https://www.nepjol.info/index.php/JPN/issue/feed Journal of Pathology of Nepal 2019-12-24T17:55:07+00:00 Dr Shiva Raj K C Shiva_kc_123@yahoo.com Open Journal Systems <p>The Journal of Pathology of Nepal is the official publication of the Association of Clinical Pathologists of Nepal (<a title="ACPN" href="http://www.acpnepal.com" target="_blank" rel="noopener">ACPN</a>) and doesn’t charge any fee for submission, processing, and publication, All articles are Open Access.</p> <p><a href="http://creativecommons.org/licenses/by/4.0/" rel="license"><img style="border-width: 0;" src="https://i.creativecommons.org/l/by/4.0/88x31.png" alt="Creative Commons Licence"></a><br>All articles published in the Journal of Pathology are licensed under a <a href="http://creativecommons.org/licenses/by/4.0/" rel="license">Creative Commons Attribution 4.0 International License</a>.<br>Journal of Pathology of Nepal is indexed on&nbsp;<a title="DOAJ-JPN" href="https://doaj.org/toc/2091-0908" target="_blank" rel="noopener">DOAJ.</a></p> https://www.nepjol.info/index.php/JPN/article/view/26713 Patient-Pathologist Consultation 2019-12-24T17:54:20+00:00 Shiva Raj K.C. shivarajkc074@gmail.com <p class="Default">Pathologists are being considered as “Doctor’s doctor”, the reason is not they are far more knowledgeable or experienced than the treating physicians. The only reason is for decades, the only bridges between the patient and Pathologists are the treating physician. Many times, the patient suffering from cancer, doesn’t know that the confirmed diagnosis was not given by the treating physician but by the Pathologist. The input of the pathologist (and radiologist) is often essential to a proper diagnosis, yet rarely is the patient given those reports and rare access to the reporting individuals. To date, Pathologists are advising clinical colleagues on appropriate tests, result-interpretation, follow-up testing and to reach the diagnosis. Various clinico-pathological meetings help in overcoming this hurdle.</p> <p class="Default">However, in this era of expanding, decentralized health systems and rapidly increasing the complexity of newer laboratory tests, diagnostic algorithms, and guidelines, it is being difficult for treating physicians to stay updated, even in the area of their expertise. One survey of laboratory utilization patterns revealed that primary care physicians were uncertain of up to 23% of tests utilized, with test ordering uncertainty in 14.7% and test interpretation uncertainty in 8.3%. The 2015 Institute of Medicine report, “Improving Diagnosis in Healthcare” recognizes diagnosis as a team effort that requires pathologist input and interaction with clinical colleagues. Educating and providing consultation is a role that pathologists must embrace. On top of this, social media is beginning to change the way that medicine is practiced. It has the power to engage people in public health and policy discussions, establish professional networks and facilitate patients’ access to information about health and services.</p> <p class="Default">We have integrated social media into our lives by choice and we in the medical practice, amidst our busy schedules, have been using it for easy connectivity with friends and families and also, if not important, for our continued education.3 Various information is available about any disease conditions and available diagnostic methods. Once a patient gets his/her report, they tend to surf on the internet and an overwhelming amount of information present on the internet may not only confuse the patient but also lead to anxiety by going through all the possible consequences which rarely occur. Furthermore, histopathological or cytological reports are better explained by the reporting pathologists. Sometimes, it becomes difficult for treating physicians to explain what exactly does “suggestive of” or “Suspicious” means and what to do next. Limitations and the superiority of any diagnostic tool are better understood by the pathologists. All the issues can be settled with patient-pathologist direct communications. This will help the patient to know the details regarding the test, it’s limitations and its superiority. Direct patient-pathologist communication greatly decreases the burden of treating physicians in counseling the patients., helps to further explain the relevance of the tests and results and have a positive impact on their health and healthcare choices.</p> 2019-12-15T00:00:00+00:00 ##submission.copyrightStatement## https://www.nepjol.info/index.php/JPN/article/view/24963 Correlation of histological grade with Estrogen, Progesterone and HER2/neu reactivity in breast cancer 2019-12-24T17:54:46+00:00 Girishma Shrestha girishma.path@gmail.com Bandana Satyal bandana_sigdel@hotmail.com Palzum Sherpa palzumsherpa@pahs.edu.np <p><strong>Background:</strong> Treatment modalities and prognosis of breast carcinoma depend largely on their hormone receptors (Estrogen and Progesterone Receptors) and HER2/neu profile. Various studies conducted within Nepal have highlighted their overall status in breast carcinomas but studies on their correlation with histological grade are few. This study aims to correlate hormone receptors and HER2/neu status with different histological grades of invasive breast carcinoma.</p> <p><strong>Materials and Methods:</strong> This is a retrospective analysis of cases received at Intrepid Cancer Diagnostics, Nepal between January 2015 to December 2018 for evaluation of status of hormonal receptors and HER2/ neu on invasive breast carcinomas. Mastectomy and excisional biopsies were included for statistical correlation between hormone receptors, HER2/neu and histological grades (n=364). P-value&lt;=0.01 was considered statistically significant.</p> <p><strong>Results:</strong> Of 364 invasive carcinomas categorized into grades 1, 2 and 3, Estrogen Receptor positivity was noted in 77.3% (34/44), 60.8% (115/189) and 28.2% (37/131) respectively; Progesterone Receptor positivity was noted in 61.4% (27/44), 52.4% (99/189) and 21.4% (28/131) respectively; HER2/neu positivity was noted in 18.2% (8/44), 20.1% (38/189) and 19.8% (26/131) respectively. Triple negativity was found to be 9.1% (4/44), 21.7% (41/189) and 41.9% (55/131) in grade 1, 2 and 3 carcinomas respectively.</p> <p><strong>Conclusions:</strong> Estrogen and Progesterone receptor expressing carcinomas were found to be more often of grade 1 category, with this rate declining through grades 2 and 3. No such correlation was noted for HER2/neu. Triple negative carcinomas were found to be of higher grade (grade 3).</p> 2019-09-29T00:00:00+00:00 ##submission.copyrightStatement## https://www.nepjol.info/index.php/JPN/article/view/25408 Megakaryocytic alterations in bone marrow aspiration smears in thrombocytopenia 2019-12-24T17:54:34+00:00 Anuja Bhandari anuja2071@yahoo.com Anil Dev Pant adpant@yahoo.com Anjan Shrestha anzsuv@gmail.com Jiwan Thapa jitha15@yahoo.com <p><strong>Background:</strong> Thrombocytopenia can be seen in any patients irrespective of age and the causes are diverse. This study was done to determine the frequency of various conditions associated with thrombocytopenia and to assess the number and morphology of megakaryocytes in various cases of thrombocytopenia. Megakaryocytic alterations in myelodysplastic versus non-myelodysplastic conditions were also evaluated in this study.</p> <p><strong>Materials and methods:</strong> This was a prospective study conducted on 132 cases of bone marrow aspirates of thrombocytopenia over a duration of one year from 14th April 2017 to 13th April 2018 in Tribhuvan University Teaching Hospital, Kathmandu. All the statistical evaluation was done by using SPSS version 24.</p> <p><strong>Results:</strong> In this study of 132 cases, megakaryocytic thrombocytopenia was the most common cause of thrombocytopenia for which bone marrow aspiration was done. The most common dysplastic change observed in megakaryocytes was micro megakaryocyte which was more commonly seen in MDS. Nondysplastic changes frequently observed were immature forms followed by bare nuclei and were more frequently seen in megakaryocytic thrombocytopenia followed by in myelodysplastic syndromes.</p> <p><strong>Conclusions:</strong> Many similar morphological changes were observed in megakaryocytes among different hematological diseases. So, the presence of dysplastic megakaryocyte should not prompt an interpretation of myelodysplastic syndromes and should always be correlated with patient’s clinical and hematological parameter.</p> 2019-09-29T00:00:00+00:00 ##submission.copyrightStatement## https://www.nepjol.info/index.php/JPN/article/view/24876 Role of Pap smear in the screening of cervical cancer: A hospital based study 2019-12-24T17:54:52+00:00 Niraj Nepal nepalniraj@gmail.com Prabesh Kumar Choudhary khushbudev.dev@gmail.com Sagar Paudel sagarr.paudelll@gmail.com Utsav Nath Adhikari utsavnathadhikari@gmail.com <p><strong>Background:</strong> Incidence of cervical cancer has decreased in the developed world due to use of Pap smear as a screening tool. It has been proven as a sensitive screening tool for cervical cancer but its coverage is very low in Nepal. The objective of this study is to find out the incidence of cervical epithelial cell abnormality, its demographic distribution and common presenting symptoms.</p> <p><strong>Materials and Methods:</strong> This retrospective comparative study was conducted in Nobel Medical College and Teaching Hospital, Biratnagar, Nepal. A total of 950 patients attending gynecological department with various symptoms were enrolled. Only 902 patients were included in the study after excluding inadequate samples.</p> <p><strong>Results:</strong> The mean age of patient was 37.94 ± 12.74 years with minimum age of 18 and maximum age of 79 years. The mean age of patients with epithelial abnormality was 47.88 ± 8.87 years. The highest number of Atypical squamous cells of undetermined significance was observed between 51-60 years (1.1%) whereas Low and High grade squamous intraepithelial lesion were mostly observed between 41-50 years (3.2% and 0.4% respectively). The most common symptom was vaginal discharge (41.6%) followed by pain abdomen (23.1%).</p> <p><strong>Conclusions:</strong> Pap smear is a cost effective, sensitive and simple screening test for cervical premalignant and malignant lesions.</p> 2019-09-29T00:00:00+00:00 ##submission.copyrightStatement## https://www.nepjol.info/index.php/JPN/article/view/25388 Histopathological study of cutaneous granulomas 2019-12-24T17:54:37+00:00 Aasiya Rajbhandari aasyarb@gmail.com Ram Chandra Adhikari rcadhikari27@gmail.com Shreya Shrivastav shreya_shrivastav@hotmail.com Sudip Parajuli sudipparajuli@gmail.com <p><strong>Background:</strong> Cutaneous granulomas comprise a wide spectrum of diseases that are frequently encountered. Since clinical assessment alone is insufficient in most of the cases, skin biopsies are a basic requisite in evaluating these lesions. Histopathological examination, although helpful in deciding the nature of granulomas and etiology in most of the cases, maybe noncontributory in some cases, thus requiring further ancillary tests such as microbial culture, polymerase chain reaction.</p> <p><strong>Materials and Methods:</strong> This prospective cross sectional study enrolled 109 cases of skin biopsies after histopathological confirmation of granulomatous lesions. The specimens were received at the Department of Pathology from 14th April 2017 to 13th April 2018.</p> <p><strong>Results:</strong> Out of 650 skin biopsies, 109 cases (16.8%) were diagnosed as granulomatous lesions on histology. Male predilection was noted and age group of 31 to 40 years was the commonest affected. Upper extremities were more commonly involved. Leprosy was the commonest etiological agent and tuberculoid granulomas were the commonest type based on their histology.</p> <p><strong>Conclusions:</strong> Leprosy was the most common cause of cutaneous granuloma followed by Tuberculosis, fungal infection and foreign body reaction. Among the cases of leprosy, borderline tuberculoid leprosy and tuberculoid leprosy were the commonest subtype.</p> 2019-09-29T00:00:00+00:00 ##submission.copyrightStatement## https://www.nepjol.info/index.php/JPN/article/view/24861 Diagnostic utility of imprint cytology of endoscopic gastric biopsy: A cyto-histo correlation study 2019-12-24T17:54:55+00:00 Prabesh Kumar Choudhary khushbudev.dev@gmail.com Niraj Nepal nepalniraj@gmail.com Rishab Shrestha risj_shr@hotmail.com Utsav Adhikari utsavnathadhikari@gmail.com <p><strong>Background:</strong> Upper gastrointestinal endoscopy is a common procedure done for suspected cases of gastric malignancies. Histopathological examination of gastric tissue has been a gold standard for the diagnosis. Imprint smears of the gastric biopsy specimen is a useful and rapid alternative diagnostic tool. This study was conducted to assess the accuracy of gastric biopsy imprint cytology as compared to the histopathology.</p> <p><strong>Materials and Methods:</strong> Imprint smears were made from all cases of gastric biopsy specimens taken from suspected cases of gastric malignancies. They were evaluated by three pathologists and categorized in to negative for malignancy, suspicious of malignancy and positive for malignancy. The diagnosis given by imprint smears was compared with histopathology. With the help of sensitivity, specificity &amp; accuracy and Kappa score, the agreement between the imprint smear and histopathology was determined.</p> <p><strong>Results:</strong> Among the total 79 cases, 49 cases were chronic non specific gastritis and 22 were adenocarcinoma. The sensitivity, specificity, and overall accuracy of gastric biopsy imprint smear were 92.0%, 98.11% and 94.93% respectively. Kappa core was 0.88.</p> <p><strong>Conclusions:</strong> The gastric biopsy imprint smears is a rapid diagnostic tool and can be used routinely as an adjunct to histopathology in the diagnosis of gastric malignancies.</p> 2019-09-29T00:00:00+00:00 ##submission.copyrightStatement## https://www.nepjol.info/index.php/JPN/article/view/25256 Role of positive glucose challenge test only versus oral glucose tolerance test in pregnancy outcome: a comparative study 2019-12-24T17:54:40+00:00 Neha Homagai neha_h@hotmail.com Nirajan Mainali mainali_nirajan@hotmail.com Sikha Rijal shikhanischaya@gmail.com <p><strong>Background:</strong> Gestational diabetes mellitus is defined as any degree of glucose intolerance which is first recognized during pregnancy and is associated with a number of adverse perinatal outcomes, such as neonatal hypoglycemia, macrosomia with an increased risk of shoulder dystocia and the need for neonatal intensive care. Maternal complications include pre-eclampsia and an increased risk of caesarean delivery. The objective of this study was to compare maternal and perinatal outcomes in pregnant women with positive and negative oral glucose tolerance test following positive glucose challenge test.</p> <p><strong>Materials and Methods:</strong> This is a prospective observational hospital based study of 120 patients admitted in Nobel Medical College Teaching Hospital, Biratnagar with glucose challenge test positive pregnancy for delivery. Oral glucose tolerance test was performed in all the glucose challenge test positive pregnant and compared with various maternal parameters and newborn’s conditions.</p> <p><strong>Results:</strong> Among 120 patients included in the study, 28 (30.4%) cases were oral glucose tolerance test. Pregnancy induced hypertension was present in 12 cases. Hyperbilirubinemia was present in 42, hypoglycemia in 32, respiratory distress in 44, birth asphyxia in 15 and macrosomia in 6 cases.</p> <p><strong>Conclusions:</strong> Pregnancy induced hypertension and hyperbilirubinemia were found to be significantly higher in OGTT positive cases so early detection of GDM screening via is advisable</p> 2019-09-29T00:00:00+00:00 ##submission.copyrightStatement## https://www.nepjol.info/index.php/JPN/article/view/24080 Clinico-histopathological correlation of pigmented skin lesions: A hospital based study at BPKIHS 2019-12-24T17:55:04+00:00 Isha Bohra isha.bohra2308@gmail.com Punam Paudyal drpunampaudyal@gmail.com Anju Pradhan dranjupradhan@gmail.com Dhan Kesar Khadka dhankesharjung@gmail.com <p><strong>Background:</strong> Pigmented skin lesions refers to melanocytic as well as nonmelanocytic lesions. Pigmentation is not just a cosmetic deformity but can also reflect underlying benign pathology as nevi or malignant lesions as melanoma. With this study we intend to evaluate the spectrum of pigmented skin lesions and to correlate the clinical diagnosis with the histological diagnosis.</p> <p><strong>Materials and Methods:</strong> This is a hospital based cross sectional descriptive study where clinicohistopathological evaluation of 46 cases of pigmented skin lesions were analyzed on paraffin embedded tissue sections for a duration of 1 year at the Department of Pathology, B. P. Koirala Institute of Health Sciences.</p> <p><strong>Results:</strong> Out of the 46 cases evaluated there were 32 cases of melanocytic lesions comprising of benign melanocytic nevi (n=27), malignant melanoma (n=5) and 14 cases of nonmelanocytic lesions including basal cell carcinoma and seborrhoeic keratosis (5 cases each). Angiokeratoma (n=1), sebaceous hyperplasia (n=1), trichoepitheloma (n=1) and venous haemangioma (n=1). The age range was from 8-83 years with slight female predominance (52.2%) and the most common site involved was head and neck (58.7%). 76.1% of the patients belonged to the Terai region. Clinicohistopathological correlation showed positive correlation in 26 cases (56.5%) and negative correlation in 20 cases (43.5%).</p> <p><strong>Conclusions:</strong> Pigmented skin lesions are common presenting problem, while majority are benign a small minority can be malignant. So, clinically pigmented skin lesions should be submitted for pathological examination in order not to miss a small percentage of malignant tumors and to differentiate melanocytic lesions from its nonmelanocytic mimickers.</p> 2019-09-29T00:00:00+00:00 ##submission.copyrightStatement## https://www.nepjol.info/index.php/JPN/article/view/25827 Histopathological pattern of skin cancer at tertiary referral skin health centre 2019-12-24T17:54:25+00:00 Ram Chandra Adhikari rcadhikari@hotmail.com Mahesh Shah drmahesh_shah@yahoo.com Anil Kumar Jha dranilkjha@hotmail.com <p><strong>Background:</strong> The skin is a heterogeneous organ, capable of producing various types of skin tumors. The incidence of skin cancers, including melanoma and non-melanoma has been reported to have risen in many parts of the world. In Asian and African countries, individuals with pigmented races have a much lower incidence of skin cancers despite sunny hot weather. This study is aimed to analyze age, sex and site wise of distribution of skin cancers.</p> <p><strong>Materials and Methods:</strong> The study included a total of 60 patients with histopathologically proven skin cancers from January 2015 to December 2018 in the department of pathology, DI skin health and referral centre, Kathmandu, Nepal.</p> <p><strong>Results</strong>: A total of 60 cases of histopathologically proven skin cancer constituted 3.69% of total skin biopsies. Patient age ranged from 15 to 88 years with mean age being 61 years. The majority of the patients were in the age group of 61-70 yrs. The male to female ratio is 1:1.3. Basal cell carcinoma was the most common skin cancer constituting 43.4%, followed by squamous cell carcinoma (28.3%). The most common site of skin cancer is head &amp; neck (73.3%), followed by lower extremities (8.3%). Other skin cancers were Bowen’s disease, melanoma, verrucous carcinoma, keratoacanthoma, trichilemmal carcinoma, extramammary Paget’s disease, Non-Hodgkin lymphoma and metastatic tumor.</p> <p><strong>Conclusions:</strong> The most common type of skin cancer is basal cell carcinoma, followed by squamous cell carcinoma and head &amp; neck being the commonest site.</p> 2019-09-29T00:00:00+00:00 ##submission.copyrightStatement## https://www.nepjol.info/index.php/JPN/article/view/26447 Clinicopathological correlation of uterine cervical lesions with focus on premalignant and malignant lesions 2019-12-24T17:54:23+00:00 Ramesh Makaju makajuram@yahoo.com Binod Dhakal dbinod@gmail.com Rachana Dhakal makajuram@yahoo.com <p><strong>Background:</strong> Cervical cancer ranks as the most frequent cancer among women in Nepal and the first most frequent cancer among women between 15 and 44 years of age. The objectives of the study are to find the incidence of premalignant and malignant cervical conditions and to correlate histopathological diagnosis with that of clinical diagnosis.</p> <p><strong>Materials and Methods:</strong> This was a retrospective study carried out at Kathmandu University Hospital. All cervical biopsy done from January 2009 to December 2018, were included in the study. A proforma was created in which relevant demographic data like age, sex along with clinical findings, gross and histopathological findings were collected.</p> <p><strong>Results:</strong> Mean age of patients with cervical intraepithelial lesion- 1, 2 and 3 was 43.5 years, 48 years and 43.4 years respectively. The most common diagnosis was cervical polyp were (38.65%) followed by 52 cases (15.9%) of unhealthy cervix which bleeds easily on touch and 42 (12.8%) cases of inflammatory condition. Clinical diagnosis of carcinoma of cervix comprised of 42 cases (12.8%). On histopathology, 51(15.6%) cases had invasive carcinoma of which 48 (94.1%) were squamous cell carcinoma, two (3.92%) were adenocarcinoma, and one (1.9%) was of small cell carcinoma. In 33 cases (78.57%), clinical examination was correctly able to identify the invasive cancer. The sensitivity rate of diagnosing cancerous and precancerous lesions by clinical examination and cervical pap smear was 80.95 percent.</p> <p><strong>Conclusions:</strong> Proper clinical history, examination, pap smearing and biopsy report helps through appropriate clinical intervention and prevents development of advanced stage of cervical carcinoma</p> 2019-09-29T00:00:00+00:00 ##submission.copyrightStatement## https://www.nepjol.info/index.php/JPN/article/view/25031 Comparison of fine needle aspiration cytology and core needle biopsy findings with excisional biopsy in breast malignancy 2019-12-24T17:54:43+00:00 Uma Bhatta umabhatta27@gmail.com Shovana Karki umabhatta27@gmail.com Gita Sayami umabhatta27@gmail.com Dosti Regmi umabhatta27@gmail.com <p><strong>Background:</strong> Fine needle aspiration cytology and core needle biopsy are reliable procedures for breast cancer detection. Core needle biopsy is an established alternative to surgical biopsy for diagnosis and prognostication. However, there may be a concern that core needle biopsy may be less reliable than excisional biopsy. The aim of this study was to compare the cytological/core needle biopsy finding with excisional histopathological diagnosis and determine their hormonal status.</p> <p><strong>Materials and Methods:</strong> A prospective study of 65 patients was conducted after obtaining a detailed clinical data. The comparison of the fine needle aspiration cytology/core needle biopsy finding with excisional histopathological diagnosis of breast malignancy was carried out after data analysis. Their ER, PR and HER-2/neu status was also studied in available cases.</p> <p><strong>Results:</strong> Out of the 65 cases of breast malignancy, 69.2% of cases had undergone fine needle aspiration, 60% cases core needle biopsy and 93.8% cases excisional biopsy. The most common carcinoma was invasive carcinoma of no special type. The diagnostic accuracy of fine needle aspiration and core needle biopsy was almost equal, however, core needle biopsy could assess the histological typing and biomarker status. The hormonal status was assessed in 69.23% cases, among them 35.6% cases were triple negative carcinomas.</p> <p><strong>Conclusions:</strong> Core needle biopsy was superior to fine needle aspiration cytology in the diagnosis of breast lesions in terms of diagnostic accuracy. Thus, our result provides valuable prognostic information to guide the decision-making process for the treatment of a patient with invasive carcinoma.</p> 2019-09-29T00:00:00+00:00 ##submission.copyrightStatement## https://www.nepjol.info/index.php/JPN/article/view/25664 Approach to native medical renal biopsy interpretation of glomerular disease 2019-12-24T17:54:31+00:00 Gopi Aryal gopiaryal1@gmail.com Sameer Chhetri Aryal sansamary49@gmail.com <p>Diverse pathogenetic mechanisms and clinical manifestation of renal diseases may produce the same renal morphologic pattern or variety of renal morphologic pattern can lead to the same clinical syndrome. The primary role of the renal biopsy is to provide a diagnosis and information about disease activity and chronicity. The systematic approach to native medical renal biopsy includes evaluation of the four compartments of the kidney sequentially (glomeruli, tubules, interstitium, and blood vessels). The diagnosis in renal pathology is an integrated process in which we must analyze all clinical data, light microscopy, immunohistology, and electron microscopy studies for diagnosis. The aim of the article is to describe the handling of the renal tissue in the anatomical pathology laboratory. It also provides the guideline to renal biopsy evaluation and approach to arrive at the diagnosis of glomerular diseases with similar clinical presentations.</p> 2019-09-29T00:00:00+00:00 ##submission.copyrightStatement## https://www.nepjol.info/index.php/JPN/article/view/25723 Understanding the gleason grading system and its changes 2019-12-24T17:54:28+00:00 Sujata Pudasaini sujatapudasaini@gmail.com Neeraj Subedi nsubedi76@gmail.com <p>Gleason Grading System is the most widely used grading system used for prostatic carcinoma. The five basic grade patterns are used to generate a histologic score, which can range from 2 to 10 (including primary and secondary patterns). The original Gleason Grading System was used to grade acinar adenocarcinoma based on architectural features and it has been correlated with excellent clinical outcomes. Since 1960s, after the discovery of the original Gleason Grading System, a modified version of the Gleason Grading System was introduced in the International Society of Urological Pathology 2005 which came up with many changes including elimination of Gleason pattern 1. The ISUP 2005 was further updated in 2014 to provide more accurate stratification of prostatic carcinoma. The new Gleason Grade Group 1 to 5 has been introduced and it has little resemblance to the original Gleason system. This Gleason Grade Group has been accepted by the 2016 World Health Organization classification of tumors of the prostate.</p> <p>For a needle biopsy, high grade component of any quantity should be included in the Gleason score as it indicates a high probability of finding significant high grade tumor in the prostate. By understanding the principles and practice of this grading system, the pathology report has to clearly indicate which system is adopted in the reporting. This review discusses GGS and its recent development focusing on major changes over the years that led to the new Grade Group system proposed by the 2014 ISUP consensus.</p> 2019-09-29T00:00:00+00:00 ##submission.copyrightStatement## https://www.nepjol.info/index.php/JPN/article/view/24590 Mixed adenoneuroendocrine carcinoma: report of two cases 2019-12-24T17:55:01+00:00 Manisha Shrestha mansha.stha@gmail.com Anita Shah anitashah50@yahoo.com Sabina Kansakar sabinakansakar977@gmail.com <p>Mixed adenoneuroendocrine carcinoma is a rare tumor that is pathologically and clinically distinct from both its neuroendocrine and adenocarcinoma components. Confusion still exists regarding its histogenesis and therefore definite treatment protocol for its management has yet to be developed. Recent molecular characterization has been able to throw some light into the molecular profiles and mutations associated with the tumor. However, large scale studies are still to be carried out to unmask the true nature of this tumor. We report two cases of mixed adenoneuroendocrine carcinoma, one of the rectum and another of the sigmoid colon.</p> 2019-09-29T00:00:00+00:00 ##submission.copyrightStatement## https://www.nepjol.info/index.php/JPN/article/view/24882 Colloid cyst of third ventricle: Histopathological and ultrastructural study 2019-12-24T17:54:49+00:00 Prasanna Karki gopiaryal1@gmail.com Sameer Chhetri Aryal gopiaryal1@gmail.com Gopi Aryal gopiaryal1@gmail.com Rajesh Panth gopiaryal1@gmail.com Manoj Bohara gopiaryal1@gmail.com Sumit Joshi gopiaryal1@gmail.com Prakash Paudel gopiaryal1@gmail.com Damber Bikram Shah gopiaryal1@gmail.com Gopal Raman Sharma gopiaryal1@gmail.com <p>Cysts occupying the third ventricle are rare lesions and may appear as an unusual cause of hydrocephalic crisis. A 40-year old woman with headache and one episode of fainting attack was diagnosed with a cystic lesion in the third ventricle after brain MRI study. She was operated with the pre-operative diagnosis of a colloid cyst. A yellowish, thick and mucoid cyst was observed intra-operatively. The total removal of the cyst was done along with the cyst wall. On histopathological evaluation, the cyst wall was lined by ciliated cuboidal to pseudostratified columnar epithelium resting on an eosinophilic basement membrane. The ultrastructural study showed the characteristic 9+2 pattern of cilia. Immunohistochemistry showed positive staining for epithelial membrane antigen (EMA), cytokeratin (CK), and negative staining for Glial fibrillary acidic protein (GFAP). Histopathological and ultrastructural findings confirm the diagnosis of a colloid cyst of third ventricles favoring the endodermal origin of the cyst.</p> 2019-09-29T00:00:00+00:00 ##submission.copyrightStatement## https://www.nepjol.info/index.php/JPN/article/view/22305 Dentinogenic ghost cell tumor: A case report 2019-12-24T17:55:07+00:00 Radha Baral radhabaral351@gmail.com Bidhata Ojha bidhataojha@gmail.com Dipshikha Bajracharya drdipshikhabaj@gmail.com Kishor Bhandari drkishorb@gmail.com <p>Dentinogenic ghost cell tumor is a rare odontogenic neoplasm that was initially considered to be a solid variant of Calcifying Odontogenic Cyst with locally aggressive behavior. Dentinogenic ghost cell tumor comprises less than 0.5% of all odontogenic tumors and characterized histologically by an ameloblastomatous epithelium with an area of ghost cell formation and a varying amount of dentinoid. Herein we report a case of intraosseous Dentinogenic ghost cell tumor in a 32 years old male patient with a clinical presentation of bony hard swelling in the left mandibular region. The diagnosis was made on the basis of histopathological findings and histochemical analysis.</p> 2019-09-29T00:00:00+00:00 ##submission.copyrightStatement## https://www.nepjol.info/index.php/JPN/article/view/24754 Neurendocrine tumor of common hepatic duct: an uncommon site tumor 2019-12-24T17:54:58+00:00 Pallavi Srivastava drpallpath@gmail.com Saumya Shukla saumyavarun@gmail.com Nuzhat Husain drnuzhathusain@hotmail.com Priyanka Sameer saumyavarun@gmail.com <p>The neuroendocrine tumor of extrahepatic biliary tract is a rare neoplasm of the gastrointestinal tract. We present a case of 16 year old male presenting with epigastric pain and jaundice with a well-defined lesion in common hepatic duct on imaging. The patient underwent tumor resection. Histopathology examination revealed thickened common hepatic duct infiltrated by tumor cells with expression of Pan CK, Synaptophysin &amp; Chromogranin with Ki- 67 proliferation index of 5%. The final diagnosis of Neuroendocrine tumor of Common Hepatic Duct, grade 2 was rendered. The patient showed no recurrence to date without intravenous chemotherapy.</p> 2019-09-29T00:00:00+00:00 ##submission.copyrightStatement##