Hormone receptor expression and Her/2neu amplification in breast carcinoma in a cohort of Sri Lankans.

OBJECTIVE: 1) To determine the profile of estrogen and, progesterone receptors (ER, PR) expression and Her/2neu amplification in carcinoma of breast of Sri Lankan women. 2) To determine their inter-relationships, and associations with age at diagnosis and histological grade. DESIGN: Retrospective analysis of data. SETTING: Department of Pathology, Faculty of Medicine, University of Peradeniya. MATERIALS: 124 samples of invasive ductal carcinoma of breast, stained for steroid receptors and Her/2neu amplification with immunohistochemistry. MEASUREMENTS: 1) Semiquantative scores of steroid receptors and Her/2neu amplification. 2) Correlations of ER, PR, Her/2neu amplification, age at diagnosis and histological grade. RESULTS: The prevalence of ER, PR and Her/2neu amplification were 53.2%, 50% and 14.6% respectively. The expression of ER and PR were significantly correlated (p < 0.001). and had a significant negative correlation with Her/2neu amplification (p0.003 each). Lower grade of the tumour was significantly related to the expression of ER (p0.000) and PR (p0.000) but not to Her/2neu amplification (p0.331). Age at diagnosis was significantly correlated to the expression of ER (p0.004), but not to PR (p0.365) or Her/2neu amplification (p0.456). CONCLUSION: Prevalence or ER, PR and Her/2neu amplification in carcinoma of breast among Sri Lankans is similar to that described internationally. The correlations of ER, PR, Her/2neu amplification, to each other, age at diagnosis and grade of tumour is as reported in other countries.

Changing patterns of thyroid cancer in Sri Lanka. Has the iodination programme helped?

OBJECTIVES: To ascertain if there has been a change in the pattern of thyroid cancer in Sri Lanka. If so, whether there is a correlation to the implementation of the programme of iodination. DESIGN: Retrospective (1974-1986) and prospective (1987-2001). SETTING: Kandy Hospital (1974-1982), Peradeniya Hospital (1982-2001) and private hospitals in Kandy (1979-2001). METHOD: Three hundred consecutive patients with cancer of the thyroid seen over 28 years (1974-2001) period were reviewed for demography, histopathology and extent of spread at presentation. Seventy one patients of this group had a pre-existing goitre of greater than 10 years' duration and were similarly reviewed. RESULTS: A highly significant reduction of anaplastic thyroid cancer and a highly significant reduction in the extent of extra-thyroidal spread at presentation of differentiated thyroid cancer were observed after 1995. In malignancy supervening on pre-existing goitre, a significant reduction in anaplastic carcinoma and a highly significant increase in papillary carcinoma were noted in the post-1996 period. A significant reduction of extra-thyroidal spread was also observed. CONCLUSION: A trend towards more differentiated thyroid cancer with lesser degree of spread was observed in recent years. The iodination programme implemented in 1995 is likely to be responsible for this change.

Severe systemic effects of Merrem's hump-nosed viper bite.

OBJECTIVE: To report unpredictable severe systemic effects of hump-nosed viper envenomation. SETTING: Medical unit, General hospital, Anuradhapura. METHODS: The clinical outcome of seven patients bitten by Merrem's hump-nosed viper were monitored until recovery or death. Limited autopsies were performed on the latter. Offending snakes were positively identified by medical officers and in one instance by a herpetologist. CONCLUSION: Merrem's hump-nosed viper bites, caused an array of potentially fatal systemic manifestations. One patient developed neurological effects, severe Raynaud's syndrome leading to ascending gangrene of distal limbs and adult repiratory distress syndrome (ARDS), in addition to the known complications of severe renal cortical necrosis and haemostatic dysfunction. Two patients who developed acute renal failure and prolonged coagulopathy recovered completely. The combination of extensive renal cortical necrosis, disseminated intravascular coagulation, and ARDS proved fatal in three.

Histopathological diagnosis of subcutaneous Dirofilaria repens infection in humans.

The host tissue response in humans, based on a study of biopsies of 14 subcutaneous nodules caused by Dirofilaria repens is described. The response was characterized by accumulation of eosinophilic material or eosinophilic pus adjacent to the parasite with surrounding granulomatous inflammation associated with extensive eosinophil infiltration of the surrounding tissue. Unlike with fungal lesions, fat necrosis was conspicuously absent. Nodules were all less than 3 cm in size. Fifteen percent of the smaller nodules (less than 1 cm) and 30% of the larger nodules required extensive examination of tissue to visualize the parasite. It is concluded that when typical tissue reactions are seen, extended histological processing is indicated for accurate diagnosis of dirofilariasis, by demonstrating the parasite.

Exfoliative cytology in screening for malignant and premalignant lesions in the buccal mucosa.

OBJECTIVE: To test the efficacy of exfoliative cytology in the detection of oral premalignant and malignant lesions. DESIGN: Cytological diagnosis of lesions of the buccal mucosa assessed using histopathological diagnosis of the same lesions as the gold standard. SUBJECTS: Patients with buccal lesions clinically diagnosed as leukoplakia (n = 91) and squamous cell carcinoma (SCC, n = 59), and healthy subjects (n = 40) in whom buccal mucosa appeared clinically normal. SETTING: Oral and Maxillo-facial Unit, General Hospital, Kandy and Department of Pathology, Faculty of Medicine, University of Peradeniya. RESULTS: A sensitivity of 77%, specificity of 100% and accuracy of 92% were obtained for leukoplakia. SCC gave a sensitivity of 94%, specificity of 100% and an accuracy of 95%. CONCLUSIONS: Oral exfoliative cytology is a useful method for detecting oral premalignant and malignant lesions. Anucleated squames in a smear is non-diagnostic.

Mucosal changes in the upper gastrointestinal tract in Sri Lankan patients with squamous carcinoma of the oesophagus.

BACKGROUNDS: Squamous carcinoma of the oesophagus, is a common tumour in Sri Lanka. A thickened and pale appearance of the oral, hypopharyngeal and oesophageal mucosa, has been observed during endoscopy. The aim of this study was to document the histological changes of the mucosa thus affected in 93 patients with squamous carcinoma of the oesophagus. METHOD: 93 patients with oesophageal carcinoma had mucosal biopsies done from the left cheek, hypopharynx and 2.5 cm. and 5 cm above the tumour, during endoscopy for biopsy of the tumour. Paraffin sections of the biopsy stained with Haematoxylin and Eosin were examined. 25 specimens of oesophageal tissue, and tissue from the mucosa and hypopharyngeal mucosa obtained at coroners' autopsies from a comparable group served as controls (15 males, 10 females). RESULTS: The tumours were squamous carcinoma of varying grades of differentiation. The mucosal biopsies showed, acanthosis, basal cell hyperplasia, intra epithelial neoplasia (IEN) grades I-III, chronic oesophagitis, koilocytosis and papillomatosis. The mucosa of the control group only showed koilocytosis and papillomatosis in two cases. CONCLUSION: Pathological changes such as acanthosis, basal cell hyperplasia, intra epithelial neoplasia, chronic oesophagitis koilocytosis and papillomatosis occur in the oral hypopharyngeal and other areas of the oesophageal squamous mucosa, in association with squamous carcinoma of the oesophagus.

First reports of subcutaneous sparganosis in Sri Lanka.

OBJECTIVE: To report and create awareness of sparganosis, a parasitic zoonosis caused by a larval stage of Spirometra sp. SETTING: Two patients with non-tender subcutaneous lumps. DIAGNOSIS CRITERIA: Morphology of solid cestode larva in excision biopsies. CONCLUSIONS: Although these two instances were innocuous, infection is potentially dangerous as larvae are long lived and could invade vital organs. The most likely source of infection in Sri Lanka is ingestion of the infected first intermediate host, Cyclops, in water.

Necrotising adenometaplasia (sialometaplasia) of the nasopharynx.

Necrotising sialometaplasia of the nasopharynx with nasal extension in a 43 year old man, with no preceding history of trauma, is reported. Some unusual histological features are described.

Skeletal fluorosis with neurological complications.

A case of skeletal fluorosis with spinal cord compression from Kekirawa following consumption of water with high fluoride content for about 20 years is described. The observations of other workers (4,5) and the present case report show that more extensive field studies among vulnerable populations is indicated in this region. The need to search for a cost effective method of defluoridation of water is stressed.