Surgery Commons^™

Ependymal Tumors With Oligodendroglioma Like Clear Cells: Experience From A Tertiary Care Hospital In Pakistan, Fauzan Alam Hashmi, Muhammad Faheem Khan, Saad Akhtar Khan, Muhammad Waqas, Muhammad Ehsan Bari, Arsalan Ahmed

Section of Neurosurgery

Background: Ependymal tumors with oligodendroglioma like clear cells have never been reported from Pakistan. We aimed to see the features and outcomes of this rare entity.
Methods: It was retrospective cohort conducted at the Department of Neurosurgery, Aga Khan University from 2003 to 2013. The medical records and radiology of patients with proven histopathology were reviewed. Analysis was done on SPSS 20.
Results: Eleven cases of ependymal tumors with clear cells were found, which equated to 1.5% of the total tumor burden in 11 years. The median age was 49 years. Most common presenting symptom was headache 54.5%. Out of …

Neurofibromatosis Type 2 Patient Presenting With Medulloblastoma, Jan Kalimullah, Abdul Malik Amir Humza Sohail, Rai Shahjehan, Sabeehuddin Siddique, Muhammad Ehsan Bari

Section of Neurosurgery

Background: Neurofibromatosis type 2 (NF2) is an autosomal dominant syndrome with a frequency of 1 in 25,000 live births and a penetrance of almost 100% by the sixth decade of life. The main tumors occurring in NF2 patients are bilateral vestibular schwannomas, other peripheral, cranial and spinal nerve schwannomas, intracranial and intraspinal meningiomas, ependymomas, and gliomas.
Case description: We report the case of a 6-year-old boy who presented with a 1-month history of nausea and recurrent vomiting. Physical examination was positive for ataxic gait and left-sided facial nerve palsy. Family history was positive for NF2 in the patient's father and …

Kikuchi-Fujimoto Disease Masquerading As Metastatic Papillary Carcinoma Of The Thyroid, S. Garg, M. Villa, J. R. Asirvatham, T. Mathew, L. J. Auguste

Journal Articles

Kikuchi-Fujimoto disease also known as histiocytic necrotizing lymphadenitis is a rare cervical inflammatory lymphadenitis that is most commonly seen in young Asian women. It is mainly characterized by lymphadenopathy, hepatosplenomegaly, fever, nocturnal sweats, myalgia, weight loss, and arthralgia, and commonly follows a self-limited course. The differential diagnosis is challenging as many other conditions such as malignant lymphoma, metastatic disease, tuberculosis and infectious lymphadenopathies can present in a similar way. We present an unusual case of Kikuchi-Fujimoto disease masquerading as metastatic papillary carcinoma of the thyroid. A 30-year-old young female presented, 2 months post-partum, with complaints of neck pain and fever. …

A Rare Case Of A Primary Squamous Cell Carcinoma Of The Stomach Presenting As A Submucosal Mass, W. Von Waagner, Z. Wang, A. I. Picon

Journal Articles

We report a case of a 70-year-old man, with a status after aortic valve replacement, who presented with melena and hypotension. On physical examination, he was hypotensive, but he responded to resuscitation. Esophagogastroduodenoscopy revealed a submucosal mass in the gastric fundus. Imaging of the chest, abdomen, and pelvis showed no evidence of local or distant metastasis. He underwent a partial diaphragmatic resection, gastrectomy, lymphadenectomy, and Roux-en-Y esophagojejunostomy. Pathology showed a gastric squamous cell carcinoma (SCC) invading the diaphragm, with negative margins of resection, and one positive perigastric lymph node. He received chemoradiation, but the patient expired 27 months after surgery.

Promoter Hypermethylation Of Tumor Suppressor Genes Correlates With Tumor Grade And Invasiveness In Patients With Urothelial Bladder Cancer, Shumaila M. Bilgrami, Sohail A. Qureshi, Shahid Pervez, Farhat Abbas

Section of Urology

Purpose: To investigate the promoter methylation status at selected loci which encode for key proteins involved in apoptosis, DNA repair, cell cycle control and progression in urothelial cell carcinoma of bladder and compare the findings from tissue samples with that of plasma.
Methods: Total genomic DNA was isolated from 43 non-muscle invasive (low grade) and 33 muscle invasive (high grade) urothelial bladder cancer samples along with 10 control cases of normal bladder mucosa. Promoter methylation status was investigated for RASSF1A, APC, MGMT, CDKN2A and CDKN2B genes using real-time methylation-specific PCR with SYBR® green. Plasma samples from 16 patients with muscle …

Metabotropic Glutamate Receptor-1 Contributes To Progression In Triple Negative Breast Cancer, Malathi Banda, Cecilia L. Speyer, Sara N. Semma, Kingsley O. Osuala, Nicole Kounalakis, Keila E. Torres Torres, Nicola J. Barnard, Hyunjin J. Kim, Bonnie F. Sloane, Fred R. Miller, James S. Goydos, David H. Gorski

Department of Surgery

TNBC is an aggressive breast cancer subtype that does not express hormone receptors (estrogen and progesterone receptors, ER and PR) or amplified human epidermal growth factor receptor type 2 (HER2), and there currently exist no targeted therapies effective against it. Consequently, finding new molecular targets in triple negative breast cancer (TNBC) is critical to improving patient outcomes. Previously, we have detected the expression of metabotropic glutamate receptor-1 (gene: GRM1; protein: mGluR1) in TNBC and observed that targeting glutamatergic signaling inhibits TNBC growth both in vitro and in vivo. In this study, we explored how mGluR1 contributes to TNBC …

Brain Region-Specific Alterations In The Gene Expression Of Cytokines, Immune Cell Markers And Cholinergic System Components During Peripheral Endotoxin-Induced Inflammation, H. A. Silverman, M. Dancho, A. Regnier-Golanov, M. Nasim, M. Ochani, P. S. Olofsson, M. Ahmed, E. J. Miller, S. S. Chavan, E. Golanov, C. Metz, K. J. Tracey, V. A. Pavlov

Journal Articles

Inflammatory conditions characterized by excessive peripheral immune responses are associated with diverse alterations in brain function, and brain-derived neural pathways regulate peripheral inflammation. Important aspects of this bidirectional peripheral immune - brain communication, including the impact of peripheral inflammation on brain region-specific cytokine responses, and brain cholinergic signaling (which plays a role in controlling peripheral cytokine levels) remain unclear. To provide insight, we studied gene expression of cytokines, immune cell markers and brain cholinergic system components in the cortex, cerebellum, brainstem, hippocampus, hypothalamus, striatum, and thalamus in mice following an intraperitoneal lipopolysaccharide injection. Endotoxemia was accompanied by elevated serum levels …

Refusal To Autopsy: A Societal Practice In Pakistan Context, Laila Akber Cassum

School of Nursing & Midwifery

Autopsies or post-mortem examinations have become a common practice in Western medicine for verifying the cause of death, and to obtain additional scientific information on certain diseases. In monotheistic religions autopsies present several ethical questions even though the advantages attributed to post-mortems in the West are well acknowledged by people living in this modern world. In Islamic Republic of Pakistan where Islam is the prevailing religion followed by the Muslims, Pakistani society have diverse perception, assumptions and hypothesis on the concept of autopsy. This presumption is due to presence of diverse objections raised in religious and sociocultural context. In our …

Sentinel Node Localisation Using Pre-Operative Lymphoscintigraphy And Intraoperative Gamma Probe In Early Oral Cavity Cancer, Mubasher Ikram, Shabbir Akhtar, Montasir Junaid, Tariq Dhari, Maseeh-Uz Zaman, Riffat Hussain, Zubair Ahmad

Section of Otolaryngology, Head & Neck Surgery

Objectives: To assess the diagnostic value of sentinel lymph node localisation using pre-operative lymphoscintigraphy and intra-operative gamma probe radio localisation in Pakistani patients suffering from early stage squamous cell carcinoma of the oral cavity.
Methods: The prospective case series was conducted between September 2007 and April 2010 at the Aga Khan University Hospital, Karachi. It comprised patients with T1and T2 oral cavity cancer with clinically and radiologically negative neck. Pre-operative lymphoscintigraphy was performed one day before surgery and intra-operative gamma probe was used to detect sentinel node. Final histo-pathological evaluation was taken as the gold standard.
Results: The study comprised …

To Re-Excise Or Not To Re-Excise: Positive Margins After Excision Of Non-Melanoma Skin Cancers, Ramon Garza, Iii Md, Courtney Edwards Md, Bharat Ranganath Md, Nathan F. Miller Bs, Joshua M. Adkinson Md, Kirsten S. Bellucci Md, Robert X. Murphy Jr, Md, Ms

Department of Surgery

No abstract provided.

Giant Cell Reparative Granuloma Of Temporal Bone: Case Report Of A 62-Year-Old Male, Muhammad Waqas, Naeem Sultan Ali, Muhammad Zubair Tahir, Syed Ather Enam, Zeeshan-Ud-Din, Mubasher Ikram

Section of Otolaryngology, Head & Neck Surgery

Giant cell reparative granuloma (GCRG) is an uncommon non‑neoplastic reactive tumor which occurs almost exclusively within the mandible and maxilla. GCRG of the temporal bone is a rare condition. It has been found to affect predominantly adolescents and adults (age: 10‑25 years). We report a case of a 62‑year‑old male with GCRG of left temporal bone who presented to us with progressive left temporal swelling for 3 months. It was associated with hearing loss. There was no history of trauma. A non‑contrast computed tomography scan brain showed a locally destructive lesion involving squamous temporal bone closely related to the left …

Primary Non-Functioning Paraganglioma Of Liver: A Rare Tumour At An Unusual Location, Muhammad Rizwan Khan, Rushna Raza, Abdul Jabbar, Arsalan Ahmed

Section of General Surgery

Pheochromocytomas are rare tumours, 22% of which are extra-adrenal and are known as paragangliomas. We report a case of a young male with non-functioning paraganglioma of the liver; a very uncommon primary site. A CT scan with contrast showed a huge, highly vascular mass lesion in the right lobe of the liver and a core biopsy confirmed it to be a paraganglioma. Whole body study with iodine-131-meta-iodobenzylguanidine (MIBG) tracer highlighted the liver tumour but was negative for any other active lesions depicting that the tumour was confined to the liver. The lesion was completely resected by extended right hepatectomy and …

Ercc1 And Rrm1 As Predictors Of Survival And Response In Pancreatic Ductal Adenocarcinoma Treated With Gemcitabine-Based Chemotherapy, Thomas Holdbrook, Kathleen D. Danenberg, Suneeta Satti, Jessica Kline, Charles J. Yeo, Jonathan R. Brody, Peter Mccue, Agnieszka K. Witkiewicz

Department of Surgery Faculty Papers

Conclusion:

In this study, we used RT-PCR and IHC to analyze RRM1 and ERCC1 mRNA and protein expression in PDA specimens. PDA patients with low expression of RRM1 by IHC derived benefit from gemcitabine-based chemotherapy. Assessment of RRM1 mRNA expression was limited by the small sample size. Low ERCC1 expression by RT-PCR was associated with a 2.5 times higher risk of mortality than high expression (p=0.031). There was no association between ERCC1 expression by IHC and survival; however, agreement between mRNA and protein expression was poor for ERCC1. This study demonstrates the ERCC1 and RRM1 expression have an impact on …

Neo-Adjuvant Chemotherapy And Radiation Therapy In Patients With Stage Iiia (N2) Non-Small Cell Lung Cancer (Nsclc): A Retrospective Analysis With Lessons Learned, Eliot L. Friedman Md, Michael F. Szwerc Md, Charles Andrews Md, Robert Kruklitis Md, Kathleen A. Leies, Ferdy Santiago

Department of Medicine

No abstract provided.

One Year Survival With Poorly Differentiated Metastatic Pancreatic Carcinoma Following Chemoembolization With Gemcitabine And Cisplatin., Daniel B Brown, Carin F Gonsalves, Charles J Yeo, Agnes K Witkiewicz, Brian I Carr

Department of Radiology Faculty Papers

While hepatic arterial chemoembolization is efficacious for a number of malignancies, there is scant data regarding treatment of pancreatic adenocarcinoma. We report a complete radiographic response at one year from diagnosis of metastatic pancreatic carcinoma. Gemcitabine/cisplatin based chemoembolization may be of potential benefit for patients with liver-dominant metastases from pancreatic carcinoma. Given the typical survival of 6 months or less in this patient group with standard therapies, further research is warranted.

Utility Of Immunohistochemical Markers In Differentiating Benign From Malignant Follicular-Derived Thyroid Nodules, Husain A. Saleh, Bo Jin, John Barnwell, Opada Alzohaili

Wayne State University Associated BioMed Central Scholarship

Abstract

Background

Thyroid nodules are common among adults though only a small percentage is malignant, which can histologically mimic benign nodules. Accurate diagnosis of these thyroid nodules is critical for the proper clinical management.

Methods

We investigated immunoexpression in 98 surgically removed benign thyroid nodules including 52 hyperplastic nodules (HN) and 46 follicular/Hurthle cell adenomas (FA), and 54 malignant tumors including 22 follicular carcinoma (FC), 20 classic papillary carcinoma (PTC), and 12 follicular variant papillary carcinoma (FVPC).

Results

The staining results showed that malignant tumors express galectin-3, HBME-1, CK19 and Ret oncoprotein significantly more than benign nodules. The sensitivity of …

Carcinosarcoma Of The Esophagus, Ziaur Rehman, Inam Pal, Zubair Ahmad, Asim Qureshi

Section of General Surgery

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.

Cancer Of The Penis: Case Report, D. K. Kiptoon, P. M. Ngugi, F. S. Rana

Pathology, East Africa

Two patients with penile carcinoma are presented after management at a district hospital in Kenya. Both had undergone ritual circumcision as teenagers and presented late. HR was a 73 year old who presented with a fungating penile mass for which a partial penectomy was performed after wedge biopsy confirmed malignancy. He thereafter declined to have the surgical specimen sent for histology and took the amputated stump for burial in his compound to avoid bad omen. GK was 25 years old and presented with a fungating mass and underwent partial penectomy after a histological diagnosis was made. He absconded from follow-up …

Silencing Of Mbd1 And Mecp2 In Prostate-Cancer-Derived Pc3 Cells Produces Differential Gene Expression Profiles And Cellular Phenotypes, Yaqinuddin Ahmed, Farhat Abbas, Syed S. Naqvi, Mohammad U. Bashir, Romena Qazi, Sohail A. Qureshi

Section of Urology

Alterations in genomic CpG methylation patterns have been found to be associated with cell transformation and neoplasia. Although it is recognized that methylation of CpG residues negatively regulates gene expression, how the various MBPs (methyl-binding proteins) contribute to this process remains elusive. To determine whether the two well characterized proteins MeCP2 (methyl-CpG-binding protein 2) and MBD1 (methyl-CpG-binding domain 1) have distinct or redundant functions, we employed RNAi (RNA interference) to silence their expression in the prostate cancer-derived PC3cell line, and subsequently compared cell growth, invasion and migration properties of these cell lines in addition to their respective mRNA-expressionprofiles. Cells devoid …

Infiltrating Syringomatous Adenoma Of Nipple, Nazia Riaz, Shaista Masood Khan, Romana Idress, Naila Kayani

Section of General Surgery

Infiltrating syringomatous adenoma of the nipple is a rare, benign lesion with distinct clinical and histological features. Origin from ducts of dermal sweat glands has been postulated. Important differential diagnosis include nipple adenoma, tubular carcinoma and adenosquamous carcinoma. Appropriate local management includes accurate diagnosis and complete excision to avoid local recurrences. This report describes the condition in a 39-year-old parous lady.

Correlation Of Three Immunohistochemically Detected Markers Of Neuroendocrine Differentiation With Clinical Predictors Of Disease Progression In Prostate Cancer, Hammad Ather, Farhat Abbas, Nuzhat Faruqui, Mohammad Israr, Shahid Pervez

Section of Urology

Background: The importance of immuno-histological detection of neuroendocrine differentiation in prostatic adenocarcinoma with respect to disease at presentation and Gleason grade is gaining acceptance. There is limited literature on the relative significance of three commonly used markers of NE differentiation i.e. Chromogranin A (CgA), Neuron specific enolase (NSE) and Synaptophysin (Syn). In the current work we have assessed the correlation of immuno-histological detection of neuroendocrine differentiation in prostatic adenocarcinoma with respect to disease at presentation and Gleason grade and to determine the relative value of various markers.
Materials and Methods: Consecutive samples of malignant prostatic specimens (Transurethral resection of prostate …

Metanephric Adenoma: A Rare Benign Renal Tumour, Nausheen Yaqoob, Jai Pal Paryani, Naila Kayani, Mohammad Zafar Rafique, Raziuddin Biyabani

Department of Pathology and Laboratory Medicine

Metanephric adenoma is a rare benign renal tumour. We are reporting one histologically proven such case in a 23 year old male from Afghanistan. He presented with severe right flank pain since 3 weeks. Nephrectomy was done and histopathology was consistent with the diagnosis of metanephric adenoma. This novel renal mass has been reported to have benign clinical course despite its symptomatic presentation and large tumour size. There is no distinguishing radiological feature with can differentiate it from malignant tumours. So far, a uniformly benign clinical course has been associated with Metanephric adenoma, but given its relatively recent identification and …

Cystic Breast Lymphangioma, S N. Waqar, H Khan, S F. Mekan, N Kayani, A J. Raja

Department of Biological & Biomedical Sciences

No abstract provided.

Early Surgical Results With Intent To Treat By Radical Retropubic Prostatectomy For Clinically Localized Prostate Cancer, Farhat Abbas, Kamran Siddiqui, Syed R. Biyabani, Jamsheer J. Talati, S. H. Hasan

Section of Urology

Aims: To evaluate the early cancer control rates, morbidity and mortality in men undergoing radical retropubic prostatectomy (RRP) for clinicallylocalized adenocarcinoma prostate.
Methods: Patient's characteristics, operative data, progressive-free survival rates, morbidity and mortality were analyzed for 23 men with clinical T1-2 prostate cancer who underwent surgery with an intent to treat by RRP between December 1997 to July 2001.
Results: Patient's mean age was 63 +/- 6.2 years (range 51 to 76 years) with American Society of Anesthesiology (ASA) status I in 4%, II in 65% and III in 31%. Two third of the patients had lower urinary tract obstructive …

Nipple Aspirate Cytology And Pathologic Parameters Predict Residual Cancer And Nodal Involvement After Excisional Breast Biopsy., E R Sauter, H Ehya, A Mammen, G Klein

Department of Surgery Faculty Papers

We previously demonstrated that abnormal nipple aspirate fluid (NAF) cytology predicted residual breast cancer (RC) and tumour size after excisional biopsy (EB), although normal NAF cytology did not exclude RC. Tumour size correlates with the risk of lymph node (LN) metastases. LN metastases provide prognostic information allowing medical and radiation oncologists to determine the need for adjuvant therapy. We hypothesized that pathologic factors known after EB, combined with NAF cytology, would predict with a high degree of accuracy the presence of RC and LN spread. NAF cytology and pathologic parameters: tumour distance from biopsy margins, multifocal and multicentric disease, sub-type …

Problem Based Learning In The 3rd World Context, V Zaman

Department of Pathology and Laboratory Medicine

No abstract provided.

Endocrine Cell Dysplasia (Nesidioblastosis): A Relatively Unrecognized Entity In Pakistan?, Nasim Sabir, Irshad Nabi Soomro, Zafar Nazir, Abdul Jabbar, Sheema Hasan

Section of Paediatric Surgery

Nesidioblastosis is quantitative as well as qualitative abnormality of pancreatic endocrine cells. There is scattering of small endocrine cell clusters arranged haphazardly rather than the peripheral location within the lobule^1,2. Islet contours are irregular, tailing off into parenchyma³. These islets are present in intimate association with ducts forming ductuloinsular complexes¹ We recently encountered a new born baby with signs and symptoms of endocrine cell dysplasia.

Spinal Cord Compression Caused By Metastatic Epithelial Myoepithelial Carcinoma Of The Parotid Gland, I N. Soomro, A S. Hussainy, K Chishti, M H. Pui, S A. Khan, R Ahmed, S H. Hasan

Department of Pathology and Laboratory Medicine

No abstract provided.

Primary Spinal T-Cell Rich B-Cell Lymphoma: A Case Report, Suhail Muzaffar Suhail Muzaffar, Irshad Nabi Soomro, Naila Kayani, Shahid Siddiqui, Yousuf A. Husein, Rashid Jooma

Department of Pathology and Laboratory Medicine

No abstract provided.