Small B cell Non-Hodgkins Lymphoma in Pakistan

To study the pattern of small B cell lymphomas in Pakistan. This descriptive study was carried out at the Aga Khan University Hospital pathology department including 1721 cases of Non-Hodgkins Lymphoma [NHL] diagnosed during a period of five years [1998-2002] and classified according to REAL/WHO classification. The antibodies used included Leukocyte Common Antigen [LCA], Pan B [CD20, CD79a], Pan T [UCHL-1], Bcl 2, Mib 1[Ki 67] and Cyclin D1 [Dako, Denmark]. Out of the 1721 NHL cases, only 140 [8.1%] could be categorized as small B-cell NHL. The study group comprised small lymphocytic lymphoma/chronic lymphocytic leukemia [58 cases; 41.4%] followed by follicular lymphoma [46 cases; 32.9%], mantle cell lymphoma [15 cases; 10.7%], extra nodal marginal zone B cell lymphoma of MALT type [15 cases; 10.7%], lymphoplasmacytic lymphoma [5 cases; 3.6%] and splenic marginal zone B-cell lymphoma [1 case; 0.7%]. No case of nodal marginal zone lymphoma was diagnosed. The age ranged from 18 to 98 years with a mean and median of 54.64 and 58.50 years respectively. Small B-cell NHL was more common in males; with male to female ratio of 2.1. Majority of the small B-cell NHL were nodal at presentation with a nodal to extranodal ratio of 3.4. It is concluded that the frequency of these small B-cell NHL is very low in our population in contrast to the western literature. Further studies based on epidemiologic and etiological factors are required to look into this marked difference of occurrence of these indolent lymphomas

Ductal Carcinoma in Situ [DCIS] in Karachi

To study the frequency of ductal carcinoma in situ [DCIS] in a large pathology series. DCIS is a proliferation of non-invasive, malignant epithelial cells within the ductolobular system of the breast. It is a heterogeneous entity with several morphologic variants that differ in gross appearance, growth pattern, cytologic features, mammography, and malignant potential. The data of The Aga Khan University' Pathology Department, diagnosed on the basis of histopathology, during a 6-year period [1st January 1998 to 31st December 2003] was reviewed, all cases of DCIS studied, and data was analyzed with the help of analytical software SPSS. Thirty-eight cases of DCIS were reported to the Aga Khan University Pathology Department, during a 6-year period [1998 to 2003], comprising approximately 1% of all breast cancers reported to the unit in the same period. The mean age of the patients at diagnosis was 48.95 years [CI 95% 44.6; 53.3]. Approximately half the cases occurred in the 45-54 year age group [figure 1]. Two cases [5.3%] were recurrences with previous lumpectomy scars. Comedo necrosis was observed in five [13.2%] cases, whereas 33 [86.8%] cases were non-comedo type. The clinical presentation was a palpable mass [92.1%], nipple discharge [5.3%] or clinically occult lesions diagnosed on mammography [2.6%]. Approximately half the patients presented with a grade 2 disease.A typical ductal hyperplasia was observed in a third of the cases, predominantly associated with a grade 1 and 2 disease. The estrogen and progesterone receptor status was studied in 12 [31.6%] cases. Estrogen positivity was observed in 11 [91.7%] cases and progesterone positivity in 7 [58.3%] cases. Microcalcification was observed in four [10.6%] cases. The cases reported in this study are the indolent grade 1 or 2 cases with a non-comedo pattern, and a positive estrogen and progesterone receptor status. If untreated, only 40% of these innocuous forms of DCIS become invasive over a time span of approximately 25-30 years. In Pakistan we are missing the more aggressive forms of DCIS which have a shorter transition to invasive carcinoma [JPMA 55:199;2005]

Malignant Smooth Muscle Tumours of Soft Tissue - a demographic and clinicopathological study at a tertiary care hospital

To determine the demographic characteristics and distribution of various reported prognostic factors of leiomyosarcoma [LMS] among subjects reporting to histopathology diagnostic centers of Aga Khan University [AKU] all over Pakistan between 2000-2004. This study analyzed 205 consecutive confirmed cases of LMS received during a period of four years. The data regarding age, sex and size of tumor was obtained from the pathology medical records. Data on grade and positivity of immunohistochemical stains was assessed and all the variables analyzed using SPSS version 12.5. Of the 205 specimens of LMS, 31 were received as blocks for second opinion. A hundred specimens were multiple fragments, and 74 were intact masses. Of the latter, 40% had clear margins. The mean size of the tumor was 7.23 cms. [95% CI 6.1; 8.4]. There were no cases of childhood LMS. Teenage LMS comprised 3% of all tumors. Grade 1 tumors were 16.6% of the total, 56.6% were grade 2, and 8.5% were grade 3. Vimentin positivity was observed in 97% of the tumors, desmin positivity in 56.7%, HHF35 positivity in 81.0%, s-100 positivity in 15.6% and cytokeratin positivity in 11% of the cases. The median age of LMS patients was 48.4 years, the mean age was 48.6 years [95% CI 45.9; 50.8] and male to female ratio was 1:1.2. The malignancy occurred a decade earlier in the females as compared to the males. The mean age of male cases was 52.3 years [95% CI 48.8; 55.8]; and of females was 45.2 years [95% CI 41.8; 48.6]. The mean age of teenage LMS was 17.2 years [95% CI 15.6; 18.7]. The most common symptom was a painless swelling. The most common sites were lower limb [24.4%] and pelvis [24.4%] followed by abdomen [20.6%] and head and neck [12.7%]. The least common sites were upper limb and chest [8.0% each]. Seventy five percent of the tumors with involved margins were more than 5.0 cms. in size whereas 47% of tumors with free margins were above 5.0 cms. in size. Approximately half the tumors in the males were less than 5.0 cms, as compared with 31.0% in the females. LMS in the extremities was equally common in both genders, but trunk LMS was nearly twice as common in the females. In our population, leiomyosarcoma occurs at a relatively younger age, has a late presentation; is more common in females as compared to males and usually excised incompletely. No genetic study for LMS has been published in Pakistan; these studies are recommended to determine the biological pattern of LMS in our population

pattern of malignancies in Karachi [1995 to 1996]

OBJECTIVE: To determine the cancer pattern of the city of Karachi for the years 1995-1996. METHODS: The Karachi Cancer Registry, established in 1995 by the Government of Sindh, in collaboration with the IARC is an active registry. The staff collect the data pertaining to cancer patients and record it on the registry forms. Hospitals in Karachi, district south as well as some of the hospitals in other districts of the city, where patients are likely to go for treatment or diagnosis are visited. People residing in the district for more than six months prior to the onset of the malignancy were considered 'residents'. All the cases diagnosed on or after 1st January 1995 till 31st December 1996 were considered for analysis. In the years 1995-96, the most common cancer sites among males were cancers of the lung, oral cavity and lymph nodes. For females, breast cancer ranked first, followed by cancer of the oral cavity and ovary. The age standardized rate for all cancers was 96.3 per 100,000 in males and 96.9 per 100,000 in females. At this early stage of registration we assume that the registry has a missing rate of approximately 20-25%. The pattern of malignancies in Karachi is similar to the western countries, with lung and breast being the commonest tumors amongst the males and females respectively. The Asian countries have stomach/lung/oral cavity/liver as the commonest tumors amongst the males and cervix/breast amongst the females. Pakistan being a Muslim country, the incidence of cervical cancer showed an expected low figure