Mucosa associated lymphoid tissue lymphoma (Maltoma) in patients with cold nodule thyroid.
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Biopsy, Needle↗
Biomedical subjects
S Muzaffar
Publications and source records attributed to S Muzaffar.
Prostatic carcinoma with emphasis on Gleason's Grading: an institution based experience.
OBJECTIVE: To grade prostatic carcinomas according to the Gleason's Grading System and see whether the frequency of incidental carcinoma is significant. METHOD: Retrospective study of all consecutive cases of prostatic adenocarcinoma diagnosed at Aga Khan University Hospital (AKUH) between January 1st, 1996 and December 31st, 1999. SETTING: The histopathology section of AKUH, Karachi. OBSERVATION: Prostatic adenocarcinomas comprised 14.2% of all prostate specimens. There were 3 types of specimens i.e. transurethral resection, suprapubic prostatectomies and core biopsies. The mean age was 72.1 years; 68.1% patients were 65 years or older. The majority of the tumours were moderately differentiated (Gleason's scores 5,6 or 7). Grading was not possible in most core biopsies. The frequency of incidental carcinoma was 31.4%. CONCLUSION: Majority of tumours were moderate to poorly differentiated, indicating that prostatic adenocarcinoma is an aggressive disease. The frequency of incidental carcinoma was also high emphasizing need for more aggressive prostatic evaluation in the vulnerable age group.
Adenocarcinoma↗
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 (III 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.
Adolescent↗
Morphological pattern of salivary gland tumours.
OBJECTIVE: To delineate the spectrum of salivary gland tumors in our setup. SETTING: The Aga Khan University Medical Centre, Karachi. METHOD: Tumors were analysed considering histological type, age and sex of the patients and anatomic location. The diagnosis of individual tumours was based on the 1991 World Health Organisation Classification. RESULTS: During the span of eight years (1991-1998), 379 cases of salivary gland tumours were diagnosed. Of these, 205 (65.7%) were male and 174 (34.3%) were female. The median age at the time of diagnosis was 35 years. The median age for patients with malignant lesions (44 years) was 12 years older than those with benign tumours (34 years). Overall, malignant tumours were seen more frequently in males, however benign tumours were distributed equally between the two sexes. The most common site was parotid gland (82.85%). Only five cases of minor salivary gland tumours were seen. The most frequently diagnosed benign salivary gland neoplasm was pleomorphic adenoma (84.5%), followed by Warthin's tumours (6.18%), Mucoepidermoid carcinoma was the most commonly encountered malignant lesion (56.9%), followed by adenoid cystic carcinoma (19.6%). CONCLUSION: Plemorphic adenoma was the most common benign salivary gland tumour and mucoepidermoid carcinoma was the most frequent malignant neoplasm. Parotid gland was the most common site of origin in both benign and malignant tumours. The overall relative frequency of salivary gland tumours in this series correlates with that reported in the international literature.
Adenoma, Pleomorphic↗
Clinicopathological profile of Wilms' tumor.
The profile of renal tumors in children less than 15 years of age during the period 1991-1997 is presented. Among the 37 children with kidney tumors, 29 (78.4%) had Wilms' tumor. There was also a 20-year-old female with Wilms' tumor. The median age at presentation was 2.6 years (range 2.5 months to 20 years). 66.7% of the cases diagnosed were < or = 3 years and 90% were < or = 6 years. Five cases were under one year of age. The male to female ratio was 2:1. Twenty-two cases (73.3%) were triphasic and 7 (23.3%) were biphasic. Only one case was monophasic with blastemal component. Five cases (16.7%) showed nephrogenic rests in the uninvolved renal parenchyma and one case had nephroblastomatosis. The tumor was favorable in 26 cases (86.7%) and unfavorable in 4. Fourteen cases were in-patients while 16 were outside referrals. The pathological (10 cases whose specimens were sent from other centers) and clinicopathological (13 hospitalized patients) staging showed 10 cases (43.5%) with stage 1, 4 cases (17.4%) with stage 2, and 7 cases (30.4%) with stage 3. In two cases (8.7%), there was stage 4 disease. The length of the follow-up period in the 13 hospitalized patients ranged from 7 days to 5 years 5 months (median 14 months). There was one recurrence and one death after 2 years of diagnosis.
Adolescent↗
Childhood non-Hodgkin's lymphoma: an immunophenotypic analysis.
OBJECTIVE: To observe the frequency of histological subtypes of childhood non-Hodgkin's lymphoma and its immunohistochemical profile. SETTING: All cases of non-Hodgkin's lymphoma diagnosed in children (< 15 years) in the section of histopathology at the Aga Khan University Hospital Karachi during the period of three years. METHODS: These consecutive cases were evaluated on H&E stained sections and then immunohistochemistry analysis of these tumors was performed by employing Peroxidase Anti-Peroxidase (PAP) technique. RESULTS: The present series included 61 cases of non-Hodgkin's lymphoma. NHL was more common in males as compared to females with male to female ratio of 5.8:1. High grade NHL comprised 87% of childhood lymphoma. The mode of presentation in majority of NHL (57%) was extranodal. Burkitt's lymphoma (33%) was the most prevalent histological subtypes, followed by lymphoblastic (28%), diffuse large cell (15%), diffuse mix small and large cell (13%), small non cleaved Non-Burkitt's (7%) and immunoblastic (4%). Immunophenotypic analysis of the childhood Non-Hodgkin's lymphoma revealed that 67% of the Non-Hodgkin's lymphoma are B-cell type while 33%, are those of T-cell lineage. CONCLUSION: NHL was more common in males. Majority of NHL in children were high grade tumors. Burkitt's lymphoma was the most frequent histological subtype. T-cell NHL comprised a significant portion of childhood lymphomas.
Adolescent↗
Breast carcinoma in Pakistani females: a morphological study of 572 breast specimens.
OBJECTIVE: To study the morphological features in breast carcinoma which have proven prognostic value. METHODS AND SETTING: A retrospective analysis of 572 mastectomy specimens received over a period of three years at the department of pathology, The Aga Khan University Hospital. RESULTS: A total of 572 mastectomy specimens were analyzed which were received over a period of three years. Most of the patients were in the 5th and 6th decades of life. The mean age at diagnosis was 48 years. The most common tumour was infiltrating ductal carcinoma (81%). Tumour size was > 2 cms. in 80% of the cases. According to Modified Bloom and Richardson system most of the tumours were in grade II (65%) followed by grade III (24%). The number of cases with > 3 lymph node metastasis was significantly higher (70%) in tumours of > 2 cms size. High grade tumours also showed increased number of lymph node involvement. CONCLUSION: In Pakistani females breast carcinoma occurs at a younger age group. They are of large size at the time of presentation and show more frequent axillary lymph node metastasis. Infiltrating ductal carcinoma is the most common type of tumour with predominance of high grade lesions.
Adult↗
Retinoblastoma tells the story of our health care system.
OBJECTIVE: To review cases of retinoblastoma. SETTING: Department of Pathology Aga Khan University Hospital Karachi. METHOD: Twenty-three specimens from cases of retinoblastoma received over a period of eight years were routinely processes and stained with haematoxylin and Eosin stain. Other stains were used for tuberculoses and melanin. Immunochemistry was resorted to in undifferentiated tumors. RESULTS: Over 60% cases of retinoblastoma were diagnosed after 5 years and nine cases showed involvement of optinerve. CONCLUSION: Late diagnosis of retinoblastoma effects the stage of the tumors and the prognosis.
Child, Preschool↗
Histological pattern of ovarian neoplasma.
OBJECTIVE: To see the morphological pattern of benign and malignant ovarian neoplasms. METHOD: Retrospective study of all consecutive cases of ovarian neoplasms diagnosed at Aga Khan University Hospital between 1st January 1993 and 30th September 1998. SETTING: The Section of Histopathology, AKUH, Karachi. OBSERVATION: Of 855 ovarian tumours 506 (59.18%) were benign and 349 (40.81%) malignant. Surface epithelial-stromal tumours comprised 63.50% of all tumours. Benign cystic teratoma was the commonest benign tumour (35.17% of all benign tumours) and serous cystadenocarcinoma was the commonest malignant tumour (33.33% of all malignant tumours). Mucinous cystadenocarcinomas are more common in our population as compared to the West and borderline and malignant mucinous tumours occur at a younger age group. Malignant germ cell tumours are also common in our population. CONCLUSION: Except for the greater frequency of malignant mucinous and germ cell tumours, the findings of our series correspond to the published Western data.
Adolescent↗
Central nervous system lymphomas: a histologic and immunophenotypic analysis.
OBJECTIVE: To observe the spectrum of non-Hodgkin's lymphomas involving the central nervous system including morphological subtypes and immunophenotypic status. SETTING: Retrospective analysis of eleven years (1986 to 1996) data from surgical pathology files of Department of Pathology. RESULTS: Forty-three cases of non-Hodgkin's lymphomas were diagnosed during the period of eleven years (from 1986 to 1996), all of which were diffuse types. A total of 1177 Central Nervous CNS biopsies were examined, out of which 937 cases were diagnosed as CNS neoplasms, the remaining were non-neoplastic in nature. Among 937 CNS neoplasms, 43 cases (4.6%) were reported as non-Hodgkin's lymphomas. As most of the cases were outside referrals, the primary or secondary nature of the lymphomatous process could not be assessed. Seventeen cases were intracranial, while 26 cases were spinal in location. Majority of the intracranial lymphomas were biopsied from the cerebrum (12 cases). Male to female ratio was 1:2. The median age for intracranial lymphomas was 50 years and for spinal lymphomas 29 years. There were 16 cases (37%) of diffuse large cell lymphomas; 7 cases (16%) of diffuse mixed small and large cell lymphomas; 3 cases (7%) of diffuse large cell immunoblastic lymphomas; 2 cases (4.6%) of lymphoblastic lymphomas and diffuse small non-cleaved cell lymphomas and one case of small lymphocytic lymphoma and diffuse small cleaved cell lymphoma. One case of T cell rich B cell lymphoma was also diagnosed in the thoracic spine as primary extranodal lymphoma. Eight cases were unclassifiable and in 2 cases the features were suggestive of lymphoma. Immunophenotypic analysis was performed in 20 cases, however, in 2 cases the results were inconclusive. Fifteen cases (83%) showed immunoreactivity for B cell markers and 3 cases showed T cell phenotype out of which one case was lymphoblastic lymphoma. CONCLUSION: CNS lymphomas were uncommon tumors and comprised 4.6% of the total CNS neoplasms in our study. Moreover, these CNS lymphomas accounted for 2.2% of the total non-Hodgkin's lymphomas, including both nodal and extranodal. There was a higher incidence of location of these lymphomas within the spinal cord than brain. Most of the lymphomas were of intermediate or high grade (75%) according to the working formulation. Immunophenotypical status revealed B-cell phenotype in 84% of the lymphomas, in which it was tested (JPMA 50:141, 2000).
Central Nervous System Neoplasms↗
Assessment of nucleolar organizer regions (NORs) in proliferative conditions of the liver.
To overcome the diagnostic dilemma in proliferative conditions of the liver which sometimes pose a problem to the working pathologist especially when the material is inadequate, a special staining technique (AgNOR) has been applied. By using this technique, nucleolar organizer regions were counted which determine the proliferative status of the cells. This prospective study included 65 cases of randomly selected liver core and fine needle aspiration biopsies. AgNOR staining was performed on formalin-fixed, paraffin-embedded tissue sections NOR dots were counted in 100 randomly selected hepatocytes at x100 oil immersion objective, and the mean count per cell was calculated for each case. Statistical analysis was done by using the Mann Whitney U test. AgNOR count results were later compared with the histologic diagnosis. The study revealed a gradual increase in mean AgNOR counts from normal liver through cirrhosis to hepatocellular carcinoma. The difference in NOR counts was significant in these three groups. The hepatocellular carcinomas were graded according to the Edmondson-Steiner histological grading system. The Grade I hepatocellular carcinomas show AgNOR counts ranging between 5-6/cell, a score which is much higher than in the normal liver, where it ranges between 1.2-2.0/cell. This technique can be used to assess the lesions where the distinction between normal liver and Grade I hepatocellular carcinoma is difficult with the use of routine methods. AgNOR counts in normal liver and chronic hepatitis cases were insignificant, but there was an appreciable difference between cases of chronic hepatitis, cirrhosis and hepatocellular carcinoma. In view of the results of this study, the AgNOR staining method is found to be a useful diagnostic tool to differentiate between normal liver, cirrhosis and hepatocellular carcinoma and also to precisely discriminate between cases of normal liver and Grade I hepatocellular carcinoma.
Biopsy, Needle↗
T cell rich B cell lymphoma (TCRBCL): study of sixteen cases with review of literature.
T cell rich B cell lymphoma (TCRBCL) is a recently described variant of diffuse non Hodgkin's lymphoma (NHL), the acronym of which has gained wide acceptance among hematopathologists in a relatively shorter period of time. The recognition of this entity requires immunohistochemical facilities especially on paraffin embedded tissues. TCRBCL is one of the many examples in the diagnostic anatomic pathology which emphasizes the need of immunocytochemistry and availability of this technique at least in referral laboratories. One of the differential diagnosis in this case includes lymphocyte predominance Hodgkin's disease (LPHD) which is the most favorable prognostic histologic subtype of Hodgkin's disease (HD) while TCRBCL is an aggressive B Cell NHL and should be treated as high grade large cell lymphoma. The other close differential includes peripheral T cell non-Hodgkin's lymphoma (PTCL). We reported sixteen (16) cases of TcRBCL diagnosed during a period of two and a half years (January 1995 to June 1997). HD and PTCL were the main differential diagnoses in most of these cases. The median age at diagnosis was 39 years and male to female ratio was equal. TCRBCL was nodal in location in 15 cases and a single case in extranodal site presenting as spinal tumor. The mean neoplastic B cell population was 12%, while that of reactive T cells was 82%. A significant polymorphous inflammatory cellular background was noted in 5 cases. Reed-Stenberg like cells were observed in 3 cases. Immunoglobulin light chain restriction studies were performed in fourteen cases and revealed lambda light chains in ten cases while in four cases kappa light chains were present.
Adolescent↗
Clinico-morphological pattern and frequency of bone cancer.
OBJECTIVE: The present study was done to find out the frequency of malignant tumors of bone and to categorize the prevalence of various histological types of osseous malignancies with respect to age, sex and site of origin. SETTING: This study included consecutive cases of malignant bone tumors, which were diagnosed in the department of pathology at the Aga Khan University Hospital, Karachi during the period of three years (1995-1997). METHODS: These tumors were initially evaluated on H & E stained section from paraffin embedded tissue blocks. Special stains and immunohistochemical analysis was performed whenever required. RESULTS: A total of 169 malignant bone tumors were diagnosed during the study period. Metastatic tumors accounted for 28.4% of all malignant tumors of bone. Osteogenic sarcoma (27.2%) was the most frequent primary tumor of bone followed by Ewing's sarcoma (12.4%), Non-Hodgkin's lymphoma (10.6%), Chondrosarcoma (8.3%), Plasma Cell Myeloma (8.3%) and other rare entities (4.8%) in order of frequency. CONCLUSION: The most common malignant neoplasm diagnosed in osseous biopsies was metastatic tumors. Osteogenic sarcoma was the most frequent primary bone tumor in this series. The bone tumors were relatively more prevalent in males. The frequency of malignant bone tumor was relatively high as compared to developed countries.
Adolescent↗
Morphological pattern and frequency of thyroid tumors.
OBJECTIVE: The present study was done to evaluate the frequency of thyroid cancer and to find out the prevalence of histological types of thyroid tumor with respect to age and sex group. SETTING: This study included consecutive cases of malignant tumors of thyroid gland, which were diagnosed in the Department of Pathology at the Aga Khan University Hospital, Karachi during the period of three years (1995-1997). METHODS: These cases were evaluated on H & E stained sections from paraffin embedded 10% buffered formalin fixed tissue blocks. Special stains and immunohistochemical analysis were performed whenever required. RESULTS: A total of 8541 malignant tumors were diagnosed in a period of 3 years which included 103 (1.2%) cases of thyroid cancer. Thyroid tumors were more prevalent in females with female to male ratio of 2.6:1. Papillary carcinoma (69%) was the most common histological type of thyroid tumors, followed by follicular carcinoma (11.6%), medullary carcinoma (9.7%), anaplastic carcinoma (5.9%), non-Hodgkin's lymphoma (2.9%) and unclassified tumors (0.9%) in order of frequency. CONCLUSION: Thyroid cancer was more common in females. Papillary carcinoma was the most common histological type of thyroid tumors in females as well as in males. Papillary carcinoma was more prevalent in third, fourth and fifth decades of life while follicular and anaplastic carcinomas were more frequent after the fourth decade of life.
Adult↗
Fine needle aspiration cytology (FNAC) in the management of thyroid pathology--the Aga Khan University Hospital experience.
OBJECTIVE: To report the efficacy of FNAC in patients with thyroid disease. METHODS: Between January 1990 and December 1994 the records of all patients treated surgically for thyroid disease at ENT Head and Neck Surgery of Aga Khan University were reviewed. All the patients had pre-operative FNAC as the first line of evaluation and the histopathologist examined post-operative thyroid specimen. RESULTS: Forty-five patients (36 female and 9 male) had thyroid surgery. In 26 patients out of 45, FNAC was conclusive in diagnosing the nature of disease, while in 19 patients the FNAC was inconclusive because of the presence of follicular cell neoplasia. CONCLUSION: Our results indicate that the FNAC is very accurate and a reliable test in the diagnosis of thyroid pathology, however, to distinguish follicular adenoma from follicular carcinoma final histology is required. FNAC is cost effective method of evaluating thyroid pathology pre-operatively and plays a vital role in planning the surgical management of thyroid nodule.
Adenocarcinoma, Follicular↗
Gastric carcinoma with lymphoid stroma: association with Epstein virus genome demonstrated by PCR.
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Female↗
Pure lipoma of the uterus: an extremely rare entity.
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Female↗
Diagnosis of pulmonary tuberculosis using PCR assays on sputum collected within 24 hours of hospital admission.
There have been few studies evaluating the efficacy of polymerase chain reaction (PCR) testing in front-line clinical practice. We assessed the diagnostic yield of PCR prospectively in a blinded study of patients admitted to rule out tuberculosis and compared PCR results to a culture and clinical diagnosis of tuberculosis. Specimens were sent for routine smear, culture, and PCR analysis. Sputum sediments were submitted for PCR amplification of IS6110 sequences by an in-house assay and also the Roche Amplicor PCR assay targeting 16s ribosomal RNA genes. Eighty-five patients were enrolled: 27 patients had cultures positive for tuberculosis; 12 were smear-positive. PCR by both assays on the first specimen picked up all patients smear-positive on any specimen. A positive PCR on at least one of two specimens collected in the first 24 h was 85 and 74% sensitive and 88 and 93% specific for tuberculosis by the in-house and Roche techniques, respectively. Sensitivity in smear-negative patients was 73 and 53%, respectively. The in-house PCR detected 100% and Roche detected 95% of patients with more than paucibacillary (greater than 20 colonies) tuberculosis. We conclude that PCR may be a useful tool to evaluate patients for tuberculosis within the first hospital day.
Female↗