Association of Serum PSA Levels with Histopathological Pattern of Prostate Lesions

Background: Pathological changes that mainly affect prostate gland are prostatitis, benign prostatic hyperplasia (BPH) and cancerous lesions. Digital rectal examination (DRE), Transrectal Ultrasonography (TUS), and prostate specific antigen (PSA) followed by histopathological examination, are routinely used tests for diagnosis of prostate lesions. The aim of the present study is to determine the role of serum PSA levels in differentially diagnosing the different types of prostate lesions.Material and Methods: This retrospective (observational) study was conducted in Ibn-e-Sina Hospital Multan. Data of 2189 patients who were operated from 2007 to 2017 due to prostatic lesions were included in this analysis. Patients with BPH, prostatitis, prostate carcinoma and Prostatic Intraepithelial Neoplasia (PIN) were grouped according to serum PSA levels (ranging from 0 to >100 ng/ml) into five groups. Frequencies and percentages were calculated for different histopathological findings. Association of PSA levels with different histological patterns was determined with chi-square test with P-value < 0.05 taken as significant difference.Results: Mean age of patients was 62.45+10.64 years. On histopathology, BPH was diagnosed in 1676 (76.56%) patients, prostatitis in 133 (6.07%), carcinoma in 378 (17.26%) and PIN in 02 (0.09%) patients, respectively. Serum PSA levels of 4.01-10 ng/ml were found in 1050 (62.64%) BPH patients and in 59 (44.36%) prostatitis patients. Serum PSA levels of 10.01-20 ng/ml were found in only 40 (2.4%) BPH patients, 47 (35.33%) prostatitis patients, 22 (5.82%) carcinoma patients and in 1 (50.0%) PIN patient. Serum PSA levels of 20.01-100 ng/ml were found in 32 (1.9%) BPH patients, 11 (8.27%) prostatitis patients, 302 (79.89%) carcinoma patients, and in 1 (50.0%) PIN patient. Serum PSA levels of >100 ng/ml were absent in patients with BPH and PIN, and present in 1 (0.75%) prostatitis and 54 (14.28%) carcinoma patients.Conclusion: Benign prostatic hyperplasia was the commonest lesion in our patients (76.56%) with serum PSA levels >10 ng/ml reported in all patients with prostate carcinoma and prostatic intraepithelial neoplasia (PIN) patients

Efficiency of Crystal Violet Stain to Study Mitotic Figures in Oral Epithelial Dysplasia

AIM: To evaluate mitotic activity in the different grades of oral epithelial dysplasia using 1% crystal violet stain. MATERIAL AND METHODS: A descriptive study was conducted in the Department of Histopathology of the Post Graduate Medical Institute, Lahore on a total of thirty-three cases of the Oral Epithelial Dysplasia (OED). Fresh, frozen paraffin-embedded archival tissue blocks were collected from Lahore General Hospital, Lahore & Oral & Maxillofacial Surgery Department of Nawaz Sharif Hospital, Yakki Gate, Lahore. The representative sections were taken and, after processing, mounted on glass slides and stained with H&E and crystal violet stains. The stained slides were then examined under an optical microscope. The efficacy of 1% crystal violet stain to identify mitotic figures in the different grades of oral epithelial dysplasia was assessed with the sample t-test. A difference of p < 0.05 was considered to be significant. RESULTS: A comparison of the mitotic figure count in two categories in sections stained with both stains showed a statistically significant difference. An increase in the mean mitotic count was noted in the sections of OED stained with crystal violet in comparison to the sections of OED stained with H&E which was statistically significant (p = 0.00). CONCLUSION: Counting of mitotic cell is the rapid and simplest way of evaluating the proliferative activity of cells. Crystal violet stain can be a rationalised step in the staining of mitotic figures compared to the usual H&E staining and can be employed as a selective stain during routine histopathological procedures

Proportion of CD44+ subset of tumour cells in single cell suspension prepared from FFPET sections directly correlates with histological subtyping of head and neck squamous cell carcinoma

CD44 expression in tumours imparts potential to progress, metastasize, recurrence, and resistance against antineoplastic therapy. In this study, we sought to describe the variation in the immuno-expression and numeration of MDR1+ and CD44+ potential cancer stem cells in different histological grades and subtypes of head and neck squamous cell carcinoma (HNSCC). Flow-cytometric analysis was performed on single cell suspension prepared from formalin fixed paraffin embedded tissue (FFPET) sections of HNSCC using anti-CD44 and anti-MDR1/ABCB-1 primary monoclonal antibodies. Immunohistochemical (IHC) staining was also carried out using both of these antibodies on HNSCC tissue sections mounted on super frosted glass slides. On immunohistochemical analysis, the mean IRS for CD44 and MDR1 were 8.6364 ±3.02114 and 1.5909 ±1.27674 respectively. When mean immune-expression scores of CD44 antibody and MDR1/ABCB-1 were compared with histological grades and subtypes of HNSCC, the relationship was found to be statistically insignificant. Interestingly, a strong statistical difference (p = 0.000) was observed when the mean score of subset of dysplastic squamous epithelial cells with characteristics of cell stemness (CD326+CD44+) was compared among different histological subtypes of HNSCC using flowcytometric analysis. While no statistically significant association was observed when the mean score for subset of dysplastic cells with potential of drug resistance (CD44+MDR1+) was compared among different histological subtypes of HNSCC. Although potential cancer stem cell marker CD44 and the multidrug resistance maker MDR1/ABCB co-expressed in HNSCC but the proportion of CD326+CD44+ subset of tumour cells (potential cancer stem cells/CSCs) significantly correlates with least aggressive to more aggressive tumour subtypes

Tuberculous Mastitis in Females of South Punjab: A Clinicopathological Analysis of Ten Years from Pakistan

Background and Objective: Extrapulmonary tuberculosis occurring in breast is a rare disorder in West but is still present in developing nations where tuberculosis is endemic. Tuberculous Mastitis (TM) is difficult to diagnose as it has vague clinical symptoms and insufficient radiological findings. The objective of this study was to determine the frequency of tuberculous mastitis by accessible modalities for early diagnosis.Methods: After the Institutional Ethical Board approvals, Pathology laboratory archives and medical records of 5000 patients from Ibn-e-Sina Hospital Research Institute, Multan and Multi Test Laboratory, were retrieved from the year 2008 to 2018. A retrospective analysis of fine needle aspiration cytology (FNAC) results of patients who presented with breast lumps was carried out. The interpretation of cytological findings and Ziehl Neelsen stained smears was carried out by cytopathologists and microbiologists respectively. Mycobacterium DNA was detected using polymerase chain reaction (PCR) in selected cases.Results: Out of 5000 patients, tuberculosis was diagnosed in 264 (5.28%) cases on FNAC. Acid fast bacilli (AFB) positive smears were found in 79.5%patients while 20.45% cases were AFB negative. Among AFB negative smears, 38 cases were further analyzed by PCR, among which 32 (84.2%) cases showed PCR positive results for TM. An increased frequency of TM among all inflammatory breast lesions from 18% in 2008 to 47.19% in 2018 was observed.Conclusion: Tuberculous Mastitis is an uncommon form of extra-pulmonary tuberculosis. It has non- specific clinical, radiological and varied histological findings that often mimic breast abscess or carcinoma. FNAC is essential to guide the patient to further tests including histochemistry and PCR that can be used as more sensitive and time effective detection modalities.</p