Bone marrow aspiration cytology in the diagnosis of hematologic and non-hematologic diseases in a multi-specialty hospital in Nepal

Background: Peripheral blood smear examination and other routine laboratory assays are not always sufficient to diagnose various diseases which affect the blood and bone marrow. A bone marrow aspirate examination is essential in most of the cases.Methods: This work was a hospital-based cross sectional analytical observational study carried out in the department of pathology at the Chitwan Medical College, Teaching Hospital, Nepal, over a period of 3 years from January, 2013 to December 2015. Bone marrow was aspirated from posterior superior iliac crest under local anesthesia; sternum was the alternative site in obese patients. Univariate analysis was performed for each variable using frequency distribution and means with the help of Statistical Package for Social Sciences 20.0 (SPSS 20.0) software.Results: One hundred and fifty-nine patients were included in the study. Eight cases of 'dry tap' were excluded, for whom bone marrow biopsy was advised. Anemia was the largest group followed by malignancy, infection and miscellaneous diseases. Among anemia, megaloblastic anemia was the most common, followed by aplastic anemia, dyserythropoietic anemia and myelopthisic anemia. The category 'malignancy' consisted of leukemia, multiple myeloma and myelodysplastic syndrome. Regarding individual diseases, megaloblastic anemia was the most common haematological disorder followed by immune thrombocytopenic purpura, leukemia and aplastic anemia.Conclusions: Bone marrow aspiration cytology is a mildly invasive technique which can diagnose many haematological and non-hematologic diseases that can be confirmed by more advanced investigations, if needed: serological, biochemical or molecular. However, bone marrow sample cannot be obtained (dry tap) in a proportion of cases. In such cases, a bone marrow biopsy needs to be performed

Correlation of Imprint Cytology of Axillary Lymph Nodes in Breast Carcinoma with the Histopathological Diagnosis

<p>Introduction Conventionally, at least ten axillary lymph nodes are dissected and examined for metastases<br>in every breast carcinoma patient to find out the metastatic status. Recently however, with<br>the use of intraoperative imprint cytologic examination of a single sentinel lymph node,<br>presence or absence of metastases in axillary lymph nodes can be detected within five<br>minutes.<br>...................................................................................................................................................................................................................................<br>Objectives The objective of this study was to determine sensitivity and specificity of imprint cytology<br>in detecting metastases in axillary lymph nodes in breast carcinoma patients taking<br>histopathological examination as the gold-standard. This is the first study of such kind<br>done in Nepal so far. If it is done in other countries, why it is needed for Nepal?<br>...................................................................................................................................................................................................................................<br>Methods 34 female patients with breast cancer who had undergone lumpectomy/mastectomy with<br>axillary lymphadenectomy were included in the study. Imprint smears of the axillary lymph<br>nodes of each case were prepared. The smears were interpreted as positive or negative on<br>the basis of whether metastases were present or absent respectively. Sensitivity and<br>specificity of imprint cytology were calculated taking histopathologic diagnosis as the<br>standard.<br>...................................................................................................................................................................................................................................<br>Results Of the 34 cases, 30 were found to have positive lymph node status in final histopathologic<br>examination. Twenty six among the thirty cases were correctly identified by imprint cytology,<br>resulting in its sensitivity rate of 86.66 percent. There were no false positive cases leading<br>to the specificity rate of 100 percent.<br>...................................................................................................................................................................................................................................<br>Conclusion Imprint cytology has been found to be highly sensitive and specific method for detecting<br>metastases in axillary lymph nodes of breast carcinoma patients.</p> <p> </p

A retrospective histopathological study of hysterectomy with or without salpingoophorectomy specimens

<p>Data obtained from international studies are in consistence with those of our study<br>regarding frequency of various pathologies found in hysterectomy with or without<br>salpingoophorectomy specimens. Leiomyoma was the most common pathology followed by<br>adenomyosis and endometrial hyperplasia. But studies done, in other centers of Nepal have<br>revealed uterine prolapse as the leading cause of hysterectomy.</p> <p> </p

Association of Knowledge, Attitude and Demographic Variables with Cervical Pap Smear Practice in Nepal

<p>Pap smear coverage in this research at 15.7% in Nepal is far lower than global average and even below the average for developing countries. It was observed that attitude was the only factor significantly associated with pap smear test uptake on multivariate binary logistic regression analysis. Thus, health education programs which are effective not only in increasing knowledge but also in bringing about positive change in attitude of women towards pap smear test should be organized to increase pap smear coverage in Nepal.</p> <p> </p

Analysis of abnormal epithelial lesions in cervical Pap smears in Mid-Western Nepal

<p>Background: Like in other developing countries, cancer of cervix is one of the most common malignancies in women in Nepal. Most women never undergo a cervical Pap smear screening. The objective of this<br>study is to determine the prevalence of abnormal cervical epithelial lesions.<br>Materials and Methods: This was a retrospective study of 880 conventional cervical Pap smears reported from the Department of Pathology, Chitwan Medical College in Chitwan, Nepal. The time period was from June 2009 to November 2010.<br>Results: In this study, High-grade Squamous Intraepithelial Lesion was the most common with 6 cases (40%), followed by Low-grade Squamous Intraepithelial Lesion with 3 cases (20%), then Atypical Squamous Epithelial Cells of Undetermined Significance, and atypical Glandular Cells and Squamous cell carcinoma with 2 cases each (13.3%). Eighty per cent of all the abnormal epithelial lesions were found in women above the age of 40 years.<br>Conclusion: At least one Pap screening test of the cervix of all women between the ages of 40-50 years is recommended.</p> <p> </p

Survival for 38 years with Animal-type malignant melanoma

<p>A 38-year-old female came with a dark pigmented nodular lesion on the left labium majus which was present since birth.</p> <p>Grossly, the lesion was uniformly black in colour<br>and measured 7x4.5x3 cm. Cut-sections showed dark pigmentation up to the level of subcutaneous fat. Microscopically, there was assymetrical proliferation of mildly atypical, polygonal tumor cells having moderate amount of heavily melanized cytoplasm in the dermis and subcutis (Clark level V). Maturation with descent was not present. Breslow thickness was 11mm. Invasion of hair follicles and subcutaneous fat was present. Intra and perineural invasion were also seen. Nucleoli were small. Animal-type malignant melanoma was the diagnosis. The patient was alive and otherwise healthy for 38 years because the tumor is low-grade malignant.</p> <p> </p> <p> </p

An uncommon presentation of Kikuchi Fujimoto disease: a case report with literature review

<p>Kikuchi–Fujimoto disease should be kept in the differential diagnosis of lymphadenopathy in young<br>patients, female or male even in tuberculosis-endemic countries and even in patients who have unusual features; for example thrombocytopenia and involvement of axillary lymph nodes in addition to cervical lymph nodes as in this case.</p> <p> </p

Teratoid Cyst of the Postauricular Region: The First Ever Case Report

Rudolf Virchow is considered to be the first scientist to have used the word sebaceous cyst. It was thought that these lesions occurred due to retention of sebaceous secretion consequent to obstruction of sebaceous ducts of sebaceous glands, although that was found not to be the case. In all these cysts, the cavity is filled with keratin. There are six types of keratin-filled cysts, namely, epidermoid, dermoid, teratoid, keratinous, trichilemmal, and teratoma cyst, which have one common name “dermoid cyst.” Of the six, teratoid cyst is the least common. In contrast to other dermoid cysts, teratoid cysts contain tissue elements derived from all the three germ layers, namely, ectoderm, mesoderm, and endoderm. Teratomas can be differentiated from teratoid cysts by the fact that recognizable organ structures may be found in the former; examples include teeth and skin. Teratoid cysts can develop anywhere in the body but rarely arise in the head and neck region. They have never been reported in the postauricular region. In this case report, we present a case of teratoid cyst in the postauricular region in a 21-year-old female. The significance of this case lies in its rarity

Role of Eosinophils in Acute Appendicitis

Introduction: High negative appendectomy rate still prevails on conventional histologic examination. Increased mural eosinophilic infiltrate had been observed in acute appendicitis. Present study aimed to evaluate the role of mural eosinophils in clinically suspected acute appendicitis but histological normal appendix, as an indicator of acute inflammation, alone or in association with edema and to estimate the cut off value for high eosinophil count for the diagnosis of acute appendicitis. Methods: A prospective cross sectional study was conducted on appendectomy specimens which were categorized into three groups of classical acute appendicitis, negative appendectomy and control. HandE and Giemsa stained section were studied for the presence of mural eosinophilic infiltrate, mast cells and edema. Results: Of total 170 cases, group 1 comprised of 68 cases, group 2 consisted of 78 cases and group 3 consisted of 24 cases. Mean eosinophil and mast cell counts in the muscularis propria were significantly higher in CAA and NA categories when compared to control group. Positive association was found between high eosinophil count and edema in CAA and NA categories. Cut off value of ≥6/ mm2 for mural eosinophil count was not significantly different in between NA and control categories. Conclusions: Increased mural eosinophils were significantly present in acute appendicitis and clinically suspected acute appendicitis but histological normal appendix when compared with control group. Sole presence of increased mural eosinophils might represent acute inflammation. However, cut off value for high eosinophil count could not be established to suggest acute appendicitis.  Keywords: adenomyosis; hysterectomy; leiomyoma; tumour; uterovaginal prolapse.