Effectiveness of vascular markers [immunohistochemical stains] in soft tissue sarcomas

Objective: To ascertain the effectiveness of IHC markers of vascular origin like CD31, CD34, FLI1 and ERG in vascular soft tissue sarcomas including angiosarcomas, Kaposi sarcomas, epithelioid hemangioendothelioma and a non-vascular soft tissue sarcoma [Epithelioid sarcoma]. Study Design: Descriptive study. Place and Duration of Study: Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, from 2011 to 2017

Methodology: Diagnosed cases of angiosarcomas [n=48], epithelioid hemangioendothelioma [n=9], Kaposi sarcoma [n=9] and epithelioid sarcoma [n=20] were selected. Immunohistochemical staining as performed on formalin fixed paraffin embedded sections. The sections were stained for the following markers: CD34 [VENTANA clone Q Bend 10], CD31 [Leica clone 1 A 10], FLI1 [CELL MARQUE clone MRQ-1] and ERG [CELL MARQUE clone EP111]

Results: A complete panel of CD34, CD31 and ERG was applied on 8/48 cases of angiosarcomas with triple positivity in 6 cases. Eight cases showed positivity for only CD31 and ERG and 2 cases showed positivity for only ERG. A complete panel of CD34, CD31 and ERG was applied on 3/9 cases of epithelioid hemangioendothelioma with positivity for all markers in 2 cases. Combined positivity for ERG and CD34 was seen in 2 cases and on 4 cases only CD31 immunohistochemical was solely applied with 100% positivity. FLI1 was not applied on any case. Among 9 cases of Kaposi sarcoma, ERG, CD34 and CD31 in combination were applied on only 1 case with triple positivity. Remaining cases show positivity for either CD34, CD31 or FLI1. Majority of cases of epithelioid sarcomas were diagnosed on the basis of cytokeratin and CD34 positivity with loss of INI1. The other vascular markers showed negativity in all cases

Conclusion: Among these four markers, ERG immunohistochemical stain is highly effective for endothelial differentiation due to its specific nuclear staining pattern in normal blood vessel endothelial cells [internal control] as well as neoplastic cells of vascular tumors and lack of background staining

Clinicopathological study of solid pseudopapillary tumor of pancreas

Objective: To study the morphological and immunohistochemical features of solid pseudopapillary tumor of pancreas. Study Design: Retrospective study. Place and Duration of Study: Shaukat Khanum Memorial Cancer Hospital and Research Centre from Jun 2016 to Mar 2017

Material and Methods: Sixty-four patients [n=64] including 61 females and 3 males with pathological diagnosis of solid pseudopapillary tumor were selected from archives of Shaukat Khanum Memorial Cancer Hospital and Research Center for the period of 2000-2017. For the sample selected, their morphological features and immunohistochemical profile were reviewed and analyzed. The morphological features are considered as gold standard for the diagnosis

Results: The mean age was 33 years [range 8-50 years]. Immunohistochemical stains were performed on formalin fixed paraffin embedded section of 55 cases. Pancytokeratin was performed on 8 cases, out of which only 2 cases showed positivity. CD10 was performed on 14 cases, out of which only 12 cases showed positivity. Neuron specific enolase [NSE], CD56, vimentin, progesterone receptor [PR] and beta catenin were performed on 8, 5, 3, 13 and 16 cases respectively and showed positivity in majority of cases. Neuroendocrine markers [chromogranin and synaptophysin] were performed on 25 and 6 cases, from which it showed weak positivity in 3 cases. CD99 was performed on 19 cases and showed characteristic dot like staining

Conclusion: Among the immunohistochemical stains, CD99 had a specific dot like staining pattern and was used as a first line marker in diagnosis

study of the spectrum of homicide in rawalakot, AJ and K

Objective: To find out the incidence of homicide, age and gender distribution of victims, type of weapons used and the most frequently targeted regions of body in victims of homicide in Rawalakot, Azad Kashmir, AJ and K

Study Design: Retrospective study

Place and Duration of Study: This study was conducted at SKBZH/CMH Rawalakot, AJ and K from Jan 2012 toMay 2015

Materials and Methods: Performa was designed for retrospective cohort study. The study was conducted in the mortuary SKBZH/CMH Rawalakot. Consent was implied and relevant information was gathered from the available record. Out of all the cases autopsied during this three and a half year period, 66 were homicidal in nature. Rest of the cases were excluded

Results: Male to female ratio was 5.6:1.Maximum number of victims belonged to 21-40yrs agegroup. Singleinjury was present in 85% [n= 56] cases while 15% [n=10] cases had multiple injuries. The most common region of the body targeted was chest 31.8%[n=21] followed by limbs, head and neck and abdomen .The most common tool used to kill was firearm in 75.8% [n=50] cases followed by sharp edged weapon in 18.2% [n=12] cases and others [including RTA, electrocution etc.] in 6.1%[n=4]cases

Immunohistochemical expression of CD-10, BCL-6 and MUM-1 antibodies and immediate clinical response in patients of diffuse large B-cell lymphomas after six cycles of chemotherapy

To determine the expression of CD-10, BCL-6 and MUM-1 in patients with diffuse large B-cell lymphoma [DLBCL] and its association with immediate clinical response after six cycles of CHOP chemotherapy. Analytical study. Armed Forces Institute of Pathology [AFIP], Rawalpindi in collaboration with Nuclear medicine, Oncology and Radiotherapy Institute [NORI], Islamabad from September 2010 to September 2011. CD-10, BCL-6 and MUM-1 antibodies were applied on cases diagnosed as DLBCL. Immediate clinical response was noted after 6 cycles of chemotherapy with the help of oncologist and divided into complete response, partial response, stable disease and relapse/ progression. Patient's age, results of expression of CD-10, BCL-6 and MUM-1 and results of immediate clinical response to chemotherapy were noted. Regarding analysis of prognostic markers [CD-10, BCL-6 and MUM-1], chi-square test was used for immediate clinical response to chemotherapy in DLBCL. CD-10 was positive in 40% cases, BCL-6 in 58.7% cases and MUM-1 was positive in 46.7% cases. About 41.3% of patients showed complete response, 10.6% partial response, 17.3% stable disease and 30.8% showed relapse/progression. CD-10 expression in DLBCL was associated with better immediate clinical response [p = 0.011] whereas MUM-1 expression in DLBCL was associated with poor immediate clinical response [p < 0.0001]. However, there was no statistically significant association of BCL-6 with immediate clinical response [p = 0.22]. DLBCL shows expression of CD-10, BCL-6 and MUM-1 in nearly fifty percent of the cases. CD-10 is associated with good whereas MUM is associated with poor response. However, there was no association of BCL-6 with immediate clinical response

Association of various factors with infantile colic

To assess the association of various factors with infantile colic. This case control study was done at Government Sardar Begum Hospital Sialkot in the period from January 2011 to December 2011. Infants visiting the outpatient department for colic were included in the study. For every infant data was collected on structured Proforma for various factors associated with infantile colic. Cases of colic were identified by applying Wessel's criteria, calculations were made using SPSS version 19, P-value, odds ratio and 95% Confidence interval were calculated and significance of various factors were evaluated. Out of the 735 infants who visited the outpatient department for colic, only 125 infants that fulfilled Wessel's criteria were included in the study. Similarly 125 age matched controls were also selected. The factors that were found significantly associated with infantile colic include, stress during pregnancy, being first born, breast feeding, improper feeding/burping techniques, GER, umbilical/inguinal hernia and disturbed sleep pattern. However no statistical significance was found for the following factors, illness in pregnancy, nutritional status, mode of delivery, educational status, maternal pulses intake, socioeconomic status of family, parental age, birth weight and gestational and stool frequency. Reducing the maternal stress during pregnancy, educating the first time mother about handling of infant may be helpful in reducing colic in infants

Atherosclerotic lesions in hypertensive subjects -a human autosy study

To assess the incidence and severity of atherosclerotic lesions in hypertensive subjects in our population. Prospective descriptive observational study. Mortuary of Forensic Department, King Edward Medical University Lahore and Pathology Department of Allama Iqbal Medical College Lahore. This study was completed in one and a half year. A total of 130 human autopsies were carried out in the mortuary of King Edward Medical University Lahore. Heart, aorta and its major branches were collected. History was taken from the close relative of deceased for hypertension. One to four areas of tissue were taken for each artery and aorta for histological examination. The section were stained with Haemotoxylin and Eosin stain. Different special stains were also performed on all cases to differentiate different components of atherosclerotic lesions. The fibrolipid plaques, complicated lesions and calcified lesions were present in a predominant number of cases in aorta and its major branches, except the fibrolipid plaques were less dominant in the right coronary artery, the complicated lesions were seen less frequently in the right coronary artery and the left renal artery and the calcified lesions were observed less dominantly in the thoracic aorta, anterior descending branch and circumflex branch of left coronary, innominate artery, coelic artery, superior mesenteric artery, inferior mesenteric artery and renal arteries. The calcified lesions were absent in the right coronary artery. This study although preliminary but basic and observational in nature indicates the considerable severity of raised atherosclerotic lesions in hypertensive subjects in our population

Atherosclerosis in relation to diabetes mellitus

To access the relationship of different categories of atherosclerotic lesions to diabetes mellitus and also in relation to age and sex. Prospective, Randomized and Comparative Study. Forensic Medicine and Toxicology Department, KEMU and AIMC, Lahore from April 2006 to Dec. 2007. 130 autopsies were performed the age range was 8 to 85 years. The autopsies were done at random. Heart, aorta and its major branches were collected from dead bodies. The history of diabetes mellitus was taken from the close relatives of the deceased. The processing of cases was done in the Pathology Department of AIMC, Lahore. The slides were stained by haematoxline and eosin. Special stains also performed, The fatty streaks were present in predominant number of cases in aorta and its major branches except in the right coronary artery where they were seen less dominantly. The fibrolipid plaques, complicated and calcified lesions were present in a predominant number of cases in aorta and its major branches except the calcified lesions were present less dominantly in the thoracic aorta circumflex branch and renal arteries. The complicated lesions were not seen in the right coronary artery and calcified lesions were absent in the right coronary artery, innominate artery and superior mesenteric artery in diabetics. In the study it was concluded that there is definite relationship between diabetes mellitus and different categories of atherosclerotic lesions. The age and sex relationship of atheroscleroses is also well indicated in this study

Analgesic effect of sucrose observed during heel prick in healthy neonates

To assess pain response during heel prick and compare analgesic effect of oral sucrose with placebo in response to pain associated with this procedure in healthy neonates. Randamoized controlled study Neonatal Unit Combined Military Hospital Multan from December 2006 to June 2007. This study was conducted on 60 healthy full term neonates with postnatal age 1-7 days who were assessed for pain response after heel prick. They were randomized into two groups. Newborns in group A were given 2ml 25% sucrose solution and group B neonates received 2ml sterile water as placebo 2 minutes before heel prick procedure. Pain was assessed by Premature Infant Pain Profile [PIPP] score and total duration of first cry. Increase in heart rate and decrease in oxygen saturation along with behavioral changes were observed in significant number of newborns who received placebo [group B]. While significant reduction in PIPP score and total duration of first cry was noted in neonates who were given oral sucrose [group A.] Perception of pain decreased significantly with oral sucrose. Sucrose can be used as safe and effective analgesic for minor procedure related pain