Predicting prognosis in lung cancer: Use of proliferation marker, Ki67 monoclonal antibody

An investigation was carried out to assess the prognostic significance of proliferation marker Ki67 in a group of lung cancer patients treated by surgery (limited disease). Tissue was not available for Ki67 immunostaining in inoperable group. The diagnosis is established by bronchial biopsy which does not carry enough tissue for frozen section and counting. This study is supplemented by estimating the prognostic significance of histological sub-types in the operable group and in a group of inoperable patients with extensive disease. These are usually treated by radiotherapy and/or chemotherapy. In all, 267 patients were studied including 105 treated by surgery. These patients attended King\u27s College and Brompton Hospital, UK, between 1986 and 1989. With regard to proliferation marker Ki67 done for the surgical group, only patients with Ki67 scores of less than 5% did survive significantly longer than the rest. Histology did not make any significant contribution in determining prognosis in both operable and inoperable groups. Although follow-up is limited (mean 20 months), Ki67 antibody seems promising in identifying low and high grade disease in the initial stage of lung cancer. It may prove useful for category of patients with high scores to be placed on chemotherapy/radiotherapy. Results suggest that in the case of lung tumour, proliferative activity is a better prognostic indicator than histological type

Association of Epstein Barr Virus (EBV) with nasopharyngeal carcinoma (NPC)

Aim: To observe the frequency of nasopharyngeal carcinoma (NPC) and its association with Epstein Barr Virus (EBV) infection. Setting: This study included consecutive cases of nasopharyngeal carcinoma, which were diagnosed in the Department of Pathology at the Aga Khan University Hospital, Karachi in the period of two years (1996-97). Methods: These tumors were initially evaluated on H&E stained sections. The tumors showing evidence of keratinization were excluded from the study. The Epstein Barr Virus was detected with the help of Polymerase chain reaction in formalin fixed, paraffin embedded tissue sections. Results: During the study period, seventeen cases of nasopharyngeal carcinoma were diagnosed which comprised 0.3% of all malignant tumors. The age ranged from 5 years to 70 years with male to female ratio of 2.4:1. The NPC was more prevalent in adults (71%) as compared to children (29%) under 15 years. Six cases (35%) exhibited positive signal for Epstein Barr Virus. Conclusion: Nasopharyngeal carcinoma is an infrequent tumor. The prevalence of Epstein Barr virus infection in nasopharyngeal carcinoma is quite low as compared to other regions of the world

Morphological pattern and frequency of thyroid tumors

Objective: The present study was done to evaluate the frequency of thyroid cancer and to find out the prevalence of histological types of thyroid tumor with respect to age and sex group.Setting: This study included consecutive cases of malignant tumors of thyroid gland, which were diagnosed in the Department of Pathology at the Aga Khan University Hospital, Karachi during the period of three years (1995-1997).Methods: These cases were evaluated on H & E stained sections from paraffin embedded 10% buffered formalin fixed tissue blocks. Special stains and immunohistochemical analysis were performed whenever required.Results: A total of 8541 malignant tumors were diagnosed in a period of 3 years which included 103 (1.2%) cases of thyroid cancer. Thyroid tumors were more prevalent in females with female to male ratio of 2.6:1. Papillary carcinoma (69%) was the most common histological type of thyroid tumors, followed by follicular carcinoma (11.6%), medullary carcinoma (9.7%), anaplastic carcinoma (5.9%), non-Hodgkin\u27s lymphoma (2.9%) and unclassified tumors (0.9%) in order of frequency.Conclusion: Thyroid cancer was more common in females. Papillary carcinoma was the most common histological type of thyroid tumors in females as well as in males. Papillary carcinoma was more prevalent in third, fourth and fifth decades of life while follicular and anaplastic carcinomas were more frequent after the fourth decade of life

p53 and PCNA expression in benign, atypical and malignant meningiomas

Objective: Alterations: p53 genes are turning out to be the most common genetic alterations in human cancers. Due to long half-life of mutated p53, its detection is possible by immunohistochemistry. Proliferating cell nuclear antigen (PCNA) is expressed by dividing cells, hence has been shown to correlate with prognosis. We have used monoclonal antibodies protein DO-7 (p53) and PC10 (PCNA) to see whether their expression correlates with histological grading in meningethelial tumour.Material and Methods: a Twenty nine meningiomas (20 benign, 7 atypical and 2 malignant) were selected from the records of our laboratory. p53 and PCNA expression was sought by immunohistochemistry using Peroxidase Anti Peroxidase (PAP) technique.Results: Four benign and 2 atypical meningiomas showed weak staining for p53. Both malignant meningiomas showed strong positivity for p53. Six benign meningiomas had less than 5% PCNA positivity, one 10% positivity and three showed 20% positivity. PCNA positivity ranged for 10-80% in atypical meningiomas. In two malignant meningiomas PCNA positivity was 70% and 90%.Conclusion: It is worthwhile to include p53 and PCNA expression along with histologic assessment in predicting outcome of meningiomas. A larger series with complete follow-up is essential in assessing value of these markers which unfortunately remains a dream in our country

Spectrum of cutaneous appendage tumors at aga khan university hospital

Objective: To determine the frequency of various types of cutaneous appendage tumors in our practice.Method: This is a partly retrospective and partly prospective study conducted at the Department of Pathology, Histopathology Section, The Aga Khan University Hospital, Karachi between 1st January 1997 and 31st December 2001.Results: One hundred sixty six skin appendage tumors were diagnosed during the study period. 87.3% were benign, while 12.6% were malignant. Male female ratio was almost equal. Mean age was 41.72 years. 37.34% showed eccrine differentiation, 14.45% showed apocrine differentiation and 41.56% showed pilosebaceous differentiation, 6.62% exhibited mixed differentiation. The 5 commonest tumors were pilomatricoma, nodular hidradenoma (eccrine acrospiroma), syringocystadenoma papilleferum, eccrine poroma and eccrine spiradenoma. The commonest malignant tumors were porocarcinoma and sebaceous carcinoma. Pilomatricoma were common in children.Conclusion: Most of our findings roughly correlate with the western published data. However, commonest site for eccrine poromas in our study was head and neck. Also, not a single case of eccrine spiradenoma was seen in the first two decades of life. These findings differ significantly from western data

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

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