Karachi Cancer Registry (KCR): Consolidated Data of 5-years 2017-2021.

OBJECTIVE:  To collect and analyse epidemiologic data of all malignancies by age group and gender for the Karachi population to estimate the cancer incidence of 5-years (2017-2021) and identify major risk factors for setting priorities towards cancer control programs. STUDY DESIGN: Observational study. Place and Duration of the Study: Karachi Cancer Registry (KCR) Secretariat, Pakistan Health Research Council (PHRC), JPMC, Karachi, from 2017-2021. METHODOLOGY: Cancer data of seven tertiary care hospitals of Karachi submitted to KCR during the study period were analysed including age, gender, date of first contact, primary site and ICD coding. All the data was cleaned, merged, and analysed. All patients 0-14 years were classified as 'children', all aged 15-19 years were classified as 'adolescents', and those age 20-years and above as 'adults'. Age standardised incidence rates (ASIR) were determined for both genders. RESULTS: During the last five years (2017-2021), a total of 65,886 malignant cases were received. The distributions seen amongst males and females were 33,510 (51%) and 32,376 (49%), respectively with 60,145 (91.3%) tumours found in adults (≥20 years), 4844 (7.3%) in children, and 897 (1.4%) in adolescents. The three most common tumour sites were oral, liver, and colorectal in males; breast, oral and ovary in females; bone, brain and connective tissue in adolescents; and leukaemia, brain and bone in children. The overall ASIR (%) in males was 89.20 for adults, 9.19 for children, and 1.61 for adolescents. The overall ASIR (%) in females was 93.44 for adults, 5.45 for children, and 1.11 for adolescents. CONCLUSION: Oral cancer, a largely preventable cancer is the leading cancer in males while breast cancer is the leading cancer in females followed by oral cancer. In adolescents and children, the incidence closely matches most of the world. KEY WORDS: Karachi, Cancer registry, Oral cancer, Breast cancer, Age-standerdised ratio.

Frequency, Distribution Of Subtypes And Immunohistochemical Profile Of Non-Hodgkin Lymphoma In Paediatric And Adolescent Patients.

BACKGROUND: Non-Hodgkin lymphoma is a common malignant disorder in paediatric and adolescent age group. There is a need of large-scale studies to understand the disease pattern in Pakistan as no official registry exist in most of the developing countries. This study comprised a large cohort of 223 patients, spanned over a decade from January 2008-December 2019 and aimed to report the prevalence of subtypes, demographics and immunohistochemical profile from this region. METHODS: Retrospective study, conducted at Indus hospital and health network and Ziauddin university hospital, Karachi, Pakistan. Sequential data analysis was carried out on all consecutive samples including both needle and excisional biopsies of patients below 18 years of age. Morphological examination of H&E stained sections along with immunohistochemistry is performed in order to identify subtypes and immunophenotypic patterns using an extensive panel of markers. RESULTS: Our results demonstrate 66% B-cell lymphomas while 34% T-cell lymphomas. Overall male to female ratio was 3.3:1 with median age 8 years (1.1-17 years). Among B-cell lymphoma, Burkitt lymphoma is most common while in T-cell, T-lymphoblastic lymphoma is the most common subtype. In anaplastic large cell lymphoma category, null cell phenotype was predominant, i.e., 65%. T-NHL frequency is found to be higher in our population. However, results of immunohistochemistry are similar to published literature. CONCLUSIONS: The study will help to identify disease patterns in terms of subtypes of NHL and its immunohistochemical profile that plays a vital role in diagnostic, prognostic and therapeutic implications.

Karachi Cancer Registry (KCR): Age-Standardized Incidence Rate by Age-Group and Gender in a Mega City of Pakistan.

OBJECTIVES: To estimate the cancer incidence by age group and gender for the population of Karachi Division by analyzing the Karachi Cancer Registry data of 2017-19. SETTINGS: The population of Karachi division is 16.1 million according to national census 2017. 'Karachi Cancer Registry' which is a part of 'National Cancer Registry' is collecting data from eight major hospitals in Karachi since 2017. For outcome measures, cancer counts and the age standardized incidence rates (ASIR) per 100,000 population were computed for age groups (0-14, 15-19 and ≥20 years), in both genders and all cancer site/type. METHODS: The population denominators were based on the population of Karachi division estimated at 16.1 million in the population census, 2017. Counts and age-standardized incidence rates (ASIR) were calculated for each of the three age categories. RESULTS: From Jan 2017 till Dec 2019 a total of 33,309 malignant cases were recorded in KCR database comprising 17,490 (52.5%) females and 15,819 (47.5%) males. ASIRs in age groups 0-14, 15-19 and ≥ 20 years, among female were 11.5, 2.4 and 223.6 and in males were 17.6, 3.2 and 216.7 respectively. The commonest diagnosis in children, adolescent and adults were (1) among females: children; bone (3.12),  leukemia (2.09) brain/CNS (1.26); in adolescents: bone (0.78), brain/CNS (0.27), connective and soft tissue (0.11), in adults: breast cancer (76.07), oral cancer (16.68) and ovary (10.89) respectively, and (2) among males: children; bone (4.56),  leukemia (2.79) and brain/CNS (1.88); in adolescent; bone (1.19), brain/CNS (0.31) and leukemia (0.21) and in adults: oral cancer (42.83), liver (16.10) and bone (13.37) respectively. CONCLUSION: Oral Cancer, a largely preventable cancer is the leading cancer in Karachi adult males while in female adults Breast Cancer is the leading cancer followed by Oral Cancer. In children and adolescents Bone, Leukemia and Brain/CNS malignancies are most common.
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Her-2/neu Oncogene Amplification by Fluorescence In Situ Hybridization and Protein Overexpression on Immunohistochemistry in Breast Cancer.

OBJECTIVE: To investigate the concordance and discordance between the test results of Her-2/neu by immunohisto-chemistry (IHC) and flourescence In Situ hybridization (FISH) in breast cancer cases. STUDY DESIGN: Descriptive cross-sectional study. PLACE AND DURATION OF STUDY: Department of Histopathology, Dr. Ziauddin Hospital, Karachi, from 2011 to 2016. METHODOLOGY: Forty-three specimens of invasive ductal carcinoma of breast were evaluated for grade and Her-2/neu status using IHC and FISH methods. Concordance and discordance between their results was determined. RESULTS: There is 100% concordance between FISH and IHC in cases scoring 0, 1+ (negative) and 3+ (positive) immunostaining. Tumour cases scoring 2+ immunostaining showed amplification in 69.2% cases. All grade-I tumours were non-amplified on FISH, while most of the grade-III tumours showed Her-2/neu amplification on FISH. There is significant association of Her-2/neu IHC with tumour grade and FISH (p<0.05). A fairly high proportion i.e. 69.7% of cases showed Her-2/neu gene amplification. There was high concordance between Her-2/neu testing on IHC and FISH, (Kappa co-efficient 0.466, p <0.001). CONCLUSION: Her-2/neu amplification increases with increasing grade of breast cancer. A high proportion of Her-2/neu gene amplified cases indicates aggressive disease in that area and need for FISH testing on large scale, which is the gold standard for equivocal cases on immunohistochemistry.

Invasive Ductal Carcinoma: Correlation of Immunophenotypic Features with Age.

OBJECTIVE: To evaluate the frequency of hormone receptors and Her2neu expression and their correlation with age in patients of carcinoma breast. STUDY DESIGN: Descriptive, cross-sectional study. PLACE AND DURATION OF STUDY: Department of Histopathology, Dr. Ziauddin Hospital, Karachi, between the period 2006 - 2013. METHODOLOGY: Estrogen receptors, progesterone receptors and Her2neu immunohistochemical staining was performed on all specimens of carcinoma breast of female patients. Allred scoring was followed using normal epithelium as internal control. Age was determined in years. Results were described as percentages. RESULTS: Three hundred and forty-six cases of infiltrating ductal carcinoma of breast between the age of 20 - 90 years (mean= 49 ±14 years) were studied. Seventy-nine (23%) cases were below the age of 40 years. ER +ve cases were 210 (61%), PR +ve were 190 (55%), and 78 (23%) were Her2neu +ve. Three were 12 (3%) triple positive cases and 58 (17%) triple negative cases. One hundred and seven (31%) cases were ER/PR+ve and Her2neu -ve. Most of the breast cancer cases were aged between 41 - 50 years. Estrogen receptor positivity was maximum between 41 - 60 years. Fifty percent cases of carcinoma breast below 30-year age were also ER positive. CONCLUSION: A high proportion of breast cancer in young Pakistani females is alarming. Younger age harbours aggressive clinicopathologic characteristics. There is a due need for identifying high risk individuals/families including BRCA1 and BRCA2 testings, biologically driven trials devoted specifically to this group.

Extraskeletal osteosarcoma.

A 50 years old male presented with ulcer and swelling in left leg for 2 years. X-ray showed soft tissue sarcoma and excision was done. A diagnosis of extraskeletal osteosarcoma was made. Extraskeletal osteosarcomas are rare malignant mesenchymal neoplasms. By definition, these are located in soft tissue without primary involvement of bone or periosteum. Since these tumours mimic other soft tissue tumours and tumour like conditions, radiology and histopathology along with tumour markers studies are important in diagnosis of this tumour.