Surgical Pathology Conference, Uncategorized

Recent advances in the Molecular Testing for Treatment Selection in Lung Cancer.


Lung cancer is still the biggest dilemma in developing countries where is no rules and regulations about smoking and control of other palliative agents. Biomarkers have recently become a part of standard-of-care treatment for cell lung cancer with the recent FDA approval of different drugs in the second-line setting for patients with advanced disease. The concept of chemotherapy and radiation is rapidly changing in advanced countries due to the invention of biomarkers.

Lung cancer is a leading cause of malignancy associated with human deaths, which is evident from its high mortality rate of 1.6 million (19.4% of total) cancer deaths Worldwide. It is more common in male and elderly group risk factors include smoking, pollution, certain metals (chromium, cadmium), some organic chemicals and radiation. The risk of genetic susceptibility can contribute especially in young.


Thyroid transcription factor 1 (TTF1) is expressed by both neuroendocrine and non-neuroendocrine carcinomas of the lung but the frequency of expression varies markedly among various histologic types.

Sensitivity is highest among adenocarcinomas & non-mucinous bronchoalveolar carcinomas where it is over 90%. The lowest expression is seen in mucinous adenocarcinomas and Squamous cell carcinomas. The TTF1 expression is also seen albeit focal in a subset of ovarian & colorectal carcinomas. Striking differences in sensitivity are seen among neuroendocrine tumors of the lung, varying from 90% in Small cell carcinoma, 50% in large cell neuroendocrine carcinoma and < 50% in carcinoid tumors.

Napsin  A is a very sensitive marker for detecting pulmonary adenocarcinomas with a level of sensitivity from 80% to over 90%. The specificity of coexpression of TTF1 and  Napsin A is extremely high for pulmonary adenocarcinomas. However Napsin A can be identified in a subset of RCC (most frequently Papillary, up to 80%). Also in a minority of endometrial adenocarcinomas and PTC & Clear cell carcinoma of the ovary.

EGFR is the most frequent mutations in Pakistani lung adenocarcinoma patients and around 29% of the patients were found eligible for erlotinib therapy.

Several other immunotherapeutics are currently under investigation for the treatment of NSCLC, including those that inhibit PD-1 and PD-L1

Conclusion: This is an extremely exciting time in the field of thoracic oncology due to the development of immunotherapeutic drugs targeting different biomarkers responsible for mutation and in the development of lung cancer. Key areas of ongoing investigation are elucidating a predictive biomarker, determining the most appropriate line of therapy to use these drugs, and defining whether the combination with other agents (including chemotherapy, targeted therapy, or other immunotherapies) can provide additional benefit.

Conference Title: International Conference on Pathology and Surgical Pathology
Date & Venue: Sep 0608, 2018 | Edinburgh, Scotland
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Authors: Prof Mulazim Hussain Bukhari
Head of Pathology Department, UCM, University of Lahore


  1. Zeeshan Ansar Ahmed, Tariq Moatter, Areeba Siddiqui, Shahid Pervez. Distribution of EGFR Mutations Commonly Observed in Primary Lung Adenocarcinomas in Pakistan as Predictors for Targeted Therapy. Asian Pac J Cancer Prev, 15 (17), 7125-7128
  2. Topalian SL, Hodi FS, Brahmer JR. Safety, activity, and immune correlates of anti-PD-1 antibody in cancer. N Engl J Med. 2012;366:2443-2454.
  3. Gettinger SN, Horn L, Gandhi L, et al. Overall survival and long-term safety of nivolumab (anti-programmed death 1 antibody, BMS-936558, ONO-4538) in patients with previously treated advanced non-small cell lung cancer [published online April 20, 2015]. J Clin Oncol. DOI:10.1200/JCO.2014.58.3708
  4. Brahmer J, Reckamp KL, Baas P, et al. Nivolumab versus docetaxel in advanced squamous-cell non-small-cell lung cancer. N Engl J Med. 2015;373:123-135.

Keywords:  Adenocarcinoma, biomarkers, immunotherapy, lung cancer, NSCLS, PD-1 and PD-L1, SCC, Squamous cell carcinoma


Surgical Pathology Conference

Breast Cancer in Iraqi Female Patients – A Clinicopathological and Immunological Study


Breast cancer is the most common malignant tumor in women worldwide, including our country. It has been claimed that there is the propensity for the disease to affect younger women in developing countries.

The most important negative regularity of cell cycle progression is the tumor suppressor gene TP53, which has been recorded to be altered in 20-40% of human cancer.


  1. To assess the demographic characteristic and clinic-pathological presentation of breast cancer in Iraq in two groups (premenopausal versus postmenopausal women).
  2. To assess the frequency of P53 tumor suppressor gene expression immunohistochemically in the randomly selected group of these patients, and correlate that with the age of patients at diagnosis and with tumor stage and grade.


The study comprised 414 patients who presented with a palpable breast lump at the main referral and training center for early detection of breast tumor at Baghdad medical city teaching hospital. These cases were randomly selected from the total population visiting the center during a seven years period (2001 till 2007). All the patients were diagnosed by cytological examination of Fine Needle Aspiration of breast lump proved to be malignant.

The study population was divided into two groups: premenopausal versus postmenopausal depending on last menopausal period and considered the cut off age of 50 years old.

The main parameters included in the comparative study: *the family history of breast cancer,*history of previous abortion,* age at first delivery, *age at onset of menarche, *educational status, *obstetrical history include the number of live birth and *history of breastfeeding.


The highest incidence, of breast cancer, occurred in the fifth decade, 11% of the patients had a family history of the disease, of which 7.4% were first degree relative, 28% of the total had abortion more than once and 16% had abortion only once, there is significant association with the educational status (higher number of postmenopausal women were illiterate compared to the premenopausal group, only 16%of the patients had their menarche before the age of 12 years while 30%of those had their first delivery between (14-19) years.

The P53 gene protein expression found in 29% of the study patients with the higher score in pre-menopausal patients, and those with higher tumor grade and advanced stage.

The frequency of P53 score and nuclear staining were directly related to the grade of the tumor is higher in poorly differentiated carcinoma.


No remarkable differences noted in the demographic characteristics of breast cancer in Iraq apart from educational status, never the less high score of P53 was demonstrated in premenopausal patients; both nuclear expression and intensity correlating directly with advanced tumor grade

For more information regarding innovations and advances attend International Conference on Pathology and Surgical Pathology scheduled in September from 06-08, 2018 at Edinburgh, Scotland.

Authors: Dr. Ahmed Ameen: Supervised by Dr. Nada Alwan, Baghdad University

International Conference on Pathology and Surgical Pathology
Sept 0608, 2018 | Edinburgh, Scotland
To know more visit: