Showing papers in "Journal of Pathology of Nepal in 2011"
TL;DR: At least one Pap screening test of the cervix of all women between the ages of 40-50 years is recommended and eighty per cent of all the abnormal epithelial lesions were found in women above the age of 40 years.
Abstract: Background: Like in other developing countries, cancer of cervix is one of the most common malignancies in women in Nepal. Most women never undergo a cervical Pap smear screening. The objective of this study is to determine the prevalence of abnormal cervical epithelial lesions. Materials and Methods: This was a retrospective study of 880 conventional cervical Pap smears reported from the Department of Pathology, Chitwan Medical College in Chitwan, Nepal. The time period was from June 2009 to November 2010. Results: In this study, High-grade Squamous Intraepithelial Lesion was the most common with 6 cases (40%), followed by Low-grade Squamous Intraepithelial Lesion with 3 cases (20%), then Atypical Squamous Epithelial Cells of Undetermined Significance, and atypical Glandular Cells and Squamous cell carcinoma with 2 cases each (13.3%). Eighty per cent of all the abnormal epithelial lesions were found in women above the age of 40 years. Conclusion: At least one Pap screening test of the cervix of all women between the ages of 40-50 years is recommended. Keywords: Pap smear; Cervical Intraepithelial Lesion; Squamous cell carcinoma. DOI: 10.3126/jpn.v1i1.4447 Journal of Pathology of Nepal (2011) Vol.1, 30-33
52 citations
TL;DR: 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, and studying the histopathological pattern is to help in correctly managing the cases.
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
48 citations
TL;DR: Fine needle aspiration cytology of lymphadenoathy is a useful tool in diagnosing metastatic lesions with good certainty in developing countries like Nepal.
Abstract: Background: Fine needle aspiration cytology is a reliable as well as an inexpensive diagnostic method. It is suitable for the developing countries like Nepal for the diagnosis of lymphadenopathy at any approachable site. Fine needle aspiration cytology not only confirms the presence of metastatic disease but also, in most cases, gives the clue regarding the origin of the primary tumor. The aim of the study was to find out the cytological diagnosis of metastatic lymph node lesions. Materials and Methods: A combined prospective and retrospective study was done of all metastatic lymph node lesions (including both superficial and deep nodes) reported in Department of Pathology, Manipal Teaching Hospital, Pokhara from January 2005 to Deceember 2010. Results: A total of 4180 cases of fine needle aspiration cytology were carried out of which 508 cases were of lymph node. Cytology results were unsatisfactory in 58 specimens (12%), “reactive” or “infective” in 347 specimens (68%), positive for metastasis in 93 specimens (18%) and hematolymphoid malignancies include 10 cases (2%). The most common site was anterior and posterior triangles cervical nodes. The most common malignancy was adenocarcinoma, seen in 62 cases (67%), followed by metastatic squamous cells carcinoma (14 cases, 15%). Conclusion: Fine needle aspiration cytology of lymphadenoathy is a useful tool in diagnosing metastatic lesions with good certainty. Keywords: Fine needle aspiration cytology; Lymphadenopathy; Metastasis DOI: http://dx.doi.org/10.3126/jpn.v1i2.5399 JPN 2011; 1(2): 92-95
37 citations
TL;DR: It can be concluded that histopathology plays an important role in classification of leprosy, and in diagnosis and management of a variety of granulomatous skin diseases.
Abstract: Background: Granulomatous skin lesions often present as a diagnostic challenge to dermatopathologists due to various modes of presentation and identical histological picture produced by several causes. The aim of the study was to study different granulomatous skin lesions and to determine the relative frequency, the level of clinicopathologic concordance and to compare our results with those of other workers. Materials and Methods : A retrospective analysis of skin biopsies received over a period of two years from January 2007 to December 2008; was performed, and cases of granulomatous dermatitis reported on histopathological examination were reviewed along with special stains. Results: Out of a total of 1590 skin biopsies 106 (6.67%) cases were found to have a granulomatous reaction. It was common in males (63.21%) with most occurring in the fourth to fifth decades. Majority of cases (79 cases, 74.5%) were categorized as infectious granulomatous lesions with predominance of leprosy (63 cases, 79.7%) followed by tuberculosis (6 cases, 7.6%). An overall clinicopathologic concordance was seen in 97% of cases of leprosy. Conclusion: In this study leprosy is the most common cause of granulomatous skin lesions. It can be concluded that histopathology plays an important role in classification of leprosy, and in diagnosis and management of a variety of granulomatous skin diseases. Special stains play a supportive role in infectious granulomas. Keywords: Granulomatous skin lesion; Leprosy; Skin biopsy DOI: http://dx.doi.org/10.3126/jpn.v1i2.5397 JPN 2011; 1(2): 81-86
27 citations
TL;DR: The most frequent type of CNS tumors in this study was astrocytoma, followed by meningioma and metastatic tumor, and the ratio of male to female for all CNS tumors was 0.9:1.
Abstract: Background: There is no documented data regarding the histopathological spectrum of the central nervous system (CNS) tumors in Nepal. The aim of this study was to establish the relative frequency of biopsy proven tumors of the CNS from a single university hospital in Nepal. Materials and Methods: In the period between1998-2000, we retrospectively analyzed data on 57 patients (28 male and 29 female) diagnosed with CNS tumors according to the World Health Organization’s diagnostic criteria. Patient data were retrieved from the archives of the department of Pathology, Nepal Medical College. Results: A total of 57 CNS tumors were diagnosed during a three year period. Of these, 49 (86%) were primary, and 8 (14%) were metastatic. The most frequent type of CNS tumors was astrocytoma (22 cases, 38.6%), followed by meningioma (8 cases, 14%) and metastatic tumor (8 cases, 14%). Among the 8 metastatic tumors, the most common histologic type was adenocarcinoma (7 cases, 87.5%). Conclusion: The most frequent type of CNS tumors in this study was astrocytoma, followed by meningioma and metastatic tumor. The ratio of male to female for all CNS tumors was 0.9:1. Female outnumbered male in meningioma (1:0.3). Keywords: Astrocytoma; Meningioma; Tumor; Nepal; Central nervous system DOI: 10.3126/jpn.v1i1.4445 Journal of Pathology of Nepal (2011) Vol.1, 22-25
26 citations
TL;DR: Benign mediastinum lesions are more common than malignant lesions with thymoma being the most commonly diagnosed mediastinal lesion.
Abstract: Background: Mediastinum is a site of non-neoplastic and neoplastic lesions, many of which present as mediastinal masses. The purpose of this study was to study our institutional experience of mediastinal lesions on fine needle aspiration cytology or biopsy. Materials and Methods: This was a retrospective study of 27 patients, who had undergone fine needle aspiration cytology or biopsy for mediastinal lesions from April 2009 to November 2010 in the Department of Pathology, Institute of Medicine, Tribhuwan University Teaching Hospital. All details of the patients pertinent clinical history was obtained from case record file in the department. Results: Out of 27 cases, 18 cases (66.6%) were benign and 7 (26%) were malignant and 2 (7.4%) were inconclusive. Among the malignant lesions, primary tumors constituted 71.5% of cases while metastases were 28.5%. Most of the lesions were seen in the anterior compartment followed by the posterior compartment. Age range was 4 months to 70 years with a mean age of 35.5 years. Thymoma (8 cases) was the commonest lesion seen in mediastinum followed by germ cell tumor and neurogenic tumor. Conclusion: Benign mediastinal lesions are more common than malignant lesions with thymoma being the most commonly diagnosed mediastinal lesion. Keywords: Mediastinum; Germ cell tumor; Thymoma; Non Hodgkin Lymphoma DOI: http://dx.doi.org/10.3126/jpn.v1i2.5404 JPN 2011; 1(2): 114-117
24 citations
TL;DR: Regular monitoring of CD4 counts and screening for these opportunistic agents in the HIV infected will help reduce the mortality and morbidity associated with infections by these agents.
Abstract: Background: Opportunistic intestinal infections cause a significant morbidity and mortality among the HIV infected people. The present study was undertaken to find the prevalence of intestinal opportunistic parasitic infections among the HIV infected populace in eastern Nepal and to correlate the occurrence with the CD4 T cell counts. Materials and Methods: Stool from 122 HIV infected people were examined microscopically for the presence of parasitic ova/cyst. CD4 T cell enumeration was done using FACS Count (Becton Dickinson). Stool from 100 age matched HIV negative controls were also examined. Results: A male preponderance in the parasite positivity was seen. Twenty five of symptomatic and 2.8% of asymptomatic harboured one or more intestinal parasites.12.3% of the study population had intestinal parasitoses with 7.3% being infected with opportunistic parasites. The mean CD4 count of the subjects was 307 while those with parasitoses were 204. A statistically significant difference was seen between the CD4 counts of symptomatic and asymptomatic patients. Conclusion: Coccidian parasites are frequent opportunistic intestinal parasites infecting HIV infected patients. A lowered CD4 count predisposes to acquisition of these agents. Regular monitoring of CD4 counts and screening for these opportunistic agents in the HIV infected will help reduce the mortality and morbidity associated with infections by these agents. Keywords: HIV; Opportunistic infection; CD4 count; AIDS DOI: http://dx.doi.org/10.3126/jpn.v1i2.5405 JPN 2011; 1(2): 118-121
21 citations
TL;DR: Bronchial brushing, forceps biopsy and transthoracic needle aspiration are complimentary in diagnosis of various lung malignancies whereas broncho-alveolar lavage is a useful procedure in detection of infections diseases.
Abstract: Background: The use of cytological methods in the diagnosis of malignant lesions of the respiratory tract has been generally acclaimed as one of its most successful applications. Flexible fiberoptic bronchoscopy revolutionized respiratory cytology, as bronchial brushings, broncho-alveolar lavage and bronchial forceps biopsy became more easy, accessible and popular, shifting the emphasis from diagnosis of advanced malignancy in inoperable patients to the use of cytology as a first line diagnostic and management tool. Respiratory tract cytology is well established throughout the world as a diagnostic procedure in the evaluation of patient with suspected lung malignancy. Materials and Methods: A prospective study was conducted on 50 patients divided in two groups who underwent fiberoptic bronchoscopy during the period from November 2007 to October 2008 at the Department of Cardiovascular and Thoracic Unit, Bir Hospital. Group I consisted of 35 cases of suspected lung malignancy on clinical and radiological examination, while group II consisted of 15 cases of non-neoplastic lung diseases. Results: Bronchial brushing and forceps biopsy showed a sensitivity of 50% and 84.21% respectively in the diagnosis of malignancy. Broncho-alveolar lavage revealed malignancy in 66.7% patients. Transthoracic needle aspiration had the highest sensitivity of 100% whereas bronchial wash was revealed malignancy only in 17.4% of the cases. Conclusion: Combination of various cytohistological techniques complements each other and enhances the diagnostic efficacy of various neoplastic and non-neoplastic lung diseases. Bronchial brushing, forceps biopsy and transthoracic needle aspiration are complimentary in diagnosis of various lung malignancies whereas broncho-alveolar lavage is a useful procedure in detection of infections diseases. Keywords: Fiberoptic bronchoscopy; Lund cancer; Infection; Cytohistologic technique DOI: http://dx.doi.org/10.3126/jpn.v1i2.5407 JPN 2011; 1(2): 126-130
19 citations
TL;DR: This retrospective study found that Ultrasonography and computed tomography guided fine needle aspiration cytology had a high sensitivity and specificity in diagnosing deep seated lesions.
Abstract: Background: Ultrasonography and computed tomography guided fine needle aspiration cytology has an important role in diagnosing intraabdominal and intrathoracic mass lesions. It has an accuracy of 70-90%, depending on the site under evaluation. Materials and Methods: This retrospective study was done in the Department of Pathology, Kathmandu Model Hospital, between June 2006 and November 2010. The study included 53 abdominal and 47 thoracic masses. The cytological diagnosis was correlated with clinical and radiological data to arrive at a final diagnosis. Results: Fine needle aspiration cytology was performed in various anatomic sites: liver (28 cases), pancreas (8 cases), lymph nodes (7 cases), ovary and gall bladder (3 cases each) and 2 cases each of gastrointestinal tract and omentum. Thoracic aspirations were done from the lung (44 cases) and mediastinum (3 cases). The most common malignancy encountered in the abdomen was hepatocellular carcinoma (12 cases). Non-small cell carcinoma was the most common diagnoses amongst the lung lesions (15 cases). Conclusion: Ultrasonography and computed tomography guided fine needle aspiration cytology had a high sensitivity and specificity in diagnosing deep seated lesions. Keywords: Computed tomography; Deep-seated masses; Fine needle aspiration; Ultrasound DOI: 10.3126/jpn.v1i1.4444 Journal of Pathology of Nepal (2011) Vol.1, 17-21
19 citations
TL;DR: It is shown that fine needle aspiration cytology has a high sensitivity, specificity and diagnostic accuracy in diagnosing salivary gland lesions, especially when dealing with cystic and some malignant lesions.
Abstract: Background: A wide variety of benign and malignant tumours originate in the salivary glands and insufficient tumour cells make their diagnosis difficult in some patients. The aim of this study was to evaluate the efficacy of fine-needle aspiration cytology in the diagnosis of salivary gland lesions and to correlate cytological findings with histopathology. Materials and Methods: This was a prospective study done from September 2002 to May 2004. Fine needle aspiration cytology was performed in 58 patients with clinically significant salivary gland masses. Results: Fine needle aspiration cytology categorized 67.24% of the salivary gland lesions as neoplastic and 32.76% as non-neoplastic lesions. Amongst the neoplastic lesions, 76.9% were benign and 23.1% were malignant cases. Histopathological examination revealed that 81.05% of the cases were benign and 18.95% were malignant. Fine needle aspiration cytology had a sensitivity, specificity and diagnostic accuracy of 81.82%, 100% and 96.55%, respectively. The positive predictive value and negative predictive value was 100% and 95.9%, respectively. Conclusion: Fine needle aspiration of the salivary gland is a safe and reliable technique in the primary diagnosis of salivary gland lesions. Although, limitations are encountered while predicting specific lesions on cytology, especially when dealing with cystic and some malignant lesions, this study has shown that fine needle aspiration cytology has a high sensitivity, specificity and diagnostic accuracy in diagnosing salivary gland lesions. Keywords: Salivary glands; Fine needle aspiration cytology; Histopathology DOI: http://dx.doi.org/10.3126/jpn.v1i2.5403 JPN 2011; 1(2): 108-113
18 citations
TL;DR: Fibroadenoma was most common benign lesion and ductal carcinoma was the most common malignant lesion in women and fine needle aspiration cytology is highly sensitive and specific technique for diagnosis of most of the malignant and benign breast lesions.
Abstract: Background: Breast cancer is the common malignant lesion in women. Fine needle aspiration cytology has high sensitivity and specificity and is a simple, rapid and safe method to diagnose breast lesions. The aim of the study was to categorize breast lesions and correlate the Fine needle aspiration cytology diagnosis with histopatholoical findings. Materials and Methods: This was a retrospective study done in department of Pathology of Institute of medicine, Trivuwan university teaching hospital, from January 2007 to December 2010. There were 1403 FNAC cases and 469 histopathology cases. Fine needle aspiration correlation with histopathology was done in 249 cases. All the cases were categorized according to risk for cancers: Unsatisfactory sample, Inflammatory breast disease Benign proliferative breast disease without atypia, Benign proliferative breast disease with atypia, Suspicious for malignancy and Malignant lesions. Results: Benign breast lesions were common in the age group of 21-30 years and malignant breast lesion common in the age of 41-50 years of age. In our study fibroadenoma was most common benign lesion and ductal carcinoma was the most common malignant lesion. The sensitivity and specificity of FNAC for malignancy were found to be 98.2% and 98.5% respectively. Conclusion: Fine needle aspiration cytology is highly sensitive and specific technique for diagnosis of most of the malignant and benign breast lesions. Keywords: Fine needle aspiration cytology; Breast lesion; Breast cancer; Fibroadenoma DOI: http://dx.doi.org/10.3126/jpn.v1i2.5408 JPN 2011; 1(2): 131-135
TL;DR: The most frequent anemia in chronic kidney disease patients was normocytic and normochromic type of a moderate degree and significant correlation was not found between the severity of anemia and serum creatinine levels in both pre and postdialysis group of patients.
Abstract: Background: Chronic kidney disease is usually associated with anemia and the level of anemia correlates with the severity of renal failure. This study was carried out to evaluate the profile of anemia and to find the correlation between the severity of anemia and serum creatinine levels in predialysis and postdialysis Chronic kidney disease patients. Materials and Methods: A cross-sectional study was conducted in 40 chronic kidney disease patients in the department of pathology and nephrology, KIST Medical College. Hemoglobin, hematocrit, red cell indices, peripheral blood smears and serum creatinine levels were examined using standard techniques. Results: There was a significant difference in the hemoglobin and hematocrit levels in predialysis and postdialysis patients (P 0.05), r=-0.14 and -0.17 in predialysis and postdialysis group respectively. Conclusion: The most frequent anemia in chronic kidney disease patients was normocytic and normochromic type of a moderate degree. Significant correlation was not found between the severity of anemia and serum creatinine levels in both pre and postdialysis group of patients. Keywords: Chronic Kidney Disease; Anemia; Creatinine; Hemoglobin; Hematocrit; Hemodialysis DOI: 10.3126/jpn.v1i1.4446 Journal of Pathology of Nepal (2011) Vol.1, 26-29
TL;DR: Though there are other causes of acute abdomen, acute appendicitis still stands first amongst all the emergencies, Histopathological examination of appendectomy specimen should not be omitted in order to see the incidence negative appendectomy rate and to avoid complications relating to malignant conditions.
Abstract: Background: Acute appendicitis is the most common surgical emergency. Obstruction of the lumen by fecolith is the usual cause of acute appendicitis.The aim of the study was to analyze clinical presentation of acute appendicitis and its histopathological correlation. Materials and Methods: A retrospective study of acute appendicitis was done in the Department of Surgery of Helping Hands Community Hospital from January 2009 to December 2010. Three hundred forty five patients out of 415 patients with clinical diagnosis of appendicitis underwent operative treatment. The histopathological reports were reviewed and correlated with clinical diagnosis. Results: Out of 345 patients who underwent operative procedure 98% (n= 338) came with chief complaint of pain in the periumbilical region migrating to the right iliac fossa. The mean age of presentation was 42 years. Increased leucocyte count was seen in only 65% cases. Acute appendicitis was more commonly seen in male patients (214 cases, 62%). The most common per operative finding was acutely inflammed appendix (84%) followed by perforated appendix (7.5%), gangrenous appendix (3.5%) and appendicular lump (1.5%). However, histopathological diagnoses were acute appendicitis (91.9%), resolving appendicitis (3.5%), lymphoid hyperplasia (2.6%), mucocele (0.3%) and carcinoid (0.3%). Normal histology was seen in 1.4% cases. Conclusion: Though there are other causes of acute abdomen, acute appendicitis still stands first amongst all the emergencies. Histopathological examination of appendectomy specimen should not be omitted in order to see the incidence negative appendectomy rate and to avoid complications relating to malignant conditions. Keywords: Acute appendicitis; Appendectomy; Appendicular perforation; Histopathology DOI: http://dx.doi.org/10.3126/jpn.v1i2.5402 JPN 2011; 1(2): 104-107
TL;DR: In conclusion, immunohistochemistry is a valuable adjunct to routine hematoxylin and eosin staining for adequate and accurate categorization of malignant small round cell tumors.
Abstract: Background: Immunohistochemistry is a key tool for the analysis of localization of target molecules within tissues. It has a significant role in the identification of tumors lacking evidence of lineage differentiation on the basis of routine light microscopic morphology alone. Approximately 90% of tumors posing diagnostic difficulties by morphology could be accurately classified by exploiting immunohistochemistry. The aim of this study is to identify the true identity of malignant small round cell tumors by immunohistochemical analysis. Materials and Methods: This was a retrospective study done in Department of Histopathology of B.P.Koirala Memorial Cancer Hospital from January 2010 to April 2011.A total of 40 cases small round cell tumors were selected for immunostaining. The immunohistochemistry technique used is the Polymer detection-EnvisionTM System, a two step staining technique based on Horse Radish Peroxidase labeled dextran polymer technology (DAKO Company). Results: Out of 40 cases of malignant small round cell tumors, there were 21 cases (52.5%) of Non- Hodgkin Lymphoma , 11 cases (27.5%) of Ewing’s Sarcoma/Primitive Neuroectodermal Tumor, 1 case (2.5%) of Lymphoblastic Lymphoma , 1 case (2.5%) of Rhabdomyosarcoma, 2 cases (5%) of Low grade neuroendocrine tumor, 1 case (2.5%) of Neuroblastoma, 2 cases (5%) of Poorly differentiated Synovial Sarcoma (small cell variant), 1case (2.5%) of Malignant Melanoma (small cell variant). Conclusion: Immunohistochemistry is a valuable adjunct to routine hematoxylin and eosin staining for adequate and accurate categorization of malignant small round cell tumors. Keywords: Immunohistochemistry; Malignant Small Round Cell Tumor; Non Hodgkin’s Lymphoma; Ewing’s Sarcoma; Rhabdomyosarcoma DOI: http://dx.doi.org/10.3126/jpn.v1i2.5398 JPN 2011; 1(2): 87-91
TL;DR: Any oral cavity lesion should have a tissue diagnosis for rational management of the case and to avoid mutilating surgery, according to the author.
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
TL;DR: In this article, the authors used immunohistochemistry to evaluate the expression of estrogen and progesterone in relation to histological grade of tumor and found that the expression is comparable to west with Estrogen and Progesterone showing inverse association with histological grades of tumor.
Abstract: Background: Breast carcinoma is the most common malignancy diagnosed among women worldwide and second leading cause of cancer mortality. One of the hallmarks of the disease is expression of estrogen receptor and progesterone receptor that ultimately drives prognosis and treatment modalities of the patient. The objective of this study was to determine the Estrogen and Progesterone receptor status in relation to histological grade of tumor. Materials and Methods: This was an observational study, carried out in the department of Pathology, BP Koirala Memorial cancer Hospital, Bharatpur, from January 2010 to December 2010. A total of 136 patients with histological proven diagnosis of breast carcinoma was included in this study. These cases were graded according to the modified Bloom and Richardson criteria into three histological grades. We used immunohistochemistry to evaluate the expression of Estrogen and Progesterone in relation to histological grade of tumor. Results: Out of 136 cases, there were 131 (96%) cases of infiltrating ductal carcinoma with mean age of 48 years. Majority of cases were grade II (59%) followed by grade III (21%) and grade I (20%). Estrogen Receptor and Progesterone Receptor expression were seen in 28% and 19% respectively. In grade I, 16 (59%) and 10 (37%) cases out of 27 were Estrogen Receptor and Progesterone Receptor positive respectively. In grade II, 21 (26%) and 15(19%) out of 80 cases were Estrogen Receptor and Progesterone Receptor positive respectively. In grade III, 1(3%) and 1 (3%) cases were positive for Estrogen Receptor and Progesterone Receptor respectively. Conclusions: Expression of estrogen and progesterone is comparable to west with Estrogen and Progesterone showing inverse association with histological grades of tumor. Keywords: Breast carcinoma; Estrogen receptor; Progesterone receptor DOI: http://dx.doi.org/10.3126/jpn.v1i2.5401 JPN 2011; 1(2): 100-103
TL;DR: Fine needle aspiration cytology can diagnose a variety of skin lesions which may be supportive in diagnosing a metastasis in cases with known primaries or it may offer a clue to underlying malignancy in unsuspected cases.
Abstract: Background: Cutaneous and subcutaneous metastasis from an underlying primary, indicates a dismal outcome for patients. It is appropriate to use fine needle aspiration cytology as a minimally invasive method for diagnosis. This study emphasises the role of fine needle aspiration cytology in diagnosing metastatic skin nodules. Materials and methods: This was a retrospective study in which the record of all patients subjected to fine needle aspiration cytology from April 2008 – Nov 2010 in the Department of Pathology, Tribhuvan University Teaching Hospital, were reviewed. Of 5,927 patients, 19 cases diagnosed as metastatic skin lesions were included in the study. Results: Out of 19 patients with metastatic skin nodules, 9 patients had metastasis simultaneously with the primary and 8 cases were previously diagnosed. All metastases were from internal solid organ tumours with male to female ratio of 1.7:1. Lung carcinoma was the most common to metastasis in both sexes which included adenocarcinoma (5 cases) and squamous cell carcinoma (6 cases). Common sites for cutaneous/subcutaneous metastasis were the chest wall (9 cases) followed by abdomen (4 cases) and scalp (3 cases). Conclusion: Fine needle aspiration cytology can diagnose a variety of skin lesions which may be supportive in diagnosing a metastasis in cases with known primaries or it may offer a clue to underlying malignancy in unsuspected cases. Keywords: Fine needle aspiration; Cutaneous metastases DOI: 10.3126/jpn.v1i1.4449 Journal of Pathology of Nepal (2011) Vol.1, 37-40
TL;DR: The view that most granulosa cell tumors are diagnosed in stage I and there is good correlation between radiological and gross findings in terms of tumor size and solid or cystic status is supported.
Abstract: Background: Ovarian granulosa cell tumors are rare malignant neoplasms that originate from the sexcord stromal cells of the ovary. The study aims to collate data of all granulosa cell tumors diagnosed in Tribhuvan University Teaching Hospital over the last 3 years and to describe the incidence, patient profile, ultrasonographic and histopathologic findings in our local context. Materials and Methods: A total of 6 (5%) granulosa cell tumors, diagnosed in Tribhuvan University Teaching Hospital during the period from April 2008 to March 2011. The patient’s age, symptoms, radiological findings, type of surgery performed, tumor size and follow-up status were evaluated. Results: All 6 patients were diagnosed as adult granulosa cell tumor, three of which were postmenopausal (50%) and remaining there was premenopausal. The symptoms recorded were uterine bleeding, abdominal pain, distention and mass. Grossly, in 3 cases granulosa cell tumors were solid and firm, in 2 cases solid and cystic and 1 case is predominantly cystic. Histologically, variety of patterns including diffuse, trabecular, cords, tubular, nesting and Call-Exner bodies were found. Nuclear grooves were observed in all cases. Follow up on 2 patients revealed no evidence of recurrence. Conclusion: This study supports the view that most granulosa cell tumors are diagnosed in stage I and there is good correlation between radiological and gross findings in terms of tumor size and solid or cystic status. Keywords: Granulosa cell tumor; Ovary; Histopathological findings DOI: http://dx.doi.org/10.3126/jpn.v1i2.5400 JPN 2011; 1(2): 96-99
TL;DR: The fine needle aspiration cytology can be used as a first line investigation in the evaluation of supraclavicular lymphadenopathy due to its low cost, simplicity and minimal invasiveness.
Abstract: Background: Fine needle aspiration cytology as a first line of investigation has assumed importance in diagnosing a variety of disease process. The aim of this study was to assess the diagnostic value of fine needle aspiration cytology in the evaluation of palpable supraclavicular lymph nodes. Materials and methods: This was a retrospective study of fine needle aspiration cytology of palpable supraclavicular lymph node done between January 1, 2007 and December 31, 2009. Fine needle aspiration cytology was performed on 149 patients (49 cases at Om Hospital & Research Centre and 100 cases at Tribhuvan University Teaching Hospital). Results: The right supraclavicular lymph node was enlarged in 55% cases, while the left supraclavicular lymph node alone was palpable in 40.3% cases and in 7 of 149 (4.7%) cases, bilateral supraclavicular lymph nodes were palpable. Cytological diagnoses were categorized as reactive (8.7%), tuberculosis (41.6%), lymphoma (4.8%) and metastasis (44.9%). Of a total of 74 cases of malignancy, 90.5% were non-lymphoid and 9.5% were lymphoid (5 Non-Hodgkin lymphoma and 2 Hodgkin lymphoma). Of the 67 cases of metastatic disease, three major types of malignancy found in supraclavicular lymph nodes were Squamous cell carcinoma (28 cases), adenocarcinoma (21 cases) and others (small cell carcinoma, papillary thyroid carcinoma etc). Adenocarcinoma tended to metastasize to the left supraclavicular lymph node. Lung was the most common primary site (43.3%), followed by stomach, ovary, breast and larynx. However, in 28.4% cases, no primary site was found. Conclusion: The fine needle aspiration cytology can be used as a first line investigation in the evaluation of supraclavicular lymphadenopathy due to its low cost, simplicity and minimal invasiveness. Keywords: Supraclavicular lymph node; Fine needle aspiration cytology; Metastasis DOI: 10.3126/jpn.v1i1.4441 Journal of Pathology of Nepal (2011) Vol.1, 8-12
TL;DR: Tumor size is not a reliable predictor of systemic metastasis or tumor rupture for splenic undifferentiated pleomorphic sarcoma and a case of 77-year old male patient with a past history of dissecting aortic aneurysm that developed acute hemorrhagic shock is reported.
Abstract: (The order of authors on this article was changed on 09/01/2012.) Primary undifferentiated pleomorphic sarcoma of the spleen is a rare and highly aggressive neoplasm that usually presents with splenomegaly, constitutional symptoms and frequent distant metastases. We report a case of 77-year old male patient with a past history of dissecting aortic aneurysm that developed acute hemorrhagic shock. Aneurysmal rupture was clinically suspected, but the postmortem examination revealed a 25 mm-sized tumor in an atrophic spleen weighing 65 gram with massive retroperitoneal bleeding. Metastases were found in the right renal hilus, the right adrenal gland and femoral bone marrow. Histology of the tumor showed undifferentiated pleomorphic sarcoma. Tumor rupture with fatal bleeding and systemic metastases had occurred despite the small size of the tumor. Tumor size is not a reliable predictor of systemic metastasis or tumor rupture for splenic undifferentiated pleomorphic sarcoma. Keywords: Undifferentiated pleomorphic sarcoma; Malignant fibrous histiocytoma; Splenic neoplasms; Retroperitoneal hemorrhage DOI: http://dx.doi.org/10.3126/jpn.v1i2.5411 JPN 2011; 1(2): 151-153
TL;DR: Due to the markedly aggressive nature of this tumor and its association with areas of endemic thyroid disease, early diagnosis and aggressive therapy is essential, especially in the Himalayan and Sub-Himalayan belt.
Abstract: Background: Thyroid cancer is fairly common. The worldwide annual incidence ranges from 0.5 to 10 cases per 100,000 people. Anaplastic thyroid carcinoma, comprising less than 10% of all thyroid carcinomas, remains one of the most virulent of all cancers in humans with a 10 year survival rate of only 0.1 %. In the present study we looked into the clinical, cytological and histological spectrum of anaplastic carcinoma and compared our experience with recent literature. Materials and Methods: This was a hospital based retrospective study from January 2000 to November 2010. Clinical, cytological and histopathological data of all the diagnosed anaplastic thyroid carcinoma cases were reviewed and analyzed. Results: Of the 59 thyroid malignancies diagnosed in the same period, 7 cases were anaplastic carcinoma. The mean age was 63 years and was predominantly found in females. All of the cases presented with a neck mass that lasted for a mean of 5.7 months. The mean tumor size was 14.9 cm and the most common sub-type was the spindle cell type. Atypical mitosis of more than 5 per high power field and necrosis was noted in all cases. Conclusion: Due to the markedly aggressive nature of this tumor and its association with areas of endemic thyroid disease, early diagnosis and aggressive therapy is essential, especially in the Himalayan and Sub-Himalayan belt. Keywords: Anaplastic carcinoma; Thyroid carcinoma; Spindle cell variant DOI: 10.3126/jpn.v1i1.4451 Journal of Pathology of Nepal (2011) Vol.1, 45-48
TL;DR: There are 3 factors required to help ensure a successful renal transplantation program: A well legislated donor and recipient program, Human Leukocyte Antigen testing (pre and post transplant), as well as a post transplant follow up program.
Abstract: End Stage Renal Disease affects many people in the world. There are three methods of renal replacement therapy available to patients: Continuous ambulatory peritoneal dialysis, haemodialysis and transplantation. Transplantation is the most viable and cost effective form of renal replacement therapy that is available for these patients. There are 3 factors required to help ensure a successful renal transplantation program: A well legislated donor and recipient program, Human Leukocyte Antigen testing (pre and post transplant), as well as a post transplant follow up program. Keywords: Renal Transplant; South Asia; Nepal; Human Leukocyte Antigen DOI: 10.3126/jpn.v1i1.4453 Journal of Pathology of Nepal (2011) Vol.1, 52-55
TL;DR: A case of castleman disease adjacent to the right pulmonary hilum loosely adherent to the interlobar branch of theright pulmonary artery that mimicked tuberculosis or malignancy in a 30-year-old man who underwent curative surgical removal of the mass is described.
Abstract: Castleman disease is a rare disorder of the lymphoid system characterized by noncancerous growths that may develop in lymph node tissues throughout the body. Most often this occurs in the neck, mediastinum, and abdomen where lymph nodes aggregate. The etiology is thought to be due to antigenic hyperstimulation of unknown origin. Two histological subtypes are described with different clinical presentations and therapeutic implications. Diagnosis is frequently accomplished only by histological analysis after surgery since no specific features have been found in imaging studies. Surgical excision is both diagnostic and curative in localized forms, whereas additional therapies are required in multicentric forms. Here we describe a case of castleman disease adjacent to the right pulmonary hilum loosely adherent to the interlobar branch of the right pulmonary artery that mimicked tuberculosis or malignancy in a 30-year-old man who underwent curative surgical removal of the mass. Keywords: Castleman disease; Pulmonary malignancy; IL-6; HHV-8; Kaposi sarcoma DOI: 10.3126/jpn.v1i1.4456 Journal of Pathology of Nepal (2011) Vol.1, 63-65
TL;DR: A systematic approach leads to a workable preliminary diagnosis, assures adequate tissue sampling for histological processing and guides the management team to explain the prognosis to the patient party and plan optimal treatment even before the final histological diagnosis is available.
Abstract: Smear cytology has been accepted as a suitable alternative to frozen section in intraoperative consultation of central nervous system tumours. Intraoperative smears from neurosurgical specimens permit rapid and accurate diagnosis. Grading of primary tumours may not be always possible on intraoperative smears, but their division into low or high-grade lesions is highly reliable and reproducible if due attention is paid to certain parameters like nuclear atypia, mitotic figures and necrosis. A systematic approach leads to a workable preliminary diagnosis, assures adequate tissue sampling for histological processing and guides the management team to explain the prognosis to the patient party and plan optimal treatment even before the final histological diagnosis is available. Keywords: Intraoperative consultation; Smear cytology; Central nervous system neoplasm DOI: http://dx.doi.org/10.3126/jpn.v1i2.5409 JPN 2011; 1(2): 136-141
TL;DR: The role of Helicobacter hepaticus infection as a nidus for formation of gallstone that ultimately leads to malignancy is controversial and its dominant role in the pathogenesis of carcinoma is yet to be determined.
Abstract: Background: Chronic cholecystitis due to cholelithiasis is one of the most common hepatobiliary surgical disorders. Bacteria are found in high concentration in bile and stone. Helicobacter hepaticus is a gram negative, micro-aerobic bacterium, curved to spiral in shape which shows positivity with urease, catalase and oxidase. Bacterial infection may be one of the causes for the pathogenesis of gallstone formation as most gallstones are colonized by a bacterial biofilm. Materials and Methods: This was a retrospective study done in the Department of Pathology, Kathmandu Medical College for a one year period, between June 2007 and July 2008. A total of 277 cases were included in the study. Results: Amongst the 277 cases, 270 cases (97.4%) were diagnosed as chronic cholecystitis and 7 cases (2.5%) were diagnosed as gallbladder carcinoma. All the cases diagnosed as gallbladder carcinoma was of adenocarcinoma except a single case of adenosquamous carcinoma. Fifty three out of the 277 cases (19.13%) showed positivity in Warthin Starry Silver stain. Out of the 7 cases diagnosed as gallbladder carcinoma, 5 cases were found to be positive Warthin Starry Silver stain. Conclusion: The role of Helicobacter hepaticus infection as a nidus for formation of gallstone that ultimately leads to malignancy is controversial and its dominant role in the pathogenesis of carcinoma is yet to be determined. Keywords: Gallbladder carcinoma; Helicobacter hepaticus; Warthin Starry Silver stain. DOI: http://dx.doi.org/10.3126/jpn.v1i2.5406 JPN 2011; 1(2): 122-125
TL;DR: A multidisciplinary team of an orthopaedic surgeon, medical oncologist, radiologist and pathologist was involved in the management of osteosarcoma cases to study the postchemotherapy biopsies.
Abstract: A multidisciplinary team of an orthopaedic surgeon, medical oncologist, radiologist and pathologist was involved in the management of osteosarcoma cases. Four cases of osteosarcoma were examined for the effects of neoadjuvant chemotherapy. Total histological mapping was done to study the postchemotherapy biopsies. Two cases were good responders (more than 90% response), and two cases were poor responders (less than 90% response). Good responders had limb sparing surgery performed on them. Long term follow up results are awaited. Keywords: Neoadjuvant chemotherapy; Osteosarcoma; Total histological mapping; Tumour response DOI: 10.3126/jpn.v1i1.4455 Journal of Pathology of Nepal (2011) Vol.1, 60-62
TL;DR: A case of a male who presented with a 3 month history of swelling in the left thumb which was mildly tender and showed mild atypia with increased mitotic activity, which would suggest 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
TL;DR: Typical light microscopic diagnostic features are important to recognize this disease, which include mesangial nodules and thickening of tubular and glomerular basement membranes, which shows a monoclonal pattern for kappa light chain, or much less commonly lambda light chain.
Abstract: Light chain deposition disease is a rather uncommon monoclonal gammopathy with predominantly renal manifestations with presence of monoclonal light chains in serum and urine. It usually occurs in elderly male patients but can have a wide age range. Patients usually present with proteinuria and some renal dysfunction, but other organs like the liver and heart may also be involved and lead to the death of the patient. The survival of the patients is only about 18 months and benefit of renal transplantation in these patients is debatable, because of high chances of recurrence. Typical light microscopic diagnostic features are important to recognize this disease, which include mesangial nodules and thickening of tubular and glomerular basement membranes. Immunofluorescence shows a monoclonal pattern for kappa light chain, or much less commonly lambda light chain. Electron microscopy is further invaluable in identifying the granular deposits in the mesangial nodules and basement membranes. Keywords: Light chain deposition disease; Renal failure; Plasma cell dyscrasia; Immunofluroescence; Electron microscopy DOI: 10.3126/jpn.v1i1.4454 Journal of Pathology of Nepal (2011) Vol.1, 56-59
TL;DR: The reasons for scientific writing range from noble to base reasons and may be considered by some to be a chore where getting published is a ‘necessary evil’ in order to fulfill certain specific minimum requirements, e.g. for getting a job or a promotion.
Abstract: The reasons for scientific writing range from noble to base reasons. Some authors write for pleasure derived from the creative activity of writing and from sharing one’s intellectual pursuits. For many authors, writing is a channel for expressing the joy of scientific discovery. At the bottom of the list, writing may be considered by some to be a chore where getting published is a ‘necessary evil’ in order to fulfill certain specific minimum requirements, e.g. for getting a job or a promotion.
TL;DR: In the latest MDS classification, the clinical implications of different groups have been given more importance and also the role of cytogenetics has been re-evaluated.
Abstract: Myelodysplastic syndrome is a group of clonal disorders having wide range of outcome. Its classification and concept have been changed over time with better understanding of its prognosis and clinical significance. The first standard classification was FAB classification which came in 1982. It was based on findings on peripheral blood and bone marrow. Later in 2001, WHO incorporated clinical data into it and proposed a modified classification. The 2001 WHO classification made several criteria and entities more precise based on inputs from several studies. New terminologies (e.g., refractory cytopenia with multilineage dysplasia) and new group (e.g., myelodysplastic / myeloproliferative disorder) have been introduced and group like ‘refractory anemia with excess blasts in transformation’ was removed. Again in 2008, in collaboration with European Association for Haematopathology and the Society for Hematopathology, as well as considering several recommendations from a group of clinical experts, WHO published a revised and updated classification. In the latest MDS classification, the clinical implications of different groups have been given more importance and also the role of cytogenetics has been re-evaluated. Several groups were again redefined (e.g., myelodysplastic syndrome – unclassified, refractory anemia with excess blasts) or eliminated (e.g., refractory cytopenia with multilineage dysplasia and ringed sideroblasts) or newly introduced (e.g., refractory cytopenia with unilineage dysplasia). Childhood MDS was considered separately as demanded by several pediatric hematologists. It was also emphasized that the diagnosis and classification of MDS mainly require identification of dysplastic morphological features, routine stains and correlation with clinical data rather than cytogenetics which may be necessary only in rare cases. Keywords: Myelodysplastic syndrome; Refractory anemia; Ring sideroblasts; MDS classification DOI: http://dx.doi.org/10.3126/jpn.v1i2.5410 JPN 2011; 1(2): 142-150