Journal of Pakistan Medical Association, Nov 3, 2020
Objective: Clinicopathological features of gastroenteropancreatic neuroendocrine tumors (GEP-NETs... more Objective: Clinicopathological features of gastroenteropancreatic neuroendocrine tumors (GEP-NETs) have rarely been studied in the Pakistani population. We investigated the clinical characteristics of these tumors according to the updated World Health Organization (WHO) 2010 classification. Methods: The data of Shifa International Hospital, Islamabad was retrospectively analysed for pathologically confirmed GEP-NETs from January 2013 to March 2018. Results: One hundred and eighteen patients (mean age, 52.2 years; male, 55.1%) were identified. 83.1% of the patients were symptomatic including5.1% functional tumors. Pancreas (28%) was the most frequent primary site noted. The most common histologic type was well differentiated neuroendocrine tumor (WDNET) in 81.4% followed by neuroendocrine carcinoma (NEC) in 16.1%. 45.8% cases of WDNET were grade 1, 27.1% were grade 2, and 8.5% were grade 3.15.3% had distant metastasis at the time of diagnosis with liver (77.7%) as the most common metastatic site. Synaptophysin positivity was seen in 96.8% of grade 1 & grade 2 WDNET, 100% of grade 3 WDNET and 92.3% of NEC and chromogranin was positive in 94.2% of grade 1 &grade 2 WDNET, 83.3% of grade 3 WDNET and 45.4% of NEC. Conclusion: GEP-NETs showed a wide clinicopathological spectrum. Pancreas is the most site of involvement by the GEP-NET however grade 3 WDNET had a predilection for the colon. Small cell carcinomas were commonly observed in esophagus. Keywords: Gastroenteropancreatic neuroendocrine tumor, well differentiated neuroendocrine tumor, neuroendocrine carcinoma. Continuous...
Journal of the College of Physicians and Surgeons--Pakistan : JCPSP, 2016
OBJECTIVE To determine the frequency of IgAnephropathy presenting at a tertiary care hospital. ST... more OBJECTIVE To determine the frequency of IgAnephropathy presenting at a tertiary care hospital. STUDY DESIGN Across sectional, observational study. PLACE AND DURATION OF STUDY Pakistan Institute of Medical Sciences, Islamabad and Shifa International Hospital, Islamabad, Pakistan, from November 2008 to November 2014. METHODOLOGY This was a retrospective analysis of renal biopsies for the diagnosis of nephropathy during the study period. Biopsies were stained with fluorescence isothyocyanate (FITC) labelled antibodies against IgG, IgA, IgM, C3, C4 and C1q for fluorescent microscopy. For histopathological examination, the specimens were stained with hematoxylin and eosin, Periodic acid Schiff and methanamine silver stains for light microscopy. RESULTS Out of total 1,658 renal biopsy cases, 142 (8.6%) were diagnosed as IgA nephropathy on light and immunofluorescence microscopy. Majority of IgAnephropathy patients were young (mean age = 33.2) and presented with proteinuria. The frequency ...
Intra-operative diagnosis of brain tumours routinely employs frozen sections. The frozen section ... more Intra-operative diagnosis of brain tumours routinely employs frozen sections. The frozen section however has several limitations and induces serious freezing artefacts. We carried out a prospective study on 40 cases of astrocytomas utilizing touch preparation cytology. The smears were quite cellular with crisp cellular details. There was 98.4% sensitivity and 90% specificity. We found touch preparation cytology highly reliable mode of intra-operative diagnosis in astrocytomas.
Journal of the College of Physicians and Surgeons--Pakistan : JCPSP, 2015
OBJECTIVE To study the spectrum of histopathological findings in live donor liver graft biopsies.... more OBJECTIVE To study the spectrum of histopathological findings in live donor liver graft biopsies. STUDY DESIGN Case series. PLACE AND DURATION OF STUDY Histopathology Department, Shifa International Hospital, Islamabad, from January 2011 to March 2014. METHODOLOGY The biopsies were received in formalin and routinely processed. The changes encountered were divided into three categories: (i) new-onset post liver transplantation (LT) complications (early and late), (ii) acute rejection and (iii) recurrence of original disease. Banff schema 1997 of rejection activity index (RAI), modified histological activity index (mHAI) and recent literature were utilized for evaluation. The results were finalized in the light of clinical details along with relevant laboratory investigations and radiological findings. RESULTS Seventy eight percutaneous hepatic graft biopsies of 59 patients were evaluated. Among them, findings noticed in descending order of frequencies were Acute Cellular Rejection (A...
Journal of Ayub Medical College, Abbottabad : JAMC, 2019
BACKGROUND C1q nephropathy (C1qN) is a rare glomerulopathy, with a very low prevalence world wide... more BACKGROUND C1q nephropathy (C1qN) is a rare glomerulopathy, with a very low prevalence world wide varying from 0.2 to 2.5%. Even though more than three decades have passed since this entity was first explained, still, it remains a dilemma for many due to the rarity of this lesion. This study was carried out principally to determine the clinical presentation, morphologic features and distribution of C1qN in our region based on renal biopsies studied by light microscopy (LM), and immunofluorescence (IF) so that this entity is better understood both by nephrologists and pathologists as no such study has ever been conducted in Pakistan to our knowledge. METHODS It was a cross-sectional study carried out from 1st January 2012 to 30th December 2016 in Histopathology department, Shifa International Hospital. All cases diagnosed as C1q nephropathy were retrieved from the hospital's computerized database. Their clinical profiles, morphology and immunohistochemical profiles were studied.....
Journal of the College of Physicians and Surgeons--Pakistan : JCPSP, 2017
Lymphoepithelioma-like carcinoma of esophagus is a rare tumor with about 20 cases reported worldw... more Lymphoepithelioma-like carcinoma of esophagus is a rare tumor with about 20 cases reported worldwide. It can involve the salivary gland, esophagus, stomach, thymus, thyroid, breast, lung, uterus, cervix, urinary bladder, and the skin. Its association with Epstein Barr virus has been postulated. We report the case of a 45-year female who had been treated for hepatitis C and esophageal tuberculosis and recovered fully from these conditions. She presented with dysphagia of 2-3 month duration. Endoscopic examination revealed narrowing of the esophageal lumen with a fungating mass at the lower end of esophagus with no extension into the stomach. ACTscan confirmed a mass at the lower end of esophagus with multiple enlarged mediastinal lymph nodes. Histological and immunohistochemistry of esophageal biopsy sample showed lymphoepithelioma-like carcinoma. She was managed with chemotherapy comprising of capecitabine, epirubicin and cisplatin followed by esophagectomy and made full recovery.
Objective: This audit was carried out principally to assess adherence of histopathological report... more Objective: This audit was carried out principally to assess adherence of histopathological reporting of colorectal cancer cases at Shifa International Hospital (SIH), Islamabad to the College of American Pathologists (CAP) Protocol. Materials and Methods: The audit sample includes 100 cases of colorectal cancer identified via large biopsies. The cases were retrospectively collected from 30-112014 to 04-06-2012 using Oracle software. Reaudit was done from 01-06-2015 to 30-09-2015 and included 09 cases of colorectal cancer. Results: Out of a total of 9 macroscopic features specimen type was mentioned in 100% of reports. 3 parameters (procedure, specimen length and tumor site) were mentioned in more than 90% reports. Macroscopic tumor perforation was mentioned in 84% reports and tumor size in 62% reports. Macroscopic intactness of mesorectum was mentioned in 87% of cases. Out of a total of 24 microscopic features histological tumor type was mentioned in 100% reports. Tumor grade, patho...
Objective: Clinicopathological features of gastroenteropancreatic neuroendocrine tumors (GEP-NETs... more Objective: Clinicopathological features of gastroenteropancreatic neuroendocrine tumors (GEP-NETs) have rarely been studied in the Pakistani population. We investigated the clinical characteristics of these tumors according to the updated World Health Organization (WHO) 2010 classification. Methods: The data of Shifa International Hospital, Islamabad was retrospectively analysed for pathologically confirmed GEP-NETs from January 2013 to March 2018. Results: One hundred and eighteen patients (mean age, 52.2 years; male, 55.1%) were identified. 83.1% of the patients were symptomatic including5.1% functional tumors. Pancreas (28%) was the most frequent primary site noted. The most common histologic type was well differentiated neuroendocrine tumor (WDNET) in 81.4% followed by neuroendocrine carcinoma (NEC) in 16.1%. 45.8% cases of WDNET were grade 1, 27.1% were grade 2, and 8.5% were grade 3.15.3% had distant metastasis at the time of diagnosis with liver (77.7%) as the most common met...
Objective: The objective of this study was to evaluate the effectiveness of intradepartmental con... more Objective: The objective of this study was to evaluate the effectiveness of intradepartmental consultation conference (IDC) as a good quality control measure and problem-solving activity in a busy histopathology department.Methods: This study was done at the histopathology department of a tertiary care hospital over a period of 6 years from 2011 to 2016. IDC is routinely held at 2 pm daily on multi-header microscope. All the difficult and problematic cases are discussed. Discussed cases with the recommendations of IDC are recorded. The cases were extracted from the record of IDC being maintained since 2011. All the record sheets were analysed and the cases were divided organ and system wise.Results: A total of 5766 (6.5%) cases were discussed in this 6-year period of a total of 89,253 cases reported at our centre. Of these, 2198 (38%) were solved on first viewing, 1783 (31%) in the second viewing and 1691 (29%) in thethird viewing. In total, 98% of the cases were resolved until the ...
Objective: The objective of this study was to determine the morphologic spectrum and risk categor... more Objective: The objective of this study was to determine the morphologic spectrum and risk category of gastrointestinal stromal tumour (GIST) and compare with overall patient survival.Materials and Methods: It is a descriptive observational study. The study was carried at Shifa International Hospital, Islamabad. Duration of the study was from January 2009 to January 2015. A total of 31 patients with the diagnosis of GIST were included, irrespective of age and gender. Data were retrieved from laboratory information system. Results were analysed by statistical software, Statistical Package of the Social Sciences. Morphologic type, site of tumour, risk category and overall survival were determined and mean, standard deviation, frequencies and percentages were calculated for age site and risk category. Results: Of 31 patients, 21 (67.7%) were male and 10 (32.3%) were female. Site of tumour was as follows: Gastric 13 (41.9%), extra visceral 6 (19.4%), small intestine 9 (29.0%), rectum 2 (...
Journal of Pakistan Medical Association, Nov 3, 2020
Objective: Clinicopathological features of gastroenteropancreatic neuroendocrine tumors (GEP-NETs... more Objective: Clinicopathological features of gastroenteropancreatic neuroendocrine tumors (GEP-NETs) have rarely been studied in the Pakistani population. We investigated the clinical characteristics of these tumors according to the updated World Health Organization (WHO) 2010 classification. Methods: The data of Shifa International Hospital, Islamabad was retrospectively analysed for pathologically confirmed GEP-NETs from January 2013 to March 2018. Results: One hundred and eighteen patients (mean age, 52.2 years; male, 55.1%) were identified. 83.1% of the patients were symptomatic including5.1% functional tumors. Pancreas (28%) was the most frequent primary site noted. The most common histologic type was well differentiated neuroendocrine tumor (WDNET) in 81.4% followed by neuroendocrine carcinoma (NEC) in 16.1%. 45.8% cases of WDNET were grade 1, 27.1% were grade 2, and 8.5% were grade 3.15.3% had distant metastasis at the time of diagnosis with liver (77.7%) as the most common metastatic site. Synaptophysin positivity was seen in 96.8% of grade 1 & grade 2 WDNET, 100% of grade 3 WDNET and 92.3% of NEC and chromogranin was positive in 94.2% of grade 1 &grade 2 WDNET, 83.3% of grade 3 WDNET and 45.4% of NEC. Conclusion: GEP-NETs showed a wide clinicopathological spectrum. Pancreas is the most site of involvement by the GEP-NET however grade 3 WDNET had a predilection for the colon. Small cell carcinomas were commonly observed in esophagus. Keywords: Gastroenteropancreatic neuroendocrine tumor, well differentiated neuroendocrine tumor, neuroendocrine carcinoma. Continuous...
Journal of the College of Physicians and Surgeons--Pakistan : JCPSP, 2016
OBJECTIVE To determine the frequency of IgAnephropathy presenting at a tertiary care hospital. ST... more OBJECTIVE To determine the frequency of IgAnephropathy presenting at a tertiary care hospital. STUDY DESIGN Across sectional, observational study. PLACE AND DURATION OF STUDY Pakistan Institute of Medical Sciences, Islamabad and Shifa International Hospital, Islamabad, Pakistan, from November 2008 to November 2014. METHODOLOGY This was a retrospective analysis of renal biopsies for the diagnosis of nephropathy during the study period. Biopsies were stained with fluorescence isothyocyanate (FITC) labelled antibodies against IgG, IgA, IgM, C3, C4 and C1q for fluorescent microscopy. For histopathological examination, the specimens were stained with hematoxylin and eosin, Periodic acid Schiff and methanamine silver stains for light microscopy. RESULTS Out of total 1,658 renal biopsy cases, 142 (8.6%) were diagnosed as IgA nephropathy on light and immunofluorescence microscopy. Majority of IgAnephropathy patients were young (mean age = 33.2) and presented with proteinuria. The frequency ...
Intra-operative diagnosis of brain tumours routinely employs frozen sections. The frozen section ... more Intra-operative diagnosis of brain tumours routinely employs frozen sections. The frozen section however has several limitations and induces serious freezing artefacts. We carried out a prospective study on 40 cases of astrocytomas utilizing touch preparation cytology. The smears were quite cellular with crisp cellular details. There was 98.4% sensitivity and 90% specificity. We found touch preparation cytology highly reliable mode of intra-operative diagnosis in astrocytomas.
Journal of the College of Physicians and Surgeons--Pakistan : JCPSP, 2015
OBJECTIVE To study the spectrum of histopathological findings in live donor liver graft biopsies.... more OBJECTIVE To study the spectrum of histopathological findings in live donor liver graft biopsies. STUDY DESIGN Case series. PLACE AND DURATION OF STUDY Histopathology Department, Shifa International Hospital, Islamabad, from January 2011 to March 2014. METHODOLOGY The biopsies were received in formalin and routinely processed. The changes encountered were divided into three categories: (i) new-onset post liver transplantation (LT) complications (early and late), (ii) acute rejection and (iii) recurrence of original disease. Banff schema 1997 of rejection activity index (RAI), modified histological activity index (mHAI) and recent literature were utilized for evaluation. The results were finalized in the light of clinical details along with relevant laboratory investigations and radiological findings. RESULTS Seventy eight percutaneous hepatic graft biopsies of 59 patients were evaluated. Among them, findings noticed in descending order of frequencies were Acute Cellular Rejection (A...
Journal of Ayub Medical College, Abbottabad : JAMC, 2019
BACKGROUND C1q nephropathy (C1qN) is a rare glomerulopathy, with a very low prevalence world wide... more BACKGROUND C1q nephropathy (C1qN) is a rare glomerulopathy, with a very low prevalence world wide varying from 0.2 to 2.5%. Even though more than three decades have passed since this entity was first explained, still, it remains a dilemma for many due to the rarity of this lesion. This study was carried out principally to determine the clinical presentation, morphologic features and distribution of C1qN in our region based on renal biopsies studied by light microscopy (LM), and immunofluorescence (IF) so that this entity is better understood both by nephrologists and pathologists as no such study has ever been conducted in Pakistan to our knowledge. METHODS It was a cross-sectional study carried out from 1st January 2012 to 30th December 2016 in Histopathology department, Shifa International Hospital. All cases diagnosed as C1q nephropathy were retrieved from the hospital's computerized database. Their clinical profiles, morphology and immunohistochemical profiles were studied.....
Journal of the College of Physicians and Surgeons--Pakistan : JCPSP, 2017
Lymphoepithelioma-like carcinoma of esophagus is a rare tumor with about 20 cases reported worldw... more Lymphoepithelioma-like carcinoma of esophagus is a rare tumor with about 20 cases reported worldwide. It can involve the salivary gland, esophagus, stomach, thymus, thyroid, breast, lung, uterus, cervix, urinary bladder, and the skin. Its association with Epstein Barr virus has been postulated. We report the case of a 45-year female who had been treated for hepatitis C and esophageal tuberculosis and recovered fully from these conditions. She presented with dysphagia of 2-3 month duration. Endoscopic examination revealed narrowing of the esophageal lumen with a fungating mass at the lower end of esophagus with no extension into the stomach. ACTscan confirmed a mass at the lower end of esophagus with multiple enlarged mediastinal lymph nodes. Histological and immunohistochemistry of esophageal biopsy sample showed lymphoepithelioma-like carcinoma. She was managed with chemotherapy comprising of capecitabine, epirubicin and cisplatin followed by esophagectomy and made full recovery.
Objective: This audit was carried out principally to assess adherence of histopathological report... more Objective: This audit was carried out principally to assess adherence of histopathological reporting of colorectal cancer cases at Shifa International Hospital (SIH), Islamabad to the College of American Pathologists (CAP) Protocol. Materials and Methods: The audit sample includes 100 cases of colorectal cancer identified via large biopsies. The cases were retrospectively collected from 30-112014 to 04-06-2012 using Oracle software. Reaudit was done from 01-06-2015 to 30-09-2015 and included 09 cases of colorectal cancer. Results: Out of a total of 9 macroscopic features specimen type was mentioned in 100% of reports. 3 parameters (procedure, specimen length and tumor site) were mentioned in more than 90% reports. Macroscopic tumor perforation was mentioned in 84% reports and tumor size in 62% reports. Macroscopic intactness of mesorectum was mentioned in 87% of cases. Out of a total of 24 microscopic features histological tumor type was mentioned in 100% reports. Tumor grade, patho...
Objective: Clinicopathological features of gastroenteropancreatic neuroendocrine tumors (GEP-NETs... more Objective: Clinicopathological features of gastroenteropancreatic neuroendocrine tumors (GEP-NETs) have rarely been studied in the Pakistani population. We investigated the clinical characteristics of these tumors according to the updated World Health Organization (WHO) 2010 classification. Methods: The data of Shifa International Hospital, Islamabad was retrospectively analysed for pathologically confirmed GEP-NETs from January 2013 to March 2018. Results: One hundred and eighteen patients (mean age, 52.2 years; male, 55.1%) were identified. 83.1% of the patients were symptomatic including5.1% functional tumors. Pancreas (28%) was the most frequent primary site noted. The most common histologic type was well differentiated neuroendocrine tumor (WDNET) in 81.4% followed by neuroendocrine carcinoma (NEC) in 16.1%. 45.8% cases of WDNET were grade 1, 27.1% were grade 2, and 8.5% were grade 3.15.3% had distant metastasis at the time of diagnosis with liver (77.7%) as the most common met...
Objective: The objective of this study was to evaluate the effectiveness of intradepartmental con... more Objective: The objective of this study was to evaluate the effectiveness of intradepartmental consultation conference (IDC) as a good quality control measure and problem-solving activity in a busy histopathology department.Methods: This study was done at the histopathology department of a tertiary care hospital over a period of 6 years from 2011 to 2016. IDC is routinely held at 2 pm daily on multi-header microscope. All the difficult and problematic cases are discussed. Discussed cases with the recommendations of IDC are recorded. The cases were extracted from the record of IDC being maintained since 2011. All the record sheets were analysed and the cases were divided organ and system wise.Results: A total of 5766 (6.5%) cases were discussed in this 6-year period of a total of 89,253 cases reported at our centre. Of these, 2198 (38%) were solved on first viewing, 1783 (31%) in the second viewing and 1691 (29%) in thethird viewing. In total, 98% of the cases were resolved until the ...
Objective: The objective of this study was to determine the morphologic spectrum and risk categor... more Objective: The objective of this study was to determine the morphologic spectrum and risk category of gastrointestinal stromal tumour (GIST) and compare with overall patient survival.Materials and Methods: It is a descriptive observational study. The study was carried at Shifa International Hospital, Islamabad. Duration of the study was from January 2009 to January 2015. A total of 31 patients with the diagnosis of GIST were included, irrespective of age and gender. Data were retrieved from laboratory information system. Results were analysed by statistical software, Statistical Package of the Social Sciences. Morphologic type, site of tumour, risk category and overall survival were determined and mean, standard deviation, frequencies and percentages were calculated for age site and risk category. Results: Of 31 patients, 21 (67.7%) were male and 10 (32.3%) were female. Site of tumour was as follows: Gastric 13 (41.9%), extra visceral 6 (19.4%), small intestine 9 (29.0%), rectum 2 (...
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