Assessment of Tumour Budding in Colorectal Adenocarcinomas

Colorectal cancer (CRC) is the third most common malignancy worldwide. According to Pakistan Annual Cancer Registry Report, it is the second most common cancer an males and sixth most common cancer amongst females.There are multiple histopathological factors which have an impact on prognosis and survival in CRC.Colorectal cancer (CRC) is the third most common malignancy worldwide. According to Pakistan Annual Cancer Registry Report, it is the second most common cancer an males and sixth most common cancer amongst females.There are multiple histopathological factors which have an impact on prognosis and survival in CRC.The features of prognostic significance include perineural invasion, lymphovascular invasion, infiltrating tumor borders, poorly defined clusters, Extra mural venous invasion (EMVI) and tumor budding.The main purpose of our study is to calculate tumor budding according to the method proposed by ITBCC in pT2 colorectal carcinomas and study its association with other prognostic indicators

Morphological Features of Ewing Sarcoma Post-Neoadjuvant Therapy and Their Impact on Prognosis

Objective: To study the effect of chemotherapeutic response on resection specimens and to assess their effect on prognosis. Study Design: Retrospective longitudinal study. Place and Duration of Study: Shaukat Khanum Memorial Cancer Hospital and Research Centre, Peshawar Pakistan, from Jan 2010 to Mar 2018. Methodology: This study included 42 cases of Ewing sarcoma diagnosed, treated and followed at our institute. Various diagnostic parameters were noted and were assessed for their impact on two-year overall survival, development of distant metastasis, recurrence and cancer-related death. Results: This study included 28 males and 14 females. The majority involved long bones followed by the axial skeleton and soft tissue. Nine cases (9) were confirmed by molecular testing. On the post-neoadjuvant chemotherapy resection specimens, 45% cases had Huvos grade I necrosis, 17% had grade-II, 12% had grade-III and 26% cases had Huvos grade-IV necrosis. Increasing Huvos grade was associated with improved disease-free survival (21%, 43% and 69% for grades-I, II and III/IV respectively). The site and size did not significantly affect the development of recurrence, development of metastasis, or twoyear survival (p>0.05). Conclusion: Meticulous assessment of post neoadjuvant resection specimens for necrosis provides helpful information about the prognostic outcome. Increasing grade of tumour necrosis was associated with increasing disease-free survival. The response to chemotherapy in our study population was worse than Western data, which may be linked to a variety of factors.

Pattern of Different Immunohistochemical Stains in Various Types of Hepatoblastoma

Objective: To assess the utility of four immunohistochemical stains in the categorization of hepatoblastoma. Study Design: Retrospective longitudinal study. Place and Duration of Study: Histopathology Department, Shaukat Khanum Memorial Cancer Hospital, Peshawar Pakistan, from 2016 to 2018. Methodology: We retrospectively reviewed 50 cases of hepatoblastoma from 2016-2018, from our hospital database and studied the pattern of four immunohistochemical stains (Beta-catenin, Glutamine synthetase, Heppar 1 and Cyclin D1) in various subtypes. Results: Ten out of fifty cases were mixed epithelial and mesenchymal hepatoblastomas, and forty were pure epithelial. In the pure epithelial category, the fetal subtype showed Heppar 1 and Cyclin D1 positivity in twenty-eight cases, while Glutamine synthetase and Beta-catenin were positive in all the thirty cases. One case of embryonal subtype displayed negativity for Heppar 1; the rest of the immunohistochemical stains were positive. Ten tumours exhibiting mixed epithelial and mesenchymal morphology showed positivity for all the four immunohistochemical stains in the epithelial component. However, Heppar 1 and cyclin D1 were negative in the mesenchymal component in all the ten cases. Five cases (50%) showed Glutamine synthetase and Beta-catenin positivity in the mesenchymal component. Conclusion: All the four immunohistochemical stains, especially Beta-catenin and Glutamine synthetase, were efficient diagnostic tool, especially for tumours with complex or vague morphological features.

Cytological and histopathological correlation of thyroid lesions

OBJECTIVE

To determine accuracy of cytological diagnosis in comparison with the corresponding histopathological diagnosis of thyroid lesions.

METHODS

The retrospective study was conducted at the Shaukat Khanum Memorial Cancer Hospital, Lahore, Pakistan, and comprised data from January to December 2017 of all in-patient cases of thyroid cytology with their histopathological diagnosis. Both Haematoxylin and Eosin stain slides and cytological smears were reviewed. True negative, true positive, false negative and false positive cases were marked using the criteria defined in Table-1.

RESULTS

Of the total 36 cases, 5(13.9%) were non-diagnostic or unsatisfactory for cytological assessment. Cytological diagnosis achieved sensitivity of 82.3%, specificity 64.3%, positive predictive value 73.6%, negative predictive value 75%, false positive rate 35.7% and false negative rate 17.6%. The diagnostic accuracy of cytological diagnosis was 63.9%.

CONCLUSIONS

There was significant cytological and histopathological concordance of thyroid lesions.

Non-Mammary Metastasis To Breast; A Diagnostic Challenge

Background: Non-mammary metastasis to the breast poses a diagnostic challenge for the pathologists especially when no prior history of non-mammary malignancy is provided. Since non-mammary metastasis is not a very common occurrence, there is a chance that it can be easily missed especially with overlapping morphology and unknown prior history of any malignancy.Methods: In total, 40 patients matching our inclusion criteria were identified through hospital information system in a 10-year period. Confirmatory stains were used to confirm the diagnosis.Results: The most common primary malignancy site was gastrointestinal tract comprising 35% of the metastasis. This was followed by small cell carcinomas (17.5%). In addition, in 72.5% of the patients, there was a known history of primary malignancy but only in 18 (45%) of the cases, the clinicians mentioned it on the biopsy request form. For the remaining cases (27.5%), the clinician was contacted after the verification of the report and was asked to evaluate the possibility of metastasis from the known primary site. Conclusion: Identifying the non-mammary metastasis is important at the time of initial diagnosis as it can prevent the patient from extensive surgery, which might not be needed, if it is not a primary breast tumor. Provision of prior history and use of immunohistochemical stains can aid in timely and accurate diagnosis.

Growth performance and survivability of the Asian seabass Lates calcarifer (Bloch, 1790) reared under hyper-saline, hypo-saline and freshwater environments in a closed aquaculture system

Salinity is one of the most critical environmental parameters regarding fish physiology, modifying food intake and growth performance in many fish species. The present study has investigated the effects of different salinity levels on growth performance, feeding and survival of Asian seabass Lates calcarifer juveniles. Asian seabass juveniles were reared at 0 (T1), 5 (T2), 22 (T3), 36 (T4), and 42 (T5) ppt salinity. Approximately eight hundred thirty fish individuals with an average weight of 1.24±0.52 g were randomly distributed (166 fish/Tank) in 5 concrete tanks (each tank 30×6×4 ft, volume 19,122 L) for forty days. Juveniles were initially fed 42% crude protein-containing diets at a rate of 6% of their body weight per day. The results showed that salinity level had a significant effect on the weight gain (WG), average daily weight gain (ADWG), specific growth rate (SGR), feed conversion ratio (FCR), survival rate (SR), total biomass and health indices (p<0.05). The highest WG (39.11±1.49 g), ADWG (1.00±0.12 g), SGR (8.74±0.03% d-1) and lowest FCR (0.96±0.20) were observed with T3 treatment, which was significantly higher compared to other treatment groups (p<0.05). Among the health indices, the highest hepatosomatic index and viscerosomatic index were found with T3 treatment, significantly higher than the other groups (p<0.05). No significant differences were found among the treatments in terms of survival rate (p>0.05), but the maximum survival rate (98.89±0.0%) was observed in the T3 and T2 treatments. The maximum level of crude proteins (19.99±1.4%) was found in the whole-body biochemical composition of Asian seabass juveniles in the T3 treatment group. The second-order polynomial regression showed that 20 ppt salinity is optimum for the best growth of Asian seabass. Thus, the present study recommends 20 to 36 ppt salinity for the commercial farming of Asian seabass under a closed aquaculture system.

Prognostic Significance of Percentage Necrosis in Clear Cell Renal Cell Carcinoma

OBJECTIVES

The consensus conference of the International Society of Urological Pathology (ISUP), held in 2012, made recommendations regarding prognostic parameters of renal tumors. There was a strong consensus that tumor morphotype, pathologic tumor stage, and tumor grade are prognostic indicators of poor outcome. It was also agreed upon that prognostic significance of tumor necrosis is in evolution, and both microscopic and macroscopic tumor necrosis should be documented in percentages. The aim of our study was to explore the impact of tumor necrosis on metastasis-free survival in clear cell renal carcinomas (ccRCCs) in Pakistani patients.

METHODS

We retrieved 318 consecutive in-house cases of ccRCC resections from 2014 to 2020 through hospital archives. Histologic slide review was done for assessment of tumor necrosis, tumor stage, and World Health Organization/ISUP grade. The follow-up data to assess metastasis-free survival were available in hospital archives.

RESULTS

In multivariable analysis performed by logistic regression model, tumor necrosis was an independent poor prognostic indicator (P = .0001): group 1 (reference group), 0% necrosis; group 2, 1% to 10% necrosis (adjusted odds ratio [AOR], 8.71; 95% confidence interval [CI], 3.62-20.98); and group 3, more than 10% necrosis (AOR, 9.48; 95% CI, 3.99-22.725).

CONCLUSIONS

Tumor necrosis is an independent predictor of poor outcome in ccRCCs.

Determination of hormoligosis of organophosphate insecticides against Phenacoccus solenopsis

Abstract Cotton mealybug is a highly invasive pest of agricultural crops worldwide. Major agriculturists most rely on the use of insecticides for the control of pesticides. So, the indiscriminate use of insecticides leads to resistance development in recent years. For this purpose, an experiment was conducted using different concentrations of the three insecticides (profenfos chlorpyrifos and triazophos) to check the hormoligosis effects against cotton mealybug (CMB) in laboratory conditions. Investigation of variations for % mortality of adults of CMB after three days revealed that all treatments had statistically significant (P ˂ 0.05). The highest mortality was observed at the highest concentrations of profenofos 2.4% (38.55%). After 7 days, all the treatments were significant with difference in means (P ˂ 0.05). The highest mortality was recorded at the highest dilution of pesticide profenofos 2.4% (77.11%). The values of fecundity and longevity exposed a valid difference among treatments (P ˂ 0.05). Maximum fecundity was observed at the concentration 2.4% (181.41%) and longevity showed (38.46%). The highest mortality was observed at a concentration of triazophos 4% (27.98%). For chlorpyriphos the highest mortality was examined at concentration 4% (24.79%). The fecundity showed a statistically significant difference for different concentrations of triazophos and chlorpyriphos (P ˂ 0.05). The results of the recent study provide valuable information regarding the selection of insecticides and hormoligosis effects. The study can be helpful in the implications of integrated pest management of P. solenopsis.

PATTERNS OF MYOINVASION IN ENDOMETRIOID ADENOCARCINOMA OF ENDOMETRIUM

Objective: To assess the patterns of myoinvasion of endometrial endometrioid adenocarcinoma, their frequencies in our hospital and to correlate these patterns with survival. Study Design: Retrospective observational study. Place and Duration of Study: Department of Pathology, Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore, from Aug 2019 to Apr 2020. Methodology: All cases of endometrial endometrioid adenocarcinoma between 2015 and 2017 were retrieved from the archives, independently reviewed by two researchers, all key reporting parameters recorded in addition to the pattern of myoinvasion as per their operational definitions described by Cole and Quick. The follow-up of 3-5 years was obtained from archives and through telephonic contact for outside hospital patients. Disease free survival and relapse-associated mortality were represented through Kaplan-Meier curves. Results: Eighty cases of myoinvasive endometrial endometrioid adenocarcinoma were reviewed. We found that infiltrating irregular gland pattern was the most frequent in all the age groups. Thirty-five (43.75%) cases showed this type of invasion, followed by broad front pattern 23 (28.75%), Microcystic Elongated and Fragmented (MELF) pattern 15 (18.75%) and adenomyotic pattern 6 (7.5%). One case showed a combination of the last two patterns, whereas adenoma malignum pattern was not seen. Follow-up of these patients showed 8 (10%) patients with relapse related mortality including 5 (62.5%) infiltrating irregular glands, 2 (25%) adenomyosis-like and 1 (12.5%) broad front pattern of myoinvasion. Seventy-two (90%) patients had recurrence free survival. Conclusion: Frequency of infiltrating irregular pattern of myoinvasion in endometrial endometrioid adenocarcinoma is high and associated with recurrence related mortality. Recognition....................

Investigation of roost composition of passerine birds in different environmental conditions

Abstract The majority of the birds in different habitats are stressed due to alteration in multiple climate factors contributing to their loss. The present study has been planned to find the roosts composition of passerine birds in different major and sub-habitats of Punjab, Pakistan. In Faisalabad, of the four species, the higher number of exits was almost comparable, while Passer domesticus and Pastor roseus were more abundant than Tachycinet bicolor and Lanius cristatus. For the three remaining birds, total exits and returns were 180 for P. roseus, 181 for T. bicolor, and 179 for L. cristatus, respectively. Considering the exits in morning hours, a total of 314, 256, 246 and 210, were recorded from Sheikhupura. In Khanewal, of the four species, the highest exits and returns were that of P. domesticus (407; 451), followed by that of the P. roseus (273; 336), T. bicolor (242; 319) and L. cristatus (220; 397). The temperature imposed serious effects on roost exits for the four birds. The varied P-values which were higher (< 0.001***, < 0.001***, 0.002 **, <0.001***) appeared to limit the roost exits for them. Nonetheless, the impact of relative humidity exerted a strong influence on the T. bicolor (0.003**). In roosts return, it was seen that roost returns were even likely in warm temperatures and precipitation did not impose seriously on returns, and even in light rainfall. Nonetheless, relative humidity (RH) strongly impacted the sparrow. The T. bicolor and L. cristatus were adversely affected with the slopes (1.37) and (2.06), indicated with each percentage increase of relative humidity, and slope variations became least.

Expression of B-cell Lymphoma 2 in Breast Cancer

Introduction

Immunohistochemical expression of B-cell lymphoma 2 (BCL-2) is seen variably in invasive ductal carcinoma. This study was conducted to determine the frequency of BCL-2 expression in different histologic grades of invasive ductal carcinoma.

Materials and Methods

A cross-sectional study was conducted in the Department of Pathology at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Pakistan, on subjects with invasive ductal carcinoma of various histologic grades. Immunohistochemistry was done using the BCL-2 antibody in all cases. The frequency of BCL-2-positive cases in different histologic grades was noted. Post-stratification, the Chi-square test was applied. P ≤ 0.05 was considered statistically significant.

Results

All 52 subjects were female (100%) with a mean age of 47.58 ± 1.43 years. BCL-2 expression was observed in 28 (53.85 %) subjects with breast cancer. Out of 33 participants with Grade III, 13 (39.39 %) participants were positive for BCL- 2 expression. Among 18 subjects with Grade II, 14 (77.78 %) subjects were positive for BCL-2 expression. Reduced frequency of BCL-2 expression was observed with increasing histologic grade (i.e., more in low-grade tumours and less in Grade III), but the difference was statistically not significant.

Conclusion

A differential expression of BCL-2 was observed across different grades of invasive ductal carcinoma. However, the difference was not statistically significant.

Cutaneous manifestation of COVID-19: What have we learned an year into the pandemic?

Coronavirus disease-19 (COVID-19) is an emerging health situation caused by the "severe acute respiratory syndrome coronavirus 2" (SARS-CoV-2). The ongoing COVID-19 pandemic which emerged from the Chinese city of Wuhan in December 2019 has spread to over 188 countries and infected over 100 million people across the globe in over one year. Most common symptoms of COVID-19 include fever and respiratory illness. Among extrapulmonary signs associated with COVID-19, dermatological manifestations have been increasingly reported from different geographical regions. The exact incidence or prevalence of COVID-19 associated skin manifestation remains largely unknown and the pathophysiological mechanisms are still unclear. In this article, we have attempted to give a comprehensive overview of what has been learned an year into the pandemic on the epidemiology, clinical and histopathological features, pathophysiological mechanisms and clinical management of COVID-19 associated cutaneous manifestations.

An Unusual Occurrence of Uterine Metastases in a Case of Invasive Ductal Breast Carcinoma

Breast cancer is the most frequent cancer in women and has a high proclivity for metastasizing, yet it seldom affects gynaecological organs. We present a case of invasive ductal carcinoma of the breast that metastasized to the uterus following initial curative treatment. Our patient was taking tamoxifen, which can induce endometrial hyperplasia and make diagnosis more complicated.

Diagnosis on Excision Biopsy of Breast Tissues Labeled As Fibroepithelial Tumors on Trucut Samples in a Developing Country

Introduction: Fibroadenomas (FAs) and phyllodes tumors (PTs) are less prevalent but allied to have malignant transformation in many instances. It is a challenge to diagnose the phyllodes by conventional trucut biopsy technique.

Objective: To evaluate the histological characteristics of tumors labeled as fibroepithelial lesions of breast tissues on trucut biopsy and compare with a diagnosis on excision biopsy.

Methods and materials: It was a descriptive cross-sectional study that was carried out in Shaukat Khanum Memorial Hospital and Research Centre within six years from January 2015 to January 2021. In trucut samples, stromal cellularity, stromal cell nuclear atypia, mitotic count, stromal overgrowth, the enhancement of stromal cellularity adjacent to epithelium were scrutinized. In each category, the activity was seen as absent, mild, moderate, or severe. Mitotic activity was graded as 0-1, 0-5, 5-10, >10.

Results: A total of 125 patients were registered for the study. The mean age of patients in our study was 33.86 ± 9.95 years. The mean size was 41.02 ± 27.38 mm with a mean lump duration of 7.52 ± 5.34 months. In the FA group, the trucut sampling report showed the stromal cellularity as mild in 62 (69.7%) and stromal cell nuclear atypia as absent in 68 (76.4%) cases. But in the phyllodes tumor group, the stromal cellularity was severe in 10 (27.8%) patients and stromal cell nuclear atypia was severe in five (13.9%). The ultimate outcome showed that 89 (71.2%) patients had FA and 36 (28.8%) had PT at excision.

Conclusion: Assessment of tumor size, stromal cellularity, mitoses, and enhancement of stromal cellularity adjacent to epithelium are useful markers for diagnosing the PT in trucut needle biopsy.

A digital score of tumour-associated stroma infiltrating lymphocytes predicts survival in head and neck squamous cell carcinoma

The infiltration of T-lymphocytes in the stroma and tumour is an indication of an effective immune response against the tumour, resulting in better survival. In this study, our aim was to explore the prognostic significance of tumour-associated stroma infiltrating lymphocytes (TASILs) in head and neck squamous cell carcinoma (HNSCC) through an AI-based automated method. A deep learning-based automated method was employed to segment tumour, tumour-associated stroma, and lymphocytes in digitally scanned whole slide images of HNSCC tissue slides. The spatial patterns of lymphocytes and tumour-associated stroma were digitally quantified to compute the tumour-associated stroma infiltrating lymphocytes score (TASIL-score). Finally, the prognostic significance of the TASIL-score for disease-specific and disease-free survival was investigated using the Cox proportional hazard analysis. Three different cohorts of haematoxylin and eosin (H&E)-stained tissue slides of HNSCC cases (n = 537 in total) were studied, including publicly available TCGA head and neck cancer cases. The TASIL-score carries prognostic significance (p = 0.002) for disease-specific survival of HNSCC patients. The TASIL-score also shows a better separation between low- and high-risk patients compared with the manual tumour-infiltrating lymphocytes (TILs) scoring by pathologists for both disease-specific and disease-free survival. A positive correlation of TASIL-score with molecular estimates of CD8⁺ T cells was also found, which is in line with existing findings. To the best of our knowledge, this is the first study to automate the quantification of TASILs from routine H&E slides of head and neck cancer. Our TASIL-score-based findings are aligned with the clinical knowledge, with the added advantages of objectivity, reproducibility, and strong prognostic value. Although we validated our method on three different cohorts (n = 537 cases in total), a comprehensive evaluation on large multicentric cohorts is required before the proposed digital score can be adopted in clinical practice. © 2021 The Authors. The Journal of Pathology published by John Wiley & Sons Ltd on behalf of The Pathological Society of Great Britain and Ireland.

Prognostic role of cardiac MRI after first episode of acute pericarditis: a long-term follow-up study

Introduction

Recurrent pericarditis (RP) complicates acute pericarditis in 30% of case. In this clinical setting guidelines suggest a one fits-all therapeutical approach, but only a minority of patients had RP. Pericardial LGE at cardiac MRI has been suggested as potential predictor of worse prognosis among patients with RP while no data are available regarding the role of CMR after first episode of pericarditis. Aim of the present study is to evaluate the role of cardiac MRI after a single episode of pericarditis for the identification of patients at higher risk of recurrent pericarditis that may merit more aggressive therapy.

Material and methods

From a registry of consecutive patients who underwent cardiac MRI from January 2014 to January 2019 we retrospectively selected a subgroup of patients with clinical diagnosis of pericarditis according ESC guidelines on pericardial disease, who underwent cardiac CMR less than 2 week after symptoms onset, for which transthoracic echocardiography and biochemical data during acute episode were available. CMR protocol included bSSFP images, T2w images and LGE in all patients. Transthoracic echocardiography was considered to be positive for pericardial disease if pericardial effusion and/or signs of pericardial constriction were present; cardiac MRI was considered to be positive for pericardial inflammation if pericardial hyperintensity signal were detected on T2w or LGE images. Clinical follow-up was recorded for a composite end-point including new episodes of recurrent pericarditis and subsequent diagnosis of chronic constrictive pericarditis

Results

A total of 26 patients were included in the study. All patients presented high risk features according to ESC guidelines on pericarditis. Pericarditis etiology was unknow (idiopathic) in 22 (84.6%), related to cancer in 3 patients (11.6%) post-myocardial injury in 1 case (3.8%). In 6 patients (24%) a myopericarditis was diagnosed. According to predefined criteria 12 patients had echocardiography positive for pericardial disease (46.2%), while in 7 patients cardiac MRI was positive for pericardial inflammation (26.9%). Both echocardiography and cardiac MRI were positive in 5 patients (19.2%). At a mean follow-up of 46.2±21.2 months a total of 8 recurrent pericarditis events were recorded and 1 patient developed chronic constrictive physiology. When corrected for peak C-reactive protein values, MRI positive for pericardial inflammation [HR (95% CI) 5.5 (1.3–24.1), p=0.034] but not echocardiography positive for pericardial disease [HR (95% CI) 0.58 (0.1–2.8), p=0.507] resulted to be associated to composite end-point at follow-up.

Conclusion

Cardiac MRI positive for pericardial inflammation may identify patients at higher risk for recurrent pericarditis, independently from peak C-reactive protein values, even after the first episode of acute pericarditis

Funding Acknowledgement

Type of funding sources: None.

Diagnostic Utility Of Fish For MDM2 In Adipocytic Neoplasms

BACKGROUND

The 2013 World Health Organization (WHO) classification of soft tissue and bone tumours recognizes benign entities such as lipoma and four major liposarcoma subtypes: atypical lipomatous tumour/well differentiated liposarcomas (ALT/WDL), dedifferentiated liposarcomas (DDL), myxoid liposarcoma and pleomorphic liposarcoma. This classification of atypical and malignant adipocytic tumours has evolved significantly over the past few decades owing to contributions from cytogenetics, molecular genetics and Immunohistochemical correlates. Most ALT/WDLs can be diagnosed on histology; however, some of the biopsies may be underdiagnosed due to focal atypia or limited nature of tissue for the biopsy. Fluorescence in situ hybridization (FISH) for MDM2 (located at 12q14-15) gene amplification has emerged as gold standard for diagnosis in cases with limiting histological factors.

METHODS

We studied MDM2 amplification by FISH in 55 such problematic adipocytic tumours with overlapping morphological features and a retrospective analysis was made against their corresponding histological features.

RESULTS

MDM2 amplification correctly identified 11 of 17 ALT/WDLs (64.71% concordance) and 8 of 10 Lipomas (80% concordance). We were able to differentiate liposarcomas from other high grade sarcomatous lesions and sub-classified these lesions into pleomorphic and dedifferentiated types.

CONCLUSIONS

FISH for MDM2 amplification should be used as a gold standard in adjunction with morphology and immunohistochemistry for problematic adipocytic neoplasms.

Frequency Of Non-Diabetic Renal Disease In Type 2 Diabetes Mellitus Patients Undergoing Renal Biopsy

BACKGROUND

Diabetes mellitus has become a major emerging health concern. Its burden, estimated to be 451 million in 2017, has been projected to rise to 693 million by 2045. This will bring a rise in the prevalence of its associated complications. There is a wide spectrum of non-diabetic renal disease (NDRD) known to be present in diabetic patients with variable prevalence. However, the majority of diabetes mellitus (DM) patients with renal disease are yet not biopsied and the diagnosis of diabetic nephropathy (DN) is presumed on clinical grounds.

METHODS

It is a retrospective cross-sectional study. We selected a total of 126 cases of renal biopsies with a history of type 2 diabetes mellitus. Demographic data was collected from the medical records and pathology reports while all cases were evaluated by reviewing the archived slides.

RESULTS

Patients were categorized into group 1 with isolated NDRD, group 2 showing NDRD mixed with DN and group 3 with isolated DN. Thirty-four (27%) cases had isolated NDRD (group 1), 14 (11%) had NDRD mixed with DN and 78 (62%) patients had isolated DN. NDRD, either alone or in combination with DN, was found to be present in 48 patients with an overall prevalence of 38%.

CONCLUSION

Our study concludes that NDRD is frequent in type 2 diabetes mellitus patients. Renal biopsy remains the key diagnostic tool in such cases, providing crucial information for proper management of the underlying pathology.

Morphological Spectrum and Survival Analysis of Diffuse Midline Glioma With H3K27M Mutation

Background

Diffuse midline gliomas with the H3K27M mutation are now recognized as separate entities due to their unique molecular signature, clinical features, and adverse outcome.

Objective

To determine the morphological spectrum and survival rate of diffuse midline gliomas with H3K27M mutation.

Material and methods

This retrospective study was conducted between January 2015 and January 2021 at Shaukat Khanum Memorial Cancer Hospital and Research Centre. Medical records of 28 cases of H3K27M-mutated midline gliomas were retrieved. Case slides were reviewed and the pertinent histological spectrum was evaluated.

Results

The mean age of patients was 24.36 ± 14.06 years. There were 21 (75%) males and 7 (25%) females. Biopsy was performed in 22 (78.6%), total resection in 1 (3.6%) while subtotal resection was done in 5 (17.9%) cases. Histologically, a spectrum of morphologies was noted with pilocytic astrocytoma (WHO grade 1) at one end and glioblastoma (WHO grade IV) at the other end. Immunohistochemically, all 28 cases were positive for Histone 3 immunohistochemistry. ATRX was performed in 7 (25.0%) cases with loss of ATRX expression in 3 (10.7%) and retained expression in 4 (14.3%) cases. Ki67 was <5% in 6 (21.4%), 5-10% in 1 (3.6%), 11-15% in 1 (3.6%), 16-20% in 3 (10.7%), 21-25% in 4 (14.3%), and 26-30% in 2 (7.1%) cases. The mean survival was 8.00 ± 9.39 months. Out of 28 patients, 15 (62.5%) patients died of disease.

Conclusion

Diffuse midline gliomas with H3K27M mutation is an aggressive entity with a broad morphological spectrum.

P–076 Probability of sperm retrieval in azoospermic patients and mRNA expression profile of JMJD1A, TNP2 and PRM2 : in a subset of karachi population

Study question

To access successfulness of sperm retrieval by evaluating the mRNA expression profile of JMJD1A, TNP1, TNP2, PRM1 and PRM2 in patients undergoing surgical sperm retrieval procedure.

Summary answer

Probability of sperm retrieval in azoospermia is decreased when mRNA expression profile of JMJD1A TNP2 and PRM2 in testicular tissue is decreased.

What is known already

Studies have been done on expression of JMJD1A in non-obstructive azoospermic patients in other part of the world with smaller sample size but this is the first study in Pakistan with larger number of patients. Study design, size, duration: Crossectional study, 100 azoospermic patients coming for purpose of sperm retrieval by TESE or micro-TESE in Australian Concept Infertility Medical Center, Karachi,from March, 2018 to December, 2019

Participants/materials, setting, methods

All recruited azoospermic patients were evaluated by history, physical examination, and hormonal assessment. RNA was extracted by pureLink RNA Micro kit and mRNA expression of the JMJD1A, TNP1, TNP2, PRM1 and PRM2 genes was determined using innu-SCRIPT One Step RT_qPCR SyGreen kit. For quantitative variables independent t test and for categorical variables chi-square/ Fisher Exact test was used. Unadjusted and adjusted prevalence ratio were reported by using cox regression algorithm. Main results and the role of chance: The patients were categorized into (i) Group-I: Patients with successful sperm retrieval n = 42, (ii) Group-II: Patients with unsuccessful sperm retrieval n = 58. The patients were categorized into (i) Group-I: Patients with successful sperm retrieval n = 42, (ii) Group-II: Patients with unsuccessful sperm retrieval n = 58. Azoospermic men in the successful sperm retrieval group had significantly decreased expression of JMJD1A (P &lt; 0.001), TNP2(P &lt; 0.001), and PRM2 (P 0.008). In addition to this regarding hormonal parameters: FSH (P 0.004), LH(P &lt; 0.001), TSH(P&lt;.011) were significantly different in azoospermic men with successful and unsuccessful sperm retrieval. In multivariate analysis, after adjusting for the other covariates, a significant association was found between JMJD1A, TNP2, PRM2 and successful sperm retrieval (p-value &lt;0.05).

Limitations, reasons for caution

It is unicentric and outcomes for fertilization were not assessed. Azoospermic patients from multi-centeres were difficult because of lack of facility of sperm retrieval procedures at these centers and it was difficult to follow the fertrilization outcome.

Wider implications of the findings: This will be useful for making the decision in azoospermic men to proceed for ICSI or not. In addition to this, the repetition of unnecessary surgical procedures can be avoided, as the azoospermic men often undergo number of rounds of ICSI, with the hope of becoming biological father.

Trial registration number

non-clinical trials

Live integration of comprehensive cardiac CT for myocardial fibrosis and coronary anatomy with electroanatomical mapping in patients with refractory ventricular tachycardia: a pilot study

Funding Acknowledgements

Type of funding sources: None.

Aim of the study was to verify the feasibility and accuracy of live integration of myocardial fibrosis evaluated at CCT with EAM. The present is the first report of live integration of cardiac computed tomography (CCT) data for myocardial fibrosis and coronary anatomy with electroanatomical mapping (EAM).

We prospectively enrolled all patients admitted with a clinical indication to endocardial and epicardial EAM before radiofrequency catheter ablation (RFCA) of refractory ventricular tachycardia (VT) and an absolute contraindication to cardiac magnetic resonance. All patients underwent per protocol CCT for myocardial fibrosis and coronary anatomy evaluation, before RFCA procedures. Sensitivity, specificity, negative predictive value, positive predictive value and diagnostic accuracy were assessed for myocardial fibrosis evaluation with CCT vs EAM on a per segment-basis taking into consideration both any type of fibrosis and ischemic vs non ischemic subtypes. Live integration feasibility of CCT vs EAM was evaluated for every patients.

Live integration feasibility and diagnostic performance of CCT vs EAM for myocardial fibrosis identification was evaluated for every patients. EAM adverse events were recorded as well.

In all patients CCT data were successfully integrated with EAM during RFCA procedure. All patients had myocardial fibrosis correctly identified at CCT vs EAM on a per-patients basis. A diagnostic accuracy of 94.1% for detection of any type of myocardial fibrosis at CCT vs EAM was recorded. No pericardial tamponade and/or pericardial effusion were recorded.

CCT identification of myocardial fibrosis is feasible and accurate vs EAM in a very selected high risk patients with clinical indication to RFCA of VT and contraindication to CMR. CCT images integration during EAM is feasible and enable to provide electrophysiologist useful information regarding myocardial fibrosis and coronary arteries location, possibly avoiding invasive coronary angiography.