Demographic and clinicopathological parameters in lung cancer in a chest hospital, Lahore - Pakistan

We are presenting the clinical and pathological characteristics of lung cancer among patients reporting to Gulab Devi Chest Hospital Lahore, the largest and the oldest health care facility for chest diseases including lung cancer in Pakistan. It was a cross - sectional, descriptive study conducted at the department of histopathology, Gulab Devi Hospital Lahore between March 2011 and February 2012. A sample of 293 patients of primary lung cancer was taken. The demographic and clinical details i.e. age, sex, history of smoking and presenting symptoms were collected after the informed consent. Histopathological diagnosis and tumour grades were added in respective columns. Data was analysed with the help of S.P.S.S. version 17.0. Mean age was 53.19 +/- 0.92 years for male and 47.36 +/- 1.92 years for females. Male to female ratio was 3:1. History of tobacco smoking was present in 2/3[rd] of the patients. Smoking was strongly associated with squamous and small cell carcinoma of lung. Most common histological diagnoses were squamous cell, small cell and adenocarcinoma respectively. Majority of squamous cell carcinoma were poorly differentiated as compared to adenocarcinoma in which well and moderately differentiated tumours constituted 25% and 45% respectively. Most of patients presented at inoperable stage. Smoking is most strongly associated with the two most common histological entities of lung cancer viz. squamous cell carcinoma and small cell carcinoma. Bronchial biopsy was the commonest diagnostic procedure in practice and surgical resection is offered to only a few cases

Immunohistochemical expression of cytokeratin-19 in non small cell lung carcinomas - an experience from a tertiary care hospital in Lahore

Previous literature reveals a significant recognition of Cytokeratin [CK] 19 as a reliable tumour marker in epithelial malignancies. With the hypothesis that CK 19 is extensively released by the tumour cells in patients with non small cell lung carcinomas [NSCLCs], this study was designed to assess [1] the clinicopathological characteristics of lung cancer in this sub-region [2] the pattern of immunohistochemical expression of CK-19 in different NSCLC subtypes with respect to their histological grades. A cross-sectional descriptive study comprising of detailed account of clinical data of 225 patients presenting with NSCLCs. After H/E staining, immunohistochemistry [IHC] was performed using prediluted ready to use mouse monoclonal antibody to CK 19. Our findings of the study revealed that the mean age of the patients was 45 years with the male to female ratio being 5:1. Most prevalent type seen was squamous cell carcinoma [SCC] and adenocarcinoma [AC] in males and females respectively. Some cases were not easily classifiable as squamous or adenocacinoma and hence they are classified as NSCLs Unclassified. SCC was commonly associated with smoking in both genders. Immunohistochemical staining of the histological tissue sections of 93.7% NSCLCs demonstrated a varying immunopositivity while showing strong, diffuse to focal cytoplasmic staining of the tumour cells. A significant association [p=0.001] was found between the increasing grades of malignancy and the strength of CK-19 expression. Supporting the previous literature, we have also come across that CK-19 is credibly expressed in patients with NSCLCs and may be applied as a reasonably reliable immunohistochemical marker. In future the patients over expressing CK-19 histologically might constitute potential candidates to be followed up through non invasive serial serum levels estimation intended for assessment of tumour burden in recurrence or advanced disease

Medulloblastoma: a life threatening cancer of infancy and childhood

Medulloblastoma is a rare and aggressive tumor of the brain that usually occurs in children or young adults with a tendency to metastasize. The incidence in infant is rare. We came across one such child who presented with slight disorientation, vomiting, irritable personality and somewhat large size head. The clinical, radiological preoperative diagnosis was space occupying lesion in the posterior fossa. On histological examination it turned out to be Medulloblastoma of infratentorial region in posterior fossa

Intracranial extra-skeletal mesenchymal chondrosarcoma

Intracranial Mesenchymal Chondrosarcoma is a very rare and uncommon entity that affects young adults. We came across one such patient who presented with severe headache and intermittent nausea and vomiting. The clinical, radiological preoperative diagnosis was a meningioma, on histological examination it turned out to be mesenchymal chondrosarcoma of tentorial region in posterior fossa, uncommon site for this entity

Correlation of glial fibrillary acidic protein [GFAP] with grading of the neuroglial tumors

To determine the distribution of glial fibrillary acidic protein [GFAP] in human neuroglial tumours and its correlation with histologic grading. Analytical. Postgraduate Medical Institute, Lahore, on the cases from 1999 to 2001. Materials and Methods: Fifty formalin fixed paraffin-embedded tissue blocks were obtained. Two sections from each block were taken. One was stained with heamatoxylin-eosin stain while second for GFAP that is the unlabelled antibody immunoperoxidase [peroxidase ' antiperoxidase PAP] method was used. The non-neoplastic brain tissue was used as positive control, while cases reported medulloblastoma tumour was used as negative control. We applied a scoring scale 0 to 3+, to evaluate its correlation with the grade of tumour. In positive control only the cell process and perikaryons of fibrous astrocytes was stained. The 35 cases of various grade astrocytoma showed a varying intensity of GFAP staining. Similarly, 3 cases of glioblastoma multiforme, 2 cases of sub-ependymal giant cell astrocytoma, 2 cases of pleomorphic xanthoastrocytoma, 2 out of 4 cases of ependymoma and the case of oligoastrocytoma showed a positive reaction. The stain was more intense over processes than in perikaryons, with the exception of gemistocytic astrocytomas and the giant cells in glioblastoma multiforme, which showed an equally intense stain over perikaryons and processes. Comparison of the histological grade with GFAP score was significantly higher in high grade tumour when compared with tumour of grade I [p<0.001]. In astrocytic neoplasms the number of GFAP positive cells and the intensity of the stain were directly proportional to the degree of malignancy. All the 3 cases of oligodendroglioma showed a negative reaction to GFAP. Only astrocytic component was positive which are poorly visualize by H and E stain. The GFAP score shows significant relation with the present WHO grading system of glial tumours. GFA protein is specific for glial cells and it is useful to diagnose those glial tumours which are difficult to be identified by heamatoxylin-eosin stain or due to rare or unusual site