Secondary ameloblastic carcinoma of mandible with pulmonary metastasis

Ameloblastic carcinoma [AC] is a very rare odontogenic malignancy. Primary AC is more common in maxilla, while secondary AC is more common in mandible. Histologically, it is an ameloblastoma with features of cancer. Presence of metastasis is not necessary to establish the diagnosis. This tumor usually metastasises in bone or lungs. We report a case of aggressive secondary AC of mandible with lung metastasis. There are few cases in medical literature discussing management of AC with lung metastasis. In this case, a 42-year woman, who was diagnosed with ameloblastoma of right mandible, was treated with right hemi-mandibulectomy. However, 10 years later, the patient developed AC with pulmonary metastasis. Patient received six cycles of carboplatin-paclitaxel-based regimen. There was noted a partial response to the therapy. However, the patient went into respiratory failure, although she was provided adequate analgesic control as part of end-of-life care. Further, oncological or surgical management was not possible as patient had poor performance status

Multiple myeloma presenting at unusual sites

To report unusual presentations of multiple myeloma and to highlight that early detection of these unusual features will encourage early investigation, diagnosis and appropriate management and consequently better prognosis of this difficult disease. Three consecutive cases of plasmacytoma reported at histopathology department of Foundation University Medical College which were later on diagnosed as multiple myeloma are presented. The clinical features and lab investigations were extracted from the patients' files. The hematoxylin and eosin stained slides were retrieved and reviewed. Three cases comprising a surgically excised chest wall mass [presternal], trucut biopsy of a mediastinal mass and a surgically excised extra dural mass along D7-D8 vertebrae were received in histopathology lab. All the patients were females. The ages of the patients were 63, 55 and 47 years respectively. On initial view of slides the diagnosis of plasma cell tumor, plasmacytoma and non-Hodgkin's lymphoma [lymphoplasmacytic type] was made respectively although the differential of large cell lymphoma with plasmacytic differentiation was also kepi in mind. Surprisingly all three cases turned out to be multiple myeloma after bone marrow aspiration, serum protein electrophoresis and skeletal x- rays. Plasmacytoma with coexistent multiple myeloma must be kept in the differential of mediastinal and vertebral masses and further lab and radiologic assessment must be done before starting the treatment.

audit of length of bone marrow trephine biopsies at a tertiary care hospital

Bone marrow trephine biopsy is a well established minor surgical procedure for the inspection of bone marrow usually done along with bone marrow aspiration. The objective of this study was to evaluate the length of trephine biopsies and the rate of positivity for diagnosis as well as unfit biopsies in various length ranges. This retrospective study was conducted at Fauji Foundation Hospital and Foundation University Medical College Rawalpindi from Jan 2007 to Dec 2009. A total of 394 trephine biopsy reports were collected and reviewed. The criterion for adequate trephine biopsy was >/= 1.5 Cm. The biopsies were divided into four groups according to length, i.e., group-1: >/= 1.5 Cm, group-2: 1-1.4 Cm, group-3: 0.5-0.9 Cm, and group-4: <0.5 Cm. The adequacy of trephine biopsy length and rate of positive diagnosis as well as unfit biopsies were compared. Total 394 trephine biopsies were reviewed. Group-1 included 88 biopsies and 87 [98.9%] had positive diagnosis. Group-2 included 137 biopsies and 133 [97.1%] had positive diagnosis. Group-3 included 99 biopsies and 91 [92%] had positive diagnosis. Group-4 included 70 biopsies and 57 [81.4%] had positive diagnosis. There was no significant difference between group-1 and group-2 for the rate of positivity of diagnosis [p=0.65]. In group-1, 1 [1.1%] was unfit for evaluation, in group-2, 4 [2.9%] were unfit, in group-3, 8 [8%] were unfit, and in group-4, 13 [18.5%] were unfit for evaluation. Total 26 trephine biopsies were unfit for evaluation, out of which 13 [50%] belonged to group-4. Trephine biopsies that were unfit for evaluation were 4 [4.9%] in 2007, 17 [10.5%] in 2008, and 5 [3.3%] in 2009. Although 22.3% biopsies were of recommended length there was no significant difference in rate of positive diagnosis between biopsies of >/= 1.5 Cm and 1-1.4 Cm

Morphological spectrum of chronic hepatitis [C] infection: experience at foundation university medical college and Fauji foundation hospital Rawalpindi

To determine the morphological patterns of HCV related liver disease in our set up. 164 routinely processed liver biopsies were assessed and scored for grading [necro-inflammatory changes] and staging [fibrosis] using modified Knodell HAI scoring system. Our patients were mostly females and maximum cases were in 4[th] and 5[th] decades. Mild portal inflammation was seen in 78% and moderate in 20% cases. Piecemeal necrosis was mild in 76% while moderate in 15% cases. HAI grades ranged from mild [161 cases] to moderate [03 cases]. Fibrous portal expansion/short fibrous septae were seen in 35[21.3%] cases. HCV related lived disease is mild in our set up and a long term follow up of these cases is required to assess the progression of disease