This prospective study was conducted at College of Medical Sciences-Teaching Hospital (CMS-TH) during December 2008 to May 2010. One hundred and fifty cases were analyzed. Age of the patients, parity, presenting symptoms, types of surgery, clinical diagnosis and complications were retrieved from case sheets. Surface epithelial tumors were more frequently observed above 30 years of age, (62.07%) cases. During 1st to 3rd decades of life, 62.8% germ cell tumors were seen; and sex cord tumors were seen in age group 41-60 years only. For all age groups, benign tumors were common than malignant tumors. There were 10.7% unmarried patients, 5.33% nulliparous, 35.55% of parity 1 to 2; 4% pregnant and 20 % postmenopausal women. There were 86.67% cases neoplastic, and 13.33% non-neoplastic ovarian lesions; 93.85% benign, 5.38% malignant and 0.77% borderline tumors. Surface epithelial tumors were the most common tumors (53.84%) followed by germ cell tumors (43.85%), constituted 46.7% and 38% among all ovarian lesions. The commonest benign tumors were serous cystadenomas and mature cystic teratomas, constituted 40% cases each. Dysgerminoma was the common malignant neoplasm (2.31%), all were seen in adolescents. Most of the other malignant neoplasms were observed above 40 years of age. Seventy percent (70%) of non-neoplastic lesions were hemorrhagic corpus luteum cysts. The commonest presenting symptom was pain in the lower abdomen (82%) followed by abdominal mass/ or distension (48.7%). Constitutional symptoms were observed in malignant cases only. Grossly, majority of the ovarian lesions were of size ranging 5 to 15 cm; and 89.93% cystic lesions. There were 48.7% lesions in the right ovary and 45.3% in the left ovary; 6% bilateral ovarian lesions, all of which were observed in benign and non-neoplastic lesions. The common complication observed was torsion (6.7%) followed by rupture of the cysts (6%).

Key Clinical MessagePyogenic granuloma is a benign vascular neoplasm of the oral cavity that usually presents as a small nodular lesion, the gingiva being the commonest site. Occasionally it occurs at uncommon sites with unusual sizes. Here we describe two cases of oral pyogenic granulomas that had an unusual presentation.

Key Clinical Message Clinicians, pathologists, and radiologists should be aware of rare malignant ovarian tumors arising in mature cystic teratoma (MCT). Suspicion should be raised if the patient is elderly, the tumor is huge, and the tumor has large solid foci. However, malignant transformations in MCTs in younger women have been reported.

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.

No abstract

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.

Tuberculosis (TB) is a common disease that ranks as the second leading cause of death from an infectious disease worldwide, after the human immunodeficiency virus (HIV). However, primary TB of the appendix is rare and may or may not be associated with specific clinical features. Thus, diagnosis is made only after histopathological examination. It suggests that all surgically removed appendices should be subjected to histopathological examination. This reported case is an uncommon case of chronic tubercular appendicitis.

No abstract