CSF oligoclonal bands in multiple sclerosis

Objective: To study the significance of oligoclonal bands in neurological disorders, specifically in Multiple Sclerosis (MS). Methods: The study was designed to assess the sensitivity and specificity of the test methodology of CSF electrophoresis by performing the retrospective analysis of CSF samples sent for oligoclonal bands (OCB). A total of 603 samples were received by the Clinical Laboratories, Department of Pathology of The Aga Khan University, during a period of 54 months (January 1993-June 1997). All of these samples were analyzed by performing CSF protein electrophoresis. One hundred thirty three out of 603 samples showed evidence of OCB. Out of these, 24 patients were registered with Section of Neurology, Department of Medicine, The Aga Khan University Hospital. These 24 patients were finally selected for analysis. Relevant clinical details such as age, sex and clinical presentations were recorded. Results: Fifteen (62%) out of 24 patients with positive OCB were diagnosed as cases of MS. Four (17%) patients were diagnosed to have subacute sclerosing panencephalitis (SSPE). Five (21%) patients were having other inflammatory neurological disorders. Conclusion: The overall relative sensitivity and specificity for multiple sclerosis were found to be 100% and 62.5% respectively. Lack of specificity was attributed to the fact that OCB were positive in other neurological disorders as well

A novel CYP1A1 gene polymorphism and the risk of head and neck cancer in Pakistani population

Several polymorphisms in the CYP1A1 locus have been identified and their genotypes appear to exhibit population frequencies that depend on ethnicity. In this study, we assessed the role of CYP1A1 genotype in 388 head and neck cancer patients in Pakistani population via a case-control study. Polymerase chain reaction (PCR) and single stranded conformational polymorphism assays were used. Most of the patients (51%) enrolled for the study, were from the age group of 40 to 60 years (±16.59). Mean age of the cancer patients involved in the study was 48 ± 16.59 years. Statistical analysis has shown that, tobacco users have more chances of head and neck cancer (P < 0.05) than non tobacco users, whereas male to female ratio is 1:1 (P > 0.05). Jobless persons are more prone to head and neck cancer (P < 0.01) compared with employers and housewives. After the genetic analysis, it was found that no already reported variants of CYP1A1 gene were found in Pakistani population. A novel mutation in CYP1A1 gene at exon 2 in 21 patients (P < 0.001, Odd Ratio (OR) = 9.4 and 95% confidence interval (CI) 1.3 to 70.8) has been found with a serine formation instead of tyrosine at amino acid 110. The patients showing this mutation have the mean age of 51.75 (±15.7). Therefore, mutation in CYP1A1 gene may be one of several factors that increase the chance of developing head and neck cancer.Key words: Cytochrome P450 1A1 gene (CYP1A1), head and neck cancer (HNC), mutation, novel polymorphism, Pakistani population

Morphological pattern of testicular tumors

Objective: To find out the mode of presentation, age distribution and the prevalence of various histological subtypes of testicular tumors.Method: All consecutive cases of testicular tumors diagnosed in the department of pathology, the Aga Khan University Hospital, Karachi, during the period of eight years (1991-98) were included in this study. Relevant clinical details such as age, clinical presentation and side of involvement of the testis were also recorded, where available.Results: During the span of eight years (1991-98), 170 cases of testicular tumors were diagnosed at the Aga Khan University Hospital, Karachi. Most of the tumors were diagnosed in the third and fourth decade of life. Scrotal mass or swelling was the predominant mode of presentation. There was a slight predominance of right-sided testicular tumors. Germ cell tumors constituted 83.5% of all malignant testicular neoplasms. Amongst these seminoma was the most common (36.5%) tumor followed by mixed germ cell tumors (28.82%). Yolk-sac tumor was the commonest testicular neoplasm in children while lymphoma was the predominant neoplasm in the elderly population.Conclusion: The overall relative frequency of testicular malignancy in this series correlated with that reported in the international literature

Male breast cancer

Objective: To review cases of male breast cancer.Settings: Histopathology Section, Department of Pathology, The Aga Khan University, Karachi.Method: Fifty one cases of male breast cancer specimens, received during a period of 10 years, routinely processed and stained with Haematoxylin and Eosin were analyzed. Special stains and Immunohistochemistry were used in difficult cases.Results: Male breast cancer affected individuals in the sixth and seventh decades of life with a mean age of 56.2 years. Infiltrating ductal carcinoma (IDC) was the predominant type. Skin involvement was seen in 27.45% of the cases. Breast lump was the most common presenting symptom followed by skin ulceration. At the time of presentation 43.13% patients had a tumour size of more than 3 cm.Conclusion: Male breast cancer is a rare disease. Most of our findings correspond to the published local and international data

CT-based texture analysis potentially provides prognostic information complementary to interim fdg-pet for patients with hodgkin's and aggressive non-hodgkin's lymphomas

OBJECTIVES: The purpose of this study was to investigate the ability of computed tomography texture analysis (CTTA) to provide additional prognostic information in patients with Hodgkin's lymphoma (HL) and high-grade non-Hodgkin's lymphoma (NHL). METHODS: This retrospective, pilot-study approved by the IRB comprised 45 lymphoma patients undergoing routine 18F-FDG-PET-CT. Progression-free survival (PFS) was determined from clinical follow-up (mean-duration: 40 months; range: 10-62 months). Non-contrast-enhanced low-dose CT images were submitted to CTTA comprising image filtration to highlight features of different sizes followed by histogram-analysis using kurtosis. Prognostic value of CTTA was compared to PET FDG-uptake value, tumour-stage, tumour-bulk, lymphoma-type, treatment-regime, and interim FDG-PET (iPET) status using Kaplan-Meier analysis. Cox regression analysis determined the independence of significantly prognostic imaging and clinical features. RESULTS: A total of 27 patients had aggressive NHL and 18 had HL. Mean PFS was 48.5 months. There was no significant difference in pre-treatment CTTA between the lymphoma sub-types. Kaplan-Meier analysis found pre-treatment CTTA (medium feature scale, p=0.010) and iPET status (p<0.001) to be significant predictors of PFS. Cox analysis revealed that an interaction between pre-treatment CTTA and iPET status was the only independent predictor of PFS (HR: 25.5, 95% CI: 5.4-120, p<0.001). Specifically, pre-treatment CTTA risk stratified patients with negative iPET. CONCLUSION: CTTA can potentially provide prognostic information complementary to iPET for patients with HL and aggressive NHL

Diagnostic evaluation of fine Needle aspiration cytology in the management of palpable Breast lesions

A total of 113 fine needle aspirates of the breast masses were evaluated in which the subsequent biopsy or mastectomy specimen were also available for histological examination. The age ranged from 16 to 80 years with a mean of 42 years. In benign conditions the mean age was 34.7 years while in malignant cases it was 48 years. The cytological diagnoses were compared with the histological results which revealed that the specificity and sensitivity of fine needle aspiration cytology in the palpable breast lesions was 86.1% and 89.2% respectively with a positive predictive value of 93% and efficiency of 88.2%. Similar statistics from other series in which the cytological results of breast lesions were compared with histological results, revealed almost same results which suggest that fine needle aspiration cytology is an effective and accurate technique for the diagnosis and management of palpable breast lumps

Morphological pattern of salivary gland tumours

Objective: To delineate the spectrum of salivary gland tumors in our setup. Setting: The Aga Khan University Medical Centre, Karachi. Method: Tumors were analysed considering histological type, age and sex of the patients and anatomic location. The diagnosis of individual tumours was based on the 1991 World Health Organisation Classification. Results: During the span of eight years (1991-1998), 379 cases of salivary gland tumours were diagnosed. Of these, 205 (65.7%) were male and 174 (34.3%) were female. The median age at the time of diagnosis was 35 years. The median age for patients with malignant lesions (44 years) was 12 years older than those with benign tumours (34 years). Overall, malignant tumours were seen more frequently in males, however benign tumours were distributed equally between the two sexes. The most common site was parotid gland (82.85%). Only five cases of minor salivary gland tumours were seen. The most frequently diagnosed benign salivary gland neoplasm was pleomorphic adenoma (84.5%), followed by Warthin’s tumours (6.18%), Mucoepidermoid carcinoma was the most commonly encountered malignant lesion (56.9%), followed by adenoid cystic carcinoma (19.6%). Conclusion: Plemorphic adenoma was the most common benign salivary gland tumour and mucoepidermoid carcinoma was the most frequent malignant neoplasm. Parotid gland was the most common site of origin in both benign and malignant tumours. The overall relative frequency of salivary gland tumours in this series correlates with that reported in the international literature

Influence of growth rate on the epitaxial orientation and crystalline quality of CeO2 thin films grown on Al2O3(0001)

Growth rate-induced epitaxial orientations and crystalline quality of CeO2 thin films grown on Al2O3(0001) by oxygen plasma-assisted molecular beam epitaxy were studied using in situ and ex situ characterization techniques. CeO2 grows as three-dimensional (3D) islands and two-dimensional layers at growth rates of 1-7 angstrom/min and \u3e = 9 angstrom/min, respectively. The formation of epitaxial CeO2(100) and CeO2(111) thin films occurs at growth rates of 1 angstrom/min and \u3e = 9 angstrom/min, respectively. Glancing-incidence x-ray diffraction measurements have shown that the films grown at intermediate growth rates (2-7 angstrom/min) consist of polycrystalline CeO2 along with CeO2(100). The thin film grown at 1 angstrom/min exhibits six in-plane domains, characteristic of well-aligned CeO2(100) crystallites. The content of the poorly aligned CeO2(100) crystallites increases with increasing growth rate from 2 to 7 angstrom/min, and three out of six in-plane domains gradually decrease and eventually disappear, as confirmed by XRD pole figures. At growth rates \u3e = 9 angstrom/min, CeO2(111) film with single in-plane domain was identified. The formation of CeO2(100) 3D islands at growth rates of 1-7 angstrom/min is a kinetically driven process unlike at growth rates \u3e = 9 angstrom/min which result in an energetically and thermodynamically more stable CeO2(111) surface