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Background: Undifferentiated tumours in the head and neck region are not uncommon. They can arise from different sites like in mucosa as well as in salivary glands, soft tissues or lymph nodes. Histopathological examination plays a central role in the diagnosis but difficulties arise with some tumours which are poorlydifferentiated due to their high inter- and intra-observer variability. In those cases, immunohistochemistry has greatly assisted to diagnose the tumours that cannot be accurately identified using routine histopathological procedures. The correct histopathological diagnosis is essential especially in case of malignant tumourwhere subsequent specific therapy is required. The aim of this study was to determine the role of immunohistochemistry for diagnosing undifferentiated malignancy in the head and neck region. Methods: This cross-sectional study was conducted during July 2014 to June 2015. A total of 35 Bangladeshi patient’s specimens of head and neck swelling were collected from two renowned laboratories in Dhaka city.These cases were diagnosed as undifferentiated tumour in histopathological examination.Standard protocol was followed for immunohistochemistry.Then primary immunohistochemical panel which included the markers for Epithelial CK (AE1/AE3),mesenchymal marker (Vimentin) and lymphoid marker (LCA) were used.The cases which were not resolved by primary immunohistochemistry panel, the second panel was applied for further sub classification (Desmin, Chromogranin, CK20, CEA, CD20, CD30, HMB45, NSE). Based on interpretation of immunohistochemical findings final diagnoses were made.Data analysis was performed using the Statistical Package for the Social Sciences for Windows version 22.0 (SPSS, Chicago, Illinois, USA). Results: A total of 35 undifferentiated tumorsof head-neck region were studied.The mean age was 46.3±17.6 years and male to female ratio was 4.8:1. The majority 13 (37.1%) patient had cervical lymphadenopathy, 11 (31.4%) had neck mass and 4(11.4%) had in nasal/sinonasal mass.Regarding histopathologicalcell types, round cell was 21 (60.0%), spindle cell 6 (17.1%), pleomorphic cells 6(17.1%) and epithelioid cells 2(5.7%). In initial histopathological examination, majority 25(71.4%) were undifferentiated malignant neoplasm, 8(22.8%) were metastatic undifferentiated carcinoma, 1(2.9%) was pleomorphic sarcoma and the remaining 1(2.9%) had malignant adnexal tumour. By application of immunohistochemistry, most (33, 94.3%) of the cases were resolved and the two cases remained unresolved. Among the resolved cases majority (15, 45.5%) were lymphoma, 4(12.1%) were metastatic carcinoma, 3(9.1%) were Ewing’s sarcoma and malignant melanoma were found in 3(9.1%) cases. Conclusion: This study supports that the immunohistochemical technique has a fundamental role in the investigation of undifferentiated tumour origin, to determine the correct guidance for treatment and improving the prognosis for head and neck tumour patients. Birdem Med J 2020; 10(1): 48-53

Renal cortical necrosis (RCN) is characterized by patchy or diffuse destruction of all the elements of renal cortex resulting from significantly diminished renal arterial perfusion due to vascular spasm and microvascular injury. It is a rare cause of acute kidney injury (AKI) in developed countries with frequency of 1.9%-2% of all patients of AKI. In contrast, the incidence of RCN is higher in developing countries ranging from 6%-7%. Obstetric complication is the main cause of RCN, earlier it was about 20%-30% which has been declining to 5% in the Indian subcontinent during the past two decades. The aim of this study is to review five consecutive cases of RCN diagnosed within very short span of time. Histopathologically, diagnosed five cases of RCN during one-month span in September 2016 at Armed Forces Institute of Pathology, Dhaka were included in this study. All the cases were referred cases from a tertiary level obstetric center of Dhaka city; the mean age was 24.2 ± 3.4 years. All the cases had the history of postpartum hemorrhage followed by septicemia. They all presented with acute renal failure dependent on hemodialysis for >21 days. On histological examination, three (60%) had patchy RCN and two (40%) had diffuse RCN. Two (40%) showed coagulative necrosis of all the glomeruli, two (40%) showed coagulative necrosis of >50% of glomeruli, and in one (20%) case necrosis of about 25% of glomeruli. One of the glomeruli showed global sclerotic change of most of the glomeruli. In all the cases, interstitium showed moderate focal lymphocytic infiltration and mild edema. Among all, one (20%) was found with immunoglobulin A nephropathy as an associated diagnosis. RCN is still encountered as an obstetric complication in our setting and this type of grave consequences should be prevented by better monitoring of pregnancies.

Background: Geographic variations with regard to incidence and histological subtypes are known to occur in Non-Hodgkin lymphoma (NHL). This study was aimed to see the incidence and subtypes of NHL in a group of Bangladeshi population.Methods: This cross sectional study was carried out in Armed Forces Institute of Pathology (AFIP) Bangladesh, from 1st April 2017 to 31st March 2018. All nodal and extranodal tissues which were morphologically diagnosed as NHL were included in the study and immunohistochemistry was done for sub-classification according to WHO classification 2016. Bone marrow trephine biopsy samples were excluded.Results: Total cases: 106, mean age: 48.5 years ± 18.5 (range 2Y 9 M –82 years), male-female ratio: 2.2:1. Total subject of B cell Lymphoma (BNHL): 83 (78.3%) and T cell lymphoma (TNHL): 23 (21.7%). Among BNHL, total subjects of diffuse large B cell lymphoma (DLBCL) 50 (60%), follicular lymphoma 9 (11%), marginal zone lymphoma 8 (10%), small cell lymphoma and mantle cell lymphoma 5 (6%) each, Burkitt lymphoma 4 (5%) and B cell lymphoblastic lymphoma 2 (1.89%) in number. Among TNHL peripheral T-cell lymphoma NOS 11 (48%), anaplastic large cell lymphoma (ALCL) 5 (22%), T cell lymphoblastic lymphoma 4 (17%), and angio-immunoblastic T cell lymphoma 3 (13%) in number. Among 5 ALCL, 4 ALK positive and 1 ALK negative. Number of primary extra-nodal NHL were 29 (27%) with most common involved organ system being GIT and most common histological subtype being DLBCL.Conclusion: Quite similar pattern of age range with mean age, male to female ratio, subtypes and extra nodal NHL distribution prevailing in our subcontinent is found in our population with subtle increased incidence of TNHL indicating the necessity of further large epidemiological study.Birdem Med J 2018; 8(3): 215-222

Background: Fine needle aspiration cytology (FNAC) is now a days the initial investigation in most cases of superficial lymphadenopathy. In clinical practice both clinicians and cytopathologists are not commonly suspecting of Toxoplasma lymphadenitis (TL), though it may constitute a significant proportion of unexplained lymphadenitis. Careful cognizance of cytological findings can give valuable clue to the diagnosis of toxoplasmosis which can be confirmed by serological evidence.Methods: This cross-sectional study was conducted in Department of Histopathology of Armed Forces Institute of Pathology (AFIP), Bangladesh from 01 July 2017 to 31 March 2018. FNAC smears of the patients with lymphadenopathy who reported for FNAC were examined and suspicion of toxoplasmosis was made on coexistence of abundance of ‘tingible body macrophages’ (TBM) and follicular center cells (FCC), small collections of epithelioid histiocytes and absence of necrosis and/or more than occasional giant cells. Serum enzyme linked immunosorbent sorbent assay (ELISA) for Toxoplasma IgM and IgG antibody was then performed in all cases that deemed suspicious for toxoplasmosis for confirmation of the diagnosis.Results: Total 925 patients were examined by FNAC of lymph node. Among them 574 were categorized as reactive hyperplasia (RH). Thirty two patients (5.74%) of RH were suspected as TL and included in the study. Serum ELISA confirmed toxoplasmosis in 22 (68.75%, twelve male and ten female) of these 32 cases. One among the positive cases revealed bradyzoites of Toxoplasma in the smear. The age of the patients diagnosed finally as TL spanned between 5 to 47 years (mean 28.59±11.51 years) though most frequent age group was 26 Yr to 35 Yr (7 cases- 31.8%).Conclusion: A high index of suspicion of TL can be made on careful study of smears of FNAC of enlarged lymph node, diagnosis of which can then be confirmed by ELISA.Birdem Med J 2018; 8(2): 103-107