BackgroundAbnormal deposition of calcium in the skin or subcutaneous tissue is termed calcinosis cutis. Idiopathic calcinosis cutis of the scrotum is an uncommon entity. The pathogenesis of idiopathic calcinosis cutis of the scrotum is debatable. The condition presents as several brown to yellowish nodules on the scrotum, gradually progressive, and mostly asymptomatic. Here we report a case of idiopathic calcinosis cutis of the scrotum with a brief review of the literature and a discussion on pathogenesis.Case presentationA healthy looking, 50-year-old Nepali man presented with multiple growths on his scrotum for 15 years, which were mostly asymptomatic with an occasional complaint of itching. On physical examination, multiple pink to brown nodules ranging in size from 0.5 × 0.5 × 0.5 cm to 3 × 3 × 1 cm, which were painless and firm in consistency, were noted. On laboratory examinations the following were found to be within normal limits: serum calcium, phosphorus, parathyroid hormone, and vitamin D hormone levels; uric acid; alkaline phosphatase; and lipid profile. Based on clinical features and laboratory reports, a diagnosis of idiopathic calcinosis cutis of the scrotum was made. The nodules were excised under local anesthesia in several sittings, which gave a good cosmetic result with no evidence of recurrence in 1-year follow-up period. A histopathological examination revealed dermis with areas of fibrosis and calcification along with numerous multinucleated giant cells and an absence of any cystic structure.ConclusionsIdiopathic calcinosis cutis of the scrotum is a benign condition, which remains mostly asymptomatic. It presents as progressive multiple nodules of varying numbers and sizes. A histopathological evaluation reveals areas of calcification. The cause is either dystrophic calcification of cysts or idiopathic. Excision is the treatment of choice.

We report a case of chondroid syringoma (CS) in a 44-year-old male. He presented with a firm asymptomatic nodule in his left upper lip of 2-year duration. The initial clue to the diagnosis was made on fine needle aspiration cytology (FNAC), and a final diagnosis was based on histopathological examination. The case highlights the importance of FNAC in providing clues to the diagnosis of suspected cases of chondroid syringoma before performing large excisions and repair, which would require more skill and time. We have also reviewed the cytological findings of all the cases of benign CS reported until the current date.

Background: 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. Materials and Methods: 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. Results: 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. Conclusions: 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.

Confluent and reticulated papillomatosis of Carteaud and Gougerot is a keratinization disorder with an infective aetiology. Patients present with hyperpigmented papules on the upper trunk and axillae that coalesce centrally and demonstrate reticulation peripherally. Diagnosis is based on clinical findings, characteristic histopathologic changes and response to therapy. We report a case of a young Nepali male who presented with gradual onset of asymptomatic raised dark brown lesions on his neck, trunk and axillae over the course of eight years. The condition was previously misdiagnosed as pityriasis versicolor and had received oral and topical antifungals. The diagnosis was revised to confluent and reticulated papillomatosis based on clinical and histopathological examination. He was subsequently started on oral minocycline 50 mg twice daily and nightly application of topical tretinoin 0.05% gel. There was complete resolution of all his lesions except for residual hyperpigmentation at the end of two months of therapy. There has been no relapse six months from the end of therapy.  This is to our knowledge, the first case of confluent and reticulated papillomatosis reported from Nepal. Oral minocycline and topical tretinoin should be considered first line in the treatment of confluent and reticulated papillomatosis.

Cervical carcinoma is the most common cause of mortality due to cancer in Nepal. Carcinosarcoma is a very rare subtype of cervical cancer which is characterized by the presence of both epithelial and mesenchymal malignant component. It constitutes less than 1% of cervical carcinoma. Due to the low occurrence of the disease, most of the data on treatment and prognosis are based on case reports and series. Here, we report a case of 69 years, female with cervical cancer (FIGO IIA2). Histopathological and immunohistochemical analysis of cervical biopsy initially showed primary adenosarcoma of the cervix. The tumor was non-responsive to primary treatment with concurrent chemoradiation. Later she was treated with abdominal hysterectomy and bilateral salpingo-oophorectomy. The final histopathology of the resected specimen showed a sarcomatous component along with carcinomatous changes in the endocervical glands favouring the diagnosis of carcinosarcoma of the cervix.

Invasive mole, classified under the gestational trophoblastic diseases, comprises of hydropic chorionic villi invading the underlying myometrium, blood vessels or extra-uterine sites. They are usually diagnosed clinically and are treated with chemotherapy. Thus, surgery is rarely performed owing to good response to chemotherapy and preservation of fertility, since most women are in reproductive age. Thus, these specimens are rarely encountered by the pathologists. Here, we report a case of invasive mole in a 48 year old female with persistent elevation of serum beta HCG levels and completed family status who underwent hysterectomy and was diagnosed as a case of invasive mole on histopathologic examination.

Background: Touch/ imprint cytology has been utilized for intraoperative evaluations of tumors to complement frozen sections in order to reach diagnosis prior to histopathology diagnosis. The main aim of this study is to find role of touch imprint in determining histopathology diagnosis of ovarian neoplasm. Materials and Methods: All together one hundred three cases were evaluated using both touch/imprint and histopathology diagnosis. The histopathology diagnoses consisted of Benign (n=85), borderline (n=4), and malignant (n=12). Touch imprint cytology consists of Negative for malignancy (n=90), Positive for malignancy (n=11) and inadequate (n=2). Inadequate smear was excluded from the study. Results: Both touch / imprint cytology were able to diagnose benign and malignant ovarian neoplasm. Out of 103 cases, in cytology showed 89.1% patients were negative and 10.9% patients were positive. Histopathology shows 84.2% of benign ovarian neoplasm, 3.9% borderline neoplasm and 11.9% of malignant. Diagnostic accuracy of touch/ imprint was 99% with sensitivity 100% and specificity was 91.67%. Positive predictive value was 98.89% and negative predictive value was 100%. Conclusion: Touch/ imprint cytology examination is simple, rapid and useful test in evaluation of ovarian neoplasms. It plays very important role in preliminary intraoperative diagnosis of benign and malignant ovarian neoplasms.

Background: Dengue fever is an endemic disease in Nepal that has shown increasing incidence each passing year. Dengue has a wide range of clinical presentations and laboratory findings. Thrombocytopenia is a common finding in dengue-infected patients along with other findings like leukopenia, lymphocytosis, raised hematocrit, and elevated liver enzymes. Thrombocytopenia is an indicator of disease severity and can lead to severe bleeding manifestations. This study aims to find the association of thrombocytopenia with other hematologic parameters. Materials and methods: This retrospective study enrolled 651 dengue patients tested at Patan Academy of Health Sciences who also underwent complete blood count at presentation. Results: Dengue-infected patients of all age groups with a slight male predominance. Thrombocytopenia was noted in 48.69% of cases. Thrombocytopenia showed a significant association with age (p=0.009), total leukocyte count(p=0.00), and hemoglobin levels (p= 0.015). Conclusions: Thrombocytopenia in dengue patients is frequently encountered. Increasing age, leukopenia, and anemia are factors significantly associated with thrombocytopenia at presentation.