Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis typically associated with autoimmune disease; however, its coexistence with giant cell arteritis (GCA) and optic neuritis is exceedingly uncommon and rarely reported. We describe a woman in her early 70s with rheumatoid arthritis and recently diagnosed GCA who developed painful breast ulcers while on tapering systemic corticosteroids for GCA, shortly after a herpes zoster infection. The ulcers showed classic PG morphology and fulfilled Delphi diagnostic criteria. She had preceding MRI-confirmed bilateral optic neuritis followed by bilateral temporal arteritis. Intralesional corticosteroid therapy resulted in complete ulcer healing within 1 month. This case highlights an unusual constellation of PG, GCA, rheumatoid arthritis and optic neuritis, with herpes zoster as a potential pathergic trigger. It emphasises the importance of considering PG in atypical ulceration occurring in patients with multisystem autoimmunity, even when lesions develop despite ongoing low-dose systemic corticosteroid therapy.

Background/Objective:Hyalinizing trabecular tumor (HTT) of the thyroid is an uncommon follicular cell-derived neoplasm. Histologically, it shares several nuclear features with papillary thyroid carcinoma (PTC), such as nuclear grooves and pseudoinclusions, making accurate diagnosis challenging, particularly in cytology. Coexistence of HTT and PTC within the same thyroid gland is exceptionally rare and can further complicate clinical interpretation. Case Report:A 54-year-old woman presented with a gradually enlarging anterior neck swelling. Ultrasound revealed 2 nodules in the right thyroid lobe with differing echogenic features. Fine-needle aspiration cytology was reported as Bethesda Category III (Atypia of Undetermined Significance). A right lobectomy was performed for definitive diagnosis. Histopathology revealed 2 distinct lesions: a 1.2 cm hyalinizing trabecular tumor showing trabecular architecture, hyalinized stroma, CD56 positivity, and characteristic membranous Ki-67 staining; and an incidental 0.1 cm papillary thyroid carcinoma exhibiting fibrovascular cores with nuclear clearing and grooves, CK19 positivity, and CD56 loss. No capsular, vascular, or extrathyroidal invasion was identified. The patient recovered uneventfully and remains disease-free after 2.5 years of follow-up. Discussion:The coexistence of HTT and PTC within the same thyroid gland is a rare but documented phenomenon, reported in only a few cases worldwide. The morphologic overlap between HTT and PTC frequently leads to diagnostic uncertainty in cytology. Immunohistochemistry and, when available, molecular testing for GLIS1/GLIS3 rearrangements provide essential diagnostic clarity. Conclusion:This case underscores the importance of integrating cytologic, histopathologic, and molecular features when evaluating thyroid nodules with overlapping characteristics. Recognition of this rare coexistence prevents misclassification and unnecessary aggressive management, ensuring accurate diagnosis and optimal patient outcomes.

Introduction and importance:Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin lymphoma, often presenting with nodal or extranodal masses. However, involvement of the chin region is extremely rare and underreported in literature. This case highlights an unusual extranodal manifestation of germinal center B-cell-like (GCB) DLBCL. Case presentation:A 56-year-old man with a history of hypertension and type II diabetes presented with an 8-month history of a painless, progressively enlarging chin mass. Prior antibiotic therapy failed to resolve the lesion. Examination revealed a firm, 4 × 3 cm subcutaneous swelling involving skin and mucosa. Computed tomography (CT) and positron emission tomography/CT imaging revealed hypermetabolic soft tissue lesions in the chin and right buccogingival region. Histopathology and immunohistochemistry confirmed GCB-type DLBCL. The patient received six cycles of rituximab, cyclophosphamide, pirarubicin, vincristine, and prednisolone chemotherapy, resulting in a significant reduction in lesion size and metabolic activity. Follow-up showed no recurrence. Clinical discussion:This case highlights the diagnostic challenges posed by extranodal DLBCL in atypical locations. Misdiagnosis as an infection led to a delayed diagnosis. Immunophenotyping revealed expression of both B- and T-cell markers, which complicated the classification of the lymphoma. A prior history of spontaneously resolving axillary masses suggested an indolent precursor phase that later transformed into aggressive DLBCL. Conclusion:DLBCL may present in rare extranodal sites such as the chin, mimicking benign conditions. Persistent lesions unresponsive to antibiotics should prompt a malignancy workup. Comprehensive evaluation, including imaging and immunohistochemistry, is critical for timely diagnosis and effective treatment. Further research is needed to understand unusual immunophenotypes and progression pathways in DLBCL.

INTRODUCTION:This study evaluated performance of pan-fungal polymerase chain reaction (PCR) for identification of fungi from histopathology-positive formalin-fixed, paraffin-embedded (FFPE) tissues. METHODS:We selected FFPE tissue biopsies with histopathologically proven fungal elements and simultaneous culture requests from 2020 to 2023. DNA extraction from blocks was performed using the QIAamp DNA FFPE Kit (QIAGEN). Conventional PCR with ITS1 and ITS4 primers was conducted, followed by gel electrophoresis and sequencing using the Basic Local Alignment Search Tool. Fisher exact and Mann-Whitney U tests were performed to determine associations of various factors with DNA amplification and concordant results. RESULTS:From a total of 96 samples, 35 (36.5%) were amplified; of these 35 samples, 7 (20.0%) yielded sequencing results. Overall, 7 of 96 (7.3%) demonstrated agreement with histopathology and 4 of 96 (4.2%) exhibited agreement with both microbiology and histopathology. Analysis of factors influencing fungal DNA amplification revealed strong associations with 10% potassium hydroxide smear positivity and sterile vs nonsterile tissue. Factors found to be significant for concordant ITS sequencing results with histopathology were septate hyphae vs nonseptate hyphae, DNA concentration, and time elapsed between sample collection and PCR. DISCUSSION:We found low positivity for pan-fungal PCR for fungal identification from FFPE tissues. Although the diagnostic yield from FFPE samples was low, optimizing conditions that influence DNA yield may improve results.

Introduction: Acinic cell carcinoma (AciCC) is a rare clinical entity and a salivary gland malignancy. It is associated with wide histological variations in the cytomorphological patterns. Methods: Sixty cases diagnosed as AciCC from 2002 to 2023 were assessed for diverse cytomorphological patterns. Results: The mean age of patients at the time of diagnosis was 44.35 +/- 16.8 years ranging from 15 to 81 years. Females comprised 58.3% for a F: M ratio of 1.4:1. Fifty three cases (88.3%) occurred in the parotid gland, two cases in the nasal region (3.3%), and one case each in the soft plate and upper lip (1.7%). The location of the remaining three cases was not specified. The most common presenting complaint was a well-defined facial swelling associated with pain. The average tumor size was 3.8 +/- 1.9 cm. The most predominant architectural pattern was solid (83.3%) followed by microcystic (60%), then follicular (41.7%), papillary cystic (14.3%), and tubulocystic (28.6%), and AciCC with de-differentiation/high-grade transformation was reported in three cases (5%). In 83.3% of the cases (50 out of 60), we noticed a mixture of two or more growth patterns. Other degenerative changes included prominent lymphoid stroma, hemorrhage, and cystic change. Conclusion: Awareness and recognition of diverse cytomorphological patterns of AciCC, especially in institutions of a developing country where there is limited availability of highly specific and sensitive immunohistochemical stains or molecular diagnostics, are crucial and essential.

Several studies have shown an association between prostate carcinoma (PCa) and Epstein-Barr virus (EBV); however, none of the studies so far have identified the histopathological and genetic markers of cancer aggressiveness associated with EBV in PCa tissues. In this study, we used previously characterized EBV-PCR-positive (n = 39) and EBV-negative (n = 60) PCa tissues to perform an IHC-based assessment of key histopathological and molecular markers of PCa aggressiveness (EMT markers, AR expression, perineural invasion, and lymphocytic infiltration characterization). Additionally, we investigated the differential expression of key oncogenes, EMT-associated genes, and PCa-specific oncomiRs, in EBV-positive and -negative tissues, using the qPCR array. Finally, survival benefit analysis was also performed in EBV-positive and EBV-negative PCa patients. The EBV-positive PCa exhibited a higher percentage (80%) of perineural invasion (PNI) compared to EBV-negative PCa (67.3%) samples. Similarly, a higher lymphocytic infiltration was observed in EBV-LMP1-positive PCa samples. The subset characterization of T and B cell lymphocytic infiltration showed a trend of higher intratumoral and tumor stromal lymphocytic infiltration in EBV-negative tissues compared with EBV-positive tissues. The logistic regression analysis showed that EBV-positive status was associated with decreased odds (OR = 0.07; p-value < 0.019) of CD3 intratumoral lymphocytic infiltration in PCa tissues. The analysis of IHC-based expression patterns of EMT markers showed comparable expression of all EMT markers, except vimentin, which showed higher expression in EBV-positive PCa tissues compared to EBV-negative PCa tissues. Furthermore, gene expression analysis showed a statistically significant difference (p < 0.05) in the expression of CDH1, AR, CHEK-2, CDKN-1B, and CDC-20 and oncomiRs miR-126, miR-152-3p, miR-452, miR-145-3p, miR-196a, miR-183-3p, and miR-146b in EBV-positive PCa tissues compared to EBV-negative PCa tissues. Overall, the survival proportion was comparable in both groups. The presence of EBV in the PCa tissues results in an increased expression of certain oncogenes, oncomiRs, and EMT marker (vimentin) and a decrease in CD3 ITL, which may be associated with the aggressive forms of PCa.

Dermatofibrosarcoma protuberans (DFSP) of the breast is an infrequent soft tissue sarcoma that usually affects young to middle-aged women. Our case report describes a unique occurrence of DFSP of the breast in an adolescent girl, which was initially being managed as a keloid for 2 years under dermatology despite being refractory to treatment. Once the diagnosis of DFSP was confirmed through punch biopsy, our patient underwent surgical excision of the lesion under general anaesthesia. Our patient was at an increased risk of damage to the ductal system due to proximity of the lesion to the nipple-areolar complex, warranting the need for early recognition and treatment. As demonstrated by our case, DFSP of the breast can be difficult to diagnose since it resembles a range of benign and malignant pathologies of the breast.

Background/Objective: Medullary thyroid carcinoma (MTC) is an uncommon thyroid cancer (TC), rarely found in hyperfunctioning goiter. Case Report: We present a case of a woman treated for breast carcinoma (BCA) found to have a benign hyperfunctioning nodular goiter, its likely transformation to MTC, and its treatment. Family history revealed papillary thyroid cancer in her nephew. Discussion: Most TCs in hyperfunctioning nodules are differentiated carcinomas. Familial MTC or MTC in association with multiple endocrine neoplasia 2 is the expected genetic association in this case. Conclusion: The association of BCA and MTC may have been coincidental, given the high prevalence of BCA in females. It could have been the result of a common genetic precursor of both tumors and/or treatment modality such as external beam radiation therapy used to treat BCA. This case highlights the importance of considering MTC as a potential diagnosis even in cases of hyperfunctioning nodular goiter. We call for consideration of calcitonin level measurement in the workup of thyroid nodules in select cases. Close follow-up of thyroid nodules, particularly in patients with another primary malignancy, is important because of possible common genotype triggers.

Background: Chromoblastomycosis (CBM) is a chronic infection of skin and subcutaneous tissue. CBM cases have been reported in local literature from Pakistan with heterogenous demographic, diagnostic and therapeutic information. The objective of this study is to share the experience of CBM from a large tertiary care hospital laboratory in Pakistan. Method: This was a retrospective observational study. Histopathology and microbiology data of suspected CBM between 2016 and 2022 was retrieved. Patients' demographics, site of involvement, histopathological findings and positive microbiology cultures were assessed. Literature search on Google Scholar, PubMed and PakMediNet was done between 1990 and 2023 with multiple terms. Result: A total of 16 CBM cases were identified; 14 were histopathology positive and two were both histopathology and culture positive. The median age was 21 years, and 11 patients were male. The predominant site was lower extremities followed by the face. Severe acanthosis, hyperkeratosis and granuloma with sclerotic bodies were observed in all histopathology slides. Alternaria spp. and Phialophora spp. were isolated from two culture- positive cases. A total of nine cases of CBM were reported from Pakistan in PubMed non- indexed journal. Conclusion: CBM is not a commonly thought of disease when evaluating skin lesions in Pakistan. A high index of suspicion when assessing patients who may have a history of trauma, exposure to soil and suggestive lesions is reasonable. An integrated approach between clinicians, histopathologist and microbiologist is required to do early identification and therapeutic interventions.

The routine histomorphological assessment of follicular thyroid neoplasms has been subject to interobserver or intraobserver variability among histopathologists. Anti-thyroid peroxidase (anti-TPO) has emerged as a useful immunohistochemical (IHC) marker, with its expression lost in papillary thyroid carcinoma (PTC). Our study aims to determine the diagnostic accuracy of anti-TPO IHC expression in the identifying PTC and its variants, particularly the Follicular variant of papillary thyroid carcinoma (FVPTC), with H&E assessment as the gold standard. Anti-TPO IHC (DAKO-MoAb47) was performed on 110 cases, including 76 malignant tumors (classic PTC, FVPTC, follicular carcinoma (FC), and oncocytic carcinoma (OC)) and 34 benign tumors (non-invasive follicular tumor with papillary-like nuclear features (NIFTP) and follicular adenoma (FA)). The loss of expression in more than or equal to 51 % of thyrocytes was considered suggestive of a PTC profile. The sensitivity of the loss of anti-TPO expression for identifying PTC among all carcinomas was 61.7 %, specificity was 75 %, positive predictive value was 90.2 %, negative predictive value was 34.2 %, and accuracy was 64.4 %. The loss of anti-TPO IHC expression combined with routine H&E assessment, supports the identification of PTC and its variants.

Salivary gland tumors are diverse in morphology and both benign and malignant tumors may pose diagnostic challenges especially in small biopsies. Secretory carcinoma (SC) is histologically characterized by microcysts, follicles, solid growth pattern and occasional papillary structures, and absence of zymogen granules. SC is molecularly defined by the presence of novel gene fusion ETV6::NTRK3. Among the positive stains (S100 and mammaglobin), MUC4 is now another promising marker for the diagnosis of SC, that would enable the pathologists to exclude other morphologically close simulators. Aim of this study was to report clinicopathological features and assess utility of MUC4 in the diagnosis of SC. MUC4 was performed on 22 cases of SC. Glass slides were reviewed to record morphological patterns and staining of S100, mammaglobin, DOG1 and MUC4. Age ranged from 9 to 63 years with mean age of 34.41 ± 16.28 years. The male: female ratio was 72.7 %:27.3 %. The majority occurred in major salivary glands. A combination of patterns was seen; microfollicles were the most prevalent (90 %) followed by papillary-cystic and macrofollicles. MUC4 was positive in 19/21 (90 %) cases with almost equal number of 2+ and 3+ staining. MUC4 was negative in all cases of acinic cell carcinoma, polymorphous adenocarcinoma, adenoid cystic carcinoma, salivary duct carcinoma, myopepithelioma and myoeithelial carcinoma, cystadenoma and cribriform adenocarcinoma and all except 3 cases of mucoepidermoid carcinoma tested. Overall sensitivity of MUC4 was 95.4 %, specificity 90 %, p-value being <0.01, positive predictive value 87.5 % and negative predictive value 96.4 %. A characteristic cytoplasmic granular pattern was observed in 76.1 % tumors. S100 and mammaglobin were positive in all the performed cases. DOG1 was positive in 6/11 (28.5 %) tumors. In conclusion, MUC4 is a useful addition to a diagnostic immunohistochemical panel for SC, and to distinguish it from close potential mimickers such as acinic cell carcinoma, especially in practice settings where molecular testing is unavailable.

Background Basal cell carcinoma (BCC) is one of the most common types of cutaneous malignancies and the most frequently occurring form of cancer worldwide. The incidence of basal cell carcinoma is difficult to determine due to its wide geographic variations; however, it has been increasing worldwide with an annual increase of 7% in the number of reported cases. Although BCC is more prevalent in the aging population, diagnosis in younger individuals is steadily increasing. BCC has overall low mortality, however, it leads to significant economic and physical impact on patients and their families along with adding burden to the healthcare system. The primary risk factor for the development of BCC is increased cumulative sun exposure, particularly to UV radiation. The UV index of Karachi averages around 12 (extremely high) during summer months, putting the population at a significantly higher risk of developing BCC in the long term.Objectives This audit was undertaken with the following primary objectives: to use the data collected to determine possible prognostic factors for BCC, to measure the rate of recurrence and the number of new primary tumors detected, to study the completeness of follow-up by patients, and to co-relate histopathological findings with the recurrence rate of basal cell carcinoma.Methods A retrospective analysis was performed for all patients with BCC who had undergone surgical resection over a six-year time period. Patient charts were reviewed for demographic information, tumor size, onset-to -diagnosis, anatomic location, clinical subtype, histologic differentiation, method of surgical treatment, and recurrence. Data were entered and analyzed in SPSS version 23 (IBM Corp., Armonk, NY).Results The review identified cases of BCC in 99 patients. Of the 99 patients, 60.39% were men and 38.38% were women. The most frequent age group was 65-85-year-olds (42 patients, 42.85%) for BCC. Based on the aesthetic units of the face, the most common location was the nasal unit (30 cases, 30.30%) for BCC. Most of the lesions were closed primarily; however; local flaps were used in the case of surgical defects. The recurrence rate was 19.19% for BCC in this study. Our study included 1.0% of patients who were classified as Clark classification level 2 of BCC, 6.1% as Clark level 3, 23.4% as Clark level 4, and 0.16% as Clark level 5. Recurrence rates were seen to increase with increasing Clark classification level in this study.Conclusion In our study, many characteristics of BCC were compared to previously published reports and the results were seen to be generally similar. This study correlates the recurrence of BCC with Clark's classification, showing that depth of invasion is a significant factor in predicting recurrence. There is a paucity of literature regarding the depth of invasion of BCC along with its' Clarks classification and recurrence. Further studies can help explore and establish the characteristics of BCC.

The immune system plays a pivotal role in identification and clearance of tumor cells, but can also be counterproductive and enhance tumor progression. Presence of neutrophils in solid tumors, including the sixth most common cancer globally - head and neck squamous cell carcinomas (HNSCC), is associated with poor prognosis. Pro-inflammatory cytokines regulated by NF-κB promote extravasation of neutrophils into tissue; neutrophils are polarized to anti-tumor (N1) or pro-tumor (N2) phenotype through the action of various pathways, including TGF-β. The mechanism and role of neutrophil recruitment in HNSCC were explored this study. Neutrophils isolated from adult donors were co-cultured for 5 hours with conditioned media (CM) from HNSCC cells SCC-9 and Cal-27, and stained with TNF-α, ICAM-1, CCL2, CCL5 for analysis of neutrophil phenotype by flow cytometry. TGF-β blocking antibody was used to explore the role of TGF-β in polarization of neutrophils. Canonical and non-canonical TGF-β signaling pathway activation was also investigated in these neutrophils through western blots. Using HNSCC patient samples, qPCR was performed for expression of genes involved in apoptosis, epithelial-to-mesenchymal transition, metastasis, and neutrophil function. Following co-culture with 24-hour HNSCC CM, neutrophils begin to exhibit cell surface markers indicative of N2 phenotype, which is impacted by TGF-β blocking antibody. Neutrophils co-cultured with HNSCC CM exhibited altered expression of TGF-β mediators Smad2/3, p38 and Akt, which was abrogated with the addition of TGF-β blocking antibody indicating specificity of a TGF-β induced signaling. Gene expression analysis exhibited significantly higher expression of anti-apoptotic BCL2 and neutrophil function marker alpha defensin 1 in HNSCC patient samples with greater neutrophil infiltration, while caspase 3 was expressed at significantly higher levels in HNSCC patient samples with low neutrophil infiltration. HNSCC cells recruit neutrophils; evidence suggests that TGF-β pathway, which typically promotes N2 phenotype in neutrophils, is involved via canonical and non-canonical mediators including p38 and Akt. Further, HNSCC patient samples have varying levels of neutrophil infiltration and differentially express genes involved in apoptosis, EMT, metastasis and invasion, inflammation. Citation Format: Kulsoom Ghias, Hina Shakeel, Alisalman Sheikh, Syed Hani Abidi, Kiran I. Masood, Saira Fatima, Fareena Bilwani. Mechanism and role of neutrophil recruitment in head and neck squamous cell carcinoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 5942.

BACKGROUND:Brain arteriovenous malformations (AVMs) are intracranial lesions that consist of a complex tangle of abnormal blood vessels. They can occasionally become hard and calcified. This may render these lesions difficult to resect and lead to neurological complications. There are very few reported cases of calcified brain AVMs in the literature.CASE DESCRIPTION:We report the case of an 11-year-old patient who presented with headaches and seizures exacerbated in the past 3 months. Preoperative imaging confirmed a large, right parasagittal AVM, with significant internal calcifications seen on the computed tomography angiogram. We performed a successful microsurgical resection of the calcified AVM and confirmed the diagnosis on histopathological analysis.CONCLUSION:Dense internal calcifications within AVMs are a clinical rarity and can be challenging cases for microsurgical resection.

Abstract Introduction: Several studies have shown an association between prostate carcinoma (PCa) and certain viral infections, such as HPV, EBV, CMV, etc. Despite the evidence about the presence of the EBV in PCa tissues, it is unknown if the presence of EBV is associated with any distinct histopathological characteristics and/or survival advantages/disadvantages in patients with PCa. In this study, therefore, we analyzed the LMP-1 expression, and histopathological characteristics of EBV-positive and -negative PCa tissues, followed by the survival analysis in patients from the two groups.Material & Methods: LMP-1 expression was determined using immunohistochemistry in the EBV PCR-positive FFPE PCa samples. Subsequently, two key parameters for the characterization of PCa, i.e., Gleason scores and perineural invasion (PNI), along with intratumoral lymphocytes and stromal lymphocytic infiltration was studied in the EBV-positive and -negative PCa tissues. Lastly, the survival benefit analysis of EBV-positive and EBV-negative PCa patients was performed.Results: EBV LMP1 protein expression was found in 70.96% of EBV PCR-positive PCa tissues. Histopathological analysis showed significantly higher (p<0.05) mean major and total Gleason scores, and perineural invasion (80%) in EBV-positive as compared with the EBV-negative PCa samples. We also found a higher percentage of intratumoral and tumor-stromal lymphocytic infiltration in EBV-positive PC samples as compared to EBV-negative PCa samples. Overall, the survival proportion was similar in both EBV-positive and EBV-negative groups. However, a small difference in survival benefit emerged in the 38th month, where the mean percent survival was higher in EBV-positive PCa (41.6%) patients as compared to EBV-negative PCa patients (19.96%).Conclusion: In conclusion, the presence of EBV in the PCa tissues may lead to aggressive forms of cancer. Further studies with a larger sample size are required to strengthen the link between EBV, PCa prognosis, and survival.

Background Thyroid cancer is the most common endocrine malignancy across the globe and is among the fastest-growing cancers worldwide. Thyroid tumors are divided into differentiated and non-differentiated, with each having further subtypes, with papillary carcinoma being the most common one. Immunohistochemical (IHC) markers’ studies play a crucial role in the accurate diagnosis of thyroid neoplasms. To the best of our knowledge, this topic has been the least researched in Pakistan. Objectives This study was designed to determine the diagnostic utility of immunohistochemical markers in the diagnosis of thyroid cancers in correlation with histopathology as the gold standard. Methods This retrospective, single-center study was carried out on 124 patients with thyroid cancer treated at our institution. The type of cancer, patient gender, and immunohistochemical markers used in each patient were recorded, and the sensitivity and specificity of the markers used in each tumor case were calculated. Results The mean age of patients was found to be 48.5 ± 15.6 years; 56 (45.2%) of the patients were male and 68 (54.8%) were female. Out of the 124 patients, 75 (60.5%) had papillary, 19 (15.3%) had medullary, 16 (12.9%) had anaplastic, and eight (6.5%) had follicular carcinoma, while six (4.8%) had primary thyroid lymphoma. Thyroglobulin was found to be a reliable tumor marker in both papillary and follicular tumors. The cluster of differentiation56 (CD56) negativity was a useful double panel study along with thyroglobulin in the confirmation of papillary carcinomas. Tumor markers used in medullary carcinoma include calcitonin, chromogranin, and synaptophysin. Cytokeratin AE 1 and vimentin were found to be useful for anaplastic tumors, while Ki 67 was a reliable marker for primary thyroid lymphoma.

The pathophysiology of prostate cancer involves both genetic and acquired factors, including pathogens, such as viruses. A limited number of studies have shown the presence of Epstein-Barr virus (EBV) in prostate cancer tissues. However, there is a dearth of data exploring EBV latency profile in prostate cancer, and the relationship of EBV with histopathological features of prostate cancer. In this study, prostate cancer and benign prostatic hyperplasia (BPH) samples were screened for the presence of EBV, followed by the characterization of the EBV latency profile and analysis of histopathological parameters in EBV-positive and EBV-negative groups. A conventional PCR strategy was employed using virus-specific primers to screen EBV in 99 formalin-fixed paraffin-embedded (FFPE) prostate cancer and 33 BPH samples received for histopathological analysis during the years 2019–2020. Subsequently, cDNA samples were used in a qPCR array to analyze the expression of EBV latency-associated genes to map the latency profile EBV maintains in the samples. Finally, statistical analyses were performed to determine the correlation between EBV and several histopathological features of the samples. EBV was detected in 39% of prostate cancer and 24% of BPH samples. The histopathological analysis of prostate cancer samples identified all samples as prostatic adenocarcinoma of acinar type, while statistical analyses revealed EBV-positive samples to exhibit significantly higher (p < 0.05) Gleason major and total Gleason scores as compared to EBV-negative samples. In the EBV-positive samples, variable expression patterns of latency-associated genes were observed, where most of the samples exhibited EBV latency II/III-like profiles in prostate cancer, while latency-II-like profiles in BPH samples. This study suggests a high prevalence of EBV in prostate samples, where EBV exhibited latency II/III-like profiles. Furthermore, EBV-positive samples exhibited a higher Gleason score suggesting a possible link between EBV and the onset/progression of prostate cancers. However, future functional studies are required to understand the role of the EBV gene expression profile in the onset/progression of prostate cancer.

Background Mycetoma is an important neglected tropical disease associated with debilitation, disfigurement and death if not diagnosed and treated adequately. In Pakistan, mycetoma cases have frequently been diagnosed in histopathology and microbiology laboratories. However, there is scarcity of published data from this country. Therefore, the objectives of this study were to evaluate the frequency and type of mycetoma reported in skin and soft tissue biopsies from a single center over 10 years and review of published literature from Pakistan. Method This descriptive observational retrospective study was conducted at the Aga Khan University Hospital laboratory, Karachi, Pakistan. Laboratory data from 2009–2018 of skin and soft tissue biopsies with positive findings of mycetoma were retrieved from hospital information system. The variables for statistical analysis were age and gender of patient, anatomical site of lesion, residence of patient (geographical location) in the country, etiologic agents of mycetoma and significant gross and microscopic histopathological findings. The data was entered, and descriptive epidemiologic assessment was carried out using MS excel 2013. Geographical information system was used for mapping the location. Literature review of mycetoma cases reported from Pakistan was done on PubMed, Google search and PakMediNet from 1980 till April 2019. Result During ten years of study period, 89 skin and soft tissue biopsies were reported as mycetoma, majority were eumycetoma [n = 66/89 (74%)] followed by actinomycetoma [n = 23/89 (26%)]. Involvement of lower limb was predominantly observed [n = 74/89 (83%)] in which foot had significant contribution [n = 65/74 (88%)]. Only 18 specimens were submitted for microbiological assessment and six grew agents of mycetoma, with Madurella mycetomatis reported in only three. Well-formed granuloma formation was observed in only 26%[n = 23/89] of cases. Specific geographical location was not identified, and cases were reported from across the country. From Pakistan, only two original papers and 7 case reports were available in published literature. Conclusion This single center study reports a handful of cases of mycetoma from Pakistan. We conclude that the index of suspicion should remain high among treating surgeons and physicians and clinical laboratories should improve their diagnostic capacity and skills. This will have a great impact on disease outcome and patient’s life.

BACKGROUND:Dermatofibrosarcoma protuberans (DFSP) of the breast is a rare entity. It is a slow-growing soft tissue tumor of low to intermediate grade. The risk of metastasis is low, but its likelihood of local recurrence is significant. OBJECTIVE:Our study aims to present the clinical and histological features of DFSP of breast and follow-up. MATERIAL AND METHODS:Patients with histologically proven DFSP between 01 January 2010 and 31 October 2023 were identified from a prospectively maintained pathology database. Two senior pathologists reviewed the clinical data and histological slides, and a follow-up was obtained. RESULTS:Twenty-six cases of DFSP breast were diagnosed between 01 January 2010 and 31 October 2023. Out of 26, 10 (38.5%) were male and 16 (61.5%) were female. The mean age of presentation was 37.2 years in females and 40.7 years in males. The mean tumor size in females was 4.7 cm and in males was 5.4 cm. Histologically, the 15 DFSP cases (58%) showed spindle cells arranged in a storiform pattern with honeycomb-type fat infiltration. Fibrosarcomatous transformation was noted in 11 (42%) cases comprising a fascicular pattern. The median follow-up period was 6.1 years. Three (12%) patients experienced recurrence. No recurrence was observed in 23 (88%) patients with complete surgical resection. CONCLUSIONS:We present the largest series of breast DFSP. The recurrence rate of 12% aligns with the DFSP of other common sites. Fibrosarcomatous transformation in breast DFSP (42%) is higher as compared to DFSP in other common locations and its long-term clinical behavior cannot be reliably predicted due to lack of long-term follow-up.

Abstract Background IgG4 related disease (IgG4-RD) is a spectrum of immune mediated disorder involving various organs of the body. In this study the clinical spectrum of possible IgG4-RD was explored. Methods Subjects tested for serum IgG4 and all biopsies of subjects with suspected IgG4-RD received at the clinical laboratory of a tertiary care hospital from April 2015 to December 2019 were included. Medical charts of subjects registered were reviewed and telephonic interviews were conducted. Subjects were divided into two groups: group I had biochemical evidence of IgG4-RD while group II had histopathological evidence of IgG4-RD. “Comprehensive diagnostic criteria for IgG4-RD, 2011” was used for labeling patients as possible, probable and definitive IgG4-RD. Results A total of 177 study subjects were recruited in the current study. Group I included 10 children and 105 adults whereas group II had 5 children and 57 adults. Out of the total 177 subjects definitive, probable and possible IgG4-RD were seen in (n = 2, 1.1%), (n = 61, 34.4%) and (n = 114, 64.4) subjects respectively. The commonest organs involved in all the study subjects were pancreas (57.6%), submandibular gland (12.4%) and liver (6.2%). Conclusion The clinical feature of IgG4-RD include single or multiple organ involvement with pancreas being the most frequently affected organ in the current population. Amalgamation of clinical, biochemical and histopathological findings are essential for the IgG4-RD, although none is pathognomonic by itself.