Primary adrenocortical carcinoma: a case report.

Adrenal tumors are very common, affecting 3-10% of the human population, and most are small, benign, nonfunctional adrenocortical adenomas. Adrenocortical carcinoma (ACC), in contrast, is a very rare disease. The median age of diagnosis is in the fifth to sixth decade. There is a predilection for the female gender (the ratio of female to male ranges from 1.5 to 2.5 : 1) the adult. Case presentation: A 28-year-old man who had no prior history of systemic hypertension or diabetes mellitus presented with bilateral limb swelling for 2 months and facial puffiness for 1 month. He had an episode of hypertensive emergencies. A radiological and hormonal work-up established the diagnosis of primary ACC. One cycle of chemotherapy was given until he lost follow-up and succumbed to death due to financial constraints. Conclusions: Adrenocortical carcinoma is an extremely uncommon tumor of the adrenal gland, and it is even more uncommon when it manifests without any symptoms. If patients exhibit signs of rapid and multiple adrenocortical hormone excess, such as weakness, hypokalaemia, or hypertension, ACC may be suspected. Recently developed gynecomastia in men may be brought on by an ACC producing too much sex hormone. To accurately diagnose the condition and give the patient a fair prognosis, a multidisciplinary approach involving endocrine surgeons, oncologists, radiologists, and internists is advised. Proper genetic counseling is recommended. It is critical to know whether the adrenal mass is malignant or not, and to get this ascertained by a computed tomography finding and biopsy.

Mean Micronuclei Score in Fine-Needle Aspiration Cytology of Patients with Malignant Breast Lump in the Department of Pathology in a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Introduction: Micronucleus is used as a biomarker of chromosomal instability, which is one of the hallmarks of neoplastic transformation. As micronuclei score increases with malignancy, it can be an effective and inexpensive adjunct to breast fine needle aspiration cytology, in diagnosing breast lumps, especially detecting grey lesions between benign and malignant tumours. The aim of this study is to find out the mean micronuclei score in fine-needle aspiration cytology of patients with malignant breast lumps in the Department of Pathology in a tertiary care centre. Methods: A descriptive cross-sectional study was conducted among patients with malignant breast lumps in the Department of Pathology in a tertiary care centre between 1 May 2020 to 31 May 2021 after receiving ethical approval from the Institutional Review Committee (Reference number: IRC/2139/021). The fine-needle aspiration cytology of breast lumps was diagnosed as per National Health services breast screening program guidelines. The mean micronuclei score was calculated. Convenience sampling was done and data were collected from the hospital records in the Department. Point estimate and 95% Confidence Interval were calculated. Results: Among 20 malignant breast aspirates, the mean micronuclei score was found to be 8.30±3.75 (3-19, 95% Confidence Interval). Conclusions: The mean micronuclei score in fine-needle aspiration cytology of malignant breast lumps was found to be similar when compared to similar studies conducted in similar settings. Keywords: biomarker; breast neoplasm; chromosomal instability; fine-needle aspiration.

Deeper Sections: Its Frequency and Diagnostic Utility in Histopathology of Noncutaneous Small Biopsy Specimen in a Tertiary Hospital in Nepal.

BACKGROUND: Biopsy is an important tool for accurate diagnosis of disease in histopathology which can be examined at multiple levels during microscopic examination. The initial sections may not be representative of the entire biopsy, which leads to frequent request for deeper sections. This study assessed the frequency and diagnostic utility of deeper sections in noncutaneous small biopsy specimens at a tertiary hospital. Material and Methods. All the formalin fixed noncutaneous small biopsy specimens received were processed for grossing followed by tissue processing and embedding. The paraffin-embedded blocks were cut into 3-5 µm sections, fixed in a glass slide, deparaffinised, and then stained with hematoxylin and eosin (H&E) stain as per the standard protocol. Deeper sections were instructed based on microscopic findings of initial slides. The overall frequency of deeper section, its levels of cutting, tissue survival, and outcome were assessed and interpreted for the final diagnosis. RESULTS: A total of 125 cases (26.9%) from 464 samples received were requested for deeper sections. The most frequent deeper sections were from cervix (72 cases) followed by stomach (18 cases) and endometrium (17 cases). The deeper sections were performed most frequently at 4 levels (17.8%) followed by 5 levels (14.8%) and 6 levels (13.3%). Deeper sections revealed nondiagnostic additional features in 28.2%, while 2.2% showed additional diagnostic features. Likewise, 2.2% had tissue segment loss. The overall mean level showing additional features was 6 levels. Tissue survival increased in 13% cases and 1.5% had decreased survival. The most common reason for requesting deeper section was to enhance sensitivity and diagnostic accuracy of disease. CONCLUSIONS: Deeper sections often contribute to final diagnosis. Therefore, deeper sections on biopsies that cannot readily be diagnosed on routine levels are recommended regardless of size of the lesion and there should be uniformity in the practice of deeper sections across the globe.

Leiomyosarcoma of the Inferior Venacava: A Case Report.

Leiomyosarcoma of inferior venacava is a rare tumor. Female are most commonly affected and middle segment of inferior vena cava is the commonest site. The diagnosis can sometimes be challenging as patients present with non-specific symptoms. We present a case of a 65-year-old female who presented with pain in right hypochondrium and epigastric region since 4 months along with weight loss, anorexia and vomiting. Histopathological examination revealed a capsulated, multilobated tumor arising from muscle layer of inferior venacava with extraluminal growth pattern and tumor cells showing cytoplasmic positivity for immuno-histochemical stain smooth muscle actin. With the diagnosis of leiomyosarcoma of inferior venacava, excision of tumor was done with tangential excision of 4 cm length of inferior venacava with primary repair. Keywords: inferior venacava; leiomyosarcoma; smooth muscle actin.

Histopathological Review of Diagnostic Categories of the Bethesda System for Reporting Thyroid Cytopathology - An Institutional Experience of 5 Years.

CONTEXT: Fine needle aspiration (FNA) plays a crucial role in the evaluation of patients with thyroid lesions. The Bethesda system for reporting thyroid cytopathology (TBSRTC) was designed with a mission to standardize the process of diagnosis and management of thyroid lesions by FNA cytology (FNAC). AIM: We aim to see the benefits of adopting TBSRTC, seek the cytological pitfalls in the diagnosis of thyroid FNAC, and identify the spectrum of thyroid lesions in our setup. SETTINGS AND DESIGN: This is a hospital-based cross-sectional study conducted from June 2009 to June 2014 of all thyroid FNACs with available histopathology reports. Cases were designated a specific diagnostic category according to TBSRTC. MATERIALS AND METHODS: A total of 109 cases were included in the study. Sixty-eight cases had been reported without using TBSRTC and were reviewed and reclassified according to TBSRTC seeking the common reasons for interpretative errors. STATISTICAL ANALYSIS USED: Data were analyzed using SPSS ver. 11.5. RESULTS: In both pre- and post-TBSRTC era, benign neoplasms constituted the major bulk. After the use of TBSRTC, there was increased ability to look for follicular neoplasms, improvement in making definitive diagnosis of the cases, decline in the suspicious category, and an improvement in diagnostic accuracy, and we were in line with the implied risk outlined by TBSRTC in most of the cases except the nondiagnostic or unsatisfactory category. CONCLUSION: Application of TBSRTC results in uniformity in reporting among pathologists and better interdisciplinary communication and patient management.

Accuracy of Frozen Section with Histopathological Report in an Institute.

INTRODUCTION: Frozen section helps in rapid intra-operative diagnosis. It is commonly used during surgical procedures to detect malignancy so that modifications of surgery can be decided at the time of surgery on the table. Frozen section is also performed for evaluation of surgical margins and detection of lymph node metastasis. In addition it is applied for detection of unknown pathological processes.The objective of this study was to assess the accuracy of frozen section diagnosis in comparison to gold standard histopathological diagnosis and to find concordance and discordance rate of frozen section with histopathological report. METHODS: This was a cross sectional study of 41 frozen section samples done in the department of pathology of BP Koirala Institute of Health Sciences from September 2014 to August 2015. All frozen section samples with their permanent tissue samples sent for final histopathological evaluation were included in the study. RESULTS: The overall accuracy of frozen section diagnosis was 97%. The sensitivity was 94%, specificity was 87%, positive predictive value was 90% and negative predictive value was 93%. The concordance rate was 90.2% and the discordance rate was 9.8%. CONCLUSIONS: The results of frozen section varied in different organ systems and the common cause of discrepancy in our study were the gross sampling error and the interpretational error.

Primary laryngeal leishmaniasis: a rare case report.

Laryngeal leishmaniasis is extremely rare. We report a case of primary laryngeal leishmaniasis in a 70-year-old male who was admitted with complaints of gradual progressive hoarseness of the voice, dyspnea, cough for the past 3 months and noisy breathing for the past 5 days. An X-ray of the soft tissue of the neck showed a prevertebral soft tissue mass causing narrowing of the airway at the C6-C7 vertebral level. A computerized tomography (CT) scan showed a soft tissue mass in the subglottic region causing significant narrowing of the airway. A direct laryngoscopy showed a pinkish-white, friable mass involving the subglottic region and the anterior half of the vocal cords. With the clinical suspicion of malignancy, an endoscopic biopsy was done. A histopathological examination showed diffuse mixed inflammatory cell infiltrate in subepithelium with numerous Leishmania donovani bodies in the cytoplasm of histiocytes.

Crohn disease in Nepal: true rarity or gross underdiagnosis?

Gross and histopathological examination of a resected segment of ileum in a 72-year-old man with the preoperative diagnosis of small intestinal perforation peritonitis revealed the first-ever diagnosed case of Crohn Disease (CD) at the B P Koirala Institute of Health Sciences, Dharan, Nepal. In view of the recent reports on rising incidence of CD in neighbouring Asian countries, it was decided to perform an exhaustive literature search to find out the documented prevalence of CD in Nepal. It was surprising to find only a single case of CD from Nepal, occurring in the year 1980, to be documented in English literature. Further, the index case of CD presenting with acute abdomen is of interest since only about 100 cases of CD with small intestinal perforation have been so far reported worldwide.