Abstracts of Presentation in International Scientific Conference of BAP in Dhaka

26-27 April 2024

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Dendritic but Different: The Many Faces of Accessory Cell Proliferations

 

Dr Anita Maria Borges

 

• Lab Director of the Centre for Oncopathology, Mumbai
• Head of Histopathology, SL Raheja Hospital, Mumbai.
• Member of the National Accreditation Board for Testing & Calibrating laboratories, India.
• Chairperson of the Advisory Committee for Medical Labs, NABL.
• Surgical Pathologist with over forty years of working in cancer pathology.
• Passionate teacher who believes in opening minds to possibilities beyond the obvious.

 

Email: anitaborges@gmail.com

 

Abstract

Accessory cells those that assist in an adaptive immune response. Many are antigen presenting cells. Some may play a role in the innate immune response as well.They are not lymphocytes or NK cells.Histiocytes and dendritic cells are usually considered to be part of this group. Since they are involved in the immune response, it can be difficult to separate reactive proliferations from neoplastic ones.  This is what makes the diagnosis challenging.

 

During this talk I will introduce the classification and ontogeny of accessory cells and contrast two cases of dendritic cell neoplasms that belongs two completely different lineages.

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Approach to Cutaneous Appendage Tumour with Presentation of  Few Interesting Cases

 

Dr. Bidyut Krishna Goswami

Professor and Head, Department of Pathology

Director, Central Laboratory, In-Charge, HHCU

North Bengal Medical College & Hospital

Sushrutanagar, Darjeeling

West Bengal, 734012

India

 

Abstract

Cutaneous  adnexal tumours,  a large group of benign and malignant neoplasms thatshow morphologic differentiation towards one of the four primary adnexal structures present in normal skin: hair follicles, sebaceous glands, apocrine glands, and eccrine glands. This is thought, that through some poorly understood mechanisms, the activation of molecular pathways responsible fortumours originate from multipotential undifferentiated cells present within the epidermis or its appendageal structures may aberrantly express one or more lines of appendageal differentiation to varying degrees. The degree to which the eccrine, apocrine, sebaceous, and follicular differentiation pathways are activated and recapitulated gives a tumour its histologic features

 

Skin adnexal tumours, occurring most superficially as well as noticeable easily by patients, surprisingly are often a source of confusion amongst even experienced pathologists, might be,  in part,  related to the wide variety of tumours with complicated nomenclature, many well-described entities have overlapping features, tumours are often only partially sampled, and many cases do not fit neatly into well-established classification schemes.They may occur sporadically or may be markers of rare genetic syndromes, including Birt-Hogg-Dubé syndrome, Brooke-Spiegler syndrome, Cowden syndrome, and Muir-Torre syndrome.

This presentation is prepared to find out a  simple algorithmic approach for adnexal tumours for the general surgical pathologists and also to shed light on some of the diagnostic dilemmas commonly encountered in our  daily practice. At the end few interesting cases have been presented.

Conclusions: Awareness and review  on  the clinical and histopathologic features of primary cutaneous adnexal tumours, and knowledge of the diagnostic dilemmas they create, will be helpful to the general surgical pathologist in diagnosing these often challenging lesions

 

Data Sources: Pathology reference texts and primary literatures regarding adnexal tumors and cases as observed in my personal practice.

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Trephine Biopsy of Hematological Cases

 

Dr. Bishnu Pada Dey

MBBS (DMC), MD (Pathology, BSMMU)

Assistant Professor

Department of Pathology

Bangabandhu Sheikh Mujib Medical University

Shahbag, Dhaka-1000, Bangladesh

 

Publication 34.

 

 

Abstract

Trephine biopsy histopathology is an important tool for the diagnosis of hematological pathology. Now a days this is widely practiced in Bangladesh. We faced some commondifficulties during trephine biopsy histopathology in our institute. I want to highlight and shear the common approach to trephine biopsy specimens that I followed to solve the diagnostic dilemma.

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Clear Cell Sarcoma of Kidney – A Rare Case Report

 

Dr. Halima Khatun Doly

Assistant Professor, Department of Pathology, KhwajaYunus Ali Medical College, Sirajgonj.

 

 

Abstract     

A 7-years-old girl was admitted in the PaediatricHaematology and Oncology Department of KhwajaYunus Ali Medical College with the complaints of abdominal distention and right sided abdominal mass for 3 weeks; there was no history of hematuria, headache, cough breathing difficulties or bone pain.Her physical examinations revealed an abdominal lump at right hypochondriac and lumber region; she was normotensive considering age. The CT scan revealed a large right sided renal mass suggestive of Wilmstumour which was about 14.0X13.0cm invading the pelvis and lower polar calyx without intra-abdominal lymphadenopathy and thrombus. Scanning of chest was normal and other initial investigations were unremarkable. With those evident she was initially treated by neo adjuvant chemotherapy according to SIOP- umbrella protocol for 4 weeks, then she was undergone open radical nephrectomy followed by histopathological examination was done.Macroscopically, the kidney measured about 11.0X9.5X8.5 cm with 8.0 cm long ureter and attached perinephric fat and fascia and small segment of renal vessels. Adrenal gland was grossly absent. On cut section, it showed a 10.5 cm large, sharply demarcated, hard, homogenous tan-graytumour that was almost occupying the entire kidney. Grossly the tumour confined to the kidney and invaded in to the renal pelvis. Ureter and renal vessels were unremarkable. No lymphnode could be identified from perinephric fat.Microscopically, the tumour was composed of anaplastic small plump to spindle cells arranged in diffuse, nests and cords separated by network of delicate arborizing fibrovascular septa. These cells had round,normochromatic nucleus with inconspicuous nucleoli and light staining indistinct vacuolated cytoplasm. Areas of necrosis, fibrosis, myxoid changes and hyalinization were also noted. The tumour had invaded into the renal pelvis and sinuses. The renal capsule, perinephric fat, Gerotafascial margin, renal vein and ureteral resection margin were free of tumour.The histological findings firmly established the diagnosis of renal clear cell sarcoma with pathological stage: ypT3aNxMx. On the basis of histopathological report patient received adjuvant chemotherapy containing doxorubicin and had been started with planning of radiotherapy.On clinical follow up at 3 weeks after post nephrectomy and 1^st cycle of adjuvant chemotherapy, patient was found apparently healthy.

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Primary Rectal  Mucinous A

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denocarcinoma  Metastasis to the Breast in an  18-year old female : A Case Report

 

Arjuman F,¹ Sharmin L,² Sharmin R,³ Sultana T,⁴ Chowdhury Y M ,⁵ Parvez M ⁶

 

¹Dr.Farida Arjuman, Associate  Professor , Dept. of Histopathology , National Institute of

Cancer Research & Hospital, Mohakhali, Dhaka, Bangladesh

²Dr. LyzuSharmin, Assistant Professor , Dept. of Histopathology  ,National Institute of

Cancer Research & Hospital, Mohakhali, Dhaka, Bangladesh

³Dr.RumanaSharmin, Assistant  Professor , Dept .of Histopathology , National Institute of

Cancer Research & Hospital, Mohakhali, Dhaka, Bangladesh

⁴Dr. Tahmina  Sultana , Lecturer  , Dept. of Histopathology , National Institute of Cancer

Research & Hospital, Mohakhali, Dhaka, Bangladesh

⁵Dr. Mohammad Yasin Chowdhury, Consultant, Surgery, Square Hospital Ltd. Dhaka

⁶Dr.Mashud Parvez, Professor , Histopathology ,Dhaka Shishu Hospital , Dhaka

 

Dr. Farida Arjuman

Dr. Farida Arjuman graduated from Chittagong Medical College, Chittagong. She joined in Government service as BCS (Health Cadre) Officer in 2005.

She achieved MCPS (Clinical Pathology) in 2008 & FCPS ( Histopathology)  in 2011.

Now she is working as Associate Professor & Head of Histopathology at National Institute of Cancer Research and Hospital ( NICRH) in Dhaka.

She has eight (8) international and nine (9) national publications.

She got training from CDC, Atlanta, USA, TATA Memorial Hospital, Mumbai and ACTREC,  Mumbai, India.

She is a regular examiner of FCPS exam in BCPS.

She is a regular member of Bangladesh College of Physicians & Surgeons (BCPS), Bangladesh Academy of Pathology ( BAP), Bangladesh Medical Association (BMA), Rotary club of Dhaka, Shanti Cancer Foundation and Sandhani.

She has presented papers in various national and international conferences and participated in poster presentation  at home and abroad.

She has keen interest in IHC and Molecular genetics and breast, gynaecology,  soft tissue tumors and childhood tumors.

 

Abstract

Primary breast cancer is themost common  malignancy  in  females . Metastasis to the breast from rectal carcinoma is extremely rare   and accounts for 0.43% ofall breast  malignancies . Breast metastasis can mimic a primary breast cancer and may present confusing diagnostic problems. The most common tumor that metastasize to the breast is a contralateral breast carcinoma followed by malignant melanoma, lymphoma, sarcoma , lung , ovary, kidney , stomach and carcinoid tumors  .

 

Here, we report a case of a 18-year – old female presented with right breast lump in outpatient department of a private  hospital. Lumpectomy was done and it was reported as mucinous carcinoma of  right  breast . She again developed right breast lump five months after the first operation . Core biopsy was done and reported as mucinous carcinoma of right breast with recurrence. At the same time she noticed per rectal  bleeding  and alteration of bowel habit . Colonoscopy reveals rectal growth and rectal biopsy  shows  mucinous adenocarcinoma.

 

The immunohistochemistry findings from  right  breast  lump  and rectal growth shows CK 20 positive , CK 7 negative , GATA-3 negative and CDX2 positive. Histomorphological evaluation and immunohistochemistry are in support of rectal adenocarcinoma (primary) and the breast reveal metastatic adenocarcinoma of colorectal  origin .

 

Conclusion

Histopathology with immunohistochemistry is very important tool in the diagnosis of cases of this nature but the clinical correlation should be taken into consideration at multidisciplinary team meetings to decide the final management of the patient.

 

 

Keywords: Breastcancer ; rectal cancer; adenocarcinoma : metastasis;immunohistochemistry

 

Corresponding  Author

Dr. Farida Arjuman, Associate  Professor& Head, Dept. of Histopathology

National Institute of Cancer Research & Hospital (NICRH), Mohakhali, Dhaka, Cell: 01715520165

email-drarju35cmc@gmail.com

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Basics of Neuropathology

 

Galam Asheaque Khan, MD

Email: Gak2@georgetown.edu

 

Galam Asheaque Khan is an academic neuropathologist and physician-scientist with diverse interests and collaborations in team science studying neuroinflammatory and neurological conditions. He investigates the pathogenesis and pathophysiology of several neurological diseases with the goal of discovering new mechanisms and targets for drug therapy. His basic research training in neuroscience and oncology combined with my medical training in neuropathology has allowed him to investigate such diseases/conditions as Multiple Sclerosis, ALS, and Alzheimer disease, etc. A major goal in his research is to understand how to prevent and find specific therapies of neuroinflammatory disease. He is Assistant Director of the Georgetown Brain Bank at Medstar Georgetown University Hospital and University, Washington DC, Consultant Pathologist of the Histopathology Shared Resource at Georgetown University Medical Center, Washington DC and member of tissue resource repository committee of PANDAS Brain Bank/ Alex Manfull Foundation, USA.

 

Education

Medical Education: Sher-E-Bangla Medical College, Barisal, Bangladesh,

Internship: Sher-E-Bangla Medical College Hospital, Medicine and Surgery, Barisal, BangladeshResidency: Westchester Medical Center/ New York Medical College, Pathology, Valhalla, New York, and Med star Georgetown University Hospital, Pathology, Washington, DC, USA, Clinical Fellowship: Neuropathology, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA

Research Fellowship, Georgetown University Medical Center, Department of Neurology, USA Georgetown University Medical Center, Washington, DC,

 

Appointment

1. Assistant Professor: Department of Neurology, School of Medicine Georgetown University.
2. Assistant Director of Georgetown Brain Bank Medstar/ Georgetown University Hospital. Washington DC.USA
3. Consultant Pathologist: Georgetown University Histology Share Resource, Lombardi Cancer Center, Washington, DC
4. Adjunct Physician/ Educator: Howard University Hospital, Department of Pathology, Washington, DC, USA

 

Medical License:   District of Columbia,Washington, DC and Commonwealth of Virginia, USA – Medicine and Surgery,

 

Recent publication: 3

Books Chapter: Neuropathology of Amyotrophic Lateral Sclerosis. Neurobiology of Disease. 2nd edition, 2015.

 

Professional Society Membership

1. American Association of Neuropathology
2. College of American Pathologist
3. Present, American Medical Association
4. American Association of Cancer Research

5.Member: Biorepository committee: Alex Manfull Foundation/ PANDAS

6.Member: Diversity and Inclusion advisory committee, Stafford County School Board, Virginia

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Breast Pathology-Potpourri of Rare Cases

 

Dr Gunvanti Rathod,

Dr. Gunvanti Rathod

MBBS, MD (Pathology), FAIMER, ACME

Additional Professor, Pathology & Lab Medicine Department, AIIMS, Bibinagar, Telangana, India

Email: neempath@gmail.com

 

 

Dr. Gunvanti Rathod is an Additional Professor of the Pathology and Laboratory Medicine Department at All India Institute of Medical Sciences (AIIMS), Bibinagar, Telangana, India. She has an administrative experience as Associate Dean (Academics) for more than 3 years. She has around 14 years of teaching experience and serving as post graduate teacher.

 

With expertise in Pathology, she has published more than 100 research articles in peer-reviewed, indexed journals and has citations more than 1050 with h index of 18 and i10 index of 32. She participated as a delegate, speaker, Judge and chaired a session in various National and International events. She is life member of various reputed organizations like Indian Medical Association, World Association of Medical Editors, Indian Association of Pathology and Microbiology, Indian Association of Cytology, Molecular Pathology Association of India, Association of Cytologists and Histopathologists, etc. She delivered more than 20 lectures in various National and International events and for the National Board of Examination. She is serving as a reviewer board member for various scientific journals.

 

Abstract

The incidence of breast cancer is rapidly increasing at present and it will strike 1 in 9 women over a lifetime. Nowadays younger patients are being diagnosed with breast cancer.  The  importance of early diagnosis cannot  be  underscored as  management and survival is markedly improved  with  early  stage of  breast cancer. The most common malignant breast lesion in our day to day practice is infiltrating duct carcinoma, not otherwise specified (IDC-NOS) followed by invasive lobular carcinoma. Apart from these, there are more than dozen variants of breast cancer and few rare lesion in benign and intermediate category which are less common but it is important to know their main characteristics to make the best treatment choice and better prognosis. It is need of hour to discuss important neoplastic and non neoplastic breast lesions that are less known and less appreciated. The diagnosis of breast lesions are done by various laboratory diagnostic procedures viz. FNAC ( Fine  Needle Aspiration  Cytology), Core needle biopsy examination and Histopathological examination of whole specimen. FNAC can be performed on any clinically palpable lumps or roentgenographically  detected  non- palpable  lesions of the  breast. The major limitations of this method is that definite  diagnosis of  some  lesions  can be difficult  to make on the basis of  cytology. Core  biopsy  is   useful   in  the  evaluation of lesions  likely to be  low histopathological   grade  and  in   those   presenting  as  architectural distortions, for which  FNA cytology may fail  to  prove  a diagnosis. Core biopsy   is  definitely  a  robust  and  reliable  diagnostic  modality,   but carries  with  it  disadvantages  in terms of a  longer  turn- around  due  to  the  tissue   processing  time, patient  discomfort  during the  procedure and higher complication rate. Histopathological examination of whole specimen of breast is the gold standard modality for final diagnosis of any breast lesion. We are going to discuss role of various diagnostic modalities in rare neoplastic and non neoplastic lesions of breast.

 

Keywords: Breast cancer, early diagnosis, FNAC, Histopathology

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Molecular Study of Non-Small Cell Carcinoma of Lung in a Tertiary Level Laboratory in Bangladesh

Karim MI,¹ Yeasmin S²

 

Col (Dr) Md Iqbal Karim

Col Dr Md Iqbal Karim graduated from Sir Salimullah Medical College, Dhaka. He joined in Bangladesh Army in 1998. He has done MCPS (Clinical Pathology ) in 2003, DCP in 2004 and FCPS (Histopathology) in Jan 2009. He served as Pathologist in different CMH of Bangladesh. He was Associate Prof of Pathology in Armed Forces Medical College, Dhaka and Senior Consultant (Histopathology) in Armed Forces Hospital, Kuwait. Now he is working as Prof of Pathology, at Armed Forces Institute of Pathology, Dhaka. He obtained international fellowship from American College of Pathology. He is a regular examiner of FCPS exam in BCPS. He has a keen interest in IHC, IF, Molecular and genetics and Electron microscopy.

 

Abstract

Background: Lung cancer is one of the leading cancer related deaths both in male and female all over the world as well as in Bangladesh. Non small cancer is the majority of lung cancer that leads to very rapid fatality without appropriate treatment. Recent advances of molecular and genetic study like Epidermal growth factor receptor (EGFR) mutation, ALK rearrangement, ROS1 mutation and PDL1 study by RT-PCR and immunohistochemistry (IHC) brings the significant changes in the treatment protocol and increases the survival of patients with improving the quality of life.

Objectives: Our goal is to investigate the prevalence of EGFR mutation, ALK, ROS1 and PDL1 study in non-small cell carcinoma of lung in Bangladesh and their treatment outcomes.

Methods: Study carried out in Armed Forces Institute of Pathology (AFIP), Dhaka from Jan 2022 to Dec 2023 with all patients diagnosed in non-small cell carcinoma of lung (Both Adenocarcinoma and Squamous cell carcinoma) . All molecular study of EGFR were done by RT PCR after DNA extraction and ALK1, ROS and PDL1 were done by IHC in Ventana machines and results were statistically analyzed in  SPSS version 20. Follow up the patient after targeted therapy combined with or without chemotherapy and reviewed the cases.

Results: In this study total 220 cases non-small cell carcinoma were included. The mean age was 63.5 yrs. (41-80 years) and male (n=-160) – female (n=60) ratio was 2.6:1. Histopathological findings where Adenocarcinoma were predominant 81.8%(n=180), followed by Squamous cell carcinoma 14.54%(n=32), Adeno-squamous cell carcinoma 2.27%(n=05) and large cell carcinoma 1.36%(n=03). Molecular study revealed EGFR mutation were 20% (n=44), ALK 2.7%(n=06), ROS1 1.8%(n=04) and PDL1 3.6%(n=08).  Regarding EGFR mutation (n=44), most common mutation was Exon 19 deletion 50%(n=22/44), 18.18%(n=08/44) in Exon 18, 27.28% (n=12) in Exon 20 among them 18.2% and 9.17% in T790M and S7681 mutation respectively. L858R mutation was 4.55% (n=2/44) in Exon 21. Most of the mutation found in Adenocarcinoma of lung and it was 98%.  By observing therapeutic response, stage II and stage III cases were well responded than stage IV. Targeted therapy more effective than conventional chemotherapy.

Conclusion: As Bangladesh is developing country, all patients are not economically solvent to do the all-molecular studies, however basing on available resources, those capable to performed the test, they are well responded in targeted therapy in Exon 18 and Exon 19 deletion than Exon 20 and Exon 21 deletion. Immunotherapy in PDLI positive patients were well responded.

 

Keywords: EGFR, Mutation, Non-small cell cancer, chemotherapy

 

Principal Author and Presenter:

Col (Dr ) Md Iqbal Karim,

MBBS, MCPS, DCP, FCPS(Histopathology), IFCAP

Prof of Pathology, Armed Forces Institute of Pathology

Dhaka Cantonment, Bangladesh

Email: iqbalhistopath@gmail.com

Phone : 01716829144

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Quality Issues in Pathology Including Molecular Testing

 

Jabed Iqbal, MD, PhD

 

Jabed Iqbal, MD, PhD, is a pathologist with a strong academic background. He obtained his MBBS degree from Dhaka Medical College. Dr. Iqbal earned a PhD from Drexel University in Philadelphia, USA. Subsequently he attained the American Board of Pathology Diplomate certification.

 

Dr. Iqbal holds clinical interest in breast cancer pathology and hematopathology. His special research interest focuses on immuno-oncology spreading over breast cancer, hematologic neoplasms and biomarker discovery. He holds the position of Associate Professor at Duke-NUS Medical School in Singapore, where he actively engages in teaching and mentoring aspiring medical professionals globally particularly medical students.

 

Dr. Iqbal is passionate about developing pathology as a crucial component of healthcare in South Asia. Through his efforts, he aims to enhance the understanding and utilization of pathology services to improve healthcare outcomes in the region.

He is currently Vice-President of the Singapore Chapter of the International Academy of Pathology (IAP).

 

Abstract

The establishment and maintenance of quality Anatomic Pathology Services (APS) is important to reduce preventable mortality from cancer. APS plays a crucial role in cancer diagnosis, treatment, and prevention at both individual and public health levels. However delivering quality APS is hindered by insufficient human capacity, inadequate education and training, and inadequate quality standards and accreditation.

 

Strategies for implementing quality improvement programs in APS include Firstly, incorporating education in quality and safety into healthcare and pathology curricula at all levels to empower local pathologists and laboratory scientists to assess and improve the quality of APS. Secondly, developing sustainable infrastructure and resources for APS including laboratory facilities and equipment. Thirdly, implementing quality assurance programs and patient safety measures to enhance the reliability and safety of laboratory services is critical. Fourthly, there is an emphatic need for a cultural shift towards quality improvement and patient safety at the organizational level, involving frontline healthcare institutions and professional organizations. Finally, establish partnerships between low-and middle-income countries (LMICs) LMICs and upper middle- and high-income countries (UMHICs) to facilitate knowledge exchange and accelerate quality improvement efforts.

 

While progress has been made in quality improvement efforts for clinical laboratory services in LMICs, pathology service requires specific attention due to its unique challenges and high risk. By implementing these strategies, the quality and safety of APS can be improved thereby contributing to reducing cancer mortality, and aligning with the sustainable development goal (SDG) goals set by the World Health Organization (WHO).

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Basics of Renal Transplant Pathology

Brig Gen Prof Sk Md Jaynul Islam (Retd)

MBBS, DCP, MCPS, FCPS (Histopath)

Senior consultant, BIRDEM General Hospital, Dhaka

 

Brig Gen Professor Sk Md Jaynul Islam is Senior Consultant, Immunohistochemistry in BIRDEM General Hospital, Shahbag, Dhaka. He is a medical graduate from Rajshahi Medical College in 1990. He has completed his FCPS in histopathology in 2001. He got fellowship in Renal Pathology from AIIMS, New Delhi, India in 2017. He also got training at Arkana Labs, Little Rock, USA in 2023.

He has served as a pathologist in Bangladesh Armed Forces for 31 years. He is an examiner of FCPS part2 (histopathology), DCP and MCPS.

He attended more than 30 scientific conferences as delegate and faculty including USCAP,WCN, ISRTP, APCON 2024, CMCPath, etc. His number of scientific publications is 45 in different national and international medical journals. He is editorial member BCPS journal, JAFIP, Journal of AMCR.

He is affiliated with professional bodies like, Bangladesh Society of Pathologists, Bangladesh Academy of Pathologists, SAARC association of cytopathologits and histopathologists, Indian Society of Renal and Transplant Pathology (ISRTP), USCAP, Electron Microscope Society of India (EMSI), Renal Pathology Society (RPS), International Society of Nephrology (ISN).

 

Cell: 01911262258

Email: jaynul.islam@gmail.com

 

Abstract

End-stage renal disease (ESRD) patients in Bangladesh increases rapidly. No definite country based study is available regarding the exact statistics. According to hospital statistics, approximately 35,000 to 40,000 patients in this country report with ESRD each year. Renal replacement therapy (RRT) is the treatment of choice which includes dialysis and renal transplantation. Renal transplantation is the better choice as it leads to longer survival and enables superior quality of life. Unfortunately, only 25% of ESRD patients in Bangladesh can access RRT, and, among them, only 2% undergo renal transplantation (RT).

 

Renal biopsies remain the gold standard to determine the cause of graft dysfunction, which occurs in about 30% of recipients early after transplant and at a rate of 2% to 4% per year after the first year.

 

Biopsies are particularly useful to guide treatment in ambiguous clinical situations and are used in combination with other diagnostic tests, including imaging and laboratory tests.

 

Indication of renal transplant biopsy includes a) when there is a persistent, unexplained increase in serum creatinine b) when serum creatinine has not returned to baseline after treatment of acute rejection c) every 7–10 days during delayed graft function d) if expected kidney function is not achieved within the first 1–2 months after transplantation e) kidney allograft biopsy is also suggested when there is new onset of proteinuria or unexplained proteinuria ≥3.0 g per 24 hours.

 

Biopsies best distinguish acute rejection, acute tubular necrosis, infections such as polyomavirus nephropathy (PVN), thrombotic microangiopathy (TMA), recurrence of original disease, CNI toxicity, and chronic rejection.

 

BANFF working classification of kidney transplant pathology is a well-accepted method worldwide to classify the causes of renal allograft dysfunction. The BANFF classification has provided a standardized approach to diagnosing and grading kidney allograft rejection for over 3 decades. Its contributions have led to improved communication among pathologists and facilitated advancements in research and clinical practice in the field of kidney transplantation.

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Polyps of the Gastro-Intestinal Tract: The Unusual Types

Mohammed Kamal

Visiting Professor of Pathology, BSMMU and

Chief Consultant Pathologist, The Laboratory,

Dhaka. Bangladesh.

 

Abstract

Polyps are intraluminal projections of mucosal or submucosal tissue.  These can be a serious health concern, as these abnormal growths can lead to cancer in some cases if left untreated. These are most commonly found in the stomach and intestines, making early detection and treatment vital. By taking action and addressing polyps early, the risk of developing cancer can be greatly reduced and proper treatment can be ensured.

 

Screening tests such as endoscopy, barium contrast x-ray, various DNA tests in stool and occult blood tests are used to detect polyps arising from the mucosa. The current clinical practice involves endoscopic detection followed by histological confirmation. The Paris classification divides lesions into two categories: polypoid (elevated) or nonpolypoid (flat). Image-enhanced endoscopy, which is the basis of NICE classification, is a highly accurate tool used to diagnose the histologic class of a polyp.

 

A small number of submucosal tumors or tumour like lesions can present as polyps in the gastrointestinal tract. These growths can be neoplastic, hamartomatous (abnormal tissue growth), or non-neoplastic inflammatory in nature. To diagnose these tumors, clinicians have to use a combination of tools including standard endoscopy, endoscopic ultrasound (EUS), computed tomography (CT), magnetic resonance imaging (MRI),  fluorodeoxyglucose-labeled positron emission tomography (FDG-PET) etc. To confirm the diagnosis, an excisional biopsy is mandatory.

 

A few polyps exhibit unusual and atypical features that demand clinical and histological correlations, making them difficult to diagnose according to well-defined lesion criteria. This presentation will showcase some of these challenging cases and will delve into the intricacies of these challenging cases, exploring the clinical and histological features that differentiate them from well-defined lesions.

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Eosinophilic Esophagitis: An update

Dr. Kaushal Kishor Prasad

MD, PDCC (Renal Pathology), CFN, MAMS, FICPath, FISG

Professor  & Chief, Division of GE Histopathology

Department of Superspeciality of Gastroenterology

Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh

kaushalkp10@hotmail.com

 

 

• Awarded Gold Medal and Certificate of merit for getting first position in Final MBBS University Examination
• Received Special State Merit Scholarship from 1984 to 1991 (During Intermediate and MBBS)
• Received 45 awards in International and National scientific forums including the prestigious ISG – SR Naik award and IAPM – V R Khanolkar award for original research work
• Authored 125 papers (85 International journals and 40 National journals), and published 205 abstracts (116 International journals and 89 National journals)
• Contributed 17 book chapter/ books in the field of Gastroenterology including invited chapters for “Encylopedia of Gastroenterology”; Liver: A complete book on Hepato-Pancreato-Biliary diseases; Gastrointestinal Tract Infections; Textbook of Hepatogastroenterology; and Handbook of Celiac disease
• Modified the Marsh-Oberhuber classification of celiac disease, developed the grading system of histological lesions in celiac disease, coined the term “Follicular esophagitis” for a novel histopathological entity in esophagus, coined the term “Sartan sprue” and developed the rice based gluten-free composite flour cookies for celiac disease patients
• Main research areas of interest are celiac disease, inflammatory bowel disease, microscopic colitis, Helicobacter pylori and extrahepatic portal vein obstruction
• Published 26 articles on celiac disease (21 in International journals and 5 articles in National journals); and 18 articles on IBD (16 in International journals and 2 articles in National journals)
• Invited international editorial board member for more than 190 international journals and reviewer for 170 international journals
• Reviewer for the extramural research projects for ICMR and intramural research projects proposals especially on celiac disease
• Travelled across the world and delivered invited lectures including “Continuing Professional Development Programme” of University of Malaya at Kuala Lumpur, Malaysia and “Joint WASPaLM-SAP Anatomical Pathology Update Seminar” at Khartoum, Sudan
• Presented 328 scientific papers (189 in International and 139 in National conferences) and attended 188 conferences (87 International and 101 National conferences)
• Life member/ member of 24 International and 13 National professional societies and also holds several key positions in various National and International scientific societies including Panels of Experts for the World Association of Societies of Pathology & Laboratory Medicine (WASPaLM)
• Guided/ guiding 46 dissertation (26 DM, 1 MCh, 11 MD, and 8 PhD)
• External examiner for Postgraduates and undergraduates examination

 

President & Founder Secretary, Association of Cytologists & Histopathologists (ACH)

Founder Joint Secretary & Secretary General (Elect), South Asian Academy of Cytopathology & Histopathology (SACH)

Founder Treasurer, Society for the Study of Liver Diseases (SSLD)

Founder Secretary, Society for Clinical Gastroenterology (SCG)

Treasurer, Society for the Advancement of Gastroenterology (SAG)

Ex-Executive Committee Member, Gastrointestinal Infection Society of India (GISI)

Ex-Education Committee Member, World Association of Societies of Pathology & Laboratory Medicine (WASPaLM)

Founder Member, Indian Society for Renal & Transplantation Pathology (ISRTP)

Phone: +91-172-2756604

Mobile: +91-9872836195; 7087008433

Fax    : +91-172-2744401, 2744450

 

 

Abstract

Over the past few decades there have been dramatic rise in eosinophilic esophagitis (EE) patients, who were thought to have gastroesophageal reflux disease (GERD) but who did not respond to medical and/or surgical GERD management. Whether, this emergence is of a true diagnostic nature or simply of an enhanced awareness. Recognition of this disease for the gastroenterologist has become paramount because of its differentiation from GERD not only from an etiologic but especially from a treatment point of view.

 

The EE is a chronic inflammatory, immunoallergic disease of the esophagus that represents the most common eosinophilic gastrointestinal diseases (EGIDs). The EE is a clinicopathological disease characterized by (1) Symptoms including but not restricted to food impaction and dysphagia in adults, and feeding intolerance and GERD symptoms in children; (2) dense esophageal eosinophilia (≥15 eosinophils/HPF) with squamous epithelial hyperplasia; (3) Exclusion of other disorders associated with similar clinical, histological, or endoscopic features, especially GERD. EE is a polymorphous disease that presents with various changes in esophageal caliber, and subtle changes in mucosal appearance, which lead to biopsy collection as a key procedure for diagnosis. The EE has now become an emerging global problem. It’s not time to put away the biopsy forceps but gastroenterologist should put an effort to obtain biopsy from esophagus in symptomatic patients. In EE, the variable distribution of eosinophils throughout the esophagus complicates the diagnosis; to avoid false-negative histologic results because of sampling errors, the endoscopist must seek biopsy from multiple areas.

The management must be multidisciplinary, including gastroenterologists, pathologists, allergologists, and also dietitian.

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Intrathoracic Small Biopsies: Diagnostic and Predictive Analysis of Selected Cases

SM KhodezaNahar Begum

Professor, Department of Pathology, DrSirajul Islam Medical College, Dhaka, Bangladesh

Consultant, Department of Anatomic Pathology , Bangladesh Specialized Hospital, Dhaka, Bangladesh

 

Professor SM KhodezaNahar Begum is an anatomical pathologist and consultant at Bangladesh Specialized Hospital. She is also a Professor of Pathology at Dr.Sirajul Islam Medical College in Dhaka, Bangladesh, with over 30 years of experience. Her areas of expertise include breast, pulmonary, gastrointestinal, gynecological, and neuropathology.

 

She is also renowned as an interventional pathologist, proficient in collecting percutaneous needle core biopsy samples from various organs. She meticulously gathers patient history and conducts clinical correlations simultaneously, enhancing her expertise in achieving accurate tissue diagnoses.

Dr. Begum pursued subspecialty fellowship training in histopathology and cytopathology at Women & Infants Hospital of Rhode Island, USA, and Singapore General Hospital, Singapore where she has completed advanced training in routine histopathology and immunohistochemistry of breast, pulmonary, gynecological, and gastrointestinal pathology.

 

Currently, Dr. Begum is collaborating with the International Centre for Diarrheal Disease Research, Bangladesh (ICDDRB) on research projects related to Helicobacter pylori infection and environmental enteric dysfunction. She is also part of the international Fibroepithelial Consortium, contributing to research on the genomic characterization of breast fibroepithelial lesions.

 

Dr. Begum’s work has been published in over forty scientific papers in national and international peer-reviewed journals. She has also delivered over ten international podium presentations. Her email is khodeza33@hotmail.com

 

 

 

Abstract

In Bangladesh, the incidence of intrathoracic malignancies is rapidly increasing, with many cases being diagnosed at late stages. Pathologists often diagnose these cases using small biopsy specimens, obtained through procedures such as EBUS/TBNA, fine needle aspiration, endobronchial biopsy, percutaneous needle core biopsy, or pleural biopsy. Obtaining a satisfactorytissuesample is challenging for radiologists, respiratorymedicine specialists, and interventional pathologists.

 

Oncologists rely on predictive biomarkers and immune checkpoint inhibitors, which are commonly evaluated using techniques such as immunohistochemistry (IHC), reverse transcription-polymerase chain reaction (RT-PCR), and next-generation sequencing (NGS). Morphological diagnosis alone is insufficient for determining optimal treatment strategies, although it plays a key role in some malignancies. The current IASLC histological grading system for non-mucinous NSCLC has been proven effective in reflecting tumourbehaviour.

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How to Navigate the Latest Glioma Classification in Daily Practice

 

Mohammad Monowar Hossain, MD; FRCPC.

 

Dr. Monowar was born in Joypurhut. Went to Dhaka Medical College 1986, batck-K43 and graduated in 1993. Went to Westchester Medical center, New York affiliated with New York Medical college in 1995 for post graduate training under the mentorship of Prof. M B Zaman. After completion of pathology training and fellowship in cytopathology, moved to Saint John Regional Hospital in New Brunswick, Canada as attending pathologist in 2001.

 

Dr. Monowar practice as a general pathologist including neuropathology, medical renal disease, flowcytometry and medicolegal autopsy. His special interest is in immunostains, started with Her 2 neu immunostain including Her 2 neu FISH in 2001 and currently Saint John Regional Hospital a provincial referral center for Her 2 neu testing. In 2017 started working on immunotherapy marker PD-L1. Teaching activities include resident/medical student sessions and a faculty of Prof. Zaman’s course and sessions in Bangladesh for more than twenty years. Work as a team member with Prof. Zaman in Tele-pathology consultation services in Bangladesh.

 

Dr. Monowar is a diplomate of American board of Pathology and Cytopathology and fellow of Royal college of physicians and surgeons of Canada. Currently in charge of anatomic pathology division.

 

In today’s session will discuss how to navigate the latest glioma classification in daily practice.

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Lymohoma- Immunohistochemical Evaluation

 

Dr Md Nasimul Islam

MBBS, M Phil (Pathology)

Professor of Pathology & Principal, Anwer Khan Modern Medical College, Dhanmondi, Dhaka.

Email: nasimul83@yahoo.com

 

Dr Md Nasimul Islam obtained his bachelor degree in medicine and surgery from Mymensingh Medical College in the year of 1983. After graduation he joined Government health service. In 1994, he obtained M Phil degree in pathology from the department of pathology of then IPGMR, under the University of Dhaka. After postgraduation Dr Islam joined as lecturer pathology in Dhaka Medical College. After that he pursued a teaching career in various capacities in the pathology departments of Faridpur Medical College and Sir Salimullah Medical College for long twenty-three years. He retired from government service while serving as Professor of Pathology & HOD at Sir Salimullah Medical College in September 2019 and joined the department of Pathology of Anwer Khan Modern Medical College. He attended many national and international scientific seminars and has more than twenty research publications in various scientific journals. During his long teaching career, he mentored a large group of pathologists now working across the country.

 

Abstract

Lymphoma is a heterogenous disorder. WHO classifies lymphoma on the basis of morphology, cell lineage, genetical aberrations and aggressiveness. Without immunohistochemistry, subclassification of lymphoma is not possible. Usually, a large panel of antibody markers are used to get the conclusive result. In many cases genetical evaluation is also necessary. Immunohistochemical markers are expensive which most of the patients in this country face difficulty to bear. However, using limited number of antibodies in the panel of markers can help reach a reasonably conclusive diagnosis in most of the cases. A number of lymphoma cases are presented here including non-Hodgkin lymphoma- nodal and extra nodal and Hodgkin lymphoma with the help of a limited panel of antibodies that includes- LCA, CD3, CD20, CD5, CD23, PAX5, CD10, BCL-2, BCL-6, MUM-1, Cyclin D-1 etc. Antibody markers are used in batches where results obtained from first batch dictate choice of markers in the next batch and so on. This helped reduce use of unnecessary markers as well as cost of the test. In case of DLBCL Hans’ algorism was used to identify more aggressive subtype (i.e. ABC type). Bare minimum markers were used to classify small B cell lymphomas that include CD5, CD23 and CD10. Immunohistochemical tests of all the cases were performed in the histopathological laboratory of Anwer Khan Modern Medical College Hospital, a Dhaka city based private medical college.

 

Keywords: Hodgkin and non-Hodgkin lymphoma, Immunohistochemistry

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A Case of Heterotopic Ossification of the Gall bladder Associated with Chronic Cholecystitis

 

1. Rahat Anjum, Associate consultant, Histopathology & Cytopathology, Apollo Imperial Hospitals, Zakirhossainroad, Chattogram,
2. Dr. G. M Zakir Hossain, General & Urological Surgeon, Chittagong medical college

 

Corresponding author: Dr. Rahat Anjum, Associate consultant, Histopathology & Cytopathology. Cell: +8801674857949, Email: anjum.r.dr@gmail.com

 

 

Abstract

Background: Hetrotopic ossification is rare in gall bladder with very few reported cases. The pathogenesis is not clearly understood but inflammation and irritation might predispose the condition.

Presentation of case: A female of 18 yrs underwent laparoscopic cholecystectomy due to persistent upper quadrant pain, nausea and post prandial vomiting. The Ultrasound reported a polyp with features of cholecystitis. The post operative period was uneventful.The Histopathology revealed fibromuscular hyperplasia, infiltration of chronic inflammatory cells, including foamy histiocytes in the lamina propria. Rokitansky – Aschoff sinuses were present. In the focus of polypoid area it showed denuded epithelium, mature bone formation and marrow materials. No metaplasia, dysplasia or evidence of malignancy noted.

Conclusion: We report a rare event of osseous metaplasia of the gall bladder which was incidental without known clinical significance. Stromal fibroblastic activity and active inflammation may play arole in osteogenic stimulation in gall bladder mucosa.

 

Keywords: Osseous metaplasia, gall bladder, Chronic cholecystitis

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Transfusion Associated Graft vs Host Disease in A Post-CABG Patient

 

Dr. Sayedatus Saba

MD, Pathology (BSMMU) Sir Salimullah Medical College Mitford Hospital 2023, MBBS (DU), Mymensingh Medical College 2012

 

Diligent Pathologist skilled in laboratory specimen handling and analysis. Trained in laboratory procedures and best practices. Organised recordkeeper with strong multitasking abilities. Detail-oriented worker follows standardised procedures in laboratory environments. Uses medical terminology and collaborates with multidisciplinary teams. Motivated medical laboratory professional diligent in completing work to achieve accurate results.

Thesis: Histopathological changes in placenta of late intrauterine fetal deaths

Email id :Sayedatussaba1616@gmail.com

Ph number : 01713409304

Abstract

TA-GVHD is a rare, usually fatal complication of transfusion of blood and blood products containing viable T lymphocytes. Very rarely it may arise in an immunocompetent individual. There is an increased risk of TA-GVHD following bypass grafting and other surgical procedures where blood transfusion are required. Here we present a case of a 57 old patient who received 5 units of whole blood from his close relatives perioperatively and manifested unexplained anaemia, fever, skin rash which later became desquamating & cheilitis on his 19^th POD. His CBC report suggested pancytopenia indicating bone marrow failure. Skin biopsy confirmed the diagnosis as chronic TA-GVHD, lichenoid type. His liver function deteriorated and he died subsequentlyon his 32^nd POD. TA-GVHD develops when immunocompetent T lymphocytes of transfused blood able to engraft in the recipient’s lymphoid tissues that fail to reject them. Those lymphocytes mediate immune response causing damage and dysfunction of the skin& other organs. Our patient showed all features of TA-GVHD that was complicated by sepsis and multiorgan failure despite aggressive management. Pathologists, surgeons, physicians and transfusion centers must be aware of this sinister complication of perioperative blood transfusion in any surgery, including CABG.  Though fatal in >90% cases, it can be prevented by using irradiated blood. Patient parties must also be discouraged to donate blood to avoid this grave outcome.

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Role of special stains in evaluation of extent of fibrosis in bone marrow biopsies of primary myelofibrosis

Dr. Sadia Afroz, Medical Officer, Department of Histopathology, National Institute of Cancer Research & Hospital (NICRH), Mohakhali, Dhaka-1212, Bangladesh. sadiatoma2813@gmail.com

 

Dr. Sadia Afrozis working as Medical Officer, Department of Histopathology, National Institute of Cancer Research & Hospital (NICRH), Mohakhali, Dhaka-1212, Bangladesh from August 2022 to present.She obtained her M.B.B.S. degree from Sir Salimullah Medical College and Mitford Hospital (SSMC & MH), Dhaka in 2014 under Dhaka University (DU). She completed Doctor of Medicine (M.D.) degree in Pathology directly supervised under the Pathology department, Bangabandhu Sheikh Mujib Medical University (BSMMU)from March 2017 to March 2022.

She worked as Assistant Surgeon, in 100 Bedded Kashiyani Upazilla Health Complex, Kashiyani, Gopalganjfrom December 2019 to September 2020.

She worked asHonorary Medical Officer, Department of Paediatrics, Sir Salimullah Medical College and Mitford Hospital, Dhakafrom July 2015 to December 2015.

 

She has 10 publications.

 

Abstract

Background: Primary myelofibrosis (PMF) is a rare hematological malignancy with higher mortality and morbidity due to progression of bone marrow fibrosis (BMF). The amount of bone marrow reticulin and collagen fibrosis is detected by reticulin and Masson’s trichrome (MT) stains, respectively. The study aimed to explore the pattern and degree of BMF in PMF cases with above mentioned special stains along with conventional Hematoxylin & Eosin (H&E) stain.

Methods: Thirty-six histopathologically suggested or diagnosed cases of PMF were studied at the Department of Pathology, BSMMU. Paraffin blocks of trephine biopsy specimens of the selected cases were collected. H&E, reticulin and MT stains were applied on the re-cut sections. Extent of fibrosis was assessed by examining the sections with each special stain using a proposed four scaled semiquantitative bone marrow fibrosis (MF) grading systems. The cases were divided into two groups. Patients having grade MF-0 to MF-1 were considered absent pathological BMF. Those cases with MF-2 to MF-3 were encountered with present pathological BMF.

Results: In this study, nineteen (52.8%) PMF cases had pathological BMF diagnosed by only H&E. Moreover, thirty-four (94.4%) patients had pathological BMF corresponding to MF-2 to MF-3 detected by special stains.

 

Conclusion: Significantly higher (p<0.05) detection of pathological BMF cases with use of additional special stains recommends that, both reticulin and MT stains can be used routinely to assess BMF properly according to special grading system.

 

Keywords: Bone marrow fibrosis, Primary myelofibrosis, Reticulin fibrosis, Collagen fibrosis, Reticulin stain, Masson’s trichrome stain, Hematoxylin & Eosin, Bone marrow fibrosis (MF) grade.

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Carcinoma of Unknown Primary

 

Professor (Dr) Santosh Kumar Mondal, HOD, Pathology, AIIMS, Kalyani MBBS from North Bengal Medical College, West Bengal in 1994

MD in Pathology from SSKM/PG Hospital, West Bengal in 2000.

Present Designations: i) Professor, Pathology, AIIMS, Kalyani

Six months certificate course and training on Oncopathology at Tata Memorial Hospital, Mumbai from 1.3.2006 to 31.8.2006

Publications: Published: 82 articles in Indexed International/National journals, first author in 50.

Citations (Google Scholar): 1523, i-10 index: 39; h-index: 18

Speakers/Judge/Chairperson: In many international, national and state conferences and CMEs.

Projects: In many funded extramural and intramural projects as PI and Co-PI.

Writer of book as Single Author:

1. “Manual of Histological Techniques” 2nd edition, from Jaypee (JP) Brothers, India.
2. “Pathology Practicals” 2 nd edition, from CBS publisher.
3. “Laboratory Manual of Clinical Pathology and Hematology” from CBS publisher.

 

Abstract

Definition: Carcinoma of unknown primary (CUP) by definition is a metastatic syndrome with an unidentifiable primary tumor, even after baseline diagnostic workup to seek the primary site. CUP constitutes 3-5% of all cancer diagnoses worldwide.

Diagnostic workup needed: Biopsy, Light Microscopy and Immunohistochemistry (IHC), Tumor markers, Tissue of origin, Assays by molecular techniques (RT-PCR, microarray, NGS). Patients are initially categorized based on the findings of initial biopsy: adenocarcinoma, squamous-cell carcinoma, neuroendocrine carcinoma and poorly differentiated carcinoma.IHCis the gold standard in the diagnosis of CUP. In practice, four primary sites (breast, ovary, prostate and thyroid) should first be investigated. The use of IHC has some pitfalls which necessitates molecular tumor profiling (NGS, RT-PCR, microarray), mutation-specific antibodies and other ancillary diagnostic tools.Appropriate patient management requires several clinical and pathological features. Current standard treatment of the unfavorable risk subtype requires assessment of prognosis and consideration of empiric chemotherapy.

 

Keywords: Carcinoma of unknown primary, immunohistochemistry, molecular techniques

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Mathematical Bridge between Epidemiological and Molecular Data On Cancer and Beyond

*Saumitra Chakravarty,¹ Khandker Aftarul Islam,² Shah Ishmam³

 

These authors contributed equally to this work.

 

*Corresponding author

 

1. Department of Pathology, Bangabandhu Sheikh Mujib Medical University, Shahbagh, Dhaka1000,Bangladesh. (saumitra@bsmmu.edu.bd)
2. Department of Computer Science and Engineering, Bangladesh University of Engineering and Technology, Dhaka1000, Bangladesh. (aftarulislam@gmail.com)
3. Department of Chemistry, Purdue University, West Lafayette47907, Indiana, USA. (smohtash@purdue.edu)

 

Abstract

Background: At least six different mathematical models of cancer and their countless variations and combinations have been published to date in the scientific literature that reasonably explain epidemiological prediction of multi-step carcinogenesis. Each one deals with a particular set of problems at a given organizational level ranging from populations to genes. Any of the models adopted in those articles so far do not account for both epidemiological and molecular levels of carcinogenesis.

Methods: We have developed a mathematically rigorous system to derive those equations satisfying the basic assumptions of both epidemiology and molecular biology without incorporating arbitrary numerical coefficients or constants devoid of any causal explanation just to fit the empirical data.

Results: We generalized all the epidemiological and molecular data using our derived equations through linear and non-linear regression and found all the necessary coefficients to explain the data. We also tested our equations against non-neoplastic conditions satisfying equivalent mathematical assumptions.

Conclusion: The aim of this treatise is not only to provide some novel insight into the mathematical modelling of malignant transformation but also to revive the classical tools we already have at our disposal to pave the way towards novel insight into integrated approaches in cancer research.

 

Keywords: Mathematical modeling, epidemiology, cancer.

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Challenges in Histopathological Diagnosis of Ovarian Serous Borderline Tumours

 

Shabnam Akhter

 

Dr. Shabnam Akhter is serving as a Faculty at Pathology department of Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh, from where she obtained her MD in Pathology in 2006. She availed an international visiting fellowship in Gynecologic Pathology and Breast Pathology in 2014 from Brown University, Providence, RI, USA. Dr. Akhter has more than 30 publications in peer-reviewed journals of home and abroad. Other than gyne and breast pathology, Dr. Akhter is also interested in medical renal diseases, gastrointestinal pathology and skin pathology. Besides pathology, she is fond of music, reading and traveling.

 

Abstract

The serous borderline tumours are the most common types of borderline ovarian tumours, also referred to as atypical proliferative serous tumours. They often cause differential diagnostic difficulties even for the experienced pathologists.All borderline tumours are distinguished from their malignant counterparts by the absence of stromal invasion. However, diagnosis of serous borderline tumours of ovary is sometimes complicated when there are issues like ovarian surface involvement by the serous tumour, micropapillary growth pattern, frequent presence of endosalpingiosis in pelvic lymph nodes, presence of peritoneal implants, and foci of microinvasion. A careful gross examination of the ovarian tumour, optimum sampling from different areas of the tumour, and thorough microscopic examination may help to resolve the issues and come to a conclusive diagnosis, thereby ensuring optimum patient care.

 

Keywords: Serous borderline tumour, micropapillary growth, peritoneal implants, endosalpingiosis

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Breast Cancer in Younger and Older Women- A Comparison of Clinicopathological Traits

 

 Dr. Shahanaz Jahan

Associate Professor, Department of Pathology, Community Based Medical College Bangladesh (CBMCB), Mymensingh, Bangladesh.

E-mail: shahnaj.dr@gmail.com.

 

Dr. Shahanaz Jahan completed her graduation at Mymensingh Medical College, Mymensingh, Bangladesh. She began her career as a lecturer at Community Based Medical College Bangladesh, Mymensingh, Bangladesh  in 2005. In 2008 she obtained her DCP (Diploma in Clinical Pathology), followed by FCPS (Fellowship in Histopathology) in 2014. Dr. Jahan plays a multifaceted role in question formulation, moderation & coordination for FCPS Histopathology as well as relevant other basic and paraclinical subjects of Fellowship examinations.

 

Her scholarly  contributions include eight international and three national publications. She has presented papers in several national conferences & seminars and participated in various national & international conferences. She is a life member of Bangladesh Medical Association (BMA) and Bangladesh College of Physicians & Surgeons (BCPS) as well as a regular member of Bangladesh Academy of Pathology (BAP) & Faculty of Basic Medical Sciences, BCPS.

 

Since 2018, Dr. Jahan has served as an Associate Professor of Pathology at Community Based Medical College, Mymensingh, Bangladesh. Her professional objectives include advancing her expertise in various histopathological domains and sharing that knowledge to enhance the skills of the younger learners through accessible and  effective techniques.

 

She exhibits a keen interest in IHC as well as molecular genetics, particularly concerning pulmonary, breast and gynecologic tumors.

 

Abstract

Breast cancer stands as the prevailing invasive cancer globally, bearing high mortality rates among women. Existing evidence indicates diminished survival rates in younger patients. Consequently, this study endeavors to assess and contrast the pathological features of breast cancer in women under 40 years of age with their older counterparts. Conducted as a cross-sectional analysis, this study encompasses 560 patients diagnosed with breast cancer, seeking treatment at Mymensingh Medical College Hospital (MMCH), Community Based Medical College (CBMCB) and several  private hospitals in Mymensingh. The gathered data incorporates information such as age, residential area, occupation, tumor histopathology, TNM classification, staging and status of hormone receptor. The patients’ mean age (standard deviation) was 49.7±11.9 years, with 20.5% below 40, most were from rural areas and were housewives. Ductal carcinoma prevailed as the most common histopathologic type (87.67%). However, younger patients exhibited a higher prevalence of lobular and other rare carcinomas compared to their older counterparts (p=0.04). Additionally, the younger group demonstrated larger tumor sizes (p=0.01), lymphatic node involvement (p=0.04) and advanced staging (p=0.004). Notably, younger age showed more negativity for estrogen & progesterone receptors. The results suggested that women under 40 years old exhibit more aggressive tumor characteristics and a more severe form of breast cancer compared to their older counterparts.

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Understanding Colon Carcinoma: A Comprehensive Overview of Diagnosis and Treatment

 

Prof Shamim Akhter Mimi

MBBS (DMC), Mphil Pathology (IPGMR)

Professor and Head

Department of Pathology

Sylhet MAG Osmani Medical College, Sylhet

 

Prof. Dr Shamim Akhter Mimi did her MBBS degree from Dhaka Medical College, in 1993 and M. Phil in Pathology from Institute of Post-Graduate Medicine and Research, Dhaka, Bangladesh in 1997. She is working as a Professor in Department of Pathology in Sylhet MAG Osmani Medical College. She has been involved in post graduate teaching for last 16 years. She has 29 publications in different National and International journals. She is Life member of Bangladesh Medical Association, Post graduate Alumni association and member of Bangladesh Academy of Pathology.

 

 

Abstract

Colon cancer is one of the most prevalent cancer worldwide. It ranks third in terms of incidence following lungs and female breast cancer. According to Globocan 2022 data, in case of Bangladesh it ranks 10^th in terms of incidence and mortality. World health organization start a project on tumor classification named as blue book on cancer since 1956 and published by IARC based on France. Latest 5^th edition of one of these series named as “WHO Classification of Tumors, Digestive system tumours”. Malignant tumors of the colon are mostly adenocarcinoma. NET, Lymphoma, GIST and smooth muscle tumors are also evident. Hereditary syndromes, genetics, environment, diets are responsible for  carcinoma development. Newer modern techniques discover more and more underlying genetics of these cancer development and progression that will help to fight cancers in the future. Conventional way of diagnosis of colon carcinoma is mainly histopathological study. Immunohistochemistry, molecular techniques, genetic studies also widen the whole scenario of cancer day by day and make us more capable of fighting these worldwide epidemics. Surgery, radiotherapy and chemotherapy has failed to reduce mortality in advanced stages of colon cancer. Targeted therapies, immunotherapies are now being applied on advanced colon cancer. Clinical trials are currently underway for novel cytotoxic agents.

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Dyshormonogenetic Goiter – A Rare Case Presentation

 

Dr. Md Sibli Ahmed, MBBS, FCPS, DCP, MCPS

E-mail: kishor.amc@gmail.com

 

Dr. Md Sibli Ahmed

• Currently working as pathologist at CMH Rajshahi.
• He worked as resident of pathology in AFIP from Jan 2021- Dec 2023.
• Worked as graded specialist (clinical pathology) in CMH Jashore from Aug 2019 to Dec 2021.
• Completed training on clinical pathology in AFIP from July 2017 to June 2019.
• He worked as senior medical officer (SMO) at BAF base Paharkanchanpur, Tangail from July 2016 to June 2017.

• Worked as medical officer at United nations mission in Liberia (UNMIL) from July 2015 to June 2016.
• Worked as officer commanding in CMH Ruma, Rangamati from September 2014 to June 2015.
• Worked as medical officer in 81 Field Ambulance, Mymensing from January 2014 to Aug 2014.
• Publications: 3

 

Abstract

Dyshormonogenetic goiter is a rare cause of congenital hypothyroidism occurring due to a lack of enzymes necessary for the synthesis of thyroid hormones. It is morphologically characterized by architectural and cellular pleomorphism that may mimic thyroid malignancy and cause difficulties in differential diagnosis.

We report a new case occurring in a 9-year-old girl with history of hypothyroidism since two years of her age and treated by thyroxin. She developed a progressively slow growing multinodular goiter. Computed tomography revealed an ill-defined nodular lesion in left lobe with heterogenous densities and a small hypodense, nodular lesion on the right thyroid lobe. A total thyroidectomy was performed.

Gross examination revealed an enlarged and multinodular thyroid gland. Histologically, the features were consistent with dyshormonogenetic goiter.

The literature on the histopathology of dyshormonogenetic goiter is reviewed and clues to avoid inappropriate overdiagnosis of malignancy are given.

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Pineal Parenchymal Tumors: Experience in a Tertiary Care  Hospital in Bangladesh

Dr Sifat Shams,¹ Prof DrNowfel Islam,² Dr Shawni Saha,³ Dr Sagana shahreen,⁴ Dr Zenat Ahsan⁵

 

¹Medical officer, Department of Neuropathology, National Institute of Neurosciences and Hospital

²Professor and Head of the department of Neuropathology, National Institute of Neurosciences and Hospital

³Assistant Professor, Department of Pathology, Shaheed Shuhrawardy Medical College

⁴ Assistant Professor, Department of Anatomy, National Institute of Neurosciences and Hospital

⁵Medical officer, Department of Neuropathology, National Institute of Neurosciences and Hospital

 

Dr. Sifat Shams, MBBS, MD (Pathology), Medical Officer, Department of Neuropathology

National Institute of Neurosciences & Hospital, Sher-E-Bangla Nagar, Dhaka.

Email: sifatshams24@gmail.com

 

Dr Sifat Shams completed her MBBS from Mymensingh Medical College in 2012 and later she accomplished MD in pathology from Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. She did her MD training from Sir Salimullah Medical College, Dhaka, Bangladesh. During her MD course, she had conducted research on “Immunohistochemical Expression of Estrogen (ER) and Progesterone (PR) in Malignant Epithelial Ovarian Tumor and Correlation with Its Grading”. As a co-author, she also had another three publications, one on the topic of gastric carcinoma and another two on cervical carcinoma. Now she is working as a medical officer in the Department of Neuropathology at National Institute of Neurosciences and Hospital, Sher-E-Bangla Nagar, Dhaka. During her working period, she also did two case reports on “Cauda equina neuroendocrine tumor” and “Lafora disease’. She is also associated with a few research projects of neurosurgery department. She has lot of interest in Neuropathology and molecular techniques. Besides her regular works, she is also taking part to run Fluorescence In situ Hybridization (FISH) in the Department of Neuropathology at National Institute of Neurosciences and Hospital,.

 

Abstract

Background: Pineal parenchymal tumors (PPTs)are rare and the incidence ranges from 0.4-1% in adult population. The morphology of tumor varies from the well differentiated pineocytoma to poorly differentiated pineoblastoma. Pineal parenchymal tumor of intermediate differentiation (PPTID) and papillary tumor of pineal region (PPTR) are in between.This single institutional based study aimed to find out the frequency and histologic spectrum of pineal parenchymal tumors in a tertiary level hospital in Bangladesh.

Objective: To evaluate the frequency of pineal parenchymal tumors and their histomorphology along with immunohistochemistry at a tertiary level hospital in Bangladesh.

Methods: It is a cross sectional observational study based on archival tissue and records.

Result: A total of twenty cases were searched out from 2019-2023 (5 years). Themale to female ratio being 1.5:1. Pineal parenchymal tumor of intermediate differentiation (40%) were the most common pineal parenchymal tumors found mainly in adult population while pineoblastomasmore frequent in pediatric group. Histological variations were observed in all cases. Out of 20 cases of PPTs,16(80%) cases were synaptophysin positiveand 10(50%) cases were positive for NSE. All cases of PPTs were negative for EMA and PanCK. Ki67 labelling index was lowin pineocytoma (<1%) and higher in pineoblastoma (25-60%).

Conclusion: Pineal parenchymal tumor of intermediate differentiation (PPTIDs) is the commonest type of pineal parenchymal tumor. It occurs mainly in adult.Pineoblastoma is the most frequent one for pediatric population. For diagnosis of PPTs, only histopathology is not enough, immunohistochemistry should be used as diagnostic adjunct.

 

Keywords: Pineal parenchymal tumor, Pineal parenchymal tumor of intermediate differentiation, pineoblastoma, papillary tumor of pineal region

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Pattern Approach to Interstitial Lung Diseases

 

Dr. Uma Debi  

MD (Radiodiagnosis,AIIMS)

Additional  Professor

Department of Radiodiagnosis and Imaging

Post Graduate Institute of Medical Education and Research,

Chandigarh (UT) – 160012 INDIA

Phone: +91-172-2704121

Mobile: +91-9417526614

Fax : +91-172-2744401, 2744450

Email: debi_uma@yahoo.co.in

 

• Published 75 papers in international & national journals
• One book published and contributed 7 chapters in books
• Member of 15 National and International societies
• Projects (n = 27) Extramural, Intramural and Departmental
• Papers/Posters presented in conferences (n = 60)
• Received 7 awards including Winner of International Association For the study of Lung Cancer (IASLC) – 2019 as one of the member of multidisciplinary team
• Areas of Research Interests: Lung malignancy, ILD, Pulmonary infections, and Cardiomyopathy

 

Abstract

Interstitial lung diseases (ILDs) are defined as a group of diffuse lung parenchymal diseases which result from damage to the lung parenchyma caused by different degrees of inflammation and fibrosis.It refers to variable patterns / diseases characterised histologically by inflammatory infiltrate in the interstitium with variable degree of fibrosis. Correlation of clinical, radiological and pathologic features is often required to reach a correct diagnosis of ILD. According to the updated American Thoracic Society–European Respira­tory Society classification, idiopathic interstitial pneumonias (IIPs) are ILD’s of unknown etiology sharing common clinical features and can be categorised into (a) “chronic fibrosing IIPs” (idiopathic pulmonary fibrosis (IPF) and idiopathic nonspecific interstitial pneumonia (NSIP)), (b) “smoking-related IIPs” (respira­tory bronchiolitis associated interstitial lung disease (RB-ILD) and desquamative interstitial pneumonia (DIP)), and (c) “acute or sub acute IIPs” (cryptogenic organizing pneumonia (COP) and acute interstitial pneumonia (AIP)) and (d) “rare IIPs” (lymphoid interstitial pneumonia (LIP) and idiopathic pleura-parenchymal fibro-elastosis (IPPFE)). Furthermore, it has been acknowledged that a final diagnosis is not always achiev­able, and the category “unclassifiable IIP” has been proposed. The diagnostic interpretation of the IIPs is often challenging because other diseases with a known etiology (most notably, connective tis­sue disease and hypersensitivity pneumonitis) may show similar morphologic patterns. Indeed, more emphasis has been given to the integration of clinical, computed tomographic (CT), and patholog­ic findings for multidisciplinary diagnosis. Typical CT-based mor­phologic patterns are associated with the IIPs, and radiologists play an important role in diagnosis and characterization. Optimal CT quality and a systematic approach are both pivotal for evaluation of IIP. Interobserver variation for the various patterns encountered in the IIPs is an issue. It is important for radiologists to understand the longitudinal behavior of IIPs at serial CT examinations, espe­cially for providing a framework for cases that are unclassifiable or in which a histologic diagnosis cannot be obtained.

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Digesting 2015-2021 WHO Lung Cancer Classification, Commets And Conclusions

 

Professor MB Zaman, MD, FCAP

 

Dr. Zaman was born in Sylhet, and studied medicine on a scholarship in King Edward Medical University, Lahore, Pakistan from 1964-69. His post-graduate training was in pathology from 1970-76 in Mount Sinai Hospital and Memorial Sloan Kettering Cancer Center of New York. On completion of a Fellowship in Cytopathology, he was offered Assistant Professorship in Cornell University and served as Assistant and Associate Attending Pathologist in Sloan-Kettering for 16 years. His research was in “Early diagnosis of lung cancer by sputum cytology”.

 

He became Professor of pathology at New York Medical College and served there from 1991-2005. He was also the Chief of Cytopathology and Program Director of Pathology Residency at Westchester Medical Center. During this period and up until the Covid-19 pandemic of 2020, he came to his native country a dozen times to teach cytology, particularly FNA-cytology to PG-students and Pathology Faculty of Bangladesh. These 3-5 days long teaching-sessions were arranged in the PG-Institutes of Dhaka and was attended by 100+ participants each time.

 

Dr. Zaman has dozens of peer-reviewed publications on lung cancer detection and has authored major chapters on FNA-cytology in Koss’ text book of cytopathology.

 

Dr. Zaman is a Diplomate of American Board of Anatomic and Clinical Pathology and holds Sub-specialty certification in Cytopatholoy. He is a fellow of the College of American Pathologists and past-president of BMA-NA.

 

Dr. Zaman is now retired, but continues to teach Pathology Residents of New York Medical College and gives free online (Tele-pathology) histopathology consultation services for “Difficult cases of Cancer Diagnosis” to Bangladeshi Pathologists on a daily basis. The patients are not billed for this “Expert-consultation” from the USA.

 

From January 2022, Dr. Zaman initiated a systematic bi-weekly (Fridays BD-time 7-9pm) WebEx based virtual remote-course in Histopathology. A select group of 36 Professors and Associate Professors of Pathology from all PG-institutes of Bangladesh (with the potential to become effective teachers) listen and interact. The teaching faculty includes 2 of his former Residents/Fellows, now in leadership positions in the USA and Canada. This remote pathology course continuesthe last Friday of the month in 2024.

 

(Updated March 2024)

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Evolutionary Changes in Pathology and its Digital Future

Professor. Dr. Mohammad Zillur Rahman

MBBS, M Phil (Pathology), PhD

Professor and Chairman

Department of Pathology,

Bangabandhu Sheikh Mujib Medical University (BSMMU),

 

Dhaka, Bangladesh.
Cell phone: 01819315116
email: drzillur@bsmmu.edu.bd, drzillur@gmail.com

 

Dr. Mohammaad Zillur Rahman was born in Chattogram on 16th November 1966. He graduated MBBS from Chittagong Medical College in 1991. He completed M Phil in Pathology in 1997 from IPGM&R ((now BSMMU). Later, in 2009, he was awarded PhD from the Faculty of Science of University of Chittagong. He published 77 original articles along with a few case reports in many international and local journals. He authored a text book titled “Pathology Tutorial” for undergraduate medical students. He also authored 15 literary books containing poems, essays and translations.

Abstract

Human dissections, autopsies, microscopy, as well as the development of histopathological, immunohistochemical, and molecular techniques are involved in the history of pathology. Our understanding of anatomy and disease improved through these methods, and models of pathogenesis were refined over time.

Pathology plays the pivotal role in driving healthcare to understand diseases. Continuing improvements in digital technologies could make this subject more efficient and more scalable. The job of pathologists could be transformed into a more creative and data-driven profession while allowing patients to receive diagnoses faster and more accurately. Let’s see what the digital future of pathology looks like! Key milestones in the evolution of pathology as a branch of medical science, from ancient civilizations to the modern day are discussed here.

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These abstracts were collected for Souvenir of International Scientific Conference. I have insert these abstract according to alfhabetic serial of name of presenter – Dr. Sadequel Islam Talukder

sadequel@yahoo.com