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

Clinicopathological and immunohistochemical analysis of anaplastic large cell lymphoma

To study the clinicopathological and immunohistochemical features of Anaplastic Large Cell Lyrnphorna [ALCL]. The study design was cross sectional descriptive study. The study was conducted in Armed forces institute of pathology. The duration of study was two years from 1[st] Jan 2010 to 31st Dec 2011. A total of twenty five consecutive biopsy proven cases of anaplastic large cell lymphoma [ALCL] were selected through non probability, consecutive sampling. The inclusion criteria was, all newly diagnosed patients of ALCL having sufficient tumour material in paraffin embedded tissue blocks with appropriate clinical information regarding age, gender and anatomic location. The exclusion criteria included all poorly fixed specimen. The clinical information regarding age, gender and location was noted. All the cases were evaluated on Haematoxylin and Eosin [H and E]. Cases were subjected to Immunohistochemistry [IHC] using CD45 [LCA], CD3, CD 45 RO, CD 15, CD20, CD 30, ALK, EMA, Cytokeratin and classified according to WHO classification of lymphoid neoplasm. Twenty five cases of anaplastic large cell lymphoma were reported during this time period. Out of 25 cases, 22[88%] were ALCL ALK positive, 2[8%] were ALCL ALK negative and 1[4%] case was cutaneous ALCL. The male to female ratio was 2.5:1. The age range was between 6 years and 70 years with majority of cases in third decade. Seventy six percent were nodal and rest were extranodal. The cervical lymph nodes were the commonest nodal group involved making 15[60%] cases followed by 3 [12%] cases of axillary lymph nodes. The histopathological appearance showed complete effacement of architecture in 17 [68%] of cases followed by sinusoidal distribution in 6[24%] cases while partial effacement of architecture in 2 [8%] of cases. All the cases were positive for CD30 while 23 [92%] cases for CD3, 22 [88%] cases for ALK and 19 [76%] cases positive for EMA. ALK negative lymphomas were 3 [12%] cases. Anaplastic large cell lymphoma is more common in males and young adults. Nodal involvement is more common. Majority of cases show complete effacement of architecture. All cases are CD 30 positive. Most of cases are anaplastic lymphoma kinase antigen positive

Frequency of p53 gene mutation and protein expression in oral squamous cell carcinoma

To determine the frequency of p53 gene mutation and protein expression in Oral Squamous Cell Carcinoma [OSCC] and to establish correlation between the two. Analytical study. Histopathology Department and Molecular Biology Laboratory, Armed Forces Institute of Pathology [AFIP], Rawalpindi, from May 2010 to May 2011. Thirty diagnosed cases of OSCC were selected by consecutive sampling. Seventeen were retrieved from the record files of the AFIP, and 13 fresh/frozen sections were selected from patients reporting to the Oral Surgery Department, Armed Forces Institute of Dentistry [AFID]. Gene p53 mutation was analyzed in all the cases using PCRSSCP analysis. DNA was extracted from the formalin-fixed and paraffin-embedded tissue sections and fresh/frozen sections. DNA thus extracted was amplified by polymerase chain reaction. The amplified products were denatured and finally analyzed by gel electrophoresis. Gene mutation was detected as electrophoretic mobility shift. The immunohistochemical marker p53 was applied to the same 30 cases and overexpression of protein p53 was recorded. Immunohistochemical expression of marker p53 was positive in 67% [95% Confidence Interval [CI] 48.7 - 80.9] of the cases. Mutations of the p53 gene were detected in 23% [95% CI 11.5 - 41.2] of the OSCC. No statistically significant correlation was found between p53 gene mutation and protein p53 expression [rs = - 0.057, p = 0.765]. A substantial number of patients have p53 gene mutation [23%] and protein p53 expression [67%] in oral squamous cell carcinoma [OSCC]

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

Alterations of P53 [gene mutation and protein expression] in oral epithelial dysplasia

Oral Squamous Cell Carcinoma [OSCC] is usually preceded by precancerous lesions. These lesions appear white or red clinically [Leukoplakia and Erythroplakia respectively] and show dysplastic epithelial changes on histopathological examination [Abbas et al, 2007]. If p53 alterations [gene mutations and protein expression] in premalignant lesions are detected and treated in their early stages, it might help in prevention of progression to cancer [Patton et al, 2008]. Aim was to determine the frequency of p53 gene mutation and protein expression in oral epithelial dysplastic lesions. This was a descriptive study carried out at the Armed Forces Institute of Pathology [AFIP], Rawalpindi and was of one year duration from 8[th] May 2010- 5[th] May 2011. Thirty cases of oral epithelial dysplasia [OED] were retrieved from the record files. Some fresh /frozen sections were also included. Gene p53 mutation was detected in these cases by PCR-SSCP Analysis. DNA was extracted from the formalin-fixed and paraffin-embedded tissue sections and fresh /frozen sections. DNA thus extracted was amplified by polymerase chain reaction. The amplified products were denatured and finally analyzed by gel electrophoresis. Gene mutation was detected as electrophoretic mobility shift. The immunohistochemical marker p53 was applied to the same 30 cases andproteinp53 expression was recorded. Mutations of the p53 gene were detected in 20% of the dysplastic lesions. Immunohistochemical staining ofmarkerp53 was positive in 60% of the cases. Gene p53 mutation and protein expression was not coexistent

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

Immunohistochemical expression of protein p53 in oral epithelial dysplasia and oral squamous cell carcinoma

The study was carried out to determine the frequency of p53 protein expression in oral dysplastic lesions and oral squamous cell carcinoma and to compare them in both the lesions. Sixty cases [30 each] of oral epithelial dysplasia [OED] and oral squamous cell carcinoma [OSCC] were retrieved from the record files along with their paraffin blocks at the Armed Forces Institute of Pathology, Rawalpindi including twenty fresh/frozen sections. The immunohistochemical marker p53 was applied using Streptavidin-Biotin technique. Staining and intensity of the marker was recorded and frequencies were compared in both the lesions. Protein p53 expression was seen in 60% of oral epithelial dysplastic lesions and 67% of oral squamous cell carcinomas. The results signify the importance of p53 for the early diagnosis and early treatment of dysplastic [precancerous] lesions

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.

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

Clinicopathological aspects of malignant salivary gland neoplasms - a study of 150 cases at Afip, Rawalpindi [Pakistan]

To study the clinicopathological aspects of malignant salivary gland tumors, diagnosed at AFIP, Rawalpindi [Pakistan]. Descriptive study. Armed Forces Institute of Pathology, Rawalpindi from Jan 2005-Dec 2009. The study included all the cases diagnosed as malignant salivary gland tumors in the last five years. Records of all the tumors of head and neck region that presented during this period were analyzed and out of these clinicopathological features of malignant salivary gland tumors were studied. The data analysis included the age, gender, site of tumor and histopathological pattern. A total of 18685 malignant tumors presented in the last five years. Out of these, malignant tumors of head and neck were 2165. Total malignant salivary gland tumors were found out to be 150 with an overall frequency of 0.8% and frequency in head and neck malignancies was found out to be 6.9%. The age ranged from 6-80 years [mean 48.02 + 1.23]. Of these 150 cases, 58.7% were males and 41.3 were females with a male to female ratio of 1.4:1. The most common tumor seen was mucoepidermoid carcinoma [49.3%] followed by adenoid cystic carcinoma [31.3%]. A total of 48.7% of the tumors originated in minor salivary glands. Parotid gland was the second most commonly involved site [40.7%]. Malignant salivary gland neoplasms are a common malignancy of head and neck region and their frequency is slightly more in our population. Almost half of the tumors originated in minor salivary glands and mucoepidermoid carcinoma was the most common type of malignancy

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

Oral squamous cell carcinoma: a clinicopathological study of 467 cases at afip Rawalpindi, Pakistan

The purpose of this study was to determine the clinicopathological and demographical characteristics of histologically diagnosed cases of oral SCC. Evaluation is based on age, gender, site of tumor and histological differentiation. Histologically diagnosed cases of oral SCC during a period of 3 years [Jan 2007 - Dec 2009] were retrieved from the tumor records of Department of Histopathology, Armed Forces Institute of Pathology, Rawalpindi, Pakistan. Biopsy specimens at the institute are obtained from Armed Forces as well as public and private sector hospitals including the review cases for second opinion. All the cases were subjected to the analysis of age, gender distribution, site of tumor occurrence and grade of histological differentiation. Out of a total of 12611 tumors recorded at AFIP Tumor registry, 467 cases of oral neoplasms were diagnosed as SCC [3.7%]. Among head and neck tumors recorded in the study period, oral SCC comprises 32.9% of the total. The mean age [ +/- standard deviation] of patients was 55.9 +/- 13.3 years [range, 5-90 years] with a male predominance [52.5%], yielding male to female ratio of 1.1:1. Peak incidence is found in 60 years of age. Most common site was buccal mucosa [29.8%] followed by tongue [23.1%] and mandible [13.5%]. Most common histological grade was well differentiated [67.5%] followed by moderately differentiated [26.8%] and poorly differentiated [5.8%] histological subtypes. Oral SCC is the most common malignancy of head and neck region in our community with peak incidence in comparatively older age group. There is an overall male predominance except in younger age group, where it is more common in females. Most common site of tumor is buccal mucosa. The well differentiated grade is the most common histological type of differentiation

Clinicopathological evaluation of nasal biopsy specimens- and afip experience

To evaluate the presence and frequency of clinically significant microscopic diagnosis in cases under going nasal polypectomy/biopsy. Cases of nasal polypectomy/biopsy reported from department of histopathology during last five years [2004-2008] were retrieved from records and evaluated microscopically for detailed histological diagnosis. A total of 383 cases were reviewed. Most frequent age was 5[th] decade. Nasal polepectomy comprised 54.73% [n=214]. Nasal Biopsy not otherwise specified comprised 21.99% [n=86]. Suspicious of growth was indicated in 23.27% [n=84] cases. Among all types of biopsy, 60.04% [n=230] were inflammatory nasal polyps, 10.44% [n=40] malignant neoplasm, 5.48% [n=21] were inverted papilloma. Rest of the cases [24.03%] showed benign inflammatory changes and benign neoplastic lesions. Although frequency of neoplastic lesion in routine polypectomy specimen as mentioned in literature is low. Our study reveals significant number of malignant cases. Considering the prognostic significant of early histological diagnosis and appropriate post considered essential. Large scale studies are required to evaluate clinicopathological correction of nasal biopsy specimens in our setup

Pattern of malignant tumours: analysis of 1205 cases at combined military hospital [CMH] Lahore

To analyze pattern of malignant tumours at our setup and to compare with the already available data on the subject. A retrospective study. The study was conducted at the department of Histopathology Combined Military Hospital Lahore from Jan 1998 to Dec 2002. All the consecutive biopsies were included in the study. The clinical information was obtained from the case files. Tissue was processed in automatic tissue processor and stained with routine dyes. The results were compared with other studies from Pakistan and abroad. The total number of biopsies dealt with during this period was 16120 and out of these malignancies were twelve hundred and five with male to female ratio of 1.08:1. Carcinoma of prostate was at the top in males followed by lymph node, urinary bladder, skin, soft tissue, liver, colon, kidney, bone and stomach. In female the top rank was of breast followed by uterus, Lymph node, Thyroid Skin, Ovary, cervix, urinary bladder, liver and soft tissue. There is high prevalence of breast carcinoma in female also seen in other national and international studies.: Certain tumours like those of prostate, skin and lymph node malignancies may be more common in this region. Variation in rest of the tumours may be departmental /institution biased. There is need for development of population based tumour registries

Acute mountain sickness [Autopsy study]

This study was conducted to investigate the cause of death in forty-eight army personnel dying of altitude sickness at or above 8000 ft. All were males,less than fortyfive years of age with maximum number in their early twenties. All developed symptoms within a week of reaching the high altitude posts and were involved in the physical activity. The predominant presenting symptoms were breathlessness, chest pain, retrosternal tightness, headache and fits. The time duration between the onset of symptoms and death showed a bimodal peak. The first in 1-3 h and the second was beyond 48 h. Histopathological examination revealed pulmonary edema in maximum [52%]with accompanying myocardial ischaemia in 6.5% of the cases. Coronary atherosclerosis with myocardial ischaemia was seen in 25%. Cerebral edema was present in twenty five%. Thrombosis in the coronary artery was present in 6.25%, pulmonary vessels in 6.25% and in superior mesenteric artery 2.08%.The other pathologies were intracranial haemorrhage and massive bleeding from peptic ulcer So it is concluded that in addition to the major systems involved, thrombohaemorrhagic episodes and myocardial ischaemia were other findings