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

incidental finding of ovarian brenner tumor

Brenner tumors of ovary are relatively uncommon neoplasms and constitute about 1.4-2.5% of all tumors of ovary. Most of these tumors present as an incidental finding either on gross examination of ovary or as a microscopic finding. They are classified in surface epithelial tumors of ovary. We report here a case of a 50 year old woman who presented to the gynecology and obstetrics department of Jinnah Post Graduate Medical Center, Karachi, Pakistan. The presenting complaints were irregular and heavy per vaginal bleeding for a few months. Total abdominal hysterectomy and bilateral salpingo-oophorectomy was performed and the specimen was received at the department of Pathology, Basic Medical Sciences Institute [BMSI], JPMC,Karachi. The microscopic examination of left ovary revealed benign Brenner tumor composed of well demarcated nests of uniform transitional cells

Low attendance in lectures at medical colleges of Karachi - a cross sectional survey

To evaluate the attendance of medical students in the lectures and to identify different factors responsible for low attendance. This cross sectional study was conducted at three medical colleges in Karachi, Pakistan during July to September 2012. Medical students of3rd year and above representing different medical colleges were asked to fill out a questionnaire to assess the different reasons why medical students tend to absent themselves from lectures, their views regarding content and quality of lectures. Students having attendance of 50% or more were included in the study. A total of 509 student responded to the survey. Two hundred and eighty two students [having >50% attendance in the last semester] were included in the study. Mean age was 21.14 +/- 1.9 years. There were 110 [39%] males and 172 [61%] females. The two most common reasons for not attending the lectures were; timing of the lectures not adjusted according to the students schedule [n=180; 63.8%] and the students preferred self/group study over lectures [n=198; 70.2%]. On the other hand majority of the students [n=173; 61.3%] were also of the opinion that it is difficult and complex to learn without lectures. There are various reasons for absenteeism from lectures including timing of the lectures and preference for self study. These need to be rectified in order to strengthen the learning process in medical undergraduates

Primary hydatid cyst of the neck

Hydatid cysts in the neck are relatively exceptional, even in areas where Echinococcus granulosis is endemic, such as Asia. Although liver and lung are frequent sites of involvement, it can involve all tissues, with neck remaining one of the most rare sites. It should come in the differential diagnosis of cystic lesion of neck, as the treatment options differ widely from common neck cysts. The role of radiological investigation is important and, in these cases, the involvement of other organs should be investigated. Serological tests may be helpful. The major treatment modality is surgical and the cyst should be excised as a whole, without being ruptured, to prevent any treatment complications, as the cyst fluid can initiate an anaphylactic reaction. Postoperative albendazole therapy is recommended particularly when there is intra-operative spillover. We report a case of an isolated hydatid cyst localized in the anterior triangle of the neck without any pulmonary or hepatic involvement.

Academic misconduct among students in medical colleges of Karachi, Pakistan

To determine the trends of academic misconduct in undergraduate students of different private and government section medical institutes. This cross sectional study was conducted at three medical colleges of Karachi, Pakistan. The students were evaluated by giving a self reported questionnaire containing various questions assessing their educational dishonesty and cheating behaviors. A total of 274 students from different years completed the questionnaire. Mean age was 21.48 +/- 1.89 years. Most of the students were in 4[th] year [n=86; 31.3%]. There were 182 [66.5%] females and 92 [33.5%] males. Majority of the students [n=155; 55.1%] accepted that they have cheated at least once. There was no significant difference regarding acceptance of cheating among different years of study [p=0.23] however females were found to accept cheating more as compared to males [p=0.036]. First year students were found more to ask teachers for answers during OSCE [p=0.01]. A large number of students accepted that they mark proxy for their friends [85.7%] and also ask their friends to mark proxy for them [85.03%]. Nearly half [44.02%] of the students rotating in wards also admitted to write fake histories. A large number of medical students admitted cheating and involvement in other academic misconduct. We need to improve our educational system, formally add professional session and strict disciplinary action should be taken against those who are found guilty

Primary chondrosarcoma of breast

Mammary sarcomas are heterogeneous group of malignant neoplasms that arise from the mammary stroma. They are uncommon tumours and most of these occur as a component of other tumours. Of the malignant breast mesenchymal tumours, pure sarcomas which lack epithelial component are rarer as these comprise only 0.5% of the breast tumours. Of these, the most common are angiosarcomas, liposarcomas and osteosarcomas. Pure, primary and De novo chondrosarcomas features as one of the rarer types of sarcomas of breast and should be differentiated from Phylloides tumours with chondromatous areas by extensive sampling which also excludes ductal elements in the tumour. This case report describes very rare primary breast sarcoma i.e. chondrosarcoma in a female aged 40 years which was treated by simple mastectomy

Back pain - are health care undergraduates at risk?

To study the prevalence of low back pain in medical and nursing undergraduate students in our institutes and its association with physical activity, smoking, depression, use of computer and other variables. It was a comparative cross sectional study carried out at two institutes of Dow University of Health Sciences, Karachi, Pakistan during October to December 2011. Two hundred and fifteen undergraduate students representing different semesters were asked to fill out the structured questionnaire. Back pain was assessed in terms of lifetime one year and point prevalence. Bivariate analysis was done to study the relationship between back pain and different variables; including gender, study program, smoking, computer use, depression and level of physical activity. Both the groups were compared for duration/ intensity of pain, seeking medical advice and duration of computer use. There were 183 undergraduate students who completed the questionnaire for back pain. Mean age was 22.84 [SD +/- 5.85] years. Gender distribution was nearly equal [females = 51.4%]. Life time prevalence was 57.9% [72% in medical students; 41% in nursing students]. Medical students were 0.47 times more at risk of having back pain [95% CI 0.15-1.48; P=0.198]. Smoking [OD=0.39, 95% CI 0.04-3.6; P=0.001] and use of laptop [OD=4.9; 95% CI 1.2-19.2; P=0.031] were found to be associated with increased prevalence of back pain. Nursing students sought medical opinion more as compared to medical students but it was not significant. However duration of computer use was more in medical students which was significant [P=0.03]. High lifetime prevalence of back pain was observed in undergraduate students. Medical students appeared to be more at risk. Preventive measures are required to improve the quality of life in future health care professionals

Cervical metastatic glioblastoma multiforme

Glioblastoma multiforme [GBM] is the most common and most malignant primary brain tumour in adults. In spite of the hostile nature of glioblastoma multiforme [GBM], extracranial spread is not a common event. With improving management choices and survival times, reports of extracranial occurrence of GBM have increased. Most commonly these metastases are to the lungs, lymph nodes, neck/skull, scalp, liver, and bones; may be evident on routine follow-up images of the original lesion. Head and neck metastasis of GBM can be debilitating. We present a case of cervical metastasis of GBM and discuss possible mechanisms of extraneural spread of this tumour

Primary angiosarcoma of breast

Primary breast sarcomas, except for phyllodes tumour, are very rare entities, accounting for < 0.1% of all malignant neoplasms. Angiosarcoma of breast is infrequent malignancy and differential diagnosis from other sarcomatous and angiomatous breast tumours holds importance. Two cases of primary angiosarcoma of breast were encountered. One involved a 32 years lady who was treated by wide local excision and six cycles of chemotherapy. The other occurred in a 54 years old lady who was treated with mastectomy, did not receive any radiation or chemotherapy and was later lost to follow-up. Neither of the patient had history of previous breast surgery, chemotherapy or radiotherapy

Squamous inclusion cyst in a sentinel axillary lymph node associated with breast malignancy

Axillary intranodal squamous inclusion cyst is a rare benign histological finding that may be confused with malignant diseases. A 52 years old female presented with a painless lump in the left breast for one and a half month. The mammogram was reported as being suspicious of carcinoma. Left breast lumpectomy and histology revealed infiltrating ductal carcinoma. After a month, modified radical mastectomy was done. Frozen section of axillary sentinel lymph nodes revealed benign histology with squamous inclusion cyst in one of the nodes. All lymph nodes recovered from mastectomy specimen were also benign