The Expression of Programmed Death Ligand-1 within Stages of Oral Squamous Cell Carcinoma: Immunohistochemical Analysis

Background: Oral squamous cell carcinoma is prevalent in South Asian countries with rising cases of its incidence and mortality. Despite advancements in treatment, survival and recurrence rates are poor. Immunotherapy is a novel therapeutic modality in immunooncology. Immune checkpoint proteins are under investigation for clinical implications amongst which Programmed Death Ligand-1 has shown valuable results in certain malignancies. Aims: To determine the immunohistochemical expression of Programmed Death Ligand-1(PD-L1) in oral squamous cell carcinoma and to find an association of Programmed Death Ligand-1 with stage and clinicopathological parameters of oral squamous cell carcinoma.Study Design:Cross-sectional study.Place and Duration of Study:Ziauddin Medical University, Karachi, 1 Year duration during 2018-2019.Methods: A total number of140 biopsy confirmed cases of oral squamous cell carcinoma were recruited in the study. Immunohistochemical expression of Programmed Death Ligand-1 was evaluated and associated with the clinicopathological parameters of oral squamous cell carcinoma (OSCC). The data was statistically analyzed through Descriptive statistics and Chi square test by using SPSS v.20.Results: Out of 140 participants, 74% were males (n=103) and 26% were females (n=37). Programmed Death Ligand-1 positivity was observed in 62.1% of cases (n=87). The Mean age of the participants was 48.91 ± 11.7 years. The most common site of cancer involvement was buccal mucosa and majority of participants were habitual of consuming chewable products i.e. Pan, Gutka and betel nut (89; 64%). Stage III and IV tumours comprised a major portion of cases in our study.(52; 37%), (56; 40%).A statistically significant p-value was noted for the association of Programmed Death Ligand-1 with stage II and IV tumours. (P-values: 0.029, 0.001)The association of Programmed Death Ligand-1 with other variables such as age, gender, ethnicity, sites or habits was not statistically significant.Conclusion:This study concludes that the statistical significance of Programmed Death Ligand-1 expression with tumour stage is suggestive of worsening prognosis and might have detrimental effects as tumour progresses in advanced stage. Programmed Death Ligand-1 positivity in patients having oral squamous cell carcinoma could be useful in future research in the light of cancer immunotherapy which has shown success in oncology.

Keratins in Oral Cancer: an overview

Oral Squamous Cell Carcinoma [OSCC] is an aggressive epithelial malignancy which has a rising incidence in the developing countries. Karachi South has reported OSCC as the second most common cancer in both genders according to 2002 statistics.It has a high mortality rate and is usually diagnosed at late stages. Precise and early diagnosis of OSCC by pathologists is important for optimum patient management. Keratins formerly known as cytokeratins are epithelial predominant intermediate filament proteins. They are a component of the keratin containing intermediate filaments in the intra cytoplasmic skeleton of epithelial cells.Keratins maintain structural integrity of epithelial cells and have certain regulatory functions as well. The expression of various keratins is found to be altered during and after the neoplastic transformation in oral malignancy and several of these can be used in immunohistochemical diagnosis and also in classification and subtyping of oral tumors.Therefore, differential expression of various keratins is extensively used in routine diagnostic pathology for precise categorization of oral cancer and also have been shown to have prognostic value

Ductal and acinar adenocarcinoma of prostate: morphological and immunohistochemical characterization

We sought to characterize the ductal and acinar subtype of prostate adenocarcinoma using hematoxylin and eosin [H and E] staining and an immunohistochemical antibody cocktail. We also investigated the clinical features, prostate-specific antigen [PSA] levels, and biological aggressiveness of these tumors. We utilized tumor bearing prostate biopsies, obtained between 2010 and 2014 from Dow Diagnostic Research and Reference Laboratory, to identify cases of prostatic ductal and acinar adenocarcinoma using routine H and E and immunohistochemical staining. The immunohistochemical antibody cocktail 34beta E12/p63/AMACR was used for staining. The association of clinicopathological variables including patient's age at diagnosis, Gleason score, and PSA levels before surgery was retrospectively analyzed. A total of 10 ductal and 140 non-ductal cases were identified. Ductal cases were predominantly high grade with advanced histopathological features [90%; p=0.030]. Marked elevation in PSA level was also reported in most cases. No other significant statistical difference was observed. Pathological and immunohistochemical examination could be used to characterize ductal and acinar adenocarcinoma of the prostate. Ductal adenocarcinoma of the prostate is a rare subtype of prostate carcinoma and is be more likely to present with advanced grade cancer suggesting that timely detection of the disease is vital

Familial, hereditary and sporadic characterization of prostate cancer and impact on diagnostic modalities

Background: A family history of prostate cancer has been associated with increased risk of prostate cancer development, but the risks were inconsistent in terms of the affected family members and the data on prostate cancer characterization with respect to family history of disease among Pakistani men is limited

Objective: To characterize prostate cancer based on family history into familial including hereditary and sporadic cases and to investigate the association with diagnostic modalities; age of patient at diagnosis and pathological tumor grade

Methods: A self-administered written questionnaire was forwarded to 100 patients diagnosed with prostate adenocarcinoma, containing questions about age at diagnosis and cases of prostate cancer in family. The information regarding age of patient at diagnosis, cases of prostate cancer in relative, pathological tumor grade and age at death for all relatives affected by prostate cancer was acquired. The data was validated through the biopsy report of patient and medical records of relative affected by prostate cancer, provided by patient respectively. Patients were then divided into three groups according to their family history: familial prostate cancer [FPC], hereditary prostate cancer [HPC] and sporadic prostate cancer [SPC] groups

Results: 17% of the patients were categorized in the FPC group, of which 2% were identified as having HPC and 81% were assigned SPC group. Overall, there was no significant statistical difference between groups and study variables

Conclusion: We found no difference in age and pathological tumor grade, in patients diagnosed with adenocarcinoma of prostate following TURP. These results are consistent with previous studies except that patients with HPC in previous studies were significantly younger at diagnosis

Perception of HPV in children

Human papillomavirus [HPV], with its more than 100 genotypes, is a cause of different diseases, ranging from malignant epithelial tumors such as squamous cell carcinoma in cervix and mouth to benign skin warts. HPV transmission generally occurs through direct person to person contact and exposure to infected material. Since the involvement of HPV in oral carcinoma in adults has been established, high risk strains are being explored in oral cavity of children. The presence of HPV in children presents a serious problem especially when the modes of viral transmission in child always remain a controversial issue. In children presence of HPV shows a strong indication of sexual abuse, though infection from direct contact cannot be ruled out, since the virus has been proven to thrive successfully at a range of sites and infect healthy people. This review aims to discuss HPV mode of transmission in children and its associated epidemiology

Glial Fibrillary Acidic Protein [GFAP] as a mesenchymal marker of early hepatic stellate cells activation in liver fibrosis in Chronic Hepatitis C infection

Objective: This study aims to determine expression of Glial Fibrillary Acidic Protein and of Alpha Smooth Muscle Actin [a-SMA] in hepatic stellate cells of CMC cases and their association with stage of fibrosis

Methods: The study was conducted at Ziauddin University, Clifton Campus during the year 2010-2012

Sixty Chronic Hepatitis C cases were immmunostained using anti a-SMA antibody and anti-GFAP antibody

Semi quantitative scoring in pericentral, periportal and perisinusoidal area of each case was done to assess immunoexpression of each marker

Results: Immunoexpression of GFAP showed significant association with a-SMA. GFAP expression was inversely correlated with progression of fibrosis

Conclusion: GFAP could represent a useful marker for early hepatic stellate cells activation

Follow up biopsies showing decline in GFAP levels may help identify the target group requiring aggressive therapy

Helicbacter pylori clearance and eradication with triple therapy in duodenal ulcer patients

Triple therapy was given to 49 chronic helicobacter pylori positive chronic duodenal ulcer cases to see its efficacy in H. pylori clearance, eradication and ulcer healing. H. pylori clearance and eradication rates at weeks 5 and 8 were 87.8 percent and 81.5 percent while ulcer healing rates 68.2 percent and 81.5 percent respectively. Seven [18 percent] cases failed to clear H. pylori and were classified as non-responders. Histologically 60 percent showed post-treatment regression of gastritis. Tolerance to drugs was excellent with a good compliance rate

Predictive value of MCV/RBC count ratio to discriminate between iron deficiency anaemia and beta thalassemia trait

Two forms of hypochromic microcytic anaemia i.e. iron deficiency and beta-thalassaemia trait are common in our society. This study reports the prevalence of iron deficiency anaemia and beta-thalassaemia trait and predictive value of MCV/RBC count ratio to discriminate between two. Venous blood was taken from 299 students of Karachi Medical and Dental College and Ziauddin Medical University in Na2 EDTA and analyzed by semi-automated Sysmex K-1000 haematology analyzer. MCV/RBC count ratio was used to discriminate between iron deficiency and beta-thalassaemia trait and > 14% was marked as iron deficiency. Hb electrophoresis was used as gold standard test for confirmation. Serum iron and TIBC was performed to confirm iron deficiency anaemia. Iron deficiency was found in 9% while beta-thalassaemia was seen in 3% students. MCV/RBC count ratio showed a positive predictive value of 91%. In areas where iron deficiency anaemia and beta-thalassaemia trait are common, MCV/RBC count ratio can be used to screen out beta-thalassaemia trait

Thyroid hormone levels in hepatitis B

Thyroid hormone levels were estimated in fifty patients with hepatitis B. In acute phase, T[3] was raised in 10% and T[4] in 60%. This rise was directly proportional to the transaminases levels. Twenty cases were also studied in the recovery phase where thyroid hormones returned to within normal limits. This rise of T[3] and T[4] in acute phase is attributed to increased thyroxin binding capacity due to release of thyroid binding globulin into circulation from necrosing hepatocytes

Economy and quality assessment of home made clinical chemistry reagents

Most laboratories in Pakistan use expensive imported clinical chemistry reagent kits resulting in high cost/test to the patients. To reduce these costs, reagents were prepared from basic chemicals, substrates and enzymes imported from Sigma Chemical Company U.K. This reduced the cost/test by upto 500% in some reagents. The quality of these reagents was tested by Wellcome External, Q.C. Locally prepared reagents were comparable to or better than commercial reagents systems in terms of accuracy and precision. This paper describes the preparations according to I.F.C.C., costs and quality control of some of the reagents i.e., glucose, calcium, bilirubin, albumin, total protein, urea, ALT, AST and LDH and their comparisons with equivalent commercial kits