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R Ashfaq

Publications and source records attributed to R Ashfaq.

At least 55 records · Page 3Linked to original sources
PubMed1997

Transitional cell carcinoma of the endometrium and endometrial carcinoma with transitional cell differentiation.

BACKGROUND: Transitional cell carcinoma (TCC) is rare in the female genital tract. Although it is most common in the ovary, small series of cases in the cervix have been reported, with isolated cases described in the fallopian tube, adnexa uteri, and endometrium. METHODS: Eight cases of primary TCC involving the endometrium and 1 case of ovarian TCC metastatic to the endometrium were retrieved from the files of the Armed Forces Institute of Pathology and the University of Texas Southwestern Medical Center. Cases were selected based on the presence of endometrial TCC, whether pure or combined with other patterns, and regardless of the relative amount. Immunostaining for cytokeratins 7 and 20 was performed. RESULTS: Among the 8 women with primary endometrial tumors, the mean age was 61.6 years (range, 41-83 years). Uterine bleeding was the presenting symptom in 7 women. Macroscopically, the tumors were polypoid, and infiltrated the myometrium, although the extent of infiltration varied. Seven endometrial tumors showed a papillary component. TCC was always admixed with other patterns (predominantly squamous, but also endometrioid, papillary, and serous patterns), with the proportion of the TCC component ranging from 5% to 95% (mean, 63.8%). TCC was the main invasive pattern observed in all three of the cases that had deep myometrial invasion; these cases also had vascular invasion. Seven tumors were confined to the uterus; one was metastatic to the ovary. The ovarian TCC metastatic to the endometrium had a pure TCC pattern. Five of 7 cases of TCC had cytokeratin 7+/20- immunoreactivity; 2 cases were cytokeratin 7-/20-. Treatment of primary endometrial tumors was mainly surgical, with adjuvant radiation therapy in 4 cases or chemotherapy in 1 case. Survival ranged from 3 months to 12.9 years (mean, 5.1 years). Of five women for whom follow-up was available, three were alive with no evidence of disease, one was alive with a local recurrence, and one died of unrelated disease. CONCLUSIONS: TCC is a rare, distinct subtype of endometrial carcinoma with morphologic features of urothelial differentiation, but retention of a mullerian immunoprofile. While the overall prognosis does not appear to be worse than what might be anticipated for the stage of tumor present, TCC appears to be the more aggressive histologic subtype among the patterns with which it is admixed.

Adult↗
PubMed1997

Comparison of conventional Papanicolaou smears and a fluid-based, thin-layer system for cervical cancer screening.

OBJECTIVE: To compare the cytologic diagnoses and specimen adequacy of a fluid-based, thin-layer preparation and conventional Papanicolaou tests. METHODS: A total of 7360 women from six separate sites-three screening centers and three hospitals-participated in split-sample/matched-pair, double-masked clinical trials. A conventional Papanicolaou test was performed, after which residual material on the sampling device was rinsed into a fluid preservative from which a thin-layer slide (ThinPrep) was prepared using the ThinPrep 2000 automated slide processor (Cytyc Corp., Boxborough, MA). Conventional and ThinPrep slides were read independently. Cytologic diagnoses and specimen adequacy were classified using the Bethesda system. RESULTS: For the three screening centers, 65% more diagnoses of low-grade squamous intraepithelial lesions and higher were made on the ThinPrep slides (P < .001); for the three hospital centers, 6% more of these diagnoses were made with the ThinPrep method (P = .294). Comparison of specimen adequacy showed a significant increase in satisfactory specimens and a reduction in the number of "satisfactory but limited by" specimens using the ThinPrep method (P < .001). CONCLUSION: The fluid-based, ThinPrep method of sample preparation resulted in a statistically significant increase in cytologic diagnosis of cervical cancer precursors and in specimen adequacy compared with the conventional Papanicolaou testing method.

Adult↗
PubMed1997

Distinguishing Cowper's glands from neoplastic and pseudoneoplastic lesions of prostate: immunohistochemical and ultrastructural studies.

Mucin-producing Cowper's glands, which are situated in the urogenital diaphragm, can be sampled inadvertently by transurethral resection of the prostate and rarely by needle biopsy. Because they are small, closely packed glandular units, Cowper's glands can be misinterpreted as prostatic adenocarcinoma. A panel of immunoperoxidase and mucin stains performed on 10 Cowper's glands showed negative immunoreactivity for prostatic-specific antigen, prostatic alkaline phosphatase, S-100 protein, and carcinoembryonic antigen. Acini in nine of the 10 Cowper's glands were negative for high-molecular-weight cytokeratin K-903 (34beta E12). One case showed faint focal staining of cells around the periphery of acinar units. Smooth muscle actin consistently stained the periphery of acini in all cases. Ultrastructural examination of one Cowper's gland showed the presence of myoepithelial cells at the periphery of the acini. Contrary to previous reports, the acini were lined by a prominent secretory cell layer underlain by an attenuated myoepithelial cell layer. A negative stain for K-903. without additional immunohistochemical study on Cowper's glands taken during transurethral resection or needle biopsy, may substantiate an erroneous diagnosis of prostatic adenocarcinoma. This potential misdiagnosis of carcinoma can be averted if samples stain positive for mucin and smooth muscle actin and negative for prostate-specific antigen and prostatic alkaline phosphatase.

Actins↗
PubMed1996

Detection of endocervical component by PAPNET system on negative cervical smears.

The presence of endocervical component (ECs) on cervical smears is considered essential for determining the adequacy of the Pap smear. The absence of an endocervical component in a negative smear suggests that a repeat Pap smear should be taken. We evaluated 635 manually screened negative cervical smears with a documented endocervical component. On PAPNET review, these cases were scrutinized for endocervical cells, metaplastic squamous cells (MSQ), or both. One-hundred and thirty-eight cases (22%), adequate manually, showed no ECs or MSQs by PAPNET. Twenty-three additional cases with both ECs and MSQ on manual, showed only MSQ by PAPNET, while another 30 cases (5%) with MSQ manually were totally missed by PAPNET. The results of this analysis shows that the endocervical component (ECs, MSQ) is missed by PAPNET in 27% of the cases. Without further improvement, this may pose the greatest deterrent for PAPNET as a primary screening instrument.

Cervix Uteri↗
PubMed1996

Splenic pathology after traumatic injury.

Little is known concerning the pathology of spleens removed for traumatic injury. The authors studied the gross and microscopic features of 44 spleens removed for trauma and received at the Surgical Pathology Division of Parkland Memorial Hospital and 10 normal control spleens from the Medical Examiner's Office, Dallas County, Texas. The mean age of patients undergoing post-traumatic splenectomy was 29.6 years with a male:female ratio of 6:1. The most common procedure done for traumatic splenic rupture was splenectomy (39 of 44 cases); wedge resection or partial splenectomy was done in 5 cases. The mean weight of the spleens was 167 g (181 g in males, 93 g in females, P = .056). Capsular laceration or rupture were noted in 86% of post-trauma spleens, usually involving the superior pole and/or hilum. Subcapsular neutrophilic infiltrates were seen in 7%. Gross evidence of parenchymal hemorrhage was seen in 25%, and microscopic evidence in 68%. Control spleens showed none of these findings. Germinal centers were present in 77% of spleens with germinal center hyperplasia in 55% (including patients 16-59 years old), numerous primary follicles in 45%, mantle zone hyperplasia in 10%, and marginal zone hyperplasia in 41% of patient spleens. Control spleens showed few or none of these findings. No patient spleens had histologic features suggestive of Epstein-Barr virus (EBV) or other infection, granulomas (other than lipogranulomas), or infarct. The findings suggest that splenic rupture after trauma may be related to prior immunologic stimulation of the spleen, and that spleens removed for trauma are not equivalent to normal controls.

Adolescent↗
PubMed1996

Carcinosarcoma arising in eccrine spiradenoma of the breast. Report of a case and review of the literature.

Although the vast majority of eccrine spiradenomas behave in a benign fashion, 23 cases of malignant transformation have been reported to date. We describe a unique example of malignant eccrine spiradenoma that arose in the right breast of a 68-year-old woman. The quiescent mass, which was present for approximately 50 years, experienced sudden enlargement with erythematous changes of the overlying skin and nipple discharge. Microscopically, the tumor showed the typical features of an eccrine spiradenoma with areas of adenocarcinoma, squamous cell carcinoma, and sarcoma. The sarcomatous component consisted of rhabdomyosarcoma and osteosarcoma. The immunoperoxidase staining revealed p53 protein expression only in the carcinomatous and sarcomatous components. This suggests that accumulation of p53 protein may be an important event in the malignant transformation of spiradenomas. Because of its location and biphasic nature, this malignant eccrine spiradenoma should be distinguished from metaplastic breast carcinoma. To our knowledge, this represents the first carcinosarcomatous transformation of eccrine spiradenoma in the breast. This case led us to conclude that breast tissue, which often undergoes apocrine metaplasia and gives rise to apocrine neoplasms, is also capable of originating benign and malignant tumors with eccrine sweat duct phenotype.

Adenocarcinoma↗
PubMed1995

Evaluation of PAPNET system for rescreening of negative cervical smears.

We rescreened 2,238 cervicovaginal smears conventionally prepared with Papanicolaou stain by PAPNET system. The slides screened manually as negative, were sent to PAPNET system. The image tapes were reviewed on a high-resolution monitor, and categorized as negative, unsatisfactory, and atypical. All atypical cases were rescreened manually. Abnormal cases were reviewed by a cytopathologist. Two-thousand one hundred and two (94%) cases rescreened by PAPNET were negative. Nine of 45 unsatisfactory cases by PAPNET were unsatisfactory by manual review. Ninety-one (4.0%) cases by PAPNET were atypical. On manual rescreening, 86 of 91 were negative, 20% showing benign cellular changes; five of 91 were atypical, the atypia, however, not exceeding low-grade category. The detection rate by PAPNET method was 0.2% (five of 2,238 cases). We conclude: 1) In a cytology laboratory with good quality control, PAPNET rescreening does not significantly increase the detection rate. 2) For cytology laboratories without in-house rescreening, PAPNET offers an alternative at a price. 3) The PAPNET system also offers a tool by which a laboratory can occasionally monitor its performance. 4) The cost benefit analysis of the system requires further study and scrutiny.

Female↗
PubMed1994

Papillary and follicular thyroid carcinomas with an insular component.

BACKGROUND: Papillary (PC) and follicular (FC) thyroid carcinomas may have a focal or predominant insular component (IC). This study correlates histologic behavior with the extent of the IC of these tumors. METHODS: Forty-one thyroid carcinomas (17 follicular variants [FV] of PC, 24 FC) with focal or predominant IC were reviewed. The tumors were stained with carcinoembryonic antigen, thyroglobulin, and calcitonin. DNA ploidy analysis was done on 18 tumors on paraffin-embedded tissue. The IC was correlated with age, stage of disease, follow-up, and ploidy analysis by Fisher's exact two-tailed test. RESULTS: No tumor was purely insular. IC was minor (10-40% tumor area) in 16 and predominant (50-90%) in 25. Nuclear features in IC included typical FC nuclei in 14, FVPC nuclei in 16, and intermediate-type nuclei in 16 tumors. Vascular invasion was seen in 22, necrosis in 10, and sclerotic stroma in all. Fourteen tumors were confined to the thyroid, 13 showed regional spread, and 9 had distant metastases; five patients are dead of disease and six are alive with disease. Thirteen tumors were diploid, three tetraploid, and two hyperdiploid aneuploid. There was no correlation of quantity of IC with tumor stage, follow-up status, or ploidy. CONCLUSION: IC within PC and FC does not adversely affect prognosis.

Adenocarcinoma, Follicular↗
PubMed1993

Renal angiomyolipomas and HMB-45 reactivity.

BACKGROUND: Renal angiomyolipomas (RAML) are mesenchymal hamartomas composed of varying amounts of blood vessels, smooth muscle, adipose tissue, and supporting connective tissue. Although most of these tumors are easy to recognize, some show unusual histologic features and may pose a diagnostic dilemma. Recent reports indicate that RAML are immunoreactive for HMB-45 antibody, which is directed against a premelanomasome-associated glycoprotein and is thought to be specific for melanocytic differentiation. METHODS: To determine whether HMB-45 reactivity would differentiate RAML from other renal tumors, the authors immunostained 72 primary renal tumors, including 19 angiomyolipomas and 2 retroperitoneal liposarcomas extending into the kidney, with HMB-45 monoclonal antibody. Also, the immunohistochemical profile of 19 renal angiomyolipomas was investigated using a broad panel of immunostains, including cytokeratin (AE1/AE3), epithelial membrane antigen, vimentin, smooth muscle actin (SMA), desmin, muscle-specific actin (MSA), S-100 protein, and neuron-specific enolase (NSE). RESULTS: All tumors except RAML were negative for HMB-45 antibody. HMB-45 immunoreactivity was present in 17 of 19 RAML. Seventeen of 19 were positive for SMA and MSA (HHF 35), 8 for desmin, 17 for vimentin, and 9 for NSE. CONCLUSIONS: Based on this study, it was concluded that, along with SMA and MSA, HMB-45 reactivity is a useful tool to distinguish RAML, especially those with unusual morphological features, from other primary renal neoplasms, including liposarcomas that extend into the kidney.

Antibodies, Monoclonal↗
PubMed1992

Acute megakaryoblastic leukemia simulating carcinoma.

Acute megakaryoblastic leukemia has emerged as an important subset of early childhood leukemia. It often presents a diagnostic dilemma because of its many morphologic manifestations and propensity to mimic metastatic carcinoma. An abdominal mass was identified by sonographic and computed tomographic scans in a 10-month-old girl, who had anemia and thrombocytopenia. An open biopsy of the 3-cm, peripancreatic mass showed cohesive nests and sheets of tumor cells with focal spindling and desmoplasia. Although the diagnosis of acute megakaryoblastic leukemia was established from a bone marrow aspirate using immunocytochemical techniques and karyotype analysis, a coexistent abdominal epithelial malignant neoplasm could not be excluded entirely by light microscopic examination alone. The megakaryoblastic nature of the abdominal tumor was established by immunocytochemical stains for glycoprotein IIIa on paraffin-embedded tissue.

Abdominal Neoplasms↗
PubMed1992

Xanthomatous pseudotumor of the small intestine following treatment for Burkitt's lymphoma.

A 9-year-old boy with a large mass in the right lower quadrant of the abdomen was diagnosed as having disseminated Burkitt's lymphoma by pleural fluid aspirate. After 4 months of chemotherapy, he developed acute small-bowel obstruction. A resected ileal segment contained a bright-yellow annular submucosal tumor, histologically a xanthoma, that infiltrated the muscularis propria and serosa. No residual lymphoma was identified. We believe that the small-bowel xanthoma in this child is an unusual, nonneoplastic, treatment-related sequela of lymphoma cell lysis and histiocytic scavenging of lipid-membranous debris.

Burkitt Lymphoma↗
PubMedDate not supplied

Genetic changes during the multistage pathogenesis of human papillomavirus positive and negative vulvar carcinomas.

OBJECTIVE: To identify the molecular alterations found in 30 human papillomavirus (HPV) positive (n = 15) and negative (n = 15) vulvar carcinomas (VC) and their associated preinvasive lesions (VIN [vulvar intraepithelial neoplasia]) and normal epithelium to determine a common molecular pathogenesis of HPV positive and negative VC. METHODS: Loss of heterozygosity (LOH) at seven 3p chromosomal regions (3p12, 3p14.2, 3p14.3-21.1, 3p21.3, 3p22-24, 3p24.3, 3p25), 13q14 (RB) and 17p13.1 (p53) loci, and TP53 gene mutations in microdissected archival tissues were investigated. RESULTS: Fourteen of fifteen HPV positive VC had HPV 16 DNA sequences. The fractional regional loss index (FRL), an index of total allelic loss at all chromosomal regions analyzed, was greater in the HPV negative VCs than in the HPV positive tumors (FRL = 0.55 versus 0.32; P = .048) and was also greater in the HPV negative high-grade VINs as compared with the HPV positive lesions (0.29 versus 0.02; P = .002). Overall, LOH at any 3p region was frequent (80%) in both groups of cancers and in their associated VIN lesions. Although TP53 gene mutations were present in a minority of VCs (20%), allelic losses at the TP53 locus were frequently present, especially in HPV negative VCs, as compared with the HPV positive tumors (62% versus 15%; P = .02). CONCLUSION: A greater number of molecular alterations are found in HPV negative VCs compared with HPV positive tumors. Allelic losses at 3p are common early events in vulvar carcinogenesis in HPV negative cancers detected at a high rate in the corresponding high-grade precursor lesions (VIN II/III). TP53 gene mutations with associated 17p13.1 LOH are more common in HPV negative cancers.

Carcinoma in Situ↗
PubMedDate not supplied

ThinPrep Pap Test. Accuracy for glandular disease.

OBJECTIVE: Although the ThinPrep Pap Test is replacing conventional Pap smears in many clinical practices, experience with the identification of glandular lesions is limited. In this study, ThinPrep cytology of glandular lesions was evaluated in a large, inner city teaching hospital with high rates of glandular abnormality. STUDY DESIGN: Six months of ThinPrep diagnoses in 1998, following nearly 100% conversion of the laboratory to the ThinPrep Pap Test, were compared to January-December 1997 conventional smear diagnoses for glandular disease. Biopsy confirmation was evaluated for these cases. Findings on all biopsy-confirmed glandular cases were also compared to findings on cytology. RESULTS: Similar overall rates of glandular cytology were found. For conventional smears (12 months), 46 cases were diagnosed out of 43,289 smears (0.11%). For ThinPrep cytology (six months), 36 cases were diagnosed out of 25,783 slides (0.14%, P = NS). In the year 1997, 9 biopsy-confirmed conventional smear diagnoses of adenocarcinoma in situ (AIS) or adenocarcinoma were noted versus 10 for six months of 1998 for the ThinPrep method. A statistically significant reduction in the number of miscellaneous nonglandular (squamous) biopsy diagnoses were found with ThinPrep glandular cytology (14 vs. 4 cases, P < .05). For known biopsy-confirmed glandular cases of AIS or adenocarcinoma, a statistically significant reduction in the cytology false negative rate was noted with the ThinPrep method (17 vs. 4 cases, P < .02). CONCLUSION: The ThinPrep method provides more accurate diagnoses of glandular disease, with an increase in both sensitivity and specificity for glandular lesions.

Adenocarcinoma↗
PubMedDate not supplied

Evaluation of the PAPNET system for prescreening triage of cervicovaginal smears.

OBJECTIVE: To assess the PAPNET System for prescreening triage of cervical smears. STUDY DESIGN: We prospectively prescreened 5,170 consecutive cervicovaginal smears with the PAPNET System. The slides were then manually screened by cytotechnologists blinded to the PAPNET diagnoses. Cases identified as abnormal by either PAPNET or manual screening were reviewed by a cytopathologist. The PAPNET and manual diagnoses were correlated. RESULTS: Diagnostic concordance between PAPNET and manual screening was seen in 4,340 (84%) of the cases (3,167 negative, 1,038 abnormal and 135 unsatisfactory). Noncorrelation between PAPNET and manual diagnosis occurred in 794 cases (543 abnormal by PAPNET and negative manually, 228 negative by PAPNET and abnormal manually, 8 abnormal by PAPNET and unsatisfactory manually, 29 unsatisfactory by PAPNET and negative manually, 7 negative by PAPNET and unsatisfactory manually). The diagnostic sensitivity of the PAPNET System was 82%, diagnostic specificity 85%, predictive value of a positive test 66% and predictive value of a negative test 93.4%. The false negative fraction of PAPNET was 6.4% for low grade squamous intraepithelial lesion and above. CONCLUSION: PAPNET performed effectively for prescreening triage, increasing the accuracy of screening and reducing the screening time.

Evaluation Studies as Topic↗
PubMedDate not supplied

Efficiency of PAPNET in detecting infectious organisms in cervicovaginal smears.

OBJECTIVE: To evaluate the effectiveness of the PAPNET system in identifying microbial organisms. STUDY DESIGN: Two hundred forty-nine previously screened cervicovaginal smears with a diagnosis of an infectious agent were rescreened by PAPNET system. The images were reviewed on a high-resolution monitor and the presence or absence of coccobacilli, trichomonads, and Candida and herpes organisms was noted. RESULTS: Of 99 cervicovaginal smears with excessive coccobacilli, 16 were missed by PAPNET (percentage of accuracy, 84). Only 60% of Candida organisms (33 of 55) and 77% of trichomonads (42 of 54) were identified by PAPNET. Herpesvirus was diagnosed correctly on PAPNET in 24 of 41 cases. Two or more infectious agents were present in 14 cases, 5 of which were correctly identified by PAPNET. The accuracy of PAPNET in identifying infectious organism when measured against manual screening was 70%, with a high false negative rate (30%). CONCLUSION: The PAPNET system identifies coccobacilli, trichomonads and Candida organisms in decreasing order of frequency, missing a high percentage of Candida organisms and trichomonads (40% and 33%, respectively), the most common causative agents in female genital tract infections.

Animals↗
PubMedDate not supplied

Rhabdomyomatous mesenchymal hamartoma of skin.

A distinctive dermal and subcutaneous hamartoma composed primarily of disorganized skeletal muscle and mature adipose tissue, designated rhabdomyomatous mesenchymal hamartoma of skin, was recently reported. We have observed two histologically similar though less polypoid lesions in boys aged 4 years. Both were also on the chin and present since birth, suggesting that site and age, as well as histology, may be characteristic. The location on the chin in three of the four neonates may reflect an etiology of aberrant embryologic development of the platysma muscle as it inserts superficially into the dermis over the mandible.

Child, Preschool↗