Glomangiomyoma of Uncertain Malignant Potential in the Urinary Bladder: A Case Report.

Glomus tumour typically occurs in subcutaneous tissue but rarely in the visceral organs. Most glomus tumours are benign but few atypical glomus tumours have been reported. Herein, we report a case of a 44-year-old male who presented with hematuria. Transurethral resection of bladder tumour was done. Microscopic examination showed nests and sheets of tumor around the blood vessels. Spindle cells resembling smooth muscle were also observed. An increase in mitosis was observed. These tumour cells show diffuse and strong cytoplasmic positivity for smooth muscle actin and negative for Pancytokeratin, Desmin, Synaptophysin, Chromogranin, S100, and Cluster of Differentiation 34. Ki-67 index was approximately 5%. To our knowledge, this is the first report of Glomangiomyoma of uncertain malignant potential in the urinary bladder which is considered as an unusual variant of atypical glomus tumor. This case emphasizes the importance of broad differential diagnosis which has to be considered in the urinary bladder mass.

Cancer Cases Referral system in Nepal.

The burden of cancer is estimated to be increasing in Nepal, whilst the country lacks national established guidelines or protocols for referral of cancer cases. Cancer patients are presenting many different health facilities throughout the country. In rural areas almost all cancer patients have their first diagnosis when visiting a health assistant or nurse at their nearest primary health care delivery service. If cancer is suspected, health care assistants or nurses will refer the patient to a medical doctor at the primary health centre, or refer the patient directly to the cancer treatment centre or oncology department of the closest hospital. Patients from urban areas will usually be seen for the first time by a medical doctor initially and then referred to either the cancer treatment centre or oncology department of the hospital. Both in rural and urban areas the referral for treatment is determined by both the patients' capacity to pay for treatment own healthcare, as well as their geographical location (i.e. availability and accessibility of cancer treatment services.

Hospital-Based Cancer Incidence in Nepal from 2010 to 2013.

BACKGROUND: Cancer is one of the leading causes of death throughout the world. Analyzing the incidence of cancer by site, sex and age is essential to detect the burden of cancer. Throughout the twelve hospital based cancer registries of Nepal, a total of 29,802 cancer cases with known age, were registered from January 1st 2010 to 2013 December 31st. The purpose of this retrospective study is to present the incidence of all cancer sites in both males and females for this period. MATERIALS AND METHODS: This paper reviews data from all the hospital based cancer registries over a four-year period. This retrospective study has illustrated the number of cases, frequencies and crude incidence of all cancers by sex and site. For statistical analysis, SPSS (version 23.0) and Microsoft Excel 2010 were used. RESULTS: Over the four-year period from January 1st 2010 to 2013 December 31st the major cancer in males was identified as follows: lung cancer (17.5%) followed by stomach cancer (7.6 %) and larynx cancer (5.4%). Among females, for the same four-year period, the three common cancers were identified as cervix (18.9 %) followed by breast (15.6 %) and lung (10.2%). CONCLUSION: This retrospective study concluded that cancer is being increased by calendar years both in males and females however, the incidence of cancer is higher in females compared to males. .

Distribution of Cancer by Sex and Site in Nepal

Background: Cancer is one of the leading causes of death throughout the world. The indicators of cancer by site are significant to identify the problem of cancer. The purpose of this retrospective study is to perform the incidence of all cancers both in males and females over the ten years in Nepal. Methods: The data collected from all the seven hospital based cancer registries of Nepal have taken for the study. This retrospective study has presented the number of cases, frequencies, and crude incidence of all cancers by sex and site. Results: A total of 55,931 cancer cases with known age were registered throughout the hospital based seven cancer registries of Nepal from 2003 to 2012. Throughout the ten years, Lung (incl. trachea and bronchus) cancer (19.08%) was the major cancer in males followed by stomach cancer (7.86%) and Pharynx cancer (5.4%). Similarly, Cervix cancer (21.9%) was the most common cancer in females followed by breast (15.48%) and Lung (incl. trachea and bronchus) cancer (10.47%) over the ten years. This retrospective study presented the distribution of the cancer site over the ten years in Nepal. Conclusion: This retrospective study showed that lung cancer is the major cancer in male while in female cervix uteri is the most common cancer ranging from 2003 to 2012.

Prediction of the Cancer Incidence in Nepal

Background: The burden of cancer will increase both in males and females in Nepal. Due to the unavailability of a population based cancer registry it is difficult to precisely predict of future incidence rates. However, using hospital-based data to predict the cancer incidence in Nepal it was found that it will certainly increase both in males and females from 2013 to 2020. Material and Methods: For this research we used the cases from the first national cancer registry report (2003) to the cases of the most recent (2012) accumulated by all the hospital based cancer registries in Nepal. We used simple linear regression to analyze the data and thereby obtained a simple linear regression equation. Result: In 2020 the highest incidence rate will be for males 38.5 per 100,000 and for females, 41.4. The present study demonstrated that female cancer incidence will be higher than that in males in Nepal. Conclusion: This study provided evidence of future trends, which will feature an increasing rate of cancer in Nepal.

Changes in the Distribution of Cancer Incidence in Nepal from 2003 to 2013

Background: Cancer incidence data are vital for cancer control planning in any nation. This retrospective study was conducted to compare the cancer incidence of all sites between the first cancer registry report and the most recent example in Nepal. Material and Methods: The cases in the first (2003) and latest (2013) national cancer registry reports, accumulated by all the hospital based cancer registries in Nepal were taken for the research. The frequencies, crude incidences and age specific incidences (per 100,000) of the five major cancers were calculated for both males and females. Result: The most common cancer type for males in both years 2003 and 2013 was lung. Stomach was the third most common cancer in 2003 while it was the second in 2013. Similarly, the first four major cancers (cervix, breast, lung and ovary) did not change between 2003 and 2013 in females. The total cancer incidence rate increased from 12.8 in 2003 to 30.4 per 100,000 in 2013 for males and from 15.1 to 33.3 in females. Conclusion: The most common cancers in males in 2003 and 2013 were in the bronchus and lung. Similarly, the most common cancer in females was cervix at both time points. The cancer incidence rate in females was higher than in males both in 2003 and 2013.

Age specific incidence of five major cancers in Nepal, 2012.

BACKGROUND: Population based cancer registry is inevitable to measure the indicators of cancer. This retrospective study was conducted to perform the age specific incidence and age standardized rate of cancer by sex, age and sites in Nepal, 2012. MATERIALS AND METHODS: The data collected by hospital based National cancer registry programme of Nepal were used to calculate the age specific incidence of five major cancers by sex and sites. The age standardized rate of ten major cancers, both in males and females of 2012 was also performed. RESULTS: The 70-74 years age group had the highest incidence rate (188.08) for men while for women the age group of 65-69 years had the highest incidence (140.61) per 100,000. For male, lung cancer had the highest incidence rate (4.45) whereas bladder had the lowest rate (0.98). Similarly for female, Cervix Uteri cancer had the highest incidence rate (5.35) whereas stomach had the lowest (1.06). CONCLUSION: This study presented that cancer was increased with age both in males and females. The leading cancer in males was bronchus and lung while in females it was cervix uteri. .

Trend of Cancer Incidence in Nepal from 2003 to 2012.

Trends in cancer incidence is a key tool to identify the pattern of cancer of any country. This retrospective study was performed to present the trends of change in cancer incidence in Nepal.The total number of cancer cases in males was 26,064 while the total number of females cancer cases was 29,867 throughout the 10 years from 2003 to 2012. The cancer incidence per 100,000 in males was 12.8 in 2003 and 25.8 people in 2012. Similarly, in females, the crude incidence rate was 15.1 in 2003 and 26.7 per 100,000 in 2012. Cancer incidence was low at early age but it was increased with age in both sexes in Nepal. Lung cancer was the most common cancer in males throughout, while it was the third most common cancer in females. Cervix uteri was the most common site of cancer in females throughout the 10 years, with a clear trend for increase in breast cancer within this time.

Initial experience in a cancer hospital in Nepal with sentinel lymph node mapping and biopsy for evaluation of axillary lymph node status in palpable invasive breast cancer.

To evaluate the performance and feasibility of sentinel lymph node biopsy in early breast cancer patients using patent blue dye. From March 2004, we are consecutively enrolling breast cancer patients with tumor size less than 5 cm with no clinically palpable axillary lymph nodes in this feasibility study. So far, 21 patients underwent sentinel lymph node biopsy using 1.0% patent blue dye injection around the tumor followed by axillary dissection. Sentinel lymph node biopsy was compared with axillary dissection for its ability to accurately reflect the final pathological status of the axillary nodes. Age of patients ranged form 32-67 years old with mean age of 46.72 years. Fifty seven percent of patients were postmenopausal. Patients with T1 lesions were 8 and T2 were 13. The sentinel lymph node/s were successfully identified in 20 out of 21 patients (95.0%). The number of sentinel lymph nodes ranged from 1 to 5 (average 2.0) and non-sentinel nodes ranged from 5-22 (average 12.0). Infiltrating ductal carcinoma was diagnosed in 15 patients, DCIS with early invasion in 4 patients, invasive lobular carcinoma in 1 and medullary carcinoma in 1 patient. Of the 20 patients in whom sentinel lymph nodes were successfully identified, nodes were positive in 35.0% (7/20) of patients. All the positive nodes were detected in group with T2 lesions. SLNs were the only positive nodes in 2 patients. There were no false negative patients, yielding an accuracy of 100.0%. Lymphatic mapping using patent blue dye alone is technically feasible for patients with small (T1 or T2) palpable breast tumors. The sentinel node can be reliably identified in the majority of these patients, and its histology reflects that of the axilla with a high degree of accuracy. This method is very useful in economically backward countries as it involves less expensive material.

Retrospective study of chest wall tumors at a cancer hospital in Nepal.

Primary and metastatic tumors of both soft tissues and bony skeleton, and primary tumors of adjacent organs invading the chest wall constitute chest wall tumors. A retrospective review of all the patients with chest wall tumors was done at BP Koirala Memorial Cancer Hospital (BPKMCH). Primary tumors of breast were excluded. Surgical treatment consisted of wide local excision (WLE). Chest wall reconstruction, if needed, was achieved by a muscular flap +/- prolene mesh +/- omental transposition. Thirty one patients were treated in the period from October 1999 to October 2003. Age of the patients varied from 3 years to 72 years (mean age--38 years). Presenting complaint was mass in 96.8% and pain in 48.4% cases. The mass was 5 cm or less in 34.4%, from 5 to 10 cm in 32.3%, and more than 10 cm in 32.3% cases. The lesions were located in sternal region, anterior, lateral, posterior, and vertebral chest wall in 6.5%, 32.3%, 41.9%, 16.1% and 3.2% respectively. WLE was done in 29 cases. Chest wall reconstruction using both muscular flaps and prolene mesh (15x15 cm) was done in 8 cases. In three of them, where concomitant wedge resection of the lung was done, omental transposition was added. In rest of the cases, primary closure, muscular/myocutaneous flap or skin grafting was done. Minor complications were observed in 31.0% cases, which were managed conservatively. Two patients received adjuvant radiotherapy and four patients--adjuvant chemotherapy. There were no postoperative deaths. The rate of malignancy was 48.4%.