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Background: Pleural effusion is a common medical condition with many possible underlying etiologies. However, Tuberculosis is the most common cause of pleural effusion especially in countries like Nepal. Pleural uid lymphocytosis is seen in tuberculosis, malignancy and few auto-immune diseases. Adenosine Deaminase activity (ADA) level in tubercular pleural effusion is markedly increased compared to non-tubercular effusions. ADA estimation being a simple colorimetric method is suitable for the rapid diagnosis of tubercular effusion. This study aims to correlate the diagnostic ef cacy of ADA with the value of differential count (lymphocytosis) in establishing different etiology of pleural effusion. Materials and Methods: This is a cross sectional study of 50 cases with pleural effusion carried out in the department of Pathology, Green city hospital for the duration of Twenty one month’s dating from October 2014 to July 2016 AD. Results: Of all, tubercular pleural effusion accounted for 26%. ADA level was raised (≥40U/L) in 92% of Tubercular pleural effusion. The sensitivity and speci city of ADA alone to diagnose tubercular pleural effusion was 92% each and when lymphocytosis alone was considered sensitivity was 85% with speci city of 32% whereas the combined effect of both ADA with lymphocytosis was 100% (sensitivity) and 87% (speci city), 83% (positive predictive value) and 100% (negative predictive value) respectively with statistically signi cant p value (Conclusion: We can conclude that the combination of pleural uid differential count (lymphocytosis >50%) and ADA level >40U/L provides with much more positive result than each component alone in differentiating tubercular effusion from other etiologies.

Background: Fine needle aspiration cytology is a minimally invasive technique used in the initial diagnosis of different types of lesions located in head and neck region commonly originating from cervical lymph node, thyroid gland, salivary glands and soft tissues. The objective of this study was to evaluate the diagnostic accuracy, sensitivity and speci city of FNAC in various head and neck lesions in correlation with their histopathological examination. Materials and methods: A hospital based prospective study was conducted among 209 patients with palpable head and neck region swellings in the Department of Pathology, Bhaktapur Cancer Hospital and the Department of Pathology, Nepal Medical College from August 2014 to July 2015. FNAC were done from palpable masses of head and neck regions. Data entry and analysis were done using SPSS 17. Result: There were 209 FNAC cases enrolled, out of which lymph node lesions (n=128) were the most common lesions followed by thyroid (n=40), other soft tissues (n=27) and salivary gland (n=14). Reactive lymph nodes, colloid goiter, epidermoid cyst and sialadenosis were the predominant diagnosis of lymph nodes, thyroid gland, soft tissues and salivary gland respectively. Highest accuracy, sensitivity and speci city were observed in thyroid gland, salivary gland and soft tissues. However, four false negative results for malignancy were reported in lymph node lesions. Conclusion: Head and neck region swellings are the commonly encountered conditions. FNAC being highly accurate, sensitive and speci c makes it useful and reliable procedure for screening and diagnosis of palpable masses in head and neck region.

Background: Cervical cancer is a leading cause of mortality and morbidity among women worldwide and most common gynaecological cancer in developing countries. Papanicolaou smear is a simple and cost effective screening test for cervical cancer. The aim of this study is to evaluate and interpret the cervical pap smear cytology in a tertiary hospital. The interpretation and reporting of the pap smear is based on 2001Bethesda system.Materials and methods: This is a prospective study conducted in a tertiary hospital, Nepal Medical College over a period of two and a half years (January 2013 to June 2015). All cervical pap smears received in the department of Pathology in the study period were included.Results: A total of 4160 cervical pap smears were reported in the study period. Majority of the cases were Negative for Intraepithelial lesion or malignancy (87.9%). Bacterial vaginosis, atrophy and reactive cellular changes associated with inflammation were seen in 5.3%, 2.4% and 1.5% cases respectively. Epithelial cell abnormalities (0.5%) include Atypical squamous cells of undetermined significance, Low grade squamous intraepithelial lesion and High grade intraepithelial lesion. 88% of Low grade squamous intraepithelial lesion was seen in reproductive age group (20-45 years).Conclusion: Cervical cancer is the most common gynaecological cancer in the developing countries. Pap smear is the simple and cost effective screening tool to detect pre invasive cervical epithelial lesions.

Background: Hematological disorders are quite frequent in all age group. Most of this hematological disorder first present as anemia. Bone Marrow Aspiration plays a major role in the diagnosis of its underlying cause. The aim of this study was to analyze the causes of hematological disorders, its spectrum and to interprete the bone marrow aspiration findings.Materials and Methods: This was a retrospective and prospective study carried out in the department of Pathology of Nepal Medical College in a period of two years. (July 2010 - June 2012). Bone marrow examination of 57 cases of suspected hematological disorders was carried out. All details of the patients were obtained from the record file in the department of pathology.Results: Out of 57 cases of bone marrow aspiration, erythroid hyperplasia was seen in 12 cases (21%). Megaloblastic anemia was seen in 7 cases (12.3%) and microcytic anemia was seen in 4 cases (7%). There were 6 cases (10.5%) of Idiopathic Thrombocypenic Purpura. Acute leukemia was diagnosed in 7 cases (12.3%) and among this acute myeloid leukemia (10.5%) was more common than acute lymphoid leukemia (1.8%). Myelodysplastic syndrome and multiple myeloma was seen in 3.5 % cases each. Aplastic anemia and kalaazar was seen in 5.3% and 1.8% cases respectively.Conclusion: Bone marrow examination is an important step to arrive at the confirmatory diagnosis of many hematological disorders.Journal of Pathology of Nepal (2012) Vol. 2, 309-312DOI: http://dx.doi.org/10.3126/jpn.v2i4.6885