Background: Immunophenotyping of acute leukemia is one of the most important clinical applications of fl ow cytometry. The aim of this study was to determine the immunophenotyping profi le of acute leukemia, by means of a fl ow cytometric method, using monoclonal antibodies all marked with a fl uorochrome, in four colour systems to assess their distribution according to type of leukemia (lymphoid B or T / myeloid). Materials and Methods: We retrospectively collected data of immunophenotyping from 52 acute leukemia patients at the department of pathology in B.P. Koirala Memorial Cancer Hospital from January 2010 to December 2011. Diagnosis was based on peripheral blood and bone marrow examination for morphology, cytochemistry and immunophenotypic studies. Results: Out of total 52 cases of acute leukemia diagnosed by fl ow cytometry over a two year period, there were 31 cases (59.6 %) of acute lymphoblastic leukemia, 20 cases (38.4 %) of acute myelogenous leukemia and one case (1.9 %) of bi-phenotypic acute leukemia. Leukemia was diagnosed among adults in 44.2 % whereas among children with age less than or equal to 15 years in 55.7 %. Thirty eight (73%) were male and 14 (27 %) were female with a male: female ratio of 2.7:1. For acute myelogenous leukemia, it was found that M0 (5.0 %), M1 (20%), M2 (60%), M3 (15%), M4 (5.0 %) were detected. CD13 and CD33 were the most useful markers in the diagnosis of acute myelogenous leukemia. The most common subtype was AML-M2. Of the 31 cases with acute lymphoblastic leukemia, 20 cases (64.5 %) were identifi ed as B-ALL and 11 cases (35.5%) as T-ALL. Aside from cytoplasmic CD3 (cCD3) and CD7 were the most sensitive antigens present in all cases of T-ALL. All cases of B-ALL showed expression of pan B-cell markers CD19 and CD22, but 15 (75 %) of 20 cases expressed CD10. Conclusion: Flow cytometric immunophenotyping was found to be especially useful in the correct identifi cation and diagnosis of acute myeloid or lymphoblastic leukemia and its subtypes. In combination with French-American-British (FAB) morphology and immunophenotyping, we were able to diagnose and classify all patients with acute leukemia in this study. Journal of Pathology of Nepal (2013) Vol. 3, No.1, Issue 5, 345-350 DOI: http://dx.doi.org/10.3126/jpn.v3i5.7856
were analyzed regarding clinical details, investigations and treatment outcomes.results: Forty-five cases of 16 to 50 years (mean 29.1 years) had gestational trophoblastic disease, among which 19 (43%) were of TibetoBurmese and 15 (33%) Indo-Aryan ethnic group. Hydatidiform mole, invasive mole and choriocarcinoma were observed in 17 (37.8%), six (13.3%) and 22 (48.8%) cases respectively. In seven cases (15.5%) molar pregnancy had occurred in primigravida, seven cases (15.5%) had previous molar pregnancy and in 16 (35.5%) cases GTD had occurred following abortion. Vaginal bleeding was the commonest presentation and 26 (57.8%) cases had anaemia. Eleven (24.5%) cases had theca luteal cyst, 17 (37.8%) had lung metastasis and 4 (8.9%) had brain metastasis. Chemotherapy was administered in 34 (75.5%) cases, among which 15 (33.3%) received single agent and 18 (40%) received multiagent chemotherapy. Hysterectomy was done in nine (20%) cases. Brain irradiation was done in a case with brain metastasis. Five (11.2%) cases with high WHO risk score left the hospital against medical advice. There were three (6.6%) mortalities. Thirty-seven (72.1%) cases were in remission and follow-up. Conclusions:Early diagnosis of disease and proper management strongly influences the outcome of GTD. Even in disseminated state GTD can be cured.
Introduction: This study aims to analyze the clinical presentation and management outcomes carcinoma of vulva managed B. P. Koirala Memorial Cancer Hospital. Methods: A descriptive study was conducted of all carcinoma of vulva cases managed at B. P. Koirala Memorial Cancer Hospital from 1999 to 2009. The case record of all women diagnosed to have carcinoma of vulva were retrieved and socio-demographic characteristics, clinical presentations, histological type, treatment modalities and outcome were obtained and analyzed. Results: There were 5152 gynecological malignancies and vulvar cancer accounted for 87, giving a prevalence of 1.7%. The ages ranged from 17 to 86 years (mean of 48.6 years). Parity was 0-10. Vulva wound and pruritus were the most frequent clinical features with presentations in stage I -8%, stage II- 28%, stage III – 52 % and stage IV -12%. Squamous cell carcinoma (93%) predominated and 62% were grade I. Among the 87 cases, 32% were treated primarily with surgery, 34% primarily with concurrent chemo-radiation and 28% with combined modality. Clinical follow-up of one to five years showed that 26 (30%) cases had local recurrence and 22 (25%) died of disease. Conclusion: Carcinoma of the vulva is a rare gynecological malignancy in Nepal. Surgery and radiotherapy remain to be the mainstay of treatment. Delayed presentation still results in greater morbidity and mortality rates.
Children between one to five years of age with nocturnal cough attributed to URTI were included in the study between November 2014 to August 2015. URTI was defined by the presence of cough and rhinorrhea of <14days duration. Children with signs or symptoms of asthma, pneumonia, laryngotracheobronchitis, sinusitis, and/ or allergic rhinitis were excluded. Children with history of reactive airways disease, asthma, or chronic lung disease were considered ineligible. Intake of Over the Counter (OTC) Cough Cold medication on prior evening was not included in the study. Double-blinded randomized design was used to conduct this study in Pediatric Outpatient
Leukaemia during pregnancy is rare, occurring approximately one in every 75,000 to 100,000 pregnancies annually. Chemotherapeutic agents may have harmful effects to the developing baby though leukaemia itself rarely harms the baby. There is no evidence that pregnancy accelerates the progression of disease or affects the outcome. However, treatment dilemmas often occur. Aims: To study the clinical presentation, treatment and outcome of leukaemia with pregnancy managed at B. P. Koirala Memorial Cancer Hospital (BPKMCH). Methods: Descriptive study was conducted at BPKMCH. Case records of women with cancer and pregnancy from January 2006 to February 2013 were analyzed regarding their clinical details, treatment, follow-up and feto-maternal outcome. Results: Six women, of 20 to 28 years had leukaemia with pregnancy among which four were chronic myeloid leukaemia (CML), one was acute lymphocytic leukaemia (ALL) and acute myeloid leukaemia (AML) each. All four cases of CML had conceived while on oral Imatinib; the three case diagnosed in the first trimester opted for immediate termination of pregnancy while the fourth one diagnosed at 22 weeks of pregnancy continued pregnancy and delivered at 34 weeks by emergency caesarean section for severe oligohydramnios. The ALL case diagnosed at 26 weeks of pregnancy wanted termination of pregnancy and immediate induction chemotherapy. The AML case diagnosed at 32 weeks of pregnancy desired to undergo induction chemotherapy with pregnancy but she defaulted treatment and had intrauterine fetal death and died due to postpartum haemorrhage. The baby, delivered to a mother exposed to Imatinib throughout pregnancy, till date has normal growth and development. Five mothers are in remission. Conclusions: Leukaemia with pregnancy, more common in younger women is rare and posed treatment challenges. Definitive treatment should be individualized according to the desire of the pregnant woman and should include a multi- disciplinary team. Termination of pregnancy in favour of definitive chemotherapy to mother is better and easier during the first trimester of pregnancy. Because of teratogenic effects of chemotherapy, effective contraception be used during therapy to prevent pregnancy.
Myeloid Sarcoma (MS) is a tumour mass of myeloblasts or immature myeloid cells in an extra-medullary site. Isolated MS is a red disease found only seen in case reports. Here, we present the case of a 25years old man with bilateral cervical lymphadenopathy who was diagnosed as MS on the basis of lymph node biopsy and immunohistochemistry. There is no definite consensus on management of MS and needs prospective trials.
Myeloproliferative neoplasms (MPNs) constitute a group of hematologic clonal diseases that affect one or more myeloid lineages with abnormal proliferation. It is rare disease entity and incidence is about 1.15 to 4.99/100 000 person-years among hematological neoplasms for all subtypes of MPNs combined. Patients who present with hepatosplenomegaly, hyperleukocytosis with monocytosis should have routine tests along with bone marrow morphology possibly biopsy, quantiferon TB Gold in tube test, Dengue fever IgM, IgG, NS-1 antigen, cytogenetics t(9;22), BCR cABL fusion gene, JAK-2 V617F, MPL mutations, CALR gene test done along with karyotyping and flowcytometry to evaluate and establish diagnosis towards management.
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