Immunohistochemical expression of epidermal growth factor receptor in head and neck squamous cell carcinoma

Objective: To determine the frequency of expression of epidermal growth factor receptor [EGFR] by immunohistochemistry in head and neck squamous cell carcinoma [HNSCC]

Study Design: Cross-sectional study

Place and Duration of Study: Armed Forces Institute of Pathology [AFIP], Rawalpindi, from September 2015 to March 2016

Methodology: Fifty-two cases of head and neck squamous cell carcinoma diagnosed on H and E stain were included in the study. Patients' gender and age were noted. Immunohistochemistry for EGFR was applied and the results were recorded. The data were analyzed by using computer software program SPSS version 19. Descriptive statistics, frequencies and percentages were calculated

Results: Out of the 52 patients of HNSCC, 37 patients were males and 15 females. The age of the patients was between 21 and 80 years with an average age of 58.58 +/- 12.63. Out of 52 cases, 45 cases [86.53%] were positive for EGFR while 7 cases [13.46%] were negative for EGFR. Significant statistical association was not seen between the tumour grade and EGFR expression [p=0.162]

Conclusion: The high expression of EGFR in head and neck cancers among Pakistani patients suggests its value as a therapeutic target. EGFR inhibitors have become well-known part of HNSCC treatment; therefore, patients with EGFR positive HNSCC can be benefitted from the therapy

Malakoplakia of appendix: a case report

We report a case of an extremely rare inflammatory condition of appendix, malakoplakia, in a 22 years old female, who presented with chronic abdominal pain. The clinicopathological features of this condition will be discussed, along with a review of the literature

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

Spectrum of rhabdomyosarcoma-A study of 53 cases at Armed Forces Institute of Pathology, Rawalpindi [Pakistan]

Objective: To study the spectrum of rhabdomyosarcoma, diagnosed at Armed Forces Institute of Pathology [AFIP], Rawalpindi [Pakistan]

Study Design: Descriptive study

Place and Duration of Study: AFIP, Rawalpindi from 1st Jan 2009 to 31st Dec 2013

Material and Methods: The study included all the cases diagnosed as rhabdomyosarcoma from 1st January 2009 to 31st Dec 2013. Records of the malignant tumors of soft tissue that presented during this period were analyzed and out of these spectrums rhabdomyosarcoma was studied. The data analysis included the age, gender, site of tumor and histopathological pattern of Rhabdomyosarcoma

Results: A total of 19140 malignant tumors were diagnosed at AFIP Rawalpindi from 1st Jan 2009 to 31st Dec 2013. Out of these, 512 [2.67%] were malignant soft tissue tumors. Out of these 53 cases were rhabdomyosarcoma with an overall frequency of 0.27% of the malignant neoplasm and 10.3% of soft tissue sarcomas. The age ranged from 1-70 years. Out of these 53 cases 36 were males and 17 were females with a male to female ratio of 2.1:1. The most common subtype of tumor seen was embryonal rhabdomyosarcoma n=22 [41.5%]. The age for embryonal rhabdomyosarcoma ranged from 3 to 71 years with median age of 16 years while most of the patients are effected during 1st decade of life [55%]. Out of 20 cases of rhabdomyosarcoma during the first two decades of life 18 [90%] were embryonal rhabdomyosacoma. Thirty cases of rhabdomyosarcoma encountered during the adult life contained only 4 cases [11%] of embryonal rhabdomyosarcoma. The majority of the tumors originated from lower extremities [41%] and in lower extremities most common site was thigh [27%]. A total of 18% of the tumors originated in head and neck region. Second most common type of the tumor was pleomorphic rhabdomyosarcoma n=21 [39.6%] with age range 40 to 78 years and median age of 60 years. Ten cases were reported during 6th and 7th decade of life. Majority of the cases occurred in lower extremities [47.6%] and thigh was the most common site [42%]. Alveolar rhabdomyosarcoma n=6 [11.32%] was the 3rd most common tumor with age range of 15 to 46 years and median age of 29 years. Four cases [67%] occurred in 3rd and 4th decades of life. The most commonly involved region was lower extremities [50%] followed by upper extremities [17%]. Among lower extremities again thigh was the most common site [33%]. Anaplastic rhabdomyosarcoma n=4 [7.54%] was the least common type of rhabdomyosarcoma with age range of 12 to 45 years and median age of 31 years. Three cases [75%] occurred in the 3rd and 4th decade of life. Two cases [50%] occurred in lower extremities and one case [25%] in the upper extremity

Conclusion: Embryonal rhabdomyosarcoma is the most common rhabdomyosarcoma during the first two decades of life. While pleomorphic rhabdomyosarcoma is the most common rhabdomyosarcoma encountered in adults. Extremities are most common site of involvement by rhabdomyosarcoma followed by the head and neck and abdomen in our setup. This finding needs to be evaluated by a larger scale study

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

Sarcoma-like mural nodule in a borderline mucinous tumour of ovary

A 37-year female presented with complaint of lower abdominal pain and amenorrhoea to the Military Hospital, Rawalpindi. Ultrasound of pelvis showed a right adnexal cystic lesion. On investigation, CA-125 was raised. Her MRI scan of pelvis revealed a right adnexal mass of fluid intensity measuring 15.2 x 12.9 x 9.2 cm. Right ovarian cystectomy was performed and the specimen was sent for histopathological examination. Grossly, the mass was cystic in appearance and measured 13.5 x 10 x 10 cm. On sectioning, it was unilocular and filled with turbid material. The cyst wall showed multiple papillary structures along with a nodule measuring 1.1 x 1 cm. Microscopically, the sections revealed borderline mucinous tumour with a sarcoma-like mural nodule composed of spindle shaped cells and epulis-like giant cells. Sarcoma-like mural nodules are rare nodules which are associated with mucinous tumours of the ovary. However, they have excellent prognosis and should not be interpreted as malignant

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

Clinicopathological spectrum of urothelial carcinoma of the urinary bladder - a study of 541 cases at AFIP Pakistan

To analyze the clinicopathological spectrum of urothelial carcinoma of urinary bladder. Descriptive case series. Armed Forces Institute of Pathology [AFIP], from 1[st] January 2012 to 31[st] October 2013. All cases of urothelial carcinoma were retrieved from AFIP tumour registry. Age, gender, histological type, grade and variant of tumour was noted. The data was analyzed by using computer software program SPSS version 19. Descriptive statistics and frequencies were calculated for age, gender, histological type, grade and variants. A total of 541 cases of urothelial carcinoma were included in the study. The age at presentation ranged from 22 to 94 years with median age of 63.56 +/- 12 years. A number [61%] of the cases were from 6[th] to 8[th] decade of life. The gender distribution showed 92.8% of patients [n=502] were males and 7.2 % [n=39] were females with male to female ratio of 12.9: 1. The most common histological type was papillary urothelial carcinoma; present in 493 cases [91.1%] followed by nonpapillary urothelial carcinoma; 48 cases [8.9%]. Among papillary urothelial carcinomas, 302 cases [61.3%] were high grade and 191 cases [38.7%] were low grade. Among nonpapillary urothelial carcinomas, all were high grade and variant histology was observed in all cases. The variants included squamoid differentiation which was present in 27 cases [56.3%], nested variant in 8 cases [16.7%]. The sarcomatoid, undifferentiated and clear cell variants in 3 cases [6.3%] each, micropapillary variant in 2 cases [4.2%], lymphoepithelial-like and plasmacytoid variant in 1 case [2.1%] each. Urothelial carcinoma is more common in males. Most of the tumours are papillary urothelial carcinomas. Most of them are high grade and pure urothelial carcinomas. A number of histologic variants are also recognized. Among them, squamoid differentiation is the most common variant histology

Non-communicating extradural arachnoid cyst of dorsal spine

Extradural arachnoid cyst in the spine is an uncommon cause of spinal cord compression in the paediatric population. Most reported cysts have communication with the intrathecal subarachnoid space through a small defect in the dura. The reported child had spinal cord compression caused by a large spinal extradural arachnoid cyst in dorsal spine that did not communicate with the intradural subarachnoid space. Surgical excision of cyst was done with recovery of neurological deficit postoperatively

Spontaneous bacterial peritonitis

To evaluate the prevalence, diagnostic criteria and microbial spectrum of spontaneous bacterial peritonitis [SBP] and its variants in cirrhotic patients with ascites. A hospital based prospective study carried out in cirrhotic patients with ascites. The study was conducted in the Department of Medicine Military Hospital Rawalpindi during October 2000 to March 2002. One hundred and eighty consecutive patients of cirrhotic liver between the ages of 20-65 years presenting with ascites reporting to outdoor patient department of Military Hospital Rawalpindi were included in the study. The diagnosis of cirrhosis was made on history, clinical examination and the ultrasonographic findings. These patients were subjected to ascites fluid tap and the patients were divided into SBP and non-SBP groups in the light of results of ascitic fluid routine examination and culture. The SBP group was further categorized into culture positive SBP, culture ne gative neutrocytic ascites [CNNA] and bacterascites [BA] on the basis of culture results and total leukocyte count, absolute polymorphonuclear leukocyte count per cubic mm of ascitic fluid. The study included 144 males and 36 females having cirrhosis with ascites. The mean age of these patients was 52.32 +/- 7.87 years. On the basis of routine examination and culture of tapped ascitic fluid from these cases 57 of 180[31.66%] patients were diagnosed to have SBP or its variants, In addition to classic SBP in 18[31.58%] patients, its variants namely culture negative neutrocytic ascites and bacterascites were detected in 37[64.92%] and two [3.5%] cases respectively. E. coli was the most frequently cultured organism. It was isolated in 12 cases of SBP [60%]. In 4 cases [20%] Klebsiella was cultured whereas Proteus mirabilus and Streptococcus were reported in two cases [10%] each. This study indicates that spontaneous bacterial peritonitis is common and potentially fatal complication in cirrhotic patients with ascites. E. coli is the most frequent offending organism

study of post operative analgesia and adverse effects produced by intrathecal neostigmine, morphine and their combination in patients undergoing elective caesarean section under spinal anaesthesia

This is a double blind placebo controlled study of 120 patients conducted in the department of anesthesiology POF's Hospital Wah Cantt: from October 2002 to April 2003 to evaluate the post-operative analgesia and side effects of IT neostigmine, morphine and their combination in patients undergoing elective caesarean section under spinal anesthesia. These patients were randomly divided into neostigmine, morphine, combined and saline [control] groups of 30 patients each. Morphine group had the longest analgesia as compared to other groups. The combined group too had a statistically significant prolongation of analgesia as compared to neostigmine [p = .01] and saline group [p = .00]. Nausea and vomiting were more frequent in neostigmine group [53%] and combined group [53%] than in the morphine group [36%] and saline group [26%]. The frequency of pruritus was not significantly different in combined [50%] and morphine group [46.66%] this study demonstrates that the combination of IT neostigmine 12.5 microgram and IT morphine 50 microgram results in post-operative analgesia for longer duration than IT neostigmine 25 microgram alone but not longer than IT morphine 100 microgram alone. The side effects seen with either drug alone are not overcome by combining the drugs in half the doses

Risk factors in high altitude pulmonary oedema

To identify the risk factors for high altitude pulmonary oedema. A case control study. The study was conducted in the Department of Medicine, Military Hospital, Rawalpindi during October 1998 to October 2000. One hundred serving army personnel between 20 to 50 years of age were divided in two groups. First group comprised of 50 patients who developed high altitude pulmonary oedema at 4000 meters height and above. Second group consisted of 50 control subjects who accompanied the patients. Detailed history was obtained regarding height of native dwelling, rate of ascent, amount of exertion and preceding respiratory tract infection. The findings of both the groups were compared and statistically analyzed by application of Pearson's chi-square test. Difference was considered significant when p-value was < 0.05. All the subjects were male. Average age of the indexed group was 29.4[ +/- 4] years as compared to 27[ +/- 5] years in the control group. Six patients [12%] were highland dwellers whereas 44 patients [88%] were inhabitants of lower heights. Average rate of ascent from 4000 meters to 4500 meters of the indexed group was 5[ +/- 2] days while in control group it was 10[ +/- 3] days. Twenty cases [40%] had history of severe exertion whereas such history was not present in any of the control group subjects. Only 2 patients had signs and symptoms of preceding respiratory tract infection. Rapid rate of ascent, extreme physical exertion, low height of native dwelling and preceding respiratory tract infection are important risk factors for the development of high altitude pulmonary oedema. Proper acclimatization with gradual ascent plays important role in preventing this potentially fatal condition