Perianal fistula (fistula-in-ano) is one of the most common anorectal diseases. It is an abnormal connection between the anal canal and the perianal skin and is lined with granulation tissue. Although benign, the condition can cause significant distress and embarrassment to the patient. Major causes of an anal fistula are clogged anal glands forming anal abscesses. Other, much less common, conditions are infections, trauma and tumors. The treatment of an anal fistula depends on the etiology and location of the fistula. Most fistulas are treated surgically, through a variety of different procedures. Actinomycosis which is a gram positive bacteria can rarely cause perianal fistulas which is difficult to diagnose clinically so can result in mismanagement and recurrences leading to repeated surgeries. Key words: Actinomycosis, Fistula in ano, Gram positive bacteria.

Background: Urine cytology is an initial noninvasive screening test done in patients with suspected urothelial carcinoma. The objective of this study was to compare the sensitivity of conventional smear cytology with cell block technique for the diagnosis of malignant cells in urine and to assess the efficacy of p53 immuno-marker in the diagnosis and prognosis of urinary bladder cancer. Methodology:   The study was carried out in the department of Histopathology, Pakistan Institute of Medical Sciences(PIMS), Islamabad. Cell blocks and cytology smears and were prepared from urine samples of 80 patients of urothelial carcinoma and p53 stain was applied. Data was analyzed using version 21. Sensitivity of conventional smear and cell block techniques were calculated for both low and high grade urothelial carcinomas. Results:The sensitivity of detecting atypical cells using conventional smear was 31% and 70.6% for low grade and high grade urothelial tumors respectively. The sensitivity increased to 41.4% and 84.3% for low and high grade urothelial carcinomas respectively with cell block technique. Positive p53 stain was seen in 13.8% of cases with low grade tumors and 66.7% cases with high grade tumors. Chi-square test was used to find the association of cytology findings with the histologic grade. Conclusion: Sensitivity of urine cell blocks is higher than the conventional smear method for detecting high grade lesions. It can be used as an efficient non-invasive technique and an adjunct tool for the determination of disease relapse and overall survival in patients. Keywords: Carcinoma, Cytology, P53 Protein, Urine

Gallbladder cancer is an uncommon malignancy and majority of these carcinomas are adenocarcinomas. Adenosquamous carcinoma of gallbladder is a rare histopathological subtype of gallbladder carcinoma. It usually presents with symptoms of cholelithiasis like epigastric pain, nausea and bloating. On clinical examination, tenderness is usually present. Radiologically in most of the cases, gallstones are found leading to the diagnosis of cholelithiasis for which cholecystectomy is done. Gallbladder carcinomas are found mostly as an incidental finding on microscopic examination of cholecystectomy specimen. This disease is curable if diagnosed earlier but in most of the cases they present at advanced stages when resection is not possible and prognosis is poor. As this disease is extremely rare so published information is largely based on the case reports and case series. This is a case of 60 years old female patient who underwent cholecystectomy for cholelithiasis with incidental finding of Adenosquamous carcinoma on histopathology report.

Schwannoma is a benign tumor of axonal nerve sheath. Head and neck area, particularly parotid gland is an uncommon site for Schwannoma, however it can rarely arise from the intraparotid part of facial nerve and present as either a symptomless mass or facial paresis. Its diagnosis before surgical intervention is important for the conservation of parotid gland and facial nerve. On clinical examination and imaging studies, it can be misdiagnosed easily. FNAC is a helpful tool for its diagnosis. This entity should not be ignored while dealing with parotid masses. We present a case of a patient who came with the complaint of a parotid mass. Magnetic imaging resonance (MRI) scan suggested a parotid tumor which proved to be a spindle cell neoplasm on Fine Needle Aspiration Cytology (FNAC). A definite diagnosis of schwannoma of intraparotid facial nerve was made on histopathological examination of the excision sample.

after approval from the Hospital Ethical Committee. Material and Methods: In a descriptive background, 50 cases were involved in the study. Cases were selected by non-probability consecutive sampling technique. Patients of all age group (Males and Females), diagnosed as basal cell carcinoma of skin by Hematoxylin & Eosin were included in study. Other epithelial tumors of skin, appendageal tumors and metastatic tumors were excluded. Cases were evaluated for expression of tumor suppressor protein-p53 by immunohistochemical technique applied on formalin-fixed paraffinembedded blocks. Results: Out of 50 cases, majority of patients were found to be male. Ratio of male to female was 2.6:1. Age range of patient was found between 21-98 years. Mainstream of the patients were between 41-60 years. Nose was found to be frequently involved site 28 (56%) cases. p53 expression was seen in 42 (84%) cases while in 8 (16%) cases p53 expression was not seen. Conclusion: It was found that p53 expression rate is very high in basal cell carcinoma of skin. This high expression of p53 immunoreactivity was explained in terms of its pathogenetic role and mutation in basal cell carcinoma.