Prevalence of Nonalcoholic Fatty Liver Disease in a Tertiary Care Teaching Hospital: A Cross Sectional Study in Province 4 of Nepal.

Background Nonalcoholic fatty liver disease (NAFLD) is collection of lipids in hepatic tissues excluding other hepatic diseases and chronic alcohol intake. It may advance to nonalcoholic steatohepatitis or cirrhosis. Ultrasonography has high sensitivity and specificity for detecting nonalcoholic fatty liver disease. Objective Lack of sufficient information in this region on sonological prevalence of nonalcoholic fatty liver disease, lead us to design the survey and may also serve as reference for further researches. Method This is a cross sectional study with 600 participants, conducted at Gandaki Medical College Teaching Hospital, Province 4 of Nepal, from September to October 2017. Ethical approval is taken from the Institutional review board. The study group includes the participants referred for abdominal sonography from outpatient department. Result In present survey, 367 (61.2%) are female and 233 (38.8%) are male participants. The mean age is 41.6 years and median age is 38 years. The prevalence of nonalcoholic fatty liver in our observation is 229 cases (38.2%) of which, 102 cases (44.5%) are male and 127 cases (55.4%) are female participants. Normal liver was seen in 61.8%, Grade one fatty liver was discovered in 24.8%, Grade one in 12.6% and Grade three in 0.6%. The mean liver size in those with fatty liver was 14.1 cm. Conclusion Province 4 of Nepal is not exempt from the growing epidemic of nonalcoholic fatty liver disease with prevalence of 38.2%. The study shows that with higher grades of fatty liver, the size of liver is also increased and the mean age of the participants involved is also in the higher side of the spectrum.

Clinicopathological Study of Malignant Melanoma at Tertiary Care Centre.

INTRODUCTION: Malignant melanoma, which causes three fourth of all deaths related to skin cancer, is more common in Caucasian population compared to Asian population. There is no reliable information about malignant melanoma in Nepal hence an effort has been made to assess the clinical and pathological features of melanoma patients. METHODS: This was a retrospective hospital based study done in the department of Pathology. All cases of malignant melanoma diagnosed on biopsy during a period of 13 years were retrieved, reviewed and collated. RESULTS: We had 35 cases with age range from 15 to 84 years with the mean of 51.4 years and M: F of 1.3:1. The predominant site was lower extremities. Most cases were less than 3 cm. Majority of histologic subtypes were nodular melanoma 29 (82.8%) followed by mucosal lentiginous melanoma 3 (8.6%), superficial spreading melanoma 2 (5.7%) and acral lentiginous melanoma 1 (2.9%). Half (50%) of the excisional biopsies were at Clark's level IV and 75% were at high Breslow thickness. CONCLUSIONS: The most frequent site in males and females were lower extremities and trunk respectively in contrast to Western studies where it is opposite. Nodular melanoma was the commonest histologic subtype while in other Asian studies and in Western studies majority were acral lentiginous melanoma and superficial spreading melanoma respectively.

Histopathological Analysis of Non-Neoplastic Superficial Lymphadenopathies.

Background Lymphadenopathies are the clinical manifestation of enlargement of lymph nodes which are a common occurrence and are processes of lymph nodes in response to a variety of exogenous and endogenous stimulants. The vast majority of enlarged lymph nodes are non- neoplastic. Objective The objective of the study is to analyze the spectrum of non-neoplastic lesions of superficial lymphadenopathies with their histomorphological features. Method This was a retrospective hospital based study done in the department of Pathology. All cases of superficial lymph node biopsies received during a period of 7 years were retrieved and divided into 2 broad categories: neoplastic and non-neoplastic. The latter group is the material for the present study. The diagnosis was made on morphological basis. Result Of all the 268 superficial lymph node biopsies, 25.4% (68 cases) were neoplastic and 74.6% (200 cases) were non-neoplastic. The non-neoplastic cases were further categorized into non-infectious 60.5% (121 cases) and infectious 39.5% (79 cases). Neck node (70%) was the most common site of involvement. There were 102 male and 98 female patients with male to female ratio 1.04:1. The age range of the patients was 2 years to 83 years with a mean of 27.16 years and most common being 11-20 years 29% (58 cases). Majority of the cases were non-specific reactive lymphadenitis 84.3% (102 cases) followed by tuberculosis 36.5% (73 cases). Conclusion The major cause for the superficial lymphadenopathy was found to be non-neoplastic etiology with slight male predominance. Reactive lymphadenitis was the leading cause unlike the studies done in other Asian and Tropical countries where tuberculosis was more common.

Ovarian Tumors: Pattern of Histomorphological Types- A 10 Years Study in a Tertiary Referral Center and Review of Literature.

Background Ovarian cancer accounts for 6% of all cancers in females. Among cancers of female genital tract, the incidence of ovarian cancers ranks below only carcinoma of the cervix and the endometrium. Objective To find the frequency of different types of histomorphological types and their association with age, side and size distribution. Method This study is a hospital based retrospective study carried out in the Department of Pathology, Manipal Teaching Hospital over a time period from Jan. 2006 to Sep. 2015. Specimens were received from the Manipal Teaching Hospital and other hospitals within the Himalayan valley of Pokhara. All the clinical and histolpathological data were retrieved from the departmental data bank and were analyzed. Result A total of 409 cases of ovarian tumors have been reported in the same period. Among them, 215 cases were of surface epithelial origin including 172 benign, 07 borderline and 36 malignant cases. Among the surface epithelial tumors, the commonest was serous cystadenoma (119 cases) followed by mucinous cyst adenoma (40 cases). There were 176 cases of tumors with germ cell origin which included 170 cases of teratoma, four dysgerminoma and one each case of choriocarcinoma and yolk sac tumor. Among seven metastatic tumors, one case was of Krukenberg tumor. Age range was 12 to 90 years and the size range from 3 to 36 cm. Conclusion In our study, we analyzed all the spectrum of ovarian tumors diagnosed on morphological bases and most of the findings were similar to other national and international studies. However, we have reported increased percentage of mucinous tumors and less sex cord stromal tumors.

Accessory hepatic lobe in right lumbar region - an incidental finding.

An accessory lobe of liver is a rare congenital anomaly which can be detected incidentally or can even present as acute surgical emergency due to torsion. We report a case of accessory hepatic lobe in right lumbar region in a 21years old female who came for a ultrasound abdomen for lower abdominal pain. We report the importance of ultrasonography and Computed Tomogram (CT) scan for the diagnosis of accessory hepatic lobe.

Computed tomogram guided fine-needle aspiration cytology of lung and mediastinal masses with cytological correlation: a study of 257 cases in Western region of Nepal.

Computed tomogram guided fine needle aspiration cytology (FNAC) is an important and useful investigation to differentiate between benign and malignant lesions of lungs. To evaluate the lung and mediastinal masses and to analyze and compare the results with cytological findings, 257 patients were retrospectively studied who underwent CT guided FNAC over a period of 2007 to 2013. The study was done in patients who presented with respiratory symptoms with a localized lung lesion which was confirmed radiologically. 252 cases of lung masses and 5 cases of mediastinal cases were included. Patients' age ranged from 24 to 84 year and the male to female ration was 1.2:1. Radiologically, out of 257 cases, 225 cases were given as malignant, 8 cases as benign and 24 cases as inflammatory lesions. Cytologically, 212 cases were malignant, 12 cases were benign and 21 cases were inflammatory. Most common lung malignancy was adenocarcinoma (87 cases) followed by squamous cell carcinoma (56 cases). 8 cases of lung metastasis were seen. Compared to biopsy, CT guided FNAC shortens the diagnostic interval and helps in differentiating lung malignancy into different cytopathological types which aids in proper management of the malignant lesion.

Bilateral Synchronous Testicular Seminoma in a Patient with Bilateral Cryptorchidism.

Cryptorchidism is a known cause of testicular tumor. The incidence of testicular tumor is 11 times more in inguinal testes and 50 times more in intra-abdominal testes. The position of the undescended testis is related to the likelihood of carcinogenesis with the intra-abdominal location having the highest risk for malignancy. Bilateral testicular tumors are rare and 80% of bilateral tumors are metachronous. Synchronous bilateral testicular tumors are rare and bilateral synchronous testicular seminoma in a patient with bilateral cryptorchidism is very rare.

Patterns of hematological and non-hematological malignancies in bone marrow in a tertiary care hospital in Nepal--11 years study.

Developing countries bear more than half of the global cancer burden and the leukemia comprises of 3% of all malignancies with an incidence of 300,500 per year. The patterns of subtypes of leukemias vary in different populations and geographic areas. Here, we analyze both the hematological and non-hematological malignancies in the Western region of Nepal. This is a retrospective study done from Janauary 2000 to June 2011. All cases of bone marrow malignancies including leukemias, multiple myeloma and infiltration/metastasis to bone marrow were included in the study. Morphological subtypes {FAB (French, American and British) classification}, gender, age at diagnosis and peripheral blood counts of all the cases were analyzed. A total of 155 cases of hematological and non-hematological malignancies were reported during this period. Age ranged from 1 year to 82 years. Among 123 leukemia cases, acute myeloid leukemia (AML) was the commonest (80 cases) followed by chronic myeloid leukemia (CML) (20 cases), acute lymphoid leukemia (ALL) (16 cases) and chronic lymphoid leukemia (CLL) (7 cases). The commonest childhood leukemia below 15 years was AML followed by ALL. The commonest subtypes of AML and ALL were M2 and L2 respectively. CML cases in our study were less common and females were more affected than other parts of the country. There were 23 cases of multiple myeloma and 9 cases of infiltration/metastasis to marrow. Males were more affected by multiple myeloma in our study. Our data reflects bone marrow malignancies in the Western region of Nepal which is more comparable to the Central than Eastern region of Nepal.

Diagnostic accuracy of computed tomogram in the evaluation of a neck mass.

OBJECTIVE: The concept of dividing extracranial head and neck into different spaces is a notion that dates back to the 1800s. Various studies have led to detailed description of the soft tissue spaces that are contained within the fascial layers. This study was carried out to determine the accuracy of computed tomogram (CT) in differentiating malignant from benign lesions in the neck, to study the spatial distribution of different types of histological groups in the neck and the prevalence of malignant versus benign diseases involving the neck. METHODS: This was a hospital-based, prospective study conducted in the department of Radiodiagnosis, Kasturba Medical college, Mangalore, from 2005-2008. A hundred consecutive patients referred for CT scan examination presenting with complaints related to involvement of neck spaces or presence of palpable neck masses were enrolled in this study. The details of all the cases regarding their radiological findings and histopathology were reviewed. RESULTS: Of the 100 patients studied, 53 % had malignant lesions, out of which 43 % were squamous cell carcinoma and 4 % were metastatic lymph nodal involvement. Twenty percent of the lesions were of an infective origin while 23 % were benign and congenital cystic lesions. CONCLUSION: CT scan as an imaging modality has the ability to evaluate the malignant and benign tumors of the neck. Considering histopathology as the gold standard, the sensitivity of CT in detecting malignant/benign lesions was 96.5 % with a specificity of 100 %. The positive predictive value was 100 % and the negative predictive value 95.2 %.

Secondary extramedullary plasmacytoma of the breast: diagnosed by fine needle aspiration cytology.

A 34years old female who was a known case of multiple myeloma presented with a mass in the right breast. Clinically a differential diagnosis of breast carcinoma or secondary involvement by multiple myeloma was considered. Fine Needle Aspiration Cytology (FNAC) of the mass was performed which showed dispersed population of plasma cells with eccentrically placed nuclei, abundant cytoplasm and the characteristic paranuclear hof.