Background: Breast cancer is the leading cause of cancer-related deaths in Asia. The number of intra-nuclear silver stained structures, termed AgNORs, is significantly higher in malignant cells than in normal, reactive or benign cells. The main purpose of this study was to evaluate the AgNOR scores in aspiration cytology smears of breast lesions and their correlation with histopathology.Materials and Methods: This was a prospective study conducted over a period of 24 months from October, 2009 to 2011. A total of 40 cases were included in the study, including fine needle aspiration and biopsy. AgNOR stain was done in both cytology and histopathology slides and scoring was done and analyzed.Results: The mean AgNOR counts were 1.734 for benign cases and 4.508 for malignant cases. Statistically significant ‘P’ value < 0.05 for both benign and malignant cases was observed. The AgNOR dots morphology was homogenous, symmetric with regular contours in both FNAC and histopathology slides of benign breast lesion. In malignant breast lesions, the dots were asymmetric with irregular contours and were aggregated, smaller and more scatteredConclusion: The mAgNOR counts were significantly higher in smears from malignant breast lesions than in those from benign. These results were similar to those obtained for tissue sections and were comparable to established data. Both AgNOR counts and SAPA score gave similar results done in this study, indicating that SAPA is also as convenient, reproducible and rapid method of AgNOR evaluation.DOI: http://dx.doi.org/10.3126/jpn.v4i8.11592 Journal of Pathology of Nepal; Vol.4,No. 8 (2014) 649-653

Background: Thyroid cancer is fairly common. The worldwide annual incidence ranges from 0.5 to 10 cases per 100,000 people. Anaplastic thyroid carcinoma, comprising less than 10% of all thyroid carcinomas, remains one of the most virulent of all cancers in humans with a 10 year survival rate of only 0.1 %. In the present study we looked into the clinical, cytological and histological spectrum of anaplastic carcinoma and compared our experience with recent literature. Materials and Methods: This was a hospital based retrospective study from January 2000 to November 2010. Clinical, cytological and histopathological data of all the diagnosed anaplastic thyroid carcinoma cases were reviewed and analyzed. Results: Of the 59 thyroid malignancies diagnosed in the same period, 7 cases were anaplastic carcinoma. The mean age was 63 years and was predominantly found in females. All of the cases presented with a neck mass that lasted for a mean of 5.7 months. The mean tumor size was 14.9 cm and the most common sub-type was the spindle cell type. Atypical mitosis of more than 5 per high power field and necrosis was noted in all cases. Conclusion: Due to the markedly aggressive nature of this tumor and its association with areas of endemic thyroid disease, early diagnosis and aggressive therapy is essential, especially in the Himalayan and Sub-Himalayan belt. Keywords: Anaplastic carcinoma; Thyroid carcinoma; Spindle cell variant DOI: 10.3126/jpn.v1i1.4451 Journal of Pathology of Nepal (2011) Vol.1, 45-48

Background: 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.Materials and Methods: 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.Results: 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.Conclusion: 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.

Background: It is estimated that 9-30% of women of reproductive age suffer from menorrhagia. Because most cases are associated with anovulatory menstrual cycles, adolescent and perimenopausal women are particularly vulnerable to this particular condition. The aim of this study was to evaluate the histopathological pattern of endometrial biopsy from patients presenting with dysfunctional uterine bleeding.Materials and Methods: This is a cross-sectional observational study done in Nobel Medical College, Biratnagar, Nepal for a period of three years from June 2012 to June 2015. All the patients presenting with dysfunctional uterine bleeding and who underwent endometrial biopsy were included in this study. Distribution of various histopathological patterns was observed in the different age groups.Results: A total of 300 cases were included in my study. The commonest pattern in these patients was proliferative endometrium 61 (%). The commonest pathology was simple cystic hyperplasia (13.3%). Other patterns identified were secretory endometrium, chronic endometritis and pill endometrium. Malignant lesion comprised of 8 (2.7%) of patients and the majority was in >50 years followed by in between 41-50 years of age. Atrophic endometrium was the commonest finding in post menopausal bleeding, comprising of 11 cases (3.6%), followed by endometrial carcinoma of 8 cases (2.7%).Conclusion: As observed from the study, there is an age specific association of endometrial bleeding, with highest incidence in perimenopausal age group. Hence, dilatation and curettage is helpful for diagnosis, to assess therapeutic response and to know the pathological incidence of organic lesions in cases of dysfunctional uterine bleeding.

A mixed adenoneuroendocrine carcinoma is a tumor composed of both adenocarcinoma and neuroendocrine carcinoma components, with each comprising at least one-third of the lesion, as defined by the World Health Organization classification of neuroendocrine neoplasms in 2010.. A 67-years-old male was admitted to the hospital with symptoms suggesting gastric cancer. Histopathology examination from endoscopic biopsy revealed adenocarcinoma. Later partial gastrectomy specimen examination the lesion show presence of well differentiated adenocarcinoma along with neuro endocrine carcinoma.

Background The most common site for metastases is lymph nodes for various types of cancers. It is a reliable and easy approachable as well as inexpensive method of diagnosis for the patient as well as for the pathologist. So, the recognition and establishing a preliminary diagnosis on patients presenting clinically with lymphadenopathy is of importance and especially categorizing whether it is an inflammatory lesion or metastatic or primary neoplastic lesion itself of the lymphnode.Material and Methods A prospective study in 1000 patients was performed of all presenting with cervical lymphadenopathies. This study was performed in the department of pathology, Nobel Medical College and Teaching hospital, Biratnagar, Nepal from the period of January 2013 to January 2016.Results Total number of cases included was 1000 of fine needle aspiration cytology in patients presenting with cervical lymphadenopathies. Out of the total 1000 cases 800 cases were benign lesions, 110 were malignant lesions, 70 cases were inflammatory lesions while 20 cases were inconclusive. Out of the 110 malignant cases, most common malignancy was squamous cell carcinoma, adenocarcinoma followed by ductal carcinoma of breast, small cell and non-small cell carcinoma, papillary carcinoma of thyroid and few cases of malignant melanoma and undifferentiated carcinoma.Journal of Nobel Medical College Vol.5(2) 2016; 26-31

Background: Thyroid lump is a common clinical problem in Nepal. The risk of malignancy has to be judged prior to surgery for which fine needle aspiration cytology is widely used. To bring the uniform reporting of thyroid aspirates, the Bethesda system for reporting thyroid cytopathology (TBSRTC) was introduced in 2007. This study was done to evaluate the various cytomorphological patterns of thyroid aspirate and to correlate the Bethesda system with final histopathology report. Materials and Methods:Fine needle aspiration were performed and were evaluated as per TBSRTC criteria. Fine needle aspiration cytology report were compared with biopsy specimen whenever possible.Results: A total of 386 cases were studied. The sensitivity, specificity, positive predictive value, negative predictive value and overall accuracy of TBSRTC were 75.2%, 98.2%, 90.0%, 94.7% and 94.03% respectively. Conclusion:Use of TBSRTC in reporting thyroid cytopathology has a greater accuracy; however, benign cases need regular follow up as there are false negative cases.

Background: Fine needle aspiration cytology is used as a primary diagnostic tool in thyroid lesions. But the bloody smears caused by negative pressure during aspiration compromise cellular concentration and cell morphology which may lead to its improper interpretation. FNNAC avoids active aspiration and depends on capillary tension to collect tissue sample in the needle bore, thus reducing bleeding and tissue trauma to the highly vascular thyroid. Material and Methods: This is a one year prospective study where FNNAC and FNAC were done on 87 patients. Cytopathologist was blind folded regarding the technique used and was asked to score the quality of slide base of Mair scoring system.Results: FNAC yielded significantly better material on the basis of hemorrhage and cellularity. Fifty six (64.37%) cases showed adequate diagnostic material in FNNAC technique while 54/87 (62.05%) cases showed adequate diagnostic material in FNAC technique. Twelve (13.79%) cases showed unsuitable diagnostic material in FNNAC technique and 26/ 87 (29.89%) cases unsuitable diagnostic material in FNAC technique. Among the individual criteria used in Mair scoring system, background clot/ blood was significantly low in FNNAC than FNAC with the p value less than 0.001. Amount of cellular material was significantly more in FNNAC with p value less than 0.001.Conclusion: FNNAC yielded more cellular and less hemorrhagic material and more diagnostic superior material than FNAC. Since thyroid is a highly vascular gland, FNNAC should be used instead of FNAC for less hemorrhagic and more cellular material.