R Baral

Bio: R Baral is an academic researcher from Kigali Institute of Science and Technology. The author has contributed to research in topics: Medicine & Glomus body. The author has an hindex of 2, co-authored 5 publications receiving 56 citations.

Histopathological pattern of endometrial samples in abnormal uterine bleeding

Abstract: Background: Histological characteristics of endometrial biopsy material as assessed by light microscopy remain the diagnostic standard for the clinical diagnosis of endometrial pathology. Management of abnormal uterine bleeding is not complete without tissue diagnosis. The aim of the study was to find out the histopathological pattern of the endometrium in abnormal uterine bleeding. Materials and Methods: Endometrial biopsy specimens received from Jan 2007 to Nov 2010 were studied retrospectively in the Department of Histopathology, Helping Hands Community Hospital, Kathmandu. The specimens were routinely processed and the hematoxyllin and eosin stained slides were studied. Results: A total of 300 specimens were analyzed. In the group of patients less than 40 years of age, 73 (50%) were normal, 34(23%) had abnormal physiologic changes and 13 (9%) had pregnancy related complications and benign changes. In the age group between 40 – 55 years, abnormal physiological changes, benign conditions and normal physiological changes were 45 (32%), 41 (29%) and 37 (26%) respectively. In the age group > 55 years, there were 3(21%) malignant and 3(21%) benign conditions. There were 5(36%) unsatisfactory samples in this age group. Conclusion: It is important to know the histological pattern of the endometrium in abnormal uterine bleeding in different age groups since it will help in the management of the cases. In this study endometrial hyperplasias were seen in 55 cases (18.8%). The importance of studying the histological pattern of endometrium in abnormal uterine bleeding in different age group is to help in correctly managing the cases. Keywords: Endometrium; Simple hyperplasia; Complex hyperplasia; Endometritis; Endometrial Carcinoma. DOI: 10.3126/jpn.v1i1.4443 Journal of Pathology of Nepal (2011) Vol.1, 13-16

Oral cavity lesions: A study of 21 cases

Abstract: Background: Development of lesions in the oral cavity is strongly linked with smoking and alcohol consumption. Non neoplastic lesions are mainly inflammatory conditions. It has been seen that the benign lesions are more common than malignant. Materials and methods: This was a retrospective study carried out in the Department of Histopathology of Helping Hands Community Hospital during a period of one and a half years from January 2009 to June 2010. The study included 21 cases of oral cavity lesions. Results: The most common site was lip with 9 cases (42.8%) followed by buccal cavity with 5 cases (23.8%). Out of the 21 cases of oral cavity lesions, 20 cases (95.2%) were benign and 1 case (4.8%) was malignant. The malignant lesion was a case of squamous cell carcinoma of soft palate. Conclusion: Any oral cavity lesion should have a tissue diagnosis for rational management of the case and to avoid mutilating surgery. Keywords: Oral cavity; Fibroma; Mucocele DOI: 10.3126/jpn.v1i1.4452 Journal of Pathology of Nepal (2011) Vol.1, 49-51

Glomus tumor of uncertain malignant potential

Abstract: Glomus tumors closely resemble the normal glomus body and have a predilection for skin and subcutaneous tissue. Clinically, Glomus tumors are present on the nail bed and are of less than 1 cm. We report a case of a male who presented with a 3 month history of swelling in the left thumb which was mildly tender. The swelling measured 6 x 6.5 cm. On microscopy the tumor showed mild atypia with increased mitotic activity. These features, by current definition, would suggest uncertain malignant potential. Keywords: Glomus tumor; Glomangioma; Merkel cell carcinoma. DOI: 10.3126/jpn.v1i1.4457 Journal of Pathology of Nepal (2011) Vol.1, 66-68

Idiopathic myelofibrosis mimicking hemolytic anemia

Abstract: Idiopathic Myelofibrosis is an infrequent chronic myeloproliferative disorder characterized by varying degrees of bone marrow fibrosis and extra medullary hematopoiesis, with the fibrosis being a reactive phenomenon to a neoplastic proliferation of a pluripotent hematopoietic stem cell. Idiopathic Myelofibrosis is heterogeneous in presentation and clinical course, with anemia being one of the most important problems. We present a case of a 59 year old male who presented with severe anemia, the peripheral blood picture mimicking hemolysis with numerous schistocytes and teardrop cells. Journal of Pathology of Nepal (2012) Vol. 2, 323-327 DOI: http://dx.doi.org/10.3126/jpn.v2i4.6888

Histopathological study of malignant lesion of Cervix in a tertiary care hospital of Nepal

Abstract: Background and objectives: Like in other developing countries, cancer of cervix is one of the leading malignancies in women in Nepal. In Nepal cervical pap-smear screening is not done my most of due to lack of awareness. The objective of this study is to find the prevalence of abnormal cervical epithelial lesions. Materials and methods: This was a retrospective study of 140 hysterectomy specimen reported from the Department of Pathology, Birat Medical College in Biratnagar. All tissue blocks of cervical tissues were retrieved, stained by Haematoxyline and Eosin (H & E) stain and re-examined. All the case was reviewed by consultant pathologist of Birat medical college. Results: In the present study out of 140 cases 08 ie. 5.71% have cervical epithelial neoplasia I. 1.42% cases is of CINII, 0.71 is of CINIII and 2.85% is squamous cell carcinoma. Conclusion: This study has demonstrated that 10.69% of the examined cases were abnormal. The squamous cell carcinoma is leading cancer in our study ie. 2.85%. In developing countries if patient is detected with abnormal pap smears then hysterectomy is indicated.

Atypical uterine bleeding-Histopathological audit of endometrium A study of 638 cases

Abstract: Background: AUB is one of the most common problems in women of all ages especially those in the peri-menopausal age group. The abnormal bleeding can be caused by a wide variety of disorders and it is one of the commonest complaints leading to endometrial sampling. Objectives: Our study aimed at determining the types and frequencies of endometrial pathologies in patients presenting with abnormal uterine bleeding at our hospital which caters largely to women of low socioeconomic status. Material and Methods: The present study was conducted at the Hakeem Abdul Hameed Centenary Hospital, New Delhi. This was a retrospective age specific comparative analysis of 638 women presenting with abnormal uterine bleeding, who underwent endometrial sampling at our hospital. The pattern of endometrial histopathological changes were identified and classified. Results: Age of the patients ranged from 15 to 70 years, maximum patients (35.89 %) in the age group 41-50 years. The most common clinical presentation was represented by menorrhagia (41%) Various patterns on histopathology were secretory endometrium(28.99%)the commonest, followed by proliferative endometrium (24.92%). Incidence of malignancy was low in the present study. Conclusion: Endometrial curetting and biopsy is an important diagnostic procedure in evaluation of AUB.. Endometrial causes of AUB are age related, therefore it is specially recommended in women of the perimenopausal age presenting with AUB, to rule out preneoplasia and malignancy.

Histopathological pattern of abnormal uterine bleeding in endometrial biopsies.

Abstract: Abnormal uterine bleeding is a common presenting complaint in gyanecology out patient department. Histopathological evaluation of the endometrial samples plays a significant role in the diagnosis of abnormal uterine bleeding. This study was carried out to determine the histopathological pattern of the endometrium in women of various age groups presenting with abnormal uterine bleeding. Endometrial biopsies and curettings of patients presenting with abnormal uterine bleeding was retrospectively studied. A total of 403 endometrial biopsies and curettings were analyzed. The age of the patients ranged from 18 to 70 years. Normal cyclical endometrium was seen in 165 (40.94%) cases, followed by 54 (13.40%) cases of disordered proliferative endometrium and 44 (10.92%) cases of hyperplasia. Malignancy was seen in 10 (2.48%) cases. Hyperplasia and malignancy were more common in the perimenopausal and postmenopausal age groups. Histopathological examination of endometrial biopsies and curettings in patients presenting with abnormal uterine bleeding showed a wide spectrum of changes ranging from normal endometrium to malignancy. Endometrial evaluation is specially recommended in women of perimenopausal and postmenopausal age groups presenting with AUB, to rule out a possibility of any preneoplastic condition or malignancy.

Morphological Spectrum of Endometrium in Patients Presenting with Dysfunc- tional Uterine Bleeding

Abstract: Dysfunctional uterine bleeding (DUB) is a clinical term used to describe bleeding not attributable to any underlying organic pathological condition. A total of 187 patients were included in the present study which were categorized in reproductive ( 50yrs) age groups. One hundred sixteen cases (62%) were in reproductive age group, 47 cases (25.1%) in perimenopausa l age group and 24 cases (12.8%) in postmenopausa l age group. Histopathological examination of dilatation and curettage (D&C) samples was done to elucidate the cause of DUB. In reproductive age group, proliferative endometrium was the most common finding (26.8%) followed by irregular maturation (25%).Complex hyperplasia was seen in 6 cases, out of which 1 case showed atypia. Nineteen cases (16.4%) showed associated endometritis. No case of malignancy was observed in this group. In perimenopausal age group, simple hyperplasia was the most frequent finding (29.8%).Complex hyperplasia was seen in 3 cases, out of which 1 revealed atypia. Three cases of malignancy (6.4%) were reported. In postmenopausal age group, most frequent finding in DUB was complex hyperplasia seen in 8 cases (33.3%), out of which 2 cases showed atypia. Six cases (25%) of simple hyperplasia and 4 cases (16.7%) of malignancy were reported. Atrophic endometrium was observed in D&C samples from 6 patients (25%).

Study of histopathological patterns of endometrium in abnormal uterine bleeding

Abstract: Background: Abnormal uterine bleeding (AUB) is a common gynecological complaint associated with considerable morbidity and significantly affects the patient's family, personal and social life. The aim of the study was to analyze the histomorphological patterns of endometrium in patients presenting with AUB and also to determine the incidence of AUB in various age groups. Materials and Methods: This is a prospective study, conducted in the Department of Pathology, in a tertiary care teaching hospital, Mangalore from October 2011 till date. All cases of AUB with a probable endometrial cause were included in the study. Data was entered in Microsoft Excel and managed in Statistical Package for the Social Sciences (SPSS) version 16. Analysis was done in the form of percentages and proportions and represented as tables where necessary. Results: A total of 156 cases were analyzed. Patients' age ranged from 23-78 years. AUB was most prevalent in the perimenopausal age group. The most common presenting complaint was menorrhagia (47%). Endometrial hyperplasia was the most common histopathological finding and was seen in 25% patients, followed by secretory endometrium in 16.7% patients, and proliferative phase pattern and disordered proliferative endometrium were seen in 12.2% patients each. Malignancy was detected in 6.4% of cases and endometrial carcinoma was the most common lesion (4.5%). Conclusions: Histopathological evaluation of endometrial samples is especially indicated in women over the age of 35 years to rule out malignancy and preneoplasia. Among the patients with no organic pathology, normal physiological patterns with proliferative, secretory, and menstrual changes were observed. The most common endometrial pathology in this series was endometrial hyperplasia.

Clinicopathological Spectrum of Endometrial Changes in Peri-menopausal and Post-menopausal Abnormal Uterine Bleeding: A 2 Years Study

Abstract: Background: Abnormal uterine bleeding is the Common pre­ senting complaint in Gynaecology Outpatient Department in all age groups. It is due to the anovulatory cycles which are commonly seen in adolescent and peri­menopausal women. Abnormal uterine bleeding is caused by wide variety of organic or non­organic causes. Histopathological examination of endometrial sample remains the gold standard for diagnosis of endometrial pathology. Aim: To study the clinicopathological spectrum of endometrium in abnormal uterine bleeding in peri­menopausal and post­ menopausal age groups. Material and Methods: The study included prospective analysis of 119 cases of endometrial samples in patients of abnormal uterine bleeding above 40 years of age. The specimens were routinely processed and H&E stained slides were studied. Patients were categorized into peri­menopausal (40­49 years) and post­ menopausal (> 50 years) age group. Results: A total of 119 specimens of endometrium were analyzed. Maximum number (73.94%) of cases were from peri­ menopausal age group. The most common presenting complaint was menorrhagia (48.86%) followed by post­menopausal bleeding (26.05%). In peri­menopausal age group proliferative endometrium (35.22%) was the predominant histopathological pattern followed by endo metrial hyperplasia (23.86%). Atrophic endometrium (25.80%) was the most frequent finding followed by endometrial hyperplasia (19.35%) in post­menopausal age group. Three cases of endometrial carcinoma were reported in post­ menopausal age group only. Conclusion: A thorough histopathological work up and clinical correlation is mandatory in cases of abnormal uterine bleeding above the age of 40 years to find out organic lesions. Careful screening can detect early cancer of endometrium which has excellent prognosis and it will help in further management.