Journal of Pathology of Nepal

ISO 15189:2022; what’s new in new?

2023-02-17T06:29:37+00:00

Not Applicable

The emerging role of pathologists in the era of modern medicine.

2023-05-11T08:19:28+00:00

In the era of modern medicine, the role of pathologists has become increasingly important and multidimensional. Most pathologists traditionally shielded comfortably behind their microscopes usually in their basement offices with minimum interactions with other clinicians or patients. The pathologists were mainly involved in the morphological diagnosis which included macroscopic and microscopic examination of received specimens. This slowly changed with pathologists starting fine needle aspirations and core biopsies. Interactions with clinicians improved with multidisciplinary meetings. The first significant change in the role of a pathologist was seen with the advent of immunohistochemistry. The understanding of protein expression on normal and pathologic cells made it possible for nosological classification of neoplasms.¹ So with the use of histochemistry pathologists were able to accurately classify neoplasms.

Recently, as modern medicine changed due to recent discoveries in cellular and molecular pathways the need to individualize oncological therapies arose. Hence, the need to analyze tumor markers that are able to predict the response of the patients to targeted therapies was seen. So while previously, diagnostic pathology was aimed to define prognostic biomarkers, in the current context the pathologists are required to identify biomarkers used to predict patient’s potential response to target drugs.² A pathologist, being a medical professional, can integrate morphological and molecular data to achieve a complete diagnosis. This significantly changed the role of a pathologist beyond morphological diagnostics to a role that’s vital for accurate disease identification, prognosis determination, and treatment planning.

Hence, the pathologist now can be described a clinician whose responsibility is to interpret and integrate morphological as well as molecular information to provide answers to diagnostic, prognostic and predictive behavior of tumors in the “ epoch of next-generation sequencing”.

It would be prudent for the currently practicing and future pathologists to incorporate the molecular knowledge into their diagnostic relam and provide continual education and training programs.

ACTH more than 2000 pg/ml; is it immunoassay interference or another matter?

2023-04-26T10:28:21+00:00

Starting rifampicin in patients with Addison’s disease or adrenal tuberculosis may precipitate an adrenal crisis as a result of the induction of CYP 3A4 which in turn leads to increased breakdown of cortisol. We report this rare phenomenon to increase awareness among healthcare professionals.

Esthesioneuroblastoma: an institutional based descriptive study of a rare tumor

2022-05-22T06:24:39+00:00

Background: Esthesioneuroblastoma is a slow-growing rare malignant neuroectodermal tumor arising from the olfactory epithelium. It has a bimodal incidence with peaks in the second and third decades of life and the sixth and seventh decades of life with equal incidence among men and women. Prognostic factors include the Hyams grade and modified Kadish stage. This study analyzed the clinicopathological features of esthesioneuroblastoma.

Materials and methods- Retrospective study of patients who were diagnosed with esthesioneuroblastoma at a tertiary care hospital between January 2012 and May 2019 was conducted. The research was performed according to the World Medical Association Declaration of Helsinki. Institutional research committee approval (IEC: 473/2019) was obtained.

Results: Clinicopathological profiles of 8 patients who were diagnosed with esthesioneuroblastoma during the period were included. Among the eight patients, five were female and three were male. Common presenting complaints were nasal obstruction, difficulty in breathing, epistaxis, local pain, and anosmia. The average age of presentation was 52 years, ranging from 14 to 73 years. Anterior rhinoscopic examination in these cases showed a polypoid mass located in the nasal cavity. According to the Hyams grading system, three of the eight cases were grade-2 and the remaining five cases were grade-3 Hyams histological grade. Three cases exhibited foci of ganglioneuroblastic transformation. Three patients had metastases to cervical lymph nodes and three patients had recurrence.

Conclusions: Esthesioneuroblastoma is a rare aggressive malignant tumor. It can exhibit divergent epithelial or ganglionic differentiation. A proper diagnosis should be made, graded and staged before proceeding to treatment.

Study of blood group and platelet counts in ER and ENT patients with epistaxis

2023-04-27T10:30:18+00:00

Background: Epistaxis is one of the most common emergencies and a very difficult problem to tackle especially in Primary Health Centers or Health Posts in rural areas of Nepal. The objective of the study was to identify blood group and platelet count with the occurrence of nasal bleeding.

Materials and Methods: A prospective study was carried out among 96 patients visiting Kathmandu Medical College and Teaching Hospital in Emergency Department and ENT Department with epistaxis from October 2021 to October 2022. Ethical clearance was obtained from IRC Kathmandu Medical College Teaching Hospital (reference no: 0609202105). A blood sample was sent for blood groups and platelet count. Convenience sampling was used. Data were entered in Microsoft Excel 2016 and analyzed in Statistical Package for Social Sciences version.

Results: The age group of 20-29 years was found to be the commonest age group presented with epistaxis. The commonest blood group with epistaxis was found to be O^+ve and platelet count was found to be within the normal range in the majority of the cases.

Conclusions: Epistaxis was found to be more common among patients with O^+ve than non ‘O’ blood groups. Patients with Blood group O^+ve need to be investigated further for coagulation profile before any kind of procedure.

Study to determine between HbA1C and C-reactive protein in Diabetes mellitus

2023-06-10T17:04:39+00:00

Background: Studies have shown that C-reactive protein, as an inflammatory marker, is an important risk factor for insulin resistance and type 2 DM. Measurement of inflammatory markers like CRP will improve the prediction of the risk of these events. The aim of this study was to investigate the relationship between hemoglobin A1c, one of the indicators of diabetes, and the highly sensitive C-reactive protein, one of the indicators of inflammation.

Materials and Methods: This prospective observational study was carried out in the Department of Pathology, Patan Hospital. This study included each 154 subjects of Type 2 diabetic patients and healthy control. Statistical analysis was done using Pearson’s correlation test and data was expressed as mean ±SD for each parameter. A p-value of < 0.05 was considered to be significant.

Results: Most (57.7%) of the patients were between 40 to 60 years with a female preponderance of (0.5:1). The HbA1c and CRP values were high in the case group compared to the control group and analysis shows statistical significance. There was a statistically significant association between CRP level in the diabetic group (patient with HbA1C greater than 5.7%) than in the control group (patient with HbA1C equal to or less than 5.7%) (p- Value=0.005).

Conclusions: Higher HbA1c levels are associated with increased CRP, demonstrating that poorly controlled diabetes mellitus is associated with increased systemic inflammation. Timely screening and early detection of elevated CRP in diabetes mellitus patients can prevent further complications and consequences.

Histopathologic study of endometrium in cases of abnormal uterine bleeding

2023-03-07T03:05:50+00:00

Background: Abnormal uterine bleeding is one of the most common presenting symptoms among women visiting the gynecology outpatient department. Sonography and endometrial biopsy are the usual methods of evaluation; rarely, invasive procedures like hysteroscopy may be needed. Endometrial sampling can be used as a first step in the evaluation. This study was done to analyze the histopathology of the endometrium and to evaluate the causes of abnormal uterine bleeding.

Materials and Methods: Endometrial samples were obtained using dilation and curettage from 50 women presenting to the gynaecology outpatient department with abnormal uterine bleeding symptoms in a medical college hospital.

Results: Among the 50 cases, 21 were found to have endometrial hyperplasia (72.4%); 24 were diagnosed to have an organic lesion (48%). The endometrium was found to be in the proliferative phase in the majority of the cases (40%). The most common age group was 31-40 years and simple cystic hyperplasia was the commonest endometrial pattern. Single-parity women were most commonly affected and they showed a secretory endometrium under microscopy.

Conclusions: Endometrial sampling should be carried out in every patient with abnormal uterine bleeding to study the histopathology of the endometrium and to evaluate the causes of the disease.

A clinicopathological study of sinonasal lesions-5 years study in a rural hospital setup

2023-05-18T09:48:23+00:00

Background: Sinonasal lesions of both non-neoplastic and neoplastic variants are frequently observed by clinicians in the nasal cavity and paranasal sinuses. Sinonasal lesions are important due to divergence in their behavior and prognosis. Hence, a careful histological workup remains the mainstay of a final definitive diagnosis and timely intervention.

Materials and methods: A prospective analysis was done on 151 patients of Sinonasal masses who presented to the Department of Otorhinolaryngology, MVJ Medical College and Hospital, from 2014 to 2019. Their biodata, clinical profile, and histopathological diagnosis were analyzed.

Results: Non-neoplastic lesions (135 cases, 89.4%) were more frequent than neoplastic lesions (16 cases, 10.59%), and showed male predominance with an M: F ratio of 1.7:1. Nasal polyp (119 cases, 88%) was the most common lesion. Nasal obstruction (89 cases 89.45%) was the most common presenting feature. Among the neoplastic lesions, lobular capillary hemangioma was the most common benign lesion (2 cases,50%), and squamous cell carcinoma 2 cases (18.1%), was the most common malignant lesion.

Conclusions: Sinonasal masses can present with overlapping clinical features, hence, it is important to categorize them into non-neoplastic and neoplastic lesions for further management. Histopathology remains the gold standard for establishing the diagnosis in such cases.

A study on the usage and wastage of blood components in blood bank of B.P. Koirala Institute of Health Sciences, Dharan

2021-11-23T04:58:37+00:00

Background: Human blood till date has no substitute. Transfusion of blood and its components is a lifesaving procedure. Hence, optimum utilization and minimum wastage of blood and its components should be strictly monitored.

Materials and Methods: This is a prospective study conducted on data collected from the blood bank of B.P. Koirala Institute of Health Sciences, Dharan, Nepal for a duration of 1 year from year 2015 to 2016. The sample size was calculated by using systematic random sampling with every third sampling interval sample collection method. The study included usage and wastage of packed red blood cells, platelet concentrate, fresh frozen plasma, and cryoprecipitate including data on the supply of blood components to different departments, age distribution, gender distribution, and distribution of blood components based on blood groups.

Results: A total of 1641 units of blood component were included in the study. A total of 92.9% (1524 units) were used and 7.13% (117 units) were wasted. The renal disorder was the most common cause of blood component utilization. The medicine department utilized the majority of the blood components. The expiry was the most common cause of wastage. Among the wasted blood components, platelet concentrate was the maximum.

Conclusion: Blood components are a life-saving resource. It should be evaluated and analyzed properly for utilization in a justifiable manner. The hospital should act in accordance so that maximum blood components are utilized in a safe manner and waste is minimized to the least.

Platelet count and platelet indices in patients of pregnancy-induced hypertension at a rural tertiary care hospital in western India

2023-05-12T09:08:32+00:00

Background: Pregnancy-induced hypertension is a serious complication during pregnancy causing maternal and fetal morbidity and mortality. Pregnancy-induced hypertension associated with thrombocytopenia can help in predicting the severity of the disease. The study aimed to study the platelet count, and platelet indices in Pregnancy induced hypertension patients and compare them with normotensive pregnant women.

Materials and methods: This was a case control study, conducted on patients visiting antenatal care (ANC) at a Tertiary care rural hospital in western India. Study population included a total of 82 patients, which were divided into 2 groups with 41 patients in each control (healthy pregnant women) and study groups (pregnant women with PIH). Patients with chronic hypertension and known case of thrombocytopenia were excluded from the study. The blood samples collected were processed on fully automated cell counter for estimation of platelet count and indices.

Results: The platelet count in the study group ranged from 186434.1±81086.9 whereas in the control group it was 268659±72206.9, showing that the platelet count was significantly lower in women with Pregnancy induced hypertension than in the control group. The MPV, PDW, systolic BP, diastolic BP was found to be significantly elevated in the study group as compared to the control group.

Conclusions: The present study concludes that blood parameter such as platelets count and platelet indices can be considered as an early, economical and easily available parameter for assessment of severity of PIH cases.

Correlation of expression of Cyclin D1 and E-cadherin with gleason grade, serum prostate specific antigen levels and prostatic volume in prostatic carcinoma

2023-05-19T09:58:17+00:00

Background: Prostate cancer is increasingly being diagnosed early due to easy access and availability of better diagnostic modalities. Gleason scoring is important for prognosis and is used to determine the management protocol. As the behavior of these tumors is unpredictable, many markers are being investigated. Cyclin D1 and E-Cadherin have been linked to the development, progression, and aggressiveness in some studies. We studied the expression of E cadherin and cyclin D1 in various grades to understand their relationship with clinicopathologic features, PSA, and prostatic volume.

Material & methods: 52 patients diagnosed with prostatic adenocarcinoma on core biopsy after ethical clearance in our tertiary care center were included in the study and their records were retrieved. Hematoxylin and Eosin stained sections were used for Gleason scoring as well as Gleason grade group as per existing protocols. Immunohistochemistry using antibodies against Cyclin D1 and E-Cadherin along with appropriate controls was performed. Studied parameters were correlated with E-Cadherin and cyclin D1. We used a statistical software package (version 22, IBM, US).

Results: Cyclin D1 showed increasing immunoexpression with an increase in Gleason score and Gleason grade group emphasizing a significant correlation between these parameters (p= 0.001). There was a significant negative association between E-cadherin score, Gleason score, and Gleason grade group (p=0.001). No correlation was obtained with serum PSA or prostatic volume.

Conclusions: E-cadherin and Cyclin D1 dysregulation could be used as prognostic and predictive markers in prostatic carcinoma.

Histomorphological patterns of skin adnexal tumours with an insight into molecular updates - A single institutional study

2022-03-21T05:09:34+00:00

Background: Skin adnexal tumors are a spectrum of benign and malignant tumors that differentiate toward or arise from the adnexal unit of the skin. These rare tumors pose a challenge in diagnosis, and often, a discrepancy is seen between clinical and histopathological diagnosis.

Materials and methods: This single institutional study was carried out among 36 patients who presented with swelling. An initial diagnosis was considered based on the clinical history followed by histopathological examination.

Results: Among the 36 patients, only 4 had malignant tumors. Among them, 3 had sebaceous differentiation, and 1 had apocrine and eccrine differentiation. Among the benign, 14 had follicular differentiation, 12 had apocrine and eccrine differentiation, and 6 had sebaceous differentiation. The clinic-pathological correlation was 65%.

Conclusions: An accurate diagnosis is not possible with just the clinical features. Histopathologic examination is considered the gold standard for diagnosis and categorization.

Assessment of thyroid lesions using fine-needle aspiration cytology in accordance with The Bethesda System and its histopathological correlation

2023-05-09T17:22:48+00:00

Background: Fine Needle Aspiration Cytology is a first-line diagnostic technique that provides an accurate and precise diagnosis for assessing thyroid abnormalities. This study was conducted to analyze the cytology smears of thyroid lesions using The Bethesda system of reporting thyroid cytology and to correlate the cytological findings with histopathology diagnosis to determine the diagnostic accuracy of FNAC.

Materials and methods: A prospective cross-sectional study was carried out. FNAC of thyroid lesions of 203 patients were examined and reported as per the Bethesda system for reporting thyroid cytopathology. Of these, 33 patients underwent surgery, whose histopathological findings were compared and correlated with respective cytopathological diagnoses. The IBM SPSS (Statistical Package for the Social Sciences) software version 27 was used for data analysis.

Results: Among 203 cases evaluated, there were 11 Non-diagnostic (Category I) cases, 171 benign (Category II) cases, 4 cases of atypia of undetermined significance (Category III), 7 were suspicious for Follicular Neoplasm (Category IV), 2 were suspicious for malignancy (Category V) and 8 were malignant (Category VI). Out of 203 patients, only 33 patients underwent surgery, of whom 26 (78.79%) were benign and 7 (21.21%) were malignant on histopathology. The corresponding values for sensitivity, specificity, and diagnostic precision of FNAC were 71.42%, 100%, and 93.93% respectively, while positive and negative predictive values were determined as 100% and 92.85% respectively.

Conclusions: The study shows that thyroid tumors can be successfully categorized and reported cytologically as per The Bethesda system.

Cavernous hemangioma in adult parotid gland encroaching on the parapharyngeal space: A case report

2023-05-22T15:39:52+00:00

Hemangiomas account for 0.4-0.6% of all tumors of the parotid gland. With about 50 cases reported worldwide in adults, diagnosing a hemangioma in the parotid gland can be difficult. An accurate diagnosis of parotid hemangiomas in adults before excision is challenging. We report a case of a 54-year-old woman with a left parotid mass of five years duration, which was rapidly increasing in size over last one year. Magnetic resonance imaging (MRI) was suggestive of a left parotid pleomorphic adenoma invading the parapharyngeal space. Fine needle aspiration cytology was inconclusive. However, with a strong clinical suspicion of a pleomorphic adenoma, left total parotidectomy was performed. The histopathological findings were of a cavernous hemangioma. The rarity of such condition in head and neck region and misdiagnosis or failing to diagnose make this case more interesting to pathologists and clinicians alike. Nevertheless, hemangioma should be considered in the differential diagnosis of parotid tumors in adults.

Incidental Inguinal Tubercular Lymphadenitis in a female of Androgen Insensivity Syndrome- A rarest of rare presentation

2023-01-14T06:05:14+00:00

Androgen insensitivity syndrome (AIS) is a rare X-linked recessive disorder occurring in phenotypic women with male genotype (46, XY) resulting due to mutation in the X chromosome. On the other hand, tuberculosis (TB) is a chronic granulomatous infection caused by Mycobacterium tuberculosis, an acid-fast bacillus. We report a case of a 22-year-old unmarried female presenting with bilateral inguinal pain and primary amenorrhea, which, on comprehensive evaluation, revealed complete female external genitalia and intra-abdominal testes. The karyotype was 46 XY, hence a diagnosis of complete AIS was made. One of the ‘probable testes’ removed surgically was an inguinal lymph node with tuberculous lymphadenitis. Isolated inguinal tuberculous lymphadenopathy, by itself, is rare. Co-occurrence of Complete AIS and inguinal tuberculous lymphadenopathy is a highly unusual and rare association that has not been documented in the literature reviewed.