patients in each group, with age ranging from 12-50 years [26.9 +/- 7.67 in open inguinal and 26.2 +/- 7.08 in laparoscopic group]. Average operative time was 34.8 +/- 7.89 minutes for open inguinal and 43.8 +/- 8.95 minutes for laparoscopic group. The analgesic requirement was 16.3 +/- 1.58 tablets in the open inguinal and 11.3 +/- 2.23 in the laparoscopic group. Postoperative pain was significantly less in the laparoscopic group. There was statistically significant [p < 0.001] improvement in sperm count as well as motility in both groups irrespective of procedure. The open inguinal [Ivanissevich] procedure and laparoscopic varicocelectomy had almost equivalent postoperative outcomes regarding improvement in semen parameters and postoperative complications. Open inguinal procedure had a shorter operating time while laparoscopic varicocelectomy had the advantage of less analgesic requirement and short hospital stay. On the whole, open inguinal [loupe magnified] varicocelectomy is an effective procedure where availability and costs of laparoscopic instruments are barriers

Spectrum of breast tuberculosis

To determine the presentation of breast tuberculosis, diagnostic methods and surgical treatments. A case series. This study was conducted at Dow University of Health Sciences and Tuberculosis Clinic at Bantwa Hospital, Kharadar, Karachi, from April 1999 to March 2007. Clinically diagnosed patients of breast tuberculosis, confirmed by laboratory work-up, were included in this study. Detailed history and examination of both breast and axillae were the primary diagnostic measures. Complete blood counts, ESR, Mantoux test, ultrasound, mammogram, fine needle aspiration cytology, staining for acid-fast bacilli both smear and culture were performed. Core biopsy for lumps more than 5 cm and wide excision biopsy for the lump less than 5 cm were the methods applied. Pre-designed research proforma was filled and descriptive statistics of age, site, side, clinical presentations, investigations were recorded and surgical treatment done. Anti-tuberculosis treatment was given to all patients. Thirty patients were studied with mean age of 28.4 years ranging from 16-48 years. Bilateral breast involvement was seen in 2 patients with 14 cases involving the right and left breast. Lymph node involvement was present in 7. Pulmonary tuberculosis was seen in 4 patients. Multifocal disease was present in 27 patients. The clinical presentation was with lump in 6, discharging sinuses in 14, cold abscess in 8, and non-healing ulcer in 2 patients. There were 5 lactating mothers. Montoux test was positive in 5, AFB smear and culture were positive in 3. Only AFB culture was positive in 4. Five patients required core biopsy for diagnosis of confirmation of lump more than 5 cm and wide excision biopsy was required in 7 patients with lump less than 5 cm. Despite antituberculous treatment, surgical management was required in 21 [70%] cases. Tuberculosis of the breast, simulating the carcinoma breast and granulomatous mastitis very closely and are difficult to be differentiated without tissue diagnosis. Surgical management is more often required

Laparoscopic cholecystectomy in the elderly patients. An experience at Liaquat University Hospital Jamshoro

Advancing age with its associated co-morbidities increases the likelihood of postoperative complications as well as conversion rate during laparoscopic cholecystectomy. Recent studies have also questioned efficacy of this procedure in geriatric patients. The present study assesses the safety and applicability of laparoscopic cholecystectomy in geriatric patients. The objective of the present study was to asses safety and applicability of laparoscopic cholecystectomy in the elderly patients of 65 years and above. This is a prospective analysis of 173 patients, over 65 years of age, who underwent laparoscopic cholecystectomy from December 2002 to November 2006 at Liaquat University Hospital, Jamshoro. Patients presenting with complicated and uncomplicated gallstone disease were included in the study population and all of them were operated laparoscopically. The data included demographic details, co-morbidities, underlying biliary pathology, indications for surgery, operative and postoperative complications, morbidity and mortality, and hospital stay. The statistical analysis of the data performed on SPSS version 10. Laparoscopic cholecystectomy undertaken in 173 elderly patients with a mean age of 69.72 years, out of whom 52 [30.05%] were males and 121 [69.94%] were females. Co-morbid conditions were identified in 53.17% [n=92] patients and included hypertension in 38 patients [21.96%], Diabetes Mellitus in 23 patients [13.29%], COPD in 19 [10.98%] patients, Coronary artery disease in 9 [5.20%] and cardiac arrhythmias in 3 [1.73%] patients. Indications for surgery included simple biliary colic in majority of patients [69.94%] and complicated stone disease in 52 [30.05%] subjects. There were 37 [21.38%] emergency laparoscopic cholecystectomies and 136 [78.61%] patients were operated electively. Mean operative time was 100 minutes with a SD 29.03. Fourteen [8.09%] patients required conversion to OC [Open Cholecystectomy] due to various reasons. Mean hospital stay was 6.28 days. Overall 23 [13.29%] patients developed postoperative complications. One patient died of acute MI on 2nd postoperative day. There is no undue risk in laparoscopic cholecystectomy in the elderly population and the procedure can be regarded as safe as in patients below 65 years of age

Clinico-pathological profile of patients with breast diseases at university hospital, Jamshoro

To assess various disorders of breast regarding their frequency, presentation, pathology and management at a University Hospital. A descriptive study. Department of Surgery, Liaquat University Hospital Jamshoro - Sindh from January 1999 to December 2003. One hundred and fifty patients with different breast disorders were studied. All cases were assessed clinically by getting history on a predesigned proforma and diagnosis was confirmed with help of relevant investigations. Patients with various breast diseases were included in the study except those who were having either no definite lump or no breast pathology. The treatment given was according to type of lesion in the form of surgery or conservative. Patients with benign breast diseases were assured and followed up after surgical treatment or kept on hormone therapy where as cases with malignant disease were referred to oncologist for cancer registry purpose and chemo-radiotherapy. Among 150 cases, majority was females with female to male ratio of 24:1. All patients presented with breast lump [100%], followed by pain in the lump [53.33%] as main symptoms. Left breast was involved in 53.33% and right breast in 44.66% of cases. Majority of cases [84.67%] underwent surgery. Histopathology revealed fibro-adenoma in 30.66%, fibrocystic disease in 15.33% and carcinoma in 35.33% cases as main disorders. All six male patients had gynaecomastia. In our set up, frequency of carcinoma of breast is increasing as compared to benign lesions. However, overall benign problems are more frequent than breast cancer