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Background: Salivary gland tumors consist of a group of heterogeneous lesion with complex clinicopathological characteristics. Fine needle aspiration (FNA) cytology has been used as a quick, non-invasive diagnostic tool for the diagnosis of neoplastic and non-neoplastic lesion of salivary gland. Aims and Objectives: The aims and objectives of the study are to perform the cytopathological evaluation of minor and major salivary gland lesions (neoplastic and non-neoplastic) in terms of its various types, frequency, site, demographic distribution and to correlate with histopathology findings whenever available. Materials and Methods: This is a hospital-based 3-year study in which 155 cases of patient underwent FNA cytology for salivary gland swelling (non-neoplastic and neoplastic) of which seven cases were excluded due to scant and inadequate aspirate, and thus, only 148 cases were included in this study and histopathological correlation was available in 42 cases. Any metastatic lesion, repeat samples from same patient were excluded from the study. Results: Out of 148 cases, male patients were 72 (49%) and female patients were 76 (51%) with M: F ratio of 0.9:1. Benign lesion was commonly seen in 31–40 years, non-neoplastic lesion at 41–60 years (n=18, 37.6%), and malignant lesions at 61–90 years (n=9, 37.5%). Parotid was the most common salivary gland involved by neoplastic and non-neoplastic lesion accounting 65.5% (n=97) followed by submandibular gland 29.7% (n=34). Pleomorphic adenoma was most frequently diagnosed among all salivary gland lesions (60%). Mucoepidermoid carcinoma outnumbered the category (14%) of malignant salivary gland lesion. On histopathology correlation, 33 cases were correctly diagnosed in cytopathology whereas 9 cases showed discordant result. FNA cytology sensitivity was 66.6%, specificity was 93.3%, positive predictive value was 80.0%, and negative predictive value was 87.5%, respectively. Diagnostic accuracy was found to be 85.7%. Conclusion: Cytopathology examination of salivary gland can be used as safe and reliable method in primary diagnosis of lesions of salivary gland.

Abstract Background Aggressive Angiomyxoma is a benign, slowly growing, locally aggressive and recurrent tumour that occurs in the pelvic-perineal region of females in their reproductive years. It presents as a painless, soft, gelatinous mass and metastasizes rarely. Suspicion can be made based on clinical examination and radiological imaging but final diagnosis is confirmed only after histopathology and immunohistochemistry. The choice of treatment is surgical wide local excision. Case presentation We hereby present a case of a 19-year, unmarried lady, with a body mass index of 21 kg/m2, who presented with a chief complaint of painless mass in left vulva which progressively increased in size in the past one year. Clinical examination revealed a large, cauliflower like, exophytic mass of 10 cm × 10 cm size. Radiological imaging confirmed involvement of lymph nodes. Wide local excision with adequate tumour free margin and depth was used as a treatment modality. The diagnosis was confirmed via histopathological examination of the excised specimen. There is no recurrence in the patient up to date. Conclusion Aggressive Angiomyxoma is a rare tumour and it is most often misdiagnosed. This report highlights the importance of considering Aggressive Angiomyxoma as a differential diagnosis of vulval masses and the two-step surgical approach for its treatment in low resource setting.

Introduction: Micronucleus is used as a biomarker of chromosomal instability, which is one of the hallmarks of neoplastic transformation. As micronuclei score increases with malignancy, it can be an effective and inexpensive adjunct to breast fine needle aspiration cytology, in diagnosing breast lumps, especially detecting grey lesions between benign and malignant tumours. The aim of this study is to find out the mean micronuclei score in fine-needle aspiration cytology of patients with malignant breast lumps in the Department of Pathology in a tertiary care centre. Methods: A descriptive cross-sectional study was conducted among patients with malignant breast lumps in the Department of Pathology in a tertiary care centre between 1 May 2020 to 31 May 2021 after receiving ethical approval from the Institutional Review Committee (Reference number: IRC/2139/021). The fine-needle aspiration cytology of breast lumps was diagnosed as per National Health services breast screening program guidelines. The mean micronuclei score was calculated. Convenience sampling was done and data were collected from the hospital records in the Department. Point estimate and 95% Confidence Interval were calculated. Results: Among 20 malignant breast aspirates, the mean micronuclei score was found to be 8.30±3.75 (3-19, 95% Confidence Interval). Conclusions: The mean micronuclei score in fine-needle aspiration cytology of malignant breast lumps was found to be similar when compared to similar studies conducted in similar settings.

Context: Fine needle aspiration (FNA) plays a crucial role in the evaluation of patients with thyroid lesions. The Bethesda system for reporting thyroid cytopathology (TBSRTC) was designed with a mission to standardize the process of diagnosis and management of thyroid lesions by FNA cytology (FNAC). Aim: We aim to see the benefits of adopting TBSRTC, seek the cytological pitfalls in the diagnosis of thyroid FNAC, and identify the spectrum of thyroid lesions in our setup. Settings and Design: This is a hospital-based cross-sectional study conducted from June 2009 to June 2014 of all thyroid FNACs with available histopathology reports. Cases were designated a specific diagnostic category according to TBSRTC. Materials and Methods: A total of 109 cases were included in the study. Sixty-eight cases had been reported without using TBSRTC and were reviewed and reclassified according to TBSRTC seeking the common reasons for interpretative errors. Statistical Analysis Used: Data were analyzed using SPSS ver. 11.5. Results: In both pre- and post-TBSRTC era, benign neoplasms constituted the major bulk. After the use of TBSRTC, there was increased ability to look for follicular neoplasms, improvement in making definitive diagnosis of the cases, decline in the suspicious category, and an improvement in diagnostic accuracy, and we were in line with the implied risk outlined by TBSRTC in most of the cases except the nondiagnostic or unsatisfactory category. Conclusion: Application of TBSRTC results in uniformity in reporting among pathologists and better interdisciplinary communication and patient management.

Colon carcinoma spreads locally around the intestine wall and can undergo distant metastasis via the hematogenous or lymphatic spread. It rarely metastasizes to the female genital tract and is not fully reported to involve a uterine leiomyoma. Herein we report such an unusual case of a 27 years female a known case of sigmoid colon adenocarcinoma who presented with abdominal pain with bilateral adnexal mass and per vaginal bleeding. Exploratory laparotomy with bilateral resection of ovaries with subsequent polypectomy was done, which on histopathology, it revealed metastatic adenocarcinoma in bilateral ovaries and submucosal leiomyoma. Hence, a lesion with dimorphic histomorphology should be carefully evaluated to rule out the possibility of malignant-to-benign tumor-to-tumor metastasis.

Medulloepithelioma is a rare childhood embryonal tumor arising from the non-pigmented ciliary epithelium of the pars plicata. We report a case of an 11-year-old male who presented with painless loss of vision of the right eye for the last three years and progressively increasing mass on the superior aspect of the globe for the last three months. On ocular examination, a firm, non-tender mass of 4cm x 3cm was noted in the superior aspect of the globe. CT-Scan of the orbit was suggestive of a foreign body with a haemorrhage or infection. The patient underwent enucleation with minimal manipulation. Histopathological examination of the enucleated globe revealed medulloepithelioma. The intraocular medulloepithelioma presentation is often late and masquerading, which may lead to extraocular extension and metastasis and ultimately unfavorable prognosis.

Collision tumors are composed of two histologically distinct neoplasms in the same organ without intermixture of cell types. The co-occurrence of a serous adenocarcinoma with a mature cystic teratoma is very rare. We present here the case of a 48 years married female with bilateral high grade serous carcinoma of the ovary with left sided mature cystic teratoma.

The pattern of glomerular disease varies worldwide. In the absence of kidney disease/kidney biopsy registry in Nepal, the exact etiology of different forms of glomerular disease is primarily unknown in our country. We analyzed 175 cases of renal biopsies performed from September 2014 to August 2016 in Internal Medicine Ward at B.P. Koirala Institute of Health Sciences. The most common indication for renal biopsy was nephrotic syndrome (34.9%), followed by systemic lupus erythematosus (SLE) with suspected renal involvement (22.3%). Majority of patients were in the 30–60 years’ bracket (57.2%), with the mean age of the patients being 35.37 years. The average number of glomeruli per core was 13, with inadequate sampling in 5.1%. Immunoglobulin A (IgA) nephropathy (17%) was found to be the most common primary glomerular disease, followed by membranous nephropathy (14.6%) and focal segmental glomerulosclerosis (14.6%). The most common secondary glomerular disease was lupus nephritis (LN). Complications associated with renal biopsy were pain at biopsy site in 18% of cases, hematuria in 6%, and perinephric hematoma in 4% cases. Although the most common primary glomerular disease was IgA nephropathy, significantly higher population of SLE with LN among Nepalese in comparison with other developing countries warrants further evaluation. As an initial attempt toward documentation of glomerular diseases in the national context, this study should serve as a stepping stone toward the eventual establishment of a full-fledged national registry of glomerular diseases in Nepal.

Filariasis is a chronic disabling parasitic disease causing a major public health problem in tropical areas of Southeast Asia. It is endemic in India, China, Nepal, Indonesia, parts of Asia and Africa. In Southeast Asia it is caused mainly by W. bancrofti and Brugia species. Microfilaria is known to be present in cytology smears prepared from swelling at various sites and also in different body fluids. However, upper arm swelling as a clinical presentation of filariasis is a very rare event. If cytology smears are screened with high index of suspicion in this group of otherwise asymptomatic patients, early institution of proper treatment can both prevent the complication of the disease as well as break the chain of transmission from healthy carriers.

Introduction: Anemia due to iron deficiency and chronic diseases is common occurrence in developing country like Nepal, the latter seen in patients with various inflammatory, autoimmune, and malignant disorders . The Intensive method of marrow iron examination, which this study has employed, provides clinically useful iron status classification in cases of functional iron deficiency. The aim of the study is to find out the prevalence of iron deficiency anemia in biochemically defined moderate to severe anemic patients in tertiary care center. Methods: A descriptive cross-sectional study was done in 43 patients who underwent bone marrow aspiration for evaluation of any cause and had moderate to severe anemia at the same time over a period of one year from Nov 2015 to 2016. Ethical clearance was obtained from Institutional Review Committee. The bone marrow iron stores were assessed by“intensive method” apart from the routinely used Gale’s method. Data was collected and entry were done in Statistical Package for Social Sciences version 24. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Results: The intensive grading system demonstrated normal marrow iron store in 13 (30.2%), depleted iron stores in 3 (7%), functional iron deficiency in 14 (32.6%), and combined deficiency in 13 (30.2%) patients. Mean log ferritin concentration was lower in patients with depleted iron stores (2.2μg/l) than in those with normal (2.7μg/l), and functional iron deficiency (2.4μg/l). The mean log ferritin in combined deficiency was lower than the mean log ferritin concentration in iron store deficiency (1.9μg/l). Conclusions: The prevalence of functional iron deficiency anemia was greatest when the intensive method for assessment of bone marrow iron was used, thus differentiating four different iron status categories, including functional iron deficiency, from actual iron store deficiency, avoiding unnecessary iron supplementation in the former group.

Leiomyosarcoma of inferior venacava is a rare tumor. Female are most commonly affected and middle segment of inferior vena cava is the commonest site. The diagnosis can sometimes be challenging as patients present with non-specific symptoms. We present a case of a 65-year-old female who presented with pain in hypochondrium and epigastric region since 4 months along with weight loss, anorexia and vomiting. Histopathological examination revealed a capsulated, multilobated tumor arising from muscle layer of inferior venacava with extraluminal growth pattern and tumor cells showing cytoplasmic positivity for immuno-histochemical stain smooth muscle actin. With the diagnosis of leiomyosarcoma of inferior venacava, excision of tumor was done with tangential excision of 4 cm length of inferior venacava with primary repair.

Introduction: Frozen section helps in rapid intra-operative diagnosis. It is commonly used during surgical procedures to detect malignancy so that modifications of surgery can be decided at the time of surgery on the table. Frozen section is also performed for evaluation of surgical margins and detection of lymph node metastasis. In addition it is applied for detection of unknown pathological processes.The objective of this study was to assess the accuracy of frozen section diagnosis in comparison to gold standard histopathological diagnosis and to find concordance and discordance rate of frozen section with histopathological report. Methods: This was a cross sectional study of 41 frozen section samples done in the department of pathology of BP Koirala Institute of Health Sciences from September 2014 to August 2015. All frozen section samples with their permanent tissue samples sent for final histopathological evaluation were included in the study. Results: The overall accuracy of frozen section diagnosis was 97%. The sensitivity was 94%, specificity was 87%, positive predictive value was 90% and negative predictive value was 93%. The concordance rate was 90.2% and the discordance rate was 9.8%. Conclusions: The results of frozen section varied in different organ systems and the common cause of discrepancy in our study were the gross sampling error and the interpretational error.