Correlation of Imaging Findings with Molecular Subtypes of Breast Cancer.

BACKGROUND: Ultrasound and Mammography are first-line imaging in breast cancer. The management of malignant breast lesions depends on molecular biomarkers in the tumor cells. This study aims to correlate different imaging findings in breast carcinoma with immune-histology subtypes. METHODS: The study was a retrospective study conducted between 2018 January to 2021 December. Patients with malignant breast lesions who underwent USG-guided biopsy of breast lesions were included in the study. Ultrasound and mammographic findings of these patients were retrieved in PACS and analyzed. Malignant breast lesions were classified according to molecular markers into Luminal A, Luminal B, Her- 2 enriched, and triple-negative breast cancers. The correlation between imaging findings and molecular subtypes of breast cancer was analyzed. RESULTS: A total of 42 patients were included in the study. The mean age of the patients in our study was 52.24+/-13.54 years with median of 51 years (IQ range-19.5 years). The most common IHC subtype was Luminal type B (22, 52.4%), followed by triple negative (15, 35.7%), luminal type A (4, 9.5%) and least common was Her-2 enriched (1, 2.4%). Mammogram was non-diagnostic in 9.5% of case. Oval shape and well marginated margin in ultrasound were more frequently associated with triple negative breast cancer than other subtypes (P<0.05). Rest of the characteristics of triple negative and other malignancies were not significantly difference in our study. No significant difference is noted between mammographic findings between various subtypes. CONCLUSIONS: Triple negative breast cancer was more common in our population than in the west. Triple-negative breast cancers are more frequently well-defined and oval in shape mimicking benign lesions.

Spondylolysis among Patients Without Low Back Pain in a Diagnostic Centre: A Descriptive Cross-sectional Study.

Introduction: Spondylolysis can either be asymptomatic or can cause significant low back pain. It is sometimes associated with the translation of one vertebra over another and is termed spondylolisthesis. The aim of the study was to find out the prevalence of spondylolysis among patients without low back pain in a diagnostic centre. Methods: A descriptive cross-sectional study was carried out in a referral diagnostic centre from 15 December 2018 to 14 December 2021 . Ethical approval was obtained from the Nepal Health Research Council (Reference number: 2903). Images of a computed tomography scan of the abdomen performed for other abdominal causes and without low back pain were reconstructed in the sagittal and coronal plane and evaluated for the presence of spondylolysis and spondylolisthesis in the lumbar spine. Demographic data were taken from the hospital records. Convenience sampling method was used. Point estimate and 95% Confidence Interval were calculated. Results: Among 768 patients without low back pain, spondylolysis was found in 59 (7.68%) (5.80-9.56, 95% Confidence Interval). Spondylolisthesis was found in only 16 (27.1%) individuals with spondylolysis. The majority of spondylolysis cases were encountered in L5 level in 54 (91.53%). The mean age of patients with spondylolysis was 41.9±14.46 years. Male to female ratio was 1:1.18. Conclusions: The prevalence of spondylolysis in our study was found to be similar to other studies done in similar settings. Keywords: low back pain; spondylolisthesis; spondylolysis.

Mean Intracranial Volume of Brain among Patients with Normal Magnetic Resonance Imaging Referred to the Department of Radiology and Imaging of a Tertiary Care Centre.

Introduction: The measurement of brain volume is an important aspect of the assessment of brain structure and function. However, limited data is available on brain volumetry in the Nepalese population. The study aimed to find the mean intracranial volume of the brain among patients with normal magnetic resonance imaging referred to the Department of Radiology and Imaging of a tertiary care centre. Methods: A descriptive cross-sectional study was conducted among patients with normal magnetic resonance imaging referred to the Department of Radiology and Imaging in a tertiary care centre. All magnetic resonance imaging of the brain during the study period was reviewed by a radiologist. Magnetic resonance imaging with abnormal findings, clinical signs of neurological deficit, dementia and psychiatric symptoms were excluded from the study. A convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval. Results: Among 285 Magnetic Resonance Imaging datasets, the mean intracranial volume was 1286.30±129.88 cc (1271.22-1301.38, 95% of Confidence Interval). The mean cerebral volume was 985.06±106.4 cc, cerebellar volume was 126.99±13.05 cc and brain stem volume was 19.97±2.54 cc. Conclusions: The mean intracranial volume of the brain among patients with normal magnetic resonance imaging was found to be lower than other studies done in similar settings. Keywords: brainstem; cerebellum; cerebrum; magnetic resonance imaging.

Zinner Syndrome: A Case Report of Rare Urogenital Anomaly.

Zinner Syndrome is a rare urogenital tract anomaly with unilateral renal agenesis, ipsilateral seminal vesicle cyst, and ipsilateral ejaculatory duct obstruction. The syndrome occurs due to an insult to the development of the paramesonephric duct during embryogenesis. Patients may present late due to dysejaculation as a result of obstruction of the ejaculatory duct or commonly remain asymptomatic. Here, we present such a case presenting with dysejaculation which was diagnosed with Zinner syndrome on ultrasound.

Ultrasound Findings in Thyroid Nodules: A Radio-Cytopathologic Correlation.

INTRODUCTION: Ultrasound (USG) can be a good screening tool to identify high-risk nodule requiring fine-needle aspiration cytology (FNAC). The study aimed to assess the association of USG characteristic of thyroid nodule with malignancy. METHODS: A cross-sectional study was performed from August 2011 to July 2012 at Tribhuvan University Teaching Hospital. Patients referred for USG of the neck with thyroid nodule more than 10 mm were offered FNAC and included in the study after taking informed consent. USG characteristics were compared with histopathologic diagnosis of benign or malignant nodule. RESULTS: USG characteristics significantly (P < 0.05) associated with malignancy were as follows: size of thyroid nodule more than 30 mm, ill-defined margin, solid echotexture, hypoechoic lesion, microcalcification, and any form of increased vascularity. High sensitivity was seen in microcalcification, hypoechoic echogenicity, and ill-defined margin and high specificity was seen in ill-defined margin and solid echotexture. Relatively high sensitivity and specificity was found in ill-defined margin. CONCLUSIONS: Texture, size, margin, echogenicity, and vascularity are important factors for discriminating benign from malignant nodule. Hypoechogenicity, vascularity of any type, ill-defined margin, and microcalcification were independent predictors of malignancy. None of the characteristics were sensitive and specific to be used independently as screening tool to identify high risk of malignancy.

Maternal Attitude and Knowledge towards Modes of Delivery.

BACKGROUND: Whether a mother should be allowed to choose between the modes of delivery is a matter of concern among practicing obstetricians. This study aims to explore the knowledge of the Nepalese women attending a tertiary care center about the benefits and complications of vaginal and caesarean delivery and their attitude and preference for the method of delivery. METHODS: The study was a hospital based cross sectional questionnaire survey conducted in Nepal Medical College teaching Hospital, Jorpati from 1stShrawan 2074 to 31st Ashoj 2074. All pregnant women who were 36 weeks or more in gestation attending the clinic during the study period were included in the study. A questionnaire was made of 10 questions for knowledge assessment regarding mode of delivery consisting of the indications, the possible complications and advantages of vaginal and caesarean delivery. RESULTS: A total of 256 pregnant women participated in the study. The knowledge of the mode of delivery, their benefit and complications was medium to good in approximately 90% of the mothers attending the antenatal OPD. Overall attitude for vaginal delivery was positive in 93% of women and negative or neutral in 6.6%.Overall attitude for caesarean delivery was positive in 24% and negative or neutral in 75.8%. CONCLUSIONS: Women in our setup agree that vaginal delivery is a natural and acceptable method of delivery and would prefer to have a vaginal delivery.

Magnetic Resonance Imaging Findings in Spondylodiscitis.

BACKGROUND: Magnetic Resonance Imaging is the imaging modality of choice for imaging spinal infection due to its high sensitivity and specificity. This study aims to study the magnetic resonance imaging changes in patients with spondylodiscitis. METHODS: The study was a retrospective study carried in a multimodality imaging centre in Kathmandu. Magnetic resonance imaging records and clinical record of 3 years duration were reviewed and patients with clinical and radiological diagnosis of spondylodiscitis were included in the study. Three radiologists interpreted Magnetic Resonance Imaging with mutual consensus in disputed issues. Data analysis was done with Statistical Package for Social Sciences21.0. RESULTS: A total of 52 patients were included in the study. The mean age of the patients was 43.9 ± 17.6 years. Spondylodiscitis involved lumbar spine in 26(50%) case, cervical and thoracic spine in 13(25%) cases each. Multiple IV discs were involved in 24(46.2%) cases, which was most common in cervical spine and least common in thoracic spine. Only one vertebral end plate was involved in 16(30.8%) cases. Epidural collection was seen in 23(44.2%) cases and paravertebral collection was noted in 63(33.5%) cases. Statistical significant difference in region of spine involved (p=0.02) and epidural collection (p=0.04) was noted between genders. CONCLUSIONS: Lumbar spine was the most common level involved with spondylodiscitis, perivertebral enhancing soft tissue was present in all cases, and involvement of disc and the endplates were the most common pattern.

Renal Cortical Elastography: Normal Values and Variations.

INTRODUCTION: Renal cortical elastography has shown conflicting but promising results in evaluation of chronic kidney disease and other renal disorders. The purpose of this study was to establish a normogram of renal cortical elasticity values and assess their variation between right and left kidney and their relation with age, gender, body mass index, renal dimensions and skin to cortex distance. METHODS: The study was a hospital based cross sectional study performed at Tribhuvan University Teaching Hospital, a tertiary care center in Kathmandu, Nepal. All individuals referred for Ultrasound from General Health Check up clinic were included in the study. Patient with abnormal ultrasound findings and abnormal renal function test were excluded from the study. Renal morphometry including length, cortical thickness, and skin to cortex distance were measured in B mode imaging and renal cortical elastography was measured with region of interest box of 1 × 0.5 cm. All analyses were done using Statistical Package for Social Sciences 20.0 soft ware. RESULTS: A total of 95 individuals who met the inclusion criteria were included in the study. The mean values of right and left renal cortical shear wave velocity were 1.49 ± 0.19 m/s and 1.54 ± 0.19 m/s respectively. Statistical significant difference was observed between the renal cortical shear wave velocity of right and left kidney. The renal shear wave velocity was seen to decrease with age, however the correlation was not statistically significant. No significant difference was also noted in renal shear wave velocity among various sex or Body mass index groups. Statistically significant negative correlation was noted between skin to cortex distance and renal cortical shear wave velocities. However no statistically significant correlation was noted between renal dimensions and renal cortical shear wave velocities. CONCLUSIONS: The normal cortical elasticity values in terms of shear wave velocity of right and left kidney were established. Renal elasticity is independent of the age, gender, Body mass index and renal dimensions.

A rare case of synchronous colocolic intussusception in association with Peutz-Jeghers syndrome.

Adult intussusception is rare and is almost always associated with a lead point. Polyposis syndromes are a common cause of adult intussusceptions, with polyps acting as lead points. Peutz-Jeghers syndrome is associated with benign hamartomatous polyps and mucocutaneous pigmentation. Although hamartomatous polyps are not premalignant, there is an increased risk of gastrointestinal and non-gastrointestinal malignancy, most commonly involving the small bowel. Most patients with Peutz-Jeghers syndrome with acute abdomen are diagnosed to have intussusceptions, mostly of the enteroenteric type. Colocolic intussusceptions are rare in Peutz-Jeghers syndrome. To the best of our knowledge, synchronous colocolic intussusception in association with Peutz-Jeghers syndrome has not been previously reported. Here we present a case of malignant jejunal mass and synchronous colocolic intussusceptions in a patient with Peutz-Jeghers syndrome.