Correlation of human epidermal growth factor receptor 2 (HER-2/neu) receptor status with hormone receptors Oestrogen Receptor, Progesterone Receptor status and other prognostic markers in breast cancer: an experience at tertiary care hospital in Karachi.

OBJECTIVE: To determine the frequency of human epidermal growth factor receptor 2 (HER-2/neu) positivity and to correlate its status in breast cancer patients with other prognostic markers. METHODS: The comparative cross-sectional study was conducted at the Department of Histopathology, Liaquat National Hospital, Karachi, from January 1 to October 31, 2010. It included all specimens of mastectomy and lumpectomy with axillary tissue. Incisional, trucut and wedge biopsies as well as all non-epithelial tumours were excluded. All samples were processed as per standard guidelines and were evaluated by immunohistochemistry. SPSS 10 was used for statistical analysis. RESULTS: The age of the 100 cases in the study ranged from 20 to 82 years with a mean of 51+/-17.6 years. Two (2%) of the patients were males. HER-2/neu over-expression increased with increasing tumour size, grade, lymph node metastasis and with oestrogen receptor and progesterone receptor negativity. No significant correlation of HER-2/neu was seen with the age of patient and with the tumour type. CONCLUSIONS: The expression of HER-2/neu was associated with decrease in oestrogen receptor and progresterone receptor positivity, and increase in tumour size, high tumour grade and lymph node metastasis.

Primary renal cell carcinoma in crossed fused ectopia: Nephron sparing surgery for a rare of rarity entity.

Primary renal cell carcinoma (RCC) in crossed fused renal ectopia represents a rare of rarity entity. Only eight cases were reported in the literature, including seven RCC and one transitional cell carcinoma. This report presents a case of a 39-years old female presented with incidentally discovered renal mass in a crossed fused ectopia. Careful preoperative planning and meticulous delineation of renal vasculature were performed to avoid unpredicted anatomy. Nephron-sparing surgery with preservation of the normal-functioning moiety was performed with uneventful postoperative course. These clinical, morphological and immune-histochemical features will be presented with a review of the current literature.

Columnar cell-like changes in the male breast.

AIMS: Columnar cell lesions are known as a link between normal breast and low grade neoplastic lesions in female, but have not been established in the male breast. This study evaluated the presence of ducts showing columnar cell-like features in the male breast. METHODS: Seventy-one consecutive surgical resections from men (6 invasive breast carcinoma of grade 3, 1 atypical ductal hyperplasia and 64 other lesions) were reviewed to identify foci of dilated ducts with columnar epithelial cells, and their morphological features including apical snouts, intraluminal secretions and calcifications were assessed. The expression of CK5/6 and estrogen receptor (ER) was evaluated immunohistochemically. Clinicopathological features including patients' age, histological diagnosis and gynaecomastoid hyperplasia were documented. RESULTS: Ducts showing columnar cell-like features were identified in 39 cases, morphologically as distended ducts with round or undulating outline. There was an outer layer of myoepithelial cells and an inner layer of columnar luminal cells showing apical snouts, but without intraluminal secretions or calcifications. Immunohistochemically, these columnar epithelial cells were negative for CK5/6 in 38/39 cases and all were ER heterogeneously positive. These changes were associated with older age, but their incidence did not differ whether they were associated with invasive breast carcinoma, atypical ductal hyperplasia and other lesions. CONCLUSIONS: In the male breast, there is an entity sharing morphological features and immunohistochemical profile of columnar cell lesions.

Intraoperative frozen section analysis of sentinel lymph nodes in breast carcinoma patients in a tertiary hospital in Pakistan.

Intraoperative evaluation of sentinel lymph nodes has become routine in many units that manage early breast carcinoma. The procedure is associated with minimal morbidity and can be cost effective, avoiding re operation and reducing hospital stay as an axillary clearance can be performed under the same anesthetic after a positive intraoperative diagnosis without awaiting conventional paraffin histology. In negative cases extensive axillary lymph node dissection and its associated side effects can be avoided altogether. With careful patient selection, the expertise of surgeons and pathologists can increase the sensitivity and specificity of the technique with a reduction in false negatives. A number of international studies have established the usefulness of intraoperative sentinel lymph node evaluation. However, no local study has assessed the accuracy of frozen section in evaluating sentinel lymph node biopsy. The purpose of our study was to compare the two techniques (frozen section versus conventional paraffin histology) of the sentinel lymph node examination and to present our local data highlighting its usefulness and pitfalls, comparing the results with those in published studies. From the results obtained, we strongly recommend intraoperative assessment of the sentinel lymph nodes in breast carcinoma patients; frozen section microscopy can be a reliable and accurate technique in the hands of an experienced histopathologist.

Frequency of precancerous lesions in endoscopic gastric biopsies in chronic gastritis.

OBJECTIVE: To determine the frequency of precancerous lesions in endoscopic gastric biopsies of patients with chronic gastritis. STUDY DESIGN: A case series. PLACE AND DURATION OF STUDY: Department of Histopathology, Liaquat National Hospital, Karachi, from July 2008 to January 2009. METHODOLOGY: Over 6 months, 375 endoscopic gastric biopsies of patients with age group of 15-65 years having endoscopic chronic gastritis were included. From final biopsy report, basic information like patient demographics and presence of precancerous lesions i.e. activity (chronic active gastritis), atrophy (atrophic gastritis), intestinal metaplasia and dysplasia were recorded on proforma. Results were described as proportions and frequency. RESULTS: The frequency of precancerous lesions in endoscopic gastric biopsies of patients with chronic gastritis in Karachi was markedly high. Most common lesion was chronic active gastritis as depicted by activity (48.3%); dysplasia (1.3%) was the least common. Proportion of more aggressive precancerous lesions were markedly higher in older age group (> 40 years). CONCLUSION: The precancerous lesions are frequent in endoscopic gastric biopsies of patients with chronic gastritis.