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.

Demographic and clinical characteristics of acute myeloid leukaemia diagnosed and treated at the tertiary level in Afghanistan.

A retrospective case series design was conducted to elucidate the demographic features of acute myeloid leukaemia in Afghanistan. This study was conducted at Jamhuriat Hospital and French Medical Institute for Mothers and Children, Kabul, Afghanistan. A total of 203 patients with AML diagnosed and managed at Jamhuriat Hospital from 1 March 2018 to 31 March 2020, were included in the current study. The median age at diagnosis was 27 years. Housewives represented the largest subset of patients from an occupational point of view constituting 37.44% of the total sample population and 81.72% of the female population, followed by 20.69% patients who were students of which 14.77% were male and 5.91% were female, and 17.24% were farmers, which constituted 31.81% of the male population. Similarly, 69.95% of individuals presented with infection, 57.14% presented with bone tenderness, 46.3% presented with bleeding tendencies, 55.66% had hepatomegaly and/or splenomegaly, and 27.58% of patients had lymphadenopathy. Considering the chemotherapeutic regime, 64.53% of the individuals received standard 7 + 3 (cytarabine + daunorubicin) induction regimen, 10.68% of those received 5 + 2 re-induction chemotherapy (cytarabine + daunorubicin). 10.84% who were diagnosed with acute promyelocytic leukaemia received all-trans-retinoic acid + arsenic trioxide, while 5.42% of patients defaulted chemotherapy. High prevalence was noted in young individuals. Similarly, a high proportion of patients were constituted by housewives.

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.

Risk factors of breast cancer among patients in a tertiary care hospitals in Afghanistan: a case control study.

BACKGROUND: Breast cancer is the second most common causes of women's death, worldwide. Data on risk factors associated with female breast cancer in the Afghan population is very limited. The aim of our study was to identifying risk factor associated with female breast cancer in Afghanistan. METHODS: A retrospective case-control study was conducted with inclusion of 201 cases and 201 controls. Patient information was collected by interviewing the patient through a structured questionnaire. Histopathological information was collected from the hospital integrated laboratory management system. The data was analyzed by using logistic regression with univariate and multivariable analyses to determine the association between breast cancer and predictors. RESULTS: The results of the current study showed that factors such as: age (OR = 1.02; 95%CI: 0.99-1.04; p-0.148); age at menarche (OR = 0.83; 95%CI: 0.72-0.92; p-0.008); age at first baby (OR = 1.14; 95%CI: 1.07-1.20; p- < 0.001); illiteracy (OR = 1.93; 95%CI: 1.16-3.22; p-0.011); smoking (OR = 2.01; 95%CI: 1.01-3.99; p-0.04) and family history of cancer (OR = 1.98; 95%CI: 1.18-3.32; p-0.009) were significantly associated with breast cancer. However, our study did not demonstrate any statistically significant correlation between breast cancer and some of the predictors that were previously highlighted in literature, such as: marital status, Body Mass Index (BMI), use of hormonal contraceptive, breastfeeding and exercise. CONCLUSION: Our study demonstrated that age at menarche, and age at first baby birth, illiteracy, smoking and family history of cancer were significant risk factors associated with development of breast cancer among women in Afghanistan. Health education of women regarding aforementioned predisposing factors are therefore, expected to be valuable in decreasing the burden of breast cancer with reduction of its burden on the healthcare system in Afghanistan.

Primary synovial sarcoma in anal canal: Report of a very rare case.

Extensive studies are required to understand the behavior as well as prognosis of SS in the colorectal region. IHC staining is essential for the accurate diagnosis when a lesion is encountered at an unusual site.

Proteus mirabilis: A rare cause of pneumonia, radiologically mimicking malignancy of the lung.

Key clinical message: Lesions that are suspected for malignancy need be managed by a multidisciplinary team. Utilization of radiological as well as pathological diagnostic modalities ensures correct diagnosis and thus timely intervention. Introduction: Proteus mirabilis is a Gram-negative rod. It is a highly motile bacterium that belongs to the Enterobacteriaceae. Lung infection and pneumonia caused by p. mirabilis is extremely rare and occurs in patients with chronic debilitation or chronic lung disease. Case Presentation: A 65-year-Old Woman presented with dry cough, dyspnoea on exertion, and chest pain of 4 months' duration. She received multiple medications including antibiotics but without any resolution of her symptoms. Computed Tomography scan of the chest was performed reported a tumor in the upper lobe of the left lung with multiple associated pulmonary nodules. The impression was that of metastatic lung disease with superimposed acute infection. Accordingly, the patient was reevaluated and a diagnostic bronchoscopy with multiple endobronchial biopsies and broncho-alveolar lavage was done. The gram stain showed Gram-Negative Bacilli and the bacteria identified P. mirabilis. Conclusion: Mass lesions suspected for malignancy should be managed with involvement of multiple medical disciplines, to ensure correct and timely diagnosis. This is to avoid miss-management.

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.

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.

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.

Sclerotherapy for the management of venous malformations: Experience from a single institution in Afghanistan.

Sclerotherapy is a convenient modality for the treatment of venous malformation. Ethanol as a sclerosing agent is easily available and cheap. Sclerotherapy for venous malformations has both functional as well as aesthetic outcome.

Forty days old infant with Pig Bronchus, presenting with recurrent pneumonia: A Case Report.

Background: Pig bronchus is rare and usually asymptomatic, but it may also cause significant respiratory symptoms such as recurrent pneumonia, chronic bronchitis, atelectasis, and difficult airway management in surgical and critical care patients. This study is aimed to examine a case of pig bronchus in which the patient presented with recurrent pneumonia in her early days of life. Case Report: A case report is the study design utilized in this assessment of a 40-days-old girl from a consanguineous marriage, who presented with cough and difficulty breathing for approximately a month. She was referred from a provincial hospital with no improvement in respiratory symptoms after three times hospitalization since birth. Radiological investigation revealed pig bronchus as the cause of recurrent pneumonia. Conclusion: Pig bronchi, if not diagnosed on time, may result in severe lung infection that can even result in fatal disease. A high level of clinical suspicion is required to initiate an appropriate diagnostic workup. The gold standard modality for the diagnosis of pig bronchus is computed tomography (CT), ideally with multi-detector three-dimensional (3D) image reconstruction.

Congenital mature cystic teratoma of the parotid gland in an infant: Report of a unique case.

INTRODUCTION AND IMPORTANCE: Teratoma is a germ cell tumor originating from pluripotent germ cells and embryonal cells that commonly occurs in the gonads with only 15 % of it arising in extragonadal sites. In infants and children, teratomas of the head and neck are uncommon that comprise 0.47 %-6 % of all teratomas, and their occurrence in parotid gland is extremely rare. It is considered a diagnostic pitfall preoperatively, and their definite diagnosis can only be made upon surgery followed by histopathological examination. CASE PRESENTATION: We present a unique case of parotid gland teratoma in a 9-month-old girl who was brought to the hospital by her parents with right side parotid region swelling since birth. The ultrasonographic findings were suggestive of cystic hygroma. Upon surgery, the mass was completely excised with a part of parotid gland. The diagnosis of mature teratoma was made based on the histopathologic examination. No tumor recurrence was noted during the 4-month postoperative follow-up. CLINICAL DISCUSSION: Teratoma of the parotid gland is an extremely rare entity that may mimic diverse benign and malignant tumors of the salivary gland. Patients often present to the health care facility with a parotid gland swelling leading to defacement. Complete surgical resection of the tumor is considered the best treatment approach with careful preservation of facial nerve. CONCLUSION: Due to the scarcity of information available regarding the behavior and clinical management of parotid gland teratoma in the literature, a good follow-up of patient is required to exclude potential recurrency and neurological deficit.

Hypokalemic periodic paralysis in a teenage boy after an intense period of exercise: A rare case report.

Key Clinical Messages: Diagnosis of rare even can be missed due to less familiarity with the disorder.In patients with muscle weakness, infectious causes are prioritized.Electrolyte profile not only identifies the problem, but also prevents unnecessary workup. Abstract: In underdeveloped countries, diagnosis of rare disorders is usually delayed due to less familiarity of the clinicians to such disorders. As a result, infectious and inflammatory causes for an ailment are prioritized as compared to non-infectious etiologies. Hypokalemic periodic paralysis (PP) is a rare disorder, characterized by episodic muscle weakness that can rarely be associated with life-threatening cardiac arrhythmia. A teenage Afghan boy presented to the emergency department with an acute flaccid paralysis, that started 1 h after intense exercise The weakness involved both, the upper and lower extremities. Laboratory investigations, led to the impression of hypokalemic PP, precipitated by intense exercise. Accordingly, intravenous potassium chloride infusion diluted with normal saline led to the complete resolution of paralysis as well as correction of electrocardiographic changes. The list of differential diagnosis for flaccid muscle paralysis is wide, which generally requires a extensive investigations, but in hypokalemic PP, a cardinal electrolytes profile can lead towards early diagnosis. High degree of clinical suspicion with appropriate history taking and physical examination helps with the immediate identification and management of this disorder.

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.

Albright hereditary osteodystrophy: Delay in the diagnosis of a rare disorder due to restricted medical services.

A teenage Afghan girl presented with seizure. Clinical features and laboratory investigations revealed elevated serum parathormone, high phosphate levels with low serum calcium. In third-world countries, diagnosis of rare disorders, such as Albright hereditary osteodystrophy (AHO), can usually be delayed due to scarcity of standard medical and diagnostic services.

Esophageal Carcinoma and Associated Risk Factors: A Case-control Study in Two Tertiary Care Hospitals of Kabul, Afghanistan.

Purpose: Esophageal cancer (EC) is the most common cancer among males in Afghanistan, thus we aimed to conduct a case-control study to determine the associated risk factors with EC in two tertiary care hospitals of Kabul, Afghanistan. Patients and Methods: We enrolled 132 EC cases and 132 controls and used conditional logistic regression to estimate the odds ratio (OR) with consideration of 95% confidence interval (CI). Results: The results of our study revealed that esophageal squamous cell carcinoma (ESCC) was the predominant type of EC constituting 75.8% of the cases. The results of the multivariate logistic analysis showed that males and older ages were at increased risk of developing EC (OR: 4.62, 95%CI, p-value=0.026) and (OR: 1.070, 95%CI, p-value <0.001), respectively. In addition, living in rural areas (OR: 46.64, 95%CI, p-value <0.001), being uneducated (OR: 13.94, 95%CI, p-value=0.042), using oral snuff (OR: 6.10, 95%CI, p-value=0.029), drinking hot tea (OR: 5.719, 95%CI, p-value=0.005), lack of physical exercise (OR: 32.548, 95%CI, p-value=0.001), less fresh fruit consumption (OR: 93.18, 95%CI, p-value<0.001) and family history of cancer (OR: 14.50, 95%CI, p-value=0.003) were significantly associated with the development of EC, while body mass index (BMI), smoking, alcohol drinking, consumption of spicy food and pickled vegetables did not have a significant association with EC. Moreover, the majority of the cases (83.3%) in our study were from to low-income families and the majority were unemployed (93.9%), of whom (50%) were farmers, who did not show statistically significant association. Conclusion: Our study concluded that EC risk was higher in older ages, males, rural residents, uneducated people, oral-snuff users, hot tea drinkers, fewer fresh fruit consumers, lack of physical exercise, and family history of cancer. Further detailed studies and screening policies of the affected groups are suggested to further elaborate on the subject.

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.

Combined lesion of central giant cell granuloma and ossifying fibroma: A case report of a rare event in oral cavity.

INTRODUCTION AND IMPORTANCE: Giant cell granulomas (GCG) and ossifying fibroma (OF) of the jaw are benign reactive lesions. GCG characterized by the presence of abundant multinucleated giant cells in a cellular stroma. On the other hand, the characteristic feature of OF is benign connective tissue replaces the normal bone. Combination of these two lesions, GCG with OF, in the jaw is extremely rare. CASE PRESENTATION: A 35-year-old woman presented with complains of right jaw swelling with no history of previous disease or lesion and no family history of such lesions. By physical examination, a painful swelling in the right jaw was observed. A computed tomography scan of the facial bone showed a large, expansible, lytic lesion with narrow zone of transition and internal septations, involving the right side of the maxilla and floor of the right maxillary sinus. Histopathologic examination revealed a lesion with combined features of OF and GCG. CLINICAL DISCUSSION: GCG and OF are two of the most frequent oral lesions. Presence of both tumors in one patient as a combined lesion is highly unusual, with only a few reported cases in the literature. On clinical and radiologic examination, diagnosing such a combined lesion is not possible, however, such lesions can be easily diagnosed by microscopic examination, indicating the importance of pathologic examination. CONCLUSION: Occurrence of combined OF and GCG is a rare event. Proper histopathologic evaluation can contribute to accurate diagnosis and better management of such lesions. Confirmative diagnosis of such lesions by radiology alone is not possible.

Prevalence, Distribution, and Histopathological Features of Malignant Tumors Reported at Tertiary Level in Afghanistan: A 3-Year Study.

Purpose: Cancer is one of the leading causes of mortality and morbidity, and therefore, tremendous research work is continuously being done around the world with consideration of etiopathogenesis as well as identification of therapeutic targets. Decades of continuous war in Afghanistan has left the medical infrastructure of the country in a miserable situation. There is a serious deficiency in research work in the fields of pathology and oncology at the moment with minimal data available to elaborate about the demographic characteristics of various malignant disorders in the country, which would be indispensable to pave the way for further research and development. Patients and Methods: A descriptive cross-sectional study was conducted to describe the prevalence, distribution, and important histopathological features of malignant tumors reported at tertiary level in Afghanistan. Results: Out of 2328 consecutive cases of solid malignant tumors included in our study, 93.8% were primary and 6.2% were metastatic. Breast was the most common site of origin for primary malignancy (29.5%) in females; however, in males, esophagus was the leading site for primary malignant tumors (16.3%). Invasive ductal carcinoma was the most common histologic type of malignancy in females (87.9%). However, in both genders, squamous cell carcinoma of esophagus and skin, osteosarcoma of bone and soft tissue, and glioblastoma of central nervous system were the most common histologic types of malignancies diagnosed. Small intestine was a frequently involved site affected by extranodal non-Hodgkin lymphomas. Overall, the majority of the cancers were diagnosed in stage-II. Conclusion: Findings in our study were somewhat similar to data presented elsewhere in the world, with some significant differences that could be related to the local factors. Our study revealed that most of the malignant tumors were diagnosed in later stages of the disease, attributable to scarcity of specialized oncology institutions and public awareness.

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.