Samina Naeem

An updated audit of fine needle aspiration cytology procedure of solitary thyroid nodule.

This study was conducted to see the sensitivity, specificity, and accuracy of fine needle aspiration cytology (FNAC) for solitary thyroid nodules and to compare our experience with that of other regions of the world. It was a prospective cross sectional study conducted on 76 thyroid samples submitted and reported at the Department of Pathology, King Edward Medical University, Lahore. There were 65 (85.5%) females and 11 (14.5%) males. Male to female ratio was 1:5.9. Ages of the patients ranged from 10 to 60 year with mean age 35.37 ± 12.17. Thirty‐three (43.42%) samples were indeterminate. There were 30 cases (39.47%) of benign lesions, comprising of colloid goiter, follicular adenoma, and diffuse hyperplasia. The final reports of these cases were almost the same. On FNAC, 13 cases were declared as malignant (6 cases) or suggestive of malignancy (3 cases) or suspicious for malignancy [4 cases (5.26%)]. Only 9 cases (11.84%) were clearly committed as malignant lesions, comprising of papillary carcinoma, anaplastic carcinoma and suggestive of follicular carcinoma. Comparison of malignant cases on histopathology (14 cases) was close to that of FNAC (13 cases). After comparison of FNAC results with histopathology, overall sensitivity of FNAC was found to be 90%, specificity 87.5%, and accuracy 87%, while positive predictive value (PPV) was 93% and negative predictive value (NPV) was 79.5%. In conclusion, we recommend this procedure in the light of views of other experts as a primary investigation of thyroid lesions. We strongly recommend the suggestion that in a patient with one or more thyroid nodule, FNAC should be advised for every patient for exclusion of cancer. We will also encourage the clinicians to embrace this procedure in the initial management of patients. As FNAC is inexpensive, sensitive, specific, and an accurate procedure it should be adapted as an initial investigation of thyroid diseases in all tertiary hospitals in developing countries like Pakistan. Diagn. Cytopathol. 2008; 36:104–112.

Clinicopathological importance of Papanicolaou smears for the diagnosis of premalignant and malignant lesions of the cervix

Background: Premalignant and malignant lesions are not uncommon in Pakistani women, especially in the older age-groups Aim: This study was conducted to determine the clinicopathological importance of conventional Papanicolaou (Pap) smears for the diagnosis of premalignant and malignant lesions of the cervix. Materials and Methods: Pap smears of 1000 women were examined from January 2007 to June 2009. Only cases with neoplastic cytology were included. Results: The overall frequency of normal, inadequate, neoplastic, and infective smears was 50%, 1.8%, 10.2%, and 38.3%, respectively. Most of the patients (67%) were in the postmenopausal age-group, with the mean age being 44.7±15.63 years. The commonest clinical signs/symptoms seen among the 102 patients with neoplastic gynecological lesions were vaginal discharge and abnormal bleeding (93/102;(91.2% and 62/102;60.7%). Of the 102 cases with neoplastic lesions 46 patients (45%) had low-grade squamous cell intraepithelial lesions (LSILs), 22 (21.5%) had high-grade squamous cell intraepithelial lesions (HSILs), 14 (13.7%) had squamous cell carcinoma, and 6 (5.8%) showed features of adenocarcinoma. Ten (9.8%) cases showed cytology of atypical squamous cells of undetermined significance (ASCUS) and four (3.9%) cases had atypical glandular cells of undetermined significance (AGUS). Conclusion: We conclude that cervical smear examination is well suited for diagnosing neoplastic disease. It is clear that cervical neoplastic lesions are becoming a problem in Pakistan.

Prognostic Significance of New Immunohistochemistry Scoring of p53 Protein Expression in Cutaneous Squamous Cell Carcinoma of Mice

This study was conducted to investigate the prognostic value and therapeutic response of treatment modalities on p53 protein expression and AgNOR index in squamous cell carcinoma (SCC). Furthermore, based on data, we proposed a new p53 immunohistochemistry (IHC) scoring system. Sixty albino mice were given 7,12‐dimethylbenz[a]anthracine (DMBA) and 12‐O‐tetradecanoly Phorbol‐13‐acetate (TPA) to produce skin tumors. The retinoids were given after the development of tumors. p53 immunohistochemical and AgNOR staining was performed on the sections taken before and after the retinoid administration. p53 protein was expressed in 31 of the lesions (60.8%). AgNOR index was high in all 51 (100%) of the pretreated lesions. There was a marked decrease in the expression of p53 protein in 16/51 (31.4%) and AgNOR index in 36/51 (70.6%) in post‐treated mice. There was no decrease in the expression of both markers in mice harboring malignant neoplasms. p53 IHC scores were 0, I, and II in epidermal hyperplasia, papilloma, and dysplasia, respectively, while they were II, III, IV, and V in SCC in situ, well‐differentiated, moderately differentiated, and poorly differentiated SCCs, respectively. Alteration of p53 and AgNOR index occured during the development of SCC. The p53 IHC scores are directly related to the grades of malignancy. Both markers might be used as a supportive tool with routinely performed Hematoxylin and Eosin staining and may help in the diagnosis of SCC. The newly proposed p53 IHC scoring system will help histopathologists in making their differential diagnosis among benign, premalignant, and malignant lesions. It will also help the oncologists to assess the prognosis and effectiveness of their chemotherapy.

Retinoblastoma; bone marrow infiltration - A study of 30 cases

Thirty patients of Retinoblastoma presenting in the Haematology Department of King Edward Medical College, Lahore were included in the study to find out the bone marrow involvement. The patients underwent bone marrow aspiration and peripheral blood examination was also done. The aspirates were screened for the presence of tumor cells. Of the patients studied 21(70%) were males while 9(30%) were females giving a male to female ratio of 2.8:1. Maximum number of patients were in the 2-3years age group. Twenty seven patients had unilateral Retinoblastomas while three patients had bilateral disease at presentation. The bone marrow of three patients showed presence of tumor cells.

Abstract A100: Histological classification of primary lung cancer in relation to age, gender, and types of tobacco smoking.

Abstracts: Frontiers in Cancer Prevention Research 2008 A100 Background According to available data the lung cancer remains the leading malignancy amongst males showing a strongest association with smoking. The study was conducted to analyze the histological classification of primary lung cancer in relation to age, gender and types of Tobacco Smoking Methods The study was conducted on randomly selected 300 patients of 10-90 years age from Ghulab Devi Chest Hospital Lahore. Light microscopy was used for histopathological classification on the sections stained with haematoxylin and eosin. Special (PAS and Alcian blue) stains were used for subclassication. Literature for WHO classification was reviewed. Results The primary malignancy of lung was more common in males (male to female ratio was 5.7:1) and in old ages with mean age was 54.17±3.46 years.. Significantly large numbers of patients (70%) were smokers. The trend of smoking is changing in Pakistan from old traditional hukka to cigarette. A strong association of smoking was found between small cell carcinoma (SCC), and squamous cell carcinoma (SQCC), and Large cell carcinoma (LCC), (P 0.05). According to the WHO classification, SQCC (43%) was found to be the commonest histological variant and SCC (22%) was second in the frequency. The frequency of ADC, LCC and others variants was 18%, 11%and 5% respectively. Conclusion WHO criteria are the better ways to classify the lung carcinoma with light microscopy and provide a potential widespread and worldwide applicationof this classification system. A strong association of lung cancer was found with age, sex, and all types of smoking and histological variants. Citation Information: Cancer Prev Res 2008;1(7 Suppl):A100.