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Shahid Pervez

Publications and source records attributed to Shahid Pervez.

At least 19 recordsLinked to original sources
PubMed2006

Estrogen receptor alpha-negative and progesterone receptor-positive breast cancer: lab error or real entity?

Aretrospective study comparing the estrogen receptor (ER) alpha subtype and progesterone receptor (PR) profile of breast carcinomas amongst 1625 cases over 2.5 years was carried out. Strictly speaking it is generally believed that breast carcinomas can biochemically express PR only if they are ER-positive. However, a few ERalpha-PR+ cases do exist paradoxically. This class of tumors was the focus of our study in which we looked at the possible reasons for such an immunophenotype and compared it with a group of ERalpha+PR+ breast carcinomas. An internationally recognized immunohistochemical method employing monoclonal antibodies against estrogen and progesterone receptors was used. Correlations with established risk factors i.e. menopausal status, grade, tumor size and lymph node status were analyzed for our study group (ERalpha-PR+) and compared with a control (ERalpha+PR+). Out of the total 1625 cases, 29.91% (486) were ERalpha+PR+, 5.11% (83) were ERalpha+PR-, 56.86% (924) were ERalpha-PR- and 8.12% (132) were ERalpha-PR+. Patients' age was significantly lower in the ERalpha-PR+ group (P=0.002). Statistical analysis of the grading between the two study groups revealed no significant difference (P=0.091), although the ERalpha-PR+ group contained significantly more poorly differentiated tumors than the ERalpha+PR+ one (P=0.032). Tumor size was also significantly larger in the ERalpha-PR+ than in the ERalpha+PR+ group (P=0.046). The frequency of lymph node metastases was independent of receptor profile. In conclusion, our study group does exhibit characteristics which are suggestive of a distinct breast cancer phenotype (ERalpha-PR+) with a different etiology and prognosis.

Biomarkers, Tumor↗
PubMed2006

Malignant vascular tumors of liver in neonates.

Malignant vascular tumors of the liver are rare in children, especially in neonates. We report two cases. One was initially diagnosed as infantile hemangioendothelioma. Rapid growth and appearance of pulmonary metastasis while on aggressive medical treatment suggested malignant transformation. The other neonate presented with intractable ascites and liver biopsy showed histological features of angiosarcoma. Ascites has rarely been reported as a presenting feature of angiosarcoma in literature. Both patients died. To date, surgery, chemotherapy, and radiotherapy have not improved the outcome of malignant vascular tumors of liver.

Ascites↗
PubMed2006

Coexistence of caseating granulomas with Hodgkin's lymphoma: a diagnostic and clinical dilemma.

Hodgkin's lymphoma (HL) is a neoplasm of the B lymphocytes. The histological picture may resemble granulomatous lesions similar to those seen in tuberculosis as collections of epitheloid cells are not uncommonly seen in HL. In areas which are endemic to tuberculosis, the close association and the coexistence of the two must be recognized for the proper diagnosis and treatment of the illness. A series of cases of Hodgkin's lymphoma is reported in which the biopsy specimens from different parts of the body portrayed caseating granulomatous lesions.

Adult↗
PubMed2006

Plaque formation reduction with glutathione monoester in mice fed on atherogenic diet.

OBJECTIVE: To determine the role of glutathione monoester on reducing the development of plaque formation in an animal model. DESIGN: Laboratory control trial. PLACE AND DURATION OF STUDY: Aga Khan University, Karachi, from January 2004 to December, 2004. MATERIALS AND METHODS: Twenty-four Balb/c mice were divided into 3 equal groups. First group was fed on atherogenic diet alone, while the second group received atherogenic diet plus twice weekly injections of glutathione monoester. The third group was fed on normal diet for mice. After one year, the animals were sacrificed. Blood was analyzed for lipid levels, while liver, kidney, spleen, heart and aorta were removed to study morphological changes. RESULTS: In the groups of mice receiving atherogenic diet (with and without glutathione monoesters), there was significant increase in levels of total cholesterol (p=0.011) and LDL cholesterol (p=0.001) compared to levels of these lipids in mice on normal diet. However, a significant decrease in levels of triglycerides (p=0.01) was observed in the group receiving atherogenic diet along with glutathione monoester. Supplementation with glutathione monoester had the most pronounced effect only on triglyceride levels. Atherosclerotic plaques were seen in heart and/or aorta of mice receiving atherogenic diet. However, such plaques were either totally absent or if seen in an animal, were extremely small and diffuse in the group receiving glutathione monoester along with atherogenic diet. Mice on normal diet had no evidence of any plaque formation. Cholesterol granuloma was seen in liver of mice on atherogenic diet alone. In mice receiving atherogenic diet plus glutathione monoester, no cholesterol granuloma was found in liver. There were no remarkable morphological changes in spleen and kidney in the three groups of mice. CONCLUSION: Glutathione monoester appears to inhibit or reduce the development of plaque formation in mice.

Animals↗
PubMed2006

Medullary carcinoma of breast with a novel germline mutation 1123T >G in exon 11 of BRCA1.

Breast cancer, the most common malignancy in females, has an estimated 5-10% hereditary predisposition. BRCA1 is a tumor suppressor gene and is known to be responsible for breast cancer and breast-ovarian cancers running in families. In breast caner patients, several mutations in BRCA1 have been reported throughout the gene. This report describes identification of a mutation in BRCA1 gene using protein truncation (PTT) assay in a patient with medullary carcinoma of breast who also had a family history of breast cancer. Following DNA sequencing, the mutation was confirmed as substitution of thymine at position 1123 with guanine of exon 11 (1123 T>G). This mutation can be added to the pool of known BRCA1 mutations in Pakistani population, which will help in developing a local screening panel of BRCA1 mutations.

Adult↗
PubMed2006

Small B cell Non-Hodgkins Lymphoma in Pakistan.

OBJECTIVE: To study the pattern of small B cell lymphomas in Pakistan. METHODS: This descriptive study was carried out at the Aga Khan University Hospital pathology department including 1721 cases of Non-Hodgkins Lymphoma (NHL) diagnosed during a period of five years (1998-2002) and classified according to REAL/WHO classification. The antibodies used included Leukocyte Common Antigen (LCA), Pan B (CD20, CD79a), Pan T (UCHL-1), Bcl 2, Mib 1(Ki 67) and Cyclin D1 (Dako, Denmark). RESULTS: Out of the 1721 NHL cases, only 140 (8.1%) could be categorized as small B-cell NHL. The study group comprised small lymphocytic lymphoma/chronic lymphocytic leukemia (58 cases; 41.4%) followed by follicular lymphoma (46 cases; 32.9%), mantle cell lymphoma (15 cases; 10.7%), extra nodal marginal zone B cell lymphoma of MALT type (15 cases; 10.7%), lymphoplasmacytic lymphoma (5 cases; 3.6%) and splenic marginal zone B-cell lymphoma (1 case; 0.7%). No case of nodal marginal zone lymphoma was diagnosed. The age ranged from 18 to 98 years with a mean and median of 54.64 and 58.50 years respectively. Small B-cell NHL was more common in males; with male to female ratio of 2.1. Majority of the small B-cell NHL were nodal at presentation with a nodal to extranodal ratio of 3.4. CONCLUSION: It is concluded that the frequency of these small B-cell NHL is very low in our population in contrast to the western literature. Further studies based on epidemiologic and etiological factors are required to look into this marked difference of occurrence of these indolent lymphomas.

Adolescent↗
PubMed2006

Uterine perivascular epithelioid cell tumour presenting as a cervical mass.

Perivascular Epithelioid Cell Tumour (PEComa) also known as myelomelanocytic tumours are uncommon, recently described mesenchymal tumours that include angiomyolipoma, clear cell "sugar" tumour of the lung, lymphangioleiomyoma and tumours composed predominantly of epithelioid cell morphology. A predilection for uterus has been described. However up till now only 14 cases of uterine PEComas have been described. All of these were seen in adult females in the peri and post menopausal age group (from 40-75years), and almost all were located in the region of body of uterus. A single case in the upper cervical region has been reported with uterine PEComatoses. We report an unusual presentation of this rare tumour presenting as a polypoidal cervical mass in a young female. Occurrence of this tumor in a young female as seen in our case warrants inclusion of PEComa in the diferential diagnosis of all epithelioid and clear cell neoplasms of uterus irrespective of age.

Adult↗
PubMed2006

Follicular dendritic cell sarcoma of lymph node--a rare entity.

Follicular dendritic cells (FDC) are non-lymphoid, non-phagocytic accessory cells in the immune system that are essential for antigen presentation and germinal center reaction regulation. These cells are CD21+, CD35+, CD1a- and S100 protein +/- and they show desmosomes ultrastructurally. The most commonly involved sites by FDC tumors are lymph nodes but may arise at a variety of extranodal sites including oral cavity, tonsil, gastrointestinal tract and liver. Most studies represent single case reports or case series. Our patient presented with tumor in the lymph nodes. Histology revealed tumor cells with abundant eosinophilic cytoplasm, hyperchromatic and pleomorphic nuclei, and prominent nucleoli. The tumor cells were found to be positive for CD21 which is a specific marker for follicular dendritic cells.

Biomarkers, Tumor↗
PubMed2006

Angiokeratoma of tongue: a series of 14 cases.

Angiokeratomas (AC) are vascular lesions which are defined histologically as one or more dilated blood vessels lying directly subepidermal and showing an epidermal proliferative reaction with ectatic capillaries in the papillary dermis. Only three other cases of isolated mucosal angiokeratoma have been reported in the indexed literature. We reviewed all cases of angiokeratoma located on the tongue, diagnosed in our department during a study period of 10 years (1995-2005). Histologically all 14 cases showed dilated and congested blood vessels in the upper papillary dermis. They lack deep dermal involvement. Hyperkeratosis and acanthosis were also seen in most of the cases. No clinical data was available to assess systemic disease. A higher incidence of of AC in tongue is seen in our study.

Angiokeratoma↗
PubMed2006

Frequency and characteristics of breast lymphomas presenting to a tertiary care hospital, Pakistan.

OBJECTIVE: To assess the relative frequency of (primary and secondary) mammary lymphomas presenting to a tertiary care hospital, Pakistan and its categorization according to WHO classification of lymphoid neoplasms. METHODS: All NHLs (nodal and extra nodal) diagnosed in the section of histopathology during 1992-2004 were retrieved and reviewed. All patients (n=30) diagnosed with lymphomatous involvement of the breast were selected. Distinction between primary and secondary breast lymphomas was not made owing to lack of availability of clinical information. RESULTS: A total of 5637 breast malignancies were diagnosed in our department during the study period of 10 years and the total number of NHLs (Nodal and extra Nodal) was 2632. Thirty (n=30) patients accounting for 1.13% were diagnosed to have lymphomatous involvement of the breast. The Female to Male ratio was 13.5:1; age range was 12-92 years with a median age of 43 years (Mean age 46.5 years and Standard deviation of age was 16.88 years). The sites of the lesions were the right breast in 11 cases (37.93%), left breast in 9 cases (31.03%) and both breasts in 2 cases (6.89%), while the location of 8 masses (27.58%) was unknown. Immunohistochemical studies were negative for cytokeratins (MNF and Cam 5.2) in all cases. All cases of DLBCL expressed B cell lineage antigens and were positive for LCA and Pan B (CD20 and 79a). CONCLUSION: We concluded that breast lymphomas represent 1.13% of all NHL and 0.5% of all breast malignancies in this study. The most frequent morphologic type was diffuse large B-cell lymphoma. As patients with primary breast lymphoma have a better prognosis than those with carcinoma of the breast or patients with extranodal lymphomas, a multidisciplinary approach including surgery, radiotherapy, and chemotherapy when needed would result in a more favourable outcome.

Adolescent↗
PubMed2005

Prognostic value of proliferating cell nuclear antigen (PCNA) in infiltrating ductal carcinoma breast.

OBJECTIVE: To assess the independent and interdependent prognostic value of proliferating cell nuclear antigen (PCNA) in carcinoma of breast in our female population and its association with pathologic variables and disease outcome. DESIGN: A descriptive study. PLACE AND DURATION OF STUDY: Section of Histopathology, Department of Pathology and Microbiology, The Aga Khan University, Karachi from January 1992 to December 1997. PATIENTS AND METHODS: All cases diagnosed with invasive ductal carcinomas (IDC) of breast with lymph nodes sampling were included. The expression of PCNA was analyzed on tumor specimens of IDC breast. These patients also had axillary lymph node sampling. The expression of PCNA protein was analyzed immunohistochemically by PAP technique. Patients were followed for a median duration of 48 months. RESULTS: The percentage of PCNA positive tumor cells was estimated semi-quantitatively. Positivity was seen in every case, mean PCNA positivity was 27% (range 10-80) with a median of 28%. The <25% positivity was seen in 149 (47%) cases, and >25% positivity seen in 166 (53%) cases. According to the pathological grading lowest mean PCNA was seen in grade-I i.e., 26% tumor cells showed nuclear reactivity to PCNA followed by grade-II 30% and grade-III 33%. PCNA categorical expression was significantly correlated with histological differentiation, (p<0.05) and tumor size (p<0.01). Distant metastases were seen in>25% positive cases (p<0.05). PCNA expression when correlated with overall survival, showed significant correlation between categorical PCNA (p<0.05). At a median follow-up of 48 months, 66% of <25 PCNA positive patients died with an overall survival of 3.16 years and disease-free survival of 2.5 years, among >25% PCNA positive patients 77% died with an overall survival of 2.7 years and a disease-free survival of 2.2 years. CONCLUSION: In this study PCNA proved to be an independent prognostic indicator in predicting disease-free and overall survival in breast carcinoma patients.

Biomarkers, Tumor↗
PubMed2005

Characterization of angioimmunoblastic T-cell lymphomas (AILT) and its association with Epstein-Barr virus (EBV) in Pakistani patients.

OBJECTIVE: To characterize angioimmunoblastic T-cell lymphoma (AILT) on morphological, immunohistochemical and molecular grounds and its association with Epstein-Barr virus (EBV) in Pakistani patients. DESIGN: Case series. PLACE AND DURATION OF STUDY: Histopathology section of the Department of Pathology and Microbiology, The Aga Khan University Hospital, Karachi from January 01, 1992 to December 31, 2002. PATIENTS AND METHODS: Over a period of 11 years archival biopsy material of 13 AILT cases (lymph nodes), identified on the basis of histological and immunohistochemical criteria, using REAL and WHO classifications, were retrieved from the files of Department of Pathology. Immunophenotyping was carried out by using CD45 (LCA), two T-cell markers CD45RO (UCHL1; monoclonal) and CD3 (polyclonal). Polymerase chain reaction (PCR) was used to assess T-cell clonality for T-cell receptor (TCR)-b, g and immunoglobulin heavy chain (IgH) for FR2 and FR3 regions using primers recognizing conserved sequences of the variable (V), diversity (D) and joining (J) region segments. Association of EBV in AILT cases was studied by PCR and in situ hybridization (ISH). RESULTS: This study showed AILT to constitute 0.71% of all NHLs (non-Hodgkin's lymphoma) [both T and B]. Immunohistochemical study revealed that the tumor cells were positive for CD45 (LCA), CD45RO (UCHL1) and CD3. All the 13 cases were largely negative for CD20 (L26), a B-cell marker, except few large scattered cells labelling. DNA extracted from all 13 lymph nodes was amplified using polymerase chain reaction (PCR). PCR technique demonstrated clonal gene rearrangement of the TCR-b, g and IgH regions in 3 (23.1%), 7 (53.8%) and 3 (23.1%) AILT cases, respectively out of 13 cases. Association of EBV was seen in 11 out of 13 cases (84.6%) of AILT by PCR. By ISH the prevalence of EBV was detected in 8 (88.8%) out of 9 cases. CONCLUSION: The prevalence of AILT in the Pakistani population is slightly lower compared to other studies and that EBV is an etiological agent in pathogenesis of this disease.

Aged↗
PubMed2005

Immunophenotypic characterization of high grade pleomorphic sarcomas: a demographic and immunohistochemical study in a major referral center of Pakistan.

OBJECTIVE: Immunophenotypic characterization of high grade (pleomorphic) sarcomas and determination of their frequency, mean/median age, sex preferences and common sites in Pakistani patients. METHODS: This study included 134 consecutive cases of high grade (pleomorphic) sarcomas diagnosed in adults above the age of 15 years in the section of histopathology at theAga Khan University Hospital, Karachi during a period of two years. These high grade (pleomorphic) sarcomas were immunophenotyped using a panel including antibodies against Vimentin, Desmin, Smooth muscle Actin, S 100, CD34, CD68 and Cytokeratin etc by indirect immunoperoxidase. RESULTS: Of the 134 cases which were characterized, 38.1% were pleomorphic leiomyosarcoma, followed by pleomorphic rhabdomyosarcoma 14.9%, Malignant Peripheral Nerve Sheath Tumour 9%, pleomorphic liposarcoma 3.7% and pleomorphic storiform Malignant Fibrous Histiocytoma 0.7%. Thirty three percent of cases could not be characterized further. Mean/ median age for Leiomyosarcoma was 50/50, for Rhabdomyosarcomas 33/22, for MPNST 42/41, for Liposarcoma 52/50 and for Malignant Fibrous Histiocytoma 46/46 respectively. The commonest site for leiomyosarcoma was lower limb (43%), for rhabdomyosarcoma head and neck (42%), for MPNSTthorax (36.4%) and for liposarcoma abdomen (50%). CONCLUSION: It was concluded that the most common pleomorphic sarcoma occurring in our adult population was Leiomyosarcoma, and that immunohistochemical stains are essential in most cases for further characterization of pleomorphic high grade sarcoma.

Adult↗
PubMed2005

Malignant smooth muscle tumours of soft tissue--a demographic and clinicopathological study at a tertiary care hospital.

OBJECTIVE: To determine the demographic characteristics and distribution of various reported prognostic factors of leiomyosarcoma (LMS) among subjects reporting to histopathology diagnostic centers of Aga Khan University (AKU) all over Pakistan between 2000-2004. METHODS: This study analyzed 205 consecutive confirmed cases of LMS received during a period of four years. The data regarding age, sex and size of tumor was obtained from the pathology medical records. Data on grade and positivity of immunohistochemical stains was assessed and all the variables analyzed using SPSS version 12.5. RESULTS: Of the 205 specimens of LMS, 31 were received as blocks for second opinion. A hundred specimens were multiple fragments, and 74 were intact masses. Of the latter, 40% had clear margins. The mean size of the tumor was 7.23 cms. (95% CI 6.1; 8.4). There were no cases of childhood LMS. Teenage LMS comprised 3% of all tumors. Grade 1 tumors were 16.6% of the total, 56.6% were grade 2, and 8.5% were grade 3. Vimentin positivity was observed in 97% of the tumors, desmin positivity in 56.7%, HHF35 positivity in 81.0%, s-100 positivity in 15.6% and cytokeratin positivity in 11% of the cases. The median age of LMS patients was 48.4 years, the mean age was 48.6 years (95% CI 45.9; 50.8) and male to female ratio was 1:1.2. The malignancy occurred a decade earlier in the females as compared to the males. The mean age of male cases was 52.3 years (95% CI 48.8; 55.8); and of females was 45.2 years (95% CI 41.8; 48.6). The mean age of teenage LMS was 17.2 years (95% CI 15.6; 18.7). The most common symptom was a painless swelling. The most common sites were lower limb (24.4%) and pelvis (24.4%) followed by abdomen (20.6%) and head and neck (12.7%). The least common sites were upper limb and chest (8.0% each). Seventy five percent of the tumors with involved margins were more than 5.0 cms. in size whereas 47% of tumors with free margins were above 5.0 cms. in size. Approximately half the tumors in the males were less than 5.0 cms, as compared with 31.0% in the females. LMS in the extremities was equally common in both genders, but trunk LMS was nearly twice as common in the females. CONCLUSION: In our population, leiomyosarcoma occurs at a relatively younger age, has a late presentation; is more common in females as compared to males and usually excised incompletely. No genetic study for LMS has been published in Pakistan; these studies are recommended to determine the biological pattern of LMS in our population.

Actins↗
PubMed2005

Colorectal carcinoma, extent and spread in our population. Resection specimens give valuable information.

OBJECTIVE: To acquire information about the extent and spread of colorectal carcinomas in our population by examining colon and colorectum resection specimens received. METHODS: All colon and colorectum resection specimens received in the section of Histopathology, Aga Khan University Hospital, Karachi from January 1, 2003 to July 31, 2003 were included in the study. RESULTS: Eighty five resection specimens were received during the study period, 69.41% patients were males, and 30.59% were females. The mean age for males was 49 years and for females 48 years. Tumor location was in left colon (58.82%), and in right colon (41.18%). The average size of the lesions in largest dimension was 5.5cms. Majority (83.53%) were colorectal adenocarcinomas, 71.76% cases were grade 11, 16.47% were grade I, and 11.76% were grade III. Most cases (85.88%) infiltrated full thickness of the bowel wall extending into the pericolonic fat. Vascular invasion was seen in 16.47% cases. Radial margin was positive in 23.08% of rectal carcinomas and 57.65% cases showed lymph node metastases. CONCLUSION: The findings in our study demonstrate that the disease is usually very advanced with extension into pericolonic fat and positive lymph nodes. Thus, the early detection and resection (while the disease is still in an early stage) are essential in our population using better surgical techniques, for proper staging of these tumors.

Adolescent↗