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.

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

Background: Fine needle aspiration cytology of superficial lesion or deep anatomical site is an increasingly common procedure in diagnosis of neoplastic lesions. Sometimes fine needle aspiration does not yield sufficient information for precise diagnosis and the risk of false negative or intermediate diagnosis always exists. In order to overcome these problems, cell block technique has been resorted to make the best use of available material.Materials and Methods:This was a prospective hospital based study conducted in the department of pathology, Manipal Teaching Hospital, Pokhara, Nepal over a period of 2 years from the year 2009 October to 2011. There were total of 49 cases included in the study of which fine needle aspiration cytology smears, cell block and biopsy specimens were available.Results: A total of 49 such cases were included in the study of which fine needle aspiration cytology smears, cell block and biopsy specimens were available. Of all the malignant cases, 12 cases were from lungs aspirate, 10 were from breast, 15 from lymph node and 12 from thyroid. With the combined use of smear and cell block, the diagnostic accuracy of the tumors approaches 100% and also significantly improves diagnostic and sub typing accuracy of malignancies. Cell blocks were found superior in diagnosing neoplasm than smears with diagnostic accuracy of 95.91% and 91.8% respectively.Conclusion: Cell block method allows the recovery and processing of minute amounts of cellular material and facilitates the better classification of tumor when reviewed along with cytological smears. The method is simple to perform and no expertise is required to handle the specimen. Therefore the routine preparation of the cell block improves the accuracy of fine needle aspiration cytology diagnosis.Journal of Pathology of Nepal (2012) Vol. 2, 272-276DOI: http://dx.doi.org/10.3126/jpn.v2i4.6876

Background: Pancytopenia refers to a reduction in all the three cellular elements of blood. The aim of this study was to identify the various causes of pancytopenia in patients attending to Manipal teaching hospital in Pokhara. Materials and Methods: This was a cross-sectional study, carried out in Manipal teaching hospital from August 2008 to August 2010. Fifty-four patients with pancytopenia were included in the study. Complete blood count, bone marrow aspirations and trephine biopsies were performed. Data were analyzed using SPSS 11.0 version. Results: Out of 54 cases, there were 16 cases (29.60%) of hypoplastic bone marrow, 15 cases (27.78%) of hematological malignancies, 13 cases (24.10%) of megaloblastic anemia, 4 cases (11.11%) of erythroid hyperplasia and 6 cases (7.41%) of normcellular bone marrow. Acute myeloid leukemia was the commonest hematological malignancy. Conclusion: The commonest cause of pancytopenia in our study was hypoplastic bone marrow followed by hematological malignancies and megaloblastic anemia. DOI: http://dx.doi.org/10.3126/jpn.v2i3.6023 JPN 2012; 2(3): 207-210

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

There is a higher incidence of toxicity and malignancy in MNG in an endemic goiter zone. The limited diagnostic and therapeutic facilities in the region under study warrant a high degree of clinical suspicion and judgment, sound knowledge of thyroid physiology, thorough interpretation of hormone test results, and meticulous surgical techniques. The treatment must be individualized with consideration of humanitarian and socioeconomic factors, without compromising the quality of care and its long-term consequences. Aggressive management of malignancy and toxicity with total thyroidectomy is needed as primary therapy in many instances. However, subtotal excision is more useful in carefully selected cases with a small remnant. Specialized training in thyroid surgery appears to be valuable in reducing complications.

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