Isolated psoas schwannoma: A rare retroperitoneal tumor

Retroperitoneal neurogenic tumors are very rare. Isolated or primary psoas schwannoma is one of the rarest tumors of retroperitoneum. The images of such a case are presented in this report.

Calcifying/ossifying synovial sarcoma: A clinicopathologic and molecular study of 5 cases.

Background: Synovial sarcoma (SS) is a soft tissue sarcoma with a generally aggressive behavior. Calcifying/ossifying SS is a rare variant associated with a favorable prognosis. Aim: The aim was to report clinicopathological features and molecular analysis of 5 cases of calcifying/ossifying SS. Materials and Methods: Record of 370 cases of SS reported in the section of Histopathology, of a tertiary care Hospital, between 2002 and 2011 were retrieved. Five cases exhibiting extensive calcification and ossification were identified. Immunohistochemistry was performed using Flex technique. Molecular analysis of these 5 cases was performed later at the collaborative Hospital abroad, by reverse transcription polymerase chain reaction. Results and Conclusions: The ages of the patients ranged from 13 to 44 years (mean age 27 years; female to male ratio 1.6:1). The duration of symptoms ranged from 5 months to 5 years. Histologically, 4 were monophasic, and 1 was biphasic. Three cases exhibited extensive calcification and two extensive ossification. Immunohistochemical stain (epithelial membrane antigen was positive in all 5 cases, CKAE1/AE3 (3/4), Bcl2 (4/4), S100 (4/4), CK7 (2/2), CD99 (1/3) and vimentin (2/2). Intact RNA was obtained from 3 cases, all of which were positive for the SYT/SSX fusion transcript. Follow-up was available in 4 cases and ranged from 19 months to 85 months (mean 50 months). Local recurrence was seen in 2 cases. In conclusions, we report clinicopathologic features of 5 cases of calcifying/ossifying SS. The duration of symptoms and mean age of patients is similar to the literature. A slight female predominance was seen in contrast to a male predominance described in the literature. The clinical course of our cases validates the favorable prognosis of this rare type of SS.

Metastases of Hepatocellular Carcinoma to Unusual Sites: A 10 Year Case Study.

Introduction: Hepatocellular carcinoma is the most common primary tumor of the liver, usually arising in a background of chronic hepatitis and cirrhosis. It is the fifth most common cancer worldwide comprising almost 6% of all newly diagnosed cancers. Aim: The aim of our study is to report unusual metastasis of HCC seen in our practice. Methods and Results: Data of 10 years were collected. A total of 30 cases diagnosed as metastatic hepatocellular carcinoma during the period 2004-2013 were retrieved and reviewed from files of the Section of Histopathology, Aga Khan University Hospital. Cases presenting with metastases to the lungs were excluded from the data. Age range of the patients was 31-84 years with mean age of 59.1 years. There were 28 males and 2 females. The most frequent unusual site of extrahepatic metastases was bone (n= 23), followed by soft tissue of the gluteal region (n=2), posterior triangle of neck (n=1), inguinal region (n=1), iliopsoas muscle (n=1), parotid region (n=1) and the eyeball region presenting as retrobulbar mass (n=1). Conclusion: Lung and bone metastases are frequently seen in patients with HCC. However, HCC sometimes metastasizes to unusual sites/organs. An early diagnosis of these metastases by appropriate diagnostic modalities is essential and can improve the quality of the patient’s life.

Comparative Study of Berseem Cultivars (Trifolium Alexandrium L.) in Support of Nodulation and Leg Haemoglobin Content Under Saline Conditions.

Aim of present study is to evaluate the effect of salinity on the growth of Rhizobium symbiosis with various cultivars of Berseem (WARDAN, BB3, JHB 052 and BB2). Two sets of plots were maintained in which one set contained non-inoculated while another set contained inoculated seeds with Rhizobium culture, which were irrigated with saline waters of different concentrations (0, 3, 6, 7.2, 10, 12 and 14 dSm-1). The observations have been recorded only at 90 and 120 DAS but nodular leghaemoglobin had been estimated at 90th day stage. Results indicated that nodulation and lb content had been increased generally upto 7.2 dSm-1 and declined thereafter. Inoculation with Rhizobium culture had invariably and significantly promoted nodulation and lb content at both durations particularly at lower EC levels and minimized the deleterious effect of salinity at 10 to 14 dSm-1. Taken together, our findings indicate that cv. BB3 produced maximum nodulation and lb content almost at all saline irrigations but cv. WARDAN registered beneficial effect of Rhizobium culture inoculation as this cultivar registered greater lb content at 3 to 7.2 dSm-1 and lesser reductions at 10 to 14 dSm-1 when compared with uninoculated sets. We concluded that this experiment reveals the great impact of Rhizobium trifolii culture on berseem cultivars along with the use of saline soil and water for agriculture without using fertile land and normal water, hence there will be a substantial conservation of normal water and soil for further use.

Effects of sub-lethal exposure of lead acetate on histopathology of gills, liver, kidney and muscle and its accumulation in these organs of Clarias gariepinus

The aim of this work was to study the effects of sub-lethal exposure of lead acetate on the histopathology of the gills, liver, kidney and muscle and its accumulation in these organs of Clarias gariepinus. Results showed that lead accumulation in the tissues of C. gariepinus was dependent on the exposure period and lead concentration. Gills and liver were the predominant storage tissue and the order of accumulation in tissues was gill > liver > kidney > muscle. Some structural changes were observed in different organs, especially in the gills of the fishes exposed to lead acetate. Epithelial hypertrophy and epithelial lifting were apparent in the gills of exposed fishes. The degeneration of cytoplasm and secondary lamellae was also observed. Necrosis of hepatocytes was apparent. Glomerular expansion and gaps between the muscular bundles were found in the fishes exposed to lead acetate.

Breast carcinoma grading, estimation of tumor size, axillary lymph node status, staging, and nottingham prognostic index scoring on mastectomy specimens.

Introduction: Breast carcinoma is the most common malignant tumor and the leading cause of cancer death in women. In western countries, a sharp increase in the detection of breast carcinoma, largely due to widespread use of mammography, has recently led to a fall in breast cancer mortality. This, however, is not true for less developed countries, in which mortality continues to rise. Objective: The aim of this study was to acquire information about the extent and spread of breast carcinoma in our patients by grading the tumors, determining the tumor size, and axillary lymph node status, staging of the tumors and Nottingham Prognostic Index (NPI) scoring on the available material. Materials and Methods: One hundred and twenty consecutive mastectomy specimens with axillary lymph node sampling removed for breast carcinoma and received in the section of histopathology, Aga Khan University, in the year 2005, were included in the study. Standard protocols were used for the processing of the specimens, and reporting was done using a standard format incorporating all relevant tumor parameters. NPI was applied to the cases. Results: Out of the 120 cases, 5 (4.17) were grade 1, 91 (75.83) were grade 2, and 24 (20%) were grade 3. Also, 9 cases (7.5%) were T1 (4 were T1b, and 5 were T1c); 53 (44.16%) were T2; 50 (41.66%) were T3; and 8 (6.66%) were T4. Axillary lymph nodes were available in 107 cases. In 13 cases, no lymph nodes were recovered. Out of 107 cases 27 (25.23%) lymph nodes were negative for metastases pN0; 29 (27.10%) cases were pN1; 26 (24.30) were pN2; and 25 cases (23.36%) were pN3. Extranodal spread was present in 56 (70%) out of the 80 cases in which lymph nodes were positive. The average microscopic size of nodal metastasis was 1.7 cms. Significant statistical association was found between the number of positive nodes and perinodal extension (P = 0.001). Tumor necrosis was present in 76 out of 120 cases (63.33%). Vascular invasion was present in 43 out of 120 cases (35.83%). NPI scores were greater than 5.4 in 60 out of 107 cases (56.1%) indicating poor prognosis. Conclusion: The large majority of the cases were grade 2 tumors. Most cases (all grades) were T2 or T3, and were axillary lymph node positive. Large majority of cases with nodel metastases showed extra nodal spread. The majority of patients had NPI scores greater than 5.4 indicating poor prognosis. Significant statistical association was found between the number of positive nodes and perinodal extension (P = 0.001). The findings show extensive and advanced disease trends in our patients.

In-house daily consensus conference: An important quality control/quality assurance activity - Experience at a major referral center.

Background: For every practicing histopathologist, improvement of diagnostic accuracy is an important objective. Personal consults are an important component of quality control (QC)/quality assurance (QA) in our Section of Histopathology. In addition, the College of American Pathologists recommends a daily in-house consensus conference, which is a prospective system by which all difficult and problematic cases are reviewed and discussed and signed out by consensus. Design: In-house consensus conference is held daily using a multi-headed microscope. This collegial session is run by the seniormost consultant in the section and is attended by all histopathology consultants and residents. The consultants and residents present cases of their choice for discussion. The cases may be selected due to diagnostic difficulty, unusual nature of a case, management purposes such as performance of additional biopsies, special studies, etc., or request on the part of clinician or patient. Cases may be shown once or, in case of lack of consensus or difficulty in diagnosis, more than once after additional work-up suggested by the conference. Results: In a 4-month period, 774 (4.1%) cases of a total of over 14,000 well-mixed surgical cases were brought to the in-house daily consultation conference. Four hundred ninety-three cases (63.7%) were conclusively decided the first time while 198 cases (25.5%) were decided by consensus after being shown twice. In 83 cases (10.7%), a definite diagnosis could not be given. The cases on which a definite diagnosis was not possible represents 0.59% of all cases received in the department during the study period. The most common cases were shown from the gastrointestinal tract (115 cases or 14.8%), lymph nodes (110 cases or 14.2%) and soft tissue (82 cases or 10.6%). In most cases in which a definite diagnosis could not be given, the main reason was scanty material or crushed nature of the tissue. Conclusion: The in-house daily consensus conference is an extremely useful QC/QA exercise, which is very important in reaching an accurate diagnosis in difficult and challenging cases and minimizing diagnostic errors.

Spectrum of malignancy in mixed tumors of salivary gland: a morphological and immunohistochemical review of 23 cases.

Malignancy arising in mixed tumors of the salivary gland is a distinct entity that can occur sporadically or in association with a background of pleomorphic adenoma. Carcinoma arising with a background of pleomorphic adenoma is well documented. However, there are rare occurrences of aggressive de novo carcinosarcomas of the parotid that have been reported. Various cell lineages such as the epithelial glandular cells and the stromal spindle cells are involved. We report 23 cases of tumors of the salivary gland comprising 18 cases of carcinoma ex pleomorphic adenoma, four cases of carcinosarcoma of the parotid and one case of benign metastasizing pleomorphic adenoma. The occurrence of various malignancies suggests that this phenomenon is not very uncommon and should be looked for when reporting a mixed tumor.

Correlation of intra-operative frozen section consultation with the final diagnosis at a referral center in Karachi, Pakistan.

BACKGROUND: The correlation of intra-operative frozen section diagnosis with final diagnosis on permanent sections is an integral part of quality assurance in surgical pathology laboratories. However, there is scant data on this topic from Pakistan. Similarly, no local study has looked at frozen section turnaround times. AIMS AND OBJECTIVES: To analyze indications, discrepancies and deferrals for all frozen sections performed or received at our institution over a 1-year period and to determine the turnaround time for frozen section diagnoses in our cases. DESIGN: A retrospective study, was undertaken, of all frozen sections reported at our institution between 1 st January 2006 and 31 st December 2006. The records of these cases were reviewed. The number and types of discrepancies, including sampling and interpretation errors were determined. The deferred cases and causes for deferral were also determined. The turnaround times of all cases were recorded. Agreement rates were calculated as percent agreement, sensitivity/specificity and positive and negative predictive values. RESULTS: A total of 356 specimens were received. Out of these, 14 cases (3.93%) were deferred to permanent sections. Of the remaining 342 cases, the discordant diagnostic frequency was 2.92% while the concordant diagnostic frequency was 97.08%. The most common pathological processes encountered were presence/typing of neoplasm (51.12%) and assessment of surgical margins (27.53%). The average turn-around time for frozen section diagnosis was 23 minutes; 60% of the cases were reported in 20 minutes or less. CONCLUSIONS: The accuracy of frozen section diagnosis at AKUH pathology department can be interpreted as comparable with most international quality control statistics for frozen sections. The overall error and deferral rates are within the range of previously published errors in pathology. Deferrals and errors in some sub-specialties were higher than in others. The results suggest specific measures should be taken to reduce the number of discrepancies. The overall goal is to reduce errors, reduce the number of deferrals and improve frozen section diagnosis turnaround times.