Ameliorative Effects of Alpha-tocopherol in Carboplatin Induced Toxicity on Histomorphology of Renal Cortex in Rats.

OBJECTIVE: To evaluate the histomorphological response of alpha-tocopherol co-administration with carboplatin chemotherapy. STUDY DESIGN: A laboratory-based experimental study. Place and Duration of the Study: Anatomy Department, Army Medical College / National University of Medical Sciences (NUMS), Rawalpindi, Pakistan, from January to December 2021. METHODOLOGY: Thirty adult Sprague-Dawley rats were divided into three groups of ten rats each. Control group A received normal diet and water, experimental group B was administered single injection of carboplatin 2.5 mg/Kg intraperitoneally; and experimental group C along with carboplatin injection also received alpha-tocopherol 62.7 mg/Kg daily. At the end of 12 weeks, the euthanasia of animals was done and kidneys were dissected out. Right-sided kidneys were stained with Haematoxylin and Eosin. Micrometry was done to measure the diameters of renal cortical tubules and renal corpuscles. RESULTS: The proximal and distal tubular and luminal diameter and transvertical diameter of renal corpuscle were increased in group B as compared to control group A. In group C, the proximal and distal tubular diameters were 5.175 ± 0.39 µm and 3.88 ± 0.364 µm, respectively; proximal and distal luminal diameters were 2.67 ± 0.35 µm and 1.64 ± 0.24 µm, respectively and transvertical diameter of renal corpuscle was 12.16 ± 0.870 µm. These values were less than experimental group B and closer to that of control group A. CONCLUSION: Renal microscopic parameters showed improvement in the group administered with alpha-tocopherol. Therefore, alpha-tocopherol has ameliorative effects on carboplatin-induced renal damage. KEY WORDS: Alpha-tocopherol, Carboplatin, Renal corpuscle, Tubules.

Gastric metastasis before diagnosis of primary invasive lobular breast carcinoma: a rare case presentation from Pakistan.

Metastatic spread of invasive lobular breast carcinoma to stomach is rare especially before diagnosis of primary breast cancer. Incorrect diagnosis might result in delay of appropriate treatment for breast cancer. Recognition of this possibility enables better clinical management. A 62-year-old female presented with upper gastrointestinal symptoms and weight loss and was referred to a gastroenterologist for investigation. At the time of initial diagnosis of stomach cancer, patient was asymptomatic for breast cancer. Multiple gastric biopsies taken showed features suspicious of metastatic breast cancer. Consequently, the initial provisional diagnosis of stomach cancer changed into metastatic invasive lobular breast carcinoma. These findings were corroborated radiologically. The patient was treated with letrozole and zoledronic acid as first-line therapy for one year. Residual metastatic breast cancer was present in the gastric mucosa. The patient was treated with endocrine therapy containing ribociclib and treatment was ineffective confirmed by PET-CT scan. But her symptoms have resolved completely despite her presentation with stage IV. We present rare case of initial presentation of gastric metastasis before diagnosis of a primary invasive lobular breast carcinoma. Correct diagnosis and appropriate treatment were accomplished through initial clinical suspicion, accurate histological examination, and endoscopy together with analysis of disease-specific biomarkers.

Histopathological and Immunohistochemical Analysis of Small Intestinal Biopsies in Adults Suspected of Celiac Disease.

OBJECTIVE: To analyse histomorphological and immunohistochemical analysis of small intestinal biopsies in adults suspected of celiac disease. STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Department of Histopathology, Army Medical College, Rawalpindi, from November 2014 to December 2015. METHODOLOGY: Fifty cases of small intestinal mucosal biopsies (duodenal and jejunal) were analysed in adult patients aged above 14 years suspected of celiac disease. Their histomorphological data was recorded using Modified Marsh Criteria. Type of intraepithelial lymphocytes was assessed using immunohistochemistry. Intraepithelial lymphocytes were counted both by H&E stain and immunostain CD3 and CD20. RESULTS: Thirty-four percent patients were aged between 21 - 30 years and 22% patients aged between 41 - 50 years. There were 84% (n=42) males. Thirteen (26%) cases showed focal villous atrophy, 32 (64%) cases showed partial villous atrophy and 5 (10%) cases showed complete villous atrophy. Anti-tissue transglutaminase antibody was positive in 21 (42%) cases. CD3 immunomarker was positive for intraepithelial lymphocytes in all 50 cases while CD20 immunomarker showed focal positivity in areas with lymphoid follicle formation. The count of intraepithelial lymphocytes was found to be almost equal (with a difference of 3 - 4 lymphocytes) on both H&E stain and immunostain CD3 and CD20. CONCLUSION: Males aged 21 - 30 years were the most commonly affected group. The most frequent change in histology was partial villous atrophy along with lymphocytic enteritis. All the intraepithelial lymphocytes were present in crescendo pattern of distribution.

Correlation of 13C urea breath test values with Helicobacter pylori load among positive patients.

BACKGROUND/AIMS: 13C urea breath test (13C UBT) is used to detect Helicbacter (H.) pylori in gastric mucosa. There are controversial results regarding associations of 13C UBT values with histopathological grades. We designed this study to correlate 13C UBT values with different histopathological grades in our local setting. METHODOLOGY: 13CO2/12CO2 ratio for 13C UBT was analyzed using mass spectrometry and histopatholgical grades were scored by updated Sydney System. RESULTS: 13C UBT values of H. pylori positive patients at different times (T10-T60) were higher as compared to negative patients. Significant positive correlation of 13C UBT values at T30 with different scores of H. pylori load (r = 0.277, p = 0.037) was observed. Associations of the mean 13C UBT values with neutrophil infiltration (p = 0.214), mononuclear cell infiltration (p = 0.648), atrophy (p= 0.620), atypia (p = 0.057) and metaplasia scores (p = 0.718) were found to be nonsignificant. H. pylori load significantly correlated with neutrophil infiltration and atrophy with exception of mononuclear cell infiltration, atypia and metaplasia. CONCLUSIONS: In the present analysis, significant positive correlation was observed between 13C UBT values and H. pylori load that would be helpful in qauntification of H. pylori in our local setting.

Diagnostic accuracy of endometrial curettage in endometrial pathology.

BACKGROUND: Abnormal uterine bleeding is one of the most frequent problems in life of an adult female. Uterine curettage or biopsy remains a preferred sampling procedure for diagnosis of the endometrial pathology. The objective of this study was to compare the sensitivity, specificity, positive and negative predictive value of endometrial curettage. PATIENTS AND METHODS: This validation study was carried out at the Department of Histopathology, Army Medical College Rawalpindi in collaboration with Military Hospital, Rawalpindi from January to December 2010. The study included 50 curettage and subsequent hysterectomy specimen of the same patients. Non-probability sampling technique was used to divide patients into two groups with 50 patients in each group. One group was of endometrial curettage having endometrial pathology (group A). Second group was of subsequent hysterectomy specimen of the same patients (group B). RESULTS: Endometrial curettage was found most accurate in diagnosing endometrial carcinoma. Sensitivity of endometrial curettage was found to be 33% whereas specificity and positive predictive value was found to be 100% each. Negative predictive value was found to be 93.1%. CONCLUSION: Endometrial biopsy is a sensitive and a specific test in and is accurate in diagnosing endometrial pathology. It is found most accurate in diagnosing endometrial carcinoma.