Secret History: Return of the Black Death Channel 4, 7-8pm In 1348 the Black Death swept through London, killing people within days of the appearance of their first symptoms. Exactly how many died, and why, has long been a mystery. This Secret History documentary follows experts as they pick through the evidence and reveal why the plague killed on such a scale. And they ask, what might be coming next?

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The aim of present study was to determine the relative frequency of primary brain tumors among children under 14 years of age in Pakistan. A retrospective review of pediatric primary brain tumors, encountered over 13 years (January 1998 through July 2010) at the Neurosurgical Unit of the Pakistan Institute of Medical Sciences (PIMS), Islamabad, Pakistan, was made covering 231 cases, 142 (61.5%) males and 89 (38.5%) females, with a male to female ratio of 1.69:1. The cases were divided into 5 age groups each covering three years of life (0-2, 3-5, 6-8,9-11 and 12-14 years), with the greatest number in age group 3 i.e. 6-8 years (32%) and the least number of patients in age groups 1 and 5 (10.3% each). The 231 malignancies were categorized by site into two groups, supratentorial (83 cases; 35.9%) and infratentorial (148 cases; 64.1%). The morphological distribution was medulloblastoma (33.3%), astrocytoma (24.7%), mixed gliomas (14.7%), craniopharyngioma (11.7%), ependymoma (8.7%), PNET (6.1%) and pineal tumor (0.9%). Since only a single institution was studied, cautious interpretation is needed. Ideally, a population-based approach would be adopted to determine the cancer burden due to pediatric malignancies of the brain in this population and for their morphological categorization in Pakistan.

A Retrospective Study of Primary Brain Tumors in Children under 14 Years of Age at PIMS, Islamabad

Objective: To find out the frequency of malignancy in nodular goiters. Methodology: A total of 204 cases were studied in the department of ENT and Head and Neck Surgery, Hayatabad Medical Complex, Peshawar. The duration of this descriptive study was from June 1, 2008 to May 31, 2010. After taking informed consent, a detailed history was obtained. Clinical and laboratory investigations were carried out as an aid to diagnosis and determine the patients' fitness for surgery. Patients with nodular goiters were categorized into two categories i.e., Solitary thyroid nodule and multinodular goiter. Surgically resected thyroid specimens were examined histopathologically. The data was analyzed using SPSS 16.0 for windows to determine the frequency of malignancy in nodular goiter. Results: Ages of the patients ranged from 17 to 84 years with a mean age of 37 + 12.48 years. The male to female ratio was 1:3.5. 18.14% cases presented as solitary thyroid nodules (STN) and 81.86% as multinodular goiters (MNG). Out of the total 83.82% cases were benign and 16.18% cases were malignant. The prevalence of malignancy in multinodular goiter was 14.37% and in the solitary thyroid nodules as 24.32%. Papillary carcinoma was the commonest malignancy followed by follicular carcinoma. Conclusion: The prevalence of cancer is significant in nodular goiters and these malignant tumours are usually of the papillary type. Solitary thyroid nodules have more chances of being malignant than multinodular goiter.

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The frequency of malignancy in nodular goiter - a single center study

Thyroid carcinoma is the leading cause of death among endocrine cancers second to carcinoma of the ovary. Now a day, the incidence of thyroid malignancy is increasing more rapidly than any other malignancy. But data on the prevalence of thyroid malignancy among thyroid enlarged patients were very limited in the study area. Therefore, this study was aimed to determine the prevalence of thyroid malignancies among thyroid enlarged patients. Data of 846 thyroid enlarged patients registered from January 2010 to February 2013 were collected from fine needle aspirate cytology and histology (for inconclusive and the neoplastic cases) log books. It was entered and analyzed using SPSS version 20. Odds ratio was calculated to assess the presence and strength of association between the outcome variable and the explanatory variables. P-values less than 0.05 were considered statistically significant. Among the 846 thyroid enlarged patients, 62(7.3%) were confirmed to have malignancy. Among malignancies papillary thyroid carcinoma was the leading, 28 (45.2%), followed by follicular thyroid carcinoma, 18 (29%), and the least type of thyroid malignancies were medullary thyroid carcinoma and hurtle cell carcinoma, each accounts 1 (1.6%). Severe form of thyroid malignancy, undifferentiated thyroid carcinoma, was also accounted significant proportion, 12.9%. Older patients having an age of greater than 60 years and patients with solitary thyroid enlargement were more affected by malignancy compared to the reference age group, 11–20 years and diffused type of enlargement respectively (AOR: 10.96 (3.15-38.1; AOR: 8.82 (3.49-22.32) respectively). The prevalence of thyroid malignancy was significantly high and the leading type of malignancy was papillary thyroid carcinoma followed by follicular thyroid carcinoma. Thyroid malignancy was found to have statistically significant association with type of enlargement and age.

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Prevalence and types of thyroid malignancies among thyroid enlarged patients in Gondar, Northwest Ethiopia: a three years institution based retrospective study

Tumors of the posterior fossa of brain leads to complications like brain stem compression, herniation and death because of its critical location, limited space and involvement of vital brain stem nuclei. This study has been conducted in the department of Pathology and Neurosurgery, Gandhi Medical College, Secunderabad from December 2008 to December 2010. The aim and objectives of this study were to analyze the histological types and to determine the frequency of posterior cranial fossa tumors in children and adults at Gandhi Hospital, Hyderabad and to study the different clinical presentations of posterior fossa space occupying lesion (SOL) and its correlation with radiological and pathological findings. Each tumor type has a different mode of presentation according to the site. With advent of modern diagnostic modalities early diagnosis and treatment is possible.

Clinicopathological study of posterior fossa intracranial lesions

Results: Among 62 patients, 43 (69.35%) were male and 38 (61.29%) patients were adult. The morphological distribution of the posterior cranial fossa tumors was as follows: Meningioma – 7 cases (11.2%), Schwannoma – 12 cases (19.3%), Acoustic Neuroma – 20 cases (32.25%), Medulloblastoma – 9 cases (14.5%), Pilocytic Astrocytoma – 2 cases (3.22%), high grade Astrocytoma – 3 cases (4.83%), Metastatic carcinoma – 5 cases (8.06%) and malignant round blue cell neoplasm – 4 cases (6.45%). Conclusion: Acoustic neuroma was the commonest benign tumor and medulloblastoma was found to be the predominant malignant tumor in this study. Medulloblastoma was also seen the commonest posterior cranial fossa tumor in children.

Morphological Pattern of Posterior Cranial Fossa Tumors

Introduction Thyroid nodules are among the commonly encountered surgical specimens in histopathology laboratory. Thyroid nodules can be solitary or multiple. Carcinoma of thyroid is uncommon accounting for only 1% of all human tumors. Annual incidence of thyroid cancer is 0.5 to 10:100,000 person’s world wide. The prevalence of carcinoma is lower in multinodular goiter (MNG) than in solitary thyroid nodule (STN) (2). Malignancy is seen in only 0 to 11% of patients with MNG and is usually an incidental finding in thyroidectomy specimens, and in 3 to 33% of patients with STN. Clinical assessment based on physical examination of thyroid nodule helps to distinguish cases having high risk of malignancy. Iodine uptake thyroid scan, ultrasonography of the gland and fine needle aspiration cytology (FNAC) can also play a significant role in establishing the preoperative diagnosis of malignancy, but FNAC is the modality of choice. One shortcoming of FNAC in MNG is false negative result because the needle may not go into the nodule on which the test needs to be done. However, its role in solitary nodule is well established. Help of ultrasound guidance for FNAC can be taken if the cell yield is poor on aspiration. STN is the most common indication for surgical resection as prevalence of malignancy is more in solitary nodules. However, the solitary nodules should be cold on thyroid scan because hot nodules are less likely to be malignant. Malignancy in thyroid is mostly seen in hypo functioning cold nodules which do not take up iodine. Men develop thyroid nodules less frequently than women. Another fact is that frequency of malignancy in STN is more common in men than in women. Solitary cold nodules in men should be thoroughly investigated. Malignant nodules need to be treated surgically whereas benign nodules can be managed conservatively. Thyroid malignancy does not cause hypo or hyperthyroidism. Patients with thyroid malignancy usually reveal normal thyroid function tests. This study is aimed to see the histological pattern and ascertain the frequency and pattern of malignancy in goiter and STN in both sexes so that recommendations can be made for management.

http://kemu.edu.pk/annals/apr-jun-2009/histopathological-evaluation-of-432-cases-of-goiter.pdf

Histopathological Evaluation of 432 Cases of Goiter

A study was conducted to review the learning curve of gynecological laparoscopic surgery from January 2012 to December 2014. Total 310 cases were included in the study. These patients had pelvic surgery including hysterectomy either total laparoscopic hysterectomy or laparoscopic assisted vaginal hysterectomy and Ade-nexal surgery (cystectomy, oophorectomy or adhesionolysis). After preoperative evaluation counseling and consent procedures were performed. Data was collected regarding patients  profile variables, indications for surgery, intraoperative findings, intraoperative time, post operative recovery findings, analgesia requirements and discharge time from the hospital. Regarding the intraoperative time, comparison was made for duration of surgery in the 2012 and at the end of study period 2014. Results:   Results of the study showed that there was no significant increase in complication either minor or major related to urinary tract or bowel injury. Operative time was decreased with time. Most common indication for hysterectomy was fibroid uterus or dys-functional uterine bleeding. Most common indication for adenexal pelvic surgery was ovarian cyst and in most cases cystectomy was done. Patient recovery was smooth and post operative analgesia was much less as compared to the routine. Patient hospital stay was less as compared to the routine procedures for hysterectomy. It is concluded from the study that laparoscopic surgery is safe procedure with the clear advantages for the patient. With appropriate surgical training & skills, the surgical time is reduced. In the study complication rate, operating time was comparable to the already published studies. With proper training it is acceptable alternate to open abdominal procedures with clear advantages for the patient. Key words:   Laparoscopic surgery, Learning curve.

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Gynecological laparoscopic surgery: learning curve

Introduction: In Pakistan, nodal Non Hodgkin s Lymphoma (NHL) cases are being reported according to Working Formu-lation (WF). A new and broader classification of lymphomas has been introduced by WHO classification 2008 which inclu-des immunohistochemical markers and cytogenetics of these tumors. This study was carried out to synchronize WF and 2008 WHO classification of nodal NHL. Materials and Methods:   This study was done on 50 consecutive diagnosed cases of nodal NHL. The paraffin blocks of these cases were retrieved from laboratory. New sections were cut and immunohistochemical staining was carried out on these sections. Results:   These results showed that small lymphocytic lymphoma (SLL) according to WF have been recategorised into (WHO) SLL-T cell and SLL-B cell. Diffuse Large cell lymphoma (WF) classified into (WHO) Diffuse large B cell NOS, Peripheral T cell NOS, Anaplastic large cell lymphoma and Angioimmunoblastic lymphoma. Lymphoblastic lymphoma (WF) revealed T lymphoblastic and B lymphoblastic lymphoma types (WHO). The small cleaved, mixed and large subtypes of follicular lymphoma (WF) have been merged as follicular lymphoma(WHO). Diffuse large B cell lymphoma NOS (WHO) includes immunoblastic lymphoma (WF), diffuse mixed (WF), and some cases of diffuse large cell lymphoma (WF) in this study. Conclusion:   The classification of lymphomas has always been a debatable issue for the pathologists and oncologists. Despite of this disparity, WF classification of lymphomas is still being used in Pakistan. However, a revised unified classi-fication would be a better step towards enhanced understanding in this field. Key Words:   Non-Hodgkin's, lymphoblastic, immunoblastic, anaplastic.

Aman ur Rehman

Papers

Morphological Pattern of Posterior Cranial Fossa Tumors

Histopathological Evaluation of 432 Cases of Goiter

Gynecological laparoscopic surgery: learning curve

Synchronization of Working Formulation and WHO Classification 2008 for Nodal Non-Hodgkinâ€™s Lymphoma