Author Archives: admin

About admin

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

Prevalence of Ear, Nose & Throat diseases and Adequacy of ENT training among General Physicians

Muhammad Farooq*, Shakeel Ghani** and Sadiq Hussain***

*Department of ENT, AJK Medical College Muzaffarabad, **Department of ENT, Paediatrics***, Mohtarma Benazir Bhutto Shaheed (MBBS) Medical College, Mirpur, Azad Kashmir

Abstract :

Background: Among general physiciens (GPs) consultations, Ear, Nose and Throat (ENT) diseases account for about 25% in adults and up to 50% in children. General physiciens are required to have adequate training to deliver efficient primary health care. This study was aimed to find prevalence of ENT diseases and adequacy of ENT training among GPs in Azad Jammu and Kashmir (AJK).

Methods: This prospective study was conducted among hundred (100) GPs; having more than 1 year experience, of major cities of AJK. A performa was designed and distributed. The responses were collected and analysed.

Results: Prevalence of ENT diseases in adults was 24% and in children 38%. Majority of GPs (72-96%) stated that there should be improvement in undergraduate training and arrangement of 4−8 weeks ENT house job rotation as well as ENT continuous medical education (CME) programs.

Fine Needle Aspiration Cytology of Pigmented Dermatofibrosarcoma Protuberance (Bednar Tumor) & it’s Pathogenesis

Anwar Ul Haque, Hajra Farooq, Maryam Sharif and Sidra Chaudhary

Department of Pathology, Azad Jammu & Kashmir Medical College, Muzaffarabad, Azad Kashmir, Pakistan


Abstract: Dermatofibrosarcoma protuberance is a soft tissue tumor of low malignant potential. At times it is associated with pigment deposits which are then it is termed as Bednar tumor. Only a few Fine Needle Aspiration Cytology studies of Bednar Tumor have been reported. We share our findings of Fine Needle Aspiration Cytology in a 30 year old man with Bednar tumor of scalp and multiple enlarged cervical lymph nodes. Our smears revealed scattered atypical large round to oval cells with scant cytoplasm. Some cells’ cytoplasm contained abundant melanin pigment which also resulted in dirty black pigmented background. The tissue sections showed melanin in both spindle shaped cells and rounded cells. At places it seemed that heavily pigmented cells became oval and globular and necrotic. The melanin pigment was extended into the cellular processes. The overlying skin epidermis shows focal kilocytotic type change. The tissue sections showed positivity for CD 34 and protein S-100. We propose that round globular cells are derived from spindly cells after melanin synthesis and when the cytoplasm is overloaded with melanin the cells undergo necrosis. Focal kilocyototic type change in overlying epidermis deserves further investigation.

Posterior Mediastinal Ancient Schwannoma Mimicking a Cyst

Kanwal Zahra, Ahmareen Khalid, Tayyaba Ali, Maria Omair, Gul-Afshan and Shaista Khursheed

Department of Pathology, Pakistan Institute of Medical Sciences, Islamabad



Background: Several types of neurogenic tumors can occur in mediastinum and commonly present as posterior mediastinal mass lesions. Generally they are categorized in to those arising from peripheral nerves or sympathetic ganglia. Schwannoma is the most common neurogenic tumor of this area. Generally they are presented as solid encapsulated lesions and are difficult to miss on radiology. Rarely they can be large enough to undergo cystic degeneration and cause confusion with other cystic mass lesions of the area.  Large masses can also cause pressure symptoms and leads to respiratory compromise.

Conclusion: Posterior mediastinal schwannomas though usually are benign and asymptomatic but can prove fatal if attain a very large size. It should always be included in the differential diagnosis of posterior mediastinal large cystic masses. Degenerative nuclear atypia associated with ancient schwannoma should not be confused with malignancy. Patient can lead a symptom free life after surgical resection of these tumors.

Keywords: Posterior mediastinum, Schwannoma, Peripheral nerves

Small Round Blue Cell Tumor Retinoblastoma vs. Neuroblastoma

Aliena Sohail, Lubna Naseem and Amna Imtiaz

Department of Pathology, Pakistan Institute of Medical Sciences, Islamabad



In histopathology, a small blue cell tumor or small round blue cell tumors refer to tumors comprised of  “blue” cell with very scant cytoplasm. As nucleus stains blue and cytoplasm pink, these tumors impart a distinct”blue” appearance”. These cells at low magnification resemble mature lymphocytes which also posses scant cytoplasm. However are significantly larger than small lymphocytes and erythrocytes. Leukemia, lymphoma, poorly differentiated carcinomas like oat cells carcinoma and several other primitive tumors may give this picture on histology sections. These tumors can be seen in any age group.  1&2 Here we report a four month old female child with diagnosed primary lesion of neuroblastoma in the right eye (from an outside laboratory) followed by metastasis to the bone marrow within a period of three months. This was a very rare finding because only 3 cases had been previously reported of Primary Neuroblastoma in the eye and that too with no metastasis. The commonest eye tumor in this age group is of course retinoblastoma which can alo spresent congenitally as well as with metastasis. Immunohistochemistry of both Neuroblastoma and Retinoblastoma give same positivity to the same markers. Hence it is difficult to differentiate the two.

Keywords: Small round cell tumor, Neuroblastoma, Retinoblastoma

Juvenile Myelomonocytic Leukemia

 Amna Imtiaz, Lubna Naseem and Sundas Ali

Department of Pathology, Pakistan Institute of Medical Sciences, Islamabad


Juvenile Myelomonocytic Leukemia (JMML), which comes under the WHO category of Myelodysplastic/ Myeloproliferative Neoplasms, is a rare aggressive hematological malignancy of early childhood caused by excessive proliferation of cells of monocytic and granulocytic lineages. The peripheral blood shows leukocytosis, thrombocytopenia and anemia. The majority of patients present with infection. Hematopoietic Stem Cell Transplantation (HSCT) is the best treatment option available. Here we present a case of a one year old female child who presented with complaints of fever, cough and progressive pallor for the last six months and abdominal distention associated with vomiting, diarrhea and sub-conjunctival hemorrhages for past 2 months. The fever did not respond to medication. She developed sepsis and intracranial bleed and expired on the 10th day of hospitalization.

Abu Marwan Abd Al-Malik Ibn Zuhr (Avenzoar) (1091-1161 C.E.)

Modern Islam beginning with Quran and the final Prophet Muhammad ﷺushered the new horizons of modern sciences and medicine! It took the sciences out of Greek myths into real life with missile speed. The seeds implanted by the Quran and the final Prophet Muhammad ﷺ soon bore fruits as Islam provided the required soil of tranquility, truth, courage, generosity, sincerity, hard work and humanity for healthiest growth of science. As a result big ban occurred not only in field of exact and natural sciences but almost in all fields! Soon numerous stars or giants were born in every field. We then see great names like Jabir bin Hayan, Ibn-e-Sina (Avisina), ar-Razi, Ibn Rushd and Ibn Haytham. One of these giants in medicine, surgery and pathology was Ibn Zuhr. In West his name was distorted variably to Avenzoar, Abumeron, Abynzoar, Abhomeron, Alomehón or Abhomjeron.

Ali-ibn-Sahl Rabban al-Tabari

Zahida Anwar* & Kanwal Zahra**

*AJ&K Medical College, Muzaffarabad, **Pakistan Institute of Medical Sciences, Islamabad

(Disclaimer:  Compilation of his account is based on various sources and it’s not an original research article. References and sources are given at the end. We are grateful to the original writers for their valuable work)

Ali-ibn-Sahl Rabban al-Tabari, commonly known as Abu-AL- Hassan, was an eminent scholar of 9th century.  Born to a renowned family of Khurasan (near present day Tehran) he marked a name as a physician in the history of medicine. He got his early education in the field of medical sciences, calligraphy, mathematics, philosophy and literature from his father Sahl who himself was a famous physician and a high level state official of his time. Ali ibn Sahl Rabbān received his preliminary education in medical and natural sciences, calligraphy, mathematics, philosophy and literature from his father. In addition to Arabic, Persian and Syriac, he had also mastered the Hebrew and Greek languages to a high degree of proficiency. He translated his own book Firdous al-hikma written in Arabic into the Syriac language.

Schwannoma of Cheek Mucosa

Anureet Kaur, Puneet Kaur and Rimpi Sarin

Department of Pathology, Giansagar Medical College and Hospital, Banur, Dist Patiala, Punjab

Abstract: Schwannoma is a relatively uncommon, benign, encapsulated, slow growing, usually solitary tumour that originates from Schwann cells of the nerve sheath derived from the neuroectoderm. Only 1% of Schwannomas have intra-oral of which most common site is tongue followed by the palate, floor of mouth, buccal mucosa, lips and jaws. We report a case of Schwannoma in cheek mucosa within oral cavity which was surgically removed and on histopathological examined revealed Schwannoma with Antoni A and Antoni B patterns with Verocay body formation.

Keywords: Schwannoma, cheek mucosa

Rhabdomyoblasts in an Ovarian Cystic Teratoma

Hajra Farooq and Anwar Ul Haque

Department of Pathology, Azad Jammu & Kashmir Medical College, Muzaffarabad

Abstract: Children with cystadenomatoid malformation of lungs may contain rhabdomyoblasts while occasionally adult lungs may contain rhabdomyoblasts. On the other hand rhabdomyosarcoma have been reported in cystic teratoma of the lung. However benign rhabdomyoblasts are not reported in the benign cystic teratoma. We report such a case here.

Keywords:  Ovarian cystic teratoma, Rhabdomyosarcoma. Rhabdomyoblasts, Cystadenomatoid malformation of the lungs