ABSTRACT
Objective: To analyse the clinicopathological spectrum of synovial sarcoma cases presenting in our institution. Study Design: Descriptive case series. Place and Duration of study: Armed Forces Institute of Pathology [AFIP] Rawalpindi, from Jan 2010 to Jan 2015
Material and Methods: All cases of synovial sarcoma diagnosed on histopathological examination were recovered from the Armed Forces Institute of Pathology [AFIP] laboratory information management system. The inclusion criteria consisted of optimally processed Haematoxylin and Eosin stained slides. Positive immunohistochemistry for epithelial membrane antigen/cytokeratin and CD99. Both genders were included. Patients' gender, age, tumour size, site, histological subtype, grade, microscopic margin status, depth and stage were noted. The data were analysed using SPSS Version 21. Frequencies and percentages were calculated for qualitative data and the standard deviation and mean for quantitative data
Results: Sixty-seven cases of synovial sarcoma [SS] were included in this study. The mean age of the patients was 35.1 years, with males at 55.2%. The most common site was the lower extremity 41.8%. The average size was 8.5 cm. The most common stage was pT2b [64.2%]. Monophasic histological subtype was more common at 58.2%. Grade 2 tumours were 77.6%. Microscopic positive margins were 30.0%. Specimens that were fragmented or not oriented properly were 33.3%
Conclusion: The clinicopathological spectrum of synovial sarcoma in our institution is similar to that of other parts of the world. This study has highlighted that a significant proportion [33.3%] of resection specimens were fragmented or unmarked; therefore surgical margins could not be evaluated in these cases, increasing the chances of inadequate surgeries
ABSTRACT
Background and Objective: To evaluate usefulness of immunohistochemical marker C-kit [CD117] in differentiating Adenoid cystic carcinoma [AdCC] from Polymorphous low-grade adenocarcinoma [PLGA] in patients of salivary gland carcinomas. AdCC is a malignant salivary gland neoplasm with poor prognosis. PLGA is a salivary gland malignancy with indolent growth pattern. Differentiating between the two entities is a diagnostic challenge. We evaluated the role of C-kit in differentiating the two
Methods: This is a Cross sectional study.Samples of 19 tumors including 12 AdCC and 4 PLGA was evaluated at Department of Histopathology, Armed Forces Institute of Pathology, Rawalpindi from December 2015 to August 2016.Immunohistochemical techniques were used to analyze the level of c-kit expression in AdCC [n = 12], polymorphous low-grade adenocarcinoma [PLGA] [n = 6]. Samples were stained using monoclonal antibody against C-kit. Statistical analysis of the data was done using SPSS version 21
Results: Strong diffuse cytoplasmic reactivity was observed in more than 50% of the tumor cells of AdCC whereas less than 20% of cells showed negative to weak positivity in PLGA. Hence, the difference in the expression of c-kit between AdCC and PLGA was statistically significant [p value <0.002]
Conclusions: CD117 expression itself can be used as a marker in differential diagnosis of salivary gland neoplasms. However, the percentage of the CD117 immunoreactive cells and the staining intensities appeared to be important factors in distinguishing AdCC from PLGA
ABSTRACT
Objective: to determine the immunohistochemical expression of CD10, BCL6 and MUM1 in differentiating diffuse large B cell lymphoma subtypes. Study Design: Descriptive, cross-sectional study
Place and Duration of Study: department of Histopathology, Armed Forces Institute of Pathology, Rawalpindi, from November 2014 to May 2015
Methodology: newly diagnosed cases of DLBCL on HandE stain as well as IHC markers, according to WHO blue book 2008, were included in the study. Patients' gender, age and site of lymphoma were noted. DLBCL subtypes [GCB and activated type or non-GCB] were assessed based on IHC expression of CD10, BCL6 and MUM1 and the results were recorded. The data were analyzed by using computer software program SPSS version 20. Descriptive statistics, frequencies and percentages were calculated
Results: out of 96 patients, 79 [82%] were male and 17 [18%] were female. Mean age was 54.66 +/-16.73 years. Thirty-six [37.5%] cases showed positivity for CD10 and BCL6 both [GCB type], whereas MUM1 was positive in 60 [62.5%] cases [non-GCB type or activated type]. A significant statistical association was seen between expression of IHC markers [CD10, BCL6 and MUM1] and DLBCL subtypes [GCB and non-GCB type, p<0.001]
Conclusion: in Pakistani population, the frequency of non-GCB type expressing MUM1 is 62.5%, which is quite high as compared to western countries. It needs to be further explored, because it represents high-risk subsets in which alternative strategies for diagnosis and management should be planned
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Objective: To determine the frequency of immunohistochemical expression of Human Epidermal Growth Factor Receptor 2 [HER2] in gastric and gastro esophageal junctional adenocarcinoma
Study Design: Cross-sectional study
Place and Duration of Study: Department of Histopathology, Pakistan Naval Ship [PNS] Shifa Hospital Karachi, from Oct 2014 to Oct 2015
Material and Methods: All specimens of gastric and gastroesophageal adenocarcinoma, irrespective of age of patient, histological type and grade of the tumor were included. Poorly fixed specimens and specimens with scanty tumor tissue were not included
Results: Majority of the patients belonged to 51 to 65 years of age group with mean age of 58.58 [SD +/- 5.56] years. Gender distribution showed that 46 [69.6%] were males and 20 [29.33%] were females. Overall frequency of HER2 expression was 38% [n=25] in cases of gastric adenocarcinoma
Conclusion: Expression of HER-2 receptor in gastric adenocarcinoma in this study was 38% and it was associated with histological grade and type of adenocarcinoma. HER-2 more frequently expressed in well differentiated than undifferentiated carcinomas with non-significant p-value i.e. [0.139] and in intestinal type phenotype with significant p-value less than [0.05]
ABSTRACT
Objective: To study the spectrum of rhabdomyosarcoma, diagnosed at Armed Forces Institute of Pathology [AFIP], Rawalpindi [Pakistan]
Study Design: Descriptive study
Place and Duration of Study: AFIP, Rawalpindi from 1st Jan 2009 to 31st Dec 2013
Material and Methods: The study included all the cases diagnosed as rhabdomyosarcoma from 1st January 2009 to 31st Dec 2013. Records of the malignant tumors of soft tissue that presented during this period were analyzed and out of these spectrums rhabdomyosarcoma was studied. The data analysis included the age, gender, site of tumor and histopathological pattern of Rhabdomyosarcoma
Results: A total of 19140 malignant tumors were diagnosed at AFIP Rawalpindi from 1st Jan 2009 to 31st Dec 2013. Out of these, 512 [2.67%] were malignant soft tissue tumors. Out of these 53 cases were rhabdomyosarcoma with an overall frequency of 0.27% of the malignant neoplasm and 10.3% of soft tissue sarcomas. The age ranged from 1-70 years. Out of these 53 cases 36 were males and 17 were females with a male to female ratio of 2.1:1. The most common subtype of tumor seen was embryonal rhabdomyosarcoma n=22 [41.5%]. The age for embryonal rhabdomyosarcoma ranged from 3 to 71 years with median age of 16 years while most of the patients are effected during 1st decade of life [55%]. Out of 20 cases of rhabdomyosarcoma during the first two decades of life 18 [90%] were embryonal rhabdomyosacoma. Thirty cases of rhabdomyosarcoma encountered during the adult life contained only 4 cases [11%] of embryonal rhabdomyosarcoma. The majority of the tumors originated from lower extremities [41%] and in lower extremities most common site was thigh [27%]. A total of 18% of the tumors originated in head and neck region. Second most common type of the tumor was pleomorphic rhabdomyosarcoma n=21 [39.6%] with age range 40 to 78 years and median age of 60 years. Ten cases were reported during 6th and 7th decade of life. Majority of the cases occurred in lower extremities [47.6%] and thigh was the most common site [42%]. Alveolar rhabdomyosarcoma n=6 [11.32%] was the 3rd most common tumor with age range of 15 to 46 years and median age of 29 years. Four cases [67%] occurred in 3rd and 4th decades of life. The most commonly involved region was lower extremities [50%] followed by upper extremities [17%]. Among lower extremities again thigh was the most common site [33%]. Anaplastic rhabdomyosarcoma n=4 [7.54%] was the least common type of rhabdomyosarcoma with age range of 12 to 45 years and median age of 31 years. Three cases [75%] occurred in the 3rd and 4th decade of life. Two cases [50%] occurred in lower extremities and one case [25%] in the upper extremity
Conclusion: Embryonal rhabdomyosarcoma is the most common rhabdomyosarcoma during the first two decades of life. While pleomorphic rhabdomyosarcoma is the most common rhabdomyosarcoma encountered in adults. Extremities are most common site of involvement by rhabdomyosarcoma followed by the head and neck and abdomen in our setup. This finding needs to be evaluated by a larger scale study
ABSTRACT
Objective: To determine the frequency of immunohistochemical expression of epidermal growth factor receptor [EGFR] and c-KIT in triple negative breast cancer [TNBC]
Study Design: Descriptive, cross-sectional study
Place and Duration of Study: Armed Forces Institute of Pathology [AFIP], Rawalpindi, from January to December 2014
Methodology: Fifty cases of triple negative breast cancer diagnosed on immunohistochemistry were included in the study
Patients' gender and age were noted. Immunohistochemistry for EGFR and c-KIT were applied and the results were recorded. The data were analyzed by using computer software programme SPSS version 19. Descriptive statistics, frequencies and percentages were calculated
Results: Out of 50 patients of TNBC, all patients were females. The ages of the patients ranged between 30 and 80 years with an average age of 48.9 years and standard deviation of +/- 10.0. Out of 50 cases, 29 cases [58%] were positive for EGFR while 15 cases [30%] were positive for c-KIT. Thirteen cases [26%] were positive for both EGFR and c-KIT
Nineteen cases [38%] were negative for both EGFR and c-KIT
Conclusion: EGFR expression was observed in 58% and c-KIT expression was seen in 30% of the cases. The results of EGFR expression are almost similar while those of c-KIT are different from international studies which suggest immunohistochemical differences between the studied populations
ABSTRACT
A 37-year female presented with complaint of lower abdominal pain and amenorrhoea to the Military Hospital, Rawalpindi. Ultrasound of pelvis showed a right adnexal cystic lesion. On investigation, CA-125 was raised. Her MRI scan of pelvis revealed a right adnexal mass of fluid intensity measuring 15.2 x 12.9 x 9.2 cm. Right ovarian cystectomy was performed and the specimen was sent for histopathological examination. Grossly, the mass was cystic in appearance and measured 13.5 x 10 x 10 cm. On sectioning, it was unilocular and filled with turbid material. The cyst wall showed multiple papillary structures along with a nodule measuring 1.1 x 1 cm. Microscopically, the sections revealed borderline mucinous tumour with a sarcoma-like mural nodule composed of spindle shaped cells and epulis-like giant cells. Sarcoma-like mural nodules are rare nodules which are associated with mucinous tumours of the ovary. However, they have excellent prognosis and should not be interpreted as malignant
ABSTRACT
Mature cystic teratoma of ovary is a common benign adnexal tumor in females. Malignant transformation in a mature cystic teratoma of the ovary occurs in only 1 - 2% of cases. Most common malignant transformation is squamous cell carcinoma [70-80% of cases], occurring mostly in postmenopausal women with large sized cysts. Here, we report a case of 46-year lady who presented with pain in lower abdomen. Ultrasound and CT scan revealed complex adnexal mass measuring 16x9 cm. Size and older age of the patients should be regarded as important predictors of malignant transformation in mature cystic teratoma. Adequate sampling followed by histopathological examination has important role in diagnosis of such rare tumor
ABSTRACT
To analyze the clinicopathological spectrum of urothelial carcinoma of urinary bladder. Descriptive case series. Armed Forces Institute of Pathology [AFIP], from 1[st] January 2012 to 31[st] October 2013. All cases of urothelial carcinoma were retrieved from AFIP tumour registry. Age, gender, histological type, grade and variant of tumour was noted. The data was analyzed by using computer software program SPSS version 19. Descriptive statistics and frequencies were calculated for age, gender, histological type, grade and variants. A total of 541 cases of urothelial carcinoma were included in the study. The age at presentation ranged from 22 to 94 years with median age of 63.56 +/- 12 years. A number [61%] of the cases were from 6[th] to 8[th] decade of life. The gender distribution showed 92.8% of patients [n=502] were males and 7.2 % [n=39] were females with male to female ratio of 12.9: 1. The most common histological type was papillary urothelial carcinoma; present in 493 cases [91.1%] followed by nonpapillary urothelial carcinoma; 48 cases [8.9%]. Among papillary urothelial carcinomas, 302 cases [61.3%] were high grade and 191 cases [38.7%] were low grade. Among nonpapillary urothelial carcinomas, all were high grade and variant histology was observed in all cases. The variants included squamoid differentiation which was present in 27 cases [56.3%], nested variant in 8 cases [16.7%]. The sarcomatoid, undifferentiated and clear cell variants in 3 cases [6.3%] each, micropapillary variant in 2 cases [4.2%], lymphoepithelial-like and plasmacytoid variant in 1 case [2.1%] each. Urothelial carcinoma is more common in males. Most of the tumours are papillary urothelial carcinomas. Most of them are high grade and pure urothelial carcinomas. A number of histologic variants are also recognized. Among them, squamoid differentiation is the most common variant histology
Subject(s)
Humans , Middle Aged , Adult , Aged , Aged, 80 and over , Female , Male , Carcinoma, Papillary , Urinary Bladder/pathology , Retrospective StudiesABSTRACT
The objective of this study is to determine the HER-2/NEU expression by imrnunohistochemistry in Urothelial carcinoma of urinary bladder. Cross sectional study. Department of Histopathology, Armed Forces Institute of Pathology [AFIP], Rawalpindi, from 15[th] August 2011 to 14[th] August 2012. Bladder cancer tissue specimens from 70 patients were selected in one year as per the inclusion criterion. Immunohistochemistry results were interpreted on light microscope using high power field objective and Her 2/ neu expression was recorded. Mean and standard deviation were calculated for quantitative variables. Frequencies and percentages were calculated for qualitative variables. Out of 70 cases of urothelial carcinoma, Her 2/ neu expression was found to be positive in 24 cases, out of which 5 were of low grade and 19 were of high grade while 16 were invasive and 8 were non invasive. The expression of Her 2/neu was detected in 16 out of 33 cases of invasive carcinoma [48.4%] and in 8 out of 37 cases of non invasive carcinoma [21.6%]. As far as grade is concerned, Her 2/ neu was found to be positive in 5 out of 30 cases of low grade carcinoma [16.6%] and 19 out of 40 cases of high grade carcinoma [47.5%]. The expression of Her 2/neu has been shown to be related to the stage and grade of urothelial carcinoma. Her 2/neu expression is increased in high grade and invasive urothelial carcinoma. Molecular targeted therapy targeting Her 2/neu can be beneficial in patients after assessment of Her 2/neu expression
Subject(s)
Humans , Male , Female , Receptor, ErbB-2 , Immunohistochemistry , Cross-Sectional Studies , UrotheliumABSTRACT
Appendicitis is a common diagnosis, but is by no means a simple one to establish. It is impractical to have a definitive preoperative diagnosis, which leads to an appreciable rate of negative appendicectomy as reported in world literature varying from 20-40% with its morbidity around 10%. This retrospective study investigated the value of clinical assessment and medical imaging [ultrasonography] for patients with suspected appendicitis. Negative appendicectomy rate and appendiceal perforation with or without medical imaging were used as end points for this investigation. This study reviewed all patients admitted in Sheikh Khalifa Bin Zaid Hospital with suspected acute appendicitis. The patient cohort was identified from the unit registry and review of medical records. The medical records were analysed, and the outcomes of patients were followed up. Between June 2010 to June 2012, 375 patients' medical records were audited. These included 56.3% males and 43.7% females. The negative appendicitis rate was 7.2% and appendiceal perforation rate was 5.3%. Ultrasound was done in 103 [27.4%] patients in whom diagnosis of appendicitis was doubtful. Medical imaging had a 50% prediction rate for acute appendicitis, 40% false-negative rate, and 10% false-positive rate. Overall, the prediction rate for appendicitis by clinical assessment supplemented by laboratory tests and medical imaging at clinician's discretion was 92.8%.Despite studies advocating routine use of medical imaging for patients with suspected acute appendicitis, this study showed that the clinical evaluation is still paramount to the management of patients with suspected acute appendicitis before considering medical imaging.
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To determine the frequency of diabetes mellitus and viral hepatitis B and C among cataract patients of Saudi origin. Record of ninety nine patients of Saudi origin who were operated for age related cataract was analyzed to note frequency of Diabetes mellitus and viral hepatitis B and C. This was besides the mandatory lab screening for HIV and sickle cell disease. Twenty nine percent patients were diabetics. Ten patients were reactive to viral hepatitis screening with six positive for hepatitis B surface antigen and four positive to anti Hepatitis C virus antibodies. Pre-op screening for common diseases should be mandatory for safety of patients and medical staff
Subject(s)
Humans , Middle Aged , Aged , Male , Female , Hepatitis C/epidemiology , Hepatitis B/epidemiology , Diabetes Mellitus/epidemiology , Hospitals, Military , PrevalenceABSTRACT
To find the prevalence of HBV and HCV infection among healthy adult males seeking recruitment in Pakistan Rangers [Punjab]. Healthy adult males 18- 25 years old across Pakistan with no previous history of jaundice or any clinical symptoms recruited in Pakistan Rangers [Punjab]. After having cleared the physical efficiency tests, blood samples were collected in gel clot containers and appropriately labeled. HBsAg and anti-HCV antibodies were tested by rapid immuno chromatographic method [Excel]. All the positive samples were confirmed by Abbott Murex enzyme immuno assay version III [HBsAg] and Murex enzyme immuno assay version IV [anti HCV]. During the study period 2960 individuals belonging to the province of Punjab were screened for hepatitis B and C virus infections. The study carried out on the recruits from Punjab showed 101 [3.4%] positive for HBsAg and 201 [6.79%] for anti HCV on screening. Ten individuals found positive for HCV on screening left the training and did not give samples for confirmation by the ELISA method. On confirmation by Murex enzyme immuno assay version III and IV [for HBsAg and anti-HCV] of the remaining 96 [3.24%] were positive for HBsAg and 160 [5.4%] for anti HCV. The specificity of immuno chromatographic methods for HBsAg and anti HCV was calculated by the Murex Version III and IV EIAs respectively the gold standard was to found be 99.8% and 98.9% respectively. District wise prevalence of HBsAg varied from 0.64% [Chakwal] to 5.6% [Sargodha] and that of anti-HCV from 1.1% [Jhelum] to 12.6% [Sahiwal]. The prevalence of anti HCV was also found to be high in Sahiwal [12.6%], Okara [11.33%], Faisalabad [10.85] and Jhang [8.9%]. This study reveals the overall prevalence of HBsAg to be 3.24% and that of anti HCV 5.4%