Olfactory neuroblastoma: a clinicopathological experience of a rare entity from Pakistan

Objectives: To present the clinicopathological experience of Olfactory Neuroblastoma [ONB] with emphasis on histopathological and immunohistochemical features

Methods: A descriptive cross-sectional study was done on 36 cases of ONB, selected by non-probability purposive sampling. Theses cases of ONB were retrieved and reviewed from surgical pathology database of Aga Khan University Hospital reported between January 1993 and March 2015

Results: Tumor size and age of presentation was wide in range without any distinct bimodal distribution. Nasal cavity was most common site along with involvement of paranasal sinuses. More than 50% cases had Kadish stage A. Microscopically, most cases were Grade-1 and majority showed partial or complete lobular architecture. Neurofibrillary matrix was observed in 2/3rd of cases. Among immunohistochemical markers, Neuron Specific Enolase was most frequently expressed. Unusual positive expression of Cytokeratin AE1/AE3 and Cytokeratin CAM5.2 was also seen focally in few cases

Conclusion: The ONB has great variability of histological and clinical presentation, and immunohistochemical markers are useful to differentiate from more common small round blue cell tumours of nasal cavity

Lymphangioma circumscriptum: clinicopathological spectrum of 29 cases

To describe the clinicopathological spectrum of Lymphangioma Circumscriptum [LC]. Observational case series. Department of Pathology and Microbiology, AKUH, Karachi, from 2002 to 2012. All reported cases of LC were retrieved from medical record. Clinical and pathological features were noted. Frequency percentages were determined. There were 29 cases of LC predominantly males [62%]. The mean age was 27.17 +/- 15.5 years. The commonest sites was anal/perianal region [24%] followed by extremities [17%] and tongue, [14%]. Vulval LC was seen in 3 patients. Two cases were described on scrotum. The lesions were most commonly suspected as viral warts, mole or polyp [in anal Region]. Vesicles with erosions and bleeding and localized growth were the usual clinical presentations. Four of the patients presented with swelling since birth. All were treated with surgical excision. Microscopic examination revealed acanthotic squamous epithelium with papillomatosis. The subepithelial region had collections of lymphatic channels composed of ectatic dilated vessels with serum and inflammatory cells in their lumina. The lymphatic channels were seen in deeper layers along with lymphocytic aggregates. Lymphangioma circumscriptum is a malformation of abnormal lymphatic channels with feeding cisterns in subcutaneous tissue. It is a benign lesion usually occurring in anal/perianal region and confused with warts. Surgical excision is preferred mode of treatment

Combination of Hot-Hypertonic Saline and pressure dressing in the management of Parotid Fistula

Parotid fistula is a rare complication of surgical or non-surgical trauma on or in the vicinity of parotid gland. Many pharmacological agents and surgical methods are used to treat it with their own merits, demerits and patient preferences. Injection of hypertonic hot saline along with compression dressing is an economical, patient-preferred and almost complication-free method to deal parotid fistula with promising results

Diagnostic value of needle-localization biopsy in the management of non-palpable breast lesions

To determine the diagnostic accuracy of needle localization biopsy in the management of non-palpable breast lesions. This study was conducted over period of two and a half year at surgery unit-II of SMBBMU and Larkana Medical Center. Total 51 patients were included who had BIRADS IV and V lesions on mammogram and ultrasound. All underwent wire/needle localization under ultrasound and latter diagnostic biopsy. All the 51 patients were females. The positive result in terms of presence of diseased breast tissue was found in 92.15%. Needle localization biopsy has good diagnostic accuracy. The results can be improved by bringing improvement in the field of interventional radiology

Squamous inclusion cyst in a sentinel axillary lymph node associated with breast malignancy

Axillary intranodal squamous inclusion cyst is a rare benign histological finding that may be confused with malignant diseases. A 52 years old female presented with a painless lump in the left breast for one and a half month. The mammogram was reported as being suspicious of carcinoma. Left breast lumpectomy and histology revealed infiltrating ductal carcinoma. After a month, modified radical mastectomy was done. Frozen section of axillary sentinel lymph nodes revealed benign histology with squamous inclusion cyst in one of the nodes. All lymph nodes recovered from mastectomy specimen were also benign

Fine needle aspiration cytology of pseudopapillary tumour of pancreas

The solid-cystic pseudopapillary neoplasm is a rare pancreatic tumor having indolent course and amenable to complete excision. This is a report of two cases of this tumour, diagnosed on fine needle aspiration cytology. One of the cases had complete surgical excision of the mass and subsequent histological evaluation. This benign and rare neoplasm of pancreas often causes few symptoms. The characteristic cytomorphological features point towards the diagnosis

Complications of laparoscopic cholecystectomy in acute cholecystitis

To assess the clinical outcome of laparoscopic cholecystectomy in the management of acute cholecystitis. Descriptive study. Surgical Units II and III of Chandka Medical College Hospital Larkana, from 01.10.2003 up to 31.12.07. In this study 100 consecutive cases of clinically and sonologically confirmed acute cholecystitis who underwent early laparoscopic cholecystectomy [within 07 days of attack] were included. Patients with symptoms of more than one week duration or those with associated diseases were excluded. There was female preponderance with male to female ratio 1:4.5. Mean age was 45.75 years [SD +/- 11.99 years]. Most of the patients were received within 24 hours after the onset of symptoms. Ultrasound revealed edematous gall bladder [GB] in 24 cases, contracted GB in ten, empyema in eight, perforated GB in four. Fifty four patients had acute cholecystitis with cholelithiasis. Peroperative complications were minor bleeding in 6 patients, minor injury to liver bed in 3, major bleeding occurred in two cases that required conversion to open surgery .Other findings which delayed the procedure or required conversion were adhesions with omentum, stomach, colon, CBD, and distorted anatomy of Calot's triangle and CBD injury. The conversion rate was 6% among them two were due to bleeding, two with friable adhesions, one with obscure anatomy. Stone in CBD could not be detected on ultrasound in one case and CBD injury occurred in one. The minimum time taken for the procedure was 50 minutes. No mortality occurred in this series. Emergency / early cholecystectomy is reliable, safe and cost effective modality, in the management of acute cholecystitis. It results in accelerated recovery, negligible wound infection or related complications, and less postoperative pain. Certain factors are responsible for conversions which are obscure anatomy, bleeding, adhesions, and CBD, injury

Breast cancer: steroid receptors and other prognostic indicators

To correlate hormone receptor status in breast cancer with patient's age, tumor size, type, grade and lymph node metastasis. A descriptive study. Department of Histopathology, Liaquat National Postgraduate Medical Center, Karachi, from January 2002 to March 2003. One hundred and fifty patients of breast cancer were studied. Estrogen and progesterone receptor status was evaluated by immunohistochemistry. This was correlated with patients' age, tumor size, type, grade and lymph node status. Out of 150 cases, 55% of cases were estrogen receptor [ER] negative progesterone receptor [PR] negative. Older women tended to have more steroid receptor reactivity as compared with younger ones. ER positivity decreased with increasing tumor size and grade, however, no significant correlation was seen with lymph node metastasis. Majority of the tumors showing ERPR positivity were infiltrating ductal carcinoma-not otherwise specified type. This study reports a significantly higher incidence of ER negative PR negative phenotype in breast cancer patients. This observation is different as compared with that in western literature where ER positive PR positive phenotype is greater than the negative phenotype suggesting that breast cancer in our patients may have different disease pattern and biology