Pure yolk sac tumor of sacrococcygeal region

The sacrococcygeal region is the most common site for the extragonadal germ cell tumors comprising seminomatous and non-seminomatous tumors. Seminomatous tumors are seminomas, and non-seminomatous tumors comprise mainly teratoma (mature and immature), yolk sac tumor (YST), embryonal carcinoma (EC), and choriocarcinoma. These tumors occur in newborns, infants, and adolescents. Other common sites for extragonadal germ cell tumors are the brain and mediastinum, although they may occur anywhere in the body. These tumors may occur in mixed as well as pure form. So, sectioning from different areas should be done before labeling them as pure germ cell tumors. YST, in its pure form, is rare and therefore should not be missed as it is chemosensitive. The patient should be thoroughly assessed clinically. Imaging also becomes necessary while evaluating swelling in the sacrococcygeal region and can aid in differentials. When the clinical and imaging suspicion of either Sacrococcygeal teratoma or other germ cell tumor is high, serum biomarkers as alfa-fetoprotein should be requested. The serum levels are necessary and should be done preoperatively, postoperatively, and during the course of chemotherapy as follow-up. However, the final diagnosis rests on the histopathological diagnosis. We report one such case of pure YST in the sacrococcygeal region in a 9-month-old female child. The imaging suggested sacrococcygeal teratoma type 4, and high alfa-fetoprotein levels were determined postoperatively.

Intrathecal 0.75% Isobaric Ropivacaine Versus 0.5% Heavy Bupivacaine For Elective Caesarean Delivery: A Randomized Comparative Study In Hundred Patient’s.

Background And Aim: Ropivacaine being comparatively less cardiotoxic and neurotoxic than bupivacaine, it also produces minimal motor blockade of shorter duration when used in spinal anaesthesia. This study was aimed to compare the intrathecal 0.75% isobaric ropivacaine for caesarean delivery with 0.5% bupivacaine heavy in pregnant patients. Method: 100 parturient belonging to ASA grade I & II scheduled for elective caesarean section were randomly selected for the study and are divided into two groups of 50 each. Group B patients received 2ml of 0.5% hyperbaric Bupivacaine intrathecally. Group R patients received 2ml of 0.75% isobaric Ropivacaine intrathecally. Onset and duration of sensory block, onset and duration of motor block, highest level of sensory block, quality of anaesthesia, and time of request for analgesia, hemodynamic parameters and adverse effects if any were studied. Results: Baseline demographic variables were similar in two groups. Neonatal outcome were also similar in two groups. Onset of sensory block at T8, time to request for analgesia, total duration of analgesia was comparable in both groups. Mean highest level of sensory block in both groups was T5 but in group R having slightly higher range (T3-T6) as compare to group B (T4-T6). Regression of sensory block at L1, duration of motor block was shorter but having longer onset of motor block in Group R as compare to group B. Conclusion: Ropivacaine 15 mg (2 ml of 0.75% isobaric Ropivacaine) provides comparable quality of sensory block but has slower onset and significantly shorter duration of motor block compared to bupivacaine.

Lymphoma of frontotemporal region with massive bone destruction and intracranial and intraorbital extension.

Primary non-Hodgkin's lymphoma with unilateral proptosis and diffuse involvement of the cra-nial vault and brain parenchyma is extremely rare. A 50-year-old woman developed a progressively increasing proptosis of her right eye, associated with a subcutaneous mass over the right frontotemporal region over the last 5 months. CT scan showed a high-density contrast-enhancing lesion with wide involvement of the cranium and intracranial and intraorbital extension. We performed a wedge biopsy for further analysis. Histological examination revealed that the tumor was non-Hodgkin's lymphoma. There was no evidence of systemic involvement. The patient received radiotherapy and was doing well at 18 months' follow-up. Primary malignant lymphoma involving the orbit and cranial vault is a rare malignancy, and treatment remains to be defined.

Systemic lupus erythematosus in childhood--a review of 11 patients at a single center in eastern Nepal.

We retrospectively evaluated the clinico-laboratory features of 11 children and adolescents with Systemic Lupus Erythematosus between the period of 2001 and 2006. All of them (100.0%) had renal involvement at the first visit in the hospital. Female to male ratio was 10:1. Skin and or mucosal involvement (90.9%), periorbital puffiness and or pedal edema (81.8%), fever (72.7%), hypertension (72.7%), and reticuloendothelial involvement (72.7%), were the commonest presentations. All patients had anemia (8.6 +/- 1.5 gm/dl), raised ESR (46.7 +/- 9.4 mm in first hour), proteinuria, and in disease activity as evident by raised ESR and positive anti-dsDNA antibody at the first visit. The mean duration of disease was 7.6 months and the average duration of disease activity was 63.18 days. Renal biopsy was performed in 8 patients: class IV lupus nephritis in 4 patients (50.0%), class II in 2 patients (25.0%), class III and V in patient (12.5%) each. Nephrotic range proteinuria and hypertension was observed in all patients of class IV and V of lupus nephritis. Class II and III lupus nephritis patients' were normotensive and had non-nephrotic range proteinuria. Three out of 11 patients (27.2%) expired. The commonest primary determinant of mortality was uncontrolled disease activity in 2 patients (66.6%). The third one had infection and developed disseminated intravascular coagulation. The mean duration of disease activity in patients who died (mean 30 days) was statistically lower than the survival group (75.6 days) (p < 0.01). Renal involvement during first visit and mortality could be attributed by late referrals and diagnosis at hospital.

Incidence of megaloblastic anaemia and its correction in leishmaniasis--a prospective study at BPKIHS hospital, Nepal.

Fifty (50) cases of Leishmaniasis were included in a prospective study after making the diagnosis based on the demonstration of L D Bodies on bone marrow aspirate. Hemoglobin (Hb) and total leucocyte count (TLC) were less than 10 gm/dl and 4000 per/ml respectively in 22 out of 50 cases. Among 50 cases, 30 showed macrocytic red cell and hypersegmented neutrophils on peripheral blood smear as features of megaloblastic anemia. Out of 30 cases of leishmaniasis with megaloblastic anemia, 10 cases showed decreased reticulocyte count. Bone marrow aspiration cytology showed megaloblastic maturation in erythroid series and giant metamyelocytes in myeloid series in all 30 cases of leishmaniasis with megaloblastic changes. Bone marrow iron was also increased in these cases. However megakaryocyte was normal in all. Among 30 cases of leishmaniasis with megaloblastic changes, 15 cases were treated with sodium antimony gluconate (SAG) only and other 15 with SAG, folic acid and Vit. B12. Rest 20 cases of leishmaniasis without megaloblastic changes were also treated with SAG only. After treatment with SAG alone as well as with SAG, folic acid and vit. B12, hemoglobin and TLC improved in all 50 cases. Of 15 cases of leishmaniasis with megaloblastic changes, who were treated with SAG, folic acid and vit. B12, the reticulocyte count reached at peak on the 7th day and normalized at the end of 4th week. Red blood cells (RBC) also became normocytic normochromic and neutrophils became normal on peripheral blood smear. But no change was observed in reticulocyte count, RBC and white blood cell (WBC) morphology on peripheral blood smear in cases of leishmaniasis without megaloblastic changes and other 15 cases of leishmaniasis with megaloblastic changes, who received SAG only.

Tuberculous splenic abscess--a case report and review of literature.

Splenic abscess due to tuberculosis is a rare condition and is mostly diagnosed in immuno-compromised hosts. A case of tuberculous splenic abscess detected incidentally after splenectomy without any underlying disease is reported in an immuno-competent patient.

Pure red cell aplasia--report of 11 cases from eastern Nepal.

There were eleven cases of pure red cell aplasia diagnosed over a period of 2 years (January 2000-December 2001). All the patients had anemia with pallor and weakness being the presenting complaints. Hematological profile depicted normocytic normochromic anemia, reticulocytopenia and marked paucity of erythroid precursors on bone marrow aspiration and biopsy studies. In the present study, one case was of congenital pure red cell aplasia, in one other case of pyrexia of unknown origin, no definitive diagnosis could be made. Other associated diseases seen with pure red cell aplasia were thymoma, septicemia, protein energy malnutrition, non-Hodgkin's lymphoma, juvenile rheumatoid arthritis, acute myeloid leukemia, tuberculosis and hepatitis C. The association of pure red cell aplasia with haematologic malignancies is rare. There are very few case reports on pure red cell aplasia with hepatitis C.

Incidence of pelvic and extrapelvic endometriosis in Eastern region of Nepal.

Endometriosis is described as the presence of endometrial glands or stroma in abnormal locations outside the uterus. It afflicts 10% women of childbearing age. A 5-year retrospective analysis of histopathologically proven cases of endometriosis was done. Haematoxylin and Eosin stained slides were reviewed for type of lining epithelium, endometrial glands, stroma, fresh and old hemorrhage & inflammatory cells. Clinical details were analyzed. Age of the patient ranged from 22 - 48 years. The most common site of endometriosis was ovaries (69.23%) followed by scars (11.43%), cervix (7.69%), fallopian tube (3.84%), vagina (3.84%) and appendix (3.84%) in descending order of frequency. Most common symptom was pain. On ultrasound and X-ray diagnosis could not be made in any case. Clinically endometriosis was diagnosed in 9 (34.62%) cases. On histopathological examination majority of the cases (42.3%) had endometrial glands, stroma and hemosiderin laden macrophages. 3 cases (11.43%) had endometrial lining epithelium and stroma only, which on laproscopy also were diagnosed to have endometriosis. It was concluded that high rate of surgical excision of organs were done because of misdiagnosis.

Morphometric study of lymphoid cells in mycosis fungoides and its simulators.

The distinction of early stages of mycosis fungoides from benign lymphoid disorders of skin is difficult by conventional histological techniques. We studied 10 cases of mycosis fungoides, 10 cases of large plaque parapsoriasis, 10 cases of other benign lymphoid disorders of skin and 5 cases of lymph nodes. Nuclear area, perimeter of the nucleus, nuclear contour index, cytoplasmic area, form factor and nuclear cytoplasmic ratio as well as DNA-ploidy were determined by image analysis. There were statistically significant difference (P value < 0.05) between all parameters except nuclear cytoplasmic ratio of the lymphoid cells of Mycosis Fungoides and benign lymphoid disorders of skin. Aneuploidy was found in 50% cases of Mycosis Fungoides. Histopathological parameters like epidermotropism pautrier micro-abscess and atypical lymphocytic infiltrate in both epidermis and dermis were more marked in aneuploid than diploid cases. So, the determination of nuclear contour index and DNA-ploidy is of importance to differentiate between Mycosis Fungoides and benign lymphoid disorders of skin.

Microcystic papillary adenoma of the nose: a case report.

Microcystic papillary adenoma of nose is rarely seen in nose. This case is reported because of its rarity and to best our knowledge is a first case report from Nepal.