Success of surgical treatment of basal cell carcinoma: role of intraoperative frozen section

Objective: To determine the success rate of surgical excision assisted with intra operative frozen section technique; in patients with high clinical suspicion of basal cell carcinoma at aesthetically important areas

Study Design: Descriptive cross-sectional

Place and Duration of Study: Department of Histopathology, Army Medical College and Armed Forces Institute of Pathology, Rawalpindi in collaboration with department of Dermatology, Pak Emirates Military Hospital, Rawalpindi from Dec 2016 to Jun 2017

Material and Methods: A total of fifty one [n=51] patients between age 35-75 years with high clinical suspicion of basal cell carcinoma of any size or histology on aesthetically important areas who were planned for surgical excision were enrolled in the study. Success rate was assessed in terms of tumor free margin on histopathology report

Results: Mean age of study subjects was 54.7 years +/-13.4 SD with M:F of 1.43:1. Success rate was found to be 84.3 percent [n=43/51]. No significant difference was observed in success rate after stratification with respect to gender, age, types of BCC [p>0.05 in all cases], but success of excision according to aesthetic areas was significant [p=0.029]

Conclusion: Conventional surgical excision for BCC at aesthetically important areas assisted with intra operative frozen section technique resulted in high success rates in terms of tumor free margins

Effects of microwave oven exposed diet on spermatogenesis in testicular tissue of mice and comparative effects of mentha piperita and melatonin

Objective: To observe the effects of microwave oven exposed diet on spermatogenesis in the testis of mice and comparative effects of Mentha piperita and melatonin

Study Design: Laboratory based randomized controlled trial

Place and Duration of Study: Anatomy Department, Army Medical College Rawalpindi, in collaboration with National Institute of Health [NIH], Islamabad, from Apr 2015 to May 2015

Material and Method: Study comprised of 32 adult male mice [BALBc strain] weighing 25-30 gms. Selection criteria based on non-probability [purposive] simple random sampling. Mice were divided into four equal groups of 8 mice each. Group 1, taken as control, was given standard diet 5-10 gm/animal/day daily for four weeks. Group 2 was given 5-10 gm/animal/day of microwave oven exposed mice pellets for four weeks. Group 3 received Mentha piperita leaf extract [1g/kg b.wt./day] along with microwave oven exposed mice pellets [5-10 gm/animal/day] for 4 weeks and group 4 received oral dosage of melatonin 12mg/kg/day along with microwave oven exposed mice pellets [5-10gm/animal/day] for 4 weeks. After four weeks animals were dissected. The shape, color and any abnormal finding of the testis were observed. Testis were processed, embedded and stained for histological study. Spermatogenesis was assessed by the Johnsons scoring. SPSS 21 was used for statistical analysis. Chi square test was applied for intergroup comparison

Results: Spermatogenesis was suppressed and Johnsons score was decreased from normal spermatogenesis [10] to [6-8] in the experimental group 2 and was more improved in the Mentha piperita treated group as compare to the melatonin

Conclusion: Microwave oven exposed mice pellets suppressed spermatogenesis and Mentha piperita had better ameliorative effects than melatonin on the testis of mice

Casein kinase 2 and survivin modulation in prostate and breast cancer

Objective: To find out whether Casein Kinase 2 [CK2] and Survivin co-express and correlate in prostate as well as in breast cancer

Study Design: A cross sectional analytical study

Place and Duration of Study: Study was done at Army Medical College and in collaboration with Armed Forces Institute of Pathology [AFIP]. The duration of this research was two years

Material and Methods: The research was authorized by the Ethical Committee of AFIP. CK2 expression was determined by immunohistochemistry in paraffin embedded tissues from established patients of prostate cancer [n=30] and breast adenocarcinoma [n=30]. Correlation of CK2 with Survivin was evaluated. Data were analyzed through SPSS version 20. For studying the correlation between the two proteins, pearson correlation coefficient was calculated. Data was considered at p-value

Results: An expressively strong and affirmative correlation was found among expression of total CK2 and total Survivin in invasive along with non-invasive cases of both prostate and breast cancers. A significantly strong and positive correlation was found between nuclear CK2 and Survivin expression in non-invasive cases of prostate cancer and invasive as well as non-invasive cases of breast cancer. A significantly strong and positive correlation was found only between cytoplasmic CK2 and Survivin expression in non-invasive cases of prostate cancer

Conclusion: CK2 and Survivin expressions have strong and positive correlation in both prostate and breast cancer particularly in non-invasive stage of the cancer

Types of traumatic lens dislocations at Larkana

The objective of this study was to determine the pattern of traumatic lens dislocations presenting at our institute. This may help develop the preventive strategies. The number of cases of traumatic lens dislocations, presented at the Department of Ophthalmology, Chandka Medical College, Larkana, Pakistan, from January 2002 to June 2015, were 59 including 61.02% [n=36] males and 38.98% [n=23] females. Cause of trauma was wood or plant impalement in 35.6% [n=21] cases, cracker blast in 13.55% [n=8] cases, fall on ground in 11.86% [n=7] cases, penetrating injuries with needle, scissors or knife in 10.16% [n=6] cases, road traffic accidents in 10.16% [n=6] cases, sports injuries [cricket ball and gulle danda] in 8.47% [n=5] cases, firearm injuries in 5.1% [n=3] cases, and fist hitting in 5.1% [n=3] cases. Lens was dislocated posteriorly in 33.90% [n=20] cases, anteriorly in 25.42% [n=15] cases, inferiorly in 11.86% [n=7] cases, medially in 10.17% [n=6] cases, laterally in 10.17% [n=6] cases, superiorly in 6.78% [n=4] cases, and a single [1.69%] case of lenticele was seen

Endobronchial ultrasound guided transbronchial needle aspiration [EBUS-TBNA] for diagnosis of mediastinal and hilar masses

Objective: To determine the sensitivity, specificity, negative and positive predictive values, and diagnostic accuracy of Endobronchial Ultrasound Guided Transbronchial Needle Aspiration [EBUS-TBNA]

Study Design: A cross-sectional validation study

Place and Duration of Study: Department of Histopathology, Army Medical College, in collaboration with Department of Pulmonology, Military Hospital Rawalpindi, from March 2014 to March 2015

Methodology: Cases of EBUS-TBNA comprised of both TBNAs and cell block/biopsy of the same patients. Diagnosis was made on the TBNA slides and cell block/biopsy material. Taking biopsy/cell block as the gold standard, the data was analysed to calculate the sensitivity, specificity, negative and positive predictive values, and diagnostic accuracy of EBUSTBNA

Results: The sensitivity of EBUS-TBNA was found to be 96.5%; whereas, specificity and positive predictive values were 100%. The negative predictive value was calculated at 50%. Diagnostic accuracy of the procedure was found to be 96.67%

Conclusion: EBUS-TBNA is a sensitive and a specific test and is accurate in diagnosing mediastinal and hilar pathologies

Histopathological and immunohistochemical analysis of small intestinal biopsies in adults suspected of celiac disease

Objective: To analyse histomorphological and immunohistochemical analysis of small intestinal biopsies in adults suspected of celiac disease. Study Design: Descriptive study. Place and Duration of Study: Department of Histopathology, Army Medical College, Rawalpindi, from November 2014 to December 2015

Methodology: Fifty cases of small intestinal mucosal biopsies [duodenal and jejunal] were analysed in adult patients aged above 14 years suspected of celiac disease. Their histomorphological data was recorded using Modified Marsh Criteria. Type of intraepithelial lymphocytes was assessed using immunohistochemistry. Intraepithelial lymphocytes were counted both by H and E stain and immunostain CD3 and CD20

Results: Thirty-four percent patients were aged between 21 - 30 years and 22% patients aged between 41 - 50 years. There were 84% [n=42] males. Thirteen [26%] cases showed focal villous atrophy, 32 [64%] cases showed partial villous atrophy and 5[10%] cases showed complete villous atrophy. Anti-tissue transglutaminase antibody was positive in 21[42%] cases. CD3 immunomarker was positive for intraepithelial lymphocytes in all 50 cases while CD20 immunomarker showed focal positivity in areas with lymphoid follicle formation. The count of intraepithelial lymphocytes was found to be almost equal [with a difference of 3 - 4 lymphocytes] on both H and E stain and immunostain CD3 and CD20

Conclusion: Males aged 21 - 30 years were the most commonly affected group. The most frequent change in histology was partial villous atrophy along with lymphocytic enteritis. All the intraepithelial lymphocytes were present in crescendo- pattern of distribution

Diagnosis of hydatid cyst parotid gland by fine needle aspiration cytology [FNAC]

Fine Needle aspiration of parotid gland swellings is commonly done as a first line investigation. Fine needle aspiration of one such cystic lesion in a 45 years old female was performed. The cytopathological appearance of the aspirate turned out to be typical of Hydatid Cyst. The case is reported with review of literature

Correlation of histological risk assessment/ scoring system with lymph node metastasis and recurrence/progression of diases in oral squamous cell carcinoma

To correlate the scoring system using histopathologic parameters; worst pattern of invasion [WPOI], lymphocytic host response [LHR] and peri-neural invasion [PNI], with disease recurrence, overall survival and cervical lymph node metastasis in OSCC patients. Study Design: Cross sectional. Department of Histopathology, Shaukat Khanam Memorial Cancer and Research Hospital, Lahore in collaboration with Department of Histopathology, Armed Forces Institute of Pathology, Rawalpindi. Study completed in 2 years. A "Risk Scoring system" was applied to 50 cases of OSCC with 2 years follow-up data, based on histopathologic parameters WPOI, LHR and PNI. The cases were divided into High risk and Non- High risk categories according to the specified parameters and then correlated with disease recurrence, overall survival and cervical lymph node metastasis. Results: There were 7 low risk, 17 intermediate risk and 26 high risk cases. No correlation was seen between the risk groups and disease recurrence, overall survival or cervical lymph node metastasis. However, when assessing the individual parameters, significant correlation was observed between PNI with disease recurrence [p = 0.03], and between WPOI and overall survival [p = 0.02] and cervical lymph node metastasis [p = 0.005]. The individual parameters, peri-neural invasion and worst pattern of invasion are observed to be significant prognostic indicators in OSCC patients. A study with a larger number of cases is required to truly assess the value of the scoring system in Pakistani patients

Breast cancer; apoptosis inhibitory protein survivin and Casein Kinase 2

CK2 enzyme is up regulated in several cancers. It has many substrates including survivin which is up regulated in cancers

Objectives: to find out the correlation between expression of CK2alpha and survivin and evaluate it as a prospective prognostic marker in pathogenesis of the breast cancer and to find if positive correlation between CK2 and surviving was associated with advancing disease

Study Design: cross Sectional Analytical type of study

Setting: department of Biochemistry and Molecular Biology, Army Medical College, Rawalpindi and Armed Forces Institute of Pathology, Rawalpindi

Duration of study: January 2013- December 2014

Methods: the research protocol was approved by Armed Forces Institute of Pathology Ethical Committee. Paraffin embedded tissue sections of diagnosed breast cancer, obtained from AFIP, were used. Immunohistochemistry was performed to determine nuclear and cytoplasm expression of survivin, and CK2 .Scoring done by three histopathologists, independently

Results: total CK2 expression was high in invasive as compared to noninvasive cases [p =0.209]. Cytoplasm and nuclear localization of CK2 in invasive group was a little higher too [p = 0.092] and [p=0.286] respectively. Total survivin expression was high in invasive as compared to non-invasive cases [p= 0.449]. Cytoplasm and nuclear localization of survivin in invasive group was higher as compared to noninvasive group with no significant different [p=0.472] and [p=0.367] respectively. A positive and strong correlation was found in CK2 and survivin expression and localization in both non-invasive as well as invasive groups

Conclusion: CK2 and survivin correlation in cancers can be used in predicting the cancer phenotype and aggression at early stages

Calretinin expression in the differential diagnosis of ameloblastoma and keratocystic odontogenic tumour

To determine calretinin expression by immunohistochernistry in ameloblastoma and keratocystic odontogenic tumors [KCOT] and to document the use of calretinin as a differentiating marker between the two lesions. A cross sectional study conducted on previously diagnosed cases of ameloblastoma and Keratocystic odontogenic tumour. Armed forces Institute of Pathology, Rawalpindi Pakistan and duration was one year. [Sep 2009 - Aug 2010]. Twenty cases each of Ameloblastoma and KCOT were retrieved from the record files along with their paraffin embedded blocks. Histological features of all the cases were reviewed on freshly prepared slides and a fresh diagnosis made regardless of the previous diagnosis. The immunohistochemical marker, Calretinin, was applied on both types of cases using the avidin-biotinylated peroxidase complex method.The results were interpreted. In the cases of Ameloblastoma the epithelial tumour nests showed positivity for Calretinin expression. In 85% cases; intense and diffuse staining was observed in more than 80% of the stellate reticulum like cells while 15% cases showed focal and moderate staining patterns. On the other hand KCOT showed contrary results as none of epithelial lining expressed positive staining for Calretinin, [p<0.001]. Calretinin can be used as a useful marker for Ameloblastoma and can be used to differentiate KCOT from Ameloblastoma

Evaluation of HER-2/NEU expression by immunohistochemistry in urothelial carcinoma of urinary bladder

The objective of this study is to determine the HER-2/NEU expression by imrnunohistochemistry in Urothelial carcinoma of urinary bladder. Cross sectional study. Department of Histopathology, Armed Forces Institute of Pathology [AFIP], Rawalpindi, from 15[th] August 2011 to 14[th] August 2012. Bladder cancer tissue specimens from 70 patients were selected in one year as per the inclusion criterion. Immunohistochemistry results were interpreted on light microscope using high power field objective and Her 2/ neu expression was recorded. Mean and standard deviation were calculated for quantitative variables. Frequencies and percentages were calculated for qualitative variables. Out of 70 cases of urothelial carcinoma, Her 2/ neu expression was found to be positive in 24 cases, out of which 5 were of low grade and 19 were of high grade while 16 were invasive and 8 were non invasive. The expression of Her 2/neu was detected in 16 out of 33 cases of invasive carcinoma [48.4%] and in 8 out of 37 cases of non invasive carcinoma [21.6%]. As far as grade is concerned, Her 2/ neu was found to be positive in 5 out of 30 cases of low grade carcinoma [16.6%] and 19 out of 40 cases of high grade carcinoma [47.5%]. The expression of Her 2/neu has been shown to be related to the stage and grade of urothelial carcinoma. Her 2/neu expression is increased in high grade and invasive urothelial carcinoma. Molecular targeted therapy targeting Her 2/neu can be beneficial in patients after assessment of Her 2/neu expression

Determination of the effects of levofloxacin on gentamicin induced nephrotoxicity in rabbits: a comparative study

To determine the effects of levofloxacin on gentamicin induced nephrotoxicity in rabbits. Comparative experimental study. The animal house of Army Medical College, Rawalpindi, and the pathology department of Army Medical College, Rawalpindi, from July 2009 to January 2010. The effects of levofloxacin on gentamicin-induced nephrotoxicity were evaluated in rabbits. Twenty four rabbits were used in this study which were randomly divided into four groups [n= 6 in each group]. Six animals were injected for 15 days with saline [NaCl; 0.9%], six with gentamicin alone at doses of 20 mg/kg of body weight/12 h [intramuscularly], six with combination of gentamicin [20 mg/kg/12 h] with low therapeutic doses of levofloxacin [30 mg/kg/24 h] and the last six were treated with gentamicin and high therapeutic doses of levofloxacin [50 mg/kg/24 h]. Levofloxacin was given by intraperitoneal route. Gentamicin induced nephrotoxicity was evaluated by histopathological and serum analysis. The extent of nephrotoxicity was significantly increased when gentamicin was given in combination with levofloxacin both in low and high doses. Levofloxacin enhances gentamicin induced nephrotoxicity and extent of this nephrotoxicity increased with increasing dose of levofloxacin

Solitary pulmonary nodule a rare case

A middle aged man presented with a solitary pulmonary nodule. He had a diagnostic dilemma as the CT guided FNAC was inconclusive. The frozen section exam reported it to be malignant so a lobectomy was performed for this lesion. The final histopathology report confirmed it to be a very rare tumor of extra skeletal synovial sarcoma

Clinicopathological and immunohistochemical analysis of anaplastic large cell lymphoma

To study the clinicopathological and immunohistochemical features of Anaplastic Large Cell Lyrnphorna [ALCL]. The study design was cross sectional descriptive study. The study was conducted in Armed forces institute of pathology. The duration of study was two years from 1[st] Jan 2010 to 31st Dec 2011. A total of twenty five consecutive biopsy proven cases of anaplastic large cell lymphoma [ALCL] were selected through non probability, consecutive sampling. The inclusion criteria was, all newly diagnosed patients of ALCL having sufficient tumour material in paraffin embedded tissue blocks with appropriate clinical information regarding age, gender and anatomic location. The exclusion criteria included all poorly fixed specimen. The clinical information regarding age, gender and location was noted. All the cases were evaluated on Haematoxylin and Eosin [H and E]. Cases were subjected to Immunohistochemistry [IHC] using CD45 [LCA], CD3, CD 45 RO, CD 15, CD20, CD 30, ALK, EMA, Cytokeratin and classified according to WHO classification of lymphoid neoplasm. Twenty five cases of anaplastic large cell lymphoma were reported during this time period. Out of 25 cases, 22[88%] were ALCL ALK positive, 2[8%] were ALCL ALK negative and 1[4%] case was cutaneous ALCL. The male to female ratio was 2.5:1. The age range was between 6 years and 70 years with majority of cases in third decade. Seventy six percent were nodal and rest were extranodal. The cervical lymph nodes were the commonest nodal group involved making 15[60%] cases followed by 3 [12%] cases of axillary lymph nodes. The histopathological appearance showed complete effacement of architecture in 17 [68%] of cases followed by sinusoidal distribution in 6[24%] cases while partial effacement of architecture in 2 [8%] of cases. All the cases were positive for CD30 while 23 [92%] cases for CD3, 22 [88%] cases for ALK and 19 [76%] cases positive for EMA. ALK negative lymphomas were 3 [12%] cases. Anaplastic large cell lymphoma is more common in males and young adults. Nodal involvement is more common. Majority of cases show complete effacement of architecture. All cases are CD 30 positive. Most of cases are anaplastic lymphoma kinase antigen positive

A comparative evaluation of lipid profile in smokers and non smokers as control.

Background: The major cardiovascular risk factors i.e. smoking, hypertension and hypercholesterolemia; person having only one of these risk factors show a 2-4 times increase in the incidence of coronary heart disease. Studied have also shown the beneficial effect of smoking cessation on the serum lipids, mainly HDL cholesterol. The risk of coronary artery disease reverts rapidly after cessation of smoking. Material and method:-Present study is conducted to reveal the effect of smoking on the lipid profile in male subject. The cross-sectional study was done in 60 male subjects age ranging from 30 to 45 years. The subjects were divided into control group (n=30) and study group i.e. smokers (n=30). All subjects were belongs from either social class 2 or 3 according to Modified Prasad’s social classification. About 5 ml of venous blood will be obtained after 10-12 hours of fasting and analysis of lipid profile was done. Result: Total Cholesterol, Total Triglycerides, High Density Lipoprotein (HDL-Cholesterol), Low Density Lipoprotein (LDL- Cholesterol) and Very Low Density Lipoprotein (VLDL-Cholesterol) will be calculated by Friedwald and Friedrickson formula. There is significant difference in lipid profile parameter of control and smokers. The Total Triglyceride, Total Cholesterol, LDL-Cholesterol ,VLDL-Cholesterol of control and smokers are respectively, which is increase significantly (p<0.05) in smokers then control. The HDL-Cholesterol of control and smokers is decrease significantly (p<0.05) in smokers then control. Conclusion: Hence we concluded that strict measures should be taken up to control the prevalence of the habits of smoking and preventing the risk factor for cardio vascular diseases, hypertension etc.