Artificial-Intelligence-Assisted Detection of Metastatic Colorectal Cancer Cells in Ascitic Fluid.

Ascites cytology is a cost-effective test for metastatic colorectal cancer (CRC) in the abdominal cavity. However, metastatic carcinoma of the peritoneum is difficult to diagnose based on biopsy findings, and ascitic aspiration cytology has a low sensitivity and specificity and a high inter-observer variability. The aim of the present study was to apply artificial intelligence (AI) to classify benign and malignant cells in ascites cytology patch images of metastatic CRC using a deep convolutional neural network. Datasets were collected from The OPEN AI Dataset Project, a nationwide cytology dataset for AI research. The numbers of patch images used for training, validation, and testing were 56,560, 7068, and 6534, respectively. We evaluated 1041 patch images of benign and metastatic CRC in the ascitic fluid to compare the performance of pathologists and an AI algorithm, and to examine whether the diagnostic accuracy of pathologists improved with the assistance of AI. This AI method showed an accuracy, a sensitivity, and a specificity of 93.74%, 87.76%, and 99.75%, respectively, for the differential diagnosis of malignant and benign ascites. The diagnostic accuracy and sensitivity of the pathologist with the assistance of the proposed AI method increased from 86.8% to 90.5% and from 73.3% to 79.3%, respectively. The proposed deep learning method may assist pathologists with different levels of experience in diagnosing metastatic CRC cells of ascites.

Poly (ADP-ribose) polymerase-1 (PARP-1) is a good prognostic marker for pancreatic/periampullary cancers.

BACKGROUND: Periampullary cancer (PAC) is highly aggressive with no effective adjuvant therapy or prognostic markers. Recently, poly (ADP-ribose) polymerases-1 (PARP-1) have emerged as a target in solid cancers, and its relationship with epithelial-mesenchymal transition (EMT) has been observed. However, the relationship between PARP-1 and EMT in PAC has not explored well. METHODS: We assessed the prognostic significance of PARP1 in 190 PACs patients and correlated it with EMT markers, including FGF8, FGFR4, MMP2, MMP3, Snail, and ZEB1. Immunohistochemistry for PARP-1 and EMT markers was performed using a tissue microarray. RESULTS: PARP-1 and FGF8 expression were associated with better survival unlike other solid cancers (P = 0.006 and P = 0.003), and MMP3 and ZEB1 expression were associated with poor prognosis in multivariate and survival analyses (P = 0.009 and P < 0.001). In addition, PARP-1 is related negatively to Snail but not related with other EMT markers, implying an independent mechanism between PARP-1 and EMT in PACs. PARP-1 and FGF8 are independent good survival markers in PACs unlike other solid cancers. CONCLUSIONS: PARP-1 and FGF8 in PACs could not be related to the EMT pathway but must be rather understood in light of similar cancer-protective roles. Further studies are required on EMT-associated immune markers in PACs.

Association of hormone receptors and human epidermal growth factor receptor-2/neu expressions with clinicopathologic factors of breast carcinoma: a cross-sectional study in a tertiary care hospital, Kabul, Afghanistan.

BACKGROUND: Breast cancer (BC) is one of the major causes of death worldwide. It is the most common cause of death before the age of 70 years. The incidence and mortality of BC are rapidly increasing, posing great challenges to the health system and economy of every nation. METHODOLOGY: A cross-sectional analytical study was conducted at the Department of Pathology and Clinical Laboratory of the French Medical Institute for Mothers and Children (FMIC) to demonstrate the association of human epidermal growth factor receptor 2 (Her2/Neu) and estrogen receptor (ER)/ progesterone receptor (PR) with clinical as well as pathological parameters among women with BC. A consecutive nonprobability sampling method was used for this study over a span of one and a half years. RESULTS: One hundred twenty participants diagnosed with breast cancer were included in the study. The mean age at diagnosis was 44.58 ± 11.16 years. Out of the total patients, 68 (56.7%) were above 40 years old, 108 (90%) were married, 94 (78.3%) were multiparous, and 88 (73.3%) had a history of breastfeeding. 33.3% of cases were within the age range of menopause (40-50 years). The positive expression rates of ER, PR, and Her2/neu were found to be 48.8%, 44.6%, and 44.6%, respectively, and Her2/neu overexpression was found to be higher among ER/PR-negative cases. CONCLUSION: In our study, we demonstrated that among Afghan women, grade II invasive ductal carcinoma, not otherwise specified, was the most common type of BC and frequently affected women above the age of 40. We also revealed that the percentage of negative ER (50.4%), negative PR (54.4%), and concordant ER/PR-negative cases were high compared to other possibilities. Additionally, the study revealed that expression of Her2/neu was in contrast with the expression of ER and PR receptors. The findings of our study still support the importance of performing immunohistochemical stains for hormonal receptor classification in terms of better clinical outcomes and prognosis.

Use of Novel Open-Source Deep Learning Platform for Quantification of Ki-67 in Neuroendocrine Tumors - Analytical Validation.

Background: Neuroendocrine tumors (NETs) represent a diverse group of neoplasms that arise from neuroendocrine cells, with Ki-67 immunostaining serving as a crucial biomarker for assessing tumor proliferation and prognosis. Accurate and reliable quantification of Ki-67 labeling index is essential for effective clinical management. Methods: We aimed to evaluate the performance of open-source/open-access deep learning cloud-native platform, DeepLIIF (https://deepliif.org), for the quantification of Ki-67 expression in gastrointestinal neuroendocrine tumors and compare it with the manual quantification method. Results: Our results demonstrate that the DeepLIIF quantification of Ki-67 in NETs achieves a high degree of accuracy with an intraclass correlation coefficient (ICC) = 0.885 with 95% CI (0.848-0.916) which indicates good reliability when compared to manual assessments by experienced pathologists. DeepLIIF exhibits excellent intra- and inter-observer agreement and ensures consistency in Ki-67 scoring. Additionally, DeepLIIF significantly reduces analysis time, making it a valuable tool for high-throughput clinical settings. Conclusion: This study showcases the potential of open-source/open-access user-friendly deep learning platforms, such as DeepLIIF, for the quantification of Ki-67 in neuroendocrine tumors. The analytical validation presented here establishes the reliability and robustness of this innovative method, paving the way for its integration into routine clinical practice. Accurate and efficient Ki-67 assessment is paramount for risk stratification and treatment decisions in NETs and AI offers a promising solution for enhancing diagnostic accuracy and patient care in the field of neuroendocrine oncology.

Huge accessory spleen with torsion, mimicking splenic lymphangioma: A case report and review of the literature.

INTRODUCTION AND IMPORTANCE: Approximately 30 % of population can have an accessory spleen, which is most often asymptomatic. Only when it becomes large in size, it may elicit symptoms, mostly due to complications, such as torsion, infarction, or traumatic hemorrhage. The preoperative diagnosis of an accessory spleen is often challenging due to its propensity to manifest the neoplasms of adjacent organs. Here we report a rare case of a huge tortured accessory spleen mimicking splenic lymphangioma and to review the literature. CASE PRESENTATION: A 27-year-old man was admitted to the emergency department following left hypochondrial pain that lasted for three days. The computed tomography scan findings demonstrate the spleen in its normal position, showing smooth outlines attached to a similar-density cystic heterogenous mass exhibiting strong radiological evidence of splenic lymphangioma. Surgical excision was performed, and a large tortured accessory spleen was discovered that was attached to the lower pole of the spleen by connective tissue. CLINICAL DISCUSSION: An accessory spleen is always smaller than 4 cm, and accessory spleens larger than that, especially with torsion, are extremely uncommon. According to literature, the identification of accessory spleen on the basis of clinical and radiological features is very difficult, especially when the patient presents with symptoms of acute abdomen. CONCLUSION: Considering the fact that accessory splenic tissue can mimics neoplasms of the spleen or nearby organs, it should be included in the differential diagnosis in an undiagnosed pre- or intraoperative hypochondrial mass, located in the vicinity of the spleen.

Clinicopathological features of dysembryoplastic neuroepithelial tumor: a case series.

BACKGROUND: Dysembryoplastic neuroepithelial tumors are rare benign supratentotrial epilepsy-associated glioneuronal tumors of children and young adults. Patients have a long history of seizures. Proper surgical resection achieves long term seizure control. We describe the clinicopathological features of dysembryoplastic neuroepithelial tumor cases reported in our practice and review the published literature. METHODS: All cases of Pakistani ethnicity were diagnosed between 2015 and 2021 were included. Slides were reviewed and clinicopathological features were recorded. Follow-up was obtained. Extensive literature review was conducted. RESULTS: Fourteen cases were reported. There were 12 males and 2 females. Age range was 9-45 years (mean 19 years). Majority were located in the temporal and frontal lobes. Duration of seizures prior to resection ranged from 2 months to 9 years with mean and median duration of 3.2 and 3 years, respectively. Histologically, all cases demonstrated a multinodular pattern, specific glioneuronal component, and floating neurons. Simple and complex forms comprised seven cases each. No significant nuclear atypia, mitotic activity, or necrosis was seen. Ki-67 proliferative index was very low. Cortical dysplasia was noted in adjacent glial tissue in four cases. Follow-up ranged from 20 to 94 months. Seizures continued following resection in all but one case but were reduced in frequency and intensity. In one case, seizures stopped completely following surgery. CONCLUSION: Clinicopathological features were similar to those in published literature. However, a marked male predominance was noted in our series. Seizures continued following resection in all but one case but were reduced in frequency and intensity. This series will help raise awareness among clinicians and pathologists in our part of the world about this seizure-associated tumor of children and young adults.

A stepwise approach to fine needle aspiration cytology of lymph nodes.

The cytological diagnosis of lymph node lesions is extremely challenging because of the diverse diseases that cause lymph node enlargement, including both benign and malignant or metastatic lymphoid lesions. Furthermore, the cytological findings of different lesions often resemble one another. A stepwise diagnostic approach is essential for a comprehensive diagnosis that combines: clinical findings, including age, sex, site, multiplicity, and ultrasonography findings; low-power reactive, metastatic, and lymphoma patterns; high-power population patterns, including two populations of continuous range, small monotonous pattern and large monotonous pattern; and disease-specific diagnostic clues including granulomas and lymphoglandular granules. It is also important to remember the histological features of each diagnostic category that are common in lymph node cytology and to compare them with cytological findings. It is also essential to identify a few categories of diagnostic pitfalls that often resemble lymphomas and easily lead to misdiagnosis, particularly in malignant small round cell tumors, poorly differentiated squamous cell carcinomas, and nasopharyngeal undifferentiated carcinoma. Herein, we review a stepwise approach for fine needle aspiration cytology of lymphoid diseases and suggest a diagnostic algorithm that uses this approach and the Sydney classification system.

Hybrid odontogenic lesions: A case series of a rare entity.

Background: The occurrence of hybrid odontogenic lesions with two or more morphologically distinct components is a rare phenomenon and poses a diagnostic challenge. We aimed to study the clinical, radiological, and pathological features and behavior of hybrid odontogenic lesions, to enhance awareness about these rare lesions. Method: Hematoxylin and Eosin slides of hybrid odontogenic lesions diagnosed between January 01, 2012 and December 31, 2020, were reviewed. Demographic and radiological information were obtained from the patient's medical records. Results: 8 cases were diagnosed with a mean age of 19.1 years and male to female ratio of 1:1.7. Involvement of mandible was more common (n = 5) as compared to maxilla (n = 3). All patients presented with swelling for an average of 9.75 months (3-25 months) duration. Bleeding, loose teeth, pain and facial asymmetry were reported in 5,3, 3, and 2 cases, respectively. Radiologically, 7 cases were well demarcated, 75% cases (n = 6) were radiolucent, and average radiological size was 4.8 cm. All patients were managed with surgery alone. 5 cases (62.5%) underwent enucleation and curettage, while local excision, en-block resection and segmental mandibulectomy were performed in 1 case each. Histologically, ossifying fibroma/cemento-ossifyiong fibroma were the most lesion, occurring in 5 cases (62%), followed by giant cell granuloma like lesions (GCG) i.e., central and peripheral giant cell granuloma (n = 3), Adenomatoid Odontogenic tumor (AOT) (n = 2), and DC (n = 2), ameloblastic fibroma (AF) (n = 1), Ameloblastoma (n = 1), calcifying odontogenic cyst (COC) (n = 1), and complex odontoma (n = 1). No evidence of recurrence was noted after 4-99 months of surgery (mean: 32.9) in cases with available data (n = 7). Long-term complaints included facial asymmetry (n = 2) and pain (n = 1). Conclusion: Most hybrid odontogenic lesions affect young females in the second decade of life and commonly show COF and OF as hybrid components. A conservative approach to management appears adequate.

A suggested way forward for adoption of AI-Enabled digital pathology in low resource organizations in the developing world.

Low- and middle-income countries (LMICs) represent a big source of data not only for endemic diseases but also for neoplasms. Data is the fuel which drives the modern era. Data when stored in digital form can be used for constructing disease models, analyzing disease trends and predicting disease outcomes in various demographic regions of the world. Most labs in developing countries don't have resources such as whole slide scanners or digital microscopes. Owing to severe financial constraints and lack of resources, they don't have the capability to handle large amounts of data. Due to these issues, precious data cannot be saved and utilized properly. However, digital techniques can be adopted even in low resource settings with significant financial constraints. In this review article, we suggest some of the options available to pathologists in developing countries which can enable them to start their digital journey and move forward despite resource-poor health system.

Recent application of artificial intelligence on histopathologic image-based prediction of gene mutation in solid cancers.

PURPOSE: Evaluation of genetic mutations in cancers is important because distinct mutational profiles help determine individualized drug therapy. However, molecular analyses are not routinely performed in all cancers because they are expensive, time-consuming and not universally available. Artificial intelligence (AI) has shown the potential to determine a wide range of genetic mutations on histologic image analysis. Here, we assessed the status of mutation prediction AI models on histologic images by a systematic review. METHODS: A literature search using the MEDLINE, Embase and Cochrane databases was conducted in August 2021. The articles were shortlisted by titles and abstracts. After a full-text review, publication trends, study characteristic analysis and comparison of performance metrics were performed. RESULTS: Twenty-four studies were found mostly from developed countries, and their number is increasing. The major targets were gastrointestinal, genitourinary, gynecological, lung and head and neck cancers. Most studies used the Cancer Genome Atlas, with a few using an in-house dataset. The area under the curve of some of the cancer driver gene mutations in particular organs was satisfactory, such as 0.92 of BRAF in thyroid cancers and 0.79 of EGFR in lung cancers, whereas the average of all gene mutations was 0.64, which is still suboptimal. CONCLUSION: AI has the potential to predict gene mutations on histologic images with appropriate caution. Further validation with larger datasets is still required before AI models can be used in clinical practice to predict gene mutations.

Validation of a Machine Learning Expert Supporting System, ImmunoGenius, Using Immunohistochemistry Results of 3000 Patients with Lymphoid Neoplasms.

(1) Background: Differential diagnosis using immunohistochemistry (IHC) panels is a crucial step in the pathological diagnosis of hematolymphoid neoplasms. In this study, we evaluated the prediction accuracy of the ImmunoGenius software using nationwide data to validate its clinical utility. (2) Methods: We collected pathologically confirmed lymphoid neoplasms and their corresponding IHC results from 25 major university hospitals in Korea between 2015 and 2016. We tested ImmunoGenius using these real IHC panel data and compared the precision hit rate with previously reported diagnoses. (3) Results: We enrolled 3052 cases of lymphoid neoplasms with an average of 8.3 IHC results. The precision hit rate was 84.5% for these cases, whereas it was 95.0% for 984 in-house cases. (4) Discussion: ImmunoGenius showed excellent results in most B-cell lymphomas and generally showed equivalent performance in T-cell lymphomas. The primary reasons for inaccurate precision were atypical IHC profiles of certain cases, lack of disease-specific markers, and overlapping IHC profiles of similar diseases. We verified that the machine-learning algorithm could be applied for diagnosis precision with a generally acceptable hit rate in a nationwide dataset. Clinical and histological features should also be taken into account for the proper use of this system in the decision-making process.

Gossypiboma of thigh mimicking soft tissue sarcoma: A case report and review of the literature.

INTRODUCTION AND IMPORTANCE: Gossypiboma is a term used to describe a surgical error related to accidental retention of surgical material within the body. Gossypibomas of extremities are rare and not only lead to serious health problems (infection and organ damage), but also, they may mimic benign or malignant tumors, especially those affecting the thigh where they may mimic soft tissue sarcomas. CASE PRESENTATION: A 50-year-old male, presented to the orthopedic department with a round palpable mass at mid-lateral of his right thigh region. The patient had history of surgical intervention on his femur due to femoral fracture 38-years ago. He had no sign of infection with normal laboratory workups. Radiological examinations suggested the possibility of a soft tissue sarcoma. Upon grossing, it revealed a white-tan and pink oval cystic mass with smooth surface. The cyst was filled with gauze fibers and creamy white-tan material. Histologically, the cystic wall of the mass revealed fibrocollagenous tissue, chronic inflammation and tiny foreign body materials, engulfed by the multinucleated giant cells, which was diagnosed as gossypiboma. CLINICAL DISCUSSION: Gossypiboma can mimic malignant soft tissue sarcomas. In most of the previously reported cases, the clinical and radiological findings suggested the possibility of malignant neoplasms. CONCLUSION: Considering the similarity between asymptomatic capsulated gossypiboma and soft tissue sarcomas radiologically, the possibility of gossypiboma should always be in the differential diagnosis, mainly in cases with presence of previous surgical scar or history of surgery at the affected area.

Secondary involvement of gallbladder by acute lymphoblastic leukemia presenting clinically as cholecystitis in a young patient: a case report.

BACKGROUND: Primary lymphoma of the liver, gallbladder, and extrahepatic bile ducts or secondary involvement of these organs by leukemia is exceedingly rare. Patients with primary lymphoma or leukemic involvement of the biliary tract and liver often present with symptoms and signs of biliary tract obstruction or inflammation. CASE PRESENTATION: We present a case of a 24-year-old male with biliary tract symptoms who underwent laparoscopic cholecystectomy. His precholecystectomy complete blood count performed on the same morning showed 72% lymphocytes while peripheral blood smears showed approximately 15% blasts. Surgeon went ahead with the procedure. Imaging done prior to surgery showed thickened gallbladder, while the liver, biliary tract, and pancreas did not show any thickening or mass lesion. However, the liver was enlarged. Grossly, the gallbladder wall did not show any stones or discrete mass involving the wall. Instead, there was subtle thickening of the gallbladder wall due to diffuse infiltration by the leukemic infiltrate. This lymphoid population reacted with PAX-5 and TdT immunohistochemical antibodies in a diffuse manner confirming precursor B-cell origin. This patient was found to have B-lymphoblastic leukemia involving his bone marrow on further clinical and diagnostic workup. Patient responded well to chemotherapy and is currently on maintenance treatment. He is well 1.5 years after his diagnosis. CONCLUSION: This case highlights a unique and rare scenario where a previously undiagnosed and unsuspected hematologic malignancy initially presented with clinical features of a chronic inflammatory condition involving an abdominal organ owing to secondary involvement by the malignant infiltrate.

Primary malignant melanoma of rectum: A rare case report.

INTRODUCTION: Malignant melanoma of the gastrointestinal tract is an extremely rare event of which 50 % occurs in anorectal region. The lesion can easily be misdiagnosed as rectal-carcinoma, which comprises >90 % of rectal tumors and has a different treatment. The behavior of the anorectal melanoma is very aggressive and has very poor prognosis with fatal outcome. PRESENTATION OF CASE: A 48-year-old man presented complaining of rectal bleeding of two months' duration, without any other significant history. Colonoscopy showed a polypoidal mass in the rectum that was in favor of adenocarcinoma. The microscope examination of biopsy tissue showed sheets of poorly differentiated malignant neoplasm. Immuno-histochemical (IHC) staining showed negativity of pan Cytokeratin and CD31. IHC for HMB45 showed diffuse and strong positivity in neoplastic cells, confirming the diagnosis of malignant melanoma. CLINICAL DISCUSSION: According to a report by the National Cancer Database of the United States, primary rectal melanoma is very rare. Mucosal surface of the body is third most common site for primary melanoma after skin and eye. The first case of anorectal melanoma was reported in 1857. Histopathological examinations are gold standard for diagnosis, but histopathology examination without immunohistochemistry will misdiagnose some cases as poorly differentiated adenocarcinoma which has completely different treatment. Surgical resection has been reported as the most useful treatment option. CONCLUSION: Malignant melanoma of the rectum is extremely rare and difficult to diagnose in low resources settings. Histopathologic examination with IHC stains can differentiate poorly differentiated adenocarcinoma from melanoma and other rare tumors of anorectal region.

Events in CNS Tumor Pathology Post-2016 WHO CNS: cIMPACT-NOW Updates and Other Advancements: A Comprehensive Review Plus a Summary of the Salient Features of 2021 WHO CNS 5.

Introduction: The 2016 World Health Organization Classification (WHO) of Tumors of the Central Nervous System (CNS) represented a major change. It recommended an "integrated diagnosis" comprising histologic and molecular information facilitating a more precise diagnosis of specific CNS tumors. Its goal was to provide greater diagnostic precision and reproducibility resulting in more clinical relevance and predictive value, ultimately leading to better patient care. Advances in molecular classification, mostly resulting from DNA methylation array profiling of CNS tumors, were occurring at a very rapid pace and required more rapid integration into clinical practice. Methods: cIMPACT-NOW updates and other recent papers plus salient features of 2021 WHO CNS5 in this comprehensive write-up were reviewed. Results: CNS tumor classification needs to be updated at a rapid pace and mechanisms put into place to guide diagnosticians and clinicians in the interim period if major changes in the classification of tumor types came to light. Recognizing the need to integrate these into clinical practice more rapidly and without inordinate delay, the International Society of Neuropathology (ISN) 2016 sponsored an initiative called cIMPACT-NOW. Discussion and/or Conclusion: Goal of cIMPACT-NOW was to provide clarification regarding contentious issues arising in the wake of the 2016 WHO CNS update as well as report new advancements in molecular classification of CNS tumors and new tumor entities emerging as a result of these advancements. cIMPACT-NOW updates: It thus laid the foundation for the 5th edition of the WHO Classification of CNS tumors (2021 WHO CNS 5). We have discussed cIMPACT updates in detail in this review. In addition, molecular diagnostics including DNA methylation-based classification of CNS tumors and the practical use of molecular classification in the prognostication and treatment of CNS tumors is discussed. Finally, the salient features of the new CNS tumor classification are summarized.

Relationship of age and gender with cytopathological findings of thyroid nodules diagnosed by FNAC: a retrospective study.

In Afghanistan, there are no reliable epidemiological data available about thyroid cytopathology and its possible relationship with the age and gender of patients. Therefore, we conducted this study to outline this relationship and the importance of fine needle aspiration cytology in this regard. A retrospective review study was conducted including 686 consecutive medical records of thyroid nodules diagnosed by fine needle aspiration cytology in a span of five years. Out of 686 consecutive patients with thyroid nodules included in this study, 566 were females and 120 were males. Most of the thyroid nodules diagnosed were benign lesions with female predominance. These nodules were commonly arising in between 3rd and 6th decades of life in both the genders with mean age of 42 ± 13 years in females and 52 ± 15 years in males. Thyroid malignancy was commonly diagnosed in middle-age females, however in males, it was frequently diagnosed in older age with a peak at 7th decade. Most of the malignant nodules were solid and complex with no purely cystic nature. In both the genders, thyroid nodules were commonly arising in the right thyroid lobe (52.3%), followed by left (35.7%), isthmus (8.7%) and bilateral (3.2%). Fine needle aspiration cytology remains the modality of choice for the diagnostic evaluation of nodular lesions of thyroid. In contrast to the data reported around the world, thyroid malignancies, in our study, were diagnosed in relatively older age groups with peak incidence in the 5th decade of life for females and 7th decade for males.

Pathological Features of Ovarian Tumors, Diagnosed at a Tertiary Care Hospital in Afghanistan: A Cross-sectional Study.

Purpose: In Afghanistan, research work is still in its infancy and there is no national level tumor registry at the moment in the country that could elaborate the histopathological features of ovarian tumors in the country. The current study was conducted with the aim to describe pathological characteristics of ovarian tumors diagnosed at tertiary level in Afghanistan. Patients and Methods: A descriptive cross-sectional study was conducted, including 198 cases diagnosed with ovarian tumors, that were consecutively included in the study from July 2017 to August 2020. All the cases were diagnosed at the Department of Pathology, French Medical Institute for Mothers and Children, Kabul, Afghanistan, that receives biopsy samples from all of the tertiary care institutions in Kabul. Results: In the current study, majority of the ovarian tumors were benign and presented with nonspecific symptoms. The mean age at diagnosis was 34.4 (SD ±13.4). Benign tumors comprised 81.8%, borderline 1.5% and malignant 16.7% of the cases. Majority of the diagnosed tumors were from surface epithelium in origin, followed by germ cell tumors, sex cord stromal tumors, and a single metastatic tumor. The most common benign neoplasm was mature cystic teratoma, followed by benign serous cystadenoma. Considering the malignant tumors, serous cystadenocarcinoma and adult granulosa cell tumors were predominant, followed by endometrioid adenocarcinoma and mucinous cystadenocarcinoma. More than half of the ovarian tumors occurred between 21 and 40 years of age. Conclusion: In the current study, the proportion of malignant ovarian neoplasms was significantly less than benign lesions. Although, many of the pathological features related to ovarian neoplasms were similar to the features demonstrated in other regions of the world, there were important findings that were exclusively noted in the cases diagnosed in Afghanistan.

Risk factors associated with esophageal cancers, diagnosed at tertiary level in Afghanistan: a descriptive cross-sectional study.

BACKGROUND: Worldwide, esophageal cancer (EC) is a common cancer in term of incidence and mortality and is the 4th common cancer in Afghanistan. Current study aimed to evaluate the profile of risk factors for EC among patients diagnosed at tertiary level in Afghanistan. METHODOLOGY: A descriptive cross-sectional study was carried out between January 2019 up to February 2021 including all esophageal cancers diagnosed at pathology department of French Medical Institute for Mothers and Children, Afghanistan. RESULT: 240 diagnosed cases were analyzed, in which 59.40% of squamous cell carcinoma and 41.07% Adenocarcinoma. Both histopathological type of were predominantly diagnosed in males. The majority of the patients were residents of rural areas. More than 80% of the patients were illiterate with only less than 2% completing higher education. Majority of the patients were laborers and farmers while less than 10% were employed. According to income assessment, more than 80% were from low-income household, the rest from middle-income and none from high-income family. Oral snuff consumption was noted in 33.9% of squamous cell carcinoma patients and 40% adenocarcinoma patients whereas, family history of esophageal cancer was observed in 37.8% and 36.7% in both types of carcinomas, respectively. More than 60% of both types of carcinomas patients were hot tea drinkers. CONCLUSION: Current study demonstrated that most patients diagnosed with esophageal cancers were male, uneducated, belongs to low-income groups, lives in rural areas. These findings suggest distribution of esophageal cancer in specific socioeconomic groups, clearly demonstrating the need further analytical study.

Acute lymphoblastic leukemia with clonal evolution due to delay in chemotherapy: A report of a case.

Clonal evolution in acute leukemias is one of the most important factors that leads to therapeutic failure and disease relapse. Delay in therapeutic intervention is one of the reasons that leads toward clonal evolution. In this report, we present a case of acute lymphoblastic leukemia in which therapeutic delay resulted in clonal evolution that was detected by conventional karyotyping and was responsible for non-responsiveness of the disease to conventional chemotherapy. A 17-year-old boy presented with generalized body aches, rapidly progressive pallor and lethargy. Bone marrow analysis was consistent with the diagnosis of B-cell ALL. Karyotypic analysis revealed 46, XY male karyotype. The patient left the hospital due to financial reasons and after 40 days came back to the hospital. Repeated bone marrow analysis including cytogenetic studies revealed presence of three different clones of blast cells: one clone showed 46, XY with del(9p) and t (11;14), second clone showed 46, XY with del(7q) and del(9p), and the third clone showed 46, XY normal karyotype. The patient did not respond to chemotherapy and died within 1 week of induction chemotherapy (HyperCVAD-A). Timely diagnosis and institution of chemotherapy in acute leukemias patients is the key to prevent clonal evolution and thus resistance of the disease to therapeutic interventions.