Journal of Pathology of Nepal <p>The Journal of Pathology of Nepal is the official publication of the Association of Clinical Pathologists of Nepal (<a title="ACPN" href="" 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="" rel="license"><img style="border-width: 0;" src="" alt="Creative Commons Licence"></a><br>All articles published in the Journal of Pathology are licensed under a <a href="" rel="license">Creative Commons Attribution 4.0 International License</a>.</p> <p>Journal of Pathology of Nepal is indexed on <a title="DOAJ-JPN" href="" target="_blank" rel="noopener">DOAJ</a>.</p> <p>&nbsp;</p> Association of Clinical Pathologists of Nepal (ACPN) en-US Journal of Pathology of Nepal 2091-0797 <ul><li><p>Copyright on any article published by Journal of Pathology of Nepal is retained by the author(s).</p></li><li><p>Authors grant Journal of Pathology of Nepal a license to publish the article and identify itself as the original publisher.</p></li><li><p>Authors also grant any third party the right to use the article freely as long as its integrity is maintained and its original authors, citation details and publisher are identified.</p></li></ul><p><a href="" rel="license"><img style="border-width: 0;" src="" alt="Creative Commons Licence" /></a><br />All articles published in the Journal of Pathology are licensed under a <a href="" rel="license">Creative Commons Attribution 4.0 International License</a>. </p><p>This license permits use, distribution and reproduction in any medium, provided the original work is properly cited.</p> Pathology and Muluki Aain 2074 <p>With the implementation of the Muluki Aain 2074, there will definitely be changes how a clinician will practice medicine. The pathologists are no longer exempted from medical negligence and hence will have to change our ways of practicing too. The pathologists too have to maintain a good standard of practice, ensure that laboratory staff follow appropriate guidelines and protocols, have good communication with clinicians, ensure clear documentation of procedures and results, maintain records and subscribe to appropriate, recognized quality assurance programs. No test is perfect, so incorrect diagnoses are part and parcel of practice in pathology. But how often this matters? Different studies have shown major errors ranging from 1.5% to 5.7% globally. Error rates vary according to different variables including anatomical site to cultures, countries, legal systems and reimbursement schemes. Error in cancer diagnosis may range from 1.8% to 9.4% and 4.9% to 11.8% of all gynecological and non gynecological cases, respectively.</p> Reetu Baral ##submission.copyrightStatement## 2018-09-06 2018-09-06 8 2 10.3126/jpn.v8i2.19462 Role of p53 and Ki-67 immunomarkers in oral premalignant lesions and squamous cell carcinoma: a hospital based study in BPKIHS <p><strong>Background: As </strong>most of the oral squamous cell carcinoma develop from precursor premalignant lesions, it would be helpful if the malignant transformation is detected early in premalignant state. The objective of the research was to study the role of immunohistochemical expression of p53 and Ki-67 in oral premalignant lesion and squamous cell carcinoma.</p><p><strong>Materials and Methods:</strong> The expression of immunomarkers p53 and Ki67 were studied on formalin fixed paraffin embedded tissue sections from human oral squamous mucosal lesion for duration of 1 year. <strong></strong></p><p><strong>Results: </strong>Of total 36 cases, 80% cases of keratosis without dysplasia showed basal pattern of p53 staining while 47.1% cases of squamous cell carcinoma showed p53 staining in all layers of epithelium. The median p53 Labelling Index of squamous cell carcinoma was more than those of keratosis with and without dysplasia though the result was statistically non-significant. 50.0% cases of keratosis without dysplasia and 83.3% cases of keratosis with dysplasia displayed Ki-67 immunostaining confined to basal and suprabasal layer whereas 94.1% cases of squamous cell carcinoma showed Ki-67 positivity in all layers of epithelium. Median Ki-67 Labelling Index increased from keratosis without dysplasia to keratosis with dysplasia to squamous cell carcinoma, difference being statistically significant. A positive and insignificant correlation was observed between p53 and Ki-67 Labelling Index.<strong></strong></p><p><strong>Conclusion: </strong>Increased expressions of Ki-67 and p53 in oral squamous cell carcinoma compared to premalignant lesion suggest that they may be useful indicator of malignant transformation in dysplastic lesion.</p> Mona Dahal Smriti Karki Paricha Upadhyaya Shyam Thapa Chettri Mehul Rajesh Jaisani ##submission.copyrightStatement## 2018-09-06 2018-09-06 8 2 1330 1336 10.3126/jpn.v8i2.20861 Clinical and histopathological analysis of the patients undergoing appendectomy <p><strong>Background:</strong> Acute appendicitis is one of the most common surgical emergencies, but the diagnosis is difficult even with the sophisticated diagnostic tools. The aim of this study is to analyze the clinical and histopathological features of acute appendicitis and to see how reliable the clinical scoring system modified Alvarado score in our setup.</p><p><strong>Materials and Methods:</strong> This was a retrospective observational study of patients who underwent appendectomy at KIST Medical College and Teaching Hospital during two years. The clinical characteristics of the patients in terms of modified Alvarado scoring were outlined. The diagnosis of acute appendicitis was confirmed by histopathological examination. The data were tabulated in MS-Excel and statistically analyzed using SPSS statistics software, version 21.</p><p><strong>Results:</strong> Among 118 patients, who underwent appendectomy, 69 were male and 49 were female with male to female ratio of 1.41:1 and mean age of 27.46±12.724 years.The clinical diagnosis of acute appendicitis was more likely (MAS 7-9) in 56 patients, less likely (4–6) in 44 patients and unlikely (MAS 1-3) in 18 patients. The highest incidence of acute appendicitis was observed in 19-40 years and the lowest incidence in 61 years or above. After histopathological examination, 52 patients out of 56 in the more likely group had acute appendicitis and 4 patients had non-inflamed appendices. 7 patients out of 62 in the less likely and unlikely groups had acute appendicitis and 55 patients had non-inflamed appendices. The overall negative appendectomy rate was 9.32 percent.</p><p><strong>Conclusion:</strong> Our clinical practice of using modified Alvarado score in the diagnosis of acute appendicitis is effective, easy and non-invasive.</p> Kamal Koirala Shiva Raj KC Ganesh Simkhada Rupesh Mukhiya Nisheem Pokharel Geetika KC ##submission.copyrightStatement## 2018-09-06 2018-09-06 8 2 1337 1340 10.3126/jpn.v8i2.20862 A histopathological study of granulomatous lesions <p><strong>Background</strong>: Granulomas are the commonest lesions that the pathologists come across in routine practice. Granulomatous inflammation is a special type of chronic inflammation that is a manifestation of many infective, toxic, allergic, autoimmune and neoplastic diseases and also conditions of unknown etiology. The aim of this study is to analyze different granulomatous lesions and to find the frequency and etiology of all granulomatous lesions.</p><p><strong>Materials and Methods</strong>: The study included a total of 218 granulomatous lesions, received over a period of one year from July 2013 to June 2014 in the department of pathology, TUTH. Special stains like Ziehl-Neelsen, PAS and Wade- Fite- Faraco were done whenever required.</p><p><strong>Results: </strong>Granulomatous lesion accounted for 3% of all biopsies. The median age of the patients was 29 years and the majority of the patients were in the age group of 20-29 years with no sex predilection. Majority of granulomas were seen in lymph nodes (32.1%), followed by skin and subcutis (29.4%), and bones and joints (11%). Tuberculosis was the most common cause of granuloma with 143 (65.6%) cases, followed by leprosy, foreign body and fungal infection. The most common type of granuloma was epithelioid (87.2%), followed by epithelioid with suppuration, histiocytic, foreign body and mixed inflammatory.</p><p><strong>Conclusion</strong>: The granulomatous lesion is common in third decade of life with no sex predominance. The commonest site is lymph node with tuberculosis being the most common cause followed by leprosy. The epithelioid type was the most common type of granuloma.</p> Akanksha Kushwah Narendra Bhattarai Ajay Koirala ##submission.copyrightStatement## 2018-09-06 2018-09-06 8 2 1341 1345 10.3126/jpn.v8i2.20863 Bronchiectasis in patients with chronic obstructive pulmonary disease <p><strong>Background: </strong>Chronic obstructive pulmonary disease is most common disease entity and third leading cause of mortality worldwide. The presence of bronchiectasis in severe chronic obstructive pulmonary disease patients had led to frequent exacerbation requiring hospitalizations. The purpose of this study was to identify the factors associated with bronchiectasis, using routine data collected during medical visits from patients diagnosed with chronic obstructive pulmonary disease.</p><p><strong>Materials and Methods: </strong>This is hospital based cross sectional study conducted on 120 chronic obstructive pulmonary disease patients. All patients were subjected through history, examination, pulmonary function test, sputum samples and imaging of chest.</p><p><strong>Results: </strong>Out of 120 patients among them 67 patients (55.8%) were chronic obstructive pulmonary disease without bronchiectasis while 53 patients (44.1%) had chronic obstructive pulmonary disease with bronchiectasis. Thirty patients (56.6%) having chronic obstructive pulmonary disease with bronchiectasis and 18 patient (26.8%) having chronic obstructive pulmonary disease without bronchiectasis had exacerbation in one year requiring hospitalisation. Most common organisms isolated were <em>Pseudomonas Aeruginosa</em> in 20 patients (55.5%), <em>Klebsillae Pneumoniae</em> in 6 patients (16.6%) among chronic obstructive pulmonary disease with bronchiectasis group.</p><p><strong>Conclusion: </strong>Chronic obstructive pulmonary disease patient with severe airflow limitation, with frequent exacerbation and colonisation with isolation of organisms resulting in bronchiectasis requiring frequent hospitalisation.</p> Milesh Jung Sijapati Narayan Bikram Thapa Rajendra Rijal Shiva Raj KC Poojyashree Karki ##submission.copyrightStatement## 2018-09-06 2018-09-06 8 2 1346 1349 10.3126/jpn.v8i2.20870 A study to assess the critical result reporting at B &C Medical College and teaching hospital <p><strong>Background</strong>: The critical value can occur while performing panels of tests at laboratory by different chemistry or blood analysers with varieties of principles. The main objective of the study was to study the process of critical result reporting and to know the way of communication and documentation done for critical value in the laboratory, ICUs and the wards.</p><p><strong>Materials and Methods</strong>: This study was prospective and non-experimental was conducted at B&amp;C Medical College and Teaching Hospital from 14.04.2018 to 14.05.2018. Total 60 critical values samples were included. The data was collected by means of observing the critical values of inpatient and the process of reporting from the laboratory to the respective wards and ICUs.</p><p><strong>Results:</strong> Out of 60 samples included in our study, there was 100% communication to concerned treating units. For the confirmation of critical value repeat test was done in 68% of cases. In 75% of cases clinicians did follow up. Recording of a critical report in lab was done in 96% of cases and almost all of the critical values 98% were immediately reported to the respective wards by technical staffs. There was no communication in 1.6% of cases to treating units by technical staff. Majority 78% of critical values were communicated by respective wards and ICUs nurses to concerned doctors.</p><p><strong>Conclusion: </strong>Critical value can occur while performing panels of tests at laboratory and reporting such values to treating clinicians or respective wards or ICUs could help heath care providers for effective treatment of the patients and their adequate care.</p> Sujan Sharma Barsha Koirala Niraj Keyal ##submission.copyrightStatement## 2018-09-06 2018-09-06 8 2 1350 1352 10.3126/jpn.v8i2.20871 Histopathological evaluation of tumours and tumour like lesions of skin and adnexa <p><strong>Background:</strong> Tumours and tumour like lesions of skin have overlapping clinical presentation and sometimes pose a diagnostic difficulty on clinical ground alone. Histopathological examination although helpful to arrive at correct diagnosis, at times may be treacherous and may require ancillary tests such as Immunohistochemistry.</p><p><strong>Materials and Methods:</strong> The study was conducted at Department of Pathology of Tribhuvan University Teaching Hospital. It was a one year prospective study which enrolled 238 cases of skin biopsies after histopathological confirmation of tumours and tumour like lesions. The specimens were processed by standard method and Hematoxylin and Eosin stained sections were examined. Data entry and analysis was done by using SPSS 20 version.</p><p><strong>Results:</strong> Epidermal cyst was commonest lesion (11.8%). Among benign tumours squamous papilloma was most frequent while Pilomatricoma and Spiradenoma were most common adnexal tumour. Squamous cell carcinoma constituted 41.8% and was commonest malignant tumour followed by basal cell carcinoma (30.2%). Benign tumours were common in 11-30 years of age, malignant tumours in 61-80 years of age while tumour like lesions were common in 21-30 years of age.</p><p><strong>Conclusion:</strong> Squamous papilloma and squamous cell carcinoma was the most common benign and malignant tumour respectively. Benign adnexal tumours exceeded malignant one and were seen in third decade of life. Epidermal cyst was the commonest tumour like lesions followed by dermoid cysts.</p> Diksha Karki Abhimanyu Jha Shreya Shreevastav Dinesh B Pokhrel ##submission.copyrightStatement## 2018-09-06 2018-09-06 8 2 1353 1359 10.3126/jpn.v8i2.20873 Fine needle aspiration cytology of cystic lesions of head and neck <p><strong>Background: </strong>Many non-neoplastic and neoplastic lesions are encountered as cystic lesions of head and neck depending on the patient’s age and anatomical site. Value of FNAC in preoperative diagnosis of these lesions has been established in various study.</p><p><strong>Materials and Methods: </strong>The study was performed in 333 patients that presented as cystic lesions of head and neck at Department of Pathology, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal from July 2013 to June 2014.</p><p><strong>RESULTS: </strong>Cystic lesions in head and neck accounted for 11.35% of all FNACs. The<br /> median age of the patients was 31 years and the majority of the patients were in the<br /> age group of 21-30 years with slight female predilection. Lateral neck was the most<br /> common site with lymph node (31.9%) the most common organ of involvement.<br /> Tuberculous lymphadenitis was the most common diagnosis with 21% of cases,<br /> followed by colloid goiter with cystic change and epidermal cyst. Pus was the most<br /> common aspiration finding. Sensitivity and specificity of FNAC in diagnosing malignancy<br /> was 83.3% and 100% respectively</p><p><strong>CONCLUSION: </strong>A significant number and wide variety of lesions present as cystic<br /> lesions of head and neck. FNAC is useful and cost effective tool to classify, diagnose<br /> and rule out malignancy in these cases.</p> Narendra Bhattarai Akanksha Kushwah ##submission.copyrightStatement## 2018-09-06 2018-09-06 8 2 1360 1364 10.3126/jpn.v8i2.20874 Subclinical hypothyroidism as a cause of leg swelling in patients attending tertiary level hospital in Kathmandu <p><strong>Background</strong>: Peripheral edema is one of the common causes of visit to medical outpatient department. After history taking and investigations few patients are left without diagnosis. This study was designed to find if there is any association between pedal edema and subclinical hypothyroidism when there is no other systemic disease is found.</p><p><strong>Materials and Methods</strong>: This is a cross-sectional observational hospital based study done in one of Medical colleges in Kathmandu for a period of 2 years .All patient coming to medical OPD for the first time with bilateral painless limb swelling were evaluated data were tabulated and analyzed using Ms Excel.</p><p><strong>Results</strong>: Out of 300 patients, 146 patients were exclude from history and clinical evaluation, 154 patients underwent laboratory evaluation. After investigations 46 patients were left without any other systemic disease. Out of them only 3 were male. About 40% of them are overweight or obese. 57% of them had high TSH level, which was significantly associated with limb swelling (t=0.012)</p><p><strong>Conclusion:</strong> Subclinical hypothyroidism is significantly associated with painless bilateral limb swelling when there is no other systemic cause. It is logical to investigate a limb swelling with thyroid function test however there needs to be a larger interventional study to exactly point out the cause in these patients.</p> Prabin Adhikari UN Pathak ##submission.copyrightStatement## 2018-09-06 2018-09-06 8 2 1365 1368 10.3126/jpn.v8i2.20875 Prevalence of dry eyes syndrome and retinopathy in diabetic patients and the association of glycosylated hemoglobin with retinopathy <p><strong>Background: </strong>Diabetes is one of the most common leading causes of blindness in 20–74 year old persons. Recently, problems involving the ocular surface, dry eyes in particular, have been reported in diabetic patients. This study was performed to assess the prevalence of dry eyes syndrome and diabetic retinopathy and its association with HbA1c in diabetic patients.</p><p><strong>Materials and Methods: </strong>All the diabetic patients referred to Eye OPD were consecutively selected during the study period of three years. All the subjects were assessed by developed questionnaire; complete eye examination and Tear Film break up time (TBUT) test and Schirmer’s test. HbA1c was performed in all patients as advised by the physician and was entered in our records.</p><p><strong>Results: </strong>Of 304 subjects, 165 patients (54.3%) suffered from dry eyes syndrome. Although dry eyes syndrome was more common in female patients, this association was not significant. Diabetic Retinopathy was found in 154 patients (50.65%). Dry eyes syndrome was more frequent in diabetic patients with diabetic retinopathy. (P = 0.02). Compared with patients without diabetic retinopathy, those with diabetic retinopathy were more likely to have higher HbA1c (p&lt;0.001). <strong></strong></p><p><strong>Conclusion: </strong>Diabetic retinopathy and dry eyes appear to have a common association like ageing.  Examination for dry eyes should be an integral part of the assessment of diabetic eye disease. In addition, high HbA1c level was an important factor associated with prevalence of Diabetic Retinopathy.  </p> Poojyashree Karki Milesh Jung Sijapati Pragya Singh Basnet Anjila Basnet ##submission.copyrightStatement## 2018-09-06 2018-09-06 8 2 1369 1373 10.3126/jpn.v8i2.20887 Analysis of blood transfusion request and utilization pattern at teaching hospital in Eastern Nepal <p class="Default"><strong>Background: </strong>Blood transfusion unit collection, storage and dispatching on Birat Medical College and Teaching Hospital began from 19 June 2016 via blood bank. After which, many blood distribution were made accessible via this service. This study analyzes the blood transfusion request and utilization pattern and also to monitor for managing the bloodstocks meeting present and future demand in hospital.</p><p class="Default"> </p><p class="Default"><strong>Materials and Methods: </strong>This is descriptive cross-sectional study conducted for all the requests of whole blood dispatched from 19th June, 2016 to 04th July, 2018. Whole blood requisitions from various departments were reviewed regarding the number of requisition, total blood unit replaced, blood group and socio-demographic profile of patients.</p><p class="Default"><strong>Results: </strong>Of 648 transfusion units dispatched, 131 and 324 patients were male and female respectively, B positive blood group were most common, followed by A positive, O positive, AB positive, A negative, O negative and AB negative respectively. The largest numbers of requisitions were from Gynecology and Obstetric department in the hospital of 258 requisitions followed by internal medicine, surgery department, postoperative ward and orthopaedic department. Majority of the requisitions were for 20-29 years age group from the local district Morang. The total blood units replaced were 75, of which 29 and 46 of male and female respectively.</p><p class="Default"> </p><p class="Default"><strong>Conclusions: </strong>B Positive was the predominant requested blood group with Gynecology and Obstetrics department making the most requests, among 20-29 years age group from Morang district. The total replaced blood units were less in number with some requisition forms even lacked essential details.</p> Santosh Upadhyaya Kafle Krishna Kumar Jha Mrinalini Singh Shilpi Shaukin ##submission.copyrightStatement## 2018-09-06 2018-09-06 8 2 1374 1377 10.3126/jpn.v8i2.20889 Comparison of Ultrafast Papanicolaou stain with standard Papanicolaou stain for cervical smear <p><strong>Background: </strong>After the first evolution of Papanicolaou smear, it has been successfully used to screen cervical cancer. With modifications in the staining method of Pap stain, the lesser staining time and unequivocal cell morphology has been achieved by Ultrafast Papanicolaou stain. The aim of this study is to compare the UFP stain and SP stain in cervical pap smears on the basis of background, cell morphology, nuclear details and overall staining.</p><p><strong>Materials and methods: </strong>This is a prospective hospital based study conducted in a tertiary hospital, Nepal Medical College over a period of six months (January 2017 to June 2017). Cervical pap smears received in the department of Pathology is subjected to Standard papanicolaou (SP) stain and Ultrafast papanicolaou (UFP) stain for comparison.</p><p><strong>Results:  </strong>Total of 368 cervical pap smears were subjected to SP stain and UFP stain. Mean age of the patient was 36.57+-10.06 years. The quality of UFP stain was assessed by considering the background, cell morphology, nuclear details and overall staining. Difference in regards to the interpretation and background was not significant when SP stain was compared to UFP stain. However, cell morphology, nuclear details and overall staining were far better in smears stained with UFP stain.</p><p><strong>Conclusion: </strong>Pap smear is the simple and effective screening tool for cervical lesions. With modifications in staining method and introduction of UFP stain, the result is lesser staining time and excellent morphological quality. Hence, UFP stain has become the choice of stain and can be used on a regular basis.</p> Sujata Pudasaini Rakesh Pathak Kricha Pande Shraddha Koirala ##submission.copyrightStatement## 2018-09-06 2018-09-06 8 2 1378 1383 10.3126/jpn.v8i2.20890 Benign melanocytic lesions with emphasis on melanocytic nevi – A histomorphological analysis <p><strong>Background: </strong>Melanocytic lesions are common and include both benign and malignant conditions. Benign melanocytic nevus may show varied microscopic features and should be differentiated from malignant lesions. In the present study, we analyse the histopathological pictures of different types of benign melanocytic nevi.</p><p><strong>Materials and methods: </strong>This study was a hospital based retrospective study and all the cases reported as melanocytic nevus in the period from Jan 2014 to June 2018 in the Department of Pathology, Manipal Teaching Hospital were retrieved and analysed in the study.</p><p><strong>Results: </strong>A total of 104 melanocytic lesions including 74 cases of benign melanocytic nevus were reported in the study period. Females were affected more with a female to male ratio of 1.8:1. The age range was 5 to 78 years with mean age of 28 years. Among the female patients, the commonest age group was 21-30 years while among the males; the most affected age group was 11-20. The commonest histopathological subtype was intradermal nevus comprising 73% cases followed by compound nevus.  On analysis of the different sites involved, face, head and neck were found to comprise 92% cases. Epidermal changes including hyperkeratosis, acanthosis were common in intradermal nevus. In most cases, tumor cells were arranged in nests. Melanin pigment was noted in majority of the cases. Secondary changes noted were chronic inflammation, fibrosis and multinucleated giant cells.</p><p><strong>Conclusion: </strong>Benign melanocytic nevus may present in varied age range and show wide spectrum of histological features. All pigmented lesions should be biopsied for its subtypes.</p> Arnab Ghosh Dilasma Ghartimagar Sushma Thapa Brijesh Sathian Binaya Shrestha Om Prakash Talwar ##submission.copyrightStatement## 2018-09-06 2018-09-06 8 2 1384 1388 10.3126/jpn.v8i2.20891 A correlation study of cervical cytology on Pap smear with cervical biopsy in a tertiary hospital of Eastern Nepal <p><strong>Background:</strong> Carcinoma cervix is among a curable cancer, if identified at an early stage. Pap smear is a simple, safe, noninvasive, outdoor and effective method for detection of lesions of the cervix but it fails to localize the lesion. Cervical biopsy, on the other hand is a gold standard but invasive technique.</p><p><strong>Materials and Methods:</strong> A prospective cross-sectional study was done in Nobel medical college from January 16, 2017 to January 15, 2018 where all pap smears received in a Department of Pathology were included in the study. However, only cases that had undergone both Pap smear and cervical biopsy were compared. Out of the 1492 pap smears, 118 cases underwent biopsy. Correlation was then done regarding cytological and histological diagnosis.</p><p><strong>Results: </strong>Majority of the cytological findings were normal. 7 patients of HSIL revealed moderate dysplasia and higher lesions in biopsy. 2 cases were that of adenocarcinoma which were diagnosed as inflammatory smear in Pap smear.<strong></strong></p><p><strong>Conclusion:</strong> Cervical Pap smear is reliable screening test to identify high grade squamous cell lesions and carcinoma, but it fails to localize the lesion and adenocarcinoma is hard to identify in a pap smear. Hence, cervical biopsy should be carried out to confirm the findings of Pap smear and in case of strong clinical suspicion.</p> Nirajan Mainali Neha Homagai Niraj Nepal Prabesh Choudhary ##submission.copyrightStatement## 2018-09-06 2018-09-06 8 2 1389 1392 10.3126/jpn.v8i2.20993 Histopathological analysis of central nervous system tumor; an observational study <p class="Default"><strong>Background:</strong>  Though the central nervous system tumor comprises ~2% of all the tumors, an overall increase has been observed especially in less developed countries. This increase in the incidence may be due to exposure of population to various risk factors or improved diagnosis with advancement in the ancillary studies. This study aims to provide a single centre histopathological spectrum of this type of tumor.</p><p><strong>Materials and Methods:</strong> A retrospective cross sectional study on a series of cases was performed in the Department of Pathology, Annapurna Neurological Institute &amp; Allied Science , Maitighar , Kathmandu, Nepal from April 2013 to Jan 2016. Data were analyzed using SPSS version 21.0.</p><p><strong>Results:</strong> A total of 221 brain and CNS tumors (125 females and 96 males) were studied. The mean age at diagnosis was 43.77 years. The most common tumor was meningioma(67 cases, 30.3%), followed by astrocytic tumor (57 cases, 25.7%) and pituitary adenoma(30 cases,13.6%). The frequency of WHO grade I, II,III and IV tumor were 94 cases (55%), 34 cases (19.9%),10 cases (5.8%), and 33 cases (19.3%) respectively. The astrocytic tumor was most frequent tumor in children (7/20 caes, 37 %).</p><p><strong>Conclusion:</strong> This study showed the most common CNS tumor to be meningioma followed by astrocytic tumors and pituitary adenoma. The spectrum of CNS tumor in children showed divergent histologic pattern according to the age. In age group 0-10 years embryonal tumors were common whereas ages group of 12-years showed propensity towards astrocytoma as in adults. </p><p class="Default"> </p> Trishna Kakshapati Ranga Bahadur Basnet Basant Pant Deepti Gautam ##submission.copyrightStatement## 2018-09-06 2018-09-06 8 2 1393 1398 10.3126/jpn.v8i2.20892 Early detection of cancer in Nepal: Role of liquid biopsy <p>Cancers of the uterine cervix, breast, lung and stomach are four of the most common cancers in Nepal. Lack of knowledge and awareness about cancer, its risk factors and negligence of the early warning signs play crucial role in raising the incidence of the cancer. Curative therapies are most successful when cancer is diagnosed and treated at an early stage.</p><p>Organized cancer screening programmes provide screening to target population and use multidisciplinary delivery teams, coordinated clinical oversight committees, and regular review by a multidisciplinary evaluation board. For population-based screening programs, decision- making and governance structures, tasks and procedures need to be defined.</p><p>In this paper, we review population-based cancer screening programmes of different countries and share recommendations and relevant evidence for screening and early detection of common cancers in Nepal. The evidence-based recommendations provided in this Review are intended to act as a guide for policy makers, clinicians, and public health practitioners who are developing and implementing strategies in cancer control.  We also discuss the role of liquid biopsy in early detection, diagnosis and monitoring of cancers using circulating biomarkers. Despite challenges, time has come to include cell free circulating tumor DNA (ctDNA) and circulating tumor cells (CTCs), as a parameters for early detection of cancer in the days to come.</p> Sameer Chhetri Aryal Gopi Aryal ##submission.copyrightStatement## 2018-09-06 2018-09-06 8 2 1399 1407 10.3126/jpn.v8i2.20893 Miscarriage and Anti TPO antibodies <p>Autoimmune thyroid disorders are common in women of reproductive age. Anti-TPO antibody and thyroglobulin antibody are frequently found to be associated. Anti-TPO antibodies are responsible for the activation of complement and are thought to be significantly involved in thyroid dysfunction. In early pregnancy women with anti TPO antibodies are prone to develop subclinical or overt hypothyroidism leading to adverse obstetric and fetal outcomes. An association between the risk of a miscarriage and anti TPO antibodies has also been reported even in absence of overt thyroid dysfunction. However, screening for these antibodies and Levothyroxin supplement in anti TPO antibodies -positive euthyroid pregnant women has not been established yet.</p> Santosh Pradhan Keyoor Gautam ##submission.copyrightStatement## 2018-09-06 2018-09-06 8 2 1408 1411 10.3126/jpn.v8i2.20894 Sudden death associated with melanoma brain metastases <p>A 48-year-old male Caucasian, with no relevant medical history except for a mild depression, was found by the partner, passed out on the bedroom floor. Since he was found in cardiac arrest, cardiopulmonary resuscitation was attempted, without success.  Initially, it was suspected to be a suicide attempt and autopsy findings revealed coronary atherosclerosis of about 40%, with no other recoverable cardiac findings.</p><p>The brain showed multiple probable neoplastic lesions, associated with cerebral and cerebellar hemorrhage. The primary tumor was not identified, but the victim had multiple cutaneous nevi. Histological examination revealed melanoma metastases, confirmed by immunohistochemistry.</p><p>In this case, the forensic autopsy allowed an accurate determination of the cause of death. Besides having fulfilled its role to the judiciary system, the autopsy also had relevance from an epidemiological point of view, which is essential for Public Health prevention programs.</p><p> </p> Durão H Carlos Veiga G Marcos Nina Pedro Gonçalves M Manuela Frederico Pedrosa ##submission.copyrightStatement## 2018-09-06 2018-09-06 8 2 1412 1415 10.3126/jpn.v8i2.20896 Angiomyolipoma; a rare entity in the left adrenal gland <p>Adrenal angiomyolipoma is a rare benign entity and only to sixteen cases have been reported in English literature till date. Other site of occurrence is liver, spleen, lungs, bone and ovary. We report a female aged 54 years, who presented with left flank pain, on CT scan showed left adrenal mass. Patient underwent laparoscopic adrenalectomy and final histopathological examination revealed angiomyolipoma of   left adrenal gland.</p> Shankar Bastakoti Binay Thakur Mukti Devkota Amrita Paudel ##submission.copyrightStatement## 2018-09-06 2018-09-06 8 2 1416 1418 10.3126/jpn.v8i2.20897 Primary duodenal tuberculosis - A rare case report <p>Gastroduodenal tuberculosis is uncommon even in parts of world where tuberculosis is endemic and accounts for 2.3 % of abdominal tuberculosis. We present here a case of duodenal tuberculosis who presented with vomiting, pain abdomen and weight loss. Duodenoscopy revealed mucosal ulceration and nodularity with marked enlarged and erythematous surrounding folds. Histopathology of duodenum showed features of tuberculosis.</p><p> </p> Mukesh Prasad Sah Santosh Gautam Chitra Raj Sharma Dewan Saifuddin Ahmed ##submission.copyrightStatement## 2018-09-06 2018-09-06 8 2 1419 1421 10.3126/jpn.v8i2.20898 Carcinoma ex pleomorphic adenoma of the parotid gland with cardiac metastasis <p>Pleomorphic adenomas are the most common neoplasms of the major salivary glands. They are also known as benign mixed tumors because of the presence of both epithelial and mesenchymal elements. In parotid gland, approximately 65%-75% of tumors are pleomorphic adenomas.   In parotid gland, usually it occur lateral to the plane of facial nerve. They present in middle aged patients as well defined, solitary, painless mass and are slow growing tumors. Few subset of tumors may undergo malignant transformation.</p><p>Carcinoma ex pleomorphic adenoma is a rare and aggressive malignancy that arises from primary or recurrent pleomorphic adenoma.  It occurs in 6% of all pleomorphic adenomas.  Diagnosis of malignancy and treatment is largely based on pathologic and radiographic features. Distant metastases have been reported mainly in the lung. . We present an unusual case of 68 yrs female patient with carcinoma ex pleomorphic adenoma of the parotid gland with cardiac metastasis.</p><p> </p> Anuja Bhandari Shovana Karki Geeta Sayami ##submission.copyrightStatement## 2018-09-06 2018-09-06 8 2 1422 1424 10.3126/jpn.v8i2.20899 Introducing an Endocrine Laboratory <p>The growing sub-specialty in Medical practice is beneficial for the patient as well as for the healthcare providers. Laboratory Medicine is also an emerging field to address the complexity of health arena. In earlier days, all laboratory investigations were performed in the single laboratory equipped with all sorts of machines and manpower. But the scenario has changed now with laboratories being specific for subject like Biochemistry, Hematology, Microbiology, Immunology, Genetics and many more. These specifications have proven that by doing so, there is better patient care and involvement of health personnel in various research activities, which ultimately helps in identification of cost effective laboratory approach of diseases.</p> Vivek Pant ##submission.copyrightStatement## 2018-09-06 2018-09-06 8 2 1425 1426 10.3126/jpn.v8i2.20900 Getting sensitized about malpractice lawsuits in practice of Pathology Medical malpractice is defined as any act or omission by a physician during treatment of a atient that deviates from accepted norms of practice in the medical community and causes an injury to the patient. In the United States, Medical malpractice is a specific subset of tort law that deals with professional negligence. “Tort” is the Norman word for “wrong,” and tort law is a body of law that creates and provides remedies for civil wrongs that are distinct from ontractual duties or criminal wrongs.Although the laws of medical malpractice differ significantly between nations, as a broad general rule liability follows when a health care practitioner does not show a fair, reasonable and competent degree of skill when providing medical care to a patient. Runa Jha ##submission.copyrightStatement## 2018-09-06 2018-09-06 8 2 1427 1429 10.3126/jpn.v8i2.20994