Histopathology Department Research Articles

HPB SO27 - Reconsidering Routine Histopathological Examination of Gallbladder Specimens in Cholecystectomy: Optimizing Clinical Practice and Resource Management

Abstract Background Cholecystectomy, the removal of the gallbladder, is a common surgery performed globally. Routine histopathological examination (HPE) of gallbladder specimens post-surgery aims to detect pathologies like gallbladder cancer (GBC). GBC incidence varies by region and ethnicity, with higher risks in women and those over 65. Advanced GBC stages often require surgery, while early stages may only need cholecystectomy. Global HPE practices differ based on resources and GBC rates. This study evaluates the necessity of routine HPE by examining the selective processing of specimens suspected of GBC, ensuring patient safety while potentially optimizing resource use. Method This retrospective cohort study conducted at Redland Hospital, a district general hospital in Australia, investigated the necessity of routine histopathological examination (HPE) for excised gallbladder specimens. Adhering to routine HPE policy, the study encompassed all elective and emergency cholecystectomies performed from January 2023 to December 2023, excluding pediatric cases, concurrent surgical procedures, and those with suspected malignancy. Demographic data, surgery indications, intraoperative findings, histopathological results, and incidental gallbladder cancer (IGC) outcomes were analyzed. Pathology reports and case documentation were reviewed for cancerous pathology indicators. Results Over the one-year study period from January 2023 to December 2023, a total of 266 gallbladder specimens were subjected to histopathological examination (HPE) post-cholecystectomy. Of these, 201 were female and 65 were male, yielding a male-to-female ratio of 3:1. Elective cholecystectomy was performed on 56.4% (150) of patients, while 43.6% (116) underwent emergency procedures. Laparoscopic cholecystectomy (LC) was the primary surgical approach, except for one case requiring conversion to an open procedure. None of the patients exhibited gallbladder carcinoma (GBC); however, 3.3% (9) displayed premalignant histopathological features in their specimens. Conclusion In conclusion, adopting a selective approach, where only gallbladder specimens with macroscopic abnormalities undergo histopathological examination (HPE), seems prudent, especially in regions with low gallbladder cancer (GBC) incidence. Our study, which revealed no cases of GBC, supports this approach. It not only reduces the risk of missing incidental carcinoma in clinically unsuspected cases but also proves cost-effective and reduces the histopathology department workload without compromising patient outcomes. Therefore, we advocate for routine macroscopic examination of gallbladder specimens for abnormalities before HPE submission, particularly in cholecystectomy patients with gallstone disease.

Immunohistochemical Expression of ROS1 in invasive ductal carcinoma of breast in association with hormonal receptor status and Her2Neu expression

Objective: To determine the frequency of immunohistochemical expression of ROS1 in invasive ductal carcinoma of the breast in relation to hormonal receptor status and HER2 expression. Study Design and Setting: Descriptive cross-sectional study. Department of Histopathology, Armed Forces Institute of Pathology, Rawalpindi from May 2022 to Dec 2022. Methodology: This study was conducted on a sample size comprising 137 patients diagnosed with invasive breast carcinoma (ductal carcinoma) on histopathological biopsy specimen. Immunohistochemistry was performed using ROS1, estrogen receptor, progesterone receptor and HER2 antibodies on patients’ tissue samples. Results were interpreted by two independent histopathologists. Finally data was analyzed using SPSS version 25. Results: The mean age of sample population was 50.85 ± 12.17 years. 131 patients were women and 6 were men. ROS1 was positive in 54 cases. ROS1 shows weak staining in 41 cases and moderate to strong staining in 13 cases. ER and PR showed no significant statistical correlation with ROS1 expression. HER2 was positive in 37 cases, equivocal in 11 cases and negative in 89 cases. A significant statistical correlation was seen between ROS1 and HER2 as 23 of HER2 positive cases showed ROS1 expression (p=<0.001). Conclusion: Significant number of ROS1 expressing cases in invasive breast carcinoma can be more revealing in the understanding of pathogenesis of breast carcinoma. In addition, it can also lead to use of certain recent tyrosine kinase inhibitors for treatment of this most common carcinoma in females.

Diagnostic Accuracy of Immunohistochemical Expression of p16, MDM2, and CDK4 in Well-Differentiated and De-Differentiated Liposarcoma in MDM2 Fluorescent in situ Hybridisation Confirmed Cases.

To establish the diagnostic utility of immunohistochemistry markers p16 along with MDM2 and CDK-4 in confirming the diagnosis of well-differentiated and de-differentiated liposarcoma while taking Fluorescent in situ Hybridisation (FISH) as a gold standard. A cross-sectional study. Place and Duration of the Study: Department of Histopathology, Armed Forces Institute of Pathology, Rawalpindi, Pakistan, from 30th January 2022 to 30th June 2023. A standard panel of three immunohistochemistry markers p16, MDM2, and CDK4 were applied to 36 cases of atypical lipomatous tumours, well-differentiated liposarcoma (WDLPS), and de-differentiated liposarcoma (DDLPS), on which the gold standard FISH was already performed. The sample size was calculated with the help of a WHO calculator taking prevalence 1-2% in Pakistani population. Qualitative variables such as gender and site of tumour were presented by calculating frequency and percentages and comparison of Immunohistochemistry results with FISH was done by using a 2x2 table. The sensitivity and specificity of this triple marker panel for detecting WDLPS/DDLPS were 43.47% and 15.38%, respectively. The sensitivity and specificity of CDK4 for detecting WDLPS / DDLPS were 82.6% and 15.4%, those of MDM2 were 73.9% and 61.5 %, and those of p16 were 60.9% and 53.8%, respectively. Among all three markers, CDK4 was the most sensitive and MDM2 was the most specific marker for detecting WDLPS-DDLPS. It also showed that a combination of these three markers improves the diagnostic credibility of the immunohistochemistry in diagnosing DDLPS and WDLPS but FISH is the most reliable and confirmatory method. De-differentiated liposarcoma, Well-differentiated liposarcoma, P16, CDK4, MDM2.

Evaluation of Turnaround Times of Diagnostic Biopsies: A Metric of Quality in Surgical Pathology.

Introduction. Timely and accurate diagnosis of diseases is crucial for effective patient care. Turnaround time (TAT) in surgical pathology, defined as the time between accessioning the sample and reporting results, is a key performance indicator reflecting quality and efficiency. This study explores factors affecting TAT for diagnostic biopsies in a tertiary oncology hospital. Methods. A 1-month pilot study was conducted, focusing on 695 in-house diagnostic biopsies. Biopsies were categorized as routine (requiring only hematoxylin and eosin (H&E) staining) or complex cases (requiring additional tests). TAT was defined as the time between sample accessioning and report availability in the electronic medical record, with delays defined as exceeding 3 days for routine cases and 4 days for complex cases. Survival analysis using Kaplan-Meier plots was utilized to analyze TAT. Results. The overall mean TAT was 3.7 ± 2 days, with routine cases at 3.1 ± 2 days and complex cases at 4.8 ± 2 days (P < 0.001). Survival analysis revealed prolonged TAT for complex cases. Organ-specific analysis highlighted variations in TAT, with brain biopsies presenting the highest complexity and longest TAT. Surprisingly, malignant cases demonstrated slightly shorter TATs compared to benign cases (P = 0.026). Delays were observed in 34% of all cases. Conclusions. Laboratory TAT is crucial and is frequently used as a performance benchmark. We analyzed the various causes of delayed TAT in our hospital's histopathology department, with an emphasis on variables in the analytical phase. The results of this study demonstrate that cases involving ancillary techniques had significantly longer TATs compared to routine H&E cases.

Reconsidering Routine Histopathological Examination of Gallbladder Specimens in Cholecystectomy: Optimizing Clinical Practice and Resource Management.

Introduction Cholecystectomy, the surgical removal of the gallbladder, is a common procedure worldwide. Despite no visible anomalies, routine histopathological examination (HPE) of gallbladder specimens post-surgery is standard practice to exclude pathologies, notably gallbladder cancer (GBC). Incidence rates of GBC vary geographically and ethnically. Surgical intervention is recommended for advanced GBC stages, while early stages may require cholecystectomy alone. Although rare, GBC and bile duct cancers pose increased risks in certain demographics, such as women and individuals over 65. Routine HPE practices vary globally based on resource availability and GBC incidence. This study assesses the necessity of routine HPE by evaluating the selective processing of gallbladder specimens suspected of GBC, prioritizing patient safety. Materials and methods This retrospective cohort study conducted at Redland Hospital, a district general hospital in Australia, investigated the necessity of routine HPEfor excised gallbladder specimens. Adhering to routine HPE policy, the study encompassed all elective and emergency cholecystectomies performed from January 2023 to December 2023, excluding pediatric cases, concurrent surgical procedures, and those with suspected malignancy. Demographic data, surgery indications, intraoperative findings, histopathological results, and incidental gallbladder cancer (IGC)outcomes were analyzed. Pathology reports and case documentation were reviewed for cancerous pathology indicators. Results Over the one-year study period from January 2023 to December 2023, a total of 266 gallbladder specimens were subjected to HPEpost-cholecystectomy. Of these, 201 were female and 65 were male, yielding a male-to-female ratio of 3:1. Elective cholecystectomy was performed on 56.4% (150) of patients, while 43.6% (116) underwent emergency procedures. Laparoscopic cholecystectomy (LC) was the primary surgical approach, except for one case requiring conversion to an open procedure. None of the patients exhibited GBC; however, 3.3% (9) displayed premalignant histopathological features in their specimens. Conclusion In conclusion, adopting a selective approach, where only gallbladder specimens with macroscopic abnormalities undergo HPE, seems prudent, especially in regions with low GBCincidence. Our study, which revealed no cases of GBC, supports this approach. It not only reduces the risk of missing incidental carcinoma in clinically unsuspected cases but also proves cost-effective and reduces the histopathology department workload without compromising patient outcomes. Therefore, we advocate for routine macroscopic examination of gallbladder specimens for abnormalities before HPE submission, particularly in cholecystectomy patients with gallstone disease.

A primary leiomyosarcoma of small intestine: A rare case report

Primary leiomyosarcoma of small intestine originating from smooth muscle cell is extremely rare entity. It mimics gastrointestinal stromal tumor (GIST) because of their common morphological appearance. Microscopic and immunochemistry findings are necessary to differentiate Leiomyosarcoma from gastrointestinal tumor (GIST). We report a case of 58-year-old male patient presented to tertiary care hospital with complain of generalized abdominal pain, vomiting, early satiety and constipation. Physical examination revealed no significant findings. Imaging findings showed Ileo-Ileal intussusceptions. Neither CT scan nor MRI reveal any evidence of tumor. The patient underwent exploratory laparotomy which revealed polypoidal mass in ileum. Resection and anastomosis of distal Ileum done &amp; specimen received in histopathology department. On microscopic examination, Diagnosis of GIST &amp; Leiomyosarcoma was considered. Immunohistochemistry was positive for Desmin marker and negative for CD 117, DOG 1, S-100 &amp; ALK marker. The diagnosis of High grade Leiomyosarcoma was confirmed.

Role of Core Needle Biopsy in Liver Metastases: A Histopathological and Immunohistochemical Approach

Abstract Background: The liver is the second most common organ involved by secondary neoplasms. Core needle biopsy of oncological patients requires an accurate histological diagnosis for the subsequent prescription of adequate management plans. Objectives: The aim of this study was to evaluate the diagnostic accuracy of core needle biopsy for suspected hepatic metastasis and to assess factors that influence the accuracy of the procedure. Materials and Methods: A cross-sectional study randomly enrolled 74 percutaneous ultrasound-guided core needle biopsies from patients with suspected hepatic neoplasm. A 16-gauge tru-cut biopsy needle was performed for all patients. Patient characteristics, procedure information, histopathology reports, and slides were collected from the Department of Histopathology at Al-Jamhorii Teaching Hospital, Mosul City, Iraq. All cases were analyzed using SPSS software, version 18.0. Results: Among 74 patients diagnosed with liver metastasis, the median age was 57 years (range 33–90 years) at the time of biopsy; of them, 61 patients (82.4%) reported a previous history of malignancy, P = 0.003. Histologically, metastatic adenocarcinoma was the most common neoplasm identified in 56 patients (75.7%), with the predominance of colorectal carcinoma. Forty-seven (63.5%) patients underwent two–five passes, which was statistically correlated with an increase in diagnostic accuracy (k = 0.21, 95% confidence interval [CI]= 0.038–1.189, P = 0.04). The overall sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of tru-cut biopsies were 100%, 97.1%, 95.7%, 100%, and 98.2%, respectively. Conclusions: The core needle biopsy is a reliable and valid diagnostic option for the histological assessment of suspected liver metastasis, particularly when supplemented by ancillary immunohistochemistry.

Expression of hormone receptors and human epidermal growth Factor2/Neu in female breast cancer patients

Overexpression of HER2/neu and estrogen receptors (ER) and/or progesterone receptors (PR) are reported to be inversely associated with breast cancer (BC). The relationship between hormone receptors and HER2/neu is attenuated by age and numerous other clinical factors. Here, we examined the link between hormone receptors and HER-2/neu in terms of an additional variable, such as the histological grades of breast tumors in women. A total of 240 breast cancer samples were obtained from the Department of Histopathology at the University of Lahore Teaching Hospital in Lahore, Punjab. Immunohistochemistry (IHC) was used to examine the expression of hormone receptors and HER-2/neu. Using the χ2 and fisher exact test, the association between hormone receptors and HER-2/neu in various age groups and histological grades was investigated. Patients that were included in this study had ages between 30 and 90 years, with a mean age of 51.89 ± 12.01 years, and were mostly having grade 1 tumors. The most prevalent type of breast cancer was invasive ductal carcinoma (95.83%). It was found that the ER, PR, and HER-2/neu were more expressive in older (above 45) and grade 1 tumors as compared to younger (≤45) and higher-grade tumor patients. HER-2 was negatively correlated with hormonal receptors in women aged >45 years old with grade-1 tumors. Hormonal receptor (ER/PR) expression is associated with HER-2/neu expression not only in older age (>45) but also in grade 1 tumors. This correlation between HER2/neu and hormone receptors that improves with age and tumor grade is useful for predicting outcomes and, likely, for guiding therapy choices.

Immunohistochemical Analysis of Glomerular Phospholipase A2 Receptor in Primary and Secondary Membranous Glomerulonephritis

Background: A common cause of adult nephrotic syndrome (NS) is membranous glomerulonephritis (MGN). The larger portion of MGN in adults is the idiopathic/ primary MGN (iMGN). So many conditions like autoimmunity, malignant tumor, drugs and infections can cause a secondary form of MGN. We can diagnose primary/ idiopathic MGN after the omission of all known secondary causes. As we know M-type phospholipase A2 receptor (PLA2R) on podocytes is the target antigen in the pathogenesis of primary MGN. Phospholipase A2 receptor (PLA2R) can be detected by immunohistochemically. Differences between primary MGN (iMGN) and secondary MGN are essential because of treatment implications. Objective: To evaluate the histopathological pattern of MGN and to correlate with PLA2R deposition in primary and secondary MGN in a group of Bangladeshi people. Methods: The research method is descriptive cross- sectional and observational. The study population was 60 patients in the department of Histopathology, AFIP, Dhaka Cantonment, Dhaka for duration of six months period from January 2019 to June 2019. At first, adequate clinical information was taken and categorized as primary and secondary MGN on a clinical basis, thereafter immuno- histochemistry of anti-PLA2R was done from formalin-fixed paraffin block of those cases. Results: A total of 60 diagnosed cases of MGN, 56 patients were found primary, and 04 were secondary based on clinical data. In my study, all primary MGN was found as PLA2R positive. Conclusion: The present study exhibits that immuno- histochemistry with anti-PLA2R antibodies can be the best diagnostic method for diagnosis of idiopathic MGN which offers an opportunity for personalized medicine. JAFMC Bangladesh, Vol 19, No 2 (December) 2023: 24-28

Diagnostic Accuracy of Fine Needle Aspiration Cytology (FNAC) in Salivary Gland Tumors.

Professor Oral Pathology, Islamabad Dental Hospital, Islamabad 6Demonstrator Oral Pathology Margalla Institute of Health Sciences, Islamabad Author`s Contribution 1Conception and idea acquisition of data, 2Data Analysis, 3Results interpretation, 4Editing and drafting, 5Critical Revision, 6Final approval of the study to be published Funding Source: None Conflict of Interest: None Received: February 02, 2024 Accepted: May 27, 2024 Address of Correspondent Dr. Zainab Niazi Associate Professor Oral Pathology, Islamabad Dental Hospital, Islamabad dr.zainabniazi@gmail.com ABSTRACT Objectives: To evaluate the diagnostic accuracy of fine needle aspiration cytology (FNAC) by comparing its findings with the gold standard histological features of salivary gland lesions. Methodology: This retrospective study was conducted at the Department of Histopathology, Islamabad Medical and Dental Hospital (IMDC), from January 2023 to December 2023, patients presenting with salivary gland swellings. Fifty-seven patients having salivary gland swelling were included on which both histological and cytological evaluation had been done. Twenty cases were excluded because either they had lack of correlation between FNAC and histology or on view of inadequate material. All the patients were clinically evaluated clinically and FNAC was done using 10ml disposable syringe and 23/24-gauge needle without using local anesthesia. The histopathology of the surgical specimens and cytology of the FNAC specimens were compared, and the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were evaluated. Results: On FNAC, 37 cases were diagnosed cytologically, as 9 cases identified malignant and 28 as benign. Histopathological examination confirmed 9 malignant cases and 25 benign cases, whereas 3 cases were classified as false positive. The specificity and sensitivity of FNAC were 75% and 94%, respectively. Overlapping cytological features, heterogeneity, and unsampled areas were the primary factors contributing to false-positive. Conclusion: This study showed that salivary gland FNA cytology is a valuable diagnostic technique for salivary gland lesions, however due to great variation in pleomorphic adenoma, the samples must be confirmed by histopathological features.

Molecular Classification of Vulvar Squamous Cell Carcinoma and Precursor Lesions Using Immunohistochemistry

Abstract Introduction: Vulvar malignancies are very rare. Two pathogenic pathways have been described in the development of vulvar squamous cell carcinoma.One is related to HPV infection and the other is related to TP 53 mutation. HPV infection related squamous cell carcinomas have a good prognosis and squamous cell carcinomas related to TP 53 mutation have the worst prognosis. Recently a third pathway which is neither HPV dependent nor p53 mutant has been identified. This pathway is found to have intermediate prognosis with better clinical outcome. Aims: The aim of this study was to classify vulvar squamous cell carcinoma and its precursor lesions molecularly using two immunohistochemical stains p16 and p53 in a cohort of South Indian population. Subjects and Methods: A retrospective observational study was conducted between January 2011 and December 2020 in the department of histopathology at a tertiary care hospital in Hyderabad, India. A total of 22 cases including all the vulval biopsies with suspected squamous cell carcinoma or precursor lesions and excision specimens operated for squamous cell carcinoma were included in this study. Paraffin blocks of representative cases were stained with hematoxylin and eosin stain, p16 and p53 immunohistochemistry (IHC) stains. Results: Out of 22 cases, two cases (9.0%) were precursor lesions of the vulva and 20 cases (90.9%) were invasive squamous cell carcinoma. Eleven (50%) of these cases were p53 mutant (p53+/p16−), 10 (45.4%) of these cases were HPV positive (p16+/p53−), and one of these cases (4.5%) was neither HPV positive nor p53 mutant (p16−/p53−). Conclusions: Classification of vulvar squamous cell lesions molecularly using simple immunohistochemical stains in routine diagnostic workup will aid in risk stratification of patients and help in their management and prognostication.

Significance of Estrogen/Progesterone Receptor Expression in Metaplastic Breast Carcinoma.

Metaplastic breast carcinoma (MBC) is a rare subgroup of breast neoplasms associated with adverse outcomes because of its aggressive nature. Typically, MBCs show triple-negative hormone receptor (HR) status. Determining the HR status of breast cancer is an integral part because it is an important prognostic factor and helps in the treatment course of the disease. This study aimed to determine the HR status of MBC, its significance, and its association with various clinicopathological parameters. This was a retrospective study conducted at the Department of Histopathology, Liaquat National Hospital. A total of 140 biopsy-proven cases of MBC were enrolled in the study. Clinical and pathological data were retrieved from the institutes' archives. Immunohistochemical studies were conducted to determine the estrogen receptor (ER) and progesterone receptor (PR) status. The mean age of MBC in our population was found to be 52.18 ± 12.19 years. The HR positivity rate in our population was found to be 32.9%. A significant association was found between HR status and tumor laterality, tumor size, tumor grade, tumor stage, and recurrence. ER/PR-negative MBCs were most probably associated with higher grade and higher tumor stage and were larger in size (6.62 ± 3.43 cm) than ER/PR-positive MBCs (4.20 ± 1.88 cm). Moreover, ER/PR-positive MBCs showed a higher recurrence rate than ER/PR-negative MBCs (43.5% vs. 25.5%, respectively). No statistically significant relationship was found between HR status and patient age, histological subtype, or survival rate. MBC is a rare breast neoplasm. MBC was found to be triple negative in most cases, but a significant percentage were HR (ER/PR) positive. Moreover, we found an association between HR status and various clinicopathological features, indicating that HR status is a significant predictor of MBC prognosis.

Frequency of loss of calretinin expression in clinically susceptible cases of Hirschprung disease in rectal biopsies

Objective: To determine the frequency of loss of calretinin expression in clinically susceptible cases of Hirschprung disease in rectal biopsies. Material and Methods: This descriptive, cross-sectional study was conducted at Department of Histopathology, Combined Military Hospital, Multan for a period of 6 months (17th Oct 2021 to 16th April 2022). A total 93 suspected cases of Hirschprung disease were taken. Specimens received in 10 % buffered formalin and fulfilling inclusion criteria were included in the study. The cases diagnosed as Hirschprung disease were taken and calretinin immunohistochemical stain was applied and result recorded after evaluation by consultant histopathologist. Data was analyzed using (Statistical Software for Social Sciences (SPSS) version 19). Results: Out of 93 cases, 67 (72.0%) were male patients, whereas 26 (28.0%) were female patients. The average age of the study participants was 7.95 months, with a minimum age of 1 month and a maximum age of 12 months. Twenty-eight (30.1%) of the 93 study cases were from rural areas, while 65 (69.9%) were from metropolitan areas. Twenty-five families (26.9%) reported monthly incomes of up to Rs. 35000, while 68 families (73.1%) reported incomes of over Rs. 35,000. Of these 93 study cases, failure to pass meconium was noted in 24 (25.8%) patients, constipation was noted in 75 (80.6%) and abdominal distension was noted in 62 (66.7%) patients. Loss of calretinin expression was noted in 34 (36.6%) of our study cases. Conclusion: According to the findings of our investigation, calretinin is very helpful in identifying suspicious cases of Hirschsprung disease. When acetylcholinesterase enzyme histochemistry is not accessible, it can be a helpful, cost-effective diagnostic assistance in centers with limited resources. It is a reliable and efficient diagnostic tool for early diagnosis of the illness. Loss of Calretinin expression was significantly associated with age and residential status. Keywords: Calretinin expression, Frequency, Hirschsprung disease, Immunohistochemistry

DIAGNOSTIC ACCURACY OF TIRADS CLASSIFICATION IN DIFFERENTIATING BENIGN AND MALIGNANT THYROID NODULES KEEPING FINE NEEDLE ASPIRATION CYTOLOGY (FNAC) AS GOLD STANDARD

Thyroid nodules represent a joint clinical presentation of various benign and malignant thyroid diseases. Diagnostic ultrasound, particularly utilizing the Thyroid Imaging Reporting and Data System (TI-RADS), has emerged as a pivotal tool for stratifying the risk of malignancy in thyroid nodules and guiding decisions regarding fine-needle aspiration biopsy (FNAC). However, comprehensive validation studies are warranted to assess the diagnostic accuracy of ultrasound-based TI-RADS classification compared to FNAC as the gold standard. This cross-sectional validation study, conducted at the Department of Radiology, CPE Institute of Cardiology Multan from August 2, 2021, to February 1, 2022, enrolled 243 patients presenting with thyroid nodules, including multiple and solitary nodules. Baseline demographic variables, including age, gender, and nodule duration, were recorded for each participant. Ultrasonography was performed in all patients, and TI-RADS scores were calculated. Subsequently, fine-needle aspiration biopsies, guided by ultrasound, were obtained in the radiology department and sent to the histopathology department for confirmation of malignancy. The mean age of the cohort was 42.05 ± 12.27 years, with a mean nodule duration of 6.87 ± 3.56 months. The mean TI-RADS score was 3.46 ± 2.00. Of the participants, 176 (72.43%) were male and 67 (27.57%) were female. Malignancy was detected in 84 (34.57%) patients based on TI-RADS score, whereas FNAC confirmed malignancy in 50 (20.58%) patients. Evaluating diagnostic accuracy with FNAC as the gold standard, the TI-RADS score demonstrated a sensitivity of 84.0%, specificity of 78.2%, positive predictive value (PPV) of 50.0%, and negative predictive value (NPV) of 95.0%. Our findings indicate that the TI-RADS scoring system is reliable in predicting malignancy in patients with thyroid nodules. With a sensitivity of 84.0% and specificity of 78.2%, TI-RADS represents a valuable adjunctive tool in the diagnostic algorithm for thyroid nodules, offering considerable potential for improved clinical decision-making and patient management strategies.

THE CORRELATION BETWEEN BETHESDA SYSTEM AND ULTRASOUND-BASED TIRADS FOR REPORTING THYROID CYTOPATHOLOGY

Objectives: To correlate the screening ability of ultrasound-based TIRADS with the FNAC-based Bethesda system when the latter is kept as a gold standard. Material and Methods: A cross-sectional study was conducted in the Histopathology department, Rehman Medical Institute, Peshawar 15th June 2022- 14th June 2023. A total of 363 patients from any age group of either gender diagnosed with thyroid nodules were included in the trial. All the participants underwent ultrasound followed by ultrasound-guided fine needle aspiration of thyroid nodules. TIRADS and Bethesda grading was done for each participant. Demographics and grading scores were recorded. Keeping Bethesda scoring as gold standard diagnostic performance of TIRADS grading was calculated. Results: Mean age of the patients was 46.68 ± 12.28 years with a female-to-male ratio of 2.3:1. TIRADS grading revealed 210 (69.8%) from TIRADS 2 while 70(82.4%), 12(50%), and 09(23.7%) patients were from TIRADS 3, 4 and 5 categories respectively. Bethesda grades were 301(82.9%), 21(5.8%), 09(2.5%), 28(7.7%), and 04(1.1%) from Bethesda 2, 3, 4, 5, and 6 categories respectively. The sensitivity of the TIRADS was 93.8%, specificity 89.1%, positive predictive value 45%, negative predictive value 99.3%, and a diagnostic accuracy of 89.5%. Conclusion: TIRADS grading has a high diagnostic ability when Bethesda scoring is kept as the gold standard. It can be used effectively in segregating benign from malignant nodules and is recommended for screening patients presenting with thyroid nodules. Keywords: Biopsy, Fine-Needle, Sensitivity and Specificity, Thyroid Nodule

Expression of Bcl-2 in Squamous Cell Carcinoma of Oral Cavity

Objectives: To investigate the expression of Bcl-2 in squamous cell carcinoma of the oral cavity. Methodology: This descriptive cross-sectional study was conducted at the Department of Histopathology, Pakistan Institute of Medical Sciences, Islamabad, from December 2021 to June 2022. Sixty patients aged 30 to 85 years, of both genders, diagnosed with squamous cell carcinoma of the oral cavity based on histopathology reports, were included. Immunohistochemistry for Bcl-2 was performed and assessed. All results were subsequently analyzed using SPSS Version 20. Results: Out of the 60 cases studied, 36 were males (60%) and 24 were females (40%). The mean age of the patients was 55 years. The most common histological grade was well-differentiated squamous cell carcinoma, accounting for 26 out of 60 cases (43.3%), followed by moderately differentiated squamous cell carcinoma (21/60, 35%). Poorly differentiated squamous cell carcinoma was the least common grade, found in 13 out of 60 cases (21.7%). Bcl-2 expression was positive in 23 patients (38.3%). Regarding grade-wise expression of Bcl-2, there was an increasing expression with increasing grades of oral squamous cell carcinoma: 19% Bcl-2 expression in well-differentiated squamous cell carcinoma, 38% in moderately differentiated squamous cell carcinoma, and 77% in poorly differentiated carcinomas. This demonstrated a significant correlation between Bcl-2 expression and histopathological grades (p value &lt;0.001). Conclusion: In summary, Bcl-2 expression was detected in 38.3% of oral squamous cell carcinoma cases. Its immuno-expression is significantly associated with the histopathological grades of oral squamous cell carcinoma. Therefore, Bcl-2 can be considered an important prognostic marker as well as a potential target for chemoresistance cases through Bcl-2 inhibition.

Histopathological and Immunohistochemical Evaluation of Malignant Ovarian Tumours

Objective: To determine the frequency and histological types of malignant ovarian tumours using morphological features and immunohistochemistry. Study Design: Cross-sectional study. Place and Duration of Study: Department of Histopathology, Army Medical College, Rawalpindi Pakistan, Jan 2016 to Dec 2018. Methodology: Newly diagnosed cases of malignant ovarian tumour who had not received chemotherapy were included. Cases of benign ovarian tumours and those who were treated with pre-surgical chemotherapy were excluded. Results: In total, 118 cases of malignant ovarian tumours were evaluated. High-grade serous carcinomas were 61(51.7%), which outnumber others, followed by granulosa cell tumours 17(14.4%), germ cell tumours 13(11%), endometrioid carcinoma 9(7.6%), clear cell carcinoma 4(3.4%), mucinous carcinoma 4(3.4%), low-grade serous carcinoma 2(1.7%) and carcinosarcoma in one case (0.8%). Cancer in the ovary was metastatic in 7(5.9%) cases. No Sertoli Leydig cell tumour, malignant Brenner tumour, embryonal carcinoma or immature teratomas were diagnosed. Conclusion: Surface epithelial tumours were the most common malignancy, followed by granulosa cell tumours and dysgerminoma. An increase in the frequency of ovarian tumours in younger age groups was also noted. Immunohistochemistry was a useful adjuvant diagnostic tool in cases of ovarian malignancy. Metastases to the ovary were mostly gastrointestinal in origin.

Small Lymphocytic Lymphoma Presenting as Breast Mass: A Rare Case Report

Abstract: Primary breast lymphoma is rare and it accounts for around 0.5% of malignant breast neoplasms. Small lymphocytic lymphoma (SLL) is a subtype of non-Hodgkin lymphoma originating from a B-cell lineage. This report presents a case of primary SLL of the breast with lung metastasis that had excellent clinical response. We reported a 67-year-old female complained a right breast mass that suddenly appeared after she got massage on her right left arm. The mass was swollen and painless with no systemic complications. The specimen was submitted to histopathology department and it revealed small diffuse lymphocytic lymphoma. Chest X-ray showed a lung metastasis. The patient was then treated with CHOP regimens (Cyclophosphamid, Doxorubicin, Vincristin, and Prednison) and the clinical result was excellent. The side effects of the medication were minimal. In conclusion, primary breast lymphocytic lymphoma is rare and this case highlights the differential diagnosis for a painless breast mass. The treatment must be individualized and multimodal, with chemotherapy being the most accepted treatment. Keywords: breast lymphoma; breast mass; malignancy

A Retrospective Single Centre Study on Histopathological Analysis of Cholecystectomy Specimens in a Pakistani Tertiary Care Centre. Is the Spectrum Changing?

Objective: To study the histopathological spectrum of gallbladder diseases and compare the occurrence of gallbladder carcinoma in relation to age, gender and weight of the patient. Methodology: This Cross-sectional study, retrospective study was conducted at Histopathology department of HBS General Hospital and Pakistan Institute of Medical Sciences (PIMS). Study was conducted over a period of 6 months from October 2021 to March 2022. Cholecystectomy specimens from either gender irrespective of their age received at the Histopathology Department of HBS General Hospital and Pakistan Institute of Medical Sciences (PIMS), over a period of 6 months were included in the study. The specimens were fixed in 10% formalin for 24 to 48 hours before sectioning. Then every specimen was macroscopically evaluated followed by cutting of the tissue into three representative sections, one each from the fundus, body and neck of the gallbladder along with the lymph nodes if provided. Hematoxylin &amp; eosin staining was done &amp; specimen. The clinical data from pathology reports and slides were retrieved from the archives and were microscopically examined by the histopathologists and the results were recorded. Results: Mean age of the patients was 54.58 ±18.04 years. Females were more than the male patients. There were 315 (77.4%) female patients as compared to 92 (22.6%) male patients. The mean weight of the patients was 60.18 ±5.11 kg. The most common finding was chronic cholecystitis in 303 out of 407 total cases (85%) followed by acute cholecystitis in 27 cases (9.8%). There were 16 cases (3.9%) of incidental carcinoma and three cases (0.7%) of dysplasia. Conclusion: A spectrum of histopathological diagnosis is observed in cholecystectomy specimen. The inflammatory gallbladder lesions are the most common pathology and the commonest diagnosis is chronic cholecystitis but the doctors cannot rely on the clinical or radiological diagnosis of gallbladder diseases. Histopathological analysis of all gallbladder specimens is necessary for the detection of carcinoma as the frequency of gallbladder cancer appears to be on the rise in our population which is significantly more common in females.

Prevalence of Fetal Inflammatory Response Syndrome and Villitis of Unknown Etiology in the Placenta of Saudi Women and Their Association with Baby Sex.

Long-term health consequences are influenced by circumstances that occur during pregnancy. The convergence of the maternal and fetal circulations occurs in the placenta, which is the first organ to develop. Placental pathology provides an accurate diagnosis of amniotic sac inflammation, and pathological alterations in preterm placentas provide evidence for the causes of numerous perinatal pathologies, including spontaneous preterm births. This retrospective study aimed to re-examine placentas regarded as normal by the Obstetrics and Gynecology Department at our institution. Thirty-seven male and forty-seven female placentas were collected following full-term delivery, and the grading and staging of any evident inflammatory responses were evaluated and correlated with the babies' sex. Full-thickness placental samples that were considered normal and not sent to the histopathology department were obtained from the central and marginal regions of placental discs. Morphological examination of the fresh placenta was conducted, and fetal and maternal inflammatory response syndromes were assessed. In addition, placental villitis of unknown etiology (VUE) and chronic deciduitis were evaluated. Immunohistochemistry was performed to evaluate the patterns of inflammation in the placenta using anti-CD8 and anti-CD68 antibodies. The correlation between silent pathologies and clinical complications or the development of fetal inflammatory response syndrome was measured. In this study, 17 (20%) maternal and 10 (12%) fetal samples showed inflammatory responses. The frequencies of chronic deciduitis and VUE were higher among pregnant Saudi women than previously reported, probably because fetal inflammatory response syndrome goes unnoticed in Saudi Arabia. In addition, the prevalence of fetal and maternal inflammatory responses was higher in the placentas of the mothers of males than in those of females, suggesting that differences occur in the inflammatory response in the placenta depending on the sex of the newborn. Grading placental inflammation (in cases of VUE) typically predicts the degree of maternal anti-fetal cellular rejection; therefore, increasing the number of placental samples sent for microscopic inspection may be preferable because of their significance in identifying the causes of chronic disorders.