Effectiveness of vascular markers [immunohistochemical stains] in soft tissue sarcomas

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

Clinicopathological study of solid pseudopapillary tumor of pancreas

Objective: To study the morphological and immunohistochemical features of solid pseudopapillary tumor of pancreas. Study Design: Retrospective study. Place and Duration of Study: Shaukat Khanum Memorial Cancer Hospital and Research Centre from Jun 2016 to Mar 2017

Material and Methods: Sixty-four patients [n=64] including 61 females and 3 males with pathological diagnosis of solid pseudopapillary tumor were selected from archives of Shaukat Khanum Memorial Cancer Hospital and Research Center for the period of 2000-2017. For the sample selected, their morphological features and immunohistochemical profile were reviewed and analyzed. The morphological features are considered as gold standard for the diagnosis

Results: The mean age was 33 years [range 8-50 years]. Immunohistochemical stains were performed on formalin fixed paraffin embedded section of 55 cases. Pancytokeratin was performed on 8 cases, out of which only 2 cases showed positivity. CD10 was performed on 14 cases, out of which only 12 cases showed positivity. Neuron specific enolase [NSE], CD56, vimentin, progesterone receptor [PR] and beta catenin were performed on 8, 5, 3, 13 and 16 cases respectively and showed positivity in majority of cases. Neuroendocrine markers [chromogranin and synaptophysin] were performed on 25 and 6 cases, from which it showed weak positivity in 3 cases. CD99 was performed on 19 cases and showed characteristic dot like staining

Conclusion: Among the immunohistochemical stains, CD99 had a specific dot like staining pattern and was used as a first line marker in diagnosis

Comparing histopathological and magnetic resonance imaging based mesorectal fascia status in patients with rectal carcinoma

To compare mesorectal fascia status on histopathological findings with MRI based radiological mesorectal fascia status in patients with rectal carcinoma taking histopathology finding as gold standard. Analytical study. Department of Pathology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, from January 2011 to April 2012. Biopsy proven cases of rectal adenocarcinoma undergoing abdominoperineal resection were included in this study. Microscopic examination of slides was done to determine mesorectal fascia status as involved or otherwise without knowing the results of mesorectal fascia status on MRI. Mesorectal fascia status of MRI was determined by a radiologist who was not aware of the histopathological assessment of mesorectal fascia. Mean and standard deviation was calculated for age. Frequency and percentage were calculated for gender and mesorectal fascia status. 2 x 2 table was generated to calculate sensitivity, specificity, positive predictive value and negative predictive values and diagnostic accuracy of MRI for mesorectal fascia involvement taking histopathology as gold standard. The sensitivity of MRI to detect mesorectal fascia involvement was 23.07% and specificity was 70.5%. Positive predictive value of MRI was 10% and negative predictive value was 54.54%. Diagnostic accuracy of MRI for mesorectal fascia involvement was calculated as 50%.MRI findings regarding mesorectal fascia status as involved or otherwise are not helpful when compared with histopathological findings which is the gold standard.

Immunohistochemical expression of CD-10, BCL-6 and MUM-1 antibodies and immediate clinical response in patients of diffuse large B-cell lymphomas after six cycles of chemotherapy

To determine the expression of CD-10, BCL-6 and MUM-1 in patients with diffuse large B-cell lymphoma [DLBCL] and its association with immediate clinical response after six cycles of CHOP chemotherapy. Analytical study. Armed Forces Institute of Pathology [AFIP], Rawalpindi in collaboration with Nuclear medicine, Oncology and Radiotherapy Institute [NORI], Islamabad from September 2010 to September 2011. CD-10, BCL-6 and MUM-1 antibodies were applied on cases diagnosed as DLBCL. Immediate clinical response was noted after 6 cycles of chemotherapy with the help of oncologist and divided into complete response, partial response, stable disease and relapse/ progression. Patient's age, results of expression of CD-10, BCL-6 and MUM-1 and results of immediate clinical response to chemotherapy were noted. Regarding analysis of prognostic markers [CD-10, BCL-6 and MUM-1], chi-square test was used for immediate clinical response to chemotherapy in DLBCL. CD-10 was positive in 40% cases, BCL-6 in 58.7% cases and MUM-1 was positive in 46.7% cases. About 41.3% of patients showed complete response, 10.6% partial response, 17.3% stable disease and 30.8% showed relapse/progression. CD-10 expression in DLBCL was associated with better immediate clinical response [p = 0.011] whereas MUM-1 expression in DLBCL was associated with poor immediate clinical response [p < 0.0001]. However, there was no statistically significant association of BCL-6 with immediate clinical response [p = 0.22]. DLBCL shows expression of CD-10, BCL-6 and MUM-1 in nearly fifty percent of the cases. CD-10 is associated with good whereas MUM is associated with poor response. However, there was no association of BCL-6 with immediate clinical response

Diagnostic utility of endoscopic ultrasound guided aspiration cytology in evaluation of pancreatic masses

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%

Dengue fever outbreak in Lahore

Dengue fever has now affected all the major cities of country. About 41,354 patients underwent antibody screening for dengue fever from Shaukat Khanum Memorial Cancer Hospital, Lahore, during the epidemic period [October 1st 2010 to December 20[th] 2010]. Out of them, 1294 [3.1%] patients were positive for IgM antibodies, and 124 [0.3%] for IgG antibodies. A total of 722 [1.7%] patients were borderline positive for IgM antibodies and 108 [0.26%] were borderline positive for IgG antibodies. Dengue fever has emerged as a global problem over the last 5 years. It has also hit Lahore badly especially after the floods in 2010. High index of suspicion should be there in case of related symptoms

Primary pulmonary rhabdomyosarcoma

Rhabdomyosarcoma is the commonest soft tissue malignancy in children; its common sites of occurrence include head and neck regions, chest wall, abdomen, perineal and anal regions. Lung is an unusual site. We report a case of two years old female child who presented with fever cough, shortness of breath and chest pain. Radiological examination showed a bullous lesion in the left lower lobe. Histological examination of bullectomy specimen revealed sheets and clusters of round blue cells with mild to moderate atypia. There were some hypocellular areas containing characteristic perivascular arrangement of tumour cells. Tumor cells showed strong positivity for Desmin. Based on histopathological and immunostain findings, diagnosis of Embryonal Rhabdomyosarcoma was made

Two unusual tumours in a patient of xeroderma pigmentosum: angiosarcoma and basosquamous carcinoma

Xeroderma pigmentosum [XP] is a rare form of genodermatosis, characterized by cutaneous pigmentary changes, sensitivity to light and development of multiple cutaneous and internal malignancies at an early age as a result of nucleotide excision repair defect after ultraviolet light exposure. Cutaneous angiosarcomas are angry neoplasms that are rarely associated with XP. In this communication, we report the case of a 22-year-old male patient with XP who developed an angiosarcoma of the face and a basosquamous carcinoma at one time. It is probably the first such case reported from Pakistan

Demographic profile of keratinocyte tumours

Keratinocytic tumours of epidermis constitute the bulk of neoplastic lesions of the skin, and comprise benign, borderline and malignant lesions. To study the characteristics of keratinocytic turnours in our hospital population and compare the collected local data with the available international data. This cross-sectional, descriptive study was conducted in University of Health Science and Mayo Hospital, Lahore from March 2010 to October 2010. A total of 112 consecutive cases of histologically diagnosed keratinocytic tumours were included in the study. Age, gender, histologic types and site distribution of these tumours were recorded and analyzed. Among keratinocytic tumours, basal and squamous cell carcinomas were the most frequent malignant lesions and viral warts were the commonest benign lesion. Males were affected more commonly than females. Patients were in the age range of 13-85 years. Head and neck region was the most frequent site of involvement. The results of the study are comparable with international data regarding age, gender and site distribution of keratinocytic tumours.

Role of immunohistochemistry [IHC] in diagnosis of ovarian malignancies - is there any change from before?

Ovarian malignancies account for about 3% of all cancers in women. After the development of immunohistochemishy, it is now considered an essential part in diagnosing malignant ovarian tumours, including metastatic tumours. To compare between the frequencies, histological patterns and histogenesis of malignant ovarian tumours before and after the advent of immunohistochemistry. This descriptive cross sectional study was conducted at department of histopathology, Armed Forces Institute of Pathology [AFIP] Rawalpindi from 1[st] Jan 2010 to 10[th] Dec 2011. A total of 128 cases of malignant ovarian tumours were included. After gross and histological examination, a panel of immunohistochemistry markers was applied and tumours were classified according to WHO classification. Most frequent malignant tumours were surface epithelial tumours [54.8%] followed by metastatic tumours [12.7%]. Frequency of metastatic tumours was higher in our study as compared to other studies. Immunohistochemistry plays an important role in correct diagnosis of malignant ovarian tumours and also in identifying metastatic tumours.

Role of p63 in differentiating morphologically ambiguous lesions of prostate

To observe the role of p63 staining in evaluation of morphologically ambiguous lesions of prostate. Descriptive [case series] study. Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, from March to September 2010. p63 immunohistochemistry staining was performed on 30 cases diagnosed as morphologically ambiguous lesions of prostate by histopathologist. Patient's name, age, histology numbers, morphological features, expression of p63 and histopathological diagnosis were recorded and described as frequency percentages. The prostatic adenocarcinomas were negative for p63 and benign lesions of prostate were positive for p63. Atypical lesions show positive staining in 77.7% and negative staining in 33.3% of cases. p63 immunohistochemistry staining can be used as a reliable marker to distinguish between benign from malignant morphologically ambiguous lesions of prostate

Patterns of fatal head injuries due to road traffic accidents autopsy findings at AFIP Rawalpindi, Pakistan

To analyze the antopsy findings in cases of fatal head injuries due to road traffic accidents. Descriptive Study. Armed Forces Institute of Pathology Rawalpindi from 2004 to 2008. The present study was conducted to ascertain the patterns of fatal head injuries due to road traffic accidents as documented during autopsies performed at AFIP, Rawalpindi during the five years period [2004-2008]. Data were analyzed using SPSS version 14. Mean, median and mode were calculated for quantitative variables 'like age and hospital stay. Frequencies and percentages were calculated for qualitative variables like time of accident, pattern of head injury, skull bones fractured, and other associated injuries, passenger status of deceased and duration of hospital stay. Out of 550 postmortem cases received during the study period, 57 [10.4%] deaths were due to head injuries. The age ranged from 19 to 51 years with mean age of 35.6+ 7.9 years. Most [50%] of the deaths occurred in 4th decade and during daytime 34 [59.6%]. Majority of subjects died on spot 40 [70.1%]. Most of the deceased suffered from more than one compartment hemorrhage 30 [52.6%] and multiple skull bone fractures 24 [42.1%]. November was the month in which most of the deaths occurred 13 [23.1%] followed by September 7 [17.5%]. Majority 36 [63.1%] of subjects were traveling as passengers. Head injury is one of the most frequent causes of death in road traffic accidents. Most of the deaths occur on spot before any life support can be given to these subjects. The pattern of skull fractures observed, was quite comparable to other studies. It indicates that road traffic accidents lead to similar kinds of fatal head injuries throughout the world. The frequencies of such injuries are more frequent in developing world due to the lack of traffic safety regulations

Reliability of MRI in measuring tongue tumour thickness: a 1.5t study

Background: Tongue tumour thickness has been shown to have a correlation with neck nodal metastasis and hence patient survival. Current AJCC guidelines recommend inclusion of tongue tumour thickness measurement in routine radiologic staging. Several studies have attempted to define the accuracy of MRI in measuring tongue tumour thickness. The aim of our study was to compare tongue tumour thickness measured at T2-weighted and STIR sequences with histologic tongue tumour thickness. Methods: Twenty-eight consecutive patients of tongue cancer who had undergone glossectomy were selected retrospectively. Tumours were measured in both STIR axial and T2- weighted coronal images and compared with histologic tumour thickness on resected specimens. Pearson's analysis was performed to determine the degree of correlation. Paired samples t-test was also used for comparison of mean tumour thicknesses measured on MRI with mean histologic tumour thickness. Results: Pearson correlation analysis showed good correlation of tumour thickness measured on MRI with actual histologic tumour thickness [R=0.876]. Conclusion: MRI provides a satisfactory prediction of tongue tumour thickness which in turn can be used to determine the need for elective neck dissection in these patients. Keywords: Lymphatic Metastasis, Magnetic Resonance Imaging/methods, Tongue Neoplasms

Morphological characterization of renal tumours according to decades of life: experience at AFIP Rawalpindi, Pakistan

To evaluate morphological characterization of renal tumours according to decades of life and to compare it with other national and international studies. Descriptive study Place and duration of study: The retrospective study was carried out in the Department of Histopathology, Armed Forces Institute of Pathology [AFIP] Rawalpindi during the years 2005 to 2008. Data of 236 nephrectomy specimens diagnosed as renal tumours during the years 2005 to 2008 was retrieved from tumour registry of AFIP, Rawalpindi. The morphological characterization of these tumours according to decades of life was done and compared with the international data. Of 236 cases of renal tumours, 169 [72%] were males and 67 [28%] were females. The mean age of the patients was 50 years [SD=18.5] ranging from 1 to 80 years. The most common histological diagnosis in adults was conventional renal cell carcinoma in 172 [73%] patients followed by papillary renal cell carcinoma in 20 [8.5%] patients. Among children Wilm's tumour was the most common in 21 [9%] of patients. Conventional renal cell carcinoma was most commonly diagnosed in the patients aged between 51 to 60 years [52 cases] where as 17 out of 21cases of Wilm's tumour were diagnosed in the age group of 1 to 10 years. Renal cell tumours are diagnosed in all ages. Conventional renal cell carcinoma and papillary renal cell carcinoma are the most common types in non pediatric age group whereas Wilm's tumor is most common type in pediatric age group. The chromophobe renal cell carcinoma was very rare in our study. Males had a greater incidence as compared to females and incidence of renal tumours has the trend of increase over the years

Gunshot wounds - autopsy findings at AFIP Rawalpindi

To provide information about details of firearm injuries as observed during autopsies performed at the Department of Histopathology AFIP, Rawalpindi, Pakistan. This was a descriptive study. A total of 300 autopsies carried out during the years [Sep 2005 - Dec 2008] were retrieved from the autopsy record of Armed Forces Institute of Pathology, Rawalpindi. Out of these, 28 autopsies were performed after death due to firearm injuries. The variables selected were: age of deceased, time of death, weapon used, number and site of entry and exit wounds, mode of death and distance of the used firearm from the body at the time of gunshot as indicated in circumstantial evidence. Out of total of 300 autopsies, 28[9.33%] died of gunshot injuries. Most deaths occurred in the 3[rd] decade [67.9%]. Most of the subjects had single [60.7%] entry wound while half had a single [50%] exit wound. Most of the entry wounds [60.7%] had diameter < 2cm and exit wounds [35.7%] had a maximum diameter in the range of 2-5cm. Most frequent used weapon was rifle [82.1%]. Anterior chest [n=12] [42.9%] sustained the highest number of injuries. In suicidal deaths, heart and left lung [n= 4] [57.14%] were most commonly hit anatomical site. The weapon was in contact with the body at the time of gunshot in all suicidal deaths. The distance was less than ten meters in accidental deaths [7.1%]. Out of 6 [21.4%] homicidal deaths, distance was in the range of 100-200 meters in 3[50%] cases and 300-400 meters in remaining 3[50%] cases. Mode of death [suicidal/homicidal/accidental] could not be determined on postmortem examination only. Circumstantial evidence was necessary in the assistance of these findings. All details of firearm wounds including site, size, shape and appearance of surrounding tissue are required to be documented in autopsy reports to ascertain the exit and entry wounds. The detailed description of wounds provided additional information to ascertain possible distance of weapon from body and help in confirming mode of death

Epithelioid haemangioendothelioma of the palate

Epithelioid Haemangioendothelioma [EHE] is an uncommon malignant vascular neoplasm that can develop at any anatomical site. In our report we describe a case of oral Epithelioid Haemangioendothelioma. A 13 years old male boy presented in the Oral Surgery Department of Armed Forces Institute of Dentistry with a growth in the left hard palate for the past 3 weeks. The growth was removed surgically and the specimen was sent to the Histopathology department of Armed Forces Institute of Pathology. On the basis of morphological features it was diagnosed as Epithelioid Haemangioendothelioma of the palate

Clinicopathological evaluation of nasal biopsy specimens- and afip experience

To evaluate the presence and frequency of clinically significant microscopic diagnosis in cases under going nasal polypectomy/biopsy. Cases of nasal polypectomy/biopsy reported from department of histopathology during last five years [2004-2008] were retrieved from records and evaluated microscopically for detailed histological diagnosis. A total of 383 cases were reviewed. Most frequent age was 5[th] decade. Nasal polepectomy comprised 54.73% [n=214]. Nasal Biopsy not otherwise specified comprised 21.99% [n=86]. Suspicious of growth was indicated in 23.27% [n=84] cases. Among all types of biopsy, 60.04% [n=230] were inflammatory nasal polyps, 10.44% [n=40] malignant neoplasm, 5.48% [n=21] were inverted papilloma. Rest of the cases [24.03%] showed benign inflammatory changes and benign neoplastic lesions. Although frequency of neoplastic lesion in routine polypectomy specimen as mentioned in literature is low. Our study reveals significant number of malignant cases. Considering the prognostic significant of early histological diagnosis and appropriate post considered essential. Large scale studies are required to evaluate clinicopathological correction of nasal biopsy specimens in our setup

Case report co-existing endometrial stromal sarcoma and leiomyoma-uterus - a case report

Leiomyoma of the uterus is an extremely common neoplasm with overall incidence of 4-11% and nearly 40% in women over the age of 50 yrs [1]. Endometrial stromal tumors tend to occur in middle aged women with average age of 45 years. Endometrial stromal sarcomas constitute about 10-15% of uterine malignancies with mesenchymal component [2]. Combined smooth muscle-stromal tumor is a rare entity and it is also called as stromomyoma in old literature [3]. We labeled our case as CO-EXISTING ENDOMETRIAL STROMAL SARCOMA [ESS] AND LEIOMYOMA-UTERUS PRESENTING AS SEPARATE MASSES which is different from combined smooth muscle-stromal tumor as evident from discussion below