Pakistan Journal of Pathology Pakistan Association of Pathologists en-US Pakistan Journal of Pathology 1024-6193 <p>The Pakistan Journal Pathology follows "CC BY NC" creative commons licensing. <a href=""><strong></strong></a>.</p> SPECTRUM OF PATHOLOGIES IN PATIENTS WITH ENLARGED PROSTATE <p><strong>Objective: </strong>To ascertain the frequency of various pathological disorders related to prostate so that benign lesions of prostate can be distinguished from adenocarcinoma prostate to avoid wrong diagnosis.</p> <p><strong>Material and Methods:</strong> This study (descriptive cross sectional) was carried out in the Histopathology Department, Foundation University Medical College, DHA Islamabad from 1<sup>st</sup> August 2019 to 31<sup>st </sup>July 2020. A total 200 biopsy specimens from patients between 50 to 92 years of age were fixed in 10 % formalin. The samples were grossed and routinely processed under standard conditions for paraffin embedding. Haematoxylin and Eosin stains were used to stain the slides while special stains were used as per requirement. Microscopic evaluation was done by consultant histopathologists after correlating histopathological findings with clinical data.</p> <p><strong>Results: </strong>Total 200 individuals were incorporated in this study. Age of patients ranged from 50 to 92 years. The mean age of study subjects was found to be 67 +9.64 years. Majority (37%) of individuals in the study belonged to age group of 61-70 years. Out of total 200 patients, 179 patients (89.5%) had diagnosis of Benign Prostatic Hyperplasia (BPH). Twenty patients (10%) were diagnosed with Adenocarcinoma prostate. One out of 200 patients (0.5%) was diagnosed as a case of Prostatitis with no other finding.</p> <p><strong>Conclusion: </strong>Benign prostatic hyperplasia is most frequent pathology of patients with prostate enlargement. Prostate cancer needs to be distinguished from spectrum of benign lesions to avoid wrong diagnosis.</p> <p><strong>Key Words: </strong>Adenocarcinoma prostate, Benign prostatic hyperplasia (BPH), Prostatitis.</p> Uzma Meral Saqib Zaheer Faiza Kazi Ashfaq Hussain Saeed Akhtar Khan Khattak Rehana Ramzan Copyright (c) 2022 Pakistan Journal of Pathology 2022-09-30 2022-09-30 33 3 78 82 10.55629/pakjpathol.v32i3.714 UNEXPECTED GALL BLADDER CARCINOMA – A SURPRISING HISTOPATHOLOGICAL DIAGNOSIS <p><strong>Objective: </strong>To determine the frequency of gall bladder carcinoma incidentally diagnosed in patients undergoing routine laparoscopic cholecystectomy.</p> <p><strong>Material and Methods: </strong>Histopathology section of Pathology Department, Azra Naheed Medical College Raiwind Road, Lahore from January 2018 to July 2021. A total of 214 simple or laparoscopic cholecystectomy specimens were included. Detailed gross &amp; microscopic examination was done. All diagnoses including benign histopathological findings and incidental gall bladder carcinoma were analyzed. The important findings like resection margin involvement, maximum wall thickness of gallbladder, type of adenocarcinoma and TNM staging were noted.</p> <p><strong>Results: </strong>Out of 214 simple or laparoscopic cholecystectomy specimens, there were three (1.4%) cases of incidental gallbladder carcinoma exclusively found in females. Mean age recorded was 45.7 years. Maximum thickness of gall bladder wall was 4.7 cm and maximum stage was pT2.</p> <p><strong>Conclusion: </strong>According to our study there were three cases of incidental gallbladder carcinomas out of 214 cholecystectomy specimens. Considering this, histopathological study of gall bladder is essential not to miss any carcinoma, keeping in view the grim prognosis.</p> <p><strong>Key Words: </strong>Gall bladder, Incidental carcinoma, Cholecystectomy, Cholelithiasis.</p> Sahar Iqbal Fariha Sahrish Samra Sameen Firdous Iqbal Sarosh Aitzaz Sara Masood Cheema Copyright (c) 2022 Pakistan Journal of Pathology 2022-09-30 2022-09-30 33 3 83 87 10.55629/pakjpathol.v32i3.696 HAEMATOLOGICAL PARAMETERS AND THEIR SIGNIFICANCE IN PREDICTING SEVERITY IN TERMS OF TUMOR GRADE IN PATIENTS WITH ORAL SQUAMOUS CELL CARCINOMA <p><strong>Objective: </strong>The objective of our study was to determine the most reliable haematological parameters for assessing the tumor severity with respect to histological grade in patients with Oral Squamous Cell Carcinoma.</p> <p><strong>Material and Methods: </strong>This retrospective cross-sectional study was conducted at Pathology Department, Pakistan Institute of Medical Sciences, Islamabad from January to December 2019. Fifty-eight patients of Oral Squamous Cell Carcinoma were selected by consecutive non-probability sampling. Preoperative hemogram values including total leukocyte count, red cell count, hematocrit, hemoglobin, red cell indices, platelet count, neutrophil to lymphocyte ratio and platelet to lymphocyte ratio were recorded and was studied how these parameters differed among the histological grades of tumor. Stratification of patients was done based on gender and histological grade of tumor. Independent-sample t-test for gender and ANOVA-test for histological grade was applied to assess differences in haematological parameter measurements between the groups. P&lt; 0.05 was considered significant.</p> <p><strong>Results: </strong>Anemia was observed as a common finding in our patients seen in 24% cases. Mean platelet count was within normal range. We observed that the haematological parameters i.e. total leukocyte count, absolute neutrophil count, absolute lymphocyte count, neutrophil to lymphocyte ratio and platelet to lymphocyte ratio varied significantly with the advancing grades of the tumor from well-differentiated to poorly-differentiated keratinizing oral squamous cell carcinoma.</p> <p><strong>Conclusion: </strong>The pre-surgical haematological profile holds many prognostic indicators, useful in predicting tumor severity in terms of histological differentiation of tumor.</p> <p><strong>Key Words</strong>: Oral squamous cell carcinoma, Prognosis, Histology.</p> Sundas Ali Manal Rauf Syeda Kiran Riaz Ahmareen Khalid Sheikh Ahson Ahmad Javera Tariq Copyright (c) 2022 Pakistan Journal of Pathology 2022-09-30 2022-09-30 33 3 88 93 10.55629/pakjpathol.v32i3.710 FREQUENCY OF WBC FLAGS GENERATED BY AUTOMATED HEMATOLOGY ANALYZER IN DIAGNOSED CASES OF DENGUE INFECTION <p><strong>Objective: </strong>To determine the frequency of WBC flags generated by automated hematology analyzers in cases of dengue diagnosed by serological tests. We also aim to compare the platelet count in the presence of different WBC flags.</p> <p><strong>Material and Methods:</strong>It was a cross sectional study, conducted at Chughtai Institute of Pathology. Total 1007 blood samples of serologically confirmed dengue patients in EDTA vial were obtained over a period of 03 months from September, 2021 to November, 2021. These samples were run through Mindray BC-6800 which displayed flags for white blood cells. WBC flags displayed were analyzed in correlation with findings of CBC and peripheral smear through careful statistical analysis of the observed parameters.</p> <p><strong>Results: </strong>An abnormal WBC flag was displayed in all patients. The most common flag among these was atypical lymphocytes in 671 (66.6%) samples, followed by atypical lymphocytes + basophilia in 136 (13.5%), Atypical lymphocytes + neutropenia in 66 (6.6%), Atypical lymphocytes + lymphocytosis in 47 (4.7%), Atypical lymphocytes + lymphopenia in 31 (3.1%), Lymphopenia in 29 (2.9%), Atypical lymphocytes + monocytosis in 15 (1.5%), Lymphopenia + neutropenia in 9 (0.9%) and Neutropenia in 3 (0.3%) samples.</p> <p><strong>Conclusion: </strong>WBC flags generated by automated hematology analyzer in a suspected dengue patient, especially during dengue epidemics can be used as a screening tool and can help in avoiding unnecessary serological testing.</p> <p><strong>Key Words</strong>: Dengue, NS1 antigen, WBC flags, Automated hematology analyzer.</p> Ayesha Younas Mavra Fatima Ayisha Imran Nauman Aslam Malik Copyright (c) 2022 Pakistan Journal of Pathology 2022-09-30 2022-09-30 33 3 94 98 10.55629/pakjpathol.v33i3.717 EVALUATING THE DIAGNOSTIC PERFORMANCE OF TOTAL BILE ACIDS AND TRANSAMINASES IN INTRAHEPATIC CHOLESTASIS OF PREGNANCY <p><strong>Objective: </strong>The objective of this study is to evaluate diagnostic performance of total bile acids and transaminases in intrahepatic cholestasis of pregnancy (ICP).</p> <p><strong>Material and Methods: </strong>This observational cross-sectional study was conducted at Gynecology &amp; Obstetrics ward, Bahawal Victoria Hospital and Pathology Laboratory of Quaid-e-Azam Medical College, Bahawalpur. Thirty pregnant females with intrahepatic cholestasis of pregnancy were included in the study. Thirty age, parity and gestational age matched controls were selected. Total bile acids and alanine transaminases (ALT) were measured in each study subject. </p> <p><strong>Results: </strong>The sensitivity and specificity for both total bile acids and ALT were calculated. Our study results showed a comparable sensitivity and specificity for both tests in patients with ICP. The rise in bile acids and ALT was statistically significant in ICP. The level of transaminases increased in proportion to total bile acids. Also, our study found an increased risk of preterm delivery, low birth weight and delivery by cesarean section in patients with ICP.</p> <p><strong>Conclusion: </strong>It is concluded that ALT can be used alternatively to total bile acids for the diagnosis of intrahepatic cholestasis of jaundice. Total bile acids are expensive and only a few laboratories in Pakistan are offering this service, making its access limited to general population. Whereas ALT is a cost effective and common test, its results are readily available with an additional benefit that no fasting sample is required. Hence, it is a more appropriate diagnostic test for ICP in our resource constraint setup. </p> <p><strong>Key Words: </strong>Bile acids, Liver enzymes, Cholestasis, Pregnancy, Aminotransaminase.</p> Saba Nadeem Sara Reza Hafiz Muhammad Salman Yousaf Nimrah Sattar Copyright (c) 2022 Pakistan Journal of Pathology 2022-09-30 2022-09-30 33 3 99 103 10.55629/pakjpathol.v32i3.727 ESTABLISHING A NATIONWIDE NEWBORN SCREENING PROGRAM FOR CONGENITAL HYPOTHYROIDISM: A SYSTEMATIC REVIEW <p><strong>Objective: </strong>The congenital hypothyroidism (CH) is a treatable hormonal disease that if left untreated in neonates, results in irreversible mental retardation. Newborn screening for CH and thyroid hormone replacement therapy started within two weeks of age can control cognitive development. This study aimed to estimate CH incidence in Pakistani population.</p> <p><strong>Material and Methods</strong>: Electronic databases and the bibliography of articles were searched, and a systematic review of publications reporting the incidence of CH in Pakistan was carried out. The studies fulfilling the following criteria were analyzed: retrospective and prospective studies, adult population; pediatric population; Thyroid Stimulating Hormone (TSH); Dried Blood Spot (DBS); serum testing quantitative; English language. </p> <p><strong>Results</strong>: We identified nine studies that narrated the incidence of CH in our country. According to this systematic review, the maximum estimated incidence of CH was 1:1600 reported for Pakistani population. Compared to the incidence of CH from other parts of the world (1:2000-1:4000), incidence from Pakistan is high.</p> <p><strong>Conclusion</strong>: According to these findings, this high incidence highlights the need for a National Newborn Screening (NBS) program for CH. We have proposed a strategy for establishing a nationwide NBS program for CH.</p> <p><strong>Key Words: </strong>Newborn screening, Congenital hypothyroidism, Pakistan, Thyroid-stimulating hormone, Mental retardation.</p> Hafsa Majid Lena Jafri Nazish Khan Aysha Habib Khan Copyright (c) 2022 Pakistan Journal of Pathology 2022-09-30 2022-09-30 33 3 104 108 10.55629/pakjpathol.v33i3.715