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

Clinical, pathological and molecular factors predicting Axillary Node involvement in primary Breast Cancer in Pakistani women

Background: Axillary lymph node involvement in primary breast cancer is one of its most important prognostic features. Thus any factors that may predict axillary lymph node involvement in this setting could be potentially helpful in treatment planning and other interventions. Objective: The objective of this study was to evaluate clinical, pathological and immuno-histochemical markers in univariate and multivariate analysis, which may be helpful predictors of axillary lymph node involvement in breast cancer. Method: A retrospective analysis of 555 cases. Of these 58% had axillary nodal positivity and 42% were negative. Conclusion: Factors of no significance included patient’s age, height, weight, age of first pregnancy, parity, marital status, menopausal status, family history of breast cancer, side of tumor. In univariate analysis the age of menarche, duration of symptoms, tumor size, site in outer quadrant, S phase and skin and nipple involvement all predicted axillary nodal involvement. The length of breast-feeding, increased intraductal component and increased PCNA were inversely proportional to nodal involvement. In multiple regression analysis however only size of the tumor, involvement of the skin and nipple and disease in the outer quadrant of breast were the factors, which assumed significanc

Breast diseases in males--a morphological review of 150 cases

Objective: This study was carried out to observe the prevalence breast diseases of males in our setup. Method: All cases of male breast disease diagnosed from 1991-97. Results: One hundred and fifty (150) cases of male breast diseases were diagnosed. Age of the patients ranged from 4 to 90 years, with mean age 38.75 years (median = 33 years). Gynecomastia was the most common pathological abnormality of the male breast (58.66%). Most of the patients presented in the 3rd decade of life. Amongst the malignant conditions, infiltrating ductal carcinoma was most prevalent (82%). Most of the patients with malignancy presented in the 5th and 6th decades of life. Conclusion: Gynecomastia was the most prevalent male breast disorder, followed by infiltrating ductal carcinoma. Our findings correspond with that of world literature

Epidermal Growth Factor Receptor (EGFR) as a Prognostic Marker: an Immunohistochemical Study on 315 Consecutive Breast Carcinoma Patients

Objective: To assess the independent and interdependent prognostic value of epidermal growth factor receptor (EGFR) in carcinoma of breast in female population. The Type I family of growth factor receptors includes epidermal growth factor receptor (EGFR also known as EGFRI). Methods: The expression of EGFR protein was analysed immunohistochemically on 315 tumour specimens of infiltrating ductal carcinoma of breast. These patients also had axillary lymph nodes sampling. Results: Overexpression and/or amplification of EGFR was observed in 70 (22.00%) tumours. Eleven (16%) were grade I, 43 (61%) grade II and 16 (23%) grade Ill tumours. Axillary lymph node metastasis had significant correlation with intensified positivity of EGFR (p\u3c 0.05). Significant number of EGFR positive patients developed local recurrence and distant metastases to brain, liver and bone (p\u3c 0.05). EGFR positivity showed significant correlation with the disease free and overall survival (p\u3c 0.05). At a median follow-up of48 (4 years) months in EGFR positive patients, the overall survival was 3.39 years and disease free survival was 2.86 years. EGFR negative tumour patients showed a better survival. In this group the overall survival was 4.62 years and the disease free survival was 4 years. Conclusion: EGFR analysis can be a useful indicator for the selection of patients who are at the high risk, for hormonal therapy decisions and can be useful as a target for new treatment modalities

The Frequency of IgA Nephropathy at a Single Center in Pakistan

Objectives: To detect the prevalence of IgA nephropathy in Pakistani patients, as no significant published data from this part of the developing world is available in the international literature for reference. Method: The study was conducted in a university hospital on 105 consecutive renal biopsy specimens. Direct immunofluorescence microscopy was performed using antibodies specific for the heavy chains of IgG, IgA, IgM, C3 and fibrinogen. Results: Seventy-nine (79) cases were classified as glomerulopathies, out of which 10 cases (12.65%) were diagnosed as IgA nephropathy, among which one case was that of Henoch- Schonlein purpura. The age range was 6 to 65 years with median age of 25 years and male to female ratio was 1.5: 1. Nephrotic range proteinuria was seen in 40% of cases and 50% cases showed impaired renal function. The light microscopic examination revealed diffuse proliferative pattern in 3 cases out of which one case showed crescent formations. Focal-segmental glomerulosclerosis, minimum histologic lesion and advanced chronic glomerulonephritic patterns were observed in 2 cases each and in one case focal proliferative morphology was appreciated. Conclusion: The frequency of IgA nephropathy among glomerular diseases was 12.65% in our study, which is somewhat higher when comparing the studies from North America, United Kingdom and Northwest Europe. However, it was significantly lower when comparing the studies from other parts of Asi

Histological pattern of central nervous system neoplasms

Objective: To see in a large series of patients the histological pattern of CNS neoplasms and to provide a comprehensive data about the frequency of CNS neoplasms in Pakistani patients and to give a clearer idea about their prevalence. Method: Retrospective study of all consecutive cases of CNS neoplasms diagnosed at The Aga Khan University Hospital (AKUH) between 1st January 1994 and 31st December, 1999. Setting: The section of Histopathology, AKUH, Karachi. Observation: Our series included a large number of cases i.e., 1110 . There are very few local studies on CNS tumours and none so large . Our data was correlated with published Western and Pakistani data . Glial tumours were the commonest primary CNS neoplasms followed by meningiomas . Among glial tumours , astrocytomas comprised the largest group and the majority were high grade (Ill and IV ) astrocytomas. Percentages of anaplastic oligodendrogliomas and ependymomas were also significant. Male to female ratio was 1.6:1. However, meningiomas were more common in females. Almost half of the CNS tumours in patients 15 years or younger were in the posterior cranial fossa . Metastatic tumours were much lower as compared to the West. Conclusion: Except for the high percentages of anaplastic oligodendrogliomas and ependymomas and the low percentage of metastatic tumours, most of our findings roughly correspond with the published data