Risk of Malignancy in Breast FNAB Categories, Classified According to the Newly Proposed International Academy of Cytology (IAC) Yokohama System.

Background: A new category system comprising five classes (C1-insufficient material, C2-benign, C3-atypical, C4-suspicious, and C5-malignant) has been proposed by the International Academy of Cytology (IAC) for fine needle aspiration biopsy cytology (FNAB) for proper diagnosis of breast cancer. Aims and Objectives: This study is designed to categorize institutional FNAB data according to the new system and calculation of the absolute risk of malignancy (ROM), sensitivity, specificity, positive predictive values, false negative and false-positive rate. Study Design: We conducted a retrospective cross-sectional study involving 2133 cases collected between June, 2008 and August, 2019, at Foundation University Medical College's Department of Histopathology and the Surgery and Oncology Department at the Fauji Foundation Hospital. All cases fulfilling the inclusion and exclusion criteria were retrieved from the archives and reviewed by two expert pathologists. Matching histopathology was compared with the cytology reports for concordance or discordance of results. Findings: We found 6.9% (n = 147) insufficient, 65.8% (n = 1403) benign, 7.2% (n = 153) atypical, 7.5% (n = 160) suspicious and 12.6% (n = 270) malignant cases. Cyto-histological correlation was found in 421 cases from the year 2014 to 2019 with 370 concordant and 51 discordant cases. The maximum number of concordant cases was 151 in the C5 category and discordant cases had a diagnosis of C3 and C4 on cytology with 16 cases in each category. The calculated values of ROM were 45.45%, 10.3%, 30.6%, 82.79% and 99.34% from C1 to C5, respectively. We calculated 83.42% absolute sensitivity and 85.24% specificity. The positive predictive value for category 3, 4 and 5 was 67.34%, 82.7% and 99.34%, respectively, while false-negative rate was 7.9% and false-positive rate was 0.66%. Conclusion: The ROM for C1 category calculated from this study is quite high (45.45%) compared to previous studies; therefore, it is recommended to perform core needle biopsy in all these cases. The higher sensitivity and specificity of this method of diagnosing malignant lesions supports its use.

Renal Amyloidosis: A Clinicopathological Study From a Tertiary Care Hospital in Pakistan.

Introduction Systemic amyloidosis can affect any organ in the body, but the kidney is the most commonly involved site. It is characterized by the extracellular deposition of insoluble fibrillar proteins. Amyloid deposits can be identified histologically by Congo red stain, which gives apple-green birefringence under polarized light. Typing of renal amyloidosis is done by direct immunofluorescence on frozen tissue. The most common types of amyloidosis seen in renal tissue are amyloid light chain (AL) primary amyloidosis and amyloid A (AA) secondary amyloidosis. Although primary amyloidosis is considered the most common type in western countries, however, in the subcontinent region, secondary amyloidosis is more common. The spectrum of signs and symptoms in renal amyloidosis is variable including isolated proteinuria, nephrotic syndrome, hypertension, hypotension, and renal insufficiency. The present study aims to evaluate the incidence and aetiology of various types of renal amyloidosis, determine their distribution within the kidney, and study various clinicopathological features. Objective The present study aims to evaluate the aetiology and clinicopathological profile of renal amyloidosis, determine its various types, and their distribution within the kidney. Materials and methods This retrospective cross-sectional study was conducted from 1st January 2013 to 31st December 2020 at the Department of Histopathology, Shifa International Hospital (SIH), Islamabad. All renal biopsies diagnosed as renal amyloidosis were included in the study. Data were analysed using SPSS version 23 (IBM Corp., Armonk, NY). Frequency and percentages were calculated for qualitative variables, and mean and standard deviation were calculated for quantitative variables. Results A total of 131 cases were diagnosed with renal amyloidosis during the study period of eight years (from 1st January 2013 to 31st December 2020) at SIH. The age range varied from 17 to 82 years. The mean age of the patients was 45 ± 16.33 years. Out of 131 patients, 82 (62.6%) were males and 49 (37.4%) were females. Amongst them, 72 (54%) cases were diagnosed with secondary AA amyloidosis and 16 (12%) cases were diagnosed with primary AL amyloidosis. The rest of the cases 43 (34%) were of indeterminate type. The associated conditions in secondary amyloidosis were tuberculosis in 41 (57%), rheumatoid arthritis in 16 (22%), ankylosing spondylitis in five (7%), lymphoma in three (4%), diabetes in two (3%), and chronic osteomyelitis, chronic heart disease, hepatitis, and vasculitis in one case each (1.7%). Out of 16 cases reported with AL amyloidosis, 10 cases (62.5%) had a history of multiple myeloma. The most common clinical presentation was nephrotic syndrome followed by subnephrotic proteinuria, renal failure, and hypertension. Conclusion The findings of the present study show underlying etiological factors and clinicopathological characteristics of renal amyloidosis. AA amyloidosis is the most common type of renal amyloidosis in our study and tuberculosis is the most common aetiological factor. AL amyloidosis is less frequent in our population.

Immunohistochemical detection of FLI-1 protein expression in Ewing Sarcoma/ peripheral primitive neuroectodermal tumour: A study of 50 cases.

OBJECTIVE: To determine friend leukaemia integration 1 transcription factor protein expression in cases of Ewing sarcoma. METHODS: This retrospective, descriptive study was conducted at the Armed Forces Institute of Pathology, Rawalpindi, Pakistan, and comprised data of diagnosed cases of Ewing sarcoma related to the period from February 2013 to December 2014. Clinico-pathological features, including patient age, gender and site of biopsy were studied. Positivity of immunohistochemical markers such as cluster of differentiation 99(membranous staining) and Friend leukaemia integration 1 transcription factor (nuclear staining) were noted. SPSS17 was used for data analysis. RESULTS: Of the 50 Ewing sarcoma cases, 26(52%) related to women and 24(48%) to men. The overall mean age was 17+11.53 years (range: 3 to 42 years). Moreover, 30(60%) patients had presented with bone swelling or growth whereas 20(40%) had presented with soft tissue swelling. The site of presentation was upper extremities in 16(32%) patients, lower extremities in 14(28%), maxilla in 7(14%), chest wall in 6(12%), paraspinal region in 4(8%), scalp in 2(4%) and retroperitoneum in 1(2%). Membranous positivity for cluster of differentiation 99 was seen in 48(98%) cases. Nuclear positivity for Friend leukaemia integration 1 transcription factor was seen in 39(78%) cases. CONCLUSIONS: Friend leukaemia integration 1 transcription factor was found to be a useful marker in diagnosing Ewing sarcoma/peripheral primitive neuroectodermal tumour. However, its positivity was more dependable when it was used in combination with other markers such as cluster of differentiation 99.

Comparison of diagnostic accuracy of touch imprint cytology and frozen section techniques in detecting breast malignancies.

OBJECTIVE: To compare the diagnostic accuracy of touch imprint cytology and frozen section in the diagnosis of malignant breast lumps keeping histopathological diagnosis as the gold standard. METHODS: The cross-sectional validation study was conducted at Foundation University Medical College, Islamabad, from February 2011 to February 2012, and comprised patients undergoing mastectomy/lumpectomy. The specimens were collected from the operation theatre of Fauji Foundation Hospital, Rawalpindi. After tissue fixation, three representative sections were processed and the slides were stained with haematoxylin and eosin stain. The person analysing touch imprint cytology slides was blinded to the frozen section and histopathological slide results and vice-versa. Data was analysed using SPSS 17. RESULTS: Out of 76 patients with a mean age of 49±15.14 years, 61(80%) were diagnosed with malignant breast diseases. The sensitivity, specificity, positive predictive value, negative predictive value and true positives of touch imprint cytology were 96.72%, 100%, 100%, 88.24% and 96.72% respectively. The corresponding values of the frozen section were 100% each. The diagnostic accuracy calculated for touch imprints and frozen section was 97.37% and 100% respectively. CONCLUSIONS: The diagnostic accuracy of frozen section was better than touch imprint cytology in rapid intra-operative diagnosis. However, touch imprints can safely be used as an alternative intra-operative procedure to ensure satisfactory results.

Frequency of corneal dystrophies on the basis of histopathology in surgically removed corneas.

OBJECTIVE: To assess the frequency of corneal dystrophies on the basis of histopathology in surgically-removed corneas. METHODS: The descriptive study was conducted at Foundation University Medical College, Islamabad, and Al Shifa Eye Hospital, Rawalpindi, Pakistan, from May to October 2011, and comprised post-keratoplasty corneal specimen irrespective of age and gender. The surgically-removed corneas were processed according to the standard guidelines of histopathological processing. The histopathological sections were examined for various corneal dystrophies. Data was recorded on a proforma and was analysed using SPSS 17. RESULTS: Of the 63 patients in the study, 12(19%) were diagnosed as having corneal dystrophies. In these 12 patients, 6(50%)were diagnosed as stromal corneal dystrophies and 5(42%)had posterior corneal dystrophies, and 1(8%)had anterior corneal dystrophy. CONCLUSIONS: Histopathological examination of corneas is a reliable method to diagnose and classify corneal dystrophies.

The interobserver reproducibility of thyroid cytopathology using Bethesda Reporting System: analysis of 200 cases.

OBJECTIVE: To determine interobserver reproducibility of thyroid cytopathology in cases of thyroid fine needle aspirates. METHODS: The retrospective, descriptive study, was conducted at the Foundation University Medical College, Islamabad, using cases related to period between 2009 and 2011. A total of 200 cases of fine-needle aspirations were retrieved from the archives. Three histopathologists independently categorised them into 6 groups according to Bethesda reporting system guidelines without looking at previous reports. Kappa statistics were used for analysis of the results on SPSS 17. RESULTS: Of the 200 patients, 194 (97%) were females and 6 (3%) were males. The overall mean age of patients was 46 +/- 20 years. Kappa value calculated for observer-1 and observer-2 was 0.735; for observer-1 and observer-3, 0.841; and for observer-2 and observer-3, 0.838, showing substantial interobserver agreement. Histopathological correlation was available, for 39 (19.5%). Of these cases, 5 (13%) were 'non-diagnostic, 20 (51%) 'benign, 2 (5%) 'atypia of undetermined significance/follicular lesion of undetermined significance, 6 (15%) 'follicular neoplasm, 1 (3%) 'suspicious for malignancy, and 5 (13%) 'malignant. CONCLUSIONS: Good overall interoberver agreement was found, but discordance was seen when certain categories were analysed separately.