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Professor, Consultant Pathologist, American Board Certified Pathologist, Fellow College of American Pathologists. Areas of interest Fine Needle Aspiration Cytology, Cytology, Cancer, Ethics, Islam, Humanity

Editorial: Integrated Examinations in 4th& 5thYear of MBBS

Anwar UlHaque

Department of Pathology, Northwest School of Medicine,Peshawar, Pakistan

Integrated modular examinations in Medical Colleges had gained worldwide acceptance due to its obvious advantages. However it has been observed that some medical colleges are not conducting integrated examinations in their 4th and final years. One fails to understand why it is not done. Of course taking traditional style annual examination is far easy and more convenient to the busy physicians but does it extracts from the candidates what it must. I mean the holistic and all multidimensional comprehension of the subject.

Original Article: Short-Term Clinical Outcomes of Drug Eluting Stents in Diabetic versus Non-Diabetic Patients Having Stable Coronary Artery Disease

Yasir Adnan*, Lubna Noor**, Muhammad Habeel Dar**,Haris Adnan*** and

Muhammad Hafizullah**

*Department of cardiology, Police and Services Hospital, Peshawar, **Department of Cardiology,

Lady Reading Hospital, Peshawar and *** Category C Hospital, Nahaqi Peshawar



Background: Diabetes mellitus (DM) increases the risk of adverse outcomes after coronary artery revascularization. Diabetic patients have a worse prognosis than non-diabetic patients, with generally greater rates of death, myocardial infarction and need for target lesion and vessel revascularization.

Objectives: The aim of this study was to assess the Short-Term clinical outcomes in diabetic versus non-diabetic patients who underwent successful percutaneous revascularization with drug-eluting stents.

Material and Methods: Between April 2011 and July 2012, 144 diabetic and 232 non-diabetic patients with stable coronary disease undergoing DES implantation at Cardiology Unit Lady Reading Hospital, were enrolled prospectively. Clinical outcomes (Myocardial infarction [MI], unstable angina [UA], and positive ETT) at three months were measured in Diabetic and non-Diabetic patients who received DES for coronary artery lesions. All patients were followed and reassessed after 3 months from the index procedure. Exercise Tolerance Test (ETT) was performed on every patient and recorded on Proforma. Data analysis was done using SPSS version 16.

Results: We evaluated 376 patients with stable coronary artery disease treated with DES of the 376 patients, 144 (38.3%) were Diabetics. The mean age was57±9.313 years. Male patients were 271(72.1%). At 3-Months follow-up, diabetic patients treated with DES had significantly higher rates for myocardial infarction (5.6 vs. 1.3%; p = 0.025), unstable angina (12.5 vs. 3.4%; p = 0.001) and positive ETT (16.7 vs. 5.6%; p = 0.001).

Conclusion: Our study revealed that despite the use of DES the risk of myocardial infarction, unstable angina, and positive ETT at three months remains higher in diabetic patients.

Key Words: Coronary Artery Disease, Drug Eluting stent, Exercise tolerance test.

Original Article: Lymphoma Distribution Trends from Single Institute of Pakistan: Spectrum of 212 Cases

Durr-e-Sameen Kamran*, Hira Salam**, Uzma Bukhari* and Shaheen Sharafat***

*Department of Pathology, **Department of Oral Pathology, ***Basic Medical Sciences, DIMT,

Dow Diagnostic, Research & Reference Laboratory. Dow University of Health Sciences, Ojha Campus,

Karachi, Pakistan



Objective: Lymphoid neoplasms encompass an enormous group with diverse subtypes. The incidence is contrastingly diminished in developing countries. Pakistan lacks a national cancer registry for exact characterization of statistics. The objective of this study was to draw histopathological spectrum of lymphoma subtypes diagnosed and characterized at Histopathology section of Dow University of Health Sciences, Karachi.

Methods: Every lymphoma case diagnosed at Dow Diagnostic Reference and Research Lab and Dow University of Health Sciences Karachi during study period (January 2014 – December 2015) was included without exception. Pertinent clinicopathological information was entered in a proforma. Paraffin-embedded tissue blocked were retrieved from histopathology archives and cross-examined. Data was analyzed using SPSS 16.0.

Results: Out of 212 lymphoma cases, 79% were of Non-Hodgkin Lymphoma (NHL) and 21% were of Hodgkin Lymphoma (HL). Diffuse Large B-cell Lymphoma (DLBCL) was the prevalent subtype. Nodular Sclerosis (NS) dominated the HL class. Mean age at onset was significantly higher for NHL (p<0.01). Male to female ratio was 1.7:1. Cervical lymph nodes are most frequently involved site for primary nodal lymphomas, whereas GIT is predominantly involved by extra-nodal group.

Conclusion: Lymphomas render a considerable measure of morbidity and mortality globally. Due to pronounced heterogeneity in divergent subtypes, their prevalence also varies and hinders understanding of etiologic factors. Epidemiologic studies are paramount for improving our understanding and subsequent delivery of healthcare. We have described the spectrum of lymphoma as registered in one hospital in Pakistan. More studies from developing countries on broader scale are imperative for streamlining future research goals.

Original Article: Validity of Mean Platelet Volume to Detect Hyperdestructive & Hypoproductive Thrombocytopenia in Tertiary Care Setting

Wardah Aslam1, Maryam Habib2, Mobina Ahsan Dodhy3, Masooma Shaheen4 and Madiha Habib5

*Department Of Pathology, Noori Hospital Islamabad, **Faculty Of Pathology Shifa College Of Medicine, ***Faculty Of Pathology, Khawaja Muhammad Safdar Medical College Sialkot, ****Department Of Pathology, District Headquarter Attock, *****Faculty Of Dentistry, University Of Malaya, Malaysia



Objective: Determine the validity of mean platelet volume (MPV) to detect hyper-destructive & hypo-productive thrombocytopenia, keeping bone marrow aspiration and biopsy as gold standard.

Study Design: Cross sectional (Validation) study.

Material and Methods: A total number of 147 patients of thrombocytopenia were enrolled.CBC of the patient was done using an EDTA sample. Bone marrow aspiration and biopsy was also performed. Keeping aspiration results as gold standard specificity and sensitivity of MPV was validated in diagnosing the type of thrombocytopenia.

Results: Mean platelet volume has a Sensitivity 95%, Specificity 15.7%, Positive Predictive Value64%, Negative Predictive Value 69.2% in detecting Hyper-destructive thrombocytopenia. It has a Sensitivity of 15.7%, Specificity 95.5% with a Positive Predictive Value of 69%and Negative Predictive Value of 64% in detecting Hypo-productive thrombocytopenia.

Conclusion: Mean platelet volume has limited sensitivity and specificity and can be used as an initial indicator but bone marrow aspiration and biopsy remains the gold standard for distinguishing between hyper-destructive and hypo-productive thrombocytopenia.

Keywords: Thrombocytopenia, hyper-destructive & hypo-productive thrombocytopenia, Mean platelet volume

Original Article: Histopathological Evaluation of Excessive Uterine Bleeding of Reproductive Age Group in Hysterectomy Specimens

Shabana Naz, Ehtisham Ahmed Khan Afridi, Shagufta Naeem and Raisa Naz

Department of Pathology, Ayub Medical College Abbottabad



Objective: Determine the frequencies of uterine pathologies in women of reproductive age group presenting with excessive uterine bleeding.

Material and Methods: This study was conducted in the histopathology section of the Department of Pathology at Ayub Medical College Abbottabad. This was a descriptive study of 100 hysterectomy specimens removed for excessive uterine bleeding received in the department over a period of six months. All the specimens belonging to patients of reproductive age group (30-50 years) with excessive uterine bleeding were included in this study. The data recorded from the specimen request forms included the patients’ clinical presentation, reproductive history and history of hormone intake.  All the specimens were received in ten-percent formalin and were examined grossly. Multiple sections 3-5 microns thick were taken, stained with haematoxylin and eosin and examined under Olympus Microscope CX23.

Result: The most common uterine lesions associated with excessive uterine bleeding were leiomyoma (43%) and adenomyosis (24%).

Conclusion: As leiomyoma is the most common lesion found in the uterus of the patients in which hysterectomy is done for excessive uterine bleeding; this is a treatable cause. As most females are in child bearing age so female of child bearing age should be investigated thoroughly before considering hysterectomy.

Key words: Hysterectomy, excessive uterine bleeding, leiomyoma, adenomyosis

Original Article : Clinicopathological and Prognostic Features of Ovarian Tumors – An Institutional Look

Aisha Akbar, Ahmareen Khalid and Ashok Kumar



Abstract: Ovarian cancer is one of the most common malignancies in Pakistan. Due to high incidence and mortality rate, it is important to determine changing trends in ovarian tumors in different settings.

Knowing histological subtypes, grading and staging of tumor also has prognostic significance. The present study was carried out to determine histopathology and clinico-pathologic features of malignant ovarian tumors.

Methods: It is retrospective study of 80 cases of malignant ovarian masses in 3 years, received in Histopathology Department of Pakistan Institute of Medical Sciences, Islamabad. Histological typing and grading of the tumor was done according to WHO criteria. Undifferentiated tumors were identified using immunohistochemistry panel. Different clinico-pathological parameters were assessed including age of the patient, peritoneal fluid involvement ovarian surface involvement, omental metastasis, nodal involvement, and invasion of other adjacent organs.

Results: 80 cases of malignant ovarian neoplasms were included. 51(63.7%) patients presented in age group 20-40 years. Majority of the patients 45 (52%) presented with high tumor grade (poorly differentiated and undifferentiated tumors). Most frequent tumors were surface epithelial tumors comprising 53 (66.2%) of all cases.  Serous cystadenocarcinoma was most common among epithelial tumors. Dysgerminoma was most common in germ cell tumors comprising 21(26.2%) cases. Positive peritoneal fluid cytology for malignant cells was seen in total 37(46.25) cases, most commonly in dysgerminoma. 17 (53.1%) cases of serous adenocarcinoma and 3 (50%) cases of endometrioid carcinoma showed capsular invasion.

Conclusion: Higher frequency of ovarian tumors was seen in reproductive age group. Epithelial tumors were most common in our setup, most frequent being serous cystadenocarcinoma. Peritoneal fluid cytology was positive in majority of the patients being an important independent prognostic marker. Serous and endometrioid carcinoma showed association with poor prognostic factors like capsular invasion and omental metastasis.

Key Words: Ovarian tumors, Ovarian Malignancy, Serous Cysadenocarcinoma, Mucinous Cystadenocarcinoma, Dysgerminoma.

Original Article: Flexible Bronchoscopy: A Favorable Diagnostic Tool

Kausar Rehana*, Muhammad Mudassir Shafiq*and Fasih Hashmi**

*Department of Pulmonology, Pakistan institute of medical sciences, Islamabad

**Statistician, CPSP Islamabad



Objective: To determine the diagnostic outcome of fiber-optic bronchoscopic biopsy in Pulmonology department of SZABMU/PIMS Islamabad.

Methods: An observational, cross sectional, retrospective study was conducted at Pulmonology department, PIMS Islamabad and record from July 2015 to June 2016 was reviewed. Demographic details of the patients, CT scan, bronchoscopic findings and biopsy outcome and final diagnosis were recorded.

Results: Out of 78 study patients, 78.2% were fall between 36 and 75 years of ages and 75.6% were male. 48.7% had right sided and 43.6% had left lung lesion on contrast enhanced CT scan. Right hilar mass (42.1%) and left hilar mass was (35.3%) was the most common among right and left sided lesions respectively. 50% had right sided, 39.7% had left sided and 10.3% had randomly distributed findings on bronchoscopy. Upper lobe mass/obstruction was the most common finding irrespective of the side of lesion (right 33.3% versus left 29.0%). 76.9% of the studied population had cancerous outcome on histopathology and squamous cell carcinoma was the most common final diagnosis (57.4%). Incidence of tuberculosis was very low (n=3). In our study association between smoking, gender and age with final diagnosis was not significant.

Conclusion: Diagnostic yield of flexible bronchoscopy is good enough, very useful for the diagnosis of pulmonary lesions and safe as a day care procedure.

Keywords: Bronchoscopy, Lung cancer, Tuberculosis, Hilar mass

Original Article: Factors Associated with Non-Compliance of Medications in Hypertensive Patients

Abdul Khalid *, ImtiazAhemd*, Ashfaq Ahmed *, RubinaRafique*, Ali Arshed*, MazharHamdani*, Raza Manzoor*, Tahir Lone *, Muhammad Riaz*.

*Department of medicine Abbas institute of Medical Sciences; AJK-Medical College Muzaffarabad Azad Kashmir



Objectives: To determine different factors associated with non-compliance to anti-hypertensive medications.

Methods: Patients diagnosed as suffering from hypertension and either taking or had taken treatment in the past were included in the study. Study Questionnaires was filled by investigators (consultants, Registrars and PG students) during face to face clinical encounters with hypertensive patients who had been non-compliant to anti-hypertensive medications. Statistical analysis was performed by using SPSS-21 software. Factor analysis was performed for assessing the validity of the responses for the 20 items present in the questionnaire for a sample comprising of 300 hypertensive patients.

Results: The Principal Component Extraction Analysis showed several factors associated with non-compliance to medications. Some patients did not have easy access to their treating physician (0.83) while others did not have any significant change or improvement in their health by using anti-hypertensive medication (0.83). Long Distance from health facility (0.75), difficulty in sparing time (0.74), polypharmacy (0.70), lack of symptoms (0.67), forgetfulness (0.67), high cost of the treatment (0.59), undesirable side effects of anti-hypertensive drugs (0.50) and lack of family support (0.45) were contributing towards non-adherence to antihypertensive treatment in this cohort of patients.

Conclusion: There are number of factors associated with non-compliance of anti-hypertensive medications. The knowledge of these factors will help to develop effective interventions with deeper understanding to overcome the non-compliance in hypertensive patients.

Key words: Hypertension, non-adherence, anti-hypertensive treatment

Case Report: Chediak-Higashi Syndromein Accelerated Phase: A Case Report

Maryam Zulfiqar, Asma Mustafa, Bushra Anam Ali and Lubna Naseem

Department of Pathology, Pakistan Institute of Medical Sciences, Islamabad

Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad


Abstract: Chediak Higachi Syndrome (CHS) is a very rare autosomal recessive disorder which presents with repeated bacterial infections, albinism, progressive peripheral neuropathy, cranial nerve abnormalities and patients have characteristic silvery grey hair and giant bluish grey granules in cytoplasm of white blood cells. Late stages presents with accelerated phase of this disease which is characterized by lymphohistiocytic infiltration of spleen, liver and lymph nodes. Here, we report a case of one year old child who presented to us in accelerated phase of CHS and diagnosis was made on clinical characteristic findings and presence of largeazurophilic granules in granulocytes and lymphocytes in peripheral blood smear and bone marrow.

Keywords: Chediac-Higashi syndrome, large azurophilicgranules, repeated bacterial infections, albinism, progressive peripheral neuropathy, cranial nerve abnormalities, silvery grey hair accelerated phase, lymphohistiocytic infiltration.

Case Report Acute Promyelocytic Leukemia in a child with Congenital Baldness: A Novel Presentation

Asfa Zawar*, Sundas Ali**, Lubna Naseem*, Aliena Sohail* and Shahzad Ali Jiskani*

Pakistan Institute of Medical Sciences, Islamabad, **Pakistan Atomic Energy General Hospital, Islamabad


Abstract: Acute leukemia is most common in adults with a worldwide incidence of 351,965 cases in 2012 with a male: female ratio of 1.4. We present the case of a 12 years old female child with congenital baldness who was admitted to our hospital with complaints of epistaxis, gum bleed and petechial rash. She was diagnosed as a case of acute promyelocytic leukemia(APL) on bone marrow biopsy. This is a rare finding not previously reported in literature.

Keywords: Acute Promyelocytic Leukemia, Congenital Baldness