Scalp Seeding Post Craniotomy and Radiosurgery for Solitary Brain Metastasis: A Case Report and Systematic Review.

BACKGROUND: Radiosurgery is being increasingly used post craniotomy for brain metastasis, instead of whole-brain radiation. We report a case of scalp metastasis following craniotomy and radiosurgery, along with a systematic review of the literature. METHODS: Our patient was a 70-year-old male who presented with a scalp metastasis, two years after craniotomy and radiosurgery, for a solitary brain metastasis from esophageal carcinoma. Using Medline® (United States National Library of Medicine, Bethesda, MD), we performed a systematic review of the literature to identify cases of isolated scalp metastases following craniotomy for brain lesions. RESULTS: The scalp metastasis was in close proximity to the craniotomy site. Workup did not show any other site of active disease. Biopsy confirmed it to be a metastasis from esophageal carcinoma. The literature review did not yield any case of isolated scalp metastasis following craniotomy and whole-brain radiotherapy or radiosurgery. However, it yielded six cases of isolated scalp metastases following craniotomy for primary brain tumors. CONCLUSION: Isolated scalp metastasis has not been reported following craniotomy and whole-brain radiotherapy for brain metastases. Our patient likely had surgical seeding during craniotomy. These surgically implanted cells could not be ablated because the radiosurgery treatment volume does not cover the surgical tract. Further research is needed to identify risk factors for surgical seeding.

Hep par-1: a novel immunohistochemical marker for differentiating hepatocellular carcinoma from metastatic carcinoma.

OBJECTIVE: To evaluate the diagnostic utility of Hep par-1 in differentiating hepatocellular carcinoma from metastatic carcinoma taking histopathology as a gold standard. STUDY DESIGN: Comparative cross-sectional study. PLACE AND DURATION OF STUDY: Pathology Department, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, from April 2007 to February 2008. METHODOLOGY: Hep par-1 immunohistochemical stain was performed on 60 cases of liver carcinoma, 30 cases each of metastatic and hepatocellular carcinoma. Information regarding patient age, gender, sign and symptoms, radiographic findings, histological grade of tumour, and expression of Hep par-1 on hepatocellular and metastatic carcinoma were recorded on proforma sheet. Sensitivity, specificity, positive and negative predictive values, and accuracy of Hep par-1 were calculated using the formulas. RESULTS: Hep par-1 expression was noted in 25 out of 30 cases of hepatocellular carcinoma (83%). Out of 30 cases of metastatic carcinoma, only one case expressed staining in < 5% tumour cells and remaining 29 cases showed no reactivity. The age of the patients with hepatocellular carcinoma ranged from 40 to 76 years with a median age of 60.5 years and 40 - 75 years for metastatic carcinomas with a median age of 57.5 years. CONCLUSION: Hep par-1 is a reliable immunohistochemical marker for cases of hepatocellular carcinoma (HCC). It can be used along with other markers in morphologically difficult cases when differential diagnosis lies between poorly differentiated HCC and metastatic carcinoma of liver.

Role of p63 in differentiating morphologically ambiguous lesions of prostate.

OBJECTIVE: To observe the role of p63 staining in evaluation of morphologically ambiguous lesions of prostate. STUDY DESIGN: Descriptive (case series) study. PLACE AND DURATION OF STUDY: Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, from March to September 2010. METHODOLOGY: p63 immunohistochemistry staining was performed on 30 cases diagnosed as morphologically ambiguous lesions of prostate by histopathologist. Patient's name, age, histology numbers, morphological features, expression of p63 and histopathological diagnosis were recorded and described as frequency percentages. RESULTS: The prostatic adenocarcinomas were negative for p63 and benign lesions of prostate were positive for p63. Atypical lesions show positive staining in 77.7% and negative staining in 33.3% of cases. CONCLUSION: p63 immunohistochemistry staining can be used as a reliable marker to distinguish between benign from malignant morphologically ambiguous lesions of prostate.

Utility of p63 immunohistochemical stain in differentiating urothelial carcinomas from adenocarcinomas of prostate.

BACKGROUND: Prostatic adenocarcinoma and urothelial carcinoma of the urinary bladder are common cancers in men. High grade forms of these tumors may present ambiguous morphologic features that do not permit a definite diagnosis. This distinction between the two tumors has significant staging and therapeutic implications. Hence, an accurate diagnosis is essential for optimal patient care. p63 is a new marker which can be used in this context. It is expressed in most of the urothelial carcinomas and negative in majority of prostatic adenocarcinomas. AIM: To compare the expression of p63 in urothelial carcinomas and adenocarcinomas of prostate. MATERIALS AND METHODS: Comparative cross--sectional study was carried out at a tertiary cancer hospital from 15 June 2006 to 15 December 2006. Immunohistochemical stain p63 was performed on 50 cases of urothelial carcinoma and 50 prostatic adenocarcinomas. Patients' name, age, histology numbers, grade of tumor, and expression of p63 were recorded. p63 expression was seen in 44 of 50 urothelial carcinomas (88%). None of the prostatic adenocarcinomas expressed p63. The ages of patients with prostatic adenocarcinoma ranged from 49 to 86 years with a median age of 71 years and 41 to 83 years for urothelial carcinomas with a median age of 60.5 years. CONCLUSION: p63 can be used as a reliable marker to distinguish prostatic adenocarcinomas from urothelial carcinomas in difficult cases in conjunction with other markers like PSA.

Generalized cutaneous granulocytic sarcoma with joint involvement.

Granulocytic sarcoma (GS) is a rare extra medullary solid tumour composed of immature myeloid cells. These tumours often display a greenish colour due to the enzymatic action of myeloperoxidase in the tumour cells. Hence, the term 'chloroma' was given to this lesion in 1853. GS commonly involves bone, periosteum, soft tissue, lymph node, and skin. Rare occurrences in muscle, meninges, breast, mediastinum, joints and ovary have been reported. Below-knee joint involvement in GS is unusual. We report a case of generalized cutaneous granulocytic sarcoma with ankle joint involvement who subsequently developed AML-M4.

National study of reproductive tract infections among high risk groups of Lahore and Karachi.

OBJECTIVE: To estimate the prevalence of reproductive tract infections (RTIs) among the Female Sex Workers (FSWs), Male Sex Workers (MSWs), Injecting Drug Users (IDUs) and truck drivers. STUDY DESIGN: Cross-sectional. PLACE AND DURATION OF STUDY: Lahore and Karachi, from March to August, 2004. METHODOLOGY: Four hundred FSWs, 400 MSWs, 200 eunuchs, 400 IDUs and 400 truck drivers were interviewed and examined. Biological testing included PCR and ELISA. RESULTS: The mean prevalence of syphilis was 17.7% (95% CI: 15.1-20.3%). Genital gonorrhoea was found among 0.8-12.3% of subjects with mean of 4.5% (95% CI: 0.8-5.2%). Genital chlamydia was seen in 0.2-11% individuals with mean of 2.6% (95% CI: 2.1-3.1%). Trichomonas was present in 19.3% FSWs of Lahore and 5.52% FSWs of Karachi. Only 0.8% truckers in Lahore had trichomonas. In Lahore, 47.6% FSWs and in Karachi, 27.4% FSWs were positive for bacterial vaginosis. A vast majority of IDUs, 91.8% in Lahore and 87% in Karachi were hepatitis C positive. CONCLUSION: The prevalence of syphilis is very high among all high-risk groups; particularly so among eunuchs (60.2% in Karachi and 32.3% in Lahore). Such a high levels of RTIs indicate a serious threat for HIV epidemic because of socially transmitted infection.

Comparison of estrogen receptors, progesterone receptors and HER-2/neu expression between primary and metastatic breast carcinoma.

OBJECTIVE: To determine whether receptor status and HER-2/neu status remains same in primary and metastatic breast carcinoma to corresponding lymph nodes of individual patients. METHODS: Estrogen receptors, progesterone receptors and HER-2/neu immunohistochemical stains were performed on primary and metastatic breast carcinoma to axillary lymph nodes in 100 patients. Data was collected on a Performa and age, tumour size, type, grade and expression of ER, PR and HER-2/neu on primary and metastatic tumours were recorded. RESULTS: Hormone receptor status was compared between primary and metastatic tumours. Estrogen receptor positivity was observed in 28% primary tumours which were reduced to 25% in metastatic carcinoma. Progesterone receptors were positive in 28% primary tumours as compared to 22% in metastatic tumours. Her-2/neu protein over expression was noted in 44% primary and 45% metastatic breast tumours respectively. In case to case comparison ER, PR and HER-2/neu showed 91%, 88% and 95% concordance in primary and metastatic tumours respectively. CONCLUSION: ER, PR and HER-2/neu biomarkers showed significant concordance between primary and metastatic breast carcinoma.

HIV risk in Karachi and Lahore, Pakistan: an emerging epidemic in injecting and commercial sex networks.

The objective of this study was to measure HIV prevalence and risk behaviour in injecting drug users (IDUs), male sex workers (MSWs), Hijras (transgenders), female sex workers (FSWs) and male truckers in Karachi and Lahore, Pakistan. The design was a linked-anonymous cross-sectional study of individuals identified at key venues or through peer referral. Approximately 400 respondents in each group (200 for Hijras) responded to a standardized questionnaire and were tested for HIV antibodies at each site. In Karachi, 23% of IDUs and 4% of MSWs were HIV positive, and HIV-positive individuals were identified in all risk groups in at least one city. Two-thirds of all IDUs used a shared needle in the previous week, and unprotected commercial sex activity with men and women was high. The HIV epidemic has entered IDU and male and female commercial sex networks in Karachi and Lahore. Targeted intervention services must be scaled up and risk group surveillance intensified.

Skin metastasis from prostate adenocarcinoma.

We are presenting an interesting case of skin metastasis from adenocarcinoma prostate. Interestingly bone metastasis were absent as documented on radioisotope bone scan and PSA levels were normal. As it was a hormone refractory disease, he was started on mitoxantrone and prednisolone chemotherapy. Lung metastatis appeared after 2 cycles of chemotherapy. He died of progressive disease 4 months later.

Yield of Terminal Duct Lobule Units in Normal Breast Stereotactic Core Biopsy Specimens: Implications for Biomarker Studies.

The purpose of this study was to assess the potential value of large-needle core biopsies of normal breast tissue for immunohistochemical studies of epithelial risk assessment. A retrospective analysis was performed to determine the yield of nonatrophic terminal duct lobule units (TDLUs) in 11-gauge vacuum-assisted core biopsies of normal adjacent breast tissue which were included in routine stereotactic core biopsies of benign lesions. Fifty-one patients had a median of two normal tissue cores (range 1-7); 82% of the patients had two or more normal tissue cores; 47% had three or more normal tissue cores. Nonatrophic TDLUs were present in only 47% of patients and in 31% (42 of 137) of all cores. Patients with heterogeneous or dense normal mammographic parenchyma at the site of the biopsy were more likely to have nonatrophic TDLUs, 45% (20 of 44), than patients with fatty normal mammographic parenchyma at the biopsy site, 0% (0 of 7), p = 0.007. Seventy percent (7 of 10) of postmenopausal women on hormone replacement therapy had nonatrophic TDLUs as compared to 41% (11 of 27) of premenopausal and postmenopausal women not on hormones (p = not significant). Eleven-gauge vacuum-assisted core biopsies of normal breast tissue have a low yield of nonatrophic TDLUs suitable for histochemical studies of epithelial risk assessment.