Epidermal Growth Factor Receptor (EGFR) as a Prognostic Marker: an Immunohistochemical Study on 315 Consecutive Breast Carcinoma Patients

Objective: To assess the independent and interdependent prognostic value of epidermal growth factor receptor (EGFR) in carcinoma of breast in female population. The Type I family of growth factor receptors includes epidermal growth factor receptor (EGFR also known as EGFRI). Methods: The expression of EGFR protein was analysed immunohistochemically on 315 tumour specimens of infiltrating ductal carcinoma of breast. These patients also had axillary lymph nodes sampling. Results: Overexpression and/or amplification of EGFR was observed in 70 (22.00%) tumours. Eleven (16%) were grade I, 43 (61%) grade II and 16 (23%) grade Ill tumours. Axillary lymph node metastasis had significant correlation with intensified positivity of EGFR (p\u3c 0.05). Significant number of EGFR positive patients developed local recurrence and distant metastases to brain, liver and bone (p\u3c 0.05). EGFR positivity showed significant correlation with the disease free and overall survival (p\u3c 0.05). At a median follow-up of48 (4 years) months in EGFR positive patients, the overall survival was 3.39 years and disease free survival was 2.86 years. EGFR negative tumour patients showed a better survival. In this group the overall survival was 4.62 years and the disease free survival was 4 years. Conclusion: EGFR analysis can be a useful indicator for the selection of patients who are at the high risk, for hormonal therapy decisions and can be useful as a target for new treatment modalities

Clinical, pathological and molecular factors predicting Axillary Node involvement in primary Breast Cancer in Pakistani women

Background: Axillary lymph node involvement in primary breast cancer is one of its most important prognostic features. Thus any factors that may predict axillary lymph node involvement in this setting could be potentially helpful in treatment planning and other interventions. Objective: The objective of this study was to evaluate clinical, pathological and immuno-histochemical markers in univariate and multivariate analysis, which may be helpful predictors of axillary lymph node involvement in breast cancer. Method: A retrospective analysis of 555 cases. Of these 58% had axillary nodal positivity and 42% were negative. Conclusion: Factors of no significance included patient’s age, height, weight, age of first pregnancy, parity, marital status, menopausal status, family history of breast cancer, side of tumor. In univariate analysis the age of menarche, duration of symptoms, tumor size, site in outer quadrant, S phase and skin and nipple involvement all predicted axillary nodal involvement. The length of breast-feeding, increased intraductal component and increased PCNA were inversely proportional to nodal involvement. In multiple regression analysis however only size of the tumor, involvement of the skin and nipple and disease in the outer quadrant of breast were the factors, which assumed significanc

Histological pattern of central nervous system neoplasms

Objective: To see in a large series of patients the histological pattern of CNS neoplasms and to provide a comprehensive data about the frequency of CNS neoplasms in Pakistani patients and to give a clearer idea about their prevalence. Method: Retrospective study of all consecutive cases of CNS neoplasms diagnosed at The Aga Khan University Hospital (AKUH) between 1st January 1994 and 31st December, 1999. Setting: The section of Histopathology, AKUH, Karachi. Observation: Our series included a large number of cases i.e., 1110 . There are very few local studies on CNS tumours and none so large . Our data was correlated with published Western and Pakistani data . Glial tumours were the commonest primary CNS neoplasms followed by meningiomas . Among glial tumours , astrocytomas comprised the largest group and the majority were high grade (Ill and IV ) astrocytomas. Percentages of anaplastic oligodendrogliomas and ependymomas were also significant. Male to female ratio was 1.6:1. However, meningiomas were more common in females. Almost half of the CNS tumours in patients 15 years or younger were in the posterior cranial fossa . Metastatic tumours were much lower as compared to the West. Conclusion: Except for the high percentages of anaplastic oligodendrogliomas and ependymomas and the low percentage of metastatic tumours, most of our findings roughly correspond with the published data

Diagnostic evaluation of fine Needle aspiration cytology in the management of palpable Breast lesions

A total of 113 fine needle aspirates of the breast masses were evaluated in which the subsequent biopsy or mastectomy specimen were also available for histological examination. The age ranged from 16 to 80 years with a mean of 42 years. In benign conditions the mean age was 34.7 years while in malignant cases it was 48 years. The cytological diagnoses were compared with the histological results which revealed that the specificity and sensitivity of fine needle aspiration cytology in the palpable breast lesions was 86.1% and 89.2% respectively with a positive predictive value of 93% and efficiency of 88.2%. Similar statistics from other series in which the cytological results of breast lesions were compared with histological results, revealed almost same results which suggest that fine needle aspiration cytology is an effective and accurate technique for the diagnosis and management of palpable breast lumps

Morphological pattern of salivary gland tumours

Objective: To delineate the spectrum of salivary gland tumors in our setup. Setting: The Aga Khan University Medical Centre, Karachi. Method: Tumors were analysed considering histological type, age and sex of the patients and anatomic location. The diagnosis of individual tumours was based on the 1991 World Health Organisation Classification. Results: During the span of eight years (1991-1998), 379 cases of salivary gland tumours were diagnosed. Of these, 205 (65.7%) were male and 174 (34.3%) were female. The median age at the time of diagnosis was 35 years. The median age for patients with malignant lesions (44 years) was 12 years older than those with benign tumours (34 years). Overall, malignant tumours were seen more frequently in males, however benign tumours were distributed equally between the two sexes. The most common site was parotid gland (82.85%). Only five cases of minor salivary gland tumours were seen. The most frequently diagnosed benign salivary gland neoplasm was pleomorphic adenoma (84.5%), followed by Warthin’s tumours (6.18%), Mucoepidermoid carcinoma was the most commonly encountered malignant lesion (56.9%), followed by adenoid cystic carcinoma (19.6%). Conclusion: Plemorphic adenoma was the most common benign salivary gland tumour and mucoepidermoid carcinoma was the most frequent malignant neoplasm. Parotid gland was the most common site of origin in both benign and malignant tumours. The overall relative frequency of salivary gland tumours in this series correlates with that reported in the international literature

Diagnostic Surgical Pathology: the importance of Second Opinion in a Developing Country

Objective: To review the cases sent to the section of histopathology, Aga Khan Universty (AKU) for second opinion and see whether there are significant differences in the original outside diagnosis and the subsequent diagnosis submitted by us. Methods: A retrospective study of all consecutive cases for second opinion in the form of paraffin blocks from 1st Novemver 2001 to 31st July 2002. The primary submitted diagnosis in each case was compared with the subsequent AKU diagnosis. Results: The study included a total of 381 cases. However, in 45 cases (11.81%), initial histopathological diagnosis was not provided. Out of the remaining 336 cases, there were differences between the original diagnosis and the subsequent AKU diagnosis in 120 cases (35.71%). Out of these 120 cases, immunohistochemistry was performed in 65 cases (54.16%) only. Conclusion: In a developing country like Pakistan, where few laboratories are equipped to function as modern histopathology units, second opinion on difficult cases is very important. Worldwide, the concept of second opinion in surgical pathology is well established

The Frequency of IgA Nephropathy at a Single Center in Pakistan

Objectives: To detect the prevalence of IgA nephropathy in Pakistani patients, as no significant published data from this part of the developing world is available in the international literature for reference. Method: The study was conducted in a university hospital on 105 consecutive renal biopsy specimens. Direct immunofluorescence microscopy was performed using antibodies specific for the heavy chains of IgG, IgA, IgM, C3 and fibrinogen. Results: Seventy-nine (79) cases were classified as glomerulopathies, out of which 10 cases (12.65%) were diagnosed as IgA nephropathy, among which one case was that of Henoch- Schonlein purpura. The age range was 6 to 65 years with median age of 25 years and male to female ratio was 1.5: 1. Nephrotic range proteinuria was seen in 40% of cases and 50% cases showed impaired renal function. The light microscopic examination revealed diffuse proliferative pattern in 3 cases out of which one case showed crescent formations. Focal-segmental glomerulosclerosis, minimum histologic lesion and advanced chronic glomerulonephritic patterns were observed in 2 cases each and in one case focal proliferative morphology was appreciated. Conclusion: The frequency of IgA nephropathy among glomerular diseases was 12.65% in our study, which is somewhat higher when comparing the studies from North America, United Kingdom and Northwest Europe. However, it was significantly lower when comparing the studies from other parts of Asi

Breast Diseases: a histopathological analysis of 3279 Cases at a Tertiary Care Center in Pakistan

Objective: To know the frequency of breast diseases in Pakistani females. Methods: A retrospective analysis of 3279 breast specimens received over a period of 4 years (1 993-1996) at the department of pathology, the Aga Khan University Hospital. Results: Out of a total of 3279 breast specimens, common breast lesions included infiltrating duct carcinoma 37%, followed by fibro adenoma 16.95%, fibrocystic change13.96%, mastitis 6.83% and duct ectasia 5.33%. Majority of the cases of infiltrating duct carcinoma were encountered in the 5th and 6th decades of life. Tumour size was 2 or \u3e2 cms. in 93% of cases and 40% of them showed 3 or \u3e3 positive lymph nodes. Grade I tumours were 11.38%, grade 11 59.17% and grade Ill tumours 29.47%. Correlation of grade with lymph node metastases (3 or \u3e3+ve nodes) showed 15 cases (1.53%) of grade 1, 178 cases (18.25%) of grade II and 68(6.97%) cases of grade Ill tumours. Conclusion: This study shows that in Pakistani females, the most commonly encountered lesion in carcinoma of the breast followed by the benign lesions such as fibro adenoma, fibrocystic disease & others. Breast carcinoma occurs at a younger age group with predominance of high-grade lesions and with frequent lymph node metastasis

Comparative Performance between Two Photogrammetric Systems and a Reference Laser Tracker Network for Large-Volume Industrial Measurement

This paper determines the capability of two photogrammetric systems in terms of their measurement uncertainty in an industrial context. The first system – V-STARS inca3 from Geodetic Systems Inc. – is a commercially available measurement solution. The second system comprises an off-the-shelf Nikon D700 digital camera fitted with a 28 mm Nikkor lens and the research-based Vision Measurement Software (VMS). The uncertainty estimate of these two systems is determined with reference to a calibrated constellation of points determined by a Leica AT401 laser tracker. The calibrated points have an average associated standard uncertainty of 12·4 μm, spanning a maximum distance of approximately 14·5 m. Subsequently, the two systems’ uncertainty was determined. V-STARS inca3 had an estimated standard uncertainty of 43·1 μm, thus outperforming its manufacturer's specification; the D700/VMS combination achieved a standard uncertainty of 187 μm