Follicular Dendritic Cell Sarcoma of Lymph Node - a Rare Entity

Follicular dendritic cells (FDC) are non-lymphoid, non-phagocytic accessory cells in the immune system that are essential for antigen presentation and germinal center reaction regulation1. These cells are CD21+, CD35+, CD1a- and S100 protein + and they show desmosomes ultrastructurally.The most commonly involved sites by FDC tumors are lymph nodes but may arise at a variety of extranodal sites including oral cavity, tonsil, gastrointestinal tract and liver. Most studies represent single case reports or case series. Our patient presented with tumor in the lymph nodes. Histology revealed tumor cells with abundant eosinophilic cytoplasm, hyperchromatic and pleomorphic nuclei, and prominent nucleoli. The tumor cells were found to be positive for CD21 which is a specific marker for follicular dendritic cells

Metastatic signet ring gastric adenocarcinoma presenting with microangiopathic hemolytic anemia.

Metastatic adenocarcinoma presenting as microangiopathic hemolytic anemia (MAHA) and leukoerythroblastic blood picture is rare. We report three patients who presented with MAHA as the initial symptom of metastatic signet ring cell gastric adenocarcinoma. One patient had past history of gastric ulcer. In all these patients the initial diagnosis was based on peripheral blood smear followed by bone marrow biopsy; upper GI endoscopy showed presence of gastric ulcers with focally scattered neo-plastic signet ring cells on histopathology. All patients died within a week of diagnosis

Impact of COVID-19 on Elective Surgical Lists in Otorhinolaryngology: An Overview

Objective: To study how the COVID-19 is affecting the treatment and management of other ailments. Try to find a strategy to resume elective OR lists.Introduction: We overviewed the effect of COVID-19 on the elective surgical lists of otorhinolaryngology in the ENT Department of Holy Family Hospital, Rawalpindi.Materials and Methods: The data from Jan 2020 to July 2020 was collected. It is a descriptive study analyzing the data, 3 months before and 3 months after the imposition of lockdown in the whole of Pakistan due to a surge in COVID-19 cases. The data was collected from the operation dating register of OPD and elective operative lists of ENT OT. Data were analyzed by Microsoft excel spreadsheet version 7. Results: There was an overall 92% decrease in the elective surgical procedures done in the ENT dept. of Holy family Hospital during the COVID-19 lockdown period. The procedures done in the COVID lockdown period were mostly emergency procedures and lifesaving procedures.Conclusion: COVID-19 has badly impacted the elective surgical procedures and in turn the health of the patients presenting to ENT OPD with various diseases which were treated surgically before COVID lockdown.Recommendations: To prevent this from happening again during the 2nd wave of COVID-19, we could opt for multiple precautionary measures to avoid the spread of infection and continue the provision of our surgical services to the patients

Prevalence of mycosis fungoides and its association with EBV and HTLV-1 in Pakistanian patients

Mycosis fungoides (MF) is an indolent T cell lymphoma that is distinguished from other lymphomas by its initial appearance on the skin. The histologic diagnosis of MF may be difficult because there is significant overlap in the histologic features of neoplastic T-cell infiltrates and inflammatory dermatoses. This T-cell neoplasm commonly occurs in a mixed, reactive background and can show only a subtle degree of cytologic atypia, rendering histologic diagnosis difficult. In this study MF constituted 0.86% of all non-Hodgkin’s lymphoma (NHL) both T and B, as compared to the Western studies which have reported 0.5% prevalence for MF of all NHL. Polymerase chain reaction (PCR) technique was used to assess T-cell clonality in paraffinembedded skin biopsies clinically and pathologically suspicious for early MF. Out of the 14 cases diagnosed as MF, amplifiable DNA was isolated from 6 cases, which were further studied for T-cell receptor (TcR)-β, γ, and δ chain gene rearrangements. Clonal product was seen in 4 out of 6 cases for β, γ, and δ TcR chain genes. Association for Epstein Barr virus (EBV) was observed in 3 out of 6 cases (50%) of MF. Although these 3 cases were positive for EBV by PCR, but were negative by in-situ hybridization (ISH). No heterogeneity was noted in these 3 cases of MF for BainHI E, K, N, and Z regions of EBV. All six cases were negative for HTLV-1 (tax region) by PCR. It was concluded that the prevalence of MF in Pakistani population is comparable to the Western data, and that EBV association to MF cases was higher than in Western studies

Frequency and Characteristics of Breast lymphomas presenting to a tertiary care hospital, Pakistan

Objective: To assess the relative frequency of (primary and secondary) mammary lymphomas presenting to a tertiary care hospital, Pakistan and its categorization according to WHO classification of lymphoid neoplasms. Methods: All NHLs (nodal and extra nodal) diagnosed in the section of histopathology during 1992-2004 were retrieved and reviewed. All patients (n=30) diagnosed with lymphomatous involvement of the breast were selected. Distinction between primary and secondary breast lymphomas was not made owing to lack of availability of clinical information. Results: A total of 5637 breast malignancies were diagnosed in our department during the study period of 10 years and the total number of NHLs (Nodal and extra Nodal) was 2632. Thirty (n=30) patients accounting for 1.13% were diagnosed to have lymphomatous involvement of the breast. The Female to Male ratio was13.5:1; age range was 12-92 years with a median age of 43 years (Mean age 46.5 years and Standard deviation of age was 16.88 years). The sites of the lesions were the right breast in 11 cases (37.93%), left breast in 9 cases (31.03%) and both breasts in 2 cases (6.89%), while the location of 8 masses (27.58%) was unknown. Immunohistochemical studies were negative for cytokeratins (MNF and Cam 5.2) in all cases. All cases of DLBCL expressed B cell lineage antigens and were positive for LCA and Pan B (CD20 and 79a). Conclusion: We concluded that breast lymphomas represent 1.13% of all NHL and 0.5% of all breast malignancies in this study. The most frequent morphologic type was diffuse large B-cell lymphoma. As patients with primary breast lymphoma have a better prognosis than those with carcinoma of the breast or patients with extranodal lymphomas, a multidisciplinary approach including surgery, radiotherapy, and chemotherapy when needed would result in a more favourable outcome

Comparison of Peri-tonsillar Injection of Tramadol with Adrenaline Vs Injection of Normal Saline (Placebo) Before Tonsillectomy in Reducing Per-operative Haemorrhage and Post-operative Pain

Introduction: Tonsillectomy is one of the most frequent surgical procedures performed in ENT. In the early postoperative period, pain and hemorrhage are considered to be the major cause of morbidity. Different methods of minimizing postoperative pain have been proposed including the use of oral analgesics, infiltration of local anesthetics, and analgesics like levobupivacaine, ketamine, and tramadol. To secure hemostasis during a tonsillectomy, several techniques including ligation, diathermy, and cauterization are used. To minimize these complications, preoperative preparation of the patient is mandatory. This study aimed to find out the efficacy of adrenaline and tramadol in controlling perioperative hemorrhage and postoperative pain respectively. Materials and Methods: A randomized controlled trial was conducted in the ENT department of Benazir Bhutto Hospital Rawalpindi for 6 months (21-11-2016 to 21-5-2017). The data was collected by operating surgeons. A total of 60 patients were included in the study with 1:1 randomization. Simple random sampling was used for the Selection of patients. Patients were divided into two groups. Group A was provided with the peri-tonsillar injection of tramadol with adrenaline while Group B was provided with normal saline injection (Placebo). Both groups were followed for 6 hours to measure mean pain scores and mean hemostasis time. After approval from the ethical review board, consent forms were distributed to patients. An Independent t-test was applied for the comparison of different variables. Results: Among all patients 60(100%), 25 (41%) males, and 35(59%) females. The mean age of patients was 12.2 years ± 4.49 SD. The mean time required for hemostasis was 4.9 minutes ± 1.92 SD. The mean pain scores were 1.3 (mild pain) ±1.12 SD. A statistically significant difference was found with time (p=0.01), mean pain (p=0.00), weight (p=0.00) and age (p=0.00) while insignificant with gender (p=0.06). Conclusion: Peri-tonsillar injection of tramadol with adrenaline during tonsillectomy leads to a significant reduction in per-operative hemorrhage and post-operative pain as compared to injection of normal saline