Objective: The objective of my study is to investigate the incidence ERG fusion positive adenocar... more Objective: The objective of my study is to investigate the incidence ERG fusion positive adenocarcinoma and its correlation with gleason grade and gleason group. Methods: it is a descriptive cross sectional study. 100 cases of prostatic adenocarcinoma were retrieved and ERG immunohistochemical stain was applied on all these cases. ERG expression, extent of staining, percentage of tumor cells positive for ERG, pattern of staining were recorded. We found out relationship of ERG expression and gleason grade/ gleason group. Results: ERG expression was seen in 62/100 (62%) cases. mean patient age of ERG positive prostatic adenocarcinoma patients was 69.68years. In GG1 (14.5%) 9 cases exhibited ERG positivity. In GG2-3, 41.93% cases and in GG4-5, 43.54% cases showed ERG expression. Conclusion: To conclude, age of presentation of ERG positive adenocarcinoma was high. ERG expression was seen in 62% of our cases which was much higher than reported in other Asian countries. In our study we fo...
Introduction: Melanoma ranks 19th among malignancies overall and second among cutaneous types. Th... more Introduction: Melanoma ranks 19th among malignancies overall and second among cutaneous types. The incidence worldwide has been on the rise over the last seven decades. Various prognostic factors have been assessed and found to have a profound impact on patient outcome. However, no such studies have been attempted in our population. Our study aimed to have an insight into the behavior of malignant melanoma in our population. Materials and Methods: Cases of cutaneous malignant melanoma treated and followed up at our institute were included in this study. Cases of mucosal and choroidal melanoma were excluded. The parameters noted were age, gender, tumor thickness, Clark level, and presence of ulceration. These parameters were individually correlated with development of distant metastasis, two-year survival, survival duration, and primary tumor and lymph node stage. Appropriate statistical analyses were done. Results: Thirty patients of cutaneous malignant melanomas were treated and followed up at our institution. There was male predilection of 1:1.5. Mean age at diagnosis was 50.1 years. Twoyear survival was significantly better in females. Sun-exposed areas of the skin were most commonly involved followed by anal canal that has an unusually high incidence in our society. Majority of our cases were pT4(25) on tumor, nodal status, metastasis (TNM) staging at time of diagnosis. Increasing tumor thickness in terms of primary tumor staging was not found to have any significant impact on two-year survival, distant metastasis, lymph node stage, or survival duration. Sixty percent of cases had ulceration. There was no statistically significant effect on two-year survival (78% in ulcerated group vs 75% in nonulcerated group) and distant metastasis (61% vs 58.3%). In terms of Clark level, 20 cases were level V, seven cases were level IV, two were level III, and one was level I. There was no statistically significant difference between the Clark levels in terms of two years survival, development of distant metastasis, and lymph node stages. Conclusion: Melanoma is an aggressive malignancy that causes high morbidity and morality. It commonly presents at an advanced stage at time of diagnosis in our population. Broader studies are required with early-stage melanomas to compare the various prognostic factors and their impact on prognosis.
Adrenocortical carcinoma (ACC) is a rare and highly aggressive tumor with a poor prognosis. The l... more Adrenocortical carcinoma (ACC) is a rare and highly aggressive tumor with a poor prognosis. The literature on prognosis from low-income or low-middle-income countries is limited and scarce. This study aimed to determine the clinical and histopathological characteristics, recurrence-free survival (RFS), overall survival (OS), and the factors affecting ACC's prognosis. This was a retrospective study of patients that presented with ACC to the Shaukat Khanum Memorial Cancer & Research Center, Lahore, Pakistan, between January 2011 and May 2018. Information regarding demographics and clinical and histopathological variables were extracted and analyzed. Of the 25 subjects, 16 (64%) were female. The median age of the sample was 35 years (range; 21-72 years). Statistically significant associations were found between RFS and functional status of the tumor (p = 0.014), cortisol overproduction (p = 0.02), androgen excess (testosterone [p = 0.03] and dehydroepiandrosterone sulfate [DHEA SO4] [p = 0.004]), Ki-67 score (p = 0.03), mitotic rate (p = 0.02), stratified mitotic rate (p = 0.01), and composite variable of disease (p = 0.004). The OS was found to have statistical associations with cortisol hypersecretion (p = 0.02), DHEA SO4 excess (p = 0.01), Modified Weis Score (p < 0.001), mitotic rate (p = 0.02), stratified mitotic rate (p = 0.003), and composite variable of disease (p = 0.001). Linear regression (forward-type) analysis suggested that the functional status of the tumor and the disease recurrence index statistically predicted the variance in RFS and OS, respectively. Multiple clinical and histopathological variables appear to affect the prognosis of ACC. However, based on multivariable analysis, it appears that the functional status of the tumor and the composite variable of disease recurrence are predictors of RFS and OS, respectively.
Journal of Ayub Medical College, Abbottabad : JAMC, 2020
BACKGROUND Secretory carcinoma of the salivary gland (SC) is a new entity that harbours a specifi... more BACKGROUND Secretory carcinoma of the salivary gland (SC) is a new entity that harbours a specific ETV6 gene rearrangement. The clinical behaviour of this tumour is not well-known as it is a relatively new entity but it is generally considered as a tumour of low malignant potential. The objective of the study was to find out the frequency of ETV6 translocation in cases diagnosed based on histology and immunohistochemistry, to study morphological features and immunohistochemical findings of our cases and to determine the survival and disease-free status of our patients. METHODS Twenty-five diagnosed cases of SC were retrieved from the archives of SKMCH and RC. Diagnosis was made primarily based on morphology and immunohistochemistry. Immunohistochemistry includes S100, p63, mammaglobin, DOG 1, GCDFP-15, TTF-1, GATA3, SMA, AMA, and AR. The diagnosis was further confirmed by molecular testing, i.e., Fluorescence in situ hybridization (FISH) studies to observe specific ETV6 gene break. ...
Objective: To evaluate the use of Ki67 as a surrogate marker for Mitotic Karyorrhectic Index (MKI... more Objective: To evaluate the use of Ki67 as a surrogate marker for Mitotic Karyorrhectic Index (MKI) in Neuroblastoma. Study Design: Cross-sectional study. Place and Duration of Study: This was a retrospective study conducted at Department of Histopathology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan. 41 cases of neuroblastoma from 2010 to 2014 were retrieved. Methodology: Forty one cases of neuroblastoma were evaluated. Clinical and morphological features like age, gender and subtype of tumor were quantified. For each case, Mitotic Karyorrhectic Index was calculated and categorized as low, intermediate and high. This was followed by immunostaining for Ki67 on each case. Using linear regression model an equation was derived to calculate ki67 from Mitotic Karyorrhectic Index. The equation was as follows: Mitotic Karyorrhectic Index = (Ki67 x 0.115) ± 1.355. Using this equation, the cut-off values for low, intermediate and high Ki67 were 23.0% respecti...
Introduction: Fibroadenomas (FAs) and phyllodes tumors (PTs) are less prevalent but allied to hav... more Introduction: Fibroadenomas (FAs) and phyllodes tumors (PTs) are less prevalent but allied to have malignant transformation in many instances. It is a challenge to diagnose the phyllodes by conventional trucut biopsy technique. Objective: To evaluate the histological characteristics of tumors labeled as fibroepithelial lesions of breast tissues on trucut biopsy and compare with a diagnosis on excision biopsy. Methods and materials: It was a descriptive cross-sectional study that was carried out in Shaukat Khanum Memorial Hospital and Research Centre within six years from January 2015 to January 2021. In trucut samples, stromal cellularity, stromal cell nuclear atypia, mitotic count, stromal overgrowth, the enhancement of stromal cellularity adjacent to epithelium were scrutinized. In each category, the activity was seen as absent, mild, moderate, or severe. Mitotic activity was graded as 0-1, 0-5, 5-10, >10. Results: A total of 125 patients were registered for the study. The mean age of patients in our study was 33.86 ± 9.95 years. The mean size was 41.02 ± 27.38 mm with a mean lump duration of 7.52 ± 5.34 months. In the FA group, the trucut sampling report showed the stromal cellularity as mild in 62 (69.7%) and stromal cell nuclear atypia as absent in 68 (76.4%) cases. But in the phyllodes tumor group, the stromal cellularity was severe in 10 (27.8%) patients and stromal cell nuclear atypia was severe in five (13.9%). The ultimate outcome showed that 89 (71.2%) patients had FA and 36 (28.8%) had PT at excision. Conclusion: Assessment of tumor size, stromal cellularity, mitoses, and enhancement of stromal cellularity adjacent to epithelium are useful markers for diagnosing the PT in trucut needle biopsy.
Purpose. Clear cell sarcoma of the kidney (CCSK) is an uncommon malignant renal tumor. It is the ... more Purpose. Clear cell sarcoma of the kidney (CCSK) is an uncommon malignant renal tumor. It is the second most common renal pediatric renal malignancy after Wilms tumor. It exhibits a heterogeneous morphology, with overlapping features with its close differentials, which results in diagnostic challenges. There was no specific immunohistochemical marker in the past, to help in this regard. BCOR antibody has recently been suggested to be helpful in the differential diagnosis. We aim to study the utility of the BCOR antibody in the diagnosis of CCSK. Methods. We selected a total of 27 cases of CCSK (n = 12), Wilms tumor (n = 12), and congenital mesoblastic nephroma (n = 3). All cases were evaluated for the extent and intensity of nuclear labeling for BCOR antibody by immunohistochemistry (IHC). Results. We found that BCOR IHC was positive in 11 out of 12 cases with diffuse and strong staining in 8 of the cases. None of the cases of Wilms tumor and congenital mesoblastic nephroma were pos...
Solitary fibrous tumours (SFTs) are fibroblastic mesenchymal tumour primarily identified in the p... more Solitary fibrous tumours (SFTs) are fibroblastic mesenchymal tumour primarily identified in the pleura but are now being reported in other anatomic sites as well. SFT is generally characterised as a radiologically confined neoplasm composed of a proliferated spindle cells arranged in patternless manner. Intervening tissue shows prominent haemangiopericytoma-like vessels. Stroma is usually fibrous. Tumour is positive for CD34. SFT has a specific translocation representing fusion NAB2 with STAT6 genes. This translocation can be highlighted with very good specificity and sensitivity using STAT6 immunohistochemical stain. Some cases of SFTs have also been described in the breast. Rarely, SFT can show aggressive behaviour. SFT enters the differential diagnoses of benign and malignant spindle cell tumours of breast and it is, therefore, important that its clinical, radiological and pathological features are known to clinicians and diagnosticians. Key words: CD34, myofibroblastoma, NAB2-ST...
Journal of Islamabad Medical & Dental College, 2019
Objective: This study was conducted to analyse the clinicopathological and radiological features ... more Objective: This study was conducted to analyse the clinicopathological and radiological features associated with Synovial lipomatosis.Patients and Methods: Cases diagnosed as Synovial lipomatosis from 2008 to 2018 were retrieved and clinical information and histology were reviewed.Results: Thirteen cases of Synovial lipomatosis were diagnosed between 2008 and 2018. Most common site was knee joint and mean age of presentation was 28.6. About 62% of subjects were males and mostly presented with joint pain and swelling. Two of the subjects had significant history of trauma and disease was bilateral in one of the cases. Microscopically, villous proliferation of synovium with infiltration of mature adipocytes was noted. Focal synovial hyperplasia and inflammatory infiltrate were other findings in some of the cases.Conclusion: Synovial lipomatosis should be considered in the differential diagnosis of joint pain and swelling and should be distinguished from Pigmented villonodular synovitis...
Introduction Follicular dendritic cell sarcoma (FDCS) is a rare neoplasm, accounting for only 0.4... more Introduction Follicular dendritic cell sarcoma (FDCS) is a rare neoplasm, accounting for only 0.4% of soft-tissue sarcomas. It shows both nodal and extranodal involvement. Considering the rarity and difficulties in diagnosing this tumor, we consider it very important to share our experience of diagnosing FDCS. Its correct diagnosis cannot be overemphasized as the treatment and prognosis of FDCS are very much different from tumors which come in its differential diagnosis. Material and Methods We are presenting eight cases of extranodal FDCS in gastrointestinal tract diagnosed at our center in a period of 3 years (Feb 2015 to Feb 2018). Presenting complaints, demographic details, gross description, histologic features, immunostain results, and clinical follow-up were evaluated. Results Four patients were females and four were males. Tumor ranged in size from 5.5 to 35 cm. In five cases, tumor cells were arranged in storiform and whorling pattern. Lymphocytes were seen sprinkled in between these cells. In one case, lymphocytic infiltrate was extensive. Giant cells and frequent mitoses were noted in two cases. One case showed extensive necrosis. Tumor cells were strongly and diffusely positive for CD21 and CD35. Mean follow up of 11.8 months (range 01 to 24 months) was noted. Conclusion FDCS is a rare tumor having distinct morphology and phenotype which if known can be correctly diagnosed. Therefore, knowledge of its varied location, morphology, and phenotype is very important to correctly diagnose this tumor and to prevent misdiagnosis and mistreatment.
Asian Pacific journal of cancer prevention : APJCP, Jan 27, 2018
Introduction:Soft tissue sarcomas are rare tumors comprising 1 percent of solid malignancies. The... more Introduction:Soft tissue sarcomas are rare tumors comprising 1 percent of solid malignancies. The latest edition of WHO soft tissue pathology lists 94 benign and malignant soft tissue tumors. Many of these show a large degree of morphological overlap. Immunohistochemistry has been shown to be reliable in many cases for differential diagnosis of lesions, although cytogenetic tests are considered the gold standard for many entities.Fluorescence in-situ hybridization (FISH) is a cytogenetic technique that uses fluorescent probes that bind to only those parts of the chromosome which have a high degree of sequence complementarity. Many soft tissue tumors show recurrent genetic mutations that are now being used as diagnostic markers. Knowledge of the molecular identity allows prediction of behavior, prognosis and treatment response. Objective:The aim of this study was to identify genetic mutations in soft tissue sarcomas using FISH testing and to assess correlations with histological diag...
Background: The presence of Epstein-Barr virus (EBV) in Non-Hodgkin's lymphoma can be identified ... more Background: The presence of Epstein-Barr virus (EBV) in Non-Hodgkin's lymphoma can be identified by immunohistochemistry for detection of EBV latent membrane protein (LMP). The role of EBV as an etiologic agent in the development of non-Hodgkin lymphoma has been supported by detection of high levels of latent membrane protein 1 (LMP-1) expression in tumors. However, no study has been conducted in a Pakistani population up till now to determine the frequency of Epstein-Barr virus positivity. The objective of our study was to determine a value for non-Hodgkin lymphoma patients using EBV LMP-1 immunostaining in our institution. Materials and Methods: This study was carried out at the Department of Histopathology, Armed Forces Institute of Pathology (AFIP), Pakistan from December 2011 to December 2012. It was a cross sectional study. A total of 71 patients who were diagnosed with various subtypes of NHL after histological and EBV LMP-1 immunohistochemical evaluation were studied. Sampling technique was non-probability purposive. Statistical analysis was achieved using SPSS version 17.0. Mean and SD were calculated for quantitative variables like patient age. Frequencies and percentages were calculated for qualitative variables like subgroup of NHL, results outcome of IHC for EBV and gender distribution. Results: Mean age of the patients was 53.6±16 years (Mean±SD). A total of 50 (70.4%) were male and 21 (29.6%) were female. Some 9 (12.7%) out of 71 cases were positive for EBV-LMP-1 immunostaining, 2 (22.2%) follicular lymphoma cases, 1 (11.1%) case of T-cell lymphoblastic lymphoma, 4 (44.4%) cases of diffuse large B cell lymphomas, 1 (11.1%) mantle cell lymphoma and 1 (11.1%) angioimmunoblastic T cell lymphoma case. Conclusion: In our study, frequency of EBV in NHL is 12.7% and is mostly seen in diffuse large B cell lymphoma. This requires further evaluation to find out whether this positivity is due to co-infection or has a role in pathogenesis.
Introduction: Diffuse large B-cell lymphomas (DLBCL) can be divided into germinal centre (GC-DLBC... more Introduction: Diffuse large B-cell lymphomas (DLBCL) can be divided into germinal centre (GC-DLBCL) and post germinal centre (post GC-DLBCL) groups by applying immunohistochemical antibodies. As these subgroups respond differently to chemotherapy, it is possible at diagnosis to select a poor prognostic subgroup for aggressive treatment. Objective: To determine the frequencies of GC-DLBCL and post GC-DLBCL in patients by immunohistochemistry (IHC) and the clinical response after six cycles of chemotherapy. Subjects and Methods: In this descriptive study conducted in AFIP and CMH, Rawalpindi and NORI, Islamabad, from September 2010 to September 2011, a total of 75 pretreatment cases of DLBCL diagnosed during the study period were included. Cases were segregated in to GC-DLBCL and post GC-DLBCL groups according to results of immunohistochemistry markers CD10, BCL6 and MUM1. Immediate clinical response was assessed after 6 cycles of chemotherapy. Response was divided into complete response, partial response, stable disease or relapse or progression. Results: The mean age was 54.2±15. Males were 53 (70.7%). Forty (53.3%) cases comprised the GC-DLBCL group; 25(62.5%) of them showed a complete response. Most patients of the post GC-DLBCL 19(54%) showed relapse/progression. Results of immediate clinical response in both prognostic subgroups were significant (p<0.05). Results regarding positivity with immunohistochemical antibodies CD10 (p 0.011), BCL6 (p 0.013) and MUM1 (p 0.000) regarding immediate clinical response were also significant. Conclusion: GC-DLBCL group shows better response to CHOP chemotherapy regimen. Immunohistochemistry should be used to further classify DLBCL as this can enable us to select aggressive group for aggressive treatment. This manuscript is important because the study is the first to becarried out exclusively in Pakistan or our part of the world.
Asian Pacific journal of cancer prevention : APJCP, 2016
There is growing evidence that there are differences in histological and genetic characteristics ... more There is growing evidence that there are differences in histological and genetic characteristics along with clinical behavior between right- and left-sided colon carcinomas. We have compared various parameters of the two types and assessed associations of the results with prognosis in patients in Pakistan. We reviewed 200 cases from our institutional database; 100 cases of right-sided and 100 cases of left-sided colon cancer. Parameters including age, gender, TNM stage, histological features and clinical outcome were analyzed. The patients with right-sided colon cancer were significantly older as compared to their counterparts with left-sided cancer. They presented with a lumbar mass rather than symptoms of obstruction and perforation as seen in left-sided colon cancers, and the histology showed higher percentage of poorly differentiated tumors with advanced pT stage. Moreover, Crohn's-like reactions, intra tumoral lymphocyte responses and other poor prognostic factors like lymp...
Objective: To compare mesorectal fascia status on histopathological findings with MRI based radio... more Objective: To compare mesorectal fascia status on histopathological findings with MRI based radiological mesorectal fascia status in patients with rectal carcinoma taking histopathology finding as gold standard. Study Design: Analytical study. Place and Duration of Study: Department of Pathology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, from January 2011 to April 2012. Methodology: Biopsy proven cases of rectal adenocarcinoma undergoing abdominoperineal resection were included in this study. Microscopic examination of slides was done to determine mesorectal fascia status as involved or otherwise without knowing the results of mesorectal fascia status on MRI. Mesorectal fascia status of MRI was determined by a radiologist who was not aware of the histopathological assessment of mesorectal fascia. Mean and standard deviation was calculated for age. Frequency and percentage were calculated for gender and mesorectal fascia status. 2 x 2 table was generated to...
Dengue fever has now affected all the major cities of country. About 41,354 patients underwent an... more Dengue fever has now affected all the major cities of country. About 41,354 patients underwent antibody screening for dengue fever from Shaukat Khanum Memorial Cancer Hospital, Lahore, during the epidemic period (October 1st 2010 to December 20th 2010). Out of them, 1294 (3.1%) patients were positive for IgM antibodies, and 124 (0.3%) for IgG antibodies. A total of 722 (1.7%) patients were borderline positive for IgM antibodies and 108 (0.26%) were borderline positive for IgG antibodies. Dengue fever has emerged as a global problem over the last 5 years. It has also hit Lahore badly especially after the floods in 2010. High index of suspicion should be there in case of related symptoms.
Journal of the College of Physicians and Surgeons--Pakistan : JCPSP, 2014
To determine the expression of CD-10, BCL-6 and MUM-1 in patients with diffuse large B-cell lymph... more To determine the expression of CD-10, BCL-6 and MUM-1 in patients with diffuse large B-cell lymphoma (DLBCL) and its association with immediate clinical response after six cycles of CHOP chemotherapy. Analytical study. Armed Forces Institute of Pathology (AFIP), Rawalpindi in collaboration with Nuclear medicine, Oncology and Radiotherapy Institute (NORI), Islamabad from September 2010 to September 2011. CD-10, BCL-6 and MUM-1 antibodies were applied on cases diagnosed as DLBCL. Immediate clinical response was noted after 6 cycles of chemotherapy with the help of oncologist and divided into complete response, partial response, stable disease and relapse/ progression. Patient's age, results of expression of CD-10, BCL-6 and MUM-1 and results of immediate clinical response to chemotherapy were noted. Regarding analysis of prognostic markers (CD-10, BCL-6 and MUM-1), chi-square test was used for immediate clinical response to chemotherapy in DLBCL. CD-10 was positive in 40% cases, B...
Objective: The objective of my study is to investigate the incidence ERG fusion positive adenocar... more Objective: The objective of my study is to investigate the incidence ERG fusion positive adenocarcinoma and its correlation with gleason grade and gleason group. Methods: it is a descriptive cross sectional study. 100 cases of prostatic adenocarcinoma were retrieved and ERG immunohistochemical stain was applied on all these cases. ERG expression, extent of staining, percentage of tumor cells positive for ERG, pattern of staining were recorded. We found out relationship of ERG expression and gleason grade/ gleason group. Results: ERG expression was seen in 62/100 (62%) cases. mean patient age of ERG positive prostatic adenocarcinoma patients was 69.68years. In GG1 (14.5%) 9 cases exhibited ERG positivity. In GG2-3, 41.93% cases and in GG4-5, 43.54% cases showed ERG expression. Conclusion: To conclude, age of presentation of ERG positive adenocarcinoma was high. ERG expression was seen in 62% of our cases which was much higher than reported in other Asian countries. In our study we fo...
Introduction: Melanoma ranks 19th among malignancies overall and second among cutaneous types. Th... more Introduction: Melanoma ranks 19th among malignancies overall and second among cutaneous types. The incidence worldwide has been on the rise over the last seven decades. Various prognostic factors have been assessed and found to have a profound impact on patient outcome. However, no such studies have been attempted in our population. Our study aimed to have an insight into the behavior of malignant melanoma in our population. Materials and Methods: Cases of cutaneous malignant melanoma treated and followed up at our institute were included in this study. Cases of mucosal and choroidal melanoma were excluded. The parameters noted were age, gender, tumor thickness, Clark level, and presence of ulceration. These parameters were individually correlated with development of distant metastasis, two-year survival, survival duration, and primary tumor and lymph node stage. Appropriate statistical analyses were done. Results: Thirty patients of cutaneous malignant melanomas were treated and followed up at our institution. There was male predilection of 1:1.5. Mean age at diagnosis was 50.1 years. Twoyear survival was significantly better in females. Sun-exposed areas of the skin were most commonly involved followed by anal canal that has an unusually high incidence in our society. Majority of our cases were pT4(25) on tumor, nodal status, metastasis (TNM) staging at time of diagnosis. Increasing tumor thickness in terms of primary tumor staging was not found to have any significant impact on two-year survival, distant metastasis, lymph node stage, or survival duration. Sixty percent of cases had ulceration. There was no statistically significant effect on two-year survival (78% in ulcerated group vs 75% in nonulcerated group) and distant metastasis (61% vs 58.3%). In terms of Clark level, 20 cases were level V, seven cases were level IV, two were level III, and one was level I. There was no statistically significant difference between the Clark levels in terms of two years survival, development of distant metastasis, and lymph node stages. Conclusion: Melanoma is an aggressive malignancy that causes high morbidity and morality. It commonly presents at an advanced stage at time of diagnosis in our population. Broader studies are required with early-stage melanomas to compare the various prognostic factors and their impact on prognosis.
Adrenocortical carcinoma (ACC) is a rare and highly aggressive tumor with a poor prognosis. The l... more Adrenocortical carcinoma (ACC) is a rare and highly aggressive tumor with a poor prognosis. The literature on prognosis from low-income or low-middle-income countries is limited and scarce. This study aimed to determine the clinical and histopathological characteristics, recurrence-free survival (RFS), overall survival (OS), and the factors affecting ACC's prognosis. This was a retrospective study of patients that presented with ACC to the Shaukat Khanum Memorial Cancer & Research Center, Lahore, Pakistan, between January 2011 and May 2018. Information regarding demographics and clinical and histopathological variables were extracted and analyzed. Of the 25 subjects, 16 (64%) were female. The median age of the sample was 35 years (range; 21-72 years). Statistically significant associations were found between RFS and functional status of the tumor (p = 0.014), cortisol overproduction (p = 0.02), androgen excess (testosterone [p = 0.03] and dehydroepiandrosterone sulfate [DHEA SO4] [p = 0.004]), Ki-67 score (p = 0.03), mitotic rate (p = 0.02), stratified mitotic rate (p = 0.01), and composite variable of disease (p = 0.004). The OS was found to have statistical associations with cortisol hypersecretion (p = 0.02), DHEA SO4 excess (p = 0.01), Modified Weis Score (p < 0.001), mitotic rate (p = 0.02), stratified mitotic rate (p = 0.003), and composite variable of disease (p = 0.001). Linear regression (forward-type) analysis suggested that the functional status of the tumor and the disease recurrence index statistically predicted the variance in RFS and OS, respectively. Multiple clinical and histopathological variables appear to affect the prognosis of ACC. However, based on multivariable analysis, it appears that the functional status of the tumor and the composite variable of disease recurrence are predictors of RFS and OS, respectively.
Journal of Ayub Medical College, Abbottabad : JAMC, 2020
BACKGROUND Secretory carcinoma of the salivary gland (SC) is a new entity that harbours a specifi... more BACKGROUND Secretory carcinoma of the salivary gland (SC) is a new entity that harbours a specific ETV6 gene rearrangement. The clinical behaviour of this tumour is not well-known as it is a relatively new entity but it is generally considered as a tumour of low malignant potential. The objective of the study was to find out the frequency of ETV6 translocation in cases diagnosed based on histology and immunohistochemistry, to study morphological features and immunohistochemical findings of our cases and to determine the survival and disease-free status of our patients. METHODS Twenty-five diagnosed cases of SC were retrieved from the archives of SKMCH and RC. Diagnosis was made primarily based on morphology and immunohistochemistry. Immunohistochemistry includes S100, p63, mammaglobin, DOG 1, GCDFP-15, TTF-1, GATA3, SMA, AMA, and AR. The diagnosis was further confirmed by molecular testing, i.e., Fluorescence in situ hybridization (FISH) studies to observe specific ETV6 gene break. ...
Objective: To evaluate the use of Ki67 as a surrogate marker for Mitotic Karyorrhectic Index (MKI... more Objective: To evaluate the use of Ki67 as a surrogate marker for Mitotic Karyorrhectic Index (MKI) in Neuroblastoma. Study Design: Cross-sectional study. Place and Duration of Study: This was a retrospective study conducted at Department of Histopathology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan. 41 cases of neuroblastoma from 2010 to 2014 were retrieved. Methodology: Forty one cases of neuroblastoma were evaluated. Clinical and morphological features like age, gender and subtype of tumor were quantified. For each case, Mitotic Karyorrhectic Index was calculated and categorized as low, intermediate and high. This was followed by immunostaining for Ki67 on each case. Using linear regression model an equation was derived to calculate ki67 from Mitotic Karyorrhectic Index. The equation was as follows: Mitotic Karyorrhectic Index = (Ki67 x 0.115) ± 1.355. Using this equation, the cut-off values for low, intermediate and high Ki67 were 23.0% respecti...
Introduction: Fibroadenomas (FAs) and phyllodes tumors (PTs) are less prevalent but allied to hav... more Introduction: Fibroadenomas (FAs) and phyllodes tumors (PTs) are less prevalent but allied to have malignant transformation in many instances. It is a challenge to diagnose the phyllodes by conventional trucut biopsy technique. Objective: To evaluate the histological characteristics of tumors labeled as fibroepithelial lesions of breast tissues on trucut biopsy and compare with a diagnosis on excision biopsy. Methods and materials: It was a descriptive cross-sectional study that was carried out in Shaukat Khanum Memorial Hospital and Research Centre within six years from January 2015 to January 2021. In trucut samples, stromal cellularity, stromal cell nuclear atypia, mitotic count, stromal overgrowth, the enhancement of stromal cellularity adjacent to epithelium were scrutinized. In each category, the activity was seen as absent, mild, moderate, or severe. Mitotic activity was graded as 0-1, 0-5, 5-10, >10. Results: A total of 125 patients were registered for the study. The mean age of patients in our study was 33.86 ± 9.95 years. The mean size was 41.02 ± 27.38 mm with a mean lump duration of 7.52 ± 5.34 months. In the FA group, the trucut sampling report showed the stromal cellularity as mild in 62 (69.7%) and stromal cell nuclear atypia as absent in 68 (76.4%) cases. But in the phyllodes tumor group, the stromal cellularity was severe in 10 (27.8%) patients and stromal cell nuclear atypia was severe in five (13.9%). The ultimate outcome showed that 89 (71.2%) patients had FA and 36 (28.8%) had PT at excision. Conclusion: Assessment of tumor size, stromal cellularity, mitoses, and enhancement of stromal cellularity adjacent to epithelium are useful markers for diagnosing the PT in trucut needle biopsy.
Purpose. Clear cell sarcoma of the kidney (CCSK) is an uncommon malignant renal tumor. It is the ... more Purpose. Clear cell sarcoma of the kidney (CCSK) is an uncommon malignant renal tumor. It is the second most common renal pediatric renal malignancy after Wilms tumor. It exhibits a heterogeneous morphology, with overlapping features with its close differentials, which results in diagnostic challenges. There was no specific immunohistochemical marker in the past, to help in this regard. BCOR antibody has recently been suggested to be helpful in the differential diagnosis. We aim to study the utility of the BCOR antibody in the diagnosis of CCSK. Methods. We selected a total of 27 cases of CCSK (n = 12), Wilms tumor (n = 12), and congenital mesoblastic nephroma (n = 3). All cases were evaluated for the extent and intensity of nuclear labeling for BCOR antibody by immunohistochemistry (IHC). Results. We found that BCOR IHC was positive in 11 out of 12 cases with diffuse and strong staining in 8 of the cases. None of the cases of Wilms tumor and congenital mesoblastic nephroma were pos...
Solitary fibrous tumours (SFTs) are fibroblastic mesenchymal tumour primarily identified in the p... more Solitary fibrous tumours (SFTs) are fibroblastic mesenchymal tumour primarily identified in the pleura but are now being reported in other anatomic sites as well. SFT is generally characterised as a radiologically confined neoplasm composed of a proliferated spindle cells arranged in patternless manner. Intervening tissue shows prominent haemangiopericytoma-like vessels. Stroma is usually fibrous. Tumour is positive for CD34. SFT has a specific translocation representing fusion NAB2 with STAT6 genes. This translocation can be highlighted with very good specificity and sensitivity using STAT6 immunohistochemical stain. Some cases of SFTs have also been described in the breast. Rarely, SFT can show aggressive behaviour. SFT enters the differential diagnoses of benign and malignant spindle cell tumours of breast and it is, therefore, important that its clinical, radiological and pathological features are known to clinicians and diagnosticians. Key words: CD34, myofibroblastoma, NAB2-ST...
Journal of Islamabad Medical & Dental College, 2019
Objective: This study was conducted to analyse the clinicopathological and radiological features ... more Objective: This study was conducted to analyse the clinicopathological and radiological features associated with Synovial lipomatosis.Patients and Methods: Cases diagnosed as Synovial lipomatosis from 2008 to 2018 were retrieved and clinical information and histology were reviewed.Results: Thirteen cases of Synovial lipomatosis were diagnosed between 2008 and 2018. Most common site was knee joint and mean age of presentation was 28.6. About 62% of subjects were males and mostly presented with joint pain and swelling. Two of the subjects had significant history of trauma and disease was bilateral in one of the cases. Microscopically, villous proliferation of synovium with infiltration of mature adipocytes was noted. Focal synovial hyperplasia and inflammatory infiltrate were other findings in some of the cases.Conclusion: Synovial lipomatosis should be considered in the differential diagnosis of joint pain and swelling and should be distinguished from Pigmented villonodular synovitis...
Introduction Follicular dendritic cell sarcoma (FDCS) is a rare neoplasm, accounting for only 0.4... more Introduction Follicular dendritic cell sarcoma (FDCS) is a rare neoplasm, accounting for only 0.4% of soft-tissue sarcomas. It shows both nodal and extranodal involvement. Considering the rarity and difficulties in diagnosing this tumor, we consider it very important to share our experience of diagnosing FDCS. Its correct diagnosis cannot be overemphasized as the treatment and prognosis of FDCS are very much different from tumors which come in its differential diagnosis. Material and Methods We are presenting eight cases of extranodal FDCS in gastrointestinal tract diagnosed at our center in a period of 3 years (Feb 2015 to Feb 2018). Presenting complaints, demographic details, gross description, histologic features, immunostain results, and clinical follow-up were evaluated. Results Four patients were females and four were males. Tumor ranged in size from 5.5 to 35 cm. In five cases, tumor cells were arranged in storiform and whorling pattern. Lymphocytes were seen sprinkled in between these cells. In one case, lymphocytic infiltrate was extensive. Giant cells and frequent mitoses were noted in two cases. One case showed extensive necrosis. Tumor cells were strongly and diffusely positive for CD21 and CD35. Mean follow up of 11.8 months (range 01 to 24 months) was noted. Conclusion FDCS is a rare tumor having distinct morphology and phenotype which if known can be correctly diagnosed. Therefore, knowledge of its varied location, morphology, and phenotype is very important to correctly diagnose this tumor and to prevent misdiagnosis and mistreatment.
Asian Pacific journal of cancer prevention : APJCP, Jan 27, 2018
Introduction:Soft tissue sarcomas are rare tumors comprising 1 percent of solid malignancies. The... more Introduction:Soft tissue sarcomas are rare tumors comprising 1 percent of solid malignancies. The latest edition of WHO soft tissue pathology lists 94 benign and malignant soft tissue tumors. Many of these show a large degree of morphological overlap. Immunohistochemistry has been shown to be reliable in many cases for differential diagnosis of lesions, although cytogenetic tests are considered the gold standard for many entities.Fluorescence in-situ hybridization (FISH) is a cytogenetic technique that uses fluorescent probes that bind to only those parts of the chromosome which have a high degree of sequence complementarity. Many soft tissue tumors show recurrent genetic mutations that are now being used as diagnostic markers. Knowledge of the molecular identity allows prediction of behavior, prognosis and treatment response. Objective:The aim of this study was to identify genetic mutations in soft tissue sarcomas using FISH testing and to assess correlations with histological diag...
Background: The presence of Epstein-Barr virus (EBV) in Non-Hodgkin's lymphoma can be identified ... more Background: The presence of Epstein-Barr virus (EBV) in Non-Hodgkin's lymphoma can be identified by immunohistochemistry for detection of EBV latent membrane protein (LMP). The role of EBV as an etiologic agent in the development of non-Hodgkin lymphoma has been supported by detection of high levels of latent membrane protein 1 (LMP-1) expression in tumors. However, no study has been conducted in a Pakistani population up till now to determine the frequency of Epstein-Barr virus positivity. The objective of our study was to determine a value for non-Hodgkin lymphoma patients using EBV LMP-1 immunostaining in our institution. Materials and Methods: This study was carried out at the Department of Histopathology, Armed Forces Institute of Pathology (AFIP), Pakistan from December 2011 to December 2012. It was a cross sectional study. A total of 71 patients who were diagnosed with various subtypes of NHL after histological and EBV LMP-1 immunohistochemical evaluation were studied. Sampling technique was non-probability purposive. Statistical analysis was achieved using SPSS version 17.0. Mean and SD were calculated for quantitative variables like patient age. Frequencies and percentages were calculated for qualitative variables like subgroup of NHL, results outcome of IHC for EBV and gender distribution. Results: Mean age of the patients was 53.6±16 years (Mean±SD). A total of 50 (70.4%) were male and 21 (29.6%) were female. Some 9 (12.7%) out of 71 cases were positive for EBV-LMP-1 immunostaining, 2 (22.2%) follicular lymphoma cases, 1 (11.1%) case of T-cell lymphoblastic lymphoma, 4 (44.4%) cases of diffuse large B cell lymphomas, 1 (11.1%) mantle cell lymphoma and 1 (11.1%) angioimmunoblastic T cell lymphoma case. Conclusion: In our study, frequency of EBV in NHL is 12.7% and is mostly seen in diffuse large B cell lymphoma. This requires further evaluation to find out whether this positivity is due to co-infection or has a role in pathogenesis.
Introduction: Diffuse large B-cell lymphomas (DLBCL) can be divided into germinal centre (GC-DLBC... more Introduction: Diffuse large B-cell lymphomas (DLBCL) can be divided into germinal centre (GC-DLBCL) and post germinal centre (post GC-DLBCL) groups by applying immunohistochemical antibodies. As these subgroups respond differently to chemotherapy, it is possible at diagnosis to select a poor prognostic subgroup for aggressive treatment. Objective: To determine the frequencies of GC-DLBCL and post GC-DLBCL in patients by immunohistochemistry (IHC) and the clinical response after six cycles of chemotherapy. Subjects and Methods: In this descriptive study conducted in AFIP and CMH, Rawalpindi and NORI, Islamabad, from September 2010 to September 2011, a total of 75 pretreatment cases of DLBCL diagnosed during the study period were included. Cases were segregated in to GC-DLBCL and post GC-DLBCL groups according to results of immunohistochemistry markers CD10, BCL6 and MUM1. Immediate clinical response was assessed after 6 cycles of chemotherapy. Response was divided into complete response, partial response, stable disease or relapse or progression. Results: The mean age was 54.2±15. Males were 53 (70.7%). Forty (53.3%) cases comprised the GC-DLBCL group; 25(62.5%) of them showed a complete response. Most patients of the post GC-DLBCL 19(54%) showed relapse/progression. Results of immediate clinical response in both prognostic subgroups were significant (p<0.05). Results regarding positivity with immunohistochemical antibodies CD10 (p 0.011), BCL6 (p 0.013) and MUM1 (p 0.000) regarding immediate clinical response were also significant. Conclusion: GC-DLBCL group shows better response to CHOP chemotherapy regimen. Immunohistochemistry should be used to further classify DLBCL as this can enable us to select aggressive group for aggressive treatment. This manuscript is important because the study is the first to becarried out exclusively in Pakistan or our part of the world.
Asian Pacific journal of cancer prevention : APJCP, 2016
There is growing evidence that there are differences in histological and genetic characteristics ... more There is growing evidence that there are differences in histological and genetic characteristics along with clinical behavior between right- and left-sided colon carcinomas. We have compared various parameters of the two types and assessed associations of the results with prognosis in patients in Pakistan. We reviewed 200 cases from our institutional database; 100 cases of right-sided and 100 cases of left-sided colon cancer. Parameters including age, gender, TNM stage, histological features and clinical outcome were analyzed. The patients with right-sided colon cancer were significantly older as compared to their counterparts with left-sided cancer. They presented with a lumbar mass rather than symptoms of obstruction and perforation as seen in left-sided colon cancers, and the histology showed higher percentage of poorly differentiated tumors with advanced pT stage. Moreover, Crohn's-like reactions, intra tumoral lymphocyte responses and other poor prognostic factors like lymp...
Objective: To compare mesorectal fascia status on histopathological findings with MRI based radio... more Objective: To compare mesorectal fascia status on histopathological findings with MRI based radiological mesorectal fascia status in patients with rectal carcinoma taking histopathology finding as gold standard. Study Design: Analytical study. Place and Duration of Study: Department of Pathology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, from January 2011 to April 2012. Methodology: Biopsy proven cases of rectal adenocarcinoma undergoing abdominoperineal resection were included in this study. Microscopic examination of slides was done to determine mesorectal fascia status as involved or otherwise without knowing the results of mesorectal fascia status on MRI. Mesorectal fascia status of MRI was determined by a radiologist who was not aware of the histopathological assessment of mesorectal fascia. Mean and standard deviation was calculated for age. Frequency and percentage were calculated for gender and mesorectal fascia status. 2 x 2 table was generated to...
Dengue fever has now affected all the major cities of country. About 41,354 patients underwent an... more Dengue fever has now affected all the major cities of country. About 41,354 patients underwent antibody screening for dengue fever from Shaukat Khanum Memorial Cancer Hospital, Lahore, during the epidemic period (October 1st 2010 to December 20th 2010). Out of them, 1294 (3.1%) patients were positive for IgM antibodies, and 124 (0.3%) for IgG antibodies. A total of 722 (1.7%) patients were borderline positive for IgM antibodies and 108 (0.26%) were borderline positive for IgG antibodies. Dengue fever has emerged as a global problem over the last 5 years. It has also hit Lahore badly especially after the floods in 2010. High index of suspicion should be there in case of related symptoms.
Journal of the College of Physicians and Surgeons--Pakistan : JCPSP, 2014
To determine the expression of CD-10, BCL-6 and MUM-1 in patients with diffuse large B-cell lymph... more To determine the expression of CD-10, BCL-6 and MUM-1 in patients with diffuse large B-cell lymphoma (DLBCL) and its association with immediate clinical response after six cycles of CHOP chemotherapy. Analytical study. Armed Forces Institute of Pathology (AFIP), Rawalpindi in collaboration with Nuclear medicine, Oncology and Radiotherapy Institute (NORI), Islamabad from September 2010 to September 2011. CD-10, BCL-6 and MUM-1 antibodies were applied on cases diagnosed as DLBCL. Immediate clinical response was noted after 6 cycles of chemotherapy with the help of oncologist and divided into complete response, partial response, stable disease and relapse/ progression. Patient's age, results of expression of CD-10, BCL-6 and MUM-1 and results of immediate clinical response to chemotherapy were noted. Regarding analysis of prognostic markers (CD-10, BCL-6 and MUM-1), chi-square test was used for immediate clinical response to chemotherapy in DLBCL. CD-10 was positive in 40% cases, B...
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