Esophageal polypoidal mass: presentation of an uncommon pleomorphic carcinoma.

Pleomorphic carcinomas are primary malignant tumours that are known to arise in the lungs, pancreas, gall bladder and intestine. A patient with polypoid tumour of the esophagus is described in this report. The patient presented with dysphagia. Diagnostic and therapeutic intervention required endoscopic evaluation and treatment. Benign esophageal tumours are rarely seen and originate from the upper third of esophagus. We observed an esophageal tumour which was interpreted as spindle cell carcinoma of the esophagus that caused obstruction. We present the clinical picture and histopathological findings of the tumour. To our knowledge this is the first local report of spindle cell carcinoma occurring in the esophagus and describes its endoscopic and histopathological features with distinctive biphasic morphology.

Rhinosporidiosis presenting as an urethral polyp.

Rhinosporidiosis is an inflammatory disease caused by Rhinosporidium seeberi, a protoctistan mesomycetozoa, member of a group of novel aquatic parasites, characterized by hyperplastic polypoid lesions of the nasal cavity and rarely other mucous membranes. We report an unusual presentation of rhinosporidiosis as an urethral polyp, which is only the second case of rhinosporidiosis reported from Pakistan.

Unusual metastases of hepatocellular carcinoma (hcc) to bone and soft tissues of lower limb.

Hepatocellular carcinoma metastasizing to bones and soft tissues of extremities is an unusual occurrence. The present report describes two such cases, where this unusual happening was the presenting feature. Role of immunohistochemistry for diagnosis is emphasized.

Thymoma : a clinicopathologic association of world health organization histologic subtype and invasive behaviour.

OBJECTIVE: To re-classify thymic epithelial neoplasms reported at Aga Khan University Hospital during the past seven years according to the revised WHO classification, to assess the ease of application and determine association between WHO histological subtype and invasive behaviour. DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: The study was carried out in the section of Histopathology, Department of Pathology and Microbiology, Aga Khan University Hospital, Karachi, from January 2000 to October 2006. MATERIAL AND METHODS: All cases of thymic epithelial neoplasms reported in the past seven years were retrieved using SNOMED coding system. Small biopsies where the tissue was insufficient for definite classification were not included. All cases were reviewed and reclassified according to WHO classification into types A, AB, B1, B2 and B3. Capsular invasion as well as extension into neighboring structures such as perithymic fat, pleura, pericardium, lung etc. was noted on morphology. RESULTS: A total of 62 cases were diagnosed as Thymic Epithelial Tumors (TET). Out of these, there were 5 type A (6 %), 17 type AB (21%), 7 type B1 (8.6%), 26 type B2 (32%) and 7 type B3 (8.6%) thymomas. Age range was from 22-78 years with a median age of 46 years. Male to female ratio was 6:1. History of associated myasthenia gravis was present in 21% of cases. A significant association was observed between WHO histologic subtype and invasive behaviour where types A, AB and B1 have lesser number of invasive cases as compared to non-invasive, whereas in types B2 and B3, more cases have shown invasion as compared to non-invasive cases (c2 = 14.093, df =1, p-value < 0.001 ). CONCLUSION: The WHO classification is simple and easy to apply and has significant association with aggressive behavior. To some extent, it reflects the clinical behaviour of thymomas along with stage and status of resection. However, morphologically benign looking thymomas can behave aggressively. Hence, tumour stage, extent of resection and histology should be combined to predict the clinical behaviour of thymomas.

Gastric carcinoma: typing, staging, lymph node and resection margin status on gastrectomy specimens.

OBJECTIVE: To determine the extent and stage of gastric carcinoma on gastrectomy specimens in terms of type, grade, location, depth of invasion, resection margins and lymph node status. STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Section of Histopathology, Department of Pathology, Aga Khan University, Karachi during 2005 and 2006. MATERIALS AND METHODS: A 100 consecutive gastrectomy specimens received during the study period, in which resection was done for gastric carcinoma were included. Exclusion criteria were gastrectomy performed for gastrointestinal stromal tumor (GIST) and gastric lymphoma. Specimens were examined according to standard techniques. The reporting incorporated all relevant parameters including gross examination, tumor location, type and grade, depth of invasion, surgical resection margins and lymph node status. Staging was done according to the TNM staging system. Restults: Fifty three (53%) tumors were located in the distal part of the stomach and 35 (35%) in the proximal part. In 12 (12%) cases, tumor was diffusely involving the entire stomach. Histologically, the tumors were signet ring type in 63 (63%) cases and intestinal type in 37 (37%). At least one peripheral resection margin was positive in 29 (29%) cases. Sixty six (66%) cases were T3, 30 (30%) were T2, 3 (3%) were T1 and one case (1%) was T4. Twenty four cases (24%) were N0, 35 (35%) were N1, 27 (27%) were N2 and 14 (14%) were N3. CONCLUSION: Gastric cancer was at very advanced stage in these patients with full thickness involvement of the gastric wall and positive lymph nodes. It is thus essential to detect and surgically treat these cancers in an early stage. Better surgical techniques are required to ensure negative peripheral resection margins and removal of adequate number of lymph nodes, so that proper staging can be performed.

Frequency of primary solid malignant neoplasms in both sexes, as seen in our practice.

BACKGROUND: To determine the frequency of various histologic types of primary solid malignant neoplasms in males and females, in our practice, in a large series of surgical biopsies. METHODS: A retrospective study of 20,000 consecutive surgical biopsies in the section of Histopathology, Aga Khan University Hospital (AKU), Karachi, in 2004. RESULTS: Squamous cell carcinoma of oral cavity was the commonest malignant neoplasm in males followed by diffuse Large B cell, Non-Hodgkin's lymphoma and Prostatic adenocarcinoma. In females, infiltrating Ductal carcinoma of the breast was overwhelmingly the commonest malignant neoplasm followed by Squamous cell carcinoma of the oral cavity and esophagus. CONCLUSION: Out of 20,000 biopsies, there were 4616 (23.08%) malignant neoplsms. Carcinoma of oral cavity is very common in our population in both sexes.

Frequency of primary solid malignant neoplasms in different age groups as seen in our practice.

BACKGROUND: To determine in a large series of surgical biopsies, the frequency of various histologic types of primary solid malignant neoplasms in males and females in different age groups. METHODS: A retrospective study of 20,000 consecutive surgical biopsies reposted in the section of histopathology, AKU in 2004. RESULTS: Malignant neoplasms are commonest in the fifth and sixth decades of life. The commonest malignant neoplasms in the first decade were Hodgkin's lymphoma and Wilm's tumor in males and females respectively. In the second decade, osteosarcoma in males and Ewing's sarcoma / PNET in females. In the third decade, colorectal adenocarcinoma in males and infiltrating. Ductal carcinoma of breast in females. In the fourth decade, squamous cell carcinoma of oral cavity in males and infiltrating ductal carcinoma of breast in females. In the fifth decade squamous cell carcinoma of oral cavity in males and infiltrating ductal carcinoma of breast in females. In sixth decade, squamous cell carcinoma of oral cavity in males and infiltrating ductal carcinoma of breast in females and in the seventh decade, prostatic adenocarcinoma in males and infiltrating ductal carcinoma of the breast in females. Above age of 70 years, the commonest malignant were again prostatic adenocarcinoma in males and infiltrating ductal carcinoma of breast in females. CONCLUSION: Malignant neoplasms are commonest in the fourth, fifth and sixth decades of life.

Subependymal giant cell astrocytoma.

Subependymal giant cell astrocytomas (SEGAs) are slowly growing tumours corresponding to WHO grade I. They are intraventricular and usually occur in the setting of tuberous sclerosis complex. They often result in obstructive hydrocephalus. Treatment is usually restricted to surgical resection, recurrences are rare and long term prognosis is excellent. We present a series of three cases.

Uterine perivascular epithelioid cell tumour presenting as a cervical mass.

Perivascular Epithelioid Cell Tumour (PEComa) also known as myelomelanocytic tumours are uncommon, recently described mesenchymal tumours that include angiomyolipoma, clear cell "sugar" tumour of the lung, lymphangioleiomyoma and tumours composed predominantly of epithelioid cell morphology. A predilection for uterus has been described. However up till now only 14 cases of uterine PEComas have been described. All of these were seen in adult females in the peri and post menopausal age group (from 40-75years), and almost all were located in the region of body of uterus. A single case in the upper cervical region has been reported with uterine PEComatoses. We report an unusual presentation of this rare tumour presenting as a polypoidal cervical mass in a young female. Occurrence of this tumor in a young female as seen in our case warrants inclusion of PEComa in the diferential diagnosis of all epithelioid and clear cell neoplasms of uterus irrespective of age.

Significance of immunohistochemistry in accurate characterization of malignant tumors.

BACKGROUND: To determine in a large series of surgical biopsies the role and significance of immunohistochemistry in the adequate and accurate characterization of malignant tumors. METHODS: A retrospective study of 20,000 consecutive surgical biopsies reported in the Section of Histopathology, AKU in 2003. Data was obtained by retrieving the filed surgical biopsy reports in the section. RESULTS AND CONCLUSIONS: Out of the 20,000 biopsies, 6534 (32.67%) were neoplastic. 4726 neoplasms (72.33%) were malignant, and 1808 (27.67%) were benign. Immunohistochemistry was performed on 29.49% of malignant tumors, and 4.97% of benign tumors. Immunos were performed on only 2.82% of routine squamous cell carcinomas and adenocarcinomas of various organs, and in only 1.9% of infiltrating breast carcinomas, the commonest malignant tumors in females. In contrast, immunos were performed on 97.12% of non-Hodgkin's lymphomas, 97.94% of Hodgkin's lymphomas, 98.09% of malignant spindle cell neoplasms, 87.96% of small round blue cell tumors of childhood, 87.30% of neuroendocrine neoplasms, and 84.37% cases of malignant melanomas. In addition, immunos were performed on all cases of malignant undifferentiated neoplasms and were able to resolve the issue in over 89% of such cases. Immunos were also performed on 54.74% of metastatic tumors. Lymph nodes were the commonest organs on which immunos were performed i.e. 96.50% of lymph node tumors, followed by CNS and renal neoplasms with 33.01% and 25.92% respectively.

Demographic and Clinicopathologic features of membranous glomerulonephritis.

OBJECTIVE: To determine the frequency of membranous glomerulonephritis(MGN) in the renal biopsy specimens. To observe the presenting features and the demographics to determine association, if any, between MGN and hepatitis B in these patients. DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: The section of histopathology, The Aga Khan University Hospital, Karachi over a period of three years (May 1999-April 2002). SUBJECTS AND METHODS: All consecutive percutaneous renal biopsy specimens received during the study period were included. A total of 1590 renal biopsy specimens were evaluated. All cases where a definitive diagnosis of MGN (stage II to IV) was made on light and/or immunofluorescence studies were included in the results. Twenty-eight cases were excluded owing to inadequate material. Cases with a presumptive diagnosis and those in stage I of MGN were also excluded. Laboratory investigations carried out include urine examination, blood urea nitrogen. (BUN), serum creatinine, 24 hours urinary protein, Hepatitis B sAg, serological tests for hepatitis C virus, ANA, dsDNA, etc. Clinical features and results of laboratory analysis were recorded along with light microscopic features and statistical analysis was carried out. RESULTS: Out of 1562 renal biopsy specimens, 835(53.4%) cases showed primary glomerular pathology. 741(47.4% of the total) cases presented with nephrotic syndrome. Out of these in 176 cases (23.75%), findings were those of membranous glomerulonephritis followed by amyloidosis and focal segmental glomerulosclerosis. Among the cases with MGN, 23(13%) cases were those of secondary MGN whereas 87% were grouped under primary MGN. The male to female ratio was 2.2:1. Mean age at presentation was 29 years, median 29 years and a mode of 30 years. Nineteen cases (1.07%) were seen in children of 14 years old or less. CONCLUSION: The frequency of MGN was much higher in our study subjects as compared to most other regional studies. No significant association with hepatitis B was seen with only 4 out of 89 cases showing positivity for HBsAg. The pattern of disease corresponds more to that seen in the west.

Cns tumors at AKU: an update plus a brief discussion on intraventricular tumors with special emphasis on central neurocytoma.

BACKGROUND: This paper is intended to be an update of our earlier published work on CNS tumors along with additional information on intraventricular tumors. Three cases of central neurocytoma are also discussed. METHODS: An analysis conducted in the Section of Histopathology, AKU to determine the frequency of all CNS neoplasms diagnosed between Jan 1, 1994 and Dec 31, 2001. Frequency of intraventricular tumors was also determined. Histological characterization of the tumors was based on the WHO and AFIP (USA) classification systems for CNS tumors. RESULTS: A total of 1677 CNS tumors were diagnosed during the study period. 1510(90.04%) were primary, and 167(9.96%) were metastatic. Among the primary tumors, gliomas constituted the largest category with 825 cases or 54.63% of all primary tumors. Meningothelial tumors comprised the second largest group with 364 cases or 24.10%. among other major categories, embayonal tumors, and peripheral nerve sheath tumors comprised 6.75% and 6.82% of all primary tumors. Among less common tumors, Non-Hodgkin's lymphomas and hemangioblastomas comprised 3.11% and 1.52% of all CNS tumors. Intraventricular tumors comprised 7.41% of all primary tumors. Ependymomas comprised 64.28% of all Intraventricular tumors. CONCLUSIONS: Gliomas and meningothelial tumors are the commonest group of primary CNS tumors. Metastatic tumors are quite common.