Differential capacity of phragmites ecotypes in remediation of inorganic contaminants in coastal ecosystems: Implications for climate change.

Remediating inorganic pollutants is an important part of protecting coastal ecosystems, which are especially at risk from the effects of climate change. Different Phragmites karka (Retz) Trin. ex Steud ecotypes were gathered from a variety of environments, and their abilities to remove inorganic contaminants from coastal wetlands were assessed. The goal is to learn how these ecotypes process innovation might help reduce the negative impacts of climate change on coastal environments. The Phragmites karka ecotype E1, found in a coastal environment in Ichkera that was impacted by residential wastewater, has higher biomass production and photosynthetic pigment content than the Phragmites karka ecotypes E2 (Kalsh) and E3 (Gatwala). Osmoprotectant accumulation was similar across ecotypes, suggesting that all were able to successfully adapt to polluted marine environments. The levels of both total soluble sugars and proteins were highest in E2. The amount of glycine betaine (GB) rose across the board, with the highest levels being found in the E3 ecotype. The study also demonstrated that differing coastal habitats significantly influenced the antioxidant activity of all ecotypes, with E1 displaying the lowest superoxide dismutase (SOD) activity, while E2 exhibited the lowest peroxidase (POD) and catalase (CAT) activities. Significant morphological changes were evident in E3, such as an expansion of the phloem, vascular bundle, and metaxylem cell areas. When compared to the E3 ecotype, the E1 and E2 ecotypes showed striking improvements across the board in leaf anatomy. Mechanistic links between architectural and physio-biochemical alterations are crucial to the ecological survival of different ecotypes of Phragmites karka in coastal environments affected by climate change. Their robustness and capacity to reduce pollution can help coastal ecosystems endure in the face of persistent climate change.

Relative biochemical and physiological docking of cucumber varieties for supporting innate immunity against Podosphaera xanthii.

Powdery mildew in cucumber is caused by the Podosphaera xanthii. No strategy for improving disease resistance can be successful in the absence of thorough insights into the physiological and biochemical responses of cucumber plants to powdery mildew. Therefore, a field experiment was executed to evaluate five commercial cucumber varieties (V1: Dynasty, V2: Long green, V3:Desi Kheera, V4:Thamin II, V5:Cucumber 363) for their inherent immunity to powdery mildew. Upon inoculating cucumber plants with Podosphaera xanthii, we noted differential responses among the varieties. Compared to other varieties, V1 and V2 showed higher values (P ≤ 0.05) for chlorophyll-a under control and pathogen-attacked plants respectively. The minimum value of anthocyanin content (-53.73%) was recorded in V3 as compared to other varieties post pathogen infection. All pathogen-infected cucumber varieties showed a considerable (P ≤ 0.05) loss in flavonoid content except V2. The maximum destruction for Phenolics under powdery mildew (179%) were recorded in V4, whereas V1 exhibited maximum phenolic content under control conditions. In pathogen-infected plants, the minimum AsA was recorded in V5 as compared to all other varieties. Pathogen invasion impacted significantly (P ≤ 0.05) the activity of superoxide dismutase (SOD). Besides, cucumber plants after pathogen inoculation resulted in a considerable (P ≤ 0.05) increase of peroxidase (POD) activity in V1 (5.02%), V2 (7.5%), and V3 (11%) in contrast to V4. Our results confirmed that cucumber varieties perform differently, which was brought on by distinct metabolic and physiological modifications that have an impact on growth and development. The changes in different attributes were correlated with cucumber resistance against powdery mildew. The results would help us fully harness the potential of these varieties to trigger disease management initiatives and defense responses.

Nerium oleander could be used for sustainable management of traffic-borne elemental-enriched roadside soils.

Metal pollutants released from motor vehicles are deposited in roadside environments. Metals are non-biodegradable and biomagnify in the food chain causing significant health hazards at all levels of the ecosystem. Hence, management of contaminated roadside verges is critically important and should be kept in mind while planning specific management strategies of such areas. Native vegetation could help to decontaminate heavy metal polluted soils in the best sustainable way. Therefore, this study was designed to assess the potential of Nerium oleander to accumulate heavy metals commonly released by automobiles such as Pb, Cd, Ni, and Zn along with various C and N compounds from five different locations along a busy road in Punjab, Pakistan, during summer and winter seasons. N. oleander showed the ability to absorb C, N, and heavy metals Pb and Cd; the maximum concentration of Pb and Cd was 8.991 mg kg-1 and 0.599 mg kg-1, respectively. These pollutants negatively affected photosynthetic pigments, gas exchange attributes, soluble proteins, and free amino acids. But antioxidant activity of N. oleander was found to be increased in both seasons. The metal accumulation in the plant was higher in the summer though. We highly recommend that by growing N. oleander at roadside verges for decontamination of vehicular pollutants could lead to sustainable management of these corridors.

Mitigation of lead toxicity in Vigna radiata genotypes by silver nanoparticles.

Heavy metal (HM) contamination of the soil through anthropogenic activities influences the living systems and drastically impacts food chain. This study examined the application of silver nanoparticles (AgNPs) in two genotypes (G1 and G2) of Mung bean (Vigna radiata) for ameliorating the Pb toxicity. Different doses of Pb (0, 25, 50 µM) were differentially tackled by AgNPs with the aim of ameliorating the plant attributes. Both genotypes displayed statistically significant quantitative and qualitative modulations for Pb tolerance. In G2, the most prominent increase in plant height (43.79%), fresh biomass (49.56%) and total chlorophyll (20%) was observed at L2 (AgNPs 10 mg/L) in comparison with the control. Overall, photosynthetic rate was increased by 26% in G2 at L6 (AgNPs 25 mg/L + Pb 25 µM). In addition, the results presented 78.5% increase in water use efficiency of G2 while G1 experienced a maximum internal CO2 concentration (209.8%) at L8 (Pb 50 µM). AgNPs triggered balanced uptake of minerals and improved growth of Vigna genotypes. 50 µM Pb was most hazardous and caused maximum reduction in growth of Vigna plants along with a significant suppression in photosynthetic activity, increase in MDA (199.7%) in G1 and H2O2 (292.8%) in G2. In comparison to control, maximum superoxide dismutase (376%), peroxidase (659.8%) and catalase (9.3%) activity was observed in G2 at L11. The application of AgNPs substantially enhanced plant growth and helped them in surviving well in absence as well as presence of Pb. G2 genotype exhibited substantial tolerance capability and revealed less impairment in the studied attributes than G1 and treatment of AgNPs i.e. 25 mg/L was the best level that yielded best results in both genotypes. The results demonstrate that AgNPs mediate response(s) of plants under Pb stress and particularly contributed to HM tolerance of plants and thus showing great promise for use in phytoremediation.

Interactions and effects of microplastics with heavy metals in aquatic and terrestrial environments.

Contamination of waters and soils with microplastics (MPs) is an emerging environmental issue worldwide. MPs constitute a cocktail of various additives and polymers besides adsorbing toxic heavy metals from the environment. This co-occurrence of MPs with heavy metals poses a threat to the health of organisms and is poorly understood. Ingestion of MPs contaminated with heavy metals may also result in subsequent transfer of heavy metals up in the food chain. MPs surfaces play a crucial role in the adsorption of heavy metals. Aged/biofouled MPs facilitate greater adsorption of metals and certain microplastic (MP) polymers adsorb some metals more specifically. External factors involved in the process of adsorption/accumulation of heavy metals are the solution pH, salinity, and the concentration of relevant heavy metals in the media. Desorption greatly depends upon pH of the external solution. This is more concerning as the guts/digestive systems of organisms have low pH which could enhance the desorption of toxic metals and making them accumulate in their bodies. The aim of this article is to discuss the abundance, distribution, adsorption, and desorption behavior of MPs for heavy metals, and their combined toxic effects on flora and fauna based on the limited research on this topic in the literature. There is an overarching need to understand the interactions of MPs with heavy metals in different ecosystems so that the extent of ecotoxic effects they pose could be assessed which would help in the environmental regulation of these pollutants.

CD117/c-KIT Expression in Phyllodes Tumor of the Breast and Its Correlation With Morphology and Clinical Outcome.

Introduction Breast phyllodes tumor's (PT) clinical behavior is difficult to predict on histology. There is limited amount of data available on the role of biological markers. The objective of this study was to assess the expression of CD117 (c-KIT) in PT of the breast and its relationship with morphology and clinical outcome. Methods A total of 78 patients having available clinical records between 2004 and 2014 with breast PT were retrieved from the cancer registry at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore and were followed up. Immunohistochemical studies were performed on all the cases using mono-clonal antibody CD117 (DAKO A4502) using Leica Bond-Max automated biosystem (Leica Biosystems, Melbourne, Australia). Staining proportion and intensity of both epithelial and stromal elements were analyzed. Evaluation of the protein expression was determined and scored. Results Patients' mean age was 45.13 ± 11.4 years. Thirty-nine (50.0%) patients had tumor on right side, 38 (48.7%) had on left and only one (1.3%) was bilateral. Thirty-two (41.0%) patients had benign PT, 21 (26.9%) had borderline and 25 (32.1%) had malignant PT. Negative CD117 expression was observed in 20 (62.5%), eight (38.0%) and 12 (48.0%) of benign, borderline and malignant PTs, respectively. Positive CD117 expression was observed in 12 (37.5%) benign, 13 (61.9%) borderline and 13 (52.0%) malignant PTs. There was insignificant association between CD117 expression with respect to tumor sub-type, patient's age and clinical behavior (p-value > 0.05). Conclusion CD117 expression was not found to be associated with tumor type and was not associated with increased risk of recurrence in this sample of patients. Further work is needed to better understand the prognostic value of CD117 expression in breast PTs.

Physiological homeostasis for ecological success of Typha (Typha domingensis Pers.) populations in saline soils.

The natural capacity of plants to endure salt stress is largely regulated by multifaceted structural and physio-biochemical modulations. Salt toxicity endurance mechanism of six ecotypes of Typha domingensis Pers. was evaluated by analyzing photosynthesis, ionic homeostasis, and stomatal physiology under different levels of salinity (0, 100, 200 and 300 mM NaCl). Typha populations were collected across different areas of Punjab, an eastern province in Pakistan. All studied attributes among ecotypes presented differential changes as compared to control. Different salt treatments not only affected gas exchange attributes but also shown significant modifications in stomatal anatomical changes. As compared to control, net photosynthetic rate, transpiration rate, total chlorophyll contents and carotenoids were increased by 111%, 64%, 103% and 171% respectively, in Sahianwala ecotype among all other ecotypes. Similarly, maximum water use efficiency (WUE), sub stomatal CO2 concentration, sodium (Na+) and chloride (Cl-) contents were observed in Sahianwala (191%, 93%, 168%, 158%) and Knotti (162%, 75%, 146%, 182%) respectively, as compared to the others ecotypes. Adaxial and abaxial stomatal areas remained stable in Sahianwala and Knotti. The highest abaxial stomatal density was observed in Gatwala ecotype (42 mm2) and maximum adaxial stomatal density was recorded in Sahianwala ecotype (43 mm2) at 300 mM NaCl salinity. The current study showed that Typha ecotypes responded varyingly to salinity in terms of photosynthesis attributes to avoid damages due to salinity. Overall, differential photosynthetic activity, WUE, and changes in stomatal attributes of Sahianwala and Knotti ecotypes contributed more prominently in tolerating salinity stress. Therefore, Typha domingensis is a potential species to be used to rehabilitate salt affected lands for agriculture and aquatic habitat. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s12298-021-00963-x.

Foliar architecture and physio-biochemical plasticity determines survival of Typha domingensis pers. Ecotypes in nickel and salt affected soil.

Six ecotypes of Typha domingensis Pers. Jahlar (E1), Sheikhupura (E2), Sahianwala (E3), Gatwala (E4), Treemu (E5) and Knotti (E6) from different ecological regions were collected to evaluate the leaf anatomical and biochemical attributes under different levels of salinity and nickel stress viz; L0 (control), L1 (100 mM + 50 mg kg-1), L2 (200 mM + 100 mg kg-1) and L3 (300 mM + 150 mg kg-1). Presence of salt and Ni in rooting medium consistently affected growth, anatomical and physio-biochemical attributes in all Typha ecotypes. Discrete anatomical modifications among ecotypes such as reduced leaf thickness, increased parenchyma area, metaxylem cell area, aerenchyma formation and improved metaxylem vessels were recorded with increasing dose of salt and Ni. The minimum anatomical damages were recorded in E1 and E6 ecotypes. In all ecotypes, progressive perturbations in ionic homeostasis (Na+, K+, Cl-, N) due to salt and metal toxicity were evident along with reduction in photosynthetic pigments. Maximum enhancement in Catalase (CAT), Superoxide dismutase (SOD), Peroxidase (POD) and modulated Malondialdehyde (MDA) activity was recorded in E1 and E6 as compared to other ecotypes. Accumulation of large amounts of metabolites such as total soluble sugars, total free amino acids content in Jahlar, Knotti, Treemu and Sahianawala ecotypes under different levels of salt and Ni prevented cellular damages in T. domingensis Pers. The correlation analysis exhibited a close relationship among different levels of salinity and Ni with various plant attributes. PCA-Biplot verified our correlational analysis among various attributes of Typha ecotypes. An obvious separation of Typha characters in response to different salinity and Ni levels was exhibited by PC1. We recommend that genetic potential of T. domingensis Pers. To grow under salt and Ni stresses must be investigated and used for phytoremediation and reclamation of contaminated soil.

Frequency Of Non-Diabetic Renal Disease In Type 2 Diabetes Mellitus Patients Undergoing Renal Biopsy.

BACKGROUND: Diabetes mellitus has become a major emerging health concern. Its burden, estimated to be 451 million in 2017, has been projected to rise to 693 million by 2045. This will bring a rise in the prevalence of its associated complications. There is a wide spectrum of non-diabetic renal disease (NDRD) known to be present in diabetic patients with variable prevalence. However, the majority of diabetes mellitus (DM) patients with renal disease are yet not biopsied and the diagnosis of diabetic nephropathy (DN) is presumed on clinical grounds. METHODS: It is a retrospective cross-sectional study. We selected a total of 126 cases of renal biopsies with a history of type 2 diabetes mellitus. Demographic data was collected from the medical records and pathology reports while all cases were evaluated by reviewing the archived slides. RESULTS: Patients were categorized into group 1 with isolated NDRD, group 2 showing NDRD mixed with DN and group 3 with isolated DN. Thirty-four (27%) cases had isolated NDRD (group 1), 14 (11%) had NDRD mixed with DN and 78 (62%) patients had isolated DN. NDRD, either alone or in combination with DN, was found to be present in 48 patients with an overall prevalence of 38%. CONCLUSION: Our study concludes that NDRD is frequent in type 2 diabetes mellitus patients. Renal biopsy remains the key diagnostic tool in such cases, providing crucial information for proper management of the underlying pathology.

EUS-FNA, ancillary studies and their clinical utility in patients with mediastinal, pancreatic, and other abdominal lesions.

BACKGROUND: Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is an important modality to obtain tissue diagnosis from mediastinal, pancreatic, and intra-abdominal lesions in close proximity to the pulmonary and gastrointestinal tract. It is considered to be a relatively safe, rapid, and minimally invasive technique with low complication rates. AIMS: To determine the diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and outcome of EUS-FNA, with histological correlation where applicable. METHODS: Data of all 1059 consecutive patients who underwent EUS-FNA from 1 January 2005 to 31 December 2017 at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore was reviewed in this retrospective study. The major sites that were targeted for EUS-FNA were pancreatic (423), mediastinal (376), and other abdominal lesions (260). RESULTS: The average number of passes per patient was 2.22. Rapid on-site evaluation (ROSE) was adequate in 969 patients (91.4%). Concordance between ROSE and final cytology was 99.5%. Follow-up was available in 810 patients (76.4%). The overall diagnostic yield was 94.3%. Ancillary studies, including immunohistochemical stains and flow cytometry, helped to increase the diagnostic yield from 78.1% to 94.3%. The overall sensitivity, specificity, PPV, NPV, and diagnostic accuracy for EUS-FNA were 94.8%, 98.6%, 99.9%, 65.5%, and 95.1%, respectively. Seven of 1059 patients (0.6%) developed complications. CONCLUSION: EUS-FNA is a very sensitive and specific diagnostic tool with a minimal complication rate. Ancillary studies helped to increase the sensitivity, as well as the diagnostic yield.

Utility of p63 and p40 in Distinguishing Polymorphous Adenocarcinoma and Adenoid Cystic Carcinoma.

OBJECTIVE: Adenoid cystic carcinoma and polymorphous adenocarcinoma are primarily the tumor of minor salivary glands. Both show certain morphological similarities, which limit their proper diagnosis in settings where there are obscuring factors and limited biopsy material. However, there is a considerable difference in treatment and prognosis, which raises the need to distinguish these two entities. In this study, we discuss the utility of two immunohistochemical stains, p63 and p40, in different combinations for distinguishing polymorphous adenocarcinoma from adenoid cystic carcinoma. MATERIALS AND METHODS: Two immunohistochemical stains, p63 and p40, were performed on 47 cases of adenoid cystic carcinoma and 23 cases of polymorphous adenocarcinoma. RESULTS: 36 out of 47 cases of adenoid cystic carcinoma showed p63+ve/p40+ve immunoprofile, followed by p63-ve/p40-ve immunoprofile, which is seen in10 cases of adenoid cystic carcinoma. However, 22 out of 23 cases of polymorphous adenocarcinoma displayed p63+ve/ p40-ve immunoprofile. p63-ve/p40+ve is the least frequent observed immunoprofile, which is seen in only one case of adenoid cystic carcinoma. CONCLUSION: On combining all possible immunoprofile combinations, p63+ve/p40-ve immunoprofile appears to be the most sensitive profile for distinguishing polymorphous adenocarcinoma from adenoid cystic carcinoma.

Follicular Dendritic Cell Sarcoma of Gastrointestinal Tract: an Uncommon Lesion, Commonly Missed.

INTRODUCTION: Follicular dendritic cell sarcoma (FDCS) is a rare neoplasm, accounting for only 0.4% of soft-tissue sarcomas. It shows both nodal and extranodal involvement. Considering the rarity and difficulties in diagnosing this tumor, we consider it very important to share our experience of diagnosing FDCS. Its correct diagnosis cannot be overemphasized as the treatment and prognosis of FDCS are very much different from tumors which come in its differential diagnosis. MATERIAL AND METHODS: We are presenting eight cases of extranodal FDCS in gastrointestinal tract diagnosed at our center in a period of 3 years (Feb 2015 to Feb 2018). Presenting complaints, demographic details, gross description, histologic features, immunostain results, and clinical follow-up were evaluated. RESULTS: Four patients were females and four were males. Tumor ranged in size from 5.5 to 35 cm. In five cases, tumor cells were arranged in storiform and whorling pattern. Lymphocytes were seen sprinkled in between these cells. In one case, lymphocytic infiltrate was extensive. Giant cells and frequent mitoses were noted in two cases. One case showed extensive necrosis. Tumor cells were strongly and diffusely positive for CD21 and CD35. Mean follow up of 11.8 months (range 01 to 24 months) was noted. CONCLUSION: FDCS is a rare tumor having distinct morphology and phenotype which if known can be correctly diagnosed. Therefore, knowledge of its varied location, morphology, and phenotype is very important to correctly diagnose this tumor and to prevent misdiagnosis and mistreatment.

Effectiveness of Vascular Markers (Immunohistochemical Stains) in Soft Tissue Sarcomas.

OBJECTIVE: To ascertain the effectiveness of IHC markers of vascular origin like CD31, CD34, FLI1 and ERG in vascular soft tissue sarcomas including angiosarcomas, Kaposi sarcomas, epithelioid hemangioendothelioma and a non-vascular soft tissue sarcoma (Epithelioid sarcoma). STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, from 2011 to 2017. METHODOLOGY: Diagnosed cases of angiosarcomas (n=48), epithelioid hemangioendothelioma (n=9), Kaposi sarcoma (n=9) and epithelioid sarcoma (n=20) were selected. Immunohistochemical staining as performed on formalin fixed paraffin embedded sections. The sections were stained for the following markers: CD34 (VENTANA clone Q Bend 10), CD31 (Leica clone 1 A 10), FLI1 (CELL MARQUE clone MRQ-1) and ERG (CELL MARQUE clone EP111). RESULTS: A complete panel of CD34, CD31 and ERG was applied on 8/48 cases of angiosarcomas with triple positivity in 6 cases. Eight cases showed positivity for only CD31 and ERG and 2 cases showed positivity for only ERG. A complete panel of CD34, CD31 and ERG was applied on 3/9 cases of epithelioid hemangioendothelioma with positivity for all markers in 2 cases. Combined positivity for ERG and CD34 was seen in 2 cases and on 4 cases only CD31 immunohistochemical was solely applied with 100% positivity. FLI1 was not applied on any case. Among 9 cases of Kaposi sarcoma, ERG, CD34 and CD31 in combination were applied on only 1 case with triple positivity. Remaining cases show positivity for either CD34, CD31 or FLI1. Majority of cases of epithelioid sarcomas were diagnosed on the basis of cytokeratin and CD34 positivity with loss of INI1. The other vascular markers showed negativity in all cases. CONCLUSION: Among these four markers, ERG immunohistochemical stain is highly effective for endothelial differentiation due to its specific nuclear staining pattern in normal blood vessel endothelial cells (internal control) as well as neoplastic cells of vascular tumors and lack of background staining.

Urdu translation and validation of shorter version of Positive Affect and Negative Affect Schedule (PANAS) on Pakistani bank employees.

OBJECTIVE: To translate, adapt and validate shorter version of positive affect and negative affect scale on Pakistani corporate employees. METHODS: This cross-sectional study was conducted in the twin cities of Islamabad and Rawalpindi from October 2014 to December 2015. The study was completed into two independent parts. In part one, the scale was translated by forward translation. Then it was pilot-tested and administered on customer services employees from commercial banks and the telecommunication sector. Data of the pilot study was analysed by using exploratory factor analysis to extract the initial factor of positive affect and negative affect scale. Part two comprised the main study. Commercial bank employees were included in the sample using convenient sampling technique. Data of the main study was analysed using confirmatory factor analysis in order to establish construct validity of positive affect and negative affect scale. RESULTS: There were145 participants in the first part of the study and 495 in the second. Results of confirmatory factor analysis confirmed the two-factor structure of positive affect and negative affect scale suggesting that the scale has two distinct domains, i.e. positive affect and negative affect. CONCLUSIONS: The shorter version of positive affect and negative affect scale was found to be a valid and reliable measure.

Construct validation of emotional labor scale for a sample of Pakistani corporate employees.

OBJECTIVE: To translate, adapt and validate emotional labour scale for Pakistani corporate employees. METHODS: This study was conducted in locale of Rawalpindi and Islamabad from October 2014 to December 2015, and comprised customer service employees of commercial banks and telecommunication companies. It comprised of two independent parts. Part one had two steps. Step one involved translation and adaptation of the instrument. In the second step psychometric properties of the translated scale were established by administering it to customer services employees from commercial banks and the telecommunication sector. Data of the pilot study was analysed by using exploratory factor analysis to extract the initial factor of emotional labour. Part two comprised the main study. Commercial bank employees were included in the sample by using convenient sampling technique. SPSS 20 was used for data analysis. RESULTS: There were 145 participants in the first study and 495 in the second study . Exploratory factor analysis initially generated three-factor model of emotional labour which was further confirmed by confirmatory factor analysis suggesting that emotional labour had three distinct dimensions, i.e. surface acting, deep acting and genuine expressions of emotions. CONCLUSIONS: The emotional labour scale was found to be a valid and reliable measure.

Motor impairment and skeletal mineralization in children with cerebral palsy.

OBJECTIVE: To evaluate the bone mineral density and the effect of motor impairment on bone mineral density in children with cerebral palsy. METHODS: The cross-sectional study was conducted at the Armed Forces Institute of Rehabilitation Medicine, Rawalpindi, Pakistan, from January 2013 to January 2015. Children diagnosed with cerebral palsy were sampled by non-probability purposive sampling from the Cerebral Palsy clinic. On the basis of Gross Motor Function Classification level of motor impairment, the children were divided into mild Cerebral Palsy (level 1 & 2) and moderate to severe Cerebral Palsy (level 3-5) groups. Bone mineral density z-score was measured at lumbar spine with Dual Energy X-Ray Absorptiometry at L1-L4 lumbar vertebra. Data was analysed using SPSS 20. RESULTS: Of the total 108 children selected, 18(16.6%) had to be excluded due to poor nutrition status or deranged serum chemistry, while in 4(3.7%) children Dual Energy X-ray Absorptiometry scan was not done on technical grounds. Of the remaining 86(79.6%) children, 39(45.3%) were males and 47(54.7%) were females. The overall mean age was 6.08±2.89 years and mean bone mineral density z-score was -2.16±0.62. Statistically significant difference was found in bone mineral density z-scores of moderate to severe compared to mild Cerebral Palsy group (p<0.05). Significant difference in bone mineral density z-scores was also found among different levels of Gross Motor Function Classification system of motor impairment (p<0.05). CONCLUSIONS: Cerebral Palsy children had low bone mineral density z-score, especially those who were non-ambulatory.

Secondary malignant melanoma in primary mediastinal germ cell tumour.

Secondary transformation in Germ Cell Tumours (GCT) is an extremely rare event. We report here a case of malignant melanoma arising in primary mediastinal GCT. A young male presented with new onset dyspnoea and a mediastinal mass. As serum alpha fetoprotein was raised, a diagnosis of primary mediastinal GCT was made. He achieved remission with standard chemotherapy and resection of the mass. After a year, he relapsed with widespread disease which on work-up revealed malignant melanoma. As examination for cutaneous melanoma was unremarkable, a diagnosis of mediastinal GCT with secondary transformation to melanoma was made. Exact origin of melanoma in GCTs is unknown, but these may occur from transformation of dermal elements or de-differentiation of germ cells to melanomas. Before making such a diagnosis, search for primary cutaneous melanoma is mandatory. No clear guidelines exist in literature for the treatment of secondary melanomas, so current management guidelines for cutaneous melanoma may be followed.

Accuracy of diagnosis of solid pseudopapillary tumor of the pancreas on fine needle aspiration: A multi-institution experience of ten cases.

INTRODUCTION: Solid pseudopapillary tumor of the pancreas (SPTP) is a neoplasm of uncertain origin and indolent biologic behavior with distinctive morphological features occurring predominantly in young women. This tumor has an excellent prognosis compared to neuroendocrine and acinar cell carcinoma, which are close differential diagnoses based on morphology, hence making it crucial to diagnose SPTP correctly. OBJECTIVES: To discuss the cytomorphological features of 10 cases of SPTP reported in two institutions and to evaluate the diagnostic accuracy of endoscopic ultrasound (EUS) guided fine needle aspiration (FNA) cytology in establishing the diagnosis of SPTP. METHODS: Ten diagnosed cases of SPTP were retrieved from the computerized endoscopy and pathology databases of our two tertiary care institutions. Nine patients had subsequent histological follow-up available. Eight patients underwent EUS-FNA while one patient each had ultrasound and computed tomography-guided FNA. The rapid on-site evaluation was carried out in all 10 cases, and additional material was retained for cell block preparation. Immunohistochemical (IHC) stains ranging from synaptophysin, progesterone receptor, chromogranin, ß-catenin, CD10, and NSE were applied on cell blocks. Histological sections of all resected specimens were reviewed, and findings were correlated with those obtained by FNA. RESULTS: Adequate material was obtained in all ten cases. IHC stains helped to confirm the cytological impression of SPTP. Histological examination of resection specimens, available in 9/10 cases, confirmed the cytological diagnosis. CONCLUSIONS: FNA particularly that obtained with EUS guidance is an effective tool in the accurate diagnosis of SPTP.

Immunohistochemical pattern of pleomorphic adenoma, polymorphous low grade adenocarcinoma and adenoid cystic carcinoma in minor salivary glands.

OBJECTIVE: To study the immunohistochemical pattern of CD 117, glial fibrillary acidic protein (GFAP), smooth muscle actin (SMA) and CD 43 in pleomorphic adenoma (PA), adenoid cystic carcinoma (AdCC) and polymorphous low grade adenocarcinoma (PLGA) of minor salivary glands. MATERIALS AND METHODS: Twenty cases of PA, 20 cases of AdCC and 10 cases of PLGA were retrieved from record files along with their paraffin blocks at Armed Forces Institute of Pathology, Pakistan. New histological diagnosis was made on freshly prepared H&E sections followed by application and analysis of immunostains. RESULTS: The mean age of the patients was 44 ± 15 (mean SD) (range; 17-86) years. There were 26 male and 24 female patients with a male to female ratio of 1.08:1. Fourteen cases of PA, 14 cases of AdCC and 6 cases of PLGA were positive for CD117. In case of GFAP, only 9 cases of AdCC and 3 cases of PLGA were positive; however, 16 cases of PA were also positive. Twelve cases of AdCC and 7 cases of PA were positive for SMA and half of the PLGA cases were also reactive. Nonetheless, the least expression was seen in case of CD 43, where only five cases of AdCC were positive. Six cases of PA and three cases of PLGA were also positive. CONCLUSION: Our results suggest that the use of GFAP, SMA, CD 117 and CD 43 as an adjunct to histological examination is not helpful in differentiating PA, AdCC and PLGA from one another.

Diagnostic utility of endoscopic ultrasound guided aspiration cytology in evaluation of pancreatic masses.

OBJECTIVE: To determine the sensitivity and specificity of endoscopic ultrasound (EUS) guided fine needle aspiration cytology (FNAC) in the evaluation of pancreatic masses. STUDY DESIGN: Analytical study. PLACE AND DURATION OF STUDY: Department of Pathology, Shaukat Khanum Cancer Hospital and Research Centre, from January 2006 to June 2011. METHODOLOGY: Patients of either gender aged above 18 years who underwent EUS guided FNAC of pancreatic masses detected on abdominal CT, were included in the study. Biphasic abdominal CT scans were carried out for all the patients, followed by EUS guided FNAC. All material aspirated for cytologic evaluation was assessed for sample adequacy on-site, followed by formal examination for diagnostic purposes. RESULTS: The mean age of patients tested was 58.94 ± 12.84 years with age ranging from 23 to 78 years. Regarding gender 23/42 (54.76%) patients were male and 19/42 (45.24%) were female. Out of 42 cases, 27 (64%) cases were diagnosed as adenocarcinoma, 4 (9.5%) as benign, 4 (9.5%) as mucinous cystic neoplasm, 2 (4.7%) as chronic pancreatitis, 2 (4.7%) as non-diagnostic, 2 (4.7%) as atypical cells seen and 1 (2.38%) as non-Hodgkin's lymphoma. The results were in full concordance with radiologic findings. CONCLUSION: EUS guided FNA is an excellent procedure for evaluation of pancreatic masses. The overall sensitivity of this procedure is 89% and the specificity is 67%.