Search

Objective:  To collect and analyse epidemiologic data of all malignancies by age group and gender for the Karachi population to estimate the cancer incidence of 5-years (2017-2021) and identify major risk factors for setting priorities towards cancer control programs., Study Design: Observational study. Place and Duration of the Study: Karachi Cancer Registry (KCR) Secretariat, Pakistan Health Research Council (PHRC), JPMC, Karachi, from 2017-2021., Methodology: Cancer data of seven tertiary care hospitals of Karachi submitted to KCR during the study period were analysed including age, gender, date of first contact, primary site and ICD coding. All the data was cleaned, merged, and analysed. All patients 0-14 years were classified as 'children', all aged 15-19 years were classified as 'adolescents', and those age 20-years and above as 'adults'. Age standardised incidence rates (ASIR) were determined for both genders., Results: During the last five years (2017-2021), a total of 65,886 malignant cases were received. The distributions seen amongst males and females were 33,510 (51%) and 32,376 (49%), respectively with 60,145 (91.3%) tumours found in adults (≥20 years), 4844 (7.3%) in children, and 897 (1.4%) in adolescents. The three most common tumour sites were oral, liver, and colorectal in males; breast, oral and ovary in females; bone, brain and connective tissue in adolescents; and leukaemia, brain and bone in children. The overall ASIR (%) in males was 89.20 for adults, 9.19 for children, and 1.61 for adolescents. The overall ASIR (%) in females was 93.44 for adults, 5.45 for children, and 1.11 for adolescents., Conclusion: Oral cancer, a largely preventable cancer is the leading cancer in males while breast cancer is the leading cancer in females followed by oral cancer. In adolescents and children, the incidence closely matches most of the world., Key Words: Karachi, Cancer registry, Oral cancer, Breast cancer, Age-standerdised ratio.

Objective: To determine the association between E-cadherin expression and hormone receptors status in patients with breast cancer., Study Design: Cross-sectional study., Place and Duration of Study: Department of Medical Oncology, Jinnah Postgraduate Medical Centre, Karachi, Pakistan, from March to December 2019., Methodology: Two hundred and forty-eight women, aged 18-65 years with histologically proven diagnosis of breast carcinoma, were included in the study. Immunohistochemistry (IHC) staining was performed for the evaluation of E-Cadherin expression and status of hormonal receptors [Estrogen receptor (ER), Progesterone receptor (PR) and HER-2-neu]. The positive homogeneous pattern of staining for the cellular membranes is considered normal. The non-homogeneous or the heterogeneous pattern of the cytoplasm and membrane, represented aberrant E-cadherin expression (loss of E-cadherin expression). SPSS version 23 was used to analyse data., Results: The results of IHC showed that 82.7% of the tumours were E-cadherin positive, 65.7% were ER positive, 62.9% were PR positive and 29.4% were HER 2 positive. A normal pattern of immunostaining of E-cadherin for the membranes is seen in hormone receptor positive and young patients with low grade tumour. Aberrant E-cadherin expression (loss of E-Cadherin)was noticed in HER 2 negative, postmenopausal women with high grade large size tumour(p<0.05)., Conclusion: The study showed that there is significant association between E-cadherin expression and hormone receptor status, HER2-neu, menopausal status, age of patients, grade of tumour and size of tumour. Key Words: E-cadherin, Hormone receptors, Breast carcinoma, ER, PR and HER 2.

Objective: To determine the remission rate in adolescent and young adult (AYA) patients with acute lymphoblastic leukemia (ALL)., Study Design: Descriptive study., Place and Duration of Study: Department of Oncology, Jinnah Postgraduate Medical Centre (JPMC), Karachi from January, 2016 to March, 2017., Methodology: Adolescent and young adult (AYA) patients aged 15-39 years, newly diagnosed with acute lymphoblastic leukemia from January, 2016 to March, 2017. Diagnosis was confirmed by bone marrow trephine biopsy and immunophenotyping. All the patients were treated with daunorubicin, vincristine, prednisone, and L-asparaginase in the induction phase. The response evaluation was done on day 35 of the induction phase and the remission rate was assessed by the bone marrow examination., Results: Of the total 50 AYA patients diagnosed with ALL, 41 patients could complete induction phase and 9 patients died during the first week of induction, therefore excluded from the study. Forty (97.8%) patients were <35years of age, 28 (68.3%) were male, of female 10 (24.4%) were housewives, 33 (80.5%) patients belonged to Sindh, 28 (68.3%) presented with fever and body ache, 17 (41.5%) patients had precursor B cell type ALL, with 7 (17.1%) patients had hemoglobin of <7 g/dL,11 (26.8%) patients had white cell count of >30x109/L, platelet count of <20x103/µL in 6 (14.6%) patients and complete morphological remission was reported in 29 (70.7%) patients., Conclusion: The remission induction rate was 70.7% in the adolescents and young adults with acute lymphoblastic leukemia at the study centre.

Dual ectopic thyroid tissue associated with normally located thyroid, is a rare anomaly. We report a case of 42 years lady, who underwent left hemithyroidectomy for nodules in the left lobe of thyroid 15 years back. She presented with right side neck swelling and dyspnea for 6 months. Right hemithyroidectomy was done for multinodular goiter involving right lobe of thyroid. She developed stridor on the first postoperative day. CT scan and MRI showed intratracheal ectopic thyroid tissue. Ectopic thyroid tissue was removed by dividing cricoid cartilage, and trachea was repaired. Radio iodine scan after 6 weeks showed another ectopic thyroid tissue in nasopharynx. Patient refused for radio iodine ablation and, she was given thyroxin replacement.

Orbital metastasis is a rare occurrence found only in about 3 - 10% of all prostate cancers. A 72 years male presented with proptosis of the left eye associated with pain, blurred vision and frequent headaches for the past 8 months. Past medical history had symptoms of bladder outflow obstruction for 3 years. MRI brain and orbit with contrast was consistent with a large soft tissue mass in the left frontal region. The mass was surgically excised in order to achieve palliation. Histopathology revealed poorly differentiated malignant neoplasm with immunohistochemistry favoring metastatic prostate carcinoma. Postoperative radiotherapy was administered with a palliative intent. CT scan identified an enlarged prostate with a nodular lesion, abdominal lymphadenopathy and soft tissue density lesion in the apical segment of left lung. Serum PSA level was 149 µg/L. Bone scan was also consistent with metastatic disease.

A 62-year-old male patient presented with right flank pain and right renal mass on CT scan. Patient left against medical advice and had nephrectomy done elsewhere. Histopathology revealed a diffuse large cell B-cell lymphoma. Patient presented again, with disseminated disease and was started on chemotherapy. Although a rare disorder, missing primary renal lymphoma as one of the causes of renal mass can lead to disseminated disease and unnecessary nephrectomy, in spite of chemotherapy being standard management.

Objective: To determine the frequency and severity of Premenstrual Syndrome (PMS) in medical college students, evaluate the impact of the condition on the quality of life and find out the associated risk factors., Study Design: An observational study., Place and Duration of Study: Isra University Hospital, Hyderabad, Sindh, Pakistan, from August to December 2006., Methodology: Unmarried medical students aged 18-25 years with regular menstrual period for the last 06 months were recruited by convenience sampling. PMS-related data was collected on daily record of severity of problems (DRSP) for two prospective cycles. Health-related quality of life data was collected on medical outcome study Short Form 36 (Sf - 36) after taking informed consent from participants. Descriptive and inferential analysis was done by two-tailed t-test and multivariate logistic regression analysis., Results: Study participants (n=172) had mean age of 21.2 + 1.9 years. Eighty-nine (51%) girls met the criteria for PMS recording to ICD - 10, among them, 53 (59.5%) had mild PMS, 26 (29.2%) had moderate and 10 (11.2%) had severe PMS. Ten (5.8%) girls were found to have Premenstrual Dysphoric Disorder (PMDD) according to DSM - IV criteria. The order of frequency of symptoms were anger, irritability, anxiety, tiredness, difficult concentration, mood swings and physical symptoms like breast tenderness and general body discomfort with great impairment in social life / activities and work efficiency/productivity. Dysmenorrhea (p=0.003) and family history of premenstrual syndrome (p < 0.001) were significantly associated with premenstrual syndrome on univariate and multivariate analysis. Sf - 36 score on Mental Component Summary (MCS) and Physical Component Summary (PCS) were significantly lower in the affected group., Conclusion: Premenstrual syndrome is a common problem in young girls which adversely affects their educational performance and emotional well-being. Strategies should be adopted for detection and management of PMS in young girls.