Metastatic Sarcomatoid Renal Cell Carcinoma: A Journey From the Kidney to the Gingiva.

Oral metastatic lesions are very rare and are often diagnosed at a later stage, complicating treatment. Renal cell carcinoma (RCC) is the third most frequent neoplasm to metastasize to the oral cavity, following breast and lung cancers. These metastatic lesions are usually asynchronous and develop after the initial diagnosis, affecting the overall survival rate. This report describes a known case of RCC with a growth in the mandibular gingiva. Multiple pulmonary and femoral metastases appeared five years after the initial renal lesion. The gingival growth was excised and referred for histopathological examination, which revealed a pleomorphic sarcomatoid cellular morphology. Immunohistochemistry with an array of markers led to the diagnosis of sarcomatoid RCC, a rare high-grade tumor. This case underscores the importance of detailed history-taking, interpretation of clinical findings, and emphasis on histopathological examination to arrive at a conclusive diagnosis.

Effect of gamma and Ultraviolet-C sterilization on BMP-7 level of indigenously prepared demineralized freeze-dried bone allograft.

The presence of bone morphogenetic proteins in demineralized freeze-dried bone allograft (DFDBA) are responsible for developing hard tissues in intraosseous defects. The most common mode of sterilization of bone allografts, i.e., Gamma rays, have dramatic effects on the structural and biological properties of DFDBA, leading to loss of BMPs. Ultraviolet-C radiation is a newer approach to sterilize biodegradable scaffolds, which is simple to use and ensures efficient sterilization. However, UV-C radiation has not yet been effectively studied to sterilize bone allografts. This study aimed to compare and evaluate the effectiveness of Gamma and Ultraviolet-C rays in sterilizing indigenously prepared DFDBA and assess their effect on the quantity of BMP-7 present in the allograft. DFDBA samples from non-irradiated, gamma irradiated, and UV-C irradiated groups were tested for BMP-7 level and samples sterilized with gamma and UV-C rays were analysed for sterility testing. The estimated mean BMP-7 level was highest in non-irradiated DFDBA samples, followed by UV-C irradiated, and the lowest in gamma irradiated samples. Our study concluded that UV-C rays effectively sterilized DFDBA as indicated by negative sterility test and comprised lesser degradation of BMP-7 than gamma irradiation.

Age-related frequency of triple negative breast cancer in women.

OBJECTIVE: To determine frequency of triple negative breast cancer (TNBC) in Pakistani women with respect to age. STUDY DESIGN: Observational study. PLACE AND DURATION OF STUDY: Armed Forces Institute of Pathology (AFIP), Rawalpindi, from July 2005 to July 2010. METHODOLOGY: Pathological records of all specimens of breast cancer were reviewed and data was obtained for estrogen receptor (ER), progesterone receptor (PR) and HER-2 neu receptor proteins. Specimens having complete record of all three proteins were included for analysis. TNBC was defined as those who were ER, PR and HER-2 neu negative. Overall frequency as well as frequency with respect to age was calculated. Descriptive and categorical variables were analyzed using SPSS version 17. RESULTS: Eight hundred and fifteen patients out of 4715 (17.28%) were found to be TNBC. Mean age of diagnosis of TNBC was found to be 46.26 ± 12.22 years of age while other breast cancers had a mean age 52.90 ± 9.78 years (p < 0.001). In the TNBC group, 537 patients (65.88%) were aged < 50 years while 278 patients (34.11%) were aged > 50 years while majority of patients with other breast cancers were elderly females (p < 0.001). CONCLUSION: TNBC comprised 17.28% of the breast cancers in Pakistani women diagnosed at the studied centre. A higher frequency of TNBC was noted in significantly younger patients.

Primary carcinoma of ectopic breast tissue in axilla.

A 30 years old married lady presented with 4 x 5 cm, firm, non-tender, mobile swelling on anterior wall of left axilla. FNAC revealed carcinoma. The examination of breast including axillary tail, arm, chest and abdomen did not reveal any abnormality. Mammogram and MRI of both breasts did not reveal any lesion in the breast including axillary tail. Local wide excision along with axillary clearance was carried out. Final histopathology revealed invasive ductal carcinoma (Grade II) of axillary breast tissue and one, out of the recovered lymph nodes, was involved by the tumour. The immunohistochemistry also confirmed the findings.

Cytomegaloviral enteritis: a rare cause of small gut perforation.

A 47-year-old man was admitted with four months history of pain upper central abdomen associated with passage of 3-4 loose watery stools per day. Abdominal examination revealed soft abdomen with mild tenderness in the para-umbilical region. There was associated hepatomegaly. His Hb% was low, liver and renal functions were deranged. Upper GI endoscopy revealed antral ulcer, and colonoscopy revealed a caecal ulcer, which were biopsied. Liver biopsy was also done. Histopathology report showed evidence of inflammatory colitis and chronic hepatitis, so a diagnosis of inflammatory bowel disease with autoimmune hepatitis was made. He was negative for HIV and hepatitis serology. He was given long list of medicine including steroids but the symptoms did not improve. Two months after admission he developed severe abdominal pain associated with distension. The X-Ray chest revealed pneumoperitoneum and laparotomy was carried out which revealed a small perforation in terminal ileum associated with multiple circular indurated areas ranging from few mm to 1.5 Cm in size with central thinning spread over distal half of small gut and enlarged mesenteric lymph nodes. The biopsy of perforated area revealed cytomegaloviral enteritis. Postoperatively patient developed ARDS and died on 13th postoperative day.