Adrenalectomy for solitary metastasis of Hepatocellular carcinoma post liver transplantation: Case report and literature review

Liver transplantation [LT] is the treatment of choice for localized hepatocellular carcinoma [HCC] associated with cirrhosis. Extra hepatic metastasis is the most common cause of death in these patients. There is very little evidence regarding the natural history and treatment options for patients developing HCC recurrence after LT

Surgical resection offers a unique opportunity for solitary metastasis

We report a 61 year old male with solitary right adrenal metastasis 15 months post LT which was managed with open adrenalectomy. The patient is alive and disease free 24 months after the surgery. The case, histo-pathological findings and literature review is discussed

Olfactory neuroblastoma: a clinicopathological experience of a rare entity from Pakistan

Objectives: To present the clinicopathological experience of Olfactory Neuroblastoma [ONB] with emphasis on histopathological and immunohistochemical features

Methods: A descriptive cross-sectional study was done on 36 cases of ONB, selected by non-probability purposive sampling. Theses cases of ONB were retrieved and reviewed from surgical pathology database of Aga Khan University Hospital reported between January 1993 and March 2015

Results: Tumor size and age of presentation was wide in range without any distinct bimodal distribution. Nasal cavity was most common site along with involvement of paranasal sinuses. More than 50% cases had Kadish stage A. Microscopically, most cases were Grade-1 and majority showed partial or complete lobular architecture. Neurofibrillary matrix was observed in 2/3rd of cases. Among immunohistochemical markers, Neuron Specific Enolase was most frequently expressed. Unusual positive expression of Cytokeratin AE1/AE3 and Cytokeratin CAM5.2 was also seen focally in few cases

Conclusion: The ONB has great variability of histological and clinical presentation, and immunohistochemical markers are useful to differentiate from more common small round blue cell tumours of nasal cavity

Primary melanotic schwannoma with typical histology

We present a case of a 17-year male with a soft tissue density spreading from the neural foramina [T3] of the spinal cord and involving the right upper thoracic cavity. We managed the patient through surgical intervention and resected the complete tumor. Gross definition and microscopic findings of the resected tissue revealed the definitive diagnosis of melanotic schwannoma. The histological characteristics in this case were very specific and harbour an important diagnostic clue for this rare disease. Malignant melanoma was ruled out on the basis of histological findings. The patient recovered completely and was healthy on one-year follow-up

Spectrum of histopathological findings in Postmenopausal Bleeding

Objective: To determine the frequencies of histopathological findings in endometrial and endocervical biopsy samples with clinical history of Postmenopausal Bleeding [PMB]

Study Design: Descriptive cross-sectional study

Place and Duration of Study: Section of Histopathology, Department of Pathology and Laboratory Medicine, The Aga Khan University Hospital, Karachi, from February 2012 to January 2013

Methodology: A total of 157 consecutive endometrial and endocervical biopsy specimens with history of postmenopausal bleeding were included. After microscopic examination, frequencies of histological findings in different age groups were generated. Chi-square and independent sample t-tests were applied to see whether the difference was significant which was set at p < 0.05

Results: One hundred and twenty-one [77.1%] specimens showed benign pathologies while 36 [22.9%] were malignant. Endometrial polyp was seen in 67 [42.7%] cases followed by endometrial carcinomas in 25 [15.9%], endometrial hyperplasia in 21 [13.4%], cervical carcinoma in 12 [7.6%] and cervical polyps in 9 [5.7%] cases. A highly significant increase in the percentage of malignant and pre-malignant lesions was seen with increasing age group [p < 0.001]. Mean age of patients with type-2 endometrial carcinoma was higher than type-1 endometrial carcinoma but statistical significance was not observed [70.2 +/- 6.5 vs. 61.8 +/- 9.1 years respectively, p=0.069]

Conclusion: Although benign pathologies were more common in postmenopausal bleeding but the collective proportion of endometrial and cervical malignancies and pre-malignant conditions was quite high. Therefore, PMB should be urgently evaluated for cause and early commencement of treatment

Nutritional status of primary school children in Abbottabad

In Abbottabad district, with the vast poverty stricken rural majority and 80% literacy rate, primary-level education faces great influx of students. This study was carried out to see the nutritional status of children 5-10 years of age attending primary schools of Abbottabad. This was a descriptive, cross-sectional study carried out in June 2009 on 400 schoolchildren of 5-10 years of age from three randomly selected primary schools of Abbottabad. After informed consent by the parents/ teachers, a semi-structured Performa/questionnaire was filled for each child. Anthropometric measurements were recorded. Correlation of age of the child with height, and weight was calculated. The nutritional status of the study children was particularly optimum; 90% children were in optimal nutritional status and had sound skeletal growth irrespective of their socioeconomic background. There was a significant correlation of nutritional status and skeletal growth of children with parents' socioeconomic status. There was a direct correlation between height and weight of children, and their age. Anthropometric measurements indicate a high majority of children in healthy status despite the overall poor setup

Choice of matrix system for direct posterior composites by the dentists in Lahore

The aim of the present study was to evaluate the preferences of dentists in Lahore regarding the selection of matrix system for posterior composites. 100 questionnaires were randomly distributed to the dental surgeons working in hospitals and clinics in Lahore. The questionnaires were designed to find out the preferences of dentists for selection of matrix system for posterior proximal composite restorations. 92 completed questionnaires were returned. 58 general dental practitioners and 34 specialists responded to the questionnaire. 65.2% of the dentists preferred Tofflemire Matrix System, for 53.3% selection depended upon the final tooth preparation requirements, 41.3% marked sectional matrix system to be the best and 24% of the dentists had a preference of using separation ring with sectional bands. Experience of the dentists had no remarkable effect on the preference. Universal Matrix System [Tofflemire] was the preference of the majority of the dentists for direct class II composite restorations. Sectional Matrix System with separation ring was mostly preferred by the specialists but the selection depended upon the restorative requirements

Trends for choosing composites for posterior restorations by the dentists in Lahore

The aim of this study was to evaluate the attitudes of dental surgeons towards posterior composite restorations in terms of case selection and concerns. 100 questionnaires were randomly distributed to the dental surgeons working in hospitals and clinics in Lahore. The questionnaires were designed to elicit information regarding case selection criteria and main concerns while placing posterior composite restorations. 92 completed questionnaires were returned. 58 general dental practitioners and 34 specialists responded to the questionnaire. 81.5% of the dentists preferred composites for restoring only small defects. 46.5% selected composites for posterior restoration on patient demand. Conservation of tooth structure was the causq for placing 81.5%, esthetics for 67.4% and patient preference for placing 74% restoration by these dentists. 69.5% of the dentists reported to adopt methods to maintain isolation during composite placement, 60% showed concern about contact point generation and 32.6% adopted techniques to minimize polymerization shrinkage stresses. Differences in responses were not remarkable between general dentist group and specialist groups. Conservation of tooth structure and esthetics were the main reasons for selection of posterior composites. Posterior composite restorations were chosen mainly for small defects. Patient preference was given weightage for material selection