Non-Hodgkin Lymphoma (NHL) in Pakistan

Lymphomas are classified as Hodgkin’s and Non-Hodgkin’s lymphomas (HL; NHL); NHL being further sub-divided into B, T and Null cell categories on the basis of WHO classification. With a few exceptions worldwide, B-NHL are more common, accounting approximately 80-85% of all cases of NHL compared to T-NHL, which accounts for about 10-15% of all NHL cases. The incidence of NHL has shown a steady increase and attention is being focused on the possible causes of this increase. Epidemiologic studies indicate that environmental factors do play a role in the causation of NHL, such as drugs, pesticides, solvents, hair dyes, viruses (EBV, HTLV-1, Hepatitic C and HIV) and Helicobacter pylori. Hence many different environmental factors of risk acting on large segments of the population can contribute for increase of NHL

Allred scoring for ER reporting and it\u27s impact in clearly distinguishing ER negative from ER positive breast cancers

Objective: To determine the scoring of Estrogen Receptor (ER) status in carcinoma breast by Allred method that is essentially bimodal and to compare the results with a conventional scoring system.Materials and Methods: A retrospective, comparative study carried out at Aga Khan University Hospital Section of Histopathology over a period of 18 months i.e. Jan 2005 to June 2006. Anti ER antibody (clone D07) was used for all IHC stains using envision detection system. ER stains of 860 consecutive breast cancer cases were reviewed and rescored by both conventional and Allred method of ER scoring.Results: Comparison of results showed that there was a substantial decrease in weak positive cases from 18% to 5% by rescoring using Allred scoring system compared to conventional scoring. The data was analyzed using chi square test.Conclusion: The sensitivity and specificity of Allred method were calculated; Sensitivity of Allred method was 99.4% & Specificity of Allred method was 99.5% whereas sensitivity and specificity of conventional method was 88.0 % and 84 % respectively

Soft tissue sarcomas: pattern diagnosis or entity

Soft tissue sarcomas (STS) are a diverse and heterogeneous group of tumours The sub-classification of these tumours is of importance for both prognosis and treatment. Classically, sub- categorization is based purely on histomorphological grounds, but as new techniques evolve, a more, conclusive and accurate diagnosis can be made. This study describes the prevalence of soft tissue sarcomas in adults diagnosed at The Aga Khan University Hospital (AKUH) and the impact of immunohistochemistry(IHC) on the precise sub-categorization of these tumours. The study included 364 adults (age 16+) who were diagnosed as soft tissue sarcoma in the past six years (May 1991 - July 1997) at the Histopathology lab of the AKUH. Where indicated, tu.mours were stained with a panel of antibodies using the PAP technique. Of these, 237(65%) were male and 127 (35%) were female. The median age at which all sarcomas were diagnosed was 39,5 years. The most common site was the lower extremity (29%). The most frequently diagnosed sarcoma was leiom yosarcoma (13%), followed by malignant nerve sheath tumour (12%), rhabdomyosarcoma (10%) and liposarcoma (10%). Cases were further analyzed by dividing them into two groups, each group comprised of all sarcomas diagnosed during the specified period. In the period 1991 - 1994, only 16% of cases were further analyzed usig IHC, while in the period 1995-1997, IHC was performed on 59% of cases. In the 1991-1994 group, a conclusive diagnosis was made in 57% of the cases and in the 1995-1997 group in 78%. A Chi-square test was performed, which proved that these results were statistically significant. Soft tissue sarcoma is one of the key areas in surgical pathology where immunohistochemistry plays an important role in both precise diagnosis and sub-categorization

Classification and immunophenotyping of acute Leukemias: a prospective study.

Over a period of 3-1/2 years, 86 cases of acute leukemia were analyzed by immunohistochemical (IHC) means on ficoll separated cytospin preparations of peripheral blood and/or bone marrow samples. Antibodies included in the panel were specific against Tdt, HLA-DR, CD19/CD2O/CD22, CALLA (CD1O), CD2, CD11C as well as against Ig heavy chains. Of 86 cases analyzed, 48 cases were of ALL, (25 of common pre-B ALL, 15 of pre-B/NULL and 8 of T ALL phenotype), twenty-four (24) out of 86 cases were of non­lymphoblastic (AML/AMML) type. In six cases, there was suggestion of a mixed lineage, while in 8 cases there was inconclusive diagnosis. Mean age was lower in common ALL sub-set of ALL as compared to pre-B/NuIl gmup (i.e., 8 vs 12 years), while in non-lymphoblastic group it was 36 years. T cell phenotype was invariably seen in young adults, who usually presented with a mediastinal mass

Spectrum of Hodgkin\u27s disease in children and adults: impact of combined morphologic and phenotypic approach for exclusion of look-alikes

Objective: To determine the prevalence of Hodgkin’s disease (HD) and its various subtypes in children and adults and assess the use of immunohistochemical (IHC) studies in confirming HD cases and excluding its close mimicries/look-alikes. Material and Methods: All 265 Hodgkin’s disease cases diagnosed at The Aga Khan University Hospital, Karachi over the last 6 years (July 1991 - July 1997) were included. Of these 219 were diagnosed on routine H&E examination while in the remaining 46 cases, diagnosis was made after a thorough IHC workup. (This group initially included 161 cases labelled as lymphoproliferative disorder with HD as one of the differentials). Results: Out of a total of 265 HD cases (206) 78% were males and (59) 22%were females in a ratio of 3.5:1. 26%(69) cases were \u3c15 years while 74% (196) were \u3e15 years old. In both age groups, the commonest subtype proved to be Mixed Cellularity (MC) (60% of \u3c15 years old and 40% of \u3e15 years old) followed by Nodular Scierosing (NS) (20% of \u3c15 years old and 27% of \u3e15 years old). Lymphocyte Predominant (LP) and Lymphocyte Depleted (LD) were seen less frequently.With the help of IHC studies performed on 161 cases in which HD was part of the differential diagnosis,46 were conclusively diagnosed as HD. In the rest of the cases the main differential was Non-Hodgkin’s Lymphoma (NHL) that accounted for 72 of the cases. Conclusion: This study shows that the most common sub-type of HD in our series in MC followed by NS. This study also suggests reasons why the more aggressive sub-type MC is predominant in Third world countries like ours compared to the better prognostic NS seen more in developed countries and why LP and LD are less and less commonly diagnosed

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

Spectrum of tamoxifen associated endometrial pathology in breast cancer patients

The objective of the study was to determine the incidence and type of endometrial abnormalities in long-term users of tamoxifen with breast cancer. All patients with a diagnosis of Oestrogen Receptor positive breast cancer on Tamoxifen therapy who had also undergone endometrial biopsy for abnormal bleeding or other symptoms were included. Among the 37 cases that had long-term follow up available, 21(57%) had evidence of endometrial pathology. There were seven cases of simple hyperplasia and thirteen of endometrial polyp. Only one case of endometrial carcinoma was seen. These findings support the association between prolonged tamoxifen therapy and endometrial pathology of possible neoplastic potential. Endometrial pathology is dependent on duration of exposure to Tamoxifen, therefore, close follow up of such patients is recommended