Primary bone lymphoma mimicking as polyarthritis

A 17 years old boy presented with warm, tender and swollen joints of both upper and lower limbs along with inflammatory back pain and heel pain since 7 months. He had developed continuous high grade fever 3 days ago and complained of marked weight loss during the last 6 months. On examination his liver, spleen and cervical lymph nodes were palpable. X ray of the affected joints revealed osteolytic lesions in tibia, fibula, and humerus and fracture head of femur. Bone marrow examination revealed infiltration by sheets of lymphoid cells which were positive for leukocyte common antigen and CD[20]. The bone biopsy from a lytic lesion in proximal left tibia revealed a similar picture of infiltration with sheets of CD[20] positive lymphoid cells. Need to remember that lymphoproliferative disorders can mimic rheumatological disorders in clinical practice. The case is presented to share the experience of others

Acute lupus haemophagocytic syndrome

A 25 year old female who had been on treatment for Systemic Lupus Erythematosus for the last 12 years presented with high grade non-remitting fever and pleural effusion. She had delivered a full term baby girl and soon developed pancytopenia, markedly raised fibrinogen degradation products, deranged coagulation profile, low serum fibrinogen level, raised liver enzymes and grossly raised serum ferritin. Bone marrow examination revealed reactive haemophagocytosis and megaloblastosis. Autoimmune disorders can lead to reactive haemophagocytic syndrome which is a treatable entity even if it presents with life threatening complications

Effect of hexavalent chromium on leydig cells

Objective: This study was designed to analyze the effects of hexavalent chromium on histology of leydig cells of mice

Place of Study: Animal House of Zoology Department, University of the Punjab, Lahore

Materials and Methods: This experiment was performed on mature adult male albino mice, which were divided into eight groups. Control groups were designated as A1, B1, C1 and D1, whereas experimental groups A,B,C and D, received chromium [2mg/kg], i.p., as potassium dichromate on alternate days for two, four, six and eight weeks, respectively

Conclusions: Significant histological changes were recorded in the testes of treated mice, after prolonged exposure of chromium. Leydig cells were reduced in number and size, nuclei of these cells were also reduced in size and were pyknotic. The resultant decrease in size is a matter of concern in young males. In case of chronic exposure more drastic deleterious effects with appear. Future research work will add further information in this regard

Morphological evaluation of colorectal carcinoma with grading staging and histological types

To evaluate the morphology, grading and staging of colorectal carcinoma [CRC] and to assess the relationship between these parameters. This cross-sectional study was carried out at the Departments of Pathology, University of Health Sciences and Sheikh Zayed Federal Post Graduate Medical Institute Lahore, Pakistan, over a period of one year. The study consisted of 100 colectomy/ hemicolectomy specimens, received fixed in 10% formalin. The specimens were examined grossly to observe the various macroscopical features of tumours Haematoxylin and Eosin stained slides were examined to determine the histological type, grade and stage of CRC. Amting the 100 cases, 59 were non mucinous adenocarcinomas, of which 4 were in Dukes stage A, 51 were in Dukes' stage B and 4 were in Dukes'stage C. Cases of nonmucinous CRC of grade I to grade i were 55 in number. In thirty, cases of mucinous carcinomas, 18 were in Dukes' stage B and 12 were in Dukes' stage C, of these 2 were of grade I, 20 were of grade II and 8 were of grade III. All the 11 signet ring cell carcinomas were of grade III and in Dukes' stage C. Mucin secreting and signet-ring cell adenocarcinomas of colon and rectum are high grade tumours and presented at an advanced stage

Efficacy of ultrasound-guided fine needle aspiration cytology [FNAC] of abdominal, pelvic and retroperitoneal lymph nodes

Objective: To evaluate the efficacy of ultrasound-guided FNAC of abdominal, pelvic and retro-peritoneal lymph nodes

Study Design: Cross sectional analytical [comparative study].Setting: Department of Histopathology, Sheikh Zayed Hospital, Lahore. Study period: One year

Material and Methods: A total of 36 lymph nodes including 12 abdominal, 10 pelvic and 14 retro-peritoneal were submitted to FNAC from January 2001 to December 2001. Adequate aspirates were obtained in all these cases. The smears were stained with Haematoxylin and Eosin [H and E], papanicolaou staining [PAP] and May-Grunwald Giemsa stain [MCG]. Results of FNAC were categorized as malignant [group-l] and non-neoplastic/ inflammatory [group-ll]. Excision biopsies from the same 36 cases were also obtained, processed and stained with routine H and E staining. Histology was taken as the gold standard

Results: On histological examination 24 of the total 36 cases were categorized as malignant, and 12 as non-neoplastic/ inflammatory lesions. FNAC picked up 20 cases as malignant with 4 false negative diagnoses, including 2 cases of Hodgkin's lymphoma and 2 cases of non-Hodgkins lymphoma. No false positive diagnosis was obtained. The most common malignancy was diffuse non-Hodgkin's lymphoma, while granulomatous lymphadenitis was the commonest inflammatory lesion. Malignant tumours revealed 83.3% sensitivity and 88.89% diagnostic accuracy, while non-neoplastic/ inflammatory lesions showed a 100% sensitivity and diagnostic accuracy

Conclusion: Majority of the malignant tumours can be categorized on FNAC with a high degree of accuracy while lymphomas, specially of the mixed large and small cell type and Hodgkin's lymphomas pose maximum diagnostic problems. Non-neoplastic/ inflammatory lesions can be correctly diagnosed on FNAC

Co-relation of sentinel lymph node metastases with the size of primary breast carcinoma

This is a cross-sectional study designed to explore the co-relation between the tumour size and incidence of metastases in the sentinel lymph node and was conducted at Departments of Pathology, Punjab Medical College, Faisalabad and Sheikh Zayed Hospital, Lahore and Departments of Surgery, Allied and DHQ Hospitals, Faisalabad from July 2002 - June 2003. The sentinel lymph node [SLN] was identified in 80 cases of early [T1 and T2] breast carcinoma by a localization technique using 1% Isosulphan Blue. The maximum size of the tumour was measured on gross examination and the margins were labelled with Alcian blue and fixed in Bouin's fluid. The entire tumour was embedded and the size of the tumour was confirmed on microscopic examination. Similarly the entire SLN was embedded and the microscopic measurement of tumour deposit was made in every case. The SLN was successfully isolated in 80 cases. Right sided carcinoma was seen in 52.5%. Stage T1 was seen in 37.5% and 62.5% were of stage T2. Most of the tumours [65%] were located in the upper outer quadrant. Nearly all [97.5%] were infiltrating ductal carcinomas. The microscopic measurement of the size of tumour varied between 5-70 mm and the size of the metastatic deposit of the tumour in the SLN varied from 2-22mm. It was noted that the involvement of SLN and non sentinel lymph node [NSLN] increased in relation to an increase in size of the primary tumour. The study concluded that as the size of the tumour increases, the chances ofmetastases occurring increases and thus has a linear relationship

Relationship of Gleason's score with age, cellularity of tumor and PSA immunohistochemical stain in prostatic carcinoma

Purpose of the study: To study the relationship between Gleason's Score with age, cellularity of Tumor and PSA immunohistochemical staining in prostatic carcinoma

Basic procedures: An exploratory study carried out at the Department of Histopathology of a Tertiary Care Hospital Lahore, from January 1999 to July 2002. Sixty-two [62] cases of prostatic adenocarcinoma were graded with Gleason's score and degree of cellularity of the prostatic cancer were determined on each slide, along with degree of positive staining with immunohistochemical stain marking tissue PSA. These were correlated and relationship was evaluated by ANOVA and simple regression

Main findings: Age of the 62 cases ranged between 50 - 90 years and no significant difference was found between age groups regarding tumor cell differentiation. Cellularity of the prostate cancer showed a weak positive relationship with Gleason's score. Relationship between staining positivity and Gleason's score showed an inverse quadratic relationship with an F statistic of 76.2 [p.0001] and Beta of -.75

Conclusions: From this study it can be concluded that cellularity of tumor tissue in a specimen bears little or no relationship with Gleason's Score. There is an inverse relationship between Gleason's Score and percentage of tumor cells showing positive staining with PSA immunohistochemical stain

Sentinel lymph node; lymphatic mapping in patients with breast carcinoma

To assess the efficacy of a localization technique for the sentinel lymph node in patients with early breast carcinoma using 1% isosulphan blue. Departments of Pathology, Punjab Medical College Faisalabad and Sheikh Zayed Hospital, Lahore and Departments of Surgery, Allied and DHQ Hospitals, Faisalabad from July 2002 - June 2003. 1% Isosulphan blue was used to identify the sentinel node in cases of early [T1 and T2] breast cancer. The dye was injected just before the incision was made. The area was massaged. Mastectomy was done. The sentinel node was identified by following the blue track to the first coloured lymph node. This was removed and submitted separately for histopathology along with the mastectomy specimen. The procedure was performed in 95 cases. SLN were identified in 80 [84%] patients. The mean age was 43.99 years. Majority of the tumours were located in the right breast in the upper outer quadrant. One SLN was identified in 93%, 2 in 3% and 3 were noted in 4% of the cases. Injection of 1% isosulphan blue around the tumour is an effective method for isolation of the SLN in selected cases. It saves the patient of the side effects of axillary clearance in node negative cases

Relationship between Gleason's score and immunohistochemical staining intensity of tissue PSA in prostatic carcinoma

To evaluate the usefulness of Immunohistochemical Staining of Tissue PSA in determining the severity of Prostatic Carcinoma. Material and An explanatory study carried out at the Department of Histopathology of a Tertiary Care Hospital Lahore, from January 1999 to July 2002. Sixty-two [62]- cases of prostatic adenocarcinoma were graded with Gleason's score and stained with immunohistochemical stain for tissue PSA. Intensity of staining was correlated with Gleason's score and relationship was evaluated by ANOVA and simple regression. Specificity and sensitivity of staining intensity was estimated for specific Gleason's scores. Age of the 62 cases ranged between 50 ' 90 years and no significant difference was found between age groups regarding tumor cell differentiation. Staining intensity was found to be positively related to cellular differentiation [->2 51]. 'Relationship between staining intensity and Gleason's score showed an inverse relationship with ANOVA / linear regression; F statistic of 209.72 [p.0001] and R 0.882. Our study confirmed the findings of other international studies exploring relationships between Gleason's score and staining intensity of tissue PSA. Staining of tissue PSA with immunohistochemical stains is helpful in diagnosing the severity of the tumor grade as a complimentary tool along with Gleason's scoring

Comparison of diagnostic reliability of abdominal masses by ultrasound guided fine needle aspiration cytology [FNAC] with histology

To determine the diagnostic reliability of FNAC [Fine Needle Aspiration Cytology] of abdominal masses. Cross-sectional analytical [comparative study].Place and Duration of Study: Department of histopathology, Sheikh Zayed Hospital Lahore, Study period - 1 year. A total of 36 abdominal masses were subjected to FNAC from January 1999 to December 1999. Adequate aspirates were obtained in all cases, and consisted of 19 lymph nodes, including 13 unspecified abdominal lymph nodes, 3 retroperitoneal and 3 para-aortic nodes. Seventeen cases were from abdominal masses of unknown source, of which 5 were retroperitoneal masses, 6 right iliac fossa [RIF] masses and 6 epigastric masses. The smears were stained with haematoxylinand Eosin [H and E], Papanicolaou staining [PAP] and May-Grunwald Giemsa stains [MGG]. Results of FNAC were categorized as benign [group I] malignant [group II] and non-neoplastic/inflammatory [group III]. Excision biopsies from the same 36 cases were also obtained, processed and stained with routine H and E staining. Histology was taken as the gold-standard. On histological examination, 24 of the total 36 cases were categorized as malignant, 6 as benign, and 6 as non-neoplastic lesions. FNAC picked up all the 24 cases as malignant. In the benign group, 1 false negative was given, but there was no false positive diagnosis. The most common malignancy was diffused non-Hodgkin's lymphoma, while benign fibrohistiocytic tumour, was the commonest benign tumour. Malignant and non-neoplastic lesions, revealed a 100% sensitivity and diagnostic accuracy, while benign tumours showed an 83.3% sensitivity and 91.6% diagnostic accuracy. Majority of the malignant tumours can be categorized on FNAC, with a high degree of accuracy, while benign tumours should be subjected to biopsy or excision, as there is a possibility of false negative diagnosis

Evaluation of nucleolar organizer region in normal brain tissues and astrocytic gliomas

This study was performed to evaluate the importance of Ag NORs in different grades of Astrocytic Gliomas. It was a descriptive study and was performed at Lahore General Hospital and Sheikh Zayad Hospital, Lahore. A total of 50 cases were collected within one year, and AgNOR staining was performed on 50 brain tumors and specimens were selected randomly. AgNOR was low, high, higher and highest in Astrocytic Gliomas, grade I [Pilocytic], II, III, and IV respectively as compared to normal brain tissue. AgNOR staining technique is a simple, quick and a cheap method to assess proliferative index in astrocytic Proliferative activity is a good parameter to assess the disease outcome in astrocytic glioma

Fine needle aspiration cytology of enlarged lymph nodes and gender differences

To observe patterns in the pathological findings of lymph-node FNAC. Exploratory and Cross-sectional examination of medical records. Department of Histopathology of Sheikh Zayed Hospital, Lahore, from 1992 to 1995 [four years]. A total of 548 fine needle aspiration cytologies were performed on patients presenting with enlarged lymph nodes. Two histopathologists evaluated each slide to confirm the findings. Descriptive analysis of the FNAC results was conducted and efficacy of the procedure was estimated. Male to female ratios were calculated and chi-square test was applied. Eighty-eight percent of the FNACs yielded a positive result on the first attempt. Infectious and cancerous FNACs averaged 42.36% and 32.09%, respectively. Granulomatous lesions were most frequently due to tuberculosis. Men were twice as likely as women to have cancer detected by an FNAC, chi[2] 24, [p 0.05]. Poorly differentiated cancer was three times as likely to be found in males than females, chi[2] 8.02. Male: female ratio for metastatic lesions was 2:1, chi[2] 11.12 [p 0.05]. In this study, infectious diseases appeared to present more frequently than cancerous lesions, as is observed in underdeveloped countries. This study complements other studies and opens new research questions, regarding gender differences in the prevalence of cancer found in enlarged lymph nodes, as cancers including the metastatic, detected on FNAC were more common in males than females

Goblet cell sialomucin, sulphomucin and O-acylated sialomucin content in ulcerative colitis

This study was carried out to investigate the pattern of goblet cell sialomucin, sulphomucin and O-acylated sialomucin in ulcerative colitis. Endoscopic biopsy material was obtained from 15 cases of ulcerative colitis, and stained with High iron diamine / alcian blue and periodic acid borohydrate saponification PAS technique. The mucin profile was correlated with degree of dysplasia. Three [27.27 %] out of 11 cases without dysplasia and one [25 %] out of 3 cases with dysplasia showed increased sialomucin content. The content, of O-acylated sialomucin was normal in 66.66%and reduced in 33.33% of the cases. The reduction in the O-acylated sialomucin was seen in 75% of the dysplastic lesions and in 18.18% of the cases with no evidence of dysplasia. It can be concluded that composition of mucin is changed in ulcerative colitis. An increase in sialomucin and reduction in O-acylated sialomucin content was seen in some of the cases, the later change was associated more frequently with dysplasia

Pattern of liver disease at Shaikh Zayed hospital, Lahore

Pattern of liver disease in patients was studied who visited Sheikh Zayed Hospital and were referred to the Department of Histopathology. A total of 427 cases, excluding FNA, were received in the 6 years between 1988 and 1993. The commonest disorders found included cirrhosis, metastatic Carcinoma, Chronic Active hepatitis, hepatocellular Carcinoma and steatosis

Immunohistochemical staining of oestrogen receptors in formalin-fixed, paraffin-embedded brest carcinomas and its correlation with other prognostic factors

The observation that many breast cancers demonstrated hormone dependency led to the discovery of oestrogen receptors in these carcinomas. The presence of these receptors is now an established index of both improved prognosis and better therapeutic response. Identification of oestrogen receptors was initially possible only in fresh frozwen tissues. Subsequently, improved immunohistochemical techniques and paraffin-embedded breast tissues were developed. In this study, oestrogen receptors were assessed and analysed in 30 cases of routinely processed, formalin fixed and paraffin wax-embedded breast tissue with carcinoma. ERICA kit was used. Different indices of prognosis including age, degree of tumour differentiation, severity of necrosis, and menstrual activity were correlated with oestrogen receptor status of breast carcinoma. Out of 30 cases, 18 were positive for oestrogen receptors. It was noticed that perimenopausal females with a well differentiated carcinoma showed a higher degree of positivity for oestrogen receptors. Severity of elastosis and the number of involved lymph nodes revealed no linear relationship with the oestrogen receptor status. Oestrogen receptor assay on formalin - fixed, paraffin-embedded tissue was found to be a reliable, inexpensive and an easy method

Goblet cell carcinoid

A case of Goblet cell carcinoid is presented where a female patient reported to the hospital with the history of constipation alternating with diarrhea and passage of black colored stools on at least three occasions during the past four months. In the past 15 days, she had experienced episodic abdominal distension with vomiting. The patient had also lost weight during this period. Initially a clinical disgnosis of illeo-cecal tuberculosis was made and right hemicolectomy was performed. On histopathological examination of the specimens, goblet cell carcinoid was diagnosed