Prognostic factors, oncological treatment and outcomes of uterine sarcoma: 10 years' clinical experience from a tertiary care center in Pakistan.

BACKGROUND: Uterine sarcoma is an uncommon aggressive malignancy. Optimal management and prognostic factors have yet to be well recognized due to their rarity and various histological subtypes. This study aims to investigate these patients' prognostic factors, treatment modalities, and oncological outcomes. METHODS: A single-center retrospective cohort study was conducted on all patients diagnosed with uterine sarcoma and treated from January 2010 to December 2019 in a tertiary-care hospital in Pakistan. The data were analyzed using STATA software and stratified on the histological subtype. Survival rates were estimated using the Kaplan-Meier method. Crude and adjusted hazard ratios with 95% CI were estimated using univariate and multivariate analysis. RESULTS: Of the 40 patients, 16(40%) had uterine leiomyosarcoma (u-LMS), 10(25%) had high-grade endometrial stromal sarcoma (HGESS), 8(20%) had low-grade endometrial stromal sarcoma (LGESS) and 6(15%) had other histological subtypes. The median age of all patients was 49 (40-55.5). Thirty-seven (92.5%) patients underwent primary surgical resection, and 24 (60%) patients received adjuvant systemic chemotherapy. The survival plots showed the overall population's DFS of 64 months and the OS of 88 months (p-value = 0.001). The median DFS in all patients was 12 months, and the median OS was 14 months (p-value = 0.001). A small but significant DFS benefit was found in patients who received adjuvant systemic chemotherapy, 13.5 versus 11 months (p-value = 0.001). Multivariate Cox-regression analysis revealed that large tumor size and advanced FIGO stage were substantial factors associated with decreased survival. CONCLUSION: Uterine sarcomas are rare malignancies with poor prognosis. Multiple factors, including tumor size, mitotic count, stage of the disease, and myometrial invasion, impact survival outcomes. Adjuvant treatment may decrease the recurrence rate and improve DFS but do not affect OS.

Secondary involvement of gallbladder by acute lymphoblastic leukemia presenting clinically as cholecystitis in a young patient: a case report.

BACKGROUND: Primary lymphoma of the liver, gallbladder, and extrahepatic bile ducts or secondary involvement of these organs by leukemia is exceedingly rare. Patients with primary lymphoma or leukemic involvement of the biliary tract and liver often present with symptoms and signs of biliary tract obstruction or inflammation. CASE PRESENTATION: We present a case of a 24-year-old male with biliary tract symptoms who underwent laparoscopic cholecystectomy. His precholecystectomy complete blood count performed on the same morning showed 72% lymphocytes while peripheral blood smears showed approximately 15% blasts. Surgeon went ahead with the procedure. Imaging done prior to surgery showed thickened gallbladder, while the liver, biliary tract, and pancreas did not show any thickening or mass lesion. However, the liver was enlarged. Grossly, the gallbladder wall did not show any stones or discrete mass involving the wall. Instead, there was subtle thickening of the gallbladder wall due to diffuse infiltration by the leukemic infiltrate. This lymphoid population reacted with PAX-5 and TdT immunohistochemical antibodies in a diffuse manner confirming precursor B-cell origin. This patient was found to have B-lymphoblastic leukemia involving his bone marrow on further clinical and diagnostic workup. Patient responded well to chemotherapy and is currently on maintenance treatment. He is well 1.5 years after his diagnosis. CONCLUSION: This case highlights a unique and rare scenario where a previously undiagnosed and unsuspected hematologic malignancy initially presented with clinical features of a chronic inflammatory condition involving an abdominal organ owing to secondary involvement by the malignant infiltrate.

Utility of MUC4 in the diagnosis of secretory carcinoma of salivary glands.

Salivary gland tumors are diverse in morphology and both benign and malignant tumors may pose diagnostic challenges especially in small biopsies. Secretory carcinoma (SC) is histologically characterized by microcysts, follicles, solid growth pattern and occasional papillary structures, and absence of zymogen granules. SC is molecularly defined by the presence of novel gene fusion ETV6::NTRK3. Among the positive stains (S100 and mammaglobin), MUC4 is now another promising marker for the diagnosis of SC, that would enable the pathologists to exclude other morphologically close simulators. Aim of this study was to report clinicopathological features and assess utility of MUC4 in the diagnosis of SC. MUC4 was performed on 22 cases of SC. Glass slides were reviewed to record morphological patterns and staining of S100, mammaglobin, DOG1 and MUC4. Age ranged from 9 to 63 years with mean age of 34.41 ± 16.28 years. The male: female ratio was 72.7 %:27.3 %. The majority occurred in major salivary glands. A combination of patterns was seen; microfollicles were the most prevalent (90 %) followed by papillary-cystic and macrofollicles. MUC4 was positive in 19/21 (90 %) cases with almost equal number of 2+ and 3+ staining. MUC4 was negative in all cases of acinic cell carcinoma, polymorphous adenocarcinoma, adenoid cystic carcinoma, salivary duct carcinoma, myopepithelioma and myoeithelial carcinoma, cystadenoma and cribriform adenocarcinoma and all except 3 cases of mucoepidermoid carcinoma tested. Overall sensitivity of MUC4 was 95.4 %, specificity 90 %, p-value being <0.01, positive predictive value 87.5 % and negative predictive value 96.4 %. A characteristic cytoplasmic granular pattern was observed in 76.1 % tumors. S100 and mammaglobin were positive in all the performed cases. DOG1 was positive in 6/11 (28.5 %) tumors. In conclusion, MUC4 is a useful addition to a diagnostic immunohistochemical panel for SC, and to distinguish it from close potential mimickers such as acinic cell carcinoma, especially in practice settings where molecular testing is unavailable.

Thyroid cytology in Pakistan: An institutional audit of the atypia of undetermined significance/follicular lesion of undetermined significance category.

INTRODUCTION: Fine needle aspiration cytology (FNAC), along with thyroid ultrasound, is an important tool in evaluation of thyroid nodules that helps in further management of these patients in making a decision of surgical intervention vs follow-up. The Bethesda System for Reporting Thyroid Cytopathology category III of atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) has risk of malignancy (ROM) ranging from 5% to 15%. The aim of the present study was to describe the frequency of AUS/FLUS in thyroid gland FNACs and the surgical outcomes of these cases. METHODS: The integrated laboratory management system retrieved the thyroid FNACs from 2010 to 2018 and subsequent surgical pathology specimens. For the AUS/FLUS cases, data regarding patient demographics, cytology and histological diagnoses were recorded. The results were tabulated as the overall frequency of AUS/FLUS in thyroid FNACs, cytohistological correlation (benign and malignant) and ROM. RESULTS: Over a period of 9 years, 256 (10.9%) cases out of 2342 thyroid FNACs were reported as AUS/FLUS at our institution. Mean age was 43.5 years. The majority (70.3%) of patients were female. Seventy-two of 104 resection specimens (69.2%) were reported as benign and 32 cases (30.7%) had malignant diagnosis. Upper-bound ROM was 30.7% (32 cases with malignant diagnosis out of 104 resection specimens). Lower-bound ROM was calculated as 12.5% (32 cases with malignant diagnosis out of 256 total AUS diagnosis). CONCLUSION: The AUS/FLUS category of thyroid cytology and associated ROM remain an evolving area. Individual institutions should monitor the frequency and include ROM in the dashboard indicators to remain within the recommended range.

Trends in per-operative parameters and postoperative complications associated with coronary artery bypass graft surgery (CABG); A four-year retrospective study.

OBJECTIVE: To determine the patterns of per-operative parameters and early outcomes of patients that underwent CABG surgery during a four-year period. METHODS: This is a cross-sectional descriptive study conducted in a tertiary care of hospital from November 2020 to January 2021. All the patients that underwent the isolated coronary artery bypass grafting (CABG) procedure were included in the study from June 2017 till June 2020. Data was collected on a data extraction form and stored in SPSS format which was analyzed for qualitative statistics keeping p<0.05 as significant. All the results were represented in the form of tables. RESULTS: A total of 1,613 patients were operated upon for Coronary Artery Bypass Grafting (CABG) procedure during the study period with 1,222 (75.8%) males and 391 (24.2%) females. Dyslipidemia (71.8%) was the most common risk factor. The average perfusion time decreased only slightly (~1 minute) from 96.01 minutes to 95.07 minutes (2017 to 2020). This change however was not significant (p=0.301). The rate of Left Internal Mammary Artery (LIMA) use stayed relatively stable over the 4-year period fluctuating between 88.7% and 92.9% (p=0.360). The average initial ICU stay (in hours), drain at 12 hours and 24 hours stays almost the same. The rate of mortality peaked in 2018 (4.76%) and subsequently fell to 3.57% by 2020. CONCLUSION: More males underwent CABG surgery at this tertiary care hospital and the overall complication rate and per-operative parameters improved over the years. The non-risk stratified mortality in this study was found to be higher than developed nations.

REVIEW- Covid-19: Diagnosis, summary of essays and evolving approaches.

COVID-19 spread worldwide after its outbreak in December 2019. This review paper aims to educate the readers regarding SARS-CoV-2 diagnostic and detection tools and the issues experienced by researchers. We identify on-the-horizon point-of-care diagnostic tests and inspire scholars to develop their innovations past conception. It will also effectively avoid potential pandemics to establish plug-and-play diagnostic information to handle the SARS infection. The authors agree that arbitrary-access, interconnected systems with flexible functionality accessible at the point-of-care, would enable fast and precise diagnosis and tracking.

Calcification and ossification in conventional schwannoma: A clinicopathologic study of 32 cases.

Calcification and ossification are uncommon in schwannomas; however, when present these findings may cause diagnostic confusion with other mesenchymal tumors which more frequently harbor these features. We sought to better characterize the type and rate of calcification and ossification in schwannomas. Cases of schwannoma diagnosed at our institution from 2005 to 2019 were reviewed to determine the type and amount of calcification and ossification present. Of 2116 total cases of schwannoma reported during the study period, 38 cases harbored calcification or ossification per the pathology report. Thirty-two of the 38 cases had slides available for review, of which 27 (84.3%) showed calcification, nine showed ossification (28.1%), and four (12.5%) cases demonstrated both. Foci of ossification typically occurred adjacent to large vessels. Of the 27 cases showing calcification, coarse dystrophic calcification was seen in 22 cases, psammomatous calcification in nine cases, and combined dystrophic and psammomatous calcification was seen in four cases. Cases with psammomatous calcification predominantly occurred in spinal roots and cerebellopontine angle of a younger age group with almost equal gender distribution. All four cases tested for protein kinase cyclic adenosine monophosphate-dependent type I regulatory subunit alpha immunohistochemical stain demonstrated retained expression. We confirm that calcification and ossification are rare findings in schwannoma. Awareness that these features may be present in these tumors will prevent misdiagnosis and ensure appropriate clinical management.

A 10-year review of histopathological findings of enucleated eyes from a tertiary-care center, Pakistan.

OBJECTIVE: To determine the histopathology of enucleated eye specimens. METHODS: The 10-year inventory was conducted at Aga Khan University Hospital, Karachi, and comprised all histopathology reports of enucleated eye specimens received from January 2007 to December 2016 by the Section of Histopathology, Department of Pathology. SPSS 19 was used for data analysis. RESULTS: A total of 232 ocular tissue specimens from 231 patients were evaluated. Ocular tumours were the most common histopathological diagnosis 186(80%). Among tumours, retinoblastoma was the most common 137(59%) followed by malignant melanoma 31(13%) and squamous cell carcinoma 15(6.5%). Overall, 16(6.9%) specimens had degenerative changes secondary to different ocular disorders. Staphyloma and Coat's disease was diagnosed in 3(1.3%) cases each. In 4(1.7%) cases, there was no formal diagnosis. CONCLUSIONS: Early identification of tumours may allow for conservative management and limit the need for enucleations.

Chemical Components and Biological Activities of the Genus Phyllanthus: A Review of the Recent Literature.

Medicinal plants have served humans since prehistoric times to treat various ailments. Both developed and underdeveloped countries rely on traditional systems of medication using natural sources from plants. Phyllanthus is one of the largest genus in the family Phyllanthaceae, comprising over 700 well known species cosmopolitan in distribution mainly in the tropics and subtropics. Phyllanthus species are being in constant used in traditional medications to cure an array of human diseases (constipation, inhalation related, arthritis, loss of appetite, injuries, conjunctivitis, diarrhoea, running nose, common cold, malaria, blennorrhagia, colic, diabetes mellitus, dysentery, indigestion, fever, gout, gonorrheal diseases of males and females, skin itching, jaundice, hepatic disorders, leucorrhea, vaginitis, menstrual irregularities, obesity, stomach pains, and tumors), confectionaries, food industry, and in some pesticides. Phyllanthus species are rich in diversity of phytochemicals e.g., tannins, terpenes, alkaloids, glycosidic compounds, saponins, and flavones etc. More in depth studies are a direly needed to identify more compounds with specific cellular functions to treat various ailments.

Decompressive Hemicraniectomy for Malignant Middle Cerebral Artery Stroke: South Asian Experience.

BACKGROUND: The randomized trials showed improved outcome and reduced mortality in malignant middle cerebral artery (MMCA) undergoing Decompressive hemicraniectomy (DHC) within 48 hours of stroke onset. Despite high prevalence of stroke, especially in younger individuals, high and short-term mortality from stroke in South Asian and Middle East, there is little published data on DHC in patients with MMCA stroke. METHODS: This is a retrospective, multicenter cross-sectional study to measure outcome following DHC using the modified Rankin Scale (mRS) and dichotomized as favorable (mRS ≤ 4) or unfavorable (mRS > 4), at 3 months. RESULTS: In total, 137 patients underwent DHC. At 90 days, mortality was 16.8%; 61.3% of patients survived with an mRS of 4 or less and 38.7% had an mRS greater than 4. Age (55 years), diabetes (P = .004), hypertension (P = .021), pupillary abnormality (P = .048), uncal herniation (P = .007), temporal lobe involvement (P = .016), additional infarction (MCA + anterior cerebral artery, posterior cerebral artery) (P = .001), and infarction growth rates (P = .025) were significantly higher in patients with unfavorable prognosis in univariate analysis. Multivariate analysis showed age, additional infarction, septum pellucidum deviation greater than 1 cm, and uncal herniation to be associated with a significantly poor prognosis. Time to surgery had no impact on outcome (P = .109). CONCLUSIONS: Similar to the results of the studies from the West, DHC Improves functional outcome in predominantly South Asian patients with MMCA Stroke.

Schwannomas with pseudoglandular elements: clinicopathologic study of 61 cases.

Schwannomas are benign neoplasms of peripheral nerve sheath. A number of morphologic variants of schwannoma have been described. The pseudoglandular variant is very rare. We retrieved and reviewed hematoxylin and eosin slides of all cases of schwannoma reported between 2007 and 2014 to look for pseudoglandular elements. Pseudoglandular cystic spaces were seen in 61 (6.3%) of 971 schwannomas diagnosed during the study period. Of these 61 cases, 56 (91.8%) were located in the spinal nerve roots. The majority (60.6%) were male. Mean age in these 61 cases was 41 years. Mean tumor size was 3.5 cm. All 61 cases showed typical Antoni A and Antoni B areas with multiple pseudoglandular cystic spaces scattered throughout. These areas were lined by flat to cuboidal cells which showed positivity for immunohistochemical stain S-100 and were negative for epithelial membrane antigen. An average of 7 pseudoglandular cystic spaces was noted per case. In conclusion, pseudoglandular cystic spaces are lined by Schwann cells and most likely represent degenerative changes in schwannoma probably degenerated Verocay bodies. They are rare albeit well-defined features seen in a significant though small number of schwannomas. It is important not to mistake them for other neoplasms. Larger studies are required to determine predilection of these changes in spinal nerve root schwannomas as seen in our series.

Peripheral T-cell lymphoma presenting as testicular mass; a diagnostic challenge.

BACKGROUND: T-cell lymphomas involve the testis infrequently, which deserve special attention because of the poor prognosis and the need to make an appropriate diagnosis, which could lead to a better therapeutic strategy. CASE PRESENTATION: A 40-year-old man presented with right testicular swelling for past three months. The swelling was painless, hard and rubbery. Testicular ultrasound showed diffuse increase in size of the testicle, with alteration in its echogenicity. The patient underwent orchidectomy, and based on histopathological and immunohistochemical tests, a peripheral T-cell lymphoma, not otherwise specified was diagnosed. CONCLUSION: Testicular peripheral T-cell lymphomas are rare and aggressive cancers, with clinical differentials of seminoma and non-neoplastic conditions.

Sinonasal teratocarcinosarcoma: a clinicopathologic and immunohistochemical study of 6 cases.

Teratocarcinosarcoma (TCS) is a rare and unusual malignant neoplasm of the sinonasal tract with a heterogenous morphology and an aggressive behavior. Patients are predominantly adults with a male predominance. The aim of this study was to describe clinicopathologic and immunohistochemical features of 6 cases of TCS. The ages ranged from 18 to 67 years (mean, 33 years) with a male-to-female ratio of 5:1. Most tumors were located in the nasal cavity. Nasal obstruction and epistaxis were the common presenting symptoms. Histologically, all tumors exhibited a heterogeneous morphology with varying proportions of benign and malignant epithelial, mesenchymal, and neuroepithelial elements. Adenocarcinoma was the malignant epithelial component in all cases. The mesenchymal elements were composed of benign to malignant spindle cells. Osteosarcomatous areas were seen in 2 cases and rhabdomyosarcoma in 1 case. Rhabdoid differentiation was also seen in 1 case. Immunohistochemical stains CKAE1/AE3 and CK Cam 5.2 were positive in the epithelial elements, vimentin in mesenchymal, and CD56 and neuron-specific enolase in neuroepithelial elements. Follow-up was available in 4 patients and ranged from 21 to 40 months (mean, 31 months). Lung and dura metastasis, respectively, were seen in 1 patient each. However, all 4 patients are alive and free of disease to date. In conclusion, TCS is a rare but highly malignant tumor with aggressive behavior characterized by benign and malignant epithelial, mesenchymal, and neuroepithelial components. Two patients in our series were younger than 20 years. The occurrence of rhabdoid differentiation and osteosarcomatous component seen in our series were rarely described in literature. Recognition of all the components requires adequate sampling, which is crucial for a correct diagnosis.

Anaplastic Large-cell Lymphoma Involving Gastrointestinal Tract: A Clinicopathologic Study of 25 Cases of a Rare Tumor at a Rare Site.

Background. Anaplastic large-cell lymphoma (ALCL) is an uncommon lymphoma divided into anaplastic lymphoma kinase (ALK) positive, ALK negative, and breast implant-associated (BIA) ALCL. Gastrointestinal tract involvement is very rare and may be difficult to diagnose. Its recognition is crucial as prognostic ramifications are different. Objectives. To describe clinicopathological features of ALCL involving the gastrointestinal tract. Materials and Methods. Slides were reviewed. Diagnosis was confirmed. Histological and immunohistochemical features were described. Results.Twenty-five tumors were diagnosed during the study period. Ages ranged from 14 to 65 years (mean 41 years). Mean age for ALK-negative and ALK-positive patients were 49 and 17 years, respectively. Twenty-one were males and 4 were females. Eighteen involved small intestine. Mean tumor size was 4.2 cm. All showed diffuse sheets of large anaplastic cells with pleomorphic nuclei, abundant pink cytoplasm, and strong positivity for CD30. Epithelial membrane antigen was positive in 17 tumors and keratin was negative in all. Eighteen tumors were ALK negative. Out of 14 patients with follow-up, 12 died within a few months of diagnosis. Seven had stage IE, 5 had stage IIE, and 2 had stage IV disease. Two patients were alive at 35 and 60 months. Twelve received chemotherapy. Conclusion. A marked male predominance was noted. Small intestine was the commonest site of involvement. Majority were ALK negative. ALK-negative tumors occurred in older patients and ALK positive in younger patients. Prognosis was poor. ALCL should be included in the differential diagnosis of anaplastic epithelioid cell neoplasms in the gastrointestinal tract.

Ki-67 Quantification in Breast Cancer by Digital Imaging AI Software and its Concordance with Manual Method.

OBJECTIVE: To validate the concordance of automated detection of Ki67 in digital images of breast cancer with the manual eyeball / hotspot method. STUDY DESIGN: Descriptive study. Place and Duration of the Study: Jinnah Sindh Medical University, Karachi, from 1st January to 15th February 2022. METHODOLOGY: Glass slides of cases diagnosed as invasive ductal carcinoma (IDC) were obtained from the Agha Khan Medical University Hospital, selected retrospectively and randomly from 60 patients. They were stained with the Ki67 antibody. An expert pathologist evaluated the Ki67 index in the hotspot fields using eyeball method. Digital images were taken from the hotspots using a camera attached to the microscope. The images were uploaded in the Mindpeak software to detect the exact percentage of Ki67-positive cells. The results obtained through automated detection were compared with the results reported by expert pathologists to see the differential outcome. RESULTS: The manual and automated scoring methods showed strong positive concordance (p <0.001). CONCLUSION: Automated scoring of Ki-67 staining has tremendous potential as the issues of lack of consistency, reproducibility, and accuracy can be eliminated. In the era of personalised medicine, pathologists can efficiently give a precise clinical diagnosis with the support of AI. KEY WORDS: Artificial intelligence, Algorithms, Breast cancer, Deep learning, Image detection, Ki-67.

Hybrid odontogenic lesions: A case series of a rare entity.

Background: The occurrence of hybrid odontogenic lesions with two or more morphologically distinct components is a rare phenomenon and poses a diagnostic challenge. We aimed to study the clinical, radiological, and pathological features and behavior of hybrid odontogenic lesions, to enhance awareness about these rare lesions. Method: Hematoxylin and Eosin slides of hybrid odontogenic lesions diagnosed between January 01, 2012 and December 31, 2020, were reviewed. Demographic and radiological information were obtained from the patient's medical records. Results: 8 cases were diagnosed with a mean age of 19.1 years and male to female ratio of 1:1.7. Involvement of mandible was more common (n = 5) as compared to maxilla (n = 3). All patients presented with swelling for an average of 9.75 months (3-25 months) duration. Bleeding, loose teeth, pain and facial asymmetry were reported in 5,3, 3, and 2 cases, respectively. Radiologically, 7 cases were well demarcated, 75% cases (n = 6) were radiolucent, and average radiological size was 4.8 cm. All patients were managed with surgery alone. 5 cases (62.5%) underwent enucleation and curettage, while local excision, en-block resection and segmental mandibulectomy were performed in 1 case each. Histologically, ossifying fibroma/cemento-ossifyiong fibroma were the most lesion, occurring in 5 cases (62%), followed by giant cell granuloma like lesions (GCG) i.e., central and peripheral giant cell granuloma (n = 3), Adenomatoid Odontogenic tumor (AOT) (n = 2), and DC (n = 2), ameloblastic fibroma (AF) (n = 1), Ameloblastoma (n = 1), calcifying odontogenic cyst (COC) (n = 1), and complex odontoma (n = 1). No evidence of recurrence was noted after 4-99 months of surgery (mean: 32.9) in cases with available data (n = 7). Long-term complaints included facial asymmetry (n = 2) and pain (n = 1). Conclusion: Most hybrid odontogenic lesions affect young females in the second decade of life and commonly show COF and OF as hybrid components. A conservative approach to management appears adequate.

Solitary fibrous tumor of head and neck region; A clinicopathological study of 67 cases emphasizing the diversity of histological features and utility of various risk stratification models.

BACKGROUND: Head and neck SFT (HNSFT) exhibit diverse histological features and can mimic various neoplasms with different treatment and behavior. While risk stratification systems have been developed for this tumor at various anatomic sites, a specific scheme for head and neck tumors is lacking. Our aim was to describe the histologic patterns present in HNSFT cases as well as assess the utility of risk assessment models in this location. METHODS: A retrospective review of pathology reports and microscopy glass slides of HNSFT cases diagnosed between January 2010 and August 2022 was performed.STAT6 was additionally performed on selected cases if needed. Follow up was obtained and various risk stratification models were applied. RESULTS: Sixty seven cases of HNSFT were collected (age range from 11 to 87 years; median 42 years; M:F 1.6:1). Most common tumor sites were orbit (n = 21; 31.3 %), sinonasal tract (n = 18; 26.9 %), and oral cavity (n = 13; 19.4 %). Tumor size ranged from 1 to 16 cm (median 4cm). Apart from common histological features, tumor cells also showed focal epithelioid morphology, clear cell change and nuclear atypia in a subset of cases. Stromal findings included myxoid and lipomatous change, pseudoglandular spaces, pseudovascular spaces and multinucleated stromal giant cells. CD34 and STAT6 were expressed in 57/67 (85.1 %) and 56/56 (100 %) cases, respectively. Recurrence was observed in 4/26 (15.4 %) cases, while none (0/22) of the patients experienced distant metastasis (follow up 1-150 months; median 20.5 months). Clinical outcome was partially concordant with risk-categories of different risk stratification models. CONCLUSION: Knowledge about histological diversity of HNSFT is essential for establishing correct diagnosis. Current risk stratification models do not perfectly predict outcome, and larger studies are needed to develop more accurate criteria for aggressive behavior.

Extranodal Follicular Dendritic Cell Sarcoma of the Head and Neck Region: A Clinicopathological Study of 7 Cases.

Background. Follicular dendritic cell (FDC) sarcoma is a rare neoplasm arising from follicular dendritic cells (FDCs). It can be nodal or extranodal. Histological diagnosis of extranodal FDC sarcoma in the head and neck region is challenging and a significant percentage are misdiagnosed. Objectives. To report clinicopathological features of head and neck extranodal FDC sarcoma cases and discuss differential diagnoses. Methods. Seven head and neck extranodal FDC sarcomas were retrieved and clinicopathological features were noted. Results. Two tumors each involved parapharyngeal space and tonsil while remaining cases involved the parotid, soft tissue of neck and oropharynx. Age range was 12 to 79 years (mean and median age were 40 and 44 years respectively) and there was a male predilection (6 males: 1 female). All showed spindle to ovoid cells arranged in fascicles, whorls and/or storiform pattern. Mitoses ranged from 3 to 20/mm2. All tumors expressed CD21 and CD23. Two patients died of their disease at 9 and 16 months. Both had tumors larger than 5 cm with ≥10 mitoses/mm2. Three patients were alive at 12, 44 and 184 months. Conclusions. There was a distinct male predominance in our cohort. FDC sarcoma should be included in the differential diagnosis of spindle cell extranodal neoplasms in the head and neck with a whorled growth pattern and intratumoral lymphocytes. Head and neck region tumors show similar clinicopathologic characteristics as their counterparts at other locations with potential for aggressive behavior especially in tumors greater than 5 cm in size and with high mitotic rates.

Use of a Novel Deep Learning Open-Source Model for Quantification of Ki-67 in Breast Cancer Patients in Pakistan: A Comparative Study between the Manual and Automated Methods.

Introduction: Breast cancer is the most common cancer in women; its early detection plays a crucial role in improving patient outcomes. Ki-67 is a biomarker commonly used for evaluating the proliferation of cancer cells in breast cancer patients. The quantification of Ki-67 has traditionally been performed by pathologists through a manual examination of tissue samples, which can be time-consuming and subject to inter- and intra-observer variability. In this study, we used a novel deep learning model to quantify Ki-67 in breast cancer in digital images prepared by a microscope-attached camera. Objective: To compare the automated detection of Ki-67 with the manual eyeball/hotspot method. Place and duration of study: This descriptive, cross-sectional study was conducted at the Jinnah Sindh Medical University. Glass slides of diagnosed cases of breast cancer were obtained from the Aga Khan University Hospital after receiving ethical approval. The duration of the study was one month. Methodology: We prepared 140 digital images stained with the Ki-67 antibody using a microscope-attached camera at 10×. An expert pathologist (P1) evaluated the Ki-67 index of the hotspot fields using the eyeball method. The images were uploaded to the DeepLiif software to detect the exact percentage of Ki-67 positive cells. SPSS version 24 was used for data analysis. Diagnostic accuracy was also calculated by other pathologists (P2, P3) and by AI using a Ki-67 cut-off score of 20 and taking P1 as the gold standard. Results: The manual and automated scoring methods showed a strong positive correlation as the kappa coefficient was significant. The p value was <0.001. The highest diagnostic accuracy, i.e., 95%, taking P1 as gold standard, was found for AI, compared to pathologists P2 and P3. Conclusions: Use of quantification-based deep learning models can make the work of pathologists easier and more reproducible. Our study is one of the earliest studies in this field. More studies with larger sample sizes are needed in future to develop a cohort.

Empathy Levels in Medical Students: A Single Center Study.

Objectives To determine the level of empathy in medical students and to determine the difference in empathy levels between the two genders in a single center. Materials & methods This qualitative study was conducted at a medical college in Peshawar from March 2021 to July 2021. Institutional ethical committee approval was taken (RMI/RMI-REC/Approval/83) before commencing the study. All students admitted into the medical college in the current academic year 2020 to 2021 were included in the study. Any students that did not fill out the questionnaire completely were excluded. The Toronto Empathy Questionnaire (TEQ) was used in this study. The questionnaire was uploaded on google forms for data collection. All the resulting scores were entered into IBM SPSS version 23.0. The mean TEQ score was calculated. Box and whisker plots were made for respective years. An Independent sample t-test was used to determine the association between mean TEQ scores and gender. Results Of 367 students, 347 (94.6%) participated in this study, with a slight female predominance (53%). The mean age of the students was 21.44 (SD = 1.751) years. The participation rate was ≥70% from each class. Most participants across the years have an above-average empathy score (49.9%). Among the participants, the year I (67.6%) showed most participants with high empathy. Year IV (40.6%) has the highest proportion of below-average empathy scores. The mean empathy score of female students was 49.08 (S.D = 7.588), while the empathy score for male students was 44.59 (S.D = 7.58). Conclusion Empathy levels decline as medical education is progressed through the years. Females show a greater sense of empathy than their male counterparts. A slight increase in empathy levels is seen in the final year of medical school after a decline over the initial years.