National guidelines for the diagnosis and treatment of hilar cholangiocarcinoma.

A consensus meeting of national experts from all major national hepatobiliary centres in the country was held on May 26, 2023, at the Pakistan Kidney and Liver Institute & Research Centre (PKLI & RC) after initial consultations with the experts. The Pakistan Society for the Study of Liver Diseases (PSSLD) and PKLI & RC jointly organised this meeting. This effort was based on a comprehensive literature review to establish national practice guidelines for hilar cholangiocarcinoma (hCCA). The consensus was that hCCA is a complex disease and requires a multidisciplinary team approach to best manage these patients. This coordinated effort can minimise delays and give patients a chance for curative treatment and effective palliation. The diagnostic and staging workup includes high-quality computed tomography, magnetic resonance imaging, and magnetic resonance cholangiopancreatography. Brush cytology or biopsy utilizing endoscopic retrograde cholangiopancreatography is a mainstay for diagnosis. However, histopathologic confirmation is not always required before resection. Endoscopic ultrasound with fine needle aspiration of regional lymph nodes and positron emission tomography scan are valuable adjuncts for staging. The only curative treatment is the surgical resection of the biliary tree based on the Bismuth-Corlette classification. Selected patients with unresectable hCCA can be considered for liver transplantation. Adjuvant chemotherapy should be offered to patients with a high risk of recurrence. The use of preoperative biliary drainage and the need for portal vein embolisation should be based on local multidisciplinary discussions. Patients with acute cholangitis can be drained with endoscopic or percutaneous biliary drainage. Palliative chemotherapy with cisplatin and gemcitabine has shown improved survival in patients with irresectable and recurrent hCCA.

An analysis of E-governance in Pakistan from the lens of the Chinese governance model.

In this era of digitalization, the role of information and communication technology (ICT) has significantly increased. The integration of ICT into the government system has improved efficiency and working processes. Some countries such as China have successfully integrated ICT into their governance system. However, many other countries especially the developing world are yet to effectively utilize the role of ICT in their governance structure and these countries are struggling to produce a better governance system. It is, therefore, imperative for the developing world to learn from successful nations and devise their governance systems so that ICT can be fully utilized and produce good governance. However, such comparative analyses are not done as such to bring strengths and weaknesses in the integration of ICT into the governance system especially in developing countries' governance systems. This study contributes by conducting a comparative study on the China-Pakistan e-government progress. China has widely implemented e-government, which has helped the country to ensure good governance. Pakistan, on the other hand, is also moving towards digitalization and making efforts to implement e-government. This research examines the United Nations' E-Government Development Index (EGDI) reports and rankings. The findings of our research show that China has significantly improved its ranking, whereas Pakistan's ranking has indicated a gradual decline except for the year 2008. This happened because of a lack of investment in infrastructure, scarcity of financial resources, weak institutional capabilities, and limited access to advanced technologies. Moreover, there is a big gap between public policy and public implementation in Pakistani scenarios. However, it has been dug out in this study that employing the Chinese model and seeking cooperation with China can improve e-governance ranking and overall governance in Pakistan. The study advances the understanding of e-governance and its challenges in Pakistan and the findings of the study will assist researchers, policymakers, and officials in the implementation and development of e-projects in Pakistan.

The Intensity and Pattern of Syndecan-1 (CD138) Expression in Normal and Diseased Livers.

Introduction Heparan sulfate proteoglycans (HSPGs) belong to the syndecan family, and syndecan-1 (CD138) is a heparan sulfate proteoglycan. Syndecan-1 has a potential role in cell-matrix and cell-cell communications as they are present in cell epithelium. Its expression is different in an extensive range of benign, inflammatory, and neoplastic diseases. In routine histopathology, it is used as a marker for plasma cells. However, it is expressed in a large variety of normal and neoplastic epithelia including squamous epithelium and gastric glandular epithelium expressed in other tissues, i.e., the liver. In the liver, variable expression is seen in cirrhosis, hepatitis, and carcinoma. The objective of this study was to investigate the expression of this marker in normal, inflammatory, and neoplastic lesions of the liver. This in turn may help clinicians to select patients who may benefit from anti-CD138 therapy. It is currently used in the diagnosis and management of plasma cell proliferations. Material and methods This is a retrospective study in which we retrieved 53 formalin-fixed paraffin-embedded (FFPE) liver specimen blocks and selected one block from each case by reviewing the hematoxylin and eosin (H&E) slides of each case. Syndecan-1 (CD138), pancytokeratin, and CD68 expression were analyzed immunohistochemically (IHC) to evaluate the percentage and intensity of CD138 expression in various hepatic entities and identify those entities where syndecan-1 can be consistently used to make a definitive diagnosis. Results The expression of pancytokeratin and CD68 was analyzed in hepatocytes and Kupffer cells, respectively. For syndecan-1 (CD138), 15.4% of cases showed basolateral membranous positivity, 44.6% of cases showed complete membranous positivity, and 40% of cases showed no positivity in hepatocytes. Cytokeratin (CK) was positive as expected in hepatocytes, and CD68 was expressed in Kupffer cells. Conclusion CD138 does not appear to be a reliable surrogate marker for liver disease. However, it may be included with other ancillary markers as a predictor of the stage of chronic liver disease and metastatic potential. The response to anti-CD138 therapy needs to be further studied.

Network Analytics Enabled by Generating a Pool of Network Variants from Noisy Data.

Mapping network nodes and edges to communities and network functions is crucial to gaining a higher level of understanding of the network structure and functions. Such mappings are particularly challenging to design for covert social networks, which intentionally hide their structure and functions to protect important members from attacks or arrests. Here, we focus on correctly inferring the structures and functions of such networks, but our methodology can be broadly applied. Without the ground truth, knowledge about the allocation of nodes to communities and network functions, no single network based on the noisy data can represent all plausible communities and functions of the true underlying network. To address this limitation, we apply a generative model that randomly distorts the original network based on the noisy data, generating a pool of statistically equivalent networks. Each unique generated network is recorded, while each duplicate of the already recorded network just increases the repetition count of that network. We treat each such network as a variant of the ground truth with the probability of arising in the real world approximated by the ratio of the count of this network's duplicates plus one to the total number of all generated networks. Communities of variants with frequently occurring duplicates contain persistent patterns shared by their structures. Using Shannon entropy, we can find a variant that minimizes the uncertainty for operations planned on the network. Repeatedly generating new pools of networks from the best network of the previous step for several steps lowers the entropy of the best new variant. If the entropy is too high, the network operators can identify nodes, the monitoring of which can achieve the most significant reduction in entropy. Finally, we also present a heuristic for constructing a new variant, which is not randomly generated but has the lowest expected cost of operating on the distorted mappings of network nodes to communities and functions caused by noisy data.

Renal Oncocytoma and Pelvic Urothelial Carcinoma in a Nephrectomy Specimen of a 72-Year-Old Patient.

We present the case of a 72-year-old gentleman who presented with a left renal mass. His Computerized Tomography Angiogram showed an 11.8 x 11.3 cm mass involving the upper pole of the left kidney. The mass showed a central stellate scar. There was no locoregional lymphadenopathy. His radical nephrectomy specimen was received in our lab. Sectioning showed a large tumor in the upper pole with a central stellate scar. Microscopically, it showed sheets and nests of round cells with eosinophilic cytoplasm and round nuclei. It was positive for CD117 and negative for CK7. The sections from the renal pelvis showed a urothelial carcinoma arising from the urothelial lining and infiltrating the muscular wall of the renal pelvis. This tumor was positive for CK7 and GATA3. In this case report, we present a rare collision tumor of renal oncocytoma and pelvic urothelial carcinoma.

Managing Hepatocellular Carcinoma in Children.

Hepatocellular carcinoma (HCC) is a rare pediatric tumor. It differs from its adult counterpart in many ways like etiology, biological behavior, and association with cirrhosis. Treating HCC requires a multidisciplinary team involving pediatric gastroenterology, oncology, hepatobiliary surgery, and interventional radiology. This case series aims to describe presenting features and management plan of three children with HCC treated at a tertiary care liver transplant center in Pakistan.

Spectrum of chronic gastrointestinal diseases with final outcome in children at a tertiary care centre: A single-centre study.

Chronic gastrointestinal (GI) diseases in children present with a wide range of symptoms. Limited resources in Paediatric Gastroenterology in developing countries like Pakistan cause considerable difficulties in managing children with chronic GI diseases in a timely fashion. This retrospective descriptive study aimed to determine the spectrum and outcomes of chronic GI diseases in children. The study was conducted at the Paediatric Gastroenterology and Hepatology Department, Pakistan Kidney and Liver Institute & Research Centre (PKLI &RC) in Lahore. The duration of the study was from August 2019 to August 2020. A total of 40 children below the age of 15 years with chronic GI diseases were included. The diagnosis was principally established with the assistance of esophagogastroduodenoscopy and ileo-colonoscopy. Coeliac disease was the most common chronic GI disease. Our systematic approach, in addition to an extensive workup, assisted in the diagnosis and management of the illness, which resulted in a more optimal outcome. Prompt referrals to tertiary centres are recommended where facilities and expertise are available to decrease morbidity and mortality.

Gastric Linitis Plastica and role of endoscopic ultrasound: An under-recognised diagnostic modality.

Gastric linitis plastica is an aggressive malignancy with poor prognosis. Timely diagnosis is important for effective management. However, the conventional endoscopic biopsies are often inconclusive leading to delay in diagnosis and subsequent management. We present a case of a 55-year old female with high suspicion of gastric linitis plastica on gastroscopy with repeated negative endoscopic biopsies. She underwent an endoscopic ultrasound fine needle aspiration (EUS-FNA) at our center with establishment of diagnosis of gastric malignancy. There are no established guidelines about the role of EUS-FNA as a sequential diagnostic modality for this tumour. However, EUS-FNA is a highly sensitive modality to establish diagnosis in challenging cases where routine endoscopy remains inconclusive.

Correlation of Viral Load With the Clinical and Biochemical Profiles of COVID-19 Patients.

Background/objective Coronavirus infectious disease (COVID-19) is a novel disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-COV-2). Some studies have shown that disease severity according to clinical and biochemical parameters are in direct relation to viral load while others have found no direct correlation. In this study, the COVID-19 cycle threshold (Ct) value, which is taken as a direct indicator of the viral load, has been correlated with the biochemical and clinical parameters in COVID-19 patients. Methods In this cross-sectional, retrospective, and single-center study, 365 patients admitted with COVID 19 were divided into three groups according to their Ct values obtained from reverse transcription-polymerase chain reaction RT-PCR as 1 (9-20), 2 (21-30), and 3 (31-40). The correlation of the COVID-19 Ct value with biochemical parameters and clinical presentation (taken as mild, moderate, and severe) was done and analyzed. The chi-square test was used for the correlation and calculated by using SPSS V-24.0 (IBM Corp., Armonk, NY). p-value <0.05 was considered significant statistically. Results Disease severity levels (mild, moderate, and severe) correlated in group 1 (Ct value 9 to 20), 2 (Ct value 21 to 30), and 3 (Ct value 31 to 40) but no significance was found between disease severity levels and the Ct value groups' p-value (>0.05). All the biochemical parameters analyzed (alanine transaminase (ALT), aspartate aminotransferase (AST), albumin, bilirubin, c-reactive protein (CRP), lactate dehydrogenase (LDH), ferritin, D-dimer, and total leucocyte count (TLC)) showed a significant p-value (<0.05) in all the three groups studied. Procalcitonin (PCT), however, did not show any significant value in any of the groups studied. In the intergroup assessment, it was found that the values of ALT, AST, albumin, CRP, ferritin, bilirubin, and TLC are maximum in group 2 with a downward trend in groups 1 and 2. Neutrophils and lymphocytes did not show any variations. LDH did not follow the trend of increasing viral load. Conclusions The severity of the disease was not statistically significant in the Ct value groups (p> 0.05). However biochemical parameters, i.e. ALT, AST, ALP, CRP, and bilirubin were statistically significant (p<0.05). Patients with COVID-19 should be closely monitored for the assessment of disease progression according to the above-mentioned biochemical parameters.

Clinical spectrum of chronic liver disease with final outcome in children at a tertiary centre: A single - centre study.

BACKGROUND AND OBJECTIVES: Chronic liver disease (CLD) in children present a broad spectrum of symptoms. Limited resources in Paediatric Hepatology in developing countries like Pakistan present considerable challenges in investigating and treating children with chronic liver disease in a timely fashion. This study aimed to determine the spectrum and outcomes of CLD other than chronic hep B & C virus (HBV& HCV) liver disease in children. METHODS: This retrospective descriptive study was conducted at the Paediatric Gastroenterology and Hepatology Department, Pakistan Kidney and Liver Institute and Research Centre in Lahore, Pakistan. The duration of the study was from August 2019 to January 2020. A total of 162 children of CLD were seen during this period of time. Of 162 there were 130 children with chronic HBV & HCV who were excluded from this study. 32 children aged 15 years or younger with chronic liver disease were included. The referrals were received from primary and secondary health care centres in different parts of the country. The data were collected from hospital electronic medical records database and then incorporated into a spreadsheet for analysis. The statistical analysis was performed by applying t-test with p value determined. RESULTS: Of 32 children autoimmune hepatitis (n=11; 34.3%) was the most common cause for chronic liver disease referrals, followed by progressive familial intrahepatic cholestasis type-2, (n=7; 21.8%), post Kasai for biliary atresia, (n=4; 12.5%), glycogen storage disease type-1 (n=5; 15.6%), Wilson disease (n=3; 9.3%) and primary sclerosing cholangitis (n=2; 6.2%). The diagnosis was principally established with the assistance of liver ultrasound, liver biopsy, magnetic resonance cholangiopancreatography and genetic testing. CONCLUSION: Autoimmune hepatitis was the most common chronic liver disease. Our systematic approach, in addition to an extensive workup, helped us to diagnose and then initiate an appropriate treatment, which resulted in a more optimal outcome. Prompt referrals to tertiary centres are recommended where resources and expertise are available to reduce patient morbidity and mortality.

Diagnosing Primary Sclerosing Cholangitis in Children.

Primary sclerosing cholangitis (PSC) is a rare chronic cholestatic liver disease in children caused by chronic inflammatory process affecting either intrahepatic or extrahepatic bile ducts. Although it is infrequent, incidence is increasing worldwide, may be due to more awareness, understanding and expertise in managing children with chronic liver disease (CLD). In the developing world like Pakistan where resources and expertise are limited, very few tertiary centers are equipped to manage CLD in children. This case report is about a teenage child who presented to us with decompensated CLD in the form of jaundice and ascites. In our center, after a much needed workup he was commenced on appropriate treatment for PSC. After six months of treatment, he has managed to clear jaundice. The liver synthetic functions have improved with normal coagulation profile. His MELD (model for end-stage liver disease) score, which has come down from 19 to 9, delays liver transplant (LT) for years, which remains the best available treatment. MELD is a scoring system to assess the severity of CLD and remains an important tool to determine the outcome and ranking for receipt of an LT. Subsequently, he developed colitis and colonoscopy confirmed lymphocytic colitis (LC), which is a rare association of PSC.

Immunohistochemical Evaluation Of Oestrogen Receptors In Adenoid Cystic Carcinoma Of Salivary Gland.

BACKGROUND: Oestrogen has a physiological role throughout the body including oral cavity. The effects are mediated by binding to two receptors in nucleus alpha and beta, which are ligand-activated transcription factors. The alpha receptors have a prognostic significance in cancer of breast while in Adenoid cystic carcinoma of salivary glands the results are inconsistent. This study was conducted to determine the oestrogen receptor Alpha staining in adenoid cystic carcinoma of salivary gland. METHODS: Paraffin blocks of thirty cases of adenoid cystic carcinoma of salivary gland were retrieved and evaluated through immunohistochemistry by anti-oestrogen antibody clone 1D5.The intensity and proportion of nuclear staining was scored using Allred scoring system. RESULTS: From total of thirty cases, 5 cases expressed as mild staining of oestrogen receptors using Allred scoring system. Three cases of cribriform and two cases from tubular pattern expressed positivity. In the case series selection of our study cohort there was no association seen in age, gender, site and histological type of tumour with the expression of oestrogen receptor. CONCLUSIONS: Role of oestrogen is well established in breast cancers, some of salivary gland adenoid cystic carcinoma also express these receptors and could be involved in the pathogenesis. Further studies are recommended to seek possible explanation of variable staining pattern observed in many other studies, and also to determine the possible therapeutic use of tamoxifen in such tumours.

Frequency of p53 gene mutation and protein expression in oral squamous cell carcinoma.

OBJECTIVE: To determine the frequency of p53 gene mutation and protein expression in Oral Squamous Cell Carcinoma (OSCC) and to establish correlation between the two. STUDY DESIGN: Analytical study. PLACE AND DURATION OF STUDY: Histopathology Department and Molecular Biology Laboratory, Armed Forces Institute of Pathology (AFIP), Rawalpindi, from May 2010 to May 2011. METHODOLOGY: Thirty diagnosed cases of OSCC were selected by consecutive sampling. Seventeen were retrieved from the record files of the AFIP, and 13 fresh/frozen sections were selected from patients reporting to the Oral Surgery Department, Armed Forces Institute of Dentistry (AFID). Gene p53 mutation was analyzed in all the cases using PCRSSCP analysis. DNA was extracted from the formalin-fixed and paraffin-embedded tissue sections and fresh/frozen sections. DNA thus extracted was amplified by polymerase chain reaction. The amplified products were denatured and finally analyzed by gel electrophoresis. Gene mutation was detected as electrophoretic mobility shift. The immunohistochemical marker p53 was applied to the same 30 cases and overexpression of protein p53 was recorded. RESULTS: Immunohistochemical expression of marker p53 was positive in 67% [95% Confidence Interval (CI) 48.7-80.9] of the cases. Mutations of the p53 gene were detected in 23% (95% CI 11.5-41.2) of the OSCC. No statistically significant correlation was found between p53 gene mutation and protein p53 expression (rs=-0.057, p=0.765). CONCLUSION: A substantial number of patients have p53 gene mutation (23%) and protein p53 expression (67%) in oral squamous cell carcinoma (OSCC).

CD 10 expression intensity in various grades and stages of urothelial carcinoma of urinary bladder.

OBJECTIVE: To evaluate CD10 expression in urothelial carcinoma of the urinary bladder and the association of immunohistochemical (IHC) CD10 expression intensity with grade and stage. STUDY DESIGN: Descriptive cross-sectional analytical study. PLACE AND DURATION OF STUDY: Armed Forces Institute of Pathology, Rawalpindi, from January to December 2011. METHODOLOGY: Fifty consecutive cases of urothelial bladder carcinomas, obtained through transurethral resections, were included in this study. Hematoxylin-eosin (HE) stained sections from each case were re-evaluated histopathologically according to WHO 2004 grading system. The TNM system was used for pathologic staging. On selected slides IHC CD10 marker was applied and a semiquantitative scoring for its expression based on the percentage of positive cells and intensity was performed. Data was entered and analysed on SPSS version 17. Fisher's exact test was used to compare grades, stages of urothelial carcinoma with CD 10 expression and age groups. P < 0.05 was taken as level of significance. RESULTS: Urothelial carcinoma was more common in males. The male to female ratio was 9:1. The older patients > 50 years had higher grade and stage as compared to the younger patients. All cases of high grade urothelial carcinoma showed higher positivity for CD 10. Twenty cases (86.95%) of high grade urothelial carcinoma were positive with +2 immunostaining while 3 cases (13.04 %) were positive with +1 staining. None of the tumors of stage pTa was positive for CD 10 expression. Of all patients with stage pT 1 tumor, 1 case (5.3%) was CD 10 negative and 17 cases (89.9%) were CD 10 positive having +1 staining with 5 - 50% staining and 1 case (5.3%) had +2 staining with more then 50% expression. Out of all patients with stage pT 2, no tumor was CD 10 negative, 3 (13.6%) patients were CD 10 positive with +1 staining and 19 (86.4%) with stage pT 2 tumor had stained positive with +2 staining. CONCLUSION: CD 10 expression was greater in high grade and invasive urothelial carcinomas; it may be associated with tumor progression in bladder cancer pathogenesis.

Changing pattern of malignancies: analysis of histopathology based tumour registry data and comparison of three decades at Armed Forces Institute of Pathology, Rawalpindi, Pakistan.

OBJECTIVE: To assess the pattern of malignancies from tumour registry data and to find any changing pattern by comparing corresponding data from earlier periods. METHODS: The descriptive study was carried out at the Department of Histopathology, Armed Forces Institute of Pathology (AFIP), Rawalpindi, Pakistan. All malignant tumours from 2002-2011 were analysed for age groups, gender distribution, and type of tumour with relation to the site. Tumours of paediatric age group were also assessed separately. Comparison with national and international studies and the data of previous decades - 1977-1988 and 1992-2001 was done to find any changing pattern. SPSS 15 was used for statistical analysis. RESULTS: A total of 32718 malignant tumours were analysed. Of them, males were 19191 and 13527 were females (M:F ratio: 1.4:1). Majority of the patients were between 50-70 years of age. In males, urinary bladder tumours 2153 (11.2%), followed by combined lymphoma/leukaemia 2020 (10.5%) and prostate 1825 (9.5%) were top three malignancies, whereas in females breast 4178 (30.9%) was the commonest. Comparison of different decades showed that in males in the first monograph lymphoma was the commonest, then it was prostatic carcinoma in the second monograph, and now tumours of urinary bladder were on top position. In females, carcinoma cervix, which was at number 5 and 9 in the two earlier monographs was not found in the list of current 10 common tumours. CONCLUSION: The study showed some interesting features, particularly in male malignancies and those related to urinary bladder tumours. The persistent increasing frequency of breast carcinoma in females is also alarming, and requires extensive efforts of awareness, screening and early detection programmes.

Spectrum of liposarcomas-a study of 106 cases.

BACKGROUND: Liposarcoma is a malignant tumour that arises in fat cells in deep soft tissue. This study was conducted to access the spectrum of liposarcomas METHODS: This descriptive study was conducted at Armed Forces Institute of Pathology (AFIP), Rawalpindi from 1st January 2008 to 31st December, 2012 and included all the cases diagnosed as liposarcomas. Records of the malignant tumors of soft tissue that presented during this period were analysed and out of this spectrum of liposarcomas were studied. RESULTS: A total of 19367 malignant tumours were diagnosed during study period. Out of these, 615 were malignant soft tissue tumours. Out of these 106 cases were liposarcoma with an overall frequency of 0.54% of the malignant neoplasm and 17.24% of soft tissue sarcomas .The age ranged from 26-85 years. Out of these 106 cases 77 were male and 29 were female with a male to female ratio of 2.6:1. The most common tumour seen was pleomorphic liposarcoma (42.5%) followed by myxoid liposarcoma (22.6%), dedifferentiated liposarcoma (19.8%) and well differentiated liposarcoma (15.1%). Fifty five (51.9%) of liposarcomas originated in lower extremity, the second most commonly involved site was upper extremity (22.6%) CONCLUSION: Pleomorphic Liposarcoma is the commonest liposarcoma of extremities and their frequency is much high in our population.

Diagnostic accuracy, sensitivity, specificity and positive predictive value of fine needle aspiration cytology (FNAC) in intra oral tumors.

OBJECTIVE: The objective of this study was to establish the diagnostic accuracy, specificity and sensitivity of fine needle aspiration cytology(FNAC) for intra-oral tumors, comparing with histopathology as the gold standard. MATERIALS AND METHODS: Forty cases of FNA cytology from intraoral tumors was performed in AFID along with the demographic data and clinical information and then diagnosed at AFIP, Rawalpindi. Then the cytology results obtained per FNAC were compared with the histopathological biopsy results of the same lesions. The following variables were recorded for each patient: Age, gender, site of biopsy, diagnosis. The data were entered and analyzed using Open-epi version 2.0. Diagnostic accuracy, sensitivity, specificity, positive predictive value and negative predictive value were calculated. Cohen Kappa was further applied to compare the agreement between the biopsy and FNAC diagnoses. A p-value of <0.05 was considered as statistically significant. RESULTS: Among the total patients included in the study there were 24 males and 16 females, with a ratio of 1.5:1. Age of the patients ranged from 24 to 80 years with a mean of 52 years. A total of six sites were aspirated from the oral cavity with maximum (11) aspirates taken from alveolar ridge. The results of FNAC revealed that there were 32 malignant and 8 benign aspirates. Confirmation through histopathological analysis came for 31/32 malignant cases while one was falsely given positive for malignancy on FNAC. Among a total of 40 cases, 31(77%) cases diagnosed were found to be malignant and remaining 9(23%) were benign. The FNAC results revealed 32 malignant and 8 benign lesions. Histopathology of the subsequent surgically excised specimen showed malignant lesions in 31(77%) and benign in 9(23%) patients. As a whole, it was found that the absolute sensitivity for intra oral FNAC was 100% and specificity 89% with positive predictive value of 97% and negative predictive value of 100%. CONCLUSION: Cytological diagnosis was almost corroborative with final histopathological diagnosis in all cases, with very few exceptions, exhibiting high diagnostic accuracy.

Paraffin-based immunohistochemistry in the evaluation of glomerular diseases in renal biopsies.

OBJECTIVE: To determine sensitivity and specificity of paraffin-based immunohistochemistry in the evaluation of glomerular diseases in renal biopsies using immunofluorescence as gold standard. STUDY DESIGN: Cross-sectional analytical study. PLACE AND DURATION OF STUDY: Department of Histopathology, Armed Forces Institute of Pathology, Rawalpindi, from August 2008 to August 2009. METHODOLOGY: Seventy renal biopsy specimens fulfilling the inclusion criteria for light microscopy and immunofluorescence during the study period were evaluated. Antibodies to immunoglobulins (IgG, IgA, and IgM) and components of complement system (C3) were applied on 70 formalin-fixed paraffin-embedded renal biopsy specimens previously classified by means of light microscopy and immunofluorescence (IF). Staining for these antibodies was recorded as positive and negative for immunohistochemistry (IHC) and IF in paired proportions presuming IF as gold standard test. The sensitivity, specificity, positive predicitive value and negative predicitive value of individual antibody were calculated. RESULTS: Of 70 patients, mean age was 33 ± 18 years ranging from 2 to 80 years. Forty five (64%) were males and 25 (36%) were females. The sensitivity, specificity and predictive values of individual antibodies to IgG, IgA, IgM and C3 were very low and generally in the range of 40 - 60%. CONCLUSION: The sensitivity, specificity and predictive values of immunohistochemistry on formalin-fixed paraffin-embedded renal biopsy specimens were very low and therefore, not suitable for evaluation of renal biopsies in current circumstances.

Diagnostic challenges and role of immunohistochemistry in metastatic liver disease.

OBJECTIVE: To evaluate the role of Immunohistochemistry (IHC) in the diagnosis of metastatic liver disease, with a descriptive, cross-sectional study at the Department of Histopathology, Armed Forces Institute of Pathology (AFIP), Rawalpindi. MATERIAL AND METHODS: A total of 130 cases of metastatic liver disease were retrieved from the tumor registry data. Eosin-haematoxylin stained sections and Immunohistochemistry panels applied to ascertain the site of primary tumor were evaluated. The panels of detailed immunohistochemical markers were applied. Frequency and percentages were calculated for qualitative variables. Mean and standard deviations were calculated for quantitative variables. RESULTS: Males were 87 (67%) and were females 43 (33.07%). The most common site of primary was in GIT (45%), followed by neuroendocrine carcinoma and gall bladder. The other less common sites were lung, breast, ovary and thyroid. CONCLUSION: There is no specific singular panel of immunohistochemistry markers which can be used in all cases of metastatic liver tumors. The best use and selection of IHC markers depend upon morphological features, clinical history and results of other relevant investigations.

Cancer data analysis in the pathology department, combined military hospital, Multan, Pakistan 2002-2007.

This study was conducted with the objective of providing the pattern of cancer distribution from a hospital based tumour registry at CMH, Multan, in comparison with patterns from other National Studies. The retrospective study of malignant tumours recorded at the pathology department from 2002-2007 featured analysis in terms of age group, gender and type of tumour. Over the six year period the total number of malignancies was 930 with a male to female ratio of 1.4:1. The common tumours in males, in order of decreasing frequency were leukaemia, prostate cancer, urinary bladder cancer, skin cancer and lymphomas. In females they were leukaemia, breast cancer, skin cancer, gallbladder cancer and lymphomas. In both sexes, the most common malignancy was leukaemia, which is contrary to other studies, pointing to a possible link with extensive use of pesticides and other agricultural chemicals in this region of the country.