ABSTRACT
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
ABSTRACT
Secondary transformation in Germ Cell Tumours [GCT] is an extremely rare event. We report here a case of malignant melanoma arising in primary mediastinal GCT. A young male presented with new onset dyspnoea and a mediastinal mass. As serum alpha fetoprotein was raised, a diagnosis of primary mediastinal GCT was made. He achieved remission with standard chemotherapy and resection of the mass. After a year, he relapsed with widespread disease which on work-up revealed malignant melanoma. As examination for cutaneous melanoma was unremarkable, a diagnosis of mediastinal GCT with secondary transformation to melanoma was made. Exact origin of melanoma in GCTs is unknown, but these may occur from transformation of dermal elements or de-differentiation of germ cells to melanomas. Before making such a diagnosis, search for primary cutaneous melanoma is mandatory. No clear guidelines exist in literature for the treatment of secondary melanomas, so current management guidelines for cutaneous melanoma may be followed
Subject(s)
Humans , Male , Neoplasms, Germ Cell and Embryonal , Mediastinal Neoplasms , Dyspnea , alpha-FetoproteinsABSTRACT
To identify the efficacy and side effects of Diacerein in patients with mild to moderate knee mteoarthritis. Quasi experimental study. Outpatient Department of Armed Forces Institute of Rehabilitation Medicine, Rawalpindi from June 2012 to June 2013. Ninety cases fulfilling American College of Rheumatology criteria for diagnosis of Knee Osteoarthritis and falling in Grades I-III of Kellgren-Lawrence Radiological Classification for Knee Osteoarthritis were included. Pre-treatment associated symptoms, complete blood count, renal and liver function tests were documented. After a baseline pain assessment on a 10-Point Visual Analogue Scale, 50 mg of Diacerein was given orally for 4 months followed by pain assessment and inquiry about adverse effects at 6[th] week, 3[rd] and 6[th] months. Post-treatment labs were repeated. Reduction in pain was analyzed by paired-sample t-test using SPSS version 17. Chi-Square test was used to assess the frequency of adverse effects. A p-value < 0.05 was considered sigruficant. Mean age was 61.5 +/- 7.8 years. Majority 77 [85.6%] were females. Mean Visual Analogue Scale at start was 6.1 +/- 0.87. Sigruficant pain reduction measured on Visual Analogue Scale was observed at six weeks [4.6 +/- 1.2] [p < 0.001], three months [2.37 +/- 0.91] [p < 0.001] and six months [2.2 +/- 0.85] [p < 0.001]. Very few patients developed diarrhea 3.3% and nausea 4.4%. Diacerein is effective drug with minimal side effects for treatment of mild to moderate painful Knee Osteoarthritis
Subject(s)
Humans , Male , Female , Osteoarthritis, Knee/drug therapyABSTRACT
To determine the sensitivity and specificity of endoscopic ultrasound [EUS] guided fine needle aspiration cytology [FNAC] in the evaluation of pancreatic masses. Analytical study. Department of Pathology, Shaukat Khanum Cancer Hospital and Research Centre, from January 2006 to June 2011. Patients of either gender aged above 18 years who underwent EUS guided FNAC of pancreatic masses detected on abdominal CT, were included in the study. Biphasic abdominal CT scans were carried out for all the patients, followed by EUS guided FNAC. All material aspirated for cytologic evaluation was assessed for sample adequacy on-site, followed by formal examination for diagnostic purposes. The mean age of patients tested was 58.94 +/- 12.84 years with age ranging from 23 to 78 years. Regarding gender 23/42 [54.76%] patients were male and 19/42 [45.24%] were female. Out of 42 cases, 27 [64%] cases were diagnosed as adenocarcinoma, 4 [9.5%] as benign, 4 [9.5%] as mucinous cystic neoplasm, 2 [4.7%] as chronic pancreatitis, 2 [4.7%] as non-diagnostic, 2 [4.7%] as atypical cells seen and 1 [2.38%] as non-Hodgkin's lymphoma. The results were in full concordance with radiologic findings. EUS guided FNA is an excellent procedure for evaluation of pancreatic masses. The overall sensitivity of this procedure is 89% and the specificity is 67%