Role of S-100 Immunostain as An Auxiliary Diagnostic Aid in Leprosy.

INTRODUCTION: Histopathologic diagnosis of leprosy is difficult when Bacillary Index (BI) is zero and neural involvement are not easily identifiable on routine Hematoxylin and Eosin stain. This study was undertaken to study the role of S-100 immunostaining in demonstrating different patterns of nerve involvement in various types of leprosy. METHODS: Thirty one skin biopsies with clinico-histopathologic diagnoses of leprosy over a period of two years were included in the study. Ten cases of non-lepromatous granulomatous dermatoses (including eight cases of lupus vulgaris and two cases of erythema nodosum) were used as controls. Tissue sections from all cases and controls were stained with Hematoxylin and Eosin (H&E) stain, Fite stain and S-100 immunostain. The H&E stained slides were used to study the histopathological features, Fite stained slides for Bacillary Index and S-100 for nerve changes. RESULTS: Neural changes could be demonstrated in the entire spectrum of leprosy using S-100 immunostaining. The most common pattern of nerve destruction in the tuberculoid spectrum was fragmented and infiltrated whereas lepromatous spectrum showed mostly fragmented nerve twigs. Intact nerves were not detected in any of the leprosy cases. CONCLUSIONS: S-100 immunostain is a useful auxiliary aid to the routine H&E stain in the diagnosis of leprosy especially tuberculoid spectrum and intermediate leprosy.

Histopathologic Analysis of Pancreaticoduodenectomy Specimen.

INTRODUCTION: Whipple's Pancreaticoduodenectomy has increasingly been used as an appropriate resectional procedure for tumors of the periampullary region which are pancreatic, periampullary, ampullary and biliary tumors. Our aim was to study the distribution and histopathologic features of these tumors and to examine local trends of periampullary neoplasms resected with a PD. METHODS: A descriptive study was conducted in the department of Pathology, Kathmandu Medical College Teaching Hospital from July 2013 to June 2016. RESULTS: Thirty five patients underwent Whipple's Pancreaticoduodenectomy procedure during a period of 36 months from July 2013 to June 2016. Malignant tumor was present in 31 (88.57%) cases where as four cases (11.43%) harboured benign lesions. Periampullary mixed carcinoma was the predominant tumor (34.28%) followed by periampullary duodenal (20%), ampullary (14.28%), pancreatic adenocarcinoma (11.42%) and distal cholangiocarcinoma (5.71%). There was no significant difference in tumor size among periampullary, ampullary, pancreatic and biliary carcinomas. Ampullary carcinomas were predominantly well differentiated (80%) where as the other tumors were mostly moderately differentiated. Lymphovascular and perineural invasion varied in different tumor types. Four pancreatic adenocarcinomas showed lymphovascular and perineural invasion. Adequate surgical margin clearance was achieved in most of the cases except in one case each of periampullary duodenal carcinoma and distal cholangiocarcinoma and two cases of pancreatic adenocarcinoma.. CONCLUSIONS: Pancreaticoduodenectomy specimen requires thorough histopathological evaluation. Pathologists should also be aware of possibility of a benign diagnosis in PD specimens which have been resected presuming malignancy based on clinical judgement and radiological data.

Histopathologic study of chronic antral gastritis.

BACKGROUND: Gastritis has a broad histopathologic and topographical spectrum and leads to different patterns of disease. The introduction of the Sydney system made it possible to grade histological parameters, identify topographic distribution and provide etiological information which would help to generate reproducible and clincally useful diagnoses. The aim of this study was to determine the prevalence of Helicobacter pylori in non-ulcer dyspepsia, duodenal ulcer and gastric ulcer; and to assess the histopathologic features associated with chronic gastritis. METHODS: Gastric antral biopsy specimens from 200 patients were examined for the prevalence of H. pylori, and were classified and graded histologically. RESULTS: The overall colonization rate of H. pylori was 44%. The colonization rates were 85%, 67% and 41% in patients with duodenal ulcer, gastric ulcer and non-ulcer dyspepsia respectively. There was not much difference between the degree of atrophy and intestinal metaplasia in H. pylori positive and negative cases. CONCLUSIONS: Helicobacter gastritis is the commonest type of gastritis present in patients presenting with dyspeptic symptoms. It is more common in patients presenting with duodenal ulcer. Adequate sampling is a must for accurate diagnosis of H. pylori colonization.

Clinicopathologic profile of bronchogenic carcinoma.

INTRODUCTION: Bronchogenic carcinoma is the most common cancer in the world. It can present in many ways. Accurate diagnosis and categorization into different types is important because of its effect on prognosis and management. We conducted this study to find out the frequency of various histological types of bronchogenic carcinoma and correlate with their clinicopathologic profile. METHODS: This is a retrospective study conducted in 174 histopathologically proven cases of bronchogenic carcinoma that were referred from different parts of the country to a private hospital in Kathmandu over a period of 4 years. RESULTS: The mean age of the patients developing bronchogenic carcinoma was 64 years. Squamous cell carcinoma was the commonest histologic subtype followed by small cell carcinoma. Adenocarcinoma was more common in females. Clinical history was available in 133 cases. Among them, almost all patients had a history of smoking, the average number of pack years being 39.99. Most of the patients consulted doctor for chief complaint of cough and shortness of breath, the average duration of symptoms being 117.53 days. CONCLUSIONS: The lung cancer must be ruled out in all patients who have persistent signs and symptoms of pulmonary disease with a history of smoking.