Diffuse large B-cell lymphoma (DLBCL) is the commonest non-Hodgkin lymphoma encountered by hematopathologists and oncologists. Management guidelines for DLBCL are developed and published by countries with high income and do not cater for practical challenges faced in resource-constrained settings. This report by a multidisciplinary panel of experts from Pakistan is on behalf of three major national cancer societies: Society of Medical Oncology Pakistan, Pakistan Society of Hematology, and Pakistan Society of Clinical Oncology. The aim is to develop a practical and standardized guideline for managing DLBCL in Pakistan, keeping in view local challenges, which are similar across most of the low- and middle-income countries across the globe. Modified Delphi methodology was used to develop consensus guidelines. Guidelines questions were drafted, and meetings were convened by a steering committee to develop initial recommendations on the basis of local challenges and review of the literature. A consensus panel reviewed the initial draft recommendations and rated the guidelines on a five-point Likert scale; recommendations achieving more than 75% consensus were accepted. Resource grouping initially suggested by Breast Health Global Initiative was applied for resource stratification into basic, limited, and enhanced resource settings. The panel generated consensus ratings for 35 questions of interest and concluded that diagnosis and treatment recommendations in resource-constrained settings need to be based on available resources and management expertise.

Objective: The purpose of this study was to evaluate the diagnostic utility of SATB2 in detecting CRC origin for patients presenting with metastatic carcinomas. Study Design: Cross sectional, comparative study. Place and Duration of Study: Study was conducted at department of Histopathology, Armed Forces Institute of Pathology, Rawalpindi from January 2019 to June 2019. Materials and Methods: Already diagnosed 68 cases of metastatic carcinoma of various origins with unknown primary were retrieved from tumour registry. Paraffin embedded blocks were taken and a panel of Immunohistochemistry was applied which includes CK7, CK20,CDX2 and SATB2. Positivity of SATB2 alone, and  combination of SATB2 with CK 7,CK20 and CDX2 was evaluated. Results: Out of 68 metastatic adenocarcinoma cases 28(41%) had positive SATB2 expression and 38 (56%) were negative. All the positive SATB2 cases had 100 % (28/28) expression with CDX2, 93% (26/28) of the cases had expression with CK20 and 21% (6/28) of the cases showed expression of CK7. The sensitivity of SATB2 alone was 100% in metastatic colorectal carcinoma as compared to CK20 and CDX2. The sensitivity of SATB2 in combination with CDX2 (100%) and CK20 (93%)in comparison to the double combination of CK20 and CDX2(93 %). The sensitivity of SATB2 and CK20 combination was 93%, which was equal to CK20 and CDX2 combination. Conclusions: Our results show that SATB2 is a sensitive marker in the IHC panel for cases with suspected metastasis from colorectal region.

Background & Objective:To evaluate usefulness of immunohistochemical marker C-kit (CD117) in differentiating Adenoid cystic carcinoma (AdCC) from Polymorphous low-grade adenocarcinoma (PLGA) in patients of salivary gland carcinomas. AdCC is a malignant salivary gland neoplasm with poor prognosis. PLGA is a salivary gland malignancy with indolent growth pattern. Differentiating between the two entities is a diagnostic challenge. We evaluated the role of C-kit in differentiating the two.Methods:This is a Cross sectional study. Samples of 19 tumors including 12 AdCC and 4 PLGA was evaluated at Department of Histopathology, Armed Forces Institute of Pathology, Rawalpindi from December 2015 to August 2016. Immunohistochemical techniques were used to analyze the level of c-kit expression in AdCC (n = 12), polymorphous low-grade adenocarcinoma (PLGA) (n = 6). Samples were stained using monoclonal antibody against C-kit. Statistical analysis of the data was done using SPSS version 21.Results:Strong diffuse cytoplasmic reactivity was observed in more than 50% of the tumor cells of AdCC whereas less than 20% of cells showed negative to weak positivity in PLGA. Hence, the difference in the expression of c-kit between AdCC and PLGA was statistically significant (p value <0.002).Conclusions:CD117 expression itself can be used as a marker in differential diagnosis of salivary gland neoplasms. However, the percentage of the CD117 immunoreactive cells and the staining intensities appeared to be important factors in distinguishing AdCC from PLGA.

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