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Objective: To audit basal cell carcinoma resections against standard guidelines., Methods: The retrospective study was done at the Department of Pathology, Sherwood Forest Hospital, Nottinghamshire, United Kingdom, from July 2020 to December 2020 and comprised basal cell carcinoma cases regardless of age and gender. All parameters laid down by the Royal College of Pathologists were matched with the data. Also, incompletely resected specimens were separated, and reasons for incomplete resection were taken into account, and compared with the British Association of Dermatologists 2018 guidelines., Results: Of the 100 consecutive cases, 67(67%) were nodular and nodulocystic, 8(8%) were superficial multifocal, 7(7%) each were infiltrative and mixed nodular and infiltrative, 6(6%) were mixed nodular and superficial, and 5(5%) were mixed superficial and infiltrative. All 100(100%) pathology reports contained the mandatory information set by the Royal College of Pathologists. There were 7(7%) incompletely excised cases. The rate of incomplete excision was also within the acceptable range defined by the British Association of Dermatologists 2018 guidelines., Conclusions: All basal cell carcinoma resections were in line with the standard guidelines.

Cancer of the breast is the leading female cancer accounting for one fourth of the malignancies. The tumour remains the most researched, read and practiced upon around the Globe. The treatment has substantially improved breast cancer related outcomes, both for early as well as late stages with substantial improvements in disease free and overall survival. Therapeutic decisions not only rest on clinical & tumour characteristics, but also with the evolution of molecular biology and tissue microarray intrinsic sub-types have been found. Attempts are being made to translate therapy from genomic architecture of individual breast cancer. This facilitates customization of treatment avoiding un-necessary toxicity, costs and inconvenience. Optimizing treatment based on individual breast biology seems logical and allows unifying treatment. The paper reviews literature, incorporate updates and also describes immunohistochemistry based molecular classification: which are found simple to adapt, record, present and subsequently manage, summarizing clinical practices in management of these patients.

Follicular dendritic cell sarcoma (FDCS) is a rare intermediate grade sarcoma involving a variety of nodal and extra nodal sites. It has two histological subtypes, conventional and inflammatory pseudotumour like variant. We report this interesting case of FDCS presenting colonic intussusception at Shifa International Hospital, Islamabad, Pakistan. Conventional FDCS presenting as a colocolic intussusception is an unusual presentation, and to our knowledge, has never been reported previously. It has wide morphological spectrum on light microscopy and has characteristic immune-reactivity for dendritic cell markers (CD21, CD23, and CD35). Surgical excision is required in all cases while role of adjuvant chemotherapy and radiotherapy is not clearly demonstrated in literature.

This descriptive study was carried out at Pathology Department, Shifa International Hospital from 2007 to 2016; all sex cord stromal tumours diagnosed during this time period were included. Epithelial, germ cell and metastatic tumours were excluded from the study. A total of 1254 Ovarian tumours were brought to Shifa of which47 (4%) were labeled as sex cord stromal tumours. Of these 36( 76 %)were granulosa cell tumour (adult33, juvenile3), 7 were labeled as sertoli leydig cell tumours (15%), 3 as thecoma/ fibroma group (7%)and only one case was labeled as microcystic stromal tumour of the ovary (2%). Overall age range for sex cord stromal tumours was 42 (12-71). Immunohistochemistry was done in 41 out of 47 cases. Sex cord stromal tumours of the ovary are rare tumours comprising 4% of the total. Adult Granulosa cell tumour is the commonest tumour seen in our study.

Although the second most common malignancy after urothelial carcinoma, squamous cell carcinoma (SCC) of the renal pelvis is a rare entity. It has strong association with nephrolithiasis thus emphasizing prompt treatment of renal calculi. Because of rarity and nonspecific clinical and radiological findings, it mostly presents at pT3 or higher stage. We report SCC of renal pelvis that was missed two times on non-contrast CT scans and was diagnosed incidentally in a nephrectomy specimen. Its prognosis is similar to that of urothelial carcinoma of comparable stage. Owing to its rarity, no standard treatment guidelines are available; however radical nephrectomy with lymph node dissection is the initial treatment which can be curative in an early stage disease. Adjuvant chemotherapy and radiotherapy are usually ineffective.

Objective: To analyse morphological types, location in the large bowel and demographic characteristics of colonic polyps., Methods: The retrospective descriptive study was conducted at the Department of Pathology, Sultan Qaboos University Hospital, Muscat, Oman, and comprised biopsy specimens of colonic polyps from patients related to a two-year period from 2011 to 2012. Demographic data, types of polyps, anatomical location and grade of dysplasia were analysed. SPSS 20 was used for statistical analysis., Results: There were 160 biopsy specimens from 143 patients. Of the patients, 91(63.6 %) were male and 52(36.4%) were female. The mean age was 55.27+-14.2 years. Of the 160 polyps, 37((23.1%) were in the rectum. The most common type was the adenomatous polyp in 88(55.0%) cases followed by hyperplastic polyps 51(31.9%) and inflammatory polyps 21(13.1%). Of the 88 adenomatous polyps, 23(26%) showed high-grade dysplasia., Conclusions: The commonest colon polyp type was adenomatous polyp. Screening programmes, such as stool occult blood testing and colonoscopies, are recommended.

Prostatic adenocarcinoma is the commonest solid malignancy seen in Omani elderly males 60-80 years of age. The Gleason grade is the most widely used grading system for prostatic carcinoma and is recommended by the World Health Organization. A peer review was carried out at the Pathology Department of Sultan Qaboos University Hospital (SQUH), Oman, to assess the quality of reporting at the center. The aim of this study was to determine inter-observer variation among 7 pathologists working at a tertiary care center in Oman. A total of 47 consecutive prostatic biopsies were interdependently reviewed by seven pathologists and the results obtained were compared with each other and the original diagnosis. This peer review indicated a fair inter-observer agreement (0.482) among 7 pathologists in the department, with fair to moderate agreement when the results were compared to the reported diagnosis, comparable to the published literature. Dual and sub-specialty reporting are being instituted to improve the performance in this vital aspect of pathology., (Creative Commons Attribution License)

Solid pseudo-papillary tumour of pancreas is a rare neoplasm having a low malignant potential. It mostly affects young adolescent females. We report an unusual case of an 18 year old male with a mass in the mesocolon which was reported as solid pseudo-papillary tumour of pancreas. This case is unusual by virtue of extra pancreatic location and male gender of the patient.

Purpose: Men are particularly concerned about pain after circumcision. Concerns about pain can be a reason to refuse surgery. We assessed the severity of postoperative pain and investigated factors that may influence postoperative pain., Materials and Methods: We performed a prospective, observational cohort study in patients undergoing circumcision. Patients were asked to complete a questionnaire using a visual analog scale for pain (severity range 0 to 10) on days 1 to 3, 7 and 21, and record the analgesia used, complications and time off work. Other data recorded were patient age, clinical indication for surgery, foreskin retractility, presence of adhesions and histology., Results: Of 211 questionnaires 112 were returned (53.1%). Mean patient age was 46.4 years. The most common clinical indication for circumcision was phimosis (75% of patients). Postoperative pain was scored as mild to moderate, including a mean of 2.4 on days 1 to 3, 2.1 on day 7 and 0.5 on day 21. Patients younger than 35 years (p = 0.025) and patients with wound infection (p = 0.036) had higher pain scores. Only 11 patients (9.8%) had severe pain at any time during recovery, including 8 with wound problems. Average ± SD time off work in the employed population was 6.6 ± 6.5 days, including 5 days for light work and 11 days for heavy physical activity., Conclusions: Pain is mild to moderate after circumcision in adults under general anesthesia with an intraoperative penile block. Severe pain is rare and mostly related to complications. Younger patients generally have more discomfort., (Copyright © 2013 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.)

Background: Whipple specimens consists of duodenum from the pylorus to the ligament of Treitz, the head of the pancreas and distal extrahepatic biliary tract, sometimes with most distal portion of the stomach. Adequate gross handling of the specimen and assessment of histological variables is of prognostic importance., Methods: At the Pathology Department of Shaukat Khanum Memorial Cancer Hospital and Research Centre, we here evaluated survival with a total of 65 pancreaticoduodenectomy specimens from 2006 to 2010 with reference to histological parameters like tumour type, site, size, grade, pT, pN, margin status and perineural invasion, and compared our results with international data. Patients were followed up and P-values were calculated regarding association between survival and prognostic factors, Kaplan-meier survival curves also being plotted., Results: Most of the patients were males (60%), with a mean age of 50 yrs. The most frequent site was periampullary region (43.2%), with adenocarcinoma, NOS accounting for 72.4%. G2 was the most common grade (58.5%) and the most frequent pT was pT2 (52.4%), nearly half presenting with lymph node metastasis (47.7%). Significant associations (p<0.05) were noted for survival with grade, pT, pN, margins, tumor size and perineural invasion, but not tumor site, tumor type and age. Kaplan-Meier curve revealed that at end of 1 month, 70% of the patients were alive, this decreasing to 40%, 15% and 5% and at the end of 6 months, 1 year and 2 years., Conclusion: Tumor size, type, pathologic T and N staging, margins and perineural invasion are directly related to survival with pancreatico-duodenal lesions.

Objective: To determine the scoring of Estrogen Receptor (ER) status in carcinoma breast by Allred method that is essentially bimodal and to compare the results with a conventional scoring system., Materials and Methods: A retrospective, comparative study carried out at Aga Khan University Hospital Section of Histopathology over a period of 18 months, i.e., Jan 2005 to June 2006. Anti ER antibody (clone D07) was used for all IHC stains using envision detection system. ER stains of 860 consecutive breast cancer cases were reviewed and rescored by both conventional and Allred method of ER scoring., Results: Comparison of results showed that there was a substantial decrease in weak positive cases from 18% to 5% by rescoring using Allred scoring system compared to conventional scoring. The data was analyzed using chi square test., Conclusion: The sensitivity and specificity of Allred method were calculated; Sensitivity of Allred method was 99.4% & Specificity of Allred method was 99.5% whereas sensitivity and specificity of conventional method was 88.0% and 84% respectively

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.

Carcinosarcoma of the esophagus is a rare neoplasm characterized histologically by presence of carcinomatous and sarcomatous elements. Case report of carcinosarcoma of the esophagogastric junction whose morphological and immunohistochemical features makes it quite distinctive from other tumours is presented. It was an ulcerated lesion diagnosed in an elderly Afghan lady located 34 cms from the incisor teeth. The patient was a smoker.

Very little epidemiological data regarding bone sarcomas from South Asia in general and Pakistan in particular are available. At the largest center for histopathology in Pakistan, we looked at three common bone sarcomas in our practice i.e. osteosarcoma, Ewing's sarcoma and chondrosarcoma. Our aim was to compile epidemiological data regarding age, gender and site distribution, and to correlate our findings with published western data in order to determine whether there were any significant differences in our population compared to the west. An overwhelming majority of osteosarcomas in our study occurred in the second and third decades of life; they were common in males; and femur, tibia and hip bone were the commonest bones involved accounting for an overwhelming majority of cases. The large majority of Ewing's Sarcomas in our study occurred in the first three decades of life; they were more common in males; vertebrae, tibia, femur and hip bone were the commonest sites. In our study, chondrosarcomas showed a wide range of age distribution and occurred quite commonly in the young. Except for the greater occurrence of chondrosarcoma in young patients; and comparatively less frequent involvement of upper limb bones, most of the bone sarcoma trends in our population appear to be similar to published western data.

Objective: To determine whether receptor status and HER-2/neu status remains same in primary and metastatic breast carcinoma to corresponding lymph nodes of individual patients., Methods: Estrogen receptors, progesterone receptors and HER-2/neu immunohistochemical stains were performed on primary and metastatic breast carcinoma to axillary lymph nodes in 100 patients. Data was collected on a Performa and age, tumour size, type, grade and expression of ER, PR and HER-2/neu on primary and metastatic tumours were recorded., Results: Hormone receptor status was compared between primary and metastatic tumours. Estrogen receptor positivity was observed in 28% primary tumours which were reduced to 25% in metastatic carcinoma. Progesterone receptors were positive in 28% primary tumours as compared to 22% in metastatic tumours. Her-2/neu protein over expression was noted in 44% primary and 45% metastatic breast tumours respectively. In case to case comparison ER, PR and HER-2/neu showed 91%, 88% and 95% concordance in primary and metastatic tumours respectively., Conclusion: ER, PR and HER-2/neu biomarkers showed significant concordance between primary and metastatic breast carcinoma.

Objectives: Data for pathological staging of radical prostatectomy specimens reported in the Section of Histopathology of a large tertiary care hospital in Pakistan were compared with sextant biopsy findings to determine whether clinically localized disease is actually localized pathologically., Design: A study was conducted of radical prostatectomy specimens reported in the Section of Histopathology from Jan 2001 to July 2008, with cases staged according to the pathologic TNM staging system. Other variables such as amount of tumor in prostatectomy specimens and lobes affected were also determined., Results: Out of 65 cases, 83.3% were clinical stage TIc. 29.2% were pT3a, 24.6% were pT3b and 3.1% were pT4. Therefore, in the majority of cases, disease was not localized to the prostate and perineurial invasion was seen in all. Comparison with biopsy results showed Gleason's grade to be altered in 20% cases., Conclusions: The large majority of prostatic carcinomas in Pakistan are advanced cancers with pathologic stage more advanced than evident on clinical staging. On average, tumors involved 35-40% of the prostate with a particular preponderance in posterior lobes.

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.

The objective of the study was to determine the incidence and type of endometrial abnormalities in long-term users of tamoxifen with breast cancer. All patients with a diagnosis of Oestrogen Receptor positive breast cancer on Tamoxifen therapy who had also undergone endometrial biopsy for abnormal bleeding or other symptoms were included. Among the 37 cases that had long-term follow up available, 21(57%) had evidence of endometrial pathology. There were seven cases of simple hyperplasia and thirteen of endometrial polyp. Only one case of endometrial carcinoma was seen. These findings support the association between prolonged tamoxifen therapy and endometrial pathology of possible neoplastic potential. Endometrial pathology is dependent on duration of exposure to Tamoxifen, therefore, close follow up of such patients is recommended.

As in many countries of the world, prostatic adenocarcinoma is extremely common in Pakistan. In a study carried out in our section, it was the third commonest malignancy in males, comprising almost 7% of all malignant neoplasms. Furthermore, another investigation revealed it to be the commonest malignant neoplasm in males in the seventh and eight decades, comprising 15% and 25% of respectively of all malignant neoplasms in these age groups. Recent data extracted from radical prostatectomy specimens in our department have revealed that the majority of carcinomas are advanced (like most other cancers in our country) when they are first diagnosed or treated. The majority of cases in which radical prostatectomy was performed showed not only advanced stage (pT3a or pT3b) but also exhibited extra-prostatic extension and positive surgical margins. For a cancer which is so common in our population, the diagnostic and therapeutic modalities available are extremely limited.

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.

We report a unique case of juvenile rectal polyp occurring in a 15-year-old male which showed osseous (bony) metaplasia on histological examination. The phenomenon is striking on histological examination but it appears to have no clinical significance.

We report a case of diffuse fibrous pseudotumour/fibromatous periorchitis, in a 43 year old male, that completely encased the right testis and was adjacent to a hydrocoele cavity. Although fibrous pseudotumours of this region are uncommon, they are reported to be the second most common benign paratesticular lesion after adenomatoid tumours. These comprise approximately 6 percent of paratesticular lesions, and are accepted as reactive lesions secondary to trauma, hydrocoele, infections or inflammation. Fibrous pseudotumours have a peak incidence in the third decade of life but can occur at any age. Clinically these lesions mimic malignancy resulting in the treatment by radical orchidectomy. Fibrous pseudotumours should be considered in differential diagnosis when one encounters a predominantly fibrocollagenous lesion.

Invasive papillary carcinomas of the Extrahepatic Bile Ducts (EBD) are uncommon (4-5%). The course is less aggressive than conventional adenocarcinomas of the extrahepatic bile ducts. Non-invasive and minimally invasive papillary carcinomas are even rarer, behave as in-situ carcinomas and are associated with excellent long-term prognosis. A variety of lesions of the EBD that show papillary architecture should be distinguished from papillary carcinoma. Here, we report a case of papillary carcinoma of the common bile duct showing minimal invasion. Separation of invasive from non-invasive or minimally invasive papillary carcinoma is critical in estimating the patient outcome.

Drug resistance to Tuberculosis is an emerging problem but proper exhaustive workup needs to be done before confirming the diagnosis. The case of a 5 year old male child who presented with low grade fever and lymphadenopathy and was being treated with anti TB drugs with no satisfactory response is presented. A detail workup including a biopsy gave the diagnosis of histoplasmosis.

Carcinosarcoma is a rare malignant neoplasm of salivary glands that manifests both carcinomatous and sarcomatous components. Specimen of a recurrent parotid tumor of a 55-year-old male was received for histopathology. Diagnosis of a biphasic malignant neoplasm was made. Morphology and immunohistochemical profile were consistent with carcinosarcoma i.e. true malignant mixed tumor.

A nephrectomy specimen was sent to the laboratory for end stage renal disease secondary to nephrolithiasis. Initial sections incidentally revealed a tumor infiltrating the normal renal tissue. Further workup including cytochemical and immuno-histochemical stains confirmed it to be collecting duct carcinoma.