Journal of Pathology of Nepal https://www.nepjol.info/index.php/JPN <p>The Journal of Pathology of Nepal is the official publication of the Association of Clinical Pathologists of Nepal (ACPN) and all the published articles are Open Access. Please go through the author guidlenes for necessary information and fee for submission, processing, and publication,&nbsp;</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="Index Copernicus-JPN" href="https://journals.indexcopernicus.com/search/details?id=45557">Index Copernicus</a>,&nbsp;<a title="DOAJ-JPN" href="https://doaj.org/toc/2091-0908" target="_blank" rel="noopener">DOAJ.</a></p> Association of Clinical Pathologists of Nepal (ACPN) en-US Journal of Pathology of Nepal 2091-0797 <p>This license enables reusers to distribute, remix, adapt, and build upon the material in any medium or format, so long as attribution is given to the creator. The license allows for commercial use.</p> Spectrum of rapidly progressive (Crescentic) glomerulonephritis at a referral diagnostic center in Nepal: one year study https://www.nepjol.info/index.php/JPN/article/view/58774 <p><strong>Background: </strong>A clinical syndrome manifested by features of glomerular disease in the urinalysis and by progressive loss of kidney function over a comparatively short period is called rapidly progressive glomerulonephritis (RPGN). RPGN is also called Crescentic glomerulonephritis(CrGN). Crescentic glomerulonephritis (CrGN) is defined as active crescents involving &gt;50% of the total glomeruli. We have done this study to find out the major cause of RPGN in Nepal.</p> <p><strong>Materials and Methods: </strong>This is a one-year prospective study done in the department of renal pathology at Pratham Pathology Private Limited over one year (1<sup>st</sup> November 2021-30<sup>th</sup> October 2022). Data of all patients were evaluated for the histopathological diagnosis. All cases of RPGN were included in the study. Evaluation of serological and demographic data, along with the number of active crescents was done.</p> <p><strong>Results: </strong>A total of 182 cases of kidney biopsies were received for evaluation during one year (1<sup>st</sup> November 2021-30<sup>th</sup> October 2022) at Pratham Pathology Laboratory Private Limited, Kathmandu, Nepal. Out of it 18 cases (9.89%) were those of Crescentic glomerulonephritis. The most common cause of Crescentic glomerulonephritis encountered was Lupus Nephritis (7/18 cases). All cases of lupus presented with Crescentic glomerulonephritis were at stage IV. % of glomeruli with crescents ranged from 50-81.25% with mean involved glomeruli 60.61%.</p> <p><strong>Conclusions: </strong>A total of 9.89% of the renal biopsies were presented with CrGN. Lupus nephritis was the most common cause of CrGN in Nepal.</p> Nirajan Mainali Rupenra Thapa Copyright (c) 2023 The Author(s) https://creativecommons.org/licenses/by/4.0 2023-12-31 2023-12-31 13 2 2033 2036 10.3126/jpn.v13i2.58774 Role of topoisomerase II α and Ki -67 biomarkers in pituitary tumors https://www.nepjol.info/index.php/JPN/article/view/51016 <p><strong>Background</strong><strong>: </strong>Pituitary Adenoma, a neoplastic proliferation of anterior pituitary hormone producing cells, is mainly considered benign but some are clinically aggressive and recurrent and very rarely malignant. From recent advances in pathological and molecular study, there is a continuous search for numerous prognostic biomarkers, to analyze better tumor behavior and prediction of response to treatment and recurrences. This study was conducted to see the epidemiological spectrum of pituitary tumors and to evaluate the correlation of TOPOISOMERASE IIα (Topo 2A), and Ki-67 biomarker with recurrence, aggressiveness, hormone subtype, radiological invasiveness, and prognostic grade of pituitary tumors.</p> <p><strong>Materials and methods:</strong>This was a prospective study with a total of 54 cases. We studied the clinical behavior, radiology, histopathological findings, and immunohistochemistry with Ki-67, Topoisomerase IIα, over 3 years at a tertiary care center.</p> <p><strong>Results</strong>:When comparing Ki-67 expression with aggressiveness, a high degree of statistical significance was found (Mann -Whitney U Test, p-value &lt;0.001 ). All of our aggressive tumors (8/54) had a Ki-67 level of≥3% while most of the nonaggressive tumors (46/54) had a Ki-67 level of &lt;3%. When comparing Topo 2A expression with recurrence, a high degree of statistical significance was found (Mann Whitney U test, <em>P </em>value &lt;0.001). Most of the recurrent tumor (11/15) had Topo 2A index of 1 % or more.</p> <p><strong>Conclusions: </strong>The benign, aggressive, recurrence, or malignant nature of PA can be effectively predicted with the help of immunohistochemistry such as TOPO 2A and Ki67, thereby guiding better patient management.</p> Chhanda Das Madhumita Mukhopadhyay Satinath Mukhopadhyay Avijit Hazra Copyright (c) 2023 The Author(s) https://creativecommons.org/licenses/by/4.0 2023-12-31 2023-12-31 13 2 2037 2042 10.3126/jpn.v13i2.51016 Role of platelet indices in pre-eclampsia: a case-control study at teaching hospital, Nepal https://www.nepjol.info/index.php/JPN/article/view/58322 <p><strong>Background</strong>: Preeclampsia is one of the major health-related ailments causing increased maternal morbidity and mortality, and complicates up to 10% of pregnancies. The study aims to find out the utility of platelet indices for early prediction of preeclampsia.</p> <p><strong>Materials and Methods</strong>: It was a prospective case-control study that included a total of 84 patients (42 in the study group with preeclampsia and 42 controls with normal blood pressure) during a one-year study period. Fresh blood samples (2 ml) were collected for the platelet indices - platelet count (PC), plateletcrit (PCT), mean platelet volume (MPV), and platelet distribution width (PDW) – and were analyzed by fully automated cell counter by impedance method, and compared between the two groups.</p> <p><strong>Results</strong>: Both groups were comparable in terms of age, parity, gestational period, and body mass index. The PC and MPV showed a significant difference; (1.98±0.7 vs. 2.42±0.8; p= 0.01) and (12.44±0.6 vs.10.0±0.48; p= 0.03) between the two groups respectively. However, the difference between the two groups was not statistically significant for PCT and PDW.</p> <p><strong>Conclusions</strong>: The low platelet count and an increased mean platelet volume were significant in patients with preeclampsia compared to the control group. It could be a marker for early diagnosis of preeclampsia in pregnancy.</p> Prabesh Choudhary Narendra Pandit Niraj Nepal M Yadav Copyright (c) 2023 The Author(s) https://creativecommons.org/licenses/by/4.0 2023-12-31 2023-12-31 13 2 2043 2045 10.3126/jpn.v13i2.58322 Study of nuclear morphometry in the cytologic evaluation of thyroid neoplasms https://www.nepjol.info/index.php/JPN/article/view/55485 <p><strong>Background: </strong>Nuclear morphometry is purported to allow better differentiation between various thyroid lesions beyond what is offered by conventional cytology. The present study was conducted to evaluate the nuclear morphometric parameters in fine needle aspirates of thyroid neoplasms and to study their role in differentiating benign and malignant thyroid neoplasms.</p> <p><strong>Materials and Methods: </strong>Nuclear morphometric parameters of all the patients presenting with thyroid swelling and undergoing fine needle aspiration cytology (FNAC) and belonging to Category III, IV, V, and VI of the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) were studied.</p> <p><strong>Results: </strong>Out of a total of 60 cases, a maximum was noted from category IV which is follicular neoplasm or suspicious for follicular neoplasm. The sensitivity of FNAC for the diagnosis of thyroid lesions in the present study was observed at 87.71%. The nuclear morphometry parameters – short axis diameter, long axis diameter, nuclear area, and perimeter showed significant differences between benign and malignant lesions (p-value &lt;0.001). The mentioned nuclear morphometric parameters were observed to be the highest in anaplastic carcinoma followed by papillary carcinoma and medullary carcinoma, and lowest in follicular neoplasms. A significant difference was observed in the nuclear parameters of follicular adenoma and follicular carcinoma.</p> <p><strong>Conclusions: </strong>Nuclear morphometry can help in distinguishing between benign and malignant thyroid lesions, particularly in the diagnosis of indeterminate smears where there is a disparity in diagnosis on conventional cytology, especially in differentiating follicular neoplasms.</p> Joyce Thomas Tulsi Shyam Chhadi Hirkani Chhadi Copyright (c) 2023 The Author(s) https://creativecommons.org/licenses/by/4.0 2023-12-31 2023-12-31 13 2 2046 2052 10.3126/jpn.v13i2.55485 A study of eosinophil count in oesophageal and gastric mucosal biopsies at a tertiary care centre https://www.nepjol.info/index.php/JPN/article/view/46929 <p><strong>Background</strong>: Eosinophils are inflammatory cells that can infiltrate several organs playing a major role in causing tissue damage and organ dysfunction. This study was conducted to establish the baseline eosinophil count in normal states and to correlate mucosal eosinophil count with abnormalities of the oesophagus and stomach.</p> <p><strong>Materials and methods: </strong>A retrospective observational study was conducted at the surgical pathology department of a tertiary care hospital in Mumbai. A total of 124 biopsies were studied. Oesophageal and stomach biopsies with some pathology including oesophagitis, gastritis, ulcer, nonspecific inflammation, etc, were considered abnormal.</p> <p><strong>Results</strong>: Out of 124 biopsies, 36 (29.03%) were normal, while 88 (70.97%) were abnormal. Eosinophilic gastrointestinal disease had male predilection. In abnormal oesophageal biopsies, 16 (88.9%) of 18 oesophageal biopsies had an eosinophil count in the 0-5 eos/HPF band, whereas 50 (71.4%) of 70 abnormal stomach biopsies had eosinophils in the 0-5 eos/HPF band. The eosinophil count reported was 24/HPF in eosinophilic oesophagitis.</p> <p><strong>Conclusions</strong>: Almost all normal oesophageal biopsies (90.9%) and stomach biopsies (100%) showed eosinophil count as 0 eos/HPF and &lt;10/HPF respectively. So if one finds eosinophils in a biopsy sample, one needs to look for other specific pathology.</p> Nilam More Amita Joshi Snehal Jumnake Pallavi Gulhane Copyright (c) 2023 The Author(s) https://creativecommons.org/licenses/by/4.0 2023-12-31 2023-12-31 13 2 2053 2058 10.3126/jpn.v13i2.46929 Agreement of results between dry and wet chemistry system for common clinical chemistry parameters https://www.nepjol.info/index.php/JPN/article/view/55219 <p><strong>Background:</strong> The advancement of analytical chemistry has led to the use of automated systems in clinical laboratories, including liquid-based wet chemistry and film-based dry chemistry systems. Reflectance spectrophotometry-based dry chemistry systems offer a viable alternative to wet chemistry analyzers. This study aimed to compare the agreement of results between the dry chemistry system and the wet chemistry system.</p> <p><strong>Materials and Methods:</strong> Secondary data from external quality control samples were analyzed using the Vitros 350 and BA-400 analyzers, over a period of one year (from 1<sup>st</sup> August 2021 to 31<sup>st</sup> July 2022). A total of 57 samples and 12 biochemical parameters were considered. Statistical analysis, including paired t-tests, Spearman's correlation, Bland-Altman plots, and the Intraclass Correlation Coefficient were applied. p value &lt;0.05 was considered to be statistically significant.</p> <p><strong>Results: </strong>The bland-Altman analysis demonstrated that the measurements from both methods fell within the 95% limits of agreement for most of the clinical chemistry parameters like glucose, urea, creatinine, and liver enzymes indicating overall agreement. ICC values indicated excellent reliability for 10 out of 12 parameters, with HDL-C showing moderate reliability and albumin demonstrating good reliability respectively.</p> <p><strong>Conclusions:</strong> The findings of the present study suggest a high level of agreement and correlation between the dry and wet chemistry systems for common biochemical parameters. However, it is important to consider the specific parameters and limitations of each system. These results have implications for laboratories and healthcare professionals in selecting the most suitable system for their needs and resources.</p> Saroj Thapa Apeksha Niraula Prabodh Risal Copyright (c) 2023 The Author(s) https://creativecommons.org/licenses/by/4.0 2023-12-31 2023-12-31 13 2 2059 2065 10.3126/jpn.v13i2.55219 Semen analysis revisited- Qualitative assessment of sperms using cytochemical stains- the new norms of male infertility workup https://www.nepjol.info/index.php/JPN/article/view/38197 <p><strong>Background:</strong> Male infertility is on the rise globally. It contributes to about 40-50% of all infertility cases. Semen analysis forms the basic investigation for the assessment of male factors of infertility, but it has its pitfalls. Literature review has suggested newer parameters of semen analysis such as sperm quality, which can have a significant role in the outcome of pregnancy. This study aims to assess sperm DNA integrity and calculate the DNA fragmentation index, which is a measure of the quality of sperm, thereby highlighting the need for assessment of sperm quality along with sperm quantity.</p> <p><strong>Materials and methods:</strong> 459 cases underwent routine semen analysis along with the DNA fragmentation index. Sperm quality was assessed using Modified Acidic Aniline blue staining. The statistical analysis was done using SPSS using a t-test and Chi-square test. Results: Advancing age did not affect all parameters. The DNA fragmentation index showed no effect on sperm count. Unpaired t-test correlation showed a negative correlation between DNA fragmentation index and sperm motility, viability, and morphology.</p> <p><strong>Conclusions:</strong> This study highlights the need for increasing awareness about the male-factor of infertility with special reference to the quality along with the routine quantitative assessment of sperm. A conventional semen analysis along with a DNA fragmentation index assessment can help the clinician put forward the choice of artificial reproductive techniques for the couple and provide an accurate success rate of treatment.</p> Vidya K Vishnupriya V Radha R.K Prathima S Copyright (c) 2023 The Author(s) https://creativecommons.org/licenses/by/4.0 2023-12-31 2023-12-31 13 2 2066 2070 10.3126/jpn.v13i2.38197 Utility of basic hematological indices in early detection of hemoglobinopathies in paediatric population of southern India. https://www.nepjol.info/index.php/JPN/article/view/52623 <p><strong>Background:</strong> Cases diagnosed as Microcytic Hypochromic Anaemia in paediatric age group will be subjected to basic hematological indices and further confirmed in cases of high suspicion through Hemoglobin Electrophoresis and High-Performance Liquid Chromatography. This study aimed to identify simple indices and cost-effective methods to detect undiagnosed cases of thalassemia syndromes being treated for nutritional deficiency anemias.</p> <p><strong>Materials and Methods:</strong> The study included 100 pediatric patients, from a period of January 2019 to June 2020. Case selection was based on children whose hemoglobin levels were below the cutoff value according to age. They were further subjected to Sehgal and Mentzer indices and suggestive cases were subjected to Gel Electrophoresis (Both Alkaline and Acid) and High-Performance Liquid Chromatography.</p> <p><strong>Results:</strong> 43% of the cases showing abnormality on screening hematological indices were further subcategorized on gel electrophoresis and confirmed on HPLC. 27% of the cases were diagnosed to be β Thalassemia Trait, which constituted the most frequent type of hemoglobinopathy detected. There were 8% of the cases diagnosed to be as Sickle Cell disease which included major and minor forms. 5% of the study cases were diagnosed as β Thalassemia major. 3% of the cases were diagnosed as HbE disease, HbE trait and ȣβ Thalassemia. </p> <p><strong>Conclusions:</strong> Hematological indices can be used effectively for early detection of suspected cases of hemoglobinopathies. </p> Hemanth Kumar VM Pushpalatha K Srinivasamurthy S Copyright (c) 2023 The Author(s) https://creativecommons.org/licenses/by/4.0 2023-12-31 2023-12-31 13 2 2071 2079 10.3126/jpn.v13i2.52623 Histopathological study of ovarian neoplasms in a tertiary healthcare center of Madesh Province https://www.nepjol.info/index.php/JPN/article/view/56517 <p><strong>Background:</strong> Ovarian tumors are a common form of neoplasm in women. Early diagnosis and management of ovarian tumors is a major problem in a developing country like Nepal, due to lack of awareness and limited facility for investigations in all parts of Nepal. Usually, the malignant ovarian neoplasms will have already advanced too far by the time they are detected. This study was proposed to identify the spectrum of ovarian tumors and their clinicopathological features.</p> <p><strong>Materials and methods:</strong> This was a hospital-based cross-sectional descriptive study over a period of two years. Ovarian tissue with clinical notes sent to the histopathology department in 10% formalin was received. The specimens were subjected to critical gross as well as histopathological study. Routine paraffin sections with Hematoxylin &amp; Eosin staining were used. The clinical as well as histological findings were compiled on proforma and then subjected to analysis. This was a descriptive study and data were tabulated and analyzed using the Statistical Package for Social Sciences (SPSS) version 21.0</p> <p><strong>Results:</strong> A total of 50 patients were included in the study with the age range from 15 years to 63 years. Maximum patients were from age group 41-50 years (36%). In the present study, abdominal pain (62%) was the most common presenting complaint followed by mass per abdomen (20%) and irregular periods (10%). The majority of the ovarian tumors belonged to benign tumors (82%) followed by malignant tumors (12%). As per WHO classification, surface epithelium tumors were found to be the most common variety (84%), followed by germ cell tumors (10%). Among the various known subtypes of ovarian tumors, serous cystadenoma (48%) was found to be the most common subtype followed by mucinous cystadenoma (20%).</p> <p><strong>Conclusions:</strong> Benign ovarian tumors are more common than malignant or borderline tumors. Among the histopathological subtypes of ovarian tumors, surface epithelial tumors are the most common type. Differentiation between benign and malignant tumors is important to assure proper management and recovery. Similar studies with greater sample size are advisable in the future.</p> Fahad Alam Anand Kumar Chaurasiya Md. Kalim Akhtar Brijesh Shrestha Copyright (c) 2023 The Author(s) https://creativecommons.org/licenses/by/4.0 2023-12-31 2023-12-31 13 2 2080 2083 10.3126/jpn.v13i2.56517 Association of clinico-pathological and immunohistochemical prognostic parameters with presence of ductal carcinoma in-situ in an invasive ductal carcinoma of breast https://www.nepjol.info/index.php/JPN/article/view/53730 <p><strong>Background: </strong>The clinical outcome of breast carcinoma varies in each individual due to its molecular heterogeneity. There is a rising interest in whether the associated ductal carcinoma in-situ in invasive ductal carcinoma of breast affects the prognosis and overall survival of the patient. This study evaluates the difference in clinico-pathological and immunohistochemical prognostic factors between invasive ductal carcinoma with associated in-situ component, and invasive ductal carcinoma alone.</p> <p><strong>Materials and Methods</strong>: The study was conducted at a tertiary care hospital in South Tamilnadu, India. Two study groups were categorized based on the presence/absence of in-situ component in invasive ductal carcinoma of breast. Clinico-pathological variables and immunohistochemistry [Estrogen receptor (ER), Progesterone receptor (PR), HER2/neu and ki67] findings were compared between the two groups and statistical analysis was performed.</p> <p><strong>Results</strong>: There were 25 cases in each group. A significant statistical difference in tumor size was observed between invasive ductal carcinoma associated with in-situ component (mean-3.6cm) and without in-situ component (mean-5.0cm). A higher proliferative index (60%) was seen in invasive ductal carcinoma alone. There was no difference in the expression of Her2neu between the two groups. A proportionate increase in premenopausal population (60%) and hormone receptor positivity (ER, PR) was observed in invasive ductal carcinoma associated with in-situ component.</p> <p><strong>Conclusions</strong>: Invasive ductal carcinoma associated with ductal carcinoma in-situ shows a less aggressive behaviour compared to invasive carcinoma alone. Further studies of a larger scale need to be done which might help in identifying the subgroup for targeted therapy.</p> Dhivya Balaiya Anitha Chellam Annadurai Jayakarthiga Subbiah Rajasekaran Copyright (c) 2023 The Author(s) https://creativecommons.org/licenses/by/4.0 2023-12-31 2023-12-31 13 2 2084 2089 10.3126/jpn.v13i2.53730 Cytological grading of breast carcinoma and its correlation with histopathological grading https://www.nepjol.info/index.php/JPN/article/view/54568 <p><strong>Background: </strong>Diagnosis of breast cancer is made in most of the cases near accurately by fine needle aspiration cytology. With the advent of neoadjuvant chemotherapy, the need for identification of aggressiveness of the tumor has become essential. So cytological grading may be of prime importance for the patient, who may undergo neoadjuvant therapy prior to surgical resection. Objective of this study was to grade the breast carcinoma on FNAC using Robinson’s and Mouriquand’s grading systems and to assess the concordance of both cytological grading systems with histological grading using a modified Scarff-Bloom-Richardson grading system.</p> <p><strong>Materials and Methods: </strong>This study was done between 2016 and 2018 in subjects with breast carcinoma undergoing FNAC. Cytological grading of the samples was done by Robinson’s and Mouriquand’s methods. Subsequent Histological grading was done on subsequent specimens according to the Modified Bloom Richardson grading system. Obtained histological grades were correlated with the cytological grades.</p> <p><strong>Results: </strong>Robinson’s grading system showed a significant association with the Modified Bloom Richardson grading system (p&lt;0.01), with a specificity of 71.4% (43/60) whereas there was no significant association in the case of Mouriquand’s grading system.</p> <p><strong>Conclusions: </strong>Cytological grading of invasive breast cancer corresponds well with the histological grade. In our study, we found that grading a tumor by Robinson’s method was more specific and elementary compared to Mouriquand’s system of grading.</p> Nikita James MK Umarani KR Shouree Copyright (c) 2023 The Author(s) https://creativecommons.org/licenses/by/4.0 2023-12-31 2023-12-31 13 2 2090 2095 10.3126/jpn.v13i2.54568 Histomorphological spectrum of gallbladder lesions- A prospective study from a teaching hospital https://www.nepjol.info/index.php/JPN/article/view/55891 <p><strong>Background:</strong> Prevalence of gallbladder diseases vary with socio-demographic factors and in India it is around 2-29%. Cholelithiasis causes varied histopathological changes in gallbladder mucosa like acute and chronic inflammation, cholesterolosis, hyperplasia, metaplasia, dysplasia and carcinoma. Gallbladder carcinomas often present as an incidental finding in cholecystectomy specimens. Present study was conducted to identify spectrum of histopathological lesions and to find the incidence of gallbladder carcinoma in cholecystectomy specimens received at tertiary care centre in North Indian state of Uttarakhand.</p> <p><strong>Materials and Methods:</strong> A prospective study was conducted in the Department of Pathology, Government Medical College, Haldwani from January 2021 to September 2022. Total 760 cholecystectomy specimens were received during the study duration. Grossing of gallbladder specimens was done as per Gallbladder Carcinoma (GBC) expert consensus statements.</p> <p><strong>Results:</strong> Out of 760 cholecystectomy specimens, 595 cases (78.29%) were obtained from females, with a female to male ratio of 3.6:1. Maximum cases were seen in 4<sup>th</sup> and 5<sup>th</sup> decades of life. Chronic cholecystitis was the most common histopathological diagnosis [709 cases (93.28%)], followed by acute cholecystitis in 20 (2.63%), follicular cholecystitis in 14 (1.84%) cases, 02 (0.26%) each of xanthogranulomatous cholecystitis and porcelain gallbladder, 05 cases (0.66%) of high-grade dysplasia and 08 cases (1.05%) of gallbladder adenocarcinoma. Out of 08 cases of gallbladder carcinoma, six were incidental diagnoses.</p> <p><strong>Conclusions:</strong> Histopathological evaluation of all resected cholecystectomy specimens is imperative for the detection of premalignant and malignant lesions that might escape in gross and radiological examination and thus could adversely affect patient outcome.</p> Megha Dabral Suchita Pant Ghazala Rizvi Copyright (c) 2023 The Author(s) https://creativecommons.org/licenses/by/4.0 2023-12-31 2023-12-31 13 2 2096 2102 10.3126/jpn.v13i2.55891 Neuroendocrine carcinoma of gallbladder: A rare entity https://www.nepjol.info/index.php/JPN/article/view/60206 <p>Gallbladder neuroendocrine carcinoma is a rare neoplasm thought to arise in the background of chronic inflammation triggered by cholelithiasis. The symptoms of this tumor overlap with those of cholecystitis and other carcinomas of the gall bladder. The imaging findings with fine needle aspiration cytology help in the pre-operative diagnosis. However, the gold standard for diagnosis is histopathology evaluation with immunohistochemistry.</p> <p>We report a case of a 76-year female who was clinically diagnosed with acute calculus cholelithiasis and underwent surgery. The histopathology and immunohistochemistry of the gallbladder revealed neuroendocrine carcinoma.</p> Manisha Shrestha Rohit Khadgi Copyright (c) 2023 The Author(s) https://creativecommons.org/licenses/by/4.0 2023-12-31 2023-12-31 13 2 2103 2106 10.3126/jpn.v13i2.60206 Uterine tumor resembling ovarian sex cord tumor: A case report https://www.nepjol.info/index.php/JPN/article/view/58525 <p>Uterine tumor resembling ovarian sex cord tumor (UTROSCT) is a rare uterine neoplasm of uncertain histogenesis, with presence of ovarian sex cord-like elements. These tumours typically occur in perimenopausal and postmenopausal women, and are considered to behave in an indolent fashion in most of the cases. However, recurrences and metastases have also been reported. We report a case of a 37 year old female who presented with lower abdominal pain and abnormal uterine bleeding, and underwent hysterectomy following a clinical and radiological suspicion of a submucosal uterine fibroid. Macroscopically the tumor resembled a Leiomyoma. However, the diagnosis of UTROSCT was made after histopathological examination and immunohistochemical studies. Clinicians and pathologists need to be aware of this diagnosis, given the rarity of this condition and potential aggressive clinical course.</p> Girishma Shrestha Rohit Khadgi Copyright (c) 2023 The Author(s) https://creativecommons.org/licenses/by/4.0 2023-12-31 2023-12-31 13 2 2107 2110 10.3126/jpn.v13i2.58525 An unusual case of painless hematuria - A rare case report and review of literature https://www.nepjol.info/index.php/JPN/article/view/46584 <p>Urachal carcinoma is a rare and aggressive cancer arising from a persistent urachus which is a remnant of the allantois that extends from blader to umblicus.This is a case report of urachal carcinoma in a 37 year old male who presented with gross painless hematuria . On radiological investigation he was found to have a tumor involving dome of bladder and urachal remnant. Cystoscoic biopsy suggested carcinoma. Partial cystectomy with enblock removal of urachus and umblicus was done. On cutting the specimen through umblicus the urachal remnant was identified very well with a tumor from distal urachus infiltrating into the bladder. Histologicaly this tumor was identified as adenocarcinoma-enteric type involving, urachus , bladder and perivesical fat.</p> Ajitha Kumari Mohan P. Sam Sany Philip Copyright (c) 2023 The Author(s) https://creativecommons.org/licenses/by/4.0 2023-12-31 2023-12-31 13 2 2111 2113 10.3126/jpn.v13i2.46584 Leukemia cutis: a rare manifestation of an underlying primary plasma cell leukemia https://www.nepjol.info/index.php/JPN/article/view/50422 <p>Plasma cell leukaemia is the rarest yet most aggressive plasma cell disorder characterized by a malignant proliferation of plasma cells in the blood and bone marrow. Leukaemia cutis includes cutaneous manifestation of any type of leukaemia, and is defined as skin infiltration by malignant leukocytes or their precursors, resulting in clinically detectable cutaneous lesions. Plasma cell leukaemia cutis is a rare clinical presentation with an adverse prognosis which makes the index case an unusual entity. We hereby report a case of primary Plasma cell leukaemia, who presented with multiple cutaneous scalp nodules. Fine needle aspiration cytology performed on these scalp nodules revealed cellular smears exhibiting mature and immature plasma cells dispersed singly and arranged in small clusters. The total leukocyte count was 25,800/cu mm, with differential count of 18% polymorphonuclear leukocytes, 20% lymphocytes and 62% abnormal plasmacytoid cells. The diagnosis of primary PCL with cutaneous involvement was subsequently rendered through histology and immunophenotyping.</p> Nutan Dixit Shalini Trivedi Vikas Kumar Bansal Pooja Jain Aditi Raina Sonal Agarwal Copyright (c) 2023 The Author(s) https://creativecommons.org/licenses/by/4.0 2023-12-31 2023-12-31 13 2 2114 2118 10.3126/jpn.v13i2.50422 Cultivating Pathologists https://www.nepjol.info/index.php/JPN/article/view/65918 Girishma Shrestha Copyright (c) 2023 Girishma Shrestha http://creativecommons.org/licenses/by/4.0 2023-12-31 2023-12-31 13 2 I I