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Shahid Pervez

Publications and source records attributed to Shahid Pervez.

At least 37 records · Page 2Linked to original sources
PubMed2004

Expression of pS2 in prostate cancer correlates with grade and Chromogranin A expression but not with stage.

BACKGROUND: The biological potential of prostate cancer is extremely variable. Particular interest is focused on markers not expressed in normal prostatic tissues. pS2 protein expression has been demonstrated in a range of malignant tissues in an oestrogen-independent pathway. Recently, it has been demonstrated that pS2, in prostate cancer, is closely associated with neuro-endocrine differentiation. In the present study, we have analyzed, the potential of Neuro-endocrine and pS2 (TFF1) expression in human prostate cancer determined by immunohistochemistry, in primary adenocarcinoma of the prostate and attempted to correlate this with the clinico-pathologic features of the patient and neuroendocrine expression. METHODS: Ninety-five malignant prostatic specimens from primary adenocarcinoma, obtained from either transurethral resection of prostate or radical retropubic prostatectomy, from 84 patients between January 1991 and December 1998 were evaluated by immuno-histochemical staining using selected neuroendocrine tumor markers i.e. chromogranin A (CgA) and estrogen inducible pS2 protein. The relationship between the expressions of pS2 was studied with CgA expression, clinical stage (TNM) and tumour grade (Gleason system). Fischer exact test was used for statistical analysis. RESULTS: The mean age of the patients was 70 + /- 9.2 years. The pS2 expression was seen in 10% of primary prostate cancers. Worsening histological grade was associated with greater expression of pS2 (p < 0.001). The expression of CgA was noted in 31% of malignant prostatic tissue. In pS2, positive cases 2/3rd of patients were also CgA +ve. However, there was no significant correlation between pS2 expression and the stage of disease. CONCLUSION: pS2 expression in prostate cancer significantly correlates with histological grade and the neuroendocrine differentiation, as demonstrated by Chromogranin A expression but not with the clinical stage of the disease. However, the overall expression was low consequently; no definitive conclusions can be drawn. We feel further work is required in a larger series, both in primary and metastatic cancer.

Adenocarcinoma↗
PubMed2004

Demographic and Clinicopathologic features of membranous glomerulonephritis.

OBJECTIVE: To determine the frequency of membranous glomerulonephritis(MGN) in the renal biopsy specimens. To observe the presenting features and the demographics to determine association, if any, between MGN and hepatitis B in these patients. DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: The section of histopathology, The Aga Khan University Hospital, Karachi over a period of three years (May 1999-April 2002). SUBJECTS AND METHODS: All consecutive percutaneous renal biopsy specimens received during the study period were included. A total of 1590 renal biopsy specimens were evaluated. All cases where a definitive diagnosis of MGN (stage II to IV) was made on light and/or immunofluorescence studies were included in the results. Twenty-eight cases were excluded owing to inadequate material. Cases with a presumptive diagnosis and those in stage I of MGN were also excluded. Laboratory investigations carried out include urine examination, blood urea nitrogen. (BUN), serum creatinine, 24 hours urinary protein, Hepatitis B sAg, serological tests for hepatitis C virus, ANA, dsDNA, etc. Clinical features and results of laboratory analysis were recorded along with light microscopic features and statistical analysis was carried out. RESULTS: Out of 1562 renal biopsy specimens, 835(53.4%) cases showed primary glomerular pathology. 741(47.4% of the total) cases presented with nephrotic syndrome. Out of these in 176 cases (23.75%), findings were those of membranous glomerulonephritis followed by amyloidosis and focal segmental glomerulosclerosis. Among the cases with MGN, 23(13%) cases were those of secondary MGN whereas 87% were grouped under primary MGN. The male to female ratio was 2.2:1. Mean age at presentation was 29 years, median 29 years and a mode of 30 years. Nineteen cases (1.07%) were seen in children of 14 years old or less. CONCLUSION: The frequency of MGN was much higher in our study subjects as compared to most other regional studies. No significant association with hepatitis B was seen with only 4 out of 89 cases showing positivity for HBsAg. The pattern of disease corresponds more to that seen in the west.

Adolescent↗
PubMed2004

Prevalence and characterization of anaplastic large cell lymphoma and its association with Epstein-Barr virus in Pakistani patients.

Anaplastic large cell lymphoma (ALCL), CD30+, is a subtype of T-non-Hodgkin's lymphoma (NHL). Its most common form is a classical systemic type that involves multiple nodal and extranodal sites. In this study, morphologic, immunohistologic, and genetic studies were performed on ALCL cases in Pakistani patients. The median age of the patients in this study was 45 years (age range: 5-70 years), with a male to female ratio of 3.4:1. Thirty-seven (37) patients were diagnosed to have Ki-1 (CD30+) ALCL, which constituted 2% of all NHLs and 12.6% of all T-NHLs, over a period of 11 years (January 01, 1992-December 31, 2002). The tumors were of either T- or null-cell type with constant (100%) expression of CD30 (Ki-1). The majority of the cases (89.2%) expressed EMA, whereas 40.5% of the cases expressed either CD45 (LCA), CD45RO (UCHL1), or ALK. The mean age of ALCL patients with null-cell phenotype was 33.8 years as compared to those with T-cell phenotype having a mean age of 36.3 years. Out of the 37 cases diagnosed as ALCL, amplifiable DNA was isolated from 28 cases, which were further assessed for T-cell clonality for T-cell receptor (TCR)-beta, gamma, and immunoglobulin heavy chain (IgH) for the FR2 and FR3 regions. The polymerase chain reaction (PCR) technique demonstrated clonal rearrangement of the TCR beta, gamma, and IgH regions in 15 (53.6%), 11 (39.3%), and 2 (7.1%) ALCL cases, respectively, out of 28 cases. Association of Epstein-Barr virus (EBV) was noted in seven out of 28 cases (25%) of ALCL by PCR, whereas ISH for EBV-encoded nuclear RNA-1 (EBER-1) detected the presence of EBV in two (16.7%) out of 12 cases, where one was T-cell ALCL and the other null-cell ALCL. Immunostaining for LMP-1 could not be performed, because tissue material was not available. In conclusion, our study demonstrated that the prevalence of ALCL in Pakistan is comparable to that reported for some of the Asian communities and by the International Lymphoma Study Group and that EBV could be partly responsible for the pathogenesis of ALCL.

Adolescent↗
PubMed2003

Prevalence of mycosis fungoides and its association with EBV and HTLV-1 in Pakistanian patients.

Mycosis fungoides (MF) is an indolent T cell lymphoma that is distinguished from other lymphomas by its initial appearance on the skin. The histologic diagnosis of MF may be difficult because there is significant overlap in the histologic features of neoplastic T-cell infiltrates and inflammatory dermatoses. This T-cell neoplasm commonly occurs in a mixed, reactive background and can show only a subtle degree of cytologic atypia, rendering histologic diagnosis difficult. In this study MF constituted 0.86% of all non-Hodgkin s lymphoma (NHL) both T and B, as compared to the Western studies which have reported 0.5% prevalence for MF of all NHL. Polymerase chain reaction (PCR) technique was used to assess T-cell clonality in paraffin-embedded skin biopsies clinically and pathologically suspicious for early MF. Out of the 14 cases diagnosed as MF, amplifiable DNA was isolated from 6 cases, which were further studied for T-cell receptor (TcR) beta, gamma, and delta chain gene rearrangements. Clonal product was seen in 4 out of 6 cases for beta, gamma, and delta TcR chain genes. Association for Epstein Barr virus (EBV) was observed in 3 out of 6 cases (50%) of MF. Although these 3 cases were positive for EBV by PCR, but were negative by in-situ hybridization (ISH). No heterogeneity was noted in these 3 cases of MF for BamHI E, K, N, and Z regions of EBV. All six cases were negative for HTLV-1 (tax region) by PCR. It was concluded that the prevalence of MF in Pakistani population is comparable to the Western data, and that EBV association to MF cases was higher than in Western studies.

Adult↗
PubMed2003

Non-Hodgkin's lymphomas presenting as cutaneous lesions.

OBJECTIVE: To analyze the spectrum of Non-Hodgkin's Lymphomas (NHL) presenting as skin lesions and to see the histological type, age, sex incidence and site predilection of different types of NHLs and to correlate our findings with western published data. DESIGN: A retrospective descriptive case series study. MATERIALS AND METHODS: All NHLs (nodal and extra nodal) diagnosed between January 1991-December 2001 in the section of Histopathology, Department of Pathology, The Aga Khan University, Karachi were retrieved by using SNOMED coding system. Cases were reviewed and those presenting with skin involvement were selected. Further characterization of these tumours was done by morphology and Immunohistochemistry. Panel of antibodies included leukocyte common antigen (CD45), Pan B markers (CD20 and CD 79a), Pan T markers(UCHL1), Ki-1(CD30) and epithelial membrane antigen (EMA). RESULTS: The total number of NHLs (nodal and extra nodal) diagnosed in our department during the study period of 10 years were 1610. Out of these, 133 cases (8.26%) of NHLs presented with skin involvement. Out of these 44.4% (n=59) were NHLs of B cell phenotype while 23.3% (n=31) cases were of T cell phenotype. Out of 133 cases, 14(10.5%) were of mycosis fungoides (MF), and 3 (2%) each were of anaplastic large cell lymphoma (ALCL:Ki-1), lymphoma and lymphoblastic lymphoma/leukemia. In 17.3% (n=23) cases the phenotype could not be ascertained. There were 97(73%) males and 36(27%) females with a M:F ratio of 2.7:1. All types of NHLs showed a site predilection for the head and neck region except MF which presented mainly as generalized body lesions. CONCLUSION: NHLs presenting as skin lesions are more commonly of B cell phenotype followed by T cell phenotype (NOS) and mycosis fungoides. Probable reasons for the high frequency of cutaneous involvement by B-cell NHL are the advanced nature of the disease at the time of presentation and biological behavior of the tumors in our population.

Female↗
PubMed2003

Case control study of novel prognostic markers and disease outcome in pregnancy/lactation-associated breast carcinoma.

A case control study of pregnancy/lactation associated breast carcinoma (PAC) was conducted on 24 test cases with two controls per case, matching age, tumor grade, tumor size and axillary lymph nodes status. During seven years of this study, 6% of all patients with breast cancer had PAC. In this study, 67% of the test cases showed positive axillary lymph nodes compared to 49% in our series of 315 cases of non-pregnancy/non-lactating women with breast carcinoma (p < 0.05). The expression of nine prognostic markers, i.e. ER, PR, p53, C-erbB-2, EGFR, Cathepsin-D, PCNA, DNA ploidy and S-phase fraction, were studied by immunohistochemistry and flow cytometry. Hormone receptor status showed a statistically significant difference between the two groups, i.e. 29% immunoreactivity in test cases compared to 58% in controls with a p value of 0.007. Among p53, C-erbB-2, EGFR and Cathepsin-D in the test group, only EGFR showed a significant correlation, i.e. 33% immunoreactivity in test cases and 19% immunoreactivity in controls (p < 0.05). Higher PCNA positivity was seen in the test group compared to controls, i.e. 35% in test patients and 28% in controls (p < 0.05). Metastasis to bone and liver was a common feature of test patients as compared to controls (p < 0.05). After a median follow-up of 72 months, there was no significant difference in the overall survival (OS) of test cases and controls as 54% deaths were recorded in test patients and 44% in controls at the end of this study (p > 0.05). In summary, in spite of some significant differences in the expression of few prognostic markers, i.e. ER/PR, EGFR, PCNA and metastatic potential, there was no significant difference in the OS of PAC vs. control group if compared stage for stage.

Biomarkers, Tumor↗
PubMed2003

Characterization of T-cell non-Hodgkin's lymphoma and its association with Epstein-Barr virus in Pakistani patients.

This study analyzes the prevalence of T-cell non-Hodgkin's lymphoma (T-NHL) in a major referral center of Pakistan and its association with Epstein-Barr virus (EBV). Ninety-two cases of T-NHL were characterized on the basis of morphology, immunohistochemistry and genetic features. The prevalence of T-NHL was 22.2% of the total NHLs diagnosed during the eight years period (1992-1999). Polymerase chain reaction (PCR) technique was used to assess T-cell clonality in paraffin-embedded tissues of known T-NHL. Amplifiable DNA was isolated from all the cases, which were further studied for T-cell receptor (TcR)-beta, gamma, delta, and IgH chain gene rearrangements. Out of 92 cases 51 cases showed clonal product and 33 demonstrated polyclonal smear for beta, gamma, or delta chain genes, respectively, whereas 8 cases exhibited IgH chain gene rearrangement for FR2 region. This study demonstrated frequent presence of EBV in T-NHL (55.4%) by PCR, which were further tested for the localization of the virus by in situ hybridization (ISH). The extent of polymorphism in EBV genome was studied by single stranded conformation polymorphism (SSCP) technique for Bam HI E, K, N and Z regions. Hypervariability in Bam HI K, and N regions was noticeably higher compared to E or Z regions. In conclusion, our study demonstrated that the prevalence of T-NHL in Pakistan is slightly higher to that reported for Western communities. In addition, the frequency of EBV genome in T-NHL is intermediate as compared to other studies. No association was established between EBV variants differentiated on the basis of sequence heterogeneity in Bam HI K, N, E and Z regions with the manifestation of different subsets of T-NHL.

Adolescent↗
PubMed2002

Large-scale pathology-based cancer data--a reflection of population-based cancer data.

Pathology-based cancer data is a high quality reflection of the patterns of cancer in the population it represents, provided the demographic details of the patients are carefully recorded. Relative frequency data is neither a replacement for population-based data nor a suggested alternative; it simply enhances the quality of population data and in very large data sets reflects the cancer patterns observed in the representative populations. Aware of the standard shortfalls of pathology-based data, the department of pathology, The Aga Khan University Hospital (AKUH) standardized its data, representing 53.4% of the cancer data of Karachi Division (Pakistan) and also reflecting the cancer pattern of other provinces of Pakistan. This data was compared with 4 different population and institutional-based data sets. The findings substantiate the observation that despite the problems of interpretation of data from pathology laboratories, they are an invaluable source of information on cancer patterns in much of the world where incidence data are unavailable . If developing countries, unable to organize National Population- Based Registry should as an alternate develop National Pathology-based Registers a well targeted and monitored, a Cancer Control Program would be possible. A good quality, large-scale pathology data with demographic details of the patient recorded can also be extended to give coverage to the population.

Female↗
PubMedDate not supplied

Cancer of the oral cavity and pharynx in Karachi--identification of potential risk factors.

The objective of the study was to provide an overview of the demographics of cancer of the oral cavity and pharynx in Karachi South (1995-2001), and identify potential risk factors. Cases recorded for Karachi South, at Karachi Cancer Registry during 1(st) January 1995 to 31(st) December 2002 were analysed. For maximum completion of data cancer cases, recorded from 1(st) January 1995 to 31(st) December 2001 were included for final analysis. The age standardized incidence rates per 100000 population (ASIRs) for cancer of the oral cavity (excluding salivary gland) in Karachi South were 17.1 and 16.5 in males and females whereas the ASIRs for cancer of the pharynx (excluding nasopharynx) were 7.1 and 2.4 in males and females, respectively. The oral pharyngeal ratios were 2.4 and 6.9 for males and females and gender ratios (M F) were 1.04 for the oral cavity and 3.0 for the pharynx. The mean ages were 51 years (95% CI 49.6; 52.2) and 56.1 years (95% CI 54.4; 57.8) respectively. Cancer of the oral cavity ranked 2(nd) in Karachi in both genders. Cancer of the pharynx ranked 7(th) in males and 14(th) in females. Approximately 97% of the oral cavity and pharyngeal cancers were histologically confirmed. The majority of the oral (47.1%) and pharyngeal (51.9%) cancer cases presented as grade II lesions, and were discovered at advanced stages. Of the cancers reported during 1995-2001, 60.4% of the oral and 78.1% of the pharyngeal lesions had spread to a distant site at the time of diagnosis. Squamous cell carcinoma comprised 96.5% and 91.8% of the totals. The incidences of these cancers are comparable to the highest risk regions of the world. As distinct from other geographical areas oral cancer is as common in females as in males, which may reflect the pattern of exposure to known risk factors such as betal quid, arecanut and tobacco and the absence of alcohol as a risk factor in both genders. Apergillus contamination of arecanut could also be a risk factor but no confirmation studies or quantification is available. Despite the common risk factors, incidence of pharyngeal cancer is three times higher in men as compared with women. The keys to reducing the incidence and mortality due to oral and pharyngeal cancers are prevention and control, emphasizing cessation of tobacco use and cancer screening. However a targeted cancer and tobacco control program does not presently exist in Pakistan.

Carcinoma, Squamous Cell↗
PubMedDate not supplied

Incidence of cancer esophagus in Quetta and Karachi, Pakistan.

OBJECTIVE: To study the differences in the incidence of cancer esophagus in Karachi and Quetta, Pakistan. METHODS: Incident cases of cancer esophagus registered from January 1, 1995 to December 31, 2000 were included for Karachi South, and those registered from January 1, 1998 to December 31, 2000 were included for Karachi Division and Quetta. RESULTS: In Quetta, cancer esophagus had age-standardized incidence rate (ASIR) of 25.5/100,000 population in males and 23.4/100,000 population in females, and it was the commonest malignancy in both genders. In comparison, in Karachi South and Karachi Division, cancer esophagus ranked 7th among cancers in males (ASIR 6.2/100,000 and 5.0/100,000 population, respectively) and 5th in females (7.0/100,000 and 4.9/100,000 population, respectively). The ASIR was similar among males and females in all data sets. CONCLUSION: The incidence of cancer esophagus in Quetta is comparable to that in high-incidence regions, whereas the incidence in Karachi is similar to that in moderate-incidence zones. In contrast to other world regions, cancer esophagus was equally common in males and females in Pakistan. The high risk in Quetta warrants investigation for risk factors and a targeted cancer control program.

Adenocarcinoma↗
PubMedDate not supplied

Epidemiology of ocular malignancies in Karachi.

The study was conducted with the objective of examining descriptive epidemiological characteristics of malignant ocular tumours in Karachi (1998-2002). The data for two hundred and forty two ocular malignancies registered at the Karachi Cancer Registry for Karachi Division during a 5-year period, from January 1(st) 1998 to December 31(st) 2002 were analysed. The age standardized incidence rate (ASIR) was 0.5/100,000 in males and 0.4/100,000 in females. The gender ratio (M:F) was 1.3. The mean age was 34.8 years (95% CI 30.1; 39.6) in males and 34.5 years (95% CI 28.0; 40.9) in females. A fourth of the malignancies were childhood tumours. The most common childhood malignancies were retinoblastomas and rhabdomyosarcomas, whereas the most common adult malignancies were conjunctival squamous cell carcinomas and melanomas. Approximately 97.0% of the tumours were histologically confirmed. The majority (62.5%) presented as low-grade (grade 1) lesions, and were localized to the eye (50%) at the time of diagnosis. The annual incidence rates remained stable during this period. The crucial importance of ocular malignancies is the high 5-year survival rates, associated disability following unilateral or bilateral enucleation and the implications as preventable components of Cancer Control Programs This article provides demographic statistics, which could be useful for the foundation, establishment and monitoring of a component of an effective cancer control program, the risk factors of ocular malignancies being well established. It is recommended that public health education to prevent ultraviolet light related ocular malignancies, information on preventative sun protection behavior, legislation for occupation related ocular cancers and genetic counseling for familial retinoblastoma should be essential primary components of all National Cancer Control Programs even in apparently low risk countries. In the long-term perspective, these efforts should further reduce the incidence - meanwhile stabilization of incidence rates could be achieved. Early detection and standardized treatment will reduce the associated morbidity and mortality.

Adolescent↗
PubMedDate not supplied

Retinoblastoma in Karachi, Pakistan.

The objective was to assess epidemiologic aspects of retinoblastoma development in Karachi, Pakistan. Incident cases, diagnosed clinically or microscopically and registered at Karachi Cancer Registry (KCR) during 1(st)January 1998 to 31(st) December 2002 were reabstracted, rechecked and reanalyzed for this purpose. One hundred and one cases of retinoblastoma were reported to KCR over the 5 years (1998-2002). Fifty-seven were residents of Karachi, 34 (59.6%) males and 23 (40.4%) females. The gender ratio (M:F) was 1.5. The mean age at diagnosis was 3.96 years (95% CI 2.92; 4.99) and 3.85 years (95% CI 2.72; 4.98) in males and females respectively. The annual crude incidence of retinoblastomas in Karachi was 4.0/100,000 and 2.4/100,000 in children under the age of 5 and 10 years respectively, the corresponding age standardized rates being 5.3/100,000 and 4.8/100,000. The age groups at risk of developing retinoblastoma, associated morbidity and possibility of almost 100% 5-year survival with available treatments, calls for ophthalmologic screening of all infants below 1 year, and high-risk children until the age of 7 years. In order to detect retinoblastoma, as early as possible, health education for parents and health providers, and improved training of ophthalmologists is essential. Genetic testing for siblings and children of retinoblastoma cases and identification of high-risk children would be helpful, but lacks financial feasibility in developing countries at present. Future health care planning should focus on capacity building for neonatal ophthalmologic screening, handling of parents'and children'emotional reactions and opportunities for education, occupational training and cosmetic rehabilitation for surviving retinoblastoma patients.

Adolescent↗
PubMedDate not supplied

Rhabdomyosarcoma in Karachi 1998-2002.

The epidemiological features of rhabdomyosarcoma (RMS), an uncommon malignancy composed of cells with histopathologic features of striated muscle, were studied in Pakistan. Incident RMS cases recorded at the Karachi Cancer Registry during 1998 to 2004 were reviewed and to ensure maximum completeness of data, only those registered between 1998 and 2002 were considered for the present study. Two hundred and seventeen cases were reported to the Karachi Cancer Registry during this five-year period. One hundred and forty eight of the patients (60.4% males; 39.6% females) were residents of Karachi. The crude and standardized annual incidence rates/100,000 were 0.3 for males and 0.2 for females. The incidence was 0.5 in children below 15 years of age. The primary RMS sites in males were head and neck (28.1%), extremities (25.8%), genitourinary (GU) tract (17.9%), trunk (9.0%), orbit (7.9%), and retroperitoneum (3.4%). RMS occurred at other sites in 7.9% of the patients. Corresponding frequencies in females were head and neck (35.6%), extremities (16.9%), GU tract (16.9%), trunk (8.5%), orbit (8.5%) and other sites in 13.6%. Approximately 60% of the cases were childhood RMS and three fourths were below 21 years. The mean age of RMS cases all sites, males, was 18.5 years (95% CI 15.6; 21.4); for childhood RMS, 7.5 years (95% CI 6.0; 9.2); and for adult RMS 34.2 years (95% CI 28.3;40.2). In females, the corresponding figures were 18.2 (95% CI 13.7; 22.7); 6.6 (95% CI 5.0; 8.1) and 33.9 (95% CI 27.5; 40.5), respectively. One hundred cases were retraceable, and the mean survival time, RMS all sites and ages in both genders, was 1.5 years (95% CI 1.1; 1.9). The 5-year survival was 10%, and 3-year survival was 30% whereas 16.7% of the patients died within a year of diagnosis. The indicators of poor prognosis, a late presentation, rapid evolution, advanced disease, tumor burden (tumor size >5.cms) and regional lymph node involvement, are characteristic of RMS in Karachi. Recent advances in RMS multimodality treatment protocols have improved RMS prognosis in patients with limited disease. Pakistan should focus on early diagnosis and prompt treatment of malignancies. This requires health education for the general population to create awareness and training of health professionals at all levels to promote early diagnosis. An RMS group is required, which would monitor the treatment, recurrence, patient education and provide psychosocial support. Cytogenetic studies are advised for a better understanding of biologic differences in RMS cases in this population.

Adolescent↗
PubMedDate not supplied

Increasing incidence of non-Hodgkin's lymphoma in Karachi, 1995-2002.

This first population-based study of non- Hodgkin lymphoma (NHL) from any region in Pakistan, provides an overview of the incidence pattern and time trends in Karachi and generates hypotheses for future experimental research. Epidemiological data for 429 incident (1(st) Jan 1995 to 31(st) Dec 2002), microscopically verified nodal and extra-nodal NHL cases, registered at the Karachi Cancer Registry (KCR) for Karachi South, were reviewed. The age standardized incidence rate (ASIR) was 5.3/100,000 in males (M) and 4.1/100,000 in females (F), in 1995. A gradual increase in the annual incidence was observed during the study period, with NHL incidence rate increasing in 2002 to 8.4/100,000 in men and 6.5/100,000 in women, almost double the 1995 rates. NHL affected all age groups in both genders and for each group the ASIR was higher among men than women, with an overall gender ratio of 1.9. The mean ages of the patients were 41.5 years (95% CI 39.1; 43.8) in males and 44.0 years (95% CI 40.8; 47.1) in females. The adult to childhood ratios were 8.6 (M) and 10.7 (F). B-cell NHL comprised 81.0% of NHL in males and 87.3% in females. One fourth of the NHL cases were extra-nodal, the largest group was of gastrointestinal origin (54.1% M, 38.5% F). The gastric component was 21% M and 25.6% F. Odds Ratios for sex, age-groups, ethnicity, religion, and subdivision by socio-economic categories were calculated by considering all malignancies, except lymphoproliferative disorders as controls. The odds ratio (OR) in men was 2.2 (95% CI 0.6; 3.0). Children and adolescents were at the highest risk of developing NHL, especially the 5-9 year olds, in both genders. A marginally higher risk was observed for the lower socioeconomic categories and for ethnicities belonging to Northern and North Western Pakistan (Punjabi, Pushtu and Baluch) residing in Karachi South. The incidence rates of NHL registered in Karachi South are likely to be a reflection of non-AIDS-associated NHL. Estimated HIV/AIDS incidence was too low during the study period in this population to have an impact on NHL incidence. The preponderance of low and intermediate grade lymphomas, paucity of central nervous system NHL and a higher childhood NHL component support this hypothesis. As yet unpublished reports, however, are raising the alarm on rising HIV positivity. NHL correlation with HIV/AIDS status and studies identifying risk factors of non- HIV/AIDS associated NHL (childhood viral infections, Hepatitis C virus, and Helicobacter pylori) are potential areas for future experimental and epidemiological research.

Adolescent↗
PubMedDate not supplied

Cancer profile of Hyderabad, Pakistan 1998-2002.

Hyderabad is the third largest city of Pakistan, the second largest city of Sindh Province and one of the oldest cities of the sub-continent. This administrative headquarter is located just east of the River Indus and is an important commercial and industrial center. Once a provincial capital, it is at a distance of approximately 200-km from Karachi. This present study was conducted with the objective of providing the cancer profile of Hyderabad, which has an urban population of 2,840,653 (52.2% M, 47.8% F) annual growth rate 1.13. The city is inhabited by all ethnicities of the country, however the predominant ethnicity is Sindhi, followed by Mohajirs (post-partition immigrants from India), and a lesser extent other ethnicities of Pakistan viz. Baluchs, Punjabis and Pathans. The study includes two sets of patients. First the incident cancer cases, residents of Hyderabad, who reached Karachi for diagnosis or treatment. Second the incident cancer cases registered at the Aga Khan University Pathology-based Cancer Registry (APCR) Pathology collection points at Hyderabad and subsequently registered at APCR, during 1st January 1998 to 31st December 2002. The pathology department of the AKU has 3 centers in Hyderabad, which provide diagnostic pathology especially oncopathology services to the city. The age-standardized rates (ASR) for cancer (all sites) 1998 to 2002 in Hyderabad were 91.6/100,000 in males and 96.0/100,000 in females. The most common malignancies (ASR per 100,000) in males were oral cavity (11.8), lymphoma (10.6), lung (8.0), urinary bladder (6.8), prostate (4.8), liver (4.4), pharynx (4.2), colo-rectum (3.6), larynx (3.2), and skin (3.2). The cancers in females (ASR per 100,000) were breast (22.4), oral cavity (11.5), gall bladder (4.8), esophagus (4.2), cervix (3.6), ovary (3.4), colo-rectum (3.4), lymphoma (3.4), uterus (3.4), and thyroid (2.4). Tobacco-associated cancers were responsible for approximately 40.0% of the tumors in males and 20.0% in females. Histological confirmation remained 96.3%, with 44.5% presenting in grade II or I, 55.5% presenting as stage III and IV. Information on grade and stage of malignancy was available in 70% and 50% of the cases respectively. Males comprised 53.1%, and females 46.9% of the cases. The mean age of cancer all sites, both genders was 45.2 years (95% CI 44.4; 45.9), males 45.4 years (95% CI 44.3; 46.5); females 44.9 years (95% CI 43.9; 45.9). Conclusions drawn from this database must be interpreted with care, as it may be identified as data from selected medical institutions. Chances of selective collection bias are minimized as the data of the AKU pathology is collected from multiple centers in the city of Hyderabad, dispersed at distances, which allows adequate sampling from the entire city. There is a slight preponderance of lymphomas in males which we feel is a true higher risk, yet it may indicate an over representation of easily accessible sites in pathology based-data. Nonetheless, this is the first attempt to determine the cancer incidence pattern of Hyderabad, and should serve as a guideline for estimation of the cancer burden and risk assessment statistics of Pakistan and the cancer control program of the country.

Adolescent↗
PubMedDate not supplied

Diffuse large B cell lymphoma (DLBCL) in Pakistan: an emerging epidemic?

There has been a recent concern among oncological clinicians and pathologists of our region regarding the disproportionate increase in the number of patients presenting with diffuse large B cell lymphoma (DLBCL). This prompted us to conduct a thorough, hospital-based epidemiological study in a major referral center of Pakistan. A total of 780 specimens were collected over last half decade from cases classified as adult Non Hodgkin's lymphoma (NHL). Out of these 780, 596 (76.4 %) were diagnosed as DLBCLs. The gender ratio was 2.3:1 (M:F) and the median age was 47.2 years, with an age range of 15-85 years. Nodal-NHLs constituted 42.2 % of all adult NHLs, with the cervical lymph nodes as the most frequent nodal site of presentation. The most frequent extranodal site was the gastro-intestinal tract (GIT), followed by the head and neck. In conclusion, we document an astonishingly high number of DLBCL amounting to an emerging epidemic in Pakistan, with a consideration of probable etiopathogenetic factors.

Adolescent↗
PubMedDate not supplied

Patho-epidemiology of lung cancer in Karachi (1995-2002).

The objective of the study was to provide an overview of the demographics of lung cancer, the number one cancer killer of men in Karachi South (1995-2002). Lung cancer cases recorded at Karachi Cancer Registry during 1st January 1995 to 31st December 2004 were analyzed. To allow for maximum data completion, cases recorded from 1st January 1995 to 31st December 2002 were included for final analysis. Trends were studied by analyzing the age standardized incidence rates (ASR)s in 2 time periods, 1995-1997 and 1998-2002. Odds ratio for sex, age-groups, ethnicity, religion, and residence by socio-economic categories were calculated by considering all malignancies (except tobacco-associated malignancies) for each group, registered at KCR for the same period as controls. Cancer of the lung ranked the most frequent malignancy in men in Karachi in the entire 1995-2002 period, though it did not feature amongst the first 10 malignancies in the females. In the 1995-1997 period, the ASR per 100,000 population for cancer of the lung was 21.4 and 2.9 in males (M) and females (F) respectively. The mean age of the patients was 60.4 years (95% CI, 59.1-61.7) M and 53.7 years (95% CI 48.9-58.5) F. In the 1998-2002 period the incidence rate increased to 25.5 per 100,000 (M) and 4.2 per 100,000 (F). Thus between 1995 and 2002, the incidence of lung cancer registered a 19% increase in men and almost 100% in women. The component of adenocarcinoma in females remained stable during 8 years, but increased 55% in males. Histologic confirmation was 80%; majority of cancer cases presented as grade 3 and grade 4 lesions (62.3%), and were discovered at advanced stages (stage III 35.7%; stage IV 55.8%). The odds ratio (OR) in men was 4.5 (95% CI 3.7; 5.4). The risk of developing lung cancer increased with age, the highest risk being observed in the 65+ age group. A marginally higher risk was observed in the higher socio-economic categories for men and in the lower socio-economic categories for women. A higher risk was also observed for men who were residing along the coastal belt, and for ethnicities belonging to Southern Pakistan (Sindhi and Mohajir) residing in Karachi South. In conclusion, Pakistan at present falls into a low risk lung cancer region in females and a moderate risk region for males and the highest registered increase between 1995 and 2002 was observed in the older age groups (65+). It is however a cause of concern that the overall lung cancer incidence rates continue to rise. The age specific rates though stable in the younger age groups (35-49 years), are at present equivalent to contemporary rates in high- risk countries. These rates correspond with the trends of smoking prevalence in the younger age groups in the last 2 decades. Published studies have given alerts to increase in the smoking habits of the present day youngsters and with an expanding population the country can expect a substantial increase in lung cancer. This threat can only be averted by implementation of stringent anti-tobacco rules and health education; prohibition of smoking in educational institutions at all levels and a ban on the sale of cigarettes to minors.

Adolescent↗