Morphological and immunofluorescent patterns of subepidermal autoimmune bullous diseases of skin in Karachi Pakistan

Subepidermal autoimmune blistering disorders [SEABD] are common in dermatological practice. Direct immunoflourescence [DIF] staining is considered gold standard for the diagnosis of these disorders. The study was conducted to determine the morphological and DIF patterns of these disorders. Retrospective Study. This study was conducted at the department of Pathology, Basic Medical sciences Institute, Jinnah Postgraduate Medical centre, Karachi, from January 2002 to July 2007. Morphological and DIF patterns were recorded and categorical diagnoses of these disorders were established. Bullous permphigoid [BP] was found to the most frequent disorder with a relative frequency of 60.71% and mean age of 54.82 years. Relative frequencies of childhood bullous pemphigoid [Ch BP], dermatitis herpetiformis [DH], chronic bullous dermatosis of childhood [CBDC] and herpes gestationis [HG] were 10.71%, 14.28%, 10.71% and 3.57% respectively. Direct immunofluorescent staining is one step procedure that should be done in all cases of SEABD. Use of salt split technique and immune electron microscopy would further enhance the level of certainty in SEABD

Association of steatosis with histopathological grading and staging of liver biopsies in hepatitis C patients

To find out the association of steatosis with histopathological grading and staging of liver biopsies in hepatitis C patients. This was a prospective study based on liver biopsies of hepatitis C patients. H and E stained slides were examined to determine the histological activity, fibrosis score and steatosis. Out of 50 patients, 28 cases had some degree of steatosis. Out of the total 22 cases with grade one activity maximum number of 14 cases had revealed no steatosis. Majority of the patients with higher grades of steatosis [12 out of 13 patients] had demonstrated severe necroinflammatory score. A significant correlation of steatosis with fibrosis [p < 0.005] was also evident from this study. Steatosis is an important cofactor in increasing liver necroinflammatory activity and fibrosis in chronic hepatitis C. Steatosis could therefore be a marker of necroinflammation and a marker of fibrosis progression

histopathological pattern of ovarian teratomas at a tertiary care centre

To determine the frequency and types of various ovarian teratomas amongst various age groups, and 2] To compare the results with other workers. Study Design: Retrospective study. The study was conducted at the Department of Pathology, Basic Medical Sciences Institute[BMSI], Jinnah Post graduate medical centre [JPMC], Karachi from 1[st] January 2001 to 31[st] December 2005. 1128 cases of ovarian biopsies were received for histopathological examination at the Department of Pathology, Basic Medical Science Institute, JPMC,Karachi.Out of 365 cases of ovarian neoplasms teratomas were separated, analyzed and classified according to the WHO classification system 1994 and their relative frequencies were recorded. Teratomas account for 14.52% [53/365] of all ovarian neoplasms. Mature cystic teratomas were the most common i.e 86.80% [46/53].Immature teratomas were 9.43% [05/53] followed by special subtypes 3.77% [02/53]. Mature cystic teratomas are the most common germ cell neoplasms of ovary. Immature teratomas are rare above 30 years of age

Frequency of endoscopic gastric neoplasms in five years at JPMC

Gastric cancer is among the most common malignancies in Pakistan. The aim of our study are i] to document different histological types of gastric malignancies as per age and sex ii] discuss its possible association in patients who underwent endoscopy and iii] compare our data with local and abroad studies. Retrospective study. This study was conducted in the Department of Pathology, Basic Medical Science Institute, Jinnah Postgraduate Medical Centre, Karachi, Pakistan, from 1[st] January 2003 to 31 December 2007. A total of 740 cases of gastric endoscopic biopsies were received for histopathological evaluation at the Department of Pathology, Basic Medical Science Institute, JPMC, Karachi. Out of these cases, a total of 70 gastric neoplasms were separated, analyzed and classified according to the WHO classification system and their relative frequencies were recorded. Gastric adenocarcinoma was the commonest neoplasm with male predominance in 5th to 7[th] decade of life, account for 88.57% [62/70] of all gastric neoplasms. Gastric lymphoma was the second common with 8.57%[06/70] and gastric carcinoid was least common with 1.43%[1/70] of all gastric neoplasms. This study highlights that adenocarcinoma is the most common gastric malignancy seen in most high risk group includes elderly males followed by lymphoma with no gender difference. So we advise regular endoscopic biopsies surveillance at least in high risk age group for the early detection of cancer

Histopathological grading and staging in liver biopsies of hepatitis C patients and their association with ALT levels

To perform the histological evaluation of liver biopsies and see its association with the serological levels of ALT. This was a prospective study based on liver biopsies of fifty hepatitis C patients, whose serum ALT levels were also estimated. H and E stained slides were examined to determine the histological activity and fibrosis score. Grade 1 activity was found in 44% of patients; whereas 42% had an activity of grade 3. About 44% cases having grade 1 activity had a mean ALT of 52.3 U/L while 42% cases having severe activity had a mean ALT of 76.14 U/L. The present study revealed a significant relationship of ALT with fibrosis [p < 0.005]. A steady and proportional rise in mean age with increasing score of fibrosis stage was also evident. Higher ALT levels are associated with more pronounced forms of necroinflammatory activity; however normal ALT level does not rule out severity of the disease suggesting that all such patients require liver biopsy to unearth clinically subtle but advanced liver disease

Morphological study of pathological lesions seen in pleural biopsies

To determine the frequency and types of different pathological lesions seen in pleural biopsies in our patients. This is a prospective study carried out in the Department of Pathology, Basic Medical Sciences Institute, Jinnah Postgraduate Medical Centre, Karachi. A total of 155 pleural biopsies over a period from 01st January 2007 to 30th June 2008 were reviewed. Haemotoxylin and Eosin [H and E] stained slides were examined to determine the various non- neoplastic and neoplastic lesions. Special stains were performed whenever required. Out of 155 cases of pleural biopsies, 110 cases were diagnosed as non-neoplastic lesions and 29 as neoplastic lesions. The remaining 16 cases were found inconclusive. The non-neoplastic lesions included chronic granulomatous inflammation consistent with tuberculosis 47 cases, chronic non-specific inflammation 42 cases and empyema 21 cases. Chronic granulomatous inflammation consistent with tuberculosis was found to be commonest non-neoplastic lesion with male predominance and maximum number of cases was seen in 2nd decade of life. Neoplastic lesions included adenocarcinoma 26 cases followed by undifferentiated small cell carcinoma, squamous cell carcinoma and malignant lymphoma each comprising single case. Adenocarcinoma was found to be commonest neoplastic lesion with slight female predominance and maximum number of cases was seen in 5th decade of life. The commonest non-neoplastic pleural biopsy lesion was found to be tuberculosis and the commonest neoplastic lesion was adenocarcinoma in pleural biopsy

Use of direct immunofluorescent microscopy in the diagnosis of vesiculobullous disorders of skin

To determine the relative frequencies of various vesiculobullous disorders of skin in our patients and the morphological and direct immunofluorescent patterns of these disorders. This retrospective study was carried out in the Department of Pathology, Basic Medical Sciences Institute, Jinnah Postgraduate Medical Centre, Karachi, Pakistan on all the cases of vesiculobullous disorders of skin diagnosed in the department from January 2002 to June 2007. All the skin biopsies received during the study period were reviewed and cases of vesiculobullous disorders were selected for detailed study. Direct immunofluorescent [DIF] staining was done on these cases using fluorescein isothiocyanate conjugate [FITC] labelled antibodies for IgG, IgA, IgM, C3c and Fibrinogen. The data was analysed statistically using SPSS software. A total of 62 DIF proven cases of vesiculobullous disorders of skin were studied. Pemphigus vulgaris [PV] was found to be the most frequent disorder [32.25%] followed by bullous pemphigoid [BP] with a frequency of 27.42%. The relative frequencies of pemphigus foliaceus [PF], dermatitis herpetiformis [DH], childhood bullous pemphigoid [CBP] and chronic bullous dermatosis of childhood [CBDC] were 20.96%, 6.45%, 4.83% and 6.45% respectively. One case each of IgA pemphigus [IgAP] and herpes gestationis [HG] were seen. IgA pemphigus can only be diagnosed after having observed the immunofluorescence pattern of this disorder. Definitive diagnosis of certain blistering lesions of skin requires the DIF microscopy. However, in special circumstances it needs to be reinforced with either salt split skin technique or immune electron microscopy

Thyroid carcinoma in Pakistan: a retrospective review of 998 cases from an academic referral center

To address the need for epidemiologic data on thyroid carcinoma in Pakistan, we evaluated the frequency and types of thyroid carcinoma with respect to age and sex. In a retrospective study conducted at the Jinnah Postgraduate Medical Centre in Karachi, we reviewed thyroid lesions reported over a period of 5 years, from July 2000 to June 2005. Pathology slides were studied to determine the types and frequencies of malignant lesions of the thyroid. Of 998 thyroid lesions reviewed, 153 cases were malignant. Papillary carcinoma was the commonest malignant lesion with a frequency of 90.2%, followed by 4.5% for medullary carcinoma, 2% for follicular carcinoma, 2% for undifferentiated carcinoma and 0.7% each for mixed medullary and papillary carcinoma and poorly differentiated carcinoma. Females were predominant [82.4%] as compared with males [17.6%] for a female-to-male ratio 4.7:1. The maximum number of the patients were in the fourth decade of life followed by the third and second decades. The commonest malignant thyroid lesion was papillary carcinoma. Thyroid cancer was more common in females. Papillary, medullary and follicular carcinomas were found in patients in the third and fourth decades of life, while poorly and undifferentiated carcinomas were diagnosed from the fifth to seventh decades of life

P53 Expression in benign, dysplastic and malignant oral squamous epithelial lesions

To observe the frequency of benign, dysplastic and malignant oral squamous epithelial lesions and to calculate p53 expression in these lesions. This was a retrospective study. All the oral biopsies received during the period 1st July 2000 to 30th June 2005 were reviewed. Histopathological parameters were noted. Immunohistochemical staining was performed to see the p53 expression in these lesions. There was a single case of benign lesion/papilloma, which showed basal p53 immunoexpression. The dysplastic lesions account for 10 cases. p53 immunoexpression was positive in 75% cases of the dysplastic lesions. Squamous cell carcnoma was found to be the commonest malignant oral epithelial lesions accounting for 412 cases. Malignancy grading was also performed which showed maximum number of cases between score of 9-12. p53 immunoexpression was found positive in 76.8% cases of squamous cell carcinoma. Squamous Cell Carcinoma [SCC] was found to be the commonest oral malignant epithelial lesion. p53 immunoexpression was found in 76.8% cases of oral squamous cell carcinoma. The p53 immunopositivity was increasing as the grade score was rising but decreasing further as the tumor became poorly differentiated. Combining histological analysis with p53 immunoexpression, evaluation of dysplastic lesions could be improved

Histopathological audit of goiter: a study of 998 thyroid lesions

Nodular goiter is the commonest Lesion of thyroid gland. This study was carried out to see histopathotogical pattern of thyroid enlargement. All thyroid lesions received in the Department of Pathology, Basic Medical Sciences Institute, Jinnah Postgraduate Medical Centre Karachi, over a period of five years were reviewed and relevant special stains were performed. A total of 998 Lesions were reviewed. Seven hundred forty three cases were found non-neoplastic and 255 were neoplastic Lesions. Multinodular goiter was found to be the commonest 91.3% non-neoplastic Lesion. In neoplastic lesions, there were 102 benign Lesions and 153 were malignant. All 102 benign Lesions were diagnosed as follicular adenoma as per existing criteria. Out of these, 35 cases showed questionable nuclear changes, which were categorized as well-differentiated tumours of uncertain malignant potential. Papillary carcinoma was the commonest malignant lesion with a total of 138 cases. The commonest cause of goiter was multinodular goiter. Papillary carcinoma was the commonest malignant Lesion

Gestational trophoblastic disease experience at the basic medical sciences institute, JPMC, Karachi

The study was carried out to evaluate the frequency and types of gestational trophoblastic diseases [GTD] in endometrial and hysterectomy specimen received for histopathology examination. Department of Pathology, Basic Medical Sciences institute, Jinnah Post Graduate Medical Center [JPMC] Karachi. One thousand three hundred forty two cases of endometrial curettage [EC] and 1832 hysterectomy specimens were examined. Out of 1342 cases of endometrial curettage [EC] 242 cases of hydatidiform mole and 5 cases of choriocarcinoma were seen, whereas out of 1832 hysterectomy specimens, 9 cases of invasive mole were seen. Hydatidiform mole was found to be the commonest gestational trophoblastic disease

Dermatofibrosarcoma protuberans

Dermatofibrosarcoma protuberans is a rare, locally aggressive, rarely metastatic skin tumor which tends to recur. A 45-year-old female presented with dermatofibrosarcoma protuberans on her breast as a recurrent nodule after excision. Lump was re-excised with wide margins and irradiated. Follow-up was done monthly for two years, with no recurrence

Angiomyofibroblastoma of the vulvoaginal region

To demonstrate the clinico pathological profile of four cases of Vulvovaginal Angiomyofibroblastoma. Setting: Department of Pathology, Basic Medical Sciences Institute and Department of Obstetric and Gynecology, Jinnah Postgraduate Medical Centre, Karachi, Pakistan. Four female patients with vulvo vaginal masses were studied. The microscopic and Immunohistochemical examinations confirmed that these vulvovaginal masses were Angiomyofibroblastoma distinct from aggressive angiomyxoma and characterized by a more indolent course. Angiomyofibroblastoma of vulvovaginal region is a distinct entity differing from aggressive angiomyxoma and must be considered in the differential diagnosis of the vulvovaginal masses

Tuberculosis with medullary carcinoma of thyroid; A clinical association, strange by st and ards

18 years old girl presented with right dominant lobe thyroid gl and in euthyyroid state. Radioisotope scanning revealed cold nodule and tine needle aspiration cytology reported follicular neoplasm. Subsequent histopathological examination revealed medullary carcinoma with tuberculosis. The medical literature abounds with evident association between chronic inflammatory process and neoplasia, considering chronic inflammation as risk factor for later. We searched the local and international medical literature in English language to find any association between neuro endocrine tumors and granulomatous inflammation. However to our knowledge no such association has so far been described, even in the form of clinical case report in any core medical journal

Solitary fibrous tumour of pleura

OBJECTIVE: To present a rare case of solitary fibrous tumour of pleura. DESIGN: Study in detail the histpathologicalfeatures of this tumour. SETTING: The Pathology department of BMSI, JPMC, Karachi. SUBJECT: An encapsulated tumour attached with the pleura. RESULT: The tumour was encapsulated, cut surface appeared fish flesh, pink-gray and rubbery in consistency. Microscopically the tumour was composed of interlac ing bundles of well differentiate fibrocollagenous tissue arranged in fascicles, storiform pattern or herringbone appearance on H and E, showed bluish green color on trichrome stain and coarse distribution of reticulin. SFT of pleura closely resemble other benign spindle cell tumour. Diagnosis is made on cellular morphology i.e. absence of pleomorphism, mitotic figures and other elements e.g. blood vessels. Special stains like trichrome highlight the fibrous origin of tumor

Aneurysmal bone cyst of skull - case report and review of literature

We report a case of Aneurysmal Bone Cyst ABC] arising in a rare location [Skull] of three years old female child presented at Department of Neurosurgery, Jinnah Postgraduate Medico I Centre, Karachi with history of gradually increasing swelling in parietal region since birth. Tumour was excised with clinical diagnosis of dermoid cyst. Histological examination revealed an aneurysmal bone cyst. A three year old female child presented with complaints of gradually increasing swelling on parietal region of the skull since birth. C.T. Scan showed lytic bone lesion. Excision of the lesion was done and submitted for histopathological examination. Examination revealed a whitish firm mass measuring 10xbx5 cms in dimension. The outer surface was smooth. Cut surface shows numerous dilated spaces of varying sizes and shapes separated by thick fibrous septae containing brownish and yellowish gelatinous material. Some spaces were empty. Microscopic Examination: Revealed a bone with lytic lesion composed of numerous blood filled cavernomatous spaces widely separated by fibrous connective tissue septae of variable cellularity. The walls of the cavernomatous spaces lacked normal features of blood vessels with no lining endothelial cells Multinucleated giant cells were prominent in some part of connective tissue. Osteoid and formation of new bony tissue was evident in some septae