Clinicohematological parameters and outcomes in a cohort of chronic lymphocytic leukemia patients with Deletion 17p from Pakistan

BACKGROUND: Chronic lymphocytic leukemia (CLL) exhibits profound heterogeneity in its clinical course. Its clinicohematological and cytogenetic features play a significant role in determining the clinical course and in predicting the treatment response and prognosis. In this context, 17p deletion is known to predict a poor prognosis, as these cases are refractory to conventional therapy. This study aimed to evaluate the clinicohematological characteristics, outcomes, and prognostic factors among CLL patients with and without del 17p in Pakistan. METHODS: This prospective observational study was conducted at the Department of Haematology, Armed Forces Institute of Pathology (Rawalpindi, Pakistan) between January 2013 and December 2017. Patients were diagnosed based on the International Workshop on Chronic Lymphocytic Leukaemia IWCLL criteria, their clinicohematological parameters were recorded, and cytogenetic analyses were performed. The time from diagnosis to treatment and the 2-year overall survival rate were also evaluated. RESULTS: We evaluated 130 CLL cases, including 24 patients (18.5%) with del 17p, who included 18 men (75%) and 6 women (25%). The median age was 68 years. Binet stage C was detected at the presentation in 16 patients (67%). Treatment was administered to 14 patients (70%) at a median interval of 11 months (range, 0–28 mo) after diagnosis. The overall response rate was 64.3%, the median event-free survival was 9 months (range, 1–23 mo), and the 2-year overall survival rate was 65%. CONCLUSION: Del 17p is relatively common in Pakistan, and patients harboring this deletion had poor treatment response and survival outcomes.

Spectrum of rhabdomyosarcoma-A study of 53 cases at Armed Forces Institute of Pathology, Rawalpindi [Pakistan]

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

Calretinin expression in the differential diagnosis of ameloblastoma and keratocystic odontogenic tumour

To determine calretinin expression by immunohistochernistry in ameloblastoma and keratocystic odontogenic tumors [KCOT] and to document the use of calretinin as a differentiating marker between the two lesions. A cross sectional study conducted on previously diagnosed cases of ameloblastoma and Keratocystic odontogenic tumour. Armed forces Institute of Pathology, Rawalpindi Pakistan and duration was one year. [Sep 2009 - Aug 2010]. Twenty cases each of Ameloblastoma and KCOT were retrieved from the record files along with their paraffin embedded blocks. Histological features of all the cases were reviewed on freshly prepared slides and a fresh diagnosis made regardless of the previous diagnosis. The immunohistochemical marker, Calretinin, was applied on both types of cases using the avidin-biotinylated peroxidase complex method.The results were interpreted. In the cases of Ameloblastoma the epithelial tumour nests showed positivity for Calretinin expression. In 85% cases; intense and diffuse staining was observed in more than 80% of the stellate reticulum like cells while 15% cases showed focal and moderate staining patterns. On the other hand KCOT showed contrary results as none of epithelial lining expressed positive staining for Calretinin, [p<0.001]. Calretinin can be used as a useful marker for Ameloblastoma and can be used to differentiate KCOT from Ameloblastoma

Rapid mycobacterium tuberculosis dna detection on fine needle aspirates from extra pulmonary lymph nodes

To evaluate the diagnostic efficacy of two rapid methods i.e. Mycobacterium tuberculosis [MTB] Polymerase Chain Reaction [PCR] on Fine Needle Aspiration [FNA] samples by comparing with cytology of respective site sample. Cross-sectional comparative study. Department of Microbiology, Armed Forces Institute of Pathology [AFIP], Rawalpindi, Pakistan, from July 2010 through November 2013. A total of 105 extra pulmonary lymph nodes aspirates obtained through fine needle aspiration were processed. Cytology and PCR were done on each specimen. Cytology was taken as gold standard. Out of the total 105 samples, 71 [67.6%] were positive for the MTB PCR while 34 [32.4%] showed negative status. According to FNA cytology [FNAC] results, 72 [68.6%] cases were positive for the disease while 33 [31.4%] were negative. Sensitivity of PCR was 90.3%, specificity 81.8%, positive predictive value [PPV] 91.5%, negative predictive value [NPV] 79.4%, with diagnostic accuracy of 87.6%. Area under the curve was 0.860 [p < 0.001]. PCR is a sensitive tool for detection of MTB on FNA samples from EPTB cases. The results are available within few hours which is helpful for the clinicians to initiate therapy

CD 10 expression intensity in various grades and stages of urothelial carcinoma of urinary bladder

To evaluate CD 10 expression in urothelial carcinoma of the urinary bladder and the association of immunohistochemical [IHC] CD10 expression intensity with grade and stage. Study Design: Descriptive cross-sectional analytical study. Armed Forces Institute of Pathology, Rawalpindi, from January to December 2011. Methodology: Fifty consecutive cases of urothelial bladder carcinomas, obtained through transurethral resections, were included in this study. Hematoxylin-eosin [HE] stained sections from each case were re-evaluated histopathologically according to WHO 2004 grading system. The TNM system was used for pathologic staging. On selected slides IHC CD10 marker was applied and a semiquantitative scoring for its expression based on the percentage of positive cells and intensity was performed. Data was entered and analysed on SPSS version 17. Fisher's exact test was used to compare grades, stages of urothelial carcinoma with CD 10 expression and age groups. P < 0.05 was taken as level of significance. Results: Urothelial carcinoma was more common in males. The male to female ratio was 9:1. The older patients > 50 years had higher grade and stage as compared to the younger patients. All cases of high grade urothelial carcinoma showed higher positivity for CD 10. Twenty cases [86.95%] of high grade urothelial carcinoma were positive with +2 immunostaining while 3 cases [13.04%] were positive with +1 staining. None of the tumors of stage pTa was positive for CD 10 expression. Of all patients with stage pT 1 tumor, 1 case [5.3%] was CD 10 negative and 17 cases [89.9%] were CD 10 positive having +1 staining with 5 - 50% staining and 1 case [5.3%] had +2 staining with more then 50% expression. Out of all patients with stage pT 2, no tumor was CD 10 negative, 3 [13.6%] patients were CD 10 positive with +1 staining and 19 [86.4%] with stage pT 2 tumor had stained positive with +2 staining. CD 10 expression was greater in high grade and invasive urothelial carcinomas; it may be associated with tumor progression in bladder cancer pathogenesis

E-cadherin expression, a valuable predictor of invasiveness in histological grades of oral squamous cell carcinoma

The aim of this study was to evaluate E-Cadherin expression in oral squamous cell carcinoma [OSCC] with its relation to histological grades. It was a quasi experimental study in which sixty diagnosed cases of oral squamous cell carcinoma were selected by purposive sampling technique. Fresh sections were prepared and re-diagnosed for relative histological grades by H and E staining, regardless of their previous diagnosis. E-Cadherin expression was assessed in terms of Intensity and Site of staining and its expression was recorded. The collected data were analyzed by SPSS version 17. The differential grades observed in 60 cases both with H and E and E-Cadherin staining methods were compared which showed a highly significant association, P-value < 0.001. A strong membranous E-Cadherin expression was observed in cells of well differentiated squamous cell carcinoma, which changed to heterogeneous [both membranous as well as cytoplasmic expression] in moderately differentiated SCC and became weak cytoplasmic to absolute negative in poorly differentiated OSCC. Intensity of E-Cadherin expression was also observed to be reduced, P-value < 0.001, with the advancing histological grades of oral squamous cell carcinoma. It was concluded that E-Cadherin expression provides accurate details of tumour behaviour at all levels in a given section which can be used to predict the prognosis of the disease more accurately

Second-opinion histopathology - a study of 142 cases at armed forces institute of pathology [AFIP], Rawalpindi, Pakistan

To assess the histopathological diagnosis made on the cases sent for second opinion to the Department of Histopathology. A descriptive study. Department of Histopathology AFIP, Rawalpindi, Pakistan from July 2010 to April 2011. During the study period, 142 cases were received for second opinion by the department. The demographical details of the patients were entered in a profroma. After initially seeing the H and slides, immunohistochemical and special stains were applied where required. The initial diagnosis and review diagnosis were then analysed. During the study period, 142 cases were analysed, 81 were male and 61 female patients. There was wide age range, from 2 months to 90 years. Out of the total 22 [15.5%] were reviewed for benign conditions and 120 [84.5%] were malignant. Majority of cases were from lymphoreticular system. In 72 [50.7%] cases diagnosis was changed on review out of which 9 were benign conditions and rest malignant. Out of the 63 malignant 27 cases and 3 out of 9 benign cases, were those where change in diagnosis was such that it changed the treatment pattern. In 12 cases the review diagnosis was changed from benign to malignant and vice versa. Getting second opinion on surgical biopsy material is very important part of treatment, particularly in our set up, where all the laboratories are not fully equipped.

Paraffin-based immunohistochemistry in the evaluation of glomerular diseases in renal biopsies

To determine sensitivity and specificity of paraffin-based immunohistochemistry in the evaluation of glomerular diseases in renal biopsies using immunofluorescence as gold standard. Cross-sectional analytical study. Department of Histopathology, Armed Forces Institute of Pathology, Rawalpindi, from August 2008 to August 2009. Seventy renal biopsy specimens fulfilling the inclusion criteria for light microscopy and immunofluorescence during the study period were evaluated. Antibodies to immunoglobulins [IgG, IgA, and IgM] and components of complement system [C3] were applied on 70 formalin-fixed paraffin-embedded renal biopsy specimens previously classified by means of light microscopy and immunofluorescence [IF]. Staining for these antibodies was recorded as positive and negative for immunohistochemistry [IHC] and IF in paired proportions presuming IF as gold standard test. The sensitivity, specificity, positive predicitive value and negative predicitive value of individual antibody were calculated. Of 70 patients, mean age was 33 +/- 18 years ranging from 2 to 80 years. Forty five [64%] were males and 25 [36%] were females. The sensitivity, specificity and predictive values of individual antibodies to IgG, IgA, IgM and C3 were very low and generally in the range of 40 - 60%. The sensitivity, specificity and predictive values of immunohistochemistry on formalin-fixed paraffinembedded renal biopsy specimens were very low and therefore, not suitable for evaluation of renal biopsies in currentcircumstances

Clinicopathdlogicai of Clinicopathological study of extranodal Non-Hodgkin Lymphoma [NHLS] at Armed Forces Institute of Pathology [AFIP] Pakistan

To evaluate the Clinicopathological analysis of extranodal Non-Hodgkin Lymphoma [NHLs] reported in Armed Forces institute of Pathology [AFIP] Rawalpindi, Pakistan. Record of a total of 206 cases of extranodal NHLs diagnosed between January 2009 to December 2010 was retrieved from AFIP tumour registry. Basic epidemiological data regarding each case was collected from the request forms. The specimens were received in 10% formal saline. Gross examination of surgical specimens was performed arid recorded on a proforma. The material was processed under standardized conditions for paraffin embedding. The sections were stained with hematoxylin and eosin [H/E]. Immunohistochemistry panel was applied for the categorization of the lymphomas according to the 2008 WHO guidelines. Data was entered and analysed on SPSS version 14. Out of 206 cases, 147 [71.3%] were males and 59 were females [28.6%]. Male to female ratio was 2.4:1. The age ranged between 7-99 years. The most commonly affected age group was the 5[th] decade with 40 cases [19,4%], The most commonly involved site was head and neck, 85 cases [41.2%], followed by the GIT, 61 cases [29.6%]. Diffuse large B-cell lymphoma [DLBCL], was the most common histologic type, 165 cases [80%].Diffuse large B-cell lymphoma is the most common extranodal Non Hodgkin lymphoma, in our population

Pulmonary alveolar proteinosis [PAP] - a rare entity

Pulmonary alveolar proteinosis [PAP] is a rare disorder characterized by intra-alveolar accumulation of lipoproteinaceous material and cellular debris. We report a case of 48 years old male who presented with 3 months history of severe dyspnea, productive cough, chest pain and weight loss. His pulmonary function tests revealed severe restrictive lung disease. A Video-Assisted Thoracoscopic Surgery [VATS] lung biopsy was taken and the specimen was sent to the Histopathology department of Armed Forces Institute of Pathology. On the basis of morphological features it was diagnosed as pulmonary alveolar proteinosis

Patterns of fatal head injuries due to road traffic accidents autopsy findings at AFIP Rawalpindi, Pakistan

To analyze the antopsy findings in cases of fatal head injuries due to road traffic accidents. Descriptive Study. Armed Forces Institute of Pathology Rawalpindi from 2004 to 2008. The present study was conducted to ascertain the patterns of fatal head injuries due to road traffic accidents as documented during autopsies performed at AFIP, Rawalpindi during the five years period [2004-2008]. Data were analyzed using SPSS version 14. Mean, median and mode were calculated for quantitative variables 'like age and hospital stay. Frequencies and percentages were calculated for qualitative variables like time of accident, pattern of head injury, skull bones fractured, and other associated injuries, passenger status of deceased and duration of hospital stay. Out of 550 postmortem cases received during the study period, 57 [10.4%] deaths were due to head injuries. The age ranged from 19 to 51 years with mean age of 35.6+ 7.9 years. Most [50%] of the deaths occurred in 4th decade and during daytime 34 [59.6%]. Majority of subjects died on spot 40 [70.1%]. Most of the deceased suffered from more than one compartment hemorrhage 30 [52.6%] and multiple skull bone fractures 24 [42.1%]. November was the month in which most of the deaths occurred 13 [23.1%] followed by September 7 [17.5%]. Majority 36 [63.1%] of subjects were traveling as passengers. Head injury is one of the most frequent causes of death in road traffic accidents. Most of the deaths occur on spot before any life support can be given to these subjects. The pattern of skull fractures observed, was quite comparable to other studies. It indicates that road traffic accidents lead to similar kinds of fatal head injuries throughout the world. The frequencies of such injuries are more frequent in developing world due to the lack of traffic safety regulations

Clinicopathalogical analysis of benign salivary gland tumours: a study of 242 cases at AFlP Rawalpindi [Pakistan]

Objective: to analyze the clinicopathological aspects of benign salivary gland tumors. Materials and Methods: This descriptive case series study was carried out from Jan 2003 to Dec 2009 at Armed Forces Institute of Pathology Rawalpindi, [Pakistan]. All cases of benign salivary gland tumors were reviewed and their diagnoses were reconfirmed. The data regarding all the major and minor salivary gland tumor was analyzed using computer soft ware program SPSS [version 17]. The descriptive statistics and frequency was calculated for type of tumors, age, gender, site and size. Association of these parameters with the type of tumor was calculated by using chi square test. Results: the most common histological tumor type found was pleomorphic adenoma, followed by Myoepithelioma. All these cases presented between 12 and 85 years of age [mean 39.7 +- 16.91] mostly in the 3rd and 4th decades of life with 48.7% males and 51.3% females respectively. The most frequent site involved by these tumors were parotid gland [66.5%]. Submandibular gland, minor salivary glands of palate and lip were the other sites involved, but none of the tumor was found in sublingual gland. The tumor size ranged between 0.4 to 18 cm with maximum variation in Pleomorphic adenoma and myoepithelioma. Conclusion: benign salivary gland neoplasm are more common than their malignant counterparts. They occur mostly in 3rd and 4th decade. Parotid gland is the most common site and pleomorphic adenoma remains the most common bengin salivary gland neoplasm followed by myoepithelioma.

study of fine needle aspiration cytology [FNAC] appearance of salivary gland tumors

To analyse the Fine Needle Aspiration Cytology [FNAC] appearance of salivary glands tumors diagnosed at AFIP Rawalpindi. The study was carried out in the Histopathology department of AFIP. A total of 95 patients were selected from January 2009 to December 2010. All the patients diagnosed as salivary gland tumors were included in the study. The FNA was performed on these patients and the material was spread on slides. These slides were then stained with Hematoxylin/Eosin and Haema color [Modified Giemsa Stain]. Routine light microscopy was performed on these cases and diagnosis was made. The data analysis was performed using SPSS version 14. The study included 95 patients with salivary gland swellings. There were 50 [60%] male and 45 [40%] female patients with an age range of 13-75 years. Pleomorphic adenoma was the most common diagnosis, 48 cases [47.8%], followed by Mucoepidermoid Carcinoma 10 cases, and Adenoid Cystic Carcinoma 7 cases. Others tumors included 4 cases of Adenocarcinoma [4.2%], 3 cases of Warthin's tumor [4%], one case each of Squamous cell Carcinoma [0.6%], Oxyphilic cell tumor [0.6%] and Benign Hemangiomatous Lesion [0.6%]. Thirteen cases of malignant neoplasms [15.4%] and 7 cases of benign neoplasms [7.1%] could not be exactly typed. It is concluded that Pleomorphic Adenoma was the most common salivary gland tumor diagnosed on FNAC, followed by Mucoepidermoid Carcinoma and Adenoid Cystic Carcinoma

Morphological characterization of renal tumours according to decades of life: experience at AFIP Rawalpindi, Pakistan

To evaluate morphological characterization of renal tumours according to decades of life and to compare it with other national and international studies. Descriptive study Place and duration of study: The retrospective study was carried out in the Department of Histopathology, Armed Forces Institute of Pathology [AFIP] Rawalpindi during the years 2005 to 2008. Data of 236 nephrectomy specimens diagnosed as renal tumours during the years 2005 to 2008 was retrieved from tumour registry of AFIP, Rawalpindi. The morphological characterization of these tumours according to decades of life was done and compared with the international data. Of 236 cases of renal tumours, 169 [72%] were males and 67 [28%] were females. The mean age of the patients was 50 years [SD=18.5] ranging from 1 to 80 years. The most common histological diagnosis in adults was conventional renal cell carcinoma in 172 [73%] patients followed by papillary renal cell carcinoma in 20 [8.5%] patients. Among children Wilm's tumour was the most common in 21 [9%] of patients. Conventional renal cell carcinoma was most commonly diagnosed in the patients aged between 51 to 60 years [52 cases] where as 17 out of 21cases of Wilm's tumour were diagnosed in the age group of 1 to 10 years. Renal cell tumours are diagnosed in all ages. Conventional renal cell carcinoma and papillary renal cell carcinoma are the most common types in non pediatric age group whereas Wilm's tumor is most common type in pediatric age group. The chromophobe renal cell carcinoma was very rare in our study. Males had a greater incidence as compared to females and incidence of renal tumours has the trend of increase over the years

Gunshot wounds - autopsy findings at AFIP Rawalpindi

To provide information about details of firearm injuries as observed during autopsies performed at the Department of Histopathology AFIP, Rawalpindi, Pakistan. This was a descriptive study. A total of 300 autopsies carried out during the years [Sep 2005 - Dec 2008] were retrieved from the autopsy record of Armed Forces Institute of Pathology, Rawalpindi. Out of these, 28 autopsies were performed after death due to firearm injuries. The variables selected were: age of deceased, time of death, weapon used, number and site of entry and exit wounds, mode of death and distance of the used firearm from the body at the time of gunshot as indicated in circumstantial evidence. Out of total of 300 autopsies, 28[9.33%] died of gunshot injuries. Most deaths occurred in the 3[rd] decade [67.9%]. Most of the subjects had single [60.7%] entry wound while half had a single [50%] exit wound. Most of the entry wounds [60.7%] had diameter < 2cm and exit wounds [35.7%] had a maximum diameter in the range of 2-5cm. Most frequent used weapon was rifle [82.1%]. Anterior chest [n=12] [42.9%] sustained the highest number of injuries. In suicidal deaths, heart and left lung [n= 4] [57.14%] were most commonly hit anatomical site. The weapon was in contact with the body at the time of gunshot in all suicidal deaths. The distance was less than ten meters in accidental deaths [7.1%]. Out of 6 [21.4%] homicidal deaths, distance was in the range of 100-200 meters in 3[50%] cases and 300-400 meters in remaining 3[50%] cases. Mode of death [suicidal/homicidal/accidental] could not be determined on postmortem examination only. Circumstantial evidence was necessary in the assistance of these findings. All details of firearm wounds including site, size, shape and appearance of surrounding tissue are required to be documented in autopsy reports to ascertain the exit and entry wounds. The detailed description of wounds provided additional information to ascertain possible distance of weapon from body and help in confirming mode of death

Comparison of heat induced antigen retrieval techniques for immune-histochemical estrogen receptor expression in ductal carcinoma of breast in females

To compare immunohistochemical estrogen receptor expression on formalin-fixed, paraffin-embedded breast carcinoma tissue sections by using regular, extended microwave heating and pressure cooker technique for heat induced antigen retrieval. Quasi experimental study. Department of Histopathology, Armed Forces Institute of Pathology, Rawalpindi, from August 2006 to July 2007. The study was conducted on 40 cases of breast carcinoma diagnosed on histopathology and selected by convenience sampling. One section each of the tumour was separately subjected to regular microwave heating [10 minutes], extended microwave heating [20 minutes] and pressure cooker [heating for 2 minutes after reaching full pressure]. A nuclear staining of > 10% cells with moderate intensity was considered positive and frequency of ER expression by each technique was compared statistically. Sensitivity and specificity of the techniques was determined using pressure cooker technique as the gold standard for this study. Out of 40 cases, ER expression in 24 [60%] cases was seen by microwave regular heating [MRH] and in 30 [75%] cases by microwave extending heating [MEH] technique. Pressure cooker [PC] technique for antigen retrieval demonstrated 34 [85%] cases with ER expression. Out of 16 which were negative by MRH technique, 6 became positive by MEH while 10 became positive by PC. Statistically significant difference in ER expression by PC and MEH technique was seen in comparison to MRH with a p-value of < 0.05. Moreover, 4 cases which were negative by MEH technique turned positive for ER expression by PC. MRH and MEH had 100% specificity but sensitivity was 70.6% and 88.2% respectively taking PC technique as gold standard with diagnostic accuracy of MEH as 90% and MRH as 75%. Pressure cooker antigen retrieval technique is a better method than microwave heating. The increase in duration of heating improves the percentage of positive cells as well as intensity of ER immuno-staining which entitles breast cancer patient to benefit from ER positive treatment protocols which have better prognosis

Steroid hormone receptor association with prognostic markers in breast carcinoma in northern Pakistan

To determine steroid hormone receptor expression and their association with histological prognostic markers and biological profile in female breast carcinoma in Northern Pakistan. Cross sectional, observational. Department of Histopathology, Armed Forces institute of Pathology, Rawalpindi, from January 2004 to December 2007. Female patients belonging to Northern Pakistan with primary operable breast carcinoma were included in the study. Patient's age, microscopic tumour size, tumour grade, lymph node status and biological profile for Her-2/neu status were evaluated. Immunohistochemical expression for ER and PR was determined individually and conjointly for ER+PR+ and ER-PR- while their association with above prognostic markers was determined using the x[2] test for univariate analysis. Out of the 726 cases, there were 657 [90.4%] cases of infiltrating ductal carcinoma with mean age of 48 +/- 12 years and mean tumour size of 4.2 +/- 2.3 cm. Tumour was grade-Il in 65% and lymph node metastases in 71.5% cases with Her-2/neu+ in 28.1%. ER and PR expression was 74.6% and 68.3% respectively. Conjoint expression of ER+PR+ was 456 [62.8%], ER-PR- in 21.2%, ER+PR- in 86 [11.8%] and ER-PR+ in 30 [4.1%] cases. Individually, ER and PR showed positive association with age, lymph node metastasis, tumour grade and inverse association with Her-2/neu. Conjoint expression of ER+PR+ [62.8%] and ER-PR-[21.2%] showed positive association with age, tumour grade, lymph node metastasis and inverse association with Her-2/neu [p < 0.05]. Hormone receptor expression of ER and PR expression is comparable to the West with ER and PR showing inverse association with Her-2/neu and positive association with age, tumour grade and lymph node metastases

Age related association of her-2/neu with prognostic markers in female breast carcinoma

To determine age-related association of Her-2/neu expression with histological and immunohistochemical prognostic markers in female breast carcinoma. Cross sectional, observational study. Department of Histopathology, Armed Forces Institute of Pathology, Rawalpindi, from January 2004 to December 2007. Patients of primary operable female breast carcinoma were categorised as <40 years [pre-menopausal], 41-50 years [pen-menopausal] and > 50 years [post-menopausal] age groups. Histological type, tumour size, tumour grade and lymph node status were determined while estrogen receptor [ER], progesterone receptor [PR] and Her-2/neu expression were evaluated immunohistochemically. Association of Her-2fneu with histological and immnuohistochemical prognostic markers was determined in pre-menopausal, pen-menopausal and post- menopausal age groups using the x[2] test for uni- and multivariate analysis. Out of the 722 patients, 230 [31.9%] were in pre-menopuasal, 221 [30.6%] in pen-menopausal and 271 [37.5%] in post-menopausal age group. Infiltrating ductal carcinoma was the pre-dominant subtype in all the age groups. Mean tumour size was 4.3 +/- 2.3 cm [range 0.4-17 cm] and lymph node metastasis was seen in 310 [70.8%] cases. Her-2/neu showed association with ER in the all the age groups while PR only showed association in the pen-menopausal and postmenopausal women. Her-2/neu showed no association with tumour size, tumor grade and lymph node metastases in pre-menopausal and pen-menopausal women while it showed positive association with tumour size and lymph node metastasis in the post-menopausal women [p <0.05]. Majority [62%] patients were under 50 years as against the Western epidemiology. Association of Her-2/neu with ER, PR, tumour size and lymph node metastasis was age related as pre-menopausal, pen-menopausal and post-menopausal had variable expression of these prognostic markers with therapeutic and prognostic implications