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Background: Urinary bladder lesions are the main source of significant clinical symptoms which are more disabling than lethal. Bladder tumors constitute one of the most common urological pathology. Urothelial carcinoma accounts for 90% of all primary tumors of the bladder. This study aimed to determine the frequency of different types of lesions of the urinary bladder and to determine the grade and stage of urothelial tumors.Materials and Methods: This is a 2 years cross sectional study of cystoscopic biopsies carried out in the Department of Pathology, Medicare National Hospital and Research Centre, Kathmandu, Nepal.Results: Out of 87 cases, 58 (66.67%) cases were neoplastic lesions and 29(33.33%) cases were non- neoplastic lesions. Majority of neoplastic lesions 96.55% were urothelial (transitional cell) tumors comprising predominantly of low grade papillary urothelial carcinoma 50.91%. Muscle invasion was seen only in high grade papillary urothelial carcinomas.Conclusion: Among bladder tumors low grade papillary urothelial carcinoma is the most common.

Background: Microcytic hypochromic anemia is a distinct morphologic subtype of anemia with well- de ned etiology and treatment. The objective of this study was to determine the etiology and frequency of microcytic hypochromic anemia. Materials and Methods: This cross-sectional observational study was conducted at Kathmandu Medical College Teaching Hospital. One hundred cases of microcytic hypochromic anemia were included. Relevant clinical history, hemogram, reticulocyte count, iron pro les were documented in a proforma. Bone marrow aspiration and hemoglobin electrophoresis was conducted when required. Data was analysed by Microsoft SPSS 16 windows. Result: Iron de ciency was the commonest etiology (49%). Dysfunctional uterine bleeding (20.8%) was the commonest cause of iron de ciency, malignancy (24.3%) was the commonest cause of anemia of chronic disease. Mean value of Mean Corpuscular Volume was lowest in hemolytic anemia (71.0 ). Mean Red cell Distribution Width was normal (14.0%) in hemolytic anemia but was raised in other types. Mean serum iron was reduced in iron de ciency anemia (32.2μg/dl) and chronic disease (34.8μg/dl), normal in hemolytic anemia (83μg/dl) and raised in sideroblastic anemia (295μg/dl). Mean serum ferritin was reduced in iron de ciency anemia (7.6ng/ml), raised in chronic disease (158.6ng/ml) and normal in hemolytic anemia (99.2ng/ml). Serum ferritin was normal in sideroblastic anemia (93ng/ml). Mean Total Iron Binding Capacity was raised in iron de ciency anemia (458μg/dl) and normal in other microcytic hypochromic anemias. Conclusion: Diagnosis of microcytic hypochromic anemia requires a standardized approach which includes clinical details, hemogram, peripheral blood smear, reticulocyte count, iron pro le, hemoglobin electrophoresis and bone marrow examination.

Background: Fine needle aspiration cytology has been shown to be simple, safe, cost effective and quick to perform procedure with excellent patient compliance. It is a well established technique for preoperative investigation of thyroid gland swellings with high sensitivity, specificity and accuracy. The aim of this study was to determine the accuracy of fine needle aspiration cytology of thyroid swellings performed at our institution. Materials and Methods: This study was carried out at Kathmandu Medical College and Teaching hospital, department of Pathology over a period of 3 years (January 2010 to December 2012). Two hundred and seventy three patients of all age groups and both sexes who underwent fine needle aspiration cytology for thyroid swelling were evaluated. Out of 273 patients, histopathological diagnosis was available in 45 patients. Results: Fine needle aspiration cytology result revealed 245 cases (89.7%) as non-neoplastic, 21 cases (7.7%) as neoplastic and 7 cases (2.6%) inadequate due to lack of cellularity. The commonest lesion in the thyroid gland was colloid goiter. Among the malignant neoplasms the commonest was papillary carcinoma. Out of 273 patients, histopathological diagnosis was available in 45 patients. Statistical analysis of our data shows the diagnostic accuracy of fine needle aspiration cytology to be 95.7%. Fine needle aspiration cytology showed a sensitivity of 96.4% and a specificity of 94.4%. Conclusion: Fine needle aspiration cytology is a well established technique for pre operative investigation of thyroid gland swellings with high sensitivity, specificity and accuracy. DOI: http://dx.doi.org/10.3126/jpn.v3i6.8988Journal of Pathology of Nepal (2013) Vol. 3, 433-436

Background: Fine needle aspiration cytology has an established role in the diagnosis of various neoplastic and non-neoplastic lesions. Its accuracy when applied by experienced and well trained practitioners matches that of histopathology in providing an equivocal diagnosis; so it can also be used as a very useful alternative to excision biopsy in the diagnostic workup of soft tissue tumors.Materials and Methods: This retrospective study was done in the Department of Pathology, Kathmandu Medical College for a period of one year from January 2006 to December 2006. A total of 60 cases presented with soft tissue tumors, of which only 50 were biopsied and the correlation done. A detailed history, clinical findings, routine relevant laboratory investigations and radiological findings were carried.Results: Fine needle aspiration cytology revealed diagnostic materials in 47 cases and 3 cases were inconclusive for a definite diagnosis. 40 cases were diagnosed as benign lesions and 7 cases as malignant lesions. Out of the benign cases, the most common were lipomas which accounted for 52.5% of cases followed by benign mesenchymal tumor- 17.5%. Out of the malignant cases 71.42% were diagnosed as malignant mesenchymal tumor and 28.57% as malignant nerve sheath tumor. The overall diagnostic accuracy of fine needle aspiration cytology in soft tissue tumors in the present study was 86%. The sensitivity and specificity of diagnosing benign soft tissue tumors was 97.36% and 66.67% respectively and for malignant soft tissue tumors 66.67% and 97.36% respectively.Conclusion: Fine needle aspiration cytology can be effective and reliable diagnostic tool in the evaluation of soft tissue tumors. It is highly sensitive to detect benign soft tissue tumors and highly specific for malignant soft tissue tumors.Journal of Pathology of Nepal (2012) Vol. 2, 305-308DOI: http://dx.doi.org/10.3126/jpn.v2i4.6884

Background: Gastric carcinoma is one of the leading causes of cancer deaths worldwide, with a mortality rate directly related to the stage at diagnosis. Endoscopic biopsy and cytology are well established techniques for the diagnosis of carcinoma of stomach.Materials and Methods: This study was conducted on 50 patients, suspected of gastric cancer on endoscopy, during a period of 18 months (October 2010 to March 2012). Endoscopic biopsy and touch smear cytology were evaluated. Biopsy was considered gold standard for final diagnosis.Results: A total of 50 cases were included out of which 36 were malignant and 14 cases were benign. Cytology was able to diagnose 33 out of 36 malignant cases. Of 17 cases which were diagnosed as benign on cytology, 3 cases turned out to be malignant on biopsy. The sensitivity and specificity of touch smear cytology are 91.6% and 100% respectively.Conclusion: Touch smear cytology is a useful adjunct in the diagnosis of gastric carcinoma and should be considered a routine method along with biopsy.Journal of Pathology of Nepal (2012) Vol. 2, 282-284DOI: http://dx.doi.org/10.3126/jpn.v2i4.6878

Paraganglioma of the larynx is a rare tumor that arises from paraganglion cells. These tumors are generally considered benign and have to be differentiated from other neuroendocrine tumors. Diagnosis relies mostly on histopathologic examination followed by immunohistochemistry. Surgical excision generally confers complete cure of the tumor. We hereby present a case of laryngeal paraganglioma in a 60-yearold female, who underwent total laryngectomy following a diagnostic micro-laryngeal biopsy, which was supported by immunohistochemistry. DOI: http://dx.doi.org/10.3126/jpn.v2i3.6031 JPN 2012; 2(3): 245-247

Abstract

Abstract

ABSTRACT Squamous cell carcinoma is a rare but well documented complication of chronic osteomyelitis. With the advent of antibiotics, better health care delivery to the people and improving socioeconomic conditions, the incidence of squamous cell carcinoma arising as a late complication of acute haematogenous osteomyelitis has become increasingly less. Occasional difficulty in the differential diagnosis of a pseudoepitheliomatous hyperplasia and well differentiated squamous cell carcinoma can be troublesome. These two cases are presented to remind the clinician of this now increasingly rare complication of chronic osteomyelitis and the occasional diagnostic dilemma involved in its histopathological diagnosis. Key Words: Squamous Cell Carcinoma, Chronic Osteomyelitis.

Introduction: Fine needle aspiration cytology (FNAC) is a rapid and relatively inexpensive technique used extensively in the diagnosis of a large variety of neoplastic and nonneoplastic lesions in many organs. There are very few literature reports documenting the role of fine needle aspiration cytology (FNAC) in the evaluation of epididymal nodules. The aim of this study was to highlight the cytomorphologic features of FNAC in epididymal nodules. Methods: A descriptive study was carried out in all the patients presented with palpable epididymal nodules for FNAC over a period of two and half years in department of pathology, Kathmandu Medical College Teaching Hospital, Sinamangal, Kathmandu. FNAC was performed using 23 gauge needle with 10ml syringe. Smears were routinely stained with PAP, Giemsa stain and Special stains whenever needed. Results: A total of 31 cases of non - neoplastic lesions were identified. Age ranged from 15 to 52 years. Majority of cases were of tuberculous epididymitis accounting for 38.70%. Conclusions: FNAC serves as an important tool to screen and diagnose all palpable epididymal nodules and provides information for further management. [ABSTRACT FROM AUTHOR]

Xanthogranulomatous inflammation is a well described inflammatory condition which can involve any organ but is commonly seen in the gallbladder and kidney. Xanthogranulomatous inflammation involving the appendix is rarewith very few cases reported in the literature. Here we report a case of 19 years old girl with xanthogranulomatous appendicitis who underwent interval appendicectomy. Histopathology revealed the presence of predominance of foamy histiocytes admixed with lymphocytes and plasma cells. [ABSTRACT FROM AUTHOR]

We report a case of a 42-year-old man with a submitral aneurysm who presented to the emergency room in circulatory collapse, with left ventricular obstruction and severe mitral valve stenosis and regurgitation secondary to the aneurysm. Resection of the aneurysm and mitral valve replacement were performed through a median sternotomy without any complication and with good results., (Copyright © 2019 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

Introduction: Bladder tumours constitute one of the most common urological conditions. Urothelial (transitional cell) carcinoma accounts for 90% of all primary tumours of the bladder. These tumours are an important cause of morbidity and mortality. The objective of this study was to present the histopathological patterns of urothelial tumours and to determine the grade and stage of these tumours., Methods: This is a 3 year descriptive study of urothelial tumours carried out in the Department of Pathology, Patan Academy of Health Sciences (PAHS), Lalitpur, Nepal. Data of all cystoscopic biopsies collected during this period were analyzed., Results: Of the 83 urinary bladder tumours, 81 (97.59%) cases were urothelial (transitional cell) tumours. Transitional cell carcinoma (TCC) was the most common bladder tumour which was seen in 67 (80.72%) cases. Thirty two (47.76%) cases of TCC were low grade while 35 (52.24%) were high grade. Forty three (64.18%) cases of TCC were superficial or in early stage (pTa and pT1) while 24 (35.82%) showed muscle invasion., Conclusions: Transitional cell carcinoma was the most common bladder cancer. Most of these tumours were high grade. A large percentage of high grade carcinomas presented with muscle invasion. Pathological grade and muscle invasion are the most valuable prognostic predictors of survival. The importance of including smooth muscle in the biopsy specimens needs to be emphasized.

Introduction: Colorectal carcinoma (CRC) ranks as the fourth most frequent cancer in men (after lung, prostate and stomach cancer), and third in women (after cancers of breast and uterine cervix).Adenocarcinoma of the colon is the most common malignancy of the GI tract and is a major cause of morbidity and mortality worldwide. It is also one of the most common cancers in Nepal., Methods: A descriptive study was conducted in a Kathmandu based Hospital. This study included 50 cases of colorectal carcinoma diagnosed on colonoscopic/sigmoidoscopic biopsies over a period of two years., Results: A total of 50 patients were studied out of these, 29 (58%) patients were male, whereas 21 (42%) were with male:female ratio of 1.3:1. Age ranged was from 20 years to 80 years. Maximum number of cases were observed between the ages of 61-70 years. The most common histological type of colorectal carcinoma was moderately differentiated adenocarcinoma and seen in 37(74%) cases. Left sided tumor constituted 40 (80%) cases of all tumors and rectum was the predominant site with 26 (52%) cases followed by sigmoid colon with 7 (14%) cases., Conclusions: Colorectal carcinoma (CRC) is not an uncommon disease in this part of the world. The use of sigmoidoscopy and colonoscopy along with biopsy when required should be encouraged as a screening program for colorectal carcinoma in an elderly age group for the detection of CRC at an earlier stage.

Introduction: Diseases of upper gastrointestinal tract are responsible for a great deal of morbidity and mortality. The histopathological study of endoscopic biopsies permits exact diagnosis for further management.The aim of this study is to find out the histopathological pattern of endoscopic biopsy., Methods: A descriptive study was conducted in consecutive endoscopic gastric biopsies in a Hospital over a period of one year. The patient of all ages and both sexes who underwent gastric biopsy during the study period was included., Results: Endoscopic biopsies were studied on patients of age ranging from 20 years female to 84 years male. The histopathology revealed non-neoplastic lesions 54 (67.5%) and neoplastic lesions 26 (32.5%). Most common non-neoplastic lesion noted was mild chronic gastritis 22(27.5%) followed by chronic active gastritis 15 (18.75%) while H. pylori was present in 13 (16.25%) and absent in 2 (2.5%)., Conclusions: Mild chronic gastritis was the commonest lesion noted in non-neoplastic lesions and adenocarcinoma was the commonest neoplastic lesion in the endoscopic gastric biopsies.

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.

Background: Gastritis has a broad histopathologic and topographical spectrum and leads to different patterns of disease. The introduction of the Sydney system made it possible to grade histological parameters, identify topographic distribution and provide etiological information which would help to generate reproducible and clincally useful diagnoses. The aim of this study was to determine the prevalence of Helicobacter pylori in non-ulcer dyspepsia, duodenal ulcer and gastric ulcer; and to assess the histopathologic features associated with chronic gastritis., Methods: Gastric antral biopsy specimens from 200 patients were examined for the prevalence of H. pylori, and were classified and graded histologically., Results: The overall colonization rate of H. pylori was 44%. The colonization rates were 85%, 67% and 41% in patients with duodenal ulcer, gastric ulcer and non-ulcer dyspepsia respectively. There was not much difference between the degree of atrophy and intestinal metaplasia in H. pylori positive and negative cases., Conclusions: Helicobacter gastritis is the commonest type of gastritis present in patients presenting with dyspeptic symptoms. It is more common in patients presenting with duodenal ulcer. Adequate sampling is a must for accurate diagnosis of H. pylori colonization.

Ovarian cysts are an extremely common gynecological problem. Majority of ovarian cysts are benign with few cases being malignant. This is a retrospective study of all the cases of ovarian cysts operated in a tertiary hospital (Kathmandu Medical College, KMC) from January 2006 to December 2008. In this 3 years duration, 102 cases (2.0%) were of ovarian cyst out of the total histopathological specimen processed in pathology department. The mean age of presentation was 38years. Ovarian cysts (27.5%) were more commonly seen in the age group 21- 30 years. Bilateral ovaries were involved in 19 cases (18.6%). Among these ovarian cysts, 89 cases (87.3%) were benign and 13 cases (12.7%) were malignant. The most common type of ovarian cyst was serous cystadenoma (40.2%) followed by mature cystic teratoma (15.7%). Metastasis to ovary was seen in 6.9% (7 cases). The most common metastasis was adeno carcinoma from gastro intestinal tract (4 cases). Other metastases to ovary were 2 cases from endometrioid adeno carcinoma of endometrium and 1 case from Non Hodgkin's Lymphoma of small intestine.

Background: Prostate Specific Antigen (PSA) has been widely used in the diagnosis and management of patients with prostate cancer. It may be elevated in other prostatic diseases and surgical procedures. PSA exists in two forms, a major bound form (cPSA) and a free form (fPSA)., Objectives: The objective of the study was to determine the relationship between serum fPSA levels and histologic findings in biopsy specimens of men with prostatic disease., Material and Methods: This study includes 91 patients planned for transurethral resection of prostate (TURP). Blood samples were collected before TURP and tested for fPSA. Histology of the tissue samples collected after TURP were studied and the relationship with fPSA analysed using SPSS 11.5., Results: The median values for benign, premalignant and malignant lesions were 1.8 ng/ml, 4.5 ng/ml and 13.20 ng/ml respectively (p<0.001). Most cases of benign prostatic hyperplasia(BPH) without inflammation had fPSA levels <2 ng/ ml, while most with active inflammation had levels >5 ng/ml. Low grade prostatic intraepithelial neoplasia (LGPIN) saw levels <5 ng/ml while high grade intraepithelial neoplasia (HGPIN) and prostate cancer (PCa) had levels > 5 ng/mL (p<0.05). For detection of high grade lesions (HGPIN and PCa), the sensitivity and specificity of fPSA level > 5 ng/ml was found to be 88.8% and 90.2% respectively., Conclusions: Serum fPSA is elevated marginally in patients with BPH without inflammation. Active inflammation and high grade lesions are associated with fPSA level more than 5 ng/ml.

Introduction: Cysticercosis is the larval manifestation of the cestode T. solium. It commonly presents as subcutaneous and intramuscular nodules which is often clinically misinterpreted as benign mesenchymal lesions and lymph nodes. Cysticerci in subcutaneous nodules can be diagnosed rapidly and with considerable accuracy by FNAC. This study highlights the cytomorphological features of subcutaneous cysticercosis diagnosed by FNAC., Methods: Forty three patients with palpable nodules diagnosed as cysticercosis or suspected as cysticercosis by FNAC between August 2005 to July 2008 were included in the study. Excision biopsy was done in 12 cases where definitive evidence of parasite was not found., Results: Solitary nodules were present in 36 (83%) patients and multiple nodules were present in seven (17%). In 31 cases (72.09%) definite evidence of cysticercus was found. In 12 cases (27.9%) a suggestion of parasitic inflammation was made based on other cytomorphological features which was confirmed by biopsy in eight cases., Conclusions: Human cysticercosis commonly presents as subcutaneous nodules which can be diagnosed with considerable accuracy by FNAC. Definite evidence and suggestion of parasitic inflammation on cytology obviates the need for subsequent histopathological examination.

Introduction: This study was undertaken to evaluate the role of Ziehl-Neelsen stain (for acid-fas bacilli), and Mantoux test in diagnosing tubercular lymphadenopathy on FNAC., Methods: FNAC was performed on patient with superficial lymphadenopathy. Ziehl-Neelsen stain for acid fast bacilli was done in all cases where cheesy or purulent material was aspirated and smear showed granulomatous lymphadenitis. A Mantoux test was also done in these patients. A Mantoux test was further done in patients of reactive lymphadenopathy where the lymph node size was more than 1 cm. If the result was positive, a repeat FNAC was performed. When the repeat FNAC showed ill-defined granulomas, excision biopsy was done., Results: Tubercular lymphadenopathy was seen in 122 (48.2%) cases. Acid- fast bacilli were found in 71 (58.1%) cases. Mantoux test was positive in 112 (91.8%) cases. A repeat FNAC was done in seven of 11 patients where the cytologic features of tuberculosis were not seen but the lymph node size was more than 1 cm and Mantoux test was positive. The repeat FNAC showed ill-defined granulomas without necrosis. Excision biopsy done in these patients diagnosed them as tubercular lymphadenitis in five of the seven cases, the remaining two cases being diagnosed as reactive lymphadenitis., Conclusions: FNAC coupled with Ziehl - Neelsen staining for AFB and Mantoux test improves the diagnostic efficiency for tubercular lymphadenopathy.

Introduction: Many doctors are leaving Nepal to work abroad. To understand this problem better, we decided to study the attitude and plans of young doctors and medical students., Materials and Methods: This cross-sectional study was conducted at Kathmandu Medical College involving 65 first year medical students, 100 interns and 100 house officers. The data collected was entered in Microsoft excel and analysed by SPSS (Statistical Package for Social Sciences) programme. Chi-square test was used to compare two proportions. Significance level was set at 5%., Results: Only 2% house officers said that their job prospects were excellent as compared to 22.4% of students, whereas 20% house officers as compared to 9% students thought job prospects in Nepal were poor (p= 0.003). Eighty two percent of students thought that a doctor's service to his country was very important as compared to 51% of interns (p= 0.001) and 58% of house officers. Forty percent of students, 58% of interns and 48% of house officers (no statistical significance between the three groups) planned to migrate to a developed country after graduation. Eighty eight percent of students, 89% interns and 74% of house officers (no statistical significant differences between the three groups) were of the opinion that improving career opportunities or working environment of the doctor could make the profession more attractive., Conclusion: Although majority of students, interns and house officers were of the opinion that a doctor's service to his community/country was very important, almost half of them still planned to migrate to a developed country after graduation. Improving the chances of professional advancement and professional working environment can make the profession more attractive, and therefore, may decrease this tendency for brain drain from our country.

Background: Fine Needle Aspiration Cytology (FNAC) is a simple and rapid diagnostic technique. Because of early availability of results, simplicity, minimal trauma and complications, the aspiration cytology is now considered a valuable diagnostic aid and is part and parcel of a pathologist's repertoire., Objectives: The aim of the study was to evaluate the results of fine needle aspiration cytology (FNAC) of lymph nodes in our institution in comparison to result of histopathology., Materials and Methods: The present study on 130 patients of lymphadenopathy was conducted in the Department of Pathology Kathmandu Medical College Teaching hospital, Kathmandu from June 2006 to May 2008 (2 years)., Results: In this series of FNAC cervical lymph nodes were 66 (50.76%), and axillary lymph nodes were 20 (15.38%). Male to female ratio of the patients was 1: 0.9. The age of patients ranged from 3 to 85 years. FNAC diagnosis was found to be as follows : reactive hyperplasia 54( 41.55%), tubercular lymphadenitis 36 (28 %), metastatic carcinoma 16 (12.3%), granulomatous lymphadenitis 12 ( 9.2 % ), lymphoma 8 (6%) and suppurative lymphadenitis 4(3%) . Out of 28 cases of FNAC 26 (92.85%) were consistent with histopathological diagnosis of tubercular lymphadenitis. In metastatic carcinoma to lymph nodes sensitivity and specificity of FNAC were 100% each., Conclusion: FNAC is useful and reliable in diagnosing neoplastic and non- neoplastic lesions of lymph nodes. It helps in planning surgery for malignant cases, where definitive operative intervention can be performed in one session.

Objectives: The aim of this study was to evaluate the diagnostic accuracy and efficacy of Fine needle aspiration cytology (FNAC) in various salivary gland swellings., Materials and Methods: This retrospective study was performed at Kathmandu Medical College Teaching Hospital (KMCTH) from January 2004- December 2006.During this period a total of 978 FNAC's were done out of which 40 FNAC's were on salivary gland swellings. Correlation was done between cytological smear slides and biopsy slides., Results: In this series of FNAC, 16 cases (40%) were benign neoplasms, 5 cases (12.5%) malignant neoplasms, non-neoplastic cysts 3 cases (7.5%) and inflammatory lesions 16 cases (40%).Histopathology was available in 24 cases out of which 22 cases correlated with cytology. There were no false positive reports but false negative result was seen in 4 cases. Sensitivity and specificity were 90% and 100% respectively., Conclusion: FNAC is useful in the diagnosis of salivary gland swellings especially in benign conditions with a sensitivity of 90% and specificity of 100%.

Objectives: The cytological findings of 50 ST Ts were evaluated aiming to determine the role of FNA in diagnosis of STTs, Methods: Fifty patients with soft tissue tumours underwent FNA in the preoperative investigation during a one year period. The smears were stained with Papanicolaou and May-Graunvald Giemsa stains., Results: Forty-four cases were reported as benign, whereas 2 were malignant. Four cases revealed insufficient material. The malignant STTs were small round cell tumour and malignant spindle cell tumour. Cytological and histological correlation could be achieved in 40 cases. The overall sensitivity and specificity were 25% and 100% respectively with overall accuracy of 80%., Conclusion: A reliable diagnosis of STTs can be made with FNA when supported by other clinical and other diagnostic data.

A number of laboratory tests are used to confirm the diagnosis of multiple myeloma, including M protein in the serum. Since M protein in the serum originate from tumour cells in the bone marrow before circulating in the serum, demonstration of M protein in bone marrow aspirate can be added to the batteries of diagnostic parameters.

Platelet aggregation is an important in vitro test to assess platelet aggregation response in IHD. The present prospective case control study was undertaken to evaluate the platelet aggregation response in IHD and the effects of aspirin therapy on it. Platelet aggregation was conducted on whole blood by the Chrono- Log whole blood Aggrometer model 540-VS. Various agonists used for platelet aggregation were collagen, ADP, Epinephrine and Thrombin. High platelet aggregation was observed in-patients of IHD as compared to controls by few or all of the reagents used. Platelet aggregation was high in both MI and angina as compared to control cases. However, cases of MI showed higher response than those of angina. Aspirin intake was associated with a decrease in platelet aggregation in patients of IHD. The platelet aggregation response was higher in PRP as compared to whole blood with similar concentration of reagents, however whole blood was equally effective as PRP in detecting hyper-responsive platelets in--patients of IHD.

A patient with lepromatous leprosy, while on WHO multidrug therapy (MDT) for multibacillary disease, was diagnosed as having dapsone syndrome with recurrent episodes of bullous lesions on the lower extremities for 4-5 years. The lesions were associated with high-grade fever. Examination revealed multiple hypopigmented macules on the limbs. Multiple atrophic scars were also found on the buttocks and lower limbs. Bilateral ulnar, radial cutaneous and lateral popliteal nerves were thickened. On day 10 of WHO-MB-MDT he developed a flaccid bulla on the lower leg. Skin slit smear showed a bacterial index (BI) of 3+ and the histopathology was consistent with type II reaction. High dose corticosteroid therapy was started but he continued to have new lesions, and was therefore referred to a centre where thalidomide was available. Clinical response was good and he remained symptom-free after gradual reduction in dosage. ENL should be differentiated from bullous drug reactions, pemphigus vulgaris, bullous pemphigoid and other blistering diseases.

Background: The purpose of the present paper was to report the spectrum of primary malignant tumours of eye and adnexa at BP Koirala Institute of Health Sciences, Nepal, from 1995 to 2000., Methods: A retrospective study of medical records with histopathological confirmation of malignant tumours of the eye and adnexa was done for the years 1995-2000. A total of 116 consecutive medical records from the Department of Pathology at BP Koirala Institute of Health Sciences were retrieved. All those patients with primary ophthalmic malignancies were included and non-malignant cases were excluded., Results: There were 80 patients of which 39 (48.8%) were male and 41 (51.2%) were female. Four patients had bilateral involvement. The most common malignancy was retinoblastoma (45.2%), followed by basal cell carcinoma (22.6%)., Conclusion: Retinoblastoma is the most common eye cancer. The incidence of melanomas is correspondingly lower than that reported in the West. The present pilot study, the first of its kind, will lay the foundation for the monitoring of the future pattern of ophthalmic malignancies in Nepal and provide a basis for comparison elsewhere.

There were eleven cases of pure red cell aplasia diagnosed over a period of 2 years (January 2000-December 2001). All the patients had anemia with pallor and weakness being the presenting complaints. Hematological profile depicted normocytic normochromic anemia, reticulocytopenia and marked paucity of erythroid precursors on bone marrow aspiration and biopsy studies. In the present study, one case was of congenital pure red cell aplasia, in one other case of pyrexia of unknown origin, no definitive diagnosis could be made. Other associated diseases seen with pure red cell aplasia were thymoma, septicemia, protein energy malnutrition, non-Hodgkin's lymphoma, juvenile rheumatoid arthritis, acute myeloid leukemia, tuberculosis and hepatitis C. The association of pure red cell aplasia with haematologic malignancies is rare. There are very few case reports on pure red cell aplasia with hepatitis C.

A case with massive ovarian edema (MOE) of left ovary--a rare pseudotumour and mature cystic teratoma of right ovary is described in a young unmarried girl of 16 years. The etiopathological concepts, morphological changes and differential diagnosis are described. Knowledge about the entity and its existence are important for correct treatment. This is the first reported case from Nepal.

An unusual case of massive cystic degeneration in an uterine leiomyoma measuring 21 cm in diameter, in a 40 year old female is being presented. It was diagnosed as a cystic adnexal tumor on ultrasonogram. Interlacing bundles of smooth muscle were identified in the cyst wall, which was confirmed on special stains. The differential diagnoses considered in this case are discussed. To the best of our knowledge, this is the largest cystic degeneration in an uterine leiomyoma reported in the literature.

Endometriosis is described as the presence of endometrial glands or stroma in abnormal locations outside the uterus. It afflicts 10% women of childbearing age. A 5-year retrospective analysis of histopathologically proven cases of endometriosis was done. Haematoxylin and Eosin stained slides were reviewed for type of lining epithelium, endometrial glands, stroma, fresh and old hemorrhage & inflammatory cells. Clinical details were analyzed. Age of the patient ranged from 22 - 48 years. The most common site of endometriosis was ovaries (69.23%) followed by scars (11.43%), cervix (7.69%), fallopian tube (3.84%), vagina (3.84%) and appendix (3.84%) in descending order of frequency. Most common symptom was pain. On ultrasound and X-ray diagnosis could not be made in any case. Clinically endometriosis was diagnosed in 9 (34.62%) cases. On histopathological examination majority of the cases (42.3%) had endometrial glands, stroma and hemosiderin laden macrophages. 3 cases (11.43%) had endometrial lining epithelium and stroma only, which on laproscopy also were diagnosed to have endometriosis. It was concluded that high rate of surgical excision of organs were done because of misdiagnosis.

Microcystic papillary adenoma of nose is rarely seen in nose. This case is reported because of its rarity and to best our knowledge is a first case report from Nepal.

A 15-year-old girl with Duke's B mucinous carcinoma of the rectosigmoid was treated with surgical resection and adjuvant chemotherapy. The patient is alive and has been disease-free for 15 months. Colorectal carcinoma is extremely rare in children and adolescents. Adenocarcinoma of colon is a virulent disease in children and has a poor prognosis. This is because of the poor histological characteristics and difficulty in diagnosis.