Histopathological changes in arsenic kushta induced nephrotoxicity in wistar rats

Objective: To determine the nephrotoxic effects of arsenic kushta [Kushta Sam-ul-Far] in Wistar rats

Study Design: Experimental study

Place and Duration of Study: Department of Morbid Anatomy and Histopathology, University of Health Sciences, Lahore from May to August 2014

Methodology: This experimental study was conducted on 48 healthy Wistar rats, each weighing 200 - 250 grams. The rats were randomly divided into 4 experimental groups each containing 12 rats. Group I was taken as control given flour pellets. Group II was given single dose [180 mg/kg] of arsenic kushta for 2 weeks. Group III received 150 mg/kg of arsenic kushta for 12 weeks; whereas, group IV was also given 150 mg/kg of arsenic kushta for 12 weeks along with 75 mg of BSA [bovine serum albumin]. Histopathological changes in glomeruli, tubules and interstitium were noted in the kidney

Results: Mesangial proliferation, thickening of basement membrane, necrosis, and interstitial edema were mainly observed in all the above groups except group I which served as control. These changes were seen in greater severity in high dose groups and the group given BSA injection along with kushta [group III, IV]

Conclusion: Herbo-mineral preparations of arsenic kushta are nephrotoxic in rats and may have similar toxic effects in human beings

Morphological changes in oral mucosa of rabbits induced by light emitting diode [LED] used as dental curing light

A dental curing light is apiece of dental tool that is used for the hardening of light cure composites. Many studies have shown these lights induce changes in DNA, mitosis and mitochondria through free radicals production. Light emitting diode [LED] are most commonly used and claim less hazards to the adjacent soft tissues. Current study was therefore designed to observe the morphological changes induced by light emitting diode [LED] as a dental curing light source in oral mucosa of experimental animals

Fifty rabbits were divided into 5 groups [4 experimental and 5th as a control group]. Cervical margin of central incisors of each animal in the experimental groups was exposed 3 times with LED light; duration of each exposure being 40 seconds with a gap of 30 seconds. Punch biopsies were taken after 24 hours, 48 hours, Iweek and 2weeks from group 1, 2, 3 and 4 animals respectively

Results showed ulceration [4%], acanthosis and vascular pathological changes [100%] enlarge [bulbous] rete ridges [97.5%], basal layer vacuolization [85%], acantholysis [27.5%] and atypical mitosis [10%] in all the experimental animals. With passage of time, a significant increase [P=0.000] in frequency of basal cell hyperplasia [90% in group 1 to 100% in group 4] and basal layer atypia [70% in group 1 to 90% in group 4] was observed. While inflammation dropped from 100% in group 1 to 0% in group 4 [P=0.000] due to healing of tissues. Changes were similar to the previous studies except some severe effects like atypical mitosis and basal layer atypia were observed which may be attributed to increase in number of light exposures in our study that is in compliance with the clinical practice in our set up

These findings may help in creating awareness among the dental practitioners to use dental curing lights with caution keeping appropriate safety measures for the adjacent oral soft tissue in consideration

Oral manifestations of chronic kidney disease

Current study was performed to evaluate the oral health status in patients with chronic kidney disease [CKD] on dialysis. This was a descriptive study. Hundred chronic kidney disease patients on dialysis were recruited in the study. Findings of the noninvasive oral examination and completed clinico demographic profile were recorded. Out of hundred patients, 53 were males and 47 were females. Mean age of patients was 51.16 +/- 15.09 years with age range of 22 to 83 years. On oral examination, oral hygiene was found to be poor in 47patients, moderate in 52 and good only in one patient. Xerostomia was present in 87% patients followed by thickened mucosa [12%], angular cheilitis [29%], periodontitis [41%], gingivitis [17%], tooth erosion [40%], tooth mobility [38%], ammonia like odour [Uraemic fetor] [45%], coated tongue [17%], mucosal pallor [37%], metallic taste [48%] and mucosal pigmentation [20%]. Regular oral I dental checkup I referral is needed for the better oral health in these patients and that will improve the compliance to oral drug therapy which in turn will promote the quality of life of CKD patients on dialysis with minimal complications

Expression of cd 10 in dentigerous cysts and ameloblastomas - a reliable prognosticator

CD 10, a surface glycoprotein, depicts the proliferation potential, differentiation and prognosis of neoplastic cells. Dentigerous Cyst [DC] is the most common developmental odontogenic cyst having high proliferative index thus related with epithelial dysplasia and neoplasms. Ameloblastoma is an uncommon, benign and locally aggressive odontogenic neoplasm with high rate of recurrence after surgery. This study was therefore designed to determine the expression of CD 10 in DCs and ameloblastomas. Twenty-five patients presenting with DCs [n=12] and ameloblastomas [n=13] were selected. Relevant clinical and radiographical findings were recorded and biopsies were submitted for histological diagnosis. CD 10 immunopositivity was assessed by immunohistochemistry in four microscopic high power fields showing maximum number of immunopositive cells. Mean age was 26.5 +/- 11.24 years and 42.07 +/- 9.24 years while male to female ratio was 7:5 and 7:6 for DCs and ameloblastomas respectively. Most of the patients [58.3%] of DCs presented as-ymptomatically while 41.6% patients reported with painful swelling. Comparing, all patients with ameloblastomas presented with painless swelling. Radiographically, all DCs and 46.2% of ameloblastomas were unicystic while 53.8% were multicystic radiolucent lesions. Histologically, epithelial atypia was seen in 50% and 23% of DCs and ameloblastomas respectively. High CD 10 cytoplasmic and membranous immunoreactivity was observed in the superficial epithelial lining of the DCs and the neoplastic epithelial cells of ameloblastomas while the stellate reticulum like cells showed only cytoplasmic immunopositivity. CD 10 expression may indicate neoplastic disposition of DCs while locally invasive and recurrence potential in ameloblastomas

Presence of various fungi in the oral smears of HIV / AIDS patients

This study was designed to observe the various fungi present in the oral buccal smears of HIV/ AIDS patients and their relation to CD4+lymphocyte count. Oral smears from n=35 patients taking antiretroviral therapy [ART] and twenty five [n=25] patients not taking ART were taken. These smears were stained with routine [H and E, Pap] and special stains recommended for fungi i.e. Grocott-Gomori's Methenamine Silver [GMS] and Periodic Acid Schiff [PAS]. The CD4+ lymphocyte count was determined using flow cytometry. Candida albicans was the most common being present in 26% patients on ART and 44% in Non-ART patients. Cryptococcus neoformans was seen in 11.4% ART patients and 4% in Non-ART patients. Coccidioides immitis was observed in 2.9% ART patients and 4% of Non-ART patients. Aspergillus was seen in 1.6% Non-ART patients only. Mean CD4+ count at which various fungi were seen was <300 cells/mm3 in all types. The CD4+ lymphocyte count was quantitatively grouped as Group 1 with CD4 + lymphocyte count <350 cells/mm3 and Group 2 having CD4+ lymphocyte count >350 cells/mm3. Fungi was found to have significant [p=0.001] association with Group1 having CD4+ count less than 350 cells/mm3 which shows their association with immunosuppression. Determination of increased colonization of Candidal and Non-Candidal fungi in oral cavity by means of simple non-invasive methods like oral smears may be helpful in indirectly predicting the immune suffered status and such patients should be given early medical treatment to prevent from disseminated fungal infections

Axillary lymph node status in primary breast carcinoma; association of axillary lymph node status with ER/PR, HER2/NEU and MMP-I in primary breast carcinoma

The most important prognostic factor in patients of breast carcinoma is axillary lymph node metastasis. Current study was conducted to find the frequency of lymph node metastasis in hundred cases of primary breast carcinoma and association of lymph node status with immunohistochemical expression of ER/PR,HER2/neu and MMP-1[matrix metalloproteinase-1]. Descriptive study. Aug 2012 to Jun 2013. U.H.S laboratory of Morbid Anatomy and Histopathology Lahore. One hundred mastectomy specimens with axillary lymph node dissection were included. After gross examination, tissue processing and microtomy the tissue slices of 4 micrometer were taken on frosted and lysine coated slides. H/E and IHC for ER/PR,HER2/neu and MMP-1 were done according to protocol. Among 100 breast cancer subjects, 72 were positive for lymph node metastasis while 28 subjects were negative. A significant association between lymph node status and ER IHC expression was noticed. When Chi square test was applied with p-value of 0.001 was observed.Also a significant association between lymph node status and PR IHC expression was noticed. Chi square test was applied and the p-value of 0.004 was obtained.Association between lymph node status and HER2/neu IHC expression was analysed. Chi square test was applied with a p-value of 0.467 was obtained [not significant].A significant association between lymph node status and MMP-1 IHC expression was observed. Chi square test was applied anda p-value of 0.004 was obtained. Most of the primary breast carcinomas were presented with axillary lymph node metastasis [72%].Significant associations were observed between lymph node status and ER/PR immuonohistochemical expressions however the association between HER2/neu IHC and lymph node status was not statistically significant. The immunohistochemical expression of MMP-1 is significantly associated with lymph node status. It shows that it is an important marker for metastatic potential in breast carcinoma

study of renal tumours in tertiary care hospitals

Renal cell carcinomas [RCC] comprise 90% of all renal tumours and are presage of poor outcome. Very little data has been published in Pakistan regarding the clinical and pathological manifestations of the disease. A total 0/50 cases presenting with different subtypes of RCC were selected from Allied Hospital Faisalabad and Sheikh Zayed Hospital, Lahore. Clinical details were obtained from the hospital records. The fresh nephrectomy specimens were further processed according to College of American Pathologists guidelines. Mean age of the study population was 50.16 +/- 11.982 years. Male to female ratio was 2.57:1. Left to right ratio was 1:1. Most tumours [n = 36, 72%] were located in the upper pole. Most common symptom was heamaturia [n = 38, 76%]. Mean of the greatest dimension was 10.41 +/- 4.22 cm. The most common stage of presentation was stage II [n = 21, 42%] and histological subtype was clear cell carcinoma [n = 37, 74%]. Renal cell carcinoma, including its chromophobe variant, is a growing malignancy in Pakistan. Delay in seeking medical care on the part of patient and inadequate facilities account for the tumour growing to a larger size and more advanced stage of malignancy in our country

Gastric Schwannoma in a Female Patient with Pulmonary Tuberculosis — A Clinicopathological Assessment and Diagnosis

Schwannomas, or neurinomas, are generally benign, slow-growing, asymptomatic neoplasms originating from the Schwann cells of a nerve sheath. As a part of spindle cell mesenchymal tumours, schwannomas arising from the gastrointestinal tract (GIT) are unusual; however, when they occur, the most common site involved is the stomach, which represents 0.2% of all gastric tumours. We report the case of a 35-year-old female patient with a history of pulmonary tuberculosis presenting with a large palpable abdominal mass reaching up to the peritoneal cavity. The initial clinical impression was a tuberculous abdominal mass, a cyst, or a teratoma. However, intra-operative findings during a subtotal gastrectomy revealed an exophytic gastric serosal mass, which suggested a gastrointestinal stromal tumour (GIST). Post-operative histopathological findings showed a fascicular arrangement of neoplastic spindle cells with pallisading nuclei that showed intense positivity for S-100 protein, and were negative for CD117 and desmin in immunohistochemistry studies. These results confirmed the final diagnosis of a gastric schwannoma.

study of the morphological patterns of extranodal non-hodgkin lymphoma in Pakistani and Saudi populations

The incidence of extranodal non-Hodgkin lymphoma [EN - NHL] is increasing particularly among the populations of South Asia and Middle East. On the whole 25 - 40% of NHL arise in the sites other than lymph nodes. This study was designed to assess the pathological patterns and the prevalence ofEN-NHL in Pakistan and in Saudi Arabia. A total 0/106 and 42 cases, from one centre in Pakistan and Saudi Arabia respectively, were included during a five year period [1998 - 2003] with a detailed account of their demographic and clinical characteristics. We observed that most of the Pakistani and Saudi patients presented in the 5[th] - 7[th] decades with the mean age being 43.2 and 46 years and a male to female ratio 0/1.07: i and 1.7: i respectively. Apart from a diverse pattern observed, diffuse large B cell lymphoma [57.5% and 63.4%] followed by MALT lymphoma [28.3% and 26.8%] were the commonest morphological subtypes of EN- NHL in both genders belonging to Pakistan and Saudi Arabia respectively. The tumours were found to be widespread, however, a predominant gastrointestinal tract [45% and 41.3%], in particular, gastric involvement was seen in [20.8% and 19.5%] Pakistani and Saudi patients respectively. However, predominant orbital involvement was seen exclusively in the latter. EN - NHL is an emerging malignancy in Pakistan and Saudi Arabia. Apart from a slight variation, no significant divergence was observed in the histological patterns of the EN -NHL in both geographical areas

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

pattern of carcinoma of lung as seen in a tertiary care hospital

This cross sectional descriptive study was conducted to assess clinicopathological characteristics of lung cancer in 142 patients, 116 males and 26 females, from various regions of Punjab presenting with clinical features consistent with the diagnosis of lung carcinoma. They were admitted to Gulab Devi Chest Hospital [GDCH], Lahore, Pakistan from January 2005 to January 2007. Our observations revealed that the most prevalent malignancy among these patients was non small cell lung carcinoma including squamous cell carcinoma and adenocarcinoma in males and females respectively. Most common affected age groups were between 41-60 years [n=82] and 51-70 years [n=15] in males and females respectively. Squamous cell carcinoma followed by small cell lung carcinoma were commonly associated with smoking in both genders. Immunohistochemistry was employed for the confirmation of diagnoses in some [n=35] cases. We observed that 4 of 10 [40%] large cell lung carcinomas were strongly positive with HDC. The remaining 06 [60%] large cell lung carcinomas though negative for HDC, were strongly positive with Cyfra 21-1. All small cell lung carcinomas, atypical and typical carcinoids were also strongly reactive to HDC immunostaining. Antimucin antibody was also strongly positive and negative in each 02 of the 04 [50%] poorly differentiated adenocarcinomas where all of them were strongly reactive to Cyfra 21-1. It is concluded that lung cancer is more common in males and is strongly associated with smoking. Hence, interventional measures for prevention and early but correct diagnosis of bronchogenic carcinoma is needed. The role of tumour markers can be very useful in finalizing cases which are difficult to be differentiated

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