Background: Like in other developing countries, cancer of cervix is one of the most common malignancies in women in Nepal. Most women never undergo a cervical Pap smear screening. The objective of this study is to determine the prevalence of abnormal cervical epithelial lesions. Materials and Methods: This was a retrospective study of 880 conventional cervical Pap smears reported from the Department of Pathology, Chitwan Medical College in Chitwan, Nepal. The time period was from June 2009 to November 2010. Results: In this study, High-grade Squamous Intraepithelial Lesion was the most common with 6 cases (40%), followed by Low-grade Squamous Intraepithelial Lesion with 3 cases (20%), then Atypical Squamous Epithelial Cells of Undetermined Significance, and atypical Glandular Cells and Squamous cell carcinoma with 2 cases each (13.3%). Eighty per cent of all the abnormal epithelial lesions were found in women above the age of 40 years. Conclusion: At least one Pap screening test of the cervix of all women between the ages of 40-50 years is recommended. Keywords: Pap smear; Cervical Intraepithelial Lesion; Squamous cell carcinoma. DOI: 10.3126/jpn.v1i1.4447Journal of Pathology of Nepal (2011) Vol.1, 30-33

No abstract

Background: Cervical cancer prevention, the most common cancer in women in Nepal, is almost nonexistent because of very low pap smear coverage. Material and methods: This study was done to find out pap smear coverage, to assess women’s knowledge about cervical cancer and cervical pap smear, to assess women’s attitude towards cervical pap smear, and to find out association of demographic variables, attitude of women towards pap smear test, and knowledge of cervical cancer and cervical pap smear test with its practice. It was a cross sectional analytical observational study which was carried out in a one-day free health camp organized in Udayapur district of Nepal jointly by Chitwan Medical College and Satya Sai Organization on January 5 of 2013. Participants were interviewed with the help of structured questionnaire. Fisher’s exact test was done to detect association of the variables with pap smear practice. Results: Fisher’s exact test showed that knowledge about pap smear test and attitude towards the test were the only variables which significantly influenced pap smear utilization (p= 0.04). Pap smear utilization was not associated with age-at-marriage, age-at-menarche, parity and age-at-first-childbirth. Conclusion: Pap smear coverage was found to be 7.8% (at 95% CI was 0.02-0.13) which is lower than the average for developing countries. This study has shown that knowledge about pap smear test and attitude towards the test significantly influence pap smear utilization. Therefore, work should be done towards that end to increase pap smear coverage. DOI: http://dx.doi.org/10.3126/jcmc.v4i4.11969

BackgroundKikuchi–Fujimoto disease is so named because Kikuchi and Fujimoto were the first scientists to describe it in Japan in 1972. Although the disease has been reported from all over the world and more so from Asia, it is rare. To date only eight cases have been reported from Nepal. Cervical lymphadenopathy, fever and raised Erythrocyte Sedimentation Rate are usual presenting features of this disease. We describe a case which presented with thrombocytopenia and axillary lymphadenopathy in addition to the usual features. Out of the total eight cases that have been reported from Nepal so far, no patients had thrombocytopenia and only one patient had axillary lymphadenopathy.Case presentationA 24-year-old Nepali female presented with a 3-week history of low-grade fever, headache, and painful, discrete, unilateral left-sided cervical and axillary lymphadenopathy. Among the multitude of tests that were carried out, Erythrocyte Sedimentation Rate was raised and there was thrombocytopenia while other tests were normal. Painful lymphadenopathy pointed to bacterial lymphadenitis while chronic low-grade fever suggested tuberculosis. A cervical lymph node was excised for histopathological examination to reach an accurate diagnosis. On the basis of pathognomonic features viz., paracortical foci composed of various types of histiocytes including crescentic type in the background of abundant apoptotic karyorrhectic debris, a diagnosis of Kikuchi–Fujimoto disease was made. On follow-up evaluation after 6 weeks, the patient had no systemic symptoms, enlarged lymph nodes had regressed in size significantly, and Erythrocyte Sedimentation Rate and platelet count had become normal.ConclusionKikuchi–Fujimoto disease should be kept in the differential diagnosis of lymphadenopathy in young patients, female or male even in tuberculosis-endemic countries and even in patients who have unusual features; for example thrombocytopenia and involvement of axillary lymph nodes in addition to cervical lymph nodes as in this case.

Background: Ovarian cancer accounts for 3% of all cancers in females. About 80% of these are benign, and they occur mostly in young women between 20 and 45 years. Borderline tumors occur at slightly older ages while incidence of malignant tumors increases with age, occurring predominantly in perimenopausal and postmenopausal women. About 190,000 new cases and 114,000 deaths from ovarian cancer are estimated to occur annually worldwide. The aim of the study was to fi nd the incidence of surface ovarian tumor in a tertiary referral centre. Materials and methods: This was a retrospective study carried out in the department of pathology, Manipal Teaching Hospital from January 2001 to December 2012. Specimens were received from the same and other hospitals. Records were retrieved from the departmental data bank and were analyzed. Results: : A total of 310 cases of ovarian tumors have been reported in the same period. Among them, 180 cases were of surface epithelial origin and out of which 24 cases had bilateral tumors. Benign tumors comprised of 148 cases, 6 were borderline and 44 were malignant. Among these, the commonest was serous cystadenoma (98 cases) and the least common was malignant Brenner (2 cases). Combined or mixed tumor was seen in 9 cases. Conclusion: : In our study surface epithelial tumors comprised 58% of all ovarian tumors. In both benign and malignant cases, serous tumor was the commonest followed by mucinous tumors. Journal of Pathology of Nepal (2013) Vol. 3, No.1, Issue 5, 397-402 DOI: http://dx.doi.org/10.3126/jpn.v3i5.7868

Background: Peripheral blood smear examination and other routine laboratory assays are not always sufficient to diagnose various diseases which affect the blood and bone marrow. A bone marrow aspirate examination is essential in most of the cases.Methods: This work was a hospital-based cross sectional analytical observational study carried out in the department of pathology at the Chitwan Medical College, Teaching Hospital, Nepal, over a period of 3 years from January, 2013 to December 2015. Bone marrow was aspirated from posterior superior iliac crest under local anesthesia; sternum was the alternative site in obese patients. Univariate analysis was performed for each variable using frequency distribution and means with the help of Statistical Package for Social Sciences 20.0 (SPSS 20.0) software.Results: One hundred and fifty-nine patients were included in the study. Eight cases of 'dry tap' were excluded, for whom bone marrow biopsy was advised. Anemia was the largest group followed by malignancy, infection and miscellaneous diseases. Among anemia, megaloblastic anemia was the most common, followed by aplastic anemia, dyserythropoietic anemia and myelopthisic anemia. The category 'malignancy' consisted of leukemia, multiple myeloma and myelodysplastic syndrome. Regarding individual diseases, megaloblastic anemia was the most common haematological disorder followed by immune thrombocytopenic purpura, leukemia and aplastic anemia.Conclusions: Bone marrow aspiration cytology is a mildly invasive technique which can diagnose many haematological and non-hematologic diseases that can be confirmed by more advanced investigations, if needed: serological, biochemical or molecular. However, bone marrow sample cannot be obtained (dry tap) in a proportion of cases. In such cases, a bone marrow biopsy needs to be performed.

Background: Cytological study of body fluids a non-invasive, simple procedure, relatively inexpensive, and helps in faster reporting that has high population acceptance. The present study aims to determine the proportion of malignant and non malignant lesions. Methods: A total of 1129 specimens of exfoliative cytology were examined during the period over five years from year January 2011 to December 2016 at Department of Pathology at Chitwan Medical College Teaching Hospital, Nepal. The fluid received was centrifuged at 3000 revolutions per minute for five minutes. Smears were made from the sediment. Two to three slides were air dried and stained with Giemsa stain. One slide was immediately fixed in 95% alcohol and stained with Papanicolaou (Pap) stain for cytological evaluation. Results: Pleural fluid was most common specimen (49.3%) with peritoneal fluid (32%), pericardial fluid (1%), BAL (7.8%), CSF (4%), sputum (3.4%), synovial fluid (2%) and urine (0.5%) specimens. Male to female ratio was 1.33:1. Maximum cases belonged to age group of 50-69 years. Only (5.8%) 67 cases were neoplastic. The maximum cases of malignant neoplasm were detected in pericardial fluid and pleural fluid, each 21 (1.8%) cases, and 20 (1.7%) cases BAL. Malignant effusions were detected in 46 (4%) cases. Maximum malignant cases were adenocarcinoma (71.6%), followed by squamous cell carcinoma (20.8%). Conclusion: Exfoliative cytology should be suggested in all cases of effusion and suspected malignancies which helps in reaching at a particular diagnosis and aids in further management.

Rudolf Virchow is considered to be the first scientist to have used the word sebaceous cyst. It was thought that these lesions occurred due to retention of sebaceous secretion consequent to obstruction of sebaceous ducts of sebaceous glands, although that was found not to be the case. In all these cysts, the cavity is filled with keratin. There are six types of keratin-filled cysts, namely, epidermoid, dermoid, teratoid, keratinous, trichilemmal, and teratoma cyst, which have one common name “dermoid cyst.” Of the six, teratoid cyst is the least common. In contrast to other dermoid cysts, teratoid cysts contain tissue elements derived from all the three germ layers, namely, ectoderm, mesoderm, and endoderm. Teratomas can be differentiated from teratoid cysts by the fact that recognizable organ structures may be found in the former; examples include teeth and skin. Teratoid cysts can develop anywhere in the body but rarely arise in the head and neck region. They have never been reported in the postauricular region. In this case report, we present a case of teratoid cyst in the postauricular region in a 21-year-old female. The significance of this case lies in its rarity.