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Objective: To study the prevalence and characterization of primary non Hodgkin′s lymphoma of bone in a major referral center of Pakistan. Methodology: All cases of primary non Hodgkin′s lymphoma of bone, diagnosed at a referral center in Pakistan from January 1998 to July 2008 have been included. Patients with diagnosis of lymphoma at some other site prior to diagnosis in bone biopsy were excluded from the study. Results: Sixty cases of primary non Hodgkin′s lymphoma of bone were received, with a male to female ratio of 7: 3 (42 males and 18 females). Overall, 52/60 (86.6 %) patients were diagnosed with Diffuse large B-cell non-Hodgkin′s lymphoma. The largest fraction of patients was found in the pediatric group i.e. 33/60(55%) followed by elderly group i.e.15/60 (15%) and adults i.e. 12/60 (20%). The commonest sites of involvement were femur (28.3 %), hip bone (16.6%) and humerus (10%). Conclusion: Diffuse large B-cell lymphoma is the commonest type of primary non Hodgkin′s lymphoma of bone in the Pakistani population. It is common in all ages. The sites most often involved are femur followed by hip bone. Primary non Hodgkin′s lymphoma of bone appears to be more common in males. Our results are comparable to international data with various studies also showing that diffuse large B cell non Hodgkin lymphoma is the commonest primary bone lymphoma. However, primary Bone Lymphoma is more common in children and young adults.

Introduction: Breast carcinoma is the most common malignant tumor and the leading cause of cancer death in women. In western countries, a sharp increase in the detection of breast carcinoma, largely due to widespread use of mammography, has recently led to a fall in breast cancer mortality. This, however, is not true for less developed countries, in which mortality continues to rise. Objective: The aim of this study was to acquire information about the extent and spread of breast carcinoma in our patients by grading the tumors, determining the tumor size, and axillary lymph node status, staging of the tumors and Nottingham Prognostic Index (NPI) scoring on the available material. Materials and Methods: One hundred and twenty consecutive mastectomy specimens with axillary lymph node sampling removed for breast carcinoma and received in the section of histopathology, Aga Khan University, in the year 2005, were included in the study. Standard protocols were used for the processing of the specimens, and reporting was done using a standard format incorporating all relevant tumor parameters. NPI was applied to the cases. Results: Out of the 120 cases, 5 (4.17) were grade 1, 91 (75.83) were grade 2, and 24 (20%) were grade 3. Also, 9 cases (7.5%) were T1 (4 were T1b, and 5 were T1c); 53 (44.16%) were T2; 50 (41.66%) were T3; and 8 (6.66%) were T4. Axillary lymph nodes were available in 107 cases. In 13 cases, no lymph nodes were recovered. Out of 107 cases 27 (25.23%) lymph nodes were negative for metastases pN0; 29 (27.10%) cases were pN1; 26 (24.30) were pN2; and 25 cases (23.36%) were pN3. Extranodal spread was present in 56 (70%) out of the 80 cases in which lymph nodes were positive. The average microscopic size of nodal metastasis was 1.7 cms. Significant statistical association was found between the number of positive nodes and perinodal extension (P = 0.001). Tumor necrosis was present in 76 out of 120 cases (63.33%). Vascular invasion was present in 43 out of 120 cases (35.83%). NPI scores were greater than 5.4 in 60 out of 107 cases (56.1%) indicating poor prognosis. Conclusion: The large majority of the cases were grade 2 tumors. Most cases (all grades) were T2 or T3, and were axillary lymph node positive. Large majority of cases with nodel metastases showed extra nodal spread. The majority of patients had NPI scores greater than 5.4 indicating poor prognosis. Significant statistical association was found between the number of positive nodes and perinodal extension (P = 0.001). The findings show extensive and advanced disease trends in our patients.

Malignancy arising in mixed tumors of the salivary gland is a distinct entity that can occur sporadically or in association with a background of pleomorphic adenoma. Carcinoma arising with a background of pleomorphic adenoma is well documented. However, there are rare occurrences of aggressive de novo carcinosarcomas of the parotid that have been reported. Various cell lineages such as the epithelial glandular cells and the stromal spindle cells are involved. We report 23 cases of tumors of the salivary gland comprising 18 cases of carcinoma ex pleomorphic adenoma, four cases of carcinosarcoma of the parotid and one case of benign metastasizing pleomorphic adenoma. The occurrence of various malignancies suggests that this phenomenon is not very uncommon and should be looked for when reporting a mixed tumor.

Background: Sex-cord-stromal tumors of the ovary are rare neoplasms and they differ from the common surface epithelial tumors in clinical and imaging features. Patients and Methods: This study was done to evaluate the morphologic and immunohistochemical pattern of 16 cases of sclerosing stromal tumor of the ovary diagnosed at a tertiary care hospital. All patients having sclerosing stromal tumor of the ovary were included with the help of medical records using the SNOMED coding system over 10 year period i.e. 1998 to 2008. Result: Sixteen cases of the stromal tumor of the ovary were diagnosed over this 10 year period; the age range was 23 to 40 years (median age 28). In 7 out of 16 cases, serum CA 125 level was done which was raised as per the available medical records. All of these cases showed unilateral. The gross appearence of all the tumors was similar and all had unilateral involvement. Mucin was negative in all of these cases.

Background: For every practicing histopathologist, improvement of diagnostic accuracy is an important objective. Personal consults are an important component of quality control (QC)/quality assurance (QA) in our Section of Histopathology. In addition, the College of American Pathologists recommends a daily in-house consensus conference, which is a prospective system by which all difficult and problematic cases are reviewed and discussed and signed out by consensus. Design: In-house consensus conference is held daily using a multi-headed microscope. This collegial session is run by the seniormost consultant in the section and is attended by all histopathology consultants and residents. The consultants and residents present cases of their choice for discussion. The cases may be selected due to diagnostic difficulty, unusual nature of a case, management purposes such as performance of additional biopsies, special studies, etc., or request on the part of clinician or patient. Cases may be shown once or, in case of lack of consensus or difficulty in diagnosis, more than once after additional work-up suggested by the conference. Results: In a 4-month period, 774 (4.1%) cases of a total of over 14,000 well-mixed surgical cases were brought to the in-house daily consultation conference. Four hundred ninety-three cases (63.7%) were conclusively decided the first time while 198 cases (25.5%) were decided by consensus after being shown twice. In 83 cases (10.7%), a definite diagnosis could not be given. The cases on which a definite diagnosis was not possible represents 0.59% of all cases received in the department during the study period. The most common cases were shown from the gastrointestinal tract (115 cases or 14.8%), lymph nodes (110 cases or 14.2%) and soft tissue (82 cases or 10.6%). In most cases in which a definite diagnosis could not be given, the main reason was scanty material or crushed nature of the tissue. Conclusion: The in-house daily consensus conference is an extremely useful QC/QA exercise, which is very important in reaching an accurate diagnosis in difficult and challenging cases and minimizing diagnostic errors.

Soft tissue neoplasms of breast thought to be derived from Myofibroblasts have been classified as myofibroblastomas. Myofibroblasts are spindle shaped mesenchymal cells derived from fibroblasts. These are rare neoplasms (more often seen in the male breast) and have same structural and immunohistochemical characteristics as those of solitary fibrous tumors. We present a case of an adult female presenting as firm breast lump diagnosed as myofibroblastoma and confirmed by diffuse positivity of CD34 immunohistochemical stain.

Objective: To evaluate the frequency of semen parameters in male partners of in sub-fertile couples. Study Design: Cross-sectional study. Setting: Department of Gynaecology, Bakhtawar Ameen Hospital, Multan. Period: July 2019 to July 2020. Material & Methods: Infertile couples from at least 12 months were selected for study. A team of Gynaecologist, andrologist and endocrinologist assessed the couples. In male partner, general physical examination, endocrine factor, genetic assessment, accessory gland infection and testicular dysfunction were evaluated. Semen sample was sent to laboratory for semen analysis. Results: In a total of 169 sub-fertile couples, the mean age of male and female partner were 37.98±4.54 years and 32.51±3.78 years respectively. Mean duration since marriage was 5.17±4.51 years. Abnormal semen parameters such as azoospermia, oilgo-azoospermia, asthenozoospermia, teratozoospermia and aspermia were noted 21 (12.4%), 26 (15.4%), 48 (28.4%), 18 (10.7%) and 10 (5.9%) subjects respectively. There were 46 (27.2%) subjects with normal semen parameters. Conclusion: Most of the male sub-fertile subjects had asthenozoospermia. More than one fourth of the subjects had normal semen parameters. [ABSTRACT FROM AUTHOR]

Background: The second premolar is one of the teeth which are crucial both aesthetically as well as functionally and one of the most commonly endodontically treated tooth. Aim of the study was to assess the number of canals in maxillary second premolar by clinical and radiographic evaluation in Pakistani sub population. It was a cross sectional study conducted in Endodontic Department of Rehmat Memorial Dental Teaching Hospital, Abbottabad, from January 2019 to January 2020. Method: One hundred and five patients were selected for the study, based on nonprobability sampling technique. All patients were examined clinically by exploration of pulp chamber followed by intra oral peri-apical radiograph to verify the clinical exploration of canals. Result: One hundred and five patients (46 males (43.8%) and 59 females (56.2%)} were selected for the study. Out of total 105 patients 47 (44.8%) had one canal and 58 (55.2%) had two canals. Out of 46 males 25 (54.3%) had two canals and out of 59 females 33 (56.9%) had two canals. Statistical analysis showed no significant difference (p=0.1871) of canals arrangements between genders. Conclusion: Clinicians should be careful whenever doing root canal treatment of maxillary second premolars because of the extreme variability of the anatomy of those teeth, there is always risk of missing the second canal. Frequency of two canals was high, which is not age or gender dependant. [ABSTRACT FROM AUTHOR]

The Critical Terrorism Studies (CTS) community has produced an important volume of work assessing and critiquing epistemological understandings of the War on (of) Terror. Largely missing from this body of work, however, is the experience of those who are directly impacted by the policies of this global phenomenon. By rethinking the War on Terror as an experience of war, I posit a wider understanding, by reassessing its temporal and spatial boundaries, but more significantly, the ways in which it is experienced. By providing a wider understanding of war and expanding our knowledge of its boundaries, I am able to show that those impacted by the policies of the War on Terror can claim to have been subject to an experience of war, even when that experience takes place outside of the war zone. This reflection, however, serves a larger purpose, which is to act as a call to the CTS community to centre the lived experiences of those impacted by the War on Terror in their work and decision-making when engaging with policy and policymakers. This represents a call for an ethical re-centring of CTS scholars to the violence of the War "of" Terror, by reminding us of the many ways in which harm can occur. [ABSTRACT FROM AUTHOR]

Background: Collaborative orthodontic-endodontic approaches are vital in addressing complex dental cases. However, existing literature reveals a notable dearth in understanding and implementing this approach among dental practitioners. Objective: This study aimed to bridge the gap in understanding current practices among dental practitioners, fostering enhanced patient care and ethical standards. This cross-sectional survey, conducted from September 1st to 30th, 2023, involved distributing a validated questionnaire to dental practitioners in the Hazara Division, yielding 96 responses from 105 visited clinics and 44 from hospitals. Descriptive statistics were used for frequencies and percentages using SPSS version 23. Methodology: The survey involved 78.6% general dentists, 13.6% orthodontists, and 7.9% endodontists. Varying levels of correct responses were observed for the knowledge-based questions. Results: Positive attitudes were seen, with 70% of respondents expressing an interest in enhancing knowledge through educational programs, and 73% agreeing to adhere to interdisciplinary guidelines. Furthermore, 79.3% of practitioners had experience treating cases requiring both orthodontic tooth movement and endodontic therapy. Conclusion: Notably, orthodontists and endodontists showed higher percentages of accurate responses compared to general dentists. In conclusion, this study underscores the need for improved education, standardized protocols, and better patient communication for effective interdisciplinary dental care specifically in general dental practitioners. [ABSTRACT FROM AUTHOR]