Background: Fine needle aspiration cytology is a reliable as well as an inexpensive diagnostic method. It is suitable for the developing countries like Nepal for the diagnosis of lymphadenopathy at any approachable site. Fine needle aspiration cytology not only confirms the presence of metastatic disease but also, in most cases, gives the clue regarding the origin of the primary tumor. The aim of the study was to find out the cytological diagnosis of metastatic lymph node lesions. Materials and Methods:A combined prospective and retrospective study was done of all metastatic lymph node lesions (including both superficial and deep nodes) reported in Department of Pathology, Manipal Teaching Hospital, Pokhara from January 2005 to Deceember 2010. Results:A total of 4180 cases of fine needle aspiration cytology were carried out of which 508 cases were of lymph node. Cytology results were unsatisfactory in 58 specimens (12%), "reactive" or "infective" in 347 specimens (68%), positive for metastasis in 93 specimens (18%) and hematolymphoid malignancies include 10 cases (2%). The most common site was anterior and posterior triangles cervical nodes. The most common malignancy was adenocarcinoma, seen in 62 cases (67%), followed by metastatic squamous cells carcinoma (14 cases, 15%). Conclusion:Fine needle aspiration cytology of lymphadenoathy is a useful tool in diagnosing metastatic lesions with good certainty.

Background:Cutaneous tuberculosis (TB) is essentially an invasion of the skin by Mycobacterium tuberculosis, the same bacteria that causes pulmonary tuberculosis.Aim:This study was conducted to study the common types of cutaneous TB and to find the management pattern in a tertiary teaching hospital in Pokhara, Nepal.Materials and Methods:All the cases of cutaneous TB were biopsied and furthermore investigated by performing Mantoux test, sputum examination, fine needle aspiration cytology, chest X-ray and ELISA.Results:In this study, we found that tuberculosis verrucous cutis (48%) had a higher incidence than other types of cutaneous TB. More males were affected than were females (1.2:1). Commonly affected sites were the limb and the buttock (48%). The most commonly affected age group was 16–25 years (40%). All cases (except two) were more than 15 mm in size in the Mantoux test. The histopathological picture was typical in all except three cases. All patients were treated with antitubercular treatment as per the national guidelines.Conclusion:The most common type of cutaneous TB was tuberculosis verrucous cutis and the most commonly affected sites were the limb and the buttock. As cutaneous TB sometimes reflects the presence of pulmonary tuberculosis, its incidence should not be ignored.

Farming is the commonest occupation in patients with chromoblastomycosis. Early histological diagnosis helps in effective management of the condition.

CD should be kept as a differential of lymphadenopathy, especially in asymptomatic and young patients.

Background & objectives:Bartonella henselae causes infections which closely resemble febrile illness and chronic diseases such as tuberculosis and haematological malignancies. There are not many studies on Bartonella infections from India. The present study was undertaken to diagnose B. henselae infection in diverse clinical conditions in a tertiary care hospital in north India.Methods:A total of 145 patients including those with fever and lymphadenopathy, infective endocarditis and neuroretinitis were enrolled in the study. Whole blood, serum and lymph node aspirate and valvular vegetations if available, were obtained. Samples were plated on chocolate agar and brain-heart infusion agar containing five per cent fresh rabbit blood and were incubated at 35°C for at least four weeks in five per cent CO2 with high humidity. Immunofluorescent antibody assay (IFA) was done for the detection of IgM antibodies in the serum using a commercial kit. Whole blood was used to perform polymerase chain reaction (PCR) for the citrate synthase gene (gltA).Results:IFA was positive in 11 of 140 (7.85%) patients and PCR was positive in 3 of 140 (2.14%) patients. Culture was negative in all the cases. A higher incidence of Bartonella infection was seen in patients with fever and lymphadenopathy (n=30), seven of whom were children. In ophthalmological conditions, four cases were IFA positive.Interpretation & conclusions:The present study shows that the threat of Bartonella infection is a reality in India. It is also an important treatable cause of fever and lymphadenopathy in children. Serology and PCR are useful tests for its diagnosis. Clinicians should consider Bartonella infection in the differential diagnosis of febrile illnesses and chronic diseases.

INTRODUCTIONFollicular thyroid carcinoma (FTC) is a slow-growing tumor, and is the second most common cancer of the thyroid. Distant spread may occur commonly to bones, brain and lungs. Soft tissue metastasis is extremely rare and the reported incidence of distant metastasis is between 11 and 25%, while the initial presentation with distant metastasis is uncommon (1). So far to our knowledge, there is no report of a synchronous bone and soft tissue metastases in the literature. We conducted this study based on the extremely rare case of soft tissue metastasis. CASE REPORTA 42-yr-old male presented with a non-toxic solitary thyroid nodule (STN) of 5 yr of duration with swellings on the scalp and on the right forearm with the durations of 3 and 2 months respectively. There was no other significant contributory history.On examination, the general condition and vital signs were normal. A left STN measuring 5×3 cm was present, and was hard in consistency. There was no cervical lymphadenopathy. The left parietal region swelling was firm, non-tender, welldefined and measured 7×5 cm. A bony defect was palpable. The right forearm subcutaneous swelling was hard, non-tender, mobile and well-defined (Fig. 1).Investigations revealed a normal hemogram and chest radiography. Radiography of the skull revealed the erosion of the outer table of the left parietal bone (Fig. 2). Fine needle aspiration cytology (FNAC) from the thyroid nodule, swellings on the scalp and the forearm revealed atypical follicular cells, suggesting a follicular neoplasm. A complete excision with adequate free margins (2 cm) of the swelling on the forearm was carried out under local anesthesia, and the histopathology revealed fibrous septae separating colloid-filled follicles lined by cuboidal follicular cells with areas of Hurthle cell change, anisonucleosis and scalloping of colloid with pseudopapillary hyperplasia (Fig. 3). Serum thyroglobulin (TG) level was found to be 580 ng/mL (normal ≤60 ng/mL). Hence, a diagnosis of FTC with synchronous metastases to bone and soft tissue was made.The patient was operated upon in two phases. First a total thyroidectomy was executed. There were no palpable enlarged lymph nodes, intraoperatively, in the neck. A week later, the scalp swelling was excised widely with adequate margins (2 cm). Final histopathology report showed follicular carcinoma in both specimens (features as described above, with presence of both capsular and vascular invasion). Post-operative period was uneventful. At the end of the 3rd week, serum thyroglobulin levels had reverted back to normal. A 131 I whole body scan at the end of the 5th week showed no residual thyroid tissue in the thyroid bed (neck), except for a hot spot in the scalp which was ablated with 131 I (30 mCi). Patient has been put on thyroxine 0.3 mg/day for life and kept under close follow-up. The patient has been free of symptoms for the next 3 yr. DISCUSSIONFTC is the second most common differentiated thyroid ma- Follicular carcinoma of the thyroid rarely manifests itself as a...

Introduction: Hydatid disease is endemic in sheep and cattle-raising areas worldwide. Its prevalence is high in Nepal. The study was carried out to determine the clinical, radiological and pathological presentations of hydatid disease.Methods: This was a retrospective study of all hydatid disease cases reported in Department of Pathology, from August 1996 to July 2010. All the clinical, radiological and pathological data were collected and collated. Results: A total of 51 cases of hydatidosis were studied. Patients presented with related symptoms in 47 cases, 92.16% with CI (84.78, 99.54) and asymptomatic in four cases, 7.84% with CI (0.46, 15.22). Involvement of liver and lung was found in 35 (68.63%) cases and 10 (19.61%) cases respectively. Involvement of other organs like kidney, pelvis and broad ligament were seen in 6 of the cases. Total 29 cases, 56.86% with CI (43.2, 70.46) had solitary cyst while rest of the cases had multiloculated cyst. All cases had radiological correlation and histopathological confirmation. Conclusions: Most cases presented with organ related vague symptoms, however it should be considered as a differential diagnosis especially in asymptomatic cases and cases with unusual sites. Imaging studies is useful in preoperative diagnosis and postoperative histopathology is confirmatory. A multicentric hospital based study will help to decrease the incidence._______________________________________________________________________________________Keywords: echinoccocus; hydatid cyst; hydatidosis.

BackgroundGastric cancer is among the most common malignancies in Asia, comprising 74% of all global cases. Identifying the environmental risk factors may possibly shed more light on effective treatment and the prevention of this disease. The aim of our study is to document  different histologic types of gastric cancer as per age, sex and ethnic groups in the patients in Nepal, to know the frequency of different gross and microscopic subtypes (according to Lauren's classification) of tumor and to find out the association of H. pylori and other major risk factors with gastric cancer.Materials and Methods  The present study is a hospital based retrospective study done in the Department of Pathology, Manipal Teaching Hospital, Pokhara, Nepal, from Jan 1999 to July 2010. All the endoscopic biopsies and gastrectomy specimens from patients with diagnosed gastric carcinoma were reviewed and the clinical and other data were analyzed.ResultsIn this study period, a total of 1223 cases related to stomach were received in Department of Pathology. Considering the inclusion and exclusion criteria, a total of 397 cases - 315 cases of endoscopic biopsy and 82 cases of gastrectomy - were included in the study. In our study, the most affected age group and caste were 61-70 years ( 47.36%, CI 42.44% to 52.27%) and Gurungs (32%, CI 27.16% to 36.32%). The commonest gross and microscopic types were Borrmann's type IV (40%, CI 29.63% to 50.86%) and intestinal type (53%, CI 47.99% to 57.81%). Gastric antrum was the most affected site (70%, CI 65.26% to 74.29%). Among the cases with H pylori, antrum (62.5% CI 45.73% to 79.27%) was found to be the commonest site. Among all cases in Gurung, Chhetri and Brahmin communities, we retrieved data regarding risk factors in 93, 65 and 50 cases respectively. Significant relationship was found between the three risk factors studied and the ethnic groups. Smoked meat and alcohol were found to be associated with gastric carcinoma more in Gurungs and Chhetris than in Brahmins (p= 0.0001). On the contrary, cases among Brahmins are found to more associated with smoking than Gurungs and Chhetris (p= 0.0001).ConclusionGastric carcinoma is a common malignancy in this part of world. The most high risk group includes elderly males with history of alcoholism and smoked meat consumption in Gurung community and with history of smoking from Brahmin family. We advise that regular endoscopic surveillance should be done at least in high risk group for the early detection of cancer.Key Words: Gastric Carcinoma; Ethnicity; Risk Factors; Epidemiology; Helicobacter pylori; NepalDOI: 10.3126/nje.v1i1.4109Nepal Journal of Epidemiology 2010;1 (1):27-32