Clinicopathological characteristics of triple negative breast cancer

Objective: To analyze the clinicopathological characteristics of triple negative breast cancer. Study Design: Descriptive case series. Place and Duration of Study: Armed Forces Institute of Pathology [AFIP], from Jan 2014 to Dec 2014

Material and Methods: All cases of triple negative breast cancer diagnosed on histopathological examination followed by immunohistochemistry were retrieved from AFIP tumour registry. Patient's gender, age, tumour laterality, tumour size, histological tumour type, histologic grade, lymphovascular invasion, involvement of surgical margins and lymph node status were noted. The data were analyzed by using computer software program SPSS version 19. Descriptive statistics, frequencies and percentages were calculated

Results: A total of 35 cases of triple negative breast cancer were included in the study. The age at presentation ranged from 32-79 years with mean age of 50.9 +/- 11.7 years. Most of the patients were females [n=34, 97.1%], out of which 51.4% cases [n=18] belonged to premenopausal age group. Right sided breast tumours were more common [n=17, 54.8%]. The most common T stage at presentation was p T2 [n=20, 57.1%], while the mean tumour size was 5.2 +/- 2.2 cm. The most common histological type was invasive ductal carcinoma, NOS [n=32, 91.4%] while the commonest histological grade was Grade II [n=22, 67.7%]. Lymphovascular invasion was observed in 54.3% [n=19] of the cases while lymph node metastasis was seen in 74.1% [n=20] of the cases. Five cases [14.3%] had positive surgical margins

Conclusion: Triple negative breast cancer was more common in premenopausal females. Most common tumour type was invasive ductal carcinoma, NOS [Grade II] with a pT2 stage at presentation. Lymphovascular invasion and lymph node involvement was also seen in a large number of cases

Immunohistochemical expression of Alpha Methylacyl-Coa Racemase [AMACR] in carcinoma prostate in Pakistani population

Objective: To determine the frequency of expression of positive diagnostic marker alpha methylacyl-COA RACEMES [AMACR] in the examination of prostate needle biopsy specimens from patients of adenocarcinoma prostate from a subset of Pakistani population

Study design: Cross-sectional study

Place and Duration of Study: Department of Histopathology, Armed Forces Institute of Pathology, Rawalpindi from Apr 2015 to Oct 2015

Material and Methods: All specimens of adenocarcinoma prostate diagnosed at Armed forces institute of pathology on the basis of immunohistochemistry and routine histopathology irrespective of age of patient, histological type or grade of the tumor were analyzed. Mean and Standard deviation were calculated for quantitative variables like patient's age and frequencies along with percentages were calculated for qualitative variables like AMACR expression

Results: Out of the total 80 cases, 68 [85%] were positive for AMACR while 12 [15%] were negative. Among the cases that were negative 9 [11.3%] showed 1 +/- staining [Weak, non-circumferential] and 3 cases [3.8%] displayed 0 staining [No cytoplasmic staining]

Conclusion: Positive staining for AMACR can be used to support a diagnosis of cancer on prostate needle core biopsies when the focus in question is <1mm in maximum dimension. The results of AMACR expression in a subset of Pakistani population are comparable to the western studies. AMACR staining must be interpreted in the context of basic haematoxylin and eosin criteria for malignancy along with the results expansion of other supportive markers, such as a basal cell specific marker like p63 or 34betaE12

Immunohistochemical expression of epidermal growth factor receptor and c-kit in triple negative breast cancer

Objective: To determine the frequency of immunohistochemical expression of epidermal growth factor receptor [EGFR] and c-KIT in triple negative breast cancer [TNBC]

Study Design: Descriptive, cross-sectional study

Place and Duration of Study: Armed Forces Institute of Pathology [AFIP], Rawalpindi, from January to December 2014

Methodology: Fifty cases of triple negative breast cancer diagnosed on immunohistochemistry were included in the study

Patients' gender and age were noted. Immunohistochemistry for EGFR and c-KIT were applied and the results were recorded. The data were analyzed by using computer software programme SPSS version 19. Descriptive statistics, frequencies and percentages were calculated

Results: Out of 50 patients of TNBC, all patients were females. The ages of the patients ranged between 30 and 80 years with an average age of 48.9 years and standard deviation of +/- 10.0. Out of 50 cases, 29 cases [58%] were positive for EGFR while 15 cases [30%] were positive for c-KIT. Thirteen cases [26%] were positive for both EGFR and c-KIT

Nineteen cases [38%] were negative for both EGFR and c-KIT

Conclusion: EGFR expression was observed in 58% and c-KIT expression was seen in 30% of the cases. The results of EGFR expression are almost similar while those of c-KIT are different from international studies which suggest immunohistochemical differences between the studied populations

Squamous cell carcinoma arising in background of mature cystic teratoma

Mature cystic teratoma of ovary is a common benign adnexal tumor in females. Malignant transformation in a mature cystic teratoma of the ovary occurs in only 1 - 2% of cases. Most common malignant transformation is squamous cell carcinoma [70-80% of cases], occurring mostly in postmenopausal women with large sized cysts. Here, we report a case of 46-year lady who presented with pain in lower abdomen. Ultrasound and CT scan revealed complex adnexal mass measuring 16x9 cm. Size and older age of the patients should be regarded as important predictors of malignant transformation in mature cystic teratoma. Adequate sampling followed by histopathological examination has important role in diagnosis of such rare tumor

Morphological spectrum of gastric lesions - endoscopic biopsy findings

A retrospective study was carried out to determine the morphological spectrum of gastric lesions at Pathology Department of Army Medical College, Rawalpindi for the duration of 02 years. Descriptive Study. The gastric mucosal biopsies of 787 patients received from Gastroenterology unit of Military Hospital Rawalpindi from January 2002 to December 2003, were studied by routine histopathology methods. A high frequency of gastric disease in males with a male to female ratio of 6:1 and an age range of 09 years to 85 years were observed. The clinical presentations mostly seen were abdominal pain, dyspepsia, vomiting, diarrhoea, decreased appetite and weight loss. On endoscopy the most frequently suspected lesions were gastritis 662[84.12%], stomach growth 45[5.72%], gastric ulcers 10[1.27%], while 70[8.89%] cases showed unremarkable mucosa. The histopathology revealed chronic non-specific gastritis 676[85.89%] followed by malignant tumours 45[5.72%], benign neoplasms 3[0.38%] and gastric ulcer 10[1.27%]. A number of biopsies 53[6.73%] were unremarkable histologically. The more prevalent lesions in this series were chronic active gastritis followed by tumours and gastric ulcers. H. pylori associated gastritis was seen in majority of the patients. Thus gastric biopsy is an essential tool for diagnosis and confirmation of clinically suspected cases

Significance of bone marrow Trephine biopsy in the diagnosis of haematological and non-haematological disorders

To evaluate the frequency and document the histological pattern of various haematologic and non 'haematologic malignancies and infections, which can be diagnosed by Bone marrow trephine biopsy. A retrospective, cross sectional study was carried out at Histopathology department of Army Medical College Rawalpindi from January 2000 to December 2004. The bone marrow trephine biopsies were taken with Jamshidi's - type needle. The tissues were fixed in 10% formal- saline and then decalcified in 5% nitric acid. These were processed under standard conditions. A total of 789 cases with age range of 9 years to 75 years were studied during a period of five years. Majority of the cases showed male preponderance [69.83%] as compared to females [30.16%]. The most common histological findings in order of frequency were reactive changes [22.43%], unremarkable marrow [16.09%], inadequate biopsy [9.63%], megaloblastic anaemia [7.73%], acute leukaemia [6.21%], erythroid hyperplasia [5.95%]. The less common lesions were multiple myeloma [3.92%], lymphoproliferative disorders [3.80%], hypoplastic marrow [3.54%], chronic granulomatous inflammation [2.53%] and myelofibrosis [2.40%]. The miscellaneous group [5.70%] comprises rare diseases. Bone marrow trephine biopsy is a valuable diagnostic tool in the diagnosis of various types of infections and hematologic and non'hematologic malignancies. Majority of our patients showed reactive changes followed by acute leukaemia and erythroid hyperplasia. It has also been proved useful in detecting micrometastases when primary is not known with the other available diagnostic modalities

Neonatal cholestasis Syndrome: an experience at Army medical college and Military Hospital Rawalpindi

To find the causes of neonatal cholestasis in our set up and to see the role of liver biopsy in differentiating neonatal hepatitis from biliary atresia. Design: A cross sectional survey. Place and duration of study: Histopathology department of Army Medical College and Military Hospital Rawalpindi from January 2000 to December 2004. Patients and A total of 62 cases were studied with age range of 1.5 months to 5 years. The subjects selected for biopsy were children with persistent jaundice and hepatosplenomegaly. The biopsy was taken with the help of Surecut needle under the cover of diluted intravenous Ketamine. The fixed tissues were processed under standard conditions. Result: Majority of the patients [62.90%] were of biliary atresia followed by neonatal hepatitis [27.42%]. Paucity of bile ductules was seen in 3 cases while three patients were of indeterminate etiology. Cirrhosis of liver was noted in 10 patients; six because of biliary atresia and two cases each of alpha-1 antitrypsin deficiency and galactosemia. Amongst neonatal hepatitis cases most of the patients were idiopathic in nature [58.82%]. In our set up, biliary atresia is an important and main cause of neonatal cholestasis and liver biopsy is a valuable diagnostic tool in differentiating biliary atresia from neonatal hepatitis

Usefulness of needle biopsy in the diagnosis of paediatric liver disorders

To see the usefulness of liver biopsy in the diagnosis and to document the spectrum of paediatric liver diseases. A retrospective, cross sectional survey at Histopathology department of Army Medical College Rawalpindi from January 2000 to December 2003. The liver biopsies were taken with Menghini needle. The fixed tissues were processed under standard conditions. During four years period, a total of 100 cases with age range of 1.5 months to 16 years were studied. The most common histological findings in order of frequency were secondary haemochromatosis [30%], biliary atresia [20%], storage disorders [16%], cirrhosis of liver [10%] and neonatal hepatitis [10%]. The less common entities were chronic hepatitis [6%], nonspecific reactive hepatitis [3%] and granulomatous hepatitis [1%]. One case each of hepatoblastoma, haemophagocytic lymphohistiocytosis and congenital fibrosis was also noted. These findings have been compared with local and international histological studies. Liver biopsy is a useful diagnostic technique in the diagnosis of paediatric liver diseases. Biliary atresia, strorage disorders and neonatal hepatitis are the most common entities in our set up

Assessment of proteinuria by using protein: creatinine index in random urine sample

To assess the quantitative measurement of proteinuria by using random urine protein: creatinine index/ratio in comparison with 24 hours urinary protein excretion in patients of renal diseases having normal glomerular filtration rate. One hundred and thirty patients, 94 males and 36 females, with an age range of 5 to 60 years; having proteinuria of more than 150 mg/day were included in this study. Qualitative urinary protein estimation was done on random urine specimen by dipstick. Quantitative measurement of protein in the random and 24 hours urine specimens were carried out by a method based on the formation of a red complex of protein with pyrogallal red in acid medium on Micro lab 200 [Merck]. Estimation of creatinine was done on Selectra -2 [Merck] by Jaffe's reaction. The urine protein: creatinine index and ratio were calculated by dividing the urine protein concentration [mg/L] by urine creatinine concentration [mmol/L] multilplied by 10 and mg/mg respectively. The protein: creatinine index and ratio of more than 140 and 0.18 respectively in a random urine sample indicated pathological proteinuria. An excellent correlation [r=0.96] was found between random urine protein: creatinine index/ratio and standard 24 hours urinary protein excretion in these patients [p<.001]. Dipsticks showed moderate correlation [r=0.52] and error in interpretation of proteinuria. The protein: creatinine index in random urine is a convenient, quick and reliable method of estimation of proteinuria as compared to 24 hours of urinary protein excretion for diagnosis and monitoring of renal diseases in our medical setup

Isolation and seroprevalence of avian influenzavirus [H9N2] at Islamabad/Rawalpindi

The aim of this study was to isolate and evaluate the seroprevalence of avian influenza virus [AIV] infection in chicken in Pakistan with special reference to its serotype/H9N2. Laboratory based prospective. This study was carried out at department of Biological Sciences, Quaid-e-Azam University Islamabad and National Agricultural Research Centre Islamabad Pakistan from 2000 to 2001. The human virological aspects were dealt by AF Institute of Pathology, Rawalpindi. The chicken flocks studied belonged to different poultry farms located at Islamabad/Rawalpindi area. For the isolation of avian influenza virus, lungs and trachea specimens were processed to prepare virus inoculum and inoculated in 9-day old embryonated eggs via allantoic route. For identification of virus, haemagglutination test and immunofluorescent antibody test [IFA] were used. Serological analysis was done by Agar Gel Precipitation Test [AGPT], Haemagglutination [HA] and Haemagglutination inhibition test [HI]. This study was divided into two parts; firstly the sera of chicken with history of respiratory tract infection were tested for the presence of antibodies against H9N2 virus. Such chicken were found to have seroconverted against H9N2. Secondly, it was aimed to isolate virus from kidneys, lungs and trachea of infected birds by growing virus in 9 days old chick embryos. Out of 40 clinical samples, 9 isolates of AIV were recovered and typed serologically as serotype H9N2. In this scenario, the presence of H9N2 in poultry in the country poses a continuous threat for the emergence of more pathogenic strains of human influenza virus. For this purpose there is a constant need to carry out surveillance for influenza viruses both in birds and humans in the country

Assessment of proteinuria by using protein: creatinine index in random urine sample

To assess the quantitative measurement of proteinuria by using random urine protein: creatinine index/ratio in comparison with 24 hours urinary protein excretion in patients of renal diseases having normal glomerular filtration rate. One hundred and thirty patients, 94 males and 36 females, with an age range of 5 to 60 years; having proteinuria of more than 150 mg/day were included in this study. Qualitative urinary protein estimation was done on random urine specimen by dipstick. Quantitative measurement of protein in the random and 24 hours urine specimens were carried out by a method based on the formation of a red complex of protein with pyrogallal red in acid medium on Micro lab 200 [Merck]. Estimation of creatinine was done on Selectra -2 [Merck] by Jaffe's reaction. The urine protein: creatinine index and ratio were calculated by dividing the urine protein concentration [mg/L] by urine creatinine concentration [mmol/L] multilplied by 10 and mg/mg respectively. The protein: creatinine index and ratio of more than 140 and 0.18 respectively in a random urine sample indicated pathological proteinuria. An excellent correlation [r=0.96] was found between random urine protein: creatinine index/ratio and standard 24 hours urinary protein excretion in these patients [p<.001]. Dipsticks showed moderate correlation [r=0.52] and error in interpretation of proteinuria. The protein: creatinine index in random urine is a convenient, quick and reliable method of estimation of proteinuria as compared to 24 hours of urinary protein excretion for diagnosis and monitoring of renal diseases in our medical setup

An autopsy study of sudden cardiac death

To determine the cause of sudden cardiac death and observe the morphological changes in the heart after death. A cross sectional survey of 66 cases was carried out at Armed Forces Institute of Pathology [AFIP] Rawalpindi from 1992 to 1994. A detailed autopsy including external and internal postmortem examination was done. Representative sections were taken for histopathological examination and some viscera were sent to Chemical Examiner at Lahore for chemical analysis. All the cases were male with age range from 21 to 58 years. These cases died within 60 minutes with or without onset of symptoms. Fifty two cases revealed mild to severe atherosclerosis. Coronary occlusion with thrombosis was seen in 37 cases whereas 9 cases showed critical narrowing without evidence of thrombosis. Five showed both symmetric and asymmetric hypertrophy. Changes in conduction system of the heart were seen in 4 individuals. Myocarditis was noted in 2 cases only. The cause of death could not be determined in 3 cases. Majority of the cases died of coronary atherosclerosis whereas 17% cases revealed hypertrophic cardiomyopathy, changes in conduction system and myocarditis and 4% cases were undetermined. A detailed and thorough postmortem examination is mandatory to ascertain the cause of sudden cardiac death

Clinicopathological study of 762 ovarian neoplasms at Army Medical College Rawalpindi

A retrospective cross sectional study was carried out at Pathology Department of Army Medical College Rawalpindi from January 1995 to December 2003 to see the morphological pattern of benign and malignant ovarian tumours. A total of 762 ovarian tumours were studied during a period of nine years. Of these, 498 [65.35%] were benign, 33 [4.33%] of borderline malignancy and 231 [30.31%] were malignant. The relative frequency of malignant ovarian tumours of all gynaecologic malignancies was found to be 24.01%. The age range of ovarian tumours was 9 to 80 years. Maximum number [66.88%] of benign tumours were in younger patients [<40 years], whereas majority of malignant tumours [65.83%] were seen in 5th to 6th decades. Histologically, the major categories included surface epithelial tumours 527 [69.16%], germ cell tumours 201 [26.37%], sex cord- stromal tumours 34 [4.46%] and miscellaneous 4 [0.52%]. Amongst the malignant tumours, the most common entity was serous cystadenocarcinoma [46.75%], followed by mucinous cystadenocarcinoma [22.94%], dysgerminoma [6.06%], granulosa cell tumours [5.62%] and endometrioid carcinoma [4.76%]. In this study, ovarian tumours were seen in younger age and serous tumours were relatively more common than experienced in the western world. Overall trends for other malignancies are more or less similar to other Pakistani studies except for mucinous carcinoma

Morphological Feature correlation with serum tumour markers in prostatic carcinoma

To find out Gleason grades, scores and to see the correlation of these morphological features with tumour markers in prostatic carcinoma. Design: A descriptive study. Place and Duration of Study: The study was conducted at the Departments of Histopathology and Chemical Pathology, Armed Forces Institute of Pathology, Rawalpindi, over a period of one year. Materials and Fifty cases of prostatic carcinoma were studied. Gleason grades and score of tumour were determined by doing haematoxylin and eosin [H and E] staining. Pre-operative serum prostatic acid phosphatase [PAP] and prostate-specific antigen [PSA] assays were carried out in these cases. The patients seen were between 50-102 years of age with an average of 70.9 years. There were 49 cases of adenocarcinoma and 01 case of mixed adeno and transitional cell carcinoma of prostate. Twenty-eight [56%] patients had Gleason score of 5-7. Twenty-nine [58%] patients were having serum PSA levels between 10.0 ng/ml and 50.0 ng/ml. Thirteen [26%] cases showed PSA assays > 50 ng/ml. The sensitivity of PSA test was 84% in these cases. Thirty-five [70%] patients were having PAP values > 3.7 U/l [sensitivity 70%]. The Gleason grading system is a specific morphological predictor. The serum PSA showed better sensitivity and specificity with Gleason grades and scores as compared to serum PAP. The serum PAP levels showed better correlation with morphological features as compared to serum PSA